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124 Cards in this Set

  • Front
  • Back
The RCA is located between the _______ AND_______
RA
RV
The RCA extends to the posterior of the heart (is dominant) in ______of the population
90%
The RCA supplies blood to the ____, ___, ______________ &_________of__________
RA
RV
most of the conduction system
inferior &posterior walls
the LV
Occlusion of the RCA may result in __________, ________or _________infarction
inferior
posterior
RV
A frequent complication is ________
heartblocks
The LAD is located _______.
btn RV and LV
The LAD is the main supply to ______,, _______, and ________.
LV
septum
anterior wall
Occlusion of the LAD results in __________MI, associated with _________ _________
anterior wall
pump
failure
The circumflex curves between the _____ and _____; it also wraps around _____________
LA
LV
the back of the heart
Occlusions of the circumflex result in ____ or ________ MI
lateral
posterior
Cardiac output is defined as
volume of blood ejected from LV over one minute (4-6 L)
Determinants of CO are ____ and ______
HR
SV
SV is affected by _____, ___ and _____
preload
afterload
contractility
The volume of blood in the ventricle at the end of diastole is _________ and is the most important component of _____
preload
SV
The tension or resistance in the systemic circulation is _____.
afterload
The SNS has the greatest effect on the _____ and ______ ________
R & L ventricles
blood
vessels
The PNS cardiac effects are______, ______ and ____
decreases HR
decr spd of cond thru AV node
slight depress of contractility
Baroreceptors respond to
Pressure changes --BP changes
Chemoreceptors respond to changes in ________, ________
blood chemistry: O2, CO2, H ion concentration (acidosis, alkalosis_
The RAAS is a compensatory mechanism that plays an important role in auto regulation by ___________________
detecting decr in BP,vasoconstriciton, decr renal perf, incr aldosterone wh incr BP
.....look at RAAS chartq
Aortic dissection pain is described as _____.
ripping and tearing, radiates to back; sometimes causes laryngitis. Not relieved by rest
Anginal chest pain may last ______ and can radiate to the ______
20-30 min
substernal chest, arm, jaw, shldr and back. May/may not be rel'd c nitro or rest
Pericarditis pain is described as ___, __________ or ______, oppressive pain that is exacerbated by _______
sharp
pleuritic
dull
inspiration
ST elevations on the 12 lead for pericarditis are _____, with out _________
global
reciprocal changes
Gastric refulx pain may mimic ___ and is described as _____ or _____, but is relieved by _____. ______ show up on ECG
MI
burning
squeezing
antacids; Will not
6 symptoms assoc with cardiac origin of pain include:
diaphoretic, cool/clammy skin, dizziness, sob, palpitations and anxiety
Dyspnea may develop ____, d/t_______
slowly
forward (LV) pump failure
Pulm edema can occur _____d/t
rapidly
anesthesia, or a strong acute ischemic event
____ or ____-______ sputum is r/t ____ ____ ____ secondary to __________
Frothy
pink
acute pulmonary edema
L heart failure
System assessment questions and considerations for cardiac pt and why: UO, fatigue, syncope, leg edema, leg pain
UO-should be >30 cc/hr
fatigue-worse at PM than AM
syncope-not perfusing well
chest pain-d/t ischemia
dizzyness and palpitations
leg edema-symetrical, look for venous ulcers
leg pain-arterial-stops if dangle over bed; venous-pain relief if elevate legs
The apical pulse (PMI) is normally seen _____
5th ICS, midclavicular line
CV palpation assessment is done with_____of hand
side/palm
normal apical pulse should not be seen or felt in more then ___ intercostal space
one
Sustatined movement of the apex is due to _____ ______ and are called ___ and _____
ventricular enlargement
lifts
heaves
Cardiac thrills are best felt with the _________, lifts and heaves are best felt with the ______
heel of the hand
fingertips
S1/S2 heart sounds are ___ ____ and best heard with the ______ of stethoscop
high freq
diaphragm
S3/S4 are ___ ____and best heard with the ____
low frequency
bell
5 cardiac auscultation landmarks.
All Physicians Take Money Eagerly
Aortic area
Pulmonic area
Tricuspid area
Mitral area
Erbs point
S1 occurs at the end of _____. S2 at the end of _____.
diastole-when Atrio Ventricular valves close.
systole-when pulmonic and aortic valves close
An S3 heart sound is considered abnormal after the age of ___
30
Differentiating systolic from diastolic murmurs is done by _____ ____ _______ _____
palpating the carotid artery
S3 and S4 can be heard distinctly for _____. S3/S4 blend together for _____ and are referred to as _______
HR < 100
HR > 100
summation gallop
Pulses are checked to determine changes in -------- --------
Heart rate
Rhythm and quality of pulse
It is important for -------- ------- to verify lost peripheral pulses with vascular surgery patients
Two
nurses
The 4Ps ---- ---- ---- and ----indicate a -----artery. this is an ----- -------
Pain pulselessness paralysis pallor
Blocked
Immediate intervention
You suspect your patient could have peripheral artery disease. you perform an ankle brachial index. this is done by
ABI=Ankle SBP/brachial SBP
ABI should be .80or greater, or decrease of no more than 15percent from baseline
Why is it important to know what the patient's baseline BP is
It is used to normalize patients BP while hospitalized
The advantages of using mean arterial pressure clinically are
Not site dependent.
Not affected by poorly damped invasive line.
Approximates perfusion pressure to cerebral and systemic arterial systems
Edema from a systemic cause is seen ---- whereas localized edema maybe caused by -----------
In all dependent areas.
a thrombus or other instructive process.
Measurement of edema should be done--------And--------
For Consistent measurement
Where the edema is greatest
Marked
Pitting edema is better assessed by---------Then by a---------
Describing length of time it takes for tissue to return to baseline
Measurement scale example 1/2 inch pitting edema
Myocardial oxygen demand is affected by blank, blank, blank, and blank blank.
Pre-load
After load
Contractility
Heart rate
How does increased or decreased pre-load affect myocardial oxygen demand
Increased preload decreases myocardial oxygenation demand.
Decreased pre-load decreases stroke volume, increases compensatory heart rate and increases oxygen demand
Contractility consumes blank of myocardial oxygen supply
70%
After load is the blank that blank must overcome to eject its blank. It is affected by blank blank blank.
Force or resistance
Ventricle
Preload
Systemic vascular resistance
Types of angina

