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TxPlan/MedComplex/SpecNeeds > MedComplex-CardioVascular1 > Flashcards

MedComplex-CardioVascular1 Flashcards

1
Q

MI: An ANTERIOR wall infarct is typically caused by occlusion of the _________ artery.

A

left anterior descending coronary

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2
Q

MI: An infarct of the LATERAL wall of the left ventricle is usually caused by occlusion of the __________ artery.

A

left circumflex coronary

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3
Q

MI: An infarct of the right ventricle and POSTERIOR wall of the left ventricle is usually caused by occlusion of the ________ artery.

A

right coronary

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4
Q

What are the three main arteries that supply blood to the heart?

A

1.Right Coronary Artery (Posterior Supply) 2.Left Anterior Descending Artery (Anterior supply) 3. Left Circumflex artery (Lateral supply)

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5
Q

Please rank the frequency of occlusions in the three main coronary arteries..

A
  1. over 50%- Left Anterior Descending 2. 30-40%- Right Coronary Artery 3. 10-20%-Left Circumflex Artery
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6
Q

What are the three complications of an MI?

A

1.Myocardial Rupture 2.Left Ventricular Aneurysm 3.Mural Thrombus

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7
Q

Complications of MI: Myocardial rupture will cause blood to fill around the heart and stay in the pericardial sac-called:

A

hemo-peri-cardium

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8
Q

Complications of MI: Myocardial Rupture will cause compression of the heart due to hemo-pericardium called:

A

Cardiac Tamponade

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9
Q

Complications of MI: How long after a myocardial rupture does cardiac tamponade take place and what is the limit for amount of blood that can surround the heart?

A

7-10 days post MI and 300-350cc’s

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10
Q

Complications of MI-Left Ventricular Aneurysm: The MI will cause _______ and _______ tissue to replace the infarcted myocardium which DOES NOT CONTRACT.

A

Granulation and Fibrous tissue

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11
Q

Complications of MI-Mural Thrombus: The _________ overlying the infarcted myocardium is often damaged and disrupted.

A

endocardium

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12
Q

Complications of MI-Mural Thrombus: What is the most common distant organ to be affected by the thrombus turning into an embolus?

A

the brain…(cerebral infarcts)

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13
Q

Acute MI-Rapid, sudden occlusion of a coronary artery, and 80-90% of TRANSMURAL infarcts are caused by _______ of a coronary artery.

A

thrombosis

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14
Q

Acute MI-Other causes (10-20%) include _______ of an embolized atherosclerotic plaque or prolonged ________.

A

ulceration…. vasospasm

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15
Q

Acute MI-Sudden cardiac death occurs in approx. ___% of cases, in most cases this is a consequence of a major cardiac arrhythmia #1 cause of death–>(i.e. ________ ) or later complete heart block and pump failure.

A

25%….V-Fibrillation

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16
Q

MI-Among the 75% of patients who survive the onset of an MI, most develop signs of heart failure and _______ shock.

A

cardiogenic

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17
Q

Most dangerous consequences of cardiogenic shock after the 1st MI are the consequences of __________ (lack of blood to THIS organ)

A

cerebral ischemia

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18
Q

Acute MI-Those that survive the 1st one… Any CEREBRAL ISCHEMIA that lasts longer than ________ irreversibly damages the brain, and the patient becomes decerebrate

A

a few minutes

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19
Q

Besides the brain, what is the other organ system MOST affected by an acute MI, and therefore must be treated in those 75% who survive the first MI.

A

KIDNEYS (oliguria, anuria are signs of renal failure)

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20
Q

What are the two types of MI’s?

A

1.Transmural 2.Subendocardial/INTRAmural

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21
Q

What kind of MI am I? The infarction involves all three layers of the heart, and usually involves the free wall of the left ventricle and/or the interventricular septum.

A

Transmural MI

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22
Q

What kind of MI am I? The infarction is usually concentric around the subendocardial layer of the left ventricle.

A

Subendocardial OR Intramural

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23
Q

Atherosclerosis and Dental Caries: The mechanism may be related to chronic low levels of ____________ in dental caries or periodontal disease and its effect on ________ integrity, plasma lipoproteins, and blood coagulation

A

gram-negative bacterial infections….endothelial integrity

24
Q

Atherosclerosis and Dental Caries: Dental caries and ischemic heart disease also share common etiologic factors- low socioeconomic state, smoking, and _______

A

diabetes

25
Q

Acute Endocarditis: What are the two “Organisms” (one bacterium, and then a group of bacteria) to blame here?

A

1.Staph Aureus 2.Gram negative bacteria

26
Q

Subacute Endocarditis: What is the “less virulent” group of organisms to blame here? What is an alternate name for this group?

A

Streptococcus Viridans (ALPHA-Hemolytic Strept)

27
Q

Which organism is responsible for the most cases of Prosthetic Valve Endocarditis? What are three other classes of organisms that can also be to blame?

