Unit 2 - Cardiovascular System Part 2

Question 1

myocardial infarction

Answer 1

occurs when there is a complete interruption in blood/O2 delivery to the heart muscle from a blockage in an artery
-result is necrosis (tissue death)

Question 2

acute MI (AMI)

Answer 2

• typically result of significant CAD that culminates in a complete blockage
• ischemia often a precipitating factor
• often fatal - 30%

Question 3

transmural

Answer 3

full thickness MI affecting all 3 layers of the heart

Question 4

nontransmural

Answer 4

partial thickness MI involving sub endocardial layer

Question 5

most common sites of coronary artery occlusion

Answer 5

1. left anterior descending artery (LAD)
2. left circumflex artery (LCX)
3. right coronary artery (RCA)

Question 6

STEMI

Answer 6

“ST Elevation Myocardial Infarction”. Typically “transmural” infarctions
~70% of AMI’s are STEMI

Question 7

non-STEMI

Answer 7

MI that does not demonstrate ST segment elevation on the EKG – Typically “subendocardial” infarctions

Question 8

pathogenesis

Answer 8

The rupture of a vulnerable atherosclerotic plaque with subsequent thrombus formation, appears to be most common cause of AMI.

“soft” plaques are more likely to rupture than “hard”

Question 9

diagnosis of MI

Answer 9

• similar to angina but more profound/severe
• chest pain, jaw/neck/shoulder discomfort, dyspnea, overwhelming fatigue
• **may also include nausea and diaphoresis

Question 10

EKG changes

Answer 10

“injury” pattern is often noted

hallmark characteristic is ST segment elevation (indicator of tissue damage)

Question 11

Serum enzyme levels

Answer 11

elevations in:

• troponin
• CPK-MB
• LDH “flipped ratio”
• AST
• myoglobin

Question 12

major complications of MI

Answer 12

Dysrhythmias
Heart Failure (HF)
Sudden Death Syndrome
Mural thrombus / CVA
Ventricular aneurysm
Ventricular rupture with tamponade

Question 13

dysrhythmias

Answer 13

Multiple PVC’s - indicates myocardial irritability
Ventricular Tachycardia
Ventricular Fibrillation

requires immediate treatment - medication or defibrillation

Question 14

heart failure

Answer 14

heart is unable to pump enough blood through the body

causes: decrease myocardial capacity, intrinsic muscle disease, increased BP, valvular disease

Question 15

sudden death syndrome

Answer 15

death occurring within 1 hour of the onset of cardiac symptoms

in adolescents/young adults under 30, “hypertrophic cardiomyopathy” is most common cause

Question 16

mural thrombus/CVA

Answer 16

blood clot on endocardial wall

if the thrombus breaks loose, it can travel to the brain causing a CVA/stroke

Question 17

ventricular aneurysm

Answer 17

when necrosis occurs during MI, the tissue is vulnerable during the healing stage and may develop an abnormal ballooning

Question 18

ventricular rupture with tamponade

Answer 18

heart becomes compressed and can no longer contract and relax normally

Question 19

medical and surgical management of MI

Answer 19

1. treat symptoms (rest, O2, meds)
2. limit damage (meds, surgery)
3. secondary prevention (lifestyle changes, rehab)

Question 20

sternal precautions

Answer 20

No lifting, pulling, pushing (10# limit) for 6 wks
Log roll technique in/out bed
No driving (4-8 wks)
ROM exercises – neck, shoulders, torso (“caution with sternectomy”)
Scar mobilization when incision is healed
Be conservative if: osteoporosis, diabetes, advanced age

Question 21

Phase I of cardiac rehab

Answer 21

= Inpatient phase: (typically 3-7 days) - review sternal precautions, initiate physical activity and provide home exercise/activity guidelines. Refer to comprehensive out-patient cardiac rehabilitation program!!

Note: monitor vital signs pre, during, and post exercise. Be aware of contraindications to exercise in the cardiac patient.

Question 22

Phase II of cardiac rehab

Answer 22

Acute outpatient: (may last up to 12 weeks) comprehensive program including individually prescribed and monitored exercise, and individual and group educational sessions aimed at reducing risk factors and secondary events.

Question 23

Phase III of cardiac rehab

Answer 23

Follows phase II: (may last 6 months or more) a continuation of phase II but patients no longer receive continuous telemetry monitoring during exercise and are more independent.