MedComplex-CardioVascular1 Flashcards
MI: An ANTERIOR wall infarct is typically caused by occlusion of the _________ artery.
left anterior descending coronary
MI: An infarct of the LATERAL wall of the left ventricle is usually caused by occlusion of the __________ artery.
left circumflex coronary
MI: An infarct of the right ventricle and POSTERIOR wall of the left ventricle is usually caused by occlusion of the ________ artery.
right coronary
What are the three main arteries that supply blood to the heart?
1.Right Coronary Artery (Posterior Supply) 2.Left Anterior Descending Artery (Anterior supply) 3. Left Circumflex artery (Lateral supply)
Please rank the frequency of occlusions in the three main coronary arteries..
- over 50%- Left Anterior Descending 2. 30-40%- Right Coronary Artery 3. 10-20%-Left Circumflex Artery
What are the three complications of an MI?
1.Myocardial Rupture 2.Left Ventricular Aneurysm 3.Mural Thrombus
Complications of MI: Myocardial rupture will cause blood to fill around the heart and stay in the pericardial sac-called:
hemo-peri-cardium
Complications of MI: Myocardial Rupture will cause compression of the heart due to hemo-pericardium called:
Cardiac Tamponade
Complications of MI: How long after a myocardial rupture does cardiac tamponade take place and what is the limit for amount of blood that can surround the heart?
7-10 days post MI and 300-350cc’s
Complications of MI-Left Ventricular Aneurysm: The MI will cause _______ and _______ tissue to replace the infarcted myocardium which DOES NOT CONTRACT.
Granulation and Fibrous tissue
Complications of MI-Mural Thrombus: The _________ overlying the infarcted myocardium is often damaged and disrupted.
endocardium
Complications of MI-Mural Thrombus: What is the most common distant organ to be affected by the thrombus turning into an embolus?
the brain…(cerebral infarcts)
Acute MI-Rapid, sudden occlusion of a coronary artery, and 80-90% of TRANSMURAL infarcts are caused by _______ of a coronary artery.
thrombosis
Acute MI-Other causes (10-20%) include _______ of an embolized atherosclerotic plaque or prolonged ________.
ulceration…. vasospasm
Acute MI-Sudden cardiac death occurs in approx. ___% of cases, in most cases this is a consequence of a major cardiac arrhythmia #1 cause of death–>(i.e. ________ ) or later complete heart block and pump failure.
25%….V-Fibrillation
MI-Among the 75% of patients who survive the onset of an MI, most develop signs of heart failure and _______ shock.
cardiogenic
Most dangerous consequences of cardiogenic shock after the 1st MI are the consequences of __________ (lack of blood to THIS organ)
cerebral ischemia
Acute MI-Those that survive the 1st one… Any CEREBRAL ISCHEMIA that lasts longer than ________ irreversibly damages the brain, and the patient becomes decerebrate
a few minutes
Besides the brain, what is the other organ system MOST affected by an acute MI, and therefore must be treated in those 75% who survive the first MI.
KIDNEYS (oliguria, anuria are signs of renal failure)
What are the two types of MI’s?
1.Transmural 2.Subendocardial/INTRAmural
What kind of MI am I? The infarction involves all three layers of the heart, and usually involves the free wall of the left ventricle and/or the interventricular septum.
Transmural MI
What kind of MI am I? The infarction is usually concentric around the subendocardial layer of the left ventricle.
Subendocardial OR Intramural
Atherosclerosis and Dental Caries: The mechanism may be related to chronic low levels of ____________ in dental caries or periodontal disease and its effect on ________ integrity, plasma lipoproteins, and blood coagulation
gram-negative bacterial infections….endothelial integrity
Atherosclerosis and Dental Caries: Dental caries and ischemic heart disease also share common etiologic factors- low socioeconomic state, smoking, and _______
diabetes
Acute Endocarditis: What are the two “Organisms” (one bacterium, and then a group of bacteria) to blame here?
1.Staph Aureus 2.Gram negative bacteria
Subacute Endocarditis: What is the “less virulent” group of organisms to blame here? What is an alternate name for this group?
Streptococcus Viridans (ALPHA-Hemolytic Strept)
Which organism is responsible for the most cases of Prosthetic Valve Endocarditis? What are three other classes of organisms that can also be to blame?
Staph Epidermis….1) Enterococci 2) Gram negative bacteria 3) fungi
Acute endocardidts location: A highly destructive infection of the ______-….also occurs in these two places:
valves (attacks a NORMAL heart valve)…ASLV (aortic semilunar valve), Aorta, Mitral Valve
Which organism is responsible for IV drug abusers contracting acute endocarditis?
