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46 Cards in this Set
- Front
- Back
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Current evidence suggests that CAD is strongly related to cigarette smoking. What % for deaths from CAD is directly related to smoking?
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25%
Incidence of MI and death is 70% higher in cigarette smokers than non smokers |
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What is the first line pharmacologic therapy now recommended for most patients with hypertension?
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For most patients a thiazide diuretic is recommended. Other types of agents are recommended for specific problems
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Thiazides:
what does side effects allergies |
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Start at 25 mg higher doses are not used • May cause: hyperglycemia, hyperuricemia, hyponatremia and hypokalemia. • Slow demineralization of bone • If allergic to sulfa may be allergic to HCTZ • Can elevate BUN and Creatinine |
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Where is renin released from
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Renin released by the juxtaglomerular system in response to decreased renal perfusion
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aldosterone
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Aldosterone acts on the kidneys to promote reabsorption of water and sodium
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Angiotensin II
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Angiotensin II produces vasoconstriction
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Blood Pressure classification (normal, etc.)
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Normal < 120/80
prehypertension 120-139/80-89 Stage 1 hypertension 140-159/90/99 stage 2 hypertension > 160/100 |
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Causes of secondary hypertension
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Renin producing tumors • Hyperthyroid • Pheochromocytoma • Licorice • Pagets disease of the bone • Coarctation of the aorta • Renal artery stenosis • Respiratory acidosis |
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Non pharmacological therapy for hypertension
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Weight reduction 3 to 9% loss will positively affect BP • Salt restriction- 2 gram sodium diet • Exercies • Diet – saturated fat increases BP • Alcohol- Decrease to 2 oz daily • Increase of Potassium intake to 60 meq per day • Fish oil suppliments • Tobacco cessation |
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P wave is
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P. Atrial Depolarization
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QRS complex is...
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QRS Ventricular Depolarization
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T wave is..
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T Ventricular Repolarization
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premature atria beat is identified by ...
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Atrial- Identified by an early P wave which is unlike other P waves
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premature ventricular beat is identified by
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Ventricular associated with a widened QRS complex
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Rule for premature ventricular contraction
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Regularity: Since this is a premature beat, the underlying rhythm will be irregular. • Rate: The rate is dependent on the underlying rhythm. • P WAVE: There is no P wave before this premature beat. There may be P waves in the underlying rhythm. • PRI: Unable to be measured in the premature beat because there is no P wave preceding the QRS complex. • QRS: Measures more than 0.12 seconds. The QRS will usually be wide and bizarre |
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treatment of AV fibrillation
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Cardioversion by pharmacologic or Electrical means • Radiofrequency ablation of the AV junction • Rate Control- B blockers first choice for control of rate |
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Atrial flutter
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Associated with rapid atrial rate of 280 to 340 beats per minute • Saw tooth pattern of P wave on ECG |
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Syncope
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Sudden transient loss of consciousness with loss of postural tone • 12 to 30 % of young adults • Must differentiate from seizure • Drugs that cause syncope: nitrates, B blockers and other vasodilators • Numerous causes: Vasovagal, Cough, Micturation, Orthostasis, arrythemia |
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CAD Risks
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Increased LDL • Low HDL • Tobacco • Diabetes Mellitus • Males sex • Increasing age • Family history • Obesity |
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Angina Treatment
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Lifestyle modification • Pharmacotherapy to improve symptoms • Decrease oxygen demand or increase oxygen supply • Nitrates, Calcium Channel blockers, B- Blockers • Antiplatelet therapy |
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Medications for Angina
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Nitroglycerin
B- adrenergic Blockers Calcium channel blockers Calcium channel blockers- Dihydropyridine |
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Prinzmetal Angina
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Variant Angina • Pain at rest • ECG with chest pain shows ST elevation and not depression • Often do not have the risk factors • During cath can be provoked by acetylcholine or methacholine |
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Treatment of Prinzmetal angina
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Treat with Calcium Channel blockers and nitrites not B- Blockers
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Cardiac Catherization
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Dye into inguinal artery • Patient is awake • Complications: stroke, MI, arrhythemias, tamponade, renal failure |
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Angioplasty
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Mechanically widening the artery narrowed due to arteriosclerosis • balloons are passed into the artery then inflated to a fixed size using water pressures some 75 to 500 times normal Blood Pressure |
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Coronary Stent
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Stainless steel tube with slots meant to widen the artery • After a few weeks epithelium grows over the mesh • drug-eluting stents • aspirin and clopidogrel |
