CCRN CARDIOLOGY

Question 1

Atrial pressure is reflective of the end-diastolic pressure for _________________

Answer 1

the respective ventricles in the absence of AV valve disease

Question 2

Right atrial pressure (RAP) reflects

Answer 2

Right Ventricular Preload

Question 3

Left atrial pressure (LAP) reflects

Answer 3

Left Ventricular Preload

Question 4

Pulmonary artery occlusive pressure (PAOP ) is an indirect measurement of?

Answer 4

Left atrial pressure (LAP) and therefore left ventricular end-diastolic pressure

Question 5

Normal Pulmonary artery occlusive pressure (PAOP )

Answer 5

8 to 12mmHg

Question 6

Pulmonary artery systolic pressure (PAs) is reflective of

Answer 6

The right ventricle because it is the pressure generated by the right ventricle to open the pulmonic valve

Question 7

Pulmonary artery dyastolic pressure (PAd) is reflective of

Answer 7

The pulmonary valsculature because it is the pressure in the pulmonary artery

Question 8

What is monoamine oxidase (MAO) inhibitor?

Answer 8

Prevents the enzyme from removing neurotransmitters norepinephrine, serotonine and dopamine from the brain making the chemicals available to effect changes in both cells and circuits that have been impacted by depression.

Question 9

What kind of test is helpful to show myocardial damage

Answer 9

echocardiogram

Question 10

Why would myocardial contusion cause dysrythmias?

Answer 10

trauma -> inflammation -> irritability

Question 11

ASA inhibits what

Answer 11

platelet aggregation

Question 12

How does a BETA BLOCKER decrease myocardial O2 consumption?

Answer 12

decreasing heart rate and contractility

Question 13

How does a NITRATES decrease myocardial O2 consumption?

Answer 13

decreasing preload primarily and maybe afterload (depends on the dosage)

Question 14

How does a CALCIUM CHANNEL BLOCKER decrease myocardial O2 consumption?

Answer 14

decreasing preload and afterload

Question 15

What is preload?

Answer 15

The volume of blood in the ventricle at the end of diastole also known as the end diastolic pressure

Question 16

What is sterling’s law of the heart

Answer 16

preload determines the stretch on the myofibrils (filaments that run parallel to form muscle fibers) and the subsequent force of the next contraction

Question 17

What is afterload?

Answer 17

The pressure against which the ventricle must pump. The pressure required to open the semilunar valve.

Question 18

1st line of management to treat chronic HTN

Answer 18

diuretics and/or beta blockers

Question 19

What is the 2nd line of tx for chronic HTN?

Answer 19

ACE inhibitor or angiotensin receptor blocker

Question 20

What is the goal in treating hypertrophic cardiomyopathy?

Answer 20

Decrease contractility and afterload

Question 21

Hypertrophy of the heart muscle results in what?

Answer 21

Left ventricular outflow tract obstruction.

Question 22

What class of meds is frequently prescribed in hypertrophic cardiomyopathy

Answer 22

Calcium channel blockers - verapamil (calan)

Beta Blockers - propranolol (inderal)

Question 23

All murmurs are load except

Answer 23

mitral and tricuspid stenosis

Question 24

What causes the murmur of mitral valve prolapse?

