STEP 3 Uworld Flashcards

Questions and Answers

What does the acronym CV stand for?

Cardiotonic

Cardiovascular (correct)

Cardioelectric

Cardiopulmonary

Define severe and malignant hypertension and provide two exceptions when treating blood pressure in strokes.

Severe hypertension is usually defined as a systolic blood pressure >180 mmHg or diastolic >120 mmHg. Malignant hypertension is a severe form that can lead to organ damage. Exceptions: BP in strokes treated only if >185/110, Aortic dissection: decrease systolic BP to 100-120 within 20 minutes.

What are some causes of secondary hypertension?

Causes include conditions like renal artery stenosis, endocrine disorders like Cushing's and Conn's syndrome, and use of certain medications.

What are the types of syncope?

Types include neurogenic (seizure), cardiogenic, orthostatic, and vasovagal. Signup and view all the answers

Why did a 70-year-old male on medication for BPH and hypertension experience a syncopal event, and what is the next step?

The syncopal event may be due to the first-dose orthostatic hypotension from medications. The next step is to stop the medication. Signup and view all the answers

What is the difference between preload and afterload?

Preload is the amount of ventricular filling before contraction, while afterload is the pressure the heart must work against to eject blood. Signup and view all the answers

What effect do CHF, ACE inhibitors, diuretics, epinephrine, and inotropes have on cardiac output, preload, and afterload?

CHF decreases cardiac output and increases preload and afterload; ACE inhibitors and diuretics decrease preload; epinephrine increases afterload. Signup and view all the answers

What is the diagnosis and next step for a patient with asymptomatic systolic dysfunction, left ventricular hypertrophy, and LVEF 35%?

Diagnosis: Heart failure with reduced ejection fraction. Next step: Start ACE-I (Lisinopril) and later a beta-blocker. Signup and view all the answers

How is a STEMI diagnosed and what are the common side effects of the medications used?

Diagnosis: ST segment elevation >1 mm in leads other than V2, V3. Treatment includes aspirin, possible PCI, fibrinolytics. Common side effects are angioedema from ACE-I, bradycardia from beta-blockers. Signup and view all the answers

What medications should a patient with acute MI go home on?

Medications include aspirin, ACE inhibitors, beta-blockers, clopidogrel, and statins. Signup and view all the answers

Study Notes

Cardiovascular (CV)

Refers to the cardiovascular system, including the heart and blood vessels.

Severe and Malignant Hypertension

Severe hypertension defined when blood pressure is significantly elevated.
Malignant hypertension characterized by severe elevation with signs of vascular damage, like papilledema.
Exceptions for treatment notably include:
- In strokes, treat BP only if exceeding 185/110 to avoid increased ischemia.
- Aortic dissection, target systolic BP should drop to 100-120 within 20 minutes.

Causes of Secondary Hypertension (ABCDE)

A: Aldosteronism (Conn's syndrome)
B: Bad Kids, refers to renal artery stenosis (RAS), commonly associated with bruits.
C: Coarctation of the aorta or other cardiovascular abnormalities.
D: Drugs like NSAIDs or oral contraceptives.
E: Endocrine disorders, including Cushing's syndrome, pheochromocytoma, and hyperthyroidism.

Types of Syncope

Neurogenic: Seizure, traumatic brain injury (TBI), stroke, migraine, or tumor-related.
Cardiogenic: Caused by bradyarrhythmias, emotional triggers, or TIA.
Orthostatic: Related to sudden changes in position.
Vasovagal: Triggered by emotional stressors.

Prazosin and Orthostatic Hypotension

Commonly causes first-dose orthostatic hypotension; effects can continue for up to a month.
Recommended to stop medication if syncopal events occur.

Preload vs. Afterload

Preload: Refers to ventricular filling; increased filling leads to greater preload.
Afterload: The pressure the heart must overcome to pump blood; increased in conditions like hypertension or aortic stenosis.

Effects of Medications on Preload and Afterload

ACE Inhibitors (ACE-I) and Nitroprusside: Decrease both preload and afterload.
Beta-blockers (B-b): Primarily decrease afterload.
Congestive Heart Failure (CHF): Typically leads to decreased cardiac output but may increase preload and afterload due to fluid retention.
Diuretics: Reduce volume, resulting in decreased preload.
Epinephrine: Increases afterload through vasoconstriction.

Management of Asymptomatic Left Ventricular Systolic Dysfunction

Begin treatment with Lisinopril, followed by a beta-blocker.
Patients typically have a reduced ejection fraction (EF) and may display signs of LV hypertrophy.

Management of Pulseless Electrical Activity (PEA)

Follow Advanced Cardiac Life Support (ACLS) protocol: compressions and breaths.
Administer 1 mg epinephrine every 3-5 minutes after 4 minutes of no pulse.

STEMI Diagnosis and Treatment

Diagnose with ST elevation greater than 1 mm in leads other than V2 and V3.
Initiate treatment with aspirin and prefer percutaneous coronary intervention (PCI) within 90 minutes of contact, or fibrinolytics if PCI cannot be performed in time.
Common medication side effects include angioedema from ACE-I, myalgia from statins, and hypotension from beta-blockers.

Post-MI Medication Regimen

Patients should be discharged with aspirin, ACE inhibitor, beta-blocker, clopidogrel (or prasugrel), and a statin.
Recommendations include refraining from sexual activity for 2-6 weeks post-MI.
Additional considerations for pacemaker placement and use of calcium channel blockers in specific scenarios.

Description

Test your knowledge with these STEP 3 Uworld flashcards focusing on cardiovascular terms and critical care management. Each card provides essential definitions and clinical scenarios aimed at preparing you for the exam.