Cardiology Exam 1 Flashcards

1
Q

Systolic dysfunction what is going on with the EF, EDV, and contractility?

A

reduced EF
reduced contractility
increased EDF

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2
Q

Diastolic dysfunction what is going on with the EF, EDV, and compliance?

A

preserved EF
reduced compliance
normal EDV

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3
Q

Orthopnea
Paroxysmal nocturnal dyspnea
Pulmonary edema
describes what type of heart failure?

A

Left sided heart failure

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4
Q

Hepatomegaly
JV distension
Peripheral edema
describes what type of heart failure?

A

Right sided heart failure

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5
Q

Valvular stenosis causes pressure overload or volume overload?

A

pressure overload

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6
Q

valvular regurgitation causes pressure overload or volume overload?

A

volume overload

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7
Q

What causes increased afterload?

A

systemic hypertension

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8
Q

Increased preload leads to symptoms of pulmonary vascular congestion
Symptoms would include what three things?

A

Dyspnea
Orthopnea – SOB when supine (gravity effect)
Paroxysmal nocturnal dyspnea, pulmonary edema
(all left sided failure issues)

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9
Q

most common cause of left-sided heart failure is?

A

right sided heart failure

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10
Q

COPD can cause which side of the heart to fail?

A

the right ventricle

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11
Q

If COPD was to cause right sided heart failure what would happen to the pulmonary vascular resistance and right sided pressure?

A

increase in pulmonary vascular resistance, resulting in right-sided pressure overload

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12
Q

Backward congestion symptoms would include?

A

Dyspnea , orthopnea, PND
JV distension (increased venous pressure)
Peripheral pitting edema

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13
Q

Signs of CHF?

A
Tachycardia
S3 (ventricular gallop) , S4 (atrial gallop)
Rales
Cardiomegaly
Ascites
Hepatic congestion (increased CVP)
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14
Q

What is a normal BNP?

A

Less than 100 thus it is elevated (100-300) the heart is starting to fail.

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15
Q

an echo can tell you what?

A

systolic and diastolic dysfunction

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16
Q

what meds reduce afterload and improve survival?

A

ACE inhibitors or ATR blockers

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17
Q

What meds treat diminished contractility?

A

Digoxin
Beta agonist – dopamine
Amrinone (PDE inhibitor)

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18
Q

What do you have the beware of with digoxin?

A

Inhibit Na/K ATPase

BEWARE digoxin toxicity with hypokalemia (with diuretics) , elderly and renal insufficiency

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19
Q

If you have digoxin toxicity what will you see on an EKG?

A

PVC’s
ST depression ‘ dig effect’
Paroxysmal atrial tachycardia with varying block

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20
Q

Anesthesia concerns with CHF?

A

watch fluid status very carefully!

avoid nitrous oxide in sever CHF

arrhythmias are poorly tolerated

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21
Q

Treatment of heart failure, what does ABCDE stand for?

A
ACE inhibitors
Beta-blockers
Calcium channel blockers
Diuretics
Endothelin receptor blockers leads to decrease pulmonary vascular resistance  

vasodilation = endothelin receptor blocker.

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22
Q

What is the major determinant of intravascular volume in the body?

A

Na+

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23
Q

What is the most important hormone for controlling vascular volume?

A

aldosterone

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24
Q

What two factors determine preload?

A

intravascular volume and venous tone

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25
Q

venous constriction leads to what?

A

high preload

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26
Q

stroke volume is determined by three factors?

A

preload
afterload
contractility

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27
Q

CO =?

A

Stroke volume x HR

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28
Q

Mean arterial pressure = ?

A

CO x SV

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29
Q

What is normal EF?

A

60-80%

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30
Q

EF = ?

A

stroke volume / end diastolic volume

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31
Q

EF is an index of ventricular contractility which is a measure of what function?

A

systolic function

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32
Q

What is normal SVR?

A

1200-1500 dynes/sec/cm-5

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33
Q

what is the major determinant of SVR?

A

Arterioles

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34
Q

SVR =?

A

MAP-CVP/CO X 80

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35
Q

What % of cardiac output goes towards coronary circulation?

A

5% = 250ml/min @ rest

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36
Q

When does maximum flow of blood occur to the coronary arteries?

A

during diastole

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37
Q

If you have diastolic dysfunction what blood supply can that interrupt?

