Coronary Artery Disease Quiz

Cardiovascular System Overview

• The cardiovascular system's function is to provide oxygen and nutrients to body cells and remove waste products.
• Heart disease is the leading cause of death for adults in the United States.
• The primary focus of treatment is disease prevention.

Pericardial Membranes

• The pericardium encloses the heart.
• The outermost layer, the fibrous pericardium, is a tough sac made of connective tissue.
• The parietal pericardium is a thin serous membrane lining the fibrous pericardium.
• The visceral pericardium (epicardium) is a serous membrane on the heart's surface.
• Serous fluid reduces friction during heartbeats.

Chambers of the Heart

• The four chambers of the heart (atria and ventricles) are composed of cardiac muscle (myocardium).
• The endocardium is a smooth layer of simple squamous epithelium lining the heart chambers and valves.
• The interatrial septum separates the right and left atria.
• The interventricular septum separates the right and left ventricles.
• The right atrium receives deoxygenated blood from the body.
• The left atrium receives oxygenated blood from the lungs.
• The right ventricle pumps blood to the lungs.
• The left ventricle pumps blood to the body.

Coronary Vessels

• Coronary vessels supply oxygenated blood to the myocardium.
• Obstruction of a coronary artery can lead to myocardial infarction (MI).

Cardiac Cycle

• The atria receive blood from veins, and as pressure increases, the AV valves open.
• Two-thirds of atrial blood flows passively into the ventricles, then atrial contraction pushes the remaining blood into the ventricles.
• Ventricular contraction closes AV valves and opens the aortic and pulmonary semilunar valves.
• Ventricular contraction pumps blood into the arteries.
• The cycle begins again as blood fills the atria.

Heart Sounds

• Lub-dup (two heart sounds) are generated by the closing of the AV and semilunar valves, respectively.
• Irregular closure of a valve can cause a heart murmur.

Cardiac Conduction Pathway

• The SA node, located in the right atrium, initiates each heartbeat.
• The SA node's cells depolarize rapidly, setting the rhythm for the heart.
• The AV node is in the lower interatrial septum, receiving and transmitting the depolarization signal from the SA node to the AV bundle.
• The AV bundle (bundle of His) is the first part of the ventricles to depolarize

Heart Rate

• A healthy adult's heart rate is typically 60-80 beats per minute.
• Children and infants have higher heart rates due to smaller size and higher metabolic rate.
• Physical fitness can influence resting heart rate.

Cardiac Output

• Cardiac output is the amount of blood pumped by a ventricle in one minute.
• Cardiac output is calculated by stroke volume multiplied by heart rate.
• Stroke volume is the amount of blood pumped in a single heartbeat.
• Starling's law states that the more the cardiac muscle fibers are stretched, the more forcefully they contract.

Regulation of Heart Rate

• The nervous system regulates the heart rate.
• The medulla contains cardiac centers (accelerator and inhibitory).
• The sympathetic nervous system increases heart rate and force of contraction.
• The parasympathetic nervous system (vagus nerves) decreases heart rate.
• Pressoreceptors monitor blood pressure in the carotid and aortic sinuses.
• Chemoreceptors in the carotid and aortic bodies monitor oxygen levels in the blood.

Aging and the Heart

• Heart muscle efficiency diminishes with age.
• Maximum cardiac output and heart rate decrease.
• Resting levels may still be adequate.
• Atherosclerosis (cholesterol deposits) is more frequent, narrowing coronary arteries and impacting blood flow.

High Blood Pressure

• Hypertension causes the left ventricle to work harder, possibly enlarging and weakening it.
• The condition can lead to congestive heart failure, thickened heart valves, heart murmurs, and arrhythmias.

Assessment of the Cardiovascular System

• Assessment frequency depends on patient symptoms, risk factors, and the clinical setting.

History Taking

• Client and/or family members provide a description of symptoms before and during admission.
• Past and family medical histories are important for identifying potential predisposing factors.
• Common signs and symptoms include chest pain (angina), shortness of breath (dyspnea), palpitations, and edema.

Physical Examination

• General appearance can reveal anxiety, depression, or pain.
• Pain can be caused by reduced blood supply and ischemia.
• Evaluation of vital signs (pulse, blood pressure) is essential.
• Auscultation of heart sounds is a critical part of the assessment.
• Palpating peripheral pulses helps determine perfusion.

Cardiac Rhythm and Heart Sounds

• Cardiac rhythm can be observed continuously with monitoring.
• Normal heart sounds (S1 and S2) are evaluated.
• Abnormal sounds (S3, S4) occur in specific pathophysiological situations.

Peripheral Pulses

• The nurse assesses peripheral pulses' presence and strength.
• Skin color changes may indicate perfusion problems (e.g. pallor, bluish discoloration, and edema).
• Assessment of peripheral edema, weight gain, and abdominal distention can be indicative of heart failure.

