Cardiovascular Flashcards
1
Q
Define
Ischemia
A
Reduced blood flow to the body or the heart
2
Q
What is teh difference b/w stable and unstable angina
A
Stable ischemic chest pain goes away w/ rest. Predictable in the occurrence.
3
Q
Define
Cardiac stress test
A
test determines amount of workload heart can tolerate.
4
Q
What are the three enzymes related to MI?
A
- Troponin T and I
- Myoglobin
- CK-MB*
Creatine Kinase
5
Q
Which valvular disease is the most severe?
A
Aortic stenosis
decrease CO, often symptomatic
6
Q
What is Rheumatic heart disease?
A
life threatening condition in which the heart valves have been damaged
7
Q
What does C-reactive protein test for?
A
systemic inflammation
8
Q
What is the normal range for potassium?
A
3.5 to 5.5
9
Q
What is the normal range for platelets?
A
150 to 400k
10
Q
The widow maker is blockage in which area?
A
LAD
Left Anterior Decending Coronary Artery
11
Q
Which cardiac enzyme is not specfic to only testing cardiac muscle?
A
Myoglobin
12
Q
Which cardiac enzyme peaks the quickest?
A
Myoglobin
13
Q
Which cardiac enzyme remains elevated the longest?
A
Troponin
14
Q
What is the protocol for possible MI?
MI
A
- Aspirin/Nitroglycerin
- EKG
- Symptom screening
- Cardiac enzyme
15
Q
When would blood thinners* be contraindicated?
Thrombolytics, Anti-coagulants, Anti-platelet
A
- Signs of Bleeding
- Platelets < 100k
16
Q
What are the allergy contraindications for cath lab procedure?
A
Allergy to shellfish or iodine dye
17
Q
What labs should be checked before cath lab?
A
renal labs (urine analysis)
healthy kidney function to excrete dye
18
Q
What type of sedation is used for cath lab?
A
conscious
19
Q
What are the risks for cardiac catherization?
A
- Bleeding
- Clot formation
- dysrhythmia
20
Q
What are the s&s of internal bleeding?
A
- Decrease BP; Increase HR
- Purpura on skin
21
Q
What is the following?
Diverts blood around narrowed or clogged parts of the major arteries to improve blood flow and oxygen supply to the heart.
A
Coronary Artery Bypass Graft
(CABG)
22
Q
What is the criteria for HFrEF?
What is the issue?
Heart failure w/ reduced Ejection Fraction
A
- Ejection fraction < 40%
- Systolic failure: The left ventricle loses its ability to contract normally. The heart can’t pump with enough force to push enough blood into circulation.
23
Q
What is the criteria for HFpEF?
What is the issue?
Heart Failure w/ Preserved Ejection fraction
A
- Ejection fraction > 40%
- diastolic failure: The left ventricle loses its ability to relax normally (because the muscle has become stiff). The heart can’t properly fill with blood during the resting period between each beat.
24
Q
Define
Ejection fraction
A
Percent of blood that is ejected during systole
25
What is the normal range for ejection fraction?
55 to 70%
26
How is ejection fraction calculated?
SV ÷ EDV x 100 = EF
| Stroke Volume ÷ End Diastolic Volume
27
Hepatosplenomegaly is associated w/ which sided heart failure?
Right
28
What is the most common cause of right-sided HF?
progressive left-sided HF
29
What does BNP cause?
| Brain Natriuretic Peptide
the release of sodium; and as a result water.
30
Which lab is an indicator for worsening **CHF**?
**Elevated** BNP = fluid volume overload
| Brain Natriuretic Peptide
31
What is the main difference between testing BNP vs NT pro-BNP?
NT pro-BNP **does not get elevated** by ARNI medication [Entresto].
| angiotensin receptor-neprilysin inhibitor
32
What is Stage **A** Heart Failure?
High risk for HF but w/o structure heart disease or symptoms of HF
| *pts w/ HTN, Athersclerotic disease, DM, obesity, family hx HF*
33
What is Stage **B** Heart Failure?
