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IDC School > CARDIO > Flashcards

CARDIO Flashcards

1
Q

the base of the heart is formed by?

A

Atria (upper chambers of the heart)

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2
Q

The apex of the heart is is the pointed end of the heart, it is formed by what?

A

Left ventricle (lower chamber of the heart)

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3
Q

what is the fibrous pericardium described as

A

tough, inelastic and outter connective tissue

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4
Q

what is the function of the pericardium that protect the heart?

A

anchor in place

prevents it from over stretching

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5
Q

why is the right ventricle of the heart thinner than the left?

A

because it pumps blood to the lungs while the left ventricle pumps blood to the entire body..

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6
Q

what is thinner and what is thicker? in regards to atria and ventricles

A

atria are the thinnest because they empty their contents into the ventricles

ventricles are thicker because they have to move blood out of the heart.

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7
Q

What does the superior and inferior vena cava do?

A

BOTH drain deoxygenated blood from the upper and lower body into the right atrium

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8
Q

what does the coronary sinus do?

A

drains deoxygenated blood from the coronary veins into the right atrium

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9
Q

what does the pulmonary trunk and pulmonary artery do?

A

blood is pumped from the right ventricle into the pulmonary trink which then branches into the pulmonary arteries that then carry this deoxygenated blood into the lungs to be oxygenated

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10
Q

what does the aorta do

A

carries oxygenated blood to the entire body from the left ventricle

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11
Q

prior to blood being oxygenated, what is the route that blood flows?

A

deoxygenated blood enters the heart via the superior and inferior vena cava or coronary sinuses, drains into the right atrium, empties into the right ventricle, then pumped to the lungs via the pulmonary trunk and left/right pulmonary arteries to be oxygenated.

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12
Q

after oxygenation of blood, what happens?

A

blood is pumped into the heart by the pulmonary VEIN into the left atrium, which empties into the left ventricle and pumped through the body via the aorta.

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13
Q

where does cardiac excitation normally begin?

A

Sinoatrial (SA) node

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14
Q

what is the electrical route of the heart

A

begin- Sinoatrial node (SA)

Atria (bachmanns bundle) - contraction

Atrioventricular node (AV)

AV bundle branches (bundle of his)

Right/Left Bundle branches

Purkinje fibers

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15
Q

What are arteries?

A

thick, vessels that carry blood away from the heart

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16
Q

what are capillaries

A

they are known as exchange vessels

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17
Q

what are veins?

A

return deoxygenated blood to the heart to be oxygenated

  • they contain about 64% of total volume of blood
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18
Q

the slowest rate of blood flow takes place where

A

capillaries

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19
Q

what is vascular resistance

A

opposition to flow. Which depends on;

  • Smaller lumen results in greater resistance
  • greater vessel length (weight gain)
  • higher viscosity (higher hematocrit) - maple syrup vs water
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20
Q

what are the four principle branches of the aorta?

A

the ascending aorta
arch of the aorta
thoracic descending aorta
abdominal descending aorta

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21
Q

A pattern of disorganized and out-of-sync depolarization among the cells in the heart is what?

A

fibrillation

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22
Q

the part of the cardiac conduction system that distributes the depolarization wave through the walls of the ventricles is what?

A

purkinje fibers

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23
Q

specialized cells in the heart that can spontaneously depolarize and act as the pacemaker, and transmit that signal to other areas of the heart is what?

A

cardiac conjuction system

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24
Q

the second node in the cardiac conduction system, which DELAYS the depolarization wave of a fraction of a second before sending it on to the inferior part of the heart,

A

atrioventricular node

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25
Q

the head pacemaker of the heart, with the leakiest membranes and therefore the fastest intrinsic rate

A

sinoatrial node

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26
Q

the part of the cardiac conduction system that quickly carries the signal down through the ventricular septum

A

atrioventricular bundle

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27
Q

the cavity between the lungs in which the heart sits

A

mediastinum

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28
Q

one of the superior chambers of the heart

A

atrium

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29
Q

one of the inferior chambers of the heart

A

ventricle

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30
Q

the name for the path blood takes between the left ventricle and right atrium

A

systemic loop

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31
Q

the simple squamous lining of the heart cavities, continuous with the lining of the blood vessels

A

endocardium

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32
Q

the difference in hydrostatic pressure between two areas that causes fluid to flow from the area of high pressure to the area of low pressure

A

pressure gradient

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33
Q

what is the name of the sac around the heart?

