Cardio

Front 1

Define Mean Arterial Pressure

Back 1

(Mean arterial pressure)
Avg. pressure through cardiac cycle in aorta
Avg=60-100 mmHg
MAP = (2 x DP + SP)/3

Front 2

At what phase of the cardiac cycle is the myocardium perfused?

Back 2

Diastole.
(During systole, all coronary vessels are flattened out. In diastole, the muscles relax and receive blood flow)

Front 3

Which are more prone to atherosclerosis: Veins or Arteries?

Back 3

Arteries. Veins are not affected by atherosclerosis.

Front 4

Define pulse pressure (PP) and cause for increased or decreased values

Back 4

PP = SP - DP
Avg 30-50 mmHg
Age or ICP: widened pulse pressure
Tachycardia or decreased stroke volume: narrowing pulse pressure

Front 5

Define cardiac Stroke Volume (SV)

Back 5

SV = EDV-ESV (End diastolic volume-End systolic volume)
(amount of blood pumped in one contraction approx. 70 mL)

Front 6

Significance of cardiac preload and after load

Back 6

(Preload-EDV) Pressure that fills the Ventricles during diastole
(Afterload-ESV) Resistance to ventricle emptying durning systole

Front 7

What system has the biggest influence on Preload?(EDV)

Back 7

Sympathetic division of the Autonomic Nervous System.

Front 8

What does TPR stand for?

Back 8

Total Peripheral Resistance

Front 9

Given a pts pulse pressure, heart rate estimate his cardiac output (Q)

Back 9

Q=2 x PP x HR

Front 10

Anatomical landmarks used for cardio exam

Back 10

PMI (Point of Maximal Impulse) - Midcavicular line, 5th intercostal space
A- 3rd intercostal space
P- 3rd inter
T- 4th inter
M- 5th inter

Front 11

Most common murmurs during systole

Back 11

(Mnemonic: *MR V HAS*)
*M*ictral *R*egurgitation

*V*entricle septum defect

*H*OCM
*A*ortic *S*tenosis

(*possibly pathological*)

Front 12

Most common murmurs during diastole

Back 12

(Mnemonic: *MS AR*nold)
*M*itral *S*tenosis
*A*ortic *R*egurgitation
*always pathological*

Front 13

Why is Mitral valve regurgitation more common than Tricuspid valve regurgitation?

Back 13

The Mitral(Bicuspid) valve is under far greater pressure.

Front 14

Various heart sounds and their causes

Back 14

Bruits in carotid signals arteriosclerosis
Thrills in carotid signal
Rales in lungs could signal left side failure
*S1-lub, systole, closure of AV valves*
*S2-dub, diastole, closure of PSL, ASL*
S3- regurataion into atrium, signals CHF
S4- last packing of blood in ventricles

Front 15

Orthopnea
Paroxysmal nocturnal dsypnea (PND)
Trepopnea

Back 15

-positional dyspnea, faster occurring than PND
-delayed onset dyspnea that wakes Pt from sleep
-SOB when laying on left side in CHF or diseased side in lung disease

Front 16

Signs and symptoms of cardiac disease

Back 16

Chest pain
Dyspnea
Wt gain
*Claudication*-Exercise induced leg pain
Fatigue

Front 17

Diagnostic examinations for cardiovascular complaints

Back 17

CXR
*ECG (gold standard for murmurs)*
Labs- CBC, electrolytes (hypertension)

Front 18

Cardiovascular Risk Factors

Back 18

Age: males>45, females>55
Hypertension
Dyslipidema
Diabetes

Front 19

Artherosclerosis
Arteriosclerosis

Back 19

-Narrowing of arteries due to plaque buildup
-Stiffening of arteriol walls with age

Front 20

Ideal lipid values

Back 20

Total cholesterol < 200
LDL < 160
HDL > 40

Front 21

Primary vs secondary dyslipidemia

Back 21

*primary*- genetic
*secondary*- thyroid, obesity, meds(diuretics, BB, steroids, ocp's)
(measurements in pregnancy not valid)

Front 22

Patient education to reduce dyslipidemia

Back 22

Exercise
Weight reduction
Diet

Front 23

Signs of Hyperlipidemea

Back 23

-Arcus Cornea-Juvenile corneal "ring"
-Xanthomas- lipid deposits under skin (eye)

Front 24

Treatment for hyperlipidemea

Back 24

-6 Months drastic diet change
-Statins if diet does not produce desired results

Front 25

What is Xanthoalasma?

