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CV diseases > Cardiac specifically > Flashcards

Cardiac specifically Flashcards

1
Q

What is the leading cause of mortality and morbidity in the developed world?

A

Ischemic Heart Disease (95% due to CAD)

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2
Q

What does IHD cause along with ischemia and angina?

A

Dysrhythmias
LV failure
Sudden death

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3
Q

What distinguishes an unstable angina from a myocardial infarction?

A

TIme (>30min is MI)

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4
Q

What are the two main causes MI?

A

CAD–>complete thrombotic occlusion

CAD + hypotensive event

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5
Q

What are NSTEMI’s?

A

Subendocardial infarctions

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6
Q

What determines the severity of subendocardial infarctions?

A

Collateral circulation

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7
Q

What is the usual form of treatment for subendocardial infarctions?

A

Medication…usually NOT stented

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8
Q

What bio-marker can be screened for to determine myocardial injury/death?

A

Troponin

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9
Q

What are some acute indicators of an MI?

A 
Severe/unrelenting angina
Acute CHF w/dyspnea (pulmonary edema/oxygen desaturation)
Cardiogenic shock
Dysrhythmias
Sudden death
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10
Q

What are some subacute indicators of an MI?

A

Mural thrombosis/risk of embolism
LV rupture (free wall septal, papillary muscle)
Pericarditis

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11
Q

What are some chronic sequelae of an MI?

A

LV aneurysm formation–>CHF (if big enough or if many)
LV EF is <45% (systolic or diastolic)
High BNP
Pleural effusions (secondary RV CHF)

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12
Q

What can reverse CHF?

A

Hypertensive medications

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13
Q

What causes sudden death with acute/chronic CAD?

A

Ischemia of conduction system–>ventricular dysrhythmia

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14
Q

How can LVH cause sudden death?

A

Larger muscle–>larger radius–>more tension–> more workload–>higher oxygen demand

Larger muscle–>larger diffusion distance–>less perfusion

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15
Q

What is a major cause of LVH?

A

Chronic HTN (over decades)

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16
Q

What can cause pure RVH?

A

Chronically high pulmonary artery pressure

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17
Q

What can cause chronically high pulmonary artery pressure?

A 
COPD (interstitial fibrosing disease)
Pulmonary vasoconstriction (Chronic hypoxia +/- lung disease [sleep apnea])
...Pulmonary vascular disease (primary pulmonary HTN and chronic recurrent thromboemboli)
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18
Q

What are some signs of RVH?

A

Peripheral edema
JVD
Hepatosplenomegaly
Ascites (fluid accumulation in peritoneal cavity)

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19
Q

What is the leading cause of RV failure?

A

LV failure

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20
Q

What is an indicator for a stenotic/obstructed valve?

A

PRESSURE overload behind the diseased valve

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21
Q

What is an indicator for a regurgitant/insufficient valve?

A

VOLUME overload behind the diseased valve

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22
Q

What are some causes of stenotic valves?

A 
Valvulitis
Congenital deformity
Calcific degenerative change
Carcinoid syndrome (Pulmonic and Tricuspid valves)
Radiation
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23
Q

What can specifically cause aortic insufficiency?

A

Thoracic aortic aneurysm or dissection

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24
Q

Which side usually has valvular problems?

A

Left side (calcific aortic stenosis, mitral valve prolapse)

25
Q

What can specifically cause atrioventricular valve problems?

A

CHF–>ring dilation

Ischemia–>papillary muscle dysfunction

26
Q

What can connective tissue diseases–like rheumatoid arthritis–cause?

A

Valvular disease

27
Q

What are some early features of calcific aortic stenosis?

A

Angina/dyspnea/syncope

High LV diastolic pressure–>high pulmonary capillary pressure

28
Q

What are some late features of calcific aortic stenosis?

A

LV decompensation with CHF (left…then right)

…Or sudden death

29
Q

What is the pressure gradient in patients with calcific aortic stenosis?

A

> 40mmHg

30
Q

What is calcific aortic stenosis associated with? What percentage of patients have it?

