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Patho
| Question | Answer |
|---|---|
| Corrigan's Pulse: | Aortic Regurg. (AR, AI) |
| Pulsus Bisferiens: | HOCM, IHSS |
| Pulsus tarvus: | Aortic Stenosis (AS) |
| Pulsus Alternans: | CHF |
| Pulsus Bigeminus: | (High beat, Low beat, Pause) |
| Stenosis: | Leads to Pressure Overload, Chamber hypertrophies |
| Regurgitation: | Leads to Stretching & Volume Overload. (leaks) |
| Mitral Stenosis pathology is classified as? | Inflow Obstruction |
| What condition may be associated with LV inflow obstruction? | LA Myxoma (Tumors) |
| Valve "Doming" with distal chamber enlargement is associated with? | Valvular stenosis |
| Most right sided heart murmurs are accentuated (more pronouced) by? | Inspiration |
| A pansystolic heart murmur occurs between what heart sounds? | s1-s2 |
| A grade 1 murmur: | Is barely audible (faint) |
| The most common arrhythmia associated with chronic mitral valve disease with CHF is? | Atrial Fibrillation |
| What type of infection may lead to rheumatic fever? | Alpha or hemolytic streptococcus (throat infection) |
| Rheumatic fever may be prevented by treating ____ infections with ____? | Bacterial throat/ Penicillin |
| What valve is most commonly damaged from Rheumatic Fever? | Mitral Valve |
| The predominate cause of Mitral Stenosis is? | Rheumatic Fever |
| Chronic Mitral Stenosis patients are prone to develop a "2nd stenosis" termed: | Reactive Pulmonary Hypertenion |
| Signs and Symptoms of Mitral stenosis may be easily confused with those of? | La myxoma orCor triatriatum |
| Primary sign or symptom with severe mitral regurg (MR): | SOB (Shortness of Breath) |
| Increasing the Cardiac Output in Mitral Stenosis will? | Increase the Diastolic pressure gradient |
| Things that could be done to more accuately evaluate MILD Mitral stenosis: | Speed the heart rate / Administer Chronotropic drugs to increase CO / Exercise him during Cath. {ANYTHING TO INCREASE CO} |
| What is the hemodynamic effect of Severe Mitral Stenosis? | Pulmonary Artery Hypertension |
| The Murmur of (MR) commonly radiates towards the? | Back |
| If a patient has Atrial Fib, what should be taken into account when reading a PAW preassure? | Atrial fib removes the "a" waves from the pressure tracing. |
| What auscultatory finding is most consistent with Mitral Valve incompetence: | Even intensity pansystolic murmur, best heard at the apex. |
| What (MR) cardiac output is higher than all the other measurements? | Increased LVMF (LV angio CO) |
| Acute (MR) is most often due to? | Chordal rupture / Papillary muscle rupture |
| Progression of MR in order: | Acute Uncompensated / Sub-acute MR Chronic Compensated / Chronic Decompensated |
| Which stage of MR has the largest "a" waves? | 2nd stage (Sub-acute MR) |
| Which stage of MR has the largest "V" waves? | 3rd stage (Chronic compensated MR) |
| Which type of angiogram would best define a failed mitral valve leaflet? | Left Ventriculogram / RAO view |
| Therapy for Mitral regurgitation includes: | Vasodilators (Nitrates, ACE inhib) Mechanical counterpulsation (IABP) |
| Which murmur is most consistent with Aortic stenosis? | DIamond-shaped ejection murmur, radiating towards the neck |
| In USA, most common form of (AS) in younger patients? | Congenital bicuspid AS |
| A patient with AS will likely have? | Large "a" waves |
| Brokenbrough's sign is associated with? | HOCM |
| Where is the Ligamentum arteriosum | Connective tissue just past the inomiate and subclavians,which attactches the aorta to the PA |
| Appropriate medical therapies for HOCM/IHSS | Beta Blockers / Calcium Channel Blockers |
| Austin Flint Murmur | common in Severe AS Mid diasystolic to presystolic |
| Progression of AS in order: | Normal LV / Severe acute AR Chronic compensated / Chronic decompensated AR |
| What stage of AR has the greatest EF and LV stroke volume? | 3rd stage (Chronic Compensated AR) |
| What stage of AR has the highest LV-edp? | 2nd stage (Severe acute AR) |
| Which of the four valve diseases complicates hemostatis, and increases the likelihood of femoral hematoma? | AR |
| Some AI (AR) and MVP (MR) patients suffer from an autosomal connective tissue syndrome called? | Marfan's Syndrome |
| Common signs associated with advanced pericardial tamponade: | Arterial Pulsus paradoxus / Prominest venous "X" descent wave Elevated venous pressures / Equalized diastolic preassure trac. |
| Common signs associated with advanced constrictive pericarditis: | Kusmaul's sign / Square root sign Elevated venous pressures / Equalized diastolic pressures |
| Electrocardiographic changes associated with pericarditis: | Lowered PR segment / Elevated S-T segment T-wave inversion |
| Cardiac rupture only occurs with? | Transmural Infarction |
| A false LV ventricular aneurysm is composed of bulging? | Pericardium and clotted hematoma |
| Which cardiac enzyme peaks early, Usually 6-7 hours after MI and declines rapidly? | Myoglobin |
| which cardiac enzyme peaks around, Usually 24 hours after MI? | CK-MB |
| Serum markers for cardiac damage? | Troponin (cTnl) / Lactic Dehydrogenase (G6P) Creatine Kinase (CK-MB) |
| Most common arrhythmia found in patients recovering from MI is? | PVC's (VPC's) |
| Warning symptoms of a heart attack: | Severe indigestion / Pressure in the center of chest Chest pain that moves to shoulders, neck, or arms. |
