Term
|
Definition
| the force against arterial walls |
|
|
Term
|
Definition
|
|
Term
| treatment of BP works to reduce these key factors |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Primary HTN reading Stage I |
|
Definition
|
|
Term
| Primary HTN reading Stage II |
|
Definition
|
|
Term
| Secondary HTN characteristics |
|
Definition
Abrupt Onset
Asymptomatic
End Organ Damage |
|
|
Term
| Malignant HTN Characteristics |
|
Definition
1% of all patients with HTN
Can be fatal
Symptoms include:
drowsiness, confusion, HA, nausea,
loss of vision, respiratory distress |
|
|
Term
| HTN in pregnancy with preeclampsia |
|
Definition
protein in urine, HAs, edema
toxemia
10% of Pregnancies
3rd tri
severe, sudden onset
low birth weight
fetus- eye or brain damage
mother- kidney damage, convulsion and coma |
|
|
Term
| HTN in pregnancy without preeclampsia |
|
Definition
before 16-20 weeks
older women
medication for treatment
can continue after pregnancy |
|
|
Term
|
Definition
"silent killer"
HA
Dizziness
Visual changes |
|
|
Term
|
Definition
Family history
Hypokalemia
Truncal obesity; moon face; hirsutism; bruising
Morbid obesity; nocturnal snoring
Renovascular Hypertension-Early onset; atherosclerosis; worsening renal function with ACE/ARB
Pheochromocytoma- Pallor; head pain; perspiration; paroxysmal hypertension/postural hypotension
Polycystic Kidney- Bilateral flank masses
Coarctation- Diminished pulses; rib notching; UE pulses greater than LE pulses (
Renal Parenchymal disease- Flank pain; dysuria; hematuria; anemia; volume overload; history RD
Drug Induced-NSAID’s; drug abuse; steroids; ETOH; contraceptives; decongestants;
Thyrotoxicosis-Excess thyroid hormone, tachycardia, goiter |
|
|
Term
|
Definition
| Unknown, but probably genetic or lifestyle causes. |
|
|
Term
| Cause of secondary hypertension |
|
Definition
| Uncontrolled essential hypertension resulting in end organ damage |
|
|
Term
| hypertensive risk factors |
|
Definition
Family history of hypertension
Tobacco
Alcohol
Dyslipidemia
Diabetes Mellitus
CAD
CVD
CHF
PVD
Renal Disease |
|
|
Term
| Roles of Race and Ethnicity in hypertension |
|
Definition
Increases with age
Age 65 > majority whites hypertensive
African Americans Develop Hypertension much earlier, most by age 55
Highest prevalence rates are in elderly African American women > 75%
After age 75 |
|
|
Term
| Lifestyle factors of hypertension |
|
Definition
Obesity
Dietary
Tobacco
Alcohol
Salt and Potassium intake
Physical Inactivity
STRESS |
|
|
Term
|
Definition
states with stroke mortality more than 10% above the national mean.
10 of the 11 states in the stroke belt are in the Southeastern United States |
|
|
Term
| risks of untreated hypertension |
|
Definition
Stroke
Cardiomegally
Cardiomyopathy
Heart Attack
Congestive heart failure
Cardiac Arrhythmia
Diabetes
Kidney Disease/Failure
Visual Changes
Sexual dysfunction |
|
|
Term
|
Definition
History
Physical Examination – BP, Fundoscopic, Cardiac, Pulses, Abdomen
Testing – urinalysis, creatnine, potassium, glucose, uric acid, calcium, lipid profile, EKG.
Treatment choice algorithm (Risk group A-C)
4 major |
|
|
Term
| The 4 major Objectives of the initial work-up |
|
Definition
Define severity of hypertension and identify target organ disease (if any)
Determine other risk factors for cardiovascular disease
Look for clues of secondary causes of hypertension
Confirm that hypertension is sustained |
|
|
Term
| Number of BP reading to be done before diagnosis of HTN |
|
Definition
at least 2
UNLESS Pressure > 180/112 --> Diagnosis made-->start treatment |
|
|
Term
| Cardiovascular risk ____ with increasing pressures |
|
Definition
|
|
Term
| Systolic pressure is a ____(better;worse) predictor of events than diastolic |
|
Definition
better
UNLESS < 50 yrs of age, then Diastolic is better |
|
|
Term
| _________ represents decreased arterial compliance and is an even better indicator of cardiovascular risk. |
|
Definition
|
|
Term
|
Definition
Pharmacologic therapy
HTN results from an altered hemodynamic relationship between cardiac output and total peripheral resistance and either or both may be elevated.
Antihypertensive agents can be characterized by their ability to lower cardiac output or total peripheral resistance.
