Midterms Flashcards
what are the 2 division of coronary artery?
Right coronary and left coronary artery
what do you call the right side of coronary atery?
posterior decending artery
what do you call the left side of coronary artery and what are the division of that? and means
left main coronary artery
Div.:
1. Circumflex coronary artery - lateral portion / side
2. Left anterior descending coronary artery - anterior portio
Most common site of blockage?
Left anterior descending coronary artery
heart specialized cells
myocytes
generates and conduct electrical impulse to the diff part of the heart
Myocytes or myocardial cell
hemodynamics cardiac cycle?
from 1 heart beat to another
what happend in diastole?
with the closing of the aortic valve (or pulmonic) and ends with the closing of the mitral valve (or tricuspid).
the heart distends the blood vessels, forcing blood from the ventricles into the systemic (or pulmonic) system.
Systole
how many cardiac output is normal?
4-6L/min
TOTAL AMOUNT OF BLOOD EJECTED BY ONE of the ventricles in L/min
Cardiac Output
cardiac output formula
Heart rate x Stroke volume
Normal stroke volume
60-130
degree of stretch of ventricular cardiac muscle fiber at the end of diastole
Preload
Resistance to ejection of blood from ventricles
Afterload
Force generated by the contracting myocardium
contractility
percent of the end-diastolic blood volumen that is ejected with each heartbeat
ejection fraction
normal ejection fraction
45-55%
decrease ejection fraction leads to?
heart failure
indication edema?
HF/Valvular disorder
indication in valvular disorder?
Edema, Fatigue, Dizziness, Syncope, SOB
palpitation and syncope difference in terms indication
palpitation is dysrhthmias
syncope arrtrhtymias
what medication need to be assess in Cardio
ASPIRIN, NTG, ANTI HYPERTENSIVE, DIGOXIN DIURETICS
AORTIC VALVE LOCATED
2nd ics Right sternum
Pulmonic valve located
2nd ics left sternum
tricuspid valce located
4th ICS L sternum
mitral valve located
5th ICS midclavicular line
Erb’s point located
3rd ICS L sternum
rapid venticular filling
s3
s3 is normal in?
children
35-40 s3 means
physiologic s3
heard immediately after s2 used what part of stetos?
bell
late diastole
s4
harsh grunting sound
friction rub
inflammed pericarditis surfaces
friction rub
turbulent flow of blood in the heart and valvular disorder
murmur
release by myocardial celss that becomes necrosis in myocardium
cardiac biomarkers:
1. Creatine kinase
2. Myoglobin
3. Troponin I
Cardiac specific isoenzyme?
creatinine kinase
increase during MI what cardiac biomarkers?
Creatinine kinase
increase when; creatinine kinase
increase within few hours;peak within 24 hrs
normal percentage and international unit of creatinen kinase
%: 3-5
IU/L 5-25
initially used when patient having chest pain?
myoglobin
myoglobin increase within?
within 2-3 hourse following a heart attack and back to normal within 24hrs
myglobin increaases within 2-3 hourse following a heart attack and back to normal
back to normal after 24 hrs
most realable to Myocardial infarction what cardioc biomarker?
Troponin I
Normal range of troponin I?
0-0.04
gym increase of what cardiac biomarker?
myoglobin mg/ml
detected few hours of troponin I detected what?
acute myocardial infarction
troponin I may remain high till?
14 days or 2 weeks
CARDIAC BIOMARKER that can detect recent MI and who fast to detect?
myglobin can detect as fast as possible but troponin I is more detect MI
total cholesterol
less that 200 mg/dl
triglycerides total
less than 150 mg/dl
HDL in male
grater than40 mg/dl M
greater than 50 mg/dl F
LDL total amount
less than 100 mg/dl
increase total choles,trigyceride. ldl leads to?
risk to atherosclenosis that lead to CAD and led to angina/MI
regulate BP and fluid volume/secreted by the ventricles
brain natriuretic peptide
BNP increase during?
MI/HF/Pulmoembolism
prognosis for heart failure
BNP
BNP more than ____ pg/ml lead to?
100
MI/HF/Pulmonary embolism
C-reative protein more than ___mg/L leads to
3risk for CVD
Homocystine morethan ____ leads to?
