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CCRN general

Terms in this set (902)

The cardio vascular system transports o____, n______, h______, water, e______, vitamins, m_______, b_____, l______, a_______, and wastes

oxygen, nutrients, hormones, enzymes, minerals, buffers, leukocytes, antibodies

The heart is __ cm wide and 12 cm long

The heart weighs ___ g/kg of ideal body weight

2/3 of the heart lies to the ____ of the midline and 1/3 to the ____ of the midline

The apex is at the _____ left intercostal space and the mid______ line

5th; clavicular

The base is at the ____ intercostal space

The _______ pericardium maintains the heart in a stationary position

The fibrous pericardium acts as a barrier against _____ and ______ invasion

infection; neoplastic

The serous pericardium is divided into the ______ and _____ layer

visceral; parietal

The ________ layer of the serous pericardium lines inner surface of the fibrous pericardium

The _____ layer of the serous pericardium lines the surface of the heart; synonymous with ________

visceral; epicardium

The _____ space is located between the parietal and visceral layers of the serous pericardium

The pericardial space contains ___-___ ml of lubricating fluid which protects the heart against ______ and erosion

10-30; friction

The epicardium is synonymous with the ______ layer of serous pericardium

Epicardial fat is between the _______ pericardium and the epicardium

Epicardial fat is increased in _______

Increased epicardial fat may increase risk of ___________ _________ disease

coronary artery

The _______ is the largest portion of the cardial wall

The myocardium consists of specialized ______ fibers and interlacing cardiac ______ fibers

conduction; muscle

The endocardium consists of _______ tissue, ______ fibers, ________ cells

connective; elastic; endothelial

Endothelial cells of the endocardium form a smooth surface for ______ contact

Endothelial cells of the endocardium deter _____ formation

Endothelial cells of the endocardium are contiguous with the lining of the great _______

Endothelial cells line the heart ______ and _____

chambers; valves

The cardiac _______ is composed of continuous dense connective tissue

The cardiac skeleton is located in the base/apex of the heart and in the ________ septum

base; interventricular

The cardiac skeleton serves as the point of origin and insertion for cardiac _______ fibers

The cardiac skeleton supports the heart _____ and includes the four valve _______ (annuli)

The atria are located ______, superior, and to the _____ of the corresponding ventricles

posterior; right

The atria contain the ______ to divide atria and ventricles

The atria are thin/thick walled, high/low pressure chambers

The right atria is ___ mm thick, __-__ mmHg pressure

The left atria is ___ mm thick, __-__ mmHg pressure

The atria act as _______ and booster ____ for the ventricles

reservoirs; pumps

__-__% of ventricular filling is passive as blood falls through atrium into the ventricle

___-___% of ventricular filling is active as the atrium contracts at the end of ventricular ______

25-30; diastole

Inflow tracts of the right atria include superior and inferior ______ _____, coronary _____, _______ veins

vena cava; sinus; thebesian

The outflow tract of the right atria is through the _____ valve into the right ventricle

Inflow tracts of the left atria include four ______ veins (carrying oxygenated blood)

Outflow tract of the left atria is through the _____ valve to the left ventricle

Ventricles act as pumps receiving blood from the ______ and pumping blood into the great _____

The right ventricle is thin walled and ___-__ mm thick

The right ventricle is a high/low pressure pump: ___/5 mmHg

The outflow tract of the right ventricle is the _______ artery (deoxygenated blood)

The left ventricle is thick walled and __-__ mmHg

The left ventricle is high pressure: ___/5 mmHg

Outflow tract of the left ventricle is the ________

Cardiac valves maintain _________ flow

Cardiac valves permit ______flow; narrowing of the valvular orifice preventing normal flow is called ________

antegrade; stenosis

Cardiac valves prevent ______ flow

Inadequate closure of valves allowing retrograde flow is referred to as r______, incompetent, or i______

regurgitant; insufficient

The atroiventricular valves are the _____ and _____ valves

tricuspid and mitral

______ valve is between right atria and right ventricle

_____ valve is between left atria and ventricle

AV valves open passively during _______

AV valves close when papillary muscles contract during _______

AV valves cause the _____ heart sound, S__, when they close during ________

first; 1; systole

Two components of S1 are _____ and ____

Aortic and pulmonic valves are _______ valves

Semilunar valves function by _______ gradients; pushed open with _______ and closed with ______

pressure; systole; diastole

Semilunar valves cause the second heart sound when they close during _________

S2 consists of _____ and _____

Ventricular diastole when _______ valves are closed and _____ valves are opened

Ventricular systole when semilunar valves are ______ and AV valves are _______

______ arteries are the 1st branch off the aorta, right outside the aortic valve

Coronary arteries lie on the ________ but branches go through to the myocardium and sub________

epicardium; endocardium

Myocardium receives __% of cardiac output and extracts ___-___% of oxygen even at basal rate

Blood flow through coronary arteries is determined by local _________ in response to the metabolic needs of the __________

autoregulation; myocardium

The left ventricle is perfused primarily during ______ due to compression of musculature around vessels during _______

diastole; systole

Determinants of myocardial oxygen demand include heart ______, p______, a______, c______

rate; preload; afterload; contractility

Determinants of myocardial oxygen supply include patent _______, ______ pressure, _______ time, oxygen _______, hemoglobin, ______ oxygen saturation

arteries; diastolic; diastolic; extraction; arterial (SaO2)

Imbalances between supply and demand of the cornary arteries cause _______ prolonged imbalances cause _______

ischemia; infarction

Coronary arteries are _______ arteites

Left coronary artery before bifurcation is referred to as the left ________ coronary artery

the left main coronary artery divides into left ________ descending and left ______ arteries

anterior; circumflex

The LAD supplies the anterior left _______, anterior __/3 of the interventricular septum

LAD supples _____ of the left ventricle

LAD supplies the Bundle of ____ and bundle ______

Left circumflex coronary artery (LCA) supplies the left ______, SA node in ___% of hearts and AV node in ___% of hears

Left marginal (obtuse marginal) supplies ______ and ______ left ventricle

lateral and posterior

Right coronary artery (RCA) supplies SA node in ___% of hearts

RCA supplies left posterior hemi_______

RCA supplies AV node in __% of hearts

Right marginal branch supplies ______ right ventricle and ______ right ventricle

lateral; inferior

In RCA dominant hearts (___% of hearts), the posterior descending artery supplies _______ right ventricle, _______ wall of left ventricle, _______ left ventricle, and posterior __/3 of septum

anterior; inferior; posterior; 1

Factors that foster collateral circulation include a______, h______, and arteriosclerosis (gradual occlusion)

anemia; hypoxemia

Most coronary veins empty into the coronary ______, which empties into the right ______

The ______ veins drain some venous blood from myocardium directly into the right _____ and _____, and left _______

thebesian; atrium; ventricle; ventricle

Thebesian veins going to the left ventricle accounts for a normal physiologic _____ because it slightly decreases _______ ______

shunt; oxygen saturation

Main cardiac lymphatic channel empties into the ______ node and then into the right ________ duct

pretracheal; lymphatic

Lymph drainage is facilitated by cardiac _______

Three types of cardiac cells- _____, ______ _______, and _______ _______

pacemaker; electrical conducting; myocardial muscle

Automaticity is the ability of certain cardiac cells to initiate impulses ________ and _______

regularly; spontaneously

__________ is the ability of cardiac cells to respond to a stimulus

Conductivity is the ability of cardiac cells to respond to a cardiac ______ by transmitting along cell membrans

_________ is the ability of the cardiac cells to respond to an impulse by muscle contraction

Rhythmicity is the ability of the cardiac cells to spontaneously generate a(n) ______ ______ at a regular rate

action potential

Phase 4 ______ ______ potential coincides with the isoelectic line between T and QRS

resting membrane

Electrical charge within the cell during resting membrane potential is -___ to -___ mV

Negativity of resting membrane potential is maintained by the ______-_____ pump

sodium-potassium

An active transport system pumps ______ out of the cell and _______ into the cell during the resting membrane potential

sodium; potassium

When ATP is low (ex. shock) the resting membrane potential cannot be maintained and _____ occurs

Phase 0 rapid depolarization coincides with ______

Depolarization occurs when a _______ is applied to the cell

Cell membrane permeability to sodium increases/decreases during depolarization so that sodium rushes into/out of the cell and potassium moves in/out entirely

increases; into; out

Depolarization is called the _____ (or fast) channel (+20 mV)

Class ___ antidysrhythmic agents (procainamide, quinidine, lidocaine) block influx of ____ into the cell, preventing depolarization

Phase I brief partial repolarization is when ______ channels close and _______ efflux continues

sodium; potassium

Phase 2 slowing of the repolarization causing a plateau coincides with ______ segment

During phase 2 ________ influx keeps the cell isoeletric but still depolarized as _______ efflux occurs at the same rate

calcium; potassium

Class ___ antidysrhythmics (calcium channel blockers such as verapamil, diltiazem) block the movement of calcium and prolong _______ and refractoriness

IV; repolarization

Phase 3 is the sudden acceleration in the rate of _________

_______ efflux accelerates during phase 3 to exceed influx of _______ and potassium influx occurs at the end of phase 3

Potassium; calcium

Class ____ antidysrhythmics (a______, ibutilide, dofetilide) block movement of _______ during repolarization and prolong refractoriness

III; amiodarone; potassium

pacemaker cells have the property of ________

pacemaker cells demonstrate slow diastolic _______ due to a time dependent leak of ______ into the cell

depolarization; sodium

when enough ______ has entered the cell that threshold potential is reached, spontaneous depolarization occurs

rate of diastolic depolarization determines intrinsic rate of _______________

Sinoatrial node rate ___-___ per minute

Atriventricular junction rate __-__ per minute

Purkinje fibers rate ___-___ per minute

No matter how strong the impulse, the cell cannot be depolarized during the _________ period

absolute refractory

Absolute refractory period correlates from phase ____ though midphase ____ on the action potential and from ______ to peak of the ___ wave on the ECG

During the _______ refractory period If the impulse is strong enough the cell may respond but abnormally (R on T can cause ventricular _____ or fibrillation)

relative; tachycardia

Relative refractory period correlates with late phase ___ of the action potential and the descending limb of the ____ wave on ECG

Effective refractory period is the ________ plus the ______ refractory period

absolute; relative

SA node is located in the _____ atrial wall near opening of the superior ______

right; vena cava

Three pathways between the SA node and AV node: anterior tract (b________), middle tract (w_______), posterior tract (t_______)

Bachmann; Wenckebach, Thorel

_________ bundle (interatrial pathway) takes the impulse from the right atrium to left atrium

AV node is located at the base of right _____ at the top of interventricular _________

