exam 3 week 6 content Flashcards by Garrett Anderson

Mitral regurgitation vs Aortic stenosis

s/s
- Fatigue
- SOA
- NO chest pain

s/s
- Asymptomatic
- Syncope, light headed, chest pain!!!
- Pulmonary edema – crackles, rhonchi, cough, congestion – from blood back up

Mitral regurgitation
Blood is leaking back through the mitral valve into the left atrium (loose)
- Most common
s/s
- Fatigue
- SOA
- NO chest pain

Aortic stenosis
Blood is unable to flow freely from the left ventricle to the aorta (tight)
s/s
- Asymptomatic
- Syncope, light headed, chest pain!!!
- Pulmonary edema – crackles, rhonchi, cough, congestion – from blood back up

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_______________
Blood is unable to flow freely from the left ventricle to the aorta (too tight)

______________
Blood is leaking back through the mitral valve into the left atrium (too loose)
- Most common

Aortic stenosis
Blood is unable to flow freely from the left ventricle to the aorta

Mitral regurgitation
Blood is leaking back through the mitral valve into the left atrium
- Most common

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Infective endocarditis (IE) in IVDA
- Veins are portal of ______
- Staph aureus, Bacteria on ______ is most common cause of infection
- Bacteria travels from peripheral vein, to inferior vena cava, to _____ side of heart
- _______ valve (1st) most often affected in IVDA
- ______ _______ can enter pulmonary artery and lungs

Veins are portal of entry
Staph aureus, Bacteria on skin is most common cause of infection
Bacteria travels from peripheral vein, to inferior vena cava, to right side of heart
Tricuspid valve (1st) most often affected in IVDA
Septic emboli can enter pulmonary artery and lungs

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Symptoms for ______
- Angina!!!
- Maybe asymptomatic at first
- But eventually as coronary arteries continue to narrow, the decreased blood flow may cause
o chest pain and/or angina
o anxiety
o nausea
o cold sweat
o burning sensation
o dizziness
o heart burn
o irregular heart beat
o weakness
- “angina” could mean chest pain and/or all these symptoms
- If complete occlusion occurs = myocardial infarction

CAD

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PACs
P=
A=
C=

PVCs
P=
V=
C=

PACs
Premature atrial contractions

PVCs
Premature ventricular contractions

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Stable angina is a risk factor for developing
SATA
- CAD
- MI
- HF

CAD
MI
X- HF

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Disease the affects the myocardium (thick, muscular layer of the heart that contracts to pump blood throughout the body. It’s essentially the “working muscle” of the heart)
- leads to heart failure

Cardiomyopathy
Cardio – heart
Myo – muscle
Opathy – disease

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~Originates in AV node
~Rate = 150-250 BPM
No P wave – or abnormal looking P wave
QRS normal
-~ Begins and ends suddenly
LOW CO!!

PSVT
Paroxysmal – occasional = Begins and ends suddenly

Supra Ventricular – above the ventricle = Originates in AV node

Tachycardia – fast heart Rate = 150-250 BPM

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stable vs unstable angina?

Coronary blood flow is diminished but not blocked, pain is usually relieved with rest

more severe form of chest pain, not relived with rest

stable angina

unstable angina

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afib or aflutter is sawtooth appearance?

a flutter

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which deadly dysrhythmia is
Associated with
- MI
- CAD
- Significant electrolyte abnormalities
- Heart failure
- Drug toxicity

Ventricular tachycardia VTACH

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Atropine – anticholinergic

will this slow the HR or increase the HR?

beta-blockers:
Propranolol
Nadolol
Timolol
Metoprolol
Atenolol
Bisoprolol
Esmolol

will these slow the HR or increase the HR?

increase HR
indications: Symptomatic Sinus bradycardia

slow HR

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HErEF or HEpEF?

Left ventricle loses ability to generate pressure to eject blood from left ventricle effectively
Weakened muscle = cant generate SV = decreased CO
LV fails = blood backs up = fluid accumulation and backup
1st in pulmonary system
2nd in rest of body

HF with reduced ejection fraction
“HFrEF” or “systolic HF”
WEAK muscles
“pqRStuv”

HFpEF/diastolic HF = THICK muscles
“DP”

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PSVT
P=
S=
V=
T=

PSVT
Paroxysmal – occasional = Begins and ends suddenly

Supra Ventricular – above the ventricle = Originates in AV node

Tachycardia – fast heart Rate = 150-250 BPM

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Systolic vs diastolic HF
___________HF =
- Weakened LV heart muscle
- Less blood pumped out of LV

___________HF =
- Stiff heart muscle
- Less blood fills LV

Systolic HF =
- Weakened LV heart muscle
- Less blood pumped out of LV
“sis is weak”

Diastolic HF =
- Stiff heart muscle
- Less blood fills LV
“di hard”

Systolic heart failure involves a problem with the heart’s pumping ability, while diastolic heart failure involves a problem with the heart’s filling ability.

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HFrEF or HFpEF?

