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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
What can specifically cause atrioventricular valve problems?
CHF-->ring dilation | Ischemia-->papillary muscle dysfunction
26
What can connective tissue diseases--like rheumatoid arthritis--cause?
Valvular disease
27
What are some early features of calcific aortic stenosis?
Angina/dyspnea/syncope | High LV diastolic pressure-->high pulmonary capillary pressure
28
What are some late features of calcific aortic stenosis?
LV decompensation with CHF (left...then right) | ...Or sudden death
29
What is the pressure gradient in patients with calcific aortic stenosis?
>40mmHg
30
What is calcific aortic stenosis associated with? What percentage of patients have it?
CAD | 2%
31
What would a mitral valve prolapse murmur sound like?
Systolic click murmur
32
What causes mitral valve prolapse?
Myxomatous degeneration/ballooning of mitral valve leaflets with elongation/thinning of chordae tendinae (+/- rupture with flail leaflets)
33
What is cardiomyopathy?
Intrinsic myocardial disease
34
What causes hypertrophic cardiomyopathy?
Genetics/mutations
35
What causes pericardial disease to be life-threatening?
High pericardial sac fluid (cardiac tamponade) | Progressive pericardial space fibrosis (constrictive pericarditis)
36
What is the effect of high pericardial sac fluid/progressive pericardial space fibrosis?
Critical compression of the heart
37
What can cause high pericardial fluid?
Pericarditis CHF Neoplastic infiltration Gross blood (hemopericardium--usually ruptured MI, retrograde rupture of aortic dissection, penetrating chest trauma)
38
How common are cardiac neoplasms?
Rare
39
What are the problems with atrial myxomas? Where are they usually?
They block atrioventricular valves...Or embolize | Left atrium
40
What tumor should be looked for in children with tuberous sclerosis?
Rhabdomyomas
41
What part of the heart is most common site of metastatic cancers?
Pericardium
42
What type of cancer is most likely to metastasize to the heart?
Breast cancer
43
What are congenital heart diseases?
Look in embryology...
44
What are some symptoms of cardiac disease?
``` Dyspnea on exertion (DOE) Chest discomfort/pain with exertion Edema/JVD/Congestive hepatomegaly/ascites Syncope Fatigue Cyanosis ```
45
What usually causes DOE?
LHF with secondary pulmonary congestion/edema
46
What can myocardial ischemia (angina) secondary to CAD cause?
Chest discomfort/pain on exertion
47
What causes all the various forms of edema?
RHF with secondary elevated systemic venous/portal pressure
48
What can result from hypotension from arrhythmias or acute pump failure?
Syncope
49
What can cause fatigue?
Reduced cardiac output | poor peripheral perfusion
50
What can cause oxygen saturation to be <85%?
Severe heart failure | R-->L shunts
51
What 4 (6) things should ALWAYS come to mind when a patient presents to the ED with chest pain?
``` Tension pneumothorax Aortic dissection/rupture PE MI ...Pneumonia ...Esophageal rupture/mediastinitis ```
52
What 10 things should ALWAYS come to mind when a patient presents to the ED with dyspnea/respiratory distress?
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
What tests should be done on patients concerned with chest pain/dyspnea?
``` Pulse Ox EKG CXR Echo CT/MR with angiography Lab studies ```
54
What lab studies should be done for patients concerned with chest pain/dyspnea?
``` Serum Troponin CK-MB D-dimer Hemoglobin BNP/pro-BNP Arterial blood gases ```
55
What does CK-MB indicate?
Myocardial necrosis...less specific than troponin
56
Why would oxygen have to be looked at in the arterial blood gases if the patient is hooked up to the pulse ox?
Patient can be hypoxemic with normal oxygen saturation
57
What would cause a patient to have hypercarbia?
Alveolar hypoventilation (from COPD)
58
What typical co-morbidity is associated with hypothyroidism?
Hyperlipidemia
59
What typical co-morbidity is associated with hyperthyroidism?
HTN

CV diseases (2 decks)

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