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Quarter 4 > Cardio Final > Flashcards

Cardio Final Flashcards

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1
Q

Levels of Traumatic Brain Injury (TBI)

A

mild (concussion), moderate, and severe (coma)

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2
Q

What factors determine intracranial pressure?

A

blood, parenchymal tissue, and CSF

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3
Q

Dose of Mannitol to decrease ICP

A

0.25 - 1 g/kg

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4
Q

Explain how mannitol affects ICP

A
  • In cerebral circulation:
    • increases osmotic force and causes fluid shift out of tissue compartment into vascular space
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5
Q

How does vascular smooth muscle respond to brief occlusion?

A

myogenic response

  • following, the vessel reamins vasodilated temporarily
    • post-ischemic hyperemia
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6
Q

How does vascular smooth muscle respond to prolonged occlusion

A

maximally dilated and a build-up of CO2 and lactate

  • may lead to reperfusion injury
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7
Q

Contraindications for arterial tourniquet

A
  • prosthetic vascular grafts
  • patients at risk for DVT
  • immobilized patients
  • extensive peripheral vascular disease
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8
Q

Compartment Syndrome

A

edema and blood accumulate within a confined osseofascial space

  • comprises circulation and tissues
  • more common in tibital and femoral fractures
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9
Q

(3) Risk factors for developing Compartment syndrome

A
  • long bone fractures or trauma
  • males under 35 yo
  • anticoagulant use
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10
Q

What is mainly secreted in pheochromocytomas?

A

norepinephrine

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11
Q

Metryosine

(demser)

A

treatment for pheochromocytoma

  • lowers blood pressure by inhibiting catecholamine production
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12
Q

Rapid-onset alpha blockers for Pheochromocytoma

A

Phentolamine

(5mg as needed)

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13
Q

Which drugs should be avoided in cocaine patients?

A
  • Ketamine
  • ephedrine
  • succinylcholine
  • etomidate
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14
Q

Difference between vascular myocyte and cardiac

A

vascular myocytes have longer thin filaments and lack troponin

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15
Q

Baroreceptors

A

sprayed sensory nerve ending found in the adventia of arteries

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16
Q

Baroreceptor location

A

carotid sinus and aortic arch

(can also be found in the coronary arteries)

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17
Q

afferent nerves from baroreceptors all terminate in the _____

A

nucleus tractus solitarius

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18
Q

Baroreceptor response

A

responds to the magnitude (static) and rate of change (dynamic) in pressure

  • alters firing rate
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19
Q

Baroreceptor of the Carotid Sinus

A

origin of internal carotid

  • joings Glossopharyngeal nerve (IX) to petrous ganglion
  • signal mean pressure and pulse pressure
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20
Q

Baroreceptor of the Aortic arch

A

located at transverse arch of aorta

  • joins vagus nerve (X)
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21
Q

an increase in MAP causes an _____ in baroreceptor firing

A

increase

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22
Q

A-fibers

A

large diameter, fast conducting, and myelinated

  • low threshold, more sensitive
  • active during normal blood pressure
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23
Q

C-fibers

A

abundant, small diameter, slow conducting, and unmyelinated

  • high threshold
  • important for high blood pressures
  • recruitment of C-fibers occurs around 100 mmHg
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24
Q