Caused by
- Impaired contractile function
- Increased afterload
- Cardiomyopathy
- Mechanical problems

Caused by
- HTN

HFrEF
Caused by
- Impaired contractile function
- Increased afterload
- Cardiomyopathy
- Mechanical problems

HFpEF
Caused by
- HTN
“lmn…p”

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patho PVD
1. atherosclerosis in ________
2. _________ of calf muscle
3. Reduced myofibers, impaired mitochondrial function, muscle damage and degeneration, impaired peripheral nerve function
4. Impaired _______ consumption, reduced leg strength
5. Pain and reduced mobility

patho PVD
1. LE atherosclerosis
2. Ischemia of calf muscle
3. Reduced myofibers, impaired mitochondrial function, muscle damage and degeneration, impaired peripheral nerve function
4. Impaired oxygen consumption, reduced leg strength
5. Pain and reduced mobility

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stable vs unstable angina?

angina pectoris - type of chest pain
not brought on by exertion/activity
may radiate
not relieved in 2-5 mins
not relived with rest
may occur with n/v, SOA, diaphoresis
risk of MI increases with angina pectoris

unstable angina

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HErEF or HEpEF?

Risk factors
- Female
- Older adult
- DM
- Obesity
- Alcohol use
- Potassium levels
- AF
- Lung disease
- Anemia

Risk factors
- Young
- Male
- CAD
- DM
- Valve disease
- CKD

HFpEF
Risk factors
“DP…OA, female”
- Female
- Older adult
- DM
- Obesity
- Alcohol use
- Potassium levels
- AF
- Lung disease
- Anemia

HFrEF
Risk factors
- Young
- Male
- CAD
- DM
- Valve disease
- CKD

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Risk factors for Coronary artery disease (CAD)/coronary heart disease

Modifiable
- HTN
- Smoking and nicotine
- DM
- Obesity – esp abdominal obesity (android)
- Inactivity
- Diet – high in ___, ___, ___, ___
o _______ diet is protective for CAD
- Hyperlipidemia!!!
o Drug - Statins treat
- Depression/stress – r/t systemic inflammation

Modifiable
- HTN
- Smoking and nicotine
- DM
- Obesity – esp abdominal obesity (android)
- Inactivity
- Diet – high in salt, carbs, fat and trans fat
o DASH diet is protective for CAD
- Hyperlipidemia!!!
o Drug - Statins treat
- Depression/stress – r/t systemic inflammation

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Risk factors PVD or angina?
- Smoking!!!
- DM
- High cholesterol
- Heart disease
- Stroke
- Older age

PVD

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Types of cardiomyopathy:

__________ cardiomyopathy
o Ischemic problem
o Valve disease
o Alcohol and drugs
o Post/peripartum heart failure issues
o Infection
o Associated with genetic link
o Leads to heart failure with decreased ejection fraction

__________ cardiomyopathy
o Big muscle
o r/t HTN
o deadly arrhythmias
o sudden cardiac death
o decreased ejection fraction

_________ cardiomyopathy (amyloid)
o Not common
o Ventricles are resistant to filling
o Muscle stops working
o Ventricle hardening, rigid, noncompliant
o Presents as right sided failure
o Leads to systemic congestion
o r/t amyloid disease

Restrictive , Hypertrophic , Dilated

Types
- Dilated cardiomyopathy
o Ischemic problem
o Valve disease
o Alcohol and drugs
o Post/peripartum heart failure issues
o Infection
o Associated with genetic link
o Leads to heart failure with decreased ejection fraction
- Hypertrophic cardiomyopathy
o Big muscle
o r/t HTN
o deadly arrhythmias
o sudden cardiac death
o decreased ejection fraction
- Restrictive cardiomyopathy (amyloid)
o Not common
o Ventricles are resistant to filling
o Muscle stops working
o Ventricle hardening, rigid, noncompliant
o Presents as right sided failure
o Leads to systemic congestion
o r/t amyloid disease

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Causes of PSVT or PACs
- re-entry phenomenon - cardiac impulse in one part of the heart continues to depolarize (let out its action potential) after the main impulse has finished
- over exertion
- emotional stress
- stimulants
- digitalis toxicity
- rheumatic heart disease
- CAD
- WPW syndrome – wolff Parkinson white
- Right sided heart failure – cor pulmonale

PSVT

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Infective endocarditis (IE)
This is a serious infection of the heart’s inner lining (endocardium), often caused by bacteria or fungi. It can lead to damage of the heart valves and other complications.
- Infection gets to _____
- Common valve this IE occurs on is the _________ valve (1st) b/c it’s the 1st valve that blood from the body reaches, so if an infection starts in your blood stream and travels to your heart, it would reach this valve first
- __________/infective masses grow on the valves
- If it breaks off it can travel to other places = _______ ________

Infective endocarditis (IE)
This is a serious infection of the heart’s inner lining (endocardium), often caused by bacteria or fungi. It can lead to damage of the heart valves and other complications.
- Infection gets to heart
- Common valve this IE occurs on is the tricuspid valve (1st) b/c it’s the 1st valve that blood from the body reaches, so if an infection starts in your blood stream and travels to your heart, it would reach this valve first
- Vegetation/infective masses grow on the valves
- If it breaks off it can travel to other places = septic emboli

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Normal Ejection Fraction = 55%-60%
________= EF 40%-49% (only slightly decreases)
________ = EF < 40%

PRESERVED… HFpEF = EF 40%-49% (only slightly decreases)

REDUCED… HFrEF = EF < 40%

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Eitology of _________
- Atherosclerosis – most common
- Thrombus
- Inflammation – thromboangitis obliterans is an arterial inflammatory condition
- Vasospasm – inappropriate vasoconstriction, raynaud’s disease or autoimmune disorders

PVD

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Enlargement and dilation of the left ventricle = Worsens HF

