Term
| What makes up the vascular system? |
|
Definition
| arteries, arterioles, capillaries, veins, venules, lymphatic vessels |
|
|
Term
| What makes up the microcirculation? |
|
Definition
| arterioles, capillaries, venules |
|
|
Term
| Flow of the vascular system |
|
Definition
| aorta- arteries- arterioles- capillaries- venules- veins- superior/inferior vena cava- right side of the heart |
|
|
Term
| True or False: Arterioles are less elastic than venulea |
|
Definition
| True, because arterioles have smooth muscle |
|
|
Term
| True or False: Capillaries have no smooth muscle/adventitia |
|
Definition
| True, they are made up of one layer of endothelial cells |
|
|
Term
| Why does cartilage/bone have a less dense capillary network? |
|
Definition
| Because there is a decreased metabolic need |
|
|
Term
| 75% of total blood volume lies where? |
|
Definition
|
|
Term
|
Definition
intima: innermost endothelial layer, want smoothness so no turbulence
media: smooth muscle and elastic layer allows for contraction/dilation
adventitia: anchors vessel |
|
|
Term
| True or false: lymphatic vessels are thick walled |
|
Definition
| False, they are thin walled |
|
|
Term
| Function of the lymphatic vessels |
|
Definition
| collects lymphatic fluid from the tissues and transports to venous systems, permeable to large molecules which allows them to return interstitial proteins to venous system |
|
|
Term
| Where are the lymph drainage entry points? |
|
Definition
Right lymphatic duct: right side of the head, neck, chest, upper arms
Thoracic duct: remained of the body |
|
|
Term
| What do the right lymphatic duct and the thoracic duct empty into? |
|
Definition
| subclavian/internal jugular vein junction |
|
|
Term
| What do increased metabolic needs do to the blood vessels? |
|
Definition
| causes the blood vessels to dilate |
|
|
Term
| What do decreased metabolic needs do to the blood vessels? |
|
Definition
| causes the blood vessels to contract |
|
|
Term
| What does increased protein in the vasculature cause? |
|
Definition
| Causes fluid to move into the vasculature (fluid is pulled in by protein) |
|
|
Term
| What can you hear when the blood is turbulent? |
|
Definition
|
|
Term
| What causes the blood to be turbulent? |
|
Definition
| increased viscosity, increased flow rate, blood vessels dilating/contracting |
|
|
Term
| What does smoking do to blood viscosity? |
|
Definition
| causes increased blood viscosity |
|
|
Term
|
Definition
| fluid in the 3rd (interstitial) space |
|
|
Term
|
Definition
| fluid pushing, arterial system has a higher pressure and pushes fluid into the venous system |
|
|
Term
|
Definition
-capillary wall damage, increased permeability
-lymphatic drainage obstruction
-elevated venous pressure
-decreased plasma protein (unable to pull fluid into vasculature) |
|
|
Term
| What factors affect hemodynamic resistance? |
|
Definition
| blood viscosity, and blood vessel diameter |
|
|
Term
| peripheral vascular resistance |
|
Definition
| opposition to blood flow provided by blood vessels |
|
|
Term
| what can cause increased peripheral vascular resistance (PVR)? |
|
Definition
| increased blood viscosity, increased length of the vessels (narrowing, smaller diameter), decreased blood vessel diameter |
|
|
Term
|
Definition
| SNS, response to physiologic/psychologic factors |
|
|
Term
|
Definition
|
|
Term
| what can cause reduced venous blood flow? |
|
Definition
| thromboembolism, incompetent venous valves, muscle pumping failure |
|
|
Term
|
Definition
| hardening of the arteries, muscle fibers thicken/harden, affects small arteries/arterioles |
|
|
Term
|
Definition
| inflammatory process, affects intima of large and medium sized arteries arteries |
|
|
Term
| What can occur due to atherosclerosis? |
|
Definition
| thrombus, after inflammation accumulation of fat occurs, as well as blood componenents, which causes increased fiber and thrombus formation |
|
|
Term
| where does plaque most frequently occur? |
|
Definition
|
|
Term
| how can plaque be stabilized? |
|
Definition
-diet
-exercise
-medication (statins) |
|
|
Term
| non-modifiable risk factors for atherosclerosis |
|
Definition
| age, gender, family genetics |
|
|
Term
| modifiable risk factors for atherosclerosis |
|
Definition
| nicotine use, diet, HTN, DM, obesity, stress, sedentary lifestyle, elevated C-reactive protein, elevated homocysteine levels |
|
|
Term
| how does nicotine use cause atherosclerosis? |
|
Definition
| carbon monoxide causes repeated episodes of hypoxia that injure endothelial cells (vessel walls), carbon monoxide also displaces oxygen from HGB in RBC's causing decreased oxygen transported in the blood causing repeated hypoxic injury in the vascular walls; also decreases HDL's which are protectors |
|
|
Term
| how does HTN contribute to atherosclerosis? |
