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Flashcards in Combank physio - heart Deck (64):
1

What is the #1 cause of constrictive percarditis in developing countries?

TB

2

What is Kussmaul's sign?

jugular venous distension upon inspiration

3

What is pulsus paradoxus?

Normal decline in systolic arterial pressure during inspiration (normal is < 10 mm Hg)

4

Constrictive pericarditis is associated with ....

fibrotic calcifications of the pericardium, Kussmaul's sign, pulsus paradoxus

5

What is the x descent on right atrial pressure tracings?

follows the 'c' wave and occurs as a result of the right ventricle pulling the tricuspid valve downward during ventricular systole.

6

What is the y descent on right atrial pressure tracings?

corresponds to the rapid emptYing of the atrium into the ventricle following the opening of the tricuspid valve.

7

Constrictive pericarditis is associated with what sign on a right atrial pressure tracing?

the "W" sign - made up of exaggerated x and y descents

8

Define sinus bradycardia

Rate of less than 60 beats/min with P wave before every QRS, normal PR and QRS intervals, and normal P, QRS, and T waves

9

Define sinus tachycardia

Rate of more than 100 beats/min with P wave before everything QRS, normal PR and QRS intervals, and normal P, QRS and T waves

10

First degree AV block

PR interval greater than 200 msec with a P wave before every QRS, normal QRS interval, and normal P, QRS and T waves

11

Normal sinus rhythm

60-100 beats per minute

12

numbers to remember when determining rate

300, 150, 100, 75, 60, 50

13

Define cardiac index

Cardiac index (CI) is a haemodynamic parameter that relates the cardiac output (CO) to body surface area (BSA), thus relating heart performance to the size of the individual. CI = CO/BSA

14

What causes cardiogenic shock and what are the characteristics?

Caused by acute coronary syndromes, valvular dysfunctions, or cardiac tamponade. Characterized by pulmonary edema, high cardiac filling pressures, low cardiac index, and high systemic vascular resistance

15

What causes neurogenic shock and how do patients present?

Caused by spinal cord or CNS injury. Patients present with bradycardia and are hypotensive

16

What causes obstructive shock and how to patients present?

Caused by cardiac tamponade, pulmonary embolism, or a tension pneumothorax. Present with symptoms of septic shock, hypotension, tachycardia and low CO

17

What causes septic shock and how does it present?

Caused by an underlying infection. Characterized by hypotension, high cardiac output that becomes depressed as symptoms progress, low systemic vascular resistance and low cardiac filling pressures

18

How do patients with hypovolemic shock present?

low cardiac output, low cardiac index, high systemic vascular resistance, low cardiac filling pressures

19

What characterizes aortic stenosis?

crescendo-decrescendo systolic ejection murmur following an EJECTION CLICK, diminished and delayed carotid upstroke

20

What are the effects of sustained hand grip?

increase systemic vascular resistance, arterial pressure, CO and left ventricular volume and filling pressures

21

Hand grip is most useful in differentiating between what two heart murmurs?

aortic stenosis and mitral regurgitation

22

How does sustained hand grip effect aortic stenosis?

intensity decreases

23

How does sustained hand grip effect mitral regurgitation?

intensity increases

24

What are the effects of squatting?

increases venous return (preload), systemic vascular resistance (afterload) and arterial pressure

25

T or F; Squatting will increase virtually all murmurs except that of hypertrophic cardiomyopathy

T

26

What are the effects of abrupt standing?

decreases venous return

27

What type of murmurs increase in intensity with inspiration?

Righted sided murmurs (tricuspid/pulmonic) - inspiration draws blood out of the venous system and into the right side fo the heart

28

The straining phase (phase 2) of valsalva has what effects?

decrease venous return, right and left ventricular volumes, stroke volumes, MAP and PP.

29

Valsalva phase 2 diminishes the intensity of which murmurs?

