Cardiovascular Review Flashcards
What is the formula for Cardiac Output?
CO= HR+SV (Heart rate plus Stroke Volume)
What is cardiac output? What is the normal range?
Amount of blood pumped by the heart per minute. 4-8 L/min. The same as normal lung minute volume.
What is cardiac index (CI)?
Assessment of the cardiac output value based on the patient’s size (BSA).
How do you calculate cardiac index? What is the range?
Divide cardiac output by patient’s BSA. 2.5 - 5 L/min
What is stroke volume?
Amount of blood ejected from ventricle with each heart beat. This is affected by preload, contractility and afterload.
What is preload?
Blood remaining after the end of diastolic.
The load that stretches cardiac tissue before each contraction. The amount of blood returned to the right heart from the body and the amount of blood returned to the left heart from the lungs.
What is contractility?
The ability of the heart to contract. Frank-Starling Law states that the stroke volume of the heart increases with response to increase in the volume of blood filling the heart.
What is Afterload?
The force of vascular resistance in relation to ventricular contraction.
(The pressure/resistance is pushed out against (SVR)
What is the difference between right and left heart afterload?
The right heart afterload is affected by pulmonary arteries (PVR) and the left heart after load is affected by systemic vascular resistance (SVR)
What is Pulmonary vascular resistance and the normal value?
Measures the afterload of right heart. 50-250 dynes
What are some examples that will increase PVR?
Acidosis, hypercapnia, hypoxia, COPD, atelectasis, ARDS
What are some examples that would decrease PVR?
Alkalosis, hypocapnia, vasodilating drugs
What is Systemic Vascular resistance (SVR) and the normal value?
Measures afterload of the left hear. 800-1200 dynes
What are some examples of increased SVR?
Hypothermia, hypovolemic shock, decreased cardiac output
What are some examples of decreased SVR?
Anaphylaxis, neurogenic (distributive) shock, spinal shock, septic shock, vasodilating drugs.
Facts about S1 heart sound.
Is the “lub” sound
Hear on systole
Bicuspid/tricuspid valve closure.
Facts about S2 heart sound.
The “dub” sound you hear
Heard on diastolic
Aortic/pulmonic valve closure
What are abnormal heart sounds?
S3 “Kentucky” and S4 “Tennessee”
What is the heart sound S3 indicative of?
Excess filling of the ventricles over filling of the left ventricle.
What are common causes of S3 heart sound?
CHF, chordae tendineae (heart string) dysfunction. CHF is the most common cause.
What is the heart sound S4 indicative of?
Myocardial Infarction
Blood being forced into a stiff (non-compliant) ventricle.
What are some common causes of S4?
Hypertrophic cardiomyopathy, hypertension, pulmonary or aortic stenosis.
What are the auscultation points for heart sounds?
(All, Physicians, Take, Money)
Aortic, Pulmonic, Tricuspid, Mitral
What does sodium do when it comes to the heart?
Flows into the cell to initiate depolarization
What does potassium do when it comes to the heart?
Flows out of our cell to initiate repolarization.
What does Hyperkalemia and Hypokalemia do to the heart?
Hypokalemia causes increases cardiac irritability
Hyperkalemia causes decreased conduction (Sin wave)
What does calcium do when it comes to the heart?
Maintains depolarization of pacemaker cells/myocardial contractility
What does hypocalcemia and hypercalcemia do in the heart?
Hypocalcemia causes decreased contractility and increased irritability.
Hypercalcemia causes increased contractility.
What does magnesium do when it comes to the heart?
Stabilizes the cell membrane.
What does hypomagnesemia and hypermagnesemia do in the heart?
Hypomagnesemia caused decreased conduction.
Hypermagnesemia causes increased myocardial irritability.
What does the right coronary Artery (RCA) do?
Supplies the right ventricle and in most of the population the SA node.
Involved in Inferior STEMI
What does the Posterior Descending Artery (PDA) do?
