Chapter 25 Cardiovascular System MA

Cardiac Glycosides (Digoxin)

Increase force and velocity of myocardial contractions by raising intracellular sodium and calcium concentrations >>improve stroke volume and CO Slows the conduction rate >>allowing for increased ventricular filling

A patient with diagnosed left-heart failure may have to take a medication every day that will increase the amount of urine he or she voids. This medication is categorized as a

diuretic

Due to the accumulation of fluid with heart failure, patients may be prescribed:

diuretics

Which of the following medications may be used to decrease edema in congestive heart failure patients?

diuretics

Patients who develop heart failure may present with complaints of difficulty when trying to breathe. The medical term for this complaint is:

dyspnea

Left sided heart failure

The left ventricle loses its ability to effectively pump oxygenated blood into the systemic circulation, leaving the body starving for oxygen and nutrients; backs up into the lungs causing pulmonary edema (congestion) -- a buildup of blood and fluid in the lung tissues that interferes with respiration.

What is the term for the lesion formed by the buildup of bad cholesterol?

fatty streak

low levels of oxygen in the blood

heart rate increases bc the left ventricle is weak and to meet the body's oxygen demands. This leads to thickening or HYPERTROPHY of the *myocardium* as it labors to push blood out of the heart against the increasing pressure in the pulmonary vessels and fluid in lung and continuing the cycle of cardiac muscle damage

When there is a pressure overload of it attempts, the left ventricle attempts to compensate for the extra strength it needs to eject blood to the aorta by:

hypertrophy of the myocardial layer (made of cardial muscle)

One of the leading signs and symptoms of right-ventricular heart failure is:

hypotension

In the event an individual arrives in the emergency room and states he has a history of heart failure and is currently taking a diuretic, you should ask:

if he has been experiencing swelling in his legs/ankles

In the event an individual arrives in the emergency room and states she has a history of heart failure and is currently taking a diuretic, you should ask:

if she has been experiencing swelling in her legs/ankles

Deoxygenated blood enters the heart via the:

inferior and superior venae cavae

What is the problem during a myocardial infarction?

ischemia

What is the term used for blockage of blood flow?

ischemia

The most common cause of right-sided heart failure is:

left-sided HF

When measuring blood pressure, how do you know when to record the systolic blood pressure?

You begin hearing the heart sounds after hearing nothing

When the heart loses its ability to pump enough blood to meet the needs of the body, the patient is diagnosed with ____

congestive heart failure

During ventricular systole, the ventricles ___

contract

Systole

contraction of the heart chambers

Right-sided heart failure that develops due to pulmonary disorders is called:

cor pulmonale

What is the condition in which a coronary artery can no longer deliver sufficient blood and oxygen to heart muscle?

coronary artery disease

HMG-CoA Reductase Inhibitors (Statins)

decrease LDL, increase HDL inhibit cholesterol synthesis in the liver and help remove LDL cholesterol from the bloodstream

When blood pressure increases, what effect should the baroreceptors cause?

decrease in heart rate

hypoxia

deficiency in the amount of oxygen reaching the tissues

The cycle begins in ___ (systole/diastole).

diastole

When assessing a patient, and it is determined that the left ventricle is failing because it cannot stretch or expand to handle the oxygenated blood from the left atrium, the patient is said to have:

diastolic heart failure

Which of the following blood pressure measurements will lead to a diagnosis of hypertension?

120/90

During diastole, what is happening inside of the ventricles?

the ventricles are filling with blood

The ability of the ventricular heart muscle cells to shorten in response to an electrical stimulus from the SA node is known as:

ventricular systole

The aortic and pulmonic valves also known as the semilunar valves are open during:

ventricular systole

Heart failure

when the heart loses its ability to pump enough blood to meet its needs (body's needs)

How does the cardiac cycle begin?

begins with both atria and ventricles in diastole. Both atrioventricular valves are open while the pulmonary and aortic semilunar valves are closed. Blood flows into RIGHT atrium through the superior and inferior vena cava. Blood flows from the lungs into the left atrium through the pulmonary veins.

A medication that is prescribed to treat angina by lowering the heart rate and decreasing the strength of the contraction is a:

beta blocker

Which of the following is NOT supplied to the heart by the coronary arteries?

carbon dioxide

A medication that is prescribed to increase the force of the heart's contraction and at the same time slow the heart rate is a:

cardiac glycoside

Patients presenting with the clinical triad of hypotension, jugular venous distention (JVD), and normal breath sounds may be diagnosed with

right ventricular failure

In the event an individual has a decrease in pulmonary circulation due to COPD or cystic fibrosis, he or she may develop:

shortness of breath

In the event an individual has an increase in pulmonary circulation due to systolic left-sided heart failure and diastolic left-sided heart failure, the patient may complain of:

shortness of breath

The pathway for pumping blood throughout the body and back to the heart is called:

systemic circulation

When assessing a patient, and it is determined that the left ventricle is failing because it no longer contracts with enough force to pump blood through the systemic circulation, the patient is said to have:

systolic left-sided HF

What is the first step in treatment of myocardial infarction, assuming the patient is conscious and breathing?

take steps to minimize clot formation

How does the hormone angiotensin II cause an increase in blood pressure?

