Exam 3 - CAD, Inflammatory and Structural Heart Disorders, & Vascular Disorders Flashcards
(184 cards)
1
Q
What is the most common type of CVD ?
A
CAD
2
Q
Coronary Artery Disease is also known as what ?
A
Athersclerosis
3
Q
What is Athersclerosis ?
A
Hardening of the arteries
4
Q
Athersclerosis can occur in any _________ in the body ?
A
artery
5
Q
CAD can be what ?
A
- Asymptomatic
- Stable angina
- Unstable angina and MI (Acute Coronary Syndrome)
6
Q
What is the Earliest stage of CAD/Athersclerosis ?
A
Fatty streaks
Earliest lesions, potentially reversible
7
Q
What is the 2nd stage of CAD/Athersclerosis ?
A
Fibrous plaque
(The fatty streak is covered by collagen, forming a fibrous plaque that appears grayish or whitish.
Results = Narrowing of the vessel lumen)
8
Q
What stage of CAD/Atherosclerosis is defined as: Continued inflammation which can result in plaque instability, ulceration, and rupture ?
A
Complicated Lesion (3rd stage)
9
Q
What is the term for when The body forms new vessel connections to bypass blockages ?
A
Collateral circulation
10
Q
When occlusion of the coronary arteries occurs slowly over a long period, the chance that adequate collateral circulation will develop is __________ ?
A
greater !
11
Q
What are Non-modifiable risk factors for CAD ?
A
- Age
- Gender (> in men until age 65, then an increase in deaths of women)
- Ethnicity
- Family History
- Genetics
12
Q
What are Modifiable (try to manage these risks) risk factors for CAD ?
A
- Elevated serum lipids
- Hypertension
- Tobacco use
- Physical inactivity
- Obesity
- Diabetes
13
Q
What is the #1 side effect of the drug Niacin ?
A
Flushing/Reddining of the face
14
Q
What is a Drug that decreases cholesterol absorption ?
A
Ezetimibe (Zetia)
15
Q
What drugs increase Lipoprotein removal ?
A
Bile acid sequestrates
16
Q
What are dugs that restrict lipoprotein production ?
A
Statins & Niacin
17
Q
Whats an example of Antiplatelet therapy ?
A
Low dose aspirin. (decreases thrombus formation)
18
Q
What type of Angina is Reversible (temporary) myocardial ischemia ?
A
Chronic Stable Angina
*NOT an MI, they just aren’t getting good perfusion to the heart, causing chest pain
19
Q
What is Chronic Stable Angina characterized by ?
A
Intermittent chest pain (pressure/squeezing) that occurs over a long period with the SAME PATTERN OF ONSET, DURATION, AND INTENSITY OF SYMPTOMS
20
Q
What type of Angina is usually caused by something ?
A
Chronic Stable Angina
21
Q
What is an ST depression very indicative of ?
A
Ischemia being present
22
Q
What are precipitating factors of Chronic Stable Angina ?
A
- physical activity
- strong emotions
- temperature extremes
- cigarette smoking
- sexual activity (extra physical activity)
- stimulants
- circadian rhythm pattern
23
Q
What type /classifications of people may not present with the typical symptoms of angina or MI ?
A
Women & Older adults
24
Q
In regards to angina or MI’s, women and Older adults may present with what ?
A
- Dyspnea
- Fatigue
- N/V
25
What type of Ischemia occurs in the absence of any subjective symptoms ?
Silent Ischemia
26
What type of ischemia is associated with diabetic neuropathy ?
Silent Ischemia
| damaged nerves can't alert to pain
27
How is Silent Ischemia confirmed ?
confirmed by ECG changes
28
Nitroglycerin should NOT be taken when a pt. is taking meds for what ?
Meds for Erectile Dysfunction
29
Why should you not take Nitroglycerin if you are taking meds for erectile dysfunction ?
The combination of both will Tank the BP !
30
Total cholesterol should be under what # ?
under 200
31
After cardiac cath's what do you need to monitor for ?
signs of re-occulusion
Ex: - chest pain
- ST elevation
- etc.,
32
in regard to cardiac catheterizations and stents being placed...there is a need for what for a few months to a year or more due to risk of restenosis ?