Answer 24

mitral regurgitation

Question 25

Describe the sound of mitral regurgitation murmurs

Answer 25

``` high pitched blowing systolic murmur loudest at apex radiates to axilla midsystolic click heard apex murmur follows the click i.e S1, click, murmur, S2 ```

Question 26

Where is the apex of the heart?

Answer 26

Left inferior anterior | 5th left intercostal space @ MCL

Question 27

Where is the base of the heart?

Answer 27

Right superior posterior | 2nd intercostal space

Question 28

Where is the heart located?

Answer 28

in the mediastinum between the sternum and spine

Question 29

What are the layers of the heart?

Answer 29

pericardium - outer wall of pericardial cavity (serous & firbous) epicardium - cover outer surface of heart (visceral pericardium) epicardial fat myocradium - muscle portion of heart endocardium - covers inner surface of heart

Question 30

Flow of blood through heart

Answer 30

superior/inferior venae cavae, R atrium, tricuspid valve, R ventricle, pulmonic valve, pulmonary artery, pulmonary capillary, pulmonary veins, L atrium, mitral valve, L ventricle, aortic valve, aorta, arteries, arterioles, capillaries, venules, veins

Question 31

What are the AV valves?

Answer 31

tricuspid and mitral

Question 32

What are the semilunar valves?

Answer 32

aortic and pulmonic

Question 33

What causes the first heart sound?

Answer 33

Closure of AV valves

Question 34

AV valves open and close during

Answer 34

Open passively during diastole | Close during systole when heart contracts

Question 35

What causes the second heart sound?

Answer 35

Closure of semilunar valves

Question 36

Semilunar valves open and close during

Answer 36

Push open with systole | Close during diastole

Question 37

Where are coronary arteries located?

Answer 37

On the epicardium but penetrates to myocardium and subendocardium.

Question 38

What determines the blood flow through the coronary arteries?

Answer 38

autoregulation in response to metabolic needs of myocardium

Question 39

What's the percentage of of cardiac output received by myocardium?

Answer 39

5%

Question 40

Myocardial blood flow is increased by

Answer 40

Dilation of coronary arteries

Question 41

Coronary artery perfusion pressure (CAPP) is equal to

Answer 41

the diastolic BP minus the pulmonary artery occlusive pressure (PAOP)

Question 42

Normal CAPP value

Answer 42

60-80mm Hg

Question 43

What determines myocardial O2 demand

Answer 43

preload afterload HR contractility

Question 44

What determines myocardial O2 supply?

Answer 44

``` patent arteries diastolic pressure diastolic time O2 extraction (Hgb and SaO2) imbalances between supply and demand ```

Question 45

A split S2 is abnormal during which one? Inspiration or expiration?

Answer 45

Expiration

Question 46

Which drug is an alpha- and noncardioselective beta-blocker that is used for heart failure?

Answer 46

Carvedilol (Coreg)

Question 47

Which drug is an alpha- and noncardioselective beta-blocker used most often for hypertension?

Answer 47

Labetalol (trandate)

Question 48

Which facial nerve is checked after carotid endarterectomy and how do you assess it?

Answer 48

Cranial nerve VII (facial nerve) | Ask patient to smile and check for symetry

Question 49

What are the therapeutic goals in acute heart failure?

Answer 49

To decrease preload, To decrease afterload, To increase contractility To decrease myocardial oxygen demand.

Question 50

Which medication is given during acute heart failure to cause venodilation and to reduce preload?

Answer 50

Morphine sulfate

Question 51

Which heart sound is an indication of diastolic dysfunction?

Answer 51

S4 | which is caused by ventricular noncompliance (inability of the heart to fill adequately)

Question 52

Which heart sound is an indication of systolic dysfunction?

Answer 52

S3

Question 53

Which heart sound is an indication of intracardiac turbulence such as a septal defect or valve problem?

Answer 53

Murmur

Question 54

Which heart sound is an indication mitral valve prolapse?

Answer 54

Midsystolic click

Question 55

A great way to remember what happens in the heart during diastole is to remember that

Answer 55

diastole equals filling

Question 56

What are signs of cardiac tamponade?

Answer 56

Pulsus paradoxus Hypotension | Jugular venous distention

Question 57

Which are two significant adverse effects of angiotensin-converting enzyme (ACE) inhibitors (e.g., captopril [Capoten])?

Answer 57

Hyperkalemia & Proteinuria ACE inhibitors may cause hyperkalemia by inhibiting the secretion of aldosterone triggered by angiotensin II. Proteinuria also may occur, even leading to nephrotic syndrome and renal failure. Monitor serum potassium, and monitor urine for proteinuria.