Cardiovascular Flashcards
Coronary artery disease risk factors
Hypertension
Hypercholesterolemia
Smoking
DM
MI
CVA
CRF
CKD
Smoking
Poor diet
Sedentary lifestyle
Family History of CV disease
Valvular disease risk factors
Age
CAD
Rheumatic heart disease
Congenital heart disease
Arrhythmia risk factors
CAD, HT, DM, thyroid disease, OSA, congenital heart disease, cardiac surgery, valvular heart disease, electrolyte disturbances, medications, excess alcohol/illicit drugs/caffeine
Common complications of cardiovascular diseases
Heart failure, myocardial ischemia or infarction, shock, stroke or TIA, aneurysm formation, peripheral artery disease, arrhythmias or sudden cardiac arrest
Causes of syncope/presyncope
- Reduced cardiac output (arrhythmia, stenosis0
- Postural hypotension
- Vasovagal cause
- Hypoglycemia
- Low BP (hypovolemia)
SOB types in heart failure
- SOBOE early sign
- Orthopnea later sign - increased blood volume to heart due to resdistribution from lower extremities, heart struggles to compensate)
- PND later sign (caused by resorption of peripheral oedema at night while lying down - patient typically opens window to breathe and can only sleep sitting up)
6 Ps of peripheral vascular disease (signs of arterial insufficiency)
Pain
Pallor
Paraesthesia
Pulseless
Perishingly cold
Paralysed
First heart sound corresponds with
Closure of the mitral and tricuspid valves
Second heart sound corresponds with
Closure of aortic and pulmonary valves
Where is first heart sound louder
Apex (mitral and tricuspid areas)
What is the physiological splitting of the second heart sound due to
Split during inspiration as blood is drawn into the chest which increases venous return and delays the closure of the pulmonary valve
Pathological cause of third heart sound (S3)
Due to exaggerated early diastolic filling into a ventricle with reduced compliance. Occurs during heart failure or valvular regurgitation
Physiological cause of third heart sound (S3)
Children and adults under 40yo, due to very rapid early diastolic filling
Cause of fourth heart sound (S4)
Always pathological - HTN, IHD (including angina and acute MI, or advanced age
What happens to respiratory system and heart sounds during inspiration
Intrathoracic and intrapericardial pressure decrease, resulting in augmented RV filling and stroke volume and, as the total pericardial space is limited, a compensatory decrease in left ventricular stroke volume occurs in early inspiration.
Lungs pull blood in inspiration. Left Ventricle pulls blood in diastole.
Explain the valsalva maneuver
Reduces the filling of the right and then the left side of the heart. Stroke volume and blood pressure falls, while the HR increases.
Valsalva initially creates a low intra-aortic pressure which stimulates the sympathetic nervous system. Following the release of the breath, a vagal response is triggered to decrease the heart rate. This vagal influence is what may break the SVT and lower the heart rate, or cause a decrease in cerebral perfusion pressure and cause the patient to have a syncopal episode while straining to have a bowel movement.
What causes heart murmur during pregnancy?
An abnormally large amount of blood flowing past a normal valve
Types of systolic murmur
Aortic stenosis
Mitral regurgitation
How can you tell if a murmur is systolic or diastolic?
Systolic:
- Between S1 and S2
- By palpating radial or carotid pulse, systolic comes with or just before this
- More common
Diastolic:
- Harder to hear and have a different rhythm
Describe the course of the Internal Jugular vein into the heart
Enters the neck behind the ear, just behind the mastoid process, next to the angle of the jaw, it is not superficial but runs deep to the sternomastoid at the sternoclavicular joint.
What does the ‘a’ wave in JVP represent?
Contraction the right atrium
When and why might an ‘a’ wave in JVP absent?
In AF - due to disorganised contraction of right atrium
What is the ‘v’ wave in JVP? When is it more prominent
Atrial filling during ventricular systole. If there is an incompetent tricuspid valve, there is blood flow back into the right atrium at systole so that the ‘v’ wave is more prominent.
