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Cardiology Flashcards

1
Q

S1 Heart Sounds AND where are they loudest?

A

-The “lub” sound created by the closure of the mitral and tricuspid valves
-Loudest at the APEX
-Marks the end of diastole and beginning of systole

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2
Q

S2 Heart Sounds AND where are they the loudest

A

-The “dub” sound created by the closure of the aortic and pulmonic valves
-Loudest at the BASE
-Marks the end of systole and beginning of diastole
-May be louder with pulmonary emboli

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3
Q

S3 Heart Sounds. Normal or Abnormal? What causes an S3 heart sound?

A

-Abnormal! Caused by a rapid rush of blood in to a dilated ventricle, pulmonary HTN, or Cor pulmonale
-Think “KEN-TUC-KEE”

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4
Q

S4 Heart Sounds. Normal or abnormal? What causes an S4 heart sound?

A

-Abnormal! Caused by aortic stenosis, ventricular hypertension, and myocardial ischemia
-Think “TEN-UH-SEE”

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5
Q

Pericardial Friction Rub. What may make it worse?

A

-Due to pericarditis (swelling of the sac around the heart)
-May get worse with deep inspiration

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6
Q

Murmurs of Insufficiency (Regurgitation). Chronic or Acute? Valve opened or closed?

A

-Chronic OR Acute. Occurs when the valve is CLOSED
-MR ASS (Mitral Regurgitation Aortic Stenosis Systole)
-May cause large V waves on PAOP

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7
Q

Murmurs of Stenosis. Chronic or Acute? Valve opened or closed?

A

-Chronic problem. Occurs when the valve is OPEN
-MS ARD (Mitral Stenosis Aortic Regurgitation Diastolic)

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8
Q

Pulse Pressure

A

Systolic - Diastolic = Pulse Pressure
- Normal is 40-06

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9
Q

What does Systolic BP Measure

A

-An indirect measurement of cardiac output and stroke volume

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10
Q

What does diastolic BP Measure

A

-In indirect measurement of systemic vascular resistance (SVR)

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11
Q

When are the coronary arteries perfused?

A

-Diastole!
-Diastole is 1/3 longer than systole

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12
Q

What is a hypertensive EMERGENCY

A

-An acute elevation of BP that shows evidence of end organ damage
-Admit to ICU! Goal to lower BP using Nitroprusside or Labetalol

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13
Q

What is hypertensive URGENCY

A

-An acute elevation of BP with no evidence of end organ damage
-Goal to lower BP using Nitroprusside or Labetalol

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14
Q

What is the greatest risk of a hypertensive emergency or urgency?

A

-STROKE!
-Accelerated HTN = Diastolic >120
-Malignant HTN = Diastolic > 140

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15
Q

Peripheral Artery Disease? What is it? What are some signs/Symptoms? Diagnostic tests?

A

-The narrowing or blockage of the vessels that carry blood from the heart to your peripheral extremities
-Pain, pallor, pulse diminished, poikilothermia, paralysis
-Test with doppler ultrasound or arteriography

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16
Q

What to do for Peripheral Artery Disease?

A

-Do NOT elevate the extremity
-Place bed in reverse Trendelenburg
-Vasodilators (The vessels are narrowed, we want to open them)
-Anti-platelet Agents (tPa)
-Angioplasty

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17
Q

Aneurysm. What is it? When is surgery considered?

A

-Blood filled out pouching in the wall of an artery. The larger it is, the more likely it is to rupture
-Greater the 4cm, surgery indicated

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18
Q

Aneurysm - Abdominal Aortic (75%). Signs and Symptoms?

A

-Pulsations in the abdomen
-Low back pain
-Abdominal pain
-Nausea and vomiting
-Shock

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19
Q

Aneurysm - Thoracic Aortic (25%). Signs and Symptoms?

A

-Widening of mediastinum on chest x-ray
-SUDDEN tearing, ripping pain in chest (may radiate to neck, shoulders, and back)
-Dyspnea, cough
-Dysphagia, hoarseness
-Difficulty walking

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20
Q

Aneurysm Treatment

A
  • LESS than 5cm
    • Monitor regulary (CT, ultrasound)
      -HTN give beta blockers
      -GREATER than 6cm or Causing symptoms
    • Surgical repair!
    • Beta blocker drip (likely Labetalol)
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21
Q

Aortic Dissection. Surgical intervention?

A

LIFE THREATENING! Tear of the aorta leading to bleeding within the aortic wall
-The tear is spiral, can be sudden or gradual. Commonly in the ascending aorta or aortic arch.
-Requires immediate surgical Intervention

22
Q

What part of the heart is most likely to suffer from cardiac trauma?

A

The aortic valve because it is most anterior in the chest

23
Q

Cardiac Trauma - Myocardial Contusion

A

-Damaged blood vessels bleeding in to the heart. WORSE OUTCOMES THEN PARICARDITIS
-ST elevation in the area of the injury

24
Q

Cardiac Trauma - Pericarditis

A

-Swelling and irritation of the thin sac tissue surrounding the heart
-Treat with NSAIDs, steroids, antibiotics
-ST elevation in ALL leads (This differentiates Pericarditis and myocardial contusion)

