Cmc Flashcards
Signs and symptoms of aortic regurg or insufficiency ?
S2 murmur
Poor coronary artery perfusion Syncope Angina Wide pulse pressure Left ventricular hypertrophy Increased left ventricular diastolic volume
What murmur do you have with aortic regurg? Where do you hear it?
Blowing Diastolic murmur
Right sternal border and radiates to the apex
What is happening when you have an S 1 murmur?
Mitral and tricuspid regurg
Aortic and pulmonic stenosis
Also with ventricular septal defects
When do you hear an S2 murmur?
Aortic and pulmonic regurg
Mitral and tricuspid stenosis
When do you hear S4
Left ventricular diastolic heart failure
When would you get a wide pulse pressure
Aortic regurg or insufficiency Aortic stiffening Iron deficiency anemia Hyperthyroidism CAD
Why would you hear a systolic click?
Mitral prolapse
Signs and symptoms of mitral regurg
SOB Fatigue A fib Pulmonary hypertension Left ventricular insufficiency-pulmonary congestion leads to rr sided 💜 failure
What is the normal cardiac index
2.5-4.0 mmhg
What is the normal cardiac output
4.0-8.0
What is a normal CVP
2-6 mmhg
What is another term for CVP?
Right atrial pressure
What is a normal PAOP (wedge)?
8-12 mmhg
What is the normal pulmonary arterial pressure?
Systolic and diastolic
15-25 mmhg/ 8-15 mmhg
What are the weaning criteria for a vented pt?
FiO2 less than 0.5 or 50%
TV greater than 6 ml/kg
RR less than 25
Nif greater than 25 cm
What is lovanox used for
NSTEMI,
Unstable angina
DVT
What is streptokinase used for?
Acute arterial thrombus/emboli
What is alteplase (activase) used for?
Acute ischemic stroke or PE
What is reteplase (retavase) used for?
AMI when thrombolisis indicates
WhT drugs can increase digoxin levels?
Alprazolam Amiodarone Anti acids Verapamil Spiralactone
What drug class is digoxin?
Cardiac glycoside
What is a cardiac glycoside?
Inhibits the activity of ATpase that controls the movement of Ca, K+, Na in the heart muscle.
Holds Ca in the heart muscle to increase strength of contractions.
What does giving digoxin do ?
Holds Ca in the heart muscle for stronger contractions
Chronotropic
Positive inotrope
Slows electrical
Activity between the atria and the ventricule
When do they use digoxin?
CHF and afib
What is the concern about potassium levels while taking digoxin?
Low potassium in the body can give you digitalis toxicity
What is the normal range for dog levels?
0.5-2.0
For arrhythmia
0.5-0.9 for heart failure
Where is the blockage if you have elevations in leads II, III, AVF?
What vessel?
Inferior, RCA
Where is the infarct for EKG changes in v1-v6? Vessels?
Anterior septal
LAD or LCerc
Changes in lead 1, AVL, V5 V6?
Vessels?
Lateral wall
LAD or circ
What are the signs and symptoms of pulmonary valve stenosis?
Right heart failure
Peripheral edema, JDV, dyspnea on exertion light headedness
How does dobutamine work?
Increases contractility but causes vasodilation to decrease systemic vascular resistance.
What does dopamine do?
Increases contractility and increases SVR
What is the cause of restricted cardiomyopathy?
S-scar tissue build up
C-Chemotheropthy
A-amyloidosis
R-Radiation exposure of the chest
Idiopathic
Signs and symptoms of restricted cardiomyopathy
Shortness of breath (at first with exercise; but over time it occurs at rest)
Fatigue (feeling overly tired)
Inability to exercise
Swelling of the legs and feet
Weight gain
Nausea, bloating, and poor appetite (related to fluid retention)
Palpitations (fluttering in the chest due to abnormal heart rhythms)
What are hallmark values in restricted cardiomyopathy?
Elevated right atrial pressure
Left ventricular diastolic disfunction occurs…. which is associated with very high end diastolic pressures and moderate to marked atrial enlargement
Normal systolic function
What patients are at risk for developing contrast-induced nephropathy when admitted for a carotid arteriogram?
Hypovolemic
Anemic
Take metformin
Anti rejection meds (cyclosporine)
What sound do you hear with a VSD?
Pansystolic mid-high pitch at the left sternal boarder
What does Holotsystolic murmur mean?
A holosystolic murmur begins at the first heart sound (S1) and continue to the second heart sound (S2), as illustrated in the phonocardiogram. Typically high-pitched, these murmurs are usually caused by ventricular septal defect, mitral regurgitation or tricuspid regurgitation, as discussed below.
Where can you hear Holotsystolic murmurs?
Holosystolic murmurs can be auscultated over the left 3rd and 4th intercostal spaces and along the sternal border.
What heart soundnis made with a tricuspid regurg?
There is a loud, , pansystolic (holosystolic) murmur.
, rumbling,
diamond-shaped diastolic murmur.
Where can you hear a Tricuspid regurg?
Harsh systolic murmur,
the maximum intensity is heard at the left lower sternal border. In addition, the murmur intensity increases with inspiration.
What does PAOP measure?
Pulmonary capillary wedge pressure (PCWP) provides an indirect estimate of left atrial pressure (LAP).
Why measure PAOP?
severity of left ventricular failure and to quantify the degree of mitral valve stenosis.
What elevates left atrial pressure therefore elevating PAOP?
Left ventricular failure
Mitral stenosis
Mitral regurg
Aortic stenosis aortic regurg
How high does left atrial
Pressure have to be to start pulmonary edema?
above 20 mmHg,
What is Milrinone?
Inotrope and vasodilator
When do you use milrinone?
heart failure.
stroke volume and cardiac output are increased
a slight fall in mean systemic arterial pressure. Decr. SVR
coronary vasodilator
What murmur is heard with mitral valve stenosis?
Rumbling diastolic murmur loaders at the apex
What is heard with an aortic stenosis?
Musical systolic murmur loudest right sternal boarder
What is Wolff-Parkinson’s-white syndrome?
An extra electrical pathway between the atria and the ventricle
Signs and symptoms of pericarditis?
Sharp chest pain can radiate to left shoulder or neck
Feels better when lean forward.
What ekg changes do you see with pericarditis?
Diffuse ST elevation With an upward concavity
