Chapter 35 - Assessment: Cardiovascular Sx - Exam 2 Flashcards
The heart is composed of 3 layers:
- a thin inner layer, ______
- a layer of muscle,_______
- an outer layer, _________
endocardium
myocardium
epicardium
A fibroserous sac called the __________ covers the heart
pericardium
The cusps of the mitral and tricuspid valves are attached to thin strands of fibrous tissue called
chordae tenineae
the p wave represents
depolarization of the atria
(contraction)
the QRS wave represents
depolarization from the av node to the ventricles
(ventricular contraction)
the t wave represents
repolarization of ventricles
(relaxation)
the u wave represents
repolarization of the purkinje fibers,
(relaxation)
a large u wave may represent hypokalemia
During ventricular contraction (depolarization), the tricuspid and mitral (atrioventricular valves) are
closed
During ventricular contraction (depolarization) the pulmonic and aortic (the semilunar valves) are
open
During ventricular relaxation (repolarization) the tricuspid and mitral (atrioventricular) valves are
open
During ventricular relaxation (repolarization) the pulmonic and aortic (semilunar) valves are
closed
Nodal (SA or AV node) and Purkinje electrical cells
Characteristics:
1. automaticity
- they initiate electrical impulse
Nodal (SA or AV node) and Purkinje electrical cells
Characteristics:
2. excitability
- they respond to electrical impulse
Nodal (SA or AV node) and Purkinje electrical cells
Characteristics:
3. conductivity
- they have an ability to transmit electrical impulse
SA node - what is it commonly called? and how many beats/min?
pace maker (primary one)
60-100 b/min
AV node - if the SA node fails, how many b/min can it produce
40-60 b/min
If the SA and AV node fail, how many beats/min can the ventricular cells produce?
30-40 b/min
_______. ________, and calcium contain ions that stimulate myocytes to exchange an electrical charge and contract
sodium, potassium
when the heart contracts this is called
depolarization
Once the myocytes discharge their energy and contract, the then rest and recharge, this is called
repolarization
________ moves through the fast channels to create fast depolarization (contraction) of myocytes
sodium
SA and AV nodes depolarize when ________ enters the electrical cells
calcium
the myocardial cells need to repolarize during ________periods
refractory
heart muscle cells have a compensatory mechanism that makes them unresponsive or _________ to restimulation during action potential
refractory
what is the “Cardiac Cycle”
events that occur in the heart from one beat to the next beat:
Diastole (all chambers resting), atrial systole (contraction), ventricular systole (contraction)
what is “atrial kick”
At the end of diastole, the atria contract a fraction faster than the ventricles. It SHOVES what blood it had in side it INTO the ventricle, adding 15-25% more blood, JUST BEFORE the ventricle contracts.
what is “cardiac output”
is the amount of blood pumped by each ventricle in 1 minute
(measured in liters)
A healthy, resting adult put about about _____liter per minute (aka cardiac output)
4-6L
what is “stroke volume”
Amount of blood ejected by the left ventricle during one contraction
Stroke volume is the amount of blood ejected by the ________ during one __________
left ventricle, contraction
Stroke volume is super effing important, what is one type of recepter that tells the heart how much blood the body needs right now
baroreceptor
where are the baroreceptors located?
aortic arch and carotid arteries
what actions do baroreceptors cause
vasoconstriction AND vasodilation
Stroke volume is also affected by preload and afterload.
What is preload?
What is afterload?
preload - how much can cardiac muscle stretch just before contraction (so during relaxation)
afterload - resistance the ventricles must overcome to eject blood out of the heart ie how constricted are the vessels due to blood clots, plaque, smoking, meds, the weather
The Frank-Starling Law states that, to a point, the more the myocardial fibers are stretched, the greater their force of contraction. The volume of blood STRETCHING the ventricles at the end of diastole, before the next contraction is called
preload
Preload can be increased by conditions such as __________, aortic valve disease, and hypervolemia
hypertension
Preload is decreased when a rapid ______ or hypovolemia reduces ventricular filling during diastole
heart rate
________ is the peripheral resistance against which the left ventricle must pump
afterload
Afterload depends on the size of the _________, wall tension, and arterial BP
ventricle
If the arterial BP is elevated, the ventricles meet increased resistance to the ejection of blood, increasing work demand. Eventually this results in
ventricular hypertrophy, an enlargement of the heart muscle without an increase in cardiac output or the size of the chambers. not good.
