Ch. 11 - Cardiovascular System Flashcards

Question

pulmonary circulation

Answer 1

Flow of blood from the heart to the lungs and back to the heart.

Answer 2

Valve positioned between the right ventricle and the pulmonary artery.

Answer 3

One of two pairs of vessels carrying oxygenated blood from the lungs to the left atrium of the heart.

Answer 4

Beat of the heart as felt through the walls of the arteries.

Answer 5

Partition or wall dividing a cavity; such as between the right and left atria (interatrial septum) and right and left ventricles (interventricular septum).

Answer 6

The pacemaker leads (wires) detect the heart’s own electrical activity and transmit that information to the generator (computer). The computer analyzes the heart’s signals and decides when and where to pace. If the rate is slow, the generator emits a signal to stimulate contraction and increase the rate. Pacemakers with multiple leads can pace the atrium and ventricle in proper sequence. Rate-responsive pacemakers have sensors that detect body movement and breathing to then determine the best heart rate.

Answer 7

Pacemaker of the heart.

Answer 8

Instrument to measure blood pressure.

Answer 9

Flow of blood from body tissue to the heart and then from the heart back to body tissues.

Answer 10

Contraction phase of the heartbeat. (From Greek systole, contraction.)

Answer 11

Located between the right atrium and the right ventricle; it has three (tri-) leaﬂets, or cusps.

Answer 12

Structure in veins or in the heart that temporarily closes an opening so that blood ﬂows in only one direction.

Answer 13

Thin-walled vessel that carries blood from body tissues and lungs back to the heart. Veins contain valves to prevent backﬂow of blood.

Answer 14

Largest vein in the body. The superior and inferior venae cavae return blood to the right atrium of the heart.

Answer 15

One of two lower chambers of the heart.

Answer 16

Small vein.

Answer 17

yellowish plaque, fatty substance (Greek athere means porridge) atheroma = The sufﬁx -oma means mass or collection. Atheromas are collections of plaque that protrude into the lumen (opening) of an artery, weakening the muscle lining. atherosclerosis = The major form of arteriosclerosis in which deposits of yellow plaque (atheromas) containing cholesterol and lipids are found within the lining of the artery.

Answer 18

atrium, upper heart chamber

Answer 19

heart cardiomyopathy = One type of cardiomyopathy is hypertrophic cardiomyopathy — abnormal thickening of heart muscle, usually in the left ventricle. The ventricle has to work harder to pump blood. The condition may be inherited or develop over time because of high blood pressure or aging. Often the cause is unknown (idiopathic). bradycardia = Slower than 60 beats per minute. Normal pulse is about 60-100 beats per minute. Brady-means slow. tachycardia = Faster than 100 beats per minute. Supraventricular tachycardia (SVT) involves rapid beats coming from the atria (above the ventricles) and causing palpitation (abnormal sensations in the chest). Tachy- means fast. cardiogenic shock = Results from failure of the heart in its pumping action. Shock is circulatory failure associated with inadequate delivery of oxygen and nutrients to body tissues.

Answer 20

cholesterol (a lipid substance) hyper cholesterolemia = Statins are drugs that work by blocking a key enzyme in the production of cholesterol by the liver.

Answer 21

Heart coronary arteries = These arteries come down over the top of the heart like a crown (corona).

Answer 22

blue cyanosis = This bluish discoloration of the skin indicates diminished oxygen content of the blood.

Answer 23

mucus myxoma = A benign tumor derived from connective tissue, with cells embedded in soft mucoid stromal tissue. These rare tumors occur most frequently in the left atrium.

Answer 24

oxygen hypoxia = Inadequate oxygen in tissues. Anoxia is an extreme form of hypoxia.

Answer 25

pericardium pericardiocentesis = Removal of excess ﬂuid from the pericardial space.

Answer 26

vein phlebotomy = A phlebotomist is trained in opening veins for phlebotomy. thrombo phlebitis = Often shortened to phlebitis. If the affected vein is deep within a muscle, the condition is deep vein thrombosis (DVT).

Answer 27

rhythm e.g. arrhythmia Dysrhythmia is also used to describe an abnormal heart rhythm. Notice that one “r” is dropped.

Answer 28

pulse sphygmomanometer = A sphygmomanometer measures pressure.

Answer 29

chest stethoscope = A misnomer because the examination is by ear, not by eye. Auscultation means listening to sounds within the body, typically using a stethoscope.

Answer 30

clot e.g. thrombolysis

Answer 31

valve valvuloplasty = A balloon-tipped catheter dilates a cardiac valve. mitralvalvulitis = Commonly associated with rheumatic fever, an inﬂammatory disease caused by inadequate treatment of a streptococcal infection. An autoimmune reaction occurs, leading to inﬂammation and damage to heart valves.

Answer 32

vessel vasoconstriction = Constriction means to tighten or narrow.

Answer 33

vein venous = A venous cutdown is a small surgical incision to permit access to a collapsed vein. An intravenous infusion is delivery of ﬂuids into a vein. venipuncture = This procedure is performed for phlebotomy or to start an intravenous infusion.

