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Intro to Cards Flashcards

1. Understand how components of the history and physical relate to making a diagnosis of cardiovascular disease, including ROS, family and social history 2. Outline the blood flow to and through the heart 3. Be familiar with the structure and function of the cardiovascular system to better understand - Acute coronary syndromes 4. Understand the concepts of preload and afterload 5. Summarize the cardiac cycle 6. Classify and be able to discuss the various heart sounds, including murmurs and

1
Q

Common symptoms of Heart Issues on an HPI

A
  1. Chest Pain (with or without exertion?)
  2. Dyspnea (with or without exertion?)
  3. Palpitations
  4. Pre-syncope
  5. Syncope
  6. Lower Extremity Edema
  7. Orthopnea/Paroxysmal Nocturnal Dyspnea
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2
Q

What may syncope be indicative of?

A

Hypertension or Heart Failure

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3
Q

What are you going to ask for in a Past Medical History important to know for Cardiology?

A
  1. Previous Intervention (CABG, Stent/Cath, Stress Test, Echo)
  2. Pacer
  3. Defibrillator
  4. Risk Factors
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4
Q

What are the risk factors for heart issues in a patient?

A
  1. Age over 45 men; over 55 in women
  2. HTN
  3. Dyslipidemia
  4. Early CAD in the family (before 55 in men; before 65 in women)
  5. Tobacco
  6. Obesity
  7. Inactivity
  8. PAD, Stroke, Renal Failure
  9. Vasculature Disease
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5
Q

What is the name of the test that can calculate the 10-year risk for MI and death from CAD?

A

Framingham Risk Assessment

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6
Q

What is CAD?

A

Coronary Artery Disease

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7
Q

What are some factors that we can try to “control” to reduce risk in patients?

A
  1. Lowering LDL
  2. Raising HDL
  3. Smoking Cessation
  4. Controlling elevated BP
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8
Q

What are the important social history intake that could indicate or worsen heart disease?

A
  1. Tobacco
  2. Alcohol
  3. Drugs
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9
Q

What Family History is important?

A
  1. CAD
  2. Stroke
  3. DM
  4. HTN
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10
Q

What recreational drugs can cause severe or are more likely to cause heart issues?

A

Cocaine

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11
Q

What are the pertinent ROS for Cardiac patients?

A
  1. CP, CPOE
  2. Dyspnea, DOE
  3. Palpitations
  4. Syncope
  5. Edema
  6. Orthopnea/PND
  7. Weight
  8. Diet
  9. Salt/Fluid Intake
  10. Exercise/Activities
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12
Q

What is important in the Physical Exam for Cardiac Patients?

A
  1. Point of Maximal Impulse, Lift
  2. Jugular Venous Pulsations
  3. Hepatojugular Reflux (may be found in Right Ventricle Heart Failure)
  4. Pulses
  5. Edema
  6. Heart Sounds (S1, S2, S3, S4)
  7. Murmurs (systolic or diastolic)
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13
Q

Xanthelasma, Bruits, Diminished Peripheral Pulses

Indicative of what disease?

A

Artherosclerosis

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14
Q

Murmurs, Displaced Position of Maximal Impulse, Thrill, Lift

Indicative of what disease?

A

Structural Heart Disease

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15
Q

Increased Jugular Venous Pulsations, S3, S4, Hepatojugular Reflux, Edema, Rales.

Indicative of what disease?

A

Heart Failure

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16
Q

What is the physiology of a S1 that creates a sound?

A

Closure of the Mitral and Tricuspid Valves

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17
Q

Closure of the aortic and pulmonic valves would be what Sound?

A

S2 Sound

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18
Q

Represents blood flow into a ventricle, may be benign, may represent pathology. More of a “Sloshing in” sound.

A

S3

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19
Q

Represents atrial contraction against a non-compliant ventricle. More of a “Stiff wall” sound.

A

S4

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20
Q

In a common healthy person, which sounds can you hear?

A

S1 and S2

S3 is sometimes a normal physiology in younger kids. Check book for age cut off? 40?

