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QuestionsAnswers
In the conduction system, what is known as the pacemaker? The SA node which fires at 60-100 impulses/min.
What sends impulses to the ventricles and at what rate? The AV node, 40-60 impulses/min.
The bundle of His is located in the septum and separates what? The ventricles.
What are five important parts of the electrophysiology of the heart? Automaticity, excitability, conductivity, contractility, and refractoriness.
What is cardiac output? Heart rate x stroke volume.
What is preload? The amount of blood coming into the heart.
What is afterload? The resistance the ventricles have to overcome to eject blood into the vessels.
What are some non-modifiable risk factors for CHF? Age, gender, ethnicity, genetics.
What are some modifiable risk factors for CHF? Smoking, inactivity, obesity.
What are some diagnostic tests for CHF? Serum lipids, C-reactive protein, angiography, EKG, stress test, echocardiograms, hemodynamic monitoring.
What does CHF mean? A less than normal cardiac output.
What are the compensatory mechanisms of the heart? Increase heart rate, increase stroke volume, arterial vasoconstriction, Na and water retention, neurohumoral response, and myocardial hypertrophy.
What are signs and symptoms of left-sided heart failure? Fatigue, weakness, daytime oliguria, angina, tachycardia, palpitations, confusion, restlessness, dizzyness, pallor, weak peripheral pulses, cool extremities, cough, dyspnea, breathlessness, orthopnea, increased respirations, crackles, noctural dyspnea.
What are the signs and symptoms of right-sided heart failure? Jugular vein distention, enlarged liver and spleen, destended abdomen (ascites), anorexia, nausea, dependent edema, noctural polyuria.
What drugs are used to treat hear failure? Digoxin, Beta-blockers, ACE inhibitors, diuretics, vasodilators.
What drug is the only commonly used glycoside? Digoxin
What is the action of Digoxin? It improves the heart's pumping ability and increases contractility.
What is the common dose for Digoxin? 0.125 mg
What is angina pectoris? Chest pain.
What are some non-pharmacologic methods for managing angina? Altering risk factors such as smoking, hypertension, hyperlipidemia, obesity, sedentary lifestyle, stress, and use of drugs that increase cardiac workload.
What medications can be used to treat angina? Organic nitrates, beta-blockers, and calcium-channel blockers.
What is the prototype and most widely used nitrate? Nitroglycerin.
What do nitrates do? Relax smooth muscle in blood vessels, and cause vasodilation in veins, coronary arteries, and arterioles.
What does dilation of veins cause? Decrease in venous return to heart (preload), Decrease in cardiac workload, and a decrease in oxygen demand.
What does the dilation of coronary arteries result in? Increased blood flow to the ischemic areas of the heart.
What does dilation of the arterioles cause? A decrease in peripheral vascular resistance (afterload), a decrease in BP, and a decrease in cardiac workload.
What are the names of less commonly used nitrates? Isosorbide dinitrate (Isordil), Isosorbide mononitrate (Imdur).
What are some side effects of nitrates? Hypotension, dizziness, light-headedness, tachycardia, palpitations, and headache.
What do beta-blockers do? Prevent usual SNS responses.
When beta blockers inhibit the SNS, what are the results? Decrease in HR, BP, contractility, oxygen demand, and cardiac output, bronchoconstriction, decreased aqueous humor in the eye, and decreased angina pain.
What is the difference between beta-1 sites and beta-2 sites? Beta-1 sites have more effect on the heart, whereas beta-2 sites have more effect on the lungs.
What letters to most beta-blockers end in? olol.
FWhat are some adverse effects of beta-blockers? Hypotension, bradycardia, bronchospasm, heart failure.
What is the rationale for not stopping beta-blockers abruptly? It can result in very high blood pressure and angina because the SNS is stimulated.
What do calcium channel blocking agents do? The prevent movement of calcium into the cells which results in dilation of coronary and peripheral arteries.
What are the results of calcium channel blockers? Improved angina, decreased workload (decreases afterload), decreased blood pressure.
What are some adverse side effects of calcium channel blockers? Hypotension, dizziness, lightheadedness, weakness, peripheral edema, headache, heart failure, pulmonary edema, nausea, and constipation.
What are the names of some calcium channel blockers? verapamil, nifedipine, diltiazem. (Very Nice Drugs)
What is hypertension? A sustained elevation of BP with at least three occasions over several weeks above 140/90.
What are the two major factors that determine hypertension? Heart rate and stroke volume.
What does hypertension cause? An increase in heart workload, enargement of the heart muscle, narrowing of arterial lumen, increased risk of thrombosis.
What are the "target organs" of hypertension? Heart, brain, kidneys, and eyes.
What are the signs and symptoms of hypertension? Fatigue, headache, dizziness, palpitations, angina
What are some non-pharmacologic treatments for hypertension? Lifestyle modification, dietary changes (restrict sodium), Limit alcohol to 1oz/day, increase activity (30 min of moderate activity/day), quit smoking, and manage stress.
