Exam 1 (cardio) Flashcards
RHF: Signs
syncope, ascites
LHF: Signs
syncope, dyspnea, cough
What is normal BP?
120/80
T/F: Inc. body temp. is indicative of heart failure
False.
“Dec.” body temp is indicative of heart failure.
Tachycardia: Indications
fear, pain, heart failure
Bradycardia: Indications
sleep, parasympathetic tone
What do you pay attention to when taking the pulse?
Rate, Rhythm, Quality
Hypokinetic Pulse: Indications
heart failure, stenosis, shock, effusion
Hyperkinetic Pulse: Indication
exercise, anemia, shunts
Respiration: Crackles - indication
fluid in lungs
Respiration: Wheezes - indication
inflammation of the lungs
What causes the S1 heart sound?
AV valves closing
What causes the S2 heart sound?
the pulmonic and aortic valves closing
What causes the S3 heart sound?
the passive filling of the ventricles (can be heard with dilated cardiomyopathy)
What causes the S4 heart sound?
the forced refilling of the ventricles (can be heard with hypertrophic cardiomyopathy)
What are causes for murmurs?
narrowing of a vessel, valvular insufficiency, inc. rate of flow, dec. viscosity
What are Radiographs used to look at in the CV system?
lungs, pleural space, and pulmonary vessels
What is Ultrasound used to look at in the CV system?
heart size, thickness, shape, function, and valves
What is ECG used to look at in the CV system?
arrhythmias
What are Angiograms used to look at in the CV system?
blood vessels for stenosis/clots
What is Phonocardiograms (PCG) used to listen for?
murmurs and heart sounds
What is the normal conduction pathway in the heart?
SA node -> AV node -> Bundle of His -> L/R AV Bundle Branches -> Purkinje Fibers
Where are the ECG leads placed?
black - FL
white - FR
red - BL
green - BR
ECG: Artifacts
interference, shivering, breathing, purring
ECG: Interference - Appearance
small, rapid, regular flux
ECG: Shivering - Appearance
large, rapid, irregular flux
ECG: Breathing - Appearance
wide tan() like lines
ECG Paper: Measurements
1 sq. = 1mm; 1cm H = 1mV
ECG: Determining HR
60 x (# of R-waves on strip/ # of sec. on strip)
What is the Mean Electrical Axis?
avg direction of activation of ventricular myocardium
Mean Electrical Axis: Normal Values
70-90
90
ECG: Normal P-wave Dimensions
0.04sec x 0.3mV
ECG: P-wave Abnormalities
inc. time (mound) = L. atrial enlargement (mitral (side))
inc. mV (peak) = R. atrial enlargement (pulmonic (side))
ECG: Normal QRS Complex Dimensions
0.04-0.08sec x 2.5-3mV
ECG: QRS Complex Abnormalities
inc. mV +/ time = L. ventricular enlargement
large S-wave = R. ventricular enlargement
ECG: R. Bundle Branch Block - Appearance
deep S, prolonged QRS, dec. R mV
ECG: L. Bundle Branch Block - Appearance
prolonged QRS, normal R
ECG: Low Voltage Complexes - Appearance
QRS complexes are
ECG: Low Voltage Complexes - Causes
obesity, pleural/pericardial effusion, pneumothorax
ECG: Normal S-T segment
within 1.5-2mm of baseline before QRS complex
ECG: Normal Q-T segment Length
inversely proportional to HR, changes with Ca/K
ECG: Normal T-wave Height
Bradyarrhythmia: Wandering Atrial Pacemaker - Cause
P-waves from outside the SA node
Bradyarrhythmia: Wander Atrial Pacemaker - Appearance
variable P-wave morphology, variable P-R interval
Bradyarrhythmia: Sinus Arrest - Cause
failure of SA node to beat
Bradyarrhythmia: Sinus Arrest - Appearance
QRS complexes w/o a P-wave (escape beats)
Bradyarrhythmia: Hyperkalemia - Appearance
tall T-waves, missing P-waves, prolonged QRS complexes
Bradyarrhythmia: AV Block - Cause
delay/failure of transmission at the AV node
Bradyarrhythmia: AV Block - 1st Degree
delayed transmission; prolonged P-R interval
Bradyarrhythmia: AV Block - 2nd Degree Mobitz Type I
intermittent failure of conduction; increasing P-R interval until missing QRS commplex
