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Medicine Recall > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Define Orthopnea

A

Difficulty breathing in the recumbent position (supine)

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2
Q

Define PND

A

Paroxysmal nocturnal dyspnoea = Patients awaken after 1–2 hours of sleep because of acute shortness of breath

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3
Q

Define Trepopnea

A

Positional dyspnea that is generally noted in either (one) the left or the right lateral decubitus position Due to disease of one lung, one major bronchus, or chronic congestive heart failure

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4
Q

Define Platypnea

A

Dyspnea that occurs only in the upright position

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5
Q

Define Hemoptysis

A

Coughing up of blood

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6
Q

Define Cheyne-Stokes respiration

A

Respiration characterized by a rapid deep-breathing phase, followed by periods of apnea

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7
Q

Define Stable angina

A

predictable pattern of angina onset and offset that is stable over time

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8
Q

Define accelerated angina

A

Angina that occurs at lower levels of exertion or that takes longer to resolve with rest or nitroglycerin; although accelerated angina fits the definition of unstable angina technically, it usually occurs over a longer period and is probably caused by progression of atheromatous coronary disease without plaque rupture.

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9
Q

Define Unstable angina

A

A change in the patient’s normal pattern of angina onset or offset, probably related to plaque rupture

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10
Q

Define ACS

A

Acute coronary syndrome. Although this could include STEMI, the term is commonly used to denote unstable or accelerated angina and NSTEMI.

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11
Q

Define Myocardial stunning

A

Prolonged depressed function of viable myocardium caused by a brief episode of severe ischemia (myocardium can recover with time if recurrent ischemic events are prevented)

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12
Q

Define Hibernating myocardium

A

Chronically depressed function of viable myocardium as a result of severe chronic ischemia (which can be reversed by revascularization)

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13
Q

Where can a PA catheter be inserted through?

A

Can be placed via the jugular, subclavian, or femoral veins

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14
Q

What chambers (in what order) does a PA catheter traverse to measure a wedge pressure?

A

The RA, RV, PA, and then to PCWP (pulmonary capillary wedge pressure)

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15
Q

What are the normal filling pressures measure by PA catheter?

A

1) RA pressure or Central venous pressure (thoracic vena cava) = 0–8 mmHg
2) RV Pressire = 15–30 / 0–8mm Hg
3) PA Pressure = 15–30 / 3–12 mmHg
4) PCWP = 3-12 mmHg

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16
Q

What is the PCWP?

A

Pulmonary capillary wedge pressure (aka PAOP, PC pressure, wedge pressure) It is the approximation of the LA and LV pressures during ventricular filling (LVEDP - end diastolic pressure)

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17
Q

How is the PC pressure obtained?

A

1–1.5 mL of air is pushed into the balloon port of the PA catheter while the PA tracing is watched. When the PA tracing is lost and the PCWP identified, the inflation is discontinued.

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18
Q

What is the danger of overinflating the balloon?

A

PA rupture, which can be fatal

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19
Q

What is the PCWP useful for?

A

For determining the intravascular volume status of the patient (i.e., PCWP >20 volume overloaded; PCWP <3 volume underloaded)

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20
Q

How is CO calculated?

A

Cardiac Output = [HR (beats/min)] * [stroke volume (mL/beat)]

(figure divided by 1000 to get L/min instead of mL)

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21
Q

What is the normal CO?

A

5 ± 1 L/min

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22
Q

How is CI calculated?

A

Cardiac Index = Cardiac output/Body Surface Area

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23
Q

What is the normal CI?

A

3 ± 0.5 L/min/m2

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24
Q

What is the Levine sign?

A

Clenched fist over the midsternum

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25
Q

What 7 historical features of chest pain must be identified to differentiate cardiac pain from noncardiac pain?

