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3 Cardiac Flashcards

1
Q

S1: valve closure, what is happening in heart, sounds prop to

A

Mitral and tricuspid. Start of systole, end of lv fill and beginning of isovolumic contraction. Sounds louder w harder contraction

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2
Q

S2: valve closure, action in heart, sound prop to

A

Aortic and pulmonic. Onset of diastole, end of lv ejection. Sound louder w htn

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3
Q

S3: suggests what, heard when

A

Gallop rumble= flaccid and inelastico heart. After S2 mid diastole

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4
Q

S4: when it occurs and caused by what

A

Atrial systole, before s1

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5
Q

Layout of sarcomeres in stenosis v regurg

A

Stenosis= in parallel. Regurg= in series

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6
Q

How pressure vol loop changes w AS

A

Inc height and shift right q

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7
Q

When it is important to listen to murmur of AS and why

A

Elderly, before spinal. Pts asymptomatic until LV dysfunction develops

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8
Q

How a line waveform diff in AS

A

Slower systolic upstroke (pulsus tardus) and a delayed peak. SV reduction= narrow PP with small amplitude (pulsus parvus). May not have a dicrotic notch/look dampened

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9
Q

When mitral stenosis is severe

A

Valve area <1, LAP-LV p gradient >10, PAP SBP >50

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10
Q

What happens in mitral stenosis

A

LA overfilled, LV underfilled, lower SV/end diastolic volume, body compensates w inc SVR. LA overload leads to afib

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11
Q

Pressure vol loop mitral stenosis

A

Lower, same width, shift left

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12
Q

HR consid mitral stenosis

A

Tx tachyarrythmias. Avoid drugs that inc hr like ketamine, atra, or anticholinergic. Otherwise may lead to pulm edema

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13
Q

PAOP waveform in mitral stenosis. How to tx LAP issue

A

Diuretics. Prominent a wave and dec y descent

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14
Q

DOC for hypotension in MS, drug to avoid

A

Vaso or neo, not ephedrine

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15
Q

When it is ok to do a spinal in mitral stenosis

A

If INR <1.5. Epidural preferred

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16
Q

Mitral regurg pressure vol loop acute and chronic

A

Both lower, wider, shifted slightly right (acute more than chronic). Acute shorter, less width, and more right than chronic overall

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17
Q

Paop waveform mitral regurg

A

Large v wave

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18
Q

SAM is a risk after which valve repair, treatment

A

Mitral valve repair. Inc vol and afterload w alpha agonist

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19
Q

Conditions that inc PVR

A

Hypercarbia, hypoxia, tburg, nitrous, lung hyperinflation, acidosis

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20
Q

When cardiologia must be injected retrograde

A

Aortic regurg

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21
Q

Pressure vol loop aortic regurg

A

Wide, shifted right, slanted

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22
Q

Bad choices for hypotension in AI

A

Neo or vaso

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23
Q

AI: spinal fx

A

Will reduce afterload and regurg fraction

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24
Q

AI ABP waveform

A

Sharp upstroke, low DBP, wide PP. may have biphasic systolic peaks/bisferiens pulse

