Nursing Care of Patients with Coronoary Vascular Disorders Flashcards
(400 cards)
1
Q
A hollow, muscular organ located in the center of the thorax occupying the space between the lungs (mediastinum) and rests on the diaphragm
A
Heart
2
Q
Pumps blood to the tissues, supplying them with oxygen and other nutrients
A
Heart
3
Q
Heart weighs approximately _____ ; the weight and size of the heart are influenced by age, gender, body weight, extent of physical exercise and conditioning, and heart disease
A
300 grams
4
Q
the inner layer, consists of endothelial tissue and lines the inside of the heart and valves
A
Endocardium
5
Q
the middle layer, made up of muscle fibers and is responsible for the pumping action
A
Myocardium
6
Q
composed of specialized cells called _____ forming an interconnected network of muscle fibers encircling the heart in a figure-of-eight pattern that facilitates a twisting and compressive movement of the heart that begins in the atria
and moves to the ventricles as controlled by the cardiac conduction system
A
Cardiomyocytes
7
Q
the exterior layer encased in a thin, fibrous sac called the pericardium
A
Epicardium
8
Q
adheres to the epicardium
A
Visceral Pericardium
9
Q
envelopes the visceral pericardium
A
Parietal Pericardium
10
Q
a tough fibrous tissue that attaches to the great vessels, diaphragm, sternum, and vertebral column and supports the heart in the mediastinum
A
Visceral Pericardium
11
Q
the space between these two layers normally filled with about 20 ml of fluid
A
Pericardial Space
12
Q
the space between these two layers (visceral & parietal pericardium) normally filled with about _____ of fluid
A
20 ml
13
Q
lubricates the surface of the heart
and reduces friction during systole
A
Pericardial Fluid
14
Q
Thickness varies due to workload required by each chamber.
A
Heart Chambers
15
Q
The myocardial layer of both atria is much _____ than that of the ventricles because there is little resistance as blood flows out of the atria and into the ventricles during diastole.
A
Thinner
16
Q
Ventricular walls are much _____ than the atrial walls for it must overcome resistance to blood flow from the pulmonary and systemic circulatory systems during ventricular systole.
A
Thicker
17
Q
The left ventricle is _____ more muscular than the right ventricle. It must overcome high aortic and arterial pressures, whereas the right ventricle contracts against a low-pressure system within the pulmonary arteries and capillaries.
A
2-3x
18
Q
receives venous blood returning to the heart from the superior vena cava (head, neck, and upper extremities), inferior vena cava (trunk and lower extremities), and coronary sinus (coronary circulation)
A
Right Atrium
19
Q
distributes venous blood (deoxygenated blood) to the lungs via the pulmonary artery (pulmonary circulation) for oxygenation
A
Right Ventricle
20
Q
receives oxygenated blood
A
Left Atrium
21
Q
from the pulmonary circulation via four pulmonary veins
A
Left Atrium
22
Q
distributes oxygenated blood to the remainder of the body via the aorta (systemic circulation)
A
Left Ventricle
23
Q
results from the ventricle’s close proximity to the chest wall, creating the pulsation created during normal ventricular contraction
A
Point of Maximal Impulse
24
Q
Point of Maximal Impulse is located at the _____ of the left chest wall and the _____
A
Intersection of Midclavicular Line, Fifth Intercostal Space
25
allows flow of blood in only one direction
Valves of the Heart
26
composed of thin leaflets of fibrous tissue, open and close in response to the movement of blood and pressure changes within the chambers
Valves of the Heart
27
composed of thin leaflets of fibrous tissue, open and close in response to the movement of blood and pressure changes within the chambers
Valves of the heart
28
separates the atria from the ventricles
Atrioventricular valves
29
opens during diastole allowing the blood in the atria to flow freely into the relaxed
ventricles and closes when the ventricles contract and blood flows upward into the cusps of the tricuspid and mitral valves as ventricular systole begins
Atrioventricular valves
30
valve closes by _____ and the _____ preventing the backflow of blood into the atria (_____) as blood is ejected out into the pulmonary artery and aorta
Papillary Muscles, Chordae Tendinae, Regurgitation
31
composed of 3 cusps or leaflets
Tricuspid Valve
32
separates the left atrium from the left ventricle
Bicuspid/Mitral Valve
33
separates the right atrium from the right ventricle
Tricuspid Valve
34
composed of 2 cusps or leaflets
Bicuspid/Mitral Valve
35
composed of 3 leaflets, shaped like half moons
Semilunar Valves
36
closed during diastole and forced open during ventricular systole as blood is
ejected from the right and left ventricles into the pulmonary artery and aorta, respectively
Semilunar Valves
37
separates the right ventricle and the pulmonary artery
Pulmonic Valve
38
separates the left ventricle and the aorta
Aortic Valve
39
supplies arterial blood to the heart originating from the aorta just above the aortic valve leaflets
Coronary Arteries
40
Coronary arteries perfused during _____ unlike other arteries, thus a heart rate of 60-80 bpm provides an ample time during diastole for myocardial perfusion
Diastole
41
courses down the anterior wall of the heart
Left Anterior Descending Coronary Artery
42
circles around to the lateral left wall of the heart
Circumflex Artery
43
travels to the inferior wall of the heart
Right coronary artery
44
supplies the posterior wall of the heart
Posterior Descending Coronary Artery
45
located superficially to the coronary arteries
Coronary Veins
46
blood returns to the heart primarily through the coronary sinus located posteriorly in the
right atrium
Coronary Veins
47
generates and transmits electrical impulses that stimulate contraction of the myocardium
Cardiac Electrophysiology
48
Cardiac Electrophysiology first stimulates contraction of the _____ and then the _____
Atria, Ventricles
49
synchronization of the atrial and ventricular events allows the ventricles to fill completely before ventricular ejection, thereby maximizing cardiac output by two specialized
electrical cells: _____ and _____
Nodal Cells, Parkinje Cells
50
3 Characteristics of the Two Specialized Electrical Cells
Automaticity
Excitability
Conductivity
51
