Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
coronary artery dise
coronary artery
| Question | Answer |
|---|---|
| 2-D ADVANTAGES IN CAD EVALUATION | Performed immediately Determines location and extent of LV wall motion abnormalities |
| Estimates systolic and diastolic function Serial studies | Assess LV function changes after infarct or reperfusion therapy |
| Complications identified ACUTE MYOCARDIAL ISCHEMIA | Ischemia is a reversible imbalance in the myocardial oxygen demand-to-supply ratio Obstructed coronaries can usually still compensate for demands at rest |
| When narrowing exceeds 70% of cross sectional area blood flow can’t keep up with demands from: | Exercise Pharmacologic interventions mental stress |
| ACUTE MYOCARDIAL ISCHEMIA Consequences I | Coronary artery occlusion/obstruction Diastolic dysfunction Impaired relaxation and decreased compliance Increased LVEDP |
| ACUTE MYOCARDIAL ISCHEMIA Consequences II | Decreased left ventricular ejection fraction Impaired systolic thickening Reduction of endocardial motion Dysynchronous contrac |
| ACUTE MYOCARDIAL ISCHEMIA Consequences III | Consequences Possible LV dilatation Large infarctions More increase in LVEDP CHF develops Increased heart rate to compensate and maintain adequate cardiac output |
| WALL MOTION ABNORMALITIES Describing abnormality: | Hypokinesis – an increase in systolic wall thickening <40% Akinesis – systolic wall thickening <10% Dyskinesis – present when wall moves outward during ventricular systole and has wall thinning |
| CLASSIFICATIONS MI’s divided into 3 categories: | Subendocardial – involving only the inner layer of the myocardium Subepicardial – involving both inner and middle layers Transmural – extending through all three layers of the myocardial walls |
| EKG FINDINGS | T wave inversion suggests ischemia Elevated ST segment represent acute MI Prominent peaked T waves show acute MI Pathologic Q waves show “old” MI May also see ventricular arrhythmias or other conduction defects |
| SYMPTOMS | Physical examination May be normal if MI is uncomplicated Symptoms are usually the last thing to occur Chest pain SOB Nausea Vomiting May not occur at all |
| MYOCARDIAL INFARCTION LAB VALUES CK I | AKA Total CK, creatine phosphokinase, CPK, creatine kinase Levels rise when muscle or heart cells are injured Levels begin to rise 4-6 hrs after MI Highest levels are 18-24hrs after Will return to normal 2-3 days |
| MYOCARDIAL INFARCTION LAB VALUES CK II | Can also be seen w/ skeletal muscle damage If CK is high, a more specific test is needed |
| LAB VALUES I CK-MB | AKA CK MB, CPK MB, creatine kinase-MB CK-MB helps differentiate between heart damage or damage to other muscles CK-MB can also tell Dr. if clot dissolving drugs are working |
| LAB VALUES CK-MB II | Ck-MB to total CK index higher than 2.5-3 indicates high likelihood of heart muscle damage Some skeletal muscle injury can be severe enough to raise CK-MB levels |
| LAB VALUES Troponin | AKA Tn1, TnT, Cardiac specific Troponin I and T Usually ordered along with other cardiac markers Troponin is starting to replace CK & CK-MB because it is more specific for heart injury |
| Troponin | Troponin is elevated for longer period of time, 1-2 weeks after a heart attack Levels are not affected by damage to other muscles |
| 2D DOPPLER EXAM Sonographer needs: | Clinical history Prior cardiac events Cardiac murmurs Evidence of CHF Systolic BP Pulmonary artery cath info in CCU Hemodynamic info 12 lead EKG for presumed infarct location |
| IMPORTANT ECHO INFORMATION | LV and RV size and function Wall motion abnormalities Valve integrity and regurgitation LV diastolic filling parameters |
| ECHO FINDINGS | 2D evidence of wall motion abnormalities is always seen in transmural infarction Wall motion abnormalities may or may not be seen where ischemia occurs in the subendocardial myocardium |
| COMPLICATION OF MI | Pericarditis Pericardial inflammation May or may not see effusion Dressler’s syndrome Delayed form of pericarditis 1-12 weeks post MI Recurrence is common Tamponade is rare |
| Symptoms of Dressler’s | Fever Pleuropericardial pain Malaise Pericarditis Pleuritis |
| RV infarction | Frequent complication of inferior MI Hemodynamic signs of RV infarction resemble those of cardiac tamponade |
| Mitral regurgitation | Common complication of acute or recent MI papillary muscle rupture can occur and cause MR Flail leaflet seen Papillary muscle dysfunction may occur due to localized ischemia with underlying wall motion abnormality |
| LV aneurysm:I | May form at the site of infarction Most commonly involved are anterior wall and apex Distortion of LV contour at end diastole and end systole Thrombus frequently forms |
| LV aneurysm:II | “hinge point” demarcates the infarct zone and aneurysm formation from normal myocardium |
| LV thrombus after MI: | Higher incidence with aneurysm formation Thrombus can spontaneously resolve, or resolve after anticoagulant therapy |
| LV pseudoaneurysm I | Myocardial rupture contained by parietal pericardium True aneurysm involves myocardium Usually seen post recent MI |
| LV pseudoaneurysm II Can also be seen in the following cases: | Cardiac trauma Myocarditis Infective endocarditis Cardiac surgery |
| LV PSEUDOANEURYSM III | There is a likelihood of rupture common in these patients Small communicating neck creates a gradient Thrombus may extend into neck and increase the size |
| Differential diagnosis of LV PSEUDOANEURYSM | Loculated pericardial effusion Pericardial cyst LV diverticulum |
| LV DIVERTICULOSIS | A rare congenital cardiac malformation which may be confused w/ aneurysm Small circular echo free space arising from LV w/ all 3 layers intact Doppler may demonstrate low velocity, systolic-diastolic flow w/in the chamber |
| Ventricular septal rupture or VSD post MI: | New systolic murmur accompanied by signs of hypoperfusion after acute MI Could be rupture or severe MR 2D, color flow, and Doppler are used together to detect rupture |
| LV free wall rupture: | Predisposing factors Large MI Lateral or posterolateral Elderly patient Post MI hypertension No prior CAD |
| LV FREE WALL RUPTURE | Seen within 48 hours of acute MI Rupture site is between the zone of necrotic and normal myocardial tissue Cardiac tamponade can develop This causes hypotension and bradycardia Survival is rare |
Created by:
100001592513232
Popular Science sets