Chapter 34 Cardiac disorders

Question 1

What is coronary artery disease

Answer 1

Occurs when the major coronary arteries that supply the myocardium are partially or completely blocked

Question 2

What is arteriosclerosis

Answer 2

An abnormal thickening, hardening, and loss of elasticity of arterial walls.

Question 3

Causes decreased flow of O2 carrying blood to the tissues

Answer 3

Arteriosclerosis

Question 4

Earliest lesion to develop
Commonly found in the aorta by age 10 and progresses with age
No symptoms are associated with this

Answer 4

Fatty Streak

Question 5

Develops over time
Smooth muscle cells, chronically stimulated by LDLs and platelet-activated growth factors, proliferate, produce collagen, and migrate over the fatty streak
This fibrous plaque sticks out from the arterial wall and trap things like WBCs, platelets, lipids, and calcium)
Contributes to loss of elasticity and impairs that vessel’s ability to vasodilate

Answer 5

Fibrous Plaque

Question 6

Outer layer of the fibrous plaque thins out
This makes he plaque unstable and increases the risk of ulceration and rupture
When plaque ruptures, platelets are activated and trigger the coagulation cascade with the development of thrombus

Answer 6

Unstable Angina

Question 7

Occurs most often with exercise or activity
Usually subsides with rest
Lasts only about 2-5 minutes
Relieved with nitroglycerin
Occurs intermittently
Diaphoresis and dyspnea may occur
Beta blockers, calcium channel blockers, and nitrates
Low dose aspirin daily or another antiplatelet if ASA is not tolerated

Answer 7

Stable angina

Question 8

Lasts longer than 5 minutes
Not relieved by nitroglycerin or requires more frequent administration
Occurs at rest or with minimal exertion
Could present as the first clinical manifestation of CHD
Higher risk for an MI as opposed to patients with stable angina
Diaphoresis, dyspnea, N and V

Answer 8

Unstable angina

Question 9

Treatment of coronary artery disease

Answer 9

A ntiplatet, antianginal, ACE inhibitor
B eta-blocker and blood pressure
C igarette smoking, cholesterol, calcium channel blockers
D iet and diabetes
E ducation and exercise
F lu vaccine

Question 10

Acute Myocardial Infarction

Answer 10

Begins with occlusion of a coronary artery.

Death of myocardial tissue from prolonged lack of blood and O2 supply

Question 11

Signs and symptoms of myocardial infarction

Answer 11

Pain is a classic symptom (more severe than pain with angina)
Chest pain but may radiate to the arm, back, neck, jaw
May begin with or without exertion and lasts > 20 minutes
May have: diaphoresis, light-headedness, N & V, dyspnea, skin may be cold and clammy, great anxiety, impending feeling of doom
Older adults and DM patients: may not experience chest pain but may c/o SOB, dizziness, and nausea.

Question 12

Signs and symptoms of myocardial infarction in women

Answer 12

fatigue, SOB, and atypical chest pain

Question 13

Acute care of a patient with acute myocardial infarction

Answer 13

P: precipitating factors (things that made it worse); palliative (things that
(made it better)
Q: quality (describe the pain in patient’s own words)
R: region or radiation
S: severity, symptoms
T: time (when did it start, how long did it last
Inspect the skin for color, temperature, moisture
VS, LOC, anxiety level
Evaluate cardiac monitor for rate and rhythm

Question 14

Signs and symptoms of left sided heart failure

Answer 14

Anxious
Pale
Weak
Tachypneic
Consecutive BPs may show a downward trend
Lungs: crackles, wheezes, dyspnea, and cough
S3 and S4 heart sounds may be heard as a result of backup of fluid in the heart
Gas exchange is impaired so restlessness and confusion

Question 15

Signs and symptoms of right sided heart failure

Answer 15

Increased central venous pressure
JVD
Abdominal engorgement
Dependent edema
Anorexia, N and V may result from abdominal engorgement
Fatigue, weight gain, and decreased urinary output

Question 16

(decreases BP, limits the progression of ventricular remodeling)

Answer 16

ACE inhibitor

Question 17

disrupt the movement of calcium through calcium channels. Calcium channel blockers are used as antihypertensive drugs, i.e., as medications to decrease blood pressure in patients with hypertension

Answer 17

Calcium chanel blockers

Question 18

decrease the HR, reduce the workload of the heart, lessen O2 demands of the myocardium

Answer 18

Beta adrenergic blockers

Question 19

Disease of the heart muscle

Answer 19

Cardiomyopathy

Question 20

dilation of the ventricle and severely impaired systolic function

Answer 20

Dilated cardiomyopathy

Question 21

LV hypertrophies and there is thickening of the ventricular septum

Answer 21

Hypertrophic cardiomyopathy

Question 22

the myocardium becomes rigid and noncompliant

Answer 22

Restrictive cardiomyopathy

Question 23

Post op care after transplant teaching to patient

Answer 23

Lifelong immunosuppression

Question 24

Primarily affect the valves
Incidence has decreased with the use of antibiotics, but there has been a resurgence of the problem in intravenous drug abusers

Answer 24

Infective endocarditis

Question 25

Pathogens, usually bacteria, enter the bloodstream by any of the previously mentioned means
The pathogen accumulates on the heart valves and/or the endocardium and forms vegetations “growths”

Answer 25

Infective endocarditis

Question 26

Signs and Symptoms of Infective endocarditis

Answer 26

Fever, chills, malaise, fatigue, and weight loss
Chest or abdominal pain; may indicate embolization
Petechiae inside the mouth and on the ankles, feet, and antecubital areas
Osler nodes on the patient’s fingers or toes
Janeway lesions on the patient’s palms and soles
New or changing heart murmur, usually mitral or aortic

Question 27

Inflammatory process increases amount of pericardial fluid and inflammation of the pericardial membranes
In chronic pericarditis, scarring of the pericardium fuses the visceral and parietal pericardia together
Loss of elasticity results from the scarring
Constrictive process prevents adequate ventricular filling

Answer 27

Patho of pericarditis

Question 28

Signs and symptoms of pericarditis

Answer 28

Chest pain
Most severe on inspiration
Sharp and stabbing, but may be described as dull or burning
Relieved by sitting up and leaning forward
Dyspnea, chills, and fever

Question 29

Mitral valve problems can occur with what

Answer 29

Strep