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100 Cards in this Set
- Front
- Back
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Normal BP values
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<120 / <80
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Prehypertension
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120-139 / 80-89
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Stage 1 hypertension
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140-149 / 90-99
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Stage 2 hypertension
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>160 / >100
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Risk factors for hypertension
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- Family history
- Advancing age - Smoking - Heavy alcohol consumption - Obesity - African American - Gender (men > women before age 55, women > men after age 55) - High dietary sodium intake - Low dietary intake of potassium, calcium, magnesium - Glucose intolerance |
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How hypertension affects renal function?
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High blood pressure makes the heart work harder and, over time, can damage blood vessels throughout the body. If the blood vessels in the kidneys are damaged, they may stop removing wastes and extra fluid from the body. The extra fluid in the blood vessels may then raise blood pressure even more. It’s a dangerous cycle.
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Which valve is most commonly affected in rheumatic heart disease?
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mitral valve
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What typically inhibits adequate blood flow from the left atrium to the left ventricle?
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mitral stenosis
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Very low density lipoprotein associated w...
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triglycerides and protein
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High density lipoprotein associated w...
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phospholipids and protein
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Low density lipoprotein associated w...
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Cholesterol and protein
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Chylomicrons are associated w...
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dietary fat packages
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Symptoms of myocardial infarction?
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substernal chest pressure, pain or none at all. Nausea, vomiting, abdominal pain and indigestion may occur. Fever, sweating, and cool and clammy skin.
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What is hypertension caused by?
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Increases in cardiac output, total peripheral resistance, or both.
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What causes primary hypertension? (also known as essential or idiopathic hypertension)
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it has a combination of genetic and environmental factors likely to be responsible for its development; a central process in the pathogenesis of primary hypertension is the shift in the pressure-natriuresis relationship. This causes less renal excretion of salt than normal.
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What causes is secondary hypertension?
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caused by any systemic disease process that raises peripheral vascular resistance or cardiac output, ie: renal disease, adrenal disorders, vascular disease, drugs
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What is isolated systolic hypertension? (ISH)
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when the systolic blood pressure is equal to or greater than 140 mmHg and diastolic blood pressure is below 99 mmHg. ISH is substantial in individuals older than 65 and is strongly associated with cardiovascular and cerebrovascular events. Rigidity of the aorta ist he chief vascular cause of ISH. An increase of pulse pressure indicates reduced vascular compliance of the larger arteries and is always present in ISH.
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What is malignant hypertension?
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rapidly progressive hypertension in which diastolic pressure is usually above 140 mmHg. It can cause profound cerebral edema.
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Hypertensive drugs
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thiazide diuretics, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers and adrenergic blockers.
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What is prinzmetal angina?
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abnormal vasospam of the coronary vessels; typically produces pain at rest and is common in women
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What is stable angina?
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occurs with activity ad is often limited and resolves with rest
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What is silent ischemia?
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occlusion of the coronary arteries without pain
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What is angina pectoris?
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chest pain, usually substernal chest discomfort
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What is the most common complication of AMI? (acute myocardial infarction)
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dysrhythmia is the most common (Dressler syndrome, pericarditis, and heart failure also are complications)
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What is hypovolemic shock?
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results from a decrease in blood volume due to hemorrage
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What is septic shock?
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result of infection and decreased systemic vascular resistance
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Which of the following is true regarding cellular injury of the myocardium?
1. Cardiac cells can withstand ischemic conditions for about 60 minutes 2. ECG changes are visible after approximately 120 seconds 3. Myocardial cells remain viable if blood flow returns within 20 minutes 4. After 20 seconds of decreased blood flow, myocardial cells become cooler |
3. is correct; myocardial cells remain viable if blood flow returns within 20 minutes. ECG changes are visible after 30 to 60 seconds of hypoxia. After 8-10 seconds of restricted blood flow, the myocardial cells are already cooler.
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Describe Raynaud phenomenon
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Raynaud phenomenon is characterized by attacks of vasospasm in the small arteries of the fingers that causes cold numb digits.
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Who is at risk for developing Thromboangiitis obliterans?
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Young men who are heavy smokers
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What are associated with bloody effusions? (pericardial effusions)
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coagulation defect, trauma, and aneurysms
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A patient has a loud pansystolic murmur that radiates to the back and axilla. Which of the following valvular abnormalities is this describing?
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mitral regurgitation
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Which of the following occurs secondary to hypertension?
1. Cardiovascular muscle atrophy 2. Hypoglycemia 3. Congestive heart failure 4. Decreased demand for coronary perfusion |
Congestive heart failure. Complications of hypertension include: ventricular hypertrophy, angina pectoris, congestive heart failure, coronary artery disease, myocardial infarction, and sudden death
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Which of the following is NOT an enzyme released by the myocardial muscle?
