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NURS 2245 Cardiac > Week 1 PP > Flashcards

Week 1 PP Flashcards

1
Q

By ethnicity & sex which are most likely to die from heart disease…

A

Black Most Deaths for Males & Females

White male most likely

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2
Q

1 in 2 men
1 in 3 women

Will die of HD befire age 40

T or F

A

T

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3
Q

Percent of deaths caused by heart disease

A

25%

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4
Q

Risk factors for heart disease (5)

A

Weight
BP
Glucose
Cholesterol
Tobacco

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5
Q

In USA about how many die from Heart Disease annually…

A

1 million

Half men / Half women

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6
Q

Most fatal type of cardiovascular disease

A

Coronary Heart Disease

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7
Q

Most likely age group to die from cardiovascular disease…

A

80+

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8
Q

Blood flow through the heart

How & where does Unoxygenated blood enter the heart?

A

Superior Vena cava Upper Body

Inferior vena cava Lower Body

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9
Q

Blood flow through the heart

  1. Unoxygenated blood enters (this portion of the heart) ___ from the Superior & Inferior Vena Cava
  2. After it travles through this valve.
  3. Unoxygenated blood in the right ventricle is then sent to the lungs. Through this Valve & this blood vessels…
  4. Blood is sent back from the lungs via this blood vessels…
  5. Oxygenated blood reaches this part of the heart first…
  6. Then, oxygenated blood is sent through this valve to this part of the heart.
  7. Finally oxygenated blood is sent through this valve & blood vessel to be distributed to the body.
A
  1. Right Atrium
  2. Tricuspid
  3. Pulmonary Valve & Pulmonary Artery (Unoxygenated)
  4. Pulmonary Vein
  5. Left atrium
  6. Mitral / bicuspid valve & Left Ventricle
  7. Aortic valve / aorta
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10
Q

The Aorta has 3 arteries that extend from it.

Name them & their function

A

Starting most leftward

Left subclavian

Supply oxygen-rich blood to the upper body, including the left arm, neck, head, and part of the brain

Left common carotid artery (LCCA)

Supplies oxygen-rich blood to the head and neck, including the brain

Brachiocephalic

Carry oxygenated blood to the upper right side of the body, specifically supplying blood to the right arm, head, and neck.

Brachiocephalic branches into 2 arteries.

The right subclavian artery (for the arm)

Right common carotid artery (for the head and neck).

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11
Q

Purpose of Chordea Tendineae

A

Attaches to the Atrioventricular Valves (AV) and prevents them from prolapsing into the Atrium with contractions

Accomplished by anchoring the Valve leaflets to the papilary muscles.

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12
Q

Located near the temples on the side of the head.

Supplies blood to parts of the forehead and scalp.

Used to assess a pulse in infants or when other sites are inaccessible.

A

Temporal Artery

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13
Q

Found on both sides of the neck.

Supplies oxygenated blood to the brain, neck, and face.

Commonly checked during CPR for pulse assessment.

A

Carotid Artery

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14
Q

Not an artery but refers to the heartbeat heard over the apex of the heart using a stethoscope.

Reflects the left ventricular contraction.

Assessed for irregularities in rhythm or rate.

A

Apical Pulse (Heart)

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15
Q

Runs along the upper arm.

Supplies blood to the arm and hand.

Used to measure blood pressure or pulse in infants.

A

Brachial Artery

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16
Q

Located on the thumb side of the wrist.

Supplies blood to the forearm and hand.

Common site for measuring pulse in adults.

A

Radial Artery

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17
Q

Found in the groin area.

Supplies blood to the lower abdomen, thighs, and legs.

Checked during trauma or emergencies to assess circulation to the lower body.

A

Femoral Artery

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18
Q

Located behind the knee.

Supplies blood to the knee joint, thigh, and calf.

Assessed for circulation in the lower leg.

A

Popliteal Artery

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19
Q

Runs along the inner side of the ankle.

Supplies blood to the foot.

Checked to assess circulation to the foot.

A

Posterior Tibial Artery

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20
Q

Located on the top of the foot.

Supplies blood to the foot and toes.

Assessed to evaluate peripheral circulation, particularly in patients with vascular disease.

A

Pedal (Dorsalis Pedis) Artery

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21
Q

Types of Semilunar Valves:

_________

Located between the right ventricle and the pulmonary artery.

Prevents backflow of blood from the pulmonary artery into the right ventricle during diastole (heart relaxation).

______

Located between the left ventricle and the aorta.

Prevents backflow of blood from the aorta into the left ventricle during diastole.

A

Pulmonary Valve

Prevents backflow of blood from the pulmonary artery into the right ventricle during diastole (heart relaxation).

Aortic Valve

Located between the left ventricle and the aorta.

Prevents backflow of blood from the aorta into the left ventricle during diastole.

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22
Q

Composed of three cusps (or leaflets).

Open during ventricular systole (contraction) to allow blood to flow out of the heart.

Close during ventricular diastole to prevent blood from flowing back into the heart.

A

Semilunar Valves

Pulmonary & Aortic Valve

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23
Q

Cardiac Conduction System

Location: Upper right atrium, near the opening of the superior vena cava.

Function:
Acts as the heart’s natural pacemaker.
Initiates electrical impulses that set the heart’s rhythm (normal rate: 60–100 beats per minute).

Causes the atria to contract, pushing blood into the ventricles.

A

Sinoatrial (SA) Node

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24
Q

Sinoatrial (SA) Node

Location….

Function… (3)

A

Location:
Upper right atrium, near the opening of the superior vena cava.

Function:

Acts as the heart’s natural pacemaker.

Initiates electrical impulses that set the heart’s rhythm (normal rate: 60–100 beats per minute).

Causes the atria to contract, pushing blood into the ventricles.

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25
Q

Electrical Conduction System

____________

Location: Lower part of the right atrium, near the interatrial septum.

Function:
Receives impulses from the SA node and delays them slightly.

This delay allows the ventricles to fill with blood before contracting.

Passes the impulses to the bundle of His.

A

Atrioventricular (AV) Node

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26
Q

Electrical Conduction System

Atrioventricular (AV) Node

Location…..

Function…. (3)

A

Location

Lower part of the right atrium, near the interatrial septum.

Function

Receives impulses from the SA node and delays them slightly.

This delay allows the ventricles to fill with blood before contracting.

Passes the impulses to the bundle of His.

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27
Q

Electrical Conduction System

___________

Location: Runs from the AV node through the interventricular septum.

Function:
Transmits electrical impulses from the AV node to the ventricles.

Divides into the left and right bundle branches for each ventricle.

A

Bundle of His (Atrioventricular Bundle)

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28
Q

Electrical Conduction System

Bundle of His (Atrioventricular Bundle)

Location….

Function….. (2)

A

Location

Runs from the AV node through the interventricular septum.

Function

Transmits electrical impulses from the AV node to the ventricles.

Divides into the left and right bundle branches for each ventricle.

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29
Q

Electrical Conduction System

_______________

Location: Extend from the bundle of His along the interventricular septum.

Function:

Conduct impulses to the left and right ventricles.

Ensure synchronized contraction of both ventricles.

A

Left & Right Bundle Branches

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30
Q

Electrical Conduction System

Left and Right Bundle Branches

Location…..

Function….. (2)

A

Location:
Extend from the bundle of His along the interventricular septum.

Function:
Conduct impulses to the left and right ventricles.
Ensure synchronized contraction of both ventricles.

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31
Q

Electrical Conduction System

________

Location: Spread throughout the walls of the ventricles.

Function:
Distribute electrical impulses to the ventricular muscle cells.
Trigger the ventricles to contract, pumping blood to the lungs (via the right ventricle) and the rest of the body (via the left ventricle).

