-
spectrum of coronary artery disease proceses from myocardial ischemia and myocardial injury to myocardial infarction and includes the clinical entities of stable and unstable angina and acute myocardial infarction.
ACS (acute coronary syndrome
-
chest pain that results when the heart's o2 requirements exceed o2 supply available from blood.
angina pectoris
-
physiologic Q waves measure:
pathologic Q waves measure:
- phy - less than .04 sec (40 mms)
- pas - greater than or equal to .04 sec
-
restoring blood flow to ischemic tissue
reperfusion
-
death and subsequent necrosis o fthe heeart muscle caused by inadequate blood supply; also (AMI) acute myocardial infarction
MI (myocardial infarction)
-
myocardial infarction that affects the full thickness of the myocardium and almost always results in a pathological Q wave in the affected leads.
transmural infarction
-
more then ________ americans have some form of CVD
60 million
-
the single largest killer of Americans is ____ in which _____people die
-
communication between 2 or more vessels.
anastomosis
-
protective mechanism that provides an alternative path for blood flow in case of a blockage somewhere in the system.
collateral circulation
-
-
law stating that blood flow through a vessel is directly proportional the the radius of teh vessel to the fourth power.
-
cardiac cycle
period of time from the end of one cardiac contraction to the end of the next
-
diastole
period of time when the myocardium is relaxed and the cardiac filling and coronary perfusion occur
-
systole
the period of the cardiac cycle when the myocardium is contracting
-
ratio of blood pumped from the ventricle to the amount remaining at the end of diastole
ejection fraction
-
stroke volume
amount of blood pumped out by heart in one cardiac contraction
-
Starling's law
the more the myocardium is stretched up to a certain point, the more forceful the subsequent contraction will be
-
afterload
resistance against which the heart must pump
-
preload
the pressure within the ventricles at the end of diastole; commonly called the end-diastolic volume
-
cardiac output
the amount of blood pumped by the heart in 1 minute
-
formula for blood pressure
blood pressure = cardiac output x systemic vascular resistance
-
formula for cardiac output
cardiac output = stroke volume x heart rate
-
chronotropy
pertaining to heart rate
-
intropy
pertaining to cardiac contractility force
-
dromotropy
pertaining to the speed of impulse transmissions
-
alpha receptors located in _______ responsible for __________
- blood vessels
- vasoconstriction
-
beta1 located in ____ increase __ and __
beta2 located in _____
- - heart increase heart rate and contractility
- - lungs cause bronchodilation and peripheral vasodilation
-
specialiazed bands of tissue inserted between myocardial cells that increase the rate in which the action potential is spread from cell to cell.
intercalated discs
-
cardiac depolarization
a reversal of charges at a cell membrane so that the inside of the cell becomes positive in relation to the outside.; the opposite of the cell's resting state in which the insideof the cell is negative in relation to the outside
-
resting potential
the normal electrical state of cardiac cells.
-
The heart receives blood from the ___, which originate in the ______
coronary arteries, aorta
-
blood is supplies to the left ventricle, interventricular septum, part of the right ventricle, and conduction system by
left coronary artery
-
the 2 major branches of the left coronary artery
anterior decending artery and the circumflex artery
-
blood is supplied to part of the right ventricle and right atrium, and part of the conduction system by
right coronary artery
-
the 2 major branches of the right coronary artery
posterior descending artery and marginal artery
-
coronary vessels receive blood during ___
diastole
-
communication between two or more vessels
anastomosis
-
layers of artery and vein walls
- innermost - tunica intima
- middle - tunica media
- outermost - tunica adventitia
-
purpose of AV junction
slow impulse down to allow ventricles to fill
-
cardiac cells have these 4 characteristics
- excitability
- conductivity
- automaticity
- contractility
-
where the esophapus meets the the stomach
hiatus
-
3 groups that may show untypical signs and symptoms of chest pain
elderly, females, diabetic
-
most common cause of fatalities from a heart attack
dysryhytmias
-
leading cause of death ACS
dysrhythmias
-
this results in increased back pressure into the pulmonary circulation
Left ventricular failure
-
this results in increased back pressure into systemic venous circlation
Right ventricular failure
-
pitting edema result of
systemic backup
-
pathophysiology of CHF
reduction in stroke volume causes fluid overload throughout the body's other tissues
-
how is hydrostatic pressure affected in CHF
increased
-
drugs to treat CHF
1st line_____
2nd_____
use cautiously___
-
in CHF mental status changes indicate
impending respiratory failure
-
primary cause for HTN emergency
noncompliance with prescribed antihypertension medications
-
signs/symptoms including headache, nausea vomiting, blurred vision, SOB, epistaxis, vertigo, tinnitis point to
hypertensive emergency
-
ballooning of an arterial wall, usually the aorta, that results from a weakness or defect in the wall
aneurysm
-
aneurysm inferior to vena cava often the result of atherosclerosis
AAA - abdominal aortic aneurysm
-
blockage of a pulmonary artery by a blood clot or other particle.