Ventricular remodeling in HF

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Deadly rhythm
Irregular wave forms of varying shapes and sizes
Ventricles are quivering
No effective contractions = no CO
Check pulse
No pulse = CPR

Ventricular fibrillation VFIB

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nursing considerations for angina
1. education
o decrease O2 demand on heart with ____ and _____
2. drug =
3. prevent/treat further _________ r/t hyperlipidemia, HTN, stop smoking
4. teach about MI
o if you rest and your pain doesn’t get better in about 5 mins = ______

nursing considerations
1. education
o decrease O2 demand on heart with rest and relaxation
2. nitrates
3. prevent/treat further atherosclerosis
o hyperlipidemia, HTN, stop smoking
4. teach about MI
o if you rest and your pain doesn’t get better in about 5 mins = call 911

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with ___________ the Myocardium is weakened =
Pump is insufficient to pump blood forward and can’t meet body’s demands =
Person is hospitalized

heart failure

The myocardium is the thick, muscular layer of the heart that contracts to pump blood throughout the body. It’s essentially the “working muscle” of the heart.

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Left vs right sided HF
Findings:
- JVD
- Dependent edema – lower extremities
- Weight gain
- Hepatosplenomegaly – enlarged spleen/liver

RIGHT HEART = BODY issues

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Cardiac conductivity – action potentials
1. SA node
Stimulates ______ to contract
2. P wave = atrial ___________
(think light switch turning on)
In atrial systole/Atrial squeeze
3. AV node
Stimulates ________ to contract
4. QRS complex = ventricular _________
In ventricle systole/ventricle squeeze
5. T wave = ventricular ___________
(think heart is ramping back up)
Ventricular are recharging/repolarizing
6. Flat line = isoelectric line

Cardiac conductivity – action potentials
1. SA node
Stimulates atria to contract
2. P wave = atrial depolarization
(think light switch turning on)
In atrial systole
Atrial squeeze
3. AV node
Stimulates ventricular to contract
4. QRS complex = ventricular depolarization
In ventricle systole
ventricle squeeze
5. T wave = ventricular repolarization
(think heart is ramping back up)
Ventricular are recharging/repolarizing
6. Flat line = isoelectric line

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Risk factors for _________
- Prosthetic valve
- Pacemaker
- IVDA - Intravenous Drug Abuse
(these high risk people would take a prophylactic abx before procedures, like dental procedures)

Infective endocarditis (IE)

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s/s of sinus brady or sinus tachy?

Lightheaded
Dizzy
Easily fatiguability
Syncope
Dyspnea
Chest pain
Confusion

sinus brady
all are r/t low CO and not getting enough O2 to tissues effectively

tachy - no s/s were listed

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Umbrella term describing several circulatory diseases affecting veins AND arteries

peripheral _________ disease is only affecting the arteries

venous disease, Venous walls and/or valves in the leg veins are not working, Venous stasis – blood pools in veins

PVD - Peripheral vascular disease

peripheral arterial disease (PAD)

Chronic venous insufficiency (CVI)

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Heart valves
1st – ________ valve
2nd – _______ valve
3rd – _______ valve
4th - _______ valve

Heart valves
1st – tricuspid valve
2nd – pulmonary valve
3rd – mitral valve
4th - aortic valve

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normal heart rhythm where the heart’s electrical impulses originate in the sinus node, a natural pacemaker located in the right atrium of the heart.
When the sinus node is functioning properly, it produces regular electrical signals that cause the heart to beat at a normal rate.

Sinus Rhythm

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PAD or CVI? arteries vs veins

Dull achy pain, tiredness in LE
LE edema!!!
Pulse present
Drainage
Sores with irregular border
Yellow slough or ruddy skin
Sores are located on ankles
Leathery looking skin
Stasis ulcers
Flaking or itching skin
New varicose veins

Chronic venous insufficiency (CVI)
s/s of venous disease

r/t inadequate return of venous unoxygenated blood from the LE to the heart
r/t Venous walls and/or valves in the leg veins are not working
r/t Venous stasis – blood pools in veins

an issue getting unoxygenated blood from LE back to heart

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Types of PVC
T/F
1. Bigeminy = every other contraction is PVC
2. Trigeminy = every 3rd contraction is PVC
4. Quadrigeminy = every 4th contraction is PVC
5. PVC can be positive or negative – above flat line or below flat line
6. 3 or more PVCs consecutively is not a concern

Bigeminy = every other contraction is PVC
Trigeminy = every 3rd contraction is PVC
Quadrigeminy = every 4th contraction is PVC
PVC can be positive or negative – above flat line or below flat line
X 6. 3 or more PVCs consecutively is VTACH = deadly rhythm!!! Requires immediate treatment

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Diagnosis of PAD or CVI/venous disease?
- Ankle brachial index (ABI) – compares BP in leg vs arm
- Normal = ankle pressure > brachial pressure
- Normal ratio > 1
- Severe = 0.5

PAD

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____ node stimulates P wave atrial contraction
___ node occurs after P wave
- Has action potential/electricity
- Tells the ventricles to stimulate QRS – ventricular depolarization
Bundle of His and purkinje fibers are responsible for those ___ contractions
- They tell the ________ to squeeze
- They occur in the ________ area