|
Definition
| high BP on the vascular endothelial surface causes injury to the vascular wall due to changes in "shear" stress on the vascular endothelium |
|
|
Term
| how does diabetes contribute to atherosclerosis? |
|
Definition
| oxidative stress (due to poor vasculature) causes vascular injuru that triggers plaque development |
|
|
Term
| How does obesity cause atherosclerosis? |
|
Definition
| associated with insulin resistance and elevated lipid levels, blood glucose levels are also elevated in the presence of insulin resistance so the pancreas produces a large amount of insulin to lower blood glucose levels resulting in hyperinsulinemia which functions as a growth factor, stimulating plaques and causing them to grow; higher levels of inflammation fuel ongoing inflammation in the plaque leading to growth |
|
|
Term
| how does elevated c-reactive protein cause atherosclerosis? |
|
Definition
| increased CRP indicates inflammatory process, produced by the liver in response to inflammation (large amt greater than 3.0, indicated CV disease) |
|
|
Term
| how do elevated homocysteine levels cause atherosclerosis? |
|
Definition
| homocysteine (amino acid) causes damage to endothelial linings; increased oxidation of LDL's; stimulateds cell division of vascular smooth muscle in the plaques; caused by diet deficient in B12 and folic acid |
|
|
Term
| what are some results of atherosclerosis? |
|
Definition
| coronary atherosclerosis, angina, MI, TIA, CVA, aneurysm, atherosclerotic lesions, renal artery stenosis, ESRD |
|
|
Term
| how does atherosclerosis cause MI? |
|
Definition
| caused by myocardial ischemic due to atherosclerosis, occluding a branch of a coronary artery in the heart, if this plaque ruptures it causes a thrombus to form that can enlarge enough to cause a significant increase or even total occlusion to blood flow |
|
|
Term
| how does atherosclerosis cause CVA? |
|
Definition
| due to occlusion of blow flow to a region of the brain, if atherosclerosis is caused by severe HTN, a hemorrhagic stroke can occur b/c HTN causes rupture of a weakened area of the cerebral artery |
|
|
Term
| how does atherosclerosis can aneurysm? |
|
Definition
| weakened portion of an arterial wall which then bulges outward and can then eventually rupture; atherosclerosis weakens the arterial wall |
|
|
Term
| how can atherosclerosis can end stage renal disease (ESRD)? |
|
Definition
| can occur when an atherosclerotic plaque occludes renal blood flow resulting in renal ischemia |
|
|
Term
|
Definition
-hairless
-dark, opaque, thick nails
-shiny skin
*vessels cannot constrict normally, remain dilated |
|
|
Term
| peripheral artery disease (PAD) |
|
Definition
-arterial insufficiency
-affects men > women
-affects lower extremities > upper extremities
-risks: DM, elderly |
|
|
Term
| where does PAD most frequently occur? |
|
Definition
| predominantly from the aorta below the renal arteries to popliteal arteries |
|
|
Term
| what are the stzges of PAD? |
|
Definition
stage 1: asymptomatic
stage 2: claudicatoin (pain w/activity)
stage 3: rest pain
stage 4: necrosis/gangrene |
|
|
Term
| compenents of a PAD physical exam |
|
Definition
-BP in both arms
-skin exam- arms/legs
-full CV exam
-peripheral vascular exam- pulses (bilaterally, grades: 0-absent, 1-diminshed, 2-normal), auscultate for bruits: aortic, renal, iliac, femoral |
|
|
Term
| PAD physical assessment findings |
|
Definition
-cool, pale when elevated
-ruddy, cyanotic in dependent position
-diminished pulses
-thick, opaque nails
-shiny, dry hairless skin
-ulcerations, gangrene, muscle atrophy
-compare right versus left extremities |
|
|
Term
|
Definition
degree of arterial insufficiency, establishes dx, highest ankle/highest brachial systolic pressure
Ex: ankle 120/brachial 120, ABI=1 |
|
|
Term
|
Definition
| ABI, doppler U/S, arteriogram |
|
|
Term
| degrees of obstruction (using ABI) |
|
Definition
normal: >.9
mild: .7-.9
moderate: .4-.7
severe: <.4 |
|
|
Term
|
Definition
| contrast dye for flouroscopy, determines blood flow, monitor for bleeding, hematoma formation |
|
|
Term
| non-pharmacologic ways to manage PAD |
|
Definition
-smoking cessation
-diet (low na, low chol)
-exercise |
|
|
Term
|
Definition
-phosphodiesterase III inhibitors (vasotropic, vasodilation efect): cilostazol, pentoxifylline
-antiplatelet agents: ASA, clopidogrel |
|
|
Term
|
Definition
| endarterectomy, arterial bypass surgery, amputation, angioplasty, stent |
|
|
Term
|
Definition
| seperates plaque from arterial wall, opens up distal segments |
|
|
Term
|
Definition
| balloon (deflated) threaded by a catheter into vessel, inflate ballon which pushes plaque against the intima wall opening up the vessel |
|
|
Term
|
Definition
-recurring inflammatory process fo small and intermediate vessel of lower extremities
-autoimmune?
