Midterms p.2 Flashcards
(143 cards)
1
Q
pathophysiology of pericarditis
A
INFLAMATION OF PERICARDIUM
1. Inflamed parietal and visceral layer - Friction rub - Chest pain
2. thickened - constrict - innefective contraction - decrease CO - decrease perfusion
3. accumulation of serum - pleural effusion - pressure to the heart below - cardiac tamponade
2
Q
what are the risk factors of pericarditis?
A
- Idiopathic autoimmune infection
- neoplastic disorders / disorders Radio theraphy
- Chest trauma / metabollic anemia
3
Q
clinical symptoms of Pericarditis
A
Asymptomatic
Chest pain
Heart rate increase
ESR Increase
Symptoms of anemia
Temperature increase
Friction rub (plueral)
Increase WBC count
R-eactive C protein
Exertion symptoms ( Conpensation)
4
Q
Diagnostic of Pericarditis
A
Echocardiogram
Pericardiocentesis
TEE
CT scan
MRI
RL ECG
5
Q
what is the difference between CT scan and MRI?
A
CT scan - Size / Shape / Location
MRI - Detect Inflam / Adhesion
6
Q
what dx to determine ST segment elevation
A
RL ECG
7
Q
RL ECG means
A
ST segment elevation
8
Q
what are the medication of Pericarditis?
A
NSAIDS
Cortecosteriods
Colchicine
Antibiotics
9
Q
nx intervention of pericarditis
A
Decrease pain - positioning / high fowlers / sitting up right leaning forwards
10
Q
removal of fluid by what? in pericarditis?
A
Pericardiocentesis by culture
11
Q
what are the disorder of the layer?
A
pericarditis , myocarditis , edocarditis
12
Q
reisk factor of myocarditis
A
microorganism / inflam reaction
13
Q
clinical symptoms of myocarditis
A
Fatigue
Increase Heart Rate
New onset of dyspnea
Dyspnea
Chest pain
High WBC
Elevated C-reactive Protein
Systolic murmur
Temporary Syncope
Syncope
Palpitations
Increase ESR
New murmur
14
Q
why do we need to avoid nsaid when having myocarditis?
A
because it increase cardiac injury
15
Q
nx intervention when having myocarditis
A
antibiotics
Bed rest
Avoid Nsaid
Anti Embolic stocking
Passive and Active Excercise
16
Q
difference of adult and child affect in endocarditis
A
adult: stapyloccocus
child: stretococcus
17
Q
small pailful node
A
oslens node
18
Q
irregular red/purple painless flat macules
A
janeway lesion
19
Q
hemorrhages with pale center in the retina
A
roth spot
20
Q
hemorrhages fingers and toe nails (reddish - brown lines / streaks)
A
splinter
21
Q
clinical symptoms of endocarditis
A
fever
heart murmur
oslens node
jane way lesions
roth spot
splinter
22
Q
diagnostics of endocarditis
A
culture and sensitivity
23
Q
what need to prevent in endocarditis
A
antibiotic - eradicate good oral hygiene
24
Q
surgery of endocarditis
A
valve replacement and debridement of vegetation
25
valves cannot fully open
valves cannot fully close
protrusion of the valves
Stenosis
Regurgitation
Prolapse
26
what happen to tricuspid stenosis?
Fatigue
Cyanosis
Diastolic Murmur
R ventricular Failure: Ascite / hepatomegaly , Peripheral edema / jugular vein distention , Decerease CO
27
r ight ventricular failure indicate?
ascites/ hepatomegaly
peripheral edema
jugular vein distention
decrease CO
28
tricuspid regugitation
Asymptomatic
RV failure
Pleural Effussion
Systolic murmur - 4th ICS
29
mitral stenosis?
Dyspnea on excertion
Fatigue - decrease CO
Dry cough - Hemoptysis / wheezing
Orthopnea
Low pitch murmur
30
Mitral regurgitation
asymptomatic
systolic murmur
31
Dx of mitral stenosis
exhocardiogram
32
mngt of mitral stenosis
anti biotics, anti coagulats , rest
33
mngt of mitral regurgitation?
ACE/ ASB
Vasodilators
Beta blockers
to decrease Afterload
34
surgery of mitral regurgutation
valvuloplasty and valve replacement
35
prolapse mitral indicate
Fatigue
Asymptomatic
Lightheadedness
Loss of consciouness
SOB
Chestpain
Palpitations
36
pulmonic stenosis
Asymptomatic / Dyspnea / Fatigue / Syncope/ RV failure (ascites /edema/hepatomegaly
37
Aortic stenosis
Dyspnea on excertion / syncope / angina / orthopnea / fatigue / systolic mumur
38
aortic regurgitation
diastolic murmur
39
reduction of blood flow to the cardiac muscle due to build up of atherosclerotic plaque in the arteries of the heart
coronary artery disease
40
what are the risk factor of coronary artery disease?