Structural heart disease w/o signs and symptoms of HF
| *pts w/ previous MI, LVH and Low EF, asymptomatic valvular disease*
34
What is Stage **C** Heart Failure?
Structural heart disease w/ prior or current symptoms of HF
35
What is Stage **D** Heart Failure?
Patients with refractory HF
| end-stage HF
36
What is normal MAP range?
| mean arterial pressure
70 to 100 mmHg
37
Normal CVP range
| central venous pressure
2 to 8 mmHg
38
# Intereventions for
* Elevated CVP
* Decreased CVP
| central venous pressure
* BV overload - Stop fluids/diuretics
* Insufficient BV - give fluids
| Blood volume
39
What causes the P-wave
atria depolarization
40
What causes the QRS wave
ventricular depolarization
41
What causes the T wave
ventricular repolarization
42
What is the most common dysrhythmia
A-fibrillation
43
what is the difference between cardioversion and defibrillation?
The patient is conscious and the machine syncs to the QRS complex in cardioversion.
| Defibrillation occurs on unconscious patient and asynchronous
44
Which is the most severe form of valvular disease?
Aortic stenosis
45
What is the **inner** lining of the heart muscle
Endocardium
46
Which valve repair treatement requires anticoagulants for life?
Mechanical valve
47
The **outer** lining of the heart is referred to as
Pericardium
48
Which two diseases are linked to endocarditis?
1. Rheumatic fever
2. Gingivitis
| Scarlet fever r/t rheumatic
49
What is Beck's Triad a sign of?
Cardiac Tamponade
50
What are the three signs of Beck's Triad?
1. Jugular venous Distention (JVD)
2. Muffled or distant heart sounds
3. Hypotension
51
What is the treatment for a cardiac tamponade?
pericardiocentesis
(*A needle and a long thin tube (a catheter) are used to remove the fluid*. )
| medical emergency
52
What are the three main types of cardiomyopathy
| Which is the most common?
1. **Dilated**
2. Hypertrophic
3. Restrictive
53
What type of dysfunction does dilated cardiomyopathy cause?
Systolic dysfunction
| Problem pumping blood out R/T extra filling space and smaller muscles
54
What structural changes occur with **dilated** cardiomyopathy?
Enlargement of all cardiac chambers usually starting with LV.
55
Which cardiomyopathy is a risk of sudden death is young athletes?
**Hypertrophic** cardiomyopathy
56
What dysfunction is occuring with **Hypertrophic** cardiomyopathy?
Diastolic dysfuntion
| Issue w/ filling; less space; stiff muscles make it hard to push out
57
What structural changes occur with **hypertrophic** cardiomyopathy?
Increased size of ventricular septum muscles
58
How does a LVAD affect physical assessment?
1. Ascultation of heart sounds obscured by machine noise.
2. Unable to obtain a normal pulse or BP.
59
Dependent Rubor or Elevated Pallor colored legs
| Arterial or Venous Insufficiency
Arterial Insufficiency
| *Peripheral Arterial Disease (PAD)*
60
Extremities are cool to touch
| Arterial or Venous Insufficiency
Arterial Insufficiency
| *Peripheral Arterial Disease (PAD)*
61
Diminished pedal pulses
| Arterial or Venous Insufficiency
Arterial Insufficiency
| *Peripheral Arterial Disease (PAD)*
62
Intermittent claudication
(*cramping when walking*)
| Arterial or Venous Insufficiency
Arterial Insufficiency
| *Peripheral Arterial Disease (PAD)*
63
Pain with legs elevated
| Arterial or Venous Insufficiency
Arterial Insufficiency
| *Peripheral Arterial Disease (PAD)*
64
No edema
| Arterial or Venous Insufficiency
Arterial Insufficiency
| *Peripheral Arterial Disease (PAD)*
65
Reddish-brown leg color
| Arterial or Venous Insufficiency
Venous Insufficiency
| *Peripheral venous Disease (PVD)*
66
Woody (*bumpy*), textured, blistered skin
| Arterial or Venous Insufficiency
Venous Insufficiency
| *Peripheral venous Disease (PVD)*
67
Normal leg temperature
| Arterial or Venous Insufficiency
Venous Insufficiency
| *Peripheral venous Disease (PVD)*
68
Legs feel better when elevated
| Arterial or Venous Insufficiency
Venous Insufficiency
| *Peripheral venous Disease (PVD)*
69
Edema present
| Arterial or Venous Insufficiency
Venous Insufficiency
| *Peripheral venous Disease (PVD)*
70
Drainage/weeping (*exudate*) possibly present
| Arterial or Venous Insufficiency
Venous Insufficiency
| *Peripheral venous Disease (PVD)*
71
What can be sometimes confused w/ PAD or PVD?
