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Apex > 3 Cardiac > Flashcards

3 Cardiac Flashcards

1
Q

S1: valve closure, what is happening in heart, sounds prop to

A

Mitral and tricuspid. Start of systole, end of lv fill and beginning of isovolumic contraction. Sounds louder w harder contraction

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2
Q

S2: valve closure, action in heart, sound prop to

A

Aortic and pulmonic. Onset of diastole, end of lv ejection. Sound louder w htn

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3
Q

S3: suggests what, heard when

A

Gallop rumble= flaccid and inelastico heart. After S2 mid diastole

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4
Q

S4: when it occurs and caused by what

A

Atrial systole, before s1

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5
Q

Layout of sarcomeres in stenosis v regurg

A

Stenosis= in parallel. Regurg= in series

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6
Q

How pressure vol loop changes w AS

A

Inc height and shift right q

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7
Q

When it is important to listen to murmur of AS and why

A

Elderly, before spinal. Pts asymptomatic until LV dysfunction develops

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8
Q

How a line waveform diff in AS

A

Slower systolic upstroke (pulsus tardus) and a delayed peak. SV reduction= narrow PP with small amplitude (pulsus parvus). May not have a dicrotic notch/look dampened

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9
Q

When mitral stenosis is severe

A

Valve area <1, LAP-LV p gradient >10, PAP SBP >50

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10
Q

What happens in mitral stenosis

A

LA overfilled, LV underfilled, lower SV/end diastolic volume, body compensates w inc SVR. LA overload leads to afib

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11
Q

Pressure vol loop mitral stenosis

A

Lower, same width, shift left

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12
Q

HR consid mitral stenosis

A

Tx tachyarrythmias. Avoid drugs that inc hr like ketamine, atra, or anticholinergic. Otherwise may lead to pulm edema

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13
Q

PAOP waveform in mitral stenosis. How to tx LAP issue

A

Diuretics. Prominent a wave and dec y descent

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14
Q

DOC for hypotension in MS, drug to avoid

A

Vaso or neo, not ephedrine

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15
Q

When it is ok to do a spinal in mitral stenosis

A

If INR <1.5. Epidural preferred

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16
Q

Mitral regurg pressure vol loop acute and chronic

A

Both lower, wider, shifted slightly right (acute more than chronic). Acute shorter, less width, and more right than chronic overall

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17
Q

Paop waveform mitral regurg

A

Large v wave

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18
Q

SAM is a risk after which valve repair, treatment

A

Mitral valve repair. Inc vol and afterload w alpha agonist

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19
Q

Conditions that inc PVR

A

Hypercarbia, hypoxia, tburg, nitrous, lung hyperinflation, acidosis

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20
Q

When cardiologia must be injected retrograde

A

Aortic regurg

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21
Q

Pressure vol loop aortic regurg

A

Wide, shifted right, slanted

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22
Q

Bad choices for hypotension in AI

A

Neo or vaso

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23
Q

AI: spinal fx

A

Will reduce afterload and regurg fraction

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24
Q

AI ABP waveform

A

Sharp upstroke, low DBP, wide PP. may have biphasic systolic peaks/bisferiens pulse

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25
Q

AS when murmur heard and where, how it can vary

A

Systole, right sternal border. May feel as a thrill and may dec with severity

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26
Q

AI: when murmur heard, wher

A

Diastolic, right sternal border. Blowing murmur less loud than AS

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27
Q

MS: when murmur heard and where

A

Diastolic, L apex and L Scilla. Snap/rumble

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28
Q

MR: when murmur heard and where

A

Systolic, l apex and l axilla. Swishing holosystolic murmur

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29
Q

Where sarcomeres are replicated in MS

A

Left atrium

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30
Q

Things to avoid in MV prolapse

A

SNS stim, dec SVR, low vol, upright positions. No ketamine

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31
Q

Primary determinant of RMP. What happens when it decreases or increases

A

K. Dec= RMP more neg, harder to depolarize. Inc= rmp more pos and easier to depolarize

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32
Q

Ventricular AP phases

A

Phase 0 na in (depolarization), phase 1 initial repol k out cl in, phase 2 plateau ca in k out, phase 3 final repol k out ca briefly in, phase 4 rmp k in na out

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33
Q

PNS vs sns tone in heart

A

PNS vagus n, rt= sa and left= av node. SNS= T1-4

34
Q

How av node AP looks diff from SA node

A

Lower slope during phase 4 which leads to slower intrinsic firing rate

35
Q

SA node AP phases

A

4 spont depol (na in ca in, funny current, -60), 0 depol ca in, phase 3 k out repolarization

