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► Med Misc 49 > cardiovascular 2 > Flashcards

cardiovascular 2 Flashcards

1
Q

What is the leading cause for heart transplant

A

Cardiomyopathy

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2
Q

A group of heart muscle diseases that affect the structure & function of the myocardium

A

Cardiomyopathy

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3
Q

Most common type of cardiomyopathy

A

Dilated (congestive)
Increase chamber size
Decrease wall thickness

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4
Q

Occurs after infectious myocarditis; possible autoimmune process

A

Dilated cardiomyopathy

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5
Q

Inflammation & rapid degeneration of myocardial fibers decreased Contractility function & ventricular dilation

A

Dilated cardiomyopathy

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6
Q

Nitrates

A

Vasodilation

Decrease preload & after load

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7
Q

Loop diuretic

A

Helps with preload

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8
Q

ACE inhibitor

A

Vasodilator

Stops angiotensin I

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9
Q

Beta blockers

A

Decrease HR, B/P, CO

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10
Q

Anticoagulant

A

Risk for blood clots

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11
Q

Indotropic

A

Decrease HR

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12
Q

Most common cause of sudden death in otherwise healthy young people

A

Hypertrophic cardiomyopathy

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13
Q

Massive ventricular hypertrophy
Rapid forceful LV contraction
Impaired relaxation of ventricles
Enlarged ventricle septum

A

Hypertrophic cardiomyopathy

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14
Q

Most common symptom of hypertrophic cardiomyopathy

A

Exertional dyspnea

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15
Q

Primary diagnostic tool for hypertrophic cardiomyopathy

A

Echocardiogram

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16
Q

Resection/remove left ventricle, may remove septum tissue

A

Ventriculomyotomy

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17
Q

Inject alcohol into LA to give infarction to septal wall

A

Percutaneous transluminal septal myocardial ablation

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18
Q

What is the least common form of cardiomyopathy

A

Restrictive cardiomyopathy

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19
Q

Myocardial fibrosis, hypertrophy & infiltration

A

Restrictive cardiomyopathy

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20
Q

Maximum time from harvest to transplant

A

4 hours

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21
Q

What is the primary complication of heart transplant

A

Infection

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22
Q

Infection or inflammatory process of inner layer of heart and heart valves
Classified by cause or affected site

A

Infective endocarditis

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23
Q

Infective carditis that occurs in existing disased valves, sicker longer

A

Subacute

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24
Q

Infective endocarditis that affects healthy valves, rapidly progresses

A

Acute endocarditis

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25
Q

Symptoms of endocarditis

A 
Low grade fever
Chills
Weakness
New or changing murmur 
Affects multiple organ system
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26
Q

Linear streak under fingers

Red then brown/black

A

.

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27
Q

Oslers nodes

A

Tender, painful, size of pea, red/purple color on fingers

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28
Q

Janeways lesion

A

Sole of feet, flat painless, initially red then brown

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29
Q

How much fluid is in the pericardial sac?

A

10-15 ml

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30
Q

Late pericarditis

4-6 weeks after MI

A

Dressler syndrome

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31
Q

Rapid or slow fluid accumulation in pericardial sac

A

Pericardial effusion

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32
Q

Life threatening fluid accumulation in pericardium

A

Cardiac tamponade

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33
Q

What is a major sign of cardiac tamponade

A

Beck’s triad

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34
Q

Beck’s triad

A

Muffled heart sounds
Hypotension
JVD

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35
Q

Exaggerated drop in systolic arterial blood pressure upon inspiration

A

Pulsus paradoxus

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36
Q

Fluid aspirated from pericardial sac

A

Pericardiocentesis

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37
Q

infection/inflammation of pericardial sac

fibrous scarring thickened & adherent pericardium

A

chronic constrictive pericarditis

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38
Q

what mimics heart failure

A

chronic constrictive pericarditis

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39
Q

what confirms the diagnosis of chronic constrictive pericarditis

A

color doppler imaging

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40
Q

removal of pericardium

A

pericardectomy

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41
Q

inflammatory/infection disease of myocardium, orgainism invades myocytes with cell damage & necrosis

