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pulmonary and cv exam > pulmonary and cv exam > Flashcards

pulmonary and cv exam Flashcards

1
Q

normal range of systolic blood pressure

A

100-140 mmhg

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2
Q

normal diastolic range

A

65-90 mmhg

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3
Q

what is mean arterial pressure?

the normal range?

A

the average arterial pressure during a single cardiac cycle

75-90 mmhg

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4
Q

how do you calculate MAP?

A

[ (SPB + 2DPB)] /3

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5
Q

What is the required mmhg required for organ perfusion?

A

> 60 mmHg

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6
Q

What is Frank starlings law?

A

HR X SV = CO

FLOW = FREQUENCY X VOLUME

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7
Q

define Preload

A

filling pressure (Volume)

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8
Q

define Afterload

A

resistance against contraction (pressure)

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9
Q

HR is the number of _____?

A

contractions

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10
Q

define contractility

A

force of contraction

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11
Q

how does the nervous system control BP

A 
sympathetic and parasympathetic receptors
adrenal hormones (fight or flight)
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12
Q

How does the renal system respond to low blood pressure

A

RAAS - with vasoconstriction and aldosterone

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13
Q

how does the endocrine system regulate bp

A

release of ADH,
increase blood volume -> increase SV -
raises blood pressure

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14
Q

a SUSTAINED increase in peripheral resistance and/or increase in blood volume is known as

A

hypertension

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15
Q

a decrease in blood pressure RESULTING IN CLINICAL EFFECTS

A

hypotension

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16
Q

what are the 3 types of HTN

A

Primary
Secondary
Systolic

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17
Q

Which type of htn is caused by environmental events

A

primary

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18
Q

what type of htn is caused by systemic diseases that increase peripheral resistance or volume

A

secondary

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19
Q

which type of HTN is common after a CVA or MI and causes aortic rigidity in older patients?

A

Systolic

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20
Q

What is the pathophysiology involving the myocardial wall caused by High BP?

A

high BP = THICKENING of myocardial wall

THICKENING causes increased contractility

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21
Q

what causes distensibility and decreased radius during HTN ?

A

arterial smooth muscles in the heart STIFFEN and narrowing of the lumen

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22
Q

What causes increased preload in patients with HTN?

A

INFLAMMATION, increased permeability and Na and H2O retention

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23
Q

what is the clinical significance of HTN in the Brain, Heart, Kidnets and Retina

A

Heart- failure, angina, MI
Brain- aneurysm, ischemia, stroke
Kidneys- insufficiency and failure
Retina- blood vessel sclerosis

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24
Q

What is the recommended treatment for patients with HTN

A

reducing risk factors, lose weight, exercise, reduce stress, nutrition, etc…

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25
Q

CAD causing hardening of medium - large arteries

A

Arterioslcerosis

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26
Q

CAD hardening of small arteries

A

ArterioROSclerosis

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27
Q

CAD hardening of arteries caused by atheromatous plaque

A

Atherosclerosis

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28
Q

What is the pathogenisis (development) of Atheroslerosis, what is the qualifying Cholesterol level

A

*excess lipids fill smooth muscles
plateletes are activated and call upon thrombi
Complicated lesions -> nectrotic occlusion(blockage)
<140

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29
Q

Clinical manifestations of CAD related to inadequate perfusion of tissues and injury vs. death

A

angina, MI
transient ischemia vs. CVA (stroke)
Hypertension

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30
Q

Unmodifiable risk factors of CAD

A

age, gender, genetic history

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31
Q

modifiable risk factors of CAD

A 
LDL levels
HTN
smoking
sedentary lifestyle
obesity
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32
Q

Angina (myocardial ischemia)

A

pain caused by insufficient blood supply to the heart, inc heart rate, inc coronary vascular resistance

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33
Q

Which type of angina has a pattern of onset, intensity and and is usually induced by activity

A

Stable Angina

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34
Q

describe Unstable angina and immediate interventions

A

progressive, sudden, unpredictable, increased coronary stenosis
immediate tertiary intervention

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35
Q

What cause is thought to be associated with Prinzmetal angina

A

stress, SPASMS of CA, bursts of pain

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36
Q

the clinical manifestations for angina(myocardial ischemia)

A

chest pain, heavy and constrictive feeling, indigestion, anxiety, feeling of impending doom. Gender must be considered when assessing sx.

