Np Test 2: Chest Disorders (Cardiac)

The correct answer is "Patient should sit in chair with feet flat on floor for at least 5 minutes before obtaining a reading." This is most reflective of the JNC-7 recommendations because it allows the patient to achieve a relaxed state and stabilize their blood pressure before the measurement is taken. This helps to ensure that the reading is accurate and representative of the patient's true blood pressure.

When starting a patient with hypertension on spironolactone, it is important to monitor their potassium levels. Spironolactone is a potassium-sparing diuretic, meaning it helps the body retain potassium. However, if potassium levels become too high, it can lead to hyperkalemia, which can be dangerous. Therefore, it is crucial to regularly check the patient's potassium levels to ensure they are within a safe range. Monitoring other lab parameters such as sodium, calcium, and chloride may also be important, but the primary concern in this case is the patient's potassium levels.

White coat hypertension refers to a temporary increase in blood pressure that occurs when a person is in a medical setting, such as a doctor's office or hospital, but not in their everyday life. This phenomenon is believed to be caused by the anxiety or stress of being in a medical environment, leading to a falsely elevated blood pressure reading. It is important to recognize white coat hypertension to avoid unnecessary treatment with medication for hypertension when it is not actually present.

Trandolapril is the correct answer because it belongs to the class of medications known as ACE inhibitors (ACEIs). ACE inhibitors work by blocking the action of an enzyme called angiotensin-converting enzyme (ACE), which helps to relax and widen blood vessels, reducing blood pressure. Clonidine, Felodipine, and Doxazosin are not ACE inhibitors but belong to different classes of medications used to treat hypertension.

Troponin I (cTnI) is the most sensitive marker for myocardial damage. Troponin I is a protein found in cardiac muscle cells and is released into the bloodstream when there is damage to the heart muscle. It is a highly specific marker for myocardial injury and is commonly used in the diagnosis of myocardial infarction (heart attack). Other markers such as aspartate aminotransferase, creatine phosphokinase (CPK), and lactate dehydrogenase may also be elevated in myocardial damage, but troponin I has been found to be the most sensitive and specific marker for detecting cardiac injury.

Hypertensive heart disease refers to heart conditions caused by high blood pressure. It is a common cause of heart failure (HF) because prolonged high blood pressure can lead to the thickening and stiffening of the heart muscle, making it less efficient at pumping blood. This can eventually result in heart failure, where the heart is unable to meet the body's demands for blood and oxygen. Therefore, hypertensive heart disease is among the most common causes of HF.

When ACE inhibitors (ACEI) are used in combination with spironolactone therapy, a potential adverse effect is hyperkalemia. ACE inhibitors can decrease the levels of aldosterone, a hormone that helps regulate potassium levels in the body. Spironolactone, on the other hand, is a potassium-sparing diuretic that can increase potassium levels. When used together, the combination can lead to an excessive accumulation of potassium in the blood, resulting in hyperkalemia. This can be a serious condition that can affect the heart's electrical activity and lead to abnormal heart rhythms. Regular monitoring of potassium levels is important when using this combination therapy.

The most important goal of treating HTN is to avoid disease-related target organ damage. This means that the primary objective of treating hypertension is to prevent damage to organs such as the heart, kidneys, brain, and blood vessels, which can occur as a result of high blood pressure. By effectively managing blood pressure levels, healthcare providers can reduce the risk of complications and improve overall health outcomes for individuals with hypertension. This goal takes precedence over other considerations such as reaching recommended numeric blood pressure measurements, developing a care plan with minimal adverse effects, and treating concomitant health problems.

Beta adrenergic antagonists are used in ACS therapy because they can reduce myocardial oxygen demand. These medications work by blocking the effects of adrenaline on the beta receptors in the heart, leading to a decrease in heart rate and contractility. This ultimately reduces the workload on the heart and the amount of oxygen it requires. By reducing myocardial oxygen demand, beta blockers can help improve symptoms and outcomes in patients with ACS.

The best intervention in this case is to initiate therapy with HCTZ (hydrochlorothiazide). This is because the patient has hypertension (HTN) with consistently elevated blood pressure readings over a period of time. HCTZ is a diuretic that helps lower blood pressure by reducing the volume of fluid in the body. Since the patient has no evidence of target organ damage and her ECG and creatinine are normal, starting with a diuretic like HCTZ is a reasonable first-line treatment option. Atenolol is a beta-blocker and methyldopa is an alpha-2 agonist, both of which can be considered as alternative options, but in this case, HCTZ is the best choice.

