Cardiovascular - Part #2 Flashcards
(80 cards)
1
Q
Know the types of CAD
Hint: Use flowchart
A
- Chronic Stable Angina
- Acute Coronary Syndrome
-> Unstable angina
-> NSTEMI
-> STEMI
2
Q
Infarction
A
Necrosis or cell death that occurs when severe ischemia is prolonged and decreased perfusion causes irreversible damage to tissue
3
Q
What is the cause of Coronary Artery Disease?
A
build up of plaque (usually due to atherosclerosis), which causes ischemia
4
Q
Compare Chronic Stable Angina from Unstable Angina
A
Chronic Stable Angina
- Fixed, stable plaque that partially blocks (narrows) coronary artery, causing temporary myocardial ischemica because of imbalance between oxygen supply and demand in the myocardium
-> Release of lactic acid irritates nerve fibers and causes pain in the cardiac nerves
Unstable Angina
- Ruptured or unstable plaque that causes a sudden clot or narrowing, causing formation of a platelet plug (clot) and the thrombus -> reduce O2 supply to myocardium
-> If thrombus enlarges and fully occludes artery -> MI
5
Q
What are nonmodifiable and modifiable risk factors for Coronary Artery Disease (Chronic Stable Angina and Unstable Angina)
A
Nonmodifiable:
- Age
-> middle aged men, but once 65+ incidence becomes equal - Gender
-> Women with CAD may have atypical symptoms - Ethnicity (African American)
- Genetics
Modifiable:
- Atherosclerosis
-> Elevated lipids - Smoking (Tobacco Use)
-> Substance Abuse - Sedentary Lifestyle
-> HTN
-> Obesity
-> Diabetes - Chronic, uncontrolled stress
- High Homocysteine level
6
Q
Risk factors for unstable angina overlap with risk factors for CAD. What are 4 specific risk factors that are specific to unstable angina?
A
- Thrombus formation
- Plaque rupture
- Worsening of previously stable CAD
- Severe or sudden increase in oxygen demand (ex: emotional or physical stress)
7
Q
What are the symptoms of Chronic Stable Angina?
How does it compare between men and women?
A
Intermittent SXS: - Same pattern of onset, duration, and intensity of symptoms
-
Referred cardiac pain
-> Occurs with exertion/activitiy in familiar pattern
-> Goes away with rest (5 - 15 minutes)
-> Pressures/Aches
-> Suffocating sensation - Pulse deficit
- Indigestion (burning)
- Cool, clammy, pale skin
Men:
- L sided chest pain, that radiates down to left arm
Female:
- Epigastric pain
- Neck/jaw/s pain
- Heartburn
8
Q
What are the symptoms of Unstable Angina?
A
-
Chest pain at rest (or with exertion), not relieved by nitro
-> Pressure/discomfort 15+ minutes
-> Increase frequency of pain - Anxious/Restless
- Tachycardia
- SOB
9
Q
What are some assessments that should be done for Chronic Stable Angina
A
- Check JVD
- Listen to heart and lung sounds
-> Check peripheral pulses
-> Tachycardia, Bradycardia
10
Q
What Imaging/Radiology should be taken for a a patient with Chronic Stable Angina or Unstable Angina
A
-
Troponin Imaging assessment
-> No change in troponin values = unstable angina
-> if elevated, NOT chronic stable angina = MI - CTCA - CT Coronary Angiography (assess coronary arter narrowing)
- CXR (look at heart size)
- Thallium Scans (ID areas of ischemia during stress/rest)
- CMR, echocardiography
11
Q
What tests should be run if patient suspected to have Chronic Stable Angina or Unstable Angina
A
- 12-lead EKG (dysrhythmias)
- Exercise tolerance (stress test)
12
Q
What surgery should be run for patient with Chronic Stable Angina or Unstable Angina
A
-
Cardiac catherization/Angiography
-> Visualize blockages (diagnostic)
-> Open blockages (interventional)
-» PCI
-» Balloon angioplasty
-» Stent
13
Q
What interventions should be done for a patient with Chronic Stable Angina if they have difficulty breathing?