SA node stimulates P wave atrial contraction
AV node occurs after P wave
- Has action potential/electricity
- Tells the ventricles to stimulate QRS – ventricular depolarization
Bundle of His and purkinje fibers are responsible for those LV contractions
- They tell the ventricles to squeeze
- They occur in the ventricular area

Cause of ____
- Repeated ischemic episodes (ischemic cardiomyopathy) r/t unstable angina
- MI with/without papillary muscle rupture
- Chronic HTN
- COPD – right ventricular failure
- Dysrhythmias = decreased CO, decreased perfusion to coronary arteries = ischemia
- Valve disorders – mitral insufficiency, aortic stenosis
- Pulmonary embolus – RVF

HF is a pump/muscle problem

s/s
- Can see on CT scan
- Petechiae – tiny bruises, from blocked periphery, small capillaries
- Splinter hemorrhages – linear streaks in the nailbeds
- Janeway lesions – erythematous, nontender lesions on palms and soles
- Oslers nodes – SQ nodules in the pulp of the finger tips, from skin dying
- Roth spots – retinal hemorrhages with pale centers, from blocked eye vessels

Infective endocarditis (IE)
septic emboli

People with HF usually come to the hospital with c/o
1.
2.

SOA
FVE – edema, swollen

PVC vs VTACH?

PVC or VTACH?
- Bigeminy = every other contraction is a PVC
- Trigeminy = every 3rd contraction is a PVC
- Quadrigeminy = every 4th contraction is a PVC
* treat the cause, but not a deadly rhythm

PVC or VTACH
- 3 or more PVCs together
* this is a deadly rhythm and requires immediate attention

PVC

VTACH = LOW CO

HF results in
- __creases CO
- __creased Myocardial contractility
- __creased preload (volume of blood in the heart)
- __creased afterload (force opposing ejection of the blood from the ventricle )

Decreases CO
Decreased Myocardial contractility
Increased preload
Increased afterload

Chronic vs Acute HF

Progressive
Episodes of decompensated HF
o New of worsening signs
o Frequent visits to ER
o Hospitalization

chronic

sinus arrhythmia
Normal electrical conductivity of the heart
1. Changes to CO?
2. Rate = ___ - ____
3. Rhythm = not regular or regular?
4. P waves = tells how the atria are contracting
o Upright and round?
o One before every QRS?
o Regular rhythm?
5. PR interval (beginning of P wave to the tip of the R wave) = 0.12 – 0.20 sec ?
6. QRS lasts < 0.12 sec
o “is _______”

Normal electrical conductivity of the heart- No changes to CO
- Rate = 60-100 times per min
X - Rhythm = NOT regular (different amount of time between each repolarization and depolarization) this is the space between each R tip is the same
- P waves = tells how the atria are contracting
o Upright and round
o One before every QRS
X o NOT Regular rhythm
- PR interval (beginning of P wave to the tip of the R wave) = 0.12 – 0.20 sec
- QRS lasts < 0.12 sec
o “is narrow”

RIGHT sided HEART failure
Blood comes from – _____
Blood pumps to – ______
So with right sided heart failure = s/s blood backs up in ________ circulation
- Congestion in right chambers
- Right ventricle size ___crease
- Backflow into vena cava, __creased blood to the lungs
- Congestion in jugular veins, liver, lower extremities (body)
- Common cause – COPD or HTN?

RIGHT HEART = BODY
Blood comes from – body
Blood pumps to – heart
So with right sided heart failure = s/s blood backs up in systemic circulation
- Congestion in right chambers
- Right ventricle size increase
- Backflow into vena cava, decreased blood to the lungs
- Congestion in jugular veins, liver, lower extremities (body)
- Common cause – COPD

HTN = left sided HF

PAD or CVI? arteries vs veins

Pain
- calf, buttock
- Numbness
- Burning
- Heaviness
- Intermittent claudication – consistent pain with walking, stops when at rest
skin changes
- Shiny skin
- Thick toenails
- Loss of leg hair
- Diminished pulses
- Cyanosis or pallor when elevated
- Redness when LE hang down – reactive hyperemia or dependent rubor
- Wounds that won’t heal
- Round smooth sores
- Black eschar
- Sores are located on toes and feet
- Leg coolness
- Diminished sensation in LE
others:
- Erectile dysfunction
- No edema
- No drainage

PAD
r/t lack of circulation
r/t local tissue ischemia in the LE
r/t narrowing of arteries which pump oxygenated blood from the heart to the LE tissue

an oxygen issue
blood going from heart to LE

what is this?

Contractions coming from an ectopic focus in the ventricles
Irregular and unexpected
ABNORMAL Rhythm
NO P waves
No atrial contraction, ventricle only
QRS lasts LONGER than the normal 0.12 sec or less
o “is WIDE” and distorted in shape
o QRS comes early!!

PVCs
Premature ventricular contractions

QRS comes early!!

Risk factors for Coronary artery disease (CAD)/coronary heart disease

Non-modifiable
- Older adult
- Family hx/genetics – shared environmental exposure
- Gender = men vs women?
- Ethnicity ?