A

Purkinje Fibers

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32
Q

Electrical Conduction System

Purkinje Fibers

Location….

Function……

A

Location:

Spread throughout the walls of the ventricles.

Function:

Distribute electrical impulses to the ventricular muscle cells.
Trigger the ventricles to contract, pumping blood to the lungs (via the right ventricle) and the rest of the body (via the left ventricle).

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33
Q

SA Node → 2. _____ contract → 3. AV Node → 4. Bundle of His → 5. Bundle Branches → 6. Purkinje Fibers → 7. ______ contract.

A

SA Node → 2. Atria contract → 3. AV Node → 4. Bundle of His → 5. Bundle Branches → 6. Purkinje Fibers → 7. Ventricles contract.

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34
Q

Function: Supplies oxygenated blood to the left side of the heart, including the left atrium and ventricle.

A

Left Coronary artery

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35
Q

Left Coronary Artery

Branches:

Left Anterior Descending (LAD) Artery:

Circumflex (Cx) Artery:

A

Left Anterior Descending

Supplies blood to the front of the left ventricle and the interventricular septum.

Critical for maintaining function in the heart’s pumping chambers.

Circumflex Artery:

Supplies blood to the left atrium and the side and back of the left ventricle.

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36
Q

_____________

Function: Supplies oxygenated blood to the right side of the heart, including the right atrium, right ventricle, and parts of the conduction system.

Branches:

Right Marginal Artery:

Supplies the right ventricle.

Posterior Descending Artery (PDA):

Supplies blood to the bottom part of the ventricles and the back of the interventricular septum.

A

Right Coronary Artery

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37
Q

Cardiac output range

A

4 / 8 L per minute

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38
Q

Cardiac Output depends on….

A

HR × SV

Heart rate times Stroke Volume

Volume of blood ejected by the left ventricle per beat (normal: ~70 mL/beat).

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39
Q

Normal HR Adult

A

60 - 100

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40
Q

Which nervous system controls the HR

A

Autonomic

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41
Q

Stroke volume (SV) is the amount of blood ejected by the ____ ventricle with each heartbeat.

It is influenced by several factors:

A

Left Ventricle

HR, Preload, Afterload, contractility

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42
Q

Explain HR relationship with SV

A

At high heart rates, stroke volume may decrease because there is less time for ventricular filling (diastole).

A balanced heart rate allows optimal ventricular filling and maximum stroke volume.

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43
Q

At high heart rates, stroke volume may decrease because there is less time for ventricular filling aka…..

Ventricular emptying aka…

A

(diastole)

Systole

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44
Q

Afterload:

Definition: The resistance the ventricles must overcome to eject blood during systole.

Relationship to SV:

Increased afterload ….

Decreased afterload….

A

Increased Afterload:
(e.g., in hypertension or aortic stenosis): Makes it harder for the heart to pump blood, reducing stroke volume.

Decreased afterload:
Reduces the resistance, allowing the ventricles to eject blood more easily, increasing stroke volume.

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45
Q

Define:

  1. The resistance the ventricles must overcome to eject blood during systole.
  2. The degree of stretch of the ventricular walls at the end of diastole, before contraction.
A
  1. Afterload
  2. Preload
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46
Q

Contractility:

Definition: The strength of the heart’s contraction, independent of preload and afterload.

Relationship to SV:

Increased contractility….

Decreased contractility

A

Increased contractility (e.g., from sympathetic stimulation or inotropic drugs): Enhances the force of contraction, increasing stroke volume.

Decreased contractility (e.g., in heart failure or myocardial ischemia): Weakens the contraction, reducing stroke volume.

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47
Q

_____ = Preload (↑) + Contractility (↑) - Afterload (↓)

A

Stroke Volume (SV)

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48
Q

Ejection Fraction (EF) is….

A

Percentage that reflects the efficiency of the heart’s pumping ability

Specifically the proportion of blood pumped out of the left ventricle with each heartbeat.

It is a key indicator of heart function, especially in diagnosing heart conditions such as heart failure.

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49
Q

StrokeVolume ÷ End-DiastolicVolume
× 100 =

A

Ejection Fraction

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50
Q

Determined by left ventricular end-diastolic volume

A

Preload

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51
Q

Degree of myocardial fiber stretch at the end of diastole…

A

Preload

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52
Q

Starling’s law is associated with Preload

Define…

A

More the heart is filled during diastole the more forcefully it contracts.

(Upto a point)

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53
Q

Preload

Excessive filling = Excessive Left Ventriclar End-Diastolic Volume - (LVEDV) = Overstretched = (High/ Low) Cardiac Output

A

Low CO

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54
Q

Pressure ventricles must overcome to eject blood into the peripheral blood vessels

Define….

A

Afterload

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55
Q

Afterload

Pressure ventricles must overcome to eject blood into the peripheral blood vessels

Is influenced by this valve….

A

Aortic

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56
Q

Increased demand to meet tissues metabolic needs will have this effect on blood vessels & blood pressure….

A

Vasodilation in active tissues, which increases blood flow.

Cardiac output increases to meet this demand, leading to a temporary increase in systolic blood pressure while diastolic pressure may remain unchanged or decrease slightly.

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57
Q

Force exerted against the blood vessels wall is…

A

Blood pressure

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58
Q

Autonomic NS & _____ regulate blood pressure

A

Kidneys

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59
Q

Autonomic NS (Sympathetic/ Parasympathetic)

Have these types of sensory receptors….

A

Chemo: respond to chemical changes ie. Hypoxemia

Baroreceptors: Respond to pressure

Stretch receptors: Sense low blood volume

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60
Q

Autonomic NS

Location:

Chemoteceptors
Baroreceptors
Stretch receptors

A

Chemoteceptors: Aortic arch & Carotid bodies

Baroreceptors: Aortic Arch & Carotid sinus

Stretch receptors: Vena Cava & Right Atrium

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61
Q

Affects of Alpha ¹ & Beta ¹ response in the sympathetic NS.

A

A¹ = Vasoconstriction = Increased BP

B¹ = Increased HR, AV Conduction, Contractility

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62
Q

Renal system does what when BP decreases…

A

Hold Sodium & Water

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63
Q

They renal system may activate this in response to low bp…

A

RAAS

Renin-Angiotensin-Aldostrone system

Increases Fluid / Blood Volume, increasing BP

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64
Q

Renal system to combat hypotension…

  1. _____ release triggers the conversion of angiotensinogen to angiotensin I, which is then converted to angiotensin II.
  2. Angiotensin II causes ____ and stimulates aldosterone release, leading to sodium and water retention in the kidneys.
A
  1. Renin
  2. vasoconstriction
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65
Q

Renal System Influencing factors

Antidiuretic hormone

A

Increase BP

Causes kidney to reabsorp H2O

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66
Q

Renal System Influencing factors

Natriuretic peptides

A

Lowers BP

Diuresis & Renal Vasodilation

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67
Q

Bradykinin & Histamine

Affect on BP…

A

Vasodilation Lower BP

Increase capillary permeability

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68
Q

Name the 3 main arteries located on the heart.

A

Left Anterior Descending

Right Coronary Artery

Circumflex

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69
Q

Which part of BP does blood flow…

A

Systolic (Primary)

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70
Q

What often causes a heart murmur ( a sound heard between heart beats)

A

Blood flowing through a restriction

Ie. Aortic stenosis/ mitral stenosis

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71
Q

Labs

Creatine Kinase (CK):

Normal Values…

Relevance…

A

Men: 38–174 U/L
Women: 26–140 U/L

Relevance: CK levels rise in muscle damage, including cardiac or skeletal injury. Non-specific for heart conditions.

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72
Q

Labs

Creatine Kinase-MB (CK-MB):

Normal Values….

Relevance….

Critical Values…

A

Norms:
0–7 ng/mL or 0–5% of total CK.

