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► Med Misc 49 > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Hollow muscular organ with 4 chambers

A

Heart

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2
Q

The average heart weighs

A

300-400 grams

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3
Q

Right ventricular side pumps blood into

A

Pulmonary circulation

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4
Q

The left ventricular side pumps blood to

A

The body

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5
Q

Atria are

A

Volume reservoirs

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6
Q

Outer surface, thin transparent structure

A

Epicardium

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7
Q

Actual contracting muscle of the heart

A

Myocardium

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8
Q

Inner most layer consists of endothelial tissue

A

Endocardium

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9
Q

Pericardial layer encased the heart to protect it from

A

Trauma & infection

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10
Q

The pericardial layer space holds how much fluid

A

5-30 mL

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11
Q

Rupture of pericardial space

A

Tamponade

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12
Q

Which wall of the heart is the thickest

A

Left ventricle

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13
Q

The mitral & tricuspid valves are attached by

A

Chordae tendineae

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14
Q

What supplies the heart with blood

A

Right & left coronary artery

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15
Q

Left anterior descending artery is aka

A

Widow maker

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16
Q

What prevents the regurgitation into ventricles at the end of each contraction

A

Pulmonic & aortic valves

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17
Q

Coronary sinus empties into

A

Right atrium near inferior vena cava

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18
Q

Local & temporary defunct of blood supply due to coronary artery obstruction or blockage

A

Ischemia

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19
Q

The electrical impulse is initiated by

A

The SA node

Pacemaker

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20
Q

Pathway of electrical impulse

A

SA node through muscle fibers of atria, to AV node, bundle of HIS, to right & left bundle branches then through the purkinje fibers

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21
Q

The cardiac cycle starts with the

A

SA node

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22
Q

The conduction pathway starts with

A

Depolarization

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23
Q

The cardiac cycle ends with

A

Repolarization

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24
Q

Firing of SA nodes, depolarization of atrial fibers

A

P wave

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25
Q

Depolarization from AV node through the ventricles

A

QRS complex

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26
Q

Replorization of ventricles

A

T wave

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27
Q

(if seen) may represent repolorazation of Purkinje fibers or hypokalemia

A

U wave

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28
Q

Myocardium contracts blood ejected from ventricles, aorta fills

A

Systole (S1)

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29
Q

Myocardium relaxes, allows for filling of ventricles

perfusion of coronary artery

A

Diastole (S2)

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30
Q

Volume blood ejected with each contraction

A

Stroke volume

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31
Q

Amount of blood pumped by left ventricle into aorta in one minute

A

Cardiac output

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32
Q

Cardiac Output= ? X ?

A

Stroke volume x heart rate

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33
Q

The more myocardial fibers are stretched the greater the force of contraction

A

Frank Starlings Law

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34
Q

Stroke volume is affected by

A

Preload
Contractility
Afterload

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35
Q

What can effect the stroke volume

A 
Hypothermia
Hypovolemia
Stress
Anemia
Vasodilation
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36
Q

CO divided by BMI

A

Cardiac index

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37
Q

Percentage of end diastolic blood volume ejected during systole that can be measured

A

Ejection fraction

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38
Q

Ability of heart to increase CO in response to various situations

A

Cardiac reserve

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39
Q

Blood vessels with thick walls composed elastic tissue

A

Arteries

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40
Q

Blood vessel, little elastic tissue, more smooth muscle

A

Arterioles

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41
Q

Blood vessels, large diameter thin walled. Low pressure, high volume

A

Veins

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42
Q

Blood vessels, small vessels collect blood from capillary beds

A

Venules

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43
Q

Blood vessels, thin walls made of endothelial cells

A

Capillaries

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44
Q

Regulation of the cardiovascular system is done by

A

Autonomic nervous system

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45
Q

Chronotropic effect

A

Heart rate

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46
Q

Inotropic effect

A

Myocardial Contractility

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47
Q

Specialized nerve endings affected by changes in arterial B/P

A

Baroreceptors

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48
Q

Where are baroreceptors

A

Located in wall of aortic arch & carotid sinuses

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49
Q

Located in terminal sections of vena cava & right atrium

A

Stretch receptors

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50
Q

Respond to pressure changes (volume) which reflect circulatory volume status

A

Stretch receptors

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51
Q

Located in aortic arch & carotid body

A

Chemoreceptors

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52
Q

Initiate changes when decreased arterial O2 pressure & plasma pH, increased arterial CO2 pressure. Increase cardiac activity

