Ch. 1 Cardiac Basics Flashcards
Atrial Kick
- Definition
-Contributes what % to overall CO?
- At the eod of diastole, the atria depolarize and contract
- Atrial kick is 20-30% of CO
What portion of the body supplies the SVC vs. IVC
- Thorax & up
- Thorax & below
Where the blood is drawn from in the heart and normal value
- SvO2
- ScvO2
- Tip of Swan Catheter (blood from pulmonary artery): 65 - 75%
- Central Line (SVC or RA): >70%
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
- 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
RCA perfuses
Circumflex perfuses
LAD perfuses
Left Main perfuses
which walls are perfused by what
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
Coronary Circulation
What percent have E?
Name each letter
A- RCA, Acute marginal
B- Left Main
C- Circumflex
D- LAD
E- Ramus, 20%
F- PDA
G- Obtuse marginals
H- Diagonals of LAD
Chordae tendinae and papillary muscle attach to what?
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
What are you hearing during S1 vs S2?
AV valves are open during _____ and semilunar valves are open during _____ ?
S1: AV valves closing (Tricuspid and Mitral)
S2: Semilunar valves closing (Aortic and Pulmonic)
Diastole, Systole
S4 Atrial Gallop
- Definition and mnemonic
- Commonly heard in what conditions?
- “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
Systole/Diastole each are what % of the cardiac cycle?
S3 Ventricular Gallop
Heard in what cardiac state? Mnemonic
Common in what 3 groups?
1/3 , 2/3
Fluid overload, S3, “I - Be - lieve”
Children, High CO, 3rd trimester
Split Heart Sounds
- definition
- best heard during
Split S1 vs split S2
- cause and examples
- 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
The “Big 5” D/c meds following ACS
- ASA indefinitely
- P2Y12 receptor blocker (1 yr or more)
- Beta blocker indefinitely
- Statin high intensity indefinitely
- Ace-inhibitor or ARB when EF<40% or anterior wall MI indefinitely
Beta Blockers
- Indications
- Action
- Side effects
- Perscription
Do not start in
- 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
Cardio-selective beta blockers vs. non-selective beta blockers
- examples
- definition
- effects
- 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
Metoprolol tartrate
- Indication
- Action
- Dose IV/PO
Metoprolol succinate
- Indication
- Action
- Dose PO
Both used for
- 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
Normal Cholesterol Levels
Desirable , Borderline High , High
For the following:
1. Total Cholesterol
2. LDL
3. HDL
4. Triglycerides
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
Statins
- Action
- Indication
- Decreases risk of what
- Side effects
- 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
Long term medical management for HFrEF includes which 3 drug classes?
Beta blocker
ACE inhibitor
Aldosterone antagonists
ABRs
Aldosterone antagonists
ARNI (angiotensin receptor neprilysin inhibitor)
What do they have in common?
They all interfere with the RAAS system
- ARBs “sartans” block angiotensin II
- Aldosterone agonists block aldosterone release
ARNIs block angiotensin I (like Entresto)
3 Goals for treatment in Heart Failure
- Reduce Preload
- Reduce Afterload
- Increase contractility
ACE inhibitors
- 4 indications
- Effects on Preload, Afterload, GFR
- Side effects
- Heart failure (LV systolic dysfunction)
- Acute MI (ACS = reduced EF)
- HTN alone or in combination w/ meds
- Nephropathy (esp. if diabetic/prediabetic)
- Preload reduction, afterload reduction, decreased GFR
- *Cough, *Hypotension, *Hyperkalemia (spironolactone), *Renal dysfunction, Headache, dizziness, fatigue
Angioedema
- Etiology
- Treatment
- 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
Hydralazine and Isosorbide Dinitrate
- Indication
- Mech of action
- Bidil
- 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
Entresto
- Class
- Indication
- Starting dose
- 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
Diuretics
- Potassium sparing / Aldosterone antagonist
- Loop Diuretics
- Thiazide Diuretics
Examples and Action
*Treatment of metabolic alkalosis
- 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
SGLT2 Inhibitor
- Examples
- Benefits
- Empagliflozin (Jardiance), Dapagliflozin (Forxiga), Canagliflozin (Invokana)
- Cause diuresis, naturesis, stabilize myocardium in EF<40%, reduced CV death, reduced hospitalizations, improved symptoms
HFrEF Treatment
1st Line - 4 Things
2nd Line - 3 things
- Ace Inhibitor, ARB or ARNI
- Beta blocker
- SGLT2 inhibitors
- Loop diuretics
- Spironolactone
- ISDN / hydralazine
- Corlanor
Dobutamine
- Action
- Indication
- Dose
- Side effects
- 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
Milrinone
- Action and class
- Dose
- 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
