THINGS SHE STRESSED PT 1 -From Steve's Study Guide (Lectures 2/13 & 2/20)

Question 1

the ability of blood vessels within organs to maintain a relatively constant blood flow regardless of changes in arterial pressure.

Answer 1

auto regulation

Question 2

____ Blood pressure leads to stretch that results in constriction of arterioles and precapillary sphincters. _____BP results in vessel dilation in order to increase flow.

Answer 2

high; low

Question 3

In the ______system obstruction manifests as distal ischemia in the _______system obstruction manifests as edema

Answer 3

arterial; venous

Question 4

__________ is a stationary blood clot formed within a vessel or a chamber of the heart. (pl thrombi)

Answer 4

thrombosis

Question 5

Inflammation in vein –_______ and with a clot–_______

Answer 5

phlebitis; thrombophlebitis

Question 6

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

Answer 6

arterial; venous; d dimer

Question 7

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.

Answer 7

left; pulmonary 2x

Question 8

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 _____

Answer 8

pulmonary embolus

Question 9

IVC / SVC or Greenfield filter – used to prevent a _________

Answer 9

pulmonary embolus

Question 10

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.

Answer 10

vasospasm

Question 11

insufficiency of the deep veins is _________.The legs become hyperpigmented, they swell, not enough flow in venous system

Answer 11

chronic venous insufficiency

Question 12

Venous stasis ulcers will occur on the ________

Answer 12

medial malleolus

Question 13

cholesterol calcium plaques deposited in the arteries

Answer 13

atherosclerosis

Question 14

___________weakening of the blood vessel where it pouches out. Predisposes to rupture and bleeding

Answer 14

aneurysms

Question 15

___________abnormal communications between arteries and veins – most commonly found in brain and GI tract.

Answer 15

Arterial venous fistulas

Question 16

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.

Answer 16

PAD

Question 17

_______ 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

Answer 17

Doppler/Duplex; Ankle Brachial Index; 0.9; severe

Question 18

due to vasoconstriction or vasospasm. Interferes and blocks blood flow leading to color changes.

Answer 18

Raynaud’s

Question 19

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.

Answer 19

PAD

Question 20

More invasive, accurate diagnostic way to diagnoses PAD is _______ –when the vascular provider or cardiologist injects dye into the arterial system of lower extremities

Answer 20

ANGIOGRAPHY

Question 21

Aneurysms: ______ increasing intracranial pressure, it might be hemorrhagic stroke. ______ sudden severe stabbing, tearing pain, radiates into back/abdomen, shock state

Answer 21

Cerebral; Aortic

Question 22

_______would have widening of pulse pressure 160 over 60

Answer 22

cerebral hemorrhagic stroke

Question 23

_________-send a probe through the esophagus and take pictures of aorta via ultrasound most diagnostic and invasive for dissecting aneurysm

Answer 23

TEE

Question 24

________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.

Answer 24

Aortic aneurysm

Question 25

_______measures tissue profusion. Greater than ____ is considered tissue profusion. Surgeons can also put a graft in to repair.

Answer 25

MAP; 70

Question 26

________ absence of arterial circulation may result from thrombi, emboli, or mechanical compression

Answer 26

ACUTE ARTERIAL OCCLUSION

Question 27

6 P's OF ACUTE ARTERIAL OCCLUSION

Answer 27

Pallor Paresthesia Paralysis Pain Polar Pulseless Pistol shot

Question 28

Chronic venous insufficiency will lead to _____. They will have _________which will occur on the medial malleolus and pain.

Answer 28

edema; venous stasis ulcers

Question 29

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.

Answer 29

lymphedema

Question 30

amount of blood ejected with each contraction of the ventricle. The amount of blood that is squeezed out of LV on systole.

Answer 30

Stroke volume

Question 31

stroke volume formula

Answer 31

SV = EDV -ESV

Question 32

Normal Stroke Volume is______% anything between 40 and 54% is considered _____dysfunction – meaning LV a little weak.

Answer 32

55-80; systolic

Question 33

_____ 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.

Answer 33

CP; CK; MI

Question 34

Anything that increases the HR has a __________

Answer 34

chronotropic effect

Question 35

Speed of conduction is a_________

Answer 35

dromotropic effect

Question 36

Force of contraction is an _________

Answer 36

Inotropic effect

Question 37

Decreases HR, force of contraction, and speed of conduction

Answer 37

beta blockers

Question 38

________refers to rate and degrees of ventricular relaxation “patient has this mechanism for their CHF, what kind do they have?” stiff non-compliant ventricles

Answer 38

Lusitropy

Question 39

amount of blood ejected with each contraction of the ventricle; Formula?

Answer 39

Stroke Volume; SV=EDV-ESV

Question 40

High levels of _____promote atherosclerosis High levels of ____ inhibit atherosclerosis

Answer 40

LDL; HDL

Question 41

What kind of intolerance promotes atherosclerosis?