A
- High/Semi-fowlers (if difficulty breathing)
- Supplemental O2 (if difficulty breathing)
14
Q
What medications (general) should be given to a patient with Chronic Stable Angina?
A
- Administer nitrate (nitroglycerin) (x3 max every 5 minutes) followed by opioid analgesic
-> Opiod: Morphine and Aspirin
15
Q
What specific medicaitons should be given to a patient with Chronic Stable Angina.
What other suggestoins may you suggest this patient to change?
A
-
Short-acting nitrates (nitroglycerin; chest pain)
-> Sublingual tablets/spray -
Long acting nitrates (isosorbide, nitro topical; chest pain)
-> 12 hours on, 12 hours off - Antihypertensives (ACEI, CCB, B blocker)
- Antiplatlets
- Lipid lowernig agent
Recommend:
- Lifestyle modifications
16
Q
A patient has Chronic Stable Angina. They took Nitrostat (short-acting) for chest pain at 0800. By 0805, the patient still feels chest pain. What is the first action the patient should take?
A
Call 911 for pain that doesnt go away with rest or nitro after the FIRST dose. After calling 911, they may go ahead and repeat a second dose
17
Q
What medications are given to someone with Unstable Angina.
A
MONA
- Morphine
- Oxygen
- Nitroglycerin
- Aspirin
18
Q
With CAD and older adults, _________ pain may not be as obvious or reported. They may have symtoms of unexplained _________, _________, and ________ symptoms
A
chest
unexplained dyspnea
confusion
GI symptoms
19
Q
T/F: Dysrhythmia may be a normal age-related change rather than a complication of MI
A
True
19
Q
For patients with CAD, nurses should plan to slowly and steadily increase in activity. What should the nurse expect to do when having these patients participate in exercise?
A
- Gradually increase activity
- Plan longer warm-up and cool-down periods when participating in exercise (bc pulse rates may not return to baseline for 30 minutes)
20
Q
Review Heart Failure chart in master notes
A
review if you want, but i would focus on knowing L vs R heart failure
21
Q
What are the categories of heart failure in regards to severity.
A
-
Acute Heart failure
-> Caused by another condition (ex: severe anemia) - Chronic Heart failure (Congestive Heart Failure)
22
Q
What are common causes of systolic left-sided heart failure?
A
Systolic left-sided heart failure is due to the heart’s inability to pump effectively because of…
- Impaired contraction (MI)
- Increased afterload (HTN)
- Cardiomyopathy
- Mechanical abnormalities (valvular heart disease)
23
Q
What structural changes occur in the left ventricle during systolic heart failure?
A
- The left ventricle loses the ability to generate enough ejection pressure to pump blood out through the aorta.
-> it becomes dilated and hypertrophied
24
What is the hallmark sign of systolic heart failure, and how is it measured?
**The hallmark is a decreased ejection fraction (EF)**.
- Normal EF: 50–70%
- Systolic HF EF: < 40% (can be as low as 10%)
- EF < 30% = high risk for cardiac death
25
What is the pathophysiology of diastolic left-sided heart failure?
- The ventricles can’t relax and fill properly during diastole (may be stiffened → ↑ pressure).
- This leads to decreased stroke volume (SV) and cardiac output (CO).
- EF remains **normal** (often >50%)
26
What are the common **causes** of **diastolic left-sided heart failure**?
- **HTN** (most common)
- MI
- Cardiomyopathy
- Valve disease (aortic, mitral)
27
How is diastolic heart failure diagnosed, and who is most at risk?
**Diagnosed based on heart failure symptoms with normal ejection fraction (EF)**
More common in:
- Older adults
- Females
- Obese patients
28
Compare the etiology of **L sided HF** vs **R sided HF**
**L Sided Heart Failure**
- Caused by left ventricular dysfunction, causing a backup of blood into the left atrium and pulmonary veins
**R Sided Heart Failure**
- R ventricle cannot empty completely, which leads to a backup of blood into the R atrium and venous circulation
29
What are the causes of L Sided Heart Failure?