A

coronary blood supply bc it occurs during diastole

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38
Q

Two ways to cause vasodilation in the heart vessels?

A

hypoxia and adenosine

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39
Q

What factors reduce coronary blood flow?

A

tachycardia

aortic stenosis

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40
Q

When talking about the heart, increase in demand for oxygen must be met with?

A

increased blood flow bc the myocardium sucks all the oxygen from the arterial blood.

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41
Q

What are the two major determinants of flow to the heart?

A

LVEDP and HR

supply vs demand

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42
Q

Most volatile anesthetics do what to the heart? (making them ideal for MI)

A

coronary vasodilators!

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43
Q

When is the right ventricle perfused compared to the left ventricle?

A

The right Ventricle is perfused throughout systole and diastole but flow to the left ventricle is largely limited to diastole

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44
Q

What all can decrease coronary perfusion?

A

decreased aortic pressure
increased LVEDP
increased HR

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45
Q

Two kinds of hypertrophy of the myocardium, what are they?

A

concentric (pressure) and eccentric (volume) hypertrophy.

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46
Q

what is concentric hypertrophy?

A

pressure will increase the thickness of the myocardium wall but does not increase chamber size.

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47
Q

What is Eccentric hypertrophy?

A

volume will increase the size by literally increasing the size of the heart chamber but not so much the mass/thickness of the wall.

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48
Q

Due to chronically elevated afterload describes?

A

Concentric hypertrophy (pressure overload)

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49
Q

Due to chronically elevated preload describes?

A

Eccentric hypertrophy (volume overload)

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50
Q

volume pressure loop that is longer than taller shows what?

A

increasing preload

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51
Q

volume pressure loop that is taller than it is long shows what?

A

increasing afterload

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52
Q

How does the P-V loop change in systolic failure?

A

diastolic portion of the P-V loop has shifted to the right.

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53
Q

How does the P-V loop change in diastolic failure?

A

diastolic portion of the P-V loop has shifted up.

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54
Q

What chamber of the heart is affected by mitral valve stenosis

A

The left atrium must work harder to push blood through the damaged valve and enlarges as a result.

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55
Q

What is normal left atrial pressure?

A

8 is normal

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56
Q

If you have mitral stenosis what will your left atrial pressure look like?

A

25/14 (high), increased wedge pressure

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57
Q

P-V loop of mitral stenosis looks like what?

A

everything is decreased bc their is less filling of the left ventricle

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58
Q

What valve issue can cause pulmonary congestion, coughing up blood with extreme congestion?

A

Mitral Stenosis

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59
Q

With mitral stenosis what is going on with the left ventricle?

A

LV is typically perfect!

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60
Q

symptoms of mitral stenosis?

A

Dyspnea, orthopnea , PND (due to pul. congestion) “backup”
Hemoptysis
A. fib leading to embolization

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61
Q

Medical therapy for mitral stenosis?

A

Diuretics for pulmonary congestion
Digoxin
Anticoagulant

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62
Q

Anesthetic concerns with someone who has mitral stenosis?

A

Maintain sinus rhythm , avoid tachycardia
Tachycardia decreases diastolic time leading to lesser filling

Avoid fluid overload and hypovolumia

Avoid spinal/epidural nerve block

Afterload reduction

Beta blockers for tachycardia

Diltiazem and digoxin in A fib

Phenylephrine as vasoconstrictor

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63
Q

How do you want the HR for mitral stenosis?

A

slow (low HR), this allows time for blood to fill the left ventricle.

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64
Q

What do you want the rhythm to be with mitral stenosis?

A

regular

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65
Q

What valve issue causes straightening of the left border of the heart?

A

mitral stenosis

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66
Q

What is valvular regurgitation?

A

when blood leaks in the wrong direction bc one or more of the heart valves closes improperly.

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67
Q

What does the P-V loop look like with chronic mitral valve regurgitation?

A

very large a oddly shaped, goes really far to the right.

68
Q

what happens in mitral regurgitation?

A

the mitral valve is incompetent and when blood is pumped from the LV into the aortic valve the mitral valve allows blood back into the left atrium

69
Q

What can rheumatic heart disease cause?

A

mitral regurgitation

70
Q

mitral regurgitation will cause a decrease in what?

