CARDIO Flashcards
Innermost later of heart
Tunica Intima
2nd layer of heart, composed of smooth muscle
Tunica Media
Outermost layer of heart
Tunica externa
ANONG LAYER LANG MAKIKITA SA CAPILLARIES
TUNICA INTIMA
WHO CREATE PULSES
ARTERIES
WHO CREATE PULSES
ARTERIES
ONLY SHOCK NA DEC AND HR
SHOCK RELATED TO BLOOD VESSEL
SHOCK RELATED TO BLOOD VOL
NEUROGENIC
DISTRIBUTIVE/CIRCULATORY SHOCK
HYPOVOLEMIC SHOCK
NORMAL BLOOD LEVEL IN HEART
SHOCK NA POSITIONING IS INEFFECTIVE
5-6 L
OBSTRUCTIVE
PULSES GRADING (0-+4)
TAWAG SA CLOT NA DI NA NADIDISSOLVE
O- absent
+1 weak
+2 normal
+3 inc
+4 bounding
THROMBUS
ANEURYSM ARTERIAL OR VENOUS PROB
2 ARTERIAL INSUFFIENCY PROB
2 VENOUS INSUFFICIENCY
ARTERY OR VENOUS PROB SA BUERGERβs?
ARTERIAL
ARTERIOSCLEROSIS OBLITERANS
RAYNAUDβs
VARICOSE
DVT
BOTH
SCLEROSIS MEANS
HARDENING
CARDIOMYOPATHY
1. Type na rx factor is viral, alcohol, pregnancy
2. Type na rx factor is autosomal dominant 50%
3. What type ung infiltration of fibrous and adipose tissue
- Dilated
- Hypertrophic, Arrhythmogenic, Restrictive
- Arrhythmogenic
CARDIOMYOPATHY
1. What type ung binablock ni aorta lahat ng oxygenated blood
2. What type ung rigid and may emboli
3. What type ung may fibrosis and necrosis
- Hypertrophic
- Restrictive
- Dilated
2 sx ng dilated cardiomyopathy
Hypertrophic cardiomyopathy sx
CARDIOMYOPATHY general sx
2 sx ng dilated cardiomyopathy
Asymptomatic
- Low O2
- HF sx
Normal BNP? Severe level?
Bat bawal strenous activity sa cardiomyopathy
<100 ; >900
Aggravate ung pagkaipit ng aorta
San pede magka AORTIC ANEURYSM and anong maririnig and feel
Thoracic AA and Abdmonal AA
Thrill and bruit
AA
1. main rx factor
2. Pain reliever ba binibigay
- High bp
- Narcotics
AA types and mngt
1. Descending/ Baba
2. Ascending
- Type B- control BP
- Type A- surgery
AA types of severe pain (impending sign of rupture)
1. Ascending
2. Thoracic
3. Abd
- Severe chest pain
- Severe epigastric pain
- Severe low back pain
Choose if Arterial or Venous insufficiency
1. Leg pain
2. Dark cyanotic pigmented thick skin
3. Small but deep ulcer w well circumscribed edges
4. No granulation tissues
5. Normal pulse
6. Pale thin skin
7. Elevate position
8. With edema
9. W intermittent claudication (more painful)
10. Ischemia
11. Congestion and phlebitis
- Both
- V
- A
- A
- A
- A
- V
- V
- A
- A
- V
DVT and Buergerβs other term
Venous thromboembolism
Thromboangitis obliterans
DVT and Buergerβs other term
Venous thromboembolism
Thromboangitis obliterans
Anong dse lang and UE ang affected
Raynaudβs
ARTERIOSCLEROSIS OBLITERANS
1. Etio
2. More common gender
3. Best dependent position
4. Meds
- Plaque hardening
- Men
- R. Trendelenburg
- Cilostazol and antiplatelet
- Sound if sira valves, inc turbulence in blood flow inside heart
- AV valve sound
- SL valve
- S3 sound
- S4 sound
- Murmur
- S1 lub
- S2 dub
- Ventricular gallop (lub dub dub)
- Atrial systole (lub lub dub)
- Inability of valves to close completely w V. Regurgitation
- Inability of valves to open completely
- Bulging/ballooning of mitral onto left atrium
- Valvular insufficiency
- Valvular stenosis
- Mitral valve prolapse
Mitral valve prolapse 2 sx
- Mitral regurgitation
- Dysthymias (systolic/ mitral click)
Compression of heart Caused by fluid collecting in pericardial sac
CARDIAC TAMPONADE
CARDIAC TAMPONADE cause ng acute and chronic
Acute- trauma, Chronic- Pericarditis
CARDIAC TAMPONADE ECG and TX
QRS complexes
Pericardiocentesis
Abnormally dilated tortous superficial veins dahil incompetent ung valves so irreversible
VARICOSE VEINS
VARICOSE VEINS prevention
Elevate, compression stocking
VARICOSE VEINS treatments
1. Vein is sini sealed/didikit
2. Uses laser fiber tips
3. Removal of superficial varicosity
4. Injection of chemical
5. For large veins using gen anes
6. Uses local anes
- Thermal ablation
- Laser therapy
- Microphlebectomy
- Sclerotherapy
- Ligation and stripping
- Ambulatory phlebectomy
Post op instruction after varicose veins interventions
Early ambulation
clot in deep veins (etio: Virchowβs triad)
DVT
Virchowβs triad
- Hypercoaguability
- Endothelial wall damage
- Venous stasis
Assessing Homanβs sign consideration
Wag ulitin (dislodge)