25
Cardiac Tamponade. What is it? Signs and symptoms?
-Abnormal amounts of fluid accumulate in the pericardial sac compressing the heart and leading to a decrease in cardiac output and shock -Hypotension, increased JVD, Widening of mediastinum on chest x-ray - **Pulseless Paradox** - ** Narrowed Pulse Pressure**
26
Pulseless Paradox
Systolic blood pressure drop >12mmHg upon inhalation
27
Coronary Artery Bypass Graft (CABG)
-Reroutes blood around blocked or narrowed coronary arteries to improve perfusion -Patient put in hypothermic state -Enhance oxygenation by hemodilution (isotonic) -Stop the heart via cardioplegic agent -The longer the bypass time, the higher complication rates are
28
Abnormal Heart Symptoms of a CABG procedure
Tamponade, Pericarditis
29
Post CABG Chest Tube Considerations
-Output > 100mL for 2 consecutive hours requires intervention -No dependent loops -Do not clamp unless changing set -Keep lower than the chest
30
Pacemaker! What do the initials mean?
- First initial - Paced - Second initial - Sensed - Third initial - Response Responses: - I - Inhibits - D - Inhibits and Triggers - O - None
31
Heart Failure (Broad Topic)
- Can be acute, chronic, or an acute exacerbation of a chronic condition - **High intracardiac pressures with decreased output**
32
Heart Failure - BNP Lab
- Brain Natriuretic Peptide - Released by the ventricles when the ventricular wall is under stress. Attempts to dilate and decrease intr-ventricular pressure
33
Systolic Heart Failure VS> Diastolic Heart Failure
- Systolic: Ejection Fraction of left ventricle is 40% or less. **Problem with ejection - Diastolic: Ejection Fraction > 50% or normal. **Problem with filling**
34
RIGHT sided heart failure - Signs/Symptoms/Causes
- Dependent edema. Venous distention. Elevated CVP/JVD - Caused by PE, RV infarct, septal defect, Pulmonary stenosis/insufficiency - Right sided HF effects the REST of the body (systems)
35
LEFT sided heart failure - Signs/Symptoms/Causes
- Hypoxemia. Tachycardia. Crackles. Cough. Pink frothy sputum. Elevated PAD/PAOP - Caused by fluid overload, chronic HTN, Cardiac tamponade, cardiomyopathy - Left sided HF effects the LUNGS
36
Cardiomyopathy - Dilated VS. Hypertrophic
- Dilated: Systolic Dysfunction (Problem ejecting). Thinning/dilation of left ventricle - Hypertrophic: Diastolic Dysfunction (Problem filling). Thickening of the heart muscle and septum -**Increased risk of sudden cardiac death**
37
Cardiogenic Shock - The worst presentation of heart failure
- Compensatory mechanisms fail to maintain cardiac output - Results in drop in cardiac output that can not adequately perfuse the organs - Increased preload and afterload due to vasoconstriction of compensatory mechanisms
38
Ventricular Assist Device (VAD)
Helps manage LEFT ventricular heart failure, cardiac myopathy, and cardiogenic shock
39
Intra Aortic Balloon Pump (IABP)
- Helps manage heart failure, cardiomyopathy, and cardiogenic shock - INFLATES at the beginning of diastole, noted by the dicrotic notch. Increases coronary artery perfusion - DEFLATES at the upward mark on an arterial line pressure wave OR on the upward mark of the R-wave. Decreases afterload
40
Pulmonary Artery Catheter (PAC) Swan-Ganz Catheter
-Used as a diagnostic tool to measure pulmonary artery pressures in the right atrium. -Pulmonary Artery Systolic Pressure ranges from 20-30 -Pulmonary Artery Diastolic Pressure ranges from 6-12 -For pressure think "quarters over dimes" ie: 25/10
41
Acute Coronary Syndrome Risk Factors - Modifiable and Non-modifiable
-Modifiable - Smoking, alc. intake, diet, obesity, hypertension, diabetes, HLD, metabolic syndrome -Non-modifiable - Age, sex, genetics, family hx
42
Unstable Angina
-Troponin Negative! Unpredictable chest pain at rest. Symptoms relieved with nitroglycerin. -ST depression or T-wave inversion
43
Non-ST Elevation Myocardial Infarction (NSTEMI)
-Troponin Positive? Sudden chest pain that is unrelieved with nitroglycerin -ST depression or T-wave inversion
44
ST Elevated Myocardial Infarction (STEMI)
-Troponin Positive! Sudden chest pain that is unrelieved with nitroglycerin -*ST elevation in 2 or more continuous leads*
45
Variant Angina aka Prinzmetals
- Troponin negative! - ST elevation with symptoms - Pain relieved with nitroglycerin - Brought on by alcohol, smoking, or cocaine ingestion - **Give Beta blockers UNLESS this is caused by cocaine use**
46
Chest Pain Management - Medications and EKG
- 12 lead EKG STAT and interpreted within 10 minutes - Aspitin - Give ASAP and chew it - Anti-platelet Agent - Clopidogrel - Beta Blocker - Usually metoprolol. *Do not give if cause is cocaine* - Pain management: Nitroglycerin and morphine - O2 supplementation if needed
47
1. STEMI Treatment and Intervention Timing 2. Door to Balloon Time? 3. Door to Drug Time?
-Requirements: Symptoms new (less than 12 hours). No response to nitro. ST elevation in 2+ continuous leads.New onset BBB - Reperfusion! Door to balloon within 90 minutes - Door to drug within 30 minutes (fibrolytic therapy)
48
Sheath Removal Monitoring
-Hold for 2 finger widths above insertion site for 20 minutes OR 30 minutes if patient is on anti-platelet drugs -Retroperitoneal Bleed: Sudden hypotension, sudden severe low back pain. *Give fluids and blood products* -Monitor pulses -Monitor chest pain and ST elevation (This would indicate re-occlusion)
49
Contraindications to Fibrolytic Therapy Post-MI
- Ischemic stroke within the last 3 months - Closed head or facial trauma within the last 3 months - Active bleeding - Prior intracranial hemorrhage
50
Dresslers Syndrome - What is it?
Often follows pericarditis. Presents with a Fever
51

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