-men 20-35 years
-tobacco can cause/aggravte b/c it causes vasoconstriction
-progressive occlusion of vessels results in pain, ischemic changes, ulcerations, and gangrene
*S/S:pain, especially after exercise, rubor, diminished pedal pulses |
|
|
Term
|
Definition
| a balloon-like arterial bulge, weakening in the wall of the vessel |
|
|
Term
|
Definition
|
|
Term
| 2 types of aortic aneurysms |
|
Definition
-thoracic (above kidneys/renal arteries)
-abdominal (below kidneys/renal arteries) |
|
|
Term
| thoracic aneurysms are caused by |
|
Definition
|
|
Term
| abdominal aneurysms are caused by |
|
Definition
|
|
Term
| thoracic aneurysms effect |
|
Definition
|
|
Term
| abdominal aneurysms effect |
|
Definition
|
|
Term
| true or false: thoracic aneurysms have a 1/3 mortality rate |
|
Definition
|
|
Term
| true or false: abdominal aneurysms occur below the renal arteries |
|
Definition
|
|
Term
| symptoms of a thoracic aneurysms |
|
Definition
| variable, asymptomatic or pain in supine position and cough |
|
|
Term
| symptoms of an abdominal aneurysms |
|
Definition
| 40% of the time heart beat/throbbing in the abdomen |
|
|
Term
| physical exam findings for a thoracic aneurysm |
|
Definition
| dilated veins in neck, arms |
|
|
Term
| treatment for a thoracic aneurysms |
|
Definition
| surgical repair, control BP, and risk factors (risk factors for atherosclerosis) |
|
|
Term
| treatment for abdominal aneurysms |
|
Definition
| surgical repair, control BP and risk factor (risk factors for atherosclerosis) |
|
|
Term
| surgical tx for thoracic/abdominal aneurysms |
|
Definition
| endovascular repair- stent graft placed via catheter through an artery in the leg, aneurysm is not resected, it can be resected and replaced with Teflon, concern of loss of pulses b/c of cross clamping |
|
|
Term
|
Definition
|
|
Term
|
Definition
1. venous stasis
2. vessel wall injury
3. altered blood coagulation |
|
|
Term
| true or false: heparin prevents enlargement of DVT |
|
Definition
|
|
Term
| how long does it take for warfarin/coumadin to reach a therapeutic level? |
|
Definition
|
|
Term
| what lab should be monitored for pt's on heparin? |
|
Definition
| PTT (should be 1.5- 2 times the normal level) |
|
|
Term
| what lab should be monitored for pt's on coumadin? |
|
Definition
|
|
Term
| How should phlebitis (d/t IV) be treated? |
|
Definition
-d/c IV
-warm, moist compress |
|
|
Term
| how does varicosity cause DVT? |
|
Definition
| varicosity (dilated vein) can cause DVT b/c of blood pooling |
|
|
Term
|
Definition
-DVT
-thrombophlebitis
-phlebothrombosis |
|
|
Term
| clinical manifestations of venous thrombosis |
|
Definition
-edema
-swelling
-pain/tenderness
-warmth
-redness |
|
|
Term
| venous thrombosis prevention |
|
Definition
-compression stockings
-PCD's
-positioning
-early ambulation
-low molecular weight heparin |
|
|
Term
| medical management of venous thrombosis |
|
Definition
-unfractionated heparin (SQ/IV)
-low molecular weight heparin (SQ)
-thrombolytic therapy
-oral anticoagulants (warfarin) |
|
|
Term
| true or false: low molecular weight heparin has a longer half-life than unfractionated heparin |
|
Definition
| true, b/c low molecular weight heparin is weight based |
|
|
Term
| true or false: low molecular weight heparin has a decreased risk of bleeding, heparin induced thrombocytopenia (HIT) |
|
Definition
|
|
Term
| true or false: unfractionated heparin is more expensive than low molecular weight heparin |
|
Definition
| false, unfractionated heparin is much cheaper than low molecular weight heparin |
|
|
Term
| unfractionated heparin and low molecular weight heparin work by |
|
Definition
| preventing extension of the thrombus |
|
|
Term
| how does thrombolytic therapy work? |
|
Definition
| it works by dissolving the clot |
|
|
Term
| benefits of thrombolytic therapy |
|
Definition
-decreases damage to valves
-decreased risk of chronic venous insufficiency |
|
|
Term
| surgical tx for venous thrombosis |
|
Definition
-thrombectomy
-placement of a vena cava filter |
|
|
Term
| how often should lovenox (LMWH) be taken per day? |
|
Definition
|
|
Term
| thrombectomy (aka embolectomy) |
|
Definition
| last resort therapy, surgical removal of thrombi |
|
|
Term
| placement of a vena cava filter |
|
Definition
| aka greenfield filter, functions to catch clots that are dissolved before it can reach the heart, used in pt's vulnerable to PE |
|
|
Term
|
Definition
| dark, causing by long term venous disease and specfically venous pooling |
|
|
Term
| chronic venous insufficiency |
|
Definition
| result of partial vein blockage or blood leakage around the valves of the veins |
|
|
Term
| risk factors for chronic venous insufficiency |
|
Definition
-hx of DVT (legs)
-age
-gender (female)
-genetic factors
-obesity
-pregnancy
-prolonged sitting/standing |
|
|
Term
| S/S of chronic venous insufficiency |
|
Definition
-redness of legs and ankles
-skin color changes around the ankles
-superficial varicose veinsmeduc
-thickening of skin on legs/ankles
-ulcers on legs/ankles
-dull aching, heaviness or cramping in the legs
-itching and tingling
-pain that worsens when standing
-pain that improves when legs are raised
-swelling of the legs |
|
|
Term
| Tx for chronic venous insufficiency |
|
Definition
-compression stocking to prevent swelling
-avoid long periods of sitting or standing
-aggresively care for wounds if breakdown or infection
-even slight leg movement can increase blood return to the heart
-possible surgical tx (varicose vein stripping) |
|
|
Term
|
Definition
| nonhealing or recurring wound or sore |
|
|
Term
|
Definition
| inadequate exchange of oxygen and other nutrients to tissues |
|
|
Term
|
Definition
-aching or sensation of heaviness, discomfort, pain, edema, discoloration
-medial or lateral malleolus, between malleolus and lower calf, most common is medial malleolus
-large, superficial, exudative |
|
|
Term
|
Definition
-intermittent claudication, pain at rest
-caused by inadequate circulation
-small, circular, deep ulcerations on tips or webs of toes, occurs distally on bony prominences
