Cardiac Flashcards
What is the mechanism of action and classification of Heparin?
Class: anticoagulant
MOA: inhibits factor Xa
What are potential causes for pericarditis?
- viruses (most common cause)
- MI
- cardiac surgery
- rheumatic fever
- neoplasia
- radiation therapy
- uremia
- tuberculosis (TB)
- idiopathic
- trauma
- drugs
What viruses are the most common cause(s) of pericarditis?
- coxsackie virus
- echoviruses
- Epstein-Barr
- influenza
- hepatitis
- varicella
- mumps
What are the s/s of pericarditis?
- precordial/retrosternal, localized, pleuritic chest pain
- Chest Pain worse with cough, swallowing, inspiration
- Chest Pain relieved by sitting forward
- dyspnea
- pericardial friction rub
A pericardial friction rub heard when auscultating heart sounds is indicative of what?
pericarditis
What ECG changes are associated with pericarditis?
- depressed PR interval (diagnostic)
- ST concave (smile) elevation in multiple leads
What lab findings are associated with pericarditis?
- leukocytosis = high WBC
- elevated erythrocyte sedimentation rate (ESR) = inflammation
1) < 50 y/o- Male > 15 mm/hr
- Female > 20 mm/hr
2) > 50 y/o - Male > 20 mm/hr
- female > 30 mm/hr
How is the diagnosis of pericarditis confirmed?
- depressed PR interval on ECG
- elevated ST concave shaped interval (smile)
- echocardiogram to confirm pericardial fluid
What is the treatment/management for pericarditis?
- colchicine (anti-inflammatory)
- NSAIDs
- proton pump inhibitor d/t risk of Gi toxicity
- corticosteroids only if NSAID use is contraindicated or has failed
- antibiotics (bacterial infections)
- monitor for cardiac tamponade
- Vicodin (PRN for pain)
Vicodin is a combination of what drugs?
hydrocodone and acetaminophen
what is the name of the medication that has hydrocodone and acetaminophen?
Vicodin
Why is colchicine used in the treatment of patients with atherosclerotic disease or with multiple risk factors for cardiovascular disease?
- reduces risk of the below by:
- reducing high-sensitivity C-reactive protein
- prevents the activation, degranulation and migration of neutrophils which causes an anti-inflammatory effect
- MI
- stroke
- cardiovascular death
What are the most common organisms that cause endocarditis?
- bacteria are most common cause
- staphylococcus aureus (gram pos)
- streptococcus pyogenes (gram pos)
- pneumococcus (gram pos)
- neisseria orgasms (gram neg)
What is the most common predisposing risk factor for endocarditis?
invasive procedures
- dental surgery
- GU surgery
- catheter placement
- HD
- burn treatment
What are the s/s of endocarditis?
- signs of infection
- splenomegaly
- pallor
What lab findings are associated with endocarditis?
- normochromic, normocytic anema
- leukocytosis with a left shift
- WBC bands present
- elevated erythrocyte sedimentation rate
What is normochromic, normocytic anemia?
type of anemia where the RBCs are the normal in size, shape and color
What tests should be done in a patient that presents with s/s of endocarditis?
- blood cultures (3 from different sites)
- echocardiogram to assess valvular involvement (presence of vegetation)
- BMP
- erythrocyte sedimentation rate
- CBC
What is the treatment/management for endocarditis?
- infectious disease consult
- empiric AB therapy that covers gram positive bacteria while waiting for cultures
What is the normal ejection fraction range?
50-70%
What are causes of HFrEF?
- ischemic heart disease (ex. CAD), myocardium can’t get enough O2
- MI, heart is damaged
- cardiomyopathy, thickened or scarred myocardium = less contractility
- aortic stenosis, decreased CO
- mitral regurgitation, decreased CO
- arrhythmias, ineffective pumping
- myocarditis, inflammation = low CO
What are risk factors/causes of HFrEF?
- age, vessels are less elastic
- obesity
- HTN
- DM type II
- CAD
- CKD
- COPD
- sleep apnea
- anemia
What are the NYHA functional classifications?
- class I: no symptoms/limitations
- class II: symptoms with moderate exertion
- class III: symptoms with any activity
- class IV: symptoms at rest
What are AHA stages of heart failure?
- Stage A: high risk, no structural disease
- Stage B: structural disease, no symptoms
- Stage C: structural disease w/ s/s
- Stage D: refractory HF, s/s at rest
What is the mortality rate r/t a diagnosis of heart failure?
50% mortality rate within 5 years of diagnosis
What is the most common cause of chronic heart failure?
LV dysfunction r/t coronary artery disease
What is the most common cause of acute heart failure?
HTN
What are the 4 compensatory mechanisms r/t heart failure?
- ventricular hypertrophy d/t increased strain and workload
- dilation d/t increase volumes caused by reduce stroke volume
- SNS activation, increased HR
- Renin-Angiotensin-Aldosterone System
What are the s/s of left sided heart failure?
