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Med Surg 1 > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Define

Ischemia

A

Reduced blood flow to the body or the heart

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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.

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3
Q

Define

Cardiac stress test

A

test determines amount of workload heart can tolerate.

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4
Q

What are the three enzymes related to MI?

A
  1. Troponin T and I
  2. Myoglobin
  3. CK-MB*

Creatine Kinase

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5
Q

Which valvular disease is the most severe?

A

Aortic stenosis

decrease CO, often symptomatic

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6
Q

What is Rheumatic heart disease?

A

life threatening condition in which the heart valves have been damaged

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7
Q

What does C-reactive protein test for?

A

systemic inflammation

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8
Q

What is the normal range for potassium?

A

3.5 to 5.5

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9
Q

What is the normal range for platelets?

A

150 to 400k

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10
Q

The widow maker is blockage in which area?

A

LAD

Left Anterior Decending Coronary Artery

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11
Q

Which cardiac enzyme is not specfic to only testing cardiac muscle?

A

Myoglobin

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12
Q

Which cardiac enzyme peaks the quickest?

A

Myoglobin

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13
Q

Which cardiac enzyme remains elevated the longest?

A

Troponin

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14
Q

What is the protocol for possible MI?

MI

A
  • Aspirin/Nitroglycerin
  • EKG
  • Symptom screening
  • Cardiac enzyme
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15
Q

When would blood thinners* be contraindicated?

Thrombolytics, Anti-coagulants, Anti-platelet

A
  1. Signs of Bleeding
  2. Platelets < 100k
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16
Q

What are the allergy contraindications for cath lab procedure?

A

Allergy to shellfish or iodine dye

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17
Q

What labs should be checked before cath lab?

A

renal labs (urine analysis)

healthy kidney function to excrete dye

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18
Q

What type of sedation is used for cath lab?

A

conscious

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19
Q

What are the risks for cardiac catherization?

A
  • Bleeding
  • Clot formation
  • dysrhythmia
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20
Q

What are the s&s of internal bleeding?

A
  • Decrease BP; Increase HR
  • Purpura on skin
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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)

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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.
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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.
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24
Q

Define

Ejection fraction

A

Percent of blood that is ejected during systole

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25
Q

What is the normal range for ejection fraction?

A

55 to 70%

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26
Q

How is ejection fraction calculated?

A

SV ÷ EDV x 100 = EF

Stroke Volume ÷ End Diastolic Volume

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27
Q

Hepatosplenomegaly is associated w/ which sided heart failure?

A

Right

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28
Q

What is the most common cause of right-sided HF?

A

progressive left-sided HF

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29
Q

What does BNP cause?

Brain Natriuretic Peptide

A

the release of sodium; and as a result water.

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30
Q

Which lab is an indicator for worsening CHF?

A

Elevated BNP = fluid volume overload

Brain Natriuretic Peptide

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31
Q

What is the main difference between testing BNP vs NT pro-BNP?

A

NT pro-BNP does not get elevated by ARNI medication [Entresto].

angiotensin receptor-neprilysin inhibitor

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32
Q

What is Stage A Heart Failure?

A

High risk for HF but w/o structure heart disease or symptoms of HF

pts w/ HTN, Athersclerotic disease, DM, obesity, family hx HF

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33
Q

What is Stage B Heart Failure?

A

Structural heart disease w/o signs and symptoms of HF

pts w/ previous MI, LVH and Low EF, asymptomatic valvular disease

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34
Q

What is Stage C Heart Failure?

A

Structural heart disease w/ prior or current symptoms of HF

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35
Q

What is Stage D Heart Failure?

A

Patients with refractory HF

end-stage HF

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36
Q

What is normal MAP range?

mean arterial pressure

A

70 to 100 mmHg

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37
Q

Normal CVP range

central venous pressure

A

2 to 8 mmHg

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38
Q

Intereventions for

  • Elevated CVP
  • Decreased CVP

central venous pressure

A
  • BV overload - Stop fluids/diuretics
  • Insufficient BV - give fluids

Blood volume

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39
Q

What causes the P-wave

A

atria depolarization

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40
Q

What causes the QRS wave

A

ventricular depolarization

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41
Q

What causes the T wave

A

ventricular repolarization

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42
Q

What is the most common dysrhythmia

A

A-fibrillation

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43
Q

what is the difference between cardioversion and defibrillation?