A branch off the RCA for most populations
Ventricular Septum
Papillary Muscles (heart strings)
What does the Left coronary Artery (LCA) do?
Supplies blood to the left side of the heart
Often called the Left main Artery.
A complete block of the LCA is called the “Widow Maker”
A complete block would be seen in V3, V4, V5, and V6
What does the Left anterior Descending Artery (LAD) do?
Supplies the anterior left ventricle and anterior septum.
Anterior, Septal, and Antero-septal MI
V3 and V4
What does the Left Circumflex Artery (LCX) do?
Supplies lateral/posterior left ventricle
Lateral and posterior MI
V5 and V6
On a cardiac panel, which enzyme is the most sensitive?
Myoglobin
On a cardiac panel, which enzyme is the most specific to cardiac tissue death?
Troponin
With Troponin, what is the timeline for measurements?
Increases within 3-12 hours from onset of chest pain
Peak at 24-48 hours and return to baseline over 5-14 days
No not be detectable for 6 hours from onset
Measured upon arrival to ED and again in 10-12 hours from the onset of symptoms.
What are some “STEMI Mimics” with the Anterior MI (LAD)?
Paced rhythms
Left ventricular hypertrophy
Early Repolarization
LBB
How can you distinguish between a “mimic” and a true STEMI?
Poor “R” wave progression
What is significant with Axis Deviation?
Helpful in determining STEMI mimics, injury, or disease process.
What is the general rule for Normal Axis?
Lead I and Lead AVF both positive deflections (2 thumbs up).
What is the general rule for Left Axis deviation?
Lead II QRS is positive and lead AVF QRS is negative (Thumb up and thumb down)
What id the general rule for right axis deviation?
Lead I QRS is negative and Lead AVF is positive (Thumb down and thumb up)
What is the general rule for Extreme right axis deviation?
Both Lead I and AVF QRS are negative. (Both thumbs down) Likely VT
What is the general rule of Axis shifts when it comes to infarctions vs. hypertrophy?
Axis shifts towards hypertrophy and away from infarctions
What is the general rule for bundle branch blocks?
Caused by defect in electrical impulse conduction (slows conduction) Widened QRS (>0.12) or "Rabbit ears Look at V1 for changes
Right bundle branch block signs on EKG?
Bunny ears in V1
imagine flipping blinker up to take a right
Left bundle branch block signs on EKG?
QRS downward
Flipping your blinker to go left
May look like a “W”
Widened QRS >.120
What is Sgarbossa’s criteria?
Used to help determine if EKG changes are normal variant with LBBB or STEMI
What is the criteria for Sgarbossa?
ST elevation >1mm in a lead with positive QRS (5 points)
ST depression >1mm in V1-V3 (3 points)
ST elevation >5 mm in a lead with negative depression (2 points)
Need to have 3 points to call a STEMI
What classification of medication is used to break down a clot with an MI? How soon after an infarct may these drugs be administered?
Fibrinolytic
Up to 12 hours post infarct
What does CABG stand for?
Coronary Artery Bypass Graft
What vessel is used to bypass the RCA in a coronary artery bypass graft (CABG)?
Saphenous Vein
What vessel is used to bypass the left anterior descending coronary artery (LAD) in a CABG?
Inferior mammary artery
What are some examples of sodium channel blockers?
Lidocaine, Phenytoin, Procainamide
What is a sodium channel blocker?
It is a class I antidysrhythmic and Blocks the rise of sodium through cell membranes. Slows heart rate, Drugs which impair the conduction of sodium ions through sodium channels. (Negative dromotropy)
What is a Beta Blocker?
It is a class II antidysrhythmic and is a type of drug that blocks norepi or epi from binding and inhibits normal sympathetic effects. Causes blood vessels to relax and dilate. Reduces heart rate, cardiac output and cardiac O2 demand.
What are examples of Beta Blockers?
Carvedilol, Labetalol, Propranolol, Timolol, Esmolol, Metoprolol.
“LOL” drug endings
What is a potassium channel blocker?
