What is the primary function of the coronary arteries?
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To supply blood flow sufficient to meet the demands of the myocardium.
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What is the primary function of the coronary arteries?
To supply blood flow sufficient to meet the demands of the myocardium.
What causes acute coronary syndromes?
Sudden coronary obstruction caused by thrombus formation over a ruptured or ulcerated atherosclerotic plaque.
What is the goal of assessing cardiac findings?
To determine between normal and abnormal assessment findings.
What are the two categories of left heart failure?
Heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF).
What is the most common cardiac rhythm disorder?
Atrial fibrillation (AF).
What does a normal ECG reading during rest indicate?
It suggests no immediate cardiac issues, but changes like ST depression or T-wave inversion during pain may indicate ischemia.
What should be ensured regarding the environment when delivering countershock?
No one should be touching the bed or the client.
What are disorders of impulse conduction?
Conditions that affect the electrical signals in the heart, leading to abnormal heart rhythms.
What is cardioversion?
A synchronized countershock to convert an undesirable rhythm to a stable rhythm.
How many times should the entire length of the client be checked before delivering countershock?
Three times.
What is the role of coronary veins?
To take nutrient-poor deoxygenated blood away from the myocardium to the right atrium.
What is a consequence of ventricular remodeling?
Deposition of collagen between myocytes, disrupting muscle integrity and decreasing contractility.
What is coronary artery disease?
A condition with inadequate supply of blood and oxygen to the myocardium.
What occurs when a thrombus occludes a vessel for a prolonged period?
Myocardial ischemia progresses to myocyte necrosis and death.
What should the client do before carotid sinus massage?
Turn the head away from the side to be massaged.
What is another term for myocardial infarction?
Heart attack.
How can disorders of impulse formation be diagnosed?
Through electrocardiograms (ECGs) and clinical evaluation.
What leads to the development of myocardial ischemia?
When the supply of coronary blood cannot meet the demand of the myocardium for oxygen and nutrients.
What is the heart rate during atrial fibrillation?
350 to 600 times per minute.
What is left heart failure also known as?
Congestive heart failure.
What diagnostic procedure should be performed to rule out clots in the atria before an elective procedure?
Transesophageal echocardiogram (TEE).
What condition is characterized by weakness of cardiac muscle due to hypertension-induced hypertrophy?
Hypertensive hypertrophic cardiomyopathy.
What causes variant angina?
Coronary artery spasm.
What should be allowed for the client to void after an acute episode?
Standing to void or using a bedside commode if prescribed.
What might chest pain or changes in the electrogram during a stress test indicate?
They may indicate ischemia.
What activates the renin-angiotensin-aldosterone system in ventricular remodeling?
Myocardial dysfunction.
What is an example of a disorder of impulse formation?
Atrial fibrillation.
How are disorders of impulse conduction diagnosed?
Diagnosis is typically made using an electrocardiogram (ECG).
Which gender has a higher risk for coronary artery disease until menopause?
Males have a higher risk than females until menopause, after which the risk is equal.
What is a potential outcome of acute coronary syndromes?
Sudden cardiac death.
What factors influence stroke volume?
Contractility, preload, and afterload.
What is the purpose of a coronary angiogram or cardiac catheterization?
To provide definitive diagnosis by assessing the patency of the coronary arteries.
What are disorders of impulse formation?
Conditions that affect the generation of electrical impulses in the heart.
What is the initial intervention following an acute episode?
Maintain bed rest as prescribed.
What causes the demand-supply mismatch of oxygen in coronary artery disease?
Occlusion of the coronary arteries.
What determines the size and character of a myocardial infarction?
The duration of ischemia.
What was heart failure (HF) previously referred to as?
Congestive heart failure (CHF).
What typically forms in the lumen of coronary arteries in coronary artery disease?
Plaques that impede blood flow.
What is the most common cause of myocardial infarction?
Underlying coronary artery disease.
What happens to the atria during atrial fibrillation?
They quiver, which can lead to thrombi formation.
What are potential treatments for disorders of impulse conduction?
Treatments may include medications, lifestyle changes, or procedures like pacemaker implantation.
What should be monitored after cardioversion?
Indications of successful response, such as conversion to sinus rhythm, strong peripheral pulses, adequate BP, and adequate urine output.
What initiates the inflammatory response in coronary atherosclerosis?
Injury to the vascular endothelium.
What is the effect of increased PVR on the left ventricle?
It creates resistance to ventricular emptying and increases workload, leading to hypertrophy of the myocardium.
What is the purpose of administering nitroglycerin?
To dilate the coronary arteries, reduce the oxygen requirements of the myocardium, and relieve chest pain.
How does insulin resistance affect heart failure?
It contributes to and complicates heart failure by causing abnormal myocyte fatty acid metabolism and ATP generation.
What characterizes a transmural infarction?
Ischemic necrosis that extends through the full thickness of the myocardial wall.
When are the coronary arteries perfused?
During diastole.
What state develops due to energy starvation in myocytes?
An energy-starved state that contributes to changes in the myocytes and ventricular remodeling.
What is another name for variant angina?
Prinzmetal’s angina or vasospastic angina.
What does HFrEF stand for?
Heart failure with reduced ejection fraction (systolic heart failure).
What are dysrhythmias?
Disturbances of heart rhythm.
What does HFpEF stand for?
Heart failure with preserved ejection fraction (diastolic heart failure).
When does variant angina typically occur?
Almost exclusively at rest.
What are nonmodifiable risk factors for coronary artery disease?
Hereditary factors, gender, ethnic background, and age.
Can HFrEF and HFpEF occur together?