AV node accounts for the physiologic _______ of .08-.12 seconds to allow the atria to ________ completely, contract, and finish filling the ventricles before the ventricles are ________

delay; depolarize; stimulated

AV node contains no ________ cells; primary function is to slow the impulse down

AV junction is tissue surrounding AV node and bundle of ___ that contains _____ cells

AV node functions as a ________ pacemaker with rate 40-60 times per minute

Bundle of His is the first portion of the _________ conduction system

intraventricular

Right bundle branch takes the impulse to the right ventricular _________

Left bundle branch divides into __ hemibundles

_______ hemibundle depolarizes the interventricular septum in a left to right direction

left anterior hemibundle (LAH) depolarizes the _________ and ________ left ventricle

anterior and superior

left posterior hemibundle (LPH) depolarizes the _______ and ________ left ventricle

posterior; inferior

Block of the ______ hemibundle does not cause a clinically identifiable situation

The ______ hemibundle is thicker than the ____ hemibundle and has a dual blood supply so less susceptible to block

posterior; anterior

The three branches (RBB, LAH, LPH) are referred to as fascicles as in ________, _____, and _________ block

unifascicular; bifascicular; trifascicular

The fascicles divide into the _______ fibers which continue to divide and take the impulse through the ________ walls to terminate in the subendocardial surface of the ventricles

Purkinje; ventricular

Purkinje fibers act as a final _______ pacemaker at the rate of 20-40 times per minute

The capability of the myocardium to respond as if it were one muscle is referred to as a functional _________

Depolarization of cardiac chambers occurs from _______ to __________

endocardium; epicardium

Repolarization of cardiac chamber occurs from _______ to ______

epicardium; endocardium

Cardiac muscle has more/less mitochondria than skeletal muscle

Cardiac muscle has greater _____ requirements because of the high energy requirements of the ________ muscular action of the heart

ATP; repetetive

Cardiac muscle remains ________ 150-300 times longer than skeletal muscle

________ disks lie between myocardial cells; they offer low electrical _______ allowing electrical stimuli to pass with ease from cell to cell

Intercalated; impedance

Stimulation of any muscle fiber results in _______ of the entire muscle mass (all or none effect)

A _______ is the basic contractile unit of the myocardium

The sarcomere is composed of the thick ______ filament and the thin ______ filament

The sarcomere contains a nucleus surrounded by a fluid called ________, which surrounded by a membrane called a ________

sarcoplasm; sarcolemma

T______ and t_____ are regulatory proteins in the sarcomere that form a complex to cover the myosin ______ sites and inhibit cross-bridging of actin and myosin when muscle is in a ______ state

troponin; tropomyosin; binding; resting

The sarcoplasmic _______, a continuation of the sarcolemma, penetrates the cell to form a complex tubular (T tubule) system surrounding each ________

reticulum; fibril

______ is stored in the sarcoplasmic reticulum and is necessary for the cross-bridging of actin and myosin

Excitation-contraction process starts with the wave of _________ spreading through conduction system to myocardial muscle cell

Excitation-contraction process step 2: The action potential reaches the sarcoplasmic reticulum, and the __________ transmit the action potential from sarcolemma to interior of the cell

Excitation-contraction process step 3: Calcium enters the cell during phase ___ of the action potential through calcium channels in the _______ and T tubules; more calcium is released from intracellular stores in the ___________ _______

2; sarcolemma; sarcoplasmic reticulum

Excitation-contraction process step 4: Calcium binds with _______ to move the troponin and tropomyosin out of the way of the _______ binding sites

troponin; myosin

Excitation-contraction process step 5: _______ and ______ myofilaments interact to form crossbridges that slide these overlapping myofilaments past one another

Actin and myosin

Excitation-contraction process step 6: shortening of the ______ occurs

Excitation-contraction process step 7: multiple sarcomere shortening, muscle contraction and ejection of _______ from the chamber occur

Excitation-contraction process step 8: ________ is pumped back into the sarcoplasmic reticulum which dissociates actin-myosin _________

calcium; crossbridges

Excitation-contraction process step 9: muscle __________

Isovolumetric contraction (systole)-subphase 1- increases pressure in the ______ but there is no change in volume because the AV valves are _____ and the semilunar valves have not yet _______

ventricle; closed; opened

Ventricular pressure must exceed pressure in the great vessel to open the ______ valve

Isovolumetric contraction accounts for __/3 of oxygen consumption of the ventricle and follows the _______

Maximal ejection: subphase 2 when the pressure in the ventricle exceeds the pressure in the great vessel, the _______ valve opens and blood is ejected

during maximal ejection aortic and pulmonary artery pressures increase/decrease rapidly and ventricular volume increases/decreases sharply

increase; decrease

Maximal ejection occurs during the ____ segment

________ ejection (protodiastole) subphase 3 blood is slowly ejected from the ventricle to the great vessel

When the pressure in the great vessel is greater than the pressure in the ventricle, the _______ valve closes and ______ ends

semilunar; systole

Reduced ejection subphase 3 occurs during the ____ wave

Isovolumetric relaxation (diastole) subphase 1 relaxation occurs and ventricular pressure increases/decreases, but volume does not change because the ______ valves have closed and the _____ valves have not yet opened

decreases; semilunar; AV

Isovolumetric relaxation subphase 1 occurs after the ___ wave

Rapid filling subphase 2 the _____ valves open and blood rushes into the ventricles

Rapid filling subphase 2 atrial and ventricular pressures increase/decrease and ventricular volume increases/decreases

decrease; increase

rapid filling subphase 2 ventricular pressure is less/ greater than atrial pressure

rapid filling subphase 2 occurs during _____ interval

Reduced filling (_______) subphase 3 atrial and ventricular pressures slowly increase/decrease

diastasis; increase

______ artery blood flow is optimal during diastasis

Diastasis occurs during the _____ interval

Atrial contraction subphase 4 is also called atrial _______

Atrial contraction accounts for ___-___% of diastolic filling volume; may be up to 50% when ______ ventricular filling is impeded (mitral stenosis)

Atrial pressure increases/decreases during atrial contraction and ventricular volume and pressure increase/decrease

decreases; increase

Atrial contraction occurs after the ____ wave

Cardiac output (CO) __-__ L/min is the amount of blood ejected by the _____ in 1 minute

Cardiac index (CI) ___-___ L/min/m2 is the cardiac _______ indexed for differences in body size by dividing by body _____ _______

2.5-4; output; surface area

Stroke volume (SV) __-___ ml/beat is the amount of blood ejected by the ventricle with each ________

60-120; contraction

SV is also defined as the difference between the end _______ volume and the end _______ volume

diastolic; systolic

Stroke index (SI) ___-___ ml/m2/beat is the stroke volume indexed for differences in body size by dividing by body _______ ______

30-65; surface area

Ejection fraction is the % of blood in the ______ ejected during systole; normal ___-___%

ventricle; 55-75

Afterload is the pressure against which the ventricle must pump; the pressure required to open the ______ valve

Preload is the volume of blood in the ventricle at the end of ___________; determines the stretch on the myofibrils and the force of the next _________ (Starling's law)

diastole; contraction

Contractility is the force and _________ of the ejection of blood from the ventricle independent of _______ and ________

velocity; preload; afterload

Heart rate is the number of times per minute the ________ contract

Determinants of cardiac output include heart _______, p______, a_______, c______

rate; preload; afterload; contractility

A rate auscultated with stethoscope or HR on an ECG must be confirmed with a __________ pulse

If HR is <50 or >150 cardiac _______ falls and tendency of _________ increase

output; dysrhythmias

Increase in heart rate > ______/min tends to increase myocardial oxygen demand more than the increase in _________ blood flow

Preload is usually evaluated by the ________ in the ventricle at the end of ________

pressure; diastole

In a compliant ventricle, there is a linear relationship between ______ and _______

volume; pressure

In a noncompliant ventricle there is a disproportionate increase in ______ with changes in ________; this is called diastolic dysfunction

pressure; volume

Some causes of noncompliant ventricles include myocardial _______ or _______, ventricular ________, hypertrophic __________, restrictive pericarditis, and cardiac _________

ischemia; infarction; hypertrophy; cardiomyopathy; tamponade

RV volumetric monitoring allows more accurate evaluation of preload through the evaluation of RV ________ rather than pressure and evaluation of RV ______ ______

volumes; ejection fraction

_________ pressure correlates to end-diastolic pressure for the respective ventricle

RV preload correlates to _______ venous pressure or right _______ pressure if no tricuspid disease

central (CVP); atrial (RAP)

LV preload correlates to ________ artery _______ pressure or left ______ pressure if no mitral valve disease

pulmonary; occlusive (PAOP); atrial (LAP)

RV volumetric monitoring requires right ______ ______ catheter

ejection fraction (REF)

RV volumetric monitoring allows measurement of right ventricular ________ volume, right ventricular end-________ volume, and right ventricular _______ fraction (more accurate reflections of preload)

systolic; diastolic; ejection

_______ venous distention, h______, and peripheral ________ indicate high RV preload

Jugular; hepatomegaly; edema

_______ neck veins when the patient is flat and o______ indicate low RV preload

S__, c_____ and dyspnea indicate high LV preload

Clinical indications of hypoperfusion (__-__L/min/m2) indicate low LV preload- t________, narrow/wide pulse pressure, t_______, cool skin, oliguria, diminished _____ sounds, confusion or restlessness

2-2.2 L/min/m2; tachycardia; narrow; tachypnea; bowel

Frank-Starling mechanism: the greater the _____ on myofibrils, the greater the force of the contraction

Both over and under______ myofibrils decrease contractions

As preload increases, myocardial oxygen consumption increases/decreases

CVP/RAP is ____-____ mmHg

PAOP/LAP is ___-___ mmHg

Afterload is affected by vascular ______, ventricular _____, mass and _______ of blood

resistance; diameter; viscosity

RV afterload correlates to __________ vascular resistance (PVR) ____-___ dynes/sec/cm-5 and PVRI ____-____ dynes/sec/cm-5/m2

pulmonary; 100-250; 225-315

LV afterload correlates to _________ vascular resistance (SVR) _____-____ dynes/sec/cm-5 and SVRI ____-____ dynes/sec/cm-5/m2

systemic; 900-1400; 1700-2600

Loud ___ and high PA _________ pressure indicate high RV afterload

Low _____ diastolic pressures indicate low RV afterload

Loud ___, cool, pale, ______ and high systemic ______ diastolic pressure indicate high LV afterload

A2; extremities; arterial

Low systemic arterial diastolic pressure indicates low LV pre/afterload

As afterload increases, myocardial oxygen consumption increases/decreases

Laplace's law, the smaller/larger the radius and the thicker the wall, the greater the force of contraction

Contractility is also significantly affected by endogenous __________ (epinephrine)