A

decreased CO (50% SV may be regurgitated)

71
Q

How does the LV compensate for mitral regurgitation?

A

by dilating and increasing LVEDV (maintains CO despite decrease in SV)

72
Q

Most patients with mitral regurgitation have a combination of what two cardiac issues?

A

pulmonary congestion plus low cardiac output

73
Q

Diffuse and hyperdynamic ventricular impulse
Holosystolic murmur best heard at apex, radiating to axilla
Wide splitting S2
S3 due to volume overload in left atrium
This describes what?

A

Mitral regurgitation

74
Q

left atrial enlargement and left ventricular hypertrophy describes findings of what?

A

Mitral regurgitation

75
Q

Goal of medical therapy with mitral regurgitation?

A

increase forward flow by reducing afterload.

Reduce pulmonary venous congestion.

76
Q

Drugs that help with mitral regurgitation?

A

Vasodilator e.g. ACE inhibitors
Digoxin to ventricular rate in A fib ( digoxin prolong conduction through AV node )
Diuretics
Anti-coagulant to prevent embolization

77
Q

mid-diastolic click describes what valve issue?

A

Mitral valve prolapse

78
Q

Is treatment needed for mitral valve prolapse?

A

No treatment needed for this condition.

79
Q

Most frequent valvular lesion, especially in younger women would be?

A

Mitral valve prolapse

80
Q

what type of murmur is produced from mitral valve prolapse?

A

murmur of mitral regurgitation

81
Q

What anesthesia meds do you want to avoid in someone with mitral valve prolapse?

A

Avoid agents that increases heart rate or release histamine

Select non-depolarizing muscle relaxant that does not have circulatory effect

82
Q

Rheumatic fever can cause?

A

aortic stenosis

83
Q

Where does aortic stenosis occur?

A

aortic valve, this is where the coronary arteries come in at to give the heart it’s blood supply.

84
Q

The aortic valve is stenosed, thus what happens?

A

very high pressure gradient between aorta and LV

85
Q

dilation of the ascending aorta, calcification of the aortic valve and hypertrophy of the LV would cause what to be diagnosed?

A

aortic stenosis

86
Q

LVESP = 200 mmHg

increased LVESV, LVEDV and decreased SV would mean?

A

aortic stenosis

87
Q

Normal aortic valve measurements are?

Stenotic aortic valve would have a measurement of?

A

Normal = 2.5-3.5cm squared

stenotic aortic valve = 0.7-0.9 cm squared (less than one cm squared)

88
Q

How does the P-V loop move in aortic stenosis?

A

upward and to the right

89
Q

Is aortic stenosis an acute obstruction or gradual?

A

gradual obstruction that allows the left ventricle to compensate and maintain SV

90
Q

Clinical symptoms of Aortic stenosis?

A

Angina w/o CAD is due to decreased O2 supply to the sub-endocardium by decreasing ventricular diastolic compliance
Syncope and faintness
Dyspnea on exertion

91
Q

Do the coronary arteries feed the heart during diastole or systole?

A

diastole

92
Q

What is the therapy a person with aortic stenosis needs?

A

aortic valve replacement

93
Q

What is contraindicated with aortic stenosis?

A

Spinal and epidural anesthetics are contraindicated in severe stenosis can lead to decrease in systemic vascular resistance

94
Q

What do you have to WATCH out for with aortic stenosis?

A

WATCH OUT FOR VASODILATION because it is associated with large reduction in blood pressure and coronary blood flow

95
Q

What is the pressor of choice for hypotension with aortic stenosis?

A

Phenylephrine

96
Q

What do you need to remember with aortic stenosis?

A
Slow (low heart rate)
Full (maintain or increase preload)
Tight (maintain or increase afterload)
To maintain coronary perfusion pressure
Regular (maintain sinus rhythm)
Not too strong (maintain contractility)
97
Q

aortic regurgitation will change the P V loop how?

A

no relaxation and no contraction bc blood is still coming down during systole, large curve that is very circular.

98
Q

causes of aortic regurgitation?

A
Rheumatic heart disease or congenital 
Infective endocarditis
3 degree Syphilis 
Aortic dissection
Marfan’s syndrome
Collagen vascular disease e.g. SLE
99
Q

aortic regurgitation would cause what to happen to the pulse pressure?

A

widened pulse pressure (160/50)

100
Q

What drives perfusion of the coronary arteries?

