heart exam 4

Play an AI-generated podcast conversation about this lesson

What is the main characteristic of heart failure?

Perfusion of the heart is not affected
Ventricles of the heart effectively pump blood
Inability of the heart to generate adequate cardiac output,Chronic, progressive condition – Affects perfusion • Heart does not generate adequate cardiac output • Ventricles of heart are unable to pump blood effectively • Unable to meet the body’s requirements (correct)
The heart meets the body's requirements efficiently

Which of the following conditions can cause left-sided heart failure?

Cor pulmonale
Primary hypertension
Mitral regurgitation, ortic stenosis CMOP Coarctation of aorta HTN - uncontrolled Heart muscle infection • Myocarditis • Endocarditis , CAD , MI , Mitral regurgitation (correct)
Pulmonary valve stenosis

What are the compensatory mechanisms that occur in heart failure?

Activation of SNS and RAAS,,,,,,,,,Ensure that enough blood is being pumped out to body – Although trying to be helpful, further contribute to HF • SNS activation • RAAS activated, ADH released from posterior pituitary • Remodeling takes place – Chambers enlarge (dilation) – Muscle mass is increased (hypertrophy) – Heart walls stiffen (correct)
Decreased ADH release
Decreased remodeling of the heart chambers
Decreased muscle mass in the heart

In left-sided heart failure, where does the blood back up to?

Lungs............Damage to the myocardium of left ventricle Caused by : HTN, CMOP, aortic stenosis, coarctation of the aorta, myocarditis, mitral regurgitation, ischemia. Blood backs up from left ventricle into lungs (C) Signup and view all the answers

What is a characteristic of systolic heart failure in the left ventricle?

Decrease in stroke volume....Left ventricle loses ability to contract. • Blood cannot be pushed into circulatio (D) Signup and view all the answers

What happens in diastolic heart failure?

DIASTOLIC HF • Left ventricle loses ability to relax • Heart cannot properly fill with blood (D) Signup and view all the answers

Which condition may result in backward build-up of blood in systemic blood vessels in right-sided heart failure?

Peripheral edema also (Left-sided HR Atrial septal defect, cor pulmonale, Pulmonary HTN, pulmonary valve stenosis)Damage to the right ventricle myocardium can happen in right side (C) Signup and view all the answers

What is congestive heart failure?

Results in congestion or fluid build up • May be left or right-sided • Not all HF is CHF • Congestion can be in lungs or periphery (D) Signup and view all the answers

Which diagnostic test can help distinguish between systolic and diastolic heart failure?

Echocardiogram (B) Signup and view all the answers

What is pulmonary edema?

acute heart failure-Sudden, severe fluid congestion within lung alveoli Conceptual Concern: Gas Exchange///// signs and symptoms include-Pink, frothy sputum, severe dyspnea, coughing, rapid respirations, crackles, Anxiety/restlessness////Nursing actions include-itals, place patient in semi-Fowler or high-Fowler position, give O2 as ordered, medications as ordered (C) Signup and view all the answers

What medications do you give for pulmonary edema?

IV medications – Nitro – Lasix – Morphine – Diuretics/Complications: arrhythmias and cardiac arrest (D) Signup and view all the answers

What is one of the complications commonly associated with chronic heart failure?

Pleural effusion • Thrombosis and emboli • Pulmonary edema • Arrhythmias • Liver damage • Kidney damage or failure • Anemia (D) Signup and view all the answers

Which diagnostic test is typically used in diagnosing heart failure?

Clinical assessment I>100BNP Indicate kidney damageBUN/creatinine Indicate liver damageliver enzymes Heart may appear enlarged, and fluid build up may be visibleChest X-ray Can help diagnose arrhythmias that may be causing HFECG Distinguishes systolic from diastolic HF, measures EFEchocardiogram- Can diagnose CAD, obtain EF Coronary angiogram- Small piece of heart muscle takenMyocardial Biopsy- (A) Signup and view all the answers

What is one of the therapeutic goals in managing heart failure?

Improve the heart's pumping ability/Identify and correct underlying cause. • Increase strength of heart’s contraction. • Maintain optimum water and sodium balance. • Decrease heart’s workload (A) Signup and view all the answers

What are therapeutic measures for CHF

O2 • Activity • Sodium Restriction – <2,000mg/day • Fluid restriction • Decrease weight – Report weight gain of 2 pounds in one day • Daily weights • Medications (B) Signup and view all the answers

What are first treatment medications for CHF?

First-choice • Used for vasodilation effects, decreases afterload ACE Inhibitors- enalapril (Vasotec), lisinopril (Zestril) (B) Signup and view all the answers

Which medication is classified as a newer class and has been shown to reduce hospitalizations and deaths from chronic heart failure?