Virulent Staphylococcus species (Staph Aureus)
What are the ____ skin lesions associated with infective endocarditis?
1.Petechiae (20-40% of pt’s) 2.
Skin lesions associated with Infective Endocarditis-Cutaneous findings include Petechiae, present in 20- 40% of patients, frequently found in the ________, _______ and skin of ________.
conjunctiva, mucosa and skin of extremities
Skin lesions associated with Infective Endocarditis- 6 of um…GO
1.Conjuntival Petechiae 2.Cutanious Petechiae 3.Subungal Linear Splinter Hemorrhages (under fingernails) 4.Red Splinter hemorrhages 5.Osler’s Nodes (bottom of toes) 6. Laneway Lesions (bottom of foot)
What are the retinal changes seen in Infective Endocarditis?
Roth’s Spots
_______ : which are found in the eyes due to retinal microemboli, appear as round white spots surrounded by hemorrhage.
Roth’s Spots
What is this talkin’ bout? These endocarditis clinical findings are more UNCOMMON than in the past due to the SHORTENED clinical course of the disease as a result of antibiotic therapy…thank GOD
cutaneous and retinal findings of endocarditis
Prophy Abx: New guidelines released from the American Heart Association now dictate that prophylactic antibiotics be used for those ____________… (vague answer, BUT more to come)
at highest risk of endocarditis
Prophy Abx: Who are the 5 types of people who are at most risk for infective endocarditis?
1.Prosthetic heart valves 2.A history of infective endocarditis 3.Congenital Heart defects (or PROSTHETIC repair of CHD) 4.Valvulopathy post heart transplantation 5. IVDA’s
Prophy Abx: The AHA recommends antibiotic prophylaxis before any dental procedure that involves manipulation of ______ tissue or the ________ region of teeth, or perforation of the oral ______…(e.g. ANY BLEEDING)
gingival, periapical, mucosa
Prophy Abx: Excluded are routine dental ________ and anesthetic _______ through non-infected tissue, dental radiography, placement and adjustment of appliances, shedding of deciduous teeth, and bleeding from trauma to the _____
cleaning….injections…lips
Prophy Abx: Regimens for dental prophylaxis should always be given HOW LONG before the procedure?
30-60 minutes
Prophy Abx: Oral ________ remains the drug of choice
Amoxicillin
Prophy Abx: For patients unable to take oral antibiotics, ________, cefazolin, or ceftriaxone can be used, either IM or IV
ampicillin
INTERESTING::::Necrotic cell membranes become disrupted so that their intercellular contents is released into the ECF, causing ________, which can affect the membrane potentials of functioning myocardial cells, leading to conduction defects!!
Hyperkalemia
WHICH MARKER? begins to rise within 2-4 hours of the onset of an MI, peaks at ___ hours, and returns to normal levels within 72 hours.
Creatine Kinase (CK)…24hrs
What is the more specific dimer of CK found in the myocardium?
CK-MB
What is the GOLD STANDARD in the diagnosis of MI? How long does it stay in the blood post MI?
Troponin’s…Troponin levels remain elevated for 7-10 days after the acute event
“I would remember that” Diet may also play a role; a high consumption of ______ is considered an important factor in the etiology of dental caries, and has also been incriminated in the development of ___________
SUCROSE… atherosclerosis
Endocarditis-DID YOU KNOW?? ______ vegetations tend to be larger than bacterial vegetations and are more commonly seen on the _____ side of the heart
FUNGAL…RIGHT (tricuspid)
Endocarditis-____________: which are linear subungual hemorrhages, are seen as dark-red streaks beneath the nailbed.
Splinter Hemorrhages
Endocarditis-________: are tender, small, raised, discolored cutaneous lesions, usually appearing on the pads of the fingers and toes.
Osler’s Nodes
Endocarditis-________: small, erythematous or hemorrhagic lesions usually seen on the palms or soles.
Janeway lesions
Endocarditis-Cutaneous findings include ________, present in 20- 40% of patients, frequently found in the conjunctiva, mucosa and skin of extremities.
Petechiae
*“I’ll ask you this” What is the #1 complication of Endocarditis?
an embolism
What % of endocarditis pathogens can be cultured to diagnose the culprit?
90%
What is the progression of Staph/Strep/Candida in an IVDAbuser?
Tricuspid Valve (over 50%), if it gets past that, pulmonary embolism
