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Flashcards in cardiovascular 2 Deck (163)
1

What is the leading cause for heart transplant

Cardiomyopathy

2

A group of heart muscle diseases that affect the structure & function of the myocardium

Cardiomyopathy

3

Most common type of cardiomyopathy

Dilated (congestive)
Increase chamber size
Decrease wall thickness

4

Occurs after infectious myocarditis; possible autoimmune process

Dilated cardiomyopathy

5

Inflammation & rapid degeneration of myocardial fibers decreased Contractility function & ventricular dilation

Dilated cardiomyopathy

6

Nitrates

Vasodilation
Decrease preload & after load

7

Loop diuretic

Helps with preload

8

ACE inhibitor

Vasodilator
Stops angiotensin I

9

Beta blockers

Decrease HR, B/P, CO

10

Anticoagulant

Risk for blood clots

11

Indotropic

Decrease HR

12

Most common cause of sudden death in otherwise healthy young people

Hypertrophic cardiomyopathy

13

Massive ventricular hypertrophy
Rapid forceful LV contraction
Impaired relaxation of ventricles
Enlarged ventricle septum

Hypertrophic cardiomyopathy

14

Most common symptom of hypertrophic cardiomyopathy

Exertional dyspnea

15

Primary diagnostic tool for hypertrophic cardiomyopathy

Echocardiogram

16

Resection/remove left ventricle, may remove septum tissue

Ventriculomyotomy

17

Inject alcohol into LA to give infarction to septal wall

Percutaneous transluminal septal myocardial ablation

18

What is the least common form of cardiomyopathy

Restrictive cardiomyopathy

19

Myocardial fibrosis, hypertrophy & infiltration

Restrictive cardiomyopathy

20

Maximum time from harvest to transplant

4 hours

21

What is the primary complication of heart transplant

Infection

22

Infection or inflammatory process of inner layer of heart and heart valves
Classified by cause or affected site

Infective endocarditis

23

Infective carditis that occurs in existing disased valves, sicker longer

Subacute

24

Infective endocarditis that affects healthy valves, rapidly progresses

Acute endocarditis

25

Symptoms of endocarditis

Low grade fever
Chills
Weakness
New or changing murmur
Affects multiple organ system

26

Linear streak under fingers
Red then brown/black

.

27

Oslers nodes

Tender, painful, size of pea, red/purple color on fingers

28

Janeways lesion

Sole of feet, flat painless, initially red then brown

29

How much fluid is in the pericardial sac?

10-15 ml

30

Late pericarditis
4-6 weeks after MI

Dressler syndrome

31

Rapid or slow fluid accumulation in pericardial sac

Pericardial effusion

32

Life threatening fluid accumulation in pericardium

Cardiac tamponade

33

What is a major sign of cardiac tamponade

Beck's triad

34

Beck's triad

Muffled heart sounds
Hypotension
JVD

35

Exaggerated drop in systolic arterial blood pressure upon inspiration

Pulsus paradoxus

36

Fluid aspirated from pericardial sac

Pericardiocentesis

37

infection/inflammation of pericardial sac
fibrous scarring thickened & adherent pericardium

chronic constrictive pericarditis

38

what mimics heart failure

chronic constrictive pericarditis

39

what confirms the diagnosis of chronic constrictive pericarditis

color doppler imaging

40

removal of pericardium

pericardectomy

41

inflammatory/infection disease of myocardium, orgainism invades myocytes with cell damage & necrosis

myocarditis

42

what confirms the diagnosis of myocarditis

endomyocardial biopsy

43

what do heart valves do

control unidirectional blood flow

44

the tricuspid and mitral valves are open during

diastole

45

the semilunar valves are open during

systole

46

what stabilizes the heart valves

chordae tendineae
"heart strings"

47

defined according to valve affected & type of altered function

valvular heart disease

48

valve orifice small, narrow

stenosis

49

incomplete closure of valve leaflets resulting in backward flow of blood

regurgitation

50

what is the most common valvular heart disorder

aortic stenosis & mitral regurgitation (left side of heart)

