adult health cardiac

which valves close during systole

mitral and tricuspid

which valves close during diastole

aortic and pulmonic valves

preload

volume in ventricles when full

afterload

resistance to ejection of blood from ventricle

factors affecting myocardial contractility (3)

oxygen supply, stretching, inotropic stimuli of the ventricles

what helps determine which type of HF is occuring

ejection fraction

EF in diastolic HF

normal or 40-50%

EF in systolic HF

less than 40%

where is renin produced

kidneys

where is angiotensinogen prodcued

liver

HF cycle

decreased cardiac output, sympathetic nervous system causes vasoconstriction, RAAS, increased preload and afterload, ventricular remodeling

characteristics of systolic HF (5)

weakened heart muscle, impaired blood pumping, incomplete emptying of ventricles, decreased SV, increased L ventricular pressure

systolic HF causes

ischemic or idiopathic dilated cardiomyopathy

characterisitcs of diastolic HF (4)

stiff heart muscle, preserved EF, impaired filling of blood, leads to pulmonary HTN

causes of diastolic HF

hypertensive, hypertrophic, or restrictive cardiomyopathy

left sided heart failure is characterized by (4)

impaired left ventricular function, pulmonary congestion, interstitial edema and impaired gas exchange

Right sided heart failure is characterized by… (2)

impaired right ventricular function, congestion of peripheral tissues

what does right sided heart failure lead to (2)

JVD, increased venous pressure

left sided HF signs and symptoms (8)

dyspnea, orthopnea, cough, rales, S3 heart sound, frothy sputum, decreased organ perfusion, drowning

right sided heart failure signs and symptoms (7)

JVD, pitting edema, abdominal distention, fatigue, polyuria, weight gain, swelling

how do diuretics treat HF

reduces fluid volume/preload. Should be used in combination with other medications.

diuretic examples

-ide, spironolactone

what do inotropes do

increase contractility

positive vs negative inotrope

positive increase workload and negative decrease workload

inotropes adverse effects

arrythmias, confusion, anorexia

examples of positive inotropes

digoxin, dobutamine, dopamine, milrinone

examples of negative inotropes

beta blockers, calcium channel blockers, antiarrhythmics

how do neprilysin inhibitors work

mimics BNP, results in diuresis and vasodilation. this reduces preload and afterload

neprilysin inhibitor example

sacubitril

neprilysin inhibitors considerations

used in combination with ARBs, cause hypotension

vasodilators/nitrates action

arterial and venous smooth muscle relaxation

vasodilators/nitrates examples

hydralazine, minoxidil, nitroglycerin

ARBs action

secrete aldosterone, this decreases sodium and water retention, lowering blood volume. this reduces preload and afterload

who are ARBs good for

those who cannot tolerate ACE inhibitors

aldosterone receptor antagonist action

eliminate sodium and water, retain potassium

effects of aldosterone receptor antagonist

angioedema and hypotension

additional cardiac therapies

ultrafiltration, cardiac resynchronization therapy, implantable defibrillators, ventricular access devices, heart transplant

aldosterone receptor antagonist example

eplerenone

cardiogenic causes of pulmonary edema

HF, MI, severe hypertension, valve problems

noncardiogenic causes of pulmonary edema

PNA, sepsis, high altitude exposure, renal failure, ARDs

pulmonary edema manifestations

frothy sputum that may be blood tinged, clammy skin, tachycardia, crackles, cyanosis

HIWINDS RF symptoms

headache, increased temperature, weakness, irritability, nausea, swollen glands, sore throat

major jones criteria

joints, heart (carditis, valve damage), nodules, erythema marginatum, sydenham chorea

minor jones criteria

previous rheumatic fever, ECG with PR prolongation, arthralgias, high CRP and ESR, elevated temperature

acute vs subacute infective endocarditis

acute is days-weeks and is a higher fever, subacute is weeks-months and is lower fever

which microorganism typically causes infective endocarditis

staphylococci

IE signs and symptoms SPINACH

spleen and heart enlargement, pain in back and joints, inc HR, night sweats, nausea, anorexia, chills/fever, heart murmur/failure

other IE symptoms (6)

abdominal discomfort, janeway lesions, osler nodes, roth spots, splinter hemorrhages, CNS manifestations

major Dukes criteria

positive blood culture, evidence of endocranial involvementm

minor dukes criteria

predisposing cardiac conditions, IV drug use, persistent fever with no alternative cause, systemic or pulmonary embolism, osler nodes, roth spots

myocarditis signs and symptoms FEED SAD JIM

fever, elevated ESR, edema, dilated cardiomyopathy, sudden HF or cardiogenic shock, arrythmias/S3, dyspnea, JVD, inc HR/RR, myalgias and fatigue

what is used to confirm myocarditis diagnosis

endomyocardial biopsy

causes of pericarditis

MI, infection, cancer, chest trauma, radiation, autoimmune, meds (procainamide, hydralazine, isoniazid)

signs and symptoms of pericarditis

mild fever, inc WBC, anemia, inc ESR and CRP, non productive cough, dyspnea unrelated to exertion, cardiogenic shock

pericarditis diagnostics

pericardial friction rub, pleuritic chest pain, pericardial effusion, 12 lead ECG with widespread ST elevation

pericarditis treatment

first line is NSAIDS and aspirin, colchicine is paired with NSAIDS for recurrent pericarditis

total cholesterol range

less than 200

triglycerides range

less than 150

HDL normal range

greater than 40

LDL normal range

less than 100

hyperlipidemia meds criteria

LDL over 190, evidence of CAD, DM with LDL over 70

statins side effects

myalgias, inc liver enzyme levels, inc blood sugar

statins contraindications

liver disease, pregnancy and lactation

nicotinic acid (niacin) side effects

flushing, inc blood sugar, inc uric acid, upper GI distress, hepatotoxicity

niacin contraindications

gout, liver disease

fibric acid examples

fenofibrate, gemfibrozil, fenofibric acid

fibric acid side effects

dyspepsia, rash, gallstones, fatigue

fibric acid contraindications

severe kidney and liver disease

negative myoglobin results meaning

MI is ruled out

high CK-MB meaning

cardiac cell damage has occured

why cant metformin be taken after PCI

because iodine is used in PCI and iodine with metformin is too much for the kidneys

secondary HTN risk factors

kidney disease, cushings disease, primary aldosteronism, pheochromocytoma, brain tumors, encephalitis

MAP range

70-100

MAP in end organ ischemia

less than 65

MAP when there is no cerebral or coronary artery perfusion

less than 60

how to calculate MAP

SBP + 2(DBP) over 3

HTN manifestations

HA, flushing, dizziness, fainting, visual disturbances, epistaxis, nocturia, polyuria