RV contractility correlates to right ventricular _______ ______ index RVSWI (5-___gxm/m2)

stroke work; 12

LV __________ correlates to left ventricular stroke work index LVSWI (____-____ gxm/m2)

contractility; 45-65

Contractility can also be evaluated by ejection fraction with REF __________

Noninvasive measures of contractility include clinical indicators of _________, diminished ______ sounds, ejection fraction by multiple _______ ______ scan MUGA or Doppler ______

gated acquisition; echocardiogram

As contractility increases, myocardial oxygen consumption increases/decreases

Heart rate is increased by SNS stimulation (exercise, f______, infection, pain, a______, hyper or hypo_________) and drugs (e_______, d_______)

fever; anxiety; volemia; epinephrine; dopamine

Heart rate is decreased by PNS (______) stimulation (_______ maneuver, c______, s________, carotid stimulation)

vagal; Valsalva; coughing; suctioning

HR is decreased by conduction abnormalities (sinus ______ or ______, ____ or _____ degree AV blocks) caused by ischemia, infarction or I_________

arrest; block; 2nd or 3rd; inflammation

HR is decreased by drugs such as ______ blockers, d_____

Increase heart rate with _______ therapies for MI, _______ for vomiting, ________ drugs (atropine), _______ drugs (epinephrine), pacemaker

reperfusion; antiemetics; parasympathetic; sympathomimetic

Decrease heart rate with ______ for fever, _______ for pain, _________ for anxiety

antipyretics; analgesics; anxiolytics

Decrease heart rate dependent upon rhythm: cardiac ________ (digoxin), beta blockers (propranolol, esmolol), ________ _______ blockers (verapamil, diltiazem)

glycosides; calcium channel

Decrease heart rate with ______ maneuvers, ______ pacemaker, a_______, cardioversion or defibrillation

Vagal, overdrive, ablation

Preload evaluated by ______ (LV) and ______ (RV) or ______ if a right ejection fraction catheter is used

PAOP; RAP; RDEDV

Preload increased by heart _______, hyper_______, ______dysrhythmias

failure; volemia; brady

Preload decreased by _______volemia, excessive ________ (vasogenic shock such as ______, ______, or ______ shock)

hypovolemia; vasodilation; septic; neurogenic; anaphylactic

Preload decreased by increased _______ pressure (PEEP), cardiac _________, ________ ventricular failure or infarction (LV)

intrathoracic; tamponade; right

Preload decreased by tachy_______, loss of ______ contractions (ex ______ fibrillation)

dysrhythmias; atrial; atrial

Low preload treatment: increase fluids, _______ crystalloids (NS, LR), colloids (a______, plasma protein fraction PPF, dextran, h________), blood

isotonic; albumin, hetastarch

Low preload treatment: adjustment of ______ dosage

High preload treatment: ______ (furosemide), ________ vasodilators (nitroglycerin, morphine, nitroprusside)

High preload treatment: _________ _______ blockers (nifedepine)

calcium channel

High preload treatment: ACE inhibitors (c______ or e_____), angiotensin receptor blockers ARBs (l______, v______), _______ (Natreocor)

captopril; enalapril; captopril; enalapril; losartan; valsartan; Nesiritide

Afterload evaluated by calculation of _____ and _____ (LV) & ____ and ______(RV)

SVR; SVRI; PVR; PVRI

Afterload increased by _______ from SNS stimulation or v_____

vasoconstriction; vasopressors

Afterload increased by h_______, aortic _______, hyper_______, pulmonary _______ (RV)

hypertension; stenosis; coagulability; hypertension

Afterload decreased by h______, ________ (vasogenic shock)

Low afterload treatment: adjustment of _______ dosage, vasopressors (p______, n_______, e_______, d______, v______)

vasodilator; phenylephrine, norepinephrine, epinephrine, dopamine, vasopressin

High afterload treatment: ______ vasodilators (nitroprusside, n______ > 1 mcg/kg/min, ________ ______ blockers (nifedepine), ______ blockers (phentolamine, l_____)

arterial; nitroglycerin; calcium channel; alpha

High afterload treatment: _____ inhibitors (captopril, enalapril), _____ (losartan, valsartan), __________ inhibitors (milnirone, inamrinone)

ACE; ARBs, phosphodiesterase (PDE)

High afterload treatment: _______ balloon pump

High afterload treatment for _______ ventricle: oxygen, _____ vasodilators (aminophylline, ______ oxide, ________ (Flolan), ________ (Tracleer))

right; pulmonary; nitric; epoprostenol, bosentan

Contractility evaluated by calculation of ______ volume and LVSWI and RVSWI

High contractility caused by _____ stimulation, _______ drugs (epinephrine)

SNS; sympathomimetic

Low contractility caused by MI, cardio______, h______, a______, shock (myocardial _______ factor)

myopathy; hypoxemia; acidosis; depressant

Low contractility treatment: cardiac glycosides (d______), sympathomimetics (d_____ or d______ at medium [~5mcg/kg/min] dose)

digoxin; dobutamine; dopamine

Low contractility treatment: PDE inhibitors (m______, I________), g_________

milrinone; inamrinone; glucagon

High contractility treatment: beta blockers, calcium channel blockers (d______, v_____)

diltiazem; verapamil

Normal CI is ____-___ L/min/m2; Subclinical hypoperfusion CI is ___-___ L/min/m2; clinical hypoperfusion CI is ___-___ L/min/m2; shock CI is <_____ L/min/m2

2.5-4; 2.2-2.5; 2-2.2; <2

Shock causes d______, hypo______, cold clammy skin, a______, absent _____ sounds, lethargy/coma

dysrhythmias; hypotension; anuria; bowel

Neurologic control of the heart (autonomic nervous system of the _______ nervous system) is extrinsic/intrinsic

extrinsic; peripheral

ANS: chronotropic- effect on ________

ANS: inotropic- effect on ________

ANS: dromotropic- effect on ________

_______ nervous system (of the ANS) is fight or flight

SNS is innervated by physiologic or psychological ______

The SNS causes positive/negative, chronotropic, inotropic, dromotropic effects

SNS receptors include _____1, _____1, ______2, and d_______

A, B, B, dopaminergic

Alpha 1 receptors are found in _______

Beta 1 receptors are found in the _______

Beta 2 receptors are found in the ______ and _____ smooth muscle

bronchial and vascular

Dopaminergic receptors are found in the ______ and _____ artery bed

renal; mesenteric

Alpha 1 receptors cause vasoconstriction of most vessels, especially ______

Beta 1 receptors cause increase in heart rate (______ effect), contractility (______ effect), and _______ (dromotropic effect)

chronotropic; inotropic; conductivity

Dopaminergic receptors cause constriction/dilation of renal and mesenteric arteries

_______ drugs are frequently used to augment the effects of SNS (adrenergic) receptors

Sympathomimetic

Phenylephrine has strong effects on _____ receptors, no effect on _____ and ______

alpha1; beta1 and beta2

Norepinephrine has strong effects on ______ receptors, some effect on _____ receptors, no effect on _______

alpha1; beta1; beta2

Epinephrine has some effect on _______, strong effect on _____ and ______

beta2; alpha1 and beta1

Dopamine has a little effect on ____ receptors

Dopamine has some effect on alpha1 if >____ mcg/kg/min and strong effect on alpha1 if > ____ mcg/kg/min

Dopamine has strong effect on beta1 if < ___/mcg/kg/min

Dobutamine has a strong effect on _____, some effect on _____, a little effect on _____

Isoproterenol has no effect on ______, strong effect on ____ and ______

________ (vagal) nervous system maintains steady state

Parasympathetic

PNS causes positive/negative chronotropic; inotropic; dromotropic effects

Though cardiovascular effects of PNS are generally undesirable in critical care, they may decrease myocardial oxygen demand by ___%

________ (vagolytic) agents (atropine) block the effects of the PNS

Parasympatholytic

Chemoreceptors are located in ______ and ______ bodies

carotid; aortic

Chemoreceptors are sensitive to changes in ______, _____, and pH

H______, h_____, and acidosis cause changes in HR and ventilator rate

hypoxia; hypercapnia

Baroreceptor (aortic) reflex: baroreceptors located in the carotid _____ and aortic _____

Baroreceptors in the carotid sinus and aortic arch are sensitive to increased _____ pressure

Baroreceptor (aortic) reflex: _________ discharge causes vagal stimulation

Baroreceptor (aortic) reflex: Vagal stimulation decreases HR and contractility, which decreases cardiac _____ and _____ pressure

output; arterial

Bainbridge reflex: baroreceptors located in the right _______

Bainbridge reflex: Baroreceptors are sensitive to increased _____ pressure and right _____ pressure

Bainbridge reflex: Medullary discharge increases/decreases vagal stimulation

Bainbridge reflex: Decreased parasympathetic tone causes a(n) increase/decrease in HR and CO which decreases venous pressure and right atrial pressure

Respiratory reflex: Inspiration increases/decreases intrathoracic pressure, which increases venous return to the right side of the heart, which causes the _____ reflex

decreases; Bainbridge

Respiratory reflex: When the increased venous return reached the left side of the heart, left ventricular CO increases/decreases, which increases ____ BP and decreases ______ through baroreceptor stimulation

Increases; arterial; HR

Repiratory reflex is partly responsible for sinus _______; an interaction between respiratory and cardiac centers in the ________ also contributes

dysrhythmias; medulla

The endocrine function of the heart- _______ and _______ natriuretic peptide, ___-type natriuretic peptide, and e______

atrial; brain; C; endothelin

ANP is produced and stored by specialized atrial ______ cells

Primary cause of ANP release is increased atrial ______

Other causes of ANP release include acute increase in ________ volume, e______, and endogenous or exogenous _________

intravascular; exercise; vasopressors

ANP is an important regulator of blood ______ and ______

volume; pressure

ANP inhibits ______ transport in the collecting ducts of the kidney resulting in ______ and water excretion

ANP decreases proliferation of cardiac _____ and ____ muscle cells, preventing ventricular _________

fibroblasts; smooth; remodeling

BNP is produced by _______ muscle tissue

Increased ________ volume triggers BNP release

BNP effects are similar to ANP with dilation of both ______ and _______

arteries; veins

Measurement of BNP is used as a diagnostic study for diagnosis of heart _____ and as a therapeutic pharmacologic agent (________ Natreocor) for heart failure

failure; nesiritide

C-type natriuretic peptide is the lowest concentration of circulating plasma natriuretic peptides, found mostly in CNS, _______ and _____ cells

kidneys; endothelial

C-type natriuretic peptide has marked _____ effects but no ______ effect

vasodilatory; natriuretic

_______ is a potent vasoconstrictive peptide produced by endothelial cells

Endothelin causes and increase in r_____, a______, a______ hormone, and SNS effects to increase systemic vascular resistance

renin; aldosterone; antidiuretic

Poiseuille's formula states that resistance depends on _____ and _____ of the vessel and _______ of blood

length; radius; viscosity

Blood flow through the body is also influenced by ______ stimulation affecting vascular tone and feature that cause _________ within the vascular lumen such as birfurcations or protrusions from the vessel lumen (a_____)

neurologic; turbulence; atheroscelrosis

Arteries are able to stretch during _____ and recoil during _____

systole; diastole

The _____ layer of the artery is a thin lining of endothelium and a small amount of elastic tissue

