Cardiovascular Flashcards
What are the three factors that increase Preload (EDV or EDP)
- Exercise
- increase in Blood Volume (e.g. overtransfusion)
- Excitement ( increase in Sympathetic Tone )
How is Cardiac Output maintained during early exercise vs. late exercise?
Early Exercise: increasing both HR and SV
Late Exercise: increasing HR (SV plateaus)
What factors affect the viscosity of blood?
-What increases viscosity?
- polycethemia
- Hyperproteinemic states (e.g. multiple myeloma)
- hereditatry spherocytosis
What factors affect the viscosity of blood?
-What decreases viscosity?
-Anemia
What accounts for most of the peripheral resistance?
Arterioles!
What is the normal ejection fraction
55%
What are the three different types of pericardititis?
- FIBRINOUS:
- Serous
- Purulent/Suppurative
What causes each of the three different types of acute pericardititis?
FIBRINOUS:
- Dressler's Syndrome
- Uremia
- Radiation
-SEROUS:
-Viral Pericarditis
-Noninfectious Inflammatory Diseases
(RA, SLE)
-PURULANT/SUPPURATIVE:
-bacteria (pneumococcus &
streptococcus)
What are the findings in Cardiac Tamponade?
-name 7
-Pulsus Paradoxus
-Decreased Cardiac Output …with a small heart
-Hypotension (or reduced MAP)
-Jugular Venous Distention ( because SVC cannot
empty)
-Tachycardia
-Distant heart sounds
-Equilibration of diastolic pressures in all 4 chambers of the heart
In which conditions do we normally find Pulsus Paradoxus?
-name 5
Asthma Cardiac Tamponade Obstructive Sleep Apnea Pericarditis Croup
Name 2 conditions that can arise from enlargement of the Left Atrium?
- Dysphagia due to compression of the esophagus
- Hoarseness due to compression of the left recurrent laryngeal nerve
Which method is best for diagnosing left atrial enlargement?
–what two other conditions can be best diagnosed by the same method?
TransEsophageal Echocardiography
- Other conditions:
1) aortic dissection
2) thoracic aortic aneurysm
Demographic Dominance of coronary circulation is determined using which artery/branch of the coronary circulation?
The PD: posterior descending/interventricular artery.
- In 85% of the pop,it arises from the RCA
- In 8%, it comes from the left circumflex coronoary artery (LCX)…a branch of the LCA
- In 7%, the PD comes from both the RCA and the LCX–in which case we call it codominance
Which artery supplies the RV?
Right Marginal A
Which artery supplies the SA and AV nodes?
RCA
Which artery supplies the LV
ANTERIOR SURFACE:
-left anterior descending artery
POSTERIOR&LATERAL SURFACE:
-left circumflex Artery (LCX)
Structures supplied by the LAD of the coronary arteries?
- anterior surface of LV
- anterior 2/3 of the IV septum
- anterior papillary muscle
- Apex
What structure(s) is/are supplied by the PD branch of the coronaries?
posterior 1/3 of the IV septum
Which disease can result in 3rd degree AV (heart ) block?
Lyme Disease!!!
4 effects of ANP on the kidney?
-name 4
All effects are in opposite to the effects of aldosterone:
1) constricts renal effecrent arterioles
2) dilates renal afferent arterioles
3) decreased Sodium reabsoprtion
4) Diuresis
NET EFFECT: reduction in blood pressure
On an EKG , what does an inversion of a T-wave indicate?
Recent MI
When is a U-wave seen on an EKG?
In states of hypokalemia or bradycardia
Rank in order, the conduction speed of the different parts of the heart electroconduction system.
Purkinje Cells>Atria>Ventricles>AV node
Rank in order, the pacemaker preference/order of the different components of the heart system.
SA node> AV node > Bundle of His/Purkinje fibers/Ventricles
What are the 3 ways in which a fast cardiac action potential (ventricular) differs from a skeletal action potential?
