1. Preload
Answer
stretch (length) of LV myocardial fibers at end diastole
2. what determines preload
Answer
venous return
3. Afterload
Answer
resistance to ventricular ejection
4. when are the coronary arteries normally perfused
Answer
during diastole (rest)
5. angina
Answer
chest pain associated with transient myocardial ischemia
6. myocardial ischemia
Answer
decrease in O2 that causes pain but NOT infarction or death
7. how is pain relieved with angina
Answer
rest and/or vasodilators (nitroglycerin)
8. stable angina pain relief
,rest or use of NTG
9. variant angina pain relief
Answer
rest, during sleep, with minimal exercise or stress
10. myocardial infarction
Answer
loss of coronary blood flow and subsequent death of myocardial cells and tissue
11. STEMI (ST Elevation Myocardial Infarction)
Answer
transmural/q-wave-involves full thickness of ventricular wall, most common with obstruction of
single coronary artery (most MI's are transmural and involve LV)
12. non-STEMI (non-ST elevation MI)
Answer
subendocardial/non-Q wave - involves inner 1/3 to 1/2 of ventricular wall - most common when
arteries are severely narrowed but still patent
13. patho of ischemia/MI
Answer
cell changes start with minutes with irreversible cell death after 20-40 minutes
14. area of necrosis
Answer
tissue has died, does not conduct electrical activity or move- will be replace with scar tissue
15. inflammatory response most at risk
Answer
4-7 days, center of infarcted area is soft/weak- may rupture
16. remodeling inflammation response
, lead to hypertrophy, loss of contractility, and heart failure
17. atypical presentation of MI common with
Answer
women and elderly
18. STEMI EKG findings
Answer
ST segment elevation
- necrotic cells become electrically inactive and cell membranes become disrupted
19. cardiac markers
Answer
enzymes and muscle proteins released from myocardial cells as they die
20. troponin
Answer
- begins to rise in 2-6 hours, peak at 12-36 hours, returns to normal in 7-10 days, found only in
heart muscle
- best practice
21. nitroglycerin
Answer
give up to 3 sublingual tabs or spray "doses" every 3-5 minutes for ongoing symptoms
22. what would you monitor while administering mitroglycerin
Answer
BP (vasodilators can lower it)
23. when should nitroglycerin not be given
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