Nursing 3Rd Medsurg: Cardiovascular Exam 1

Front 1

A lipid profile is also known as a lipid panel or _____ ____ panel. The body's blood lipids (or blood fats) can generally be categorized into three categories, what are they?

Back 1

A lipid profile is also known as a lipid panel or coronary risk panel. The body's blood lipids (or blood fats) can generally be categorized into three categories: cholesterol, triglycerides, and phospholipids.

Front 2

The lipid profile has been shown to be a good indicator of whether someone is at risk for 5 things?

Back 2

atherosclerosis
CAD
MI
CVA
PAD

Front 3

______ is a waxy, fat-like substance, though it is not an actual fat in its chemical structure. ________ is only found in animal tissue, in every cell, and is needed for formation of cell membranes, steroid hormones, sex hormones, bile salts, and the absorption and transport of fatty acids.

Back 3

cholesterol
cholesterol

Front 4

In addition to being absorbed from food in the GI tract, cholesterol is also synthesized in the ____. What are the 3 fundamental types of cholesterol?

Back 4

In addition to being absorbed from food in the GI tract, cholesterol is also synthesized in the liver. The 3 fundamental types of cholesterol include LDL (low density lipoprotein)
VLDL (very low density lipoprotein) and HDL (high density lipoprotein).

Front 5

Triglycerides are fat compounds of _____ or _____ origin and are made up of ______ ____ and ____.

Back 5

Triglycerides are fat compounds of animal or vegetable origin and are made up of fatty acids and glycerol.

Front 6

The body uses ___ for energy storage, fuel, insulation, and other functions. Triglycerides are ingested in the foods we eat and rise and are measurable in the blood soon after consumption of a fat-containing meal. Triglycerides are also made in the body, derived from other energy sources.

Back 6

The body uses fat for energy storage, fuel, insulation, and other functions. Triglycerides are ingested in the foods we eat and rise and are measurable in the blood soon after consumption of a fat-containing meal. Triglycerides are also made in the body, derived from other energy sources.

Front 7

__________ contain glycerol, fatty acids, phosphates, and a nitrogenous compound. They are components of cell membranes, a source of the neutrotransmitter ______, and play an important role in lipid _____, and are an ____ storage vehicle.

Back 7

Phospholipids contain glycerol, fatty acids, phosphates, and a nitrogenous compound. They are components of cell membranes, a source of the neutrotransmitter acetylcholine, and play an important role in lipid transport, and are an energy storage vehicle.

Front 8

Phospholipids are formed in most cells, but generally enter the circulation in the form of ______ after being synthesized in the ___.

Back 8

Phospholipids are are formed in most cells, but generally enter the circulation in the form of lipoprotein after being synthesized in the liver.

Front 9

Describe what a lipoprotein is.

Back 9

For lipids to be used and transported by the body, they must become soluble in the blood. They do this by combining with proteins. The body's lipids, circulating in the blood bound to proteins, give rise to the word "lipoprotein" as in "low density lipoprotein" or LDL cholesterol. So while there is a total cholesterol value in the blood, electrophoresis can be done to separate out the various types of cholesterol into the LDL, VLDL, and HDL.

Front 10

___ cholesterol is sometimes referred to as “bad cholesterol.” This is because ___ cholesterol, which is both made by the ____ as well as consumed in animal foods we eat, has a tendency, especially when elevated, to deposit in ____ _____.

Back 10

LDL cholesterol is sometimes referred to as “bad cholesterol.” This is because LDL cholesterol, which is both made by the liver as well as consumed in animal foods we eat, has a tendency, especially when elevated, to deposit in arterial walls.

Front 11

True or False: LDL cholesterol contains more cholesterol than any of the other lipoproteins.

Back 11

true

Front 12

The affinity of LDL cholesterol for depositing on arterial walls, over time (and depending on a person’s genetics and other coronary risk factors) can lead to the development of atherosclerosis. For this reason, LDL cholesterol is considered _____ or causative of atherosclerosis.

Back 12

atherogenic

Front 13

Atherosclerosis narrows blood flow in arteries and may compromise blood and oxygen supply to vital tissues. In the heart’s coronary arteries, this can lead to a myocardial infarction. In the brain, this can lead to a CVA, and in the large arteries of the legs, this can lead to___ and possible ______.

Back 13

Atherosclerosis narrows blood flow in arteries and may compromise blood and oxygen supply to vital tissues. In the heart’s coronary arteries, this can lead to a myocardial infarction. In the brain, this can lead to a CVA, and in the large arteries of the legs, this can lead to PAD and possible amputation.

Front 14

____ cholesterol contains primarily triglycerides and moderate amounts of cholesterol and phospholipids. ____ cholesterol is also believed to deposit cholesterol directly on the walls of arteries, but not as greatly as LDL cholesterol does.

Back 14

VLDL

Front 15

____ cholesterol is sometimes referred to as “good cholesterol.” This is because ____ cholesterol, manufactured in the ____ and possibly boosted by certain healthy foods we eat, “rounds up” ___ cholesterol in the blood and returns it to the ____ for metabolism and ______.

Back 15

HDL cholesterol is sometimes referred to as “good cholesterol.” This is because HDL cholesterol, manufactured in the liver and possibly boosted by certain healthy foods we eat, “rounds up” LDL cholesterol in the blood and returns it to the liver for metabolism and excretion.

Front 16

HDL cholesterol contains more _____ by weight and fewer ____ than any other lipoprotein. High HDL cholesterol values are desirable for their protective benefits to the heart and blood vessels. Some individuals have an inherently low HDL cholesterol, and this puts them at risk for the development of ___________,

Back 16

HDL cholesterol contains more protein by weight and fewer lipids than any other lipoprotein. High HDL cholesterol values are desirable for their protective benefits to the heart and blood vessels. Some individuals have an inherently low HDL cholesterol, and this puts them at risk for the development of atherosclerosis.

Front 17

For those with heart disease, diabetes, or peripheral arterial disease (high risk patients), what are the desired values for total, LDL, and HDL cholesterol and for triglycerides?

Back 17

Total cholesterol < 160 mg/dl
LDL cholesterol < 70 mg/dl
HDL cholesterol > 40 mg/dl
Triglycerides < 150 mg/dl

Front 18

For those with 2 or more coronary risk factors without heart disease, what are the desired values for total, LDL, and HDL cholesterol and for triglycerides?

Back 18

Total cholesterol < 160 mg/dl
LDL cholesterol < 100 mg/dl
HDL cholesterol > 40 mg/dl
Triglycerides < 150 mg/dl

Front 19

For those with 0-1 coronary risk factors without heart disease, what are the desired values for total, LDL, and HDL cholesterol and for triglycerides?

Back 19

Total cholesterol < 200 mg/dl
LDL cholesterol < 130 mg/dl
HDL cholesterol > 40 mg/dl
Triglycerides < 150 mg/dl

Front 20

What are some important nursing implications regarding lipd profiles?

Back 20

The patient needs to be fasting for a lipid profile and be instructed about this. Although cholesterol testing doesn’t require a fasting state, triglyclerides, which are also measured in a lipid profile, do require a fasting state. Alchohol consumption should be avoided even longer prior to the test (generally 48 hours prior to testing) because the glucose content of alcohol raises triglycerides.

