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Cardiovascular > Cardio Final > Flashcards

Cardio Final Flashcards

1
Q

A Congenital Heart Deft is…

A

An abnormality of the heart or great vessels which are present from birth

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2
Q

The two types of congenital heart defects are

A

cyanotic and acyanotic

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3
Q

A nickname for cyanosis is…

A

blue babies (eaLRy cyanosis)

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4
Q

Cyanosis is…

A

is a right-to-left shunt in which de-oxygenated blood is shunted into systemic circulation.

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5
Q

Does cyanosis require treatment?

A

yes, urgent surgical treatment or maintenance of a PDA

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6
Q

What are the 5 T’s of Cyanotic congenital heart disease?

A

Truncus arteriosus
transposition
tricuspid atresia
tetralogy of fallot
TAPVR

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7
Q

What is the nickname for acyanosis?

A

pink babies (LateR cyanosis)

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8
Q

Acyanosis results in

A

left to right shunts of oxygenated blood from the lungs back into the pulmonary circulation.

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9
Q

which is more severe - cyanosis or acyanosis?

A

cyanosis

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10
Q

is premedication needed for acyanosis?

A

no

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11
Q

what are the results of acyanotic defects

A

Volume overload or pressure overload

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12
Q

in regard to acyanotic defects, what are the types of volume overload?

A

ASD, VSD, PDA

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13
Q

in regard to acyanotic defects, what are the types of pressure overload?

A

AS, pulmonic stenosis, coarctation of the aorta

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14
Q

What causes chronic volume overload

A

left to right shunt, increases pulmonary vascular resistance, reversal direction of shunt flow, subsequent cyanosis

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15
Q

What is infective endocarditis?

A

a rare disorder that causes inflammation of the endocardium

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16
Q

What causes inflammation of the endocardium

A

exposure to bacteria through trauma
infection of the valves
arrythmias

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17
Q

FROM JANE pneumonic

A

Fever
Roth Spots
Osler Nodes
Murmur
Janeway Lesions
Anemia
Nail bed hemorrhage
Emboli

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18
Q

When is antibiotic prophylaxis indicated for infective endocarditis

A

-history of infective endocarditis
-prosthetic heart valve
-heart transplant with vavlular regurgitation
-unrepaired cyanotic heart disease
-repaired congenital heart defects with residual shunts or valvular regurgitation

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19
Q

What are some dental procedures the warrant antibiotic prophylaxis?

A

Manipulation of the gingiva
working in the periapical region
extractions
cleanings and SRPs
Fitting orthodontic bands
Placement of temporary anchoring devices
Biopsy
Sutures

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20
Q

What immunocompromised patients warrant antibiotic prophylaxis?

A

-patients with HIV whose T cell count is <200
-recipients of a bone marrow transplant
-patients suffering from neutropenia
-patients with a history of chemo
-patients with rheumatoid arthritis
-uncontrolled diabetics

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21
Q

Antibiotic prophylaxis guidelines

A

oral: amoxicillin 2g or 50mg/kg or azithromycin (500mg)
IM or IV: ampicillin or cefazolin(1g)

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22
Q

What is rheumatic fever?

A

Rheumatic fever is an autoimmune inflammatory process that develops two or four weeks after a strep throat infection

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23
Q

what are the major manifestations of rheumatic fever?

A

J(heart)NES
-Joint = migratory polyarthritis of the large joints
-Heart carditis of all three layers
-Nodules in the skin
-Erythema marginatum
-Syndenham chorea - a neurologic disorder with involuntary rapid movements

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24
Q

What is the diagnostic requirements for rheumatic fever?

A

evidence of streptococcus infection
two major criteria
one major + two minor criteria

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25
Q

What is the most common type of hypertension?

A

primary or essential

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26
Q

secondary hypertension is caused by what?

A

secondary hypertension is caused by another medical condition or medication

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27
Q

acute hypertension

A

acute hypertension is caused by physical exertion, anxiety or stress caused by physical exertion, anxiety, or stress
BP IS NORMAL ONCE STIMULUS IS REMOVED

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28
Q

Chronic Hypertension

A

high blood pressure that occurs with or without stimuli

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29
Q

White-coat stimuli hypertension

A

hypertension experienced in a healthcare setting and is common in older populations

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30
Q

what is the AHA categories of Blood Pressure?