A

myocarditis

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42
Q

what confirms the diagnosis of myocarditis

A

endomyocardial biopsy

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43
Q

what do heart valves do

A

control unidirectional blood flow

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44
Q

the tricuspid and mitral valves are open during

A

diastole

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45
Q

the semilunar valves are open during

A

systole

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46
Q

what stabilizes the heart valves

A

chordae tendineae

“heart strings”

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47
Q

defined according to valve affected & type of altered function

A

valvular heart disease

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48
Q

valve orifice small, narrow

A

stenosis

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49
Q

incomplete closure of valve leaflets resulting in backward flow of blood

A

regurgitation

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50
Q

what is the most common valvular heart disorder

A

aortic stenosis & mitral regurgitation (left side of heart)

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51
Q

damage & scarring to valve leaflets & chordae tendineae, valves become thick, funnel shape, shortened (fish mouth)

A

mitral valve stenosis

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52
Q

common causes of mitral valve regurgitiation

A

MI, rhumatic heart disease

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53
Q

blood backflow from LV to LA

A

mitral valve regurgitation

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54
Q

therady pulses with cool, clammy extremities, shock and pulmonary edema are symptoms of

A

acute mitral valve regurgitation

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55
Q

what is the most common valvular heart disease in US

A

mitral valve prolapse

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56
Q

abnormal valve strucutre causing valve leaflets to buckle into LA in systole

A

mitral valve prolapse

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57
Q

blood flow is obstructed from LV to aorta

A

aortic valve stenosis

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58
Q

triad of symptoms for aortic valve stenosis

A

angina pectoris
syncope
exertional dyspnea

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59
Q

allows blood to flow back from aorta to LV

A

aortic valve regurgitation

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60
Q

results in increased blood volume in RA & RV

A

tricuspid and pulmonic valve disease

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61
Q

strong quick beat then collapses immediatly

A

water hammer pulse

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62
Q

what is used to diagnose valvular disorders

A

Echo/TEE

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63
Q

splits open fused leaflets, a balloon tipped catheter threaded from femoral artery/vein to stenotic valve, the balloon inflates to separate valve leaflets

A

precutaneous transluminal balloon valvuoplasty

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64
Q

what is needed after a mechanical heart valve

A

long term anticoagulants

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65
Q

what is the INR therapeutic range for a mechanical valve

A

2.5-3.5

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66
Q

what is the most common location for a aortic aneurysms

67
Q

grey turnes sign

A

back/fank pain, ecchymosis

68
Q

what is the most accurate diagnostic test

69
Q

signs of aortic aneurysms

A

increase HR, decrease B/P, increase RR, decrease LOC

70
Q

a small aneurysm is what size

A

less than 5 cm

71
Q

whta is the threshold for repair

72
Q

what is the mortality rate with AAA

73
Q

alternative to conventional surgical repair, placement of sutureless aoritc graft into abd. aorta inside aneurysm, done through femoral artery

A

endovascular graft procedure

74
Q

results of a false luman through which blood flows, classified by location and duration of onset

A

aortic dissection

75
Q

sudden severe chest pain, described as “sharp or tearing”

A

aortic dissection

76
Q

is an aortic dissection an aneurysm

77
Q

hypotension, narrowed pulse pressure, JVD, muffled heart sounds, pulsus paradoxus, blood in pericardial sac

