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Cardio= Clin Med > Clinical Cardiology > Flashcards

Clinical Cardiology Flashcards

1
Q

Blood Flow

A 
Right Atria
Tricuspid valve
Right Ventricle
Pulmonic Valve
Pulmonary Arteries
Pulmonary Vasculature
Pulmonary Veins
Left Atria
Mitral Valve
Left Ventricle
Aortic Valve
Aorta
Systemic Vasculature
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2
Q

Systole ventricular contraction (S1 sound) valves are:

A

Aortic and Pulmonic (semilunar) valves are open

Mitral and Tricuspid (artioventricular) valves are closed

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3
Q

Diastole atrial contraction and ventricular relaxation (S2) valves are:

A

Aortic and pulmonic (semilunar) valves are closed

Mitral and Tricuspid (artioventricular) valves are open

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4
Q

S1 Sound

A

During systole the mitral valve closes because the pressure in the LV exceeds that of the LA. And the tricuspid valve but it is a lower pressure therefore not as prominent

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5
Q

S2 Sound

A

blood leaves the LV the pressure drops below that in the Aorta and the Aortic Valve closes. also the pulmonic valve

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6
Q

S3 Sound

A

When that rapid blood flow hits the wall of the LV

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7
Q

S4 Sound

A

the LA contracts “to squeeze the last bit of” blood out into the LV

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8
Q

Stroke Volume determined by? (3)

A

Preload
Afterload
Muscle Contractility

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9
Q

Preload

A

The volume that stretches the cardiac muscle prior to contraction.

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10
Q

Afterload

A

Vascular resistance– how hard your heart has to push against the gradient head

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11
Q

Muscle Contractility

A

ability for the cardiac muscle to contract when given a volume.

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12
Q

4 things that make up Arterial Pressure

A

Systolic Pressure= The maximum pressure during systole
Diastolic Pressure = The lowest pressure during diastole
Pulse Pressure = difference between the systolic and diastolic pressures
Mean Arterial Pressure = Diastolic + 1/3(Systolic –Diastolic)

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13
Q

Normal Cardiovascular Vital Signs

A

Blood pressure 60 mmHg
Central Venous Pressure 8-12 mmHg
Pulmonary Artery Occlusion Pressure 6-12 mmHg
Heart Rate 60-100

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14
Q

Pulsus paradoxus

A

A drop in Systolic pressure by more than 10 mmHg during inspiration due to increased pressure in the thoracic compartment.

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15
Q

Pulsus alterans

A

pulse alternates in amplitude from beat to beat when the rhythm is nml. May suggest LV failure
Jugular Venous Distension

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16
Q

2 Types of Murmurs

A

Stenotic Valve
Insufficient Valve
Regurgitation
The Valvular abnormalities create turbulent flow and cause abnormal heart sounds

17
Q

4 types of Murmurs

A

Aortic Stenosis is heard best in aortic area during systole
Aortic Regurgitation heard best along the Left lateral border during diastole
Mitral Stenosis heard best at the apex during diastole
Mitral Regurgitation heard best at the apex during systole

18
Q

Creatine Kinase

A

peaks 4-8 hours post infarction and declines after 2-3 days. Peak is usually after 24 hours

CK isoenzymes
MM (skeletal and cardiac), BB (brain and kidney) and MB (cardiac and skeletal (1-3%), small amounts in small intestine, tongue, diaphragm, uterus and prostate)

A ratio of 2.5 or greater of MB is usually indicative of an MI (CK-MB index)

Inaccurate in the setting of skeletal breakdown and large CK release or in chronic skeletal injury resulting in release of MB or when the CK is in the nml range and the MB in elevated ? Microinfarctions.

19
Q

Troponin

A

Three types that regulate calcium-mediated contractile process of striated muscles
Troponin C which binds calcium
Troponin I which binds to actin and inhibits actin-myosin interactions
Troponin T binds to tropomyosin thereby attaching the troponin complex to the thin filament.

Released when a myocyte is damaged after about 3 hours and persist for 7 to 10 days (Trop I) and can last upwards of 10-14 days. (Trop T)

20
Q

B type Natretic Peptide

A

released in the setting of atrial stretch
< 100 pg/dL is nml (accuracy of 81.2%)
>400 pg/dL has a high predictive value for CHF
Lipid Panel
Total Cholesterol, HDL, LDL, Triglycerides

21
Q

EKG

A

graphic recording of the electrical signals created by the heart

22
Q

PQRST Waves of EKG

A 
P wave = atrial depolarization
QRS wave = Ventricular polarization/atrial repolarization.
Q wave= septal depolarization
R wave= Ventricular depolarization
S wave= purkinje fibers
T wave= ventricular repolarization
23
Q

Trans-Esophageal Echocardiogram (TEE)

A 
More Invasive than Transthoracic
Inadequate trans-thoracic views
Aortic Disease
Infective Endocarditis
Source of embolism
Valve Prosthesis
Intraoperative
24
Q

Echocardiography

A

Uses ultrasound technology to visualize the heart. TRANSTHORACIC

25
Q

Doppler Echocardiography

A 
Valve Stenosis
Gradient
Valve area
Valve Regurgitation
Intracardiac pressures
Volumetric flow
Diastolic filling
Intracardiac shunts (“bubble” studies)– a whole between the 2 atria or ventricles
26
Q

Stress Echocardiography

A 
2 D
Myocardial Ischemia
Viable myocardium
Doppler
Valve disease
27
Q

Nuclear Imaging

A

Injection of a radioactive isotope which emits photons. The photons are captured by a special camera.
The problem with isotopes is that that emit photons in all directions. Using high energy isotopes results in less scattering

28
Q

Types of Stress Tests

A 
Stress Electrocardiography
Dukes Treadmill Score
Stress Echocardiography
Decreased Ejection Fraction and decreased end diastolic volume or WMA/
Stress Nuclear Imaging
Imaging Defects
Exercise Stress Testing
Bruce Protocol
29
Q

Relative Contraindications for Cardiac Angiography

A

Infants < 1 mo old, elderly > 85 yo
Functional Class IV 10x greater than I-II
L main disease
Valvular disease
EF < 30%
Renal disease, DM, vascular disease, severe pulmonary disease

30
Q

Indications and Complications of Cardiac Angiography

A

Needed when cardiac disease needs confirmation.
Acute or worsening cardiac dysfunction or MI

Complications
CVA, MI, Arrhythmia, vessel damage (rupture/dissection), heart damage (rupture), renal failure or allergic reactions from contrast dye

31
Q

Pulmonary Artery Catheter

A

entitled Catheterization of the heart in man with the use of a flow-directed balloon-tipped catheter
Placed intravenously and floated into the pulmonary artery.
NOT FOR DETERMINING INTRAVASCULAR VOLUME

32
Q

Risks of PAC

A 
Infection
Bleeding
Clotting
Pneumothorax
Pulmonary Artery Rupture
Pulmonary embolism
Death

Cardio= Clin Med (7 decks)

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