Blood Pressure Alterations and Cardiac Alterations Flashcards
(165 cards)
1
Q
what ejects blood out of the heart
A
the muscles
2
Q
what do the muscles in the heart respond to
A
electrical conduction
3
Q
if the heart muscles didn’t listen to the electrical conduction what would happen
A
death
4
Q
what do the valves of the heart do
A
open/close to keep blood flowing forward
5
Q
what is preload
A
The stretch of the ventricles - volume of blood/pressure in the chamber
6
Q
what is afterload
A
the slingshot- what the heart is having to pump against
7
Q
what is another name for what the heart is having to pump against
A
systemic vascular resistance
8
Q
How much blood/pressure is needed to go through the right atrium into the right ventricle for preload and why
A
0-5mmhg because it only has to fill up enough to get to the lungs
9
Q
how much blood/pressure is needed to go through the left atrium into the left ventricle for preload and why
A
6-12mmhg because it has to fill up enough to go to the entire body
10
Q
what is systolic blood pressure
A
the top number - maximum pressure the heart exerts while contracting
11
Q
what is the goal for systolic blood pressure
A
90-120
12
Q
what is diastolic blood pressure
A
the bottom number - residual pressure in the arteries
13
Q
what is the goal for diastolic blood pressure
A
60-80
14
Q
what is the mean arterial pressure
A
average pressure in the arterial system
15
Q
what is the mean arterial pressure goal
A
60-90
16
Q
what is cardiac output
A
amount of blood ejected from the heart in liters/min
17
Q
what is cardiac output goal
A
4-6L/min
18
Q
what is the equation for cardiac output
A
HR x Stroke volume
19
Q
what is stroke volume
A
volume of blood pumped out of the left ventricle of the heart during each contraction.
20
Q
what is normal blood pressure
A
below 120 / below 80
21
Q
what is an elevated blood pressure
A
130-139 / over 80
22
Q
what is high blood pressure stage 1
A
130-139 / 80-89
23
Q
what is high blood pressure stage 2
A
140 or higher/ 90 or higher
24
Q
what should someone do immediately if they are having an hypertensive crisis
A
call the doctor
25
what is the hypertensive crisis range generally
higher then 180 / higher then 120
26
what is a hypertensive crisis for people over 60
150/90
27
what is a hypertensive crisis for people younger then 60
below 140/90
28
according to the joint national committee people who dont reach the goals should be treated with....
drugs
29
what does hypertension do to the body and arteries
damage to organs, thickening of the arteries
30
what is orthostatic hypotension
sitting to standing decrease of 20 of systolic or increase in HR by 20 bpm
31
what is essential hypertension caused by
no specific cause for most cases
32
what is secondary hypertension cause by
a cause that can be identified and treated
33
what is another name for malignant hypertension
hypertension crisis
34
what is malignant hypertension (hypertension crisis )
severe hypertension that rapidly progresses
35
what is malignant hypertension (hypertension crisis ) range
over 180/120
36
what is a hypertension urgency
over hours or days may be managed outpatient
37
what is a hypertensive emergency
hypertensive urgency + target organ damage and requires hospitalization
38
what could hypertensive emergency cause
head bleed, heart failure, heart attack, renal failure, dissecting aneurysm
39
what are some common risk factors for essential hypertension
obesity, smoking, stress, family history
40
what are some common risk factors for secondary hypertension
renal disease, primary aldosterone (retaining fluid so high sodium and low K), pheochromocytoma (tumor on adrenal medulla causing excretion of epinephrine and norepinephrine leading to h, Cushing's syndrome (high cortisol levels=retain fluid), medications
41
what do they call the silent killer
hypertension
42
what are the common ss of hypertension
fatigue, dizziness, palpitations, angina, dyspnea
43