Baroreflex

A

adjusts cardiac output and peripheral vascular tone to stabilize arterial BP

  • acute pressure elevation triggers depressor reflex
  • hypotension triggers pressor reflex
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25
Depressor Reflex
enchances vagal parasympathetic output and inhibits sympathetic * bradycardia, decreased contractility, hypotension, and decrease PVR
26
depressor reflex example
carotid sinus massage
27
Pressor reflex
increases sympathetic outflow and decreases parasympathetic * tachycardia, increased contractility, vasoconstriction, and splanchnic venoconstriction
28
Baroreflex sensitivity and set point
* sensitivity - "gain" * slope of response curve * decreased by age and chronic hypertension * set point - pressure that reflex tries to maintain * higher during exercise
29
(4) Types of Cardiopulmonary Afferents
* myelinated veno-atrial mechanoreceptor * non-myelinated cardiac mechanoreceptor * coronary artery baroreceptor * ventricular chemosensors
30
Myelinated Veno-Atrial Mechanoreceptors
stretch receptors that measure CVP and atrial filling * located in great veins and both atria * tachycardia and diuresis
31
Bainbridge Reflex
an increase in heart rate due to an increase in CVP * detected by Veno-Atrial mechanoreceptors * shifts blood from venous to arterial
32
Non-myelinated Cardiac Mechanoreceptors
cause bradycardia and vasodilation * located in atria and left ventricle * signal over-distension
33
Coronary Artery Baroreceptors
similar to other baroreceptors but with greater potency * Bezold-Jarisch Reflex
34
Bezold-Jarisch Reflex
increased pressure in coronary arteries causes bradycardia and hypotension * mediated by Coronary Artery Baroreceptors
35
Ventricular Chemosensors
vagal fibers that mediate ischemic heart pain in the left ventricle * increases sympathetic activity in response to: * adenosine, bradykinin, prostaglandin, histamine, thromboxane, lactic acid, K+, and ROS
36
Cushing's Reflex
increased ICP causes an increase in peripheral sympathetic activity
37
Cushing's Triad
hypertension, reflex bradycardia, and abnormal breathing
38
Oculocardiac Reflex
pressure on eye or extraocular muscles * increase parasympathetic tone * bradycardia
39
Renin - Angiotensin - Aldosterone
promotes salt and water retention when blood pressure is low
40
Addison's Disease
low Aldosterone * causes hypotension * chronic adrenal insufficiency
41
Anti-Diuretic Hormone | (vasopressin)
promotes water retention to restore extracellular volume * stimulated by low blood volume
42
Atrial Natriuretic Peptide
promotes salt excretion and diuresis * reelased in response to atrial distension * directly affects central blood volume
43
RAAS response to decreased BP
* increase renin increases: * angiotensin II * aldosterone * Na+ absorption * fluid absorption
44
Mechanoreceptors
inhibit cardiac vagal tone * stimulated by local pressure and muscle contraction
45
Metaboreceptors
stimulated by substances released during exercise * more active during isometric exercise due to less blood flow
46
Somatic Pain response
increase HR and BP | (opposite for visceral pain)
47
Asphyxia
hypoxemia with hypercapnia * stimulates increase BP, cerebral perfusion, and oxygen delivery
48
Clinical Shock
hypotension, hypovolemic, and cardiac shock * causes rapid breathing and increases peripheral resistance
49
What regulates alveolar ventilation and BP during asphyxia and clinical shock?
arterial chemoreflex
50
Nucleus Tractus Solitarus
integrates virtually all cardiovascular afferents and relays them to the hypothalamus, cerebellum, and medulla
51
Destruction of the nucleus tractus solitarus causes a sustained \_\_\_\_\_
hypertension
52
Rostral Ventrolateral Medulla (RVLM)
tonically active vasopressor * regulated by the CVLM * primary regulator of the sympathetic nervous system
53
Paraventricular Nucleus
regulates sympathetic activity * recieves information from NTS * project into RVLM and SC to influence sympathetic outflow * located in hypothalamus
54
Magnocellular Neurons
secrete oxytocin and vasopressin * located in PVN of the hypothalamus
55
Alerting Response
tachycardia, increased CO, vasodilation, and increased BP * generated by amygdala, hypothalamus, and preiaqueductal grey matter
56
"playing dead" response
bradycardia and hypotension * originates in cingulate gyrus of limbic system
57
Valsalva Maneuver
forced expiration against a closed or narrow glottis that creates high intrathroacic pressure * ultimately increases stroke volume and pulse pressure while decreasing HR
58
Oxygen uptake | (equation)
VO2 = Q \* (CaO2 - CvO2)
59
Dynamic exercise
cycles of contraction and relaxation * increased CO balanced by decreased PVR
60
Static exercise
isometric contraction * stimulation of mechanoreceptors * increase HR, CO, and SVR
61
endurance is dependent on the maximum rate of \_\_\_\_\_\_
O2 transport from lungs to mitochondria
62
Endurance atheletes
increased CO and SV ## Footnote **eccentric hypertrophy**
63
Eccentric Hypertrophy
increases myocyte length (not width) * found in endurance atheletes * increased number of capillaries * bigger chamber in proportion to increase in wall thickness
64
Concentric Hypertrophy
increase in wall thickness \> chamber size * found in strength training * similar to chronic HTN
65
Diving Response
apenea, bradycardia, and peripheral vasoconstriction
66
Arterial Oxygen Content | (equation)
CaO2 = (1.31 \* Hb \* SaO2) + (0.003 \* PaO2)
67
All forms of shock have a decrease in ____ and an increase in \_\_\_\_\_
decrease in MAP increase in lactic acid
68
distributive shock
systemic hypotension, sepsis, anaphylaxis, or neurogenic shock * decrease * PAWP, SVR * increase * CO, SvO2
69
Obstructive Shock
