CMN 574 CHEST AND HEART FAILURE EXAM 1. QUESTIONS WITH 100% CORRECT ANSWERS.

What did the CHADs scoring in the Swedish Hospital test show? Women with atrial fibrillation have an increased risk of stroke compared to men. AND Women with A-fib, YOUNGER than 65 WITHOUT other RISK FACTORS, have a low risk for stroke and do not need anticoagulants. Chlorthalidone Diuretic/antihypertensive but is not potassium sparing like eplerenone or spironolactone Eplerenone Mineralocorticoid receptor antagonist Diuretic: blocks aldosterone Ivabradine (Corlanor): HCN channel blocker, slows heart rate, used in management of stable chest pain in conjunction with Beta Blockers. Works in SA node and heartrate must be at least 70 BPM Isosorbide Nitrate: used to prevent angina, vasodilates blood vessels for more easy flow. Patients with Sickle cell induced acute chest syndrome often present with what? Chest pain, fever, cough. Myocardial ischemia is described as what kind of pain? a dull, aching pressure, tightness, squeezing or gas pain. Usually subsides within 5-20 minutes. Pain is accompanied by a sense of anxiety or uneasiness. Pain is usually referred pain due to lack of somatic innervation. A cardiac friction rub represents ____________ until proven otherwise. pericarditis: watch for tamponade What is the strongest predictor of acute myocardial infarction in terms of ECG? S.T. segment elevation on ECG. Findings of pneumomediastinum or new pleural effusion are consistent with __________ ___________. Esophageal perforation What is a T.I.M.I score and what does a score of 1 mean? Thrombolysis in Myocardial Infarction Risk Score: It is a score for chest pain to determine if patients are able to be safely discharged from the ER. A score of less than or equal to 1 indicates a patient can be discharged. If the score is higher, the patient must be admitted. What would a supraventricular arrhythmia sound like? a midsystolic click of mitral valve prolapse could be present. or a holosystolic murmur. lovenox unfractionated heparin cannot be taken orally Enoxaprain LOVENOX: LMWH, more predictable than unfractionated heparin. Metabolized by kidneys. -cannot be taken orally Fondaparinux A factor XA inhibitor. Chemically related to LMWH, exclusively metabolized by kidneys, should be avoided in patients with creatinine clearance less than 30. Has a long half life, once daily dosing. No neutralizing agent exists! -cannot be taken orally warfarin can be taken orally, must be monitored with INR, not as predictable as D.O.A.C.S. LMWH are more effective than unfractionated heparin in the immediate treatment of DVT and PT. True or False? True Pulmonary congestion is a hallmark of ____ sided heart failure. Pulmonary congestion is a hallmark of LEFT sided heart failure. What are some of the features of musculoskeletal pain? Duration is a gradual onset. Chest wall pain if reproducible by palpation of muscles, ligaments or costochondral junctions. Zoster pain. What test is used when ECG are hard to interpret, and can confirm diagnosis, localize ischemia, distinguish ischemia from MI or to assess success of revascularization? Myocardial stress imaging MSI. ECG from normal to acute MI: 1. hyperacute T wave changes, S.T. elevation. 2. Marked S.T. elevation. STEMI. 3. Pathological Q waves. T wave inversion: necrosis and fibrosis. 4. Pathologic Q waves: upright T waves: fibrosis. T waves changes reflect what? reversible myocardial ISCHEMIA. (very nonspecific) S.T. segment elevation signifies what? Myocardial INJURY. Significant Q waves (greater than 0.04 or 1 square wide) indicate what? IRREVERSIBLE myocardial CELL DEATH. Diagnostic of MI.. Acute Coronary syndrome chest pain at rest with minimal exertion, substernal but may radiate to jaw, are, shoulder. Pain 30mins. 30% acute MI patients have NO chest pain; elderly, women, diabetics so HIGHER mortality. May have: nausea, dyspnea, diaphoresis, anxiety, syncope. What medication is usually used in combination with diuretics and is THE FIRST LINE FOR ALL PATIENTS WITH HFrEF? Ace Inhibitors. captopril, enalapril, lisinopril. All aces can cause increased potassium so monitor carefully. Watch for ANGIOEDEMA: life threatening side effect.