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Cardiac Impairments

What is a TEE? Transesophageal Endoscope- Procedure used to view outside of heart (Blood vessels, etc.)
What is the heart's natural pacemaker? SA Node
What happens if the SA node stops functioning? The AV node compensates temporarily until problem is resolved.
What happens if a left or right bundle branch is blocked? The other side (L or R) compensates temporarily.
What happens to the conduction in the heart is O2 is low? Can't function correctly and MI can occur
What is the term for contraction of the myocardium? Systole
What is the term for relaxation of the heart (filling of the ventricles with blood)? Diastole
What is the term for the amount of blood ejected from the ventricles with each heartbeat? Stroke volume
What is the term for the amount of blood pumped by each ventricle in one minute? Cardiac output
What is the term for the percentage of the total volume of blood ejected with each heartbeat (Measures what was ejected compared to what is left in percentages)? Ejection fraction
How is the ejection fraction measured? Echocardiogram
In blood pressure, which is always present, systole or diastole? Systole
What system is the HR regulated by? Autonomic nervous system
What 3 factors affect stroke volume? Preload, afterload and contractility
What is the degree of stretch of cardiac muscle at the end of diastole (filling), PRIOR to contraction? Preload
If blood volume is increased, what happens to preload? Increases
What is the resistance the ventricles must overcome to eject blood into systemic circulation? Afterload
If blood pressure (resistance) increases, what happens to afterload? Increases
What body system affects afterload and how? Sympathetic nervous system (fight or flight)- HR increases
What is the force of contractions generated by myocardial muscle? Contractility
What are two factors that can decrease contractility? Arrhythmias and fibrillation
What med is given to increase contractility which allows the heart to not work as hard? Digoxin
What must you check before administering Digoxin and why? HR- Digoxin decreases HR
What is defined as the number of complete cardiac cycles per minute? Heart rate
What do chemoreceptors do for the heart? Measure amount of 02
What do baroreceptors do in the heart? Measure blood pressure
What two places in the heart are baroreceptors located? Aortic arch and carotid sinuses
If baroreceptors sense blood pressure is not in an ideal range, what do they do? Signal the medulla to either increase or decrease HR
What enzyme stimulates release of angiotension? Renin
What hormone constricts blood vessels thereby increasing blood pressure? Angiotension
As we age, collagen increases while elastin decreases. T or F? True
What series of cardiac events can lead to SOB? Preload increases ad forces heart to work harder to pump blood, causing SOB
What is a common cause (not severe) of chest pain in women? Indigestion
If a pt presents with chest pain, what are the first two things you do? EKG then call MD
What is the only narcotic that can truly relieve chest pain? Morphine
Because ACE inhibitors are less effective in African Americans, what is a common alternative? Thiazides
What drug typically requires African Americans to get a higher dose while Asian Americans get a lower dose? Beta blockers
What is the term for the enzymes released into the bloodstream from damaged myocardial cells? Cardiac markers
What cardiac marker is present in all muscles and brain tissue and can give a false positive if a pt was exercising before the test? CK- Creatinine kinase
What test is 95% specific to cardiac tissue, rises 4-6 hrs after onset of chest pain and peaks after 18-24H? CK-MB
What test is 100% specific to cardiac tissue and begins rising at onset of damage, even if pt is symptomatic? Troponin
What is a normal Troponin level? <0.1%
What level of LDL is recommended for pt's with CAD compared to a pt with no CAD? CAD: <70 No CAD: <160
What test is used for measuring cholesterol? Non-fasting blood draw
What level is recommended for total cholesterol (HDL and LDL combined)? <200
What do elevated triglycerides as well as elevated cholesterol place pt at risk for? CAD
What is the term that describes how much fat is in the blood? Triglycerides
What test do we use to measure triglycerides? Fasting blood draw (min. 12H and no ETOH for 24H)
What is the recommended level for triglycerides in a diabetic pt compared to that of a non-diabetic pt? Diabetic: <150 Not diabetic: 100-200
What lab values are included in serum chemistry? NA, K, Ca, Mg, BUN, Cr, Glucose
What are the normal values for Na and what symptoms appear if Na in not WNL (within normal limits)? 135-145 Neurologic (confusion)
What are the normal values for K and what can occur if levels are not WNL? 3.5-5.0 Arrhythmmias and renal impairment
What are the normal values for glucose? 70-110
What are normal BUN values and what is indicated if BUN is low? 10-20, Fluid overload
What are normal Cr levels and what is indicated if levels are high? 0.6-1.2, Kidney failure
What is indicated with an elevated BUN and a normal Cr? Dehydration
What are normal levels for PTT? 25-38, Pt on Heparin: multiply baseline by 1.5-2.0
What are normal levels for PT? 12-18, Pt on Coumadin: multiply baseline by 1.0-1.5
What are normal levels for INR? 2.3 if on COumadin for DVT or pulmonary embolism 2.5-3.5 for pt with Afib or prosthetic valve
How do we measure efficacy of Lovenox? We can't. We can only measure platelets.
