Cardiovascular/EKG Flashcards
(101 cards)
1
Q
Stroke volume
A
Amount of blood ejected with each heartbeat
2
Q
Cardiac output
A
Amount of blood pumped by ventricle in Liters per minute
3
Q
Preload
A
Degree of stretch of cardiac muscle at the end of diastole
4
Q
Afterload
A
Resistance to ejection of blood from ventricle
5
Q
Ejection fraction
A
Percent of end diastolic volume ejected with each heartbeat
6
Q
What medication should be given to increase contractility in patients with heart failure?
A
Digoxin
7
Q
Peripheral vascular resistance gives
A
Afterload
8
Q
To decrease afterload, what meds should be given?
A
Vasodialator
Nitroglycerin
Ca+ channel blockers
Beta blockers
9
Q
To decrease prelaod, what medication should be given?
A
Diuretics (Lasix, hydrochlorathiazide, K+ sparring)
10
Q
Contractility is increased by
A
Catecholamines
11
Q
Lab tests for CVD
A
CK, CK-MB Myoglobin Troponin T and I Lipid profile BNP C-reactive protein
12
Q
What does the P wave represent
A
Atrial depolarization
13
Q
What does the QRS represent
A
Ventricular depolarization
14
Q
The T wave represents
A
Ventricular repolarization
15
Q
P-R interval should be b/w how many seconds
A
0.12 and 0.20 seconds
16
Q
QRS complex should be how many seconds
A
0.12 seconds or 3 small boxes
17
Q
R-R wave or P-P wave is used to determine
A
Rate and regularity of cardiac rhythm
18
Q
Lipid profile is used to evaluate
A
A persons risk for developing CAD, especially if there is a family hx of premature heart disease, or to dx a specific lipoprotein abnormality
19
Q
HDL transports
A
Cholesterol out of the arteries
20
Q
LDL deposits
A
Cholesterol in the artery
21
Q
Cholesterol is required for
A
Hormone synthesis and cell membrane function
22
Q
Normal level for cholesterol
A
200mg/dL
23
Q
Normal value for triglycerids
A
less than 150mg/dL
24
Q
Normal value for LDL
A
less than 100mg/dL
Less than 70 for very high risk patients
25
Normal value for HDL
Men: 35-70mg/dL
Women: 35-80mg/dL
In patients with CAD the goal is to increase it to more than 40mg/dL for males and 50 for women
26
A lipid profile tests
Cholesterol
Triglycerides
Lipoproteins (LDL and HDL)
27
Factors that lower HDL
Smoking
Diabetes
Obesity
Physical inactivity
28
QT interval should be between how many seconds
0.34 to 0.43 seconds
29
ST segment is depressed with
Ischemia
30
ST segment is elevated with
Cardiac injury
31
Atherosclerosis
Abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen
32
Manifestations of atherosclerosis
```
Sx are due to myocardial ischemia
Angina pectoris
MI
Heart failure
Sudden cardiac death
```
33
Angina may be described as
Tightness
Choking
Heavy sensation
34
Other sx of angina include
Dyspnea/SOB
Dizziness
N/V
35
Unstable angina is characterized by
Increased frequency and severity and is not relieved by rest and NTG
36
Medications to treat angina
```
NTG
Beta blockers
Ca+ channel blockers
ASA
Clopidogrel (Plavix)
Heparin
Glycoprotein IIB/IIIa agents
```
37
An MI is caused by
reduced blood flow in a coronary artery due to rupture of an atherosclerotic plaque and subsequent occlusion of the artery by a thrombus
38
Contractility
The ability of cardiac muscle to develop force for a given muscle length
39
Heart failure can be caused by
CAD
HTN
Cardiiomylopathy
Atherosclerosis
40
Sx of left sided HF
```
Crackles
Dyspnea
Dry cough
Low 02 sat
S3 or gallop
Pt may report orthopnea
Diminished CO
Oliguria
```
41
Sx of right sided HF
```
JVD
Edema of lower extremities
Hepatomegaly
