Newman Review

Question 1

What is the degree at which stenosis is significant?

Answer 1

70%

Question 2

Increased demand is cause by? What does this dictate?

Answer 2

HR and Systolic BP, How we treat chronic unstable angina pectoris.

Question 3

Acute coronary syndrome is what?

Answer 3

Someone who exhibits exertion at rest, probably an atherosclerotic plaque that has opened so procoagulative substances are released (TXA2, endothelin, decreased NO)

Question 4

What is STEMI?

Answer 4

A complete occlusion of CA, urgent intervention needed

Question 5

What is automaticity? What is it caused by?

Answer 5

Alteration of phase 4 diastolic depolarization of the AP; hypoxemia, hypokalemia, increased CO2, acidosis, Drugs - digitalis

Question 6

What are the causes of re-entry?

Answer 6

Alternative pathway and slower conduction velocity (AV Block)

Question 7

What is pulsus paradoxis?

Answer 7

When one inhales, HR decreases (exacerbation of this normal phenomenon is present in the condition known as cardiac tamponade); caused by LV volume decreasing from pressure around the heart not allowing RA fill = Septum goes into LV = decrease preload = decrease CO = decrease BP

Question 8

Acute pericarditis; what will be heard?

Answer 8

Scratching sound at apex of heart

Question 9

CHF is defined as?

Answer 9

The symptoms of salt and water retention; water in legs and lungs, Na and H2i ascites (30L), low Ej, Orthopnea = Ej of 20% = RAAS activation, SNS activation, BNP

Question 10

How can you treat CHF?

Answer 10

Altering afterload, or impedance, to contraction of the LV; Afterload = pressure of blood in arteries and volume of the ventricle

Question 11

When is Aortic Regurg observed?

Answer 11

During Diastole

Question 12

What happens when the heart adapts to aortic regurg?

Answer 12

Eccentric hypertrophy (sarcomeres in series), this is a response to increased volume

Question 13

When is Aortic Stenosis heard?

Answer 13

Heard in systole - like someone hearing their throat

Question 14

What happens to the heart during Aortic Stenosis?

Answer 14

Results in concentric hypertrophy (sarcomeres in parallel), response to increased pressure

Question 15

How do you know when to send a mitral stenosis patient to surgery?

Answer 15

What is the gradient (difference between diastolic pressure between LV and LA); and what is the flow (defined as CO)

Question 16

How do you tell if mitral regurg is acute?

Answer 16

Did it occur this morning? Or has it occurred his entire life? If absence of LA eccentric hypertrophy, if absent then acute, measure by Echo.

Question 17

What other pressures can you measure for mitral regurg?

Answer 17

Pulmonary capillary pressure and pulm arterial pressure can be measured

Question 18

How can you tell if mitral regurg is chronic?

Answer 18

LA Dilated, coronary pressure is normal, pulm capillary pressure is normal

Question 19

What is the sound heard in MCC (mitral valve prolapse)? What must pt do before dental procedures?

Answer 19

Lub-click-dub, take amoxacillin (2000 mg) 1 hr before dental appt, if patient comes in a year later no having taken this precaution and presents with mitral regurg symptoms, then vegetation may be present on valves, possibility of thrombus formation in LA

Question 20

What do you use to treat Low Ej CHF?

Answer 20

Beta blockers, ACE, spironolactone

Question 21

What causes sudden death?

Answer 21

V-Fib = if survive implant a pacemaker (AICD)

Question 22

What do you worry about if there is a vegetation on tricuspid valve?

Answer 22

Pulmonary embolism

Question 23

A-fib is most common cause of stroke, how do you prevent a stroke?

Answer 23

Warfarin