Cardiology

Question 1

Indications of Reperfusion following PCI or fibrinolysis

Answer 1

• Pain cessation
• Reversal of ST segment elevation with return to baseline
• short runs of ventricular tachycardia

Question 2

Anterior Wall MI

Answer 2

• Acute Anterior STEMI
  
  • LAD occlusion
  • Likely results in ventricular septal defect (VSD)
  • Murmur at Left Sternal Border
  • ST elevation in V2, V3, and V4
• Rhythm change
  
  • Second degree, Type II heart block possible (Mobitz)
• Medications
  
  • Beta Blocker (cardioselective) beneficial (Metoprolol)
  • Anti-platelet (aspirin)
  • Anticoagulant (heparin)

Question 3

Propanolol (Inderal)

Answer 3

• Beta-adrenergic blocker (NOT cardioselective)
• Affects beta receptors in heart muscle and lung tissue
• More likely to cause bronchoconstriction

Question 4

Second Degree, Type II (Mobitz)

Answer 4

• Often develops after acute anterior MI, generally due to occlusion of LAD (left anterior descending artery)
• LAD supplies the HIS-Purkinje system (HIS bundle)
• Conduction disease in HIS bundle is irreversible (not subject to autonomic tone or AV blocking medications)
• Permanent pacemaker indicated

Question 5

Inferior Wall MI

Answer 5

• Acute inferior STEMI
  
  • RCA occlusion may result in an RV infarct
  • Right Coronary Artery (RCA) occlusion
    
    • Result in papillary muscle dysfunction or rupture of the mitral valve
    • Supplies area of the left ventricle where mitral valve is attached
    • Acute mitral regurgitation
    • Does NOT result in systolic murmur at apex of heart or lung crackles
  • RIght-sided ECG may help confirm RV infarct
• Rhythm change
  
  • Due to SA node or AV node ischemia
    
    • Sinoatrial block
    • Second degree, type I (Wenkebach)
    • Third degree, complete
• Treatment
  
  • Development of complete heart block : Assess. If serious S/S develop, begin transcutaneous pacing (TCP)

Question 6

Dilated Cardiomyopathy

Answer 6

• Results in systolic dysfunction
  
  • ↓ contractility
  • Compensatory arterial constriction
  • Results in higher left ventricular preload
• Therapy aimed at…
  
  • ↑ contractility
  • ↓ afterload (arterial constriction)
  • ↓ preload that is too high

Question 7

Electrolytes that may cause QT prolongation

Answer 7

• ↓ magnesium
• ↓ potassium
• ↓ calcium
  
  • QT prolongation may result in torsades de pointes ventricular tachycardia
  • If self limiting, may result in transient syncopal episode

Question 8

Retroperitoneal Bleeding

Answer 8

• Causes signs of hypovolemia and hypovolemic shock
• Complication of a PCI
  
  • Femoral artery access site
• Back Pain

Question 9

Dressier’s Syndrome

Answer 9

• Type of pericarditis
  
  • Inflammation of the sac surrounding the heart (pericardium)
• Results after an acute MI
• Believed to be an immune system response after damage to heart tissue or to pericardium

Question 10

Mitral Valve Regurgitation

Answer 10

• Murmur at the apex of the heart (midclavicular, 5th ICS)
• Occurs when the valve should be closed
• S/S
  
  • Shortness of breath
  • Recurrence of chest pain
  • Loud systolic murmur at apex of heart
• Mitral valve should be closed during systole

Question 11

Permanent Pacemaker

Answer 11

• First letter indicates chamber paced
• Second letter indicates chamber sensed
• Third letter indicates response to sensing

Question 12

Cardiogenic Shock

Answer 12

• Results in ↓ CO with resultant drop in coronary artery perfusion and compensatory vasoconstriction
• IABP therapy

Question 13

Intra Aortic Balloon Pump (IABP Therapy)

Answer 13

• Deflation of balloon placed into descending aorta is beneficial
• Deflation = ↓ afterload & ↓ work of the left ventricle
• Inflation of the balloon is beneficial because it “boluses” blood into the coronary arteries
• Inflation = ↑ diastolic augmentation & ↑ perfusion

Question 14

Percutaneous Coronary Intervention (PCI)