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25
AS when murmur heard and where, how it can vary
Systole, right sternal border. May feel as a thrill and may dec with severity
26
AI: when murmur heard, wher
Diastolic, right sternal border. Blowing murmur less loud than AS
27
MS: when murmur heard and where
Diastolic, L apex and L Scilla. Snap/rumble
28
MR: when murmur heard and where
Systolic, l apex and l axilla. Swishing holosystolic murmur
29
Where sarcomeres are replicated in MS
Left atrium
30
Things to avoid in MV prolapse
SNS stim, dec SVR, low vol, upright positions. No ketamine
31
Primary determinant of RMP. What happens when it decreases or increases
K. Dec= RMP more neg, harder to depolarize. Inc= rmp more pos and easier to depolarize
32
Ventricular AP phases
Phase 0 na in (depolarization), phase 1 initial repol k out cl in, phase 2 plateau ca in k out, phase 3 final repol k out ca briefly in, phase 4 rmp k in na out
33
PNS vs sns tone in heart
PNS vagus n, rt= sa and left= av node. SNS= T1-4
34
How av node AP looks diff from SA node
Lower slope during phase 4 which leads to slower intrinsic firing rate
35
SA node AP phases
4 spont depol (na in ca in, funny current, -60), 0 depol ca in, phase 3 k out repolarization
36
How heart rate changes
Rate of spont 4 depol (can inc w sns stim), tp (more neg= shorter distance), rmp (less neg= shorter distance). PNS fx phase 4 and rmp
37
How to calc DO2
CO x ((hgb x sao2 x 1.34) + (pao2 x 0.003)) x 10
38
Normal do2, normal o2 extraction, extraction ratio
1000 ml/min, 250 ml/min, 25%
39
Normals: Ca02, EO2, VO2, CvO2
20. 25%. 250 ml/min. 15 ml/dl
40
How to calc map
(CO X SCR)/80 + CVP
41
Pouiseilles law
Flow= pi x r4 x change in pressure / 8xnxl
42
Effect of doubling radius on flow
16 fold
43
How reynolds number correlates to flow type
<2000= laminar, >4000= turbulent, in between= transitional
44
Dihydropyrodines v non
Dyhydro targets vascular smooth muscle. Non dihydro targets myocardium
45
More likely in constrictive than in acute pericarditis
Kussmauls sign, pulsus paradoxus, atrial dysrhythmias
46
Pulsus ____ more likely in pericardial tamponade
Pulsus paradoxus, SBP decreases on insp
47
How long to delay elective sx after a BMS V drug eluding
Bare= 30 days. Des= 6 mo if current, 12 months if 1st gen
48
Act goal before bypass
400 seconds
49
Protamine dose
1 mg per 100u of heparin
50
When to wait for elective surgery after an mi
4-6 weeks
51
Factors that dec myo 02 delivery
Hi hr, dec aortic p, dec vessel diameter, inc edp, dec CaO2, l shift 02 dissoc curve/dec p50
52
Best leads to monitor for st changes on nml ekg
V3 >v4 >v5>II>avf
53
Pts w cad: 5 lead v 3 lead best to watch for st
5: v4, avf, mcl5, or III. 3: avf, mcl5
54
Ventricular compliance
Ventricle vol / ventricular pressure
55
How compliance effects the curve
Decreased shifts up and left, increased shifts down and right
56
Hallmark of systolic HF
Decreased EF with an inc EDV
57
Hallmark diastolic HF
Symptomatic Hf w normal EF
58
Systolic HF causes
MI, regurg, dilated cm
59
Diastolic HF causes
Mi, stenosis of valves, htn, HOCM, cor pulm, obesity
60
Suffix that goes w: ang II receptor antag, ARB
ANG II= Spartan, arb- zosin
61
Dilator that targets A and V equally
SNP
62
Dihydropyridine ending and types of rx
Dipine, vasculature
63
Ccb contractility impair most to least
Verapamil, nifedipine, dilt, nicardipine
64
What cardiac tamponade looks like on pressure volume loop
Shift left, narrower, smaller. Dec volume and compliance
65
Kussmauls sign
Inc cvp and JVD on inspiration
66
Drugs to avoid in tamponade
IAs, prop, tpl, opioids, regional
67
Safer drugs in tamponade
Ketamine, nitrous, benzos, low dose opioids
68
Hemodynamic goals in tamponade
Maintain HR, Maintain/inc preload, maintain/inc contractility, maintain afternload
69
Conditions that distend LVOT/make HOCM better
Inc volume, dec contractility, inc AO pressure
70
Conditions that make HOCM worse
Dec vol, inc contractility, dec AO pressure
71
How long to wait after angioplasty without stent
2-4 weeks
72
How long to wait for sx after a cabg
6 weeks
73
When to d/c before sx: asa, plavix, ticlid
3 days, 7 days, 14 days
74
Where distal tip IABP should be
2cm distal to L subclavian A
75
IABP balloon deflation occurs when on ekg
R wave
76
Aortic pressure differences with and without IABP
IABP decreases EDP and SBP
77
Coronary perf pressure
Aortic DBP - LVEDP
78
CBF autoreg range
60-140
79
Things that decrease 02 delivery
Tachycardia, dec aortic pressure, dec vessel diameter, inc edp, hypoxemia, anemia, L shift/dec p50, dec capillary density
80
Things that inc 02 demand
Tachy, htn, sns, inc wall tension, inc EDV, inc afterload, inc contractility

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