In each blank, try to type in the
word that is missing. If you've
typed in the correct word, the
blank will turn green.
If your not sure what answer should be entered, press the space bar and the next missing letter will be displayed. When you are all done, you should look back over all your answers and review the ones in red. These ones in red are the ones which you needed help on. Question: Describe Coronary Disease:Answer: diseases caused by impaired coronary blood flow. Question: What are of CHD:Answer: cardiac angina, MI, cardiac arrhythmias, heart failure and death.
Risk factors for CHD: Question: CHD:Answer: Affects the left coronary artery in most
75% of the vessel lumen needs to be occluded before has symptoms
Effects of CHD range from: ischemia and pain to MI. Question: What Tests for evaluation of circulation:Answer: ECG, test, nuclear imaging and cardiac catheterization. Question: Two types of CHD:Answer: Ischemic diseases. Cardiac angina
Myocardial infarction Question: Define :Answer: suppress or withhold blood flow. In heart it happens when the coronary arteries do not supply adequate blood to meet the demands of the , especially during activity/exercise. Question: What leads to :Answer: can be due to: , vasospasm, thrombosis. Question: What are Sx of Ischemia:Answer: Cardiac ischemia can be symptomatic (angina ) or silent (more risk for MI and sudden death). Question: Angina:Answer: “to choke” Question: Describe :Answer: Chest pain or pressure on chest due to ischemia. Question: What are the of Pain of Angina:Answer: The PAIN is constrictive, squeezing and suffocating. It is steady, located in precordial area.
Pain can radiate to jaw, shoulder, arm, area.
Pain is brief, less than 5 minutes. Question: Does Angina Pain ?Answer: can radiate to jaw, , arm, abdominal area. Question: Is pain Chronic?Answer: Pain is brief, less than 5 . Question: What are the 3 of angina:Answer: Classic
Unstable
Variant
Describe Angina: Question: Unstable Angina:Answer: pre-infarction angina, usually significant CHD present, risk for MI and heart failure is high.
Pain with any /level of exertion Question: Describe Variant (Prinzmetal ):Answer: vasospasm, in rest or , has a pattern. Question: Contributing for Angina:Answer: cold, smoke, emotional stress before bed time, high autonomic activity (high anxiety) Question: Meds for :Answer: Nitroglycerin* (vasodilator) and Ca channel ariant/Prinzmetal Question: What are the Medication for Angina:Answer: Nitroglycerin: Sublingual or dermal
β blockers (antagonists) – selective to β1
β1 primarily in heart ↑ HR and contractility
β2 primarily in bronchial system and peripheral vascular system vasoconstriction and bronchoconstriction
Calcium cha Question: β blockers:Answer: (antagonists) – selective to β1
β1 primarily in heart muscle ↑ HR and contractility
β2 primarily in system and peripheral vascular system vasoconstriction and bronchoconstriction Question: Which β blocker works on heart :Answer: β1, ↑ HR and Question: Which β blocker works on Bronchial Systemand peripheral system:Answer: β2 causes vasoconstriction and Question: Define Infarction:Answer: “Heart attack” – ischemic death of myocardial tissues associated with atherosclerotic of coronary arteries. Question: How is MI:Answer: 1.5 million new or cases per year. 1/3 of them die within the first hour. Question: cause of MI:Answer: 90% are from a obstructing a coronary artery. Question: Are you most likely to get an MI in the or Evening?Answer: 3 times more in early morning to noon. Question: Pain Manifestation of MI:Answer: PAIN – abrupt, severe and crushing – “something sitting on my chest”.
Pain lasts longer than , not relieved by rest or nitroglycerin.
Pain can refer to jaw, arm, shoulder, stomach. Question: Describe Sx of MI:Answer: restless, , tachycardia, sweating, nausea and vomiting, extreme fatigue. Skin pale cool and moist Question: If someone has pain do they have an MI or Angina?Answer: MI Pain longer than angina, Question: Describe Heart damage over time an MI:Answer: 20-40 minutes to resuscitate – during which cells reversibly injured.
>40 minutes cell death and .
In 2-3 days scar tissue forms.
