Alterations in Cardiovascular Function and Perfusion Flashcards

Comprehensive review flashcards covering Coronary Artery Disease, lab values, Valvular Dysfunction, Heart Failure, Cardiomyopathy, Pericarditis, Pericardial Effusion, PVD, and PAD based on the lecture material.

What is the primary cause of Coronary Artery Disease (CAD)?

Atherosclerosis, which causes the narrowing or blockage of coronary arteries.

How does reduced blood flow from Coronary Artery Disease (CAD) affect heart tissue?

It decreases oxygen delivery to the myocardium.

How do stable angina and unstable angina differ regarding when symptoms occur?

Stable angina occurs with increased oxygen demand during activity or exertion, whereas unstable angina occurs at rest.

What severe condition can result from complete arterial occlusion in CAD?

Myocardial infarction (MI).

What are eight major risk factors for Coronary Artery Disease (CAD)?

Hypertension, diabetes, smoking, obesity, sedentary lifestyle, hyperlipidemia, family history, and age.

What is the clinical presentation of Coronary Artery Disease (CAD) during its initial stage?

CAD is initially asymptomatic.

What is the most common clinical complaint associated with decreased blood flow in CAD?

Angina (chest pain).

How is anginal chest pain typically described by clients?

Tightness, fullness, or pressure in the midsternal area.

To which anatomical locations can anginal pain radiate?

Left arm, neck, jaw, or back.

Which specific patient populations may not present with typical chest pain during a myocardial infarction?

Female clients, older clients, and clients with diabetes.

What clinical manifestations can accompany angina in CAD?

Diaphoresis, dizziness/lightheadedness, nausea/vomiting, shortness of breath, and weakness.

What is the normal target lab reference range for total cholesterol?

$$<200\,\text{mg/dL}$$

Why is Low-density lipoprotein (LDL) referred to as 'bad cholesterol'?

It is the primary source of plaque build-up in the arteries.

What is the target reference range for Low-density lipoprotein (LDL)?

$$<130\,\text{mg/dL}$$

What function does High-density lipoprotein (HDL) serve in the body?

It acts as 'good cholesterol' by carrying cholesterol away from the arteries.

What are the target HDL reference ranges for males and females?

Males: $>45\,\text{mg/dL}$; Females: $>55\,\text{mg/dL}$

What does C-Reactive Protein (CRP) measure, and what is its normal reference level?

It measures inflammation in the body; normal reference level is $10\,\text{mg/L}$ ($1.0\,\text{mg/dL}$).

What is Creatine Kinase-MB (CK-MB) and what is its detection timeline after myocardial injury?

An enzyme specific to heart muscle; detected within $4\,\text{hours}$, peaks by $24\,\text{hours}$, and returns to normal in $48\text{--}72\,\text{hours}$.

Why is CK-MB clinically useful in cardiac evaluation?

It is useful for detecting re-infarction.

What is the normal reference range percentage for Creatine Kinase-MB (CK-MB)?

$$0\%\text{--}5\%$$

What is the detection timeline and duration of elevation for Troponin I following cardiac injury?

Detected within $4\,\text{hours}$ of symptom onset, peaks in $24\text{--}48\,\text{hours}$, and remains elevated for days.

What is the normal reference range for Troponin I?

$$<0.03\,\text{ng/mL}$$

What is the normal reference range for Troponin T?

$$<0.1\,\text{ng/mL}$$

What is Homocysteine, and how do excess levels contribute to vascular pathology?

An amino acid that breaks down into vitamin $B_{12}$, vitamin $B_6$, and folic acid; excess levels damage the arterial lining leading to blood clots or blockages.

What is the normal reference range for Homocysteine?

$$5\text{--}15\,\text{mcmol/L}$$

What is Myoglobin, and how rapidly is it detectable after myocardial injury?

A blood protein found in cardiac and skeletal muscle; detectable within $1\,\text{hour}$ after myocardial injury.

What are the normal Myoglobin reference ranges for males and females?

