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NURS 501 Advanced Pathophysiology UofA > Week 4 Cardiovascular Function > Flashcards

Week 4 Cardiovascular Function Flashcards

1
Q

what class of lipids make up the plasma membrane?

A

phospholipids

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2
Q

What is the name for a bound lipid?

A

lipoprotein

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3
Q

What are the 4 main functions of lipids?

A
  1. stored energy
  2. make up of cellular membrane
  3. hormone production (estradiol/testosterone)
  4. production of bile acids
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4
Q

What organ produces cholesterol?

A

Liver

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5
Q

What are chylomicrons primarily made of (80%)?

A

triglycerides

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6
Q

What is the function of chylomicrons

A

supply tissue with fat from dietary ingestion of cholesterol

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7
Q

What is the smallest lipoprotein?

A

HDL

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8
Q

What is the largest lipoprotein

A

Chylomicron

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9
Q

Which lipoprotein causes vascular injury?

A

LDL

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10
Q

Which lipoprotein is protective to the cardiovascular system

A

HDL

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11
Q

Where are triglycerides stored?

A

In fat cells and liver

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12
Q

What protein binds to lipids to form lipoproteins?

A

apolipoproteins

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13
Q

Which apolipoprotein is attached to HDL?

A

Apo A1

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14
Q

Which apolipoprotein is attached to LDL?

A

Apo B

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15
Q

What is the function of Apo A1

A

To move cholesterol and phospholipids from inside cell to outer surface.

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16
Q

What is the function of Apo B

A

To carry fat and cholesterol through the bloodstream to the body.

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17
Q

How is hs-CRP used in cardiology? When else could it be elevated?

A

Non-specific test to determine risk of developing CAD. Can also be elevated in RA, MS, Lupus, etc. due to increased inflammation in autoimmune conditions.

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18
Q

What cardiac testing involves a CT scan?

A

CT calcium score. Looks for buildup of Calcium.
1-10=minimal
11-100=mild
101-400=moderate
>400=cardiologist referal

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19
Q

What is the optimal value of total cholesterol?

A

<200

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20
Q

What is the optimal lab value of HDL?

A

> 40

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20
Q

What is the optimal lab value of Triglycerides?

A

<150

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21
Q

What is the optimal lab value of LDL?

A

<100

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21
Q

What is the optimal lab value of Cholesterol to HDL-C Ratio? What does a high ratio indicate?

A

<3.5 Higher ratio = higher risk of heart disease.

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22
Q

What are 5 treatments for atherosclerosis?

A

1) Same Tx for dyslipidemia (statin, diet, exercise)
2) angioplasty (opens occlusions)
3) Laser (disintegrates plaque)
4) Atherectomy (removes plaque)
5) B-complex vitamins (reduces inflammation by lowering homocysteine levels)

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23
Q

What is the bpm produced by the AV node?

A

40-60 bpm

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24
Q

What is the primary pacemaker of the heart?

A

SA node

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25
Q

What rate can the ventricles generate impulses if the SA and AV nodes fail?

A

20-40 bpm

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26
Q

What are 5 infections that are associated with pericarditis?

A

coxsackievirus, echoviruses, HSV, CMV, HIV

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27
Q

What are non-infectious causes of pericarditis?

A

MI, thoracic trauma or surgery, cancer, Lupus, RA, scleroderma

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27
Q

What are the sx of acute cardiac tamponade?

A

Beck’s Triad: Low blood pressure, JVD, muffled heart sounds
Tachypnea
Tachycardia

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27
Q

What is the most serious complication associated with pericarditis and what does it do?

A

Cardiac tamponade. Fluid builds to the point that the heart is compressed leading to reduced cardiac output. (heart failure, death)

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28
Q

What is the treatment for pericarditis?

A
  1. Antibiotics - infection
  2. Steroid - inflammation
  3. Analgesics - pain
  4. O2
  5. Pericardiocentesis or pericardiectomy
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28
Q

Symptoms of pericartitis

A
  1. Dyspnea
  2. chest pain - anterior, sharp, sudden, worsens inspiration and laying flat, decreases sitting up.
  3. Flu-like sx
  4. pericardial friction rub
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29
Q

What are the non-infectious causes of endocarditis?

A
  1. Clot formation on valves
  2. Lupus “Libman-Sacks endocarditis”
  3. IV drug use (tricuspid valve)
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30
Q

What are the infections that cause endocarditis?

A

Strep. viridans (mouth)
Staph. aureus (skin/gut) (IV drugs)

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31
Q

What are the sx of endocarditis?

A
  1. Flu-like sx - fever, chills, fatigue
  2. heart murmur
  3. petechiae, under nailbed
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32
Q

What is the diagnostic scale used for endocartitis?