acute pulmonary embolism
-
sudden occlusion of arteriol blood flow due to trauma, thrombosis, tumor, embolus, or idiopathic means
acute arteriol occlusion
-
inflammation of the blood vessels commonly stems from rheumatic diseases and syndromes
vasculites
-
dialated superficial veins common with pregnancy and obesity
varicose veins
-
blood clot in vein that typically occurs in larger veins of thigh and calf - swelling, pain and tenderness, with warm red skin.
deep venous thrombosis
-
can be chronic often associated wth diabetes. estremities exhibit pain, coldness, numbness, and pallor
peripheral arterial atherosclerotic disease
-
5 P's for assesing assessment and management of vascular disorders
- pallor
- pain
- pulselessness
- paralysis
- parethesia
-
reeentry may cause _______ that occurs when ___. can result in rhytms such as ____
- isolated premature beats
- ischemia or another disease process alters 2 branches of a conduction pathway conducted retrograde back to branch's origin
- - PSVT and A-fib
-
electrolytes most commonly associated with ecg disturbances are
potassium and calcium
-
hypokalemia
condition where potassium level in blood is low
-
hypokalemia effect on ecg
cause prominent u wave and flatten T wave
-
hyperkalemia
potassium level in blood is elevated
-
hyperkalemia effect on eck
tall pointed T waves
-
- hypocalcemia can be caused by
- effects on ecg
- - diuretics and certain endocrine conditions
- - prolongs repolarization and causes prolonged ST segment and prolonged QT interval
-
-hypercalcemia can be caused by?
- effect on ecg
- - adrenal insufficiency, hyperparathyroidism, kidney failure, or malignancies.
- - shortens the repolarization phase thus ST segment to shorten
-
effects of digitalis on ecg
sagging or scooping of ST segment and can prolong pr interval
-
effects of hypothermia on ecg
osborn (J) wave
-
the ratio of blood pumped from the ventricle compared with the amount contained at the end of diastole
ejection fraction
-
series of events between the end of a cardiac contraction to the end of the next
cardiac cycle
-
the resistance against which the heart must pump
afterload
-
. the phase of the cardiac cycle during which the heart contracts
systole
-
the amount of blood pumped by the ventricle during one cardiac contraction
stroke volume
-
the amount of blood pumped by the ventricle during one minute
cardiac output
-
the phase of the cardiac cycle during which the heart muscle is relaxed
diastole
-
the end-diastolic volume in the ventricle
preload
-
The parasympatholytic agent used to treat symptomatic bradycardias is
atropine
-
the most common presenting symptoms in cases of cardiac disease.
chest pain
-
A blood clot in one of the pulmonary arteries is called
pulmonary embolism
-
progressive degenerative disease of the medium-sized and large arteries.
Artherosclerosis
-
Conduction of the electrical impulse through the heart’s conductive system in an abnormal fashion
aberrant conduction
-
A delay in conduction at the level of the AV node is called
first degree AV block
-
The five Ps of acute arterial occlusion are
pain, pallor, paresthesia, pulselessness, and paralysis
-
law states that the flow rate of a fluid through a tubular vessel was linked to the radius of the tube. The flow rate or pressure of blood flow through a blood vessel therefore is related to the radius or size of the vessel.
Poiseuille’s Law
-
Chest pain that results when the heart’s oxygen demands exceed the blood’s supply is called
angina pectoris
-
variant of angina pectoris caused by vasospasm of the coronary arteries is called
Prinzmetal’s __________ angina
-
and subsequent necrosis of the heart muscle caused by inadequate blood supply
myocardial infarction
-
A cerebral disorder of hypertension indicated by severe headache, nausea, vomiting, and altered mental status is called
hypertensive encephalopathy
-
The thickening, loss of elasticity, and hardening of the walls of the arteries from calcium deposits is known as
artherosclerosis
-
are standardized such that the paper moves across the stylus at the rate of
25 mm/sec
-
When properly calibrated, a deflection of ______ large box(es) is equivalent to 1 mV.
2
-
One small horizontal box on an ECG is equivalent to ___ _________, and one large box is equivalent to _____seconds________________.
0.04 and 0.20
-
The time-interval markings placed at the top of ECG paper are located at intervals of
3 seconds
-
Prominent U waves and a widened QRS complex are both ECG evidence of this electrolyte imbalance
hypokalemia_________________.