Bradyarrhythmia: AV Block - 2nd Degree Mobitz Type II
intermittent failure of conduction; no P-R interval changes before QRS complex is missing
Bradyarrhythmia: AV Block - 3rd Degree
no conduction through AV node; P-waves w/ escape beats
Bradyarrhythmia: Sick Sinus Syndrome - Cause
abnormal SA node + AV system
Bradyarrhythmia: Sick Sinus Syndrome - Appearance
intermittent Sinus arrest +/ AV block
Tachyarrhythmia: Superventricular Premature Depolarization - Cause
ectopic pathway in atria
Tachyarrhythmia: Superventricular Premature Depolarization - Appearance
premature P-waves (poss. hidden in T-wave), normal QRS
Tachyarrhythmia: Ventricular Premature Depolarization - Cause
ectopic focus in ventricle
Tachyarrhythmia: Ventricular Premature Depolarization - Appearance
premature, prolonged, bizarre QRS complexes, no P-wave;
if (+) R-wave, ectopic focus is in R. ventricle
if (-) R-wave, ectopic focus is in L. ventricle
Tachyarrhythmia: Ventricular Premature Depolarization - Fusion Beat
combo of normal and ectopic beats
Tachyarrhythmia: Ventricular Tachycardia - Appearance
4+ VPD’s in a row
Tachyarrhythmia: Atrial Fibrillation - Cause
multiple ectopic foci
Tachyarrhythmia: Atrial Fibrillation - Appearance
no P-waves, normal QRS complexes, random R-R interval
Heart Failure: LCHF - Signs
Hypotension - pale mm, inc. CRT, HR; dec. pulse pressure, weakness, syncope, azotemia
Pulmonary Edema - dyspnea, coughing, tachypnea, exorcise intolerance, cyanosis
Hear Failure: RCHF - Signs
ascites, distended jugular veins, hepatosplenomegally, pleural effusion, hypotension
Heart Failure: Phase I
dz but no signs
Heart Failure: Phase II
cough, dyspnea/ exorcise intolerance
Heart Failure: Phase III
cough, dyspnea/orthopnea at night, exorcise intolerance
Hear Failure: Phase IV
cough, dyspnea, cyanosis at rest
Heart Failure: Stage A
high risk, but no dz
Heart Failure: Stage B1
structural dz, but no signs and normal rads and echo
Heart Failure: Stage B2
structural dz, but no signs, L. heart enlargement
Heart Failure: Stage C
past/current clinical signs of failure
Heart Failure: Stage D
End-stage dz
Heart Failure: Precautions
handle w/ care, oxygenate, reduce edema (diuretics), dec. preload (venodilators), dec. afterload (ACE inhibitors), inc. contractility (digoxin, pimobendan), restricted NA diet (kidney/geriatric)
Patent Ductus Arteriosus: Definition
duct connecting the pulmonary artery and the aorta
PDA: Dx - Radiographs
enlarged LA + LV, angiography
PDA: Dx - U/S
Enlarged LA + LV, doppler
PDA: Tx
surgery, embolization coil
Aortic Stenosis: Definition
band of fibrocartilage neart the aortic valve => LV hypertrophy
Aortic Stenosis: Effects
inc. afterload; dec. diastolic filling, output; hypoxia, arrhythmia, mismatched pulse (hypotonic), stenotic murmur
Aortic Stenosis: Dx - Radiographs
poss. LV hypertrophy, post stenotic aortic dilatation
Aortic Stenosis: Dx - U/S
thickened wall, narrowing near aortic valve, doppler, M-mode
Aortic Stenosis: Tx
symptomatic, dec. BP (B-blocker), control CHF, surgery
Pulmonic Stenosis: Definition
valvular dysplasia (thickening +/ fusion)
Pulmonic Stenosis: Effects
R. hypertrophy, arrhythmia, murmur, poss. uneven hypertrophy, turbulence => dilatation
Pulmonic Stenosis: Dx - Radiographs
enlarged R. heart, pulmonary trunk dilation, angiogram
Pulmonic Stenosis: Dx - U/S
doppler, appreciate valves
Pulmonic Stenosis: Tx
balloon valvuloplasty, patchgraft valvulplasty
Ventricular Septal Defect: Definition
a hole in the intraventricular wall
Ventricular Septal Defect: Effects
Volume overload => eccentric hypertrophy + dilatation (R. side too if defect is low); murmur
T/F: The louder the murmur, caused by VSD, the worse the prognosis.
False.
The louder the murmur, the better the prognosis. B/c it’s a smaller hole.
