ch 32-38 terms

  1. action potential p. 687
    electical impulses
  2. afterload p. 689
    is the peripheral resistance against which the left ventricle must pump.  afterload is affected by the size of the ventricle, wall tension, and arterial blood pressure (BP).
  3. arterial blood pressure p. 690
    a measure of the pressure exerted by blood against the walls of the arterial system.
  4. cardiac index (CI) p. 689
    is the CO divided by the body surface area (BSA)
  5. cardiac output (CO) p. 689
    is the amount of blood pumped by each ventricle in 1 minute.  it is calculated by multiplying the amount of blood ejected from the ventricle with each heartbeat --the stroke volume-- by the heart rate per minute.

    CO= SV x HR
  6. cardiac reserve p. 689
    Ability to alter CO in response to demands such as health and illness (exercise, stress, hypovolemia)
  7. coronary angiography p. 706
    done with a left-sided heart catheterization.  the catheter is positioned at the origin of the coronary arteries and contrast medium is injected into the arteries.  patients often feel a temporary flushed sensation with dye infection.  the images identify the location and severity of any coronary blockages.
  8. diastole p. 687
    relaxation of the myocardium, allows for filling of the ventricles
  9. diastolic blood pressure (DBP) p. 690
    is the residual pressure in the arterial system during ventricular relaxation (or filling).  BP is usually expressed as the ratio of systolic to diastolic pressure.
  10. ejection fraction (EF) p. 704
    the percentage of end-diastolic blood volume that is ejected during systole, can also be measured.  the EF provides information about the function of the left ventricle during systole.
  11. heaves p .697
    sustained lifts of the chest wall in the precordial area that can be seen or palpated.  they may be caused by left ventricular hypertrophy.  Normally no pulsations are seen or felt here.
  12. Korotkoff sounds p. 690
    the BP is measured by auscultating for sounds of turbulent blood flow through a compressed artery.
  13. mean arterial pressure (MAP) p. 690
    the MAP refers tot he average pressure within the average of the diastolic and systolic pressures because the length of diastole exceeds that of the systole at normal HRs. 

    Map is calculated as: (SBP+2DBP)/3
  14. murmur p. 691
    turbulent blood flow across the affected valve
  15. point of maximal impulse (PMI) p. 697
    also called the apical pulse.  this reflects the pulsation of the apex of the heart.  the PMI lies medial to the midclavicular line int he fourth or fifth ICS.
  16. preload p. 689
    the volume of blood in the ventricles at the end of diastole, before the next contraction.  preload determines the amount of stretch placed on myocardial fibers.
  17. pulse pressure p .690
    difference between the SBP and DBP. it is normally about one third of the SBP.

    ie if BP is 120/80, pulse pressure is 40 mm Hg
  18. systole p. 689
    contraction of the myocardium, results in ejection of blood form the ventricles
  19. systolic blood pressure (SBP) p. 690
    the peak pressure exerted against the arteries when the heart contracts.
  20. blood pressure (BP) p 710
    the force exerted by the blood against the walls of the blood vessel.
  21. hypertension p. 712
    defined as a persistent systolic BP (SBP) of 140 mm Hg or more, diastolic BP (DBP) of 90 mm Hg or more, or current use of antihypertensive medication.
  22. hypertensive crisis p. 726
    term used to indicate either a hypertensive urgency or emergency.  this is determined by the degree of target organ disease and how quickly the BP must be lowered.
  23. isolated systolic hypertension (ISH) p. 712
    an average SBP of 140 mm Hg or more, coupled with an average DBP of less than 90 mm Hg.  SBP increases with aging.  DBP rises until approx. age 55 and then declines.  Control of ISH decreases the incidence of stroke, heart failure, and death.
  24. orthostatic hypotension p. 723
    • a decrease of 20 mm Hg or more in SBP, a decrease of 10 mm Hg or more in DBP and/or an increase in HR of 20 beats/minute or more from supine to standing indicates orthostatic hypotension.  common causes are: intravascular volume loss and inadequate vasocontrictor mechanisms related to disease or medications.
