Cardiac Flashcards
(123 cards)
1
Q
P wave
A
atrial depolarization
2
Q
QRS complex
A
ventricular depolarization and atrial repolarization; contraction of the ventricles
3
Q
T wave
A
ventricular repolarization; ventricles return to resting state
4
Q
ventricular gallop
A
S3
5
Q
atrial gallop; rapid firing of the atria
A
S4
6
Q
When do you hear S3?
A
right after S2
7
Q
When do you hear S4?
A
right before S1
8
Q
Systolic murmurs
A
could or could not be bad;
MR PASS MVP: mitral regurg physiologic aortic stenosis systolic mitral valve prolapse
9
Q
diastolic murmurs
A
always bad!
MS ARD: mitral stenosis aortic regurg diastolic
10
Q
stenosis
A
- valve is stiff and doesn’t allow blood to get through
- valve will not open all the way
- harder to get blood through
- hear murmur when the valve is open
11
Q
regurgitation
A
- blood goes backwards
- the valve doesn’t close all the way
- it leaks when it is closed
- hear murmur when closed
12
Q
location of the apical pulse
A
5th or 6th intercostal space at the midclavicular line
13
Q
Problem with jugular vein distention
A
right sided HF
14
Q
bruit in the carotid artery
A
send to the ER- stroke is imminent
15
Q
small or weak pulse
A
hypovolemia, HF, poor circulation
16
Q
large, bounding pulse
A
heart block, fever, anemia, compensatory, or lack of O2, hyperthyroidism
17
Q
bisferiense
A
double systolic peak in pulse
from aortic regurg, combined aortic stenosis and regurg, or hypertrophic cardiomyopathy
18
Q
pulsus alternans
A
- regular rhythm but changes in amplitude
- goes with L sided HF
- should also hear S3 sound
19
Q
bigeminal pulse
A
regular irregular rhythm
-very important bc its tells us if someone is having a PVC (premature ventricular contraction)
20
Q
paradoxical pulse/ pulsus paradox
A
decreases in strength with inspiration, gets strong with expiration;
- on inspiration, R heart fills with extra blood, then L ventricle is compressed and cannot accept much blood; L ventricle cannot pump much blood on the next heartbeat- systolic pressyre decreases
- COPD or cardiac tamponade
- need thoracentesis STAT
21
Q
hemostasis
A
stoppage of blood flow in 5 stages:
1) vessel spasm
2) formation of the platelet plug
3) development of a blood clot
4) clot retraction
5) clot dissolution
22
Q
normal platelets
A
150,000-450,000
23
Q
reasons someone would have thrombocytopenia
A
Leukemia
HIV
bone marrow disfunction
24
Q
signs of thrombocytopenia
A
platelets less than 100,000
petechiae
25
thrombocytopathia
impaired platelet function
| -most commonly from aspirin, NSAIDs, and Von Willobrand
26
antibody buildup to platelets
| -how to treat
ITP- Immune Thrombocytic Pepura
| -treat with platelets and steroids to drecrease antibodies that are trying to attack them
27
COX-1
catalyzes production of thromboxame A2
| effects platelets
28
COX-2
catalyzes production of prostacycline
| effects pain and inflammation
29
Effect of Von Willebrand disease on the platelets
decreased platelet adhesion
30
DIC
- disseminated intravascular coagulation
| - ultimate outcome is bleeding
31
hemolytic anemia
premature destruction of RBCs; when RBC destruction occurs in the bood
-if there's too much Hg in the blood, free Hb causes hemoglobinemia and you turn red; excreted Hg in the urine causes urine to be darker in color (hemoglobinuria
32
why is malaria called "black water fever"
the urine turns so dark from the blood cells bursting intravascularly
33
RBCs are made in the ___ and destroyed in the ___
bone marrow; spleen
34
erythropoietin is made in the ___; its function is ___
kidneys, and it stimunates the bone marrow to produce RBCs
35
how much blood can we loose without symptoms in slow blood loss?
50%
36
iron deficient anemia
hypochromic and microcytic
37
megaalobloastic anemia
big cells- people with vitamin b12 deficiency
- if you're born with it, its pernicious anemia
- most common reason is alcoholism- look at the mean corpuscular volume
38
what helps sickled cells move along better
fluids
39
G6PD deficiency
Glucose-6-phosphate dehydrogenase is a RBC ezyme whose function is to protect hemoglobin from oxidation
-deficiency is inherited and leads to hemolytic anemia
40
Thalassemias
inherited diseases that cause anemia; deficiency in Hb due to decreased synthesis of the effective chain and increased synthesis of the ineffective chain
41
Alpha thalassemia
defective alpha chain
- 1 to 4 defective genes
- could effect fetus or adult
- most common in asians
42
Beta thalassemia
beta- defective gene
- >100 different mutations
- only effects adults
- major type needs regular blood transfusions because of too much iron- give Desperol that will bind to iron or bleed them
43
aplastic anemia
bone marrow depression; stops the bone marrow from functioning at all- need bone marrow transplant
44
iron deficiency anemia
```
blood loss or deficient diet
low Hg and hematocrit
hypocromic and microcytic erythrocytes
Poikilocytosis (irregular shape)- oblong
Anisocytosis (irregular size)- microcytic
```
45
Polycythemia
increased RBC count and hematocrit >50%
| -person would look red
46
relative polycythemia
loss of plasma colume
47
absolute polycythemia
increased red cell mass
48
primary neoplastic polycythemia
making too many RBCs, treated by phlebotomy (remove a lot fo the cells about every 4 months)
49
Why worry about too many RBCs?
