cardio part 2 Flashcards
1
Q
_____&______ mean “no rhythm” and “abnormal rhythm, but ____ is used more often
A
arrhythmia and dysrhythmia; arrhythmia
2
Q
an EKG looks at this
A
the electrical activity of the heart; does not actually mean the heart is beating, but that it’s getting a signal to
3
Q
what happens in the ST segment
A
ventricles repolarize part 1
4
Q
what happens in the T wave
A
ventricles repolarize part 2
5
Q
what are arrhythmias?
A
dysfunction in the condiction system of the heart that can lead to cardiac ischemia, effect perfusion, and lead to cardiac death
6
Q
what are arrhythmias caused by
A
ischemia, lytes, pH, HTN, thyroid dysfunction, drugs, anesthesia
7
Q
are ventricular arrhythmias or atrial more serious
A
ventricular
8
Q
what is sinus rhythm?
A
regular spacing; p wave before each ventricular beat
9
Q
what is premature atrial
A
extra beat inserted into background rhythm
10
Q
what are the requirements of the heart with delivering blood?
A
deliver the right amount of blood (minute volume/CO), at the right pressure, and with enough O2
11
Q
minute volume is AKA
A
cardiac output
12
Q
what happens to diastole as HR increases
A
it shortens
13
Q
faster HR leads to what
A
decreased cardiac perfusion and less time for the heart muscle itself to get its own nourishment
14
Q
what happens to stroke volume as HR decreases
A
stays constant
15
Q
what can very slow heart rates lead to
A
cardiac ischemia, dizziness, loss of consciousness
16
Q
what happens to CO as HR increases
A
CO increases to a point then decreases
17
Q
ventricular fibrillation?
A
disorganized heartbeat
18
Q
what are interventricular conduction delays
A
when the 2 ventricles do not beat at the same time causing the septum to move and affect SV
19
Q
what are interventricular conduction delays AKA
A
bundle branch block
20
Q
treatable causes of arrhythmias
A
hypoxia, hypovolemia, H ions, hyper/hypokalemia, hypothermia
toxins, tamponade, tension pneumothorax, thrombosis, pulmonary, thrombosis, coronary
21
Q
where is pericardial fluid located
A
btwn parietal pericardium and visceral pericardium
22
Q
acute pericarditis, pericardial effusion, pericardial tamponade, and restrictive pericarditis area all these types of diseases
A
pericardial diseases
23
Q
acute pericarditis?
A
aseptic inflammation of pericardium that causes fever, myalgias, malaise, and severe chest pain
24
Q
in this disease, pain is worse when lying down and better when leaning forward
A
acute pericarditis
25
dx of acute pericarditis?
EKG with PR segment depression and ST elevation
26
trmt for acute pericarditis?
rest, drugs (NSAIDS)
27
how much fluid must be in the pericardial sac for it to be labeled as pericardial effusion
over 50 mL
28
possible causes of pericardial effusion
viral, bacterial, TB, lupus, rheumatoid arthritis, cancer, kidney failure, trauma, heart surgery, transudate from other organs close by
29
pericardial effusion can lead to what
pericardial tamponade
30
cardiac tamponade?
accumulation of fluid in the pericardial sac that increases diastole and decreases systole and reduces CO
31
what is becks triad for pericardial tamponade
hypotension, muffled heart sounds, and distended neck veins
32
initial trmt of pericardial effusion
pericardiocentesis
33
recurrent trmt for pericardial effusion
surgery; pericardial window or pericardial stripping
34
bc systole dec and diastole inc in pericardial tamonade, what happens to pulse pressure
it decreases pulse pressure so the difference btwn diastolic and systolic pressure are less than 25 mmHg
35
late sign of pericardial tamponade
pulsus paradoxus; drop in SBP on inspiration and pulses that come and go
36
constrictive/restrictive pericarditis?
fibrous scarring and calcification causing the visceral and parietal layers of the pericardium to stick together so the heart cannot stretch well (dec sv)
37
sx of constrictive/restrictive pericarditis?