Pick an agent based on the underlying hemodynamic abnormality |
|
|
Term
| major pharmacologic categories or classes |
|
Definition
Diuretics
Beta-Blockers
Central Acting Adrenergic Agents
Vasodialators
ACE Inhibitors
Alpha blockers
ARBs
CCBs |
|
|
Term
| treatment of resistant hypertension |
|
Definition
Add new drugs
Consider possible non-compliance
Look for secondary causes
Rule our renal artery stenosis (No ACE if present)
Refer to hypertension specialist/clinic |
|
|
Term
| Non-Pharmacologic therapy |
|
Definition
|
|
Term
| Drug treatment of hypertensive emergencies |
|
Definition
Nitroprusside
Nitroglycerin
Labetalol
Esmolol
Enalaprit |
|
|
Term
| Drugs shown to reduce morbidity and mortality |
|
Definition
| diuretics, beta blockers and ace inhibitors |
|
|
Term
| Beta blockers can induce ______in patients with chronic lung disease |
|
Definition
|
|
Term
| ____________ may worsen renal function, especially so if RA stenosis is present |
|
Definition
|
|
Term
| Thiazide diuretics are ineffective when serum creatnine > ________ |
|
Definition
|
|
Term
| Spirinolactone may induce ______________ |
|
Definition
|
|
Term
| Alpha blockers can induce _____hypotension in the elderly |
|
Definition
|
|
Term
| ACE Inhibitors and ARB’s are contraindicated in ___________ |
|
Definition
|
|
Term
| Abrupt cessation of Clonidine may lead to ________hypertension |
|
Definition
|
|
Term
| Beta Blockers CAN _____triglyceride levels and _____HDL cholesterol levels |
|
Definition
|
|
Term
|
Definition
Obesity
Hypertension
Hyperglycemia
Hypertriglyceridemia
Low HDL |
|
|
Term
| Sinus Arrhythmia _______ HR with inspiration |
|
Definition
|
|
Term
| Sinus Arrhythmia is common in these populations |
|
Definition
|
|
Term
|
Definition
1. Paroxysmal Supraventricular Tachycardia (PSVT)
2. Atrial Fibrillation
3. Atrial Flutter |
|
|
Term
| Sinus Arrythmias are due to |
|
Definition
| Reflex changes in vagal tone |
|
|
Term
|
Definition
|
|
Term
| Sinus bradycardia has HR of |
|
Definition
|
|
Term
| Sinus Bradycardia is common among |
|
Definition
|
|
Term
| In Sinus Bradycardia HR _______ with exercise or atropine |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Causes of Sinus Tachycardia |
|
Definition
| Fever, exercise, pain, anemia, shock, hyperthyroid etc |
|
|
Term
| Onset and termincation of Sinus Tachycardia |
|
Definition
|
|
Term
| If Sinus Tachycardia is higher than 160bpm |
|
Definition
| think other atrial arrhythmias |
|
|
Term
| Premature Atrial Beats (PAC’s)have an abnormal _-wave |
|
Definition
|
|
Term
| ________in HR usually makes PACs disappear |
|
Definition
|
|
Term
|
Definition
| Firing of atrial ectopic focus |
|
|
Term
| paroxysmal supraventricular tachycardia types |
|
Definition
|
|
Term
| Which type of paroxysmal supraventricular tachycardia is more commone |
|
Definition
|
|
Term
|
Definition
| - re-enters AV node;circular re-entry |
|
|
Term
|
Definition
| re-entry pattern somewhere other than the AV node-->more dangerous because there is no refractory period |
|
|
Term
| Signs and Symptoms of paroxysmal supraventricular tachycardia |
|
Definition
palpitations/CP/SOB
EKG-HR usually 160-220 bpm and regular |
|
|
Term
| Treatments of paroxysmal supraventricular tachycardia |
|
Definition
i. Mechanical measures: Valsalva, head b/t knees, cold water (baroreceptors reset), cough, carotid sinus massage (baroreceptors reset)
ii. Drugs: adenosine, Ca2+ blockers, B-blockers
iii. Cardioversion
iv. Ablation |
|
|
Term
| WPW (supraventricular tachycardia) has an additional wave called a |
|
Definition
| delta wave- occurs at beginning of QRS wave |
|
|
Term
| Treatment of supraventricular tachycardias |
|
Definition
| catheter ablation or drugs |
|
|
Term
|
Definition
| most common chronic arrythmia |
|
|
Term
| causes of atrial fibrillation |
|
Definition
| Valvular dz., CHF, HTN, hyperthyroid, CAD, “holiday heart”, pulm. dz., chest trauma, surgery |
|
|
Term
| Signs and Symptoms of atrial fibrillation |
|
Definition
palpitations, fatigue, irregularly irregular rhythm on exam
EKG-ALWAYS irregularly irregular rhythm;no P-waves |
|
|
Term
| treatment of hemodynamically stable atrial fibrillation |
|
Definition
| AV blocking agents or cardioversion (48 hr rule) - risk for embolism goes up because it will push it out. Put them on blood thinners and control heart rate. Fix it later |
|
|
Term
| treatment of hemodynamically unstable atrial fibrillation |
|
Definition
|
|
Term
| Long-term Management of A. fib |
|
Definition
Ventricular Rate control (drugs) & anticoagulation (Coumadin)
vs.
