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Block 4 - Cardio > Cardio Toolbox > Flashcards

Cardio Toolbox Flashcards

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0
Q

What was the total and indirect cost for care for cardiovascular disease and stroke in 2008?

A

298B dollars

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1
Q

How many deaths does coronary heart disease account for?

A

1 in 6

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2
Q

What are the 7 health behaviors as defined by the AMA?

A 
Maintaining lean body mass
Avoidance of smoking
Regular physical activity
Healthy dietary take (DASH diet)
Untreated total cholesterol <100 mg/dl
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3
Q

What are the four noncommunicable diseases the WHO is focusing on and what are the four common risk factors they share?

A

Cardiovascular disease, cancer, diabetes, chronic lung disease
Tobacco, inactivity, unhealthy diet, alcohol

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4
Q

What are some cardiac causes of chest pain?

A

Ischemia or angina pectoris
Pericardial Inflammation - more sharp
Aortic dissection - severe tearing pain radiating to back

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5
Q

What can dyspnea with exertion be due to?

A

Pulm venous congestion

Inadequate increase in cardiac output with activity

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6
Q

What can dyspnea in supine position (orthopnea) be due to?

A

Gravitational forces redistributing flow back to central circulation, allowing elevation of pulm venous and capillary pressures

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7
Q

What are five common cardiac complaints?

A 
Chest pain
Palpitations
Dyspnea 
Syncope
Edema
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8
Q

What are feature on general appearance that suggest heart disease?

A

Obesity and/or cyanosis - suggests sleep apnea, RHF
cachexia - end stage HF
slender, nervous - hyperthyroidism
Sow, non pitting edema - hypothyroidism
Febrile, ill, skin lesions - endocarditis

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9
Q

What is the normal systolic drop with inspiration and why does it occur?

A

Less than 10 mm Hg

Increased right ventricular volume displaces septum toward left decreasing left ventricular SV and dimension

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10
Q

What is pulsus paradoxus and what are its major and minor causes?

A

Inspiratory fall in systolic pressure of more than 12 mmHg
Main cause - cardiac tamponade - pressure in pericardial space that impinges upon heart and causes interdependence of ventricles
Minor - obesity and lung disease

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11
Q

Why might an elevated jugular venous pressure be missed in the supine but noticed when patient is upright?

A

Vertical distance from right atrium increased when patient is upright

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12
Q

What are the venous/atrial wave forms and what does each represent?

A

A wave - right atrial contraction
C wave - closure of tricuspid valve
X descent - right atrial relaxation and ventricular contraction
V wave - right atrial filing
Y descent - tricuspid valve opening and atrial emptying

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13
Q

How does respiration affect the jugular venous waveform?

A

Inspiration - decrease in intrathoracic pressure increases flow to right side of heart, decreasing volume in vena cava and jugular venous pressure
Expiration - venous return inhibited, pressure goes up

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14
Q

What is Kussmauls sign?

A

Paradoxic increase in jugular venous pressure during inspiration due to inability of right side to accommodate increased flow
Occurs with constrictive pericarditis and acute right ventricular infarction

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15
Q

What may giant a waves in the jugular venous waveform reflect?

A

AV dissociation (cannon a waves) - because atria contracting against closed valve
Increased right atrial volume
Restriction to right ventricular filling (pulm HT)
AV obstruction (tricuspid stenosis, myxoma)

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16
Q

What can absent a waves represent?

A

A fib

A flutter

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17
Q

What do large v waves on the jugular venous waveform represent?

A

Tricuspid regurgitation

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18
Q

What do different displacements of the PMI represent?

A

Laterally - ventricular dilation
Inferior - low diaphragm (maybe obstructive lung disease)
Sustained during systole - LV hypertrophy

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19
Q

What are causes of an increased amplitude of the carotid upstroke?

A

Aortic insufficiency - classic example
Decrease in peripheral resistance - due to compensatory increase in CO and SV - Patent ductus arteriosis, sepsis, anemia, thyrotoxicosis, peripheral arterio-venous malformation, fever

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20
Q

What is a water hammer (corrigan pulse)?

A

In aortic insufficiency
LV SV increased which increases systolic volume and translates into rapid upstroke with increased peak amplitude and rapid downslope (widened pulse pressure)

21
Q

What is parvus et tardus?

A

Slow rising pulse that is weak and late relative to its normal
Seen in aortic outflow obstruction - aortic stenosis, sub/supra valvar stenosis

22
Q

What is a bisferiens pulse?

A

Two systolic peaks during peak amplitude of arterial pulse
In hypertrophic obstructive cardiomyopathy
Second peak due to transient increase in degree of LV outflow obstruction

23
Q

What is pulsus alternans?

A

Strong pulse followed by weak pulse

Seen in patients with severely depressed LV systolic function

24
Q

What is S1?

A

First heart sound - heard prior to palpable upstroke of carotid arterial pulse
Closure of AV valves (tricuspid and mitral)
Intensity affected by position of valve leaflets at onset of systole

25
Q

What is s2?

A

Second heart sound - audible after peak carotid pulse
Closure of aortic and pulmonic valves
A2 comes before P2 component
Intensity affected by leaflet mobility and pulm and system HT

26
Q

What is the cause of the physiological splitting of S2?

