Cardiovascular Flashcards
Which heart sound is associated with heart failure?
S3
- may occur before crackles
- caused by rush of blood into dilated ventricle
- occurs early in diastole
S3 is caused by:
- pulmonary hypertension and cor pulmonale
- mitral, aortic, or tricuspid insufficiency
Systolic blood blood pressure is and indirect measurement of what?
cardiac output and stroke volume
Diastolic blood pressure is an indirect measurement of what?
systemic vascular resistance (SVR)
-A decrease in diastolic pressure (wider pulse pressure) may indicate vasodilation, drop in SVR (sepsis, septic shock)
When are coronary arteries perfused?
during diastole
Murmurs of insufficiency occur when the valve is open or closed?
closed
acute or chronic
Murmurs of stenosis occur when the valve is open or closed?
open
chronic
Difference between Unstable Angina and NSTEMI?
NSTEMI: positive troponin, unrelenting chest pain
- Both will have ST depression or T-wave inversion
- (Unstable angina can be relieved by nitro)
What is Prinzmetal’s angina, aka variant
S/S of Variant or Prinzmetal’s Angina:
- Unstable angina with transient ST elevation (pain and ST relieved by nitro)
- Due to coronary artery spasm
- Occurs randomly, or at rest, or same time each day
- Can be due to nicotine, ETOH, or cocaine
- Troponins are negative
Treatment/Management of Chest Pain
- Stat EKG
- (MONA)
- Anticoagulant
- Antiplatelet
- Beta blocker
- Treat the pain (nitro/morphine)
Types of antiplatelet agents:
- Clopidogrel (Plavix)
- Abciximab (Reopro)
- Eptifibatide (Integrilin)
- Tirofiban (Aggrastat)
Contraindications of beta blocker for ACS
-cocaine, hypotension, bradycardia, use of phosphodiesterase inhibitor drugs like sildenafil (Viagra)
(Metoprolol is cardioselective but propranolol isn’t)
What labs would you check for ACS/Chest Pain?
cardiac biomarkers, lipid profile, CBC, electrolytes, BUN, creatinine, mag, PT, and PTT
ECG lead changes in RCA and inferior LV
II, III, and aVF
ECG lead changes in LAD and anterior LV
V1, V2, V3, V4
ECG lead changes in circumflex and lateral LV
V5, V6, I, and aVL
ECG lead changes in low lateral LV
V5 and V6
ECG lead changes in high lateral LV
I and aVL
LOOK up videos and stuff for page 27, lead changes based on location of CAD
ugh (the last two bullets I didn’t make cards for)
Circumflex supplies what part of the heart? Which ECG leads?
lateral
I, aVL, V5, V6
RCA supplies what part of the heart? Which ECG leads?
Inferior
II, III, aVF
LAD supplies what part of the heart? ECG leads?
anterior wall and septum (bundle of His)
-Vleads 1-4 (V1, VII, VIII, V4)
Where in the heart is conduction located? Which wall?
Inferior (AV node and SA node)
Circumflex supplies the ____ part of the heart
Lateral wall
RCA supplies the ______ part of the heart
Inferior wall
LAD supplies the ____ part of the heart
Anterior wall and septum
S1 sounds
caused by closure of ____ valves
loudest at the ____
marks the end of ______
closure of AV valves
loudest at the apex
end of diastole, beginning of systole
S2
caused by closure of _____ valves
loudest at the ____
marks the end of ____
closure of semilunar valves (aortic/pulmonic)
loudest at the base
end of systole, beginning of diastole
S3 is caused by….?
heart failure, pulmonary hypertension, cor pulmonale, or mitral/aortic/or tricuspid insufficiency
what’s a normal pulse pressure?
40-60
systolic - diastolic
What is the evidence of reperfusion (post fibrinolytic therapy for MI)?
relief of chest pain
no more ST deviations
Increased troponin and CK-MB
Reperfusion arrhythmias (VT, VF, accelerated ICR)
review page 29 (infarcts)
vbn,
look up
Sic Sinus Syndrome
what are two complications of PCI?
Stent thrombosis (chest pain, ST elevation) and retroperitoneal bleed
prolonged QT interval can lead to
torsades de point
Causes of prolonged QT :
and treatment?
Drugs: amio, quinidine, haldol, procainamide
Electrolyte problems: hypokalemia, hypocalcemia, hypomagnesmia
tx: magnesium
failure to pace:
failure to capture:
failure to sense:
pace: no spike (at all) when expected
capture: spike without a QRS (for vent pacing)
sense: pacing in native beats
systolic dysfunction (heart failure): associated with EF of …
40% of less
which heart failure shows an enlarged heart on x-ray
systolic HF
s/s of right sided heart failure (7)
hepatomegaly splenomegaly dependent edema venous distention elevated CVP/JVD tricuspid insufficiency abdominal pain
s/s of left sided heart failure
orthopnea, dyspnea, tachypnea hypoxemia tachycardia crackles cough with pink, frothy sputum elevated PA diastolic/PAOP Diaphoresis Anxiety, confusion
what are the differences between dilated and hypertrophic cardiomyopathy?
Dilated: Systolic dysfunction, thinning, enlargement of LV; mitral valve regurge common d/t vent dilation
Hypertrophic: Diastolic dysfunction, thickening of heart muscle and septum (at the expense of the LV chamber)
How is left ventricular preload and afterload affected by cardiogenic shock?
preload is elevated with associated pulmonary symptoms (high PAOP)
left ventricular afterload (SVR) is elevated d/t vasoconstrictive compensatory mechanisms
what are 3 positive inotropes used to treat cardiogenic shock
norepi
dopamine
dobutamine, milrinone
In treatment of cardiogenic shock, what will enhance the effectiveness of the “pump”?
positive inotropes (levo, dopa, milrinone/dobutamine)
In treatment of cardiogenic shock, what will decrease the demand on the “pump”?
preload reduction afterload reduction optimize oxygenation mechanical ventilation treat pain IABP for short term support VAD (ventricular assist device), may be used for longer periods of time than IABP
VAD are used in which conditions?
ventricular heart failure, cardiogenic shock, and cardiac myopathies, pts awaiting heart transplant
What are the benefits of IABP therapy?
increases coronary perfusion and decreases afterload
What are 2 life threatening complications of a CABG?
tamponade and pericarditis
look up mediastinum
asdf
Which leads show the circumflex ?
lateral leads (I, AVL, V5, and V6)
which leads show the RCA?
inferior leads (II, III, and AVF)
Which leads show the LAD?
septum and anterior leads (V1-V4)
Which coronary artery supplies the SA and AV nodes?
RCA
An occlusion in the bundle of His would result in what heart block?
second-degree type II
What part of the heart does the RCA supply?
left ventricle
Where is the mitral valve attached on the heart?
left ventricle