Restoring sinus rhythm (drugs/cardioversion) & antiarrhythmic drugs
Paroxysmal A. fib-needs anticoagulation |
|
|
Term
|
Definition
| REGULAR, really fast- conduction 4:1 or 3:1 P to QRS waves |
|
|
Term
|
Definition
250-350 bpm-regular rhythm-variable conduction
Sawtooth pattern |
|
|
Term
|
Definition
vii. Rate control
viii. Anticoagulation |
|
|
Term
| Ventricular Premature Beats |
|
Definition
Isolated beats from ventricular tissue-benign in healthy hearts
GOES AWAY WITH EXERCISE |
|
|
Term
|
Definition
| Every other regular beat is a PVC |
|
|
Term
|
Definition
|
|
Term
|
Definition
| 3 or more consecutive PVC’s-usu. 160-240 bpm |
|
|
Term
| Ventricular Tachycardia-->patients with |
|
Definition
Acute MI
Cardiomyopathy
Myocarditis |
|
|
Term
|
Definition
| less than 30 sec. and terminating spontaneously |
|
|
Term
| Treatment of Nonsustained V-tach |
|
Definition
| -treat with drugs (B-blockers) |
|
|
Term
| treatment of sustained V. tach with LV dysfunction (CHF) |
|
Definition
|
|
Term
| treatment of sustained V. tach with normal LV function |
|
Definition
| can try medical mgmt (B-blockers, amiodarone) |
|
|
Term
| What are the causes of V-fib |
|
Definition
| LVH, CHF, HCM, A.S., PPH, congenital heart dz, Brugada syndrome |
|
|
Term
|
Definition
|
|
Term
|
Definition
| rare inborn heart condition in which delayed repolarization of the heart following a heartbeat increases the risk of episodes of torsade de pointes |
|
|
Term
|
Definition
| TDP, a form of irregular heartbeat that originates from the ventricles |
|
|
Term
| long QT syndrome can lead to |
|
Definition
| palpitations, fainting and sudden death due to ventricular fibrillation. Episodes may be provoked by various stimuli, depending on the subtype of the condition |
|
|
Term
|
Definition
| Fibrosis of conduction system |
|
|
Term
| Sinus sick syndrome is most common in what population |
|
Definition
|
|
Term
| sick sinus syndrome symptoms |
|
Definition
| syncope, dizziness, palpitations |
|
|
Term
| sick sinus syndrome treatment |
|
Definition
|
|
Term
| Accelerated idioventricular rhythm |
|
Definition
| rhythm of ectopic ventricular origin, faster than the normal rate of the His-Purkinje system but slower than 100 beats per minute, without retrograde conduction to the atria |
|
|
Term
|
Definition
| PR interval > 0.21 sec ( a little prolonged) You watch it to see if it progresses further. No real treatment. |
|
|
Term
|
Definition
Mobitz Type I (Wenckebach)-PR interval progressively lengthens then drops a beat (drugs, ischemia, fibrosis etc.) P wave gets longer and longer and longer then drops.
Mobitz Type II-intermittently drop beats w/o PR interval lengthening (usu. organic dz) drop beat = no QRS, its gone, then picks back up.
Usually progress to 3rd degree, watch closely. Usually get pacemakers before it gets to 3rd degree. |
|
|
Term
|
Definition
complete dissociation b/t atria and ventricles-slow ventricular rate at around 45 bpm
i. Atria does its own thing, ventricle does its own thing. Won’t really see a P-wave because QRS overrides it.