ability to initiate an electrical impulse
Automaticity
52
ability to respond to an electrical impulse
Excitability
53
ability to transmit an electrical impulse from once cell to another
Conductivity
54
the primary pacemaker of the heart composed of nodal cells located at the junction of the superior vena cava and the right atrium
Sinoatrial Node
55
SA node inherent firing rate of _____ impulses/beats per minute but may change the rate changes in response to the metabolic demands of the body
60 - 100
56
initiated electrical impulses are conducted along the myocardial cells of the atria via specialized tracts called _____ causing electrical stimulation and subsequent contraction of the atria and conducted to the AV Node
Internodal pathways
57
the secondary pacemaker of the heart composed of nodal cells located in the right atrial wall near the tricuspid valve
Atrioventricular node
58
coordinates the incoming electrical impulses from the atria and after a slight delay (allowing the atria time to contract and complete ventricular filling) relays the impulse to the ventricles
Atrioventricular node
59
AV Node inherent firing rate of ____ impulses/beats per minute
40-60
60
AV nodes conducts impulses through a bundle of specialized conducting tissue (_____) that divides into the _____ (conducting impulses to the right ventricle) and the _____ (conducting impulses to the left ventricle). The left bundle branch will further branch out into the _____
and _____ bundle branches
Bundle of His, Right Bundle Branch, Left Bundle Branch, Left Anterior, Left Posterior
61
Impulses travel through the bundle branches to reach the terminal point in the conduction system, the _____.
Purkinje Fibers
62
the terminal point in the conduction system
Purkinje fibers
63
composed of Purkinje cells that rapidly conduct impulses throughout the thick walls of
the ventricles stimulating the ventricular myocardial cells to contract
Purkinje Fibers
64
Purkinje Fibers inherent firing rate of _____ impulses/beats per minute
30-40
65
non-invasive graphic recording of the heart’s electrical activity
Electrocardiogram
66
recording electrical impulse that travels through the heart can be viewed by means of _____
Electrocardiography
67
Electrocardiogram reflects the _____ in specific waveforms on the screen of a cardiac monitor or on a strip of ECG graph paper
Phases of the Cardiac Cycle
68
1 small box - Amplitude _____ mV
.1
69
1 small box - Height _____ mm
1
70
1 small box - Duration _____ seconds
0.04
71
1 large box - Amplitude _____ mV
.5
72
1 large box - Height _____ mm
5
73
1 large box - Duration _____ seconds
.20
74
1 large box - _____ small boxes
25
75
Standard height _____ mm (_____ small boxes)
10, 10
76
Standard Amplitude _____ mV (_____ small boxes)
1, 10
77
1 second strip _____ small boxes / _____ large boxes
25, 5
78
6 second strip _____ large boxes / _____ small boxes
30, 150
79
represents the electrical impulse starting in the SA node and spreading through the atria (atrial depolarization)
P Wave
80
P Wave Height _____ mm or less (_____ small boxes)
2.5, 2 1/2
81
P Wave Duration _____ seconds or less (_____ small boxes)
.11, <3
82
reflects ventricular depolarization
QRS Complex
83
QRS Complex Duration _____ seconds (_____ small boxes)
<.12, <3
84
Not all _____ have all three waveforms
QRS Complex
85
QRS Waveforms are _____, small letters are used (q,r,s) if QRS waveforms are _____, capital letters are used (Q,R,S)
less than 5 mm, more than 5 mm (?)
86
first negatively deflecting waveform after P wave
Q wave
87
Less than 25% of the R wave amplitude
Q wave
88
Q wave Duration _____ seconds (_____ small box)
<.04, <1
89
first positively deflecting waveform after P wave
R wave
90
first negatively deflecting waveform after R waveform
S wave
91
represents ventricular repolarization (simultaneously with atrial repolarization but is not visible on the ECG)
T wave
92
follows the QRS complex and is usually the same direction (deflection) as the QRS complex
T wave
93
represent the repolarization of the Purkinje Fibers
U wave
94
follows the T wave and is smaller than the P wave
U wave
95
a rare waveform, but may sometime appear in patients with hypokalemia, hypertension, or heart disease
U wave
96
represents the time needed for sinus node stimulation, atrial depolarization, and conduction through the AV node before ventricular depolarization
PR Interval
97
measured from the beginning of the P wave to the beginning of the QRS complex
PR Interval
98
PR Interval normal duration _____ seconds (_____ small boxes)
.12-.20, 3-5
99
represents early ventricular repolarization
ST segment
100
lasts from the end of the QRS complex to the beginning of the T wave
ST segment
101
represents the total time for ventricular depolarization and repolarization
QT interval
102
measured from the beginning of the QRS complex to the end of the T wave
QT interval
103
QT normal duration _____ seconds (_____ small boxes);
.32 - .40, 8-10
104
normal duration for QTc: males _____ seconds; females: _____ seconds)
.39 - .45, .39 - .46
105
measured from the end of the T wave to the beginning of the next P wave (isoelectric period)
TP Interval
106
TP Interval preferred reference for the _____
Isoelectric line
107
the period when no electrical activity is detected, the line on the graph remains flat
Isoelectric line
108
compared with ST segment to detect any changes
Isoelectric line
109
measured from the beginning of one P wave to the beginning of the next P wave
PP interval
110
PP wave used to determine _____ rate and rhythm
atrial
111
measured from one QRS complex to the next QRS complex
RR interval
112
RR wave used to determine _____ rate and rhythm
ventricular
113
a brief change in voltage (membrane potential) across the cell membrane of heart cells
Cardiac Action Potential
114
stimulates the myocytes causing contraction due to exchange of electronically charged
particles
Cardiac Action Potential
115
the repeated cycle of depolarization and repolarization
Cardiac Action Potential
116
return of ions to its resting state
repolarization
117
exchange of ions causes a positively charged intracellular space and a negatively charged extracellular space
depolarization
118
Depolarization _____ enters the cells; _____ exits the cells
NA+ & CA++, K+
119
Repolarization _____ enters the cells; _____ exits the cells
