Test 4

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Aneurysm

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1

Aneurysm

Weakening of an artery, Wall of artery weakens and stretches, risk of clot formation

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2

Where can an artery occur?

abdominal aorta, thoracic aorta, cerebral femoral, and popliteal arteries

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3

Aneurysms can...

rupture - exsanguination (bleeding), hemorrhage

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4

Risk factors of Aneurysms

congenital defects, atherosclerosis, hypertension, dyslipidemia, diabetes mellitus, tobacco, advanced age, trauma

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5

True aneurysms

affect all 3 vessel layers

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6

Saccular aneurysm

bulge on the side

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7

fusiform aneursym

occurs the entire circumference

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8

false aneurysms

does not affect all 3 layers of the vessel

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9

dissecting aneurysms

occurs in inner layer

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10

aortic aneurysm

involve any part of the aorta, look for pulsating mass, most dreaded complication is rupture, risk increases with size of aneurysm, dissecting aneurysm is acute, life threatening

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11

signs and symptoms of aneurysms

depend on location and size, may be asymptomatic, may include: pulsating mass, pain, respiratory difficulty, and neurologic decline

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12

diagnosis of aneurysms

exam, x-ray, echocardiogram, CT, MRI, arteriograph

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13

Tx of aneurysms

eliminating or managing cause and surgery

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14

Risk factors of hypertension

advancing age, ethnicity, family history, being overweight or obese, physical inactive, tobacco use, high-sodium diet, low-potassium diet, high vitamin D intake, excessive alc. intake, stress and other chronic conditions

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15

hypertension

prolonged elevation in bp, excessive cardiac workload due to increased afterload and vasoconstriction

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16

sign & symptoms of hypertension

fatigue, HA, malaise, and dizziness; early detection and management is essential to prevent complications

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17

complications of hypertension

atherosclerosis, aneurysms, heart failure, stroke, hypertensive crisis, renal damage, vision loss, metabolic, syndrome, memory problems

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18

lifestyle modification has been shown to reduce BP

wt reduction, regular exercise, reduce salt, smoking cessation, reduce alc

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19

Primary HTN

most common form, develops gradually over t

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20

secondary HTN

tends to be more sudden & severe causes: renal disease, adrenal gland tumors, certain congenital heart defects, certain meds, illegal drugs

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21

Hypertensive Crisis/Malignant HTN

acclerated or severe form may not respond as well to tx situations in which markedly elevated BP is accompanied by progressive or impending target-organ damage associated w/ secondary HTN diastolic BP>120 severe HTN= SBP>180/DBP>110 hypertensive urgency= DBP>110 and HA or dyspnea hypertensive emergency = DBP>120 and rapidly progressing damage and symptoms

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22

Pregnancy-induced hypertension

S/Sx: high blood pressure, proteinuria, edema Risk factors: history of pregnancy-induced hypertension, renal disease, diabetes mellitus, multiple fetuses, and maternal age less than 20 years or greater than 40 years May cause seizures, miscarriages, poor fetal development, and placental abruption TX: bed rest and magnesium sulfate

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23

Pheochromocytoma

Tumor of chromaffin tissue that contain sympathetic nerve cells that stain with chromium salts. Most commonly in adrenal medulla Can cause serious hypertension Tumor cells secrete epinephrine and norepinephrine. Hypertension is from massive release of catecholamines. Periodic episodes of HEADACHE, excessive sweating, palpitations, nervousness, tremor, pallor, weakness, fatigue May have sustained or intermittent HTN.

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24

Coarctation of Aorta

Narrowing of the aorta. • Results in increase in systolic BP and blood flow to upper body; Blood pressure in lower extremities may be normal or low. • Need to take BP in both arms and one leg! • Maintenance of blood pressure to lower body probably a result of renin-angiotensin-aldosterone system activated by decreased renal blood flow. TX: surgical repair or balloon angioplasty

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25

Oral Contraceptives

• Most common cause of secondary hypertension in young women. • Take blood pressure regularly. • May increase risk of long-term development of hypertension. • Complications usually in >35 and smokers.

