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127 Cards in this Set
- Front
- Back
Describe Auto-graft |
A valve self-transplant |
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Describe Homograft & AKA |
AKA Allograft Transfer from one human to another |
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Describe Heterograft & AKA |
Xenograft Transfer from animal to human |
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Describe Porcine bioprosthetic valve |
Pig's AoV used for MV replacement |
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Describe Bovine bioprosthetic valve |
Cow's Parietal Pericardium for AoV replacement |
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MC Autograft bioprosthetic valve procedure performed |
Ross procedure |
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Describe the Ross Procedure |
Patient's own PV used for AoV |
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Complications of Bioprosthetic valves |
Calcs/degeneration Dehiscence Regurg/leaks Stenosis Infective Endocarditis |
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S/P cardiac surgery septal motion should be _____ |
Paradoxical |
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First type of mechanical valve used |
Ball & cage **Starr-Edwards |
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90% of mech valves used today are _____ |
Bileaflet Tilting Disc **St. Jude leading manufac |
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MC dysfunction of mechanical valves |
Thrombus Formation |
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Mechanical Valve Malfunctions |
Thrombus/Abscess Formation Structural changes- variance Endocarditis- Incr risk b/c foreign Regurg/perivalv leak Dehiscence |
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Doppler of Prosthetic Valves |
Mildly stenotic by nature Peak Vel > 2.5 m/sec is ABNORM |
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Prosthetic valve MVA Abnormal when PHT is _____ MVA is ____ |
PHT > 180 msec MVA < 1.8 cm2 |
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Auscultation of "Honking" murmur |
Post TAVR |
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Valve transplant from one human to another: A) Autograft B) Allograft C) Xenograft D) Heterograft |
B) Allograft *ALL the same |
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The Ross Procedure is an example of A) Autograft B) Allograft C) Xenograft D) Heterograft |
A) Autograft PV to AoV |
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T/F: Bioprosthetic valves are subject to calcification and degeneration |
True |
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T/F: Mechanical valves are subject to calcification and degeneration
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False |
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T/F: Bioprosthetic valves are subject to dehiscence
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True |
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T/F: Mechanical valves are subject to dehiscence
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True |
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T/F: Bioprosthetic valves are subject to variance
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False *Dont change Shape |
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T/F: Mechanical valves are subject to variance
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True |
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MC type of mechanical valve used today |
Bi-leaflet tilting disc St Jude |
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Endocarditis can be defined as an invasion of : A) Micro-organism B) Vegetation C) Abscess |
A) Micro-organism |
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IV drug abusers w/ endocarditis will most likely present w/ A) IVS abscess B) Ant MV leaflet abcess C) MV veg D) TV veg |
D) TV Veg *RT heart valve d/t venous flow |
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Chamber enlargement d/t sig regurg indicates A) acute veg B) chronic veg |
B) chronic veg |
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T/F: Vegs w/ the worst prognosis (d/t embolization) are those < 1cm |
False |
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MC method to treat Endocarditis |
Antibiotics |
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The ___ is continuous w/ the endocardium at the base of the great vessels A) Tunica Adventitia B) Tunica Media C) Tunica intima D) all above E) None |
C) Tunica Intima (Endothelium) |
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Which carries GREATEST risk of endocarditis? A) Mechanical heart valve B) Bioprosthetic heart valve C) CAD D) Syphilis |
A) Mechanical heart valve |
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Which is best method to diagnose endocarditis? |
Blood test |
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Clinical S&S's of Endocarditis |
FUO + blood cultures New/worsening heart murmur January Lesions & Osler's Nodes |
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Describe Moderator Band |
A thick bundle of muscle of the RV |