The correct answer is to arrange for at least two additional BP measurements during the next 2 weeks. This is because the patient's blood pressure is elevated at 144/98, which indicates hypertension. However, a single elevated blood pressure reading is not enough to diagnose hypertension. It is recommended to confirm the diagnosis by obtaining multiple blood pressure measurements over a period of time. This will help determine if the elevated blood pressure is sustained or if it was just an isolated reading. Therefore, arranging for additional BP measurements is the next best action to accurately diagnose and manage the patient's hypertension.

When evaluating a patient for hypertensive target organ damage, one of the key things to look for is evidence of left ventricular hypertrophy. This is because long-standing, poorly controlled hypertension can cause the heart muscle to thicken and enlarge in response to the increased workload. Left ventricular hypertrophy is associated with an increased risk of cardiovascular events such as heart failure, arrhythmias, and myocardial infarction. Therefore, identifying left ventricular hypertrophy in a patient with poorly controlled hypertension is important for assessing the extent of organ damage and determining appropriate management strategies.

Spironolactone is an aldosterone antagonist. It works by blocking the effects of aldosterone, a hormone that regulates sodium and water balance in the body. By blocking aldosterone, spironolactone helps to reduce fluid retention and lower blood pressure. This medication is commonly used to treat conditions such as hypertension, heart failure, and edema. Clonidine, HCTZ, and furosemide are not aldosterone antagonists, but rather belong to different classes of medications used to treat hypertension and other conditions.

Patients with prosthetic heart valves are at the highest risk for developing infective endocarditis. Therefore, the 54-year-old woman with a prosthetic aortic valve is in the greatest need of endocarditis prophylaxis when planning dental work.

Nitrates are used in ACS therapy because they cause vasodilation. Vasodilation refers to the widening of blood vessels, which helps to increase blood flow and reduce resistance in the arteries. By causing vasodilation, nitrates help to improve blood supply to the heart muscle, relieve angina symptoms, and reduce myocardial oxygen demand. This can be beneficial in treating acute coronary syndrome (ACS) as it helps to alleviate chest pain and improve overall cardiac function.

Orthopnea is a condition characterized by dyspnea (shortness of breath) that develops when the individual is lying down and is relieved when they elevate their head. This means that the person experiences difficulty breathing when they are in a lying position, but the symptoms improve when they sit up or raise their head. This is different from dyspnea with exercise, which occurs during physical activity, and dyspnea at rest, which happens even when the person is not exerting themselves. The description of sudden awakening at night with severe anxiety and breathlessness is characteristic of paroxysmal nocturnal dyspnea, which is not the same as orthopnea.

Women with acute coronary syndrome (ACS) are more likely to present with angina, which is chest pain or discomfort, compared to men. This is because women tend to have more atypical symptoms of ACS, such as shortness of breath, fatigue, or nausea, rather than the typical symptom of chest pain. On the other hand, men are more likely to present with acute myocardial infarction (MI), which is a heart attack. Women also have a lower incidence of heart failure (HF) compared to men. Therefore, it is more common for women with or at risk for ACS to present with angina and less commonly with acute MI or HF.

The correct answer is Doxazosin. According to the recommendations in JNC-7, all of the medications listed (HCTZ, Atenolol, and Trandolapril) are designated as having a compelling indication for use in individuals with high cardiovascular disease risk. However, Doxazosin is not specifically mentioned as having a compelling indication in this context.

When a heart valve fails to open to its normal orifice size, it is said to be stenotic. This means that the valve is narrowed or constricted, which restricts blood flow through the valve. This can lead to symptoms such as chest pain, shortness of breath, and fatigue. Stenosis can occur in any of the heart valves, including the aortic valve, mitral valve, tricuspid valve, and pulmonary valve. Treatment for stenotic valves may involve medication or surgical intervention to repair or replace the affected valve.

A physiological split S2 heart sound refers to a normal variation in the timing of the closing of the aortic and pulmonic valves, resulting in a split sound. This is commonly observed in young and healthy individuals, particularly athletes, due to their increased cardiac output and enhanced cardiovascular conditioning. Therefore, the 19-year-old healthy athlete is most likely to have a physiological split S2 heart sound.

