Exam 2 Flashcards
(75 cards)
1
Q
What is the average cardiac output?
A
5-6 L/min
2
Q
What is the formula for calculating cardiac output?
A
HR x SV (Heart Rate x Stroke Volume)
3
Q
What is preload?
A
Volume of vascular system and stretch on the heart at the end of diastole (EDV)
4
Q
What factors affect preload?
A
- Changes in fluid volume status
- Heart Rate
- Venous return
- Heart Failure
- Valve disease
- Pregnancy
5
Q
What is afterload?
A
Pressure required for the left ventricle to force blood out of the body during systole
6
Q
What factors affect afterload?
A
- Valve disease/stenosis
- Vascular resistance (atherosclerosis)
- Congestive heart failure
7
Q
What is contractility?
A
The amount of blood ejected by the ventricle with each contraction
8
Q
What is the ejection fraction?
A
The percentage of blood ejected from the ventricle during contraction
9
Q
What are positive inotropic factors?
A
- SNS
- Medications: Dobutamine, Epinephrine, Norepinephrine, Digoxin
10
Q
What are negative inotropic factors?
A
- PNS
- Medications: Beta blockers, Calcium channel blockers
11
Q
What is the normal heart rate range?
A
60-100 bpm
12
Q
What is the impact of dysrhythmias on cardiac output?
A
They can impair filling and reduce blood ejected from the heart
13
Q
What is coronary artery disease (CAD)?
A
Atherosclerosis of the coronary blood vessels
14
Q
What are the three developmental stages of atherosclerosis?
A
- Fatty Streaks
- Fibrous Plaque
- Complicated Lesion
15
Q
List major modifiable risk factors for CAD.
A
- Hyperlipidemia
- Hypertension
- Smoking
- Sedentary lifestyle
- Diabetes
- Obesity
16
Q
What are the recommended LDL and HDL levels?
A
- LDL: <130 mg/dL
- HDL: >45 mg/dL (M), >55 mg/dL (W)
17
Q
What lifestyle changes can help manage CAD?
A
- Heart-healthy diet
- Physical activity (FITT formula)
- Smoking cessation
18
Q
What is angina?
A
Chest pain due to myocardial oxygen demand exceeding supply
19
Q
What are the classes of stable angina?
A
- Class 1: Strenuous, prolonged activity
- Class 2: Rapid walking, stair climbing
- Class 3: Limits ordinary physical activity
- Class 4: Pain at rest
20
Q
What is unstable angina?
A
Chest pain that occurs with exercise or at rest, increasing in severity and duration
21
Q
What is the immediate consequence of a myocardial infarction?
A
Irreversible myocardial cell necrosis and death
22
Q
Fill in the blank: CAD is a result of _______.
A
atherosclerosis
23
Q
What are common symptoms of angina?
A
- Tightness
- Squeezing
- Heavy pressure
- Pain radiating to jaw/neck/shoulder
24
Q
What do you expect to see in a patient with CAD?
A
- Angina
- Myocardial infarction
- Dysrhythmias
- Heart failure
25
What medications can be used for managing CAD?
* Statins
* Beta Blockers
* ACE inhibitors
* Calcium channel blockers
* Antiplatelet drugs
26
What is the purpose of statins?
To inhibit the synthesis of cholesterol in the liver
27
What should be monitored in patients taking statins?
Liver enzymes
28
List the '4 S' characteristics of stable angina.
* See it coming (predictable)
* Short-lived (relief in <15 minutes)
* Stops with rest or medication
* Stiff/stenosis in arteries
29
What is a common side effect of nicotinic acid (Niacin)?
Flushing/warmth
30
What is myocardial infarction?
Irreversible myocardial cell necrosis and death, begins in 20 minutes
## Footnote
Myocardial infarction can lead to decreased ejection fraction (EF)
31
What are the major clinical manifestations of myocardial infarction?
Unstable vital signs, dysrhythmias, crushing pain, nausea/vomiting, diaphoresis, pale appearance
## Footnote
First sign may be sudden cardiac death (SCD)
32
What diagnostic tests are used for angina/acute coronary syndrome?
