pulmonary and cv exam Flashcards
1
Q
normal range of systolic blood pressure
A
100-140 mmhg
2
Q
normal diastolic range
A
65-90 mmhg
3
Q
what is mean arterial pressure?
the normal range?
A
the average arterial pressure during a single cardiac cycle
75-90 mmhg
4
Q
how do you calculate MAP?
A
[ (SPB + 2DPB)] /3
5
Q
What is the required mmhg required for organ perfusion?
A
> 60 mmHg
6
Q
What is Frank starlings law?
A
HR X SV = CO
FLOW = FREQUENCY X VOLUME
7
Q
define Preload
A
filling pressure (Volume)
8
Q
define Afterload
A
resistance against contraction (pressure)
9
Q
HR is the number of _____?
A
contractions
10
Q
define contractility
A
force of contraction
11
Q
how does the nervous system control BP
A
sympathetic and parasympathetic receptors adrenal hormones (fight or flight)
12
Q
How does the renal system respond to low blood pressure
A
RAAS - with vasoconstriction and aldosterone
13
Q
how does the endocrine system regulate bp
A
release of ADH,
increase blood volume -> increase SV -
raises blood pressure
14
Q
a SUSTAINED increase in peripheral resistance and/or increase in blood volume is known as
A
hypertension
15
Q
a decrease in blood pressure RESULTING IN CLINICAL EFFECTS
A
hypotension
16
Q
what are the 3 types of HTN
A
Primary
Secondary
Systolic
17
Q
Which type of htn is caused by environmental events
A
primary
18
Q
what type of htn is caused by systemic diseases that increase peripheral resistance or volume
A
secondary
19
Q
which type of HTN is common after a CVA or MI and causes aortic rigidity in older patients?
A
Systolic
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
21
Q
what causes distensibility and decreased radius during HTN ?
A
arterial smooth muscles in the heart STIFFEN and narrowing of the lumen
22
Q
What causes increased preload in patients with HTN?
A
INFLAMMATION, increased permeability and Na and H2O retention
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
24
Q
What is the recommended treatment for patients with HTN
A
reducing risk factors, lose weight, exercise, reduce stress, nutrition, etc…
25
CAD causing hardening of medium - large arteries
Arterioslcerosis
26
CAD hardening of small arteries
ArterioROSclerosis
27
CAD hardening of arteries caused by atheromatous plaque
Atherosclerosis
28
What is the pathogenisis (development) of Atheroslerosis, what is the qualifying Cholesterol level
*excess lipids fill smooth muscles
plateletes are activated and call upon thrombi
Complicated lesions -> nectrotic occlusion(blockage)
<140
29
Clinical manifestations of CAD related to inadequate perfusion of tissues and injury vs. death
angina, MI
transient ischemia vs. CVA (stroke)
Hypertension
30
Unmodifiable risk factors of CAD
age, gender, genetic history
31
modifiable risk factors of CAD
```
LDL levels
HTN
smoking
sedentary lifestyle
obesity
```
32
Angina (myocardial ischemia)
pain caused by insufficient blood supply to the heart, inc heart rate, inc coronary vascular resistance
33
Which type of angina has a pattern of onset, intensity and and is usually induced by activity
Stable Angina
34
describe Unstable angina and immediate interventions
progressive, sudden, unpredictable, increased coronary stenosis
immediate tertiary intervention
35
What cause is thought to be associated with Prinzmetal angina
stress, SPASMS of CA, bursts of pain
36
the clinical manifestations for angina(myocardial ischemia)
chest pain, heavy and constrictive feeling, indigestion, anxiety, feeling of impending doom. Gender must be considered when assessing sx.
37
Dx test for angina
EKG, stress test, nuclear imaging, angiogram
38
tx of coronary artery occlusion
dec BP, HR and contractility-- possible
| surgery
39
destruction of cardiac cells caused by inadequate blood supply from CA is known as
Myocardial Infarction
40
what can happen within hours of an MI
irreversible hypoxia and cell death
41
A patient experiencing an MI may describe their sx as_____?
```
severe and unresolved chest pain
nausea/vomiting
cool, clammy skin
fever
possible left arm pain
```
their CO is decreased
42
Treatment of an MI
```
M- morphine
O- oxygen
N-itroglycerin(vasodilator)
A- spirin (dec. platelete aggregation)
B--eta- blockers
```
43
layers of the heart --- outermost to innermost
pericardum- myocardium- endocardium
44
what layer of the heart involves the outermost layer of the heart?
the layer is called pericardium and the disorder is called pericarditis
45
Which disorders are associated with the myocardium of the heart?
MI, Cardiomyapothy, congestive HF
46
infective endocarditis, rheumatic heart disease and valve diseases are associated with which layer of the heart?
Endocardium
47
what is the etiology of acute perecarditis?
| patho?
E => viruses, cardiac surgery, MI, idiopathic(unknown causes)
P => inflamed, roughened pericardial sacs and/or accumulation of exudates(drainage)
48
What sx will a patient experiencing pericarditis most likely display? Which one is unique to this disorder?
fever, chest pain restlessness
FRICTION RUB during auscultation
49
what are the tx of pericarditis?
antibiotics, pain meds, pericardiocentiesis (centesis = usingh a needle to extract fluids
50
Methods for Dx pericarditis include______?
EKG, Echocardiogram, EJECTION FRACTION(desired is >75%)
| CXR
51
Pericardial effusion and Cardiac Tamponade are complications associated with which disorder?
Acute Pericarditis
52
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?
Acute Pericarditis
53
Constrictive pericarditis in differentiated from acute Per. because it is a _______
CHRONIC inflammation of the pericardium.
54
FIBROUS SCARRING, A RIGID SHELL coupled with calcification of pericardium describe the pathophysiology of?
