Ch 19 disorders of cardiac funtion

approximately ____ to _____ days post MI and acute _____________ response develops in the area surrounding the necrotic tissue.

2 to 3 days Inflammatory response

Treatment of mitral valve prolapse focuses on the relief of symptoms and prevention of complications, name 3 lifestyle modifications

CESSATION OF STIMULANTS 1. caffeine 2. alcohol 3. cigarettes

What are other causes of dilated cardiomyopathy>

Infections i.e. viral, bacteria, fungal, mycobacterial, parasitic. Toxins alcoholism chemotherapeutic agents metals.

An arterial switch procedure is the treatment for ____________

Transposition of the great arteries

The damaged area of the heart after a MI is gradually replaced with ___________ ___________ tissue, which in turn becomes less ____________ and more _____________ in composition

Vascularized granulation tissue vascular fibrous

Acquired cardiomyopathies include those that have their origin in the inflammatory process 1. ___________, 2. pregnancy (____________) and 3. Stress (_____________) cardiomyopathies

(e.g., myocarditis), pregnancy (peripartum cardiomyopathy), and stress (takotsubo cardiomyopathy).

the normal pericardial space contains about ___ to ___ mL of fluid.

15 to 50

name 4 subtypes of chronic ischemic coronary artery disease.

1. Silent MI 2. Stable angina 3. variant or vasospastic 4. angina

Name the major risk factors of CAD: (there are 8)

1. cigarette smoking 2. elevated blood pressure 3. elevated LDL (bad) Cholesterol 4. low HDL (good) cholesterol 5. DM 6. Advancing age 7. Abd obesity 8. physical inactivity.

Tetralogy of Fallot consists of 4 associated defects:

1. ventricular septal defect 2. dextroposition of the aorta 3. obstruction or narrowing of the pulmonary outflow channge 1. hypertrophy of the right ventricle.

Atrial tachycardia and atrial fibrillation develop in _____% to _____% of clients with mitral valve stenosis.

30-40

At _____ to ____ days, the center of the infarcted area is ________ and ________.

4 to 7 days soft and yellow

by the ____Th week post MI, the necrotic area is completely replaced by _________ ________ tissue

7th fibrous scar tissue

The nurse would anticipate that which of the following clients would be considered a good candidate for coronary artery bypass grafting (CABG)? A) A 56-year-old with a history of MI experiencing new-onset chest pain and ST elevation B) A 24-year-old auto accident client diagnosed with pericardial effusion and cardiac tamponade C) A 87-year-old client admitted with uncontrolled dilated cardiomyopathy D) A 78-year-old client admitted with increasing fatigue related to aortic stenosis

A) A 56-year-old with a history of MI experiencing new-onset chest pain and ST elevation Feedback: Coronary artery bypass grafting (CABG) may be the treatment of choice for people with significant coronary artery disease (CAD) who do not respond to medical treatment and who are not suitable candidates for percutaneous coronary intervention. CABG does not address valve disorders, pericardial effusion, or cardiomyopathies.

When educating the parents of a cyanotic infant diagnosed with of tetralogy of Fallot, the nurse will include which of the following statements related to the physiological abnormalities? The infant has: Select all that apply. A) A hole in the ventricular septal B) A small, narrow pulmonary outflow channel C) A large, thick, right ventricular wall D) A very small, narrow aorta E) The pulmonary artery arises from the left ventricle

A) A hole in the ventricular septal B) A small, narrow pulmonary outflow channel C) A large, thick, right ventricular wall Ans: A, B, C Feedback: Tetralogy of Fallot consists of four associated defects: a ventricular septal defect; dextroposition of the aorta; obstruction or narrowing of the pulmonary outflow channel; and hypertrophy of the right ventricle. Narrowing, or coarctation, of the aorta is not associated with tetralogy of Fallot. Rising of pulmonary arteries from the left ventricle instead of the right is a sign of transposition of the great vessels.

