Exam 2: Cardiac Conditions

Atherosclerosis vs arteriosclerosis

Athero: form of arteriosclerosis in which the arteries are blocked due to plaque buildup

Arterio: chronic hardening/stiffening of the arteries

consistently elevated systemic arterial BP

Hypertension

An increased ______ and total _______ ________ ________ causes hypertension.

1. CO (high volume)

2. peripheral vascular resistance

Which pt is most likely to have hypertensive issues?

A. 43 yrs, male, white

B. 70 yrs, female, black

C. 40 yrs, male, black

D. 55 yrs, male, black

E. 60 yrs, female, white

D

Stage 2 hypertension?

140 or higher/90 or higher

Secondary hypertension (HTN) is caused by ______ diseases. 3 examples are…

systemic

1. renal failure

2. adrenal disorders

3. vascular disease

T or F: narcotics, stimulants, and depressant drugs—such as oxycodone, methadone, and fentanyl—can cause hypertension.

T

Which of the following is not a cause of hypotension?

A. atomic variations

B. altered body chem.

C. antihypertensive therapy

D. antidepressants

E. immobility

F. prolonged stress

G. starvation

H. physical exhaustion

I. hypovolemia

J. pooling in veins

F

What is the #1 reason for hypotension? #2?

1. volume depletion (dehydration)

2. drug therapy

Your pt came in with a cold. Now, c/o or blurred vision and an overwhelming feeling of nausea. They have eaten lunch already. Their subjective interview data states that they take vitamin B once every day in the mornings and antihypertensive drugs once once every day at night. What might your pt’s issue be?

A. aspiration

B. aneurysm

C. pulmonary fibrosis

D. hypotension

E. MI

D

You are completing your initial physical assessment, and are at examining the feet. Your pt came in with a cold. Now, c/o or blurred vision and an overwhelming feeling of nausea. They have eaten lunch already. Their subjective interview data states that they take vitamin B once every day in the mornings and antihypertensive drugs once once every day at night. What should you do next?

A. continue with the physical assessment of their feet, document, then take vital signs

B. document then immediately fetch a cold towel and place it over their forehead and eyes

C. check orthostatic BP, then document

D. check orders for IV fluid needs, administer IV, document

C

What quantities define hypotension?

<90/<60

localized dilation of vessel wall/cardiac chamber (pouch that protrudes outward)

Aneurysm

What cardiac structure is most susceptible to aneurysms?

A. pulmonary trunk

B. aorta

C. SVC

D. RA

E. LV

B

What is the most common cause of aneurysms? second?

1. atherosclerosis

2. syphilis/other infections

T or F: hypotension causes aneurysms.

F (hypertension)

What are the 2 types of aneurysms? Define them.

1. true: real weak spot that causes an arterial bulge; involves all 3 layers of vessel

2. false: extravascular hematoma filled with blood caused by arterial injury/block canal

What is another name for a false aneurysm?

saccular

What are 2 other names for true aneurysms?

1. fusiform

2. circumferential

When does a pt stop being asymptomatic with an aneurysm? What are the first 3 symptoms?

when artery ruptures (hole)

1. pain

2. dysphagia

3. dyspnea

hard, scaly, and possibly thick fat/sugar buildups

plaque

Plaque is often caused by… (2)

1. diabetes

2. hyperlipidemia

Plaque in the brain leads to…

stroke

Why do aneurysms affect swallowing?

dysphagia bc bulge pushes up and over on esophagus

Why do aneurysms affect breathing?

dyspnea bc bulge takes up space, so thoracic pressure changes in the cavity

What happens if an aneurysms continues to leak into the abdomen?

distention then death

How can you treat aneurysms? Select all that apply.

A. surgery

B. exercises

C. diet changes

D. drug therapy

A

perforated arterial wall that separates its 3 layers rather than ballooning out entire wall

Dissecting aneurysm

clot attached to vessel wall

Thrombus

clot that travels from site where it was form

thromboembolism

What might cause thromboembolism?

conditions that promote coagulation/clotting cascade

Why is a blood clot dangerous to dislodge?

may block blood flow from heart (MI), brain (stroke), or lungs (pulmonary infarction)

vein inflammation characterized by long red line up vein caused by blockage of vein from a blood clot

Thrombophlebitis

What condition might you be worried about concerning the causation of thrombophlebitis?