Relevance:
CK-MB rises 3–6 hours after a heart attack, peaks at 12–24 hours, and returns to normal within 48–72 hours.

Critical Values:

Levels greater than 10 ng/mL strongly suggest myocardial infarction.

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73
Q

Labs

Lactate Dehydrogenase (LDH):

Normal Values….

Relevance…

Critical Values…

A

Normal Values: 140–280 U/L (varies by lab).

Relevance: LDH levels rise in tissue damage, including the heart. LDH-1 and LDH-2 isoenzymes are heart-specific, with LDH-1 > LDH-2 often indicating myocardial infarction.

Critical Values: LDH levels >400 U/L may indicate significant tissue injury.

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74
Q

Troponin (I and T):

Normal Values:

Troponin I…
Troponin T…

Relevance….

Critical Values…

A

Troponin (I and T):

Normal Values:

Troponin I: <0.04 ng/mL.
Troponin T: <0.01 ng/mL.

Relevance: Troponin rises 4–6 hours after myocardial injury, peaks at 12–24 hours, and remains elevated for 7–10 days.

Critical Values: Levels >0.40 ng/mL strongly indicate a myocardial infarction.

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75
Q

Natriuretic Peptide (BNP):

Normal Values….

Relevance….

Critical Values…..

A

Natriuretic Peptide (BNP):

Normal Values: <100 pg/mL.

Relevance: Elevated BNP indicates heart failure severity. Levels >400 pg/mL are highly suggestive of heart failure, while 100–400 pg/mL warrants further investigation.

Critical Values: >900 pg/mL is associated with severe heart failure.

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76
Q

Homocysteine:

Normal Values….

Relevance…..

Critical Values….

A

Homocysteine:

Normal Values: 4–15 µmol/L.

Relevance: Levels >15 µmol/L indicate an increased risk of atherosclerosis and cardiovascular disease.

Critical Values: Levels >30 µmol/L suggest severe risk for vascular disease.

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77
Q

C-Reactive Protein (CRP):

Normal Values:

Relevance:

Low risk….

Moderate risk….

Critical Values….

A

C-Reactive Protein (CRP):

Normal Values: <3.0 mg/L.

Relevance:

Low risk: <1.0 mg/L.

Moderate risk: 1.0–3.0 mg/L.
High risk: >3.0 mg/L for cardiovascular events.

Critical Values: High-sensitivity CRP (hs-CRP) >10 mg/L indicates acute inflammation.

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78
Q

Serum Lipids:

Normal Values:

Total Cholesterol: ____ mg/dL.
LDL (Bad Cholesterol): ____ mg/dL.
HDL (Good Cholesterol): ____mg/dL.
Triglycerides: ____ mg/dL.

Relevance….

Critical Values: LDL _____/dL or total cholestrol ____ mg/dL is high risk for coronary artery disease.

A

Normal Values:

Total Cholesterol: <200 mg/dL.
LDL (Bad Cholesterol): <100 mg/dL.
HDL (Good Cholesterol): >60 mg/dL.
Triglycerides: <150 mg/dL.

Relevance: Elevated LDL or low HDL increases cardiovascular risk.

Critical Values: LDL >190 mg/dL or total cholesterol >240 mg/dL is high risk for coronary artery disease.

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79
Q

Electrolytes:

Normal Values:
Sodium (Na+)……
Potassium (K+)…
Calcium (Ca2+)…..
Magnesium (Mg2+)….

Relevance: Imbalances can cause arrhythmias and impact heart contractility.

Critical Values….

A

Electrolytes:

Normal Values:
Sodium (Na+): 135–145 mmol/L.
Potassium (K+): 3.5–5.0 mmol/L.
Calcium (Ca2+): 8.5–10.2 mg/dL.
Magnesium (Mg2+): 1.7–2.2 mg/dL.

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80
Q

Cardiac Enzymes

cTnT; cTnl (Troponin)

Onset, Peak, Duration

A

4 - 6

18 - 24

Up to 10 days

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81
Q

Cardiac Enzymes

CKMB

Onset, Peak, Duration

A

4 - 12

18 - 24

36 - 48

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82
Q

Cardiac Enzymes

LDH

Onset, Peak, Duration

A

6 - 12

24 - 48

6 - 8 days

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83
Q

Cardiac Enzymes

Myoglobin

Onset, Peak, Duration

A

1 - 2 hrs

8 - 10 hrs

24 hrs

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84
Q

BNP

VALUES

<100
100 - 300
>300
>600
>900

A

<100: No heart failure

100 - 300: Suggests possible

> 300: Mild HF

> 600: Mod HF

> 900: Severe HF

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85
Q

____ is secreted from the heart when stretched.

A

BNP

Elevations > 300 mild HF
>600 Mod HF
>900 Severe HF

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86
Q

Difference between 12 & 18 lead ELE cardio testing

A

18 can detect problems with Right Ventricular & Posterior Myocardial Infarction

Leads are placed on Chest, Arms, Legs

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87
Q

12 / 18 leads can diagnosis… (5)

Key data provided… (5)

Describe basically what it is and used for…

A

Diagnoses arrhythmias, ischemia, myocardial infarction, electrolyte imbalances, and structural abnormalities.

Data:

Heart rate, rhythm, axis, conduction delays, and ischemic changes (e.g., ST-segment elevation).

medical test that measures the electrical activity of the heart and is a key tool in diagnosing cardiovascular conditions:

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88
Q

Ambulatory ECG (Holter Monitor or Event Recorder) - Difference between them…

Type of data it records…

A

Holter Monitor: Portable device worn for 24–48 hours - Continuous monitoring

Event Recorder: Weeks - Records only during symptoms- Manuel & Automatic

Data:
Detects intermittent arrhythmias, monitors heart rate variability, and evaluates symptoms like palpitations or dizziness.

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89
Q

Exercise/ Drug induced Stress Test (dobutamine).

Purpose:
Identifies…(4)

A

Ischemia (Reduced Blood Flow) or

Coronary artery disease that may not be evident at rest.

Advantage: Detects exercise-induced changes such as ST-segment depression or arrhythmias.

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90
Q

Electrophysiologic Study (EPS)

Description….

Purpose:
Diagnoses arrhythmias and identifies their origins.

Evaluates conduction pathways and determines the effectiveness of treatments like ablation.

Procedure…

A

Invasive procedure uses catheters inserted into blood vessels and guided to the heart to record electrical activity from within.

Procedure
Electrical impulses are delivered to provoke arrhythmias under controlled conditions, allowing mapping of abnormal pathways.

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91
Q

Resting ECG/EKG

Purpose….

Prep:

Procedure….

Post-Procedure Care:

A

Purpose:
Detects arrhythmias, myocardial infarction, ischemia, and structural heart issues.

Provides a baseline heart electrical activity

Prep:
No specific preparation required.
Avoid heavy meals, caffeine, and smoking before the test to reduce interference.

Wear loose, comfortable clothing.

Procedure:
Electrodes are placed on the chest, arms, and legs.
Patient lies still while the ECG machine records heart activity for a few minutes.

Post procedure

No recovery needed; the test is non-invasive.
Resume normal activities immediately.

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92
Q

Exercise Stress Test

Purpose:

Prep:

Procedure:

Post-Procedure Care:

A

Purpose:
Evaluates heart function under stress (exercise).

Detects ischemia, arrhythmias, or exercise intolerance.

Prep:
Avoid caffeine, smoking, and heavy meals 2–4 hours before the test.

Wear comfortable exercise clothing and shoes.

Inform the provider of any medications being taken.

Procedure:

Patient walks on a treadmill or pedals a stationary bike with increasing intensity.

ECG, blood pressure, and symptoms are monitored.