How are CO and SV effected?
Chronic Pericarditis
decrease in CO and SV
55
who is most likely to contract infective endocaritis, which microorganisms vegetate, often near valves
IV drug users.
| Stapholococcus
56
Janeways lesions and oslers node(painful), arthralgia(joint pain), splinter hemorrhages (bleeding under nails), murmur are all manifestions of what infective disorder?
infective endocarditis
57
Dx for Inf. Endocarditis
blood culture, increase WBC and echocardiogram
58
Tx of infective endocarditis
antibiotics, manage sx
59
a delayed autoimmune response to group a-beta hemolytic streptococcus, pharyngeal infection, scarring of heart and genetic predisposition are al causes of
rheumatic fever/heart disease
60
dx rests for inf. endo.
throat culture, WBC count, anti-streptolysis O titers, Echocardiogram
61
tx of infective endocarditis
abx, possibly heart valve repair,
62
what is happening when there is stenosis of a heart valve/ what complications will result?
Ca++ deposits stiffen and constrict the ability to open= the chamber fed by the affected valve will have to sork harder (hypertrophy)
63
What is going on during valve regurgitation?
| what are the consequences?
valve is unable to fully close causing back flow of blood.
| chamber dilation and hypertrophy
64
aortic stenosis causes obstruction of flow in which chambers of the heart?
LV to aorta during systole
| LV hypertrophy
65
what sx will a patient with aortic stenosis experience?
S- yncope => fainting
A- ngina => chest pain
D-yspnea => shortness of breath
systolic murmur
66
aortic regurgitation causes
back flow from aorta in LV 2/2
LV hypertrophy
Dec contractility
RV failure, congestion
67
clinical manifestations of Aortic regurgiation
inc SV, murmur, sx of heart failure
68
mitral stenosis causes
incomplete emptying of LA, inc pressure, LA hypertrophy
| => dec in LV filling => dec SV & CO
69
sx of mitral stenosis
pulmonary congestion, murmur, palpitations, fatigue, weakness
70
pathophysiology of mitral regurgitation includes the backflow of blood from, this causes
inc volume=> LV dilation
| L heart failure => R heart failure
71
sx of mitral regurgitation are
fatigue, weakness, murmur, SOB, palpitations
72
stenosis and regurgitation of which valve will affect the RA
Tricuspid
73
stenosis and regurgitation of which valve will affect the RV
Pulmonic Valve
74
which type of valve failure is more common in the right side of the heart
Regurgitation
75
valve problems are dx and tx by?
CXR/ EKG
echocardiogram
cardiac catheterization
tx=> meds/surg
76
decreased O2 carriers, O2 supply and poor tissue uptake can (acidosis and edema) are the main causes of which CV disorder?
decreased systemic perfusion
77
what is the definition of HF?
inability to provide sufficient CO foe tissues and metabolic needs
78
systolic failure is caused by
pump failure, high workload, valve regurgitation, MI
79
diastolic failure means _____
heart cannot relax to fill, stiffening od ventricles
80
what sx are associated with LH failure
weakness, fatigue, chest pain, pulmonary edema, confusion, metabolic acidosis, nocturia, orthopnea(SOB when lying down)
81
RH failure causes ____
```
peripheral edema (fluid in the body)
engorged liver
ascites (abdomen swell)
anasarca (generalized edema)
JVD
fatique
```
82
the tx goal of R or L heart failure is to ____.
how is this goal acheived?
```
dec ventricular workload and demand, increase systemic oxygenated blood flow
----how?
dec. HR
decrease preload of afterload
increase of decrease contractility
```
83
```
define cardiomyopathy
(heart muscle disease)
```
permanent change in the structure and function of myocardium
84
primary and Secondary causes of cardiomyopathy
P: ischemic heart disease, HTN
S: infection, toxins
85
patho/effects of dilated cardiomyapothy
dilation of chambers ==> dec contr.
| inc Volume congestion in the heart chambers==> decreased CO
86
patho and results of hypertrophic cardiomyapothy
thick ventricular walls, impaired relaxation. fluids back up into the LA there can be increased or decreased CO depending on disease stages
87
restrictive cardiomyopathy
stiff V muscles, resist filling and diastolic function. high pressure is required for ventricles to maintain CO.
88
tx of cardiomyopathy
minimize workload and optimize tissue perfusion
| achieved with drug therapy and procedures to correct underlying patho changes to prevent ischemia
89
what is the definition of shock?
CV system is not able to perfuse tissues ==> decreased cellular metabolism
90
hypovolemic shock
caused by severe bleeding and dehydration. everything decreases.
91
what is the tx for hypovolemic shock
re-perfusion, manage sx, transfusion
92
what happens during cardiogenic shock
decrease in hearts ability to pump, decrease in contractility and ventricular compliance
93
3 intrinsic pacemakers and their ranges
1- SA Node: 60-80 bpm
2-AV Node: 40-60 bpm
3- Ventricles: 20-40 bpm
94
what does sinus rhythm mean?
normal HR
95
what is happening in premature atrial contraction
interruption of regular heart beat
stress, alcohol, etc...
can lead to atrial fibrillation
96
what is the problem with atrial fibrilation?
what are some causes?
what is the tx?
atria are unable to empty.
decrease CO
etiology: Hypertension, alcohol, CAD, CHF
tx: reduce heart rate, anticoagulants
97
what is thrombus and what is the tx?
a blood clot attached to a vessel wall
tx: thrombolysis(dissolve)
anticoagulants
thrombectomy
98
saccular, fusiformed and ruptured are all forms of what?
aneurysm
99
what enzymes are released into the body during a heart attack
CKMB and troponin
100
what rhythm represents an ectopic origin
PVC