ii. Need-pacemake
iii. AV (Heart) Block |
|
|
Term
| Intraventricular conduction |
|
Definition
| a delay in conduction of a ventricular impulse within the ventricles that does not correspond to either a right bundle branch block or a left bundle branch block. |
|
|
Term
|
Definition
| control of the atria by one pacemaker and of the ventricles by another, independent pacemaker |
|
|
Term
|
Definition
| (vasovagal, neurocardiogenic)-”faint”-common in young women in response to stress, pain, claustrophobia |
|
|
Term
|
Definition
| lying down, removing offending stimulus, fluids, supportive care |
|
|
Term
|
Definition
| Nausea, diaphoresis, tachycardia prior to fainting |
|
|
Term
| ORTHOSTATIC (POSTURAL) HYPOTENSION |
|
Definition
| elderly, DM, autonomic neuropathy, drugs (vasodilators, diuretics, B-blockers etc.), volume depletion |
|
|
Term
| ORTHOSTATIC (POSTURAL) HYPOTENSION signs |
|
Definition
| >20 mm Hg decline in BP upon standing |
|
|
Term
| ORTHOSTATIC (POSTURAL) HYPOTENSION treatment |
|
Definition
| gait training/stability, remove offending agents, volume repletion |
|
|
Term
|
Definition
usu. no prodrome so injury is common
Mechanical: A.S., pulm. stenosis, HCM, congenital heart dz |
|
|
Term
| CARDIOGENIC SYNCOPE Signs |
|
Definition
| Arrhythmic: sick sinus, AV block, SVT, V. tach |
|
|
Term
| CARDIOGENIC SYNCOPE Treatment |
|
Definition
| fix/treat underlying problem |
|
|
Term
| Questions to ask about Arrythmias |
|
Definition
a.Slow or fast? Rate helps diagnose
b.If fast, how fast?
c.Regular or irregular?
d.Narrow (atrial) or wide (ventricular) complex?
e.Symptomatic? |
|
|
Term
|
Definition
1. Change in alertness
2. Gripping chest or throat
3. Palor or Cyanosis
4. Labored breathing
5. Sweating
6. Apnea/No pulse |
|
|
Term
|
Definition
1. Chest pain
2. Shortness of breath
3. Weakness and feeling lightheaded
4. Nausea and vomiting
5. Pain, numbness, and swelling in the feet and ankles, abdomen
6. Pale skin with or without sweating
7. Wet cough
8. Indigestion
9. Anxiety and restlessness
10. Backache
11. Difficulty feeding and poor weight gain in infants
12. Erectile dysfunction
13. Fatigue
14. Activity intolerance
15. PND
16. Orthopnea
17. Change in level of consciousness or alertness
18. Fatigue or activity intolerance
19. Extreme sweating and clammy, pale skin |
|
|
Term
| Ventricle dilation and hypertrophy |
|
Definition
i. Reduced pumping efficiency
ii. Heart Failure
iii. Development of arrhythmias, blood clots, reduced exercise capacity, shortness of breath, fainting, fatigue |
|
|
Term
|
Definition
| Hypertrophic Cardiomyopathy |
|
|
Term
| Cardiomyopathy Acquired (causes) |
|
Definition
| Inflammatory, peripartum, Viral Infections, Sarcoidosis |
|
|
Term
| Cardiomyopathy toxin (causes) |
|
Definition
| Drugs, Alcohol, Heavy Metals, Chemotherapeutic agents |
|
|
Term
| Cardiomyopathy Endocrine Disorders (causes) |
|
Definition
| Diabetes, Thyroid Disease |
|
|
Term
| Cardiomyopathy Autoimmune Disorders (causes) |
|
Definition
|
|
Term
| Cardiomyopathy Nutritional Deficiencies (causes) |
|
Definition
|
|
Term
|
Definition
Genetic
Acquired
Toxins
Endocrine Disorders
Autoimmune Disorders
Nutritional Deficiencies |
|
|
Term
|
Definition
puts pressure on the heart, causing poor heart function. If left untreated, pericardial effusion can cause heart failure or death
Pericardial effusion may be related to inflammation of the pericardium that's caused by disease or injury
pericardial effusion can also occur without inflammation.