A

Inspiration - right ventricle fills and delays pulm valve closure so 50-90 ms between A2 and P2
Expiration - two components approximate each other (w/i 10 ms)

27
Q

What is a fixed split S2 pathognomonic of?

A

Atrial septal defect

28
Q

What are the causes of a wide split due to a late P2?

A 
Prolonged right ventricular contraction -
RBBB
Pulmonic valve stenosis
RV dysfunction
PE
Pulm HT
29
Q

What are the causes of a wide split due to an early A2?

A

Decreased duration of left ventricular contraction -
Mitral regurgitation
Ventricular septal defect

30
Q

What are the causes of a paradoxical split (P2 precedes A2)?

A

Delayed LV contraction delays A2 (LBBB, aortic stenosis, hypertrophic cardiomyopathy)
Early pulmonic valve closure - tricuspid regurgitation

31
Q

What is S3?

A

Third heart sound occurring during early diastole as ventricle fills
Can be normal in children and adolescents, or pathologic

32
Q

What are the causes of a pathologic S3?

A

Decreased ventricular compliance - ventricular failure - dilated cardiomyopathy
Increased flow across AV valve - increased ventricular volume - mitral regurgitations, aortic insufficiency, ventricular septal defects

33
Q

What is S4?

A

Fourth heart sound occurs prior to ventricular activation and is secondary to atrial contraction
Audible prior to S1

34
Q

What are the common causes of S4?

A

Decreased ventricular compliance - ventricular hypertrophy - arterial HT, aortic stenosis, hypertrophic cardiomyopathy

35
Q

What are ejection sounds?

A

Early in ventricular systole secondary to blood flow across aortic or pulmonic valve into great vessel
Usually implies underlying pathology

36
Q

What is the grading scale of cardiac murmurs?

A

Grade 1 - barely audible
Grade 2 - detected with stethoscope on chest wall
Grade 3 - loud
Grade 4 - loud murmur accompanied by thrill
Grade 5 - loudest murmurs heard, still requires stethoscope
Grade 6 - audible without a stethoscope

37
Q

When do right sided murmurs typically get louder?

A

With inspiration

38
Q

What kind of murmur does aortic stenosis produce?

A

Systolic ejection murmur
Crescendo decrescendo
More severe means later peaking of murmur
Single or paradoxical split S2 due to prolonged LV contraction
Often accompanied by pulsus ET tardus

39
Q

What kind of murmur does mitral regurgitation result in?

A

Soft, blowing, high pitched holo systolic murmur
Begins with S1 and ends with A2
Frequently accompanied by S3 due to increased flow across valve
Intensity increases with isometric exercise

40
Q

What kind of murmur does mitral valve prolapse result in?

A

Mid systolic ejection click and late systolic murmur
Audible earlier in standing or Valsalva maneuver when less blood in ventricle because more mismatch in ventricle size and valve leaflets

41
Q

What kind of murmur does hypertrophic cardiomyopathy cause?

A 
Systolic election murmur beginning after S1
Increased intensity of S1 
May have s3 and/or s4
May be associated mitral regurgitation 
Dynamic outflow obstruction
42
Q

What are some maneuvers that increase the intensity of aortic outflow obstruction murmurs?

A

Decrease LV dimension - Valsalva, vasodilators (nitrates)

Increased inotropy - post premature ventricular beat, inotropic medication

43
Q

What are some maneuvers that decrease the intensity of aortic outflow obstruction murmurs?

A

Increase LV dimension - squatting, mueller maneuver

Increase in after load - isometric exercise (hand grip), phenylephrine

44
Q

What kind of murmur does aortic valve regurgitation lead to?

A

Diastolic, high pitched decrescendo
Begins immediately following s2
s1 normal or decreased, s2 normal
S3 often present due to increase in LV volume

45
Q

What kind of murmur does mitral valve stenosis show?

A

P2 may be increased
Opening snap heard shortly after S2
Low pitch diastolic murmur follows snap
Might have presystolic accentuation close to S1

46
Q

What kind of murmur does an atrial septal defect result in?

A

Right sided murmur
Widely fixed split s2
Ejection click and crescendo decrescendo systolic murmur

47
Q

What kind of murmur does tricuspid regurgitation result in?

A

Right sided murmur
Usually secondary to right ventricular dilation
Holosystolic and high pitched from s1 to a2
Inspiration increases intensity of the murmur

48
Q

What kind of murmur does pulmonic valve stenosis result in?

A

Right sided, systolic, crescendo decrescendo
Peak late in systole
Right sided ejection click
Stenosis severity increases, leads to widely split s2

49
Q

What kind of murmur does pulmonary valve regurgitation result in?

A

Right sided, diastolic, decrescendo
Increase in p2
Widely split s2 due to prolonged RV contraction

50
Q

What are continuous murmurs?

A

Begin during systole and continue into diastole (may not occupy all of diastole)
Indicate communication between arterial and venous circulations
Causes include coronary arterial venous fistulae, ruptured venous sinus of Valsalva and patent ductus arteriosus

51
Q

What kind of murmur does a patent ductus arteriosus cause?

A

Begins in systole
Peak near s2 then continues into diastole
Higher degree of pulm HT causes shorter duration of diastole component
Shaped like a diamond

Block 4 - Cardio (15 decks)

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