Week 5 Flashcards
1
Q
What is sinus bradycardia?
A
A heart rhythm where the heart rate is less than 60 bpm.
ECG shows sinus bradycardia (SB).
2
Q
What is sinus tachycardia?
A
A heart rhythm where the heart rate is more than 100 bpm.
ECG shows sinus tachycardia (ST).
3
Q
What are the clinical associations of sinus bradycardia?
A
- Decreased firing of the sinoatrial (SA) node
- Increased parasympathetic tone
- Hypothyroidism
- Inferior wall MI
- Drug effects (BB, CCB)
- Possible normal findings in athletes
4
Q
What are the clinical manifestations of sinus bradycardia?
A
- Dizziness
- Dyspnea
- Hypotension
- Decreased cardiac output
- Angina
- Pale, cool skin
- Dizziness
- Syncope
- Confusion
5
Q
What is the treatment for symptomatic sinus bradycardia?
A
- Atropine (anticholinergic)
- Pacemaker consideration
- Epinephrine or dopamine infusion (sympathomimetics)
6
Q
What is heart failure (HF)?
A
An abnormal clinical syndrome involving impaired cardiac pumping, filling, or both.
Associated with numerous other cardiac diseases (CAD, HTN, MI).
7
Q
What are the primary risk factors for heart failure?
A
- Coronary artery disease (CAD)
- Hypertension (HTN)
- Diabetes mellitus (T2DM)
- Tobacco smoking
- Obesity
- High serum cholesterol
8
Q
What are the two types of heart failure based on ejection fraction?
A
- HF with Reduced Ejection Fraction (HFrEF)
- HF with Preserved Ejection Fraction (HFpEF)
9
Q
What characterizes HF with Reduced Ejection Fraction (HFrEF)?
A
Impaired left ventricle (LV) pumping ability, known as systolic HF.
Causes include impaired contractility, increased afterload, mechanical abnormalities.
10
Q
What characterizes HF with Preserved Ejection Fraction (HFpEF)?
A
Inability of the ventricles to relax and fill during diastole, known as diastolic HF.
Most commonly caused by LV hypertrophy from HTN.
11
Q
What are common causes of cardiac arrhythmias?
A
- Heart failure
- Conduction defects
- Hypertrophy of cardiac muscle
- Myocardial infarction (MI)
- Acid-base imbalance
- Electrolyte imbalances
- Poisoning
- Hypoxia
- Hypothermia
- Alcohol, caffeine, tobacco
- Drug effects
- Shock
12
Q
What are the compensatory mechanisms in heart failure?
A
- SNS activation
- Neurohormonal response
- Ventricular dilation
- Ventricular hypertrophy
13
Q
What is the mechanism of action of nitrates in heart failure treatment?
A
Causes vasodilation related to relaxation of smooth muscles, increasing oxygen to ischemic myocardial tissue.
Used for prevention and treatment of angina.
14
Q
What are the main pharmacological classifications of drugs to treat hypertension?
A
- Diuretics
- ACE inhibitors
- Angiotensin II receptor blockers (ARBs)
- Beta-blockers
- Calcium channel blockers
15
Q
What are the clinical manifestations of left-sided heart failure?
A
- Backup of blood into the left atrium and pulmonary veins
- Increased pressure in pulmonary veins
- Pulmonary congestion
- Pulmonary edema with pink, frothy sputum
16
Q
What are the clinical manifestations of right-sided heart failure?
A
- Backup of blood into the right atrium and venous circulation
- Peripheral edema
- Hepatomegaly
- Splenomegaly
- Jugular venous distension (JVD)
- Vascular congestion of the GI tract
17
Q
What is a common complication of heart failure?
A
- Pleural effusion
- Arrhythmias
- Left ventricular thrombus
- Hepatomegaly
- Renal insufficiency or failure
18
Q
Fill in the blank: Heart failure is characterized by impaired cardiac ________ and/or ________.
A
[pumping] and [filling]
19
Q
True or False: Normal ejection fraction (EF) is approximately 55-70%.
A
True
20
Q
What is the goal of pharmacological treatment in heart failure?
A
Enhance myocardial contractility and decrease preload and afterload.
21
Q
What is the significance of natriuretic peptides in heart failure?
A
Hormones produced by the heart muscle that have renal, cardiovascular, and hormonal effects.
Help signal heart failure compensation.
22
Q
What is a cerebrovascular accident (CVA)?
A
It is a stroke caused by the obstruction of a blood vessel in the brain.
23
Q
What is a pulmonary embolus (PE)?
A
It is caused by an obstruction of a pulmonary artery when a clot travels to the lungs.
24
Q
What is deep vein thrombosis (DVT)?
A
It is when a clot travels to a vein in the leg and obstructs blood flow.
25
What are thromboembolic events?
They are complications collectively involving CVA, PE, and DVT.
