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115 LEC > Exam 3 - Cardio > Flashcards

Exam 3 - Cardio Flashcards

1
Q

The heart is composed of what 3 layers?

Inside to outside

A

Endocardium - lines inside of heart
myocardium - muscle fibers
epicardium - exterior

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2
Q

The pericardial space hold how much fluid?

A

20mL which lubricates the surface of the heart

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3
Q

What happens during diastole?

A

-All 4 chambers of the heart relax simultaneously
-Allows ventricles to fill

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4
Q

What happens during systole?

A

-Contraction of artia and ventricles
-Not simultaneous
-Atrial contraction occurs first, then ventricle
*allows ventricles to fill completely prior to ejction of blood

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5
Q

What artery is the only artery which carries deoxygenation blood?

A

Pulmonary artery

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6
Q

What route does blood flow through heart?

Starting with Right Atrium

A

-R atrium gets unoxygenated blood via superior/inferior vena cava from body.
-R atrium drains into R ventricle, which is pumped through pulmonary arteries to lungs
-Lungs oxygenate blood & sends back to heart via L artium
-L atrium drains to L ventricle and pumped out aortic arch to body

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7
Q

What position does the heart lie in the chest?

A

R ventricle lies anteriorly - just beneath sternum)
L ventricle is posteriorly

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8
Q

Where is the PMI located?

A

intersection of midclavicular line of left chest wall, 5th intercostal space

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9
Q

What do the AV valves do?
Where are they?
During diastole are they open or closed?

A

AV - separate atria from ventricles
Tricuspid - R atria/R ventricle
Mitral/bicuspid - L atria/L ventricle
Diastole - open, allowing blood to drain

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10
Q

Where are the semilunar valves?
Open or closed during diastole?

A

R ventricle & pulmonary artery is pulmonic valve
L ventricle & aotra is aortic valve
Diastole - closed / forced open during systole and blood is ejected

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11
Q

Where is the SA node located?
what is the firing impulses per min of SA node?
Impulses of AV node?

A

-Located junction of superior vena cava and R atrium
SA - 60-100bpm
AV - 40-60
30-40

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12
Q

Explain cardiac action potential

A

Phase 0 - depolarization - NA+ ions influx into cell. 40+
Phase 1 - Early repolarization as P exits
Phase 2 - Plateau. Ca+ enter
Phase 3 - Repolarization / resting state Na + out
Phase 4 - Resting -80 (refractory)

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13
Q

Each Cardiac cycle has what 3 events?

A

Diastole
atrial systole
ventricular systole

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14
Q

Cardiac output refers to

A

total amount of blood ejected by 1 of ventriles in liters per minute
*resting adult is 4-6L/min

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15
Q

Stroke volume

A

amount of blood ejected from one of ventricles per heartbeat
-60-130mL

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16
Q

C/O is increased by both S/V and HR
Changes in HR are due to
PNS travel to SA via?
SN increase SA by?

A

HR - inhibition or stimulation of SA by para or sympathic
PNS - SA via vagus nerve to SLOW HR
SN - beta 1 receptor in SA to INCREASE DR

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17
Q

Stroke volume is effected by what 3 factors?

A

preload - degree of stretch of ventricle muscle at end of diastole (bigger stretch bigger contraction)
afterload - resistance to ejection
contractility- force generated by contracting myocardium

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18
Q

ejection fraction

A

% of end diastolic blood volume that is ejected with each heart beat
55% - 65%
>40% likely requires treatement for HF

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19
Q

ANGINE PECTORIS
Symptoms
Duration
Aggravating factors
Alleviating factors

A

Uncomfortable pressure, squeezing in chest - can radiate to arms, hands, jaw/ numbness, tingle, achy
-5-15min
-Excersice, emotional upset, large meal, extreme temps
-rest, nitroglycerin, oxygen

