AC 3 Exam 1 Flashcards
What’s the normal range for PRI?
0.12 - 0.2 seconds
What’s the normal range for QRS?
0.04 - 0.12 seconds
What does SVT stand for?
Supraventricular tachycardia = above the ventricle tachycardia
Rapid stimulation of atria
What’s paroxysmal SVT?
Sudden start & stop of SVT
No intervention
How is SVT treated?
- Vagus nerve stimulation
- 6 mg adenosine
- 12 mg adenosine
- Synchronized cardiovert
What first line medication is used to treat SVT?
Adenosine
What determines the severity of SVT symptoms?
Ventricular response; rapid ventricular rate = more severe the symptoms
What’s the last resort treatment for persistent, recurrent SVT?
EP study with radiofrequency ablation
What are the desired outcomes of SVT treatment?
Decrease ventricular rate
Convert to NSR
Treat underlying cause
What other medications can be used to treat/manage SVT other than adenosine?
Beta Blockers
Calcium channel blockers (Cardizem, verapamil, -dipines)
What are some causes of PVCs?
MI, CHF, COPD, anemia, hypokalemia, hypomagnesemia, anesthesia, stress nicotine, caffeine, alcohol, infection, surgery, post-menopause with caffeine
When are we concerned about PVCs?
If > 6 PVCs/min consistently
How are PVCs treated?
Treat the underlying cause
What are some causes of VTach?
Ischemic heart disease, MI, HF, drug toxicity, hypotension, illicit drugs
What medication is used to treat VTach with a pulse?
Amiodarone; 150mg first and if that doesn’t work, 300mg
What medication is used to treat VTach without a pulse?
Epinephrine
What medication is given to Torsades de Pointes?
Magnesium sulfate
Pt comes to the ED with chest pain, palpitations, dizziness, and SOB. When the nurse got the EKG, it showed VTach but the pt still has a pulse and their BP is stable. What do you do?
O2, Amiodarone.
Ablation if nothing works
Pt is in VTach, was stable, so they got O2 and amio. But now their BP is 90/52. They still have a pulse. What do you need to do?
300mg Amio if not administered
Synchronized cardioversion at bedside
Pt who came in with VTach now does not have a pulse. What should you do?
Start CPR
Defibrillate
Pt is in VFib. Does that pt have pulse?
No. Along with that, no respirations, no perfusion because their cardiac output is shit due to heart not contracting
What kind of shock are you delivering to VTach pt with a pulse?
Synchronized cardiovert
What kind of shock are you delivering to VTach pt without a pulse?
Defib
What kind of shock are you delivering to VFib pt?
Defib
When doing CPR, how often should you check for ROSC?
Q2min
What can cause VFib?
CAD, MI, hypokalemia or magnesemia, hemorrhage, drug therapy, SVT, shock, surgery, trauma
What medications can you give to asystole patients?
Atropine
Epinephrine
Possibly vasopressin
What are some causes of asystole?
MI, HF, severe hyperkalemia (this is why we don’t IV push hard for K+)
Acidosis
What AV node block is usually asymptomatic?
1st degree AV block
What can increased vagal stimulation cause (EKG wise)?
Second degree AV block type 1
How is second degree AV block type 1 treated when pt is asymptomatic?
No treatment. monitor for s/s of impaired perfusion
How are heart blocks treated?
Same as bradycardia; but correct underlying condition
1. O2
2. Atropine
3. Epinephrine
4. Transcutaneous/permanent pacing
Why is atropine used to treat heart blocks?
It increases HR and therefore increases cardiac output -> better perfusion
When is transcutaneous pacing needed for heart block pts?
When they are symptomatic and BP drops
Why is Mobitz 2 more serious than Mobitz 1?
Because more beats are dropped
What are some symptoms of Mobitz 2?
LIghtheaded, dizzy, hypotension, syncope
Why is pacing needed in heart block pts?
AV node is blocked; SA and AV can’t communicate, which means atria and ventricles can’t really communicate for effective contractions leading to poor perfusion.
How does 3rd degree AV block (complete heart block) look like?