K+, NA+ & CA++
120
Initiated cellular depolarization; Na+ enters the cell
Phase 0
121
Early repolarization begins; K+ exits the cell
Phase 1
122
Rate of repolarization slows: Ca++
enters the cell
Phase 2/ Plateau Phase
123
Repolarization completed; Cell returns to resting state
Phase 3
124
Resting phase before the next depolarization
Phase 4
125
the brief period immediately following the response especially of a muscle or nerve before it recovers the capacity to make a second response
Refractory Period
126
the cell is completely unresponsive to any electrical stimulus; it is incapable of initiating an early depolarization
Effective Refractory Period
127
Effective Refractory Period corresponds to _____ of the cardiac action potential
Phase 0 to middle of Phase 3
128
in this period, if an electrical stimulus is stronger than normal, the cell may depolarize prematurely causing premature contractions, placing the patient at risk for dysrhythmias
Relative Refractory Period
129
the physical study of flowing blood and of all the solid structures (such as through which it flows
Cardiac Hemodynamics
130
refers to the events that occur in the heart from the beginning of one heartbeat to the next
Cardiac Cycle
131
number of cycles depends on the number of _____
heart rate
132
composed of major sequential events cause blood to flow through the heart due to
changes in chamber pressures and valvular function during diastole and systole
Cardiac Cycle
133
the total amount of blood ejected by one of the ventricles in liters per minute
Cardiac Output
134
resting adult is _____ L/min but varies greatly depending on the metabolic
needs of the body
4-6
135
Cardiac Output is computed by multiplying the _____ (the amount of blood ejected from one
of the ventricles per heartbeat. The average resting is about 60 to 130 mL) by the _____
Stroke Volume, Heart Rate
136
Too much effort will result in fatigue, sometimes leading to a complete collapse, with the need to slow down substantially or even to stop.
Contractility
137
the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole
Preload
138
an intrinsic property of myocardial cells is that the force of their contraction depends on the length to which they are stretched: the greater the stretch (within certain limits), the greater the force of contraction - preload value will eventually be reached at which cardiac output will no longer increase
Frank Starling or Starling Law
139
the force against which the ventricles must act in order to eject blood, and is largely dependent on the arterial blood pressure and vascular tone
Afterload
140
has an inverse relationship with stroke volume, is increased by arterial
Afterload
141
vasoconstriction, which leads to decreased stroke volume. The opposite is true with arterial vasodilation, in which case it is reduced because there is less resistance to ejection, and stroke volume increases
Afterload
142
specific enzymes released from myocardial cells that become necrotic from prolonged ischemia or trauma that leaks into the interstitial spaces of the myocardium and are carried by the lymphatic system into general circulation, resulting to abnormally high levels of in serum blood samples
Cardiac Biomarkers
143
a protein which becomes elevated with any muscle damage
Myoglobin
144
Myoglobin elevates within ____ hours from damage, peaks at _____ hrs, and returns to normal within _____ days
1-4, 6-12, 1-2
145
not specific to the myocardium or cardiac muscle so it could be indicative
of other muscle damage
Myoglobin
146
isoenzyme released in the presence of ischemia within muscle tissue
CK-MB
147
not specific to cardiac muscle, but is more specific than myoglobin and highly likely to be elevated with cardiac ischemia
CK-MB
148
CK-MB begins to elevate within _____ hours, peaks at _____ hrs, and a _____ days to return to normal
6-12, 12-24, few
149
an enzyme specific to cardiac muscle that is released with ischemia and damage
Troponin I
150
the most consistently specific to cardiac muscle and, due to it’s trend timing, is the most reliable
Troponin I
151
Troponin I begins to rise within _____ hours, peaks at _____ hrs, and takes a couple of _____ to return fully to normal
4-6, 18, weeks
152
a lipid required for hormone synthesis and cell membrane formation
Cholesterol
153
calculated by adding the HDL, LDL, and 20% of the triglyceride level
Cholesterol
154
the primary transporter of cholesterol and triglycerides into the cell
Low Density Lipoprotein
155
results to deposition on the walls of arterial vessels
Low density Lipoprotein
156
transports cholesterol away from the tissue and cells of the arterial wall to the liver for excretion
High density Lipoprotein
157
composed of free fatty acids and glycerol, are stored in the adipose tissue and are a source of energy
Triglycerides
158
increase after meals and are affected by stress. Diabetes, alcohol use, and obesity can elevate triglyceride levels. These levels have a direct correlation with LDL and an inverse one with HDL
Triglycerides
159
a neurohormone that helps regulate BP and fluid volume
Brain Natriuretic Peptide
160
primarily secreted from the ventricles in response to increased preload with
resulting elevated ventricular pressure
Brain Natriuretic Peptide
161
increases as the ventricular walls expand from increased pressure, making it a
helpful diagnostic, monitoring, and prognostic tool in the setting of HF
Brain Natriuretic Peptide
162
a protein produced by the liver in response to systemic inflammation that plays a role in the development and progression of atherosclerosis
C-reactive Protein
163
elevation places patient at risk for developing CVD
C-reactive Protein
164
an amino acid, is linked to the development of atherosclerosis because it can damage the endothelial lining of arteries and promote thrombus formation
Homocysteine
165
elevation is thought to indicate a high risk for CAD, stroke, and peripheral vascular disease, although it is not an independent predictor of CAD
Homocysteine
166
a graphic representation of the electrical currents of the heart
Electrocardiography
167
obtained by placing disposable electrodes in standard positions on the skin of the
chest wall and extremities
Electrocardiography
168
a standard ECG is composed of _____ leads or _____ different views, although it is possible