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20
Q

PERICARDITIS
Symptoms
Duration
Aggravating factors
Alleviating factors

A

Sharp, severe substernal/epigastric pain. Can radiate to neck, arms, back. Fever, malaise, dyspnea, cough, nausea, dizziness, palpitations

-Intermittent
-SUdden onset, increases with inspiration, swalling, coughing, rotation
-Sitting upright, analgesia, antiinflammatory

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21
Q

PULMONARY DISORDERS
Symptoms
Duration
Aggravating factors
Alleviating factors

pneumonia, pulmonary embolism

A

Sharp, severe substernal or epigastric pain arise from inferior pluera, maybe able to localize pain

->30mins
-infectious or noninfectious process (MI, cardiac surgery, cancer). increases with inspiration, coughing, movement, supine, inconjunction with CAP or HAP
-Treatment of underlying cause

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22
Q

ESOPHAGEAL DISORDERS
Symptoms
Duration
Aggravating factors
Alleviating factors

A

Substernal pain, sharp, burning, heavy, Often mimic angina, Can radiate to neck, arm, shoulders

-5-60min
-Cold liquids, exercise
-Food or antacid, nitroglycerin

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23
Q

ANXIETY / PANIC DISORDERS
Symptoms
Duration
Aggravating factors
Alleviating factors

A

Stabbing to dull ache. Palpitations, SOB, tingling, fear, unreal

less than 3o mins
-anytime including during sleep, assoc by a specific trigger
-Removal of stimulus, relaxation, medications

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24
Q

MUSCULOSKELETAL DISORDERS
Symptoms
Duration
Aggravating factors
Alleviating factors

A

Sharp or stabbing pain localized in anterior chest. Unilateral, radiate across chest or back

hours to days
-Follows respiratory tract infection, coughing, vigorous exercise or posttrauma, idiopathic, exacerbated by deep breathing, coughing, sneezing, movement
-Rest, ice, heat, analgesic, antiinflammatory

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25
Q

Managing diet are important for managing what 3 major cardio risks?

A

hyperlipidemia
hypertension
diabetes

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26
Q

Screening for bloody urine or stools should be done in patients taking what 3 types of meds?

A

Antiplatelets
Platelet aggregation inhibitors
anticoagulants

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27
Q

What are the 6 P’s for obstruction of arterial blood flow of extremities?

A

Pain
Pallor
Pulselessness
paresthesia
poikilothermia (coldness)
paralysis

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28
Q

What does prolonged cap refill indicate?

A

inadequate arterial perfusion to extremities

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29
Q

What does clubbing of fingers indicate?

A

chronic hemoglobin desaturation
Assoc with congenital heart disease

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30
Q

What are the 2 stages of htn

A

Stage 1 - systolic 130-139 or diastolic 80-89
STage 2 - systolic over 140 or diastolic over 90

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31
Q

What is pulse pressure
Narrow?
Wide?

A

Difference between systolic and diastolic pressure
*normal 40 mmhg

-Narrow >18 mmhg occurs vasoconstriction conpensating for low stroke volume (shock, HF,hypovolemia
-Wide <50mmHg (anxiety, exercise, bradycardia or vasodialtion (fever, septic shock)

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32
Q

What are normal postural responses when a person stands up

A

HR increase of 5-20bpm
unchanged systolic or decrease of 10mmHG
Slight increase in diastolic 5 mmhg

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33
Q

Orthostatic hypotension

A

sustained decrease of at least 20 mmhg in systolic BP or 10mmhg in diastolic within 3 mins of standing up

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34
Q

What is pulse deficit

A

disturbances of rythym resulting in difference between apical and radial pulse rates
*commonly occur with atrial fibrillation, flutter, premature ventriclur contractions

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35
Q

What does it mean if apical impulse is palipable 2 or more adjacent intercostal spaces?
An apical impulse below the 5th intercostal means?
If apical impulse can be felt in 2 distinct locations?
Broad or forceful impulse is?