Front 21

A subcomponent of most lipid profiles is the _______/_____ ratio. This is a value that is MORE important than either value alone. The risk assessment for CAD is determined by comparing the ____ ____ to ____ ______over time. This is done by dividing the total cholesterol level by the HDL cholesterol. What are the target values for men and women?

Thehigher/ lower this number, the lower the risk for coronary artery disease.

Back 21

A subcomponent of most lipid profiles is the cholesterol/HDL ratio. This is a value that is more important than either value alone. The risk assessment for CAD is determined by comparing the total cholesterol to HDL cholesterol over time. This is done by dividing the total cholesterol level by the HDL cholesterol. Target values are:
Cholesterol/HDL ratio for men less than 5
Cholesterol/HDL ratio for women less than 4.4

The lower this number, the lower the risk for coronary artery disease.

Front 22

HDL cholesterol is protective for heart disease. The higher this number, the better. In fact, an HDL cholesterol level of __ mg/dl or above is considered a “_____ risk factor” which needs to be considered in the total evaluation of the lipid results. For example, a high LDL cholesterol is offset somewhat by a high HDL cholesterol. This is where the cholesterol/HDL ratio becomes an important parameter for risk assessment. In women, HDL cholesterol usually runs higher than in men, until menopause. The loss of _____ causes women to lose this protective benefit and become more at risk for heart disease if HDL values drop significantly.

Back 22

HDL cholesterol is protective for heart disease. The higher this number, the better. In fact, an HDL cholesterol level of 60 mg/dl or above is considered a “negative risk factor” which needs to be considered in the total evaluation of the lipid results. For example, a high LDL cholesterol is offset somewhat by a high HDL cholesterol. This is where the cholesterol/HDL ratio becomes an important parameter for risk assessment. In women, HDL cholesterol usually runs higher than in men, until menopause. The loss of estrogen causes women to lose this protective benefit and become more at risk for heart disease if HDL values drop significantly.

Front 23

Some individuals have a “low HDL syndrome” which is usually inherited. They are at risk for _____ heart disease, defined as heart disease in a male relative under age __or a female under age __.

Back 23

Some individuals have a “low HDL syndrome” which is usually inherited. They are at risk for premature heart disease, defined as heart disease in a male relative under age 55 or a female under age 65.

Front 24

Triglycerides have been directly linked to the risk of heart and blood vessel disease. Lifestyle and comorbidities can contribute to elevated triglycerides, such as diabetes, obesity, hypothyroidism, high alcohol consumption, high intake of refined carbohydrates and simple sugars, and physical inactivity. Can people have normal cholesterol values but elevated triglycerides? Lipid metabolism is complex, and many disorders of lipid metabolism are _____,

Back 24

People can have normal cholesterol values but elevated triglycerides. Conversely people can have elevated cholesterol values but normal triglycerides. Lipid metabolism is complex, and many disorders of lipid metabolism are inherited.

Front 25

Treatment of lipid disorders involves dietary measures, namely a low ___, low ______ diet, exercise, and the addition of medications if necessary to lower cholesterol and/or triglycerides. The “____" group of drugs are commonly used for
cholesterol problems; there are several other drug groups as well. Commonly, Lopid (gemfibrizol) or combination drugs are used to treat elevated triglycerides. Overall risk factor control is mandatory, such as control of HTN, DM, cessation of smoking, a moderate aerobic exercise program, and stress reduction.

Back 25

Treatment of lipid disorders involves dietary measures, namely a low fat, low cholestrol diet, exercise, and the addition of medications if necessary to lower cholesterol and/or triglycerides. The “statin" group of drugs are commonly used for
cholesterol problems; there are several other drug groups as well. Commonly, Lopid (gemfibrizol) or combination drugs are used to treat elevated triglycerides. Overall risk factor control is mandatory, such as control of HTN, DM, cessation of smoking, a moderate aerobic exercise program, and stress reduction.

Front 26

One teaspoon of salt contains about _____ mg of sodium. Plant sources have less sodium than animal sources, and processed foods are usually higher in sodium.

Back 26

2300

Front 27

Sodium is essential for regulating many cellular activities in the body, including the body’s water balance. Due to the osmotic force of sodium, water will be pulled toward it and be retained in the body. In some people, a diet high in sodium can cause the body to retain too much fluid, which contributes to hypertension and worsens congestive heart failure, renal failure, and other fluid overload states. As _______ is a major risk factor for the development of cardiovascular disease, and both CHF and renal failure are common medical problems encountered by nurses, patient education in sodium awareness and restriction in the diet is an important nursing intervention.

Back 27

Sodium is essential for regulating many cellular activities in the body, including the body’s water balance. Due to the osmotic force of sodium, water will be pulled toward it and be retained in the body. In some people, a diet high in sodium can cause the body to retain too much fluid, which contributes to hypertension and worsens congestive heart failure, renal failure, and other fluid overload states. As hypertension is a major risk factor for the development of cardiovascular disease, and both CHF and renal failure are common medical problems encountered by nurses, patient education in sodium awareness and restriction in the diet is an important nursing intervention.

Front 28

The body only needs about___ mg of sodium per day. Most Americans, however, get anywhere from _____-____ of sodium per day. A level that has been shown to help reduce the risk of fluid retention (as in CHF) and the risk and control of hypertension, and is supported by the American Heart Association is ____ mg of sodium per day.

Back 28

The body only needs about 500 mg of sodium per day. Most Americans, however, get anywhere from 6000-8000 mg of sodium per day. A level that has been shown to help reduce the risk of fluid retention (as in CHF) and the risk and control of hypertension, and is supported by the American Heart Association is 2000 mg of sodium per day.

Front 29

Sources of sodium. Sodium in the diet comes from these primary sources:
1) Sodium occurring naturally in food and water
2) Sodium added to food during processing
3) Sodium added to food at the table and in cooking
Sodium added to food in processing, which people buy to eat, and added salt in food preparation or “table salt” are areas people have control over. For this reason, the focus of patient teaching is in these areas. Most sodium in the diet comes from salt added during food preparation and at the table. Each shake of the salt shaker adds about ____ mg of sodium at each meal.

Back 29

Sources of sodium. Sodium in the diet comes from these primary sources:
1) Sodium occurring naturally in food and water
2) Sodium added to food during processing
3) Sodium added to food at the table and in cooking
Sodium added to food in processing, which people buy to eat, and added salt in food preparation or “table salt” are areas people have control over. For this reason, the focus of patient teaching is in these areas. Most sodium in the diet comes from salt added during food preparation and at the table. Each shake of the salt shaker adds about 150 mg of sodium at each meal.

Front 30

Are people born with the taste for salt?

Back 30

People are not born with the taste for salt; it is acquired. It takes about a month of consuming less salt and high-sodium foods to reduce the desire to salt foods.

Front 31

Sodium is also added to a number of foods when they are commercially prepared and processed. Canned, frozen, and packaged foods tend to contain high amounts of sodium, both for flavor and preservation. In addition, there are a number of other
ingredients besides salt that contribute significant amounts of sodium in the diet. What kinds of salt ingredients should patients be instructed to look for on food labels?