- Has a plateau phase which is due to the balance of calcium influx and potassium efflux
- Spontaneously depolarizes during diastole leading to funny currents repsonsible for slow mixed Na+/K+ inward current
- The cardiac APs in each cell are coupled together via gap junctions
Give examples of factors that increase contractility (i.e ionotropy) of the heart.
-name 3
1) Increased HR (calcium clearance is less efficient so intracellular Ca builds up)
2) Sympathetic stimulation: phosphoryation of phospholamban allows faster relaxation and therefore Calcium is easily recycled
3. Digoxin: increases intracellular calcium stores
4. Decrease in extracellular Na+ (hence affecting Na+/Ca+ exchanger)
NB: increase in contractility results in increase in SV
What is the effect of vEnodilators on the heart?
What is the effect of vAsodilators on the heart?
Venodilator (e.g nitroglycerin): lower PRELOAD
Vasodilators (e.g. hydralazine) lower AFTERLOAD
Give examples of factors that reduce contractility (hence S.Volume indirectly)
- Bradycardia (low heart rate)
- Beta Blockers
- Calcium channel blockers
- Venodilators (reduce preload)
- Acidosis —decreases Troponin C’s affinity for
Ca2+ - Heart Failure
- Hypoxia/Hypercapnia:- —decreases Troponin
C’s affinity for Ca2+
What factors increase the O2 demand of the heart?
-increasing HR
-Increasing contractility
-Increasing afterload (proportional to arterial
pressure)
-cardiac hypertropy…due to increased wall tension
What are the normal pressures in each chamber of the heart?
-include the aorta and the pulm artery as well
RA: <12mmHg
RV: 25/5mmHg
LV: 130/10mmHg
AORTA: 130/90mmHg
Pulm Artery: 25/10mmHg
What do each of the 4 hears sounds S1-S4 resemble?
S1: Mitral and Tricuspid closing
-loudest at mitral area
S2: Aortic and Pulmonary valve closing
-loudest at left sternal border
S3: During rapid ventricular filling (increasing filling
pressure)
-normal in pregnancy and children
-pathologic: Dilated ventricles, CHF,mitral
regurgitation
S4: Atrial kick pushing against a hypertrophied
heart…can be present in chronic hypertension
To which variables does the carotid sinus baroreceptor respond?
To which variables does the aortic arch baroreceptor respond?
CAROTID SINUS: increase AND decrease in BP
AORTIC SINUS: BP increase ONLY.
What is the Cushing Reaction (vasopressor triad)?
This is a triad of responses that take place when Intra-Cranial-Pressure (ICP) rises.
–Bradycardia
–Respiratory Depression
–Hypertension via widening of pulse
pressure
How do the following organs maintain constant blood flow over time?
HEART:
LUNG:
KIDNEY:
SKIN:
BRAIN:
SKELETAL MUSCLE:
HEART: local metabolites (CO2, adenosine, NO)
-all three are vasodilatory
LUNG: Hypoxic Pulmonary Vasoconstriction (ensures only ventilated areas are perfused)
KIDNEY: myogenic and tubuloglomerular feedback
SKIN: sympathetic nervous system, which regulates temperature
BRAIN: CO2 levels (i.e. pH)
SKELETAL MUSCLE: local metabolites (lactate, adenosine, K+)
How do the following substances affect blood flow (venous and arteriole) in their sites of release?
- Serotonin:
- Histamine:
- Bradykinin:
- Prostglandins
a) Prostacyclin:
b) Thromboxane A2:
- Serotonin: arteriolar constriction
- Histamine: arteriolar dilator and venous constrictor
- Bradykinin: arteriolar dilator and venous constrictor
- Prostglandins
a) Prostacyclin: vasodilator in several vascular
bedsb) Thromboxane A2: vasoconstrictor in several
vascular beds
Which classes of drugs are used to treat Primary (essential) Hypertension?
-Name 4
- Diuretics
- L-type calcium channel blockers
- ACE inhibitors
- Angiotensin II receptor blockers (ARBs)
Which 7 diseases can one be predisposed to if they have hypertension?
