2. Estimate CO w/ a Pts PP (pulse pressure) and HR?
3. What is the avg value for CO?
1. CO= HR x SV
2. 2 x PP x HR = CO
3. Avg value is 4900 ml
Cardiac Stroke Volume?
EDV -subtracted from- ESV
End Diastolic Volume (EDV) - End Systolic Volume (ESV)
Avg Value is: 70 ml
The Cardioregulatory Neurotransmitters are?
Acetycholamine (Ach)
- Slows HR/ reduces Stroke Volume
- Released by Parasympathetic system
Norepinephrine (NE) & Epinephrine
- Increase HR/Stroke Volume
- Released by sympathetic neurons
The ________ can provide "input" by allowing emotion, fear, anxiety to affect HR.
Hypothalmus
The 4 anatomical landmarks for the Cardiovascular system.
Aortic- 2nd RICS
Pulmonary- 2nd LICS
Tricuspid- 4th LICS
Mitral/PMI- 5th LICS MCL
"APT M"
Claudication
exercise induced lower extremity pain, relieved by rest
Normal Heart sounds
S1 (Lubb) : Closure of AV Valves = Systole (Diaphram)
S2 (Dubb) : Closure of Semilunar valves = Diastole (diaphragm)
Extra Heart Sounds
S3 : Rapid Ventricular Filling (Left Ventricle failure) (Use bell) *Patho in older and Physio in younger*
S4 : Forceful atrial ejection into a distended ventricle (L Ventricle Hypertrophy) *seen in CHF and constrictive conditions*
Murmurs: Valvular pathology
Rubs: Pericarditis
*Think HTN or CHF if S3 or S4 are present*
Physiologic splitting of S2
Delayed closure of pulmonary valve ; Normal variant if noted on INSPIRATION but may be pathogenic if noted on EXPERATION.
Dyslipidemia:
LDL >160 mg/dL
HDL <35mg/dL;
Subtract 1 risk factor if HDL >60
Artherosclerosis
Plaque formation within the ARTERIAL linings and structures. NOT the veins. Associated w/ DYSLIPIDEMIA and LDL's
Hyperlipidemia Causes:
Primary = Genetic
Secondary = HYPERTHYROIDISM (1 of leading causes)
Diet, Obesity, Excess ETOH intake,
Pregnancy, Obstructive Liver disease, MEDS
TLC
"Therapeutic Lifestyle Changes":
-Decreased fat/cholesterol intake,
-Diet adjustments,
-Increases PT,
-Stop smoking, etc.
The most common etiology of Ischemic heart Disease is ?
Artherosclerosis
Desirable Lipid Levels on a Random Screeen
Total Cholesterol <200 mg/dL
TG <200 mg/dL
LDL <160 mg/dL
HDL >35 mg/dL
T or F
ALL Cholesterol medications cause GI irritation & Niacin uniquely causes skin flush & itch. (Cholesterol Meds = Bile Acid, Sequestrants, Fibrates, Niacin, Statins)
TRUE
Rhabdomyolysis
Acute, potentially fatal skeletal muscle condition characterized by SKELETAL MUSCLE DESTRUCTION (Myoglobinuria & CK elev. 10X normal)
Complications include: Hyperkalemia, Cardiomyopathy, DIC, Hyperuricemia, Resp. &/or renal failure, metabolic acidosis (This is a concern with any “statin” drug therapy)
Fixed corneal clouding from hypercholesterolemia, most likely in adolescents ?
Arcus Juvenilis
Myotoxicity S/Sx
Gradually decreased muscle strength & localized or generalized muscle weakness *These S/Sx happen early or delayed in disease process*
T or F
Lipid levels may effect the evaluation of Glucose & Uric Acid?
TRUE
Critical Stenosis
75% (or greater) of the lumen of 1 or more coronary arteries are obstructed by artherosclerotic plaque.
Do you need to have cath studies to make a differential Dx of Coronary Artery Disease or Atherosclerosis?
NO!
Angina Pectoris and it's 3 types?
Intermittent Chest Pain caused by reversible ischemia.
-Typical (STABLE) = Onset w/ the "4 E's" (eating, exercise, emotional, environmental) relieved w/ rest or NTG
Development of a defined area of myocardial necrosis caused by local ischemia. Leading single cause of death in industrialized nations.
