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Anes 540b Exam 1 > Cardia IV: Cardiac Diseases + 12-Lead EKG > Flashcards

Cardia IV: Cardiac Diseases + 12-Lead EKG Flashcards

1
Q

Manifestations include Angina Pectoris, Acute Myocardial Infarction, Sudden Death

A

Ischemic Heart Disease

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2
Q

Why does IHD cause Sudden Death?

A

Likely due to cardiac dysrhythmias

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3
Q

Main risk factors for CAD?

A

Increasing age, male because estrogen is protective

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4
Q

Ischemic heart disease reflects the presence of _________ in coronary arteries, also known as:

A

atherosclerosis in coronary arteries = coronary artery disease (CAD)

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5
Q

Moderate risk factors include hypercholesteremia, hypertension, smoking

A

CAD

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6
Q

Lesser risk factors include diabetes mellitus, obesity, sedentary life style, family history of premature event

A

CAD

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7
Q

What causes angina pectoris?

A

An imbalance between coronary blood flow and myocardial oxygen consumption (supply vs. demand)

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8
Q

Angina pectoris can precipitate

A

Ischemia

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9
Q

Why must we be mindful of volume depletion in anemic patients?

A

The O2 supply for anemic patients is already low, so any other disturbance to blood supply will mess up the supply vs. demand balance.

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10
Q

When imbalance that causes angina pectoris is extreme, what may happen?

A

Congestive heart failure (CHF)
Electrical instability/ cardiac dysrhythmias (may precipitate IHD)
Myocardial infarction (MI)

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11
Q

The most common cause of myocardial ischemia?

A

Atherosclerosis

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12
Q

Retrosternal chest pain (described as pressure or heaviness), discomfort typically radiates to the neck, left shoulder, left arm, or lower jaw

A

Angina pectoris

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13
Q

What induces angina pectoris?

A

Physical exertion, emotional tension, and cold weather

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14
Q

What is Levine’s sign?

A

Clutching your chest at your heart

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15
Q

Angina causes what changes to EKG?

A

ST depression and T-wave inversion

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16
Q

Nuclear Stress Imaging assesses coronary perfusion by:

A

defining vascular regions in which stress-induced coronary blood flow is limited

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17
Q

Gold standard of diagnosing angina pectoris?

A

Coronary angiography

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18
Q

What is coronary angiography?

A

Determines anatomic extent of CAD & LV function (EF)

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19
Q

Life style changes that can improve angina?

A

Smoking cessation
Maintenance of IBW
Regular exercise
Treatment of HTN

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20
Q

Pharmacologic treatments of angina?

A 
Antiplatelet drugs
B-blockers
Calcium channel blockers
ACE inhibitors
Nitrates
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21
Q

Revascularization to treat angina?

A

CABG + PTCA

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22
Q

Nearly all MIs are caused by:

A

thrombotic occlusion of a coronary artery

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23
Q

Percentage of stenosis required to produce angina pectoris

A

Stenosis >70%

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24
Q

Rise and fall of serum cardiac enzyme markers Troponin T or I indicates:

A

MI within four hours of event

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25
Q

What lung sound might you hear during MI?

A

Moist rales representing CHF

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26
Q

Cardiac murmur during MI may reflect:

A

Ischemic mitral regurgitation

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27
Q

Treatment of MI: remember MONA

A

Morphine
Oxygen
Nitrates
Aspirin

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28
Q

Role of morphine post-MI

A

Reduce pain and anxiety to decrease myocardial oxygen demand

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29
Q

Role of O2 post-MI:

A

To increase supply of oxygen

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30
Q

Role of nitrates post-MI:

A

Serves to vasodilate coronary arteries to allow blood to flow past the plaque

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31
Q

Role of aspirin post-MI:

A

Thins the blood to break down platelets to get rid of remaining clot in the coronaries

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32
Q

Thrombolytic therapy post-MI should take place within:

A

30-60 minutes of arrival to hospital

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33
Q

What is thrombolyic therapy?

