cardiology Flashcards
(156 cards)
1
Q
Atrial contraction squeezes last bit out into the ventricles, 10% of EDV
A
Atrial kick
2
Q
What is S1 from?
A
Tricuspid and mitral valve closure during systole
3
Q
What is S2 from?
A
Pulmonic and Aortic valves close during diastole
4
Q
Division of the aortic root that supplies the septum and anterior ventricular wall (left coronary circulation)
A
Left Anterior Descending Artery
5
Q
Division of the aortic root that supplies the left ventricular wall (left coronary circulation)
A
Left circumflex artery
6
Q
Division of the aortic root hat supplies the right ventricle (right coronary circulation)
A
Marginal Branch
7
Q
Division of the aortic root that supplies the posterior and inferior left ventricle (right coronary circulation)
A
Posterior descending
8
Q
What % of people have a posterior descending artery from the RCA?
A
80%, right dominance
9
Q
The ability of cardiac cells to independently and repeatedly depolarize
A
automaticity
10
Q
How do you find CO?
A
CO = SV x HR
11
Q
How do you find SV?
A
EDV - ESV = SV
12
Q
Cardiac muscle stretch at the start of systole
A
Preload
13
Q
Pressure that the ventricles contract against during systole (aortic pressure)
A
Afterload
14
Q
What affects preload?
A
Blood volume Distribution of BV Atrial contraction Heart Rate Ventricular complicance (BDAHV)
15
Q
T or F: Aortic pressure = ventricular pressure = Systolic BP
A
True
16
Q
T or F: As BP rises, there is more SV
A
False. More resistance, less SV
17
Q
What affects afterload?
A
Vascular resistance (systemic) Elasticity of the aorta Arterial blood volume Ventricular wall tension Aortic Valve stenosis
18
Q
What could affect stroke volume on both preload and afterload curve?
A
Contractility
19
Q
What affects contracility?
A
Calcium (intramyocardial) Ischemia/Necrosis Rate Fibrosis or ventricular compliance Ventricular remodeling
20
Q
How do you find mean arterial pressure?
A
MAP = 1/3 systolic BP + 2/3 diastolic BP
21
Q
What are the three layers of arteries and veins?
A
Intima
Media
Adventitia
22
Q
Which structure has elastic tissue between intima and media?
A
Aorta
“vasa vasorum”
23
Q
Myocardial contraction
A
Inotropy
24
Q
Myocardial relaxation
A
Lusitropy
25
SA node firing
Chronotropy
26
AV node conduction velocity
Dromotropy
27
P wave on EKG
Atrial systole
28
How are mitral and tricuspid valves during atrial systole?
OPEN
29
What is S4 from?
Extra heart sound during atrial systole from forceful atrial contraction against a stiff ventricle
30
QRS on EKG
Isovolemic contraction
31
Ventricular pressure > atrial pressure
Ventricular contraction, aka Isovolemic contraction
32
How are mitral and tricuspid valves during isovolemic contraction?
Closed (S1)
33
Ventricular emptying. Ventricular pressure > Aortic pressure
Rapid ejection
34
ST segment and T wave on EKG
Rapid ejection
35
How are aortic and pulmonary valves during rapid ejection?
Open
36
Closure of the cycle, Aortic pressure > Ventricular pressure.
Isovolemic relaxation
37
What heart sound is associated with isovolemic relaxation?
Aortic and pulmonary valves closing (S2)
38
What is S3 from?
Extra heart sound in which you can hear rapid filling of ventricles
39
How are mitral and tricuspid valves during rapid filling?
OPEN
40
Peak pressure in the arteries near the end of systole
SBP
41
resting pressure in the arteries during diastole
DBP
42
Why worry about HTN?
```
It DOUBLES the risk of:
CAD
PAD
CHF
Stroke
Renal failure
```
43
How does BP change over time?
SBP: men higher than women until 60, then women are higher
DBP: increase until 55, then decrease
44
If you're over 60, there's a _____% chance of having HTN
60
45
What are the signal pathways through which the ANS regulates BP?
