Cardiology Flashcards
What do the baroreceptors do? and where are they located?
Location: Aortic Arch, and left common carotid artery.
Function: Senses the stretch of vessels walls (activating baroreceptors), and the body responds to this by either increasing or decreasing the BP. Either by release of catecholamines to increase BP or increasing parasympathetic activation to decrease BP.
What can happen with atrial stretch?
Expansion of the L atria via volume administration, results in conduction slowing and potential termination of AF.
What are the 3 P’s in HEART RSV3P that is helpful to rule in or rule out CP? And what does it mean if these are found?
Pleuritic, positional, palpable and it means it has a lower likelihood of being ACS
Factors Affecting Inotropy?
Infarction/ischemia, Cardiomyopathy, Acidosis, Electrolyte Imbalance, Drugs
Factors Affecting Preload?
Fluid overload, renal faillure, medication non-compliance
Factors affecting Afterload?
Chronic HTN, Medication non-compliance, drugs, catecholamine dump
How does BNP help in CHF? How is it activated?
BNP is activated when the heart is stretched out and has too much volume, causing an issue of contraction. BNP tells the kidneys to increase sodium excretion (natural diuresis as water follows sodium), BNP also tells the arteries and the veins in the lower limbs and tells them to vasodilate –> decrease preload and the heart can deal with the volume it needs to eject.
Why does pressure back up into the lungs from the LV/LA?
There is no valve separating the lungs and the LA, nothing stops it from flowing backwards.
In what condition would you expect to find, splinter hemorrhages, janeway lesions, and oslers nodes?
Left Sided Endocarditis
In left sided endocarditis what valve would you expect to have the vegetation?
Mitral Valve
What heart sounds would you expect to hear in pericarditis?
Friction rub
What is becks triad? What does it signify?
Muffled heart sounds, JVD, Hypotension. Signifies a Tamponade.
What is pulsus paradoxus?
The changing of pulsatile strength during inspiration and expiration, could be an indication of tamponade.
What does tamponade do, how does it cause obstructive shock?
Pericarditis could lead to an effusion which can lead to tamponade. A tamponade is an accumulation of blood or fluid within the pericardial sac that impairs preload.
What would you call an infection of the Tricuspid Valve?
Right sided endocarditis.
What is indicated if Lead 3 STE is greater then Lead 2?
Could have RV involvement.
3 ACS Syndromes or parts?
Unstable Angina, NSTEMI. STEMI
If hyper acute T waves noted on the ecg what should be your next step as a provider, providing clinical significance matches?
This patient would benefit from you riding up to the hospital with them and performing serial ECG’s, this could be the beginning stages of an OMI.
What are four reasons for the development of VT?
Ischemia (Hypoxia), Meds, Drugs (Meth, Cocaine), and Electrolyte Imbalances
What is atrial kick and why is it important?
Increased force of ejection from the atria down into the ventricles during contraction, specifically from the LA to the LV during atrial systole, it can be responsible for 30% of blood delivered to the LV. When the pressure equalizes in the LA and LV blood flow into LV stops, when the atria contracts “kicks” this increased pressure forces more blood into LV prior to LV contraction thus increasing EF.
What happens during loss of atrial and what causes it? Why is it important?
Loss of atrial kick can be attributed to conditions that cause asynchronous contraction of the atria, diminishing atrial contractions these conditions are Afib and Aflutter. The second mechanism for loss of atrial kick is when an atrial arrhythmia such as flutter, causes increased rapid ventricular depolarization decreasing ventricular filling time, leading to a decrease in cardiac output and potential further decline of the patient such as ischemia due to decreased filling times leading to a supply and demand mismatch.
What are the 3 factors in myocardial oxygen demand?
Wall stress, HR, Contractility
The 3 groupings of etiologies that can lead to HF are?
1) Impaired contractility
2) Increased Afterload
3) Impaired Ventricular filling and relaxation
What is systolic dysfunction?
Heart failure with reduced ejection fraction, it is HF resulting from an abnormality in ventricular emptying
What is diastolic dysfunction?
HFpEF. HF due to abnormality of diastolic relaxation or ventricular filling.
Define heart failure
Hearts inability to pump blood to meet the metabolic demands of the body, or ability to do it only at high cardiac filling pressures.
Describe the frank starling mechanism
Increase in preload = an increase in stretch and increase in contractility. Same goes for decrease in preload but reverse.
What is preload?
End diastolic volume, or the amount of stretch on the ventricles prior to contraction.
What is afterload?
The force against which the ventricles have to contract against. The pressures it takes to eject blood out of the heart. Increased pressure = decreased contraction
What is contractility?
Chemical and hormonal influences on cardiac contraction.
What is Stroke volume?
The amount of blood ejected out of the heart in one beat. It is a sum of preload, afterload, and contractility.
What is cardiac output?
Amount of blood pumped out of the heart, usually defined by litres per minute. It is a sum of HR x SV
What conditions decrease preload? If afterload and contractility present.
Anything that decreases intravascular volume. As well as anything decreasing left ventricular compliance, such as LVH or MI. Stiff ventricle = decreased diastolic filling leading to decreased preload.
What conditions affect afterload? If preload and contractility are present?
HTN, Aortic stenosis. Increased LV ejection pressures lead to increased ventricular work and LVH.