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Chapter TenChapter Ten

Cardiovascular System Cardiovascular System

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QuoteQuote

““A good exercise for the heart is bending downA good exercise for the heart is bending down

and helping someone to get up.”and helping someone to get up.”

– – ProverbProverb

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Functions and Specialty/SpecialistFunctions and Specialty/Specialist

FunctionsFunctions Transportation of Transportation of

substancessubstances• To cellsTo cells

Oxygen, nutrients, Oxygen, nutrients, other substancesother substances

• Away from cellsAway from cells Waste productsWaste products

SpecialtySpecialty CardiologyCardiology

SpecialistSpecialist CardiologistCardiologist

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Pulmonary and Systemic CirculationPulmonary and Systemic Circulation

Role and routes of:Role and routes of: Pulmonary Pulmonary

circulationcirculation Systemic Systemic

circulationcirculation

Pulmonary and systemic circulation Pulmonary and systemic circulation

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Pulmonary and Systemic Circulation, Pulmonary and Systemic Circulation, (cont’d)(cont’d)

Vessels (vascul/o, angi/o, vas/o) Vessels (vascul/o, angi/o, vas/o) of the circulatory systemof the circulatory system Aorta (aort/o)Aorta (aort/o) Arteries (arteri/o)Arteries (arteri/o) Arterioles (arteriol/o)Arterioles (arteriol/o) Capillaries (capillar/o)Capillaries (capillar/o) Venules (venul/o)Venules (venul/o) Veins (ven/o, phleb/o)Veins (ven/o, phleb/o) Venae cavaeVenae cavae

Arteries, veins, capillaries Arteries, veins, capillaries

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Anatomy of the Heart (cardi/o, Anatomy of the Heart (cardi/o, coron/o)coron/o)

LocationLocation PrecordiumPrecordium

SizeSize Blood supplyBlood supply

Coronary arteries Coronary arteries

CoronaryCoronaryarteriesarteries

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Anatomy of the HeartAnatomy of the Heart

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Anatomy of the Heart (cont’d)Anatomy of the Heart (cont’d)

ChambersChambers Atria (atri/o)Atria (atri/o) Ventricles (ventricul/o)Ventricles (ventricul/o) Septa (sept/o)Septa (sept/o)

LayersLayers Endocardium Endocardium

(endocardi/o)(endocardi/o) Myocardium (myocardi/o)Myocardium (myocardi/o) Pericardium (pericardi/o)Pericardium (pericardi/o)

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Clicker QuestionClicker Question

The upper chambers of the heart are the:The upper chambers of the heart are the:A. arteriolesA. arterioles

B. atriaB. atria

C. venulesC. venules

D. ventriclesD. ventricles

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Blood Flow through the HeartBlood Flow through the Heart

Deoxygenated blood:Deoxygenated blood: Right atrium Right atrium tricuspid tricuspid

valve valve Right ventricle Right ventricle pulmonary pulmonary

semilunar semilunar valve valve

Pulmonary Pulmonary capillaries capillaries arteries of the arteries of the

lungs lungs

Oxygenated/deoxygenated Oxygenated/deoxygenated bloodblood

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Blood Flow through the Heart Blood Flow through the Heart (cont’d)(cont’d)

Oxygenated bloodOxygenated blood

CapillariesCapillaries pulmonarypulmonaryof lungs of lungs veinsveins

Left Left bicuspid/ bicuspid/ atrium atrium mitral valve mitral valve

LeftLeft aortic aortic ventricleventricle semilunar semilunar

valve valve

AortaAorta

Route of blood in heartRoute of blood in heart

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Did You Know?Did You Know?

A good way to remember how the blood flows A good way to remember how the blood flows through the heart valves is to memorize the through the heart valves is to memorize the phrase “Try (tri) before you buy (bi).” In the phrase “Try (tri) before you buy (bi).” In the heart, blood flows through the tricuspid valve heart, blood flows through the tricuspid valve and then through the bicuspid (mitral) valve.and then through the bicuspid (mitral) valve.

