Week 11

Question 1

Ejection Fraction

Answer 1

percentage of total ventricular end-diastolic volume ejected with each beat (normal is 50-75%)

decrease indicates heart failure

Question 2

SA node

Answer 2

“pace maker”

where electrical impulses come from causing the contraction of the atria

Question 3

AV node

Answer 3

conducts action potentials to the ventricles

Question 4

Bundle of HIS

Answer 4

right and left bundle branches, bridge from atria to ventricles

Question 5

Nervous System and Cardiac

Answer 5

Sympathetic: increase conductivity and strength of contraction

Parasympathetic: Slow HR and conduction, reduce strength of contraction, release of acetylcholine

Question 6

B1 Receptor Cardiac

Answer 6

found in SA node, AV node, cardiac monocytes

increases HR, automaticity, contractility

Question 7

B2 Receptor Cardiac

Answer 7

Blood vessel walls

causes vasodilation

Question 8

Alpha 1 Receptor Cardiac

Answer 8

Postsynaptic in the systemic and coronary arteries

causes vasoconstriction

Question 9

Preload

Answer 9

volume/pressure inside ventricle at end of diastole

left ventricular end-diastolic volume (LVEDP)

Laplace law: tension directly related to amt of fluid, wall thickness, and radius of space

Question 10

Afterload

Answer 10

Resistance to ejection of blood from left ventricle

load muscle must move after it starts to contract

determined by system vascular resistance in aorta

Question 11

Myocardial Contractility

Answer 11

myocardium’s ability to stretch and contract in response to filling of the heart with blood

stroke volume and preload

Question 12

Cardiac Output

Answer 12

Stroke Volume x Heart Rate

Question 13

Vascular Endothelium Functions

Answer 13

Filtration
Vasomotor: contract and relax
Inflammation: where the changes happen during inflammation
Angiogenesis: creation of new blood vessels

Question 14

Laminar Blood Flow

Answer 14

parabolic-shaped velocity of blood flow that is straight

Question 15

Turbulent Blood Flow

Answer 15

associated with bruit, blood flowing in many directions

Question 16

Chronic Venous Insufficiency

Answer 16

Inadequate venous return over a long period due to varicose veins or valvular incompetence

causes venous stasis ulcers from pooling blood (from breakdown of endothelial wall)

can cause deep vein thrombosis

Question 17

Stages of Venous Insufficiency

Answer 17

C1: Telangiectasias “spider veins” - little blue veins

C2: Varicose Veins

C3: Edema

C4: Skin Changes - pigmentation, hardening, patterns

C5: Healed venous ulcer (from breakdown of endothelial wall)

C6: Active venous ulcer

Question 18

Primary Hypertension

Answer 18

Essential or idiopathic hypertension (92-95% of HT)

risk factors:
high sodium intake
natriuretic peptide abnormalities
inflammation
larger body habitus
insulin resistance

Question 19

Secondary Hypertension

Answer 19

More acute

Caused by a systemic disease process that raises peripheral vascular resistance or cardiac output

Question 20

Arteriosclerosis

Answer 20

Chronic disease of the arterial system, abnormal thickening and hardening of the vessel walls

Question 21

Atherosclerosis

Answer 21

Form of arteriosclerosis where vessel walls are thickened and hardened by accumulation of lipid-laden macrophages in the arterial wall, plaque development

*arethomas

Question 22

Disorders of the pericardium

Answer 22

Acute pericarditis (often infection)
Pericardial Effusion, associated with decreased heart sounds
- Tamponade - no room for filling, cannot beat effectively

Question 23

Cardiomyopathies

Answer 23

disorder of the myocardium

dilated cardiomyopathy (congestive cardiomyopathy

hypertrophic cardiomyopathy

restrictive cardiomyopathy (stiff)

Question 24

Disorders of the Endocardium

Answer 24

Valvular Stenosis
- Aortic stenosis (could be congenital)
- Mitral stenosis

Valvular Regurgitation
- Aortic (can be congenital or degenerative), Mitral, Tricuspid (more common, can be caused by rheumatic heart disease

Mitral Valve Prolapse Syndrome (most common heart disorder)
- palpitation, tachycardia, chest pain, headiness (possible)

Question 25

Mitral Stenosis

Answer 25

Can be caused by rheumatic heart disease from a strep infection, leading to scarring

Question 26

Bacterial Endocarditis

Answer 26

From infection of the bloodstream fever, chills, fatigue, heart murmurs, SOB

Question 27

Murmurs

Answer 27

Intensity: Grade 1 - faint, barely audible Grade 6 - loudest, audible without stethoscope touching Timing: Systolic - at or after S1 Diastolic - after S2 (early, mid, late)

Question 28

Pathophys of HT

Answer 28

Genetics and Environment Obesity, adipokines, insulin resistance dysfunction of the SNS, RAAS, and natriuretic hormones inflammation leads to: retinal changes, renal disease, cardiac disease, neurologic disease

Question 29

BP Stages

Answer 29

Normal: Up to 120 Elevated: 120-129 Stage 1: 130-139 Stage 2: >140 Hypertensive Crisis: >180

Question 30

Heart Failure

Answer 30

s/s caused by structural or functional damage to the heart pulmonary or systemic congestion inadequate CO

Question 31

Natriuretic Peptides

Answer 31

Atrial NP B-type NP C-type NP control renal sodium excretion (volume control) require potassium, calcium, magnesium released when heart has too much mechanical stress - reduce RAAS and cause vasodilation test for these to indicate heart failure, track progression

