AV valves - ✔✔ mitral, tricuspid
Semilunar valves - ✔✔ aortic, pulmonic
S1 - ✔✔ Closure of AV valves - loudest at apex - beginning
... [Show More] of systole
S2 - ✔✔ Closure of semilunar valves - loudest at base - beginning of diastole, louder with PE
S3 - ✔✔ Right after S2, associated w HR - also caused by pulmonary HTN and cor pulmonale
S4 - ✔✔ Right before S1 - associated c aortic stenosis, myocadial ischemia, atrial gallop (Tennessee)
Narrowing pulse pressure - ✔✔ severe hypovolemia
Widening pulse pressure - ✔✔ A drop in SVR - often sepsis
When are coronary arteries perfused? - ✔✔ Diastole
Is diastole or systole longer? - ✔✔ Diastole - by 1/3
Murmurs of insufficiency (regurgitation) occur when the valve is... - ✔✔ closed
Murmurs of stenosis occur when the valve is... - ✔✔ open
Systolic murmurs - ✔✔ -Semilunar valves are open during systole (aortic stenosis, pulmonic stenosis)
-AV valves are closed during systole (mitral/tricuspid insufficiency)
-VSD
Diastolic murmurs - ✔✔ -Semilunar valves are closed during diastole
-AV valves are open during diastole
When is the mitral valve closed? - ✔✔ Systole
When is the mitral valve open? - ✔✔ Diastole
When is the aortic valve open? - ✔✔ systole
When is the aortic valve closed? - ✔✔ Diastole
Where is papillary muscle dysfunction/rupture loudest at? - ✔✔ The apex
Where do you hear a VSD? - ✔✔ Sternal border/5th ICS
Unstable angina - ✔✔ -Chest pain at rest
-May be relieved by nitro
-Troponin negative
-ST depression or T-wave inversion
NSTEMI - ✔✔ -Troponin positive
-ST depression
-T-wave inversion
STEMI - ✔✔ -Troponin positive
-ST elevation in 2+ leads
-Unrelenting CP
Variant/Prinzmetal Angina - ✔✔ -unstable angina w/ transient ST elevation
-coronary artery spasm
-Nicotine/etoh/cocaine ingestion
-occurs at rest
-Troponin negative
ACS - ✔✔ -EKG done and read w/in 10min
-Aspirin
-Anticoagulant
-Antiplatelet
-BB (unless cocaine use) - not if Viagra use
Changes in II, III, aVF --> what location - ✔✔ RCA, Inf LV
Changes in V1, V2, V3, V4 --> what location - ✔✔ LAD, ant LV
Changes in V5, V6, I, aVL --> what location - ✔✔ circumflex, lateral LV
Inferior MI - ✔✔ -RCA occlusion
-ST elevation in II, III, aVF
-AV conduction disturbances (2nd-degree type 1, 3rd deg, SSS, SB
-Systolic murmur
-Tachycardia associated c inf MI --> higher mortality
- BB and NTG c caution
R ventricular infarct - ✔✔ -JVD, high CVP, HOTN, bradyarrhythmias
-ECG w
-ST elevation in V4R
-Fluids, positive inotropes
-Avoid preload reducers
Anterior MI - ✔✔ -LAD occlusion
-ST elevation in V1-V4
-May develop 2nd deg type 2 HB and RBBB (OMINOUS SIGN)
-Higher mortality than inferior - heart failure
Lateral MI - ✔✔ -ST elevation in V5, V6, I, aVL
-Involves left circumflex artery
Complications of PCI - ✔✔ -Stent thrombosis (occurs w/in 24h of stent placement, or subacutely in first 30d)
-Retroperitoneal bleed
Hypertensive Emergency/Crisis - ✔✔ Elevated BP w/o evidence of end-organ damage - critical care admission
Hypertensive urgency - ✔✔ Elevated BP w/out evidence of end-organ damage - no critical care admission [Show Less]