A

The patient is conscious and the machine syncs to the QRS complex in cardioversion.

Defibrillation occurs on unconscious patient and asynchronous

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44
Q

Which is the most severe form of valvular disease?

A

Aortic stenosis

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45
Q

What is the inner lining of the heart muscle

A

Endocardium

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46
Q

Which valve repair treatement requires anticoagulants for life?

A

Mechanical valve

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47
Q

The outer lining of the heart is referred to as

A

Pericardium

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48
Q

Which two diseases are linked to endocarditis?

A
  1. Rheumatic fever
  2. Gingivitis

Scarlet fever r/t rheumatic

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49
Q

What is Beck’s Triad a sign of?

A

Cardiac Tamponade

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50
Q

What are the three signs of Beck’s Triad?

A
  1. Jugular venous Distention (JVD)
  2. Muffled or distant heart sounds
  3. Hypotension
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51
Q

What is the treatment for a cardiac tamponade?

A

pericardiocentesis
(A needle and a long thin tube (a catheter) are used to remove the fluid. )

medical emergency

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52
Q

What are the three main types of cardiomyopathy

Which is the most common?

A
  1. Dilated
  2. Hypertrophic
  3. Restrictive
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53
Q

What type of dysfunction does dilated cardiomyopathy cause?

A

Systolic dysfunction

Problem pumping blood out R/T extra filling space and smaller muscles

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54
Q

What structural changes occur with dilated cardiomyopathy?

A

Enlargement of all cardiac chambers usually starting with LV.

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55
Q

Which cardiomyopathy is a risk of sudden death is young athletes?

A

Hypertrophic cardiomyopathy

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56
Q

What dysfunction is occuring with Hypertrophic cardiomyopathy?

A

Diastolic dysfuntion

Issue w/ filling; less space; stiff muscles make it hard to push out

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57
Q

What structural changes occur with hypertrophic cardiomyopathy?

A

Increased size of ventricular septum muscles

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58
Q

How does a LVAD affect physical assessment?

A
  1. Ascultation of heart sounds obscured by machine noise.
  2. Unable to obtain a normal pulse or BP.
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59
Q

Dependent Rubor or Elevated Pallor colored legs

Arterial or Venous Insufficiency

A

Arterial Insufficiency

Peripheral Arterial Disease (PAD)

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60
Q

Extremities are cool to touch

Arterial or Venous Insufficiency

A

Arterial Insufficiency

Peripheral Arterial Disease (PAD)

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61
Q

Diminished pedal pulses

Arterial or Venous Insufficiency

A

Arterial Insufficiency

Peripheral Arterial Disease (PAD)

62
Q

Intermittent claudication
(cramping when walking)

Arterial or Venous Insufficiency

A

Arterial Insufficiency

Peripheral Arterial Disease (PAD)

63
Q

Pain with legs elevated

Arterial or Venous Insufficiency

A

Arterial Insufficiency

Peripheral Arterial Disease (PAD)

64
Q

No edema

Arterial or Venous Insufficiency

A

Arterial Insufficiency

Peripheral Arterial Disease (PAD)

65
Q

Reddish-brown leg color

Arterial or Venous Insufficiency

A

Venous Insufficiency

Peripheral venous Disease (PVD)

66
Q

Woody (bumpy), textured, blistered skin

Arterial or Venous Insufficiency

A

Venous Insufficiency

Peripheral venous Disease (PVD)

67
Q

Normal leg temperature

Arterial or Venous Insufficiency

A

Venous Insufficiency

Peripheral venous Disease (PVD)

68
Q

Legs feel better when elevated

Arterial or Venous Insufficiency

A

Venous Insufficiency

Peripheral venous Disease (PVD)

69
Q

Edema present

Arterial or Venous Insufficiency

A

Venous Insufficiency

Peripheral venous Disease (PVD)

70
Q

Drainage/weeping (exudate) possibly present

Arterial or Venous Insufficiency

A

Venous Insufficiency

Peripheral venous Disease (PVD)

71
Q

What can be sometimes confused w/ PAD or PVD?

