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🄼💊 CARDIO PATH/RX > PATH: 9-30 CHF and Chest Pain Evaluation > Flashcards

PATH: 9-30 CHF and Chest Pain Evaluation Flashcards

1
Q

A: A: Congestive Heart Failure is a ______ (disease /syndrome) and is typically the ultimate manifestation of every _____ disease.

B: 4 Major Determinants of Cardiac Performance

C: Define Preload

D: How is Contractility approximated?

A

A: Congestive Heart Failure is a SYNDROME and is typically the ultimate manifestation of every cardiac disease.

B: HR (most important) / [Preload LV-EDP] / Afterload / Contractility

C: Preload = Amount of [Ventricular Wall tension/stretching] present at the end of Diastole

D:

Contractility is Approximated by the [slope of endsystolic pressure-volume relationship] (ESPVR)

in the intact heart

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2
Q

A: Before contraction, when does Ca+ enter myocyte, how does it enter and what response does it cause?

B: Describe how Ca+ is involved with cross-bridge formation

C: Name the 3 ways released Ca+ is resequestered in order to activate carduc muscle relaxation

D: What does phospholamban do?

A

A: Before contraction, Ca+ enters myocyte during plateau phase via [Voltage Gated L-type Ca+ Channels] —> [CICR- Ca+ induced Ca+ release] from the [intracell SR] after [Ryanodine Receptor] are activated by initial Ca+

B: Ca+ binds to [Troponin-C] on the thin filament, which moves [Troponin-T] into the [actin groove]. This exposes the Myosin binding site on [G-actin monomers] so Myosin can Bind for contraction!

C: [Sarcoplasmic Reticulum Ca+ ATPase- SRCA] / [Na+/Ca+ exchanger] / [Sarcolemmal Ca+ Pump]

D: Regulates [Sarcoplasmic Reticulum Ca+ ATPase- SRCA]

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3
Q

Normal Values at rest:

  • C.O.
  • Heart Rate
  • LV End-Diastolic Volume (LVEDV
  • *LV End-Systolic Volume (LVESV)
  • Stroke Volume (SV)
  • LV Ejection Fraction
A

Normal Values at rest:

  • C.O. ≈ 5L/min
  • Heart Rate ≈ 70 beats per minute
  • LV End-Diastolic Volume (LVEDV) ≈ 120 ml
  • *LV End-Systolic Volume (LVESV) ≈ 50 ml
  • Stroke Volume (SV) = LVEDV - LVESV ≈70 ml
  • LV Ejection Fraction = (SV/LVEDV) x 100 ≈ 60%
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4
Q

A: Decreasing afterload has a similar effect as increasing ______ on the Frank-starling curve

B: What 2 things does a Swan-Ganz catheter measure?

A

A: [Decreasing afterload] has a similar effect as [increasing contractility] on the Frank-starling curve

B: To measure Cardiac Ouput and [LV End Diastolic pressure] (pressure volume loops aren’t used clinically becuz there’s inaccurate measuring of volume)

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5
Q

A:Name the 3 categories of CHF

B: Which Heart Failure (systolic vs. diastolic) is associated with REDUCED EJECTION FRACTION?

B2: This is AKA ____

C: Which Heart Failure causes Pulmonary Congestion?

A
  1. Contractility Impairement (i.e. from MI)
  2. Markedly INCREASED AFTERLOAD (i.e. HTN)
  3. Ventricular Relaxation impairment (i.e. Tamponade)

B: SYSTOLIC HEART FAILURE (AKA HFREF)

C: BOTH! [Systolic HEFREF] and [Diastolic HEFpEF]

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6
Q

A: Which direction does the pressure volume loop moves when a pt has Diastolic Heart Failure?

B: Ejection Fraction Formula

C: In what way is R Ventricle more equipped for heart failure than L ventricle?

A

A: “[Diastolic HEF_pEF]_ is up and to the left “

B: (EF=[SV / EDV] x 100)

C:

RV can tolerate much larger changes in filling without changes in pressure, but does not

tolerate changes in afterload nearly as well as the LV
(RV is very susceptible to acute changes in pulmonary vascular resistance)

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7
Q

A: Most Common Cause of R Ventricle Heart Failure?

