Term
ST elevation + elevated enzymes + chest pain
What do you do? |
|
Definition
| send them to the cath lab |
|
|
Term
| Trace the electrical conduction through the heart |
|
Definition
SA node --> AV node --> bundle of his --> fascicles --> purkinje fibers
|
|
|
Term
Which part of the EKG represents ventricular depolarization?
Which part represents atrial depolarization?
Which part represents ventricular repolarization? |
|
Definition
QRS - ventricular depolarization
P wave - atrial depolarization
T - ventricular repolarization |
|
|
Term
| Collection of cells that are able to depolarize spontaneously over and over at a particular rate to create their own action potential. They undergo spontaneous depolarization in phase 4 called ____ until threshold is reached, triggering an AP. |
|
Definition
| pacemaker cells, automaticity |
|
|
Term
| Heart rate is based on what 3 things? |
|
Definition
sympathetic stimulation
vagal stimulation
body's demand for increased CO
(also thyroid) |
|
|
Term
| on EKG, 2 sec is represented by ___ large boxes |
|
Definition
|
|
Term
| What is a normal QT interval? |
|
Definition
| less than half the RR interval |
|
|
Term
| When can a QT interval that is <1/2 be bad? |
|
Definition
| in a pt who's hr is slow bc QT interval is heart-rate dependent |
|
|
Term
EKG leads:
___ leads measure the electrical potential between two different points on the body. Which leads do these include?
___ leads measure one point on the body and a virtual reference point. Which leads do these include? |
|
Definition
bipolar - limb leads (I, II, and III)
unipolar (aVR, aVL, aVF, V1-V6) |
|
|
Term
|
Definition
an area of necrosis has no electrical forces moving throuhg it and the forces all move away from it, resulting in an abnormal Q wave. This necrosis can be permenant or reversible.
Abnormal Q waves are pathognomonic of transmural infarcation |
|
|
Term
| What is the difference between a transmural and subendocardial infarction? |
|
Definition
transmural - ischemia extends all the way through the wall of heart muscle
subendocardial - ischemia hasn't made it all the way through the wall but partially |
|
|
Term
What artery supplies the anterior wall and thus would be affected if leads __, ___, and ___ show infarct?
What artery supplies the inferior wall and thus would be affected if leads ___, ___, and ___ show infarct?
What artery supplies the lateral wall and thus would be affected if leads ___, ___ and ___ show infarct? |
|
Definition
LAD - anterior - leads V3, V4, I
RCA - inferior - II, III, aVF
Circumflex - lateral - aVR, aVL, V5, V6
|
|
|
Term
| If the anterior wall is infarcted, the ___ leads will show reciprocal changes, and vice cersa |
|
Definition
|
|
Term
Hyperkalemia changes on EKG
Less than 5.5
5.5-6.5
6.5-8
>8 |
|
Definition
<5.5 = normal
5.5-6.5 - peaked T waves
6.5-8 = big P waves, prolonged PR interval, widened QRS complex, deep S wave
>8 = sine wave then asystole |
|
|
Term
___ is a benign dysrhythmia in which a ventricular cell fires early and causes a beat that starts at the bottom of the heart. is often noticable by the pt.
___ is a benign dysrhythmia in which
both are frequent causes of palpitations in what population? |
|
Definition
PVC
PAC
palpitations in young pts without any other s/s of heart disease
no tx
frequency increases with fatigue, caffeine, stress/catecholamines, msg
|
|
|
Term
| How do you calculate hr on an ekg? |
|
Definition
1. Take the number of "big boxes" btwn neighboring QRS complexes and divide into 300. The result will be approximate hr. ONLY works with regular rhythms.
2. Count by # of big boxes down: 300, 150, 100, 75, 60, 50
3. For regular or irregular rhythms, count the # of beats on 1 pg and multiply by 6 because there are about 10 sec recorded per page. |
|
|
Term
____ are medications synthesized from foxglove and used to increase the efficiency of the heart and improve the contraction of the heart muscle.
It increases/decreases the heart rate by decreasing the conduction through the SA and AV nodes (negative inotropic effect) and increases/decreases the force of contraction of the cardiac muscle (positive inotropic effect). Should NOT be used for very active pts as it doesn't account for exercise
What diseases dose it treat?
