CARDIOVASCULAR PROBLEMS EXAM QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS VERIFIED LATEST UPDATE

CARDIOVASCULAR PROBLEMS EXAM QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS VERIFIED LATEST UPDATE Terms in this set (82) most prevalent in cerebral vascular disease Ischemic symptoms of carotid artery and vertebrobasilar occlusions hemiparesis, vision field deficits, ataxia, Babinski, speech difficulties, headache loss of vision - amaurosis fugax (someone pulled the shades down), ipsilateral eye/brain, weakness of contralateral face/limb, changes in language, speech, cognition and behavior Carotid Artery Occlusion A complex clinical syndrome that results from any Structural or Functional Impairment of Ventricular filling or ejection of blood Heart Failure Cardinal Manifestations of Heart Failure Dyspnea, Fatigue, Fluid Retention Most patients have heart failure symptoms due to impaired LEFT VENTRICULAR myocardial function Most common reason for CHF impaired Left Ventricular function impairment in the ability of the ventricle to contract/eject blood, leads to heart failure Systolic Heart Failure how well the heart contracts systolic function a measure of systolic function Ejection Fraction EF = Diastole - Systole = %EF Left EF ___ is abnormal 45% is abnormal how well the ventricles can receive blood Diastolic function stiff or impaired filling/relaxation of ventricle Diastolic heart failure Change in size, geometry, function of heart after injury Ventricular Remodeling increased volume dilation increased mass hypertropy Meds the prevent and reverse remodeling ACE and Beta Blockers Stages of Heart Failure A, B, C, D high risk for developing HF Stage A - lifestyle and ACE/ARB, Statin have risk factors - HTN, DM, CAD, Family Hx asymptomatic HF, structural evidence without symptoms may have had an MI, valve disease, LV systolic dysfunction Stage B - ACE,/ARB and Beta Blocker Symptomatic Heart Failure - known structural disease Stage C - ADD ALDOSTERONE ANGTAGONIST/diuretic, maybe hydralazine, dig, ACE/ARB, CRT, ICD, revascularize End stage HF Stage D Right sided heart failure symptoms edema, early morning satiety/anorexia, wt gain/loss How is volume status assessed in CHF patients weight and jugular venous distention, vital signs Most common cause of right heart failure left heart failure Edema, ascites, hepatic congestion, increased pressure in systemic veins, elevated jugular venous pressure Right Sided Heart Failure Isolated right sided heart failure can result from Lung Disease What does S3 in an adult mean ALWAYS means decompensated Heart Failure Cachexia (wt. loss), muscle atrophy, wasting, Rales, Effusions, increased jugular venous pressure, ventricular lifts, S3, cool, edematous extremities Right Heart failure side effects to monitor with spironolactone hyperkalemia, acute kidney injury gynecomastia Mitral and Tricuspid valve regurgitation means Volume overload (like in right heart failure) Secreted in response to myocyte stretch, non-invasive measure of filling pressure BNP Diagnostic tests for Heart Failure EKG, BNP, CXR, ECHO - initial evaluation, repeat measures of EF, Right heart catheterization (not routine) looks for valve abnormalities, atrial and ventricle size, ventricle function ECHOcardiogram Stage A heart failure treatment ACE or ARB, Statin Stage B heart failure treatment (asymptomatic w/structural heart disease) ACE/ARB and Beta Blocker (ICD, Revascularization if appropriate) Stage C heart failure treatment (prior or current symptoms w/structural heart disease) Diuretics - loop ACE/ARB and Beta Blocker Aldosterone antagonist - Spironolactone Hydralazine/Isosorbide dinitrate in Af. Americans Digitalis Spironolactone is the first choice aldosterone antagonist, but what must you monitor Hyperkalemia (K+ 5) Renal Function (Cr 2.5/2.0 men/women) what vasodilators do we use in stage c? Isosorbide dinitrate and Hydralazine who gets isosorbide dinitrate and hydralazine in Stage C? African Americans - even if on ACE/ARB and BB any patient who cannot take ACE/ARB When is device therapy/CRT recommended LVEF 35% QRS 150 class II-IV symptoms