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Cardiology Flashcards

1
Q

What are the Antiarrhythmic Classifications?

A 
Class I: Sodium Channel Blockers
Class II: Beta Receptor Blockers
Class III: Potassium Channel Blockers
Class IV: Calcium Channel Blockers
Class V: Miscellaneous
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2
Q

Which Class is Procainamide?

A

Class I: Sodium Channel Blocker

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3
Q

Which class is Lidocaine?

A

Class I: Sodium Channel Blocker

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4
Q

Which class is Amiodarone?

A

Class III: Potassium Channel Blocker

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5
Q

How do you calculate Mean Arterial Pressure (MAP)?

A

((2 x Diastolic) + Systolic) / 3

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6
Q

What are the layers of the Pericardium?

A
  • Fibrous Pericardium (outer)
  • Serous Pericardium (attached to the surface of the diaphragm)
  • Visceral Pericardium (inner)
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7
Q

What are the layers of the heart?

A
  • Epicardium (outer)
  • Myocardium (middle)
  • Endocardium (inner)
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8
Q

Which artery supplies the Right Atria?

A

Right Coronary Artery (RCA)

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9
Q

Which artery supplies the Left Atria?

A

Left Circumflex Coronary Artery (LCX)

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10
Q

What are the four key characteristics of myocardial cells?

A

1) Automaticity - if left without input, a single cardiac cell will contract rhythmically at a steady rate
2) Excitability - the ease with which cardiac cells undergo change
3) Conductivity - the intrinsic ability of the cardiac cell to conduct electrical impulses
4) Contractility - the intrinsic ability of the heart muscle to contract to a given length

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11
Q

What are the three coronary arteries?

A
  • Left Coronary Artery (LCA)
  • Right Coronary Artery (RCA)
  • Circumflex artery (LCX)
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12
Q

Describe the cardiac cycle?

A

1) Systole - depolarization (Na+ and Ca+ move into cell)
2) Isovolumetric Contraction - Contraction occurs in ventricles increasing pressure before semilunar valves are opened (Diastole repolarization - Na+ and Ca+ channels closed and K+ flows out of the cell)
3) Isovolumetric Relaxation - Relaxation occurs and Ventricular pressure decreases after semilunar valves closed and before AV valves have opened
4) AV valves open filling the ventricles
5) Atrial Kick - completely filling ventricles

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13
Q

What is Preload?

A

The stretch on the myofibril at the end of diastole which allows for filling of the ventricles

  • Frank - Starling’s Law
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14
Q

What is Afterload?

A

The pressure against which the ventricle must pump to open the semilunar valve
- Resistance to flow

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15
Q

What is Contractility?

A

Contractile force of the heart independent of preload and after load.

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16
Q

What is Stroke Volume?

A

The amount of blood ejected by the ventricles with each contraction.

  • Normal Stroke Volume is 60 - 130 cc’s per beat
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17
Q

What is a normal Ejection Fraction (EF)?

A

50 - 70%

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18
Q

What is Pericarditis?

A

Inflammation of the pericardium causing extra fluid to build up restricting preload and afterload in the heart

  • Related to kidney problems and dialysis patients
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19
Q

What is the most common presenting complaint in elderly patients with acute coronary syndrome (ACS)?

A

Dyspnea

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20
Q

In Pericarditis and Myocarditis, ST _________ can be seen in almost all leads.

A

Elevation

  • ST Depression occurs in late stages
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21
Q

What is the most comfortable position for a patient that has Pericarditis?

A

Pain is usually made worse when the patient lies flat, and is relieved when the patient leans forward.

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22
Q

What is Beck’s Triad?

A
  • Used to asses a patient that may have a cardiac tamponade (pericarditis leads to tamponade)
  • Hypotension
  • JVD
  • Muffled heart tones
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23
Q

What type of EKG rhythm is most common with Pericarditis?

A

Electrical Alternans - Varying QRS amplitudes (heart swinging in pericardial sac)

24
Q

What is the treatment for Pericarditis?

A

Lots of fluids to counteract the pressure from the fluid in the Pericardial sac and precent the RA and RV from collapsing during Diastole.

25
Q

What is Myocarditis?

A

Inflammation of the Myocardium and the conduction system of the heart

26
Q

What is Endocarditis?

A

Injury to the heart via infection due to turbulent flow near valves.

27
Q

What are the layers of the blood vessel?

A
  • Tunica Adventitia (Outer)
  • Tunica Media (Middle)
  • Tunica Intima (Inner)
28
Q

What are the 3 types of Aortic Aneurysm’s and what are they?

A

1) True Aneurysm - Involves all 3 layers of the blood vessel wall
2) False Aneurysm - Contained by the 2 outer layers of the blood vessel wall and a clot
3) Dissection - Separation of the vessel wall which allows blood to leak between the layers of the vessel

29
Q

What is the most common aneurysm?