Males: $28\text{--}72\,\text{ng/mL}$; Females: $25\text{--}58\,\text{ng/mL}$

What ECG abnormalities are indicative of ischemia or injury in CAD diagnostics?

ST segment elevation in 2 adjoining leads, or ST depression/T wave inversion in 2 adjoining leads.

What diagnostic procedure is considered the gold standard for CAD?

Cardiac catheterization.

What is the clinical purpose of a Stress Echocardiogram in evaluating CAD?

It detects how well the heart is functioning and if there is any decreased blood flow related to CAD.

What occurs during a Nuclear Stress Test?

A radioactive tracer is injected into the patient's vein to assess myocardial blood flow.

What are the key nursing priorities for a patient presenting with CAD?

Assess chest pain characteristics, monitor ECG and cardiac enzymes, and recognize early signs of decreased perfusion.

What principle emphasizes the need for rapid reperfusion during myocardial injury?

'Time is muscle' - rapid reperfusion prevents further myocardial tissue loss.

How is stable angina managed and relieved?

It is relieved by rest or nitroglycerin.

How do STEMI and NSTEMI differ in terms of arterial occlusion and cardiac markers?

STEMI results from abrupt interruption of blood flow (showing ST elevation), while NSTEMI presents similarly with elevated cardiac markers but lacks classic ST elevation.

What occurs in valvular regurgitation?

Diseased valves fail to close normally, causing blood to flow backward.

What occurs in valvular stenosis?

The valve opening becomes narrowed, obstructing forward blood flow.

How does valvular dysfunction impact cardiac workload?

It increases cardiac workload and can lead to heart failure.

What visual differences characterize healthy, stenotic, and regurgitant heart valves shown in cross section?

Healthy valves close cleanly without backflow; stenotic valves develop narrowed and calcified openings; regurgitant valves fail to close completely, leading to backflow.

What are six potential causes of valvular dysfunction?

Rheumatic disease, endocarditis, hypertension, MI, congenital defects, and lupus.

What are the clinical signs and symptoms of valvular dysfunction?

Murmur, dyspnea, fatigue, palpitations, chest discomfort, peripheral edema, and syncope/dizziness.

Which imaging diagnostics are utilized to diagnose valvular dysfunction?

Echocardiogram (TTE/TEE) and Cardiac MRI.

Which diagnostic tests assess cardiac electrical and hemodynamic function in valvular disease?

ECG, cardiac catheterization, and stress testing.

What medications are commonly prescribed to manage valvular dysfunction?

Diuretics, beta blockers, and digoxin.

What invasive procedures or surgeries are used to treat valvular dysfunction?

Valve repair, balloon valvuloplasty, and valve replacement (mechanical or biologic).

What are the primary nursing priorities when caring for a patient with valvular dysfunction?

Monitor symptoms and functional ability, assess heart sounds and edema, and educate on reporting symptom changes.

What is the primary pathophysiology of heart failure?

The heart cannot pump enough blood to meet body demands because ventricles do not fill properly or eject blood properly into systemic circulation.

What underlying cardiovascular conditions can result in heart failure?

CAD, hypertension, MI, diabetes, arrhythmias, and valve disease.

How do manifestations of heart failure affect a client's ability to perform activities of daily living (ADLs)?

Shortness of breath, fatigue, weakness, difficulty sleeping, edema, and depression/hopelessness impair functional ADL performance.

What safety considerations and education should be provided to clients with heart failure?

Self-monitoring manifestations, proper administration of oxygen (if needed), education on reducing modifiable risk factors, and knowing when to report manifestations (especially in ages $65+$).

What are the clinical manifestations of Left-sided Heart Failure?

Shortness of breath, dyspnea, orthopnea, exertional or paroxysmal nocturnal dyspnea, pulmonary congestion, lower extremity edema, weight gain, increased abdominal girth, JVD, hypotension, and tachycardia.

What are the clinical manifestations of Right-sided Heart Failure?

JVD, shortness of breath, chest discomfort, S3 murmurs, palpitations, ascites, peripheral edema, and enlarged liver and spleen.

What defines biventricular heart failure?

Manifestations of both right-sided and left-sided heart failure.