- HTN
- CAD
- Valvular Disease
30
What are the **causes** of **R Sided Heart Failure**?
- L ventricular failure
- R ventricular dilation and hypertrophy
- R ventricular MI
- Pulmonary HTN
31
What are the **symptoms** of **L sided Heart Failure**?
Left sided HF = Lung fluid
- Pulmonary edema
- Pulmonary congestion
-> Crackles
- Pink sputum
- Paroxysmal nocturnal dyspnea (panic and feelings of suffocation; strong desire to sit/stand up)
-> Dyspnea
-> Othopnea
- Cyanosis
- Arm heaviness
32
What are the **symptoms** of **R sided Heart Failure**?
Rocks the body with fluid
- Dependent edema
- Jugular vein distention
- Hepatojugular reflux
- Increase abdominal girth
-> Ascietes (fluid volume overload)
-> Hepatomegaly (big liver)
33
Whta 3 (general) **diagnostic assessments** should be done for a patient with **R and L sided HF**?
- Labs
- Imagine Assessment
- Hemodynamic Monitoring
34
These categories of **diagnostic assessmnets** should be run for a patient with **R or L sided heart failur**e. Be able to name examples of assessments in each category:
- Labratory Assessments
- Imaging Assessmnet
- Hemodynamic Monitoring
**Labratory Assessments**
- Serum electrolytes
-> Na+
-> K+
- H/H (check anemia)
- BNP (evaluate volume overload)
- Urinalysis (assess renal damage)
- ABGs
**Imaging Assessment**
- **Echocardiogrpahy** (asses EF)
- CXR
- Radionucleotide studies (assess EF)
- MUGA (assess EF)
**Hemodynamic Monitoring**
- Direct assessment of cardiac function and volume status
- PAP (measure P in pulm artery)
- PAWP (assess. L arterial presure)
35
What medications will be given to patients with heart failure (L and R)?
**Medications**: DAA-BVP
- Diuretics (Lasiz, Aldactone)
-> reduce fluid overload
- ACE inhibitors (-prils)
-> lower BP
- ARBS (Losartan)
- Beta Blocker (-olol)
- Vasodilators (nitrates)
- Positive inotropes (digoxin)
-> improve contracility
36
What self-management education should you include for patients with HF (L and R)?
**Self-Management Education**
- Nutrition (may restrict fluid intake, sodium)
- Monitor weight gain **DAILY**
-> 1kg of weight gain/loss = 1L of retained/lost fluid
-> 3lbs/week - contract provider (R sided HF)
- Acitivty and rest
-> E conservation
37
What is the most common type of heart failure? What is it AKA? What was it formally known as
- L sided HF
- AKA: Forward failure
- Formerly known as congestive heart failure
-> leads to fluid leakage from pulmonary capillary bed into interstitum and alveoli
38
T/F: Pitting edema is a sign of L sided heart failure
False, putting edema is a sign of R sided heart failure because arteries become backed up with fluid
39
R sided HF is mostly causes by... ______________
L sided HF
40
If L sided HF is not present, the cause of R sided heart failure is usually ______________ related
pulmonary
41
What Factors Affect CO?
- Preload
- Afterload
- Contractility
- HR
42
**High Output Heart Failure**
heart is pumping normally or even more than normal, BUT the body’s metabolic demands are so high that the heart still can’t keep up
not a weak heart, its an overworked heart
43
What are the **causes** of **High Output Heart Failure** ?
| A S H H
(all increase demand on the heart)
- Hyperthyroidism
- High fever
- Anemia
- Septicemia
44
What are the 4 NYHA functional **classifications** of **heart failure**?
