Critical Care Cardiology Flashcards Preview

CCP-C/FP-C Certification Review > Critical Care Cardiology > Flashcards

Flashcards in Critical Care Cardiology Deck (60):
1

Cardiac Output (CO)

Heart Rate x Stroke Volume

(Typically 4-8L/min)

2

Stroke Volume (SV)

Amount of blood ejected from the heart with each ventricular contraction.  Affected by preload, contractility, and afterload.

3

Preload

The load that stretches the cardiac tissue before contraction.

4

Contractility

The intrinsit ability of the heart/myocardium to contract

5

Frank-Starling Law

The stroke volume of the heart increases in response to an increase in the volume of blood filling the heart.  Increased volume stretches the ventricular wall causing the muscle to contract more forcefully.

6

Afterload

The degree of vascular resistance to ventricular contraction.  Right heart is affected by pulmonary vascular resistance, left heart by systemic vascular resistance.

7

Pulmonary Vascular Resistance (PVR)

  • Measures afterload of the right heart
  • Normal = 50-250 dynes
  • Increased: Acidosis, hypercapnia, hypoxia, atelectasis, ARDS
  • Decreased: Alkalosis, hypocapnea, vasodilating drugs

8

Systemic Vascular Resistance (SVR)

  • Measures afterload of the left heart
  • Normal = 800-1200 dynes
  • Increased: Hypothermia, hypovolemic shock, decreased CO
  • Decreased: Anaphylaxis, neurogenic shock, septic shock, vasodilating drugs

9

S1 Heart Sound

"Lub"

Bicuspd/tricuspid valve closure.

10

S2 Heart Sound

"Dub"

Aortic/pulmonic valve closure.

11

S3 Heart Sound

"Kentucky"

  • Excessive filling of the ventricles
  • CHF, chordae tendinae dysfunction

12

S4 Heart Sound

"Tennessee"

  • Blood being forced into a stiff (non-compliant) ventricle
  • Causes: Hypertrophic cardiomyopathy, HTN
  • Associated with MI!!!

13

PMAT Mnemonic

Heart Sound Ausculation Points

  • Pulmonary
  • Mitral
  • Aortic
  • Tricuspid

14

Right Coronary Artery (RCA)

  • Supplies the RV and in most of the population the SA node
  • Inferior MI
  • Bradycardia due to SA node involvement

15

Posterior Descending Artery (PDA)

  • Branch off of the RCA
  • Inferior Wall
  • Ventricular Septum
  • Papillary Muscles

16

Left Coronary Artery (LCA)

A complete block is called the "widow maker" because it occludes both the LAD and LCX.

17

Left Anterior Descending (LAD)

  • Supplies anterior left ventricle/anterior septum
  • Anterior MI/septal MI/Anteroseptal MI

18

Left Circumflex (LCX)

  • Somtimes called the "circumflex artery"
  • Supplies lateral left ventricle/posterior left ventricle in 45% of population
  • Lateral MI/Posterior MI

19

STEMI Criteria

  • ST elevation in 2 continuous leads > 1mm
  • Cardiac death "happening now"
  • Often associated with new onset LBBB
  • + cardiac markers/enzymes

20

NSTEMI

  • ST depression of dynamic T wave changes in 2 contiguous leads
  • ST depression caused by lack of O2 to cardiac tissue
  • + cardiac markers/enzymes

21

Unstable Angina (UA)

  • Angina that is not relieved by rest, nitro, or is different quality than patient's normal chest pain
  • May have ST segment depression

22

Cardiac Panel

(Typically)

Troponin I

CK-MB

MB

23

Troponin I

  • Specificity: High
  • Detectable: 2 Hours
  • Peak Level: 12 hours

24

Creatinine Kinase Myoglobin (CK-MB)

  • Specificity: Moderate
  • Detectable: 4-8 Hours
  • Peak Level: 12-24 Hours

25

Myoglobin (MB)

  • Specificity: Low
  • Detectable: 3 Hours
  • Peak Levels: 4-9 Hours

26

Posterior MI

  • LCX
  • Elevation V8-V9
  • Reciprocal Changes V1-V4
  • ST depression predominantly in V1-V2

27

Anterior MI

  • LAD
  • ST changes V2-V4

28

Inferior MI

  • RCA
  • ST Changes in II, III, aVF
  • Papillary muscle dysfunction
  • Get a right sided - V4R
  • Can cause bradycardia, AV blocks
  • No NTG or Beta-blockers

29

Lateral MI

  • LCX
  • Lateral/Posterior Wall ST segment changes in I, aVL, V5-V6

30

Anteroseptal MI

  • LAD
  • ST changes in V1-V4
  • LV and septum affected
  • papillary muscle dysfunction - cardiogenic shock

31

Bundle Branch Blocks

  • Caused by a defect in electrical impulse
  • Widened QRS > 0.12s
  • Look at V1 for changes - turn signal rule

32

Standard AMI Treatment

  • Reduce Pre-load/Pain
  • Reduce HR/O2 demand (Beta-blockers, CCBs)
  • Clot Prevention (ASA)
  • Reperfusion (chemical or surgical)

33

Beta Blockers in MI

REduces HR, thus reducing O2 demand.  DO NOT use in bi-fascular blocks or BBB

34

Heparin/Low Molecular Weight Heparin

Prevents fibrinogen conversion to fibrin to decrease clot formation in the coronary arteries.