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21
Q

MR PASS

MS ARD

A 
Mitral
Regurgitation
Physiologic (also known as functional, systolic flow murmur, a heart murmur heard in the absence of cardiac abnormality)
Aortic
Stenosis
Systolic (These are all systolic)

Mitral
Stenosis
Aortic
Regurgitation
Diastolic (These are all diastolic)
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22
Q

What is do MR. PASS and MS. ARD do?

A

Determining between systolic and diastolic murmur.

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23
Q

What represents abnormal blood flow across normal cardiac structures or normal blood flow across abnormal cardiac structures?

A

Murmurs

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24
Q

Grade this murmur!

Very loud murmur, may be heard posteriorly

A

Grade 5

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25
Q

Grade this murmur!

Murmur of medium intensity (faint murmur but can be easily identified)

A

Grade 2

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26
Q

Grade this murmur!

Loud murmur with a THRILL (but you aren’t feeling for a thrill wink wink)

A

Grade 4

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27
Q

Grade this murmur!

Barely audible murmur

A

Grade 1

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28
Q

Grade this murmur!

Murmur audible with stethoscope off the chest

A

Grade 6

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29
Q

Grade this murmur!

Loud murmur without a thrill (moderately loud murmur)

A

Grade 3

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30
Q

What grades of murmurs are most commonly heard?

A

Grades 2 and 3

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31
Q

What are the 4 most important tests completed for cardiac patients?

A
  1. CK (Creatinine Kinase)
  2. CK-MB
  3. Troponin I or T
  4. BNP (Brain Natriuretic Peptide)
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32
Q

This enzyme is found in skeletal muscle, cardiac muscle, and the brain.

This enzyme will begin to rise 4-8 hours after muscle damage and peaks in about 24 hours. These levels will return to normal after 3-4 days.

A

Creatinine Kinase (CK)

33
Q

This enzyme is found primarily in cardiac muscle but also in skeletal muscle

After muscle damage, this will begin to rise in 3-12 hours with a peak in 24 hours and will return to normal in 2-3 days.

A

Creatinine Kinase - MB

34
Q

This enzyme is found in the cardiac muscle. It is the most specific and sensitive biomarker for cardiac injury.

After muscle damage, it will begin to rise within 3-12 hours, peaks in 24 hours, and will return to normal in 5-10 days.

A

Troponin I or T

35
Q

This enzyme is found in very high concentrations in the cardiac ventricles. It is released under strain/stress of the ventricles and can be indicative of heart failure..

A

BNP (Brain Natriuretic Peptide)

36
Q

Why do we check cardiac markers at 0, 6, and 12 hours after Chest Pain?

A

Because you want to compare the enzymes are the different times that it can “onset” if you suspect heart issues (MI, etc.)

37
Q

What are the two types of Echocardiogram?

A
  1. Trans Thoracic

2. Trans Esophageal

38
Q

This type of echocardiogram evaluates cardiac function, including LVEF, valvular function, and filling pressures. It may also reveal heart abnormalities.

A

Trans Thoracic

39
Q

This type of echocardiogram allows for a higher resolution because of the positioning of the transducer. Gives an excellent view of the left atria and aorta.

A

Trans Esophageal

40
Q

What is a stress test?

A
  1. A way to stress the heart with exercise or medication

2. Imaging (ECG, Echo, Nuclear)

41
Q

This type of stress test makes the patient exercise on a treadmill or bike using protocal of increased workload. Then you will perform a EKG, Echo, or nuclear perfusion is used as imaging.

A

Exercise Stress Test

42
Q

This type of stress test includes giving the patient a medication (because there is a lack of physical activity). Then a perfusion imaging is used to evaluate the coronary arteries

A

Pharmacologic Stress Test

43
Q

What are the two common medications used in a pharmacologic stress test?

A
  1. Adenosine

2. Dobutamine

44
Q

What is adenosine?

A

Vasodilator

45
Q

What is Dobutamine?

A

An inotropic agent

46
Q

When would we order a Stress Test?

A

Patients who have typical cardiac chest pain but no EKG or enzyme markers of a blocked artery.

