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CSC Prep > Ch. 1 Cardiac Basics > Flashcards

Ch. 1 Cardiac Basics Flashcards

1
Q

Atrial Kick
- Definition
-Contributes what % to overall CO?

A
  • At the eod of diastole, the atria depolarize and contract
  • Atrial kick is 20-30% of CO
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2
Q

What portion of the body supplies the SVC vs. IVC

A
  • Thorax & up
  • Thorax & below
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3
Q

Where the blood is drawn from in the heart and normal value
- SvO2
- ScvO2

A
  • Tip of Swan Catheter (blood from pulmonary artery): 65 - 75%
  • Central Line (SVC or RA): >70%
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4
Q

Coronary Sinus
- Location
Aortic sinuses
-Branches into
- Coronary arteries are perfused during what
- Tachycardia has a negative impact on what cardiac measure of ejection of blood? d/t what

A
  • Heart posterior joining of great cardiac vein and oblique vein which feeds to right atrium
  • Located @ base of the aorta immediately above the aortic valve on a widened area known as the sinuses of valsalva
  • branch into left, right and non coronary
  • CA’s perfused during DIASTOLE
  • Negative impact on CO & Stroke Volume d/t shortened diastolic filling time
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5
Q

RCA perfuses
Circumflex perfuses
LAD perfuses
Left Main perfuses

which walls are perfused by what

A

RCA: Inferior wall, Right atrifum, Right ventricle, posterior septum, PDA
Circumflex: Lateral wall, left atrium, posterior left ventricle
LAD: Septal and Anterior wall, Anterior and inferior left ventricle, anterior septum, bundle of HIS/BB, papillary muscle - mitral valve
Left Main: Circumflex & LAD

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6
Q

Coronary Circulation

What percent have E?
Name each letter

A

A- RCA, Acute marginal
B- Left Main
C- Circumflex
D- LAD
E- Ramus, 20%
F- PDA
G- Obtuse marginals
H- Diagonals of LAD

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7
Q

Chordae tendinae and papillary muscle attach to what?

A

A- Tricuspid Valve
B- Pulmonic Valve
C- Aortic Valve
D- Mitral Valve

Attach to tricuspid and mitral valves from inside the ventricles to prevent prolapse into atria

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8
Q

What are you hearing during S1 vs S2?

AV valves are open during _____ and semilunar valves are open during _____ ?

A

S1: AV valves closing (Tricuspid and Mitral)
S2: Semilunar valves closing (Aortic and Pulmonic)

Diastole, Systole

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9
Q

S4 Atrial Gallop
- Definition and mnemonic
- Commonly heard in what conditions?

A
  • “Te - ne - ssee” / “Believe me”
    Sound caused by vibration of atria ejecting blood into non-compliant ventricles
  • Heard in cases of left ventricular hypertrophy, auscultated during ischemia, HTN, Pulmonary stenosis, CAD, aortic stenosis
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10
Q

Systole/Diastole each are what % of the cardiac cycle?

S3 Ventricular Gallop
Heard in what cardiac state? Mnemonic

Common in what 3 groups?

A

1/3 , 2/3

Fluid overload, S3, “I - Be - lieve”

Children, High CO, 3rd trimester

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11
Q

Split Heart Sounds
- definition
- best heard during
Split S1 vs split S2
- cause and examples

A
  • Sound made when one valve closes later than the other
  • Best heard during inspiration
  • S1: Mitral closes before tricuspid
  • RBBB, Pacing, PVCs
  • S2: Aortic closes before pulmonic
  • Overfilled RV, ASD
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12
Q

The “Big 5” D/c meds following ACS

A
  1. ASA indefinitely
  2. P2Y12 receptor blocker (1 yr or more)
  3. Beta blocker indefinitely
  4. Statin high intensity indefinitely
  5. Ace-inhibitor or ARB when EF<40% or anterior wall MI indefinitely
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13
Q

Beta Blockers
- Indications
- Action
- Side effects
- Perscription

Do not start in

A
  • Arrhythmias
  • Blocks catecholamine, blunts the sympathetic nervous system causing decreased heart rate and AV node conduction, decreased contractility and myocardial O2 consumption, decreased automaticity and slowed remodeling
  • Can cause fatigue for several months
  • Administered within 24 hours, continued indefinitely

Do not start with BB in active decompensation

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14
Q

Cardio-selective beta blockers vs. non-selective beta blockers
- examples
- definition
- effects

A
  • Cardio-selective block only Beta 1, Non-selective block Beta 1 and Beta 2 (& sometimes alpha)
  • Metoprolol (lopressor), Metoprolol XL (toprolol XL), Metoprolol tartrate & succinate, Atenolol (tenormin),
  • Carvedilol, Sotalol, Labetalol, Bisoprolol, Propranolol
  • Negative inotropic effects = slows HR, suppresses contractility
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15
Q

Metoprolol tartrate
- Indication
- Action
- Dose IV/PO
Metoprolol succinate
- Indication
- Action
- Dose PO
Both used for

