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Ch. 15 Cardiac
Ischemia, Angina, MI, Atherosclerosis, Hyperlipidemia, & Hypertension
| Question | Answer |
|---|---|
| Which term applies to the signs and symptoms that may be present in a myocardial infarction that are not considered to be the typical presentation of chest pain? | Angina Equivalents -Signs and symptoms associated with a myocardial infarction that differ from the typical angina pectoris presentation |
| What is it called when a patient suffering from a myocardial infarction places his or her fist over the sternal area? | Levine's Sign |
| Intermittent leg claudication and Cushing’s triad are not associated with myocardial infarctions: true or false? | True -They are NOT associated with MIs |
| Because of the concern of myocardial infarction (MI), the physician orders an electrocardiogram (ECG), which reveals the patient has ST segment elevation. Which of the following statements are true? | -The patient's results indicate presence of STEMI -The ECG explains why patient was having angina equivalents because of the arterial occlusion |
| Which factor supports a diagnosis of myocardial infarction? | Elevated cardiac troponin I |
| What is cardiac troponin I? | -A factor released from cardiac cells undergoing necrosis -Elevates in the blood after myocardial infarction -Considered to be the preferred biomarker for myocardial infarction |
| The absence of what factor would indicate that an MI is likely not actually occurring? | Creatine phosphokinase myocardial band -It is another cardiac marker |
| WHEN does cardiac troponin I elevate? | Within the first 4-8 hours after the onset of chest pain |
| What medication options can be used to help manage MIs? | -Oxygen (when SAO2 is lower than 95%) -Aspirin (reduces platelet aggregation) -IV nitrates (alleviates pain and vasodilates arteries) -Morphine (alleviates pain) -Beta-adrenergic blockers (reduce workload of heart) |
| Which test is most helpful in revealing the extent of damage to patient’s heart? | Radionuclide myocardial perfusion imaging -Involves injecting a radionuclide dye into the bloodstream to highlight areas of the heart lacking perfusion |
| Why are echocardiograms not the most helpful in revealing heart damage? | An echocardiogram cannot differentiate an acute MI from an old one |
| Percutaneous coronary intervention (PCI) was used to restore perfusion. Which of the following likely occurred for patient during PCI? | A drug-eluting stent placement |
| You are concerned that during patient’s treatment there may be further injury to myocardial cells by normalized oxygen levels. What is the term used for this type of injury? | Reperfusion injury -Can occur because damaged myocardial cells poorly tolerate normalized levels of oxygen |
| Stable angina | Consistent, chronic chest pain |
| Which procedure will require the use of a healthy vein or artery to circumvent a coronary artery occlusion? | A CABG (Coronary Artery Bypass Graft) |
| A patient is diagnosed with a STEMI in the emergency room. This means: | The patient is experiencing complete occlusion of a coronary artery |
| Factors that influence the amount of damage an MI causes include: | -Location -Duration -Collateral circulation |
| Atherosclerosis | -Basic physiological change that results in CVD -Foam cell formation/hyperlipidemia -C-reactive protein and homocysteine levels are used for assessment (inflammation markers) |
| Aneurysm | -Weak arterial wall resulting in bulging of the artery -Abdominal aorta most commonly affected -Fusiform and saccular shapes/forms -Can result in ruptures of arteries --> internal hemorrhaging |
| What is the difference between a fusiform aneurysm and a saccular aneurysm? | Fusiform = balloons out on BOTH sides of blood vessel Saccular = balloons out on only ONE side of blood vessel |
| Aortic Dissection | -Sudden onset of symptoms including chest pain and tearing sound -BP is differential b/w right and left arm because of compromised blood flow -Surgical repair needed -33% of patients die within first 24 hours |
| Vasculitis | -Inflammation of the vessels and is classified according to the size of the vessels affected -Associated with autoimmune disease -Immune complexes deposited in arterial walls -Takayasu arteritis; it affects the aorta and pulmonary arteries |
| Peripheral Artery Disease (PAD) | -Intermittent claudication develops from occulsions of peripheral arteries (femoral artery) -Decreased peripheral pulses -Ankle-brachial index used for assessment (compares the blood pressure in the ankles with the blood pressure in the arms) |
| Intermittent claudication | When blood flow through the narrowed arteries cannot match the metabolic demands of the tissues |
| Raynaud’s phenomenon | -Occurs with an exaggerated sympathetic response causing vasoconstriction resulting in numbness, coolness, and tingling of the extremities -Associated with autoimmune diseases -Calcium channel blockers may be an effective treatment |
| Kawasaki’s disease | -A disease that affects the coronary arteries of children |
| Abdominal Aortic Aneurysm | -Most common type of aneurysm -May rupture, leading to internal bleeding -May be detected as a bulge in the abdominal aorta |
| LDL | BAD cholesterol -High levels of this can lead to atherosclerosis |
| HDL | GOOD cholesterol -High levels of this are cardioprotective -Increased with exercise |
| Other laboratory results indicate fasting plasma glucose of 120 mg/dL, an elevated TSH, and reduced thyroxine level. Based on these results and the patient's data, which additional risk factors for hyperlipidemia may the patient have? | -Type II diabetes mellitus -Hyperthyroidism -Obesity |
| What physical factors are associated with hyperlipidemia? | Xanthoma and Xanthelasma -Yellowish deposits under the skin and near the eye |
| Many medications are used to treat hyperlipidemia. Which of the following statements are true? | -Fibrates treat high triglyceride levels -Hyperlipidemia/Cholesterol-lowering medications are combined |
| What are risk factors for hypertension? | -Obesity -Excess sodium intake in diet -African American ethnicity -Family history |
| Tissues from what organs are most likely to be damaged by hypertension? | -Heart -Kidneys -Retina -Brain |
| Which assessment results may be associated with hypertensive damage of body tissues? | -LV hypertrophy -Microalbuminuria (albumin present in urine b/c of damage the filtration membrane of the glomerulus) -Cerebral hemorrhage -Arteriovenous nicking in retina (arteries and veins cross) -S4 sound -Shift of point maximal impulse of heart |
| What medications can help treat hypertension? | -ACE inhibitors (block the activation of angiotensin II which reduces vasoconstriction and blood pressure) -Diuretics (reduce blood volume and thus blood pressure) -Calcium antagonists (also reduce vasoconstriction and blood pressure) |
Created by:
kmeans34
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