    • *drug alrter: doxazosin (cardura)
  25. prehypertension p. 712
    defined as SBP of 120-139 mm Hg or DBP of 80 to 89 mm Hg.
  26. primary hypertension p. 712
    (essential or idiopathic) is elected BP without an identified cause and it accounts for 90%-95% of all cases of hypertension.  although the exact cause of primary hypertension is unknown there are several contributing factors.  these include increased SNS activity, overproduction of sodium-retaining hormones and vasoconstricting substances, increased sodium intake, greater than ideal body weight, diabetes mellitus, tobacco use, and excessive alcohol consumption.
  27. secondary hypertension p. 712
    elevated BP with a specific cause that often can be identified and corrected.  this type of hypertension accounts for 5%-10% of hypertension in adults.  this type of HPTN should be suspected in people who suddenly develop high BP especially if it is severe.  clinical findings suggest secondary HPTN relate to the underlying cause.
  28. systemic vascular resistance (SVR) p 710
    the force opposing the movement of blood within the blood vessels.  the radius of the small arteries and arterioles is the principal factor determining vascular resistance.
  29. acute coronary syndrome (ACS) p 746
    develops and encompasses the spectrum of unstable angina, non-ST-segment elevation MI and ST-segment-elevation MI.
  30. angina p. 740
    chest pain, is the clinical manifestation of reversible myocardial ischemia.  either an increased demand for oxygen or a decreased supply of oxygen can lead to myocardial ischemia.
  31. atherosclerosis p 731
    comes from the two greek words: athere meaning fatty mush and skleros, meaning hard.  this combination implies that atherosclerosis begins as soft deposits of fat that harden with age.  consequently, atherosclerosis is commonly referred to as "hardening of arteries".  although this condition can occur in any artery in the body, the atheromas (fatty deposits) prefer the coronary arteries.
  32. chronic stable angina p 741
    refers to chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms.  when questioned, some patients may deny feeling pain but describe a pressure or ache in the chest.
  33. collateral circulation p 732
    arterial anastomoses or connections
  34. coronary artery disease (CAD) p 731
    a type of blood vessel disorder that is included in the general category of atherosclerosis
  35. coronary revascularization with an elective percutaneous coronary intervention p 745
    • if coronary bloackage is amenable to an intervention, coronary revascularization with an elective percutaneous coronary intervention is done. 
    • During this procedure: a catheter with an inflatable baloon tip is inserted into the appropriate coronary artery.  When the blockage is located, the catheter is passed through it, the balloon is inflated, and the atherosclerotic plaque is compressed, resulting in vessel dilation.  this procedure is called balloon angioplasty.
  36. metabolic equivalent (MET) p 760
    one method of identifying levels of physical activity.  1 MET is the amount of oxygen needed by the body at rest --3.5 mL of oxygen per kilogram per minute, or 1.4 cal/kg of body weight per minute.  the MET determines the energy costs of various exercises.
  37. myocardial infarction (MI) p 747
    occurs because of sustained ischemia, causing irreversible myocardial cell death (necrosis).  Thrombus formation causes 80%-90% of all acute MIs.
  38. Prinzmetal's angina p 742
    (variant angina) often occurs at rest, usually in response to spasm of a major coronary artery. it is a rare form of angina frequently seen in patients with a history of migraine headaches and Raynaud's phenomenon.  the spasm may occur int he absence or presence of CAD.  Prinzmetal's angina is not usually precipitated by increased physical demand.  Strong contraction (spasm) of smooth muscle in the coronary artery results from increased intracellular calcium.
  39. silent ischemia p 742
    refers to ischemia that occurs in the absense of any subjective symptoms.  patients with diabetes have an increased prevalence of silent ischemia most likely due to diabetic neuropathy affecting the nerves that innervate the cardiovascular system.