In a patient with acute coronary syndrome (ACS), it is expected to find ST segment deviation (>0.05 mV) on the 12-lead ECG. This can indicate myocardial ischemia or injury, which is commonly seen in ACS. Flattened T-waves can also be seen in ACS, but they are not specific to this condition and can be seen in other cardiac abnormalities as well. R-wave larger than 25 mm is not typically associated with ACS. Fixed Q waves, on the other hand, can be seen in patients with a previous myocardial infarction, but they are not specific to ACS.

A grade 3/6 crescendo-decrescendo systolic murmur with radiation to the neck is characteristic of aortic stenosis. Aortic stenosis is the narrowing of the aortic valve, which obstructs the flow of blood from the left ventricle to the aorta. This causes the blood to flow through the narrowed valve with increased velocity, resulting in a murmur. The crescendo-decrescendo pattern indicates the turbulent blood flow through the stenotic valve. The radiation to the neck suggests that the murmur is audible in the carotid arteries, which are located in the neck.

A person presenting with unstable angina may experience chest pressure that lasts for a longer duration (20 minutes) and occurs at rest. Unstable angina is characterized by chest pain or discomfort that is unpredictable, occurs at rest or with minimal exertion, and is more severe and prolonged compared to stable angina. The fact that the chest pressure lasts for 20 minutes and occurs at rest suggests that it is consistent with unstable angina.

The extra heart sound early in diastole is most likely an S3 sound. S3 is commonly heard in patients with heart failure and is associated with ventricular filling during rapid diastolic filling. It is often described as a "gallop" sound and can indicate volume overload or ventricular dysfunction. In this case, the patient's history of heart failure and increasing shortness of breath suggest that the S3 sound is likely indicative of her underlying cardiac condition.

Losing 10 kg of weight would likely yield the greatest potential reduction in blood pressure (BP) in a person with hypertension (HTN) and a BMI of 30. Obesity is a known risk factor for HTN, and weight loss can significantly lower BP. Losing 10 kg would result in a substantial reduction in body mass, leading to decreased strain on the cardiovascular system and improved overall health. Dietary sodium restriction, regular aerobic physical activity, and moderate alcohol consumption can also contribute to lowering BP, but the impact of weight loss is generally more significant.

Nisoldipine should not be prescribed as part of therapy in ACS because it is a calcium channel blocker primarily used for hypertension and angina, not for acute coronary syndrome. Aspirin is commonly prescribed in ACS to prevent blood clot formation, metoprolol is a beta blocker that helps reduce heart rate and blood pressure, and lisinopril is an ACE inhibitor that helps relax blood vessels and lower blood pressure. However, nisoldipine does not have the same beneficial effects in ACS and is not recommended for this condition.

When diagnosing a patient with new stage 1 primary hypertension, it is important to assess certain factors that could contribute to the condition. Hematocrit (Hct), creatinine, and potassium levels are all relevant indicators that can help determine the cause and severity of hypertension. Uric acid, on the other hand, is not directly related to hypertension and therefore would not be necessary to include in the diagnostic testing.

Pindolol is a beta-adrenergic receptor antagonist. Beta-adrenergic receptor antagonists, also known as beta-blockers, block the action of adrenaline and noradrenaline on beta receptors in the body. Pindolol specifically blocks both beta-1 and beta-2 adrenergic receptors, making it effective in treating conditions such as hypertension and angina. Clonidine is an alpha-2 adrenergic agonist used for hypertension, spironolactone is a potassium-sparing diuretic used for heart failure and hypertension, and HCTZ is a thiazide diuretic used for hypertension.

Aliskiren (Tekturna) is a direct renin inhibitor. Renin is an enzyme involved in the production of angiotensin II, which is a potent vasoconstrictor. By inhibiting renin, aliskiren reduces the production of angiotensin II, leading to vasodilation and decreased blood pressure. It is not an ACEI, beta-adrenergic antagonist, or centrally acting agent.