A

Normal
Elevated
High - stage 1
High -stage 2
Hypertensive Crisis

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31
Q

Normal BP

A

Systolic: less than 120
AND
Diastolic: less than 80

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32
Q

Elevated BP

A

Systolic: 120-129
AND
Diastolic: less than 80

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33
Q

High - Stage 1 BP

A

Systolic: 130-139
OR
Diastolic: 80-89

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34
Q

High - Stage 2 BP

A

Systolic: 140+
OR
Diastolic: 90+

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35
Q

Hypertensive Crisis BP

A

Systolic: 180+
AND/OR
Diastolic: 120+

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36
Q

What are the risk of hypertension?

A

Obesity
Smoking
High sodium/alcohol diet
old age
family history
medications & disease (2ndary)

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37
Q

What are some medications used to treat HTN?

A

alpha blockers
alpha 2 agonists
vasodilators
peripheral adrenergic inhibitors
beta blockers
alpha and beta blockers
CCBs
Diuretics
ACE inhibitors
Angiotensin II Receptor Blockers

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38
Q

What are some oral side effects of HTN meds?

A

xerostomia
gingival hyperplasia
Angioedema and dry cough
bleeding gums

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39
Q

What are some management techniques for patients with hypertension? BP <160/100

A

Elective: none
Emergency: none

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40
Q

What are some management techniques for patients with hypertension? BP >160/100

A

Elective: if repeated, get clearance
Emergency: use stress management every 10-15 min

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41
Q

What are some management techniques for patients with hypertension? BP Systolic >180 snd/or diastolic >100

A

DEFER AND REFER TO PHYSICIAN

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42
Q

What is the classification of lipoprotein particles?

A

HDL
LDL
IDL
VLDL
chylomicrons

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43
Q

What is the cascade for hyperlipidemia and atherosclerosis?

A
  1. high levels of lipids in the blood
  2. build-up of fat deposits in the arterial walls
  3. displace endothelial cells from smooth muscle
    ***blocks nitric oxides vasodilatory effects
  4. increased risk for cardiac events
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44
Q

What are the classifications of angina?

A

stable = chest pain at exertion
unstable = chest pain at rest

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45
Q

what is ischemia?

A

the heart does not get enough oxygen but not enough to result in necrosis

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46
Q

What is the protocol for angina?

A

oxygen THEN nitroglycerin THEN aspirin

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47
Q

MI - myocardial infarction

A

is a heart attack
ischemia and necrosis

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48
Q

What is the most commonly occluded vessel in MI

A

Left anterior descending artery (LAD)

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49
Q

Can you provide emergency dental care within 6 months after an MI?

A

Yes

50
Q

When can elective dental care be resumed after MI?

A

after 6 months

51
Q

What is Turner Syndrome?

A

45 XO aneuploidy
it is a genetic disorder that affects the development of females
it is a missing x chromosome and is usually evident by age 5

52
Q

What are the dental signs of Tuner syndrome?

A

high arched palate
dental

53
Q

Trisomy 21

A

down syndrome
3 copies of chromosome 21

54
Q

Marfan’s syndrome

A

aortic root aneurysm/dissection
ectopic lentils
low levels of fibrillin
FBN1 gene on chromosome 15
long arms, legs, fingers, and toes

55
Q

DiGeorge Syndrom

A

Micro deletion of chromosome 22q11.2
cleft palate
hypocalcemia
thymic hypoplasia
80% with CHD

56
Q

Familial hypercholesterolemia

A

most common of the mendelian disorders
LDL has impaired transport and catabolism in the liver and develops skin xanthomas and premature atherosclerosis

57
Q

What are CMPs?

A

cardiomyopathies are diverse heart muscle disorder that affects myocardial systolic and/or diastolic function

58
Q

what are the types of CMPs?

A

Dialated CM
Hypertrophic CM
Restrictive CM
Arrhythmogenic CM
Unclassified

59
Q

What is dilated cardiomyopathy (DCM)

A

DCM is a progressive disease of the heart muscle that is characterized by ventricular chamber enlargement and systolic dysfunction. *** the right ventricle may be also dilated and dysfunctional

60
Q

what is the morphology of DCM?

A

large heart with all 4 chambers dialated

61
Q

what are the causes of DCM?

