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Med-Surg > Cardiovascular Disease > Flashcards

Cardiovascular Disease Flashcards

1
Q

acute coronary syndrome (ACS)

A

range of conditions associated with symptomatic CAD that result in myocardial ischemia or infarction
- imbalance of myocardial O2 supply and demand

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2
Q

non modifiable risk factors for acute coronary syndrome

A

age, male gender, DM type 1, genetic predisposition

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3
Q

modifiable risk factors for acute coronary syndrome

A

hyperlipidemia, hypertryglyceridemia, DM type 2, metabolic syndrome, HTN, obesity, physical inactivity, smoking, diet

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4
Q

most common cause of acute coronary syndrome

A
  • coronary atherosclerosis
  • other causes of decreased coronary blood flow
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5
Q

coronary atherosclerosis

A

thickening / narrowing of blood vessels

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6
Q

what can decrease coronary blood flow

A
  • vasospasm
  • myocardial trauma
  • structural disease / valve disease
  • congenital anomalies
  • decreased O2 supply
  • conditions in which increase demand for O2
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7
Q

triggers of inflammatory response in endothelial cells

A
  • dyslipidema
  • diabetes
  • auto-immune mechanisms
  • increase blood viscosity
  • vessel wall sheer stress
  • increase fibrinogen
  • viral infections
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8
Q

ischemic pain

A

typically described as diffuse rather than localized, described as knife like or burning
- not relieved by antacids, nor affected by respiration, or NSAIDs
- n+v are symptoms more common in inferior MI affecting the LV
- dyspnea may be present of LVF is present
- variations according to gender and diabetes

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9
Q

acute coronary syndrome classification

A

(1) may have ECG changes of ischemia but no damage
(2) NSTEMI
(3) STEMI

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10
Q

NSTEMI

A

non ST elevation MI
ischemic ECG changes and elevated cardiac markers

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11
Q

STEMI

A

ST segment elevation MI on ECG and elevated cardiac markers

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12
Q

stable classification

A

pain with exertion and relieved by rest

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13
Q

unstable classification

A

pre-infarction or crescendo, symptoms more frequent and last longer, pain may occur at rest

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14
Q

silent ischemia

A

pt has ECG changes but shows / experiences no symptoms

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15
Q

on an ECG for ischemia the hyperactive phase shows a

A

tall T wave

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16
Q

on an ECG for ischemia the early acute phase shows

A

tall T wave and elevated ST segment

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17
Q

on an ECG for ischemia the later acute phase shows

A

elevated ST segment and inverted T wave

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18
Q

on an ECG for ischemia the fully evolved phase shows

A

elevated ST segment and inverted T wave and Q wave

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19
Q

Infarction depends on

A

length of time and absorbent blood flow, extent of collateral flow and the degree in which vasoactive changes occur as a result of loss of blood flow

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20
Q

______ min without blood flow results in permanent damage

A

25-30 min

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21
Q

_____ min causes irreversible injury

A

40-60 min

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22
Q

explain “time is muscle”

A
  • door to drug within 30 min
  • door to balloon inflation 90 min
  • 12 lead ECG within 10 min
  • targeted history and physical done asap
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23
Q

treatment for STEMI

A
  • antiplatelet, anti-ischemic, or anti-coagulant therapy
  • thrombolytics
  • PCI or CABG
  • long term management
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24
Q

treatment for NSTEMI

A
  • antiplatelet, anti-ischemic, or anti-coagulant therapy
  • PCI or CABG
  • long term management
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25
Q

what is CABG

A

coronary artery bypass graft

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26
Q

serum troponin

A

cTn1 - cardiac specific - sensitive indicator of early MI
- done on admission - 6 and 9 hrs, repeat in 12-25hrs
- superior sensitivity and specificity

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27
Q

Cardiac markers

A

CK-MBs is a cardio specific isoenzyme indicating myocardial necrosis

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28
Q

when does the CK begin to rise

A

increase begins 4-12 hrs from onset of damage

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29
Q

what is a rise in CK marker dependent on

A

dependent on cardiac damage, therefore MI with minimal damage may go undetected

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30
Q

a EKG should be done within ____ mins

A

10 mins

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31
Q

leads I, II, III show

A

positive QRS deflection

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32
Q

aVR is

A

negative QRS deflection

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33
Q

aVL is

A

biphasic

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34
Q

aVF is

A

positive QRS deflection

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35
Q

V1 lead

A

QRS is a negative deflection

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36
Q

QRS progresses through until V__

A

V6

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37
Q

ischemic area is composed of ________, where _____________ and this shows __________

