CVS Flashcards

0
Q

Identify 4 unique functional properties of cardiac cells.

A

automaticity - independent electrical activity and initiation
excitability - ability to respond to external stimuli (chemical, mechanical, or electrical)
conductivity - conducting electrical activity from cell to cell
contractility - contraction in response to stimulus

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1
Q

What is starling’s law?

A

the greater the stretch, the greater the contraction

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2
Q

What happens when Beta 1 sympathetic receptors are stimulated?

A

increased heart rate, increased force of contraction, increased speed of conduction via the AV Node, increased oxygen consumption

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3
Q

What happens when beta 2 adrenergic receptors are stimulated?

A

affects the heart, lungs, and skeletal muscle by dilation, and increased organ perfusion

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4
Q

What is the inherent rates of the SA node?

A

60-100 bpm

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5
Q

What is the intrinsic rate of the av junction?

A

40-60 bpm

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6
Q

What is the intrinsic pacemaker rate of the purkinje fibres?

A

20-40 bpm

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7
Q

What does PQRST mean?

A
P - Precipitating factors
Q - Quality and Quantitative
R - Radiating
S - Signs and Symptoms
T - Timing and Treatment
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8
Q

What are the characteristics of S3?

A

end diastolic sound, normal in pregnancy, children, and YA due to rapid ventricular feeling, abnormal after 40 years. Causes are acute MI, heart failure, valve disease, systematic or pulmonary hypertension

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9
Q

Why are hemoglobin, WBC and platelets so important when assessing your adult cardiac patient?

A

Hemoglobin oxygen carrying capacity not below 90
WBC inflammation, infection
Platelets - risk of coronary artery disease - increased clotting factors

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10
Q

How does magnesium affect the heart?

A

affects AV node conduction

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11
Q

How does creatine kinase show cardiovascular function?

A
  • enzyme specific to brain, myocardium, skeletal muscle
  • followed to determine timeline of the injury
  • level rises 4 - 8 hours, peaks in 24 hours, decreases in 48-72 hours
  • total CK
  • CK - MB enzyme more specific to myocardium
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12
Q

How does troponin show cardiac function?

A

released into the circulation with cellular damage
specific to myocardial cells - most sensitive indicator of myocardial damage
rises in 4 to 6 hours; remains detectable for 7 - 15 days (is undetectable by 2 weeks)

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13
Q

How does BNP indicate cardiac function?

A

brain natriuretic peptide
hormone secreted from the ventricles of the heart
secreted in response to changes in pressure (stretch) occurring when heart failure develops and worsens

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14
Q

How does CRP indicate cardiac function?

A

indicates acute inflammation
trend more beneficial
increased CRP levels correlate with increased cardiac risk
-threeford increase in risk of acute MI

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15
Q

How does HbgA1c indicate cardiac function?

A

minor component of hemoglobin to which glucose is bound
higher the glucose concentration in blood, higher the level of HbA1c
not influenced by daily fluctuations in blood glucose; reflects average glucose levels over prior six to eight weeks

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16
Q

What is the formula for figuring out MAP?

A

SBP + 2 DBP divided by 3

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17
Q

What are the characteristics of central venous pressure?

A

reflects preload - end diastolic volume
normal 2 - 6mmHg
mean reading used
obtained through CVC

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18
Q

What is the normal ejection fraction?

A

55-70%

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19
Q

define afterload

A

the amount of resistance to flow the ventricles must overcome to eject blood from the heart
increased afterload means an increased workload of the heart

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20
Q

What are the steps to troubleshooting a pacemaker?

A
  1. find pacemaker rate
  2. should it have fired? if there is an intrinsic beat between pacer beats it shouldn’t fire
  3. is it sensing?
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21
Q

Define arterosclerosis

A

hardening of the arteries

22
Q

Define atherosclerosis

A

chronic inflammatory disorder

formation of plaque with fibrous cap

23
Q

define coronary artery disease

A

progressive atheroslerotic disoder, narrowing to complete occlusion of coronary arteries.

24
Q

What are the three types of angina?

A

stable - predictable, specific triggers, responds to treatment
unstable - unpredictable, increased frequency, increased duration, no response to treatment
variant - prinzmetal angina, coronary artery spasm, occurs with or without atherosclerotic lesions

25
Q

What are the immediate treatments for a suspected MI?

A
early triage
initiate O2
vital signs
data collection
ECG
initiate medications such as ASA and clopidigrel
26
Q

What do beta blockers do?