what are the ss of malignant hypertension (hypertension crisis )
headaches and nose bleeds
44
when measuring someones blood pressure what should they not do prior
caffeine, smoke, exercise for at least 30 minute prior
45
what labs would you take to diagnosis hypertension
BMP, lipid panel, TSH, ECG, home monitoring
46
what are some lifestyle modifications someone can make for hypertension
lose weight, change diet (DASH - less red meats, salt =, and sweets and low sodium), decrease ETOH (alcohol), dont smoke, reduce stress, excersise
47
how much sodium should someone with hypertension consume
2300mg/day
48
how much alcohol should someone with hypertension consume
1-2 drinks/day
49
what are some 1st line drug therapies for hypertension
ACE-1, ARBs, CCB, Diruretics
50
can you take ACE-1 and ARBs together
NO
51
what doe ACE-1 end in
pril
52
what do ARBs end in
sartan
53
what are some calcium channel blockers
end in dipine or diltiazem, verapamil
54
what is a common side effect of calcium channel blockers
peripheral edema
55
who should avoid taking calcium channel blockers
CHF
56
what should you avoid with when taking calcium channel blockers
grape fruit juice
57
what are some common side effects of ACE
dry cough (lisinopril), hyperkalemia, decreased HR
58
what are some 2nd line medications for hypertension
beta-blockers, potassium-sparing diuretics, direct vasodilators, adrenergic inhibiting agents
59
what do beta blockers end in
lol
60
what are some cardio-selective beta blockers
bisoprolol, metoprolol, esmolol
61
what are some non-cardio selective beta blockers and where does it work on
propranolol -lungs
62
since propanolol is working on the lungs who should not take it
COPD/asthma
63
what are some side effects of beta blockers
mask hypoglycemia increased HR
64
what is a common side effect for non-cardio selective beta blockers
bronchospasm
65
what should you avoid when taking hypertensive meds and why
NSAIDs because it may cause renal damage and retains fluid
66
how many drugs does someone with hypertension normally take
2 drugs for 2 different classes - titrate 1st one to correct dose before adding the other one
67
what are some mixed cardioselectvity beta blockers
carvedilol and labetalol
68
what are some potassium sparing diuretics
spironolactone and eplernone
69
what are some direct vasodilators
hydralazine, nitroglycerin, sodium nitroprusside
70
what is a adrenergic inhibiting agent medication
clonidine - last resort
71
what are some risk factors for malignant hypertension (hypertension crisis )
non-compliant, head injury, pheochromocytoma, illegal drugs, preeclampsia
72
what is the goal for malignant hypertension (hypertension crisis ) -- MAP and DBP
decrease in MAP by 20% or diastolic bp 110-115 with IV antihypertensives in the first 2-6 hours
73
what are some vasodilators used for malignant hypertension (hypertension crisis )
sodium nitroprusside, nicradipine, labetalol, and esmolol
74
what are the interventions for malignant hypertension (hypertension crisis )
monitor BP and HR every 5-15 minutes, UOP hourly, bedrest semi fowlers, O2, neuro status
75
what can happen to the heart because of hypertension
coronary artery disease, left ventricular hypertrophy, and heart failure
76
what can happen to the brain because of hypertension
stroke and elevated intracranial pressure
77
what can happen to the peripheral vascular because of hypertension
claudication, aortic aneurism, aortic distension
78
what can happen to the kidneys because of hypertension
chronic kidney disease,
79
what are the values for chronic kidney disease cause by hypertension
Creatine over 1.5 and proteinuria
80
what can happen to the eyes because of hypertension
retinal damage - retinal hemorrhage, blurry vision, and loss of vision
81
what is the p wave on an ECG
the SA (sinoatrial) node
82
what is the SA node
electrical impulses 60-100 beats/min
83
what is the PR segment on an ECG
the av (atrioventricular) node
84
what is the AV node
