1. Stable 2. Unstable (preinfarction)- recent, low levels of exertion 3. Variant/Prinzmetal- resting pain, spasm

Cardiac Flashcards by Casey Smith

Atrioventricular Valves

between atria and ventricles; close at beginning of ventricular contraction, open when ventricle relaxes; Mitral and Tricuspid Valve

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Semilunar valves

open during ventricular contraction, closed when ventricles relax; Pulmonary and aortic valves

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Cardiac Conduction (greatest to least)

SA node (60-100), AV node, Bundle of HIS (40-60), purkinje FIbers

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Electrical Waves

P wave= atrial contraction
QRS= ventricular contraction
T wave= resetting

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First Heart Sound

S1, AV valves closed at beginning of systole d/t increasing pressure in ventricles

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Second Heart Sound

S2, Semilunar valves closed at end of systole d/t decreased pressure in ventricle; physiologic split

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Atherosclerosis (what is it)

hardening of material in arteries; coronary arteries most affected

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Atherosclerosis (Causes)

most common cause of CAD-MI, CVA accumulation of fatty, fibrous plaque; caused changes in vessel ability to dilate; calcification and rupture can occur

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Atherosclerosis (S/S)

fatty streaks, foam cells (macrophages with lipids and Tcells), fibrous plaque, complicated lesions (ulceration)–> adhereance, platelet aggregation–> thrombus

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Atherosclerosis (Risk Factors)

Dyslipidemia- high LDL, low HDL
Smoking
Diabetes Mellitus- gengrene, hyperlipidemia 
Hypertension (most tx)
Obesity and inactivity

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Coronary Artery Disease (what is it)

leading cause of death; most common in morning (highest platelet aggregation); narrowing/obstruction of arteries, decreased perfusion, no O2 supply–> hypertnetion angina, dysrhythmia, MI, CHF, death

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Sudden Cardiac Death(causes)

75% - CAD, 25% myocardial abnormalities,

90% lethal dysrhythmias

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Collateral Circuation

takes time to develop, re-routing blood flow d/t occlusion, more common in older people

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Coronary Artery Disease (S/S)

chest pain (angina) provoked by exertion/anxiety, alleviated by rest; imbalance of O2 supply/demand

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Types of Angina (3)

Stable
Unstable (preinfarction)- recent, low levels of exertion
Variant/Prinzmetal- resting pain, spasm

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ECG/EKG Pattern

elevated ST segment with MI

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Angina (Dx)

ECG, stress test (Persantine), cardiac enzymes, cardiac cath/ coronary arteriography

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Angina (Tx)

pain management, bed rest, O2, nitroglycerin is good lung function, ECG, continuous cardiac monitoring, drugs (nitrates, beta blockers, calcium channel blockers)

For unstable- daily aspirin, anti-coagulant (heparin)

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Surgical Procedures for Angina

PTCA, laser angioplasty, atherrectomy, vascular stent, coronary artery bypass graft (CABG)

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Percutaneous Transluminal Coronary Angioplasty (PTCA)

dilate artery with balloon catheter, re occlusions can occur

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Cardiac Catheterization

shorter hospitalization; travels from Inferior venacava, R atrium, R ventricle to coronary artery

Contraindicated:left main coronary artery stenosis
severe diffuse multi-vessel disease

Laser- Assisted Angioplasty

laser probe used for small occlusions in distal superficial femoral, proximal popliteal, and common iliac arteries

Atherectomy

rotating blade that scrapes away arterial plaque, works best in straight lesions, loose pieces can break off and cause thrombus/embolism

Coronary Artery Stent

used with PTCA, stent maintains patency of newly opened artery

Coronary Artery Bypass Graft (CABG)

Attach saphenous vein between ascending aorta & stenotic coronary artery

Coronary Revascularization

CABG, PTCA if medications failed, improves survival

Acute Myocardial Infarction (AMI) (what is it)

thrombotic occlusion superimposed on CAD, blood clot on top of already narrowed vessels; impaired L ventricular filling, L sided HF

Acute Myocardial Infarction (causes)

ineffective endocarditis emboli, thrombi from prothetic valves, atrial thrombi, vasospasm from cocaine, small vessel disease, trauma

Myocardial Infarction (MI) (what is it)

myocardial tissue abruptly/severely deprived of O2- 6 hours later when affected area blue and swollen, 48 hours- grey w/ yellow streaks

Q-wave infarct/transmural

damage to muscle has gone through all 3 heart layers

Size of MI depends on...

1) extent, severity, duration of ischemic episode 2) collateral circulation 3) metabolic needs

Widow Maker

LAD- left anterior descending artery, anterior L ventricle, Apex, interventricular spetum

Layers of Infarct

``` center= necrotic (not regenerated, replaced by scar tissue) middle= injured area outside= ischemic area ```

Location of MI

R coronary artery= inferior wall circumflex artery= posterior wall LAD= anterior wall/septal wall

Acute Myocardial Infarction (S/S)

intense, severe, crushing pain for 30-60min, radiates to arm, neck, jaw, diaphoresis, weakness, doom, restlessness, confusion, fever, edema, JVD, cough/wheezing,crackles, SOB, frothy sputum

Acute Myocardial Infarction (Dx)

complete blood count (WBC), ESR, myoglobin( O2 binding protein) Creatine Kinase (CK), or Creatine Phosphokinase , TroponinT/1, AST, LDH All would be higher w/ AMI

3 types of Creatine Enzymes

``` CK-MM= skeletal muscle CK-MB= cardiac muscle CK-BB= brain/lung ```

Troponin (2 types)

T: regulatroy protein found in skeletal and cardiac muscle fibers, antibodies can detect in myocardial injury. 1: protein in cardiac muscle, specific to myocardium (GOLD STANDARD)

Stenosis

failure of valve to open completely; narrowed; SYSTOLIC murmur

Regurgitation

Failure of valve to close completely; leaky; DIASTOLIC murmur

Causes of Valve Disease

Myxomatus degeneration (connective tissue weakens), calcific degeneration (valves calcified), congential defects, ineffecctive endocarditis (bacteria), CAD (wall damage), AMI (tissue damage)

Mitral Valve Stenosis

diastolic murmur, LA to LV, Afib, Pulmonary Congestion, decrease Systolic Volume

Mitral Valve Prolapse (MVP)

mid-systolic murmur; risk of ineffective endocarditis, rhythm disturbances, dizzy, dyspnea, chest pain, anxiety

Aortic Valve Stenosis

Systolic Murmur, LV hypertrophy to LV failure; angina, syncope, fatigue, hypotension, decreased peripheral pulses

Aortic Regurgitation

diastolic murmur, bounding peripheral pulses, LV hypertrophy/dilated

Dx of Valve Problems

Cardiac ausculation, Chest Xray, Echocardiography, Trans-esophageal echocariography, electrocardiography, coronary angiography, MRI, Doppler ultrasound

Rx for Valve Problems

digitalis, diuretics, anticoagulants, beta blockers, calcium channel blockers

Valvulotomy

commissurotomy; surgical incision to open stenosis, make bigger

Valvuloplasty

widening valve using a balloon

Valve Replacement

natural (shorter lasting, no clots), cadaver, artificial/mechanical (last longer, have blood clots)