A

decreases cardiac workload, myocardial O2 demand, decreases risk for tachyarrythmias

27
Q

What do ACE inhibitors do?

A

blocks conversion of angiotensin I to angiotensin II
prevents Na and water reabsorption
reduces afterload

28
Q

What are the considerations to unfractionated heparin?

A

response to medication unpredictable
narrow therapeutic window
closely monitor PTT
acts within minutes of administration

29
Q

What are the considerations of low molecular weight heparin?

A

more predictable and sustained response
proven better efficacy
no need for lab monitoring
ease of administration

30
Q

What are some complications of an acute MI?

A
dysrhythmia
shock
papillary muscle rupture
ventricular septal rupture
pericarditis
sudden cardiac death
31
Q

What are some medications to treat tachycardic rhythms?

A

adenosine, amiodarone, metoprolol, sodium channel blockers (procanimide, lidocaine, dilantin, propalenone), diltiazem (calcium channel blocker)

32
Q

Which phase of the cardiac cycle is altered by calcium channel blockers?

A

phase 2, depressed SA and AV node conduction

33
Q

What are the benefits of atropine?

A

stimulation of SA node

increases cardiac workload

34
Q

What are the effects of dopamine?

A

increased contractility, increased heart rate, vasoconstriction, smooth muscle constriction

35
Q

What are the effects of norepinepherine?

A

increased cardiac workload
severe peripheral vasoconstriction
commonly needed in septic shock

36
Q

What are the diagnostic criteria of pericarditis?

A

chest pain that worsens on deep inspiration due to increased thoracic pressure
positioning helps relieve pain
non-focal ST elevation
myocardial biomarkers not elevated

37
Q

What are the treatments for pericarditis?

A

avoid thromolytics
unrelieved by nitro or narcotics
treat with NSAIDS
may require tap if pericardial effusion develops
nothing to increase fluid around pericardial sac

38
Q

What is the pathophysiology of pericarditis?

A

inflammation of the pericardial sac
severe chest pain
pericardial friction rub
common post MI

39
Q

What is the pathophysiology of endocarditis?

A

infection of the endothelial lining of the heart with valvular involvement
can be caused by IV drug users, diabetics, male, coronary artery disease

40
Q

What would be the clinical signs and symptoms of acute heart failure?

A

SOB, pulmonary and peripheral edema, decreased LOC, decreased cerebral perfusion, hypoxemia, respiratory alkalosis, decreased BP, tachycardia, mottle, cold, clammy skin, decreased u/o

41
Q

What are the effects of hydralazine?

A

potent arterial vasodilator, smooth muscle relaxant, can cause reflex tachycardia

42
Q

What is the normal J value for defibrilation?

A

120-360J, usually 200

43
Q

what are the usual J for synchronized cardioversion?

A

50-200J

44
Q

What are the characteristics of a junctional rhythm?

A
Rate: 40-60
Rhythm: regular
P waves: inverted or buried in QRS
PR: <0.12 if prior to QRS
QRS: 0.04-0.10
escape rhythm
?lost atrial kick
45
Q

What are the characteristics of AV block?

A
Rate: normal
Rhythm: regular
P waves: normal, precede each QRS complex
PR: >0.20 seconds
QRS: 0.04-0.1
46
Q

Describe the characteristics of second degree AV block type 1

A
Rate: normal
Rhythm: a - regular v - irregular
P waves: normal
PR: gradually lengthens until it drops QRS
QRS: 0.04-0.1
47
Q

Describe the characteristics of second degree AV block type 2

A

Rate: A> than ventricular because some v beats blocked
Rhythm: A regular, V irregular
P wave: normal in size and shape
PR interval: normal or slightly prolonged but consistent
QRS: usually 0.04-0.1 when present

48
Q

What is the dicrotic notch in an arterial waveform indicative of?

A

the aortic valve closing at the end of systole

49
Q

What is measured by a pulmonary capillary wedge pressure?

A

measures CVP of left ventricle

50
Q

What are the important points about monitoring CVP?

A
  • inaccurate for preload because all kinds of factors can influence pressure (vasoconstriction/dilation)
  • tells info about right atria because as systolic starts to fail, preload increases because right side backs up with blood
  • normal is 2-6mmHg
51
Q

Which drugs are used for rhythms that are too fast?

A

adenosine, amiodarone, metoprolol, and diltiazem

52
Q

Which drugs are used for management of rhythms that are too slow?

A

atropine
dopamine
norepinephrerine