A

modified Duke criteria

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33
Q

What is the gold standard testing for myocarditis?

A

endomyocardial biopsy

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34
Q

What 2 valves are most commonly associated with valvular disorders?

A

Aortic and Mitral - higher pressures and work load of left side of heart.

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35
Q

What condition does valvular stenosis cause in the heart muscle?

A

hypertrophy - enlarged heart wall
causing decreased cardiac output

36
Q

What are the 3 most common causes of Aortic stenosis?

A
  1. Congenital
  2. rheumatic fever
  3. degenerative calcification.
37
Q

What are the 2 most common causes of Aortic regurgitation?

A
  1. Infective endocarditis (bacterial)
  2. aortic root disease (degenerative/age)
38
Q

What is the single most common cause of mitral stenosis?

A

Rheumatic fever

39
Q

What are 4 causes of mitral regurgitation?

A
  1. Primary mitral regurgitation Dz
  2. Intrinsic valve Dz
  3. Ischemia
  4. Valve displacement - caused by left ventricular enlargement.
40
Q

What condition develops when the ventricles become enlarged (stretched) and can’t contract efficiently?

A

Dilated cardiomyopathy (DCM)

41
Q

Which type of cardiomyopathy has a reduced ejection fraction (EF)?

A

Dilated cardiomyopathy (DCM)

42
Q

Which type of cardiomyopathy has a normal ejection fraction (EF)?

A

Hypertrophic cardiomyopathy (HCM)

43
Q

What causes 50% of dilated cardiomyopathy (DCM) cases?

A

Genetic abnormalities. Mutations affecting sarcomere cell function. Ex: PPCM (peripartum-related DCM) in women.

44
Q

Which cardiomyopathy is the most common familial heart disease? What type of inheritance pattern?

A

Hypertrophic cardiomyopathy (HCM).
Autosomal dominant inheritance pattern.

45
Q

Where in the heart is the most common place of hypertrophy?

A

the septum

46
Q

In all cardiomyopathies, what does backflow pressures lead to? and what heart rhythm would be seen?

A

Atrial enlargement. A-fib.

47
Q

What is the most common dysrhythmia in adults?

A

Atrial fibrillation.

48
Q

Which dysrhythmia causes blood to pool increasing clot formation?

A

A fib.

49
Q

What are 4 Rx treatments for A fib that focus on the rhythm control?

A
  1. Beta-blockers
  2. Calcium channel blockers
  3. glycosides (digoxin),
  4. cardioversion
50
Q

What are 3 Rx treatments for A fib that focus on anticoagulation?

A
  1. direct thrombin inhibitor (dabigatran)
  2. factor Xa inhibitor (apixaban, rivaroxaban)
  3. warfarin
51
Q

What is the definition of HFrEF (heart failure with reduced EF)?

A

EF <40% resulting from systolic dysfunction (thin weak heart muscle that can’t pump blood out)

52
Q

What is the definition of HRpEF (heart failure with preserved EF)?

A

EF >50% resulting from diastolic dysfunction.

53
Q

Name the two most common causes of heart failure.

A
  1. Coronary artery disease
  2. hypertension
54
Q

Name the 3 categories of drugs that can cause heart failure.

A
  1. anticancer drugs
  2. antidiabetic drugs
  3. appetite suppressants
55
Q

What are attributes of Left ventricular remodeling in heart failure?

A
  1. myocyte loss
  2. decreased contractility
  3. LV dilation and hypertrophy
  4. Beta adrenergic desensitization (less responsive)
56
Q

What type of heart failure is associated with pulmonary congestion?

A

Left-sided HF

57
Q

What type of heart failure is associated with systemic edema?

A

Right-sided HF

58
Q

What hormone is released when the ventricles are overstretched?

A

NT-proBNP (N-terminal pro-brain natriuretic peptide)

59
Q

What Rx’s are used to treat heart failure?

A
  1. ACE inhibitors (angiotensin-converting enzyme)
  2. ARBs (angiotensin receptor blockers)
  3. ARNIs (angiotensin receptor-neprilysin inhibitors)
  4. alpha or beta-blockers
60
Q

What 2 medications can worsen heart failure?

A
  1. Calcium channel blockers (depress contractility)
  2. NSAIDS (cause Na and water retention)
61
Q

What is the most common congenital heart defect?

A

Ventricular septal defect.

62
Q

What part fails to close after birth that causes atrial septal defect?

A

Foramen ovale located between the atrium. Causes PFO (patent foramen ovale)

63
Q

Where is the ductus arteriosus located that can cause PDA (patent ductus arteriosus)?

A

Between the aorta and the pulmonary artery causing left to right shunt.

64
Q

What are the four abnormalities in Tetralogy of Fallot??