Answer 34

ventricle, lower heart chamber

Answer 35

yellowish plaque artery joint

Answer 36

Abnormal heart rhythms (dysrhythmias). Arrhythmias are problems with the conduction or electrical system of the heart. More than 4 million Americans have recurrent cardiac arrhythmias.

Answer 37

Failure of proper conduction of impulses from the SA node through the AV node to the atrioventricular bundle (bundle of His). Damage to the SA node may cause its impulses to be too weak to activate the AV node and impulses fail to reach the ventricles. The heart beats slowly and bradycardia results. If the failure occurs only occasionally, the heart misses a beat in a rhythm at regular intervals (partial heart block). If no impulses reach the AV node from the SA node, the ventricles contract slower than the atria and are not coordinated. This is complete heart block. Right and left bundle branch block (RBBB and LBBB) are common types of heart block. They involve delay or failure of impulses traveling through the right and left bundle branches to the ventricles. Implantation of an artificial cardiac pacemaker overcomes arrhythmias and keeps the heart beating at the proper rate. The pacemaker power source is a generator that contains a computer and lithium battery. It is implanted under the skin just below the collarbone, with leads (wires) to both chambers or one chamber, on the right side of the heart. A newer type of pacemaker, called a biventricular pacemaker, treats delays and abnormalities in ventricular contractions (dysynergy) and also can relieve symptoms and improve quality of life in patients with congestive heart failure. It reduces exacerbations of heart failure that require hospital admission.

Answer 38

Rapid but regular contractions, usually of the atria. Heart rate may reach up to 300 beats per minute. Atrial ﬂutter often is symptomatic of heart disease and frequently requires treatment such as medication, electrical cardioversion, or catheter ablation (see below under ﬁbrillation).

Answer 39

Very rapid, random, inefﬁcient, and irregular contractions of the heart (350 beats or more per minute). Atrial ﬁbrillation (AF) is the most common type of cardiac arrhythmia, affecting 5% to 10% of 70- to 80-year-old people and greater than 15% of individuals in their 80s. Electrical impulses move randomly throughout the atria, causing the atria to quiver instead of contracting in a coordinated rhythm. Common symptoms are palpitations (uncomfortable sensations in the chest from missed heartbeats), fatigue, and shortness of breath. Patients with paroxysmal AF (irregular heartbeats occur periodically and episodically) and permanent or persistent AF (irregular heartbeats continue indeﬁnitely) are at a much greater risk for stroke. This is because ineffective atrial contractions can lead to the formation of blood clots in the left atrial appendage (the area where clots form) that may travel to the brain. Also, sometimes AF can make the heart beat very fast for long periods of time, leading to weakening of the heart muscle. The risk for stroke with AF can be reduced by 80% with the use of anticoagulants (blood thinners such as warfarin) and anticoagulants called DOACs (direct oral anticoagulants). Examples of DOACs are apixaban (Eliquis), dabiatran (Pradaxa), and rivaroxaban (Xarelto). Other medications are used to reset the rhythm of the heart or control its rate. In ventricular ﬁbrillation (VF), electrical impulses move randomly throughout the ventricles. This life-threatening situation may result in sudden cardiac death or cardiac arrest (sudden stoppage of heart movement) unless help is provided immediately. If treatment is immediate, VF can be interrupted with deﬁbrillation (application of an electrical shock). Deﬁbrillation stops electrical activity in the heart for a brief moment so that normal rhythm takes over. An implantable cardioverter-deﬁbrillator (ICD) is a small electrical device that is implanted inside the chest (near the collarbone) to sense arrhythmias and terminate them with an electric shock. Candidates for ICDs are people who have had or are at high risk for having ventricular tachycardia, ventricular ﬁbrillation, and cardiac arrest. Automatic external deﬁbrillators (AEDs) may be found in workplaces, airports, and other public places and are used in an emergency situation to reverse ventricular ﬁbrillation. Catheter ablation is a minimally invasive treatment to treat cardiac arrhythmias. The technique, using radiofrequency energy delivered from the tip of a catheter inserted through a blood vessel and into the heart, destroys tissue that causes arrhythmias. Supraventricular tachycardia (SVT), atrial ﬂutter, atrial ﬁbrillation, and ventricular tachycardia (VT) may be treated with ablation when clinically indicated. This procedure may provide a permanent cure in many clinical situations.

Answer 40

A dual-chamber, rate-responsive pacemaker (actual size shown) is designed to detect body movement and automatically increase or decrease paced heart rates based on levels of physical activity. Cardiac pacemaker with leads in the right atrium and right ventricle enable it to sense and pace in both heart chambers. Biventricular pacemaker with leads in the right atrium and the right and left ventricles to synchronize ventricular contractions.

Answer 41

Don’t confuse palpitation with palpation, which means to touch, feel, or examine with the hands and fingers.

Answer 42

Narrowing (coarctation) of the aorta. Surgical treatment consists of removal of the constricted region and end-to-end anastomosis of the aortic segments.