A

diastolic pressure, thus in aortic regurgitation when diastolic pressure is decreased you may have angina due to decreased coronary blood to the heart.

101
Q

Post MI you can get what syndrome?

A

Dressler’s syndrome

102
Q

*What is Dressler’s syndrome?

A

Immune reaction against necrotic myocardium, causes inflammation of the pericardium.

103
Q

*What type of EKG findings might a pt. have with acute pericarditis?

A

tachycardia

diffuse ST segment elevation (important)

104
Q

Pulsus paradoxus?

A

decrease systolic BP > 10 mmHg during inspiration (normal drop is 6 mmHg)

105
Q

Kussmaul’s sign?

A

distension of JVP during inspiration

106
Q

pulses paradoxus and kussmaul’s sign typically occur with what heart issue?

A

cardiac tamponade

107
Q

Constrictive pericarditis treatment is?

A

surgical stripping

108
Q

type A aneurysms involve?

type B aneurysms involve?

A
A= ascending aorta 
B= does not involve the ascending aorta
109
Q

What is Takayasu arteritis?

A

A type of systemic vasculitis. Inflammation of aorta and major vessels, causing weak pulse.

110
Q

S/S of Takayasu arteritis?

A

upper extremity claudication, angina, CHF, absent pulses, arterial bruits, BP differences btwn two arms.
young asian women are at higher risk

111
Q

What is temporal arteritis?

A

ischemia of vessels in the carotid artery region and include unilateral headache, visual disturbance (impairment of ophthalmic artery) and jaw claudication – “sore jaw”

112
Q

Tx for temporal arteritis?

A

Steroids to prevent Blindness

113
Q

What is Buerger’s dz, what are the symptoms, and treatment?

A

Inflammation of small and medium sized arteries
Smoker’s disease
Foot claudication
Leg pain, ulceration , skin necrosis
Treatment: Choose one; your legs or cigarette

114
Q

What is Wegener’s granulomatosis, Diagnosis and treatment?

A

Triad of upper and lower airway disease and renal disease- glumerulonephritis
Sinusitis and hematuria
Dx: ANCA (antineutrophilic cytoplasmic antibodies)
Tx
Cyclophosphamide, steroid and/or methotrexate

115
Q

What is polyarteritis nodosa, treatment?

A

Involves medium-sized arteries in kidneys , gut , skin
S/S: fever, weight loss, malaise, abdominal pain,melena, headache, myalgia,hypertension and cutaneous erruption
Microaneurysms on angiography
Treatment: cyclophosphamide, steroid

116
Q

What is kawasaki dz, s/s, treatment?

A

Acute, self-limiting necrotizing vasulitis in infants/children.
In Asian population
Fever, conjunctivits, changes in lips/oral mucosa “strawberry tongue”, lymphadenitis, desqumative rash
Treatment: aspirin , immunoglobulins

117
Q

DVT may give rise to what? (bad)

A

PE

118
Q

Tx for DVT?

A

Anticoagulation

Thrombolytic therapy

119
Q

In someone who has CAD and a third heart sound, what does that show?

A

global ischemia

120
Q

In the first 6 hours of MI what is the gold standard for diagnosis?

A

EKG

121
Q

When is Cardiac troponin I used?

A

4 hours after cardiac ischemia and up to 7-10 days after.

122
Q

ST elevation shows?

A

transmural ischemia

123
Q

Q waves show?

A

transmural infarct

124
Q

Myoglobin is used for what time period after infarct?

A

less than 2 hours

125
Q

Indications for cardiac catheterization?

A

Suspicion of severe or extensive CAD
Marked positive stress test
Failure to respond to medical management

126
Q

tearing chest pain radiating to back with normal EKG would indicate?

A

Aortic dissection

127
Q

Angina pectoris how much CAD narrowing?

A

> 75%

128
Q

stable angina ?

A

is usually precipitated by physical exertion and is relieved by rest and/ or nitrates.

129
Q

Unstable angina?

A

refers to pain that occurs at rest, or without a provoking cause. New dramatic onset. Most ominous sign of CAD. Risk of MI

130
Q

NON cardiovascular causes of angina?

A
Esophageal disease e.g. reflux 
PUD
Biliary disease e.g. gall stones
Musculoskeletal disease e.g. costochondritis
Pleurisy 
Pulmonary infarction
Pneumothorax
131
Q

cardiovascular causes of angina?