A

Staph Epidermis….1) Enterococci 2) Gram negative bacteria 3) fungi

28
Q

Acute endocardidts location: A highly destructive infection of the ______-….also occurs in these two places:

A

valves (attacks a NORMAL heart valve)…ASLV (aortic semilunar valve), Aorta, Mitral Valve

29
Q

Which organism is responsible for IV drug abusers contracting acute endocarditis?

A

Virulent Staphylococcus species (Staph Aureus)

30
Q

What are the ____ skin lesions associated with infective endocarditis?

A

1.Petechiae (20-40% of pt’s) 2.

31
Q

Skin lesions associated with Infective Endocarditis-Cutaneous findings include Petechiae, present in 20- 40% of patients, frequently found in the ________, _______ and skin of ________.

A

conjunctiva, mucosa and skin of extremities

32
Q

Skin lesions associated with Infective Endocarditis- 6 of um…GO

A

1.Conjuntival Petechiae 2.Cutanious Petechiae 3.Subungal Linear Splinter Hemorrhages (under fingernails) 4.Red Splinter hemorrhages 5.Osler’s Nodes (bottom of toes) 6. Laneway Lesions (bottom of foot)

33
Q

What are the retinal changes seen in Infective Endocarditis?

A

Roth’s Spots

34
Q

_______ : which are found in the eyes due to retinal microemboli, appear as round white spots surrounded by hemorrhage.

A

Roth’s Spots

35
Q

What is this talkin’ bout? These endocarditis clinical findings are more UNCOMMON than in the past due to the SHORTENED clinical course of the disease as a result of antibiotic therapy…thank GOD

A

cutaneous and retinal findings of endocarditis

36
Q

Prophy Abx: New guidelines released from the American Heart Association now dictate that prophylactic antibiotics be used for those ____________… (vague answer, BUT more to come)

A

at highest risk of endocarditis

37
Q

Prophy Abx: Who are the 5 types of people who are at most risk for infective endocarditis?

A

1.Prosthetic heart valves 2.A history of infective endocarditis 3.Congenital Heart defects (or PROSTHETIC repair of CHD) 4.Valvulopathy post heart transplantation 5. IVDA’s

38
Q

Prophy Abx: The AHA recommends antibiotic prophylaxis before any dental procedure that involves manipulation of ______ tissue or the ________ region of teeth, or perforation of the oral ______…(e.g. ANY BLEEDING)

A

gingival, periapical, mucosa

39
Q

Prophy Abx: Excluded are routine dental ________ and anesthetic _______ through non-infected tissue, dental radiography, placement and adjustment of appliances, shedding of deciduous teeth, and bleeding from trauma to the _____

A

cleaning….injections…lips

40
Q

Prophy Abx: Regimens for dental prophylaxis should always be given HOW LONG before the procedure?

A

30-60 minutes

41
Q

Prophy Abx: Oral ________ remains the drug of choice

A

Amoxicillin

42
Q

Prophy Abx: For patients unable to take oral antibiotics, ________, cefazolin, or ceftriaxone can be used, either IM or IV

A

ampicillin

43
Q

INTERESTING::::Necrotic cell membranes become disrupted so that their intercellular contents is released into the ECF, causing ________, which can affect the membrane potentials of functioning myocardial cells, leading to conduction defects!!

A

Hyperkalemia

44
Q

WHICH MARKER? begins to rise within 2-4 hours of the onset of an MI, peaks at ___ hours, and returns to normal levels within 72 hours.

A

Creatine Kinase (CK)…24hrs

45
Q

What is the more specific dimer of CK found in the myocardium?

A

CK-MB

46
Q

What is the GOLD STANDARD in the diagnosis of MI? How long does it stay in the blood post MI?

A

Troponin’s…Troponin levels remain elevated for 7-10 days after the acute event

47
Q

“I would remember that” Diet may also play a role; a high consumption of ______ is considered an important factor in the etiology of dental caries, and has also been incriminated in the development of ___________

A

SUCROSE… atherosclerosis

48
Q

Endocarditis-DID YOU KNOW?? ______ vegetations tend to be larger than bacterial vegetations and are more commonly seen on the _____ side of the heart

A

FUNGAL…RIGHT (tricuspid)

49
Q

Endocarditis-____________: which are linear subungual hemorrhages, are seen as dark-red streaks beneath the nailbed.

A

Splinter Hemorrhages

50
Q

Endocarditis-________: are tender, small, raised, discolored cutaneous lesions, usually appearing on the pads of the fingers and toes.

A

Osler’s Nodes

51
Q

Endocarditis-________: small, erythematous or hemorrhagic lesions usually seen on the palms or soles.

A

Janeway lesions

52
Q

Endocarditis-Cutaneous findings include ________, present in 20- 40% of patients, frequently found in the conjunctiva, mucosa and skin of extremities.

A

Petechiae

53
Q

*“I’ll ask you this” What is the #1 complication of Endocarditis?

A

an embolism

54
Q

What % of endocarditis pathogens can be cultured to diagnose the culprit?

A

90%

55
Q

What is the progression of Staph/Strep/Candida in an IVDAbuser?

A

Tricuspid Valve (over 50%), if it gets past that, pulmonary embolism

TxPlan/MedComplex/SpecNeeds (21 decks)

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