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Clin Med-Cardiology Exam 1 > Cardiac Labs > Flashcards

Cardiac Labs Flashcards

1
Q

What is systole

A

Ventricular contraction

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2
Q

What is diastole

A

atrial contraction and ventricular relaxation

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3
Q

What causes the S1 sound

A

mitral valve closes

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4
Q

What causes the S2 sound

A

the aortic valve closes

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5
Q

What happens during Diastole

A

• LV pressure drops → mitral valve then opens →Opening Snap → rapid flow of blood to the LV wall→ S3 sound (nml in children and young adults, S3 gallop in older adults can be pathologic)→LA contracts → produces S4 (diseased wall → narrowing, CHF).

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6
Q

What causes the split of the S2 heart sound

A

The pulmonary valve closing slightly after the aortic valve

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7
Q

Cardiac output=

A

HRxSV

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8
Q

What 3 things determine stroke volume

A

Preload, Afterload & Muscle Contraction

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9
Q

What is preload

A

Volume that stretches the cardiac muscle prior to contraction

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10
Q

What is Afterload

A

Vascular resistance

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11
Q

What is Muscle Contractility

A

The ability for the cardiac muscle to contract when given a volume

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12
Q

What is Systolic Pressure

A

The maximum pressure during systole

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13
Q

What is Diastolic pressure

A

the lowest pressure during diastole

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14
Q

mean arterial pressure=

A

Diastolic + 1/3(Systolic –Diastolic)

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15
Q

What is a dicrotic notch

A

Back flow of blood from Aortic valve, creates a small pressure as the valve is closing

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16
Q

What does an A wave show in venous pulsation

A

atrial contraction

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17
Q

what does x descent show in venous pulsation

A

Starts with atrial relaxation and continues with RV contraction (which pulls the floor of the RA downwards).
• V wave = Tricuspid closure and rise in RA pressure.

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18
Q

what does V wave show in venous pulsation

A

Tricuspid closure and rise in RA pressure.

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19
Q

What does Y descent show in in venous pulsation

A

Opening of the Tricuspid and drop in the RA pressure

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20
Q

Normal Cardiovascular Vital Signs for

  1. BP
  2. Mean arterial pressure
  3. central venous pressure
  4. Pulmonary Artery pressure
  5. Heart Rate
A
  1. 60mmHg
  2. 8-12mmHg
  3. 6-12 mmHg
  4. 60-100
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21
Q

What are common signs and symptoms of a pathological heart

A 
o	Chest Pain/Discomfort
	Dyspnea, Paroxysmal nocturnal dyspnea
oOrthopnea—difficulty breathing while supine
oCyanosis
oHyper/Hypotension
oLightheadedness/Presyncope/Syncope
o	Peripheral edema, anasarca
o	Cardiac Arrthymias (Supraventricular, AV nodal, and Ventricular)
o	Palpitations
o	Pulmonary edema
o	EKG changes
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22
Q

what is pulsus paradoxus

A

A drop in Systolic pressure by >10 mmHg during inspiration due to increased pressure in the thoracic compartment.

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23
Q

Where is aortic stenosis best heard

A

aortic area during systole

24
Q

Where is aortic regurgitation best heard

A

along the Left lateral border during diastole

25
Q

Where is mitral stenosis best heard

A

apex during diastole

26
Q

Where is mitral regurgitation best heard

A

apex during systole

27
Q

what are the 4 guidelines by the NY heart association for approach to cardiac patient

A

Determine underlying etiology
Determine id an anatomic abnormality present
Detertemine if a physiologic disturbance is present
determine if a functional disability is present (is Pt able to perform strenuous tasks)

28
Q

How to obtain cardiac diagnosis

A 
obtain history
Physical exam
Lab tests
Noninvasive diagnostic Test
Invasive diagnostic Test
29
Q

When does creatine kinase peak

A

•Peaks 4-8 hours post infarction and declines after 2-3 days. Peak is usually after 24 hours

30
Q

What are the 3 Creatine kinase isoenzymes

A

MM (skeletal and cardiac), BB (brain and kidney) and MB –MC’ly checked (cardiac and skeletal

31
Q

What is the ration of CK/MB that is indicative of MI

A

2.5 or greater of MB

32
Q

What are the 3 types of troponin?

