Cardiology Flashcards
(24 cards)
What are the classic findings in a patient w/ mitral stenosis?
A loud first heart sound (S1), an early diastolic high-frequency opening snap after the second heart sound (S2), and a low-pitched diastolic rumble.
What does a patient history of rheumatic fever now presenting with exertional dyspnea and a diastolic murmur at the cardiac apex most likely represent?
Mitral stenosis.
What is considered a hallmark of reversible injury?
Cellular swelling arising secondary to changes in ion concentration and the influx of water. It is not directly associated w/ the leakage of intracellular proteins such as creatinine kinase.
What is the role of gluthathione peroxidase?
It reduces cellular injury by catalyzing free radical breakdown. The presence of this enzyme is not responsible for the release of creatinine kinase.
What does mitochondrial vacuolization do?
It reduces the cellular capacity for ATP generation and is associated w/ irreversible injury. Creatine kinase is not directly associated w/ this mitochondrial change.
What does nuclear shrinkage (pyknosis), fragmentation, and dissolution characterize?
Irreversible injury of the cell. Creatine kinase release is not directly associated with such nuclear changes.
When does reperfusion injury occur?
It is thought to occur secondary to oxygen free radical generation, mitochondrial damage, and inflammation.
What is coronary steal?
When use of adenosine and dypyridamole causes vasodilation of cornary arterioles in nonischemic regions, it leads to decreased perfusion pressure within the collateral microvessels supplying the ischemic myocardium, diverting blood flow from ischemic to nonischemic areas. This phenomenon is known as coronary steal and it may lead to hypoperfusion and potential worsening of existing ischemia.
What are the epicardial vessels?
The epicardial vessels refer to the large coronary arteries of the heart and include the right coronary, left main, left anterior descending, and circumflex arteries.
What is the effect of mixed arterial and venous dilation?
Mixed arterial and venous dilation decreases ventricular wall tension by reducing arterial pressure and volume, respectively. Thus, mixed arteriovenous dilators decrease myocardial oxygen demand and are very effective agents for treating coronary heart disease.
In addition to subclavian steal, what else can cause subclavian steal syndrome?
Although innominate (braciocephalic; unnamed or classified) artery stenosis or occlusion can cause subclavian steal syndrome, patients with significant occlusion would develop retrograde flow through the right vertebral artery rather than the left.
Coronary-subclavian steal phenomenon and the internal mammary artery (IMA).
Coronary-subclavian steal phenomenon occurs in patients w/ prior coronary artery bypass surgery using the IMA. Similar to that of subclavian steal syndrome, blood flow through the IMA can reverse and steal flow from the coronary circulation during increased demand (e.g., upper extremity exercise). However, symptoms are typically related to coronary ischemia (e.g., angina pectoris).
What can happen due to an internal carotid artery occlusion?
Internal carotid artery occlusion may occur due to thrombosis or embolism, leading to a transient ischemic attack (TIA) or ischemic stroke.
Describe hypersensitive myocarditis.
It results from an autoimmune reaction to a medication and is characterized by an interstitial infiltrate of eosinophils. Many classes of drugs, including diuretics (e.g., furosemide, hydrochlorothiazide) and antibiotics (e.g., ampicillin, azithromycin), can causes this hypersensitivity.
What kind of murmur is produced in a mitral valve regurgitation?
Holosystolic murmur.
What causes the opening snap?
The opening snap is caused by the sudden opening of the mitral valve leaflets when the left ventricular pressure falls below the left atrial pressure at the beginning of diastole.
Where are the findings of mitral stenosis best heard?
These findings are best heart at the cardiac apex using the bell of the stethoscope with the patient lying on the left side in held expiration.
What patient presentation is suggestive of atrial fibrillation?
Palpitations, tachycardia, irregularly irregular rhythm.
What does the ECG in a patient with AF show?
Absence of P waves, irregularly irregular rhythm with varying R-R intervals, and some patients have irregular, low amplitude, fine fibrillatory waves (f waves) b/n QRS complexes that represent chaotic atrial activation.Narrow QRS complexes.
What is the most common tachyarrhythmia?
AF. It is often precipitated by acute systemic illness or increased sympathetic tone.
When is AF occasionally seen?
It is occasionally seen in patients after short-term excessive alcohol consumption (“holiday heart syndrome”).
What are systemic illness that can precipitate AF?
Long-standing HTN, heart failure, and hyperthyroidism.
What are high QRS voltage in the precordial leads a sign of?
Ventricular hypertrophy, which most commonly results from prolonged untreated hypertension.
What can prolong the QT interval?
Chronic, heavy alcohol use.