Diagnostic Tests

• General laboratory tests assess chemical levels, such as blood glucose and electrolytes, cholesterol, and triglycerides.
• Tests for enzymes and isoenzymes are used to assess tissue or cellular damage (especially cardiac tissue).
• Radiography, radionuclide studies, MRI, echocardiography, and electrocardiography are valuable in diagnosing cardiovascular issues and monitoring progress.

Cardiac Cycle

• Cardiac catheterization is a procedure with a catheter inserted into a vessel (artery or vein) and guided to the heart.

Arteriography

• A series of radiographic images of the heart chambers and vessels, after injection of dye.
• Techniques vary, including coronary arteriography, angiocardiography, and aortography.

Disorders of the Cardiovascular System

• Disorders may arise from various causes and may impact heart function in different ways.
• Conditions like hypertension, heart failure (left and right-sided), and other specific cardiac disorders will be addressed in later sections.

Cardiac Hemodynamics

• Cardiac output (CO) assesses the heart's pumping ability.
• CO is calculated as the product of heart rate (HR) and stroke volume (SV).
• The autonomic nervous system, the kidneys, and other endocrine glands regulate arterial pressure.

Hypertension

• Blood pressure (BP) is the force of blood against the blood vessel walls and is affected by cardiac output and peripheral resistance.
• Classifications, including primary (essential) and secondary hypertension, are considered.
• Modifiable and non-modifiable risk factors contribute to hypertension.
• Signs and symptoms, including hypertension crisis (urgency and emergency), clinical presentation, and diagnostic assessment will be discussed in detail.

Heart Failure

• Heart failure occurs when the heart cannot pump blood effectively to meet the body's metabolic needs.
• Complications include pulmonary edema and other systemic effects.
• Etiology describes the mechanisms and causes behind this condition.
• Signs and symptoms provide a basis for recognizing heart failure.
• Classifications of heart failure (acute and chronic, left and right-sided) will be considered.

Compensation Mechanisms

• Compensatory mechanisms initiate to try to restore homeostasis when heart function is impaired.

Cardiogenic Pulmonary Edema

• This condition results from fluid accumulation in the lungs due to impaired cardiac function.
• Mechanisms, signs, symptoms, diagnosis, management and complications associated with cardiogenic pulmonary edema.

Coronary and Peripheral Vascular Disorders

• These diseases can affect blood vessels outside the heart.
• Conditions like atherosclerosis, angina, myocardial infarction, and thrombosis.

Atherosclerosis

• Atherosclerosis involves fatty deposits (plaque) that accumulate in the arteries affecting blood flow.

Angina Pectoris

• Angina pectoris is a condition characterized by chest pain due to insufficient blood flow to the heart.
• It can be stable or unstable, among other types.

Myocardial Infarction

• Myocardial (heart) infarction (MI) happens when a portion of cardiac muscle dies due to oxygen deprivation.

Causes of Coronary Artery Disease

• Risk factors for coronary artery disease (CAD) include modifiable factors like hyperlipidemia, smoking, and hypertension and non-modifiable factors like aging, family history, and gender.

Peripheral Vascular Diseases

• Peripheral vascular diseases affect blood flow in smaller blood vessels outside the heart.
• Conditions such as Raynaud's phenomenon (primary and secondary), thrombosis, and embolism.
• Pathogenesis, clinical presentation, diagnostic procedures, and management strategies for these conditions.

Varicose Veins, Venous Insufficiency and Aneurysms

• Disorders affecting the veins and other significant blood vessels.

Cardiac Dysrhythmias

• Disorders of the heartbeat's electrical conduction system.
• Conditions like sinus bradycardia, sinus tachycardia, premature atrial contractions, atrial fibrillation, atrial flutter, heart block, and premature ventricular contractions.
• Classifications, causes, signs, symptoms, and management methods for each issue.

Valvular Disorders of the Heart

• Conditions impacting the heart valves.
• Examples including aortic stenosis, aortic regurgitation, and mitral regurgitation.

Septal Defects

• Conditions involving abnormal openings in the heart's septum (wall that separates the left and right sides).

Cardiomyopathy

• Diseases associated with structural and functional cardiac abnormalities.
• Classifications, pathophysiology, clinical signs, and management strategies.

Infectious and Inflammatory Heart Diseases

• Conditions causing inflammation of the heart structures, including endocarditis, myocarditis, rheumatic carditis, and pericarditis.

Other Relevant Topics

• Specific details on various diagnostics, treatments, and management strategies for each condition.

Test your knowledge on coronary artery disease, including types of angina, risk factors, and myocardial infarction. This quiz covers important concepts related to heart health and medical management. Explore the specific characteristics and consequences of coronary artery conditions.