Condensed CV Flashcards
(301 cards)
1
Q
What is cardiomegaly?
A
Enlarged heart (hypertrophy, dilation)
Cardiomegaly can result from various conditions, including hypertension and heart valve disease.
2
Q
What is the pathway of blood flow through the heart?
A
Right atrium → tricuspid valve → right ventricle → pulmonic valve → lungs via pulmonary arteries → left atrium → mitral valve → left ventricle → aorta → systemic circulation
Blood returns oxygenated via pulmonary veins.
3
Q
What type of vein is the coronary sinus?
A
A type of vein
The coronary sinus collects deoxygenated blood from the heart muscle.
4
Q
What is coronary circulation?
A
The blood supply of the myocardium
It is essential for providing oxygen and nutrients to the heart muscle.
5
Q
When does coronary blood flow primarily occur?
A
Diastole
This is the phase of the heartbeat when the heart relaxes and fills with blood.
6
Q
What are the two main coronary arteries?
A
Right Coronary Artery (RCA) and Left Coronary Artery (LCA)
These arteries originate from the aorta.
7
Q
What are the branches of the Left Coronary Artery?
A
Left Anterior Descending (LAD) artery and Left Circumflex artery
These branches supply different areas of the heart.
8
Q
What areas does the Right Coronary Artery supply?
A
Right atrium, right ventricle, posterior wall of left ventricle
It also supplies portions of the interventricular septum.
9
Q
What areas does the Left Coronary Artery supply?
A
Left atrium, left ventricle, anterior portion of interventricular septum
It is critical for supplying the majority of the left side of the heart.
10
Q
True or False: In ~90% of people, the AV node and bundle of His are supplied by the RCA.
A
True
A blockage in the RCA can lead to conduction defects.
11
Q
What can a blockage in the RCA lead to?
A
Conduction defects
This is because it supplies the AV node in most people.
12
Q
What do coronary veins run parallel to?
A
Coronary arteries
13
Q
What type of blood do coronary veins take from the heart muscle?
A
DEOXYGENATED blood
14
Q
Where do coronary veins drain into?
A
Coronary sinus
15
Q
Into which chamber of the heart do coronary veins empty?
A
Right atrium
16
Q
What is the pathway of blood after it reaches the left ventricle?
A
Aorta -> enters coronary arteries again (as OXYGENATED blood)
17
Q
What is the function of cardiac valves?
A
Keep blood flowing forward and prevent regurgitation
18
Q
What are the two types of atrioventricular valves?
A
- Tricuspid valve (3 leaflets) * Mitral (bicuspid) valve (2 leaflets)
19
Q
What is Chordae Tendinae?
A
Thin, fibrous tissue that anchors valves to papillary muscles
20
Q
What are the two types of semilunar valves?
A
- Pulmonic valve * Aortic valve
21
Q
True or False: The tricuspid valve has two leaflets.
A
False
22
Q
Fill in the blank: The presence of _______ is a characteristic of atrioventricular valves.
A
Chordae Tendineae
23
Q
What is systole?
A
Contraction of heart muscle -> ejection of blood FROM the ventricles
Systole refers to the phase of the heartbeat when the heart muscle contracts and pumps blood from the chambers into the arteries.
24
Q
What is diastole?
A
Relaxation of heart muscle -> filling of blood IN the ventricles
Diastole is the phase of the heartbeat when the heart muscle relaxes and the chambers fill with blood.
25
What is Mean Arterial Pressure (MAP)?
Average of systole and diastole
## Footnote
MAP is a useful measure to assess the blood flow to organs and is essential for ensuring adequate perfusion.
26
What is the normal range for Mean Arterial Pressure to maintain adequate perfusion?
Between 60 and 70 mm Hg
## Footnote
Maintaining MAP within this range is critical for organ function and overall health.
27
What factors affect Mean Arterial Pressure?
CO and Systemic Vascular Resistance
## Footnote
Cardiac Output (CO) and the resistance in blood vessels are primary determinants of MAP.
28
Define stroke volume.
Amount of blood ejected with each heart beat
## Footnote
Stroke volume is a key component in determining cardiac output.
29
What is cardiac output?
Amount of blood pumped by each ventricle in 1 minute
## Footnote
Cardiac output is a critical measure of heart function and is typically measured in liters per minute.
30
How is cardiac output calculated?
CO = Heart rate × Stroke volume
## Footnote
This formula highlights the relationship between the number of heartbeats and the volume of blood ejected with each beat.
31
What is the normal range for cardiac output?
4-8 L/min
## Footnote
Normal cardiac output varies between individuals but generally falls within this range for healthy adults.
32
What is preload?
Volume of blood in ventricles at end of diastole
## Footnote
Preload influences the amount of blood available for the heart to pump during the next contraction.
33
Define contractility.
How well the heart is contracting
## Footnote
Contractility reflects the strength of the heart's contractions and can be influenced by various factors including health status and medications.
34
What is afterload?
Amount of pressure that the heart needs to exert in order to eject blood during ventricular contraction
## Footnote
Afterload is an important factor in determining cardiac efficiency and workload.
35
What are the purposes of the arterial system?
* Delivers oxygen and nutrients to various body tissues
## Footnote
The arterial system is essential for transporting blood rich in oxygen and nutrients to cells throughout the body.
36
What are the purposes of the vascular system?
* Carries deoxygenated blood toward the heart to be oxygenated
* Provides a route for blood to travel from the heart to nourish the various tissues of the body
* Carries cellular wastes to the excretory organs
* Allows lymphatic flow to drain tissue fluid back into the circulation
* Returns blood to the heart for recirculation
## Footnote
The vascular system plays a crucial role in maintaining homeostasis and supporting metabolic processes.
37
What is the exception in the vascular system regarding blood oxygenation?