A

Cellulitis
(common bacterial skin infection that causes redness, swelling, and pain in the infected area of the skin)

72
Q

How is arterial/venous insufficiency R/O when suspecting Cellulitis?

3 signs

A
  1. Infection redness begins to move up.
  2. Increased WBC count
  3. Fever
73
Q

Elevation of D-Dimer would be indicative of what?

A

Clot formation in the blood

74
Q

What are the two ways to diagnosis pulmonary embolism?

A
  1. Chest x-ray
  2. D-Dimer blood test
75
Q

What is Virchow’s Triad?

A

Factors that contribute to thrombosis

blood clot that causes blockage in artery or vein

76
Q

What are the three factors in Virchow’s Triad?

A
  1. Venous stasis
  2. Hyper coagulability
  3. Endothelial injury
77
Q

What is suffix for Beta Blockers?

A

-olol

78
Q

What do Beta Blockers treat?

A

Hypertension (high BP);
Tachycardia

79
Q

When would the nurse hold the administration of Beta Blockers?

A

SBP < 100;
HR < 60

80
Q

What do Statin drugs treat?

A

Hypercholesteremia

elevated cholesterol

81
Q

Which class of diuretics would be first line use for hypertension?

A

Thiazide

Hydrochloride Thiazide (Microzide)

82
Q

When should you hold Thiazides and Loop Diuretics?

A

Potassium < 3.5 mmol

risk of hypokalemia

83
Q

What is a common Potassium-sparing Diuretic used off-label for the Tx of acne?

A

spironolactone (Aldactone)

84
Q

What are three ways to determine diuretics are working?

Which is the quickest sign to appear?

A
  1. Increased urine output (15-30 mins)
  2. Decreased symptoms (improved breathing)
  3. Decreased weight
85
Q

What is the suffix for ACE-I?

A

-pril

Enalapril (Vasotec)

86
Q

What is the suffix for ARB?

Angiotensin receptor blockers

A

-(s)artan

87
Q

Angioedema is an adverse effect that can occur with which CV drugs?

A
  • ACE-I
  • ARB (angiotensin receptor blocker)
  • ARNI (Angiontensin Receptor Neprilysin Inhibitor)
88
Q

What is a common side effect of ACE-I, what consideration can be made by the provider if it occurs?

A

Dry cough, consider switching to ARB.

89
Q

What is ARNI specifically used to treat?

Angiotensin Receptor Neprilysin Inhibitor

A

Heart Failure

90
Q

What are three positive inotropic agents?

A
  1. Digoxin
  2. Dobutamine
  3. Dopamine
91
Q

What is the purpose of positive inotropic agents?

A

Positive inotropes strengthen the force (contraction) of the heartbeat

92
Q

Which drugs are used to treat cardiogenic shock?

heart suddenly can’t pump enough blood to meet your body’s needs

A
  1. Dobutamine
  2. Dopamine

Positive Inotropic agents

93
Q

What is digoxin used to treat?

A
  • Low ejection fraction*
  • Anti-arrhythmic (e.g., tachyarrythmia)

R/T end-stage HF

94
Q

What are the signs of digoxin toxicity?

A
  1. Nausea, vomiting, diarrhea
  2. Visual changes (blurred, halos)
  3. Bradycardia
  4. Confusion
95
Q

When would you hold Digoxin administration?

A
  1. HR < 60
  2. Potassium < 3.5 mmol
96
Q

Which drug can be used to treat HTN and psychiatric disorders?

A

Clonidine

Alpha-2-agonist

97
Q

Which medication would be used to treat Raynaud disease?

A

Nifedipine

calcium channel blocker

98
Q

What are the four common Calcium channel blockers?

