Gerontology 113 Cardiovascular

Front 1

refers to the loss of elasticity of the artery. Rubberband theory.

Back 1

arteriosclerosis

Front 2

refers to the accumulation of fatty deposits chiefly composed of cholesterol on the walls of the artery. Athere- fatty mush. Skerlos- hard

Back 2

atherosclerosis

Front 3

Loss of o2 to tissues

Back 3

ischemia/hypoxia

Front 4

this disease is the narrowing of the coronary arteries sufficiently to prevent adequate blood supply to the myocardium

Back 4

Coronary artery disease

Front 5

narrowing, which is usually a result of atherosclerosis, may progress to the point where the heart muscle is damaged due to ____blood supply

Back 5

lack

Front 6

Non-modifiable risks factors. Things we ____ change.

Back 6

can't. age, gender, ethnicity, family

Front 7

women don't develop CAD as early as men because ____ gives proteins to the heart

Back 7

estrogen

Front 8

Modifiable risk factors of CAD are things we ____ change. Risk factors include?

Back 8

can.
hypertension, elevated serum lipids, obesity, tobacco use, physical inactivity

Front 9

Name the the stats of hypertension?

Back 9

120/80 normal
121-139/81-89 pre
140-159/90-99 hyper
>160/100 very hypertensive

Front 10

the stress of constant elevated bp increases atherosclerosis. Because it damages _____ cells of the coronary arteries, which in turn causes hypertrophy of LV. If we catch this BP early can help decrease atherosclerosis

Back 10

endothelial cells

Front 11

Modifiable risk factors of CAD is things we ___ control

Back 11

can.
hypertension, elevated serum lipids, obesity, tobacco use, physical inactivity

Front 12

Elevated serum lipids is > ___ is bad. Fasting tyrglycerides is > ___is bad

Back 12

200, 150

Front 13

IN regards to CAD, obesity mortality rate is greater in obese with CAD BMI >___. Hypertension is more likely to develop 3x higher in obese. Individual who stores fat in ___. At a higher risk for cad.

Back 13

30, abdomen

Front 14

If you use tobacco, there is a 2-6x higher of devloping ____. Smoking has been linked to decreasing ___ levels in women. Estrogen protects the ____***… This puts premenpausal women at greater risk. The more you smoke the greater risk. Pipe and cigar still has increase. Nicotine releases _____and norepinephrine

Back 14

CAD, women, heart, epinephrine

Front 15

physical inactivity- lack of activity on regular basis. ___minutes at a time. is recommeneded. 5x a week. Physical active people increases ___. Collateral circulation increases with exercise

Back 15

30, HDLs

Front 16

Personality in regards to CAD. Type _ are anal and more prone to get CAD and type __ are more laid back

Back 16

A, B

Front 17

A complete lipid provile is suggested at the age of __ and to draw up every _ years

Back 17

20, 5

Front 18

Cholesterol lowering drug therapy. These drugs are the most widely used and studied lipid-lowering drugs.

Back 18

Statin Durgs

Front 19

i. mevacor (lovastatin)
ii. Lipitor (atovastatin)
iii. crestor (rosuvastatin)

Statin, cholesterol absorption inhibitor, bile acid sequestrants

Back 19

statin

Front 20

These meds inhibit the synthesis of cholesterol in the liver. This inhibition causes an increased in hepatic LDL receptors which allows the liver to remove more LDLs from the blood. A small increase in HDLs is also seen

Statin, cholesterol absorption inhibitor, bile acid sequestrants

Back 20

statin

Front 21

Drugs that increase lipoprotein removal

Statin, cholesterol absorption inhibitor, bile acid sequestrants

Back 21

bile-acid sequestrants

Front 22

i. Questran (cholestyramine)
ii. colestid (colestipol)

Statin, cholesterol absorption inhibitor, bile acid sequestrants

Back 22

Bile-acid sequestrants

Front 23

meds binds with bile acids in the intestine, forming insoluble complex and excreted in feces. Binding results in removal of LDL and cholesterol. Liver takes cholesterol into bile acids and then out thru poop. Can have some GI symptoms show up. This can lower LDls by as much as 20%. Effective and safe for Long term use. Side effects will eventually go away. This can interfere with Dig and Coumadin, vancomyacin, and thiazide diuretics.

