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