A client is admitted with dilated cardiomyopathy with left ventricular dysfunction. The nurse should assess for which of the following clinical manifestations? Select all that apply. A) Dyspnea B) Orthopnea C) Extreme fatigue with activity D) Excess abdominal fluid E) Fainting

A) Dyspnea B) Orthopnea C) Extreme fatigue with activity Ans: A, B, C Feedback: The most common clinical manifestations of DCM are those related to heart failure, such as dyspnea, orthopnea, and reduced exercise capacity. Hypertrophic cardiomyopathy (HCM) is characterized by myocardial thickening and abnormal diastolic filling. They experience fainting/syncope. Restrictive cardiomyopathy, in which there is excessive rigidity of the ventricular wall, increases the work of ventricular emptying and causes cardiac hypertrophy. These clients experience excess abdominal fluid (ascites).

An elderly client is admitted with the diagnosis of severe aortic regurgitation. Which of the following client reports support this diagnosis? Select all that apply. A) Exertional dyspnea B) Orthopnea C) Frequent angina D) Paroxysmal nocturnal dyspnea E) Palpitations

A) Exertional dyspnea B) Orthopnea D) Paroxysmal nocturnal dyspnea E) Palpitations Ans: A, B, D, E Feedback: As aortic regurgitation progresses, signs and symptoms of left ventricular failure begin to appear. These include exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Angina is a rare symptom. Tachycardia, occurring with emotional stress or exertion, may produce palpitations, head pounding, and premature ventricular contractions.

A person newly diagnosed with Kawasaki disease in the acute phase will likely have which of the following clinical manifestations? Select all that apply. A) Fever B) Peeling of the skin of the fingers and toes C) Edematous hands and feet D) Bilateral conjunctivitis E) Irritability and lability of mood

A) Fever C) Edematous hands and feet D) Bilateral conjunctivitis Ans: A, C, D Feedback: The acute phase begins with an abrupt onset of fever, followed by bilateral conjunctivitis, usually without exudates; erythema of the oral and pharyngeal mucosa with "strawberry tongue" and dry, fissured lips; redness and swelling of the hands and feet; rash of various forms; and enlarged cervical lymph nodes. The other symptoms occur in the subacute phase.

Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by: A) Fixed coronary obstruction B) Increased collateral circulation C) Intermittent vessel vasospasms D) Excessive endothelial relaxing factors

A) Fixed coronary obstruction Feedback: Chronic stable angina is caused by fixed coronary obstruction that produces an imbalance between coronary blood flow and the metabolic demands of the myocardium. Endothelial relaxing factors relax the smooth muscle in the vessel wall and allow increased blood flow; treatment for chronic stable angina is with a vasodilating agent, such as nitroglycerine, that relaxes the vessels and enhances coronary blood flow. Intermittent vessel vasospasms, in conjunction with coronary artery stenosis, cause the vasospastic type of angina. Increased formation of collateral vessels is a compensatory response that allows adequate blood circulation to tissues distal to an obstruction.

An elderly female client who reports increasing fatigue has been diagnosed with aortic stenosis, a disease that her primary care provider believes may have been long-standing. Which of the following compensatory mechanisms has most likely maintained the woman's ejection fraction until recently? A) Left ventricular hypertrophy B) Increased blood pressure C) Increased heart rate and stroke volume D) Aortic dilation

A) Left ventricular hypertrophy Ans: A Feedback: Because aortic stenosis develops gradually, the left ventricle has time to adapt by increasing in wall thickness to maintain a normal ejection fraction. Increased blood pressure and heart rate and dilation of the aorta are not responses that mitigate the effects or aortic stenosis.