A

Chemoreceptors

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53
Q

Measurement of pressure exerted by blood against walls of arterial system

A

Blood pressure

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54
Q

Difference between systolic & diastolic

A

Pulse pressure

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55
Q

Orthostatic B/P

A

Take laying, sitting, standing

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56
Q

Physical exam

A

Inspection
Palpation
Percussion
auscultation

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57
Q

Sustained heavy breaths

A

Heaves

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58
Q

Yellow plaque cholesterol filled nodules on eyelids & ears

A

Xanthomas

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59
Q

Diagonal earlobe crease

A

McCarthy’s sign

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60
Q

Reflects volume & pressure circumstances on right side of heart, visible while laying down

A

JVD

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61
Q

PMI

A

Apical pulse

5th ICS MCL

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62
Q

Pulsations in epi gastric region may reflect

A

AAA

abdominal aortic aneurysm

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63
Q

What are you looking for when you palate pulses

A

Rate
Rhythm
Quality

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64
Q

Insoluble yellow brown protein gives skin reddish brown pigmentation

A

Hemosiderin

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65
Q

Discrepancy between apical & radial pulse

A

Pulse deficit

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66
Q

S1is the closure of

A

Tricuspid & mitral valve
Beginning of systole
Lub

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67
Q

S2 is closure of

A

Aortic & pulmonic valves
Beginning of diastole
Dub

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68
Q

Heard early in diastole results from vibrations produced during rapid early ventricular filling into dilated ventricle

A

S3
Ventricle gallop
Lub——-dub–Dee
Heard in pt’s with heart failure

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69
Q

Vibrations produced in late diastole occurs during atrial contraction
Forces blood into a ventricle that resists filling

A

S4
Atrial gallop
Dee–Lub——-dub
Acute MI, angina, ischemia

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70
Q

Audible vibration from turbulent blood flow in heart & great vessels

A

Murmur

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71
Q

Cause of murmur

A

Increased velocity of blood through normal & abnormal valves
Turbulent glow in dilated chamber

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72
Q

Grade III/VI

A

Easily audible
Moderately loud
Same intensity as S1 & S2

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73
Q

Sound that initiates ventricular systole

Tricuspid & mitral valves close

A

S1

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74
Q

Decrease of volume is an _____ in pulse deficit

A

Increase

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75
Q

Sound of ventricular diastole

Aortic & pulmonic valves close

A

S2

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76
Q

Inflammation of pericardial sac

Short, high pitch squeaky sound

A

Pericardial friction rub

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77
Q

Hypo kinetic

A

Weak pulse

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78
Q

Hyperkinetic

A

Bounding pulse

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79
Q

Weak & strong beats alternate

A

Pulses alterans

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80
Q

Greater than 10 mmHg drop in SBP during normal inspiration

A

Pulses paradoxus

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81
Q

chest xray can show

A

cardiac contours, heart size, configuration and anatomic changes

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82
Q

what is the most important diagnostic test to determine extent and treatment for MI

A

serial EKG

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83
Q

p wave

A

impulse though atria

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84
Q

QRS wave

A

impulse through ventricles

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85
Q

T wave

A

electrical recovery or repolarization

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86
Q

holter monitor

A

keeps diary of activities and sympotms

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87
Q

what is different in elderly with a stress test (tredmill test)