-
inflammation and clots within a vein
thrombophlebitis
-
relief of dyspnea on sitting upright
orthopnea
-
alternation of weak and strong pulse over time
-
-
episodes of being awakened at night by shortness of breath
paroxysmal nocturnal dyspnea
-
drop of more than 10 mmHg in systolic BP with inspiration
pulsus paradoxus
-
T wave inversion indicative of what on ecg
infarcted tissue or extensive transient ischemia
-
pathological Q wave on ecg idicative of
infarcted tissue that has formed a scar
-
S-T segment elevation on indicative of
-
-
S-T segment depression
myocardial ischemia
-
infarction affects the full thickness of myocardium and almost always results in pathological Q waves in the leads associated with the region of tissue death.
transmural myocardial infarction
-
The most common and one of the most life-threatening complications of an acute MI
dysrhythmias
-
The typical window for thrombolytic therapy in the setting of acute MI is initiation of therapy within _________ of onset of symptoms
3
-
An MI is usually associated with complaints of radiating chest pain that lasts longer than 30 minutes
acute MI
-
is the heart's reduced stroke volume causing an overload of fluid in the body's other tissues.
CHF
-
sudden episode of difficult breathing that occurs after lying down
paroxysmal nocturnal dyspnea
-
The accumulation of excess fluid inside the pericardium is called
cardiac tamponade
-
The inability of the heart to meet the metabolic needs of the body, resulting in inadequate tissue perfusion
cardiogenic shock
-
The absence of any ventricular contraction is called
cardiac arrest
-
death within one hour after the onset of symptoms.
sudden death
-
duration from the beginning of the cardiac arrest until effective CPR is established.
downtime
-
Left ventricular failure causes back pressure of fluid into the pulmonary veins and into the lungs, resulting in
pulmonary backup
-
is the most common symptom of congestive heart failure (CHF).
Labored breathing
-
problems are the most common cause of cardiac arrest in infants and children.
respiratory and shock
-
is a late and often sudden sign of cardiovascular decompensation in pediatric patients.
hypotension
-
The initial dosage of fluid in a pediatric patient suffering from hypovolemia should be
20ml/kg_________ of an isotonic fluid
-
What is the suggested initial setting for defibrillation of pediatric patients?
- What energy is used on subsequent shocks?
-
What is the initial IV dose of epinephrine in pediatric cardiac arrest
0.01 mg/kg
-
passage of electrical current through the heart during a specific part of the cardiac cycle to terminate certain dysrhythmias
. synchronized cardioversion
-
passage of electrical current through a fibrillating heart to depolarize a critical mass of myocardium, resulting in conversion to an organized rhythm
defibrillation
-
Dyspnea, tachycardia, noisy, labored breathing, gallop heart rhythm
-
-
Syndrome in which the heart’s pumping ability does not meet body needs
heart failure
-
Unresponsiveness with apnea and pulselessness
cardiac arrest
-
Jugular venous distention, engorged liver, edema, tachycardia
-
right ventricular failure
-
possible diagnosis to Pulsus paradoxus and pulsus alternans
cardiac tamponade
-
Dyspnea, orthopnea, decreased systolic BP with narrowing pulse pressures
pulmonary edema
-
Severe headache, visual disturbance, seizures, stupor, diagnostic vital signs
. hypertensive encephalopathy
-
adenosine for ped dose SVT
0,1 mg/kg may double dose once for the second dose
-
left sided heart failure can present with
pulmonary edema
-
atropine for bradycardia adult dose
0.5 mg IV may repeat up to 3mg
-
atropine bradycardia peds does
0.02 mg/kg IV may repeat up to 1mg
-
side effects atropine
Blurred vision, dilated pupils, dry mouth, tachycardia, drowsiness, confusion
-
Amiodarone for VF peds dose
5mg/kg IV max dose is 15 mg/kg
-
amio side effects
Hypotension, bradycardia, prolonged PR interval
-
-
0.1 mg/kg, may repeat once in 1-2 min. at 0.2mg/kg., max dose is 12 mg
-
-
Facial flushing, headache, SOB, dizziness, nausea
-
. Epinephrine for cardiac arrest adult dose
- 1mg 1:10000 IV
- Every 3 – 5 minutes until circulation retstored
-
. Epinephrine for cardiac arrest peds dose
0.01 mg/kg 1:10000 IV every 3 to 5 minutes
-
epi side effects
Nausea, vomiting, palpitations, dizziness,anxiety
-
dopamine dose adult and peds
2-5 mcg/kg/min up to 20mcg/kg/min titrated to ef
-
dopamine sides
tachy, nausea, vomiting, headache, dilated pupils
-
fentanyl adult dose
25 to 100 mcg
-
Fentanyl ped dose
2.0 mcg/kg IV
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