Cardio Phys

Front 1

which part of the bp is related to resistance?
volume?
only time this doesn't apply?

Back 1

resistance = systolic
volume = diastolic
doesn't apply w/ eisenmonger

Front 2

what is eisenmongers?

Back 2

L to R shunt causing pulm HTN which reverses everything so now have R to L shunt

Front 3

side of heart w/ decr pressure and resistance? - consequence (in relation to the valve opening/closing)

Back 3

R
valves will open first and close 2nd

Front 4

side of heart w/ inc pressure and resistance? consequence (in relation to the valve opening/closing)

Back 4

L
valves will close first, open 2nd

Front 5

when inhale, which side of heart gets inc volume? why?

Back 5

R
b/c when inhale, bring in O2, and will cause vasodilation of the pulm vessels

Front 6

when exhale, which side of heart gets inc volume?

Back 6

exhale - L

Front 7

3 physio effects for wider S2 split

Back 7

bring in inc O2
inc volume in RV
delay opening and therefore closing of pulm valve

Front 8

only dz to give FIXED wide S2 split

Back 8

ASD

Front 9

opening snap?

Back 9

Tricuspid stenosis
Mitral stenosis

Front 10

ejection click?

Back 10

Aortic stenosis
Pulmonic stenosis

Front 11

Midsystolic click
when does it occur when stand up?
when lay down?

Back 11

MVP
standing: closer to S1
lay down: closer to S2

Front 12

Reasons for soft S1

Back 12

one of the valves isn't closing:
Tricuspid regurg
Mitral regurg
Valve is missing

Front 13

Soft S1 w/ cyanosis

Back 13

tricuspid atresia
mitral atresia

Front 14

Reasons for loud S1

Back 14

stiff valve bangs shut (tricuspid / mitral stenosis)

ventricle contracting harder

Front 15

Reasons for soft S2

Back 15

one of the valves isn't closing or valve is missing
Aortic regurg
Pulmonic regurg

Front 16

Soft S2 and cyanosis

Back 16

Aortic / pulmonary atresia

Front 17

Reasons for loud S2

Back 17

stiff valve (aortic / pulmonic stenosis)

high pressure in front of the valves

Front 18

Reasons for S3

Back 18

volume overload
dilated ventricle
decompensation

Front 19

when is S3 normal?

Back 19

adolescent females
pregnant women

Front 20

Reasons for S4

Back 20

pressure overload
hypertrophy
compensation

Front 21

at what point do females have an inc incidence of heart dz? why? what do they complain of?

Back 21

at menopause - due to decr estrogen - complaint = GI issue

Front 22

what does estrogen cause the liver to produce?

Back 22

lipoproteins
TBG
Angiotensinogen
Clotting factors (esp fibrinogen; not F11)

Front 23

Pt comes in asking for OCPs. Current meds include thyroxin. What do you advise the pt?

Back 23

inc thyroxin dosage to counteract hypothyroid effect - since estrogen inc TBG, more T3 will be bound and so have a transient hypothyroid effect

Front 24

young adult comes in w/ an inc systolic bp (NL diastolic) - what are you thinkin?

Back 24

drugs!

Front 25

pressure in:
RA
RV
pulm artery
LA
LV
aorta

Back 25

RA: -/0-8
RV: 16-24/0-8
pulm artery: 32-48/16-24
LA: 16-24/8-10
LV: 140/8-10 - must always be 20 higher than systolic in aorta
aorta: 120/80

Front 26

what does the pulmonary capillary wedge pressure represent? what are the components?

Back 26

total volume in lungs
components = volume from bronchial arteries and volume from pulm artery

Front 27

max volume on right side of heart?
min volume on left side of heart?

Back 27

max on R = 8
min on L = 8

Front 28

AVO2 diff in:
RA, RV, LA, LV, pulm artery

Back 28

RA: 75
RV: 75
LA: 100
LV: 97
pulm artery: 75

Front 29

reason for difference in AVO2 difference between LA and LV

Back 29

bld lost to the thesbian veins

Front 30

SV, HR, TPR
which changes in whites? med?
blacks/hisp? med?
elderly? med?

Back 30

whites: HR - give b-blocker
blacks/hisp: SV - give diuretic
elderly: TPR - CCB

Front 31

how to treat inc ICP?

Back 31

1. put on ventilator (inc O2, decr CO2) - vasoconstricts vessels in CNS
2. mannitol - gets rid of extra volume
3. acetazolamide - decr CSF
4. Burr hole - creates vacuum for brain to move back into place

Front 32

all systolic murmurs
why?

