Cardio diagnosis

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Cardio diagnosis
2011-02-13 21:17:33
Sherman Cardio diagnosis

Flashcards for Cardio diag study as taught at sherman
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  1. What is cardiac output?
    • The amount of blood that the left side of the heart pumps into the arterial system per minute
    • Stroke volume X Heart rate
  2. What are normal values for SV and HR?
    • SV = 70 mL
    • HR = 60 to 100 beats/min
  3. What is SV?
    The amount of blood that the left ventricle pumps into the arterial system per contraction
  4. What is VR?
    The amount of blood that the right side of the heart recieves per minute from the venous system
  5. What is the Frank-Sterling mechanism?
    CO depends on VR
  6. What does SV depend on?
    • Pre-load
    • After-load
    • Contractility of cardiac muscle
  7. What is pre-load?
    • The amount of blood in LV at the end of diastole
    • Degree of LV muscle tension at the end of diastole
  8. What is another name for Pre-load? What is it normally?
    • End diastolic volume (EDV)
    • 120 mL
  9. Equations relating EDV, SV, ESV, CO and HR.
    • SV = EDV - ESV
    • CO = (EDV - ESV) X HR
  10. What is after-load? What is its normal value?
    BP in aorta at the beginning of systole (normal = 80 mmHg)
  11. What determines the contractility of cardiac muscle?
    sympathetic activity
  12. What is the P-wave?
    Positive deflection representing atrial depolarization
  13. What is the QRS complex?
    Negative, positive, negative wave representing ventricular depolarization
  14. What is the T-wave?
    Positive deflection representing ventricular repolarization
  15. What is the PQ-interval?
    • beginning of P-wave to beginning of Q-wave
    • 0.12 to 0.20 seconds
    • How long from atrial depolarization to ventricular depolarization
  16. What is the QT-interval?
    • Distance from the beginning of Q wave to the end of T wave
    • 0.36 to 0.44 seconds when HR = 60 to 100 beats/min
    • >0.44 seconds when HR < 60
    • <0.36 when HR > 100
    • How long it takes the ventricles ot depolarize and repolarize
  17. What two segments are isoelectric?
    ST segment (end of S wave to beginning of T wave) and PQ segment (end of P wave to beginning of Q wave)
  18. What are the 4 types of QRS complexes?
    • Normal
    • Amplitude of Q = 0
    • Amplitude of S = 0
    • Amplitude of Q and S = 0
  19. What occurs when oxygen supply is less than the demand of cardiac muscle?
  20. What will increase cardiac demand?
    • HR > 100 beats/min
    • Systemic hypertension
    • Increase in tension of cardiac muscle (ventricular hypertrophy) - most common
    • Fever
    • Cocaine use
  21. What will decrease oxygen supply?
    • Decreased radius of coronary blood vessels - most common
    • Low level of oxygen in blood
    • Low level of RBCs
  22. What will decrease the radius of coronary blood vessels?
    • Coronary obstruction
    • Coronary spasm (vasospasm)
  23. Atherosclerosis is the most common cause of?
    • Coronary obstruction
    • Coronary spasm
    • Decreased blood supply
  24. What is the most common symptom of blood supply < demand?
  25. What is angina?
    Chest pain caused by decreased blood supply to or increased demand on cardiac muscle
  26. What are the two main types of angina? What is a third less common type?
    • Stable
    • Unstable
    • Variant - rare, caused by coronary vasospasm
  27. What is stable angina?
    • lasts from 2 to 20 minutes
    • predictable
    • occurs during exercise or stress
    • alleviated by rest and nitrates
  28. What is unstable angina?
    • lasts > 20 minutes
    • not predictable (can start at any time)
    • often starts early in morning because of decreased coronary blood flow
    • pre-infarction angina (board Q)
