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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 + 2DBP) / 3

Anything less than 60 requires immediate intervention because tissues are not being adequately perfused.
Below 75 is concerning.

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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?
Extra Heart sounds are best heard with what part of the stethoscope?

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 because they are of lower pitch.

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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? What restriction should be put in place?

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
What might cause valve stenosis?
Rheumatic fever, calcification, congenital factors
21
How does mitral stenosis affect the rest of the heart?
Can precipitate atrial fib, cause decreased cardiac output, and can cause tachycardia that will decrease filling time
22
What are the classic s/s for heart failure?
--> Orthopnea --> Dyspnea --> Paroxysmal nocturnal dyspnea May also see fatigue, JVD, edema, crackles, S3 noises
23
How is HF diagnosed?
Echocardiogram, Doppler, 12 lead.
24
Which populations experience confusion, dizziness, or shortness for breath with MI? Which has vague symptoms and fatigue? Which are occasionally asymptomatic?
Older adults, women, diabetes
25
How long should you wait between nitro doses?
5 minutes.
26
What is the appropriate course of action for a pt with chest main?
--> put on monitor --> Oxygen --> Nitro (not w/o IV access) --> ASA --> Morphine/fent (after 3 shots of nitro, low dose opioid for pain)
27
What is Starling's Law?
Greater stretch of the ventricles means greater preload
28
What is preload? Afterload?
Preload: volume of blood in ventricle at end of diastole Afterload: The peripheral resistance against which the left ventricle must overcome to pump
29
What is an echo used to detect?
reduced EF in HF
30
Which elevated blood protein is a marker for coronary artery disease?
highly sensitive CRP --> Marker of inflammation
31
What is cardiac output?
Stroke volume x HR = amount of blood pumped from left vent per minute
32
What is the DASH diet?
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
What is homocysteine? How does it effect cardiovascular health?
A breakdown product of the aa methionine from dietary protein --> Contributes to atherosclerotic plaque development, modifiable risk factor in CAD, stroke, and embolism
34
How do calcium channel blockers help with CAD?
Decrease conduction through AV nodes, slows heart rate, decreased O2 demand.
35
How does morphine help with CAD?
Analgesic reduces anxiety, tachypnea, and relaxes bronchial SM to improve gas exchange
36
What is angina decubitus?
Angina that occurs when laying down
37
What are the two kinds of silent ischemia?
Nocturnal angina and angina decubitus.
38
What is mitral stenosis? What are some signs and symptoms?
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
Mitral stenosis can precipitate what?
Atrial fibrillation
40
What is aortic stenosis? What are some signs and symptoms?
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
What is mitral regurgitation? What are some signs and symptoms?
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
What is aortic regurgitation?
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
What lab results might indicate left sided heart failure?
hypoxemia and BNP >500 mg/mL
44
What are splinter hemorrhages and what might they indicate?
Small black streaks under the fingernails -->Indicate infective endocarditis (or just finger trauma)
45
What might a displaced apical pulse indicate?
Left vent dilation
46
When might you hear s3?
Mitral valve regurg or patient with left ventricular failure
47
What might S4 indicate?
CAD, left vent hypertrophy d/t aortic stenosis/regurg
48
What is the average pulse pressure? EF? CO? What should MAP be higher than?
PP: 40 mmHg (1/3 SBP) EF: 60% CO: 5L/min MAP: >60
49
If afterload increases what happens to arterial resistance and cardiac output? What about in inverse?
If afterload increases, AP increases with it and cardiac output decreases If afterload decreases, AP decreases with it and cardiac output increases.
50
What are some blood proteins that indicate cardiac damage?
CK-MB, Troponin, Myoglobin
51
What does elevated BNP indicate?
Peptide released from atria that causes natriuresis --> Indicates HF and differentiates between cardiac and respiratory dyspnea
52
What does elevated cholesterol and triglycerides predispose someone to?
Cholesterol (lipoprotein-associated phospholipidase A2) --> Risk factor for atherosclerosis Triglycerides --> Elevations associated with CDV diseases and diabetes
53
What are some non-invasive cardiac studies (7)? What are they used to detect?
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
What are the invasive cardiac diagnostic studies discussed in this class?
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
How long after MI will CKMB be elevated? Tropinin?
Troponins T and I - 4-6 hours CKMB - 6+ hours Making troponin a better indicator of recent MI.
56
What is Erb's point?
At the left sternal border, 3rd interspace.
57
What medications are used to manage primary hypertension?
Diuretics --> Furosemide, HCTZ Antihypertensives --> ACE inhibitors, C-channel blockers
58
What health promotion activities can be done to prevent HTN?
Individual patient evaluation, screening programs
59
What causes primary HTN?
SNS stimulation, overproduction of Na-retaining hormones, DM, alcohol, increased body weight.
60
Nutritional therapy for CAD involved keeping cholesterol consumption under what?
200 mg a day
61
What medications can help people with CAD?
Cholesterol inhibiting, antiplatelet, b-blockers, c-channel blockers, thrombolytics.
62
When should fluid restriction be put in place for HF?
If sodium is lower than 132 mmol/L
63
What is often the first manifestation of CAD?
unstable angina

MedSurg (14 decks)

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