A
  1. Nifedipine
  2. Diltiazem
  3. Amlodipine
  4. Verapamil

Common CCB suffix “-pine” and “-zem”

99
Q

What must be checked before Calcium Channel Blockers are administered? When will it be held?

A

Blood pressure & Heart rate
SBP < 100;
HR < 60

100
Q

Which two class of CV drugs are used tachycardia and hypertension

A
  1. Beta Blockers
  2. Calcium channel blockers
101
Q

What are two medications to treat hypotension?

A
  1. Norepinephrine
  2. Epinephrine

Vasoconstrictors - increase BP

102
Q

What are the three anti-coagulant medications?

not counting DOACs

A
  1. Heparin
  2. Enoxaparin (Lovenox)
  3. Warfarin (Coumadin)
103
Q

Which anti-coagulant cannot be taken at home?

A

Heparin

104
Q

Which anti-coagulant is a low-molecular weight Heparin?

A

Enoxaparin (Lovenox)

105
Q

Which labs are conducted for Heparin use?

A

Partial Thrombin Time (PTT)

how long it takes for blood to clot

106
Q
  1. What are the symptoms of elevated Heparin?
  2. What is used reverse Heparin?
A
  1. Signs of bleeding (check mucosa sites/openings)
  2. Protamine sulfate
107
Q

What is the normal range of PT/INR?
What is the expected range on an warfarin (coumadin)?

A
  • Normal = 1
  • Warfarin Range = 2-3
108
Q

What serves to reverse warfarin (Coumadin)?

A

Vitamin K

109
Q

What are two alternative methods for pulmonary embolism treatment if anticoagulants are not viable

A
  1. IVC filter*
  2. Embolectomy

Inferior vena cava filter

110
Q

What is the treatment for HIT*

heparin induced thrombocytopenia

A

Argatroban

direct thrombin inhibitor

111
Q

Who is at most risk for Abdominal Aortic Aneurysm?

A

65+ year old male smoker w/ family hx

112
Q

What are the signs of abdominal aortic aneurysm?

A

Often asymptomatic;
must be aware of risk factors

113
Q

What is the most common symptom of hypertension?

A

Severe headache

114
Q

What is parameter for Stage 1 hypertension

A

SBP 130 to 139 mmHg
or
DBP 80 to 89 mmHg

based on an average of ≥ 2 readings obtained on ≥ 2 occasions

115
Q
  1. What is the following ECG?
  2. What potential interventions if symptomatic?
A
  1. Sinus bradycardia
  2. Atropine, defibrilation, pacemaker
116
Q

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

A

Sinus rhythm

117
Q
  1. What is the following ECG?
  2. What is the treatment?
A
  1. Ventricular fibrillation (v-fib)
  2. Code: Crash Cart, CPR, Defibrillation, Epinephrine
118
Q

What are the two types of left sided HF?

A
  • Heart failure with reduced ejection fraction(HFrEF)
  • Heart failure with preserved ejection fraction (HFpEF)
119
Q

What are the four signs of right-sided heart failure?

A
  1. Dependent edema in lower extremities
  2. Ascities*
  3. Hepatosplenomegaly
  4. Jugular venous distention (JVD)

*edema in abdomen

120
Q

What symptoms are associated with congestive HF?

A

Patient experiences left and right sided HF symptoms which include but not limited to: pulmonary vascular congestion symptoms, edema, fatigue, tachycardia, confusion.

121
Q

What are possible adventitious sounds associated with left sided HF?

A

Crackles and wheezing

122
Q

What are the three possible interventions for SVT?

Supraventricular Tachycardia

A
  1. Adenosine
  2. Electrical cardioversion
  3. Vagal maneuvers
123
Q
  1. What is the purpose of cardioversion?
  2. What are the two types?
A
  1. Cardioversion is a procedure used to return an abnormal heartbeat to a normal rhythm (SA).
  2. Chemical and Electrical
124
Q
  1. What is the purpose of vagal maneuvers?
  2. What are examples to vagal maneuvers?
A
  1. to slowdown heart rate
  2. Hold breath, Bear down, Dunk Head in ice water, Carotid massage, coughing

Activate parasympathetic response

125
Q
  1. What is Adenosine used to treat?
  2. How is it administered?
  3. What is an expected outcome on the ECG?
A
  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
Q

What are the four anti-arrhythmic medications?

