First Aid Cv

Front 1

what is contained within the carotid sheath?

Back 1

V- internal jugular Vein
A- Carotid Artery
N- vagus Nerve

Front 2

Where is coronary artery occulsion most likely to happen?

Back 2

LAD (anterior interventricular septum)

Front 3

Where is the most posterior portion of the heart? What happens if this enlarges?

Back 3

Left atrium! enlargement can cause dysphagia (esophageal nerve compression) or hoarseness(recurrent laryngeal nerve)

Front 4

What affects Cardiac Output?

Back 4

SV= CAP
C- contractility
A- Afterload
P- preload

Front 5

Afterload vs. preload (which vascular system?

Back 5

Afterload is Arterial, Preload is venous

Front 6

What decreases afterload? preload?

Back 6

Dilators, either venous or vaso.

Front 7

Name one arterial vasodilator

Back 7

hydralazine

Front 8

What increases contractility?

Back 8

CALCIUM! Increased by digitalis, increased calcium concentration, or increased activity of the CA pump in the SR (catecholamines)

Front 9

What decreases contractility?

Back 9

B1 blocker, HF, acidosis, hypoxia, NON-DHP ca blockers

Front 10

What is Ejection fraction?

Back 10

SV/EDV
A measure of contractility

Front 11

What can increase viscosity? Why is this important?

Back 11

Polycythemia, hyperprotein states. Resistance (BP) is proportional to viscosity, increase viscosity increase BP and work.

Front 12

What is the S1 sound?

Back 12

mitral and tricuspid closure

Front 13

What is the S2 sound?

Back 13

aortic and pulmonic closure

Front 14

what is the S3 sound? What can this denote?

Back 14

DIASTOLIC, associated with increased filling pressures, i.e. dilated ventricles.

Front 15

What is the S4 sound? What does it denote?

Back 15

Late diastole, Associated with hypertrohy

Front 16

What does fixed splitting typically denote?

Back 16

ASD

Front 17

If you hear a murmur at the Aortic Valve in Systole it is what? In diastole?

Back 17

Systole- Aortic stenosis
Diastole- Aortic regurgitation

For Aortic and pulmonic Systole= stenosis

Front 18

If you hear a mumur at the pulmonic valve in systole it is what? Diastole?

Back 18

Systole- Pulmonic stenosis
Diastole- Pulmonary regurg

Front 19

For aortic and pulmonic valves a murmur in systole is what?

Back 19

AV + PV in systole is Stenosis

Front 20

For aortic and pulmonic valves a murmur in diastole is what?

Back 20

AV + PV in diastole is regurg

Front 21

If you hear a murmur at the MV during systole it is what? Diastole?

Back 21

Systole- Mitral regurg
diastole- Mitral stenosis

During Diastole, the Mitral valve should be OPEN(no sound) so a sound denotes stenosis.

Front 22

If you hear a murmur at the Tricuspid valve in systole it is what? Diastole?

Back 22

Systole- regurg
diastole- stenosis

During Diastole, the Tricuspid valve is OPEN (no sound) so a sound denotes stenosis (partial closure)

Front 23

Normal splitting happens during _________.

Back 23

expiration

Front 24

Cardiac myocytes are dependant on _____ for contraction.

Back 24

Ca

Front 25

Ventricular (myocyte) action potentials:
Phase0, 1=__________
Phase 2=__________
phase 3 = __________

Back 25

0,1: Na influx
2: K efflux, Ca influx
3: K efflux

Front 26

Pacemaker AP
0: ______
3:________

Back 26

0: Ca influx
3: K efflux

Front 27

Name what happens in each of the ECG waves:
P, QRS, T

Back 27

P: atrial depolarization
QRS: Ventricular depolarization
T: Ventricular repolarization

Front 28

Torsades is often caused by what?

Back 28

K channel block leading to an EAD and QT interval prlongation (i.e. ibutilide, amiodarone, etc)

Front 29

WPW has the characteristic mark of ?

Back 29

DELTA wave

Front 30

Describe the mechanism of WPW

Back 30

accessory conduction pathway that allows the ventricles to begin to depolarize faster.

Front 31

What is associated with WPW (re-entry)

Back 31

SVT

Front 32

This ECg rhythm is described as irregularly irregular.

Back 32

A fib

Front 33

What is a hallmark of A fib?

Back 33

No P waves!

Front 34

How do we treat A fib?

Back 34

Beta or calcium blocker + coumadin

Front 35

A flutter has a characteristic _____ appearance

Back 35

saw tooth

Front 36

How do we treat A flutter?