Back 25

Superficial lipid deposits, medial aspect of eyelid, "Amber and Rubbery"

Front 26

DDx for chest pain

Back 26

GERD
All cardiac and vascular
Herpes zoster
Pulmonary
MSK strain or chostrochondritis

Front 27

Diagnosis of MI

Back 27

-chest pain, neck, jaw, shoulder
-dyspnea
-no relief with nitrates
-ST and Q wave changes
-enzyme Troponin increase

Front 28

Stable angina
Variant (prinzmetal's) angina
Crescendo angina

Back 28

- intermidate chest pain caused by reversible myocardial ischemia
-due to vasospasm near a plaque
-crushing chest pain caused by acute change in plaque morphology

Front 29

What is Prinzmetal Angina?

Back 29

Coronary Artery Spasm(vasospastic angina)
-May occur at rest

Front 30

Define HOCM

Back 30

Hypertrophic Obstructive CardioMyopathy

Front 31

HOCM Signs/Symptoms

Back 31

Dyspnea*
Angina Pectoris*
Syncope/Presyncope*
Systolic murmur(hard to hear when squatting)
Reversed S2 Splitting
*-Exertionally Induced

Front 32

Signs of pericarditis

Back 32

*Pericardial friction rub*
*ECG- ST elevated, PR depressed*
Tripod position
Fever

Front 33

What is AV Nicking?

Back 33

Found on fundoscopic exam:
-Artery-vein crossing at right angles, "pinching" of the vein.

Front 34

Management of pericarditis

Back 34

NSAIDs
Decreased Physical Activity

Front 35

T/F: Pericarditis is the most common cause of Cardiac Tamponade

Back 35

True

Front 36

Signs and symptoms of cardiac tamponade

Back 36

-*Becks triad*
1.JVD
2.systemic hypotension
3.Muffled heart sounds
-Pulsus paradoxis

Front 37

Treatment of Cardiac Tamponade

Back 37

-Pericardiocentesis (needle aspiration)
-Intravenous volume bolus
-Vasodepressors

Front 38

Def, SSx, Tx of endocarditis

Back 38

-Def: *inflamation of endocardium and heart valves, usually from bacterial infection*
-SSx: fever, chills, new onset murmur, Janeway lesions(feet) no pain, splinter hemorrhages(nails), sub conjunctival hemorrhages, Osler nodes(finger pads) painful, Roth spots(eye)
Tx: vancomycin, immediate referral

Front 39

SSx of rheumatoid fever

Back 39

SSx: *History of strep pharyngitis*
Fever
Rheumatic nodules
Murmur
*Migratory arthritis*
-Tx: ABx, EKG, ABx prophylaxis

Front 40

What is the Etiology of Rheumatoid Fever?

Back 40

Untreated Strep Pharyngitis

Front 41

T/F: S3 Gallop can be a normal finding in youth and pregnancy.

Back 41

True.

Front 42

SSx of aortic dissection

Back 42

Pulsation in abdomen
*CXR- widening mediastinum*
Severe 10+ chest/back pain
Some neurological deficit
*Asymmetric peripheral pulses > 20 diff*

Front 43

Predisposing factors to aortic dissection

Back 43

> 50
Martians or Ehler-Danlos- connective tissue disorders
Pregnancy

Front 44

Management of suspected aortic dissection

Back 44

Calm pt to lower BP
Surgical ASAP

Front 45

SSx of pulmonary embolus

Back 45

Sudden onset pleuritic chest pain
(*Usually associated DVT*)
*Dyspnea*
Virchow'd triad (Hypercoagulability,
Hemodynamic changes (stasis, turbulence),
Endothelial injury/dysfunction)

Front 46

Factors predisposing to pulmonary embolus

Back 46

Virchows triad:
-Venous stasis- prolonged travel, bed rest
-Hypercoagulability- preg, malignancy, estrogen therapy, nicotine use
-Endothelial damage- surgery, trauma

Front 47

Tx of pulmaory embolus

Back 47

Low molecular wt Heparin
ASA
Bed rest

Front 48

Stages of severity of hypertension

Back 48

Normal: 120/80
*Grade 1: 140-159/90-99 lifestyle changes
Grade 2: 160-179/100-109 verify, start meds
Grade 3: >180/>110 start meds
Isolated systolic: >140/<90
" w/ widen PP: >160/<70

Front 49

BP control through the renin/angiotensin/aldosterone system

Back 49

*Angiotensin II causes vaso-constriction* and the release of aldosterone, which tells kidneys to hold onto Na and water.

