Assessment 4 Cardiology

PaPh Assessment 4 Review
Assessment 4: Cardiology: Bold things are what teachers said in class to know for test.
 Resistance= dp/Q = 8ln/(π x r4 )
 During diastole, elastic recoil of arteries propels blood into small vessels
o Arterioles determine systemic pressure
 Balance of oncotic and hydrostatic pressure determines where fluid is transported
 S3 relates to early ventricular filling, S4 relates to early atrial filing (or a stiff ventricle)
o Click= aortic pulmonary valve opening, Snap=Mitral tricuspid opening
 I bands=actin, A bands= thick filaments
 Series element contract, parallel elements prevent heart from being stretched too far
 dV/dP= compliance, therefore dP/dV=stiffness
 Cardiac output= SV x HR
 SV determined by size of heart, diastolic relaxation, and extent of myocardial shortening
 Preload, afterload, contractility determine myocardial shortening
 Blood pressure and ventricular size determine afterload
 RAAS increases effective blood volume and increases peripheral resistance
 Coronary blood flow and saturation levels determine oxygen supply,
o HR, contractility and wall tension determine oxygen demand
 Ventricular performance is directly proportional to EDV
 Three types of coronary disease
o Chronic stable angina
 Exertional angina
 Person who has a positive treadmill test
 Increased demand on heart (exercise) results in ischemic conditions due to
narrowing of arteries
 Two determinants of myocardial oxygen demand:
 Wall Tension
 Heart Rate
o Acute coronary syndrome
 Ruptured atherosclerotic plaque
o ST elevation MI
 Complete sudden blockage of a coronary artery
 Zero flow of blood through the artery
 If someone places a swan-ganz catheter into a patient who is critically ill, what is measured?
 S. Viridians is the number one cause of infective endocarditis, S. aureus is second
 Vegetation is a mixture of RBC’s, WBC’s, germs and fibrin that deposits on a valve
 Diastolic vs. Systolic Heart Failure
Normal Ejection fraction
Stiff ventricle
Elastic tissue replaced by fibrous tissue
No drugs available
Low ejection fraction
Drugs can help
PaPh Assessment 4 Review
 Three drugs help in systolic heart failure
o ACE inhibitors
o Beta blockers
o Spironolactone
 Three neurohumeral responses in heart failure
o Increased RAAS
o Increased sympathetic activity (catecholamines)
o Increased BNP
 An unrestrictive VSD in a newborn infant is likely to be associated with little to no murmur
 Unrestrictive VSD n a 2 month old infant with normal pulmonary resistance is likely to be
associated with IV/VI systolic murmur at mid left sternal border, and a II/VI diastolic rumble at
the apex
 Physiologic murmurs are never diastolic
 Mechanism for systolic murmur at left upper sternal border in a patient with ASD is relative
pulmonary stenosis from increased pulmonary flow
 Cyanosis can be caused by:
o Central Apnea
o Pneumonia, Pneumothorax
o Intercardiac shunting
o Congenital defects
 Truncus arteriosus
 Tetralogy of Fallot
 Tricuspid atresia
 Transposition of great vessels
 Total analomous venous return
 Coronary artery disease risk factors
o HTN, smoking, hyperlipidemia, lack of exercise
 ST depression shows myocardial ischemia
 ST elevation shows acute cell damage (necrosis)
 Electrical instability due to V. fib can cause sudden death
 Stary’s classification atherosclerosis
o Foam cellsFatty streakintermediateatheromafibrous plaquecomplicated
 Complications of MI
o Aneurysm, thrombus
o Rupture
o Pericarditis
o Venous thrombosis
 Cardiac but no coronary causes of chest pain
o Aortic stenosis
o Hypertrophic cardiomyopathy
o Pulmonary HTN
PaPh Assessment 4 Review
 Electrophysiology
o Amplitude and direction of deflection depends on relation of electrode to polarity of
field, strength of field, and distance between electrode and field
o PR wave s conduction from SA node to purkinje system
o Increased Q wave is ventricular hypertrophy
o Lengthened QRS is bundle branch block
o Negative deflection of T wave is from ischemia
o Disorders of impulse formation (causes) **
 Re-Entry
 Tissue path with slower conduction, pathways are contiguous,
unidirectional block in one pathway
 Altered phase 4 of action potential
 Know the following EKG’s:
PaPh Assessment 4 Review
No P waves!
Volume overload=eccentric hypertrophy, stenosis/HTN= concentric hypertrophy
Main cause of mitral stenosis is rheumatic fever
Higher the HR the more severe mitral stenosis is
Types of pericardial disease
o Pericarditis
 Gets better when patient sits forward
 Inflammation of pericardium
 Friction rub on auscultation
o Pericardial Effusion
o Pericardial Tamponade
 Mechanism of Pulsus Paradoxus
o Inspiratory decrease in BP (normal)
o When systolic BP decreases more than 10mmHg on inspiration it is pulsus paradoxus
o RV expands on inspiration (due to decreased intrathoracic pressure and increased
venous return to RA and therefore RV), encroachment on IV septum into ventricular
cavity decreases volume of left ventricle which results in decreased contractility (frank
starling relationship) and decreased cardiac output. When cardiac output decreases the
pressure decreases resulting in decreased pulse seen on inspiration.