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Cardio Test one
chapter 32, 34,35, 37, 36,67 lewis
| Question | Answer |
|---|---|
| What is another name for Fibrous plaque ? | Tuberous Sclerosis |
| What is another name for complicated lesion | Atheromas |
| A person with a calcium greater than ______ has a high probability of having at least one coronary artery with significant lesion. | Greater than > 400 |
| What is another name for unstable angina and myocardial infarction ? | Acute coronary syndrome ( ACS ) |
| What is angiogenesis ? | New blood vessels termed collateral circulation . |
| How should you measure triglyceride levels > | in a fasting state . anything greater than >150mg/dl is a risk factor. |
| What are the modifiable risk factors for CAD ? | 1. elevated lipids 2. hypertension 3. tabacco 4. lack of physical activity |
| Why are HDLs good for you ? | HDLs carry lipids away from arteries and to the liver for metabolism. Physical exercise , moderate alcohol consumption, and estrogen administration increase HDls. Desired amount is man greater than 40mg/dl and female greater than 50mg/dl. |
| What can we take to decrease the homocysteine that contribute to atherosclerosis by damaging the inner lining of blood vessels , promoting plaque build up and altering clotting mechanism ? | B- complex vitamins ( B6 and B12 and folic acid) have been shown to lower blood levels of homocysteine . |
| What should be the fat intake % ? | Fat intake should be about 30 % of calories with most coming from monosaturated fats. Red meats, eggs, whole milk products are major source of saturated fat and cholesterol . |
| What should we know about Statins ? Atrovastatin (Lipitor) etc. | Monitor liver enzymes and creatine kinase. (if muscle weakness and pain occur. ) side effects Rash Gi disturbance , myopathy, rhabdomyolysis. |
| How much aspirin is recommended for most people with CAD? | 81 mg |
| How long are cells viable in a ischemic conditions ? | for approximately 20 minutes |
| In a chronic stable angina how long does the pain last ? | Angina is rarely sharp or stabbing and it usually does not change with position or breathing. The pain usually last for only 5 to 15 minutes. Pain at rest is unusual. |
| What is reveled on the ECG during chronic angina ? | An ECG usually reveals TRANSIENT ST segment depression , and or T WAVE INVERSION indicating ischemia. |
| what is silent ischemia ? | Silent ischemia refers to ischemia that occurs in the absence of any subjective symptoms. Patients with diabetes have a increase prevalence due to diabetic neuropathy. |
| What is angina decubitus? | it is chest pain that occurs only while the person is lying down and usually relieved by standing or sitting. |
| What is Prinzmetal's angina? | Variant angina - often occurs at rest, usually in response to spasm of a major coronary artery. It is a rare form of angina frequently seen in patients with history of migraine headaches and Raynauds phenomenon. |
| What factors precipitate coronary artery spasm? | increased myocardial oxygen demand, increased levels of tobacco smoke, histamine. When spasm occurs the patient experiences angina and transient ST segment elevation. Calcium channel blockers and or nitrates are used to control the pain. |
| What does PQRST assessment stand for in angina | P - precipitating events, q- quality of pain, r- radiation of pain, s- severity t- timing |
| How do extremes of temperature act on the heart ? | Temperature extremes increase the workload of the heart. blood vessels constrict in response to cold stimulus. Blood vessels dilate and blood pools in the skin in response to a hot stimulus. |
| Occurs at rest or with minimal exertion | Unstable angina |
| How much aspirin do you give to treat and how much to prevent ? | 81 mg to prevent and 325 mg to treat |
| Relieved by rest or nitroglycerin ? | Chronic stable angina |
| whats the etiology of Prinzmetal's Angina ? | Coronary vasospasm |
| When does Prinzmetal angina usually occurs ? | occurs primarily at rest , triggered by smoking and increased level of substances like histamine , angiotensin , and epinephrine |
| An ECG reveals transient ST segment depression and T wave inversion | Chronic Stable angina |
| How do short acting nitrates work ? | 1. dilating peripheral blood vessels. 2. dilating coronary arteries and collateral vessels. |
| How does warfarin ( Coumadin ) work ? | Interferes with hepatic synthesis of vitamin K- dependent clotting factors . It is alternative medication for patient who cannot take aspirin. IT prevents clot formation ( anticoagulant) |
| How do nitrates work ? | Promote peripheral vasodilation , by which decrease preload and afterload. Dilates coronary arteries . |
| How do B-Adrenergic Blockers work > | Drugs end in LOL . Inhibit sympathetic nervous stimulation of the heart. Reduce heart rate , contractility and blood pressure. Decrease AFTERLOAD. |
