Week 10 Flashcards
angina pain can be felt from __
ear lobe to epigastric
coronary flow reserve assessed using __
Glagov’s coronary remodeling hypothesis
how does stress test assess coronary flow reserve
exercise > increased HR & BP > hyperaemic response > augmented coronary flow
what happens during sub total occlusion of acute coronary syndrome
sub-total occlusion > sub-endocardial ischaemia > sub-endocardial infarction
what happens during total occlusion of acute coronary syndrome
total occlusion > transmural ischaemia > transmural infarction
what does ST elevation mean
transmural ischaemia
what does ST depression mean
subendocardial ischaemia
what does non-Q wave mean
subendocardial infarction
what does Q wave mean
transmural infarction
what are pharmacological interventions for acute coronary syndrome
anti-thrombotics
statins
beta-blockers
ACE-I/ARB
revascularization
what does MPI mean
myocardial perfusion imaging
where are the rhythmic contractile myocardial cells found
myocardium
BP formula
cardiac output x peripheral vascular resistance
systolic BP measured during __
ventricular contraction
diastolic BP measured during __
relaxation
preload is recorded __
volume at end diastole
afterload is recorded __
force needed for ejection
key arteries of the heart are __
- left anterior descending artery
- left circumflex artery
- right coronary artery
types of acute coronary syndrome
unstable angina = ischemia without infarction
NSTEMI = sub-endocardial infarction
STEMI = full-thickness infarction
what are the findings of aortic stenosis
murmurs, reduced valve area
what are the findings of mitral regurgitation
murmurs, left atrial enlargement
how to manage aortic stenosis
valve replacement
Transcatheter Aortic Valve Implantation
how to manage mitral regurgitation
repair
mitraclip
what are vasodilators used for
reduce pre/after load
what are beta blockers used for
lower HR & BP
what are Ca2+ channel blockers used for
angina & hypertension
what are diuretics used for
increase urine output, reduce edema
what are ACE inhibitors
decrease BP & afterload
what are statins
lowers LDL & cholesterol
what are the different diagnositcs used
ECG
stress test
imaging
blood tests
what are ECGs used to detect
arrhythmias, ischemia, infarction
what are stress tests used to evaluate
coronary flow reserve
what are the different imaging methods
x-rays for cardiac size, echocardiogram, angiography
what blood tests are used for heart
troponins, lipid profiles
what is the pathophysiology of coronary artery disease
atherosclerosis / plaque build up leading to ischemia
what is angina
recurrent chest pain due to oxygen deficit
what is myocardial infarction
ischemia causing muscle necrosis
symptoms of heart failure
dyspnea
edema
fatigue
how many classifications of NYHA are there
stages I - IV
treatments for heart failure
diuretics, beta blockers, ACE inhibitors, aldosterone antagonists, digoxin
types of arrhythymias
sinus, atrial, ventricular
management of arrhythymias
ECG monitoring, anti-arrhythmic drugs, pacemakers, defibrillation
when is BP considered hypertension
> 140/90
how to manage hypertension
lifestyle changes, antihypertensives (ACE inhibitors, ARBs, beta-blockers)
what leads look at inferior wall of the left ventricle
Lead II, III, aVF
what leads look at high lateral wall of the left ventricle
aVL, Lead I
what leads look at anterior wall of left ventricle
V1 - 6
x-ray indications of heart failure
perihilar congestion
upper zone venous congestion
Kerley B lines
cardiomegaly
pleural effusion
different modes used on echocardiography
2D echo, M-mode Echo, Colour Flow Doppler, Spectral Doppler
what parts of the heart are involved in ICDs
RA, RV, LV
HF is a syndrome characterized by
- elevated cardiac filling pressure
- inadequate peripheral o2 delivery due to dysfunction
pulmonary edema
fluid accumulation in lungs
pleural effusion
fluid accumulation around lungs
what does parasternal short axis view assess
RV & LV
how is LV ICD implanted
through coronary sinus vein
secondary management of HF includes
- less water intake
- less salt intake
- exercise
what is electrical flow of the heart
sinoatrial node > atrioventricular node & Bachmann’s bundle > right & left bundle branch
when is atrial fibrillation considered paroxymal
< 48 hrs
AF management involves
rate control, rhythm control, prevent thromboembolism
which drug is the most effective for rate control
beta blockers
why should digoxin be reserved for those with systolic HF
poor rate control during exertion
AV nodal blocking drugs can be used to control __
ventricular response
what is the most effective anti-arrhythmic drug but is highly toxic and reserved as last resort
amiodarone
patients taking amiodarone should be monitored for __
thyroid, hepatic & pulmonary toxicity
bradycardia causes
permanent structural damage to bundle branches
bradycardia associated with
extensive anterior myocardial infarction / sclerodegenerative conduction disease
site of conduction block is __
below His Bundle
AVNRT
atrioventricular nodal reentrant tachycardia
what is AVNRT very responsive to __
AV nodal blocking agents such as beta blockers, Ca2+ channel blockers, adenosine
what forms the 4 heart valves
endocardium
stroke volume
volume of blood pumped from the ventricle in one contraction
cardiac output
volume of blood ejected by the heart in 1 minute
cardiac reserve
ability of heart to increase cardiac output in response to increased demand
preload
volume of blood in the ventricle at the end of diastole (ventricle at largest volume)
issues related with increased preload
hypervolemia, HF, regurgitation
issues related with increased afterload
hypertension, vasoconstriction
what are the 3 layers of arteries & veins
inner to outer
- tunica intima
- tunica media
- tunica externa/adventitia
what triggers vasodilation
acidosis, hypoxia release of histamine, increased temperature
what acts as beta1-adrenergic receptors in heart to increase HR & contractility
Sympathetic Nervous System & epinephrine
what stimulates alpha1-receptors in arterioles
SNS, epineprhine, norepinephrine
atherosclerosis characterized by
persistent inflammation, platelet aggregation, enlarging thrombus formation
atheroma in coronary arteries lead to __
angina / myocardial infarction
ahteroma in carotid arteries lead to __
transient ischemic attack / cerebral vascular accidents
myocardial fiber in necrotic area is replaced by __
non-functional fibrous tissue after 7 days
tachycardia
rapid HR
bradycardia
low HR
sick sinus syndrome
alternating bradycardia & tachycardia
atrial flutter
atrial rate 160 - 350 bpm
atrial fibrillation
atrial rate > 350 bpm
what is effect of cardiac arrhythmias
reduces cardiac pumping efficiency
anti-arrhythmic drugs
beta1-adrenergic blockers, Ca2+ channel blockers, digoxin
AV node abnormalities
1st, 2nd, 3rd heart blocks
ventricular conduction abnormalities
- premature ventricular contractions
- bundle branch block
- ventricular tachycardia
- ventricular fibrillation
Ca2+ antagonist end with
-pine
ACE inhibitors end with
-pril
angiotensin receptor blockers end with
-sartan
beta-blockers end with
-lol
what is not recommended combination between blockers
angiotensin receptor blockers & ACE inhibitors
digoxin is what type of cardiac med
cardiac glycoside