Answer 43

Passageway (ductus arteriosus) between the aorta and the pulmonary artery remains open (patent) after birth. The ductus arteriosus normally closes after birth, but in this congenital condition it remains open, resulting in the ﬂow of oxygenated blood from the aorta into the pulmonary artery. PDA occurs in premature infants, causing cyanosis, fatigue, and rapid breathing. Although the defect often closes on its own within months after birth, treatment may be necessary if patency continues. Treatments include use of a drug (indomethacin) to promote closure; surgery via catheterization (with coil embolization to “plug” the ductus); and ligation (tying off) performed through a small incision between the ribs.

Answer 44

Small holes in the wall between the atria (atrial septal defects) or the ventricles (ventricular septal defects). Although many septal defects close spontaneously, others require open heart surgery to close the hole between heart chambers, or they may be repaired through minimally invasive surgery, using a catheter inserted through a blood vessel leading to the heart. A heart-lung machine is connected to the patient’s circulatory system during open heart surgery to relieve the heart and lungs of pumping and oxygenation functions during surgery.

Answer 45

Congenital malformation involving four (tetra-) distinct heart defects. The condition, named for Étienne-Louis Fallot, the French physician who described it in 1888. The four defects are: 1) Pulmonary artery stenosis = Pulmonary artery is narrow or obstructed. 2) Ventricular septal defect = Large hole between two ventricles lets venous blood pass from the right to the left ventricle and out to the aorta without oxygenation. 3) Shift of the aorta to the right = Aorta overrides the interventricular septum. Oxygen-poor blood passes from the right ventricle to the aorta. 4) Hypertrophy of the right ventricle = Myocardium works harder to pump blood through a narrowed pulmonary artery. An infant with this condition is described as a “blue baby” because of the extreme degree of cyanosis present at birth. Surgery for tetralogy of Fallot includes a patch closure of the ventricular septal defect and removing obstruction to the outﬂow at the pulmonary artery. Other congenital conditions such as transposition of the great arteries (TGA) (pulmonary artery arises from the left ventricle and the aorta from the right ventricle) cause cyanosis and hypoxia as well. Surgical correction of TGA involves an arterial switch procedure (pulmonary artery and aorta are reconnected in their proper positions).

Answer 46

Heart is unable to pump its required amount of blood. There are two types of congestive heart failure: systolic and diastolic. In systolic CHF, there is a reduced ejection fraction (the amount of blood that leaves the left ventricle). Less blood is pumped from the heart. In diastolic CHF, fluid backs up in the lungs and other parts of the body. Symptoms of CHF include shortness of breath, exercise intolerance, and fluid retention. Pulmonary edema (fluid accumulation in the lungs) and swelling or edema in the legs, feet, and ankles are common. Treatment includes lowering dietary intake of sodium and the use of diuretics to promote fluid loss. For patients with CHF with a reduced ejection fraction and heart bundle branch block, cardiac resynchronization therapy (CRT) devices may be used. These implanted devices consist of a pulse generator and thin, insulated wires and function like a normal pacemaker and defibrillation devices. If drug therapy and lifestyle changes fail to control congestive heart failure, heart transplantation may be the only treatment option. While waiting for a transplant, patients may need a device to assist the heart’s pumping. A left ventricular assist device (LVAD) is a booster pump implanted in the abdomen, with a cannula (tube) inserted into the left ventricle. It pumps blood out of the heart to all parts of the body. LVAD may be used either as a “bridge to transplant” or as a “destination” therapy when heart transplantation is not possible. Because of the severe shortage of donor hearts, research efforts are directed at developing total artificial hearts.

Answer 47

Disease of the arteries surrounding the heart. The coronary arteries are a pair of blood vessels that arise from the aorta and supply oxygenated blood to the heart. After blood leaves the heart via the aorta, a portion is at once led back over the surface of the heart through the coronary arteries. CAD usually is the result of atherosclerosis. This is the deposition of fatty compounds on the inner lining of the coronary arteries (any other artery can be similarly affected). The ordinarily smooth lining of the artery becomes roughened as the atherosclerotic plaque collects in the artery. The plaque first causes plugging of the coronary artery. Next, the roughened lining of the artery may rupture or cause abnormal clotting of blood, leading to thrombotic occlusion (blocking of the coronary artery by a clot). Blood flow is decreased (ischemia) or stopped entirely, leading to death (necrosis) of a part of the myocardium. This sequence of events constitutes a myocardial infarction, or heart attack, and the area of dead myocardial tissue is known as an infarct. The infarcted area is eventually replaced by scar tissue. Figure 11-16 shows coronary arteries branching from the aorta and illustrates coronary artery occlusion leading to ischemia and infarction of heart muscle. Figure 11-17 is a photograph of myocardium after an acute myocardial infarction. Acute coronary syndromes (ACSs) are conditions caused by myocardial ischemia. These conditions are unstable angina (chest pain at rest or chest pain of increasing frequency) and myocardial infarction (Figure 11-18). Patients with ACSs benefit from early angiography (x-ray imaging of coronary arteries) and PCI (percutaneous coronary intervention with a balloon catheter and stents) or CABG (coronary artery bypass grafting) to improve blood flow to the heart muscle (revascularization). Drugs used to treat ACSs are anticoagulants and antiplatelet agents such as aspirin and clopidogrel (Plavix), prasugrel (Effient), and ticagrelor (Brilinta). For acute attacks of angina, nitroglycerin is given sublingually (under the tongue). This drug, one of several called nitrates, is a vasodilator that increases coronary blood flow and lowers blood pressure. Nitrates also produce venodilation to reduce venous return and decrease myocardial oxygen consumption, both of which help decrease the work of the heart. Physicians advise patients to avoid risk factors such as smoking, obesity, and lack of exercise, and they prescribe effective drugs to prevent CAD and ACSs. These drugs include aspirin (to prevent clumping of platelets), beta blockers (to reduce the force and speed of the heartbeat and to lower blood pressure), ACE inhibitors (to reduce high blood pressure and the risk of future heart attack even if the patient is not hypertensive), calcium channel blockers (to relax muscles in blood vessels), and statins (to lower cholesterol levels). Cardiac surgeons perform an open heart operation called coronary artery bypass grafting (CABG) to treat CAD by replacing clogged vessels. Interventional cardiologists perform percutaneous coronary intervention (PCI), in which catheterization with balloons and stents opens clogged coronary arteries.