Risk factors
Non-modifiable
- Older adult
- Family hx/genetics – shared environmental exposure
- Gender
o Men – early
o Women – same risk after menopause, estrogen is cardioprotective
- Ethnicity – nonwhite and nonasian

Chronic progressive condition
heart muscle unable to pump enough blood to meet the body’s needs for blood and oxygen.
Heart can’t keep up work load
its a pump/muscle problem

Heart failure

which heart sound=
- Common in HF
- Abnormal and indicative of HF
- Low pitched sound heard after S2
- Hear it during rapid fill of the ventricle in the early part of diastole
- r/t high ventricular end-diastolic volume – fluid left in ventricle after it has contracted
- caused by increased pressure within ventricles

S3 gallop

serious heart rhythm disorder where the lower chambers of the heart (the ventricles) beat rapidly and irregularly.
- 3 or more PVCs together!!!
- Deadly rhythm
- Something is happening to set off Action potentials making the ventricle contract rapidly and repeatedly
- No atrial contractions occurring
- VERY low CO = heart damage
- Rate = 150-200 BPM!!!
- Rhythm = regular
- No P waves
- NOT MEASUREABLE PR interval

Ventricular tachycardia VTACH

Action potentials occur because
- ___, ___ and ATP creates the ___ ____ pump
- ___, ____ pump causes action potential to occur

Action potentials occur because
- Na, K, and ATP creates the Na, K pump
- Na, K pump causes action potential to occur

P waves
o Early
o Look different
PR interval = 0.12 – 0.20 sec
QRS lasts < 0.12 sec
o “is narrow”

everything is good except the P waves are abnormal. What is it?

treatment :
If occasional = ___________
If frequent = high risk for other dysrhythmias like _____
- Check _________
- consider _________
- Provide safe environment

PACs
Premature atrial contractions

If occasional = no consequences
If frequent = high risk for other dysrhythmias like A fib
- Check electrolytes
- consider Hypoxia? May need O2
- Provide safe environment

Sinus arrhythmias vs dysrhythmias

_______________ are not regular rhythm and DO NOT affect CO.

Normal HR + abnormal rhythm = normal CO

_____________ are not regular rhythm and DO affect CO.

Abnormal HR + abnormal rhythm = abnormal CO

which is worse Sinus arrhythmias vs dysrhythmias?

Sinus arrhythmias are not regular rhythm and do not affect CO.
Normal HR + abnormal rhythm = normal CO

dysrhythmias are not regular rhythm and do affect CO.
Abnormal HR + abnormal rhythm = abnormal CO

worse = dysrhythmias

Left vs right sided HF
Findings:
- Cough, crackles, wheezes
- Pulmonary edema – frothy sputum, blood tinged
- Paroxysmal nocturnal dyspnea (PND) – feel smothered at night
- Orthopnea – tripod to breathe best

LEFT HEART = LUNGS issues

sinus brady
T/F
1. Some people like athletes live with low HR and that is they’re normal
2. Must find out if they’re symptomatic
3. Non Symptomatic = issue, requires treatment
4. Symptomatic = no issue, no treatment

Some people like athletes live with low HR and that is they’re normal
Must find out if they’re symptomatic
X- Symptomatic = issue, requires treatment
X- Non symptomatic = no issue, no treatment

2 deadly rhythms: VFIB vs VTACH

________
- 3 or more PVCs together!!!
- Deadly rhythm
- Something is happening to set off Action potentials making the ventricle contract rapidly and repeatedly
- No atrial contractions occurring
- VERY low CO = heart damage
- Rate = 150-200 BPM!!!
- Rhythm = regular
- No P waves
- NOT MEASUREABLE PR interval

_________
- Deadly rhythm
- Irregular wave forms of varying shapes and sizes
- Ventricles are quivering
- No effective contractions = no CO

VTACH

VFIB

Septic emboli
Infected masses that break off heart and travels through body
1. Microorganisms traveling in blood stick to damaged _________ tissue in the heart
2. Vegetation/infected mass occurs on ________
3. Pieces can _______ (embolize)
4. Pieces get carried through body via _________ (septic emboli) and can initiate infection of ischemia in remote places

Septic emboli
Infected masses that break off and travel through body
1. Microorganisms traveling in blood stick to damaged endothelial tissue in the heart
2. Vegetation/infected mass occurs on valve
3. Pieces can break off (embolize)
4. Pieces get carried through blood stream (septic emboli) and can initiate infection of ischemia in remote places

Atrial flutter vs A fib?

________________
Multiple irritable spots in the atria
- Irregularly irregular – both atrial and ventricular
- Originates in AV node
- Heart Rate = 100-175 BPM
- No identifiable P waves
- Instead there are just waves before every QRS

__________________
- Originates in AV node
- Atrial Rate = >250 BPM
- Atrium Rhythm regular
- P waves = Sawtooth appearance
- QRS lasts < 0.12 sec
o “is narrow”
- QRS wave ventricular rate is slower
- Reentry impulse that is repetitive and cyclic
- May be 2:1, 3:1, or 4:1
o 2, 3, or 4 p waves before every QRS

A fib

A flutter

sinus brady vs sinus tachy?

