Free CV-BC Exam Flashcards

During diastole, when the aortic valve closes and the myocardium relaxes. Sustained tachycardia shortens diastole, so it cuts coronary filling time at the same moment oxygen demand is rising.

S3 is an early-diastolic sound of rapid filling into a volume-overloaded, dilated ventricle, a classic sign of decompensated heart failure. S4 is a late-diastolic sound made by the atrial kick striking a stiff ventricle (hypertension, ischemia, hypertrophy), so it disappears in atrial fibrillation because organized atrial contraction is lost.

Right-sided failure backs blood into the systemic veins: jugular venous distension, positive hepatojugular reflux, hepatomegaly, ascites, and dependent edema. Left-sided failure backs blood into the lungs: crackles, exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.

Divide the higher ankle systolic pressure by the higher brachial systolic pressure. A resting ABI of 0.90 or less is diagnostic of peripheral artery disease, 0.91-0.99 is borderline, 1.00-1.40 is normal, and above 1.40 means noncompressible, calcified vessels that require toe pressures instead.

It is a standardized 11-item neurologic exam scored from 0 to 42, with higher totals meaning more severe deficit. Cardiac-vascular nurses use it to quantify and re-check stroke severity in patients at embolic risk, such as those in atrial fibrillation or after cardiac surgery.

New ST elevation at the J point in two anatomically contiguous leads: 1 mm or more in most leads. V2-V3 need more - 2 mm in men 40 and older, 2.5 mm in men under 40, and 1.5 mm in women.

The inferior wall, usually supplied by the right coronary artery. Obtain right-sided leads (especially V4R), because an accompanying right ventricular infarction makes the patient preload dependent, and nitrates or aggressive diuresis can then cause abrupt hypotension.

An irregularly irregular ventricular response with no discrete P waves and a chaotic fibrillatory baseline. Loss of the atrial kick can cut cardiac output by as much as roughly 20% to 30%, and stasis in the left atrial appendage creates embolic stroke risk.

It identifies myocardial injury, not automatically infarction; an MI diagnosis also needs ischemic symptoms or ECG or imaging evidence plus a rise and/or fall on serial draws. High-sensitivity assays allow 0/1-hour or 0/2-hour serial protocols, so a single early value should never rule out ACS by itself.

Both rise with ventricular wall stress, so low values argue strongly against acute decompensated heart failure as the cause of dyspnea. Interpret in context: obesity falsely lowers levels while age, atrial fibrillation, and renal impairment raise them, and sacubitril/valsartan raises BNP while leaving NT-proBNP usable for trending.

Altered rate or rhythm, weak or absent peripheral pulses, cool and clammy skin, narrowed pulse pressure, urine output under about 0.5 mL/kg/hr, and new restlessness or confusion. The diagnosis describes the patient's response to impaired forward flow, which is what the nurse independently monitors and treats.

Device activation within 90 minutes of first medical contact when the patient presents to a PCI-capable hospital, and within 120 minutes when transfer from a non-PCI facility is required. These are quality measures reported by STEMI-receiving centers.

When primary PCI cannot be delivered within 120 minutes of first medical contact and the patient is within 12 hours of symptom onset. The door-to-needle target is 30 minutes; screen first for active bleeding, prior intracranial hemorrhage, recent ischemic stroke, or suspected aortic dissection.

An ARNI (or an ACE inhibitor/ARB when an ARNI is not feasible), an evidence-based beta-blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor. Only bisoprolol, carvedilol, and metoprolol succinate have mortality evidence in HFrEF, so beta-blockers are not interchangeable here.

Complete medication reconciliation with a written, plain-language medication list, and arrange a follow-up visit generally within 7 days of discharge. Add weight-monitoring instructions and a symptom action plan before the patient leaves the unit.

Hold the ACE inhibitor for 36 hours before the first ARNI dose. Overlapping the two drugs stacks bradykinin effects and sharply raises angioedema risk; no washout is needed when switching from an ARB.

Phosphodiesterase-5 inhibitors: withhold nitrates for 24 hours after sildenafil or vardenafil and 48 hours after tadalafil, because the combination causes profound, refractory hypotension. Ask every chest-pain patient about these drugs before giving nitroglycerin.

Atorvastatin 40-80 mg or rosuvastatin 20-40 mg daily, the doses expected to lower LDL cholesterol by 50% or more. High-intensity therapy is started during the hospitalization regardless of the admission LDL value.

