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109 Cards in this Set
- Front
- Back
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Cardio Vascular Disease Etiology
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Genetic
Neurohumoral Infalmmatory Mechanisms Tissue & cellular processes (endothelial injury, remodeling, stunning, reperfusion injury, autoimmune disease) |
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Veins Carry
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Deoxygenated blood EXCEPT: Pulmonary Veins - carry 02 blood
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Circulatory: Right Heart does:
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Receives blood from superior and inferior vena cava;
Pumps blood thru pulmonary arteris to lungs |
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Circulator: Left Heart does:
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Receives blood from the pulmonary veins. Pumps blood thru aorta into systemic circulation.
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Aorta is called the:
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Powerhouse
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Superior Vena Cava comes from
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head and arms
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Right & Left Pulmonary Artery carries
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Deoxygenated blood to lungs
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Pulmonary Veins carries:
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Oxygenated blood from lung to L Ventricle
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Pulmonary Semilunar Valve
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Right - leading to pulmonary trunk
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Tricuspid Valve
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Between right atrium and right ventricle
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Mitral Valve
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BEtween Left Ventricle and Left atrium
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Cardiac Cycle: Diastole
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Rest
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Cardiac: Systole
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Pumps
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Ejection Fraction:
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Amount of blood can squeeze out. Not all ejected (66%) - 2/3
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Cardiac Cycle Phases
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Atrial systole
Ventricular systole Ventricular ejection (semilunar valves open) Ventricular relaxation (closure of aortic valve Ventricular filling (opening of mitral) |
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Normal blood output
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5 L
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Intracardiac Pressure is Highest on which side?
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Left
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Cardiac system is controlled by
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Nervous system: Sympathetic nerves (speeds up)
Parasympathetic nerves (slows down; Vegus nerve) alpha & beta receptors Norepi & Epi (excites heart) |
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Inderol (propranalol)
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Beta blocker / antihypertensive (decreases BP)
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Preload
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Pressure at the end of diastole
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Afterload
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Resistance to ejection during systole
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Stroke volume
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Amount ejected in systole - depends on force of contraction which depends on myocarial contracability
(Liters per beat) EDV - ESV ; blood flow per beat Preload, Afterload, Contractability |
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Ejection Fraction =
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SV / EDV = 66%
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Frank Starling law of the heart
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VOLUME of blood & STRETCH phenonimon and when we have blood left at end of diastole.
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Heart: More stretch =
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Increased force of contraction
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Heart Output
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Heart rate x Stroke Volume = 5L
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Laplace's Law
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Under aneurysm secion - r/t tension / pressure & radius
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Cardiac Output
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Volume o f blood flowing thru either systemic or pulmonary circuit in liters per minute = 5L/min
Stroke Volume x heart rate |
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Blood carries
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Oxygen and CO2
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What affects blood flow?
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Poiseuille's Law:
*Pressure (BP) *Resistance - Diameter / length contribute to resistance *Baroreceptors (in corodid sinus) *Arterial chemoreceptors (resond to 02, co2 or pH *velocity *laminar (straight) vs turbulent flow *vascular compliance |
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Arteriosclerosis
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Chronic disease of arterial system.
Thickening and hardening of vessel Smooth muscle cells and collagen fibers migrate to tunica intima |
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Atherosclerosis
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Form of arteriosclerosis.
