509 - Lec 3 - Cardiac Differential Diagnosis And Consideration

Front 1

Why take BP on right hand?

Back 1

Because most people are right handed

Front 2

What is coarctation of Aorta?

Back 2

When Aorta is pinched or narrowed, restricting blood flow to the body

Front 3

What can cause difference between left and right BP measurement?

Back 3

Coarctations of aorta
PVD
PAOD (peripheral arterial occlusive disease)

Front 4

precautions/CI against taking braichial BP
(7)

Back 4

1 AV grafts & fistulas
2 s/p CVA
3 left right difference >10mm
4 IV line
5 sickle cell trait/crisis
6 too many bP measurement attempts
7 post arm position & maneuvers

Front 5

What is pulse pressure?

Back 5

difference between diastolic and systolic

Front 6

pulse pressure >60mmHg predictive of?

Back 6

CHF

Front 7

High pulse pressure indicates:
(5)

Back 7

>60 mmHg, CHF
aortic/vascular wall stiffness
severe anemia
hyperthoryoidism

Front 8

Lower pulse prsesure indicates:
(3)

Back 8

lower cardiac output for those in acute heart failure
left ventricular failure
hypovolemia

Front 9

orthostatic hypotension defined by

Back 9

>20mmHg drop in SBP
>10mmHg drop in DBP
within first 3 min of table

Front 10

what is pulsus paradoxus

Back 10

>10mmHg drop in SBP with deep inspiration
suggests pericardial effusion (ie cardiac tamponade)
(and rarely, constrictive pericarditis)

Front 11

What's a good way to treat CHF in regards to exercise?

Back 11

Interval training with mild(er) pace

start from reasonable MET level that does not overwhelm heart

Front 12

describe stable angina

Back 12

lumen narrowed by plaque
inappropriate vasoconstriction

Front 13

describe unstable angina

Back 13

plaque rupture
platelet aggregation
thrombus formation
unopposed vasoconstriction

Front 14

described variant angina

Back 14

no overt plaque
intense vaso-spasms

Front 15

4 E's that precipitate stable angina

Back 15

execise
exertion
emotions
eating

Front 16

how many % occlusion that cause stable angina?

Back 16

70%

Front 17

hwo to relieve stable angina?

Back 17

rest
nitroglycerine

Front 18

describe fixed threshold variant for stable angina

Back 18

stable rate -pressure product
(HR x SBP)

represents a linear relationship between myocardial O2 uptake and coronary blood flow

Front 19

pattern of symptoms for UNSTABLE angina

Back 19

+ frequency
+ duration
+ intensity
symptoms during rest!

Front 20

distinguishing characteristics of variant angina

Back 20

inappropriate vasoplasm
occur mostly at rest or when waking up from sleep
may subside with activity

Front 21

what is ergonovine test?

Back 21

for variant angina:
induce vasoconstriction
patient's are more sensitive and experience angina symptoms

Front 22

who is at risk for silent ischemia

Back 22

diabetics
neuropathy

Front 23

how is silent ischemia diagnosed?

Back 23

ambulatory EKG, GXT

Front 24

what is syndrome X

Back 24

normal coronary arteries?
insufficient vasodilation,
or frank constriction of small vessels

Front 25

what is #1 cause of death in US?

Back 25

myocardial infarction

Front 26

signs and symptoms of MI

Back 26

chest discomfort/pressure that does not go away
lasts >30 min
can occur at center of chest, one or both arms, back, neck, jaw or stomach

Front 27

how many % of patients have minimal to no chest discomfort for MI?

Back 27

25%

Front 28

Myocardial infarction signs and symptoms

Back 28

restless appearance
cool & clammy skin
low grade temp
possible crackles and wheezes
sudden loss of vision/blurred vision
pallor/diaphoresis
weakness, numbness faintness
SOB

Front 29

differential diagnosis for MI checks against what other conditions?

Back 29

chest wall (muscular pain)
GI disroder
pericarditis
cervical osteoarthritis

Front 30

techniques for differential diagnosis for MI?

Back 30

deep breathing (pericarditis)
palpation
ROM
physical activity
NTG

Front 31

P wave represents

Back 31

atrial depolarization

Front 32

QRS complex represents

Back 32

ventriculra depolarization

Front 33

T wave represents

Back 33

ventricular REpolarization

Front 34

U wave represents

Back 34

late repolarizing of ventricles/bundle branches

Front 35

ST and T wave represent

Back 35

defines entire ventricular REpolarization period

Front 36

what wave changes in ECG is a sensitive indicator of MI or infarction?

Back 36

shift in ST segment and T wave inversion

Front 37

What does NSTEMI (unstable MI) look like on ECG?

Back 37

ST depression or T inversion
(basically dips down past neutral after the big upward spike)

Front 38

What does STEMI (stable) look like?

Back 38

ST elevated, extra tall after big spike

Front 39

what's the exercise progression/testing for MI patient?

Back 39

2-3 days: ambulate
1-3 weeks: submax stress test
3-6 weeks: return to work
6-8 weeks: max stress test

Front 40

what is CHF?

Back 40

failure of one or more of the heart chambers, resulting in decreased heart function

Front 41

what are causes of CHF?

Back 41

direct: disease, deficiency
overload: volume, pressure
restrictive filling: pericarditis, myopathies

Front 42

Left heat failure
signs/symptoms

Back 42

sub: dyspnea, orthonea, paroxysmal nocturnal dyspnea, cough, fatigue
obj: rales, S3 gallop, pleural effusion, peripheral cyanosis, inc. resp rate, dec. urine output

Front 43

Right heart failure
signs/symptoms

Back 43

sub: abdominal pain, anorexia/nausea, bloating, fatigue, bilat ankle edema
obj: JVD, peripheral edema, ascites, dec. urine output, hepatomegaly