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Patho > Cardiac > Flashcards

Cardiac Flashcards

1
Q

P wave

A

atrial depolarization

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2
Q

QRS complex

A

ventricular depolarization and atrial repolarization; contraction of the ventricles

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3
Q

T wave

A

ventricular repolarization; ventricles return to resting state

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4
Q

ventricular gallop

A

S3

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5
Q

atrial gallop; rapid firing of the atria

A

S4

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6
Q

When do you hear S3?

A

right after S2

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7
Q

When do you hear S4?

A

right before S1

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8
Q

Systolic murmurs

A

could or could not be bad;

MR PASS MVP: mitral regurg physiologic aortic stenosis systolic mitral valve prolapse

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9
Q

diastolic murmurs

A

always bad!

MS ARD: mitral stenosis aortic regurg diastolic

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10
Q

stenosis

A
  • valve is stiff and doesn’t allow blood to get through
  • valve will not open all the way
  • harder to get blood through
  • hear murmur when the valve is open
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11
Q

regurgitation

A
  • blood goes backwards
  • the valve doesn’t close all the way
  • it leaks when it is closed
  • hear murmur when closed
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12
Q

location of the apical pulse

A

5th or 6th intercostal space at the midclavicular line

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13
Q

Problem with jugular vein distention

A

right sided HF

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14
Q

bruit in the carotid artery

A

send to the ER- stroke is imminent

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15
Q

small or weak pulse

A

hypovolemia, HF, poor circulation

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16
Q

large, bounding pulse

A

heart block, fever, anemia, compensatory, or lack of O2, hyperthyroidism

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17
Q

bisferiense

A

double systolic peak in pulse

from aortic regurg, combined aortic stenosis and regurg, or hypertrophic cardiomyopathy

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18
Q

pulsus alternans

A
  • regular rhythm but changes in amplitude
  • goes with L sided HF
  • should also hear S3 sound
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19
Q

bigeminal pulse

A

regular irregular rhythm

-very important bc its tells us if someone is having a PVC (premature ventricular contraction)

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20
Q

paradoxical pulse/ pulsus paradox

A

decreases in strength with inspiration, gets strong with expiration;

  • on inspiration, R heart fills with extra blood, then L ventricle is compressed and cannot accept much blood; L ventricle cannot pump much blood on the next heartbeat- systolic pressyre decreases
  • COPD or cardiac tamponade
  • need thoracentesis STAT
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21
Q

hemostasis

A

stoppage of blood flow in 5 stages:

1) vessel spasm
2) formation of the platelet plug
3) development of a blood clot
4) clot retraction
5) clot dissolution

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22
Q

normal platelets

A

150,000-450,000

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23
Q

reasons someone would have thrombocytopenia

A

Leukemia
HIV
bone marrow disfunction

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24
Q

signs of thrombocytopenia

A

platelets less than 100,000

petechiae

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25
Q

thrombocytopathia

A

impaired platelet function

-most commonly from aspirin, NSAIDs, and Von Willobrand

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26
Q

antibody buildup to platelets

-how to treat

A

ITP- Immune Thrombocytic Pepura

-treat with platelets and steroids to drecrease antibodies that are trying to attack them

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27
Q

COX-1

A

catalyzes production of thromboxame A2

effects platelets

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28
Q

COX-2

A

catalyzes production of prostacycline

effects pain and inflammation

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29
Q

Effect of Von Willebrand disease on the platelets

A

decreased platelet adhesion

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30
Q

DIC

A
  • disseminated intravascular coagulation

- ultimate outcome is bleeding

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31
Q

hemolytic anemia

A

premature destruction of RBCs; when RBC destruction occurs in the bood
-if there’s too much Hg in the blood, free Hb causes hemoglobinemia and you turn red; excreted Hg in the urine causes urine to be darker in color (hemoglobinuria

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32
Q

why is malaria called “black water fever”

A

the urine turns so dark from the blood cells bursting intravascularly

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33
Q

RBCs are made in the ___ and destroyed in the ___

A

bone marrow; spleen

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34
Q

erythropoietin is made in the ___; its function is ___

A

kidneys, and it stimunates the bone marrow to produce RBCs

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35
Q

how much blood can we loose without symptoms in slow blood loss?