Need for:
| - Aspirin (ASA) & Plavix
33
What are acute interventions for Anginal attacks ?
- Administration of supplemental oxygen
- Assess VS & PoX
- 12-lead ECG
- Auscultation of heart sounds
- Prompt relief with Sublingual Nitro
34
In regards to an Acute Anginal Attack, how many Nitro can you take and how far apart ?
can take a total of 3 Nitro, 5min apart
35
If your having an Acute anginal attack, take 1 Nitro, and have no relief of symptoms or the symptoms worsen, what is the likely cause ?
Likely Acute Coronary Syndrome
36
What Syndrome develops when ischemia is prolonged and is not immediately reversible ?
Acute Coronary Syndrome (ACS)
37
What does ACS encompass ?
- Unstable angina
- Non-ST-segment-elevation myocardial infarction (NSTEMI)
- ST-segment-elevation MI (STEMI)
38
What do NSTEMIs have ?
- ST elevation
&
- Positive cardiac enzymes !
39
What type of STEMI requires prompt treatment ?
NSTEMI !
40
What medical condition is defined as --> An infection of the inner layer of the heart that usually affects the cardiac valves ?
Infective Endocarditis
41
In what kind of medical condition does Vegetation (fibrin, leukocytes, platelets, and microbes) adhere to the valve or endocardium, and can embolize into circulation ?
Infective Endocarditis
42
```
Clinical manifestations such as:
- Nonspecific
- fever in 90% of patients
- chills
- weakness
- fatigue
- arthralgia (joint pain)
Are present with what type of medical condition ?
```
Infective Endocarditis
43
additional Vascular/Respiratory manifestations such as:
- Splinter hemorrhages in nail beds (black longitudinal streaks)
- Petechiae
- Osler's nodes on fingers or toes (painful red lesions)
- Janeway's lesions on palms or soles
- Roth's spots (hemorrhagic retinal lesions)
- Murmurs in most patients
Are seen with what medical condition ?
Infective Endocarditis
44
What medical condition is seen in up to 80% of patients with aortic valve endocarditis ?
HF
45
With Infective Endocarditis, what should you screen patients for a history of ?
- Recent dental, urologic, surgical, or gynecologic procedures
- Recent cardiac catheterization or surgery
- Intravascular device placement
- Renal dialysis
- Skin, respiratory, or urinary tract infection
- History of previous Infective Endocarditis
46
Pt's with a history of Infective Endocarditis are more at risk for what ?
Re-occurence
47
Patients with Infective Endocarditis may need what in terms of collaborative care ?
May need open-heart surgery to replace the valve all together
48
In terms of Collaborative Care for Infective Endocarditis, Prophylactic antibiotic treatment may be needed for patients having what ?
- Certain dental procedures (especially if the pt has a replacement heart valve or valve disease)
- Respiratory tract incisions
- GI wound infections
- Congenital heart disease or heart transplant
49
What type of treatment is there for Infective Endocarditis ?
Antibiotics many times IV
| Sometimes for 4-6 weeks
(Intensive treatment plan !)
50
What is Acute Pericarditis ?
Inflammation of the pericardial sac (pericardium)
51
Acute Pericarditis results from what ?
- Virus (coxsackie B virus)
- Bacteria
- Trauma
- Radiation therapy
- MI
etc. ,
52
What is the most common Virus that causes Acute Pericarditis ?
Coxsackie B virus
53
What are clinical manifestations of Acute Pericarditis ?
- Severe sharp chest pain
- pleuritic chest pain (worse with inspiration) and when lying down
- Relieved by sitting up and leaning forward
- Pericardial friction rub (heard best at the L sternal boarder w/ pt. leaning forward)
54
What relieves Acute Pericarditis ?
Relieved by sitting up and leaning forward
55
What does Pericardial friction rub sound like ?
Scratching/grating high pitched sound
56
What are complications of Acute Pericarditis ?
- Pericardial effusion
| - Cardiac Tamponade
57
What are types of Diagnostic studies used for Acute Pericarditis ?
