CARDIO Flashcards
the base of the heart is formed by?
Atria (upper chambers of the heart)
The apex of the heart is is the pointed end of the heart, it is formed by what?
Left ventricle (lower chamber of the heart)
what is the fibrous pericardium described as
tough, inelastic and outter connective tissue
what is the function of the pericardium that protect the heart?
anchor in place
prevents it from over stretching
why is the right ventricle of the heart thinner than the left?
because it pumps blood to the lungs while the left ventricle pumps blood to the entire body..
what is thinner and what is thicker? in regards to atria and ventricles
atria are the thinnest because they empty their contents into the ventricles
ventricles are thicker because they have to move blood out of the heart.
What does the superior and inferior vena cava do?
BOTH drain deoxygenated blood from the upper and lower body into the right atrium
what does the coronary sinus do?
drains deoxygenated blood from the coronary veins into the right atrium
what does the pulmonary trunk and pulmonary artery do?
blood is pumped from the right ventricle into the pulmonary trink which then branches into the pulmonary arteries that then carry this deoxygenated blood into the lungs to be oxygenated
what does the aorta do
carries oxygenated blood to the entire body from the left ventricle
prior to blood being oxygenated, what is the route that blood flows?
deoxygenated blood enters the heart via the superior and inferior vena cava or coronary sinuses, drains into the right atrium, empties into the right ventricle, then pumped to the lungs via the pulmonary trunk and left/right pulmonary arteries to be oxygenated.
after oxygenation of blood, what happens?
blood is pumped into the heart by the pulmonary VEIN into the left atrium, which empties into the left ventricle and pumped through the body via the aorta.
where does cardiac excitation normally begin?
Sinoatrial (SA) node
what is the electrical route of the heart
begin- Sinoatrial node (SA)
Atria (bachmanns bundle) - contraction
Atrioventricular node (AV)
AV bundle branches (bundle of his)
Right/Left Bundle branches
Purkinje fibers
What are arteries?
thick, vessels that carry blood away from the heart
what are capillaries
they are known as exchange vessels
what are veins?
return deoxygenated blood to the heart to be oxygenated
- they contain about 64% of total volume of blood
the slowest rate of blood flow takes place where
capillaries
what is vascular resistance
opposition to flow. Which depends on;
- Smaller lumen results in greater resistance
- greater vessel length (weight gain)
- higher viscosity (higher hematocrit) - maple syrup vs water
what are the four principle branches of the aorta?
the ascending aorta
arch of the aorta
thoracic descending aorta
abdominal descending aorta
A pattern of disorganized and out-of-sync depolarization among the cells in the heart is what?
fibrillation
the part of the cardiac conduction system that distributes the depolarization wave through the walls of the ventricles is what?
purkinje fibers
specialized cells in the heart that can spontaneously depolarize and act as the pacemaker, and transmit that signal to other areas of the heart is what?
cardiac conjuction system
the second node in the cardiac conduction system, which DELAYS the depolarization wave of a fraction of a second before sending it on to the inferior part of the heart,
atrioventricular node
the head pacemaker of the heart, with the leakiest membranes and therefore the fastest intrinsic rate
sinoatrial node
the part of the cardiac conduction system that quickly carries the signal down through the ventricular septum
atrioventricular bundle
the cavity between the lungs in which the heart sits
mediastinum
one of the superior chambers of the heart
atrium
one of the inferior chambers of the heart
ventricle
the name for the path blood takes between the left ventricle and right atrium
systemic loop
the simple squamous lining of the heart cavities, continuous with the lining of the blood vessels
endocardium
the difference in hydrostatic pressure between two areas that causes fluid to flow from the area of high pressure to the area of low pressure
pressure gradient
what is the name of the sac around the heart?