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Blood Flow through the Heart Blood Flow through the Heart (cont’d)(cont’d)

Ejection fractionEjection fraction Normal: approximately 65%Normal: approximately 65%

Heart rateHeart rate Beats per minute (BPM)Beats per minute (BPM) Normal: 60--100 bpmNormal: 60--100 bpm

Pulse pointsPulse points

Pulse pointsPulse points

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The Cardiac CycleThe Cardiac Cycle

Blood pressure (BP)Blood pressure (BP) SphygmomanometerSphygmomanometer

Electrical pathwayElectrical pathway Sinoatrial node (SA)Sinoatrial node (SA) Atrioventricular node (AV)Atrioventricular node (AV) Bundle of His/Bundle of His/

atrioventricular bundleatrioventricular bundle Purkinje fibersPurkinje fibers

Electrical conduction Electrical conduction pathways of the heart pathways of the heart

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Clicker QuestionClicker Question

The abbreviation for a normal heart rhythm is:The abbreviation for a normal heart rhythm is:A. AVA. AV

B. BPB. BP

C. NSRC. NSR

D. SAD. SA

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Terms Related to Cardiac Signs and Terms Related to Cardiac Signs and SymptomsSymptoms

Bradycardia vs. TachycardiaBradycardia vs. Tachycardia CardiodyniaCardiodynia

AtypicalAtypical IschemicIschemic

CardiomegalyCardiomegaly CyanosisCyanosis DiaphoresisDiaphoresis

ECGsECGsA, normal B, bradycardia C, tachycardiaA, normal B, bradycardia C, tachycardia

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Terms Related to Cardiac Signs and Terms Related to Cardiac Signs and Symptoms (cont’d)Symptoms (cont’d)

ClaudicationClaudication DyspneaDyspnea Dyspnea on exertion Dyspnea on exertion

(DOE)(DOE) EdemaEdema

Nausea and emesisNausea and emesis Bruit Bruit MurmurMurmur PallorPallor

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Terms Related to Cardiac Signs and Terms Related to Cardiac Signs and Symptoms (cont’d)Symptoms (cont’d)

PalpitationsPalpitations Pulmonary congestionPulmonary congestion Shortness of breath (SOB)Shortness of breath (SOB) SyncopeSyncope ThrillThrill Venous distensionVenous distension

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Clicker QuestionClicker Question

The term that means fainting is:The term that means fainting is:A. bruitA. bruit

B. diaphoresisB. diaphoresis

C. emesisC. emesis

D. syncopeD. syncope

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Terms Related to Congenital Terms Related to Congenital Disorders of the HeartDisorders of the Heart

Coarctation of the aortaCoarctation of the aorta Patent ductus arteriosus Patent ductus arteriosus

(PDA)(PDA) Septal defectSeptal defect

Atrial septal defect Atrial septal defect (ASD)(ASD)

Ventricular septal defect Ventricular septal defect (VSD)(VSD)

Tetralogy of FallotTetralogy of FallotCoarctation of the aortaCoarctation of the aorta

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Terms Related to Valvular Heart Terms Related to Valvular Heart DiseaseDisease

Aortic stenosis (AS)Aortic stenosis (AS) Mitral stenosis (MS)Mitral stenosis (MS) Tricuspid stenosis (TS)Tricuspid stenosis (TS)

Valvular heart diseaseValvular heart disease

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Terms Related to Valvular Heart Terms Related to Valvular Heart Disease (cont’d)Disease (cont’d)

Mitral regurgitation Mitral regurgitation (MR)(MR)

Mitral valve prolapse Mitral valve prolapse (MVP)(MVP)

OrthopneaOrthopnea ValvulitisValvulitis

Mitral valve prolapseMitral valve prolapse

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Terms Related to Cardiac Terms Related to Cardiac DysrhythmiasDysrhythmias

Dysrhythmia/ Dysrhythmia/ arrhythmiaarrhythmia

Ectopic beatsEctopic beats Atrial vs. VentricularAtrial vs. Ventricular

FibrillationFibrillation AtrialAtrial

• ParoxysmalParoxysmal VentricularVentricular

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Terms Related to Cardiac Terms Related to Cardiac Dysrhythmias (cont’d)Dysrhythmias (cont’d)

FlutterFlutter Heart blockHeart block

Atrioventricular blockAtrioventricular block Bundle branch block (BBB)Bundle branch block (BBB)

Sick sinus syndrome (SSS)Sick sinus syndrome (SSS) Ventricular tachycardiaVentricular tachycardia

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Did You Know?Did You Know?