Which of the following diagnostic/assessment findings would been seen in a client with worsening mitral valve stenosis? Select all that apply. A) Low-pitched diastolic murmur that is increasing in duration B) Sharp elevation in left atrial pressure C) Decreased cardiac output D) Severe elevation in left ventricular end-diastolic pressure E) Left ventricle increases its stroke volume

A) Low-pitched diastolic murmur that is increasing in duration B) Sharp elevation in left atrial pressure C) Decreased cardiac output Ans: A, B, C Feedback: The increased left atrial pressure eventually is transmitted to the pulmonary venous system, causing pulmonary congestion. A characteristic auscultatory finding in mitral stenosis is an opening snap following the second heart sound, which is caused by the stiff mitral valve. As the stenosis worsens, there is a localized low-pitched diastolic murmur that increases in duration with the severity of the stenosis. Manifestations are related to the elevation in left atrial pressure and pulmonary congestion such as dyspnea with exertion, decreased cardiac output owing to impaired left ventricular filling, and left atrial enlargement with the development of atrial arrhythmias and mural thrombi. Severe elevation in left ventricular end-diastolic pressure and left ventricle increases its stroke volume occur with aortic regurgitation.

Which of the following would be considered a clinical manifestation of acute pericarditis? Select all that apply. A) Sharp, abrupt onset of chest pain that radiates to the neck B) Pericardial friction rub C) Narrowed pulse pressure D) Muffled heart sounds E) Abnormal ECG results

A) Sharp, abrupt onset of chest pain that radiates to the neck B) Pericardial friction rub E) Abnormal ECG results Ans: A, B, E Feedback: The manifestations of acute pericarditis include a triad of chest pain, an auscultatory pericardial friction rub, and electrocardiographic (ECG) changes. The pain usually is sharp and abrupt in onset, occurring in the precordial area, and may radiate to the neck, back, abdomen, or side. Pain in the scapular area may result from irritation of the phrenic nerve. The pain typically is pleuritic (aggravated by inspiration and coughing) and positional (decreases with sitting and leaning forward) because of changes in venous return and cardiac filling. A pericardial friction rub results from the rubbing and friction between the inflamed pericardial surfaces.

The plaques in a client's coronary arteries are plentiful, and most have small- to moderate-sized lipid cores with thick fibrous caps. This form of atherosclerosis is most closely associated with which of the following diagnoses? A) Stable angina B) Non-ST-segment elevation MI C) ST-segment elevation MI D) Unstable angina

A) Stable angina Feedback: The fixed or stable plaque is commonly associated with stable angina, and the unstable plaque is implicated in unstable angina and myocardial infarction (MI).

An IV drug abuser has been diagnosed with infective endocarditis. He is in the emergency department reporting increasing shortness of breath, rapid breathing, chest pain that worsens with breathing, and coughing up blood. The health care provider recognizes this may be caused by: A) Vegetative emboli traveling in the blood stream to the lungs B) Blood clots in the left ventricle traveling through the aorta C) Microemboli being developed in the carotids by Staphylococcus epidermidis D) Infarction of the tissue surrounding the endocardium of the heart

A) Vegetative emboli traveling in the blood stream to the lungs Feedback: The client is exhibiting signs of pulmonary emboli. The infectious loci continuously release bacteria into the bloodstream and are a source of persistent bacteremia, sometimes contributing to pericarditis. As the lesions grow, they cause valve destruction and dysfunction such as regurgitation, ring abscesses with heart block, and perforation. The loose organization of these lesions permits the organisms and fragments of the lesions to form emboli and travel in the bloodstream, causing cerebral, systemic, or pulmonary emboli. If clots are in the left ventricle, they will travel to the brain or kidneys. If emboli are located in the carotids, they will travel to the brain tissue. Infarction of heart tissue will exhibit signs of a myocardial infarction, not pulmonary emboli.

abnormal Q waves occur with

Acute coronary syndrome (ACS)

Kussmaul sign? Indicative of what?

An absence of jugular vein collapse on inspiration. Sign of impaired right sided heart filling (right sided heart failure)

List the early signs of constrictive pericarditis

Ascites pedal edema dyspnea on exertion fatigue jugular venous destention

what is the preferred anti-platelet agent for preventing platelet aggregation in persons with acute coronary syndrome (ACS)

Aspirin (i.e. acetylsalicyclic acid, acts by inhibiting synthesis of the prostaglandin thromboxan A2. promotes reperfusion and reduce the likelihood rethrombosis.