Pulmonary arteries (deO2 blood -> lungs) and Pulmonary Veins (O2 blood -> heart)
## Footnote
Unlike other arteries and veins, pulmonary arteries carry deoxygenated blood, while pulmonary veins carry oxygenated blood.
38
What factors affect blood pressure regulation?
Autonomic nervous system, kidneys, endocrine system, baroreceptors
## Footnote
Each of these factors plays a crucial role in maintaining and regulating blood pressure.
39
What does the sympathetic autonomic nervous system (SANS) do to heart rate?
Increases heart rate
## Footnote
SANS activation leads to increased heart rate and force of contractions.
40
How does the SANS affect the speed of impulses through the AV node?
Increases the speed of impulses
## Footnote
This results in faster conduction of electrical signals in the heart.
41
What is the effect of SANS stimulation on vascular smooth muscle?
Causes vasoconstriction
## Footnote
Vasoconstriction increases blood pressure.
42
What is the role of the parasympathetic autonomic nervous system (PANS) in blood pressure regulation?
Decreases heart rate
## Footnote
PANS, mediated by the vagus nerve, slows down heart activity.
43
How do kidneys contribute to blood pressure regulation?
Sense changes in blood flow and activate RAS
## Footnote
Activation of the Renin-Angiotensin System (RAS) leads to increased blood pressure.
44
What hormones are released by the endocrine system that affect blood pressure?
Catecholamines, serotonin, histamines
## Footnote
These hormones stimulate the sympathetic nervous system at the tissue level.
45
Where are baroreceptors located?
In the aortic arch and carotid sinus
## Footnote
Baroreceptors are sensitive to changes in stretch and pressure.
46
What happens when baroreceptors detect fluid overload?
Send information to the vasomotor center, inhibiting SANS and enhancing PANS
## Footnote
This leads to decreased heart rate and peripheral vasodilation, resulting in lower blood pressure.
47
What occurs with a decrease in arterial pressure?
The opposite response occurs
## Footnote
This means SANS is activated, increasing heart rate and blood pressure.
48
Define systolic blood pressure.
The pressure in the arteries during heartbeats
## Footnote
It is the higher number in a blood pressure reading.
49
Define diastolic blood pressure.
The pressure in the arteries between heartbeats
## Footnote
It is the lower number in a blood pressure reading.
50
What is the most common valvular disorder in older adults?
Aortic stenosis
## Footnote
Aortic stenosis is characterized by narrowing of the aortic valve, affecting blood flow from the heart.
51
How does aging affect pacemaker cells in the heart?
Decreases the number of pacemaker cells, leading to longer conduction time
## Footnote
This can result in slower heart rates and increased risk of arrhythmias.
52
What happens to the left ventricle as it ages?
Increases in size and may undergo fibrotic changes, leading to decreased filling speed during early diastole
## Footnote
Fibrotic changes contribute to stiffness in the ventricle.
53
What changes occur in the aorta and large arteries with aging?
Thickening and stiffening
## Footnote
These changes lead to increased systolic blood pressure and systemic vascular resistance.
54
What is the relationship between arterial stiffness and left ventricular function?
Increased stiffness leads to increased systemic vascular resistance, causing left ventricular hypertrophy
## Footnote
The left ventricle must work harder to pump against the greater resistance.
55
How does age affect baroreceptor sensitivity?
Increased age leads to decreased sensitivity
## Footnote
This results in less effective regulation of blood pressure.
56
What does a 0 grading on the peripheral pulses grading scale indicate?
No pulse, absent
## Footnote
Further assessment is required using Doppler ultrasound.
57
What does a 1+ grading on the peripheral pulses grading scale indicate?
Weak/thready pulse
## Footnote
It feels like a small cord or thread.
58
What does a 2+ grading on the peripheral pulses grading scale indicate?
Normal pulse
## Footnote
This is considered a standard pulse strength.
59
What does a 3+ grading on the peripheral pulses grading scale indicate?
High-normal pulse
## Footnote
This indicates a stronger than average pulse.
60
What does a 4+ grading on the peripheral pulses grading scale indicate?
Bounding pulse
## Footnote
Could indicate cardiac disease.
61
What are the 5 cardiac landmarks used for assessment?
Aortic, Pulmonic, Erbs Point, Tricuspid, Mitral
## Footnote
These landmarks are critical for auscultation of heart sounds.
62
Where is the Apical Pulse (Point of Maximum Impulse; PMI) found?
At the Mitral landmark
## Footnote
This is commonly assessed in patients with cardiac history.
63
What part of the stethoscope is used to listen for lower-pitched sounds?
Bell (small) of stethoscope
## Footnote
This helps in detecting murmurs and other low-frequency heart sounds.
64
What is Troponin?
A protein found in heart muscles that is not normally in the blood.
## Footnote
Troponin is released into the bloodstream if heart muscle is damaged, such as during a myocardial infarction (MI).
65
Why is the Troponin test ordered?
To assess for heart muscle damage, especially in cases of chest pain.
## Footnote
High levels of troponin indicate poor heart health.
66
What is the goal level for Cholesterol?
< 200
## Footnote
Higher cholesterol levels are associated with increased risk of coronary artery disease (CAD).
67
What does HDL stand for and its significance?
High-density lipoprotein, known as 'good' cholesterol.
## Footnote
Higher levels of HDL are better for heart health.
68
What does LDL stand for and its significance?
Low-density lipoprotein, known as 'bad' cholesterol.
## Footnote
Lower levels of LDL are better for heart health.
69
What is the goal level for Triglycerides?
< 150
## Footnote
Elevated triglycerides have a strong association with coronary artery disease (CAD).
70
What is Homocysteine?
An amino acid produced when proteins are broken down that is normally found in the blood.
