Newman Review

Question 1

How could you raise the stroke volume?

Answer 1

Increase preload or contractility

Question 2

Most important equation

Answer 2

Pressure (MAP) = Flow (CO = HR x SV) x R (TPR)

Question 3

What is the ejection fraction?

Answer 3

SV/EDV

Question 4

What do you do when you encounter heart failure with low ejection fraction? How do you do it?

Answer 4

Reduce the afterload via 1 of 2 determinants: left ventricular size or SBP

Dilated ventricle is a big part of this (afterload)

Question 5

What does aortic regurgitation cause?

Answer 5

Volume overload leading to eccentric hypertrophy

Question 6

What are the 2 mechanisms of dysrhythmias?

Answer 6

Automaticity and reentry

Question 7

What things alter automaticity?

Answer 7

Digoxin, hypoxia, CO2, acidosis, hypokalemia, low magnesium

Alter phase 4 of the AP such that it reaches threshold

Question 8

What are the prerequisitites for reentry?

Answer 8

Two continuous pathways with different conduction velocities

Question 9

What does it mean if you have JVD, barely palpable BP, and pulse that goes away with inhale (i.e., pulsus paradoxus)?

Answer 9

IV septum has received inspiratory volume, ventricle has tried to expand, but can’t, so IV septum imposes on LV, decreasing stroke volume

Question 10

What are the signs of heart failure with a low EF? How do you fix this?

Answer 10

Laterally displaced PMI, larger than a dime or nickel, S3

Renin, angiotensin up

ACEI: decreases afterload (have to check serum potassium in 1 week b/c worried about hyperkalemia) -> should increase CO

Question 11

What is the stress-exercise test for?

Answer 11

Test to diagnose CAD

Question 12

What is stable CAD? How does it progress?

Answer 12

Supply-demand mismatch due to coronary narrowing

2 major determinants of O2 demand: HR and SBP (both of which INC during exercise; this is why you do a stress test)

Coronary angiogram: stable, fixed stenosis (usually about 70%)

3 MONTHS LATER: elephant sitting on chest -> rupture of plaque, leading to MI

Question 13

How do you confirm aortic regurgitation?

Answer 13

Confirm via echo

LV will adapt via eccentric hypertrophy

Question 14

How do you detect aortic stenosis?

Answer 14

Bell of stethoscope right underneath right clavicle

Concentric hypertrophy og LV

Echo

Risk for CAD development

Question 15

How do you determine if person with mitral stenosis needs to be sent to sx?

Answer 15

Gradient: difference b/t LA and LV in diastole (normal is 0); can be measured via Doppler echo

Flow across valve: echo (flow affects CO)

Question 16

How do you tell if mitral regurgitation is acute?

Answer 16

Echo, cath to look for lack of adaptation (eccentric hypertrophy) and/or marked elevation of pressure upstream (i.e., LA, pulmonary vein or capillary)

Question 17

What are the big risks with bacterial endocarditis?

Answer 17

Embolism (tricuspid to lungs; mitral to brain, kidneys, legs, coronary/MI)

Acute regurgitant lesions (i.e., chew up chordae tendineae)

Question 18

How do you detect pericarditis?

Answer 18

Feel better when they lean forward

Friction rub

Question 19

What causes sudden cardiac death? What if they survive?

Answer 19

Ventricular fibrillation

ICD

Question 20

What does mitral regurg sound like? Most common cause?

Answer 20

Systolic blowing murmur at the apex

Mitral valve prolapse (often has a distinctive click)

Question 21

Asymptomatic mitral regurg patient with no eccentric hypertrophy about to have dental procedure? What do you do?

Answer 21

Give her 4 amoxicillin an hour before

Question 22

What are some causes of ST elevation in absence of CAD?

Answer 22

Cocaine, vasospasm, hematocrit of 12 (anemia), aortic stenosis (not enough blood to coronary arteries), coronary emboli