A

-left intercostal enlargement
-left ventriclur enlargement from HF
-ventricular aneurysm
-left ventricular heave or lift

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36
Q

What creates the S1 sound?
Where is it heard the loudest?

A

Tricuspid and Mitral valve closure
Apical area

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37
Q

Intensity of S1 increases during

A

Tachycardias or mital stenosis

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38
Q

What creates the S2 sound?
Where is it the loudest

A

Closure of pumonic and aortic valves
loudest over aortic/pumonic areas

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39
Q

When are S3 and S4 gallop sounds heard?

A

during diastole

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40
Q

WHat causes S3 sound
Normal / abnormal

A

rapid ventricular filling
*normal finding in children up to 35-40yrs old
**Older adults -suggest HF

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41
Q

Summation gallop

A

Durning tachycardia all 4 sounds (s1,s2,s3,s4) combine

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42
Q

Opening snaps

A

abnormal diastolic sounds heard during opening of AV valve
*mitral stenosis

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43
Q

Systolic click

A

result of the opening of rigid and calcified aortic or pulmonic valve during ventricular contractions

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44
Q

Murmurs are created by

A

Turbulant blood flow
*could be narrowed valve, malfunctioning valve, defect in vent wall, increased blood flow

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45
Q

Friction rub

A

a harsh grating sound that can be heard in both systole and diastole
*Caused by abrasion of inflammed pericardial surfaces form pericarditis

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46
Q

What is a cardiac biomarker analysis?

A

Myocardial cells that become necrotic release specific enzymes **(creatin kinase CK), (CK-MB), myoglobin and troponin. **

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47
Q

BUN
Normal level
indicates?

A

-End products of protein metabolism excreted by kidneys
8-20mg/dL
**-Elevated indictates reduced renal perfusion from decreased cardiac output or fluid volume deficit as a result of dehydration or diuretics **

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48
Q

Calcium
Normal range

Necessary for?

A

8.8-10.4
Blood coagulation, neuromuscluar activity, automaticity of nodal cells

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49
Q

Hypocalcemia
Hypercalcemia

A

Hypo- slows nodal function and impair contractility
Hyper - increased contractility, increased heart block and sudden death from ventricular fibrillation
*HYPER Can occur with thiazide diuretics bc reduce renal excretion of Ca

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50
Q

CREATININE
Normal level
increased level indicates?

A

Male 0.6-1.2 / female 0.4-1.0
Increased indicates renal impairment

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51
Q

Magnesium
normal level
Necessary for

A

1.8-2.6

absorption of calcium, maintenance of postassium, metaboloism of adenosine triphosphate/ major role in protein and carb synthesis and muscular contraction

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52
Q

Hypomagnesia
Hypermagnesia

A

Hypo - enhanced renal excretion of mag from due of diuretic or digitalis therapy. Predisose pts to atrial or ventricular tachycardias
Hyper - caused by the use of cathartics or antacids containing magnesium. Depress contractility and excitability of myocardium, causing heart block and asystole

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53
Q

Potassium
normal level
Necessary for

A

3.5 - 5

Major role in cardiac electrophysiologic function

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54
Q

Hypokalemia
Hyperkalemia

A

Hypo - Due to postassium-excreting diuretics can cause arrythmias, ventricular tachycardia, vent fibrillation
Hyper - increased intake of potassium, decreased renal excretion of pot, or use of pot sparing diuretics. Heart block, asystole, ventricular arrhythmias

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55
Q

Hyponatremia
Hypernatremia

A

Hypo - indicate fluid excess, can be caused by heart failure or admin of thiazide diuretics
Hyper - fluid deficits and can result from decreased water intake or loss of water through excessive sweating or diarrhea

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56
Q

Activated partial thromboplastin time (aPTT)
lower limit of normal
measures?

A

21-35s

activity of intrinsic pathway, used to assess affects of unfractionated heparin.
*Therapeutic range is 1.5-2.5X baseline value

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57
Q

Prothrombin time (PT)
Lower limit of normal
measures?