A

pericardium

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34
Q

coming from inferior and superior branches, this largest VEIN in the body brings blood from the systemic circuit back to the right atrium

A

vena cava

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35
Q

the middle layer of the wall of the heart made of cardiac MUSCLE tissue

A

myocardium

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36
Q

the name for the path blood takes between right ventricle and left atrium

A

pulmonary loop

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37
Q

the period of ventricular contraction, when ventricular pressures are high and they are pushing blood out

A

systole

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38
Q

the valve through which the left ventricle pushes blood

A

aortic semilunar valve

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39
Q

small, thin-walled blood vessels that allow materials like fluid and respiratory gases to enter and exit the blood stream

A

capillaries

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40
Q

the valve through which the right ventricle pushes blood

A

pulmonary semilunar

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41
Q

also called the left atrioventricular valve, the valve through which the left atrium pushes blood into the left ventricle

A

mitral vlave

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42
Q

also called the right atrioventricular valve, the valve through which the right atrium pushes blood into the right ventricle

A

tricuspid

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43
Q

the heart chamber that receives blood coming from the lungs via the pulmonary vein

A

left atrium

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44
Q

the inner layer of the pericardial sac, that is the outer part of the heart wall, and is also known as the visceral pericardium

A

epicardium

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45
Q

the blood vessels that carry either oxygenated or deoxygenated blood AWAY from the heart

A

arteries

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46
Q

the structures that allow blood to flow in one direction, but not in the other and make the lub-dub heart sounds

A

valve

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47
Q

the blood vessels that carry either oxygenated or deoxygenated blood TOWARD the heart

A

veins

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48
Q

the outer layer of the serous membrane surrounding the heart, it is also called the pericardial sac

A

parietal pericardium

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49
Q

the period of ventricular relaxation, when ventricular pressures are low and they are filling with blood

A

diastole

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50
Q

the largest artery in the body, this receives blood from the left ventricle and distributes it to the systemic circuit

A

aorta

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51
Q

the first korotkoff sound indicates what?

A

systolic

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52
Q

the LAST korotkoff sound indicates what?

A

Diastolic

not 2nd, 3rd 4th korotkoff sound. the LAST

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53
Q

While palpating the arteries in your physical exam what is the scale?

A

described on a scale from 0-4

0 - absent: not palpable
1 - Diminished: barely palpable
2 - Expected 
3 - Full, increased
4 -  bounding: aneurysmal
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54
Q

when palpating the extremities fr temperature and venous distention and edema. What is the scale for pitting edema?

A

1+ slight pit, disappears rapidly (2-3mm in depth)
2+ somewhat deep pit, disappears in 10 to 15 seconds(4-5mm)
3+ noticeable deep pit that lasts more than a minute(6-7mm)
4+ very deep pit that lasts 2 to 5 minutes (8-9mm in depth)

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55
Q

what is the clinical test for thrombosis?

A

homans sign

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56
Q

when testing for jugular venous pressure what is a value that is expected

A

a value less than 9cm is expected.

Anything above that indicates severe heart failure.

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57
Q

what is another term used to describe lower extremity swelling, reproducible lower extremity pain with excertion that resolves the pain with rest?

A

claudication

peripheral venous disease

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58
Q

if an s3 heart sound is heard upon examination, what is happening within the heart

A

early diastole (passive filling) vibration of ventricular walls

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59
Q

if an s4 heart sound is heard upon examination what is happening within the heart

A

Ventricular filling from atrial kick (late diastole) loss of compliance or increase stroke volume secondary to high output. (this is BEFORE s1)

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60
Q

wide apical pulsation may indicate what?

A

left ventricular hypertrophy. Loss of palpable apical pulsation may indicate fluid, air or displacement

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61
Q

If a thrill is found, what might this indicate

A

associated with failure of the semilunar valve to close, aortic or pulmonary stenosis, or atrial septal defect

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62
Q

loud S1 suggest what

A

increased blood velocity, mitral stenosis, heart block, hypertension or calcification of mitral valve

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63
Q

a loud s2 suggest what?

