Cardio Flashcards
What does angina mean?
Chest pain due to reduced blood flow (ischemia) to the heart
The coronary arteries supplying blood to the heart itself have more than 70% stenosis (note: <70% stenosis would be asymptomatic and 100% stenosis/ blockage would be an MI)
What are the 3 causes of holosytolic murmurs (same level of loudness throughout systole)?
- Tricuspid Regurgitation
- Mitral Regurgitation
- VSD (Ventricular Septal Defect)
What defect produces a continuous, “machine-like” murmur?
PDA (Patent Ductus Arteriosus)
*The reason it is continuous is an open PDA means there is a shunt causing blood to flow from aorta—> pulm. Arteries. This is outside the heart, so not dependent on systole or diastole.
You’re listening to the heart at the 4 different valves. What are the landmarks of where to listen?
AORTIC- 2nd intercostal space on the patient’s right/ right upper sternal border
PULMONIC- 2nd intercostal space on the patient’s left/ left upper sternal border
TRICUSPID- left lower sternal border on the patient’s left
MITRAL- 5th intercostal space on the patient’s left, mid-clavicular line
Are systolic murmurs always pathological? Diastolic murmurs?
Systolic murmurs can be normal/ innocent in kids, young thin patients, and pregnant women.
Diastolic murmurs are always pathologic!
The main side effect of statins is myopathy. What does that mean?
Problems with muscles. Muscle fibers not functioning properly, muscle aches
What does myalgia mean?
Muscle pain (a major side effect of statins)
Some symptoms of pericarditis= fever, leukocytosis, high ESR (inflammation). What does leukocytosis mean?
High WBC count
What EKG changes are seen in acute pericarditis? How is this distinguished from ischemia like in an MI?
ST elevations all over the EKG (whereas, just in one heart region in ischemia) and/or PR depression
What is the most common cause of pericarditis?
A viral infection- often Coxachie
What does myopericarditis mean?
Myocarditis + pericarditis (patient has inflammation of the myocardium/ heart muscle AND the pericardium/ heart covering)
If a patient has an elevated JVP (jugular venous pressure), what does that tell you?
Fluid from the RA is getting backed up (because the jugular vein turns into the SVC and dumps into the RA). There’s increased pressure in the RA and some heart pathology going on (ex: pericarditis)
What EKG findings do you see in cardiac tamponade?
Low-voltage QRS (lower peaks) and electrical alternans
The electrical recording isn’t as strong because the heart is swinging around in fluid in the pericardial sac
What are the 3 layers of the pericardium (heart covering)? Other heart layers?
Fibrous pericardium—> parietal layer of the serous pericardium—> visceral layer of the serous pericardium a.k.a. Epicardium—> myocardium (heart muscle)—> endocardium (inner lining)
Which valves have chordae tendonae (heart strings attached to papillary muscles)?
The AV valves (tricuspid + mitral/bicuspid)
Conceptually, what does cardiac output (CO) mean? What is its equation?
CO is the amount of blood your heart pumps out per minute (L/min)
CO= SV * HR
Conceptually, what is stroke volume (SV)? What is its equation?
The volume of blood that gets pumped out (closely related to the contractility of the heart) SV= EDV- ESV (blood your heart is filled with at the end of diastole minus blood that’s still in your heart after it contracts in systole= blood that got pumped out)
Conceptually, what is contractility?
How hard the heart muscle squeezes (closely related to stroke volume, or SV)
Conceptually, what is myocardial oxygen demand?
How much oxygen/ energy the heart needs to do its work
Conceptually, what is preload? Afterload?
Preload- VOLUME of blood available to load into the LV before it gets pumped out
Afterload- PRESSURE the LV has to develop/ overcome to pump
Conceptually, what is ejection fraction (EF)? What is normal EF?
% of blood pushed out the LV with each heartbeat
Normal= about 55-60%
What is the ejection fraction (EF) formula?
SV/ EDV= (EDV-ESV)/ EDV
What’s getting pumped out over the total amount of blood the heart initially was filled with before it pumped
Conceptually, what is mean arterial pressure (MAP)? What are the 2 equations?
The average pressure in arteries during 1 cardiac cycle.
MAP= CO* Resistance (TPR or SVR)
…and…
MAP= 2/3 diastolic BP + 1/3 systolic BP
(*you can’t take the average BP like a normal mean bc 2/3rds of time is spent in diastole, 1/3rd in systole and you have to account for that)
What happens to BP and blood flow in (1) vasoconstriction and (2) vasodilation?
(1) vasoconstriction: increases BP; decreases blood flow
(2) vasodilation: decreases BP; increases blood flow