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CCP S2 > 216 Cardiovascular Emergencies > Flashcards

216 Cardiovascular Emergencies Flashcards

1
Q

List the vasculature that branches off the aorta from the base of the aorta, through the ascending aorta and the aortic arch

A

-R coronary
-L coronary
-brachiocephalic trunk (splits into: R subclavian & R common carotid)
-L common carotid
- L subclavian

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2
Q

List the vasculature that branches off the aorta in the descending thoracic aorta

A

-bronchial
-mediastinal
-esophageal
-pericardial
-superior phrenic
-intercostal and subcostal

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3
Q

List the vasculature that branches off the aorta in the abdominal aorta

A

-inferior phrenic
-celiac (splits into: L gastric, splenic, common hepatic)
-superior mesenteric
-middle suprarenal
-renal
-gonadal (testicular or ovarian)
-inferior mesenteric
-median sacral
-lumbar

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4
Q

define aortic dissection

A

a separation of the layers of the wall of the aorta due to an intimal tear

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5
Q

What do the bronchial arteries supply?

A

bronchi, bronchioles, lung tissue

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6
Q

What do the pericardial arteries supply?

A

pericardium

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7
Q

What do the esophageal arteries supply?

A

esophagus

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8
Q

What do the mediastinal arteries supply?

A

mediastinal structures

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9
Q

what do the intercostal arteries supply?

A

vertebrae, spinal cord, back muscles, body wall, skin

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10
Q

What do the superior phrenic arteries supply?

A

vertebrae, spinal cord, back muscles, body wall, skin, diaphragm

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11
Q

What do the inferior phrenic arteries supply?

A

diaphragm, inferior portion of esophagus

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12
Q

What does the left gastric artery supply?

A

stomach, adjacent portion of esophagus

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13
Q

What does the splenic artery supply?

A

spleen, stomach, pancreas

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14
Q

What does the common hepatic artery supply?

A

Liver, stomach, gallbladder, duodenum, pancreas

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15
Q

What does the superior mesenteric artery supply?

A

pancreas, small intestine, appendix, first 2/3 of large intestine

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16
Q

What does the inferior mesenteric artery supply?

A

last 1/3 of the large intestine

17
Q

What do the suprarenal arteries supply?

A

Adrenal glands

18
Q

What do the renal arteries supply?

A

Kidneys

19
Q

What do the gonadal arteries supply?

A

Testes or ovaries

20
Q

What do the lumbar arteries supply?

A

Vertebrae, spinal cord, abdominal wall, lumbar region

21
Q

What is a Stanford Type A dissection? Which De Bakey classifications fall into it?

A

Aortic dissection involving the ascending aorta. May progress to involve aortic arch and thoracoabdominal. De Bakey Type 1 and Type 2 fall into this category. These are always surgical emergencies

22
Q

What is a Stanford Type B dissection? Which De Bakey classifications fall into it?

A

Aortic dissection involving the descending thoracic or thoracoabdominal aorta distal to the L subclavian artery without involvement of the ascending aorta. De Bakey Type 3a and Type 3b fall into this category. Likely can be managed medically.

23
Q

define De Bakey Type 1 dissection

A

Involves ascending aorta, aortic arch, descending thoracic aorta and may involve the abdominal aorta

24
Q

define De Bakey Type 2 dissection

A

Involves the ascending aorta only

25
Q

define De Bakey Type 3a dissection

A

Involves the thoracic aorta distal to the L subclavian and proximal to the celiac artery

26
Q

define De Bakey Type 3b dissection

A

Involves the thoracic and abdominal aorta distal to the L subclavian and distal to the celiac artery

27
Q

Describe the pathophysiology of an aortic dissection

A

An initial tear occurs in the intima of the aorta. Blood at high pressure passes through the tear and separates the intima from thee media and/or adventitia, creating a false lumen which can spread proximally or distally and whatever arteries that branch off the aorta that are affected will often cause associated symptoms.

28
Q

What is the difference between an uncomplicated and complicated Type B aortic dissection?

A

Considered complicated if there is evidence of poor perfusion, rapid expansion, impending or frank rupture, uncontrolled pain or refractory hypertension (refractory to 3 or more antihypertensives at max dose)

29
Q

What are risk factors for aortic dissection?

A

HTN, atherosclerosis, prior cardiac Sx, aortic aneurysm, connective tissue disorder (Marfan’s, Loeys-Dietz syndromes), bicuspid aortic valve, prior aortic Sx.

30
Q

What are the S/S of aortic dissection?

A
  • sudden onset severe pain to the anterior chest, may radiate to neck, back, abd and may migrate.
  • comparison of bilat carotid, subclavian or femoral pulses shows different strengths
  • aortic valve regurg (diastolic murmur)
  • signs of cardiac tamponade
  • signs of ischemic stroke, spinal cord ischemia, ischemic neuropathy, hypoxic encephalopathy
  • ECG: type A can cause coronary ischemia (RCA most common)
  • CXR: widened mediastinum, unexplained pleural effusion
31
Q

Causes of R axis deviation on ECG

A
  • RVH
  • Acute RV strain (i.e. PE)
  • Lateral STEMI
  • Chronic lung disease (COPD)
  • HyperK
  • Sodium-channel blockade (TCA OD)
  • WPW
  • Dextrocardia
  • Ventricular ectopy
  • L posterior fascicular block (diagnosis of exclusion)
  • Normal pediatric ECG
32
Q

Causes of L axis deviation on ECG

A
  • LVH
  • LBBB
  • Inferior MI
  • Ventricular pacing/ectopy
  • WPW
  • L anterior fascicular block (diagnosis of exclusion)
33
Q

Causes of extreme axis deviation on ECG

A
  • ventricular rhythms
  • HyperK
  • severe RVH
34
Q

List the components of the cardiac electrical conduction system

A
  • SA node
  • AV node
  • Bundle of HIS
  • L and R bundle branches
    • L divides into anterior, septal and posterior fascicles
  • Purkinje fibres
35
Q

What properties of vasculature will differentiate arteries vs veins on ultrasound?

A
  • veins are compressible
  • arteries are pulsatile
  • arteries will have a thicker wall due to the musculature
36
Q

Describe the cardiac action potential

A

-Phase 0: Rapid depolarization. Cell is brought to threshold, Na+ channels open, Na+ rapidly enters the cell and the cell becomes positively charged around +45mV. Ca2+ channels also open during depolarization but the Ca2+ moves into the cell much slower than the Na+
-Phase 1: Initial repolarization. K+ channels open and K+ moves out of the cell.
-Phase 2: Plateau. Ca2+ enters the cell and K+ leaves the cell.
-Phase 3: Repolarization. Potassium moves out of the cell and the cell returns to -90mV.
-Phase 4: Na+/K+ pump maintains resting membrane potential at -90mV

37
Q

Define preload

A

the particular stretch of LV myocardial fibers at end-diastole, which is determined by the resting force, myocardial compliance and degree of filling from the LA.

38
Q

Define afterload

A

The impedance during ejection. (or) The wall stress in the ventricle during contraction. Wall stress is the tension in any one myocyte during contraction.

CCP S2 (19 decks)

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