Question 32

Diastolic Heart Failure

Answer 32

HFpEF (preserved) pulmonary congestion despite normal stroke volume and cardiac output near normal EF (>50%) causes: myocardial hypertrophy and ischemia, diabetes, valvular and pericardial disease more common in women, S4

Question 33

Systolic Heart Failure

Answer 33

HFrEF (reduced) Pulmonary congestion with decreased stroke volume and cardiac output Low EF <40% causes: MI, cardiomyopathy, long standing pulmonary conditions more common in men, S3

Question 34

Heart Failure Classifications

Answer 34

Stage A: high risk but no structural heart disease Stage B: structural heart disease with no symptoms Stage C: past or current symptoms of HF associated with underlying heart disease Stage D: patients with end-stage disease who need mechanical circulatory support, continuous IV inotrope (help squeeze) infusions, cardiac transplantation, hospice care

Question 35

Right Sided Heart Failure Symptoms

Answer 35

Fatigue, inc peripheral venous pressure, ascites, hepatomegaly and splenomegaly, distended jugular veins, anorexia and complaints of GI distress, weight gain, dependent edema may be secondary to chronic pulmonary problems

Question 36

Left Sided Heart Failure

Answer 36

Paroxysmal Nocturnal Dyspnea, Elevated Pulmonary Capillary Wedge Pressure, Cough, Crackles, Wheezes, Blood-tinged sputum, tachypnea, restlessness, confusion, orthopnea, tachycardia, exertional dyspnea, fatigue, cyanosis

Question 37

Nonpharm HT Treatment

Answer 37

Limit ETOH Restrict sodium consumption Reduce saturated fat and cholesterol; increase fresh fruit and vegetable intake Increase aerobic physical activity Discontinue tobacco use Reduce stress Maintain optimum weight

Question 38

benazapril, enalapril...

Answer 38

ACE inhibitor competitive inhibitor of ACE. arteriolar dilation - lowers BP, venous dilation, suppress aldosterone HTN, MI, Diabetic neuropathy hypotension, hyperkalemia, intractable cough, allergic response (angioedema) first dose hypotension (worse than HT), check VS prior inquire new onset of persistent, dry, irritating cough monitor chem panel, especially potassium

Question 39

losartan, valsartan, candesartan

Answer 39

Angiotensin Receptor Blockers block angiotensin I to II. cause dilation of vessels. reduce secretion of K+, decrease release of aldosterone. increase renal excretion of sodium and water HTN, HF, MI, stroke prevention, diabetic neuropathy hypotension, hyperkalemia, cough monitor for angioedema review chem panel, can worsen renal impairment not for pregnant

Question 40

atenolol, carvedilol, metoprolol, bisoprolol

Answer 40

Beta-Adrenergic Blockers Decrease HR and contractility, block B1 Receptors Decrease excessive SNS stimulation, protect from dysrhythmias, HF progression, HT fluid retention, fatigue, hypotension, bradycardia take apical pulse and VS prior change position slowly to protect from ortho Do not abruptly discontinue, can have adverse reaction Carvedilol often used in class II heart failure

Question 41

nifedipine, amlodipine, felodipine

Answer 41

Calcium Channel Blockers, Dihydropyridine (only act on arteries) Block calcium ion channels, causing vasodilation HTN, angina, atrial fibrillation with RVR (rapid ventricular rate) dizziness, headache, flushing, peripheral edema, gingival hyperplasia ensure baseline VS and ECG avoid grapefruit juice (increases levels) no ETOH

Question 42

verapamil

Answer 42

phenylalkylamine, Calcium Channel Blockers act on arterioles and heart - produce vasodilation, coronary perfusion, decrease myocardial contraction angina pectoris, HTN, cardiac dysrhythmias, migraines flushing, vertigo, heart block, edema to ankles, hypotension check VS monitor for new or worsening edema educate about ortho

Question 43

diltiazem

Answer 43

benzothiazepine, Calcium Channel Blocker block calcium channels in heart and vessels, lower blood pressure angina pectoris, HTN, cardiac dysrhythmias heart block, elevate liver enzymes, hypotension do not use with liver impairment elderly may have increased hypotension check VS

Question 44

hydrochlorothiazide

Answer 44

Thiazide-Like Diuretic inhibit sodium reabsorption in the distal tubules - increase excretion of Na+, water, K+, H+ HTN, edema hypokalemia, hypotension Monitor Labs - CBC, Lytes, Chem Panel, Glucose Monitor VS Monitor for hearing loss

Question 45

doxazosin

Answer 45

Alpha1-Adrenergic Antagonist Block sympathetic receptors in arterioles leading to vasodilation benign prostate hypertrophy dizziness, headache, hypotension, somnolence (sleepiness) caution with use of NSAIDs Concurrent use of other antihypertensives will result in hypotension

Question 46

clonidine

Answer 46

Alpha 2 Agonist Decrease outflow of sympathetic nerve impulses from CNS to heart and arterioles causing vasodilation and reduced CO resistant HT (when nothing else is working, not common) nausea, vomiting, constipation, dry mouth, bradycardia, rebound hypertension when stopped abruptly, CNS depression contraindicated in pregnancy and breastfeeding many drug interactions with other antihypertensives VS - BP and HR Lab: renal function

Question 47

hydralazine

Answer 47

Vasodilator Cause vasodilation by direct relaxation of arterial smooth muscle HTN, HF, hypertensive crisis headache, palpitations, flushing, nausea monitor chem panel and electrolytes monitor for fluid retention abrupt withdrawal cause rebound HTN and anxiety educate on ortho drug-drug: with other antihypertensives cause hypotension, NSAIDs decrease antihypertensive effects