Cardiology Flashcards
What three factors are needed to maintain adequate pressure in the cardiovascular system?
1) Pump, 2) Volume, 3) Resistance
Name 3 catecholamines, where they are produced, and how they relate to shock.
1) Epinephrine and 2) Norepinephrine produced in adrenal medulla. 3) Dopamine produced in substantia nigra. Some typical effects are increases in heart rate, blood pressure, blood glucose levels, and a general reaction of the sympathetic nervous system
What type of shock is hemorrhagic shock?
Hypovolemic ( **most common shock)
Name some types of cardiogenic shock
MI, arrhythmia, CHF, congenital malformation, hypertension
What type of shock is tension pneumothorax, PE, obstructive valve disease, and pericardial tamponade?
Obstructive shock
Name types of distributive shock
sepsis, anaphylaxis, neurogenic
Your ICU vitals are: BP 90/65, heart rate 120, altered MMS, urine output has ceased, peripheral pulses are absent. What 9 labs are you going to get?
1) CBC, 2) blood type and cross, 3) coagulation parameters, 4) electrolytes, 5) glucose, 6) urinalysis, 7) serum creatinine, 8) pulse ox, 9) serial ABG
How do you treat shock initially?
ABCs. Fluids to restore blood pressure, if that doesn’t work or if it is cardiogenic: use vasoactive medications such as epinephrine, norepinephrine, dopamine, and vasopressin
In which type of shock is contractility increased?
Hypovolemic, distributive, obstructive (NOT cardiogenic)
In which type of shock is central venous pressure decreased?
hypovolemic, distributive
Define postural hypotension, and how do you differentiate between hypovolemic and CNS problems?
drop in more than 20 systolic from sitting to standing. if the heart rate increases to compensate when standing (15+bpm), it is probably hypovolemic. If pulse does not change, CNS problems.
Name 10 primary and secondary causes/exacerbating factors of HTN
Primary: high salt diet, black, male, age, hereditary, obesity, alcohol, cigarettes, no exercise, low potassium intake, NSAIDs.
Secondary: sleep apnea, estrogen, phechromocytoma, coarctation of aorta, RAS, chronic steroids, pregnancy, primary hyperaldosteronism
What NYH classification of heart disease? “Marked limitation of physical activity, comfortable at rest but symptoms with even slight activity.”
Class III.
(1=no limitation of activity, 2=slight limitation, 3=marked limitation but fine at rest, 4=symptoms even AT REST).
What is malignant hypertension?
HTN so bad that it is causing papilledema, encephalopathy, nephropathy, or other organ problems. progresses to death.
What labs should you get on a HTN emergency patient?
BP, CBC, BUN, CR, Glucose, serum uric acid, plasma aldosterone, renin, electrolytes, EKG, lipids.
How do you treat essential HTN?
thiazide diuretic (loop if renal dysfunction) + one of the following… ACE/ARB (if diabetic, renal disease, young and white) OR CCB (for blacks) OR alpha blockers (good for BPH).
in Refractory HTN use aldosterone receptor antagonists (spironolactone), nitroprusside, nitroglycerine, labetalol, nicardipine, clonidine, captopril
When would you use nitroprusside, nitroglycerin, and labetalol?
MI
When would you use nicardipine vs clonidine?
Nicardipine for HTN emergency, clonidine for HTN urgency
What is the first symptoms of CHF?
dyspnea.
How are the symptoms of left vs right sided heart failure different?
Left sided: backs up into lungs=cough, PND, basilar rales, exercise intolerance.
Right sided backs up into body= JVD, perihperal edema, ascites, nausea, hepatomegaly.
What heart sound is associated with heart failure?
S3
What are potassium and sodium levels like in heart failure?
hyponatremia and hyperkalemia
How do you treat CHF?
diuretic + ACE. you also can add a direct inotropic agent (digitalis, or dilators.
An elevated CRP in an individual without disease can be predictive of what?
increased risk of diabetes, hypertension and cardiovascular disease