- LV contractility is impaired resulting in increased filling of the LV and backup of blood in the left atrium, pulmonary veins and lungs = pulmonary edema
- dyspnea, SOB
- cough
- rales, wheezes, crackles
- blood tinged sputum
- bilateral infiltrates on CXR
- increased PCWP (> 12mmHg)
- tachypnea
- tachycardia
- cyanosis
- pulsus alternans
- A-Fib d/t atrial enlargement
What is the term for when every other pulse beat is diminished and what is it r/t?
pulsus alternans
- r/t left sided heart failure
What are the s/s of right sided heart failure?
- RV contractility is impaired causing reduced emptying and backup in to the systemic venous circulation
- cor pulmonale
- jugular vein distention
- increased CVP (>12 mmHg)
- peripheral edema
- splenomegaly
- hepatomegaly
- ascites
- weight gain
What is the term for right ventricular enlargement cause by a pulmonary condition/disease process?
cor pulmonale
What is cor pulmonale?
right ventricular enlargement cause by a pulmonary condition/disease process
What are the general symptoms of heart failure?
- fatigue
- orthopnea
- cough
- tachycardia
- peripheral edema
- nocturia, fluid shifts from tissues back to vessels when patient lies down, increasing renal perfusion
- diaphoretic, cool, dusky skin
What tests should be done in patient suspected of heart failure?
- ABG
- BNP
- BNP
- magnesium
- BUN/Creatine
- GFR
- glucose
- lipid profile
- liver function tests (AST,ALT)
- CXR
- ECG
- echocardiogram
- nuclear stress test
- NT-proBNP if HF diagnosis is uncertain
Which BP medication is recommended for all patients with HFrEF (<40%) and DO NOT have renal insufficiency?
ACE inhibitors
What is Carvedilol also known as?
Coreg
- non-selective 3rd generation beta blocker
- block B1, B2, and A1 adrenergic receptors
What does ARNI stand for?
angiotensin receptor/neprilysin inhibitor
- neprilysin breaks down natriuretic peptides which are released to help heart pump better
What is Entresto’s MOA?
angiotensin II receptor blocker and neprilysin inhibitorW
What two medications are are combined to make Entresto?
- Sacubitril, blocks breakdown of natriuretic peptides
- Valsartan, angiotensin receptor blocker
What is the recommended initial daily dose of Carvedilol (coreg) for a patient with HFrEF?
Coreg initial dose = 3.125mg BID
Why is carvedilol used in the treatment of patients with HFrEF?
Improves LV function and reduces symptoms r/t HF by:
1) Reducing the following:
- HR
- mean pulmonary arterial pressure
- pulmonary capillary wedge pressure
2) Increases the stroke volume = increased ejection fraction
What is the recommended initial daily dose of metoprolol for a patient with HFrEF?
12.5 - 25 mg QD
What is the creatinine goal of therapy when using an aldosterone antagonist or mineralocorticoid receptor antagonist for a patient with HFrEF?
- men < 2.5 mg/dl
- women < 2.0 mg/dl
Which BP/cardiac meds are standards of therapy for a patient with HFrEF?
ACE inhibitors used with a beta blocker
- an ARB can be substituted if the patient cannot tolerate an ACEi
What are the 3 layers of an artery?
- intima (inner)
- tunica media (middle)
- adventitia (outer)
What is the inner most layer of an artery called?
intima
- monolayer of endothelial cells
What is the middle layer of an artery called?
tunica media
- consists of smooth muscle cells
What is the outer most layer of an artery called?
adventitia
- consists of fibroblasts, mast cells and nerve terminals
Which e-lyte is responsible for vascular smooth muscle contractions?
calcium
- voltage dependent L-type calcium channels open and calcium enters cell
What is the normal ejection fraction?
50-70%
Pulsus paradoxus is a sign of what condition(s)?
- cardiac tamponade
- massive pulm embolism
- hemorrhagic shock
- severe obstructive lung disease
- tension pneumothorax
What does the S1 heart sound represent?
- AV valve closure
- tricuspid (Right side)
- mitral (left side)
What does the S2 heart sound represent?
Semi lunar valve closure
- aortic
- pulmonic
What is the most common cause of a mid systolic murmur in an adult?
Aortic stenosis
What type of murmur is associated with aortic stenosis?
A mid systolic murmur, heard after S1 and ends before S2
A mid systolic murmur, heard after S1 and ends before S2
The intensity of a heart murmur is graded on a scale of _____?
1-6
What is Hypertrophic obstructive cardiomyopathy (HOCM)?
a heart condition that causes the heart’s muscle tissue to thicken, often blocking blood flow from the left ventricle to the aorta
What is the normal flow of depolarization of the heart?
SA node, AV node, bundle of his, bundle branches, purkinje fibers
What is the junction between the end of the QRS complex and beginning of the ST-segment called?
The J point
What is the J-point on an EKG?
the junction between the end of the QRS complex and beginning of the St-segment
Which EKG leads show activity on the frontal plane of the heart?
the limb leads
- lead I
- lead II
- lead III
- lead aVR
- lead aVL
- lead aVF
The limbs leads show the electrical activity of what part of the heart?
the frontal plane
Which EKG leads show activity on the horizontal plane of the heart?
chest leads
(V1-V6)
What is the normal length of the PR interval on an EKG?
120-200ms
What is the normal length of the QRS interval on an EKG?
60-100ms
What it is the normal QTc interval for men?
< 450ms
What it is the normal QTc interval for women?
< 460ms