| What does MONA stand for ? | M - Morphine O - Oxygen N- nitrate A- Asprin |
| Facts about Fibriolytic therapy ? | It breaks up fibrin meshwork in clots. It is used only in ST-segment elevation MI ( complete black) STEMI . Do not use for NSTEMI . |
| How does morphine effect preload and afterload ? | It decreased preload and afterload . |
| What patient teaching is needed for Nitroplycerin? | Tell the patient to lay down due to orthostatic hypotension , do not combine with drugs used for erectile disfunction. If symptoms or pain are unchanged or worse after 5 minutes contact emergency medical services. |
| How do calcium channel blockers work ? | Drug names end in - PINE Prevent calcium entry into vascular smooth muscle cells and myocytes ( cardiac cells) It causes coronary and peripheral vasodilation. It reduces the heart rate , contractility and blood pressure. |
| When to check pt and ptt | Check pt for Coumadin and ptt for heparin |
| How to know if beta blocker is being effective? | if the patient can do ADLs with out discomfort. |
| How does Heparin work ?? | Prevent conversion of fibrinogen to fibrin |
| How does glycoprotein work ? | Prevent the binding of fibrinogen to platelets, thereby blocking platelet aggregation. standard antiplatelet therapy in combination with aspirin for patients at high risk for unstable angina. |
| How long does it take for the entire thickness of the myocardium to become necrotic ? | It takes 4 to 6 hours. Time= muscle |
| There are three areas of damage after a Myocardial infarction . | 1. Area of infarction 2. Area of injury 3. Area of ischemia . |
| Area of Infarction | O2 deprived , damage is irreversible, Causes Q WAVE on the ekg. |
| Area of Injury | Next to infarct. Tissue is viable as long as circulation remains adequate. Increasing O2 may save this area from necrosis. Causes S-T segment elevation on ekg. |
| Area of ischemia | Viability may not be damaged as long as MI doesn't extend and collateral circulation is able to compensate. Causes DEPRESSED S-T segment on ecg. |
| What is transmural infarction ? | Ischemia is in all the layers of the heart. full thickness |
| which part of the heart due most MIs involve ? | Most MI involve Left ventricle. |
| Myoglobin | Earliest marker detected in MI. Found in cardiac and skeletal muscle. Cleared form the circulation rapidly . Serum concentrations rise 30 to 60 min after MI . Peak at 6 to 7 hours. |
| Troponins I and T | No levels of these are seen in healthy individuals . Wide diagnostic timeframe . Peak at 24 - 48 hours after |
| CK-MB | Predictable rise and fall during specific time period. CK is found in the brain , heart and skeletal . MB is found in myocardial mm only . Serum levels increase 4 to 6 hours after MI . |
| Healing process after MI | at 24 hours the healing starts. at four days the necrosis is cleared out and the wall is very thin and weak. at 10 to 14 days the scar tissue is forming. at 6 weeks the area is considered healed. |
| What is ventricular remodeling > | In an attempt to compensate for the infarcted muscle , the normal myocardium will hypertrophy and dilate. it can later lead to the development to heart failure. . |
| What is the most common complication of MI | The most common complication of MI are Dysrythmias. Present in 80 percent of patients. Most common cause of death in the prehospital period. Most often seen with anterior MI , Heart failure or shock . |
| What is cardiogenic shock ? | Occurs when inadequate oxygen and nutrients are supplied to the tissues because of severe Left Ventricular failure. Requires aggressive management. |
| What is ventricular aneurysm > | Results when the infarcted myocardial wall becomes thinned and bulges out during contraction. |
| What is papillary muscle dysfunction? | Causes mitral valve regurgitation. Conditions aggravates and already compromise LV |
| What is acute pericarditis ? | 1. An inflammation of visceral and or parietal pericardium ? 2. May result in cardiac compression, decreased LV filling and emptying, heart failure. 3. Pericardial friction rub may be heard. 4. Chest pain different from MI Pain. |
| What is Dressler syndrome ? | Characterized by pericarditis with effusion and fever that develop 4 to 6 weeks after MI. 2 Pericardial chest pain. 3. Pericardial friction rub may be heard. 4. Arthralgia |
| What is the drug therapy for Acute Coronary Syndrome ? | 1. IV nitroglycerin 2. morphine sulfate 3. B adrenergic blockers 4. Ace inhibitors 5. antidysrhythmia drugs 6. cholesterol lowering drugs 7. stool softeners |
| What is the treatment of choice for confirmed MI ? | Emergent PCI . Balloon (PTCA) angioplasty plus drug eluting stent . Patient ambulatory 24 hours after procedure. |
Created by:
rkasiejka
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