| Referred angina pain from MI is commonly located? | Along the ulnar aspect of the Left Arm |
| Angina pectoris is often described as? | "Band across chest" / "Squeezing or strangling sensation" "Pressure sensation like weight on chest" |
| Patient with angina, but arteries all appear normal, even during stress. This is called? | Syndrome X |
| Three major risk factors associated with heart attack include: | Cigarettes / High Blood cholesterol / Hypertension |
| ECG associated with Transmural MI is? | Pathologic Q wave |
| ECG associated with acute MI is? | ST segment elevation |
| Compensatory mechanisms used to maintain cardiac output in CHF: | Increase Preload / Myocardial hypertrophy / Increased catecholamines |
| Right side CHF eventually leads to? | RVH, RAD, and atrial hypertrophy |
| Activation of the "Renin-Angiotensin" system in low cardiac states; | Vasoconstriction / NA+ retention |
| Common cause of Isolated RHF is? | Emphysema |
| Common signs of RHF? | Swollen puffy legs / Enlarged liver / Distended neck veins |
| HOCM is a? | Genetic disorder with hypertrophied and hypercontractile LV |
| New York Heart classification: | I No undue symptoms with normal activites II Comfortable at rest, slight fatique III Comfortable at rest, symptoms with activity IV Symptoms at Rest |
| Rare form of heart failure, patient has good pressures: | High output HF |
| CHF patient must sit up to get his breath, this is called? | Orthopnea |
| Diuretics in the treatment of congestive heart failure are intended to? | Decrease preload |
| Medical treatment for acute CHF: | Diuretics / Vasodilators |
| Signs of Circulatory Shock: | Cold clammy skin / Collapsed neck veins / Decreased urine output / Hypotension |
| acutely dyspnic anaphylactic shock: | IV fluids / IV epinephrine |
| During Heart/Lung bypass surgery, patients are cooled to reduce metabolic rate. Termed: ____ an body temp is lowered too:____? | Moderate Hypothermia / 24-32 C |
| During CABG surgery, cold KCI cardioplegia solution is used, why? | Infused directly into the coronaries to quiet the heart so surgeons can work, Primary function is to induce Diastolic arrest (flaccid) |
| List the 5 components of a bypass circuit in order 1-8 | Arterial Line and Cannula / Bubble trap and Filter / Arterial Roller pump / Oxygenator and heart Exchanger / Venous Reservoir / Sucker line, pump & filter / Venous Cannula and Return line / Vent Line |
| Arterial pressure of a pt. while on cardiopulmonary bypass? | Sine wave shape / BP around 50mmHg |
| Range of blood flow required for an average Normothermic persion? (perfusionists adjust the pump flow rate to CI of). | 2.0-2.2 L/min/M2 |
| Gold standard treatment for atherosclerotic stenosis of the common carotid bifurcation is? | Carotid endarterectomy |
| What type of Mitral Stenosis surgery is descriped? "Small incision is made in the LA and the surgeons finger pushes through the LA into the tight mitral valve, enlarging it. | Closed Mitral Commissurotomy |
| List 5 types of prosthetic heart valves: | Ball in cage / Disk in cage / Bi-leaflet / Tilting disk / Tissue valve |
| Ball in Cage valve: | Starr valve, longest record, disadv.. is bulky cage so no small hearts used, blood flows around ball. |
| Disk in Cage valve: | One disc pops open, blood flows around all sides, seldom used now |
| Bi-leaflet valve: | St.Jude mechanical valve, most commonly used, |
| Tilting Disk valve: | "toilet seat valve", one disc pivots, low profile and excellent hemodynamic charact.., MORE thrombogenic than Bi-leaflets |
| Tissue valve: | "porcine" or "pig" , least thrombogenic, least durable. |
| Ball in Cage valve inventor: | Starr-edwards, Smeloff, Braunwald |
| Disk in Cage valve inventor: | Hufnagel, Kay-shiley, Beall |
| Bi-leaflet valve inventor: | St judes, Duromedics |
| Tilting Disk valve inventor: | Lillehel, Bjork, Onmiscience |
| Tissue valve inventor: | Carpentier-edwards, Hancock |
| What type of prosthetic valve does NOT usually require anticoagulation? | Tissue valve by Carpentier-edwards, Hancock porcine. |
| What prosthetic valve should be used in the tricuspid position? | Tissue vavle by Carpentier-edwards, Hancock porcine (because tricuspid valve has lowest blood flow, making it more likely to thrombose. Therefore a tissue valve is what you want) |
| Valve from another human: | Homo-graft |
| Valve from the same individual: | Auto-graft |
| Valve from a different species: | Hetero-graft |
| Valve from metal and polycarbons: | Mechanical prosthesis |
| Younger patients with severe mitral valve regurgitation should be treated with? | Mitral Valve repair |
| Surgery for AR on young people, that replaces aortic valve with a pulmonary graft? | Ross procedure |
| A blood abnormality commonly found in pt. with prosthetic valves is? | Hemolytic anemia |
| Mechanical valve with the best flow, and commonly implanted worldwide? | Bileaflet, St jude |
| What type of bypass is the fastest for an emergency RCA bypass? | Saphenous veins |
| List 3 advantages of IMA grafts: | Less atherosclerosis / less intimal hyperplasia / closer in size match to coronaries |
| overall intra-operative mortallity rate for CABG surgeries: | 5% |
| Increasing the CO or flow across a stenosis always ________pressure gradient. | Increases the Diastolic |
Created by:
IdAhOmEyEr
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