"Resistance" -pressure and stress the ventricle faces RV: PVR (pulmonary vascular resistance) - more sensitive LV: SVR (systemic vascular resistance) ⬆️afterload = ⬆️ myocardial O2 demand ⬇️afterload by ⬇️SVR (vasodilator, ⬇️ blood volume, repair leaky valve)

- equalization of pressures (RAP, PAD, PAOP) - large A waves and V waves=M pattern on waveform - hypotension

Cardiac Flashcards by Melanie Lepkowski

Prinzmetal angina

“Variant” or “vasoapastic angina”

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AICD

Automatic implantable cardioverter/ defibrillator

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Inferior wall MI

12 lead: II, III, and aVF
-reciprocal: I, AVL

-affects the RCA (supplies blood to the AV node) = conduction deficits and heart blocks

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Anterior wall MI

12 lead: V2-V4 (anterior)
   -reciprocal: II, III, AVF
V1 &amp; V2 (septal)
May see BBB, and AV block type II
   -reciprocal: V5-V6

-affects the LAD (left main/ widow maker)

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Lateral wall MI

12 lead: I, aVL, V5& V6
Reciprocal: II, III, AVF

-affects the left circumflex and the obtuse marginal artery (a branch of the circumflex)

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Posterior wall MI

12 lead: V7-V9 (right sided 12 lead)
Reciprocal: V1-V3

-affects RCA

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CARDIAC INDEX

2.5-4.5 L/min

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CARDIAC OUTPUT

5-6 L/min

*stroke volume x HR

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PRELOAD

“Filling”
-pressure generated by the volume of blood at the end of diastole

*RV: 
       CVP (N: 0-5 mmHg, optimal 0-10)
       RAP 
*LV: (by arterial pressure monitors) 
     -PAD, LVEDP

-affected by venous return, total blood volume, atrial kick, and ventricle compliance

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AFTERLOAD

“Resistance”
-pressure and stress the ventricle faces

RV: PVR (pulmonary vascular resistance)
- more sensitive

*LV: SVR (systemic vascular resistance)

*⬆️afterload = ⬆️ myocardial O2 demand
*⬇️afterload by ⬇️SVR (vasodilator, ⬇️ blood volume, repair leaky valve)

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RAP

Right atrial pressure

2-6mmHg

*measures pressure in the right atrium by a PA cath

Elevated in RV failure

*reflective of RV preload

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CVP

Central venous pressure, catheter in superior vena cava

*measures pressure in the great vessels as blood returns to the heart

Normal: 0-5mmHg
Optimal: varies- 10 mmHg

-depends on MD

Tells about preload in the RV

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PAOP

Pulmonary arterial occlusion pressure (wedge pressure)

Normal: 6-12 mmHg
Optimal: 14-18 mmHg

Tells about preload in the LV

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SVR

Systemic vascular resistance

Normal: 800-1200 dynes/sec/cm

SVRI: 1970-3900

Measures afterload

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PVR

Pulmonary vascular resistance

Normal: <250 dynes/sec/cm

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Pulmonary artery pressure

Normal:
Sys:15-25/
Dia: 6-12

PAs: reflective of RV (pressure needed to open the pulmonic valve)

PAd: reflective of the pulmonary vasculature

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Difference between PAD and PAOP

“Right to left gradient”

PAD > PAOP by 5 mmHg or less

If difference>5 =pulmonary HTN

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CARDIAC Tamponade

equalization of pressures (RAP, PAD, PAOP)
large A waves and V waves=M pattern on waveform
hypotension

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Pulmonary hypertension

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⬆️PAD, and PAOP= normal

Mitral regurg

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large V waves in PAOP waveform

* due to acute MI

Classes of antidysrhythmics

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I: block the movement of sodium during depolarization
-ex: quinidine, procainamide, lidocaine

II: block beta receptors (affect automaticity)
-ex: metoprolol, propranolol

III: block the movement of potassium (during late depolarization)
-ex: amiodarone

IV: blocks movement of Ca (during early depolarization)
-ex: diltiazem, verapamil

Nesiritide (Natrecor)

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Vasodilation

Is a brain-type naturiuretic peptide (BNP)

Causes excretion of sodium and water
(Diuretic effect)

First line therapy for HTN

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Diuretics

Then BB

Then ACE inhibitor

Stenosis & Regurgitation

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REMEMBER BLOOD DOES NOT TRAVEL UPHILL

ABI

Ankle Brachial INDEX Ankle artery pressure (normally is higher) divided by brachial artery pressure Normal= >1 *ankle artery pressure decreases long before pulses are lost

Dilated cardiomyopathy

S& S: - mitral regurg (dt vent dilation and stretching of mitral valve ring) - hypotension

Restrictive cardiomyopathy

S& S: | -elevated sedimentation rate (dt inflammatory response from connective tissue disorders)

Hypertrophic cardiomyopathy

Heart muscle enlarges causing ventricle walls to thicken - can cause regurg - associated with obstruction and poor outflow S& S: syncope Treatment: decrease contractility and afterload

Ventricular gallop "ken-tuc-KY" Cause: left ventricular failure (earliest finding) Indicates HF and fluid overload Occurs at the beginning of diastole

Occurs during the end of diastole -when the atria contract but the ventricle is noncompliant Atrial gallop "TEN-nes-see" Cause: -myocardial ischemia, infarction, severe hypertension, and hyper trophy *normally heard in acute MI for the first 48 hours

Atrial enlargement

*leads II, and V1 are the best P wave leads R atrial enlargement: P waves tall and peaked in lead II (P PULMONALE), dominate initial half of biphasic P in V1 L atrial enlargement: P waves wide and notched (P MITRALE), dominant terminal half of biphasic P

Automaticity

Ability of certain CARDIAC cells to initiate impulses regularly and spontaneously Enhanced automaticity: causes ectopic beats and is associated with catecholamines

Triggered activity

Related to depolarization problems Causes torsades de pointes

Accessory pathways

Causes palpitations, tachydysrhythmias

Reentry

Most common mechanism for tachydysrhythmias

Propranolol

Non cardio selective BB Not to be used in PTs with COPD or asthma (causes further bronchospasms Cardioselevctive BB: metoprolol, atenolol, and esmolol

Diacritic notch

Arterial waveform= closure of the aortic valve Pulmonary artery waveform= closure of the pulmonic valve

Transient systolic murmur

Papillary muscle ischemia and dysfunction

Midsystolic click

Mitral valve prolapse

Paradoxical split of S2

L BBB, RV premature ventricular contraction, transvenous endocardial pacemaker, valvular problem

Split S2

Normal: only split on inspiration Abnormal: split in expiration More common than a split S1

Supra ventricular tachycardia with aberrancy

A run of wide QRS complexes triggered by a PAC vTach= a run of wide QRS complexes triggered by a PVC

R BBB

Wide QRS (>.12) V1: QRS has rsR "M" or bunny ear pattern V6: slurred S wave

L BBB

QRS wide (>.12) V1: QRS is negative V6: QRS is rsR

Barorecptors

PRESSURE RECEPTORS!! Vasodilators= stimulation of barorecetors -can cause reflex tachycardia

Cardiac Flashcards

(45 cards)