**Class I** – Cardiac disease but no symptoms and no limitation in ordinary physical activity.
**Class II** – Mild symptoms and slight limitation during ordinary activity.
**Class III** – Significant limitation in physical activity due to symptoms.
**Class IV** – Severe limitations; symptoms occur even at rest.
44
What is the **cause** of **Mitral Stenosis**
- Rheumatic fever (causing Rheurmatic carditis)
45
What is the **pathophysiology** of **Mitral Stenosis**
1. Mitral valve thickens (bc of fibrosis and calcification)
2. Fusion and stiffening of valve leaflets, causing narrowing of the valve
3. Difficult for blood to flow forward from L atrium to L ventricle
- Increases workload on the heart
46
What **chambers** are affected in **Mitral Stenosis**
- Left Atrium -> lungs -> R Ventricle
47
What are the **symptoms** of **Mitral Stenosis**
What would you hear upon ascultation?
**May be asymptomatic**
- Paroxysmal nocturnal dyspnea
-> Dyspnea (on exertion)
-> Orthopnea
- Palpitations
- Dry Cough
**Symptom Upon Ascultation**
- Rumblind, apical diastolic murmur
48
What are the **causes** of **Mitral Regurgitation (Insufficiency)**?
- Rheumatic fever (causing Rheumatic Heart Disease)
- Mitral valve prolapse
- Infective endocarditis
- Connective Tissue Disease (Marfan Syndrome)
- Dilated cardiomyopathy
- MI
49
What is the **pathophysiology** of **Mitral Regurgitation (Insufficiency)**
1. Mitral valve is unable to close completely during systole (due to fibrotic and calcification changes)
2. Valve becomes leaky
3. Blood flows backward
50
What **chamber** is affected in **Mitral Regurgitation (Insufficiency)**
- L atrium (volume overload)
51
What are the **symptoms** of **Mitral Regurgitation (Insufficiency)**
What would you hear upon ascultation?
| A F A R
**May be asymptomatic for decades**
- Fluttering of heart (A-fib)
- Fatigue
-> Chronic weakness
- Respiration changes
-> Dyspnea on exertion
-> Orthopnea (later sxs)
- Anxiety
**Symptom upon ascultation**
- High pitched systolic mumur
52
What is the **cause** of **Mitral Valve Prolapse (MVP)**?
**Varies**
- Genetic (family hx)
53
What is the **pathophysiology** of **Mitral Valve Prolapse**?
1. Mitral leaflets enlarge and prolapse into L atrium (during systole)
2. Blood leaks back into L atrium
- Leads to mitral regurgitation (insuffieincy)
54
What are the **symptoms** of **Mitral Valve Prolapse (MVP)?**
What would you hear upon ascultation?
**May be asymptomatic**
- Chest pain
- Palpitations
- Exercise intolerance
**Symptom upon ascultation**:
- Midsystolic click
- Late systolic murmur
55
What **diagnostic** **assessment** can you perform for **Mitral Stenosis, Mitral Regurgitation (Insufficiency), Mitral Valve Prolapse (MVP)**?
- Echocardiography
- TEE or TTE (assess valve problems)
56
What are **early** and **late** potential complications of **Mitral Stenosis**?
