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Cardio Patho Flashcards

(121 cards)

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1
Q

what is coronary artery disease?

A

the coronary arteries that come off of the aorta to supply the heart with oxygenated blood becomes arteries clogged due to atherosclerosis, then the heart muscles can die from lack of oxygenation.

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2
Q

what is the most dangerous location to have atherosclerosis related to coronary arteries - why?

A

left anterior descending artery, this supplies the left ventricle with blood, and it is responsible for perfusion to the body

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3
Q

what are the non-modifiable risk factors for CAD?

A

older age
family history (+ shared environmental exposure)
males earlier in life
postmenopausal women
ethnicity (black, hispanic, native, indigenous)

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4
Q

what are the modifiable risk factors for CAD?

A

hypertension
smoking
diabetes
obesity
diet high in salt, fat, and carbs
hyperlipidemia
depression / stress

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5
Q

describe the endothelial dysfunction with CAD, what causes it?

A

even though the vessels are entirely blocked, they constrict when they are supposed to dilate (and vice versa).
caused by DM, HTN, HPL, smoking

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6
Q

what are the clinical manifestations of CAD?

A

angina (may not have, but the more narrowed = decrease blood flow = chest pain)
complete occlusion = MI
symptoms associated with chest pain: heartburn, irregular pulse, palpitations, weakness, dizziness, nausea, cold sweats, burning in the chest / shoulder / abdomen

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7
Q

how long, on average, does stable angina last?

A

2-5 minutes

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8
Q

how long, on average, does unstable angina last?

A

> 10 minutes

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9
Q

what is stable angina often mistaken for and why?

A

indigestion - this is because it can happen after eating a large meal.

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10
Q

what causes stable angina most commonly?

A

atherosclerosis

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11
Q

what is the basic description of cardiac chest pain?

A

pressure or a tightness

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12
Q

what is the basic description of non cardiac chest pain?

A

stabbing or sharp

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13
Q

what is the general location of cardiac chest pain?

A

diffuse, poorly localized

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14
Q

what is the general location of non cardiac chest pain?

A

focal and well localized

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15
Q

what usually brings on stable angina, what relieves it?

A

exertion usually brings it, usually relieved by rest

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16
Q

when can unstable angina be triggered?

A

at rest

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17
Q

cardiac or non-cardiac chest pain: which is associated with physical exertion or other stresses

A

cardiac

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18
Q

cardiac or non-cardiac chest pain: which may be positional or spontaneous at rest?

A

non-cardiac

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19
Q

cardiac or non-cardiac chest pain: which is relieved with rest and can be resolved usually within a few minutes?

A

cardiac

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20
Q

cardiac or non-cardiac chest pain: which has no predictable relation to physical exertion?

A

non-cardiac

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21
Q

how long can non-cardiac chest pain last?

A

seconds to days

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22
Q

what are common symptoms for angina for women?

A

hot / burning or tenderness around the chest (but doesn’t always have to be the chest)
indigestion
heartburn
nausea
fatigue / weakness
lightheadedness
dyspnea

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23
Q

where can the pain be in relation to a myocardial infarction?

A

neck, jaw, upper abdomen, shoulders, and arm

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24
Q

what symptoms often accompany a myocardial infarction?

