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NR667 CEA Study Guide Complete With Correct Solutions
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NR667 CEA Study Guide Complete With Correct Solutions
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NR667 CEA Study Guide Complete With CorrectSolutions
Cardiovascular anatomy and flow complications Right Ans - > Location
- Central anterior chest
- RV is anteriorly located
- LV is posteriorly located
> Flow of blood in the body
- Lungs > pulmonary veins > left atrium > left ventricle > aorta > body tissues
> vena cava > right atrium > right ventricle > pulmonary arteries > lungs.
> Blood flow complications
- Contractility: EF, CAD, LVH, Cardiomyopathy
- Preload: Central fluid volume status
- Afterload: Arterial backpressure on outflow (Chronic hypertension).
(**RAAS system typically manages this).
Metabolic syndrome Right Ans - > Insulin-resistance syndrome and
Syndrome X.
> Higher need for type II DM and CVD
> Includes three of the following traits
- Male waist circumference > 40
- Female waist circumference > 35
- HTN, BP > 130/8-
- Triglycerides > 150
- HDL < 40 males, < 50 females
- Hyperglycemia, Fasting glucose > 100 mg/dl.
Hypertension Right Ans - >JNC8
- Defined as 140/90
- Secondary HTN: Up flow issue going up to kidney, ex: renal stenosis.
- Age > 60 or < 60 years. (>60 = 150/90).
- DM and CKD: ACE/ARBs (nephro protective).
- Non-black vs. Black: Calcium channel blocker for African Ascent.
- General starting place: Thiazides/ACE/ARBs.
- ACE/ARBS: "Prils" and "Sartans"
,- Beta Blockers: "olol" not on JNC8 guidelines, history of cardiac disease,
reduce HR. Carvedilol is a dual alpha/beta, great for Heart failure.
- CCB: Dihydropyrines and Non-Dihydropyrines. Dihydropyrines work more
peripherally (amlodipine, etc). Non-Dihydropyrines work more on heart
(Verapamil and diltiazem). Common ASE: Constipation and peripheral edema.
- Diuretics: Thiazides, Loops. Thiazides are less potent. Thiazide= Low
electrolytes, Higher calcium. Loops- lowers everything. Potassium-sparing
diuretics (Increase potassium, lowers sodium).
Heart failure Right Ans - >HFrEF (Less than 40%)
> HFpEF (Higher than 40%)
> Systolic heart failure: inability for myocardium to effectively contract.
> Diastolic heart failure: inability to myocardium to effectively relax.
> Typical patient: elderly with comorbidities of HTN, DM, Smoking.
- Class I: Mild symptoms
- Class II-III: Symptoms with exertion (II), ADL's cause symptoms (III)
- Class IV: Symptoms severe, likely needs hospitalization.
> Classic symptoms: SOB, Fatigue, exertional dyspnea, dependent and
pulmonary edema, low activity tolerance, abdominal bloating, orthopnea.
> Causes: ischemic heart disease, valve disease, MI, cardiomyopathy.
> Treatment: ACE/ARB, ARB/ARNI, BB, Diuretics, nitrates plus hydralazine,
Fluid and salt restriction, daily weights.
Lipid management Right Ans - >AVSCD
- Statins
- Hight-intensity statins: Atorvastatin 40-80mg and Rovusatan 20-40mg
(Don't require being taken at bedtime). LDL < 190
- Common ASE: Myalgia. Rhabdomyolysis worse case scenario.
- Statins, Ezetimibe in conjunction. PC9-Inhibitors (injectable Q2 weeks).
(Cardiology at consult prior to PC9-Inhibitors).
- Familial homozygous hyperlipidemia= PC9-Inhibitors.
- HDL: "Cleaning agent."
- LDL- "Scrum between glass window in shower"
Valve disease and aneurysms Right Ans - > Aortic stenosis: Narrowing of
outflow to aortic root through aortic valve due to calcification. Symptoms tend
to mirror CAD with addition of syncope/near syncope.
,> Aortic Regurgitation/Insufficiency: instability for aortic valve to
appropriately close. Commonly due to aortic root dilation or
endocarditis/infection. A direct contraindication for IABP use (common board
exam question).
>Mitral stenosis: Narrowing of inflow into LV through the mitral valve due to
calcification.
> Mitral regurgitation/Insufficiency: instability for mitral valve leaflets to
close. Commonly due to mitral root dilation from an MI, CHF, induced LV
dilation, papillary muscle rupture, endocarditis.
> Identifying Murmurs (left sternal border, 2nd intercoastal).
- Aortic stenosis: swishing, systole, tends to radiate to neck.
- Mitral stenosis- low-frequency, diastole, tends to radiate to lateral chest.
- Mitral regurgitation: systole,
- Aortic regurgitation, Diastole
>Aortic layers
- Tunica externa
- Tunica media
- Tunica intima
>Aneurysm
- Stanford A (Ascending before the left subclavian): requires surgery (risk of
dissecting coronary ostia/aortic valve).
- Stanford B (descending after the left subclavian): typically treated with
endovascular grafting if anything at all.
- Presentation: asymptomatic, ruptured: classic triad of acute abdominal pain,
abdominal distention, and hemodynamic instability, pulsable mass on
abdomen, tearing feeling in back.
- Congenital concerns: marfan's syndrome, Ehlers's-Danlos syndrome,
Bicuspid aortic valve commonly found.
- Other causes: atherosclerosis, vasculitis, uncontrolled HTN. Tobacco use.
- Supportive management: avoid heavy lifting, BP control, avoidance of
fluroquinolone antibiotics = weakening vascular tissue.
DVT/PE Management Right Ans - > PE
, - Saddle emboli commonly require surgery. (will see evidence of right heart
strain, S1Q3T3, TR on 2D echo, enlarged RV.
- Subsegmental not typically requiring emergent surgery (commonly treated
with tPA and/or IV anticoagulation through a direct PA catheter. May use
ultrasound-assisted technology (EKOs).
- Provoked vs. Unprovoked.
- Anticoagulation for at least 3 months.
- Unprovoked: at least 3 months, may be lifelong if any reoccurrence.
> DVT
- Virchow's triad: Venous stasis, hypercoagulability, endothelial injury.
- Initial diagnostics: CBC, PT/PTT, PT/INR, US with doppler.
- Treatment: Anticoagulation for provoked and unprovoked.
PAD and pleural effusions Right Ans - > PAD
- Clinical findings: pale, waxy, hairless legs, pain with ambulation that
improves with cessation of ambulation.
- Diagnosed with ABI, confirmatory diagnosis with angiography.
- Treatment: stents or bypass of occluded/near occluded vessels.
- Medications: antiplatelet agents (clopidogrel, cilostazol, aspirin), statins for
lipid management.
- Smoking cessation
- Management of comorbid conditions such as DM.
- Daily ambulation exercise therapy.
>Intermittent Claudication
- Not as severe of blockage
- Requires exercise
- Antiplatelet/aspirin regimen
- Treat underlying causes: smoking, HTN, HLD, DM.
]
>Pericardial Effusion and Tamponade
- Fluid around the heart inside the pericardium
- Normally a small volume (<50 ml) present
- If chronic effusion, may drastically increase without consequence.
- Treatment: address underlying causes: malignancy, hypothyroid,
hypercoagulable state, trauma.
- If acute tamponade (narrowed pulse pressure, tachycardia, JVD, muffled
HTs)
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