A

viable cells where repolarization is impaired but eventually becomes normal; shows T wave inversion

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38
Q

injury surrounds the ________ zone; cells do not fully _______; this shows ___________

A

infarcted zone; repolarize; this shows ST elevation

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39
Q

infarction refers to the area of _______________ and ____________; this causes lack of ____________ and is shown in the ___________-

A

cellular death and muscle necrosis; repolarization; Q waves

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40
Q

transmural infarcts

A

involve 50% or more of the total thickness of the ventricular wall

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41
Q

what characterizes transmural infarcts

A

Q waves and ST changes

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42
Q

non transmural infarctions may involve ______________ or ______________ portions of _________

A

sub-endocardial; pericardial; ventricle

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43
Q

percutaneous coronary intervention (PCI)

A

catheter with small ballon inserted via an artery into the occluded coronary artery. The balloon is inflated to re-open the coronary artery to resume vessel patency and blood flow.

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44
Q

what is the treatment of choice for STEMI

A

percutaneous coronary intervention (PCI)

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45
Q

thrombolytic therapy

A

pharmacological agents - tPA
- must be given within the first 3hrs post MI
- adjunct therapies include heparin, enoxaparin

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46
Q

when giving thrombolytics what preparations and assessments are needed

A
  • continuos cardiac monitoring
  • med administration
  • IV hydration
  • pt and family education
  • NPO prior to
  • ALLERGIES - shellfish
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47
Q

contraindications of thrombolytic therapy

A
  • active bleeding
  • aortic aneurysm
  • recent brain injury or trauma
  • AV malformation
  • intracranial neoplasm
  • previous hemorrhagic stroke
48
Q

what is a stent

A

provides structural support to the artery

49
Q

when are stents placed

A

at time of angioplasty

50
Q

nursing management of pt undergoing PCI

A
  • frequent vital signs
  • assess site bleeding, clotting, and limb circulation
  • maintain straight leg and limit mobility
  • fluids IV and oral
  • anti-platelet drugs (plavix)
  • anticoagulant (heparin)
  • pt and family anxiety
51
Q

complications of PCI

A
  • hypotension
  • severe anaphylaxis
  • bleeding post-thromolytic therapy
  • superficial bleeding at puncture sites is most common
  • reperfusion arrhythmias
  • rupture of vessel
  • emboli from angioplasty
  • stent placement
52
Q

routine for pt with chest pain

A
  • assess and vital signs
  • IV
  • MONA
53
Q

what is MONA

A

Morphine
Oxygen
Nitroglycerin
Aspirin

54
Q

stroke volume

A

amount of blood ejected from the left ventricle with each heartbeat

55
Q

cardiac output

A

amount of blood the heart pumps each minute

56
Q

equation for cardiac output (CO)

A

heart rate (HR) x stroke volume (SV) = CO

57
Q

how much blood does the heart pump per minute

A

4-8L/min

58
Q

preload

A

stretching of myocardial cells in a chamber during diastole, prior to onset of contraction
- “priming process” of pump

59
Q

how is preload measured

A

as the end-diastolic volume or end-diastolic pressure

60
Q

preload is equal to _______ return plus the residual volume left in _______ chamber after the last ________

A

venous; cardiac; contraction

61
Q

increased _________ and increased _______ _______ means the heart works harder

A

preload; stroke volume

62
Q

afterload

A

amount of resistance to the ejection of blood from the ventricle - it is the amount of pressure that the heart must pump against

63
Q

afterload = _________

A

pressure

64
Q

pressure = _______ x _______

A

flow x resistance

65
Q

major factors that influence afterload

A
  • vascular resistance
  • diameter and distendability of aorta and pulmonary artery
  • blood pressure
66
Q

ejection fraction (EF)

A

% of blood expelled from the left ventricle with every contraction

67
Q

myocardial contractility

A

the force/strength of ventricular contraction

68
Q

contractility can be affected by

A

MI, angina, HF, infectious heart disease, valvular disorders

69
Q

Heart failure

A

an abnormal condition involving impaired cardiac pumping

70
Q

in heart failure angiotensin I is converted to ______________ = ____________ and increased _____

A

angiotensin II; vasoconstriction; BP

71
Q

increased bp = _________ afterload

A

increased

72
Q

aldosterone release causes ________

A

sodium and water retention

73
Q

sodium and water retention from aldosterone release causes _______________ and ______________

A

increased preload and worsens failure

74
Q

risk factors for heart failure

A

HTN, CAD, valvular heart disease, peripheral vascular disease, lifestyle choices, infectious diseases, medication effects, metabolic disorders