What is the rationale for quitting smoking? Nicotene use causes vasoconstriction.
What risks are associated with hypertension? Heart attack, stroke, and kidney failure.
What medications can be used to treat hypertension? Angiotensin-converting enzyme inhibitors (ACE), Angiotensin II receptor blockers, anti-adrenergics, calcium channel blockers, diuretics, vasodilators (direct acting).
Hypertension medications have what 2 main actions? Reduction of systemic vascular resistance, and reduction of volume of circulating blood.
What do ACE inhibitors do? They block the enzyme that converts angiotensin I into angiotensin II (strong vasoconstrictor) which results in vasodilation.
What effect does vasodilation have? A decrease in blood pressure.
What do most ACE inhibitors end in? pril.
What does anti-coagulent mean? Prevents the formation of clots. (does not dissolve clots)
What does anti-platelet mean? Inhibits platelet aggregation.
What does thrombolytic mean? Dissolves thrombi.
What lab values need to be monitored when heparin is given IV? PTT (partial thromboplatin time)
What is an example of a low molecular weight heparin? Lovenox (enoxaparin).
What is the most commonly used oral anticoagulant? Coumadin (warfarin).
Why would you choose coumadin over heparin? For long-term therapy.
What lab values need to be monitored when Coumadin is given? PT (prothrombin time), and INR (international normalized ratio)
What kinds of foods should people who take Coumadin avoid? Green leafy vegetables, tomatoes, bananas, fish. (the all contain vitamin K)
What is the antidote for heparin? protamine sulfate.
What is the antidote for Coumadin? Vitamin K.
What are some non-pharmacologic ways to treat arteriosclerosis and atherosclerosis? Diet, exercise, quit smoking.
What are some signs and symptoms of peripheral arterial disease? Pain, intermittent claudication, bruit, trophic skin changes, rubor or blanching, arterial ulcers (start on feet or toes, painful).
What are some nonsurgical ways to mange PAD? Exercise (increase slowly, stop if pain), Positioning, protect feet, decrease weight, stop smoking, avoid tight clothing..crossing legs..cold..direct heat.
What are some drugs that treat PAD? Trental, ASA, Plavix.
What are some post-op cares for an arterial revascularization? Keep leg straight, bedrest first 24 hrs, check extremity, assess pulses and pain.
What are the treatments for acute peripheral arterial occlusions? Heparin, or a trombectomy.
What are some signs and symptoms of acute peripheral arterial occlusions? Severe pain, affected areacould be cool or cold or pulseless or mottled, areas on toes may be black or gangrenous.
What could an acute peripheral arterial occlusion cause? An embolism.
What are some of the symptoms of aneurysms? Pain when supine (pressure on structures), Abd pain, back pain, dyspnea, cough, pulsating abd mass, but some have no symptoms.
Why would you want to decrease the blood pressure of someone with an aneurysm? To lessen the chance of rupture.
What are some signs and symptoms of Buerger's Disease? Burning pain, sensitivty to cold, intermittent claudication, superficial phlebitis, ulcerations and gangrene.
What are the treatments for Buerger's Disease? Stop smoking and all use of tobacco, avoid the cold, vasodilating drugs.
What is Raynaud's Phenomenon? Vasospasm of arterioles and arteries.
What are signs and symptoms of Raynaud's Phemomenon? Blanching, cyanosis, cold, pain, ulcers on tips of fingers.
What are the treatments for Raynaud's Phenomenon? Avoid cold, stress, and trauma to the fingers, stop smoking, avoid caffeine, meds.
What is Venous thromboembolism? A deep vein thrombophlebitis.
What are signs and symptoms of a venous thromboembolism? Edema, difference in size of calves of legs, increased temp, redness of area, tenderness.
What is a complication of a venous thromboembolism? Pulmonary Embolism.
How do you threat a venous thromboembolism? Bedrest, elevation of limb, warm moist packs, anticoagulents, thrombectomy ("umbrella" filter).
What are the signs and symptoms of venous insufficiency? Steady throbbing pain, edema, brown pigmentation of lower legs, ulcers (around the ankle, little pain, superficial, chronic, infection risk).
What should a patient with venous insufficiency be encouraged to do? Elevate legs, wear compression stockings, exercise, avoid long periods of standing, do not cross legs, avoid tightness on legs.
How do you treat a venous ulcer? With an occlusive dressing (hydrocolloid-DuoDerm), unna boot on for 1 week, compression stockings.
What causes varicose veins? Incompetent valves.
What are signs and symptoms of varicose veins? Edema, dull aching, enlarged leg veins.
What are the treatments for vericose veins? Walk, slerotherapy, surgical removal.
Created by: thisgirl