A

11-13s
extrinsic pathway and used to monitor level of anticoagulation with warfarin

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58
Q

International normalized ratio
(INR)
Normal range
used for

A

0.8-1.2

used to monitor effectiveness of warfarin
Therapeutic range is 2-3.5

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59
Q

Hematocrit
Normal %
Represents

A

Male 42-52% / Female 36-48%

represents % if red blood cells found in 100mL of whole blood.

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60
Q

Hemoglobin
Normal range
Measures

A

Male 14-17.4 / Female 12-16

Measures amount of oxygenation saturation

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61
Q

Platelets
Normal range

A

140,000-400,000

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62
Q

WBC
Normal levels

A

4500-11,000

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63
Q

What is the harmful effect of LDL

A

Primary transport of cholestrol and triglycerides into the cell
deposition of these into arterial vessels

64
Q

What is the protective effect of HDL

A

Carries cholestrol and triglyercides away from tissues/cells to liver for excretion

65
Q

What is Brain natriurtic peptide
(BNP)

A

neurohoromone that helps regulate BP adn fluid volume
-Secreted from ventricles in response to increased preload with resulting elevated vent pressure
*level of BNP increases as vent walls expand
**occur in conditions PE, MI, ventricular hypertrophy, HF

BNP GREATER than 100pg/ml is suggestive of CONGESTIVE HF

66
Q

C-reactive protein
CRP

A

Produced by liver in response to systemic inflammation
*ppl with high crp levels may be at risk for CVD complications

67
Q

Homocysteine

A

an amino acid, linked to develop of atherosclerosis bc it can damage endothelial lining of arteries and promote thrombus formation

*Elevated blood level of homocysteine indicates high risk for CAD, stroke, peripheral vascular disease
*genetic factors, diet low in folate, vit b6, vitb12 are assoc with eleveled homo levels

68
Q

Hardwire cardiac monitoring

A

used to continuously observe heart for arrythmias using 1 or 2 leads

69
Q

Central venous pressure monitoring

A

measurement of pressure in vena cava or right atrium

70
Q

Pulmonary artery pressure monitoring

A

assessing left vent function, diagnosing etiology of shock, patients response to medical interventions

71
Q

Artherosclerosis

A

abnormal accumulation of lipid or fatty substances and fibrous tissue in lining of arterial blood vessels. These substances block and narrow coronary vessels which reduces blood flow to myocardium

*involves a reptitious inflam response

72
Q

What is the patho of atherosclerosis?

A

-Injury to vascular endothelium (smoking, HTN, etc)
-Inflam cells ingest lipids becoming FOAM CELLS that transport lipids into arteral wall creating fatty streaks
-Macrophages release chems that further damage arterial wall = oxidized LDL = more damage
-smooth muscle forms fibrous cap over a core filled with lipid called ATHEROMAS which protrude into lumen and narrow

a vulnerable plaque may rupture and cause thrombus

73
Q

What characterized metabolic syndrome

A

3 of 5 of the below
-Enlarged waist circumference
-Elevated triglycerides
-Reduced HDL
-Hypertension
-Elevated fasting glucose

74
Q

a fasting lipid profile should demonstrate the following values

A

LDL - less than 100mg/dl
Total cholestrol less than 200 mg/dl
HDL greater than 40 mg/dl
Triglycerides less than 150 mg/dl

75
Q

What are the medications given to lower lipids

A

Statins
Fibrates
Bile acid sequestrants
Cholesterol absoprtion inhibitor
PCSK9

76
Q

HMG-CoA Reductase inhibitors (Statins)
Therapeutic effects
Considerations

A

*inhibit enzyme involved with lipid synthesis
Decrease total cholesterol, LDL, TGs / increase DHL

Consideration - myalgia/arthralgia are common side effects/ contraindicated in liver disease