DVT def test
Angiography
DVT if may pulmonary embolism na intervention
- Semi F
- Low flow 02
- Report
Arterial vasospasm, blue-white-red dse
RAYNAUDβs
RAYNAUDβs
1. Upper or lower extremities
2. Pede babad hand sa heat?
3. Iwasan ang anything na nagpapa __
4. DOC
5. Phenomenon causes
- Eto lang ang upper
- No (disturbed sensory perception)
- Nagpapa vasoconstrict
- Diltiazem
- RA, SLE, SCLERODERMA
Scleroderma CREST syndrome
- Calcinosis
- Raynaudβs phenomenon
- Esophageal dysmotility
- Syndactyly
- Telangiectasia
Aka thromboangitis obliterans where both arterial and venous insufficiency
BUERGERβs
BUERGERβs
1. No. 1 rx factor
2. Common to what gender
3. anything na nagpapa__ is bawal
4. Massage pede?
5. Cross leg pede?
- Smoking
- Men
- Vasoconstrict
- No
- No
ENDOCARDITIS
1. 2 types
2. Causes
3. Sx
4. Rx for what shocks
- Infective (mc). Noninfective (inflammation lang)
- Dental visits, GABHS, heart surgeries
- FROM JANE (fever. roth spots. Osler nodes. Murmur. Janeway lesions. Anemia. Nail bed/splinter/ hemorrhage. Emboli)
- Cardiogenic and septic shock
ENDOCARDITIS
1. Consideration prior dental visits
2. Antibac of choice
3. Bat green ung vegetation
4. Oral care instruction
- Prophylaxis
- Penicillin, if wala erythro, amox or azithro
- May pus, platelets, fibrin, microthrombi, WBC
- Brush 2x a day NO FLOSSING
PERICARDITIS
1. Type of chest pain
2. compli and its triad
- Pericardial chest pain (at 4th ICS Left parasternal, worsens at deep Inspiration relieved pag orthopneic position. Creaky/ scratchy/ grating/ leathery sound)
- Cardiac tamponade aka pericardial effusion (jugular vein distention. Muffled heart sounds. Pulsus paradoxus)
PERICARDITIS
1. Cause
2. Drug
3. Drain fluid sa heart sac
- HAIR (heart attack/MI. Autoimmune dses. Infection. Renal failure)
- Indomethacin and ASA. Prednisone if severe na
- Pericardiocentesis
HYPERTENSION
1. Anong organs affected
2. How to Confirm the dx
3. Kilala as__ bc__
4. Sx
- Multi organ dysfxn
- 2 consecutive readings 1 wk apart. SBP +30, DBP +15
- Silent killer, asymptomatic
- Head ache, dizziness, epistaxis, angina, retinopathy
HYPERTENSION
1. Ecg
2. value ng elevated, stage 1 &2, HPN crisis
3. 2 Labs
4. Oral contraceptives nakaka cause?
5. Nationality cause
- Tall R peaks
- Elevated: 120-129/80 or less. Stage 1: 130-139/80-89. Stage 2: 140/90. HPN crisis: 180/120
- BNP and Cholesterol panel
- Yes
- African American
HYPERTENSION
1. Ace inhibitors SE
2. Beta blockers caution 4Bβs
3. Short acting and long acting ng CCB
4. Diuretics given at sino ung pang maintenance
- ACE (angioedema, cough, electrolytes imbalance: low NA, high K)
- Bradycardia, Bp low, breathing probs, blood sugar high)
