Term
|
Definition
Troponin (and tropomyosin) regulate contraction and relaxation of cardiac cells
Measure as a lab test to detect cardiac muscle death = MI |
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Term
| Calcium and cardiac cell contractions |
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Definition
| The more calcium, the faster the contraction and the longer the contraction is maintained |
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Term
| Electrical conduction system of the heart |
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Definition
- SA node (60-100bpm): primary pacemaker
- AV node
- Ventricles
- Sum of electrical activity of heart is measured by the EKG |
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Term
| Electrical conduction: how do systole and diastole fit in |
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Definition
Systole: follows depolarization of the ventricles
Diastole: follows repolarization |
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Term
| Cardiac Output (CO): what is it and what affects it |
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Definition
= stroke volume X heart rate
Factors affecting CO: exercise, age, fever, metabolism, pregnancy, disease |
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Term
| Heart rate: how the ANS controls it |
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Definition
Parasympathetic NS
- Inhibitory via vagus nerve
- Acetylcholine
- Decreases HR
Sympathetic NS
- Stimulatory
- Norepinephrine and epinephrine
- Increases HR and contractility |
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Term
| What factors control stroke volume? |
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Definition
Contractility
Preload
Afterload |
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Term
| Contractility (Inotrophy) |
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Definition
- Frank Starling Law: the more the heart can stretch, the greater the contraction's force
- Factors affecting contractility: sympathetic NS, Ca2+, medications, ischemia |
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Term
|
Definition
The volume of blood in the ventricles at the end of diastole (filling)
- Determined soley by venous return
- Factors affecting preload: absolute blood volume, blood distribution in body, atrial kick, ventricular function (contractility), ventricular compliance (stiffness) |
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Term
|
Definition
Resistance or pressure ventricle has to overcome to eject blood
- Factors affecting afterload: HTN, ventricular outflow obstruction (aortic valve stenosis), sympathetic NS stimulation
- Vasoconstriction increases afterload
- Vasodilation decreases afterload |
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Term
| Non-modifiable risks for heart disease |
|
Definition
Age
Gender
Ethnic origin
Family history
Strep infections
Medical history |
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Term
| Modifiable risk factors for heart disease |
|
Definition
Food choices
Activity
Obesity
Psychological variables
Cigarette use
Meds-estrogen |
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Term
|
Definition
Heart has rich capillary system, big need for oxygen.
Supplied by blood from the aorta
Left coronary artery that branches into descending coronary artery is the one that usually gets blocked |
|
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Term
| Why MIs are more dangerous at a younger age |
|
Definition
| Collateral circulation develops over time with chronic ischemia. If you have an MI earlier you don't have that collateral circulation |
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Term
| Risk factors for atherosclerosis |
|
Definition
- Low HDL-C
- High LDL-C
- Increased triglycerides
- Genetic predisposition
- DM
- Obesity
- Sedentary lifestyle
- Smoking
- Stress
- African American or Hispanic ethnicity
- Older adult |
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Term
|
Definition
- Small amounts of protein in urine
- Clear marker of widespread endothelial dysfunction in DV disease
- Detects cardiac compliance
- Good measure for HF, elevates before BNP rises |
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Term
| How atherosclerosis happens |
|
Definition