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26

Target organ damage

Typically asymptomatic • Problems usually associated with kidneys, heart, eyes, blood vessels. • Risk of atherosclerosis • Increased workload on the heart • Chronic HTN leads to kidney problems • Dementia and other cognitive problems more common.

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27

orthostatic hypotension

• Abnormal drop upon standing • Baroreceptors in thorax and carotid sinus initiate reflex constriction of veins and arteries • AKA postural hypotension. • Causes: Reduced blood volume, medications, aging, bedrest and immobility, and autonomic nervous system disorders

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28

varicose veins

• Engorged veins resulting from valve incompetency • Most common in the legs • May also occur as esophageal varices and hemorrhoids • Can cause stasis pigmentation, subcutaneous induration, dermatitis, and thrombophlebitis • Risk factors: genetic predisposition, pregnancy, obesity, prolonged sitting or standing, alcohol abuse and liver disorders (esophageal varices), and constipation (hemorrhoids)

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29

S/Sx of Veins

–Pedal edema –Fatigue –Aching in the legs –Shiny, pigmented, hairless skin on the legs and feet –Skin ulcer formation -Irregular, purplish, bulging veins

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30

Dx & Tx of Varicose Veins

exam, Doppler ultrasound, and venogram

elevate affected leg, compression stockings, avoid prolonged standing or sitting, exercise, sclerotherapy(treat bv malformations), and surgical removal

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31

venous thrombosis

Stationary blood clot • Virchow’s Triad – endothelial injury, sluggish blood flow, and increased viscosity • Emboli – traveling body –Maybe a thrombus, air, fat, tissue, bacteria, amniotic fluid, tumor cells, and foreign substances –Can become lodged in places like the lungs, brain, and heart

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32

S/sx, DX of venous thrombosis

Depends on location

Arteriography, ultrasound, echocardigram, MRI

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33

Prevention of Venous Thrombosis

increasing mobility, hydration, antiembolism hose, sequential compression devices, antiplatelet agents, and anticoagulants

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34

Tx of Venous Thrombosis

thromblytic agents and embolectomy

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35

D/o that affect whole heart

Coronary Artery Disease, Pericardial Disorders, Myocardial Diseases

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36

Coronary Artery disease

Atherosclerotic changes of the coronary arteries, impairs myocardial tissue perfusion, angina (stable & unstable), infarction, causes are arthrosclerosis, vasospasms, thrombus blood clots and cardiomyopathy

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37

Angina

Intermittent chest pain resulting from myocardium ischemia

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38

Stable angina

Goes away with the demand reduction while doing some thing

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39

Unstable angina

increased intensity or frequency, does not go away with the demand reduction, or occurs at rest

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40

Infarction

Necrotic damage to myocardium

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41

Complications of coronary artery disease

Myocardial infarction, heart failure, dysrhythmias, and sudden death

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42

Signs and symptoms of coronary artery disease

Angina, indigestion like sensation, nausea, vomiting, clammy extremities, diaphoresis, and fatigue

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43

Diagnosis of coronary artery

History, exam, contributing factors, stress test, echocardiogram, ECG

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44

Treatment of coronary artery disease

Similar to dyslipidemia/atherosclerosis but add meds to help reduce workload on the heart and manage blood pressure and dysrhythmias and O2

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45

Acute coronary syndrome

ECG changes and serum cardiac markers

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46

Acute coronary syndrome ECG changes

T-wave inversion, ST segment depression or elevation, abnormal Q wave, T wave and ST segment also known as ventricular repolarization are usually the first involved in myocardial ischemia and injury

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47

Acute coronary syndrome serum cardiac markers

Proteins released from the necrotic heart cells like myoglobin, creatine kinase, troponin

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48

Acute myocardial infarction

Death of the heart muscle, coronary artery blood flow is blocked due to atherosclerosis, thrombus, or vasospasms, risk factors are the same as those for atherosclerosis