-resulting in gangrene |
|
|
Term
| true or false: venous ulcers do not effect capillary refill |
|
Definition
| true, capillary refill is normal (less than 3 seconds) |
|
|
Term
| how do arterial ulcers effect capillary refill? |
|
Definition
| prolonged capillary refill, >4-5 seconds |
|
|
Term
|
Definition
-antibiotics if needed
-compression stockings
-elastic wraps
-debridement (silvadene): removes dead of infected tissue
-wound dressing |
|
|
Term
|
Definition
| the measurement of force applied to artery walls |
|
|
Term
|
Definition
| unknown etiology, affects 90-95% |
|
|
Term
|
Definition
caused by:
-coarctation of aorta
-renal artery narrowing or renal disease
-hyperaldosteronism
-pregnancy
*affects 5-10% |
|
|
Term
| blood pressure is measured by |
|
Definition
| cardiac output (CO) x peripheral resistance |
|
|
Term
| cardiac output is measured by |
|
Definition
| heart rate x stroke volume (SV) |
|
|
Term
| HTN does what to cardiac ouput and peripheral resistance? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| how does aging affect HTN? or why are the elderly more likely to develop HTN? |
|
Definition
aging results in
-accumulation of atherosclerotic plaque
-fragmentation of arterial elastins
-increased collagen deposition
-decreased vasodilation
-DECREASED ELASTICITY OF MAJOR BLOOD VESSELS |
|
|
Term
| prolonged HTN can cause damage to |
|
Definition
-eyes
-brain
-kidneys
-heart |
|
|
Term
| consequences of prolonged HTN |
|
Definition
-MI
-heart failure
-CVA
-renal failure
-impaired vision |
|
|
Term
| how can HTN affect the eyes? |
|
Definition
can cause:
-retinal hemorrhage
-retinal exudates (fluid/pus)
-retinal artery narrowing
-papilledema (optic disc swelling) |
|
|
Term
| what can HTN do the heart? |
|
Definition
can cause:
-angina
-MI
-left ventricular hypertrophy (LVH, think: that is where blood is being pumped out, increased workload causes walls to thicken) |
|
|
Term
| how can HTN affect the kidneys? |
|
Definition
can cause:
-nocturia
-increased BUN and creatinine |
|
|
Term
| how can HTN affect the brain? |
|
Definition
|
|
Term
| what diet modifications should pts with HTN make? |
|
Definition
-low sodium diet <2.4g per day
-DASH diet: rich in fruit and veggies, low in fat
-moderate alcohol consumption (<2 drinks per day for men, <1 drink per day for women) |
|
|
Term
| pts with HTN should get how much physical activity per day? |
|
Definition
| >30 min per day of aerobic exercise |
|
|
Term
| medications used for managing HTN function to |
|
Definition
-decreased peripheral resistance
-decreae blood volume
-decrease strength of myocardial contraction
-decrease rate of myocardial contraction |
|
|
Term
| drugs that decrease peripheral resistance |
|
Definition
-alpha 1 blockers (prazosin, terazosin)
-combined alpha & beta blockers (carvedilol, labetalol)
-vasodilators (nitroprusside, minixodil, hydralazine)
-ACE inhibitors
-angiotensin II receptor blockers
-dihydropyridines (nifedipine, amlodipine, nicardipine)
-direct renin inhibitors (aliskiren) |
|
|
Term
| drugs that decrease blood volume |
|
Definition
-thiazide diuretics (chlorothiazide, hydrochlorothiazide)
-loop diuretics (furosemide, torsemide)
-potassium-sparing diuretics (amiloride, triamterene)
-aldosterone receptor blockers (eplerenone, spironolactone-also a potassium sparing diuretic) |
|
|
Term
| drugs that decrease strength of myocardial contraction (negative inotropes) |
|
Definition
-beta-blockers (atenolol, propanolol, metoprolol, nadolol, timolol)
-beta-blockers with intrinsic sympathomimetic activity |
|
|
Term
| drugs that decrease the rate of myocardial contraction (negative chronotropes) |
|
Definition
-central alpha 2 agonists (clonidine, metholdopa, reserpine)
-beta blockers
-beta blockers with intrinsic sympathomimetic activity
-calcium channel blockers (verapamil) |
|
|
Term
| hypertensive emergency is definied as a BP over |
|
Definition
|
|
Term
| a hypertensive emergency is clinical evidence of |
|
Definition
|
|
Term
| true or false: a hypertensive emergency does require prompt treatment |
|
Definition
| false, it require immediate tx |
|
|
Term
| how is a hypertensive emergency treated? |
|
Definition
-IV vasodilators (NTG, nitroprusside, nicardipine)
-check BP every 5 minutes
-want to reduce mean BP by 25% over first hour
-reduction goal of 160/100 over 6 hours |
|
|
Term
| if the pt has a an aortic dissection and is in a hypertensive emergency, how much do we need to lower the BP? |
|
Definition
| need to lower systolic to 100 mmHg or less |
|
|
Term
| true or false: if the pt in hypertensive emergency is also suffering an ischemic stroke, there is no benefit in immediate BP reduction |
|
Definition
|
|
Term
|
Definition
| elevated BP without evidence of target organ damage, occurs with nosebleeds, severe anxiety, headaches |
|
|
Term
| goal BP reduction during hypertensive urgency |
|
Definition
| reduce BP over 24-48 hours |
|
|
Term
| treatment for hypertensive urgency |
|
Definition
-oral beta blockers (labetolol)
-ACE inhibitors (captopril)
-alpha 2 agonists (clonidine) |
|
|
Term
| how often should BP be taken during hypertensive urgency? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| amount of resistance to ejection |
|
|
Term
|
Definition
| force generated by contracting myocardium |
|
|
Term
| stroke volume is determined by |
|
Definition
| preload, afterload, contractility |
|
|
Term
|
Definition
- the greater the initial strength/length of the cardiac muscle cells, the greater degree of shortening that occurs
-the force of contraction will increase as the heart is filled with more blood |
|
|
Term
| how do vasodilating agents affect preload and afterload? |
|
Definition
|
|
Term
| true or false: preload is increased with fluid volume |
|
Definition
|
|
Term
| true or false: afterload is decreased with vasoconstrictors |
|
Definition
|
|
Term
| true or false: contractility is increased by sympathetic activity |
|
Definition
|
|
Term
| effects of age on stroke volume |
|
Definition
-ventricles atrophy
-decreased elasticity of heart muscle
