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Clin Med Comprehensive > Cardio Gen > Flashcards

Cardio Gen Flashcards

1
Q

What is the first heart sound?

A

closing of AV valve

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2
Q

When is the period of isovolumic contraction?

A

QRS when AV valve and aorta are closed and ventricles are contracting

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3
Q

When is the period of isovlolumic relaxation?

A

After T wave when ventricles are relaxing and all valves are closed

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4
Q

What is second heart sound?

A

closing of aortic valve

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5
Q

When is systole?

A

When ventricles begin to contract to when the aortic valve closes and period of ejection closes

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6
Q

When is diastole?

A

Begins when aortic valve closes and continues through filling phase until ventricle contracts and AV valve closes

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7
Q

Define cardiac cycle

A

synchronous pumping activities of hearts two atrioventricular pumps

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8
Q

What is the population of cardiac muscle cells i the wall of the R atrium that initiate electrical stimulation?

A

SA nodal cells

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9
Q

What is the function of the SA node cells?

A

provide electrical stimulation to initiate cardiac cycle

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10
Q

What does the QRS complex represent?

A

ventricular contraction

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11
Q

What does p wave represent?

A

atrial contraction

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12
Q

What does T wave represent?

A

ventricular relaxation

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13
Q

What are the high and low points of a persons heart in the chest?

A

sternal angle and xiphoid process

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14
Q

How much pericardial fluid does a normal adult contain?

A

20 to 30 ml

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15
Q

What is the function of the pericardial cavity?

A

provides lubricated free space that separates heart from the rest of the organs and body structures

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16
Q

What occurs when a person has injury to pericardial cavity?

A

cardiac tamponade

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17
Q

How do you treat cardiac tamponade?

A

insert needle at L infrasternal angle

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18
Q

What is the L border of the heart mostly when looking at persons chest in PA film?

A

L ventricle

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19
Q

What is the R border of the heart mostly when looking at persons chest in PA film?

A

R atrium

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20
Q

What is anterior surface in L lateral chest film?

A

R ventricle

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21
Q

What is posterior surface in L lateral chest film?

A

L atrium and L ventricle

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22
Q

What is coronary artery disease?

A

Any condition brought on by a sudden reduction or blockage of blood flow to the h (UA, NSTEM, STEMI)

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23
Q

What is the pathophys of CAD?

A

fatty streak formation, macrophages turn to foam cells form plaque and progression to slowly encroach on lumen area

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24
Q

RF for CAD

A

DM, cigarettes, age, FH, phys inactivity, obesity, emotional stress

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25
Q

Pathophys of ischemia

A

insuficient blood flow, cytokine release (pain), if prolonged becomes injury

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26
Q

pathophys of injury

A

occurs with sustrained ischemia, release cardiac biomarkers, ST elevation

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27
Q

infarction

A

irreversible cell death, decrease cardiac function, release cardiac biomarkers, Q wave formation

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28
Q

What should every patient who presents with hx of chest pain get?

A

12 lead ECG

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29
Q

What does LV hypertrophy tell you

A

HTN, increased risk for infarction

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30
Q

What does a fib tell you?

A

previous infarct or risk of infarct

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31
Q

What do BBB tell you?

A

is new LBBB increased risk of infarction, can mask ischemia, injury and infarct

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32
Q

How does ischemia present on EKG?

A

ST depression, T wave inversion

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33
Q

How does injury present on SKG?

A

ST elevation, T wave inversion, new LBBB

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34
Q

How does infarction present on EKG?

A

ST elevation plus pathologic Q waves, or just the pathologic Q waves

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35
Q

What does ambulatory ECG monitoring detect?

A

paroxysmal dysrhythmias (SVT or A fib), periods of ischemia (correlate with angina journal)

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36
Q

What does echocardiography detect?

A

inappropriate flow through valves and valvular stenosis

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37
Q

When do you stop exercise stress testing?

A

angina, hypotension, changes in ECG

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38
Q

What does stress echocardiography show?

A

wall abnormalities consistent with ischemia

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39
Q

What does myocardial perfusion scan detect?

A

defects show up where ischemic or infarction

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40
Q

What is the gold standard test for diagnosing CAD?

A

coronary angiography (good because can also treat right away)

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41
Q

What are risks of coronary angiography?

A

anaphylaxis, allergic rxn, kidney problems

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42
Q

What lab studies should be ordered for CAD?

