Made Ridiculously Simple Flashcards
If the L ventricle cannot pump adequately out to the body, where will the blood back up?
Pulmonary vasculature
A back up in pressure from an improperly functioning left ventricle increases pulmonary veins, which ultimately leads to..
Pulmonary edema (and causes dyspnea!)
Lung exam of a pt w L heart failure will reveal what
Crackles in the base
the worse the failure and the more fluid in the lungs, the higher up in the lung field these crackles will be heard
If a pt has L sided HF, leading to pulmonary HTN and edema…what else can develop?
R sided HF
If we have R sided HF, where does the blood back up? What do you expect to see on exam?
backs up in the body!
*will see an elevated JVP
Ascites
Hepatic congestion
Peripheral edema
..all signs of?
R sided heart failure
Muscle fatigue, weakness
SOB
Drowsiness
Change in mental status
All indicative of..
Poor cardiac output
When standing, gravity causes blood to pool in the feet. When lying, all of the blood can find its way to the heart easier and a failing heart cannot handle this. Blood backs up into the lungs, causing SOB
Orthopnea
A pt wakes up in the middle of the night coughing and SOB, classically resolving when getting up
Paroxysmal nocturnal dyspnea
Blood pressure in the left ventricle at the end of diastole, right before the ventricles contract
Preload
Preload comes to the heart from the..
venous system
______ is the systemic vascular resistance, or the resistance to flow in the arterial tree in which the heart must work
After load
Drug classes that increase forward flow by increasing cardiac output
- Inotrope (ie digoxin)
- Beta blockers
Increase the force of ventricular contraction
Inotropes (ie digoxin, dobutamine)
Decrease the rate of contraction to increase filling time (allowing for more blood to accumulate in the ventricles, leading to subsequent increase in cardiac output)
Beta blockers
Nitro and diuretics decrease…
Preload
ACE inhibitors are arterial dilators, which decrease
Afterload
Decrease cardiac output, leading to decreased blood flow to kidneys causes release of…
Renin
Renin converts angiotensinogen into..
angiotensin I
Angiotensinogen I is converted into Angiotensinogen II by..
ACE
A reentrant circuit in the atrium that travels at very high speeds. The atrial rate is typically between 200-400 beats per minute
A flutter
Many reentrant circuits in atria. Rates in the atria can be over 400 beats per minute
A fib
Atherosclerosis or clot formation in the coronary vasculature can cause..
Angina and/or MI
What type of angina occurs secondary to intermittent vasospasm. It can occur at anytime and is not related to activity.
Variant, or Prinzmetal’s angina
Decreasing the heart’s demand for oxygen can be accomplished by:
Beta blockers
Calcium channel blockers
DOC for Prinzmetal’s angina
Calcium channel blockers
2 pathways in which lipids are processed in the body
- exogenous
2. endogenous
Which lipid pathway absorbs fats from the digestive tract into circulation
Exogenous pathway
Which lipid pathway transports fats synthesized in the liver between the liver and the peripheral tissues
Endogenous pathway
LDL, good or bad?
BAD
HDL, good or bad?
GOOD
LDL transports cholesterol to the…
periphery (where it may be incorporated into atherosclerotic lesions)
HDL transports cholesterol…
from the periphery to the liver
Most cases of HTN have no identifiable cause
Essential HTN
What can cause failure to adequately excrete sodium and water, increasing intravascular volume
Renal disease
Renal artery stenosis can activate the…
Renin-angiotensin-aldosterone axis
increases blood volume, can cause HTN
Renal artery stenosis can be caused by either..
- atherosclerosis
2. fibromuscular dysplasia
Hyperaldosteronism
Increased cortisol
Hyperthyroidism
Increased epinepherine/norepin.
Hormonal changes that can cause HTN
aortic coarctation and vasculitis can cause..
hypertension
Kidney damage (nephropathy) Retinopathy Stroke Intracranial hemorrhage Aortic aneurysm Aortic dissection
Consequences of HTN
Hyper coagulable states Inflammatory conditions (Lupus)
can cause..
Non infectious causes of endocarditis
Common bacterial causes of endocarditis:
S. viridans
S. aureus
Which valve would you expect an IV drug user to have endocarditis?
Tricuspid
drugs injected into venous system can cause infectious material to travel to the R heart
Which bacteria is the most common cause of IV drug related endocarditis?
S. aureus
When might surgical replacement of a valve be necessary in endocarditis?
If heart failure develops
Presents as..
fever, joint pain, subcutaneous nodules, chorea and/or other uncontrolled purposeless movements
Rheumatic fever
The long term effects of the inflammation in the heart can include mitral stenosis and/or regurg as well as aortic stenosis and/or regurg
Rheumatic heart dz
Most common viral cause of myocarditis
Coxsackie B
