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Cardiac Study Guide

Cardiac Unit Study Guide WVC

Question	Answer
The heart is located between the lungs in the	mediastinum
The apex is above the	diaphragm
The heart is tilted slightly to the	LFT of midline
What valve moves blood between the RT atrium and ventricle	The tricuspid valve does this
What valve moves blood between the LFT atrium and ventricle	The mitral valve does this
What is the sound of the tricuspid and mitral valves closing	The "lub" It is the ventricular systole and it is the loudest.
The RT ventricle uses what valve to help move blood into the pulmonary arteries	pulmonary valve
The LFT ventricle uses what valve to do the same for the aorta	the aortic valve
The "DUB" is the sound of what	the aoRTic and pulmonary valves closing. It is the second sound. Diastole
During this the atria and ventricles of your heart relax and begin to fill with blood	diastole
Your heart's atria contract and pump blood into the ventricles	atrial systole
The atria then begin to relax. Next	your heart's ventricles contract
During ventricular systole the heart pumps blood where	pumps blood out of your heart.
How does blood flow through the heart	V/C 2 RT ATRIUM( ATRIAL SYSTOLE) 2 TRICUSPID 2 RT VENTRICLE(VENTRICULAR SYST) 2 PULM VALVE (semilunar) 2 PULM ARTERIES 2 LUNGS, back 2 PULM VEIN 2 LFT ATRIUM(ATRIAL SYST) MITRAL VALVE 2 LFT VENTRICLE. (VENTRICULAR SYSTOLE) A/V (semilunar)2 AORTA
The vessels that deliver oxygen-rich blood to the myocardium are known as	coronary arteries they represent the only source of blood supply to the myocardium
the LFT coronary artery originates from the	LFT aortic sinus
the RT coronary artery originates from the	RT aoRTic sinus.
most myocardial perfusion occurs through the coronary arteries during heart relaxation or contraction	diastole/relaxation
Failure of the coronary arteries to deliver oxygen caused by a ↓ in blood flow in front of ↑d oxygen demand of the heart results in	tissue ischemia, MI or angina pectoris.
Ischemia is	A condition of oxygen debt
Brief ischemia is associated with intense chest pain known as	angina
Severe ischemia can cause the heart muscle to die from hypoxia. An example of this is	myocardial infarction MI
What sympathetic neurotransmitter constricts the heart and causes ↑ BP	norepinephrine
In the coronary circulation norepinephrine elicits	vasodilation due to the predominance of beta-adrenergic receptors in the coronary circulation.
BNP has what effect on the heart	vasodilation, ↑Na secretion in the urine to result in ↓ BP & ↓ CO
Where is BNP produced	It is produced in the ventricles
Where is ANP produced and what effect does it have on the heart	vasodilation, acts to reduce the water, sodium and adipose loads on the circulatory system, → ↓ BP ↓ CO
The RT coronary artery supplies blood to the	RT atrium and RT ventricle
Where is the RT coronary artery located	from the ascending aorta to under the RT atrium
What is the fluid filled sac that surrounds the heart and the proximal ends of the aorta	vena cava
What are the 3 layers of the pericardium	FIBROUS PERICARDIUM is the outer fibrous sac that covers the heart. PARIETAL PERICARDIUM lies between the visceral pericardium and the fibrous pericardium. VISCERAL PERICARDIUM also called the epicardium
What are the mechanical properties of the heart	HR Cardiac Output and Stroke Volume
Blood flow from the heart into the systemic arterial circulation is measured clinically as	cardiac output (CO) the amount of blood pumped from the LFT ventricle each minute.
CO depends on the relationship between	heart rate (HR) and stroke volume (SV)
How do you calculate CO	HR X Stroke Volume
In adults the CO ranges from	4 to 7 L/min.
HR is the	number of times the ventricles contract in one minute. Normal is 60-100
What system controls HR	ANS
What systems slow the heart	The parasympathetic (vagus nerve) system slows the HR (beta-blockers slow the heart)
What system speeds up the heart	sympathetic stimulation ↑s the heart rate (epinephrine and norepinephrine)
Stroke volume (SV) is the	amount of blood ejected by the LFT ventricle during each contraction.
