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MedSurg > Lecture 4 - CDV > Flashcards

Lecture 4 - CDV Flashcards

1
Q

What happens during each waveform of the ECG?

A

P - Depolarization of atria

QRS Complex - Depolarization of Ventricles

T wave - Repolarization of Ventricles

U Wave (if present) - Repolarization of purkinje fibers, may be associated with hypokalemia

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2
Q

What is the formula for MAP? What would be a concerning mean arterial pressure?

A

[SBP + 2(DBP)] / 3

Anything less than 60 requires immediate intervention because tissues are not being adequately perfused.

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3
Q

What is the range for blood calcium? What does it do for the heart?

A

2.25-2.75 mmol/l

Controls force of contraction

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4
Q

What can decrease blood pressure?

A

PNS stimulation
–> Valsalva maneuver
–> Muscarinic receptors/vagal nerve

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5
Q

What are S1,2,3,4?

A

S1 - Closure of tricuspid and mitral
S2 - Closure of aortic and pulmonic valve
S3 - Ventricular vibration (mitral regurg)
S4 - Occurs w left vent hypertrophy or aortic stenosis

Extra sounds are best heard with the bell of stethoscope.

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6
Q

Why might a stress test with an echocardiogram be used?

A

To determine ejection fraction in HR, valve health, and chamber size.

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7
Q

What can an MRI be used to detect?

A

Aneurism

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8
Q

What is a CT scan used to test with CDV health?

A

Coronary artery disease

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9
Q

What does elevated creatinine kinase indicate? CKMB? Troponin?

A

CK indicates muscle damage - elevation seen within a few hours

Troponin I or T, CKMB indicates cardiac muscle damage - elevation seen within 6 hours

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10
Q

What might cause an increased troponin that is not related to heart health (false high)?

A

Kidney damage

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11
Q

What might cause an elevated C-reactive protein read?

A

Inflammation

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12
Q

What is hemodynamic monitoring?

A

Monitoring vitals and heart health more directly

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13
Q

Who is at risk for hypertension?

A

Age, women, Indigenous people

HTN is known as the silent killer.

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14
Q

What is isolated systolic hypertention?

A

Sustained elevated SBP w/o DBP elevation.

More common in older persons, related to loss of elasticity of large arteries

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15
Q

What might cause primary HTN?

A

–> Increased SNS activity
–> Increased sodium retaining hormones and vasoconstrictors, increased sodium intake
–> DM
–> Excessive alcohol
–> High weight

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16
Q

What clinical findings might indicate secondary hypertension?

A

–> Unprovoked hypokalemia
–> ABD bruit
–> Variable pressures with a history of tachy, sweating, and tremor
–> Family history of renal disease

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17
Q

What are some common symptoms of hypertension?

A

Headaches, blurred vision, fatigue

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18
Q

What diagnostic studies are used for HTN?

A

–> Urinalysis for protein
–> Blood work for K, Na, urea, creat
–> Fasting BGL, cholesterol & triglycerides
–> 12 lead ECG

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19
Q

What diet can be helpful to people with HTN?

A

Orange veg - K + Mg rich
Whole grains reduce cholesterol
>1500 Mg sodium daily

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19
Q

What is considered a hypertensive crisis? When does it occur?

A

Abrupt increase in DBP >120-130 mm HG

Occurs in patients with a history of HTN who have failed to adhere to their medication regiment or who have been undermedicated

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19
Q

Which artery is most commonly affected by coronary artery disease?

A

Left anterior descending

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19
Q

How can nutritional therapy help people with coronary artery disease?

A

Can reduce serum triglycerides by keeping cholesterol intake to under 200 mg/day. Can help person reach ideal body weight.

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19
Q

What kind of fats are best for people with cardiovascular disease?

A

monosaturated - fish oil, avocados, canola, peanut, and olive oil

Polysaturated - vegetable oils, margarine, seeds and nuts

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20
Q

What medical history should you be aware of in a person with valve disease?

A

Rheumatic fever

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20
Q

What might cause valve stenosis?

A

Rheumatic fever, calcification, congenital factors

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21
Q

How does mitral stenosis affect the rest of the heart?

A

Can precipitate atrial fib, cause decreased cardiac output, and can cause tachycardia that will decrease filling time

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22
Q

What are the classic s/s for heart failure?

A

–> Orthopnea
–> Dyspnea
–> Paroxysmal nocturnal dyspnea

May also see fatigue, JVD, edema, crackles, S3 noises

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23
Q

How is HF diagnosed?

A

Echocardiogram, Doppler, 12 lead.

24
Q

Which populations experience confusion, dizziness, or shortness for breath with MI? Which has vague symptoms and fatigue? Which are occasionally asymptomatic?

A

Older adults, women, diabetes

25
Q

How long should you wait between nitro doses?

A

5 minutes.

26
Q

What is the appropriate course of action for a pt with chest main?

A

–> put on monitor
–> Oxygen
–> Nitro (not w/o IV access)
–> ASA
–> Morphine/fent (after 3 shots of nitro, low dose opioid for pain)

27
Q

What is Starling’s Law?

A

Greater stretch of the ventricles means greater preload

28
Q

What is preload? Afterload?

A

Preload: volume of blood in ventricle at end of diastole

Afterload: The peripheral resistance against which the left ventricle must overcome to pump

29
Q

What is an echo used to detect?

A

reduced EF in HF

30
Q

Which elevated blood protein is a marker for coronary artery disease?

A

highly sensitive CRP
–> Marker of inflammation

31
Q

What is cardiac output?