Research results show that men and women often Research results show that men and women often experience different heart attack symptoms. Although experience different heart attack symptoms. Although men are more likely to experience crushing pressure men are more likely to experience crushing pressure or pain, nausea, and shortness of breath, women or pain, nausea, and shortness of breath, women may not. Many women report extreme fatigue, may not. Many women report extreme fatigue, weakness, dizziness, and a cold sweat, along with weakness, dizziness, and a cold sweat, along with shortness of breath. Unfortunately, because most shortness of breath. Unfortunately, because most women are unaware that these symptoms may signal women are unaware that these symptoms may signal a life-threatening condition, they often delay seeking a life-threatening condition, they often delay seeking medical assistance.medical assistance.

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Terms Related to Other Disorders of Terms Related to Other Disorders of Coronary CirculationCoronary Circulation

Angina pectorisAngina pectoris Coronary artery Coronary artery

disease (CAD)disease (CAD) Myocardial Myocardial

infarction (MI)infarction (MI)

MyocardialMyocardialinfarction infarction

AnginaAnginapectorispectoris

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Clicker QuestionClicker Question

Extremely rapid and irregular heartbeats:Extremely rapid and irregular heartbeats:A. ectopic beatsA. ectopic beats

B. fibrillationB. fibrillation

C. flutterC. flutter

D. angina pectorisD. angina pectoris

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Terms Related to Other Cardiac Terms Related to Other Cardiac ConditionsConditions

Cardiac tamponadeCardiac tamponade CardiomyopathyCardiomyopathy Heart failure (HF)Heart failure (HF) EndocarditisEndocarditis PericarditisPericarditis

CardiomyopathyCardiomyopathy

From the CDCFrom the CDC

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Did You Know?Did You Know?

Since 1900, cardiovascular disease has been Since 1900, cardiovascular disease has been the number one killer in the United States the number one killer in the United States every year except for 1918. Cardiovascular every year except for 1918. Cardiovascular disease claims almost 10,500 more lives disease claims almost 10,500 more lives each year than the next six leading causes of each year than the next six leading causes of death combined.death combined.

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Terms Related to Vascular DisordersTerms Related to Vascular Disorders

ArteriosclerosisArteriosclerosis AtherosclerosisAtherosclerosis

AneurysmAneurysm Esophageal Esophageal

varicesvarices HemorrhoidHemorrhoid

Atherosclerosis Atherosclerosis

From Damjanov: Pathology for the health professions, ed 3, Mosby

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Terms Related to Vascular Disorders Terms Related to Vascular Disorders (cont’d) (cont’d)

HypertensionHypertension Primary/essentialPrimary/essential SecondarySecondary MalignantMalignant

HypotensionHypotension OrthostaticOrthostatic

Peripheral arterial Peripheral arterial occlusionocclusion

Peripheral vascular Peripheral vascular disorderdisorder

Complications of hypertensionComplications of hypertension

From Damjanov: Pathology for the health professions, ed 3, MosbyFrom Damjanov: Pathology for the health professions, ed 3, Mosby

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Terms Related to Vascular Disorders Terms Related to Vascular Disorders (cont’d) (cont’d)

Raynaud diseaseRaynaud disease ThrombophlebitisThrombophlebitis

DeepDeep SuperficialSuperficial

Varicose veinsVaricose veins VasculitisVasculitis

ThrombophlebitisThrombophlebitis

From Lewis: Medical-surgical nursing, ed 7, Mosby

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Clicker QuestionClicker Question

Inflammation of a vein with formation of a clot Inflammation of a vein with formation of a clot is:is:A. varicose veinsA. varicose veins

B. thrombophlebitisB. thrombophlebitis

C. claudicationC. claudication

D. Raynaud diseaseD. Raynaud disease

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Terms Related to Benign NeoplasmsTerms Related to Benign Neoplasms

Atrial myxomaAtrial myxoma HemangiomaHemangioma

HemangiomaHemangioma

From Zitelli: Atlas of pediatric physical diagnosis, ed 5, MosbyFrom Zitelli: Atlas of pediatric physical diagnosis, ed 5, Mosby

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Terms Related to Malignant Terms Related to Malignant NeoplasmsNeoplasms

Cardiac myxosarcomaCardiac myxosarcoma HemangiosarcomaHemangiosarcoma

Cardiac myxosarcoma

From Damjanov: Pathology for the health related professions, ed 3, Mosby

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Clicker QuestionClicker Question