A

cardiac tamponade

78
Q

thick walled vessel that transports O2 away from heart

79
Q

single layer cells in tissues, exchange essential cellular products

A

capillaries

80
Q

transports deoxygenated blood to the heart, think walled, large diameter

81
Q

which has valves, arteries or veins

82
Q

which has pulses, arteries or veins

83
Q

6 p’s of peripheral vascular assessment

A

pain, pulses, poikilothermia, pallor, parasthesia, paralysis

84
Q

arterial pain is described by and relieved by

A

sharp unrelenting, @ night relieved by dangling at side of bed

85
Q

venous pain is described by and relieved by

A

aching, cramping, relieved by excercise, homans sign

86
Q

arterial findings with skin

A

absent hair, thick brittle nails, shiny, taut skin, wlcers

87
Q

venous findings with skin

A

garter sign, chronic edema, ulcers

88
Q

pruritus

89
Q

irregularly shaped, ruddy color, “wet” edges due to extensive drainage

A

venous statsis

90
Q

pressure points, symmetrical/circular, gangrene, deep and painful, trash foot blue toe

A

arterial ulcers

91
Q

most common venous disorder

A

venous thrombosis

92
Q

traveling clot

93
Q

virchows triad

A

hypercoagulability of blood
damage to intima of vein wall
venous stasis

94
Q

a thrombus is made up of

A

RBC, WBC, platelets and fibrin

95
Q

commonly occurs at valve cusps of vein

A

venous stasis

96
Q

inflammation of a superficial vein

A

superficial thrombophlebitis

97
Q

how is a superficial thrombophelbitis is diagnosed

A

visual physical exam

98
Q

most common site for DVT

99
Q

what is the % of asymptomatic pts with DVT

100
Q

a clot that travels to the lung

A

pulmonary embolism

101
Q

swelling in a vein that occludes, very suddenly causes cyanosis

A

phelgmasia cerulea dolens

rare!

102
Q

what is the most commonly used diagnostic studies for DVT

A

duplex scanning

103
Q

what is not used on pt with DVT

104
Q

do anticoagulants dissolve clots

A

no, prevent furthur clot formation and enlargment of clots

105
Q

what is used to dissolve clots

A

thrombolytics-IV “clot buster”

106
Q

dilated, tortuous, subcutaneous veins frequently found in sapheous system due to increased venous pressure

A

varicose veins

107
Q

varicosity pulled through stab incision then vein excised and removed

A

phlebectomy

108
Q

incrased pressure in veins from reflux of blood

A

chronic venous insufficency

109
Q

break down of RBC’s

A

hemosiderin

110
Q

gradual thickening and narrowning of arterial wall

A

atherosclerosis

111
Q

progressive narrowing & eventual obstruction of the arteries to lower extremities

A

peripheral arterial disease (PAD)

112
Q

what is the most significant risk factor for peripheral arterial disease

A

smoking, hyperlipidemia, HTN, primary cause is atherosclerosis

113
Q

what is the normal ankle-brachial index

114
Q

contrast dye injected into catheter in vessel, usually in femoral artery

115
Q

percutaneous transluminal balloon angioplasty

A

similar to cardiac cath, used for peripheral arterial disease

116
Q

synthetic graft or autogenous vein used to carry blood around stenosed or occluded artery

A

peripheral artery bypass operatoin

117
Q

surgically opening an artery and removing the “fatty plaque scrapple”

A

endarterectomy

118
Q

opening of an artery, removal of plaque, apply a patch to widen artery lumen and increase blood flow to area

A

parch graft angioplasty

119
Q

sudden interruption in arterial blood flow to tissue, organ, extremity

A

acute arterial ischemic disorders

120
Q

most common acute arterial ischemic disorders

A

emboli from heart

121
Q

constricted or obstructed arteries, occurs with only tobacco users, not related to plaque

A

buergers disease aka thromboangiitis obliterans

122
Q

what is a major complication of thrombolytics

A

bleeding in brain

123
Q

transection of nerve, ganglion and or nerve plexus of SYS, stops vasoconstriction

A

sympathectomy

124
Q

characterized by vasospasm induced color changes, exaggerated SNS response

A

raynauds phenomenon

125
Q

White, blue, red color changes of hands

A

raynauds phenomenon

126
Q

what medications are used for raynuds phenomenon

A

vasodialator and calcium channel blockers

127
Q

largest artery in body, supplies blood (o2) to all vital organs

128
Q

abdominal aortic aneurysms above or below the renal artery are more common

129
Q

wall of artery forms the aneurysm with aat least one vessel layer still intact

A

true aneurysm

130
Q

circumferential, relatively uniform in shape aneurysm

131
Q

pouch like with narrow neck connecting buldge to one side of arterial wall

A

saccular aneyrysm

132
Q

disruption of all layers of arterial wall, results in bleeding contained by surrounding structures, AKA pseudoaneurysm

