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Z - M2 Cardiology > M2 Cardiology Key Facts - Week 3 > Flashcards

M2 Cardiology Key Facts - Week 3 Flashcards

1
Q

Shock - Definition

A

Low tissue perfusion leads to cellular hypoxia and energy defect - usually with hypotension - compensation can delay hypotension onset.

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2
Q

Two Major Class of Shock (3 Types Each)

A

Low CO Shock - Cardiogenic, Obstructive, Hypovolemic

Disruptive - Low Resistance Shock - Sepsis, Neurogenesis, Anaphalaxis

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3
Q

Two Major Compensation Mechanisms for low CO Shock

A

Baroreceptors - Detect low BP - Decrease signal, decreases their parasymp stimulation + symp inhibition - Symp. Dominates - Increases CO and Vasoconstriction

RAAS - Low Kidney Perfusion - Activates Renin - AI - AII - Aldosterone - Vasoconstriction + Fluid Retention

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4
Q

Responses to Low CO Shock (Universal) - 3

A

1) Increased Vasoconstriction - Cold/Clammy
2) Metabolic Acidosis
3) Tachypnea

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5
Q

Cardiogenic Shock - Causes (4) + Major Signs/Symptoms (3)

A

Causes

1) #1 = Acute MI > 40% of Ventricle
2) Cardiomyopathy
3) Valve Disease
4) CHF

Major Symptoms - Pump Failure = Pulm. Overload

1) Pulm. Congestion with Rales/Wheezes + S3 and maybe S4
2) If RCA MI - Mitral Regurgitation
3) Cold/Clammy
4) JVD

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6
Q

Hypovolemic Shock - Causes (3) + Major Signs/Symptoms (3)

A

Causes - Loss of Volume/Plasma

1) Trauma/Surgery
2) GI Fluid Loss - Choleara
3) Plasma Loss via Burn Injury

Major Symptoms - Decreased Preload

1) Weak Thready Pulse + Narrow Pulse Pressure + Tachycardia
2) Weak/Cold/Clammy

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7
Q

Obstructive Shock - Causes (2) + Major Signs/Symptoms (3)

A

Causes - Restricted Venous Return

1) Cardiac Tamponade
2) Pneumothorax

Major Symptoms - Decreased Preload
Tamponade (4)
Becks Triad = Hypotension + Muffled Heart Sounds + JVD
Pneumothorax (2)
Trachea deviated to opposite side of pneumothorax + JVD + Absent breathe sounds

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8
Q

Hypovolemic vs. Cardiogenic Shock

A

Both Low CO - Hypovolemia has no lung/JVD Signs

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9
Q

Septic vs. Hypovolemic Shock

A

Septic has normal skin color because there is no vasoconstriction

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10
Q

Neurogenic Shock vs. Anaphylactic Shock

A

Neurogenic - Loss of Symp. Tone after SCI

Anaphylactic - Histime and Prsotagladin Vasodilation

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11
Q

Septic Shock - Causes (2) + Major Signs/Symptoms (3)

A 
Causes 
Bacteria signals (LPS etc.) induce massive vasodilation via NO with inability for CO to compensate

Major Symptoms

1) Hypotension less responsive to vasopressors (NE is best)
2) Reduced peripheral oxygen extraction
3) Not Cold/Clammy

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12
Q

Hypovolemic Shock vs. Obstructive

A

Obstructive with JVD vs. No JVD in Hypovolemic

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13
Q

Infectious Endocarditis - Common Causes (3)

A

1) 80% = Staph or Strep
2) Strep Viridans = Most Common Sub-Acute Cause
3) Staph Aureus = Most Common Acute Cause - IV Drug Users + Tricuspid

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14
Q

S. Aureus Endocarditis - 3 Keys

A

1) Acute Onset
2) IV Drug User
3) Tricuspid Involvement

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15
Q

Common Valves Infected by Endocarditis (3)

A

All Regurgitationn Murmurs

1) Aortic - 60%
2) Mitral - 35%
3) Tricuspid (S. Aureus IV Drug User)