Calculate cardiac output by multiplying the amount of blood ejected from the ventricle with each heartbeat:
how do we write this equation
CO = SV X HR
Ejection fraction is?
percentage of blood ejected from the heart at the end of each beat.
the left ventricle usually ejects about 55%-___%
65%
If the left ventricle usually ejects about 55-65% of blood in the heart, a lower percentage would tell us
this is possibly a weaker heart or the vessels are gunky and malfunctioning, some type of heart failure
the CV sx must respond to many situation in health and illness, the ability to respond to these demands by maintaining or increasing CO is the
cardiac reserve
the 3 major types of blood vessels are
arteries, veins, capillaries
the large ______ have thick walls composed mainly of elastic tissue
arteries
The elastic property of arteries properly cushions the impact of the pressure from ventricular ______
contraction
capillaries connect the _______and the _______
arterioles and venules
The largest veins are
superior and inferior vena cava
elevated right atrial pressure can cause distended ______veins
neck
The autonomic nervous system consists of the ____________and ____________
sympathetic ns and the parasympathetic ns
stimulation of the Sym NS increases HR, speed of impulse conduction thru the AV node, and force of contractions. This effect is mediated by specific sites in the heart called ___________receptors
beta-adrenergic receptors
beta-adrenergic receptors are receptors for
norepinephrine and epinephrine
In contrast, stimulation of the parasym NS (mediated by the _____ nerve) slows the _______ by decreasing the impulses from the SA node and conduction through the AV node
vagus, heart rate
The source of neural control of blood vessels is the __________nervous system
sympathetic
_______________ receptors are found in vascular smooth muscles
alpha-adrenergic receptors
Stimulation of alpha-adrenergic results in
vasoconstriction
decreased stimulation of alpha-adrenergic receptors causes
vasodilation
baroreceptors in the aoritc arch and carotid sinus are sensitive to _____or ______withing the arterial system
stretch or pressure
Chemoreceptors are found in the aortic and carotid bodies and the medulla. They can cause changes in ______ and __________ in response to hypercapnia
RR and BP
what is a carotid artery
major blood vessels that provide brain’s blood supply
the arterial blood pressure is a measure of
the force exerted by the blood against the walls of the arterial system
the _____________ is the peak pressure exerted against the arteries when the heart contracts
systolic blood pressure
The ______________ is the residual pressure in the artrial system during ventricular relaxation or filling
diastolic blood pressure
Pulse pressure is the difference between SBP and DBP. It is normally 1/3 of the SBP.
if the blood pressure is 120/80 mm Hg, the pulse pressure is
40 mm Hg
_________is the difference between SBP and DBP
pulse pressure
One of the greatest risk factors for CVD is
age
The most common problem is coronary artery disease caused by
atherosclerosis
what is atherosclerosis
build up of plague, cholestorl, fats on the inner walls of arteries
Heart valves thicken and stiffen due to 3 things which are
lipid accumulation
collagen degeneration
fibrosis
The _______valves are most often thicken and stiffened
aortic and mitral
because the valves dont function properly this results in _______of blood when the valve should be closed or narrowing
regurgitation of blood
an older patient has kyphosis, during assessment we may notice
altered chest landmarks for palpation, percussion, and auscultation. Distant heart sounds
urbulent blood flow across an affected valve is heard as a whoosing sound or ________between heart beats
murmur
The number of pacemaker cells in the SA node and conduction cells, bundle of his, and bundle branches _______with age
decreases
The number and unction of b-adrenergic receptors in the heart _____with age
decreases
with age arteries and veins _____ and become less__________
thicken, elastic
Valves in the large leg veins return blood to the heart less effectively, often resulting in
dependent edema
when an older adult changes position, the sym nerve pathway produces a blunted (reduced) response, which may lead to a drop in _____, and sense of lightheadedness on arising. this is called
blood pressure, orthostatic hypotension
an older adult has arterial stiffening caused by loss of elastin in arterial walls, thickening of intima of arteries, and progressive fibrosis of media. upon assessment we may find
increase in SBP and possible increase or decrease in DBP
decreased pedal pulses
intermittent claudication
what is claudication?
pain or cramping in the legs that happens during physical activity that is then relieved by rest
LP is a 63 yo man, brought to hospital after reporting chest tightness, SOB, and palpations. The paramedics started an IV and O2 at 2 L/min via NC. They obtained a 12 lead ecg and gave him 4 low dose ASA and a nitroglycerin tablet. LP is pain free on arrival but still has palpations
- what are the possible causes of LPs symptoms?