Post-Procedure Care:

Rest and rehydrate after the test.

Report any persistent chest pain, dizziness, or discomfort.

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93
Q

Chemical Stress Test

Purpose:

Prep:

Procedure:

Post-Procedure Care:
(Meds withheld?)

A

Chemical Stress Test

Purpose:

Simulates the effects of exercise on the heart using medication (e.g., dobutamine, adenosine).

Used for patients unable to exercise.

Procedure:

Medication is administered intravenously to stress the heart.
ECG, blood pressure, and symptoms are monitored during the test.

Post-Procedure Care:

Rest after the test.

Monitor for any lingering side effects like headache, nausea, or palpitations.

Prep:

Avoid caffeine, smoking, and heavy meals for at least 4 hours before the test.

Certain medications (like beta-blockers) may need to be withheld—consult your provider.

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94
Q

Ambulatory ECG (Holter Monitor)

Purpose:

Prep:

Procedure:

Post-Procedure Care:

A

Ambulatory ECG (Holter Monitor)

Purpose:

Monitors heart rhythm continuously for 24–48 hours to detect intermittent arrhythmias or evaluate symptoms like palpitations.

Prep:

Shower before the appointment (as the monitor cannot get wet).

Avoid using lotions or oils on the skin.

Procedure:

Electrodes are attached to the chest and connected to a small recording device worn on the body.

Patient resumes normal daily activities while recording symptoms and activities in a diary.

Post-Procedure Care:

Return the monitor to the healthcare provider for analysis.

Follow up with results and next steps as advised.

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95
Q

Electrophysiologic Study (EPS)

Purpose:

Prep:

Procedure:

Post-Procedure Care:

A

Description: A catheter is sent to your heart and a Dr. triggers electric induced arythmias to: Determine cause of Arythmias, Determine Trouble with Electrical Pathway, & need for ablation (Creating Scars in the heart to prevent abnormal Arrhythmia)

Purpose:

Diagnoses arrhythmias, evaluates conduction pathways, and determines the need for treatments like ablation or pacemaker implantation.

Prep:

Avoid food and drink for 6–8 hours before the test.

Inform the provider about medications and stop certain drugs as directed.

Arrange for someone to drive you home post-procedure.

Procedure:

Catheters are inserted through veins (e.g., femoral vein) and guided to the heart.

Electrical impulses are delivered to provoke arrhythmias for mapping.
Procedure is performed under local anesthesia and conscience sedation.

Post-Procedure Care:

Monitor puncture site for bleeding or swelling.

Avoid strenuous activity for 24–48 hours.

Report any severe pain, swelling, or fever to the provider.

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96
Q

Evaluates size & posistion of heart

Remove metal jewelry from chest area

Contraction in Preggers.

No aftercare

A

X ray

97
Q

Echocardiogram (Echo)

Purpose…

Prep….

Procedure…

Post-Procedure Care…

Contraindications…

A

Echocardiogram (Echo)

Purpose:

Assesses heart structure, function, and blood flow using Ultrasound

Detects valve disorders, heart failure, or congenital heart defects.

Prep:

No specific preparation for a transthoracic echo.

For transesophageal echo (TEE): Avoid eating or drinking 6 hours before the test.

Procedure:

Transthoracic Echo (TTE): A probe is placed on the chest to capture images.

Transesophageal Echo (TEE): A probe is passed down the esophagus for clearer images.
Takes about 30–60 minutes.

Post-Procedure Care:

For TEE: Avoid eating or drinking until the throat numbing wears off.

Contraindications:

For TEE: Esophageal abnormalities or swallowing difficulties.

98
Q

Ultrasound (General Cardiovascular Ultrasound)

Purpose:

Prep:

Procedure:

Post-Procedure Care:

Contraindications:

A

Purpose:

Non-invasive imaging of blood vessels and surrounding tissues.

Evaluates blood flow, blockages, and vessel structure.

Prep:

No specific preparation for most ultrasounds.

For abdominal vessel imaging: Fasting may be required.

Procedure:

A transducer is moved over the skin, emitting sound waves to create images.

Takes 30–60 minutes.

Post-Procedure Care:

No recovery needed; it’s non-invasive.

Contraindications:

None; safe for most patients, including pregnant individuals.

99
Q

Arteriogram (Angiogram)

Purpose:

Prep…

Procedure:

Post-Procedure Care:

Contraindications:

A

Purpose:

Visualizes blood flow in arteries to detect blockages, aneurysms, or malformations.

Procedure:

A catheter is inserted into a blood vessel (usually in the groin or arm).
Contrast dye is injected, and X-rays are taken to map blood flow.

Completed in 1–2 hours.

Post-Procedure Care:

Monitor insertion site for bleeding or swelling.

Avoid strenuous activity for 24–48 hours.

Prep:

Avoid eating or drinking for 6–8 hours before the test.

Inform the provider about allergies (especially to contrast dye) or blood-thinning medications.

Contraindications:

Kidney dysfunction (risk from contrast dye).

Severe allergies to contrast dye.

100
Q

Coronary Arteriogram (Cardiac Catheterization)

Purpose…

Prep…

Procedure:

Post-Procedure Care:

A

Coronary Arteriogram (Cardiac Catheterization)

Purpose:

Identifies blockages in coronary arteries and evaluates heart function.
Guides interventions like stent placement or angioplasty.

Prep:

Fast for 6–8 hours before the procedure.

Inform the provider about allergies or current medications.

Discontinue blood thinners if instructed.

Procedure:

A catheter is guided through a blood vessel to the coronary arteries.

Contrast dye is injected to visualize blockages.

Completed in 30–60 minutes.

Post-Procedure Care:

Monitor for bleeding at the catheter site.

Lie flat for several hours to reduce bleeding risk.

Report any chest pain, swelling, or difficulty breathing.

101
Q

Cardiac Catheterization

Dye is injected into…

A

Coronary arteries

102
Q

Cardiac Catheterization

Is for Diagnosis & Evacuation of… (4)

A

Great vessel disease

Coronary artery occlusion

Valvular disease (Stenosis, insufficiency, regurgitation)

Atrial or Ventriclar Septal Defect

103
Q

Cardiac Catheterization measures which kind of pressure…

A

Cardiac & Pulmonary

104
Q

Contradictions for Cardiac Catheterization

A

Renal insufficiency
Coagulopathy
Fever / Systemic infection
Ventricular instability
Uncompensat3d heart failure
Contrast dye allergies

105
Q

Pre Cardiac Catheterization

  1. Consent needed?
  2. Hold…
A
  1. Yes
  2. Food & Fluids 4 - 6 hrs
    Nephrotoxic meds 48hrs - 2 wks
    (Metformin? NSAIDs: Ibuprofen, Naproxen
    ACE Inhibitors: Lisinopril
    ARBs: Losartan
    Proton Pump Inhibitors (PPIs): Omeprazole, Pantoprazole
    Diuretics: Furosemide (Loop Diuretic), Hydrochlorothiazide (Thiazide)

Anticoagulantion meds maybe with held

Warfarin
Apixaban
Rivaroxaban
Dabigatran
Enoxaparin

106
Q

Left heart cath

Assess: left sided pressure, mital/ aortic valves, coronary artery circulation

Describe the path of the cath procedure: Femoral, radial, Brachial artery to….

A

Aorta, across aortic valve, LV,

107
Q

Coronary angiography

Evaluates which arteries…

A

RCA Right Coronary Artery: Supplies blood to All Right side, AV & SA node, Left Ventricle Anterior wall.

LCA Left Coronary Artery

Branches:

Left Anterior Descending (LAD): Supplies the front of the left ventricle and the interventricular septum.

Circumflex Artery (LCX): Supplies the left atrium and the outer portion of the left ventricle.