26
What is the mechanism of action of warfarin?
It is an anticoagulant.
27
What is the primary antagonist for warfarin?
Vitamin K.
28
What is the mechanism of action of unfractionated heparin?
It is an anticoagulant.
29
What is DVT prophylaxis?
It is the prevention of deep vein thrombosis.
30
What are the indications for using tinzaparin?
It is indicated for anticoagulation therapy.
31
Which is the most frequent adverse effect of anticoagulant use?
D) Internal and superficial bleeding.
32
What should a nurse anticipate if a patient on IV heparin shows signs of bleeding?
A) Hold heparin, get stat PTT level, strict bedrest, possible endoscopy.
33
Which instruction is correct when administering tinzaparin subcutaneously?
D) Use a new, sterile, 25-28g needle to administer.
34
What is Peripheral Artery Disease (PAD)?
It is the thickening of artery walls, resulting in progressive narrowing of the arteries.
35
What are common clinical features of PAD?
* Intermittent claudication
* Paresthesia
* Shiny thin skin
* Hair loss
* Diminished peripheral pulse
* Pallor
* Erectile dysfunction
* Reactive hyperemia
* Pain with rest
* Critical limb ischemia.
36
What is the leading cause of PAD?
Atherosclerosis related to inflammation and endothelial injury.
37
What are the risk factors for PAD?
* Tobacco smoking
* Diabetes
* Hyperlipidemia
* Uncontrolled HTN
* Genetics
* Other modifiable factors.
38
What therapies are used for PAD?
* Antiplatelets
* ACE inhibitors
* Drug treatment for intermittent claudication
* Exercise
* Smoking cessation
* Nutritional therapy
* Complementary and alternative therapies.
* Interventional therapies
* Surgery for revascularization.
39
What diagnostic studies are used for PAD?
* Doppler ultrasonography
* Angiography
* MRI
* D-dimer (if DVT is suspected).
40
What complications can arise from PAD?
* Delayed healing
* Wound infection
* Necrosis
* Non-healing ulcers
* Amputation.
41
What is the mechanism of action of acetylsalicylic acid (ASA)?
It is an antiplatelet and NSAID.
42
What is the mechanism of action of clopidogrel?
It is an antiplatelet.
43
What lifestyle modifications should a nurse instruct a patient with right-sided heart failure to make?
Patient education on lifestyle changes is necessary.
44
What adverse effects should the nurse monitor in a patient prescribed captopril?
The nurse should monitor for cough and hypotension.
45
How does diltiazem treat hypertension?
It works by relaxing blood vessels to lower blood pressure.
46
True or False: It is important for a patient to understand why they need medication even if their blood pressure is not high.
True.
47
What is the primary function of the cardiovascular system?
To pump blood to tissues and return blood back to the heart
## Footnote
The cardiovascular system consists of the heart (the pump) and blood vessels (the pipes) that transport blood throughout the body.
48
What are the components of the heart's mechanical system?
Epicardium, Myocardium, Endocardium
## Footnote
These layers make up the structure of the heart and are essential for its function.
49
What is the path of deoxygenated blood through the heart?
Vena cava → Right Atrium → Right Ventricle → Lungs
## Footnote
This process allows for the exchange of carbon dioxide for oxygen in the lungs.
50
What is the path of oxygenated blood through the heart?
Lungs → Left Atrium → Left Ventricle → Aorta → Body
## Footnote
Oxygenated blood is delivered from the lungs to the rest of the body.
51
What is the mean arterial pressure (MAP) required to perfuse vital organs?
60-70 mmHg
## Footnote
Maintaining adequate MAP is crucial for organ perfusion.
52
What is automaticity in the context of cardiac function?
The heart's ability to generate its own electrical impulses
## Footnote
This is due to intercalated discs that facilitate conduction.
53
What does the cardiac cycle consist of?
Conduction → Contraction
## Footnote
The cycle involves rhythmic contraction and relaxation of the heart.
54
What is the formula for calculating cardiac output (CO)?
CO = HR x SV
## Footnote
Where HR is heart rate and SV is stroke volume.
55
What is preload in cardiac physiology?
The maximal fill/stretch of the wall of the ventricle when the left ventricle is filled
## Footnote
Preload affects the force of contraction according to Frank-Starling's Law.
56
What is afterload?
The resistance blood experiences as it leaves the left ventricle
## Footnote
Afterload is inversely related to stroke volume.
57
What is the normal resting heart rate range?
60-100 BPM
## Footnote
This range is considered normal for adults at rest.
58
What are the two main divisions of the autonomic nervous system affecting heart rate?
Sympathetic (SNS) and Parasympathetic (PNS)
## Footnote
SNS increases heart rate and blood pressure, while PNS decreases them.
59
What is blood pressure (BP)?
The force that blood exerts against the walls of the arteries
## Footnote
BP is affected by cardiac output and systemic vascular resistance.