Aspirin plus a P2Y12 inhibitor for at least 12 months is the default when bleeding risk is not high; the 2025 ACC/AHA ACS guideline also allows a switch to ticagrelor monotherapy after at least 1 month of DAPT to reduce bleeding. Teach the patient never to stop the P2Y12 agent on their own, since unplanned early discontinuation drives stent thrombosis.

2.0-3.0 for atrial fibrillation, venous thromboembolism, and bioprosthetic valves; 2.5-3.5 for a mechanical mitral valve. Confirm the indication before judging whether a reported INR is therapeutic.

DOACs need no routine INR monitoring, but dosing depends on renal function, age, and weight, so creatinine clearance must be rechecked periodically. Their short half-life means a missed dose leaves the patient unprotected within a day; reversal uses idarucizumab for dabigatran and andexanet alfa for factor Xa inhibitors.

Use an in-line filter and prefer central access for concentrations above 2 mg/mL, since the drug is a peripheral vein irritant. Monitor continuously for hypotension and bradycardia during the load and slow the rate rather than stopping abruptly when blood pressure falls.

Synchronized cardioversion is for unstable tachyarrhythmias that still have a pulse, such as atrial fibrillation with rapid response, SVT, or monomorphic VT; the device times the shock to the R wave to avoid the vulnerable T-wave period. Unsynchronized defibrillation is for ventricular fibrillation, pulseless VT, and polymorphic VT.

Select and hold a constant target between 32 and 37.5 degrees Celsius for adults who do not follow commands after ROSC; the 2025 AHA guidelines call it reasonable to continue temperature control for at least 36 hours. Treat shivering, because it raises metabolic demand and defeats the temperature target.

The balloon inflates at the dicrotic notch as diastole begins, raising aortic root pressure and coronary perfusion, and deflates just before systole, dropping afterload so the left ventricle ejects against less resistance. Mistimed inflation or deflation increases, rather than decreases, ventricular workload.

Many of these patients have no palpable pulse, so pulse oximetry and automated cuffs are unreliable; obtain a mean arterial pressure using a Doppler over the brachial artery with a manual cuff. Also inspect and secure the driveline exit site at every shift, since driveline infection is a major complication.

Radial access uses a compression band with patent hemostasis; check hand color, warmth, sensation, and capillary refill, and the patient can sit up and walk sooner. Femoral access needs supine bed rest with the leg straight and head of bed low, plus checks for hematoma, distal pulses, and back or flank pain that suggests retroperitoneal bleeding.

The proceduralist explains the procedure, risks, benefits, and alternatives; the nurse witnesses the signature and verifies that consent is voluntary and that the patient can describe what was explained. If the patient cannot, stop the process and notify the provider rather than re-explaining the procedure yourself.

Apply a risk assessment on admission, mobilize early, and use pharmacologic prophylaxis such as low-molecular-weight or unfractionated heparin unless bleeding risk forbids it. When anticoagulants are contraindicated, use intermittent pneumatic compression and document why mechanical prophylaxis was chosen.

A platelet drop of 50% or more from baseline, typically 5-10 days after heparin exposure, often with new thrombosis rather than bleeding. Stop every heparin source including flushes and coated catheters, start a non-heparin anticoagulant such as argatroban or bivalirudin, and delay warfarin until platelets recover.

Amiodarone raises the serum concentration of both. The digoxin dose is usually cut by about half with level and rhythm monitoring, and the warfarin dose is reduced with more frequent INR checks because the INR climbs over the following days to weeks.

A sudden rise in vitamin K intake antagonizes warfarin and lowers the INR. Teach consistency rather than avoidance: keep weekly intake of leafy greens steady, and report any major diet change, new antibiotic, herbal product, or change in alcohol use so the INR can be rechecked.

Start only when eGFR is above 30 mL/min/1.73 m2 and potassium is below 5.0 mEq/L, then recheck potassium and creatinine within the first week after starting or raising the dose and again within the first month. Hyperkalemia is the dose-limiting adverse event: stop the MRA if potassium cannot be kept under 5.5 mEq/L, and avoid potassium-chloride salt substitutes.

