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Drugs/Physiology Keystone Exam 1 > Cardiac Lectures > Flashcards

Cardiac Lectures Flashcards

1
Q

Hemodynamics of heart failure

A

increased atrial (L > dyspnea, pulmonary congestion, R > dependent edema/ascites (+JVP)) filling pressure with decreased cardiac output

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2
Q

Symptoms of heart failure

A

dyspnea and/or fatigue (exertional)

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3
Q

New York Heart Association Functional (NYHA) Classification (symptoms due to angina or heart failure)
Class I

A

Ordinary activity without symptoms

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4
Q

New York Heart Association Functional (NYHA) Classification (symptoms due to angina or heart failure)
Class II

A

Ordinary activity With symptoms

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5
Q

New York Heart Association Functional (NYHA) Classification (symptoms due to angina or heart failure)
Class III

A

Less than ordinary activity with symptoms

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6
Q

New York Heart Association Functional (NYHA) Classification (symptoms due to angina or heart failure)
Class IV

A

Symptoms at rest and with any physical activity > symptoms

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7
Q

T or F: Patients can be reclassified inn the NYHA classification system?

A

T: can go from I to III or vice versa

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8
Q

Physical exam findings of heart failure

A

Narrow pulse pressure (when SV decreases), increased RR, bibasilar inspiratory crackles, S3 with L HF

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9
Q

One of best laboratory findings for diagnosis of heart failure

A

Echocardiography

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10
Q

3 Main causes of Heart failure

A

Arrhythmia, myocardial, mechanical

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11
Q

Systolic dysfunction (myocardial etiology) Findings

A

Hallmark: enlarged end diastolic volume with cardiomegaly on CXR, poor contractility with sign decreased ventricular ejection fraction, HALLMARK = S3 gallop

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12
Q

Diastolic dysfuncion

A

normal end diastolic volume with minimal/no cardiomegaly on CXR, decreased compliance with normal contractility, relatively normal ventricular ejection fraction (>40%, normal = >50%), HALLMARK = S4 gallop

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13
Q

“High Output States”

A

Infection, pregnancy, anemia, thyrotoxicosis (hyperthyroidism)

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14
Q

Workup of newly diagnosed HF

A

Echocardiogram, CBC with chem screen and TSH, CXR, EKG

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15
Q

Treatment of NON-hypotensive pulmonary edema

A

Oxygen, I.V. Morphine (venous vasodilator/slow RR/increase filling pressure), I.V. Furosemide, Vasodilator (nitroglycerin)

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16
Q

Heart Failure Stage A

A

At risk for heart failure WITHOUT structural disease or symptoms

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17
Q

Heart Failure Stage B

A

Structural heart disease WITHOUT signs/symptoms

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18
Q

Heart Failure Stage C

A

Structural heart disease with prior/current symptoms

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19
Q

Heart Failure Stage D

A

Refractory heart failure requiring specialized interventions

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20
Q

T/F: Once a patient is diagnosed with a Heart Failure Stage, it is permanent.

A

T

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21
Q

Treatment of Heart Failure Stage A

A

Treatment of comorbidities (hypertension, thyroid disease, [glucose]), exercise/weight reduction, No EtOH/Nicotine

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22
Q

Treatment of Heart Failure Stage C

A

All stage A treatments and salt restriction, diuretics as needed, ACE-Is for all with decreased LVEF or PH of MI, B-blockers for all with decreased LVEF or PH of MI

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23
Q

Which drug classes should be avoided in treatment of Stage C heart failure?

A

Anti-arrhythmic drugs (Class I/III, exception of amiodorone and dofetilide), Ca-Channel blockers (Verapamil & diltiazem, due to neg ionotrophic effect > decreased contractility), NSAIDs (exception of aspirin)

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24
Q

Which vasodilators/diuretics are most effective for African Americans?