ECG, CXR, echocardiogram, cardiac markers (Troponins), exercise electrocardiography testing, myocardial perfusion imaging, cardiac catheterization
## Footnote
These tests help assess heart function and damage
33
What are the cardiac markers for myocardial damage?
Troponins, BNP (brain natriuretic peptide)
## Footnote
Troponins are the most sensitive for cardiac damage
34
What does a troponin delta of <20% indicate?
Low risk
## Footnote
It helps classify the severity of cardiac damage
35
What is Percutaneous Coronary Intervention (PCI)?
Includes balloon angioplasty and intracoronary stent placement
## Footnote
Drug-eluting stents (DES) are commonly used
36
What is the purpose of collateral circulation?
To supplement myocardial O2 demand and reduce ischemia
## Footnote
It develops when occlusion occurs over a long period
37
What are the risk factors for variant angina (Prinzmetal)?
Vasoconstricting drugs (ephedrine, cocaine, marijuana)
## Footnote
Relieved by vasodilators like nitroglycerin and calcium channel blockers
38
What defines hypertension?
A persistent BP of 130/80 mmHg or more
## Footnote
Elevated BP is defined as 120-129/<80
39
What are the classifications of blood pressure?
* Normal: <120/<80
* Elevated: 120-129/<80
* Stage 1 HTN: 130-139/80-89
* Stage 2 HTN: ≥140/≥90
* Hypertensive crisis: >180/>120
## Footnote
Classification is made by averaging two or more readings
40
What is primary hypertension?
Essential or idiopathic hypertension with no specific cause
## Footnote
Risk factors include age, race, obesity, smoking, and lifestyle choices
41
What is secondary hypertension?
Hypertension caused by another disease
## Footnote
Examples include chronic kidney disease or hyperthyroidism
42
What are the symptoms of hypertensive crises?
Headaches, blurred vision, dyspnea, SBP >180 mmHg, DBP >120 mmHg
## Footnote
Often attributed to medication noncompliance
43
What is the management strategy for hypertension?
Lifestyle changes, medication adherence, regular follow-up
## Footnote
DASH diet and physical activity are recommended
44
What is heart failure?
A condition where the heart's ability to contract or relax is impaired, leading to decreased cardiac output and tissue perfusion
## Footnote
Can be acute (due to MI) or chronic (due to excessive workload)
45
What are the types of heart failure?
* Systolic heart failure (HFrEF)
* Diastolic heart failure (HFpEF)
* Left-sided heart failure
* Right-sided heart failure
## Footnote
Symptoms vary based on the type of heart failure
46
What is the Frank-Starling mechanism?
Chamber dilation and hypertrophy as a compensatory mechanism for low cardiac output
## Footnote
It can lead to decreased contractility and increased oxygen needs
47
What are common risk factors for heart failure?
* Coronary artery disease (CAD)
* Hypertension
* Obesity
* Smoking
* Age (>65 years)
* Diabetes
## Footnote
Black Americans are at higher risk
48
What is the gold standard for diagnosing heart failure?
Echocardiogram (transesophageal or transthoracic)
## Footnote
It assesses heart structure and function
49
What are key risk factors for Heart Failure?
* CAD
* Smoking
* Obesity
* Substance abuse
* HTN
* DM
* Race - Black Americans
* Age - >65 years old
* Cardiomyopathy
* Valve disease
* Congenital heart defects
* Previous MI
* Lung disease, OSA
## Footnote
CAD: Coronary Artery Disease; HTN: Hypertension; DM: Diabetes Mellitus; MI: Myocardial Infarction; OSA: Obstructive Sleep Apnea.
50
What is the gold standard diagnostic tool for assessing Heart Failure?
Echocardiogram (Transesophageal or Transthoracic)
## Footnote
It assesses EF, heart function, and valves.
51
What hormone is elevated in Heart Failure due to overfilled ventricles?
Brain Natriuretic peptides (BNP)
## Footnote
Normal BNP levels are <100 pg/mL.
52
What are common symptoms of pulmonary edema in Heart Failure patients?
