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Questions and Answers
What is the primary function of the heart described in the content?
What is the primary function of the heart described in the content?
What indicates myocardial injury on a 12-lead electrocardiogram?
What indicates myocardial injury on a 12-lead electrocardiogram?
Which cardiac biomarker has a normal level of less than 0.04 ng/mL?
Which cardiac biomarker has a normal level of less than 0.04 ng/mL?
What medication is known for reducing platelet aggregation?
What medication is known for reducing platelet aggregation?
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What is an expected use of troponin levels in clinical evaluation?
What is an expected use of troponin levels in clinical evaluation?
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What is the primary cause of hypertension in approximately 90% of cases?
What is the primary cause of hypertension in approximately 90% of cases?
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At what systolic blood pressure (SBP) is an individual classified as having Stage 1 hypertension?
At what systolic blood pressure (SBP) is an individual classified as having Stage 1 hypertension?
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Which of the following is a common condition that chronic high blood pressure can lead to?
Which of the following is a common condition that chronic high blood pressure can lead to?
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Which class of antihypertensive therapy does Metoprolol belong to?
Which class of antihypertensive therapy does Metoprolol belong to?
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What is one of the effects of calcium channel blockers on the cardiovascular system?
What is one of the effects of calcium channel blockers on the cardiovascular system?
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What is the primary role of the renin-angiotensin-aldosterone system (RAAS) in blood pressure regulation?
What is the primary role of the renin-angiotensin-aldosterone system (RAAS) in blood pressure regulation?
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What is the adult dosage for Clonidine as a centrally acting adrenergic inhibitor?
What is the adult dosage for Clonidine as a centrally acting adrenergic inhibitor?
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What is the classification for a blood pressure reading of 135/85 mmHg?
What is the classification for a blood pressure reading of 135/85 mmHg?
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What condition is associated with abnormal blood pressure regulation due to a benign or malignant adrenal tumor?
What condition is associated with abnormal blood pressure regulation due to a benign or malignant adrenal tumor?
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Which of the following has been shown to decrease heart rate as an effect?
Which of the following has been shown to decrease heart rate as an effect?
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What is the primary action of calcium channel blockers in the treatment of cardiac conditions?
What is the primary action of calcium channel blockers in the treatment of cardiac conditions?
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Which of the following medications is contraindicated for clients with respiratory conditions such as asthma?
Which of the following medications is contraindicated for clients with respiratory conditions such as asthma?
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What is the main purpose of anticoagulants like heparin during cardiac events?
What is the main purpose of anticoagulants like heparin during cardiac events?
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What is a key characteristic of percutaneous coronary intervention (PCI)?
What is a key characteristic of percutaneous coronary intervention (PCI)?
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Which class of drugs is particularly effective in managing heart failure by inhibiting the renin-angiotensin-aldosterone system?
Which class of drugs is particularly effective in managing heart failure by inhibiting the renin-angiotensin-aldosterone system?
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Which factor is NOT listed as a major cause of heart failure?
Which factor is NOT listed as a major cause of heart failure?
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What is the primary effect of angiotensin receptor blockers (ARBs) in heart failure treatment?
What is the primary effect of angiotensin receptor blockers (ARBs) in heart failure treatment?
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Which of the following describes a benefit of coronary artery bypass graft (CABG) surgery?
Which of the following describes a benefit of coronary artery bypass graft (CABG) surgery?
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What condition is treated with minoxidil?
What condition is treated with minoxidil?
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Which of the following is a common type of arteriosclerosis?
Which of the following is a common type of arteriosclerosis?
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Which of these is NOT considered a modifiable risk factor for cardiovascular disease?
Which of these is NOT considered a modifiable risk factor for cardiovascular disease?
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What is the primary effect of nitroglycerin in treating angina pectoris?
What is the primary effect of nitroglycerin in treating angina pectoris?
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Which factor contributes to the thickening of the intima media in arteries?
Which factor contributes to the thickening of the intima media in arteries?
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What is one side effect of using nitroglycerin?
What is one side effect of using nitroglycerin?
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Which of the following statements about unstable angina is true?
Which of the following statements about unstable angina is true?
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What condition can lead to myocardial ischemia?
What condition can lead to myocardial ischemia?
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Study Notes
Cardiovascular System Overview
- This presentation covers the cardiovascular system, focusing on hypertension.
Hypertension
- 90% of hypertension cases have an unknown cause (etiology).
- 10% of cases are related to renal disease.
- Pre-eclampsia during pregnancy can cause hypertension.
- Pheochromocytoma (tumor of the adrenal gland) can lead to secondary hypertension.
- Benign or malignant tumors of the adrenal gland can cause secondary hypertension.
- Adrenalectomy is a surgical procedure to remove the adrenal gland (used to treat certain types of hypertension).
Blood Pressure Classification (Adults)
- Normal: Systolic Blood Pressure (SBP) less than 120 mmHg and Diastolic Blood Pressure (DBP) less than 80 mmHg.
- Prehypertension: SBP 120-139 mmHg and DBP 80-89 mmHg.
- Stage 1 Hypertension: SBP 140-159 mmHg and DBP 90-99 mmHg.
- Stage 2 Hypertension: SBP ≥ 160 mmHg and DBP ≥ 100 mmHg.
Hypertension: Silent Killer
- Untreated hypertension can lead to serious complications.