## Footnote
Elevated levels of homocysteine are a risk factor for cardiovascular disease.
71
What is C-reactive protein (CRP)?
A protein made by the liver that serves as an inflammatory marker.
## Footnote
Elevated CRP indicates inflammation but does not specifically indicate cardiovascular disease.
72
What may alter Fluid and Electrolytes in heart failure?
Sodium (Na+) and Potassium (K+) levels.
## Footnote
Alterations in these electrolytes may indicate renal involvement in heart failure.
73
What does a HIGH level of Troponin indicate?
Bad heart health or damage to the heart muscle.
## Footnote
High troponin levels are often associated with myocardial infarction.
74
True or False: Elevated triglycerides are beneficial for heart health.
False
## Footnote
Elevated triglycerides are detrimental and linked to increased risk of coronary artery disease.
75
What is the range for HDL levels?
40 - 60+
## Footnote
Higher levels of HDL are considered better for cardiovascular health.
76
What is the range for LDL levels?
70 - 130
## Footnote
Lower levels of LDL are better for reducing cardiovascular risks.
77
What is the purpose of a Posterioanterior (PA) and lateral CXR?
Differentiates between cardiac and respiratory causes of symptoms such as shortness of breath
## Footnote
Shows size of heart (enlarged heart = cardiomegaly), pulmonary congestion.
78
How is a Posterioanterior (PA) and lateral CXR performed?
Non-invasive X-ray taken PA (back to front) and laterally.
79
What does angiography visualize?
Blood vessels and blood flow
## Footnote
Contrast dye is injected and X-ray is performed to visualize blood flow.
80
What is the purpose of cardiac catheterization?
Used to diagnose or treat heart conditions such as clogged arteries and irregular heartbeats.
81
What is done during cardiac catheterization?
Catheter is inserted into an artery and dye is injected to visualize blood flow
## Footnote
Can place stent to restore blood flow.
82
What does an ECG or EKG assess?
Heart rate, heart rhythm, and type of rhythm abnormalities (e.g., A-fib, MI).
83
How is an ECG or EKG performed?
Electrodes are placed and done at bedside.
84
What does an electrophysiologic study (EPS) record?
Electric activity and identifies abnormal rhythms.
85
What is involved in an electrophysiologic study (EPS)?
Insert catheter and measure electrical signals inside the heart
## Footnote
Mildly invasive procedure.
86
What does an exercise electrocardiography (stress test) assess?
Oxygen status and changes in cardiac rhythm under stress.
87
What is required from the patient during an exercise electrocardiography?
Patient walks on treadmill for approximately 20 minutes while connected to pulse oximeter and EKG.
88
What does echocardiography check?
Chamber and valve function, blood flow (ejection fraction).
89
What is transesophageal echocardiography (TEE)?
View cardiac heart structure using a specialized ultrasound probe passed into the esophagus.
90
What is the process of transesophageal echocardiography (TEE)?
Done under sedation.
91
What does myocardial nuclear perfusion imaging (MNPI) show?
Heart rate before and after exercise and detects ischemia.
92
What type of stress test uses a PET scan?
Myocardial nuclear perfusion imaging (MNPI).
93
What does a CT scan detect in coronary arteries?
Calcium formation to identify atherosclerosis.
94
What does MRI evaluate?
Cardiac wall thickness, chamber dilation, valve function, ventricular formation, blood movement into greater vessels.
95
What is the blood pressure goal according to the American Heart Association (AHA)?
< 130/80
## Footnote
This goal indicates optimal blood pressure management to reduce cardiovascular risk.
96
What are the JNC8 guidelines for blood pressure for people over 60?
< 150/90
## Footnote
These guidelines provide specific targets for older adults to manage hypertension effectively.
97
What is required for an official diagnosis of hypertension (HTN)?
Need 2 readings by provider
## Footnote
Consistent readings are essential for an accurate hypertension diagnosis.
98
What is primary (essential) hypertension?
Not caused by existing health problems
## Footnote
Develops gradually over time from genetic and environmental factors.
99
What is secondary hypertension?
Caused by specific disease states and drugs
## Footnote
Increases susceptibility to elevated blood pressure.
100
What complication can arise from chronically high elevated blood pressure?
Medial hyperplasia
## Footnote
This condition involves an increase in the number of smooth muscle cells in the tunica media of arteries.
101
List three non-modifiable risk factors for hypertension.
* Age > 60 years old
* Gender (Men in younger/middle adulthood, women after menopause)
* Ethnicity: African American
## Footnote
These factors cannot be changed and increase the risk of hypertension.
102
List three modifiable risk factors for hypertension.
* Smoking
* Obesity
* Elevated sodium intake
## Footnote
Lifestyle changes can reduce these risk factors and lower blood pressure.
103
What is the recommended alcohol intake for males to avoid hypertension?
DO NOT drink more than 2 alcoholic beverages/day
## Footnote
This guideline helps manage blood pressure in men.
104
What is the recommended alcohol intake for females to avoid hypertension?
DO NOT drink more than 1 alcoholic beverage/day
## Footnote
This guideline helps manage blood pressure in women.
105
What are some symptoms of hypertension?
* Headaches
* Blurred vision
* Palpitations
* Fatigue
* Dizziness
## Footnote
Many may have no symptoms, making hypertension a 'silent killer.'
106
What is the goal of testing kidney function in relation to hypertension?
90 - 120
## Footnote
Values below 90 may indicate possible reduced kidney function.
107
What is the DASH diet?
Heart-healthy diet
## Footnote
It emphasizes fruits, vegetables, low-fat dairy, and reduced sodium intake.
108
What are the four classes of medications used to treat hypertension?
