THINGS SHE STRESSED PT 1 -From Steve's Study Guide (Lectures 2/13 & 2/20) Flashcards
the ability of blood vessels within organs to maintain a relatively constant blood flow regardless of changes in arterial pressure.
auto regulation
____ Blood pressure leads to stretch that results in constriction of arterioles and precapillary sphincters. _____BP results in vessel dilation in order to increase flow.
high; low
In the ______system obstruction manifests as distal ischemia in the _______system obstruction manifests as edema
arterial; venous
__________ is a stationary blood clot formed within a vessel or a chamber of the heart. (pl thrombi)
thrombosis
Inflammation in vein –_______ and with a clot–_______
phlebitis; thrombophlebitis
During a thrombosis in the _____ system, patients will experience intermittent claudication, cool, cyanotic blue, painful ulcer in big toe. _______thrombosis – could be no s/s or could be life threatening (pulmonary embolism) calf/groin tenderness, swelling and Homan’s sign. Another way you can tell if a patient has a DVT is to do a _____. It’s not specific but it could start the work up for a PE
arterial; venous; d dimer
Embolis traveling to _____ventricle will go to the brain and will cause an ischemic stroke also known more specifically as an embolic stroke, that occludes a cerebral artery. An embolus leaving right ventricle gets into ______artery and causes a _____ embolis.
left; pulmonary 2x
Patients will present with sudden onset of SOB, Tachypnea, chest pain – this can cause sudden death, sometimes also back pain or scapular pain in a _____
pulmonary embolus
IVC / SVC or Greenfield filter – used to prevent a _________
pulmonary embolus
Clinical manifestations: often women more than men, organ specific – prinzmetal angina, in the brain can cause spasming and rupture of cerebral artery causing hemorrhagic stroke, migraine headaches would be another S/S.
vasospasm
insufficiency of the deep veins is _________.The legs become hyperpigmented, they swell, not enough flow in venous system
chronic venous insufficiency
Venous stasis ulcers will occur on the ________
medial malleolus
cholesterol calcium plaques deposited in the arteries
atherosclerosis
___________weakening of the blood vessel where it pouches out. Predisposes to rupture and bleeding
aneurysms
___________abnormal communications between arteries and veins – most commonly found in brain and GI tract.
Arterial venous fistulas
People who have atherosclerotic plaque do not just have it in one location they have it everywhere. They get ____ in the legs – stroke and CVA, myocardial infarction.
PAD
_______ studies these are both ultrasounds that use sound waves to determine whether there’s an obstruction). ________ test done to determine if a pt ankle systolic over brachial systolic. If less than _____ it’s considered PAD. Lower number lower the index more ____ PAD
Doppler/Duplex; Ankle Brachial Index; 0.9; severe
due to vasoconstriction or vasospasm. Interferes and blocks blood flow leading to color changes.
Raynaud’s
CLINICALLY MANIFESTED as intermittent claudication. Lack of adequate perfusion to the legs – atrophy potential. Cool to touch extremities, weak or absent pulses, hair loss – the skin will look shiny.
PAD
More invasive, accurate diagnostic way to diagnoses PAD is _______ –when the vascular provider or cardiologist injects dye into the arterial system of lower extremities
ANGIOGRAPHY
Aneurysms: ______ increasing intracranial pressure, it might be hemorrhagic stroke. ______ sudden severe stabbing, tearing pain, radiates into back/abdomen, shock state
Cerebral; Aortic
_______would have widening of pulse pressure 160 over 60
cerebral hemorrhagic stroke
_________-send a probe through the esophagus and take pictures of aorta via ultrasound most diagnostic and invasive for dissecting aneurysm
TEE
________medical emergency treated medically with vasodilators it’s important to keep BP low – as low as possible to maintain perfusion, b/c the shearing force from the pressure will make the ripping of layers apart even worse.
Aortic aneurysm
_______measures tissue profusion. Greater than ____ is considered tissue profusion. Surgeons can also put a graft in to repair.
MAP; 70
________ absence of arterial circulation may result from thrombi, emboli, or mechanical compression
ACUTE ARTERIAL OCCLUSION
6 P’s OF ACUTE ARTERIAL OCCLUSION
Pallor Paresthesia Paralysis Pain Polar Pulseless Pistol shot
Chronic venous insufficiency will lead to _____. They will have _________which will occur on the medial malleolus and pain.
edema; venous stasis ulcers
normal lymphatic flow is altered – usually secondary to mastectomy, radiation, or lymph node removal. You cannot draw blood or do blood pressures from this arm.
lymphedema
amount of blood ejected with each contraction of the ventricle. The amount of blood that is squeezed out of LV on systole.
Stroke volume
stroke volume formula
SV = EDV -ESV
Normal Stroke Volume is______% anything between 40 and 54% is considered _____dysfunction – meaning LV a little weak.
55-80; systolic
_____ is the immediate source of energy for myocardium to move. But it needs to be converted to ATP by the enzyme ______, when there is damage to the myocardium it will be released. One sign of ____ is the elevation of the enzyme.
CP; CK; MI
Anything that increases the HR has a __________
chronotropic effect
Speed of conduction is a_________
dromotropic effect
Force of contraction is an _________
Inotropic effect
Decreases HR, force of contraction, and speed of conduction
beta blockers
________refers to rate and degrees of ventricular relaxation “patient has this mechanism for their CHF, what kind do they have?” stiff non-compliant ventricles
Lusitropy
amount of blood ejected with each contraction of the ventricle; Formula?
Stroke Volume; SV=EDV-ESV
High levels of _____promote atherosclerosis High levels of ____ inhibit atherosclerosis
LDL; HDL
What kind of intolerance promotes atherosclerosis?