  40. stent p 746
    an expandable meshlike structure designed to keep the vessel open by compressing the arterial wall.  Because stents are thrombogenic, unfractionated heparin or low-molecular-weight heparin is started to maintain the open vessel.
  41. sudden cardiac death (SCD) p 762
    unexpected death resulting form a variety of cardiac causes.  an estimated 382,800 people experience SCD annually.
  42. unstable angina (UA) p 747
    chest pain that is new in onset, occurs at rest, or has a worsening pattern.  the patient with chronic stable angina may develop UA, or UA may be the first clinical sign of CAD.
  43. cardiac transplantation p. 783
    transfer of a health donor heart to a patient with a diseased heart.  this surgery is used to treat a variety of terminal or end-stage heart conditions.  Restransplantation (i.e. a second or third heart transplant) is also done.  in the US, more than 2000 cardiac transplants are done each year.
  44. diastolic failure p 767
    inability of the ventricles to relax and fill during diastole.  Diastolic failure is often referred to as HF with normal EF. decreased filling of the ventricles results in decreased stroke volume and CO.
  45. heart failure (HF) p 766
    an abnormal clinical syndrome that involves inadequate pumping and/or filling of the heart.  it is a major health problem in the US.
  46. paroxysmal nocturnal dyspnea (PND) p 771
    occurs when the patient is asleep.  It is caused by the reabsorption of fluid from dependent body areas when the patient is flat.  the patient awakes in a panic, has feelings of suffocation, and has a strong desire to sit or stand up.
  47. pulmonary edema p 770
    ADHF can mnifest as pulmonary edema.  This is an acute, life-threatening situation in which the lung alveoli become filled with serosanguineous fluid.  the most common cause of pulmonary edema is left-sided HF secondary to CAD.
  48. systolic failure p 767
    results from an inability of the heart to pump blood effectively.  It is caused by impaired contractile function (e.g. MI), increased afterload (e.g. hypertension), cardiomyopathy, and mechanical abnormalities (e.g. valvular heart disease)
  49. asystole p. 795
    absence of all cardiac electrical activity.  Some degree of AV block may be present
  50. atrial fibrillation p 796
    characterized by a total disorganization of atrial electrical activity because of multiple ectopic foci, resulting in loss of effective atrial contraction.
  51. atrial flutter p 795
    an atrial tachydysrhythmia identified by recurring, regular, sawtooth-shaped flutter waves that originate from a single ectopic focus in the right atrium or, less commonly, the left atrium.
  52. automatic external defibrillator (AED) p. 802
    can detect heart rhythms and advise the user to deliver a shock using hands-free defibrillator pads.  proficiency in use of the AED is part of the basic life support course for HCPs.
  53. cardiac pacemaker p. 803
    an electronic devise used to pace the heart when the normal conduction pathway is damaged.
  54. complete heart block p. 798
    third-degree AV block; constitutes one form of AV dissocation in which no impulses from the atria are conducted to the ventricles.  The atria are stimulated and contract independently of the ventricles.  the ventricular rhythm is an escape rhythm, and the ectopic pacemaker may be above or below the bifurcation of the bundle of His
  55. dysrhythmias p. 787
    abnormal cardiac rhythms
  56. premature atrial contraction (PAC) p. 794
    a contraction starting from an ectopic focus in the atrium (i.e. a location other than the SA node) and coming sooner than the next expected sinus beat.
  57. premature ventricular contraction (PVC) p. 799
    a contraction coming from an ectopic focus in the ventricles.  it is the premature occurrence of a QRS complex.
  58. telemetry monitoring p. 790
    observation of a patient's HR and rhythm at a site distant from the patient.  the use of this technology can help rapidly diagnose dysrhythmias, ischemia, or infarction. There are two types of systems for telemetry monitoring: surveillance and the second doesn't require constant surveillance
  59. ventricular fibrillation (VF) p.800
    a severe derangement of the heart rhythm characterized on ECG by irregular waveforms of varying shapes and amplitude.