* Angiotensin-Converting Enzyme Inhibitors (ACEIs) (lisonopril) "-pril"
* Beta Blockers (-olol)
* Calcium Channel Blockers (amlodipine) "-pine"
* Diuretics (thiazide) "-ide"
## Footnote
These medications target different mechanisms to lower blood pressure.
109
True or False: The most common type of hypertension is secondary hypertension.
False
## Footnote
Primary (essential) hypertension is the most common type.
110
What is a potential result of untreated hypertension?
Damage to vital organs
## Footnote
Organs such as the heart and kidneys can be significantly affected.
111
What is a hypertensive crisis?
A severe and rapidly progressive elevation in blood pressure that can cause damage to organs.
## Footnote
Also referred to as malignant hypertension.
112
What are common symptoms of hypertensive crisis?
* Morning headaches
* Blurred vision
* Dyspnea
* Uremia
## Footnote
These symptoms indicate potential organ damage.
113
What are the systolic and diastolic blood pressure readings that define a hypertensive crisis?
Systolic: > 200 mmHg, Diastolic: > 150 mmHg.
114
What are the IV medications used to treat hypertensive crisis?
* Nitroprusside
* Nicardipine
* Fenolopam
* Labetalol
115
What is atherosclerosis?
A thickening/hardening of the arterial wall involving the formation of plaque within the arterial wall, leading to narrowing of arteries.
116
What are the nonmodifiable risk factors for atherosclerosis?
* Age
* Gender
* Ethnicity (African American, Hispanics)
* Heredity
117
What are the modifiable risk factors for atherosclerosis?
* Hypertension
* Sedentary lifestyle
* Elevated lipids
* Obesity
* Diabetes Mellitus
118
What are some complications of atherosclerosis?
* Hypertension
* Peripheral Vascular Disease (PVD)/Peripheral Artery Disease (PAD)
* Myocardial Infarction (MI)
119
What is the importance of assessing blood pressure in both arms?
To identify potential differences that may indicate vascular issues.
120
What diagnostic assessments are used for atherosclerosis?
* Cholesterol levels
* Low HDL-C
* High LDL-C
* Elevated triglycerides
121
What dietary guidelines are recommended for managing atherosclerosis?
Follow similar guidelines to DASH (Dietary Approaches to Stop Hypertension).
122
What type of physical activity is recommended for atherosclerosis management?
Aerobic exercise (30 minutes, 3 times a week or more).
123
What medication class is commonly used to lower cholesterol?
-statin.
124
True or False: Atherosclerosis is a leading risk factor for cardiovascular disease.
True.
125
What is Peripheral Arterial Disease (PAD)?
A chronic condition resulting from systemic atherosclerosis leading to partial or total arterial occlusion that decreases perfusion to the extremities.
## Footnote
Oxygen issue can lead to possible necrosis or tissue death.
126
What is Peripheral Venous Disease?
A condition where blood in the veins cannot flow properly back to the heart, usually due to ineffective valves caused by venous hypertension.
## Footnote
This leads to veins stretching out from pressure.
127
What are the major causes of Peripheral Vascular Disease?
* Systemic atherosclerosis
* Thrombus formation
* Venous thromboembolism (VTE)
* Virchow's Triad (stasis, vessel damage, hypercoagulability)
* Defective valves
* Skeletal muscle that does not contract
128
What are the nonmodifiable risk factors for PAD?
* Age (60 - 80s)
* Gender (male)
* Ethnicity (African American)
* Family history
129
What are the modifiable risk factors for PAD?
* Atherosclerosis
* Chronic kidney disease
* Tobacco use
* Sedentary lifestyle
* Hypertension
* Hyperlipidemia
* Obesity
* Diabetes mellitus
* History of VTE
* Valve disorders
* Abnormal clotting
130
What does the acronym 'SHINY PADS' represent in PAD symptoms?
* Shiny, taut skin
* Hair loss
* Intermittent claudication
* Numbness (paresthesia)
* You feel weak pulses
* Pallor with elevation
* Absent pulses
* Dependent rubor: (dusky red discoloration of lower leg with dependent position)
* Skin color changes and sores that won’t heal
* Tissue necrosis
131
What is intermittent claudication?
Ischemic muscle pain caused by a constant level of exercise, resolving within 10 minutes with rest and reproducible with exercise.
132
What are some serious complications of PAD?
* Atrophy of skin and underlying muscles
* Delayed wound healing
* Wound infection
* Tissue necrosis
* Arterial ulcers
* Nonhealing arterial ulcers and gangrene, possibly leading to amputation
133
What are key diagnostic assessments for PAD?
* Segmental systolic BP measurement
* Ankle-branchial index (ABI)
* Magnetic Resonance Angiography (MRA)
* Exercise tolerance training
* Plethysmography
134
What is the recommended positioning for patients with PAD?
Have legs hang; avoid elevating above heart level.
135
What lifestyle modifications are suggested for managing PAD?
* Smoking/tobacco cessation
* Avoid caffeine and stress
* Exercise 30-45 min daily, 3 times a week
136
What medications are commonly used in the treatment of PAD?
* Antiplatelets (primary therapy): (e.g., aspirin, clopidogrel)
* Antiplatelet (e.g., pentoxifylline)
Clopidogrel (Plavix): Another antiplatelet medication that also helps prevent blood clots.
Statins: Lower cholesterol levels, reduce plaque buildup in arteries, and can help prevent heart attacks and strokes. (-statins)
Blood Pressure Medications:
ACE inhibitors (-pril) and ARBs (-sartan): Help lower blood pressure, which can reduce the risk of cardiovascular events.
137
What surgical interventions are available for PAD?
* Arterial revascularization(restoring blood flow to an area of the body by bypassing or clearing blocked arteries)
* Percutaneous vascular intervention (angioplasty with stent)
* Inferior Vena Cava (IVC) filter
138
What is a sign of worsening PAD?