77
Q

FIBRIC ACIDS
Therapeutic effects
Considerations

A

Increase HDL/ decrease TGs, synthsis of TG

-COnsiderations - adverse diarrhea, flatuence, rash, myalgia/ pancreatitis, hepatotoxicity, rhabdomylysis/

contraindicated in severe kidney and liver disease

78
Q

BILE ACID SEQUESTRANTS
Therapeutic effects
Considerations

A

Decrease LDL, slight ^ HDL, cholestrol into bile acids

Side effects - constipation, ab pain, GI bleed
Take before meals

79
Q

CHOLESTEROL ABSORPTION INHIBITOR
Therapeutic effects
Considerations

A

Decrease LDL, inhibits absoprtion of cholestrol in sm, intestine

Side effects: ab pain, arthralgia, myalgia
Contraindicated in liver disease

80
Q

PCSK9
Therapeutic effects
Considerations

A

Promotes clearance of cholestrol, decrease LDL, MI & stroke, need for stent or CABG

ONly admin subq
Side effects - rhinitis, sore throat, flulike symptoms, muscle pain, diarrhea, redness, pain, brusing

81
Q

ANGIA PECTORIS
Patho
Symptoms
Management

A

Episodes of pain or pressure anterior chest
Patho - insufficient coronary blood flow caused by obstruction
Symptoms - poorly localized, may radiate. Tightness, SOB, pallor, dizzy, nausea, vomit
Management - Subsized with REST. Nitroglycerin, betablockers, Calcium ion antagoinsts, antiplatelet, anticoags

82
Q

Unstable angina

A

attacks that increase in freq and severity and are not relieved by rest and nitroglycerin

83
Q

Nitroglycerin

MOA

A

Vasodilator that improves blood flow to the heart muscle and relieves pain

Causes veinous pooling = less blood return to heart and filling pressure is reduced

Decreased BP and Decreased afterload

84
Q

Beta-adrenergic blockers
MOA

A

Blocks beta-adrenergic sympathic stimulation
Reduced HR, BP and contractilty
*helps control chest pain, delays onset of ischemia during work or excersice

Side effects: hypotension, bradycardia, acute heart failure, bronchoconstriction

Metroprolol & atenolol

85
Q

Calcium Channel blockers
MOA

A

Decrease SA and AV node conduction = slower HR and weaker contraction
Dilate smooth muscle wall of coronary arteries
*also prescribed for HTN

Amlodipine & diltiazem

86
Q

What are the antiplatelets meds?

A

Asprin
Clopidogrel
Prasugrel
Ticagrelor

87
Q

What does heparin do

A

Prevent formation of new blood clots

  • a decrease in platelet count may indicate heparin induced thrombocytopenia, an antibody mediated reaction to heparin that may result in thrombosis
88
Q

Acute Coronary syndrome (ACS)

A

an emergent situation by an onset of myocardial ischemia that results in myocardial death

Spectrum includes: unstable angine, NSTEMI, ST-segment elevation myocardial infarction

89
Q

Patho of ACS
In unstable angina?
In MI?

A

Unstable angina - reduced blood flow due to rupture of atherosclerotic plaque

In MI, plaque rupture and thrombus result in complete occulusion of artery

90
Q

Clinical manifestations of ACS

A

Chest pain that occurs suddenly and continues despite rest and medication

91
Q

The first ECG signs of an acute MI are usually seen in what waves?

A

T wave and ST segment
*appearance of abnormal Q wave is also an indication of MI

92
Q

What would indicate an old MI

A

abnormal Q wave without ST segment and T wave changes

93
Q

How are patients diagnosed with ACS
Unstable angina
STEMI
NSTEMI

A

Unstable - symptoms of coronary ischemia but ECG and BIOmarkers show no evidence
STEMI - ECG evidence of MI with evidence in 2 continous leads on 12 lead. Damange to myocardium
NSTEMI - Elevated biomarkers (troponin) but not ECG evidence

