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Systems Screening III > Cardiovascular system E1 > Flashcards

Cardiovascular system E1 Flashcards

1
Q

What are the leading risk factors for cardiovascular disease (CVD)?

A
  1. Hypertension
  2. high serum cholesterol levels
  3. smoking
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2
Q

What is the difference between primary, secondary, and primordial prevention of CVD?

A

primary - before CV event occurs and achievable by lifestyle and environmental changes
secondary - aimed to decrease recurrence and reduce death from CVD
primordial - aimed at younger children to instill proper CV ideals and that they carry it into adulthood

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3
Q

What are the cardinal symptoms of cardiac disease?

A
  1. chest, neck or arm pain/ discomfort
  2. palpitations
  3. dyspnea
  4. syncope (fainting)
  5. fatigue
  6. cough
  7. cyanosis
    - edema and leg pain are most common symptoms of the vascular component
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4
Q

Chest pain or discomfort occurring when a heart muscle does not get enough oxygen

A

angina

  • symptom of CAD
  • starts behind breastbone and may project in the arm, shoulder, neck, jaw, throat, and back
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5
Q

presence of an irregular, fast, or extra heartbeat; described as a bump, point, jump, flop, flutter, butterfly, or racing sensation of the heart

A

palpitations

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6
Q

What ventricle is impaired that causes dyspnea (shortness of breath)?

A

left ventricle

- unable to contract completely, resulting in abnormal accumulation of blood in the pulmonary circulation

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7
Q

What dyspnea frequently accompanies congestive heart failure?

A

paroxysmal nocturnal dyspnea

  • sudden, unexplained episodes of sOB that at night awaken a person sleeping in supine position
  • moving into an upright position brings relief bc the amount of blood returning to the heart and lungs from the LE decrease in this position
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8
Q

The term used to describe breathlessness that occurs during recumbency and is relieved by sitting upright, using pillows to prop the head and trunk

A

Orthopnea

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9
Q

Fainting or lightheadedness caused by reduced oxygen to the brain when the heart’s pumping ability becomes compromised; S and S = arrhythmia, orthostatic hypotension, aortic dissection, hypertrophic cardio myopathy, CAD, vertebral artery insufficiency, and hypoglycemia

A

cardiac syncope

- predictors: hx of stroke, TIA, use of cardiac medication, and HTN

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10
Q

a narrowing or constriction that prevents the valve from opening fully and may be caused by scars or abnormal deposits on the leaflets; causes obstruction to blood flow and the chamber behind the narrow valve must produce extra work to sustain cardiac output

A

stenosis

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11
Q

occurs when the valve does not close properly and causes blood to flow back into the heart chamber; the heart gradually dilates in response to the increased volume work

A

Insufficiency (regurgitation)

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12
Q

affects the mitral or tricuspid valve and occurs when enlarged leaflets bulge backward into the atrium

A

Prolapse

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13
Q

What is the hallmark of ventricular failure?

A

decreased ejection fraction

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14
Q

What should the normal numbers be for:

BMI, Total cholesterol, HDLs, LDLs, triglycerides

A 
BMI: 18.5 - 24.0
Total cholesterol: less than 200 mg/ dL
HDL:  greater than 40 mg/ dL
LDL: greater than 50, less than 120 mg/ dL (optimal = 100 mg/ dL)
Triglycerides: less than 150 mg/ dL
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15
Q

When would you hear an abnormal sound as a result of aortic insufficiency (regurgitation)?

A

Diastole

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16
Q

When would you hear an abnormal sound as a result of mitral stenosis?

A

Diastole

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17
Q

When would you hear an abnormal sound as a result of pulmonic insufficiency (regurgitation)?

A

diastole

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18
Q

When would you hear an abnormal sound as a result of tricuspid stenosis?

A

diastole

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19
Q

When would you hear an abnormal sound as a result of aortic stenosis?

A

systole

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20
Q

When would you hear an abnormal sound as a result of mitral insufficiency (regurgitation)?

A

systole

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21
Q

When would you hear an abnormal sound as a result of mitral prolapse?

A

systole

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22
Q

When would you hear an abnormal sound as a result of pulmonary stenosis?

A

systole

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23
Q

When would you hear an abnormal sound as a result of tricuspid insufficiency (regurgitation)?

A

Systole

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24
Q

When are the AV valves closed?

A

Systole; during the isovolumetric contraction, reduced ejection, and isovolumetric relaxation

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25
Q

When are the AV valves open?