Pressure
Volume
Chemoreceptors
46
Receptor Alpha 1: Location, effect?
Vascular smooth muscle
| Vasoconstricts
47
Receptor Alpha 2: Location, effect?
neurotransmitter (epi or NE) synthesizing nerves
| Inhibits NT release
48
Receptor Beta 1: Location, effect?
Cardiac cells
| Increases rate and contractility
49
Receptor Beta 2: Location, effect?
Vascular smooth muscle
| Vasodilation
50
Stretch or pressure sensor in aortic arch and carotids
Baroreceptors
51
With an increase in pressure, and therefore increased stretch, signals are released that cause what?
Decrease in sympathetic output
| Decrease in HR and pressure
52
With a decrease in pressure and a decrease in stretch, signals are released that cause what?
Increase in sympathetic output
| Increase in HR and Pressure
53
An alpha 1 antagonist would cause what?
lower BP
54
An alpha 1 agonist would cause what?
Higher BP
55
An alpha 2 antagonist would cause what?
higher BP
56
An alpha 2 agonist would cause what?
Lower BP
57
A beta 1 agonist would cause what?
higher BP
58
A beta 1 antagonist would cause what?
lower BP
59
A beta 2 antagonist would cause what?
higher BP
60
A beta 2 agonist would cause what?
lower BP
61
What effect does norepinephrine have at arteriole level?
Vasoconstricts
| Main source of afterload
62
What will the kidneys release renin in response to?
Low BP
Low sodium
NE stimulation (Sympathetic signaling)
63
Where is angiotensin formed?
liver
64
How does angiotensin become fully activated angiotensin II?
Anigotensin (made by liver) is cleaved by renin (made by kidneys) into angiotensin 1. Angiotensin 1 is cleaved by ACE in the lungs and vasculature to angiotensin II.
65
How does Angiotensin II work in its different locations?
Vascular: triggers smooth muscle contriction
Kidneys: triggers water resorption
Pituitary: Triggers ADH release
Adrenals: triggers Aldosterone release (renal sodium resorption)
66
What else does ACE do besides convert angiotensin 1 to II?
Make bradykinin (vasodilater) inactive
67
What happens to large vessels from remodeling?
Increased intima and media thickness
68
What happens to small vessels from remodeling?
Decreased lumen diameter
69
What is metabolic syndrome?
Constellation of insulin resistance, abdominal obesity, HTN, dyslipidemia
70
What is the most common cause of secondary hypertension?
primary renal disease
71
How can HTN and the kidneys be involved in a vicious cycle?
HTN causes renal cell death
Renal cell death leads to a loss of auto-regulation
Loss of auto-regulation leads to HTN
This repeats until kidney failure :(
72
What is considered HTN?
Anything over 140/90
73
Cardiovascular disease DOUBLES for every ____ above 115 SBP and ____ above 75 DBP
20 mmHg
| 10mmHg
74
How do you diagnose HTN?
2 recordings at 2 or more different office visits.
75
BP cuff bladder width should be _____% the arm circumference. Bladder length should be _____% the arm circumference.
40%
| 80%
76
Someone with BP of 135/90 would be in what stage?
Stage 1
77
Someone with BP of 138/85 would be in what stage?
Pre-HTN
78
Someone with a BP of 160/96 would be in what stage?
Stage II
79
Refractory HTN associated with insulin resistance and hypokalemia. Increased salt as well.
Primary aldosteronism. Aldosterone increases independent of RAAS.
80
Excess Cortisol prouction, excess ACTH secretion.
Cushing's syndrome
81
Catecholamine (epi) secreting tumor of the adrenal medulla. Rare, treatment is surgical.
Pheochromocytoma
82
What is the most common congenital cardiovascular cause of HTN?
Coarctation of the aorta (narrowing of the aorta)
83
A drop of 10 lbs can result in BP drop of ___ mmHg systolic and ____ 3 mmHg diastolic.
6 SBP
| 3 DBP
84
If your patient is hypertensive, what salt recommendation should you give them to lower BP?