A

hypertension, valve disorder, stenosis or fluid

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64
Q

what is a friction rub defined as

A

pericardial sac inflammation

65
Q

blood pressure is regulated by

A

relaxing or contracting of smooth muscles around the ARTERIOLES

66
Q

What are the signs and symptoms of hypertension?

A

Stage 1 HTN: Sys <130-139 Dias- <80-89
Stage 2 HTN: Sys: >140 Dias: 90

BP MUST BE ELEVATED OVER 3 OR MORE SEPERATE OCCASIONS to be considered HTN

67
Q

what is the treatment for hypertension?

A

First: life style modifications (yields moderate results)
2nd (first line): HCTZ 12.5-25 mg daily
- ACEI (first line): (end in pril) Lisinopril, 5-10mg daily
- ARB: Losartan 50mg daily
- CCB: Diltiazem 180mg daily or Amlodipine 2.6mg daily, titrate up to max dose of 10mg daily
- Alpha blockers: Terazosin 1mg once daily, titrate as needed based on patient response up to a 20mg daily in 1 or 2 divided doses

68
Q

Complications of HTN/ Disposition

A
  • Refer to MO to work up accompanying cardiovascular disease or secondary hypertension if just discovering it and have had 3-5 readings at qualifies as HTN
  • REnew medication if well controlled
  • Should have blood work done (CHEM) every year to evaluate for kidney dysfunction
69
Q

What is a hypertension urgency?

A
  • SBP >220 OR DBP >125
  • NO SIGNS OF END ORGAN DAMAGE
  • Blood pressure must be reduced within a few years
70
Q

What is the treatment of HTN Urgency?

A
  • Goal is reducing DBP <110 over 24 hours, Use PO medications
  • Already on one- Re-initiate it, if dose is unknown then give HCTZ 25mg PO
  • NOT ON ANTI-HYPERTENSIVE AGENT: initiate oral alpha beta blocker or beta blocker. (clonidine or labetalol is typically used as first line)

Alpha Blocker- Clonidine (primary treatment) - initial dose= 0.1 -0.2 then 0.1 mg every hour 0.8 mg orally
Beta Blocker - Selective blocker = metoprolol 50mg twice daily
non-selective - Labetalol = 100mg twice daily
-

71
Q

What is a hypertensive emergency

A
  • Blood pressure is usually strikingly elevated >130 DBP but correlation between pressure and end organ damage is poor
  • SIGN OF END ORGAN DAMAGE OCCURING
72
Q

What are the signs of end organ damage is occurring

A
  • mental status change, confusion, headache
  • intracranial hemorrhage
  • Ischemic stroke
  • Hypertensive nephropathy (proteinuria, hematuria, and progressive kidney dysfunction)
  • Unstable angina, AMI, CHF, Aortic dissection
  • ## Pulmonary edema
73
Q

What signs are you looking for in a hypertensive emergency when doing your neuro and cardio exam?

A
  • Neuro: deficits, mental status change, change in vision, headache, nausea/vomiting
  • Cardio: Heart failure (S3, new murmurs), auscultate for carotid bruits, pulmonary edema (rales, crackles), complaints of sudden onset SOB, Chest pain
  • Fundoscopic: Looking for papilledema or hemorrhage
74
Q

What is the treatment for Hypertensive emergency

A

Establish IV

  • O2 if < 94%
  • monitor with telemetry
  • LABETALOL 20mg IV
  • Once stable, start metoprolol 25-50mg PO twice daily
  • Closely monitor whatever end organ was damaged
75
Q

What are the S/SX of Coronary Artery Disease?

A
  • Angina
  • Left shoulder pain
  • indigestion
  • N/V
  • Pale
  • Diaphoresis
  • NEW HEART MURMUR
  • Rales on expiration
  • S3/S4 present
  • Sudden Cardiac death
76
Q

What is the treatment of CAD

A

Life style changes: Low fat diet in fruits in veggies
SMOKING CESSATION, Moderate use of alcohol, Control HTN, diabetes, and hypercholesterolemia

  • HMG-CoA (Lipid lowering - STATINS)
    Atorvastatin (10mg before bedtime, titrate to a maximum dose of 80mg before bed)
    -INHIBITORS: Simvastatin 10mg
  • ANTIPLATELET- Aspirin 81mg daily
  • SURGICAL - Coronary Artery Bypass Grafting (CABG), stenting, primary percutaneous coronary intervention
77
Q

what is the electrical structure of the heart?

