Week 4

Question 1

develops if the supply of coronary blood cannot meet the demand of the myocardium for oxygen and nutrients.

Answer 1

myocardial ishmeia

Question 2

most common cause of myocardial ishmeia

Answer 2

atherlosclerosis

Question 3

chest pain caused by myocardial ischemia.

Answer 3

Angina pectoris

Question 4

substernal chest discomfort, ranging from a sensation of heaviness or pressure to moderately severe pain

Answer 4

angina pectoris

Question 5

Pain may radiate to the neck, lower jaw, left arm, and left shoulder
-Pallor, diaphoresis, and dyspnea
- relieved by rest and nitrates;

Answer 5

angina pectoris

Question 6

-gradual luminal narrowing and hardening of the arterial walls
-associated with physical exertion or emotional stress.

Answer 6

stable angina

Question 7

-transient ischemia of the myocardium that occurs unpredictably and almost exclusively at rest.

Answer 7

Prinzmetal angina (also called variant angina)

Question 8

when does variant angina occur

Answer 8

at rest and randomly

Question 9

Management of Reversible Ischemia

Answer 9

-increase delivery of oxygen
-omprove coronary artery blood flow and to -reduce myocardial oxygen consumption.

Question 10

Myocardial Ischemia treamtnet

Answer 10

1. Nitrates (nitroglycerin)-
2. Beta Blockers-
3. Calcium channel clockers (CCBs)

Question 11

improve coronary blood flow and reduce myocardial demand by decreasing peripheral vascular resistance

Answer 11

1. Nitrates (nitroglycerin)-

Question 12

diminish catecholamine induced elevations of heart rate, myocardial contractility, and blood pressure

Answer 12

2. Beta Blockers-

Question 13

decrease the influx of calcium into myocardial cells and vascular smooth muscle cells
-modify SA and AV nodes

Answer 13

calcium channel blockers (CCBs)

Question 14

procedure whereby stenotic (narrowed) coronary vessels are dilated with a catheter

Answer 14

Percutaneous coronary intervention (PCI)

Question 15

atherosclerotic plaque has ruptured, and infarction may soon follow.

Answer 15

unstable angina

Question 16

-occludes the vessel for no more than 10 to 20 minutes
-new onset angina, angina that is occurring at rest, or angina that is increasing in severity or frequency.

Answer 16

unstable angina

Question 17

Unstable angina is precurssor
Infarction happens if last more than 20 mins

Answer 17

Unstable angina is precurssor
Infarction happens if last more than 20 mins

Question 18

Subendocardial myocardial infarction

Answer 18

involves only one layer of the heart
the mysocradium

Question 19

Transmural MI

Answer 19

-effects all 3 layers of heart
Transmural infarction usually causes marked elevations in the ST segments on ECG.
-immediate intervention

Question 20

Cardiac cells can withstand ischemic conditions for about ___–minutes before cellular death takes place.

Answer 20

20

Question 21

when ischemic injury is exacerbated once blood flow is restored

Answer 21

Reperfusion Injury
-involves the release of toxic oxygen radicals, calcium flux, and pH changes
-mitochonrdia death

Question 22

first symptom of acute MI is

Answer 22

usually sudden, severe chest pain

Question 23

heavy and crushing, such as an“elephant sitting on my chest.
-radiate to the neck, jaw, back, shoulder, or left arm.

Answer 23

myocardial infarction

Question 24

most commonly occluded artery and most associated with death after MI

Answer 24

left anterior descending artery (LAD)

Question 25

most specific indicator of MI and should be obtained on admission to the emergency department

Answer 25

Cardiac troponin I

Question 26

cTnI elevation is detectable

Answer 26

-2 to 4 hours after onset of symptoms -reaches peak at 48 hours

Question 27

heart is unable to generate an adequate cardiac output such that there is inadequate perfusion of tissues or increased diastolic filling pressure of the left ventricle, or both.

Answer 27

heart failure

Question 28

risk factors for heart failure

Answer 28

Ischemic heart disease and hypertension

Question 29

which side of heart failure is most common

Answer 29

L sided

Question 30

an ejection fraction of <40% and an inability of the heart to generate an adequate cardiac output to perfuse vital tissues.

Answer 30

systolic heart failrue

Question 31

_____- are the result of pulmonary vascular congestion and inadequate perfusion of the systemic circulation

Answer 31

HFrEF Heart Failure with reduced ejection fraction

Question 32

cardinal signs of CHF

Answer 32

dyspnea fatigue edema pulmonary edema hypotension or hypertension S3 gallop underlying CAD or hypertension

Question 33

drugs for left sided heart failure

Answer 33

ACE inhibitors and beta blockers -Salt restriction, loop diuretics, and aldosterone-blockers such as spironolactone and eplerenone are effective in reducing preload and improving outcomes.

Question 34

________- ventricular failure causes fluid to back up in the veins of the systemic circulation.

Answer 34

Right

Question 35

R sided heart failure sxs

Answer 35

-Pitting edema in the ankles, feet, or lower back -Hepatomegaly / hepatic tenderness -jugular vein distention

Question 36

Sinus Bradycardia

Answer 36

-less than 60 BPM -regular rhythm -fatigue, lightheadedness, dizziness, exercise intolerance, syncope or presyncope, worsening of anginal symptoms, worsening of heart failure, or cognitive slowing

Question 37

Sinus tachycardia

Answer 37

->100 bpm -regular rhythm -dyspnea, chest pain, lightheadedness, dizziness, syncope, and presyncope.

Question 38

Premature Ventricular Contraction (PVC)

Answer 38

-heartbeat is initiated by the Purkinje fibers rather than the SA node. -PVC occurs before a regular heartbeat, there is a pause before the next regular heartbeat -begign and don't need tx

Question 39

most common sustained cardiac arrhythmia

Answer 39

Atrial Fibrillation

Question 40

loss of atrial contraction and the rapidity and irregularity of the ventricular rate

Answer 40

Atrial Fibrillation

Question 41

pulse rate >300 and on EKG usually no observable PR interval and QRS rate variable and rhythm irregula

Answer 41

Atrial fibrillation

Question 42

Arrhythmias originating from the ventricular myocardium or His-Purkinje system are grouped under ventricular arrhythmia (VA)

Answer 42

ventricular fibrillation

Question 43

ventricular rate of usually greater than 300 with discrete QRS complexes on the electrocardiogram (ECG).

Answer 43

ventricular fibrillation

Question 44

extremely dangerous rhythm significantly compromising cardiac output and ultimately leading to sudden cardiac death (SCD).

Answer 44

VF

Question 45

attacks of vasospasm in the small arteries and arterioles of the fingers and, less commonly, the toes

Answer 45

Raynaud’s

Question 46

-pallor, numbness, and the sensation of cold in the digits -billateral -gin at the tips of the digits and progress to the proximal phalanges

Answer 46

Raynaud’s