Pain unrelieved by rest.
139
Fill in the blank: Virchow's Triad includes ______, vessel damage, and hypercoagulability.
stasis
140
True or False: PAD may sometimes be asymptomatic.
True
141
What symptom is characterized by redness of the foot when in a dependent position?
Dependent rubor
142
What are typical skin changes associated with PAD?
* Mottled skin color
* Nonhealing wounds
143
What is Coronary Artery Disease (CAD)?
A condition characterized by the build-up of plaque in the coronary arteries, leading to ischemia and potential myocardial infarction.
## Footnote
CAD includes chronic stable angina and acute coronary syndromes.
144
Define chronic stable angina.
A type of chest pain or discomfort that occurs when the heart muscle doesn't get enough oxygen-rich blood, typically triggered by physical activity or stress.
145
What is unstable angina?
A sudden and unpredictable chest pain that occurs at rest or with minimal exertion, indicating a high risk of heart attack.
146
What are the two types of myocardial infarction?
NSTEMI (Non-ST Elevation Myocardial Infarction) and STEMI (ST Elevation Myocardial Infarction).
147
What is ischemia?
Insufficient oxygen supplied to meet the requirements of the myocardium.
148
What is infarction?
Necrosis or cell death that occurs when severe ischemia is prolonged, resulting in irreversible damage to tissue.
149
What is the primary cause of Coronary Artery Disease?
The build-up of plaque, usually due to atherosclerosis, causing ischemia.
150
What is the difference between stable and unstable plaque?
Stable plaque partially blocks the artery, while unstable plaque can rupture, causing sudden clot formation and reduced oxygen supply.
151
List nonmodifiable risk factors for CAD.
* Age
* Gender
* Ethnicity
* Genetics
152
List modifiable risk factors for CAD.
* Atherosclerosis
* Elevated lipids
* Smoking
* Sedentary lifestyle
* Obesity
* Hypertension
* Diabetes
* Chronic stress
* Homocysteine levels
153
What symptoms are commonly associated with CAD?
* Chest pain
* Dyspnea
* Fatigue
* Pain between shoulders
* Aching jaw
* Choking sensation with exertion
* Indigestion
* Cool, clammy, pale skin
154
What unique symptoms do women experience with CAD?
* Epigastric pain
* Neck/jaw pain
* Heartburn
* Chest pain at rest or with exertion not relieved by nitroglycerin
155
What diagnostic assessments are used for CAD?
* Troponin levels
* CT Coronary Angiography
* Chest X-ray
* Thallium Scans (identifies areas of ischemia during stress test)
* 12-lead EKG
* Exercise tolerance tests
* Cardiac catheterization/angiography
156
What does MONA stand for in CAD management?
* Morphine
* Oxygen
* Nitroglycerin
* Aspirin
157
What interventions should be taken for CAD patients experiencing difficulty breathing?
* Positioning in high/semi-fowlers
* Supplemental oxygen
158
True or False: CAD rarely requires aggressive treatment.
True
159
What is indicated if chest pain does not go away with rest or nitroglycerin?
Call 911
160
What lifestyle modifications can help manage CAD?
Regular exercise, healthy diet, smoking cessation, weight management, and stress reduction.
161
What symptom may be less obvious in older adults experiencing CAD?
Chest pain may not be as obvious or easily reported
## Footnote
Associated symptoms may include unexplained dyspnea, confusion, or gastrointestinal symptoms.
162
What are fibrinolytics used for in CAD?
Fibrinolytics are clot busters that can reduce mortality rate but have side effects
## Footnote
The suffix '-ase' typically indicates a fibrinolytic agent.
163
How might dysrhythmia present in older adults?
Dysrhythmia may be a normal age-related change rather than a complication of MI.
164
What should be done if dysrhythmia is causing significant symptoms?
Notify the health care provider.
165
What are some side effects of beta blockers in older adults?
Side effects may include:
* Dizziness
* Bradycardia
* Depression exacerbation
166
What is the recommended approach for increasing activity in older adults?
Plan slow, steady increases in activity.
167
What benefit do older adults with minimal previous exercise experience from?
They show particular benefit from a gradual increase in activity.
168
What should older adults include in their exercise routine?
Longer warm-up and cool-down periods.
169
How long may pulse rates take to return to baseline after exercise?
Pulse rates may not return to baseline for 30 minutes.
170
What is heart failure?
Inadequate pumping and/or filling of the heart that makes the body unable to meet oxygen needs of tissue.
171
Which sides of the heart are involved in heart failure?
Both left and right sides of the heart.
172
What functions are affected in heart failure?
Systolic and diastolic function.
173
What is a key pathophysiological factor in heart failure?
Interference with normal cardiac mechanics that regulate cardiac output.
174
What are some risk factors for heart failure?
Risk factors include:
* Hypertension (especially chronic)
* Coronary artery disease
* Myocardial infarction
* Valvular disease (structural heart changes)
175
What are common symptoms of heart failure?
Symptoms include:
* Orthopnea
* Paroxysmal nocturnal dyspnea
* Dry, nonproductive cough
* Weight gain >3lbs in 2 days
* Skin changes (dusky)
176
What should be included in the assessment of heart failure?
History of heart conditions, activity tolerance, breathing, sleeping, urinary problems.
177
What demographic trend is increasing heart failure rates?
The aging population.
178
Why are more people developing heart failure?
More people are surviving myocardial infarctions and later developing heart failure.
179
What is a common cause of hospitalization in older adults?
Heart failure is a common cause.
180
What are the two main types of heart failure?
Acute Heart Failure and Chronic Heart Failure
## Footnote
Acute heart failure is caused by another condition, while chronic heart failure is also known as congestive heart failure.