A

Isosorbide dinitrate in combination with hydralazine

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25
When should a implantable cardioverter-defribulator be implemented?
When LVEF is below 30% (need to recheck)
26
When should a biventricular electronic pacing/CRT be implemented?
LVEF 130 sec on EKG
27
Treatment of Heart Failure Stage D
All appropriate treatment for A, B & C in addition to end of life care, cardiac transplantation, etc.
28
Which therapies improve survival and symptoms of HF
ACE-Is and B-blockers
29
Which therapies improve symptoms alone
Diuretics (minus aldosterone) and digoxin
30
Diagnosis of mitral valve prolapse
Unique symptoms = exertional dyspnea/fatigue, murmur during systole with click in addition with S3 gallop Echocardiogram (w/o physical examination findings (murmur during systole, can include click) > suggest prolapse), PE + echo - diagnosis
31
Mechanisms of sudden cardiac death
1. Ventricular fibrillation (60%) 2. Asystole, Bradycardia, electromechanical dissociation (30%) 3. Ventricular tachycardia (10%) First 2 can be reversed
32
Determinants of O2 demand
1. Preload (ventricular volume) 2. Afterload (blood pressure) 3. Heart rate 4. Contractility
33
Determinants of O2 supply
1. Coronary blood flow | 2. Oxygen delivery- hematocrit and O2 saturation
34
Whats the only determinant of O2 supply that can be manipulated to increase supply?
Coronary blood flow | (A-V)O2 cannot be improves as it is at its maximum when heart rate is at rest
35
How do you increase coronary blood flow?
equation: Flow = Pressure/resistance: can manipulate pressure via decrease aortic diastolic pressure, decrease LV diastolic pressure, Resistance via pharmacological agents
36
Etiology of ischemic heart disease
1. aortic outflow obstruction (aortic stenosis) > left ventricular hypertrophy 2. Hypertrophy > vascular proliferation unable to keep up with demand
37
Classification of Typical angina ("definite")
Must have all 3: 1. Substernal chest discomfort with a characteristic quality and duration 2. Provoked by exertion or emotional stress 3. Releived by rest of s.l. nitroglycerin
38
Classification of Atypical angina ("probable")
Must have 2: 1. Substernal chest discomfort with a characteristic quality and duration 2. Provoked by exertion or emotional stress 3. Releived by rest of s.l. nitroglycerin
39
Classification of non cardiac chest pain
Meets 1 or none: 1. Substernal chest discomfort with a characteristic quality and duration 2. Provoked by exertion or emotional stress 3. Releived by rest of s.l. nitroglycerin
40
What is relatively diagnostic for stable/probable angina on treadmill?
Classic ST depression that duplicates with chest discomfort, can be false positive
41
T/F: A coronary angiogram is the most definitive test and diagnosis of presence of epicardial coronary artery disease
False: does not diagnose CAD, symptoms usually require at least 50% blockage but symptoms not always present
42
Commons signs of myocardial infarction
Cardiac ischemic pain/discomfort similiar to angina pectoris but longer and more sever, dyspnea, sweating, nausea (can be silent) Ascultation: S4 gallop, some have S3 > indicate CHF from systolic dysfunction, pericardial rub post 24 hrs (different from pericarditis via no L trapezius border pain)
43
Diagnosis of myocardial infarction
History very important but EKG findings: new Q wave formation, ST elevation Labs = Rise/fall of troponin (peak occurs 6-8 hr post MI and remains abnormal for 1-2 weeks)
44
Complications of acute MI
Arrhythmias (V. fib = potent killer), CHF due to DD or SD, hypotension
45
Isosorbide dinitrate
Nitroglycerin (S.L.), 3x/day
46
Isosorbide mononitrate
nitroglycerin (s.l.), 1/day
47
What happens if you take nitroglycerin 24/7 to alive angina?
Risk of tachyphylaxis
48
Which two Ca2+ channel blocker are bradycardic?
Verapamil and Diltiazem > cause decreased contractility + decrease HR and AV node
49
Amlodipine
Ca2+ antagonist, 1.5 day half-life = can take whenever (can't use for acute events)
50
Which Ca2+ channel blocker does not have bradycardia effects?
Nifedipine
51
Which to B-blockers are B1 selective?