- ECG (to rule out MI)
- Echo
- WBC
- CRP
- May have elevated troponin
58
When treating Acute Pericarditis, what medication(s) will give the best pain relief ?
**NSAIDS
59
What are s/s of Cardiac Tamponade ?
- Muffled heart sounds
- Tachypnea
- Tachycardia
- May need pericardiocentesis
60
Rheumatic Fever and Rheumatic Heart Disease are complications from what ?
Group A streptococcal pharyngitis
| Type III Hypersensitivity
61
What are clinical manifestations of Rheumatic Fever and Rheumatic Heart Disease ?
- Carditis
- Arthritis
- Sydenhams's chorea (involuntary movements)
- Erythema marginatum (red lesions on skin. On the trunk of the pt's body or limbs)
62
What is the Tx for Rheumatic Fever and Rheumatic Heart Disease ?
- Antibiotics to prevent spread
| - Anti-inflammatories
63
What happens if Rheumatic Fever (or strep throat) isn't taken care of right away ?
Leads to Rheumatic Heart Disease (which is a life long disease)
64
__________ is where the Valve orifice is restricted ?
Stenosis
65
With _________ forward blood flow is impeded ?
Stenosis
66
______________ results in the incomplete closure of valve leaflets ?
Regurgitation
67
_____________ results in the backward flow of blood ?
Regurgitation
68
S1 is the closure of the __________ and ___________ valves ?
Tricuspid and Mitral valves
69
Which one, S1 or S2 is the beginning of systole ?
S1
70
S2 is the closure of the __________ and __________ valves ?
aortic and pulmonic valves
71
True or False: Mitral Valve Prolapse has an unknown cause ?
True
72
If a pt. has a Hx of a murmur(s) and is reporting new onset chest pain, dizziness, SOB, etc., what is the likely cause ?
Pt. may not have enough cardiac output. --> Could lead to an MI, Stroke, etc., so notify the MD !
73
Porcine valves are also known as what ?
Biologic valves
74
What type of valve(s) usually only lasts on average 10 years ?
Porcine valves
75
With what type of valve(s) are anticoagulants not needed ?
Porcine valves
76
Individuals older than 65yrs might benefit more from what type of valve(s) ?
Porcine valves
- Because they don't carry the risks that Mechanical valves have, with having to take Coumadin and the risks that come along with that
77
What type of valve(s) would be appropriate for women of childbearing age ?
Porcine Valves
* because Anticoagulants are not needed ! *
78
What type of valve(s) typically last longer than 10yrs ?
Mechanical valves !
79
What class of drugs are required for Mechanical valve(s) ?
Anticoagulants !
80
In regards to Mechanical valves, what is the Anticoagulant of choice ?
Coumadin
81
With Mechanical Valve(s) why do you need to take Coumadin ?
Need to take Coumadin to reach a therapeutic INR of 2.5 to 3.5
* Need frequent monitoring for this *
82
Why are Mechanical Valve(s) better for young individuals ?
Because of their durability !
83
Which type of valves take more maintenance ?
Mechanical Valves
84
Aortic Stenosis is associated with what type of Murmur ?
Systolic Murmur - S1
85
Mitral regurgitation is associated with what type of murmur ?
Systolic murmur- S1
- blood comes back into the R atrium from the ventricle
86
Mitral stenosis is associated with what type of Murmur ?
Diastolic Murmur - S2
- blood backs up into the L atrium and lungs
87
Aortic regurgitation is associated with what type of Murmur ?
Diastolic Murmur - S2
- blood flows back into the L ventricle from the aortic arch
88
_______________ is a group of diseases that affects the structural and functional ability of the myocardium ?
Cardiomyopathy (CMP)
89
What stage of Cardiomyopathy is the etiology of the disease unknown (idiopathic) ?
Primary Cardiomyopathy
90
What stage of Cardiomyopathy is secondary to another known cause ?
Secondary Cardiomyopathy
91
What can Cardiomyopathy lead to ?
Cardiomegaly and HF
92
What is the leading cause for heart transplantation ?