A. 2 week use of antibiotics

B. arteriosclerosis

C. thromboembolisms

D. hormonal supplements

E. 3 day period of IV catheter use

E

T or F: venous clots are more dangerous than arterial clots.

F

bolus circulating bloodstream (usually made up of air)

Embolism

Which of the following can not form an embolism in the arteries?

A. air

B. amniotic fluid

C. WBC pus

D. fat

E. bacteria

F. cancer cells

G. mercury from drugs

D. thrombus

C

An obstruction of a vessel causes by an embolus can lead to _____ or _____ distal to to the obstruction site. This later leads to organ ______ and _____.

1. ischemia

2. infarction

3. dysfunction

4. pain

T or F: a huge bubble is more fatal than smaller, broken up bubbles.

F

Arteriosclerosis decreases an arteries ability to change _______ ____.

lumen; size

stiffness

sclerosis

What 2 substances within the arteries lead to atherosclerosis?

A. RBC

B. calcium

C. lipids

D. cellular waste

E. fibrin

C, E

What is the #1 cause of atherosclerosis? #2? Other 2?

1. age/genetic predisposition

2. physiologic status (health)

3. vessel location

4. risk factors

Which of the following are not risk factors of atherosclerosis. Select all that apply.

A. smoking

B. HTN

C. drug abuse

D. diabetes

E. autoimmune diseases

F. infections

C

What is the leading contributor to CAD and strokes?

atherosclerosis

T or F: atherosclerosis is always uncontrollable.

F (controllable unless genetics)

T or F: atherosclerosis decreases afterload

F

vascular disease that narrows/occludes coronary arteries (heart)

Coronary artery disease (CAD)

Which of the following is a modifiable risk factor of CAD?

A. hyperlipidemia

B. genetics

C. male

D. family history

A

too many fats in blood (cholesterol and triglycerides)

Hyperlipidemia

Which of the following is not a modifiable risk factor of CAD?

A. hyperlipidemia

B. hypertension

C. smoking

D. diabetes

E. obesity

F. not exercising

G. NSAIDs

H. estrogen deficiency

I. alcohol

J. anxiety

K. anger

L. poor diet

G

What does NSAIDs stand for? What are they used for?

nonsteroidal anti-inflammatory drugs; pain and fever (inflammation0

local, temporary impaired blood flow to myocardium

Myocardial ischemia

Which of the following is false about chronic myocardial ischemia?

A. it causes stabile angina

B. it causes prinzmetal angina

C. it causes silent ischemia

D. it causes acute dyspnea

D

middle muscle layer of heart

Myocardium

T or F: myocardial ischemia developed within 5 seconds of deprivation.

F (10 secs)

Myocardial ischemia occur due to insufficient coronary blood flow that fails to meet the metabolic demands of ______ ______

myocardial cells

Which of the following is not a cause of reduced blood supply/flow?

A. increased demand

B. starvation

C. tachycardia

D. valvular dysfunction

E. low hemoglobin

F. shock

G. plaque buildup

B

Shock is a systemic disorder, or ______ failure, caused by the heart not being able to _______ ____ ______ as needed due to blood being stuck in places.

1. multisystem

2. squeeze as fast

Which of the following does not increase the demand of blood supply?

A. hypertension

B. stress

C. hyperthyroidism

D. hyperkalemia

E. anemia

D

What is the most common cause of CAD?

atherosclerosis

What is the most common cause of myocardial ischemia?

atherosclerosis

Coronary artery blockage on LV —> ________ —> LV dysfunction —> ______

ischemia; death

What is the difference between prinzmetal and stable angina?

s: chest pain that comes and goes based on exertion (strain)

p: chest pain at rest

Your pt has stable angina. What medication should they take?

A. beta blockers

B. nitroglycerin pills

C. NSAIDs

D. amoxicillin

E. blood clotting drugs

B

What question do you ask to find out if angina has a cardiac or pulmonary cause? What do the 2 answers to this mean?

Is there a cough?

dry, hacking: pulmonary

wet: cardiac

T or F: males tend to have more cardiac related issues.

F

severe, sudden inflammation of the pericardium

acute pericarditis

Which of the following does not cause acute pericarditis?

A. infection

B. uremia

C. shock

D. neoplasm

E. MI

F. surgery

G. trauma

C

Which of the following are manifestations of acute pericarditis? Select all that apply.