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49

Signs and symptoms of acute MI

Some asymptomatic - “silent” MI, includes angina, fatigue, N/V, SOB, sweating, indigestion, elevation in cardiac markers, EKG changes, neck/ear pain and women may present with different symptoms in men

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50

How is chest pain in acute myocardial infarction

Severe, crushing, constrictive or like heartburn

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51

How is the sympathetic nervous system response in acute myocardial infarction

GI distress, nausea, vomiting, tachycardia, vasoconstriction, anxiety, restlessness, feeling of impending doom

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52

Hypotension and shock in acute myocardial infarction

Weakness in arms and legs

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53

Diagnosis of acute MI

Exam, ECG, cardiac markers, stress testing, nuclear imaging and angiography

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54

Treatment of acute MI

Treatment varies depending on timing of treatment, need to reestablish blood flow within 20 to 40 minutes, I want to limit the formation of fibrous scar tissue

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55

Immediately MONA in acute myocardial infarction

Pain management (MORPHINE) Increase O2 (OXYGEN) Open up vessels (NITRATE) Keep platelets from blocking (ASPIRIN)

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56

What else can you administer in acute MI

Thrombolytics which are clot busters

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57

Post MI

Similar to those for atherosclerosis

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58

Complications of acute MI

Heart failure, dysrhythmias, cardiogenic shock, pericarditis, thromboemboli/thrombosis, rupture of the heart, death, ventricular aneurysms

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59

Chronic ischemic heart disease

Imbalance in blood supply and the heart demands for oxygen When there is less blood… Atherosclerosis, vasospasm, thrombosis When there is higher oxygen demand… Stress, exercise, cold

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60

Chronic ischemic heart disease – chronic stable angina

Pain when hearts oxygen demand increases

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61

Chronic ischemic heart disease – variant (vasospastic) angina

Pain when coronary arteries spasm

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62

Chronic ischemic heart disease - Silent myocardial ischemia

Myocardial ischemia without pain

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63

Ischemic heart disease is characterized by…

Stable angina, which is associated with plaques that are fixed obstructions

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64

Unstable angina is characterized by…

Plaques with platelets that to them (these are likely to form a thrombus) they cause a range of coronary artery syndromes

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65

Endocardial structures

Lining the heart can cause heart failure

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66

If the AV valves leading into the into the ventricles do not work (mitral or tricuspid) can cause

Heart failure

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67

If the semilunar valves leading out of the ventricles do not work (aortic or pulmonary) problems it can cause

Heart failures

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68

Infective endocarditis

Formally called bacterial endocarditis, commonly caused by staphylococcus, but also streptococcus and enterococci are common, vegetation forms on internal structures and creates small thrombi, micro emboli occur as they are dislodged resulting in micro hemorrhages

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69

Risk Factors of infective endocarditis

IV drug use, valvular disorders, prosthetic heart valves, rheumatic heart disease, coarctation of the aorta, congenital heart defects and Marfan syndrome

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70

Signs and symptoms of infective endocarditis

Flu like symptoms, embolization, heart murmur, petechiae, splinter hemorrhages under the nails like glass, hematuria and Osler‘s nodes

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Diagnosis of infective endocarditis

Exam, blood cultures, CBC, urinalysis, serum rheumatoid factor, erythrocytes sedmentation rate, ECG, echocardiogram

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Treatment of infective endocarditis

Identify cause, anti-infective meds, bed rest, oxygen therapy, antipyretics, surgical valve repair, and prosthetic valve replacement

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73

Rheumatic heart disease (endocardial d/o)

Immune mediated, multi system inflammatory disease, occurs at a few weeks after group a beta hemolytic streptococcal pharyngitis, inflammation of myocardium, pericardium and heart valves, chronic valvular dysfunction biggest consequence, may have persistent deformity of heart valves from scar tissue (vegetations)

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74

Valvular heart disease

Disrupt blood flow through the heart in any of the four valves, stenosis or regurgitation can occur

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75

stenosis in valvular heart disease

Narrowing, less blood flow can flow through the valve, causes decreased cardiac output, increase cardiac workload, and hypertrophy