What is an example of one of these drugs? |
|
Definition
cardiac glycosides/cardiotonics
decreases hr, increases contraction
CHF, A-fib, A flutter, PAT
digoxin (lanoxin) |
|
|
Term
| 3 categories of antianginal drugs. when would you use these drugs? |
|
Definition
calcium channel blockers
vasodilators
beta-adrenergic blockers
used in pts who cannot go to cath lab or have bipass due to other comorbidities.
|
|
|
Term
___ are drugs that dilate blood vessels by inhibiting movement of ca across cellular membranes. What are some examples?
in what condition are these contraindicated? |
|
Definition
ca channel blockers
Norvasc, varapamil
CHF |
|
|
Term
___ are drugs that relax smooth muscle in the heart which allows for dilation of the vessels and allow for more blood flow. They decrease preload, afterload, and myocardial O2 consumption.
example? |
|
Definition
|
|
Term
____ are drugs that decrease the activity of the sympathetic nervous system in certain tissues. It decreases the excitability of the heart, decreases cardiac workload, and O2 consumption and provides stabiliztion of dysrhythmias.
increases/decreases hr and increases/decreases force of contraction
What diseases are they used for?
what are some examples? |
|
Definition
beta blockers
decreases, decreases
HTN, arrythmias
coreg, betapace, lopressor, toprol xl, inderal |
|
|
Term
___ are drugs used to prevent and treat cardiac arrhythmias, control tachycardia, and angina such as Afib and ventricular tachycardia
MOA: slowing the rate of the impulse of conduction, depressing automaticity, increases resistance to premature stimulation |
|
Definition
|
|
Term
4 classes of antiarrhythmics:
I: membrane stabilizing effect. Quinidine, procainamid, norpace, lidocaine, tambocor, and rythmol. used to tx?
II: decrease myocardial tissue response to stimulus from epinephrine/NE, includes beta blockers. brevibloc, inderal, metoprolol. Used to tx?
III: prolongs repolarization and refractory period and increases refractory period for V fib. amiodarone, corvert, tikosyn. used for?
IV: calcium channel blockers which inhibit the movement of calcium across the cell membrane. verapamil, diltiazem, felodipine, nifedipine. used for? |
|
Definition
I - v-tach, PAT/flutter
II - ventricular arrhythmias, HTN, angina, MI
III - ventricular arrhythmias, conversion of Afib to NSR
IV - SVT, rapid ventricular rate in afib/flutter |
|
|
Term
____ are used to treat HTN, CHF, and to treat post MI
they work to increase blood flow to the renal system by decreasing vasocontriction/blocks production of angiotensin and lowers bp and blood volume. reduces afterload.
what is the #1 side effect? |
|
Definition
ACE inhibitors
ACE-I cough due to release of bradykinin. if pts have this, stop ACE inhibitor and start ARB or deal wtih cough |
|
|
Term
| Vasotec, monopril, prinivil, accupril are all examples of what kind of drug? |
|
Definition
|
|
Term
Cozaar, micardis, diovan, avapro, atacand are all ____ drugs.
They are similar MOA to ACE inhibitors but are more costly and have fewer side effects. |
|
Definition
| Angiotensin II receptor blockers (ARBs) |
|
|
Term
| ____ are drugs used to relieve chest pain. examples include? |
|
Definition
analgesics
nitroglycerin, morphine, NTG |
|
|
Term
___ are drugs that increase the secretion of H2O, wastes, and electrolytes from the body.
used in what dzs? |
|
Definition
diuretics
heart failure, fluid overload, HTN |
|
|
Term
Bumex, lasix, and demadex are all examples of what kind of drugs?