Causes of sinus ______
- Hyperkalemia – slows depolarization
- Vagal response – when vagal nerve is stimulated
- Digoxin toxicity
- Medications - Amiodarone, beta blockers, calcium channel blockers
- MI - Ischemia in/around SA node = wont work right
- Late hypoxia sign

Causes of sinus ________
- Catecholamines released by exercise, pain, strong emotions = increase HR
- Fever = increased metabolic rate = increased HR
- FVD
- Medications – epinephrine, albuterol, beta agonists
- Substances – caffeine, nicotine, cocaine
- Hypoxia – early sign

Causes of sinus brady
- Hyperkalemia – slows depolarization
- Vagal response – when vagal nerve is stimulated
- Digoxin toxicity
- Late hypoxia sign
- Medications - Amiodarone, beta blockers, calcium channel blockers
- MI - Ischemia in/around SA node = wont work right

Causes of sinus tachy
- Catecholamines released by exercise, pain, strong emotions = increase HR
- Fever = increased metabolic rate = increased HR
- FVD
- Medications – epinephrine, albuterol, beta agonists
- Substances – caffeine, nicotine, cocaine
- Hypoxia – early sign

sinus rhythm
Normal electrical conductivity of the heart
1. HR Rate = ____ - ____
2. Rhythm = _______
3. P waves = tells how the atria are contracting
o Upright and_____
o One before every _____
o Regular rhythm
4. PR interval (beginning of P wave to the tip of the R wave) = 0.12 – 0.20 sec
5. QRS lasts < 0.12 sec
o “is ________”

Normal electrical conductivity of the heart
- Rate = 60-100 times per min
- Rhythm = regular (same amount of time between each repolarization and depolarization) this is the space between each R tip is the same
- P waves = tells how the atria are contracting
o Upright and round
o One before every QRS
o Regular rhythm
- PR interval (beginning of P wave to the tip of the R wave) = 0.12 – 0.20 sec
- QRS lasts < 0.12 sec
o “is narrow”

Left vs right sided HF

LEFT HEART = _______ issues

RIGHT HEART = ______ issues

LEFT HEART = LUNGS issues

RIGHT HEART = BODY issues

5 P’s of PAD

Pain = intermittent claudication
Pulselessness = weak or no pulse
Palpable coolness = pale, blue, cool
Paresthesia = numbness or tingling
Paresis = muscle weakness

When chest pain occurs…
It is important to

1st = exclude _______
2nd = explore _________

exclude the heart as the cause of chest pain – first

explore non-cardiac causes – second

stable vs unstable angina?

O2 supply/demand imbalance
Occurs – episodic, intermittent
Brought on by – exertion, activity
Relieved with – rest
Lasts – 2-5 mins
Causes – most common is atherosclerosis of coronary arteries
Maybe mistaken for indigestion
Treatment – rest, meds like nitrate

stable angina

abnormalities that happen to what part of heart
- Wear and tear
- Calcification/calcium deposits
- Pannus/ring around valve
- Endocarditis – inflammation
- Thrombus – clot formation

heart valves

HF with __________ ejection fraction
“systolic HF”
Left ventricle loses ability to generate pressure to eject blood from left ventricle effectively

HF with __________ Ejection Fraction
“diastolic HF”
Inability of the ventricles to relax and fill during diastole

HF with reduced ejection fraction
“HFrEF”

HF with Preserved Ejection Fraction
“HFpEF”

CO = SV x HR

HR
- __ - ___= best CO
- Less or more isn’t good for CO

60-100

Ischemic heart disease Cause –
1. _________ develops in the arteries supplying the myocardium = artery blocked
2. ___creased tissue perfusion
3. ___________ dysfunction
4. heart must now work harder to pump blood

Cause –
1. atherosclerosis develops in the arteries supplying the myocardium = artery blocked
2. decreased tissue perfusion
3. endothelial dysfunction
4. heart must now work harder to pump blood

serious heart rhythm disorder where the lower chambers of the heart (the ventricles) quiver chaotically instead of beating normally. This prevents the heart from pumping blood effectively, leading to a loss of consciousness and death within minutes if not treated immediately.

Ventricular fibrillation VFIB

HErEF or HEpEF?

LV is stiff and non-compliant = high filling pressure = decreased SV = decreased CO = fluid congestion

HF with Preserved Ejection Fraction
“HFpEF” or “diastolic HF”

VTACH Requires immediate treatment

If patient is in VTACH: With Pulse
- Maybe antidysrhythmic meds (RR control: A,A,A,D), and/or beta blockers, and/or CCB
- Electrolyte replacement
- All pulse VTACH people will eventually turn into pulseless VTACH people if untreated b/c your heart cant sustain this rhythm for very long
- Sustained VTACH – ongoing for more than 10-15 secs

If patient is in VTACH: Without pulse
- ACLS – Advanced Cardiac Life Support
- _______

Maybe antidysrhythmic meds (RR control: A,A,A,D), and/or beta blockers, and/or CCB
With Pulse
- Maybe antidysrhythmic meds – beta blockers or CCB
- Electrolyte replacement
- All pulse VTACH people will eventually turn into pulseless VTACH people if untreated b/c your heart cant sustain this rhythm for very long
- Sustained VTACH – ongoing for more than 10-15 secs

Without pulse
- ACLS – Advanced Cardiac Life Support
- CPR

treatment of PVD
1. Reduce contributing factors
- smoking
- physical activity
- Weight
- Stress
- DM
- HTN
2. Intervention aimed at the occlusion
- Bypass
- Balloon stent or other Stent
3. pharm
- Antiplatelet agents =
- Anticoagulants =
- Thrombolytics
- Lipid lowering agents =
- Agents that increase blood supply to LE =

Antiplatelet agents – Aspirin, clopidogrel, ticagrelor
Anticoagulants - warfarin, heparin
Thrombolytics
Lipid lowering agents - statins
Agents that increase blood supply to LE – cilostazol and pentoxifylline

Aortic stenosis
Blood is unable to flow freely from the ______ ventricle to the _____

Mitral regurgitation
Blood is leaking back through the ______ valve into the ____ atrium
- Most common

Aortic stenosis
Blood is unable to flow freely from the left ventricle to the aorta

Mitral regurgitation
Blood is leaking back through the mitral valve into the left atrium
- Most common

__________ heart failure involves a problem with the heart’s pumping ability

_______ heart failure involves a problem with the heart’s filling ability.

diastolic vs systolic HF?