The name of medication that inhibits synthesis of prostaglandin thromboaxan A2 and promoters reperfusion

Asprin

_____________ ______________ is a conduction disorder that impairs atrial emptying

Atrial fibrillation

Which of the following individuals is suffering the effects of acute coronary syndrome (ACS)? A) A client whose most recent ECG indicates that silent myocardial ischemia has occurred B) A client who occasionally experiences persistent and severe chest pain when at rest C) A client who sometimes experiences chest pain when climbing stairs D) A client who has recently been diagnosed with variant (vasospastic) angina

B) A client who occasionally experiences persistent and severe chest pain when at rest Feedback: The onset of STEMI involves abrupt and significant chest pain. The pain typically is severe, often described as being constricting, suffocating, and crushing. Substernal pain that radiates to the left arm, neck, or jaw is common, although it may be experienced in other areas of the chest and back. Unlike that of angina, the pain associated with MI is more prolonged and not relieved by rest or nitroglycerin. Silent MI, stable angina, and variant, or vasospastic, angina are subtypes of chronic ischemic coronary artery disease.

On the 3rd day following an acute myocardial infarction, the client is being discharged home. The nurse is explaining how the heart tissue heals following an MI. "Since today is your 3rd day after your heart attack, the tissue is: A) Soft, mushy, and yellow." B) Acutely inflamed." C) Forming granulation tissue." D) Developed a fibrous scar."

B) Acutely inflamed." Feedback: Approximately 2 to 3 days post-myocardial infarction, an acute inflammatory response develops in the area surrounding the necrotic tissue. The damaged area is gradually replaced with vascularized granulation tissue, which in turn becomes less vascular and more fibrous in composition. At 4 to 7 days, the center of the infarcted area is soft and yellow. By the 7th week, the necrotic area is completely replaced by fibrous scar tissue.

Clients with ischemic coronary vessel disease and acute coronary syndrome (ACS) are classified as low or high risk for acute myocardial infarction based on characteristics that include significant: A) Heart murmurs B) ECG changes C) Pulmonary disease D) Pericardial effusion

B) ECG changes Feedback: Persons with ischemic coronary vessel disease and ACS are routinely classified as low or high risk for acute myocardial infarction based on clinical history, ECG variables, and serum cardiac biomarkers. Chronic pulmonary disease increases pulmonary vascular resistance, leading to right or left heart failure. Pericardial effusion increases intracardiac pressure and venous pressure. Heart murmurs result from turbulent blood flow through a diseased valve.

Atherosclerotic plaque is most likely to be unstable and vulnerable to rupture when the plaque has a thin fibrous cap over a: A) Red thrombus B) Large lipid core C) Calcified lesion D) Vessel wall injury

B) Large lipid core Feedback: Plaque disruption causes thrombus formation, with white platelet-containing thrombi being associated with unstable angina. The major determinants of plaque vulnerability to disruption include the size of its lipid-rich core, lack of stabilizing smooth muscle cells, presence of inflammation with plaque degradation, and stability and thickness of its fibrous cap. Plaques with a thin fibrous cap overlaying a large lipid core are at high risk for rupture. Plaque tends to be stable or fixed unevenly in any area of the coronary arteries. Calcified plaque tends to be stable and encased in a thrombus, until it begins to degrade.

Which of the following assessment findings would be suggestive of cardiac tamponade? A) Increasing PaCO2 and decreasing PaO2 B) Audible crackles on chest auscultation and presence of frothy sputum C) A 20 mm Hg drop in systolic blood pressure during respiration D) Normal ECG combined with complaints of chest pain and shortness of breath

C) A 20 mm Hg drop in systolic blood pressure during respiration Ans: C Feedback: A key diagnostic finding in cardiac tamponade is pulsus paradoxus, or an exaggeration of the normal variation in the systolic blood pressure, commonly defined as a 10 mm Hg or more fall in the systolic blood pressure, which occurs with inspiration. Worsening blood gases, chest secretions, and chest pain are not symptoms specific to cardiac tamponade. The client's ECG would not be normal.

A father experienced the onset of chest pain and dies suddenly. The family asks, "What caused him to die so suddenly?" The health care provider's reply that is most appropriate would be, "There's a high probability that your loved one developed an acute heart attack and experienced: A) Acute myocarditis." B) High troponin levels." C) Acute ventricular arrhythmia." D) Hypertrophic cardiomyopathy."