cardiac output- too many RBCs increases resistance and decreases afterload
50
can you have polycythemia and shock? why?
yes. you usually do bc you're losing volume but maybe not cells- most commonly in distributive shock
51
all types of polycythemia can be caused by....
high altitude, chronic lung disease, smoking
52
LDL transports cholesterol from ____ to ___
the liver to the cells
53
HDL transports cholesterol from ____ to ____
the cells to the liver
54
atherosclerosis
LDLs are oxidized and deposited and become plaque
55
unstable plaques
have thin, fibrous caps
- plaques can rupture ---> clot forms
- may completely block the artery
- may break free and become an embolus
56
PAD (peripheral arterial disease
atherosclerotic blockages of the large arteries in the peripheries
-lots of amputations with PAD
57
thromboangitis obliterans (Buerger disease)
nonatherosclerotic inflammation and thrombosis
| -small and medium sized arteries and veins
58
Raynauds
intense vasospasms
59
aneurysm
wall of the vessel stretches and weakens
60
true aneurysm
wall is weak but intact
61
false aneurysm
there is a tear in the artery and the aneuysm is actually a tear and clot that forms
62
berry aneurism
dilation of bifurcation
| -happens in the circle of willis- you have a stroke and possibly death
63
fusiform aneurism
has to do with the shape
| -involves the entire circumference of the cessels
64
dissecting aneurysm
nearly always fatal because blood is just pouring out
65
pulse pressure
systolic-diastolic
- normal is 30 to 40
- if pressure is higher, the heart is working much harder
66
lower or more narrow PP
decreased stroke volume and CO
67
higher or wider PP
increased stroke volume or CO
| -can be from stiff arteries, aortic regurg, pregnancy, increased cranial pressure
68
mean arterial pressure
1/3 systolic + 2/3 diastolic
- mean arterial pressure of 120/80 is 93
- normal is 70-105
69
cardiac output
HR x stroke volume
- stroke colume- 1cc/kh... about 70 avg
- normal CO is about 5 liters/min
70
blood pressure
CO x peripheral resistance
71
hypertensive urgency
high BP , but not to 180/120... no organ damage
72
hypertensive emergency
BP greater than 180/20... organ damage
73
Preeclampsia
HT after 20 weeks, proteinuria, and PT 140/90
- seizures from eclampsia lead to death
- deliver is the only safe cure
74
proteinuria
protein spilling into urine
75
gestational hypertension
BP 140/90, no proteinuria
| worried about preeclampsia being developed
76
enzyme that points to MI
elevated troponin
77
acute coronary syndrome (ACS)
- ECG changes- T-wave inversion (different from MI, which has abnormal Q wave)
- troponin released from necrotic cells
78
acute myocardial infarction
chest pain, sympathic response (GI upset, tachy, vasoconstriction, anxiety, doom), hypotension, shock
79
widow maker
having an dMI in the lateral ascending artery, which supplies blood to the septum of the heart
80
chronic ischemic heart disease
imbalance in the blood supply and the hearts demand for oxygen
- less blood- atherosclerosis and vasospasm
- higher O2 demand- stress, cold, exercise
81
chronic stable angina
- pain when the heart's oxygen demand rises
- you're fine unless you run to your car
- treat with rest and nitro
82
silent myocardial ischemia
myocardial ischemia without pain
83
variant/ vasospastic angina
- pain when coronary arteries spasm
- usually occurs at rest
- when pt says "i woke up with pain in my chest"
84
which side of the heart is failing with pitting edema
Right
85
which side of the heart is failing with paroxysmal nocturnal dyspnea
left- mitral stenosis
86
which side of the heart is failing with congested liver
right
87
which side of the heart is failing with distended jugular vein
right
88
which side of the heart is failing with productive cough with frothy, pink sputum
Left
89
pericarditis manifestations
inflammation of the pericardium:
- pain and exudate and subsequent restriction of the heart's movement
- pain when pt moves position
- ECG changes
- FEVER (different from MI)
- cough
90
serous exudate in pericarditis
cardiac tamponade: rapid accumulation of exudate compresses the heart
91
fibrous exudate in pericarditis
causes friction rub; adhesions
| -sounds like rubbing fingers up to your ear
92
pericardial effusion
serous exudate filling the pericardial cavity
-->restricts the heart's expansion
-->L ventricle cannot accept enough blood
-->decrease CO
-->decreased BP and shock
OR
-->R ventricle cannot accept enough blood
-->increased venous pressure