A

PQRST:

1) Precipitating factors—pain that follows exertion, exposure to cold, or meals suggests angina (or GERD); pain that follows retching or a twisting movement suggests alternative causes.
2) Quality—sustained squeezing or pressure may be described as “a heavy feeling,” “tightness,” “an elephant sitting on my chest,” or “bandlike.”
3) Radiation and location—pain may be central, left, or right sided (a specific location suggests alternative causes); radiation may extend to the neck, left arm, or right arm. Some pains can be tearing or pleuritic.
4) Relief—nitroglycerin relieves most angina in 2–5 minutes (a longer duration suggests MI or other causes); relief with leaning forward (positional effects) suggests pericarditis; relief with antacids suggests GI causes.
5) Risk factors—a history of CAD, family history, gender, tobacco use, diabetes, hyperlipidemia, and hypertension are risk factors.
6) Symptoms—such as dyspnea, nausea, vomiting, belching, diaphoresis, and palpations all suggest angina; patients often express a sensation of impending doom or total denial.
7) Time and duration—very brief (seconds) episodes are not angina; prolonged (hours) episodes may indicate infarction or other causes (e.g., pericarditis, dissection).

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26
Q

What are the major cardiovascular causes of chest pain?

A

1) Myocardial ischemia
2) Myocardiac infarction (MI)
3) Aortic dissection
4) Aortic aneurysm
5) Pulmonary emboli

6) Mitral Valve Prolapse (MVP)
7) Pericarditis
8) Pulmonary hypertension

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27
Q

List some noncardiovascular causes of chest pain

A

1) Gastrointestinal (e.g., esophageal spasm, reflux, and rupture; gastric, duodenum, or gallbladder disease)
2) Pleura and lung conditions (e.g., pneumothorax, pleural adhesions)
3) Shoulder-hand syndrome, shoulder girdle
4) Diseases of the chest wall (e.g., thrombophlebitis, herpes zoster infection, costochondritis)
5) Diseases of the spine and mediastinum

28
Q

What are some important causes of hemoptysis?

A

Multiple Sclerosis

Obstructive cardiomyopathy

Congenital heart disease with right-to-left shunting

Aortic aneurysm

Pneumonia

Pulmonary infarction

Pulmonary carcinoma

Pulmonary vasculitis

Pulmonary tuberculosis

29
Q

What are some of the causes of dyspnea?

A

11 Ps:

  • Pulmonary bronchoconstriction (asthma, COPD)
  • Pulmonary embolus
  • Pulmonary hypertension
  • Pneumonia
  • Pneumothorax
  • Pump failure (congestive heart failure)
  • Pericardial tamponade
  • Psychogenic
  • Poison (carbon monoxide)
  • Peak seekers (high altitude)
  • Paroxysmal spasm of the vocal cords (vocal cord dysfunction)

Others:

  • Anemia and thyroid disease
  • Restrictive Lung disease (e.g. idiopathic pulmonary fibrosis)
  • interstitial lung disease (e.g. silicosis)
  • Deconditioning and chest wall weakness (muscle or nerve disease)
30
Q

Why is it important to use the appropriately sized BP cuff ?

A

An undersized BP cuff results in an overestimated BP measurement; an oversized BP cuff results in an underestimated BP measurement.

31
Q

How accurate is a BP cuff ?

A

± 5mmHg

32
Q

How close should the right and left arm pressures be?

A

Within 10 mmHg;

if > 10 mmHg, consider subclavian stenosis, aortic coarctation, and aortic dissection

33
Q

What is arcus senilis?

A

Circumferential light ring around the iris, which is frequently associated with hypercholesterolemia if present in patients younger than 50 years

34
Q

What is ectopia lentis and what is it associated with?

A

Dislocated lenses; homocystinuria or Marfan syndrome

35
Q

What are the causes of blue sclera?

A

Ehlers-Danlos syndrome, osteogenesis imperfecta, and Marfan syndrome, which are all associated with aortic root dilation or aneurysm or with MVP

36
Q

What are plaques of Hollenhorst?

A
37
Q

What are the causes of clubbing?

A

1) Cyanotic congenital heart disease (e.g. right-to-left shunting, malposition of the great arteries)
2) Pulmonary disease (e.g., hypoxia, lung cancer, bronchiectasis, and cystic fibrosis)
3) IE
4) Biliary cirrhosis
5) Regional enteritis
6) Familial clubbing

38
Q

Where is the normal PMI (apex beat) found?