Statin, cholesterol absorption inhibitor, bile acid sequestrants

Back 23

bile-acid sequestrants

Front 24

drugs that decrease cholesterol absorption

Zetia. Inhibits the absorption of dietary and biliary cholesterol across the intestinal wall. It is used as an adjunct to dietary changes. When combined with statin, even greater reducting in LDLs

Statin, cholesterol absorption inhibitor, bile acid sequestrants

Back 24

Cholesterol absorption inhibitor

Front 25

i. Garlic used for high cholesterol, triglycerides.
ii. omega-3 fatty acids used for ↑ triglycerides and CVD prevention
iii. Niacin- used for ↑ cholesterol
iv. Soy used for ↑ cholesterol.
v. Red yeast rice ↑ cholesterol

Back 25

Info

Front 26

Name the stages in orderof CAD:

Back 26

Foam cell
fatty streak
atheroma
fibrous plaque
Complicated lesion/rupture

Front 27

CAD stages. macrophages and smooth muscle cells, which have accumulated LDLs in them. Fat started to collect. 1st cells found at a fatty streak

Back 27

Foam cell

Front 28

Cad Stages. lipid filled muscle cells. Earliest leasion of atherosclerosis
Takes on yellow appearance. Have been observed at age 15

Back 28

Fatty streak

Front 29

CAD stages. fatty deposits. At this stage fat is being laid down.

Back 29

atheroma

Front 30

CAD stages.the fatty streak is covered with collagen. Collagen is laid down which makes more of a lesion... This is the most dangerous stage. As fibrous plaque is growing causes complication, platelets catch on here and further occlude the artery and form a thrombus.

Back 30

Complicated lesion/rupture

Front 31

when occlusion occurs in the coronary arteries, this type of circulation allows blood flow. Vessels grow to bypass this occlusion.. So the heart grows these vessels to prevent blood stoppage.

Back 31

collateral circulation

Front 32

This refers to chest pain that occurs intermittenlty over a long period with the same pattern of onset, duration, and intensity of symptoms.

Back 32

Chronic stable angina

Front 33

The 1st clinical signs of and MI is ____/chest pain

Back 33

angina

Front 34

In angina, pain is described as pressure or ache in the ___, constrictive, squeesing, heavy, choking suffocating sensation. Pain can raidate to neck, __, shoulders and arm

Back 34

chest, jaw

Front 35

In angina attacks, temperature can cause angina becase cold ____ the blood vessels. emotion can be a factor because of the ____ or ____ sympathetic nervous system. Consumption of heavy meals can ____ workload of heart because blood is shunted to the GI. Tobacco increases the work load of hte heart because ______ is released from the tobacco stimulants. Also cocain and methamphetamines increase the heart rate too.

Back 35

cold, fight or flight, increase, epinephrine.

Front 36

Name this type of angina:
occurs only at night but not necessarily when the person is in recumbent position of during sleep
nocturnal, decubitus, Prinzmetals

Back 36

nocturnal

Front 37

this type of angina occurs only while the person is lying down.
nocturnal, decubitus, Prinzmetals

Back 37

decubitis

Front 38

this angina often occurs at rest and may be result of a coronary artery spasm.

nocturnal, decubitus, Prinzmetals

Back 38

prinzmetals

Front 39

Chest pain that is new in onset occurs at rest or has a worsening pattern. It is unpredictable and represents an emergency

Back 39

unstable angina

Front 40

Drugs therapy for angina. This is a short acting nitrate.

Back 40

Nitroglycerine

Front 41

This is a long acting nitrate?

isordil, lopressor, calan

Back 41

isordil

Front 42

This drug therapy for angina decreases myocardial contractility, decreases heart rate and lowers BP.

inderal ( propanolol), lopressor (metoprolol), Corgard (nadolol), Ternormin (atenolol)

Back 42

Beta blockers

Front 43

This drug therapy for angina causes smooth muscle relaxation and vasodilatation of the coronary artersy by blocking the binding of calcium to its receptors.

