cardiac Flashcards
(109 cards)
1
Q
diastole
A
when blood returns to the heart and heart is relaxed
2
Q
systole
A
when the heart is contracted
3
Q
pulmonary system pressure
high or low
A
low pressure except for in utero
4
Q
systemic system pressure
A
high pressure except for in utero
5
Q
purpose of one way venous valves
A
to prevent pooling and backflow
6
Q
factors affecting arterial resistance
A
diameter, length, blood viscosity
7
Q
mean arterial pressure (MAP) =
A
cardiac output (CO) x systemic vascular resistance (SVR)
8
Q
cardiac output (CO) =
A
stroke volume (SV) x heart rate (HR)
9
Q
factors affecting cardiac output
A
preload, contractility and afterload
10
Q
preload
A
amount of blood brought back to the heart
11
Q
afterload
A
resistance that heart has to pump against (BP)
12
Q
sympathetic receptors in heart
A
beta 1 receptors
13
Q
parasympathetic receptors in heart
A
muscarinic receptors
14
Q
stroke volume
A
amount of blood ejected by a ventricle with each contraction
15
Q
stroke volume (SV) =
A
end diastolic volume (EDV) - end systolic volume (ESV)
16
Q
starling’s law of the heart
A
higher end diastolic volume causes a stronger contraction and therefore a higher stroke volume due to myocyte stretch
17
Q
blood pressure =
A
CO x systemic vascular resistance
18
Q
RAAS system to control BP
A
decreased kidney perfusion –> renin released –> angiotensin I –> angiotensin II (arteriole constriction) (within hours) –> aldosterone (retention of Na+ and water; remodeling of heart muscle) (within weeks-months)
19
Q
primary/essential hypertension
A
no single cause; 90-95% of cases; risk factors
20
Q
hypertension risk factors
A
race, sodium intake, smoking, low potassium, family history, age, high cholesterol, too much caffeine, obesity, restricted activity, sleep apnea, alcohol use
21
Q
secondary hypertension
A
has a direct cause; 5-10% of cases; precipitating conditions like cardiovascular, renal, and endocrine (high aldosterone) disorders; pregnancy; and medications
22
Q
high blood pressure symptoms
A
headache (due to intracranial pressure), blurred vision (due to impeded optic nerve), chest pain (due to plaque build up in coronary arteries), nose bleeds (high pressure vessels rupture easily)
23
Q
hypertension is also known as
A
“the silent killer”
24
Q
end organ damage from hypertension
A
cerebrovascular damage (stroke, retinopathy), vasculopathy (atherosclerosis, aortic aneurysm), heart disease (left ventricular hypertrophy, coronary artery disease, HF), nephropathy/renal failure
25
ventricular hypertrophy
ventricular wall thickens due to having to work harder because of high peripheral vascular resistance; causes less volume in ventricle, decreasing CO and making heart work even harder
26
approaches to hypertension treatment
inhibit sympathetic impulses to decrease contractility, HR, and vasoconstriction; inhibit smooth muscle function; inhibit RAAS; inhibit retention of water
27
classes of antihypertensives
diuretics, calcium channel blockers, beta blockers, alpha 1 blockers, alpha 2 agonist, direct vasodilator, ACE/ARBs
28
goal of diuretics
move sodium into the tubules so that water follows and is excreted
29
furosemide (lasix)
loop diuretic; treat HTN, HF, renal disease, edema, and pulmonary edema; **not potassium or calcium sparing; **can cause orthostatic hypotension, electrolyte imbalances, photosensitivity, hyperglycemia, dehydration; caution - **ototoxicity** (hearing loss); monitor inputs and outputs
30
loop diuretic
inhibits sodium and chloride reabsorption in kidney; treat HTN, HF, renal disease, edema, and pulmonary edema; more potent than thiazides; rapid (effect in 30-50 mins); decrease vol. CO, and BP. **furosemide (lasix)**
## Footnote
otoxicity
31
thiazide diuretics
less potent than loop diuretic; inhibits sodium and chloride reabsorption; excretion of sodium, chloride and water; used with normal functioning, not for pt. in distress; treat HTN, peripheral edema, and cirrhosis of the liver
32
hydrochlorothiazide (HCTZ)
thiazide diuretic; **calcium sparing**; not for pt. in distress; may cause low K+, hyperglycemia, hypovolemia, photosensitivity; monitor input/output; monitor renal function and weigh daily; monitor blood sugar; **use sunscreen** and replace K+ as needed
33
potassium sparing diuretic
weak diuretic; promotes sodium and water excretion but potassium retention; blocks aldosterone (normally causes sodium resorption); use w/ HTN, edema, HF, ascites, hyperaldosteronism
34
spironolactone
potassium sparing diuretic; not as powerful as loop or thiazide diuretic; can cause hyperkalemia, hypotension, dry mouth, **gynecomastia** (breast enlargement in men); avoid foods high in K+
35
osmotic diuretic