A
  1. Pulmonary valve stenosis
  2. Large ventricular septal defect (VSD)
  3. overriding aorta over VSD
  4. right ventricular hypertrophy
65
Q

What is the pulmonary atresia?

A

complete closure of pulmonary valve

66
Q

What arteries are switched in the defect of “transposition of great arteries”?

A

aorta and pulmonary arteries are switched positions.

67
Q

What happens in the defect of “coarctation of the aorta”?

A

The aorta is narrow obstructing blood flow through arch.

68
Q

How many days until the ductus arteriosus closes completely?

A

21 days.

69
Q

What are 3 symptoms of peripheral artery disease?

A
  1. pain in extremities, worse with elevation and exercise.
  2. diminished pulses
  3. non-healing ulcers
70
Q

What ABI (ankle brachial index) is diagnostic for peripheral artery disease?

A

≤0.90

71
Q

What are the most common triggers of stable angina?

A

exercise, cold, stress, intercourse, stimulants (cocaine)

72
Q

When is angina considered unstable?

A

When it is unstable, occurs at rest, or increases in duration >20 mins.

73
Q

What type of angina is caused by vasospasms in the coronary arteries WITHOUT atherosclerosis?

A

Prinzmetal angina

74
Q

What type of angina affects the small vessels of the coronary arteries?

A

Microvascular angina

75
Q

What EKG changes are seen with coronary artery disease?

A

ST depression

76
Q

What are 5 Rx treatments for angina?

A
  1. nitrates
  2. beta-adrenergic blockers
  3. calcium channel blockers
  4. sodium channel blocker (Ranolazine)
  5. O2 therapy
77
Q

What 2 EKG changes are associated with MI (myocardial infarction)?

A
  1. ST elevation (STEMI) or normal ST (NSTEMI)
  2. Pathologic Q wave: deeper and wider than normal.
78
Q

What cardiac biomarker has the fastest onset (1 hour) with an MI?

A

Myoglobin. (rapidly returns to normal)

79
Q

What are the 3 cardiac biomarkers associated with MI?

A
  1. CK-MB (creatine kinase-muscle/brain)
  2. Myoglobin
  3. Troponins
80
Q

Which cardiac biomarker requires a repeat screen if the first result is negative for MI symptoms?

A

Troponin.

81
Q

What systemic vasculitis disease occurs most often in boys under 5 years of asian or Pacific Island descent?

A

Kawasaki disease

82
Q

What are the 5 clinical presentations of Kawasaki disease in addition to high fever?

A
  1. Bilateral conjunctivitis
  2. Oral mucositis, dry/cracked lips, strawberry tongue
  3. Rash
  4. Red and swollen hands and feet
  5. swollen cervical lymph nodes
83
Q

What is the treatment for Kawasaki disease?

A
  1. IV immunoglobulin
  2. aspirin
84
Q

What disease is associated with a “white attack” from vasospasms in the hands?

A

Raynaud Disease

85
Q

What medications can lead to secondary hypertension?

A

Birth control pills, HRT (hormone replacement therapy), antihistamines, decongestants, and glucocorticoid steroids.

86
Q

Which type of hypertension develops gradually?

A

Essential/primary hypertension

87
Q

What is the criteria for gestational hypertension?

A

BP ≥ 140 mmgH systolic OR ≥90 mmgH diastolic at ≥20 weeks gestation.

88
Q

What diagnostic tests puts a woman into the preeclampsia category?

A

proteinuria + gestational hypertension.
BP ≥160 systolic AND ≥90 diastolic
Symptoms: headache, blurred vision
impaired liver function tests
renal insufficiency (elevated serum creatinine)

89
Q

Criteria for eclampsia?

A

Grand mal seizure with preeclampsia diagnosis.

90
Q

What is the condition where blood pressure does NOT drop at night by the usual 10%?

A

Nocturnal hypertension

91
Q

What BP reading is required to be Hypertensive Urgency?

A

≥180 systolic AND/OR 120 diastolic but NOT symptomatic

92
Q

What BP reading is required to be Hypertensive Urgency?

A

≥180 systolic AND/OR 120 diastolic WITH symptoms.

93
Q

First line Rx for hypertension recommended by AHA?

A

thiazide or thiazide-type diuretic, ACEI or ARB or CCB

94
Q

What are the 6 steps for the one-hour sepsis bundle?

A
  1. Lactate level. Redraw if >2
  2. Blood cultures - prior to Abx
  3. Abx - broad spectrum within ONE our
  4. Fluids at 30 mL/kg for hypotension or lactate ≥4
  5. Vasopressors - hypotension to maintain MAP ≥65
  6. O2 - high flow for hypoxemic resp. failure.

NURS 501 Advanced Pathophysiology UofA (9 decks)

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