A

At the fifth (to sixth) intercostal space at the left midclavicular line

39
Q

What causes an S1?

A

Closure of the mitral and tricuspid valves

40
Q

What causes a soft S1?

A

1) Mitral Regurgitation (rheumatic or calcific)
2) Atrioventricular block
3) Aortic regurgitation
4) Severe acute aortic insufficiency (valve closes prematurely)

41
Q

What causes an S2?

A
42
Q

What is the first sound of a split S2?

A
43
Q

What causes splitting of S2?

A
44
Q

What happens to the splitting during respiration?

A

During inspiration, the venous return to the right atrium is increased (due to negative intrathoracic pressure), resulting in a larger stroke volume and consequent longer ejection cycle (thus pulmonic sound P2 occurs later), with a concomitant reduction in left atrium venous return and a smaller LV stroke volume and shorter ejection phase (earlier A2), resulting in widening of the splitting.

45
Q

What causes a widely split S2?

A

1) Right Bundle Branch Block
2) LV pacing
3) RV outflow obstruction
4) pulmonary atresia
5) pulmonary hypertension
6) Rarely, severe Mitrial Regurgitation

Could be paradoxical splitting:

7) LBBB
8) Aortic stenosis

46
Q

What causes fixed splitting of S2?

A

i. e. splitting does not vary with inspiration
1) Septal defect (usually atrial septal defect)

47
Q

What is paradoxical splitting of S2?

A

The pulmonic closure sound (P2) is heard before the aortic closure sound (A2), and splitting therefore occurs during expiration

48
Q

What is included in the differential of paradoxical splitting?

A

1) Pulmonary hypertension
2) Left Bundle Branch Block
3) Aortic stenosis
4) Hypertrophic cardiomyopathy
5) Patent ductus arteriosus (left-to-right shunt)
6) Tricuspid regurgitation

49
Q

What causes a soft A2?

A

1) Aortic Stenosis (decreased mobility), or
2) Aortic Insufficiency (fails to coapt)

50
Q

What causes a loud P2?

A

Pulmonary hypertension

51
Q

What causes an S3?

A

Unknown, but it occurs in patients with volume-overloaded hearts (RV or LV) or hyperdynamic circulation - In case of rapid ventricular filling (e.g. Mitral regurgitation, Ventricular septal defect), or Poor left ventricular function (e.g. post-MI)

May also be a normal variant in patients younger than 40 years.

52
Q

What causes an S4?

A

Organized atrial contraction into a stiff ventricle (i.e. ventricular fibrosis it does not occur in AF).

53
Q

Define galloping rhythm

A

A (usually abnormal) rhythm of the heart on auscultation; It includes three or four sounds (with S3 or/and S4), thus resembling the sounds of a gallop.

54
Q

How are S3 and S4 gallops best heard?

A

By using the bell of the stethoscope over the apex (S3) or the left sternal border (S4)

55
Q

What is an opening snap?

A

A high-pitch additional sound heard after the A2 during diastole, usually due to mitral stensosis

56
Q

What is a pericardial friction rub?

A

A sound heard with irritation of the pericardial/myocardial interface (e.g. pericarditis)

57
Q

What are the general causes of central cyanosis?

A

Decreased arterial oxygen saturation caused by:

  • *1) Cardiac (right-to-left shuntin)**
  • Heart failure
  • Tetralogy of Fallot
  • Transposition of great vessels
  • Tricuspid atresia
  • *Eisenmenger syndrome from uncorrected L2R shunt e.g. atrial or ventricular septal defects
  • *2) Pulmonary (reduced function)**
  • Hypoventilation
  • V/Q mismatches (e.g. pneumonia)
  • Pulmonary venous fistulas
  • Intrapulmonary shunts

3) Haemotological (impaired ability of Hgb to bind O2)
- methemoglobinemia
- Sulfhaemoglobinaemia
- abnormal Hgb variants

58
Q

What are the causes of peripheral cyanosis?