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Describes the 'coumadin/warfarin ridge' |
Tissue separating the LAA & LUPV |
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Describe the epicardial fat pad List DDx & differentiate the 2 |
Located anteriorly- btw Epi & Myocardium appears anechoic DDx Loculated Effusion: btwn Epi & Parietal pericardium! |
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Describe eustachian valve |
A flap of membranous, endocardial tissue located at opening of the IVC & RA *More stiff than Chiari |
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Describe Thebesian valve |
Flap of endocardial tissue which guards the opening of the Coronary Sinus into the RA |
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Describe the Chiari Network |
A freely mobile, lace-like membrane Located in RA near orifice of coronary sinus |
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Describe Primary Tumors |
75% are benign |
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Describe Secondary Tumors |
More Common than primary tumors |
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MC benign tumor of adult pop |
Myxoma |
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MC benign tumor found in children |
Rhabdomyoma |
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MC location of Myxoma |
LA |
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MC location of attachment of Myxoma |
By a stalk to the IAS near the fossa ovalis |
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Auscultation of Myxoma |
Tumor "plop" |
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M-mode findings of Myxoma |
blunted E-point MV Reduced E-F slope |
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MC tumor of cardiac valves & valve apparatus |
Papilloma/papillary fibroelastoma |
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Describe Papilloma |
small, pedunculated benign tumor |
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Describe Lipoma |
Neoplasm of mature fat cells |
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MC location for Lipoma |
IAS |
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Describe Lipoma appearance |
"Dumbell" shaped IAS Thickening of IAS w/ sparing of fossa ovalis |
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Fibroma MC arises from : |
LV free wall or IVS |
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Describe Fibroma |
Does not invade the pericardium Isolated Slow growing Echogenic |
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Describe Rhabdomyoma |
Multiple tumors Assoc w/ tuberous sclerosis Found in RV walls |
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Describe Hemangioma |
Vascular tumors |
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MC primary malignant tumor of the heart |
Angiosarcoma |
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MC location of Angiosacroma |
RA |
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Describe Metastatic/ Secondary Tumors |
MC than primary Pericardial > myocardial |
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The Eustachian Valve in utero will direct bl into the ___ |
PFO |
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Chiari network will more likely be ___ as compared to the Eustachian valve |
Mobile or free floating |
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The Eustachian valve & chiari network are found in the |
RA |
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MC cardiac tumors are a) Primary & benign b) Primary & malignant c) Secondary & malignant d) Secondary & benign |
c) secondary & malignant |
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Myxoma is an example of a ___ tumor |
Primary & bengin |
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A myxoma will most often arise from the ___ |
Fossa Ovalis |
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The 2nd MC location of a myxoma to arise from is |
Pulm V |
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If a myxoma mimics MS, the MC presenting S&S will be : |
DOE |
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Akas for Mural Thrombi |
Layered, Laminated, sessile |
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MC location for Thrombi |
Apex |
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Aka for Mobile Thrombi |
Pedunculated |
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Describe the 2 layers of Pericardium |
Parietal- thick outer layer Visceral/Serous/Epicardium- inner layer |
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Normal amount of Pericardial fluid |
20 cc's |
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Define Acute Pericarditis |
Inflammation of pericardium Usually results in pericardial effusion |
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Complications of Acute Pericarditis |
Constrictive pericarditis Cardiac Tamponade Dressler's Syndrome |
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Describe Dressler's Syndrome |
Pericardial Effusion s/p MI surfaces 1 week - 3 months later |
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MC S&S of Acute Pericarditis |
