Ccrn Cardiovascular

Front 1

Impairment of blood flow through the coronary arteries

Back 1

Ischemia of cardiac muscle

Front 2

Ischemia of cardiac muscle leads to..

Back 2

angina pectoris, pain in sternum, chest, neck, arms (esp left) or back

Front 3

How long do stable angina episodes usually last?

Back 3

<5 minutes and are fairly predictable

Front 4

Episodes of stable angina are caused by what action in the coronary arteries?

Back 4

Atherosclerotic lesions blocking >75% of the lumen of the effected coronary artery

Front 5

Stable angina precipitating events include what 5 actions?

Back 5

exercise, decrease in environmental temperature, heavy eating, strong emotions (fright, anger), exertion (coitus)

Front 6

How is stable angina usually resolved?

Back 6

by decreasing activity level and/or administering sublingual nitro

Front 7

Preinfarction or crescendo angina is also known as what type of angina?

Back 7

unstable angina

Front 8

This type of angina occurs when there is a change in the pattern of stable angina.

Back 8

Unstable angina

Front 9

This type of angina may have increased pain, may not respond to a single nitro, and may persist for >5 minutes.

Back 9

Unstable angina

Front 10

What type of angina may be indicative of a rupture of an atherosclerotic plaque and the beginning of thrombus formation?

Back 10

Unstable angina

Front 11

What type of angina results from spasms of the coronary arteries, which can be associated with or without atherosclerotic plaques, and is often related to smoking, alcohol, or illicit stimulants?

Back 11

Variant angina (Prinzmetal's angina)

Front 12

What are 5 characteristics of a Q-wave MI?

Back 12

1. abnormal Q wave (wider and deeper), esp in AM (r/t adrenergic activity)

2. infarction is prolonged and results in necrosis

3. Coronary occlusion complete in 90-90%

4. transmural-across the entire wall

5. Peak CK levels occur after about 27 hours

Front 13

What are mortality rates with Q-wave MIs?

Back 13

10% mortality

Front 14

What are 5 characteristics of a non-q-wave MI?

Back 14

1. changes in ST-T wave with ST depression

2. reperfusion occurs spontaneously

3. not across the entire wall

4. Coronary occlusion is complete in only 20-30%

Peak CK levels in 12-13 hours

5. Reinfarction is common

Front 15

What are mortality rates with non-q-wave MIs?

Back 15

2-3% mortality

Front 16

What type of myocardial infarction involves the full thickness of the heart (the endocardium, myocardium, and epicardium)

Back 16

Transmural MI

Front 17

What type of infarction occurs with occlusion in the proximal left anterior descending artery, and may damage the left ventricle?

Back 17

Anterior wall infarction

Front 18

What type of infarction occurs with occlusion of the circumflex coronary artery, often causing damage to the anterior wall as well?

Back 18

Left lateral wall infarction

Front 19

What type of infarction occurs with occlusion of the right coronary artery and causes conduction malfunctions?

Back 19

Inferior wall infarction

Front 20

What type of infarction occurs with occlusion of the proximal section of the right coronary artery and damages the right ventricle and the inferior wall?

Back 20

Right ventricular infarction

Front 21

What type of infarction occurs with occlusion in the right coronary artery or circumflex artery and may be difficult to diagnose?

Back 21

Posterior wall infarction

Front 22

What are the general symptoms of an Acute MI?

Back 22

Angina with pain in chest radiating to neck/arms;

palpitations;

HTN or hypotension;

ECG changes (ST segment and T-wave changes, tachycardia, bradycardia, dysrhythmias);

dyspmena;

pulmonary edema, dependent edema;

N/V;

decreased urinary output;

Palor, cold, clammy skin; change in LOC- light-headed, headache, slurred speech, feer

Front 23

What are the typical ECG changes observed with MI?

Back 23

T-wave inversion;

ST segment elevation;

abnormal Q waves

Front 24

When does CK-MB typically peak following an MI?

Back 24

24 hours

Front 25

When does Myoglobin typically peak following MI?

Back 25

12 hours, failure to increase can be used to r/o MI

Front 26

This protein within the myocardium and its isomers (C, I, and T) regulate cardiac contraction and levels increase as with CK-MB, but remeain elevated for up to 3 weeks following an MI. What is thie protein called?

Back 26

Troponin

Front 27

What type of infusion is indicated for MI with these conditions present:

Symptoms of MI, <6-12 hours since onset of symptoms;

> 1mm ST elevation in >2 contiguous leads;

no cardiogenic shock

Back 27

Fibrinolytic infusion

Front 28

How soon should fibrinolytic agents be administered, ideally?

