Cardiology Quiz: Hemodynamics and Heart Sounds

Questions and Answers

What is the primary hemodynamic effect of dopamine >10 mcg/kg/min?

Increase afterload (correct)

Increase contractility

Decreased afterload

Increase preload

Decrease contractility

Decrease preload

What causes the S3 sound?

Pulmonary hypertension and cor pulmonale; Mitral, aortic, or tricuspid insufficiency.

When are coronary arteries perfused?

During diastole.

What may you hear before crackles when a patient is going into heart failure?

S3 heart sound. Signup and view all the answers

What is variant or Prinzmetal's angina?

Unstable angina with transient ST segment elevation. Signup and view all the answers

What type of MI is indicated by changes in leads II, III, aVF?

Inferior MI. Signup and view all the answers

What type of MI is indicated by changes in leads V1, V3, V4?

Anterior MI. Signup and view all the answers

What type of MI is indicated by changes in leads V5, V6, I, aVL?

Lateral MI. Signup and view all the answers

What type of MI is indicated by changes in leads V5, V6?

Low lateral MI. Signup and view all the answers

What type of MI is indicated by changes in leads I, aVL?

High lateral MI. Signup and view all the answers

What type of MI is indicated by changes in leads V1 and V2?

Posterior MI. Signup and view all the answers

What type of MI is indicated by changes in leads V3R, V4R?

Right ventricular infarct. Signup and view all the answers

What are some signs of reperfusion following fibrinolytic treatment of a STEMI?

Marked elevation of troponin, resolution of ST segment deviations, chest pain relief. Signup and view all the answers

What should you do if a patient experiences unrelenting chest pain and ST elevation after PCI?

Contact the physician; could be coronary artery re-occlusion/stent thrombosis. Signup and view all the answers

What is happening if a patient has severe back pain and hypotension after PCI?

Retroperitoneal bleeding. Signup and view all the answers

What is a normal ankle-brachial index (ABI)?

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How should you care for the affected extremity in a patient with PAD after bypass graft?

Do not elevate the affected extremity; put the bed in reverse Trendelenburg. Signup and view all the answers

What deadly rhythm can prolonged QT lead to?

Torsades de Pointes. Signup and view all the answers

What are causes of prolonged QT interval?

Amiodarone, Haldol, Quinidine, Procainamide, low magnesium, calcium, or potassium. Signup and view all the answers

What do you do if a pacemaker patient goes into V-tach and becomes unresponsive?

Administer Amiodarone 150 mg IV over 10 min; prepare for elective synchronized cardioversion. Signup and view all the answers

What are signs of right-sided heart failure?

Jugular vein distention, ascending dependent edema, weight gain, hepatomegaly. Signup and view all the answers

What are signs of left-sided heart failure?

Shortness of breath, crackles, oliguria, frothy sputum, displaced apical pulse. Signup and view all the answers

What is a Ventricular Assist Device (VAD)?

A mechanical pump that helps the ventricles pump blood. Signup and view all the answers

What is the function of IABP?

Inflates to increase coronary artery perfusion and deflates to decrease afterload. Signup and view all the answers

What are complications of CABG?

Tamponade, pericarditis, increased bleeding risk due to heparin dose. Signup and view all the answers

What are signs of cardiac tamponade?

Narrowed pulse pressure, hypotension, distended neck veins, diminished heart sounds (Beck's triad). Signup and view all the answers

What is the normal PAWP (pulmonary artery wedge pressure)?

4-12 mmHg. Signup and view all the answers

What does a PAWP of 1-3 mmHg mean?

Hypovolemia. Signup and view all the answers

What does a PAWP of >12 mmHg indicate?

Hypervolemia. Signup and view all the answers

What is considered anatomic dead space?

Air within the trachea, pharynx, larynx, bronchi, and nasal passages. Signup and view all the answers

What causes alveolar dead space?

Pulmonary embolism. Signup and view all the answers

How should you position a patient with left-sided pneumonia?