Answer 48

Inﬂammation of the inner lining of the heart. Damage to the heart valves from infection (bacterial endocarditis) produces lesions called vegetations (resembling cauliﬂower) that break off into the bloodstream as emboli (material that travels through the blood). The emboli can lodge in other vessels, leading to a transient ischemic attack (TIA), or a stroke, or in small vessels of the skin, where multiple pinpoint hemorrhages known as petechiae (from the Italian petechio, a ﬂea bite) form. Antibiotics can cure bacterial endocarditis.

Answer 49

High blood pressure affecting the heart. This condition results from narrowing of arterioles, which leads to increased pressure in arteries. The heart is affected (left ventricular hypertrophy) because it pumps more vigorously to overcome the increased resistance in the arteries.

Answer 50

Improper closure of the mitral valve. This condition occurs because the mitral valve enlarges and prolapses into the left atrium during systole. The physician hears a midsystolic click on auscultation (listening with a stethoscope) and occasionally mitral regurgitation (backﬂow of blood into the left atrium). Most people with MVP live normal lives, but severely prolapsed valves can be associated with severe mitral regurgitation and on rare occasions may become infected (endocarditis).

Answer 51

Extra heart sound, heard between normal beats. Murmurs are heard with the aid of a stethoscope and usually are caused by a valvular defect or disease that disrupts the smooth ﬂow of blood in the heart. They also are heard in cases of interseptal defects, in which blood ﬂows abnormally between chambers through holes in the septa. Functional murmurs are not caused by valve or septal defects and do not seriously endanger a person’s health. A bruit (BRU-e) is a murmur heard on auscultation. It is the turbulent ﬂow of blood through a vessel. A thrill, which is a vibration felt on palpation of the chest, often accompanies a murmur.

Answer 52

Inﬂammation of the membrane (pericardium) surrounding the heart. In most instances, pericarditis results from a viral illness or the etiology may be idiopathic. Bacteria and viruses cause the condition, or the etiology may be idiopathic. Malaise, fever, and chest pain occur, and auscultation often reveals a pericardial friction rub (heard as a scraping or grating sound). Compression of the heart caused by collection of ﬂuid in the pericardial cavity is cardiac tamponade (tăm-pō-NŎD). Treatment includes anti-inﬂammatory drugs and other agents to manage pain. If the pericarditis is infective, antibiotics or antifungals are prescribed, depending on the microorganisms detected in specimens obtained by pericardiocentesis or using blood tests.

Answer 53

Heart disease caused by rheumatic fever. Rheumatic fever is a childhood disease that follows a streptococcal infection with sore throat (pharyngitis). The heart valves can be damaged by inflammation and scarred with vegetations so that they do not open and close normally (Figure 11-19A). Repeat streptococcal infection is thought to be required to produce heart disease, so children with a history of rheumatic fever are treated with monthly penicillin injections given intramuscularly until the age of 21. Mitral stenosis, atrial fibrillation, and congestive heart failure, caused by weakening of the myocardium, also can result from rheumatic heart disease. Treatment consists of reduced activity, drugs to control arrhythmia, surgery to repair a damaged valve, and anticoagulant therapy to prevent emboli from forming. Artificial and porcine (pig) valve implants can replace deteriorated heart valves.

Answer 54

Local widening (dilation) of an arterial wall. An aneurysm (Greek aneurysma, widening) usually is caused by atherosclerosis and hypertension or a congenital weakness in the vessel wall. Aneurysms are common in the aorta but may occur in peripheral vessels as well. The danger of an aneurysm is rupture and hemorrhage. Treatment depends on the vessel involved, the site, and the health of the patient. In aneurysms of small vessels in the brain, treatment is occlusion of the vessel with small clips. For larger arteries, such as the aorta, a stent graft may be sewn within the affected vessel. Figure 11-20A shows an abdominal aortic aneurysm (called “ AAA”), and Figure 11-20B illustrates a stent graft in place. Note that the graft is anastomosed to the normal portion of the aorta, and the aneurysm sac is closed around the graft to prevent ﬁstula formation from graft to bowel.