A

1) Cutaneous vasoconstriction caused by low CO (e.g. congestive heart failure)
2) Cutaneous vasoconstriction due to cold exposure
2) Raynaud phenomenon (cold, stress)

59
Q

What are the causes of peripheral edema?

A

1) Cardiac (increased venous or hydrostatic pressure; renal salt & water retention due to decreased renal perfusion due to decreased CO)

  • Congestive cardiac failure
  • Chronic Venous insufficiency
  • Constrictive pericarditis
  • Venous obstruction

2) Liver (Hypoalbuminaemia which decreases plasma oncotic pressure; renal salt & water retention due to decreased renal perfusion due to splanchnic bed vasodilatation)
- Hepatic cirrhosis
3) Renal (hypoalbuminaemia; renal salt & water retention)

  • Nephrotic syndrome
  • Renal failure

4) Others

  • Myxedema (hypothyroidism)
  • Pregnancy
  • Lymphatic obstruction
  • Angioedema (allergy)
  • Drug side effects (e.g. Fluoxetine, Olanzapine)
60
Q

In the jugular venous tracing shown in Figure 3-1, identify the various numbered waveforms.

A
  1. a wave
  2. c wave
  3. v wave
  4. x descent
  5. y descent
61
Q

Identify the various waveforms in the jugular venous tracing, and their timing or event in the cardiac cycle.

A

The “ a “ wave corresponds to right Atrial contraction and ends synchronously with the carotid artery pulse. The peak of the ‘a’ wave demarcates the end of atrial systole

The “ c “ wave corresponds to right ventricular Contraction causing the triCuspid valve to bulge towards the right atrium.

The “ x’ “ (x prime) descent follows the ‘c’ wave and occurs as a result of the right ventricle pulling the tricuspid valve downward during ventricular systole. (As stroke volume is ejected, the ventricle takes up less space in pericardium, allowing relaXed atrium to enlarge). The x’ (x prime) descent can be used as a measure of right ventricle contractility.

The “ x “ descent follows the ‘a’ wave and corresponds to atrial relaXation and rapid atrial filling due to low pressure.

The “ v “ wave corresponds to Venous filling when the tricuspid valve is closed and venous pressure increases from venous return - this occurs during and following the carotid pulse.

The “ y “ descent corresponds to the rapid emptYing of the atrium into the ventricle following the opening of the tricuspid valve.

62
Q

Define and list the major causes of pronounced a waves.

A

An abnormally large and abrupt outward movement of the jugular vein that occurs before the first heart sound. The ‘prominent’ a-wave precedes ventricular systole and the carotid pulse upstroke:

1) Right ventricular hypertrophy

  • Cor pulmonale
  • Pulmonary hypertension
  • Pulmonary stenosis
  • Pulmonary embolus

2) Tricuspid stenosis or atresia
3) ? Mitral valve disease

63
Q

What is the major cause of pronounced v waves?

A
64
Q

What is the abdominal- jugular (also called hepatojugular) reflux? What’s its mechanism?

A

An increase of 3 cm H2O in JVP with 10–30 seconds of periumbilical pressure.

Putting pressure on the right upper quadrant assists in venous return to the right side of the heart via the inferior vena cava. The increased volume of blood returning to the right side of the heart is met with raised end-systolic and -diastolic pressures in the right atrium and ventricle (due to the right-sided dysfunction) and venous blood and pressure is ‘backed up’ into the jugular veins. The right ventricle cannot accommodate additional venous return.

65
Q

What causes Hepatojugular reflux?

A

1) Any cause of right ventricular dysfunction – systolic or diastolic dysfunction
2) Heart failure and volume overload
3) Elevated right ventricular afterload

66
Q

Define and explain causes of cannon a waves?

A

A large, abrupt flicker/flicker of the a-wave that occurs after S1 and on the carotid pulse upstroke due to atrial contraction against a closed tricuspid valve:

1) Heart block, in particular third-degree (complete) AV block
2) Ventricular tachycardia
3) Premature junctional beats
4) pulmonary hypertension
5) Severe tricuspid stenosis

Medicine Recall (2 decks)

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