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37
Q

Dx test for angina

A

EKG, stress test, nuclear imaging, angiogram

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38
Q

tx of coronary artery occlusion

A

dec BP, HR and contractility– possible

surgery

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39
Q

destruction of cardiac cells caused by inadequate blood supply from CA is known as

A

Myocardial Infarction

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40
Q

what can happen within hours of an MI

A

irreversible hypoxia and cell death

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41
Q

A patient experiencing an MI may describe their sx as_____?

A 
severe and unresolved chest pain
nausea/vomiting
cool, clammy skin
fever
possible left arm pain

their CO is decreased

42
Q

Treatment of an MI

A 
M- morphine 
O- oxygen
N-itroglycerin(vasodilator)
A- spirin (dec. platelete aggregation)
B--eta- blockers
43
Q

layers of the heart — outermost to innermost

A

pericardum- myocardium- endocardium

44
Q

what layer of the heart involves the outermost layer of the heart?

A

the layer is called pericardium and the disorder is called pericarditis

45
Q

Which disorders are associated with the myocardium of the heart?

A

MI, Cardiomyapothy, congestive HF

46
Q

infective endocarditis, rheumatic heart disease and valve diseases are associated with which layer of the heart?

A

Endocardium

47
Q

what is the etiology of acute perecarditis?

patho?

A

E => viruses, cardiac surgery, MI, idiopathic(unknown causes)
P => inflamed, roughened pericardial sacs and/or accumulation of exudates(drainage)

48
Q

What sx will a patient experiencing pericarditis most likely display? Which one is unique to this disorder?

A

fever, chest pain restlessness

FRICTION RUB during auscultation

49
Q

what are the tx of pericarditis?

A

antibiotics, pain meds, pericardiocentiesis (centesis = usingh a needle to extract fluids

50
Q

Methods for Dx pericarditis include______?

A

EKG, Echocardiogram, EJECTION FRACTION(desired is >75%)

CXR

51
Q

Pericardial effusion and Cardiac Tamponade are complications associated with which disorder?

A

Acute Pericarditis

52
Q

fluids/inflammation in pericardial cavity, cardiac standstill (due to compression) decrease in Atrial and ventricular filling and a DEC in CO and SV despite an INC in HR are all associated with which disorder?

A

Acute Pericarditis

53
Q

Constrictive pericarditis in differentiated from acute Per. because it is a _______

A

CHRONIC inflammation of the pericardium.

54
Q

FIBROUS SCARRING, A RIGID SHELL coupled with calcification of pericardium describe the pathophysiology of?
How are CO and SV effected?

A

Chronic Pericarditis

decrease in CO and SV

55
Q

who is most likely to contract infective endocaritis, which microorganisms vegetate, often near valves

A

IV drug users.

Stapholococcus

56
Q

Janeways lesions and oslers node(painful), arthralgia(joint pain), splinter hemorrhages (bleeding under nails), murmur are all manifestions of what infective disorder?

A

infective endocarditis

57
Q

Dx for Inf. Endocarditis

A

blood culture, increase WBC and echocardiogram

58
Q

Tx of infective endocarditis

A

antibiotics, manage sx

59
Q

a delayed autoimmune response to group a-beta hemolytic streptococcus, pharyngeal infection, scarring of heart and genetic predisposition are al causes of

A

rheumatic fever/heart disease

60
Q

dx rests for inf. endo.

A

throat culture, WBC count, anti-streptolysis O titers, Echocardiogram

61
Q

tx of infective endocarditis

A

abx, possibly heart valve repair,

62
Q

what is happening when there is stenosis of a heart valve/ what complications will result?

A

Ca++ deposits stiffen and constrict the ability to open= the chamber fed by the affected valve will have to sork harder (hypertrophy)

63
Q

What is going on during valve regurgitation?

what are the consequences?

A

valve is unable to fully close causing back flow of blood.

chamber dilation and hypertrophy

64
Q

aortic stenosis causes obstruction of flow in which chambers of the heart?

A

LV to aorta during systole

LV hypertrophy

65
Q

what sx will a patient with aortic stenosis experience?