Stable angina
Predictable, does not increase in severity or duration, relieved with rest and or nitro
Types of angina

Unstable angina
Previously diagnosed but occurs more frequently and last longer or produces symptoms with less and less exertion
Types of angina

Prinzmetal angina
Also called variant angina. Usually occurs at rest and is due to coronary artery spasm
Types of angina

Anginal equivalent
Symptoms that do not include chest pain, such as dyspnea, diaphoresis, Jaw, tooth, neck or arm pain.
Types of angina

Silent ischemia
Ischemia without symptoms. Detectable only through ECG
Types of angina

Associated angina
Associated with an MI. Angina lasting greater than 20 to 30 minutes of onset. MI and/or infarction should be considered
The labvalues specific to myocardial infarction are blank and blank
CK/MB
Troponin's. Troponin's are the most reliable marker for cardiac injury.
Reinfarction is diagnostic if troponins taken 3 to 6 hours apart show ------
Elevation of greater than 20 percent
MRI is suspected with ST elevation is greater than blank on the ECG or if it occurs in blank or blank
1 mm
In two leads that look at the same area of the heart.
Hyper a cute T waves are shown.
Supplemental oxygen should be applied for what three reasons.
1. if arterial oxygen saturation is less than 90%.
2: if patient is exhibiting respiratory distress.
3. If patient is at high risk for hypoxemia.
What are the functiosof nitrates?
Vasodilator, decreased preload, dilates coronary arteries allowing more oxygenated blood to the myocardium.
What are the functions of morphine given for acute coronary event
Increases venous capacitance therefore decreases preload in patients with heart failure secondary to ischemia. Decreases heart rate therefore decreases workload
Standard medications used to treat and MI are
Oxygen. Nitrates. Anticoagulants. Beta blockers. Ace inhibitors. Calcium channel blockers. Fibrinolytics.
Cardio selective beta blockers are safer to use for pations with reactive airway disease and include -------, -------,--------
Metoprolol -lopressor
atenolol -tenor in
Esmolol
Standard of care of ST elevation myocardial infarction includes.

