Cardiovascular Flashcards
1
Q
What is the pump of the heart?
A
Left ventricle
2
Q
When should you listen to apical pulse?
A
When radial pulse is irregular
3
Q
What does 0-3 means when documenting pulse?
A
0: absent
1: thread, dissappear with slight pressure
2: normal
3: bounding, strong and palpable with slight pressure
4
Q
What is the natural pacemaker of the heart?
A
SA node
5
Q
What does SA node do?
A
Cause atrial muscle to contract and fill blood to ventricles
6
Q
What does PEA stand for?
A
Pulseless electrical activity
7
Q
What does PEA mean?
A
Heart still has electrical activity but is not pumping
8
Q
How does blood flow through the heart?
A
Starts at left atrium
Goes through mitral valve to left ventricle
Goes out from aorta to head and feet
Comes back from superior and inferior vena cava to right atrium (deoxygenated blood)
Goes through tricuspid valve to right ventricle
Goes out through pulmonary artery to lungs and get oxygenated
Goes back to left atrium through pulmonary veins
And the cycle starts again
9
Q
Which side of the ventricle wall is thicker?
A
Left
10
Q
What is cardiac output?
A
The amount of blood ejected by left ventricle in 1 minute
11
Q
What is the stroke volume?
A
Amount of blood ejected by left ventricle in one contraction (ave 60-80 ml/beat)
12
Q
How do you calculate cardiac output?
A
Stroke volume × heart rate
13
Q
What is ejection fraction?
A
Total amount of blood in left ventricle that is ejected with each heart beat
14
Q
What is the normal ejection fraction?
A
55-70%
15
Q
What does epinephrine do to the heart?
A
Increase heart rate, force contraction, and dilate coronary vessells
16
Q
What does aldosterone do?
A
Regulate Na and K
17
Q
What does atrial natriuretic peptide (ANP) do?
A
Increase secretion of Na inhibiting secretion of aldosterone
18
Q
Epinephrine vs acetylcholine
A
Epinephrine:
Sympathetic: fight and flight (active)
Pupil: dilate
Saliva: low
Hr: high
Bronchi: dilate
Digestion: slow
Rectum: relax
vs
Acetylcholine:
Parasympathetic: rest and digest (calm)
Pupil: constrict
Saliva: high
Hr: low
Bronchi: relax
Digestion: fast
Rectum: contract
19
Q
Arteries carry oxygen ____ blood
A
Rich
20
Q
Do arteries have pulse?
A
Yes
21
Q
Veins carry ____________ blood
A
Deoxygenated
22
Q
Do veins have a pulse?
A
No
23
Q
Where does the exchange between blood and tissue fluids occur?
A
At the capillary
24
Q
What is peripheral vascular resistance (PVR)?
A
Blood vessels’ ability to stretch
25
What is venous return?
Ability of blood returning to right atrium
26
What would be suspected if no venous return?
DVT, edema, or blood clots in lower extremities
27
How should you take orthostatic blood pressures?
Wait at least 1 min between supine and sitting bp, another min between sitting and standing bp
28
What is a murmur?
Swishing sound when valve failed to close correctly (blackflow)
29
What is pericardial rub?
Sandpaper rubbing sound due to inflammation of pericardium
Common after MI or chest trauma
30
What is S3?
Ventricular gallop
Sounds like ken-tu-cky
Will hear better with the bell of stethoscope on the apex of heart
Common in hypervolemia, left-side HF, and mitral valve regurgitation
31
What is S4?
Atrial gallop
Sounds like ten-nes-see
Common in HTN, coronary artery disease, and pulmonary stenosis
32
What should you do before pt receives a CT angiography?
Ask for allergies b/c dye will be injected into pt
33
Classic tests for cardiac enzymes?
CK
CK-MB
troponion (norm: <0.05)
34
What are 2 invasive studies that can be done on the heart?
Angiograms and cardiac catheterization
35
What do angiograms and cardiac catheterization use?
Dye
36
What data should the nurse collect before pt receives an angiogram or cardiac catheterization?
Allergies and renal function (creatinine)
37
What is the primary risk factor for CV disease and stroke?
HTN
38
HTN s/s
Headache, anxiety, epistaxis, shortness of breath
39
Why are African Americans at higher risk for HTN?
Because they have high renin activity genetically, and that can increase the risk for HTN
40
What diet do pt get for HTN?
DASH diet
41
How well does limiting salt intake help with HTN?
bp may not respond to salt restrictions alone and meds may be needed
42
What is rheumatic fever?