A cancer of the cells that line the blood A cancer of the cells that line the blood vessels:vessels:A. atrial myxomaA. atrial myxoma

B. cardiac myxosarcomaB. cardiac myxosarcoma

C. hemangiomaC. hemangioma

D. hemangiosarcomaD. hemangiosarcoma

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Age MattersAge Matters

PediatricsPediatrics Congenital disordersCongenital disorders

GeriatricsGeriatrics HypertensionHypertension CADCAD MIMI ArrhythmiasArrhythmias PVDPVD

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Terms Related to General Diagnostic Terms Related to General Diagnostic ProceduresProcedures

Blood pressureBlood pressure SphygmomanometerSphygmomanometer

Auscultation and Auscultation and percussionpercussion StethoscopeStethoscope

SphygmomanometerSphygmomanometer

From the CDCFrom the CDC

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Terms Related to ImagingTerms Related to Imaging

EchocardiographyEchocardiography Transesophageal echocardiographyTransesophageal echocardiography

Exercise stress test Exercise stress test (EST)(EST)

Magnetic resonance Magnetic resonance imaging (MRI)imaging (MRI)

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Terms Related to Imaging (cont’d)Terms Related to Imaging (cont’d)

MUGA scanMUGA scan Myocardial perfusion Myocardial perfusion

imagingimaging Positron emission Positron emission

tomography (PET)tomography (PET) RadiographyRadiography PhlebographyPhlebography

MUGA scanMUGA scan

From Frank et al: Merrill’s atlas, ed 11, Mosby From Frank et al: Merrill’s atlas, ed 11, Mosby

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Terms Related to Imaging (cont’d)Terms Related to Imaging (cont’d)

AngiocardiographyAngiocardiography Digital subtraction Digital subtraction

angiography (DSA)angiography (DSA)

DSADSA From Frank et al: Merrill’s atlas, ed 11, MosbyFrom Frank et al: Merrill’s atlas, ed 11, Mosby

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Terms Related to Imaging (cont’d)Terms Related to Imaging (cont’d)

Cardiac catheterizationCardiac catheterization Swan-Ganz catheterSwan-Ganz catheter

Cardiac catheterizationCardiac catheterization

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Terms Related to Imaging (cont’d)Terms Related to Imaging (cont’d)

Electrocardiography Electrocardiography (ECG/EKG)(ECG/EKG)

Holter monitorHolter monitor

Holter monitor

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Terms Related to Laboratory TestsTerms Related to Laboratory Tests

Cardiac enzymes testsCardiac enzymes tests Lipid profileLipid profile PhlebotomyPhlebotomy

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Clicker QuestionClicker Question

What is the term for a portable EKG?What is the term for a portable EKG?A. angiocardiographyA. angiocardiography

B. digital subtraction angiographyB. digital subtraction angiography

C. Holter monitorC. Holter monitor

D. myocardial perfusion imagingD. myocardial perfusion imaging

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Terms Related to Cardiac Terms Related to Cardiac ProceduresProcedures

AtherectomyAtherectomy Laser angioplastyLaser angioplasty

Automatic implantable cardioverter-Automatic implantable cardioverter-defibrillator (AICD)defibrillator (AICD)

Cardiac defibrillatorCardiac defibrillator Cardiopulmonary Cardiopulmonary

resuscitation (CPR)resuscitation (CPR) CommissurotomyCommissurotomy

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Terms Related to Cardiac Terms Related to Cardiac Procedures (cont’d)Procedures (cont’d)

Cardiac pacemakerCardiac pacemaker

Pacemakers Pacemakers

From Frank et al: Merrill’s atlas, ed 11, Mosby

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Terms Related to Cardiac Terms Related to Cardiac Procedures (cont’d)Procedures (cont’d)

Coronary artery bypass graft (CABG)Coronary artery bypass graft (CABG)

CABGCABG

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Terms Related to Cardiac Terms Related to Cardiac Procedures (cont’d)Procedures (cont’d)

Extracorporeal circulation (ECC)Extracorporeal circulation (ECC) Heart transplantationHeart transplantation Left ventricular assist device (LVAD)Left ventricular assist device (LVAD) Minimally invasive direct coronary artery Minimally invasive direct coronary artery

bypass (MIDCAB)bypass (MIDCAB)

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Did You Know?Did You Know?