C) Acute ventricular arrhythmia." Feedback: Sudden death from an acute myocardial infarction in an adult is usually caused by fatal (ventricular) arrhythmias. Hypertrophic cardiomyopathy is the most common cause of sudden cardiac death in the young, since the disorder can be inherited as an autosomal dominant trait. Troponin is normally present in cardiac muscle; serum levels of troponin enzymes are diagnostic and will elevate within 3 hours of the acute event. Myocarditis is inflammation of the heart muscle and conduction system without evidence of myocardial infarction.

A child's history of a recurrent sore throat followed by severe knee and ankle pain has resulted in a diagnostic workup and a diagnosis of rheumatic fever. What are the treatment priorities for this child? A) Cardiac catheterization and corticosteroid therapy B) Implanted pacemaker and -adrenergic blockers C) Antibiotics and anti-inflammatory drugs D) Pain control and oxygen therapy

C) Antibiotics and anti-inflammatory drugs Ans: C Feedback: A diagnosis of rheumatic fever (RF) necessitates the use of antibiotics (usually penicillin) and anti-inflammatory drugs. These measures supersede the importance of pain control and oxygen therapy. Cardiac catheterization, corticosteroid therapy, pacemakers, and -adrenergic blockers are not common treatment modalities for RF.

Implantation of a pacemaker is most likely to benefit a client with which of the following cardiomyopathies? A) Myocarditis B) Takotsubo cardiomyopathy C) Dilated cardiomyopathy (DCM) D) Primary restrictive cardiomyopathy

C) Dilated cardiomyopathy (DCM) Ans: C Feedback: Arrhythmias and dysrhythmias are characteristic of DCM, often requiring the use of an implanted pacemaker or an implantable cardioverter-defibrillator. Implanted pacemakers are not noted to be among the common treatments for myocarditis, Takotsubo cardiomyopathy, or primary restrictive cardiomyopathy.

Which of the following lab results strongly suggest an immunologic response in the client with possible rheumatic heart disease? A) Elevated white blood cell count B) Elevated erythrocyte sedimentation rate (ESR) C) Group A (-hemolytic) streptococcal antibodies D) High C-reactive protein levels

C) Group A (-hemolytic) streptococcal antibodies Ans: C Feedback: The pathology of RF does not involve direct bacterial infection of the heart. Rather, the time frame for development of symptoms relative to the onset of pharyngitis and the presence of antibodies to the GAS organism strongly suggests an immunologic response. It is thought that antibodies directed against the M-protein of certain strains of streptococci cross-react with glycoprotein antigens in the heart, joints, and other tissues to produce an autoimmune response through a phenomenon called molecular mimicry. Elevated erythrocyte sedimentation rate (ESR) is a blood test that can reveal inflammatory activity in your body. The level of CRP rises when there is inflammation throughout the body. Elevated WBC indicates an infection.

Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to "an enlarged heart." Which of the following disorders was the player's most likely cause of death? A) Takotsubo cardiomyopathy B) Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) C) Hypertrophic cardiomyopathy (HCM) D) Dilated cardiomyopathy (DCM)

C) Hypertrophic cardiomyopathy (HCM) Ans: C Feedback: The most frequent symptoms of HCM are dyspnea and chest pain in the absence of coronary artery disease. Syncope (fainting) is also common and is typically postexertional, when diastolic filling diminishes and outflow obstruction increases. Ventricular arrhythmias are also common, and sudden death may occur, often in athletes after extensive exertion. Risk factors for sudden cardiac death among clients with HCM include a family history of syncope or sudden cardiac death, certain mutations, and extreme hypertrophy of the left ventricle. HCM is characterized by a massively hypertrophied left ventricle with a reduced chamber size.