Back 31

Sodium bicarbonate
Monosodium gluatamate
Baking powder
Hydrolyzed vegetable protein
Sodium nitrate
sodium nitrite
Soy sauce
Sodium benzoate
sodium phosphate
Sodium ascorbate

Front 32

For conditions that can cause heart failure, what are some causes of abnormal volume load ( which increase/decrease preload/afterload)? (4)

Back 32

For conditions that can cause heart failure, what are some Abnormal volume load ( which increase preload):
*Volume overload
*Valvular insufficiency (mitral, aortic, tricuspid)
*Endocrine disorders (Cushing’s disease)
*Congenital anomalies causing L-> R shunt

Front 33

For conditions that can cause heart failure, what are some causes of Abnormal pressure load (preload/afterload)?

Back 33

afterload
Aortic stenosis
IHSS
Coarctation of the aorta
HTN

Front 34

For conditions that can cause heart failure, what are some causes of Myocardial dysfunction (increased/decreased contractility)? (10)

Back 34

decreased contractility
*Myocardial infarction
*Myocardial ischemia
* CAD
*Cardiomyopathy
*Myocarditis
*Pericardial tamponade
*Ventricular aneurysm
*Collagen disorders (RA; SLE; Scleroderma)
*Myxedema
*Toxins; drugs

Front 35

For conditions that can cause heart failure, what are some causes of decreased/Increased metabolic demand? (5)

Back 35

increased met. demand
*Anemias
*Fever
*Graves Disease; Thyrotoxicosis
*Paget’s disease
*Pregnancy

Front 36

Where does the body receive the return blood from the coronary veins?

Back 36

coronary sinus

Front 37

The heart has four specialized properties. Describe each one.

Back 37

automaticity
excitability
conductivity
contractility

Front 38

Describe automaticity

Back 38

a characteristic unique to cardiac muscle and refers to the heart's ability to generate its own signal to contract. Rather than receiving input from the central nervous system, at rest the heart relies on pacemaker cells located in the right upper chamber to spontaneously generate electrical signals, which lead to the rhythmic contractions known as heartbeats. The rate of the heartbeat is based on how long it takes the pacemaker cells to fire, reset and fire again. Interestingly, these pacemaker cells function in such as a way as to prevent the heart from holding a contraction for a long period of time. If the heart muscle were to sustain a contraction for a long period, it would not be able to adequately deliver blood and nutrients to the rest of the body. The inability of the myocardium to hold a contraction, or continuously fire without resetting, is a protective mechanism built into pacemaker cells. (ability to transmit impulses automatically, especially important when there's an obstruction or problem interfering with conduction

Front 39

Describe conductivity

Back 39

In order to transmit the electrical signal that is generated in the upper right quadrant of the heart to the rest of the myocardium, the muscle fibers must be able to conduct electricity. Cardiac muscle has the ability to pass the electrical signal from one fiber to the next until it has spread throughout the entirety of the heart. Once each fiber has been given the signal, the heart will contract as a whole. Contracting in this fashion allows for a significant amount of force to be generated by the two lower chambers of the heart, which will allow blood to be delivered to the lungs and throughout the whole body. Without conductivity, each muscle fiber would need to have its own pacemaker and would likely disrupt the synchronicity, rhythm and efficiency of myocardial contractions.

Front 40

Describe contractility

Back 40

Contractility is the ability of the heart to generate tension, or produce force, in order to eject blood from the heart. It is, in essence, the physical expression of the electrical signals initiated by the pacemaker cells and passed throughout the heart muscle. The mechanisms by which the amount of force generated by the heart can be regulated by a variety of factors such as the amount of blood that fills up the chambers of the heart and signals, such as norepinephrine, released from nerve endings. Both factors will increase the strength of cardiac contractions and allow for greater force production.

Front 41

Describe excitability.

Back 41

Although cardiac muscle can generate its own electrical signal, the pacemaker cells fire at a very steady rate. Because of this, any increases in heart rate have to be governed by an external stimulus. The heart's ability to respond to an additional stimulus and change its rate of contraction is known as excitability. Just as norepinephrine increases the contractility of the heart, it also increases the rate of contraction of the heart muscle. The characteristic of excitability is vital in allowing the body to more rapidly deliver adequate amounts of oxygen and nutrients in times of physical stress, such as during exercise.

Front 42

Which are there usually more problems with valves, on the left side or right side? Why?

Back 42

Left. It's the workforce, it's thicker, and a higher pressure system than the right. Right side is a lower pressure system.

Front 43

Right sided heart failure secondary to lung disease is known as ...

Back 43

cor pulmonale

Front 44

The _____ valve is between the RA and RV

Back 44

tricuspid

Front 45

The pulmonic semilunar valve goes from where to where?

Back 45

RV pulmonary arteries

Front 46

The ____ or bicuspid valve takes blood from the _____ atrium and the ___ ventricle

Back 46

mitral
left
left

Front 47

The valve that takes blood from the left ventricle to the aorta is the ___ ___

Back 47

aortic semilunar

Front 48

Electrical impulses are initiated in a cluster of cells located in the anterior/posterior wall in the ____ atrium-- it's called the ____ ____ node. It's known as the _______ of the heart or the captain of the ship! If someone is in "normal sinus rhythm" then the impulse originates here. From there, the impulse goes to the ____ bilaterally, which are polarized/depolarized--sodium in/out and potassium in/out-- (action potential). In the meantime, blood flows in, coordinated in that once the maximum amount of blood fills the chambers, _______ is complete. Then the atrial systole/diastole (contraction) occurs dumping blood bilaterally into the _______s. Then the impulse goes to what 4 places. Depolarization now occurs in the ______s. Blood accumulates and causes tension and stress on ventricular walls. Once depolarization is complete, a massive uprising or swelling of the heart leads to massive contractile force that propels blood forward, the right side sending blood to the lungs, and the left side sending to the aorta and out to the body!!! amen!

Back 48

Electrical impulses are initiated in a cluster of cells located in the posterior wall in the right atrium-- it's called the sino atrial (SA)node. It's known as the pacemaker of the heart or the captain of the ship! If someone is in "normal sinus rhythm" then the impulse originates here. From there, the impulse goes to the atrium bilaterally, which are depolarized--sodium in and potassium out-- (action potential). In the meantime, blood flows in, coordinated in that once the maximum amount of blood fills the chambers, depolarization is complete. Then the atrial systole (contraction) occurs dumping blood bilaterally into the ve ntricles. Then the impulse goes to AV node, bundle of His, and R and L bundle branches, then to Purkinje fibers which are imbedded deep into ventricular musculature. Depolarization now occurs in the ventricles. Blood accumulates and causes tension and stress on ventricular walls. Once depolarization is complete, a massive uprising or swelling of the heart leads to massive contractile force that propels blood forward, the right side sending blood to the lungs, and the left side sending to the aorta and out to the body!!! amen!

Front 49

What is stroke volume?
What is cardiac output?
How do you figure out Cardiac Output (CO)?