A

S- yncope => fainting
A- ngina => chest pain
D-yspnea => shortness of breath
systolic murmur

66
Q

aortic regurgitation causes

A

back flow from aorta in LV 2/2
LV hypertrophy
Dec contractility
RV failure, congestion

67
Q

clinical manifestations of Aortic regurgiation

A

inc SV, murmur, sx of heart failure

68
Q

mitral stenosis causes

A

incomplete emptying of LA, inc pressure, LA hypertrophy

=> dec in LV filling => dec SV & CO

69
Q

sx of mitral stenosis

A

pulmonary congestion, murmur, palpitations, fatigue, weakness

70
Q

pathophysiology of mitral regurgitation includes the backflow of blood from, this causes

A

inc volume=> LV dilation

L heart failure => R heart failure

71
Q

sx of mitral regurgitation are

A

fatigue, weakness, murmur, SOB, palpitations

72
Q

stenosis and regurgitation of which valve will affect the RA

A

Tricuspid

73
Q

stenosis and regurgitation of which valve will affect the RV

A

Pulmonic Valve

74
Q

which type of valve failure is more common in the right side of the heart

A

Regurgitation

75
Q

valve problems are dx and tx by?

A

CXR/ EKG
echocardiogram
cardiac catheterization

tx=> meds/surg

76
Q

decreased O2 carriers, O2 supply and poor tissue uptake can (acidosis and edema) are the main causes of which CV disorder?

A

decreased systemic perfusion

77
Q

what is the definition of HF?

A

inability to provide sufficient CO foe tissues and metabolic needs

78
Q

systolic failure is caused by

A

pump failure, high workload, valve regurgitation, MI

79
Q

diastolic failure means _____

A

heart cannot relax to fill, stiffening od ventricles

80
Q

what sx are associated with LH failure

A

weakness, fatigue, chest pain, pulmonary edema, confusion, metabolic acidosis, nocturia, orthopnea(SOB when lying down)

81
Q

RH failure causes ____

A 
peripheral edema (fluid in the body)
engorged liver
ascites (abdomen swell)
anasarca (generalized edema)
JVD
fatique
82
Q

the tx goal of R or L heart failure is to ____.

how is this goal acheived?

A 
dec ventricular workload and demand, increase systemic oxygenated blood flow
----how?
dec. HR
decrease preload of afterload
increase of decrease contractility
83
Q 
define cardiomyopathy 
(heart muscle disease)
A

permanent change in the structure and function of myocardium

84
Q

primary and Secondary causes of cardiomyopathy

A

P: ischemic heart disease, HTN
S: infection, toxins

85
Q

patho/effects of dilated cardiomyapothy

A

dilation of chambers ==> dec contr.

inc Volume congestion in the heart chambers==> decreased CO

86
Q

patho and results of hypertrophic cardiomyapothy

A

thick ventricular walls, impaired relaxation. fluids back up into the LA there can be increased or decreased CO depending on disease stages

87
Q

restrictive cardiomyopathy

A

stiff V muscles, resist filling and diastolic function. high pressure is required for ventricles to maintain CO.

88
Q

tx of cardiomyopathy

A

minimize workload and optimize tissue perfusion

achieved with drug therapy and procedures to correct underlying patho changes to prevent ischemia

89
Q

what is the definition of shock?

A

CV system is not able to perfuse tissues ==> decreased cellular metabolism

90
Q

hypovolemic shock

A

caused by severe bleeding and dehydration. everything decreases.

91
Q

what is the tx for hypovolemic shock

A

re-perfusion, manage sx, transfusion

92
Q

what happens during cardiogenic shock

A

decrease in hearts ability to pump, decrease in contractility and ventricular compliance

93
Q

3 intrinsic pacemakers and their ranges

A

1- SA Node: 60-80 bpm
2-AV Node: 40-60 bpm
3- Ventricles: 20-40 bpm

94
Q

what does sinus rhythm mean?

A

normal HR

95
Q

what is happening in premature atrial contraction

A

interruption of regular heart beat
stress, alcohol, etc…
can lead to atrial fibrillation

96
Q

what is the problem with atrial fibrilation?
what are some causes?
what is the tx?

A

atria are unable to empty.
decrease CO
etiology: Hypertension, alcohol, CAD, CHF
tx: reduce heart rate, anticoagulants

97
Q

what is thrombus and what is the tx?

A

a blood clot attached to a vessel wall
tx: thrombolysis(dissolve)
anticoagulants
thrombectomy

98
Q

saccular, fusiformed and ruptured are all forms of what?

A

aneurysm

99
Q

what enzymes are released into the body during a heart attack

A

CKMB and troponin

100
Q

what rhythm represents an ectopic origin

A

PVC

pulmonary and cv exam (2 decks)

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