what is a side effect of these drugs? |
|
Definition
| loop diuretics - hypokalemia, so need to use potassium supplement |
|
|
Term
| aldactone is an example of what kind of drug? |
|
Definition
| potassium sparing diuretcs |
|
|
Term
| When might you use anticoagulants? |
|
Definition
a-fib
prevention of DVT
post MI
post stneting procedures |
|
|
Term
| examples of anticoagulants |
|
Definition
coumadin
heparin
lmw heparins |
|
|
Term
| What kind of drugs are activase (TPA) and streptokinase? when should they be used? |
|
Definition
thrombolytic drugs
used in first 6 hours after MI |
|
|
Term
| P2Y12 receptor inhibitors such as plavix are ____ agents used after MI or storke. Reopro is another one of these. |
|
Definition
|
|
Term
| ___ are used in combination wtih diet, exercise, and weight loss to treat elevated cholesterol and triglyceride |
|
Definition
| antihyperlipidemics (statins) - lipitor, zocor, crestor |
|
|
Term
| 4 drugs for life for all CAD pts |
|
Definition
beta blocker
ACEI or ARB
Statin
ASA |
|
|
Term
a condition in which the blood flow and thus oxygen is restricted to a part of the body
chest pain or discomfort when an area of the heart muscle does not receive enoguh oxygen rich blood |
|
Definition
|
|
Term
| 4 major areas of cardiovascular disease |
|
Definition
coronary heart disease - manifested by MI, angina, heart failure, and coronary death
cerebrovascular disease manifested by stroke and TIA
peripheral arterial disease manifested by intermittent claudication
aortic atherosclerosis and thoracic or abdominal aortic aneurysm |
|
|
Term
| ___ is the most common cause of heart failure |
|
Definition
|
|
Term
| Coronary atherosclerosis begins prior to age ___ |
|
Definition
|
|
Term
| atherosclerosis can be accelerated by identifiable risk factors |
|
Definition
overweight
htn
dyslipidemia
fhx
smoking
smoke exposure |
|
|
Term
| How does atherosclerosis occur? |
|
Definition
| injury to the endothelium by local disturbances of blood flow at angulated or branch points along with systemic risk factors perpetuates a series of events that culminate in the development of atherosclerotic plaque |
|
|
Term
| the earliest lesion of atherosclerosis, the ____ ,is common in children and is a pure inflammatory lesion, consisting only of monocyte-derived macrophages and t lymphs |
|
Definition
|
|
Term
Functions of healthy ___:
thrombo-resistant
produces relaxation and constriction factors that affect tone of underlying media and maintains arterial homeostasis
secretes plasminogen to lyse fibrin clots
regulates permeability |
|
Definition
|
|
Term
| What happens to damaged endothelium in atherosclerosis? |
|
Definition
increased permeability to lipoproteins
decreased NO production
increased leukocyte migration and adhesion
prothrombotic dominance
vascular growth stimulation due to vessels being clogged
vasoactive substance release |
|
|
Term
| 3 pathophysiological consequences of atherosclerosis |
|
Definition
internal elastic lamina is more permeable
atheroma - fatty streaks form
foam cells - macrophages that have scooped up LDL
fibrous cap forms |
|
|
Term
| ___ are macrophages that have scooped up LDL - seen in atherosclerosis |
|
Definition
|
|
Term
| infarction in this artery is called the "widow maker" |
|
Definition
|
|
Term
| ___ is the most significant contributor to plaque formation |
|
Definition
|
|
Term
| morning is the most common time to have MI because of increased ____ and ____ |
|
Definition
| catecholamines and cortisol |
|
|
Term
| Acute coronary syndrome has been shown to develop more often because of rupture and thrombosis of mild (<___%) coronary stenoses. These are called ___ plaques. |
|
Definition
|
|
Term
| ___ is the most common manifestation of coronary heart disease. |
|
Definition
| silent (asymptomatic) ischemia |
|
|
Term
| Pt under 40 who has MI and no significant family hx of early CAD... what behavior should you suspect them of? |
|
Definition
|
|
Term
what condition is diagnosed by a pt having at least three of the following?
fasting glucose >110 mg/dl
hypertension (>130/85
triglycerides > 150 mg/dl
HDL < 40 in mend and <50 in women
Abdominal obesity > 40 in in men and > 35 in women |
|
Definition
metabolic syndrome
these pts have 2x increased risk for CVD |
|
|
Term
| people with periodontal/gum disease are ____x as likely to have cad |
|
Definition
|
|
Term
| ___ is the strongest risk factor for development of CAD |
|
Definition
|
|
Term
__-__% stenosis show sx with heavy exertion
__-__% steonsis show sx wtih moderate/light exertion
__% stenosis show sx at rest |
|
Definition
|
|
Term
sx of ___ include:
angina that occurs at rest and lasts >20 min
new onset angina
increasing angina
sob
atypical sx such as arm, jaw, neck, ear, or stomach pain |
|
Definition
|
|
Term
| ____: is when a pt presents to you saying, "three years ago when i had my heart attack it felt just like this" |
|
Definition
|
|
Term
Which level of prevention?