Immediate care:
12 lead ECG within 10 minutes. CBC and cardiac enzymes. Start IV. Chest x-ray. Oxygen and possibly cathlab
Standard of care of ST elevation myocardial infarction includes.

Medication
Nitro, morphine, aspirin, Clopidigrel, beta blocker, anti-thrombin, GP IIb IIIa platelet receptor blocker.
Standard of care ST elevation myocardial infarction includes

Reperfusion
Fibrynolytic 30 minutes door to needle, emergent PCI 90 minutes door to balloon. Urgent/emergent cabs
How is an non STEMI differentiated from STEMI
Non-STEMI=ischemia

STEMI=injury

Treatment is predominantly the same except in NonSTEMI no reperfusion therapy and no Fibrinolytics
Other significant reasons beta blockers and Ace inhibitors are used in patients with myocardial infarction are
Beta blockers decrease sympathetic nervous system effects: decrease after load, decrease hypertension, decrease heart rate, and Decrease ventricular remodeling.
Ace inhibitors prevent remodeling, decrease after load, and decrease workload of heart. Both beta blockers and Ace inhibitors are utilized to prevent remodeling in an effort to retain normal myocardial cell functioning.
Hypertension is defined
Systolic blood pressure greater than or equal to 140. Diastolic blood pressure greater than or equal to 90. Taking anti-hypertension medications. Been told twice by Dr. or other health professional that hypertension is present.
Pathologic consequences for hypertension includes
CAD. MI. HF. Stroke.
In adults greater than 50 years old, -------- is a more important indicator for CV risk and is more difficult to control than -----
SBP>140
DBP
-----rises with age. ------- lowers with age
SBP
DBP
Systolic blood pressure greater than 160 with a normal diastolic blood pressure is termed – -- ----
and is common in the -- patient.
Isolated systolic hypertension

Elderly
90% of the population of hypertension has –
Primary essential hypertension which is defined as hypertension with no known cause.
Secondary Hypertension
Hypertension with an identifiable cause that can be corrected
Resistant hypertension criteria is ---
Patient is on a full dose therapy including a diuretic.
Blood pressure levels greater than 250/150 requires emergency treatment with in – and is termed –.
One hour

Hypertensive crisis
Complications due to hypertensive crisis include
Encephalopathy. Vasospasm. Ischemia. Cerebral edema. Hemorrhage. Brain loses ability to autoregulate
Signs and symptoms of hypertensive crisis include
Blood pressure greater than 250/150. Severe headache. Altered level of consciousness. Seizure. Vomiting. Signs and symptoms of heart failure.
Blood pressure should not be lowered more than – or to a level of – when treating hypertensive crisis.
25% in first two hours.

160/100.
Nitroprusside for hypertensive crisis
0.25 - 0.5 µg per kilogram per minute. Potent arterial vasodilator
Heart failure is defined as impaired ventricles to either – or –
Fill properly

Eject optimally
What are two symptoms a patient presents with which manifest heart failure
Dyspnea or fatigue

Extracellular fluid retention
Heart failure is – of hospitalization in the United States in patients older than –.
Single most common cause

65
Preload is –
Volume dependent
After load is dependent on – or – is in the –
Systemic vascular resistance
How much vasoconstriction
Arteries
– may be the earliest warning sign of heart failure
Sinus tachycardia
Failure of compensatory mechanisms to compensate for the overworked heart and heart failure leads to
1. Increase preload
2 increased after load
3 decrease contractility
4 decreased ejection fracture due to failure of LVto eject full SV.
5 increased left atrial pressure
5 increased right ventricular pressure
Common causes of left heart failure due to left ventricular dysfunction include
CAD. Hypertension. Dilated cardiomyopathy. Aortic valve disease. Incompetent mitral valve disease. Other causes include myocardial infarct. Congenital mechanical cardiac defects. Chronic tachycardias. PeriPartum, Cardiomyopathy. Cardio toxic agents. Alcohol. Drug abuse. Thyroid and connective tissue disorders. Idiopathic.
Right ventricular failure may result from ---
Prolonged left ventricular failure.
Isolated right ventricular myocardial infarction. Primary pulmonary hypertension. Acute or chronic lung disease.
It is important to assess – in the heart failure patient to determine if patient activity has been decreased to compensate for –
Exercise tolerance