- Is LPs condition stable or unstable?
Antipsychotics can cause these CV effects
dysrhythmias, orthostatic HTN
Corticosteroids can cause these CV effects
hypotension, edema, potassium depletion
hormone therapy like birth control can cause these CV effects
MI, thromboembolisim, stroke, HTN
NSAIDs (non-steroidal antiinflammatory drugs) can have these CV effects
MI, stroke, HTN, HF
Psychostimulants can have these CV effects
tachycardia, angina, MI, HTN, dysrhythimias
Tricyclic antidepressants can have these CV effects
dysrhythmias, orthostatic hypotension
females ten to have ____hearts and their vessels tend to be
smaller, narrower
______ protects women from heart disease by _______blood vessels, and improving HDL and LDL
estrogen, dilating
during an assessment a patient reports increased voiding and/or nocturia from which medicaiton
duretics
teach patients with heart problems to avoid straining during _________
shitting
CV often disrupt ____
what questions can we ask for clues?
sleep
paroxysmal nocturnal dyspnea “do you have shortness of breath during sleep”
do you experience cheyne-stokes during sleep
how many pillows do you use
sleep apnea is associated with an increased risk for life threatening _________especially in patients with HF
dysrhythmias
______, a common finding in CVD, interrupts normal sleep patterns
nocturia
a focused subjective assessment of LP revealed the following:
Medical hx: HTN, mitral prolapse with mild regurgitation, HF, and type 2 diabetes
meds: lisinopril, metoprolol, aspirin, furosemide
perception: denies any hx of chest pain or CAD. he reports he feels fine until this morning when he woke up with SOB, chest tightness, palpations while walking to the bathroom, he thought he was having a heart attack.
LP denies edema or nocturia
- which sub findings most concern you?
- how will you conduct a patient-centered assessment?
- is this a good time to teach him about nitroglycerin tablets?
- what should you include in physical assessment?
objective assessment:
measure BP bilaterally. readings can vary from 5 to ___ mmHg between arms
15
Obtain orthostatic (postural) BP and HR while the patient is ______, then sitting with legs ______, and then standing.
SBP should not decrease more than ____ mm Hg from the supine to standing position.
HR should not increase more than ___ beats/min from supine to standing position
supine, dangling, 20 mm Hg, 20 beats/min
Inspection:
Inspect the skin for color, _____ distribution, and venous pattern.
Check the extremities for ______, dependent rubor, clubbing of nails, variscosities, and lesions such as stasis ulcers
hair, edema
_________in the legs can be caused by gravity, varicosities, or ______sided HF
edema, right
______sided HF can cause distention and prominent pulsation of the neck veins referred to as jugular venous distention JVD
right
what is anasarca?
what does this finding indicate?
generalized body edema, severe right sided heart failure
Jugular vein distention is a clue for
heart failure
what are the six P’s when inspecting the extremities?
pain, pallor, pulselessness, paresthesia, poikilothermia, paralysis
when palpating the arteries rate the force using the following scale
0 absent
1+ weak
2+ normal
3+ increased, full, bounding
when palpating the pulse, mrs. leonard is not a big fan of
only checking someones pulse at their wrist
how do we assess for a pulse deficet
assess apical and peripheral pulse for 1 minute
an artery that is narrowed or has a bulging wall may create turbulent blood flow. This abnormal flow can cause a buzzing or humming called a________
how do we hear this?
