Adult CCRN NotesStudy online at https://quizlet.com/_dthxjb1.What is preload?Preload, also known as the left ventricular end-diastolic pressure (LVEDP), is the amount of ventricular stretch at the end of diastole. Think of it as the heart loading up for the next big squeeze of the ventricles during systole. Some people remember this by using an analogy of a balloon - blow air into the balloon and it stretches; the more air you blow in, the greater the stretch.2.What is after-load?Afterload, also known as the systemic vascular resistance (SVR), is the amount of resistance the heart must over-come to open the aortic valve and push the blood volume out into the systemic circulation. If you think about the balloon analogy, afterload is represented by the knot at the end of the balloon. To get the air out, the balloon must work against that knot.3.Why would you want to increase preload?An increase in preload allows for increased cardiac output via the Frank-Starling mechanism; HOWEVER, in an al-ready weak heart, this mechanism does not augment car-diac output as much as it causes excessive hypervolemia, leading to peripheral edema and pulmonary congestion seen in clinical heart failure4.Why would you want to decrease afterloadAfterload is the pressure against which the heart must work to eject blood during systole (systolic pressure). The lower the afterload, the more blood the heart will eject with each contraction.5.What medica-tions decrease afterloadBeta 1 blockersCCB Diuretics Vasodilators Nitroglycerin6.What medica-tions decrease preloadNitratesDiuretics7.S11 / 79 1 / 4
Adult CCRN NotesStudy online at https://quizlet.com/_dthxjbthe first heart sound, heard when the atrioventricular (mi-tral and tricuspid) valves closeLoudest at apexMarks end of diastole, beginning of systole8.S2the second heart sound, heard when the semilunar (aortic and pulmonic) valves closeLoudest at baseMarks end of diastole, beginning of systole9.S3Rapid rush of blood into dilated ventricle heard best at apex HF - may occur before crackles can also be associated with Pulmonary HTN and cor pulmonale Mitral, aortic, or tricuspid insufficiency10.S4Caused by atrial contraction of blood into a non compliant ventricle occurs right before s1 heard best at apex stenosis "Tennessee"11.Narrowing Pulse Pressurea decrease in systolic blood pressure with little change or even an increase in diastolic blood pressuremost often seen with hypovolemia or a severe drop in cardiac output, severe hypovolemia12.Widening pulse pressureDecrease in diastolic BP that widens pulse pressure - vasodilation, a drop in SVR - often seen in sepsis, septic shock (100/38)13.When do coro-nary arteries get perfused?During diastole14.Cardiac Output2 / 79 2 / 4
Adult CCRN NotesStudy online at https://quizlet.com/_dthxjbSystolic BP is an indirect mea-surement of ...15.Diastolic BP is an indirect mea-surement of ...SVR16.What can cause a murmurHF CAD, MIDilated cardiomypoathy degenerationbicuspid aortic valve geneticsrheumatic feverinfection connective tissue diseases17.Mitral Regurgita-tionback up of blood during systole18.Mitral Stenosishard to push blood through during diastole19.Tricuspid regur-gitationback of blood during systole20.Tricuspid steno-sishard to push blood through during systole21.Aortic regurgita-tiondiastolic murmur22.Pulmonic Regur-gitationdiastolic murmur23.arotic stenosissystolic murmur24.Pulmonic Steno-sisstystolic murmur3 / 79 3 / 4
Adult CCRN NotesStudy online at https://quizlet.com/_dthxjb25.Murmurs asso-ciated with an acute MIMitral valve is attached to the LV wall with paipillary mus-cles and chordae tendinae - myocardial ischemia/infarct can lead to acute mitral valve regurgitation26.Ventricular Sep-tal Defectloudest at sternal border 5th ICS27.Papillary mus-cle dysfunc-tion/ruptureHeard loudest at apex rupture is a surgical emergency28.Non-Modifiable risk factors for heart diseaseage, gender, family history29.Modifiable risk factors for heart diseasehypertension, elevated cholesterol level, smoking, poor diet, obesity, sedentary lifestyle, oral contraceptives, hor-mone replacement therapy, and high stress.30.Unstable Angina FindingsCP at rest, but can be relieved with NTGnegative trops ST depression or T wave inversion on EKG31.NSTEMI Find-ingsPositive troponin EKG - T wave inversion chest pain that doesn't go away32.STEMI Findingspositive troponin EKG ST elevations in 2 or more leads chest pain33.Variant (Prinzmetal's) Angina Findingsunstable angina that has transient st segment elevation due to Coronary artery spasm w/ or w/o atherosclerotic lesions may be precipitated by nicotine, ETOH, cocaine ingestion34.Management of ACS (Medica-tions)EKG first aspirin asap - chew it then anticoagulants - heparin, lovenox antiplatelet - plavix, abciximab, eptifibatide, tirofiban 4 / 79
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