Atria sending impulses but ventricles never hear them
No pattern, PRI not consistent
What are some symptoms of complete heart block (3rd degree AV block)?
Severe fatigue, dyspnea, CP, lightheaded, mental status changes, loss of consciousness, hypotension, pale, diaphoretic
What’s the ultimate treatment for 3rd degree AV block (complete heart block)?
Permanent pacemaker
When does Coronary Artery Disease (CAD) and Coronary Heart Disease (CHD) start?
In 20s; building cholesterol in blood vessels
What’s metabolic syndrome?
Any disease/condition that affects metabolism
Ex) diabetes, obesity, kidney injury, CAD, etc
Who’s at risk for metabolic syndrome?
Pre-diabetic/diabetic patients
Sedentary life style
Who are the key players to aid patients with or has the possibility of metabolic syndrome?
Primary care (annual physical usually reveals)
Cardiology (if pt already sees them)
When a pt has MI, what do we want to do ASAP?
EKG within 10 minutes
Procedure/treat within 90 minutes
What does stable angina mean?
CP is predictable; for instance, CP with exertion and relieved by nitro/rest
What causes chronic stable angina?
Fixed atherosclerotic plaque; exertion makes blood vessels contract. If there’s a plaque in place and blood vessels get squeezed, that’s going to hurt. That’s CP
What kind of angina responds to nitro?
Stable angina
What medications are used to manage chronic stable angina?
Aspirin
Statins
Beta-blockers
Calcium channel blockers
Nitrates
What’s Acute Coronary Syndrome (ACS)?
Unstable angina
Acute MI
What’s the patho behind ACS?
Atherosclerotic plaque ruptures and platelets congregate and form a clot, resulting in vasoconstriction
What are some symptoms of unstable angina?
CP at rest or with exertion
Severely limited activity
CP not relieved by nitro
What EKG changes are expected in unstable angina?
St & T wave change
Pt in the ED has CP at rest and nitro is not helping. Suspecting MI, their blood work was normal and did not show anything related to MI. What does that mean?
No MI yet but it’s a precursor
Ischemia is there but no MI yet; that pt will get an MI if not treated
What’s the difference between STEMI and NSTEMI?
STEMI = blocking/occlusion
NSTEMI = narrowing
When should STEMI be treated?
Within 6 hours
What pt education need to be done if they are at a risk for an MI?
TIme = tissue
Get help right away if experience CP
Why is morphine used to treat pain caused by acute MI?
Fentanyl is too potent
Morphine has slight vasodilating effect
Pain will not be relieved if it’s not an opioid
Why is NSTEMI more common in women and STEMI more common in men?
Generally, women have smaller vasculature so it gets narrower faster I guess
In what order should you give medications for acute MI?
Aspirin
Oxygen
Nitro
Morphine
Beta-blocker can be added
What labs are collected to confirm an acute MI?
CK (inflammatory)
CK-MB (inflammatory marker specific to heart muscle)
Troponin I or Y
Myoglobin (damaged muscle)
Why is the left anterior descending coronary artery called the “widow maker”?
This one feeds the left ventricle. If this dies, you are not pumping blood to the body and you die
Why is the femoral artery used when doing cardiac cath with percutaneous coronary intervention (PCI)?
Femoral artery is big so it’s hard to miss
How long should pt be at bedrest after a cardiac cath through femoral artery?
6 hours flat/straight
Pt had a cardiac cath through radial approach. How should you position them?
No flat bedrest
Limit use of affected limb
What should you assess for after a cardiac cath?
Bleeding, hematoma
Diminished/absent pulses or poor capillary refill
Your pt just had a cardiac cath with femoral approach and is now in bed. pt reports increasing back pain and sudden inability to urinate. Upon assessment, their abdomen is distended. What do you think is happening?
Retroperitoneal bleed; bleeding where kidneys are
Therefore urine output decreases and bruising on back
What medications will a pt be on post MI?
Statins
ACE inhibitors/ARBs
Beta blockers
Antiplatelet agents
What are some contraindications for beta blockers?
Bradycardia
Hypotension
Asthma
Hypoglycemia for diabetic pt
Why is there a risk of dysrhythmias after a CABG?
