NURS 5315 UTA Exam 3 (Cardiac) | Questions with Verified Answers

NURS 5315 UTA Exam 3 (Cardiac) | Questions with Verified Answers Beta 1 This receptor causes increased contractility, increased HR, and increased renin secretion Beta 2 This receptor causes vasodilation and bronchial dilation Albuterol stimulates the _________ receptors and is administered during respiratory distress Beta 2 Alpha 1 This receptor causes vasoconstriction and is stimulated by Norepinephrine Dopamine 1 This receptor causes vasodilation Dopamine administered in low doses causes vaso_______________. Dilation Dopamine administered in high doses causes vaso__________ because it activates the ___________ receptor. constriction, alpha 1 A moderate dose of dopamine causes ________ contractility and ______________ cardiac output increased, increased Epinephrine primarily activates the ____________ receptor Beta 1 Epinephrine also activates Beta 2 and Alpha 1 receptors which _________________________ vascular tone. does not change Epinephrine causes _________________ contractility and _____________________ cardiac output. increased, increased Levophed activates which 2 receoptors to cause increased vasocontriction and increased contractility? Beta 1 and Alpha 1 Epinepherine and norepinephrine are released by the ____________________ nervous system and the ________ gland. Sympathetic, adrenal Beta 1 receptors are located in the __________. Heart Beta 2 and alpha 1 receptors are located mainly in the ______________________. Blood vessels These receptors are located in the renal, mesenteric, coronary, and cerebrovascular blood vessels Dopamine 1 Dobutamine stimulates ___________ receptors to improve contractility and _____________ HR. Beta 1, increase Chronotropy pertaining to heart rate Inotropy force of myocardial contraction Drugs that affect the chronotropy affect the __________________. Heart rate Drugs that affect the inotropy affect the _____________________. myocardial contraction Acetylchoine is released by the _____________________ nervous system and _______________ heart rate, ______________ contractility, and causes vaso_____________. Parasympathetic, decreases, decreases, dilation Diastole Relaxation of the heart Systole Contraction of the heart There are _____ pulmonary veins that take blood back to the ________________ (chamber). 4, left atrium slight pause of impulse between SA and AV so the blood has time to push into the left ventricle. Represents about _____% of cardiac output. atrial kick, 20 The right side of the heart has ______ pressures than the left side. Lower The left side of the heart has ____________ pressures than the right side. Higher Cardiac output heart rate x stroke volume 5 L/min normal adult cardiac output at rest Stroke volume The amount of blood ejected from the ventricle in one contraction. Preload degree of stretch of the cardiac muscle fibers at the end of diastole a saturation of 50% results in a(n) ______________ in myocardial contraction. Decrease Ejection Fraction measurement of the volume percentage of left ventricular contents ejected with each contraction normal ejection fraction 55-65% EF _____________ in systolic heart failure. Decreases HF may result from ________________ preload as it causes a decline in stroke volume and a back-up of blood into the pulmonary circulation. Increased The force or resistance against which the heart pumps. Afterload Includes aortic pressure and systemic vascular resistance Afterload hypertensive patients have a ________ SVR and a __________ aortic pressure, resulting in a ________ afterload. High, high, high Increased afterload increases the work of the ____________ and results in ______________. Ventricle, Hypertrophy A low afterload enables the heart to contract ____________. Faster Arterial blood pressure cardiac output x total peripheral resistance systolic blood pressure the pressure created in the arteries when the left ventricle contracts and forces blood out into circulation diastolic blood pressure the pressure in the arteries when the left ventricle is refilling average pressure in the arteries during the cardiac cycle and is dependent on the elasticity of the _________ walls and the mean volume of __________ in the arterials. Mean arterial pressure, arterial, blood SVR is directly related to the ______________ of the arteries. Diameter Vasocontriction Angiotensin II impact on arteries Vasoconstriction Epinepherine impact on arteries Vasodilation Natiuretic hormones impact on arteries Vasodilation Urodilatin impact on arteries The greater the amount of intracellular calcium, the _______ the contraction. Stronger Troponin C binds calcium to cause contraction Drugs which alter intracellular calcium levels will affect _______ and ________. Tension, contraction 2 common non-dihydropyridine CCBs Diltiazem and Verapamil CCBs inhibit calcium influx into the ________ to decrease calcium concentration and _________ tension and contractility. Myocardium, decrease Calcium channel blockers have ________ _________ Effects Negative Inotropic CCBs should be avoided in ________________ ___________ _____________________. Systolic Heart Failure Catecholaimes: increase activity of the _____________ ________ in the sarcoplasmic reticulum (SR); therefore, increase the release of _________ from the SR. calcium pump, calcium Decreased extracellular sodium ________ the activity of the Na/Ca exchanger, _______ the amount of intracellular calcium. Decreases, increasing _____________ blocks the Na/K pump which increases intracellular Na, decreases the activity of the Na/Ca exchanger, causing an _________ of intracellular calcium. Digitalis, increase block effects of catecholamines, __________ the amount of intracellular calcium Beta Blockers, decreasing Acidosis ____________ cardiac contractility Decreases Hypoxia and hypercapnia ___________ cardiac contractility Decrease Ingestion of these 3 by mother can lead to CHD in baby Phenytoin, Aspirin, Ethanol Infection of mother with this virus can lead to CHD in baby Rubella a significant increase in blood oxygen content between two right sided chambers would indicate this Left to right shunt Left to right shunt leads to volume overload in the ___________ __________ of the heart which leads to ___________ _______________, and bilateral ventricular _____________. Right side, pulmonary hypertension, hypertrophy Eisenmenger syndrome reversal of L-R shunt to a R-L shunt, with cyanosis and clubbing of fingers Ventricular septal defect Most common CHD In VSD, blood moves from the _____ ventricle to the right ventricle. Left, right VSD Harsh holosystolic murmur heard best at lower left sternal border in a pt with history of frequent respiratory infections, dyspnea, FTT, and CHF. echocardiogram is diagnostic. Tetralogy of Fallot a congenital malformation of the heart involving four distinct defects defects in tetralogy of fallot (1) VSD (2) pulmonary stenosis (3) RVH (4) over-riding aorta Infants with a _____ VSD will develop _____ _______ and have poor weight _______. Large, heart failure, gain 3 symptoms see in adults with VSD. Pulmonary hypertension, cyanosis and clubbing atrial septal defect Most common CHD in adults Most common cause of ASD is a _________ ____________ __________ that does not close Patent foramen ovale In ASD, blood flows from the _______ atrium to the ________ atrium Left, right Two syndromes associated with ASD FAS, Down Syndrome Murmur heard in ASD crescendo-decrescendo ASD is associated with an increased risk for developing a(n) ___________. Embolus patent ductus arteriosus passageway between the aorta and the pulmonary artery remains open after birth Congenital Rubella Associated with Septal defects, PDA, and pulmonary artery stenosis murmur heard in patent ductus arteriosus Machine-like Type of shunt initially seen in PDA Left to right A reversal of the shunt seen initially in PDA may occur if _____________ _______ develops from _____________ blood flow through the pulmonary artery. Pulmonary HTN, increased If reversal of the shunt initially seen in PDA occurs, the child will be _______________ in the _______________ portion of their body but normal in the _______________ body. This occurs because deoxygenated blood enters the aorta below the level of the __________ artery. Cyanotic, lower, upper, subclavian cyanotic shunt right to left SaO2 below ________% will result in cyanosis in a right to left shunt. 80 Right to left shunt will increase the work load on the _____ side of the heard leading to myocardial hypertrophy. Left Most common cyanotic CHD Tetralogy of Fallot In VSD, pressure on the right side is initially ________, causing the volume on the left side to be initially ________. Higher, higher In early PDA, the ______ side of the heart works harder Left Transposition of the great vessels a congenital abnormality where the aorta is attached to the right ventricle and the pulmonary artery to the left ventricle (this is backwards and leads to two separate blood routes) Pulmonary artery Carries deoxygentated blood from the heart to the lungs The _________ _________connects the umbilical vein to the inferior vena cava, carries _________ blood. Ductus venous, mixed connects the two atria in the fetal heart, transports _________ blood. foramen ovale, oxygenated a blood vessel in a fetus that bypasses pulmonary circulation by connecting the pulmonary artery directly to the ascending aorta, carries _______ blood. ductus arteriosus, mixed Fetal blood Cycle: Oxygenated blood leaves the ________ and passes through the ______ ______ into the inferior vena cava, entering the heart in the _______ _______ (chamber). It then passess through the ___________ _____________ into the _______ ________ (chamber) where it is transported to the ________ _________ (chamber) so that it can be spread to the head and body. placenta, ductus venous, right atrium, foramen ovale, left atrium, left ventricle Fetal blood cycle: Mixed blood leaves the ________ and passes through the ______________ _____________ into the inferior vena cava, enters the _____________ ______________ (chamber) where it then travels to the _______________ _______________ (chamber). It then enters the ______________ _____________ and then passes through the __________ ___________ _______________ to enter the ____________ before returning to the _________________ to re-oxygenate and rid of waste. placenta, ductus venous, right atrium, right ventricle, pulmonary artery, patent ductus arteriosus, aorta, placenta Heart Failure Clinical manifestations are consistent with volume overload and poor perfusion secondary to pump failure 2 most common causes of heart failure Hypertension and ischemia heart failure with reduced ejection fraction HFrEF, systolic heart failure Heart failure with preserved ejection fraction HFpEF, diastolic heart failure HFrEF most commonly affects the ______ side of the heart Left EF in HFrEF is _____% 40 Myocardial Infarction Most common cause of HFrEF or decreased systolic function A decrease in contractility in the left ventricle (HFrEF) will lead to __________ stroke volume, ___________ cardiac output, and __________________ preload Decrease, decrease, increase First step of ventricular remodeling is the decrease in _____________________ of the ____________ ________________ (chamber) Contractility, left ventricle In ________ related to HF, muscle fibers lengthen and volume in the heart chambers increases due to ventricular remodeling Ventricular dilation Myocardial systolic dysfunction and low cardiac output seen in HFrEF lead to the release of ________ that cause vasoconstriction in an attempt to ______________ afterload and cardiac output. Hormones, increase ___________________ detect decreases in blood pressure and notify the medulla to activate the SNS and stimulate the release of _____________________________. Baroreceptors, catecholamines Compensatory hormone release in HFrEF cause ________ effects on myocytes leading to more _______________ and worsening ________________. toxic, damage, contraction Angiotensin II increases blood pressure by stimulating kidneys to reabsorb more water and by releasing aldosterone Angiotensin II Contributes to sacromere death, loss of normal collagen, and the development of interstitial fibrosis. Aldosterone "salt-retaining hormone" which promotes the retention of Na+ by the kidneys. na+ retention promotes water retention, which promotes a higher blood volume and pressure Aldosterone contributes to the development of myocardial fibrosis, autonomic dysfunction, and dysrhythmias. _________ causes vasoconstriction and fluid retention which contributes to the edema seen in HG and exacerbates ______natremia ADH, hypo Natiuretic Hormones Stimulate renal excretion of sodium but are not effective in HFrEF Endothelin Inflammatory cytokine released in HFrEF that is a vasoconstrictor. Its release is an indicator of a poor prognosis. TNF Released in HFrEF. prevents the synthesis of nitric oxide, thus causing vasoconstriction, induces myocyte apoptosis, and causes weakness and weight loss. Beta Blockers Given in HFrEF to block the effects of catecholamines ACE Inhibitors and ARBS Given in HFrEF to block the effects of RAAS In remodeling, myocyte transport of calcium is _____________. Impaired _____________ resistance is a complication of HF but may also contribute to myocardial deterioriation Insulin Insulin resistance __________________ the remodeling process Enhances Glycolysis Increases in a failing heart due to an increase demand for oxygen and energy that causes the heart to be unable to metabolize fatty acids for energy as it would in normal physiology. Glycolysis in HG leads to a decrease in effective ____________ use and production. ATP Ultimately, a person with HFrEF will experience ____________ _______________ secondary to the back of blood and high pressures into the ________________ circulation Pulmonary edema, pulmonary Pulmonary edema Clinical manifestations include dyspneea, orthopnea, cough with frothy sputum, fatigue, decreased urine output, and edema. Pulmonary edema In assessment you will observe cyanosis, pulmonary rales, pleural effusions, and an S3 gallop. Hypotension or HTN may be seen. EF is normal, stroke volume is normal, cardiac output is normal but there is pulmonary congestion HFpEF Most commonly caused by HTN-induced hypertrophy or myocardial ischemia which result in remodeling HFpEF Results from the inability of the myocytes to actively pump calcium from the cytosol which impairs ventricular relaxation (diastole) HFpEF Increase in LVEDP in HFpEF increases the __________ ________ (chamber) pressure and causes an increase in the pressure in the _______________ circulation leading to _______________ edema. Left atrial, pulmonary, pulmonary The contractility of the heart is _____________ in HFpEF with ____________ filling of the ventricles. Normal, decreased synonymous with HFrEF Left-Sided HF Right ventricle is unable to adequately pump blood forward to the pulmonary circulation Right-Sided HF