4.4-7.4 g/day
85
How much does a decrease in salt lower BP?
4 mmHg systolic
| 1 mmHg diastolic
86
What can reduce risk of CVA by 35-40% in 5 years?
Reduction of 10-12 mmHg SBP and 5-6 mmHg DBP
87
What can reduce risk of CAD by 12-16% in 5 years?
Reduction of 10-12 mmHg SBP and 5-6 mmHg DBP
88
On average, how much do most meds drop BP by?
Systolic: 7-13 mmHg
Diastolic: 7-8 mmHg
89
Inhibits the Na/Cl pump in the distal convoluted tubule
Diuretics
90
First line antihypertensive
Hydrochlorothiazide (diuretic)
91
Block sodium channels in the distal nephron
K+ sparing diuretics
92
First line antihypertensive that is potassium sparing with once daily dosing
Amiloride (Midamor)
93
Potassium sparing antihypertensive with BID dosing
Triamterne (Dyrenium)
94
The "-semides"
Loop diuretics
95
Block Na/K/Cl transporter in loop of Henle causing decreased Na resorption (and thus less water resorption).
Loop diuretics
96
Diuretic used in pts with CHF
Loop diuretic
97
Best for pressure and volume reduction in a CHF patient. Dosed BID
Furosemide (Lasix) loop diuretic
98
Best for pressure and volume reduction in a CHF patient with daily dosing.
Torsemide (Demandex)
99
The "-prils"
ACEI
100
Decreases Angiotensin II production, increases bradykinin levels, decreases sympathetic activity.
ACEI
101
Best for first line antihypertensives for patients with renal disease
```
ACEI:
Lisinopril (Prinvil) OR
Enalapril (Vasotec)
ARBs:
Valsartan (Diovan) OR
Losartan (COZAAR)
```
102
What are SE for ACEIs?
Cough, angioedema
103
The "-sartans"
ARBs
104
Works by blocking the angiotensin receptors
ARBs
105
Receptor antagonist that decreases Na resorption, thereby decreasing water resorption and increasing potassium.
Aldosterone antagonists
106
Second line aldosterone antagonist taken daily or BID
spironolactone (aldactone)
107
What are SE of spironolactone?
Binds to androgen receptors, decreasing testosterone and increasing estradiol.
Gynecomastia, impotence, menstrual abnormalities
108
The "-olols"
Beta blocker
109
How do beta blockers work?
Competitive inhibition of beta 1 receptor.
| Decreases heart and contractility, thereby lowering cardiac output
110
Beta blocker that is best for patients with a history of MI?
| 50-100 mg PO
Metoprolol (lopressor)
111
Who would metoprolol NOT be indicated for?
Asthma/COPD patients
112
Beta blocker that is best for patients with history of MI that also has Alpha 1 inhibition?
Labetalol (trandate)
113
The "-azosins"
Alpha blockers (alpha-1 receptor blockers)
114
Used in prostatic hypertrophy, not as effective as other meds for HTN
alpha blockers:
Doxazosin (Cardua)
Terazosin (Hytrin) taken QHS
115
Alpha-2 receptor agonists that decrease sympathetic outflow and decrease peripheral vascular resistance by depleting NE
Sympatholytic Agents
116
What are SE of Clonidine (Catapress)?
Sympatholytic Agents
| Rebound HTN, sexual dysfunction, helps with heroin withdrawal
117
How do CCBs reduce HTN?
Block calcium channels, reducing intracellular calcium and reduces vasoconstriction
118
What do nondihydrophyridines focus on?
CCB that causes:
Decreased force of contraction
Vasodilation
Decreased conduction through SA and AV node
119
What do dihydrophyridines focus on?
CCB that causes:
Decrease SVR and arterial pressure
Can have REFLEX tachy
Doesn't affect AV node conduction
120
Which CCB is first line?
Dihydros
Amlodipine (NORVASC)
Nifedipine (PROCARDIA)
121
When would you prescribe diltiazem (cardiazem)?
First line CCB for patients with conduction issues, like A. Fib.