Yes, they can occur together in one individual or singly.
What is the first step in the immediate management of chest pain?
Assess pain and institute pain relief measures.
Why is calcium transport critical in myocytes?
It is essential for normal contractile function.
What occurs when coronary blood flow is interrupted for an extended period?
Myocyte necrosis.
What is the first step in using an AED?
Place the client on a firm, dry surface.
What is a key characteristic of systolic congestive heart failure?
A complex constellation of neurohumoral, inflammatory, and metabolic processes.
What is defibrillation used for?
To terminate pulseless VT or VF.
What happens if the thrombus lodges permanently in the vessel?
The infarction extends through the myocardium from endocardium to epicardium, resulting in severe cardiac dysfunction.
What role do conduction pathways play in dysrhythmias?
Dysrhythmias can arise from abnormal conduction of impulses through the heart's conduction system.
How does the energy used in cardioversion compare to defibrillation?
A lower amount of energy is used in cardioversion than in defibrillation.
What are potential symptoms of impulse conduction disorders?
Symptoms may include palpitations, dizziness, and syncope.
Where should the electrode patches be placed?
In the correct position on the client’s chest.
What are common causes of high-output failure?
Anemia, septicemia, hyperthyroidism, and beriberi.
What triggers the inflammatory response in atherosclerosis?
Injury to the artery wall.
What does a spike on the monitor or ECG strip indicate?
It indicates that a pacing stimulus has been delivered to the heart.
What is tolvaptan used for?
Treatment of heart failure that is resistant to conventional diuretics.
What can cause disorders of impulse formation?
Ischemia, electrolyte imbalances, and structural heart changes.
What is the effect of disorders of impulse formation on heart rhythm?
They can lead to arrhythmias or irregular heartbeats.
What happens when a major coronary artery is narrowed by more than 50%?
It impairs blood flow sufficiently to hamper cellular metabolism under increased myocardial demand.
What leads to plaque disruption in acute coronary syndromes?
Shear forces and inflammation with the release of multiple inflammatory mediators.
What is the most common complication of acute myocardial infarction (MI)?
Dysrhythmias.
What is the purpose of carotid sinus massage?
To determine whether a change in cardiac rhythm occurs.
What does the activation of the RAAS lead to?
Increased peripheral vascular resistance (PVR) and plasma volume, raising afterload and preload.
What is Heart Failure with Reduced Ejection Fraction (HFrEF) defined as?
An ejection fraction of <40% and an inability of the heart to generate adequate cardiac output.
When can cardioversion be performed?
As an elective procedure for stable tachydysrhythmias resistant to medical therapies or as an emergent procedure for hemodynamically unstable tachydysrhythmias.
What is the priority postprocedural assessment for a client after an atrial fibrillation procedure?
Ability to maintain airway and breathing.
What is the purpose of a pacemaker?
To provide electrical stimulation and maintain heart rate when the intrinsic pacemaker fails.
How can dysrhythmias occur in relation to the SA node?
From an abnormal rate of impulse generation by the SA node or other pacemaker.
What changes in calcium transport mechanisms can lead to heart failure?
Alterations in calcium ion channels, intracellular transport in the sarcoplasmic reticulum, and calcium cycling.
What are the two major types of myocardial infarction?
Subendocardial infarction and transmural infarction.
What does the term 'heart failure' indicate?
Myocardial disease with impaired contraction (systolic dysfunction) or filling (diastolic dysfunction) of the heart.
What is high-output heart failure?
The inability of the heart to adequately supply the body with blood-borne nutrients, despite adequate blood volume and normal or elevated myocardial contractility.
What could thrombosis in coronary artery disease lead to?
Subtotal or total occlusion of the lumen, resulting in acute coronary syndrome (ACS).
What is ventricular remodeling?
Changes in left ventricular geometry, mass, and volume in response to myocardial injury or alterations in load.
What is the effect of the vicious cycle on left heart failure?
It causes progressive worsening of left heart failure.
What role does the sympathetic nervous system (SNS) and renin-angiotensin-aldosterone system (RAAS) play in heart failure?
They are activated by heart failure and contribute to insulin resistance.
What ECG changes are typically seen in a STEMI?
Marked elevations in the ST segments.
What diagnostic tool should be obtained during immediate management?
A 12-lead ECG.
How long can cardiac cells withstand ischemic conditions before cellular death occurs?
About 20 minutes.
What do the left and right coronary arteries supply?
Nutrient-rich, oxygenated blood to the heart.
What is the recommended anticoagulant therapy duration before an elective procedure for atrial fibrillation or flutter?
4 to 6 weeks.
How do healthy coronary arteries respond to increased myocardial oxygen needs?
They dilate to increase the flow of oxygenated blood.
What are disorders of impulse formation?
Conditions that affect the generation of electrical impulses in the heart.
What can cause disorders of impulse conduction?
Causes can include ischemia, electrolyte imbalances, and structural heart changes.
What causes atrial fibrillation?
Disorganized electrical impulses in the heart.
What is the most common symptom associated with coronary artery disease?
Chest pain.
What is a key characteristic of systolic congestive heart failure?
A complex constellation of neurohumoral, inflammatory, and metabolic processes.
What can cause disorders of impulse conduction?
Causes may include ischemia, electrolyte imbalances, and structural heart disease.
What causes angina pectoris?
Myocardial ischemia due to inadequate blood and oxygen supply or an imbalance between supply and demand.
What is the purpose of dangling legs at the side of the bed?
To progress mobility as prescribed.
What is one common type of impulse conduction disorder?