108
Q

Right heart cath (Evaluates valves & intracardic pressures)

Will enter either of the 2 vena cava.

Which vein allows access to each…

A

Femoral - Inferior vena cava

Basilic - Superior

109
Q

Key differences between Right & Left Cardiac Catheterization.

Assess site…

Focus:

Risk Level:

A

Assess site

Right: Veins (venous system).
Left: Arteries (arterial system).

Focus:

Right: Evaluates pressures and flow on the right side and pulmonary circulation.

Left: Focuses on coronary arteries and left ventricle function.

Risk Level:

Right: Lower risk, less invasive.

Left: Higher risk, involves dye and arterial puncture.

110
Q

Describe the directional path foe Right Cath

Femoral vein (Inferior vena cava) or
Basilic vein (Superior vena cava)

To…..

A

RA, RV, PA

111
Q

Biggest alert post procedure for Cardiac Catheterization…

A

Resuscitation equipment needed

Ventricular arythmias may occur

112
Q

How often to monitor VS post procedure cardiac Catheterization…

A

Q15Min first 1hr

Q30min for next hour

113
Q

Post cardiac Catheterization

Evaluate…

A

Peripheral pulse
Skin Color
Temp
Sensation

114
Q

Post cardiac Catheterization

Ensure to assess this site…

A

Site for assess for cather

Bleeding
Hematoma
Pseudoaneurysm

115
Q

After cardiac Catheterization ensure that patient is in semi fowlers position…

A

Flase

May need to lay flat 1 - 6 hrs

116
Q

Describe the differences in complications for Rigjt & Left Cardiac Catheterization.

What complications do they have in common…

A

Right:
Embolus
Vagal Response
Artial Dysrhthmias

Left:
MI
CVA
Ventricular Arrhythmia
Artery bleeding

BOTH:
Tamponade
Hypovolemia
Hematoma
Pseudo aneurysms
Contrast dye reaction
Infection
Death

117
Q

Contrast induced Nephropathy

Best Prevention (4)

Harmful (2)

A

Best

ID patient at risk
Hydration
Limit contrast exposure
Withhold Nephrotoxic Meds

Harmful

Furosemide
Haemodialysis

There are also Not Helpful Strategies
Sodium bicarbonate
Ascorbic acid
Acetylcysteine
Statin plus fluid
Amimophylline

118
Q

Heart sounds

Position the Patient….

A left lateral decubitus position may be used for better auscultation of ….

A

Position the Patient:

Ensure the patient is in a comfortable position, typically supine or sitting upright.

A left lateral decubitus position may be used for better auscultation of low-pitched sounds (e.g., mitral stenosis).

low-pitched sounds (e.g., mitral stenosis).

119
Q

Heart sounds

Aortic Valve Area:

Location….

Sound….

A

Aortic Valve Area:

Location: 2nd ICS, right of the sternum.
Sound: Best for high-pitched sounds like aortic stenosis or regurgitation.

120
Q

Heart sounds

Pulmonic Valve Area:

Location….

Sound…

A

Pulmonic Valve Area:

Location: 2nd ICS, left of the sternum.
Sound: Best for pulmonic stenosis or regurgitation.

121
Q

Heart sounds

Erb’s Point:

Location….

Sound…

A

Erb’s Point:

Location: 3rd ICS, left of the sternum.
Sound: Good for listening to overall heart sounds and murmurs

122
Q

Heart sounds

Tricuspid Valve Area

Location….

Sound…..

A

Location: 4th or 5th ICS, left of the sternum.

Sound: Best for low-pitched murmurs of tricuspid stenosis or regurgitation.

123
Q

Heart Sounds

Mitral Valve Area (Apical):

Location….

Sound….

A

Mitral Valve Area (Apical):

Location: 5th ICS, midclavicular line.
Sound: Best for mitral stenosis, regurgitation, and S1 sounds

124
Q

Heart Sounds

Listen for Specific Sounds:

Normal Heart Sounds… Name

Extra Heart Sounds… name / cause

Murmurs: Graded 1–6 for intensity, caused by turbulent blood flow.

Pericardial Friction Rub: A scratchy sound from pericarditis.

A

Listen for Specific Sounds:

Normal Heart Sounds: S1 (“lub”) and S2 (“dub”).

Extra Heart Sounds: S3 and S4, often heard in heart failure or stiff ventricles.

Murmurs: Graded 1–6 for intensity, caused by turbulent blood flow.

Pericardial Friction Rub: A scratchy sound from pericarditis.

125
Q

What procedure uses US waves to visualize cardiac structures & measure ejection Fraction ( Percentage of blood pumped out of ventricles with each contractions- 50 - 70% )

A

Echocardiogram

126
Q

Which lab values are used to assess kidney function prior to Cardiac Catheterization?

Why assess kidney function?

A

BUN
Creatinine

Assess due to the contrast dye needs to be urinated out or else is toxic to kidneys.

127
Q

Patient posistion after cardiac Catheterization

A

Flat 4 - 6 hrs after

128
Q

Preload, Contractility, Afterload

Describe using the balloon analogy

A

Preload: Refers to the stretchyness of the ballon in relation to the amount of air (blood) that was in it at the End of Filling (Diastole).

Sterling’s law states Preload the more stretch in the ventricles in Diastole the great the contraction during systole (Ejection)

Contractility: Ballons inherit ability to stretch - IS IT DEPENDENT ON PRE / AFTERLOAD

Afterload: The knot in the end of the ballon closing it. Afterload is the force systole must overcome to enter into the aorta

129
Q

Angiogram & Cardiac Catheterization are closely related but different

Scope:
Broad diagnostic/interventional tool

Imaging test for blood vessels

Purpose
Measures heart function and pressures

Visualizes blood vessel abnormalities

Invasiveness
Involves catheter placement

Performed as part of catheterization

Use of Contrast Dye

Optional depending on purpose

Always involves dye injection

Common Applications

Diagnosing or treating heart disease

Detecting coronary artery blockages

A

Scope:
Broad diagnostic/interventional tool
Cardiac Catheterization

Imaging test for blood vessels
Angiogram

Purpose
Measures heart function and pressures
Cardiac Catheterization

Visualizes blood vessel abnormalities
Angiogram

Invasiveness
Involves catheter placement
Cardiac Catheterization

Performed as part of catheterization
Angiogram

Use of Contrast Dye

Optional depending on purpose
Cardiac Catheterization

Always involves dye injection
Angiogram

Common Applications

Diagnosing or treating heart disease
Cardiac Catheterization

Detecting coronary artery block
Angiogram

130
Q

LCA Left Coronary Artery

Branches….

A

Left Anterior Descending (LAD): Supplies the front of the left ventricle and the interventricular septum.

Circumflex Artery (LCX): Supplies the left atrium and the outer portion of the left ventricle.

131
Q

What are the two main branches of the left coronary artery in most people? Select all that apply:

A. posterior descending artery
B. left anterior descending artery
C. right marginal branch
D. circumflex artery

A

B: Left anterior descending artery
D: Circumflex

The left anterior descending artery and circumflex artery are the TWO main branches of the left coronary artery.

132
Q

Which artery circles around onto the posterior side of the heart and supplies the left atrium and ventricle?

A. right marginal artery
B. posterior descending artery
C. circumflex artery
D. diagonal branches

A

C: The Circumflex artery wraps around the left coronary artery onto the posterior side of the heart and supplies the left atrium and ventricle.

133
Q

What structure in the heart does the right marginal artery supply?

A. left atrium
B. right ventricle
C. SA node
D. right atrium

A

B: Right Marginal Artery supplies the right ventricle & extends to the apex of the heart

134
Q

What artery supplies the interventricular septum, left ventricular, some of the right ventricle and bundle branches?