A

Diastole; during rapid ventricular filling, diastasis, and atrial systole

26
Q

What event within the heart causes the AV valves to open? close?

A
  • When atrial pressure is greater than ventricular pressure. Atrial filling leads up to the opening of AV valves
  • ventricular pressure is greater than atrial pressure
27
Q

When are the semilunar valves closed?

A

Diastole; during the period of isometric relaxation, rapid ventricular filling, diastasis, atrial systole, and isometric contraction

28
Q

When are the semilunar valves open?

A

Systole; during the period of rapid and reduced ejection

29
Q

What event causes the semilunar valves to open? close?

A
  • Increase in ventricular pressure

- Increase in pulmonic and aortic pressure that is greater than ventricular pressure

30
Q

Are both sets of valves closed during any part of the cycle? If so, when?
Both open? when?

A
  • Yes, during isovolumetric contraction and isometric relaxation
  • no
31
Q

At what point in the cardiac cycle is the pressure in the heart highest? lowest?

A
  • Rapid ejection

- Rapid ventricular filling

32
Q

What event results in the pressure deflection called the dicrotic notch?

A

The slight rise in pressure in the pulmonary and aortic arteries following the closure of semilunar valves

33
Q

What two factors promote the movement of blood through the heart?

A
  1. The atrium druing atrial systole

2. The ventricle during ventricular systole

34
Q

What portion of the cardiac cycle is shortened by this more rapid heart rate?

A

diastole

35
Q

Explain the process of atherosclerosis

A
  • Arterial wall damage occurs either from injury caused by harmful substances in the blood or by physical wear and tear as a result of high BP
  • Injury to the blood vessel wall permits the infiltration of macromolecules (esp cholesterol) from blood through the damaged endothelium into underlying smooth muscle cells
  • Naked collagen causes platelets to aggregate at the site of injury and plug up the wound.
  • macromolecules are laid down and occlude vessel
36
Q

Identify the Clinical Signs and Symptoms of left sided heart failure

A
  1. Progressive dyspnea
  2. Paroxysmal nocturnal dyspnea
  3. Orthopnea
  4. Productive spasmodic cough
  5. Pulmonary edema (extreme breathlessness, anxiety, frothy pink sputum, nasal flaring, accessory muscle use, crackles, tachypnea, diaphoresis)
  6. Cerebral hypoxia (irritability, restlessness confusion impaired memory, sleep disturbances)
  7. Fatigue, exercise intolerance
  8. Muscular weakness
  9. Renal changes
37
Q

Identify the Clinical Signs and Symptoms of right sided heart failure

A
  1. Dependent edema (ankle or pretibial first)
  2. Jugular vein distention
  3. Abdominal pain and distention
  4. Weight gain
  5. R upper quadrant pain (liver congestion)
  6. Cardiac cirrhosis
  7. Ascites
  8. Jaundice
  9. Anorexia, nausea
  10. Cyanosis (nail beds)
  11. Psychologic disturbances
38
Q

What is the Framingham criteria for congestive heart failure

A
  • Diagnosis of CHF requires the simultaneous presence of at least 2 major criteria or 1 major criterion in conjunction with 2 minor criteria.
  • Major criteria:Paroxysmal nocturnal dyspnea, Neck vein distention,Rales, Radiographiccardiomegaly(increasing heart size on chest radiography), Acute pulmonary edema, S3 gallop, Increased central venous pressure (>16 cmH2O at right atrium),Hepatojugularreflux, Weight loss>4.5 kgin 5 days in response to treatment
  • Minor criteria:Bilateral ankle edema, Nocturnal cough, Dyspneaon ordinary exertion, Hepatomegaly, Pleural effusion, Decrease in vital capacity by one third from maximum recorded, Tachycardia (heart rate>120 beats/min.)
39
Q

What determines your blood pressure?

A
  1. Cardiac output (HR x SV) and Peripheral vascular resistance
  2. BP is the amount of force placed on the artery and arteriole walls when the heart contracts (systolic pressure/ top number) and relaxes (diastolic pressure/ bottom number).
40
Q

What is cardiac output?

A

The amount of blood pumped per unit of time

41
Q

What is ejection fraction?

A

Stroke volume / diastolic volume

42
Q

What is stroke volume?

A

Amount of blood pumped out in one cardiac cycle

43
Q

What is end systolic volume?

A

Amount of blood left in the ventricle after systole

44
Q

What is end diastolic volume?

A

Amount of blood that’s inside of the ventricle at the end of diastole

45
Q

How does the renin-angiotensin system function to regulate blood pressure?

