Cardiovascular

Question 1

is a condition that occurs when perfusion of the myocardium is compromised due to some imbalance between myocardial oxygen supply and/or demand

Answer 1

Ischemia

Question 2

is regulated by the patency or size of the lumen of the coronary vessel, the ability of the ventricular wall to compress and the amount of time the ventricle spends in diastole

Answer 2

Oxygen supply

Question 3

is dependent upon myocardial contractility, HR, and amount of ventricular stress

Answer 3

Demand

Question 4

an abrupt or acute reduction in blood flow to the myocardium caused by thrombus, coronary vasospasm or platelet aggregation.

Answer 4

Supply ischemia

Question 5

an increase in need for oxygen and nutrients due to exercise or stress

Answer 5

Demand ischemia

Question 6

3 common causes of ischemia?

Answer 6

• blockage of coronary artery (thrombus)
• spasm of coronary artery
• coronary artery obstruction (formation of plaque)

Question 7

It only takes ___ mins to progress to necrosis if the flow to the myocardium is not restored

Answer 7

20 mins

Question 8

is a continuum that begins with plaque rupture within a coronary artery and results in infarction of myocardial tissue if perfusion is not restored in good time.

Answer 8

acute coronary syndrome

Question 9

3 phases of acute coronary syndrome

Answer 9

• unstable angina
• NSTEMI
• STEMI

Question 10

Formation of fatty fibrous lesion with a lipid core and fibrous cap

Answer 10

stable angina

Question 11

Rupture of fibrous cap allows leaking of lipids and platelet aggregation

Answer 11

unstable angina

Question 12

Clot formation

Answer 12

NSTEMI

Question 13

Thrombus causes occlusion of vessel

Answer 13

STEMI

Question 14

The T wave represents

Answer 14

ventricular repolarization

Question 15

is often seen on an ECG as ST segment depression and T wave inversion during the period of pain.

Answer 15

unstable angina

Question 16

necrosis of myocardial tissue occurs, but because the full thickness of the ventricle is not involved, electrical activity is not disrupted and there are no obvious changes on the ECG.

Answer 16

non-STEMI

Question 17

is an enzyme found in the heart, brain, and skeletal muscle and is released when these cells are damaged.

Answer 17

Creatinine Kinase (CK)

Question 18

CK-MM

Answer 18

skeletal muscle

Question 19

CK-BB

Answer 19

brain tissue

Question 20

CK-MB

Answer 20

myocardial tissue

Question 21

• a protein found in skeletal and cardiac muscle

- increases earlier, more quickly, and stays elevated longer than CK

Answer 21

Troponin

Question 22

arterial occlusion is complete, resulting in necrosis of the full thickness of the ventricle, which alters electrical conduction.

Answer 22

STEMI

Question 23

seen as ST elevation on the ECG and cardiac biomarkers are elevated

Answer 23

STEMI

Question 24

cell death and necrosis has occurred; seen as pathological Q waves on the ECG; cells replaced with scar tissue.

Answer 24

zone of infarct

Question 25

injured but potentially viable tissue, surrounding the area of infarct; seen as ST segment elevation on the ECG

Answer 25

zone of injury

Question 26

outer region of the infarcted area; cells are still viable; manifests as T wave inversion on the ECG.

Answer 26

zone of ischemia

Question 27

is depicted by the flipped or inverted T wave

Answer 27

ischemia

Question 28

depicted by the elevated ST segment

Answer 28

injury

Question 29

depicted by a pathological Q wave (deep or wide)

Answer 29

infarct

Question 30

are often caused by movement to anaerobic metabolism in the presence of ischemia without manufacture of enough ATP

Answer 30

Dysrhythmias

Question 31

decreases afterload through vasodilation

Answer 31

morphine

Question 32

vasodilates vascular smooth muscle, decreases afterload and myocardial oxygen demand and improves coronary and artery blood flow.

