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189 Cards in this Set
- Front
- Back
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levine sign (no not the maroon 5 guy)
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clenched fist over the chest for ischemic cardiac pain
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where does levin sign pain radiate
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medial aspect of the arm
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how does the pain of ischemia start (times)
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onset with exertion, 5 minutes duration slow buildup over 45 seconds
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what chemicals released when pain starts in MI
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adenosine and bradykinis that stimulate cardiac chemo and mechanoreceptors
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what sympathetic ganglia is stimulated
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5
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what test is contradicted with unstable angina
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stress test
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pain longer than how long can be capable of causing damage
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20 minutes
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what happens with 20 minute pain
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subendocardial damage
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what happens with 2-3 hour pain
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transmural infarct
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besides the left arm, where else can pain radiate
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epigastric, back, shoulders
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angina that occurs at rest
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prinzmetal
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what ST change with prinzmetal angina
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ST elevation
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what stress test result with prinzmetal
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negative
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what rare things on physical examination can you see during an episode of prinzmetal angina
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S3 S4 gallop or mitral regurg, but rare
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productive cough indicates lung or heart pathology
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lung
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sputum production is more likely heart or lung
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lung
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orthopnea or PND
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heart
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bilateral leg edema
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heart
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when PT complains of SOB what three things to ask for
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do they have orthopnea, PND or sputum production, the latter is not associated with HF
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most common cause for passing out
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postural orthostatic hypotension
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three causes of syncope in young patients
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long QT
WPW hypertrophic obstructive cardiomyopthy |
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what is normal right atrial filling pressure
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0-2mm
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what valve do you hear at the PMI
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mitral
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diaphragm for what pitch
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high
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bell for what pitch
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low
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rubella in first trimester of pregnancy does what
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congenital heart disease
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accutane, ETOH and lithium cause what in prgenancy
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congenital heart disease
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4T's for blue baby
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tetrology
transposition truncus arteriosus tricuspid atresia |
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TOF symptoms go
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transpositin of the aorta
pulmonary artery stenosis vsd RVH |
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what is the most common blue baby defect
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TOF
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how does TOF present on EKG
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severe RVH, far left axis
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how does a TOF heart look on xray
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boot shaped cour en sabat
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diabetic mothers have babies with this condition
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artery transposition
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what is a single artery from two ventricles with a large secondary VSD called
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truncus arteriosus
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what kind of murmur is present with truncus arteriosus
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systolic ejection
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no tricuspid valve
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tricuspid atresia
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what must exist in order for a PT with tricuspid atresia to live
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ASD, VSD or a PDA
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box shaped heart
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tricuspid atresia
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what is the only congenital heart defect that occurs more in females
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ASD
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when do most VSD's close
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end of the first year
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when do PDA close
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35% 3 months, almost all by a year
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VSD is a what to what shunt
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left to right
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what is the most common congenital defect
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VSd
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two causes of an ASD
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patent foramen ovale or an endocardial cushion defect
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ASD gender preference
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female
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how would you detect an ASD on exam
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fixed split on S2
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how would you detect an ASD on EKG
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incomplete RBBB, R vs L axis
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what is it called when you have an ASD and a VSD in the same partient
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AV canal defect
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what valves can be broken with AV canal defects
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AV and aortic
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what congenital defect has a high correlation with AV canal defects
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Down's syndrome
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what would you see on exam for AV canal defect
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VSD and pulmonary flow murmurs
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consistent machinery murmur at birth is what
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PDA
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when does a PDA usually close and then seal
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closed in 24 hours
sealed in 3 weeks |
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what presents with hypertension, radial femoral pulse delay, continuous murmur in the back and SCM anterior
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coarctation
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40 % of coarctation patients have what valve defect
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bicuspid AV valve
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preductal coarctation is associated with what
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turners syndrome
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what presents with a Himilayan P wave, 1 degree RBBB and atrialization of the right ventricle
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Epsteins abnormality
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kite shaped systolic murmur
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unicuspid or bicuspid aortic valve
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closure of what valves generates S1 heart sound
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mitral and tricuspid due to increasing ventricular pressure
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ejection click
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is the aortic valve is thickened by some pathologic process, generates this sound
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when is an ejection click heard
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right behind S 1
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in a normal patient, what is blood pressure cuff pressure equal to
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left ventricular peak systolic pessure
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venous return increases with?
