JEOPARDY January 2013

Basics

100

Transportation is this body fluid's main function

What is blood?

200

These heart valves are attached to chordae tendinea

What are the tricuspid and mitral valves. (PS): these valves need extra support and tethering because they must withstand the full ventricular systolic pressure without regurgitation

300

The pericardium is normally filled with this amount of clear serous fluid.

What is 10-50 ml. PS: When the pericardial content exceed 150 ml's acutely the pressure rise sand begins to compress the heart. This may reduce cardiac output by decreasing venous return, pericardiocentesis may be needed and save the individual.

400

This coronary artery supplies the Right Bundle Branch

What is LAD PS: the LAD runs in the anterior interventricular groove near the conduction bundles. The LBB may be supplied by either the IV groove baranches (PDCA or LAD).

500

Stenosis of a valve eventually causes proximal......, and regurgitation usually causes proximal ..... Word Bank: hypertrophy, dilatation, prolaspe, calcification, stenosis, enlargement, engorgement.

What is hypertrophy and dilatation PS: stenosis causes a pressure overload which in turn causes hypertrophy. Stenotic valvular defects dissipate pressure energy. This causes the proximal chamber to build up more pressure to achieve the same cardiac output, chronic pressure overload leads to hypertrophy of the chamber

JACHO

100

This simple act can save lives.

What is washing hands.

200

The transfer of responsibility from one caregiver to another.

What is a hand off.

300

The 6 CCHS core values.

What is teamwork, leadership, caring, integrity, service, excellence (pneumonic – TCL IS Excellence.)

400

The 2011 heart attack care result is 98.5 percent, up from 88.6 percent in 2002 – an improvement of 9.9 percentage points. A 98.5 percent score means that hospitals provided an evidence-based heart attack treatment 985 times for every 1,000 opportunities to do so. What are some factors that helped improve this?

This composite includes: • Aspirin at arrival • Aspirin at discharge • ACEI or ARB at discharge • Beta-blocker at discharge • Fibrinolytic therapy within 30 minutes • PCI therapy within 90 minutes • Statin prescribed at discharge

500

The CCHS mission statement.

What is Christiana Care Health System is dedicated to improving the health of all individuals in the communities we serve through health care services, education & research.

Picture This

100

This appears on the EKG when the individual has had a prior myocardial infarction

What is Q wave. PSL: Q waves never go away

200

This patient in Cardiogenic Shock has the following therapy represented by this waveform.

What is IABP (2:1)

300

This pressure waveform is commonly associated with Cardiac Tamponade

What is Arterial Pulses Paradoxus.

400

Which type of ventricular myopathy is shown in the diagram at #2?

What is Hypertrophic cardiomyopathy. PS: Hypertrophy involves thickening of the muscle wall. This increased muscle bulk may be in response to pressure overlad or due to some primary pathologic condition-as in cardiomyopathy. Theouter LV diameter increases, but the internal dimensions may not change. In the picture: 1. Normal ventricle 2. Hypertrophic cardiomyopathy 3. Dilated cardiomyopathy 4. Restrictive cardiomyopathy

500

This waveform represents a pullback from the LV apex into the Aorta

What is Hypertrophic Obstructive Cardiomyopathy (HOCUM) PS: Gradient occurs wihtin the outflow track. This is usually due to a thick hypertrophied LV that contracts down on itself pinching off the outflow and systolic pressure

Hemodynamics

100

This blip on the arterial waveform signifies closure of the aortic valve

What is the dicrotic notch. PS: The dicrotic notch or "incisura" is the notch on the down slope of the great vessel pressures. It is sometimes called the "incisura". The incisura results from back flow of blood in the great vessel as each semilunar valve closes. The dicrotic notch begins ventricular diastole.

200

This signifies the amount of blood pumped during a single systole

What is stroke volume. PS: Stroke volume is the amount of blood the heart pumps with each beat. This can be calculated from the CO and HR. SV=CO/HR. Eg: 150ml - 80ml=70ml Stroke volume adjusted to body size is termed Stroke Index. It is stroke volume divided by the persons body surface area. SI=SV/BSA

300

This arterial pulse is felt as two distinct impulses during systole. 1. Alternans 2. Paradoxicus 3. Bisferiens 4. Bigeminus

What is Pulsus bisferiens. PS: This is a double systolic pulse (bi=2). both bumps occur before the dicrotic cnotch, which may look like a third hump. Pulsus bisferiens is associated with both IHSS and AR. In IHSS/HOCM it is due to a double outflow of systolic blood where the subvalvular obstruction closes mid systole. Aortic insufficiency has a characteristic water-hammer pulse (ex 180/50) which tends to overshoot systole and resonate in the aorta creating a double pulse.