B: 4 Pulmonary causes of R Ventricle Heart Failure

A

A: LV Failure

B: COPD / ARDS / [Interstitial Lung Dz] / [Primary Pulmonary HTN] / PE

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8
Q

A: 4 Compensatory Mechanisms during CHF Progression

B: Con of these 4 Compensatory Mechanisms

A

A:

  1. Frank-Starling
  2. [Autonomic Baroreceptor Reflex] (from DEC CO)
  3. [Renin-Angiotensin Aldosterone System- RAAS]
  4. Hormones = Vasopressin/ Endothelin/Natriuretic Peptides

B:

Acutely Beneficial, but Can Ultimately –> Worsening Ventricular Performance!

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9
Q

Post-MI Ventricular Remodeling

Mitchell and Pfeffer Definition

A

Left Ventricle enlargement and distortion of regional and global ventricular geometry occurring Post-MI

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10
Q

Post-MI Ventricular Remodeling

Whittaker and Kloner Definition

A

Any architectural / structural change occuring post-MI in either infarcted OR noninfarcted heart

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11
Q

Post-MI Ventricular Remodeling

Samarel Definition

A

Hypertrophy and dilatation of noninfarcted segments

occurring weeks to years after acute MI.

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12
Q

What is this and what is the cause?

A

Concentric L ventricular Hypertrophy

[LEFT Sided Heart Failure 2º to HTN] (chronic pressure overload)

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13
Q

What is this and what is the cause?

B: What are 3 examples of this?

A

eCCentric L ventricular Hypertrophy

[Left Sided Heart Failure 2º to Volume Overload]

B: [Mitral Regurgitation] / [AV Fistula] / Hyperthyroidism

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14
Q

Wall Stress Formula

A

Wall Stress = [Pressure x Radius] / [Wall THICKNESS]

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15
Q

A: Symptoms of Left Sided Heart Failure (4)

B: Signs of Left Sided Heart Failure (6)

A

A: Sx:

  1. DOE - Dyspnea on Exertion
  2. Orthopnea (inability to lie flat)
  3. [Paroxysmal Nocturnal Dyspnea] = awakening SOB due to fluid mobilization while sleep
  4. Fatigue

B: Signs:

  • Diaphoresis
  • Tachycardia / Tachypnea
  • Pulmonary rales
  • S3 Gallop in systolic dysfunction
  • S4 Gallop in diastolic dysfunction
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16
Q

A: Symptoms of RIGHT Sided Heart Failure (2)

B: Signs of RIGHT Sided Heart Failure (3)

A

A: Sx:

  1. Peripheral Edema
  2. RUQ Abd Pain from hepatic congestion

B: Signs:

  • JVD - Jugular Venous Distension
  • Hepatomegaly
  • Peripheral edema (mostly pretibial and sacral)
17
Q

A: MOST Non-Emergent Chest Pain is of ______\_ Origin with ______ being second and _____ being third

B: 4 Killer Chest Pains

C: Syndrome X ​

C2: Who often presents with Syndrome X

A

A: MOST Non-Emergent Chest Pain is Musculoskeletal Origin with [GI being second] and [Cardiac being third

B:

  1. Acute Coronary Syndromes
  2. Pulmonary Embolism
  3. Aortic Dissection
  4. Tension Pneumothorax

C: What is Syndrome X?

Angina but with normal [epicardial Coronary Arteries]: typically found in [Aortic Stenosis pts] since development of L Vt Hypertrophy outstrips coronary blood supply –> Angina

18
Q

A: Clinical Presentation of Acute MI and [Stable Angina]

B: Name the other 6 body locations a pt may experience pain during Acute MI/Angina

C: If both present similarly, what’s the key difference?

D: What Pain presentations are rarely cardiac? (3)

A

A: substernal [Crushing pressure or tight chest pain] induced by exertion or mental stress

B: [L Jaw] / [Inner L Arm] / Epigastrim / Neck / [R Shoulder and arm]

C: Angina is relieved in [less than 20 – 30 minutes], vs. infarct pain persists

  • D: Rarely Cardiac:*
  • -Pain only lasting seconds*
  • -pain/pressure under L breast*
  • -Pain/Pressure below Umbilicus is never cardiac*
19
Q

A: Between Acute MI and angina, which pts typically present with additional physical exam findings?