It is a class III antidysrhythmic and are drugs that bind to and block the potassium channels that are responsible for phase 3 repolarization
What are some examples of Potassium Channel Blockers?
Amiodarone, Bretylium, Sotalol (also has class II potential)
What is a Calcium Channel Blocker?
Class IV (4) and blocks calcium entry into the cell, causing vasodilation. Negative Inotropy, chronotropy, and dromotropy
What was examples of calcium channel blockers?
Amlodipine, Diltiazem, Nifedipine (Procardia), Verapamil
What does each each receptor do? A1, B1 and B2?
A1-Vasoconstricts (pipe drug)
B1- Pump drug increases heart rate and contractility
B2- Dilates bronchioles and blood vessels
Remember you have 1 heart and 2 lungs. B1 affects heart B2 affects lungs
What is an example of a drug that possesses pure alpha agonistic effects?
Neosynephrine (Phenylephrine)
What are some vasopressor agents?
Neo-synephrine (phenylephrine) (pipe drug)
Norepi and Epi (Both A agonist and B agonist activity.
Dopamine
Dobutamine
Vasopressin
Milrinone
Isooriternol
What are some medications that increase SVR? (vasoconstrictors)
Dopamine, Neosynephrine, Epi, Levophed
What are the medications that decrease the SVR? (vasodilators)
Nitroprusside, Nicardipine, high doses of Nitro, Dobutrex, A- blockers and Natrecor.
What is Inotropy?
Contractility (stretch)
What is Chronotropy?
Heart rate
What is Dromotropy?
Conduction (rate/speed)
What are some drugs that decrease preload? (vasodilators)
Morphine, Lasix, Nitro
Makes Cardiac output worse.
What would you see on the 12 lead EKG to increase your suspicions of Wolfe-Parkinson-White syndrome (WPW)?
Delta wave which is an upstroke on the leading edge of the QRS.
What is endocarditis?
Inflammation or infection on the inside of the heart.
What is the #1 cause of endocarditis?
IV drug use
If you have a patient that has painful red fingertips, what is this called and what is it caused from?
Osler nodes and from endocarditis.
If your patient presents with red lesions on the palm or soles, what is this called and what is caused from?
Janeway lesions and caused by endocarditis
What is pericarditis?
Inflammation or infection on the outside of the heart.
What are some symptoms of pericarditis?
Substernal chest pain when breathing or lying supine.
What EKG findings would you suspect to see when a patient has Pericarditis?
Global ST elevation
What is Dressler’s Syndrome?
Pericarditis seen in patient’s post MI/Cardiac surgery.
What are some signs and symptoms of Dressler’s Syndrome?
Substernal chest pain that is severe or sharp and radiates into the neck/shoulder area.
Dyspnea/Dysphagia
Fever
Tachycardia
What is the treatment of Dressler’s syndrome?
Administration of Colchicine and Indomethacin
What are 4 findings on a chest X-Ray for Congestive Heart failure?
Butterfly pattern
Kerley A or Kerley B lines
Diffuse bilateral infiltrates
Heart is greater than 50% width of the chest
What BNP levels indicate mild, moderate and severe CHF?
Mild >300
Moderate >600
Severe >900
What is the most important therapy for Pulmonary edema/CHF?
NIPPV
When treating Aortic Dissections, what is the order of drugs that should be used to reduce the pressure in the Aorta?
Beta blockers 1st
Vasodilators 2nd
Which region of the aorta is the most common site for dissection?
Ascending Aorta (type II dissection)
Which region of the aorta is the most common site for dissection?
Ascending Aorta (type II dissection)
What are the three tissue layers of the heart from innermost to outermost?
Endocardium, Myocardium and pericardium
Catecholamines such as epi and norepi are hormones secreted by the what?
Adrenal Medulla
What receptor site, when stimulated, will cause an increase in inotropy and chonotropy?
Beta 1 and Beta 2 receptors
What two branches come off of the left coronary artery?
The left anterior descending artery and the Circumflex Artery