Answer 14

• Addresses cause of the problem, not only treat signs and symptoms

Question 15

Hypertrophic Cardiomyopathy

Answer 15

• Problem with filling
• Diastolic dysfunction
  
  • NOT a problem with ejection, EF is normal
• Drug therapy
  
  • Beta blocker (Metoprolol)
    
    • Decrease heart rate to ↑ filling time

Question 16

Ventricular Septal Defect (VSD)

Answer 16

• Holosystolic murmur @ Left Sternal Border

Question 17

Right Ventricular Infarct

Answer 17

• Right-sided ECG may help confirm
• S/S:
  
  • hypotension
  • clear lungs
  • jugular vein distention (JVD)

Question 18

Acute Inferior STEMI Treatment

Answer 18

• Definitive treatment: Emergent PCI
• Fluid administration
  
  • ↑ coronary artery perfusion
    • correcting hypotension
    • ensure adequate RV preload

Question 19

What medication is contraindicated for a patient with heart failure due to diastolic dysfunction?

Answer 19

Digoxin

Question 20

Heart Failure (Diastolic dysfunction)

Answer 20

• Problem with FILLING, not ejecting
• S/S
  
  • hypertension
  • left ventricular hypertrophy
  • EF > 40%

Question 21

Digoxin

Answer 21

• Positive inotrope
• ↑ wall stress
• Worsen filling of the left ventricle

Question 22

NYHA Heart Failure Class

Answer 22

Question 23

Chronic Right-Sided Heart Failure

Answer 23

• Clinical S/S
  
  • Jugular Venous Distention (JVD)
  • Peripheral edema
  • Abdominal discomfort
  • *** JVD occurs in Acute RS HF but not peripheral edema and abdominal discomfort. Those are due to liver engorgment.***

Question 24

Cardiac Tamponade

Answer 24

• S/S
  
  • Sudden drop in B/P
  • Distended neck veins (JVD)
  • Muffled heart tones
  • Pulsus paradoxus
  • ​Minimal chest tube output (S/P CABG patient)
• Treatment
  
  • Emergent pericardiocentesis to drain fluid
  • Emergent return to OR (S/P CABG patient)

Question 25

Left Ventricular Failure S/S

Answer 25

* Bibasilar crackles * Tachypnea * Frothy Sputum

Question 26

Pulsus Paradoxus

Answer 26

* Systolic pressure that fluctuates with breathing pattern by more than 12 mmHG * Best seen with arterial line * Inspiration increases thoracic pressure * Combined with fluid surrounding the heart in cardiac tamponade, inspiration further decreases venous return to the heart, leading to drop systolic pressure by \> 12mmHg during the inspiratory phase

Question 27

Pulsus Alternans

Answer 27

* Change in amplitude of the systolic waveform from beat to beat * Indicative of severe left ventricular failure

Question 28

Pulsus Magnus

Answer 28

Bounding pulse

Question 29

Atrial Fibrillation

Answer 29

* Even with normal B/P, development of Afib drops CO by 20% to 25% * loss in "atrial kick" provided by normal sinus rhythm * Treatment/therapy * Cardiac glycoside (such as digoxin) * Weak positive inotrope * May compensate for loss of atrial kick * Calcium-channel blockers * Keep the rate controlled

Question 30

Left Ventricular Systolic Dysfunction S/S

Answer 30

* S3 * Indicative of high left ventricular pressure * Cough * Bibasilar crackles * Sign of pulmonary edema secondary to ↑ left ventricular end diastolic pressure (PAOP) * EF \< 40%

Question 31

Acute Coronary Syndrome

Answer 31

* Interventions * Start fluid bolus * Give chewable aspirin * ECG (needed to help make diagnosis)

Question 32

Heart Valves during Systole (left ventricular ejection)

Answer 32

Aortic Valve = Open (allowing for ejection) Mitral Valve = Closed

Question 33

Heart Valves during Diastole (filling)

Answer 33

Aortic Valve = Closed Mitral Valve = Open

Question 34

Dopamine

Answer 34

Low dose ( \< 10 mcg/kg/min) = Affect mainly beta-1 receptors in the heart, producing a positive inotropic effect High dose ( \> 10 mcg/kg/min) = Stimulates alpha receptors in artiers and causes vasoconstriction