Back 28

within 30 minutes

Front 29

This agent converts plasminogen to plasmin, breaking down fibrin and dissolving clots

Back 29

fibrrinogen

Front 30

Streptokinase & anistreplase (1st generation), Alteplace or tissue plasminogen activator (tPA) (2nd generation), Reteplase & tenecteplase (3rd generation) are all what type of agents?

Back 30

fibrinolytic agents

Front 31

What are the 6 absolute contraindications to receiving fibrinolytic therapy?

Back 31

1. Present or recent bleeding, or history of severe bleeding

2. History of brain attack (<2-6 months) or hemorrhagic brain attack

3. Anticoagulation therapy

4. Acute unctonrolled HTN

5. Aortic dissection or pericarditis

6. Pregnancy, incracranial/intraspinal surgery or trauma w/in 2 months or neoplasm, aneurysm, or AVM

Front 32

The tricuspid valve is an atrioventricular valve separating the atria from the ventricle on which side of the heart?

Back 32

Right

Front 33

The bicuspid (mitral) valve is the atrioventricular valve separating the atria from the ventricle on which side of the heart?

Back 33

Left

Front 34

Which muscles are located on the sides of ventricular walls and connect the atrioventricular valves with fibrous bands called chordae tendineae?

Back 34

Papillary muscles

Front 35

In which part of the cardiac cycle do the papillary muscles contract, tightening the chordae tendineae, closing the valves?

Back 35

Systole

Front 36

This is a type of complication of an MI that can lead to mitral regurgitation or tricuspid regurgitation depending on which side of the heart is affected. What is this complication?

Back 36

papillary muscle rupture

Front 37

Mitral valve regurgitation with resultant pumonary edema and cardiogenic shock is likely a result of papillary muscle rupture on which side of the heart following MI?

Back 37

left

Front 38

Are these characteristics of peripheral arterial or venous insufficiency?

1. Intermittent claudication/severe constant pain;

2. weak or absent pulse;

3. Rubor on dependency, but pallor of foot on elevation. Pale, shiny, cool skin with loss of hair in toes and foot. Thick and ridge nails;

4. Pain, deep, circular, often necrotic ulcers on toe tips, toe webs, heels, or other pressure areas;

5. minimal extremity edema

Back 38

Peripheral arterial insufficiency

Front 39

Are these characteristics of peripheral arterial or venous insufficiency?

1. Aching and cramping pain;

2. Present pulses;

3. Brownish discoloration around ankles and anterior tibial area;

4. Varying degrees of superficial pain, irregular ulcers on medial or lateral malleolus and sometimes anterior tibial area;

5. moderate to severe extremity edema

Back 39

Venous Insufficiency

Front 40

What comprises Virchow's triad?

Back 40

blood stasis, injury to endothelium, and hypercoagulability

Front 41

Actue venous thromboembolism (VTE) is a condition that indluces what two conditions?

Back 41

Deep vein thrombosis (DVT) and pumonary emboi (PE)

Front 42

What are the 5 most common symptoms of VTE?

Back 42

1. Aching or throbbing pain

2. Positive Homan's sign (pain in calf when foot dorsiflexed)

3. Erythema and edema

4. Dilation of vessels

5. Cyanosis

Front 43

What diagnostic tests are done to confirm PE?

Back 43

1. D-dimer (tests serum for cross-linked fibrin derivatives)

2. CT scan

3. Pulmonary angiogram

4. V/Q lung scan

Front 44

This medication reduces the risk of thromboses by interfering with the function of the plasma mebmrane, interfering with clotting. These medications include Ticlid, Plavix, and aspirin and prevent clot formation.

Back 44

Antiplatelet agents

Front 45

This medication reduces the risk of thromboses by diverting blood from ischemic areas, by dilating arteries and decreased clotting. They are used for control of intermittent claudication. Ex. Pietal

Back 45

Vasodilators

Front 46

This medication reduces the risk of thromboses by reducing blood viscosity and rigidity of erythrocytes. ex. Trental

Back 46

Hemorrheologics

Front 47

This medication reduces the risk of thromboses by slowing the progression of atherosclerosis. ex. Zocor, Questran

Back 47

Antilipemic

Front 48

These agents prevent blood clots from forming. ex. Coumadin and Lovenox

Back 48

Anticoagulants

Front 49

This anticoagulant increases the activity of antithrombin III. It is used for those with MI undergoing PCI or other cardiac surgery.