Cellulitis
(*common bacterial skin infection that causes redness, swelling, and pain in the infected area of the skin*)
72
How is arterial/venous insufficiency R/O when suspecting Cellulitis?
| 3 signs
1. Infection redness begins to move up.
2. Increased WBC count
3. Fever
73
Elevation of D-Dimer would be indicative of what?
Clot formation in the blood
74
What are the two ways to diagnosis pulmonary embolism?
1. Chest x-ray
2. D-Dimer blood test
75
What is Virchow's Triad?
Factors that contribute to thrombosis
| blood clot that causes blockage in artery or vein
76
What are the three factors in Virchow's Triad?
1. Venous stasis
2. Hyper coagulability
3. Endothelial injury
77
What is suffix for Beta Blockers?
-olol
78
What do Beta Blockers treat?
**Hypertension** (high BP);
Tachycardia
79
When would the nurse hold the administration of Beta Blockers?
SBP < 100;
HR < 60
80
What do Statin drugs treat?
Hypercholesteremia
| *elevated cholesterol*
81
Which class of **diuretics** would be **first line** use for **hypertension**?
Thiazide
| Hydrochloride Thiazide (*Microzide*)
82
When should you **hold** Thiazides and Loop Diuretics?
Potassium < 3.5 mmol
| *risk of **hypo**kalemia*
83
What is a common Potassium-sparing Diuretic used off-label for the Tx of acne?
spironolactone (Aldactone)
84
What are three ways to determine diuretics are working?
| Which is the quickest sign to appear?
1. **Increased urine output** (*15-30 mins*)
2. Decreased symptoms (*improved breathing*)
3. Decreased weight
85
What is the suffix for ACE-I?
-pril
| Enala**pril** (Vasotec)
86
What is the suffix for ARB?
| *Angiotensin receptor blockers*
-(s)artan
87
Angioedema is an adverse effect that can occur with which CV drugs?
* **ACE-I**
* **ARB** (*angiotensin receptor blocker*)
* **ARNI** (*Angiontensin Receptor Neprilysin Inhibitor*)
88
What is a common side effect of ACE-I, what consideration can be made by the provider if it occurs?
**Dry cough**, consider **switching** to ARB.
89
What is ARNI **specifically** used to treat?
| Angiotensin Receptor Neprilysin Inhibitor
Heart Failure
90
What are three **positive** inotropic agents?
1. Digoxin
2. Dobutamine
3. Dopamine
91
What is the purpose of **positive** inotropic agents?
Positive inotropes strengthen the force (*contraction*) of the heartbeat
92
Which drugs are used to treat **cardiogenic shock**?
| *heart suddenly can't pump enough blood to meet your body's needs*
1. Dobutamine
2. Dopamine
| Positive Inotropic agents
93
What is digoxin used to treat?
* Low ejection fraction*
* Anti-arrhythmic (*e.g., tachyarrythmia*)
| R/T end-stage HF
94
What are the signs of digoxin toxicity?
1. Nausea, vomiting, diarrhea
2. Visual changes (*blurred, **halos***)
3. Bradycardia
4. Confusion
95
When would you hold Digoxin administration?
1. HR < 60
2. Potassium < 3.5 mmol
96
Which drug can be used to treat HTN and psychiatric disorders?
Clonidine
| Alpha-2-agonist
97
Which medication would be used to treat Raynaud disease?
Nifedipine
| calcium channel blocker
98
What are the four common Calcium channel blockers?