Atrioventricular (AV) block.
What should be administered to a patient experiencing chest pain?
Oxygen by nasal cannula as prescribed.
Which ethnic group is particularly noted as a risk factor for coronary artery disease?
African Americans.
What are the types of acute coronary syndromes?
Unstable angina and myocardial infarction.
How quickly do myocardial cells become ischemic after coronary occlusion?
Within 10 seconds.
What response is stimulated by baroreceptors when they detect decreased perfusion?
Stimulation of the SNS to cause vasoconstriction and the hypothalamus to produce antidiuretic hormone.
What equipment should be available during carotid sinus massage?
A defibrillator and resuscitative equipment.
What is a transmural myocardial infarction?
An infarction that extends through the entire myocardium, resulting in severe cardiac dysfunction.
What position should the patient be placed in during immediate management?
Semi-Fowler’s position.
What is the energy setting for a monophasic defibrillator?
360 joules.
How does the SA node affect the ventricles during AF?
The response of the ventricles can also be rapid and irregular, depending on the filtering effect of the SA node.
What are the three zones associated with myocardial infarction?
The zones are the necrotic zone, the zone of injury, and the zone of ischemia.
What are the major causes of HFpEF?
Hypertension-induced myocardial hypertrophy and myocardial ischemia.
What is the fundamental cause of Atrial Fibrillation?
Atrial remodeling that generates ectopic foci or 'triggers' for electrical impulses.
What is the role of HDL in relation to cholesterol?
HDL helps remove cholesterol from tissues.
How is stable angina relieved?
With rest and nitroglycerin.
What does a spike preceding the QRS complex indicate?
That the ventricle is being paced.
What is the zone of injury in myocardial infarction?
It is the area surrounding the necrotic zone that is still alive but at risk of dying.
What is an example of a disorder of impulse formation?
Sick sinus syndrome.
What can cause disorders of impulse formation?
Ischemia, electrolyte imbalances, and structural heart changes.
What are common symptoms of impulse conduction disorders?
Symptoms may include palpitations, dizziness, syncope, and shortness of breath.
What is a subendocardial myocardial infarction?
An infarction that involves only the myocardium directly beneath the endocardium.
What can cause dysrhythmias?
Ischemia, hypoxia, ANS imbalances, lactic acidosis, electrolyte abnormalities, conduction defects, drug toxicity, or hemodynamic abnormalities.
What percentage of stenosis is required for a plaque to cause angina at rest?
At least 90%.
What are common causes of increased myocardial demand for blood?
Tachycardia, exercise, hypertension (hypertrophy), and valvular disease.
What does an increase in preload (LVEDV) indicate?
Decreased contractility or excess plasma volume.
How often should the client progress to ambulation in their room?
3 times a day.
What characteristic wave is typically absent in atrial fibrillation?
Definitive P wave.
What should you do after turning on the AED?
Follow the voice prompts.
What is considered a high total serum cholesterol level that is a risk factor for coronary artery disease?
Above 300 mg/dL.
What is atherosclerosis?
A progressive disease characterized by the accumulation of lipids and fibrous elements in arterial walls, reducing blood flow to the myocardium.
What happens to heart cells after several minutes of ischemia?
They lose the ability to contract, leading to decreased cardiac output.
What results from structural or functional cardiac disorders in heart failure?
Impaired ability of the ventricles to fill or eject blood.
What is stable angina also known as?
Exertional angina.
How is myocardial infarction clinically categorized?
STEMI (ST Elevation MI) and non-STEMI (non-ST Elevation MI).
Which law describes the relationship between preload and cardiac output?
The Frank-Starling law of the heart.
How does anemia affect the body in high-output failure?
It decreases the oxygen-carrying capacity of the blood, leading to metabolic acidosis as cells switch to anaerobic metabolism.
What is the primary focus of treatment for left ventricular dysfunction?
Management of the left ventricular dysfunction.
What is the primary goal in managing chronic left heart failure?
Increasing contractility and reducing preload and afterload.
What medication should be held prior to an elective cardioversion?
Digoxin should be held for 48 hours preprocedural to prevent post-cardioversion ventricular irritability.
What type of diet should be prescribed to clients following an acute episode?
A low-sodium, low-fat, and low-cholesterol diet.
What does LVEDV stand for?
Left ventricular end-diastolic volume.
What role does diabetes play in HFpEF?
It increases the risk for diastolic dysfunction.
Why should clients be provided with a list of potassium-rich foods?
Because diuretics can cause hypokalemia (except for potassium-retaining diuretics).
What occurs in the zone of ischemia during myocardial infarction?
This zone has reduced blood flow and may show changes on an electrocardiogram (ECG).
What is an atheroma?
A plaque formed by lipid and inflammatory deposits in the arterial wall.
What is systolic heart failure?
A condition where the heart cannot pump effectively due to decreased contractility.
What happens when the plaque substrate is exposed?
It activates platelet activation and adherence, resulting in fast thrombus formation.
What are the findings of cardiac enzyme and troponin levels in angina?
They are typically normal.
What characterizes heart failure as a clinical syndrome?
Signs and symptoms of fluid overload or inadequate tissue perfusion.
How do disorders of impulse formation affect heart function?
They can lead to irregular heartbeats and impaired cardiac output.
What is the most common cause of increased afterload?
Increased peripheral vascular resistance (PVR), such as that seen with hypertension.
How is angina pectoris described?
As transient substernal chest discomfort, ranging from heaviness or pressure to moderately severe pain.
What should be documented during carotid sinus massage?
An electrocardiographic rhythm strip before, during, and after the procedure.