AMI Intial Management:
MONA-IV
Morphine – 2-4 mg IV if pain not relieved post 3 sublingual NTG tabs
O2 via nasal cannula 2-4 L/Min.
NTG (sublingual or spray) 0.4 mg q 5 min (unless syst. B/P <90)
ASA 325 mg. (chewed & swallowed)
IV
Pericarditis
Most often viral etiology = Acute syndrome caused by inflammation of the pericardium & characterized by chest pain, distinctive ECG changes & a pericardial friction rub on PE.
Rheumatic Fever
Inflammatory disease resulting from untreated GROUP B SSTREP (GABS) Pharyngitis
Key clinical Features = S/Sx occur weeks after pharyngitis, Migratory Joint Pain (most common initial presentation), Erythema Marginatum, carditis/murmur, SQ Nodules, Chorea (involuntary, irregular movements)
T or F
Always rule out Thyroid Disease & OTC’s as secondary causes of HTN?
TRUE
Pericarditis Clinical Manifestations
1) Preceding URI 2) Fever, myalgias, fatigue 3) Pericardial Friction Rub 4) ECG Changes (ST elev., PR seg depression) 5) Sudden onset chest pain: Aggravated by swallowing, decreased w/ sitting/leaning forward, Retrosternal, Pleuritic, Radiation to trapezius/neck region
Rheumatic Fever TX?
Penicillin (PO/Parenteral)
Cephalosporins
Corticosteroids (If carditis present)
Salicylates (If carditis present)
Secondary Prophylaxis x 5 years = Pen VK daily, Benzathine Pen G IM q 4 weeks
"PCS"
PE will present with?
A) Beck’s Triad (Elev. JVP, systemic hypotension, muffled heart sounds)
B) Pulsus Paradoxis (10 mm/hg drop on inspiration)
C) Tachypnea
D) Tachycardia
Basic Pericarditis management ?
Indocin, Ibuprofin, Naprosyn
Aortic Dissection
Intima tear with entry of blood into the media. "Dissects" between the intima and adventia. #1 site is at the ascending aorta at the ligamentum arteriosum. Abrupt and severe. “Tearing/Ripping” Pleuritic Chest Pain usually w/ a Hx of untreated HTN, CXR shows widened mediastinum, indistinct aortic knob.
Nausea, Vomiting, Diaphoresis is common.
#1 Risk factor for PE
Prior DVT/PE
Cardiac Tamponade
Is a complication of Pericarditis w/ - Increase in pericardial fluid volume – Impaired ventricular filling – Decreased cardiac output. Physical Exam findings of “Becks Triad” (JVD, Muffled heart sounds, Hypotension) Pulsus Paradoxus. TX: Pericardiocentesis if severe & volume expanders w/ Vasopressors (Dopamine) if less severe.
Aortic Disection TX:
Lower Systolic BP to 100-110 mmHg, HR 60-80, Decrease LV contractility
A) Nipride + Esmolol
B) Labetolol
Early CT surgery involvement
Infective Endocarditis
Is a complication of Pericarditis w/ - Increase in pericardial fluid volume – Impaired ventricular filling – Decreased cardiac output. Physical Exam findings of “Becks Triad” (JVD, Muffled heart sounds, Hypotension) Pulsus Paradoxus. TX: Pericardiocentesis if severe & volume expanders w/ Vasopressors (Dopamine) if less severe.
Obstructive inflammatory diesese of superficialdistant arteries, usually involves digits of hands and toes. Numbness, tingling, and pain. Typical Male "Heavy Smoker". Signs of Pallor, ulcerative, gangrenous tissue change. Directly linked to NICOTINE!
Virchow’s Triad:
1) Venous Stasis: prolonged travel, bed rest, etc.
2) Hypercoagulabillity: pregnancy, estrogen therapy, protein deficiency
3) Endothelial Damage: Recent surgery, trauma
Pulmonary Embolism TX:
Consider? Monitor, O2, Pulse Ox, IV
1) Anticoagulate first
2) Low molecular wt Heparin
Spontaneous Pneumothorax
Thought to result from a rupture of a sub pleural Bleb. symptoms vary w/ size and rate of progression.