- CHF
- Renal Failure
- LVHypertrophy
- Athereclerosis
- stroke
- retinopathy
- aortic dissection
What are the 3 different types of arteriosclerosis and how do they differ from each other?
MONCKENBERG (calcification):
-Calcification of the MEDIA layer of medium-seized arteries (radial and ulnar usually)..which is usually benign. It does not obstruct blood flow.
ARTERIOSCLEROSIS (onion skinning + other):
Two types affecting intima:
a) Hyaline: thickening of small arteries in
essential HTN or DMellitus due to deposition
of portein in the wall
b) Hyperplastic: “onion skinning” of smaller
arteries in malignant HTN
Onion skin = concentric wall thickening
-due to hyperplasia of the smooth muscle of
the vessels
ATHERESCLEROSIS (foam cells):
Fibrous plaques and atheromas formation in the INTIMA of small arteries
What are the modifiable and non-modifiable risk factors of atherosclerosis?
MODIFIABLE:
- hypertension
- diabetes
- smoking
- hyperlipidemia
NON-MODIFIABLE:
- positive family Hx
- age
- gender (males and post-menopausal women)
Which factors promote S.Muscle cell migration from media to intima in the progression of atherosclerosis?
FGF and PDGF
What are the 2 single-most important factors required in the development of atherosclerosis?
Inflammation and Endothelial Dysfunction
Which arteries are common sites for atherosclerosis, rank them in order?
-name 4
Abdominal Aorta>Coronary Artery>Popliteal A>Carotid A
What are some of the possible complications of
atherosclerosis?
-name 6
- thrombus
- emboli
- aneurysm
- ischemia
- infarction
- peripheral vascular disease
What are the 3 symptoms of atherosclerosis>
trick
- Claudication
- Angina
- asymptomatic (in some people, hence the “tricky” part)
What are the main causes of acute and subacute bacterial endocardititis?
ACUTE: usually occurs in normal heart valves
S. Auresu
SUBACUTE: usually in diseased oro congenitally abnormal valves
-Viridans streptococcus
(usually a sequelae of dental procedures)
What is the main bacteria found in the endocardititis of prosthetic valves?
S. Epidermidis in the 1st 6 months, then
S. Aureus and the Viridans group are the main culprits afterwards
***if patient with new valve develops new murmur, take ECG and blood cultures
What is the main bacteria found in the endocardititis of colon cancer?
Srep. Bovis
What is the main bacteria found in the endocardititis of GI Surgery?
Enterococci
What is the main bacteria found in the endocardititis of total parenteral nutrition?
Fungi (this is OT a bateria!!!)
What is the main bacteria found in the endocardititis of alcoholic or the homeless?
Bartonella Henselae
What are the 8 classical findings (presentation) in Bacterial Endocardititis?
MNEMONIC = “ FROM JANE”
F= Fever , which is the common symptom
R=Roth’s spots
O=Osler’s Nodes
M=new Murmur
J=Janeway lesions
A=Anemia
N=Nailbed splinter hemorrhages
E=Emboli
Name the 3 different types of cardiomyopathies and mention if sytolic or diastolic dysfunction ensues in each of those myopathies
- DILATED (congestive cardiomyopathy):
- most common type ~90%
- results in dilation of the chambers of the heart
- systolic dysfuntion ensues (because of )
- eccentric hypertrophy
- HYPERTROPHIC Cardiomyopathy:
-concentric hypertrophy
-diastolic dysfunction because there is a filling
problem - RESTRICTIVE (obliterative cardiomyopathy):
-least common of the 3
-diastolic dysfunction ensues because its a
filling problem
**no effective therapy is known
What are the possible etiologiess of dilated cardiomyopathy?
-name 9
- Idiopathic (most common) & ~50% are familial
- chronic alcohol abuse
- wet beriberi
- coxsackie B virus myocardititis
- chronic cocaine use
- Chaga’s disease
- Doxorubicin toxicity
- hemochromatosis
- peripartum cardiomyopathy
What is the mode of inheritance of hypertrophic cardiomyopathy?
