Cardiac Diseases and Conditions Flashcards
Aortic stenosis
Aortic valve narrows or does not open fully
Pressure load
Mid-systolic (ejection) murmur (crescendo, decrescendo) at upper right sternal border radiating to neck
Later on can have low BP and high HR to compensate
Dyspnea, LV hypertrophy
EF decreases
PV loop skinnier, taller and on right half of normal PV loop
Rheumatic fever can cause this, or can have bicuspid aortic valve
EKG: high voltages (QRS) in V1, V2, V3, V4, V5, V6
Mitral prolapse
Abnormally thickened mitral valve leaflet goes back into left atrium
Causes click during early part of systole (but not at very beginning)
Sometimes causes murmur, but usually a click
Pulmonary hypertension
Increase in blood pressure in pulmonary veins, pulmonary capillaries, pulmonary veins
Backflow of blood into right ventricle from pulmonary trunk/arteries
Widely split S2 with very loud P2
Shortness of breath, diziness, fainting, extreme fatigue
Heart transplant
Recipient keeps posterior walls of atria, so still has SA node
Donor gives another SA node (somehow) and AV node
Recipient’s sympathetic and parasympathetic cardiac nerves cannot control the HR and contractility. No baroreceptor reflexes!
However, during exercise, the HR and contractility do increase because you have increased CIRCULATING EPI/NE from adrenal glandwhich can act on SA node cells to increase HR (just not as efficiently as direct sympathetic innervation). Also, temperature intrinsically slows heart (so you’re tachycardic if you have a fever!)
No change in PR interval or QT interval when pacemaker speeds HR
Left-sided heart failure
MI damages LV heart tissue
Dyspnea, RR elevated 30, lack of energy, skin cold and clammy, auscultation = inspiratory rales in lung indicating fluid, palpation = enlarged heart
Pulmonary edema caused by elevated pressure backed up from LV to pulmonary veins
Possible peripheral edema, enlarged (edematous) liver and/or ascites (fluid acculumation in peritoneal cavity because backup of pressure to RV). Possible history of hypertension, smoking and MI
Treatment: Nitrates (venodilate to decrease preload), Lasix/furosemide (diuretic to decrease preload), ACE inhibitor (vasodilate to decrease afterload), Dobutamine (beta1 agonist to increase contractility and CO, but this can cause arrhythmias), BIPAP (positive pressure ventilation for pulmonary edema)
Mitral stenosis
Blood can’t get easily from LA to LV, so LA and pulmonary veins/pulmonary arteries and RA have extra blood and pressure.
Diastolic murmur (especially at end during atrial kick)
Shortness of breath
PV loop shifted left because can’t fill LV as much, and also LV a little stiffer
Rheumatic fever can cause this
EKG: RA and RV hypertrophy seen as tall P wave in leads I and II and tall R wave in lead V1
Mitral regurgitation
During systole, LV ejects blood back into LA as well as aorta (also remember since no valve between pulmonary vein and atrium, blood goes back into pulmonary veins too)
EF increased, but have to pump out 10L just to get 5L to body
Holosystolic murmur (starts the instant the mitral valve is supposed to close but doesn’t) at apex
Volume load
LA and LV will be enlarged
Caused by abnormalities in papilary muscles, chordae tendinae, leaflets, or valve ring
Well-tolerated by patients
Aortic regurgitation
During diastole, blood flows back from aorta into LV. Diastolic pressure decreases and systolic pressure increases. Also LA pressure increases.
Volume load
Diastolic murmur starting with S2 at upper right sternal border
Caused by developmental abnormality or damage of aortic valve.
Well-tolerated by patients
Intra or Extracardiac Shunt
ASD, VSD, or patent ductus arteriosus
Hole between higher pressure left side and lower pressure right side causes blood to flow from L to R but then return to L with subsequent beats.
Forward flow decreased but increased volume to be pumped out so LV volume loaded during diastole.
Cardiogenic shock
Damaged heart cannot supply enough blood to body
Pressure and volume load
EF will continue to fall unless you can reduce radius and increase contractility
Drugs to give post-MI
Aspirin
ACE inhibitor
Beta blocker
Clopidogrel (Plavix)
Cholesterol (Statins)
Diet
Exercise
Fish oil (for plaque stabilization)
Premature Ventricular Contraction (PVC)
Extra beat originates in ventricle, travels myocyte to myocyte instead of through His system so takes a long time
Feels like “skipped beat” because the PVC has small SV so you only feel the one before and after (long duration between them)
Compensatory pause after extra beat because (1) ventricle refractory so can’t make another QRS even though P was fired and (2) PVC traveled retrogradely to SA and depolarized/re-set it
EKG: No P wave, wide QRS
First Degree Heart Block
Slowed conduction (could be due to fibrosis in old person, but many people have it in their sleep–increased vagal tone)
PR interval greater than 200ms
No symptoms or palpitations
Very common
Complete Heart Block
No communication between SA node and AV node, so have P waves not corresponding to QRS
QRS sets rate very slowly (<30bpm)
Causes fainting
Fixed with pacemaker
Sinus Arrhythmia
Just changes in heart beat with breathing
Irregularly irregular WITH P waves