94
Q

Troponin

A

Protein found in myocardial cells, regulates myocardial contractil process

*reliable markers of myocardial injury

95
Q

Patient with suspected MI should immediately recieve what

A

Supplemental oxygen
aspirin
nitrogycerin
morphine

96
Q

Percutaneous coronary interventions

A

**Percutaneous transluminal coronary angioplasty **- balloon tipped cath to open blocked artery
**Coronary artery stent **- metal mesh

97
Q

Coronary artery bypass graft

A

surgery in which a blood vessel is grafted into a occluded coronary artery so that blood can flow beyond occulusion

for ppl who:
Angina cannot be controlled with meds
left main artery stenosis & mulivessel CAD
Prevent MI, arrhythmias, HF
complications from unsuccessful PCI

98
Q

Heart failure

A

Clincal syndrome resulting from cardiac disorders so that the heart is unable to pump enough blood to meet the bodies demands

99
Q

Systolic heart failure
Aka heart failure with reduced ejection fraction

A

results in decreased blood ejected from the ventricle
*sensed by baroreceptors which stims SNS to release epinephrine and NE = increased HR and contractility

Continued response = vasoconstriction of skin, GI, kidneys = decrease in renal perfusion = increased fluid volume overload = increased cardiac workload

100
Q

Diastolic heart failure
Heart failure with preserved ejection fraction

A

from increasing workload ^
heart compensates by increasing muscle and cells become dysfunctional and die, and the heart becomes fibrotic = a stiff ventricle resists filling and less blood = less Co2

*low CO leads to mechanisms which make heart work harder = vicious cycle

101
Q

Left sided heart failure

A

when left ventricle can not effectively pump blood out of ventricle into aorta and systemic circualtion

pulmonary venous blood volumn and pressure increase in lungs forcing fluid from capilaries into tissues and alveoli causing edema and impaired gas exchange

Dyspnea, cough, pulmonary crackles, and low oxygen, s3 may be detected, cough with secreations frothy pink or tan

102
Q

Right sided heart failure

A

when right vent fails the congestion peripheral tissues increases = increased JVD

**edema, hepatomegaly, ascites, weight gain

103
Q

Congestive heart failure

A

When R and L sides fail causing swelling in body, abdomen, gi, liver

104
Q

Pulmonary edema

A

Actue event, following an mI or chronic HF

When left side fails and blood backs up into pulmonary circulation

105
Q

Ejection fraction

A

measure of ventricular contractility; % of end diastolic blood volume that is ejected with each heartbeat
Normal is 55%-65%

106
Q

Heart failure with reduced ejection fraction

A

systolic heart failure
*left vent loses ability to contract effectively = less than 40% reflecting decreased CO and pump failure

107
Q

Heart failure wtih preserved ejection fraction
Diastolic heart failure

A

left vent function measures greater than 50% yet ventricle loses ability to relax

108
Q

Heart failure with midrange ejection fraction

A

Efs with 40-49%

109
Q

1.

What is Stage A heart failure
Patient characteristics
Treatment

A

-HTN, Atherolsclerotic disease, diabetes, metabolic syndrome

-Heart healthy lifestyle / risk factor control

110
Q

What is stage B heart failure
Patient characteristics
Treatment

A

-History of MI, Left vent hypertrophy, low ejection fraction

-Stage A treament plus ACE, beta or statin

111
Q

What is stage C heart failure
Patient characteristics
Treatment

A

-SOB, fatigue, decreased excersice tolerance

-A and B plus diuretics, aldosterone antagonist, sodium restriction, implantable defibrillator, cardiac resynchronization therapy

112
Q

What is Stage D heart failure
Patient characteristics
Treatment

A

-Symptoms despite max medical therapy, Recurrent hospitaliations

-A,B,C plus Fluid restriction, end of life care, inotropes, cardiac transplant, mechanical support