A

false aneurysm

133
Q

often asymptomatic deep diffuse chest pain, pain may extend to interscapular area, increase pain with laying flat

A

thoracic aorta aneurysm

134
Q

angina, hoarsness, if presses on superior vena cava, decrease venous return, distended neck veins, edema of head and arms

A

ascending aorta/aortic arch aneurysm

135
Q

most common location asymptomatic frequently detected on physical exam or when examined for unrelated problem

136
Q

anticoagulants are used for

A

prophylaxis (prevent formation of thrombus)

treatment for existing clot (prevents enlargement, new clots from forming, embolization)

137
Q

what do anticoagulants not do

A

dissolve a clot that has already formed

138
Q

name the 3 stages of natural clotting

A

stage 1- vascular response- vasoconstriction
stage 2-platelet response, clump & form platelet plug, initiates pathways in clotting cascade
stage 3-common pathway, prothrombin to thrombin then fibrinogen to fibrin, creates fibrin mesh

139
Q

a series of interactions that result in the formation of a fibrin clot

A

clotting cascade

140
Q

formation of a clot can result from activation of 1 or 2 pathways which are

A

extrinsic or intrinsic pathway

141
Q

intrinsic pathway

A

begins with damage to a blood vessel
when blood comes in contact with a damaged blood vessel surface, it activates factor XII
factor XII inititaes a cascade of enzyme reactions that lead to inactive factor X, the common pathway then a clot

142
Q

extrinsic pathway

A

begins with tissue damage, occurs outside the vessel, tissue factor and thromboplastin initiate the clorring cascade that leads to the common pathway and a clot

143
Q

what is the bodys natural process to form clot

A

fibrinolytic pathway

144
Q

3 Rx that affect clotting process

A

antiplatelet
anticoagulants
thrombolytics

145
Q

prevents platelets from sticking together

A

antiplatelets

146
Q

anti platelet medications

A

inhibit platelet aggregation “sticking together”

147
Q

blocks conversion of prothrombin to thrombin and fibrinogen to fibrin, prevents furthur extension of existing clots and new clots from forming

148
Q

what do you need for a heparin shot

A

25 gage needle
3 ml syringe
must change needle prior to injecting
2 inches away from belly button in smily face
must be checked by 2 RN’s regardless of route

149
Q

DVT prophlaxis heparin amount

A

5000 units q8-12 hour

150
Q

what is monitored while on heparin

A

anti Xa & PTT

151
Q

anti Xa therapeutic range

A

0.3-0.7 IU/ml

152
Q

what is measured 6h after heparin drip started and q6h until in therapeutic range for two draws in a row

153
Q

what is a complication of heparin

A

HIT (heparin induced thrombocytopenia)

154
Q

lovenox

A

low molecular weight heparin
dont expel air bubble in syringe, 1 mg/kg SubQ
in love handles
dont need to monitor with lab work

155
Q

what is the antidote with lovenox

A

protamine sulfate

156
Q

what is the antdote with heparin

A

protamine sulfate

157
Q

what is the antidote with coumadin

158
Q

what is ideal for HIT pts

A

leech saliva

159
Q

inhabits activation of the Vit K dependent coagulation factors in the liver

160
Q

INR therapeutic INR

A

2-3 prophylactic/PE

2.5-3.5 prosthetic heart valve

161
Q

Intermittent claudication

A

Exercise pain

162
Q

what medications should be avoided when on coumadin

163
Q

Positive blood culture
New/changed murmur
Intracardiac mass/ vegetation

A

Inflammation of the pericardium

► Med Misc 49 (29 decks)

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