Cardiology Flashcards
PAOP/normal values/ parameter measured
LV- (8-12 mmHG) preload
RAP/ normal values/ parameter measured
Right Ventricle ( 2-6mmHg) preload
SVR/SVRI/ normal values/ parameter measured
Systemic vascular resistance/ (800-1400)/ afterload
What formula states: resistance in a vessels depends on: length of the vessel, radius of the vessel, and the viscosity of the vessel
Poiseuille’s Formula
the nutrient bed where exchange of gases, nutrients, and metabolites takes place by the process of diffusion
Capillary bed
a term used to describe fluid accumulation in any space that is not intravascular or intracellular
third spacing
Angiotensin II causes
vasoconstriction and secretion of aldosterone
Angiotensin I is converted to antiotensin II by ___ ___ ___ as the blood travels through the lung
Angiotensin converting enzyme
Lactic acidosis is a result of anaeorbic metabolsim, and elevated serum arteral lactate level indicates a
tissue oxygen deficit
What is the normal arterial lactate level
1mmol/L
Herbal Suppliments:
may increase risk of bleeding with warfarin
Alfalfa
Herbal Suppliments:
may cause hypotension
Black cohosh
Herbal Suppliments: may increase hr and/or bp
ephedra
Herbal Suppliments: may potentiate warfarin
ginger
Herbal Suppliments: may increase risk of bleeding with anticoagulants
garlic
Herbal Suppliments: may potentiate warfarin; may cause hypertension, hallucinations, or delirium
goldenseal
Herbal Suppliments: increases effects of statins, calcium channel blockers
grapefruite juice
Herbal Suppliments: may decrease effects of warfarin
green tea
Herbal Suppliments: potentiate effects of cardiac glyocosides and nitrates
hawthorn
Herbal Suppliments: may increase HR or BP; may decrease digoxin blood level
St. John’s Wort
alternating pluse waves, every other beat being weaker than the preceding one, characteristic of:
Pulses Alternans
Characteristics of LVF
an exaggeration of normal physiologic response to inspiration, BP drop of more than 10mmHg during inspiration
Pulsus paradoxus
Characteristic of: cardiac tamponade, pericardial effusion
advance HF
hemorrhagic shock
identified by dorsiflexing the foot with the knee slightly bent, present if:
indicates:
Homan’s sign
present if the patient has pain in the calf
indicates thrombophlebitis
What are the 6 P’s of acute arterial occlusion
Pain, Pallor, Pulselessness, Parasthesia, Paralysis, Polar (cold)
Stroke Volume
60-120
In cardiac pulmonary edema, the __ is elevated, ___ is elevated, and the difference between the PA diastolic and PAOP is less than __ mmHG
PAP (10-20) , PAOP(8-12), 5mmhg
Most common cause is acute respiratory distress syndrom or drowning
Noncardiac pulmonary edema
In noncardiac pulmonary edema, the __ is elevated, ___ is normal, and the difference between PAOP and PA diastolic is greater than ___ mmHg
PAP, PAOP, 5mmHg
MI Leads/CA Infarct:
Extensive Anterior
Leavs V1-V6
Left Main
MI Leads/CA Infarct:
Septal
Leads V1, V2, V3, V4
Left Anterior descending artery
MI Leads/CA Infarct:
Lateral
Leads 1, aVL, V5, V6
Left Circumflex artery
MI Leads/CA Infarct:
Inferior
Leads II, III, aVF
Right coronary artery
MI Leads/CA Infarct:
Posterior
Leads V1, V2, V7-V9
Right Coronary artery
Most common cause of right ventricular failure is
left ventricular failure
inability of the ventricle to shorten against a load; the left ventricle loses its ability to contract normally against progressive increase in afterload
systolic dysfunction HF
Clinical indications of what type of HF:
displaced PMI, JVD; S3 Crackles, dyspnea, peripheral edema; cardiomegaly
Systolic dysfunction (pump problem)
Drug Therapy for what type of HF:
diuretics if congestive symptoms, ACE inhibitor or ARB; BB OR ALPHA AND BETA blocker; inotropes may be requried for diuretic-resistant congestion; andti-dysrhythmics and anti-coagulants may be indicated
Systolic dysfunction (pump problem)
an impairment in LV filling at near normal or mildly elevated left atrial and ventricular pressures; due to decrease in ventricular compliance; small changes in volumes are associated with a disproportionate increase in pressure
diastolic dysfunction (filling problem)
Clinical indications of what type of HF:
S4, crackles, dyspnea, peripheral edema, precordial heave; normal heart sounds
diastolic dysfunction (filling problem)
Hemodynamics of HF:
increased contractility; normal EF, increased cardiac pressures, with normal or slightly increased cardiac volumes
diastolic dysfunction (filling problem)
what certain pharmacologic agents should you avoid with HF
antidysrhytmics used to suppress asymptomatic dysrhytmias
most calcium channel blockers
NSAIDS (increased resistance to diuretics)
More than half of patients with HF are __ with H&H less than __ g/dL and treatment of anemia improves cardiac function
anemic
12
indication for heart as the result of systolic and diastolic dysfunction. Acts as a cardioprotective agent to protect the heart from excessive catecholamines
decrease LV mass and volume
changes the shape of the ventricle from spherical to elliptical
BB
Coreg
Zebeta
Lopressor, Toprol
Contraindications of BB
BRONCHIAL asthma
Second or third degree AV block
severe hepatic dysfunction
Indication for heart failure as the result of systolic and diastolic dysfunction, block conversion of angiotensin I to angiotensin II and the resultant vasoconstriction and aldosterone release
ACE Inhibitors
captoPRIL
enalaPRIL
ramiPRIL
especially helpful in patients who have a very high afterload that is refractory to arterial vasodilators or who are too hypotensive to utilize arterial dilators to reduce afterload
IABP
which of the following cardiac biomarkers most likely would be elevated within 4-6 hours of an acute myocardial infarction and stay elevated for several days?