113
Q

DIURETICS
Therapeutic effects
Key considerations

Heart failure

A

Decrease fluid overload, decrease signs of HF

-observe for electrolyte imbalances, renal dysfunction, decreased bp. Carefully monitor I&O, daily weight.
**observe for increase K+ and decrease Na+

114
Q

Angiotensin system blockers
Therapeutic effects
Key considerations

Heart failure

A

Decrease BP, afterload, signs of HF

**observe for decrease bp, increase K, cough and worsening renal functions

115
Q

Beta-Adrenergic-blocking agents
Therapeutic effects
key considerations

Heart failure

A

Dilated blood vessels and decrease afterload, decrease signs of HF, improve excersice capacity

**observe for decreased HR, BP, dizziness, fatique

116
Q

IVABRADINE
Therapeutic effect
Key considerations

heart failure

A

Decreases rate of contraction through SA node

-Observe for decreased HR, BP, dizziness, fatigue

117
Q

Hydralazine-isosobidedinitrate
Therapeutic effect
Key considerations

HEart failure

A

Dilated blood vessels, decrease BP & afterload

-Observe for decrease in BP

118
Q

Digitalis
Therapeutic effect
Key considerations

heart failure

A

Improves cardiac contractility, decreases signs of HF

-observe for decrease HR and digitalis toxicity

119
Q

Dopamine
Dobutamine
Milrinone

Heart failure

A

Dopamine - vasopressor - increase BP and myocardial contractility
Dobutamine - stims beta 1 to increase contractility and renul perfusion
Milrinone - increased intracellular calcium increasing contractility

120
Q

Cardiogenic shock

A

When decreased CO leads to inadequate tissue perfusion and initiation of shock syndrome

121
Q

Thromboembolism

A

Intracardiac thrombi can form in pts with atrial fibrillation bc atria do not contract forcefully, resulting in slow flow increasing likelyhood of thrombus

122
Q

Pericardial effusion

A

accumulation of fluid in pericardial sac

*chest pain, tachypnea, dyspnea,
*pulsus paradoxus - systolic pressure lower during inhalation

123
Q

Pericardiotcentesis
Pericardiotomy

A

Pericardiotcentesis - puncture of pericardial sac to aspirate fluid
Pericardiotomy- portion of pericardium is excised to permit fluid to drain into lympatic system

124
Q

Cardiac arrest

A

Heart unable to pump and circulate blood to the bodys organs
*often caused by arrhythmia, progressive bradycardia or asystole

**conciousness, pulse, bp are lost, breathing ceases, respiratory gasping, pupils dilate in less than minute and seizures may occur. Pallor and cyanosis

125
Q

Pulseless electrical activity

A

electrical activity is present but cardiac contractions are ineffective

126
Q

Arteries carry blood to or from heart?

A

Thick walled vessels carry blood FROM the heart to Tissues

127
Q

Approx how much of total blood volume is in veins?

A

about 75%

128
Q

Flow rate =

A

Pressure difference /resistance

129
Q

Blood flow becomes turblant when

A

flow rate increases, blood vicosity increases, diameter of vessels increases, or segments of vessel are narrowed = this creates an abnormal sound called a bruit

130
Q

What are potent vasodilators

A

nitric oxide
prostacyclin
histamine
bradykinin
prostaglandin
certain muscle metabolites

131
Q

Heart failure with left ventricular ejection fraction causes accumulation of blood where?

A

in lungs and a reduction in cardiac output which results in inadequate flow to tissues

132
Q

Heart failure with preserved left ventricluar ejection fraction causes blood to go where

A

systemic venous congestion

133
Q

Signs of arterial insufficency
symptoms
ulcer signs

A

Relief with rest
Diminished or absent pulses
Cool skin, loss of hair, nails thickened, pallor of foot, dry shiny skin

Ulcer - Pressure points, painful, deep, circular, pale to black, minimal edema

134
Q

Signs of venous insufficiency
symptoms
ulcer signs

A

Aching, throbbing, cramping. Pulses present but difficult due to edema, Skin red. better with movement

Ulcer - SUperficial, irregular border, granulation tissue (beefy red to yellow), moderate to severed edema

135
Q

Intermittent claudication

A

muscular cramp-type pain, discomfort or fatigue in extremeities consistently reproduced with same degree of activity and relieved by rest in patients with peripheral arterial insufficiency

136
Q

Rubor

A

a reddish-blue discoloration of extremities 20 sec to 2 mins after extremity is places in dependent postiion.