Dyspnea or fatigue
Signs of right ventricular backward failure include
JVD. Abdominal swelling. Peripheral edema. Anorexia. Seizure. Hepatic tenderness.
Signs of left heart failure include
Left ventricular hypertrophy. Dyspnea on exertion. Cough.Orthopnea. Paroxysmal nocturnal dyspnea.
Lab values to monitor in the heart failure patient are:
Potassium due to diuretics decreasing K levels.
Dig level -digtoxicity
BUN and creatinine levels to assess renal function.
Hemoglobin and hematocrit
When you assess the heart failure patient nursing assessment in the following include:
A. Systolic blood pressure to a goal of –
b. heart sounds
C. Loans –, –, –, –, or –.
D. Hypoxemia signs and symptoms – or –
E. ECG findings
F. Kidney findings
G. Activity intolerance
A. Greater than 90.
B. s3,s4
C. Crackles wheezes. Cough.Frothy blood tinged sputum. Pulmonary edema.
D. Restlessness. Decreased mentation.
E. Ventricular arrhythmias or supraventricular arrhythmias
F. Heart failure can cause kidney injury and vice versa. Anemia can cause the Ischemiaand worsen heart failure; anemia causes end organ hypoperfusion.
G. Decrease SBP>10, decr DBP>5, ^ HR >20beats over resting heart rate, unable to talk with activity, or word dyspnea
Hold criteria for medications in heart failure patients may be –
Lower than in patients without heart failure
– – Is the worst state of acute decompensation
Pulmonary edema
Assessment findings of acute decompensated heart failure include
Low systolic blood pressure. S3 and S4 sounds. Lung sounds with crackles wheezes cough,blood tinged sputum. Restlessness. Fluid in Lungs. Monitor cardiac rhythm especially ventricular. Kidney function. Anemia resulting in hypoperfusion. Activity intolerance.
The goal of diuretic therapy for heart failure is to
Relieve symptoms of congestion while maintaining adequate circulation.
The most common cardiomyopathy is --
Dilated cardiomyopathy
Dilated cardiomyopathy compensatory mechanisms and clinical presentation or the same as – –.
Heart failure.
The common diagnostic tool for cardiomyopathy is
Echocardiogram
When listening to heart sounds stenosis is heard when the valves are supposed to be –. Regurgitation is heard when the valves are supposed to be –
Open.

Closed.
Beta blockers are – in patients with aortic stenosis and used with caution or avoided with – –.
Contra indicated
Aortic regurgitation.
Medications contraindicated with aortic regurgitation include-- or ---
Vasoconstrictors or vasoppressors
Atrial fibrillation commonly occurs with – – and – –. The patient should be assessed for this condition if new on set atrial fibrillation occurs.
Mitral stenosis

Mitral regurgitation
Patients with severe mitral stenosis may have a physical sign called –.
Mitral facies, which is pinkish purplish discoloration of cheeks
An ejection fraction less than 60 is considered – in mitral regurgitation.
Abnormal
The risk or embolic episodes is greatest with
Dilated cardiomyopathy
When administering heparin and nitroglycerin concurrently, the nitroglycerin may block some of the anti-thrombin effects of the heparin
True
The goals of treatment for a STEMI are
Administration of a fibrinlytic agent within 30 minutes of arrival or, if interventional therapy is available, first angioplasty balloon inflation within 90 minutes
– Is not an indication for temporary cardiac pacing
General anesthesia in the elderly
The energy or electricity generated by the pacemaker is called output and is measured in milliamps or mA
True
Which ECG leads record the electrical activity on the anterior surface of the left ventricle
V3, V4
Which ECG leads record the electrical activity on the lateral surface of the left ventricle
I, aVl, V5, V6
When a patient with heart failure is treated with an ace inhibitor the nurse will assess the following laboratory work prior to medication administration
Serum creatinine and serum potassium
The goals of therapy for managing heart failure might include
Improving cardiac output by decreasing preload and afterload with diuretics, and nitroglycerin
A Homografts valve is
Tissue valve from human donor