Cardiac 1-10

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bcb2127
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147332
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Cardiac 1-10
Updated:
2012-04-12 23:33:57
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Cardiac
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cardiac
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  1. Obj 1
    Make sure you're comfortable with heart anatomy.
  2. Obj 1
    Ventricle contraction begins, which closes the tricuspid & mitral valves = ______ heart sound: "____" beginning of _________ (systole or diastole?)
    Once pressure in right/left ventricle is less than pulm artery or aorta, valves close = ____ heart sound: "___" = beginning of _________
    • S1
    • Lub
    • Systole
    • S2
    • Dub
    • Diastole
  3. Obj 1
    ECG
    Define:
    P Wave
    QRS Spike
    T wave
    • 1 atrial depolarization
    • 2 ventricular depolarization (and atrial repolarization)
    • 3 ventricular repolarization
  4. Obj 1
    ________: what's left in the ventricles after it has pumped
    ________: what's left in the ventricle at the very end of filling, diastole
    ________: amount pumped out of heart. How is it calculated?
    How do you calculate ejection fraction?
    How do you calculate cardiac output?
    How do you calculate cardiac index?
    • 1 end systolic volume
    • 2 end diastolic volume
    • 3 stroke volume, EDV - ESV
    • 4 SV / EDV = EF
    • 5 SV x HR = CO
    • 6 cardiac index = cardiac output (CO) / body surface area
  5. Obj 1
    Give ejection fraction percentages:
    normal
    mild LV dysfunction
    moderate LV dysfunction
    severe
    • >55%
    • 40-55%
    • 30-40%
    • <30%
  6. Obj 1
    _________: amount of volume-pressure in ventricle before (previous) to systole
    _________: pressure blood ecounters after leaving heart, out in peripheral vascular system
    ____________: injection of blood from atria giving quick stretch (atrial kick) to ventricle
    • preload
    • afterload
    • frank-starling mechanism (contractility)
  7. Obj 1
    ________ inotropic drugs increase force of contraction of heart muscle
    ________ inotropic drugs decrease force of contraction of heart
    • positive
    • negative
  8. Obj 2
    I'd just read through obj 2. I doubt we have to memorize all of it, just understand it.
    Obj 3
    relative and absolute contraindications to exercising (Watchie 239-240)
    you could probably make up the appropriate amount of contraindications
  9. Obj 4
    _______ __________ : CHF - pump failure: tachy/dys/orthopnea, fatigue, increased LE edema, wt gain >2-3 #/day, jugular venous distension, crackles, s3 heart sound
    ________: CAD: angina, diaphoresis, pallor, nausea, confusion, dizziness, pt. denial, fatigue, claudication, regurl HR becomes irregular
    _____________: sign of acute hearp pump failure: reserve capacity of heart has been exceeded, sometimes called cardiac decompensation
    • Volume Overload
    • Ischemia
    • SBP (or HR) fails to rise or decreases
  10. Obj 4
    responding to cardiac distress:
    abnormally high vitals during exercise that come down when you reduce RPE, no pt complaint?
    vital signs drop with exercise but stabilize with rest?
    nonstable angina, diaphoresis, pallor, nausea, confusion, ataxia, dizziness that is relieve with rest?
    non-stable angina not relieved sublingual nitro OR no angina but all others present and not relieved with rest?
    • 1 lower exercise level and continue, assess vital signs and document
    • 2 stop exercise, monitor vitals (5 min), document and fax vitals to PCP
    • 3 stop exercise, monitor vitals (5 min), document and call PCP
    • 4 stop exercise and call 911, grab AED and monitor vitals continuously, document
  11. Obj 4
    Blood pressure:
    Normal
    Prehypertension
    HTN Stage 1
    HTN Stage 2
    • <120/<80
    • 120-139/80-89
    • 140-159/90-99
    • >160/>100
  12. Obj 4
    Formula for heart rate reserve (HRR) "Karvonen"
    = ((HR max - HR rest) x ____%)) + HR rest
  13. Obj 4
    Wolthius
    70% maximal effort: HR inc _____, SBP inc ______
    89% maximal effort: HR inc _____, SBP inc ______
    • 53, 28
    • 84, 45
  14. Obj 5
    Coronary Arteries:
    _____ supplies RA, RV, inferior LV, AV, Bundle of His, and 1/3 of septum
    _____ supplies posterior septum and inferior part of LV
    _____ supplies anterior LV, 2/3 septum, bundle bracnhes and is most common lesion because it's a work horse
    _____ supplies LA, inf & post LV, SA node in 45% of population, AV node in 10%
    • Right Coronary Artery
    • Posterior Descending Artery
    • Left Anterior Descending Artery
    • Circumflex Artery
  15. Obj 6
    Differential for Shoulder Pain
    What should you rule out? (2 things)
    What can manifest after an MI?
    5 things I don't know how to ask a question about.
    • Rule out: muscuoloskeletal and neurological
    • RSD
    • 1 subjective: angina constant and dull rather than throbbing/sharp
    • 2 lots of stuff refers to shoulder
    • 3 Ask if nitro relieves
    • 4 increase aerobic activity increases angina
    • 5 no position change relieves angina but supine makes it worse
  16. Obj 9.4
    Protocol for taking nitro:
    • Place under tongue, should relieve in 5 min
    • If no relief take second pill and wait 5 min
    • If still no relief take 3rd pill
  17. Obj 10
    4 types of angina:
    ______: common with diabetic or alcholic neuropathy or heart transplant
    _________: occurs with exertion at predictable rate, stops when activity stops, nitro works on this
    __________: emergency situation and may occur at rest
    __________: cause by coronary artery vasospasm, not related to atherosclerosis & typically occurs at rest
    • Silent Angina
    • Stable Angina
    • Unstable Angina
    • Atypical Angina
  18. Obj 10
    What is the formula for RPP?
    SBP x HR and drop last 2 digits of 5 digit number, no units for value

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