A

Tissue plasminogen activator

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34
Q

Coronary angioplasty post-MI should take place within:

A

1-2 hours

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35
Q

When you assess for murmer:

A

character, location, intensity, and direction of radiation

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36
Q

AP valves open; so murmurs heard are AP stenosis or MT insufficiency (AS, PS, MR, TR)

A

Systolic murmurs

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37
Q

Aortic stenosis, pulmonic stenosis, mitral regurgitation, and tricuspid regurgitation are examples of:

A

Systolic murmurs

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38
Q

MT valves open; so murmurs heard are MT stenosis or AP insufficiency (MS, TS, AR, PR)

A

Diastolic murmurs

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39
Q

Mitral stenosis, tricuspid stenosis, aortic regurgitation, and pulmonic regurgitation are examples of:

A

Diastolic murmurs

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40
Q

Most common with rheumatic mitral valve disease & left atrial enlargement

A

Atrial fibrillation

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41
Q

Can occur (even without ischemic heart disease) from increased myocardial O2 demand from enlarged cardiac muscle mass (hypertrophy)

A

Angina Pectoris

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42
Q

Which murmur is a sequela of Rheumatic Heart Disease?

A

Mitral stenosis

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43
Q

In mitral stenosis, decreased MV orifice causes obstruction to LV diastolic filling and increases in LA volume and pressures: this increased pressure in the LA can eventually lead to:

A

Pulmonary edema

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44
Q

In mitral stenosis, the MV area drops from a normal (4-6 cm2) area to:

A

<1 cm2

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45
Q

In the case of severe MS, transvalvular pressure is

A

> 10 mmHg

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46
Q

Stressors of mitral stenosis include:

A

sepsis
AF
PE
pregnancy

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47
Q

Mitral stenosis is characterized by:

A

opening snap

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48
Q

Normally, what treats mitral stenosis?

A

Diuretics

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49
Q

Why should you avoid tachycardia in patients with mitral stenosis?

A

It impairs LV filling + increases LA pressure.

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50
Q

Why should you avoid decreases in systemic vascular resistance in patients with mitral stenosis?

A

Need to avoid compensatory increase in HR because tachycardia is not tolerated

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51
Q

A murmur that usually due to Rheumatic fever and is almost always associated with Mitral stenosis

A

Mitral regurgitation

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52
Q

Isolated mitral regurgitation =

A

Acute MI

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53
Q

Principal pathological change caused by a decrease in forward LV systolic volume & CO:

A

LA volume overload

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54
Q

Severe MR indicates a regurgitant fraction of:

A

<0.6

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55
Q

Fraction of the stroke volume that enters LA depends on:

A

1) size of MV orifice
2) HR
3) pressure gradient across MV

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56
Q

Early treatment of mitral regurgitaiton =

A

MV repair

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57
Q

Prolapse of one or both mitral leaflets into the LA during systole with or without MR

A

Mitral valve prolapse

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58
Q

Associated with a mid-systolic click and a late systolic murmur (click-murmur syndrome)

A

Mitral valve prolapse

59
Q

Most common form of valvular heart disease

A

Mitral valve prolapse

60
Q

Which form of MVP is associated with connective tissue diseases?

A

Secondary (syndromic) form

61
Q

Idiopathic disease resulting from degeneration and calcification of aortic leaflets

A

Aortic stenosis

62
Q

More likely to occur in persons born with bicuspid aortic valves than with normal tricuspid valves

A

Aortic stenosis

63
Q

Risk factors for aortic stenosis?

A

HTN & hypercholesterolemia

64
Q

Which murmur is associated with an increased incidence of sudden death?

A

Aortic stenosis

65
Q

Characterized by obstruction to ejection of blood into the aorta due to decreases in the area of the AV orifice which increase LV pressures to maintain forward stroke volume

A

Aortic stenosis

66
Q

Symptoms of angina pectoris?

A

Angina pectoris, syncope, and dyspnea on exertion

67
Q

Angina pectoris with aortic stenosis has a life expectancy of how many more years?

A

5 years

68
Q

Syncope with aortic stenosis has a life expectancy of how many more years?

A

3 years

69
Q

Dyspnea with aortic stenosis has a life expectancy of how many more years?