Front 50

First line meds for hypertension

Back 50

*ACE inhibitors*
*Angiotensin receptor blockers (ARB)*
Ca channel blocker
*Diuretic (Thiazides)*

Front 51

Second line meds for hypotension

Back 51

ACE inhibitor plus thiazide
ACE inhibitor plus Ca channel blocker
ARB plus Ca channel blocker

Front 52

Hypertensive crisis and Tx

Back 52

BP > 220/140 but really >180/110
Evidence of end organ damage
Tx: gradually reduce BP (*never more than 25%*)

Front 53

Difference in left/right side CHF SSx

Back 53

-Left: Valve disease, HOCM resulting in S3 gallop, *dyspnea*, rales
-Right: LVD, cor pulmonale resulting in edema, *JVD*, ascites, *dependent edema*

Front 54

Jugular venous pressure means what

Back 54

Right atrial pressure

Front 55

Tx of acute CHF

Back 55

(Mnemonic: LMNOP)
Lasix (diuretic)- decreased preload
Morphine- anxiety
Nitrates- vasodilator- decreased per/afterload
Oxygen
Positioning- semi reclining

Front 56

Difference in SSx of PAD and PVD

Back 56

(PAD: Blood can't get there
PVD: Blood can't get back)
Cool vs warm
Pallor vs flushed
Dry ulcer vs weeping venous ulcer
Sharp pain vs aching pain
Decreased pulse vs edematous

Front 57

Risk factors for development of DVT

Back 57

Virchow's Triad

Front 58

SSx of DVT

Back 58

Calf pain
Homan's sign (calf pain with dorisflexion)
Unilateral leg swelling
Erythema and warmth
Palpable cord in calf
Less harmful if below the knee

Front 59

What causes narrowing pulse pressure

Back 59

Anything that restricts pressure in left side of heart

Front 60

Tx of DVT

Back 60

-Low molecular wt Heparin therapy sub-Q every 12 hrs
-ASA (for anti-platelet therapy)
-*Non-ambulatory*, then Warfarin (Coumadin)

Front 61

sympathetic and parasympathetic effect on the heart

Back 61

Sym- cardio accelerator
Para- cardio inhibitor

Front 62

Define Claudication

Back 62

Exercise induced leg pain that completely resolves with rest. (common arthrosclerotic complication)

Front 63

Common systolic murmurs

Back 63

Mitral Regurgitation
Aortic Stenosis
HOCM
Ventricle septum defect

Front 64

Common diastolic murmurs

Back 64

Mitral stenosis
Aortic Regurgitation
*always pathological

Front 65

Grade 4 heart sound

Back 65

Very easily heard and is pathological

Front 66

Rhabdomyolysis

Back 66

-Skeletal muscle destruction resulting in massive release of myoglobin
-Myoglobin clogs kidneys
-cardiac function
-side effect of Statins (very rare .44 cases per 10,000)

Front 67

Critical stenosis of ischemic heart disease

Back 67

75% blockage of one or more coronary artery

Front 68

Secondary hypertension causes

Back 68

(ABCDE)
-Accuracy
-Apnea
-Aldosteronism
-Bad kidneys (listen for bruits)
-Catacholamine excess- excess adrenalin
-Coarctation of aorta or narrowing that limits blood supply to lower body
-Diet and drugs
-Endocrinopathy- hyperthyroidism

Front 69

Antihypertensive drug strategies

Back 69

-Reduce cardiac output- Beta blocker, Ca channel blocker
-Dilate peripheral vessels- Ca blocker, ACE inhibitor, ARB
-Reduce vascular volume- diuretics

Front 70

Negative side effects of diuretics

Back 70

Glucose intolerance
Potassium reduction

Front 71

Beta blockers may be contraindicated in what patients?

Back 71

Asthmatics
Patients with 2nd or 3rd degree heart block
Patients with severe dyslipidemia

Front 72

Side effects of ACE inhibitors

Back 72

Dry cough
Angioedema
Proteinuria
Pregnancy Category D

Front 73

Beta blockers MOA

Back 73

Decrease CO
Decrease CNS outflow
Decrease renin release

Front 74

How do Calcium Channel Blockers work?

Back 74

Lower heart contractility
Vasodilator

Front 75

What are the most common causes of cardiac complications?

Back 75

Metabolic
Infection
Nutritional
Toxic

Front 76

What is the average adult stroke volume

Back 76

70 ml (each ventricle)

Front 77

What is Buerger's disease?

Back 77

-Thromboangiitis Obliterans
-Obstructive inflamm disease of superficial distant arteries, usually digits of hands/feet
-Tx: absolute nicotine avoidance

Front 78

Raynaud's Disease

Back 78

-Periodic vasopastic events causing pallor or cyanotic of fingers
-bilateral pallor of digits triggered by cold, stress

Front 79

Activation potentials of heart conduction system

Back 79

SA node: 60-100
AV node: 40-60
Bundle of His: <40
Perkinje fibers: <40

Front 80

What are the "Six P's" of Peripheral Arterial Disease?

Back 80

1.Pain
2.Parasthesis
3.Paralysis
4.Pallor
5.Pulselessness
6.Poikilothermia(Inability to regulate temperature)

Front 81

What are the "Four E's" of Stable Angina Pectoris?

Back 81

Exercise
Emotional Upset
Eating a heavy meal(blood diverts to GI system)
Environmental Extremes