Back 49

Heparin

Front 50

This type of anticoagulant is a direct thrombin inhibitor used for unstable angina, PCI, and for prophylaxis and tx for thrombosis in heparin-inducted thrombocytopenia.

Back 50

Lepirudin (Refludan) and bivalirudin (Angiomax)

Front 51

This type of surgical intervention for treatment of severe arterial insufficiency requires the harvest of a section of the saphenous vein or an upper extremity vein to bypass damaged arteries and supply blood to distal vessels. Because veins have valves, they must be reversed or st ripped of valves prior to attachment.Synthetic grafts have a higher failure rate.

Back 51

Bypass graft

Front 52

This site is a common site for development of plaques

Back 52

common carotid artery- because it branches from the subclavian artery and bifurcates into the external carotid and internal carotid arteries

Front 53

Carotid artery stenosis interferes with blood flow to what part of the body?

Back 53

cranial blood flow

Front 54

This type of diagnostic test combines conventional ultrasound with Doppler, to determine blood flow and obstruction

Back 54

Duplex ultrasound

Front 55

This type of treatment for carotid artery stenosis involves clamping the carotids and then opening and removing the plaque that is occluding the artery. A shunt may be inserted during the procedure to ensure blood supply to the brain.

Back 55

Carotid endarterectomy

Front 56

This type of syndrome is usually identified by severe, unilateral headache relieved by raising head

Back 56

Hyperperfusion syndrome

Front 57

What are the symptoms of acute cardiac-related pulmonary edema?

Back 57

1. severe dyspnea,

2. cough with blood-tinged frothy sputum,

3. cyanosis,

4. diaphoresis

Front 58

This type of surgical procedure used to repair cardiac valves involves a catheter with an inflatable balloon positioned in the stenotic valve and infalted and deflated many times to dilate the opening

Back 58

Valvotomy/Valvuloplasty

Front 59

What is the procedure called that uses the patient's pulmonary artery with the pulmonary valve to replace the aortic valve and part of the aorta, then uses a donor graft to replace the pulmonary artery?

Back 59

Ross procedure

Front 60

This catheter is threaded into the descending thoracic aorta, the balloon inflates during diastole to increase circulation to the coronary arteries. It then deflates during systole to decrease afterload. What is this called?

Back 60

IABP

Front 61

IABP is indicated for what 6 common problems?

Back 61

1. After cardiac surgery to treat left ventricular failure

2. Unstable angina

3. MI with complications or persistent angina

4. Cardiogenic shock

5. Papillary muscle dysfunction or rupture with mitral regurg or ventricular septal rupture

6. Ventricular dysrhythmias that don't respond to treatment

Front 62

What surgical intervention is used for the removal of an atheroma from an occluded coronary artery?

Back 62

Directional Coronary Atherectomy (DCA)

Front 63

This procedure has a large balloon catheter that is usually inserted over a femoral sheath. The catheter has an open window on one side of the balloon with a rotational cutting psiton that shaves the atheroma with the plaque residue pushed inside the device for removal.

Back 63

Directional Coronary Atherectomy (DCA)

Front 64

This procedures uses a laser to burn and create channels that stimulate an inflammatory response, causing new blood vessels to form (angiogenesis), improving circulation to the myocardium and reducing ischemia and pain.

Back 64

Transmyocardial laser revascularization

Front 65

This is a surgical treatment for agina that doesn't respond to medical treatment, unstable angina, blockage of >60% in left main coronary artery, blockage of multiple coronary arteries (prosimal LAD, left ventricular dsyfunction, previous unsuccessful PCI)

Back 65

CABG

Front 66

What sites are the grafts for CABG obtained from?

Back 66

Gastroepiploic artery, Internal mammary artery, Radial artery, Saphenous vein (most common)

Front 67

This is blood accumulation around the heart

Back 67

Cardiac Tamponade

Front 68

Postoperative care of a patient who underwent a CABG is important to monitor for this complication that can result from hemolysis and damge d kidney tubules.

Back 68

Hemoglobinuria

Front 69

These drugs are used to inhibit platelet binding and prevent clots prior to and following invasive cardiac procedures such as angioplasty and stent placement

Back 69

Glycoprotein IIB/IIIA Inhibitors

Front 70

These medications are contraindicated in those with a low platelet count or active bleeding (3)

Back 70

Abciximab (ReoPro), Eptifibatide (Integrillin), Tirofiban (Aggrastat)

Front 71

This medication is used with both heparin and aspirin for ACS and PCI and affects platelet binding for 48 hours after administartion

Back 71

Abciximab (ReoPro)

Front 72

This medication is used with both heparin and aspirin for ACS and PCI and affects platelet binding for 6-8 hours after administartion. IT should not be used in patients with renal problems.