Answer 55

Aortic aneurysms are often associated with Marfan syndrome, a genetic disorder marked by long, thin ﬁngers, great arm span, ocular lens dislocation, and loose joints. Abraham Lincoln is thought to have had Marfan syndrome, and the syndrome also has been diagnosed in basketball and volleyball players who have died suddenly as a result of ruptured aortic aneurysms.

Answer 56

Blood clot (thrombus) forms in a large vein, usually in a lower limb. This condition may result in a pulmonary embolism (clot travels to the lung) if not treated effectively. Examples of anticoagulants (blood-thinning drugs) are warfarin (Coumadin) and direct oral anticoagulants (DOACs). They are used to prevent DVTs and pulmonary emboli (PEs)

Answer 57

High blood pressure. Most high blood pressure is essential hypertension, with no identiﬁable cause. Categories of blood pressure readings are shown in Table 11-1. Diuretics, ACE inhibitors, calcium channel blockers, and beta-blockers are used to treat essential hypertension. Losing weight, limiting sodium (salt) intake, stopping smoking, and reducing fat in the diet also can reduce blood pressure. In secondary hypertension, the increase in pressure is caused by another associated lesion, such as glomerulonephritis, pyelonephritis, or vascular disease, or disease of the adrenal glands.

Answer 58

Blockage of arteries carrying blood to the legs, arms, kidneys, and other organs. Any artery can be affected, such as the carotid (neck), femoral (thigh), or popliteal (back of the knee). A sign of PAD in the lower extremities is intermittent claudication (absence of pain or discomfort in a leg at rest, but pain, tension, and weakness after walking has begun). Treatment is exercise, avoidance of nicotine (which causes vessel constriction), and control of risk factors such as hypertension, hyperlipidemia, and diabetes. Surgical treatment includes endarterectomy and bypass grafting (from the normal proximal vessel around the diseased area to a normal vessel distally). Percutaneous treatments include balloon angioplasty, atherectomy, and stenting. Embolic protection devices are parachute-like ﬁlters used to capture embolic debris during stenting.

Answer 59

While the oral anticoagulant warfarin is used to prevent or treat thromboembolic diseases, treatment with warfarin requires careful monitoring and is complicated by drug-drug or drug-food interactions. Direct oral anticoagulants (DOACs) such as apixaban (Eliquis), edoxaban (Savaysa), dabigatran (Pradaxa), and rivaroxaban (Xarelto) address these limitations and have been approved by the Food and Drug Administration (FDA) for anticoagulation in non-valvular atrial ﬁbrillation and for the prevention and treatment of DVTs and PEs.

Answer 60

Recurrent episodes of pallor and cyanosis primarily in ﬁngers and toes. This is a rare disorder of unknown cause that affects blood ﬂow in arteries. Raynaud’s is sometimes called a disease, phenomenon, or syndrome. It is marked by brief episodes of intense constriction and vasospasm of arterioles in young, otherwise healthy women. See Figure 11-21. Episodes can be triggered by cold temperatures, emotional stress, or cigarette smoking and caffeine. Raynaud’s can be controlled by protecting the body from cold and avoiding other triggers. Medications that increase blood ﬂow to the hands and feet may relieve symptoms.

Answer 61

Abnormally swollen and twisted veins, usually occurring in the legs. This condition is caused by damaged valves that fail to prevent the backﬂow of blood. The blood then collects in the veins, which distend to many times their normal size. Because of the slow ﬂow of blood in the varicose veins and frequent injury to the vein, thrombosis may occur as well. Hemorrhoids (piles) are varicose veins near the anus. Physicians now treat varicose veins with sclerotherapy (injections with sclerosing solution) or laser and pulsed-light treatments to seal off veins. Surgical interventions such as vein stripping and ligation are used less frequently.

Answer 62

Unstable angina and myocardial infarction (heart attack), which are consequences of plaque rupture in coronary arteries.

Answer 63

Chest pain resulting from myocardial ischemia. Stable angina occurs predictably with exertion; unstable angina is chest pain that occurs more often and with less exertion.

Answer 64

Antihypertensive drug that blocks the conversion of angiotensin I to angiotensin II, causing blood vessels to dilate. It prevents heart attacks, CHF, stroke, and death.

Answer 65

Listening for sounds in blood vessels or other body structures, typically using a stethoscope.

Answer 66

Drug used to treat angina, hypertension, and arrhythmias. It blocks the action of epinephrine (adrenaline) at receptor sites on cells, slowing the heartbeat and reducing the workload on the heart.

Answer 67

Device enabling ventricles to beat together (in synchrony) so that more blood is pumped out of the heart.

Answer 68

Abnormal blowing or swishing sound heard during auscultation of an artery or organ.

Answer 69

Drug used to treat angina and hypertension. It dilates blood vessels by blocking the inﬂux of calcium into muscle cells lining vessels.

