CV - things in red Flashcards
Conduction system: the ____ node is the _________ of the heart, which conducts to the ____ node, through the bundle of his, to the lt and rt bundles branches, diffuses through the ventricle walls via the Purkinje fibers; takes all of _____.
SA - sinoatrial - pacemaker
AV - atrioventricular node
0.12 seconds
HTN:
- systolic BP ?
- DBP?
How many measurements?
systolic 140 or higher
diastolic 90 or higher
either or for HTN
Need more than one measurement
Dietary HTN management?
DASH - dietary approaches to stop HTN - low fat dairy and lots of fruits and veggies - recommended to combine with low sodium too
Effects of aging on the heart:
- Amount of _____ in the heart increases and the amount of ______ decreases
- Decreased ______ and heart rate
- cardiac valves become _____ and _____ due to _____ accumulation, valve incompetence or stenosis = _____
- number of pacemaker cells in the ___ node decreases causing?
- decreased ________ NS control of CV system
- Arterial blood vessels thicken and become less elastic causing an increase in _____.
collagen ↑; elastin ↓
contractility ↓
thicker, stiffer - lipid accumulation
valve incompetence and stenosis = murmur
SA pacemakers ↓ –> bradycardia, heart block
↓sympathetic input
↑BP - arterial walls thicken and become less elastic
Congenital heart defects:
Survival rate - ___% of infants born with complex heart defects reached adulthood
90%
Pericarditis - Dx
- Symptoms - most important one?
Pain decreases when patient leans forward
Women and CAD:
- Heart disease kills more Canadian women than all forms of _____ combined
- It is the #__ cause of death in women over ___
- _____ deaths in women than men
- Women manifest CAD __ years later than men due to the cardioprotective effects of natural ______, which are lost after ______
- higher mortality and complications with CABG surgery, because they have ______ arteries, are ______, and are referred ______
- These three things are powerful predictors of CAD in wome
cancer 1, >55 more 10, estrogen, menopause smaller, older, later diabetes, smoking, decreased estrogen levels
Risk factors for CAD
- Modifiable:
- Smoking -?
- Blood pressure?
- Cholesterol?
Non-modifiable
- what are the three?
smoking 1+ packs a day
BP - >160
cholesterol - >240
non-modifiable
- family Hx of heart disease
- Age
- Gender (men > women til age 60)
Angina pectoris
Stable angina - no permanent damage is done to the heart muscle. Predictable and typically relieved with ______
rest
Medications for angina pectoris:
Anticoagulants/Antiplatelet - prevent platelet aggregation - benefit is what?
Improves blood flow
Acute coronary syndrome (MI)
- Severe, _______ chest pain not relieved by rest or nitrates
immobilizing
MI Assessment
- GI - ?
- Integument?
- Neuro?
- Psychological
GI - will VOMIT and be NAUSEOUS - if there is food, they will vomit
Integumentary - pale, cool, clammy, DIAPHORETIC - sweating buckets
Neuro - ANXIOUS
Psychogolical - FEELING OF IMPENDING DOOM
Diagnostic studies - non-invasive
- Albumin cobalt - binding test
Blood studies (name):
- cardiospecific enzyme >3-5% indicates MI
- Contractile proteins released following MI
- cholsterol, TGs, lipoproteins
Cobalt binds to damaged tissue and confirms location of infarct
CK-MB
Troponin T and I (i)
Serum lipids
MI treatment acronym?
MONA M - morphine for pain O - oxygen per nasal cannula 2-4L/min N - nitrates A - aspirin
MI treatment - real important one?
Cardiac catheterization
What is required after cardiac catheterization?
Pressure dressing
Bed rest post-procedure
What effect on a client and their family’s QOL would symptoms of CHF have?
Very high level of stress for the patient and family
Interprofessional treatment for CHF:
- Acute:
- -Drugs - number one drug for heart failure patients?
Chronic:
- Diet??
Digitalis - Digoxin
Sodium restricted diet
A cardiac glycoside, slows and strengthens the heart
Digoxin
When is digoxin held?
If pulse < 50
What are signs and symptoms of digitalis toxicity?
Bradycardia/tachycardia, pulse deficit, dysrhythmias
NV, diarrhea and abdominal pain
What is a cardinal sign of pulmonary edema?
Pink, frothy sputum
Life-threatening arrythmia, Dx when there is a run of 3 or more PVCs. Decreased CO and can carry on the this.
Vtac –> Vfib
Treatment of VTAC?