**most potent diuretic**; pulls water into tubule for excretion **without sodium loss**; hypertonic solution; use for cerebral edema, acute renal failure and shock; only given IV
36
mannitol
osmotic diuretic; very intense diuresis; use for cerebral edema, acute renal failure and shock; causes sudden drop in fluids that may cause hypoTN, lightheadedness, confusion and HA; given IV; perform neuro assessment and LOC; caution in pt. w/ renal disease, anuria, intracranial bleeding or dehydration
37
carbonic anhydrase inhibitors
use at the same time as diuretic to cause more intense diuresis; block the effect of carbonic anhydrase; slow down movement of hydrogen ions; more sodium and bicarbonate lost in the urine; use for edema with heart failure, acute pulmonary edema, liver disease, and renal disease
38
acetazolamide (diamox)
carbonic anhydrase inhibitor; use in adjunct with diuretic for more intense diuresis; edema w/ HF, acute pulmonary edema, liver or renal disease; may cause **metabolic acidosis** due to less bicarbonate to be a buffer, hypokalemia, confusion; interacts with salicylates and lithium
39
ACE inhibitors
inhibits angiotensin converting enzyme which normally converts angiotensin I --> II and causes vasoconstriction; ACE inhibitor decreases vasoconstriction and BP; use for HTN and HF
40
lisinopril
ACE inhibitor; use for HTN and HF; lowers constriction and BP; may cause dry persistent cough, **angioedema** (swelling under skin), and hyperkalemia; monitor for hypoTN and K+ levels; **can't stop suddenly, causes rebound hypertension**
41
angiotensin receptor blockers (ARBS)
blocks angiotensin II receptors in smooth muscle and adrenal cortex; blocks release of aldosterone to prevent peripheral vasoconstriction
42
losartan
angiotensin receptor blocker; treat HTN; blocks angiotensin II receptors; may cause angioedema, hyperkalemia, and renal failure
43
angiotensin II
causes vasoconstriction to increase BP
44
aldosterone
increases retention of sodium and water, remodeling of heart muscle over time to increase blood pressure
45
angioedema
swelling beneath the skin
46
beta blockers
inhibit beta 1 receptors in SNS to block norepinephrine and epinephrine; causes in HR, force of contraction, and velocity of impulse conduction; used for stable angina, HTN, HF, cardiac dysrhythmias, and sometimes performance anxiety; can be selective or non selective.
47
cardio selective beta blockers
metoprolol, atenolol; blocks only beta 1 receptors in heart; reduce CO
48
non-selective beta blockers
propranolol (inderal), carvedilol; blocks both beta 1 and 2 receptors; may cause bronchoconstriction and blood sugar masking; caution in pt. w/ diabetes; may be used for performance anxiety
49
calcium channel blockers
blocks movement of calcium to cause relaxation and less nerve impulses; often couples w/ beta blockers; lowers HR and BP; may be dihydropyridines or non-dihydropyridines
50
dihydropyridines
amlodipine and nifedipine; calcium channel blockers that act only on arterial smooth muscle cells (not on cardiac calcium channels); vasodilates arteries to lower BP; used for angina and HTN; may cause ankle edema,** gingival hyperplasia** (overgrown gums), proteinuria, and hypoTN
51
non-dihydropyridines
verapamil and diltiazem; calcium channel blockers that act on arterial SMCs and cardium; causes arterial vasodilation, slowing of HR in SA node **(chronotropic)**, slowing of conduction in AV node **(dromotropic)**, and reduction in contractility of myocardium **(ionotropic)**; used for stable angina, HTN and dysrhythmias; may cause bradycardia and heart block; interacts with beta blockers and digoxin
52
chronotropic
alter rhythm
53
dromotropic
alter conductivity
54
ionotropic
alter contractility
55
adrenergic blockers
block postsynaptic alpha 1 receptor sites in arteries, bladder and urethra; dilates peripheral arteries to lower peripheral resistance and BP; treat HTN, benign prostatic hyperplasia, and raynaud's
56
prazosin (minipress)
adrenergic blocker used to treat HTN, benign prostatic hyperplasia, and raynaud's; lowers BP; may cause orthostatic hypoTN (give at night), reflex tachycardia (inc HR in response to dec. BP), nasal congestion, **impotence** (erectile dysfunction), or **rebound hypoTN** (take at same time every day)
57
hydralazine
arterial vasodilator; decrease afterload to reduce workload; inc. perfusion of heart
58
nitroprusside, nitroglycerine, isosorbide
venous vasodilators; reduce venous return, **reduces preload**
59
vasodilators
used to treat HTN, HF, MI, and angina; different ones chosen for different reasons; may cause postural hypoTN, reflex tachycardia, and HA; combine with diuretic to avoid blood volume inc.