-valves become thick and rigid
-increased tissue in the area of the SA, AV nodes |
|
|
Term
|
Definition
6 chest electrodes
4 limb electrodes |
|
|
Term
| normal electrical conduction pattern |
|
Definition
| SA node - Bachman's bundle - AV node- bundle of HIS - right bundle branch/left bundle branch - purkinje fibers |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| normal rate of ventricles |
|
Definition
|
|
Term
| the p-r interval represents |
|
Definition
|
|
Term
| the QRS complex represents |
|
Definition
| ventricular depolarization |
|
|
Term
| the QRS complex represents |
|
Definition
| ventricular depolarization |
|
|
Term
|
Definition
| ventricular repolarization |
|
|
Term
|
Definition
| ventricular depolarization (QRS) |
|
|
Term
|
Definition
| ventricular repolarization (T wave) |
|
|
Term
| what does the U wave represent? |
|
Definition
| repolarization of the purkinje |
|
|
Term
|
Definition
-increase heart rate
-increases speed of conduction through the AV node
-increased force of contraction |
|
|
Term
| parasympathetic nerve fibers |
|
Definition
-decrease heart rate
-decrease AV conduction
-decrease contractility |
|
|
Term
| a large box on an EKG strip represents how much time on the horizontal axis? |
|
Definition
| 5 mm box, .2 seconds (thin: 5 x .04) |
|
|
Term
| how much time does a small box on an EKG strip represent on the horizontal axis? |
|
Definition
|
|
Term
| how do you measure voltage on an EKG strip? |
|
Definition
small box= .1mv, or 1mm
large box= .5mv, or 5 mm |
|
|
Term
|
Definition
| beginning of P wave to beginning of QRS |
|
|
Term
|
Definition
|
|
Term
|
Definition
| beginning of Q wave (if present) or R wave to end of S wave |
|
|
Term
|
Definition
|
|
Term
|
Definition
| end of QRS to beginning of T wave; isoelectric (no variation in electric potential) |
|
|
Term
|
Definition
| beginning of QRS to end of T wave |
|
|
Term
|
Definition
| .32-.40 seconds; rate dependent; prolonged may indicate torsades de pointe |
|
|
Term
| what can a biphasic p wave indicate? |
|
Definition
| p wave has 2 peaks instead of one, indicates atrial enlargement |
|
|
Term
| presence of a U wave may indicate? |
|
Definition
|
|
Term
| what levels should be checked when a dysrhythmia is present? |
|
Definition
| magnesium, calcium, oxygen (could be d/t hypoxemia) |
|
|
Term
|
Definition
| intraventricular contraction delay or bundle block |
|
|
Term
|
Definition
-60-100 bpm
-regular
-P:QRS 1:1 |
|
|
Term
|
Definition
| any variation from normal sinus rhythm |
|
|
Term
|
Definition
-cardiac (conduction defects, CHF, MI)
-electrolyte imbalance
-hypoxia
-shock
-acid/base imbalance
-caffeine
-drugs |
|
|
Term
| major types of dysrhythmias |
|
Definition
-sinus node
-atrial
-junctional
-ventricular
-conduction abnormalities- blocks |
|
|
Term
|
Definition
-less than 60 bpm
-regular
-PR interval normal |
|
|
Term
|
Definition
|
|
Term
|
Definition
| works by speeding up the firing of the SA node |
|
|
Term
| causes of sinus bradycardia |
|
Definition
-sleeping
-vasovagal response (BM, voiding, bearing down) |
|
|
Term
|
Definition
-rate greater than 100 bpm in adults
-regular rhythm |
|
|
Term
| causes of sinus tachycardia |
|
Definition
-hypovolemia (decreased blood volume)
-fever
-pain |
|
|
Term
|
Definition
-sinus node creates impulse with irregular rhythm-normal change with respiration
-EKG wave form is normal except rhythm is slightly irregular
-benign no tx |
|
|
Term
| premature atrial contraction (PAC) |
|
Definition
-impulse originates in atrium
-abnormal P wave comes early
-P wave abnormal or hidden in T wave
-frequent (more than 6 min) may be serious |
|
|
Term
|
Definition
IRRITABLE AREA IN SA NODE
-caffeine
-hypokalemia
-ischemia |
|
|
Term
|
Definition
-rapid, regular, atrial impulses
-atria are firing very quickly
-P waves: sawtooth pattern, flutter or F
-ventricular rhythm regular/irregular due to AV conduction |
|
|
Term
| symptoms of atrial flutter |
|
Definition
|
|
Term
|
Definition
-if pt is STABLE, calcium channel blockers, beta blockers, digoxin
-may convery rhythm w/Amiodarone
-if pt is UNSTABLE, cardiovert (anesthesia before if possible) |
|
|
Term
|
Definition
-atria deflections- irregular & chaotic
-wavy baseline, f wave
-rhythm is irregulary irregular |
|
|
Term
|
Definition
-fatigue
-palpitations
-pulse deficit (apical vs. peripheral) |
|
|
Term
| pts with a fib have a risk of developing what? |
|
Definition
| a thrombus/embolism, also myocardial ischemia |
|
|
Term
|
Definition
| calcium channel blockers, digoxin, coumadin, cardioversion |
|
|
Term
| premature junctional complex |
|
Definition
-impulse originates in AV node
-P wave may be absent, occur after QRS, or occur befoe QRS with shortened PRI
-short PRI (less than .17)
-irritable area in vicinity of the AV junction |
|
|
Term
|
Definition
-digixon toxicity (toxic to SA node)
-CHF
-CAD |
|
|
Term
| signs of digoxin toxicity |
|
Definition
-nausea
-vomiting
-malaise
-fatigue |
|
|
Term
| what medication is given to treat dig toxicity? |
|
Definition
|
|
Term
|
Definition
-AV node is pacemaker
-HR 40-60, regular
-P wave may or may not be present
-shortened PRI
-P wave inverted in lead 2
-may be benign in young adults
-dig toxic if rapid rate |
|
|
Term
| supraventricular tachycardia (SVT) |
|
Definition
-rapidly occuring impulse above the ventricles
-P waves not seen
-regular, sudden onset |
|
|
Term
|
Definition
-caffeine
-stress
-hypoxemia |
|
|
Term
|
Definition
| vagal stimulation: coughing, bearing down, carotid massage (MD only) |
|
|
Term
| preventricular contraction (PVC) |
|
Definition
-impulse originates in the ventricle
-bigeminy, trigeminy, quadrigeminy, unifocal, multifocal |
|
|
Term
|
Definition
| the depolarization is triggered from the one site in the ventricle causing the peaks on the ECG to look the same |
|
|
Term
|
Definition
| when more than one site in the ventricles initiate depolarization causing each peak on the ECG to have a different shape |
|
|
Term
|
Definition
| every other heartbeat is a PVC |
|
|
Term
|
Definition
-nicotine
-caffeine
-alcohol