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CABG
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Coronary Artery Bypass graft • Saphenous vein, Internal Mammary arteries • New Minimally Invasive procedures |
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Cardiogenic Shock
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Tissue hypoperfusion due to MI or heart failure • 5 to 19 % of people with MI • Tissue death leads to arrythemia and/or insufficient pumping of the ventricle • Often 40% or more of the LV myocardium is involved • Insufficient perfusion of the body • Meds to increase tissue perfusion used. • Signs – Decreased BP – Decreased urine output – Hypoxia – Decreased consciousness • Often fatal |
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Heart Failure
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Problem with the contractility of the heart • Decreased cardiac output to meet needs • Fluid collects in the lungs and extracellular space • Causes: – Systolic dysfunction – Diastolic dysfunction – Valvular problems – Disorders of heart rate and rhythm – Ischemia |
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Clinical findings of heart failure
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Dyspnea • Orthopnea • Paroxysmal Nocturnal Dyspnea • Pulmonary Edema- rales on exam • Fatigue • Fluid Retention • Abdominal Symptoms • Apnea associated with hypoxemia • Diaphoresis • Jugular Vein Distention |
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How do you diagnose Heart Failure
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CXR • EKG • ECHO • Measurement of Natiuretic Peptides • BNP • Brain natriuretic peptide (BNP), now known as B-type natriuretic peptide(also BNP) or GC-B, is a 32 amino acid polypeptide secreted by the ventricles of the heart in response to excessive stretching of heart muscle cells |
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Cardiomyopathy
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Disease of the heart Muscle • Types: – Hypertrophic – Dilated – Restrictive • Due to – Ischemia – Genetic problems – Systemic Disease |
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Hypertrophic Cardiomyopathy
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Genetic – autosomal dominant • Clinical expression occurs during periods of rapid growth • Unexplained LVH - often thickened septum • pathology – myocyte disarray and fiberous tissue • Symptoms: – Syncope – Palpitations – Sudden death • Treatment – Surgery if considerable outflow obstruction |
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Dilated Cardiomyopathy
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Ventricular dilatation and impaired contraction • Left or right ventricles • Develops as a result of infection, toxins, cardiac problems or systemic problems – ETOH – Chemotherapy- Adriamycin – Cocaine • Symptoms – Atypical chest pain – Decompensation |
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Restrictive Cardiomyopathy
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Walls of the ventricle become stiff but not necessarily thickened • Ventricles cannot fill adequately during diastole • May have genetic component • Usually associated with medical problems that affect many systems such as amyloidosis or sarcoidosis |
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Second Degree Heart block - Mobitz 1 or Wenkebach
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Mobitz I heart block is characterized by progressive prolongation of the PR interval on the (EKG) on consecutive beats followed by a blocked P wave (i.e. a 'dropped' QRS complex). After the dropped QRS complex, the PR interval resets and the cycle repeats
• Disease of the AV |
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Second Degree Heart block Mobitz 2
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is almost always a disease of the distal conduction system • is characterized on a ECG by intermittently nonconducted P waves not preceded by PR prolongation and not followed by PR shortening • Can lead to complete heart block |
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Third Degree Heart Block
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Impulse from the SA node does not go to the ventricle • Low heart rate as the ventricle starts it’s own impulse • Due to ischemia • Pacemaker |
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Junctional Rhythm
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AV note sends impulse in retrograde fashion • 40 to 60 beats per minute • Noted in younger people with increased vagal tone |
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Ventricular Fibrillation
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Poor conduction • Cardiac Emergency as circulation will stop • Treatment with defibrillation – patients at high risk will get an implantable defibrillator |
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Aortic Stenosis
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1% of the population are born with Bicuspid aortic valve- 1/3 of which becomes stenotic • Can occur in tricuspid aortic valves • Progression of symptoms: • Angina Syncope Heart Failure • Physiologically: Increased LV pressure and LVH and decreased CO • Low oxygen, low cerebral perfusion, decreased contractility • Systolic Ejection Murmur in the aortic area |
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Treatment of Aortic Stenosis
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With symptoms- 3 year mortality rate is 75% • Aortic Valve Replacement animal, mechanical , human or pulmonary valve • Balloon valvotomy may provide short term relief of aortic stenosis |
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Mitral Regurgitation
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Caused by abnormality in the structures of the valve • Most commonly Mitral Valve Prolapse them Myocardial ischemia • Causes LV dysfunction and heart failure • Holosystolic Murmur which radiated towards the axilla • Treatment goal is to increase cardiac output with vasodilators then consider repair or replacement |
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Mitral Valve Prolapse
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One or more leaflets prolapse into the atrium • Most people asymptomatic but may have palpitations, syncope, and chest pain • Midsystolic click and late systolic murmur. • Dx: echocardiogram • 10% of people develop endocarditis, stroke, and Mitral regurgitation |
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Peripheral Vascular Disease
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Progression from no symptoms to Claudication to Ischemia • 90% have associated CAD • Higher risk in diabetics |
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Negative Pressure
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Vaccuum - Pressure that is less than atmospheric
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