60
arteriosclerosis
loss of arterial elasticity; hardening of the vessel walls; natural process of aging; calcium deposited into cytoplasm and causes elasticity loss
61
atherosclerosis
inflammatory disease; small tears in inside of arteries then fill with fatty streaks and fibrous plaque; made up of cholesterol; can be reversed
62
manifestations of atherosclerosis
no s/s until severe; claudication (leg pain caused by dec. blood flow); reduced exercise tolerance and shortness of breath; HTN, stroke, MI
63
atherosclerosis risk factors
smoking (stiffens vessels), obesity, high fat diet, HTN, diabetes, lack of exercise, family history
64
atherosclerosis modes of treatment
treat BP and cholesterol, anticoagulant
65
peripheral artery disease
narrowing or blockage of artery causing decreased blood flow towards tissue; creates ischemia below the occlusion; can cause ischemic ulcers and changes in skin, swollen grey feet, hair loss; pulses are diminished or absent; sharp stabbing pain
66
peripheral artery disease treatment
vasodilators, antiplatelets
67
peripheral venous disorders
deoxygenated blood can't get back to heart; pooling in extremities; areas of ischemia and necrosis due to low O2; dull and achy, edema, diminished/absent pulses, warm legs, ulcer risk.
68
deep vein thrombosis (venous thromboembolism)
clot in vein preventing return of blood to heart; platelets adhere to damaged wall and form platelet plug, clotting factors create clot, can become dislodged and enter right atrium and enter pulmonary system(pulmonary emboli); test for D-dimer levels to assess risk
69
virchow's triad
risk factors for DVT; hypercoagulability; venous stasis; vascular damage
70
deep vein thrombosis symptoms
pain (w/ dorsiflexion of foot), swelling, redness, warmth of lower extremities
71
DVT treatment
thrombolytic enzymes (break up thrombus); thrombectomy (surgery to remove thrombi); IVC filter; compression stockings (prevent venous stasis); calf exercises; anticoagulants, low dose aspirin
72
coronary artery disease (CAD)
atherosclerosis in 1 or more coronary arteries; narrowing/obstruction; causes dec. perfusion of myocardium; leads to HTN, MI, HR, death (more lethal in younger pt.); s/s don't occur until there's enough blockage to cause ischemia
73
coronary artery disease risk factors
modifiable: BMI >30, diabetes, HTN, alcohol use, high LDL, low HDL, smoking -- cause inc. inflammation and clotting factors
non-modifiable: age 65+, family history
74
coronary artery disease treatment
nitrates, calcium channel blockers, cholesterol-lowering medications
75
variant (prinzmetal) angina
most severe; pain at rest without provocation; triggered by smoking; associated with AV block or ventricular arrhythmias; with or without CAD; treated with calcium channel blockers and stopping smoking
76
stable angina
myocardial atherosclerosis (CAD); pain with exertion; aggravated by exercise, cold temps, stress; stable pattern; relieved by rest; 1st line of treatment is nitrates (vasodilation) and aspirin (prevent clots)
77
unstable angina (pre-infarction angina)
angina of increasing intensity, frequency, or duration; what used to make it stop doesn't anymore; at rest or with minimal activity; lasts >15 mins; unresponsive to nitroglycerin (NTG)
78
angina medications
nitrates (vasodilate); beta blockers (dec. O2 consumption); calcium channel blockers (relax); antiplatelet (prevent thrombosis formation)
79
nitrates (nitro-bit, nitrostat)
antianginal; vasodilation of veins and large arteries; does not dilate coronary arteries; decrease preload and afterload to dec. work of heart; sublingual, take up to 3 tabs and call 911 if still have pain; store in a dark tightly capped bottle
80
myocardial infarction risk factors
atherosclerosis, CAD, high cholesterol, smoking, HTN, obesity, sedentary, stress
81
myocardial infarction
myocardial tissue abruptly and severely deprived of O2; thrombus lodged in coronary artery; sudden crushing chest pain radiating to shoulder (in men) or jaw (in women); NV, shortness of breath, sweating
82
MI signs in older adults
shortness of breath, pulmonary edema, dizziness, altered mental status, dysrhythmias
83
low density lipoproteins (LDL)
bad; tightly packed cholesterol, triglycerides, and lipids; carried by proteins that enter circulation; healthy level: under 100
84
high density lipoproteins (HDL)
good; loosely packed lipids; used for energy; pick up remanent of fats and cholesterol left in periphery by LDL breakdown; healthy level: above 60
85