Cardiomyopathy
93
What is the most common type of cardiomyopathy (CMP) ?
Dilated Cardiomyopathy
94
What are causes of Dilated Cardiomyopathy ?
- Genetics (increase in middle-aged A.A. men)
- Infectious myocarditis
- Autoimmune process
- Alochol
- Pregnancy
- CAD
95
What are Sx of Dilated Cardiomyopathy ?
- HF sx
- Murmur
- Dysrhythmias
96
Aortic Aneurysms fall under what type of Disorders ?
Vascular Disorders
97
What type of aneurysm is defined as outpouchings or dilations of the arterial wall ?
Aortic aneurysm
98
Most Aortic aneurysms occur where ?
Below the renal arteries
99
True or False: The Growth rate for an aneurysm is unpredictable ?
True
100
The larger the aneurysm, the greater the risk for what ?
Rupture !
101
What is the largest artery in the body ?
Aorta
102
The ________ is an essential vessel to perfuse the rest of the body ?
Aorta
103
True or False: the Aorta is very very long ?
True
104
What would a rupture lower in the aorta be called ?
Abdominal aortic aneurysm (AKA: Triple A (AAA) )
105
3/4 of Aortic aneurysms are what type ?
AAA (Abdominal Aortic Aneurysms
106
True or False: Thoracic aorta aneurysms are often asymptomatic ?
True
107
What is the most common manifestation of Thoracic aorta aneurysms ?
- Deep defuse chest pain
| - Pain may extend to the interscapular area
108
Where on the Aorta, do ascending aorta/aortic arch aneurysms happen ?
These type of aneurysms happen very high up on the Aorta, at the beginning of the Aorta
109
What are some s/s of an ascending aorta/aortic arch aneurysm ?
- Angina
- Horseness
- If the aneurysm is pressing on the Superior Vena Cava, some s/s would include...
- Decreased venous return.... Which would present as -------> - Distended neck veins
- Edema of Head and Arms
110
True or False: AAA are often asymptomatic, unless you have a rupture or there is leaking of the aorta ?
True
111
Individuals with AAA are often asymptomatic, so how are they generally detected?
Frequently detected on physical exam, when the pt. is examined for an unrelated problem.
(i.e., CT scan, Abdominal x-ray)
112
AAA may mimic what ?
Pain assocaited with abdominal or back disorders
113
**Severe, new onset back pain is a red flag for what ?
Possible ruptured AAA !
114
What is a s/s of a rupture ?
immediate Bruising on the back/flank over the kidneys, may be black and blue or red
115
What will a rupture into the thoracic or abdominal cavity result in ?
- Massive Hemorrhage !
| * most do not survive long enough to get to the hospital*
116
Those pt's who do make it to the hospital with a ruptured thoracic or abdominal aneurysm, would be initially treated for what ?
Hypovolemic shock !
- because there loosing sooooo much volume !
117
What are initial VS and symptoms that we would see in someone coming in with Hypovolemic shock, from a ruptured thoracic or abdominal aneurysm ?
- HUGE decrease in BP
- Increased HR
- Pale clay skin (b/c we've lost our perfusion)
- Low urine output
- decreased LOC (and falling)
- Abdominal pain and tenderness (in addition to back pain)
118
A pt. who made it to the hospital with a ruptured aneurysm would need immediate what ?
IMMEDIATE surgical repair !
* time is of the essence... they will bleed out quickly !
119
What diagnostic study is the most accurate to determine/diagnose Aortic aneurysms ?
CT scan
120
Small aneurysms are considered what size ?
< 4cm
121
If aneurysms are small (< 4cm) what type of treatment is given ?
Conservative Therapy Used !
- Risk factor modification
- Decrease BP
- Annually monitoring via ultrasound, MRI, or CT scan
122
In regards to aneurysms, what is the threshold for repair ?
5.5cm
> 5cm for women with AAA
123
Surgical interventions for aneurysms may occur earlier, before reaching 5.5cm under what circumstances ?
- Younger, low-risk patients
- Rapidly expanding aneurysm
- Symptomatic pt's
- High rupture risk
124
Surgical repair of aneurysms are often what type of repair (what is it called)?
