Patho
Help!
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| Apex is formed __ by left ventricle and is the ___ ___ intercostal space | 2/3, left, 5th
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| is the right atrium posterior of anterior? | anterior
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| ___ is a thin projection at the top of the anterior surface | auricle
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| fossa ovalis is remnant of | foramen ovailis
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| air tends to collect at the __ and __ junction | SVC and RA
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| IVC, SVC, or Coronary sinus has the lowest Sv02 | Coronary sinus 80% venous return from the coronary circulation
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| what are two ways the fossa ovalis can remain open or reopen? | RAP> LAP or positive pressure
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| which valves is the largest? | tricuspid
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| T or F do both ventricles perfuse through the entire cardiac cycle? | False; only the right ventricle
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| which valve is difficult to visualize on TEE | pulmonary valve
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| what causes a aortic dissection | the shearing effect of the ligamentum arteriosum which is attached to the aorta
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| which is the most common site to develop blood clots? | Left auricle
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| what allows for expansion of the L atrium to take in larger volume | left auricle
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| blood entry into the left artium is via | four pulmonary veins
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| the left ventricle is only perfused during? | Diastole
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| What can develop from a inferior MI? | Mitral regurg. secondary to papillary damage from ischemia
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| papillary muscles stablize? | chordae tendinea
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| Sv02 is highest when returning from the OR vs. open awakening? T or F | true
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| Tricuspid, Mitral, and Aortic valves have how many cusp? | T(3) M(2) A(3)
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| what is defined as critical stenosis | less than 1 cm2
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| this coronary artery is dominant in 20% of individuals | LCA
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| what is the sinus of valsalva | where the LCA arises from left aortic sinus
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| how is the LM branched out? | LM-LAD-D1,D2
LM-Lcirc.-OM1,OM2
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| is the R or L more susceptible to myocardial infraction? | Left
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| the RCA orignates from the | right aortic sinus
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| the R or L CA supplies the SA and AV nodes | RCA
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| if the RCA becomes occluded you will experience tachyarrythmias? | false; commomly causes bradycardias
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| coronary flow is balanced in __% of pts | 30
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| ventricle size __ the risk for ischemia? | increase
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| L ventricle drains to the ____ found in the found in the right atrium? | coronary sinus
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| where are retrograde catheters placed? | coronary sinus
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| these drain deep muscle to RA and RV | thebesian veins
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| some direct drainage from the RV wall into __? | RA
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| where is the attachment points for the ductus venosum? | it turns into ligamentum venosum. Attached to the left branch of the portal vein within the pora hepatis of theliver.
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| what is know as the widow maker? | LMA
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| occlusion of the RCA: leads, area | II, III, aVF
inferior wall
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| occlusion of the LAD: leads, area | V1-V2
anterior wall
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| occlusion of the circ: leads, area | V4,V4,V6
lateral wall
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| if you have lead changes in II,II,aVf you would expect what type of rhythm? | Bradycardia; RCA supplies the SA/AV node
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| if you see ST depression in leads V1-V2 you would expect what? | Anterior wall ischemia
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| ST elevation in leads V4,V5,V6 | lateral wall injury
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| the presents of Q waves | infarct
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| this has a zero reference point, T-P segment is the reference line | the J point
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| ST depression may or may not have T wave inversion | ischemia
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| ST segment elevation, with or without loss of R wave | injury
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| what are some causes of inverted T waves | Conduction defects, Hypertrophy, Ischemia, Pericarditis, SAH, Subendocardial infarction.
CHIPSS
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| causes of short QT | hypercalcemia
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| causes prolonged QT | ischemia, drugs, low: Ca, Mag, K
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| what makes cardiac muscle contraction take place? | Ca
influx of Ca causes mov't of tropomyosin, allowing attachment of myosin head to the actin filament therefore allowing contraction
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| what relaxes muscle contraction? | ATP; binds to myosin and breaks hold
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| What terminates muscle contraction | re-uptake of Ca
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| if you have a pt with 2nd degree type II block why shouldn't you put them to sleep? | when placed on positive pressure it causes the RA to stretch and increase PVR which can turn into 3rd degree. caution in pt with SA node disease as well.
