Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Drugs/Physiology Keystone Exam 1 > Cardiac Lectures > Flashcards

Cardiac Lectures Flashcards

1
Q

Hemodynamics of heart failure

A

increased atrial (L > dyspnea, pulmonary congestion, R > dependent edema/ascites (+JVP)) filling pressure with decreased cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Symptoms of heart failure

A

dyspnea and/or fatigue (exertional)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

New York Heart Association Functional (NYHA) Classification (symptoms due to angina or heart failure)
Class I

A

Ordinary activity without symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

New York Heart Association Functional (NYHA) Classification (symptoms due to angina or heart failure)
Class II

A

Ordinary activity With symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

New York Heart Association Functional (NYHA) Classification (symptoms due to angina or heart failure)
Class III

A

Less than ordinary activity with symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

New York Heart Association Functional (NYHA) Classification (symptoms due to angina or heart failure)
Class IV

A

Symptoms at rest and with any physical activity > symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

T or F: Patients can be reclassified inn the NYHA classification system?

A

T: can go from I to III or vice versa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Physical exam findings of heart failure

A

Narrow pulse pressure (when SV decreases), increased RR, bibasilar inspiratory crackles, S3 with L HF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

One of best laboratory findings for diagnosis of heart failure

A

Echocardiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

3 Main causes of Heart failure

A

Arrhythmia, myocardial, mechanical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Systolic dysfunction (myocardial etiology) Findings

A

Hallmark: enlarged end diastolic volume with cardiomegaly on CXR, poor contractility with sign decreased ventricular ejection fraction, HALLMARK = S3 gallop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Diastolic dysfuncion

A

normal end diastolic volume with minimal/no cardiomegaly on CXR, decreased compliance with normal contractility, relatively normal ventricular ejection fraction (>40%, normal = >50%), HALLMARK = S4 gallop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

“High Output States”

A

Infection, pregnancy, anemia, thyrotoxicosis (hyperthyroidism)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Workup of newly diagnosed HF

A

Echocardiogram, CBC with chem screen and TSH, CXR, EKG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Treatment of NON-hypotensive pulmonary edema

A

Oxygen, I.V. Morphine (venous vasodilator/slow RR/increase filling pressure), I.V. Furosemide, Vasodilator (nitroglycerin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Heart Failure Stage A

A

At risk for heart failure WITHOUT structural disease or symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Heart Failure Stage B

A

Structural heart disease WITHOUT signs/symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Heart Failure Stage C

A

Structural heart disease with prior/current symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Heart Failure Stage D

A

Refractory heart failure requiring specialized interventions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

T/F: Once a patient is diagnosed with a Heart Failure Stage, it is permanent.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Treatment of Heart Failure Stage A

A

Treatment of comorbidities (hypertension, thyroid disease, [glucose]), exercise/weight reduction, No EtOH/Nicotine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Treatment of Heart Failure Stage C

A

All stage A treatments and salt restriction, diuretics as needed, ACE-Is for all with decreased LVEF or PH of MI, B-blockers for all with decreased LVEF or PH of MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which drug classes should be avoided in treatment of Stage C heart failure?

A

Anti-arrhythmic drugs (Class I/III, exception of amiodorone and dofetilide), Ca-Channel blockers (Verapamil & diltiazem, due to neg ionotrophic effect > decreased contractility), NSAIDs (exception of aspirin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which vasodilators/diuretics are most effective for African Americans?

A

Isosorbide dinitrate in combination with hydralazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When should a implantable cardioverter-defribulator be implemented?

A

When LVEF is below 30% (need to recheck)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When should a biventricular electronic pacing/CRT be implemented?