Open Aneurysm Repair (OAR)
- OAR's have very large incisions
125
What is the mortality rate for ruptured AAA ?
90% mortality rate
126
Surgical repairs of aneurysms can be completed in what time frame ?
30-45 minutes
127
If surgical repair of an aneurysm requires "cross-clamping", where must they be applied ?
above the renal arteries
128
In regards to aneurysms, post-op renal complications increase significantly when ?
When the repair is able the renal arteries
129
Why do we want to **Monitor renal status after an Aortic aneurysm ?
If its above kidney level it can be really taxing on our kidneys and it can trigger the individual into an AKI
130
To **monitor renal staus post-op of an Aortic aneurysm repair, what labs should be considered ?
* Creatinine
* BUN
- Hightened levels of either of these, means the kidneys are struggling
131
What is a Normal Creatinine range ?
0.6 - 1.3
132
What is a normal BUN range ?
6 - 20
133
With Aortic Aneurysm Repairs, why do we want to monitor pulses distally to graft, post-op ?
To check for occlusion
- Pre-op: mark/document pedal pulse sites before surgery
134
Why do we want to monitor fluid status post-op for a pt. who just had an Aortic Aneurysm Repair ?
Don't want pt. to become Hypovolemic
135
What do we want to make sure the patient is back to post-op of an Aortic aneurysm repair (or any surgery for that matter) ?
Back to Baseline !
136
What medical problem is defined as a Tear in the intimal lining which allows blood to "track between the intima and media" ?
Aortic Dissection
137
True or False: Aortic Dissections may rupture = death ?
True !
138
With what medical problem is the pain characterized as...
- Sudden
- Severe pain in the anterior part of the chest, or intrascapular pain radiating down the spine to the abdomen or legs.
- Described as "sharp" and "worst ever"
Aortic Dissection
139
Aortic Dissections may mimic that of what ?
an MI
140
True or False: With Aortic Dissections (and aneurysms) hey need to be repaired immediately ?
True !
141
What disease, Involves progressive narrowing and degeneration of arteries of the neck, abdomen, and extremities ?
Peripheral Arterial Disease (PAD)
142
What is the leading cause of Peripheral Arterial Disease (PAD) in the majority of cases ?
Atherosclerosis
143
PAD typically present when (age range) ?
Between ages 60s to 80s
* May see it develop a little bit earlier in patients with diabetes
144
True or False: PAD is largely undiagnosed ?
True
145
What are Risk Factors for PAD ?
- Cigarette smoking
- Hyperlipidemia
- Hypertension
- DM
146
What is a Classic Symptom of PAD ?
Intermittent claudication
147
What is Intermittent claudication ?
- Ischemic muscle ache or pain that is precipitated by a constant level of exercise
- Resolves within 10 minutes or less with rest
- Reproducible
148
_____________ is defined as, Numbness or tingling in the toes or feet ?
Paresthesia
149
With Paresthesia, injuries often go ____________ by the patient ?
Unnoticed
150
What does Paresthesia produce ?
Loss of pressure and deep pain sensation
151
What are the below points, Clinical Manifestations of ?
- Thin, shiny, and taught skin
- Loss of hair on the lower legs
- Diminished or absent pedal, popliteal, or femoral pulses
- Pallor of foot with leg elevation
- Reactive hyperemia of foot with dependent position
PAD
152
The muscle aches and pain associated with Intermittent Claudication are due to what ?
Build up of lactic acid while exercising
153
What are Severe Clinical Manifestations of PAD ?
- Pain
- Pallor
- Pulselessness
- Paresthesia (numbness & tingling)
- Paralysis
- Poikilothermia
154
What is poikilothermic ?
Loss of temperature regulation
Temperature varies with the temperature of surrounding
155
What are possible interventions if a pt. is showing clinical manifestations such as...
- pain
- pallor
-pulselesness
- parathesia
- poikilothermia
... that may indicate an embolism, thrombus, to trauma ?