A

CAD

2%

31
Q

What would a mitral valve prolapse murmur sound like?

A

Systolic click murmur

32
Q

What causes mitral valve prolapse?

A

Myxomatous degeneration/ballooning of mitral valve leaflets with elongation/thinning of chordae tendinae (+/- rupture with flail leaflets)

33
Q

What is cardiomyopathy?

A

Intrinsic myocardial disease

34
Q

What causes hypertrophic cardiomyopathy?

A

Genetics/mutations

35
Q

What causes pericardial disease to be life-threatening?

A

High pericardial sac fluid (cardiac tamponade)

Progressive pericardial space fibrosis (constrictive pericarditis)

36
Q

What is the effect of high pericardial sac fluid/progressive pericardial space fibrosis?

A

Critical compression of the heart

37
Q

What can cause high pericardial fluid?

A

Pericarditis
CHF
Neoplastic infiltration
Gross blood (hemopericardium–usually ruptured MI, retrograde rupture of aortic dissection, penetrating chest trauma)

38
Q

How common are cardiac neoplasms?

A

Rare

39
Q

What are the problems with atrial myxomas? Where are they usually?

A

They block atrioventricular valves…Or embolize

Left atrium

40
Q

What tumor should be looked for in children with tuberous sclerosis?

A

Rhabdomyomas

41
Q

What part of the heart is most common site of metastatic cancers?

A

Pericardium

42
Q

What type of cancer is most likely to metastasize to the heart?

A

Breast cancer

43
Q

What are congenital heart diseases?

A

Look in embryology…

44
Q

What are some symptoms of cardiac disease?

A 
Dyspnea on exertion (DOE)
Chest discomfort/pain with exertion
Edema/JVD/Congestive hepatomegaly/ascites
Syncope
Fatigue
Cyanosis
45
Q

What usually causes DOE?

A

LHF with secondary pulmonary congestion/edema

46
Q

What can myocardial ischemia (angina) secondary to CAD cause?

A

Chest discomfort/pain on exertion

47
Q

What causes all the various forms of edema?

A

RHF with secondary elevated systemic venous/portal pressure

48
Q

What can result from hypotension from arrhythmias or acute pump failure?

A

Syncope

49
Q

What can cause fatigue?

A

Reduced cardiac output

poor peripheral perfusion

50
Q

What can cause oxygen saturation to be <85%?

A

Severe heart failure

R–>L shunts

51
Q

What 4 (6) things should ALWAYS come to mind when a patient presents to the ED with chest pain?

A 
Tension pneumothorax
Aortic dissection/rupture
PE
MI
...Pneumonia
...Esophageal rupture/mediastinitis
52
Q

What 10 things should ALWAYS come to mind when a patient presents to the ED with dyspnea/respiratory distress?

A

Choking
Anaphylactic shock (laryngeal edema/bronchospasm)
Bronchospasm (especially status asthmaticus)
Acute pulmonary edema
PE
Tension pneumothorax/large pleural effusions
Pericardial tamponade
Pneumonia
Massive hemorrhage or acute hemolysis
Poison/toxin

53
Q

What tests should be done on patients concerned with chest pain/dyspnea?

A 
Pulse Ox
EKG
CXR
Echo
CT/MR with angiography
Lab studies
54
Q

What lab studies should be done for patients concerned with chest pain/dyspnea?

A 
Serum Troponin
CK-MB
D-dimer
Hemoglobin
BNP/pro-BNP
Arterial blood gases
55
Q

What does CK-MB indicate?

A

Myocardial necrosis…less specific than troponin

56
Q

Why would oxygen have to be looked at in the arterial blood gases if the patient is hooked up to the pulse ox?

A

Patient can be hypoxemic with normal oxygen saturation

57
Q

What would cause a patient to have hypercarbia?

A

Alveolar hypoventilation (from COPD)

58
Q

What typical co-morbidity is associated with hypothyroidism?

A

Hyperlipidemia

59
Q

What typical co-morbidity is associated with hyperthyroidism?

A

HTN

CV diseases (2 decks)

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