And which genetic condition is often associated with this heart condition?
Autosomal Dominant
-Fredreich’s Ataxia
What are the possible etiologiess of resrictive (obliterative) cardiomyopathy?
-name 6
- Sarcoidosis
- Amylodoidosis
- Postradiation Fibrosis
- Endocardial Fibroelastosis
- Loffler’s Syndrome
- Hemochromatosis
What is Loffler’s Syndrome?
One of the causes of restrictive cardiomyopathy due to fibroplastic thickening of the endocardium
–It is endomyocardial fibrosis with a prominent eosinophilic infiltrate
What are the causes of left heart failure?
-name 3
- Systolic Dysfunction due to decreased contractility and/or increased afterload
- Diastolic Dysfunction due to impaired ventricular filling, relaxation, or compliance
What are the causes of Right-heart failure?
-name 2
- Left heart failure!!
2. Cor Pulmonale
Name 4 main clinical findings in Left Heart Failure
-Orthopnea
-Dyspnea
-Pulmonary Edema (rales)
-Paroxysmal Nocturnal Dyspnea
-Histologically: Presence of hemosiderin laden
macrophages
Name 4 main clinical findings in Right Heart Failure
- Peripheral Edema (usually pitting on the ankles)
- Hepatomegaly (nutmeg liver)
- Slenomegaly
- Jugular Venous Distention
***NBB: Organomegaly such as nutmeg liver only happen with long-standing CHRONIC congestive failure….it doesn’t happen in the acute setting
Which drugs are used in the treatment of heart failure?
Which ones reduce mortality, which ones are for symptomatic relief?
REDUCE MORTALITY:
- B-blocker
- ARB
- ACE Inhibitor
- Spironolactone
SYMPTOMATIC RELIEF:
-loop and thiazide diuretics
REDUCE MORTALITY AND SYMPTOMS(both):
-hydralazine with nitrate
What are the 2 common types of aortic aneurysms and what causes each?
AAA:
-causes by atherosclerosis, esp in men over 50
who smoke
Thoracic Aortic Aneurysm:
-caused by a number of conditions
1) tertiary syphilis–affects the ascending
portion
2) HTN
3) Cystic Medial Necrosis (Marfan
Syndrome)
What is the classical imaging finding in an aortic dissection?
-name 2
-False Lumen:
due to LONGITUDINAL intraluminal tear
-Mediastinal Widening on CXR
What are the causes of aortic dissection?
-name 4
- HTN
- Bicuspid aortic valve
- cystic medial necrosis
- Inherited CT disorders (e.g. Marfan Syndrome)
Which condition leads to the classic”tree bark” appearance of the aorta?
-what causes that?
- Tertiary Syphillis
- It causes obliterative endarteritis (disruption of the vasa vasorum) of the proximal aorta (ascending/aortic roott)…consequently leading to atrophy of the vessel
- Tertiary Syphillis can also cause aneurysms in the aortic root
What kind of a a reaction is Rheumatic Fever?
.It is an immune reaction: Type II hypersensitivity
just like MG. Lambert-Eaton, and Graves Disease
- **it’s the antibodies reacting against your own valve/heart tissue.
- *** It’s a cross-reactivity of the antibodies against M-protein of the Group A beta-hemolytic streptococci cross-reacting with cardiac antigens
Which heart valves are most affected in Rheumatic Fever?
-what is special about these valves?
.Mitral»»Aorta»»Tricuspid
OFTEN mitral stenosis
__It’s the high pressure valves that are most affected
How is Rheumatic Fever treated, generally?
.Itself is NOT an infection so antibotics will not work!!!!