**Early**
- Pulmonary congestion
- R sided HF
**Late Complications**
- Decrease CO
57
T/F: Mitral Regurgitation (Insufficiency) has a rapid progression
False, it has a slow progression
58
T/F: Mitral Valve Prolapse may progress to Mitral Stenosis
**False**, Mitral Valve Prolapse may progress to Mitral Regurgitation
59
What is the **cause** of **Aortic Stenosis**
- Rheumatic Fever
- Wear-and-tear (degenerative calcification)
- Atherosclerosis
60
What is the **pathophysiology** of **Aortic Stenosis**
1. Narrowing of the aortic valve
2. Difficult for blood to leave L ventricle
- Increases afterload and causes L ventricle to work harder
61
What are the **symptoms** of **Aortic Stenosis**
Asymptomatic early (from fixed CO)
- Paroxysmal noctural dyspnea
-> Orthopnea
-> SOB
- Palpitations
- Syncope
62
What is the **cause** of **Aortic Regurgitation (Insufficiency)**
Nonrheumatic Conditions
- Infective Endocarditits
- Connective Tissue Disease (Marfans Syndrome)
- HTN
- Congestinal abnormalities
63
What is the **pathophysiology** of **Aortic Regurgitation (Insufficiency)**
1. Aortic valve unable to close completely during diastole
2. Backflow of blood from aorta into L ventricles
64
What are the **symptoms** of **Aortic Regurgitation (Insufficiency)**
May be asymptomatic for years:
- Paroxysmal noctural dyspnea
-> Orthopnea
-> SOB (upon exertion)
- Palpitations (severe disease)
- Bounding pulse
- High SBP and low DBP
- Murmur
65
What **diagnostic assessment** can be used for **Aortic Stenosis** and **Aortic Regurgitation (Insufficiency)?**
- Echocardiography
66
What assessments (and questions) should you ask/perform for patients suspected with aortic stenosis or regurgitation
**Assess for:**
- Sudden illness or slowly developing symptoms over many years
**Ask about**
- Attacks of rheumatic fever
- Infective endocarditis
- IV drug use
67
T/F: Surgery is the only definitive treatment for aortic stenosis
TRUE
68
A patient with aortic stenosis will need urgent surgery if...
surface area of the valve is 1cm or less
69
What surgery would be indicative for a person with aortic stenosis?
TAVR (Transcatheter Aortic Valve Replacement)
70
What is the best way to reduce risk of aortic stenosis
- Control lipids and cholesterol
- Manage diabetes
- Control chronic hypertension
71
What are potential complications of Aortic Stenosis
- Ventricular hypertrophy
- R sided HF (late)
72
Which is the most common valve dysfunction in the US?
Aortic Stenosis
73
What disease is termed the disease of "wear and tear"
Aortic Stenosis
74
Describe: **Balloon Valvuloplasty**
Include: (Procedure Descrition [ Invasive?, Surgical?], Disease use for, What Type of Patients Would Need This Type of Surgery?)
**Procedure Description
(Invasive?, Surgical?**)
- Invasive
- Non-surgical
**Disease Used For**
*Stenosis*
- Mitral Stenosis
- Aortic Stenosis
**What Type of Patients Would Need This Type of Surgery?**
*Carefully select patients*
- Noncalcified (more mobile) mitral valves
- Older adult with high surgery risk
75
Describe: **TAVR (Transcatheter Aortic Valve Replacement)**
Include: (Procedure Descrition [ Invasive?, Surgical?], Disease use for, What Type of Patients Would Need This Type of Surgery?, MISC)
**Procedure Description
(Invasive?, Surgical?**)
- Minimally invasive
**Disease Used For**
- Aortic Stenosis
**What Type of Patients Would Need This Type of Surgery?**
- Nonsurgical candidates
**MISC**
- Alternative to surgical valve replacement
76
Describe: **Surgical Valve Replacement**
Include: (Procedure Descrition [ Invasive?, Surgical?], What Type of Patients Would Need This Type of Surgery?)
**Procedure Description
(Invasive?, Surgical?**)
- Invasive
**Disease Used For**
- x
**What Type of Patients Would Need This Type of Surgery?**
- Use on patients who need more invasive repair or replacement
77
Surgical Valve Replacement can include **Mechanical and Tissue Valves**
Compare the lifespan and benefits to each, and include any extra important information about each
**Mechanical Valves**
- Long lifespan: Last 20+ years
- Lower chance of needing secondary surgery
- REQUIRE LIFELONG ANTICOAGULATION (blood thinners)
**Tissue Valves**
- Biologically similar to natural valves
-> Short lifespan: Lasts 8 - 10 years
-> High likelihood of needing repeat replacement
78
If a patient has an artificial valve...
they must take **prophylactic** **antibiotics** before procedures (e.g., dental work) to prevent endocarditis