contraction know as the atrial kick - pushing blood into the ventricles
85
what is happening for the QRS on ECG
when the heart pushes the blood from the ventricles up to the aorta or pulmonary
86
what is the T wave on an ECG
the recovering of the ventricles
87
what determines heart rate
beats/min
88
how do you measure PR interval
how long for energy to travel through atrium to make it contract
89
what is included in the autonomic nervous system
parasympathetic (decrease) and sympathetic (increase)
90
what is the normal pacemaker of the heart
SA node 60-100 bpm
91
what are the secondary pacemakers of the heart
AV node (40-60bpm)
his-purkinje fibers (20-40bpm)
92
what is sinus bradycardia
SA node is firing at less then 60bpm
93
what is sinus tachycardia
SA node is firing faster because of vagal inhibition or sympathetic stimulation
94
what could be come causes for sinus bradycardia
normal in athletes, hypothermia, vagal stimulation, beta clockers, and calcium channel blockers, HYPOthyroidsm, increased intracranial pressure myocardial infarction
95
what could be some causes for sinus tachycardia
stressors (exercise, pain, low BP or fluid, heart failure, HYPERthyroidsm ), drugs (norepinephrine, epinephrine, caffeine, theo-durr, hydralazine OTC cold remedies
96
what could be some ss of bradycardia
hypotension, pale, cool skin, weakness, angina, dizziness, confusion, SOB
97
what could be some ss of tachycardia
dizziness, dyspnea, hypotension, angina with patients with CAD
98
what drug could be used for sinus bradycardia
Atropine (1mg every 3-5 minutes for a total dose of 3mg)
99
what are some other interventions besides medications that could be used for sinus bradycardia
pacemaker (temporary or permanent ), stop offending drugs
100
what is tachycardia treatment guided by
by cause do decrease fever pain stress
101
what are some other interventions for tachycardia
vagal maneuver (bear down)
102
what are some medications that can decrease HR in sinus tachycardia
beta blockers and calcium channel blockers
103
what is paroxysmal supra-ventricular tachycardia
abrupt onset and ending starting above the bundle of his where a reexcitation of the atria
104
what is the HR normally for paroxysmal supra-ventricular tachycardia
150-220bpm
105
who is at risk for paroxysmal supra-ventricular tachycardia
FEMALE (healthy young women)
106
what could be some common causes for paroxysmal supra-ventricular tachycardia
overexertion, emotional stress, stimulants such as caffeine and tobacco
107
what are the ss of paroxysmal supra-ventricular tachycardia
feeling unwell, weak, fatigue, heart racing,
108
what are the ss for prolonged paroxysmal supra-ventricular tachycardia
hypotension, dyspnea, angina
109
how would you diagnosis paroxysmal supra-ventricular tachycardia
12 lead ECG
110
what are some vagal stimulants for paroxysmal supra-ventricular tachycardia
carotid massage, valsalva, coughing
111
what is the 1st drug of choice for paroxysmal supra-ventricular tachycardia how dose dosing wrk
IV adenosine 6mg-12mg-12mg flush 20ml continous monitoring on ECG
112
what are some common side effects of IV adenosine
flushing, dizziness, chest pain
113
what are some other drugs you could use for IV adenosine
beta blockers, calcium channel blockers, amiodarone
114
if someone is hemodynamically unstable and has IV adenosine what would the treatment be
dirrect current (DC) cardioversion
115
what is atrial flutter
recurring, sawtooth-shaped flutter waves originates from a SINGLE ectopic focus in the atrium (atrial and ventricle rhythm is regualr)
116
what is atrial fibrillation
disorganized of atrial activity caused by MULTIPLE ectopic focus = ineffective atrial contraction
117
how does atrial fibrillation look on an ECG
no clear P waves, no atrial contractions, loss of atrial kick and irregular ventricle response
118
if something is persistent how long is it lasting
more then 7 days
119
atrial fibriliation usually develops _____ with...
