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91 Cards in this Set
- Front
- Back
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What causes S1?
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closing of the mitral and tricuspid value
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What closes first, mitral or tricuspid?
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mitral
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What causes S2?
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closing of aortic and pulmonary valves
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Both S1 and S2 are caused by valves doing what?
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closing
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What is Eisenmenger syndrome?
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backwards flow through the heart- L - R shunt
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What happens in a L-R shunt when pulmonary hypertension greatly increases?
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flow reverses to a R-L shunt
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What is the treatment for Eisenmenger?
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bosentan
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Why Bosentan?
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it pulmonary dilates preferentially
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What does an opening snap on the right mean?
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tricuspid stenosis
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What does an opening snap on the left mean?
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mitral stenosis
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When would you hear an opening snap?
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during diastole
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What does an ejection click mean?
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valve is popping open during systole
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An ejection click on the right would mean? left?
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right- pulmonary stenosis
left- aortic stenosis |
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A midsystolic click means what?
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mitral value prolapse
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When standing, what does the midsystolic click sound closer to?
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S1
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When sitting, what does the midsystolic click sound closer to?
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S2
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What is pre-eclampsia?
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HTN and proteinuria in pregnancy
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When is pre-eclampsia very serious?
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when BP >160
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What is eclampsia?
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the brain is involved, usually preceeded by pre-eclampsia
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What is the treatment for pre-eclampsia?
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mg-sulfate to block Na channels
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What does a soft S1 indicate?
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either the the tricuspid or the mitral is not closing properly
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If one of the values is not closing properly, what does that mean?
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mitral or tricuspid regurgitation or total value atresia (not there)
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What does it mean if you have a loud S1?
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mitral or tricuspid stenosis or the ventricle is contracting harder
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What does a soft S2 mean?
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pulmonary or aortic reguritation or valve atresia
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With any valve atresia, what will the pt. present as?
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cyanotic
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For atresia to happen, what failed?
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apoptosis
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What does a loud S2 mean?
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pulmonic or aortic stenosis
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What does an S3 mean?
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noncompliant ventricle
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When does S2 splitting occur?
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when you breath in
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What 3 things make S2 wider?
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increased O2, increased volume in rt. ventricle and increased delay in closure of the pulmonary value
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What are the 3 things that cause S3?
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volume overload, dilated ventricle or decompensation
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When is the only time S3 is normal?
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in an adolescent female because of increased estrogen
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In a hypothyroid woman that gets pregnant, what do you do?
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increase T3 replacement therapy
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What is the reason women have softer muscle tone?
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estrogen
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What does estrogen do to muscles?
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it's a relaxant
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What makes an S4?
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atrial kick
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What 3 things are a cause of S4?
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pressure overload, hypertrophy, compensation
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CVP is a measure of what pressure?
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right atrial pressure
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What is the normal CVP?
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3-5 cc
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What is the diastolic pressure of the RA?
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0-8
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What is the sys and dia pressure of the RV?
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16-24/0-8
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What is the sys and dia pulmonary pressure?
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32-48/16-24
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What is the sys and dia LA pressure?
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16-24/8-10
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What is the sys and dia pressure of the LV?
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140/8-10
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What is the pressure in the aorta?
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120/80
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What is the average CO?
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5L/min
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What is the pulse pressure equal to?
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the difference between systolic and diastolic pressure- eg. 120/80
pulse P = 120-80 = 40 |
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Of the avg 5L/min of CO, what percent does the brain, heart, and kidney get?
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each 20%- 1L
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What is the CO equation?
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CO = SV x HR
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What is the BP equation?
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CO x TPR = BP = SV x HR x TPR
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What is the SV equation?
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SV = EDV - ESV
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How do you calculate MAP?
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MAP = (sysP + diaP) / 2
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What BP is at the upper end of normal?
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135/85
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What are murmurs caused by?
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turbulent blood flow
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A reynold's number >2500 means what?
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turbulence
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To have a TIA, you must be at least what percent stenosed?
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70%
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What is the classic sign that a pt has had a TIA?
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amaurosis fugax- lose vision temporarily
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A systolic pressure from 135-155 is what?
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mild HTN
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A systolic pressure from 155-175 is what?
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moderate HTN
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A systolic pressure >175 is what?
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severe HTN
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How do you know when to send a pt to surgery after an MI?
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more than 70% of the left main is stenosed or 3 or more vessel involvement at 90% blockage
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What is the top 6 treatments of an MI in order?
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aspirin, beta blocker, nitrates, O2, moraphine, heparin/tPa
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What two treatments for an MI decrease mortality rate significantly?
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aspirin and beta blocker
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What causes a systolic murmur?
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valves that are supposed to be open (aortic or pulmonic) are stenotic or valves that should be closed are not- mitral or tricuspid regurgitation
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What does a pansystolic or holosystolic murmur look like?
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all the way from S1 to S2
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What causes a pansystolic murmur?
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M or T regurgitation or a VSD
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If a murmur increases on inspiration, what side would it be on?
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right
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If a murmur increases on expiration, where would it be?
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left
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A pansystolic murmur that increases on expiration would be caused by what?
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mitral regurgitation
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A pansystolic murmur that increased on inspiration would be what valve?
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tricuspid regurgitation
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A pansystolic murmur that radiates to the axilla is caused by what?
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mitral regurgitation
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What does a systolic ejection murmur look like?
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strong at S1 and tapers off to half way to S2
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What is a systolic ejection murmur caused by?
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aortic or pulmonary stenosis
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Where does aortic stenosis radiate to?
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carotids in the neck
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When does an aortic stenosis get louder?
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when you lean forward, make a fist, blow up a pressure cuff, or squat
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What causes a cresendo-decresendo murmur?
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pulsus tardus
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What does a cresendo-decresendo murmur look like?
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diamond shape
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What is IHSS?
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idiopathic hypertrophic subaortic stenosis
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What is the inheritance of IHSS?
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AD
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What does IHSS look like histologically?
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hypertrophied, but very disorganized
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What is a big clue for IHSS?
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any young athlete that dies suddenly especially during peak exercise
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What causes the subaortic stenosis?
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the septum is very thick, especially at the top
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What is the treatment for IHSS?
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beta blockers, adequate fluid intake, no organized sports, echo on entire family
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What causes diastolic murmurs?
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either the valves that should be open (M and T) are stenotic or the valves that should be closed (A and P) and regurgitant
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What causes a diastolic blowing or decresendo murmur?
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A or P regurgitation
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If the diastolic blowing murmur increases on inspiration, what valve is it?
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pulmonary
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If the diastolic blowing murmur increases on expiration, what valve is it?
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aortic
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What is the treatment of aortic regurgitation?
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replace the valve
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What is a classic clue pointing to aortic regurgitation?
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widened pulse pressure (increased sys/decreased dia)
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What is a classic clue for pulmonary regurgitation?
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radiates to the back
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What causes diastolic rumbles?
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tricuspid or mitral stenosis
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