pericardium
coming from inferior and superior branches, this largest VEIN in the body brings blood from the systemic circuit back to the right atrium
vena cava
the middle layer of the wall of the heart made of cardiac MUSCLE tissue
myocardium
the name for the path blood takes between right ventricle and left atrium
pulmonary loop
the period of ventricular contraction, when ventricular pressures are high and they are pushing blood out
systole
the valve through which the left ventricle pushes blood
aortic semilunar valve
small, thin-walled blood vessels that allow materials like fluid and respiratory gases to enter and exit the blood stream
capillaries
the valve through which the right ventricle pushes blood
pulmonary semilunar
also called the left atrioventricular valve, the valve through which the left atrium pushes blood into the left ventricle
mitral vlave
also called the right atrioventricular valve, the valve through which the right atrium pushes blood into the right ventricle
tricuspid
the heart chamber that receives blood coming from the lungs via the pulmonary vein
left atrium
the inner layer of the pericardial sac, that is the outer part of the heart wall, and is also known as the visceral pericardium
epicardium
the blood vessels that carry either oxygenated or deoxygenated blood AWAY from the heart
arteries
the structures that allow blood to flow in one direction, but not in the other and make the lub-dub heart sounds
valve
the blood vessels that carry either oxygenated or deoxygenated blood TOWARD the heart
veins
the outer layer of the serous membrane surrounding the heart, it is also called the pericardial sac
parietal pericardium
the period of ventricular relaxation, when ventricular pressures are low and they are filling with blood
diastole
the largest artery in the body, this receives blood from the left ventricle and distributes it to the systemic circuit
aorta
the first korotkoff sound indicates what?
systolic
the LAST korotkoff sound indicates what?
Diastolic
not 2nd, 3rd 4th korotkoff sound. the LAST
While palpating the arteries in your physical exam what is the scale?
described on a scale from 0-4
0 - absent: not palpable 1 - Diminished: barely palpable 2 - Expected 3 - Full, increased 4 - bounding: aneurysmal
when palpating the extremities fr temperature and venous distention and edema. What is the scale for pitting edema?
1+ slight pit, disappears rapidly (2-3mm in depth)
2+ somewhat deep pit, disappears in 10 to 15 seconds(4-5mm)
3+ noticeable deep pit that lasts more than a minute(6-7mm)
4+ very deep pit that lasts 2 to 5 minutes (8-9mm in depth)
what is the clinical test for thrombosis?
homans sign
when testing for jugular venous pressure what is a value that is expected
a value less than 9cm is expected.
Anything above that indicates severe heart failure.
what is another term used to describe lower extremity swelling, reproducible lower extremity pain with excertion that resolves the pain with rest?
claudication
peripheral venous disease
if an s3 heart sound is heard upon examination, what is happening within the heart
early diastole (passive filling) vibration of ventricular walls
if an s4 heart sound is heard upon examination what is happening within the heart
Ventricular filling from atrial kick (late diastole) loss of compliance or increase stroke volume secondary to high output. (this is BEFORE s1)
wide apical pulsation may indicate what?
left ventricular hypertrophy. Loss of palpable apical pulsation may indicate fluid, air or displacement
If a thrill is found, what might this indicate
associated with failure of the semilunar valve to close, aortic or pulmonary stenosis, or atrial septal defect
loud S1 suggest what
increased blood velocity, mitral stenosis, heart block, hypertension or calcification of mitral valve
a loud s2 suggest what?
hypertension, valve disorder, stenosis or fluid
what is a friction rub defined as
pericardial sac inflammation
blood pressure is regulated by
relaxing or contracting of smooth muscles around the ARTERIOLES
What are the signs and symptoms of hypertension?
Stage 1 HTN: Sys <130-139 Dias- <80-89
Stage 2 HTN: Sys: >140 Dias: 90
BP MUST BE ELEVATED OVER 3 OR MORE SEPERATE OCCASIONS to be considered HTN
what is the treatment for hypertension?
First: life style modifications (yields moderate results)
2nd (first line): HCTZ 12.5-25 mg daily
- ACEI (first line): (end in pril) Lisinopril, 5-10mg daily
- ARB: Losartan 50mg daily
- CCB: Diltiazem 180mg daily or Amlodipine 2.6mg daily, titrate up to max dose of 10mg daily
- Alpha blockers: Terazosin 1mg once daily, titrate as needed based on patient response up to a 20mg daily in 1 or 2 divided doses
Complications of HTN/ Disposition
- Refer to MO to work up accompanying cardiovascular disease or secondary hypertension if just discovering it and have had 3-5 readings at qualifies as HTN
- REnew medication if well controlled
- Should have blood work done (CHEM) every year to evaluate for kidney dysfunction
What is a hypertension urgency?
- SBP >220 OR DBP >125
- NO SIGNS OF END ORGAN DAMAGE
- Blood pressure must be reduced within a few years
What is the treatment of HTN Urgency?