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16
Q

S. Viridans Endocarditis - 2 Keys

A

1) Sub-Acute (Most Common)

2) Requires predisposed valve (e.g. via Rheumatic Fever or Artificial Valve)

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17
Q

Major Endocarditis Findings (6)

A

1) New Regurgitation Murmur
2) Unremitting Fever
3) Nail Bed Splinter
4) Roth Spot (Eye)
5) Janeway Lesions - Painless - Palm/Sole
6) Osler Nodes - Painful Fingertip Nodules

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18
Q

Olser Nodes vs. Janeway Lesions

A

Painful Fingertip Nodules vs. Painless on Palm

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19
Q

Peripheral Arterial Occlusive Disease - Basics and Comparison to CAD

A

Intermittent Claudication - Stable Angina
Rest Pain - Unstable Angina
Ischemic Limb - NSTEMI/STEMI

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20
Q

Peripheral Arterial Occlusive Disease - Most Common Causes (2) + Most Common Symptom (1)

A

Causes - Atherosclerosis + Emboli

Finding - Poor Healing Wounds (Low O2 Perfusion

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21
Q

Key for Intermittent Claudication (3) vs. Spinal Stenosis (3)

A

IC = Reproducible + No Discomfort when standing + relieved by rest
Spinal Stenosis - Variable + Discomfort with standing + Relieved when flexing the spine via sitting

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22
Q

Intermittent Claudication Pain + Associated Vessel (2)

A

Calf Pain - Superficial Femoral = Most Common

Thigh + Buttock with Erectile Dysfunction - Aortoiliac Area

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23
Q

Acute Limb Ischemia - 5 P’s

A

1) Pain
2) Pulseless
3) Paresthesias
4) Paralysis
5) Poiklytothermia (Feels Cold)

Most Common Cause = Emboli
Most Common Location = Femoral Artery Bifurcation

24
Q

Major Symptoms of Claudication (6)

A

1) Bruits (Renal, Femoral, Illiac
2) Decreased Distal Pulse
3) Decreased ABI (Ankle-Brachial Index) - Normal > 1 because of gravity
4) Atrophy of Calf Muscle
5) Thin Shinny Skin
6) Depedent Rubor - Redness that goes away on knee lifting

25
Q

3 Major Class of Heart Failure

A

Systolic - Reduced EF - Increased Afterload or Decreased Contractility
Diastolic - Preserve EF - Decreased Preload /Impaired Filling
Right Heart Failure

26
Q

Systolic Heart Failure Causes (5)

A

Reduced Contractility

1) MI/Ischemia
2) Chronic Valve Overload Valve Disease (Regurgitation) - Aortic or Mitral
3) Dilated Cardiomyopathy

Increased Afterload
Chronic HTN
Aortic Stenosis

27
Q

Diastolic Heart Failure Causes (4)

A

Reduced Filling

1) LVH - Stiff LV
2) Restrictive Cardiomyopathy
3) Cardiac Tamponade
4) Pericardial Constriction

28
Q

Right Heart Failure Causes (4)

A

1 = Left HF

Isolated Right HF - Pulm. Issue
COPD 
Chronic Chroncitis 
Smoking
Primary Pulm. HTN (PE + Right MI)
29
Q

Compensation for CHF - Low Perfusion Pressure Response (4)

A

1) Increase RAAS - Volume Overload + Cardiac Remodeling
2) Increase Contracility (Symp. via Baroreceptors)
3) Increase ADH
All good at first but make it worse later - Volume Overload + high SVR

30
Q

Symptoms of Left Heart Failure (3)

A

1) Dyspnea (Pulm. Congestion)
2) Orthopnea/PND
3) Fatigue (Low Perfusion

31
Q

Symptoms of Right Heart Failure (2)

A

1) Peripherial Edema

2) Right Upper Quadrant Pain

32
Q

Exam Findings in Left Heart Failure (5)