A

Starts: SA node –conducted through–> The atria [causes contraction] —>Atrioventricular node (AV) —> AV bundle of his –> R/L Bundle branches —> Purkinje fibers

78
Q

What does the P wave represent

A

Atrial depolarization

79
Q

What does the QRS complex represent

A

Ventricular depolarization (masks atrial repolarization due to size)

80
Q

What does the T wave represent

A

ventricular repolarization

81
Q

what is the cardiac output formula?

A

stroke volume x heart rate
- 70ml/beat x 75 beats/min
= 5250 ml/min or 5.25 L/min

82
Q

which has the larger lumen? Arteries or veins

A

Veins

83
Q

what are the four principle branches of the aorta

A

the ascending aorta
arch of the aorta
thoracic descending aorta
abdominal descending aorta

84
Q

what artery supplies the right side of the head and neck

A

right carotid artery

right subclavian artery

85
Q

what artery supplies the shoulder

A

axillary artery

86
Q

what supplies the upper arm

A

brachial artery

87
Q

what supplies the lateral portion of the forearm, wrist and hand

A

radial artery

88
Q

what supplies the medial portion of the forearm, wrist and hand

A

ulnar artery

89
Q

what does the thoracic aorta supply

A
  • bronchial arteries
  • esophageal arteries
  • posterior intercostal arteries
  • superior phrenic arteries
90
Q

what does the abdominal aorta supply

A

Celiac trunk
(which further branches but itll make this flash card too long)
- superior/inferior messentric artery
- suprarenal
- renal
-Gonad
- common iliac arteries branching to form the abdominal aorta

91
Q

the external illiac arteries supply

A

lower limbs

92
Q

internal iliac arteries supplies what

A

supplies pelvis

93
Q

what are the three systematic veins that carry deoxygenated blood to the heart

A

coronary sinus
superior vena cava
inferior vena cava

94
Q

what are the three main veins that drain blood away from the head

A

internal jugular
external jugular
vertebral veins

95
Q

what are the principle veins that drain the upper body (deep)

A

radial - lateral forearm
ulnar - medial forearm
brachial - drain forearms, elbow joints, arms
axillary - arms, axillae, upper chest wall
subclavian - arms, neck, thoracic wall

96
Q

what are the veins that drain the abdomen

A

hepatic portal (blood drains from the GI tract and spleen into hepatic, then to the liver to be processed and returns to systemic circulation through hepatic vein)

97
Q

what are the principal veins that drain the lower body (deep)

A

posterior tibialis
anterior tibial veins
popliteal
femoral

98
Q

what is the normal heart rate

A

around 75 bpm

99
Q

below 60 bpm is called?

A

bradycardia

100
Q

above 100 bpm is called what

A

tachycardia

101
Q

what are the benefits of exercise

A 
maintain low resting heart rate
BETTER BLOOD PRESSURE CONTROL
decrease anxiety and depression
controls weight 
INCREASES OUR BODYS ABILITY TO DISSOLVE BLOOD CLOTS BY INCREASING FIBRINOLUTIC ACTIVITY
102
Q

What is regular exercise considered to be

A

at least 20 minutes, 3-5 times weekly is essential to improve overall cardiovascular health

103
Q

Patient is known to have a history of HTN and presents with the following symptoms, Palpitations Dyspnea on exertion Lightheadedness and chest pain. The following (see photo) was found on the ECG tracing. What is likely the cause for the patients chest pain based off of the ECG?

A

Atrial Fibrillation

104
Q

This is typically associated with Pulmonary disease, what type of ECG is shown in the picture?

A

Atrial flutter

105
Q

Patient came in for a physical and needed an ECG completed. Upon examination of the ECG below, what is the patient exhibiting? And What is the treatment

A

1st degree AV block

-None warranted as it will not progress to any further arrhythmia or AV block.

106
Q

Patient came to medical due to feeling light headed and dizzy. When you took vitals you noticed that their heart rate was 48 bpm and decided to get an ECG. In the photo is your results, what is the diagnosis?