Procardia (nifedipine), Calan (verapamil), Cardizem (diltiazem)

Back 43

CCB

Front 44

Guidelines for Nitrol, Keep pills in a ___ bottle, Remove the ____ from the bottle. The pills are good from _to _ months once the bottle is open. You know the stuff is good if it causes a ____ sensation.

Back 44

colored. Cotton, 3-6. tingle sensation

Front 45

Adverse affects of Nitro is it can cause a throbbing ___ but last no longer than 20 minutes. Can give tylenol to relieve pain. Try to put the ointment on a place that is free of ___. as a nurse always ___ placement of nitro patch, date, time and name

Back 45

h/a, hair, switch

Front 46

Left side cath goes through an ____.

Back 46

artery

Front 47

Right side cath goes through an ____

Back 47

vein

Front 48

This is when you put a catheter into a artery and it increases the size of the lumen. It is a balloon,

Back 48

angioplasty

Front 49

This is used to open up an coronary arter and it stays in place with in that artery.

Back 49

Stent

Front 50

Stents can cause a ____, which is bulid of plaque and stationary, when something breaks off it is called an ____

Back 50

thrombus, Emboli

Front 51

These are stents that slowly release medication to prevent overgrowth of tissue.

Back 51

Drug eluding stents

Front 52

Most serious complication of stents are ____ that can initiate an acute MI and a coronary spasm. can cause heart arrhythmias

Back 52

emboli

Front 53

This occurs as a result of sustained ischemia, causing irreversible myocardial cell death ( necrosis)

Back 53

MI

Front 54

cardiac cells can withstand ischemic conditions for approximately ___ minutes before cellular death begins

Back 54

20

Front 55

__ to __% of myocardial infarction are secondary to thrombus formation.

Back 55

80 90

Front 56

Almost all MI involves the __ venticle. Because it is the ___ important ventricle. The first tissue of the heart that becomes ichemic is the _____. It takes approximately _ to _ hours for the heart to become fully necrosed.

Back 56

Left. Most. endocardium. 4-6

Front 57

The infarctions are described by ___ of damage. The Doctor will classify the MI. Damage can occur in more than one locaiton

Back 57

location

Front 58

Myocardial infarctions usually occur in the ____.

Back 58

morning

Front 59

The first thing that happens in an MI is ___ is number 1. Then the sympathetic nervous system releases epi and noraepi to the body resulting in a ____, and the body ____ all the blood to the heart.

Back 59

pain, vasoconstriction, shunts

Front 60

Cardiovascular manifestations of an MI: Initially BP & HR is ___ because of the adrenaline released. The BP will eventually ___, crackles will be heard in the lungs because the ___ is being backed up causing _____ edema. This is because the blood is being backed up due to __ ___ not pumping out the blood. Soon this will back flow into the _ ____, and then the _ ____ cuasing _____ vein distention in the neck. Liver enlarment, and edema in the extremities.

Back 60

elevated. drop, blood, pulmonary, left ventricle, right atrium, right venticle, juglar

Front 61

Clinical manifestations of mi:

Back 61

pain, sympathatetic nervous system stim, cardiovascular manifestations, N/V, fever

Front 62

in an MI, temperature can increase the first 24 hours and get up to ___ degrees resulting from the inflammation of heart cells dying.

Back 62

102

Front 63

Healing process of MI: within leukocytes infiltrate the area. Enzymes are rleased form the dead cardiac cells and are important in diagnostic indicators of MI. Macrophages remove all necrotic tissues. There is accue tissue degeneration, The infarct is soft and necrotic. THE PT IS VERY PRONE TO DYSRHYTHMIAS.. which day?

Onset to 3rd day, 4 to 7th day, 8 to 10th day, 12 day, 3 to 4 weeks, 2 to 3 months.

