Family Nurse Practitioner (FNP) > Cardiovascular > Flashcards

Cardiovascular Flashcards

Recognize, evaluate, and treat cardiovascular conditions using current primary care standards. (114 cards)

Study These Flashcards
1
Q

What is the normal blood pressure according to the American Heart Association and the American College of Cardiology?

A

Systolic less than 120 and a diastolic less than 80.

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2
Q

Fill in the blank:

Hypertension stage 1 is defined as a systolic between ______ and a diastolic of 80 to 89.

A

130 and 139

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3
Q

What is the gold standard for diagnosing hypertension?

A

Ambulatory blood pressure monitoring

(ABPM)

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4
Q

List the criteria indicating hypertension using ABPM.

A
  • 24-hour mean systolic of 125 or greater, or diastolic of 75 or greater
  • Daytime mean systolic of 130 or greater, or diastolic of 80 or greater
  • Nighttime mean systolic of 110 or greater, or diastolic of 65 or greater
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5
Q

When are out-of-office confirmatory readings not required for hypertension diagnosis?

A
  • Hypertensive urgency or emergency (SBP 180 or greater or DBP 120 or greater)
  • SBP of 160 or greater or DBP of 100 or greater with known target end organ damage
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6
Q

What are the non-pharmacological treatments for hypertension?

A
  • Dietary salt restriction
  • Weight loss
  • Exercise
  • Limiting alcohol intake
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7
Q

List the first-line pharmacological agents for hypertension.

A
  • Angiotensin converting enzyme inhibitors (ACE inhibitors)
  • Angiotensin II receptor blockers (ARBs)
  • Calcium channel blockers (CCBs)
  • Thiazide diuretics
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8
Q

True or False:

Single drug therapy is likely to be successful if a patient’s blood pressure is more than 20/10 above the goal.

A

False

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9
Q

What is the preferred combination therapy for patients with a SBP of 140 or greater or a DBP of 90 or greater?

A

ACE or ARB + dihydropyridine CCB

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10
Q

In which patients are thiazide diuretics preferred over CCBs?

A
  • Patients with edema
  • Patients with osteoporosis
  • Patients with calcium nephrolithiasis
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11
Q

What are the side effects related to decreased angiotensin II when using ACE inhibitors?

A
  • Hypotension
  • Acute kidney injury
  • Hyperkalemia
  • Pregnancy complications
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12
Q

What are the side effects related to increased kinins when using ACE inhibitors?

A
  • Dry hacking cough
  • Angioedema (rare, but life-threatening)
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13
Q

What are the contraindications for ACE inhibitors and ARBs?

A
  • Pregnancy
  • ACE inhibitors and ARBs cannot be taken together
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14
Q

What are the side effects of dihydropyridine calcium channel blockers?

A
  • Headache
  • Lightheadedness
  • Flushing
  • Dependent peripheral edema
  • Gingival hyperplasia
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15
Q

What are the dose-dependent side effects of thiazide diuretics?

A
  • Hypokalemia
  • Hyponatremia
  • Hypomagnesemia
  • Hyperuricemia
  • Hyperglycemia
  • Hyperlipidemia
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16
Q

What is the first-line treatment for dyslipidemia?

A

Statin therapy

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17
Q

What LDL-C level indicates the need for statin therapy?

A

LDL-C ≥190 mg/dL

(≥4.9 mmol/L)

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18
Q

What is the recommended action for patients with a 5 to 7.4% risk of a cardiac event within the next 10 years and an LDL of 100 to <190?

A

Initiate a statin

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19
Q

What is the goal LDL level after starting statin therapy?

A

LDL <100

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20
Q

What are the contraindications for statins?

A

Pregnancy

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21
Q

What labs should be checked before initiating statins?

A
  • Baseline aminotransferase levels
  • Thyroid function (TSH)
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22
Q

What is peripheral artery disease (PAD)?

A

Narrowing of arteries that supply the limbs, reducing blood flow and perfusion.

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23
Q

What are the risk factors for peripheral artery disease?

