Cardio Gen Flashcards
(108 cards)
1
Q
What is the first heart sound?
A
closing of AV valve
2
Q
When is the period of isovolumic contraction?
A
QRS when AV valve and aorta are closed and ventricles are contracting
3
Q
When is the period of isovlolumic relaxation?
A
After T wave when ventricles are relaxing and all valves are closed
4
Q
What is second heart sound?
A
closing of aortic valve
5
Q
When is systole?
A
When ventricles begin to contract to when the aortic valve closes and period of ejection closes
6
Q
When is diastole?
A
Begins when aortic valve closes and continues through filling phase until ventricle contracts and AV valve closes
7
Q
Define cardiac cycle
A
synchronous pumping activities of hearts two atrioventricular pumps
8
Q
What is the population of cardiac muscle cells i the wall of the R atrium that initiate electrical stimulation?
A
SA nodal cells
9
Q
What is the function of the SA node cells?
A
provide electrical stimulation to initiate cardiac cycle
10
Q
What does the QRS complex represent?
A
ventricular contraction
11
Q
What does p wave represent?
A
atrial contraction
12
Q
What does T wave represent?
A
ventricular relaxation
13
Q
What are the high and low points of a persons heart in the chest?
A
sternal angle and xiphoid process
14
Q
How much pericardial fluid does a normal adult contain?
A
20 to 30 ml
15
Q
What is the function of the pericardial cavity?
A
provides lubricated free space that separates heart from the rest of the organs and body structures
16
Q
What occurs when a person has injury to pericardial cavity?
A
cardiac tamponade
17
Q
How do you treat cardiac tamponade?
A
insert needle at L infrasternal angle
18
Q
What is the L border of the heart mostly when looking at persons chest in PA film?
A
L ventricle
19
Q
What is the R border of the heart mostly when looking at persons chest in PA film?
A
R atrium
20
Q
What is anterior surface in L lateral chest film?
A
R ventricle
21
Q
What is posterior surface in L lateral chest film?
A
L atrium and L ventricle
22
Q
What is coronary artery disease?
A
Any condition brought on by a sudden reduction or blockage of blood flow to the h (UA, NSTEM, STEMI)
23
Q
What is the pathophys of CAD?
A
fatty streak formation, macrophages turn to foam cells form plaque and progression to slowly encroach on lumen area
24
Q
RF for CAD
A
DM, cigarettes, age, FH, phys inactivity, obesity, emotional stress
25
Pathophys of ischemia
insuficient blood flow, cytokine release (pain), if prolonged becomes injury
26
pathophys of injury
occurs with sustrained ischemia, release cardiac biomarkers, ST elevation
27
infarction
irreversible cell death, decrease cardiac function, release cardiac biomarkers, Q wave formation
28
What should every patient who presents with hx of chest pain get?
12 lead ECG
29
What does LV hypertrophy tell you
HTN, increased risk for infarction
30
What does a fib tell you?
previous infarct or risk of infarct
31
What do BBB tell you?
is new LBBB increased risk of infarction, can mask ischemia, injury and infarct
32
How does ischemia present on EKG?
ST depression, T wave inversion
33
How does injury present on SKG?
ST elevation, T wave inversion, new LBBB
34
How does infarction present on EKG?
ST elevation plus pathologic Q waves, or just the pathologic Q waves
35
What does ambulatory ECG monitoring detect?
paroxysmal dysrhythmias (SVT or A fib), periods of ischemia (correlate with angina journal)
36
What does echocardiography detect?
inappropriate flow through valves and valvular stenosis
37
When do you stop exercise stress testing?
angina, hypotension, changes in ECG
38
What does stress echocardiography show?
wall abnormalities consistent with ischemia
39
What does myocardial perfusion scan detect?
defects show up where ischemic or infarction
40
What is the gold standard test for diagnosing CAD?
coronary angiography (good because can also treat right away)
41
What are risks of coronary angiography?
anaphylaxis, allergic rxn, kidney problems
42
What lab studies should be ordered for CAD?