Glucose/diabetes
For atherosclerosis you can use_________ which is a catheter into groin, femoral artery, threaded into heart and inject contrast dye and you can see blockages that way. In areas where there is not good profusion – will be _____spots indicative of ischemia or even necrosis.
angiography; cold
First line treatment for atherosclerosis is _______
exercise/smoking cessation;
Second line treatment for atherosclerosis is ______
drugs like aspirin, or balloon laser therapy/angioplasty
Treatment for Raynauds?
warm ball or calcium channel blockers
_____________- is stimulated - results in reduction in heart rate, and speed of action potential conduction (via binding of acetylcholine to muscarinic receptors) massaging the carotid artery can stimulate the vagus nerve – can bring the HR down until they get drugs.
Parasympathetic stimulation / Vagus nerve
can spot irregularities in impulse initiation, conduction, waves and pathways.
ECG
PR interval (PRI) is normal at ________. If it’s prolonged there is delayed conduction through the AV node, anything greater than ______ is considered a 1st degree heart block.
.12-.2, .2
A normal QT interval is ________sec
.36-.44
A prolonged QT interval (usually >_____) means the patient is at high risk for _______and a deadly arrhythmia known as Torsades de pointes
.5; V Tach
Torsades de pointes arrythmia is terminated by high dose _____.
magnesium solfate
Tall Peaked T wave associated with _______ (will be almost as high as the QRS),
hyperkalemia
U wave associated with ________
hypokalemia
The ST segment, when we’re doing a stress test and a stress test is positive, there will be ST segment depression, which is indicative of _____. When you have ST segment elevation its indicative of _____ or STMI (“Stemi”)
ischemia; MI
CO formula
SV X HR
SV and HR have _____ relationship
inverse
______is a measure of cardiac output relative to body surface area. Done electronically. Gives you degree of tissue perfusion. anything less than _____ pt has really bad heart failure and they are not perfusing tissue.
Cardiac index; 2.2
Determinants of Stroke Volume: the volume of blood in the heart _____. The contractile capabilities _______. The pressure the LV has to overcome to eject blood through the aorta _______-
preload; contractility; after load
_____and ____ act on kidneys to remove excess water and sodium. When ___is elevated = volume overload - potentially signaling CHF.
ANP and BNP; BNP
provides electrical information Echo – can do a transthoracic or transesophagea
ECG
radioactive substances injected into bloodstream used to trace the patterns of blood flow in the heart – assesses the adequacy of blood flow to the cardiac tissues can identify cold spots decreased perfusion
Nuclear Cardiography
will give you information about pressures /volume go through the femoral vein and lodge in pulmonary artery can give you information about pressure within rt atrium, CVP, right ventricular pressure, left atrial pressure .
right cardiac catheterization
do to evaluate if they have atherosclerotic plaque / blockages in coronary arteries. Would insert femoral artery lodge in coronary sinus and dye is injected.
left cardiac catheterization
Who would go for right cardiac catheterization
someone with heart failure
When would you do a left cardiac catheterization
someone presents with chest pain and positive enzyme test
_____can assess: Cardiomegaly, ventricular hypertrophy, valvular disorders, incompetence, stenosis, collections of fluid can, left ventricular function
echocardiogram
Which of the following is the preferred test for measuring ejection fraction?
echocardiogram
inability to have sufficient CO to meet the metabolic demands of tissues and organs
CHF
PINK FROTHY SPUTUM
PULMONARY EDEMA
The sound of excess volume, a ventricular gallop
S3
sound of ventricles when blood is trying to enter the stiff noncompliant L ventricle – an atrial gallop, ‘Tennessee’ tachycardia
S4
LESS INVASIVE Echocardiogram, will give you info about whether there’s a dissection will give info volume of blood in heart, how much blood loss is occurring, valvular status, info about EF, info about blood clotting in any chambers of heart
TTE
you see a widening of the _______ with aortic dissection
mediastinum
People with ejection fraction under 30% get a ____
ICD – internal cardioverter defibrillator
EF <40% but can walk two flights of stairs or two blocks and does not get SOB,
NYHA Class 1
2 flights of stairs, 2 city blocks SOB and have to stop
NYHA Class 2
Shaving, combing hair and causing SOB – minimal exertion
NYHA Class 3
Dyspnea at rest
NYHA Class 4
the patient has S/S of venous congestion, manifested as Edema, fluid can exit to the peritoneal cavity they can have a condition where the abdomen fills up with fluid (ascites), JVD_________
Backwards effects of R heart failure due to congestion of venous system
Management is aimed at stopping SNS activation, meds used: ______ to block norepinephrine and epinephrine for stopping systolic heart failure.
beta blockers
Identified by EF of 40% or less
systolic dysfunction
MI and ischemia common etiologies of __________
systolic dysfunction
reduced inotropy during ventricular systole
systolic dysfunction
Due to low output state of LV, a sympathetic response b/c tissue is not being perfused will be the release of neurohormone ________ but ultimately this re-arranges the tissue which is termed _________
norepinephrine; ventricular remodeling
Heart Failure with preserved ejection fraction “the heart has problem relaxing” a sign of what kind of dysfunction?
Diastolic dysfunction
Low cardiac output, congestion, and edema formation with normal ejection fraction. It’s a Lusotropic problem. The ventricles are stiff and don’t relax properly.
Diastolic Dysfunction
Explain the 6 box method
let’s say you find a QRS complex that falls directly on a line on an EKG strip, and then you count over, if the next QRS complex occurred at 1, HR would be 300. If the next QRS complex was at 2 HR would be 150 and so on.