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| what part of the sarcomere moves during contraction? | Z-lines move as the myosin heads pull the actin
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| where is the CA located inside the cell? | sarcoplastmic reticulum in the mitochondria
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| CPP equation | ADP-LVEDP
aortic diastolic pressure
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| which ventricle has the least compliance | left
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| where does sympathetic myocardial innervation take place | right stellate ganglion supplies the coronary sinus and AV node
left stellate ganglion innervates the ventricle, distributed throughtout the entire heart
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| where does the parasympathetic myocardial innervation take place | primarily distributed in the atrium and specialized conduction system. SA and AV node. Vagus nerve
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| what is preload? | the sarcomere length just prior to contraction, importance of sarcoma length, pressure volume curves mimic this
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| how is preload measured | can't be measured except with rapid echo, indirectly as the LVEDV/LVEDP
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| what is preload | load that the muscle must do once contraction begins
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| what does afterload depend on | ventricular intracavity presure, wall thickness, chamber radius, geometry of the ventricle, vascular load, ventricular load
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| how is afterload measured | no measured but calculated
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| what is contractility | ability of the heart to contract with force
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| how is contractility assessed | echo, SV
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| what is normal SV? | 60ml (65%EF) 3L/min at rest
LVEDV 120-140
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| what causes decreases in slope 4 | vagal stimulation, positive airway pressure, acute hyperkalemia, arrythmias
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| increases in slope 4 | art.hypoemia, hypercarbia, catecholamines, sympat. drugs, acute hypokalemia, hyperthermia, HTN,
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| what part of the EKG is considered the health of the AV node | PR interval
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| what electrolyte is decreased by stress and bacteria | mag
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| which dysrhythmia a pacemaker is indicated | Second degree AV block type II
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| bifascicular block is also | a third degree block
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| esmolol should not be given to which pts | ST, PSVT with unknown cause, need to dx cause first
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| what is considered irregular, irregular | A.fib
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| this rhythm has a pathway of kent | WPW
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| what med shouldn't you give a WPW pt | verapamil
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| this access. pathway is inside the AV node, short PR interval | lown-ganong-levine syndrome
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| causes of PVCs | lt. anesthesia, vagal, art. hypoxemia, hypercarbia, MI, SNS activation, hypokalemia, hypomagnesemia, drugs, mechanical irritation
(caffeine, ETOH, dig tox,local tox, volatile)
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| how would you tx a pt that starts having lots of PVC's? | is pt receiving O2, cancel case, indication for list of possible causes, consider cause and treat.
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| how do you monitor ischemia | 1)TEE, 2)PA cath,3)EKG
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| what causes prolonged QRS | hypertrophy, cardiac dilation, purkinje syst. block, cardiac injury
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| what cause changes in QRS ht/width(voltage) | increase voltage:hypertrophy
decrease voltage:myopathies,tamponade,pleural effusions, COPD, pneumothorax, BBB
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| how do you dx a RBBB | (-)lead I, (+) lead aVF vector analysis
or bunny ears in V1
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| how do you dx a LBBB | (+)lead I, (-) lead aVF vector analysis or bunny ears in lead I
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| why is it important to to dx R or L BBB | if placing a PA cath, if you have a LBBB you can knock out the R side and end up with complete block (SC pacer pads at bedside)
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| how do you treat neurogenic and spinal shock? | ABC's, IVF therapy, vasopressors, inotropes, corticosteroids, monitor for acidosis, evaluate level of injurt
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| how would you treat hypovolemic shock? | ABC's, evaluate and tx cause, intubate if in full shock, if not in full shock assess bld gases and ability to maintain airway, IVResuscitation, vasopressors, DON'T put in trendelenburg, A/L needed
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| what are the five important variables to ascertain shock? | CO, SVR, PAOP, CVP, SvO2
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| SMART stands for? | stabilize, monitor, assess, review, treat
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| how are hypovolemic and neurogenic shock different? | hypovolemic:hemorrhagic or nonhemorrhagic due to electrolyte loss
#1 Diarrhea
Neurogenic: spinal cord injury
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| what drugs should be avoided in WPW | Verapil, Ketamine, Pancuronium
and others that increase HR
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| what organs get affected by HTN | HTN leads to MSOF (multisystem organ failure)
Cardiac-CHF
Renal-CRF
Neurogenic-CVA
Liver-why not?
