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Adult 2 > Cardio > Flashcards

Cardio Flashcards

1
Q

MAP must be ___ to maintain blood flow through coronary arteries

A

At least 60 mm Hg

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2
Q

MAP must be ___ to maintain perfusion of major body organs

A

Between 60 and 70 mm Hg

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3
Q

The left anterior descending branch supplies blood to what?

A
  • Portions of LV
  • Ventricular septum
  • Chordae tendineae
  • Papillary muscle
  • RV
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4
Q

The left circumflex branch supplies blood to what?

A
  • LA
  • Lateral/posterior LV surfaces
  • Portions of interventricular septum
  • SA node in 1/2 people
  • AV node for small # of people
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5
Q

The right coronary artery supplies blood to what?

A
  • RA
  • RV
  • Inferior LV
  • AV node
  • SA node to 1/2 people
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6
Q

How to calculate CO

A

HR x Stroke Volume

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7
Q

Normal CO range

A

4-7 L/min

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8
Q

How to calculate CI

A

Body surface area/CO

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9
Q

Normal CI range

A

2.7-3.2 L/min/m squared

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10
Q

Stroke volume

A

Amount of blood ejected by the LV during each contraction

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11
Q

The degree of myocardial fiber stretch at the end of diastole and just before contraction

A

Preload

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12
Q

Determined by the amount of blood returning to the heart from both the venous system and the pulmonary system

A

Preload

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13
Q

Starling’s Law

A

The more the heart is filled during diastole, the more forcefully it contracts

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14
Q

The pressure/resistance the ventricles must overcome to eject blood through the semilunar valves and into peripheral blood vessels

A

Afterload

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15
Q

Afterload is directly related to what?

A

Arterial BP and the diameter of the blood vessels

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16
Q

Amount of pressure generated by the LV to distribute blood into the aorta with each contraction

A

Systolic BP

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17
Q

Amount of pressure against the arterial walls during the relaxation phase of the heart

A

Diastolic BP

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18
Q

Coronary arteries originate where?

A

Just above the cusp of the aortic valve

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19
Q

When does coronary blood flow to the heart muscle occur?

A

During diastole

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20
Q

Blockage in LAD is called what?

A

“Widow maker” bc the mortality rate is so high. It supplies a large portion of muscle mass

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21
Q

Function of papillary muscles

A

Keep valves where they’re suppose to be

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22
Q

Branches on the LAD

A

Diagonal

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23
Q

Branches on the LCX

A

Obtuse marginal

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24
Q

Problems in LCX

A

Conduction problems/arrhythmias bc it supplies blood to SA node where impulses are generated

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25
Q

CVP filling pressures

A

Preload

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26
Q

Resistance heart pumps against

A

Afterload

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27
Q

Take oxygen in

A

Arteries

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28
Q

Take waste products and unoxygenated blood out

A

Veins

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29
Q

Where does the transition take place from O2 and unO2 blood?

A

Where arterial capillaries merge with venous capillaries

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30
Q

Sympathetic nervous system

A

Increases HR and BP, vasoconstricts

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31
Q

Parasympathetic nervous system

A

Decreases HR and BP, vasodilates

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32
Q

Baroreceptors

A

Sense when there is a fall in MAP, present around carotid arteries and aortic notch. Strategically places where arteries carry blood to your head.

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33
Q

Chemoreceptors

A

Respond to a decrease in O2 levels, will increase constriction to increase perfusion

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34
Q

Stretch receptors

A

The more they’re stretched, the harder the heart will contract

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35
Q

How does the renal system regulate BP when it senses a decrease in renal flow?

A

Retains sodium and water, renin-angiotensin-aldosterone system vasoconstricts to increase perfusion pressure

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36
Q

How does endocrine system regulate BP?

A

When you get angry or scared, there is a release of catecholamines, kinins, and histamine which stimulates the SNS to increase BP

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37
Q

What helps propel venous system?