Thickening and hardening r/t accumulatin of lipid-laden macrophages in arterial wall. Plaque development Process occuring thruout body |
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Atherosclerosis Progression
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Inflammation of endothelium
Cellular prliferation Macrophage migration *LDL oxidation (bad lipid - need protein carrier) Fatty streak Fibrous plaque Complicated plaque |
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Coronary Artery Disease (CAD)
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Any vascular disorder that NARROWS OR OCCLUDES CORONARY ARTERIES
Most common cause: Atherosclerosis |
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Most common cause of CAD
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Atherosclerosis
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CAD Risk Factors
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Dyslipidemia (LDL)
Hypertension, CIGARETTES AND DIABETES (increases risk together! Obesity Defect in endothelial cells |
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Dietary fat packaged into:
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Chylomicrons for absorption in small intestine:
Triglycerides: in chylomicrons VLDL - mainly triglycerides & protein carrier LDL - mainly cholesterol & protein carrier HDL - Mainly phospholipids & protein (GOOD) |
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CAD Nontraditional risk factors
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Markers of INFLAMMATION & THROMBOSIS (c-reactive, fibrinogen, protein C, pasminogen activator inhibitor)
Hyperhomocysteinemia Infection |
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Proeine C helps
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Blood clot
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Hyperhomocysteinemia
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Too much homocystein. Don't want! Bad for arteries
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Myocardial Ischemia
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Lower blood FLOW;
local, temp. reduced coronary supply Stable ANGINA Prinzmetal angina Silent ischemia Angina pectoris |
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Stress affects
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Heart!. Type A personality is losing proof!
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Right Coronary Artery
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Right marginal branch
Posterior descending branch |
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Left Coronary Artery
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Left anterior descending artery
Circumflex artery |
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Diabetes impedes
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collateral formation
Increased production of antiangiogenic factors (endostatin & angiostatin) |
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Coronary Veins
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Coronary sinus
Great cardiac vein Posterior vein of left ventricle |
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Myocardial Infarction
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sudden & extended obstruction of myocardial blood supply. HEART ATTACK. Cell injury
Cellular death - permanent Structural & functioinal changes Repair - sometimes |
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Changes with myocardial infarction
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ICG changes
Cardiac enzymes (troponins & CK-MB LDH Hyperglycemia |
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Thrombus
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Blood clot that remains attached to vessel wall
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Embolism
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Blood clot that moves to another site and blocks circulation obstructing blood flow
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Many arterial embo are from
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the heart
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What occurs secondary to myocardial infarction (MI
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valve disease, endocarditis, dysrhythmias, heart failure
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Peripheral Artery Disease (PAD)
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Atherosclerotic diesease of arteries that perfuse LIMBS
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PAD risk factors
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same as atherosclerosis (fat, smoke, hypertension, obesity, dyslipidemia
Often asymptomatic Intermittent Claudication |
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Angina comes with:
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Heart attack
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Intermittent Claudication comes with:
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Peripheral artery disease
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Buerger's Diesase
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Thromboangitis obliterans
Inflamm. disease of peripheral arteries resulting in nonatherosclerotic lesions Obliterates small & medium size arteries |
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Buergers Disease occurs mainly in
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young men who smoke. Can cause loss of limbs
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Buergers manifestations:
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pain
tenderness hair loss slow sluggis blood flow Can leade to gangrenous, amputation All r/t decreased blood flow |
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Raynaud Phenomenon / Diesase
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Episodic vasospasm in arteries and arterioles of fingers & possible toes
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Raynaud manifestations
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tricolor changes inhands / feet
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Raynaud secodnary to:
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collagen vascular diease (scleroderma)
smoking pulmonary hypertension myxedema vnrionmental factors (cold, vibration) |
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Disorders of Pericardium
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Inflammation pericardiumitis
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Cardiomyopathies
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Another heart diesease;
heart muscle doesn't function; dilates and contributes to congestion |
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Valvular Heart Diesaes (Endocardium)
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Affects endocarium = inside of heart
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Valvular Heart Diesase Sx
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Aoritic stenosis (tight/narrow)
Mitral Stenosis Aortic regurgtitation (blood backup r/t valve not function) Mitral regurgitation Tricuspid regurg. Mitral valve prolapse (doesn't close) |
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Ecocardiogram
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to look at valves and struction
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Esophogeal Echocardiogram
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more intrusive. more accurate; can read ejection fraction
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Rheumatic Heart Disease
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May have scarlet fever as child & affects heart;
Diffuse, inflamm. disease caused by delayed immune response to infection by group A beta-hemolytic strptococci |
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Rheumatic Fever
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Carditis
Polyarthritis Chorea Erythema marginatum |
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Endocardidis
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Inflammation of endocardium (inner)
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Cause of endocarditis
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bacteria, virus, fungi, rickettsiae, parasites
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Endocarditis is assocated with
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prostheitc valves, indwelling catheters, heart surgery
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Cardiac Complications of AIDS
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Myocarditis
Endocardidtis Pericarditis Cariomyopathy |
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Order of heart tissue
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Pericardium
Myocardium Endocardium (outside to inside) |
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Heart Failure
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Describes several types of cardiac dysfunction that resut in inadedquate TISSUE PERFUSION (Pump problem)
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Congestive Heart Failure
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Inable to generate cardiac oupt to perfuse tissues / pulmonary congestion despite normal stroke volume and cardiac output
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Right heart failure
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Caused by diffuse hypoxic pulmonary disease
Can result from increase in left ventricular filling pressure |
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High output failure
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Inability of heart to supply body w/ blood-borne nutrients despite adequate blood volume and normal or elevated myocardial contractitliy.
