Combank physio - heart Flashcards
What is the #1 cause of constrictive percarditis in developing countries?
TB
What is Kussmaul’s sign?
jugular venous distension upon inspiration
What is pulsus paradoxus?
Normal decline in systolic arterial pressure during inspiration (normal is < 10 mm Hg)
Constrictive pericarditis is associated with ….
fibrotic calcifications of the pericardium, Kussmaul’s sign, pulsus paradoxus
What is the x descent on right atrial pressure tracings?
follows the ‘c’ wave and occurs as a result of the right ventricle pulling the tricuspid valve downward during ventricular systole.
What is the y descent on right atrial pressure tracings?
corresponds to the rapid emptYing of the atrium into the ventricle following the opening of the tricuspid valve.
Constrictive pericarditis is associated with what sign on a right atrial pressure tracing?
the “W” sign - made up of exaggerated x and y descents
Define sinus bradycardia
Rate of less than 60 beats/min with P wave before every QRS, normal PR and QRS intervals, and normal P, QRS, and T waves
Define sinus tachycardia
Rate of more than 100 beats/min with P wave before everything QRS, normal PR and QRS intervals, and normal P, QRS and T waves
First degree AV block
PR interval greater than 200 msec with a P wave before every QRS, normal QRS interval, and normal P, QRS and T waves
Normal sinus rhythm
60-100 beats per minute
numbers to remember when determining rate
300, 150, 100, 75, 60, 50
Define cardiac index
Cardiac index (CI) is a haemodynamic parameter that relates the cardiac output (CO) to body surface area (BSA), thus relating heart performance to the size of the individual. CI = CO/BSA
What causes cardiogenic shock and what are the characteristics?
Caused by acute coronary syndromes, valvular dysfunctions, or cardiac tamponade. Characterized by pulmonary edema, high cardiac filling pressures, low cardiac index, and high systemic vascular resistance
What causes neurogenic shock and how do patients present?
Caused by spinal cord or CNS injury. Patients present with bradycardia and are hypotensive
What causes obstructive shock and how to patients present?
Caused by cardiac tamponade, pulmonary embolism, or a tension pneumothorax. Present with symptoms of septic shock, hypotension, tachycardia and low CO
What causes septic shock and how does it present?
Caused by an underlying infection. Characterized by hypotension, high cardiac output that becomes depressed as symptoms progress, low systemic vascular resistance and low cardiac filling pressures
How do patients with hypovolemic shock present?
low cardiac output, low cardiac index, high systemic vascular resistance, low cardiac filling pressures
What characterizes aortic stenosis?
crescendo-decrescendo systolic ejection murmur following an EJECTION CLICK, diminished and delayed carotid upstroke
What are the effects of sustained hand grip?
increase systemic vascular resistance, arterial pressure, CO and left ventricular volume and filling pressures
Hand grip is most useful in differentiating between what two heart murmurs?
aortic stenosis and mitral regurgitation
How does sustained hand grip effect aortic stenosis?
intensity decreases
How does sustained hand grip effect mitral regurgitation?
intensity increases
What are the effects of squatting?
increases venous return (preload), systemic vascular resistance (afterload) and arterial pressure
T or F; Squatting will increase virtually all murmurs except that of hypertrophic cardiomyopathy
T
What are the effects of abrupt standing?
decreases venous return
What type of murmurs increase in intensity with inspiration?
Righted sided murmurs (tricuspid/pulmonic) - inspiration draws blood out of the venous system and into the right side fo the heart
The straining phase (phase 2) of valsalva has what effects?
decrease venous return, right and left ventricular volumes, stroke volumes, MAP and PP.
Valsalva phase 2 diminishes the intensity of which murmurs?
Flow murmurs - aortic/pulmonic/tricuspid/mitral stenosis/regurgitation
Name the action – increases intrathoracic pressure, limits venous return back to the heart
valsalva maneuver
Which baroreceptors have a higher threshold pressure and are thus less sensitive?
aortic arch baroreceptors
What is Hering’s nerve?
nerve responsible for carrying the signals detected by the baroreceptors located in the carotid sinus to the vasomotor centers in the brain; part of cranial nerve IX
When does increases in the firing rate of Herings nerve occur?
when the blood volume exceeds the set point of 100 mmHg, in situations of volume overload
1st degree AV block can be caused by what two classes of antiarrhythmic drugs?
beta blockers (class II) and calcium channel blockers (class IV)
3rd degree AV block
no P wave gives rise to a QRS wave; there is complete disassociation between the atrial and ventricular signals
T/F vasopressin release will be increased in all states of shock
T
2nd degree AV block (Mobitz type I, Wenckebach)
PR interval becomes longer before every subsequent QRS until eventually a beat is dropped and the PR resets itself
T/F patients with 2nd degree AV block (Mobitz type I, Wenckebach) are usually asymptomatic
T
What cardiac drugs can cause 2nd degree type I AV block?
digoxin, calcium channel blockers, or beta blockers
A left bundle branch block will show what on EKG?
wide QRS complex and two R waves in V5 or V6
ST depressions are indicators of what?
myocardial ischemia that is not transmural
Abnormal Q waves indicate?
a transmural infection
ST elevations indicate?
acute transmural ischemia – found in Prinzmetals angina and MI
What are the effects of nitrates?
forms nitric oxide, which leads to venous dilation and decreased preload
Patients with which type of heart block will often progress to third degree heart block?
Mobitz Type II 2nd degree heard block b/c it is usually located below the AV node
a wave
positive wave that corresponds to atrial contraction
c wave
positive wave that occurs during right ventricular contraction
x- descent
negative wave that correlates to atrial relaxation and tricuspid closure
y-descent
negative wave that correlates to the passive emptying of the right atrium into the right ventricle
v wave
positive upsloping wave that correlates with right atrial filling in systole when the tricuspid valve is closed
When does an accentuated a wave occur?
when there is restricted filling of the right side of the heart
When does a giant v wave occur?
tricuspid regurgitation; blood refluxes back into the right atrium during systole
tricuspid valve listening area
lower left sternal border
What is the most common cause of tricuspid regurgitation?
Rheumatic heart disease
Mitral valve prolapse causes a murmur that
begins with a midsystolic click followed by a crescendo murmur
mitral valve prolapse is enhanced by?
squatting, hand grip, valsalva maneuver; all increases TPR
Right sided heart murmurs increase in intensity with …
inspiration - intrathoracic pressure is negative causing a “pulling effect” on the blood to move back to the right heart
Inverted T waves are seen in what types of patients?
patients with ischemic heart diseaes
in RBBB dual R waves are seen most commonly in which lead?
V1
non-specific ST segment and T wave changes are most common in patients with?
acute pulmonary embolisms
Gram negative septic shock is caused by?
lipid A portion of lipopolysaccharide
Characteristics of PVCs
wide QRS complexes which are not preceded by a P wave and are followed by a compensatory pause
Criteria to Dx a LBBB
heart rhythm supraventricular in orgin; QRS duration must be greater than 80ms (2 small blocks); there should be a QS or rS complex in lead V1; there should be a monophasic R wave in leads I and V6
Criteria to Dx RBBB
heart rhythm must originate above ventricles; QRS duration must be more than 80 ms (incomplete heart block) or more than 120 ms (complete heart block); there should be a terminal R wave in lead V1; there should be a slurred S wave in leads I and V6
