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33 Cards in this Set
- Front
- Back
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What is the difference in Troponin I and Troponin T
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Troponin I and T are specific for an MI; troponin should be undetectable in healthy people; relevation means new reinfarction; can persist up to 14 days after AMI; rise 2-3H after onset of MI;
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J.K. is in the ER w/ chest pain but undetectable troponin levels. There is no ST segment elevation, EKG is nondiagnostic, but clinical suspicion is high. What do you do?
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start reperfusion therapy--it should not be delayed to await cardiac biomarker results.
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What is a normal CK level? What CK level is diagnostic for an acute MI?
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22-198 U/L; to be diagnostic for an MI it must be 2 times above normal. Elevated CKMB in presence of normal total CK suggests an MI. Same thing as CPK.
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How can you measure triglycerides when they are above 400?
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use the VLDL
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what are the causes for low HDL?
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high triglycerides, obesity, inactivity, smoking, high carb intake, type 2 diabetes, B-Blockers, anabolic steroids, progestational agents, genetic factors
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Mr. J's CRP value came back > 8 (normal 1-3mg/L). what do you do now?
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repeat in 2-3 weeks. may represent acute-phase response, consistently high values represent very high risk of future CVD.
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What is a normal BNP value? What does BNP do?
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<100 mg/dL; promotes diuresis, natriuresis, inhibits renin-angiotensin system, endothelin secretion, and systemic and renal sympathetic activity. Levels > 400 have high positive predictive value for HF as etiology of dyspnea.
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What factors increase BNP?
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age (older), gender (female), ethnicity (AA), acute MI or ACS, R sided HF (cor pulmonale, acute PE), high output HF (cirrhosis, sepsis)
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what factors can decrease BNP?
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obesity, early acute HF (< 1H), acute MR, MS (in absence of RV failure), Stable NYHA Class I patients with decreased LV EF
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What diagnostic studies are done to evaluate the heart?
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echo, radionuclide ventriculograpy, cardiovascular MRI, computed tomography, stress test, rest and stress imaging studies, cardiac cath, coronary angiography
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Data from Swan Gantz and normal pressures?
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systolic 20-30
diastolic 5-10 wedge 5-12 CO 4-6 CI 2.2-4.0 |
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what are the s/s of a right ventricular MI?
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distended neck veins
hepatojugular reflux S3 S4 elevated RA pressures elevated RV pressures elevated CVP Normal PAP and PAWP |
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What do you see on the EKG with a RV MI?
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Q wave, ST segment, and T wave inversion in leads V4R, V5R, and V6R
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Treatment for R sided MI.
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maximized filling pressures-dont dehydrate them
afterload reduction--nipride!!! |
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what determines the outcome of an MI?
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suddeness of occlusion, degree of perfusion insufficiency, duration of the ischemia. you have a 4-6H window for thrombolytics. L Main is the "widow maker".
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what is Becks Triad?
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muffled heart sounds
elevated cvp paradoxical pulse indicates cardiac tamponade |
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Pericarditis
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s/s CP, friction rub, PR segment depression
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describe a ventricular gallop (S3)
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heard early in diastolic phase, heard best in mitral area (apex) heard best w/ bell, L lateral position may increase sound, associated with CHF. Tennessee
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describe an atrial gallop (S4)
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produced by blood entering a noncompliant left ventricle during atrial contraction, heard late in the diastolic phase (near S1), heard best in mitral area with bell, L lateral position may increase sound, assoc. with chf, mi htn, cad, aos, NOT HEARD WITH A FIB
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What is a murmur:
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murmurs are abnormal heart sounds that are produced by turbulent blood flow caused by either: High flow rates with a normal or abnormal valve, forward flow thru either a constricted valve or into a dilated vessel or chamber, backward flow thru and regurgitant valve. Grade I-6. harsh, blowing, rumbling, cresendo, decresendo, diamond shaped.
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how do you determine the D02? what is the formula?
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CI x (hgb x 1.34) x Sa02 x 10
normal between 500-720ml/min/M2 this means what is being delivered to my toes. assume the cells arent satisfied if the D02 keeps climbing |
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what is a normal V02?
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60-80%
if > 80% you are shunting |
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how do you determine the V02?
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CI x (Hgb x 1.34) x (Sa02 -SV02) x 10
this is what was consumed by my toes |
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What is the patho of ventricular hypertrophy?
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decreased compliance
hindered diastolic filling depressed contractility increased myocardial demand compression of coronary arteries |
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S/S of ventricular hypertrophy?
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SOB/DOE
CHF Angina Syncopy TIAs |
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What are the criteria for surgery rather than a PTCA?
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> 3 vessels
L main disease (>50%) 2 vessel disease including LAD |
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after surgery, optimize preload, reduce afterload, optimize preload.
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can use vasopressin after surgery to increase the SVR
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67 y/o woman s/p AVR; EF 55%; arrived SICU 30 min. ago
VS: 35.5 HR 105 BP 135/78 cvp 14 pad 15 co/ci 3.8/1.8 drips: epi 3 mcg/min; levo 10mcg/min what do you do? |
tank is full but CI bad. stop levo--bp is ok. she has diastolic dysfunction from LV hypertrophy. good EF. whats dias. dysfunction? has norm. LV function with normal LV filling pressures AND low CO--how do you fix this? push the PAD to 20--fill the tank!
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how do you determine if your patient is going into tamponade?
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Becks triad-- muffled heart sounds, elevated CVP and a paradoxical pulse (>10MM HG)
PAD=CAD tachy, hypotension Beck’s Triad (in basic terms): 1. Distended Neck Veins; 2. Muffled Heart Sounds; 3. Hypotension. |
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when do the coronary arteries perfuse?
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during diastole
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when, after surgery, would you expect to see an intraventricular septal rupture?
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early 1-2 days or late 6-14 days. more likely to occur if disease in both RCA and LAD. get a L to R shung--hear a holosystolic murmur and anterior pericordial thrill, S3 and S4, CHF
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what kind of murmur would you expect to hear with a papillary muscle dysfunction?
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loud systolic crescendo-decresendo murmur heard at apex. loud then soft, diamond shaped.
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what is pericarditis?
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inflammation of the pericardium. s/s: CP, pericardial friction rub, PR segment depression
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