Answer 70

Sudden, unexpected stoppage of heart action, often leading to sudden cardiac death.

Answer 71

Pain, tension, and weakness in a leg after walking has begun, but absence of pain at rest.

Answer 72

Pressure on the heart caused by ﬂuid in the pericardial space.

Answer 73

Drug that treats arrhythmias and strengthens the heartbeat.

Answer 74

Clot or other substance that travels to a distant location and suddenly blocks a blood vessel.

Answer 75

Drugs used in the treatment of angina. They dilate blood vessels, increasing blood ﬂow and oxygen to myocardial tissue.

Answer 76

Area of dead tissue.

Answer 77

Nitrate drug used in the treatment of angina

Answer 78

Closure of a blood vessel due to blockage.

Answer 79

Uncomfortable sensations in the chest related to cardiac arrhythmias, such as premature ventricular contractions (PVCs).

Answer 80

Scraping or grating noise heard on auscultation of the heart; suggestive of pericarditis.

Answer 81

Small, pinpoint hemorrhages.

Answer 82

Drugs used to lower cholesterol in the bloodstream.

Answer 83

Vibration felt over an area of turmoil in blood ﬂow (as a blocked artery).

Answer 84

Clumps of platelets, clotting proteins, microorganisms, and red blood cells on diseased heart valves.

Answer 85

Measurement of BNP (brain natriuretic peptide) in blood. BNP is elevated in patients with heart failure, and it is useful in the diagnosis of CHF in patients with dyspnea who come to the emergency department. Its presence also identiﬁes patients at risk for complications when presenting with acute coronary syndromes (e.g., myocardial infarction, unstable angina). It is secreted when the heart becomes overloaded, and it acts as a diuretic to help heart function return to normal. Cardiologists also measure NT-proBNP levels to assess the degree of heart failure. NT stands for N-terminal. The reference to brain in this term originates from the initial identiﬁcation of the protein in the brain of a pig.

Answer 86

Chemicals are measured in the blood as evidence of a heart attack. Damaged heart muscle releases chemicals into the bloodstream. The substances tested for are troponin-I (cTnI) and troponin-T (cTnT). Troponin is a heart muscle protein released into circulation after myocardial injury. C-reactive protein (CRP) is a biomarker of inﬂammation. High-sensitivity CRP (Hs-CRP) is useful in predicting risk for heart attack, stroke, or other major heart disease.

Answer 87

Measurement of cholesterol and triglycerides (fats) in a blood sample. High levels of lipids are associated with atherosclerosis. The general guideline for total cholesterol in the blood is less than 200 mg/dL. Saturated fats (of animal origin, such as milk, butter, and meats) increase cholesterol in the blood, whereas polyunsaturated fats (of vegetable origin, such as corn and safﬂower oil) decrease blood cholesterol. Treatment of hyperlipidemia includes proper diet (low-fat, high-ﬁber intake) and exercise. Niacin (a vitamin) also helps reduce lipids. Drug therapy includes statins, which reduce the risk of heart attack, stroke, and cardiovascular death. Statins lower cholesterol by reducing its production in the liver. Examples are simvastatin (Zocor), atorvastatin (Lipitor), pravastatin (Pravachol), and rosuvastatin (Crestor).

Answer 88

Lipoproteins (combinations of fat and protein) are physically separated and measured in a blood sample. Examples of lipoproteins are low-density lipoprotein (LDL) and high-density lipoprotein (HDL). High levels of LDL are associated with atherosclerosis. The National Guideline for LDL is less than 130 mg/dL in normal persons and less than 70 mg/dL in patients with CAD, PAD, and diabetes mellitus. High levels of HDL protect adults from atherosclerosis. Factors that increase HDL are exercise and alcohol consumption in moderation.

Answer 89

X-ray imaging of blood vessels after injection of contrast material. Arteriography is x-ray imaging of arteries after injection of contrast via a catheter into the aorta or an artery.

Answer 90

Three-dimensional x-ray images of the heart and coronary arteries using computed tomography (64-slice CT scanner). This newer technique takes hundreds of images of the heart per second. Crosssectional images are assembled by computer into a three-dimensional picture. It is less invasive than angiography (contrast material is injected into a small peripheral vein with a small needle) and provides excellent views of the coronary arteries for diagnosis of coronary artery disease .

Answer 91

Video equipment and a computer produce x-ray images of blood vessels. After taking an initial x-ray picture and storing it in a computer, physicians inject contrast material and take a second image of that area. The computer compares the two images and subtracts digital data for the ﬁrst from the second, leaving an image of vessels with contrast.

Answer 92

Electron beams and CT identify calcium deposits in and around coronary arteries to diagnose early CAD. A coronary artery calcium score is derived to indicate future risk of heart attack and stroke.

Answer 93

0-99 low risk 100-399 intermediate risk > 400 high risk A calcium score > 400 is associated with a nearly 25% chance of a heart attack or stroke occurring within 10 years.