Systolic heart failure involves a problem with the heart’s pumping ability

diastolic heart failure involves a problem with the heart’s filling ability.

chest pain cardiac VS non-cardiac

s/s _________
- Pressure or tightness
- Diffuse – not localized
- r/t activity or exertion
- relieved with rest within mins
- prolonged symptoms = maybe MI

s/s ____________
- sharp or stabbing
- focal – localized
- occurs at rest
- not r/t exertion or activity
- lasts seconds to days

chest pain cardiac s/s
- Pressure or tightness
- Diffuse – not localized
- r/t activity or exertion
- relieved with rest within mins
- prolonged symptoms = maybe MI

chest pain non-cardiac s/s
- sharp or stabbing
- focal – localized
- occurs at rest
- not r/t exertion or activity
- lasts seconds to days

patho Ventricular remodeling in HF

Weakened heart muscle =
Secretion of molecular substances (which are supposed to be helpful, but aren’t) =
o Angiotensin II
o Aldosterone
o Endothelin
o TNF alpha
o Catecholamines
o Insulin like growth factor
o Growth hormones
Provoke genetic changes, apoptosis and hypertrophy of cardiac myocytes, collagen deposits and myocardial fibrosis =
Enlargement and dilation of the left ventricle =
Worsens HF

Ventricular remodeling in HF

Enlargement and dilation of the left ventricle = Worsens HF

cilostazol and pentoxifylline

in general do what?

treat what?

Agents that increase blood supply to LE

Treatment for PVD and intermittent claudication (pain while walking from PVD)

3 main problems that cause dysrhythmias
1. ____________ – a cell initiates action potential or electrical impulse when it’s not supposed to
2. ______________ – an extra impulse is generated during or just after repolarization/recharging. Cells get confused and contract when they’re not supposed to
3. __________ – cardiac impulse in one part of the heart continues to depolarize (let out its action potential) after the main impulse has finished

Triggered activity
Inappropriate automaticity
Re-entry

3 main problems that cause dysrhythmias
1. Inappropriate automaticity – a cell initiates action potential or electrical impulse when it’s not supposed to
2. Triggered activity – an extra impulse is generated during or just after repolarization/recharging. Cells get confused and contract when they’re not supposed to
3. Re-entry – cardiac impulse in one part of the heart continues to depolarize (let out its action potential) after the main impulse has finished

T/F

Heart valve disease causes
1. Genetics?
2. Childhood diseases?

the papillary muscles are attached to heart valves
right side of heart has more pressure and works harder
valves abnormalities may cause Stenosis – very tight and heard for the blood to get through
valves abnormalities may cause Regurgitation – very loose and the blood flows backward with increased pressure

Heart valve disease causes
1. Genetics?
2. Childhood diseases?

the papillary muscles are attached to heart valves

X 4. LEFT side of heart has more pressure and works harder

valves abnormalities may cause Stenosis – very tight and heard for the blood to get through
valves abnormalities may cause Regurgitation – very loose and the blood flows backward with increased pressure

endothelium - the inner lining of blood vessels

endothelial dysfunction -
are vessels blocked or
do they narrow when they are supposed to dilate?

cause – DM, HTN, HPL, smoking

vessels aren’t blocked, they narrow when they are supposed to dilate

causes of cardiomyopathy
- idiopathic
- ischemia
- HTN
- Inherited disorder
- Infections
- Toxins
- Myocarditis
- Autoimmune condition

heart muscle disease leads to HF

Causes of PVCs
- Stimulants
- Electrolytes!!!
- Hypoxia
- Fever
- Exercise
- Emotional stress
- CVD

treatment =

PVCs
Premature ventricular contractions =
- No atrial contraction, ventricle only
- Irregular and unexpected ventricle contractions

Treat the cause

Patho with HF
- volume overload = heart not pumping effectively with each beat = fluid _________
- Impaired ventricular filling = heart doesn’t _________
- Diastole or systole is when filling occurs?
- Weakened ventricular muscle
- Decreased ventricular contractility = doesn’t ________
- Occurs with systole or diastole - squeeze, heart contraction?

Patho with HF
- Volume overload = heart not pumping effectively with each beat = fluid back up in lungs or body
- Impaired ventricular filling = heart doesn’t fill up well
o Diastole is when filling occurs
- Weakened ventricular muscle
- Decreased ventricular contractility = doesn’t pump effectively
o Occurs with squeeze, systole, heart contraction

atypical angina in women
women present differently
- pain location ___
- hot or cold?
- tenderness?
- indigestion?
- heart burn?
- nausea?
- fatigue/weakness?
- lightheadedness?
- dyspnea?

atypical angina in women
women present differently
- pain location not always in chest
- hot or burning
- tenderness
- indigestion
- heart burn
- nausea
- fatigue/weakness
- lightheadedness
- dyspnea

common type of heart rhythm irregularity where the heart rate speeds up and slows down naturally.

