Cardiac abnormalities Flashcards
Cardiac valve abnormalities cause stenosis upstream or down stream?
Upstream
-Thus right side - systemic
Left side- pulmonary capillaries have increased pressure
What predominates in edema, hydrostatic or osmotic pressures?
Increase in hydrostatics leads to edema
Venules usually have high oncotic or hydrostatic pressure?
higher oncotic pressures (resorption)
What are the 4 valve abnormalities of the left heart?
- Mitral valve insufficiency and stenosis
- Aortic insufficiency and stenosis
- similar conditions can occur on the right
What is the characteristic signs of aortic stenosis?
- Subnormal aortic pressure due to increased ventricular pressure
- Low pulse pressure
- high ejection velocity of blood leads systolic murmur
What are the consequences can rise from aortic insufficiency and what is its cause?
Left ventricular hypertrophy due to increase afterload
What are the characteristic signs of mitral stenosis?
- increased pressure in atria during diastole
When is the murmur heart in mitral stenosis?
Diastolic murmur
What are some of the consequences of mitral stenosis?
Left atrial hypertrophy which can lead to pulmonary edema due to congestion leading to SOB
What are the characteristic signs of Aortic insufficiency?
- Aortic pressure falls faster than normal during diastole
- low diastolic pressure
- Large pulse pressure
What happens to EDV and EDP in aortic insufficiency?
Both increased due to leaking
When is the murmur heard during aortic insufficiency?
Diastolic murmur
What is the primary physiologic consequence of aortic insufficiency?
reduced EF and increased workload
What is the characteristic sign of mitral regurgitation?
Left atrial pressure is abnorally high
What happens to EDV and EDP in mitral regurg?
Both increase
When is the murmur heard in mitral regurg?
Systole which can lead to pulmonary SOB symptoms
Which lead can usually dx any excitation problems in the heart?
Lead 2
What are the consequences of abnormal excitation and conduction?
- Evokes tachycardia, limits ventricle filling time
2. Reduces SV through decrease myocyte coordination
How frequent should QRS complexes show up and how long is its normal duration ?
1 per second
120 msec
How long should a PR interval be?
How long should a QT interval be?
Less than half than the R-R interval
What are 4 ways to see clinically cardiac abnormalities
- HR
- Rhythm
- Site of origin
- Complexes on EKG
Where do Suprventricular abnormalities originate?
Atria or AV node
What is Paroxysmal suprventricular tachy?
PSVT
- Rapid usually regular rhythm
- but comes and goes abrubtly
What are some signs and consequences of PSVT?
P and T waves superimposed on one another
- low blood pressure and dizziness
What it called when you have a 3 second pause or more without a heart beat?
Sinus arrest
What is first degree heart block?
slow conduction causing long PR interval
What is 2nd degree heart block?
not all impulses travel through AV node and thus
- thus some but not all P waves are followed by a QRS wave
What is 3rd degree heart block?
No impulses are transmitted through the AV node. His is default ventricular pace make and thus atrial and ventricle are completely dissociated.
- P waves have no correlation with QRS complexes
What are PAC’s?
Early extra beats that originate in the atria
What is characteristic of accessory pathway tachycardias?
Delta Waves
What are the 3 divisions of AV nodal reentrant tachycardia?
- Atrial tach
- Atrial fibrillation
- Atrial Flutter
What is a result of many disordered impulses competing to travel through the AV node leading to loss of coordinated atrial contraction?
Atrial fibrillation
- no P waves
- Ventricular rate normal
- Atrial depole and repole random
What abnormal rhythm is known as the sawtooth rhythm?
Atrial flutter
Where do ventricular abnormalities originate?
Ventricles or His-Purkinjes.
What is EKG characteristics of a bundle branch block? Where do they originate
- often due to MI
- Widing of QRS more the .12 secs
- Splitting of R wave
- usually inconsequential and occur in septum or Purkinjes
What are PVCs? Their relation?
Premature ventricular contractions.
- Early extra beats
- Usually asymptomatic and due to stress, nicotine, caffeine, and exercise
- can be HD or electrolyte imbalance
What are some characteristics of PVCs?
Large amplitudes and long QRS
What is V-Tach? What does it precede?
Ventricular tachycardia
- Rapid rhythm from lower chambers of the heart.
- Decrease ventricular filling
- Ventricular fibrillation
What is long QT syndrome?
Longer than 450ms
- should be less than 50% of R-R interval (except high HR)
- increased risk or Torsades and V-Tach
What are some causes of long QT syndrome?
Delayed repolarization
- Due to inappropriate Na+ channels opening or prolonged closure of K+ channels
- puts at risk for extra stimuli during refractory period
What is ventricular fibrillation?
Erratic disorganized firing of impulses from the ventricles
- can discern P waves from QRS
When is the ventricle susceptible to fibrillation?
premature excitation at the end of a T-wave