Congenital heart defects can cause a right heart-to-left heart shunting of blood that results in increased: A) Pulmonary blood volume B) Right ventricle workload C) Unoxygenated blood flow D) Right atrial blood volume

C) Unoxygenated blood flow Ans: C Feedback: Right-to-left shunts transfer unoxygenated blood from the right side of the heart to the left side, diluting the oxygen content of blood that is being ejected into the systemic circulation and causing cyanosis. Left-to-right shunts cause recycling of blood through the pulmonary vessels and the right side of the heart, causing increased volume and workload of the right side of the heart and pulmonary circulation.

Triad of acute pericarditis

Chest pain ausculatatory pericardial friction rub ECG changes

Persistent cyanosis has led an infant's care team to suspect a congenital heart defect. Which of the following assessment findings would suggest coarctation of the infant's aorta? A) The child has a split S2 heart sound on auscultation. B) ECG reveals atrial fibrillation. C) The child experiences apneic spells after feeding. D) Blood pressure in the child's legs is lower than in the arms.

D) Blood pressure in the child's legs is lower than in the arms. Ans: D Feedback: The classic sign of coarctation of the aorta is a disparity in pulsations and blood pressures in the arms and legs. In coarctation, the pressure in the legs is lower and may be difficult to obtain. A split S2, dysrhythmias, and apneic spells are not characteristics of coarctation of the aorta.

A client was in car accident client while not wearing a seatbelt and has sustained multiple rib fractures. During assessment, the nurse is having a hard time hearing heart sounds, and the client reports chest pain/pressure repeatedly. This client may be experiencing: A) Cardiomyopathy B) Pericarditis C) Pulmonary hypertension D) Pericardial effusion

D) Pericardial effusion Ans: D Feedback: Pericardial effusion is the accumulation of fluid in the pericardial cavity, usually as a result of an inflammatory reaction. It may develop with neoplasms, cardiac surgery, or trauma. Pericardial effusion exerts its effects through compression of the heart chambers. The normal pericardial space contains about 15 to 50 mL of fluid. Increases in the volume of this fluid, the rapidity with which it accumulates, and the elasticity of the pericardium determine the effect that the effusion has on cardiac function. This leads to cardiac standstill or failure. Pericardial sac thickening due to inflammation can restrict the heart, rather than to allow stretching. Rupture of the sac is pathologic, resulting in heart expansion. A friction rub sound (rubbing between the inflamed pericardial surfaces) is characteristic of acute pericarditis. Acquired cardiomyopathies include those that have their origin in the inflammatory process (e.g., myocarditis), pregnancy (peripartum cardiomyopathy), and stress (takotsubo cardiomyopathy). In congenital heart defects, in most cases, pulmonary vascular resistance is only slightly elevated during early infancy, and the major contribution to pulmonary hypertension is the increased blood flow.

Endocarditis and rheumatic heart disease are both cardiac complications of systemic infections. Characteristics include a new or changed heart murmur caused by: A) Chronic atrial fibrillation B) Myocardial inflammation C) Left ventricle hypertrophy D) Vegetative valve destruction

D) Vegetative valve destruction Feedback: Murmurs are sounds produced by blood flow through incompetent valves. Both infective endocarditis and carditis of rheumatic heart disease are characterized by growth of vegetation on valve leaflets, causing destruction, regurgitation, and murmur. Atrial fibrillation is a conduction disorder that impairs atrial emptying rather than valve function. Myocardial inflammation is present but does not cause murmurs. Valve dysfunctions can chronically decrease emptying and lead to left ventricular hypertrophy.

serum troponin levels

Diagnosis of MI is based on presenting signs and symptoms and results of diagnostic testing including 12-lead ECG and blood tests to check cardiac enzymes. The most reliable blood test is the troponin level, which determines how much heart damage has occurred. will elevate within 3 hours of the acute event

Which cardiomyopathy are arrhythmia and dysrhytmias characteristic of and often require the use of an implanted pacemaker of caroiverter-defibrillator?

Dilated cardiomyopathy

What is the common cause of heart failure and the leading indication for heart transplant?