How can disorders of impulse conduction be diagnosed?
Through electrocardiograms (ECGs) and clinical evaluation.
How can increases in LVEDV affect cardiac output?
They can improve cardiac output up to a certain point.
What percentage of left heart failure cases is attributed to HFpEF?
Approximately 50%.
What happens to the endothelium during the progression of atherosclerosis?
It stops producing normal antithrombotic and vasodilating agents.
When is an asynchronous (fixed rate) pacemaker used?
When the client is asystolic or profoundly bradycardic.
What effects does arginine vasopressin have in heart failure?
Causes peripheral vasoconstriction and renal fluid retention, exacerbating hyponatremia and edema.
From which spinal cord levels do the nerve fibers related to anginal pain enter?
From levels C3 to T4.
What happens to the myocardium during ventricular remodeling?
Disruption of the normal myocardial extracellular structure, resulting in dilation and progressive myocyte contractile dysfunction.
What are the indications for calcium channel blockers such as Verapamil and Amlodipine?
Anginal prophylaxis, negative inotropic effects, and treatment for vasospasms.
What typically triggers stable angina?
Activities involving exertion or emotional stress.
What occurs when contractility decreases?
Stroke volume falls and left ventricular end-diastolic volume (LVEDV) increases, causing heart dilation and increased preload.
What role do increased preload and afterload play in heart failure?
They contribute to the progression of left heart failure.
What are unstable plaques in coronary artery disease?
Plaques that are prone to ulceration or rupture, potentially leading to thrombus formation.
What role do ectopic foci play in AF?
They serve as additional sources of electrical impulses that disrupt normal conduction.
What happens to cardiac cells if blood flow returns within 20 minutes?
They can remain viable even if metabolically altered and nonfunctional.
What is a major risk factor for myocardial infarction related to blood vessel health?
Coronary Artery Disease (CAD).
What should be recorded before, during, and after the Vagal Maneuvers?
An electrocardiographic rhythm strip.
What occurs in the second phase of a biphasic shock?
The current reverses direction and runs from the second electrode back to the first via the heart.
What are some causes of right heart failure?
Right ventricular myocardial infarction (MI), cardiomyopathies, and pulmonic valvular disease.
How quickly are myocardial oxygen reserves used after cessation of coronary flow?
Within about 8 seconds.
How long does it take for CK-MB isoenzyme to return to normal?
It returns to normal 48-72 hours later.
What characterizes diastolic heart failure?
The heart has difficulty filling with blood due to stiff or thickened heart muscles.
What ECG finding is associated with variant angina?
ST-segment elevation, indicating possible total blockage or myocardial infarction.
What neurohormones are released during ventricular remodeling?
Angiotensin II, aldosterone, catecholamines, and cytokines.
What monitoring is required during carotid sinus massage?
The client must be on a cardiac monitor.
What ECG changes are associated with a non-STEMI?
ST depression and T-wave inversion.
What causes the symptoms associated with heart failure?
The heart cannot generate sufficient cardiac output to meet the body's demands for oxygen and nutrients.
What is Heart Failure with Preserved Ejection Fraction (HFpEF)?
A type of heart failure characterized by pulmonary congestion despite normal stroke volume and cardiac output.
What is the consequence of inefficient oxygen extraction from coronary arteries?
It can lead to myocardial ischemia if not compensated by increased blood flow.
What is the most common cause of decreased contractility?
Myocardial infarction.
What causes the pain in angina pectoris?
Buildup of lactic acid or abnormal stretching of the ischemic myocardium irritating nerve fibers.
What is the energy range for charging a biphasic defibrillator?
120 to 200 joules.
What characterizes pathologic hypertrophy?
Myocyte death, fibrosis, inflammation, and alterations in cardiac energetics.
How do beta blockers like Propranolol and Metoprolol help in anginal prophylaxis?
By blocking beta-adrenergic stimulation of the heart, reducing myocardial oxygen demand.
Which gender is more commonly affected by HFpEF?
Women.
What is the treatment for severe impulse conduction disorders?
Treatment may include medications, pacemaker implantation, or catheter ablation.
Describe the Valsalva Maneuver.
While lying on your back, take a deep breath and act like you’re exhaling with your nose and mouth closed for 10 to 30 seconds.
What should be administered before cardioversion?
Sedation as prescribed.
What are foam cells?
Macrophages that ingest lipids.
What is a modified version of the Valsalva Maneuver?
Sitting up, taking a deep breath, and then having the PHCP lower the bed while bringing the knees to the chest or legs in the air for 30 to 45 seconds.
When do ECG changes become visible after hypoxia?
After 30 to 60 seconds.
What are the two types of heart failure mentioned?
Right-sided and left-sided heart failure.
What do anticoagulants like Heparin and Enoxaparin prevent?
Thrombus formation.
What happens to the heart's output in overwhelming septicemia?
It may not be able to raise its output enough to compensate for vasodilation, leading to septic shock.
Why is coordinated activity of the atria and ventricles important?
It is essential for efficient pumping of blood by the heart.
What occurs in septicemia that affects cardiac output?
Disturbed metabolism, bacterial toxins, and the inflammatory process cause systemic vasodilation and fever, leading to increased cardiac output to maintain blood pressure.
What is unstable angina also called?
Preinfarction angina.
What precaution should be taken if the gag reflex is stimulated during the procedure?
Provide an emesis basin and initiate precautions to prevent aspiration.
What is the most common cause of Right Heart Failure?
Severe left heart failure.
What should be administered to control the ventricular rhythm?
Cardiac medications as prescribed.
What is the main goal of management in HFpEF?
