CV Flashcards
1
Q
QT prolongation may lead to…
A
torsades de pointes
2
Q
causes of prolonged QT include
A
drugs - amiodarone, quinidine, haloperidol, procainamide
electrolyte problems - hypokalemia, hypocalcemia, hypomagnesemia
3
Q
treatment for torsades VT
A
magnesium
4
Q
what is the first letter of a pacemaker code?
A
chamber paced
5
Q
what is the second letter of a pacemaker code?
A
chamber sensed
6
Q
what is the third letter of a pacemaker code?
A
response to sensing
I = inhibits (pacer detects intrinsic cardiac activity and withholds its pacing stimuli)...demand D = inhibits and triggers (pacer detects intrinsic cardiac activity and fires a pacing stimulus in response) O = none
7
Q
what does failure to pace look like?
A
no spikes when expected
8
Q
what does failure to capture look like?
A
spikes without a QRS for ventricular pacing
9
Q
what does failure to sense look like?
A
pacing in native beats
10
Q
ICDs programmed to shock can…
A
defibrillate or synchronized cardiovert
11
Q
ICDs programmed to burst pace can…
A
sense tachyarrhythmias, provide a series of beats faster than the tachyarrhythmia, then stop suddenly with hopefully the SA node recovering
12
Q
ICDs can provide pacing for which arrhythmia?
A
bradyarrhythmias
13
Q
S1 is caused by closure of which valves?
A
AV (mitral and tricuspid) valves
14
Q
S1 is loudest where?
A
at apex of heart (midclavicular, 5th ICS)
15
Q
which valves open during S1?
A
pulmonary and aortic valves
16
Q
S2 is caused by closure of which valves?
A
semilunar valves (aortic and pulmonic)
17
Q
S2 is loudest where?
A
at base of heart (right sternal border, 2nd ICS)
18
Q
S2 splits when?
A
on inspiration; wide fixed splitting of S2 caused by RBBB
19
Q
S2 is louder with what pulmonary issue?
A
PE
20
Q
S3 is caused by…
A
a rapid rush of blood into a dilated ventricle
- pulmonary HTN and cor pulmonale
- mitral, aortic, or tricuspid insufficiency
21
Q
S3 is associated with…
A
heart failure
ventricular gallop “Kentucky”
22
Q
S4 is caused by…
A
atrial contraction of blood into a noncompliant ventricle
23
Q
S4 is associated with…
A
myocardial ischemia, infarction, HTN, ventricular hypertrophy, aortic stenosis
atrial gallop “Tennessee”
24
Q
pulse pressure is…
A
systolic - diastolic
normal is 40-60mmHg. i.e.,120/80
25
SBP is an indirect measurement of ...
CO and SV
26
narrowing pulse pressure is...
a decrease of SBP with little change or increase in diastolic pressure
seen with severe hypovolemia or severe drop in CO
27
DBP is an indirect measurement of ...
SVR
28
widening of pulse pressure is...
decrease in DBP
may indicate vasodilation, drop in SVR; seen in severe sepsis, septic shock; i.e.,100/38
29
coronary arteries are perfused when?
during diastole
30
murmurs of insufficiency (regurgitation) occur when valve is...
closed
31
murmurs of stenosis occur when valve is...
open
32
what valves are open/closed during systolic murmurs?
semilunar valves (A&P) are OPEN during systole (stenosis)
AV valves (M&T) are CLOSED during systole (insufficiency)
33
ventricular septal defect (which is most common with acute MI) may cause what kind of murmur?
systolic murmur
heard at sternal border, 5th ICS
34
what valves are open/closed during diastolic murmurs?
```
semilunar valves (A&P) are CLOSED during diastole (insufficiency)
AV valves (M&T) are OPEN during diastole (stenosis)
```
35
papillary muscle dysfunction and rupture are heard loudest where?
at apex
36
varient/Prinzmetal's angina - what is it? what causes it? when does it occur? what can precipitate it? troponin +/-? what medication can relieve chest pain?
- type of unstable angina associated with ST segment elevation
- due to coronary artery spasm with or without atherosclerotic lesions
- occurs at rest, may be cyclic
- may be precipitated by nicotine, ETOH, cocaine
- troponin (-)
NTG relieves CP, STs return to normal
37
where is the location of CAD if there are changes in II, III, aVF
RCA, inferior LV
38
where is the location of CAD if there are changes in V1, V2, V3, V4
LAD, anterior LV
39
where is the location of CAD if there are changes in V5, V6, I, aVL
circumflex, lateral LV
40
where is the location of CAD if there are changes in V5, V6
low lateral LV
41
where is the location of CAD if there are changes in I, aVL
high lateral LV
42
where is the location of CAD if there are changes in V1, V2
RCA, posterior LV
43
where is the location of CAD if there are changes in V3R, V4R
RCA, RV
44
what are some signs of reperfusion?