A

1) Symp Stim - Diaphoresis + Tachycardia + Tachypnea
2) Pulmonary Rales
3) S3 Sound - Abnormal Filling of a Dilated Chamber (Systolic Failure)
4) S4 Sound - Forceful contraction against a stiff LV (Diastolic Failure)
5) Elevated BNP Peptide

33
Q

Exam Findings In Right Heart Failure (6)

A

1) Peripherial Edema
2) Ascities
3) JVD
4) Hepatomegaly
5) Palpable Parasternal RV Heave
6) Right S3/4 with Tricuspid Regurgitation

34
Q

Key Pearl - Dilated (2) vs. Hypertrophic (3) vs. Restrictive (3) Cardiomyopathy

A

Dilated

1) Problem with Preload
2) Linked with Mitral/Tricuspid Regurgitation

Hypertrophic

1) Problem with Afterload
2) Key pathology = disarray of myofibers on histopathology
3) Can cause functional aortic stenosis + LV septum enlargement

Restrictive

1) Problem with Expansion
2) ECG with diminished QRS = Key Finding
3) FIbrosis of Endocardium

35
Q

Pathophysiology - Dilated (3) vs. Hypertrophic (2) vs. Restrictive (2) Cardiomyopathy

A

Dilated

1) Systolic Dysfunction of ventricles bilateraly leading to CHF
2) Eccentric - Myocytes added in series
3) Loss of Ejection Fraction - Systolic Failure

Hypertrophic

1) Diastolic Dysfunction - Impaired relaxation leads to low filling volume due to high compliance
2) Concentric - Myocytes added in parallel

Restrictive

1) Stiff LV with impaired relaxation and filling
2) Preserved Ejection Fraction - Diastolic Failure

36
Q

Common Causes - Dilated (5) vs. Hypertrophic (2) vs. Restrictive (3) Cardiomyopathy

A

Dilated

1) Alcohol
2) Coxsackie A + B
3) Cocaine
4) Pregnancy
5) Genetics (Beri-Beri)

Hypertrophic

1) Genetics
2) High Afterload (HTN/Aortic Stenosis

Restrictive

1) Amyloidosis
2) Hematochromatosis
3) Scleroderma

37
Q

Major Symptoms - Dilated (4) vs. Hypertrophic (3) vs. Restrictive (2) Cardiomyopathy

A

Dilated
1) Left HF - Dyspnea + Orthopnea + PND

Hypertrophic
1) Like Angina - Dyspnea on Exertion + Syncope

Restrictive
1) Dyspnea on Exertion + Fatigue

38
Q

Major Exam Findings - Dilated (4) vs. Hypertrophic (3) vs. Restrictive (2) Cardiomyopathy

A

Dilated

1) Pulmonary Crackles/Weeze
2) S3/4
3) Right Heart Signs - JVD + Peripheral Edema

Hypertrophic

1) S4 + Systolic Murmur (if Aortic Stenosis Present)
2) Possibly Mitral Regurgitation

Restrictive
1) Mostly Right Side Signs - JVD + Hepatomegaly

39
Q

3 Major Disorders Linked to Congenital Heart Defects

A

VSD - Fetal Alcohol Syndrome
ASD - Osium Primum = Down’s Syndrome
Coartaction of the Aorta - Turner’s Syndrome

40
Q

ASD - Key Associations (3)

A

1) Murmur - Fixed Split S2 - LA/RA Balance Pressures
2) Primum Associated with Downs + Valve Disease
3) Secondum = More Common

41
Q

VSD - Key Associations (3)

A

1) Murmur - LLSB = Holosystolic
2) Associated with Fetal Alcohol Syndrome
3) Early VSD Closing = Stem Cells

42
Q

Tetraology of Fallot - Key Associations (4)

A

1) Cynosis development based on degree of pulmonic stenosis
2) - 4 Components - VSD + Overriding Aorta + Pulmonic Stenosis + RV Hypertrophy
3) Boot Shaped Heart on CXR
4) Mid-pitched coarse systolic murmur LUSB Radiating to the Chest

