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