Which diagnostic tools and classification systems assess the clinical severity of Heart Failure?

Framingham Diagnostic Criteria of Heart Failure and New York Heart Association (NYHA) Classification.

What diagnostic criterion table divides heart failure symptoms into Major and Minor Criteria?

Framingham Diagnostic Criteria for HF.

What clinical manifestations constitute the Major Criteria in the Framingham Diagnostic Criteria for HF?

Acute pulmonary edema, cardiomegaly, hepatojugular reflux, neck vein distention, paroxysmal nocturnal dyspnea or orthopnea, pulmonary rales, third heart sound (S3 Gallop), weight loss of $4.5\,\text{kg}$ or more in $5\,\text{days}$ in response to treatment, CVP >16\,\text{cm\,H_2O}, and radiographic cardiomegaly.

What Central Venous Pressure (CVP) reading satisfies a major Framingham criterion for Heart Failure?

Central venous pressure greater than $16\,\text{cm}$ of water.

How much treatment-related weight loss fulfills a major Framingham criterion for Heart Failure?

Weight loss of $4.5\,\text{kg}$ or more in $5\,\text{days}$ in response to treatment.

What clinical findings constitute the Minor Criteria in the Framingham Diagnostic Criteria for HF?

Ankle edema, dyspnea on exertion, hepatomegaly, nocturnal cough, pleural effusion, tachycardia (heart rate $>120/\text{min}$), and a decrease in vital capacity by one-third the maximal value recorded.

What heart rate threshold defines tachycardia as a minor Framingham criterion for HF?

Heart rate greater than $120/\text{min}$.

What functional staging system is outlined in the New York Heart Association (NYHA) Classification of Severity of Heart Failure table?

Classes I through IV, describing progression from no activity limitations to severe symptoms present at rest.

What defines NYHA Class I Heart Failure?

Client is able to perform normal activities and functions; no manifestations.

What defines NYHA Class II Heart Failure?

Client has slight limitations in performing normal activities due to experiencing mild manifestations; at rest is comfortable.

What defines NYHA Class III Heart Failure?

Client has moderate limitations in performing decreased activities due to moderate symptoms; only comfortable at rest.

What defines NYHA Class IV Heart Failure?

Client has severe limitations in performing minimal activities due to severe manifestations; manifestations present at rest.

What general manifestations are associated with NYHA Heart Failure stages?

Chest pain, shortness of breath, fatigue, heart palpitations, and fainting.

What is the diagnostic significance of Brain Natriuretic Peptide (BNP) in HF?

Elevated BNP indicates worsening HF, correlates with NYHA class, differentiates cardiac from noncardiac dyspnea, and monitors treatment effectiveness.

What do elevated BNP levels combined with NYHA classification predict?

Strong predictors of readmission risk and risk of death.

When is cardiac catheterization indicated in a client with Heart Failure?

When heart failure is related to a myocardial infarction (MI).

Why is an Echocardiogram beneficial in diagnosing heart failure?

It assesses both systolic and diastolic dysfunction and identifies abnormalities in wall motion or heart valve function.

What does a chest X-ray evaluate in a client with heart failure?

It assesses the size of the heart and the degree of pulmonary congestion.

What medical management strategies and medications are used to treat Heart Failure?

Sodium/fluid management, ACE inhibitors, ARBs, ARNIs (Entresto), Beta blockers, Diuretics, and ICD or biventricular pacemaker.

What rate of weight gain serves as a must-know exam fact indicating worsening Heart Failure?

Weight gain of $2\text{--}3\,\text{lb/day}$ or $5\,\text{lb/week}$.

What are the essential nursing priorities for managing a client with Heart Failure?

Daily weights, monitoring fluid overload, assessing lung sounds, monitoring ability to perform ADLs, and teaching medication and diet adherence.

What advanced supportive device is depicted in a client managing severe mechanical circulatory assistance?

A Left Ventricular Assist Device (LVAD) with external battery pack and abdominal driveline dressing.

What key pathophysiological features define Dilated Cardiomyopathy?