Pericardial effusion can be caused by the accumulation of blood after a surgical procedure or injury |
|
|
Term
|
Definition
| Heart loses its ability to blood to body |
|
|
Term
|
Definition
1. Shortness of breath
2. Chest pain
3. Syncope
4. Reduced exercise tolerance
5. Orthopnea/Paroxysmal Nocturnal Dyspnea
6. Extremity or Abdominal edema
7. Blood clots |
|
|
Term
| Dyspnea is associated with what diseases |
|
Definition
| Orthopnea, Paroxysmal nocturnal dyspnea, decreased LV function causing increased LA pressure transmitted through the pulmonary veins leading to venous congestion |
|
|
Term
| Chest Pain is associated with what conditions |
|
Definition
| Pericarditis, Aortic dissection, Pulmonary Emboli, MI |
|
|
Term
| Palpitations are associated with what conditions |
|
Definition
|
|
Term
| Syncope is associated with what conditions |
|
Definition
| Acute MI, Valvular disease, Hypertrophic obstructive cardiomyopathy, Arrhythmias, Reflex vasodilatation or bradycardia, Acute pulmonary embolism, Hypovolemia |
|
|
Term
| Edema is associated with what conditions |
|
Definition
Increase LV pressure leads to pulmonary edema
increased RV pressure leads to peripheral edema |
|
|
Term
| Cyanosis is associated with what conditions |
|
Definition
| : left heart shunting as caused by a structural abnormality (ASD or VSD), pulmonary parenchymal disease or vascular disease (COPD, PE, pulmonary AV fistula), vasoconstriction due to decreased cardiac output |
|
|
Term
| Fatigue is associated with what conditions |
|
Definition
| nonspecific symptom of cardiac disease; by poor cardiac output or even medical therapy |
|
|
Term
| elements of a general screening cardiovascular physical examination |
|
Definition
a. Fundoscopic
b. Jugular Venous pressures
c. Carotid Auscultate
d. Arterial Pressure
e. Precordium
f. Auscultation of the chest
g. Abdominal Exam
h. Pulses
i. Diagnostic testing |
|
|
Term
| CV disease diagnostic tests |
|
Definition
Blood Work
CT
MUGA
Nuclear Cardiology
Cardiac Cath
Echocardiogram
Stress Tests
EKG
MRI
U/S |
|
|
Term
| risk factors for coronary artery disease |
|
Definition
a. Diabetes (DM)
b. Hypertension (HTN)
c. Hyperlipidemia
d. Male sex, + FH of CAD, age, obesity, smoking, sedentary lifestyle, poor diet
e. CAD is a disease of risk factors
f. Metabolic Syndrome
g. C-Reactive Protein (CRP)
h. Myocardial hybernation
i. Angina |
|
|
Term
| chronic stable angina pectoris symptoms |
|
Definition
• Circumstances-consistently reproducible, relieved with NTG/rest
• Characteristics-typical pain pattern
• Location/Radiation-often L shoulder/upper arm |
|
|
Term
| chronic stable angina pectoris signs |
|
Definition
| HTN, murmur, signs of other diseases |
|
|
Term
| chronic stable angina pectoris EKG at rest |
|
Definition
|
|
Term
| chronic stable angina pectoris EKG on exertion |
|
Definition
| ST-segment depression, T wave flattening/inversion |
|
|
Term
| What are differential diagnoses for Chest Pain |
|
Definition
GERD
Pneumonia
PE
Pneumothorax
Costochondritis
Pericarditis
Aortic Dissection |
|
|
Term
| Treatment of Stable Angina |
|
Definition
1. Nitrates (vasodilators)
2. Beta-blockers-decrease mortality
3. Calcium channel blockers-anti-anginal properties
4. Anti-platelet agents (ASA, Plavix)
5. Revascularization-stenting vs. CABG |
|
|
Term
|
Definition
| a classification encompassing clinical presentations ranging from unstable angina through non, sometimes also including Q wave infarction. |
|
|
Term
|
Definition
| normal or diseased arteries-triggered by cold, emotional stress, vasoconstricting meds (Cocaine) |
|
|
Term
| Prinzmetal angina (syndrome “X”) |
|
Definition
| women < 50 yo without usual risk factors, often early am sx. which awaken pt. from sleep, can have arrhythmias and conduction defects, |
|
|
Term
|
Definition
| EKG = ST segment elevation |
|
|
Term
| Prinzmetal angina treatment |
|
Definition
| treat with nitrates and Ca2+ channel blockers |
|
|
Term
|
Definition
| ST-segment depression, T wave flattening/ inversion |
|
|
Term
|
Definition
• Anticoagulation/anti-platelet therapy-ASA, Plavix, LMWH etc.