Autoimmune reaction 2-3 weeks after upper resp infection such as strep throat
43
How long can rheumatic heart disease stay not evident?
Can be not evident for years after rheumatic fever
44
Rheumatic fever s/s
Pneumonitis, arthralgia, carditis, chorea, polyarthritis, subcutaneous nodules (not painful)
45
What is mitral valve prolapse (MVP)?
Valve fails to close during LV contraction, blood leaks back to LA, causing mitral regurgitation
46
What will you hear with a mitral valve prolapse?
Murmur b/c of backflow
47
When is tx needed for mitral valve prolapse?
When pt becomes symptomatic (angina, dizziness, palpitations, dysrhythmias)
48
What is the major cause of mitral stenosis?
Rheumatic fever
49
What is mitral stenosis?
Narrow mitral valve opening
50
What happens with mitral stenosis?
Decreased blood flow from LA to LV, causing LA enlargement and increased pressure
Blood backs up into pulmonary veins, RA, RV, eventually causing right sided HF due to excessive workload
51
Mitral stenosis s/s
Activity intolerance, dizziness, syncope, A fib, A flutter, fatigue, resp infections and cough
52
What can form from blood stasis in left ventricle due to mitral stenosis?
Emboli
53
What is mitral regurgitation?
Incomplete closure of mitral valve causing backflow into LA
54
What can mitral regurgitation cause?
Left and right side HF, A fib, emboli
55
What can cause mitral regurgitation?
HTN, MI, MVP, rheumatic fever, endocarditis
56
Mitral regurgitation s/s
Murmur, palpitation, fatigue, dyspnea
57
What's the most commonly acquired valvular disease in adults?
Aortic stenosis
58
What is aortic stenosis?
Aortic valve obstructs blood flow from LV
59
What will you hear with aortic stenosis?
Systolic murmur right after S1 and right before S2
60
What can cause aortic stenosis?
Rheumatic heart disease, age
61
Aortic stenosis early s/s
Angina, activity intolerance, syncope, dizziness
62
Aortic stenosis late s/s
Angina, syncope, HF (start with left side, resulting in pulmonary edema and right side HF)
63
What is TAVR?
Transcatheter aortic valve replacement
64
What are 2 types of TAVR?
Mechanical: lifelong anticoagulant
Biological: from animals, lasts 12 years
65
What is aortic regurgitation?
Blackflow of blood from the aortic into LV, increase of LV blood volume
66
What happens with aortic regurgitation?
Heart wears out quicker and lead to left sided heart failure and decreased cardiac output
67
What can cause aortic regurgitation?
Severe hypertension, rheumatic heart disease, ankylosing spondylitis (arthritis that causes chronic inflammation to certain parts of spine)
68
What will you find in a pt with aortic regurgitation?
Forceful pulse, murmur, palpitations, fatigue, dyspnea
69
What is infective endocarditis?
Infection of endocardium
70
What can endocarditis lead to?
Emboli caused by vegetative lesions forming and breaking
71
What is one important contributing factor to endocarditis?
Dental disease
72
What can you find on the palm and soles of feet in pt with endocarditis?
Janeway lesions
73
What are janeway lesions?
Small, painless, red-blue lesions
(Acute findings!)
74
TX for endocarditis?
At least 6 weeks of IV antibiotics
75
What is pericarditis?
Acute or chronic inflammation of pericardium
76
What is the pericardium?
The sack around the heart to reduce friction with movements
77
What can you find in pt with pericarditis?
Chest pain, fatigue, edema, palpitations, fever, dyspnea, orthopnea
78
What is the most common complication resulted from pericarditis?
Pericardial effusion
79
What is cardiac tamponade?
A complication resulted from pericarditis
Life-threatening compression of the heart due to fluids accumulated within the pericardial sack
80
Tx for pericarditis
Antibiotics, anti-inflammatory, colchicine, diuretics, digoxin, or surgically remove the pericardium to prevent complications
81
What is myocarditis?
Inflammation of myocardium (middle layer of heart wall)
82
What can cause myocarditis?
Viral infection
Ex: covid, parasites, fungi, bacteria
83
How long does myocarditis usually occur after viral infections?
About 2 weeks
84
S/s of myocarditis
Fatigue, chest pain, fever, malaise, muscle aches, GI discomfort, enlarged lymph nodes, tachycardia, palpitations, dyspnea
85
What can myocarditis cause?
