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CV 2012 (wk 1-maki)
| Question | Answer |
|---|---|
| what supplies the apex of the heart | anterior interventricular (fr the left coronary) |
| PPParietal PPPericardium is invervated by? | PPPPhrenic (SSSomatic=SSharp) |
| visceral Pericardium | innerv by visceral afferents (dull pain) |
| where can you find B1 | heart and kidney (inc renin!) |
| where can you find b2 | SM (relax) and Liver (glycogenolysis and gluconeogenesis) |
| where can you find b3 | adipose (lipolysis) |
| where can you find a1 | BV, urinary trigone, and iris radial (NE binds a1 and opens pupil!) |
| What does the action potential of SA/AV node look like? | phases 0,3,4...achetylchol-"lean" causes the AP to lean/delay |
| short term BP control? long term BP control? | short=Baroreflex...long=kidneys |
| Whats with Neurofibromatosis? | think pheochromocytoma (inc NE & Epi) and hypertension |
| what makes up CO | HR x SV |
| what makes up SV? | myocardial contraction and venous return |
| what makes up venous return? | Blood volume and venous capacitance |
| what does a Beta blocker effect? | TAKE POST-MI...heart, kidney and CNS |
| 5 densities of radiology (air-fat-soft-mineral-metal) | air=black, fat=dark, soft tissue/fluid=gray, mineral=white, metal=bright white |
| 3 things needed for optimal viewing | "dark. HD Movie theater. Alone" ... i.e. hi resolution, dark, no distractions |
| chest film pattern approach | MD PLOTS (mediastinum, diaphragm, pleura, lungs, osseous structures, trachea, stomach/soft tissue...check size shape position and density |
| why does air appear dark on xrays? | it has a low atomic # so the x ray gets thru easier (Hi energy and low atomic # means more likely to pass thru) |
| hypertensive urgency vs emergency | both have systolic over 180 and diastolic over 120 but the EEEEmergency requires evidence of EEEEnd organ damage |
| normal BP reg system | |
| abnormal BP reg mechanism | |
| treatment of hypertensive urgency | |
| treatment of hypertensive emergency | |
| signs of end organ damage | CV (MI/arm-jaw pain/vom/cough, angina, CHF/edema, aortic dissec/back pain, dec breath, orthopnea); Kidneys (renal fail=oliguria/inc Cr); Neuro (encephalopathy, stroke, hemorrhage); Heme (microangiopathic hemolytic anemia due to shearing forces fr hi BP) |
| assess for cardiac end organ damage by... | auscultate heart, ausc/percuss lungs (effusion/edema), pulse check, inspect neck and legs |
| s4 sound means... | ventrical is stiff during the relaxation phase |
| a lateral film is the only place where you see what part of the heart clearly? | right ventricle |
| Which has LESS magnification: PA or AP Xray? | PA b/c heart is closer to the cassette and xray is 6 ft from the cassette |
| the rt border on a chest film is what structure? | the rt atria! makes up the entire border! |
| compare the mediastinums | superior (above t5), inf has ant (back of sternum to pericardium), middle (pericardium and heart/lymph), and posterior (pericardium to vert) |
| drawing a line from the rt cardiophrenic angle to pulm a separates what on an xray | the aortic and pulmonary from the tricuspid and bicuspid valves |
| how do you determine if the heart is enlarged on a film? | cardiothoracic ration...transverse heart diameter should be less than 50% of the chest diameter (pitfalls=depth of inspir., pectus excavatum, emphysema ie. pulm dis that depress the diaphragm, abd. disease ie. prego/ascites/hepatomegaly, or obesity) |
| Q) rt upper mediastinum on film is composed of | SVC and asc aorta in elderly |
| Q) aortic knob on film is formed by... | jcn of tverse and desc aorta |
| Q)left heart border on film is made of.. | left atrial appendage (rt below pulm a) |
| what imaging studies don't use radiation? | MRI and ultrasound (radiation exposure adds up over your lifetime) |
| which studies use contrast? | similar to radiation effects, can also cause anaphylatic shock.... (didn't mention them...) |
| what is one of the first things that appears on a film with CHF | azigos vein |