Back 63

ONSET TO 3RD DAY

Front 64

Softening of the infarcted area is the greatest. Danger for aneurysm formation on the ventricle wall. Ventricular wall may balloon out during systole.
healing process of MI

Onset to 3rd day, 4 to 7th day, 8 to 10th day, 12 day, 3 to 4 weeks, 2 to 3 months.

Back 64

4th to 7th day

Front 65

Rupture of the ventricle will almost always lead to ____
Healing process of Mi

Back 65

death

Front 66

Newly formed capillaries develop around the infarct. It takes 2 to 3 weeks before ther is proper circulation
Healing process of MI

Onset to 3rd day, 4 to 7th day, 8 to 10th day, 12 day, 3 to 4 weeks, 2 to 3 months.

Back 66

8th to 10th day

Front 67

Collage fibers begin to form around this time. Collagen fibers are insoluble proteins that help in healing process
Healing process of MI.

Onset to 3rd day, 4 to 7th day, 8 to 10th day, 12 day, 3 to 4 weeks, 2 to 3 months.

Back 67

12th day

Front 68

The scar begins to gro firm
Healing process of Mi

Onset to 3rd day, 4 to 7th day, 8 to 10th day, 12 day, 3 to 4 weeks, 2 to 3 months.

Back 68

3 to 4 weeks

Front 69

Complications of MI: Dys____, heart failure, _____ shock, ____ muscle dysfunction

Back 69

rhytmias, cardiogenic, papillary

Front 70

This is a type of shock that decreased pumping ability of the left side of the heart to deliver o2 and nutrients to the body.

Back 70

Cardiogenic

Front 71

The muscles around the valves of the heart

Back 71

Papillary

Front 72

The function of the papillary muscle is so that blood doesn't seep ____

Back 72

backwards

Front 73

This is the blowing up of you vessels on the left side of your heart

Back 73

ventricular aneurysm

Front 74

this can develop with 2 to 3 days after Heart attack. Pain can change from breathing and not breathing. to diagnose 12lead ekg. Common complication. Inflammation of the outside of the heart.

Back 74

Pericarditis

Front 75

pericarditis that develops 4 to 6 weeks after a Heart attack. This is because the cells were dying this is an autoimmune response, not very common. It is a syndrome

Back 75

dresslers syndrome

Front 76

The p-wave indicates _____ contraction, QRS indicates ____ the T wave indicates _____, the U wave indicates.

Back 76

atrial contraction, ventricular contraction, repolarization of the ventricle, U wave is repoloarization of the perkindje fibers

Front 77

An early sign of an MI is when the ___ segement of ekg has a degree of increase. NOt all heart attacks have this.

Back 77

ST

Front 78

Diagnostic studies of the heart: angiogram, stress test, stress test with medicine, echocardiogram, doplar

Back 78

info

Front 79

In MI's it is exrtremly important to ___ quickly

Back 79

diagnose

Front 80

This is a therapy to disolve the clot quickly. Aimed at stopping hte MI, by opening the coronary artery. given with in 1st hour. Bleeding is a complication in this therapy.

Back 80

fibrinolytic terhapy

Front 81

Heart failure is divided into two subgroups: primary chronic causes: CAD, hypertension, Bacterial endocarditis. Acute: pumoanry emboli, myocarditis

Back 81

info

Front 82

the ___ heart failure is the most common. Meds that are good to decrease the heart workload and improves circulation is ____, diuretics, and vasodilators

Back 82

dig

Front 83

this is right sided heart failure an elargment of the right ventricle due to high blood prressure exerted by the lungs. You will see edema, acites, jugular veing distension, elarged liver

Back 83

Cor Pulmonale

Front 84

in edema < 5 mm

Back 84

2+

Front 85

in eema 5-10mm

Back 85

3+4

Front 86

in edema >10mm

Back 86

4+

Front 87

accumulation of fludin in the alveoli. Most common cause is of this is left sided heart failure

Back 87

pulmonary edema

Front 88

This is when the whole heart is not working properly. The heart is already damaged. Death rate is between 50 to 80% when it reaches this far.

Back 88

Cardiogenic shock

Front 89

This balloon pump coordinates with heart beat, this is a temporary means to keep blood flowing. Sometimes you can put the heart at rest.. The machine takes over.