A

2nd degree AV block

107
Q

Patient presents with chest pain and fatigue. Below are the results of the ECG, What is the diagnosis?

A

Type II 2nd degree AV block

108
Q

What is the diagnosis for the ECG presented in the photo? It it often times associated with sudden cardiac arrest

A

3rd degree AV block

109
Q

Patient presents with acute onset of palpitations, mild chest pain and shortness of breath. You conducted an ECG and the results are pictured, what is the diagnosis?

A

Paroxysmal Supraventricular Tachycardia (PSVT)

110
Q

Patient presents with palpating and dizziness. You decide to obtain an ECG and pictured below are your results. What is the diagnosis?

A

Premature Ventricular Contraction (PVC)

111
Q

What is the diagnosis for the ECG strip below?

A

Torsades de Pointes

112
Q

Patient is found unconscious with no pulse and the ECG shows the following. What is the diagnosis?

A

Ventricular fibrillation

113
Q

What is the diagnosis for the ECG below?

A

Ventricular tachycardia

114
Q

What is the diagnosis for the ECG shown below?

A

Sinus Tachycardia

115
Q

Leads I, aVL, V5-V6 represents

A

lateral aspect of the heart and receives blood from the LCx.

116
Q

Leads II, III, aVF represents

A

the inferior aspect of the heart and receives blood from the RCA.

117
Q

Leads V1-V2 represents

A

the septal area of the heart and receives blood from the Left Anterior Descending Artery (LAD)

118
Q

Leads V3-4 represents

A

the anterior area of the heart (in particular the LV) and receives blood from the LAD.

119
Q

How is a left bundle branch block identified?

A

Identified by having a wide QRS complex (greater than 0.12 seconds) along with a broad S wave in lead V1 and wide R wave in lead V5 or V6

120
Q

What is the diagnosis based on the ECG strip below? Patient is lightheaded with a pulse of 45bpm

A

Sinus bradycardia

121
Q

If a patient has unstable sinus bradycardia what is the treatment?

A

1st give Atropine 0.5 mg IV push and repeat q 3-5 minutes for a maximum of 3 mg

122
Q

What is the treatment for PSVT?

A

ABCs, IV, Vitals, Monitor, Oxygen if saturation < 94%

Particular effort should be made to terminate an attack if unstable via cardioversion.

Mechanical Measures should be attempted if patient is stable:
-stimulate the vagus nerve and increase vagal tone

If stable and mechanical measures do not work, give 6mg IV Adenosine or Metoprolol 5 mg (beta blocker)

123
Q

If you are palpating and feel heaves/thrills what is this indicative of?

A

Aortic Disection

124
Q

What positions will the patient be in when you listen for heart sounds?

A

Sit/Lean forward
Supine
Left Lateral Recumbent

125
Q

Is an S3/S4 heart sound commonly heard in kids?

A

Yes

126
Q

How will you characterize a murmur

A

Systolic/diastolic, timing and duration, pitch, location, radiation and is there a snap?

127
Q

Where do you auscultate for bruits?

A 
Temporal
Carotid 
Femoral 
Abdominal
Renal
128
Q

Bilateral edema is a sign of what

A

CHF

129
Q

What is the average pulse pressure range

A

30-40 mm mercury

130
Q

In a color Doppler, blood flowing toward the probe is what color

A

Red

Away is blue

131
Q

How will cardiac tamponade appear in an ultrasound

A

Hypo-echoic

132
Q

How many times must a person have high blood pressure in clinic before you diagnose with HTN

A

3 to 5

133
Q

What stimulants can cause stage II HTN

A 
PSEUDOFED
Coccaine
Caffeine 
NSAIDS
Contraceptives 
As well as hypothyroidism
134
Q

What is the MOA of a diuretic?

A

Reduce plasma volume

135
Q

What is the goal when attempting to lower blood pressure in a hypertensive emergency?

A

Lower 25% within 1-2 hours and <160/110 within 24 hours

136
Q

If a person has an uncomplicated cardiac contusion what are you going to do

A

ECG/EKG monitor for 6 hours and then another at 24 hours

137
Q

What is the most common cause of acute arterial limb occlusion of a limb?