* SOB
* Shallow, rapid breathing
* Crackles/ productive cough
* Pink/ frothy sputum
* Orthopnea
* Increased HR
* Hypotension
* Additional heart sounds (S3, S4)
* Anxiety/ agitation/ fear
## Footnote
SOB: Shortness of Breath; HR: Heart Rate.
53
What is the purpose of using diuretics in Heart Failure treatment?
Decrease fluid overload
## Footnote
Monitor for excessive diuresis.
54
Which medications are used to decrease afterload in Heart Failure?
* ACE-Inhibitors
* ARBs
* Beta Blockers
* Vasodilators
## Footnote
They help reduce edema and pulmonary congestion.
55
What are the signs of Digoxin toxicity?
* N/V
* Yellow sclera
* Slowed HR
* Blurred vision
## Footnote
Must monitor potassium (K) levels.
56
What does the acronym GDMT stand for in Heart Failure management?
Guideline Directed Medical Therapy
## Footnote
Refers to the AHA 2022 guidelines.
57
What are the four main drug classes for decreasing mortality in Heart Failure patients?
* Beta blockers
* ARBs
* MRAs (e.g., spironolactone)
* SGLT-2 Inhibitors
## Footnote
SGLT-2 Inhibitors help with sodium/glucose transport.
58
Fill in the blank: BNP is elevated in ________.
Heart Failure
59
What are the 6 Ps to assess in Peripheral Vascular Disease (PVD)?
* Pain
* Pallor
* Pulselessness
* Paresthesia
* Paralysis
* Poikilothermy
## Footnote
These symptoms help evaluate perfusion.
60
What is Virchow's Triad in relation to Venous Thromboembolism (VTE)?
* Venous stasis
* Endothelial damage
* Hypercoagulability
## Footnote
These factors increase the risk of thrombus formation.
61
What is the gold standard diagnostic tool for Pulmonary Embolism (PE)?
CT Scan
## Footnote
It is used to visualize clots in the lungs.
62
What are common risk factors for developing Venous Thromboembolism (VTE)?
* Age
* Afib
* Bed rest
* Chronic HF
* Pregnancy
* Reduced mobility
* Smoking
* Obesity
## Footnote
HF: Heart Failure; Afib: Atrial Fibrillation.
63
What are the stages of Peripheral Artery Disease (PAD)?
* Stage 1: Asymptomatic
* Stage 2: Claudication
* Stage 3: Rest pain
* Stage 4: Necrosis/Gangrene
## Footnote
Symptoms progress from asymptomatic to severe tissue damage.
64
What interventions are recommended for managing VTE?
* Early ambulation
* Anticoagulation therapy
* Mechanical prophylaxis
* Graduated compression stockings
## Footnote
Anticoagulation includes Vitamin K antagonists and Factor Xa inhibitors.
65
What does the term aneurysm refer to?
Permanent dilation of an artery
## Footnote
It can be true, false, or dissecting and increases the risk of rupture.
66
What is the primary goal of VTE management?
Prevention of emboli
## Footnote
VTE stands for Venous Thromboembolism.
67
What is an aneurysm?
Permanent dilation of an artery
68
List some risk factors for bleeding.
* Active GI ulcer
* Prior bleeding history
* Thrombocytopenia
* Hepatic or renal failure
* Rheumatic disease
* Age > 85
69
True or False: Early ambulation increases the risk of pulmonary embolism (PE).
False
70
What are the most common locations for aneurysms?
* Abdomen (AAA)
* Thoracic (TAA)
71
What are the most common causes of aneurysms?
* Atherosclerosis
* Hypertension (HTN)
* Hyperlipidemia (HLD)
* Smoking
* Increased age
* Family history
72
What type of treatment is preferred for aneurysms?
Endovascular (minimally invasive) treatment
73
What complications can aneurysms lead to?
Rupture due to weakened artery layers
74
Why is an aneurysm considered a medical emergency?
Because of hemorrhage
75
Fill in the blank: The risk for bleeding increases with a history of _______.
Prior bleeding history
