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Flashcards in cardiac management Deck (39)
1

SVR equation & normal

[ (MAP - CVP) / CO ] x 80
- 800 to 1200 (1000)

2

MI door-to-needle

30 min

3

MI door-to-cath

60 min

4

MI elevations (CK-MB, Trop I & T) & note

CK-MB: gt 120 IU/L
Trop I: gt 0.35 mcg/L
Trop T: gt 0.2 mcg/L

note: repeat 8 hours later

5

cardiac reserve

difference between the rate at which the heart pumps blood and its maximum capacity for pumping blood at any given time

6

metabolic syndrome criteria

3 of 5
- waist 40 m/ 35 f
- hyperlipidemia
- hypertension
- ↑ CRP
- insulin resistance (FBG 110+)

7

What precedes S1 and what is it?

Diastole precedes, S1 = closure of AV valves.

8

What precedes S2 and what is it?

Systole precedes, S2 = closure of semilunar valves.

9

dilated cardiomyopathy: pathophys

severe ventricular dilation + systolic dysfxn

causes: idiopathic, postpartum, EtOH, viral myocarditis, ischemic heart disease

10

dilated cardiomyopathy: mgmt

↓ preload: restrict Na, fluid
↓ afterload: vasodilation
↓ workload: activity restriction
↑ contractility: digoxin, dobutamine

SAME TX AS HF D/T REMODEING

11

hypertrophic cardiomyopathy: pathophys

aka idiopathic hypertrophic subaortic stenosis

increased muscle mass of septum obstructs LVOT

12

hypertrophic cardiomyopathy: mgmt

max preload/more filling time: BB, CCB

control dysrhythmias: amiodarone (CCB)

reduce septum size: septal myectomy OR alcohol ablation

NOTE - AV node, Bundle of His in septal wall = conduction problems

13

hypertrophic cardiomyopathy: dx

Echo: septal wall hypertrophy, increased pressure gradients between aorta & LV

12 lead: LV hypertrophy

PE: systolic murmur

14

restrictive cardiomyopathy: pathophys

muscle becomes constricted & can't fill/pump

causes: amyoidosis (produced in bone marrow, accumulates in organs) or collagen disorders

15

ankle brachial index: calculation & purpose

highest dopplered --
SBP (PT or DP) / SBP (brachial)

screening for PAD severity

16

ABI scoring
- no disease
- mild to mod
- severe
- rigid/calcified arteries

- rigid/calcified arteries: gt 1.3
+ ultrasound to evaluate!

- no disease: 0.91 - 1.3
+ no sx

- mild to mod: 0.41 - 0.90
+ intermittent claudication & visual signs

- severe: lt 0.40
+ sx @ rest

17

gold standard diagnosis for PVD

ultrasound!

18

PAD mgmt

pharm: PDE-3 inhibitor + antiplatelet + ACE-inhibitor

medical: risk factor reduction, tx comorbs, exercise 30-45 min walking/day, avoid restrictive clothes

endovascular mgmt: stent, bypass

19

what is critical limb ischemia?

severe PAD complication (2-5% pts)

EMERGENCY! reperfusion needed.

20

critical limb ischemia: s/s

pain
pulseless
paresthesia
paralysis
pallor

21

carotid artery stenosis often asx until

severe - 50 to 60% occlusion

22

most common presentation of carotid artery stenosis patient

TIA

23

carotid artery stenosis gold standard diagnostic

suplex ultrasound

24

carotid artery stenosis mgmt

asx + 30-50% stenosis:
↓ risk factor
tx comorbs
antiplt rx
vascular surgery follow up

over 50% + sx OR over 80% w/o sx:
vasc surg consult: @ risk complications
- carotid endarterectomy, angioplasty, stent

25

renal artery stenosis presentation

uncontrolled htn refractory to meds

26

gold standard for renal artery stenosis diagnosis

renal angiography (beware contrast since renal problems!!!)

so doppler US is most common (initial catch)

27

virchow's triad: what are the s/s and purpose?

s/s VTE!
1. venous stasis
2. hypercoagulability
3. vascular endothelial injury

28

thoracic vs abominal aortic aneurysm

AAA = past renal arteries

29

aortic aneurysm s/s

usually asx, found incidentally 80 - 90%

chest, back pain
new/changing abdominal mass (80% are palp when gt 5.5 cm)

30

what is an aortic dissection?

results from intimal layer tear (aorta)

occurs when blood = in between intima/media → false lumen

ruptured aneurysm without dissection possible

31

best diagnosis tool for aortic dissection

CTA - visualize the intimal flap

32

aortic dissection physical exam findings

new diastolic aortic valve murmur

unilateral: pulse deficit, cold/mottled extremity

BP discrepancy in extremities

abd pain on palpation

33

how to tell compartment syndrome vs critical limb ischemia

HISTORY!

34

intracompartmental pressure: normal vs compartment syndrome vs surgical intervention needed

normal: 10 - 12 mmHg

compartment: 25- 30 mmHg

fasciotomy time: ΔP = DBP - highest intracompartmental pressure = gt 30mmHg

35

fasciotomy purpose

for compartment syndrome - prophylactic: prevents change from occurring, doesn’t reverse damage from initial injury

36

AAA diagnostics

1. bedside ultrasound (stat)
2. CTA (time to eval if op appropriate)
3. angiogram (least sensitive)

37

reperfusion injury

serious complication following reoxygenation of tissues after ischemia/hypoxia

highly reactive oxygen intermediates (oxidative stress) cause further membrane damage + mitochondrial Ca overload

WBC especially affected

38

beck's triad - what is it & purpose

muffled heart sounds
increased JVD
BP decreased 20 between S1 & S2 (pulsus paradoxus)

signs of cardiac tamponade

39

pulsus paradoxus

BP decreased 20 between S1 & S2