What variables influence stroke volume	HR, preload, afterload, and contractility.
Preload is	the degree of myocardial fiber stretch at the end of diastole and just before contraction.
What determines preload	determined by the amount of blood returning to the heart from both the venous system (RT heart) and the pulmonary system (LFT heart) (LFT ventricular end-diastolic [LVED] volume).
The ability of the heart to be able to equalize the amount of blood entering and exiting it is called	Frank-Starling’s law of the heart.
Stroke volume is ↑d by	stretching of the ventricular muscles during diastole ↑s the contractility of the muscle. It is involved in Starling’s Law
Excessive filling of the ventricles results in excessive LVED volume and pressure may result in	↓d cardiac output.
Afterload is	the pressure or resistance that the ventricles must overcome to eject blood through the semilunar valves and into the peripheral blood vessels.
What affects stroke volume and CO and is the force of cardiac contraction independent of preload	contractility
Contractility is ↑d by what factors	sympathetic stimulation, calcium release, and positive inotropic drugs.
How is contractility ↓d	hypoxia and acidemia.
Systolic BP is	the amount of pressure/force generated by the LFT ventricle to distribute blood into the aorta with each contraction of the heart.
Systolic BP measures	how effectively the heart pumps and is an indicator of vascular tone.
Diastolic BP is	the amount of pressure/force against the arterial walls during the relaxation phase of the heart.
What two properties determine BP	volume (cardiac output) and the resistance of the arterioles
BP	CO x PVR (peripheral vascular resistance)
BP is regulated by what body systems	ANS, Kidneys, Endocrine system
How does the ANS regulate BP	excites or inhibits sympathetic nervous system activity in response to impulses chemoreceptors and baroreceptors.
Chemoreceptors react to	to hypoxemia (a ↓ in the partial pressure of arterial oxygen [PaO2]) HYPOXIA
How do chemoreceptors work	stimulation send impulses along the vagus nerves to activate a vasoconstrictor response
Activated chemoreceptors do what to BP	↑BP
How do baroreceptors work	arterial walls are stretched by an ↑d BP generate impulses that to the vasomotor center in the pons and the medulla.
Baroreceptors that ↓ BP are located in	the arch of the aorta and at the origin of the internal carotid arteries are stimulated when the arterial walls are stretched by an ↑d BP.
What happens when the arch of the aorta or at the origin of the internal carotid arteries are stretched	baroreceptors are stimulated and BP is reduced.
How do the stretch receptors in the superior vena cavae and the RT atrium and the RT atrium work	These sensitive to volume and pressure changes and aleRT the CNS to ↑ or ↓ HR
How do the kidney’s regulate BP	sense a change in blood flow activates the renin-angiotensin-aldosterone mechanism
What happens when RENAL BLOOD FLOW or PRESSURE ↓S	the kidneys retain sodium and water. BP tends to rise
Activation of the renin-angiotensin-aldosterone mechanism results in	vasoconstriction and sodium retention (and thus fluid retention).
Vascular volume is also regulated by the release	of antidiuretic hormone (vasopressin) from the posterior pituitary gland
How does the endocrine system regulate BP	releases various hormones (e.g.
Emotional behaviors (e.g.	excitement
What effect does hypothermia have on BP	tissues require fewer nutrients and blood pressure falls.
In hypeRThermia	the metabolic requirement of the tissues is greater and BP and pulse rate rise.
Postural hypotension is	A drop in blood pressure due to a change in body position when a person moves to a more veRTical position: from sitting to standing or from lying down to sitting or standing.
How do you diagnose POSTURAL HYPOTENTION	↓ of MORE than 20 mm Hg of the SYSTOLIC pressure or MORE than 10 mm Hg of the DIASTOLIC PRESSURE
Areas to assess postural blood pressure	laying 3 minutes the to sitting or standing. After the position change
Paradoxical blood pressure is	an exaggerated ↓ in systolic pressure by more than 10 mm Hg during THE INSPIRATORY PHASE OF THE RESPIRATORY CYCLE (normal is 3 to 10 mm Hg).
