Cardiovascular
NCLEX Clinical Study Booklet · 12 cards
Hypertension.
VascularWhat is Hypertension?
- Persistently elevated BP ≥130/80 mmHg — the 'silent killer'.
- Increases cardiac workload and damages blood vessels over time.
What are the Causes / Risk Factors?
- Primary (idiopathic) — most common
- Obesity, high-sodium diet
- Smoking, excess alcohol
- Sedentary lifestyle, stress
- Family history, older age
- Secondary: renal or endocrine disease
What are the Symptoms?
- Often asymptomatic
- Headache (occipital, morning)
- Dizziness, blurred vision
- Epistaxis
- Chest pain / dyspnea (advanced)
How is it Diagnosed?
- BP ≥130/80 on 2+ visits
- Assess target organs (eye, heart, kidney)
- Labs: lipids, glucose, renal function
- ECG
What is the Treatment?
- DASH diet, ↓sodium, exercise, weight loss
- Diuretics, ACE/ARB, CCB, beta blockers
- BP monitoring; adherence teaching
- Do not stop meds abruptly (rebound)
NCLEX TipHTN is usually asymptomatic — stress medication adherence even when the patient feels fine.
Coronary Artery Disease.
VascularWhat is Coronary Artery Disease?
- Narrowing of coronary arteries by atherosclerotic plaque.
- Reduces blood flow and oxygen to the myocardium.
What are the Causes / Risk Factors?
- Hyperlipidemia (↑LDL)
- Hypertension
- Smoking
- Diabetes
- Obesity, inactivity
- Family history
What are the Symptoms?
- Often asymptomatic early
- Angina on exertion
- Dyspnea
- Fatigue
How is it Diagnosed?
- Lipid panel
- Stress test, ECG
- Coronary angiography (gold standard)
- Coronary calcium score
What is the Treatment?
- Risk-factor & lifestyle modification
- Statins, antiplatelet (aspirin)
- Nitrates, beta blockers
- PCI/stent or CABG if severe
NCLEX TipFocus teaching on modifiable risks: smoking, lipids, BP, diabetes, weight, activity.
Angina Pectoris.
CardiacWhat is Angina Pectoris?
- Chest pain from myocardial ischemia (O₂ demand exceeds supply).
- Stable = predictable, relieved by rest/nitro. Unstable = at rest, worsening.
What are the Causes / Risk Factors?
- CAD / atherosclerosis
- Exertion, stress, cold, heavy meals
- Coronary spasm (Prinzmetal)
What are the Symptoms?
- Substernal pressure / tightness
- Radiation to left arm, jaw, back
- Dyspnea, diaphoresis
- Relieved by rest & nitroglycerin (stable)
How is it Diagnosed?
- ECG (ST depression during pain)
- Stress test
- Troponin (normal in angina)
- Angiography
What is the Treatment?
- Stop activity, rest
- Nitroglycerin SL — up to 3 doses q5min; call 911 if unrelieved
- O₂, beta blockers, CCB
- Treat underlying CAD
NCLEX TipUnstable angina (pain at rest or worsening) is an emergency — rule out MI.
Myocardial Infarction.
EmergencyWhat is Myocardial Infarction?
- Death of myocardial tissue from prolonged ischemia (blocked coronary artery).
- A medical emergency — 'time is muscle'.
What are the Causes / Risk Factors?
- Coronary thrombosis on ruptured plaque
- Severe CAD
- Coronary spasm or embolism
What are the Symptoms?
- Crushing chest pain >20 min, NOT relieved by rest/nitro
- Radiation to left arm/jaw
- Diaphoresis, nausea/vomiting
- Dyspnea, anxiety / impending doom
- Atypical in women, elderly, diabetics
How is it Diagnosed?
- ECG: ST elevation (STEMI) / ST-T changes
- ↑Troponin (most specific), CK-MB
- Monitor for dysrhythmias
What is the Treatment?