*suggests severe peripheral arterial damage

137
Q

What does the ankle-brachial index measure?

A

ratio of systolic blood pressure in akle to systolic pressue in arm

138
Q

What does Computed tomography (CT) show

A

cross sectional images of soft tissue and visualized the area of volume changes to an extremity

139
Q

Arteriosclerosis

A

hardening of the arteries

140
Q

Atherosclerosis

A

affecting intima of large and medium sized arteries
*accumulation of lipids, calcium, blood components, carbohydrates, and fibrous tissue referred to as atheromas or plaques

141
Q

Fatty streaks are

A

yellow and smooth, protrude slightly into lumen of artery and composed of lipids and elongated smooth muscle cells

142
Q

Fibrous plaques are

A

composed of smooth muscle cells, collagen fibers, plasma componenets and lipids. White to yello and protrude, sometimes obstructing.

*found in abdominal aorta, coronary, popliteal and internal carotid arteries.

143
Q

Endovascular therapy

A

procedures that use a puncture or small incision to place catheters inside a blood vessel to repair or insert a device

144
Q

Symptoms of intermittent claudication

A

aching, cramping, fatigue, weakness that occurs with activity, relieved with rest

*sensation of coldness or numbness in extremeities, skin and nail changes, ulceration, gangrene, bruits, peripheral pulses diminishes

**Cilostazol - direct vasodilator that inhibits platelet aggregration

145
Q

Venous thromboembolism
cause

A

DVT and PE collectively
Virchow triad - endothelial damage, venous stasis, altered coagulation

146
Q

Venous stasis

A

occurs when blood flow is reduced; when veins are dilated and when skeletal muscle is reduced.

147
Q

Pulmonary embolism

A

obstruction of the pulmonary artery or one of its branches by a thrombus

*dislodged or fragment of DVT

148
Q

Chronic venous insufficiency/postthrombotic syndrome

A

obstruction of venous valves in the legs or a reflux of blood through valves

*edema, altered pigmentation, pain, stasis dermatitis, less symptoms in morning more in evening.

149
Q

Hyperbaric oxygenation

A

beneficial as adjunct treatment in pt siwth diabetes and no signs of wound healing after 30 days of standard treatment.

*chamber increases barometric pressue while patient is breahting 100% oxygen

150
Q

Negative pressure wound therapy

A

using vaccum assisted closure devices decreases time to healing in complex wounds that have not healed in 3 weeks

151
Q

Varicose veins

A

abnormally dilated, tortuous, superficial veins caused by incompetent venous valves

*dull aches, muscle cramps, increased fatgiue in lower extremities, edema, heaviness, nocturnal cramp

151
Q
A
152
Q

Difference between primary htn and secondary

A

Primary - no identifiable cause
Secondary - with underlying cause

153
Q

What is patho for HTN

A

result from increases in cardiac output and increases in peripheral resistance or both

-Increased SNS activity
-Increased renal reabsorption of sodium, chloride and water
-Increased activity of RAAS
-decreased vasodilation of arteries
-Resistance to insulin
-Immune system dysfuntion leading to inflammation

154
Q

What are clinical manifestations of HTN

A

Retinal changes
angia & mI
Changes in kidneys

155
Q

Resistant HTN

A

pt takes at least 3 antihypertensives from different classes including a diuretic and bp is still not controlled (not less than 130/80)

156
Q

What is a hypertensive emergency

A

severe BP elevation wiht new or worsening target organ damage

115 LEC (5 decks)

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