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inspiration
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S2 split should be heard in what breathing stage?
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inspiration
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what are the normal heart sounds
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S1, S2 (with physiologic split)
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what are diastolic sounds caused by opening valves
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opening snaps
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mid systolic click is what valve
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mitral closing (Middle = mitral)
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what valves can give you early systolic clicks
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aortic and pulmonary
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S3
Opening snap tumor plop mitral prosthetic valve opening sound |
early diastolic sound
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S3
summation gallop |
mid diastolic
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S4
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late diastolic (almost S1 somtime)
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ejection fraction involves what vnetricle
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left
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what can measure end systolic volume
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echo/angiography
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what is normal ejection fraction
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55-75
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what is the average Cardiac output of a male
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5l/minute
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what determines cardiac output
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body physiological need
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Cardiac output equation
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CO = HR/minute X SV
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cardiac indexequation
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CO/total body surface area
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what percentage problems systolic
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80
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what % problems diastolic
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20
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where are murmurs heard
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downstream from the affected valve
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what happens when a murmur progresses pathologically?
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thrill can be palpated
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murmurs are always indicative of what
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valve dysfunction
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failure of a valve to close completely
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regurgitation
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failure of a valve to open fully
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stenosis
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carotid pulse is the best indicator of what stenosis
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aortic
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what is turbulent flow in an artery called
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bruit
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best location to palpate the carotid
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lateral to the thyroid cartilage and superior to the hyoid
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pulsus alternans is what
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alternating pulse volume
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what is pulsus alternans significant for
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CHF
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parvus and tardus pulse means what
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pulse is delayed and weak - seen in aortic stenosis
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where is paradoxical pulse seen
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tamponade with sudden or large fluid accumulation
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waterhammer pulse
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expansive pulse with quick collapse
seen in aortic regurgitation |
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bisderiens pulse
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two peaks
seen in aortic regurgitation |
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spike and dome carotid
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early normal, then delayed middle
seen in hypertrophic cardiomyopathy |
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bounding pulse
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wide pulse pressure, seen post exercise
seen with hyperthyroidism |
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two most common adult murmurs
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aortic stenosis and mitral regurgitation
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what three symptoms does aortic stenosis present with
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chest pain, SOB, syncope
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when is a unicuspid valve present with aortic stenosis
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birth
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when is a bicuspid stenotic aortic valve present
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40-80,, mostly men
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what two pulses are diagnostic for aortic stenosis
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parvis and tardis
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when would you hear an ejection click in aortic stenosis
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in early systole
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how would you characterize the murmur in aortic stenosis (the sound qualities)
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creschendo/decreschendo systolic murmur
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boot shaped heart
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aortic stenosis
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what kind of pulse would you feel in hypertrophic cardiomyopathy as opposed to aortic stenosis
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both in systole, CM would be later on
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what condition does the brockenbrough sign correlate with
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hypertrophic cardiomyopathy
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what does the brockenbrough sign indicate
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increase in murmur, decrease in carotid pulse
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what is the only circumstance in which an aortic regurgitation can be found
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post bacterial infection or trauma
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how does acute AR present with?
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staph aureus infection, presents with shock
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what is usually one of the first symptoms someone with pathologically bad AR will present with
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SOB
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three causes of AR
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marfans, bicuspid aortic valve, aging
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where would you ascultae a dilated root AR
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right of the sternum, 3rd ICS
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where would you ascultate a valvular AR
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left of the sternum, 3rd ICS
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cor bovinum
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chronic aortic regurgitation
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can you treat AR when chronic symptoms are present?
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no, too late
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mitral stenosis caused by
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rheumatic fever usually
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what gender is predominant for MS
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women
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what condition is significantly increased in patients with mitral stenosis
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a fib
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what condition presents (chronically) with a bluish mottled appearance, malar
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MS
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where would you ascultate mitral stenosis
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use bell, at apex, left lateral decubitus
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how can you tell mitral stenosis with sound?