| the ventricle in assoc with the sternum | should be at or below 1/3 the sternum (if not=enlarged) |
| what can displace the trachea and surrounding structures? | aortic dissection/aneurysm |
| functional renal insuff | microvasc. renal disease, renal a. stenosis, dehydration, heart failure, and NSAID use |
| how is GFR maintained in a renal a stenosis patient? | the reduced flow in the afferent causes an inc in renin, inc in ang 2, and this causes the efferent to constrict (ACE-I can impair glom. filt. and lead to renal insuff/failure) |
| adverse effects of ACE-I | hypotension, hyperkalemia, anemia (suppress erythropoietin prod.), loss of taste/metal taste, skin rash, angioedema (tongue), cough |
| Captopril causes what side effects.... | loss of taste/metallic taste, skin rash ...sulfur in this drug, twice a day drug |
| why does angioedema and cough occur with ACE-I | they inc the bradykinen levels and subs P |
| ARBs end in... | -sartan |
| the one renin inhibitor | Aliskiren ("-ren"in)---can use alone for HPTN or in combo with others |
| ARBs adverse effects.. | same as ACE-i (renal insuff, hypotension, hyperkalemia, don't use with bilat renal a stenosis and pregnancy) |
| Non-selective alpha blockers | phentolamine and phenoxybenzamine |
| selective alpha 1 blockers | -osins (Prazosin, Terazosin, Doxazosin) |
| drugs for BPH | tamsulosin and alfuzosin (alpha1 blockers) |
| alpha 1 blockers trigger what compensatory mechanisms? | reflex tachy and renin release |
| 1st line drug tments for HPTN | diuretics, b blockers, CCB, ACE-i, ARBs, Renin inhib |
| 2nd line drugs or for hypertensive u/e | a antag, a/b antags, centrally acting a2 agonists, adrenergic neuron blocking agents, direct vasodilators |
| adverse effects of a antags | orthostatic HPTN, reflex tachy, edema, headache, wkness, dizziness |
| an a and b antag | LABETALOL, carbedilol/bucindolol (check heart failure lecture) |
| labetalol acts as a partial agonist for what receptor | b2...competes with NE |
| centrally acting a2 agonists | activates a2 which inhibits symp in CNS vasopressor centers of brainstem (lipid soluble to cross BBB)---methyldopa and clonidine |
| what do you use on pregos | methyldopa |
| adverse effects of centrally acting a2 agonists | think clonidine....sedation, dry mouth, depression(5ht), impotence |
| what drug gives + coombs test | methyldopa...checking for hemolytic anemia |
| what effects occur with abrupt stop in clonidine | rebound HPTN, nervousness, tachy, headache, sweating |
| adrenergic neuron blocking agents | obsolete (guanethidine, reserpine--dec NE/5HT NTs, guanadrel) |
| direct vasodilators | hydralazine (IV/HPTN emergencies), minoxidil, nitroprusside |
| which direct vasodilators affect arteries and which do arteries/veins | arteries (hydralazine, minoxidil), arteries and veins (nitroprusside)---> compensatory systems are activated and BP inc again (stop by using a b blocker) |
| minoxidil mech of action | activate K on arterial SM = hyperpolarization = arterial SM relaxation |
| adverse effects of hydralazine | LUPUS-like, fever, arthralgia, skin rashes....vasodil/hypotension (which then gives us = flush, headaches, sweat, nausea, dizzy, angina..) |
| adverse effects of minoxidil | hypertrichosis (abn hair growth!) |
| nitroprusside mechanism | NO -> inc cGMP -> arterial & venous vasodilation |
| when to use nitroprusside | HPTN emergency! and controlled hypotension during surgery....IV infusion=rapid action/short duration |
| adverse effects of nitroprusside | cyanide and thiocyanate tox, hypotension (headache, nausea, vom, dizzy, palpitations) |
| drugs for hypertensive urgency | ACE-i (captopril = short), a2 agonist (clonidine = short), a/b blocker (Labetalol), CCB (Nifedipine----dont use this!) |
| CI for labetalol | asthma and heart failure (dec. inotropy) b/c its an a/b blocker |
| CI for captopril | renal a. stenosis, can inc K = arrhythmia = death |
| what drugs are used for HPTN fr excess catecholamine excess | phentolamine and nicardipine....(don't use b blocker alone with a pheochromocytoma!!) |
Created by:
BrittanyBeland