Ascites
Generalized weakness (reduced CO)
```
42
In right sided HF, hepatomegaly may increase pressure on the diaphragm causing
Respiratory distress
43
Meds used to treat HF
```
Beta blockers
ACE inhibitors
Angiotensin Receptor blockers
Diuretics
Digitalis
```
44
ACE inhibitors
| Lisinopril, Enalapril
Promote vasodilation and diuresis, ultimately decreasing afterload and preload. Decrease the secretion of aldosterone, promote renal excretion
45
Patients on ACE inhibitors are monitored for
Hyperkalemia
Hypotension
Alterations in renal function
46
Angiotension receptor blockers
| Diovan/Valsartan
Block the vasoconstricting effects of angiotensin II. Used as an alternative to ACE inhibitors
47
Beta Blockers
| -lol, cavedilol, metoprolol
Relax blood vessels, lower BP, decrease afterload and cardiac workload. Dose is titrated up
48
Side effects of beta blockers
```
Dizziness
Hypotension
Bradycardia
Fatigue
Depression
```
49
Diuretics
Remove excess extracellular fluid by increasing urine output
50
Example of Loop diuretic
Lasix (furosemide)
51
Example of thiazide diuretic
Hydrochlorathiazide
52
Spirinolactone (Aldactone)
K+ sparring diuretic that blocks the effects of aldosterone in the distal tubule and collecting duct
53
Digitalis (Digoxin)
Increases the force of myocardial contraction and slows conduction thru the AV node. Improves contractility
54
Cardiogenic shock occurs when
Decreased CO leads to inadequate tissue perfusion and initiation of the shock syndrome
55
NY heat association classification of heart failure
| Stage 1
No limitation of physical activity
| Ordinary activity does not cause fatigue, palpitations, or SOB
56
NY heat association classification of heart failure
| Stage 2
Slight limitation of physical activity
| Comfortable at rest, but ordinary physical activity causes fatigue, palpitations, or SOB
57
NY heat association classification of heart failure
| Stage 3
Marked limitation of physical activity
| Comfortable at rest but less than ordinary activity causes fatigue, palpitations, or SOB
58
NY heat association classification of heart failure
| Stage 4
Unable to carry out any physical activity w/o discomfort
| Sx of cardiac insufficiency at rest
59
Classification of BP
| Prehypertension
Systolic: 120-139
Diastolic: 80-89
60
Classification of BP
| Stage 1 hypertension
Systolic: 140-159
Diastolic: 90-99
61
Classification of BP
| Stage 2 hypertension
Systolic: 160<
Diastolic: 100<
62
What is primary HTN?
High BP from an unidentified cause, most common
63
What is secondary HTN?
High BP that is secondary to a condition
| cause such as renal disease, narrowing of renal arteries, medications
64
HTN can result from
Increases of CO, increases in peripheral resistance
65
Sx of HTN
may be asymptomatic
CAD with angina
MI
Nocturia
66
Meds for HTN
```
Thiazide diuretics
ACE inhibitors
ARB's
Beta blockers
Ca+ channel blockers
Vasodialators
```
67
What is DASH dieting?
A diet that is rich in fruits, vegtables, and low fat dairy products with a reduced content of saturated and total fat
68
What is hypertensive emergency?
BP is extremely elevated and must be lowered immediately to prevent damage to target organs. Goal is to reduce pressure by 20-25% within the first hour
69
What is hypertensive urgency?
BP is very elevated but there is no evidence of impending or progressive target organ damage.. Associated with severe headaches, nosebleeds, or anxiety. ACE inhibitors and beta blockers are used to treat.