Dilated cardiomyopathy (DCM)

Describe peripartum cardiomyopathy

HF that develops during last trimester, or with in 5 mo after birth Etiology Uknown (usually) More common in multiparous or older women and twin fetuses or preeclampsia women of African ancestry Mortality ~10% Important to discourage future pregnancy

Atrial fibrillation can occur as a long-term consequence of elevated left atrial pressures due to

Hypertrophic cardiomyopathy

Death of young athletes after extensive exertion is common in _________ ____________ because of ventricular arrhythmia's

Hypertrophic cardiomyopathy

What cardiomyopathy is an autosomal dominant disorder caused by mutations in genes encoding proteins of the cardiac sarcomere (i.e. muscle fibers)?

Hypertrophic cardiomyopathy

What is the most common cause of sudden cardiac death in young athletes?

Hypertrophic cardiomyopathy

________ to ________ shunting causes recycling of blood through the pulmonary vessels, cause increased workload of the _______ side of the heart and pulmonary circulation

Left to right Right side of the heart

Pain the is prolonged and not relieved by rest or Nitroglycerin indicates pain associated with a ________.

MI

Treatment goals for stable angina

MI prevention symptom reduction for quality of life

Pulmonary congestion, including nocturnal paroxysmal dyspnea and orthopnea are symptoms of

Mitrial Valve stenosis

Transient ischemic attack (TIA) occur more frequently in person with __________ _____________ prolapse

Mitrial valve

Pain typically severe and often described as being constricting, suffocating, and crushing indicates what?

Onset of STEMI

symptoms that occur in the subacute phase of kawasakie disease are.

Peeling of the kin of the fingers and toes irritability and lability of mood

Which cardiomyopathy do the clients experience excess abdominal fluid (ascities)?

Restrictive cardiomyopathy

chronic pulmonary disease increases pulmonary vascular resistance leading to _________ or ___________ heart failure

Right or Left heart failure

_________ to ________ shunting in the heart transfers unoxygenated blood diluting the oxygen content of blood being ejected into the system circulation and causing cyanosis.

Right to left.

What differentiates unstable angina and NSTEMI

Serum cardiac markers. unstable angina has no elevated serum cardiac markers NSTEMI has detectable and elevated serum cardiac markers.

What bacteria causes inefective endocarditis in IV drug users?

Staphylococcus aureus

Prosthetic heart valve inefctive endocarditis is usually caused by what coagulase-negative staphylococci

Staphylococcus epidermidis

rheumatic heart disease (RHD) is normally caused by ____________ infections

Streptococcal

The nurse is assessing the ECG of a client who is experiencing unstable angina. The nurse observes:

T-wave changes.

Mitrial/bicuspid valve stenosis affects

The left Atrium

A friction rub sound (rubbing between the inflamed pericardial surfaces) is characteristic of __________ ___________

acute pericarditis.

Surgical treatment for tetralogy of Fallot includes the repair of the _____________________

Ventricular septal defect

A client with a long history of stable angina suddenly experienced substernal pain that radiates to the left arm, neck, and jaw. He describes the pain as severe and feels as if he is suffocating. He has take nitroglycerin and not experienced any relief. The client is most likely experiencing: a) Onset of STEMI b) GERD c) pneumonia d) ARDS

a) onset of STEMI feedback the onset of STEMI involves abrupt and significant chest pain. The pain is typically severe and describes as being constricting, suffocating, and crushing. Substernal pain that radiates to the Left arm, neck or jaw is common, although it may be experienced in other areas of the chest and back.

A client is brought to the emergency department presenting with symptoms of ACS (acute coronary syndrome). Select the most important interventions that should be implemented. SELECT ALL THAT APPLY! a) oxygen b) acetaminophen c) ECG monitoring d) Nitrates e) morphine f) beta adrenergic blocking agents.

a) oxygen c) ECG monitoring d) Nitrates e) morphine f) beta adrenergic blocking agents. Feedback symptoms of ACS providers should perform a 12-lead ECG and continuous ECG monitoring Treatment regimens include administration of oxygen, ASA, nitrates, morphine, anti-platelet and anticoagulant therapy, beta-blockers, and ACE inhibitors.

pulsus paradoxus is an

an exaggeration of the normal variation in the systolic blood pressure, commonly defined as a 10 mm Hg or more fall in the systolic blood pressure, which occurs with inspiration.