A

50%

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36
Q

iron deficient anemia

A

hypochromic and microcytic

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37
Q

megaalobloastic anemia

A

big cells- people with vitamin b12 deficiency

  • if you’re born with it, its pernicious anemia
  • most common reason is alcoholism- look at the mean corpuscular volume
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38
Q

what helps sickled cells move along better

A

fluids

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39
Q

G6PD deficiency

A

Glucose-6-phosphate dehydrogenase is a RBC ezyme whose function is to protect hemoglobin from oxidation
-deficiency is inherited and leads to hemolytic anemia

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40
Q

Thalassemias

A

inherited diseases that cause anemia; deficiency in Hb due to decreased synthesis of the effective chain and increased synthesis of the ineffective chain

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41
Q

Alpha thalassemia

A

defective alpha chain

  • 1 to 4 defective genes
  • could effect fetus or adult
  • most common in asians
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42
Q

Beta thalassemia

A

beta- defective gene

  • > 100 different mutations
  • only effects adults
  • major type needs regular blood transfusions because of too much iron- give Desperol that will bind to iron or bleed them
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43
Q

aplastic anemia

A

bone marrow depression; stops the bone marrow from functioning at all- need bone marrow transplant

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44
Q

iron deficiency anemia

A 
blood loss or deficient diet
low Hg and hematocrit
hypocromic and microcytic erythrocytes
Poikilocytosis (irregular shape)- oblong
Anisocytosis (irregular size)- microcytic
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45
Q

Polycythemia

A

increased RBC count and hematocrit >50%

-person would look red

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46
Q

relative polycythemia

A

loss of plasma colume

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47
Q

absolute polycythemia

A

increased red cell mass

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48
Q

primary neoplastic polycythemia

A

making too many RBCs, treated by phlebotomy (remove a lot fo the cells about every 4 months)

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49
Q

Why worry about too many RBCs?

A

cardiac output- too many RBCs increases resistance and decreases afterload

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50
Q

can you have polycythemia and shock? why?

A

yes. you usually do bc you’re losing volume but maybe not cells- most commonly in distributive shock

51
Q

all types of polycythemia can be caused by….

A

high altitude, chronic lung disease, smoking

52
Q

LDL transports cholesterol from ____ to ___

A

the liver to the cells

53
Q

HDL transports cholesterol from ____ to ____

A

the cells to the liver

54
Q

atherosclerosis

A

LDLs are oxidized and deposited and become plaque

55
Q

unstable plaques

A

have thin, fibrous caps

  • plaques can rupture —> clot forms
  • may completely block the artery
  • may break free and become an embolus
56
Q

PAD (peripheral arterial disease

A

atherosclerotic blockages of the large arteries in the peripheries
-lots of amputations with PAD

57
Q

thromboangitis obliterans (Buerger disease)

A

nonatherosclerotic inflammation and thrombosis

-small and medium sized arteries and veins

58
Q

Raynauds

A

intense vasospasms

59
Q

aneurysm

A

wall of the vessel stretches and weakens

60
Q

true aneurysm

A

wall is weak but intact

61
Q

false aneurysm

A

there is a tear in the artery and the aneuysm is actually a tear and clot that forms

62
Q

berry aneurism

A

dilation of bifurcation

-happens in the circle of willis- you have a stroke and possibly death

63
Q

fusiform aneurism

A

has to do with the shape

-involves the entire circumference of the cessels

64
Q

dissecting aneurysm

A

nearly always fatal because blood is just pouring out

65
Q

pulse pressure

A

systolic-diastolic

  • normal is 30 to 40
  • if pressure is higher, the heart is working much harder
66
Q

lower or more narrow PP

A

decreased stroke volume and CO

67
Q

higher or wider PP

A

increased stroke volume or CO

-can be from stiff arteries, aortic regurg, pregnancy, increased cranial pressure