- MONA: Morphine, O₂, Nitro, Aspirin (chewed)
- Reperfusion: PCI ≤90 min or thrombolytics
- Beta blockers, statins, anticoagulation
- Continuous cardiac monitoring; rest
NCLEX TipMI pain is NOT relieved by rest or nitro. Give chewable aspirin and get reperfusion fast.
Heart Failure.
CardiacWhat is Heart Failure?
- The heart cannot pump enough blood to meet the body's needs.
- Left-sided → pulmonary congestion; right-sided → systemic congestion.
What are the Causes / Risk Factors?
- CAD, prior MI
- Chronic hypertension
- Valvular disease
- Cardiomyopathy
- Dysrhythmias
What are the Symptoms?
- LEFT: dyspnea, orthopnea, crackles, frothy sputum, PND
- RIGHT: JVD, peripheral edema, weight gain, ascites
- Fatigue, ↓activity tolerance
How is it Diagnosed?
- ↑BNP (key marker)
- Echocardiogram (ejection fraction)
- CXR: cardiomegaly, congestion
- Daily weight
What is the Treatment?
- ACE/ARB, beta blockers, diuretics, digoxin
- Restrict sodium & fluids
- Daily weight; report >2–3 lb/day gain
- High Fowler's, O₂; monitor I&O
NCLEX TipLeft-sided HF = Lung congestion; Right-sided = Rest of body (edema, JVD). BNP confirms.
Atrial Fibrillation.
RhythmWhat is Atrial Fibrillation?
- Rapid, disorganized atrial activity — an 'irregularly irregular' rhythm.
- Blood pools in the atria → clot and stroke risk.
What are the Causes / Risk Factors?
- HTN, HF, CAD
- Valvular disease
- Hyperthyroidism
- Alcohol, caffeine, stress
What are the Symptoms?
- Palpitations
- Irregular pulse
- Fatigue, dyspnea
- Dizziness
- Signs of ↓cardiac output
How is it Diagnosed?
- ECG: no clear P waves, irregular R-R
- Apical–radial pulse deficit
- Echo, electrolytes, TSH
What is the Treatment?
- Rate control: beta blockers, CCB, digoxin
- Rhythm control: antiarrhythmics, cardioversion
- Anticoagulation (warfarin/DOAC)
- Ablation if refractory
NCLEX TipA-fib's biggest danger is a clot causing a stroke — anticoagulation is essential.
Infective Endocarditis.
CardiacWhat is Infective Endocarditis?
- Infection of the endocardium and heart valves, usually bacterial.
- Vegetations form on valves → embolism risk.
What are the Causes / Risk Factors?
- IV drug use
- Prosthetic or damaged valves
- Recent dental/invasive procedures
- Central venous lines
What are the Symptoms?
- Fever, chills, night sweats
- New or changed heart murmur
- Petechiae, Osler nodes, Janeway lesions, splinter hemorrhages
- Fatigue, embolic events
How is it Diagnosed?
- Blood cultures (multiple sets)
- Echocardiogram (vegetations)
- ↑ESR/CRP, WBC
What is the Treatment?
- Long-term IV antibiotics (4–6 weeks)
- Prophylactic antibiotics before procedures (high-risk)
- Valve surgery if severe
- Monitor for emboli and HF
NCLEX TipHigh-risk patients need prophylactic antibiotics before dental and invasive procedures.
Pericarditis.
CardiacWhat is Pericarditis?
- Inflammation of the pericardial sac around the heart.
- May progress to effusion and cardiac tamponade.
What are the Causes / Risk Factors?
- Viral or bacterial infection
- Post-MI (Dressler syndrome)
- Autoimmune (lupus, RA)
- Uremia, malignancy
What are the Symptoms?
- Sharp, pleuritic chest pain — WORSE lying down, BETTER sitting/leaning forward
- Pericardial friction rub
- Fever
- Dyspnea
How is it Diagnosed?
- ECG: diffuse ST elevation
- Echo (effusion)
- ↑ESR/CRP
What is the Treatment?