In a week softening of the tissue and risk for rupture
In 7 weeks the regeneration and scar formation complete. Question: How do you Dx MI:Answer: Dx: need ECG, Lab tests
ECG: ST elevation, ST depression, T inversion, Q wave formation
Labs: CK-MB and LDH . Cardiac troponin and myoglobin levels go up in blood. Question: Describe TIME:Answer: 1 hour after the attack of MI, after that hour cell is irreversible. Question: of MI are:Answer: dysrhythmia specially ventricular tachycardia
Heart failure, cardiogenic shock
rupture of heart or other anatomical elements
thrombo-emboli Question: Tx for a man over 35 y/o or woman over 40 y/o with pain from area up to jaw with no medical check up for to rule out heart problem:Answer: REFER TO MD for EKG to rule out heart problems. If Cold , call 911 Question: Tx for Pt w/chronic HT has angina episode:Answer: If he has nitro available give it to him. If no response to 2 doses . Call 911 Question: What is a mistake of cardiac pain?Answer: -Cardiac pain may be mistaken for acid reflux (& vice versa)
-Cardiac pain may be mistaken for pain (& vice versa) Question: Tx for Pt who has “chronic acid reflux” but TCM interview reveals palpitation & :Answer: Okay to Tx this time but to MD for heart assessment/WM Dx before next TCM Tx. Question: Tx for Pt who reports “stomach pain that & goes”, not associated w/eating food. Usually morning onset, maybe sweating:Answer: DO NOT – Refer to MD for assessment. Question: Myocarditis:Answer: Inflammation of the heart muscle, post . Mostly self limited.
Past Hx of “flu” or “cold” Question: Sx of :Answer: , dyspnea, palpitation, fever Question: Cardiomyopathies:Answer: Disorders of the heart muscle.
Ex: cardiomyopathy and peripartum cardiomyopathy. Question: What are types of Cardiomyopathy?Answer: Hypertrophic cardiomyopathy
Dilated cardiomyopathy Question: Hypertrophic cardiomyopathy:Answer: of intraventricular septum and left ventricle. Question: Etiology of Cardiomyopathy:Answer: , HTN, obstructive valvular disease, thyroid disease Question: What heart kills young athletic people?Answer: Hypertrophic cardiomyopathy is a major cause of death in young athletes who seem completely healthy but die heavy exercise. However, certain normal changes in athletes' hearts can confuse the diagnosis. Question: Dilated cardiomyopathy:Answer: Muscle fibers are damaged, and contract Question: Etiology of cardiomyopathy:Answer: infections, HTN, ischemic heart dz, drugs, EtOH, cardiomyopathy Question: Define Restrictive :Answer: Left ventricular hypertrophy and fibrosis Question: Define Infectious and disorders of the heart:Answer: The Endocardium and heart muscle are attacked by:
Infectious agent especially in endocarditis
Immunologic especially in rheumatic fever Question: Infectious/bacterial Endocarditis:Answer: The bacteria enters blood stream directly
Most common: aureus, Strep pneumonia. Question: Sx of /bacterial Endocarditis:Answer: malaise, fatigue, fever low grade, petechia and splinter hemorrhages, arthritis and , and sometimes diarrhea. Question: Complications of /bacterial Endocarditis:Answer: lungs, kidneys, , CNS Question: Describe disorders of the heartAnswer: – rheumatic heart disease
Rheumatic : acute inflammatory disease that follow a throat infection with group A β-hemolytic streptococci.
Incidence mostly in age range 5-15 y.old. Question: Complications of Immunologic of the heart:Answer: valvular heart disease and permanent cardiac dysfunction. Question: Describe Fever:Answer: Inflammatory disease strep throat Question: Primary Manifestation of feverAnswer: Hx of sore throat – sore throat is exudative and pus producing. Can see white coat back of the throat most of the times. Question: Sx of Rheumatic feverAnswer: : migratory polyarthritis, fever, HA, abdominal pain, nausea and lymph nodes. Question: Complications of Fever:Answer: chorea, migrans, mitral valve prolapse, permanent cardiac dysfunctio Question: What would labs positive for Rheumatic show:Answer: high ESR and CRP and . Question: Treatment for Rheumatic :Answer: Antibiotic
Steroids
Rest Question: Define disease:Answer: – vasculitis of coronary arteries in <5yo post-URI
Sx: exhaustion, very high fever that is unresponsive to medications. Question: Valvular heart disease:Answer: opening decreases in size (stenosis) or valves don’t close properly. Question: etiology of Dysfunctional heart valves:Answer: Congenital, trauma, IHD, degenerative , and inflammation.
RF is a common cause for valvular problems.
They produce blood flow turbulence
Mostly chronic conditions Question: Stenosis:Answer: (stenotic valvular problems):Decrease of blood flow through a valve, resulting in impaired emptying and increased work demand on the heart chamber that empties blood the diseased valve Question: Ex of :Answer: stenosis, aortic stenosis Question: Define of Valves:Answer: (regurgitant valvular defect):
Permit the blood flow to when the valve is closed.
Exp: tricuspid regurgitation, aortic regurgitation, mitral regurgitation with prolapse. Question: Describe Mitral valve (MVP):Answer: Bulging of MV into the left atrium. Can be part of connective disorder in body Question: Is valvular heart disease more prevalent in men or ?Answer: Prevalence: 2.5% in men and 7.6% in Question: Sx of valvular disease:Answer: chest pain (non-exertional), weakness, , dyspnea, palpitation, anxiety, lightheadedness. Question: Tx plan of MVP:Answer: Use of β-blockers to treat manifestations.