B: Name these Physical signs and describe their etiology (5)

C: What % of Pts with Acute MI actually have NORMAL EKGs?

A

A: Pts with Acute MI (and some with angina) typically have physical signs present / “These pts look sick”

B: PPMSS: Acute MI physical signs

  1. Sympathetics= [Pallor, sweating, anxiety, tachycardia, [BP INC]
  2. [S4 gallop] from decreased left ventricular compliance after ischemia/infarct
  3. Mitral regurgitation occurs in inferior wall ischemia or infarction and may be transient with pain.
  4. [Paradoxically split S2] indicates a new LBBB and possible acute MI.
  5. Pulsus alternans indicate impending LV failure and cardiogenic shock.

C: 50% have normal EKGs smh (40% have ST elevation)

20
Q

A: EKG during an Acute MI event shows….. (3)

B: Name 2 conditions that make it difficult to diagnose MI from an EKG

C: Which 3 conditions are “EKG Imposters” for an acute MI

A

A: EKG in acute myocardial infarction shows

  • elevated ST segments,
  • inverted T waves as the infarct evolves
  • development of Q waves within 12 hours

B:

  • LBBB
  • pacemaker

C: EKG “imposters”

*Pericarditis

*J-Point elevation

*Wolf-Parkinson White

21
Q

D: General Concept for what [ST Elevation] and [ST depression] indicate

D2: What do [EKG Q Waves] indicate?

A

D:

  1. ST Elevation = Infarction
  2. ST depression = ischemia

D2: Q waves indicate transmural myocardial damage.

22
Q

A: [Troponin I and T] are Specific for ______ injury and Most sensitive when diagnostic window is extended to ____ hours

B: Why aren’t Troponin test good for earlier markers?

C: Elevated Troponin indicates what?

D: Which Troponin does peak earlier post myocardial damage

A

A:

Troponin I and T are Specific for cardiac injury and Most sensitive when diagnostic window is extended to 24 hours

It is not an earlier marker!

B: Most Troponins are NOT elevated in first few hours but remains elevated for days!

C: Possible [NSTEACS -non-ST elevation Acute Coronary Syndrome]

D: Troponin I

23
Q

Describe the 4 Classes of Angina Pectoris

Class 1 (2)

Class 2 (5)

Class 3 (2)

Class 4 (2)

A
  • Class 1: Angina ONLY occurs with strenuous or rapid exerition
  • Class 2: Slight limitation of ordinary activity: Angina occurs on [walking up x> 1 flight stairs] / cold weather / [few hours after waking] / [emotional stress] / [walking more than 2 blocks]
  • Class 3: MARKED Limitation of ordinary activity: Angina occurs on [walking up 1 flight stairs] or [walking <2 blocks]
  • Class 4:Inability to carry ANY physical activity without discomfort or [angina is present at rest]
24
Q

During Stress testing, what EKG findings indicates ischemia / coronary insufficiency? (2)

A

[1mm or greater ST segment depression] + [horizontal or downward slope] = ischemia / CAD

25
Q

A: Name the other Common Dx for Chest Pain (9) (aside from MI)

B: Describe how they’re differentiated from MI

A

“Don’t confuse MI with a CUPPED BXN”

  • Dissecting aortic aneurysm – history / TEE/ [normal EKG]
  • Pericarditis – (alleviated w/sitting up)/ [low voltage and diffuse ST elevation].
  • Pulmonary Embolism – diagnosed by a positive ventilation perfusion scan.
  • PneumothoraX – seen on chest x-ray.
  • PNeumonia – fever, cough, abnormal chest x-ray.
  • Costochondritis – pain on examination of chest wall.
  • Esophageal – history and upper endoscopy.
  • Peptic Ulcer disease – GI bleed, upper endoscopy.
  • Biliary colic – 1-2 cases/year, history and US imaging
26
Q

4 Major Sequelae of Aortic Stenosis

A

CHF – 2 year survival

Syncope – 3 year

Angina – 5 year

Asymptomatic - may die suddenly

27
Q

[T or F] Depression and Anxiety are causes of Chest Pain

A

TRUE!

28
Q

Which Viral Infection can mimic Myocardial Infarction presentation almost exactly???!

A

Herpes Zoster

🄼💊 CARDIO PATH/RX (22 decks)

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