- CP relief due to fibrinolysis of clot
- resolution of ST segment deviations due to return of blood flow
- elevated troponin/CK-MB due to myocardial stunning when vessel opens
- repercussion arrhythmias (VT, VF, AIVR) due to stunning
45
what type of MI is associated with AV conduction disturbances: 2nd degree type I, 3rd degree heart block, sick sinus syndrome, and sinus bradycardia?
inferior MI
46
which type of MI may develop systolic murmur, mitral valve regurgitation secondary to papillary muscle rupture?
inferior MI
47
use beta blockers and NTG with caution in which MI?
inferior MI
48
S&S of RV infarct?
JVD, high CVP, hypotension, usually clear lungs, bradyarrhythmias, ECG with ST elevation in V4R
49
how to treat RV infarct?
fluids, positive inotropes
avoid preload reducers (nitrates, diuretics)
caution with BB due to hypotension
50
which type of MI will have reciprocal changes in lateral wall (I, aVL)?
inferior MI
51
which type of MI will have reciprocal changes (ST depression) in inferior wall (II, III, aVF)?
anterior MI
52
which type of MI may develop 2nd degree type II heart block or RBBB
anterior MI
53
which type of MI may develop systolic murmur and possible VSD?
anterior MI
54
Anterior/inferior MI has higher mortality?
anterior --> heart failure
55
bradycardia or tachycardia with inferior MI has higher mortality?
tachycardia
56
what are some complications of PCI?
STENT THROMBOSIS, RETROPERITONEAL BLEED, coronary artery perforation, distal coronary artery embolization, failure of stent deployment, intramural hematoma, stroke/TIA, arrhythmias, renal failure, MI, death
57
nitroprusside...when to use, what does it do, what to watch for when using?
used for hypertensive crisis/emergency
preload and after load reducer
watch for cyanide toxicity secondary to drug metabolite (thiocyanate); mental status change, tachycardia, sz, need for increase dose, unexplained metabolic acidosis
58
what are signs of systolic heart failure?
- dilated LV
- PMI shift to left
- mitral valve insufficiency
- EF <40%
- pulmonary edema due to poor ventricular emptying
- S3
- BP normal/low
- BNP elevated
59
what is the treatment for systolic heart failure?
- BB
- ACE inhibitors
- diuretics
- dilators
- aldosterone antagonists
- positive inotropes (increase strength of muscular contractions)
60
what are signs of diastolic heart failure?
- normal ventricular size
- hypertrophied ventricular walls and/or thick septum
- normal contractile function
- normal EF
- pulmonary edema due to high ventricular pressure
- S4 with HTN
- high BP
- BNP elevated
61
what is the treatment for diastolic heart failure?
- BB
- ACE inhibitors/ ARBs
- CCBs
- low dose diuretics
- aldosterone antagonists
62
what are some causes of right sided heart failure?
- acute RV infarct
- massive PE
- septal defects
- pulmonary stenosis/insufficiency
- COPD
- pulmonary HTN
- LV failure
63
what are some causes of left sided heart failure?
- CAD, ischemia
- MI
- cardiomyopathy
- fluid overload
- chronic, uncontrolled HTN
- aortic stenosis/insufficiency
- mitral stenosis/insufficiency
- cardiac tamponade
64
what are some signs of right sided heart failure?
- hepatomegaly
- splenomegaly
- dependent edema
- venous distention
- elevated CVP/JVD
- tricuspid insufficiency
- abdominal pain
65
what are some signs of left sided heart failure?
- orthopnea, dyspnea, tachypnea
- hypoxemia
- tachycardia
- crackles
- cough with pink, frothy sputum
- elevated PA diastolic/PAOP
- diaphoresis
- anxiety, confusion
66
what is the issue with dilated cardiomyopathy?
- systolic dysfunction, problem ejecting
- thinning, dilation, enlargement of LV chamber
- mitral valve regurgitation due to ventricular dilation
67
what symptoms can be seen with dilated cardiomyopathy?
- similar to systolic heart failure
| - may need ventricular assist device (VAD), heart transplant
68
what is the issue with hypertrophic cardiomyopathy?
- diastolic dysfunction, problem filling
| - increased thickening of the heart muscle and septum at the expense of the LV chamber
69
what symptoms can be seen with hypertrophic cardiomyopathy?
- symptoms similar to diastolic heart failure
| - fatigue, dyspnea, chest pain, palpitations, s3, s4, pre syncope/syncope
70
dilated or hypertrophic cardiomyopathy is at increased risk for sudden cardiac death?
hypertrophic
71
S&S of cardiogenic shock in compensatory stage
- NARROW PULSE PRESSURE
- tachycardia
- tachypnea
- crackles, mild hypoxemia
- ABG with respiratory alkalosis or early metabolic acidosis
- anxiety, irritability
- neck vein distention
- S3, S4
- cool skin
- decreased UO
- lower than baseline BP
72
S&S of cardiogenic shock in progressive stage?