A

N/V, SOA, diaphoresis

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25
what do we usually do for stable angina, in general?
educate the patient - encouraging rest and avoiding increased demands nitrates prevent and treat atherosclerosis teach s/s of a heart attack
26
what is cardiomyopathy?
a disease that affects the myocardium (which is the muscle), these diseases decrease the ability of the muscle to contract and can eventually lead to HF.
27
what are the potential causes of cardiomyopathy?
usually idiopathic - but can be from ischemia, HTN, inherited disease, infections, toxins, myocarditis, autoimmune condition
28
what are the potential causes of dilated cardiomyopathy?
can be from ischemia, alcohol / drugs, infection, peri / post partum, valve disease, genetics
29
what does dilated cardiomyopathy lead to?
HF with decreased EF
30
what is the common cause of hypertrophic cardiomyopathy?
HTN
31
what does hypertrophic cardiomyopathy increase the risk for?
deadly arrhythmias
32
what is the least common type of cardiomyopathy?
restrictive
33
what is heart failure?
a progressive condition in which the heart muscle is unable to pump enough blood to meet the demands of the body for blood and oxygen
34
how is cardiac output affected with heart failure?
decreased
35
what components make up stroke volume?
preload, myocardial contractility, afterload
36
what is preload and afterload?
preload - the amount of volume in the left ventricle right before it contracts afterload - the pressure the heart has to squeeze against when it contracts
37
how does heart failure affect cardiac output, myocardial contractility, preload, and afterload?
CO = decrease MC = decrease preload + afterload = increase
38
what are the 4 hallmarks of heart failure?
volume overload (can't pump it out) impaired ventricular filling weakened ventricular muscle decreased ventricular contractile function
39
what are the potential causes of HF?
repeated ischemic episodes (stable angina, cardiomyopathy) MI chronic HTN COPD - causes right sided dysrhythmias (d/t decreased output) valve disorders, mitral insufficiency, aortic stenosis PE
40
what are the risk factors of developing HF?
hypertension (biggest one) within 6 months of a MI men and postmenopausal women black / african american family hx age DM ischemic heart disease smoking sedentary COPD anemia congenital heart defects viruses alcohol / drug abuse CKD
41
what type of HF would cause increased left ventricles?
left sided heart failure
42
what is left sided heart failure?
congestion backed up into the left ventricles causing backflow into the pulmonary veins
43
what are common findings for left sided heart failure?
cough, crackles, wheezes frothy, pink tinged sputum paroxysmal nocturnal dyspnea orthopnea
44
what is right sided heart failure?
heart failure commonly caused by COPD causing congestion in the right chambers of the heart snd backflow into the vena cava. This decreases blood flow to the lungs.
45
what are common findings with right sided heart failure?
JVD dependent edema weight gain hepatosplenomegaly
46
other names for heart failure with reduced ejection fraction?
HFrEF or systolic HF
47
what is the EF for someone who has HFrEF?
< 40
48
what causes HFrEF?
impaired contractile function, increased afterload, cardiomyopathy, and mechanical problems
49
what is heart failure with reduced ejection fraction?
left ventricle loses the ability to generate pressure to eject blood, the weakened muscle can't generate a strong enough stroke volume to get the blood out. Eventually the LV fails and fluid backs up and causes accumulation.
50
what are other names for heart failure with preserved ejection fraction?
HFpEF, diastolic HF
51
what is HFpEF?
inability of the ventricles to relax and fill during diastole, this leads to a high filling pressure and a decreased SV and CO, causing fluid congestion
52
what is the EF for a patient with diastolic HF?
normal or moderately decreased (40-49%)
53
what is ventricular remodeling, what disease process does it come with?
HF this happens when the body recognizes that the heart isn't working right. The body releases substances (angiotensin II, ADH, endothelin, TNF-alpha, catecholamines, insulin-like growth factors, and growth hormones) that actually end up hurting the body over time (causes genetic changes, apoptosis, hypertrophy of cardiac myocytes, collagen deposits, and fibrosis). All of this leads to changes that cause enlargement and increased dilation in the LV, worsening the HF.
54
when does S3 happen, what does it indicate?
S3 happens during the filling of the ventricles (after S2). This means that there is still fluid left in the left ventricle which is commonly indicative of HF.
55
define automaticity
ability to generate an electrical impulse
56
define excitability
ability to respond to an outside impulse
57
define conductivity
ability to receive an electrical impulse and conduct it on
58
define contractility
ability to myocardial cells to shorten in response to an impulse
59
what 2 electrolytes are responsible for the action potentials in the heart?
Na+ and K+
60
is atrial / ventricular depolarization systole or diastole?
systole
61
is atrial / ventricular repolarization systole or diastole?
distole
62
atrial depolarization is indicated by what wave on an EKG?
P wave
63
ventricular depolarization is indicated by what complex on an EKG?
QRS complex
64