PE, cardiac tamponade, VAE, or tension pneumothorax * decrease * CO, SvO2 * increase * PAWP, SVR
70
Hypovolemic shock
* increase * SVR * decrease * PAWP, CO, and SvO2
71
Cardiogenic Shock
* increase * PAWP, SVR * decrease * CO, SvO2
72
\_\_\_\_\_% of blood loss may produce hypovolemic shock
20-30%
73
Hemorrhagic Shock
* cardiopulmonary stretch receptors and arterial baroreceptors decline * chemoreceptor activity increases * equal MAP, but decreased pulse pressure
74
Hemorrhagic Shock | (long term responses)
* reduced renal excretion and increased fluid intake * albumin synthesis * RBC production
75
Blood loss ultimately results in increased ____ (4)
HR, contractility, venous tone, and SVR
76
Framingham Risk Score
determines risk of developing IHD or CVA * age, gender, cholesterol, smoker, systolic BP, and anti-hypertensive medication * low risk \< 10% * high risk \> 20%
77
Metabolic Syndrome
group of risk factors that occur together and increase risk for IHD and stroke * 3 or more: * waise \> 40 or 35 * TG \> 150 * HDL \< 40 or 50 * fasting glucose \> 100 * BP \> 130/85
78
Syndrome X
group of risk factors that indicate predisposition to diabetes * glucose intolerance, high triglycerides, obesity, and hypertension
79
Transesophageal echo (TEE) contraindications
* pharyngeal or esophageal obstruction * active upper GI bleed * suspected perforated viscus * instability of cervical spine * uncooperative patient
80
Why should class III patients not recieve a treadmill stress test?
baseline ECG abnormalities * WPW, paced rhythm, ST depression, or complete LBBB
81
Treadmill Stress Test contraindications
* acute MI * angina * aortic stenosis * PE * aortic dissection * psychosis
82
Treadmill stress test is best used in evaluation of a patient with \_\_\_\_\_
intermediate risk with atypical history or a low risk with typical history
83
imaging for myocardial ischemia
nuclear imaging or PET
84
imaging for systolic/diastolic dysfunction
stress echo
85
imaging for chest pain
history
86
Pharmocologic stressors in Nuclear Stress Testing
* Dipyridamole (persantine) * Adenosine * Regadenoson **(lexiscan)**
87
Nuclear stress testing effects _____ receptors
adenosine receptors A2A - coronary artery vasodilation
88
Nuclear Stress Test imaging agents
* Thallium * Tecnhitium * Sestamibi (cardiolite) * Tetrofosmin (myoview) * Teboroxime (cardiotec)
89
Contraindications for Nuclear Stress Testing
* I-131 therapy within 12 weeks * Tc-99m studies * caffeine * allergies to diphyridamole or aminophylline * active asthma
90
What test is the gold standard to find blockages?
**cardiac catheterization** coronary angiography or left ventirculography
91
Cardiac Catheterization contraindications
* coagulopathy * renal failure * dye allergy * active infection * CHF * severe hypertension
92
Acute Coronary Syndrome
blood supply to myocardium is suddenly blocked * umbrella term including: * STEMI, non-STEMI, and unstable angina
93
Fondaparinux | (arixtra)
factor Xa inhibitor ## Footnote **antithrombin**
94
most sensitive and specific cardiac enzyme to test for myocardial damage
Troponin
95
right-to-left shunt
systemic venous into systemic arterial
96
left-to-right shunt
pulmonary venous into pulmonary arterial
97
o reduce right to left shunt flow through a VSD, which should be avoided?
hypoxemia
98
Atrial Septal Defect
defect in interatrial septum allowing **left-to-right** shunt * dyspnea, SVT, right heart failure, and paradoxical embolism * 2 cm
99
Patent Foramen Ovale
hole between upper atria * NOT an atrial septal defect * venous blood leaks into left atrium
100
ventricular septal defect
hole between the ventricles * volume overload to right ventricle * early pulmonary hypertension * may develop PVOD * **most common CHD** * 50% sponatenously resolve
101
Patent Ductus Arteriosus
hole between pulmonary artery and aorta * mixed blood goes from aorta into pulmonary artery * treated with ligation using Pancuronium and ketamine
102
Coarctation of the Aorta
narrowing of descending thoracic aorta * often appears with Turner syndrome * mostly post-ductal * associated with aortic stenosis, bicuspid valve, and VSD * increases resistance to left ventricular outflow
103
Tetralogy of Fallot
combination of four defects: (VSD, pulmonary stenosis, overriding aora, and RVH) * most common cyanotic leasion
104
Treatment of TET spells
* 100% oxygen * compression of femoral arteries * morphine * fluid bolus (15-30 mL/kg) * NaHCO3 to correct acidosis * Phenylephrine to increase SVR
105
what should not be given during TET spells?
beta agonists | (worsens RVOT obstruction)
106
Hypoplastic Left Heart Syndrome
underdeveloped left heart * systemic perfusion is dependent on PDA flow
107
Transposition of Great Arteries
inappropriate orientation of vessels and cardiac chambers * two circulations in parallel (not series) * PDA and FO must remain open
108
Eisenmenger Syndrome
large L-to-R shunt * develops pulmonary vascular disease and hypertension
109
classic triad of symptoms with Aortic Stenosis
angina, dyspnea, and syncope
110
Most common type of aortic stenosis
valvular
111
Normal arotic valve area
3 - 4 cm2 ## Footnote **critical aortic stenosis is AVA \< 0.7 cm2**
112
Physical findings of Aortic Stenosis
* pulsus parvus et tardus * systolic ejection murmur * paradoxically split S2
113
paradoxically split S2 causes \_\_\_\_
* severe aortic stenosis * LBBB * hypertrophic cardiomyopathy
114
most common cause of aortic stenosis
age-related calcific degeneration
115
most common causes of acute mitral regurge
ischemic heart disease, endocarditis, and rupture of chordae tendinae
116
Primary cause for mitral stenosis
rheumatic heart disease

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