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Flashcards in Cardio Deck (127):
1

MAP must be ___ to maintain blood flow through coronary arteries

At least 60 mm Hg

2

MAP must be ___ to maintain perfusion of major body organs

Between 60 and 70 mm Hg

3

The left anterior descending branch supplies blood to what?

-Portions of LV
-Ventricular septum
-Chordae tendineae
-Papillary muscle
-RV

4

The left circumflex branch supplies blood to what?

-LA
-Lateral/posterior LV surfaces
-Portions of interventricular septum
-SA node in 1/2 people
-AV node for small # of people

5

The right coronary artery supplies blood to what?

-RA
-RV
-Inferior LV
-AV node
-SA node to 1/2 people

6

How to calculate CO

HR x Stroke Volume

7

Normal CO range

4-7 L/min

8

How to calculate CI

Body surface area/CO

9

Normal CI range

2.7-3.2 L/min/m squared

10

Stroke volume

Amount of blood ejected by the LV during each contraction

11

The degree of myocardial fiber stretch at the end of diastole and just before contraction

Preload

12

Determined by the amount of blood returning to the heart from both the venous system and the pulmonary system

Preload

13

Starling's Law

The more the heart is filled during diastole, the more forcefully it contracts

14

The pressure/resistance the ventricles must overcome to eject blood through the semilunar valves and into peripheral blood vessels

Afterload

15

Afterload is directly related to what?

Arterial BP and the diameter of the blood vessels

16

Amount of pressure generated by the LV to distribute blood into the aorta with each contraction

Systolic BP

17

Amount of pressure against the arterial walls during the relaxation phase of the heart

Diastolic BP

18

Coronary arteries originate where?

Just above the cusp of the aortic valve

19

When does coronary blood flow to the heart muscle occur?

During diastole

20

Blockage in LAD is called what?

"Widow maker" bc the mortality rate is so high. It supplies a large portion of muscle mass

21

Function of papillary muscles

Keep valves where they're suppose to be

22

Branches on the LAD

Diagonal

23

Branches on the LCX

Obtuse marginal

24

Problems in LCX

Conduction problems/arrhythmias bc it supplies blood to SA node where impulses are generated

25

CVP filling pressures

Preload

26

Resistance heart pumps against

Afterload

27

Take oxygen in

Arteries

28

Take waste products and unoxygenated blood out

Veins

29

Where does the transition take place from O2 and unO2 blood?

Where arterial capillaries merge with venous capillaries

30

Sympathetic nervous system

Increases HR and BP, vasoconstricts

31

Parasympathetic nervous system

Decreases HR and BP, vasodilates

32

Baroreceptors

Sense when there is a fall in MAP, present around carotid arteries and aortic notch. Strategically places where arteries carry blood to your head.

33

Chemoreceptors

Respond to a decrease in O2 levels, will increase constriction to increase perfusion

34

Stretch receptors

The more they're stretched, the harder the heart will contract

35

How does the renal system regulate BP when it senses a decrease in renal flow?

Retains sodium and water, renin-angiotensin-aldosterone system vasoconstricts to increase perfusion pressure

36

How does endocrine system regulate BP?

When you get angry or scared, there is a release of catecholamines, kinins, and histamine which stimulates the SNS to increase BP

37

What helps propel venous system?

Skeletal muscles in extremities

38

Primary function of the venous system

To complete the circuit of unoxygenated blood back to the heart

39

Effects of gravity on venous system

Increased when standing up (orthostatic hypotension) and lessened when laying down. This is why "raising extremities" increases blood flow to heart

40

Age related changes to heart

-Valves thicken/stiffen
-SA node decreases in mass/function (low HR)
-Decreased contractility
-Coronary arteries dilate, more tortuous/calcified

41

Age related changes to blood vessels

-Thicken/stiffen (can't constrict and dilate as fast, so less responsive to intrinsic changes)
-Slowed exchange of nutrients from blood and tissues (slow healing)

42

Age related changes to blood

-Decreased volume
-Decreased marrow and production of RBC
-Decreased H&H
-Increased risk for clots r/t increased plt aggregation and decreased fibrinolytic action

43

Deconditioning

Changes in blood and heart with aging are from decreased activity, not "age"

44

PQRST chest pain assessment

-Provocation
-Quality
-Region/radiation
-Severity (1-10)
-Timing/treatment

45

Paroxysmal nocturnal dyspnea

Abrupt onset of SOB after lying flat for several hours r/t redistribution of blood flow

46

Alternating strong and weak heart beats

Pulsus alterans

47

Epigastric area

Over the lower right sternal border

48

Tricuspid area

5th intercostal space at the lower left of the sternal border

49

Mitral area

5th intercostal space at the apex of the heart (mid-clavicular line)

50

Pulmonic area

2nd intercostal space just left of the sternum

51

Aortic area

2nd intercostal space just right of the sternum

52

Closure of AV valves

S1

53

Closure of PV/AV

S2

54

Heard during diastole

S2

55

Best heard at apex or LLSB

S1

56

Heard during ventricular systole

S1

57

Best heard at base of heart

S2

58

Ventricular gallop, early sign of heart failure

S3

59

Atrial gallop. Indicates HTN, MI, aortic or pulmonic stenosis

S4

60

Heart murmurs

Turbulent blood flow across valves, grades I-VI

61

Grade 1 heart murmur

You're pretty sure it's there but can't get to it-usually only used by cardiologists

62

Grade 6 heart murmur

It's so loud you can hear it at the bedside without a stethoscope

63

Total cholesterol normal levels

64

What should HDL be?