A
  • Decreased blood flow to kidneys = release of renin
  • renin –> angiotensin I –> angiotesnin II (very powerful vasoconstrictor) –> release of aldosterone (causes retention of fluids and sodium) = increase of PVR
46
Q

Why is hypertension a risk factor in atherosclerosis?

A

It increases the amount of pressure being placed on the arterial walls; over time the stress can injure the artery

47
Q

What facilitates autonomic regulation of blood pressure?

A

The adrenal medulla; releases epinephrine and NE

  • Epinephrine causes vasoconstriction and increased cardiac output due to increased cardiac contraction
  • NE causes vasoconstriction
48
Q

Is there a link between osteoporosis and hypertension? Why?

A

Yes, evidence points to an association between HTN and abnormal calcium metabolism, leading to increased calcium loss, secondary activation of the parathyroid gland, increased movement of calcium from bone, and increased risk of kidney stones and osteoporosis

49
Q

Explain the sequential progression of the ischemic cascade that precedes the infarction

A
  1. Mismatch between cardiac perfusion and demand
  2. Leads to regional dystolic dysfunction (seen on EKG, dysrhythmia)
  3. Heart motion abnormalities - i.e., atrium fires when ventricles fiver
  4. Decrease = LV ejection fractions
  5. S-T segment changes (ventricular repolarization); ST segment depression = ischemia - Stays below the baseline
  6. Angina - Chest, left arm, jaw
  7. Myocardial infarction - Biggest post infarct sx = dysrhythmia
50
Q

How is ischemia identified on an EKG?

A

Ischemia can be identified by an inverted T wave

51
Q

What are the phases of the cardiac cycle?

A
  1. Atrial systole (systole)
  2. Isovolumetric contractraction (systole)
  3. Rapid Ejection (systole)
  4. Reduced Ejection (systole)
  5. Isovolumetric Relaxation (diastole)
  6. Rapid ventricular filling (diastole)
  7. Diastesis (diastole)
52
Q

Name this part of the cardiac cycle: Ventricular contraction causes the AV valves to close from contraction of papillary muscles; All valves closed

A

Isovolumetric contraction

- S1 happens here

53
Q

Name this part of the cardiac cycle: Continued ventricular contraction pushes blood out of the ventricles, causing the semilunar valves to open; AV valves still closed

A

Rapid ejection

54
Q

Name this part of the cardiac cycle: intraventricular pressure falls sufficiently causing semilunar valves to close; all valves are closed

A

Isovolumetric relaxation

  • S2 happens here
  • dicrotic notch happens here (associated with a small back flow of blood into the ventricles resulting in aortic and pulm a. pressure tracings)
55
Q

Name this part of the cardiac cycle: The AV valves open and blood flows into the relaxed ventricles, accounting for most of the ventricular filling

A

Rapid ventricular filling

56
Q

Name this part of the cardiac cycle: The atria contract and complete ventricular filling; AV valves open, semilunar closed

A

Atrial systole

- last 10% blood pushed into ventricle

57
Q

Name this part of the cardiac cycle: Aortic and pulmonic valves are open, while AV valves remain closed; contraction of ventricle decreases and rate of ejection falls

A

Reduced ejection

58
Q

What spinal levels do afferent sympathetic fibers enter, accounting for the varied locations and radiation patterns of anginal patterns? What common nerve distribution pattern is often followed?

A

C3-T4; Ulnar
- pain can present at back of neck, lower jaw, teeth, left upper back, inter scapular area, abdomen and possibly down the left arm

59
Q

What causes angina?

A

It is a symptom of ischemia usually brought on by an imbalance btw cardiac workload and oxygen supply to myocardial tissue, usually secondary to CAD

60
Q

What are the risk factors for atherosclerosis?

A
  1. Age: Men>45, women>55
  2. Family history: heart attack, bypass surgery, or sudden death before 55 for father/brother, or before 65 for mother/sister
  3. Smoker, or have quit < 6 mos, or is exposed to environmental smoke
  4. Obesity: BMI > 30
  5. HTN: 140/90, or taking medication
  6. Dyslipidemia: LDL > 130, or HDL <40, or TC > 200
  7. Pre-diabetes: IFG> 100, or OGTT >140 and <199
61
Q

What are the post infarctions complications?

A
  1. arrhytmias
  2. CHF
  3. Cardiogenic shock
  4. Pericarditis
  5. rutupre of the heart
  6. Thromboembolism
  7. recurrent infarction
  8. sudden death

Systems Screening III (9 decks)

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