A

Skeletal muscles in extremities

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38
Q

Primary function of the venous system

A

To complete the circuit of unoxygenated blood back to the heart

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39
Q

Effects of gravity on venous system

A

Increased when standing up (orthostatic hypotension) and lessened when laying down. This is why “raising extremities” increases blood flow to heart

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40
Q

Age related changes to heart

A
  • Valves thicken/stiffen
  • SA node decreases in mass/function (low HR)
  • Decreased contractility
  • Coronary arteries dilate, more tortuous/calcified
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41
Q

Age related changes to blood vessels

A
  • Thicken/stiffen (can’t constrict and dilate as fast, so less responsive to intrinsic changes)
  • Slowed exchange of nutrients from blood and tissues (slow healing)
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42
Q

Age related changes to blood

A
  • Decreased volume
  • Decreased marrow and production of RBC
  • Decreased H&H
  • Increased risk for clots r/t increased plt aggregation and decreased fibrinolytic action
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43
Q

Deconditioning

A

Changes in blood and heart with aging are from decreased activity, not “age”

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44
Q

PQRST chest pain assessment

A
  • Provocation
  • Quality
  • Region/radiation
  • Severity (1-10)
  • Timing/treatment
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45
Q

Paroxysmal nocturnal dyspnea

A

Abrupt onset of SOB after lying flat for several hours r/t redistribution of blood flow

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46
Q

Alternating strong and weak heart beats

A

Pulsus alterans

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47
Q

Epigastric area

A

Over the lower right sternal border

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48
Q

Tricuspid area

A

5th intercostal space at the lower left of the sternal border

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49
Q

Mitral area

A

5th intercostal space at the apex of the heart (mid-clavicular line)

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50
Q

Pulmonic area

A

2nd intercostal space just left of the sternum

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51
Q

Aortic area

A

2nd intercostal space just right of the sternum

52
Q

Closure of AV valves

A

S1

53
Q

Closure of PV/AV

A

S2

54
Q

Heard during diastole

A

S2

55
Q

Best heard at apex or LLSB

A

S1

56
Q

Heard during ventricular systole

A

S1

57
Q

Best heard at base of heart

A

S2

58
Q

Ventricular gallop, early sign of heart failure

A

S3

59
Q

Atrial gallop. Indicates HTN, MI, aortic or pulmonic stenosis

A

S4

60
Q

Heart murmurs

A

Turbulent blood flow across valves, grades I-VI

61
Q

Grade 1 heart murmur

A

You’re pretty sure it’s there but can’t get to it-usually only used by cardiologists

62
Q

Grade 6 heart murmur

A

It’s so loud you can hear it at the bedside without a stethoscope

63
Q

Total cholesterol normal levels

A
64
Q

What should HDL be?

A

> 40 mg/dL

65
Q

What should LDL be?

A
66
Q

What should triglycerides be?

A
67
Q

Released with any myocardial damage

A

Troponin 1

68
Q

Point of Care Troponin 1 test

A

Results should be available within 15 minutes

69
Q

CK-mb

A

Heart damage

70
Q

CK-mm

A

Skeletal muscle damage (bruise on leg)

71
Q

CK-bb

A

Brain damage

72
Q

Creatine Kinase peak and rise

A

Peaks within 24 hrs

Rise begins within 3 hrs

73
Q

Myoglobin

A

Earliest marker available, never used

74
Q

Risk for CAD is 3x greater with serum cholesterol greater than what?

A

260

75
Q

Positively correlated with CAD

A

LDL

76
Q

Decreased K and Mg levels means what?

A

Increased risk for DVTs

77
Q

Heart Cath

A

NPO, must lie flat on table, bedrest 4-6 hrs after, check distal pulse

78
Q

What do you ask a pt who just had a heart cath and reports chest pain?

A

If it’s the same kind of pain that brought them to the hospital

79
Q

Transesophageal echo

A

Swallow the tube, must be NPO

80
Q

Transthoracic echo

A

Don’t have to be NPO

81
Q

NICS

A

Looks at carotid arteries

82
Q

NIAS

A

Looks at arteries in legs

83
Q

NIVS

A

Looks at veins in legs to rule out DVT or at veins in arms for placement of a dialysis shunt

84
Q

12 lead ECG

A

Circumferential around whole heart. Doesn’t predict anything. If pt is having chest pain, get another ECG.

85
Q

Thickening or hardening of arterial wall associated w/ aging

A

Arteriosclerosis

86
Q

Formation of plaque within the arterial wall itself

A

Atherosclerosis

87
Q

Stable plaque

A

Fibrous covered cholesterol core

88
Q

Unstable plaque

A

Usually liquid lipid center

89
Q

What eventually happens to plaque in arteries?