–Need to give steroids or salicylic acid to reduce inflammation and pain
-as for the Group A infection itself, use penicillin to treat
What are the major (5) and minor (8) criteria of clinical findings included in the Jones criteria for Rheumatic Fever symptoms following srep throat (pharyngeal infection)
MAJOR:
- St. Vitus Dance ( Sydenham's Chorea) - Carditis (new onset murmur) - Erythema Marginatum - Migratory polyarthritis - Subcutaneous Nodules
MINOR:
-Fever
-arthralgia
-valvular damage (esp Mitral Regurg or Mitral
Stenosis in chronic R.Fever)
-increased ESR and/or CRP
-long PR interval
-ASO titer
-Anemia
-high WBC count
What are the classic histologic findings in Acute Rheumatc Fever?
-name 3
Aschoff Bodies (granuloma with giant cells) consisting of
- Aschoff cells and
- Anitschkow's cells (activated histiocytes) - -NB: Aschoff bodies contain both anitschkow and aschoff cells
What is the early lesion in Rheumatic Fever?
What is the late lesion in Rheumatic Fever?
EARLY: mitral regurgitation
LATE: mitral stenosis
How does the following bedside maneuvers affect the intensity of heart sounds (murmurs)?
***describe mechanism
INSPIRATION:
INSPIRATION:
-increase intesmtiy of right heart
EXPIRATION:
-increase intesmtiy of left heart
HAND GRIP (increases sytemic resistance):
-increase intesity of MR, AR,VSD murmurs
-decrease intensity of AS, hypertrophic
cardiomyopathy murmurs
-increase murmur intensity of MVP(later onset
of click/murmur)
VALSALVA (decrease venous return):
- decrease intensity of most murmurs
-increase intensity of hypertrophic
cardiomyopathy murmurs
-decrease murmur intensity of MVP(early
onset of click/murmur)
RAPID SQUATTING:
-decrease intensity of hypertrophic
cardiomyopathy murmurs
–increase murmur intensity of MVP(later
onset of click/murmur)
How does the following bedside maneuvers affect the intensity of heart sounds (murmurs)?
***describe mechanism
EXPIRATION:
EXPIRATION:
-increase intesmtiy of left heart
How does the following bedside maneuvers affect the intensity of heart sounds (murmurs)?
***describe mechanism
HAND GRIP:
HAND GRIP :
-increase intesity of MR, AR,VSD murmurs
-decrease intensity of AS, hypertrophic
cardiomyopathy murmurs
-increase murmur intensity of MVP(later onset
of click/murmur)
MECHANISM: increased sytemic resistance
How does the following bedside maneuvers affect the intensity of heart sounds (murmurs)?
***describe mechanism
VALSALVA:
VALSALVA:
- decrease intensity of most murmurs
-increase intensity of hypertrophic
cardiomyopathy murmurs
-decrease murmur intensity of MVP(early
onset of click/murmur)
MECHANISM: decreased venous return
How does the following bedside maneuvers affect the intensity of heart sounds (murmurs)?
***describe mechanism
RAPID SQUATTING:
RAPID SQUATTING:
-decrease intensity of hypertrophic
cardiomyopathy murmurs
–increase murmur intensity of MVP(later
onset of click/murmur)
MECHANISM: increased venous return = increased preoad = increased afterload with prolonged squatting
Name the systolic heart sounds
Aortic/Pulmonic Stenosis
Mitral/Tricuspid Regurgitation
Ventriculr septal defect
Mitral Valve Prolapse
Name the diastolic heart sounds
.-Aortic/Pulmonic Regurgitation
-Mitral/Tricuspid Stenosis
What are the 4 physiologic maneuvers used to aid in the characterization of cardiac murmurs?
- beathing (inspiration vs. expiration)
- rapid squatiing
- hand grip
- valasalva maneuver
- standing
Describe the characterization and nature of a Mitral/Tricuspid Regurgitation.
–which maneuvers enhance the MR?
–which maneuvers enhance the TR?
“Holosystolic High-Pitched Blowing Murmur”
MR ENHANCED BY: maneuvers that increase TPResitance (e.g. squatting or handgrip) or those increasing LA return (e.g. expiration)
TR ENHANCED BY: maneuvers that increase RA return (e.g. inspiration)
Describe the characterization and nature of a Aortic Stenosis.