exercise intolerance, dyspnea with exertion, fatigue, and anorexia
38
what is cardiomyopathy (CMP)? what is it measured by
weakened heart measured by EF
39
what is the ejection fraction?
fraction of blood that fills the ventricle during diastole and gets pumped out during systole; normally 55%
40
when should one be concerned about EF
when its below 35%
41
what is ischemic CMP from
prior MI or ongoing cardiac ischemia
42
trmt for ischemic CMP
correct underlying causes of ischemia with stent, bypass, etc, or manage with meds like beta blockers
43
what do beta blockers do
lengthen diastole, dec afterload, dec hr,
44
cmp can either be...
ischemic or nonischemic
45
3 types of nonischemic cmp
dilated, hypertrophic, and restrictive
46
what is hypertrophic obstructive cardiomyopathy (HOCM)
inherited heart defect with a thick septum and ventricular wall where the septum moves left with dehydration and reduces LV inflow and output
47
sx of hypertrophic obstructive cardiomyopathy (HOCM)
angina, syncope, palpitations
48
trmt for hypertrophic obstructive cardiomyopathy (HOCM)
avoid dehydration, beta blockers, defibb, surgery, ablation
49
who is hypertrophic cardiomyopathy common in
young athletes
50
2 types of hypertrophic CMP
hypertrophic obstructive cardiomyopathy (HOCM) and hypertensive hypertrophic cardiomyopathy
51
is hypertrophic obstructive cardiomyopathy (HOCM) symmectrical or assymetrical
assymetrical
52
what is hypertensive hypertrophic cardiomyopathy
symmetrical hypertrophy of myocytes from HTN that lead to stiffening of the myocardium and valvular dysfunction
53
because the myocardium stiffens in hypertensive hypertrophic cardiomyopathy, what else happens
diastole is impaired and EF is decreased
54
what is dilated CMP?
when all 4 cardiac chambers stretch and thin
55
MC CMP?
dilated CMP
56
least common type of CMP?
restrictive CMP
57
what is takotsubo CMP
broken heart syndrome; dilated CMP from sudden illness, loss of a loved one, serious accident, or natural disaster
58
this type of CM often results from a systemic condition
restrictive cmp
59
what is restrictive cmp
myocardium in walls of ventricles becomes stiff and cannot stretch
60
pathognomonic for restrictive cmp
cant increases diastole even with increased diastolic filling pressures with fluids
61
mcc of restrictive cmp
idiopathic scar tissue
62
causes of restrictive cmp
idiopathic scar tissue, amyloidosis, chemo/radiation, hemochromatosis (excessive iron), sarcoidosis
63
hemochromatosis?
excessive iron
64
stenosis?
valve orifice is constricted and narrow so it doesnt open all the way
65
regurgitation/"insufficiency"/"incompetency"
valve doesnt close completely so not as much blood flows out and the chamber size increases
66
murmurs may indicate this in a valve
regurgitation or stenosis
67
what valves are commonly stenotic
aortic and mitral
68
what valves are commonly regurgitation
aortic, tricuspid, and mitral
69
extra blood entering a chamber stimulates chamber _______
dilation
70
pumping against a stenotic valve stimulates chamber____
hypertrophy
71
tell me about a mechanical valve
has a long life, but needs long term anticoagulation therapy (blood thinners)
72
tell me about a bioprosthetic valve
only lasts about 20 yrs but no anticoagulation is needed
73
aortic stenosis?
orifice into aorta narrows and causes dec blood flow into the aorta
74
sx of aortic stenosis?
angina, syncope, heart failure
75
trmt for aortic stenosis?
medical management but then possibly transcatheter aortic valve replacement (TAVR)
76
mitral valve stenosis?
impaired flow from left atrium to left ventricle most commonly from rheumatic fever which is a complication of strep throat
77
dx of mitral valve stenosis?
late diastolic murmur
78
aortic regurgitation?
valve leaflets do not close properly during diastole
79
manifestations of aortic regurgitation?
pulse pressure widened from inc SV followed by diastolic backflow and a diastolic murmer
80
effects of AR
inc SBP to maintain MAP, LV hypertrophy, inc diastolic filling pressure from regurgitation, atrial enlargement from inc filling pressure
81
mitral valve regurgitation?
blood goes back into the left atrium during systole and causes fluid in the lungs
82
MCC of mitral valve regurgitation?
mitral valve prolapse and rheumatic heart disease
83
clinical sx of mitral valve regurgitation?
systolic murmur, enlarges left atrium, dec prefusion, CHF
84
mitral valve prolapse?