A. dyspnea

B. irritability

C. anxiety

D. restlessness

E. muffled heart sounds

F. weakness

G. dysphagia

H. low systolic BP

I. high diastolic BP

J. malaise

K. fever

L. bradycardia

M. tachycardia

B, C, D, F, G, J, K, M

general feeling of being unwell; discomfort; worn out

Malaise

What is the #1 cause of acute pericarditis? #2?

1. trauma

2. infection

T or F: pericarditis pain is similar to pleuritic pain.

T

T or F: acute pericarditis pain worsens with breathing and exertion.

F (exertion is true but lying down > exertion)

Your pt has acute pericarditis. What medication should they take?

A. beta blockers

B. nitroglycerin pills

C. NSAIDs

D. amoxicillin

E. blood clotting drugs

C

accumulation of fluid in cavity/sac that lines the heart

Pericardial effusion

What are the 2 types of pericardial effusion? Define them.

1. serous: thin, watery

2. exudate: pus

fluid

Effusion

Pericardial effusion causes _______, which is the compression of the heart. This leads to (decreased/increased?) CO and later shock.

1. tamponade

2. decreased

What indicates tamponade? Define it.

pulsus paradoxus: >10 mmHg fall in BP during inspiration (widened valueses bn systolic and diastolic BP)

Which of the following is not a clinical manifestation of pericardial effusion?

A. dyspnea on exertion

B. muffled/distant heart sounds

C. acute hypertension

D. dull angina

C

Why is a severe pleural effusion an emergency?

fluid is drowning the heart by putting great pressure on heart and vessels

What are 2 ways to relieve pericardial effusion?

1. draw off fluid with needle (most common)

2. pericardial window: hole in sac for drainage

heart disease making it harder to heart to pump blood

Cardiomyopathy

Cardiomyopathy is caused by ________ of the myocardium secondary to ___ and ______.

1. remodeling

2. hypertension

3. ischemia

Which of the following is not a reason why ventricular tissues enlarge?

A. infection

B. toxins

C. starvation

D. hyperglycemia

E. hypertension

F. ischemia

D

What are the 3 types of cardiomyopathy? List and describe them.

1. dilated- thinning/stretching of ventricles (large area)

2. hypertrophic- thickening/stiffening of LV (small area)

3. restrictive (amyloid)- stiff ventricles cause lack of pumping

T or F: hypertrophic cardiomyopathy is the most common type of cardiomyopathy.

F (dilated and restrictive are the most common)

stiff valves that constrict and thus inhibit blood flow (narrowing)

valvular stenosis

T or F: workload in front of areas experiencing valvular stenosis are decreased.

F (increased)

What does a valve that doesn’t close all the way (due to stenosis) cause?

blood regurgitation

backward blood flow

Regurgitation

Regurgitation causes an (increase/decrease) in the volume that the heart must pump, and an (increase/decrease) in the atria/ventricle’s workload.

x2 increase

Which of the following does not increase afterload?

A. vasoconstriction

B. regurgitation

C. stenosis

D. low vascular resistance

D

List and define the 2 types of stenosis.

1. aortic: narrowing semilunar aortic valve (impair blood flow from LV to body)

2. mitral: narrowing of the L atrioventricular valve (impair blood flow from LA to LV)

List whether these instances cause aortic (A) or mitral (M) stenosis.

1. rheumatic heart disease

2. acute rheumatic fever (infection)

3. damage from inflammation

4. congenital malformation

5. bacterial endocarditis

6. infective endocaritis

7. degeneration

8. calcification

1. A

2. M

3. A

4. A

5. M

6. A

7. A

T or F: aortic stenosis develops quickly and suddenly.

F

What are the clinical manifestations of aortic stenosis?

A. LV hypertrophy (LVH)

B. low SV

C. high systolic BP

D. low systolic BP

E. low (narrowed) pulse pressure

F. bradycardia

G. tachycardia

H. chamber dilation

I. high CO

A, B, D, E, F

What are the clinical manifestations of mitral stenosis?

A. LV hypertrophy (LVH)

B. low SV

C. chamber dilation

D. low systolic BP

E. edema

F. bradycardia

G. pulmonary HTN

H. chamber dilation

I. low CO during exertion

J. RV failure

A, C, E, G, I, J