CVS Flashcards by Arwa Elbaghdady

What does the ECG represents?
P wave..
QRS Complex..
T wave..
U wave..
Q-T interval..

P wave-Atrial depolarization
QRS Complex-Ventricular depolarization
T wave-Ventricular repolarization
U wave-last renin any of ventricular repolarization (papillary muscles)
Q-T interval-Ventricular depolarization and repolarization (ventricular action potential)

How well did you know this?

Not at all

Perfectly

When do the following abnormal waves appear?
U wave..
J wave..
Delta wave..

U wave-Hypokalemia
J wave-Hypothermia
Delta wave-WPW syndrome

How well did you know this?

Not at all

Perfectly

What are the ECG changes caused by Hypercalcemia?

Short QT

How well did you know this?

Not at all

Perfectly

What are the ECG changes caused by Hypocalcemia?

Long QT

How well did you know this?

Not at all

Perfectly

What are the ECG changes caused by Hyperkalemia?

Small p, tall T, wide QRS

How well did you know this?

Not at all

Perfectly

What are the ECG changes caused by Hypocalcemia?

Small p, flattened or inverted T, prolong PR, U wave

How well did you know this?

Not at all

Perfectly

How does the Cardiac ischemia appear in the ECG?

ST elevation

Anteroseptal-V1-V4
Septal V1,V2
Anterior V3,V4
Lateral 1,aVL, V5,V6
Inferior 2,3,aVF

How well did you know this?

Not at all

Perfectly

How is pulmonary embolism characterized in the ECG?

Inverted T in V1-V3, tachycardia

(S1,QT3)
Depressed S in lead 1, Q wave, inverted T in lead 3

How well did you know this?

Not at all

Perfectly

What is the investigation of choice in pulmonary embolism?

CT pulmonary angiography

How well did you know this?

Not at all

Perfectly

What is the treatment of pulmonary embolism?

If non massive stable:
-Pleurisy chest pain, hemoptysis, cyanosis and low grade fever.
Ttt: IV anticoagulant as heparin or LMWH

If massive unstable:
-Tightness of chest, severe cyanosis, congested neck veins and shock.
Ttt: Thrombolysis or embolectomy

If recurrent regardless the regular use of anticoagulants:
Ttt: Vena cava filter

How well did you know this?

Not at all

Perfectly

How is heart block characterized in the ECG?

P wave and QRS complex are not correlating + Bradycardia

How well did you know this?

Not at all

Perfectly

When may heart block happens and what is the treatment?

May occur after aortic valve replacement

Treated by urgent pacing and if the patient is unstable/intraoperative—atropine

How well did you know this?

Not at all

Perfectly

What is the importance of JVP and when do we have non-pulsatile JVP?

It cause information on the right atrial pressure and is seen in SVC obstruction

How well did you know this?

Not at all

Perfectly

What does the waves of the JVP represent?

A-Atrial contraction
X-Atrial relaxation
V-Venous return
Y-Atrial emptying

How well did you know this?

Not at all

Perfectly

What are the abnormalities of “a” wave?

1-Raised- tricuspid stenosis, pulmonary stenosis, pulmonary hypertension
2-Absent-Atrial fibrillation
3-Cannon “a” wave-Atrial contraction against closed tricuspid valve in heart block

How well did you know this?

Not at all

Perfectly

What are the abnormalities of “V” wave?

Gaunt V wave occurs in tricuspid regurgitation

How well did you know this?

Not at all

Perfectly

What is the C wave in JVP?

Closure of cusps of the AV valves (Tricuspid)

How well did you know this?

Not at all

Perfectly

What are the valves formed of?

Dense fibrous tissue

How well did you know this?

Not at all

Perfectly

What is the characteristics of aortic stenosis and calcification?

Both have ejection systolic murmur but;

-Aortic stenosis: propagates to the carotid and in any age
-Aortic calcification: doesn’t propagate and affects old age mainly

How well did you know this?

Not at all

Perfectly

What is the incisura?

It corresponds to the elastic recoil of the aorta at aortic pressure curve.

How well did you know this?

Not at all

Perfectly

In which phase of the cardiac cycle does the tricuspid valve close?

Isovolumic contraction

How well did you know this?

Not at all

Perfectly

What are the murmurs of;
AR
MS
AS
MR

AR-Early diastolic
MS-Mid diastolic
AS-Ejection systolic
MR-Pan systolic

How well did you know this?

Not at all

Perfectly

What is COP?

COP=Stroke volume(70ml/beat)*heart rate (70beat/minute)=5-6L/minute

What happens to the COP when the venous return increase?

⬆️Cardiac preload or atrial filling or EDV which ⬆️COP

What is the effect of positive intrathoracic pressure on VR?

⬇️Venous return

What are the effects of tachycardia on coronary filling?

Coronary flow occurs mainly during diastole so pathological tachycardia decrease diastolic time (interval) which ⬇️coronary filling and causes angina/ischemia&chest pain

Contraction is triggered by the influx of … through the …

Calcium Sarcolemma

What is cerebral perfusion pressure?

