Cardiovascular Flashcards
(91 cards)
1
Q
Diastole
A
- period where the atria & ventricles are relaxed
- allows ventricles to fill with blood
2
Q
Atrial systole
A
- at end of diastole
- the atria contract forcing the remaining blood into the ventricles
3
Q
Ventricular systole
A
increased pressure in the ventricles
- closes the AV valves & forces the semilunar valves to open
- permits one way flow of blood from right ventricle into the pulmonary artery into the lungs, from the left ventricle into the aorta and into systemic circulation
4
Q
Depolarization
A
electrical activation of cell
-cause by influx of sodium into cell while potassium exits cell
5
Q
Repolarization
A
return of cell to resting state
-caused by re-entry of postassium into cell while sodium exits
6
Q
Cardiac Output
A
amount of blood pumped by ventricles in liters per minute; 4-6 liters/minute
-CO= SV x HR
7
Q
Control of heart rate
A
ANS baroreceptors-specialized nerve cells
- changes in heart rate
- sensitive to changes in blood pressure
8
Q
Stroke volume
A
amount of blood ejected with each heartbeat; about 70 ml/beat
9
Q
Preload
A
-the volume of blood being returned to right side of the heart from the systemic circulation
10
Q
Frank-Starling Law
A
the more the stretch, the stronger the contraction
11
Q
Afterload
A
- resistance to ejaction of blood from ventricle
- affected by systemic vascular resistance & pulmonary vascular resistance
12
Q
Contractility
A
- ability of heart to squeeze blood from the ventricles
- prepares for next contraction
13
Q
Ejection Fraction
A
- measurement of the percentage of blood leaving ventricles with each contraction
- measurement of myocardial contractility
- normal from left ventricle is 55-65%
14
Q
Left Ventricle Ejection fraction
A
measurement of how blood is being pumped out of the left ventricle with each contraction
15
Q
Right ventricle ejection fraction
A
measurement of how much blood is pumped out of the right ventricle to the lungs
16
Q
what are the cardiac biomarkers?
A
- CK, CK-MB
- myoglobin
- Troponin T and I
17
Q
Stress testing
A
exercise, pharmacologic stress test, combined with imaging techniques
18
Q
Echocariography
A
traditional or TEE
19
Q
Radionuclide Imaging
A
radioisotopes to evaluate coronary arter perfusion noninvasively
20
Q
Cardiac CT
A
looks at calcium deposits
21
Q
Cardiac Catheterization
A
- invasive procedure to measure cardiac chamber pressure & assess patency of coronary arteries
- Angiography involves injection of a contrast agent in the vascular system to visualize heart & blood vessels
- preparation includes ECG, blood tests, allergies
- Post-procedure: assess bleeding, hematoma formation, circulation, arrhythmias, bedrest
22
Q
Coronary Artery Disease
A
- most common cardiovascular disease in adults
- is leading cause of death in US for men & women of all racial & ethnic groups
23
Q
Atherosclerosis
A
is the abnormal accumulation of lipid deposits & fibrous tissue with in arterial walls ->. inflammatory response
- most common cause of CV disease
- Blockages & narrowing reduce blood flow to the myocardium
24
Q
myocardial ischemia
A
- an increase in oxygen demand
- a decrease in oxygen supply
- related to location & degree of vessel obstruction
- development of collateral circulation
25
Angina Petoris
- a symptom of coronary atherosclerosis, characterized by episodes or paroxysmal pain or pressure in the anterior chest caused by insufficient coronary blood flow
- physical exertion or emotional stress increases myocardial oxygen demand and the coronary vessels are unable to supply sufficient blood flow to meet the oxygen demand
26
Stable angina
- effort induced & predictable pattern
| - subsided with rest or NTG
27
Unstable angina
| pre-infarction angina
- increased frequency, severity & duration
- unpredictable
- not relieved by rest or NTG
28
Intractable: (refractory) angina
debilitating
29
Variant (Prinzmetals)
| angina
coronary arter vasospasm; often at rest
30
Silent ischemia
elderly & DM -> autonomic neuopathy
31
Characteristics of Angina pain
- described as tightness, choking, or heavy sensation, indigestion
- poorly localized & may radiate to neck, jaw, shoulders, back or arms
- anxiety frequently accompanies the pain
- other: dyspnea, SOA, dizziness, N/V, numbness in upper extremities
32
Treatment for Angina
- measures to decrease myocardial oxygen demand & to increase oxygen sypply
- medications
- O2
- Reduce & control risk factors
- A, B, C, D, E
- percutaneous coronary interventions
- CABG
- TIME IS MUSCLE
33
what do you assess for in angina pectoris?