Good lung down. Signup and view all the answers

What is the normal V/Q ratio?

0.8. Signup and view all the answers

What is a pathologic shunt?

Refractory hypoxemia due to blood passing through the lungs without being oxygenated. Signup and view all the answers

What is the normal level for carbon monoxide?

0-5%. Signup and view all the answers

What are contraindications to NIV (BiPAP/CPAP)?

Suspected pneumothorax, hemodynamic instability/life-threatening arrhythmias, secretions/aspiration risks. Signup and view all the answers

What is indicated for patients with increased WOB/hypoxic respiratory failure?

CPAP. Signup and view all the answers

What is indicated for patients who need both ventilation and oxygenation?

BiPAP. Signup and view all the answers

What is the treatment for status asthmaticus?

High flow oxygen, inhalation of salbutamol, IV hydrocortisone, and oral prednisolone. Signup and view all the answers

What are ventilator considerations for a patient in status asthmaticus?

Use low rate to increase exhalation time, low tidal volumes to prevent auto-PEEP. Signup and view all the answers

What does a silent chest indicate?

Serious airflow obstruction or pneumothorax; intubation may be necessary. Signup and view all the answers

What could a patient developing petechiae, cough, low-grade fever, and anxiety after a femur fracture indicate?

Fat emboli. Signup and view all the answers

What are common causes of non-cardiogenic pulmonary edema?

ALI and ARDS. Signup and view all the answers

Should steroids be used in ARDS?

False Signup and view all the answers

What is the plateau pressure limit in ARDS?

Limit to 30 or less. Signup and view all the answers

What should Vt be limited to in ARDS?

4-6 ml/kg. Signup and view all the answers

Is tension pneumothorax worse than regular pneumothorax?

True Signup and view all the answers

What are the signs and symptoms of regular pneumothorax?

Tracheal deviation toward affected side, decreased/absent breath sounds, hypoxia, unequal chest excursion, chest pain, shortness of breath. Signup and view all the answers

Where should the ETT be placed?

3-5 cm above carina. Signup and view all the answers

What is the typical Vt for a patient?

8-10 ml/kg. Signup and view all the answers

Which cranial nerve is responsible for swallow and gag reflex?

Cranial nerve IX. Signup and view all the answers

What do you check to assess cranial nerve III?

Check pupils for pupillary response. Signup and view all the answers

If a patient has a right-sided head injury, where would you expect a blown pupil?

On the right side. Signup and view all the answers

If a patient has a right-sided head injury, where would you expect a positive Babinski reflex?

On the left side. Signup and view all the answers

What does a positive dolls eyes reflex indicate?

This is a good sign. Signup and view all the answers

Is it bad if the eyes do not move with the dolls eyes maneuver?

True Signup and view all the answers

Is the oculovestibular reflex a good sign?

True Signup and view all the answers

What kind of neuro problem indicates hyperventilation?

Midbrain problem. Signup and view all the answers

What type of neuro problem indicates apneustic breathing?

Pontine problem. Signup and view all the answers

What kind of neuro problem does ataxia indicate?

Medulla problem. Signup and view all the answers

If your patient has a left-sided stroke, where may his eyes deviate?

Toward the pathology. Signup and view all the answers

If a patient is having hemianopsia in the left eye, what kind of stroke did they have?

Left-sided stroke. Signup and view all the answers

In an uncal herniation, what will you see first, LOC change or blown pupil?

Blown pupil. Signup and view all the answers

What is the most common cause of uncal herniation?

Epidural hematoma in the temporal area. Signup and view all the answers

What happens in central herniation?

Swelling on both sides and downward displacement of hemispheres. Signup and view all the answers

What are signs of pontine stroke?

A) Apneustic breathing, B) Pinpoint pupils, C) Parasympathetic innervation. Signup and view all the answers

Why is Decadron given in neuro cases?

To prevent elevated intracranial pressure. Signup and view all the answers

What is the first sign of increased ICP?