Entresto////Newer class, shown to reduce hospitalizations and deaths from chronic HF • Combo drug of valsartan/sacubitril, often used in conjunction with beta blockers and diuretics Beta Blockers – Carvedilol (coreg), Metoprolol (lopressor), • Reduce adverse effects of SNS- lower HR and BP (D) Signup and view all the answers

What is the main mechanism of action of Aldosterone antagonists like Spironolactone in the treatment of heart failure?

Block effects of aldosterone-which causes sodium and fluid retention), reduce fluid volume (A) Signup and view all the answers

Which medication is commonly used in conjunction with beta blockers and diuretics for the treatment of heart failure?

neprilysn and entresto (B) Signup and view all the answers

What is the primary purpose of Inotropes like Digoxin, milrinone, dobutamine in treating heart failure?

Strengthen ventricular contraction, increasing CO • Be aware of signs/symptoms of Digoxin toxicity • N/V, diarrhea, arrhythmias, vision changes, decreased appetite, confusion • Therapeutic range 0.8- 2ng/mL (A) Signup and view all the answers

Which mechanical assistive device provides respiratory and circulatory support for patients with heart failure?

ECMO (B) Signup and view all the answers

What is the primary purpose of an Intra-aortic balloon pump?

Increase circulation to coronary arteries (D) Signup and view all the answers

Which mechanical assistive device is specifically used to assist cardiac pumping to maintain cardiac output?

Pacemaker (A) Signup and view all the answers

What end-stage disease may require treatment through cardiac transplantation?

end stage disease (D) Signup and view all the answers

Which mechanical assistive device provides both respiratory and circulatory support?

Ventricular assistive device (B) Signup and view all the answers

In the treatment of heart failure, what is the main function of a Ventricular assistive device?

Assist cardiac pumping to maintain CO (D) Signup and view all the answers

What is the main difference between arteriosclerosis and atherosclerosis?

Arteriosclerosis involves the formation of plaque within arterial walls, while atherosclerosis is characterized by thickening, loss of elasticity, and calcification of arterial walls. (C) Signup and view all the answers

What is a key event in the pathophysiology of arteriosclerosis?

hickening, loss of elasticity, and calcification of arterial walls Part of aging process (D) Signup and view all the answers

How does a fibrous cap in atherosclerosis contribute to potential complications?

ATHEROSCLEROSIS: PATHO CONT. A fatty streak forms on the lining of the artery Plaque has jagged edges that allow blood cells and other materials to adhere to wall Fibrous cap forms • Can tear or rupture and a blood clot forms which can block artery Vessel become narrowed from plaque buildup (D) Signup and view all the answers

Which factor contributes significantly to the risk of developing atherosclerosis? NON modifiable

Age- – Men after 50, – women after menopause • Gender- – Men • Ethnicity- – African Americans • Genetics- – Family hx. of hyperlipidemia (C) Signup and view all the answers

What is the final consequence of a ruptured fibrous cap in atherosclerosis?

The formation of a blood clot that can potentially block an artery (C) Signup and view all the answers

What is the critical value for triglycerides that indicates an increased risk for atherosclerosis?

400 mg/dL (C) Signup and view all the answers

What are the lipid profile labs?

otal cholesterol (<200mg/dL) • >200 associated with CAD • Measurement of HDL, LDL, and VLDL Triglycerides 40 – 160 mg/dL • Critical value > 400mg/dL • >160 mg/dL LDLs (<130mg/dL) • LDL contains both cholesterol and trigs and may deposit cholesterol directly onto walls of arteries/HDLs carry LDL to liver to be broken down and excrete (A) Signup and view all the answers

What does a C-reactive protein (CRP) level above 3.0 mg/L indicate?

Low-grade inflammation(<10 mg/L Cardiac risk = >3 mg/L) (C) Signup and view all the answers

What is the primary purpose of a stress test in diagnosing atherosclerosis?

To assess heart function during physical activity (D) Signup and view all the answers

Which therapeutic measure is known to increase HDL levels and reduce insulin resistance in patients with atherosclerosis?

Regular exercise (A) Signup and view all the answers

SAtherosclerosis diagnosis stress test

Shows how heart works during physical activity • Can be on a treadmill/bike – If patient unable to exercise adenosine or another vasodilator used to open up vessels • Nuclear stress test – Small amounts of radioisotopes given IV – Photos taken and compared (B) Signup and view all the answers

Which of the following is a common nursing consideration after a cardiac catheterization procedure?

Assess for allergies prior – Obtain consent – When patient returns from cath lab • Keep on bedrest • assess vitals • entry site • 6 Ps (D) Signup and view all the answers

What is a significant therapeutic measure for atherosclerosis besides diet and exercise?