-ischemia |
|
|
Term
|
Definition
| lidocaine if frequent and in acute setting |
|
|
Term
| how do PVC's present on sn EKG? |
|
Definition
-wide QRS (>12 sec)and bizarre
-T wave usually in opposite direction/polarity of QRD |
|
|
Term
|
Definition
-more than 3 PVC's in a row
-rate greater than 100
-may precede VF
-pt may be awake
-if stable, may cardiovert
-if unstable (PULSELESS), treat as VF- EMERGENCY- DEFIBRILLATE PULSELESS V TACH! |
|
|
Term
|
Definition
-ventricles are quivering
-absence of pulse and respirations |
|
|
Term
| ventricular fibrillation is caused by |
|
Definition
|
|
Term
| how to treat ventricular fibrillation |
|
Definition
-treat cause
-antiarrhythmics
-EMERGENCY, IMMEDIATE DEFIBRILLATION |
|
|
Term
|
Definition
-impulse occurs below AV node
-dying heart, escape rhythm
-rate 20-40 bpm
->40= accelerated idioventricular rhythm
-pt usually unconscious |
|
|
Term
| how to treat idioventricular rhythm? |
|
Definition
-atropine
-vasopressors
-pacing
NEVER LIDOCAINE |
|
|
Term
|
Definition
-FLATLINE
-check 2 diff leads (could be fine VF)
-no heart rate, no pulse
-poor prognosis |
|
|
Term
|
Definition
| hypoxia, acidosis, severe electrolyte imbalance, overdose, hypothermia |
|
|
Term
|
Definition
-CPR
-intubation
-get IV access
-administer epi, atropine
-pacing |
|
|
Term
| what is transcutaneous pacing? |
|
Definition
-external pacing
-temporary means of pacing a patients heart during a medical emergency
-delivers pulses of electric current through the pt's chest, stimulating the heart to contract |
|
|
Term
|
Definition
-impaired impulse conduction through the AV node
-1st, 2nd, or 3rd degree |
|
|
Term
| what causes conduction abnormalities? |
|
Definition
| meds, MI, ischemia, valve disorders |
|
|
Term
| S/S of conduction abnormalities |
|
Definition
-varies
-1st degree may be asymptomatic
-3rd degree may have decreased perfusion |
|
|
Term
| tx for conduction abnormalities |
|
Definition
| depends on hemodynamic status |
|
|
Term
|
Definition
-consistently prolonged PRI
-sinus node originated beats |
|
|
Term
| 2nd degree heart block type 1 (Wenckebach) |
|
Definition
-PRI becomes increasingly longer until QRS is dropped
-each atrial impulse takes longer and longer to travel to AV node until one impulse is completely blocked |
|
|
Term
| 2nd degree AV block type 2 |
|
Definition
-only some atrial impulses are conducted through the AV node
-for those conducted, PRI is constant
-numerous dropped QRS |
|
|
Term
| 3rd degree AV block (complete heart block) |
|
Definition
-no atrial impulses conducted through AV node
-atria and ventricles beating independently (AV dissociation)
-irregular PR intervals |
|
|
Term
| how to treat an unstable pt with a complete heart block |
|
Definition
|
|
Term
| risk factors for a complete heart block |
|
Definition
-cardiac
-electrolyte imbalances
-emotional crisis
-hypoxia
-shock
-acid base imbalance
-caffeine
-drugs |
|
|
Term
| S/S of complete heart block |
|
Definition
-irregular heart rhythm, palpitations
-chest, neck, shoulder, or arm pain
-hypotension, dizziness, syncope
-coly, clammy, diaphoretic |
|
|
Term
| how does cardioversion/defibrillation work? |
|
Definition
-deliver an electrical current to repolarize myocardial cells
-if cells repolarize, hopefully sinus node can take over as pacemaker |
|
|
Term
| what is the difference between cardioversion and defibrillation? |
|
Definition
|
|
Term
| rational for placement of paddles/pads during cardioversion/defibrillation |
|
Definition
| positioned so it goes through the largest part of the myocardium, the left ventricle |
|
|
Term
| true or false: during cardiversion, you need to verify leads are on pt and that the defibrillator is on sync mode |
|
Definition
|
|
Term
| how much pressure should be applied during cardioversion? |
|
Definition
|
|
Term
| when is the shock delivered during cardioversion? |
|
Definition
| ventricular depolarization (QRS) |
|
|
Term
| why is cardioversion synchronized? |
|
Definition
| prevents shock from being delivered during teh T wave, if shock is delivered during the 2nd half of the T wave (relative refractory period), which is very vulnerable,could cause a more serious dysrhythmia |
|
|
Term
| if cardioversion is elective |
|
Definition
-anticoagulate pt several weeks prior
-hold digoxin 48 hours before |
|
|
Term
| which rhythms are cardioverted rather than defibrillated? |
|
Definition
| a fib, SVT, v tach, a flutter |
|
|
Term
| which rhythms should never be defibrillated? |
|
Definition
| V tach w/pulse, asystole (CPR only) |
|
|
Term
| preparation for cardioversion |
|
Definition
-NPO 4 hours prior
-analgesia/anesthesia
-bag valve mask patient
-intubation tray at bedside |
|
|
Term
| how many joules are delivered during cardioversion? |
|
Definition
|
|
Term
| synchronized cardioversion process |
|
Definition
|
|
Term
| defibrillation is an emergency tx for |
|
Definition
| pulseless v tach or v fib |
|
|
Term
| true or false; defibrillation requires higher energy le (vels |
|
Definition
|
|
Term
| true or false: defibrillation should be alternated with CPR |
|
Definition
|
|
Term
| what meds may be used during defibrillation to help convert? |
|
Definition
-epi
-vasopressin
-amiodarone
-lidocaine (for ventricular irritability)
-magnesium (torsades) |
|
|
Term
| monophasic defibrillation |
|
Definition
| delivers current in 1 direction |
|
|
Term
| how long should cycles of CPR be inbetween defibrillation? |
|
Definition
|
|
Term
|
Definition
| delivers current in 2 directions, lower energy needed |
|
|
Term
| how many joules should we start with during biphasic defibrillation? |
|
Definition
| 120 joules, then 150 joules, then 200 joules |
|
|
Term
| implantable cardiac defibrillator (ICD) |
|
Definition
-for patients at risk for VT/VF
-can also convert SVT
-battery life lasts about 5 years
-some can also pace
-complications similar to pacemakers |
|
|
Term
| true or false: v tach and v fib are considered sudden death episodes |
|
Definition
|
|
Term
| what pt's are at risk for sudden death episodes? |
|
Definition
those with...