–which 3 cardiac-related conditions can result from Aortic Stenosis?
“Crescendo-Descrescendo systolic ejection murmur following Ejection Click”
-The Ejection Click is due to abrupt halting of the valve leaflets
RESULTING CONDITIONS: Syncope, Angina, Dyspnea on exertion—from CHF
mnemonic = S.A.D
Describe the characterization and nature of a Ventricular Septal Defect.
–which maneuvers enhance this murmur?
“Holosystolic, harsh-sounding murmur”
ENHANCED BY: hand grip maneuver which increases afterload
Describe the characterization and nature of an Aortic Regurgitation.
- -which maneuvers enhance this murmur?
- -which maneuvers decrease the intensity of this murmur?
“Immediate High-Pitched Blowing Diastolic Decrescendo Murmur”
ENHANCED BY: Hand grip
DIMINISHED BY: Vasodilators
Describe the characterization and nature of a Patent Ductus Arteriosus.
–what normally causes a PDA?
“Continous Machince Like Murmur”
CAUSE: Congenital Rubella or Prematurity
Before birth: Blod flows from Left Pulm A to Aorta
After Birth: Direction of flow reverses..
If the ductus arteriosus remains patent (PDA), then Pulm HTN may ensue—which may end as Eisenmenger Syndrome in the worst case if it remains uncorrected
Describe the characterization and nature of a mitral stenosis
–which maneuvers enhance this murmur?
“High-pitched opening snap after S2 followed by a descrescendo murmur or rumble that intensifies at the end of diastole”
ENHANCED BY: maneuvers that increase LA return e.g. expiration
** The diastolic rumble is best heard in a lateral decubitus position.
Describe the characterization and nature of a mitral valve prolapse
–which maneuvers enhance this murmur?
“Late Systolic Crescendo murmur with midsystolic click”
ENHANCED BY: The murmur occurs earler in maneuvers that decrease venous return (e.g. valsalva or Standing)
Does actual blood flow across an ASD cause a murmur?
Why or why not?
NO!!
Because there is no pressure gradient!
The murmur presents with a pulmnary flow murmur and then later progreses to a louder diastolic murmur of pulmonic regurgitation from dilation of the pulmonary artery.
In which areas of asucultation do we normall hear the following sounds?
FLOW MURMUR (e.g. ASD or PDA):
AORTIC REGURGITATION:
VENTRICULAR SEPTAL DEFECT:
AORTIC REGURGITATION:
HYPERTROPHIC CARDIOMYOPATHY:
PULMONIC REGURGITATION:
FLOW MURMUR (e.g. ASD or PDA):
-pulmonic area
AORTIC REGURGITATION:
-left sternal border
VENTRICULAR SEPTAL DEFECT:
-tricuspid regurgitation
AORTIC REGURGITATION:
-left sternal border
HYPERTROPHIC CARDIOMYOPATHY:
-left sternal border
PULMONIC REGURGITATION:
-left sternal border
What is Torsades de Pointes?
What is the treatment?
What is the commonest risk factor
DEFINITION: It is ventricular tachycardia that is characterized by shifting sinusoidal waveforms on ECG.
–it can progress to ventriclar fibrillation
TREATMENT: Magnessium Sulfate
RISK FACTOR: prolonged QT interval can predispose to Torsades de Pointes
Which congenital Syndrome can present with Torsades de Pointes?
Jervell and Lange Nielsen syndrome: severe congenital sensorineural deafness
What are the 2 common types of cardiac tumors?
-Which age groups do they affect?
Cardiac Myxoma =most common primary cardiac tumor in adults…Usally found in the atria here it causes ball-valve obstructions of the mitral valve and embolization of tumor fragments
Cardiac Rhabdomyoma=most common primary cardiac tumor in children
- –associated with tuberous sclerosis
- -usually found in the ventricles
NB: Metastases like the pericardium, where they cause pericarditis
What are the usual locations of the two types of cardiac tumors?