400

A patient with an elevated PAW pressure has elevated (what chamber and is it afterload or preload)

What is LV Preload PS: LV-EDP and PAW are the two most common indicators of LV preload. Elevated PAW pressures indicates that LA and LV-EDP have increased. These are strictly related to diastolic filling of the ventricle and Starling's law. According to Starling's Law, the greater the preload-the greater the force of contraction. It is a sign that the heart is trying to compensate for dysfunction. Elevated lV preload is often associated with CHF and pulmonary edema.

500

Isometric ventricular diastole begins with the closing of these valves?

What are the semilunar valves. PS: closing of semilunar valves causes the dicrotic notch. Iso=constant, metric=measurment (volume). Isometric phases of the ventricle occur when both inlet and outlet valves are closed. The ventricle may contract (isometric contraction) or relax (isoemtric relaxation) but NO blood moves. These are the short phases of rapid ventricular pressure increase or decrease.

Heart Beats

100

This is the most common cause of death in the United States

What is CAD. PS: CAD is the most common cause of death in the western world. Approximately one million American died of CV disease in 1990. Approximately 1,500,000 MI's occur in the USA each year and approximately 1/4 of ALL American daths occur from Acute MI's.

200

A critical coronary stenosis occurs when the stenosis exceeds what percentage of reduction in diameter?

What is 50% reduction in diameter. PS: Mild stnoses are not usually significant. They only reduce cornoary flow at high flow rates. That is why exercise stress tests are most sensitive in detecting CAD. To be signifacnt on exercise a stenosis must be at least 50% in diameter (75% area reduction). Only when they reach this level is intervention or surgery considered.

300

The most common arrhythmia found in patients recovering from MI's.

What are PVC's. PS: PVC's are most common, especially in the setting of myocardial ischemia. Ischemic tissue may set up a reentry loop which cause unifocal PVC's, Multifocal PVC's. Runs of 3 or more PVC's are called Ventricualr Tachycardia. *Treat the pt. not the monitor.

400

Match these - TIMI flow: 1. TIMI 0 2. TIMI 1 3. TIMI 2 4. TIMI 3 A. No perfusion: No antegrade flow beyond the point of occlusion. B. Penetration without perfusion: The contrast material passes beyond the area of obstruction, but “hangs up” and fails to opacify the entire coronary bed distal to the obstruction for the duration of the cine run. C. Partial reperfusion: The contrast material passes across the obstruction and opacifies the coronary bed distal to the obstruction. However, the rate of entry of contrast into the vessel distal to the obstruction and/or its rate of clearance from the distal bed are perceptibly slower than its entry into and/or clearance from comparable areas not perfused by the culprit vessel (e.g., the opposite coronary artery or coronary bed proximal to the obstruction). D. Complete perfusion: Antegrade flow into the bed distal to the obstruction occurs as promptly as into the bed proximal to the obstruction and clearance of contrast material from the involved bed is as rapid as from an uninvolved bed in the same vessel or the opposite artery.

What is : 1. A 2. B 3. C 4. D TIMI Grade Flow - a grading system for coronary flow: 0 = No perfusion: No antegrade flow beyond the point of occlusion. 1 = Penetration without perfusion: The contrast material passes beyond the area of obstruction, but “hangs up” and fails to opacify the entire coronary bed distal to the obstruction for the duration of the cine run. 2 = Partial reperfusion: The contrast material passes across the obstruction and opacifies the coronary bed distal to the obstruction. However, the rate of entry of contrast into the vessel distal to the obstruction and/or its rate of clearance from the distal bed are perceptibly slower than its entry into and/or clearance from comparable areas not perfused by the culprit vessel (e.g., the opposite coronary artery or coronary bed proximal to the obstruction). 3 = Complete perfusion: Antegrade flow into the bed distal to the obstruction occurs as promptly as into the bed proximal to the obstruction and clearance of contrast material from the involved bed is as rapid as from an uninvolved bed in the same vessel or the opposite artery.

500

DING DING DING!! DOUBLE JEAPORDY!! What does the large solid arrow show?

An anomolous left main coronary artery. http://www.invasivecardiology.com/files/10 NewTech_pg536_Fig 1.png