Positional CP worse when pt is supine or swallows |
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Auscultation of Acute Pericarditis |
Pericardial friction rub Distant muffled heart sounds |
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EKG findings of Acute Pericarditis |
Low voltage QRS - loose electricity in fluid around heart |
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Describe best way to meas fluid in pericardial effusion |
PLAX - in Systole |
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Pericardial Effusion Severity Scale Norm: Physiologic: Mild: Mod: Sev: |
Norm: 15-50cc (20)
Physiologic: Only seen in systole <50cc Mild: Seen Post in Syst &Dyst, <1cm, <100cc Mod: Ant & Post in Syst &Dyst, <1cm, 100-500cc Sev: Ant & Post in Syst&Dyst, > 1cm, >500cc |
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References to help determine Pericardial vs Pleural effusion |
Desc Ao in PLAX Coronary sinus in A2C |
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Define Constrictive Pericarditis |
A fibrotic thickened & adherent pericardium -restricts diastolic filling of vents |
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MC Etiology of Constrictive Pericarditis in underdeveloped countries |
TB |
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MC Etiology in US |
Idiopathic |
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Auscultation of Constrictive Pericarditis |
Diastolic "knock" |
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Cath Lab findings of Constrictive Pericarditis |
"square root" sign Early diastolic dip: rapid filling Plateau: mid to late diastole where little vent vol expansion |
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2D findings of Constrictive Pericarditis |
No fluid "bound down" appearance of free walls Negative sniff test |
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T/F: A pt with acute pericarditis will always present on echo with fluid accumulation |
False |
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All of the following are referring to the serous pericardium EXCEPT: A. Epicardium B. Endocardium C. Visceral D. Inner Layer |
B. Endocardium |
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All of the following etiologies for Pericardial Effusions, EXCEPT: A. Pregnancy B. Hypertension C. Tuberculosis D. Trauma E. Aortic Dissection |
B. HTN (Causes LVH!) |
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All of the following can be used to differentiate a pericardial from a pleural effusion, EXCEPT: A. Descending aorta B. Coronary Sinus C. Parietal pericardium D. Visceral pericardium |
D. Visceral pericardium |
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Signs & symptoms of Acute Pericarditis include all of the following EXCEPT: A. Chest pain B. Fever & Chills C. Dyspnea D. Pericardial friction rub E. Hepatomegaly and peripheral edema |
E. Hepatomegaly and peripheral edema **Chronic S&S! |
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A mild Pericardial Effusion would be estimated at _____ ml: A. 20-50 B. <100 C. 300 D. >500 |
B. <100
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A mild Pericardial Effusion will be seen as a : A. Ant & Post anechoic area seen in syst & diast B. Post anechoic area seen in syst, not diast C. Post anechoic area seen in syst & diast |
C. Post anechoic area seen in syst & diast
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Heart sounds will be ___ in the presence of a large pericardial effusion. A. Diminished B. Intensified C. Unchanged |
A. Diminished
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If a pt has constrictive pericarditis, the majority of ventricular filling will occur in: A. Early diastole B. Mid diastole C. Late diastole *The above will be noted on the ____ via the 'square root sign' |
A. Early diastole
*Cardiac cath |
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Definition of cardiac tamponade |
Accumulation of pericardial fluid, usually RAPIDLY, which leads to increased intra-pericardial pressure |
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Increased intra-pericardial pressure causes: |
- Diastolic compression/collapse - Impaired diastolic filling - Incr resistance to venous return to heart - Decreased cardiac output (no bl to pump) - Decreased systemic BP - Changes w/ respiration |
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Describe what changes with respiration occur with cardiac tamponade |
- Transvalvular and venous flow velocities: IVRT - Pulsus Paradoxus - Ventricular cavity volume change |
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Common Etiologies of Caridac Tamponade |
MC: Malignant metastatic disease ideopathic or iatriogenic metabolic infectious inflammatory TB |
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Cardiac Tamponade S&S's |
Positional CP Beck's Triad ! dyspnea/ tachypnea cough/ hoarseness JVD/ hepatomegaly peripheral cyanosis/ cold extremities tachycardia |
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Describe Beck's Triad |
Hypotension Quiet heart sounds Increased venous pressure |
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* Rule of Thumb with Cardiac Tamponade! * |