Troponin
What are the 5 E’s which are common causes of angina pain?
Exercise, exertion, emotion, exposure, and eating
Pinkish discoloration of the cheeks (malar blush) is common with which valvular disorder?
Mitral stenosis
Clinical Presentation of which valvular disease:
palpitations, cough, dyspnea, orthopnea, crackles, dysphagia, syncope, RV heave palpabel at sternum,
mid-diastolic murmur (heard loudest at apex)
Mitral stenosis
Clinical Presentation of which valvular disease:
hemodynamic paramaters PAOP waveform shows large a waves
Mitral stenosis
Clinical Presentation of which valvular disease:
dyspnea, orthopnea, syncope, widened pulse pressure, Water-hammer pulse: rapid rise that collapses quicly, visible capillary pulsation of nailbeds when fingertip is pressed, S3, crackles, JVD, hepatomegaly, diastolic murmur, aortic ejection click
Aortic regurgitation
Clinical Presentation of which valvular disease:
chest pain, fatigue, weakness, narrow pulse pressure,split s1, systolic ejection murmur-loudest at aortic area radiating to neck, may have aortic ejection click
Aortic stenosis
On a pulmonary artery waveform, the dicrotic notch represents closure of which valve?
Pulmonic valve
antidysrhythmic agents associated with serious adverse effects when used long term
amiodarone
an inotropic agen at doses of about 5 mcg/kg/min and primarily a ____. increases afterload and possibly preload by decreasing the vasular capacitnce
Dopamine
vasoconstrictor
an arterial dilator and would decrease afterload
Hydrolazine HCL
a mixed vasodilator with predominant arterial end effect. would decrease afterload more than preload
Nitroprusside
medication dilates predominantly veins and increasing venule capcitance, venous return to the heart and therefore preload are reduced
Nitroglycerin
the skin changes associated with chronic peripheral arterial disease are:
pale and shiny skin with hair loss, ulceration at pressure points, and diminished or absent pulses
the skin changes associated with chronic peripheral venous disease are:
thickened with brownish discoloration at the ankles, unclerations at the sides of the ankles, and rubor when in dependent position
may occur after converion of atrial fibrillation to a sinus rhythm. when the atria are in fibrillation, there is a blood stasis with potential formation of these. after conversion, the more forceful contraction of the atrium may dislodge and propel them. these will travel into the coronary, cerbral or systemic ciriculation
cerebral microemboli that orginate in the left atrium or ventricle
what is the treatemnt for unstable narrow QRS complex tachycardia
immediate cardioversion with sedation (if pt is conscious)
inotropic agent of choice in LV ventricular failure associated with acute myocardial infarction, and it would also decrease preload
Dobutamine
When should hemodynamic parameters be measured for consistency
end of expiration
which drug category is used to block the maladaptive sympathetic nervous system innervation in HF
BB
first stage of compensation for HF is sympathetic nervous system stimulation, whic causes tachycardia and vasoconstriction
QRS complex >0.12 and QRS complex that is positive in leads V5 and V and negative in V1 and V1. Causes a paradoxical splitting of S2 (split on expiration but no on inspiration).
LBBB
what happens when a magnet is placed over a pacemaker?
the pacemaker is converted to asynchronous. the pulse interval can be measured even if the patient’s rate is above the pacing rate- allows evaulation of battery life
Which of the following would not be recommended for diastolic dysfunction
Inotropes
What is the most frequently ID primary mechanism of cardiac arrest?
VF
Which of the following should be suspected if ST segment elevation occurs in the anterior leads and the inferior leads
Pericarditis
the pacemaker sense the T wave or other inappropriate signals and is inhibited. this is an example of:
oversensing
What is the best position for the patient during assessment for JVD
on his or her back with the head of the bed elevated at 45 degrees
A patient with severe hypertension most likely would have what?
S4 - patient with severe hypertension would develop ventricular hypertrophy, whic makes the ventricle noncompliant
The sudden decrease in the pulmonary aretery diastolic pressure most often indicates that the catheter has:
flipped back into the right ventricle
EKG showing pacing spikes not followed by a QRS complex (or P wave)
failure to capture
evidenced by pacing spikes occuring on time regardless of the patient’s intrinsic rhythm
failure to sense
No spikes on a pt EKG who is supposed to be paced indicates and intrinisc rate slower than the pacemaker rate
failure to pace
In determining readiness to wean a patient from a IABP, which parameters are most important?
CI and SVR.
What is a manifestation of left atrial enlargement on the electrocardiogram?
Wide, notched P waves in lead II on 12-lead ECG.
Normal range of PAd
2-6mm Hg
Which is normally higher? PAd or PAOP
PAOP should not be higher than the PAd
What is the most appropriate immediate treatment for failure to capute
turn the patient to his or her left side
A wide and abnormally notched P wave may be seen in patients with
Mitral stenosis-
sometimes referred to as P Mitrale
What is often present in dilated cardiomyopathy as a result of ventriculaar dilation and stretching of the mitral valve ring?
dilated cardiomyopathy
the pain of pericarditis is lessened when the patient is in what position?
sitting up and leaning forward- the heart is more vertical and free, hanging with minimal pressure on adjacent structures