MV cusps go back into the left atrium during systole; mitral regurgitation may occur too
85
MC valvular abnormality
mitral valve prolapse
86
sx of mitral valve prolapse?
asymptomatic or occasional chest pain
87
what happens in tricupsid regurgitation
too much blood builds up in the right heart and increases systemic venous BP which can lead to right heart failure and edema
88
rheumatic fever/rheumatic heart disease, infective endocarditis, and complications of AIDS are all these types of diseases
infective
89
what is rheumatic fever (RF)
a delayed immune response to an infection caused by group A beta hemolytic strep that causes inflammation in joints, skin, NS, and heart
90
rheumatic ______ can cause rheumatic ________
fever, heart disease
91
clinical sx of RF
murmur, polyarthritis, chorea, erythema marginatum truncal rash
92
chorea?
irregular involuntary mvmts
93
tx for RF
antibiotics for 10 days, NSAIDS, prophylactic antibiotics for 5 yrs after
94
infective endocarditis?
inflammation of endocardium from infectious organisms such as bacteria, spreptococci, staphylococci, and enterococci
95
how does one get infective endocarditis?
endocardium is damaged and a bloodborne microorganism attaches. this can then break off and become mycotic emboli and go somewhere else
96
MCC infective endocarditis?
IV
97
MC valve involved in infective endocarditis?
tricuspid
98
clinical manifestations of infective endocarditis?
fever, murmur, petechial lesions, osler nodes and janeway lesions
99
osler nodes?
erythematous nodes on finger and toe pads
100
janeway lesions?
hemorrhagic lesions on palms and soles that are NOT painful
101
trmt for infective endocarditis?
IV then oral antimicrobial antibiotics drugs for any CHF, possibly surgery to replace valve
102
what must be done after IV abx therapy in infective endocarditis?
transesophageal echo to make sure there's no vegetation on valve
103
complications of AIDS?
pericardial effusion (MC), myocarditis, endocarditis, cardiomyopathy
104
does every pt have sx in CHF
no
105
RHF?
when the body can't provide pulmonary circulation which causes dec contractility and inc RV afterload
106
sx of RHF?
JVD, peripheral edema, hepatosplenomegaly
107
LHF?
when the heart cant supply blood to the tissues of the body at the correct volume or pressure
108
2 types of LHF?
inadequate CO and perfusion and reduced preload from stiff ventricles
109
inadequate CO/perfusion in LHF is AKA
CMP, systolic HF, HF with reduced EF (HFrEF)
110
reduced preload due to a stiff ventricle in LHF is AKA
diastolic dysfunction, diastolic HF, and HF with preserved EF (HFpEF)
111
can you have both types of LHF at the same time?
yes
112
what affects stroke volume?
contractility/EF, afterload, preload
113
frank starling law says...
EF increases up to a certain point with increased preload, but then decreases
114
HF trmts
give O2, inc EF, manage fluid and Na intake, meds, physical rehab
115
what is high output heart failure
when the body cant supply enough O2 to the tissues as demand increased even though there is enough volume and contractility
116
MCC of high output heart failure
anemia
117
what causes high output heart failure
anemia, septicemia, hyperthyroidism, beriberi
118
beriberi?
dec vitamin B1 which leads to inc HR
119
clinical manifestations of LHF
dyspnea, orthopnea, cough with frothy sputum
120
LHF edema is where?
lungs
121
decompensated heart failure is... (symptomatic or asymptomatic)
symptomatic
122
compensated heart failure sx relieved through ...
changed behavior or meds
