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Medsurg > Cardiovascular Disorders and Perfusion Disorders > Flashcards

Cardiovascular Disorders and Perfusion Disorders Flashcards

Exam 2

1
Q

Anatomy of the Heart: What are the two major groups of valves?

A
  1. Atrioventricular valves
  2. Semilunar valves
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2
Q

Anatomy of the Heart: What are atrioventricular valves?

A
  1. Tricuspid
  2. Bicuspid (mitral)
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3
Q

Anatomy of the Heart: What are semilunar valves?

A
  1. Pulmonic
  2. Aortic
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4
Q

How does blood flow through the heart?

A

Rigth atrium–> Right Ventricle –> lungs–> oxygenated blood goes to Left atrium to Left ventricle

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5
Q

What initiates the contractility of the heart?

A

SA node

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6
Q

What is the rate the SA node generates impulses?

A

60-100 bpm

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7
Q

When the SA node fires, where are the impulses spread?

A

SA node fires.

Impulses spread through the atrial myocardium

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8
Q

If SA node fails to send impulses, what takes over?

A

AV node takes over (rate is 40-60 bpm)

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9
Q

After electrical impulse spreads through atrial myocardium, where does it go?

A

Impulse travels to the AV node

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10
Q

How does impulse leave the AV node in a normal functioning heart?

A

Impulse leaves the AV node through the bundle of His

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11
Q

After the impulse leaves the Bundle of His, where does it travel?

A

Impulse travels through the bundle branches

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12
Q

After the impulse leaves the bundle branches, where does it go?

A

Impulse extends into the ventricular tissue through the Purkinje fibers

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13
Q

Electrocardiogram: What are the components of the waves?

A

P wave
P R interval
P R segment
Q R S complex
Q R S interval
T wave
Q T interval

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14
Q

P wave

A

corresponds with atrial depolarization

The P wave is a record of the electrical activity through the upper heart chambers (atria).

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15
Q

PR interval: Where does it start and end?

A

Starts at the start of the P wave up to the beginning of QRS complex

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16
Q

PR interval: What does it represent?

A

It represents the time for electrical activity to move between the atria and the ventricles.

From SA node –> ventricular myocardium of the heart

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17
Q

What does the QRS interval represent?

A

Ventricular depolarization

Atrial repolarization

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18
Q

What does the T wave represent?

A

Ventricular repolarization

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19
Q

What is included in the cardiac cycle?

A

Diastole

Systole

Blood Pressure

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20
Q

Diastole- What is occurring?

A

The ventricles are filling

The ventricles are relaxes

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21
Q

How is the pressure in atria v ventricles in diastole?

A

Blood pressure is higher in the atrium than the ventricles

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22
Q

Systole- What is occurring

A

When the ventricles are contracting

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23
Q

How does the atrial pressure compare to the ventricular pressure in systole?

A

Atrial pressure is lower in systole

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24
Q

What is cardiac output?

A

The number in which the heart ejects blood from the left ventricle in 1 minute

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25
Q

Formula for cardiac output

A

CO= HR x SV

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26
Q

What is the range of cardiac output?

A

4-8 L per minute

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27
Q

How should cardiac output be in rest compared to exercising?

A

CO should be higher while exercising than at rest

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28
Q

Heart Rate

A

number of beats per minute

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29
Q

What is a normal HR?

A

60-100

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30
Q

Stroke Volume

A

The amount of blood ejected with each ventricular contraction

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31
Q

What is stroke volume effected by?

A

Preload

Afterload

Contractility

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32
Q

Preload

A

The amount of blood in the ventricles at the end of diastole

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33
Q

Afterload

A

the resistance that the ventricles need to overcome to open the semilunar valves.

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34
Q

Contractility

A

Refers to the force of the mechanical contraction

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35
Q

When would contractility be decreased?

A

During hypoxia or acidotic state

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36
Q

Assessment

A

History
Current health problems
Physical Assessment – General assessment

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37
Q

Physical Assessment – General assessment
includes:

A

Color
Diaphoresis
Edema
Restlessness
Agitation
Confusion
Weight
Shortness of breath
Mobility
Vital signs

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38
Q

Assessment : What are you inspecting for?