chem 7, CBC, cholesterol, if recent chest pain then also troponin I and T, CKMB and myoglobin
43
What is typical angina?
substernal chest discomfort with characteristic quality and duration that is provoked by exertion or emotional stress and relieved by nitroglycerin
(atypical only some of these symptoms)
44
What is significance of friedewald formula?
calculated LDL levels and theres room for error
45
RF for hypercholesterolemia
age, HTN, cigarettes, obesity, physical inactivity, high cholesterol, low HDL, diabetes, kidney dysfunction, FH
46
Prevention of hypercholesterolemia
decrease cholesterol, control BP, stop smoking, increase activity, reduce stress, statins
47
What is the 1st line test for diagnosis of CAD?
EKG stress test if capcable of exercise
48
What is 1 MET?
the amount of oxygen consumed while sitting at rest
49
What is 1st line test for assessment of LV structure and function?
echocardiography
50
What can you see with a parasternal short axis view?
R and L vertnicle
51
What is normal ejection fraction?
<55%
52
What are indications of nuclear cardiology?
diagnose CAd, assess physiologic significance of CAD, evaluate ventricular function
53
Define coronary reserve
the ability of coronary vessels to meet metabolic demands
54
Patient instructions for nuclear stress test
no caffeine 24 hours prior to testing, nothing to eat
hold beta blockers
take all BP meds
test takes 3-4 hrs
55
Indications of cardiac CT
non-invasive anatomic assessment of coronary artery disease or structural heart disease
56
What is gadolinium?
class of contrast agents used in CMR
57
Indications for cardiac MRI
cardiomyopathy, inflammation, myocarditis, congenital heart disease, tumors
58
Why are non-stenotic plaques more dangerous?
more frequent
59
What are limitations of traditional stress test for diagnosing CAD?
cannot detect vulnerable patient without obstructive lesion
60
Echo vs nuclear test
Echo better for blockages and nuclear better for known disease
61
What is CCS scoring system?
scores angina
```
Class 0-asymptomatic
class 1-angina w/ strenuous exercise
Class 2-angina w/ mod exertion
Class 3- angina w/ mild exertion
Class 4-angina w/ any levrl of phys exertion
```
62
Why do you have to be careful with NTG?
potent vasodilator that will work immediately and can dissolve on skin so it not patient can have syncope
63
What is CABG?
take vein from leg and attach distal to where block was
| improves mortality
64
What happens if you give a patient nitro when they recently took viagra?
can pass out or have stroke (must have taken >12 hr ago)
65
What is PCI?
stenting and angioplasty
66
Prevention of stable angina?
lower cholesterol, statins, treat HTN, weight loss, exercise, long acting nitrates, beta blockers, Ca channel blockers, aspirin
67
Who is not a candidate for cardiac rehab?
unstable CHF, unstable angina, hymodynamic instability, 3rd degree blocks, systolic BP>200 or diastolic BP >110 or other illnesses/fever
68
What are the phases of cardiac rehab?
Phase I acuter care hospital (3-5 days)
Phase II discharged from home /w intensive monitoring(6-12 wks)
Phase III pt stable less monitoring than II
Phase IV high risk pts
69
Who needs telemetry?
```
EF < 30%
ventricular arrhythmias at rest
dec BP with exercise )(10-20 mmHg)
survivors of sudden death
post complicated MI
severe CAD & marked exercise induced ischemia
inability to self monitor
```
70
What might you hear when a patient is going into heart failure
new S3, crackles in lower lungs
71
How many minutes of exercise a day to maintain weight?
300 minutes/week
72
How do you prescribe prescriptions for cardiac patients?
mode, intensity, duration, frequency and progression
73
What needs to be monitored for cardiac rehab?
```
Hemodynamic responses (Bp),
ECG (HR & rhythm) responses via telemetry or
portable ECG monitor
Oxygenation (pulse oximeter)
Signs & symptoms
```
74
How do you determine cardiac hreab intensity?