OR

Patients who have an atypical chest pain complaint but lots of risk factors for CAD

47
Q

What are we trying to find by completing a Stress test?

A

We are trying to identify the risk for a MI in hopes to modify the risk or perhaps we can open up arteries if there is a complete blockage.

48
Q

What do you do in a cardiac cath?

A

Access the femoral or brachial artery to visualize the heart chambers and coronary vessels.

49
Q

How do you visualize the arteries in a cardiac cath?

A

Contrast Dye

50
Q

Where can you access the vessels in a cardiac cath?

51
Q

What can be completed in a cardiac cath that can aid in reducing risk of further MIs/Heart Issues?

A

PTCA (Percutaneous transluminal coronary angioplasty)

Also called a balloon

52
Q

What is the order of the conduction of the heart?

A 
SA Node
AV Node
Bundle of His
Left and Right Bundles
Perkinje Fibers
53
Q

What is the function of the SA Node?

A

Natural Pacemaker

Rate of 60-100 bpm

54
Q

What is the function of the AV Node?

A

Upon failure of the SA node, the AV node will pick up the pacing rate.
Rate of 45-50 bpm

55
Q

What is the function of the Bundle of His?

A

Rate between 40-45 bpm

56
Q

What is the left and right bundles?

A

Fascicles!

Rate of 40-45 bpm

57
Q

What is the function of the Perkinje fibers?

A

Rate between 35-40 bpm

58
Q

Blood flow of the Heart

A
  1. Superior & Inferior Vena Cava : deoxygenated blood from body to R atrium.
  2. R atrium –> tricuspid valve –> R ventricle
  3. R ventricle –> pulmonary artery –> lungs
  4. Lungs –> pulmonary vein –> oxygenated blood to L atrium
  5. L atrium –> mitral valve –> L ventricle –> aorta
  6. Aorta carries oxygenated blood to body
59
Q

Understand the Basic ECG Waveform

A

Look at the image, be sure to understand!

60
Q

What does a P wave represent?

A

Atrial Depolarization

61
Q

What does the ST segment represent?

A

Electrically neutral period between ventricular depolarization and repolarization – should be at baseline.

62
Q

What does the T wave represent?

A

Ventricular Repolarization

63
Q

What does the QRS complex represent?

A

Ventricular depolarization

64
Q

Ventricular Contraction is what phase of the cardiac cycle?

65
Q

Ventricular Relaxation/Filling

66
Q

What occurs during Systole?

A

Aortic Valve Opens
Mitral Valve Closes
Blood flows from the L. ventricle into the aorta

67
Q

What occurs during Diastole?

A

Aortic Valve Closes
Mitral Valve Opens
Blood flows from the L. atrium to the L. ventricle

68
Q

What is the equation for Cardiac Output?

A

CO = HR x SV

69
Q

The amount of blood ejected from the _______ contraction would be called?

A

Ventricular Contraction

Cardiac Output

70
Q

What determines the cardiac output?

A
  1. Preload
  2. Afterload
  3. Contractility
71
Q

What is the preload in cardiac output?

A

Amount of blood in the ventricle at the end of diastole.

Represents venous return

72
Q

What is the afterload in cardiac output?

A

Force opposing ventricular contraction

Systemic Vascular Resistance

73
Q

The volume of blood pumped from one ventricle of the heart with each beat.

A

Stroke Volume

74
Q

What clinical situations/correlations can affect the Cardiac Output?

A
  1. Beta Blocker (relaxes the heart)
  2. Anemia
  3. Stiff Heart
  4. Sinus tachycardia
75
Q

When are the coronary arteries supplied with new blood?

A

During diastole

76
Q

The coronary arteries are ________ during systole

A

Constricted/Compressed

77
Q

Where do the coronary veins drain into?

A

Coronary Sinus in the Right Atrium

78
Q

KNOW the coronary arteries and what ventricles of the heart they feed

A

Look at Powerpoint!!!!

79
Q

What are the two main arteries that feed the left ventricle? Where do they come from?

A
  1. LAD Artery
  2. Circumflex Artery

Left Main Coronary Artery

Cardiology Medicine (13 decks)

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