To improve ventricular relaxation and prolong diastolic filling times to reduce diastolic pressure.
What do baroreceptors in the central circulation detect?
A decrease in perfusion.
What can happen when some plaques rupture in coronary artery disease?
Exposure of tissue factor, leading to thrombosis.
What is a synchronous (demand) pacemaker?
A device that senses the client's rhythm and paces only if the intrinsic rate falls below the set rate.
What is arginine vasopressin also known as?
Antidiuretic hormone.
What are some common assessment findings in patients with coronary artery disease?
Angina, dyspnea, pallor, sweating, palpitations, tachycardia, dizziness, syncope, hypertension, and digestive disturbances.
What are Vagal Maneuvers used for?
To induce vagal stimulation of the cardiac conduction system and terminate supraventricular tachydysrhythmias.
What is required if the cardioversion is an elective procedure?
Informed consent must be obtained.
What happens to systemic venous circulation when pressure rises in right heart failure?
It results in jugular venous distention, peripheral edema, and hepatosplenomegaly.
Which factors mediate pathologic hypertrophy?
Angiotensin II, catecholamines, and changes in intracellular signaling within the myocytes.
What factors are included in modifiable risk factors for coronary artery disease?
Hyperlipidemia, obesity, physical inactivity, smoking, stress, hypertension, and diabetes.
What should be done immediately after delivering a countershock?
Resume CPR for 5 cycles or about 2 minutes.
When are shocks recommended with an AED?
For pulseless VT or VF only.
What characterizes the necrotic zone in myocardial infarction?
It is the area where myocardial cells have died due to lack of blood supply.
What do fatty streaks in the arterial wall consist of?
Dead foam cells at the site of endothelial damage.
How many shocks are usually delivered if indicated?
Usually 3 shocks.
What role does TNF-α play in heart failure?
Elevated levels contribute to myocardial hypertrophy, remodeling, and down-regulation of nitric oxide synthesis.
When does the total creatinine kinase level rise after chest pain onset?
It rises within 6 hours after the onset of chest pain and peaks within 18 hours.
What dietary advice should be given to patients following an acute episode?
Dietary changes must be maintained for life.
How do stable plaques affect coronary blood flow?
They limit coronary flow and can cause ischemia, especially during exercise.
What vital sign changes might indicate acute pulmonary edema?
Tachycardia and tachypnea.
How can electrocardiographic alterations indicate myocardial infarction?
Changes such as ST elevation or depression and T wave inversions can be observed.
How does unstable angina differ from stable angina?
It occurs with an unpredictable degree of exertion or emotion and worsens over time.
How do ACE inhibitors affect mortality in chronic left heart failure?
They significantly reduce mortality.
What occurs during plaque rupture?
The fibrous cap covering the plaque breaks open.
How does systolic heart failure affect ejection fraction?
It typically results in a reduced ejection fraction (less than 40%).
What types of ECG results can indicate a myocardial infarction?
Either STEMI or NSTEMI.
What condition can result from high blood levels of thyroxine?
An abnormally elevated cardiac output may be inadequate.
What diagnostic tests may be performed following the acute stage of a myocardial infarction?
Exercise tolerance test, thallium scan, multigated cardiac blood pool imaging, and cardiac catheterization.
What are common gastrointestinal symptoms associated with myocardial infarction?
Nausea and vomiting.
What is the significance of recognizing disorders of impulse formation?
Early identification can prevent complications such as stroke or heart failure.
What characterizes intractable angina?
Severe, incapacitating chest pain.
What is the primary use of nitrates like Nitroglycerin and Isosorbide dinitrate?
Anginal prophylaxis and reduction of myocardial oxygen consumption through vasodilation.
What medications should be administered as prescribed?
ACE inhibitors, ARBs, calcium channel blockers, aspirin, thienopyridines, and lipid-lowering agents.
What can be observed instead of a P wave in atrial fibrillation?
Fibrillatory waves before each QRS complex.
What characterizes the electrical activity in Atrial Fibrillation (AF)?
It is rapid and irregular, leading to no coordinated atrial contraction.
What type of cholesterol is increased in coronary artery disease risk?
Low-density lipoproteins (LDL).
What vital signs should be monitored after the procedure?
Vital signs, cardiac rhythm, and level of consciousness.
What abnormalities can ischemia cause in the heart?
Conduction abnormalities that lead to dysrhythmias.
What are the initial insults that can lead to left heart failure?
Decreased contractility (e.g., myocardial infarction), increased preload (e.g., renal failure), or increased afterload (e.g., hypertension).
How does diabetes contribute to heart failure?
Through disturbed calcium metabolism, oxidative stress, changes in fatty acid and glucose metabolism, and mitochondrial dysfunction.
How long can cardiac cells remain viable under ischemic conditions?
Approximately 20 minutes.
What is the purpose of antiplatelet medications like Aspirin and Clopidogrel?
Prevention of platelet aggregation.
How does a monophasic waveform deliver electrical shocks?
In a single direction from one electrode to another.
What happens when energy demand exceeds ATP supply in the myocardium?
Contractility of the myocardium is compromised.
What should patients do if chest pain occurs after an acute episode?
Stop activity, rest, and take nitroglycerin as prescribed.
What characterizes the pattern of stable angina?
Stable onset, duration, severity, and relieving factors.
What dietary change is recommended for patients with chronic left heart failure?
Salt restriction.
What diagnostic tools are used for HFpEF?
Electrocardiography and echocardiography.
What is the peak elevation time for CK-MB isoenzyme after chest pain onset?
