Cardiovascular - Part #1 Flashcards
(81 cards)
1
Q
Be able to describe the blood flow through the heart
A
1. R atrium recieves venous blood (deoxygenated) from the superior and inferior vena cava and coronary sinus
2. DeO2 blood frows through the tricuspid valve and intor the R ventricle
3. DeO2 blood flows through the pulmonic valve and goes into the lungs via pulmonary arteries
4. Gas exchange occurs at the alveoli and blood becomes oxygenated
5. Oxygenated blood is returned to the L atrium via pulmonary veins
6. Oxygenated blood flows through the mitral valve and into the left ventricle
7. It then passes through the aortic valve and goes into the aorta and coronary arteries
2
Q
T/F: The myocardium has its own blood supply
A
True
3
Q
Coronary blood flow occurs mostly during ____________ (systole/diastole)
A
diastole
4
Q
Describe the Left coronary artery
(Originate, Branches, Areas Supplied By Artery and Its Branches)
A
Originate
- Aorta
Branches
- L anterior descending (LAD) artery
- L circumflex artery
Areas Supplied By Artery and Its Branches
- L atrium
- L ventricle
- Interventricular septum (anterior)
- Portion of R ventricle
5
Q
Describe the Right coronary artery
(Originate, Areas Supplied By Artery and Its Branches)
A
Originate
- Aorta
Branches
- x
Areas Supplied By Artery and Its Branches
- R atrium
- R ventricle
- Posterior wall of L ventricle
6
Q
In most people, the AV node and bundle of His are supplied by which coronary artey?
A
Right Coronary Artery
blockage in RCA can lead to conduction defects
7
Q
Coronary veins run __________ to coronary arteries.
Know the pathway of blood starting from the coronary veins and ending in the coronary arteries
A
- Run parallel to coronary arteries
1. Coronary veins take DEOXYENATED blood from the heart muscle (myocardium)
2. Drains into coronary sinus
3. Empties into right atrium (near inferior vena cava)
4. Continue normal blood circulation pathway to become oxygenated
5. Once it reaches left ventricle -> aorta -> enters coronary arteries again (as OXYGENATED blood)
8
Q
Chordae Tendinae
A
thin, fibrous tissue that anchor valves (tricuspid and mitral leaflets) to papillary muscles (muscle projections) of the ventricles
9
Q
Compare Atrioventricular vs Semilunar valves.
Be able to fill out the chart under “Cardiac Valves” in master notes.
A
refer to master notes
10
Q
Systole
A
Contraction of heart muscle -> ejection of blood FROM the ventricles
11
Q
Diastole
A
Relaxation of heart muscle -> filling of blood IN the ventricles
12
Q
Mean Arterial Pressure
What MAP value is needed to maintain adequate perfusion?
A
Average pressure of the arteries (of systole and diastole)
60 - 70 mmHg for adequate perfusion
13
Q
Stroke volume
A
Amount of blood ejected with each heart beat
14
Q
Cardiac output
A
Amount of blood pumped by each ventricle in 1 minute
15
Q
What is the formula for cardiac output? What is the nomal CO?
A
CO = HR x SV
normal: 4 - 8L/min
16
Q
What are the 3 factors affecting cardiac output?
A
- Preload
- Contractility
- Afterload
17
Q
Preload
A
Volume of blood in ventricles at end of diastole (before the next contraction)
18
Q
Contractility
A
How well the heart is contracting
19
Q
Afterload
A
amount of pressure that the heart needs to exert in order to eject blood during ventricular contraction
20
Q
Be able to understand which arteries/veins carry oxygenated and deoxygenated blood
A
21
Q
What are the 5 factors that affect BP regulation
A
- ANS
- Kidneys
- Endocrine System
- Baroreceptors
- Systolic and Diastolic BP
22
Q
Be able to describe how each factor affects BP regulation:
- ANS
- Kidneys
- Endocrine System
- Baroreceptors
- Systolic and Diastolic BP
A
ANS
-
SANS
-> ⬆ HR
⬆speed of impulses through AV node
⬆force of atrial and ventricular contractions -
PANS
-> ⬇HR
⬇impulse from SA node and conduction through AV node
Kidneys
- sense low BP -> activate RAS -> increase Na+ and H20 resorption -> ⬆BP
Endocrine System
- release hormones that stimulate SNS
-> catacholamines
-> seratonin
-> histamines
Baroreceptors
- Baroreceptors stretch (high pressure) → signal brain to ⬇ SANS activity → ⬆PANS → ⬇HR and peripheral vasodilation occurs (⬇BP)
Systolic and Diastolic BP
- tbh this one doesnt make any sense
23
Q
Where are baroreceptors located?