A

2 years

70
Q

systolic ejection murmur that radiates to the neck, best heard in the aortic area (2nd right ICS)

A

Aortic stenosis

71
Q

Treatment for aortic stenosis?

A

Aortic valve replacement

72
Q

Results from disease of the aortic leaflets or the aortic root that distorts the leaflets, preventing their coaptation

A

Aortic regurgitation

73
Q

Acute aortic regurgitation is caused by

A

infective endocarditis

74
Q

Characteristic blowing murmur heard best along the right sternal border plus peripheral signs of hyperdynamic circulation

A

Aortic regurgitation

75
Q

When do symptoms of AR emerge?

A

When LV dysfunction is advanced.

76
Q

Treatment of Aortic regurgitation?

A

Aortic valve replacement

77
Q

Usually functional, caused by tricuspid annular dilation secondary to dilation of the right ventricle due to Pulmonary HTN

A

Tricuspid regurgitation

78
Q

Often accompanies Pulmonary HTN and RV volume overload due to LV failure produced by Aortic or Mitral valve disease

A

Tricuspid regurgitation

79
Q

Most common circulatory derangement affecting 30% of adults

A

Systemic hypertension

80
Q

Systemic hypertension affects what percentage of adults?

A

30%

81
Q

In essential hypertension, cause:

A

cannot be determined

82
Q

Essential hypertension accounts for what percent of HTN cases?

A

95%

83
Q

In secondary hypertension, there is a known etiology. What percentage of all cases of HTN?

A

5%

84
Q

Most common etiology that define secondary hypertension:

A

Renovascular HTN from Renal Artery Stenosis= most common

85
Q

In what type of hypertension is treatment often surgical?

A

Secondary hypertension

86
Q

Defined as acute diastolic BP increases > 130 mmHg

A

Hypertensive crisis

87
Q

When removing patient from hypertensive crisis, what should you NOT do?

A

Return BP to normostasis–decrease by 20% in the first 2 hours, then additional decreases over the next 24-48 hours.

88
Q

Occurs when the heart is unable to provide sufficient pump action to distribute blood flow to perfuse tissues and organs of the body

A

CHF

89
Q

Most common cause of CHF:

A

Impaired myocardial contractility secondary to ischemic heart disease or cardiomyopathy

90
Q

Most common form of heart failure

A

Left-sided heart failure

91
Q

Heart failure that most commonly results from left-sided heart failure

A

Right-sided heart failure

92
Q

The left ventricle can’t contract vigorously, indicating a pumping problem: EF < 45%

A

Systolic HF

93
Q

The left ventricle can’t relax or fill fully, indicating a filling problem from noncompliant (stiff) ventricles. EF often normal.

A

Diastolic HF

94
Q

Ordinary physical activity does not cause symptoms

A

Class I

95
Q

Symptoms occur with ordinary exertion

A

Class II

96
Q

Symptoms occur with less than ordinary exertion

A

Class III

97
Q

Symptoms occur at rest

A

Class IV

98
Q

Fatigue at rest or with minimal exertion indicates

A

CHF

99
Q

Hallmark of left CHF:

A

pulmonary symptoms

100
Q

Hallmark of right CHF:

A

systemic venous congestion

101
Q

What is the most useful test in diagnosing CHF?

A

Echocardiogram

102
Q

Why are opioids so beneficial in treating patient with CHF?

A

They inhibit adrenergic activation.

103
Q

Renin converts angiotensiogen to:

A

Angiotensin I

104
Q

Angiotensin converting enzyme converts Angiotensin I to:

A

Angiotensin II

105
Q

ARBs work on which angiotensin receptors?

A

Angiotensin receptor-1

106
Q

Which angiotensin receptor induces a sympathetic response?

A

Angiotensin receptor-1

107
Q

LVH in the absence of other cardiac diseases capable of inducing LVH

A

Hypertrophic cardiomyopathy

108
Q

Principle symptoms of hypertrophic cardiomyopathy?

A

Angina pectoris, fatigue or syncope, tachydysrhythmias, and heart failure

109
Q

What relieves angina in patients with hypertrophic cardiomyopathy? Why?

A

Laying down; decreases outflow obstruction

110
Q

What is the best way to diagnose hypertrophic cardiomyopathy?