ventricular repolarization is indicated by what wave on an EKG?
T wave
65
what 2 structures are specifically responsible for telling the ventricle to contract?
bundle of Hiis and purkinje fibers
66
where in an EKG reading would you see atrial repolarization?
QRS complex
67
what is the normal PR interval?
0.12 - 0.20 seconds
68
what is the normal QRS interval?
< 0.12 seconds
69
for sinus rhythms where does the electrical conduction originate?
SA node
70
what is the time represented by the individual boxes on an EKG strip?
0.04 seconds
71
what is sinus arrhythmia?
a degree of variability in the heart rate, is considered normal still. will not change CO. still normal bpm, PR interval, and QRS complex. this is most common in younger people. heart rate will change with respirations or autonomic nervous system.
72
what is a dysrhythmia?
an abnormal cardiac rhythm that will affect cardiac output
73
what 3 things can potentially cause dysrhythmias?
inappropriate automaticity - a cell initiating an action potentials when it isn't supposed to (usually in the atria) triggered activity - extra impulse during or after a repolarization re-entry - this is where a part of the heart continues to depolarize after the main impulse is done
74
where does sinus bradycardia originate?
SA node
75
what is the rate of sinus bradycardia?
< 60 bpm
76
how are the PR interval and the QRS complex different in sinus bradycardia?
they aren't different, just farther in general
77
what are the causes of sinus bradycardia?
hyperkalemia vagal responses digoxin toxicity late hypoxia CCB, BB, amiodarone MI
78
what are the clinical manifestations of sinus bradycardia?
lightheadedness, dizziness, fatigued, syncope, dyspnea, chest pain, confusion
79
where does sinus tachycardia originate?
SA node
80
what is the rate for sinus tachycardia?
100-150 bpm
81
how are the PR interval and the QRS complex different in sinus tachycardia?
PR intervals and QRS complex is normal
82
how are P waves different in sinus tachycardia?
they may be hard to see because it is faster, but they should be the same
83
what are common causes of sinus tachycardia?
exercise pain strong emotions fever FVD * medications - epi, albuterol, beta-agonist caffeine, nicotine, cocaine early hypoxia
84
what is PSVT?
paroxysmal supraventricular tachycardia
85
what is the rate of PSVT?
150-250 bpm
86
where does the impulse for PSVT happen?
above the ventricles, maybe the AV node
87
how are the P waves different in PSVT?
usually no P wave, if there is they look weird
88
what is the QRS complex interval in PSVT?
normal
89
what usually causes PSVT?
re-entry phenomenon
90
what do patients typically say they feel when having PSVT?
a sudden heart racing
91
what are common causes of PVST?
overexertion emotional stress stimulants dig tox rheumatic heart diesase CAD wolff-parkinson-white right sided HF
92
what are clinical manifestations of PVST?
palpitations chest pain fatigue dizziness dyspnea
93
what is PAC?
premature atrial contraction
94
how do the P waves change with PAC?
early P waves that may look a little weird
95
how does the PR interval and QRS change with PAC?
they are the same, QRS does follow a run of PAC
96
what dysrhythmia does having PAC's put the patient at risk for?
afib
97
what two things should the nurse monitor if a patient has PAC's?
electrolyte levels and O2
98
where does the impulse generate for atrial flutter?
AV node
99
what physiological process causes atrial flutter?
re-entry
100
what is the atrial rate of atrial flutter?
can be > 250
101
how are P waves and QRS different in atrial flutter?
there is not a QRS complex after every P wave P wave have a sawtooth appearance QRS timing is normal when it happens
102
where does the impulse generate for atrial fibrillation?
random irritable spots in the atria
103
what is the rate for atrial fib?
100-175 bpm
104
how do P waves change with atrial fib?
there is no identifiable P wave
105
what are the common causes of a-fib?
electrolytes hypoxia cardiovascular diseases
106
what are the complications of a-fib?
decreased cardiac output heart failure embolism stroke
107
patients with a-fib have an increased risk of having what?
a stroke
108
what is PVC?
premature ventricular contraction
109
where does the impulse for PVC come from?
an ectopic focus in the ventricles
110
how are P waves and QRS complexes different in PVC?
QRS complex comes earlier than it should and doesn't come after a P wave QRS is WIDE and DISTORTED ( > 0.12 s)
111
what are common causes of PVC?
stimulants electrolytes hypoxia fever exercise emotional stress CVD
112
when you begin to see PVC regularly what is the concern and what should you check?
check electrolytes worries about the patient decompensating and going into a more dangerous rhythm
113
what is VTACH?
ventricular tachycardia - made up of 3 PVCs back to back
114
where does the impulse for VTACH originate from?
ectopic focus in the ventricle
115
do atrial contractions happen with VTACH?
no
116
how does cardiac output get affected by VTACH?
severely decreased
117
what is the rate for VTACH?
150-200 bpm
118
how are P waves and the PR interval different in VTACH?
no P wave PR interval is not measurable because there is no P wave
119
what 2 rhythms are considered deadly?
VTACH and Vfib
120
what is vfib?
ventricular fibrillation
121
how is cardiac output affected with vfib?
no effective contractions - no cardiac output

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