  60. ventricular tachycardia (VT) p. 799
    a run of three or more PVCs.  It occurs when an ectopic focus or foci fire repeatedly and the ventricle takes control as the pacemaker.
  61. aortic regurgitation (AR) p. 823
    may be the result of primary disease of the aortic valve leaflets, the aortic root, or both.  Trauma, IE, or aortic dissection can cause acute AR, which constitutes a life-threatening emergency.  chronic AR is generally the result of rheumatic heart disease, a congenital bicuspid aortic valve, syphilis, or chronic rheumatic conditions such as ankylosing spondylitis or reactive arthritis.
  62. aortic stenosis (AS) p. 822
    generally found in childhood, adolescence, or young adulthood.  In older adults, AS is the result of RF or degeneration that may have an etiology similar to that of coronary artery disease.
  63. cardiac tamponade p. 815
    develops as the pericardial effusion increases in volume.  this results in compression of the heart.  the speed of fluid accumulation affects the severity of clinical manifestations.  Cardiac tamponade can occur acutely (e.g. rupture of heart, trauma) or subacutely (e.g. secondary to renal failure)
  64. chronic constrictive pericarditis p. 817
    results from scarring wth consequent loss of elasticity of the pericardial sac.  It usually beings with an initial episode of acute pericarditis and is characterized by fibrin deposition with a clinically undetected pericardial effusion.
  65. dilated cardiomyopathy p. 827
    the most common type of CMP, with a prevalence of 5-8 cases per 100,000 people in the US.  Dilated CMP often follows an infectious myocarditis.  Some evidnce links dilated CMP with an autoimmune process.
  66. hypertrophic cardiomyopathy p. 828
    asymmetric left ventricular hypertrophy without ventricular dilation.  In one form of the disease, the septum between the two ventricles becomes enlarged and obstructs the blood flow from the left ventricle.  It is termed hypertrophic obstructure cardiomyopathy or assymetric septal hypertrophy
  67. infective endocarditis (IE) p. 811
    an infection of the endocardial layer of the heart.  the endocardium is the innermost layer of the heart and heart valves.  therefore, IE affects the valves.
  68. mitral valve prolapse (MVP) p. 822
    an abnormality of the mitral valve leaflets and the papillary muscles or chordae that allows the leaflets to prolapse, or buckle, back into the left atrium during systole.  It is the most common form of valvular heart disease in the US.
  69. myocarditis p. 817
    a focal or diffuse inflammation of the myocardium.  Possible causes include viruses, bacteria, fungi, radiation therapy, and pharmacologic and chemical factors
  70. pericardiocentesis p. 816
    usually performed for pericardial effusion with acute cardiac tamponade, purulent pericarditis, and suspected neoplasm.  hemodynamic support for the patient being prepared for the pericardiocentesis may include administration of volume expanders and inotropic agents and the discontinuation of any anticoagulants.
  71. pericarditis p. 814
    a condition caused by inflammation of the pericardial sac (pericardium).  the pericardium is composed of the inner serous membrane (visceral pericardium) and the outer fibrous (parietal) layer.
  72. regurgitation p. 821
    also called incompetence of insufficiency, is incomplete closure of the valve results in the backward flow of blood.
  73. rheumatic heart disease p. 818
    a chronic condition resulting from RF that is characterized by scarring and deformity of the heart valves
  74. stenosis p. 821
    constriction of narrowing
  75. Rheumatic fever (RF) p. 818
    an acute inflammatory disease of the heart potentially involving all layers (endocardium, myocardium and pericardium)
  76. cardiomyopathy (CMP)
    a group of diseases that directly affect myocardial structure or function.  A diagnosis of CMP is based on the patient's clinical manifestations and noninvasive and invasive diagnostic procedures.
Card Set
ch 32-38 terms
ch 32-38 terms to know