A

Cyanosis, Capillary refill time, Edema, Distention of jugular veins, Clubbing of fingers/toes

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39
Q

Palpation- What are you palpating for?

A

Skin temperature, Pulses

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40
Q

What are you Auscultating for?

A

Heart sounds, Lung sounds

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41
Q

Diagnostic Studies include:

A

Laboratory Markers as Predictors of Heart Disease

Markers of Acute Cardiac Damage or Injury

EKG

Radiology

Echocardiogram

42
Q

Diagnostic Studies:

Laboratory Markers as Predictors of Heart Disease

A

Lipid panel

43
Q

Diagnostic Studies:

Laboratory Markers as Predictors of Heart Disease: Lipid panel includes

A

Total cholesterol
Low-density lipoprotein
High-density lipoprotein
Triglycerides

44
Q

High-Density Lipoproteins (HDLs)

A

Scavengers- cause reuptake in the liver.

Is good cholesterol

45
Q

What is the good ranges for HDLs?

A

Greater than 60 but 40 is acceptable

46
Q

What are good LDL levels?

A

Less than 100

47
Q

Diagnostic Studies:

Markers of Acute Cardiac Damage or Injury include:

A

Creatinine kinase
Troponin
Myoglobin
Brain natriuretic peptide

48
Q

Creatinine kinase

A

Just a general marker of cellular injury, is not specific to the heart

49
Q

CKMB

A

It is specific to the heart and specific to cardiac damage.

50
Q

How are CK-MB levels in an injury? For how long?

A

elevated within four hours of the injury, and it stays elevated for at least ten days.

51
Q

Myoglobin- What is it and is it specific to the heart?

A

Protein released when there is muscle damage

52
Q

What markers of acute cardiac damage are specific to the heart?

A

Troponin levels

53
Q

Diagnostic Studies: Radiology

A

Chest
x-ray

53
Q

Diagnostic Studies: Electrocardiography

A

Assesses electrical conduction system

54
Q

Diagnostic Studies: Echocardiography includes

A

Transthoracic

Trans-esophageal

55
Q

Transesophageal echocardiogram (TEE): How is it done?

A

Transducer on the patient’s esophageal region.

56
Q

Transesophageal echocardiogram (TEE): What is not allowed during TTE?

A

Patient should not be eating or drinking anything for 8 hours- should be NPO. Meds should be given but with a small sip of water only.

57
Q

Transthoracic echocardiogram (TTE)

A

Place transducer on patient’s chest (thoracic area)

58
Q

Diagnostic Studies: Cardiac Stress Test- What are the types?

A

Regular Stress Test

Isotope (nuclear) stress test

59
Q

Catheterization and Angiography includes

A

Cardiac catheterization

Coronary angiography

60
Q

What are cardiac stress tests done for?

A

These are done to evaluate the function of the heart during increased work.

Also used to gage a person’s symptoms if they have chest pain to see what if they have any type of dysrhythmias

61
Q

Why would a chemical stress be done?

A

For someone who is unable to do the exercise required for a regular stress test

62
Q

What drugs should not be given during a nuclear stress test?

A

Certain bp meds like beta blocker should not be given.

Beta blockers blocker certain things from being seen

63
Q

For a nuclear stress test, how should a patient prepare?

A

The patient should not smoke or caffeine the day before the procedure. They should not eat four hours before the procedure

64
Q

Cardiac catheterization

A

Invasive procedure where a catheter is advanced to evaluate cardiac filling pressures

65
Q

Cardiac catheterization- What does it measure?

A

Cardiac output

66
Q

Cardiac angiography-what is it used for?

A

TO get a good visualization of the vessels

67
Q

What does a patient need to do during a cardiac angiography?

A

The patient needs to lay flat because then getting up can increase the pressure and cause bleeding.

68
Q

Complications of cardiac angiography?

A

Bleeding

69
Q

After a cardiac angiography what do you need the patient to do?

A

Need the patient to lay flat anywhere between 2-6 hours and monitor their vital signs.