- Injury brings platelets, they aggregate
- LDL accumulates, brings macrophages, try to eat LDL but can't, make them frothy
- Platelets seal them, results in smaller vessel
- Thrombus is what actually occludes the vessel = infarct |
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Term
| Risk factors for hyperlipidemia |
|
Definition
- Cigarette smoking
- HTN
- Low HDL (<40)
- Family history of premature CHD (in male 1st degree relative <55, in female 1st degree relative <65)
- Age (men >45, women >55) |
|
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Term
|
Definition
Desireable = <200
Borderline high = 200-239
High >240 |
|
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Term
|
Definition
Optimal = <100
Near optimal/above optimal = 100-129
Borderline high = 130-159
High = 160-189
Very high = 190 |
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Term
|
Definition
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Term
| Causes of secondary dyslipidemia |
|
Definition
- Diabetes
- Hypothyroidism
- Obstructive liver disease
- Chronic renal failure
- Drugs that raise LDL and lower HDL (progestins, anabolic steroids, corticosteroids) |
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Term
|
Definition
Plaque rupture leads to MI, depending on the degree of occlusion. The MI is usually a thrombus superimposed on a plaque
- Plaque with fibrous cap
- Cap ruptures
- Blood clot forms around rupture, blocking artery |
|
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Term
| Stable vs. unstable plaques |
|
Definition
Stable:
- when it ruptures, thrombosis and constriction obstruct vessel causing inadequate perfusion and oxygenation to distal tissues
Unstable:
- Causes more severe damage, after rupture, causes rapid thrombus formation which can blood blood vessel and result in ischemia and infarction |
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Term
| How damage happens from heart attacks |
|
Definition
- EKG changes after 30-60 sec, cells still viable for 20 min
Continuum of damage
- Blockage leads to ischemia (hypoxia)
- Cells need O2, do anaerobic metabolism, acid accumulates leading to acidosis
- Acid leads to cell death
- Leads to heart failure |
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Term
|
Definition
- CAD: angina, MI, CABG
- PVD or CVA
- Dyslipidemia
- HTN
- Family history |
|
|
Term
| Cardiac enzymes for diagnosis of MI |
|
Definition
- Troponin
- CK-MB
- Myoglobin |
|
|
Term
| Physical assessment for MI |
|
Definition
- Monitor BP
- Palpate pulses in all major sites of body
- Assess for prolonged capillary refill
- Assess for bruit |
|
|
Term
|
Definition
- ST-elevation MI (STEMI): need immediate treatment
- T-wave inversion
- Non-ST-elevation MI (NSTEMI): indicates ischemia, cardiac enzymes can initially be normal
- Q wave: because necrotic cells don't conduct electricity, can be permanent |
|
|
Term
| Q wave MI vs. Non-Q wave MI |
|
Definition
Q waves are areas of infarct that can't be depolarized because they're dead
- Higher incident of acute mortality
- Increased muscle damage
- Development of CHF
Non-Q wave diagnosed by elevated troponin
- Higher long-term mortality due to less aggressive therapy |
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|
Term
| Treatment of acute MI: anti-ischemia therapy |
|
Definition
- Nitroglycerin: converts to NO (endogenous vasodilator) - pain relief
- ACE inhibitors
- Beta blockers
- Calcium channel blockers |
|
|
Term
|
Definition
- Dilates coronary arteries
- Drive under tongue
- Pain relief in 1-2 minutes
- Give 3 doses in 5 min intervals
- Monitor pt for low HR and BP before and after administering |
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|
Term
|
Definition
For left ventricle dysfunction or CHF, diabetics
- Promotes vasodilation
- Limits neurohormonal activation during ischemia
- Slow development of atherosclerosis
- Inhibit platelet activation
- Reverse negative vascular remodeling |
|
|
Term
|
Definition
- Decrease myocardial contractility and myocardial oxygen demand
- Decrease renin secretion and level of angiotension II
- Monitor for bradycardia, hypotension, decreased LOC, chest discomfort |
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Term
|
Definition
| Use if beta blockers are contraindicated |
|
|
Term
| Treatment of acute MI: antiplatelet and anticoagulants |
|
Definition