15mcmol/L
CAD / PVD/Stroke
what is the scale of amplitude?
+4 bounding
+3 strong
+2 Normal
+1 weak
+0 absent
normal amplitude?
+2
Normal heart sound
S1: closure of tricuspid and mitral valve
s2: closure of pulmonic and aortic valve
abnormal heart sound
S3: early in diastole - rapid ventricular filling - after s2
S4: late diastole - after s1 - atrial contraction
Prognostic tool for heart failure
Brain natriuretic peptide
what need to monitor when having exercise stress test
HR, rhythm, BP, skin temp, appearance, symptoms
when to stop when having exercise stress test
increase, dyspnea, chest pain, dizziness, fatigue, leg cramping
stop when the target HR is achieved
pre provedure of excercise stress test
NPO for several hourse / avoid stimulants / meds can be take with sip of water/ hold Beta / Ca channel blocker/ digoxin for 48hrs / post procedure monitoring for 10-15 mins
what meds or the pharmacologic stress testing that can be revesersed by?
vasodilating agent/ adenosic dobutamine / aminophyline
pharmacologic stress testing duration
1-3 hrs
pharmacologic stres testing what need to be stoped/avoid?
stimulants 24 hrs before procedure
xantines for 24-48hrs
what are the cardiac stress testing
- excercise stress test
- pharmacologic stress testing
- myocardial perfusion imaging
- magnetic resonance angiography
- Echocardiography
- Cardiac catheterization
- Electrophysiologic testing
for evaluation of perfusion and detect blockage
radionuclide imaging / radioistopes
2types of myocardial perfusion imaging and differences
- single photo emision computed tomography
- most common
- painless / non invasive but need to insert IV
- insert radionucleotide - safe - Positron emmision testin
- provides 3 dimensional images
-evaluates glucose metabolism - normal cbg before procedure
- avoid stimulant for 24hrs
- assess claustrophobia
- needs IV access
position of positron emission testing
lie still/ hands above the head
baseline 30 mins
completion 1-3hrs
provides class sectional imaging
CT scan
use to enhance the xray / improve visualization of ct scan
contrast
diagnose disease use of magnetic resonance angiography
- congenital lesions
- aorta
- heart muscle
- pericardium
diagnose of transthoracic?
pleural effusion
determine size of the chambers
etiology of murmurs
what is transesophageal?
- provides clear image
- use topical anesthesia and sedation
- evaluate: CVD / HF / valvular disorder / arrthymias
- complication: Resiratory depression , Aspiration , perforation
what measures transthoracic?
ejection fraction / size / shape / evaluates function of valves
use to diagnose structural and functional disease of the heart
Cardiac catheter
what need before cardiac catheter?
blood test / reneal fxn / coagulation / allergy for contrast / npo 8-12/
what are the hemodynamic monitoring and differences
- central venous pressure
- measurement of pressure in vena cava or right atrium - Pulmunary artery pressure monitoring
- Left ventricular function
- dx: shock
- balloon tip
what is the normal value and indication of abnormal value of cetral venous pressure
N: 2-6mmhg
abnormal increase: fluid overload / hypertension
abnormal decrease: deficit/shock/hypovolemia
complication of pulmonary artery pressure
- rupture of pulmonary artery
- pulmonary infection and thrombolism
- air embolism
- catheter kinking
- arrtythmias
components of electrocardiogram w/ definition / height / duration
P wave
- electrical impulse starting SA node
- atrial depolariaztion
- HT: 2.5mm or less
- Duration: 0.11 sec
QRS wave:
- ventricular Depolarization
- HT: more than 5 mm QRS / Less than 5mm qrs
T wave
- Atrial repolarization
- Resting state
U wave
- Purkinje fiber Repolarization
- Hypokalemia
PR interval
- Beginning of P to QRS
- n less than .12 to 20 sec
ST interval
- Ventricular repolarization end of QRS to beginning of T wave
QT interval
- Total time of ventricular depo and repo
- Beginning of QRS to end of T wave
- .32 to .40 sec
TP interval
- End of T beginning of P
- Isoelectric period
PP interval
- P to P
RR interval
- R to R
ventricular rhythm
rr interval
Atrial rhythm
pp interval