Answer 94

Sound waves measure blood ﬂow within blood vessels. An instrument focuses sound waves on blood vessels, and echoes bounce off red blood cells. The examiner can hear various alterations in blood ﬂow caused by vessel obstruction. Duplex ultrasound combines Doppler and conventional ultrasound to allow physicians to image the structure of blood vessels and measure the speed of blood ﬂow. Carotid artery occlusion, aneurysms, varicose veins, and other vessel disorders can be diagnosed with duplex ultrasound.

Answer 95

Echoes generated by high-frequency sound waves produce images of the heart . ECHOs show the structure and movement of the heart. Intransesophageal echocardiography (TEE), a transducer placed in the esophagus provides ultrasound and Doppler information. This technique detects cardiac masses, prosthetic valve function, aneurysms, and pericardial ﬂuid.

Answer 96

Images show blood ﬂow and myocardial function following uptake of radioactive glucose. PET scanning can detect CAD, myocardial function, and differences between ischemic heart disease and cardiomyopathy.

Answer 97

Technetium Tc 99m sestamibi injected intravenously is taken up in cardiac tissue, where it is detected by scanning. This scan is used in persons who have had an MI, to assess the amount of damaged heart muscle. It also is used with an exercise tolerance test (ETT-MIBI). Sestamibi is a radioactive tracer compound used to deﬁne areas of poor blood ﬂow in heart muscle.

Answer 98

Concentration of radioactive thallium is measured to give information about blood supply to the heart muscle. Thallium studies show the viability of heart muscle. Infarcted or scarred myocardium shows up as “cold spots.”

Answer 99

Images of the heart are produced using radiowave energy in a magnetic field. These images in multiple planes give information about left and right ventricular function, wall thickness, and fibrosis, aneurysms, cardiac output, and patency of peripheral and coronary arteries. The magnetic waves emitted during MRI could interfere with implanted pacemakers because of their metal content and heat generation, so it is currently contraindicated for a patient with a pacemaker to undergo cardiac MRI. However, new MRI-safe pacemakers have been approved. Magnetic resonance angiography (MRA) is a type of MRI that gives highly detailed images of blood vessels. Physicians use MRA to view arteries and blockage inside arteries. Gadolinium is the most common contrast agent used for MRI procedures.

Answer 100

Thin, flexible tube is guided into the heart via a vein or an artery. This procedure detects pressures and patterns of blood flow in the heart. Contrast may be injected and x-ray images taken of the heart and blood vessels. This procedure may be used in diagnosis and treatment of heart conditions (see under percutaneous coronary intervention [PCI]). At the time of catheterization, the interventional cardiologist also may perform intravascular ultrasound (IVUS) to evaluate the severity of vessel narrowing. It also measures fractional flow reserve (FFR) to determine the impact of the coronary artery blockage on blood flow.

Answer 101

Recording of electricity ﬂowing through the heart. Continuous monitoring of a patient’s heart rhythm in hospitals is performed via telemetry (electronic transmission of data—tele/o means distant). Sinus rhythm begins in the SA node, and the normal rate is between 60 to 100 beats per minute.

Answer 102

An ECG device is worn during prolonged period to detect cardiac arrhythmias. Rhythm changes are correlated with symptoms recorded in a diary.

Answer 103

Exercise tolerance test (ETT) determines the heart’s response to physical exertion (stress). A common protocol uses 3-minute stages at set speeds and elevations of a treadmill. Continual monitoring of vital signs and ECG rhythms is important in the diagnosis of CAD and left ventricular function.

Answer 104

Brief delivery of radiofrequency energy to ablate (remove) areas of heart tissue that may be causing arrhythmias. A catheter is guided through a vein in the leg to the vena cava and into the heart. The abnormal electrical pathway is located and ablated (destroyed) using energy emitted from the catheter.

Answer 105

Arteries and veins are anastomosed to coronary arteries to detour around blockages. Internal mammary (breast) and radial (arm) arteries and saphenous (leg) vein grafts are used to keep the myocardium supplied with oxygenated blood (Figure 11-27B). Cardiac surgeons perform minimally invasive CABG surgery using smaller incisions instead of the traditional sternotomy to open the chest. Vein and artery grafts are removed endoscopically through small incisions as well. Although most operations are performed with a heart-lung machine (“on pump”), an increasing number are performed “off pump” with a beating heart. See In Person: Coronary Artery Bypass Surgery

Answer 106

Brief discharges of electricity are applied across the chest to stop dysrhythmias (ventricular ﬁbrillation). For patients at high risk for sudden cardiac death from ventricular dysrhythmias, an implantable cardioverter-deﬁbrillator (ICD) or automatic implantable cardioverter-deﬁbrillator (AICD) is placed in the upper chest. Cardioversion is another technique using lower energy to treat atrial ﬁbrillation, atrial ﬂutter, and supraventricular tachycardia.

Answer 107

Surgical removal of plaque from the inner layer of an artery. Fatty deposits (atheromas) and thromboses are removed to open clogged arteries. Carotid endarterectomy is a procedure to remove plaque buildup in the carotid artery to reduce risk of stroke.