A client who has just been diagnosed with dilated cardiomyopathy asks the nurse what caused the condition. The most appropriate response would be a) Heart failure b) alcohol abuse c) genetic abnormalities d) Heart transplant

c) genetic abnormalities rationale 35% of cases of dilated cardiomyopathy are reported as familial an autosomal dominant trait. But autosomal recessive, X-linked recessive and mitochondrial inheritance patterns have been identified.

The health care provider is preparing to assess a client who has been diagnosed with hypertrophic cardiomyopathy. The provider anticipates the assessment data will inclued: a) enlarged chamber size b) systolic dysfunction c) reduced chamber size d) orthopnea

c) reduced chamber size rationale: Hypertrophic cardiomyopathy (HCM) is characterized by unexplained left ventricular hypertrophy with disproportionate thickening of the ventricular septum, leading to small chamber size abnormal diastolic filling, cardiac arrhythmia, and intermittent left ventricular outflow obstruction.

Chronic stable angina is provoked by

exertional or emotional stress and is relieved within minutes by rest of by nitro.

Persons with _______________ ____________ usually have heart sounds that become muffled because of the insulating effects of the pericardial fluid and reduced cardiac function.

cardiac tamponade

a nurse is assessing a child who has a congenital heart defect for cyanosis. Select the most important area for the nurse to assess. a) palms of the hands b) tongue c) sclera of the eyes d) mucous membranes

d) mucous membranes feedback Cyanosis is most notable in the nail beds and mucous membranes.

Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, and Kingella are associated with inefective endocarditis caused by

dental surgery, all found in the oral cavity

Cyanosis, the blue discoloration of the skin and mucous membranes develops when

deoxygenated blood from the RIGHT side of the heart mixes with the oxygenated blood in the LEFT side of the heart.

The most frequent clinical manifestations of Hypertrophic cardiomyopathy

dyspnea chest pain in the absence of coronary arty disease. Syncope and is typically post-exertional, when diastolic filling diminishes and outflow obstruction occurs

Chronic stable angina is caused by__________ __________ __________ that produces an imbalance between blood _____________flow and the _____________ _____________of the myocardium.

fixed coronary obstruction coronary metabolic demands

When cause of dilated cardiomyopathy is identified what is the name?

idiopathic DCM

Myocarditis is

inflammation of the heart muscle and conduction system without evidence of myocardial infarction

Pericardial effusion increases ___________ pressure and __________ pressure.

intracardiac pressure and venous pressure

Acyanotic heart defects

left to right shunting, do not compromise oxygenation of blood in the pulmonary circulation

aortic stenosis

narrowing of the valve orifice and failure of the valve leaflets to open normally. increased the work and volume of the chamber emptying through the narrowed valve

Dilated cardiomyopathy is characterized by

progressive cardiac dilation contractile (systolic dysfunction) concurrent with hypertrophy

A key diagnostic finding in cardiac tamponade is ______________ ______________ or an exaggeration of the normal variation in the systolic blood pressure.

pulsus paradoxus

Endothelial relaxing factors

relax the smooth muscle in the vessel wall and allow increased blood flow

What is the treatment for coarctation of the aorta?

resection of the narrowed segment of the aorta and end-to-end anastomoses of healthy tissue

Transposition of the great vessels is when the

rising of pulmonary arteries from the left ventricle instead of the right.

Treatment of constrictive pericarditis

surgical removal of the pericardium (pericardectomy)

Aortic Stenosis affects

the left ventricle

Intermittent vessel vasospasms, in conjunction with coronary artery stenosis, cause

the vasospastic type of angina

Where do clots in the left ventricle travel to,

they will travel to the brain or kidneys.

Heart Murmurs are caused by

turbulent blood flow

Late signs of constrictive pericarditis

weight loss muscle wasting exercise intolerance

treatment for chronic stable angina is

with a vasodilating agent, such as nitroglycerine, that relaxes the vessels and enhances coronary blood flow.