• Nitrates-vasodilators
• Beta-blockers-decrease mortality-decrease sympathetic activity
1. Control sympathetic surge (Epi/NE)
2. Post op arrhythmia risk
• Statins-anti-inflammatory properties
• Coronary angiography |
|
|
Term
|
Definition
• CK-MB-serial enzymes (positive enzymes) MB fraction
1. Serial enzymes-draw more than once because there is a lag time between onset of symptoms every 6-8 hrs for 3 sets (24 hrs)
• Troponin-very sensitive and specific (+ for 5-7 days)-may not be elevated early-careful with renal insufficiency
1. Can be elevated superficially in renal insuffiency |
|
|
Term
|
Definition
o pain at rest,
o often in early am-sweaty,
o apprehensive,
o N/V,
o dyspnea,
o sudden death and
o ventricular arrhythmias more common-can have painless infarction (DM, women, elderly) |
|
|
Term
|
Definition
| anxious, diaphoretic, resp. distress, CHF |
|
|
Term
|
Definition
|
|
Term
|
Definition
| ST-segment elevation which can progress to Q waves (Q-wave vs. non-Q-wave MI) |
|
|
Term
|
Definition
o Anti-platelet therapy
o Analgesia-morphine (also a vasodilator), morphine is helpful in acute MI
o Beta-blockers-careful with bradycardia or shock, DECREASE HR
o Nitrates
o ACE inhibitors-decrease remodeling, really good for post MI, in response to Hypoxia
o Coronary angiography, thrombolytics |
|
|
Term
| complications of acute myocardial infarction |
|
Definition
o Postinfarction ischemia
• Myocardial Dysfunction
• RV infarction
• Mechanical defects-papillary muscle or IV septum rupture
• Myocardial rupture-LV free wall
• LV aneurysm
• Pericarditis-Dressler syndrome
• Mural thrombus-large anterior infarcts-arterial emboli |
|
|
Term
| post-infarction management |
|
Definition
Statins
Beta-blockers-reduce sudden death
Antiplatelet therapy (ASA, Plavix, warfarin, aspirin)
ACE inhibitors/ARB’s-prevents cardiac remodeling esp. with LV dysfunction/CHF
Cardiac rehab/exercise programs |
|
|
Term
| Signs and Symptoms of Right sided HF |
|
Definition
1. Marked JVD
2. Clear chest
3. Hypotension
4. Marked peripheral edema
5. Ascites, hepatomegaly
6. Poor exercise tolerance |
|
|
Term
| Treatment of Right Sided HF |
|
Definition
1. Often will be on Lasix, Digoxin,
2. Have chronic pump failure |
|
|
Term
| Signs and Symptoms of left-sided HF |
|
Definition
Severe apprehension, agitation, confusion
Pulmonary congestion
Jugular Venous Distention
Level of Conciousness
Chest Pain
Diaphoresis
Cyanosis |
|
|
Term
|
Definition
Severe apprehension, agitation, confusion
Pulmonary congestion
Jugular Venous Distention |
|
|
Term
|
Definition
i. Kerley’s lines : A and B fluid infiltrating between lobes
ii. Pulmonary Edema
iii. Cephalization
iv. Pleural Effusions (bilateral)
v. Cardiomegaly – bigger than half chest cavity |
|
|
Term
|
Definition
i. Can have weird heart rhythms
ii. Left atrial enlargement
iii. Arrhythmias
iv. Hypertrophy (left or right)
v. Types of rhythms |
|
|
Term
|
Definition
i. Heart Sounds noted with CHF (sometimes)
ii. Systolic Murmurs
1. Mitral Regurg
2. Aortic Stenosis
iii. Diastolic Murmurs
1. Mitral Stenosis
2. Aortic Insufficiency
iv. S3: Rapid filling of a diseased ventricle, ken-tuc-kee
v. S4: valves flapping ten-ess-ee |
|
|
Term
|
Definition
i. Chemistry
1. Renal Function: Be Wary
ii. BNP > 5000 is CHF (if neg BNP, not CHF)