1. CK-MB 2. LDH 3. AST 4. Troponin I |
AST is a liver enzyme that indicates damage to the liver cells. The other three are indicators of myocardial damage.
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Which of the following is true regarding arteriosclerosis?
1. Arteriosclerosis is an acute process of heart muscle degeneration 2. Atherosclerosis is thickening and hardening of the vessel wall 3. A plaaque is caused by neutrophils 4. Fatty streaks and foam cells are identical |
Arteriosclerosis is a chronic degeneration of blood vessel walls.
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Which is true regarding cigarette smoke?
1. Associated with decreased LDL 2. Associated with increased HDL 3. Increase in thrombotic state 4. Decreased inflammatory state |
Increase in thrombotic state. There is an increased LDL level and thrombotic and inflammatory state and decreased HDL.
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What are varicose veins?
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a condition in which blood has pooled, producing distended and palpable vessels
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How many types of congenital heart disease are there?
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35 documented types
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What percentage of deaths are caused by congenital heart diseases within the first year of life?
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35%
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What is a sign of left ventricular heart failure in an infant?
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poor feeding
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What represents the measure of time from the onset of atrial activation to the onset of ventricular activation?
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The PR interval
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What represents the sum of all ventricular muscle cell depolarizations?
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QRS complex
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What interval is the time when the entire ventricular myocardium is depolarized?
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ST interval
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What is QT interval called?
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"electrical systole"
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A _____ in pressure at the renal artery causes increased renin release
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DECREASE
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Define preload
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pressure generated in the left ventricle at the end of diastole
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Define afterload
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resistance or impendance to ejection of blood from the left ventricle
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What hormones are released from atrial tissue in response to increases in blood volume?
1. Epinephrine 2. Norepinephrine 3. Thyroid hormone 4. Atrial natriuretic peptide |
Atrial natriuretic peptide is released from atrial tissue in response to increases in blood volume.
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What is the effect of angiotensin II?
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Vasoconstriction; it is a potent vasoconstrictor and causes the stimulation of aldosterone.
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What does aldosterone do?
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It causes reabsorption of sodium from the kidneys.
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What determines cardiac output?
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heart rate and stroke volume
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What drugs have a major effect in decreasing the strength of cardiac contraction?
1. Calcium channel blockers? 2. Narcotics (morphine) 3. Aspirin |
Calcium channel blockers block the calcium channel, prohibiting the movement of calcium into the myocardial cell. Calcium is necessary for the activation of excitation-contraction coupling; this will decrease the strength of contraction.
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Define "oliguria"
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the production of abnormally small amounts of urine
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How does the renin-angiotensin system compensate for hypovolemic shock?
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Aldosterone release, which retains Na and hence water to increase blood volume
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How does any type of shock cause oliguria?
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By decreasing perfusion to the kidneys
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What is the final common pathway in all shock?
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Impairment of cellular metabolism
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HTN is a common clinical manifestation in early stages of left ventricular failure. This clinical sign is related to:
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SNS compensation for decreased CO
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In left ventricular failure, decreased perfusion to the kidneys stimulates the renin-angiotensin-aldosterone system which may ultimately result in:
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Increased systemic vascular resistnace
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The most immediate sign of mitral valve regurgitation is:
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pulmonary edema
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Which valve disorder causes a backflow of blood into the left ventricle?
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Aortic regurgitation
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Mitral stenosis results in the incomplete emptying of the...
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Left atrium
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Stenosis of the aortic valve results in...
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increased myocardial oxygen demand
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In valvular ____, the valve opening is constricted and narrowed because the valve leaflets, or cusps, fail to open completely
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Stenosis
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The aim for therapy for a myocardial ischemia includes all of the following except:
1. Increased ventricular preload 2. Increased ventricular afterload 3. Decrease HR 4. Decreased myocardial oxygen demand |
Increased ventricular afterload
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Myocardial infarction leads to impairment of ventricular function because...
1. There is temporary alterations in electrolyte balance 2. There is too much stress on the heart 3. The cells become hypertropic 4. The resulting ischemia leads to hypoxic injury and myocardial cell death |
The resulting ischemia leads to hypoxic injury and myocardial cell death
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Angina pectoris is a manifestation of coronary artery disease and occurs primarily when:
1. CO has fallen below normal levels 2. Myocardial oxygen supply has fallen below demand 3. Myocardial stretch has exceeded the upper limits |
Myocardial oxygen supply has fallen below demand
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Most cerebral emboli originate from the
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left ventricle
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Most pulmonary emboli originate from the
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deep veins of the leg
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Mechanisms of organ damage secondary to sustained hypertension are:
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Ischemia and edema
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Most cases of combined systolic and diastolic HTN have no known cause and are diagnosed as ___ hypertension
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Primary
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Arteriosclerosis raises systolic blood pressure by
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Decreasing arterial distensibility
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In general, atherosclerosis is usually caused by:
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endothelial injury and inflammation
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Atherosclerosis is characterized by:
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abnormal thickening and hardening of vessel walls
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Troponin test
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The most sensitive and specific test for myocardial damage. Because it has increased specificity compared with CK-MB, troponin is a superior arker for myocardial injury. Peak is 12 hours.