- Goal is reducing DBP <110 over 24 hours, Use PO medications
- Already on one- Re-initiate it, if dose is unknown then give HCTZ 25mg PO
- NOT ON ANTI-HYPERTENSIVE AGENT: initiate oral alpha beta blocker or beta blocker. (clonidine or labetalol is typically used as first line)
Alpha Blocker- Clonidine (primary treatment) - initial dose= 0.1 -0.2 then 0.1 mg every hour 0.8 mg orally
Beta Blocker - Selective blocker = metoprolol 50mg twice daily
non-selective - Labetalol = 100mg twice daily
-
What is a hypertensive emergency
- Blood pressure is usually strikingly elevated >130 DBP but correlation between pressure and end organ damage is poor
- SIGN OF END ORGAN DAMAGE OCCURING
What are the signs of end organ damage is occurring
- mental status change, confusion, headache
- intracranial hemorrhage
- Ischemic stroke
- Hypertensive nephropathy (proteinuria, hematuria, and progressive kidney dysfunction)
- Unstable angina, AMI, CHF, Aortic dissection
- ## Pulmonary edema
What signs are you looking for in a hypertensive emergency when doing your neuro and cardio exam?
- Neuro: deficits, mental status change, change in vision, headache, nausea/vomiting
- Cardio: Heart failure (S3, new murmurs), auscultate for carotid bruits, pulmonary edema (rales, crackles), complaints of sudden onset SOB, Chest pain
- Fundoscopic: Looking for papilledema or hemorrhage
What is the treatment for Hypertensive emergency
Establish IV
- O2 if < 94%
- monitor with telemetry
- LABETALOL 20mg IV
- Once stable, start metoprolol 25-50mg PO twice daily
- Closely monitor whatever end organ was damaged
What are the S/SX of Coronary Artery Disease?
- Angina
- Left shoulder pain
- indigestion
- N/V
- Pale
- Diaphoresis
- NEW HEART MURMUR
- Rales on expiration
- S3/S4 present
- Sudden Cardiac death
What is the treatment of CAD
Life style changes: Low fat diet in fruits in veggies
SMOKING CESSATION, Moderate use of alcohol, Control HTN, diabetes, and hypercholesterolemia
- HMG-CoA (Lipid lowering - STATINS)
Atorvastatin (10mg before bedtime, titrate to a maximum dose of 80mg before bed)
-INHIBITORS: Simvastatin 10mg - ANTIPLATELET- Aspirin 81mg daily
- SURGICAL - Coronary Artery Bypass Grafting (CABG), stenting, primary percutaneous coronary intervention
what is the electrical structure of the heart?
Starts: SA node –conducted through–> The atria [causes contraction] —>Atrioventricular node (AV) —> AV bundle of his –> R/L Bundle branches —> Purkinje fibers
What does the P wave represent
Atrial depolarization
What does the QRS complex represent
Ventricular depolarization (masks atrial repolarization due to size)
What does the T wave represent
ventricular repolarization
what is the cardiac output formula?
stroke volume x heart rate
- 70ml/beat x 75 beats/min
= 5250 ml/min or 5.25 L/min
which has the larger lumen? Arteries or veins
Veins
what are the four principle branches of the aorta
the ascending aorta
arch of the aorta
thoracic descending aorta
abdominal descending aorta
what artery supplies the right side of the head and neck
right carotid artery
right subclavian artery
what artery supplies the shoulder
axillary artery
what supplies the upper arm
brachial artery
what supplies the lateral portion of the forearm, wrist and hand
radial artery
what supplies the medial portion of the forearm, wrist and hand
ulnar artery
what does the thoracic aorta supply
- bronchial arteries
- esophageal arteries
- posterior intercostal arteries
- superior phrenic arteries
what does the abdominal aorta supply
Celiac trunk
(which further branches but itll make this flash card too long)
- superior/inferior messentric artery
- suprarenal
- renal
-Gonad
- common iliac arteries branching to form the abdominal aorta
the external illiac arteries supply
lower limbs
internal iliac arteries supplies what
supplies pelvis
what are the three systematic veins that carry deoxygenated blood to the heart
coronary sinus
superior vena cava
inferior vena cava
what are the three main veins that drain blood away from the head
internal jugular
external jugular
vertebral veins
what are the principle veins that drain the upper body (deep)
radial - lateral forearm
ulnar - medial forearm
brachial - drain forearms, elbow joints, arms
axillary - arms, axillae, upper chest wall
subclavian - arms, neck, thoracic wall
what are the veins that drain the abdomen
hepatic portal (blood drains from the GI tract and spleen into hepatic, then to the liver to be processed and returns to systemic circulation through hepatic vein)
what are the principal veins that drain the lower body (deep)
posterior tibialis
anterior tibial veins
popliteal
femoral
what is the normal heart rate
around 75 bpm
below 60 bpm is called?