to record _____ leads
12, 12, 15 or 18
169
used to diagnose dysrhythmias, conduction abnormalities, and chamber enlargement, as well as myocardial ischemia, injury, or infarction. It can also suggest cardiac effects of electrolyte disturbances (high or low calcium and potassium levels) and the effects of antiarrhythmic medications
Electrocardiography
170
obtained to determine the size, contour, and position of the heart
Chest Xray
171
reveals cardiac and pericardial calcifications and demonstrates physiologic
alterations in the pulmonary circulation
Chest Xray
172
can help diagnose some complications and placement of pacemakers
Chest Xray
173
an x-ray imaging technique that allows visualization of the heart on a screen
Fluoroscopy
174
shows cardiac and vascular pulsations and unusual cardiac contours
Fluoroscopy
175
useful aid for positioning transvenous pacing electrodes and for guiding the insertion
of arterial and venous catheters during cardiac catheterization and other cardiac procedures
Fluoroscopy
176
detects abnormalities in cardiovascular function during times of increased demand or stress
Cardiac Stress Testing
177
Cardiac Stress Testing determines the ff:
▪ presence of CAD
▪ cause of chest pain
▪ functional capacity of the heart after an MI or heart surgery
▪ effectiveness of antianginal or antiarrhythmic medications
▪ occurrence of dysrhythmias
▪ specific goals for a physical fitness
program
178
Cardiac Stress Testing Contraindications
▪ acute MI within 48 hours
▪ unstable angina
▪ uncontrolled dysrhythmias
with hemodynamic compromise
▪ severe aortic stenosis
▪ acute myocarditis or pericarditis ▪ decompensated HF
179
the patient walks on a treadmill (most common) or pedals a stationary bicycle wherein exercise intensity progresses according to established protocols
Exercise Stress Testing
180
protocol selected for the test is based on the purpose of the test and the physical fitness level and health of the patient
Exercise Stress Testing
181
Exercise Stress Test is terminated when the target heart rate is achieved or if the patient experiences signs of _____
Myocardial Ischemia
182
indicated for patients who are cognitively impaired and unable to follow directions or physically disabled or deconditioned
Pharmacologic Stress Resting
183
Pharmacologic Stress Testing drug of choice: _____ (Persantine), _____ (Adenocard), or _____ (Lexiscan) that mimic the effects of exercise by maximally dilating normal coronary arteries
Dipyridamole, Adenosine, Regadenoson
184
Pharmacologic Stress Testing Antidote
IV Aminophylline
185
Pharmacologic Stress Testing Alternative Medication
Dobutamine
186
noninvasive ultrasound test that measures the ejection fraction and examine the size, shape, and motion of cardiac structures
Transthoracic Echocardiography
187
useful for diagnosing pericardial effusions; determining chamber size and the etiology of heart murmurs; evaluating the function of heart valves, including prosthetic heart valves; and evaluating ventricular wall motion
Transthoracic Echocardiography
188
involves transmission of high-frequency sound waves into the heart through the chest wall and the recording of the return signals though a handheld transducer applied to the front of the chest
Transthoracic Echocardiography
189
a common invasive procedure used to diagnose structural and functional diseases of the heart and great vessels
Cardiac Catheterization
190
guides treatment decisions to manage structural defects of the valves or septum
Cardiac Catheterization
191
involves percutaneous insertion of radiopaque catheters into a large vein and an
artery using catheters through the right and left heart with the aid of fluoroscopy
Cardiac Catheterization
192
Before Cardiac Catheterization, Instruct patient to fast, usually for _____ hours, before the procedure
8-12
193
Patient remains on bed rest for up to hours with the affected leg straight and the head of the bed elevated no greater than 30°
Femoral Artery Approach
194
The patient may be turned from side to side with the affected extremity straight for comfort.
Femoral Artery Approach
195
Check local nursing care standards and anticipates that the patient will have fewer activity restrictions
Use of Percutaneous Vascular Closure Device or Patch
196
Use of Percutaneous Vascular Closure Device or Patch, Patient may be permitted to ambulate within _____
2 hours
197
Patient remains on bed rest for 2 hours or until the effects of sedation have dissipated
Radial Artery Approach
198
A hemostasis band or pressure dressing may be applied over the catheter access site.
Radial Artery Approach
199
Radial Artery Approach, Patients are instructed to avoid sleeping on the affected arm for _____
hours.
24
200
Radial Artery Approach, Avoid repetitive movement of the affected extremity for _____
hours.
24-48
201
a term used to describe conditions that affect the arteries that provide nutrients, blood, and oxygen to the heart
Coronary Artery Disease
202
commonly caused by atherosclerosis
Coronary Artery Disease
203
Atherosclerosis comes from two Greek words: _____, meaning “fatty mush”, and _____, meaning “hard”
athere, skleros
204
an abnormal accumulation of lipid, or fatty substances, and fibrous tissue in the lining of arterial blood vessel walls
Atherosclerosis
205
the major cause of CAD commonly referred to as the hardening of the arteries → implies that atherosclerosis begins as soft deposits of fat that harden with age
Atherosclerosis
206
Nonmodifiable Risk Factors of Atherosclerosis
- Increasing age
- Gender
- Ethinicity
- Genetic predisposition and family history of heart disease
207
Coronary Artery Disease Modifiable Risk Factors
- Serum Lipids
- Blood Pressure
- Diabetes Mellitus
- Tobacco Use
- Physical Inactivity
- Obesity
208
Contributing Factor for Coronary Artery Disease
- Fasting blood glucose > 100 mg/dL
- Psychosocial risk factors
- elevated homocysteine levels
209
Disease process of coronary artery disease starts with _____ or the accumulation of fatty deposits along the coronary blood vessel walls
atheroma formation
210
Atheroma starts to develop as a result of damage or injury to the inner lining of the artery, the _____
endothelium
211
_____ damage facilitates accumulation of cholesterol, fats, lipoproteins at the site of injury in the wall or intima of the artery.