68
Q

mean arterial pressure

A

1/3 systolic + 2/3 diastolic

  • mean arterial pressure of 120/80 is 93
  • normal is 70-105
69
Q

cardiac output

A

HR x stroke volume

  • stroke colume- 1cc/kh… about 70 avg
  • normal CO is about 5 liters/min
70
Q

blood pressure

A

CO x peripheral resistance

71
Q

hypertensive urgency

A

high BP , but not to 180/120… no organ damage

72
Q

hypertensive emergency

A

BP greater than 180/20… organ damage

73
Q

Preeclampsia

A

HT after 20 weeks, proteinuria, and PT 140/90

  • seizures from eclampsia lead to death
  • deliver is the only safe cure
74
Q

proteinuria

A

protein spilling into urine

75
Q

gestational hypertension

A

BP 140/90, no proteinuria

worried about preeclampsia being developed

76
Q

enzyme that points to MI

A

elevated troponin

77
Q

acute coronary syndrome (ACS)

A
  • ECG changes- T-wave inversion (different from MI, which has abnormal Q wave)
  • troponin released from necrotic cells
78
Q

acute myocardial infarction

A

chest pain, sympathic response (GI upset, tachy, vasoconstriction, anxiety, doom), hypotension, shock

79
Q

widow maker

A

having an dMI in the lateral ascending artery, which supplies blood to the septum of the heart

80
Q

chronic ischemic heart disease

A

imbalance in the blood supply and the hearts demand for oxygen

  • less blood- atherosclerosis and vasospasm
  • higher O2 demand- stress, cold, exercise
81
Q

chronic stable angina

A
  • pain when the heart’s oxygen demand rises
  • you’re fine unless you run to your car
  • treat with rest and nitro
82
Q

silent myocardial ischemia

A

myocardial ischemia without pain

83
Q

variant/ vasospastic angina

A
  • pain when coronary arteries spasm
  • usually occurs at rest
  • when pt says “i woke up with pain in my chest”
84
Q

which side of the heart is failing with pitting edema

A

Right

85
Q

which side of the heart is failing with paroxysmal nocturnal dyspnea

A

left- mitral stenosis

86
Q

which side of the heart is failing with congested liver

A

right

87
Q

which side of the heart is failing with distended jugular vein

A

right

88
Q

which side of the heart is failing with productive cough with frothy, pink sputum

A

Left

89
Q

pericarditis manifestations

A

inflammation of the pericardium:

  • pain and exudate and subsequent restriction of the heart’s movement
  • pain when pt moves position
  • ECG changes
  • FEVER (different from MI)
  • cough
90
Q

serous exudate in pericarditis

A

cardiac tamponade: rapid accumulation of exudate compresses the heart

91
Q

fibrous exudate in pericarditis

A

causes friction rub; adhesions

-sounds like rubbing fingers up to your ear

92
Q

pericardial effusion

A

serous exudate filling the pericardial cavity
–>restricts the heart’s expansion
–>L ventricle cannot accept enough blood
–>decrease CO
–>decreased BP and shock
OR
–>R ventricle cannot accept enough blood
–>increased venous pressure
–>jugular distension

93
Q

constrictive paricarditis

A

fibrous scar tissue making the pericardium stick to the heart

94
Q

cardiomyopaty

A

chronic disease of the heart muscle

95
Q

hypertrophic cardiomyopathy

A

genetic; defects in contractile proteins make cells too weak

  • cells hypertrophy to do the same amt of work as other cells
  • needs more oxygen and performs less effeiciently
  • sudden death of many young athletes
  • tell if your kid has it if their PMI is in the 6th or 7th intercostal space instead of 4th or 5th
96
Q

arrhythmogenic cardiomyopathy

A

genetic;

causes right ventricular tachycardia

97
Q

dilated cardiomyopathy

A

genetic and aquired;
most common cause of HF and heart transplant;
big, floppy heart, walls are not very muscular and very poor pump