A
  • Hyperlipidemia
  • Smoking
  • Hypertension
  • Diabetes
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24
Q

What is the ankle-brachial systolic pressure index (ABI) used for?

A

Diagnosis of peripheral artery disease

(PAD)

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25
What are the **classic symptoms** of heart failure?
* Dyspnea * Fatigue * Edema
26
What is the **classification of heart failure** with a left ventricle ejection fraction (LVEF) ≤40 percent?
HF with reduced ejection fraction | (HFrEF)
27
What is the **presentation** of atrial fibrillation?
* Palpitations * Tachycardia * Fatigue * Weakness * Dizziness * Lightheadedness * Reduced exercise capacity * Increased urination * Mild dyspnea
28
What is the **CHA2DS2-VASc scoring system** used for?
To determine when oral anticoagulants are indicated.
29
What is the **maximum score** on the CHA2DS2-VASc scoring system?
9
30
# Fill in the blank: Oral anticoagulants are recommended for males with \_\_\_\_\_\_ points or higher on the CHA2DS2-VASc score.
2
31
# Fill in the blank: Oral anticoagulants are recommended for females with \_\_\_\_\_\_ points or higher on the CHA2DS2-VASc score.
3
32
What is the **characteristic sound** of a Grade IV murmur?
Loud murmur with a palpable thrill.
33
Which **diagnostic test** should be performed on all patients with a **cardiac murmur** that have not already been evaluated?
Echocardiogram
34
# True or False: Systolic murmurs are always pathological.
False
35
List two examples of **systolic murmurs**.
* Mitral regurgitation * Aortic sclerosis or stenosis
36
What is the **typical position** for best hearing a mitral regurgitation murmur?
Left lateral decubitus position
37
Which **type of murmur** occurs almost always pathologically?
Diastolic murmurs
38
# Fill in the blank: Diastolic murmurs occur at \_\_\_\_\_\_ or after and end before S1.
S2
39
What are **two examples** of diastolic murmurs?
* Mitral stenosis * Aortic regurgitation
40
Which **diagnostic test** helps diagnose or rule out a STEMI?
12-lead ECG
41
What does a **D-dimer test** help diagnose or rule out?
Pulmonary embolism
42
What are **two red flags** for chest pain?
* Anginal symptoms at rest * New onset angina
43
Which **imaging test** helps diagnose or rule out **cardiomegaly**?
Chest x-ray
44
# Fill in the blank: Serial troponins help to diagnose or rule out \_\_\_\_\_\_.
Acute coronary syndrome
45
What **condition** is indicated by chest pain described as pressure?
Angina
46
Which **diagnostic test** can help diagnose or rule out pericardial effusions?
Bedside ultrasound
47
What are the **preferred thiazide-like diuretics** over hydrochlorothiazide?
* Chlorthalidone * Indapamide
48
What should be considered if **hyperkalemia** occurs and is unable to be managed while on ACE inhibitors?
ACE termination
49
# True or False: ACE inhibitors and ARBs can be taken together.
False
50
Which cardiac medications are **contraindicated** in pregnancy?
* ACE inhibitors * ARBs * Statins
51
What are the **side effects** of ARBs compared to ACE inhibitors?
Higher rates of hypotensive symptoms and less likely to cause a cough and angioedema, with ARBs.
52
What is the **primary use** of non-dihydropyridine calcium channel blockers?
Decrease the contractility of the heart.
53
Which **calcium channel blockers** are examples of non-dihydropyridines?
* Verapamil * Diltiazem
54
# Fill in the blank: Thiazide-like diuretics are more effective at treating hypertension and reducing cardiac events and mortality compared to \_\_\_\_\_\_.
Hydrochlorothiazide
55
What are the **contraindications** for thiazide diuretics?
* Sulfa allergy * Anuria
56
Which alpha 1 blocker is useful for patients with **benign prostatic hyperplasia (BPH)**?
Terazosin
57
Which **beta blocker** is the drug of choice for pregnant patients with hypertension?
Labetalol
58
