Cardiac

Question 1

Mean arterial pressure

Answer 1

2 x diastolic + (diastolic/3)

• normal: 65-110 mmHg
• Indicator of tissue perfusion

Question 2

P-wave

Answer 2

depolarization of the atria - atria pump

Question 3

PR interval

Answer 3

Delay of the AV node to allow time for ventricle to fill

Question 4

QRS complex

Answer 4

Depolarization of ventricles - ventricles pump

Question 5

ST segment

Answer 5

beginning of ventricular repolarization (flat)

Question 6

T-wave

Answer 6

Ventricular repolarization

Question 7

Cardiac output

Answer 7

CO = HR x SV

• volume of blood pumped per minute

Question 8

Factors affecting venous return

Answer 8

• blood volume and venous tone
• meds
• auxillary skelletal muscle pump

Question 9

Preload

Answer 9

The amount of blood in the ventricles after diastole

Question 10

Afterload

Answer 10

The pressure the left ventricle has to overcome to pump blood into the aorta

Question 11

What impacts stroke volume?

Answer 11

Preload, contractility, afterload

Question 12

Hypertension outcomes

Answer 12

• ## end organ damage

Question 13

Stable angina

Answer 13

• chest pain w/ exertion that is relieved with rest
• CAD
• blood flow to coronary artery partially occluded
• no troponin or cardiac muscle damage (yet)

Question 14

Unstable angina

Answer 14

• pain not relived when resting
• caused by CAD, emboli, thrombus, vasospasm

Question 15

Variant angina

Answer 15

Pain from spasm

Question 16

STEMI

Answer 16

• ST interval elevated in ECG
• troponins elevated

Question 17

Ischemia tests/labs

Answer 17

• 12 lead EKG
• troponin I
• metabolic panel
• CBC
• chest x-ray

Question 18

Angina treatment

Answer 18

Stable/unstable
- organic nitrates
- beta blocker
- Ca channel blocker
- antianginal

Variant
- organic nitrates
- Ca channel blockers

Question 19

BNP

Answer 19

B-natriuretic peptides
- produced in ventricles and brain
- decreased blood volume, increased venous capacity
- reduce cardiac preload

Question 20

signs of right-sided HF

Answer 20

• peripheral edema
• distended jugular veins

Question 21

Systolic left-sided HF

Answer 21

• leads to pulmonary edema
• left ventricle doesn’t pump efficiently

Question 22

Diastolic left-sided HF

Answer 22

• left ventricle is stiffened and can’t relax enough to fill properly
• fluid backup - extra pressure on lungs

Question 23

Cardiac glycosides

Answer 23

• Digoxin
• controls atrial arrhythmias in mild to moderate HF
• increases Na resulting in increased Ca2+ to increase contractility of the heart
• used for systolic HF
• SE - arrhythmias, toxicity, rash, HA, weakness, gynecomastia

Question 24

Digoxin toxicity

Answer 24

• N/V
• fatigue

Question 25

Contraindications of cardiac glycosides

Answer 25

Acute MI, hypersensitivity, V-fib, myocarditis, hypokalemia, hypomagnesemia

Question 26

Beta-blockers

Answer 26

• carvedilol, metoprolol
• Indications: HTN, HF, MI, afib/flutter, angina
• MOA: Beta 1 andrenergic receptor inhibitor
• SE: fatigue, depression, bradycardia, hypotension, bronchospasm, dizziness

Question 27

Contraindications of beta-blockers

Answer 27

• Avoid abrupt withdrawal (can lead to tachycardia, HTN, angina, or MI)
• Avoid in Pts with heart block without pacemaker

Question 28

HMG-CoA reductase inhibitors (statins)

Answer 28

• atorvastatin
• reduces cholesterol synthesis in liver and increases LDL receptors in hepatic cells
• SE: arthralgia (muscle pain), GI symptoms, insomnia, UTI

Question 29

Contraindications of statins

Answer 29

• Hypersensitivity
• liver disease
• pregnancy
• avoid use for Pts on CYP3A4 inhibitors (verapamil, erythrmycin) - can further stress the liver

Question 30

ACE-inhibitors

Answer 30

• lisinopril
• reduce afterload by reducing levels of angiotensin II
• SE: hyperkalemia, dry cough, angioedema