acutely with thyrotoxicosis, alcohol intoxication, caffeine use, heart surgery, and electrolyte imbalances
120
what is the most common dysrhythmia in the world
a fib
121
why is there in an increase risk of stroke in atrial flutter and a fib
irregular cardiac rhythm, blood stasis
122
how do you rate control for atrial flutter and a fib
calcium channel blockers, and beta blockers
123
how do you rhythm control for atrial flutter and a fib
antidysrhythmic drugs,
124
if complete AV node ablation occurs in atrial flutter and a fib they must be on a
anticoagulant
125
what are some procudures done for a fib
maze procedure with cryoblation, left atrial appendage occlusion
126
if someones on an anticoagulant what should you be checking
INR PT
127
if someone is experiencing a fib or flutter for 48 hours how long are they going to take anticoagulants
3-4 weeks before cardioversion and then several weeks after that
128
what procedure can be done to see if there are any clots in the atria
transesophogeal echocardiogram
129
for long term anticoagulants what is the drug of choice
warfarin
130
what is a 1st degree AV block
every impulse is conducted to the ventricles but the conduction is prolonged after it moves through the AV node it is normal again
131
what are the risks for 1st degree AV block
cardiac drugs drugs or disease - if multiple cardiology consult
132
what are the ss of 1st degree AV block
asymptomatic
133
how do you diagnosis 1st degree AV block
ECG, TSH, BMP, consider causative factors
134
what is the treatment for 1st degree AV block
monitor
135
what is a 2nd degree AV block type 1
gradual lengthening of PR interval - because the prolonged AV conduction making atrial not conduct and QRS is blocked since the QRS is missing the another p will start
136
what is 2nd degree AV block type 2
p wave is non conducted without progressive lengthening of PR interval but still missing QRS
137
what drugs are used for 2nd degree AV block type 1
digoxin or beta blockers
138
what is the treatment for symptomatic 2nd degree AV block type 1
atropine to increase HR and temp pacemaker especially is experienced MI
139
what is the treatment for asymptomatic 2nd degree AV block type 1
monitor, transcutaneuous pacemaker on standby
140
what are the ss of 2nd degree AV block type 2
decreased cardiac output, hypotension, myocardial ischemia
141
what is the treatment for 2nd degree AV block type 2
transcutaneous pacing to permanent pacemaker
142
can you use atropine for 2nd degree AV block type 2
not effective
143
does type 1 or 2 2nd degree AV block usually progressive to 3rd degree
type 2
144
what is a 3rd degree AV block
no impulses from atrium are conducted to the ventricles (2 no QRS)
145
what is the treatment for 3rd degree AV block
pacemaker
146
what is a temporary drug measure for 3rd degree AV block
epinephrine and norepinephrine to increase HR and supoprt BP
147
what is a premature ventricular contraction
QRS is happening to soon
148
what are the risks for premature ventricular contraction
stimulants (caffeine, alcohol, nicotine), electrolyte imbalances, hypoxia, fever, exercise, stress, cardiac disease
149
what are the ss of premature ventricular contraction
not harmful with normal heart
heart disease: CO reduction, angina, HF
150
how do you treat premature ventricular contraction
treat cause
151
what is a complication of premature ventricular contraction
Ron T Phenonomenon QRS happening on T wave when the heart is recovering can cause ventricular tachycardia and ventricular fibrillation aka no pulse
152
what is ventricular fibrillation
run of three or more PVCs can be stable (pulse) or unstable (no pulse)
153
what is monomorphic ventricular fibrillation
has QRS that is same shape size and direction
154
what is polymorphic ventricular fibrillation (torsades de pointes)
when QRS gradually change back and forth from one shape and size to another
155
what is a ventricular fibrillation sustained and nonsustained
sustained loner then 30 seconds
non sustained less then 30 seconds
156
what are the ss of ventricular fibrillation
hypotension, pulmonary edema, decreased cerebral blood flow, and cardiopulmonary arrest
157
what is monomorphic ventricular fibrillation treated with
antidysrhythmias
158
what is polymorphic ventricular fibrillation (torsades de pointes) treated with
beta blockers, aminodarone, procainamide, magnesium
159
what is ventricular fibrillation
irregular wave forms of varying shape and sizes firing of multiple ectopic folci no pulse it is deadly so treat quick
160
what should you do if someone has ventricular fibrillation
d fib them asap
161
what is pulseless electrical activity
you can see electrical activity but no mechanical activity is evident aka no pulse
162
what are some risk factors for pulseless electrical activity
hypovolemia, hypoxia, acidosis, hyper/hypokalemia, hypoglycemia, hypothermia, toxins, tamponade, thrombosis, tension pneumothorax, trauma
163
what is the treatment for pulseless electrical activity
CPR intubation and epinephrine
164
what is asystole
no electrical activity no contraction
165
most sudden cardiac death result from what
ventricular dysrhythmias