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presense of an opening snap (indicative of diastolic murmur)
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what three things will you see on EKG with this
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LAE, RVH, A Fib
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what do you see on xray with MS
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Large LA and RA
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what is one of the major causes of mitral regurg
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aortic root dilation and leaflet problems
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what happens when you have an acute MR secondary to SBE
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CHF, pulmonary edema
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what happens in chronic MR
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LVH, LAE, until symptoms progress = too late SOL
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what kind of murmur would you ascultate with chronic MR
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holosystolic soft plateau murmur, does not go beyond grade 3
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what is more important for MR, loudness or length
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length
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how does chronic MR present on Xray
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cor bovinum
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how can you tell if a PT has an acute MR
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secondary to sudden chorda tendinae rupture
instant Pulmonary edema/ shock low BP, murmur stops half way through systole |
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how much does coronary supply go up with exercise
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3-4 fold
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RCA flow in systole and diastole
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equal
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LCA flow in systole and diastole
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mostly diastolic flow as LV wall tension high in systole
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what might help to dialate coronaty arteries in angina
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adenosine leaking from ATP to ADP to AMP to Adenosine
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how much adenosine is lost from a myocardial cell in 30 minutes of ischemia
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50 %
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MI permanent damage in how many minutes
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20
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EKG changes with angine
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T wave elevation
ST Depression - Flat wave Sharp J point |
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acute coronary syndrome is defined as
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unstable angine in some way
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what is the primary cause of acute coronary syndrome
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acute coronary thrombus
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what is the cause of secondary acute coronary syndrome
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CAD with development of tachyarrythmias
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what effect on ST waves does prinzmetal angina have
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elevation
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thrombolysis treatment
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door to needle 30 minutes
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intravascular interventional treatment
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door to lab in 1 hour
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what enzyme elevated for acute Mi
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troponin
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most common cause of death post MI
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arrythmias
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where do free wall ruptures usually happen
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anterior wall
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what is the second most common cause of hostpital death
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anterior wall ruputure post MI
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1-2% of MI and occurs 2-14 days post MI
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VSD
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what vessel is the highest cause of VSD
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LAD
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where can an aneurysm be located
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anterior - apical MI
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sudden onset of severe CHF or pulmonary edema, most occur in the posterior medial papillary muscle supplied by the RCA
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papillary muscle rupture causing secondary mitral regurgitation
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these occur post transmural infarcts usually after an apical MI
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mural thrombus
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so much damage to a heart post MI that the heart cannot efficiently pump blood
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cardiogenic shock
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in CHF what gender has a higher rate of diastolic dysfunction
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females
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men have a higher percent of what disfunction
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systolic
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CHF
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inability of the heart to adequately supply the needs of the body
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most common cause of hospital admit after 65
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chf
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what is CHF usually secondary to
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loss of left ventricle function which has about 60-70% of the myocardial cells in the heart
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most common cause of right sided failure
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left sided failure
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what percentage of the EF does heart failure begin
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<45
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majority of heart failure is systolic or diastolic
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systolic
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Right heart failure signs
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JVD, hepatomegaly, ascites and edema
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relationship between sympathetic stimulation and vasopressin
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increases, causes fluid retention
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what nervous receptor is activated when BP falls in an effort to increase BP
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alpha 1
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when you have fluid retention in CHF what happens when you lie supine
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orthopnea and PND, fluid returns to chest
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CHF grading
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incoming...
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Stage A
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high risk of developing in future, no symptoms
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Stage B
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structural disorder, no symptoms
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Stage C
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symptoms managed by RX
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Stage D
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transplant or pallative care necessary
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pulmonary capillary pressure of what will give a 50% death rate in 30 minutes
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28mm
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pulmonary edema presents when left atrial pressure at
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26 - 28 mmhg
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BNP is a marker for what
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LV dysfunction
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where does BNP originate from
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dilated ventricular myocytes
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ANP works on what
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atria priomarily
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low Ca levels cause the release of what
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cGMP second messenger
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what does NO do when released
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vasodilation and increases naturesis
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syncope
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reduced cerebral perfusion
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what happens with a PO2 of 30
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hypoxia to vasodilation
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Po2 20
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coma as increased H ion depresses neuronal activity
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PT presents with syncope, are their eyes open
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yes, faking it if closed
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PT presents with a history of a fainting episode, constant light headedness, nausea and blurred vision
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vasovagal syncope
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possible cause oc vasovagal syncope
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bezold jarish reflex
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bezold jarish reflex
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induce bradycardia and decrease contracility
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ischemia in ASHD yields increase in what
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PVCs
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what is one of the most commonly preventable diseaes in the hospital
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15%
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virchow's triad
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stasis, hypercoagulability and intimal injury
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most common findings in PE
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tachycardia and tachypnea
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knee replacement has a high risk of .....
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PE
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