A

chem 7, CBC, cholesterol, if recent chest pain then also troponin I and T, CKMB and myoglobin

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43
Q

What is typical angina?

A

substernal chest discomfort with characteristic quality and duration that is provoked by exertion or emotional stress and relieved by nitroglycerin

(atypical only some of these symptoms)

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44
Q

What is significance of friedewald formula?

A

calculated LDL levels and theres room for error

45
Q

RF for hypercholesterolemia

A

age, HTN, cigarettes, obesity, physical inactivity, high cholesterol, low HDL, diabetes, kidney dysfunction, FH

46
Q

Prevention of hypercholesterolemia

A

decrease cholesterol, control BP, stop smoking, increase activity, reduce stress, statins

47
Q

What is the 1st line test for diagnosis of CAD?

A

EKG stress test if capcable of exercise

48
Q

What is 1 MET?

A

the amount of oxygen consumed while sitting at rest

49
Q

What is 1st line test for assessment of LV structure and function?

A

echocardiography

50
Q

What can you see with a parasternal short axis view?

A

R and L vertnicle

51
Q

What is normal ejection fraction?

A

<55%

52
Q

What are indications of nuclear cardiology?

A

diagnose CAd, assess physiologic significance of CAD, evaluate ventricular function

53
Q

Define coronary reserve

A

the ability of coronary vessels to meet metabolic demands

54
Q

Patient instructions for nuclear stress test

A

no caffeine 24 hours prior to testing, nothing to eat
hold beta blockers
take all BP meds
test takes 3-4 hrs

55
Q

Indications of cardiac CT

A

non-invasive anatomic assessment of coronary artery disease or structural heart disease

56
Q

What is gadolinium?

A

class of contrast agents used in CMR

57
Q

Indications for cardiac MRI

A

cardiomyopathy, inflammation, myocarditis, congenital heart disease, tumors

58
Q

Why are non-stenotic plaques more dangerous?

A

more frequent

59
Q

What are limitations of traditional stress test for diagnosing CAD?

A

cannot detect vulnerable patient without obstructive lesion

60
Q

Echo vs nuclear test

A

Echo better for blockages and nuclear better for known disease

61
Q

What is CCS scoring system?

A

scores angina

Class 0-asymptomatic
class 1-angina w/ strenuous exercise
Class 2-angina w/ mod exertion
Class 3- angina w/ mild exertion
Class 4-angina w/ any levrl of phys exertion
62
Q

Why do you have to be careful with NTG?

A

potent vasodilator that will work immediately and can dissolve on skin so it not patient can have syncope

63
Q

What is CABG?

A

take vein from leg and attach distal to where block was

improves mortality

64
Q

What happens if you give a patient nitro when they recently took viagra?

A

can pass out or have stroke (must have taken >12 hr ago)

65
Q

What is PCI?

A

stenting and angioplasty

66
Q

Prevention of stable angina?

A

lower cholesterol, statins, treat HTN, weight loss, exercise, long acting nitrates, beta blockers, Ca channel blockers, aspirin

67
Q

Who is not a candidate for cardiac rehab?

A

unstable CHF, unstable angina, hymodynamic instability, 3rd degree blocks, systolic BP>200 or diastolic BP >110 or other illnesses/fever

68
Q

What are the phases of cardiac rehab?

A

Phase I acuter care hospital (3-5 days)
Phase II discharged from home /w intensive monitoring(6-12 wks)
Phase III pt stable less monitoring than II
Phase IV high risk pts

69
Q

Who needs telemetry?

A 
EF < 30%
ventricular arrhythmias at rest
dec BP with exercise )(10-20 mmHg)
survivors of sudden death
post complicated MI
severe CAD &amp; marked exercise induced ischemia
inability to self monitor
70
Q

What might you hear when a patient is going into heart failure

A

new S3, crackles in lower lungs

71
Q

How many minutes of exercise a day to maintain weight?

A

300 minutes/week

72
Q

How do you prescribe prescriptions for cardiac patients?

A

mode, intensity, duration, frequency and progression

73
Q

What needs to be monitored for cardiac rehab?

A 
Hemodynamic responses (Bp),
ECG (HR &amp; rhythm) responses via telemetry or
portable ECG monitor
Oxygenation (pulse oximeter)
Signs &amp; symptoms
74
Q

How do you determine cardiac hreab intensity?