Back 32

AS, PS, MR, TR, VSD
valves that are supposed to be open or valves that should be closed

Front 33

holosystolic murmurs

Back 33

TR, MR, VSD

Front 34

holosystolic inc on inspiration

Back 34

TR

Front 35

holosystolic inc on expiration

Back 35

MR, VSD

Front 36

holosystolic inc on expiration w/ radiation to axilla

Back 36

MR

Front 37

systolic ejection murmur radiating to the neck

Back 37

AS

Front 38

systolic murmur inc when lean forward, making fist, or squatting

Back 38

AS

Front 39

crescendo-decrescendo murmur

Back 39

AS

Front 40

Young athlete suddenly dies on the field - histo?

Back 40

fibers are hypertrophied and disorganized

Front 41

young boy comes in for physical required b/f basketball season. auscultation shows murmur louder upon standing or w/ valsalva. doc also notices radial pulse w/ 2 peaks. what do you tell young boy?

Back 41

can't play. has hypertrophic cardiomyopathy.
rx w/ beta blocker and fluid
ECHO whole family

Front 42

blowing diastolic murmur

Back 42

AR, PR

Front 43

blowing murmur inc on insp

Back 43

PR

Front 44

blowing murmur inc on exp

Back 44

AR

Front 45

murmur that can cause another murmur (2 of em)

Back 45

AR - causes MR
PR - causes TR

Front 46

diastolic murmur w/ widened pulse pressure

Back 46

AR

Front 47

diastolic murmur radiating to the back

Back 47

PR

Front 48

diastolic rumbles

Back 48

TS
MS

Front 49

cause of CHF (in terms of muscle)

Back 49

overstretched muscle fibers due to inc EDV and ESV

what happens to contractility?

Hint 49

decr so decr CO and EF

Front 50

if decr CO, what's consequence?

Back 50

shock

Front 51

CHF after MI - MCC?

Back 51

left coronary artery infarct

how much myocardium is lost?
what's the ejection fraction?

Hint 51

lose 40%
EF: <45%

Front 52

pt comes in w/ orthopnea and crackles on lung exam - dx?

Back 52

left sided heart failure

Front 53

pt comes in w/ bilateral lower extremity edema and hepatomegaly - lungs are clear on auscultation - dx?

Back 53

right sided heart failure

MCC?

Hint 53

left sided heart failure

Front 54

S3 heart sound

Back 54

dilated cardiomyopathy

what happens to contractility?

Hint 54

decr

Front 55

S4 heart sound

Back 55

hypertrophic cardiomyopathy

what happens to contractility?
treatment?

Hint 55

inc

rx: beta blocker to decr HR to allow for max filling time

Front 56

which type of heart failure is a systolic dysfxn? diastolic?

Back 56

systolic: dilated
diastolic: hypertrophic

Front 57

ways to rx CHF (general)

Back 57

give O2
decr volume
inc contractility
decr TPR

Front 58

ways to decr volume in CHF?

Back 58

give furosemide
decr Na intake
decr volume intake

why is furosemide the best loop to give?

Hint 58

b/c hearing loss is reversible and also dilates lymphatic channels so lose volume faster

Front 59

ways to inc contractility in CHF

Back 59

digitalis
dobutamine
dopamine

which do you give in hospital? which to send home with?

Hint 59

to send home: digitalis
in hospital: the other 2

Front 60

ways to decr TPR in CHF

Back 60

ACEI
ARBs
B-blocker

which will decr mortality

Hint 60

beta blocker

Front 61

MOA of digitalis

Back 61

blocks Na/K pump by competing w/ K+ - causes inc Ca++ so inc contractility

also stimulates the vagus

side effects?

Hint 61

blue/yellow around light
ventricular arrhythmias initially from inc Na inside -> narrow QRS
optic nerve can swell from trapped Na
dig toxicity if have hypokalemia or hypercalcemia

Front 62

how does MOA of dopamine change when give at low dose or high dose

Back 62

low dose - will be D1 and beta 1 agonist
at high dose, will work at alpha 1

Front 63

what 3 drugs can we use in heart failure that will decr mortality?

Back 63

beta blockers
spironolactone (how)
nitrates (in who)

Hint 63

spironalactone will block cardiac fibrosis caused by aldosterone from ACEI use
nitrates used in blacks