Aortic stenosis in a 15-year-old is most likely a result of a congenital defect. This means that the individual was born with a narrowed aortic valve, which restricts blood flow from the left ventricle to the aorta. It is less likely to be a sequela of rheumatic fever, which is an inflammatory condition that can cause damage to the heart valves. Calcific aortic stenosis typically occurs in older individuals due to the buildup of calcium deposits on the valve leaflets. There is no mention of an atrial septal defect in the question, so it is not relevant to the most likely cause of aortic stenosis in this case.

Thrombolytic therapy is indicated in patients with chest pain and ECG changes such as 3-mm ST segment elevation in leads V1 to V4. This indicates a significant myocardial infarction (heart attack) and is a clear indication for thrombolytic therapy. Thrombolytic therapy helps dissolve blood clots that may be causing the blockage in the coronary arteries, restoring blood flow to the heart muscle and preventing further damage.

The given blood pressure readings of 130-135 / 82-86 mmHg fall within the prehypertension range. Prehypertension is a condition where blood pressure levels are higher than normal but not yet classified as hypertension. This condition serves as a warning sign that the individual is at risk of developing high blood pressure in the future. It is important for the woman to monitor her blood pressure regularly and make lifestyle changes to prevent the progression of prehypertension to hypertension.

Doxazosin is an alpha-adrenergic antagonist medication. It works by blocking the alpha-1 adrenergic receptors in the smooth muscles of the blood vessels and prostate. This causes relaxation of the blood vessels, leading to a decrease in blood pressure. It is commonly used to treat hypertension and benign prostatic hyperplasia. Enalapril, Diltiazem, and Felodipine are not alpha-adrenergic antagonists and have different mechanisms of action.

The recommended low-density lipoprotein (LDL) goal for a 64-year-old man with diabetes mellitus who had a myocardial infarction (MI) 2 years ago should be less than 70 mg/dL. This is because individuals with diabetes and a history of MI are at a higher risk for cardiovascular events, and maintaining a lower LDL level can help reduce this risk. Additionally, guidelines from organizations such as the American Diabetes Association recommend an LDL goal of less than 70 mg/dL for high-risk individuals with diabetes.

Telmisartan is an angiotensin receptor antagonist. It works by blocking the action of angiotensin II, a hormone that causes blood vessels to narrow, thereby relaxing and widening the blood vessels. This helps to lower blood pressure and improve blood flow. Trandolapril is an ACE inhibitor, Methyldopa is a centrally acting alpha-2 adrenergic agonist, and Atenolol is a beta blocker, none of which are angiotensin receptor antagonists.

The presence of a mid-systolic click is an additional finding in MVP. This click occurs during systole, specifically in the middle of systole, and is caused by the sudden tensing and bulging of the mitral valve leaflets into the left atrium. It is typically heard best at the apex and may be followed by a late systolic murmur. The mid-systolic click is a characteristic finding in MVP and is caused by the abnormal movement of the mitral valve.

The NP anticipates finding 12-lead ECG changes consistent with left ventricular hypertrophy in a person with aortic stenosis. Aortic stenosis is a condition characterized by the narrowing of the aortic valve, which leads to increased pressure and workload on the left ventricle. Over time, this can cause the left ventricle to become hypertrophied, or thicker, as it tries to pump blood against the narrowed valve. These changes can be detected on an ECG, such as increased voltage amplitudes in the left ventricular leads and repolarization abnormalities.

A patient presenting with acute MI would typically experience retrosternal diffuse pain for a prolonged period of time, usually longer than 20 minutes. This pain is often described as a crushing or squeezing sensation in the chest. Diaphoresis, or excessive sweating, is a common symptom seen in patients with acute MI. These symptoms are indicative of myocardial ischemia and should be taken seriously as they may lead to a heart attack.

Carvedilol is an alpha/beta-adrenergic antagonist because it blocks both alpha and beta receptors in the body. This medication is commonly used to treat high blood pressure and heart failure. By blocking these receptors, carvedilol helps to relax and widen blood vessels, which reduces blood pressure. It also slows down the heart rate and decreases the force of contractions, which can be beneficial in heart failure. Atenolol, metoprolol, and propranolol are all beta-adrenergic antagonists, but they do not block alpha receptors like carvedilol does.

Verapamil is a calcium channel blocker that can be used to treat migraine headaches. Migraine headaches are a comorbid condition commonly seen in individuals with hypertension (HTN). Verapamil works by relaxing the blood vessels and reducing the frequency and severity of migraines. Therefore, using Verapamil to treat migraines in a person with HTN can have a favorable effect on their comorbid condition.