1. Used in ER departments the world over
2. Good negative correlation
3. Need baseline for positivity
4. Pulmonary versus cardiac dyspnea |
|
|
Term
|
Definition
ii. Vasodilators—ACE inhibitors
iii. Diuretic agents
iv. Inotropic agents
v. CCB
vi. BB |
|
|
Term
|
Definition
1. Pulmonary congestion (left heart failure)
dyspnea (rest, exertional, nocturnal), orthopnea
2. Systemic congestion (right heart failure)
edema, nausea, abdominal pain, nocturia
3. Low cardiac output
4. Hypotension, tachycardia, tachypnea
5. Fatigue and weakness |
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Term
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Definition
1. CXR (enlarged heart, CHF)
2. Electrocardiogram (tachycardia, A-V block, LBBB, NSSTT changes, PVC’s)
3. 24-hour Holter monitor
a. if lightheadedness, palpitation, syncope
4. Echocardiogram (left ventricular dilation, global hypokinesis, low EF)
5. Myocardial biopsy, rare
6. Cardiac catheterization (R/O CAD) |
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Term
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Definition
1. shortness of breath upon exertion
2. sudden respiratory distress after sleep
3. difficulty breathing, except when sitting upright
4. coughing |
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Term
| Pulmonary Edema Diagnosis |
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Definition
1. Rapid pulse, rapid breathing, abnormal breath and heart sounds, and enlarged neck veins.
2. Chest x ray is often used to confirm the diagnosis.
3. Arterial blood gas testing may be done.
4. Sometimes pulmonary artery catheterization is performed to confirm that the patient has pulmonary edema and not a disease with similar symptoms |
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Term
| Pulmonary Edema Treatment |
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Definition
1. Placing the patient in a sitting position,
2. Oxygen
3. Assisted or mechanical ventilation (in some cases)
4. Drug therapy
5. The goal of treatment is to reduce the amount of fluid in the lungs, improve gas exchange and heart function, and, where possible, to correct the underlying disease. |
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Term
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Definition
| Cardiac disease, but no symptoms and no limitation in ordinary physical activity, e.g. shortness of breath when walking, climbing stairs etc |
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Term
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Definition
| Mild symptoms (mild shortness of breath and/or angina) and slight limitation during ordinary activity. |
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Term
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Definition
| Marked limitation in activity due to symptoms, even during less-than-ordinary activity, e.g. walking short distances (20–100 m).Comfortable only at rest. |
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Term
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Definition
| Severe limitations. Experiences symptoms even while at rest. Mostly bedbound patients. |
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Term
| AHA/ACC Heart Failure Stage A |
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Definition
| People at high risk for developing heart failure but who do not have heart failure or damage to the heart |
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Term
| AHA/ACC Heart Failure Stage B |
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Definition
| People with damage to the heart but who have never had symptoms of heart failure; for example, those who have had heart attack |
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Term
| AHA/ACC Heart Failure Stage C |
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Definition
| People with heart failure symptoms caused by damage to the heart, including shortness of breath, tiredness, inability to exercise |
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Term
| AHA/ACC Heart Failure Stage D |
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Definition
| People who have advanced heart failure and severe symptoms difficult to manage with standard treatment |
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Term
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Definition
| Ventricular dilation, hypokinetic left ventricle, and systolic dysfunction |
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Term
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Definition
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Term
| Most common of the cardiomyopathies |
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Definition
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Term
| Hypertrophic cardiomyopathy |
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Definition
| i. Genetic disease characterized by hypertrophy of the left ventricle with marked variable clinical manifestations morphologic and hemodynamic abnormalities |
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Term
| Hypertrophic cardiomyopathy without Obstruction |
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Definition
Exessive thickening of the muscle
Hypertrophy is usually greatest in the septum.
left ventricle is almost always affected |
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Term
| Hypertrophic cardiomyopathy with Obstruction |
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Definition
| Asymmetric septal hypertrophy with obstruction to the outflow of blood from the heart may occur |
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Term
| Restrictive Cardiomyopathy |
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Definition
Abnormal diastolic function
Rigid ventricular wall with impaired ventricular filling
Bear some functional resemblance to constrictive pericarditis
Importance lies in its differentiation from operable constrictive pericarditis |
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Term
| Restricive Cardiomyopathy Classifications |
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Definition
Idiopathic
Myocardial
Noninfiltrative
Endomyocardial |
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Term
| Restricive Cardiomyopathy Signs and Symptoms |
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Definition
| Symptoms of right and left heart failure |
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Term
| Dialated Cardiomyopathy Diagnosis |
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Definition
1. CXR (enlarged heart, CHF)
2. Electrocardiogram (tachycardia, A-V block, LBBB, NSSTT changes, PVC’s)
3. 24-hour Holter monitor
a. if lightheadedness, palpitation, syncope
4. Echocardiogram (left ventricular dilation, global hypokinesis, low EF(below 35%))
5. Myocardial biopsy, rare
6. Cardiac catheterization (R/O CAD) |
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Term
| Dialated Cardiomyopathy Treatment |
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Definition
1. Limit activity based on functional status
2. Salt restriction
3. Fluid restriction
4. Initiate medical therapy
5. Cardiac transplantation
6. Left Ventricular Reduction Procedures |
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Term
| Hypertrophic Cardiomyopathy Diagnosis |
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Definition
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Term
| Hypertrophic Cardiomyopathy Treatment |
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Definition
1. Beta-adrenergic blockers (atenolol, toprol, sotalol, tenormin etc)
2. Calcium channel blockers (norvasc, cardizem, etc)
3. Anti-arrhythmics – Amiodarone, norpace
4. Pacemakers (ICD)
5. Myomectomy (resection of septum)
6. Alcohol septal ablation (controlled MI through septal perforator perfusing basal septum) -->wall thinning-->decreases in LVOTO
7. Transplantation |
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Term
| Restrictive Cardiomyopathy Diagnosis |
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Definition
Symptoms of right and left heart failure
Jugular Venous Pulse
Echo-Doppler