Endothelial
212
High concentrations of low density lipoprotein (LDL) penetrate the damaged endothelium and undergo a chemical process called _____ that attracts white blood cells or leukocytes to migrate towards the vessel wall.
oxidation
213
As macrophages appear, they engulf the lipoproteins and become foam cells. These foam cells give rise to the earliest visible form of an atheromatous lesion called the _____
fatty streak.
214
Once the fatty streak is formed, it then attracts the smooth muscle cells to the site, where they multiply and start to produce extracellular matrix comprising of collagen and proteoglycan that forms a large portion of the atherosclerotic plaque. This turns the fatty streak into a _____
fibrous plaque.
215
The lesion then starts to bulge into the inner wall of the blood vessel causing a significant narrowing of the _____
luminal space
216
As the _____ grows, continued inflammation can result in plaque instability, ulceration, and rupture.
fibrous plaque
217
Once the integrity of the artery’s inner wall is compromised, platelets accumulate in large numbers, leading to a _____.
thrombus
218
refers to chest pain that is brought about by myocardial ischemia caused by significant coronary atherosclerosis
Angina Pectoris
219
_____ may show left ventricular hypertrophy, ST-T changes, arrhythmias, and possible Q waves.
Resting ECG
220
_____ with or without perfusion studies shows ischemia.
Exercise stress testing
221
_____ shows blocked vessels.
Cardiac catheterization
222
FITT formula
Frequency
Intensity
Type
Time
223
Medical Management of CAD
Physical Activity
Nutritional Therapy
Pharmacologic Therapy
224
Nutritional Therapy - Decrease in _____and _____ and an increase in _____
saturated fat and cholesterol, complex carbohydrates
225
_____ reduce the risks associated with CAD when eaten regularly.
Omega-3 fatty acids
226
For individuals without CAD, the AHA recommends eating fatty fish _____ a week because fatty fish such as salmon and tuna contains two types of omega- 3 fatty acids: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).
twice
227
_____ medications (nitrates, beta-adrenergic blockers, calcium channel blockers, and angiotensin converting enzyme inhibitors) to promote a favourable balance of oxygen supply and demand.
AntiAnginal
228
_____ medications to decrease blood cholesterol and tricglyceride levels in patients with elevated levels. DOC: Simvastatin
AntiLipid
229
_____ agents to inhibit thrombus formation. DOC: Aspirin
Antiplatelet
230
_____ and _____ to reduce homocysteine levels.
Folic acid & B complex vitamins
231
a minimally invasive procedure to open blocked or stenosed coronary arteries allowing unobstructed blood flow to the myocardium
Percutaneous Transluminal Coronary Angioplasty or Percutaneous Coronary Intervention
232
improves coronary blood flow by inserting a balloon-tipped catheter inflated once the catheter has been placed into the narrowed area of the coronary artery, compressing the fatty tissue in the artery and makes a larger opening inside the artery
Percutaneous Transluminal Coronary Angioplasty or Percutaneous Coronary Intervention
233
circumvents an occluded coronary artery with an autogenous graft, thereby restoring blood flow to the myocardium
Coronary Artery Bypass Grafting
234
uses healthy blood vessels from another part of the body (arteries from the arm or chest, or veins from the legs) and connects them to blood vessels above and below the blocked artery, creating a new route for blood to flow that bypasses the narrowed or blocked coronary arteries
Coronary Artery Bypass Grafting
235
a minimally invasive surgical procedure employed for the treatment of patients with severe angina
Transmyocardial Revascularization
236
a minimally invasive surgical procedure employed for the treatment of patients with severe angina
Transmyocardial Revascularization
237
an alternative treatment for patients who are not a candidate for surgery due to factors such as risk of procedure failure, ill-health, advanced age, advanced heart disease, and other health conditions
Transmyocardial Revascularization
238
uses a special carbon dioxide laser to shoot tiny pinholes or channels through the heart muscle and into the heart's lower left chamber (left ventricle) improving the flow of oxygen-rich blood to the heart muscle, reducing the effects of angina
Transmyocardial Revascularization
239
a systolic pressure of 140 mmHg or higher or a diastolic pressure of 90 mmHg or higher
Hypertension
240
elevated BP without an identified cause
Primary Hypertension
241
accounts for 90% to 95% of all cases of hypertension
Primary Hypertension
242
elevated BP with a specific cause that often can be identified and corrected
Secondary Hypertension
243
accounts for 5% to 10% of hypertension
Secondary Hypertension
244
blood pressure is between, less than 120 mmHg and less than 80 mmHg.
Normal
245
from 120 mmHg to 129 mmHg for systolic blood pressure and less than 80 mmHg for diastolic pressure.
Elevated
246
starts when the patient has a systolic pressure of 130 to 139 mmHg and a diastolic pressure of 80 to 89 mmHg.
Stage 1 Hypertension
247
Stage 2 starts when the systolic pressure is already more than or equal than 140 mmHg and the diastolic is more than or equal than 90 mmHg.
Stage 2 Hypertension
248
Causes of Hypertension
- Increased sympathetic nervous system activity
- Increase renal reabsorption
- Increased RAAS activity.