A

o Troponin C which binds calcium
o Troponin I which binds to actin and inhibits actin-myosin interactions
o Troponin T binds to tropomyosin thereby attaching the troponin complex to the thin filament.

33
Q

When is Troponin released

A

•Released when a myocyte is damaged after about 3 hours and persist for 7 to 10 days (Trop I) and can last upwards of 10-14 days. (Trop T)

34
Q

What causes an increase in BNP

A

Anything that increases pressure in the Atria

35
Q

What is the value of BNP that is a high predictive value of CHF

A

> 400pg/dl

36
Q

How does Echocardiography work

A

• Uses ultrasound technology to visualize the heart

37
Q

What is 1st line Echocardiography used with

A 
2D Trans-Thoracic Echocardiogram
Shows:
Cardiac chambers
Valves
Pericardium
Great vessels
Masses
38
Q

When is a Trans-Esophageal Ecocardiogram used (TEE)

A

Used to better visualize mitral valve

39
Q

What is doppler Echocardiography used for

A 
o	Valve Stenosis
•	Gradient
•	Valve area
o	Valve Regurgitation
o	Intracardiac pressures
o	Volumetric flow
o	Diastolic filling
o	Intracardiac shunts (right to left shunt) (“bubble” studies)
40
Q

How are stress Echocardiography performed

A

Pharmacologic agents to induce stress in the heart

41
Q

How does nuclear imaging work

A

• Injection of a radioactive isotope, which emits photons.

42
Q

What is the problem with isotopes

A

that that it emits photons in all directions

43
Q

What is Nuclear imaging used to assess

A

Ventricular functioning, myocardial perfusion (stress vs resting using exercise or pharmacologic stress i.e. adenosine or dipyridoamole or dobutamine)

44
Q

How is a stress tests chosen?

A

determined upon the initial EKG, pts physical ability, and underlying diseases.

45
Q

What types of stress testing are available

A 
oStress Electrocardiography
•	Dukes Treadmill Score
oStress Echocardiography
•	Decreased Ejection Fraction and decreased end diastolic volume or WMA/
oStress Nuclear Imaging
•	Imaging Defects
oExercise Stress Testing
•	Bruce Protocol
46
Q

What is MRI/CT imaging used for

A

evaluate complex anatomical abnormalities

47
Q

What is CT good for evaluating

A

o Good at evaluation of pericardial calcification (constrictive pericarditis), cardiac masses, coronary calcifications (a marker of CAD)

48
Q

What is CTA used to evaluate

A

evaluates intra-vessel abnormalities

49
Q

What does cardiac angiography look for

A

looks for areas of narrowing in R/L Coronary Artery, L anterior descending, & circumflex.

50
Q

When is cardiac angiography indicated

A

when cardiac disease needs conformation

51
Q

when is cardiac angiography contraindicated

A

oInfants < 1 mo old, elderly > 85 yo
oFunctional Class IV 10x greater than I-II
oL main disease
oValvular disease
oEF < 30%
oRenal disease, DM, vascular disease, severe pulmonary disease

52
Q

what are complication of Cardiac angiography

A

o CVA, MI, Arrhythmia, vessel damage (rupture/dissection), heart damage (rupture), renal failure or allergic reactions from contrast dye

53
Q

When can stents be used

A

can only be put in proximal area, if it’s too distal, bypass is needed to remove block

54
Q

What is the problem with using a pulmonary artery catheter

A

difficult to interpret and rarely used

55
Q

What are the problems with Pulmonary Artery Catheter

A

inappropriately interpreting data
Increased intrathoracic pressure can give falsely elevated PAOP by increasing intracardiac pressure
Left ventricle compliance is an important factor and can be altered
Myocardial stiffness
Pulmonary Artery Occlusion Pressure (NOT FOR DETERMINING INTRAVASCULAR VOLUME)

Clin Med-Cardiology Exam 1 (8 decks)

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