- Antiplatelet: ASA, plavix, I ntegrilin
- Anticoagulants: Heparin, Lovenox, Fragmin |
|
|
Term
| Treatment of acute MI: revascularization |
|
Definition
Angioplasty/stent: used for 1-2 vessel disease or 3 vessel disease if normal LVF and no DM
- Monitor that clot has resolved
- Administer heparin
CABG: bypass occluded coronary artery with pts own blood vessel or synthetic graft
- For left main disease, 2-3 vessel disease and decreased EF
- Promote coughing and deep breathing
- Early ambulation |
|
|
Term
| Repair of damaged myocardium |
|
Definition
- 24 hours: enzymes break down necrotic cells
- 10-14 days: collagen matrix formed, initially weak, mushy, vulnerable to reinjury
- 6 weeks: necrotic areas replaced by scar tissue, unable to contract and relax like healthy tissue |
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Term
| Nursing interventions to prevent future cardiac events |
|
Definition
Nutrition therapy
- Decrease LDL, increase HDL
- Total far to <30% total calories
- Increase fiber, decrease NA+
Activity
- Close monitoring
- Cardiac rehab
Stress reduction
Medication education |
|
|
Term
| 3 mechanisms that regulate blood pressure |
|
Definition
1. Autonomic nervous system: excites or inhibits sympathetic activity in response to impulses from chemoreceptors and baroreceptors
2. Kidneys: sense change in blood flow and activate the renin-angiotensin-aldosterone mechanism
3. Endocrine system: releases various hormones to stimulate the sympathetic nervous system at the tissue level |
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Term
| Assessment of cardiac related pain |
|
Definition
Discomfort
Indigestion
Squeezing
Heaviness
Viselike |
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Term
|
Definition
Chest pain or discomfort
Dyspnea
Fatigue
Palpitations
Weight gain
Syncope
Extremity pain |
|
|
Term
| The triad of symptoms women with CVD present with |
|
Definition
Indigestion or abdominal fullness
Chronic fatigue desite adequate rest
Inability to catch breath |
|
|
Term
|
Definition
Invasive diagnostic procedure performed when arterial obstruction is suspected
- Assess patient for allergy to contrast media
- Increase fluids because dye acts as diuretic |
|
|
Term
|
Definition
Most definite test in diagnosis of heart disease, insert catheter through femoral artery
- Prepare patient by explaining risks and side effects
- Monitor vitals
- Make sure patient lies supine for 2-6 hours
- Assess insertion site for bloody drainage
- Assess circulation distal to insertion site
- Assess for change in LOC |
|
|
Term
|
Definition
Cardiac dysrhythmias
Myocardial ischemia
Site and extent of MI
Cardiac hypertrophy
Electrolyte imbalances
Effectiveness of cardiac drugs |
|
|
Term
|
Definition
| Chronic stable angina and acute coronary syndromes affect arteries providing blood, O2, and nutrients to the myocardium |
|
|
Term
|
Definition
Chest discomfort that occurs with moderate to prolonged exertion in a frequency, duration, and intensity that remains the same over time
- Results in only slight limitation of activity
- Associated with fixed atherosclerotic plaque
- Relieved by nitroglycerin and rest, managed by drug therapy, rarely requires aggressive treatment |
|
|
Term
|
Definition
| Presentation with either unstable angina or an acute myocardial infarction, resulting in platelet aggregation, thrombus formation, and vasoconstriction |
|
|
Term
|
Definition
| Chest pain or discomfort that occurs at rest or with exertion, causes severe activity limitation, and the attacks and intensity of pain increase |
|
|
Term
| Populations with atypical angina |
|
Definition
- Women: may experience indigestion, pain btwn the shoulders, aching jaw, or choking sensation with exertion
- Diabetics: no pain bc of neuropathy
- Older adults: can't verbalize pain |
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|
Term
| Symptoms of cardiac tamponade |
|
Definition
- Cessation of previously heavy mediastinal drainage
- JVD with clear lungs
- Pulsus paradoxus
- Cardiovascular collapse
- Friction rub |
|
|
Term
|
Definition
| Must be at least 60mmHg to maintain adequate perfusion to the tissues |
|
|
Term
|
Definition
| Indicates inflammation and is increased in people at risk for atherosclerosis and ACS, but it does not indicate an acute problem. |
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