A Still's murmur is a benign innocent heart murmur that is commonly heard in children and usually disappears by adulthood. It is not associated with any structural abnormalities or increased risk for developing bacterial endocarditis. Therefore, the 55-year-old man who was diagnosed with a Still's murmur as a child has no significant increased risk for developing bacterial endocarditis.

A physiological murmur is a normal sound heard during the cardiac cycle. It is typically heard in early systole and is not associated with any underlying heart condition. It is usually heard in a widespread area of auscultation, rather than localized. Additionally, a physiological murmur does not typically affect the sound of the second heart sound (S2). However, it may become softer when the patient changes position from supine to standing due to changes in blood flow dynamics.

Evidence of hemoconcentration on a hemogram is unlikely to be noted in a person experiencing heart failure (HF). Hemoconcentration refers to an increase in the concentration of red blood cells and other blood components due to a decrease in plasma volume. In HF, there is typically fluid retention and congestion, leading to an increase in blood volume and dilution of blood components. Therefore, hemoconcentration is not expected to be observed in HF patients.

Less-than-ordinary activity leads to fatigue, dyspnea, palpitations or angina best describes the patient presentation of NY Heart Association stage III heart disease. This means that the patient experiences symptoms such as fatigue, difficulty breathing, palpitations, or chest pain with activities that would normally be considered less strenuous or demanding. This indicates a moderate limitation in physical activity due to the heart disease.

Amlodipine is a dihydropyridine calcium channel blocker. It works by blocking the calcium channels in the smooth muscles of blood vessels, causing them to relax and dilate. This helps to lower blood pressure and improve blood flow. Lisinopril is an ACE inhibitor, Verapamil is a non-dihydropyridine calcium channel blocker, and Doxazosin is an alpha-1 blocker. Therefore, Amlodipine is the correct answer as it belongs to the dihydropyridine class of calcium channel blockers.

Diltiazem is a nondihydropyridine calcium channel blocker. It works by blocking the movement of calcium ions into the smooth muscle cells of the heart and blood vessels, which helps to relax and widen the blood vessels, thus reducing blood pressure. Lisinopril is an ACE inhibitor, Amlodipine is a dihydropyridine calcium channel blocker, and Prazosin is an alpha-1 blocker. Therefore, the correct answer is Diltiazem.

Pectus excavatum is a condition where the breastbone sinks into the chest, creating a concave appearance. It is commonly seen in individuals with connective tissue disorders such as Marfan syndrome, which is associated with mitral valve prolapse. The presence of pectus excavatum in this 24-year-old woman suggests a possible underlying connective tissue disorder, which may be contributing to her mitral valve prolapse.

In a patient with dilated cardiomyopathy and heart failure, the point of maximal impulse (PMI) is typically displaced laterally due to the enlargement of the heart. Therefore, it would not be expected to find the PMI at the fifth intercostal space, mid-clavicular line. Jugular venous distention is commonly seen in heart failure due to increased central venous pressure. Tenderness on right upper abdominal quadrant palpation may indicate liver congestion, which can occur in heart failure. Peripheral edema is another common finding in heart failure due to fluid retention.

Azithromycin should be used for endocarditis prophylaxis in patients who are allergic to PCN because it is a macrolide antibiotic that is effective against the bacteria that commonly cause endocarditis. Macrolides are considered an alternative to penicillin for prophylaxis in patients with PCN allergy. Erythromycin is also a macrolide antibiotic, but it is not the preferred choice due to its higher incidence of gastrointestinal side effects. Dicloxacillin is a penicillin antibiotic and should not be used in patients with PCN allergy. Ofloxacin is a fluoroquinolone antibiotic and is not recommended for endocarditis prophylaxis.

Pain reproduced with palpation is least likely to be reported in ACS because it is a symptom that is more commonly associated with musculoskeletal issues rather than cardiovascular problems. ACS typically presents with symptoms such as chest pain, shortness of breath, and other signs of cardiac distress. While pain reproduced with palpation could potentially be present in ACS, it is less specific to this condition and could be attributed to other causes. Therefore, it is less likely to be reported in ACS.