Back 72

Eptifibatide (Integrillin)

Front 73

This medication is used with heparin for PCI patients with reduced dosage for those with renal problems and affects platelet binding for only 4-8 hours after administartion.

Back 73

Tirofiban (Aggrastat)

Front 74

What chambers of the heart are most vulnerable to blunt cardiac trauma because they are antrior to the rest of the heart?

Back 74

right atrium and right ventricle

Front 75

Severe decelerating, blunt force, or penetrating injuries most common result in which great vessel injury?

Back 75

aorta trauma (tear or incomplete laceration)

Front 76

The two primary penetrating cardiac injuries are:

Back 76

exsanguination (gunshot wounds) and cardiac tamponade (knife wounds)

Front 77

What 3 characteristics are present with cardiogenic shock?

Back 77

Increased preload, increased afterload, decreased contractibility

Front 78

Decreased CO and increased SVR to compensate the increased preload, increased afterload, and decreased contractibility is present with what type of shock?

Back 78

Cardiogenic shock

Front 79

During cardiogenic shock, the increased afterload in the left ventricle cause an increased need for what?

Back 79

oxygen

Front 80

In Cardiogenic shock, as the CO continues to decrease, tissue perfusion decreases, coronary artery perfusion decreases, fluid backs up and the left ventricle fails to adequately pump the blood, resulting in what?

Back 80

Pulmonary edema and right ventricular failure

Front 81

These are symptoms of what?

1. hypotension with systolic BP <90

2. Tachycardia >100 bpm w/weatk, thready pulse and dysrhythmias

3. Decreased heart sounds

4. Chest pain

5. Tachypnea and basila rales

6. Cool, moist skin, pallor

Back 81

Cardiogenic shock

Front 82

What is the treatment for cardiogenic shock?

Back 82

IV fluids, Inotropic agents, Antidysrhythmics, IABP/LVAD

Front 83

This is a rare genetic, occasionally idiopathic, disorder often undetected until adolescence when increased symptoms become noticeable. Heart mass and size increase (thickness of septum) = smaller ventricular capacity so ventricles fill less and atria have to work harder.

Back 83

Hypertrophic cardiomyopathy (asymmetric septal hypertrophy)

Front 84

This disorder may increase the size of the septum, thereby pulling on structures, such as mitral valve, out of alignment, causing some obstruction of the blood flow throught the valve to the aorta.

Back 84

Hypertrophic cardiomyopathy

Front 85

This is the most frequent type of cardiomyopathy. It occurs with an increase in size of ventricles and systolic dysfunction.

Back 85

Dilated cardiomyopathy

Front 86

These are characteristics of what type of cardiomyopathy:

1. tissue loses elasticity, areas of myocardial cells become necrotic

2. Loss in elasticity results in less blood being ejected during ventricular systole, so during diastole less blood is able to enter the partially-filled ventricles = Increase in pressure at end of diastole, increased pulmonary pressure

3. As ventricles stretch, valves may be displaced, causing regurgitation.

4. Poor blood flow may also cause thrombus formation and emboli

Back 86

Dilated cardiomyopathy

Front 87

What conditions may cause dilated cardiomyopathy?

Back 87

1. pregnancy

2. alcoholism

3. toxic compounds

4. autoimmune disease

5. viral infections

Front 88

This type of cardiomyopathy is the least common type of cardiomyopathy, but is a common complication of heart transplants.

Back 88

Restrictive cardiomyopathy

Front 89

What are the treatments of restrictive cardiomyopathy?

Back 89

use of beta blockers, which allow the v entricles to fill mroe effectively, heart transplant

Front 90

This is a condition in which the protein amyloid is deposited in the cells.

Back 90

Amyloidosis

Front 91

With this type of cardiomyopathy, the heart may be normal in size, but the ventricular walls become increasingly fibrotic and rigid so that the ventricles cannot relax and fill adequately during diastole. Ventricles become unable to contract effectively, reducing blood flow, and icnreased pulmonary, peripheral, and systemic edema?

Back 91

Restrictive cardiomyopathy

Front 92

What part of the electrocardiogram represents the repolarization of the purkinje fibers?