181
What is acute heart failure caused by?
Another condition, such as severe anemia
## Footnote
Acute heart failure can occur suddenly and is often due to an underlying issue.
182
What distinguishes chronic heart failure from acute heart failure?
Chronic heart failure is not always associated with pulmonary congestion
## Footnote
Chronic heart failure can manifest with various symptoms and does not necessarily involve fluid accumulation in the lungs.
183
What are the two types of left-sided heart failure?
Systolic and Diastolic
## Footnote
Systolic heart failure involves impaired contraction, while diastolic heart failure involves the inability to relax and fill.
184
Define systolic heart failure.
Inability of the heart to pump effectively due to impaired contraction, increased afterload, cardiomyopathy, or mechanical abnormalities
## Footnote
Systolic heart failure is characterized by a decreased ejection fraction.
185
What is the hallmark of systolic heart failure?
Decrease ejection fraction
## Footnote
A normal ejection fraction ranges from 50-70%.
186
What is the ejection fraction threshold that indicates high risk for cardiac death?
<30%
## Footnote
Ejection fractions can be as low as 10% in severe cases.
187
What happens to stroke volume (SV) and cardiac output (CO) when there is a decrease in filling?
Decrease in SV and CO
## Footnote
This is typically a result of left ventricular hypertrophy.
188
What is commonly associated with diastolic heart failure?
Stiff ventricles leading to increased pressure
Even though the ventricle doesn't fill as much as it should, it still pumps out a normal or near-normal percentage of blood with each beat (ejection fraction).
## Footnote
Diastolic heart failure can occur with normal ejection fraction.
189
What conditions can lead to left ventricular hypertrophy?
* Hypertension (most common)
* Myocardial Infarction (MI)
* Valve disease (aortic, mitral)
* Cardiomyopathy
## Footnote
These conditions can contribute to the development of heart failure.
190
In which demographic is diastolic heart failure more common?
Older adults, females, and obese individuals
## Footnote
These populations are at higher risk for developing heart failure.
191
What is Right Sided Heart Failure?
R ventricle cannot empty completely, leading to a backup of blood into the R atrium and venous circulation
192
What is Left Sided Heart Failure?
Caused by left ventricular dysfunction, causing a backup of blood into the left atrium and pulmonary veins
193
List the causes of Right Sided Heart Failure.
* L ventricular failure (Left HF)
* R ventricular dilation and hypertrophy
* R ventricular MI
* Pulmonary HTN
* HTN
* CAD
* Valvular Disease
194
What are the symptoms of Right Sided Heart Failure?
* Dependent edema
* Jugular vein distention
* Hepatojugular reflux
* Increase abdominal girth
* Ascites
* Hepatomegaly
195
What are the symptoms of Left Sided Heart Failure?
* Pulmonary edema
* Pulmonary congestion
* Crackles
* Pink sputum
* Paroxysmal nocturnal dyspnea
* Dyspnea
* Orthopnea
* Cyanosis
* Arm heaviness
196
What laboratory assessments are used for diagnostic evaluation?
* Serum electrolytes
* Na+
* K+
* H/H
* BNP
* Urinalysis
* ABGs
197
What imaging assessments are used for cardiac evaluation?
* CXR
* Echocardiography
* Radionucleotide studies( Myocardial Perfusion Scan: Evaluates blood flow to the heart. )
* MUGA (multigated acquisition) scan is a nuclear medicine imaging test that evaluates how well your heart is pumping blood: measures ejection fraction
198
What is the purpose of hemodynamic monitoring?
Direct assessment of cardiac function and volume status
Hemodynamic monitoring involves a range of techniques used to measure and track the circulation of blood within the body. These methods can be broadly categorized as non-invasive and invasive
199
What are common medications for heart failure treatment?
* Diuretics (Lasix, Aldactone)
* Ace inhibitors (-prils)
* ARBs (Losartan)
* Beta Blocker (-olol)
* Vasodilators (nitrates)
* Positive inotropes (digoxin): medications that increase the force of the heart's contractions, enhancing its ability to pump blood
200
What self-management education should be provided for heart failure patients?
* Nutrition (fluid intake, sodium)
* Monitor weight gain DAILY
* 1kg of weight gain or loss = 1L of retained or lost fluid
* 3lbs/week - contact provider
* Activity and rest
201
Fill in the blank: Venous congestion leads to ______.
[JVD, Hepatomegaly, Splenomegaly, Vascular congestion of GI, Peripheral edema (pitting)]
202
What is the most common cause of Right Sided Heart Failure?
Mostly caused by Left Sided Heart Failure, but if Left Sided HF is not present, usually pulmonary related
203
What is another name for heart failure?
Forward failure, formerly known as congestive heart failure
204
What leads to fluid leakage in heart failure?
Leads to fluid leakage from pulmonary capillary bed into interstitium and alveoli
205
What are the factors that affect CO?
Preload, Afterload, Contractility, HR
206
What is High Output Heart Failure?
Occurs when the heart is pumping normally or more than normal, but cannot meet the body's metabolic demands
207
What are acute causes of High Output Heart Failure?
* Septicemia
* High fever
* Anemia
* Hyperthyroidism
208
What is the classification of heart failure with no symptoms?
Class 1 - Cardiac disease, but NO SXS and no limitation in ordinary physical activity
209
What characterizes Class 2 heart failure?
Mild symptoms and slight limitation during ordinary activity
210
What are the characteristics of Class 3 heart failure?
Significant limitation in activity due to symptoms
211
What defines Class 4 heart failure?
Severe limitations, symptoms even while at rest
212
What is the sequence of events from rheumatic fever to chronic damage?
Rheumatic fever → Rheumatic carditis (acute) → Rheumatic heart disease (chronic damage)
213
What two conditions can result from rheumatic heart disease?
* Mitral regurgitation
* Mitral stenosis
214
What is the root problem that leads to mitral regurgitation and mitral stenosis?
Rheumatic fever leading to rheumatic carditis and valve damage
215
Fill in the blank: Some people develop _______ (narrowing) and others develop _______ (leaking) from rheumatic heart disease.
stenosis, regurgitation
216
True or False: Some individuals can develop both mitral stenosis and regurgitation at the same time.
True
217
What is Mitral Stenosis?
Narrowing of the mitral valve, making it difficult for blood to flow from the left atrium to the left ventricle
## Footnote
Caused by conditions like rheumatic fever and fibrosis.
218
What is Mitral Regurgitation (Insufficiency)?
Inability of the mitral valve to close completely, leading to backward blood flow into the left atrium
## Footnote
Often results from fibrotic changes and valve prolapse.
219
What causes Mitral Valve Prolapse (MVP)?
Genetic factors, connective tissue diseases, and conditions like Marfan syndrome
## Footnote
Can also be related to rheumatic fever.
220
What is the pathophysiology of Mitral Stenosis?
Mitral valve thickens due to fibrosis and calcification, causing narrowing and increased workload on the heart
## Footnote
This results in difficulty for blood to flow forward.
221
What are common symptoms of Mitral Stenosis?
* Paroxysmal nocturnal dyspnea
* Orthopnea
* Dyspnea on exertion
* Palpitations
* Dry cough
## Footnote
May be asymptomatic for decades.
222
What type of murmur is associated with Mitral Stenosis?
Rumbling, apical diastolic murmur
## Footnote
This is a key finding upon auscultation.
223
What diagnostic assessment is used for mitral valve problems?
Echocardiography (TEE or TTE)
## Footnote
Essential for assessing valve function.
224
What are potential early complications of Mitral Stenosis?
* Pulmonary congestion
* Right-sided heart failure
## Footnote
These complications can arise from volume overload.
225
What is Aortic Stenosis?
Narrowing of the aortic valve, making it difficult for blood to leave the left ventricle
## Footnote
Often results from rheumatic fever or degenerative calcification.
226
What causes Aortic Regurgitation (Insufficiency)?
Inability of the aortic valve to close completely, leading to backflow of blood into the left ventricle
## Footnote
Commonly related to aortic valve degeneration.
227
What are symptoms of Aortic Stenosis?
* Paroxysmal nocturnal dyspnea
* Orthopnea
* Shortness of breath upon exertion
* Palpitations
* Syncope
## Footnote
Patients may be asymptomatic early on.
228
What is a characteristic finding in Aortic Stenosis?
High blood pressure with low diastolic blood pressure and a murmur
## Footnote
Often associated with a bounding pulse.
229
What is the definitive treatment for Aortic Stenosis?
Surgery, indicated when the valve surface area is 1 cm or less
## Footnote
TAVR (transcatheter aortic valve replacement) is a common procedure.
230
What is the best way to prevent Aortic Stenosis?
Control lipids and cholesterol, manage diabetes, and control chronic hypertension
## Footnote
These measures can reduce risk significantly.
231
What are potential complications of Aortic Stenosis?
* Ventricular hypertrophy
* Right-sided heart failure
## Footnote
These complications can develop over time.
232
What is the most common valve dysfunction in the US?
Aortic Stenosis
## Footnote
Often referred to as a disease of 'wear and tear'.
233
What is Balloon Valvuloplasty?
Invasive, non-surgical procedure for treating mitral and aortic stenosis
## Footnote
Carefully select patients with noncalcified mitral valves or older adults with high surgery risk.
234
What type of patients would benefit from Balloon Valvuloplasty?
Patients with noncalcified (more mobile) mitral valves and older adults with high surgery risk
## Footnote
This procedure is for those who are typically not candidates for more invasive surgical options.
235
What does TAVR stand for?
Transcatheter Aortic Valve Replacement
## Footnote
It is a minimally invasive procedure used for aortic stenosis.
236
What are the characteristics of TAVR?
Minimally invasive, used for aortic stenosis, suitable for nonsurgical candidates
## Footnote
It serves as an alternative to surgical valve replacement.
237
What is the main purpose of Surgical Valve Replacement?
To repair or replace valves in patients needing more invasive intervention
## Footnote
It is used when less invasive procedures are not sufficient.
238
What is the lifespan of Mechanical Valves?
Lasts 20+ years
## Footnote
They have a lower chance of needing secondary surgery.
239
What is required for patients with Mechanical Valves?
Lifelong anticoagulation (blood thinners)
## Footnote
This is necessary to prevent blood clots.
240
What are Tissue Valves similar to?
Biologically similar to natural valves
## Footnote
They are made from animal or human tissues.
241
What is the lifespan of Tissue Valves?
Lasts 8 - 10 years
## Footnote
There is a high likelihood of needing repeat replacement.
242
True or False: Balloon Valvuloplasty is a surgical procedure.
False
## Footnote
It is a non-surgical, invasive procedure.
243
What should patients learn about heart failure?
Symptoms of heart failure
## Footnote
Understanding symptoms helps in timely medical intervention.
244
When should a patient call their provider?
When experiencing symptoms of heart failure
## Footnote
Early communication can prevent complications.
245
List the types of medications that valve patients should know about.
* Diuretics
* Vasodilators
* Beta blockers
* Antibiotics
## Footnote
These medications play crucial roles in managing heart conditions.
246
What must a patient with an artificial valve do before procedures?
Take prophylactic antibiotics
## Footnote
This is necessary to prevent endocarditis.
247
True or False: Patients with an artificial valve do not need antibiotics before dental work.
False
## Footnote
Prophylactic antibiotics are essential to prevent infection.
248
What is preload?
Volume of blood in ventricles at end of diastole (before the next contraction)
## Footnote
Preload helps to determine the amount of stretch that is placed on myocardial fibers.
249
What conditions may increase preload?
* Aortic disease
* Hypervolemia
## Footnote
These conditions lead to an increased volume of blood in the ventricles.
250
What is contractility?
How well the heart is contracting
## Footnote
Contractility is an important factor in determining stroke volume.
251
What substances may increase contractility?
* Epinephrine
* Norepinephrine
## Footnote
These hormones enhance the heart's ability to contract.
252
How does increased contractility affect stroke volume?
⬆contractility = ⬆SV
## Footnote
Stronger contractions lead to more blood being ejected by ventricles, resulting in a higher stroke volume.
253
What is afterload?
Amount of pressure that the heart needs to exert in order to eject blood during ventricular contraction
## Footnote
Afterload is a critical factor in cardiac output.
254
What factors may affect afterload?
* Size of ventricle
* Tension in heart walls
* Blood Pressure
## Footnote
These factors influence the resistance the heart faces during ejection of blood.
255
What is the relationship between blood pressure and afterload?
If ⬆BP = ⬆resistance to ejection of blood by ventricles
## Footnote
Increased blood pressure can lead to ventricular hypertrophy due to the increased workload on the heart.
256
What can lead to ventricular hypertrophy?
Increased blood pressure
## Footnote
Ventricular hypertrophy is a form of ventricular remodeling that occurs in response to increased afterload.
257
What is the drug class of Metoprolol?
Beta Blockers
## Footnote
Examples include Metoprolol and Atenolol.
258
What are the primary uses of Beta Blockers?
HTN, CAD, angina, post-MI
259
What action do Beta Blockers have on the heart?
Decreases HR, BP, and myocardial oxygen demand
260
What are common side effects of Beta Blockers?
Bradycardia, fatigue, hypotension
261
What is the NCLEX Tip for administering Beta Blockers?
Hold if HR <60 bpm
262
What is the drug class of Lisinopril?
ACE Inhibitors
## Footnote
Examples include Lisinopril and Enalapril.
263
What are the primary uses of ACE Inhibitors?
HTN, heart failure, post-MI
264
What action do ACE Inhibitors perform?
Prevents vasoconstriction, lowers BP
265
What are common side effects of ACE Inhibitors?
Dry cough, hyperkalemia, angioedema
266
What is the NCLEX Tip for ACE Inhibitors?
Monitor potassium and renal function
267
What is the drug class of Amlodipine?
Calcium Channel Blockers
## Footnote
Examples include Amlodipine, Diltiazem, and Verapamil.
268
What are the primary uses of Calcium Channel Blockers?
HTN, angina, arrhythmias
269
What action do Calcium Channel Blockers have?
Vasodilation, reduces cardiac workload
270
What are common side effects of Calcium Channel Blockers?
Edema, hypotension, constipation
271
What is the NCLEX Tip for Calcium Channel Blockers?
Avoid grapefruit juice
272
What is the drug class of Nitroglycerin?
Nitrates
## Footnote
Examples include Nitroglycerin and Isosorbide mononitrate.
273
What are the primary uses of Nitrates?
Acute angina, unstable angina
274
What action do Nitrates perform?
Vasodilation, decreases preload & afterload
275
What are common side effects of Nitrates?
Headache, hypotension, dizziness
276
What is the NCLEX Tip for Nitrates?
Sit before taking; may cause drop in BP
277
What is the drug class of Aspirin?
Antiplatelets
## Footnote
Examples include Aspirin and Clopidogrel.
278
What are the primary uses of Antiplatelets?
MI prevention, CAD, post-stent
279
What action do Antiplatelets perform?
Inhibits platelet aggregation
280
What are common side effects of Antiplatelets?
GI upset, bleeding
281
What is the NCLEX Tip for Antiplatelets?
Monitor for bleeding/bruising
282
What is the drug class of Atorvastatin?
Statins
## Footnote
Examples include Atorvastatin and Simvastatin.
283
What are the primary uses of Statins?
Hyperlipidemia, CAD prevention
284
What action do Statins perform?
Lowers LDL, raises HDL
285
What are common side effects of Statins?
Myopathy, liver dysfunction
286
What is the NCLEX Tip for Statins?
Monitor LFTs, take at bedtime
287
What is the drug class of Hydrochlorothiazide?
Diuretics (Thiazide/Loop)
## Footnote
Examples include Hydrochlorothiazide (HCTZ) and Furosemide.
288
What are the primary uses of Diuretics?
HTN, HF, fluid overload
289
What action do Diuretics perform?
Reduces fluid volume, BP
290
What are common side effects of Diuretics?
Hypokalemia, dehydration, ototoxicity (loop)
291
What is the NCLEX Tip for Diuretics?
Give in morning, monitor electrolytes
292
What is the drug class of Heparin?
Anticoagulants
## Footnote
Examples include Heparin and Warfarin.
293
What are the primary uses of Anticoagulants?
DVT/PE, Afib, MI
294
What action do Anticoagulants perform?
Inhibits clot formation
295
What are common side effects of Anticoagulants?
Bleeding, bruising
296
What is the NCLEX Tip for Anticoagulants?
Monitor aPTT (heparin), INR (warfarin)
297
What is the drug class of Losartan?
ARBs
## Footnote
Examples include Losartan and Valsartan.
298
What are the primary uses of ARBs?
HTN, HF, post-MI (if ACE not tolerated)
299
What action do ARBs perform?
Blocks angiotensin II → vasodilation
300
What are common side effects of ARBs?
Hyperkalemia, hypotension (no cough)
301
What is the NCLEX Tip for ARBs?
Similar to ACE but without cough