Answer 41

Glucose/diabetes

Question 42

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.

Answer 42

angiography; cold

Question 43

First line treatment for atherosclerosis is _______

Answer 43

exercise/smoking cessation;

Question 44

Second line treatment for atherosclerosis is ______

Answer 44

drugs like aspirin, or balloon laser therapy/angioplasty

Question 45

Treatment for Raynauds?

Answer 45

warm ball or calcium channel blockers

Question 46

_____________- 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.

Answer 46

Parasympathetic stimulation / Vagus nerve

Question 47

can spot irregularities in impulse initiation, conduction, waves and pathways.

Answer 47

ECG

Question 48

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.

Answer 48

.12-.2, .2

Question 49

A normal QT interval is ________sec

Answer 49

.36-.44

Question 50

A prolonged QT interval (usually >_____) means the patient is at high risk for _______and a deadly arrhythmia known as Torsades de pointes

Answer 50

.5; V Tach

Question 51

Torsades de pointes arrythmia is terminated by high dose _____.

Answer 51

magnesium solfate

Question 52

Tall Peaked T wave associated with _______ (will be almost as high as the QRS),

Answer 52

hyperkalemia

Question 53

U wave associated with ________

Answer 53

hypokalemia

Question 54

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”)

Answer 54

ischemia; MI

Question 55

CO formula

Answer 55

SV X HR

Question 56

SV and HR have _____ relationship

Answer 56

inverse

Question 57

______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.

Answer 57

Cardiac index; 2.2

Question 58

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 _______-

Answer 58

preload; contractility; after load

Question 59

_____and ____ act on kidneys to remove excess water and sodium. When ___is elevated = volume overload - potentially signaling CHF.

Answer 59

ANP and BNP; BNP

Question 60

provides electrical information Echo – can do a transthoracic or transesophagea

Answer 60

ECG

Question 61

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

Answer 61

Nuclear Cardiography

Question 62

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 .

Answer 62

right cardiac catheterization

Question 63

do to evaluate if they have atherosclerotic plaque / blockages in coronary arteries. Would insert femoral artery lodge in coronary sinus and dye is injected.

Answer 63

left cardiac catheterization

Question 64

Who would go for right cardiac catheterization

Answer 64

someone with heart failure

Question 65

When would you do a left cardiac catheterization

Answer 65

someone presents with chest pain and positive enzyme test

Question 66

_____can assess: Cardiomegaly, ventricular hypertrophy, valvular disorders, incompetence, stenosis, collections of fluid can, left ventricular function

Answer 66

echocardiogram

Question 67

Which of the following is the preferred test for measuring ejection fraction?

Answer 67

echocardiogram

Question 68

inability to have sufficient CO to meet the metabolic demands of tissues and organs

Answer 68

CHF

Question 69

PINK FROTHY SPUTUM

Answer 69

PULMONARY EDEMA

Question 70

The sound of excess volume, a ventricular gallop

Answer 70

S3

Question 71

sound of ventricles when blood is trying to enter the stiff noncompliant L ventricle – an atrial gallop, ‘Tennessee’ tachycardia

Answer 71

S4

Question 72

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

Answer 72

TTE

Question 73

you see a widening of the _______ with aortic dissection

Answer 73

mediastinum

Question 74

People with ejection fraction under 30% get a ____

Answer 74

ICD – internal cardioverter defibrillator

Question 75

EF <40% but can walk two flights of stairs or two blocks and does not get SOB,

Answer 75

NYHA Class 1

Question 76

2 flights of stairs, 2 city blocks SOB and have to stop

Answer 76

NYHA Class 2

Question 77

Shaving, combing hair and causing SOB – minimal exertion

Answer 77

NYHA Class 3

Question 78

Dyspnea at rest

Answer 78

NYHA Class 4

Question 79

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_________

Answer 79

Backwards effects of R heart failure due to congestion of venous system

Question 80

Management is aimed at stopping SNS activation, meds used: ______ to block norepinephrine and epinephrine for stopping systolic heart failure.

Answer 80

beta blockers

Question 81

Identified by EF of 40% or less

Answer 81

systolic dysfunction

Question 82

MI and ischemia common etiologies of __________

Answer 82

systolic dysfunction

Question 83

reduced inotropy during ventricular systole

Answer 83

systolic dysfunction

Question 84

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 _________

Answer 84

norepinephrine; ventricular remodeling

Question 85

Heart Failure with preserved ejection fraction “the heart has problem relaxing” a sign of what kind of dysfunction?

Answer 85

Diastolic dysfunction

Question 86

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.

Answer 86

Diastolic Dysfunction

Question 87

Explain the 6 box method

Answer 87

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.