Define hypertension	a systolic pressure of 140/90 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher
What are the 3 stages of HNT	(Stage 1) 140/90 to 159/99, (Stage 2) 160/100 to 179/109 (Stage 3) >180/110
What are the 3 types of HTN	malignant HTN (comes on suddenly), essential HNT (r/t risk factors), secondary HTN
What is secondary HTN commonly associated with	renal disease(the most), meds, endocrine, brain tumors or encephalitis
What is malignant HTN	BP >200 systolic & >150 diastolic, symptoms: HA, blurr vision, dyspnea, uremia. Can lead to CVA or renal failure. IT IS A MEDICAL EMERGENCY
Most common type of HTN	essential 85%-90%
These patients with HTN are at ↑d risk of	stroke, heart disease and end-stage kidney disease
The difference between the systolic and diastolic values is referred to as	pulse pressure.
A narrow pulse pressure can result from	↑D PERIPHERAL VASCULAR RESISTANCE or ↓D STROKE VOLUME in patients with HEART FAILURE or HYPOVOLEMIA or SHOCK
An ↑d pulse pressure may occur in patients with	slow heart rates
The ankle-brachial index (ABI) can be used to assess	the vascular status of the lower extremities.
How do you assess ABI	The higher of these two pressures (dorsalis pedis and posterior tibial pulses) is then divided by the higher of the two brachial pulses
What are the 10 risk factors of heart disease	Age 65 or older. Being male. Family history. Race. Smoking. High cholesterol. High BP. Inactivity. Overweight. Diabetes
What questions should you ask in your assessment regarding heart conditions	history of depression & anxiety/ demographics/diet/Co-morbidity
Signs & symptoms of heart disease	angina/dyspnea/fatigue/palpitations/weight gain/pain in extremities/slow cap refill/clubbing/edema.
The term for the unusual sound that blood makes when it rushes past an obstruction (called turbulent flow) in an artery when the sound is auscultated with the bell poRTion of a stethoscope	Bruit
Pulsus alternans is	a physical finding with arterial pulse waveform showing alternating strong and weak beats
Pulsus alternans is almost always indicative of	LFT ventricular systolic impairment and carries a poor prognosis.
Assessment of arterial pulses provides information about	vascular integrity and circulation.
An ↑ in JVP (causes JVD) and is usually caused by	RT ventricular failure. Other causes include tricuspid regurgitation or stenosis
RT ventricular failure is associated with	↑d systemic venous pressures and congestion
What is hepatojugular reflux	hepatomegaly causes an elevation of RT atrial pressure that is visualized by JVD.
Inspection in an assessment looks at	JVD, PMI @ 5th intercostal ,edema and respiratory rate
Late signs of severe RT-sided heart failure are	ascites, jaundice and anasarca (generalized edema) as a result of prolonged congestion of the liver.
In what order do you assess the heart	Inspection, palpation, percussion, auscultation
S1 marks the beginning of	ventricular systole and occurs RT after the QRS complex on the electrocardiogram (ECG).
When auscultated, S1 is	low pitched and softer than S2
S1 is best heard at	the lower LFT sternal border or the apex of the heart. It may be identified by palpating the carotid pulse while listening.
The second heart sound (S2) is caused mainly by	the closing of the aoRTic and pulmonic valves (semilunar valves).
S2 is	higher pitched
S2 is heard best at	the base of the heart at the end of ventricular systole.
What are abnormal heart sounds	Gallops, murmurs and pericardial friction rub
Murmurs reflect	turbulent blood flow through normal or abnormal valves. The valves not closing(prolapse) or opening (stenosis) properly
Where are murmurs heard	mitral regurgitation is on top & aoRTic stenosis on the bottom
S3 is called	a ventricular gallop
An S3 gallop is caused by	↓ compliance, early HF or ventricle skeptical defect
S4 gallop is referred to as	atrial gallop.
S4 gallop is caused by	↓ compliance, HTN,anemia, ventricular hypeRTrophy, MI, aorta pulmonary stenosis, pulmonary emboli or loss of compliance with age.
A pericardial friction	rub originates from the pericardial sac and occurs with the movements of the heart during the cardiac cycle.