- Long acting is diltiazem and verapamil, dipines short acting
- Spironolactone. Furosemide, Hydroclothiazide (maintenance), Metazone
HYPERTENSION
1. Hydralazine and NTG bawal ibigay together with?
2. 2 anticlogging and considerations
3. Nag dizzy gagawin
- Viagra/sildenafil
- Antiplatelets ASA and clopidogrel (bleeding). Statins (liver toxic NO grapefruit)
- Check BP bc pede rin hypotension
HYPERTENSION
1. ARBS how to take
2. Acts on alpha 2 centrally acting and SE
3. -zosins consideration
- W meals (GI toxic)
- Clonidine methyldopa (drowsy so bedtime take)
- NO warm shower. NO prolonged standing bc nakaka orthostatic hypotension
Choose between MI and Angina
1. Reversible
2. Timing more than 30 mins
3. Rest and NTG relieving factors
4. Pede atypical (no sx) like in elders
5. Radiates to left shoulder, arm, neck, jaw
6. Common to men
- A
- M
- A
- M
- Both
- Both
Types of angina and mngt
1. No sx
2. Levine sign
3. Atherosclerosis/ pre infarction
4. Inc cardiac workload
5. Dt coronary vasospasm
- Silent ischemia
- Intractable
- Unstable: NTG and O2
- Stable: rest and SEMI F
- Prinzmetal: NTG and O2
CAD Common artery affected
LEFT ANTERIOR DESCENDING BRANCH
MI ECG
1. Injury
2. Infarction
3. Ischemia
4. Old MI/scar
- ST depression
- ST elevation (early)
- T wave inversion
- Pathologic Q wave
2 types of MI
- STEMI
- NSTEMI (atypical)
MI cardiac enzyme/markers
1. Most specific
2. Most reliable/ sensitive, 2nd na tataas
3. Pinakalate tataas
4. PROTEIN NA Unang tataas (2 hrs)
5. Taken q 6h, Tells if panecrosis nang panecrosis
6. Non specific kasi released din ng skeletal muscles
- CK MB
- Troponin
- LDH
- MYOGLOBIN
- CK MB
- LDH & TOTAL CK
MI
1. when continue ang therapies
2. Avoid what med
- Depende sa cardiac rehab if kaya na ng 2 flights of stairs with NO SOB
- NSAIDS
AFTER MI meds
- Heparin, antiplatelets like ASA and clopidogrel, statins
- BB
- CCB
- DILATORS like nitroprusside, NTG, Hydralazine
Discharge meds MI
- Ace as first choice
- ARBS
ANGINA
1. Med for chronic angina
2. Rx fo cardiogenic shock what position
3. avoid__
4. Surgical intervention
- Ranolazine
- Modified tren
- Valsava maneuver and lifting
- percutaneous transluminal coronary angioplasty (PTCA)
Cath Lab
1. included dito na surgeries
2. May contrast?
3. 3 Affected
4. Hrs ng NPO
- Angiography, angiogram, CABG
- Yes
- Kidney (crea >1.3 bad. Urine <30 ml/h bad. STOP metformin before and after. Pulse (diminished 4-12h). Bleeding
- 6-12 hrs
Compli ng MI and prio intervention
- HF- IV diuretics
- Cardiogenic shock- defib (- pulse) or cardioversion (+ pulse)
anong NTG form if unstable and stable angina
- Unstable angina- NITRO PATCH (1x daily, yes shower, rotate loc daily, no sa hairy callous skin, nalaglag? Tane nitro pill/spray and new patch 40-60 mins. Loc is sa subclavian/arm,upperchest)
- Stable- pill/spray (take before strenous exercise, replace q 6 mos, no sa pocket yes sa purse
CABG
1. veins bawal
2. type of anes
- Subclavian/ jugular dat ung di masyadong need
- General anes bc open heart surgery
MNGT FOR MI
MONA TASS
1. Morphine (constipation
2. O2
3. NTG
4. antiplatelet (ASA)
5. Thrombolytics
6. Anticoag
7. Stool softener
8. Sedatives
2 stress tests and considerations
- Treadmill stress test (stop of chest pain and ST elevation)
- Nuclear Pharmacological stress test (24-48h before bawal stimulants and meds tas NPO 4 h before and after
VALVE DISORDERS
1. CAUSE
2. meds
3. 3 surgeries
4. Avoid__
5. 4 types
- Anything damages the heart
- Anticoag, antiplatelet, NTG
- Valvular replacement. Valve replacement. Valvuloplasty
- Dental procedures 6 mos after
- Aortic Stenosis. Mitral stenosis. Aortic regurgitation. Mitral regurgitation.
