Central Venous Devices

Question 1

Excitability

Answer 1

Refers to the ability of the cell to respond to stimulation (flutter and fibrillate, caused by potassium, calcium, sodium etc, electrolyte imbalance

Question 2

Conductivity

Answer 2

Refers to impulse transmission (poor = not good enough conduction)
degree of stretch before contraction (venous return or diastole) (peripheral vascular disease results in poor return to heart)

Question 3

Preload

Answer 3

Degree of stretch before contraction (venous return or diastole) (peripheral vascular disease results in poor return to heart)

Question 4

Afterload

Answer 4

Refers to the resistance or force required of the heart muscle during contraction (ejection or systole) (determines resistance & blood pressure)

Question 5

Cardiac Output

Answer 5

Amount of blood pumped from the heart/minut (5L)

Question 6

Metabolic Syndrome

Answer 6

Precursor to Heart Disease, Diabetes & Stroke***
Risk factors: hypertension, dyslipidemia, different body shapes (apple is worse because fat in stomach is metabolically active & resistant to insulin)
Causes: High BP, high cholesterol, large circumference (greater than 35 for women & 40 for men)
Diagnostic Labs & Tests: lipid profile (cholesterol (HDL good, LDL bad), triglycerides (can maintain with exercise), vital signs, blood sugar, weight, diet, smoking (sticky arterial walls, vasoconstriction & vasospasm), stress (increased BP & cortisol)

Question 7

What impact does increased salt intake have on your body?

Answer 7

Results in fluid retention = increased blood volume = increased resistance in arteries = decreased preload = increased afterload = increased BP

Question 8

Angina

Answer 8

30 minutes of tightness in chest, pressure, sore left arm radiating to neck & jaw, SOB, nausea, lower back pain (in women), diaphoresis
Warning sign of imbalance d/t ischemia & can be resolved with stress
Sign of peripheral vascular disease, if it lasts longer than 30 minutes it evolves into a myocardial infarction

Question 9

Acute Coronary Syndrome

Answer 9

Issues with supply (coronary blood flow, O2 carrying capacity & demand (HR, contractility, systolic wall tension)
Involves MI, atherosclerosis (narrowing) & arteriosclerosis (hardening & decreased elasticity)

Question 10

Heart Attack

Answer 10

SDoH: obesity, sedentary lifestyle, processed foods.
Diagnostics: troponin (when heart attack is occurring at that moment), CKNB (muscle damage), ECG, electrolytes (potassium, calcium, sodium & magnesium are involved in arrhythmias), coronary angiogram (vascular structure), rescue/abort heart attack
OCCURS MOSTLY IN LEFT VENTRICLE!***
SA node –> pacemaker in heart

Question 11

Treatment for Heart Attack

Answer 11

fibromyltics (destroys clot), angioplasty (coronary angiogram with a balloon at the end of the probe that pushes the cholesterol against the walls, OR), stents (coating of steel that allows blood flow in the arteries with the angioplasty),
open heart surgery, nitro (spray, patch (wear when most demands on the body)), vasodilator (decreased BP), baby aspirin (160mg, makes platelets slippery), calcium channel blockers (decrease contractility & increase contractile time to decrease BP), diuretics (decrease blood volume & decrease resistance), beta blockers (decreased risk of another heart attacks by 50%), ACE inhibitors (“pril”, prevent conversion of angiotensin 1  2, decrease blood volume)

Question 12

Acute Heart Failure (S&S, Risks, Diagnostics)

Answer 12

Leads to consolidation in lungs decreasing surface area of lungs & resulting in hypoxia.
Result of heart disease.
S&S: SOB, chest pain (d/t hypoxia), anxiety, denial
Causes: muscle fatigue d/t heart attack b/c muscle along clot dies, viruses, bacteria
Risk Factors: smoking, increased salt, environment, incompetent valves, severe infections, lots of blood clots, no immunizations
Diagnostic: Brain naturetic peptide (BNP), arterial blood gases, troponin, electrolytes, blood cultures (for infection), lipid panel. CBC & diff (WBC (infection, inflammation, anemia, infiltration of cancerous cells)), BUN & creatinine, chest xray, ECG, coronary angiogram, ECHO

Question 13

Acute Heart Failure (Right & Left side, Treatment)

Answer 13

Right Sided: right ventricle is ineffective & everything packs up (peripheral edema, bounding pulses)
Left Sided: left ventricle is ineffective (consolidation in lungs, SOB, increased work load use of accessory muscles, frothy, pink sputum)

Treatments:
Non-medical: lifestyle habits
Medical: diuretics, ACE inhibitors (decreasing hypervolume & demand on heart), Ca channel blockers & beta blockers (decrease excitability, increasing rate of contractions, fox glove (digoxin  take apical rate so its greater than 60bpm and increases contractility)

Question 14

Arrhythmia

Answer 14

Decreases CO and becomes irregular & decreases perfusion in the rest of the body
Treated with pacemakers

Question 15

Atrial Fibrillation

Answer 15

Atria shake, results in stasis of the blood & increases clots formation, leads to MIs, Pulmonary embolism, or strokes.
No rhythm to the irregularity of beats (most common), try to convert it via electrical stimulation, pharmacological intervention or end up being on coumadin for rest of life or rate control drug

Question 16

Sick Sinus Syndrome

Answer 16

Due to electrolyte disturbances.
SA node interferes with and has range of heart beats 60-100bpm, (sinus rhythm),
If SA node doesn’t work AV node takes over and goes down to HR 40-60
Then AV node doesn’t work, Bundle of His works, beats 20-40 and then that doesn’t work so the Percininge fibers take over (0-20bpm)

Question 17

Dyslipidemia

Answer 17

Changes to cholesterol d/t diet or genetic predisposition & lifestyles.
Diagnostics: lipid profile
Treatment: diet & exercise first, “statins” can lead to liver dysfunction, test liver enzymes, depends on pre-existing conditions (diabetes: high BP range is 120/80 and treat aggressively). Look at cardiac output & peripheral resistance

Question 18

Peripheral Vascular Disease

Answer 18

Central vascular disease will most likely lead to PVD b/c cholesterol spreads
Often results in intermittent claudication (pain in calves when walking)
Risk Factors: diabetes, smoking, immunocompromised, secondary infections, usually 2 ft are affected (if unilateral b/c decreased perfusion d/t atherosclerosis)
Diagnostics: peripheral angiograms
Treatment: stent, angioplasty, emerol popliteal bypass, amputation

Question 19

Congenital Defects

Answer 19

Septal defects are most common. Depends on how big the kid is
Ventricle septic defect: oxygenated & deoxygenated blood mixes, most common
Hypoplastic syndrome: very small left ventricle
SDOH: poor maternal care (poor diet, smoking, alcohol, rubella, Accutane)
Treatment: beta blockers, Ca channel blockers, digoxin…same as adult just smaller doses