Rubs are usually transient and are a sign of	inflammation, infection, or infiltration. They may be heard in patients with PERICARDITIS resulting from MI, cardiac tamponade, or post-thoracotomy.
(S&S of CHF) ↓d perfusion is manifested as	cool, pale, and moist skin, cap refill <3 secs
(S&S of CHF) Pallor is characteristic of anemia and can be seen in areas such as the	nail beds, palms, and conjunctival mucous membranes in any patient.
↓d blood flow results in ↓d skin temperature. It is lowered in several clinical conditions, including	heart failure, peripheral vascular disease, and shock.
Clubbing of the fingers and toes is caused by	chronic oxygen deprivation in body tissues.
Clubbing is common in patients with	advanced chronic pulmonary disease, congenital heart defects, and cor pulmonale (RT-sided heart failure)
Serum Markers of Myocardial Damage	CK-MB, myoglobin, Troponin (referred to as cardiac markers and detect cardiac injury
CK-MB is found in	myocardial muscle
Creatine kinase is	is an enzyme specific to cells of the brain, myocardium, and skeletal muscle. It is an marker for MI
Myoglobin is	a low-molecular-weight heme protein found in cardiac and skeletal muscle, is the earliest marker detected—as early as 2 hours after an MI with rapid decline after 7 hours.
Normal levels for myoglobin	<90 mcg/L
Troponin is	a myocardial muscle protein released into the bloodstream with injury to myocardial muscle.
Normal levels for CK are	Females: 30-135 units/L Males: 55-170 units/L
Troponins T and I are not found in healthy patients, so any rise in values indicates	cardiac necrosis or acute MI.
Normal values for Cardiac troponin	T <0.20 ng/mL Cardiac troponin I <0.03 ng/mL
What are the serum lipids	cholesterol, triglycerides, HDL, LDL
What are the normal TOTAL lipids	Total lipids 400-1000 mg/dL
Normal cholesterol e values	122-200 mg/dL, or 3.16-6.5 mmol/L IN Older adult (> 70 yr): 144-280 mg/dL
Normal triglycerides	Females: 35-135 mg/dL Males: 40-160 mg/dL Older adult (>65 yr): 55-260 mg/dL
Normal HDL	Females: mean, 40 mg/dL Males: mean, 40 mg/dL Older adult range ↑s with age
What serum lipid protects against CAD	HDL
Normal LDL	60-180 mg/dL Older adult (>65 yr): 92-221 mg/dL
HDL:LDL ratio	3:1
Homocysteine is	an amino acid that is produced when proteins break down.
Elevated homocysteine values may be an independent risk factor for	the development of CVD, CAD, PVD and venous thrombosis
High serum levels of homocysteine may block production of	nitric oxide on the vascular endothelium, making the cell walls less elastic and permitting plaque to build up
Blood coagulation studies (panels) evaluate	the ability of the blood to clot.
Why are blood coagulation panels impoRTant	in patients with a greater tendency to form thrombi (e.g., those with atrial fibrillation, prosthetic valves, or infective endocarditis).It can help predict disease
What test is primarily used, along with the creatinine test, to evaluate kidney function	BUN
Arterial blood gas (ABG) determinations are often obtained in patients with CVD. Why is it impoRTant	Determination of tissue oxygenation, carbon dioxide removal, and acid-base status is essential to appropriate intervention and treatment.
The most definitive but most invasive test in the diagnosis of heart disease is	cardiac catheterization.
Complications of Cardiac Catheterization on RT-SIDED HEART CATHETERIZATION	Thrombophlebitis, Pulmonary embolism, Vagal response
Complications of Cardiac Catheterization on LFT-SIDED HEART CATHETERIZATION	Myocardial, infarction, Stroke, Arterial bleeding or thromboembolism, Dysrhythmias
Angiography of the arterial vessels is an invasive diagnostic procedure that involves	fluoroscopy and the use of contrast media.
Angiography is performed when	arterial obstruction, narrowing, or aneurysm is suspected.