Back 92

U wave

Front 93

Which heart sounds represents the closure of the mitral and tricuspid valves (heard at apex/left ventricular area of the heart)?

Back 93

S1

Front 94

Which heart sound represents the closure of the aortic and pulmonic valves (heard at the base of the heart)

Back 94

S2

Front 95

The time between S1 and S1 is which part of the cardiac cycle?

Back 95

Systole

Front 96

The time between S2 and the next S1 is which part of the cardiac cycle?

Back 96

Diastole

Front 97

A harsh, grating heart sound heard in systole and diastole is indicative of what disease?

Back 97

pericarditis

Front 98

A gallop (S3 or S4) is indicative of what heart disorder?

Back 98

heart failure, left ventricular failure, ventricular hypertrophy, CAD, HTN, AV stenosis

Front 99

This technique is used to assess what?

Elevate pts head to 45-90 degrees with pts head turned right. Position light at an angle to illuminate veins and shadows. Measure the height of the jugular vein pulsation above the sternal joint (normal is < 4cm above sternal angle)

Back 99

JVD

Front 100

Increased pressure in the right atrium, right heart failure, pericarditis or tricuspid stenosis may be indicated by what noninvasive technique?

Back 100

JVD assessment

Front 101

6 Common causes of sinus bradycardia:

Back 101

1. conditions that lower the body's metabolic needs (hypothermia, sleep)

2. Hypotension, decreased oxygenation

3. Meds-calcium channel blockers, Beta blockers

4. Vagal stimulation that may result from vomiting, suctioning, defecating

5. Increased intracranial pressure

6. Myocardial infarction

Front 102

This cardiac rhythm decreases diastolic filling time, causing reduced CO with resultant hypotension. Acute pulmonary edema may result from decreased ventricular filling if untreated.

Back 102

Sinus Tachycardia

Front 103

5 common causes of sinus tachycardia

Back 103

1. acute blood loss, shock, hypovolemia, anemia

2. sinus arrhythmia, hypovolemic heart failure

3. hypermetabolic conditions, fever, infection

4. Exertion/exercise, anxiety

5. Meds-sympathomimetic drugs

Front 104

These are some common causes of what type of arrhythmia?

alcohol, caffeine, nicotine, hypervolemia, hypokalemia, hypermetabolic conditions, atrial ischemia or infarction

Back 104

Premature atrial contractions

Front 105

This arrhythmia occurs when the atrial rate is faster than the AV node conduction, so not all of the beats are conducted into the ventricles, effectively blocking the AV node, preventing Vfib.

Back 105

Atrial flutter

Front 106

These are the causes of 2 types of arrhythmias:

CAD, valvular disease, pulmonary disease, heavy alcohol ingestion, cardiac surgery

Back 106

atrial fibrillation, atrial flutter

Front 107

What are the treatments of atrial flutter?

Back 107

Cardioversion. Meds-to slow ventricular rate and conduction through AV node (Cardizem, Calan), medicatinos to convert to sinus rhythm (Corvert, Cardioquin, Norpace, Cordarone)

Front 108

What are the treatments of atrial fibrillation?

Back 108

for acute (ibutilide: procainamide, digoxin), to maintain rhythm (quinidine, amio), to control ventricular rate (beta blockers, calcium channel blockers, verapamil)

Front 109

What type of arrhythmia may be an indication of digoxin toxicity?

Back 109

premature junctional contractions

Front 110

With this rhythm, the AV node becomes the pacemaker of the heart because the sinus node is depressed from increased vagal tone or a block at the AV node preventing sinus node impulses from being transmitted.

Back 110

Junctional rhythms

Front 111

This arrhythmia occurs when the Purkinje fibers below the AV node create an impulse

Back 111

Idioventricular rhythm

Front 112

This is left-sided heart failure and reduces the amount of blood ejected from the ventricles during contraction (decreased EF), stimulating the sympathetic nervous system (SNS) to produce epinephrine and norepinephrine to support the myocardium.

Back 112

Systolic heart failure 1

Front 113

This type of heart failure leads to an increase in preload and afterload, increased the workload on the heart, especially ventricles. Heart muscle begins to lose contractibility and blood begins to pool in the ventricles during, stretching myocardium and enlarging the ventricles.

Back 113

Systolic heart failure 2

Front 114

In this type of heart failure, the heart compensates by thickening the muscle w/o an adequate increase in capillary blood supply because of the vasoconstriciton of coronary arteries, leading to ischemia.

Back 114

Systolic heart failure 3