Decreased level of consciousness. Signup and view all the answers

What is considered a normal ICP?

0-10 mmHg. Signup and view all the answers

How to calculate cerebral perfusion pressure?

CPP = MAP - ICP. Signup and view all the answers

What is the average CPP?

80-100 mmHg. Signup and view all the answers

What does high ICP with hypotension indicate?

Very bad results in poor cerebral perfusion. Signup and view all the answers

What does Cushing's triad consist of?

Elevated systolic BP, bradycardia, irregular respirations. Signup and view all the answers

What do A waves of ICP monitoring indicate?

Awful signs; high ICP. Signup and view all the answers

What do B waves of ICP monitoring indicate?

Bad signs; signify significant intracranial pressure changes. Signup and view all the answers

What do C waves of ICP monitoring indicate?

Common signs; typically present in ICP monitoring. Signup and view all the answers

What results in A waves and high ICP?

Cerebral vasospasm. Signup and view all the answers

Should you give 0.45 NS to a patient with high ICP?

False Signup and view all the answers

Should you give D5W to a patient with high ICP?

False Signup and view all the answers

Should hyperventilation be used to decrease ICP?

False Signup and view all the answers

What could a skull fracture associated with CSF drainage indicate?

Basilar fracture. Signup and view all the answers

What is death due to cerebral hypermetabolism in status epilepticus?

Prolonged seizure activity. Signup and view all the answers

What kind of meningitis presents with low glucose in CSF?

Bacterial meningitis. Signup and view all the answers

What kind of meningitis presents with normal glucose in CSF?

Viral meningitis. Signup and view all the answers

After how long would you reconnect the vent and do an ABG for apnea test?

8-12 minutes. Signup and view all the answers

What does a positive apnea test for brain death indicate?

8-10 minutes with PCO2 >60 or >20 from baseline. Signup and view all the answers

What does the Tensilon test evaluate?

Myasthenic crisis vs. Cholinergic crisis. Signup and view all the answers

What are the symptoms of cholinergic crisis?

Salivation, lacrimation, urination, defecation, gastrointestinal upset, emesis, miosis. Signup and view all the answers

What are pulmonary complications of pancreatitis?

Atelectasis, left pleural effusion, ARDS. Signup and view all the answers

What does Grey Turner's sign indicate?

Bruising in flank area (lower back area). Signup and view all the answers

What does Cullen's sign indicate?

Ecchymosis in umbilical area. Signup and view all the answers

What electrolyte abnormality is seen in pancreatitis?

Low calcium. Signup and view all the answers

What does Kehr's sign indicate?

Referred pain down the left shoulder. Signup and view all the answers

Where is the injury if there is intraabdominal bleeding with Cullen's sign?

Intraabdominal injury. Signup and view all the answers

Where is the injury if there is intraabdominal bleeding with Grey Turner's sign?

Retroperitoneal injury. Signup and view all the answers

Where is the injury if there is left shoulder pain with abdominal trauma?

Ruptured spleen. Signup and view all the answers

Where is the injury if you hear bowel sounds in the chest after abdominal trauma?

Diaphragmatic rupture. Signup and view all the answers

What does free air on X-ray indicate?

Disruption of GI tract. Signup and view all the answers

Study Notes

Hemodynamic Effects of Dopamine

High-dose dopamine (>10 mcg/kg/min) increases afterload.
Potential hemodynamic effects include increased preload, decreased preload, and decreased contractility.

Heart Sounds and Conditions

S3 heart sound indicates heart failure and may be heard before crackles.
Conditions causing S3 include pulmonary hypertension, cor pulmonale, mitral, aortic, or tricuspid insufficiency.

Coronary Artery Perfusion

Coronary arteries are primarily perfused during diastole.

Angina Types

Variant or Prinzmetal's Angina presents as unstable angina with transient ST segment elevation; can occur at rest and is often triggered by substances like nicotine or alcohol.

