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45 Cards in this Set

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There are three types of angina, which is the most dangerous?
stable, unstable and variant. Unstable
angina is the most dangerous. It does not follow a pattern and can
happen without physical exertion. It is does not go away with rest or
medicine. It is a sign that you could have a heart attack soon.
Sometimes the pain of unstable angina and acute MI can be very similar, so we would
look at...
serum markers and ECG changes to see if it is acute MI
Your 65 year old mother calls you following her doctor's appointment with news that she
has high blood pressure, 148/96. The doctor gave her a prescription for a 'blood
pressure pill' but she doesn't think she will take it. She goes on to explain, "Your aunt
took blood pressure pills a long time ago and had such severe side effects, that she quit
taking them". You ask "Aunt Berniece? The one who had a stroke?"

What will you talk with her about?
First, I'd tell her to listen to her doctor or she will end up like Aunt Bernice. Second, I'd
explain to her what I think may be going on. Based on her bp numbers, I suspect she
has Essential HTN. I would explain to her that this is a disorder that runs in the family
and since we think Aunt Bernice had it as did both her (my mom's) parents, she was a
real good candidate. I would then tell her that along with taking the prescribed
medication, she needed to make some lifestyle chances such as decreasing sodium,
caloric, and alcohol intake as well as increase her physical activity (this last one will be a
touch sell). Finally, I'd explain that should she chose not to take this medication, she
may be doing longterm damage to her kidneys, heart, eyes, and blood volume all of
which could lead to a cardiovascular event of massive proportions.
You are caring for an 18 year old female on your orthopedic floor following a MVC
(motor vehicle collision). She has a pelvic fracture and has been on bedrest for 4 days.
When you are assessing her, you note her left lower extremity is reddened and swollen.
You ask her to point her "toes toward her head". When she does she says "Ouch, that
hurts."

What's your gut feeling about this scenario?
This patient's immobility has lead to stasis of blood in her leg. She has developed
venous thrombosis. The procedures she may have went through after the MVC may
have caused vessel wall injury, putting her at further risk. She may need some
anticoagulation therapy.

Ask ker to "point her toes towards her head" and resulting pain demonstrates a positive Homan's sign. By definition, this is pain resulting from
dorsiflexion that is a pretty good indicator of a DVT.
You are working in the ER when a 78 year old male comes in with severe shortness of
breath, respiratory rate of 40. You quickly attach a pulse oximetry and note an oxygen
saturation of 86%. His wife tells you he had heart attack 2 weeks ago, was hospitalized
for only 5 days because he was doing so well. Using a stethoscope, you auscultate his
respirations on his anterior chest and posterior chest. You hear crackles bilaterally.

The wife asks you 'Is he going to die? What's happening to him?'. What will you say?
crackles are a sign of left sided heart failure - with the stethoscope, we can actually hear a sound, like rice krispy treats in milk, of fluid in the
airways (alveoli). Pulmonary edema is real severe left-sided heart failure with lots more
severe manifestations. It is NOT a spasm of the pulmonary vessels, though. It is fluid
moving into the alveoli because of increased capillary filtration pressure in the
pulmonary circulation.

What you could say to the wife is .... when someone has a heart attack, like your
husband did a few weeks ago, part of the heart muscle is non-functioning, or doesn't
pump as well. So blood that should be ejecting into the rest of the body is backing up
into his lungs. That's why he is short of breath. This is a fairly common problem and we
can treat it with .... (you'll learn this in the fall).
Stroke volume is the amount of blood that the left ventricle pumps with each beat.
But what influences stroke volume?
stroke volume depends on several factors such as heart size,
contractility of the heart muscle, duration of contraction, preload (end-diastolic volume),
and afterload.

If the heart has to eject blood into arteries that are 'resistant', increased peripheral
resistance, then the stroke volume (amt of blood ejected with each heart beat) will be decreased.
heart failure is characterized by two factors
decrease in cardiac output and
compensatory mechanisms

increase in diastolic volume
4 compensatory mechanisms that increase cardiac output for a while in heart failure. They work for a while but then cause problems.
frank starling

increased nervous system stimulation, but becomes a problem when the increased afterload blocks blood flow to kidney

