Cardiology

Question 1

What do the baroreceptors do? and where are they located?

Answer 1

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.

Question 2

What can happen with atrial stretch?

Answer 2

Expansion of the L atria via volume administration, results in conduction slowing and potential termination of AF.

Question 3

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?

Answer 3

Pleuritic, positional, palpable and it means it has a lower likelihood of being ACS

Question 4

Factors Affecting Inotropy?

Answer 4

Infarction/ischemia, Cardiomyopathy, Acidosis, Electrolyte Imbalance, Drugs

Question 5

Factors Affecting Preload?

Answer 5

Fluid overload, renal faillure, medication non-compliance

Question 6

Factors affecting Afterload?

Answer 6

Chronic HTN, Medication non-compliance, drugs, catecholamine dump

Question 7

How does BNP help in CHF? How is it activated?

Answer 7

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.

Question 8

Why does pressure back up into the lungs from the LV/LA?

Answer 8

There is no valve separating the lungs and the LA, nothing stops it from flowing backwards.

Question 9

In what condition would you expect to find, splinter hemorrhages, janeway lesions, and oslers nodes?

Answer 9

Left Sided Endocarditis

Question 10

In left sided endocarditis what valve would you expect to have the vegetation?

Answer 10

Mitral Valve

Question 11

What heart sounds would you expect to hear in pericarditis?

Answer 11

Friction rub

Question 12

What is becks triad? What does it signify?

Answer 12

Muffled heart sounds, JVD, Hypotension. Signifies a Tamponade.

Question 13

What is pulsus paradoxus?

Answer 13

The changing of pulsatile strength during inspiration and expiration, could be an indication of tamponade.

Question 14

What does tamponade do, how does it cause obstructive shock?

Answer 14

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.

Question 15

What would you call an infection of the Tricuspid Valve?

Answer 15

Right sided endocarditis.

Question 16

What is indicated if Lead 3 STE is greater then Lead 2?

Answer 16

Could have RV involvement.

Question 17

3 ACS Syndromes or parts?

Answer 17

Unstable Angina, NSTEMI. STEMI

Question 18

If hyper acute T waves noted on the ecg what should be your next step as a provider, providing clinical significance matches?

Answer 18

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.

Question 19

What are four reasons for the development of VT?

Answer 19

Ischemia (Hypoxia), Meds, Drugs (Meth, Cocaine), and Electrolyte Imbalances

Question 20

What is atrial kick and why is it important?

Answer 20

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.

Question 21

What happens during loss of atrial and what causes it? Why is it important?

Answer 21

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.

Question 22

What are the 3 factors in myocardial oxygen demand?

Answer 22

Wall stress, HR, Contractility

Question 23

The 3 groupings of etiologies that can lead to HF are?

Answer 23

1) Impaired contractility
2) Increased Afterload
3) Impaired Ventricular filling and relaxation

Question 24

What is systolic dysfunction?

Answer 24

Heart failure with reduced ejection fraction, it is HF resulting from an abnormality in ventricular emptying

Question 25

What is diastolic dysfunction?

Answer 25

HFpEF. HF due to abnormality of diastolic relaxation or ventricular filling.

Question 26

Define heart failure

Answer 26

Hearts inability to pump blood to meet the metabolic demands of the body, or ability to do it only at high cardiac filling pressures.

Question 27

Describe the frank starling mechanism

Answer 27

Increase in preload = an increase in stretch and increase in contractility. Same goes for decrease in preload but reverse.

Question 28

What is preload?

Answer 28

End diastolic volume, or the amount of stretch on the ventricles prior to contraction.

Question 29

What is afterload?

Answer 29

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

Question 30

What is contractility?

Answer 30

Chemical and hormonal influences on cardiac contraction.

Question 31

What is Stroke volume?

Answer 31

The amount of blood ejected out of the heart in one beat. It is a sum of preload, afterload, and contractility.

Question 32

What is cardiac output?

Answer 32

Amount of blood pumped out of the heart, usually defined by litres per minute. It is a sum of HR x SV

Question 33

What conditions decrease preload? If afterload and contractility present.

Answer 33

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.

Question 34

What conditions affect afterload? If preload and contractility are present?

Answer 34

HTN, Aortic stenosis. Increased LV ejection pressures lead to increased ventricular work and LVH.