Ventricular Septal Defect: Dx - Radiographs
enlarged LV + LA, enlarged pulmonary vessels
Tetrology of Fallot: Definition
pulmonic stenosis, overiding aorta (aorta goes around pulmonary artery), VSD, enlarged RV
Tetrology of Fallot: Effects
cyanotic (in front and back), erythrocytosis, murmur (softens with inc. viscosity)
Tetrology of Fallot: Dx - Radiographs
dec. pulmonary vessel size, dilated pulmonary artery, angiogram
Tetrology of Fallot: Dx - U/S
doppler, identify defects and stenosis
Tetrology of Fallot: Tx
surgery
Dilated Cardiomyopathy: Definition
enlargement of LV
Dilated Cardiomyopathy: Signs
wt. loss, atrial fib, VPD, V-tach, LCHR +/ RCHF
Dilated Cardiomyopathy: Dx - Radiographs
globous heart
Dilated Cardiomyopathy: Dx - U/S
M-mode, doppler
Dilated Cardiomyopathy: Dx - ECG
atrial fib, VPD, V-tach
Dilated Cardiomyopathy: Tx - Early Phase
monitor
Dilated Cardiomyopathy: Tx - Occult Phase
ACE inhibitor, pimobendan, B-blockers, treat arrhythmias
Dilated Cardiomyopathy: Tx - Classic Phase
furosimide, ACE inhibiters, pimobendan, restricted Na diet
Dilated Cardiomyopathy: Tx - Severe (Hospitalized) Phase
O2, drain any fluid, furosimide, dobutamine/pimobendan, restricted Na diet, ACE inhibiter
Hypertrophic Cardiomyopathy: Definition
Thickening of the LV wall
Hypertrophic Cardiomyopathy: Signs
syncope, dyspnea, paresis (saddle thromus), steroids/stress, L-CHF, poss. murmur, focal retinal degeneration
Hypertrophic Cardiomyopathy: Dx - Radiographs
valentine shaped, enlarged LA, angiogram (shrunken LV space)
Hypertrophic Cardiomyopathy: Dx U/S
wall thickness
Hypertrophic Cardiomyopathy: Tx
nothing, treat failure accordingly; B-blockers help heart to fill more
Arrythmogenic RV Cardiomyopathy: Definition
fibrosis, inflammation, +/ fat infiltration of the RV
ARVC: Forms
Concealed - no signs
Overt - signs present
myocardial dysfunction - severe case
ARVC: Signs
weakness, syncope, R/L-CHF, VPD
ARVC: Dx
postmortem
ARVC: Tx
symptomatic, sotalol, carnitine?, Omega-3
Myxomatous AV Valvular Degeneration: Definition
callogen abnormality of the LAV valve => dysfunction, ruptured cordea tendonea
Myxomatous AV Valvular Degeneration: Syndromes
little regurge - asymptomatic, inc. LA, coughing
large regurge - L-CHF, coughing
Myxomatous AV Valvular Degeneration: Signs
asymptomatic, cough, acute/chronic LHF (exercise intolerance, syncope, dyspnea, tamponade, systolic murmur (clicking sound), crackles
Myxomatous AV Valvular Degeneration: Dx - Lab
inc. BUN, Crea, liver enzymes
Myxomatous AV Valvular Degeneration: Dx - Radiographs
enlarged LA
Myxomatous AV Valvular Degeneration: Dx - U/S
thickened/prolapsed valves, enlarged LA, doppler
Myxomatous AV Valvular Degeneration: Tx
Symptomatic, CHF; arteriodilators - dec. resistance in the aorta making it the path of least resistance
Endocarditis: Definition
bacterial infection of the endocardium (often the aortic valve)
Endocarditis: Causative agents
Bartonell, Staph, Strep, E. coli, Corynebacterium, pseudomonas
Endocarditis: Effects
CHF, dysrrhythmia, septic emboli, polyarthritis, glomerulonephritis
Endocarditis: Signs
infection (source of bact), intermittent malaise, wt. loss, shifting lameness, fever, murmur (sudden, loud), bounding pulse, poss. renal/neuro signs
Endocarditis: Dx - Lab
infection leukogram, anemia, thrombocytopenia, PCR
Endocarditis: Dx - U/S
irregular valve
Endocarditis: Dx - Radiographs
CHF signs w/o enlarged heart
Endocarditis: Tx
symptomatic, antibiotics
Pericardial Effusion: Definition
inc. fluid in the pericardial sac,
Pericardial Effusion: Signs
lethargy, dyspnea, syncope, wt. loss, ascites, vomiting, pale mm, inc. CRT, muffled heart sounds
Pericardial Effusion: Dx - Radiology
round heart (smooth edges)
Pericardial Effusion: Dx - U/S
appreciate pericardial effusion
Pericardial Effusion: Dx - Lab
nRBCs, pericardioscentesis
Pericardial Effusion: Tx
balloon, pericardiotomy