Flow murmurs - aortic/pulmonic/tricuspid/mitral stenosis/regurgitation

30

Name the action -- increases intrathoracic pressure, limits venous return back to the heart

valsalva maneuver

31

Which baroreceptors have a higher threshold pressure and are thus less sensitive?

aortic arch baroreceptors

32

What is Hering's nerve?

nerve responsible for carrying the signals detected by the baroreceptors located in the carotid sinus to the vasomotor centers in the brain; part of cranial nerve IX

33

When does increases in the firing rate of Herings nerve occur?

when the blood volume exceeds the set point of 100 mmHg, in situations of volume overload

34

1st degree AV block can be caused by what two classes of antiarrhythmic drugs?

beta blockers (class II) and calcium channel blockers (class IV)

35

3rd degree AV block

no P wave gives rise to a QRS wave; there is complete disassociation between the atrial and ventricular signals

36

T/F vasopressin release will be increased in all states of shock

T

37

2nd degree AV block (Mobitz type I, Wenckebach)

PR interval becomes longer before every subsequent QRS until eventually a beat is dropped and the PR resets itself

38

T/F patients with 2nd degree AV block (Mobitz type I, Wenckebach) are usually asymptomatic

T

39

What cardiac drugs can cause 2nd degree type I AV block?

digoxin, calcium channel blockers, or beta blockers

40

A left bundle branch block will show what on EKG?

wide QRS complex and two R waves in V5 or V6

41

ST depressions are indicators of what?

myocardial ischemia that is not transmural

42

Abnormal Q waves indicate?

a transmural infection

43

ST elevations indicate?

acute transmural ischemia -- found in Prinzmetals angina and MI

44

What are the effects of nitrates?

forms nitric oxide, which leads to venous dilation and decreased preload

45

Patients with which type of heart block will often progress to third degree heart block?

Mobitz Type II 2nd degree heard block b/c it is usually located below the AV node

46

a wave

positive wave that corresponds to atrial contraction

47

c wave

positive wave that occurs during right ventricular contraction

48

x- descent

negative wave that correlates to atrial relaxation and tricuspid closure

49

y-descent

negative wave that correlates to the passive emptying of the right atrium into the right ventricle

50

v wave

positive upsloping wave that correlates with right atrial filling in systole when the tricuspid valve is closed

51

When does an accentuated a wave occur?

when there is restricted filling of the right side of the heart

52

When does a giant v wave occur?

tricuspid regurgitation; blood refluxes back into the right atrium during systole

53

tricuspid valve listening area

lower left sternal border

54

What is the most common cause of tricuspid regurgitation?

Rheumatic heart disease

55

Mitral valve prolapse causes a murmur that

begins with a midsystolic click followed by a crescendo murmur

56

mitral valve prolapse is enhanced by?

squatting, hand grip, valsalva maneuver; all increases TPR

57

Right sided heart murmurs increase in intensity with ...

inspiration - intrathoracic pressure is negative causing a "pulling effect" on the blood to move back to the right heart

58

Inverted T waves are seen in what types of patients?

patients with ischemic heart diseaes

59

in RBBB dual R waves are seen most commonly in which lead?

V1

60

non-specific ST segment and T wave changes are most common in patients with?

acute pulmonary embolisms

61

Gram negative septic shock is caused by?

lipid A portion of lipopolysaccharide

62

Characteristics of PVCs

wide QRS complexes which are not preceded by a P wave and are followed by a compensatory pause

63

Criteria to Dx a LBBB

heart rhythm supraventricular in orgin; QRS duration must be greater than 80ms (2 small blocks); there should be a QS or rS complex in lead V1; there should be a monophasic R wave in leads I and V6

64

Criteria to Dx RBBB

heart rhythm must originate above ventricles; QRS duration must be more than 80 ms (incomplete heart block) or more than 120 ms (complete heart block); there should be a terminal R wave in lead V1; there should be a slurred S wave in leads I and V6