- Decreased vasodilation of the arterioles.
249
Excessive sodium intake is linked to the start of hypertension. A high sodium intake may activate a number of pressor mechanisms and cause water retention.
Water and Sodium Retention
250
High plasma renin activity (PRA) results in the increased conversion of angiotensinogen to angiotensin I. Any rise in BP inhibits the release of renin from the renal juxtaglomerular cells.
Altered Renin-Angiotensin-Aldosterone Mechanism
251
Psychologic and physiologic responses to stress results in a prolonged increase in SNS activity producing increased vasoconstriction, increased HR, and increased renin release.
Stress & Increased Sympathetic Nervous System Activity
252
Increased renin activates the RAAS, leading to elevated BP. People exposed to high levels of repeated psychologic stress develop hypertension to a greater extent than those who experience less stress.
Stress and Increased Sympathetic Nervous System Activity
253
High insulin levels stimulate SNS activity and impair nitric oxide–mediated vasodilation. Additional pressor effects of insulin include vascular hypertrophy and increased renal sodium reabsorption.
Insulin Resistance and HyperInsulinemia
254
The red blood cells carrying oxygen is having a hard time reaching the brain because
of constricted vessels, causing _____.
headache
255
due to the low concentration of oxygen that reaches the brain
Dizziness
256
due to decreased oxygen levels.
Chest Pain
257
due to too much constriction in the blood vessels of the eye that red blood cells carrying
oxygen cannot pass through.
Blurred Vision
258
_____ may show small perfusion defects.
Position emission tomography
259
_____ shows wall motion abnormalities and ejection fraction.
Radionuclide ventriculography
260
Medical Management: Prevention
- Weight reduction
- Adopt DASH
- Dietary sodium retention
- Physical activity
- Moderation of alcohol consumption
261
DASH
Dietary Approach to Stop Hypertension
262
_____ and _____ for uncomplicated hypertension.
Diuretics & Beta blockers
263
_____ diuretics decrease blood volume, renal blood flow, and cardiac output.
Thiazide
264
are competitive inhibitors of aldosterone binding.
ARBs
265
block the sympathetic nervous system to produce a slower heart rate and a lower blood pressure.
Beta blockers
266
inhibit the conversion of angiotensin I to angiotensin II and lowers peripheral resistance.
ACE Inhibitors
267
Stage 1 Hypertension pharmacologic management
Anti hypertensive
268
Stage 2 Hypertension pharmacologic management
Diuretics & Antihypertensive
269
term used to indicate either a hypertensive urgency or emergency
Hypertensive Crisis
270
occurs more often in patients with a history of hypertension who have not adhered to their medication regimens or who have been undermedicated
Hypertensive Crisis
271
a situation in which a patient’s BP is severely elevated (usually above 180/110 mm Hg), but there is no clinical evidence of target organ disease
Hypertensive Urgency
272
Hypertensive Urgency develops over _____
Days to Weeks
273
a situation in which a patient’s BP is severely elevated (often above 220/140 mm Hg) with clinical evidence of target organ disease
Hypertensive Emergency
274
Hypertensive Emergency develops over _____
Hours to Days
275
can cause encephalopathy, intracranial or subarachnoid hemorrhage, acute left
ventricular failure, MI, renal failure, dissecting aortic aneurysm, and retinopathy
Hypertensive Emergency
276
clinical manifestations: severe headache, nausea, vomiting, seizures, confusion, and coma
Hypertensive Emergency
277
the initial goal is to decrease MAP by no more than 20%-25%, or to decrease MAP to 110-115 mmHg by gradual titration of medications.
Decrease Mean Arterial Pressure
278
Formula for MAP
SBP + 2DBP/3
279
IV for Decreasing MAP
Nicardipine Drip
280
Pharmacologic Management for Hypertensive Emergency
- IV vasodilators
- IV adrenergic inhibitors
- IV ACE inhibitor
- IV calcium channel blockers
281
used to describe patients who have either unstable angina or an acute myocardial infarction
Acute Coronary Syndrome
282
believed that the atherosclerotic plaque in the coronary artery ruptures, resulting in platelet
aggregation (“clumping”), thrombus (clot) formation, and vasoconstriction
Acute Coronary Syndrome
283
amount of disruption of the atherosclerotic plaque determines the degree of coronary artery obstruction (blockage) and the specific disease process
Acute Coronary Syndrome
284
artery has to have at least 40% plaque accumulation before it starts to block blood flow
Acute Coronary Syndrome
285
Categories of Acute Coronary Syndrome
Unstable Angina
ST-elevation Myocardial Infarction
Non ST-elevation Myocardial Infarction
286
chest pain or discomfort that occurs at rest or with exertion and causes severe activity limitation
Unstable Angina
287
an increase in the number of attacks and in the intensity of the pressure indicates _____
Unstable Angina
288
pressure may last longer than 15 minutes or may be poorly relieved by rest or nitroglycerin
Unstable Angina
289
present with ST changes on a 12-lead ECG but will not have changes in troponin or creatine kinase (CK) levels
Unstable Angina
290
patient who has his or her first angina symptoms, usually after exertion or other increased demands on the heart
New Onset Angina
291
chest pain that occurs in the days or weeks before an MI
Pre-Infarction Angina
292
most serious acute coronary syndrome, often referred to as acute MI
Myocardial Infarction
293
can result from undiagnosed or untreated angina
Myocardial Angina
294
occurs when myocardial tissue is abruptly and severely deprived of oxygen
Myocardial Infarction
295
have ST and T-wave changes on 12-lead ECG indicating myocardial ischemia.