Peak elevation occurs 18 hours after the onset of chest pain.
What should patients be assisted with after an acute episode?
Identifying angina-precipitating events and setting lifestyle change goals.
What lifestyle habit is considered a risk factor for myocardial infarction?
Smoking.
What should clients balance after an acute episode?
Periods of activity and rest.
What are the two forms of hyperthyroidism?
Chronic (thyrotoxicosis) and acute (thyroid storm).
What type of activities should clients avoid to prevent increased heart pressure?
Isometric activities.
How does unstable angina relate to myocardial infarction (MI)?
It is characterized by chest pain that occurs days to weeks before an MI.
What medications should be prepared for administration in a client with pulmonary edema?
Diuretic and morphine sulfate.
What psychological symptoms may accompany acute pulmonary edema?
Acute anxiety, apprehension, and restlessness.
What are the consequences of the right ventricle's increased workload over time?
Progressive diastolic and systolic deterioration, leading to dilation and failure.
What happens when preload continues to rise beyond a certain point?
It causes stretching of the myocardium, leading to dysfunction of the sarcomeres and decreased contractility.
What should be encouraged regarding the client's feelings after a myocardial infarction?
Encourage the client to verbalize feelings regarding the MI.
Which cells are attracted to the site of endothelial injury in atherosclerosis?
Macrophages.
What must be ensured during rhythm analysis?
No one is touching the client to avoid motion artifact.
What should be monitored for during the recovery process?
Monitor for complications.
What are stable plaques in coronary artery disease?
Plaques that gradually increase in size and may partially occlude the vessel lumina, limiting coronary flow and causing ischemia, especially during exercise.
What does a spike preceding a P wave indicate?
That the atrium is being paced.
What physiological response occurs due to metabolic acidosis in high-output failure?
Heart rate and stroke volume increase to circulate blood faster.
What happens to troponin levels after a myocardial infarction?
Troponin levels rise within 3 hours and remain elevated for up to 7-10 days.
What should be monitored during Vagal Maneuvers?
Heart rate, rhythm, and blood pressure.
What happens during the first phase of a biphasic shock?
The current runs from the first electrode to the second electrode via the patient’s heart.
What is a key symptom of acute pulmonary edema?
Severe dyspnea.
What occurs after 8 to 10 seconds of decreased blood flow to the myocardium?
The affected myocardium becomes cyanotic and cooler.
Which condition characterized by fatty deposits in the arteries is a risk factor for myocardial infarction?
Atherosclerosis.
Where do electrical impulses begin in the heart?
In the sinoatrial (SA) node.
What is the role of IL-6 in heart failure?
Elevated in severe heart failure and cardiogenic shock, contributing to immune activation.
What characterizes systolic congestive heart failure?
A complex constellation of neurohumoral, inflammatory, and metabolic processes.
What metabolic changes occur as glycogen stores decrease during ischemia?
Anaerobic metabolism begins, leading to the accumulation of hydrogen ions and lactic acid.
What is a serious complication characterized by fluid accumulation in the lungs after a myocardial infarction?
Pulmonary edema.
What do ischemic myocardial cells release that predisposes individuals to dysrhythmias?
Catecholamines.
What daily monitoring should clients perform?
Monitor daily weight.
How does physical inactivity contribute to the risk of myocardial infarction?
It increases the likelihood of other risk factors such as obesity and hypertension.
What are neprilysin (NEP) inhibitors and how do they benefit heart failure patients?
A new class of medications that, when combined with ARBs, can improve heart failure outcomes.
What are some signs of sympathetic nervous system activation in acute pulmonary edema?
Profuse sweating and cold, clammy skin.
What complication involves leakage of blood from the mitral valve after a myocardial infarction?
Mitral valve insufficiency.
What are common causes of diastolic heart failure?
Hypertension, aging, and conditions that cause stiffening of the heart muscle.
Where are signs of right ventricular failure evident?
In the systemic circulation.
What type of therapy should be administered and monitored for signs of bleeding?
Thrombolytic therapy.
What accounts for the variety of locations and radiation patterns of anginal pain?
The entry of nerve fibers into the spinal cord from levels C3 to T4.
What is the consequence of increased muscle mass in the heart?
An increase in oxygen and energy demand.
What is endothelin and its significance in heart failure?
A potent vasoconstrictor associated with poor prognosis in heart failure.
What is the most common cause of right heart failure in the absence of left heart failure?
Pulmonary hypertension resulting from diffuse hypoxic pulmonary disease.
Which medications are indicated for all patients with reduced ejection fraction in chronic left heart failure?
ACE inhibitors and beta-blockers.
What happens if anemia is severe in high-output failure?
Even maximum cardiac output does not supply enough oxygen for cellular metabolism.
Which diseases are associated with pulmonary hypertension leading to right heart failure?
Chronic obstructive pulmonary disease (COPD) and cystic fibrosis.
What position should a client with pulmonary edema be placed in?
High Fowler’s position.
What are the signs of inadequate blood supply in septic shock?
Body tissues show signs of inadequate blood supply despite a very high cardiac output.
What fluid management advice should be given to clients if fluid restriction is prescribed?
Spread the fluid intake throughout the day and suck on hard candy to reduce thirst.
What is the body's response to lowered systemic vascular resistance (SVR) in septicemia?
Cardiac output increases to maintain blood pressure and prevent metabolic acidosis.
What complication involves the heart's inability to pump effectively after a myocardial infarction?
Heart failure.
What equipment should be available during Vagal Maneuvers?
A defibrillator and resuscitative equipment.
How does sympathetic nervous system activation initially compensate for decreased cardiac output?