Lt heart "decreases" with inspiration Rt heart "increases" with inspiration Lt heart "increases" with expiration Rt heart "decreases" with expiration |
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Cardiac Tamponade S&S's (con'd) :
Name & describe *Apply Rule of Thumb for Left heart |
Pulsus Paradoxus - decrease of >10mmHg in syst BP w/ inspiration Total Paradoxus - complete absence of pulse w/ inspiration (Systemic BP = Left heart!) |
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Cardiac Tamponade S&S's (con'd) :
Name & describe *Apply Rule of Thumb for Right heart |
Kussmaul's Sign - paradoxical rise in venous press w/ JVD upon inspiration *Suggests impaired filling of RV, incr blood backs up into venous system (normally JVD would fall with insp. to allow RV to expand in diastole) |
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EKG findings of Cardiac Tamponade |
Low Voltage: fluid absorbs electricity Electrical alternans: variation in QRS beat to beat |
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Auscultation of Cardiac Tamponade |
Diminished/ muffled heart sounds Pericardial friction rub |
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CXR of Cardiac Tamponade |
"Water bottle" shaped heart |
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2D Findings of Cardiac Tamponade |
- Pericardial Effusion - Swinging heart motion - RV early diastolic collapse - RA dimpling sign of pre-tamponade - Dilated IVC & HV's (Failed SNIFF test) |
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M-mode Findings of Cardiac Tamponade |
RV diastolic collapse - RVIDd = 7mm RV/LV volume changes w/ resp (Rule thumb- L decr w/ insp) Decreased MV E-F slope w/ insp (Rule thumb) |
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Treatment for Cardiac Tamponade |
MC = Pericariocentesis - needle aspiration Pericardial window Pericardiectomy |
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*Respiration Review* Inspiration |
Inspiration: Rule of Thumb! - Decreased intrathoracic pressure - Decreased pulm vasc impedance (dump into LA) - Decreased flow from lung into Lt heart - Increased venous return to Rt heart |
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*Respiration Review* Expiration |
Expiration: Rule of Thumb! - Increased intrathoracic pressure - Increased flow from lung into Lt heart - Decreased venous return to Rt heart |
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Doppler of Tamponade & CONSTRICTIVE PERICARDITIS!! |
PW Doppler used Sweep speed of 25 mm/sec -respiratory variations in transvalvular flow! *Rule of thumb Lt heart: MV, AoV, Pulm Vs decrease w/ insp Rt heart:TV, PV, Systemic Vs increase w/ insp |
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IVRT w/ Cardiac Tamponade & CONSTRICTIVE PERICARDITIS |
IVRT Prolonged w/ inspiration Shortened w/ expiration |
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Constrictive Peri Card vs RCM E/E' : Ausc: Velocity Variations: Diastolic ____: |
Constrictive Peri Card vs RCM E/E': CPC norm, RCM stage 3 DD Ausc: CPC pericardial knock RCM S3 present in early diast Velocity Variation only in CPC not RCM CPC diastolic reversal in HV's!! RCM diastolic MR/TR |
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All of the following may result from cardiac Tamponade EXCEPT: A. Decreased cardiac output B. Increased cardiac output C. Impaired diastolic filling D. Pulsus paradoxus |
B. Increased cardiac output
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The MC cause of cardiac tamponade is: A. Metabolic B. Infectious C. Congenital D. Malignant metastatic disease |
D. Malignant metastatic disease
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T/F: Acute pericarditis may cause cardiac tamponade |
True |
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Iatrogenic means A. No known cause B. Created surgically or accidentally, but we know what caused it C. Born in the atria |
B. Created surgically or accidentally, but we know what caused it
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Dysphagia means: A. Difficulty swallowing B. Difficulty eating C. Leaning forward to breath easy D. Hoaresness |
A. Difficulty swallowing
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'Alteration in QRS voltage from beat to beat' describes: A. Pulsus Paradoxus B. Kussmaul's sign C. Beck's Triad D. Electric alternans |
D. Electric alternans
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A patient with cardiac tamponade will most likely ___ the sniff test A. Pass B. Fail |
B. Fail
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The transvalvular velocity of the MV will ____ with inspiration when the pt has cardiac tamponade A. Decrease B. Increase C. Remain constant |
A. Decrease
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The transvalvular velocity of the MV will ____ with inspiration when the pt has RCM
A. Decrease B. Increase C. Remain constant |
C. Remain constant
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Diastolic reversal seen in the hepatic Vs is indicative for: A. RCM B. Constrictive pericarditis/cardiac tamponade |
B. Constrictive pericarditis/cardiac tamponade
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