The intima layer decreases ________ to flow and minimizes the chance of platelet ______

resistance; aggregation

The media later of the artery has ____ muscle and _____ tissue; changes the lumen _____ as needed

smooth; elastic; diameter

The adventitia layer of the artery has _______ tissue; strengthens and _____ the vessel

connective; shapes

Arterioles may lead to _______, _______, and precapillary sphincters which control blood flow into capillary bed

capillaries; metaarterioles

Capillary bed is the nutrient bed where exchange of _____, ______, and metabolites takes place by _________

gases; nutrients; diffusion

Capillaries contain no _______ ______

The _______ of the capillary depends on changes in pre and post capillary tone

Capillary __________ pressures push fluid out of the capillary and into interstitium; Interstital ________ pressures push fluid into the capillary

hydrostatic; hydrostatic

Capillary _______ oncotic pressure pulls and holds fluid in the capillary. Interstitial _______ oncotic pressure pulls fluid into the insterstitium

colloidal; colloidal

Pressures pushing fluid out of the capillary dominate at the ______ end

Pressures pushing fluid back into capillary dominate at the ________ end

______ is caused by an imbalance between capillary and hydrostatic pressures or an increase in capillary __________

Edema; permeability

Third spacing is fluid that accumulates outside intravascular or intracellular spaces (interstitial ______, a______, pleural _________, ______ effusion, lumen of the intestine)

edema; ascites; effusion; pericardial

In heart failure, peripheral edema is caused by venous _____ and excessive _____ pressure at the venous end

congestion; hydrostatic

In protein malnutrition or liver disease, decrease in plasma _____ decreases capillary colloidal oncotic pressure and allows excessive fluid to leak out of the __________

proteins; capillary

The venous system holds ___-___% of total blood volume

The venous pump sends blood back to the _____ side of the heart; ______ muscles contract, compress veins, and propel blood toward the heart

right; skeletal

Valves in the veins prevent ______ flow

The endothelium is a _______ cell layer that lines the heart and blood vessels, surrounds the _________, comprises the ______ bed

single; endocardium; capillary

The endothelium regulates vascular _____, prevents _____ formation

Blood pressure regulation: 1) ________ nervous system 2) ______-_______-_____ RAA system 3) capillary fluid shifts: especially from _______ to _______ 4) local control mechanisms

Autonomic; renin-angiotensin-aldosterone; interstitial to intravascular

Renin is secreted by the ______ in response to decreased blood pressure stimulating _______ receptors in _______ cells

kidneys; stretch; juxtaglomerular

Renin is secreted in response to ______ nervous system stimulation or hypo______

sympathetic; hyponatremia

Renin stimulates conversion of ______ to ________

angiotensinogen to angiotensin I

Angiotensin I is converted to angiotensin II by _______ converting enzyme as blood travels through the ______

angiotensin (ACE); lung

Angiotensin II causes ________ and secretion of __________

vasoconstriction; aldosterone

Vasoconstriction and _____ and _____ retention increases blood pressure and decreases _____ secretion

sodium and water; renin

Angiotensinogen is produced by the ______

Aliskiren (Tekturna) blocks ______

ACE inhibitors block angiotensin converting enzyme (ends in _____)

Angiotensin receptor blockers (ARBs, end in ______) block ______

sartan; angiotensin II

Aldosterone is released by the ________ _______

Aldosterone causes Na and H2O retention by renal ______, increasing preload/afterload

tubules; preload

Angiotensin II causes vasoconstriction which increases preload/afterload and BP

Systemic vascular resistance (SVR) is determined by vessel _____, _______, and blood _______

length; diameter; viscosity

Blood pressure = ______x____

Heart _____ and _____ volume determine CO

______, _____, and contractility determine stroke volume

preload; afterload

______ pressure is the difference between ______ and _____ pressures

systolic; diastolic

Pulse pressure is affected by ________ volume and arterial _________

stroke; elastance

Mean arterial pressure (MAP) is the average pressure in the _______ and its major branches during the cardiac cycle

[__BP + (__BP x 2)] / 3 = MAP

[SBP + (DBP x 2)] / 3

__BP + 1/__ pulse pressure = MAP

Normal MAP is ____-____ mmHg

MAP affected by _____ and ____

Auto regulation is the ability of the tissues to control blood ____; vasodilation is caused by h_____, hyper__, and a_______

flow; hypoxia; hypercapnia; acidosis

Precapillary sphincters relax and permit more blood flow when oxygen tension _______, they constrict when oxygen tension ______

Stimulating the SNS (of the ANS) maintains ______ pressure, decreases vascular c________, increases venous return to the heart and ________

arterial; capacitance; preload

With baroreceptors, increase in BP or volume decreases HR, _______, SVR, and blood ________

contractility; pressure

With baroreceptors, increase in BP or volume causes peripheral __________

With baroreceptors, decrease in BP or volume causes increased _____, contractility, ______, and BP

With baroreceptors, decrease in BP or volume causes peripheral ___________

vasoconstriction

Vasoconstrictor area of the vasomotor center (m________) causes increase in HR, ____, ___

medulla; CO; BP

Vasoconstrictor area causes venoconstriction, which increases/decreases vascular capacitance, thus increasing venous return to the heart, preload, and ____

Vasodepressor area causes decrease in _____, CO, ___

Vasodepressor area causes venodilation which increases/decreases vascular capacitance, thus decreasing venous return to the heart, ______, and BP

Oxygen delivery to the tissues: DO2 is a product of ______ and arterial _______ content CaO2

Cardiac index (___-___) is the CO/body surface area (BSA)

Hgb x SaO2 (as a decimal) x ____ (the amount of oxygen that 1gm of hemoglobin can carry if its 100% saturated) = CaO2

CaO2 is normally ___-___ mL/dL

CO (L) x ____ (g/dL) x SaO2 (in decimals) x ___.4 = DO2

CO (L) x Hgb (g/dL) x SaO2 (in decimals) x 13.4 = DO2

Normal DO2: _____-_____ mL/min

___ (L) x Hgb (g/dl) x _____ x 13.4 = DO2I

CI (L) x Hgb (g/dL) x SaO2 x 13.4 = DO2I

Normal DO2I is ____-____ ml/min/m2

Oxygen consumption by tissues is __O2/__O2I

Saturation of venous blood SVO2 determined by measuring the oxygen saturation in mixed in the _______ artery with an oximetric ________ artery catheter (PAC) or by blood gas analysis from the ______ port of the PAC

pulmonary; pulmonary; distal

Normal SVO2 is ____-____%

_____ x _____ x 1.34 = Venous oxygen content (CvO2)

Hgb x SVO2 (decimal) x 1.34 = CvO2

VO2 is volume of oxygen consumed per ______

VO2 determined by comparing oxygen content in _______ blood to the oxygen content in mixed ______ blood (distal port of PAC)

arterial; venous

CO x Hgb x 13.4 x (______-_____) = VO2

CO x Hgb x 13.4 x (SaO2- SVO2) = VO2

Normal VO2 is ____-____ mL/min

CI x _____ x 13.4 x (____-____) = VO2I

CI x Hgb x 13.4 x (SaO2- SVO2) = VO2I

Normal VO2I ___-___ mL/min/m2

Oxygen extraction ratio (O2ER) is the amount of O2 that is extracted from the ________ blood as it passes through ______

arterial; capillaries

O2ER is the ratio of the difference between the content of oxygen in the arterial blood and the content of oxygen in ______ blood to the content of oxygen in the _______ blood

venous; arterial

(CaO2 -_______) / _______ = O2ER

Normal O2ER is ____-____%

Oxygen extraction index (O2EI) is an estimation of O2ER using only __________

(SaO2 - _____) / _______ = O2EI

Normal O2ER is ____-___%

The tissues normally use ~____% of oxygen delivered and there is ___% reserved

SaO2 is normally ___% and SVO2 is normally ___% so the tissues used 25% and 75% is reserved

CaO2 is normally ~____ ml/dl and CVO2 is normally ~_____ ml/dl so the tissues used 25% and 75% is reserved

DO2I is normally ~_____ ml/min/m2 and VO2I is normally ~_____ ml/min/m2 so the tissues sued 25% and 75% is reserved

Oxygen reserve is reduced if _____ is decreased or ______ is increased

Factors that decrease DO2/DO2I include decrease in ______ (ARF, high altitude decreases barometric pressure, smoke inhalation decreases inspired O2), decrease in ______ (anemia, hemorrhage), decrease in _____ (heart failure, hypovolemia)

Factors that increase VO2 include patient care activities (bath, dressing change, suctioned, having a visitor, etc), physiologic states such as a______, s______, fever, increased WOB, severe I_______, b________, MODS, trauma, anything that stimulates SNS

agitation; shivering; infection; burns

Physiologic compensation for increased O2 demand at the cellular level includes increase in ____, redistribution of blood flow by recruiting underperfused ______ beds, increased oxygen ________ by cells

CO; capillary; extraction

A critical level of oxygen delivery exists where oxygen delivery and consumption are __________ (critical DO2I point)

Wen the critical oxygen delivery point is exceeded, oxygen _______ is dependent on oxygen _____, and oxygen deficit, ________ metabolism, and _______ acidosis will occur

consumption; delivery; anaerobic; lactic

If ________ improves with increase in DO2, oxygen consumption and delivery are independent

If SVO2 does not improve with _______ in DO2, oxygen consumption is dependent on oxygen delivery

_________ _______ is the result of anaerobic metabolism, and elevated serum arterial _______ level indicates a tissue oxygen deficit

Lactic acidosis; lactate

Normal serum arterial lactate level is less than ____ mmol/L

Serum lactate > ____associated with increased mortality

Increase DO2 by supplemental oxygen (______), administering PRBCs (______), and _______ agents (CO)

SaO2; Hgb; inotropic

Decrease VO2 with s__________________, muscle _________, hypo___________

sedation; paralytics; thermia

Angina pectoris can be caused by e______, exertion, exposure to ______, eating, s_________

exercise; cold; smoking

Angina pectoris palliation is r_____, o______, nitroglycerin, ________ blockers (nifedepine)

rest; oxygen; calcium channel

Angina pectoris feels h______, or like pressure, t_____, s______, dull ache, burning

heavy; tightness; squeezing

Angina pectoris is s_______, may be diffuse and vague, may radiate to arms, n_____, jaw, b_____, upper abdomen

substernal; neck; back

Angina pectoris may be mild to _______

Angina pectoris may be gradual or _______ onset; usually ___-___ minutes but may be 5-15