-->jugular distension
93
constrictive paricarditis
fibrous scar tissue making the pericardium stick to the heart
94
cardiomyopaty
chronic disease of the heart muscle
95
hypertrophic cardiomyopathy
genetic; defects in contractile proteins make cells too weak
- cells hypertrophy to do the same amt of work as other cells
- needs more oxygen and performs less effeiciently
- sudden death of many young athletes
- tell if your kid has it if their PMI is in the 6th or 7th intercostal space instead of 4th or 5th
96
arrhythmogenic cardiomyopathy
genetic;
| causes right ventricular tachycardia
97
dilated cardiomyopathy
genetic and aquired;
most common cause of HF and heart transplant;
big, floppy heart, walls are not very muscular and very poor pump
98
restrictive cardiomyopathy
genetic and acquired;
heart becomes stiff
radiation and tumors
99
myocarditis
acquired cadiomyopathy;
| inflammation of the heart
100
peripardum cardiomyopathy
acquired;
| 1 month before or after giving birth; at risk if older when giving birth or if taking supplements to get pregnant
101
takotsubo
acquired cardiomyopathy; caused by stress, often seen in women;
ventricle balloons out
102
shunt
opening or connection that lets blood move from one side of the circulation to the other
103
ductus venosus
lets blood flow from the visceral veins to the vena cava, bypassing the liver;
left to right
104
foramen ovale
lets blood flow from the right atrium to the left atrium bypassing the lungs;
right to left
105
ductus arteriosus
lets blood flow from the pulmonary trunk to the aorta to bypass the lungs;
right to left
106
in left to right shunts...
less blood goes to the body
| more blood goes to the lungs
107
in right to left shunts...
deoxygenated blood goes to the body
| less blood to the lungs
108
arterial septal defects
blood will flow from high to low pressure;
| left to right
109
ventricular septal defects
blood will flow from high to low pressure;
| left to right
110
pulmonary stenosis
increased right sided pressure bc blood can't get out of the pulmonary valve
111
coarctation of the aorta
narrowing of the aorta;
- symptomatic is L sided HF
- BP is high in arms and low in legs
- causes intermittent claudication (low blood supply to lets and feet, causing them to be painful and cold, esp when exercising)
112
frank starling
if the CO goes down the body with compensate- good for a moment, but bad long term
113
ejection fraction
net volume of blood per beat
- divide stroke volume by the end diastolic volume
- normal is about half the blood in the ventricle... need at least half to get out or you have HF
- systolic measure
114
chain stoke breathing
start with shallow breaths and get deeper and deeper, then shallow, then no breathing, and over again
115
manifestations of HF
- dependent edema and ascites
- anorexia, GI distress, weight loss
- impaired liver function
- activity intolerance and signs of decreased tissue perfusion
- cyanosis and signs of hypoxia
- cough with frothy sputum
- orthopnea
- parolysmal nocturnal dyspnea
116
manifestations of left sided HF
body lacks blood
| lungs fill with blood (pulmonary edema)
117
manifestations of right sided HF
body fills with blood
| lungs do not oxygenate enough blood
118
hypovolemic shock
most common kind of shock;
- acute blood loss volume (15%)
- anything than causes fluid loss
- huge sympathetic trigger
- if we lose more than 40% of volume- death
119
cardiogenic shock
heart fails to pump blood adequately
- bc of MI, sustained arrhythmias, cardiac surgeries
- "normal volume shock"
- decreased CO lowers BP
- sympathetic response, but vasoconstriction increases resistance causing increase work on the heart, furthering HF
120
distributive or vasodilatory shock
blood vessels dilate- massive dilation= loss of tone
- loss of tone from neurogenic shock or nanphylaxis (all fluid goes to the skin)
- not enough blood to fill the circulatory system
- blood flow decreases
- less blood is returned to the heart
- less blood is circulated to the body
- if you don't have a changein BP after fluids, you're going to die
121
septic shock
infection gets into blood stream
- fever... **key to sepsis
- increased HR
- hypotension
- hypoxia
- increased WBCs
- -- give antibiotics
122
do this with all types of shock except cardiogenic
give fluids
123
5 major complications of shock
- acute respiratory distress syndrome
- acute kidney injury
- GI complications
- Disseminated Intravascular Coagulation (DIC)
- Multiple Organ Dysfunction Syndrome
