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