day 4

Question 1

conditions that increase HR
conditions that decrease HR

Answer 1

Conditions that: increase heart rate
SNS stimulation
Pain, anxiety, fear, perceived threats,
medications
Cardiac conduction syndromes (WPW)

Conditions that: decrease heart rate
PNS stimulation (muscarinic receptors/vagal nerve)
Valsalva
Medications,
conduction issues

Question 2

Assessment of Cardiovascular System

heart sounds

Answer 2

Auscultation
S1 = the closure of the tricuspid and mitral valves (AV atrial ventricular) valves = LUB
S2 = the closure of the aortic and pulmonic valve (semilunar) = DUB

S3 = ventricular vibration (mitral valve) regurgitation

S4 = occurs in patients with CAD, left ventricular hypertrophy or aortic stenosis

Question 3

hypertension

Answer 3

Sustained elevation of systemic arterial blood pressure (BP)

Persistent elevation of
Systolic blood pressure (SBP) ≥140 mm Hg or

Diastolic blood pressure (DBP) ≥90 mm Hg or

Question 4

3 hypertension subtypes

Answer 4

Isolated systolic hypertension
(Sustained elevation of SBP ≥140 mm Hg and a DBP <90 mm Hg)

Primary (essential) hypertension

Secondary hypertension
5 to 10% of adults

Question 5

Contributing factors to Primary Hypertension

3 s’s

Answer 5

↑ SNS activity
↑ Sodium-retaining hormones and vasoconstrictors
↑ Sodium intake
Diabetes mellitus
Excessive alcohol intake

Question 6

secondary hypertension

clincial findings and causes

Answer 6

Clinical findings
Unprovoked hypokalemia
Abdominal bruit
Family history of renal disease

causes
narrowing of the aorta
Renal disease
Cushing’s syndrome
hyperaldosteronism
Neurological disorders such as brain tumours,

Question 7

Primary Hypertension: 7 Complications and medications

Answer 7

Hypertensive heart disease
Coronary artery disease
Left ventricular hypertrophy
Heart failure
Cerebrovascular disease
Peripheral arterial disease
Nephrosclerosis
Retinal damage

Medications”
Diuretics (Furosemide, HCTZ)
Antihypertensives (ACE Inhibitors, Calcium Chanel blockers)

Question 8

CAD

etiologies

Answer 8

CAD results in ischemia and infarction of myocardial tissue.
LAD (left anterior descending artery) is most commonly affected.
Highly sensitive CRP (risk of MI)

etiologies:
Atherosclerosis
Coronary vasospasm
Microvascular angina

Question 9

medications for CAD and the therapies

Answer 9

morphine
B-blockers
Calcium channel blockers
Nitrates
Thrombolytics

Cholesterol-lowering medication therapy
Antiplatelet therapy

Question 10

Cardiac Valve Dysfunction

valve stenosis

Answer 10

Valve Stenosis

Thickened and stenotic valve leaflets

Caused by
Rheumatic fever (main)
Calcification
Congenital factors

Question 11

Mitral Valve Stenosis

s/s and treatment

Answer 11

Early period—may have no symptoms
Later—excessive fatigue, dyspnea on exertion, orthopnea, dry cough, hemoptysis, or pulmonary edema
Rumbling apical diastolic murmur and a-fib are common

Monitor for a-fib with thrombus formation
Prophylactic antibiotic therapy before any invasive procedures
May require surgical repair or valve replacement

Question 12

valve regurgitation

MR and AR

Answer 12

Mitral valve regurgitation (MR)
Insufficient or incompetent mitral valve (prolapse)
Regurgitation of blood back into LA
Can lead to left sided heart failure

Aortic valve regurgitation (AR) – aka aortic insufficiency
Incompetent aortic valve, allows blood from aorta back into LV during diastole
LV hypertrophy to maintain Stroke Volume
Systolic murmur
Rheumatic fever

Question 13

Left Sided Heart Failure

causes symptoms signs lab findings

Answer 13

Causes: LV infarct, cardiomyopathy, hypertension


Symptoms: shortness of breath, cough, orthopnea, pulmonary edema, paroxysmal nocturnal dyspnea


Signs: S3 gallop, tachycardia, inspiratory rales beginning
at lung bases, expiratory wheezes due to bronchospasms

Laboratory findings:
hypoxemia
pulmonary edema or pleural effusions
BNP levels greater than 500 ng/mL

Question 13

Right Sided Heart Failure

causes, symptoms, signs, Tests

Answer 13

Causes: LHF, RV infarct, pulmonary or tricuspid valve disease, pulmonary HTN, COPD, Pulmonary Edema

Systemic Congestion

Symptoms: dyspnea on exertion, fatigue, weight gain, fluid retention

Signs: ↑ Central Venous Pressur, hepatomegaly, ascites, peripheral or sacral edema, and pleural and pericardial effusions

Lab Tests: ↑ LFTs, ↑BUN/Cr, ↑ PT/INR, hyponatremia

Question 14

Heart failure diagnostics and medications

Answer 14

Diagnostic
Echo, Doppler,12 lead

Medications
ACE Inhibitors
ARBs (angiotensin blockers)
Beta blockers
Loop and Thiazide diuretics

(Fluid restrictions)

Question 15

heart failure management

Answer 15

Oxygen
Limit sodium intake
Fluid restriction
Avoid alcohol

Question 16

angina

supply vs demand

Answer 16

Supply vs demand

Increased demands
↑ heart rate, ↑ contractility, ↑ preload

Decreased supply
CAD, spasm, anemia, hypoxemia, shock

Question 17

angina medical risk factors

Answer 17

Smoking
hypertension
Diabetes
Chronic kidney disease
Metabolic syndrome
Menopause
Hyper-homocysteinemia
Vascular inflammation

Question 18

angina grade classification

Answer 18

Grade 1
Angina occurs with strenuous exertion

Grade 2
Angina occurs w/walking 2 blocks or 1
flight of stairs

Grade 3
Angina occurs w/walking < 2 blocks

Grade 4
Rest angina

Question 19

chronic stable angina drug management

Answer 19

Short-acting / long acting nitrates
Nitro (SL or Transdermal)
β-Adrenergic blockers
Calcium channel blockers
Angiotensin-converting enzyme inhibitors

Question 20

Unstable Angina

what does it indicate?

Answer 20

New onset that can occur many times per day
Pain is increasing in severity; unrelieved w/ Ntg
Rest angina
Indicative of unstable plaque
Preinfarct or crescendo

Question 20

Chest Pain Pharmacological (med) Treatment

Answer 20

Therapy (MONAM)
Monitor
Oxygen
Nitroglycerin
ASA
Morphine

β-Adrenergic blockers
Angiotensin-converting enzyme inhibitors
Antidysrhythmia drugs
Cholesterol-lowering drugs
Stool softeners