Angina pectoris is associated with tachy____, tachy____, dyspnea, n______, vomiting, d________, weakness, a_____, may have ___-___ changes with pain

cardia; pnea; nausea; diaphoresis; anxiety; ST-T

Acute MI may have no specific precipitator or may be caused by ______ change or s_____, usually occurs within ____ hours of awakening

lifestyle; stress; 3

Acute MI palliated by n______, reperfusion by f_____ or p______ coronary intervention (angioplasty, arthrectomy)

narcotics; fibrinolytics; percutaneous

Acute MI not relieved with r______ or n_____

rest; nitroglycerin

Acute MI has the same qualities as _______ _____, may show _____ sign (clenched fist over sternum)

angina pectoris; Levine's

Acute MI pain s_______, may be diffuse and vague, may radiate to arms, n_____, jaw, b_____, upper abdomen

substernal; neck; back

Acute MI may have ______ symptoms to severe pain

Absence of pain with acute MI is common in ________ patients or older adults

Acute MI has sudden onset, duration lasts longer than _____ minutes, usually ___-___ hours

Associated S/S acute MI same as angina pectoris, as well as feeling of impending ______

ECG changes with acute MI: ____ wave inversion. _____ segment elevation, eventually ____ waves

Dissecting aortic aneurysm is caused by ________ vascular disease, _______ syndrome, aortitis, HTN and/or hypertensive _______, _______ trauma

peripheral; crisis; chest

Dissecting aortic aneurysm is relieved by n______, s_____; not relived by _______ or ________

narcotics; surgery; rest; nitroglycerin

Dissecting aortic aneurysm feels like _______ or ______

ripping; tearing

Dissecting aortic aneurysm is in the ______ chest, radiates to shoulders, b______, neck, a_______

anterior; back; abdomen

Dissecting aortic aneurysm pain is ________

Dissecting aortic aneurysm pain is worse at ________; lasts ______ to ______

onset; hours; days

Associated S/S dissecting aortic aneurysm tachycardia, t_______, d_______, confusion, diaphoresis, s_________, dyspnea, a_________, unilateral absence of ________

tachypnea; dysphagia; syncope; anxiety; pulse

Other associated S/S dissecting aortic aneurysm ______ differences between sides, motor/_______ changes, murmur of aortic ________

BP; sensory; regurgitation

Pericarditis is caused by MI, cardiac _______, trauma, i______, u______, lupus

surgery; infections; uremia

Pericarditis is palliated by _______ (ibuprofen, indomethacin), sitting ____ and leaning ________

NSAIDs; up; forward

Pericarditis feels s______, stabbing, knifelike, worsened by i_______, c________, movement, _______ position

sharp; inspiration; coughing; recumbent

Pericarditis region is p______, substernal, radiating to neck, b______, s________, arms

precordial; back; shoulders

Pericarditis is mild to _________

Pericarditis is sudden/gradual onset, lasts _________

Associated S/S pericarditis include tachycardia, t_______, fever, d________, pericardial _________ rub, l__________, diffuse concave ______ segment

tachypnea; dyspnea; friction; leukocytosis; ST

Pulmonary embolism is caused by venous _______ (immobility, pelvic surgery, A. fib), h________ (oral contraceptives, malignancy, polycythemia), ________ to vessel wall (IVs, vascular surgery)

stasis; hypercoagulability, injury

Palliation of pulmonary embolism includes n______, ______ _______ position, ________ of chest

narcotics; High Fowler's; splinting

Pulmonary embolism feels sharp, knifelike, s_________, deep ________, pressure, worsened by deep ________ or coughing

shooting; ache; inspiration coughing

Pulmonary embolism is substernal or _______ chest, radiates to s_______ or neck

lateral; shoulder

Pulmonary embolism pain is ________ to severe

Pulmonary embolism onset is ______; lasts _______ to ______

sudden; minutes; hours

Associated S/S pulmonary embolism tachycardia, tachypnea, d______, p_______ or _________, cough, anxiety, feeling of impending doom, sinus ________ or ______ dysrhythmia

dyspnea; pallor; cyanosis; tachycardia; atrial

Other associated S/S pulmonary embolism include accentuated ____, right sided _____, possible right sided ____

Other associated S/S pulmonary embolism if RVF: __________; if pulmonary infarction: ________ friction rub, h_______, f______

JVD; pleural; hemoptysis; fever

Pneumothorax is caused by congenital ______, emphysematous _________, large ______ volumes or PEEP on vent; chest trauma, exacerbated by c______, e______, Valsalva

bleb; bullous; tidal; coughing; exertion

Pneumothorax is relieved by _____, insertion of _________

narcotics; chest tube

Pneumothorax feels like t________, sharp, worsened by _________

tearing; breathing

Pneumothorax region is _______ chest, radiates to s______, back, arms

lateral; shoulders

Pneumothorax is mild to _______

Pneumothorax has sudden/gradual onset; lasts ______ to days

Pneumothorax S/S tachycardia, tachypnea, dyspnea, a_______, JVD, _________ to percussion of affected side

anxiety; hyperresonance

Pneumothorax has _______ breath sounds on affected side, may have _____________ emphysema

diminished; subcutaneous

Pneumothorax may have tracheal deviation, esp with _________ pneumothorax

Pleuropulmonary (________) is caused by respiratory ______, aspiration

pleurisy; infection

Pleuropulmonary is relieved by n_______, sitting up

Pleuropulmonary feels sharp, worsened by c_______, I_______, movement

cough; inspiration

Pleuropulmonary is in the ______________ chest, may radiate to shoulder, n_______

Pleuropulmonary pain is _____________

Pleuropulmonary has sudden/gradual onset, lasts _______ to ______

gradual; days to weeks

Pleuropulmonary S/S include tachypnea, tachycardia, d_________, fever, _____________ cough, pleural friction rub

dyspnea; productive

GI chest pain caused by hot/cold liquids, food (esp s______, acidic, or high in ______), alcohol, c______, stress, smoking, e_________

cold; spicy; fat; caffeine; exercise

GI chest pain feels like heartburn, d_________, s____________, worsened by eating or __________ position

dull; squeezing; supine

GI chest pain is r_________ or lower substernal, upper ____________, midline

retrosternal; abdomen

GI chest pain radiates to ______ arm, neck, j_____, upper abdomen, back, s___________

left; jaw; shoulder

GI chest pain is mild to ____________

GI chest pain has gradual or sudden onset, lasts minutes to _____________

S/S GI chest pain d__________, d_______________, anxiety, d_______, eructation, vomiting

dyspnea; diaphoresis; dysphagia

Musculoskeletal chest pain caused by ______ or ______ strain, movement, coughing, deep ____________, CPR

neck; arm; breathing

Musculoskeletal chest pain relieved by rest, h_____, _________ (aspirin, ibuprofen)

Musculoskeletal chest pain has s_____________, stabbing or ______________ sensation, tenderness, worsened with I___________ and movement

soreness; sticking; inspiration

Musculoskeletal chest pain is localized to one side of the ____________

Musculoskeletal pain is mild to ___________; gradual or sudden onset; lasts __________

moderate; weeks

Musculoskeletal chest pain S/S tachy______, __________ respirations, localized tenderness on site of pain

tachypnea; splinting

Psychosomatic chest pain caused by stress or ___________; relieved by rest and ______________

fatigue; anxiolytics

Psychosomatic chest pain feels sharp or ______ ache, stabbing, s___________-

dull; superficial

Psychosomatic chest pain is in the p____________, localized; frequently on ______ side

precordium; left

Psychosomatic chest pain is mild to _________; gradual or sudden onset; lasts minutes to ________-

Psychosomatic chest pain S/S h______, dyspnea, palpitations, dry mouth, d__________, tingling of hands, f_________, frequent sighing

hyperpnea; dizziness; fatigue

____________ means patient is unable to lie flat because of dyspnea

Paroxysmal nocturnal dyspnea means patient awakens with feeling of suffocation ___-___ hours after going to sleep; if accompanied by wheezing, may be called _______ asthma

Cardiac cough usually occurs at night/in the morning and is precipitated by heart ___________, mitral __________, or by turning to one side

failure; stenosis

Cough may be a side effect of __________ inhibitors or caused by pulmonary ____________

Hemoptysis may be related to pulmonary _______ or pulmonary ___________

edema; embolism

Palpitations may be described as s_________, pounding, ____________ sensation

skipping; thumping

Palpitations are associated with ___________ beats or other dysrhythmia

Palpitations may be accompanied by s_________ or chest pain

___________ syncope is transient loss of consciousness that occurs shortly after heavy activity is started

Effort syncope may be associated with ______ or sub_____ stenosis

aortic; subaortic

_________ attack is dramatic loss of consciousness, related to heart block or d___________

Stokes-Adams; dysrhythmia

____________ syncope caused by malfunction or failure of an artificial pacemaker

Hypersensitive carotid sinus syncope caused by pressure applied on a carotid sinus body of a patient with a_________ and h_______ carotid arteries

atherosclerotic; hypersensitive

H_____ may be related to hypertension

Ascites may be related to ______ ventricular failure

Abdominal pain may be related to ________ ventricular failure

Edema or weight gain frequently related to ______ ventricular failure

Fatigue or weakness may be related to ______ ventricular failure

_________ may be related to heart failure or diuretic use

Diaphoresis may be related to ___________ nervous system stimulation or I______

sympathetic; infection

Unexplained joint pain may be related to _____________ fever

Intermittent claudication is hip, thigh, or calf pain that occurs with _______ and ceases with __________

Intermittent claudication indicated peripheral ________ disease

Decrease in hair, skin color changes, ulcers that don't heal, and thin shiny appearance may indicated peripheral ______________ disease

Calf tenderness may be related to ________________, may be accompanied by red, warm skin over vein

thrombophlebitis

Hx present illness: use PQRST format (and associated S/S)

Provocation, Palliation; Quality, Quantity; Region, Radiation; Severity; Timing

Hx of recent trauma important to differentiate MI from myocardial contusion- recent chest trauma is a contraindication for _______________

Percutaneous coronary intervention (PCI) procedures include a___________, a____________, _________ placement, valvuloplasty

angioplasty; arthrectomy; stent

Social history includes relationships and family structure, o____________, ___________ level, daily activities, stress level, ___________ type, r____________, exercise habits, diet, caffeine intake, tobacco use (recorded as pack/day X ______), alcohol use (drinks/month, week, or day), ________ exposure, travel

occupation; educational; personality; recreational; years; toxin

Type A is a sense of time ____________, h__________, a________, ambition, c___________, impatience, frustration

urgency; hostility; aggression; competetiveness

Drugs causing potential problems for pts with cardiovascular disease: sinus or cold remedies may contain ____________ and increase BP

