NR 507 CARDIOVASCULAR EXAM QUESTIONS
AND ANSWERS UPDATED (2024/2025)
(VERIFIED ANSWERS)
CAD should strongly be suspected and further testing to assess the extent of
the patient's disease including: - ANS ✓Electrocardiogram (ECG), cardiac
enzymes & troponin, lipids, and cardiac stress test. In most cases, the patient will
be referred to and co-managed by a cardiologist. Treatment will include both
non-pharmacological and pharmacological management of the disease.
Heart Failure - ANS ✓Heart failure is a very complex disease state that can be
the result of structural or functional impairment of the heart, which then leads to
the heart's impaired ability to fill or eject sufficient amounts of blood out to the
body. Let's review some basic concepts related to this disease:
-Cardiac Output (CO): The amount of blood that the heart pumps in 1
minute. CO is also known as cardiac contractility.
-CO Formula: CO=heart rate (HR) x stroke volume (SV).
-SV: The volume of blood pumped out of the left ventricle during each
systolic cardiac contraction.
-Afterload: The force, or load, which the heart must contract against in
order to pump blood. Afterload is also known as systemic vascular
resistance (SVR).
-Preload: The amount of stretch that the cardiac muscle exhibits at the end
of ventricular filling.
Not all patients present with the same signs and symptoms of heart failure
and symptoms are dependent upon which side of the heart is affected. Let's
discuss the difference.
Right-sided Heart Failure - ANS ✓-Right ventricle
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-Superior vena cava (preload)
-Pulmonary artery (afterload)
Let's shift to right heart failure (Cor Pulmonale). This is defined as the
inability of the right ventricle to provide adequate blood flow into the
pulmonary circulation.
Causes of right heart failure include:
1) pulmonary disease that causes pulmonary hypertension. This is the most
common cause;
2) right ventricular myocardial infarction (MI), which weakens the cardiac
muscle;
3) right ventricular hypertrophy (secondary to cardiac damage);
4) tricuspid valve damage (causing backflow of the blood into the right
atrium or right ventricle after ejection);
5) secondary failure as a result of left heart failure due to the build-up of
pressure in the damage left ventricle.
Since pulmonary hypertension is the most common cause of right-sided
heart failure, it will be used to outline the disease process. Again, keep in
mind that regardless of the cause of right heart failure, the overall process
outlined here will be the same.
High pulmonary vascular pressure (increased afterload) will cause an
increased right ventricular contraction force in order to eject the blood.
Overtime, this will reduce the ejection fraction and the right ventricle will
be unable to eject the normal amount of blood. This will increase the
amount of blood remaining in the right ventricle and, as a result, increase
right ventricular preload, resulting in the inability for the right atrium to
eject the normal amount of blood into the right ventricle. This will increase
the amount of blood remaining in the right atrium and, therefore, increase
right atrial preload. This causes the back-up of blood volume and pressure
in the vena cava and systemic veins.
NR 507
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