Every year more than 2000 Americans receive a Every year more than 2000 Americans receive a heart transplant. Many more candidates die heart transplant. Many more candidates die each year for lack of donor organs. Research each year for lack of donor organs. Research continues in the development of an artificial continues in the development of an artificial heart.heart.

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Clicker QuestionClicker Question

The C in CABG stands for:The C in CABG stands for:A. cardiacA. cardiac

B. circulationB. circulation

C. coronaryC. coronary

D. corporealD. corporeal

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Terms Related to Cardiac Terms Related to Cardiac Procedures (cont’d)Procedures (cont’d)

Percutaneous transluminal coronary Percutaneous transluminal coronary angioplasty (PTCA)angioplasty (PTCA) stentstent

PTCAPTCA

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Terms Related to Cardiac Terms Related to Cardiac Procedures (cont’d)Procedures (cont’d)

PericardiocentesisPericardiocentesis Port-access coronary artery bypass (PACAB)Port-access coronary artery bypass (PACAB)

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Terms Related to Cardiac Terms Related to Cardiac Procedures (cont’d)Procedures (cont’d)

Radiofrequency Radiofrequency catheter ablation catheter ablation (RFA)(RFA)

Transmyocardial Transmyocardial revascularization revascularization (TMR)(TMR) AngiogenesisAngiogenesis

ValvuloplastyValvuloplastyValvuloplastyValvuloplasty

From Black and Hawks, Medical-surgical nursing, ed 7, SaundersFrom Black and Hawks, Medical-surgical nursing, ed 7, Saunders

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Terms Related to Vascular Terms Related to Vascular ProceduresProcedures

Endovenous laser ablation (EVLT)Endovenous laser ablation (EVLT) HemorrhoidectomyHemorrhoidectomy Peripherally inserted central catheter (PICC)Peripherally inserted central catheter (PICC) PhlebectomyPhlebectomy SclerotherapySclerotherapy

MicrosclerotherapyMicrosclerotherapy

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Clicker QuestionClicker Question

What is the term for a surgical puncture of the What is the term for a surgical puncture of the sac surrounding the heart?sac surrounding the heart?A. RFAA. RFA

B. TMRB. TMR

C. PTCAC. PTCA

D. pericardiocentesisD. pericardiocentesis

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PharmacologyPharmacology

Angiotensin-converting enzyme (ACE) Angiotensin-converting enzyme (ACE) inhibitorsinhibitors

Angiotension II receptor blocker (ARB) drugsAngiotension II receptor blocker (ARB) drugs Antiarrhythmic drugsAntiarrhythmic drugs AnticoagulantsAnticoagulants AntihyperlipidemicsAntihyperlipidemics

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Pharmacology (cont’d)Pharmacology (cont’d)

Beta-blockersBeta-blockers Calcium channel blockers (CCBs) Calcium channel blockers (CCBs) DiureticsDiuretics

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Pharmacology (cont’d)Pharmacology (cont’d)

Nitrates (antianginals)Nitrates (antianginals) Routes of administrationRoutes of administration

• SublingualSublingual

• IntravascularIntravascular

• TransdermalTransdermal

ThrombolyticsThrombolytics

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Clicker QuestionClicker Question

Which type of drug is used to lower Which type of drug is used to lower cholesterol levels?cholesterol levels?A. antihyperlipidemicsA. antihyperlipidemics

B. ACE inhibitorsB. ACE inhibitors

C. beta-blockersC. beta-blockers

D. nitratesD. nitrates

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Sort these terms into their correct Sort these terms into their correct categoriescategories

TermsTerms

1. syncope1. syncope

2. extracorporeal circulation2. extracorporeal circulation

3. tetralogy of Fallot3. tetralogy of Fallot

4. phlebotomy4. phlebotomy

5. diastole5. diastole

CategoriesCategories

__ A+P__ A+P

__ Pathology__ Pathology

__ Diagnostic Procedures__ Diagnostic Procedures

__ Therapeutic __ Therapeutic InterventionsInterventions

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Parting ThoughtParting Thought

““The challenge is in the moment; the time isThe challenge is in the moment; the time is

always now.”always now.”

– –James James BaldwinBaldwin