A

HR does not increase right away

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88
Q

If your pt has a c/o chest pain while doing the stress test what would you do

A

stop the test immediatley

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89
Q

uses ultrasound waves to record movement of structures of heart

A

Echocardiogram

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90
Q

what test shows the best view of the heart

A

Transesophogeal echocardiogram (TEE)

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91
Q

probe introuduced into esophags @ level of heart-posterior view

A

TEE

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92
Q

IV injection radioavtive isotopes

A

nuclear cardioplogy

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93
Q

what is used to rule out blood clots incase of a-fib

A

TEE

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94
Q

analyze cardiac enzymes and proteins to diagose acute MI or other cardiac disorders

A

cardiac markers

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95
Q

name the cardiac markers

A 
creatine kinase (CK)
myoglobin
cardiac specific troponins
homocystine
c-reactive protein (CRP)
B-type natriuretic peptide (BNP)
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96
Q

creatnine kinase

A

levels rise 4-12 hours, peak 18-24, may return to normal 2-3 days after MI, drawn @ timed intervals

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97
Q

myoglobin

A

levels tise within 30-60 minutes, peak 6-7 hours, return to baseline 24 hours

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98
Q

what is the most specific to finding myocardial damage

A

Troponin I

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99
Q

troponin I

A

levels rise 3-12 huors, peak 24-48, returnes to normal in 5-14 days

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100
Q

homocystine

A

shows irritation to blood vessels

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101
Q

produced by liver, shows risk for CAD

A

C-reative protein (CRP)

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102
Q

sevreted in response to increased ventricle volume & pressure occurs in heart failure

A

BNP- b-type natriuretic peptide

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103
Q

triglycerides

A

40-190

women can be as low as 10

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104
Q

marker for heart failure, grade of heart failure

A

BNP

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105
Q

PTT-partial thromboplastin time

A

normal clotting 21-35 seconds, monitor response of heparin

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106
Q

protrombin time

A

normal range 10-14 seconds, monitored oral anti-coagulation therapy
*coumadin

107
Q

what medications can affect prothrombin time

A

vitamin K, antibiotics

108
Q

INR international normalized ratio

A

best means standardizing PT to monitor oral anticoagulant therapy

109
Q

theraputic level of digoxin

A

0.8-2 ng/ml

110
Q

passing catheter into artery or vein in arm or leg into the heart, measures blood pressure & flow in chambers of heart & O2 saturation

A

cardiac catheterization

111
Q

what may a pt experience during a caridac cath

A

hot flushing, nausea

112
Q

what do you monitor post cath

A

bleeding, site, pulses below site

113
Q

injection or radiopaque contrast mediumdirectly into coronary arteries by same procedure as cardiac cath

A

coronary angiography

114
Q

invasive study to record intracardiac electrical activity using catherters with multiple electrodes inserted into femoral vein into right side heart

A

electrophysiology studies

115
Q

atheromas

A

fatty deposits

116
Q

a type of blood vessel disorder that is included in the general category of atherosclerosis

A

CAD

117
Q

what is the leading cause of all cardiovascular disease deaths & deaths in general

A

heart attacks

118
Q

focal deposits of cholestrol and lipids primarily within the intimal wall

A

atherosclerosis

119
Q

what are the two main causes of atherosclerosis

A

HTN

hyperlipidemia

120
Q

development of atherosclerosis lesions involves

A

the presence and effects of fat substances in arteries

121
Q

stages of atherosclerosis

A

fatty streak
raised fibrous plaque
complicated lesion

122
Q

stenosis of what percentage is concidered dangerous

A

75%

123
Q

collateral circulation is attributed to two factors

A

inherited predisposition and the presence of chronic ischemia

124
Q

what is collateral circulation

A

when arteries in heart branch around the blocked area of the artery to aabove the affected area of the artery

125
Q

name nonmodifiable risk factors for CAD

A

age
race
gender
genetic predisposition

126
Q

name modifiable risk factors for CAD

A

elevated serum lipids
HTN
smoking
physical inactivity

127
Q

bind with protien to form lipoprotein to be able to transport in blood throughout the body