A
found in aortic arch and carotid sinus
24
Q
What is the most common valvular disorder in older adults?
A
Aortic stenosis
25
**Describe what happens to each of the items as a a person ages**:
- Cardiac valves
- Conduction system
- Left ventricle
- Aorta and other large arteries
- Baroreceptors
**Cardiac Valves**
- may undergo calcification that interferes with opening/closing (increase cardiac workload)
**Conduction System**
- slower conduction through hearts electrical system due to decrease of pacemaker cells in SA node
**Left Ventricle**
- Size may increase and increase risk for fibrotic changes (stiffening), leading to decrease speed of filling
**Aorta and other Large Arteries**
- Thicken = ⬆ systolic BP (compensatory mechanism)
- Stiffening = ⬆ Systemic vascular resistance = Left ventricle has to pump against greater resistance ➡ ventricular hypertrophy
**Baroreceptors**
- ⬆ age = ⬇ sensitivity ➡ less effective at regulating BP
26
Know the peripheral pulses grading scale
How else can you assess a persons peripheral pulses if you do not feel any pulse?
- **0** - no pulse, absent
-> Assess further use Doppler
- **+1** - weak/thready (feel like small cord/thread)
- **+2** - normal
- **+3** - high-normal
- **+4** - bounding (could indicate cardiac dz)
27
Know the 5 cardiac landmarks.
What can be found in the mitral area?
APE To Man
- Aortic
- Pulmonic
- Erbs Point
- Tricuspid
- Mitral
- Apical Pulse (Point of Maximum Impulse; PMI) found here
28
If patient has a cardiac history and you need to assess lung sounds, you should assees the lung sounds using which side of the stethoscope and why?
**Listen using**:
- bell (small) of stethoscope
- Helps pick up lower-pitched sounds (ex: murmurs)
29
________ is a protein found in the heart muscles that is NOT normally found in the blood
Troponin
30
Describe this labratory assessment: **Serum Cardiac Enzymes**
(Examples, Ordered For Patient With, Why Is This Test Ordered? Range/Goal)
**Examples**
- Troponin T and I
**Ordered For Patient With**
- Chest pain
**Why Is This Test Ordered?**
- Troponin is a protein found in the heart muscle, that is not normally found in the blood
-> If heart muscle is damage (ex: MI), troponin is released in the bloodstream
**Range/Goal**
- HIGH troponin = bad 😡
**MISC**
- x
31
Describe this labratory assessment: **Lipid Panel (Serum Lipids)**
(Examples, Why Is This Test Ordered? Range/Goal)
**Examples**
- Cholesterol
- Triglycerides
-> Most common fat in body
- HDL (high-density lipoprotein)
-> GOOD cholesterol
- LDL (low-density lipoprotein)
-> BAD cholesterol
**Ordered For Patient With**
- Chest pain
**Why Is This Test Ordered?**
- Cholesterol
-> Help determines risk factors
**Range/Goal**
- **Cholesterol**
-> Goal: < 200
->> Higher levels = BAD = ⬆CAD
- **Triglycerides**
-> Goal: < 150
- **HDL**
-> Range: 40 - 60+
->> HIGHER = BETTER
- **LDL**
-> Range: 70 - 130
-> LOWER = BETTER
**MISC**
- Elevated triglycerides and LDL have a strong association with CAD
32
Describe this labratory assessment: **Homocysteine**
(Why Is This Test Ordered?)
**Why Is This Test Ordered?**
- An amino acid that is produced when proteins are broken down that are NORMALLY found in the blood
-> If elevated = RF for CV disease
33
Describe this labratory assessment: **C-reactive protein (CRP)**
(Why Is This Test Ordered?)
**Why Is This Test Ordered?**
- A protein made by the liver that is an inflammatory marker
-> If elevated = inflammation present (but doesnt mean CV disease)
34
Describe this labratory assessment: **Fluid and Electrolytes**
(Why Is This Test Ordered?)
**Why Is This Test Ordered?**
- May be altered in heart failure, esp if renal involvement
-> Ex: Na+ and K+
35
What is also know as the silent killer?
blood pressure (hypertention)
36
What are the blood pressure goals for the AHA?