A. left anterior descending artery
B. posterior descending artery
C. left marginal branches (obtuse)
D. right marginal artery

A

A: Left anterior descending artery supplies the interventricular septum, left ventricle, some of the right ventricle and bundle branches in most people.

135
Q

What artery or branches come off the left anterior descending artery and supply the left ventricle?

A. anterior ventricle branches
B. left marginal branches (obtuse)
C. atrial branches
D. diagonal branches

A

D: Diagonal branches come off the left anterior descending artery and supply the left ventricle.

136
Q

What artery can originate from either the right or left coronary artery, is found on the posterior side of the heart, and supplies the AV node in some people along with supplying the right and left ventricle, and the interventricular septum?

A. right marginal artery
B. posterior descending artery
C. circumflex artery
D. left anterior descending artery

A

The answer is B. The posterior descending artery most commonly arises from the right coronary artery. It supplies the AV node in some people along with supplying the right and left ventricle, and the interventricular septum.

137
Q

What are the branches that come off of the circumflex artery and supply the left ventricle?

A. right marginal branches
B. diagonal branches
C. right anterior ventricle branches
D. left marginal branches (obtuse)

A

The answer is D. The left marginal branches (obtuse) come off of the circumflex artery and supply the left ventricle.

138
Q

The left anterior descending artery is part of the __________ coronary artery.

Right
Left

A

LEFT

139
Q

In most people, the posterior descending artery mostly originates from the ___________ coronary artery.

Right
Left

A

Right

140
Q

The right anterior ventricle branch is part of the __________ coronary artery.
Right
Left

A

Right

141
Q

Left Anterior Descending (Supplies blood where)

Circumflex Artery (Supplies blood where)

WHICH ARTERY DO THEY BOTH COME FROM

A

LAD Supplies blood to the Anterior Left Ventricle and the interventricular septum.

Critical for maintaining function in the heart’s pumping chambers.

Circumflex
Left Atrium
Posterior & Lateral Left ventricle

Left Coronary Artery LCA

142
Q

Which artery is aka widow maker

A

Left Anterior Descending

Blockages can cause Anterior wall mycardio infaction.

143
Q

Stroke volume is…

A

The amount of blood ejected by left ventricle in a single contraction

144
Q

Percentage of blood ejected from the left ventricle with EACH heartbeat compared to the total amount of blood in the ventricle at the end of diastole (filling phase).

A

Ejection Fraction 55 - 70%

145
Q

(Electrophysiologic Study (EPS) / Cardiac Catheterization) : Focuses on blood flow and structural issues of the heart.

(Electrophysiologic Study (EPS) /Cardiac Catheterization) : Focuses on the heart’s electrical activity, primarily for diagnosing and managing arrhythmias.

A

Cardiac Catheterization focus on blood flow and structural issues

Electrophysiologic Study focus on electrical activity- Diagnoses & treats arrhythmias

146
Q

Name procedure:
Diagnosing coronary artery disease (blockages).
- Performing interventions like stenting or angioplasty.
- Assessing valve function. - Diagnosing arrhythmias.

Name procedure
- Identifying areas for ablation therapy.
- Evaluating syncope or palpitations

A

Cardiac Catheterization
Diagnosing coronary artery disease (blockages).
- Performing interventions like stenting or angioplasty.
- Assessing valve function. - Diagnosing arrhythmias.

Electrophysiologic Study
- Identifying areas for ablation therapy.
- Evaluating syncope or palpitations

147
Q

This procedure

Measures electrical signals from the heart

Used to evaluate the following

Diagnosing arrhythmias (e.g., atrial fibrillation, ventricular tachycardia).

Detecting myocardial infarction (heart attack) or ischemia.

Evaluating heart function in conditions like heart failure or cardiomyopathy.

Monitoring treatment effectiveness (e.g., pacemaker, medications).

Pre-operative cardiac risk assessment.

A

ECG

148
Q

Echocardiogram measures…

Which structure…

A

Ejection Fraction.

Total Percent of blood ejected from left ventricle in 1 contraction, in relation to amount of blood in left ventricle after diastole (Filling)

Heart valves Aortic

149
Q

Normal percentage of ejection Fraction

A

55 - 70%

150
Q

Difference between stroke volume & ejection Fraction

A

Stoke volume: Amount of blood ejected from 1 contraction of the left ventricle. 50 - 100mL

Ejection Fraction: Percent of blood ejected from LV in relation to how much it was filled during diastole

151
Q

Electrophysiologic Study

What type of problems are they looking for…

Where in the heart is the catheter placement….

What type of treatment that will be given if problem is found….

A

Electrical problem

Right side with the SA, AV, Bundle of His, Branches, fibers

Ablation

152
Q

Cardiac Output (CO) measures the volume of blood the heart pumps out in …..

Volume

A

1 minute

CORRECT

4- 7 L / minute

153
Q

CO depends on relationship between…

A

HR & Stroke Volume

154
Q

Echocardiogram (Echo) OR Electrocardiogram (ECG/EKG)

Purpose Assesses heart structure and function.

Records the electrical activity of the heart.

Focus Provides images of the heart’s chambers, valves, walls, and blood flow.

Monitors heart rhythms and detects electrical abnormalities.

Procedure Uses ultrasound to create detailed images of the heart.

Uses electrodes attached to the skin to measure electrical signals.

Common Uses - Evaluate heart function (e.g., ejection fraction)
- Detect valve diseases, clots, or structural abnormalities
- Assess blood flow in heart and vessels

  • Diagnose arrhythmias
  • Detect ischemia, heart attack, or conduction disorders
  • Monitor heart rhythm over time

Imaging Produces real-time images of the heart (ultrasound).

Does not produce images; outputs a graph of electrical activity.

Invasiveness Non-invasive (or minimally invasive with transesophageal echo).

Non-invasive.

Duration 15–45 minutes.

5–10 minutes.

Outcome Visual and functional assessment of the heart.

Detection of electrical or rhythm abnormalities.

Conditions Diagnosed
- Heart failure
- Valve diseases
- Congenital defects -

-Arrhythmias
- Myocardial infarction
- Heart block

A

Top = Echocardiogram

Bottom = ECG/EKG

155
Q

Ejection Fraction is measured by…

A

Echocardiogram

156
Q

determined by L ventricular end-diastolic volume (LVEDV)

A

Preload in Ejection Fraction

157
Q

Increased preload will have this affect on CO

A

Increased

CO = Cardiac output

158
Q

Medications to increase afterload…

A

Ace inhibitors & ARBS

159
Q

Interventions to increase preload….

A

Legs elevated : increase Venus return
SCD / TED Hose

Meds: Vasoconstrictors Norepinephrine

Positive inotropic drugs

160
Q

Which valve most affects afterload

A

Aortic semilunar valve

161
Q

force of cardiac contraction independent of preload

A

Contractility

162
Q

Meds for afterload…

A

BP meds

ACE INHIBITORS
ARBS
CCB
Diuretics
BB

163
Q

Increased Afterloads affect on CO

A

Decreased

Afterload is the force left ventricle must overcome come in the aortic valve to enter the systemic system

164
Q

Sympathetic NS: Describe Alpha ¹ affects….
Describe its affects on Afterload…

Describe Beta¹ affects (3)

A

Alpha¹: Causes vasoconstriction of coronary blood vessels, increasing blood pressure and afterload.

Beta¹

Increased Heart Rate (Chronotropy): Stimulates the sinoatrial (SA) node, increasing the rate of depolarization.

Increased Contractility (Inotropy): Enhances the force of contraction in ventricular myocardium.

Increased Conduction Velocity (Dromotropy): Speeds up electrical conduction through the atrioventricular (AV) node.

165
Q

RAAS

Renin to Angiotensin 1

Angiotensin 1 - Angiotensin II

What Angiotensin II do….