Ventricular enlargement and poor contraction.

What key pathophysiological features define Hypertrophic Cardiomyopathy?

Thickened ventricular walls, often genetic in origin.

What key pathophysiological features define Restrictive Cardiomyopathy?

Stiff ventricles with poor filling.

What pathophysiological changes occur in Arrhythmogenic Cardiomyopathy, and what lethal rhythms can result?

Fibrous-fatty replacement of myocardium causing lethal arrhythmias such as ventricular tachycardia and ventricular fibrillation.

What are common symptoms and primary risks associated with Cardiomyopathy?

Fatigue, dyspnea, chest discomfort, palpitations, edema, and risk of sudden cardiac death.

What treatments are utilized for managing Cardiomyopathy?

Lifestyle modifications, diuretics, ACE inhibitors, beta blockers, ICD placement, LVAD, and heart transplant for advanced disease.

What is the pathophysiology of Pericarditis?

Inflammation of the pericardial sac of the heart, which can result in a rigid and constricted pericardium if untreated.

How is pericarditis pain described, and how does position affect it?

Pain is sharp and pleuritic, may radiate to the shoulder, and worsens when laying flat.

What are common causes and risk factors for Pericarditis?

Usually idiopathic, respiratory/viral infections, bacterial infections, cancer (lung, breast, lymphoma), and autoimmune disorders (hypothyroidism, lupus).

What classic ECG changes occur in acute Pericarditis?

ST elevation and PR depression.

What pharmacological treatments are indicated for Pericarditis?

NSAIDs, Colchicine, and Glucocorticoids when needed.

What physical restriction is required for clients recovering from acute pericarditis?

Avoid strenuous activity for $3\,\text{months}$.

What is the pathophysiology of a Pericardial Effusion?

Fluid accumulation in the pericardial sac compresses the heart and decreases cardiac output.

What clinical manifestations indicate a Pericardial Effusion?

Hypotension, tachycardia, muffled heart sounds, dyspnea, chest pain, and fatigue.

What invasive procedure shown below drains pericardial fluid under ultrasound or fluoroscopic guidance?

Pericardiocentesis.

What is a pericardial window?

Removal of a small portion of the pericardial sac to allow continuous drainage of fluid into the pleural space.

What defines Chronic Venous Insufficiency (CVI)?

Constant increased venous pressure caused by improperly working venous valves or venous obstruction.

What three factors constitute Virchow's Triad in Venous Thrombosis?

Injury or changes to the wall of the vein, abnormalities in blood clotting components, and slowed or stopped blood flow within the vein.

What elements does the CEAP tool evaluate in Chronic Venous Disease?

Clinical manifestations, Etiology (primary, secondary, congenital), Anatomy (superficial, deep, perforators), and Pathophysiology (obstruction or reflux).

What are common clinical manifestations of Peripheral Vascular Disease (PVD)?

Varicose veins, brown ankle pigmentation, edema, pruritus, venous ulcers, and leg heaviness.

How does valve function differ between normal veins and varicose veins as shown below?

Normal veins have intact valves ensuring unidirectional upward blood flow, whereas varicose veins have incompetent valves allowing abnormal retrograde blood flow and pooling.

Which diagnostic tests evaluate vascular patency, volume changes, and venous reflux in PVD?

Duplex ultrasound (assesses vascular patency, valve competence, and reflux) and Plethysmography (measures leg blood volume changes).

What key nursing interventions are implemented for clients with Peripheral Vascular Disease?

Compression therapy, leg elevation, exercise, wound care, weight reduction, history taking, lower extremity assessment, and safety/fall assessment.

What classic presentation and risk factors characterize Peripheral Artery Disease (PAD)?

Progression of arterial atherosclerosis causing intermittent claudication (walking pain relieved by rest), diminished pulses, pale/shiny skin, poor wound healing, and reduced leg hair growth.

What are the '6 Ps' of Acute Limb Ischemia in Peripheral Artery Disease (PAD)?

Pain, Pallor, Pulselessness, Paresthesia, Paralysis, and Poikilothermia (cool limb).