Use of medications to reduce lipid levels (B) Signup and view all the answers

What is the role of adenosine or another vasodilator in stress tests for patients unable to exercise?

Opens up the heart vessels for improved blood flow(Fruits and veggies, avoid trans fats, reduce saturated fats, reducing sugar and sodium) (B) Signup and view all the answers

Which factor plays a crucial role in reducing insulin resistance and promoting collateral circulation in patients with atherosclerosis?

Smoking cessation (B) Signup and view all the answers

Which drug is specifically used to prevent the conversion of fats into vLDLs?

Niacin (B) Signup and view all the answers

What is the primary function of Bile Acid Sequestrants in drug therapy for atherosclerosis?

increase conversion of cholesterol to bile acidsBile Acid Sequestrants: • Cholestyramine (Questran) • Colesevelam (WelChol) • Colestipol (Colestid (D) Signup and view all the answers

Which drug is a statin used in reducing cholesterol synthesis for atherosclerosis?

Atorvastatin (Lipitor) • Pravastatin (Pravachol) • Simvastatin (Zocor) • Rosuvastatin (Crestor) (C) Signup and view all the answers

What is the main purpose of Fibrates in drug therapy for atherosclerosis?

Reduce triglycerides(Fenofibrate (TriCor) • Gemfibrozil (Lopid)) (A) Signup and view all the answers

Which drug is classified as a Cholesterol Absorption Inhibitor in the treatment of atherosclerosis?

Ezetimibe (C) Signup and view all the answers

What is a key characteristic of unstable angina?

Increases unpredictably in frequency, occurs at rest, during sleep. Not relieved by meds or rest • Should be treated as emergency, can lead to MI (A) Signup and view all the answers

Which type of angina is characterized by coronary artery spasms?

Variant or Vasospastic angina(Caused by coronary artery spasms. Pattern is cyclical, lasts longer than stable) (A) Signup and view all the answers

What are common symptoms of microvascular angina?

Spasms in walls of tiniest arteries. Pain may be more severe (D) Signup and view all the answers

Angina signs and symptoms(Angina is chest pain due to ischemia – Narrowed blood vessels unable to dilate – Carry less blood/oxygen for heart muscle)

Discomfort, burning, fullness, pressure, squeezing Pain may radiate Heaviness in arms Women may have atypical symptoms • SOB, fatigue, nausea Lasts 5-15 minutes (C) Signup and view all the answers

What is the primary role of Nitroglycerin in the treatment of angina?

Reducing the workload of the heart(Sublingual – Acts in 1-2 minutes – Last 30-40 min. • 1 Q5min x 3 • Side effects: Hypotension, headache) (A) Signup and view all the answers

What is the primary cause of acute coronary artery syndrome

Includes unstable angina and MI • Caused by sequence of inflammatory processes – Thrombus formation leading to reduced blood flow (Unstable angina) – Partial or complete occlusion of coronary artery (MI) • NSTEMI or STEMI (C) Signup and view all the answers

Which type of myocardial infarction (MI) affects the full thickness of the heart muscle?

STEMI (D) Signup and view all the answers

What is the critical difference between NSTEMI and STEMI?

The extent of heart muscle damage/STEMI- Most serious, affects full thickness of heart • NSTEMI- Less serious, blockage is usually partial--Results in death of heart muscle – 80-90% of time caused by thrombus formation • Ischemic injury happens over hours before complete necrosis takes place • Area of heart affected depends on coronary artery affected/Time is muscle!!! • Scar tissue may form in the damaged area (C) Signup and view all the answers

What is the main characteristic that distinguishes unstable angina from stable angina?

Longer duration and sudden onset/Chest pain – New – Worse – Sudden – Occurs at rest, while asleep, with little exertion – Lasts longer than stable angina – Not relieved by medicine • Usually caused by atherosclerosis, which can rupture leading to blood clot • Should be treated as an emergency, can lead to MI (C) Signup and view all the answers

What is emphasized by the statement 'Time is muscle' in the context of acute coronary syndrome?

The importance of quick diagnosis and management in ACS (D) Signup and view all the answers

What are signs and symptoms of myocardial infarction?

Heaviness, pressure, tightness, burning, constriction, or crushing pain- “elephant sitting on my chest” – Substernal or retrosternal, may radiate • Fatigue • Weakness • SOB • Anxiety • SNS is activated – Low BP – Elevated HR – Diaphoresis – Cool, Clammy, gray skin • Nausea/vomiting (C) Signup and view all the answers

Myocardial treatment?