A
  1. Atropine
  2. Adenosine
  3. Amiodarone
  4. Lidocaine

There are more; Digioxin & CCB’s are also considered

127
Q

What is Atropine used to treat?

A

Symptomatic bradycardia

128
Q

What is Amiodrone used to treat?

A

atrial fibrillation (A-fib)

energy drink Mio makes your heart beat fast

129
Q

What will a patient w/ third degree heart block (complete) require if underlying causes are not found?

A

Pacemaker

130
Q

What three types of arrhythmias require a code if they are occurring?

A
  1. V-Fib
  2. V-Tach
  3. Third-Degree Heart Block
131
Q

What are the two anti-platelet medications?

A
  1. Aspirin
  2. Clopidogrel (Plavix)
132
Q

How does aspirin and nitroglycerin help during a suspected MI?

A
  • Aspirin is an anti-platelet which prevents further clot formation.
  • Nitroglycerin vasodilates vessels.

Aspirin stops further blockage, Nitroglycerin increases blood flow

133
Q

What are thee Direct-acting Oral Anti-Coagulants (DOAC)

A
  1. Dabigatran
  2. Apixaban
  3. Rivaroxaban
134
Q

What causes NSR w/ Premature ventricular contractions?

Normal Sinus Rhythm

A
  • Smoking
  • alcohol
  • caffeine
  • anxiety
  • exercise
  • stress
  • electrolyte imbalance (postassium imbalance, low Mg)
  • medications (e.g., digoxin )
135
Q

Which blood thinners causes the highest risk for bleeding?

Thrombolytics, Anti-coagulants, Anti-platelet

A

Thrombolytics

136
Q

What are four things to provide education on after pacemaker insertion

A
  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
Q

Pacemaker strikes occurring at inappropriate times

A

Failure to sense

138
Q

Pacemaker strikes do not appear at all

A

Failure to pace

139
Q

Pacemaker strike; beats do not occur

A

Failure to capture

140
Q

A patient reports chest pain, that increases w/ deep inspiration that decreases when leaning forward. What is suspected?

A

Pericarditis

141
Q

What are the five major Caprini Thrombosis Risk Factors?

A
  1. Stroke < 1 month
  2. Multiple traumas
  3. Lower extremity arthroplasty
  4. Hip, pelvis, leg fractures
  5. Acute spinal cord injury < 1 month
142
Q

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)
A

Raynaud’s Phenomenon

143
Q

What is an expected side effect of nitroglycerin?

A

headache

144
Q
  1. What does homocysteine test for?
  2. What foods are eaten to lower it?
A

1.Indicator of atherosclerosis
2.foods rich in B-vitamins (esp folic acid)

145
Q

Which electrolyte can be an indicator for cardiac contractility?

A

Ca2+

146
Q

What are four MI symptoms that may be specific to women?

A
  1. Fainting
  2. Indigestion
  3. Extreme Fatigue
  4. Pain in lower chest
147
Q

What position should a patient be in after cardiac catheterization ?

A

Supine position for several hours
(Siting up puts pressure on abdominal area which puts pressure on femoral artery (risk for bleed)

148
Q

What is the “Door to Balloon Time” goal?

A

≤ 90 minutes from entering hospital to cath lab for MI

149
Q

What is used to diagnosis HF?

A

Echocardiogram
(uses sound waves to check the structure of your heart)

Determines current ejection fraction

150
Q

What is the main concern w/ a-fib?

A
  1. BP dropping quickly (syncope)
  2. Risk for stroke due to clot formation
151
Q

What are the three risks for LVAD?

Left ventricular assist device

A
  1. Pump thrombosis (req anti-coags for life)
  2. Bleeding
  3. Infection

Med Surg 1 (7 decks)

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