- Put a pt. on heparin drip to help dissolve the clot immediately, and then we would transition them to warfarin
- Possible removal of the thrombus in surgery, if it is an immediate need
- Might have/get TPA on board (TPA = clot buster)
- Amputation may be needed, if the clot isn't dealt with immediately
156
Nonhealing arterial ulcers and gangrene are the most serious complications of what disease ?
arterial disease
157
Atrophy of the skin and underlying muscles is the general definition of a complication of what disease ?
arterial disease
158
A complication of arterial disease may be _____________ , if blood flow is not adequately restored, or if severe infection occurs ?
Amputation
159
- decreased or absent pulses
- usually no edema, unless in dependent position for a long time
- loss of hair on the feet/legs
- wound rounded; black or pink
- skin thin, shiny, and cool
....are s/s complications of what disease ?
complications of arterial disease
160
What type of drug is TPA ?
Clot Busting drug !!!
161
When you can't feel a pulse, what should be your next step ?
Using a Doppler ! - allows you to hear the pulse !
Formal definition: Uses sound waves to determine if blood is flowing through a blood vessel
162
What type of diagnostic test is a "medical imaging technique that is used to visualize the inside, or lumen, of blood vessels and organs of the body" ?
Angiography
163
in regards to PAD, what type of diagnostic test "uses high-frequency ultrasound to visualize the anatomy and blood flow in the legs" ?
Duplex imaging
164
what type of diagnostic test "compares the ratio of the blood pressure in the lower legs to the blood pressure in the arms ?
Ankle Brachial Index (ABIs)
165
What risk factor modifications should be made for patients with PAD or who are susceptible to PAD ?
- Smoking cessation (including not using nicotine products long-term)
- Decreasing hyperlipidemia
- lowering/mainting BP <140/90
- Diabetes control (A1C <7)
166
What kind of drug therapy would be provided for patients with PAD ?
- Anti-platelet therapy (aspirin & clopidogrel (placix) )
- ACE inhibitors
167
What is an example of a drug prescribed for the treatment of Intermittent Claudication ?
* Pentoxifylline (Trental)
- increases erythrocyte flexibility
- decreases blood viscosity
* Cilostazol (Pletal)
- increase vasodilation
- increase walking distance
168
What is the first line treatment for patients with PAD ?
Exercise program !
169
Walking is the most effective exercise for individuals with ________________ ?
Claudication
170
What are some recommendations for walking in patients with PAD experiencing claudication ?
- walk 30-60 minutes daily
| - if pain results... stop, rest, and then start again
171
What are patient teaching points we should give for someone with PAD ?
- exercise/walk till claudication occurs , then rest and walk a little further
- Inspect feet daily
- void crossing the legs
- Avoid exposure to cold of extremities
- Never apply direct heat to the feet
- Avoid tobacco and caffeine (caffeine = vasoconstrictor)
- Elevate feet at rest (but above the level of the heart)
172
What medical condition is defined as "Episodic vasospastic disorder of small cutaneous arteries (finger/toes) ?
Raynaud's Phenomenon
173
How long does Raynaud's phenomenon typically last for ?
Lasts for a few minutes to hours & then resolves on its own !
174
Can Raynaud's phenomenon be painful ?
Yes
175
Raynaud's phenomenon is most common in who (gender) ?
Women (15-40yrs old)
176
What characteristic is associated with Raynaud's Phenomenon ?
Vasospasm-induced color changes of the fingers, toes, ears and nose (white/blue/red)
177
Venous stasis ulcers affect ____________ circulation ?
venous circulation
178
True or False: Venous stasis ulcers can be chronic ?
True
179
Venous Stasis Ulcers are caused by what ?
Venous insufficiency
180
True or False: pulses are present with venous stasis ulcers ?
True
181
True or False: There is Edema with venous stasis ulcers but not PAD ?
True !
182
How does the skin appear in patients with Venous Stasis Ulcers ?
Skin...
- warm
- thick
- hardened
183
Venous Stasis Ulcers, produce a staining on the skin that results in what type of color ?
Brownish color/look on the skin
184
What kind of drainage is present with venous stasis ulcers ?
Large drainage with yellow/red wounds