Antibiotics for preventive infective endocarditis before dental work. Question: Definition of Heart :Answer: Failure of the heart as a pump, to eject blood out and into the and pulmonary systems Question: Describe the impact of Heart Failure in :Answer: Incidence of heart failure is increasing every year. 2 million have HF, and 400000 new cases each year Question: What is the rate of Heart Failure:Answer: is high even with appropriate and aggressive treatment (more than 50%). Question: Define :Answer: reflects the loading condition of the at the end of diastole; or better to say the amount of blood stored in the heart during diastole that needs to be pumped out Question: Afterload:Answer: represents the force that the heart must generate to blood out of itself; systemic (peripheral) vascular resistance dictates how strong the heart needs to contract to eject blood. (it reflects volume of blood exiting the heart and the pressure) Question: Frank-Starling law:Answer: In a range, an increase in the preload will increase the stroke volume meaning the more enters the heart the more leaves the heart, as the heart does not like to keep the blood in it Question: Describe Heart :Answer: Heart failure happens when the heart does not have the strength to eject blood out; so besides blood accumulating in the heart, there will not be enough blood entering the systemic circulation and also will back flow in the pulmonary system. Question: of Heart failure:Answer: Congestive heart failure, pulmonary edema and cardiogenic Question: What are for heart failure:Answer: Cardiac function, Excess work demand Question: Impaired Cardiac function:Answer: Myocardial diseases: Myocarditis, CAD, MI and Cardiomyopathies.
Valvular heart disease: Stenosis in the valves or regurgitation in the .
Congenital heart diseases
Constrictive pericarditis Question: Describe Excess work :Answer: HTN either or pulmonary
Hyperthyroidism
Anemia Question: Heart Failure Classes:Answer: In all classes heart disease present.
Class 1: no limitation in physical activity
Class 2: rest no , ordinary PA causes symptoms
Class 3: marked limitation in PA present.
Class 4: symptoms even happen during rest. Question: What are symptoms show chance of heart failure?Answer: , palpitation, dyspnea and anginal pain. Question: What mechanisms compensate for Heart :Answer: Increased sympathetic nervous system activity
Renin-Angiotensin-Aldosterone
Reabsorption of fluids in kidney (Na and ADH)
Increase systemic vascular resistance
Atrial Natriuretic hypertrophy Question: Tx for Failure:Answer: Goal is to relieve the symptoms and improve quality of life.
Correction of reversible causes such as and thyrotoxicosis, control HTN
Modification of physical activity
Restriction of salt intake
Meds Question: Meds for Tx of Failure:Answer: Diuretics
Inotropic agents: digitalis, B adrenegic agonists.
ACE inhibitors (major side : cough)
Vasodilators Question: of Congestive heart Fiailure:Answer: HF is accompanied by congestion of body tissues. Congestion can happen in the pulmonary system causing blood accumulation in the lungs; or back flow of blood into . Question: Sx of Heart Failure:Answer: based on vs left side heart failure. Question: Describe Rt Heart Failure :Answer: Fatigue, dependent edema (edema in lower extremities), of the jugular vein, distension of liver, ascites, anorexia and complications of GI distress due congestion of GI, cyanosis. Question: Describe Lt Failure symptoms:Answer: Exertional , orthopnea, cough, blood-tinged sputum, cyanosis. Question: Describe Acute pulmonary :Answer: Life condition. Blood, fluids accumulate in the lung Question: Manifestations of pulmonary edema:Answer: Dyspnea and for air, rapid pulse, cool moist skin, cyanosis, confusion and stupor. Cough and bloody sputum. Crackles in the lungs. Question: Tx of Acute pulmonary :Answer: O2 and send to ER asap. Question: Definition of Cardiogenic :Answer: Failure of the heart to pump the blood in the systemic circulation, no O2 and nutrients provided to and organs due to impaired perfusion. Question: of Cardiogenic Shock:Answer: MI
Arrhythmias (especially MI) Question: Sx of Cardiogenic :Answer: , cyanosis…. Question: Tx of of Shock:Answer: REFER Question: Causes of Cardiac conduction and :Answer: Disturbance in impulse generation
Disturbance in conduction
Normal heart Rhythm is called sinus rhythm and there is physiologic dysrhythmia with respiration Question: What are disorders of Cardiac conduction and ?Answer: Sinus bradycardia:<60 bpm
Sinus tachycardia:>100 bpm
Sinus arrest: asystole, no coming
Sick sinus syndrome (SSS) brady- and tachy- cardia alternatively.
Atrial dysrhythmias usually asymptomatic unless they get transferred to AV and to ventric Question: Are in heart more serious in ventricle or atrium?Answer: in ventricles are more serious Question: of PVC:Answer: PVC (premature ventricular contraction) is caused by an ectopic pacemaker in heart. Question: Ventricular tachycardia:Answer: 160 -250 bpm, can after MI. Question: Describe Ventricular :Answer: > 350 bpm is and can happen after MI. |
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