A

They become ulcerated or thrombosed and impacts the entire vessel wall

90
Q

Stable angina pectoris

A
  • Temporary ischemic state, usually associated with activity

- Freq, duration remains stable/predictable

91
Q

How to manage stable angina

A

Nitrates, beta blockers, rest

92
Q

Stable angina is associated with what kind of plaque?

A

Stable

93
Q

Increase in the incidence and intensity of chest pain

A

Unstable angina pectoris

94
Q

Prinzmetal’s angina (variant)

A

Chest pain occurs at the same time every day, caused by spasms not blockage

95
Q

Goal of angina treatment

A

Increase O2 supply and decrease O2 demand

96
Q

What medication dilate coronary arteries?

A

Calcium channel blockers

97
Q

Nitrates vasodilate which causes what?

A

Increasing supply of O2

98
Q

Nitrates

A

Nitroglycerine (fast acting, short acting), indur (slower and longer acting), isordil

99
Q

Common complication of nitrates

A

Headache

100
Q

Effect of beta blockers

A

Decreases contractility and slows HR, decrease demand of O2

101
Q

Usually treat prinzmetal’s angina with what?

A

Ca channel blockers to decrease spasms

102
Q

Smoking causes what

A

Coronary artery vasoconstriction

103
Q

Diet for atherosclerosis

A

Low fat, low triglycerides

104
Q

How to use Nitroglycerine

A

IV, sublingual (can take q 5 minutes up to 3 doses), and a spray which goes under their tongue. 1-2 sprays at onset of chest pain, 3rd spray after 5 minutes. The medication is good for 30 days. Protect the meds from light

105
Q

Most important thing to do when giving nitroglycerine

A

Tell them to keep it with them at all times

106
Q

Most common anti platelet med prescribed

A

Aspirin, then plavix, elequis

107
Q

Percutaneous transluminal coronary angioplasty

A

Thread a wire into obstruction, thread cath over it, inflate balloon, remove, obstruction is moved back onto wall, NOT GONE. Artery is widened

108
Q

Problem with stent insertion

A

Body reacts to foreign body, lots of people developed clots and heart attacks were caused. 30% of stents occlude within 6 months

109
Q

PTCA candidate selection

A
  • Blockage in one or two arteries (If all 3…bypass sx)

- Not left main disease bc if something messes up the pt dies

110
Q

PTCA is treatment of choice for what?

A

Non-calcified lesions and straight lesions

111
Q

Significant artery blockage

A

> 60%

112
Q

Complications of PTCA

A

Patency of vessel, distal circulation (take plavix every day for a long time), chest pain (artery reoccluded)

113
Q

Priority after PTCA

A

Chest pain, patency of vessel. Not distal circulation, you can live without a leg but not without heart.

114
Q

Selection for CABG

A

Leg vein last 7-15 yrs, mammory artery last 15-20

115
Q

What co-morbidities affect CABGs?

A

Pulmonary, renal, DM

116
Q

Cardioplegia

A

Temporary stopping of heart muscle during CABG. Ice cold, potassium rich

117
Q

Cardiopulmonary bypass

A

Temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the body

118
Q

How long can you stay on cardiopulmonary bypass?

A

Depends on the skill of the surgeon, the less time on bypass the better outcome

119
Q

Normal post op CABG

A

-Ventilated

120
Q

Complications of CABG

A
  • Prolonged vent
  • Renal failure-came with it or kidneys didn’t like being on bypass
  • “Pump head”-out of it for a while
  • A fib from sticking cannula in right atrium
  • Pneumonia/atelectesis
  • Infection (more likely with decreased immune system or COPD cause they’re on prednisone which decreases wound healing and decreases immune system)
121
Q

Mediastinal chest tube

A

Strictly for drainage. Only thing in mediastinum is heart.

122
Q

Pleaural chest tube

A

In pleural space, drains pleural fluid and expands lungs

123
Q

Chest tubes after CABG

A

Usually 2 mediastinal and 1 pleural

124
Q

Pacing wires after CABG

A

Right side-atrial

Left side-ventricular

125
Q

Incision care after CABG

A

Plain soap and water, incision open to air

126
Q

Activity order after CABG d/c

A

Tell them to walk up and down their driveway a few times, not down the street cause they’ll walk until they’re tired and then they have to walk back still.

127
Q

Follow up appointments after CABG

A

CV surgeon in 2 weeks
Cardiologist in 4 weeks
CV surgeon in 6 weeks

Adult 2 (8 decks)

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