What are the blood pressure goals for people over 60 and for people under 60 according to the JNC8 guidelines.
**American Heart Association (AHA)**
- < 130/80
**JNC8 Guidelines**
- For people over 60 = < 150/90
- For people under 60 = < 140/90
37
T/F: You need 3 readings by provider before being officially diagnosed with HTN
False, you need 2 readings by the provider before being officially diagnosed with HTN
38
What is the difference in the cause of Primary (Essential) Hypertenion and Secondary Hypertention
**Primary (Essential) Hypertention**
- Not caused by existing health problems (dvlp gradually overtime from genetic/environemental factors)
**Secondary Hypertention**
- Caused by specific disease states and drugs increase persons susceptibility to elevated BP
39
What is a consequence of chronically high blood pressure?
Chronically high elevated BP put stress on arterial walls, causing smooth muscle in arteries to thicken, causing medial hyperplasia
40
What are the **Non-Modifiable and Modifiable risk factors** in regards to **Primary (Essential) Hypertention**
**Non-Modifiable**
- Family history
- ⬆ Age > 60 yrs old
- Gender (Men in younger/middle adulthood, women after menopause)
- Ethnicity: African American
**Modifiable**
- Smoking
- Tobacco (nicotine)/Vaping
- Alcohol (strongly associated with HTN)
-> Male - DO NOT drink more than 2 alc bev/day
-> Female - DO NOT drink more than 1 alc bev/day
- Sedentary lifestyle
-> Obesity
-> Elevated lipids (RF for CAD)
-> Elevated sodium intake
-> Diabetes
-> Stress
41
What are the **symptoms** of **Primary (Essential) Hypertention** and **Secondary Hypertention**
**May have no SXS** - *ABC*
- Headaches (Achy head)
- Blurred Vision
- Palpitations (Chest Pain)
- Facial flushing
- Fatigue
- Fainting
- Dizziness
- Dyspnea
42
What are the **risk factors** in regards to **Secondary Hypertention**
**Disease States:**
- Kidney Disease
- Dysfunction of Adrenal medulla/adrenal cortex
- Cushing Disease
**Drugs**:
- Estrogen
- Glucocorticoids
- Mineralcorticoids
- Sympathomimetics
43
What are the **assessment** of **Primary (Essential) Hypertention** and **Secondary Hypertention**
**History**
- Risk Factors
- Kidney/CV disease
- Drug therpay or illicit drug use
44
**T/F**: There are diagnostic tests, such as a urinalysis and CXR, that can be done to diagnose HTN
False, no diagnostic tests are specific to HTN, but labs can be done to ID possible causes (for secondary HTN)
45
What are the diagnostic tests that can be done for **Primary (Essential) Hypertension** and **Seconday Hypertension**
**Test for Kidney Disease:**
- **Urinalysis**
-> Protein
-> RBC
-> BUN
-> Creatinine
- **eGFR** - tells how well kidneys are filtering
-> GOAL: 90 - 120 (if below 90 = possible reduced kidney function)
**Test for Heart Abnormalities**
- **CXR** (cardiomegaly)
- **ECG**
-> Show degree of cardiac involvement
46
What are 3 main treatment/management options (general categories) for **Primary (Essential) Hypertension** and **Secondary Hypertension**
- Diet
- Physical Activity
- Medications
47
What type of **diet** should a patient with **Primary (Essential) Hypertension** and **Secondary Hypertension** follow?
**DIET**
- **DASH diet** (heart-healthy diet)
-> ⬆ in fruits, vegetables, low-fat dairy products
-> ⬆intake of potassium, calcium, magnesium, fiber
- **⬇ intake of sodium**
-> Less than 1500 mg/day
- **Avoid tobacco** use (alc in moderation)
48
In terms of **physical activity**, what **treatment/management** options should be implemented for **Primary (Essential) Hypertension** and **Secondary Hypertension**?
**PHYSICAL ACTIVITY**
- **Weight reduction**
-> ⬆physical activity (30 min - 3x/week +)
49
What **medications** can be given in the treatment/management of **Primary (Essential) and Secondary Hypertension** ?
**Medications** *ABCD*
- Angiotensin-Converting Enzyme Inhibitors (ACEIs) (-pril)
- Beta Blockers (-olol)
- Calcium Channel Blockers (amlodipine)
- Diuretics (thiazide)
50
Which type of hypertension is the most common?
