Cardiac Disease Part I Flashcards
CAD
Plaque deposits that restrict load flow to the heart major blood vessels
Stable angina
CP less than 5 min
- predictable relieved with nitro
Goal : relief of symptoms and reduce lifestyle
ACS
Unstable - pain last longer than 20 min and NOT relieved by rest or medication
- need EKG to see ischemic changes
Silent ischemia
Goes undetected due to atypical presentation
Common in elderly, dm, and known CAD puts
Coronary spams
Typically right coronary artery, transient pain at rest, ST elevation, relieved with nitro
Microvascular disease
Angina -like CP in setting of normal coronary arteries
It’s a reduce capacity to respond to increased demand
GERD
Pain typically at night but think about this and work this up
Cholecystitis
+ Murphy sign, N/V
Costrochrondritis
Recent lifting, coughing , often reproducible pain
Pleurisy
Inflammation - sharp pain with deep breath, cough , pleural friction rub present
CP presentation with women / elderly / DM
Fatigue, SOB w or w/o CP,
W : discomfort in arms, back, neck, shoulder blades
Nausea, lightheadedness, sudden cold sweat
Waxing and waxing chest discomfort
Abdominal fullness or burning sensation
APRN role in CAD
Assure cardiology follow
Management of risks
Education
Murmurs
Sound produced by turbulent blood flow across a heart valve. Occurs during systole or diastole
Stenosis
Narrowed opening
Regurgitation
Backward flow of blood
Prolapse
Valves are floppy and do not close tightly
Grade of murmurs 1-6
1 being very soft to 6 being so pound that it audible even without direct placement of stethoscope on the chest
Grade 2 M
Is soft but can be readily heard by skilled examiner
Grade 3
Is easy to hear
Grade 4
Is slightly loud and accompanied by a palpable thrill
Grade 5
Is very loud and accompanied by a easily palpable thrill
Systolic murmurs
AS, MR, MP
Occurs between s1 and s2
Aortic Stenosis definition
Narrowed aortic valve resulting in obstruction of the blood flow from the left ventricular into the aorta
A systolic crescendo-decrescendo murmur that results in increased afterload on the left ventricle and ultimate LV failure
AS pathophysiology
As the valve area decreases the left ventricle works harder to pump blood throughout the body
The increased work load of the left ventricle increases left ventricular myocardial oxygen demand and in response to the increased workload, the myocardium of the left ventricular —> hypertrophies
AS PE
Weak or delayed carotid upstroke due to delay in blood flow
LV hypertrophy
Palpable wide apical impulse
Paradoxical splitting of s2
Maneuver to accentuate murmurs
Valsalva and standing - decreases venous return, decreases ejection fraction resulting in decrease murmur
Mitral Valve Prolaspe (MP)
Occurs during mid to late systole, the mitral valve leaflets bulge back into he left atrium and can lead to mitral regurgitation
W >M
MP PE
Mid-systolic click
MP treatment
ECHO - will show displacement of mitral valve leaflets during systole
Mitral Valve regurgitation
Changes to the mitral valve so that is no longer to able to close properly
Blood in the left ventricle is primped back into the pulmonary veins and pulmonary circulation
MR ( PE)
Prominent PMI
Apical thrills may be felt in severe MR
Muffled 1st heart sounds
Holosystolic murmur w/blowing quality heard best at the apical area
How to differentiate between AS and MR
Sustained hand grip increased vascular resistance and after load. In MR the murmur increases and in AS it decreases
Diastolic Murmurs
Mitra stenosis and Aortic Regurgitation
Occurs between S2 and S1
Mitral stenosis ( MS)
Occurs during diastole due to the narrowed, stenotic valve in whose obstructs blood flow between the left atrium and left ventricle, this obstructing fling of the left ventricle
MS PE
Mid-diastolic rumbling murmur
Heard loudest at the 5ht intercostal space midclavivular line with patient lying on the left side
Opening snap can be heard as the calcified calve is forced open the LA contraction
Pulmonary HTN can occur in severe MVS
Aortic Regurgitation
Incomplete aortic valve disorder characterized by incomplete aortic valve close.
Results in the regurgitation of blood from teh aorta into the left ventricle during diastole
AR PE
High pitched diastolic decrescendo blowing murmur
Best heard at 2nd and 3rd intercostal space R and L sternal border
Maybe associated with S3
Maneuvers to accentuate sound
- squatting and hand grip increased murmur
- sitting up right and leaning forward
Afibb definition
Common rhythm disturbance cauterized by irregular QRS complexes adn loss of synchronous atrial contraction
Afibb causes
Mitral valve defect, HTN, HF, ischemic heart disease , cardiomyopathy
COPD, PE, hyperthyroidism
Hypokalemia
Alcohol
Lyme carditis
Afibb S.S
Often none
Palpitations irregular heart rate, chest pain, dyspnea, lightheadedness , dizziness and snycope
Afibb PE
EKG - absence of P waves and irregularly irregular conduction tot he ventricules with irregular RR intervals
Irregular pulse
- Rapid > 100
- Slow <60
Afibb dx testing
EKG, 24 holter EKG, Cardiac Echo
Afibb treatment
Correct reversible risk factors
- Electrolytes and Hyperthyroidism
Restore Rhythm control
- cardioversion, ablation w/implantation
- pharm cardioversion
- rate control with BB, CCB and digoxin
Prophylaxis of thromboembolism with anticoagulation
- CHAD score
Types of anticoagulation
Warfarin target inr 2-3
Dabigatran
Rivoraxaban - factor Xa inhibitor
Apixaban “ “
AV block - def
A slowing down of signal conduction in electrical impulse as it travels from the atria to the ventricles through he AV node
AV block s/s
Varies depending on degree of block, range from none to sycophants to cardiogenic shock
First degree block
Not an actual block
Only prolonged AV conduction
PR interval is prolonged > .20 sec
2nd degree heart block type 1
Lengthening of PR interval until it fails to conduct ventricle and a QRS
“ going , going , gone”
2nd degree type II
P wave but no QRS
Episodic and unpredictable
PR interval the same
3rd degree HB
Atria and ventricles are controlled by separate pacemaker
PR intervals irregular
Prolonged QT
QT = Torsades
Meds Antiemetics Antifungals Antimalarials Antidepressants Antipsychotics Antibiocs - macrolides