-SVT
-prolonged QT interval (torsades)
-hypertrophic cardiomyopathy |
|
|
Term
| ICD's are designed to respond to what? |
|
Definition
-rate > preset rate
-change in isoelectric line
may deliver 6 sequential shocks, can override rapid rates |
|
|
Term
| which blocks most commonly warrant the need for a pacemaker? |
|
Definition
| blocks in the AV node, sometimes SA node blocks warrant a pacemaker but not as frequently |
|
|
Term
| how is a AAA treated surgically? |
|
Definition
| endovascular repair, stent placed in the lumen of abdominal aorta and extended distally into the iliac arteries |
|
|
Term
|
Definition
-permanent-internal or temporary-external
-small, battery operated
-provides electrical stimulus when intrinsic stimulus is defective
-replaced defective natural pacemaker or pathway |
|
|
Term
| indications for a pacemaker |
|
Definition
-sick sinus syndrome: SA node defective and beats slowly
-sinus node dysfunction
-symptomatic bradycardia: lightheadedness, hypotension
-conduction system sclerotic changes: r/t myocardial ischemia, can cause MI
-chronic a fib w/slow ventricular response: slows ventricular rate, loss of atrial kick which contributes to CO
-tachycarrhythmias: need to slow patient down
-3rd degree AV block |
|
|
Term
| S/S indicating need for a pacemaker |
|
Definition
-syncope
-hypotension
-shock
-CHF w/pulmonary congestion
-chest pain
-dyspnea |
|
|
Term
| 2 components of a pacemaker |
|
Definition
-electronic pulse generator (circuit and battery)
-pacemaker electrodes/leads: conveys hearts electrical activity to generator and generator sends response through electrodes |
|
|
Term
|
Definition
-endocardial leads
-epicardial wires
-transcutaneous |
|
|
Term
|
Definition
-threaded through major vein into right ventricle (under flouroscopy)
-placed through external jugular
-connected to permanent generator
-subcutaneous generator
-usually done in cardiac cath or EP lab |
|
|
Term
|
Definition
-always temporary
-after open heart surgery
-lightly sutured to epicardium
-wires connected to temporary pulse generator |
|
|
Term
|
Definition
-on most pacemakers
-for emergency pacing
-increased voltage (mA) to penetrate skin |
|
|
Term
| pacemaker functions (1st 3 letters only) |
|
Definition
-1st letter= chamber paced
-2nd letter= chamber sensed
-3rd letter= type of response |
|
|
Term
|
Definition
O= none
A= atrium
V= ventricle
D= dual A/V |
|
|
Term
|
Definition
O= none
A= atrium
V= ventricle
D= dual A/V |
|
|
Term
|
Definition
O= none
T= triggered
I= inhibited
D= dual, T/I |
|
|
Term
|
Definition
| delivery of electrical stimulus to stimulate atrial and or ventricular beat |
|
|
Term
|
Definition
| amount of voltage needed for electrical stimulus to provide capture of the impulse |
|
|
Term
|
Definition
| appropriate EKG complex should follow pacing spike |
|
|
Term
|
Definition
| Senses intrinsic activity & paces only when needed |
|
|
Term
|
Definition
| only set to pace but not sense |
|
|
Term
| what to do if there is a loss of capture |
|
Definition
-turn pt on side
-increase voltage (mA) if possible
-let doc know right away |
|
|
Term
| complications of pacemakers (ICD's as well) |
|
Definition
-infection
-bleeding
-hematoma
-hemothorax (puncture of subclavian vein)
-ventricular ectopy-PVC's, irritability of ventricle
-tachycardia
-dislocation of leads/dislodgment
-phrenic nerve stimulation- hiccups
-cardiac tamponade (rare) |
|
|
Term
| what to monitor after pacemaker insertion |
|
Definition
-v/s (do not assess apical over generator site)
-cardiac rhythm
-pacemaker function |
|
|
Term
| what is the most common pacemaker complication and how can it be prevented? |
|
Definition
-lead displacement
-to prevent minimize activity
-if transvenous lead is dislodged, turn pt to left side to improve endocardial contact |
|
|
Term
| true or false: doctor should be called if pulse 5 bpm more or less than generator preset rate |
|
Definition
|
|
Term
| activity restrictions post-pacemaker placement |
|
Definition
-restrict movement of affected arm 24-48 hours after
-avoid raising arm over shoulder for 4-6 weeks
-do not lift anything >10 lbs for 4-6 weeks |
|
|
Term
| what should we do for a pt with a pacemaker if hiccups or muscle twitching are present? |
|
Definition
-call doc
-obtain chest x-ray
-obtain EKG
-anticipate return to OR for lead repositioning |
|
|
Term
| discharge teaching for pts with pacemakers |
|
Definition
-take pulse for 1 min, call dr if 5 more or less preset rate
-S/S of pacemaker failure
-S/S of infection at pacemaker generator
-keep incision dry/clean for 72 hours
