Clinical Cardiology Flashcards
Blood Flow
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
Systole ventricular contraction (S1 sound) valves are:
Aortic and Pulmonic (semilunar) valves are open
Mitral and Tricuspid (artioventricular) valves are closed
Diastole atrial contraction and ventricular relaxation (S2) valves are:
Aortic and pulmonic (semilunar) valves are closed
Mitral and Tricuspid (artioventricular) valves are open
S1 Sound
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
S2 Sound
blood leaves the LV the pressure drops below that in the Aorta and the Aortic Valve closes. also the pulmonic valve
S3 Sound
When that rapid blood flow hits the wall of the LV
S4 Sound
the LA contracts “to squeeze the last bit of” blood out into the LV
Stroke Volume determined by? (3)
Preload
Afterload
Muscle Contractility
Preload
The volume that stretches the cardiac muscle prior to contraction.
Afterload
Vascular resistance– how hard your heart has to push against the gradient head
Muscle Contractility
ability for the cardiac muscle to contract when given a volume.
4 things that make up Arterial Pressure
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)
Normal Cardiovascular Vital Signs
Blood pressure 60 mmHg
Central Venous Pressure 8-12 mmHg
Pulmonary Artery Occlusion Pressure 6-12 mmHg
Heart Rate 60-100
Pulsus paradoxus
A drop in Systolic pressure by more than 10 mmHg during inspiration due to increased pressure in the thoracic compartment.
Pulsus alterans
pulse alternates in amplitude from beat to beat when the rhythm is nml. May suggest LV failure
Jugular Venous Distension
2 Types of Murmurs
Stenotic Valve
Insufficient Valve
Regurgitation
The Valvular abnormalities create turbulent flow and cause abnormal heart sounds
4 types of Murmurs
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
Creatine Kinase
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.
Troponin
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)
B type Natretic Peptide
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
EKG
graphic recording of the electrical signals created by the heart
PQRST Waves of EKG
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
Trans-Esophageal Echocardiogram (TEE)
More Invasive than Transthoracic Inadequate trans-thoracic views Aortic Disease Infective Endocarditis Source of embolism Valve Prosthesis Intraoperative
Echocardiography
Uses ultrasound technology to visualize the heart. TRANSTHORACIC