Answer 32

nitroglycerin

Question 33

prevents platelet aggregation; should be chewed

Answer 33

ASA

Question 34

decrease workload of the heart by decreasing contractility and heart rate

Answer 34

beta-blockers

Question 35

prevents activation of the glycoprotein IIIb/IIIa complex required for platelet aggregation

Answer 35

Adenosine Diphosphate Receptor Antagonist (Clopidogrel)

Question 36

accelerates action of anti-thrombin, which inactivates thrombin to prevent formation of thrombus

Answer 36

Anticoagulant (Heparin)

Question 37

fibrinolysis is achieved with tenecteplase (TNK) to re-establish artery patency.

Answer 37

Reperfusion therapy

Question 38

A balloon tipped catheter is used to open occluded arteries in the catherization lab; a stent may be inserted to keep the artery open

Answer 38

PCI- percutaneous coroniary intervention

Question 39

A surgical technique where the patient's own blood vessels are harvested from a distant site, and used to bypass an occluded artery.

Answer 39

CABG- coronary artery bypass grafting

Question 40

Decreases thrombus formation by making platelets less "sticky" so that risk of clot formation is decreased.

Answer 40

Glycoprotein IIIb/IIIa inhibitors

Question 41

Results in relaxed vessels and decreased LV workload | Prevents conversion of angiotensin I to angiotensin II

Answer 41

ACE-I

Question 42

Prevents angiotensin from attaching to receptors, which inhibits vasoconstriction and ultimately decreases LV workload

Answer 42

ARB (angiotensin receptor blocker)

Question 43

Inhibit HMG-CoA Reductase, the enzyme needed for cholesterol synthesis, reducing LDL levels

Answer 43

Statins

Question 44

Due to fluid shifting from capillaries, the individual develops congestion of peripheral tissues, including the liver, GI tract and distant periphery such as the ankles

Answer 44

right sided HF

Question 45

Pulmonary congestion occurs, as fluid leaks into pulmonary tissues

Answer 45

left sided HF

Question 46

what is a normal ejection fraction?

Answer 46

50-75%

Question 47

the amount of volume in the ventricle at the end of diastole

Answer 47

preload

Question 48

the amount of resistance the ventricle is up against as it tries to contract

Answer 48

afterload

Question 49

the ability of the muscle to stretch and contract, like an elastic

Answer 49

contractility

Question 50

refers to the patient for whom normal daily falls to produce symptoms

Answer 50

class I

Question 51

refers to those whose normal daily activities initiates symptoms but the patient controls them with rest

Answer 51

class II

Question 52

is reserved for those in whom minimal activity produces symptoms, but they remain symptom free at rest

Answer 52

class III

Question 53

is attributed to those for whom any activity precipitates symptoms

Answer 53

class IV

Question 54

____ balances arterial and venous vasodilation reducing BP, permitting the LV to eject more efficiently, raising the CO and decreasing serum levels of NE and aldosterone, and blunting activation of the RAA system

Answer 54

Nesiritide (a synthetic BNP)

Question 55

is a unique form of pacemaking that helps to re-establish normal coordinated contractions between the atria and ventricles of the heart

Answer 55

Cardiac resynchronization therapy (CRT)

Question 56

are medications that improve contractility, decrease afterload

Answer 56

inotropes

Question 57

reduce volume and thus, pressures by inducing sodium and water excretion

Answer 57

diuretics

Question 58

Increase contractility, but also increase oxygen consumption and should be used with caution

Answer 58

beta adrenergic agonists

Question 59

also improves contractility through inotrope effects but also acts as a negative chronotrope, reducing heart rate and thus myocardial workload

Answer 59

cardiac glycosides (ex. Digoxin)

Question 60

improve contractility, vasodilate, increase CO and reduce BP, given IV and in the short term

Answer 60

phosphodiesterase inhibitors

Question 61

Prevents angiotensin II activity as well as that of aldosterone; improves hemodynamic function; decreases afterload and MV02

Answer 61

ACE-I

Question 62

increase venous capacity, reducing afterload

Answer 62

vasodilators

Question 63

have negative chronotropic and inotropic activity, decreasing the overall workload of the heart

Answer 63

Beta blockers