–which secondary conditions are associated with each of these tumors?
Cardiac Myxoma: usually in the left atrium e.g. septum ot mitral valve
—associated with multiple syncopal episodes
Cardiac Rhabdomyoma= arises within the myocardium
—-associated with tuberous sclerosis (Aut. Dominant disorder manifesting with cortical tubers, harmatomas, hypopigmented “ash-leaf spots on skin, renal angiomyolipoma and cardiac rhabdomyoma”)
Which condition is associated with the classic desription of “ball valve obstruction”?
Cardiac Myxoma
What are the common metastasis that lead to secondary cardiac tumors?
-name 4
–Which part of the heart do they predilect?
Melanoma Lymphoma bronchogenic carcinoma (lung) Breast pancreatic or esophageal carcinoma
–They commonly involve the pericardium, resulting in pericardial effusion
Describe the diastolic pressure in cardiac tamponade.
Why is that so?
There is diastolic pressure equalization in all 4 chambers.
The reason is that there is collapse of the RA and RV during diastole
What does the ECG show in acute pericarditis?
Widespread ST segment elevation with upright T waves and/or PR depression
How do patients with acute pericarditis relieve their symptoms–usually before any cinical intervention?
–Describe the nature of their pain
Sitting up and leaning forward
-Pain is usually some form of pleuritic chest rub which worsens on inspiration and when coughing.
====because of the inflammation, they usually have a friction rub present
What is the “Kussmaul’s Sign”?
-In which conditions do you find it?
This is a paradoxial rise in JVP during inspiration i.e. we normally expect the JVP to fall on inspiration, but in this sign: there is a actually marked Jugular Venous Distention!!
—The reason is that upon inspiration: there negative intrathoraic pressure is not transferred to the pericardium and the RA and RV have impaied filling–>leading to JVDistention!! i.e. stiff right heart
–Conditions like chronic restrictive pericardititis or cardiac tamponade can produce the Kussmaul’s sign
What are the three types of Angina and how does each one show on an ECG?
A: STABLE…transient ST elevation during pain
B. PRINZMETAL/VARIANT…ST elevation
C. UNSTABLE…no ST elevation, but depression follows
What causes each of the three types of Angina?
A: STABLE…caused by atherosclerosis and occlusion
B. PRINZMETAL/VARIANT…cuased by coronary artery vasospasm Rx = vasodilator or Ca2+ channel blocker
C. UNSTABLE/CRESCENDO…caused by a ruptured plaque that then lodges wothout complete coronary artery occlusion
Coronary Steal Syndrome?
What sort of agents trigger this phenomenon?
Vasodialtors such as dipyridamole can aggravate ischemia by shunting blood away from areas that are not being perfused enough already.
–seen espeically in coronary arteries
What usually causes sudden cardiac death?
Death within ~ 1 hour of onset of symptoms…
-caused by lethan arythmias such as Ventricular Fibrillation
Which coronary arteries are most commonly occluded in an MI? Rank them in order of frequency.
LAD>RCA>Circumflex
Name 7 classic presentation signs of an MI
- crushing retrosternal chest pain,
- pain radiating to neck, jaw and left arm
- nausea
- diaphoreis
- vomitting
- SOB
- Fatigue
What are the 2 types of infarcts?
-describe their appearance on an ECG
Subendocardial= ST depression
Transmural Infart= ST elevation and Q waves (caused by coagulative necrosis)
-sometime we see inverted T-waves
What are the 6 complications that could arise as a result of an MI?
–which one/s usually lead to death?
- Cardiac Arrhythmia= most important cause of death before reaching the hospital
- LV failure and Pulm Edema
- Cardiogenic Shock
- Cardiac Rupture (ventricular wall or septum rupture)
- Ventricular Aneurysm formation
- Postinfarction fibrinous pericardititis
- -Dressler’s Syndrome