- hypotension
- worsening tachycardia, tachypnea, oliguria
- metabolic acidosis
- worsening crackles ad hypoxemia
- clammy, mottled skin
- worsening anxiety, or lethargy
73
cardiogenic shock treatment?
enhance effectiveness of pump:
- positive inotropes (avoid negative isotropy agents), vasodilators
decrease demand on pump:
- preload reduction
- after load reduction
- optimize oxygenation
- mechanical ventilation
- treat pain
- IABP for short-term support
- VAD may be used to longer periods of time than IABP
74
what is a ventricular assist device (VAD) used for?
used in the management of LV heart failure, cardiogenic shock, cardiac myopathies, and used in patients awaiting heart transplant
75
what are the benefits of IABP therapy?
inflation - increases coronary artery perfusion; inflates are dicrotic notch of the arterial waveform, beginning of diastole
deflation - decreases after load; deflates right before systole begins; determined by set trigger for deflation, R-wave of ECG or upstroke of the arterial pressure wave
76
what are some post-op CABG complications to look for?
```
TAMPONADE
PERICARDITIS
hemodynamic abnormalities
arrhythmias
electrolyte abnormalities
bleeding
pulmonary, renal, endocrine, GI
pain, anxiety
infection
```
77
what do you do during post op chest tube management?
- maintain patency - no dependent loops, only milk/strip if clots appear
- mediastinal tubes remove serosanguinous fluid from the operative site; pleural chest tubes remove air, blood, or serous fluid from the pleural space
- keep chest tubes lower than pt
- don't clamp system unless changing the drainage system or there is a system disconnect
- if output >100 x 2hrs maintain hemodynamic stability, correct volume status, give blood products
78
what are some S&S to look for in cardiac tamponade?
- NARROWED PULSE PRESSURE
- PULSUS PARADOXUS - excessive drop in SBP during inspiration, cardiac muscle restriction due to tamponade, with inspiration, intrathoracic pressure increases, decreases venous return
- equalization of CVP, pulmonary diastolic and PAOP
- restlessness, agitation
- hypotension
- increased JVD
- muffled heart tones
- enlarged cardiac silhouette and mediastinum on CXR
79
which valve is at most risk for rupture due to trauma?
aortic valve because it's most anterior in chest
80
what are some etiologies of pericarditis?
```
trauma (rare)
viral
after MI
post-op cardiac surgery
radiation
idiopathic
Dressler's syndrome - immune response after an MI, surgery, or traumatic injury
```
81
what are some S&S of pericarditis?
```
chest pain that worsens with inspiration
dyspnea
low grade temp
increased sed rate
*ST elevation in ALL leads
cardiac tamponade
post-MI, Dressler's syndrome
```
82
what is the treatment for pericarditis?
```
treat symptoms
analgesics
anti-inflammatory agents
NSAIDs
steroids
abx
monitor for worsening symptoms
monitor for constrictive pericarditis
monitor for cardiac tamponade
```
83
what are some etiologies for myocardial contusion?
trauma; worse outcome than pericarditis, broken vessels bleed into heart, cardiac dysrhythmias, death can occur within first 48 hours
84
what are some S&S of myocardial contusion?
```
signs of trauma
chest pain that worsens with inspiration
dyspnea
low grade temp
*ST elevation in area of injury
```
85
what is the treatment for myocardial contusion
monitor or arrhythmias
| analgesics as needed
86
inferior MI is associated with what occlusion?
RCA
87
ST elevation is seen in which leads for inferior MI?
II, III, aVF
88
what blood vessel supplies the RV?
RCA (also supplies inferior wall of LV)
about 30% of inferior wall MI patients also have RV infarct
89
anterior MI is associated with what vessel occlusion?
LAD
90
ST elevation is seen in which leads for anterior MI?
V1-V4 precordial leads
91
myocardial ischemia or infarction can affect which valve function and lead to what?
mitral valve function and lead to acute mitral valve regurgitation
92
papillary muscle dysfunction is loudest where?
apex
93
papillary muscle rupture is loudest where?
apex
94
ventricular septal defect is be heard where?
sternal border, 5th ICS
95
class 1 heart failure is what?
extraordinary activity results in heart failure symptoms; ordinary activity doesn't cause fatigue, dyspnea, palpitation, or anginal pain; no limitation of physical activity
96
class 2 heart failure is what?
ordinary activity results in heart failure symptoms; comfortable at rest; some limitation of physical activity
97
class 3 heart failure is what?
minimal activity results of heart failure symptoms; comfortable at rest, but less than ordinary activity causes HF symptoms; marked limitation of physical activity
98
class 4 heart failure is what?
resting causes HF symptoms; severe limitation of physical activity
99
what is the main cause of death for HF patients?
sudden arrhythmia; patients with class 2-4 HF are candidates for ICD
100
what will cause large, giant V-waves on the PAOP pressure tracing if the patient has a PA Cath?
mitral insufficiency