Primary (Essential) Hypertension
51
**Hypertensive Crisis**
Define, AKA?
- AKA: Malignant Hypertension
- Medical emergency - severe and rapidly progressive elevation in blood pressure that can cause damage to organs
52
What are the **symptoms** of **Hypertensive Crisis**?
What blood pressure readings are indicative of a hypertensive crisis?
**Morning, BUD**
- Morning headaches
- Blurred vision
- Uremia
- Dyspnea
- **Systolic**: > 200 mmHg
- **Diastolic**: > 150 mmHg
53
What **type** of medications and what are **examples** of **medications** to be given for patients with **hypertensive crisis**?
**Treatment**
- IV medications
-> Nitroprusside
-> Nicardipine
-> Fenolopam
-> Labetalol
54
Compare **Arteriosclerosis** from **Atherosclerosis**
| Hint: What is it?
**Arteriosclerosis**
- thickening/hardening of arterial wall
**Atherosclerosis**
- TYPE of arteriorsclerosis, involving formaiton of plaque within arterial wall, leading to narrowing of arteries
55
What is the **risk factor** for **arteriosclerosis**?
Risk Factor
- Aging
56
What is the **risk factor** for **atherosclerosis**?
| Separate the nonmodifiable from modifiable
**Nonmodifiable**
- Age
- Gender
- Ethnicity (African American, Hispanics)
- Hereditary
**Modifiable**
- HTN
- Sedentary lifestyle
-> Elevated lipids
-> Obesity
-> DM
57
What **complications** can arise from **arteriosclerosis**/**atherosclerosis**
**Complications**
- HTN
- PAD/PVD
- MI
58
What **assessments** should be done in regards to **arterosclerosis** and **atherosclerosis**?
**History**
- RF
**Physical Assessmen**t
- Assess BP in BOTH arms
- Palpate carotid arteries (separatley)
- Bruit
- Capillary Refill
| focus on ID lifestly habits, nutrition, physical activity
59
What **diagnostic assessments** should be done in regards to **arterosclerosis** and **atherosclerosis**?
- **Cholesterol**
-> Low HDL-C
-> High LDL-C
- **Triglycerides** (elevated)
60
What **treatment options for Dietary Changes, Physical Activity and Medications** should be done in regards to **arterosclerosis** and **atherosclerosis**?
**Diet**
- Follow similar guidelines to DASH
**Physical Activity**
- Aerobic exercise (30 min - 3x/week +)
**Medications**
- Lower cholesterol (-statin)
61
___________ is the leading risk factor for CV disease
Atherosclerosis
62
Compare **Peripheral Arterial Disease** (PAD) from **Peripheral Venous Disease** (PVD)
**PAD**
- chronic condition that **results** from systemic **ATHEROSCLEROSIS**, where there is partial/total arterial occlusion that *decrease* perfusion **TO** extremities
- O2 issues -> POSSIBLE NECROSIS/DEATH = BADD
**PVD**
- Blood in the veins cannot flow properly back to the heart usually due to ineffective valves that may have been caused by venous HTN (veins stretch out from pressure)
- O2 POOL PARTY
| PAD = NO O2; PVD = O2 ok
63
Compare the **causes** of **PAD** vs **PVD**
**PAD**
- Systemic atherosclerosis
**PVD**
- Thrombus formation
-> VTE (DVT and PE)
- Defective valves
- Skm that do not contract
64
What is Virchows Triad?
What are the components to it?
**Virchows Triad** (3 major risk factors that contribute to VTE)
- Stasis
- Vessel Damage (vein)
- Hypercoagulability
65
What are the **Risk Factors** for **Peripheral Arterial Disease** (PAD)?
**Nonmodifiable**
- Age (60 - 80s)
- Gender (male)
- Ethnicity (African American)
- Family Hx
**Modifiable**:
- **Atherosclerosis**
- **Chronic kidney disease**
- Tobacco use (smoking)
- Sedentary Lifestyle
-> HTN
-> Hyperlipidemia
-> Obesity
-> DM
66
What are the **Risk Factors** for **Peripheral Venous Disease** (PVD)?
- HTN
- Hx VTE
- Valve disorders
- Abnormal clotting
- PAD
67
What are the **symptoms** of **Peripheral Arterial Disease** (PAD)?
