Cardiac

Manifestations of infective endocarditis include..

Fever, a new, cardiac murmur, splinter hemorrhages, petechiae, osler nodes, Roth spots (fundoscopic examination), janeway lesions, spleenomegaly

S4 heart sound is described as…

extra heart sound heard in late diastole before S1

a pericardial friction rub sound is described as…

a high pitch, scratchy noise

S3 heart sound is described as…

extra hear sound in early diastole

symptoms of digoxin toxicity include…

• weakness

• yellowing of the vision (xanthopsia)

• hyperkalemia

• dysthymias

• vomiting

dixogin is indicated for…

heart failure (fluid overload) and a-fib

heavily excreted by the kidneys

describe the 4 stages of hypertensive retinopathy

• stage 1 = mild; some narrowing of the retinal arterioles but typically no symptoms or vision changes

• stage 2 = moderate; AV nicking but vision still remains unaffected

• stage 3 = severe; flame hemorrhages- may start to have vision and permeant retinal changes; typically seen with a DBP > 110 (hypertensive emergency)

• stage 4 = emergent; patients will have papilledema and a “big black hole in the center of their vision”; typically seen with a DBP > 130

first line meds for antihypertensives

1. thiazide diuretics

2. CCBs

3. ACEs/ARBs

discuss thiazide diuretics

• cause sodium depletion…but also depletes magnesium, calcium and potassium

• avoid in patients with elevated triglycerides, uric acid or glucose

discuss CCBs

• two types

  • DHP = end in -pine (amlodipine); may cause ankle edema and headaches

  • non DHP = end in -zem (diltiazem, Cardizem); most potent BP lowering med ever

• caution in use of those with heart/renal/liver failure or GERD

discuss ACEs/ARBs

• potassium sparing medications

• not pregnancy safe

• educate patients on adequate hydration due to risk of hyperkalemia

discuss the second line meds for antihypertensives

betablockers

• end in -lol

• only seen used for HF or difficult hypertension

aldosterone antagonists

• spironolactone

• very potent

• potassium sparing

• risk of decreased libido and gynecomastia

what are safe BP meds in pregnancy (New Little Mama)

• nifedipine

• labetalol

• methyldopa

you initiate BP meds with the ASCVD risk is…

greater than 10%

what meds are considered “high intensity statin therapy”?

atorvastatin, rosuvastatin

• decrease LDL by 50%

  • minor effects on HDL and triglycerides

• avoid in patients 75+, advanced CKD, multiple comorbidities or is taking a fibrate

what is the most common adverse effect associated with high intensity statin therapy meds like atorvastatin or rosuvastatin?

rhabdomyolysis or mytosis; watch for muscle pain and any indication of jaundice

A patient undergoing high intensity statin therapy begins experiencing new muscle pain. What do you do?

check creatinine kinase level; will be 5x normal level

risk of acute renal failure

A patient undergoing high intensity statin therapy begins experiencing symptoms of jaundice. What do you do?

check liver function test due to drug induced hepatitis

what meds are considered “moderate intensity statin therapy”?

• rosuvastatin

• atorvastatin

• simvastatin

• lovastatin

• pravastatin

these meds decrease LDL by 30-49%

what class/drug is associated with a significant decrease in LDL?

select cholesterol absorption inhibitor - ezetimibe

• lowers LDL by 20% and minimally increases HDL