43
Q

Small Slit Left Heart - Syndrome + Pathology

A

Hypoplastic Left Heart Syndrome

PFO Shunts the blood back and PDA keeps you alive (basically blood goes from pulm circulation back to RA from LA and then into circulation via PDA

44
Q

PDA - Key Features

A

1) Continuous Machine Like Murmur
2) Increases Risk of Infection
3) Closed by Prostaglandin Drop + High O2 at Birth - Kept open by prostaglandin inhibitor indomethacin

45
Q

Bicuspid Aortic Valve - Associated Predispositions (2) + Associated Pathology (5)

A

Syndromes that Predispose to Bicuspid
Marfan
Ehler-Danlos

Assocaited Pathology
Aortic Regurgitation
Aortic Stenosis
Aortic Endocarditis
AAA
Aortic Dissection
46
Q

Aortic Dissection - Risk Factors (7)

A

1) Smoking
2) Hylaine Atherosclerosis of Vaso Vasorum
3) Pregnancy
4) Cocaine
5) Chronic HTN
6) Marfan
7) Ehlers-Danlos

47
Q

Aortic Dissection - Classifications (2) + Second Most Common Site

A

1) - Sanford A - Ascending Aorta Involved
2) - Sanford B - No Ascending Aorta Involved

Second Most Common Site - Distal to Left-Subclavain - Trauma = Ligamentum Arteriosus Tear

48
Q

Aortic Dissection - Exam Findings (2) + Secondary Pathology (3)

A

Findings

1) HTN + Murmur/Aortic Regurgitation
2) Perfusion Deficit

Secondary Pathology

1) Cardiac Tamponade
2) MI
3) Renal Artery Occlusion

49
Q

Thoracic Aortic Aneurysm - Congenital Causes (3) + Acquired Causes (2)

A

Congenital

1) Marfan
2) Ehlers-Danlos
3) Bicuspid Aortic Valve

Acquired
1) Smoking
2) Tertiary Syphilis (Endartaritis)
3)

50
Q

Thoracic Aortic Aneurysm - Major Complications (3)

A

1) Dilated Root
2) Aortic Regurgitation
3) Mediastinum Compress

51
Q

Abdominal Aortic Aneurysm Rupture Symptoms

A

Beck’s Triad

1) Flank Pain
2) Hypotension
3) Pulsatile Mass (Still)

4) Shock - More likely in the setting of acute abdominal pain vs. sepsis

52
Q

Acute Pericarditis - Causes (7)

A

1) Cocksackie
2) Enterovirus
3) MI (Acute + Autoimmune)
4) Trauma
5) TB
6) Procainamide
7) Hydralazine

53
Q

Acute Pericarditis - Signs/Symptoms (3)

A

1) Pericardial Pain - Worse on inspiration - better leaning forward/expiration
2) Pericardial Friction Rub
3) ECG Changes - Diffuse ST Elevation

54
Q

Acute Pericardial Effusion - Causes (3)

A

Trauma, Acute MI with Rupture, Aortic Dissection

55
Q

Acute Pericardial Effusion - Findings (6)

A

1) Soft Heart Sounds
2) Reduced Intensity of Pericardial Rub
3) ECG - Electric Alterans - QRS with alternating amplitudes
4) Dysphagia
5) Dyspnia
6) Hoarseness

56
Q

Cardiac Tamponade - Signs + Symptoms (6)

A

Beck’s Triad

1) Hypotension
2) Muffled Heart Sounds
3) Elevated JVP

4) Pulsus Paradoxus
5) Pulm. Rales
6) Less y Ascent on JVP Tracing

57
Q

Constrictive Pericarditis - Signs + Symptoms (5)

A

1) Pericardial Knock
2) Reduced CO (Hypotension)
3) Right HF Mimic - Hepatosplenomegaly + Ascities much worse than expected based on peripherial edema
4) Kausmall’s Sign - Elevated JVP on Inspirtation (normall not the case)
5) Exaggerated y wave on JVP

Z - M2 Cardiology (5 decks)

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