Newman Review Session Flashcards
What equation determines the ways that you can raise/alter blood pressure?
MAP = CO x TPR
**CO = HR x SV
What are some ways that you can increase the following factors that play into BP?
• SV
• HR
• TRP
Increase SV:
• Increase Contractility
• Increase Preload
Increase HR:
• no clinical way
Increase TPR:
•Dilate/Constrict Arterioles (drugs can do this)
What equation determines ejection fraction?
• what do you want EF to be?
EF = SV/EDV
= (EDV-ESV)/EDV
***Want EF to be 55% or better
What main factor do you want to treat in heart failure (aka EF
Want to Reduce Afterload
Systolic BP:
• want to reduce it (beta blocker etc.)
Dimensions of LV:
• eccentric hypertrophy - LV dilation (more than 5 sontimeters)
• Want to reduce this size
T or F: Aortic Regurgitation is a form of volume overload.
True –> this can lead to CHF
By what two mechanisms can dysrrhythmias occur?
Automaticity
Re-entry
What causes increased automaticity?
• what factors give an increased chance of this happening?
- Alteration of phase 4 of the AP so that slope moves up to threshold
- Digoxin, sympathetics, hypoxia, Inc. CO2, Acidosis, Hypokalemia
What is Re-entry?
• 2 parallel circuits with different conducting velocities
What is Pulsus Paradoxus?
• what will the pt. look like?
Patient will be sick with JVD
Pulsus Paradoxus - barely palpable pulse that disappears on inspiration
What is the mechanism of Pulsus Paradoxus?
- In Cardiac Tamponade the RV can expand in the pericardium so it expands into the LV.
- Reduced LV volume means decreased Preload and reduced CO
- Reduce CO results in reduced BP b/c (MAP = CO x TPR)
(it is normal to decrease by 10mmHg but greater than 15-20mmHg is not good)
What changes would you expect to see in the following with EF lower than 20%?
• PMI
• Neurohumoral
**Treatment?
PMI:
•should be located below the left nipple, here it will be found below the left armpit
• Size will increase larger than a dime (size of a quater)
Neurohumoral:
• RAAS inc.
• Epi inc.
• BNP inc.
Treat:
• These patients should be treated with ACE Is
What effects of ACE Is are for people with HF?
- Decreasing Systolic BP
- HYPERKALEMIA (from inc. Aldosterone)
- inc. CO by REDUCING TPR
What is the principle cause of exertional angina?
• Myocardial Demand exceeds supply
If you suspect Coronary Artery disease that is causing angina what test should you do next?
• what do you expect to see?
- Treadmill Test
* ST depression
What causes the discrepancy between supply and demand in Exertional Angina?
• what would you expect to see on angiogram?
Supply:
• Coronary Narrowing via Blockage and Stenosis
Demand:
• Inc. HR (during excercise)
•Inc. Systolic BP
Angiogram: would show 70% stenosis
What clinical findings would you expect to see in a patient with exertional angina who wakes up one night with an elephant sitting on his chest?
• cause?
- ST elevation
* Unstable Plaque probably ruptured
Aortic Regurgitation
• when do you expect to hear it?
• what do you expect to hear?
• CAUSE?
DIASTOLIC (after S2 pulseless sound) the murmur will be decrescendo
CAUSE: Eccentric Hypertrophy of the LEFT ventricle
Aortic Stenosis • Where do you hear it? • what does it sound like? • Risk? • what do you see on echo?
- Heard under Right Clavicle 2nd ICS
- sounds like Clearing Your Throat
- Increased Risk for Coronary Artery Disease Development
- Echo will show CONCENTRIC hypertrophy
How you assess the severity of mitral valve stenosis to determine if the patient needs surgery?
- GRADIENT btwn LA and LV in DIASTOLE
* CO - tells you how much flow is getting across the valve
What are you looking for to diagnose ACUTE mitral regurgitation?
• what should you use to look?
Mitral Regurg - use ECHO or Cath to determine
- LACK OF ECCENTRIC HYPERTROPHY - means atria has not yet had time to adapt
- MARKED ELEVATION OF UPSTREAM PRESSURES - LAP, Pulm. venous pressure, pulm cap pressurre, pulm artery pressure
What are the 2 major complications of bacterial endocarditis?
- Emboli
2. Acute Regurgitant lesion (bacteria chew through chordae tendinae/valve0
What are the 2 MAJOR HALLMARKS of acute pericarditis?
- Friction Rub (paper rubbing together)
2. Pain Relieved by leaning forward
What causes Reentrant Arrhythmias?
- Unidirectional Block
2. Two pathways (1 slow, 1 fast)
What causes sudden cardiac death?
• treatment?
- Ventricular Fibrillation
* Rescusitation then ICD
You hear a blowing systolic murmor at the apex of the heart in a young girl?
• what likely caused this?
• Mitral Valve Prolapse = most common cause
what causes a STEMI in the absence of Coronary Artery Disease?
• aka Acute ST elevation
Cocaine, Stress, - vasospasm
Low Hct - not enough O2 delivered
Severe Aortic Stenosis w/ SBP 400 mmHg
Endocarditis with Coronary Emboli
If someone does a treadmill test and has ST depression do they have complete obstruction of a CA?
• do they have a disease?
NO - depression is ischemia not infarction
• Yes, they have CAD
T or F: chronic stable angina invovles ruptured plaques?
False, it may however involve endothelial dysfunction that prevents vasodiation
What determines a patients afterload who has an EF of 20%?
• SYSTOLIC Pressure - determined by RAAS
You start a patient on an ACE inhibitor, what test do they need to come back and have done a week later?
Test for Potassium Concentrations (hyperkalemia may be an issue)
A person got shot and comes in with a blood pressure of 80/30 what do you need to do and why?
*Give them fluids to Increase Preload
Which murmur is associated with concentric hypertrophy and which with dilated cardiomyopathy?
Concentric Hypertrophy - aortic stenosis (systolic murmur)
Dilated Cardiomyopathy - aortic regurg (diastolic murmur)
What the biggest risk in a patient with mitral valve prolapse that goes to the dentist and comes back a week later with IE?
STROKE