What are the **contraindications** for beta blockers?
* Severe bradycardia * AV block, 2nd-3rd degree * Decompensated heart failure * Sick sinus syndrome * Asthma
59
What are the **complications** associated with hypertension?
* Stroke * Coronary artery disease * Heart failure * Atrial fibrillation * Abdominal aortic aneurysm * Peripheral vascular disease
60
What are the **severe retinal microvascular changes** associated with hypertension?
* Arteriolar narrowing and sclerosis * Arteriovenous (AV) nicking * Retinal hemorrhages * Cotton-wool spots * Hard exudates ## Footnote Plus: Papilledema (optic disc edema) - the hallmark of severe or malignant hypertension
61
What is **dyslipidemia**?
Abnormally elevated cholesterol or lipids and is a risk factor for atherosclerotic cardiovascular disease.
62
List **examples** of statins.
* Lovastatin * Pravastatin * Simvastatin * Fluvastatin * Atorvastatin * Rosuvastatin
63
What are the **risk factors** for hypertriglyceridemia?
* Insulin resistance * Renal disease * Hypothyroidism * Diet with excess caloric intake * Daily alcohol consumption * Pregnancy * Multiple myeloma * Lupus * Various medications
64
What are the **triglyceride levels** for moderate hypertriglyceridemia?
150 to 499 mg/dL.
65
What is the **treatment** for severe hypertriglyceridemia (≥1000 mg/dL)?
Extreme dietary fat restriction, alcohol abstinence, fibrate.
66
What are the **risk factors** for heart failure?
* Ischemia or infarction * Uncontrolled hypertension * New onset or uncontrolled atrial fibrillation * Excessive tachycardia * Pulmonary embolism * Uncontrolled diabetes * Thyroid dysfunction * Substance abuse
67
What is **HF** with **reduced** ejection fraction (HFrEF)?
HF with LVEF < 40 percent
68
# Fill in the blank: HF with LVEF of 41 to 49 percent is known as \_\_\_\_\_\_.
HF with mid-range ejection fraction | (HFmrEF)
69
What is **HF** with **preserved** ejection fraction (HFpEF)?
HF with LVEF ≥50 percent
70
What are **additional symptoms** of heart failure?
* Exercise intolerance * Unintentional weight loss * Recurrent ventricular arrhythmias * Hypotension * Signs of inadequate perfusion
71
# True or False: Class 1 heart failure patients experience limitations during ordinary physical activity.
False
72
What **characterizes** Class 2 heart failure patients?
Patients with cardiac disease and with SLIGHT limitations. Normal activity causes some fatigue and dyspnea, however patient is comfortable at rest.
73
What is the **classification** of heart failure patients who are comfortable ONLY at rest?
Class 3
74
Which **class of heart failure** patients experiences symptoms at rest?
Class 4
75
What **tests** are used to support the diagnosis of CHF?
* History and physical exam * Echocardiogram * ECG * Natriuretic peptide levels * Chest radiograph
76
What is the **role of an echocardiogram** in CHF diagnosis?
To assess cardiac dysfunction and identify possible cause.
77
What does a **normal ECG** rule out in heart failure diagnosis?
Left sided heart failure
78
What can be observed on an **x-ray** to support a diagnosis of heart failure?
* Cardiomegaly * Pleural effusion * Kerley B lines
79
What is the **preferred combination therapy** for heart failure treatment?
* Angiotensin blocker (preferably sacubitril-valsartan) * Beta blocker (preferably metoprolol, carvedilol or bisoprolol) * Mineralocorticoid receptor antagonist (preferably eplerenone) * SGLT2 inhibitor (preferably dapagliflozin or empagliflozin)
80
What is **required** for heart failure with fluid overload?
Diuretic
81
What are **examples** of loop diuretics?
* Furosemide * Torsemide * Bumetanide
82
What is the **presentation** of atrial fibrillation?
Irregularly irregular ventricular rhythm and the absence of distinct P waves
83
What are the **options for long-term rate control** in atrial fibrillation?
* Beta blocker * Non-dihydropyridine CCB * Digoxin
84