A

Aortic stenosis
Pericarditis
Aortic dissection

132
Q

Treatment for unstable angina?

A

Hospitalization “ ROMI”
IV Nitroglycerine
Aspirin and anti-platelet therapy to prevent thrombus
Patients who don’t stabilize with medical therapy should undergo cardiac cath for revascularization

133
Q

Prinzmetal’s angina hallmark symptom, associated with, and treatment?

A

Angina at rest that is associated with ST segment elevation (hallmark)
2° to coronary artery spasm
Associated with Reynold’s disease
Treatment with nitrates and Ca++ channel blockers to treat vasospasm

134
Q

In who does silent ischemia tend to occur? Treatment?

A

diabetics

Tx is nitrates and calcium channel blockers

135
Q

How do Ca++ channel blockers relieve angina?

A

by decreasing afterload, HR, and contractility

136
Q

What is the most potent calcium channel blocker?

what is the order of potent calcium channel blockers?

A

Verapamil is the most potent in lowering HR and decreasing contractility.
Verapamil>diltiazem>nifedipine

137
Q

How do Beta blockers treat CAD?

A

Decrease HR
Decrease BP
Decrease contractility resulting in decreased 02 consumption.

138
Q

What medication is useful in exercise induced ischemia (most useful for this)?

A

beta blockers

139
Q

Beta blockers should be avoided in what conditions with CAD?

A

Bronchial spasm
CHF
Bradycardia

140
Q

How do diuretics and ACE inhibitors help CAD?

A

Decrease myocardial 02 demand

141
Q

How do nitrates relieve angina?

A

venodilation which decreases cardiac wall tension

142
Q

What over the counter medication can reduce the risk of MI in patients with CAD?

A

Low dose aspirin

143
Q

CABG improves survival in patients with? (3 answers)

A

Left main coronary disease Left main=OR

Triple vessel disease

EF < 50%

144
Q

overall success rate of angioplasty is?
Restenosis rate is?
When is it performed?

A

overall success rate is 80-90%
restenosis rate = 30%
single or two vessels disease poorly controlled with meds would call for angioplasty.

145
Q

Most Common Cause of acute MI is?

A

chronic coronary atherosclerosis

146
Q

acute MI most often occurs in what three vessels (greatest to least)

A

LAD>RCA>circumflex

147
Q

In RVF the lungs are congested or clear?

A

clear

148
Q

typical clinical presentation of acute MI?

A

Severe persistent anginal PAIN > 30 MINUTES ; pain in left arm , jaw, SOB, fatigue, adrenergic symptoms.

149
Q

During acute MI tachycardia would be due to?

A

pump failure, anxiety, pericarditis

150
Q

During acute MI bradycardia would be due to?

A

inferior wall MI (RCA) or increased vagal tone

151
Q

Increased JVP during acute MI is due to?

A

right ventricular failure or bi-ventricular failure. in RVF lungs are clear

152
Q

what heart sound tells you “volume overload”

A

S3

153
Q

ST elevation tells you?

A

transmural ischemia

154
Q

Q wave tells you?

A

transmural infarct

155
Q

what is the test (lab) of choice in the first 24 hours post MI?

A

CK-MB

156
Q

When does a CK-MB return to normal?

A

72-96 hours

157
Q

persistent elevation of a CK-MB shows what?

A

post infarct ischemia- DO CATH.

158
Q

Acute management for MI, remember what to do with what acronym?

A
BOOMAR :
Bed rest
Oxygen
Opiate
Monitoring
Anticoagulation 
Reduce clot size
159
Q

Thrombolytic therapy would include what two drugs?

A

tpa

streptokinase

160
Q

thrombolytic therapy is most useful in what time frame?

A

1 HOUR onset of symptoms, success rate is 50-75%, decreases after 6 hours

161
Q

does first degree heart block require therapy?

A

Rarely requires surgery

162
Q

In which heartblock is a pacemaker indicated?

A

mobitz type II

163
Q

In which heartblock is pacemaker not indicated?

A

Mobitz type I

164
Q

both RBBB and LBBB require what temporarily?

A

pacemaker

165
Q

Most common cause of death after Acute MI is?

A

cardiac arrhythmias (90%)