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76

Regurgitation in valvular heart disease

Insufficient closure, blood flows in both directions to the valve, cause decreased cardiac output, increase cardiac workload, hypertrophy and dilation

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77

Causes of valvular disorders

Congenital defects, infective endocarditis, rheumatic fever, MI, cardiomyopathy, and heart failure

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78

Signs and symptoms of Valvular disorders

Depends on the valve involved, reflect alteration in blood flow through the heart, may cause signs and symptoms of left-sided or right sided heart failure

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79

Diagnosis of valvular disorders

Exam, heart catheterization, chest x-ray, echocardiogram, MRI, ECG

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80

Treatment of valvular disorders

Diuretics, anti-dysrhythmics, vasodilators, angiotensin converting enzyme inhibitors and beta adrenergic blockers (BP meds), anticoagulants, oxygen therapy, low sodium diet, surgical valve repair and prosthetic valve replacement

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81

Mitral valve disorders

Mitral valve stenosis, mitral valve regurgitation, mitral valve prolapse

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82

Aortic valve disorders

Aortic valve stenosis, aortic valve regurgitation

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83

Mitral valve regurgitation

Mitral valve does not close as it should, portion of the stroke volume (amt of blood ejected by the ventricle) leaks back into the left atrium, decreases the amount of blood that is ejected during that beat (SV), often from rheumatic heart disease

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84

MItral valve prolapse

Seen more in women, may be familial mucous degeneration of the mitral leaflets, may or may not cause regurgitation most asymptomatic, but most may have prolonged chest pain, dyspnea, fatigue, anxiety, palpitations and lightheadedness characterized by spectrum of findings when you listen with a stethoscope stop stimulants like caffeine, nicotine, alcohol to control symptoms

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85

Identifying Defective Leaflets

The blood going through the valve makes a noise which are called heart murmurs

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86

You can identify heart murmurs by

Where they are which valve are they near?, How they sound high or low pitched?, When they happen systole or diastole?

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87

If a valve is stenotic,

You will hear a murmur of blood shooting through the narrow opening when the valve is open

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88

If a valve is reguritant,

You will hear a murmur of blood leaking back through when the valve should be closed

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89

Acute pericarditis

Inflammation of the pericardium causes: pain, exudate, ECG changes

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90

How is the exudate in acute pericarditis

Serous -> pericardial effusion, cardiac tamponade Fibrous -> friction rub, adhesions

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91

Cardiac tamponade

Rapid accumulation of accident compresses the heart

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92

Signs and symptoms of pericarditis

Pericardial friction rub, sharp, sudden, severe chest pain that increases with deep inspiration and decreases when sitting up and leaning forward, dyspnea, tachycardia, edema, flu like symptoms (think inflammation)

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Pericardial friction rub

Grating sound heard when breath is held

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94

Diagnosis of pericarditis

History, exam, complete blood count, ECG, chest x-ray, echocardiogram, CT, MRI

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Treatment of pericarditis

Identify and resolve the underlying cause, NSAIDs, meds for inflammation, pain meds, bed rest, oxygen therapy, pericardiocentesis, and pericardiectomy

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96

Pericardial effusion

Accumulation of fluid in the pericardial cavity, usually result of infectious or inflammatory process including pericarditis, may also develop with neoplasm, cardiac surgery, and trauma, it compresses the chambers of the heart, if small amount may not be symptomatic but if rapid or large rises intra cardiac pressures, echocardiogram can detect

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97

Pericardial effusion cardiac tamponade

Cardiac compression from excessive fluid accumulation, life-threatening

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98

Signs and symptoms of cardiac tamponade

Falling arterial pressures, rising venous pressures, narrowing pulse pressure, and muffled heart sounds

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99

Complications of cardiac tamponade

Heart failure, shock, death

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100

Cardiac tamponade and pulses paradoxus

On inhaling, the right ventricle fills with extra blood because the heart cannot fully expand when the right ventricle is overfilled, the left ventricle is compressed and cannot accept much blood on the next heartbeat, The left ventricle does not send out much blood: systolic blood blood pressure drops

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