Blood Pressure Alterations and Cardiac Alterations Flashcards
what ejects blood out of the heart
the muscles
what do the muscles in the heart respond to
electrical conduction
if the heart muscles didn’t listen to the electrical conduction what would happen
death
what do the valves of the heart do
open/close to keep blood flowing forward
what is preload
The stretch of the ventricles - volume of blood/pressure in the chamber
what is afterload
the slingshot- what the heart is having to pump against
what is another name for what the heart is having to pump against
systemic vascular resistance
How much blood/pressure is needed to go through the right atrium into the right ventricle for preload and why
0-5mmhg because it only has to fill up enough to get to the lungs
how much blood/pressure is needed to go through the left atrium into the left ventricle for preload and why
6-12mmhg because it has to fill up enough to go to the entire body
what is systolic blood pressure
the top number - maximum pressure the heart exerts while contracting
what is the goal for systolic blood pressure
90-120
what is diastolic blood pressure
the bottom number - residual pressure in the arteries
what is the goal for diastolic blood pressure
60-80
what is the mean arterial pressure
average pressure in the arterial system
what is the mean arterial pressure goal
60-90
what is cardiac output
amount of blood ejected from the heart in liters/min
what is cardiac output goal
4-6L/min
what is the equation for cardiac output
HR x Stroke volume
what is stroke volume
volume of blood pumped out of the left ventricle of the heart during each contraction.
what is normal blood pressure
below 120 / below 80
what is an elevated blood pressure
130-139 / over 80
what is high blood pressure stage 1
130-139 / 80-89
what is high blood pressure stage 2
140 or higher/ 90 or higher
what should someone do immediately if they are having an hypertensive crisis
call the doctor
what is the hypertensive crisis range generally
higher then 180 / higher then 120
what is a hypertensive crisis for people over 60
150/90
what is a hypertensive crisis for people younger then 60
below 140/90
according to the joint national committee people who dont reach the goals should be treated with….
drugs
what does hypertension do to the body and arteries
damage to organs, thickening of the arteries
what is orthostatic hypotension
sitting to standing decrease of 20 of systolic or increase in HR by 20 bpm
what is essential hypertension caused by
no specific cause for most cases
what is secondary hypertension cause by
a cause that can be identified and treated
what is another name for malignant hypertension
hypertension crisis
what is malignant hypertension (hypertension crisis )
severe hypertension that rapidly progresses
what is malignant hypertension (hypertension crisis ) range
over 180/120
what is a hypertension urgency
over hours or days may be managed outpatient
what is a hypertensive emergency
hypertensive urgency + target organ damage and requires hospitalization
what could hypertensive emergency cause
head bleed, heart failure, heart attack, renal failure, dissecting aneurysm
what are some common risk factors for essential hypertension
obesity, smoking, stress, family history
what are some common risk factors for secondary hypertension
renal disease, primary aldosterone (retaining fluid so high sodium and low K), pheochromocytoma (tumor on adrenal medulla causing excretion of epinephrine and norepinephrine leading to h, Cushing’s syndrome (high cortisol levels=retain fluid), medications
what do they call the silent killer
hypertension
what are the common ss of hypertension
fatigue, dizziness, palpitations, angina, dyspnea
what are the ss of malignant hypertension (hypertension crisis )
headaches and nose bleeds
when measuring someones blood pressure what should they not do prior
caffeine, smoke, exercise for at least 30 minute prior
what labs would you take to diagnosis hypertension
BMP, lipid panel, TSH, ECG, home monitoring
what are some lifestyle modifications someone can make for hypertension
lose weight, change diet (DASH - less red meats, salt =, and sweets and low sodium), decrease ETOH (alcohol), dont smoke, reduce stress, excersise
how much sodium should someone with hypertension consume
2300mg/day
how much alcohol should someone with hypertension consume
1-2 drinks/day
what are some 1st line drug therapies for hypertension
ACE-1, ARBs, CCB, Diruretics
can you take ACE-1 and ARBs together
NO
what doe ACE-1 end in
pril
what do ARBs end in
sartan
what are some calcium channel blockers
end in dipine or diltiazem, verapamil
what is a common side effect of calcium channel blockers
peripheral edema
who should avoid taking calcium channel blockers
CHF
what should you avoid with when taking calcium channel blockers
grape fruit juice
what are some common side effects of ACE
dry cough (lisinopril), hyperkalemia, decreased HR
what are some 2nd line medications for hypertension
beta-blockers, potassium-sparing diuretics, direct vasodilators, adrenergic inhibiting agents
what do beta blockers end in
lol
what are some cardio-selective beta blockers
bisoprolol, metoprolol, esmolol
what are some non-cardio selective beta blockers and where does it work on
propranolol -lungs
since propanolol is working on the lungs who should not take it
COPD/asthma
what are some side effects of beta blockers
mask hypoglycemia increased HR