A

LVEF 130 sec on EKG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Treatment of Heart Failure Stage D

A

All appropriate treatment for A, B & C in addition to end of life care, cardiac transplantation, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Which therapies improve survival and symptoms of HF

A

ACE-Is and B-blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which therapies improve symptoms alone

A

Diuretics (minus aldosterone) and digoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Diagnosis of mitral valve prolapse

A

Unique symptoms = exertional dyspnea/fatigue, murmur during systole with click in addition with S3 gallop
Echocardiogram (w/o physical examination findings (murmur during systole, can include click) > suggest prolapse), PE + echo - diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Mechanisms of sudden cardiac death

A
  1. Ventricular fibrillation (60%)
  2. Asystole, Bradycardia, electromechanical dissociation (30%)
  3. Ventricular tachycardia (10%)
    First 2 can be reversed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Determinants of O2 demand

A
  1. Preload (ventricular volume)
  2. Afterload (blood pressure)
  3. Heart rate
  4. Contractility
33
Q

Determinants of O2 supply

A
  1. Coronary blood flow

2. Oxygen delivery- hematocrit and O2 saturation

34
Q

Whats the only determinant of O2 supply that can be manipulated to increase supply?

A

Coronary blood flow

(A-V)O2 cannot be improves as it is at its maximum when heart rate is at rest

35
Q

How do you increase coronary blood flow?

A

equation: Flow = Pressure/resistance: can manipulate pressure via decrease aortic diastolic pressure, decrease LV diastolic pressure, Resistance via pharmacological agents

36
Q

Etiology of ischemic heart disease

A
  1. aortic outflow obstruction (aortic stenosis) > left ventricular hypertrophy
  2. Hypertrophy > vascular proliferation unable to keep up with demand
37
Q

Classification of Typical angina (“definite”)

A

Must have all 3:

  1. Substernal chest discomfort with a characteristic quality and duration
  2. Provoked by exertion or emotional stress
  3. Releived by rest of s.l. nitroglycerin
38
Q

Classification of Atypical angina (“probable”)

A

Must have 2:

  1. Substernal chest discomfort with a characteristic quality and duration
  2. Provoked by exertion or emotional stress
  3. Releived by rest of s.l. nitroglycerin
39
Q

Classification of non cardiac chest pain

A

Meets 1 or none:

  1. Substernal chest discomfort with a characteristic quality and duration
  2. Provoked by exertion or emotional stress
  3. Releived by rest of s.l. nitroglycerin
40
Q

What is relatively diagnostic for stable/probable angina on treadmill?

A

Classic ST depression that duplicates with chest discomfort, can be false positive

41
Q

T/F: A coronary angiogram is the most definitive test and diagnosis of presence of epicardial coronary artery disease

A

False: does not diagnose CAD, symptoms usually require at least 50% blockage but symptoms not always present

42
Q

Commons signs of myocardial infarction

A

Cardiac ischemic pain/discomfort similiar to angina pectoris but longer and more sever, dyspnea, sweating, nausea (can be silent)
Ascultation: S4 gallop, some have S3 > indicate CHF from systolic dysfunction, pericardial rub post 24 hrs (different from pericarditis via no L trapezius border pain)

43
Q

Diagnosis of myocardial infarction

A

History very important but EKG findings: new Q wave formation, ST elevation
Labs = Rise/fall of troponin (peak occurs 6-8 hr post MI and remains abnormal for 1-2 weeks)

44
Q

Complications of acute MI

A

Arrhythmias (V. fib = potent killer), CHF due to DD or SD, hypotension

45
Q

Isosorbide dinitrate

A

Nitroglycerin (S.L.), 3x/day

46
Q

Isosorbide mononitrate

A

nitroglycerin (s.l.), 1/day

47
Q

What happens if you take nitroglycerin 24/7 to alive angina?

A

Risk of tachyphylaxis

48
Q

Which two Ca2+ channel blocker are bradycardic?

A

Verapamil and Diltiazem > cause decreased contractility + decrease HR and AV node

49
Q

Amlodipine

A

Ca2+ antagonist, 1.5 day half-life = can take whenever (can’t use for acute events)

50
Q

Which Ca2+ channel blocker does not have bradycardia effects?

A

Nifedipine

51
Q

Which to B-blockers are B1 selective?

A

Metoprolol and atenolol

52
Q

B1 receptor blocking effects

A

Bradycardia, renin suppression, decrease free FA

53
Q

Which B-blockers are lipid soluble and what are their characteristics?