bruit, bell of stethoscope
bluish tinge in tongue, conjunctivae, or inner surface of lips may indicate
inadequate o2 saturation of arterial blood because of a pulmonary or cardiac disorder
clubbing of the nails may indicate
endocarditis, congenital defects, prolonged o2 deficiency
pallor, cyanosis, mottling of skin after limb elevation, dependent rubor (reddish blue discoloration), glossy skin may indicate
chronic decreased arterial perfusion
JVD may indicate
increased right atrial pressure, right sided HF
bluish tinge in extremities or in nose and ears may indicate
decreased blood flow from HF, vasoconstriction, cold environment
venous ulcers: necrotic crater-like lesions usually at medial malleolus, slowly healing wounds may indicate
poor venous return, varicose veins, incompetent venous valves
arterial ulcers: pale ischemic base, well-defined edges usually found on toes, heels indicate
arteriosclerosis, diabetes
a thready pulse, weak, slowly rising pulse easily obliterated by pressure indicates
blood loss, decreased CO, aortic valve disease, peripheral arterial disease
a thrill, a vibration of vessel or chest wall indicates
aneurysm, aortic regurgitation
asymmetry in limb circumference, measurable swelling indicates
venous thrombembolisim, lymphedema
cold extremities, hands or feet cold to touch indicates
decreased CO, severe anemia, peripheral arterial disease
delayed capillary refill of nails indicates
decreased perfusion, anemia
pitting edema of lower extremities or sacral area indicates
right sided HF, interruption of venous return to the heart
what is a 3rd heart sound S3
what could it indicate
extra heart sound, low pitched, heard early of diastole, similar to sound of a gallop
left ventricular failure, volume overload, mitral, aortic, or tricuspid regurgitation, HTN
what is a 4th heart sound S4
what could it indicate
extra heart sound, low pitched, heard in late diastole, similar to a gallop
forceful atrial contraction from resistance to ventricular filling (eg left ventricular hypertrophy, aortic stenosis, HTN, coronary artery disease)
heart murmurs indicate
heart valve disorder, abnormal blood flow patterns
pericardial friction rub indicates
pericarditis
a pulse deficit indicates
dysrhythmias,
pulse deficit is when the apical heart rate exceeds peripheral pulse rate
the S3 heart sound is a low intensity vibration of the ventricular walls usually from decreased compliance of the ______ during filling
ventricles
the S4 heart sound is a low frequency vibration caused by _____ contraction
atrial
what would be normal physical assessment findings upon inspection
no pallor or cyansis
PMI not visible
no JVD with patient at 45 degree angle
what would be normal physical assessment findings upon palpation
skin warm
capillary refill <2 sec
PMI palpable in 4th ICS at left MCL
no thrills or heaves
slight palpable pulsations of abdominal aorta in epigastric area
carotid and extremity pulses at 2+ and equal bilaterally
no pedal or sacral edema
what would be a normal physical assessment when auscultating
s1 and s2 heard
apical-radial pulse equal
no murmurs or extra heart sounds
Physical assessment findings of LP are as follows:
BP 100/54, apical pulse rate 154 and irregular, RR 20, Temp 98.2, O2 sat 94% with room air
awake, alert, oriented x3
lungs clear, systolic murmur present
heart monitor shows atrial fibrillation with rapid ventricular response
+1 pedal pulses bilaterally
no peripheral edema, jvd, or heaves noted
- which physical assessment findings most concern you?
- based on the results of your assessment findings what diagnostic studies should be ordered for LP?
when cells are injured, they release contents including enzymes and other proteins into circulation. These ______ are useful in diagnosing acute coronary syndrome.
biomarkers
Interpreting biomarker level results require you to consider the _______elapsed form the onset of symptoms
time
cardiac-specific _______ is a heart muscle protein released into circulation after injury or infarction
troponin
troponin is
a heart muscle protein released into circulation after injury or infarction
normal troponin range is _______, anything above is taken very seriously
0-0.4 ng/mL
Troponin can be detected up to ____ to ____ days after cardiac event
10 to 14
______ is the biomarker of choice in diagnosing acute coronary syndrome
troponin
creatine kinase (CK) enzymes are
cardiac enzymes, can show the rise and fall of MI, used to be the standard diagnostic study for MI
what does BNP stand for
b-type natriuretic peptide
what is natriuresis
excretion of sodium in urine
BNP levels should be <100, anything greater than 100 indicates
HF
BNP is a neuro________
hormone
BNP is the marker of choice for distinguishing between cardiac or respiratory cause of
dyspnea
BNP is a neurohormone that
regulates BP and fluid volume
helps diagnose HF, MI, emboli
C-reactive protein is made by the _____ during periods of acute inflammation
liver
Increased C-reactive protein levels are linked with ______ and the first occurrence of a heart event
atherosclerosis
homocystein is an amino acid made during protein catabolism. High Hcy levels are linked to a higher risk for
CVD, PVD, and stroke
Serum Lipids:
- total cholesterol
- tryglyceride
- HDL
- LDL
what should these levels be?