Increase LDL , age Gender, smoking , DM, Increase
SBP, decrease HDL, inactivity
41
pathophysiology of Coronary artery disease
endodelium - injury - inflamatory process - macrophage ingest lipids - transport it to the arterial wall - fatty streaks - activation of macrophage - release of biochemical subs - damage to endothelium - oxidation of LDL - toxic endothelial wall - atherosclerotic formation - rupture- attract more platelets -thrombus formation - obstruction - MI
42
s/sx of coronary artery
chest pain
decrease Tissue perfusion
decrease anabolic respi - decrease co2 - lactic acidosis leads to irritant to muscle
43
how to prevent coronary artery disease
1. control cholesterol
2. physical activty
3. medications: c-statin , fibrates, cholesterol inhibito
44
how many min in phyiscal activity to prevent CAD? or to reduce cholesterol
75-100 min/week
45
how to determine if there is a presence of clot formation or blockage?
Percutaneus Transluminal Coronary Angiography
46
pain/pressue on the anterior chest
angina pectoris
47
risk factors of angina pectoris
Exerciton / exposure to cold / Elevated BP / Eating heavy meal / emotion provoking situation
48
what type of angina pectoris is : predictable / consistent / occurs on excertion relieved by rest and NTG
Stable
49
stable angina pectoris can be relieved by?
NTG and rest
50
what type of angina pectoris may not be relieved by rest or NTG
unstable
51
what type of angina pectoris is severe / incapacitating chest pain / cannot relieved
intractable
52
what type of angina pectoris prinzmetal / pain @ rest
Variant
53
what is silent angina pectoris
no report of pain but ecg changes
54
what is the s/sx of angina pectoris?
chest pain radiate to neck and shoulder left arm
55
what are the dx of angina pectoris ?
12- lead ecg
stress test
cardiac cath
coronary artery angioplasty
Echo
56
T wave inversion ABN Q wave
12 lead ECG
57
mngt of angina pectoris
OBJ: Decrease O2 demand
58
decrease SA node automaticity
Ca channel blocker
59
AV node conduction
CA channel blocker
60
pharmacologi of angina pectoris
NTG
Beta-blocker
Ca channel blocker
Antiplatelet / coagulant / aspirin (oral) / heparin (IV)
02
61
decrease myocardial consumption what drug
beta-blocker
62
AKA acute coronary syndome
Myocardial Infarction
63
s/sx of Myocardial infarction
CAN I Stop Chestpain
Chest pain
Anxiety
Nausea
Indigention
Shortness of breath
Cool pale moist skin
64
if the ecg found T wave invertion it indicate?
Ischemia
65
ecg found ST segment indicate?
injury
66
ecg found Abn in Q wave indicate?
Infarction
67
in echo what will youu see having MI?
hypokinetic and akinetic wall motion
68
when pci is not available what medication? in MI
thrombolitics (IV) and should be given 30 mins of symptoms onset
69
drug of choice for chest pain in MI
morphine sulfate
70
nX management of valvular disorder
echo: after 3 to 4 wks
Repeated: 1-2 yrs
Avoid dental procedure 6 months
Avoid heavy lifting
71
A ballon tipped catheter is used to open blocked coronary artery and what is the purpose
Percutaneus Transluminal Coronary Angiography to miprove blood flow
72
PTCA inserted where?
femoral and radial
73
compress the plaque formation
angioplasty
74
what will you do when in radial artery is bleeding?
put pressure
75
what will you do when femoral artery is bleeding?
put sand bag
76
what need to monitor in PTCA?
6P's
1. Pulse
2. Poikilothermia (cold)
3. Paresthesia
4. Pain
5. Pallor
6. Paralysis
77
exapandable metallic device which are introduce into coronary artery that are clogged due to atherosclenosis
Coronary stent
78
what are the complication of coronary stent
Dissection
Perforation
Abrupt Closure
Vasospasm
79
what are the 2 invasice coronary artery procedures and types
1. Percutaneus coronary iinterventions
- percutaneus transluminal coronoary angography
- coronary stent
2. coronary artery revascularization
- Coronary brpass graft
80
Indication to alleviation of angina that cannot be controlled with medication or PCI
Coronary ARtery Bypass graft
81
commonly used inserted Coronary bypass graph
saphenous vein
- L internal thoracic artery
82
what is sinud bradycardia? count
SA node impulse is decrease - less than 60 bpm
83
what are the mngt in sinus bradycardia if it's reponsive and unresponsive
responsive: Atropine
unresponsive:
- Dopa / isoprotenerol
- EPI / "E" Transcutaneous Pacing
84
what is sinus tachycardia and count?
SA node increase impulse more than 100 bpm
85
what are the cause of sinus tachycardia?
stress / medications / Disorders
86
mngt of sinus tachycardia?
Carotid massage / Gagging / Bearing down / Coughing / Cold stimuli to the face
87
Medication sinus tachycardia?
Adenosine
Sync Cardioversion
IV beta Blockers
CA channel Blockers
88
Originated fro the Foci
Atrial arrhythmias
89
what are the 3 Atrial arrhythmias
1. Premature Atrial Complex
2. Atrial Fibrilation
3. Atrial flutter
90
premature atrial complex is caused by?