Drugs causing potential problems for pts with cardiovascular disease: over the counter weight _______ agents may contain ephedrine

Drugs causing potential problems for pts with cardiovascular disease: _______ prolongs blood clotting

Drugs causing potential problems for pts with cardiovascular disease: ___________ antidepressants may causes dysrhythmias (torsades de pointes)

Drugs causing potential problems for pts with cardiovascular disease: phenytoin may cause ___________

Drugs causing potential problems for pts with cardiovascular disease: phenothiazines may cause _________, h______________

dysrhythmias; hypotension

Drugs causing potential problems for pts with cardiovascular disease: oral contraceptives may predispose to _______, ________

embolus, thrombosis

Drugs causing potential problems for pts with cardiovascular disease: doxorubicin (Adriamycin) may cause _______________

Drugs causing potential problems for pts with cardiovascular disease: lithium may cause ___________

Drugs causing potential problems for pts with cardiovascular disease: corticosteroids cause ______ and _____ retention and exacerbate heart failure

Drugs causing potential problems for pts with cardiovascular disease: theophylline preparations cause ________ and may cause dysrhythmias

Drugs causing potential problems for pts with cardiovascular disease: cardiac stimulants (cocaine) cause tachycardia, dysrhythmias and _______ artery spasm

Herbal supplements causing potential problems for patients with cardiovascular disease: ________ may increase risk of bleeding with warfarin

Herbal supplements causing potential problems for patients with cardiovascular disease: black cohosh may cause h_________

Herbal supplements causing potential problems for patients with cardiovascular disease: ephedra may increase HR and/ or ____, may cause ______ interactions with many cardiac drugs

Herbal supplements causing potential problems for patients with cardiovascular disease: garlic may increase risk of bleeding with ________________

Herbal supplements causing potential problems for patients with cardiovascular disease: ginger may potentiate ___________

Herbal supplements causing potential problems for patients with cardiovascular disease: gingko may increase risk of bleeding with _____, _____, or COX2 inhibitors

warfarin; aspirin

Herbal supplements causing potential problems for patients with cardiovascular disease: goldenseal may potentiate ______, may cause h___________, h_____________, or delirium

warfarin; hypertension; hallucinations

Herbal supplements causing potential problems for patients with cardiovascular disease: grapefruit juice increases effects of s______, _________ blockers

statins; calcium channel

Herbal supplements causing potential problems for patients with cardiovascular disease: green tea may decrease effect of ___________

Herbal supplements causing potential problems for patients with cardiovascular disease: hawthorn potentiates effects of cardiac _______, and n_______

glycosides; nitrates

Herbal supplements causing potential problems for patients with cardiovascular disease: kelp increases effect of anti____________ and anti____________

antihypertensive; anticoagulants

Herbal supplements causing potential problems for patients with cardiovascular disease: licorice root may cause h______, h______, ___________ toxicity

hypertension; hypokalemia; digoxin

Herbal supplements causing potential problems for patients with cardiovascular disease: oleander may cause heart _____, h_________, dysrhythmias, death

block; hyperkalemia

Herbal supplements causing potential problems for patients with cardiovascular disease: St. John's wort may increase HR and/or BP may decrease _____ level

The angle of Louis is at the junction of the m______ and the body of the __________

manubrium; sternum

The costal margin is the ________ edge of the chest; formed by the __________ edge of the rib cage

The costal angle is the angle beneath the __________

Reduction of SBP > ___ mmHg and DBP > __mmHg after standing 2-3 min indicates orthostatic changes

Variation of up to ___ mmHg between arms is normal

BP in lower extremities is expected to be _____ mmHg higher than in upper extremities

Narrowed/widened pulse pressure frequently indicates vasoconstriction as occurs with SNS stimulation (__________ shock)

narrowed; hypovolemic

Widened pulse pressure frequently indicates excessive _____________ as occurs with ___________ mediator release in septic shock

vasodilation; vasodilatory

Pallor may indicate a_____, _____ innervation, or sympathomimetic agents (p________, n_________, d_____)

anemia; SNS; phenylephrine; neosynephrine; dopamine

Peripheral (cold) cyanosis seen on fingertips and toes associated with peripheral h_________, or v__________

hypoperfusion; vascoconstriction

Central (warm) cyanosis seen on l____, t______, mucous membranes associated with _____ grams of deoxygenated Hgb

lips; tongue; 5

Central cyanosis may be a late sign of ______ in severely anemic patients

Central cyanosis may be an early sign of hypoxemia in p_______ patients

Patients with _____________ are called blue bloaters because of chronic hypoxemia and chronic _______

chronic bronchitis; RVF

Ruddiness is related to p_______ or h_______

polycythemia; hypercapnia

Decrease in skin turgor, or t_______, is related to interstitial _______________

tenting; dehydration

Edema indicated increase in interstitial fluid of ____% above normal

Generalized edema (anasarca) occurs in end stage ______ ______, end stage _______ ______, severe hypo___________

renal failure; heart failure; hypoproteinemia

Degree of pitting: 1+ = 0-___ inch

Degree of pitting: 2+ = ____-___ inch

Degree of pitting: 4+ > ____ inch

Degree of pitting: 3+ = 1/2-___ inch

__________ disease may cause ulcers at toes or points of trauma

Venous disease may cause ulcers at sides of __________

Clubbing present if angle between base of nail and skin is > _____ degrees; indicates chronic _________

________ hemorrhages are red/black streaks under the nailbed, indicates bacterial ___________

Splinter; endocarditis

__________ nodes are painful red nodules on fingertips, indicated embolization in infective _______

Osler's; endocarditis

Episodic facial flushing may indicate p____________

pheochromocytoma

Head bobbing up and down with each heartbeat is called _________ sign, indicates aortic _________ or r__________

de Musset's; aneurysm; regurgitation

____________ palpebrarum are benign fatty yellow plaques on eyelids associated with h_______________

Xanthoma; hyperlipidemia

Corneal ______ is a light colored ring around the iris: normal in elderly, associated with ___________ in younger patients

arcus; hyperlipidemia

Exophthalmos may be seen in advanced ______ failure with pulmonary _____________

heart; hypertension

Diagonal bilateral earlobe creases (________ sign) may indicate _____ if seen in individuals under 45 years old

To evaluate JVD place patient at a _____ degree angle, identify _______ angle (angle of Louis)

Normal height of neck vein distention is __-___ cm above the sternal angle

Determine height of JVD above sternal angle and add _____ cm to estimate CVP in cm of H2O pressure

Neck vein distention > 3 cm can indicate ______ ventricular failure, hyper________, __________ pneumothorax, cardiac ___________

right; hypervolemia; tension; tamponade

Normal CVP is ___-____ cm of H2O pressure

The hepatojugular reflex is performed by applying pressure over _______ upper quadrant for 30-60 sec while evaluating increase in neck vein distention

A positive hepatojugular reflex is a sustained increase in neck vein distention of ____ cm or more or a fall of ____ or more after release of pressure

A positive hepatojugular reflex indicates ______ failure

Normal location of point of maximal impulse (PMI) is at the ______LICS at the MCL

Lateral displacement of PMI (apical impulse) is associated with _______ ventricular dilation (aortic or mitral insufficiency), upward displacement of ___________ (pregnancy, ascites)

left; diaphragm

Lateral displacement of PMI is associated with right to left mediastinal shift (_______ pleural effusion or ________ pneumothorax)

Heave is lifting of the chest wall indicative of failure (left ventricular heave felt at or near the __________, right felt at or near the __________)

Aortic pulsation is normally visible especially during inspiration/expiration

Aortic pulsation normally palpable at midline or _______ of midline, feel for lateral expansion may indicate ________

Arterial vascular disease pain: excruciating in acute ________, intermittent claudication in _________ occlusion

occlusion; chronic

Venous vascular disease pain: _________ pain, Homan's sign in _____________

crampy; thrombophlebitis

Pulses diminished or absent in __________ vascular disease; normal in ________

arterial; venous

Arterial vascular disease color is _______, venous disease is _______ or normal

Temp is arterial vascular disease is _______, temp in venous disease is ______

Edema is absent in _______ vascular disease; present in ______ vascular disease

arterial; venous

Skin changes in arterial disease: thin/thick, shiny, atrophic skin; loss of ______; thickened _________

thin; hair; toenails

Venous vascular disease causes ______ pigmentation at ankles

Excessively warm skin may indicate h_________ or fever

hyperthyroidism

Pulse 1+ is weak and thready, easily ___________

Pulse ___+ is normal, not easily obliterated

Pulse 3+ is full and _______, cannot obliterate

Apical-radial pulse deficit (______ pulse rate < ______ rate) is indicative of dysrhythmia (a.fib, ventricular ectopy)

Pulsus _______ is a strong bounding pulse with rapid upstroke and downstroke

Pulsus magnus is characteristic of h_________, t__________, aortic insufficiency, PDA, arteriovenous _________

hypertension; thyrotoxicosis; fistula

Pulsus parvus (thready) is characteristic of aortic ________ also tardus, mitral __________, constrictive __________, cardiac tamponade

stenosis; stenoisis; pericarditis

Pulsus alternans means every other beat is ________ than the preceding one

Pulsus alternans is characteristic of ______ ventricular failure

Pulsus paradoxus is an exaggeration of normal physiologic response to _____________

The normal decrease in BP during inspiration is _____ mmHg or less, anymore is pulsus paradoxus

Pulsus paradoxus is characteristic of ___________ effusion, constrictive pericarditis, cardiac tamponade, severe _______ disease, advanced HF, ____________ shock

pericardial; lung; hemorrhagic

Pulsus bisferiens (double-peaked) is 2 pulses palpated during _____ with second slightly _______ than the first

systole; weaker

Pulsus bisferiens is characteristic of ______________ cardiomyopathy, _______________ cardiomyopathy, ________ stenosis or regurgitation

hypertrophic; constrictive; aortic

Water-hammer (_________) pulse is an increased pulse pressure with a rapid upstroke and downstroke with shortened _________ (collapsing)

Corrigan's; peak

Water-hammer pulse associated with ______ regurgitation or patent _______ ________

aortic; ductus arteriosus

Homan's sign is identified by flexing/dorsiflexing the foot with the knee slightly bent, if there is _______ pain then it suggests __________

dorsiflexing; calf; thrombophlebitis

Assess neurovascular status after _________ catheterization, after percutaneous coronary interventional (PCI) procedure (a_____, a________, v___________)

cardiac; angioplasty; athrectomy; valvuloplasty

Assess neurovascular status when the patient has an intraaortic ____________ pump catheter in place

Assess neurovascular status when the patient has a fracture of an extremity (to monitor for ___________ syndrome)

Assess neurovascular status when the patient has a circumferential _______ of an extremity

