Ten more

6 Apr

Credit the artist: Heart by ~snul found on deviantART.

That is some cardiomegaly she is carrying around. It reminds me of cardiac remodeling. It must be heavy carrying around a large heart. It just does not function properly. The whole stretch, Starling thing.

Don’t tell me I have a big heart! No thanks, I am happy with my skinny heart. ❤

I really wish someone would distract me, to prevent me from being sucked in to the bodies compensatory mechanism during heart failure that actually exacerbate the failing heart.

The thing is, when the heart is failing, and cardiac output is decreased the body does not know why cardiac output is low. The body actually thinks the person is roaming through the desert, dehydrated with no oasis in sight, so it activates the SNS, the RAAS, and the aldosterone system to: increase the heart rate, vasoconstrict and hold on to salt and water. When the pump is failing these are the things we do not want to happen, so we give drugs, like beta-blockers  and diuretics to stop the bodies natural compensation and prevent more work for the heart. I mean seriously, the failing heart can not pump out the blood it has, and therefore these systems just make everything so much worse.

If only the failing heart could say: Yo! I don’t need your compensation, just let me rest! You are making me work harder!

It can’t so we give drugs.

10 PCCN questions with some rationales, the same as before. Answers are underlined and colored red for cardio LOVE again.

1. You hear an S4 gallop during assessment, this may signify:

a. Heart Failure

b. Decreased compliance of ischemic myocardium

c. Aortic stenosis

d. Increased left ventricular filling volume

*The atria contract and blood is forced into and non compliant ventricle, it is a stiff wall and the sound is heard before S1

2. Heart failure caused by the inability of the heart to fully relax is:

a. Systolic

b. Diastolic

c. BiVentricular

d. Complete

* the heart can not relax, the forward flow is decreased and the EF is normal in diastolic heart failure as opposed to systolic failure the contraction is weak. The treatment right now appears to be the same.

3. The primary function of drug therapy with beta blockers in heart failure is:

a. Increase blood pressure

b. Block compensatory mechanisms

c. Increase urine output

d. Decrease arrhythmias

*See the opening speech on this post.

4. Early symptoms of fluid overload and pulmonary edema:

a. Rales and hypoxia

b. S3 and tachycardia

c. Increased respiratory rate and subjective dyspnea

d. ST segment elevation in the chest leads

*The earliest symptoms are increased resp rate and shortness of breath. When the fluid moves into the interstitial space, the lungs are still clear and the patient seems anxious.

5. Which coronary artery supplies the atrioventricular node?

a. Right coronary

b. Coronary sinus

c. Left anterior descending

d. Nodal artery

*The right coronary artery supplies the right side of the heart and the bottom of the heart, the electrical system is in the right side of the heart.

6. The S4 heart sound occurs:

a. After ventricular contraction

b. Is best heart with the diaphragm of the stethoscope

c. Is a normal finding in children

d. During atrial contraction

*Again S4 is heard when blood is pushed into a noncompliant ventricle and this happens during atrial contraction.

7. A 20 year old athlete collapsed playing sports and was resuscitated on site. He is awake and orientated now but having many PVCs. What is the most likely reason for this cardiac arrest?

a. Myocardial infarction

b. Pericarditis

c. Peripheral vascular disease

d. Cardiomyopathy

*Changes in the structure of the heart.

8. The patient has palpitations, the tele monitor shows sinus tachycardia. What is the initial treatment?

a. Adenosine

b. Defibrillation

c. Treat fever, pain or dehydration

d. Valsalva maneuver

*NOT a STAT cardio consult and check the hemoglobin.

9. An inferior wall myocardial infarction will show changes in what EKG leads?

a. V1 to V4

b. V1 and AVL

c. V5 and V6

d. II, III, AVF

*I have a hard time imagining the 12 lead to heart anatomy so I just memorize.

10. The most common complication of an acute myocardial infarction:

a. Dysrhythmia

b. Congestive heart failure

c. Cardiogenic shock

d. Pulmonary embolism

*While cardiogenic shock is the worst case scenario, the most common complication is dysrhythmias, they might be having PVCs.

Pretty straight forward so far, nice forward flow. The only problem is that I want to be distracted, so I will either play words with friends, if someone will entertain me, or I will go on to read about: what is going on with diastolic versus systolic heart failure treatment and the future of that, or I will go play outside since the sun is popping out.

Test date April 21. I still have a lot to study and I am wasting my time apparently studying cardiac, the stuff I already know.

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