Back 49

Stroke volume is the amount of blood ejected from ventricles with each systole or ejection.
Cardiac output is the amount of blood the heart ejects over one minute.
HR x SV

Front 50

The P wave represents....

Back 50

atrial depolarization

Front 51

QRS complex represents....

Back 51

ventricular depolarization

Front 52

upright T wave represents....

Back 52

ventricular repolarization

Front 53

Where is the atrial repolarization?

Back 53

buried in QRS can't see it

Front 54

True or False: Atrial systole, an electrical event of depolarization, always proecedes the mechanical ventricular systole.

Back 54

true

Front 55

The autonomic nervous system has alternating effects on the CV system. The SNS increases ___ and ___, speed of impulse conduction throught the ___ node, and force of contractions. The PNS is stimulated by the ____ nerve, cranial nerve (#)___. This decreases HR by slowing down the ___ node rate of firing and decreases conduction.

Back 55

The autonomic nervous system has alternating effects on the CV system. The SNS increases HR & BP, speed of impulse conduction through the AV node, and force of contractions. The PNS is stimulated by the vagus nerve, cranial nerve 10. This decreases HR by slowing down the SA node rate of firing and decreases conduction.

Front 56

Baroreceptors or ________ are located in blood vessels and other places and respond to _____ BP. They dilate to decrease/increase pressure and constrict to decrease/increase pressure. Chemoreceptors respond to ___ and ____ levels, they effect the HR etc. to compensate. Where are the heart and respiratory centers in the brain?

Back 56

Baroreceptors or pressoreceptors are located in blood vessels and other places and respond to arterial BP. They dilate to decrease pressure and constrict to increase pressure. Chemoreceptors respond to CO2 and O2 levels, they effect the HR etc. to compensate. The heart and respiratory centers in the brain are in the brainstem.

Front 57

The first phase of the cardiac cycle marks the onset of.....
It is heard as S1/S2, the ___ of the lub-dub. This signifies closure of the ____ and ___ valves (which is what we hear). THe heart sounds are made by pressure gradients of blood which forces the valves shut. Blood volume and pressure are what force the ________ valves shut and pushes the ______ and ____ valves open.

Back 57

The first phase of the cardiac cycle marks the onset of ventricular systole.
It is heard as S1, the lub of the lub-dub. This signifies closure of the mitral and tricuspid valves (which is what we hear). The heart sounds are made by pressure gradients of blood which forces the valves shut. Blood volume and pressure are what force the atrioventricular (AV) valves shut and pushes the pulmonic and aortic valves open.

Front 58

The second phase of the cardiac cycle marks the onset of....
It is heard as...
It signifies closure of the ____ and ____ valves. The heart sounds are made by pressure gradients of blood which force valves shut (AV valves are pushed open from pressure coming through from atrium on the way to fill the ventricles)

Back 58

The second phase of the cardiac cycle marks the onset of ventricular diastole
It is heard as the S2, the dub of the lub dub.
It signifies closure of the aortic and pulmonic valves. The heart sounds are made by pressure gradients of blood which force valves shut (AV valves are pushed open from pressure coming through from atrium on the way to fill the ventricles) RIght? check me on this but I think this is what's happening..

Front 59

Murmors are _____ _____ or r_______.

Back 59

Murmors are valvular stenosis or regurgitation.

Front 60

Extra heart sounds, either S3 or S4 can signify a few things, what are they?

(Know what these might represent)

Back 60

S3: Ventricular gallop (↓ compliance LV; seen in CHF; valvular regurgitation; heard after S2)

S4: Atrial gallop (caused by abnormal atrial contraction;
heard before S1 of NEXT cycle)

Front 61

Describe a pericardial friction rub

Back 61

an audible medical sign used in the diagnosis of pericarditis.[1] Upon auscultation, this sign is an extra heart sound of to-and-fro character, typically with three components, two systolic and one diastolic. It resembles the sound of squeaky leather and often is described as grating, scratching, or rasping. The sound seems very close to the ear and may seem louder than or may even mask the other heart sounds. The sound usually is best heard between the apex and sternum but may be widespread.
The inner and outer (parietal and visceral) layers are normally lubricated by a small amount of pericardial fluid, but the inflammation of pericardium causes the walls to rub against each other with audible friction

Front 62

Murmors are heart sounds that are produced as a result of turbulent blood flow that is sufficient to produce audible noise. A functional murmur or "physiologic murmur" is a heart murmur that is primarily due to physiologic conditions outside the heart, as opposed to structural defects in the heart itself. Functional murmurs are benign (an "innocent murmur"). Murmors are graded in the severity of their volume and intensity, graded in ____ ____.

Back 62

roman numerals

Front 63

Describe the location of the listening points for each of the areas of the heart that are auscultated.

Back 63

Aortic area – 2nd ICS, R sternal border

Pulmonic area – 2nd ICS, L sternal border

Erb’s point – 3rd ICS, L sternal border

Tricuspid area – 4th or 5th ICS, L sternal border

Mitral area – 4th or 5th ICS, medial to, or at MCL (also known as the PMI & the AP
site)

Front 64

The coronary arteries originate at the root of the ____ just above the ____ valve. They then courseover the myocardium (surface of heart) and they perfuse the myocardium during _____ diastole when the ____ valve and ____ valve are closed.

Back 64

The coronary arteries originate at the root of the aorta just above the aortic valve. They then courseover the myocardium (surface of heart) and they perfuse the myocardium during ventricular diastole when the pulmonic valve and aortic valve are closed.

Front 65

What is known as the "widow makers" disease?

(Read over P. 7 of Cardiovascular Overview for reveiw about coronary arteries, also look at P. 6 for landmarks of listening points.)

Back 65

left main disease

Front 66

Coronary Artery Disease (CVD) is a major cause of death in the US. CAD is the most common type of _____ _____ and is responsible for most of these deaths. CAD is also the most common cause of SCD- Sudden Cardiac Death. SCD is sometimes the first sign of illness for 25 % of those who die of heart disease and had no real signs before this. It is a major public health problem and is usually the effect of lifestyle and bad habits.

Back 66

Coronary Artery Disease (CVD) is a major cause of death in the US. CAD is the most common type of Cardiovascular Disease (CVD) and is responsible for most of these deaths. CAD is also the most common cause of SCD- Sudden Cardiac Death. SCD is sometimes the first sign of illness for 25 % of those who die of heart disease and had no real signs before this. It is a major public health problem and is usually the effect of lifestyle and bad habits.

Front 67

Coronary Artery Disease (CAD) is atherosclerotic _________ of the _______ arteries caused by accumulation of fatty deposits (lipids) and cholesterol within the ______ or first layer of the arterial wall, it eventually can invade into the media.

Back 67

Coronary Artery Disease (CAD) is atherosclerotic narrowing of the coronary arteries caused by accumulation of fatty deposits (lipids) and cholesterol within the intima or first layer of the arterial wall, it eventually can invade into the media.

Front 68

_______ refers to the fatty plaque in the artery, eventually reducing ____ size, diminishes or obstructs blood flow which leads to ____ and/or ________ of the myocardium.

