Cardiovascular Flashcards
S1 heart sound
Closure of AV (mitral, tricuspid) valve
Loudest at apex
Beginning of systole
S2 heart sound
Closure of semilunar (aortic, pulmonic)
Loudest at base
Beginning of diastole
Louder with PE
S3 heart sound
Rush into dilated ventricle
Associated with HF, pulm HTN, cor pulmonale, mitral/aortic/tricuspid insufficiency
S4 heart sounds
Caused by atrial contraction into non compliant ventricle
Associated with ischemia, infarct, HTN, vent hypertrophy, aortic stenosis
Pericardial friction rub
Due to pericarditis
Murmurs
Valvular disease, septal defects
When are coronary arteries perfused?
Diastole
Systolic BP is an indirect measurement of?
CO and stroke volume
Narrowing pulse pressure often see. With hypovolemia or severe drop of CO
Diastolic BP is an indirect measurement of?
systemic vascular resistance
Widening pulse pressure may indicate vasodilation, drop is SVR or severe sepsis
Causes of valvular heart disease
coronary artery disease, ischemia, MI Dilated cardiomyopathy Degeneration Bicuspid aortic valve (genetic) Rheumatic fever Infection Connective tissue disease
Murmurs of insufficiency:
Occurs when valve is CLOSED
Murmurs of stenosis:
Occurs when valve is OPEN
Chronic problem
Systolic murmurs
Semilunar valves are OPEN during systole
Aortic stenosis and pulmonic stenosis
AV valves are CLOSED during systole
Mitral and tricuspid insufficiency
Ventricular septal defect
Diastolic murmurs
Semilunar valves are CLOSED during diastole
Aortic and pulmonic insufficiency
AV valves are OPEN during diastole
Mitral and tricuspid stenosis
ECG lead changes & location
II, III, aVF - RCA, interior LV V1, V2, V3, V4 - LAD, anterior LV V5, V6, I, aVL - circumflex, lateral LV V5, V6 > low lateral LV I, aVL > high lateral LV V1, V2 - RCA, posterior VL V3R, V4R - RCA, RV infarct
Treatment of STEMI criteria
ST elevation in 2 or more continuous leads OR new onset LBBB
Onset of CP < 12 hours
Chest pain of 30 mins
CP unresponsive to nitro
Inferior MI
RCA occlusion ST elevation in II, III, aVF Associated with AV conduction disturbances, RV infarct, posterior MI Development of systolic murmur Tachy Use BB & NTG with caution!!!
RV infarct
30% have of inferior wall MI have RV infarct
S/S - JVD at 45, high CVP, hypotension, Brady, V4R ST elevation
Give - positive inotropes, fluids
Avoid - preload reducers: nitrates, diuretics
Anterior MI
LAD occlusion
V1-V4 ST elevation
May develop second degree type 2 or RBBB ***
Systolic murmur
Higher mortality than inferior: HEART FAILURE
Complications of MI
Arrhythmias!
Complications of PCI
Coronary artery perf
Stent thrombosis **
Stroke
Retroperitoneal bleed **
Vasovagal response during sheath removal
Hypotension with/without bradycardia
Absence of compensatory tachycardia
Pallor, nausea, yawning, diaphoresis
Vasovagal management
Hold nitrates
Atropine (even if not brady)
IV bolus if unresponsive to atropine
Hypertensive emergency def
Elevated BP with evidence of end organ damage
Hypertensive urgency def
Elevated BP without evidence of end organ damage
PAD S/S
Pain, pallor, pulse absent, paresthesia, paralysis, poikilothermia (loss of hair, glossy)
Ankle-brachial index
Normal > 1
Patient care management of PAD
Bed in reverse trendelenburg
Do NOT ELEVATE
Prolonged QT
Causes - drugs (amio, quinidine, haldol, procainimide), electrolyte problems (hypo)
Systolic dysfunction
EF <40%, problem with ejection
Diastolic dysfunction
EF >50%, problem with filling
Pathophysio of acute decompensated systolic dysfunction
CAD, cardiomyopathy, arrhythmia, valvular dysfunction >
Wall motion abnormality, LV unable to eject >
Pulm edema, hypoxemia >
^SVR, vCO >
vBP, ^SVR
Pathophysio of HF with diastolic dysfunction
HTN, valvular disease, hypertrophic cardiomyopathy >
Stiff LV, impaired filling >
Pulm edema
Signs of systolic HF
Ejection problem
Dilated LV, valve insufficiency, EF<40, pulm edema, s3, BP norm/low, enlarged on imaging
Treatment of systolic HF
BB, ACEs/ARB, diuretics, dilators, aldosterone antagonist, positive inotropes
Signs of diastolic HF
Filling problem
Normal vent size, thick walls or septum, normal EF, pulm edema, s4 with HTN
Treatment of diastolic HF
BB, ACE/ARB, calcium channel blockers, diuretics, aldosterone antagonist
Causes of R sided HF