Non ST-Elevation Myocardial Infarction (NSTEMI)
296
cardiac enzymes may be initially normal but elevate over the next 6 to 12 hours
Non ST-Elevation Myocardial Infarction (NSTEMI)
297
have ST elevation in two contiguous leads on a 12-lead ECG indicating myocardial
infarction/necrosis and requires immediate treatment
ST-Elevation Myocardial Infarction
298
the initial area of infarction, often in the subendocardial layer of cardiac muscle
Zone of Necrosis
299
Zone of Necrosis ECG Changes
Abnormal Q waves
300
the tissue that is not injured, but is necrotic
Zone of Injury
301
Zone of Injury ECG changes
ST Elevation
302
Zone of Ischemia ECG changes
T Wave Inversion
303
tissue that is oxygen deprived
Zone of Ischemia
304
_____ is a dynamic process that does not occur instantly. Rather, it evolves over a period of several hours.
Infarction
305
deficient oxygen delivery for given oxygen demand
Ischemia
306
Ischemia ECG changes
T wave inversion and ST depression
307
abrupt significant interruption of blood supply
Injury
308
Injury ECg changes
ST elevation in involved area
309
irreversible cell necrosis and death
Infarction
310
Infarction ECG changes
Pathologic Q waves
- any Q wave in V2 or V3 > 0.04 secs and >2 mm in amplitude, deeper than 2 small squares
311
ST segment Acute changes appear within _____
minutes to hours
312
ST Segment Recent changes remain _____ after the event
Days to Weeks
313
ST segment may or may not have returned to baseline
Recent
314
abnormal Q waves, QS complexes, or regression of R
Old
315
ST segments are isoelectric
Old
316
Old ST segment T wave inversion may _____
persist indefinitely
317
Hallmark of Myocardial Infarction
Severe, immobilizing chest pain
318
the first-line diagnostic tool for the diagnosis of acute coronary syndrome and should be
obtained within 10 minutes of the patient’s arrival in the emergency department
Electrocardiogram
319
ST elevation in two contiguous leads:
✓Greaterthan _____ mm in men younger than 40 years, greater than _____ mm in men older than 40 years, or greater than _____ in women in leads V2-V3 and/or
✓Greater than _____ mm in all other leads
5, 2, 1.5, 1
320
ST segment depression in two contiguous leads
New horizontal or down-sloping ST-segment depression greater than _____ mm in 2 contiguous leads
5
321
T-wave changes in two contiguous leads:
T inversion greater than _____ mm in two contiguous
leads with prominent R waves or R/S ratio of greater than 1
1
322
a protein which becomes elevated with any muscle damage
Myoglobin
323
indicated when ECG and serum cardiac markers do not confirm MI
Stress Testing
324
Initial Management for MI
Morphine
Oxygen
Nitroglyceride
Aspirin
325
Morphine is for ____ and ____
Blood Pressure and Respiratory Rate
326
Aspirin is for
Thrombus Formation
327
Nitroglyceride is for
Vasodilation
328
Oxygen is for
Ischemia
329
Dual antiplatelet therapy (e.g., aspirin and ticagrelor) and heparin (UH or LMWH) is
recommended
Ongoing angina and negative cardiac markers
330
Coronary angiography with possible PCI is considered once the patient is stabilized and angina is controlled, or if angina returns or increases in severity.
Ongoing angina and negative cardiac marker
331
to salvage as much myocardial muscle as possible, _____ is initiated
Reperfusion Therapy
332
first line of treatment for patients with confirmed MI
Emergent PCI
333
Emergenct PCI - to open the blocked artery within _____ minutes of arrival to a facility that has an interventional cardiac catheterization laboratory
90
334
should be given as soon as possible to stop the infarction process by dissolving the thrombus in the coronary artery and reperfusing the myocardium
Thrombolytic Therapy
335
Thrombolytic Therapy is given ideally within _____ minutes upon arrival to a facility without interventional cardiac catheterization laboratory and preferably within the first 6 hours after the onset of symptoms
30
336
Thrombolytic Therapy: mortality is reduced by _____ if reperfusion occurs within 6 hours
25%
337
used in the initial treatment of the patient with ACS
IV Nitroglyceride
338
goal: to reduce anginal pain and improve coronary blood flow
IV Nitroglyceride
339
side effects of IV Nitroglyceride _____ and _____
Hypotension and Tolerance
340
the drug of choice for chest pain that is unrelieved by NTG
Morphine Sulfate
341
decreases cardiac workload by lowering myocardial oxygen consumption, reducing contractility, and decreasing BP and HR
Morphine Sulfate
342
Morphine sulphate nursing management: Monitor patients for signs of ____ or ____ ,
Bradypnea, Hypotension
343
decrease myocardial oxygen demand by reducing HR, BP, and contractility
Beta adrenergic Blockers
344
should be started within the first 24 hours and continued indefinitely in patients recovering from STEMI of the anterior wall, with heart failure, or an EF of 40% or less
Angiotensin-Converting Enzyme Inhibitors
345
Other Pharmacologic Management for MI
Antidysrhythmic Drugs
Lipid-lowering Drugs
Stool Softeners
346
Antidysrhythmic Drug
Digoxin
347
Stool Softener
Lactulose
348
Nursing Management for MI: Provide NTG, morphine, and supplemental oxygen as needed to eliminate or reduce _____.
chest pain
349
a chronic condition in which partial or total arterial occlusion (blockage) deprives the lower extremities of oxygen and nutrients
Peripheral Arterial Disease / PAOD
350
the narrowing or blockage of the vessels that carry blood from the heart to the legs as a result of systemic atherosclerosis
Peripheral Arterial Disease / PAOD
351
obstructions involving the distal end of the aorta and the common, internal, and external iliac arteries – above the inguinal ligament
Inflow Obstruction
352
obstructions involve the femoral, popliteal, and tibial arteries and are below the superficial femoral artery (SFA)
Outflow Obstruction
353
a classic leg pain wherein patient can walk only a certain distance before a cramping, burning muscle discomfort or pain forces them to stop and relieves after rest
Intermittent Claudication
354
a numbness or burning sensation, often described as feeling like a toothache that is severe enough to awaken patients at night and is relieved by placing feet dependently
Rest Pain
355
usually located in the toes, the foot arches, the forefeet, the heels, and, rarely, in the calves or ankles
Rest Pain
356
Discomfort in the lower back, buttocks, or thighs - for patient with _____ disease.