Denial common – Wait to seek care • “Time is muscle” – Call 911 – Do not drive self or ride with others – Reperfusion time critical • Chew one uncoated adult aspirin (A) Signup and view all the answers

What are diagnostic test for MI

Troponin I (<0.03 is normal) • The more damage the higher number will be Myoglobin and creatine kinase- (CK)- MB • Not as sensitive as Troponin EKG- • Look at ST segment Magnesium and potassium (B) Signup and view all the answers

What are emergencvy drugs for MI

MONA TASS-morphine oxygen nitro aspirin, thrombo, anti, stool soft, sedatives (D) Signup and view all the answers

MI treatment

Cardiac catheterization – Balloon angioplasty – Percutaneous coronary intervention (PCI) • Coronary Artery Bypass Graft (CABG) (B) Signup and view all the answers

What is a common symptom of Peripheral Arterial Disease (PAD) that involves thin, shiny, and taut skin?

ntermittent Claudication- Pain in calves with activity Paresthesia Thin, shiny, and taut skin Loss of hair on the lower legs Diminished or absent pedal, popliteal, or femoral pulses Pallor of extremity when elevated, reddish-purple when dependent Cool skin Thickened toenails Dry, flaky, scaly skin Decreased sensation Pain at rest (C) Signup and view all the answers

Which diagnostic study for PAD involves taking the systolic pressure of the leg divided by the systolic pressure of the arm?

Ankle-brachial index (ABI) (D) Signup and view all the answers

What is a common complication of PAD that involves tissue death due to reduced blood supply?

COMPLICATIONS • Atrophy of the skin and underlying muscles • Delayed healing • Wound infection • Tissue necrosis • Arterial ulcers • Amputation (D) Signup and view all the answers

Which risk factor for PAD is specifically related to an individual's genetic predisposition?

Smoking Hyperlipidemia Hypertension Diabetes mellitus Elevated BMI Family history of atherosclerosis Age Ethnicity- African Americans (A) Signup and view all the answers

What is a key sign of PAD that involves pain in the calves during physical activity due to reduced blood flow?

Intermittent Claudication (C) Signup and view all the answers

What is the primary risk factor for aortic aneurysms according to the text?

Age Male gender Smoking HTN Atherosclerosi s Family history High cholesterol Elevated BMI (C) Signup and view all the answers

Which type of aneurysm is characterized by a saccular dilation of the entire circumference of the arterial wall?

Fusiform aneurysm.....................................Saccular • Bulges on one side of arterial wall Saccular • dilation of entire circumference Fusiform • Cavity is formed from tear in artery wall Dissecting (B) Signup and view all the answers

What is a common symptom associated with abdominal aortic aneurysms (AAA) according to the text?

Pulsatile massOften asx Pulsatile mass Bruit Back or flank pain Abdominal pain, feeling of fullness (B) Signup and view all the answers

Which diagnostic test is typically used for detecting aortic aneurysms as per the information provided?

Abdominal ultrasound (C) Signup and view all the answers

What is the minimally invasive treatment option mentioned for aneurysms in the text?

Lifestyle changes • Surgery – Dilated aorta section is removed, graft sutured in place • Endovascular aneurysm repair (EVAR) – Minimally invasive – Catheter threaded through femoral artery, stent and graft placed to support aneurysm (C) Signup and view all the answers

Which symptom is most indicative of an aortic aneurysm rupture into the retroperitoneal space?

Aortic dissection • Rupture—serious complication – into retroperitoneal space: • Sudden, severe back pain • Cool, clammy skin • Bleeding may be tamponaded by surrounding structures – into thoracic or abdominal cavity: • Massive hemorrhage • Usually don’t make it to the hospital (B) Signup and view all the answers

What is a common outcome when aortic aneurysms rupture into the thoracic or abdominal cavity?

Usually not making it to the hospital (B) Signup and view all the answers

How does aortic dissection pathophysiology differ from aortic aneurysm rupture?

Tear occurs Blood “tracks” between inner and middle layer Inner and middle layers separate (dissect) Systolic pulsation ↑ pressure on damaged area Further ↑ dissection May occlude major branches of aorta (C) Signup and view all the answers

Aortic dissection signs and symptoms

AORTIC DISSECTION: S/SX sudden, severe Something is sharp or tearing in chest Pain weakened or absent pulses Cardiovascular decreased LOC dizziness syncope Neurologic dyspnea Respiratory More likely to present with hypotension and vague symptoms. Geriatric presentation (B) Signup and view all the answers

What are aortic dissection complications

Cardiac tamponade – Life-threatening – Blood escapes from dissection into pericardial sac • Hypotension, muffled heart sounds , narrowed pulse pressure • Rupture of Aorta – Hemorrhage, can lead to death – Can hemorrhage into mediastinal, pleural, or abdominal cavity, retroperitoneal space • Occlusion of arterial supply to organs (spinal cord, renal, abdominal) (C) Signup and view all the answers