A

Abdominal Aorta Aneurysm (AAA)

30
Q

What is the difference in pain between a MI and a Dissection?

A

For a Dissection pain will present with sudden onset of maximal chest pain

31
Q

Where are Aortic Dissections most common and what is the leading cause?

A
  • Where pressure in the aorta is highest (Ascending Aorta)

- Hypertension

32
Q

With patients with a suspected dissecting aneurysm what is the target heart rate and blood pressure?

A

Target Heart Rate = 60 - 80 beats per minute

Target Systolic Blood Pressure = 100 - 120 mmHg

33
Q

What medication is recommended for Dissecting Aneurysms?

A

Beta Blockers - to reduce the blood pressure, thereby reducing the sheer force on the aortic arch.

34
Q

What is the difference between Hypertensive Urgency and Hypertensive Emergency?

A
  • Hypertensive Urgency - Results in an increase in BP, but no damage to the body’s organs
  • Hypertensive Emergency - Organ damage occurs as a result of the hypertension
35
Q

What symptoms occur when a patient has End-Stage organ damage?

A
  • Seizures (HTN Encephalopathy)
  • Flash Pulmonary Edema
  • Acute Renal Failure
  • MI
  • AMS
36
Q

Ina hypertensive crisis, the MAP should not be lowered by more than ______ in the first hour of treatment. Why?

A
  • 20%

- Rapid reduction of blood pressure can result in ischemia or infarction of major organ systems (watershed stroke)

37
Q

What is the most common form of Congestive Heart Failure?

A

Left-sided Heart Failure

38
Q

What medications are recommended for CHF?

A
  • ACE inhibitors (reduce afterload)

- Diuretics (fluid balance)

39
Q

What is Variant Angina (Prinzmetal’s)?

A

Chest pain that occurs spontaneously, and at rest

  • usually at night
  • Coronary Artery Spasms
40
Q

What causes the pain in chest pain?

A

Pain occurs because blood flow to the heart is decreased or impaired

  • During these time the heart uses anaerobic metabolism, where the primary byproduct is lactic acid (muscle decay)
  • The build up of Lactic Acid causes the pain
41
Q

What is the difference between STEMI and non-STEMI?

A
  • STEMI is usually caused by complete obstruction of the coronary artery
  • non-STEMI is usually caused by partial obstruction of the coronary artery
42
Q

What diseases can cause people to have atypical or no signs or symptoms associated with MI?

A
  • Diabetics
  • Post-Menopausal women
  • Post-heart transplant
  • Smokers
  • Elderly
43
Q

True or False

CK-MB cardiac enzyme test can show up 4 hours after onset of infarction and peaks at about 24 hours with a duration of 72 hours.

A

True

  • Can also be elevated in skeletal muscle injury
44
Q

How many days can a Troponin (cTnl) remain elevated for post infarct?

A

Troponin can be elevated 7-14 days post infarct

45
Q

What is the preferred biochemical marker for MI?

A

Troponin

  • it increases 20 x in value after an MI
  • even the slightest increase in troponin levels can show cardiac injury
46
Q

True or False

For a patient with an Acute MI (AMI) increasing oxygen to supra normal levels is beneficial to the patient.

A

False

Increasing Oxygen to supra normal levels will increase BP and vascular resistance (afterload).

47
Q

What does Dopamine do? and whats the dose?

A
  • Increases myocardial contractility and supports the blood pressure

5-10 mcg/kg/min

48
Q

What does Dobutamine do? and what is the dose?

A
  • induces significant positive inotropic (contractility) effects with mild chronotrophic (rate) effects

2-20 mcg/kg/min

49
Q

What does Norepinephrine do? and what is the dose?

A

(Levophed)
- Potent alpha adrenergic agonist with minimal beta adrenergic agonist effects

0.2 - 1.5 mvg/kg/min

50
Q

What does Epinephrine do? and what is the dose?

A

Increases the MAP by increasing the cardiac index and stroke volume, along with an increase in SVR and HR

1 - 10 mcg/min

Last choice medication

51
Q

What is the biggest concern with regards to non-bacterial thrombotic endocarditis (NBTE)?

A

a clot breaking lose and going to the heart or brain

52
Q

For a patient in Cardiogenic shock what treatment may be warranted to regulate heart rate?

53
Q

What is the normal range of Systolic (SBP)?

A

90-140 mmHg

54
Q

What is the normal range of Diastolic (DBP)?

A

60-90 mmHg

55
Q

What is the normal range of Mean Arterial Pressure (MAP)?

A

70-100 mmHg

56
Q

What is the normal range of Cardiac Index (CI)?

A

2.5 - 4 L/min/m2

57
Q

What is the normal range of Cardiac Output (CO)?

Cardiology (3 decks)

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