Back 36

A flutter is an ectopic (ventricular) issue. You can block sodium or potassium because of the myocyte AP. (use class IA, IC, or III anti-arrythmics.

Front 37

What is characterisic of an AV block?

Back 37

Prolonged PR interval. (think about it, what is happening beween the P wave and R wave? conduction from atria to ventricles)

Front 38

Describe a 2nd degree block (mobitz I or wenckebach)

Back 38

PR progressively lengthens unil a beat is dropped.

Front 39

Describe a 2nd degree block (mobitz II)

Back 39

Dropped beat with out Pr interval shortening

Front 40

Describe a 3rd degree block

Back 40

P waves have no relationship to the QRS, (i.e. 2 p waves then one QRS, then 3 p waves and one QRS)

Front 41

describe V fib

Back 41

erratic rhythm. SHOCK

Front 42

What happens when MAP decreases? (regulatory mechanism)

Back 42

renin-angiotensin system makes ANg II and aldosterone to increase BV and vasoconstrict leading to increase MAP (BP)

Front 43

What is the fxn of Betas on the heart?A1?

Back 43

beta1 activation leads to increased HR and contractility, alpha1 leads to vasoconstriction and increased BP.

Front 44

Where are the Baroceptors located?

Back 44

Carotids and Aorta

Front 45

what do chemoreceptors detect?

Back 45

low O2, high CO2 and PH.
(just think what the "chemistry" of the blood is)

Front 46

What do baroreceptors detect?

Back 46

Stretch! hypotension = decreased stretch

Front 47

Edema is caused by (physical principles of capillary exchange)

Back 47

increased capillary pressure, increased capillary permeability and increased interstital fluid

Front 48

What are the early cyanosing congenital heart defects?

Back 48

the 5 T's:
Teratology, Transposition, Truncus, Tricuspid atresia, TAVPR

Front 49

right to left shunts are known as _____babies.

Back 49

Blue (early cyanosis)

Front 50

L to R shunts are known as _____ and are named ____,____, and ____>

Back 50

blue kids, ASD, VSD, PDA

Front 51

L to R shunts only cause cyanosis when....

Back 51

They convert to R to L shunts

Front 52

What is eisenmenger's syndrome?

Back 52

L to R shunt that switchs to R to L shunt as pulmonary resistance increases during the L to R shunt.

Front 53

Describe the 4 condititions associated with Tetralogyt of fallot

Back 53

PROVe
P- pulmonary stenosis
R- RVH
O- Overriding Aorta
V- VSD

Front 54

What does Teratology of fallot look like on Xray?

Back 54

Boot!

Front 55

What is needed to keep someone alive with transposition of the great vessels?

Back 55

A shunt ! (VSD, ASD or PDA)

Front 56

What embrologic issue is associated with transposition of the great vessles?

Back 56

Failure of aorticopulmonary septum to spiral

Front 57

Coarctation of the aorta is associated with _____in infants and _____ in adults.

Back 57

INfantile= IN close to the heart ( preductal)
ADult- Distal to Ductus

Front 58

What is the physical finding in coartcation of the aorta?

Back 58

hypertension in upper extremities and weak pulses in lower extremities

Front 59

how do you close a PDA?

Back 59

Endomethacin

Front 60

How to you keep a PDA open? when would you want to?

Back 60

PGEE; transposition of the great vessels

Front 61

A PDA is associated with what kind of murmur?

Back 61

machine- like murmur

Front 62

an uncorrected PDA will present with what in the PE?

Back 62

cyanosis in the lower extremities

Front 63

Define Athermoa

Back 63

Plaque in blood vessel walls

Front 64

Define Xanthoma

Back 64

Plaque in the skin (eyelids)

Front 65

Define Corneal Arucs

Back 65

lipid deposit in the cornea

Front 66

Define Monckeberg Ateriosclerosis

Back 66

calcification in media of arteries (ulnar or radial)

Front 67

Arteriosclerosis vs. Atherosclerosis

Back 67

arterio- thickening of the small arteries hyaline
athero- plaques and atheroma in the intima of arteries

Front 68

A patient present with chest pain radiating to the back and the CXR shows mediastinal widening. You should be suspicious of?

Back 68

Aortic Dissection

Front 69

Atherosclerosis involves _____ in the arteries?

Back 69

intima

Front 70

Stable vs. Prinzmetals vs.unstable angina

Back 70

Stable- On exertion secondary to atherosclerosis

Prinzmetals- at rest, coronary spasm

Unstable-ST depression on ECG, progressively worsening pain

Front 71

What is the most commonly occulded arteries in an MI?