Compensations of valve disorders
- VS- cardiomegaly and murmur
- MVP- cardiomegaly and systolic/mitral click
HF
1. no. 1 rx factor
2. RSHF cause
3. LSHF cause
- HPN
- Non cardiac (pulmonary embolism, pulmonary HPN, LSHF)
- Cardiac (MI, CAD AND ACS)
Hemodynamic monitoring normal values and what type of catheter
2-8 mmHg. Swan Ganz Pulmonary Artery catheter
HF: Pulmonary edema crisis intervention
HOPE
1. HOB 45 or higher/ orthopneic
2. O2
3. Push furo + morphine + positive inotropes
4. End sodium (oral and IV)
ABCDDD na nagpapa dec ng cardiac workload
- ACE and ARBS
- BB
- CCB
- DIGOXIN
- DILATORS
- DIURETICS
Considerations in giving ACE
- avoid preg
- Angioedema
- Cough
- Elec imbalance (HIGH K, low Na)
Considerations in giving BBs
ARBS
- 4Bβs
- Bradycardia
- Blood sugar high
- Breathing probs
- Bad for HF pts
- ++ Avoid pregnant and elec imbalance din
- GI toxicβw meals
Considerations in giving CCB
- dec HR sila ni ARBS si ACE lang hindi
- Diltiazem and verapamil are long acting
- Dipines are short acting
Considerations in giving Diuretics
- K wasting (furosemide, Hydrochlothiazide, Metolazone) eat high in K like fruits and green leafy
- K wasting ass for sulfonamide hyper sensitivity
- Spironolactone (K sparing) avoid salt substitutes
Considerations in giving Dilators (NTG, Hydralazine, Nitroprusside, Isosorbide)
- Amber color
- No viagra/sildenafil
- X stock marami dali expire usually 6 mos, No pocket yes purse. 3 tabs x 5 mins
Considerations in giving Digoxin
- inotropic and (-) chronotropic so check BP and dec HR
- BAWAL SABAY sa BB and Amiodarone (dec HR)
- Apical pulse. Withold <60
- Toxic >2
- Potassium <3.5 toxic (nagretain digo)
- Vanda SE (Vision, Anorexia, NV, Diarrhea, Arrhythmia)
- Digibind
S3 and S4 seen at?
S3- C H F
S4- Hypertension (syllable)
HF classes (1-4)
Class 1: no limitation
Class 2: slight
Class 3: marked
Class 4: sx present even at rest
EKG and tx: Less than 60 bpm
Sinus Bradycardia. Atropine ONLY if c sx
EKG and tx: QRS no P wave
Vfib. Defib & LAP (Lidocaine, Amiodarone, Procainamide)
EKG and tx: tombstone pattern
Vtach. Defib if NO PULSE, WITH PULSE (Cardioversion)
EKG and tx: No P wave
Afib. Cardioversion, Digoxin, Warfarin
EKG and tx: sawTooTh
Atrial flutter. Same mngt c Afib
EKG and tx: Superfast
Supraventricular tachycardia.
1. Vagal maneuver (cause ng bradycardia)
2. RAPID PUSH OF ADENOSINE
3. cardioversion
EKG and tx: Dt low Mg
Torsades de Pointes. Magsul
EKG and tx: Flatlined
Aystole. Epi/Atropine + CPR (βdefib)
Key terms
1. P wave
2. QRS wave
3. Chaotic/unorganized
4. Bizarre
5. Sawtooth
- Atrial
- Ventricular
- Fibrillation
- Tachycardia
- Flutter
seconds ng EKG
1. PR interval
2. QRS
- 0.10-0.20
- <0.12
Heart sounds memory trick
All Pigs Eat Too Much
- AORTIC (2nd ICS, R sternal)
- PULMONIC (2nd ICS, L sternal)
- ERBβS (3rd ICS, L sternal)
- TRICUSPID (3-4th ICS, L sternal)
- MITRAL (5th ICS, MIdclavicular)
5 EKG placement
1. black
2. Red
3. White
4. Green
5. Brown
- LU
- LL
- RU
- RL
- Middle
12 Lead ECG placement placement
V1 4th ICS RIGHT of the sternum
V2 4th ICS LEFT of the sternum
V3 between V1 &2
V4 5th ICS MIDCLAVICULAR line Mitral
level with
V5 level with V4 at LEFT ANTERIOR AXILLARY line
V6 level with V5 at left MIDAXILLARY line (directly under the midpoint of the armpit)
V4R 5th ICS, RIGHT midclavicular line