51

damage & scarring to valve leaflets & chordae tendineae, valves become thick, funnel shape, shortened (fish mouth)

mitral valve stenosis

52

common causes of mitral valve regurgitiation

MI, rhumatic heart disease

53

blood backflow from LV to LA

mitral valve regurgitation

54

therady pulses with cool, clammy extremities, shock and pulmonary edema are symptoms of

acute mitral valve regurgitation

55

what is the most common valvular heart disease in US

mitral valve prolapse

56

abnormal valve strucutre causing valve leaflets to buckle into LA in systole

mitral valve prolapse

57

blood flow is obstructed from LV to aorta

aortic valve stenosis

58

triad of symptoms for aortic valve stenosis

angina pectoris
syncope
exertional dyspnea

59

allows blood to flow back from aorta to LV

aortic valve regurgitation

60

results in increased blood volume in RA & RV

tricuspid and pulmonic valve disease

61

strong quick beat then collapses immediatly

water hammer pulse

62

what is used to diagnose valvular disorders

Echo/TEE

63

splits open fused leaflets, a balloon tipped catheter threaded from femoral artery/vein to stenotic valve, the balloon inflates to separate valve leaflets

precutaneous transluminal balloon valvuoplasty

64

what is needed after a mechanical heart valve

long term anticoagulants

65

what is the INR therapeutic range for a mechanical valve

2.5-3.5

66

what is the most common location for a aortic aneurysms

abdominal

67

grey turnes sign

back/fank pain, ecchymosis

68

what is the most accurate diagnostic test

CT scan

69

signs of aortic aneurysms

increase HR, decrease B/P, increase RR, decrease LOC

70

a small aneurysm is what size

less than 5 cm

71

whta is the threshold for repair

5.5 cm

72

what is the mortality rate with AAA

90%

73

alternative to conventional surgical repair, placement of sutureless aoritc graft into abd. aorta inside aneurysm, done through femoral artery

endovascular graft procedure

74

results of a false luman through which blood flows, classified by location and duration of onset

aortic dissection

75

sudden severe chest pain, described as "sharp or tearing"

aortic dissection

76

is an aortic dissection an aneurysm

NO

77

hypotension, narrowed pulse pressure, JVD, muffled heart sounds, pulsus paradoxus, blood in pericardial sac

cardiac tamponade

78

thick walled vessel that transports O2 away from heart

arteries

79

single layer cells in tissues, exchange essential cellular products

capillaries

80

transports deoxygenated blood to the heart, think walled, large diameter

veins

81

which has valves, arteries or veins

veins

82

which has pulses, arteries or veins

arteries

83

6 p's of peripheral vascular assessment

pain, pulses, poikilothermia, pallor, parasthesia, paralysis

84

arterial pain is described by and relieved by

sharp unrelenting, @ night relieved by dangling at side of bed

85

venous pain is described by and relieved by

aching, cramping, relieved by excercise, homans sign

86

arterial findings with skin

absent hair, thick brittle nails, shiny, taut skin, wlcers

87

venous findings with skin

garter sign, chronic edema, ulcers

88

pruritus

itchy

89

irregularly shaped, ruddy color, "wet" edges due to extensive drainage

venous statsis

90

pressure points, symmetrical/circular, gangrene, deep and painful, trash foot blue toe

arterial ulcers

91

most common venous disorder

venous thrombosis

92

traveling clot

embolus

93

virchows triad

hypercoagulability of blood
damage to intima of vein wall
venous stasis

94

a thrombus is made up of

RBC, WBC, platelets and fibrin

95

commonly occurs at valve cusps of vein

venous stasis

96

inflammation of a superficial vein

superficial thrombophlebitis

97

how is a superficial thrombophelbitis is diagnosed

visual physical exam

98

most common site for DVT

saphenous

99

what is the % of asymptomatic pts with DVT

50%

100

a clot that travels to the lung

pulmonary embolism

101

swelling in a vein that occludes, very suddenly causes cyanosis

phelgmasia cerulea dolens
rare!

102

what is the most commonly used diagnostic studies for DVT

duplex scanning

103

what is not used on pt with DVT

EPC's

104

do anticoagulants dissolve clots

no, prevent furthur clot formation and enlargment of clots

105

what is used to dissolve clots

thrombolytics-IV "clot buster"

106

dilated, tortuous, subcutaneous veins frequently found in sapheous system due to increased venous pressure

varicose veins

107

varicosity pulled through stab incision then vein excised and removed

phlebectomy

108

incrased pressure in veins from reflux of blood

chronic venous insufficency

109

break down of RBC's

hemosiderin

110

gradual thickening and narrowning of arterial wall

atherosclerosis

111

progressive narrowing & eventual obstruction of the arteries to lower extremities

peripheral arterial disease (PAD)