```
Healthy pop-Max HR =220-age
post MI-exercising HR<120 bpm or RHR + 20
Post CABG-RHR+30bpm
Inpatients-Borg RPE 11-13
5 MET level
```
75
What level should patient be function in BORG scale?
11-13
76
How often should patient be exercising for good heart health?
60 min day/day (at least 5 days)
77
Normal responses to exercise
```
Gradual and linear increase in
HR
Gradual and linear increase in SBP
Slight increase, decrease or no change in DBP
Increase in SV
Increase in CO
Increase in O2 demands
```
78
Abnormal responses to exercise
Decrease in HR
Decrease in SBP > 20mm Hg
Dyspnea, diaphoresis, pallor, duskiness, dizziness, nausea
Skipped beats develop after exercise
Rales/crackles or new S3 develops after exercise
79
Special considerations for exercising deconditioned patients
short duration
80
Special considerations for exercising Beta blocked patients
HR & BP response abnromal
| USE BORG scale
81
Special considerations for exercising COPD
SPO@
82
Special considerations for exercising DM
blood glucose levels
83
Special considerations for exercising PAD
foot pain, leg pain due to ischemia so do short bouts of exercise
84
Special considerations for exercising arthritis
swimming or biking
85
Special considerations for exercising patient with pacemaker
shoulder flexion restrictions for 2-4 wks
86
Special considerations for exercising pt with pacing wires
shoulder flexion restrictions
87
Special considerations for exercising cardioverted patient
rest
88
Special considerations for exercising S/P L Heart Catheterization or S/P R heart
bed rest
89
phase 2 cardiac rehab duration
12-18 wks
90
CMS outptient coverage
(1) a documented diagnosis of AMI within the preceding 12 months;
(2) coronary artery bypass surgery; and /or
(3) stable angina pectoris
– heart valve repair/replacement; or
– percutaneous transluminal coronary angioplasty (PTCA) or
coronary stenting
– heart or heart/lung transplant.
91
What is the MC cause of heart disease?
atherosclerosis followed by HTN and congenital heart disease
92
What happens when the cross section of the lumen of a coronary artery is 75% narrowed?
compensatory coronary vasodilation is
| insufficient to meet moderate increases in myocardial O2 demand leading to ischemia
93
What is the MC cause of a MI?
coronary thrombosis due to atherosclerotic plaque
94
What are complications of MI?
Papillary muscle dysfunction/rupture External rupture of the infarct
IV septal rupture
Mural thrombosis Ventricular aneurysm Arrhythmia
CHF, Sudden Cardiac Death
95
What are complications of HTN?
```
Cardiac hypertrophy
Congestive heart disease
Renal insufficiency
Hypertensive encephalopathy
Hypertensive retinopathy
```
96
What is the MC vessel to be occluded?
L anterior descending
97
What is the MC cause of intercerebral hemorrhage?
HTN
98
What is Takayasu s Arteritis?
Narrowing of brachiocephalic, carotid, and subclavian arteries
99
Define heart failure
inability of the heart to pump blood at a sufficient rate to meet the metabolic demands of the body (e.g. oxygen and cell nutrients) at rest and during effort or to do so only if the cardiac filling pressures are abnormally high
100
What is the MC cause of hospitalization in people over 65 in the US?
heart failure
101
Define shock
Life threatening condition of circulatory failure, initially reversible but rapidly becomes irreversible resulting in multi-organ failure and death
102
What is distributive shock?
septic causes-bacteria
| non-septic-cessation of steroids, forms of ischemia, trauma
103
What is cardiogenic shock?
anything that happens to the heart, myocarditis, MI, infarction
104
What is hypovolemic shock?
hemorrhagic, trauma, GI bleed, vomiting, diarrhea, skin losses
105
What is obstructive shock?
acute PE, anything causing obstruction to circulation, tumors
106
What is hypotensive BP?
<90/<65
107
What is the resting membrane potential in most cardiac cells?
-90 mV (only influenced by K+)
108
Define syncope
sudden temporary LOC (symptom not a diagnosis)