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If Right heart does not push to lungs then...
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lung problems - peripheral edema
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Dysrhythmias
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Conduction problem. Disturbane in rhythm. Occasional 'missed' or rapid beat
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Dysrhythmias caused by
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abnormal rate of impuse generation or abnormal impuls conduction
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Sinoatrial node (SA)
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Intranodal pathways
In L atria to AV node to peurkinje fibers and out |
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Factors controlling conduction
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Cardiac excitation
Depolarization Repoarization |
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Dysrhythmias
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Bradycardia
tachycardia atrial flutter fibrillation (may need coumadin) premature atrial contraction heart block premature ventricular contraction ventricular tachycardia (boom, boom,boom) ventricular fibrillation BAD - need to defibrilate Asystole (flat line) |
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P wave
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ATRAIL depolarizatrion
Flutter = atrial |
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PR Interval
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Onset of atrail activation to onset of ventricular activation (time from sinus node through atrium, AV node an dhis purkinje system to activate ventricular myocardial cells
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QRS complex
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VENTRICULAR depolarization
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ST interval
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Ventricular depolarized
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QT interval
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Electrical systole of ventricles
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Aneurymal Disease
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Local dilation or out-pouching of vessel wall or cardica chamber
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True Aneurysms
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Fusiform aneurysms
circumferential aneurysms |
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False aneurysms
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Saccular aneurysms
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Aneurysms and Laplace's law
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r/t TENSION & PRESSURE
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Cardiovascular Assessment
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Review Lab
Ass mucous membrans (pink, pale) Palpation of pulses (all) Auscultation of heart Ankle-brachial index (PAD) |
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Noninvasive cardiovascular tests
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Doopler studies
Pulse volume recordings Magnetic resonance imaging Stress tesing Chest x-ray (to see enlargement) |
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Invasive cardivascular tests
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Nuclear imaging w/ reioactive isotopes
CT scan cardiac catherization |
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Pre-Hypertenstion
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120 - 139 / 80-90
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Hypertension
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140 / 90 + sustained
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Who makes changes to hypertenstion parameters?
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Joint National Committee - JNC 7
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Factors affecting blood pressure
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Mean arterial pressure (MAP)
Cardiac output resistance hyperemia hormones (epi , norepi, antidiuretic HM, renin/antiotensin, aldosterone system, natriuretic peptides) |
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Risk factors for hypertension
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Family history
age Female < 55; Male > 74 Black race, high sodium, heavy alcohol use, obesity, smokeing, low potassium,, Mg, Ca |
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Treatment of hypertenstion
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polypharmacy! (Diuretics & ace, beta blocker, ...)
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Orthostatic HypOtension
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Decrease in systolic by 20 mmHg and diastolic by 10 mmHg on standing
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Proper way to do BP
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Sit for 10 minutes then check L & R.
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Whenever administering antihypertensives do...
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check BP
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The myocardium differs from other muscle tissues in that it contains its own
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conduction system - cells to generate action potentialsw/o stimulation from nervous system.
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Heart Rate is affected by
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Sympathetic and parasympathetic nerves (affect speed) and diametery of coronary vessels.
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Strong link between lipoproteins and
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CAD
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