>40 mg/dL

65

What should LDL be?

66

What should triglycerides be?

67

Released with any myocardial damage

Troponin 1

68

Point of Care Troponin 1 test

Results should be available within 15 minutes

69

CK-mb

Heart damage

70

CK-mm

Skeletal muscle damage (bruise on leg)

71

CK-bb

Brain damage

72

Creatine Kinase peak and rise

Peaks within 24 hrs
Rise begins within 3 hrs

73

Myoglobin

Earliest marker available, never used

74

Risk for CAD is 3x greater with serum cholesterol greater than what?

260

75

Positively correlated with CAD

LDL

76

Decreased K and Mg levels means what?

Increased risk for DVTs

77

Heart Cath

NPO, must lie flat on table, bedrest 4-6 hrs after, check distal pulse

78

What do you ask a pt who just had a heart cath and reports chest pain?

If it's the same kind of pain that brought them to the hospital

79

Transesophageal echo

Swallow the tube, must be NPO

80

Transthoracic echo

Don't have to be NPO

81

NICS

Looks at carotid arteries

82

NIAS

Looks at arteries in legs

83

NIVS

Looks at veins in legs to rule out DVT or at veins in arms for placement of a dialysis shunt

84

12 lead ECG

Circumferential around whole heart. Doesn't predict anything. If pt is having chest pain, get another ECG.

85

Thickening or hardening of arterial wall associated w/ aging

Arteriosclerosis

86

Formation of plaque within the arterial wall itself

Atherosclerosis

87

Stable plaque

Fibrous covered cholesterol core

88

Unstable plaque

Usually liquid lipid center

89

What eventually happens to plaque in arteries?

They become ulcerated or thrombosed and impacts the entire vessel wall

90

Stable angina pectoris

-Temporary ischemic state, usually associated with activity
-Freq, duration remains stable/predictable

91

How to manage stable angina

Nitrates, beta blockers, rest

92

Stable angina is associated with what kind of plaque?

Stable

93

Increase in the incidence and intensity of chest pain

Unstable angina pectoris

94

Prinzmetal's angina (variant)

Chest pain occurs at the same time every day, caused by spasms not blockage

95

Goal of angina treatment

Increase O2 supply and decrease O2 demand

96

What medication dilate coronary arteries?

Calcium channel blockers

97

Nitrates vasodilate which causes what?

Increasing supply of O2

98

Nitrates

Nitroglycerine (fast acting, short acting), indur (slower and longer acting), isordil

99

Common complication of nitrates

Headache

100

Effect of beta blockers

Decreases contractility and slows HR, decrease demand of O2

101

Usually treat prinzmetal's angina with what?

Ca channel blockers to decrease spasms

102

Smoking causes what

Coronary artery vasoconstriction

103

Diet for atherosclerosis

Low fat, low triglycerides

104

How to use Nitroglycerine

IV, sublingual (can take q 5 minutes up to 3 doses), and a spray which goes under their tongue. 1-2 sprays at onset of chest pain, 3rd spray after 5 minutes. The medication is good for 30 days. Protect the meds from light

105

Most important thing to do when giving nitroglycerine

Tell them to keep it with them at all times

106

Most common anti platelet med prescribed

Aspirin, then plavix, elequis

107

Percutaneous transluminal coronary angioplasty

Thread a wire into obstruction, thread cath over it, inflate balloon, remove, obstruction is moved back onto wall, NOT GONE. Artery is widened

108

Problem with stent insertion

Body reacts to foreign body, lots of people developed clots and heart attacks were caused. 30% of stents occlude within 6 months

109

PTCA candidate selection

-Blockage in one or two arteries (If all 3...bypass sx)
-Not left main disease bc if something messes up the pt dies

110

PTCA is treatment of choice for what?

Non-calcified lesions and straight lesions

111

Significant artery blockage

>60%

112

Complications of PTCA

Patency of vessel, distal circulation (take plavix every day for a long time), *chest pain* (artery reoccluded)

113

Priority after PTCA

Chest pain, patency of vessel. Not distal circulation, you can live without a leg but not without heart.

114

Selection for CABG

Leg vein last 7-15 yrs, mammory artery last 15-20

115

What co-morbidities affect CABGs?

Pulmonary, renal, DM

116

Cardioplegia

Temporary stopping of heart muscle during CABG. Ice cold, potassium rich

117

Cardiopulmonary bypass

Temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the body

118

How long can you stay on cardiopulmonary bypass?

Depends on the skill of the surgeon, the less time on bypass the better outcome

119

Normal post op CABG

-Ventilated

120

Complications of CABG

-Prolonged vent
-Renal failure-came with it or kidneys didn't like being on bypass
-"Pump head"-out of it for a while
-A fib from sticking cannula in right atrium
-Pneumonia/atelectesis
-Infection (more likely with decreased immune system or COPD cause they're on prednisone which decreases wound healing and decreases immune system)

121

Mediastinal chest tube

Strictly for drainage. Only thing in mediastinum is heart.

122

Pleaural chest tube

In pleural space, drains pleural fluid and expands lungs

123

Chest tubes after CABG

Usually 2 mediastinal and 1 pleural

124

Pacing wires after CABG

Right side-atrial
Left side-ventricular

125

Incision care after CABG

Plain soap and water, incision open to air

126

Activity order after CABG d/c

Tell them to walk up and down their driveway a few times, not down the street cause they'll walk until they're tired and then they have to walk back still.

127

Follow up appointments after CABG

CV surgeon in 2 weeks
Cardiologist in 4 weeks
CV surgeon in 6 weeks