CARDIOVASCULAR -- BARRON'S CCRN|UPDATED&VERIFIED|100% SOLVED|GUARANTEED SUCCESS

S3 occurs where and when? heard best at the apex of the heart right after S2 what is S3 associated with? Heart failure, Pulmonary hypertension, cor pulmonale, and mitral/aortic/tricuspid insufficiency what is S3? rapid rush of blood into a dilated ventricle what is S4? atrial constriction of blood into a non-compliant ventricle Where and when does S4 occur? Best heard over the apex with the bell right before S1 what is s4 associated with? myocardial ischemia, infarction, hypertension, ventricular hypertrophy, aortic stenosis Pericardial friction rub is associated with what? Pain during deep inspiration and positional pain Pulse pressure equation systolic - diastolic = pulse pressure normal pulse pressure values 40-60 systolic BP represents what? Cardiac output and stroke volume what does a decrease in systolic pressure mean if diastolic doesn't change? This = narrowing pulse pressure. Seen often with severe hypovolemia or a severe drop in Cardiac output. diastolic BP represents what? Systemic vascular resistance (SVR) what does a decrease in diastolic BP mean? this = widening pulse pressure. May indicate vasodilation, severe sepsis, septic shock. time ratio for systolic vs. diastolic 1.0/1.33 what is perfused during diastole? Coronary arteries causes of valvular heart disease - coronary heart disease - dilated cardiomyopathy - Degeneration - Bicuspid aortic valve - Rheumatic fever - Infection - Connective tissue diseases murmurs of insufficiency are? regurgitation when the valve is close murmurs of stenosis are? regurgitation when the valve is open are these murmurs acute or chronic? Stenosis = chronic Insufficiency = acute or chronic systolic murmurs sound like what? lub...shhhhh...dub what are the valves doing during a systolic murmur? aortic and pulmonic valve stenosis (they are open) Mitral and tricuspid insufficiency (they are closed) how does a mitral valve insufficiency show up on a pulmonary artery catheter? giant v waves what other defect can cause systolic murmurs? ventricular septal defect (heard on the left sternal border) what do diastolic murmurs sound like? lub...dub...shhhhh what are the valves doing during diastolic murmurs? aortic/pulmonic insufficiency (closed) Mitral/Tricuspid stenosis (open) mitral valve stenosis is particularly associated with what? atrial fibrillation due to atrial enlargement grades of acute MI grade 1/2 -- papillary muscle dysfunction grade 5/6 -- papillary muscle rupture (emergency) unstable angina = chest pain at rest, unpredictable relievers for Unstable angina? what do labs look like? ECG? Nitroglycerin. Troponin negative. ST depression or T wave inversion. NSTEMI labs? ECG? Relievers? troponin positive. ST depression or T wave inversion. Unrelenting pain. STEMI labs? ECG? Relievers? Troponin positive. ST elevation in 2 or more contiguous leads. Unrelenting chest pain Prinzmetal's angina = unstable angina w/ transient ST elevation What causes prinzmetal's angina? Right coronary artery spasms w/ or w/o atherosclerotic lesions. Prinzmetal's pain & relief? Labs? Pain at rest/cyclic. Nitroglycerin to change ST wave. Troponin negative. what may precipitate prinzmetal's angina? ETOH, nicotine, cocaine ingestion. Management of chest pain - Stat ECG and read within 10 minutes - aspirin - Anticoagulants - Antiplatelet agents - Beta Blockers - Treat pain what should one do w/ aspirin? chew it (improves morbidity and mortality)