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Ch. 16 & 17 Cardiac
L&R HF, Conduction Disorders, MI Complications, Cardiac Assessment
| Question | Answer |
|---|---|
| Coronary angiography reveals significant blockage in the coronary artery serving the anterior/inferior left ventricle. Which artery is occluded? | Left anterior descending artery -Serves as the artery for the left ventricle (LV), particularly the anterior and inferior portions of the LV |
| What side of the heart is the circumflex artery on? | Left side of heart |
| Which structures may have been damaged by the patient’s myocardial infarction that elicited a new murmur? | Papillary muscles -Attached to the atrioventricular (AV) valves and help keep the valves closed during ventricular systole |
| What happens if the papillary muscles are damaged? | The AV valve closure may be disrupted, enabling blood to flow through the valve during systole, resulting in turbulent flow and a heart murmur |
| The physician is closely monitoring patient’s ECG because she is worried about a rhythm disturbance that may develop as a result of reentry circuits. Given patient’s current presentation, which of the following is the most concerning? | Ventricular Tachycardia -It's the most worrisome of the conduction disorders as it can result in inadequate pumping of blood from the left ventricle |
| Because of the damage to the left ventricle, the physician is concerned about poor ejection and stasis of blood in the ventricular chamber leading to further complications. What may be a primary concern? | Thromboembolism -Risk of clot formation increases with blood stasis; clot can travel from the heart to other tissues, such as the lungs -A poorly performing left ventricle may increase the risk of a thromboembolism forming |
| What does a bulging left ventricular wall indicate on an ECG? | Ventricular aneurysm -A primary concern of a ventricular aneurysm is that the bulge may rupture leading to a medical emergency -Surgical repair of a ruptured ventricular aneurysm is critical |
| Over time, the patient seems to have difficulty maintaining adequate arterial oxygen levels. When you auscultate patient’s lungs you hear the presence of crackles. What complication do you suspect may be developing? | Heart failure -LV damaged, decreasing blood to pump forward; lack of forward ejection results in blood pooling in the LA, backs up into pulmonary circulation; hydrostatic pressure in the pulmonary capillaries increases due to the fluid backup=pulm. edema |
| Patient returns 10 days later complaining of chest pain and fever. They state the chest pain worsens when they take a deep breath. On auscultation of patient’s chest, a pericardial friction rub is present. What have they developed? | Dressler's Syndrome -An autoimmune process in which antibodies and an inflammatory response occur as a result of cardiac proteins being released during a myocardial infarction -The immune complexes deposit in the pericardium, causing pericarditis |
| Auscultation | The action of listening to sounds from the heart, lungs, or other organs, typically with a stethoscope, as a part of medical diagnosis |
| Pericardial friction rub | -An audible medical sign used in the diagnosis of pericarditis - Upon auscultation, this sign is an extra heart sound of to-and-fro character, typically with three components, two systolic and one diastolic -Resembles sound of squeaky leather |
| Following a myocardial infarction, the sac surrounding the heart may become inflamed. Which structure may develop inflammation? | Pericardium |
| A block at the AV node is likely to appear as a ____________ on an ECG. | Prolonged PR interval |
| Rapid, irregular P waves are known as ____________. | Atrial fibrillation |
| A single, widened QRS complex is referred to as a _______________. | Premature Ventricular Contractions (PVC) |
| Which conduction abnormality is associated with an increased risk for clot formation? | AV fibrillation |
| If venous return increases, preload ___________. | Increases |
| Venous return | Amount of blood returning to the heart |
| Preload | Amount of blood filling the heart -Refers to the volume of blood filling the heart before it contracts |
| Stroke Volume | The volume of blood pumped out of the left ventricle during each systolic cardiac contraction |
| Afterload | The resistance the heart works against |
| If afterload increases, then stroke volume ___________. | Decreases |
| If capillary hydrostatic pressure increases, then the likelihood of edema __________. | Increases |
| If blood pressure decreases, then compensatory measures cause heart rate to ___________. | Increase |