By causing smooth muscle contraction

Your patient swears that his antihypertensive medication is making him worse, not better. How should you respond?

"Because hypertension has no symptoms and antihypertensive medications have side effects, it is common to feel worse while taking the medication. However, it is imperative for your health to stay on the medication."

Angiotension Receptor Blockers (ARBs)

- prevent the release of aldosterone; block angiotension II from receptors in tissues - causes arteries to narrow

Which of the following scenarios would lead to a diagnosis of essential hypertension?

A 42-year-old woman with blood pressure of 152/95; she admits to eating fast food often and smokeshalf a pack of cigarettes per day.

Afterload

A volume of oxygenated blood from the lungs into left atrium --> left ventricle --> systemic circulation

Diuretics

Antihypertensive medications administered to increase urine secretion in order to rid the body of excess water and salt reduce fluid volume and venous return by inhibiting sodium and water reabsorption along the kidneys' renal tubular system.

Which normal blood pressure reading and cardiac cycle phase match?

B/P of 120, cardiac systole

Why is blood pressure higher in systemic arteries and lower in systemic veins?

Because systemic arteries are closer to the heart than systemic veins

Why does hypertension cause heart failure?

Because the heart has to work harder to push the blood against the higher pressure, causing the heart to become less effective

Beta Blockers

Block effects of adrenaline on heart and arteries. BBs compete with norepinephrine molecules for binding sites on cardiomyocytes, preventing norepinephrine's effects, resulting in reduced speed and strength of the contractions, which can support more efficient circulation through the body. Keep blood pressure low; ease heart's pumping action

There are no antihypertensive medications that have which of the following mechanisms of action?

Block the effects of acetylcholine, a neurotransmitter of the autonomic nervous system.

What is the origin of the right and left coronary arteries?

Distal to the aortic valve

What is the first step in treating a patient with hypertension?

Ensure the patient has no underlying illness causing the hypertension.

Left-sided hear failure

Left ventricle cannot pump adequate preload out of the heart causing pulmonary congestion - a buildup of blood in the pulmonary vessels -> causing fluid and lung tissues that impedes normal respiration

systolic left sided heart failure

Left ventricle's inability to contract with enough force to drive blood out of the heart against resistance (afterload) to the rest of the body. Left ventricle contracts the blood left behind causes backup into the left atrium, and pulmonary circulation - leads to pulmonary congestion

In the event an individual develops venous congestion with hepatomegaly and ascites, he or she is considered to have:

Right-sided HF

Diastolic Left-sided heart failure

The heart's inability to pump blood is due to impairment of the left ventricle's ability to relax and fill due to myocardial stiffness (in ventricular muscle). As a result of reduced myocardial contractility, the unexpelled blood pools inside the left ventricle, and the chamber expands to hypertrophic size

In the event an individual arrives in the emergency room and states he has a history of heart failure, you should:

ask for list of meds he currently takes

How do obesity, high-salt diet, stress, high cholesterol, and diabetes mellitus all contribute to the development of hypertension?

They all increase resistance in the peripheral arteries

In the event an individual arrives in the emergency room and states she has a history of heart failure, you should

assess her feet and ankles for peripheral edema

Preload

a volume of deoxygenated blood comes in through superior and inferior vena cava --> right atrium

endovascular stent

a wire mesh tube to flatten the plaque against the artery wall to keep it patent

A lesion containing foam cells and a lipid core is called

an atheroma

The valve that opens when the left ventricle expels blood into the aorta is the _______ valve.

aortic semilunar

right and left coronary arteries

arise from the aorta and supply the heart with blood nutrients and oxygen

How many heartbeats make up a complete cardiac cycle?

one

All of the following are used to treat heart failure EXCEPT ____

radiation therapy

Angiotensin-converting enzyme (ACE) inhibitors

reduce production of angiotensin block hormones in the renin angiotensin aldosterone system, dilating vessels, lowering blood volume, and venous return, decreasing the heart's workload, and halting ventricular hypertrophy.

Calcium Channel Blockers CCBs

relax blood vessels letting blood flow more easily; lowers B/P

Diastole

relaxation of the heart chambers