A

Atrial fibrillation

138
Q

What is the treatment for acute arterial limb occlusion

A

Enoxaparin 1mg/kg (lovenox)

139
Q

If you have diagnosed someone with occlusive cerebrovascular disease what is important to do in regards to their blood pressure

A

SBP can be maintained at 180 in most situations (think of this like a stroke)

140
Q

Primary prevention of hyperlipidemia is the use of ASCVD scale, if someone who is 40-79 has a >10% risk what is your treatment plan

A

Aspirin and initiate a statin

if they are >5% then only a statin

141
Q

High triglycerides can precipitate what?

A

Pancreatitis

142
Q

When looking at an ECG/EKG what is the difference between seeing ST depression and an ST Elevation

A 
Depression = ischemia 
Elevation = Infarction (tissue death)
143
Q

What is Identified by having a wide QRS complex (greater than 0.12 seconds) along with a broad S wave in lead V1 and wide R wave in lead V5 or V6

A

Left bundle branch block

144
Q

What is the treatment for unstable bradycardia?

A

Atropine 0.5 every 3-5 minutes up to 6 doses and if medication is ineffective then transcutaneous pacing

145
Q

How do you identify PSVT

A

Heart rate is greater than 150 up to 240, narrow QRS and no p wave

146
Q

What can you do for stable PSVT

A

Vasovagal maneuvers

  • carotid massage
  • face in an ice bucket
  • valsalva (pop ears)
147
Q

How do you treat unstable PSVT

A

Cardio version

Adenosine or beta blocker (metoprolol)

148
Q

What is significant in an EKG of someone who has WPW

A

Delta wave is present

149
Q

What are some predispositions of A-fib?

A

Rheumatic fever, HTN, pericarditis, CHF, excessive ETOH use, Excessive caffeine use

*A-fib predisposes patients to thromboembolic events.

150
Q

What will you see in a EKG with someone who is experiencing A-fib

A

Atrial rate ~ 400 beats/min and presents as fibrillation waves (wavy baseline).

R-R interval is irregularly irregular

151
Q

Patients with AF > 48 hours are at risk for cardioembolic events and should not be cardioverted until anti-coagulated for a minimum of _____weeks prior to attempting elective cardioversion.

A

Three

152
Q

What is the defining feature of Ventricular tachycardia on an EKG?

A

Tombstone (Wide QRS complex)

Tachycardia, usually HR 160-240 beats/min.

Moderately regular R-R interval.

153
Q

If you cannot feel pulses on someone what is the first thing you’re going to do

A

Start CPR

154
Q

If you want to establish an airway can you stop compressions during CPR?

A

No, Compressions can only be stopped for a max of 10 seconds unless the AED is assessing/shocking

155
Q

After 2 minutes of CPR what medication can you give

A

Epinephrine and if that doesn’t work then Lidocaine or Amiodarone

Doses:

Provide CPR for 2 minutes, administer Epinephrine 1mg IV push, consider advanced airway and capnography.

Provide CPR for 2 minutes, administer Amiodarone 300 mg IV push or

Lidocaine 1-1.5 mg/kg IV push.

156
Q

Following second round of medications then start to evaluate causes of cardiac arrest looking at H’s and T’s. What are those H’s and T’s?

A

1) Hypovolemia
2) Hypoxemia
3) Hydrogen ion excess (acidosis)
4) Hyper-/hypokalemia
5) Hypothermia
6) Hyper-/hypoglycemia
7) Tamponade
8) Tension Pneumothorax
9) Thrombosis (pulmonary embolism)
10) Thrombosis (myocardial infarction)
11) Toxins

157
Q

A type of Angina that is Rare, caused by coronary vasospasm often without any CAD.

A

Prinzmetal’s Angina

158
Q

Acute Coronary Syndrome (ACS) comprise the spectrum of unstable cardiac ischemia from unstable angina to acute myocardial infarction what is the number one sign of ACE or AMI?

A

Substernal chest pain (#1 symptoms).

(2) Chest pain commonly described as pressure on chest (like an elephant is sitting on their chest).
(3) Chest pain can radiate to left shoulder, left arm, neck or jaw.
(4) Occurs at rest, commonly in the morning.

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