Metoprolol and atenolol
52
B1 receptor blocking effects
Bradycardia, renin suppression, decrease free FA
53
Which B-blockers are lipid soluble and what are their characteristics?
Metoprolol and labetalol | Liver metabolized, short half life (2-5 hrs, must give 2/day)
54
Which B-blockers are water soluble and what are their characteristics?
``` Atenolol Renal excretion (mainly unmetabolized), long half-life (6-24 hrs, give 1/day) ```
55
Which nonselective B blocker is useful to treat patients with ascites/liver disfunction?
Propanolol
56
Which B-blockers also has alpha1 blocking characteristics
Carvedilol and labetalol (also has B2 agonist activity), Alpha1 blocker helpful in systolic heart failure
57
What is cut off line for revascularization?
3-V CAD with normal LV fx WITH symptoms Will improve angina and survival, this list for revascularization would also include 3-V CAD with abnormal LV fx and L. main coronary after blockage
58
T/F: undergo angiography when patient has a positive treadmill test
F: not always for positive but not markedly test, make sure medications are not working beforehand in addition with percutaneous transluminal coronary angioplasty
59
What is initial management for stable angina?
1. Start with single drug from B-blocker/vasodilator group and get to maximum dose 2. If symptoms persist > add second from other group and get to max 3. If symptoms persist > discuss catheterization/revascularization
60
How do you differentiate MI from pericarditis?
Chest pain often radiates to L. Trap ridge in pericarditis, otherwise most symptoms are the same. In addition, their is a rub heard in both Peri: pain is worse when lying down, relieved when sitting up/leaning forward Labs that differentiate: Peri has increased WBC/ESR/CRP
61
History/physical exam findings of pericardial effusion with cardiac tamponade
Increased JVP, negative Kussmaul's sign, increases RR, BP with normal to low BP, decreases pulse pressure Often SOB with orthopnea Positive: PARADOXICAL PULSE (due to inspiration leading to R ventricle expansion/L ventricle compromised due to limited space > decrease SV > decrease BP > 10 mmHg)
62
T/F: Normal heart size on CXR excluded pericardial effusion/tamponade
False
63
What is the treatment for pericarditis?
Pericardiocentesis of pericardial fluid
64
Equation to relate valve area, flow and gradient of aorta
valve area = flow across valve/ sqRtValve systolic pressure gradient
65
LV LA findings in aortic stenosis
Hypertrophy without dilatation of chamber cavity, palpable atrial kick Best diagnosed via echocardiogram
66
What valvular disease would present with BP of 180/30?
Aortic regurgitation (evident hyperdynamic carotid pulse)
67
What vavlvular disease would present with BP of 100/80?
Aortic stenosis
68
What Valvular disease could present with normal BP?
Mitral valve regurgitation (potentially more)
69
T/F? Ventricular septal defect is considered a pressure overload lesion?
False: it is a volume overload lesion > leads to congestive heart failure Does not present until AFTER the ew born period (>30days)
70
What are the 3 causes of PVR>SVR in fetal lungs?
Alveolar hypoxia, Increased SM in pulmonary vessels, collapsed lungs
71
What is the main driving factor behind pulmonary vasodilation in a new born?
O2 > leads to decrease in PVR (PVR rise in pulmonary blood flow
72
T/F? In congenital heart failure, weight is less affected than height in FTT.
False: weight is more affected > due to poor feeding from fatigue/dyspnea of CHF
73
Management of congenital congestive heart failure
Digitalis + diuretics, enhance caloric intake via formula density
74
6Ps of acute ischemia
Pain, pallor, paresthesia, paralysis, pulselessness and poikilothermia (coolness)
75
Whats it the ankle-brachial index of patients with claudication?
0.4-0.8 (ankle usually higher than brachial)
76
T/F: Arterial claudication commonly occurs with standing alone?
F: occurs during movement
77
Most common site for aortic aneurysm?
Infrarenal aorta
78
Most common site for peripheral aneurism?
popliteal a.

Drugs/Physiology Keystone Exam 1 (2 decks)

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