A

Genetic
Myocarditis
Toxins
Pregnancy
CV diseases
Idiopathic

62
Q

What is hypertrophic Cardiomyopathy (HCM)

A

A heritable autosomal dominant disease of the heart characterized by marker hypertrophy of the myocardium with myofibril dissarray and and small LV cavity

63
Q

How to diagnose HCM?

A

History and physical exam
ECG (likely abnormal)
Chest x-ray (cardiomegaly)
ECHO
Genetic Testing
Cardiac Muscle Biopsy (myofibril disarray)

64
Q

Restrictive Cardiomyopathy (RCM)

A

RCM is impaired ventricular filling with normal or decreased diastolic volume of either or both ventricles

65
Q

What is a characteristics of RCM?

A

The ejection fraction is greater than 50%

66
Q

What are some symptoms associated with RCM?

A

edema
Elevated JVP
Hepatic congestion
Dyspnea

67
Q

The leading cause of death in the US is heart disease. What is the greatest risk for cardiovascular disease?

A

obesity

68
Q

What is obesity

A

an imbalance between food consumed and physical activity that results in the accumulation of fat in adipose tissue and causes adverse effects on health

69
Q

What are some non-modifiable risk factors that affect obesity?

A

age and genetics

70
Q

What are the 3 ways to measure body fat?

A

BMI (weight/height)
Waist circumfrence
Waist to hip ration

71
Q

What happens to adipocytes in obese individuals?

A

hypertrophy(size) and/or hyperplasia(number)

72
Q

What is the criteria for dyslipidemia and atherosclerosis?

A

High >200
High LDL> 130
Low<40
High triglycerideride >150

73
Q

What is a normal blood glucose level?

A

fasting (80-100) after eating(170-200) 2-3 after eating (120-140)

74
Q

What is an impaired blood glucose level?

A

fasting (101-125) after eating(190-230) 2-3 after eating (140)

75
Q

What is a diabetic blood glucose level?

A

fasting (126+) after eating(220-300)

76
Q

What is metabolic syndrome?

A

central obesity
high blood pressure
insulin resistence
high triglycerides
low HDL cholesterol

77
Q

What are some ways for nutritional management?

A

weight reduction
lifestyle modification
change of diet (dash)
salt restrictions
no alcohol

78
Q

What is the difference between the Mediterranean and Western diets?

A

Mediterranean is nutrient dense
Westen is energy dense

79
Q

What is the difference between a prebiotic and a probiotic?

A

Probiotic = alive bacteria (yogurt)
Prebiotic = probiotic’s nutrients and is nondigestable

80
Q

What is heart failure?

A

heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood through the heart to meet the body’s needs for blood and oxygen
HALLMARK = LOW CARDIAC OUTPUT

81
Q

What are the risk factors for developing heart failure?

A

coronary artery disease
advanced age
hypertension
diabetes
obesity
smoking
valvular heart disease
race (black)

82
Q

What are the categories of heart failure?

A

systolic
diastolic
right-sided

83
Q

What is systolic heart failure?

A

characterized by an insufficient ejection fraction of the left ventricle with subsequent poor perfusion of end organs
PUMPING PROBLEM, DECREASED EJECTION FRACTION

84
Q

What is diastolic failure?

A

Diastolic failure is characterized by a decreased expansion and filling of the left ventricles with blood during diastole
FILLING PROBLEM, NORMAL EJECTION FRACTION

85
Q

What is right-sided heart failure?

A

characterized by tissue congestion with jugular distension (JVD), periperal edema, acites, and organ engorgenment

86
Q

What is pulmonary hypertension?

A

Pulmonary hypertension (PH) is an increase in mean pulmonary artery greater or equal to 25mm Hg at rest or greater than 30 mm Hg during exercise.

87
Q

What is the mechanism of pulmonary hypertension?

A

The mechanism of pulmonary hypertension is due to increased pulmonary vascular resistance that eventually leads to right ventricular failure

88
Q

What is the normal mean pulmonary artery

A

20mm Hg

89
Q

How many classes of PH are there based on the WHO?