Angiotensin II To Aldosterone

Aldosterone does…

A

Angiotensin II increases Vasoconstriction (Increased BP)
& Releases Aldosterone

Aldosterone increases sodium & water

166
Q

Ace inhibitor will lower BP by interference with the RAAS By blocking angiotensin 1 - 2 conversion.

Name SE…

A

Dry cough
Hyperkalemia
Hypotension
Angioedema Death
Renal Dysfunction

167
Q

Losartan (Cozaar)
Valsartan (Diovan)
Irbesartan (Avapro)
Olmesartan (Benicar)
Candesartan (Atacand)
Telmisartan (Micardis)

Examples of…

A

ARBS Medications

168
Q

( This type of medication ) prevent angiotensin II from binding to its receptor, thus causing blood vessels to relax and widen, which lowers blood pressure.

A

ARBS

Losartan (Cozaar)
Valsartan (Diovan)
Irbesartan (Avapro)
Olmesartan (Benicar)
Candesartan (Atacand)
Telmisartan (Micardis)

169
Q

Blood flows to the coronary arteries from the ____, primarily during ____.

A

Aorta / diastole

170
Q

Age Related Changes

valves: calcification=

A

Murmurs ( favor left side)

171
Q

Age Related

Conduction: SA fibrotic=

A

increase time, dysrhythmias

172
Q

Age Related Changes

LV: hypertrophy=

A

Decreased filling time, Decreased ability to meet demands

173
Q

Age Related Changes

large arteries: stiff, increase SVR (Systemic Vascular Resistance- Hard to push blood through blood vessels) leads to:

A

HTN, wide pulse pressure

174
Q

Age Related Changes

baroreceptors:

A

Less sensitive, postural and postprandial hypotension

175
Q

Pulse pressure define

Normal/ Abnormal

Example

A

Difference between Systolic & Diastolic BP

NORMAL 30 - 40

Wide pulse pressure >40
Aortic regurgitation or arteriosclerosis (stiffening of the arteries).

Narrow pulse pressure <30
Heart failure or significant blood loss.

176
Q

Can S³ be a normal finding

A

S3 can be normal in young people e.g. 15 year old)

177
Q

Common abnormal finding in elderly

A

aortic murmur
*calcification in 80% of older adults

178
Q

Define basic

Homocysteine

A

protein that increases the risk of heart disease

179
Q

C reactive protein

A

blood test used to measure the level of inflammation in the body; may indicate conditions that lead to cardiovascular disease

180
Q

Hypo/Hyperkalemia

EKG

A

Hypo U waves

Hyper Tall T waves

181
Q

Mg 1.8 - 2.2

Describe low / high effects

A

low: dysrhythmias

high: low BP, cardiac arrest

182
Q

CA 8 - 10

DESCRIBE AFFECT ON THE HEART

A

Low

Prolonged QT - Torsade de pointe
Decreased contractility
Hypotension
Tetany

High
Shortened QT Ventriclar Arythmias
Increased contractility
Hypertension
Vascular calcification

183
Q

elevations associated with heart failure
secreted from the heart when stretched *

A

BNP

184
Q

Pre Procedure for Cardiac Catheterization (5)

A

consent

hold: food, oral fluids (4-6 hrs prior)

nephrotoxic meds: 48 hours to 2 weeks prior (metformin and contrast due to kidney injury; lasix also hurt kidneys with contrast)

anticoagulation meds may be withheld
must have IV access

pre-procedure: versed: follow direction; some not remember much from the procedure

185
Q

Length of time for Cardiac Catheterization

A

1 - 3 hrs

186
Q

Left Cardiac Catheterization Flow - Aorta - Aortic valve - Left Ventricle assesses… (3)

A

left sided pressures
mitral/aortic valves
coronary artery circulation

187
Q

Biggest concern post cardiac Catheterization

A

Alert!! ventricular arrhythmias may occur
resuscitation equipment MUST be available

188
Q

How to detect hematoma post cardiac Catheterization

A

Feel for it, Not look for it

189
Q

Right Catheterization complications (3)

A

embolus
vagal response
atrial dysrhythmias

190
Q

Left Catheterization Complications

A

MI
CVA
ventricular dysrhythmias
arterial bleeding

191
Q

Risk in either side of cardiac Catheterization (6)

A

tamponade
hypovolemia
hematoma
pseudo aneurysms
contrast dye reaction
infection
death: risk is <1%: 0.1%

192
Q

Contrast induced Nephrotoxicity

Best prevention…

A

identify pt at risk
hydration: before and after
limit contrast exposure
withhold nephrotoxic meds: METFORMIN and LASIX

193
Q

Types of medications given 1 hr before patient goes into the cath lab

A

Aspirin
Heparin
Versed
BB
Nitroglycerin

194
Q

Type of echocardiogram used to identify disease of the mitral valve, left atrium, or aortic arch…

A

Transesophageal

195
Q

Heart is incapable of maintaining a CO adequate to accommodate metabolic requirements and the venous return

NOT a disease; unable to pump to meet body’s needs

A

Heart failure

196
Q

heart failure: muscle works harder
(What happens to the heart muscle), stretched out, exhausted
apoptosis: cells die
CO: decreased

A

hypertrophy

197
Q

1/3 of the time is systolic (contracting), 2/3 diastole (relaxing)

T or F

A

T

198
Q

Formula for CO (Cardiac output)

A

HR × Stroke Volume

199
Q

Stretch receptors on the vena cava and right atrium do what..

A

sense decrease volume

200
Q

Type of medication that works on the RAAS system

Caution….

A

ACE INHIBITORS -Pril
ARBS- Sartin
Aldosterone blocker

CANT GIVE MORE THAN 1 AT A TIME

201
Q

Which of the following is not a Beta1 response?

-Increased heart rate
-Stronger contractility
-Faster conduction
-Vasoconstriction

A

-Vasoconstriction
This is Alpha ¹

202
Q

Sclera (Xanthelasma)=

A

yellow spots (cholesterol build up) on the eyes

203
Q

edema- (this side) heart failure

A

Right

204
Q

PMI (Apical Pulse)

Location

Potential problems…

A

5th intercostal space, mid-clavicular line; if it shifts to the left, indicates left ventricular hypertrophy (enlarged)=> Heart failure

205
Q

Heart Sounds

S1- closure of tricuspid and mitral (AV) valves

Best heard…

A

Best heard: At the apex of the heart (left 5th intercostal space, midclavicular line).
Stethoscope: Use the diaphragm.

206
Q

Closure of tricuspid & mitral valve

Best heard: At the apex of the heart (left 5th intercostal space, midclavicular line).

Stethoscope: Use the diaphragm.

Name heart sound

A

S¹

207
Q

Closure of the aortic and pulmonary valves at the beginning of diastole.

Aortic area: Right 2nd intercostal space, near the sternum.

Pulmonic area: Left 2nd intercostal space, near the sternum.

Stethoscope: Use the diaphragm.

Name heart sounds

A

S2

208
Q

S2
Closure of the aortic and pulmonary valves at the beginning of diastole.

Best heard….

A

At the base of the heart, particularly at the:

Aortic area: Right 2nd intercostal space, near the sternum.

Pulmonic area: Left 2nd intercostal space, near the sternum.

Stethoscope: Use the diaphragm.

209
Q

A low-frequency sound occurring during early diastole due to rapid ventricular filling.

Often associated with volume overload or heart failure.

Best heard: At the apex, with the patient lying in the left lateral decubitus position.

Stethoscope: Use the bell (low-pitched sound).

Name heart sound…

A

S3

210
Q

S3
What it is: A low-frequency sound occurring during early diastole due to rapid ventricular filling. Often associated with volume overload or heart failure.

Best heard…..

A

At the apex 5th IC Midclavicular line with the patient lying in the left lateral decubitus position.