1. relies on early detection of the dz procss and application of interventions to prevent progression of the disease or to limit disability
2. deals wtih delaying or preventing the onset of disease
3. focuses on recovery or rehabilitation after disease |
|
Definition
secondary
primary
tertiary |
|
|
Term
| 3 most significant modifiable factors in cad |
|
Definition
smoking
htn
hypercholesterolemia |
|
|
Term
| the ___ study demonstrated that nearly 90-95% of population-attributable risk of MI is related to 9 potentially modifiable risk factors |
|
Definition
|
|
Term
| ___ is the single most important preventative measure in CAD |
|
Definition
|
|
Term
| Lipid screening in men should start at age __ if they do not have risk factors. Age ___ in women |
|
Definition
|
|
Term
| what are chd equivalents? |
|
Definition
same risk as someone who's already had an MI
DM
sx CAD
PAD
AAA
multiple risk factors |
|
|
Term
|
Definition
diet and lifestyle cahnges to reduce ldl
statins
cholesterol absoprtion inhibitors
nicotinic acid
fibrates (wihtout statins)
bile acid sequestrants
omega-3-fish oi. |
|
|
Term
|
Definition
|
|
Term
| what drug should you never use in pts with very high triglycerides (> 1000 mg/dl)? |
|
Definition
| statins - could cause acute pancreatitis |
|
|
Term
What is the goal for toatl cholesterol?
LDL?
HDL?
Tgy? |
|
Definition
total: 100-200
LDL: <100
HDL: 40-60
tgy: <150 |
|
|
Term
| studies of vit E, c, homocysteine, and beta-carotene show ___ in heart disease risk? |
|
Definition
|
|
Term
| studies of Ca intake in the elderly show ___ risk of MI |
|
Definition
|
|
Term
| high/low CRP levels have been correlated with increased CAD risk |
|
Definition
|
|
Term
| pt presents with peripheral edema... what is the one thing you should definitely NOT give them? |
|
Definition
|
|
Term
| ___ is occlusive plaques calcification or inflammatory dz that develops within the peripheral arteries, vein, or lymphatics |
|
Definition
| peripheral vascular disease |
|
|
Term
| #1 sx of arteriosclerosis |
|
Definition
| intermittent claudication (cramping in legs when walking) |
|
|
Term
| Pt says they have to sleep with their feet hanging off the bed becasue they get such bad burning pain at night. Think what dz? |
|
Definition
|
|
Term
PE:
decreased peripheral pulses
dependent rubor
blanching of skin on elevation
no hair on toes
atrophic/shiny skin
ischemic ulcers/gangrene
cool skin on feet |
|
Definition
|
|
Term
| Pt presents with sudden pain or numbness in an extremity and they can tell you the exact minute it started happening.. think what? |
|
Definition
|
|
Term
| 35 y/o male that is heavy smoker presents with ulcerations at tips of fingers and toes... think what disease? |
|
Definition
| buerger's disease (thromboangiitis obliterans) |
|
|
Term
| uncontrolled high BP in a young person with no significant risk factors... think ? |
|
Definition
|
|
Term
| Pt presents with chest pain suggestive of ischemia... what 4 initial tests shoudl you get? |
|
Definition
EKG
cardiac enzymes
electrolytes/cbc/lipids/bun/creatinine/glucose/coags
CXR |
|
|
Term
| What emergent care should a pt receive with s/s of ischemia wtihint the first ten min? |
|
Definition
iv access
cardiac monitoring
oxygen
aspirin
nitrates |
|
|
Term
EKG assessment:
1. st elevation or new LBBB
2. ST depression or dynamic t wave inversions |
|
Definition
|
|
Term
| what diseases fall under the heading of "acute coronary syndromes" and why is this on the rise? |
|
Definition
unstable angina
STEMI
NSTEMI
on the rise due to aging population, increasing obesity and insulin resisitance, and improved survival following MI |