Back 68

Atheroma refers to the fatty plaque in the artery, eventually reducing lumen size, diminishes or obstructs blood flow which leads to ischemia and/or infarction of the myocardium.

Front 69

______ drugs decrease formulation of cholesterol deposits.

Back 69

Statin drugs decrease formulation of cholesterol deposits.

Front 70

When a coronary artery is _______ percent narrowed, meaning that _____ percent of the lumen of the artery is patent, the patient will likely report symptoms of tightness, squeezing of the chest with activity. At this point, doctors will start doing some kind of intervention.

Back 70

When a coronary artery is eighty percent narrowed, meaning that twenty percent of the lumen of the artery is patent, the patient will likely report symptoms of tightness, squeezing of the chest with activity. At this point, doctors will start doing some kind of intervention.

Front 71

The pathophysiology and etiology of CAD appears to be a response to ________ (inner lining) injury to intima and inflammation. Intact normal endothelium is _____ to the deposition of fats, cholesterol, platelets and coagulation, and blood flows smoothly through the blood vessel. However, when the endothelium is injured due to h________, d_____ m______, or t_____ use etc. the environment is prone to ______ development. What lab is usually elevated in many patients with CAD (not part of lipid profile)?

Back 71

The pathophysiology and etiology of CAD appears to be a response to endothelial (inner lining) injury to intima and inflammation. Intact normal endothelium is resistant to the deposition of fats, cholesterol, platelets and coagulation, and blood flows smoothly through the blood vessel. However, when the endothelium is injured due to HTN, DM, or tobacco use etc. the environment is prone to plaque development. CRP (C-reactive protein) is usually elevated in many patients with CAD (not part of lipid profile)?

Front 72

_______ in cigarette smoking appear to contribute to CAD. No one knows exactly what causes CAD but the risk factors are known.

Back 72

Hydrocarbons in cigarette smoking appear to contribute to CAD. No one knows exactly what causes CAD but the risk factors are known.

Front 73

_________ causes a increased force of blood against arterial walls, causing cracks and tears. This means there is no longer an ____ endothelium. _____ deposits and _____ can much more easily hook on. It's much more worse if the person smokes, which speeds up the damage of the endothelial lining. Diabetes has a corrosive effect, where there are problems with ______ at the basement _____. ______ is also linked to heart disease, so if you hate your boss, quit your job, if you can't stand your husband get a divorce! (______ hormones are linked to heart disease).

Back 73

Hypertension causes a increased force of blood against arterial walls, causing cracks and tears. This means there is no longer an intact endothelium. Fatty deposits and cholesterol can much more easily hook on. It's much more worse if the person smokes, which speeds up the damage of the endothelial lining. Diabetes has a corrosive effect, where there are problems with microcirculation at the basement membrane. Stress is also linked to heart disease, so if you hate your boss, quit your job, if you can't stand your husband get a divorce! (Stress hormones are linked to heart disease).

Front 74

The only real way to regress fatty deposits is to lower ___ and increase ___. Quitting smoking will NOT reverse the process but it will stop accelerating the process.

Back 74

The only real way to regress fatty deposits is to lower LDL and increase HDL.

Front 75

CAD is a progressive/non progressive disease. What are the stages of plaque development? The development of _______ _____ may help compensate. Explain what this is.

Back 75

CAD is a progressive/non progressive disease. The stages of plaque development include fatty streak, fibrous plaque, and finally- complicated lesion. (Review sim lab prep for details!) Collateral circulation may help compensate. when a part of the heart muscle isn't receiving enough oxygen because the blood supply of the coronary artery is responsible for supplying blood to that area, if happens slowly over time, patient will develop tiny feeder blood
vessels to go around, branch off coronary artery, the obstruction, to feed part of heart muscle that is
undernourished, which can prevent an MI or the MI is smaller than it would have been. So collateralization is a very imp. idea it is most likely not going to be present in someone in their 30's or 40's, in which an MI is likely to be fatal. Someone in their 70's has had time to
develop this and is able to compensate. This also occurs in legs etc- PAD (peripheral artery disease)

Front 76

We all have some ____ streaks by the time we are teenagers, do they obstruct the lumen?

Back 76

We all have some fatty streaks by the time we are teenagers. No, they don't really obstruct the lumen- pretty harmless. It happens. Just don't want it to progress further. (No more french fries etc!)

Front 77

When there is plaque in the coronary arteries, it has a ____ cap. When this cap _____s it becomes an un_____ plaque, a blood ____ forms around the rupture ____ing the artery.

Back 77

When there is plaque in the coronary arteries, it has a fibrous cap. When this cap ruptures it becomes an unstable plaque, a blood clot forms around the rupture blocking/obstructing the artery. (The clot tries to fix the problem but this just makes it worse and causes a complete obstruction- causing necrosis or infarct - blood can't flow downstream from this part-- which is where the damage to the myocardium occurs.)

Front 78

LAD means .... and causes damage to the ____ wall.

Back 78

LAD- left anterior descending artery, causes damage to the anterior wall.

Front 79

Review risk factors for CAD on ..

Back 79

sim lab prep

Front 80

________ cholesterol is made by the liver, _______ cholesterol is from the diet.

Back 80

Endogenous cholesterol is made by the liver, exogenous cholesterol is from the diet.

Front 81

Manifestations of CAD include ____ stable angina, and _____ coronary ______ (ACS) which includes _______ angina and an acute _____ ______ (actual damage to heart muscle).

Back 81

Manifestations of CAD include chronic stable angina, and acute coronary syndrome (ACS) which includes chronic angina and an acute myocardial infarction (actual damage to heart muscle).

Front 82

Unstable angina is often a complicated lesion that may cause preinfarctional angina (before an MI) was just during exercise, now chest discomfort is at rest, or there is an increase in frequency, intensity, or duration. Review different types of angina p. 771-779

Back 82

read about this!~

Front 83

Angina can be a precursor to real thing. Angina Pectoris is a symptom of chest pain or discomfort caused by lack of ____ supply to the myocardium due to atherosclerotic _______ing or s_____ of the coronary arteries. This ischemia and resulting discomfort reflects an imbalance of oxygen supply and demand. O2 demand is up/down and/or O2 supply is up/down.

Back 83

Angina can be a precursor to real thing. Angina Pectoris is a symptom of chest pain or discomfort caused by lack of oxygen supply to the myocardium due to atherosclerotic narrowing or spasm of the coronary arteries. This ischemia and resulting discomfort reflects an imbalance of oxygen supply and demand. O2 demand is and/or O2 supply is down.

Front 84

Angina Pectoris is generally transient, and stops with ____ or ____. What's the difference between angina an MI?

Back 84

Angina Pectoris is generally transient, and stops with rest or sublingual nitroglycerin. In angina, there's no damage to the myocardium while there is damage in an MI.

Front 85

A spasm causes just enough constriction to cut off blood supply, but not due to __________.

Back 85

A spasm causes just enough constriction to cut off blood supply, but not due to atherosclerosis.

Front 86

Nitroglycerin directly ______ the coronary arteries, thereby improving ______ to the myocardium, reducing ______, and it makes it easier for the heart to pump blood.