- total cholesterol <200
- triglyceride <150
- HDL >40
-LDL <70
If c-reactive protein is measured at 3 or higher this indicates
CVD
if homocysteine is >15 this indicates a
high risk for CAD
a lipid panel usually measures
cholesterol, triglyceride, LDL, HDL
triglycerides, the main storage form of lipids, make up about ____ of fatty tissue
95%
Cholesterol is a structural part of
cell membranes and plasma lipoproteins
Cholesterol is absorbed from food in gi and then _______ in the ______
synthesized, liver
blood coagulation studies:
PT/INR
study for patiens taking coumadine, a blood thinner
blood coagulation studies:
PTT
partial prothrobin time
if the patient is on heparin
cardiac catheterization what is it?
involves insertion of catheter into heart via a vein or artery. evaluates chest pain and obtain info about the heart and major vessels. measures pressures within the heart chambers, contrast medium is injected to help see structures and motion of the heart
what is an electrophysiology study
invasive study to record intracardiac electrical activity using catheters inserted via the femoral or jugular veins into right side of heart. electrodes record the electrical activity in different heart structures. Can induce and stop dsrhythmias,
what is a radiofrequecy ablation for arrhythmias
uses radiofrequency energy to destroy heart tissue causing rapid and irregular heart beats. helps restore regular rhythum
where is the blood flow altered when a patient has a tricuspid valve problem?
a. vena cava and right atrium
b. left atrium and left ventricle
c. right atrium and right ventricle
d. right ventricle and pulmonary artery
c
a patient has a severe blockage in his right coronary artery which heart structures would the nurse expect to be affected by this blockage (select all)
a. av node
b. left ventricle
c. coronary sinus
d. right ventricle
e pulmonic valve
a,b,d
which part of the vascular system provides hemostasis
a. thin capillary vessels
b. endothelial layer of the arteries
c. elastic middle layer of the veins
d. smooth muscle of the arterial wall
b
which homeostatic mechanism is stimulated to compensate for a rise in blood pressure
a. baroreceptors that inhibit the sym NS, causing vasodilation
b. chemoreceptors, that inhibit sym NS, causing vasodilation
c. baroreceptors that inhibit the parasympathetic NS, causing vasodilation
d. chemoreceptors that stimulate the sym NS, causing an increased HR
a
which action does the p wave on an ecg represent
b. firing of sa node and depolarization of right atria
what subjective data would the nurse plan to obtain
b,c,d
smoking hx
spiritual preferences
how many pillow used to sleep
which heart valve sound is heard best at the LMC at the level of the 5th intercostal space
b. mitral
which condition is likely to cause a pulse deficeit of 23 beats
a. dysrhythmia
which finding is expected in the assessment of an 81 year old patient
c. difficulty isolating the apical pulse
which item would the nurse zero to establish accurate hemodynamic monitoring for a patient
a. pressure monitoring system to phlebostatic axis
which nursing responsibilities are priorities when caring for a patient returning from catheterization
ab
monitoring vital signs
assessing catheter insertion site
a normal splitting of S2 is heart best where?
pulmonic area.
normally no sound is heard between s1 and s2 but and exception to this is is normal splitting of s2 heard best over the pulmonic area during inspiration.
what type of pulse would a nurse expect to hear when a patient is anxious?
rapid, thready, irregular, pulsus alternans
rapid
thready is associated with peripherial artery disease or decreased cardiac output, irregular would be seen in dysrhymias,
pulsus alternans is associated with HF
what is pulsus alternans
characterized by a regular heartbeat in which the strength of the pulse alternates with each beat. In other words, the pulse feels strong with one beat and weak with the next beat, and this pattern repeats consistently. It’s typically observed during a physical examination by a healthcare professional associated with HF
which symptom would the nurse expect to find when assessing the CV sx of an 83 year old patient?
