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Patho

QuestionAnswer
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