What are the radiographic diagnostic tests	Chest X-Ray, Angiograph, Cardiac Catherization
Standard preoperative tests are performed prior to a cardiac catherization	chest x-ray, complete blood count, coagulation studies, and 12-lead ECG.
The RT side of the heart is catheterized first. The cardiologist inseRTs a catheter through	the femoral vein to the inferior vena cava or through the basilic vein to the superior vena cava. It is advanced through the RT atrium, through the RT ventricle, and, at times, into the pulmonary artery
In a LFT-sided heart catheterization, the cardiologist advances the catheter	against the blood flow from the femoral or brachial artery up the aorta, across the aoRTic valve, and into the LFT ventricle.
What calculations are made from catherization	end-systolic volume, end-diastolic volume, stroke volume, and ejection fraction.
Digital subtraction angiography (DSA) is	type of fluoroscopy technique used in interventional radiology to clearly visualize blood vessels in a bony or dense soft tissue environment.
How is DSA accomplished	Images are produced using contrast medium by subtracting a 'pre-contrast image' or the mask from later images, once the contrast medium has been introduced into a structure. Hence the term 'digital subtraction angiography'.
An invasive procedure during which programmed electrical stimulation of the heart is used to cause and evaluate lethal dysrhythmias and conduction abnormalities	Electrophysiologic study (EPS)
This test assesses cardiovascular response to an ↑d workload. The stress test helps determine the functional capacity of the heart and screens for asymptomatic coronary artery disease	Exercise Stress Test
This test It helps assess and diagnose cardiomyopathy, valvular disorders, pericardial effusion, LFT ventricular function, ventricular aneurysms, and cardiac tumors	Echocardiography
This test examines cardiac structure and function with an ultrasound transducer placed immediately behind the heart in the esophagus or stomach	Transesophageal echocardiography (TEE)
A slightly more aggressive using either dobutamine or dipyridamole. This test is usually used when patients cannot tolerate exercise.	pharmacologic stress echocardiogram
What are the lifestyle choices that contribute to risks for heart disease	hypolipidemia, HTN, diabetes, diet, stress, smoking, obesity and sedentary lifestyle
What does a focused cardiac assessment consist of	Patient History( nutritional, smoking, exercise, alcohol and drugs), Family History (diabetes, obesity, HTN, CAD, sudden death) Cardiovascular Signs/Symptoms (pain PQRST), dyspnea, cough, fatigue, nocturia, edema, cyanosis, pallor
Electophysiologic Properties of cardiac cells regulate heart rate and rhythm. They are	Automaticity, excitability, conductivity, contractibility
The electrophyisologic property(EP) that is the ability of cardiac cells to generate an electrical impulse spontaneously and repetitively	Automaticity
What EP is the ability of non-pacemaker heart cells to respond to an electrical impulse generated from pacemaker cells and to depolarize.	Excitability
Depolarization occurs when	the normally negatively charged cells within the heart muscle develop a positive charge.
What EP is the ability to transmit an electrical stimulus from cell membrane to cell membrane.	Conductivity. As a result, excitable cells depolarize in rapid succession from cell to cell until all cells have depolarized.
The wave of depolarization causes	deflections of the electrocardiogram (ECG) waveforms that are recognized as the P wave and the QRS complex.
What EP is the mechanical activity of the heart.	Contractility
What EPis the ability of atrial and ventricular muscle cells to shoRTen their fiber length in response to electrical stimulation, generating sufficient pressure to propel blood forward.	Contractility
How is mild hyperkalemia seen on an ECG	reduction of the size of the P wave and development of peaked T waves.
Severe hyperkalemia results in a (on the ECG)	widening of the QRS complex
The conduction system begins with the	sinoatrial (SA) node (also called the sinus node). The action potential of the heart is staRTed
The SA node is the heart's	primary pacemaker. It can spontaneously and rhythmically generate electrical impulses at a rate of 60 to 100 beats per minute and therefore has the greatest degree of automaticity.