A

lipids

128
Q

smoking causes

A

vasoconstriction

129
Q

what can pts work ok that hey can change for health promotion

A

stress factors

130
Q

drugs that restrict lipoprotein production are

A

Statins

Lipitor

131
Q

drugs that increase lipoprotein removal

A

Bile acid sequestrants

Questran

132
Q

drugs that decrease cholesterol absorption

A

Ezetimibe (zetia)

133
Q

niacin

A

increse HDL level

134
Q

fibric acid derivatives

A

increases HDL level, can be used to statins

135
Q

results when the lack of oxygen supply is temporary and reversible

A

chronic stable angina

136
Q

develops when the oxygen supply is prolinged and not immediately reversible

A

acute coronary syndrome

137
Q

what are the 3 things that make up acute coronary syndrome

A

unstable angina
non ST segment elevation myocardioal infarction (NSTEMI)
ST segment elevation (STEMI)

138
Q

for ischemia to occur the artery is usually ____% or more stenosed

A

75%

139
Q

most common clinical manifestation of Chronic stable angina is

A

Chest pain or discomfort

140
Q

chest pain occuring intermittently over a long period of time with the same pattern of onset, duration and intensity of symptoms

A

chronic stable angina

141
Q

is stable angina predictable

A

yes

142
Q

silent ischemia

A

occurs without symptoms

143
Q

occurs only at night

A

nocturnal angina

144
Q

chest pain while lying down, relieved by standing or sitting

A

angina decubitus

145
Q

occurs at rest usually in response to spasm of major coronary artery

A

prinzmetals angina

146
Q

what is the drug therapy goal of chronic stable angina

A

decrease O2 demand, increase O2 supply

147
Q

what is the 1st line of treatment for chronic stable angina

A

asa

148
Q

side effects of nitrates

A

HA

hypotension

149
Q

what dialates coronary arteries to increse oxygen supply

A

nitrates

150
Q

-olol

A

beta blockers

151
Q

decrease HR
decrease force of contraction
decrease rate of AV conduction

A

beta blockers

152
Q

-pines

A

calcium channel blockers

153
Q

calcium channel blockers

A

decreases conductivity of the heart
decreases demand for O2
decreases contractility

154
Q

what should you do prior to giving a beta blocker

A

HR

B/P

155
Q

is cardiac catheterization a surgery or diagnostic study

A

diagnostic study

156
Q

percutaneous coronary intervention (PCI)

A

surgical intervention alternitive

ballon angioplasty or stent or both

157
Q

if a stent placement is done what must be taken after surgery

A

anticoagulants

158
Q

the plaque is shaved off using a type of rotational blade

A

atherectomy

159
Q

used to precisely dissolve the blockage

A

laser angioplasty

160
Q

develops when ischemia is prolonged and not immediatley reversible

A

acute coronary syndrome

161
Q

manifestations of unstable angina

A

new onset
occurs @ rest
has worsening pattern

162
Q

result of sustained ischemia, greater than 20 mintues causing irreversible myocardial cell death

A

MI

163
Q

transmural MI

A

entire thickness of myocardium

164
Q

subendocardial MI

A

damage has not penetrated through entire thickness

165
Q

most MIs involve what area of the heart

A

left ventricle

166
Q

infarction in the anterior of the heart is occlusion of

A

LAD

167
Q

infarction in the inferior of the heart is

A

right coronary artery

168
Q

infarction in the posterior of the heart is

A

circumflex

169
Q

infarction of the lateral of the heart is

A

circumflex

170
Q

the hallmark of an MI

A

severe immobilizing pain

171
Q

total occlusion anaerobic metabolism and lactic acid accumulation

A

MI

172
Q

symptoms of MI

A 
increase of HR then a decease
crackles
JVD
peripheral edema
S3 or S4
173
Q

angina

A

relieved by position or nitro

174
Q

MI

A

not relieved by nitro or position

175
Q

in an attempt to compensate for infarcted muscle, normal myocardium will

A

hypertrophy and dialte

176
Q

S3 indicates

A

heart failure

177
Q

what is the most common complication of MI

A

dysrhymias

178
Q

a complication that occurs when the pumping power of the heart has diminished

A

CHF

179
Q

occurs when inadequate oxygen and nutrients are supplied to the tissues because of severe LV failure