Cardiomegaly
86
Tx for myocarditis
Bed rest, ACE inhibitors, ARBs, beta-blockers, diuretics
87
What to avoid if you have myocarditis?
NSAIDs, alcohol, smoking
88
what is cardiomyopathy?
Enlargement of heart muscle, reduces cardiac output
89
What can cardiomyopathy lead to?
HF, MI, myocardial ischemia
90
Why is cardiac output decreased with cardiomyopathy?
Dilated myocardium too weak to pump blood effectively
91
What is restrictive cardiomyopathy?
Ventricular walls stiff
92
What is hypertrophic cardiomyopathy?
Ventricular walls too thick
93
Does hypertrophic cardiomyopathy have any tx?
Tx is not required for hypertrophic
94
Pt education for cardiomyopathy
1. Family CPR training
2. Med regimen
3. Place emergency contact in wallet with pt or on fridge
95
What is venous thromboembolism?
Blood clot in the veins
Ex: DVT with risk of PE
96
What is thrombophlebitis?
Formation of a clot followed by inflammation within a vein
97
What pt are in high risk of VTE?
Immobile and post op
98
Common sites of VTE?
Legs, thighs, and pelvis
99
Interventions for VTE
Ambulate early, low molecular weight heparin, monitor PLT, hydration, ted hose, elevate extremity, warm heat, analgesics, NSAIDs
100
What are the 2 types of cardiac trauma?
Penetrating and non-penetrating
101
Is cardiac trauma an emergency?
Yes!
102
What causes non-penetrating cardiac trauma?
Blunt force, injure the heart without piercing the skin
103
What can non-penetrating cardiac trauma lead to?
Cardiac tamponade (blood fills pericardial sac, increase pressure on the heart)
104
What can be done to treat cardiac tamponade?
Pericardiocentesis, to drain the blood and restore function
105
What causes penetrating cardiac trauma?
Stabbing injury, gun shot injury
106
What can penetrating cardiac trauma cause?
Tamponade, hemothorax (pleural sac filled with blood and not draining, lungs can't expand, tx: chest tube)
107
What is atherosclerosis?
Plaque forming on the interior wall of arteries
108
What is arteriosclerosis?
Thinning of arteries, less elasticity, no flex on the arteries
109
What is coronary artery disease?
Obstruction if coronary artery blood flow from atherosclerosis (plaque build up)
110
What can coronary artery disease lead to?
Angina, MI, sudden death
111
How to prevent coronary artery disease?
Low cholesterol diet
Lipid-lowering agents (meds)
Low dose aspirin (prevent clot)
112
What is angina?
Chest pain, decreased blood flow and O2 to heart muscle
113
Typical angina s/s
Heavy tight crushing pain in chest center in the morning
Pale
Dyspneic
Diaphoretic (sweaty)
114
Female angina s/s
Chest jaw lower back pain, heartburn, fatigue, nausea, vomiting, breathlessness
115
What is a stable angina?
Moderate exertion in a pattern that's familiar to the pt, pain predictable, may last a few minutes, usually relieved by rest/nitroglycerin tablets
116
What is an unstable angina?
When rest/meds doesn't work
117
What does nitroglycerin do?
Vasodilation, lower bp
118
What is MI?
Death of heart muscle due to decrease in O2
119
MI patho
Coronary artery blockage, less cardiac blood supply
120
NSTEMI vs STEMI
NSTEMI: partial blockage
STEMI: complete blockage
121
What is a common sign of MI?
Hands gripping the chest
122
What does 12 lead EKG help determine during MI?
If it's STEMI or NSTEMI
123
MI s/s
Crushing pain that radiates to arm/shoulder/neck/jaw, dyspneic, restlessness, dizziness, fainting, nausea, disphoresis
124
Intervention for MI
"MONA"
1. Morphine
2. O2
3. Nitro/nitrate
4. Aspirin (golden dose: 325mg tab, or 4 81mg chewables)
125
Intervention for MI other than "MONA"
Bedrest, glucose check, daily weight, low-sodium clear liquids, low-fat/cholesterol/sodium diet, no caffeine, fluid restriction, weight loss, smoking cessation, antiplatelets, statins/ACE inhibitors/beta-blockers/nitro PRN/low molecular weight heparin
126
Pre-hospital care for MI
325mg aspirin
Nitroglycerin
Call 911 in 5 minutes if unrelieved chest pain
Pt should not drive themselves to the hospital!
127
What is ApoB?
ApoB: blood lipid test
Indicate coronary artery disease
>=90: high risk for CAD
128
What should you ask the pt before cardiac catheterization?
