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50 Cards in this Set
- Front
- Back
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Where can S1 be heard? S2?
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S1 - heard best at the apex of the heard
S2 - heard best at the base of the heart |
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S4 aka
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atrial gallop
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s3 sounds like what?
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ken - tuckee
lub-dub-a after S2 |
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s4 sounds like
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Tene-seee
a-lub-dub before S1 |
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S3 is usually a sign of what condition?
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heart failure
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When would you hear S4? when would you hear S3?
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S4 - HTN, history of MI, aortic stenosis
S3 - heart failure, pulmonary edema, atrial septal defect, acute MI, 3rd trimester of pregnancy |
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What is preload and afterload?
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they are both pressures
pre - pressure as the ventricles stretch at the endof diastole while they are filling after - pressure causing resistance to ejection of blood from the ventricles |
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What is ejection fraction? nromal?
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ejection fraction is the fraction of the blood that is ejected from the ventricles (SV/EDV)
55-65% |
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What are common signs and symp of CVD - cardiovascular disease
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top to bottom
-syncope, dizziness, changes in LOC - chest pain, - dyspnea, orthopnea, shortness of breath - intermittent claudication - weight gain, peripheral edema - fatigue |
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What is CAD?
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coronary artery disease = atherosclerosis of coronary arteries
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nonmodifiable risk factors for CAD?
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= things you can't control
family history age gender race |
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modifiable risk factors for CAD?
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= factors you can control
hyperlipidimia, obesity, physcial activity tobacco HTN, DM lack of estrogen in women |
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What is an example of a good lipid profile?
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triglycerides - 100-200 mg/dl
cholesterol - <200 mg/dl - LDL - must be lower than 160 mg/dl |
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What is good cholesterol? what is bad?
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HDL - H for keep it high, because its good
LDL - L for keep it Low, because its bad |
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Patient has DM and smokes. What range should he keep his LDL?
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patient has 2 risk factors. LDL should stay below 130 mg/dl.
160 - 1 or more risk factors 130 - 2 or more risk factors 100 - has CAD or risk for CAD 70 - high risk for cardiac event |
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pt. has CAD. What should his LDL be?
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< 100 mg/dl
160 - 1 or more risk factors 130 - 2 or more risk factors 100 - has CAD or risk for CAD 70 - high risk for cardiac event |
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doctor ordered fluoroscopy for pt. why?
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fluoroscopy = moving xray images
- allows visualization of moving internal structures, ie can visualize cardiac pulsations |
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Atherosclerosis vs ateriosclerosis
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arterio = lack of elasticity
artherosclerosis - type of arterio, in which fat deposits and fibrous tissue causes loss of elasticity |
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An elderly woman is experiencing nausea, weakness, and dyspnea. Is there any need for concern?
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nausea, weakness and dyspnea is an atypical sign of myocardial ischemia in women, elderly, and DM pts.
angina pectoris is more common for men |
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What is angina pectoris? What is caused by?
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Angine pectoris is sudden/paroxysmal chest pain or pressure.
it is caused by the insufficient supply of blood to the heart (via coronary arteries), which may be influenced by hiher oxgen demand during physical or emotional stress, and insuffiicient blood flow (artherosclerosis) |
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Pt. has angina pectoris. What are ways that you can try to differenitate between different kinds?
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stable - stops hurting while resting
unstable - may keep hurting while resting. pain more severe. intractable or refractory angina - doesn't go away - very incapacitating pain. silent ischemia - no pain, but ischemia visual on EKG or stress test |
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What is classic symptoms of myocardial ischemia?
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- angina pectoris
- numbness or tingling up left arm - referred left retrosternal pain, jaw, shoulders |
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what drug usually subsides angina pectoris/
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nitoglycerine
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How to treat someone with angina pectoris at home?
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1. stop all activity, sit or rest in bed
2. take aspirin 3. call 911 4.calmly assess VS, observe resp, assess pain (unstable vs stable) |
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How would a nurse treat sometone with angina pectoris?
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1. apply O2
2. VS 3. NTG or MS? 4. 12 lead EKG refer to book? |
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What is classic symptoms of myocardial ischemia?