Clinical manifestations of acute arterial occlusion: p_____, p______, p________, p_______, polar (cold), pain

pallor; pulselessness; paresthesias, paralysis

Stethoscope tubing should be no longer than ____-_____ inches

Stethoscope _________ is used for high pitched sounds (S1, S___, most _____, pericardial friction rubs)

diaphragm; S1; murmurs

Stethoscope bell is for low pitched sounds (S__, S___, murmurs of _____ valve stenosis

Auscultatory areas: mitral is _____ LICS at _____

Auscultatory areas: tricuspid is 5th LICS at ______

LSB (left sternal border)

Auscultatory areas: Erb's point is ______ LICS at ______

Auscultatory areas: Pulmonic is _____ LICS at _____

Auscultatory areas: Aortic is ______ RICS at _______

Left-sided heart events precede right sided heart events (_______ component precedes the _________ component of S1 and the _________ component precedes the ______ component of S2)

mitral M1; tricuspid T1; Aortic A1; Pulmonic P2

Left-sided heart events are normally louder than right sided heart events (___ is the loudest component of S1 and ____ is the loudest component of S2)

Left sided heart events are normally loudest during _______ and right sided heart events are loudest during ___________

expiration; inspiration

S1 is caused by the closure of _____ valves: _______ and _______

AV; mitral and tricuspid

S1 marks the end of _____ and beginning of ________, loudest at the _____________

diastole; systole; apex

S2 caused by closure of _________ valves: ______ and __________

semilunar; aortic; pulmonic

S2 marks the end of ________ and the beginning of _______, loudest at the _________

systole; diastole; base

A split S1 (both M1 and T1 can be heard) is heard best at the _________ area

A split S1 may be associated with __________ BBB, _______ ventricular (epicardial) pacemaker, ______ ventricular ectopy

right; left; left

A split S2 (both A2 and P2 can be heard) is heard best at the __________ area

_________ only split of S2 is normal (esp under 50 years old)

Expiratory split of S2 (split even more during inspiration) associated with ______ BBB, ______ ventricular ectopy or pacemaker, severe ________ regurgitation, pulmonary __________, pulmomary __________, VSD

right; left; mitral; hypertension; stenosis

Fixed splitting (same on inspiration and expiration) associated with ______ septal defect

Paradoxical split (split on _____ but not _________) associated with _______ BBB, ______ ventricular (endocardial) pacemaker, ____ ventricular ectopy, severe aortic _______ or regurgitation, PDA

expiration; inspiration; left; right; right; stenosis

S3 is also called ____________ gallop ("ken-tuc-KY")

S3 is a dull, low pitched sound occurring early in ________ after S2

S3 is caused by rapid rush of blood into a dilated __________, abnormal in patients over ____

S3 is heard best with bell/diaphragm with patient lying on the ______ side

Left sided S3 heard best at ___________ during _________

apex; expiration

Right sided S3 heard best at ________ during __________

sternum; inspiration

S3 associated with HF, fluid _______, c_________, VSD or ______, mitral or tricuspid ________

overload; cardiomyopathy; PDA; regurgitation

S4 also known as _____ gallop ("TEN-nes-see)

S4 is a dull, low pitched sound occurring late in ________ before _________

S4 is due to _______ contraction of blood in a noncompliant ventricle, abnormal in adults

S4 is heard best with bell/diaphragm with patient lying on the ______ side

Left sided S4 heard best at ________

Right sided S4 heard best at __________

S4 associated with MI, h______, ventricular ________, ______ blocks, severe _____ or _____ stenosis

hypertension; hypertrophy; AV; aortic; pulmonic

________ rhythm is all four heart sounds are heard

Summation gallop is all four heart sounds with __________________

Summation gallop merging of S3 and S4 causes a louder mid-_________ sounds

Pericardial friction rub is a ______-pitched "to and fro" scratchy sound

Pericardial friction rub is usually ____phasic including systolic, early ________, and late _________ components

triphasic; diastolic; diastolic

Pericardial friction rub is heard best at the ___-____ intercostal space as lower LSB with patient leaning backward/forward

4th-5th; forward

To differentiate between pericardial and pleural friction rub ask patient to .......... if the rub persists its pericardial

hold their breath

Pericardial friction rub is caused by inflammation of the _____________, commonly heard after MI or cardiac __________

pericardium; surgery

Pericardial knock is a loud, early/late diastolic sound best heard at lower LSB

Pericardial knock is caused by _____________ pericarditis

Opening snap is a short, high pitched sound heard early in _______ at ____-____ LICS at LSB

diastole; 3rd-4th

Opening snap is earlier, higher pitched than S___

Opening snap caused by opening of stenotic _____ valve, usually precedes a ___________ murmur

Opening snap can also be caused by increased flow (ventricular __________ defect, patent _______ __________)

septal; ductus arteriosus

Closing snap is really a loud S__

Closing snap is caused by closure of _____ valve

Clicks are high pitched sounds heard during _______

Aortic ejection click is a high pitched sound heard early over __________ area to apex

Aortic ejection clock may precede systolic ejection _____________

Aortic ejection click is caused by aortic valve disease (aortic ______ or c__________)

aneurysm; coarction

Pulmonic ejection click is a high pitched heard early in ______ over ______________ area

systole; pulmonic

Pulmonic ejection click is caused by pulmonic valve disease, pulmonary __________, pulmonary ______________, hyper__________

embolism; hypertension; hyperthyroidism

Midsystolic click is a high pitched sound heard best at ______ or lower left __________ border

Midsystolic click may occur alone or prior to a late systolic ____________

Midsystolic click is due to __________ valve prolapse or regurgitation

Prosthetic valve click is a __________ click caused by opening and closing of a prosthetic valve

Mediastinal crunch is a crunching sound heard best at _____ or along LSB in left ___________ position

Mediastinal crunch is caused by air in the ___________

Murmurs are causes of _____________ (murmur if __________ or bruit if __________)

turbulence; intracardiac; extracardiac

Flow murmurs are increased flow across a normal _______; may also be called __________

valve; functional

Flow murmurs are always soft (not louder than grade ___/____) and systolic

Functional murmurs are caused by hyper__________, anemia, p_______, hyper______

thermia; pregnancy; thyroidism

Murmurs may also be caused by forward flow through a ________ valve

Murmurs may also be caused by backward flow through a _______ (incompetent) valve

Murmurs may also be caused by flow through an AV _______ or __________ defect

fistula; septal

Murmurs may be caused by flow into a __________ chamber or portion of a vessel

Systolic murmurs include holosystolic (______ regurgitation or ________ septal defect), ejection or midsystolic (________ stenosis), and late

AV; ventricular; semilunar

___________ murmurs are never holosystolic

Late systolic murmurs are caused by ________ muscle dysfunction, _______ valve prolapse, hypertrophic ____________

papillary; mitral; cardiomyopathy

Early diastolic murmurs are caused by ________ regurgitation

Mid-diastolic or late diastolic murmurs are caused by ______ stenosis

Grade ___/VI murmur is moderately loud without a thrill

Grade ___/VI murmur is clearly audible but quiet

Grade ____/VI is loud with or without a thrill

Grade ___/VI is barely audible, difficult to detect

Grade ___/VI is very loud, thrill present, audible with stethoscope partially off the chest

Grade VI/VI is loudest possible, ____ present, audible without ___________

thrill; stethoscope

Crescendo: gets ________

___________: gets softer

Crescendo-descrescendo: ____________ then ___________

Mitral and tricuspid regurgitation: ______ pitched (heard best with diaphragm)

Aortic and pulmonic stenosis: _______ pitched

Mitral and tricuspid stenosis: ______ pitched

Aortic and pulmonic regurgitation: _______ pitched

Bruit is a turbulent sound heard over c_______, aorta, r___, i_________, f________

carotids; renals; iliacs; femoral

Bruits may be associated with p_____ or a_______

plaque; aneurysm

A Doppler stethoscope is used to measure the blood pressure distal to vascular _____ or surgery

To get Doppler pressure apply sphygmomanometer on the _____ or below graft site and inflate to pressure above patient's __________ brachial pressure; allow pressure to decrease and note pressure when ______ is audible again

calf; systolic; pulse

Use the best pressure (posterior tibial or dorsalis pedalis)to calculate ankle-_________ index (ABI)

Divide the systolic pressure from the leg by the ______ systolic pressure to calculate ABI

ABI > 1 consider using ____/brachial index (TBI)

To get toe/brachial index ____ SBP/ _____ SBP

great toe; brachial

Normal ABI is ___-____

Mildly abnormal ABI is 0.95-___

Moderately abnormal ABI is 0.75-____

ABI- ischemic is 0.5-___

ABI- severe ischemia is less than ____

Clinically significant ABI is decrease of 0.___ or more

Normal sodium 136-____ mEq/L

Normal potassium 3.5-____ mEq/L

Normal chloride is 96-____ mEq/L

Normal calcium is 8.5-____ mg/dL

Normal phosphorus is 3-____ md/dL

Normal magnesium is 1.5-____ mEq/L or 1.8-____ mg/dL

Normal glucose is 70- ____ mEq/L

Normal BUN is 5-___ mg/dL

Normal creatinine is 0.7-_____ mg/dL

Total CK males: 55-____ U/L

Total CK females: 30-____ U/L

Normal CK-MB ____% of total CK

Normal LDH is 90-____ IU/L

Normal LDH-1 is 17-___% of total LDH

Normal myoglobin is less than _____ ng/mL

Normal troponin I is less than ____ ng/mL

Normal troponin T is less than ____ ng/mL

Normal cholesterol is ____-____ mg/dL

Normal triglycerides is 40-_____ mg/dL

Normal HDL is 29-____ mg/dL

Normal LDL is 62-___ mg/dL

Normal homocysteine is less than ____ umol/L

Normal C-reactive protein is less than ___ mg/dL

Normal BNP is less than _____ picograms/mL

Mild heart failure BNP is 100-____ pg/mL

Moderate heart failure is 300-____ pg/mL

Severe heart failure is more than _______ pg/mL

BNP may be an earlier indicator of acute MI than either ______ or troponin ___

Normal pH is 7.35-____

Normal PaCO2 is 35-___ mmHg

Normal HCO3 is 22-___ mM

Normal base excess is -___ to +___

Normal PaO2 is ____-100 mmHg

Normal SaO2 is greater than ___%

Normal arterial lactate is less than ___ mmol/L

Normal hematocrit (males) 40-____% and (females) 35-___%

Normal hemoglobin (males) 13-_____ g/dL and (females) 12-____ g/dL

Normal WBCs 3500-______ mm3

Normal ESR (males) up to _____ mm/hr and (females) up to _____ mm/hr

Normal Prothrombin time (PT) 12-___ seconds; therapeutic 1.5-___ times normal

Normal partial thromboplastin time (PTT) 60-____ seconds; therapeutic 1.5-____ times normal