Ask for allergies!
129
Which vein is the most common for blood clot?
Saphenous vein
130
Peripheral artery disease patho
Chronic, progressive arterial narrowing, reduced blood supply
131
PAD s/s
Intermittent pain, cool skin, diminished/absent pulses, pain/cramping after walking, extremity reddish-purple when dependent and pale when elevated
132
What do you do if you see a pale cool extremity?
Notify charge nurse immediately b/c the tissue in there might be dying
133
Diet for PAD?
Low fat/cholesterol/calorie diet
134
Meds for PAD
Lipid-lowering agents
Pentoxifylline (Trental)
Thrombolytics
135
What to assess and monitor for PAD?
Assess for pain, monitor extremities for color, motion, sensation, pulse, and ulcers
136
Pt education for PAD
Inspect skin daily
Exercise to increase arterial blood flow
Avoid cold exposure, tobacco, and caffeine b/c causes vasoconstriction
137
What is Raynaud's disease?
Vasoconstriction with cold/stress causing ischemia
138
What does Raynaud's disease mainly affect?
Hands
139
Interventions for Raynaud's disease
Keep warm, avoid vasoconstriction, keep cold and stress low, take vasodilators
140
What is Buerger's disease?
Recurring inflammation of small and medium arteries and veins if hands/feet
141
What is the primary contribution factor to Buerger's disease?
Heavy cigarette smoking
142
Buerger's disease s/s
Vein inflammation
Intermittent claudication（跛行）
Lower extremities red or cyanotic in dependent position
143
Interventions for buerger's disease
Smoking cessation, calcium channel blocker, skin assessment
144
What are aneurysms?
Tumor in arteries（动脉瘤）
145
What is fusiform aneurysms?
The entire circumference of artery is dilated
146
What is saccular aneurysms?
Only one side of the artery is dilated
147
What is dissecting aneurysms?
There is a tear in the inner layer of artery causing cavity to form between layers, fills with blood and expands with each heart beat
148
What can cause venous stasis ulcer?
Chronic venous insufficiency
149
Where does venous stasis ulcer usually appear at?
At the ankle
150
What will you see on pt with venous stasis ulcer?
Leg/foot edema, brownish/discoloration, hardened/leathery skin
151
Interventions for venous stasis ulcers
Compression wraps, elevate leg, bed rest, avoid prolonged standing/sitting/dependent posture of legs and walking
Skin graft should be the last resort!
152
What is lymphangitis?
Inflammation/infection of lymphatic channels
153
What are lymphangitis most often caused by?
Strep bacteria
154
What will pt experience if they have lymphangitis?
Pain, red streak, fever/chills
155
Intervention for lymphangitis
Decrease edema, increase circulation
Antibiotic, heat, elevation, pneumatic pressure devices
156
What is the natural pacemaker of the heart?
SA node
157
What is the isoelectric line on the cardiac movement strips?
The baseline where nothing is happening
158
What does P wave represent?
Atrial depolarization
159
What is PR interval?
The time it takes for electricity to move from SA to AV node
160
What does QRS waves represent?
Ventricular depolarization
161
what does QT interval represent?
Ventricular depolarization and repolarization
162
What can prolonged/shortened QT interval lead to?
Ventricular dysrhythmias
163
What does T wave represent?
Ventricular repolarization
164
What does it mean when T wave is abnormal (pointing downward)?
Tissue ischemia in the ventricles
165
What should you monitor when you see a U wave?
Electrolyte balance
166
What does a pointed T wave mean?
Hyperkalemia
167
What does a flatter and wider T wave and U wave mean?
Hypokalemia
168
When are U waves usually seen?
When pt has medication toxicity
Ex: digoxin
169
Six step process of reading strips?
1. Regularity of rhythm
2. hr
3. P wave
4. PR interval
5. QRS complex
6. QT interval
170
What does premature Atrial Contractions look like?
1. Rhythm: PAC interrupts rhythm
2. hr: Per underlying rhythm
3. P waves: early beat, abnormal shape
4. PR interval: 0.12-0.2 sec (norm)
5. QRS interval: <=0.10 sec (norm)
171
What does atrial flutter look like?
1. Rhythm: atrial rhythm regular
2. hr: depends
3. P waves: 4 F waves (sawtooth) pattern
4. PR interval: not measurable
5. QRS: <=0.10 sec
172
What to do when Premature Atrial Contraction happens?
