cardiovascular 2 Flashcards
(163 cards)
1
Q
What is the leading cause for heart transplant
A
Cardiomyopathy
2
Q
A group of heart muscle diseases that affect the structure & function of the myocardium
A
Cardiomyopathy
3
Q
Most common type of cardiomyopathy
A
Dilated (congestive)
Increase chamber size
Decrease wall thickness
4
Q
Occurs after infectious myocarditis; possible autoimmune process
A
Dilated cardiomyopathy
5
Q
Inflammation & rapid degeneration of myocardial fibers decreased Contractility function & ventricular dilation
A
Dilated cardiomyopathy
6
Q
Nitrates
A
Vasodilation
Decrease preload & after load
7
Q
Loop diuretic
A
Helps with preload
8
Q
ACE inhibitor
A
Vasodilator
Stops angiotensin I
9
Q
Beta blockers
A
Decrease HR, B/P, CO
10
Q
Anticoagulant
A
Risk for blood clots
11
Q
Indotropic
A
Decrease HR
12
Q
Most common cause of sudden death in otherwise healthy young people
A
Hypertrophic cardiomyopathy
13
Q
Massive ventricular hypertrophy
Rapid forceful LV contraction
Impaired relaxation of ventricles
Enlarged ventricle septum
A
Hypertrophic cardiomyopathy
14
Q
Most common symptom of hypertrophic cardiomyopathy
A
Exertional dyspnea
15
Q
Primary diagnostic tool for hypertrophic cardiomyopathy
A
Echocardiogram
16
Q
Resection/remove left ventricle, may remove septum tissue
A
Ventriculomyotomy
17
Q
Inject alcohol into LA to give infarction to septal wall
A
Percutaneous transluminal septal myocardial ablation
18
Q
What is the least common form of cardiomyopathy
A
Restrictive cardiomyopathy
19
Q
Myocardial fibrosis, hypertrophy & infiltration
A
Restrictive cardiomyopathy
20
Q
Maximum time from harvest to transplant
A
4 hours
21
Q
What is the primary complication of heart transplant
A
Infection
22
Q
Infection or inflammatory process of inner layer of heart and heart valves
Classified by cause or affected site
A
Infective endocarditis
23
Q
Infective carditis that occurs in existing disased valves, sicker longer
A
Subacute
24
Q
Infective endocarditis that affects healthy valves, rapidly progresses
A
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