A

Metoprolol and labetalol

Liver metabolized, short half life (2-5 hrs, must give 2/day)

54
Q

Which B-blockers are water soluble and what are their characteristics?

A 
Atenolol
Renal excretion (mainly unmetabolized), long half-life (6-24 hrs, give 1/day)
55
Q

Which nonselective B blocker is useful to treat patients with ascites/liver disfunction?

A

Propanolol

56
Q

Which B-blockers also has alpha1 blocking characteristics

A

Carvedilol and labetalol (also has B2 agonist activity), Alpha1 blocker helpful in systolic heart failure

57
Q

What is cut off line for revascularization?

A

3-V CAD with normal LV fx WITH symptoms
Will improve angina and survival, this list for revascularization would also include 3-V CAD with abnormal LV fx and L. main coronary after blockage

58
Q

T/F: undergo angiography when patient has a positive treadmill test

A

F: not always for positive but not markedly test, make sure medications are not working beforehand in addition with percutaneous transluminal coronary angioplasty

59
Q

What is initial management for stable angina?

A
  1. Start with single drug from B-blocker/vasodilator group and get to maximum dose
  2. If symptoms persist > add second from other group and get to max
  3. If symptoms persist > discuss catheterization/revascularization
60
Q

How do you differentiate MI from pericarditis?

A

Chest pain often radiates to L. Trap ridge in pericarditis, otherwise most symptoms are the same. In addition, their is a rub heard in both
Peri: pain is worse when lying down, relieved when sitting up/leaning forward
Labs that differentiate: Peri has increased WBC/ESR/CRP

61
Q

History/physical exam findings of pericardial effusion with cardiac tamponade

A

Increased JVP, negative Kussmaul’s sign, increases RR, BP with normal to low BP, decreases pulse pressure
Often SOB with orthopnea
Positive: PARADOXICAL PULSE (due to inspiration leading to R ventricle expansion/L ventricle compromised due to limited space > decrease SV > decrease BP > 10 mmHg)

62
Q

T/F: Normal heart size on CXR excluded pericardial effusion/tamponade

A

False

63
Q

What is the treatment for pericarditis?

A

Pericardiocentesis of pericardial fluid

64
Q

Equation to relate valve area, flow and gradient of aorta

A

valve area = flow across valve/ sqRtValve systolic pressure gradient

65
Q

LV LA findings in aortic stenosis

A

Hypertrophy without dilatation of chamber cavity, palpable atrial kick
Best diagnosed via echocardiogram

66
Q

What valvular disease would present with BP of 180/30?

A

Aortic regurgitation (evident hyperdynamic carotid pulse)

67
Q

What vavlvular disease would present with BP of 100/80?

A

Aortic stenosis

68
Q

What Valvular disease could present with normal BP?

A

Mitral valve regurgitation (potentially more)

69
Q

T/F? Ventricular septal defect is considered a pressure overload lesion?

A

False: it is a volume overload lesion > leads to congestive heart failure
Does not present until AFTER the ew born period (>30days)

70
Q

What are the 3 causes of PVR>SVR in fetal lungs?

A

Alveolar hypoxia, Increased SM in pulmonary vessels, collapsed lungs

71
Q

What is the main driving factor behind pulmonary vasodilation in a new born?

A

O2 > leads to decrease in PVR (PVR rise in pulmonary blood flow

72
Q

T/F? In congenital heart failure, weight is less affected than height in FTT.

A

False: weight is more affected > due to poor feeding from fatigue/dyspnea of CHF

73
Q

Management of congenital congestive heart failure

A

Digitalis + diuretics, enhance caloric intake via formula density

74
Q

6Ps of acute ischemia

A

Pain, pallor, paresthesia, paralysis, pulselessness and poikilothermia (coolness)

75
Q

Whats it the ankle-brachial index of patients with claudication?

A

0.4-0.8 (ankle usually higher than brachial)

76
Q

T/F: Arterial claudication commonly occurs with standing alone?

A

F: occurs during movement

77
Q

Most common site for aortic aneurysm?

A

Infrarenal aorta

78
Q

Most common site for peripheral aneurism?

A

popliteal a.

Drugs/Physiology Keystone Exam 1 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions