CVS Flashcards

0
Q

Identify 4 unique functional properties of cardiac cells.

A

automaticity - independent electrical activity and initiation
excitability - ability to respond to external stimuli (chemical, mechanical, or electrical)
conductivity - conducting electrical activity from cell to cell
contractility - contraction in response to stimulus

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1
Q

What is starling’s law?

A

the greater the stretch, the greater the contraction

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2
Q

What happens when Beta 1 sympathetic receptors are stimulated?

A

increased heart rate, increased force of contraction, increased speed of conduction via the AV Node, increased oxygen consumption

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3
Q

What happens when beta 2 adrenergic receptors are stimulated?

A

affects the heart, lungs, and skeletal muscle by dilation, and increased organ perfusion

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4
Q

What is the inherent rates of the SA node?

A

60-100 bpm

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5
Q

What is the intrinsic rate of the av junction?

A

40-60 bpm

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6
Q

What is the intrinsic pacemaker rate of the purkinje fibres?

A

20-40 bpm

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7
Q

What does PQRST mean?

A
P - Precipitating factors
Q - Quality and Quantitative
R - Radiating
S - Signs and Symptoms
T - Timing and Treatment
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8
Q

What are the characteristics of S3?

A

end diastolic sound, normal in pregnancy, children, and YA due to rapid ventricular feeling, abnormal after 40 years. Causes are acute MI, heart failure, valve disease, systematic or pulmonary hypertension

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9
Q

Why are hemoglobin, WBC and platelets so important when assessing your adult cardiac patient?

A

Hemoglobin oxygen carrying capacity not below 90
WBC inflammation, infection
Platelets - risk of coronary artery disease - increased clotting factors

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10
Q

How does magnesium affect the heart?

A

affects AV node conduction

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11
Q

How does creatine kinase show cardiovascular function?

A
  • enzyme specific to brain, myocardium, skeletal muscle
  • followed to determine timeline of the injury
  • level rises 4 - 8 hours, peaks in 24 hours, decreases in 48-72 hours
  • total CK
  • CK - MB enzyme more specific to myocardium
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12
Q

How does troponin show cardiac function?

A

released into the circulation with cellular damage
specific to myocardial cells - most sensitive indicator of myocardial damage
rises in 4 to 6 hours; remains detectable for 7 - 15 days (is undetectable by 2 weeks)

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13
Q

How does BNP indicate cardiac function?

A

brain natriuretic peptide
hormone secreted from the ventricles of the heart
secreted in response to changes in pressure (stretch) occurring when heart failure develops and worsens

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14
Q

How does CRP indicate cardiac function?

A

indicates acute inflammation
trend more beneficial
increased CRP levels correlate with increased cardiac risk
-threeford increase in risk of acute MI

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15
Q

How does HbgA1c indicate cardiac function?

A

minor component of hemoglobin to which glucose is bound
higher the glucose concentration in blood, higher the level of HbA1c
not influenced by daily fluctuations in blood glucose; reflects average glucose levels over prior six to eight weeks

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16
Q

What is the formula for figuring out MAP?

A

SBP + 2 DBP divided by 3

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17
Q

What are the characteristics of central venous pressure?

A

reflects preload - end diastolic volume
normal 2 - 6mmHg
mean reading used
obtained through CVC

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18
Q

What is the normal ejection fraction?

A

55-70%

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19
Q

define afterload

A

the amount of resistance to flow the ventricles must overcome to eject blood from the heart
increased afterload means an increased workload of the heart

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20
Q

What are the steps to troubleshooting a pacemaker?

A
  1. find pacemaker rate
  2. should it have fired? if there is an intrinsic beat between pacer beats it shouldn’t fire
  3. is it sensing?
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21
Q

Define arterosclerosis

A

hardening of the arteries

22
Q

Define atherosclerosis

A

chronic inflammatory disorder

formation of plaque with fibrous cap

23
Q

define coronary artery disease

A

progressive atheroslerotic disoder, narrowing to complete occlusion of coronary arteries.

24
What are the three types of angina?
stable - predictable, specific triggers, responds to treatment unstable - unpredictable, increased frequency, increased duration, no response to treatment variant - prinzmetal angina, coronary artery spasm, occurs with or without atherosclerotic lesions
25
What are the immediate treatments for a suspected MI?
``` early triage initiate O2 vital signs data collection ECG initiate medications such as ASA and clopidigrel ```
26
What do beta blockers do?
decreases cardiac workload, myocardial O2 demand, decreases risk for tachyarrythmias
27
What do ACE inhibitors do?
blocks conversion of angiotensin I to angiotensin II prevents Na and water reabsorption reduces afterload
28
What are the considerations to unfractionated heparin?
response to medication unpredictable narrow therapeutic window closely monitor PTT acts within minutes of administration
29
What are the considerations of low molecular weight heparin?
more predictable and sustained response proven better efficacy no need for lab monitoring ease of administration
30
What are some complications of an acute MI?
``` dysrhythmia shock papillary muscle rupture ventricular septal rupture pericarditis sudden cardiac death ```
31
What are some medications to treat tachycardic rhythms?
adenosine, amiodarone, metoprolol, sodium channel blockers (procanimide, lidocaine, dilantin, propalenone), diltiazem (calcium channel blocker)
32
Which phase of the cardiac cycle is altered by calcium channel blockers?
phase 2, depressed SA and AV node conduction
33
What are the benefits of atropine?
stimulation of SA node | increases cardiac workload
34
What are the effects of dopamine?
increased contractility, increased heart rate, vasoconstriction, smooth muscle constriction
35
What are the effects of norepinepherine?
increased cardiac workload severe peripheral vasoconstriction commonly needed in septic shock
36
What are the diagnostic criteria of pericarditis?
chest pain that worsens on deep inspiration due to increased thoracic pressure positioning helps relieve pain non-focal ST elevation myocardial biomarkers not elevated
37
What are the treatments for pericarditis?
avoid thromolytics unrelieved by nitro or narcotics treat with NSAIDS may require tap if pericardial effusion develops nothing to increase fluid around pericardial sac
38
What is the pathophysiology of pericarditis?
inflammation of the pericardial sac severe chest pain pericardial friction rub common post MI
39
What is the pathophysiology of endocarditis?
infection of the endothelial lining of the heart with valvular involvement can be caused by IV drug users, diabetics, male, coronary artery disease
40
What would be the clinical signs and symptoms of acute heart failure?
SOB, pulmonary and peripheral edema, decreased LOC, decreased cerebral perfusion, hypoxemia, respiratory alkalosis, decreased BP, tachycardia, mottle, cold, clammy skin, decreased u/o
41
What are the effects of hydralazine?
potent arterial vasodilator, smooth muscle relaxant, can cause reflex tachycardia
42
What is the normal J value for defibrilation?
120-360J, usually 200
43
what are the usual J for synchronized cardioversion?
50-200J
44
What are the characteristics of a junctional rhythm?
``` Rate: 40-60 Rhythm: regular P waves: inverted or buried in QRS PR: <0.12 if prior to QRS QRS: 0.04-0.10 escape rhythm ?lost atrial kick ```
45
What are the characteristics of AV block?
``` Rate: normal Rhythm: regular P waves: normal, precede each QRS complex PR: >0.20 seconds QRS: 0.04-0.1 ```
46
Describe the characteristics of second degree AV block type 1
``` Rate: normal Rhythm: a - regular v - irregular P waves: normal PR: gradually lengthens until it drops QRS QRS: 0.04-0.1 ```
47
Describe the characteristics of second degree AV block type 2
Rate: A> than ventricular because some v beats blocked Rhythm: A regular, V irregular P wave: normal in size and shape PR interval: normal or slightly prolonged but consistent QRS: usually 0.04-0.1 when present
48
What is the dicrotic notch in an arterial waveform indicative of?
the aortic valve closing at the end of systole
49
What is measured by a pulmonary capillary wedge pressure?
measures CVP of left ventricle
50
What are the important points about monitoring CVP?
- inaccurate for preload because all kinds of factors can influence pressure (vasoconstriction/dilation) - tells info about right atria because as systolic starts to fail, preload increases because right side backs up with blood - normal is 2-6mmHg
51
Which drugs are used for rhythms that are too fast?
adenosine, amiodarone, metoprolol, and diltiazem
52
Which drugs are used for management of rhythms that are too slow?
atropine dopamine norepinephrerine