HMG-CoA Reductase inhibitors (statins)
atorvastatin (lipitor); blocks enzyme HMG-CoA (normally helps synthesize cholesterol); used in hyperlipidemia, CAD prevention (primary), stabilize plaques in pt. w/ CAD (secondary)
86
atorvastatin (lipitor)
HMG-CoA reductase inhibitor; treat hyperlipidemia, prevent CAD, stabilize plaques in pt. w/ CAD; limit cholesterol synthesis; may cause flatulence, abd. cramps, constipation, dizziness, HA, pruritus (itching), hepatotoxicity; teratogenic; grapefruit juice inc. toxicity risk
87
bile acid sequestrants
cholestyramine; binds to bile acid to force liver to use cholesterol to make more bile; decreases serum cholesterol levels; prevention of CAD; dissolves gallstones
88
cholestyramine
bile acid sequestrant; decreases cholesterol levels to prevent CAD; gritty power must be dissolved; take w/ lots of fluids; usually combo with statin; may cause constipation; malabsorption of fat soluble vitamins (A, K, E, D), diuretics, digoxin, warfarin, thyroid hormones, and corticosteroids
89
cholesterol absorption inhibitors
ezetimibe (zetia); inhibit absorption of cholesterol; treat hypercholesterolemia, sitosterolemia
90
ezetimibe (zetia)
cholesterol absorption inhibitor; treat hypercholesterolemia; may cause abd. pain, diarrhea, muscle aches and pain; caution in combo with statin; interacts w/ cholestyramine, fenofibrate, gemfibrozil, and warfarin
91
niacin
vitamin B3; inhibits release of free fatty acids from adipose tissues; inc. rate of triglyceride removal from plasma; may cause flushing
92
fenofibrates
inhibits triglyceride synthesis in liver to lower LDL; inc. uric acid secretion; stimulate triglyceride break down
93
omega 3-acid ethyl esters (lovaza)
inhibits liver enzyme system to dec. synthesis of triglyceride
94
omega 3-carboxylic acid (epanova)
fish oil mixture; free fatty acid approved as an adjunct to diet to reduce triglyceride levels with severe hypertriglyceridemia
95
QRS complex
ventricular contraction
96
arrhythmia (dysrhythmia)
disruption in cardiac rate or rhythm; due to electrolyte imbalances, medications, hypoxia of myocardium, aging, or structural damage; results in lower cardiac output and the associated symptoms
97
sinus arrythmias
can still sustain life; tachycardia or bradycardia
98
ectopy
type of arrhythmia; early contraction; premature atrial contraction (PAC) or premature ventricular contraction (PVC); can be harmless if not over time
99
junctional rhythms
originates from AV node or bundle of his; atria and ventricles fire at different rates; another node fires separately from the SA node
100
amiodarone (potassium channel blocker)
block potassium channels and slow outward movement of K+ during phase 3 of the action potential; first line for V-fib maintenance; works for atrial and ventricular; can cause HF, N/V, hypoTN
101
adenosine
antiarrhythmic; for emergency situation; for supraventricular tachycardia (SVT); short half life so give as close to heart as possible (antecubital) and follow w/ flush
102
digoxin
only cardiac glycoside in the US; troublesome-narrow therapeutic range; use for HF, A. fib, A. flutter, A. tachycardia; inc. force of contraction; vagal stimulation; high K+ reduces effect (ACE inhibitor); low K+ inc. toxicity risk (diuretics); hold if apical pulse <60bpm
103
ways to stimulate vagal nerve (to dec. HR + conduction)
knees to chest, vomiting, ice on face (kids), straining to stool (elderly)
104
left ventricular failure (congestive HF)
most common HF; BP drops; back up into lungs; cyanosis, pulmonary congestion, dyspnea, orthopnea, fatigue, confusion
105
right ventricular failure (cor pulmonale HF)
back up in venous system, can lead to venous congestion of organs (liver); right HF is the most common cause; inc. peripheral venous pressure, ascites, distended jugular veins, edema, weight gain, red
106
systolic HF
problem with contraction and ejection results in dec. ventricular output --> baroreceptors stimulate SNS to inc HR; heart tries to compensate by releasing natriuretic peptides
107
diastolic HF
problem with relaxing and filling; cardiac cells die during systolic HF and muscles become fibrotic --> diastolic HF; fibrotic ventricle resists filling leading to dec. CO; low CO inc. work for the heart and perpetuates HF
108
diagnosing HF
history + physical assessment; echocardiogram, chest x ray; EKG; enzyme labs; stress test; cardiac catheter
109
heart failure treatment
ACE inhibitor/ARB; aldactone (K+ sparing diuretic); digoxin (cardiac glycoside); Lasix (loop diuretic); beta blocker