Normal activated partial thromboplastin time (aPTT) 25-____ seconds; therapeutic 1.5-____ times normal

Normal acitvated clotting time (ACT) 70-____ seconds; therapeutic 150-_____ seconds

Normal thrombin time 10-____ seconds

Normal bleeding time 1-____ minutes

International normalized ratio (INR) less than ____

Therapeutic INR for A.fib 1.5-____

Therapeutic INR for DVT or pulmonary embolus 2-____

Therapeutic INR for prosthetic valves 2.5-____

Normal platelets 150,000-_______ mm3

Normal urine glucose is ______

Normal urine ketones is ________

Normal urine specific gravity is 1.005-_____

Normal urine osmolality is 50-_____ mOsm/liter

Aortography evaluates aortic valve ______, aneurysms or dissection of ______ aorta, c______ of aorta, and injuries to the aorta

insufficiency; ascending; coarction

Contrast medium used in aortography; check for allergy to i______, s______, dye; ensure hydration following procedure

iodine; shellfish

Monitor signs of anaphylaxis (f____, u____, stridor) during aortography and ______ site after

flushing; urticaria; puncture

Cardiac biopsy evaluates effect of cardiotoxic ______, evidence of transplant ________, ________ heart disease, tumors, cardio______

drugs; rejection; inflammatory; cardiomyopathy

After cardiac biopsy observe for signs of cardiac _____ and/or tamponade

Cardiac catheterization and coronary angiography evaluates severity of coronary artery _____, cardiac _______ function, ________ within the heart, cardiac output and _______ fraction, blood _____ analysis within the chambers

stenosis; muscle; pressures; ejection; gas

Cardiac catheterization and coronary angiography allows a______, a________, intracoronary _____, or lasers to reduce coronary artery obstruction

angioplasty; athrectomy; stents

Prior to cardiac catheterization and coronary angiography, check for allergy to dye, after the test ensure _________, keep extremity in which catheter was placed immobilized for ___-___ hours

hydration; 6-12

After cardiac catheterization and coronary angiography, monitor arterial puncture point for hemorrhage or ________; __________ (Angioseal) or stitch device (P______) may be used

hematoma; collagen; Perclose

After cardiac catheterization and coronary angiography, monitor _________ status of affected limb and monitor for _____ pain and VS changes (retroperitoneal hemorrhage)

neurovascular; back

Chest xray evaluates cardiac _____ and _____ and chamber ______

size; shape; size

Chest xray can evaluate presence of thoracic _________ or _______ of the aorta

aneurysm; calcification

Ask about p_______ before chest x ray

Computed tomography (CT), Electron beam computerized tomography (EBCT) evaluates _______ ventricular wall motion, cardiac _______, MI, pericardial ______, aortic aneurysm and ________

left; tumors; effusion; dissection

CT and EBCT may be done with/without __________ _______

contrast medium

Digital subtraction angiography evaluates _______ disease and degree of _________

vascular; occlusion

Digital subtraction angiography uses ________ ______; monitor for __________ and puncture site

contrast medium; anaphylaxis

Doppler ultrasonography and Duplex ultrasonography evaluates ______ disease and degree of ______

vascular; occlusion

M-mode echocardiography is a _______ ultrasound beam

2-D echocardiography is a _________ ultrasound beam; wider view of heart and heart structures

Doppler echocardiography adds Doppler to demonstrate flow of blood through the _______

Color flow echocardiography is __________ blood flow superimposed on ________ echocardiography

Stress echocardiography is images taken before, during, and after _________ or pharmacologic _______

exercise; stress

Transesophageal echocardiography (TEE) places a transducer in the ___________

echocardiography evaluates ________ size and _________ thickness

echocardiography evaluates ________ functioning, _______ muscle functioning, _________ valve functioning, ventricular wall _________ abnormalities

valve; papillary; prosthetic; motion

echocardiography evaluates intracardiac ________

echocardiography evaluates presence of ______________ fluid

__________ echocardiography evaluates intracardiac ________, EF and CO, valve ________, intracardiac shunts

Doppler; pressures; gradients

TEE evaluates thoracic ____________

_________ echocardiography is better if patient is obese, has COPD, chest wall _______ or trauma, or thick chest dressings

Transesophageal; deformity

Monitor for m_____________ if anesthetic is used in echocardiography

methermobloginemia

If TEE, monitor for indications of esophageal perforation (sore _______, d_______, e_______ or substernal pain)

throat; dysphagia; epigastric

Electrocardiography (ECG) evaluates d______, ____________ defects including intraventricular blocks, ________ imbalance drug toxicity, MI, ischemia, chamber h_______

dysrhythmias; conduction; electrolyte; hypertrophy

List what _________ the patient is receiving on ECG request, be alert to ______ safety hazards

drugs; electrical

Electrophysiologic studies (EPS) evaluates _________ under controlled circumstances

EPS is best therapy for control of dysrhythmia: d_____, required dosage of therapy; p_________; cardiac ________

drug; pacemaker; ablation

Patients may have __________ experience during EPS, encourage expression of emotions

Monitor _________ site after EPS

_________ monitor evaluates suspected dysrhythmias over 24-48 hour period; __________ function; silent ________

Holter; pacemaker; ischemia

On Holter monitor instruct patient on importance of ________ keeping

Intravascular ultrasound (IVUS) evaluates _________ artery size and patency, structure of ______ wall

coronary; vessel

IVUS evaluates coronary artery ______ position and patency

IVUS evaluates a______ and presence of aneurysm, dissections

Monitor IVUS as you would for cardiac __________

catheterization

Magnetic resonance imaging (MRI) gives a ______-dimensional view of the heart, evaluates anatomy and structure of heart and great vessels

MRI evaluates c________, __________ defect, m__________, aneurysm; and changes of _______ of tissues before ________ changes occur

cardiomyopathy; congenital; masses; chemistry; structural

MRI does/does not involve radiation or dyes

MRI cannot be used in patients with any implanted metallic device including p________, implantable d______, metallic heart ________, intracranial aneurysm _____

pacemakers; defibrillators; valves; clips

Multiple-gated acquisition (MUGA) scan (radionuclide angiography) evaluates __________ size and __________ wall motion

ventricular; ventricular

MUGA scan evaluates cardiac _________, cardiac ________, end-______ and _________ volume, ejection fraction, intracardiac ________

output; index; systolic; diastolic; shunts

Pericardiocentesis and pericardial fluid analysis evaluates presence of blood, ________, _______, or malignancy (observe for signs of tamponade)

Pericardiocentesis is also used for emergency relief of cardiac ____________

Peripheral angiography evaluates ____________ plaques, occlusion, a_________, traumatic injury

atherosclerotic; aneurysm

Contrast medium is/is not used in peripheral angiography

After peripheral angiography keep limb immobilized in a straight position for ___-____ hours, monitor for indications of systemic _______

Arterial plethysmography evaluates ___________ of peripheral arteries and presence of ___________ vascular disease

patency; occlusive

Venous plethysmography evaluates patency of peripheral veins and presence of _________

Plesthysmography requires one normal _________ since one is compared to the other

Positron emission tomography (cardiac PET scan) evaluates severity of coronary artery __________, ___________ circulation, patency of _______ grafts, size and location of ___________ tissue

stenosis; collateral; bypass; infarcted

Sestamibi exercise testing and scan Sestamibi-dypyridamole stress (for those who can't exercise) evaluates MI during exercise; ischemic areas show increased/decreased uptake of radioactive activity (_____ spots)

increased; spots

Signal-averaged ECG evaluates presence of late ___________ potentials which may be responsible for malignant ___________ dysrhythmias

electrical; ventricular

Signal-averaged ECG may be performed before or after _____________

During a signal-averaged ECG patient must lie still for _____ minutes

Stress electrocardiography (or exercise tolerance test ETT) evaluates persons with high risk for ________, patients with known ________, or post-CABG patients for ischemia with exercise or drugs (a_______, d_______, dobutamine)

CAD; CAD; adenosine; dipyridamole

During ETT, _____ millimeter or greater transient ST depression _____ msec after the J point is suggestive of CAD

During ETT monitor closely for exercise induced ___________ or _________ dysrhythmias

hypotension; ventricular

__________ is the preferred agent for pharmacologic stress test because it has a short half-life and does not require reversal agent

Technetium-99 pyrophosphate scan evaluates size, location of MI (_____ spots ____-____ days after MI)

Technetium-99 has peak accuracy ___-___ hours after initial symptoms

Thallium stress echocardiography evaluates MI during ______ (ischemic areas show increased/decreased uptake of radioactivity "_____ spots"

exercise; decreased; cold

Thallium-201 scan evaluates MI (______ spots)

Vectorcardiography evaluates chamber __________, BBB and hemi_______, MI

hypertrophy; blocks

Venography (ascending contrast phlebography) evaluates deep ______ veins, DVTs, competence of deep vein ______

Venography may be used to locate suitable vein for ______ bypass graft

Contrast medium is/is not used in venography; monitor for anaphylaxis and _________ site

Ventriculography evaluates ventricular wall _________, wall __________, ventricular _________, ________ valve motion, LV end-diastolic and systolic volume, SV, EF

motion; thickness; mitral

Ventriculography evaluates intracardiac _______; uses contrast medium

__________ axis of the ECG measures time

Each small (1mm) box equals _____ seconds

Each large (5mm) box equals _____ seconds

Small marks at the top of the ECG paper identify ____ second intervals

Vertical axis on the ECG measures __________

Vertical axis only useful on multiple lead ECG because rhythm strips are not ___________

Each 1mm box equals _____ mV

Each 5mm box equals ____ mV

Impulses traveling towards the positive pole of a lead cause a ___________ deflection

Impulses traveling away from the positive pole cause a ____________ deflection

White lead goes just below _______ clavicle

Brown (V1) goes on ________ ICS at right sternal border

Black lead goes below _______ clavicle

Green lead goes on lower chest, above and to _______ of umbilicus (______ leg)

Brown (V6) goes on ______ ICS at left _________ line

Red lead goes on lower chest, above and to _____ of umbilicus (____ leg)

5 lead ECG shows ___, II, III, aVR, _____, ____ or V

3 lead system: Lead II- positive (____) at lower ______ torso

3 lead system: negative (______) under right ______

white; clavicle

3 lead system: ground (_____) under left _________

black; clavicle

Modified chest leads: MCL1 (set at lead ___)- place positive (______) at 4th ICS at ______; negative (______) under left _________; ground (red) under right _________

I; black; RSB; white; clavicle; clavicle

MCL6 (set at lead ___)- place positive at _____ ICS at left mid_______ line

II; 5th; axillary

V leads are _____polar (preferred) and MCLs are ___polar

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