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| what is the difference b/n primary and secondary HTN | Primary HTN: unknown(90% pts)
Secondary HTN:Drugs, renal disease, pyelonephritis, glomerulonephriitis, diabetic nephropathy, vascular disease, coarchtation of the aorta, hyperadrenocorticism, primary aldosteronism, intracranial HTN, pheochromocytoma
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| what is malignant HTN | hypertensive crisis: diastolic>130mmHg
results in damage to retinal vessels (papilledema),
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| what med should be avoided in HTN crisis | ACE Inhib
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| what is a key concept in shock? | perfusion
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| with shock when should you give bicarb? pH___ | <7.20
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| what is a sign of flank bruishing? | retroperitoneal hemorrhage
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| where is LVEDP and LVEDV located on the press. vol. curve | look on the pressure-vol. curve LOL!
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| complications of thiazides diuretics | low:K,Mag,lithium clearance
high:Ca, glucose, cholesterol, uricicemia
dermatitis, alkalosis, photosensitivity
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| complications of K-sparing diuretics | hyperkalemia
hyponatermia
megablastic anemia
dermatitis
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| compilations of clonidine | sedation, orthostatic HypoTN, bradycardia, impaired glucose tolerance, rebound HTN, dry mouth
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| complications of beta blockers | CHF, bradycardia, bronchospasm, sedation, rebound angina, parasthesias, impotence masking of hypoglycemia, raynauds phenomena
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| complications of ACE inhibitors | hyperkalemia, proteinuria, cough, fetal death, dermatitis, ANGIOEDEMA
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| complications of hydralazine | reflex tachycardia lupus like syndrome, fever
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| what is the final common pathway in shock | organ regional bld flow disturbances, lack of cellular oxygenation, leads to ATP depletion and eventually cell damage and death
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| what symptoms do you always get with shock | Neuro:mental status changes, miosis(overdose), mydriasis Cardiac:↑HR, ↓BP,↓contract., new murmurs, dysrhythmias,↑JVP(RHF), ↓JVP(hypoTN), disparate perip. pulses(aortic diss) Resp:↑RR,Pedema, hypoxia Renal:oliguria Skin:cool, clammy lactic acidosis, fever
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| What is the most important thing to remember when you manage anybody in shock? | ABC's
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| How do you differentiate b/n anaphlaxtic shock and neurogenic shock | you can't
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| how can you dx carogenic shock? | CI must be less than 2L/min/m2
PAOP must be greater than 17-20 mm Hg
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| what kind of shock is left ventricular MI? | cardiogenic shock
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| what is considered impedance to ventricular filling | pericardial tamponade
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| what is considered impedance to ventricular outflow | massive pulmonary embolism
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| what is the txment for anaphylaxis shock | vol. expansion, epi early, diphenhydramine, steroids
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| what is considered trauma without hypovolemia | Burns, crush injuries
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| what causes the fast Na channels to remain inactivated in pacemaker cells | the max negative voltage -60
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| what is Na intra, extra, and equilibrium potential | 144, 7, +81
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| what is K intra, extra, and equilibrium potential | 4, 151, -97
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| what is Cl intra, extra and euilibrium potential | 114, 4, -90
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| during phase 2 of the cardiac action potential what occurs | plateau phase 2:1
ca influx 1 enters
K efflux 2 leave
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