Back 86

Nitroglycerin directly dilates the coronary arteries, thereby improving perfusion to the myocardium, reducing afterload, and it makes it easier for the heart to pump blood.

Front 87

A myocardial infarction causes myocardial cell death or ______ due to sustained ischemia caused by atheromatous plaque rupture and thrombus formation. A thrombus occludes the involved coronary artery completely, blocking perfusion tho the myocardium distal to the clot which leads to _____ then to ____ and then to decreased ability to ____. If the process is not interrupted, in ___ to ____ h permanent damage will occur. Sometimes people wait 3 days to come in. Extent of damage depends on timing, _____ of artery, which artery is involved, and whether there is development of collateral _______.

Back 87

A myocardial infarction causes myocardial cell death or necrosis due to sustained ischemia caused by atheromatous plaque rupture and thrombus formation. A thrombus occludes the involved coronary artery completely, blocking perfusion tho the myocardium distal to the clot which leads to ischemia then to necrosis and then to decreased ability to contract. If the process is not interrupted, in 4 to 6 h permanent damage will occur. Sometimes people wait 3 days to come in. Extent of damage depends on timing, size of artery, which artery is involved, and whether there is development of collateral circulation.

Front 88

True or False: If an MI occurs in the left main artery, it's not as big of deal as other arteries.

Back 88

false, more issues, greater damage here.

Front 89

After an MI, will the damaged area heal?

Back 89

No, it won't ever heal. Now it's just a scar and the patient is in heart failure or CHF.

Front 90

What are some clinical manifestations of an MI?

Back 90

unrelenting pain, discomfort, or pressure not relieved by rest or TNG
Pain may radiate, vary in intensity (may be atypical)
SNS activation: diaphoresis, cool clammy skin, increased HR (may be irregular and/or weak) increased BP (initially), kicks in to compensate for decreased cardiac output and stroke volume etc, dilates bronchioles
some s/s similar to hypoglycemia- cold clammy skin (not like exercise- but a sympathetic response)
Cardiovacular- hypotension d/t decreased CO and SV, crackles d/t LV dysfunction, SOB, decreased CO may cause decreased renal perfusion, decreased urinary output if BP low enough-- kidneys can become ischemic too
N/V - due to irritation to diaphram
fever- leukocytosis (infl response)
fear, sense of impending doom (classic signs)
some get dizzy, lightheaded
fatigue, earlobe pain and other radiating pain or sensation

Front 91

MI's are named after the coronary artery.
Anterior MI is _____.
Inferior MI is _____
Lateral MI is _____
Posterior MI is _____ or ______
More than one area involved ______, ______. Which is the worst?

Back 91

MI's are named after the coronary artery.
Anterior MI is LAD. (worst)
Inferior MI is RCA ( right coronary artery, not as critical of muscle mass)
Lateral MI is Cx (circumflex art)
Posterior MI is circumflex or RCA
More than one area involved anteroseptal, anterolateral

Front 92

The higher/lower the lesion during an MI, the more muscle effected.

Back 92

higher

Front 93

The base of the heart is at the top/bottom, the apex is at the top/bottom. Inferior is underside or underneath, and is due to occlusions of the _____ or branch thereof. These kinds can cause problems with ______, can lead to ______, need for a temporary ______ because the branches of the right coronary artery feed the ....

The circumflex branches off the ____ artery and around ____ side of ____ atrium and ventricle and _____ wall.

Back 93

The base of the heart is at the top, apex at bottom. Inferior is underside or underneath, and is due to occlusions of the RCA or branch thereof. These kinds can cause problems with conduction, can lead to bradycardia, need for a temporary pacemaker because the branches of the right coronary artery feed the electrical conduction system. The circumflex branches off the left main coronary artery and around lateral side of left atrium and ventricle and posterior wall.

Front 94

Review locations of coronary arteries p. 7 of CAD lecture, also review what was said at 0:37

Back 94

..do this!


read read read........omg!

Front 95

Most MI's involve some part of what chamber of the heart? Phases of an MI correlate with classic ECG changes. ECG changes in leads view the areas of infraction. Ex- Inferior MI, changes in Leads I, II, III, AVF
ECG changes reflect the 3 I's: _______, _____, and ______.

Back 95

Most MI's involve some part of the LV. Phases of an MI correlate with classic ECG changes. ECG changes in leads view the areas of infraction. Ex- Inferior MI, changes in Leads I, II, III, AVF
ECG changes reflect ishemia, injury, and infarction.

Front 96

Myocardial ischemia is seen as what 2 changes on the ECG?

Back 96

ST segment depression
or
T wave inversion

Front 97

read section in book about

Back 97

..sudden cardiac death

Front 98

Ischemia is due to lack of oxygen to the area involved. It is caused by electrical disturbance in myocardial cells due to inadequate supply of blood and oxygen, which leads to interference with normal _____ and ____.

Back 98

Ischemia is due to lack of oxygen to the area involved. It is caused by electrical disturbance in myocardial cells due to inadequate supply of blood and oxygen, which leads to interference with normal depolarization and repolarization.

Front 99

Is ischemia reversible?

Back 99

Yes, the artery becomes ischemic like with a tourniquet, but it's all about being released in time, if not then it becomes necrotic.

Front 100

In an MI, occlusion of a coronary artery deprives muscle cells of o2 but these arteries also feed the electrical conduction system , so during an MI there is also an electrical disturbance. Myocardial injury is seen as ___ elevation. A history of an old MI will show as a ___ deflection.

Back 100

Myocardial injury is seen as ST elevation. A history of an old MI will show as a Q deflection.

Front 101

The Q wave is the first _______ deflection, it is pathological if the degree of depth is significant enough clinically that the patient has had myocardial necrosis
Myocardial necrosis seen as pathological Q
wave. Is it always present?
In a normal healthy heart, there is just a tiny q wave deflection.

Back 101

The Q wave is the first downward deflection, it is pathological if the degree of depth is significant enough clinically that the patient has had myocardial necrosis
Myocardial necrosis seen as pathological Q
wave. Not always present.
In a normal healthy heart, there is just a tiny q wave deflection.

Front 102

Relisten for sure between 0:40- 1:00 on Julie's tape

Back 102

do this! quiz on this stuff once details are figured out...p. 6 -9 of PP

Front 103

Some complications of an acute MI include
d_______, _____ failure,
Extension of MI,
_______ fibrillation,
Cardiogenic ____,
______ muscle rupture or dysfunction
Ventricular ________
_______ (acute or Dressler’s syndrome)
pericardial _______

Back 103

Some complications of an acute MI include
dysrhythmias, heart failure,
Extension of MI,
ventricular fibrillation,
Cardiogenic shock
papillary muscle rupture or dysfunction
Ventricular aneurism
pericarditis (acute or Dressler’s syndrome)
pericardial effusion
(Ventricular aneurism- is a ballooning out, weakened area in myocardium , aneurism on epicardium of ventricle)
Cardiogenic shock is a physiologic state in which inadequate tissue perfusion results from cardiac dysfunction, most commonly following acute myocardial infarction (MI). Although ST-elevation MI is encountered in most patients, cardiogenic shock may also develop in patients with non–ST-elevation acute coronary syndrome (NSTEMI, NSTACS, or unstable angina). (The clinical definition of cardiogenic shock is decreased cardiac output and evidence of tissue hypoxia in the presence of adequate intravascular volume, not enough cardiac output or BP to sustain life)

Front 104

Any myocardial cell is capable of initiating an electrical impulse, but it's not good if it takes over the conduction instead of the ___ ____
needs to be shocked to fix it, such as in ventricular fibrillation.

