Cardiovascular

Question 1

ACE inhinitors

Answer 1

(Angiotensin converting enzyme)
Ends in -Pril (Captopril, Enalapril, Benzapril)
Action: decrease vascular resistance without increasing cardiac output, rate, or contractility.
Effects: dizziness, orthostatic hypotension, GI distress, Nonproductive cough, HA

Question 2

Beta-Blockers

Answer 2

End in -olol -alol (propranolol, Atenolol)
Action: Blocks beta receptors in the heart causing a decrease in HR, decrease in force of contraction, and decrease in rate of AV conduction.
SE: bradycardia, lethargy, GI disturbance, CHF, decrease in BP, and depression.

Question 3

Calcium Channel blockers

Answer 3

“Very Nice Drugs”- (Verapamil, Nifedipine, Diltiazem)
Action: Blocks calcium access to cells causing:
decrease in contractility and conductivity of the heart therefore decreasing the demand for oxygen.

SE: decreased BP, bradycardia, may precipitate AV block, HA, abdominal discomfort (constipation, nausea), peripheral edema

Question 4

Myocardial infarction

Answer 4

Pain: sudden onset, substernal, crushing, tightness, severe, unrelieved by Nitro, may radiate to the back, neck, jaw, shoulder, or arm.
-dyspnea -syncope -nausea -vomiting -extreme weakness - diaphoresis -denial is common -increase in HR

tx: O2 - IV - Meds -monitor dietary restrictions -decrease in NA, Chol, caffeine -PCI? -surgery? -pacemaker?

Question 5

Preload

Answer 5

Force that stretches the ventricles during diastole (how much blood is emptied into them)

Question 6

Afterload

Answer 6

Pressure the left ventricle needs to exert to overcome the higher pressure in the aorta to eject blood; influenced by the size and wall thickness of the ventricle and pressure in the systemic arteries and veins.

Question 7

Stroke Volume

Answer 7

Volume of blood ejected by the ventricle with each contraction (70-80ml)
components: 1) preload 2) afterload 3) contractility (influenced by Ca, K, acidosis, hypoxia)

Question 8

Akinesis

Answer 8

lack of contractile motion

Question 9

Hypokinesis

Answer 9

reduced inward wall motion

Question 10

Dyskinesis

Answer 10

paradoxical wall motion (systolic bulging)

Question 11

CXR

Answer 11

Can depict cardiac contours, heart size and configuration, anatomic changes.
Records displacement or enlargement, presence of extra fluid, pulmonary congestion.

Question 12

EKG/ECG -Electrocardiogram

Answer 12

Standard 12 lead
-measures heart electrical activity, records wave forms, electrodes on chest and limbs.
-each wave represents transmission of electrical impulse thru the heart muscle (depolarizing)
-repolarization-electrical potential returns to normal resting state
3 basic elements: p wave, QRS complex, T wave
Detects: rhythm, activity of pacemaker, conduction abnormalities, heart position, size of atria and ventricles, injury, history of MI

Question 13

P wave

Answer 13

impulse thru atria

Question 14

QRS complex

Answer 14

impulse thru ventricles

Question 15

T wave

Answer 15

electrical recovery or repolarization

Question 16

Most important diagnostic test to determine extent and tx of MI

Answer 16

Serial ECG

Question 17

Holter monitor

Answer 17

• Ambulatory ECG can provide more info that standard testing
• Usually 24-48 hrs
• Patient wears small tape recorder connected to bipolar electrodes on chest
• keeps diary of activities and symptoms

Question 18

Heart Failure

Answer 18

• An abnormal condition involving impaired cardiac pumping (pump failure)
• Heart is unable to produce an adequate cardiac output to meet metabolic needs
• Heart failure is NOT a disease it is a syndrome. associated with long-standing HTN and CAD

Question 19

Causes of HF

Answer 19

• Most common reason for hospitalization in adults >65 years
• Primary: CAD and advancing age
• Contributing factors: HTN, diabetes, tobacco use, obesity, high cholesterol, being African American
• either systolic or diastolic failure

Question 20

Systolic Failure

Answer 20

The most common cause

• Hallmark finding: decrease in the left ventricular ejection fraction
• Caused by impaired contractile function, increased afterload (HTN), cardiomyopathy, mechanical abnormalities (valve disease)

Question 21

Diastolic failure

Answer 21

• impaired ability of the ventricle to relax and fill during diastole, resulting in decreased stroke volume and CO
• diagnostic based on the presence of pulmonary congestion, pulmonary hypertension, ventricular hypertrophy, normal ejection fraction (EF)
• Caused by: left ventricular hypertrophy from chronic HTN, aortic stenosis, hypertrophic cardiomyopathy
• isolated right ventricular diastolic failure from pulmonary hypertension from COPD

Question 22

Tamponade

Answer 22

increase in fluid around the heart –constricts.

Question 23

Right Coronary Artery (RCA)

Answer 23

Supplies: the Right Atrium and ventricle
-inferior part left ventricle
SA & AV nodes, Bundle of His
Posterior interventricular spetum
Occlusion- infarction of inferior and posterior part of LV, affects conduction

Question 24

Left Coronary Artery divides into two main branches….

Answer 24

• Left anterior descending artery (LAD)

- Left circumflex

Question 25

Left anterior descending artery (LAD)

Answer 25

"widow maker"
Supplies:
Anterior wall left ventricle
anterior interventricular septum
Apex of left ventricle
Bundle of His in 10% of population
infarction affects Anterior LV & interventricular septum, apical area LV