Back 89

Intraaortic balloon pump

Front 90

Mechanical valves are ___ made, they are more ___ then biological valves but the trouble with these valves are the ____ risk of blood clots. Blood thinners are a must

Back 90

man, durable, increase

Front 91

Biological valve is from a cow called ___, and pig called ___

Back 91

bovine, porcine

Front 92

The biological doesn't last long compared to the mechanical because of ____

Back 92

calcification

Front 93

If you have a biological valve you won't need _____ ____

Back 93

blood thinners

Front 94

Prego women prefer___ valves, younger people prefer ___ valves

Back 94

biological, mechanical

Front 95

This is when you take a graft from the saphenous bein and put it in the heart

Back 95

coronary artery bypass graft

Front 96

Another graft they can use for the coronary artery bypass is this artery. 90% of the people who use this graft lasts 10 years

Back 96

mammary

Front 97

this is the dilatation of the arterial wall out pouching

Back 97

aneurysm

Front 98

Of true aortic aneurysms, ___ are in the abdominal area and __ is in the thoracic areay

Back 98

abdominal, thoracic

Front 99

Aortic aneurysms are usually deteced on a ____ physical examination

Back 99

routine

Front 100

If aneurysmms are ___ mmthe go in and take care of it

Back 100

5.5

Front 101

If an aneurysm ruptures __% mortality rate

Back 101

94

Front 102

T or F malignant tumors in he heart are rare?

Back 102

true

Front 103

The rare tumor that occurs is a metastatic tumor

Back 103

True

Front 104

Malignant tumors grow____, benign grow ___

Back 104

faster, slower

Front 105

Cancer of the heart

Back 105

cardiac neoplasia

Front 106

This is when the heart sac swells with fluid

Back 106

periocarditis

Front 107

Drawing fluid out of sac around the heart

Back 107

pericardiocentesis

Front 108

This is an artificial heart that uses air to help circulate blood. till a new heart arrives. just the atrial part of the heart remains.. This replaces the ventricles

Back 108

cardiowest total

Front 109

another artificial heart is called the

Back 109

abiocor implantable replacement heart

Front 110

The artificical hearts are called the___- driver and the ____ driver. The ___ driver is not yet improved for use in the use

Back 110

blue, freedom

Front 111

This device makes little channels where the coronary arteries feed on down to myocardium and the rengenertaions of vessels go into the myocardium

Back 111

Transmyocardial laser revascularization

Front 112

This is inflammation of the vein cuased by a blood clot. Usually find this in legs or arms they are tender warm to touch, painful is the s/s.. infection follows the vein affected, red,

Back 112

superficial thrombophlebitis

Front 113

This occurs many times in the leg, whereever there is a deep vein it clogged up by the valve of the vein. tenderness edema, mild to moderate pain, deep reddish color over the tissue

Back 113

DVT

Front 114

Risk factors for a DVT: Venous _____, ______damage, ______ of blood

Back 114

stasis, Endothelial, hypercoagulability of blood

Front 115

This is a risk factor for dvt:
advanced age, atrial fibrillation, chornic heart failure, orthopedic surgery, pregnancy, prolonged immobility, stroke, varicose veins

Venous stasis, endothelial damage, hypercoagulability of blood

Back 115

venous stasis

Front 116

This is a risk factor for dvt:
abdominal and and pelvic surgery, fractures of the pelvis, hip or leg, history of DVT, trauma.

Venous stasis, endothelial damage, hypercoagulability of blood

Back 116

endothelial

Front 117

This is a risk factor for dvt:
cigs, dehydration, oral contraceptives, postapartum period, prego, sepsis, malignancies.

Venous stasis, endothelial damage, hypercoagulability of blood

Back 117

hypercoagulability

Front 118

To help with a DVT: ___ irritant, use ___ hose, if these aren't present you can use an __ ___

Back 118

remove, ted, ace wrap

Front 119

The whole prupose of useing anticoagulant therapy is to to keep more clots from ____. Use blood thinners. The body ____ clots.