75
Q

mitral stenosis

A

narrowing of the mitral valve orifice

76
Q

affects of mitral stenosis

A
  • reduces blood volume to L ventricle
  • reduces cardiac output
  • rise in pressure in L atrium
  • causes L atrial hypertrophy and pulmonary congestion
  • increased pressure in pulmonary vessels
77
Q

what does increased pressure in pulmonary vessels cause

A

hypertrophy in R ventricle and R atrium

78
Q

medication used for cardiovascular diseases

A
  • diuretics
  • morphine
  • calcium channel blockers
  • beta blockers
  • ACE inhibitors
  • digoxin
  • nitroglycerin
79
Q

what are the basic cell working groups

A

(1) myocardial working cells
(2) specialized pacemaker cells

80
Q

myocardial working cells

A

responsible for generating the physical contraction of heart cells
- physical contraction of myocardial tissue actually generates blood flow

81
Q

where are myocardial working cells

A

muscular layer of arterial walls and thicker muscular layer of ventricle walls

82
Q

specialized pacemaker cells

A

do not have the ability to contract
- responsible for controlling rate and rhythm by coordinating regular depolarization
- primary function is generalization and conduction of electrical impulses

83
Q

where are specialized pacemaker cells found

A

in electrical conduction system of the heart

84
Q

primary cardiac cell characteristics

A

(1) contractility
(2) automaticity
(3) excitability
(4) conductivity

85
Q

contractility

A

mechanical function - also referred to as rhythmicity, ability of cardiac cells to shorten and cause cardiac muscle contraction in response to electrical stimulus

86
Q

automaticity

A

electrical function - ability of cardiac pacemaker cells to spontaneously generate own electrical impulses without stimulation

87
Q

excitability

A

electrical function - ability of cardiac cells to respond to electrical stimulus; also referred to as irritability

88
Q

conductivity

A

electrical function - ability of cardiac cells to receive an electrical stimulus and then to transmit the stimulus to other cardiac cells, they function collectively as a unit

89
Q

cardiac depolarization

A

when impulse develops and spreads throughout the myocardium, changes occur in the heart muscle fibers

90
Q

difference between cardiac depolarization and repolarization

A

depolarization - Na rushes into the cell, changing interior charge to + after cell is stimulated
repolarization - Na returns to outside the cell and potassium returns to inside of the cell

91
Q

three major cations that affect cardiac function

A

(1) potassium
(2) sodium
(3) calcium

92
Q

how does potassium affect cardiac function

A

performs major function in cardiac depolarization and repolarization

93
Q

how does sodium affect cardiac function

A

performs vital part in depolarization of myocardium

94
Q

how does calcium affect cardiac function

A

important function in depolarization and myocardial contraction

95
Q

___ node depolarizes

A

SA node

96
Q

electrical activity goes rapidly to the ____ node via ________ _________

A

AV node via internodal pathways

97
Q

________ spreads more slowly across atria and conduction slow through ____ node.

A

depolarization; AV node

98
Q

depolarization moves rapidly through ventricular conducting system to the ______ of the ______

A

apex of the heart

99
Q

depolarization wave spreads ________ from the apex

A

upwards

100
Q

sinoatrial node is the

A

primary pacemaker of the heart

101
Q

SA node is located in

A

the upper posterior portion of the R atrial wall of the heart

102
Q

SA node firing rate

A

60 to 100 bpm

103
Q

what occurs after impulse leaves SA node

A

depolarization and myocardial contraction

104
Q

internodal pathways receive

A

electrical impulse as it exits SA node

105
Q

internodal pathways transmit impulse from ____ node to ____ node

A

SA node to AV node

106
Q

atrioventricular node is located

A

on the floor of the R atrium above tricuspid valve

107
Q

AV node delays electrical activity ___ seconds

A

0.5 secs

108
Q

AV node allows for more

A

complete filling of the ventricles

109
Q

the AV node is the only pathway of ________ elctrical impulse to the __________

A

atrial electrical impulse to the ventricles

110
Q

AV junction

A

where SA node joins bundle of HIS

111
Q

AV junction is the

A

secondary pacemaker

112
Q

if the SA node fails or slows below normal the ___ _________ tissues initiate electrical activity

A

AV junctional

113
Q

Bundle branches

A

conduct electrical activity from bundle of HIS to Purkinje’s network
- divide into 2 branches; L and R branches

114
Q

a 12 lead EKG views the heart in _____ distinct planes

A

2

115
Q

two planes an EKG views the heart in

A

frontal - what limb leads look at
horizontal - what vector leads look at

116
Q

normal ejection fraction (EF)

A

50 - 70%

Med-Surg (15 decks)

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