Cardiac Disorders and 12 Lead EKG Part 4 Flashcards
In diastolic heart failure, EF is often normal. True or false?
true
NY Heart Association classification system:
No limitation and no symptoms with ordinary physical activity is Class ___.
I
NY Heart Association classification system:
Slight limitation and symptoms with ordinary physical activity. Comfortable at rest.
Class __.
2
NY Heart Association classification system:
More pronounced limitation because of symptoms, even with less than ordinary physical activity. Comfortable only at rest.
Class __
3
NY Heart Association classification system:
Severe to complete limitation of physical activity. Symptoms are present with any degree of physical activity and also appear at rest.
Class ___
4
Symptoms of ____ include fatigue at rest or with minimal exertion.
CHF
Hallmark symptoms include dyspnea, tachypnea, orthopnea, PND, and S3.
Signs include moist rales in the lungs –> pulmonary edema.
Left CHF
Hallmark symptoms include systemic venous congestion as evidence by JVD, oranomegaly (liver and spleen), RUQ tenderness and elevation of liver tests, and pulmonary edema.
Right CHF
In CXR, distension of the pulmonary veins in upper lobes of the lungs (pulmonary venous HTN), hilar and perihilar haze (perivascular edema, pleural effusions and pericardial effusion indicate ____.
CHF
Short-term treatment of CHF goals include: (3)
- relieve symptoms of circulatory congestion
- increase tissue perfusion
- improve quality of life
Long-term treatment goals for CHF: (1)
slow or reverse progressive LV dysfunction (ventricular remodeling) that results in a dilated ventricular chamber and low EF
Non-pharmacologic management of CHF: (6)
- Na restriction
- exercise
- angioplasty and bypass surgery
- valve repairs
- heart transplant
- ventricular assist device
List 4 drugs that are good options for CHF patients.
- ketamine
- opioids
- benzodiazepines
- etomidate
Caution: nitrous oxide & opioids/benzos = cardiac depression!
Volatile anesthetics are encouraged for CHF patients. True or false?
false
Use caution when using propofol for CHF patients. True or false?
true
It is not a direct myocardial depressant, but causes peripheral vasodilation which decreases BP.
For severe CHF patients, consider opioids only, positive pressure ventilation, invasive monitoring, and support of CO with dopamine and dobutamine also. True or false?
true
What condition is characterized by myocardial dysfunction unrelated to the usual causes of heart disease (CAD, valve disease, or HTN)
cardiomyopathy
Common to all cardiomyopathy is progressive, life threatening CHF. True or false?
true
Right ventricular enlargement that develops secondary to pulmonary HTN indicates ____ ____.
Cor Pulmonale
COPD with associated loss of pulmonary capillaries and arterial hypoxemia –> pulmonary vascular vasoconstriction –> hypertrophy of vascular smooth muscle and increases pulmonary vascular resistance–> ______ _____.
cor pulmonale
____ ____ is obscured by COPD and results in:
- dyspnea
- effort -related syncope
- elevated pulmonary artery pressures
Cor pulmonale
CXR reveals:
- right ventricular hypertrophy reflected by decreases in retrosternal space on lateral view, or,
- prominence of PA and decreased vascular markings are suggestive of pulmonary HTN
in this type of heart condition.
cor pulmonale
Peaked p waves in II, III, AVF and right ventricular hypertrophy (right axis deviation and RBBB) show signs of ___ ____.
cor pulmonale
To treat cor pulmonale, decrease the workload of the right ventricle by decreasing PVR. True or false?
true
Treatments for cor pulmonale include: (7)
- supplemental O2
- anticoalgulation
- diuretics
- digitalis for CHF
- vasodilators
- antibiotics
- heart-lung transplant
Characterized by a sustained increase of pulmonary artery pressure without a demonstrable cause.
Primary pulmonary HTN
In primary pulmonary HTN,
mean PA pressure > ___ mmHg (rest)
\> \_\_\_ mmHg (exertion)
25
30
Primary pulmonary HTN pathological changes include: (3)
- in situ thrombosis
- smooth muscle hypertrophy
- intimal proliferation
Early symptoms or primary pulmonary HTN include: (2)
dyspnea
fatigability
____ ____ ____ to confirm diagnosis of primary pulmonary HTN.
Right heart catheterization
There is no cure for primary pulmonary HTN. True or false?
true
Treat primary pulmonary HTN with: (2)
- Ca channel blockers (nifedipine & diltiazem)
- or, IV prostacyclin as a bridge to transplantation for non-responders
Inflammation of the pericardium usually caused by a viral infection is known as:
acute pericarditis
What do these symptoms indicate?
- chest pain worsening with inspiration
- friction rub
- diffuse ST segment elevation
acute pericarditis
Treatment for acute pericarditis: (2)
- oral analgesics for pain
- NSAIDs
What is the abnormal accumulation of fluid in the pericardial cavity?
pericardial effusion
A pericardial effusion with enough pressure to adversely affect heart function is known as what?
cardiac tamponade
Signs of impending tamponade include: (3)
dyspnea
low BP
distant heart sounds
CXR reveals a “water bottle heart” indicates what?
cardiac tamponade
What is the treatment for cardiac tamponade?
pericardiocentesis
needle is inserted through the chest wall into the pericardial space to withdraw excess fluid
_____ ____ is a long-term inflammation of the pericardium with thickening, scarring, and muscle tightening.
Causes include heart surgery, radiation therapy to the chest and TB.
Constrictive pericarditis
Symptoms of constrictive pericarditis include: (5)
- dyspnea
- fatigue
- peripheral edema
- ascites
- weakness
What tests indicate constrictive pericarditis? (4)
- chest CT (demonstrate thickening)
- TEE
- doppler flow studies
- cardiac cath
Treatment for constrictive pericarditis include: (2)
either resolves
surgical stripping of pericardium