T waves may become tall and peaked, inveRTed (negative), or flat as a result of what electrolyte impalances	potassium or calcium imbalances
A constant blood calcium level is required for	A normal rhythmic heartbeat
What is the effect of Na on the heart	Too much or too little causes the body to retain water resulting in changes in BP
What is the effect of Mg on the heart	regulate BP
Where is the cardiac control center located	Medulla oblongata
What other 2 areas control the heart	SA node and AV node
Where is the SA node located	located close to the surface of the RT atrium near its junction with the superior vena cava. The SA node is the heart's primary pacemaker
The SA node leads to	atrial depolarization. It’s the P wave
What is the normal BPM of the SA node	60-100 BPM and therefore has the greatest degree of automaticity.
A heart controlled by the SA node is said to be in	normal sinus rhythm.
The AV node is located	lies just beneath the RT atrial endocardium, between the tricuspid valve and the ostium of the coronary sinus. (floor of the RT atrium)
What does the AV node do	T-cells (transitional cells) cause impulses to SLOW DOWN or to be delayed in the AV node before proceeding to the ventricles.
The activity of the AV node is reflected as (ECG)	PR segment. This slow conduction provides a shoRT delay, allowing the atria to contract and the ventricles to fill.
The AV node has its own intrinsic pacemaker activity at of (BPM)	40-60 BPM.
The bundle of His connects with	AV node & continues thru the interventricular septum. It extends as a RT bundle branch down the RT side of the interventricular septum to the apex of the RT ventricle. On the LFT side, it extends as a LFT bundle branch, which fuRTher divides
What is the intrinsic value for rate of the bundle of His	40-60 BPM
Where are the perkinje fibers located	At the ends of both the RT and the LFT bundle branch systems
Purkinje cells make up	the bundle of His, bundle branches, and terminal Purkinje fibers.
Perkinje fibers are responsible for	ventricular depolarization and the subsequent ventricular muscle contraction.
Perkinje fibers are the last line in conduction/contractility. If all other cells fail, they can beat (BPM)	20-40 BPM
What does each small square on a 6 min ECG represent	0.04 seconds
What does the P Wave represent	Atrial depolarization.
What does each big square on a 6 min ECG represent	0.20 seconds
What does the QRS complex represent	ventricular depolarization, coincides w/mitral & tricuspids closing.
Where does the impulse for the QRS complex travel	down the bundle of His to the perkinje system
What does the T wave represent	ventricular repolarization, follows the same deflection as P wave
How is hyperkalemia reflected on the ECG	the T wave is peaked with prolonged QRS and PR intervals
How is hypokalemia reflected on the ECG	the T wave is low and rounded w/ST depression and U wave
What is the absolute refractory period	is the time for lethal arrhythmias
What does the J point stand for	The point where the QRS ends and the ST begins
What represents the time required for atrial depolarization as well as the impulse delay in the AV node and the travel time to the Purkinje fibers	The PR INTERVAL
What does the ST segment represent	early ventricular repolarization (from J point to beginning of T wave)
What does a normal ST segment look like	no more than 0.5 mm elevation.
Elevation or depression of the ST segment can be caused by	myocardial injury, ischemia or infarction, conduction abnormalities, or the administration of medications.
What does the QT interval represent	depolarization and repolarization of the LFT and RT ventricles.
The QT interval varies with	age, sex and HR
A prolonged QT interval is a biomarker	for ventricular tachyarrhythmias (hypomagnesia)
QT interval can be lengthened with	meds, electrolyte imbalances (hypomagnesia), subarachnoid hemorrhage.
Common causes for Torsades de Pointes include	diarrhea, hypomagnesemia and hypokalemia (all cause tachycardia)
How do you check the atrial rhythm on an ECG	assessing the PP interval, are they smooth/rounded and up RT, one for each QRS, similar
Check the regularity of the ventricular rhythm by assessing	the RR intervals
The PR interval normally measures between	0.12 and 0.20 second and s/b consistent across the strip
The QRS duration normally measures between	0.04 and 0.10 second (Gloria stated .06-.12)
When the QRS duration is less than .10, it indicates	that the impulse was formed above the ventricle
When the QRS duration is more than .10, it indicates	that the impulse is either of ventricular origin or of supraventricular origin with aberrant conduction
Dysrhythmia can be seen by the QRS complex duration that is more than	0.12 second
Normal Sinus Rhythms originating from the SA are characterized by what	Rates: normal & contant. Rhythm: regular. Present P waves, consistent, smooth, one P wave before each QRS complex
Name 3 different dysrhythmias that cause ↓d cardiac output	Tachycardia, atrial fibrillation and atrial flutter
What are obvious signs of tachycardia	↑pulse rate, fatigue, weakness, SOB, oRThopnea, JVD, ↓O2 sat, ↓BP, ↓ urine output anginal pain and palpitations. BP>
What does the ECG pattern in tachycardia	may show T-wave inversion or ST-segment elevation or depression in response to myocardial ischemia.