1. Caffeine
2. Alcohol
3. Nicotine
4. Anxiety
5. Hypokalemia
91
Premature complex is needed a treatment?
false
92
Rapid, Disorganized and uncoordinated twitching of the atria
Atrial fibrilation
93
Atrial Fibrilation is associated with ?
aging
94
Risk factors of Atrial Fibrilation?
Hpn/DM/Obese/HeartDisease/MI/Alcohol/Smoking/Excercise/Surgery
95
Atril fibrilation what wave is non present?
No P wave Quivering
96
mngt for Atrial Fibrilation
anticoagulant
Cardioversion
97
Atrial fibrilation
what is atrial rate?
300-600
98
atrial fibrilation what V rate?
120-200
99
Conduction detect in atrium
Atrial flutter
100
Atrial rate of Atrial flutter
250-400
101
ventricular rate of atrial flutter
75-150
102
no P wave quivering
Atrial fibrilation and atrial flutter
103
saw tooth in reading
Atrial flutter
104
mngt for atrial flutter
Vagal maneuver
IV adenosine Rapid administration
105
what are the ventricular arrythmias?
1. Premature Ventricular Complex
2. Ventricular Tachycardia
3. Ventricular Fibrilation
4. Ventricualr asystole
106
cause of premature ventricular complex
3ID HA
Ischemia / infarction / increase workload / Digitalis toxicity / hypoxia / Acidosis
107
if freqquent and persistent premature ventricular complex what medication?
amiodarone and Betablocker
108
defined as 3 or more PVC in a row
Ventricular tachycardia
109
what are the vetricular and atrial rate of ventricular tachycardia?
100-200
110
whappen to P wave and QRS wave in ventricular tachy cardia?
P wave (+) but difficult to detect
QRS is bizzare and abnormal (-)
111
mngt of ventricular tachycardia
phocainamide
amiodarone
sotalol
lidocaine
= anti arrthmic
112
difference of cardioversion and defibrilation in ventricular tachycardia
cardiversion : Conscious : (+) pulse
Defibrilation : unconscious : (-) pulse
113
common arrthmias in pt. with cardiac arrest
ventricular fibrilation
114
rapid disorganized ventricular rhythm
ventricular fibrilation
115
absence of an audible heartbeat / palpable pulse
ventricular fibrilation
116
mngt of ventricular fibrilation
Early defib / CPR
Amiodarone / EPI
117
Ventricular fibrilation V rate
more than 300
118
vetricular asystole aka?
flatline
119
ventricular asystole mngt.
CPR / Intubation
120
atrial impulse are conducted through AV node into the ventricles at a slower rate
First degree block
121
what happend to first degree block?
P wave is Normal
Pr interval greater than .20
122
there is a repeating pattern in which all but one of a series of atrial impulses are conducted through AV node into the vetricles
Type 1
123
intial treatment of Type 1 Second degree block is?
IV bolus atropine
124
Some of the atrial impulse are conducted through the AV node into the ventricels
Type 2
125
No atrialimpulse is conducted through the AV node into the ventricles
third degree block
126
V/a rate of 3rd degree
depends on the shape and rhythm
127
joules of cardioversion
50-360
128
monphasic defib joules
360 joules
129
biphasic joules
150 - 200
130
after initial unsuccessful defib what be given?
EPI
131
when women have a large breast what should do?
Placed underneath or lateral to the left breast
132
Why do we not used UTZ gel?
poor electical activity
133
how many pressure should have for good skin contact?
20-25 pounds
134
electronic device that provides electrical stimulation of the heart
pacemaker
135
used when Pt. has a permanent temporary slower than normal pulse
pace makerc
136
controls tachyarrthmias that do not respond to meds
pacemaker
137
during cardioversion monitor whaT?
monitor leads: must be attached to pt. set tje defib in sync
138
Pathophysiology of Right sided heart failure
Cannot eject Blood efficiently - returns to venous circulation - 1. Increase veous pressure - jular vein distention, hepatomegaly , spleenomegaly 2. increase hydrostatic pressure - intravascular fluid goes to interstitial spaces - edema
139
Pathophysiology of LEFT sided heart failure
cannot pump blood out of the ventricle - 1. to aorta - decrease CO - decrease Tissue perfusion 2. Left ventricle - Backflow - L atrium - backflow - pulmonary vein - lungs - pulmo congestion - cough, dyspnea, crackles, sub orthopnea.
140
pharmacologic heart failure and meaning
1. diuretics - remove excess fluid
2. ACE / ARBS - decrease BP and Afterload
3. Beta blockers- Dilates blood vessel - decrease afterload
4. Ivabradine - decrease rate of conduction of the SA node
5. Hydralazine- Decrease BP / decrease afterload / dilated blood vessels
6. Digoxin - imrpoves contractility
141
heart is unable to pump and circulate blood to the body's organs and tissues
cardiac arrest
142
cardiac arrest is caused by
Vfibrilation and asystole
143
manefestation of cardiac arrestq
loss of consciouness / no BP / rr / Pr / cyanosis