**SHINY PADS**
- Shiny, taut skin
- Hair loss
- ***Intermittent claudication*** (classic sxs of PAD = **sharp** calf pain)
- Numbness (paresthesia)
- You feel weak pulses (diminished/absent on pedal, popliteal, femoral)
- Pallor with elevation
- Absent pulses
- Dependent rubor (redness of foot when in dependent position; reactive hyperemia)
- Skin color changes (mottled) and Sores that won’t heal (nonhealing wounds)
-> tissue necrosis
68
What are the **symptoms** of **Peripheral Venous Disease** (PVD)?
May be asymptomatic: **VEINY**
- Volumptious pulses (warm legs)
-> Unequal pulses
- Edema (blood pooling)
-> Unilateral
- Irregularly shaped sores
- No sharp pain (dull)
-> Calf/groin pain
- Yellow and brown ankles
69
What are the **complications** of **Peripheral Arterial Disease** (PAD)?
- Atrophy of skin and underlying muscles
- Delayed wound healing
- Wound infection
- Tissue necrosis
- Arterial ulcers (around bony prominences)
-> Most serious complications: Nonhealing arterial ulcers and gangrene
-> May result in amputation if no adequate blood flow restored or severe infection
70
What is **intermittent claudication**?
- ischemic muscle pain caused by contant level of exercise, where muscles arent getting enough oxygen and leads to a build up of lactic acid, causing sharp calf pain
-> resolves in 10 min (or less) with rest
-> reproducible with exercise
71
What **Diagnostic Assessments** can be done for PAD and PVD?
**SAME P**
- **Segmental systolic BP measurement**
-> Done using Doppler
- **Ankle-branchial index**(ABI)
-> Compare ankle systolic pressure to brachial systolic pressure
- **Magnestic Resonance Angiography** (MRA)
-> Assess BF in arteries
- **Exercise tolerance training**
-> evaluate presence of muscle pain (claudication)
- **Plethysmography**
-> measures arterial flow in lower extremities
72
What **interventions** can be done for PAD?
**Positioning**
- Have legs h**A**ng
-> avoid elevating above heart level
**Applications**
- apply warmth (not cold) = promote vasodilation = increase BF to extremities
73
What **interventions** can be done for **PVD**?
**Positioning**
- Ele**v**ate legs
**Applications**
- apply warmth
- compression stockings
-> DO NOT MASSAGE
74
T/F: It is appropriate to put compression stockings on a patient with PAD
**FALSE**, do NOT use compression if there are signs of arterial disease (like PAD) as it can worsen ischemia
75
T/F: It is appropriate to massage a patients lower extremities on a patient with PVD
**FALSE**, if you massage a patient who had PVD there is a chance you might dislodge a blood clot and might travel into the lungs and cause pulmonary embolism
76
What **treatment** options (**general**) should be implemented/enforced to patients with **PAD**?
- Control
- Lifestyle Modifications
- Drugs
- Surgery
77
In terms of these categories, give **examples** of each that can be used in the treatment of **PAD**?
- Control
- Lifestyle Modifications
- Medications
- Surgery
**Control**
- BP
- Glucose in diabetics
- Hyperlipidemia
**Lifestyle Modifications**
- Smoking/tobacco cessation
- Avoid caffeine/stress
- Exercise walk 3--45 min/daily - 3x/week
**Medications**
- Anticoagulants (aspirin, clipidrogrel)
- Antiplatelets (pentoxifylline)
**Surgery**
- **Arterial Revascularization**
- **Percutaneous vascular intervention**
-> Puncute into the groin and inflates a balloon to compress plaque against artery wall (angioplasty) and usually has stent
78
What **treatment** options (**general**) should be implemented/enforced to patients with **PVD**?
- Activity
- Medications
- Surgery
79
In terms of these categories, give **examples** of each that can be used in the treatment of **PVD**?
- Activity
- Medications
- Surgery
**Activity**
- Increase activity gradually
**Medication**
- Anticoagulants (warfarin, heparin)
-> Check PT/PTT/INR
**Surgery**:
- Revascularization surgery
- **Inferior Vena Cava (IVC) filter**
-> Trap emboli in IVC before they can travel and reach lungs
- Debride and clean ulcers
80
What is a major sign that PAD is worsening?
pain is unrelieved by rest
81
T/F: PAD is largely misdiagnosed
True