Myocardial Infarction (MI) Recognition

RCA (Right Coronary Artery) inferior changes observed on leads II, III, aVF.
LAD (Left Anterior Descending) anterior changes observed on leads V1, V3, V4.
Circumflex artery changes seen in leads V5, V6, I, and aVL.

Reperfusion Signs Post STEMI

Signs of reperfusion after fibrinolysis include ST segment resolution and relief of chest pain.
Monitoring for reperfusion arrhythmias, such as VT or VF, and marked elevation of troponin levels.

PCI Complications

Unrelenting chest pain within 24 hours of PCI may indicate coronary artery re-occlusion. Immediate contact with a physician is necessary.
Sudden severe back pain and hypotension post-PCI suggest retroperitoneal bleeding; nursing interventions include fluid resuscitation.

Ankle-Brachial Index (ABI)

A normal ankle-brachial index is >1, indicating no significant vascular occlusion.

Patient Care for PAD

In patients with PAD post-bypass graft, do not elevate the affected extremity, as it could reduce perfusion. Use a reverse Trendelenburg position.

Prolonged QT Interval

Causes of prolonged QT include medications like Amiodarone, Haldol, and electrolyte imbalances.
Torsades de pointes is a dangerous arrhythmia resulting from prolonged QT.

Heart Failure Symptoms

Right-sided heart failure symptoms: JVD, dependent edema, weight gain, hepatomegaly.
Left-sided heart failure symptoms: shortness of breath, crackles, oliguria, frothy sputum, displaced apical pulse.

Mechanical Ventricular Support

A Ventricular Assist Device (VAD) assists in pumping blood, reducing heart workload in specific cardiac failures.

Intra-Aortic Balloon Pump (IABP)

Inflates during diastole to increase coronary artery perfusion and deflates before systole to reduce afterload.

Cardiac Tamponade Signs

Indicators include narrowed pulse pressure, pulsus paradoxus, restlessness, JVD, hypotension, and diminished heart sounds (Beck's triad).

Cerebral Monitoring

Normal pulmonary artery wedge pressure (PAWP) ranges from 4-12 mmHg.
A PAWP of 1-3 mmHg indicates hypovolemia, while >12 mmHg indicates hypervolemia.

Airway and Ventilation Management

Anatomic dead space includes airways not involved in gas exchange (trachea, bronchi).
Positive pressure ventilation is indicated when simultaneous ventilation and oxygenation are required (e.g., BiPAP, CPAP).

Respiratory Complications

ARDS causes a pathologic shunt, leading to severe hypoxemia not corrected by increasing FiO2.
Ventilator settings in ARDS should limit tidal volume to 4-6 ml/kg to avoid pulmonary injury.

Head Injury Signs

Changes in pupil response, such as blown pupils or positive Babinski reflex, can indicate neurological compromise.
The “doll's eye reflex” assesses brainstem function; abnormal responses indicate serious brain injury.

Stroke Indicators

Eye deviation toward or away from the pathology in stroke cases signifies brain function status.

Intracranial Pressure (ICP) Management

Cushing's triad (elevated BP, bradycardia, irregular respirations) indicates increased ICP.
Normal ICP is maintained between 0-10 mmHg; values exceeding this may lead to severe neuro complications.

Meningitis Differentials

Low glucose levels in cerebrospinal fluid (CSF) are characteristic of bacterial meningitis; viral meningitis typically retains normal glucose levels.

Trauma Assessment

Cullen's sign (periumbilical ecchymosis) and Grey Turner's sign (flank bruising) indicate internal bleeding due to abdominal trauma.

Pancreatitis Signs

Complications of pancreatitis can manifest as signs like bruising (Grey Turner's sign) and low calcium levels leading to potential seizures or extended QT intervals.

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Description

This quiz covers key concepts related to hemodynamic effects of dopamine, heart sounds, coronary artery perfusion, and angina types. Test your knowledge of myocardial infarction recognition and relevant cardiac conditions. Perfect for medical students and professionals in cardiology.