Troponin is released during MI from the cytosolic pool of the mocytes. Its subsequen release is prolonged with degradation of actin |
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Define "nephrosclerosis"
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arteries in the kidneys are damaged so they can't transfer enough oxygen to the tissues
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CPK-MB test
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it is relatively specific when skeletal muscle damage is not present. Peak is 10-24 hours. CK-MB resides in the cytosol and facilitates high energy phosphates into and out of mitochondria. It is distributed in a large number of tissues even in the skeletal muscle. Since it has a short duration, it cannot be used to suggest infarct extension if levels rise again. This is usually back to normal within 2-3 days.
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Lactate dehydrogenase (LDH) test
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not as specific as troponin; peak 72 hours. Lactate dehydrogenase catalyses the conversion of pyruvate to lactate. LDH-1 isozyme is normally found in the heart muscle and LDH-2 is found predominately in blood serum. A high LDH-1 level to LDH2 level suggest MI. LDh levels are also high in tisue breakdown or hemolysis. It can mean cancer, meningitis, encephalitis, or HIV.
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Stable angina electrocardiography:
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Normal, possible transient ST deression and T wave inversion
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Prinzmetal angina electrocardiography:
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Transient ST elevation
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Unstable angina
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Transient ST depression and T wave inversion
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Infarction
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Elevated ST; later, pronounced Q waves
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Symptoms of decreased renal perfusion?
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Decrease in urine output, elevated blood urea nitrogen (BUN) and elevated creatinin lab values
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Define dyslipidemia
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elevation of LDL cholesterol and triglycerides, and low levels of HDL
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Defining features of myocardial infarction?
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pain relieved only by morphine, cardiac markers are going to be elevated
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Aortic stenosis
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Most common cause is congenital bicuspid valve, degenerative changes with aging, rheumatic heart disease. Results in left ventricular hypertrophy followed by left heart failure; decreased coronary blood flow with myocardial ischemia.
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Mitral stenosis
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Most common cause is rheumatic heart disease. Results in left atrial hypertrophy and dilation with fibrillation, followed by right ventricular failure; pulmonary edema: dyspnea on exertion, pulmonary hypertension
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Aortic regurgitation
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Most common cause is infective endocarditis; aortic root disease, dilation of the aortic root due to aging and hypertension. Results in left ventricular hypertrophy and dilation, followed by left heart failure.
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Mitral regurgitation
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Most common cause is mitral valve prolapse. Results in left atrial hypertrophy, followed by left heart failure; pulmonary edema with dyspnea on exertion
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RV--> LV shunt... Cyanotic or Acyanotic?
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Acyanotic
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Symptoms of aortic stenosis in children?
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Infants: decreased CO w/faint pulses, hypotension, tachycardia, and poor feeding. Loud harsh systolic ejection murmur is expected.
Children: may have complains of exercise intolerance and chest pain. They are at risk for bacterial endocarditis, coronary insufficiency, ventricular dysfunction, and, rarely, sudden death. |
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How does SOURCE of children's hypetension differ from that of adults?
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In children under 10 it's usually a secondary condition.
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How is left heart failure manifested in infants?
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Poor feeding and sucking, often leading in failure to thrive. Pallor, mottline, retractions, grunting, nasal flaring.
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What do symptomatic dysrhythmias of any kind eventually lead to?
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Decreased cardiac output, decreased perfusion
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Define bradycardia
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< 60 beats per minute for heart rate; people are usually symptomatic at 50.
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ECG complex associated w/ cardiac ischemia
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Inverted T wave
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ECG complex associated w/ cardiac infarction
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ST elevation
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Define pericarditis
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Inflammation of the pericardium; causes: viral, bacterial, fungal, ideopathic, immunologic (related to lupus or rheumatic fever)
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Define pericardial effusion
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Accumulation of fluid in the pericardial cavity
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Define dilated cardiomyopathy
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globular shape, heart stretched out, dilated and weak
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Define hypertrophic cardiomyopathy
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wall of left ventricle thickened, heart is asymmetrical
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Define restrictive cardiomyopathy
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rigid walls that causes restrictive filling
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