By increasing heart rate and peripheral vascular resistance.
When should ARBs be used in heart failure management?
Only in individuals who do not tolerate ACE inhibitors.
What complication occurs when the heart cannot maintain adequate circulation after a myocardial infarction?
Cardiogenic shock.
What is the response of the right ventricle to increased workload in Right Heart Failure?
The right ventricle hypertrophies.
What laboratory test is used to check for infections and anemia?
Complete blood count (CBC).
What are the consequences of Ang II-mediated remodeling?
Sarcomere death, loss of the normal collagen matrix, interstitial fibrosis, decreased contractility, changes in myocardial compliance, and ventricular dilation.
How does thiamine deficiency affect the myocardium?
It impairs cellular metabolism in all tissues, including the myocardium.
What does kidney function testing assess?
Kidney injury.
What do cardiac biomarkers and B-type natriuretic peptide (BNP) assess?
Underlying heart disease.
What should a client with pulmonary edema avoid?
Over-the-counter medications.
What should clients avoid after an acute episode?
Large amounts of caffeine found in coffee, tea, cocoa, chocolate, and some carbonated beverages.
What should be established for medication administration?
An IV access route.
How does hypertension affect myocytes in HFpEF?
It decreases their ability to actively pump calcium, resulting in impaired relaxation.
What occurs if coronary artery occlusion persists beyond 20 minutes?
Myocardial infarction (MI) occurs.
What lifestyle factors contribute to the risk of coronary artery disease?
Obesity, metabolic syndrome, physical inactivity, cigarette smoking, and substance abuse.
What happens when unstable plaques rupture?
Underlying tissues of the vessel wall are exposed, resulting in platelet adhesion and thrombus formation.
What is referred to as 'capture' in pacing?
An atrial spike followed by a P wave or a ventricular spike followed by a QRS complex.
How does TNF-α affect myocytes?
Induces myocyte apoptosis and may contribute to cardiac cachexia.
What is one of the nursing interventions for a patient at risk of emboli?
Administer anticoagulants as prescribed.
What role do loop diuretics and aldosterone-blockers play in chronic left heart failure management?
They are effective in reducing preload and improving outcomes.
How does hyperthyroidism affect cellular metabolism?
It accelerates cellular metabolism through elevated levels of thyroxine from the thyroid gland.
What physical signs may indicate respiratory distress in acute pulmonary edema?
Nasal flaring and use of accessory breathing muscles.
How does severe left heart failure affect the right heart?
Increased left ventricular filling pressure is reflected back into the pulmonary circulation, raising pressure in the pulmonary circulation.
How can outcomes be improved in primary pulmonary arterial hypertension?
By using vasodilators.
What happens to the resistance faced by the right ventricle during Right Heart Failure?
Resistance to right ventricular emptying increases as pressure in the pulmonary circulation rises.
What is the ejection fraction in diastolic heart failure?
It is usually preserved (greater than 50%).
What is the significance of an elevated WBC count in myocardial infarction?
An elevated count can reach up to 20,000 cells/mm³.
What causes irreversible hypoxic injury and cellular death after myocardial ischemia?
About 20 minutes of ischemia.
What does a Basic Metabolic Panel (BMP) assess?
Electrolyte abnormalities.
What are common causes of systolic heart failure?
Coronary artery disease, myocardial infarction, and cardiomyopathy.
What emotional responses may accompany a myocardial infarction?
Feelings of fear and anxiety.
What position should the patient be placed in during the acute stage of myocardial infarction?
Semi-Fowler’s position.
What is a common cardiac dysrhythmia to monitor for in the first few hours after myocardial infarction?
Tachycardia and PVCs.
What forms the fibrous cap in atherosclerosis?
Proliferation of smooth muscle cells filled with lipid and inflammatory deposits.
What is the procedure if the initial shocks are unsuccessful?
Continue CPR for 1 minute and then deliver another series of shocks.
What is Right Heart Failure?
The inability of the right ventricle to provide adequate blood flow into the pulmonary circulation at a normal central venous pressure.
What is a common complication of Myocardial Infarction related to heart rhythm?
Dysthymias.
What is the first step in managing a client with pulmonary edema?
Administer oxygen.
How do plaques affect blood flow in arteries?
They protrude into the lumen, narrowing it and obstructing blood flow.
What is the function of the atrioventricular (AV) node?
It delays the transit of electrical impulses before they enter the ventricles.
What is a key symptom of unstable angina?
Chest pain lasting longer than 15 minutes.
What preparation should be made for a client undergoing cardioversion?
Prepare the client for cardioversion as prescribed.
Which risk factor for myocardial infarction is associated with excess body weight?
Obesity.
What is the role of beta-blockers in chronic left heart failure?
They improve symptoms and increase survival.
What complication involves inflammation of a vein due to a blood clot after myocardial infarction?
Thrombophlebitis.
What type of heart failure does beriberi cause?
A mixed type of heart failure.
When might anticoagulants and antithrombotics be indicated in heart failure patients?
In selected individuals, particularly those with intracardiac thrombi or atrial fibrillation.
What is the purpose of thyroid function tests?
To check for hyperthyroidism.
What syndrome is characterized by a combination of pericarditis, pericardial effusion, and pleural effusion following myocardial infarction?
Dressler’s syndrome.
What medication can be administered to slow heart rate and increase myocardial perfusion?
Beta blockers.
What does echocardiography reveal in HFpEF?
Poor ventricular filling, abnormal relaxation, hypertrophy, and/or left atrial enlargement with normal ejection fractions.
What does the management of right heart failure rely on?