- Blood vessel damage (arteriosclerosis) is a potential outcome.
- Possible complications include heart attack, heart failure, and kidney failure.
- Stroke can also occur.
Hypertension: Physiological Control
- The sympathetic nervous system plays a role in regulating blood pressure
- Baroreceptors in the right atrium, aortic arch, and carotid bodies sense blood pressure changes.
- The renin-angiotensin-aldosterone system (RAAS) is important in blood pressure regulation.
Antihypertensive Therapy (Drugs)
-
Beta Blockers:
- Propranolol (Inderal) - Nonselective (blocks Beta 1 & Beta 2).
- Nadolol (Corgard) - Nonselective (blocks Beta 1 & Beta 2).
- Metoprolol (Lopressor) - Cardio-selective (blocks Beta 1 only).
- Atenolol (Tenormin) - Cardio-selective (blocks Beta 1 only).
-
Angiotensin Converting Enzyme (ACE) Inhibitors:
- Benazepril (Lotensin).
- Captopril (Capoten).
-
Calcium Channel Blockers:
- Cardizem (Diltiazem).
- Procardia (Nifedipine).
Centrally Acting Adrenergic Inhibitors
- Clonidine (Catapres): Adult dosage is 1 mg BID.
- Methyldopa (Aldomet): Adult dosage is 250 mg 2-3 times daily for 2 days.
Vasodilators
- Minoxidil (Loniten) – Vasodilator used to treat refractory hypertension.
- Nitroprusside (Nipride) – potent and direct vasodilator (needs to be administered intravenously).
Arteriosclerosis/Atherosclerosis
- Arteriosclerosis is a general term for "hardening of the arteries."
- Atherosclerosis is a type of arteriosclerosis causing plaque buildup in the arteries.
- This buildup leads to myocardial ischemia (lack of oxygen to the heart muscle).
Unmodifiable Risk Factors:
- Age and Gender are unmodifiable risk factors that affect the development or progression of cardiovascular disease
Modifiable Risk Factors
- High blood pressure
- Smoking
- Stress
- Hyperlipidemia
- Sedentary lifestyle
- Obesity
- Diabetes Mellitus (linked with other cardiovascular risks).
Angina Pectoris
- Stable angina is relieved by rest.
- Unstable angina is not relieved by rest, indicating a more serious condition.
Treatment of Angina Pectoris
- Morphine (opioid analgesic).
- Oxygen to improve oxygen supply.
- Nitroglycerin (vasodilator) - can cause headaches.
- Aspirin (to decrease platelet aggregation).
Myocardial Infarction (MI)
- MI primarily occurs on the left side.
- Left anterior descending (LAD) artery is commonly affected.
- LAD is a major artery in the heart.
- MI results in dead heart tissue.
Diagnosis/Screening
- 12-Lead ECG is used for diagnosis and screening.
- ST elevation indicates injury.
- ST depression indicates ischemia.
- Deep and wide Q waves suggest a pathologic infarction.
Laboratory Tests (Cardiac Biomarkers)
- Elevated CPK-MB signifies muscle injury.
- Elevated Troponin I or T frequently indicate myocardial injury, even heart attack (MI).
- Other conditions can cause elevated troponins.
Stress Test
- This assessment evaluates the heart's response to physical activity (often treadmill).
Drugs
- ASA – Lowers platelet aggregation.
- Lipid-reducing agents (e.g., lovastatin) lower total cholesterol and LDL cholesterol.
- Vasodilators (e.g., nitroglycerin) dilate blood vessels (sublingually administered).
Drugs (cont.)
- Calcium channel blockers (e.g., Cardizem, Procardia) dilate coronary arteries and lower blood pressure.
- Beta blockers (e.g., propranolol) decrease heart rate and contractility. These medications are contraindicated for clients with certain respiratory conditions.
- Anticoagulants (e.g., heparin) can help prevent blood clots.
Physical Assessment of the Heart
- Specific areas of the chest are examined for heart sounds (e.g., aortic area, pulmonic area, tricuspid area, mitral area).
Focused Cardiac Assessment
- Location, radiation, quality, aggravating factors, and alleviating factors of pain are key elements of the assessment.
Percutaneous Coronary Intervention (PCI)
- This non-surgical procedure is performed in a catheterization laboratory.
- It may involve stent placement to restore blood flow.
Coronary Artery Bypass Graft (CABG)
- CABG surgically restores blood flow to the heart muscle.
- It can help alleviate angina and prolong life.
Heart Failure: Causes
- Excessive workload.
- Hypertension
- Myocardial infarction
- Alcohol abuse
- Cocaine abuse
Treatment of Heart Failure
- Diuretics (treat fluid buildup).
- Agents that inhibit the Renin-Angiotensin-Aldosterone system (RAAS).
- ACE Inhibitors.
- Cardiac Glycosides (e.g., Digoxin).
- Positive inotropic effects strengthen the heartbeat.
- Negative chronotropic effects help regulate the heart rate.
ACE Inhibitors Examples
- Enalapril (Vasotec).
- Lisinopril (Prinivil).
- Fosinopril (Monopril).
- Quinapril (Accupril).
- Ramipril (Altace).
Angiotensin Receptor Blockers (ARBs)
- Candesartan (Atacand).
- Valsartan (Diovan).
- ARBs block Angiotensin II action, resulting in vasodilation and reduced blood volume.
- ARBs can improve heart failure outcomes.
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