Back 104

SA Node

Front 105

The healing process post - MI: The inflammatory process kicks in. There is gradual formation of ___ tissue in area of infarction, this takes about __ weeks (sometimes longer if larger MI, or less time if smaller and less enzyme elevation-- not as much time needed to recover). The vulnerable period is between ___ to ___ days post MI- when the scar is thin and unstable. What is ventricular remodeling?

Back 105

The healing process post - MI: The inflammatory process kicks in. There is gradual formation of scar tissue in area of infarction, this takes about 6 weeks (sometimes longer if larger MI, or less time if smaller and less enzyme elevation-- not as much time needed to recover). The vulnerable period is between10- 14 days post MI- when the scar is thin and unstable. Ventricular remodeling is hypertrophy and dilation of the unaffected myocardium to compensate, can lead to CHF later- it's not a good thing! (read over ventricular remodeling in book)

Front 106

Dx of an acute MI include the patient's history, risk factors, and acute changes in the ECG. However, the ECG may be normal depending on the timing of the reading. Serum cardiac markers are also very important and include ____ , ___, and ____.

Back 106

Dx of an acute MI include the patient's history, risk factors, and acute changes in the ECG. However, the ECG may be normal depending on the timing of the reading. Serum cardiac markers are also very important and include Creatine kinase (CK), CK-MB, Troponin.

Front 107

Serum cardiac markers are ____ and _____ released from ____ muscle after an MI and get into the bloodstream. Increase in serum cardiac markers that occurs with cellular death indicates presence of cardiac muscle ___ and the extent of the ____.

Back 107

Serum cardiac markers are enzymes and proteins released from necrotic muscle after an MI and get into the bloodstream. Increase in serum cardiac markers that occurs with cellular death indicates presence of cardiac muscle damage and the extent of the damage. (if the enzymes are negative, markers are normal--- then no MI. However, they could have had one a week earlier etc.)

Front 108

CK-MB is specific to cardiac muscle but ____ is is even more specific to cardiac muscle and is the "gold standard" in evaluating serum studies to determine if an MI occurred. It rises similarly to CK MB. The only real proof that someone had an MI is a ...

Back 108

troponin

proof: coronary angiogram

Front 109

People can have elevations in cardiac markers without an MI such as when....

Back 109

they have defibrilators
significant HF
after CPR
damage/weakening of heart muscle
(look at big picture--- s/s, ecg, angiogram etc to determine if there was an MI)

Front 110

Describe the timing the cardiac markers are elevated in the bloodstream after an MI.

Is there an elevation with angina?

Back 110

CK levels:
– Rise 3-12 hrs after MI
– Peak in 24 hrs
– Return to normal in 2-3 days
– CK enzymes are fractionated into bands: CK-MB

Troponin:
– Highly specific to cardiac muscle (> CK-MB)
– Rises similarly to CK, CK-MB levels

No elevation with angina

Front 111

If someone has triple vessel disease, repeated angioplasties, repeated failed stenting, left main disease etc.. they are disqualified from ___ or ____ and need a ____ instead.

Back 111

If someone has triple vessel disease, repeated angioplasties, repeated failed stenting, left main disease etc.. they are disqualified from angioplasty or stents and need a bypass instead.

Front 112

Review remainder of CAD & ACS including diagnostic tests

Back 112

...

Front 113

What are the 3 main coronary arteries?

Back 113

Right coronary artery
Left anterior descending artery
Left circumflex artery

Front 114

In most people, the _____ ____ artery supplies the AV node.

Back 114

In most people, the right coronary artery supplies the AV node.

Front 115

Blood flow into the coronary arteries occurs primarily during the _____ phase of the cardiac cycle.

Back 115

diastolic

Front 116

Put the following areas in correct order to sequence the path of the action potential along the conduction system of the heart.

AV node
Purkinje fibers
Internodal pathways
Bundle of His
Ventricular cells
SA node
Right and left atrial cells
Right and left bundle branches

Back 116

SA node
Internodal pathways
Right & Left atrial cells
AV node
Bundle of His
Right & Left Bundle Branches
Purkinje Fibers
Ventricular Cells

Front 117

The ___ wave represents repolarization of the ventricles

Back 117

T

Front 118

The ___ interval represents depolarization from the AV node through the ventricles

Back 118

QRS

Front 119

Indicate how stroke volume is effected (either increasing or decreasing preload, afterload, or contractility) by the following factor and whether CO is increased or decreased by the factor.

VALSALVA MANEUVER

Back 119

decreases preload
decreases CO

Front 120

Indicate how stroke volume is effected (either increasing or decreasing preload, afterload, or contractility) by the following factor and whether CO is increased or decreased by the factor.

VENOUS DILATION

Back 120

decreases preload
decreases CO

Front 121

Indicate how stroke volume is effected (either increasing or decreasing preload, afterload, or contractility) by the following factor and whether CO is increased or decreased by the factor.
HYPERTENSION

Back 121

increases afterload
decreases CO

Front 122

Indicate how stroke volume is effected (either increasing or decreasing preload, afterload, or contractility) by the following factor and whether CO is increased or decreased by the factor.
Adm. of EPINEPHRINE

Back 122

increases contractility
increases CO

Front 123

Indicate how stroke volume is effected (either increasing or decreasing preload, afterload, or contractility) by the following factor and whether CO is increased or decreased by the factor.
Obstruction of pulmonary artery

Back 123

decreases preload
decreases CO

Front 124

Indicate how stroke volume is effected (either increasing or decreasing preload, afterload, or contractility) by the following factor and whether CO is increased or decreased by the factor.
Hemorrhage

Back 124

decreases preload
decreases CO

Front 125

Small red/black streaks under the fingernails are known as ____ _____ (an abnormal finding in a cardiovascular assessment).

Back 125

Small red/black streaks under the fingernails are known as splinter hemorrhages(an abnormal finding in a cardiovascular assessment).

Front 126

When the strength of a pulse varies with each beat it is known as ____ ______ (an abnormal finding in a cardiovascular assessment).

Back 126

When the strength of a pulse varies with each beat it is known as pulsus alternans (an abnormal finding in a cardiovascular assessment).

Front 127

A blue tinge on the lips and conjunctiva is known as _____ ______ (an abnormal finding in a cardiovascular assessment).

Back 127

central cyanosis

Front 128

An extra heart sound heard early in diastole is known as ______ (an abnormal finding in a cardiovascular assessment).

Back 128

S3

Front 129

____ ______ are commonly heard with heart valve disorders. (an abnormal finding in a cardiovascular assessment).

Back 129

Cardiac murmors

Front 130

______ _____ ______ is associated with increased right atrial pressure. (an abnormal finding in a cardiovascular assessment).

