Cardiology Flashcards by Henry Slocum

What are the Antiarrhythmic Classifications?

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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Which Class is Procainamide?

Class I: Sodium Channel Blocker

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Which class is Lidocaine?

Class I: Sodium Channel Blocker

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Which class is Amiodarone?

Class III: Potassium Channel Blocker

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How do you calculate Mean Arterial Pressure (MAP)?

((2 x Diastolic) + Systolic) / 3

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What are the layers of the Pericardium?

Fibrous Pericardium (outer)
Serous Pericardium (attached to the surface of the diaphragm)
Visceral Pericardium (inner)

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What are the layers of the heart?

Epicardium (outer)
Myocardium (middle)
Endocardium (inner)

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Which artery supplies the Right Atria?

Right Coronary Artery (RCA)

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Which artery supplies the Left Atria?

Left Circumflex Coronary Artery (LCX)

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What are the four key characteristics of myocardial cells?

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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What are the three coronary arteries?

Left Coronary Artery (LCA)
Right Coronary Artery (RCA)
Circumflex artery (LCX)

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Describe the cardiac cycle?

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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What is Preload?

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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What is Afterload?

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

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What is Contractility?

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

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What is Stroke Volume?

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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What is a normal Ejection Fraction (EF)?

50 - 70%

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What is Pericarditis?

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

Dyspnea

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

Elevation

ST Depression occurs in late stages

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

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

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What is Beck’s Triad?

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

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What type of EKG rhythm is most common with Pericarditis?

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

What is the treatment for Pericarditis?

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

What is Myocarditis?

Inflammation of the Myocardium and the conduction system of the heart

What is Endocarditis?

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

What are the layers of the blood vessel?

- Tunica Adventitia (Outer) - Tunica Media (Middle) - Tunica Intima (Inner)

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

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

What is the most common aneurysm?

Abdominal Aorta Aneurysm (AAA)

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

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

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

- Where pressure in the aorta is highest (Ascending Aorta) | - Hypertension

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

Target Heart Rate = 60 - 80 beats per minute | Target Systolic Blood Pressure = 100 - 120 mmHg

What medication is recommended for Dissecting Aneurysms?

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

What is the difference between Hypertensive Urgency and Hypertensive Emergency?

- 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

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

- Seizures (HTN Encephalopathy) - Flash Pulmonary Edema - Acute Renal Failure - MI - AMS

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

- 20% | - Rapid reduction of blood pressure can result in ischemia or infarction of major organ systems (watershed stroke)

What is the most common form of Congestive Heart Failure?

Left-sided Heart Failure

What medications are recommended for CHF?

- ACE inhibitors (reduce afterload) | - Diuretics (fluid balance)

What is Variant Angina (Prinzmetal's)?

Chest pain that occurs spontaneously, and at rest - usually at night - Coronary Artery Spasms

What causes the pain in chest pain?

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

What is the difference between STEMI and non-STEMI?

- STEMI is usually caused by complete obstruction of the coronary artery - non-STEMI is usually caused by partial obstruction of the coronary artery

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

- Diabetics - Post-Menopausal women - Post-heart transplant - Smokers - Elderly

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.

True - Can also be elevated in skeletal muscle injury

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

Troponin can be elevated 7-14 days post infarct

What is the preferred biochemical marker for MI?

Troponin - it increases 20 x in value after an MI - even the slightest increase in troponin levels can show cardiac injury

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

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

What does Dopamine do? and whats the dose?

- Increases myocardial contractility and supports the blood pressure 5-10 mcg/kg/min

What does Dobutamine do? and what is the dose?

- induces significant positive inotropic (contractility) effects with mild chronotrophic (rate) effects 2-20 mcg/kg/min

What does Norepinephrine do? and what is the dose?

(Levophed) - Potent alpha adrenergic agonist with minimal beta adrenergic agonist effects 0.2 - 1.5 mvg/kg/min

What does Epinephrine do? and what is the dose?

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

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

a clot breaking lose and going to the heart or brain

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

Pacing

What is the normal range of Systolic (SBP)?

90-140 mmHg

What is the normal range of Diastolic (DBP)?

60-90 mmHg

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

70-100 mmHg

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

2.5 - 4 L/min/m2

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

4-8 L/min