Inflow
357
Burning or cramping in the calves, ankles, feet, and toes - for patient with _____ disease.
Outflow
358
painful and develop on the toes (often the great toe), between the toes, or on the upper aspect of the foot
Ulcer Formation
359
small and round with a “punched out” appearance and well-defined borders
Ulcer Formation
360
may be done if stenting of the narrowed vessel is planned or to determine the exact amount of narrowing or occlusion before peripheral bypass surgery
Arteriography of the Lower Extremity
361
involves injecting contrast medium into the arterial system and has serious risks including hemorrhage, thrombosis, embolus, and death
Arteriography of the Lower Extremity
362
an inexpensive, noninvasive method of assessing PAD using a doppler probe
Segmental Systolic Blood Pressure Measurement of the Lower Extremities
363
blood pressure readings in the thigh and calf are lower than the brachial pressure
(blood pressure readings are higher in the former than the latter)
Segmental Systolic Blood Pressure Measurement of the Lower Extremities
364
used to assess blood flow in the peripheral arteries
Magnetic Resonance Imaging
365
evaluates arterial flow in the lower extremities
Plethysmography
366
provides graphs or tracings of arterial flow in the limb
Plethysmography
367
waveforms are decreased to flattened, depending on the degree of occlusion if an
occlusion is present
Plethysmography
368
most commonly used to increase arterial blood flow in an affected limb
Arterial Revascularization
369
Surgical bypass of femoropopliteal and femorotibial arterial occlusions (_____ obstruction)
outflow
370
Surgical bypass of aortoiliac, aortofemoral, and axillofemoral arterial occlusions (_____ obstruction)
inflow
371
may improve arterial blood flow to the affected leg through buildup of the collateral
circulation
Exercising and Positioning
372
Encourage patients to prevent exposure of the affected limb to the _____.
cold
373
_____ is a hemorheologic agent that increases the flexibility of red
blood cells. It decreases blood viscosity by inhibiting platelet aggregation and
decreasing fibrinogen and thus increases blood flow in the extremities.
Pentoxifylline (Trental)
374
_____, such as aspirin and clopidogrel (Plavix), are commonly used. Aspirin 325 or 81mg daily may be recommended for patients with chronic PAD. However, clopidogrel is better than aspirin for reducing the risk for myocardial
infarction (MI), ischemic stroke, and vascular death.
Antiplatelet agent
375
opens blood vessel and improves arterial blood flow through an arterial puncture in the
patient’s groin and dilates one or more arteries with a balloon catheter advanced through a cannula, which is inserted into or above an occluded or stenosed artery
Percutaneous Transluminal Angioplasty (PTA)
376
a nonatherosclerotic, segmental, recurrent inflammatory disorder of the small- and medium-sized arteries and veins of the upper and lower extremities
Buerger’s Disease
377
cause is unknown although there is a strong association with tobacco smoking and is typically identified in young adult men who smoke.
Buerger’s Disease
378
muscle pain caused by an inadequate blood supply of the arch of the foot
Claudication
379
Diagnostic Studies in Buerger’s Disease - diminished or absent compared with those for opposite leg
Doppler Ultrasonography
380
shows an unfilled segment of the vein in an otherwise completely filled vein with its connecting collaterals
Phlebography
381
superficial skin vessels are constricted and blanching of the extremity occurs, followed
by cyanosis and returns to becoming reddened when the vasospasm is relieved
Reynaud’s Disease
382
attacks are intermittent and can be aggravated by cold or stress
Reynaud’s Disease
383
the unilateral spasm of small arteries causes episodes of reduced blood flow to end arteriole of the upper and lower extremities
Reynaud’s Phenomenon
384
Reynaud’s Disease occurs in people older than _____ years
30
385
the bilateral spasm of small arteries causes episodes of reduced blood flow to end arteriole of the upper and lower extremities
Reynaud’s Disease
386
Reynaud’s Disease can occur between the ages of ____
17-50 years
387
Reynaud’s Disease is more common in
women
388
Vasospasm induced color changes of fingers, toes, ears, and nose (_____, _____ and _____)
White, Blue, Red
389
decreased perfusion results in pallor (white). The digits then appear cyanotic (bluish
purple). These changes are followed by rubor (red), caused by the hyperemic
response that occurs when blood flow is restored
Vasospasm
390
Coldness and numbness
vasoconstriction phase
391
Throbbing, aching pain, tingling,and swelling in the hyperaemic phase
Vasodilation st age
392
Pharmacologic therapy of Buerger’s Disease
Relief from vasoconstriction
393
Surgical Management for Reynaud’s Disease indicated for severe symptoms not reduced by drugs
Lumbar Sympathectomy
394
cutting surgically the sympathetic nerve fibers that cause vasoconstriction of blood
vessels in the legs
Lumbar Symathectomy
395
cutting surgically the sympathetic nerve fibers that cause vasoconstriction of blood vessels in the upper extremities
Symapathetic Ganglionectomy
396
Drugs that promote vasodilation
Nifedipine
397
Blood thinner, decrease cardiac output
Streptokinase
398
Excessive Sweating
Diaphoresis
399
If all nodes does not function, what will happen
Cardiac Arrest
400
X - _____
Y - _____
Amplitude, Height, Voltage
Duration, Time