- NSAIDs, colchicine
- Treat underlying cause
- Position upright / leaning forward
- Monitor for tamponade
NCLEX TipPericarditis pain improves leaning forward — opposite of MI. Watch for tamponade.
Cardiac Tamponade.
EmergencyWhat is Cardiac Tamponade?
- Fluid in the pericardial sac compresses the heart.
- Impairs ventricular filling → falling cardiac output. Emergency.
What are the Causes / Risk Factors?
- Pericarditis / effusion
- Chest trauma
- Post-cardiac surgery
- Malignancy
What are the Symptoms?
- Beck's triad: ↓BP, JVD, muffled heart sounds
- Pulsus paradoxus
- Tachycardia
- Dyspnea, anxiety
How is it Diagnosed?
- Echocardiogram (definitive)
- ECG: low voltage, electrical alternans
- CXR: enlarged cardiac silhouette
What is the Treatment?
- Pericardiocentesis (emergency drainage)
- IV fluids to support filling
- Hemodynamic monitoring
- Treat the cause
NCLEX TipBeck's triad (hypotension, JVD, muffled heart sounds) = tamponade → pericardiocentesis.
Peripheral Arterial Disease.
VascularWhat is Peripheral Arterial Disease?
- Atherosclerotic narrowing of peripheral (usually leg) arteries.
- Reduced arterial blood flow to the extremities.
What are the Causes / Risk Factors?
- Atherosclerosis
- Smoking (major)
- Diabetes
- HTN, hyperlipidemia
What are the Symptoms?
- Intermittent claudication (pain walking, relieved by rest)
- Cool, pale, shiny, hairless skin
- ↓ or absent pulses
- Pain worse elevated, better dependent
How is it Diagnosed?
- Ankle-brachial index (ABI)
- Doppler ultrasound
- Angiography
What is the Treatment?
- Smoking cessation, walking program
- Antiplatelets, statins, cilostazol
- Keep legs DEPENDENT (dangle)
- Meticulous foot care; avoid injury
NCLEX TipArterial = pain with activity, pulses down, legs DEPENDENT. Venous is the opposite (elevate).
Deep Vein Thrombosis.
VascularWhat is Deep Vein Thrombosis?
- A blood clot in a deep vein, usually of the leg.
- Can dislodge and travel to the lungs (pulmonary embolism).
What are the Causes / Risk Factors?
- Virchow's triad: stasis, hypercoagulability, vessel injury
- Immobility, recent surgery
- Pregnancy, oral contraceptives
- Cancer, obesity
What are the Symptoms?
- Unilateral calf swelling, warmth, redness
- Pain / tenderness
- May be asymptomatic
How is it Diagnosed?
- Venous duplex ultrasound
- D-dimer
- Assess for PE (sudden dyspnea, chest pain)
What is the Treatment?
- Anticoagulation (heparin → warfarin/DOAC)
- Do NOT massage the leg
- Elevate; compression stockings; early ambulation (prevention)
- Monitor for PE
NCLEX TipNever massage a suspected DVT — it can dislodge and cause a pulmonary embolism.
Cardiogenic Shock.
EmergencyWhat is Cardiogenic Shock?
- The heart fails to pump enough blood for tissue perfusion.
- Often follows a massive MI; high mortality.
What are the Causes / Risk Factors?
- Large myocardial infarction
- End-stage heart failure
- Serious dysrhythmias
- Cardiac tamponade
What are the Symptoms?
- Hypotension
- Tachycardia, weak pulses
- Cool, clammy, mottled skin
- ↓ urine output
- Altered mental status, pulmonary edema
How is it Diagnosed?
- Hemodynamic monitoring (↓CO, ↑PCWP)
- ECG, troponin
- Echo; ABG / lactate
What is the Treatment?
- Inotropes (dobutamine), vasopressors
- Treat the cause (reperfusion for MI)
- Intra-aortic balloon pump / mechanical support
- O₂; monitor perfusion & urine output
NCLEX TipCardiogenic shock is pump failure — support perfusion and treat the cause (usually MI).
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