Drug therapy (e.g. IV lidocaine), CARDIOVERSION
VFIb treatment?
CARDIOVERSION, CPR, drug therapy (IV epi)
Describe whether left or right sided heart failure:
A:
- SOBOE
- Orthopnea
- Dry congested cough
- Bibasilar crackles
- Oligouria
B:
- JVD
- Edema (dependent)
- Hepatomegaly
- Ascites
- Anorexia
A - left
B - right
A client with heart failure is concerned about decreased urinary output. What would you tell the client regarding the cause of their decreased output?
A - You are dying so your body is shutting down.
B - Your chest pain caused a negative feedback loop to your bladder to tell it to stop producing urine.
C - Decreased cardiac output which results in decreased urinary output.
D - I’m sure if you tried hard enough you could have a better urine output.
C
Frothy blood-tinged sputum would indicate which of the following?
A - Spinal cord trauma
B - Fat embolism
C - Right sided heart failure
D - Left sided heart failure
D - specifically pulmonary edema
Progressive narrowing and degeneration of the arteries of neck, abdomen or extremities.
PAD
What is the major cause of PAD?
Atherosclerosis
PAD:
- __ years of age or older; earlier age with ____
- Clinical manifestations occur when there is between __-___% vessel occlusion
50+; DM
60-75%
Risk factors for PAD:
- Non-modifiable?
- Modifiable?
non-mod - age, gender, genetics
Modifiable - smoking (nicotine), HTN, diet, obesity, sedentary lifestyle, stress, DM
Arterial leg ulcer characteristics:
- Painful - _______ _______
- ABPI?
intermittent claudication
ABPI < 0.8 - if <0.4 - critical ischemia
How is ABPI calculated?
Ankle systolic / greatest systolic pressure in arm
Aneurysms:
- Outpouchings or _____ of the blood vessel wall
- ______ most common vessel
- usually caused by ______ and ______
- AAA major risk factors are ____, age over ___, and _____ use
- classified as _____ or ______
- Sign - pulsating swelling that produces a blowing ____ on auscultation (______)
dilations aorta HTN, atherosclerosis males, 65+, tobacco true, false murmur (bruit)
Where is an AAA located?
What is the treatment?
Location: below the kidneys, above femoral artery bifurcation
Surgeon puts pt on heart-lung machine and completes a bifurcation graft
Buerger’s disease:
- Rare, non-atherosclerotic, segmental ________ disorder
- Cause?
inflammatory
TOBACCO SMOKE
Episodic vasospastic disorder of small cutaneous arteries.
Raynaud’s phenomenon
Raynaud;s phenomenon
- cause?
- Primarily affects this demographic
- Association with ______ diseases (e.g. RA, SLE)
- Colour change of fingers and toes, ears, nose to this
- Attacks brought on by _____ or ______ stimuli
cause unknown women 15-40 yrs collagen white, blue, red cold, emotional
What is the treatment for Raynaud’s phenomenon?
Loose, WARM clothing, no nicotine, caffeine or vasoconstrictive drugs
Calcium channel blockers
What is the recipe for disaster for developing DVT called?
Virchow’s triad:
- Venous stasis
- Damaged endothelium of vein
- Hypercoagulability of blood
DVT:
- Women at greater risk due to this?
If on estrogen, smoke and over 35 y.o.
Describe varicose veins
Valves become dysfunctional in the perforating vein - get backflow and tortuous, extended veins
Venous insufficiency pathology:
- _________ which blocks outflow. DVT
- _______ incompetence, permitting retrograde backflow
- _______ muscle pump failure, which results in incomplete emptying
obstruction
valvulvar
calf
Differentiate venous vs. arterial ulcers:
Arterial:
- painful, mostly toes and malleolus
- skin shiny, taut, lack of hair
- cold
- ABPI < 0.8
- punched out
Venous:
- normal ABPI
- often painless
- large, irregular shape, often in gaiter area (above ankle, below knee)
- inverted champagne bottle (lipodermatosclerosis)
- buckets of exudate
Most important thing for management of venous ulcers?
COMPRESSION
- cornerstone of prevention
- NEVER use without doing ABPI first
Compression bandaging precautions
- always document this?
PATIENT TEACHING PROVIDED TO PT AND FAMILY
Support/Compression stockings:
- For ________
- ordered once ______ is controlled
- mild to high compression
- prescribed by?
- replaced at this frequency
- removed at _____ and reapplied in the _____
prevention edema MD, NP, ET, WCS q3-6 months bedtime, morning
