PBL Meeting Notes u3 w1

Question 1

Stable and Unstable Angina

Answer 1

Stable -chest pain preceded by exertion, relieved by rest and nitroglycerin. Caused by underlying CAD, oxygen demand by heart cannot be met during exertion
Unstable - chest pain/discomfort caused by insufficient blood and oxygen. Caused most commonly by narrowing of coronary artery due to thrombus on disrupted atherosclerosis plaque. Consider this when chest pain increases or lasts 20-30 minutes

Question 2

CAD - what is it?

Answer 2

atherosclerosis in the vessels supplying the heart

Question 3

anatomy of a blood vessel

Answer 3

adventitia or tunica externa, then tunica media, tunica intima

Question 4

which layer is the muscle in blood vessels?

Answer 4

tunica media, and in arteries it is bigger than in veins

Question 5

damage to blood vessels is caused by

Answer 5

LDL, smoking, high blood pressure

Question 6

dead macrophages called foam cell are where and are full of what?

Answer 6

under the endothelium of the blood vessel and are full of cholesterol

Question 7

plaque in the artery is made of what?

Answer 7

fibrous cap and fatty streak

Question 8

what percent of occlusion starts to cause down stream cellular injury and necrosis?

Answer 8

70% occlusion

Question 9

Why does calcium deposit in the plaque?

Answer 9

the smooth muscle cells proliferate into the plaque and deposit calcium, causing the area to become more rigid. HDL is unable to help reduce this because of the LDL present

Question 10

covid infection increase chance of myocarditis

Answer 10

x35, covid vaccination x3

Question 11

Beta-1 specific blockers are specific to what tissues?

Answer 11

cardiac

Question 12

don’t give sotalol to who?

Answer 12

patients with long QT syndrome because sotalol can worsen this

Question 13

affect of aspirin on GI

Answer 13

epithelial injury, microvascular injury, chronic ulcer

Question 14

cough associated with heart condition?

Answer 14

1) backflow to pulmonary veins causes fluid leak into lungs
2) ACE inhibitors increase cough reflex, possibly due to kinase II activity (accumulation of kinins, substance P, and prostaglandins)

Question 15

Hypertensive Goals

Answer 15

under 130/80?

Question 16

Dilated cardiomyopathy defined by how much left ventricular ejection fraction?

Answer 16

less than or equal to 40%

Question 17

Dilated cardiomyopathy PE findings

Answer 17

rales, elevated JVP, S3 gallop, murmurs of functional mitral or tricuspid, regurgitation, cheyne-stokes breathing, pulsus alternans, pallor, cyanosis

Question 18

Abnormal S2 splitting can be cause by:

Answer 18

1) paradoxical - delay in aortic valve closure, split occurs during expiration

2) persistent - prolonged left ventricular closure, split is more during inspiration but is present for both

3) fixed - wide s2 splitting present at baseline, wide splitting at both inspiration and expiration, atrial septal defect

NORMAL s2 splitting is caused on inspiration

Question 19

eisenmenger syndrome

Answer 19

unoxygenated blood gets pushed through the left ventricle to the aorta, bypassing the lungs, caused sometimes by patent ductus arteriosus or other causes, flips the shunt

Question 20

murmur assosicated with Patent Ductus Arteriosus

Answer 20

systolic, continuous “machinery” murmur

Question 21

patent foramen ovale between the right and left atrium, occurs in what percent of the population?

Answer 21

occurs in 25% of people. 50% of cases self corrected by 6 months, 75% of cases closed by adulthood

Question 22

Acyanotic Heart congenital heart defects

Answer 22

ventricular and atrial septal defects, patent ductus ateriosus, atrioventricular canal defect, pulmonary stenosis, aortic stenosis, aortic coarctation

Question 23

cyanotic congenital heart murmurs

Answer 23

tetralogy of fallot, tricuspid atresia, ebstein’s anomaly, truncus arteriosis, total anomalous pulmonary venous return, transposition of the great arteries

Question 24

how to test for recent strep infection?

Answer 24

ASO (antistreptolysin O), AntiDNase B (ADB). both negative means probably no strep infection

Question 25

signs and symptoms and PE of rheumatic fever

Answer 25

S/S: JONES - joint pain, carditis and mitral valve disease, node inflammation, erythema marginatum, Sydenham’s chorea
PE: mitral/aortic valve most often involved, tricuspid valve, mitral valve regurgitation ausculation - apex, blowing sound, radiates to the axilla, high pitched, pansystolic

Question 26

what is normal rhythm on an EKG?

Answer 26

P wave is present, P wave before every QRS, QRS after every P, PR intervals are constant

Question 27

What is the most common congenital anomaly encountered in the adult population?

Answer 27

congenital aortic stenosis

Question 28

What is an atrial septal defect?

Answer 28

one of the most common congenital heart defects, it is a hole between the septum dividing the eft and right atrias. occurs in up to 25% of children. most of time it closes on its own, but if it is big they use a patch to close it

Question 29

what is a ventricular septal defect?

Answer 29

most common congenital abnormality associated with down syndrome and alcohol exposure. most of the time they spontaneously close. the murmur is hard, high-pitched, holosystolic murmur and is loudest at the lower left sternal border (sounds like two men pulling a saw).

Question 30

Rheumatic heart disease

Answer 30

mostly causes mitral valve changes, but can cause aortic regurgitation or stenosis. It causes mitral valve prolapse - mid systolic click. mitral valve regurgitation sounds like systolic murmur heard at apex radiating to the axilla

Question 31

what is paroxysmal supra-ventricular tachycardia?

Answer 31

intermittent episodes of regular, sudden-onset and spontaneously terminating tachycardia. It is the second most common tachycardia, following atrial fib

Question 32

what is PVC?

Answer 32

premature ventricular contraction, heartbeat initiated by the Purkinje fibers rather than the SA node. causes huge dip in the ECG reading

Question 33

What are PACs?

Answer 33

premature atrial contractions. early contraction of atrium, can double up with the t wave.

Question 34

heart block poem

Answer 34

if the r is far from p, then you have a first degree
longer longer longer drop, then you have a wenkebach
if some Ps don’t get through, then you have a mobitz II
if the Ps and Qs dont agree, then you have a third degree