98
Q

restrictive cardiomyopathy

A

genetic and acquired;
heart becomes stiff
radiation and tumors

99
Q

myocarditis

A

acquired cadiomyopathy;

inflammation of the heart

100
Q

peripardum cardiomyopathy

A

acquired;

1 month before or after giving birth; at risk if older when giving birth or if taking supplements to get pregnant

101
Q

takotsubo

A

acquired cardiomyopathy; caused by stress, often seen in women;
ventricle balloons out

102
Q

shunt

A

opening or connection that lets blood move from one side of the circulation to the other

103
Q

ductus venosus

A

lets blood flow from the visceral veins to the vena cava, bypassing the liver;
left to right

104
Q

foramen ovale

A

lets blood flow from the right atrium to the left atrium bypassing the lungs;
right to left

105
Q

ductus arteriosus

A

lets blood flow from the pulmonary trunk to the aorta to bypass the lungs;
right to left

106
Q

in left to right shunts…

A

less blood goes to the body

more blood goes to the lungs

107
Q

in right to left shunts…

A

deoxygenated blood goes to the body

less blood to the lungs

108
Q

arterial septal defects

A

blood will flow from high to low pressure;

left to right

109
Q

ventricular septal defects

A

blood will flow from high to low pressure;

left to right

110
Q

pulmonary stenosis

A

increased right sided pressure bc blood can’t get out of the pulmonary valve

111
Q

coarctation of the aorta

A

narrowing of the aorta;

  • symptomatic is L sided HF
  • BP is high in arms and low in legs
  • causes intermittent claudication (low blood supply to lets and feet, causing them to be painful and cold, esp when exercising)
112
Q

frank starling

A

if the CO goes down the body with compensate- good for a moment, but bad long term

113
Q

ejection fraction

A

net volume of blood per beat

  • divide stroke volume by the end diastolic volume
  • normal is about half the blood in the ventricle… need at least half to get out or you have HF
  • systolic measure
114
Q

chain stoke breathing

A

start with shallow breaths and get deeper and deeper, then shallow, then no breathing, and over again

115
Q

manifestations of HF

A
  • dependent edema and ascites
  • anorexia, GI distress, weight loss
  • impaired liver function
  • activity intolerance and signs of decreased tissue perfusion
  • cyanosis and signs of hypoxia
  • cough with frothy sputum
  • orthopnea
  • parolysmal nocturnal dyspnea
116
Q

manifestations of left sided HF

A

body lacks blood

lungs fill with blood (pulmonary edema)

117
Q

manifestations of right sided HF

A

body fills with blood

lungs do not oxygenate enough blood

118
Q

hypovolemic shock

A

most common kind of shock;

  • acute blood loss volume (15%)
  • anything than causes fluid loss
  • huge sympathetic trigger
  • if we lose more than 40% of volume- death
119
Q

cardiogenic shock

A

heart fails to pump blood adequately

  • bc of MI, sustained arrhythmias, cardiac surgeries
  • “normal volume shock”
  • decreased CO lowers BP
  • sympathetic response, but vasoconstriction increases resistance causing increase work on the heart, furthering HF
120
Q

distributive or vasodilatory shock

A

blood vessels dilate- massive dilation= loss of tone

  • loss of tone from neurogenic shock or nanphylaxis (all fluid goes to the skin)
  • not enough blood to fill the circulatory system
  • blood flow decreases
  • less blood is returned to the heart
  • less blood is circulated to the body
  • if you don’t have a changein BP after fluids, you’re going to die
121
Q

septic shock

A

infection gets into blood stream

  • fever… **key to sepsis
  • increased HR
  • hypotension
  • hypoxia
  • increased WBCs
  • – give antibiotics
122
Q

do this with all types of shock except cardiogenic

A

give fluids

123
Q

5 major complications of shock

A
  • acute respiratory distress syndrome
  • acute kidney injury
  • GI complications
  • Disseminated Intravascular Coagulation (DIC)
  • Multiple Organ Dysfunction Syndrome

Patho (10 decks)

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