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- angina pectoris
- numbness or tingling up left arm - referred left retrosternal pain, jaw, shoulders |
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what drug usually subsides angina pectoris/
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nitoglycerine
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How to treat someone with angina pectoris at home?
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1. stop all activity, sit or rest in bed
2. take aspirin 3. call 911 4.calmly assess VS, observe resp, assess pain (unstable vs stable) |
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How would a nurse treat sometone with angina pectoris?
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1. apply O2
2. VS 3. NTG or MS? 4. 12 lead EKG refer to book? |
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what does pmi mean? what is its significance in cardiovascular health?
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pmi - point of maximal impulse
aka apical impulse this is furthest (laterally, and inferiorly) point apex pulse can be palpated. deviation from its notmal location (5th intercostal, midclavicular line) indicates cardiomegaly. forceful impluse also indicates HTN |
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What medications are usually used to treat pt's with angina pectoris?
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nitrates (nitroglycerine)
beta-adrenergic blocking agnets Calcium ion antagonists antiplatelet meds (aspirin) anticoagulation med (heparin) |
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What does nitroglycerine do?
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NTG primarily works as a vasodilator, but can also work as an arteriodilator.
Vasodilation relieves preload pressure in heart. arteriodilation relieves afterload. This mechanisms decrease workload of heart, decreasing need for oxygen. |
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How do beta-adrenergic blocking agents work?
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They block the beta-adrenergic receptors of the sympathetic system, thus causing a decrease in heart rate, BP, contractility, and slow down conduction.
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How do calcium antagonists work?
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they decrease SA and AV node conduction, resulting in slower heart rate, lower contractility, vasodilation, lower bp, dilate smooth muscle wall of coronary arterioles
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What to antiplatelets are usually given to patients at high risk for MI?
Why are two given simultaenously? |
aspirin and clopidogrel
they block different steps in the platelet activation pathway for a more cumulative effect |
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What medication is used to treat vasospasm?
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calcium blocking meds
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Descibe action of heparin. What else must a nurse consider for a pt on heparin?
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prevents formation of NEW clots
pt's on heparin are placed on bleeding precautions: 1. apply pressure on puncture sites for longer periods of time 2. avoid IM injections 3. avoid tissue injury |
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What are signs of MI in an ECG?
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T wave inversion
elevated ST segment abnormal Q wave |
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What does T wave inversion indicate on ECG?
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ischemia - ischemic region remains depolarized
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What is the significance of an elevated ST segment? (ECG)
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key diagnostic for MI - injured myocardial cells repolarize quicker
(repolarization usually in T wave) |
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What is the significance of an abnormal Q wave?
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presence of necrotic tissue - can't depolarize - longer and deeper
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What does it mean when you see an abnormal Q wave but normal ST segment?
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old MI - Q wave alterations are permanent
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What is differnece betnween STEMI and NSTEMI?
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STEMI = ST segmeng of ecg elevation = dx MI
NSTEMI = no eleveation of ST, but biomarkers present, indicating MI |
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What biomarkers help to diagnose MI?
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creatinine kinase - CK - MB
Myoglobin troponin |
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What is the significance of CKMB?
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indicator of acute MI
peaks within 24 hours, and lasts 48 hours |
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What is function of myoglobin?
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it is a heme protein that delivers oxygen to muscle.
can also be used as a biomarker to detect MI, however not specific to MI. If low, it does help to rule out acute MI. |
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What is troponin? what is significance of its lab value?
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troponin is a molecule involved in regulating the contraction of muscles.
specific tropnins, I and T, are very reliable indicators of myocardial injury |
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What is typical pharm therapy for patients suspected wiht MI
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aspirin, NTG, morphine, IV beta blocker
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Are there any precautoins for patients taking pharm therapy for MI?
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NSAIDS should be discontinued because they are associated with adverse cardiac events
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What is considered more effective therapy for MI - PCI or thrombolytics?
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pci = percutaneous coronary interventions- ie PTCA percutaneous transluminal coronart angioplasty and corontary artery stents
thrombolytics = dissolves existing thrombi PCI more effective because it also compresses or removes the underlying artherosclerotic lesion |
