Oxygenation Flashcards by Andrew Vigorito

What is Angina?

A clinical manifestation of reversible myocardial ischemia

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What causes Chronic Stable Angina?

Coronary Artery Disease

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What is the term for when heart muscle demands more oxygen than it is supplied?

Ischemia

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In ischemic conditions, how long will cardiac cells last?

20 minutes

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At what percentage do blocked arteries generally begin causing pain?

75% blockage

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How long must a coronary occlusion last before the myocardium becomes hypoxic?

10 seconds

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If an occlusion lasts longer than 10 seconds, what happens?

Anaerobic metabolism begins, which build lactic acid

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Why does anaerobic metabolism cause pain?

Lactic acid irritates the myocardial nerve

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Why does the pain “radiate” to the shoulders or arms?

Because the myocardial nerve trasmits a pain message to the cardiac nerves and the upper thoracic nerves

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What does the PQRST chest pain assessment stand for?

P = precipitating events
Q = quality of pain
R = radiation of pain
S = severity of pain
T = timing

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Pain from chronic stable angina is usually NOT characterized how?

Sharp or stabbing

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What would an EKG show in the event of an event of angina?

ST depression or T wave inversion

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Patients with what disease are most like to have silent ischemia?

Diabetes

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What is chest pain at night called?

Nocturnal angina

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What is chest pain when lying down called?

Decubitus angina

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What is Prinzmetal’s Angina?

Angina at rest due to coronary artery spasm

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What is the primary treatment of Prinzmetal’s angina?

Calcium channel blockers

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What is microvascular angina?

Angina from myocardial ischemia due to abnormalities or blockages of the coronary microcirculation

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Who does microvascular angina primarily affect?

Women

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What is the “first line of therapy” for treatment of angina?

Short-acting nitrates

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What should a patient on short acting nitrates be told?

it causes a headache
protect the bottle from light
replace bottle every 6 months

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What is ABC major treatment of Chronic Stable Angina?

A = Anticoagulant, Antianginal, ACE inhibitors and angiotensin receptor blockers.
B = Beta-blockers and blood pressure meds.
C = Cigarette-cessation, Calcium channel blockers and cholesterol management.
D = Diet and diabetes control.
E = Education and exercise
F = Flu vaccine

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What class of drugs all end with “lol”?

Beta-blockers

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People with what pre-existing condition should not take Beta-blockers?

Asthma

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What is the mechanism of action of ACE inhibitors?

They prevent angiotensin I from converting to angiotensin II

What is the mechanism of action of a calcium channel blocker?

They prevent calcium from entering smooth muscle, causing smooth muscle relaxation and vasodilation of the coronary arteries (which improves blood flow)

What are common Calcium channel blockers?

Norvasc, Cardizem, Plendil, Procardia and Calan

What is the effect of Digoxin?

Reduced HR and increased contractility

What is a "sodium current inhibitor"?

Given to pt's who do not respond to other therapies; inhibits Na+ current

What caution should be taken with a Sodium channel blocker?

Do not give with drugs which prolong the QT interval

What symptoms are classic of infective endocarditis?

Osler nodes, Janeway lesions, splinter hemmorhages and Roth's spots

What is a "Osler node"?

Painful, pea-sized, red or purple lesions on the fingertips and/or toes

What is a "Janeway lesion"?

Flat, painless, small red spot on the palms and soles of the feet

What is the "hallmark sign" of acute pericarditis?

Pericardial friction rub

What is the most common etiological agent of Myocarditis?

Coxsackie A and B virus

Arthralgia and sucutaneous nodules are indicative of what disease?

Rheumatic fever

What is mitral valve regurgitation?

mitral valve regurgitation is when your heart's mitral valve doesn't close tightly, allowing blood to flow backward in your heart.

What are the systemic effects of mitral valve regurgitation?

blood can't move through your heart or to the rest of your body as efficiently, making you feel tired or out of breath.

What additional hearts sounds does mitral valve regurg cause?

A loud holosystolic murmur at the apex of the heart radiating to the left axilla, and an audible S3

What is mitral valve stenosis?

The valve opening narrows, preventing adequate blood flow from the left atrium to the left ventricle

What is mitral valve prolapse?

The valve leaflets bulge up (prolapse) into the left atrium on systole; it may progress to mitral regurgitation

What is aortic stenosis?

The aortic valve stiffens and narrows, obstructing the outflow of blood from the left ventricle on systole

What is aortic regurgitation?

Regurgitation of blood from the aorta back into the left ventricle in diastole

What body position relieves pain in a patient with Myocarditis?

Sitting up

Which manifestation should the nurse expect when taking the health history of a patient with aortic stenosis?

Angina

What are clinical manifestations of chronic mitral valve regurgitation?

Fatigue, dyspnea, and weakness

The names of medications in what drug class all end in "pril"?

ACE inhibitors

What are "Aschoff's bodies"?

Nodules formed in response to inflammation from Rheumatic Fever; it forms scar tissue and thickens the layers of the heart (ultimately can cause HF)

What are the clinical findings of Rhematic fever?

- arthritis - Sydenham's chorea (CNS; sudden, jerky movements) - Erythema marginatum - Subcutaneous nodules

Cardiac symptoms 7-10 days after a viral illness indicates what condition?

Myocarditis

Fever, fatigue, myalgias, pharyngitis, dyspnea, lymphadnopathy, nausea and vomiting all reflect what in relation to myocarditis?

They are early signs/symptoms

What are the late signs and symptoms of myocarditis?

Heart Failure, development of an S3 (ventricular gallop) heart sound, crackles, JVD, syncope, peripheral edema and angina.

What drug would the nurse anticipate to give a patient with myocarditis?

- Diuretics - Beta blockers - Anticoagulants - Angiotensin-converting enzyme (ACE) inhibitors

What is the most common cardiac valve disorder?

Mitral valve prolapse

What is the most common cause of aortic valve stenosis?

Age; it is an age-related degenerative change

What actually causes the stenosis of the aortic valve?

Calcium deposits narrow the opening of the valve

A "water-hammer" pulse may be seen in what condition?

Aortic valve regurgitation

What are the two primary causes of tricuspid stenosis?

Rheumatic stenosis and IV drug users

What is the primary cause of pulmonic stenosis?

Generally it is congenital

What are the treatments indicated for heart failure?

Vasodilators, inotropes, beta blockers, ACE inhibitors, diuretics and a low sodium diet

What are the three types of cardiomyopathy?

Dilated, Hypertrophic and Restrictive

What medical management is indicated for cardiomyopathy?

Diuretics, antihypertensives, antidysrhythmics, anticoagulants, corticosteroids, and sodium restriction