Ask if they have any chest pain=bad

make sure they don’t have signs of stroke

70
Q

Cardiac Dysrhythmia: What is it a problem with?

A

Conduction system

71
Q

What is a cardiac rhythm of the heart electrical current starting at the SA node?

A

sinus rhythm

72
Q

Dysrhythmias- Clinical manifestations include?

A

Palpitation
Hypotension
Diaphoresis
Shortness of breath
Syncope

73
Q

Risk Factors for dysrhythmias?

A

Age
Myocardial infarction (M I)
Hypertension (H T N)
Heart valve disease
Heart failure (H F)
Cardiomyopathy (C M)
Infections
Diabetes mellitus
Sleep apnea

Heart surgery (and procedures)
Electrolyte disturbances
Recreational drug use such as cocaine, alcohol, or tobacco
Medication toxicities such as digoxin toxicity

74
Q

Sinus Bradycardia- bpm? how does it appear?

A

Less than 60 beats per min
Symtomatic
Nonsymtomatic
Treatment

75
Q

When would we treat a patient for sinus brady?

A

When they are symptomatic

76
Q

What is the treatment for sinus bradycardia if the patient is symptomatic?

A

1 mg of atropine IV push

77
Q

Causes of sinus bradycardia:

A
  1. Athlete
  2. Hypothermia
  3. Hypoxia
  4. Sleeping
78
Q

Sinus Tachycardia

A

Regular rhythm with greater than 100 bpm

79
Q

Sinus Tachycardia: causes

A

Fever

Anemia

hypovolemia

PE

Hypotension

MI

80
Q

Treatment for Sinus Tach?

A

Finding cause of sinus tach

Or give a beta blocker or calcium channel blocker

81
Q

Premature Atrial Contraction (PAC)

A

Is an early impulse or beat

82
Q

What is the treatment of PACs? What can be the cause?

A

find cause and eliminate cause

excessive stimuli like caffeine or med

83
Q

Atrial Fibrillation (Afib)- What are characteristics of it?

A

No defined p-wave

Irregularly irregular

84
Q

What kind of Afib do we treat? What kind do we not?

A

Spontaneous Afib is not treated.

Non-spontaneous or persistent Afib is treated.

85
Q

Causes of Afib:

A

Obesity

Hypothyroidism

Diabetes

Kidney Disease

86
Q

Afib treatments

A

Beta blockers,

Calcium channel blockers

Digoxin

87
Q

Atrial flutter- What are characteristics?

A

No p waves

Sawtooth pattern

88
Q

Range for Aflutter?

A

250-350 bpm

89
Q

Treatment for Aflutter?

A

Controlling the ventricular rate by giving a beta blocker or a calcium channel blocker.

Only treat when patient is symptomatic

90
Q

Supraventricular Tachycardia

A

Rapid heart rate

91
Q

Supraventricular Tachycardia- Where does it originate?

What are characteristics?

A

Originates above the ventricle

Regular, narrow QRS

92
Q

Treatment for SVT?

A

Look at causes

Only do cardioversion if they are symptomatic?

93
Q

PVCs?

A

Wide and atypical QRS complex

No p wave

Can be unifocal or multifocal

94
Q

Two pvcs in a row? Every third ? Every other pvc?

A

Couplet

Trigeminy

Bigeminy

95
Q

Ventricular Tachycardia?

A

Three or more PVCs in a row that is greater than 150 bpm

96
Q

What does it mean when a patient has vtach with a pulse? What is the treatment?

A

They are able to maintain a blood pressure.

Amiodarone and replacement of electrolytes

97
Q

What does it mean if a patient is vtach and pulseless? What is the treatment?

A

This patient is in cardiac arrest

Immediately initiate CPR and defibrillation

98
Q

After initiating CPR and defibrillator in pulseless vtach patient, what do you administer?

A

Amiodarone and Epinephrine

99
Q

Asystole

A

No measure of electrical activity

100
Q

Asystole- treatment

A

Chest compressions

if full code, initiate epinephrine

Medsurg (21 decks)

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