This variation is often considered normal electrical conductivity of the heart , especially in young people and athletes

HR fluctuates with respiration or autonomic nervous system

No changes to CO

originates from the SA node

Sinus arrhythmia

CO __creases with HF
CO = SV x HR

CO decreases with HF
CO = SV x HR

Coronary artery disease (CAD)/coronary heart disease
- __________ of the coronary (heart) arteries is the foundation for CAD
- Coronary arteries branch from the ______
- Arteries become ______ from atherosclerosis
- Left anterior descending artery is the most problematic bc it feeds left ventricle of heart which supplies ________

Coronary artery disease (CAD)/coronary heart disease
- Atherosclerosis of the coronary (heart) arteries is the foundation for CAD
- Coronary arteries branch from the aorta
- Arteries become clogged from atherosclerosis
- Left anterior descending artery is the most problematic bc it feeds left ventricle of heart which supplies blood to body

CO = SV x HR

SV
- Preload – volume of blood in the heart
o issue r/t _________
- Myocardial contractility – contractile capabilities of the heart
o Issues r/t _________
- Afterload – force opposing ejection of the blood from the ventricle
o issue r/t__________

Preload – volume of blood in the heart
o issue r/t fluid volume
Myocardial contractility – contractile capabilities of the heart
o Issues r/t pump/muscles
Afterload – force opposing ejection of the blood from the ventricle
o issue r/t BP of heart

This is a serious infection of the heart’s inner lining (endocardium), often caused by bacteria or fungi. It can lead to damage of the heart valves and other complications.

Infective endocarditis (IE)

treatment for sinus brady vs tachy?

Treatment of symptomatic sinus ______
- Atropine – anticholinergic
- If drug is not effective – pacemaker

Treatment for sinus _______
is more Based on cause
- Hypovolemia/FVD = fluids
- Fever = antipyretics
- Pain = analgesic
- Cardiac disease state = beta blockers

Treatment of symptomatic sinus brady
- Atropine – anticholinergic = INCREASES HR
- If drug is not effective – pacemaker

Treatment
Based on cause
- Hypovolemia/FVD = fluids
- Fever = antipyretics
- Pain = analgesic
- Cardiac disease state = beta blockers to LOWERS HR and myocardial O2 consumption

____________ – blood pumped out with each squeeze

Ejection fraction – blood pumped out with each squeeze

s/s
- Fever
- Chills
- Anorexia
- Weight loss
- Myalgias – pain in muscle
- Arthralgias – joint pain
- Heart murmur
- Ischemia or infarction of the extremities, spleen, kidney, bowel or brain
- Neurologic issues, meningitis, seizures, encephalopathy, brain abscesses – if septic emboli lodge in cerebral artery causing ischemic stroke

Infective endocarditis (IE)

Risk factors for HF
- HTN!!!
- DM
- MI
- Men - early
- Women - after menopause
- Black
- Family hx and Genetics 100% link
- Older age
- Ischemic heart disease
- Obesity
- Smoking
- Sedentary lifestyle
- COPD
- Severe anemia = decreased perfusion
- Congenital heart defects
- Viruses – may cause myocarditis which weakens heart muscles r/t inflammation
- Alcohol/drug abuse – cocaine, crack
- Kidney conditions – excess blood volume, edema, HTN, accumulation of nitrogenous waste = weaken the heart

HF is a pump/muscle problem

s/s of PSVT
- Palpitations
- Chest pain
- Fatigue
- Lightheaded or dizzy
- Dyspnea

all r/t _______ heart and ____ CO

all r/t tired heart and low CO

Purpose of cardiac muscle cells
1. ___________ - ability to generate electrical impulse (Starts)
2. ___________ – ability to respond to an outside impulse; chemical, mechanical, electrical (responds)
3. ___________ – ability to receive and conduct an electrical impulse (receives)
4. ___________ – ability of myocardial cells to shorten in response to an impulse (pumps/squeezes)

Conductivity
Automaticity
Contractility
Excitability

Purpose of cardiac muscle cells
1. Automaticity - ability to generate electrical impulse (Starts)
2. Excitability – ability to respond to an outside impulse; chemical, mechanical, electrical (responds)
3. Conductivity – ability to receive and conduct an electrical impulse (receives)
4. Contractility – ability of myocardial cells to shorten in response to an impulse (pumps/squeezes)

cardiac cells must be able to:
electrical pulse - start, respond (outside impulse), conduct/receive (inside impulse), react/squeeze/pump

LEFT sided HEART failure
Blood comes from – ____
Blood pumps to – ______

So with left sided heart failure = s/s blood backs up in _____________ circulation
- Congestion in left chambers
- Left ventricle size __crease
- Backflow into pulmonary veins
- Congestion in _____
- Common cause – HTN or COPD?

Blood comes from – lungs
Blood pumps to – body
So with left sided heart failure = s/s blood backs up in pulmonary circulation
- Congestion in left chambers
- Left ventricle size increase
- Backflow into pulmonary veins
- Congestion in lungs
- Common cause – HTN

COPD = right sided

Originates in SA node
Rate = < 60 BPM
Rhythm = regular
P waves = tells how the atria are contracting
o Upright and round
o One before every QRS
o Regular rhythm
PR interval (beginning of P wave to the tip of the R wave) = 0.12 – 0.20 sec
QRS lasts < 0.12 sec
o “is narrow”

everything is normal except
- Rate = < 60 BPM

Sinus bradycardia

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