| What monitors blood pressure in the aorta and carotids? | Baroreceptors -When they detect a fall in blood pressure, they activate the sympathetic nervous system, which in turn stimulates heart rate to compensate for the pressure drop |
| If preload increases within a normal range, then stroke volume _________. | Increases |
| Why do preload and stroke volume have a direct relationship? | The more the heart is filled with blood, the more blood is ejected with each stroke |
| If blood volume decreases, then blood pressure may ___________. | Decrease |
| If kidney perfusion decreases, then renin release ____________. | Increase |
| When is renin released by the kidneys? | When there is low blood flow and pressure to the kidneys -Released by the juxtaglomerular (JG) cells of the kidney |
| If nitric oxide increases, then vasodilation ____________. | Increases |
| If angiotensin II is inhibited, then vasoconstriction ___________. | Decreases |
| Function of Angiotensin II: | Causes vasoconstriction to elevate BP |
| Function of Aldosterone: | Causes sodium and water retention to elevate both BP and BV |
| If angiotensin II increases, then aldosterone __________. | Increases |
| If aldosterone is released, then blood volume __________. | Increases |
| If blood pressure decreases, then the ADH levels __________. | Increases |
| Function of ADH: | Decreases urine output and increases water retention -Low blood pressure stimulates the release of ADH -Increasing fluid volume in the body helps to maintain blood pressure |
| Which term refers to the heart’s force of contraction? | Contractility |
| Which term indicates the volume of blood entering the heart at the end of diastole? | Preload |
| Which responses are instituted by the body to compensate for low blood pressure? | -Increased blood volume -Activation of RAAS |
| A patient appears with hypotension. Which of the following may contribute to hypotension? | Reduced blood volume |
| What can cause heart failure? | -Ischemic injury to the heart -Dysrhythmias -Chronic hypoxia -Hypertension |
| What signs and symptoms are associated with right-sided heart failure? | -Peripheral edema (swelling in legs and other extremities) -Ascites (build-up of fluid in abdominal space) -Hepatosplenomegaly (enlargement of spleen and liver) -Jugular Vein Distention (bulging of major veins in the neck) |
| What signs and symptoms are associated with the backward effects of left-side heart failure? | -Pulmonary edema -Lung crackles -Paroxysmal nocturnal dyspnea (breathlessness while lying down and sleeping) -Orthopnea (breathlessness while standing or sitting) |
| What signs and symptoms are associated with the forward effects of left-side heart failure? | -Decreased BP and increased HR( due to inability of ventricle to adequately pump blood into systemic circulation) -Headache (due to poor perfusion of the brain) |
| What are ways the body attempts to compensate for heart failure? | -Baroreceptors detect low BP and initiate increased heart rate to compensate by activating SNS -ADH release causes fluid retention in attempt to increase BV and BP (*can cause edema however*) |
| What signals are associated with retention of fluid? | -Increased aldosterone -Increased renin |
| What increases urine output and decreased BV? | -Decreased ADH -Natriuretic peptide |
| Which value may provide further evidence that a patient has left ventricular failure? | Increased pulmonary capillary wedge pressure (PCWP) -Estimates the pressure in the left atria -In left ventricular pressure, as fluid backs up in the left side of the heart, PCWP increases |
| Which value may provide further evidence that a patient has right ventricular failure? | Increased central venous pressure (CVP) |
| What are medication options for heart failure (both sides)? | -Diuretics (reduce the fluid overload that occurs in heart failure) -Positive inotropic agents (stimulate more effective heart contractility -ACE inhibitors (reduce fluid overload and vasoconstriction) -Beta blockers (reduce the work load of the heart) |
| Why are ACE agonists detrimental to someone with heart failure? | They reduce heart contractility |
| In response to hypertension, the left ventricle may undergo hypertrophy, reducing filling volume of the left ventricle. This is an example of _____________. | Diastolic dysfunction |
| The backward effect of total heart failure may cause __________________. | -Paroxysmal nocturnal dyspnea -Pulmonary edema -Pulmonary crackles -JVD |
Created by:
kmeans34
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