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AG-ACNP – Cardiovascular:- Questions & Solutions
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AG-ACNP – Cardiovascular:- Questions & Solutions
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AG-ACNP – Cardiovascular:- Questions & SolutionsWhat are the characteristics of a Grade IV/VI heart murmur? Right Ans -
Loud
Thrill - palpable thrill
Patient presents with history of multiple syncopal episodes. Physical exam
remarkable for loud, diamond shaped, systolic murmur at 2nd R ICS that
radiates to neck. What do you suspect and what are your actions? Right
Ans - Aortic Stenosis - syncope r/t decreased cardiac output
Consult cardiology
Which murmur is associated with S3, systolic murmur at 5th ICS MCL that
radiates to L axilla? Right Ans - Mitral Regurgitation
Define heart failure. Right Ans - Syndrome where cardiac output is
insufficient to meet metabolic demands of the body.
Define diastolic heart failure. Right Ans - Inability to relax and fill =
decreased cardiac output
HFpEF >40%
Define systolic heart failure Right Ans - Inability to contract = decreased
cardiac output
HFrEF <40%
S1 is associated with which heart valves? Right Ans - S1 - Mitral and
Tricuspid (AV) CLOSE
S2 is associated with which heart valves? Right Ans - S2 - Aortic and
Pulmonic (SL) CLOSE
Define systole. Right Ans - The period between S1 (MT close) and S2 (AP
close)
Define diastole. Right Ans - Period between S2 and S1
Which heart sound is best associated with CHF? Right Ans - S3 - atrial
gallop. FVE states.
,Which heart sound is best associated with LVH? Right Ans - S4 - ventricular
gallop. Stiff ventricular wall - MI, HTN, LVH
Define acute heart failure. Right Ans - LCHF L= LUNGS
Follows AMI, LVH, HTN, valve rupture
Define chronic heart failure Right Ans - RCHF
Develops as a result of inadequate compensatory mechanisms that have been
in response to decrease CO
What are the signs and symptoms of Acute Heart Failure? Right Ans - L CHF
- L = LUNGS
Crackles, rales in all lung fields
Dyspnea at rest
Frothy cough
S3 gallop - FVE
Mitral Regurgitation - systolic murmur, apex
What heart murmur is associated with Acute Heart Failure? Right Ans -
Mitral Regurgitation - systolic
What are the signs and symptoms of Chronic Heart Failure? Right Ans - R
HF
Peripheral edema
JVD
Hepatomegaly
Paroxysmal nocturnal dyspnea (PND)
Displace PMI
Abdominal fullness
S3 and/or S4
According to NYHA, which stage of heart failure is classified as, "comfortable
at rest, but less than ordinary activity causes symptoms?" Right Ans - Class
III
, What signifies a NYHA Class IV Heart Failure score? Right Ans - Inability to
carry out any physical activity without discomfort. S/S at REST
What diagnostics are indicated for heart failure? Right Ans - ABG -
hypoxemia, hypocarbia
BMP
UA
CXR - pulmonary edema, Kerley B lines, pleural effusions
Echo - EF, contractility, LV function
EKG - underlying AMI, arrythmia
What is the non-pharmacological management of HF? Right Ans - Sodium
restriction
Rest/activity balance
Weight reduction
What is the pharmacological interventions indicated for HF? Right Ans -
Ace Inhibitors
Diuretics: Furosemide (Lasix)
Anticoagulation - atrial fibrillation
Define Acute/Flash Pulmonary Edema Right Ans - Alveoli filled with
intravascular fluids caused decrease in gas exchange resulting in poor
oxygenation.
Causes - AMI, HF, increased LV pressure
What is the inpatient management of acute pulmonary edema? Right Ans -
O2
Semi-Fowlers
Morphine 2-4 mg IVP q30 mins PRN
Furosemide (Lasix) 40 mg IVP q 10mins if no response
Nitroprusside/Hydralazine
Albuterol (Proventil)
Dobutamine 2.5-20 ug/kg/min
SBP <100 mmHg - Dopamine 5-20 ug/kg/min
What is indicated to reduce afterload and preload in the setting of pulmonary
edema? Right Ans - Nitroprusside
Hydralazine (Apresoline) - arterial vasodilator
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