-symptoms & activities, especially those that precede & precipitate attacks
34
Nursing interventions for the patient with Angina Pectoris
- treat pain a priority, IV site
- stop all activity, sit or rest in bed
- Assess: pain, VS, respiratory status, ECG pattern
- Oxygen
- Follow medication protocol: NTG, ASA, MS
- control anxiety
- Lab & ECG
35
patient teaching for Angina
- lifestyle changes & risk factor reduction to avoid future episodes of ischemia
- Disease process
- Medications: carry NTG, ASA protocol
- stress reduction
- prevent constipation
- When to seek emergency care
36
Acute Coronary Syndrome
CAD can lead to ACS which is a condition characterized by signs & symptoms of sudden myocardial ischemia
- a sudden decrease in blood flow to the heart
- a continuum of intensity that results in myocardial death
37
what happens in unstable angina?
the plaque ruptures but the artery is not completely occluded
38
MI patho
- an area of the myocardium is permanently destroyed
- usually caused by a reduced blood flow in a coronary artery
- due to rupture of an atherosclerotic plaque & subsequent occlusion of the artery by a thrombus
- cardiac cells deprived of oxygen -> ischemia develops ->cellular injury -> infarction or death of cells
39
Ischemia
blood supply to the tissues is not keeping up with the demand
40
Injury
MI is happening now
41
Infarction
death of heart cells
42
NSTEMI
non ST segment elevation myocardial infarction: thrombus partially. or intermittently occluded the coronary artery
43
STEMI
ST elevation myocardial infarction: thrombus fully occluded the coronary arter
44
Symptoms of MI
- chest pain, BP elevated or decreased
- SOA, dyspnea, tachy
- N/V
- decreased UO
- Cool, clammy, diaphoretic, pale
- anxiety, restlessness, dizziness
- Atypical symptoms: N/V, weakness, dizziness
45
What are the gender differences with an MI
men have more CVD events prior to age 75
women more likely to die than men
- higher prevalence of total CVD
- may delay seeking care
46
What are the cardiac biomarkers
release of cellular contents into the circulation when myocardial cells die
- CK-MB
- Troponin
- Myoglobin
- CRP
47
Treatment for an MI
- follow institution and/or professional organizations guidelines
- Reestablish coronary blood flow
- NSTEMI vs STEMI
- injury location
- acute, evolving, old
48
Treatment for Acute MI
- lab draw & ECG within 10 min of admission to the ED
- Oxygen
- Aspirin, NTG, Morphine
- Beta Blocker and/or ACE within 24 hours
- MONA
- Evaluate for percutaneous coronary intervention or thrombolytic therapy
- With STEMI, patient taken directly for a cardiac cath (or transport)
- Thrombolytics within 30 minutes if PCI unavailable or transport to long
49
PTCA
door to balloon time
- a balloon tipped catheter used to open blocked coronary vessels to resolve ischemia
- performed in cardiac catheterization lab under fluoroscopy
- to prevent re-stenosis, a stent is placed
50
CTO PCI
minimally invasive technique used to treat patients with chronic total occlusion or complete blockages of the coronary arteries
51
CABG
surgical procedure in which a blood vessel is grafted to the occluded coronary artery to allow blood flow beyond the occlusion
52
What are the indications for a CABG
- when angina cant be controlled with medications or PCI
- multi-vessel CAD or treatment for LAD stenosis
- Treat complications from unsuccessful PCI
- Prevention & treatment of MI, arrhythmias, or HF
53
What are commonly used for bypass graft procedures?