what is a common side effect for non-cardio selective beta blockers
bronchospasm
what should you avoid when taking hypertensive meds and why
NSAIDs because it may cause renal damage and retains fluid
how many drugs does someone with hypertension normally take
2 drugs for 2 different classes - titrate 1st one to correct dose before adding the other one
what are some mixed cardioselectvity beta blockers
carvedilol and labetalol
what are some potassium sparing diuretics
spironolactone and eplernone
what are some direct vasodilators
hydralazine, nitroglycerin, sodium nitroprusside
what is a adrenergic inhibiting agent medication
clonidine - last resort
what are some risk factors for malignant hypertension (hypertension crisis )
non-compliant, head injury, pheochromocytoma, illegal drugs, preeclampsia
what is the goal for malignant hypertension (hypertension crisis ) – MAP and DBP
decrease in MAP by 20% or diastolic bp 110-115 with IV antihypertensives in the first 2-6 hours
what are some vasodilators used for malignant hypertension (hypertension crisis )
sodium nitroprusside, nicradipine, labetalol, and esmolol
what are the interventions for malignant hypertension (hypertension crisis )
monitor BP and HR every 5-15 minutes, UOP hourly, bedrest semi fowlers, O2, neuro status
what can happen to the heart because of hypertension
coronary artery disease, left ventricular hypertrophy, and heart failure
what can happen to the brain because of hypertension
stroke and elevated intracranial pressure
what can happen to the peripheral vascular because of hypertension
claudication, aortic aneurism, aortic distension
what can happen to the kidneys because of hypertension
chronic kidney disease,
what are the values for chronic kidney disease cause by hypertension
Creatine over 1.5 and proteinuria
what can happen to the eyes because of hypertension
retinal damage - retinal hemorrhage, blurry vision, and loss of vision
what is the p wave on an ECG
the SA (sinoatrial) node
what is the SA node
electrical impulses 60-100 beats/min
what is the PR segment on an ECG
the av (atrioventricular) node
what is the AV node
contraction know as the atrial kick - pushing blood into the ventricles
what is happening for the QRS on ECG
when the heart pushes the blood from the ventricles up to the aorta or pulmonary
what is the T wave on an ECG
the recovering of the ventricles
what determines heart rate
beats/min
how do you measure PR interval
how long for energy to travel through atrium to make it contract
what is included in the autonomic nervous system
parasympathetic (decrease) and sympathetic (increase)
what is the normal pacemaker of the heart
SA node 60-100 bpm
what are the secondary pacemakers of the heart
AV node (40-60bpm)
his-purkinje fibers (20-40bpm)
what is sinus bradycardia
SA node is firing at less then 60bpm
what is sinus tachycardia
SA node is firing faster because of vagal inhibition or sympathetic stimulation
what could be come causes for sinus bradycardia
normal in athletes, hypothermia, vagal stimulation, beta clockers, and calcium channel blockers, HYPOthyroidsm, increased intracranial pressure myocardial infarction
what could be some causes for sinus tachycardia
stressors (exercise, pain, low BP or fluid, heart failure, HYPERthyroidsm ), drugs (norepinephrine, epinephrine, caffeine, theo-durr, hydralazine OTC cold remedies
what could be some ss of bradycardia
hypotension, pale, cool skin, weakness, angina, dizziness, confusion, SOB
what could be some ss of tachycardia
dizziness, dyspnea, hypotension, angina with patients with CAD
what drug could be used for sinus bradycardia
Atropine (1mg every 3-5 minutes for a total dose of 3mg)
what are some other interventions besides medications that could be used for sinus bradycardia
pacemaker (temporary or permanent ), stop offending drugs
what is tachycardia treatment guided by
by cause do decrease fever pain stress
what are some other interventions for tachycardia
vagal maneuver (bear down)
what are some medications that can decrease HR in sinus tachycardia
beta blockers and calcium channel blockers
what is paroxysmal supra-ventricular tachycardia
abrupt onset and ending starting above the bundle of his where a reexcitation of the atria
what is the HR normally for paroxysmal supra-ventricular tachycardia
150-220bpm
who is at risk for paroxysmal supra-ventricular tachycardia
FEMALE (healthy young women)
what could be some common causes for paroxysmal supra-ventricular tachycardia
overexertion, emotional stress, stimulants such as caffeine and tobacco
what are the ss of paroxysmal supra-ventricular tachycardia
feeling unwell, weak, fatigue, heart racing,
what are the ss for prolonged paroxysmal supra-ventricular tachycardia
hypotension, dyspnea, angina
how would you diagnosis paroxysmal supra-ventricular tachycardia
12 lead ECG
what are some vagal stimulants for paroxysmal supra-ventricular tachycardia
carotid massage, valsalva, coughing
what is the 1st drug of choice for paroxysmal supra-ventricular tachycardia how dose dosing wrk
IV adenosine 6mg-12mg-12mg flush 20ml continous monitoring on ECG
what are some common side effects of IV adenosine
flushing, dizziness, chest pain
what are some other drugs you could use for IV adenosine
beta blockers, calcium channel blockers, amiodarone
if someone is hemodynamically unstable and has IV adenosine what would the treatment be
dirrect current (DC) cardioversion
what is atrial flutter