36
Q

How heart rate changes

A

Rate of spont 4 depol (can inc w sns stim), tp (more neg= shorter distance), rmp (less neg= shorter distance). PNS fx phase 4 and rmp

37
Q

How to calc DO2

A

CO x ((hgb x sao2 x 1.34) + (pao2 x 0.003)) x 10

38
Q

Normal do2, normal o2 extraction, extraction ratio

A

1000 ml/min, 250 ml/min, 25%

39
Q

Normals: Ca02, EO2, VO2, CvO2

A
  1. 25%. 250 ml/min. 15 ml/dl
40
Q

How to calc map

A

(CO X SCR)/80 + CVP

41
Q

Pouiseilles law

A

Flow= pi x r4 x change in pressure / 8xnxl

42
Q

Effect of doubling radius on flow

A

16 fold

43
Q

How reynolds number correlates to flow type

A

<2000= laminar, >4000= turbulent, in between= transitional

44
Q

Dihydropyrodines v non

A

Dyhydro targets vascular smooth muscle. Non dihydro targets myocardium

45
Q

More likely in constrictive than in acute pericarditis

A

Kussmauls sign, pulsus paradoxus, atrial dysrhythmias

46
Q

Pulsus ____ more likely in pericardial tamponade

A

Pulsus paradoxus, SBP decreases on insp

47
Q

How long to delay elective sx after a BMS V drug eluding

A

Bare= 30 days. Des= 6 mo if current, 12 months if 1st gen

48
Q

Act goal before bypass

A

400 seconds

49
Q

Protamine dose

A

1 mg per 100u of heparin

50
Q

When to wait for elective surgery after an mi

A

4-6 weeks

51
Q

Factors that dec myo 02 delivery

A

Hi hr, dec aortic p, dec vessel diameter, inc edp, dec CaO2, l shift 02 dissoc curve/dec p50

52
Q

Best leads to monitor for st changes on nml ekg

A

V3 >v4 >v5>II>avf

53
Q

Pts w cad: 5 lead v 3 lead best to watch for st

A

5: v4, avf, mcl5, or III. 3: avf, mcl5

54
Q

Ventricular compliance

A

Ventricle vol / ventricular pressure

55
Q

How compliance effects the curve

A

Decreased shifts up and left, increased shifts down and right

56
Q

Hallmark of systolic HF

A

Decreased EF with an inc EDV

57
Q

Hallmark diastolic HF

A

Symptomatic Hf w normal EF

58
Q

Systolic HF causes

A

MI, regurg, dilated cm

59
Q

Diastolic HF causes

A

Mi, stenosis of valves, htn, HOCM, cor pulm, obesity

60
Q

Suffix that goes w: ang II receptor antag, ARB

A

ANG II= Spartan, arb- zosin

61
Q

Dilator that targets A and V equally

A

SNP

62
Q

Dihydropyridine ending and types of rx

A

Dipine, vasculature

63
Q

Ccb contractility impair most to least

A

Verapamil, nifedipine, dilt, nicardipine

64
Q

What cardiac tamponade looks like on pressure volume loop

A

Shift left, narrower, smaller. Dec volume and compliance

65
Q

Kussmauls sign

A

Inc cvp and JVD on inspiration

66
Q

Drugs to avoid in tamponade

A

IAs, prop, tpl, opioids, regional

67
Q

Safer drugs in tamponade

A

Ketamine, nitrous, benzos, low dose opioids

68
Q

Hemodynamic goals in tamponade

A

Maintain HR, Maintain/inc preload, maintain/inc contractility, maintain afternload

69
Q

Conditions that distend LVOT/make HOCM better

A

Inc volume, dec contractility, inc AO pressure

70
Q

Conditions that make HOCM worse

A

Dec vol, inc contractility, dec AO pressure

71
Q

How long to wait after angioplasty without stent

A

2-4 weeks

72
Q

How long to wait for sx after a cabg

A

6 weeks

73
Q

When to d/c before sx: asa, plavix, ticlid

A

3 days, 7 days, 14 days

74
Q

Where distal tip IABP should be

A

2cm distal to L subclavian A

75
Q

IABP balloon deflation occurs when on ekg

A

R wave

76
Q

Aortic pressure differences with and without IABP

A

IABP decreases EDP and SBP

77
Q

Coronary perf pressure

A

Aortic DBP - LVEDP

78
Q

CBF autoreg range

A

60-140

79
Q

Things that decrease 02 delivery

A

Tachycardia, dec aortic pressure, dec vessel diameter, inc edp, hypoxemia, anemia, L shift/dec p50, dec capillary density

80
Q

Things that inc 02 demand

A

Tachy, htn, sns, inc wall tension, inc EDV, inc afterload, inc contractility

Apex (21 decks)

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