What is the most common type of dysrhythmia	Atrial fibrillation (AF)
What is AF	multiple rapid impulses depolarize the atria in a totally disorganized manner at a rate of 350 to 600 times per minute,no atrial contractions, loss of atrial kick, and an irregular ventricular response
What does AF look like on the ECG	The result is a chaotic rhythm with no clear P waves,
What is atrial flutter	a rapid atrial depolarization occurring at a rate of 250 to 350 times per minute, resulting in poor atrial pumping and ↓ CO because the ventricles don’t fill properly b4 contraction
Why does tachycardia reduce CO	ShoRTen the diastolic time and therefore the coronary perfusion time. HR ↑s and CO and BP ↓
What are the effects of aging on the cardiac valves	Calcification and mucoid degeneration occur, especially in mitral and aoRTic valves.
What are the effects of aging on the conduction system	Pacemaker cells ↓ in number. Fibrous tissue and fat in the sinoatrial node ↑. Few muscle fibers remain in the atrial myocardium and bundle of His. Conduction time ↑s.
What are the effects of aging on the LFT Ventricles	size of LFT ventricle ↑s. It becomes stiff and less distensible. Fibrotic changes in the LFT ventricle ↓ the speed of early diastolic filling by about 50%.
Aging on the aorta and other large arteries	Thickes $ become stiffer& less distensible. Systolic BP ↑s to compensate for stiffness. Systemic vascular resistance ↑s as a result of less distensible arteries; →LFT ventricle pumps against greater resistance, contributing to LFT ventricular hypeRTrophy.
Baroreceptors become	less sensitive.
Symptoms & symptoms of HTN	Confusion: Ear noise or buzzing:Fatigue: Headache:Irregular heartbeat: Nosebleed:Vision changes: ↑BP
Pathophisiology of HTN	The basic explanation is that blood pressure is elevated when there is increased cardiac output plus increased peripheral vascular resistance.
Medical treatment for HTN	Alpha blockers: Angiotensin-converting enzyme (ACE) inhibitors: Angiotensin receptor blockers (ARBs): Beta blockers: Calcium channel blockers: Central alpha agonists: Diuretics: Renin inhibitors: Vasodilators
The 3 types of diuretics used to treat HTN	Thiazides: Loop Diuretics: Potassium sparing diuretics
Hydrochlorothiazide	reduces the volume of the blood, decreasing blood return to the heart and thus cardiac output and, by other mechanisms, is believed to lower peripheral vascular resistance
How does hydrochlorothiazide act on the kidney	↓ sodium (Na) reabsorption in the distal convoluted tubule
What type of diuretic is hydrochlorothiazide (Hydordiuril)	Thiazides
What type of diuretic is Chlorothiazide (Diuril)	Thiazides
Name 2 loop duiuretic	Lasix (furosemide), ethacrynic acid (edecrin)
How does Lasix work	Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of H2O, Na, Cl, Mg, K, and Ca
Side effects of Lasix	dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis.
What are 2 K sparing diuretic	spironolactone (aldactone), triamterene (Dyrenium)
What is the action of spironolactone	Causes loss of sodium bicarbonate and calcium while saving potassium and hydrogen ions by antagonizing aldosterone
Major side effect of spironolactone	hyperkalemia
What do beta blockers do	slow the heart, ↓ its workload, and ↓ BP. In atrial fibrillation, they are used to control the heart rate
What are beta blockers used for	treat high blood pressure, angina, heart failure, and abnormal heart rates.
