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Combank Q facts > Combank physio - heart > Flashcards

Combank physio - heart Flashcards

1
Q

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

A

TB

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2
Q

What is Kussmaul’s sign?

A

jugular venous distension upon inspiration

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3
Q

What is pulsus paradoxus?

A

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

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4
Q

Constrictive pericarditis is associated with ….

A

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

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5
Q

What is the x descent on right atrial pressure tracings?

A

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

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6
Q

What is the y descent on right atrial pressure tracings?

A

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

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7
Q

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

A

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

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8
Q

Define sinus bradycardia

A

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

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9
Q

Define sinus tachycardia

A

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

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10
Q

First degree AV block

A

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

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11
Q

Normal sinus rhythm

A

60-100 beats per minute

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12
Q

numbers to remember when determining rate

A

300, 150, 100, 75, 60, 50

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13
Q

Define cardiac index

A

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

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14
Q

What causes cardiogenic shock and what are the characteristics?

A

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

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15
Q

What causes neurogenic shock and how do patients present?

A

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

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16
Q

What causes obstructive shock and how to patients present?

A

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

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17
Q

What causes septic shock and how does it present?

A

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

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18
Q

How do patients with hypovolemic shock present?

A

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

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19
Q

What characterizes aortic stenosis?

A

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

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20
Q

What are the effects of sustained hand grip?

A

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

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21
Q

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

A

aortic stenosis and mitral regurgitation

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22
Q

How does sustained hand grip effect aortic stenosis?

A

intensity decreases

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23
Q

How does sustained hand grip effect mitral regurgitation?

A

intensity increases

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24
Q

What are the effects of squatting?

A

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

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25
Q

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

A

T

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26
Q

What are the effects of abrupt standing?

A

decreases venous return

27
Q

What type of murmurs increase in intensity with inspiration?

A

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

28
Q

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

A

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

29
Q

Valsalva phase 2 diminishes the intensity of which murmurs?

A

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

30
Q

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

A

valsalva maneuver

31
Q

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

A

aortic arch baroreceptors

32
Q

What is Hering’s nerve?

A

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
Q

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

A

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

34
Q

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

A

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

35
Q

3rd degree AV block

A

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

36
Q

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

A

T

37
Q

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

A

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

38
Q

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

A

T

39
Q

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

A

digoxin, calcium channel blockers, or beta blockers

40
Q

A left bundle branch block will show what on EKG?

A

wide QRS complex and two R waves in V5 or V6

41
Q

ST depressions are indicators of what?

A

myocardial ischemia that is not transmural

42
Q

Abnormal Q waves indicate?

A

a transmural infection

43
Q

ST elevations indicate?

A

acute transmural ischemia – found in Prinzmetals angina and MI

44
Q

What are the effects of nitrates?

A

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

45
Q

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

A

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

46
Q

a wave

A

positive wave that corresponds to atrial contraction

47
Q

c wave

A

positive wave that occurs during right ventricular contraction

48
Q

x- descent

A

negative wave that correlates to atrial relaxation and tricuspid closure

49
Q

y-descent

A

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

50
Q

v wave

A

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

51
Q

When does an accentuated a wave occur?

A

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

52
Q

When does a giant v wave occur?

A

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

53
Q

tricuspid valve listening area

A

lower left sternal border

54
Q

What is the most common cause of tricuspid regurgitation?

A

Rheumatic heart disease

55
Q

Mitral valve prolapse causes a murmur that

A

begins with a midsystolic click followed by a crescendo murmur

56
Q

mitral valve prolapse is enhanced by?

A

squatting, hand grip, valsalva maneuver; all increases TPR

57
Q

Right sided heart murmurs increase in intensity with …

A

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

58
Q

Inverted T waves are seen in what types of patients?

A

patients with ischemic heart diseaes

59
Q

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

A

V1

60
Q

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

A

acute pulmonary embolisms

61
Q

Gram negative septic shock is caused by?

A

lipid A portion of lipopolysaccharide

62
Q

Characteristics of PVCs

A

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

63
Q

Criteria to Dx a LBBB

A

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
Q

Criteria to Dx RBBB

A

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

Combank Q facts (11 decks)

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