    • not relieved by nitrates
  29. What are the three stages the heart goes through when blood supply < demand?
    • Ischemia
    • Injury
    • Necrosis
  30. Which steps are reversible if blood supply is restored?
    • Ischemia
    • Injury
  31. Which steps are irreversible?
  32. What are two consequences of blood supply < demand?
    • decreased activity of Na/K pump (not enough oxygen to produce sufficient ATP) --> K builds up outside the cell, Na accumulates inside cell and attracts water --> cellular edema
    • increased amount of ischemic substances (lactic acid, adenosine, histamine) which cause angina
  33. How will an ECG of an ischemic patient appear?
    • Negative T-wave
    • Depression of ST segment
  34. How will an ECG of a patient with cardiac injury appear?
    Elevation of ST segment > 1mm above PQ segment
  35. How will an ECG of a patient with cardiac necrosis (MI) appear?
    • Ascending Q wave > or = 30% of ascending R wave
    • Non-Q wave cardiac necrosis - normal Q wave
  36. What are the two main cardiac enzymes? What would you expect their levels to be?
    • CK-MB will be normal in the first 3 to 4 hours then will increase to max. at 24 hours then returns to normal within 72 hours (3 days)
    • Troponin-I will be normal in first 3 hours then will increase to max and remain elevated for up to 14 days
  37. What is it called if CK-MB does not return to normal within 3 days?
  38. Is congestive heart failure a disease? What is it?
    No, it is a condition in which the heart cannot pump normal amount of blood (CO < demand of peripheral organs)
  39. What are the three classifications of heart failure? Which one will boards ask about?
    • Left or right - boards
    • Acute or chronic
    • Increased or decreased CO
  40. What is left heart dysfunction?
    left side of heart does not pump sufficient blood for all organs
  41. What does decreased blood supply to the kidney's activate?
    Renal-Angiotensin-Aldosterone system (RAAS) --> produces renin --> angiotensinogen --> angiotensin-I --> ACE in lungs converts to angiotensin-II which increases the reabsorption of sodium and water from urine
  42. What is the result of the activation of RAAS?
    Increased blood volume which increases periperal capillary hydrostatic pressure (PCHP or CHP) which increases filtration of plasma and decreases resorption of interstitial fluid leading to peripheral edema
  43. What is the first symptom of heart failure?
    Peripheral edema (board Q)
  44. What results from decreased coronary blood flow?
    blood supply < demand --> cardiac ischemia --> angina
  45. When do coronary vessels recieve blood?
    During diastole
  46. What is the second result of the increased blood volume from activation of RAAS?
    Blood builds up in the liver (hepatomegaly) and the spleen (splenomegaly) and jugular veins (jugular distention), person will demonstrate a positive hepatojugular reflex (press on liver --> jugulars distend, especially right one)
  47. What is systemic congestion? What are the symptoms?
    • Too much blood in systemic circulation
    • Peripheral edema
    • Hepatomegaly
    • Splenomegaly
    • Postive hepatojugular reflex
    • Jugular distention
  48. Where does the blood back up in left HF? What does this cause?
    • pulmonary system which increases the pulmonary CHP
    • Fluid builds up in the interstitial space --> decreased O2 and increased CO2 --> tachypnea, dyspnea
    • Fluid builds up in the alveoli --> when expiration occurs fluid rises and activates cough receptors --> cough with sputum (wet cough)
  49. What are the symptoms of pulmonary edema? Which are the most important for boards?
    • Tachypnea*
    • Cough with sputum*
    • Dyspnea
    • Interstitial edema
    • Alveolar edema
  50. What occurs in right HF?
    • Left side recieves less blood --> decreased CO --> RAAS --> systemic congestion