Without a compelling condition, lower systolic pressure by no more than 25% in the first hour, then to under 160/100 mm Hg over the next 2-6 hours, using a titratable IV agent with continuous monitoring. Aortic dissection is the exception: systolic pressure goes below 120 mm Hg within the first hour along with heart-rate control.

A pulsatile, tender groin mass with a new systolic bruit or thrill at the access site, sometimes with expanding ecchymosis. Duplex ultrasound confirms it, and treatment is usually ultrasound-guided compression or thrombin injection rather than repeat manual pressure alone.

Abrupt dyspnea, pleuritic chest pain, tachycardia, and hypoxemia that does not fit the patient's known cardiac picture, often after immobility or recent surgery. Anticoagulation begins while the workup proceeds when bleeding risk allows; sustained hypotension marks high-risk PE and triggers consideration of thrombolysis or embolectomy.

IV thrombolysis is given within 4.5 hours of last known well in eligible patients, with a door-to-needle target of 60 minutes or less. Mechanical thrombectomy extends to 24 hours from last known well in selected large-vessel occlusions identified by advanced imaging.

Persistent hypotension, typically systolic pressure below 90 mm Hg, with hypoperfusion signs such as cool mottled extremities, oliguria, rising lactate, and altered mental status despite adequate filling. Norepinephrine is the preferred first-line vasopressor while the cause is treated and mechanical support is considered.

A gain of 2-3 pounds overnight or about 5 pounds in a week, because fluid retention shows on the scale days before dyspnea or edema appear. The number is only trustworthy under matched conditions: same scale, each morning after voiding, before breakfast, in similar clothing.

Caffeine, exercise, or smoking within 30 minutes, a full bladder, talking, crossed legs, an unsupported back or arm, and a cuff placed over clothing all push the reading up. Teach a 5-minute seated rest with the bare upper arm at heart level, then two readings a minute apart, morning and evening, averaged and logged.

Normal is under 120/80; elevated is 120-129 systolic with diastolic under 80; stage 1 is 130-139 systolic or 80-89 diastolic; stage 2 is 140 or higher systolic or 90 or higher diastolic. The 2025 AHA/ACC guideline keeps the general treatment goal below 130/80 mm Hg.

Under 2,300 mg per day, with an optimal goal near 1,500 mg (AHA/ACC). The 2022 heart failure guideline advises avoiding excessive sodium without naming one limit, so heart failure patients follow the target set by their HF team; teach label reading either way, since most sodium is added before food reaches the table.

At least 150 minutes per week of moderate-intensity aerobic activity, or 75 minutes of vigorous activity, plus muscle-strengthening work on two or more days. Any increase above baseline helps, so patients who cannot reach the target should still be encouraged to move more.

Ezetimibe first, then a PCSK9 inhibitor if LDL remains at or above 70 mg/dL. Before escalating, confirm the statin is actually taken every day and ask about muscle symptoms, because missed doses and unreported intolerance are the most common reasons LDL stays high.

Use the 5 A's - Ask, Advise, Assess, Assist, Arrange - at every contact and document it. Combining behavioral counseling with pharmacotherapy such as varenicline, nicotine replacement, or bupropion works better than either approach alone.

If chest discomfort is unimproved or worse 5 minutes after the first dose, call 911 rather than waiting through three doses; a second and third tablet may follow at 5-minute intervals while help is on the way. Sit down before dosing, let the tablet dissolve under the tongue, and keep tablets in the original light-protective bottle.

Medically supervised, monitored exercise with risk-factor education and psychosocial support, typically up to 36 sessions. Medicare covers it after events such as myocardial infarction, PCI, CABG, valve surgery, transplant, stable angina, and chronic HFrEF with an ejection fraction of 35% or less, so referral should be placed before discharge.

The clinic adjusts dosing from each INR, tracks time in therapeutic range, and reviews diet and drug interactions at every contact. Trained, stable patients can use a fingerstick point-of-care meter at home, which shortens the interval between result and dose change.

Ask the patient to explain the instruction in their own words, then reteach whatever is missing. It verifies comprehension, whereas asking 'Do you understand?' invites a yes from patients with limited health literacy who do not want to appear uninformed.

Age, sex assigned at birth, race or ethnicity, and family history cannot be changed; smoking, blood pressure, lipids, diabetes, weight, diet, and inactivity can. Family history is premature when a first-degree male relative had coronary disease before age 55 or a first-degree female relative before age 65.