112

what is the most significant risk factor for peripheral arterial disease

smoking, hyperlipidemia, HTN, primary cause is atherosclerosis

113

what is the normal ankle-brachial index

0.91-1.30

114

contrast dye injected into catheter in vessel, usually in femoral artery

angiogram

115

percutaneous transluminal balloon angioplasty

similar to cardiac cath, used for peripheral arterial disease

116

synthetic graft or autogenous vein used to carry blood around stenosed or occluded artery

peripheral artery bypass operatoin

117

surgically opening an artery and removing the "fatty plaque scrapple"

endarterectomy

118

opening of an artery, removal of plaque, apply a patch to widen artery lumen and increase blood flow to area

parch graft angioplasty

119

sudden interruption in arterial blood flow to tissue, organ, extremity

acute arterial ischemic disorders

120

most common acute arterial ischemic disorders

emboli from heart

121

constricted or obstructed arteries, occurs with only tobacco users, not related to plaque

buergers disease aka thromboangiitis obliterans

122

what is a major complication of thrombolytics

bleeding in brain

123

transection of nerve, ganglion and or nerve plexus of SYS, stops vasoconstriction

sympathectomy

124

characterized by vasospasm induced color changes, exaggerated SNS response

raynauds phenomenon

125

White, blue, red color changes of hands

raynauds phenomenon

126

what medications are used for raynuds phenomenon

vasodialator and calcium channel blockers

127

largest artery in body, supplies blood (o2) to all vital organs

aorta

128

abdominal aortic aneurysms above or below the renal artery are more common

below

129

wall of artery forms the aneurysm with aat least one vessel layer still intact

true aneurysm

130

circumferential, relatively uniform in shape aneurysm

fusiform

131

pouch like with narrow neck connecting buldge to one side of arterial wall

saccular aneyrysm

132

disruption of all layers of arterial wall, results in bleeding contained by surrounding structures, AKA pseudoaneurysm

false aneurysm

133

often asymptomatic deep diffuse chest pain, pain may extend to interscapular area, increase pain with laying flat

thoracic aorta aneurysm

134

angina, hoarsness, if presses on superior vena cava, decrease venous return, distended neck veins, edema of head and arms

ascending aorta/aortic arch aneurysm

135

most common location asymptomatic frequently detected on physical exam or when examined for unrelated problem

AAA

136

anticoagulants are used for

prophylaxis (prevent formation of thrombus)
treatment for existing clot (prevents enlargement, new clots from forming, embolization)

137

what do anticoagulants not do

dissolve a clot that has already formed

138

name the 3 stages of natural clotting

stage 1- vascular response- vasoconstriction
stage 2-platelet response, clump & form platelet plug, initiates pathways in clotting cascade
stage 3-common pathway, prothrombin to thrombin then fibrinogen to fibrin, creates fibrin mesh

139

a series of interactions that result in the formation of a fibrin clot

clotting cascade

140

formation of a clot can result from activation of 1 or 2 pathways which are

extrinsic or intrinsic pathway

141

intrinsic pathway

begins with damage to a blood vessel
when blood comes in contact with a damaged blood vessel surface, it activates factor XII
factor XII inititaes a cascade of enzyme reactions that lead to inactive factor X, the common pathway then a clot

142

extrinsic pathway

begins with tissue damage, occurs outside the vessel, tissue factor and thromboplastin initiate the clorring cascade that leads to the common pathway and a clot

143

what is the bodys natural process to form clot

fibrinolytic pathway

144

3 Rx that affect clotting process

antiplatelet
anticoagulants
thrombolytics

145

prevents platelets from sticking together

antiplatelets

146

anti platelet medications

inhibit platelet aggregation "sticking together"

147

blocks conversion of prothrombin to thrombin and fibrinogen to fibrin, prevents furthur extension of existing clots and new clots from forming

heparin

148

what do you need for a heparin shot

25 gage needle
3 ml syringe
must change needle prior to injecting
2 inches away from belly button in smily face
must be checked by 2 RN's regardless of route

149

DVT prophlaxis heparin amount

5000 units q8-12 hour

150

what is monitored while on heparin

anti Xa & PTT

151

anti Xa therapeutic range

0.3-0.7 IU/ml

152

what is measured 6h after heparin drip started and q6h until in therapeutic range for two draws in a row

anti Xa

153

what is a complication of heparin

HIT (heparin induced thrombocytopenia)

154

lovenox

low molecular weight heparin
dont expel air bubble in syringe, 1 mg/kg SubQ
in love handles
dont need to monitor with lab work

155

what is the antidote with lovenox

protamine sulfate

156

what is the antdote with heparin

protamine sulfate

157

what is the antidote with coumadin

vit K

158

what is ideal for HIT pts

leech saliva

159

inhabits activation of the Vit K dependent coagulation factors in the liver

coumadin

160

INR therapeutic INR

2-3 prophylactic/PE
2.5-3.5 prosthetic heart valve

161

Intermittent claudication

Exercise pain

162

what medications should be avoided when on coumadin

ASA

163

Positive blood culture
New/changed murmur
Intracardiac mass/ vegetation

Inflammation of the pericardium