PBL 4 Flashcards
What are crepitations in lung auscultation caused by?
Crackles or crepitations are caused by the “popping open” of small airways and alveoli collapsed by fluid, exudate, or lack of aeration during expiration
What conditions cause lung crepitations? (6)
Crepitations are heard in
- pneumonia
- atelectasis (collapse of part of a lung)
- pulmonary fibrosis,
- acute bronchitis
- bronchiectasis.
- Pulmonary edema secondary to left-sided congestive heart failure.
What is a pan-systolic murmur, and what is it usually caused by? (3)
Holosystolic (pansystolic) murmurs start at S1 and extend up to S2. They are usually due to regurgitation in cases such as mitral regurgitation, tricuspid regurgitation, or ventricular septal defect (VSD).
What are the other names for the mitral valve? (2)
the bicuspid valve or left atrioventricular valve
What type of drug is Furosemide and what is it used to treat?
Furosemide is a loop diuretic used to treat congestive heart failure / oedema.
What is heart failure and what are its symptoms? (3)
Heart failure (HF) often called congestive heart failure (CHF) is the inability of the heart to supply sufficient blood flow to meet the needs of the body. Heart failure symptoms include shortness of breath, leg swelling, and exercise intolerance.
What are the common causes of heart failure? (5)
Common causes of heart failure include
- myocardial infarction
- other ischemic heart disease,
- valvular heart disease
- cardiomyopathy (degeneration of the myocardium)
- hypertension (becasue increased peripheral resistance puts more pressure on the heart to pump; the heart cannot keep pumping forcefully enough)
How does the drug digoxin improve the output of the heart?
High ventricular rate leads to insufficient diastolic filling time. By slowing down the conduction in the AV node and increasing its refractory period**, digoxin can reduce the ventricular rate. Arrhythmia is not improved, but the pumping function of the heart improves owing to improved filling.
(**Refractory Period: the amount of time it takes for an excitable membrane to be ready for a second stimulus once it returns to its resting state following excitation)
What do you commonly prescribe digoxin for (2) but which other drugs would you consider first? (2)
The most common indications for digoxin are atrial fibrillation and atrial flutter with rapid ventricular response, but beta-blockers or calcium channel-blockers should be the first choice.
What do you use Glyceryl trinitrate (GTN)/ nitroglycerin for? (4)
Nitroglycerin is used for the treatment of
- angina,
- acute myocardial infarction,
- severe hypertension
- coronary artery spasms due to cocaine.
How does nitroglycerin work? Why don’t use it long term?
It is useful in decreasing angina attacks, perhaps more so than reversing angina once started, by supplementing blood concentrations of nitric oxide (nitrogen monoxide, NO). However the effectiveness of glyceryl trinitrate is limited by development of tolerance/tachyphylaxis within 2–3 weeks of sustained use.
What problems can troponin T test indicate? (7)
Elevated troponin T shows that cardiac muscle has been damaged. This occurs in:
- Myocardial infarction,
- Coronary vasospasm
- Severe tachycardia
- Heart failure
- Pericarditis
- Myocarditis (inflammation of the heart muscle - myocardium)
- Cardiomyopathy (degeneration of the myocardium)
Name two markers which can be tested for that show myocardial damage has occured
cardiac Troponin T (cTnT) and cardiac Troponin I (cTnI). Young, healthy individuals will have almost none of either substance in their blood.
What is the range of numbers for normal blood pressure?
Systolic range:
Diastolic range:
- Systolic range: 90 - 120
- Diastolic range: 60 - 80
You do a troponin t test to differentiate between which conditions?
Angina and myocardial infarction