Renin/aldosterone system

myocardial hypertrophy (the heart gets bigger, educing chamber size, and it increases oxygen needs of the heart, making problems worse
low output heart failure is more or less common?
more common.
systolic heart failure refers to __________
impaired ejection.
diastolic heart failure refers to _________
venricular filling impaired
frank starling method allows
capability of myocardial fibers to stretch to accomodate an increased volume in the diastole in the ventricles also known as end diastolic volume.
increased sympathetic nervous sytem can also compensate for heart failure
stimulationm results in increased hreart rate and increased contractility. But, in time, the increased afterload decreases blood flow to vital organs such as the kidney, skin , muscle
renin/angiotensin/ aldosterone system causes
decreased renal flow stimulates this sytem. Salt and water retantion increases blood volume, which is problematic in heart failure
heart failure can be classified as
high output vs. low

high output is rare

sistolic (impaired ejection due to myocardial infarctions, hypertension, etc) vs diastolic (impaired filling due to an increased ventricular size) Most people have both systolic and diastolic heart failure

right vs left (initial problem will begin on one side, but will progress to both sides bi-ventricular heart failure)

Low output more common
right side failure
blood is backed up into sytemic venous circulation causes abdominal conjestion, JVD.

Caused by conditions that restrict blood flow into the lungs, pulmonary disease, which results in corpulmanale (rt sided heart failure)
congestion of peripheral tissues
right side
pulmonary edema is sign of severe
heart failure
blood leaves lung without being fully oxygenated. Patient will be gasping for air. Lips and nail beds are cyatnotic, frothy sputum cough, crackles (result of air moving through the alveolar fluid)
5 categories of shock
cardiogenic
distributive
septic
common impairments in shock
MAP is less than 60. This represent the average blood pressure. b/c of reduced pressure, pts can have acute renal failure, gi complications, DIC, multiple organ failure. High mortality rate
cardiogenic shock
only form of shock that ia caused by the failure of the heart as a pump

Most common cause is myocardial infarction.

Signs are the same as extreme heart failure-inadequate cardiac output, decreased tissue perfusion, impaired cellular metabolism
hypovolemic shock
loss of whole blood from trauma, loss of plasma due to burns, loss of fluids due to _______
obstructive shock
results from mechanical obstruction of flow through central circulation (lungs , great veins and heart). Most common cause is pulmonary embolism. JVD is sign
3 types of distributive shock
neurogenic
anaphaylaxis
septic

Characterized by loss of vascular tone, enlargement of vascular compartment,
neurogenic shock
spinal cord injury, stress, Maifestations are : slow heart rate, skin is dry and warm, rare and transitory.
anayphylactic shock
increased vascular permeability
insect venom, penicillin and latex
Abdominal cramps, skin is itchy, hives, choking, wheezing, dypsnea, drop in blood pressure, and weak pulse
septic shock
sever infection and body's response to it. Ex gram negativbe infection. Endotoxins induce tissure damage. Mortality rate of 40%. changes in personality, hypovolemia
complications of shock
acute renal failure
DIC
multiple organ dysfunction syndrome (progressive dysfunction of 2 or more organs, usu. caused by septic shock)
heart failure across the life span
infants and children...
congenital heart defects,severe chronic nemia, end stage congenital diasease. Manifestations similar to adults. Irritability may signal
Liver congestion-liver enlarges. Infants may have prolonged feeding time and low weight gain.
3 functional categories fof cardiomyopathies?
dilated, hypertrophic, and restrictive
which valvular diaorder would cause a hypertrophy of the of the left atrium and a dialstolic murmur?
mitral stenosis
which valvular diaorder would cause a widened pulse pressure and throbbing peripheral pulse
aortic regurgitation
which valvular diaorder would cause a narrowed pulse pressure and heart murmur
aortic stenosis
a loud murmur that radiates to back and axilla
mitral regurgiation
which valvular diaorder would cause anxiety, depression, panic attacks, atypical chest pain, and a midsystolic click?
mitral valve prolapse
which valvular diaorder would be caused by an autosomal dominant inherited trait
mitral valve prolapse
pressure generated at the end of diastole is called
preload
multiplying heart rate by stroke volume gives you
cardiac output
what characteristic sign would be present with pericardial effusion
pulsus paradoxus

also muffled heart sounds, friction rub.
leading cause of ishemic heart disease is
coronary artery disease
Why is myocaridal infarction a bad thing (besides that it can kill you)
infarction involves death of a tissue. This area of the heart will be repaired with scar tissue which does not contract, and will resist stretching for filling the heart
Why is the production of renin during heart failure a bad thing?
Renin is produced by the kidneys when the kidneys have a decreased blood flow. Renin activates angiotensin II which constricts peripheral vessels, raising blood pressure and afterload, making it harder for the heart to pump blood against this vascular resistance
right sided heart failure that occurs without left sided failure is usually due to ...
lung problems, such as chronic obstructive pulmonary disorders, cystic fibrosis, and adult respiratory distress syndrome.
what is the medical term for heart attack
myocardial infarction
what is the very specific indicator of acute pericarditis?
pericardial rub