A

Definitive endomyocardial biopsy

111
Q

Pharmacological treatment of hypertrophic cardiomyopathy

A

Beta blockers + Ca++ channel blockers

112
Q

In patients with hypertrophic cardiomyopathies, what are some things anesthetists should avoid?

A

Sympathetic stimulation, dehydration, or vasodilation

113
Q

Characterized by LV or biventricular dilation, systolic dysfxn, and nl ventricular wall thickness

A

Dilated cardiomyopathy

114
Q

Most common cardiomyopathy is:

A

Dilated cardiomyopathy

115
Q

3rd most common cause of HF:

A

Dilated cardiomyopathy

116
Q

Rare dilated form of CM arises during 3rd trimester until 5 months postpartum

A

Peripartum cardiomyopathy

117
Q

Cardiomyopathy due to systemic illnesses that produce myocardial infiltration and severe diastolic dysfunction

A

Secondary CM with restrictive physiology

118
Q

Principle cause of secondary cardiomyopathy with restrictive physiology?

A

Amyloidosis: a rare disease that occurs when a substance called amyloid builds up in your organs. Amyloid is an abnormal protein that is produced in your bone marrow and can be deposited in any tissue or organ.

119
Q

A cardiomyopathy that exhibits atrial dilation, but ventricles normal in size

A

Secondary cardiomyopathy with restrictive physiology

120
Q

In the case of secondary CM with restrictive physiology, what measure is diagnostic?

A

Endomyocardial biopsy

121
Q

Right ventricular enlargement (hypertrophy/dilation) that may progress to right sided heart failure.

A

Cor Pulmonale

122
Q

Common cause of Cor Pulmonale:

A

diseases that induce pulmonary hypertension, such as COPD

123
Q

Clinical signs of this disorder include peripheral edema, dyspnea, + effort-related syncope.

A

Cor Pulmonale

124
Q

How to diagnose Cor Pulmonale on EKG?

A

Peaked p-waves on leads II, III and aVF indicate P Pulmonale

125
Q

In patients with Cor pulmonale, how to treat?

A

Decrease the workload of the right ventricle by decreasing PVR and PA pressure

126
Q

Inflammation of pericardium usually caused by a viral infection

A

Acute Pericarditis

127
Q

Diagnostics include chest pain worsening with inspiration, pericardial friction rub, and ECG changes (diffuse ST segment elevation)

A

Acute Pericarditis

128
Q

Abnormal accumulation of fluid in the pericardial cavity. Because of the limited amount of space in the pericardial cavity, fluid accumulation leads to an increased intrapericardial pressure which can negatively affect heart function

A

Pericardial effusion

129
Q

A pericardial effusion with enough pressure to adversely affect heart function

A

Cardiac tamponade

130
Q

CXR = “water bottle heart” in what condition?

A

Cardiac tamponade

131
Q

Chronic inflammation of the pericardium with thickening, scarring, and muscle tightening (contracture)

A

Constrictive pericarditis

132
Q

The frontal plane views the electrical activity of the heart as it moves:

A

up, down, left, right

133
Q

The horizontal plane views the electrical activity of the heart as it moves:

A

anteriorly + posteriorly

134
Q

Represents the time from the start of atrial depolarization to the start of ventricular depolarization including delay in conduction from AV node

A

PR interval

135
Q

Length of time of PR interval:

A

0.12 - 0.2 s

136
Q

Which leads note R wave progression in precordial leads?

A

Precordial leads

137
Q

Because both an approaching wave of depolarization and receding wave of repolarization generate a positive deflection on EKG:

A

the same electrodes that generate a positive R wave generate a positive T wave.

138
Q

Encompasses the time from the beginning of ventricular depolarization to the end of ventricular repolarization

A

QT interval

139
Q

QT interval duration devoted more to:

A

repolarization

140
Q

QT duration proportionate to:

A

HR

141
Q

QT interval composes what percentage of the cardiac cycle?

A

40%

142
Q

P-wave is negative in what lead?

A

aVR

143
Q

P-wave is biphasic in what lead?

A

III, V1

Anes 540b Exam 1 (4 decks)

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