recurring, sawtooth-shaped flutter waves originates from a SINGLE ectopic focus in the atrium (atrial and ventricle rhythm is regualr)
what is atrial fibrillation
disorganized of atrial activity caused by MULTIPLE ectopic focus = ineffective atrial contraction
how does atrial fibrillation look on an ECG
no clear P waves, no atrial contractions, loss of atrial kick and irregular ventricle response
if something is persistent how long is it lasting
more then 7 days
atrial fibriliation usually develops _____ with…
acutely with thyrotoxicosis, alcohol intoxication, caffeine use, heart surgery, and electrolyte imbalances
what is the most common dysrhythmia in the world
a fib
why is there in an increase risk of stroke in atrial flutter and a fib
irregular cardiac rhythm, blood stasis
how do you rate control for atrial flutter and a fib
calcium channel blockers, and beta blockers
how do you rhythm control for atrial flutter and a fib
antidysrhythmic drugs,
if complete AV node ablation occurs in atrial flutter and a fib they must be on a
anticoagulant
what are some procudures done for a fib
maze procedure with cryoblation, left atrial appendage occlusion
if someones on an anticoagulant what should you be checking
INR PT
if someone is experiencing a fib or flutter for 48 hours how long are they going to take anticoagulants
3-4 weeks before cardioversion and then several weeks after that
what procedure can be done to see if there are any clots in the atria
transesophogeal echocardiogram
for long term anticoagulants what is the drug of choice
warfarin
what is a 1st degree AV block
every impulse is conducted to the ventricles but the conduction is prolonged after it moves through the AV node it is normal again
what are the risks for 1st degree AV block
cardiac drugs drugs or disease - if multiple cardiology consult
what are the ss of 1st degree AV block
asymptomatic
how do you diagnosis 1st degree AV block
ECG, TSH, BMP, consider causative factors
what is the treatment for 1st degree AV block
monitor
what is a 2nd degree AV block type 1
gradual lengthening of PR interval - because the prolonged AV conduction making atrial not conduct and QRS is blocked since the QRS is missing the another p will start
what is 2nd degree AV block type 2
p wave is non conducted without progressive lengthening of PR interval but still missing QRS
what drugs are used for 2nd degree AV block type 1
digoxin or beta blockers
what is the treatment for symptomatic 2nd degree AV block type 1
atropine to increase HR and temp pacemaker especially is experienced MI
what is the treatment for asymptomatic 2nd degree AV block type 1
monitor, transcutaneuous pacemaker on standby
what are the ss of 2nd degree AV block type 2
decreased cardiac output, hypotension, myocardial ischemia
what is the treatment for 2nd degree AV block type 2
transcutaneous pacing to permanent pacemaker
can you use atropine for 2nd degree AV block type 2
not effective
does type 1 or 2 2nd degree AV block usually progressive to 3rd degree
type 2
what is a 3rd degree AV block
no impulses from atrium are conducted to the ventricles (2 no QRS)
what is the treatment for 3rd degree AV block
pacemaker
what is a temporary drug measure for 3rd degree AV block
epinephrine and norepinephrine to increase HR and supoprt BP
what is a premature ventricular contraction
QRS is happening to soon
what are the risks for premature ventricular contraction
stimulants (caffeine, alcohol, nicotine), electrolyte imbalances, hypoxia, fever, exercise, stress, cardiac disease
what are the ss of premature ventricular contraction
not harmful with normal heart
heart disease: CO reduction, angina, HF
how do you treat premature ventricular contraction
treat cause
what is a complication of premature ventricular contraction
Ron T Phenonomenon QRS happening on T wave when the heart is recovering can cause ventricular tachycardia and ventricular fibrillation aka no pulse
what is ventricular fibrillation
run of three or more PVCs can be stable (pulse) or unstable (no pulse)
what is monomorphic ventricular fibrillation
has QRS that is same shape size and direction
what is polymorphic ventricular fibrillation (torsades de pointes)
when QRS gradually change back and forth from one shape and size to another
what is a ventricular fibrillation sustained and nonsustained
sustained loner then 30 seconds
non sustained less then 30 seconds
what are the ss of ventricular fibrillation
hypotension, pulmonary edema, decreased cerebral blood flow, and cardiopulmonary arrest
what is monomorphic ventricular fibrillation treated with
antidysrhythmias
what is polymorphic ventricular fibrillation (torsades de pointes) treated with
beta blockers, aminodarone, procainamide, magnesium
what is ventricular fibrillation
irregular wave forms of varying shape and sizes firing of multiple ectopic folci no pulse it is deadly so treat quick
what should you do if someone has ventricular fibrillation
d fib them asap
what is pulseless electrical activity
you can see electrical activity but no mechanical activity is evident aka no pulse
what are some risk factors for pulseless electrical activity
hypovolemia, hypoxia, acidosis, hyper/hypokalemia, hypoglycemia, hypothermia, toxins, tamponade, thrombosis, tension pneumothorax, trauma
what is the treatment for pulseless electrical activity
CPR intubation and epinephrine
what is asystole
no electrical activity no contraction
most sudden cardiac death result from what
ventricular dysrhythmias