Back 130

Jugular Vein Distention is associated with increased right atrial pressure.

Front 131

Delayed _____ ____ ____ can be indicative of decreased peripheral perfusion. (an abnormal finding in a cardiovascular assessment).

Back 131

capillary refill time

Front 132

An extra heart sound heard in late diastole is ___. (an abnormal finding in a cardiovascular assessment).

Back 132

S 4

Front 133

Blue tinge around the nose and ears is ____ ______ (an abnormal finding in a cardiovascular assessment).

Back 133

peripheral cyanosis

Front 134

At what level does total cholesterol become a risk factor for CAD in an individual without risk factors for CAD?

Back 134

>200

Front 135

At what level does triglycerides become a risk factor for CAD in an individual without risk factors for CAD?

Back 135

>150

Front 136

At what level does LDL become a risk factor for CAD in an individual without risk factors for CAD?

Back 136

>160

Front 137

At what level does HDL become a risk factor for CAD in an individual without risk factors for CAD( both men and women)?

Back 137

men < 37
women <40

Front 138

When myocardial ischemia is temporary and reversible, the condition is called...

Back 138

stable angina

Front 139

The 3 conditions that are included as manifestations of acute coronary syndrome are...

Back 139

unstable angina
stemi
nstemi

Front 140

the type of angina that occurs only when the person is recumbent

Back 140

angina decubitus

Front 141

the type of angina that is usually precipitated by exertion

Back 141

chronic stable angina

Front 142

the type of angina that is unpredictable and unrelieved by rest

Back 142

unstable angina

Front 143

the type of angina that is prevalent in diabetics

Back 143

silent ischemia

Front 144

the type of angina that is characterized by progressive severity

Back 144

unstable angina

Front 145

the type of angina that occurs with the same pattern of onset, duration, and intensity

Back 145

chronic stable angina

Front 146

the type of angina that is asymptomatic MI

Back 146

silent ischemia

Front 147

the type of angina that usually occurs in response to coronary artery spasm

Back 147

Prinzmetal's angina

Front 148

the type of angina that occurs only at night

Back 148

nocturnal angina

Front 149

the 2 types of angina that may occur in the absence of CAD

Back 149

Prinzmetal's angina
Microvascular angina

Front 150

What drug used to prevent and treat angina decreases preload?

Back 150

nitrates

Front 151

What 2 drugs used to prevent and treat angina dilates coronary arteries?

Back 151

nitrates
calcium channel blockers

Front 152

What drug used to prevent and treat angina prevents thrombosis of plaques?

Back 152

antiplatelet aggregation agents such as aspirin

Front 153

What 2 drugs used to prevent and treat angina decrease heart rate?

Back 153

Calcium Channel Blockers
Beta Blockers

Front 154

What 2 drugs used to prevent and treat angina decrease afterload?

Back 154

nitrates, beta blockers

Front 155

What 2 drugs used to prevent and treat angina decrease myocardial contractility?

Back 155

beta blockers
calcium channel blockers

Front 156

Nitrates decrease ____, decrease ____, and dilate _____ arteries.

Back 156

Nitrates decrease preload, decrease afterload, and dilate coronary arteries.

Front 157

Calcium channel blockers _____ coronary arteries, decrease ______ ______, and decrease ______ _____.

Back 157

Calcium channel blockers dilate coronary arteries, decrease heart rate, and decrease myocardial contractility.

Front 158

Beta blockers decrease ______, decrease ____ _____, and decrease _____ ______.

Back 158

Beta blockers decrease afterload, decrease heart rate, and decrease myocardial contractility.

Front 159

____ ____, a complication of MI, can manifest as crackles in lungs and S3 or S4 heart sounds.

Back 159

Heart Failure

Front 160

____ ____, a complication of MI, can manifest as decreased CO with falling BP.

Back 160

cardiogenic shock

Front 161

____ muscle _____, a complication of MI, can manifest as systolic murmor at the cardiac apex radiating toward the axilla.

Back 161

Papillary muscle dysfunction

Front 162

____ ____, a complication of MI, can manifest as intractable dysrthyhmias and heart failure

Back 162

ventricular aneurism

Front 163

____ , a complication of MI, can manifest as persistent or intermittent pericardial friction rub.

Back 163

pericarditis

Front 164

A _____ procedure involves surgical construction of new vessels to carry blood beyond obstructed coronary artery

Back 164

CABG

Front 165

A _____ _______ procedure requires anticoagulation following the procedure.

Back 165

stent placement

Front 166

A ____ ____ _____ is the most common alternative to a CABG.

Back 166

PCI- Percutaneous coronary intervention

Front 167

A ____ ____ involves a structure applied to hold vessels open.

Back 167

stent placement

Front 168

A ____ ____ ___ involves laser-created channels between the left ventricular cavity and coronary circulation

Back 168

TMR- transmyocardial laser revascularization

Front 169

_____ ____ ___ involves compression of atherosclerotic plaque with a balloon.

Back 169

PCI- Percutaneous coronary intervention

Front 170

What medication or class of medications controls ventricular dysrhythmias?

Back 170

IV amniodarone (Cordarone)

Front 171

What medication or class of medications relieves pain by decreasing O2 demand and increasing O2 supply?

Back 171

IV nitroglycerin

Front 172

What medication or class of medications helps prevent ventricular remodeling?

Back 172

ACE ibhibitors

Front 173

What medication or class of medications relieves anxiety and cardiac workload?

Back 173

IV morphine

Front 174

What medication or class of medications is associated with decreased reinfarction and increased survival?

Back 174

Beta Blockers

Front 175

What medication or class of medications minimizes bradycardia from vagal stimulation?

Back 175

stool softeners....
wtf?

Front 176

A patient hospitalized for evaluation of unstable angina experiences severe chest pain and calls the nurse. Prioritize the following interventions in order of priority.
Notify Dr.
Perform a focused assessment
Assess pain & adm. analgesics
Administer O2 per NC
Obtain a 12-lead ECG
Check patient's VS

Back 176

Administer O2 per NC
Assess pain & adm. analgesics
Check patient's VS
Obtain a 12-lead ECG
Perform a focused assessment
Notify Dr.

Front 177

Systolic/Diastolic failure is characterized by abnormal resistance to ventricular filling.

Back 177

diastolic

Front 178

A common cause of systolic/diastolic failure is left ventricular hypertrophy.

Back 178

diastolic

Front 179

Systolic heart failure results in a reduced left _____ ____ fraction.

Back 179

Systolic heart failure results in a reduced left ventricular ejection fraction.

Front 180

Any condition that interferes with the efficiency of the heart to pump will lead to a decrease in ___ ____. Therefore, pump failure has many causes, but all lead to decreased ____ ____.

Back 180

cardiac output
cardiac output

Front 181

Cardiac output is dependent on the relationship between ___ ___ and ____ ____ and CHF is best understood by looking at this relationship.

Back 181

HR & SV

Front 182

HR and SV are the determinants of cardiac output. The heart rate is controlled by the ____. Stroke volumes is determined by what 3 factors%3