What is the **therapeutic range** for digoxin?
Between 0.8 to 2 ng/mL
85
What are the **symptoms** of digoxin toxicity?
* Arrhythmias * Gastrointestinal symptoms * Confusion * Vision changes
86
What are **examples** of direct oral anticoagulants?
* Dabigatran (Pradaxa) * Rivaroxaban (Xarelto) * Apixaban (Eliquis)
87
When should **direct oral anticoagulants** not be used?
In patients with severe kidney disease, pregnancy, and with patients who have mechanical prosthetic heart valves
88
What is the **target INR** for warfarin in patients with a **mechanical heart valve**?
2.5 to 3.5
89
What is the **target INR** for warfarin in **atrial fibrillation**?
Between 2.0 and 3.0
90
What causes a **murmur**?
Turbulent blood flow, that is heard loudest at the point of origin
91
What characterizes a **Grade I murmur**?
The faintest audible murmur heard
92
What characterizes a **Grade VI murmur**?
Loudest murmur, audible with the stethoscope off the chest and a palpable thrill
93
What should be done for all patients with a **cardiac murmur**?
An echocardiogram should be done if they have not already been diagnosed and evaluated with an echo, or if they are symptomatic.
94
Where is the **aortic area** located for auscultation?
2nd ICS (intercostal space), right of the sternum
95
What are **examples** of systolic murmurs?
* Mitral regurgitation * Aortic sclerosis or stenosis * Mitral valve prolapse * Tricuspid regurgitation (rare) * Midsystolic ejection murmur * Ventricular septal defect
96
What characterizes a **holosystolic murmur**?
Begins with the first heart sound and extends to, or through, the heart sound
97
What is **Carvallo’s sign**?
Tricuspid regurgitation increases w/ inspiration
98
What is the **most common cause** of a late systolic murmur?
Mitral valve prolapse
99
What are **examples** of diastolic murmurs?
* Mitral stenosis * Pulmonic regurgitation * Aortic regurgitation * Tricuspid stenosis
100
What is **infective endocarditis**?
An infection of one or more heart valves
101
List the **risk factors** for infective endocarditis.
* Heart valve disease * Mechanical heart valve * Device such as a pacemaker * Immunocompromised patients * Persons who use IV drugs
102
What are **Janeway lesions**?
Hemorrhagic macules found on the palms of the hand and soles of the feet, that are not painful
103
What are **splinter hemorrhages**?
Small blood clots that appear as streaks under the nail plate
104
What are **Osler nodes**?
Tender lesions on the finger pads and toe pads
105
What **percentage** of patients with **infective endocarditis** have a murmur?
Approximately 85%
106
List the **EKG rhythms** to review.
* Normal sinus rhythm (NSR) * Sinus bradycardia and tachycardia * Supra ventricular tachycardia (SVT) * ST elevation myocardial infarction (STEMI) * Atrial fibrillation (AF) * Ventricular fibrillation (VF) * 1st, 2nd and 3rd degree heart block * Atrial flutter
107
# Fill in the blank: \_\_\_\_\_\_ muscle is found exclusively in the heart and is responsible for pumping blood.
Cardiac muscle
108
What are the **normal ranges** for adult pulse (heart rate)?
60 to 100 beats per minute (BPM)
109
What are the **red flags** for the cardiovascular system during a physical exam?
* Irregular heartbeat * Clicks * Friction rub * Presence of murmurs or thrills * S3 or S4 * Bruits over arteries * Jugular venous distention * Weak or absent pulses * Pitting edema
110
What is the **normal range** for total cholesterol?
Less than 200 mg/dL
111
What is the **optimal range** for low-density lipoprotein (LDL) cholesterol?
Less than 100 mg/dL
112
What is considered a **protective level** for high-density lipoprotein (HDL) cholesterol?
60 mg/dL or higher
113
What is the normal range for **triglycerides**?
Less than 150 mg/dL
114
What is the normal range for **very low-density lipoprotein** (VLDL)?
5–40 mg/dL
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