CPP=MAP (diastolic pressure + 1/3 of the pulse pressure)-ICP Example: MAP=110/80 CPP=80+1/3(110/80)=90

Cerebral blood flow to the brain is about … from COP

15%

What is the affect of hyperventilation on cerebral circulation?

Hyperventilation ⬇️ PCO2 which ⬇️ ICT (Because the ⬆️CO2 causes cerebral VD)

What is the Cushing triad? (Related to head injury)

⬆️BP + ⬇️HR +⬇️RR عكس أي trauma

What happens in BP in response to increased intracranial pressure?

⬆️BP in response to increased intracranial pressure cause sympathetic vasoconstriction

What happens to HR in response to baroreceptors stimulation in Cushing triad?

⬇️HR in response to baroreceptors stimulation to parasympathetic stimulation or sympathetic inhibition

What are the types of shocks?

⬆️systemic vascular resistance (Cardiogenic shock+Hemorrhagic shock) ⬇️systemic vascular resistance (Septic shock+Neurogenic shock+ Anaphylactic shock)

What is the difference between between cardiogenic shock and hemorrhagic shock?

Cardiogenic shock: ⬇️BP and ⬆️JVP Hemorrhagic shock: ⬇️BP and ⬇️JVP

What is the triad of cardiac tamponade?

Beck triad (⬇️BP, ⬆️JVP, muffled heart sound)

What is this difference between septic shock and neurogenic shock?

Septic shock: ⬆️or normal COP and HR Neurogenic shock: ⬇️COP and HR

What is the treatment of Anaphylactic shock?

Adrenaline IM then SC

How is SIRS diagnosed?

2 or more of these criteria: -Respiratory rate>20 (pco2 <4.5) -Heart rate> 90 -Temperature <36 or >38 -TLC <4 or >12

How is sepsis diagnosed?

Documented infection + 2 or more of the SIRS criteria

How is sever sepsis diagnosed?

Sepsis with organ affection

What is the difference between severe sepsis and septic shock?

Severe sepsis is Sepsis with organ affection but septic shock is sepsis with refractory hypotension

What is the clinical picture of septic shock and how is it diagnosed?

It is shock with warm peripheries and treated by noradrenaline mainly and C-protein may be used

What is the nervous response to shock?

Baroreceptors is the first thing to be affected in shock to correct it. Baroreceptors are usually stimulated to maintain the BP (para sympathetic) But when inhibited it stimulates the sympathetic system to ⬆️BP

What is the hormonal response to shock?

-Renin angiotensin aldosterone system ⬆️BP -Cortisol ⬆️BP -ADH or vasopressin ⬆️BP -Adrenal medulla secreted mainly adrenaline ⬆️BP

What are the differences between adrenaline and noradrenaline?

Nor adrenaline is secreted after sympathetic stimulation from synapses between nerves which is more powerful Adrenaline is secreted from the adrenal medulla in the blood and stimulated by sympathetic stimulation

Give examples of vasodilator agents?

Histamine PGE1 and PGE2 Nitric oxid ANP

Give examples of vasoconstrictor agents?

Serotonin Ephedrine Thromboxane A2 Angiotensin Vasopressin

Give example of an agent that is considered vasodilator and vasoconstrictor? (Dose dependent)

Dopamine Acts on the following receptors: (DOPA) D: dopamine receptor -VD P: B receptor -VD A: Alpha receptor -VC

What are the effects of the Andre ethic receptors? Alpha and Beta?

Alpha1: vasoconstriction Beta1:Increased cardiac contractility (positive inotropic) and increased heart rate (positive chronotropic)

Mention the following regarding noradrenaline; -Receptor -Action -Uses

-Receptor: Alpha receptor -Action: Vasopressor effect -Uses: Septic shock

Mention the following regarding adrenaline; -Receptor -Action -Uses

-Receptor: Alpha and beta agonist -Action: vasopressor effect and increases COP -Uses: Cardiac arrest

Mention the following regarding dobutamine and isoprenaline (isoproterenol) respectively: -Receptor -Action -Uses

-Receptor: Beta1 agonist/ Beta agonist -Action: Increase COP -Uses: Cardiogenic shock/ used in bradycardia after heart replacement

Mention the receptors, actions and uses of dopamine

Low dose: -D1 receptor (renal, cerebral, mesenteric and splanchnic vessels causing VD) -B1 receptor (on heart causes increase COP) High dose: -Alpha1 receptors (on blood vessels cause VC) Used in Cardiogenic shock

What are the receptors, actions and uses of milrinone (premaquor)?

Action: ⬆️phosphodiesterase inhibitors so increase cAMP, so ⬆️contractility (Short half life and act as vasodilator) Uses: Acute cardiac failure with decreased afterload

What are the receptors, actions and uses of Ephedrine?

Receptors: Alpha+Beta receptors Action: Vasopressor and increase COP Uses: used mainly in hypotension related to spinal anesthesia

What are the receptors, actions and uses of Metaraminol?

Receptors: Alpha1 agonist received in cannula*** Action: Vasopressor effect Uses: hypotension especially due to anesthesia