Cardiac III: Cardiac Diseases & 12-Lead EKG Part 1.5 Flashcards
What condition is this? BP > 140/90 on at least 2 occasions measured at least 1-2 weeks apart
systemic hypertension
The following conditions can develop as a result of ____ ______.
ischemic heart disease
congestive heart failure
cerebral vascular accident
arterial aneurysm
end stage renal disease
systemic hypertension
Optimal BP is: ____/_____ Normal BP is less than ____/____
120/80
130/85
High-normal BP ranges from: Systolic: ___ - _____ Diastolic: ____ - _____
130-139
85-89
Stage 1 Hypertension ranges from: Systolic: ____-____ Diastolic: _____-____
140 - 159
90 -99
Stage 2 Hypertension ranges from: Systolic: ____-____ Diastolic: _____-____
160 - 179
100 - 109
Stage 3 Hypertension BP is ___ / ___
180
110
What accounts for 95% of all cases of HTN?
essential HTN
The cause of ____ HTN cannot be identified.
essential
Familial incidence and patholphysiological factors such as: increased sympathetic NS activity overproduction of Na retaining hormones & vasoconstrictors high Na intake increased renin secretion deficiencies of vasodilators describe ______ hypertension.
essential
Known etilogy is present in _____ HTN.
secondary
What is the most common secondary type of HTN?
Renovascular HTN from renal artery stenosis
When renovascular HTN is present, diastolic BP is usually > ____ mmHg and an ____ ____ ___ is present.
125
upper abdominal bruit
What test confirms secondary HTN?
MRI
What is the treatment of essential HTN?
lifestyle modification: weight reduction, increase in physical activity, moderation in alcohol, quit smoking pharmacologic therapy: diuretics, beta-blockers, ACE inhibitors, angiotensin receptor blockers calcium channel blockers
Secondary HTN is treated by: (2)
treatment is often surgical (angioplasty, surgery for stenotic renal artery, adrenalectomy)
pharmacologic therapy reserved for patients in those where surgery is not possible
Hypertensive crisis when acute diastolic BP > _____mmHg.
130
Need for emergent treatment determined by absolute BP rather than rate of increase. True or false?
False, determined by rate of increase rather than absolute BP
Patients with evidence of acute or ongoing target organ damage (encephalopathy, CHF, renal insufficiency, subarachnoid hemmorage) require prompt treatment with ____ BP lowering agents.
IV
Don’t decrease BP to normotensive levels! Desired decrease is MAP < ___% in first 2 hours, then additional decreases over next ___-___ hours.
20 24-48
Meds to consider delivering during hypertensive crisis: (3)
Nitroprusside Hydralazine Nitroglycerine
Anesthetic considerations for HTN during preop evaluation: (3)
determine adequacy of BP control review drugs being administered for BP control evaluate evidence of end-organ damage
For HTN patients: induction of anesthesia considerations: (2)
anticipate exaggerated BP changes limit duration of DL
For HTN patients: maintenance of anesthesia considerations: (2)
administer a volatile anesthetic to blunt HTN responses monitor for MI
For HTN patients: post-op management considerations (2)
anticipate periods of HTN maintain monitoring of end-organ function
Condition occurs when the heart is unable to provide sufficient pump action to distribute blood flow to perfuse tissues and organs of the body.
Congestive heart failure
What are the causes of CHF? (4)
valve abnormalities
impaired contractility secondary to ischemic heart disease or cardiomyopathy systemic
HTN
pulmonary HTN (cor pulmonale)
What is the most common form of heart failure? Fluid may back up in the lungs causing SOB.
left-sided heart failure
What most commonly results from left-sided heart-failure?
right-sided heart failure
Fluid may back up into the abdomen (ascites) and legs and feet (edema) in this type of heart failure.
right-sided heart failure
In this type of heart failure, the left ventricle cannot contract vigorously, indicating a pumping problem. EF < ___% in this case.
systolic
45
In this type of heart failure, the left ventricle cannot relax or fill fully, indicating a filling problem from noncompliant ventricles.
diastolic heart failure
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 ___.
1
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
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 of 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
Symptoms of MI: (4)
- Anxiety, sinus tachycardia, hypotension (caused by left or right ventricular dysfunction or cardiac dysrhythmias)
- Moist rales representing CHF (due to LV dysfunction)
- Cardiac murmur may reflect ischemic mitral regurgitation.
- Rule out other causes of CP: pulmonary embolism, aortic dissection, spontaneous pneumothorax, pericarditis, cholecystitis
Treatment of MI (6)
Aspirin
IV Morphine: pain relief and decrease the stimulus to catecholamine release and increases in myocardial oxygen requirements.
Thrombolytic Therapy: Tissue plasminogen activator (t-PA, streptokinase) within 30-60 min of hospital arrival.
Coronary Angioplasty: within 1-2 hours
CABG: reperfusion achieved more quickly with Thrombolytics or PTCA, emergent CABG reserved for patients who’s anatomy precludes PTCA, failed angioplasty, infarct related ventricular septal defect or MR
- Adjunctive Medical Therapy: Heparin IV, Beta blockers, ACE inhibitors, nitrate therapy
A systolic murmur indicates what type of valve issues? (4)
AP valves open; so murmurs heard are AP stenosis or MT insufficiency
- Aortic stenosis
- Pulmonary stenosis
- Mitral regurgitation
- Tricuspid regurgitation
A diastolic murmur indicates what type of valve issues? (4)
MT valves open; so murmurs heard are MT stenosis or AP insufficiency (MS, TS, AR, PR)
What cardiac dysrhythmia is most common with rheumatic mitral valve disease & left atrial enlargement?
atrial fibrillation
Angina Pectoris can occur (even without ischemic heart disease) from increased myocardial O2 demand from enlarged cardiac muscle mass (hypertrophy). True or false?
true
What are the symptoms of mitral stenosis?
dyspnea on exertion
orthopnea
PND from LV dysfunction (if AR and MR also present –> significant LV dysfunction)
What valve condition is characterized by an “opening snap”?
Mitral stenosis
What type of cardiomyopathy is indicated by:
biventricular dilation
increased ventricular volume
decreased ejection fraction
increased ventricular filling pressure
decreased stroke volume
dilated cardiomyopathy
What cardiomyopathy is characterized by:
decreased ventricular compliance
increased ventricular filling pressure
restrictive cardiomyopathy
What cardiomyopathy is characterized by:
marked increase EF
marked decrease of ventricular compliance
increased LV and septum size
hypertrophic cardiomyopathy
What cardiomyopathy is characterized by:
thickened endocardium
decreased ventricular compliance
obliterative cardiomyopathy