A

Stroke volume x HR = amount of blood pumped from left vent per minute

32
Q

What is the DASH diet?

A

Dietary Approaches to Stop Hypertension
–> Fruits, veggies, low-fat dairy and soluble fiber (high K + Mg)
–> Whole grains, plant based protein that has less saturated fat and cholesterol

33
Q

What is homocysteine? How does it effect cardiovascular health?

A

A breakdown product of the aa methionine from dietary protein
–> Contributes to atherosclerotic plaque development, modifiable risk factor in CAD, stroke, and embolism

34
Q

How do calcium channel blockers help with CAD?

A

Decrease conduction through AV nodes, slows heart rate, decreased O2 demand.

35
Q

How does morphine help with CAD?

A

Analgesic reduces anxiety, tachypnea, and relaxes bronchial SM to improve gas exchange

36
Q

What is angina decubitus?

A

Angina that occurs when laying down

37
Q

What are the two kinds of silent ischemia?

A

Nocturnal angina and angina decubitus.

38
Q

What is mitral stenosis? What are some signs and symptoms?

A

When mitral valve narrows and limits blood flow from left atria to ventricle

S/S: pulmonary edema, dyspnea, hemoptysis, apical diastolic murmur, dry cough.

39
Q

Mitral stenosis can precipitate what?

A

Atrial fibrillation

40
Q

What is aortic stenosis? What are some signs and symptoms?

A

When aortic valve becomes stenotic, limiting blood flow between left ventricle and aorta.

S/S: Decreased cardiac output, lightheadedness or syncope, s4 murmur.

Fatal if untreated.

41
Q

What is mitral regurgitation? What are some signs and symptoms?

A

Mitral incompetency causes blood to flow back from left ventricle to the atrium. Can lead to left sided heart failure

S/S: S3 murmur

42
Q

What is aortic regurgitation?

A

Aortic insufficiency occurs when blood flows back from aorta to left ventricle. during diastole. Leads to left-vent hypertrophy to maintain stroke volume.

S/S: Hx of rheumatic fever, systolic murmur.

43
Q

What lab results might indicate left sided heart failure?

A

hypoxemia and BNP >500 mg/mL

44
Q

What are splinter hemorrhages and what might they indicate?

A

Small black streaks under the fingernails
–>Indicate infective endocarditis (or just finger trauma)

45
Q

What might a displaced apical pulse indicate?

A

Left vent dilation

46
Q

When might you hear s3?

A

Mitral valve regurg or patient with left ventricular failure

47
Q

What might S4 indicate?

A

CAD, left vent hypertrophy d/t aortic stenosis/regurg

48
Q

What is the average pulse pressure? EF? CO? What should MAP be higher than?

A

PP: 40 mmHg (1/3 SBP)
EF: 60%
CO: 5L/min
MAP: >60

49
Q

If afterload increases what happens to arterial resistance and cardiac output?

What about in inverse?

A

If afterload increases, AP increases with it and cardiac output decreases

If afterload decreases, AP decreases with it and cardiac output increases.

50
Q

What are some blood proteins that indicate cardiac damage?

A

CK-MB, Troponin, Myoglobin

51
Q

What does elevated BNP indicate?

A

Peptide released from atria that causes natriuresis –> Indicates HF and differentiates between cardiac and respiratory dyspnea

52
Q

What does elevated cholesterol and triglycerides predispose someone to?

A

Cholesterol (lipoprotein-associated phospholipidase A2)
–> Risk factor for atherosclerosis

Triglycerides
–> Elevations associated with CDV diseases and diabetes

53
Q

What are some non-invasive cardiac studies (7)? What are they used to detect?

A

Chest Radiograph
–> Displacement, anatomical changes, effusion and congestion

ECG
–> Conduction abnormalities

Stress Testing
–> Heart’s response to stress and increased o2 demand

Echo
–> EF, valves, chamber size

Nuclear cardiology
–> Perfusion imaging

MRI
–> Diagnosis of MI

Computed Tomography
–> CAD

54
Q

What are the invasive cardiac diagnostic studies discussed in this class?

A

Coronary Catheterization/Angiography
–> Tells us about perfusion, ventricle function, and valve issues

Electrophysiology Study
–> Node function

Intracoronary Ultrasound
–> 3d imaging, helps evaluate response to stent placement and complications

Blood Flow and Pressure Measurements
–> Hemodynamic monitoring
–> Peripheral vessel blood flow

55
Q

How long after MI will CKMB be elevated? Tropinin?

A

Troponins T and I - 4-6 hours
CKMB - 6+ hours

Making troponin a better indicator of recent MI.

56
Q

What is Erb’s point?

A

At the left sternal border, 3rd interspace.

57
Q

What medications are used to manage primary hypertension?

A

Diuretics
–> Furosemide, HCTZ

Antihypertensives
–> ACE inhibitors, C-channel blockers

58
Q

What health promotion activities can be done to prevent HTN?

A

Individual patient evaluation, screening programs

59
Q

What causes primary HTN?

A

SNS stimulation, overproduction of Na-retaining hormones, DM, alcohol, increased body weight.

60
Q

Nutritional therapy for CAD involved keeping cholesterol consumption under what?

A

200 mg a day

61
Q

What medications can help people with CAD?

A

Cholesterol inhibiting, antiplatelet, b-blockers, c-channel blockers, thrombolytics.

62
Q

When should fluid restriction be put in place for HF?

A

If sodium is lower than 132 mmol/L

63
Q

What is often the first manifestation of CAD?

A

unstable angina

MedSurg (13 decks)

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