CCRN CARDIOLOGY Flashcards Preview

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Flashcards in CCRN CARDIOLOGY Deck (57):
1

Atrial pressure is reflective of the end-diastolic pressure for _________________

the respective ventricles in the absence of AV valve disease

2

Right atrial pressure (RAP) reflects

Right Ventricular Preload

3

Left atrial pressure (LAP) reflects

Left Ventricular Preload

4

Pulmonary artery occlusive pressure (PAOP ) is an indirect measurement of?

Left atrial pressure (LAP) and therefore left ventricular end-diastolic pressure

5

Normal Pulmonary artery occlusive pressure (PAOP )

8 to 12mmHg

6

Pulmonary artery systolic pressure (PAs) is reflective of

The right ventricle because it is the pressure generated by the right ventricle to open the pulmonic valve

7

Pulmonary artery dyastolic pressure (PAd) is reflective of

The pulmonary valsculature because it is the pressure in the pulmonary artery

8

What is monoamine oxidase (MAO) inhibitor?

Prevents the enzyme from removing neurotransmitters norepinephrine, serotonine and dopamine from the brain making the chemicals available to effect changes in both cells and circuits that have been impacted by depression.

9

What kind of test is helpful to show myocardial damage

echocardiogram

10

Why would myocardial contusion cause dysrythmias?

trauma -> inflammation -> irritability

11

ASA inhibits what

platelet aggregation

12

How does a BETA BLOCKER decrease myocardial O2 consumption?

decreasing heart rate and contractility

13

How does a NITRATES decrease myocardial O2 consumption?

decreasing preload primarily and maybe afterload (depends on the dosage)

14

How does a CALCIUM CHANNEL BLOCKER decrease myocardial O2 consumption?

decreasing preload and afterload

15

What is preload?

The volume of blood in the ventricle at the end of diastole also known as the end diastolic pressure

16

What is sterling's law of the heart

preload determines the stretch on the myofibrils (filaments that run parallel to form muscle fibers) and the subsequent force of the next contraction

17

What is afterload?

The pressure against which the ventricle must pump. The pressure required to open the semilunar valve.

18

1st line of management to treat chronic HTN

diuretics and/or beta blockers

19

What is the 2nd line of tx for chronic HTN?

ACE inhibitor or angiotensin receptor blocker

20

What is the goal in treating hypertrophic cardiomyopathy?

Decrease contractility and afterload

21

Hypertrophy of the heart muscle results in what?

Left ventricular outflow tract obstruction.

22

What class of meds is frequently prescribed in hypertrophic cardiomyopathy

Calcium channel blockers - verapamil (calan)
Beta Blockers - propranolol (inderal)

23

All murmurs are load except

mitral and tricuspid stenosis

24

What causes the murmur of mitral valve prolapse?

mitral regurgitation

25

Describe the sound of mitral regurgitation murmurs

high pitched blowing systolic murmur
loudest at apex
radiates to axilla
midsystolic click heard apex
murmur follows the click i.e S1, click, murmur, S2

26

Where is the apex of the heart?

Left inferior anterior
5th left intercostal space @ MCL

27

Where is the base of the heart?

Right superior posterior
2nd intercostal space

28

Where is the heart located?

in the mediastinum between the sternum and spine

29

What are the layers of the heart?

pericardium - outer wall of pericardial cavity (serous & firbous)
epicardium - cover outer surface of heart (visceral pericardium)
epicardial fat
myocradium - muscle portion of heart
endocardium - covers inner surface of heart

30

Flow of blood through heart

superior/inferior venae cavae, R atrium, tricuspid valve, R ventricle, pulmonic valve, pulmonary artery, pulmonary capillary, pulmonary veins, L atrium, mitral valve, L ventricle, aortic valve, aorta, arteries, arterioles, capillaries, venules, veins

31

What are the AV valves?

tricuspid and mitral

32

What are the semilunar valves?

aortic and pulmonic

33

What causes the first heart sound?

Closure of AV valves

34

AV valves open and close during

Open passively during diastole
Close during systole when heart contracts

35

What causes the second heart sound?

Closure of semilunar valves

36

Semilunar valves open and close during

Push open with systole
Close during diastole

37

Where are coronary arteries located?

On the epicardium but penetrates to myocardium and subendocardium.

38

What determines the blood flow through the coronary arteries?

autoregulation in response to metabolic needs of myocardium

39

What's the percentage of of cardiac output received by myocardium?

5%

40

Myocardial blood flow is increased by

Dilation of coronary arteries

41

Coronary artery perfusion pressure (CAPP) is equal to

the diastolic BP minus the pulmonary artery occlusive pressure (PAOP)

42

Normal CAPP value

60-80mm Hg

43

What determines myocardial O2 demand

preload
afterload
HR
contractility

44

What determines myocardial O2 supply?

patent arteries
diastolic pressure
diastolic time
O2 extraction (Hgb and SaO2)
imbalances between supply and demand

45

A split S2 is abnormal during which one? Inspiration or expiration?

Expiration

46

Which drug is an alpha- and noncardioselective beta-blocker that is used for heart failure?

Carvedilol (Coreg)

47

Which drug is an alpha- and noncardioselective beta-blocker used most often for hypertension?

Labetalol (trandate)

48

Which facial nerve is checked after carotid endarterectomy and how do you assess it?

Cranial nerve VII (facial nerve)
Ask patient to smile and check for symetry

49

What are the therapeutic goals in acute heart failure?

To decrease preload, To decrease afterload, To increase contractility
To decrease myocardial oxygen demand.

50

Which medication is given during acute heart failure to cause venodilation and to reduce preload?

Morphine sulfate

51

Which heart sound is an indication of diastolic dysfunction?

S4
which is caused by ventricular noncompliance (inability of the heart to fill adequately)

52

Which heart sound is an indication of systolic dysfunction?

S3

53

Which heart sound is an indication of intracardiac turbulence such as a septal defect or valve problem?

Murmur

54

Which heart sound is an indication mitral valve prolapse?

Midsystolic click

55

A great way to remember what happens in the heart during diastole is to remember that

diastole equals filling

56

What are signs of cardiac tamponade?

Pulsus paradoxus Hypotension
Jugular venous distention

57

Which are two significant adverse effects of angiotensin-converting enzyme (ACE) inhibitors (e.g., captopril [Capoten])?

Hyperkalemia &
Proteinuria

ACE inhibitors may cause hyperkalemia by inhibiting the secretion of aldosterone triggered by angiotensin II. Proteinuria also may occur, even leading to nephrotic syndrome and renal failure. Monitor serum potassium, and monitor urine for proteinuria.