Stethoscope: Use the bell (low-pitched sound).

211
Q

A low-frequency sound occurring during late diastole due to atrial contraction against a stiff or non-compliant ventricle (e.g., in left ventricular hypertrophy or hypertension).

Best heard: At the apex, with the patient in the left lateral decubitus position.

Stethoscope: Use the bell (low-pitched sound).

Name heart sound…

A

S4

212
Q

S4 What it is: A low-frequency sound occurring during late diastole due to atrial contraction against a stiff or non-compliant ventricle (e.g., in left ventricular hypertrophy or hypertension).

Best heard….

A

At the apex, with the patient in the left lateral decubitus position.

Stethoscope: Use the bell (low-pitched sound).

213
Q

Tips for listening to heart sounds

Position the patient appropriately:
____ for S1 and S2.

_______ for S3 and S4.

Use light pressure with the bell for low-pitched sounds (____)

firm pressure with the diaphragm for high-pitched sounds (_____).

A

Supine

Light pressure & bell S3 & 4

Firm pressure & diaphragm S1 & 2

214
Q

Indicates the closure of the mitral and tricuspid valves at the start of systole.

Common Associations:
Loud: Mitral stenosis, tachycardia.
Soft: Mitral regurgitation, heart block.

Name Sound & Nickname

A

S1 Lub

215
Q

Represents the closure of the aortic and pulmonary valves at the start of diastole.

Common Associations:

Split: Can be physiological or pathological (e.g., pulmonary hypertension, right bundle branch block).

Accentuated: Hypertension (aortic or pulmonary).

Name sound & Nickname

A

S2 & Dub

216
Q

Clinical Significance:

Normal in children, young adults, and athletes.

Pathological in adults over 40, typically indicating heart failure or volume overload (e.g., dilated cardiomyopathy).

A

S3 lub-dub-ta, Ventriclar gallop

217
Q

Clinical Significance:

Always abnormal, indicating a stiff or non-compliant ventricle (e.g., left ventricular hypertrophy, hypertension, aortic stenosis

Name sound amd nickname

A

S4 ta-lub-dub Atrial Gallop

218
Q

common assessment finding in the older adult is…

-Decreased ventricular size
-Leg edema
-Postprandial hypertension
-Aortic murmur

A

Aortic murmur

219
Q

K- low-> arrhythmia,
high-> slow conduction/electrical,

K will not correct….

A

Low = arrhythmia
High = slow conduction / electrical

If Mg is low, Correct Mg first then L

220
Q

Ca- low-> …

High->…..

A

Low: Arrhythmia

High: block, slowing down of electrical activity

221
Q

Mg- low-> …

High -> …

A

Low: arrhythmia

High: hypotension/cardiac arrest

222
Q

Direct injuries involve bleeding at the puncture site

-Arterial dissection

-Vasovagal response-hypotension, decrease HR, decrease BP

-Renal, cardiac, or neurological complications

-Allergic reaction to dye- radioactive contrast, can cause kidney damage

Risks for…

A

Angiography Risks

223
Q

Great vessel disease
-Coronary artery occlusion
-Valvular disease ( stenosis, insufficiency, or regurgitation)
-Atrial or ventricular septal defects

Measurement of cardiac and pulmonary pressures

Indications for…

A

Cardiac Catheterization

224
Q

Contradictions for Cardiac Catheterization (6)

A

Renal insufficiency-pretreatment necessary to prevent further injury

-Coagulopathy-can give vitamin K

-Fever or systemic infection

-Ventricular irritability

-Uncompensated heart failure

-Contrast dye allergies-pretreatment

225
Q

Renal insufficiency-pretreatment necessary to prevent further injury
-Coagulopathy-can give vitamin K
-Fever or systemic infection
-Ventricular irritability
-Uncompensated heart failure
-Contrast dye allergies-pretreatment

Contradictions for…

A

Cardiac Catheterization

226
Q

AFib and PVC’s

Good candidates for this procedure…

A

Electrophysiologic Study

227
Q

Used to assess peripheral vessel perfusion

-Pulses or sounds are evaluated to assess

A

Doppler

228
Q

Used to:
-Size of ventricles, wall motion
-For valve conditions, estimate EF

2 types

Only 1 has these precautions..

A

-Trans esophageal echocardiography-
*Must be NPO, can look at the top part of the heart, atrium, aorta. Have to be under anesthesia so check gag reflex post-procedure.

***Best test to look at valves
**Noninvasive to measure EF

229
Q

Technetium Pyrophosphate Scan
(technetium scan)
-Isotope accumulates in damaged myocardial tissue
-Hotspot

Thallium Imaging
-Stress test and then Thallium injected
-Scan to assess myocardial perfusion
-Cold spot-goes to healthy tissue

A

Myocardial Nuclear Perfusion Imaging

230
Q

Stress test and then ____ injected

A

Thallium

231
Q

Examples:
Lisinopril
Enalapril
Captopril
Ramipril
Benazepril

Common Uses….

A

ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors)
These medications lower blood pressure by blocking the conversion of angiotensin I to angiotensin II, a vasoconstrictor.

Common Uses:
Hypertension
Heart failure
Post-myocardial infarction
Chronic kidney disease

232
Q

Examples:
Metoprolol (selective beta-1 blocker)
Atenolol (selective beta-1 blocker)
Propranolol (non-selective beta blocker)
Carvedilol (non-selective beta blocker with alpha-blocking activity)
Bisoprolol

Common Uses…..

A

Beta-Blockers
These drugs reduce heart rate, blood pressure, and myocardial oxygen demand by blocking beta-adrenergic receptors.

Common Uses:
Hypertension
Angina and coronary artery disease
Heart failure (specific beta-blockers like metoprolol, carvedilol)
Atrial fibrillation (rate control)
Post-myocardial infarction
Migraine prevention (propranolol)

233
Q

Examples:
Dihydropyridines (Primarily Vasodilators):
Amlodipine
Nifedipine
Felodipine
Non-Dihydropyridines (Cardioselective):
Verapamil
Diltiazem

A

Calcium Channel Blockers (CCBs)
These medications inhibit calcium influx into vascular smooth muscle and cardiac cells, leading to vasodilation and reduced cardiac workload.

Common Uses:
Hypertension (dihydropyridines like amlodipine)
Angina (both classes)
Atrial fibrillation or flutter (non-dihydropyridines like diltiazem, verapamil for rate control)
Raynaud’s phenomenon (dihydropyridines)

234
Q

Why will a fib take beta blockers…

A

To control rate

235
Q

Which coronary cath is looking for breathing issues

Right / Left

A

Right

236
Q

What happens if patient talks during ECG

A

Invalid

Causes Errors / Artifacts

237
Q

Pre procedure instructions for Stress Tests (3)

A

No beta blockers
NPO 4 - 8 hrs
No caffeine

238
Q

Uncompensated heart failure

Take these meds

A

Diuretics (e.g., Furosemide): Reduce fluid overload, preload, and pulmonary congestion. Monitor electrolytes and renal function.

Vasodilators (e.g., Nitroglycerin): Lower preload and afterload, improve cardiac output. Watch for hypotension.

Inotropes (e.g., Dobutamine): Enhance contractility and cardiac output in severe cases. Monitor for arrhythmias.

Anticoagulants (e.g., Heparin): Prevent clot formation.

Beta-Blockers (e.g., Metoprolol): Reduce heart rate and oxygen demand if stable; avoid in shock.

ACE Inhibitors/ARBs (e.g., Lisinopril): Decrease afterload if stable; avoid in kidney injury or hyperkalemia.

Nursing Tips: Ensure stability, monitor vitals and fluid status, and educate the patient on pre-procedure care.

NURS 2245 Cardiac (8 decks)

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