A 
Healthy pop-Max HR =220-age 
post MI-exercising HR<120 bpm or RHR + 20
Post CABG-RHR+30bpm
Inpatients-Borg RPE 11-13
5 MET level
75
Q

What level should patient be function in BORG scale?

A

11-13

76
Q

How often should patient be exercising for good heart health?

A

60 min day/day (at least 5 days)

77
Q

Normal responses to exercise

A 
Gradual and linear increase in
HR
Gradual and linear increase in SBP
Slight increase, decrease or no change in DBP
Increase in SV
Increase in CO
Increase in O2 demands
78
Q

Abnormal responses to exercise

A

Decrease in HR
Decrease in SBP > 20mm Hg
Dyspnea, diaphoresis, pallor, duskiness, dizziness, nausea
Skipped beats develop after exercise
Rales/crackles or new S3 develops after exercise

79
Q

Special considerations for exercising deconditioned patients

A

short duration

80
Q

Special considerations for exercising Beta blocked patients

A

HR & BP response abnromal

USE BORG scale

81
Q

Special considerations for exercising COPD

A

SPO@

82
Q

Special considerations for exercising DM

A

blood glucose levels

83
Q

Special considerations for exercising PAD

A

foot pain, leg pain due to ischemia so do short bouts of exercise

84
Q

Special considerations for exercising arthritis

A

swimming or biking

85
Q

Special considerations for exercising patient with pacemaker

A

shoulder flexion restrictions for 2-4 wks

86
Q

Special considerations for exercising pt with pacing wires

A

shoulder flexion restrictions

87
Q

Special considerations for exercising cardioverted patient

A

rest

88
Q

Special considerations for exercising S/P L Heart Catheterization or S/P R heart

A

bed rest

89
Q

phase 2 cardiac rehab duration

A

12-18 wks

90
Q

CMS outptient coverage

A

(1) a documented diagnosis of AMI within the preceding 12 months;
(2) coronary artery bypass surgery; and /or
(3) stable angina pectoris
– heart valve repair/replacement; or
– percutaneous transluminal coronary angioplasty (PTCA) or
coronary stenting
– heart or heart/lung transplant.

91
Q

What is the MC cause of heart disease?

A

atherosclerosis followed by HTN and congenital heart disease

92
Q

What happens when the cross section of the lumen of a coronary artery is 75% narrowed?

A

compensatory coronary vasodilation is

insufficient to meet moderate increases in myocardial O2 demand leading to ischemia

93
Q

What is the MC cause of a MI?

A

coronary thrombosis due to atherosclerotic plaque

94
Q

What are complications of MI?

A

Papillary muscle dysfunction/rupture External rupture of the infarct
IV septal rupture
Mural thrombosis Ventricular aneurysm Arrhythmia
CHF, Sudden Cardiac Death

95
Q

What are complications of HTN?

A 
Cardiac hypertrophy
Congestive heart disease
Renal insufficiency
Hypertensive encephalopathy
Hypertensive retinopathy
96
Q

What is the MC vessel to be occluded?

A

L anterior descending

97
Q

What is the MC cause of intercerebral hemorrhage?

A

HTN

98
Q

What is Takayasu s Arteritis?

A

Narrowing of brachiocephalic, carotid, and subclavian arteries

99
Q

Define heart failure

A

inability of the heart to pump blood at a sufficient rate to meet the metabolic demands of the body (e.g. oxygen and cell nutrients) at rest and during effort or to do so only if the cardiac filling pressures are abnormally high

100
Q

What is the MC cause of hospitalization in people over 65 in the US?

A

heart failure

101
Q

Define shock

A

Life threatening condition of circulatory failure, initially reversible but rapidly becomes irreversible resulting in multi-organ failure and death

102
Q

What is distributive shock?

A

septic causes-bacteria

non-septic-cessation of steroids, forms of ischemia, trauma

103
Q

What is cardiogenic shock?

A

anything that happens to the heart, myocarditis, MI, infarction

104
Q

What is hypovolemic shock?

A

hemorrhagic, trauma, GI bleed, vomiting, diarrhea, skin losses

105
Q

What is obstructive shock?

A

acute PE, anything causing obstruction to circulation, tumors

106
Q

What is hypotensive BP?

A

<90/<65

107
Q

What is the resting membrane potential in most cardiac cells?

A

-90 mV (only influenced by K+)

108
Q

Define syncope

A

sudden temporary LOC (symptom not a diagnosis)

Clin Med Comprehensive (9 decks)

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