What tests do we use to measure efficacy of Coumadin? PT/INR
What tests do we use to measure efficacy of Heparin? PTT
What is the typical dose for Lovenox considering its half life? Lovenox has a half life of 12H so it is usually given 2x/day
What cell carries Hgb? RBCs
What cells are elevated in the event of infection? WBCs
What are our clotting factors? Platelets
What are 2 meds that prevent platelet aggregation (sticking)? Lovenox and Plavix
What protein in our blood carries oxygen? Hgb
What measures the amount of RBCs in the plasma? Hct
What is the condition where there are too many RBCs creating thickened blood? Polycythemmia
Why is ASA given to a pt with chest pain? If the problem is an occlusion, ASA will prevent platelets from sticking and causing a full blockage.
How does low Hgb manifest in the respiratory system? SOB
What is the marker of choice for distinguishing cardiac vs. respiratory cause of dyspnea? BNP or B-type Natriuretic Peptide
What is BNP specific to? CHF
What level of BNP indicates HF? >100
What is a marker of inflammation that can predict cardiac events such as CHF, angina, etc.? CRP or C-reactive protein
What test predicts MI? None
What amino acid indicates risk for CV disease when elevated? Hcy or Homocysteine
What is a diagram of the electrical activity of the heart? Electrocardiogram or EKG
What are 6 events an EKG can show? Dysrhythmias, conduction abnormalities, **lack of O2 to heart muscle**, Afib, misfires and blockages
What test evaluates CV response physical exercise or med. induced (nuclear) stress? Cardiac stress test
If a pt fails a stress test (body responds in an unhealthy way), is the test considered positive or negative? Positive
What must pt refrain from before a stress test? Stimulants, NPO per provider, and some meds (beta blockers)
What systolic and diastolic levels are considered normal in an adult BP reading? Systolic: <120 Diastolic: <80
What systolic or diastolic levels indicate prehypertension? Sys: 120-139 Dias: 80-89
What sys. and dias. levels indicate stage 1 HTN? Sys: 140-159 Dias: 90-99
What sys. and dias. levels indicate stage 2 HTN? Sys: >160 Dias: >100
What is the formula for BP? CO x SVR= BP
Vasodilation decreases BP while vasoconstriction increases BP. T or F? True
Where are Alpha and Beta receptors located and what do they affect? In the Sympathetic Nervous System. Affect preload, afterload and contractility
What part of the body controls sodium excretion, ECF volume and controls the RAAS, contributing to BP regulation? Kidneys
What is stimulated by A-II to release aldosterone? Adrenal cortex
What gland releases ADH? Posterior pituitary
Does water retention and edema increase or decrease BP? Increase
What type of HTN is due to loss of elasticity in vessels and is measured by sys >140 and dias <90? Isolated systolic HTN
What type of HTN includes 90-95% of all pt.s with HTN? Primary HTN
What type of HTN is caused by another disease or medication? Secondary HTN
Name four risk factors for developing HTN? Obesity, family history, sedentary lifestyle and smoking
What are 5 common S&S of blood pressure abnormailties? Nosebleeds, dizziness, HA, blurred vision, ear ringing
A pt with HTN is at high risk for developing failure of what body system? Renal
What is the name of the diet specifically used to try to prevent or stop hypertension? DASH diet
What are 2 common diuretics? Lasix and thiazide
What should be monitored for with pt.s on diuretics? Hypokalemia
What class of meds blocks angiotension (vasoconstrictor) thereby reducing BP? What does the drug name typically end with? ACE inhibitors- "pril"
What class of meds block receptors causing decreased CO and HR? What does the drug name typically end with? Beta blockers- "lol"
What class of meds interferes with flux ions from entering smooth muscle causing vasodilation, decreasing BP and HR? Calcium channel blockers
WHat are 2 examples of calcium channel blockers? Verapamil, Calan and Norvasc
Created by: mm318