Greater and lesser saphenous veins
54
Heart Failure
the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen & nutrients
-Impaired contraction or filling of the heart
55
Heart Failure with Reduced ejection fraction
<40%
- systolic HF
- emptying problem reduced left ventricular contractility and strength
- Causes: HTN, CAD, MI, valve disorders
56
Heart Failure with preserved ejection fraction
>50%
- diastolic HF
- Left ventricle unable to fill
- Stiff ventricle
- Cause: HTN, CAD, valve disorders, aging, arrhythmias, inflammatory heart
57
Left sided heart failure
results in inadequate left ventricle output followed by inadequate tissue perfusion; an ejection fraction is performed to help determine type of HF
58
Systolic Failure
weaken heart muscle; an emptying problem
59
Diastolic Failure
stiff and noncompliant heart muscle, preventing adequate ventricular filling
60
Right sided heart failure
usually occurs as a result of left sided failure
- when the left ventricle fails, increased fluid pressure is transferred back through the lungs, eventually damaging the hearts right side
- When the right side loses pumping power, blood backs up in the bodys veins causing swelling or congestion in the legs, ankles, GI, and liver
61
Preload
pressure generated in the ventricles at the end of diastole and the resultant stretching of the muscle fibers
62
Afterload
the amount of resistance to ejection of blood from the ventricle
63
Contractility
the force generated by the contracting myocardium under any given condition
64
stroke volume
amount of blood ejected with each heartbeat
65
CO
amount of blood pumped by ventricles in liters per minute
66
Ejection fraction
percentage of blood leaving ventricles with each contraction
| Hallmark of heart failure
67
ANP and BNP
released in response to increase blood volume and increase BP that increase stretching of the heart tissue
- inhibit sodium reabsorption in the kidney and increase GFR
- Net effect is the increase urine excretion, relax blood vessels and decrease BP and decrease heart workload
68
Labs that can be drawn for heart failure
electrolytes, BUN, creatinine, TSH, CBC, ABGs, UA, BNP, glucose, albumin, liver function, PT/INR
69
Diuretics
decrease preload by excretion of sodium and fluid
70
Digoxin
inatropic agent to increase contractility and improves CO and perfusion
71
Entresto
works to relax blood vessels; causes an increase in levels of natriuretic peptides to decrease blood pressure
72
Corlanor
a specific type of channel blocker that lowers HR within the SA node
73
ACE inhibitors
promote diuresis and vasodilation by decreasing afterload; blocks conversion of angiotension I to II
74
ARBs
blocks agiotension II; decrease systemic vascular resistance, increase CO, reduces afterload
75
Beta Blockers
decrease adverse effects of the SNS, slows HR allowing left ventricle to fill more completely increase EF
76
Vasodilators
nitrates to decrease preload and afterload; increase blood flow to the heart
77
Human B-type natriuretic peptide
causes diuresis and vasodilation
78
anticoagulants
to prevent thrombus formation; risk associated with congestion, stasis and atrial fibrillation
79
Milrinone
IV inotrope
- promotes vasodilation to decrease preload & afterload
- Reduces cardiac workload
80
Dobutamine
IV inotrope
- increases cardiac contraction
- improves renal perfusion
81
Ultra filtration (aquapheresis)
remove fluid from extravascular compartment
82
ICD
implantable cardiac defibrillator
83
Life Vest
wearable defibrillator
84
Cardiac Resynchronization
Biventricular pacemaker
85
VAD
ventricular assist device
86
Cardiogenic pulmonary edema
fluid accumulates in the interstitial spaces and alveoli of the lungs
87
Noncardiac pulmonary edema
renal failure, liver failure, or an oncologic condition
88
What are symptoms of pulmonary edema?
- Frothy pink sputum and cough
- hypoxemia
- tachy, dyspnea, and orthopnea
- cold, moist skin and cyanotic nail beds
- weak and rapid pulse, crackles, JVD, decrease UO
89
MADDOG
| for pulmonary Edema
```
M morphine
A aminophylline
D digoxin
D diuretics
O oxygen
G blood gases
```
90
Pericardial effusion
accumulation of fluid in the pericardial sac
- venous return to the heart is obstructed and amount of blood pumped is reduced, decreasing CO
- result in cardiac tamponade
91
What is cardiac tamponade
compression of the heart from fluid accumulation in the pericardial sac