A

cardiogenic shock

180
Q

causes mitral valve reguritation

A

papillary muscle dysfunction

181
Q

results when infarcted myocardial wall becomes thinned and bulges out during contraction

A

ventricular aneurysm

182
Q

inflammation of visceral and or parietal pericardium

A

acute pericarditis

183
Q

what is the best way to diagnos

A

echocardiogram

184
Q

sudden severe chest pain

A

pulmonary embolism

185
Q

what is the window for MI

A

90 minute window from ER to cath lab

186
Q

MONA

A

morphine
oxygen
nitrates
asa

187
Q

CABG coronary artery bypass graft

A

uses arteries or veins for grafts

188
Q

6 areas of optimal function for cardiac rehab

A 
physiologic
psychologic
mental
spiritual
economic
vocational
189
Q

unexpected death from cardiac causes

A

sudden cardiac death

190
Q

CAD accounts for ____% of sudden cardiac death

A

80%

191
Q

most sudden cardiac death is caused by

A

ventricular dysrhythimas

192
Q

what kind of presentation of coronary artery disease are found in women

A

atypical

193
Q

what is found to be the single most powerful predictor of CAD in women

A

DM

194
Q

what is the most powerful contributer for women under 50 for CAD

A

smoking

195
Q

precardia

A

area over heart

196
Q

increase cardiac output
increase cardiac rate
increase cardiac contractility

A

ace inhinitors

anfiotension converting enzyme

197
Q

any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood

A

heart failure

198
Q

is heart failure a disease

A

no its a syndrome

199
Q

inability to contract/fill effectivly bc of a stiffened ventricle

A

ventricular dysfunction

200
Q

decrese in the left ventricular ejection fraction

A

systolic failure

201
Q

inability to relaz between beats and fill during diastole

A

diastolic failure

202
Q

diastolic failure is found more in

A

the elderly

203
Q

when HR increases and CO does what and why

A

decreases bc of shortened fill time in ventricles

204
Q

what do compensatory mechanisms do

A

are activated to maintain adequate CO

205
Q

what are the compensatory mechanisms in heart failure

A 
sympathetic nervous system
kidneys release renin
proinflammaroty cytokines
endothelin is stimulated by ADH, angio II
ventricular dilation
increase muscle mass
natriuetic peptides
206
Q

most common type of heart failure

A

left sided HF

207
Q

signs of L sided heart failure

A 
increse HR
crackles
S3 &S4
changes in mental status
restlessness
pulsus alterans
PND
208
Q

pumping failure

A

left sided heart failure

209
Q

backup of blood into the right artrium and venous systemic circulation

A

right sided HF

210
Q

what symptoms will you find with acute decompensated HF

A

blood tinged sputum

bc of pulmonary edema

211
Q

what is the earliest symptom of CHF

A

fatigue

212
Q

sidden weight gain of greater than 3 pounds may indicate

A

an exacerbation of HF

213
Q

what in CHF will you get restlessness, confusion and decreased memory

A

due to the decrease of O2 to the brain

214
Q

thrombus

A

clot

215
Q

embolus

A

traveling clot

216
Q

what labs would you check for kidney

A

BUN

creatin

217
Q

what labs would you check for liver

A

ALT,

AST

218
Q

what labs would you check for heart

A

BNP
troponin
CK-MB

219
Q

what labs would you check for hypoxia

A

ABG’s

220
Q

% of blood ejected during systole

A

ejection fraction

221
Q

BEADS

A 
beat blockers
ejection fraction
ace inhibitors, ARB's
discharge instructions
smoking cession
222
Q