35

Angiotensin Converting Enzyme Inhibitors

Prevents ventricular remodeling in the post-MI patient (keeps heart muscle from growint too much to make up for the lost tissue from the MI)

36

NAVEL for ETT Meds

Naloxone

Atropine

Vasopressin

Epinephrine

Lidocaine

37

Class I Antidysrhythmics

  • Sodium Channel Blockers
  • Lidocaine, Phenytoin, Procainamide
  • Interferes with Na+ channels

38

Class II Antidysrhythmics

  • Beta blockers
  • Carvedilol, labetalol, propranolol, timolol, esmolol, metoprolol
  • Anti-sympathetic nervous system agnts
  • Reduce heart rate, reduce cardiac oxygen demand

39

Class III Antidysrhythmics

  • Miscellaneous
  • Amiodarone
  • Affects K+ efflux

40

Class IV Antidysrhythmics

  • Calcium Channel Blockers (CCBs)
  • Verapamil, diltiazem
  • Affects the AV node

41

Class V Antidysrhythmics

  • Other
  • Adenosine, digoxin, MgSO4
  • Works by "other" mechanism - no good way to classify/stratify

42

Neurovascular System Effects

  • Alpha-1 - vasoconstrict
  • Beta-1 - increase heart rate, contractility
  • Beta-2 - dilate bronchioles/blood vessels
  • Dopaminergic - gut kidney vessel dilation
  • Cholinergic - decrease heart rate

43

Fibrinolytic Indications

  • Clinical presentation of AMI w/in 12hrs of Sx onset
  • EKG showing STEMI or new onset LBBB
  • Absence of contraindications
  • Absence of cardiogenic shock

44

Fibrinolytic Absolute CI

  • Prior Intracranial Hemorrhage
  • Known structural cerebral vascular lesion
  • Known malignant intracranial neoplasm
  • Ischemic stroke within 3 months
  • Suspected aortic dissection
  • Active bleeding or bleeding diathesis
  • Significant closed-head/facial trauma within 3 months

45

PCTA

Percutaneous Trans-Luminal Coronary Angioplasty

  • Administer GP2B3A Inhibitors
  • Keep leg straight during transport and hold direct pressure for 30min post cath

46

Glycoprotein-2B3A Inhibitors

Prevents platelet activity.  Can be titrated and have a half-life of about 8 hours.  Examples - Reopro, Integrilin, Aggrastat

47

CABG

Coronary Artery Bypass Graft

  • RCA - repaired using the sapneous vein
  • LAD - repaired using the inferior mammary artery

48

Angina

Stable - lasting 1-5min and releived by NTG and rest.  Predictable course

49

Prinzmetals Angina

  • Chest pain at rest, has a circadian rhythm (often early AM)
  • Most often seen in women
  • Treated with NTG and CCBs

50

Silent Angina

No pain but evidence of ischemia on EKG (ST depression)

51

Heart Transplant

  • Decompensation = immediate cardioversion
  • Dopamine and NSS bolus in setting of bradycardia
  • Can also use neosynephrine

52

Wolff-Parkinson-White Syndrome (WPW)

  • Extra electrical circuit in the heart, causes tachycardia
  • Common cause of tachycardia in infants/children
  • Treated by surgical ablation of the aberrant pathway
  • Causes a delta wave on EKG

53

Endocarditis

  • Inflammation or infection inside the heart
  • Sudden onset with new murmur
  • #1 cause is IV drug abuse
  • Osler Nodes (painful red fingertips)
  • Janeway Lesions (red lesions on palm and soles)

54

Pericarditis

  • Inflammation or infection on the outside of the heart
  • Substernal chest pain when breathing or laying supine (pericardium rubs against the sternum)
  • 80% have idiopathic cause
  • Global ST elevation, round T waves
  • Treated with NSAIDs (usually Indocin)
  • Colchicine becoming treatment of choice

55

Uremic Pericarditis

Can be seen in a patient that is undergoing dialysis because they are in renal failure.

56

Dressler's Syndrome

Pericarditis occurring in the post MI/post cardiac surgery patient

57

Congestive Heart Failure (CHF)

  • Progressive dyspnea, frosthy sputum
  • CXR Findings - butterfly/Kerley B lines, bilateral diffuse infiltrates
  • Heart >50% width of chest
  • BNP elevated
  • Tx - CPAP and Nitrates, ACE inhibitors, Beta-blockers, ? lasix

58

B-Type Natriuretic Peptide (BNP)

  • BNP released by the ventricles in response to stretching and causes diuresis, reducing preload and afterload
  • Natrecor (Nesiritide) is synthetic BNP
  • < 100 pg/mL = no heart failure
  • > 300 pg/mL = mild heart failure
  • > 600 pg/mL = moderate heart failure
  • > 900 pg/mL = severe heart failure

59

Aortic Dissection

  • Ripping or tearing sensation between shoulder blades
  • Can also present in chest/abdomen
  • Common in Marfan's syndrome
  • Ascending aorta most common site
  • CXR Findings - widened mediastinum, loss of aortic knob, pleural effusion
  • Difference in 20mmHg SBP between arms is common

60

Aortic Aneurysm

  • Out pouching of either the cardiac or abdominal aorta
  • Typically found on routine CT or during physical exam
  • Surgical repair when >5cm or symptomatic