60
What is the typical blood pressure reading considered hypertensive?
Systolic BP: 140+ mmHg OR Diastolic BP: 90+ mmHg
## Footnote
These parameters indicate hypertension based on average readings.
61
What are the complications associated with hypertension?
* Heart failure
* Stroke
* Kidney failure
* Vision loss
* Coronary artery disease
## Footnote
Hypertension can lead to significant end-organ damage.
62
What are the two types of hypertension?
* Primary (essential) HTN
* Secondary HTN
## Footnote
Primary HTN accounts for 90-95% of cases and has no universally established cause.
63
What is the role of diuretics in hypertension?
To accelerate urine formation and remove sodium and water
## Footnote
Diuretics are a mainstay of therapy for hypertension and heart failure.
64
What are the classes of antihypertensive drugs?
* ACE inhibitors
* Angiotensin II receptor blockers (ARBs)
* Beta-blockers
* Calcium channel blockers
* Diuretics
## Footnote
These classes help manage high blood pressure through various mechanisms.
65
What does the ejection fraction (EF) measure?
The percentage of end-diastolic blood volume ejected during systole
## Footnote
EF is an important measure of left ventricular function.
66
What are common assessments in cardiovascular evaluation?
* Vital signs
* Physical examination
* History of health
* Diagnostic studies
## Footnote
These assessments help identify cardiovascular problems.
67
What is the significance of S1 and S2 heart sounds?
S1 indicates the beginning of systole; S2 indicates the beginning of diastole
## Footnote
These sounds reflect the closure of heart valves during the cardiac cycle.
68
What lifestyle modifications are recommended for hypertension management?
* Nutritional therapy
* Weight management
* Regular exercise
* Tobacco cessation
* Limited alcohol consumption
## Footnote
These changes can significantly impact blood pressure control.
69
What is the purpose of a cardiac catheterization?
To visualize coronary arteries and assess heart function
## Footnote
This invasive study can identify blockages and other cardiac issues.
70
What is the primary cause of secondary hypertension?
Specific causes related to renal, endocrine, or vascular disease
## Footnote
Secondary hypertension is less common and accounts for 5% of cases.
71
What should patients taking diuretics along with digoxin be taught?
To watch for digoxin toxicity
## Footnote
Digoxin toxicity can lead to serious complications and needs careful monitoring.
72
What should patients with diabetes mellitus monitor when taking thiazide or loop diuretics?
Blood glucose and watch for elevated levels
## Footnote
Diuretics can affect glucose metabolism.
73
What precaution should patients take to prevent dizziness and fainting related to orthostatic hypotension?
Change positions slowly and rise slowly after sitting or lying
74
What should patients be encouraged to keep a log of?
Their daily weight
75
What should patients be reminded to do regarding follow-up care?
Return for follow-up visits and laboratory work
76
What are the therapeutic effects to monitor in patients taking diuretics?
* Reduction of edema
* Reduction of fluid volume overload
* Improvement in manifestations of heart failure
* Reduction of hypertension
* Return to normal intraocular pressures
77
What is the primary action of thiazide diuretics?
Inhibits Na, K & Cl reabsorption, causing water loss
78
Where are thiazide diuretics active in the nephron?
Distal convoluted tubules
79
What major side effect can thiazide diuretics cause?
Electrolyte imbalance
80
What should be monitored in patients taking thiazide diuretics?
* Lethargy
* Confusion
* Muscle weakness
81
What are loop diuretics primarily used for?
Acute treatment of fluid overload
82
What is the mechanism of action of loop diuretics?
Blocks sodium reabsorption in the loop of Henle
83
What is a characteristic of loop diuretics regarding onset?
Rapid onset
84
What are potassium-sparing diuretics known for?
Blocking aldosterone receptors (antagonist)
85
What do potassium-sparing diuretics cause to be excreted?
Na and H2O, while K+ is exchanged
86
What should not be combined with potassium-sparing diuretics?
Lithium or potassium supplements
87
What should be monitored for in patients taking potassium-sparing diuretics?
Hyperkalemia
88
What do carbonic-anhydrase inhibitors do?
Inhibit carbonic anhydrase enzyme in the kidney
89
What happens when carbonic anhydrase is blocked?
Water is excreted as urine
90
How are diuretic drugs classified?
According to their sites of action
91
What are the two primary forms of lipids in the blood?
* Triglycerides
* Cholesterol
92
What is a lipoprotein?
Combination of triglycerides or cholesterol with apolipoprotein
93
What role does high-density lipoprotein (HDL) play?
Responsible for recycling cholesterol (good cholesterol)
94
What is atorvastatin (Lipitor) classified as?
HMG CoA Reductase Inhibitors (the ‘statins’)
95
What should be considered when prescribing atorvastatin?
Indications, contraindications, adverse effects, drug interactions, and dosage