    • Decreased blood supply to lungs --> diminished pulmonary perfusion
    • Blood backs up in venous system --> systemic congestion
  51. Left HF forward effects?
    • Jugular venous distention
    • Hepatomegaly
    • Splenomegaly
    • Peripheral edema
    • Positive hepatojugular reflex
    • Angina
    • Weakness
    • Increased HR
    • Confusion
  52. Left HF backward effects?
    • Cough with sputum
    • Tachypnea
    • Dyspnea
    • Alveolar edema
    • Interstitial edema
    • Orthopnea
  53. Right HF forward effects?
    • Jugular venous distention
    • Hepatomegaly
    • Splenomegaly
    • Peripheral edema
    • Positive hepatojugular reflex
    • Dyspnea
    • Tachypnea
    • Hypoxia
    • Central cyanosis
  54. Right HF backward effects?
    • Jugular venous distention
    • Hepatomegaly
    • Splenomegaly
    • Peripheral edema
    • Positive hepatojugular reflex
  55. What are the two ways that right HF can cause peripheral edema?
    • Forward effects: Increased blood volume (from RAAS)
    • Backward effects: Increased blood pressure (from blood backing up into venous system)
  56. How is peripheral edema treated?
    • Diuretics to decrease blood volume
    • Blood pressure meds
  57. What is the most common cause of HF in US? What are other common causes?
    • Myocardial infarction - most common - cardiac enzymes
    • Systemic hypertension - history
    • Aortic stenosis
    • Mitral stenosis
    • Aortic regurgitation
    • Mitral regurgitation
    • Myocarditis
    • Pericarditis
    • Coronary heart ds - history
  58. What are normal values for CK?
    • Total CK = 38 to 120
    • CK-MB = 0 to 3
  59. What are life-threatening causes of chest pain?
    • heart attack
    • angina
    • aortic dissection
    • pulmonary embolus
    • spontaneous pneumothorax
    • perforated viscus
  60. What are non-life-threatening causes of chest pain?
    • Acute pericarditis
    • Mitral valve prolapse
    • Pneumonia
    • GERD
    • Esophagitis
    • Costochondritis
    • Herpes Zoster
  61. What are the three main coronary arteries and where do they supply?
    • Left anterior descending - front
    • Left circumflex - left
    • Right coronary artery - right and bottom
  62. What are the risk factors for coronary artery disease?
    • Heredity
    • High cholesterol
    • Tobacco
    • Obesity
    • High blood pressure
    • Diabetes
    • Lack of regular exercise
    • High-fat diet
    • Type A personality
    • Stress
  63. What are risk factors for angina (heart attack)?
    • Hypertension
    • High cholesterol
    • Diabetes
    • Smoking
    • Male
    • Sedentary lifestyle
    • Family history
    • Stimulants
  64. What are signs and symptoms of angina?
    • pain/pressure in chest, possibly spreading down arm, lasting more than a few minutes
    • Lightheadness
    • Anxiety
    • Cold, sweaty skin
    • Increased heart rate
    • Pale
  65. What are pathophysiology of unstable angina?
    • supply-demand mismatch
    • plaque disruption
    • thrombosis
    • vasoconstriction
  66. What can cause increased myocardial oxygen demand?
    • Fever
    • Tachyarrhythmias
    • Malignant hypertension
    • Thyrotoxicosis
    • Cocaine use
    • Amphetamine use
    • Aortic stenosis
    • Obstructive cardiomyopathy
  67. What can cause decreased oxygen supply?
    • Anemia
    • Hypoxemia
    • Polycythemia
  68. Labs for heart?
    CK-MB, myoglobin, Troponin-1
  69. Compensatory mechanisms?
    • Adrenergic system
    • RAAS
    • Ventricular hypertrophy
  70. Causes of Right CHF?
    • Pulmonary embolus
    • Right ventricular infarction
    • Backing up of blood from left CHF
  71. Causes of Left CHF?
    • Left ventricular infarction
    • Hypertension
    • Mitral valve diseae
  72. Systems affected by CHF?
    • Respiratory
    • Circulatory
    • Renal
    • CNS
  73. Causes of low ventricular output?
    • Infarction
    • Hypotension
    • Cardiomyopathy
    • Hemorrhage
  74. Causes of high ventricular output?
    • Fever
    • Thyrotoxicosis
    • Anemia
    • Pregnancy