70
Myocardial cells that become necrotic from prolonged ischemia or trauma release
CK
CK-MB
Myoglobin
Troponin T and I
71
BNP is a neurohormone that regulates
BP and Fluid volume
72
What is secreted by the ventricles in response to increased preload
BNP
73
Elevations of BNP can occur from
Pulmonary embolus
MI
ventricular hypertrophy
74
Normal level of BNP
100pg/mL, greater than that is indicative of HF
75
C-Reactive protein is produced by _____ in response to ______
The liver, inflammation
76
What is metabolic syndrome?
A cluster of conditions that occur together, increasing your risk of heart disease, stroke and diabetes.
77
What are the metabolic risk factors?
```
Obesity
High cholesterol
High levels of C-reactive protein
High blood pressure
High blood sugar
High fibrinogen levels
```
78
Patho of atherosclerosis
Inflammation begins with injury, injury is initiated by smoking, HTN, or hyperlipidemia. The presence of inflammation attracts macrophages. Macrophages ingest lipids, becoming "foam cells" that transport lipid into the arterial wall. The macrophages release substances that contribute to oxidation of LDL which fuels the progression of the atherosclerotic process. Smooth muscle cells prliferate and form a fibrous cap over a core. This protrudes into the lumen of the vessels, narrowing it and obstructing blood flow.
79
Risk factors for CAD
```
Elevated LDL
Age, Gender
Smoking history
Level of cholesterol and HDL
Metabolic syndrome
```
80
Nitrates (Nitroglycerin)
Standard treatment of angina pectoris. Potent vasodilator., improves blood flow, relieves pain, primarily dialates veins. Preload is reduced
81
Stable angina
predictable and consistent pain that occurs on exertion and is relieved by rest and or NTG
82
intractable or refractory angina
Severe incapacitating chest pain
83
Silent ischemia
objective evidence of ischemia (ekg changes with stress test) but pt reports no pain
84
Variant angina
pain at rest wit reversible ST segment elevation, thought to be caused by coronary artery vasospasm
85
Patients taking beta blockers are cautioned not to stop taking them abruptly because
Angina may worsen and MI may develop
86
Calcium channel blockers
| Amlodipine/Norvasc
Slow heart rate and decrease the strength of myocardial contraction (Negative inotropic effect).
87
Side effects of Ca+ channel blockers
Hypotension
AV block
Bradycardia
Constipation
88
What is myoglobin
A heme protein that helps transport oxygen
89
An EKG should be obtained within how many minutes from the time a patient reports pain or arrives in the ED
10 minutes
90
EKG changes that occur with an MI
T wave inversion
ST elevation
Abnormal Q-wave
91
STEMI
Patient has ekg with evidence of acute MI with characteristic changes in two contiguous leads on a 12 lead. In this type of MI, there is significant damage to the myocardium
92
NSTEMI
The pt has elevated cardiac biomarkers but no definite EKG evidence of acute MI. In this type of MI there may be less damage to the myocardium.
93
Side effects of ACE inhibitors
Dry cough
94
Most common cause of abdominal aortic aneurysm
Atherosclerosis
95
Patho and Sx of abdominal aneurysm
Damaged media layer of vessel caused by weakness, trauma, or disease. Risk factors include genetic predisposition, smoking, and HTN. Sx include patient reporting a feeling that their heart beating in their abdomen when lying down, feeling of abdominal mass.
96
Raynauds Phenomenon
Form of arteriolar vasoconstriction that results in coldness, pain and pallor of the fingertips and toes. Most common in women between 16-40y/o
97
Medical management of Raynauads
Avoiding the stimuli (cold, tobacco)
Ca+ channel blockers may be effective
Sympathectomy
98
Arterial ulcer
Characterized by pain caused by activity and relieved after a few minutes of rest. Typically small, circular, deep ulcerations on the tips of toes or in the web spaces b/w of the toes. Often occur on the medial side of the hallux or 5th lateral toe
99
Cause of arterial ulcer
Combination of ischemia and pressure
100
Venous ulcers
Characterized by pain described as aching or heavy. The foot and ankle may be edematous. Typically large, superficial and highly exudative.
101
Time for venous ulcer to heal
6-12 months completely