Acute RV infarct, massive PE, septal defects, pulm stenosis/insufficiency, COPD, pulm HTN, LV failure
Causes of L sided HF
CAD, ischemia, MI, cardiomyopathy, fluid overload, uncontrolled HTN, aortic or mitral stenosis/insufficiency, tamponade
S/S of R sided HF
Hepatomegaly, splenomegaly, dependent edema, JVD distention, elevated CVP, tricuspid insufficiency, abdominal pain
S/S of L sided HF
Orthopnea, dyspnea, hypoxemia, tachycardia, crackles, cough, elevated PA, diaphoresis, anxiety
Dilated cardiomyopathy
SYSTOLIC dysfunction, problem ejecting
Signs - thinning, enlargement of LV, mitral regurg
Symptoms similar to systolic HF
May need VAD or transplant
Hypertrophic cardiomyopathy
DIASTOLIC dysfunction, problem filling
Signs - increased thickening of muscle and septum
Symptoms similar to diastolic HF - fatigue, dyspnea, CP, palpitations
Increased right of sudden cardiac death ***
Causes of cardiogenic shock
EXTREME DROP IN STROKE VOLUME secondary to systolic dysfunction
Acute MI, CHF, cardiomyopathy, dysrhythmias, tamponade, papillary muscle rupture (emergency)
Compensatory cardiogenic shock
Tachycardia, tachypnea, crackles, resp alkalosis, anxiety, JVD, S3, cool skin, decreased UO, NARROW PULSE PRESSURE, BP norm/low
Progressive cardiogenic shock
Hypotension, worsening tachycardia, oliguria, metabolic acidosis, worse crackles, hypoxemia, skin clammy, lethargy
Treatment of cardiogenic shock
Identify, manage arrhythmia, repercussions if STEMI, surgery if ruptured papillary or VSD
Cardiogenic shock: enhancing pump effectiveness
Positive inotropes (Levo, dopamine, dobutamine)
AVOID neg inotropes
Vasodilators may be used in conjunction with IABP
Cardiogenic shock: decrease demand
Preload reduction After load reduction Optimize oxygenation Mechanical ventilation Treat pain IABP short term VAD for long term
VAD used for?
LV HF, cardiogenic shock, and cardiac myopathies or those awaiting transplant
Benefits of IABP: inflation
Increases coronary artery perfusion
Inflates at dicrotic notch of art waveform, beginning of diastole
Benefits of IABP: deflation
Decreases afterload
Deflates before systole begins
Reasons for CABG
Chronic angina unresponsive to medical therapy, not candidate for PCI
Left main lesion
3 vessel disease
Post op CABG complications
Hemodynamic abnormalities, arrhythmia, TAMPONADE, PERICARDITIS, bleeding, pulm, renal, endocrine (BG)
Chest tube management of CABG
Mediasternal tubes remove serosang fluid for operative site
Pleural remove air, blood, or serous fluid
If output >100 for 2 hours consecutively > stability, correct volume status, blood products
Causes of cardiac tamponade
Post op surgery, pericarditis, trauma
S/S of tamponade
Restlessness, agitation, hypotension, increased JVD, equalization of CVP, pulm artery diastolic and PAOP, muffled heart tones, enlarge on imaging
NARROWED PULSE PRESSURE
Pulsus paradoxus
Excessive drop is SBP during inspiration > with inspiration intrathoracic pressure increases and venous return decreases
Caused by cardiac muscle restriction due to tamponade
Etiology of pericarditis
Trauma, viral, MI, post op, radiation, Dressler’s syndrome
S/S of pericarditis
CP, pain worsens with inspiration, dyspnea, low grade temp, increased sed rate, ST elevation in all leads, tamponade
Treatment of pericarditis
Analgesics, anti inflammatory agents, NSAIDS, steroid, antibiotics, monitor for worsening, constriction, and tamponade
Etiology of myocardial contusion
TRAUMA - worse outcome than pericarditis, similar to MI, dysrhythmias, death within 48 hrs
Signs of cardiac trauma
CP, pain worse with inspiration, dyspnea, low grade temp, ST elevation
Etiology of aneurysms
Arteriosclerosis, HTN, smoking, obesity, bacterial infection, congenital anomalies, trauma, Marfans syndrome
Abdominal AA
75%
Asymptomatic if small, pulsations in abdominal area, abdominal/low back pain, N/V, shock
Thoracic AA
25%
Sudden tearing pain in chest radiating to shoulders, back, neck
Cough, dysphagia, dyspnea, dizziness, difficulty walking, widening mediastinum
Treatment of aneurysms <5 cm
Monitor regularly (US/CT), treat HTN with BB
Treatment of aneurysms causing symptoms or >6 cm
Surgical repair, aggressive treatment of HTN and HR control
Aortic dissection
Tear is spiral, sudden or gradual, ascending aorta or aortic arch, life threatening