A

5

90
Q

Group 1 PH

A

Pulmonary arterial hypertension (PAH)

91
Q

Group 2 PAH

A

Pulmonary hypertension (PH) secondary to left heart disease -heart failure, valvular heart disease

92
Q

Group 3 PAH

A

PH from chronic lung disease and/or hypoxia-obstructive lung disease, restrictive lung disease

93
Q

Group 4 PAH

A

PH due to pulmonary artery obstructions-chronic thromboembolic PH

94
Q

Group 5 PH

A

PH due to unclear and/or multifactorial mechanisms-systemic and metabolic disorders.

95
Q

How many stages of PH are there according the the WHO?

A

4

96
Q

Class I PH

A

No limitation with functional activity

97
Q

Class II PH

A

Comfortable at rest but has slight limitations with activity such as shopping, climbing stairs, or making the bed

98
Q

Class III PH

A

Comfortable at rest but has significant limitations with activity such as activities of daily living such as dressing, bathing, toileting, or transfers.

99
Q

Class IV PH

A

Symptoms at rest. Signs and symptoms suggestive of right-sided congestive heart failure.

100
Q

What are the types of shock?

A

Hypovolemic
cardiogenic
obstructive
distributive

101
Q

hypovolemic shock

A

↓blood volume resulting from internal or external fluid loss

102
Q

cardiogenic shock

A

Acute MI
End-stage cardiomyopathy
Advanced valvular disease
Cardiac arrhythmias

103
Q

Obstructive shock

A

Pulmonary embolism
Cardiac tamponade
Tension pneumothorax

increase in intrathoracic pressure

104
Q

Distributive shock

A

Inflammatory mediators disrupt blood flow:
Severe sepsis
Anaphylaxis
Neurogenic shock

105
Q

What are characteristics of diastolic heart failure?

A

-Small LV cavity, concentric LV hypertrophy.
-Systemic hypertension is a common cause.
-Elderly women are more common
-Normal or increased EF
-S4 gallop (atrial gallop); late diastolic sound from forceful atrial contraction into a stiff ventricle
-Prognosis not as poor.
-Myocardial ischemia is common.

106
Q

What are characteristics of systolic heart failure?

A

*Large dilated heart.
*Normal or low BP
*Broad age group, more men.
*Low ejection fraction (EF).
*S3 gallop: ventricular gallop possibly caused by tensing of chordae tendinaeduring rapid filling and expansion of the ventricle
*Poor prognosis
*Some cases with a myocardial ischemia role.

107
Q

What are the types of heart failiure?

A

Left, right, and backwards

108
Q

What is left heart failure?

A

*Dyspnea, especially on exertion
*Paroxysmal nocturnal dyspnea (sudden wake-up short of breath)
*Orthopnea (cannot breathe lying flat)

109
Q

What is Right heart failure?

A

*Increased jugular venous pressure
*Lower extremities edema
*Liver congestion (rarely can cause cirrhosis)

110
Q

What are causes of acute heart failure?

A

*Large acute MI.
*Acute valvular dysfunction (mitral or aortic regurgitation).
*Fluid overload.
*Acute right heart failure may occur with pulmonary emboli

111
Q

What are the causes of chronic heart failure?

A

*Chronic Ischemic Heart Disease
*Chronic work overload
–Hypertension
–Valve diseases
*Dilated cardiomyopathies
*Shunting in ASDs, VSDs, PDAs

112
Q

How do you manage acute HF?

A

DIURESE , DIURESE, DIURESE

113
Q

How do you manage chronic HF?

A

Improve Symptoms, Improve LVEF,Improve Mortality, Prevent Hospitalizations

114
Q

Angiotensin converting enzyme inhibitors (ACEI)

A

Captopril
Lisinopril
Enalapril

115
Q

Angiotensin receptor blockers (ARB)

A

Losartan
Valsartan
Candesartan

116
Q

Beta Blockers

A

Metoprolol XL
Carvedilol
Bisoprolol

117
Q

Aldosterone Antagonist

A

Spironolactone

118
Q

Diuretics

A

Furosemide (Loop)
Torsemide (Loop)
Bumetanide (Loop)
Hydrochlorothiazide (Thiazide)

119
Q

Inotropic Agents

A

Digoxin
Dobutamine

120
Q

Direct Vasodilators and Venodilators

A

Hydralazine
Nitroglycerin

121
Q

Neprilysin Inhibitor

A

Sacubitril

122
Q

Anti-Arrhythmic Drugs

A

Amiodarone

Cardiovascular (5 decks)

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