Treating the underlying condition, managing intravascular volume, and assisting right ventricular contractility.
What should be assessed quickly in a client with pulmonary edema?
Lung sounds.
When does myoglobin rise after cell death?
Myoglobin rises within 2 hours after cell death, with a rapid decline after 7 hours.
What is essential to ensure for a client with pulmonary edema?
An intravenous (IV) access device is in place.
What type of sputum may be expectorated in acute pulmonary edema?
Large amounts of blood-tinged, frothy sputum.
What symptoms indicate worsening cardiac ischemia in unstable angina?
Symptoms that are not relieved with nitroglycerin.
What are common symptoms of systolic heart failure?
Fatigue, shortness of breath, and fluid retention.
What is the term for inflammation of the pericardium following a myocardial infarction?
Pericarditis.
What effects does aldosterone have in systolic congestive heart failure?
Causes salt and water retention, contributes to myocardial fibrosis, autonomic dysfunction, dysrhythmias, endothelial dysfunction, and prothrombotic effects.
Where are signs of left ventricular failure evident?
In the pulmonary system.
What medication regimen should a client with pulmonary edema be instructed on?
Digoxin, a diuretic, ACE inhibitors, low-dose beta blockers, and vasodilators.
What should a client do if unable to take medications due to illness?
Contact the PHCP.
What medical condition characterized by high blood pressure is a risk factor for myocardial infarction?
Hypertension.
What causes sequential contraction of cardiomyocytes?
The propagation of electrical impulses through the atria and ventricles.
What are some deleterious effects of catecholamines on the myocardium?
Direct toxicity to myocytes, induction of myocyte apoptosis, myocardial remodeling, downregulation of adrenergic receptors, facilitation of dysrhythmias, and potentiation of autoimmune effects.
What happens to the heart's pumping ability due to oxygen deprivation?
It diminishes due to electrolyte disturbances and loss of contractility, potentially leading to heart failure.
What signs of fluid retention should clients report?
Edema or weight gain.
What symptom of myocardial infarction is characterized by chest pain that lasts 30 minutes or longer?
Angina.
What is released into interstitial spaces due to necrosis of myocardial tissue?
Intracellular enzymes, such as troponin.
What symptom indicates excessive sweating during a myocardial infarction?
Diaphoresis.
What is the priority medication for pain relief during the acute stage of myocardial infarction?
Morphine.
What should a client be advised to do if side effects occur from medications?
Notify the PHCP.
What should be established for medication administration during the acute stage?
IV access route.
What abnormal lung sounds may be heard during auscultation in acute pulmonary edema?
Wheezing and crackles; gurgling respirations.
What does the body's increased demand for oxygen during hyperthyroidism lead to?
An increase in cardiac output.
What diagnostic procedure is used to monitor heart activity?
Obtain an ECG.
What role does Angiotensin II (Ang II) play in heart failure?
It increases preload and afterload and causes direct toxicity to the myocardium, mediating remodeling of the ventricular wall.
What should be inserted as prescribed for a client with pulmonary edema?
A Foley catheter.
What symptoms are associated with diastolic heart failure?
Similar symptoms like shortness of breath and fluid retention, but may also include exercise intolerance.
What is a significant skin change that can occur in acute pulmonary edema?
Cyanosis.
What should be assisted in identifying after an acute episode of pulmonary edema?
Precipitating risk factors of heart failure.
What physical signs may indicate a myocardial infarction?
Pallor, cyanosis, and coolness of extremities.
What should be assessed to identify poor cardiac output?
Distal peripheral pulses and skin temperature.
What should be prepared for if required in a client with pulmonary edema?
Intubation and ventilator support.
What should be documented after managing a client with pulmonary edema?
The event, actions taken, and the client’s response.
What does the D-dimer test assess?
The breakdown of fibrin in the presence of blood clots.
What should be done if systolic blood pressure drops below 100 mm Hg after medication administration?
Lower the head of the bed and notify the PHCP.
What is the term for chest pain that occurs after a myocardial infarction?
Postinfarction angina.
What serious complication can occur involving a rupture of the heart's ventricle after a myocardial infarction?
Ventricular rupture.
What should be monitored closely after administering medications in the acute stage?
Blood pressure.
What should be done to assess the patient's cardiovascular status?
Obtain vital signs and maintain cardiac monitoring.
What are disorders of impulse conduction?
Conditions that affect the electrical signals in the heart, leading to abnormal heart rhythms.
What happens to arterial branches during systole?
They are compressed, preventing perfusion.
What happens to renal perfusion as cardiac output falls?
Renal perfusion diminishes, activating the RAAS.
What type of exercises should be provided to prevent thrombus formation?
Range-of-motion exercises.
What is the purpose of an Automated External Defibrillator (AED)?
To be used by laypersons and emergency medical technicians for prehospital cardiac arrest.
What can cause imbalances between myocardial demand and coronary blood supply?
A number of conditions that affect blood flow and oxygen delivery.
What is silent ischemia?
Objective evidence of ischemia without reported pain by the patient.
What are the two main objectives of medical management for myocardial oxygen supply?
Decrease the oxygen demand of the myocardium and increase its oxygen supply.
What should be incorporated into the health history of a patient with cardiovascular disease?
Assessment of cardiac risk factors.
What major aspect should be recognized and evaluated in cardiovascular dysfunction?
Major manifestations of cardiovascular dysfunction.
What percentage of oxygen does the heart require from coronary arteries?
70 - 80%.
What is the relationship described in this chapter regarding the cardiovascular system?
The relationship between anatomic structures and physiologic function.