|
|
Term
| What is the main difference between unstable angina and NSTEMI? |
|
Definition
no diff in clinical presentaiton
NSTEMI will have elevated enzymes |
|
|
Term
|
Definition
| creatine kinase myocardial band - indicative of NSTEMI |
|
|
Term
| Pt presents wtih s/s of acute coronary syndrome but no elevated cardiac enzymes or EKG changes - what do you do? |
|
Definition
monitor in ER
repeat EKG and enzymes in 6-12 hours
|
|
|
Term
| What is the preferred tx for STEMI? |
|
Definition
|
|
Term
| Pt with STEMI but cath lab is not available... what do you do? |
|
Definition
| start TPA - thrombolytics |
|
|
Term
| if Q waves develop in a pt with MI, what does it mean? |
|
Definition
|
|
Term
| New LBBB is considered ___ until proven otherwise |
|
Definition
|
|
Term
| what class of drugs are streptokinase, reteplase, alteplase, and tenecteplase? |
|
Definition
| fibrinolytics - used for STEMI tx |
|
|
Term
| Absolute contraindications to fibrinolytic use in STEMI |
|
Definition
prior intracranial hemorrhage
known cerebral vascular lesion
known malignant intracranial neoplasm
ischemic stroke w/in 3 mos
suspected aortic dissection
active bleeding
significant clsoed head or facial trauma in last 3 mos |
|
|
Term
| most people who die of sudden cardiac death are in stages __-__ of heart failure. |
|
Definition
II-III
severe hf pts tend to die of pump failure
|
|
|
Term
| LV dysfunction is defined as cardiac output < __%. most common cause of this is ___. |
|
Definition
|
|
Term
| 3 compensatory mechanisms for heart failure |
|
Definition
1. Frank starling mechanism: optimum crossover where the max # of troponin fibers attach to myosin to make the most efficient/hardest contraction
2. neurohormonal activation: sympathetic nervous system, rennin-angiotensin-aldosterone systm, vasopression
3. ventricular remodeling |
|
|
Term
| basis of clinical diagnosis of CHF |
|
Definition
| failure of compensatory mechisms |
|
|
Term
| elevated levels of ___ are seen in right and left heart failure and is used to track the successfulness of heart failure treatment. it has diuretic and vasodilatory properties |
|
Definition
| brain natriuertic peptide |
|
|
Term
| ___ are small protein molecules produced by a variety of tissues and cells. elevated levels of these are associated wtih a worse clinical outcome in heart failure pts |
|
Definition
|
|
Term
|
Definition
| pts becomes bradycardic when treated for A fib... needs meds to control tachycardia and pacemaker to control bradycardia |
|
|
Term
| Ca Channel and Beta blockers work on rate or rhythm? |
|
Definition
|
|
Term
| Disorders of the heart muscle itself - not a result of valvular, coronary, hypertensive, or congenital abnormalities |
|
Definition
|
|
Term
| 3 types of cardiomyopathy |
|
Definition
dilated
restrictive
hypertrophic |
|
|
Term
| Kid who dies of sudden cardiac death... think what dz? |
|
Definition
| hypertrophic cardiomyopathy |
|
|
Term
| Young kid with fever, strawberry tongue, injected eyes, friction rub, new murmur of mitral regurg... think waht dz? |
|
Definition
|
|
Term
| In adults, the most common causes of mitral regurg are?? |
|
Definition
| degenerative, ischemia, endocarditis, rheumatic |
|
|
Term
| Mitral ___ is becoming more prevalent, mitral ___ is becoming less prevalent |
|
Definition
|
|
Term
| comlications of pericardiocentesis |
|
Definition
tamponade
dysrhythmias
hemo/pneumo thorax
laceration of coronary or internal mammary arteries
perforation of myocardium |
|
|
Term
| Pt with mild regurg develops severe regurg suddenly... what happened? |
|
Definition
|
|