1. Nifedi**pine**
2. Diltiazem
3. Amlodi**pine**
4. Verapamil
| Common CCB suffix "-pine" and "-zem"
99
What must be checked before Calcium Channel Blockers are administered? When will it be held?
Blood pressure & Heart rate
SBP < 100;
HR < 60
100
Which two class of CV drugs are used **tachycardia** and **hypertension**
1. Beta Blockers
2. Calcium channel blockers
101
What are two medications to treat **hypo**tension?
1. Norepinephrine
2. Epinephrine
| Vasoconstrictors - increase BP
102
What are the three anti-coagulant medications?
| not counting DOACs
1. Heparin
2. Enoxaparin (Lovenox)
3. Warfarin (Coumadin)
103
Which anti-coagulant cannot be taken at home?
Heparin
104
Which anti-coagulant is a low-molecular weight Heparin?
Enoxaparin (Lovenox)
105
Which labs are conducted for Heparin use?
Partial Thrombin Time (PTT)
| *how long it takes for blood to clot*
106
1. What are the symptoms of elevated Heparin?
2. What is used reverse Heparin?
1. Signs of bleeding (*check mucosa sites/openings*)
2. Protamine sulfate
107
What is the normal range of PT/INR?
What is the expected range on an warfarin (coumadin)?
* Normal = 1
* Warfarin Range = 2-3
108
What serves to reverse warfarin (Coumadin)?
Vitamin K
109
What are two alternative methods for pulmonary embolism treatment if anticoagulants are not viable
1. IVC filter*
2. Embolectomy
| Inferior vena cava filter
110
What is the treatment for HIT*
| heparin induced thrombocytopenia
Argatroban
| direct thrombin inhibitor
111
Who is at most risk for Abdominal Aortic Aneurysm?
65+ year old male smoker w/ family hx
112
What are the signs of abdominal aortic aneurysm?
Often asymptomatic;
must be aware of **risk factors**
113
What is the most common symptom of hypertension?
Severe headache
114
What is parameter for Stage 1 hypertension
SBP 130 to 139 mmHg
or
DBP 80 to 89 mmHg
| based on an average of ≥ 2 readings obtained on ≥ 2 occasions
115
1. What is the following ECG?
2. What potential interventions if **symptomatic**?
1. Sinus **brady**cardia
2. Atropine, defibrilation, pacemaker
116
# What type of rhythm is this called?
the normal rhythm of the heart where electrical stimuli are initiated in the SA node, → AV node → bundle of His, → Purkinje fibres
Sinus rhythm
117
1. What is the following ECG?
2. What is the treatment?
1. Ventricular fibrillation (v-fib)
2. Code: Crash Cart, CPR, Defibrillation, Epinephrine
118
What are the two types of left sided HF?
* Heart failure with reduced ejection fraction (HFrEF)
* Heart failure with preserved ejection fraction (HFpEF)
119
What are the four signs of **right**-sided heart failure?
1. Dependent edema in lower extremities
2. Ascities*
3. Hepatosplenomegaly
4. Jugular venous distention (JVD)
| *edema in abdomen
120
What symptoms are associated with congestive HF?
Patient experiences **left and right sided HF symptoms** which include but not limited to: pulmonary vascular congestion symptoms, edema, fatigue, tachycardia, confusion.
121
What are possible adventitious sounds associated with **left** sided HF?
Crackles and wheezing
122
What are the three possible interventions for SVT?
| Supraventricular Tachycardia
1. Adenosine
2. Electrical cardioversion
3. Vagal maneuvers
123
1. What is the purpose of cardioversion?
2. What are the two types?
1. Cardioversion is a procedure used to return an abnormal heartbeat to a normal rhythm (SA).
2. Chemical and Electrical
124
1. What is the purpose of vagal maneuvers?
2. What are examples to vagal maneuvers?
1. to slowdown heart rate
2. Hold breath, Bear down, Dunk Head in ice water, Carotid massage, coughing
| Activate parasympathetic response
125
1. What is Adenosine used to treat?
2. How is it administered?
3. What is an expected outcome on the ECG?
1. Supraventricular Tachycardia (SVT)
2. Rapid infusion (1-2 seconds) followed by NS flush
3. ECG will flat-line briefly
| *Adenosine is the only anti-arrhythmic w/ an "S"*
126
What are the four anti-arrhythmic medications?