a. systolic murmur
b. diminished pedal pulses
c. a narrowed pulse pressure
d. increased systolic bp
e. difficulty in isolating the apical pulse
a,b,d,e
which assessment finding would the nurse expect when assessing a patient with right sided heart failure
a. peripheral cyanosis
b. splinter hemorrhages
c. pericardial friction rub
d. JVT
e. pitting edema of lower extremities
a,d,e
the nurse assesses a patient with cardiac problems and finds that one calf is larger than the other. which condition is a possible explanation for this finding
a. lymphedema
b. hypertension
c. varicose veins
d. angina pectoris
e. venous thromboembolisim
a,c,e
a patient is admitted to the hospital with chest pain. which diagnostic study would the nurse expect to be ordered
a. stress test
b. chest x ray
c. funduscopy
d. electrocardiogram
e. electroencephalogram
a,b,d
an older adult presents to the ER with recent weight gain, pitting edema to LE, and distended neck veins. which other assessment findings would the nurse expect
a. irregular heart rate
b. lower extremity cyanosis
c. third heart sound upon auscultation
d. displaced point of maximal impulse
e. high pitched scratching sound during s1 or between normal heart sounds
b,c,d
pitting bilateral edema, weight gain, and JVD are all hallmarks of
heart failure
lower extremity cyanosis, a third heart sound, and displaced PMI are all symptoms often found in a patient with
heart failure
irregular heart rate is a hallmark of
atrial fibrillation
a patient being treated for peripheral artery disease reports erectile dysfunction. which medication classification in a patient’s health record may be contributing to the condition?
diuretics, b-adrenergic receptor blockers
when providing care for a patient requiring hemodynamic stability monitoring, which clinical manifestation would the nurse associate with the patient being hemodynamically unstable
a. diarrhea
b. absent bowel sounds
c. high body temp
d. reduced urinary output
e. tiredness and exhaustion
b,d,e
what is the normal range for cardiac output?
2.8-4.2 L/min/m2
true or false: diuretics and vasodilators decrease preload
true,
pg 779
affects of aging:
remember…. in the older adult patient the aorta….
widens!
affects of aging:
remember in the older patient the heart valves thicken, stiffen, and fail to close properly causing back flow and audible….
murmurs!
affects of aging:
remember….in the older patient the systolic BP will gradually….
elevate as the patient ages
affects of aging:
dont forget.. your looking for the PMI but kyphosis may cause….
altered chest landmarks for auscultation
women who smoke and take oral contraceptives are at increased risk for
blood clots
You are inspecting a patient and immediately notice anasarca.
what is this and what does it indicate
generalized body edema
severe right sided heart failure
_____-sided heart failure can cause distention and prominent pulsation of the neck veins referred to as
jugular vein distension
an ____that is narrowed or has a bulging wall may create turbulent blood flow. This abnormal blood flow can cause a buzzing or humming termed…
a bruit
S3 may indicate
left ventricular failure
s4 may indicate
left ventricular hypertrophy
the PMI (the point of maximal impulse) reflects….
the pulsation of the apex of the heart
the first heart sound, s1 represents closure of the ___and ____valves
tricuspid and mitral
the second heart sound, s2 represents the closure of the ____and_____valvese
aortic and pulmonic
when auscultating the apical area, simultaneously palpate the radial pulse. determine wheather the rhythm is regular or irregular while listening and feeling. if the apical and radial pulses are not equivalent, count the apical pulse while a second person simultanously counts the radial pulse for 1 MINUTE.
A difference between the 2 numbers, called a ________ can indicate dysrhythmias
pulse deficit
okay the paradoxical splitting is confusing to me but here is what the book says…pg 778
normally, no sound is heard between s1 and s2. an exception to this is a normal splitting of s2, which is heard best at the pulmonic area during INSPIRATION.
Splitting of s2 can be ABNORMAL if it is heard during EXPIRATION or it is constant..
so i guess remember….
splitting of s2 is ABNORMAL if it is heard during EXPIRATION
severe heart failure can lead to fluid retention and congestion in the veins, which can cause fluid to accumulate in the abdomen,
this is called
ascites
The S3 sound is a low intensity vibration of the ventricular walls usually from decreased compliance of the ventricles during filling
an s3 sound may be normal in young adults. However, it is pathologic in patients with left-sided heart failure or mitral valve regurgitation.
this sound is also known as
ventricullar gallop
The s4 sound is a low frequency vibration caused by atrial contraction.
this is also known as
atrial gallop
preload is
the volume in the ventricle at the end of diastole
afterload refers to
the forces opposing ventricular ejection of blood
these forces include systemic arterial pressure aortic valve resistance and the blood volume and density
BNP is the biomarker of choice for distingguishing between _____ or _____ cause of dyspnea
cardiac or respiratory