No s/s, no interventions, but we want to treat the underlying cause and potentially give beta-blockers
173
What's the F waves in atrial flutter?
4 F waves = 1 ventricular beat
174
What does A fib look like?
1. Rhythm: irregularly irregular
2. hr: not measurable
3. P wave: not identifiable
4. PR interval: not measurable
5. QRS interval: <=0.10 sec
175
What does Premature ventricular contraction look like?
Opposite of PAC
1. Rhythm: PVC interrupts rhythm
2. hr: per underlying rhythm
3. P wave: absent
4. PR interval: none
5. QRS interval: >0.10 sec
176
Premature ventricular contraction s/s
Palpitation, fatigue, dizziness, potentially lead to dysrhythmia
177
What can we give to pt who has PVC?
Antiarrhythmics
Ex: amiodarone, beta-blocker
178
What is bigeminal PVC?
It means every other heart beat will be followed by an early beat (PVC)
179
What does ventricular tachycardia (V tach) look like?
1. Rhythm: regular
2. hr: 150-250
3. P wave: absent
4. PR interval: none
5. QRS interval: >0.10 sec
180
What can V tach result in?
Significant decrease of cardiac output
181
Causes of V tach
Hypovolemia, hypoxia, acidosis, toxins, cardiac tamponade
182
Tx for V tach with pulse:
Give amiodarone (antiarrhythmics), replace electrolytes
183
Tx for pulseless V tach:
CPR!
Defibrillation, epinephrine, vasopressor, antiarrhythmics (amiodarone)
184
V tach with pulse s/s
Dyspnea, palpitation, cardiac arrest
185
Pulseless V tach s/s
Lightheaded, angina
186
What does V fib look like?
1. Rhythm: chaotic, extremely irregular
2. hr: not measurable
3. P wave: none
4. PR interval: none
5. QRS interval: none
187
What does V fib do?
Preventing ventricle from pushing blood out of heart, stopped cardiac output, can lead to death
188
Causes of V fib
Similar to V tach
Hypovolemia, hypoxia, acidosis, toxins, electrolyte imbalance
189
Tx for V fib
CPR! (immediate high quality CPR!)
Med follow up
Correct underlying cause
190
What does asystole look like?
No heart muscle contraction
1. None
2. None
3. None
4. None
5. None
191
What tondo when asystole occurs?
Start high quality CPR and call for help immediately
192
What are cardiac pacemakers for?
Generate impulse, override tachycardia
193
What meds do pt with A fib need to be on?
Blood thinners b/c atriums are not emptying completely
194
when A fib hr <100 is called?
Controlled response
195
When A fib hr >100 is called?
Rapid ventricular response (RVR)
196
What is synchronized cardioversion used for?
Used in dysrhythmias when R wave is present!
197
When to use defibrillator?
Pulseless V Tach, V fib
198
When to use synchronized cardioversion?
V Tach with pulse, A fib, A flutter
199
What will pt receive before synchronized cardioversion?
Conscious sedation
200
What's the most common cause for HF in elderly?
Ischemia
201
Where does left sided HF cause blood to go?
Backflow into lungs
202
What is the major cause of right sided HF?
Left sided HF
203
Where does right sided HF cause blood to go?
Backflow into systemic circulation
204
Left sided HF s/s
Night dyspnea, cough, crackles, wheezes, blood-tinged sputum, tachypnea, orthopnea, tachycardia, confusion, fatigue, cyanosis
205
Right sided HF s/s
Fatigue, dependent edema, distended jugular veins, anorexia, GI distress, weight gain, enlarged liver and spleen
206
What is pulmonary edema?
Life-threatening!
Acute HF, severe fluid congestion in alveoli, feel like drowning in own secretion
207
Pulmonary edema s/s
Pink frothy sputum
tachypnea w/accessory muscles
crackles, wheezes
Severe dyspnea, orthopnea
Clammy, cold skin
Anxiety, restlessness
208
Interventions for pulmonary edema
Reduce workload of LV
Fowler's
O2
IV diuretics/morphine/vasodilators
209
Which route should we administer meds when pt have pulmonary edema
IV b/c we are not waiting on oral to take affect!
210
Chronic HF s/s
Fatigue, weakness
Dyspnea all the time
Cough
Crackles, wheezes
Tachycardia
Chest pain
Edema
Cyanosis
Confusion
Cheyne-stokes respiration
211
Chronic HF interventions
Decrease heart's O2 demand and workload
Daily weight
Low sodium
Avoid alcohol, caffeine, fried food
