Newman Review Flashcards
(23 cards)
What is the degree at which stenosis is significant?
70%
Increased demand is cause by? What does this dictate?
HR and Systolic BP, How we treat chronic unstable angina pectoris.
Acute coronary syndrome is what?
Someone who exhibits exertion at rest, probably an atherosclerotic plaque that has opened so procoagulative substances are released (TXA2, endothelin, decreased NO)
What is STEMI?
A complete occlusion of CA, urgent intervention needed
What is automaticity? What is it caused by?
Alteration of phase 4 diastolic depolarization of the AP; hypoxemia, hypokalemia, increased CO2, acidosis, Drugs - digitalis
What are the causes of re-entry?
Alternative pathway and slower conduction velocity (AV Block)
What is pulsus paradoxis?
When one inhales, HR decreases (exacerbation of this normal phenomenon is present in the condition known as cardiac tamponade); caused by LV volume decreasing from pressure around the heart not allowing RA fill = Septum goes into LV = decrease preload = decrease CO = decrease BP
Acute pericarditis; what will be heard?
Scratching sound at apex of heart
CHF is defined as?
The symptoms of salt and water retention; water in legs and lungs, Na and H2i ascites (30L), low Ej, Orthopnea = Ej of 20% = RAAS activation, SNS activation, BNP
How can you treat CHF?
Altering afterload, or impedance, to contraction of the LV; Afterload = pressure of blood in arteries and volume of the ventricle
When is Aortic Regurg observed?
During Diastole
What happens when the heart adapts to aortic regurg?
Eccentric hypertrophy (sarcomeres in series), this is a response to increased volume
When is Aortic Stenosis heard?
Heard in systole - like someone hearing their throat
What happens to the heart during Aortic Stenosis?
Results in concentric hypertrophy (sarcomeres in parallel), response to increased pressure
How do you know when to send a mitral stenosis patient to surgery?
What is the gradient (difference between diastolic pressure between LV and LA); and what is the flow (defined as CO)
How do you tell if mitral regurg is acute?
Did it occur this morning? Or has it occurred his entire life? If absence of LA eccentric hypertrophy, if absent then acute, measure by Echo.
What other pressures can you measure for mitral regurg?
Pulmonary capillary pressure and pulm arterial pressure can be measured
How can you tell if mitral regurg is chronic?
LA Dilated, coronary pressure is normal, pulm capillary pressure is normal
What is the sound heard in MCC (mitral valve prolapse)? What must pt do before dental procedures?
Lub-click-dub, take amoxacillin (2000 mg) 1 hr before dental appt, if patient comes in a year later no having taken this precaution and presents with mitral regurg symptoms, then vegetation may be present on valves, possibility of thrombus formation in LA
What do you use to treat Low Ej CHF?
Beta blockers, ACE, spironolactone
What causes sudden death?
V-Fib = if survive implant a pacemaker (AICD)
What do you worry about if there is a vegetation on tricuspid valve?
Pulmonary embolism
A-fib is most common cause of stroke, how do you prevent a stroke?
Warfarin