what is the #1 choice for elderly with heart failure

A

dirretics

bc decreases preload and pulmonary congestion

223
Q

what would you do to decrease venous return

A

high fowlers

IV nitro

224
Q

primary intervention for HF

A

maintain oxygenation

225
Q

for digoxin what does the HR have to be or else you have to hold the medication

A

60 bpm

226
Q

first line of therapy for HF

A

ace inhibator

227
Q

Lovastatin

A

mevacor
statin
antihyperlipidemic
decreases LDL, increases HDL

228
Q

what is the treatment for prinzmetals angina

A

calcium channel blocker

229
Q

metoprolol

A

lopressor
beta blocker
increases blood supply by decreasing O2 consupmtion, B/P, HR,

230
Q

nesiritide

A

natrecor
b-type natiuretic peptide
helps with diuresis, vasodialtor

231
Q

morphine

A

opiate

232
Q

heparin

A

prevents blood clots, doesnt take care of ones already there

233
Q

vasotec

A

enalapril
ACE inhibitor
renin/angiotension II suppressor

234
Q

capoten

A

captopril
ACE inhibitor
renin/angiotension II suppressor

235
Q

nadolol

A

corgard
beta blocker
antihypertensive

236
Q

Stroke volume

A

Preload
Contractility
After load

237
Q

Statin

A

Inhibit the action of an enzyme that controls the rate at which the body produces cholesterol
Lower LDL
raise HDL

238
Q

Medications ending in _____ are statins

A
  • Statin
  • ol
  • or
239
Q

Creatine kinase

A

Shows acute MI if elevated

240
Q

Myoglobin

A

Functions as an oxygen bonding muscle protein

It’s released when ischemia, trauma or inflammation of muscle occurs

241
Q

Troponin I

A

Stays elevated for days

242
Q

Homocysteine

A

Amino acid

High levels irritate blood vessels

243
Q

C-reactive protein

A

Produced by liver

Inflammation in body

244
Q

B-type natriuretic peptide

BNP

A

Hormone secreted by ventricular tissues in heart

Secreted in response to increased ventricular volume & pressure that occur when pt is in heart failure

245
Q

PTT helps monitor pt’s response to

A

Heparin

246
Q

PT helps monitor pt’s response to

A

Coumadin

247
Q

PTT time should be

A

21-35

248
Q

PT time should be

A

10-14

249
Q

An INR level for a pt on Coumadin should be?

If the pt has a mechanical prosthetic heart valve the INR should be?

A
  1. 0-3.0

2. 5-3.5

250
Q

Diuretics

A

Reduce preload by decreasing total blood volume

251
Q

ACE inhibitors

A

Dilate blood vessels & decrease vascular resistance thereby reducing work load

252
Q

Vasodilators are used if

A

Pt’s can’t tolerate ACE inhibitors

They increase cardiac output by decreasing after load

253
Q

Stroke volume is affected by

A

Preload
Contractility
After load

254
Q

Lack of contractile motion (ventricles)

A

Akinesis

255
Q

Reduced inward wall motion

A

Hypokinesis

256
Q

Paradoxical wall motion (systolic bulging)

A

Dyskinesis

257
Q

Local & temporary deficiency of blood supply due to obstruction

A

Ischemia

258
Q

Tissue death

A

Infarction

259
Q

Regulation of the cardiovascular system is done by

A

Autonomic nervous system

260
Q

Autonomic nervous system regulates

A

HR

chronotropic effect

261
Q

Sympathetic nervous system

A

Increases HR
Contractility
Vasoconstricton

262
Q

What is the first line of defense for chronic stable angina

A

Asa

263
Q

What is the best way to diagnosis acute pericarditis

A

Echo

264
Q

Amount of blood the heart pumps in one minute

A

Cardiac output

► Med Misc 49 (29 decks)

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