Back 71

LAD>RCA> Circumflex

Front 72

What are the risks associated with MI in the following time periods?
day 1
day 2-4
day 5-10
7 weeks

Back 72

day 1- arrythmia
day 2-4 arrythmia
day 5-10- free wall rupture secondary to macrophage degradation
7 weeks- ventricular aneursym.

Front 73

What is the most sensitive LAB test for MI?

Back 73

Troponin I

Front 74

ECG changes during an MI include:

Back 74

St elevation, ST depression

Front 75

DCM vs. HCM vs RCM (cardiomyopathies) On PE

Back 75

dilated- S3, dilated heart on Ultrasound, balloon appearance on CXR

HCM- Normal size, S4

RCM-rare

Front 76

bacterial endocarditis Mneumonic

Back 76

FROM JANE
F- fever
R- Roth spots
O- Osler nodules
M- Murmur
J- janeway lesions
A- anemia
N- Nail bed hemorrhage
E- Emboli

Front 77

What condition is associated with Libman- Sacks endocarditis? What is it?

Back 77

SLE, vegetations occur on both sides of mitral valve.

Front 78

What organism most often causes ACUTE bacterial endocarditis? Subacute?

Back 78

Staph (treat with naficillin)
Subacute- viridans strep.,

Front 79

Rheumatic heart disease is associated with what organism?

Back 79

Group A strep!

Front 80

What is the PE findings of Rheumatic Fever?

Back 80

FEVERSS
Fever, Erythma marginatum, Valve damage, ESR increased, Red hot joints, Subcutaneous nodules, St. Vitus dance

Front 81

What is the mechanism of rheumatic heart disease?

Back 81

Type II hypersensitiity rxn to the antibodies of M protein

Front 82

Define Beck's triad...what is it associated with?

Back 82

Becks->muffled heart sounds,JVD, and hypotension.

Cardiac Tamponade

Front 83

Serous Pericarditis is associated with

Back 83

SLE, RA

Front 84

Fibrinous pericarditis is associated with

Back 84

MI and Rheumatic fever

Front 85

Hemorrhagic pericarditis is associated with

Back 85

TB/ malignancy

Front 86

What is the most common heart tumor?

Back 86

Myoxoma of the Left atrium

Front 87

What is the most common heart tumor in children?

Back 87

Rhabdomyomas

Front 88

What is kussmaul's sign? what is it associated with?

Back 88

In JV pressure on inspiration, cardiac tumors

Front 89

What is the mechanism, use and toxivity of hydralazine?

Back 89

Vasodilator!
Used in CHF, hypertension in pregnancy,and in severe hypertension
lupus-like syndrome

Front 90

What is the mechanism, use, and toxicity of minoxidil?

Back 90

Vasodilator! Used in severe hypertension
Hypertrichosis

Front 91

What is the mechanism of the CA channel blockhers? Which acts more on the heart?

Back 91

Block L-type calcium channels to reduce contractility, used for hypertension, angina, and raynauds.
On heart: Verapimil>>dilitazem>nifedipine

Front 92

what si the mechanism of isosorbide dinitrate?

Back 92

vasodilate by releasing NO. dilates veins >> arteries.

Front 93

which affects preload? Nitrates, beta blockers?

Back 93

Nitrates (venous dilation)

Front 94

Which affects afterload?Nitrates, betablockers?

Back 94

Beta blockers (decrease arterial BP)

Front 95

What does HMG-COA reductase inhibitors effect?

Back 95

LDL

Front 96

What does niacin affect?

Back 96

LDL + HDL

Front 97

What does bile acid resins affect?

Back 97

LDL

Front 98

What does cholesterol absorption blockers affect?

Back 98

LDL

Front 99

what is the one drug that significantly decreases TGs?

Back 99

Fibrates

Front 100

What is a down side to using cholestyramine? who can use it?

Back 100

Pregnant women, frequent dosing

Front 101

What is the mechanism of cardiac glycosides like digoxin?

Back 101

Directly inhibit NA/K atpase to inhibit NA/CA exchanger (efflux) and increase CA concentration.

Front 102

In regards to MI, describe the use of class IB and IC antiarrythmics.

Back 102

IB- Best post MI
IC- contraindicated post MI

Front 103

In what arrythmias would you use a B blocker?

Back 103

Vtach, SVT, Rate control in A fib/flutter

Front 104

What is the drug of choice for treating a SVT?

Back 104

adenosine

Front 105

What drug would you use in torsades?

Back 105

Mg2+

Front 106

What drug would you use in digoxin toxicity?

Back 106

K+ (binds NA/K exchanger)

Front 107

When would you use a Ca blocker in an arrythmia?

Back 107

NODAL ONLY (SVT, etc)