Back 119

forming, dissolves

Front 120

This is a little medical device that is in the inferior vena cave and it catches blood clots

Back 120

greefield filter

Front 121

This is incompetent veins/valves. Engorged torturous veins. Increases venous pressure because blood is not getting back to the heart. so this causes engorgement and may cause edema.

Back 121

varicose veins

Front 122

a ____ is stationary and an____ travels

Back 122

thrombus. Embolus

Front 123

Which thrombosis is this?
i extremity suddenly become white, cold and extremely painful
ii. numbness and tingling will be present
iii. cramping may be present
iv. eventually wil have a loss of sensation and inability to move the affected area
v. absence of pulse below the occlusion

Back 123

Arterial

Front 124

what type of thrombosis
i. may be asymptomatic if deep and very small vein
ii. edema
iii. warmth and tnedernes over the affected area
iv. can experience calf pai or dosiflexion (Postive homans sign)
v. pain may be relieved by elevation of the xtremity
vi. skin warm, red or reddish blue with severe edema, skin cool and cyanotic
vii. pulses normal or diminished

Back 124

Venouns

Front 125

a. results from inadequate or poor circulation in the legs
b. ulceration of the tissues of the legs most commonly is due to an indadequate arterial or venous blood supply to an extremity
c. this results in ischemia and ultimately necrosis of the tissues

Back 125

leg ulcers

Front 126

Two types of hypertension. this is idiopathic. cause is unknown in 90-95% of the cases

Back 126

primary

Front 127

Type of hypertension that is due to a known cause

Back 127

secondary

Front 128

Hypertension Target organ diseases occur most frequently in the, heart, ____, peripheral vasculature, _____, eyes

Back 128

brain, kidney

Front 129

Weight loss of 10 kg may decrease SBC by approx _ to__ mm hg.

Back 129

5-20

Front 130

Dietary sodium restriction in hypertension is < ___ g of soidum a day

Back 130

2.4

Front 131

In hypertension, men should not consum no more than _ drinks/ day and women _ drink/ day

Back 131

2, 1

Front 132

The most important goal of MIs is to ___ the quality of life and promote health

Back 132

improve

Front 133

An enzyme present in heart muscle, skeletal muscle and brain tissue

Back 133

Creatine Kinase MB

Front 134

______ levels rise after 4-6 hours after symptom onset, Peak 18-24 hours and return to baseline within 3 days after MI.

Back 134

Ck-MB

Front 135

This ia a myocardial muslce protein released into circulation after injury

Back 135

cardiac-specific troponin

Front 136

Normally there is ____ circulating troponin so rise in its level is diagnositc witing 1 hour of MI. peaks within 12 hours

Back 136

no

Front 137

A low-molecular heme protein found in cardiac and skeletal muscle. Elevation is a sensitive indicator of early myocardial injury

Back 137

Myoglobin

Front 138

Serum elevations levels occur with 30 to 60 minues afte injury but decline rapidly after 7 hours

Back 138

myoglobin

Front 139

< 6 cardiac marker testing

Back 139

myo
ck-mb
troponin

Front 140

6-36 hours

Back 140

myo
ck-mb
trop 1

Front 141

>36 hours
cardiac markers
ck mb, myoglobin, troponin

Back 141

ck-mb
trop 1

Front 142

These are proteins in the blood whose main purpose is to transport cholesterol, tryglycerides and other insoluble fats.

Back 142

lipoproteins

Front 143

These lipoprotiens are carriers of chlolesterol. There sole purpose is to remove cholesterol from the peripheral tissues and transport them to the liver for excretion. Goo Cholesterol within the blood

Back 143

HDLs

Front 144

We want this lipoprotein to be >60

Back 144

HDL

Front 145

This is the bad cholesterol

Back 145

LDL

Front 146

These markers carry cholestoral and deposit them into the peripheral tissue. The level of this marker should be <100

Back 146

LDL

Front 147

This lipid marker are the predominant carriers of blood triglycerides.

Back 147

VDLS

Front 148

The main component of LDL and HDLs is

Back 148

cholesterol