Answer 108

Heart-lung machine diverts blood from the heart and lungs while the heart is repaired. Blood leaves the body, enters the heart-lung machine, where it is oxygenated, and then returns to a blood vessel (artery) to circulate through the bloodstream. The machine uses the technique of extracorporeal membrane oxygenation (ECMO).

Answer 109

Donor heart is transferred to a recipient. While waiting for a transplant, a patient may need a left ventricular assist device (LVAD), which is a booster pump implanted in the chest or abdomen with cannulae (ﬂexible tubes) from the left ventricle to the ascending aorta.

Answer 110

Balloon-tipped catheter is inserted into a coronary artery to open the artery; stents are put in place. An interventional cardiologist places the catheter in the femoral or radial artery and then threads it up the aorta into the coronary artery. Stents (expandable slotted metal tubes that serve as permanent scaffolding devices) create wide lumens and make restenosis less likely. Drug-eluting stents (DESs) are coated with polymers that elute (release) anti-inﬂammatory and antiproliferative drugs to prevent scar tissue formation leading to restenosis. Other devices are bioabsorbable vascular scaffolds (BVSs), made of dissolvable material, and drug-coated balloons (DCBs) that release paclitaxel. PCI techniques include percutaneous transluminal coronary angioplasty (PTCA), stent placement, laser angioplasty (a small laser on the tip of a catheter vaporizes plaque), and atherectomy.

Answer 111

Placement of a balloon-expandable aortic heart valve into the body via a catheter. The catheter is guided into the heart through the femoral artery, and a stent valve device is inserted using the catheter. This is a newer, minimally invasive catheterbased technology used to treat aortic stenosis.

Answer 112

abdominal aortic aneurysm inhibitor angiotensin-converting enzyme inhibitor advanced cardiac life support; CPR plus drugs and deﬁbrillation acute coronary syndrome adenosine diphosphate; ADP blockers are used to prevent cardiovascularrelated death, heart attack, and strokes and after all stent procedures

Answer 113

automatic external deﬁbrillator atrial ﬁbrillation automatic implantable cardioverterdeﬁbrillator acute myocardial infarction angiotensin II receptor blocker

Answer 114

arrhythmogenic right ventricular dysplasia aortic stenosis atrial septal defect atrioventricular aortic valve replacement

Answer 115

bundle branch block brain natriuretic peptide; elevated in congestive heart failure blood pressure coronary artery bypass grafting coronary artery disease

Answer 116

coronary computed tomography angiography coronary care unit catheterization congestive heart failure creatine kinase; enzyme released after injury to heart muscles

Answer 117

coarctation of the aorta cardiopulmonary resuscitation cardiac resynchronization therapy; biventricular pacing and deﬁbrillation devices cardiac troponin-I and cardiac troponin-T; troponin is a protein released into the bloodstream after myocardial injury drug-eluting stent

Answer 118

direct oral anticoagulant digital subtraction angiography deep vein thrombosis electrocardiography echocardiography extracorporeal membrane oxygenation

Answer 119

extracorporeal membrane oxygenation electrophysiology study; electrode catheters inserted in veins and threaded into the heart to measure electrical conduction (tachycardias are provoked and analyzed) exercise tolerance test exercise tolerance test combined with a radioactive tracer (sestamibi) scan endovascular aneurysm repair

Answer 120

fractional ﬂow reserve high-density lipoprotein; high blood levels mean lower incidence of coronary artery disease high-sensitivity C-reactive protein; biomarker for inﬂammation in prediction of heart attack risk hypertension (high blood pressure) intra-aortic balloon pump; used to support patients in cardiogenic shock invasive coronary angiography implantable cardioverter-deﬁbrillator intravascular ultrasound

Answer 121

left anterior descending (coronary artery) left bundle branch block low-density lipoprotein; high blood levels lead to cholesterol buildup in arteries low-molecular-weight heparin left ventricle left ventricular assist device left ventricular ejection fraction

Answer 122

left ventricular hypertrophy myocardial infarction multiple-gated acquisition scan; a radioactive test of heart function mitral valve prolapse non–ST elevation MI normal sinus rhythm N-terminal pro-peptide of BNP

Answer 123

premature atrial contraction peripheral arterial disease percutaneous coronary intervention patent ductus arteriosus pulmonary embolus premature ventricular contraction

Answer 124

thoracic endovascular aneurysm repair transposition of the great arteries tissue-type plasminogen activator; a drug used to prevent thrombosis unstable angina; chest pain at rest or of increasing frequency ventricular ﬁbrillation ventricular septal defect ventricular tachycardia Wolff-Parkinson-White syndrome; abnormal ECG pattern associated with paroxysmal tachycardia

Answer 125

right bundle branch block sinoatrial node sudden cardiac death shortness of breath single photon emission computed tomography; used for myocardial imaging with sestamibi scans ST elevation myocardial infarction supraventricular tachycardia; rapid heartbeats arising from the atria and causing palpitations, SOB, and dizziness transcatheter aortic valve replacement transesophageal echocardiography

Ch. 11 - Cardiovascular System Flashcards

from The Language of Medicine, 12th Edition (156 cards)