Abnormal mitral inflow pattern
Prominent E wave (rapid diastolic
filling)
Reduced deceleration time (increased LA
pressure) |
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Term
| Restrictive Cardiomyopathy Treatment |
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Definition
i. No satisfactory medical therapy
ii. Drug therapy must be used with caution
1. Diuretics for extremely high filling pressures
2. Vasodilators may decrease filling pressure
3. (?) Calcium channel blockers to improve diastolic compliance
4. Digitalis and other inotropic agents are not indicated |
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Term
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Definition
a. Retrosternal Chest Pain
b. Cough
c. Dyspnea
d. Fatigue
e. Sputum production |
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Term
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Definition
1. Tachycardia
2. Cyanosis
3. Finger Clubbing
4. Accentuated right ventricle precordial thrust
5. Along left sternal border
6. Accentuated and Split pulmonic heart sound (P2)
7. Right sided S4 Heart Sound
8. Right Sided Heart Failure signs
9. Kussmaul's Sign
10. Distention of jugular neck veins on inspiration
11. Pulsus Paradoxus
12. Exaggerated fall in Blood Pressure on inspiration
13. Jugular Vein Distention
14. Hepatomegaly with Ascites
15. Pedal edema |
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Term
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Definition
a. Mitral Stenosis
b. Left to right cardiac shunts |
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Term
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Definition
• Enlarged pulmonary artery
• Dilated right ventricle
• Primary Pulmonary Hypertension signs
• Tapering of pulmonary artery branches |
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Term
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Definition
| • Evaluate suspected recurrent Pulmonary Embolism |
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Term
| Idiopathic Pulmonary Hypertension |
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Definition
| is a progressive condition that affects the heart and lungs. |
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Term
| Idiopathic Pulmonary Hypertension Symptoms |
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Definition
ii. Dyspnea (60% of patients)
iii. Weakness (19%)
iv. Recurrent syncope (13%)
v. Women are more likely to be symptomatic than men. |
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Term
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Definition
| Often described as more of a sharp, stabbing pain in, often lasts for hours, positional |
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Term
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Definition
| Knifelike, excruciating chest pain more common in– tearing pain |
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Term
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Definition
| sharp, pleuritic chest pain, worse with inspiration, cough |
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Term
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Definition
| sharp, worse with inspiration, cough, movement(rule out others) |
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Term
| Esophagitis/gastritis pain |
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Definition
| Dull, retrostrenal, may be positionalor associated with eating |
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Term
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Definition
| Pain associated with rash |
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Term
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Definition
| an uncomfortable, heightened awareness of breathing frequently experienced during exertion, although can be experienced at rest in severe cardiac disease |
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Term
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Definition
| inability to breath while supine– need an extra pillow or two |
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Term
| Paroxysmal nocturnal dyspnea |
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Definition
| premature reawakening due to dyspnea |
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Term
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Definition
| decreased LV function causing increased LA pressure transmitted through the pulmonary veins leading to venous congestion |
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Term
| what Venous congestion lead to |
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Definition
| exudation of the fluid into the alveolar space leading to decreased gas exchange |
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Term
| In cardiac patients dyspnea can be an ______ __________ |
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Definition
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Term
| what is an anginal equivalent |
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Definition
| a symptom other than typical anginal type chest pain, with the same cause |
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Term
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Definition
| the subjective sensation of the heart beating |
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Term
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Definition
| is the transient loss of consciousness resulting from inadequate cerebral blood flow |
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Term
| cardiac disease edema is the result of ______________________ |
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Definition
| increased venous pressure |
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Term
| _______LV pressure leads to pulmonary edema and ________ RV pressure leads to peripheral edema |
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Definition
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Term
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Definition
| the unusual bluish discoloration of the skin |
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Term
| Cyanosis is a reflection of |
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Definition
| decreased arterial oxygenation (lower than 85%) |
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Term
| Central cyanosis often results from |
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Definition
from right to left heart shunting as caused by a structural abnormality (ASD or VSD)
pulmonary parenchymal disease or vascular disease (COPD, PE, pulmonary AV fistula) |
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Term
| Peripheral cyanosis may be a result of |
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Definition
| systemic vasoconstriction due to decreased cardiac output |
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Term
| Localized peripheral cyanosis may be a result of |
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Definition
| venous or arterial occlusive or vasospastic disease (thrombotic, embolic, Raynauds) |
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Term
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Definition
| poor cardiac output or even medical therapy |
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Term
| Fatigue may be the only symptom of cardiac disease in |
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Definition
| in atypical populations, dementia, stoic individuals |
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Term
| Ventricle dilation and hypertrophy can cause |
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Definition
Reduced pumping efficiency
Heart Failure
Development of arrhythmias, blood clots, reduced exercise capacity, shortness of breath, fainting, fatigue |
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Term
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Definition
loss of heart muscle contractility,
valvular dysfunction,
fluid overload,
hyperdynamic state |
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