It is Nondihydro
122
SE of Dilitazem?
Peripheral edema
123
If your patient is younger, they MAY do better with what?
Beta or ACEI
124
If your patient is over 50, they MAY do better with what?
diuretic or CCB
125
What's average Joe with HTN's target BP?
<135-140/80-85
126
What's someone with CAD and DM's target BP?
<130/80
127
What's someone with proteinurea's target BP?
<120 systolic
128
What's someone with CHF's target BP?
no set number
129
What is considered resistant hypertension?
BP >140/90 while on 3 antihypertensive agents
130
What are the main causes of resistant HTN?
Non-adherence
Obesity
Drugs or alcohol
131
What is the initial lab work up of someone with resistant HTN?
BUN/Cr (renal function)
Electrolytes
Urinalysis (proteinuria, renal dz)
Fasting glucose and cholesterol (metabolic syndrome?)
132
According to JNC 8, a pt with DM or CKD between ages 30-59 should shoot for what DBP?
<90
| Same as someone without those diseases in any age group
133
According to JNC 8, what treatment method was eliminated?
Beta blockers
134
According to JNC 8, what should you use to treat African Americans?
CCB or Thiazide
135
According to JNC 8, what should you use for someone with CKD?
Add ACE or ARB to improve renal outcomes
136
What were differences with JNC 7 and JNC 8?
JNC 7: thought SBP >140 was more important than any DBP.
Initial treatment with Thiazide, then add any other class.
WIth DM and CKD, goal BP 130/80
137
Why aren't beta blockers being used as much anymore?
More cardiovascular events when compared to ARBs
138
In the general nonblack population, including those with DM, initial antihypertensive treatment should include anything but what?
Alpha and beta blockers
| Use thiazide diuretic, CCB, ACEI, or ARB
139
Initial treatment for African Americans should be what?
thiazide or CCB
140
T or F: Beta blockers have been shown to cause depression.
False
141
What antihypertensive would you put someone on with A. fib?
Diltiazem
| nondihydro that slows conduction
142
>180/100 mmHg with end organ damage
Hypertensive Emergency
| That pressure without organ damage would be hypertensive URGENCY
143
What organs are involved in hypertensive end organ damage?
```
Eye (retinal hemorrhage)
Brain (stroke, seizure, encephalopathy)
Heart (MI, CHF, aortic dissection)
Lung (pulmonary edema from CHF)
Kidney (acute renal failure)
```
144
Sudden HTN in a previously normotensive pt
| Sudden spike in known HTN patient
Malignant hypertension
145
What is malignant HTN associated with?
Diffuse necrotizing vasculitis
Arteriolar thrombi
Fibrin deposition in arteriolar wall
Fibrin necrosis of arterioles of brain, retina, and kidney
146
What is the treatment goal of malignant HTN?
Lower BP to 160/110-100 OR
| NO more than 25% reduction in MAP in first 2 hours
147
What meds are used for malignant hypertension?
Beta Blockers
| CCBs
148
Continuous IV that blocks beta-1 and alpha-1
Labetalol (trandate)
149
Continous IV CCB for malignant HTN
Nicardapine (cardene)
150
What med is best for hypertensive encephalopathy?
Nitroprusside (nitropress)
| Vasodilation via action on vessel smooth muscle
151
What are SE of Nitroprusside?
Cyanide toxicity, drug is photosensitive
152
What are situations besides malignant HTN where BP management is crucial?
```
Hypertensive encephalopathy
Stroke
MI
Aortic Dissection
Eclampsia
```
153
What is generally used in an MI?
Nitroglycerine
154
What two things do you want to control in an aortic dissection?
1. Control shearing forces with a reduction in rate and contractility (beta blocker)
2. Control hypertension (Nitroprusside)
155
What med is best for a pregnant hypertensive pt?
Hydralazine
Arterial vasodilator.
SE: rebound HTN
156
What are all the med options for a hypertensive pregnant woman?
Hydralazine, labetalol, nicardipine.
| Magnesium used too, but not for BP control