-avoid travelling for 3 months after pacemaker insertion
-carry pacemaker ID card
-medical alert bracelet
-avoid high voltage areas/magnetic fields
-notify airport security (no wanding)
-do not drive until MD says ok
-no contact sports |
|
|
Term
|
Definition
| vertigo, syncope, twitching muscles, hiccups, chest pain |
|
|
Term
| true or false: the person who touches a patient being shocked may feel tingling |
|
Definition
|
|
Term
| what should we teach pts regarding ICD failure? |
|
Definition
| cough CPR, may teach family CPR |
|
|
Term
| what rhythms can put patients into cardiac arrest? |
|
Definition
-V fib
-V tach- pulseless
-pulseless electrical activity (PEA)
-asystole |
|
|
Term
| after starting CPR, how often should rhythm and pulse be reassesed? |
|
Definition
|
|
Term
| after starting CPR, how often should rhythm and pulse be reassesed? |
|
Definition
|
|
Term
| why is it important not to provide excessive ventilation? |
|
Definition
| excessive ventilation increases intrathoracic pressure, decreasing venous return |
|
|
Term
| how many joules for monophasic defibrillation? |
|
Definition
|
|
Term
| once intubated, how often should we ventilate the patient? |
|
Definition
| 8-10 breaths/min, do not synchronize with chest compressions |
|
|
Term
| how do we confirm placement of an ETT? |
|
Definition
| bilateral chest expansion, auscultation, exhaled CO2, chest xray |
|
|
Term
| rate of chest compressions |
|
Definition
|
|
Term
| how far should we depress the sternum with each compression? |
|
Definition
|
|
Term
| if it is unknown whether the defibrillator is monophasic or biphasic what voltage should we shock at? |
|
Definition
|
|
Term
|
Definition
-CPR while defibrillator charges
-restart CPR after shock, 5 cycles (2 min) beginning w/compressions
-check rhythm and pulse after 5 cycles |
|
|
Term
| true or false: if we are administering drugs via ETT, 2-2.5 times the drug is given |
|
Definition
|
|
Term
| what should we do following peripheral drug administration in an emergency situation? |
|
Definition
| bolus 20cc and elevate extremity |
|
|
Term
| how often do we administer epi in an emergency situation? |
|
Definition
| 1g every 3-5 min, may improve effectiveness of defibrillation, fosters perfusion in the brain |
|
|
Term
| true or false: in an emergency situation, drugs should be administered ASAP after rate/rhythm check |
|
Definition
|
|
Term
| what should we give if pulseless VT or VF persists after 2-3 shocks plus vasopressor (epi or vasopressin) admin? |
|
Definition
| antiarrhythmic: Amiodarone 150-300mg once IV, then 150 mg |
|
|
Term
| what should we consider administering for tx of torsades? |
|
Definition
|
|
Term
| true or false: defibrillation has no effect on asystole |
|
Definition
|
|
Term
| what meds may be administered for tx of asystole? |
|
Definition
-epi or vasopressin
-atropine (1mg IVP) |
|
|
Term
|
Definition
|
|
Term
|
Definition
-hypovolemia
-hypoxemia
-hydrogen ion (acidosis)
-hypo/hyperkalemia (hypo common in renal pts)
-hypoglycemia
-hypothermia |
|
|
Term
|
Definition
-toxins- environment?-anaphylactic
-tamponade (fluid accumulation in pericardial sac)
-tension pneumothorax
-thrombosis- coronary
-thrombosis- pulmonary
-trauma |
|
|
Term
| true or false: lidocaine if given to treat PVC's in an emergency situation |
|
Definition
| false, lidocaine if given to treat PVC's but not in an emergency situation |
|
|
Term
| which cardiac meds are given for SVT? |
|
Definition
|
|
Term
|
Definition
| increases perfusion to brain & coronaries during CPR |
|
|
Term
|
Definition
| may cause coronary & renal vasoconstriction (vasoconstriction b/c we want pt to clamp down) |
|
|
Term
|
Definition
| inotrope & potent vasoconstrictor; used for severe hypotension; central line (extravasation) |
|
|
Term
|
Definition
dose dependent effects:
.5-2 mcg/kg/min: dopaminergic (renal perfusion)
2-10 mcg/kg/min: inotropic
>10mcg/kg/min: vasoconstriction |
|
|
Term
|
Definition
| synthetic catecholamine & potent inotrope; severe systolic heart failure |
|
|
Term
|
Definition
| inotropic, vasodilator of vascular smooth muscle; heart failure |
|
|
Term
|
Definition
|
|
Term
|
Definition
| relaxes vascular smooth muscle; CHF, HTN |
|
|
Term
|
Definition
potent peripheral vasodilator; HTN
TAKE BP EVERY 5-15 MIN b/c we are titrating medication |
|
|
Term
|
Definition
-cool pts to 32-34C for patients in a coma after cardiac arrest from VF
-cardio protective/neuro protective
-large-volume ice, cold IV fluids, cold blankets |
|
|
Term
|
Definition
|
|