bradycardia
above 100 bpm is called what
tachycardia
what are the benefits of exercise
maintain low resting heart rate BETTER BLOOD PRESSURE CONTROL decrease anxiety and depression controls weight INCREASES OUR BODYS ABILITY TO DISSOLVE BLOOD CLOTS BY INCREASING FIBRINOLUTIC ACTIVITY
What is regular exercise considered to be
at least 20 minutes, 3-5 times weekly is essential to improve overall cardiovascular health
Patient is known to have a history of HTN and presents with the following symptoms, Palpitations Dyspnea on exertion Lightheadedness and chest pain. The following (see photo) was found on the ECG tracing. What is likely the cause for the patients chest pain based off of the ECG?
Atrial Fibrillation
This is typically associated with Pulmonary disease, what type of ECG is shown in the picture?
Atrial flutter
Patient came in for a physical and needed an ECG completed. Upon examination of the ECG below, what is the patient exhibiting? And What is the treatment
1st degree AV block
-None warranted as it will not progress to any further arrhythmia or AV block.
Patient came to medical due to feeling light headed and dizzy. When you took vitals you noticed that their heart rate was 48 bpm and decided to get an ECG. In the photo is your results, what is the diagnosis?
2nd degree AV block
Patient presents with chest pain and fatigue. Below are the results of the ECG, What is the diagnosis?
Type II 2nd degree AV block
What is the diagnosis for the ECG presented in the photo? It it often times associated with sudden cardiac arrest
3rd degree AV block
Patient presents with acute onset of palpitations, mild chest pain and shortness of breath. You conducted an ECG and the results are pictured, what is the diagnosis?
Paroxysmal Supraventricular Tachycardia (PSVT)
Patient presents with palpating and dizziness. You decide to obtain an ECG and pictured below are your results. What is the diagnosis?
Premature Ventricular Contraction (PVC)
What is the diagnosis for the ECG strip below?
Torsades de Pointes
Patient is found unconscious with no pulse and the ECG shows the following. What is the diagnosis?
Ventricular fibrillation
What is the diagnosis for the ECG below?
Ventricular tachycardia
What is the diagnosis for the ECG shown below?
Sinus Tachycardia
Leads I, aVL, V5-V6 represents
lateral aspect of the heart and receives blood from the LCx.
Leads II, III, aVF represents
the inferior aspect of the heart and receives blood from the RCA.
Leads V1-V2 represents
the septal area of the heart and receives blood from the Left Anterior Descending Artery (LAD)
Leads V3-4 represents
the anterior area of the heart (in particular the LV) and receives blood from the LAD.
How is a left bundle branch block identified?
Identified by having a wide QRS complex (greater than 0.12 seconds) along with a broad S wave in lead V1 and wide R wave in lead V5 or V6
What is the diagnosis based on the ECG strip below? Patient is lightheaded with a pulse of 45bpm
Sinus bradycardia
If a patient has unstable sinus bradycardia what is the treatment?
1st give Atropine 0.5 mg IV push and repeat q 3-5 minutes for a maximum of 3 mg
What is the treatment for PSVT?
ABCs, IV, Vitals, Monitor, Oxygen if saturation < 94%
Particular effort should be made to terminate an attack if unstable via cardioversion.
Mechanical Measures should be attempted if patient is stable:
-stimulate the vagus nerve and increase vagal tone
If stable and mechanical measures do not work, give 6mg IV Adenosine or Metoprolol 5 mg (beta blocker)
If you are palpating and feel heaves/thrills what is this indicative of?
Aortic Disection
What positions will the patient be in when you listen for heart sounds?
Sit/Lean forward
Supine
Left Lateral Recumbent
Is an S3/S4 heart sound commonly heard in kids?
Yes
How will you characterize a murmur
Systolic/diastolic, timing and duration, pitch, location, radiation and is there a snap?
Where do you auscultate for bruits?
Temporal Carotid Femoral Abdominal Renal
Bilateral edema is a sign of what
CHF
What is the average pulse pressure range
30-40 mm mercury
In a color Doppler, blood flowing toward the probe is what color
Red
Away is blue
How will cardiac tamponade appear in an ultrasound
Hypo-echoic
How many times must a person have high blood pressure in clinic before you diagnose with HTN
3 to 5
What stimulants can cause stage II HTN
PSEUDOFED Coccaine Caffeine NSAIDS Contraceptives As well as hypothyroidism
What is the MOA of a diuretic?