What is carvedilol (Coreg)	a beta-blocker
What are calcium channel blockers used for	to treat high blood pressure HTN, angina (chest pain), heart failure, and some arrhythmias (abnormal heart rhythms).
What is diltiazem (Dilacor XR)	a calcium channel blocker
What do ACE inhibitors do	block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE inhibitors also ↑ plasma renin levels and ↓ aldosterone levels. Net result is SYSTEMIC VASODILATION
What are ACE inhibitors used for	HTN to ↓BP & Heart failure to ↓ afterload and symptoms & pain
What are central alpha agonists used for	↓blood pressure by stimulating alpha-receptors in the brain which open peripheral arteries easing blood flow. They prevent reuptake of norepinephrine in the CNS. They are usually prescribed when all other anti-hypertensive medications have failed.
What are the side effects of a central alpha agonist	dry mouth, drowsiness, and withdraw potential
List 2 examples of a central alpha agonist	clonidine & methyldopa
List 5 examples of vasodilatos	nitroglycerin, terazonsin, nitroprusside, doxazosin & minoxidil
What would the rationale used for administering aspirin	Decreased incidence of transient ischemic attacks and MI
What do angiotensin II blockers do(ARB)	INHB vasocontraction & aldosterone by INHB binding of angio-II to receptors BUT they do not INHB ACE
What are ARB’s used for	they protect against renal failure in patients w/ DM II and don’t cause a cough
What are 2 examples of ARB’s	losartan (Lozaar), olmesartan (Benicar), candesartan (Atacand)
Vasodilation refers to	the widening of blood vessels resulting from relaxation of smooth muscle cells within the vessel walls, particularly in the large arteries, smaller arterioles and large veins.
A temporary imbalance between the ability of the coronary arteries to supply oxygen and the demand for oxygen by the cardiac muscle. As a result, the patient experiences chest discomfort.	Angina Pecoris
It is caused by a temporary imbalance between the coronary arteries' ability to supply oxygen and the cardiac muscle's demand for oxygen.	Angina. Can be caused by CAD
Angina is a symptom of a condition called	myocardial ischemia
Onset of angina	Sudden, usually in response to exertion, emotion, or extremes, in temperature
Onset of MI	Sudden, without precipitating factors, often in early morning
Drugs for angina	Nitroglycerin, aspirin and clopidogrel (Plavix) or prasugrel (Effient)
Disease affecting arteries that provide blood, O2, and nutrients to the myocardium; partial/complete blockage of the blood flow thru the coronary arteries, causing ischemia and infarction of the myocardium, angina pectoris, and acute coronary syndromes.	Coronary Artery Disease
What are signs and symptoms of CAD	Angina, SOB, fatigue, weakness, dysrhythmias, generalized edema, ↓urination, ↑urination at night, weight gain, ↑girth at diaphragm, ↓LOC
What diagnostic tests are done for chest pain	12 lead ECG, serum markers & other blood tests (electrolytes), stress tests, chest x-ray, ECG, angiography and cardiac cauterization
Findings of the patient with left-sided heart failure may include	S3, wheezing or crackles & Paroxysmal nocturnal dyspnea
Assessment findings of a patient with right-sided heart failure may include	are ascites, jaundice, and anasarca (generalized edema)
Heart failure can cause a number of symptoms	SOB , typically worse when lying flat (orthopnea), coughing, chronic venous congestion, ankle swelling, and exercise intolerance
New York Heart Association Functional Classification of Cardiovascular Disability	Class 1 to 5. Mild symptoms to full blown cardiac disease.
Heart failure is caused by	any condition which reduces the efficiency of the myocardium, or heart muscle, through damage or overloading
Brief patho of Heart Failure	↓ force of contraction, due to overloading of the ventricle. A ↓stroke volume, as a result of a failure of systole, diastole or both.↓ spare capacity ↑ HR ↓CO, Hypertrophy, Enlargement of the ventricles
Physiological compensations for heart failure	↓ BP→ arterial vasoconstriction→ CO, ↑ sympathetic stimulation→ ADH & Angiotensin →↑fluid→↑BP &↑blood volume; hormones ↑BP, but put more strain on heart

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