1. Atropine
2. Adenosine
3. Amiodarone
4. Lidocaine
| There are more; Digioxin & CCB's are also considered
127
What is Atropine used to treat?
Symptomatic bradycardia
128
What is Amiodrone used to treat?
atrial fibrillation (A-fib)
| *energy drink Mio makes your heart beat fast*
129
What will a patient w/ third degree heart block (*complete*) require if underlying causes are not found?
Pacemaker
130
What three types of arrhythmias require a code if they are occurring?
1. V-Fib
2. V-Tach
3. Third-Degree Heart Block
131
What are the two anti-platelet medications?
1. Aspirin
2. Clopidogrel (Plavix)
132
How does aspirin and nitroglycerin help during a suspected MI?
* Aspirin is an anti-platelet which prevents further clot formation.
* Nitroglycerin vasodilates vessels.
| Aspirin stops further blockage, Nitroglycerin increases blood flow
133
What are thee Direct-acting Oral Anti-Coagulants (DOAC)
1. Dabigatran
2. Api**xaban**
3. Rivaro**xaban**
134
What causes NSR w/ Premature ventricular contractions?
| Normal Sinus Rhythm
* Smoking
* alcohol
* caffeine
* anxiety
* exercise
* stress
* electrolyte imbalance (*postassium imbalance, low Mg*)
* medications (*e.g., digoxin* )
135
Which blood thinners causes the highest risk for bleeding?
| *Thrombolytics, Anti-coagulants, Anti-platelet*
Thrombolytics
136
What are four things to provide education on after pacemaker insertion
1. Keep incision clean/dry for 48 hrs.
2. Avoid vigorous arm movements/lifting for 4 to 6 week on the side w/ device.
3. Don't drive for 1 week
4. Avoid **large** electromagnetic fields (*e.g., airport, MRI*)
137
Pacemaker strikes occurring at inappropriate times
Failure to sense
138
Pacemaker strikes do not appear at all
Failure to pace
139
Pacemaker strike; beats do not occur
Failure to capture
140
A patient reports chest pain, that increases w/ deep inspiration that decreases when leaning forward. What is suspected?
Pericarditis
141
What are the five major Caprini Thrombosis Risk Factors?
1. Stroke < 1 month
2. Multiple traumas
3. Lower extremity arthroplasty
4. Hip, pelvis, leg fractures
5. Acute spinal cord injury < 1 month
142
# Which condition is described?
* Patients fingers turn different colors in response to certain triggers (*e.g., stress, cold*)
* Can be a primary disease or associated w/ AID (*e.g., scleroderma, lupus*)
Raynaud’s Phenomenon
143
What is an expected side effect of nitroglycerin?
headache
144
1. What does **homocysteine** test for?
2. What foods are eaten to lower it?
1.Indicator of **atherosclerosis**
2.foods rich in B-vitamins (esp folic acid)
145
Which electrolyte can be an indicator for cardiac contractility?
Ca2+
146
What are four MI symptoms that may be specific to women?
1. Fainting
2. Indigestion
3. Extreme Fatigue
4. Pain in lower chest
147
What position should a patient be in after cardiac catheterization ?
Supine position for several hours
(*Siting up puts pressure on abdominal area which puts pressure on femoral artery (risk for bleed)*
148
What is the "Door to Balloon Time" goal?
≤ 90 minutes from entering hospital to cath lab for MI
149
What is used to diagnosis HF?
Echocardiogram
(*uses sound waves to check the structure of your heart*)
| Determines current ejection fraction
150
What is the main concern w/ a-fib?
1. BP dropping quickly (syncope)
2. Risk for stroke due to clot formation
151
What are the three risks for LVAD?
| Left ventricular assist device
1. Pump thrombosis (*req anti-coags for life*)
2. Bleeding
3. Infection