Reduce plasma volume
What is the goal when attempting to lower blood pressure in a hypertensive emergency?
Lower 25% within 1-2 hours and <160/110 within 24 hours
If a person has an uncomplicated cardiac contusion what are you going to do
ECG/EKG monitor for 6 hours and then another at 24 hours
What is the most common cause of acute arterial limb occlusion of a limb?
Atrial fibrillation
What is the treatment for acute arterial limb occlusion
Enoxaparin 1mg/kg (lovenox)
If you have diagnosed someone with occlusive cerebrovascular disease what is important to do in regards to their blood pressure
SBP can be maintained at 180 in most situations (think of this like a stroke)
Primary prevention of hyperlipidemia is the use of ASCVD scale, if someone who is 40-79 has a >10% risk what is your treatment plan
Aspirin and initiate a statin
if they are >5% then only a statin
High triglycerides can precipitate what?
Pancreatitis
When looking at an ECG/EKG what is the difference between seeing ST depression and an ST Elevation
Depression = ischemia Elevation = Infarction (tissue death)
What is Identified by having a wide QRS complex (greater than 0.12 seconds) along with a broad S wave in lead V1 and wide R wave in lead V5 or V6
Left bundle branch block
What is the treatment for unstable bradycardia?
Atropine 0.5 every 3-5 minutes up to 6 doses and if medication is ineffective then transcutaneous pacing
How do you identify PSVT
Heart rate is greater than 150 up to 240, narrow QRS and no p wave
What can you do for stable PSVT
Vasovagal maneuvers
- carotid massage
- face in an ice bucket
- valsalva (pop ears)
How do you treat unstable PSVT
Cardio version
Adenosine or beta blocker (metoprolol)
What is significant in an EKG of someone who has WPW
Delta wave is present
What are some predispositions of A-fib?
Rheumatic fever, HTN, pericarditis, CHF, excessive ETOH use, Excessive caffeine use
*A-fib predisposes patients to thromboembolic events.
What will you see in a EKG with someone who is experiencing A-fib
Atrial rate ~ 400 beats/min and presents as fibrillation waves (wavy baseline).
R-R interval is irregularly irregular
Patients with AF > 48 hours are at risk for cardioembolic events and should not be cardioverted until anti-coagulated for a minimum of _____weeks prior to attempting elective cardioversion.
Three
What is the defining feature of Ventricular tachycardia on an EKG?
Tombstone (Wide QRS complex)
Tachycardia, usually HR 160-240 beats/min.
Moderately regular R-R interval.
If you cannot feel pulses on someone what is the first thing you’re going to do
Start CPR
If you want to establish an airway can you stop compressions during CPR?
No, Compressions can only be stopped for a max of 10 seconds unless the AED is assessing/shocking
After 2 minutes of CPR what medication can you give
Epinephrine and if that doesn’t work then Lidocaine or Amiodarone
Doses:
Provide CPR for 2 minutes, administer Epinephrine 1mg IV push, consider advanced airway and capnography.
Provide CPR for 2 minutes, administer Amiodarone 300 mg IV push or
Lidocaine 1-1.5 mg/kg IV push.
Following second round of medications then start to evaluate causes of cardiac arrest looking at H’s and T’s. What are those H’s and T’s?
1) Hypovolemia
2) Hypoxemia
3) Hydrogen ion excess (acidosis)
4) Hyper-/hypokalemia
5) Hypothermia
6) Hyper-/hypoglycemia
7) Tamponade
8) Tension Pneumothorax
9) Thrombosis (pulmonary embolism)
10) Thrombosis (myocardial infarction)
11) Toxins
A type of Angina that is Rare, caused by coronary vasospasm often without any CAD.
Prinzmetal’s Angina
Acute Coronary Syndrome (ACS) comprise the spectrum of unstable cardiac ischemia from unstable angina to acute myocardial infarction what is the number one sign of ACE or AMI?
Substernal chest pain (#1 symptoms).
(2) Chest pain commonly described as pressure on chest (like an elephant is sitting on their chest).
(3) Chest pain can radiate to left shoulder, left arm, neck or jaw.
(4) Occurs at rest, commonly in the morning.