A
  • Used post MI for arrhythmia protection
  • Both block renin production and block hormones like adrenaline
  • IV: Full dose 15 mg
  • PO: 100-400 mg QD
  • Used in heart failure
  • Beta 1 blocker max dose 200 mg PO if tolerated
  • Both can be used for hypertension and angina
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16
Q

Normal Cholesterol Levels

Desirable , Borderline High , High

For the following:
1. Total Cholesterol
2. LDL
3. HDL
4. Triglycerides

A

Desirable , Borderline high , High
1. Total cholesterol <200 , 200-239 , <240
2. LDL <130 , 130 - 159 , >160
3. HDL >50 , 40-49 , <40
4. Triglycerides <200 , 200-399 , >400

17
Q

Statins
- Action
- Indication
- Decreases risk of what
- Side effects

A
  • Reduces inflammation, reduces the amount of cholesterol made by the liver
  • Prescribed to people to decrease risk of MI and stroke by 40%
  • Decreases risk of cardiac death by 25-35%
  • Myalgia and muscle weakness, increased LFTs, increased RMG or DMT2
18
Q

Long term medical management for HFrEF includes which 3 drug classes?

A

Beta blocker
ACE inhibitor
Aldosterone antagonists

19
Q

ABRs
Aldosterone antagonists
ARNI (angiotensin receptor neprilysin inhibitor)

What do they have in common?

A

They all interfere with the RAAS system

  • ARBs “sartans” block angiotensin II
  • Aldosterone agonists block aldosterone release
    ARNIs block angiotensin I (like Entresto)
20
Q

3 Goals for treatment in Heart Failure

A
  1. Reduce Preload
  2. Reduce Afterload
  3. Increase contractility
21
Q

ACE inhibitors
- 4 indications
- Effects on Preload, Afterload, GFR
- Side effects

A
  1. Heart failure (LV systolic dysfunction)
  2. Acute MI (ACS = reduced EF)
  3. HTN alone or in combination w/ meds
  4. Nephropathy (esp. if diabetic/prediabetic)
  • Preload reduction, afterload reduction, decreased GFR
  • *Cough, *Hypotension, *Hyperkalemia (spironolactone), *Renal dysfunction, Headache, dizziness, fatigue
22
Q

Angioedema
- Etiology
- Treatment

A
  • Caused by rising levels of bradykinin (vasodilator) that causes capillary permeability, leading to edema
  • Stop ACE inhibitor, Anti-histamines and corticosteroids, FFP- Kinase II breaks down accumulated bradykinin, suppresses bradykinin
23
Q

Hydralazine and Isosorbide Dinitrate
- Indication
- Mech of action
- Bidil

A
  • Used in HF if unable to tolerate BB
  • Hydralazine: vasodilator which decreases afterload / SVR
  • ISDN: venodilator which decreases intracardiac filling pressures, pathologic cardiac remodeling
  • Bidil is a combo of both hydralazine and ISDN
24
Q

Entresto
- Class
- Indication
- Starting dose

A
  • ARB / ARNI
  • Indicated to reduce the risk of cardiovascular death and hospitalization for heart failure (patients w/ CHF and reduced EF <40%)
  • Starting dose 24/26 mg PO BID
25
Q

Diuretics
- Potassium sparing / Aldosterone antagonist
- Loop Diuretics
- Thiazide Diuretics
Examples and Action

*Treatment of metabolic alkalosis

A
  • Spironolactone, Eplerenone: Aldosterone antagonists prevent retention of sodium and water
  • Furosemide/Lasix, Torsemide/Demedex, Bumetanide/Bumex, Ethacrynic acid: inhibit Na/K/Cl transporter
  • HCTZ, metolazone/Zaroxolyn, Diuril/Chlorathiazide: Inhibit reabsorption of luminal sodium

*Give Diamox/acetazolamide

26
Q

SGLT2 Inhibitor
- Examples
- Benefits

A
  • Empagliflozin (Jardiance), Dapagliflozin (Forxiga), Canagliflozin (Invokana)
  • Cause diuresis, naturesis, stabilize myocardium in EF<40%, reduced CV death, reduced hospitalizations, improved symptoms
27
Q

HFrEF Treatment
1st Line - 4 Things
2nd Line - 3 things

A
  1. Ace Inhibitor, ARB or ARNI
  2. Beta blocker
  3. SGLT2 inhibitors
  4. Loop diuretics
  5. Spironolactone
  6. ISDN / hydralazine
  7. Corlanor
28
Q

Dobutamine
- Action
- Indication
- Dose
- Side effects

A
  • Stimulates beta receptors (beta1 and some alpha) improving contractility and cardiac output
  • Used in cardiac surgery and septic shock
  • Dose: 2-20 mcg/kg/min IV (max dose 40)
  • Tachycardia, hyper/hypotension, ectopy, hypokalemia
29
Q

Milrinone
- Action and class
- Dose

A
  • Phosphodiesterase inhibitor which increases myocardial contractility and causes pulmonary vasodilation
  • Dose: 0.375 - 0.75 mcg/kg/min
  • Increased CO, decreased PAOP and SVR, No change in HR

CSC Prep (8 decks)

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