They stop your heart during surgery and start back. When that happens, the heart is not happy and throws dysrhythmias
Atelectasis management
IS Q10 min every hour when awake
Turn, deep breathe, cough
How much drainage post CABG should you report?
Over 150 ccs all tubes total
What does stenosis mean?
Narrowing/hardening
Does not open fully
Regurgitation?
Does not close fully
What kind of heart sounds are expected in mitral regurgitation?
Loud holosystolic murmur
What kind of heart sounds are expected in aortic stenosis?
Harsh systolic murmur, S4
Why can’t we give nitro/vasodilator to pt with stenosis?
Stenosis is like a small opening of a big garden hose. If we were to vasodilate, that small hole will not handle all the blood flow caused by the vasodilator
What kind of heart sounds are expected in mitral stenosis?
Diastolic murmur
What is the most common cause of mitral stenosis?
Rheumatic fever
Where is the mitral valve located?
Between left atria and left ventricle
What are some symptoms of mitral stenosis?
S/s HF, A fib comes with it
What causes stenosis?
Wear & tear
CAD
Uncontrolled BP
Why does the left ventricle hypertrophy when there’s aortic stenosis?
Stenosis, because it’s like a tiny hole for a big hose, it causes a lot of pressure
Why are both stenosis and regurgitation pt at risk of MI?
Because of decreased perfusion
Why is checking gag and cough reflex important after pt wakes up from anesthesia
It’s for swallowing and to see if they are protecting their away
What medications are used to treat/manage HF?
ACE inhibitors
Diuretics
Beta-blockers
Digoxin
O2
CCBs
Valve replacement increases a risk of
Infective endocarditis
What important pt teaching is needed for valve disease patients?
Let doctor know before getting invasive dental or oral procedure so you can get prophylactic antibiotic therapy prior to it.
Bacteria from teeth can travel to the heart, causing endocarditis
What 3 electrolytes should you monitor post cardiac surgery?
Potassium (cardiac dysrhythmia)
Magnesium (cardiac dysrhythmia; torsades de pointes)
Calcium (goes together with magnesium)
Why is maintaining stable, consistent BP important post cardiac surgery?
Hypertension will cause leaking from graft site and possible tearing
Hypotension can cause graft to collapse
Why is body temperature regulation important post cardiac surgery?
Cold -> vasoconstricts
Hot -> vasodilates
No sudden change of body temperature. maintain normal range
Why are infective endocarditis pts so sick?
They experience HF symptoms + has to fight infection
What are the 4 physical symptoms of infective endocarditis?
Olser’s nodes (painful and palpable red nodules on hands)
Janeway lesions (painless red dots on feet)
Rothe spots (spots in optic nerve)
Splinter hemorrhages (fingernail)
Infective endocarditis pt may have low hct & hgb. why?
Vegetation of the valve blocks circulation, leading to poor perfusion. So kidneys are not getting enough blood; that’s what sends things to bone marrow to make RBCs
How is infective endocarditis treated?
High does abx through central line
Contact precautions: MRSA (blood cultures)
Anticoagulants to prevent septic emboli
Valve repair/replacement
Monitor H&H, electrolytes, perfusion, VS, etc
What are some examples of typical HF meds?
Furosemide (diuretic)
Amlodipine (CCB)
Potassium chloride
Metoprolol (Beta blocker)
What is the cause of pericarditis?
Acute: infection or MI
Chronic: TB, radiation, trauma, renal failure, metastatic cancer
What happens during pericarditis to the pericardium that affects cardiac contractility?
Pericardium stiffens, causing more resistance, which prevents filling of ventricles and difficulty contracting
How do you tell the difference between pleural friction rub & pericardial friction rub?
Lean forward, hold breath, and listen
If hearing anterior, pleural friction rub
If hearing posterior, pericardial friction rub
What are some symptoms of pericarditis?
Substernal pain aggravated on inspiration, coughing, swallowing
Pericardial friction rub
EKGs with ST elevation in all leads
How does ST elevation in all EKG leads indicate pericarditis?
That means there’s irritation/inflammation all over; pericarditis affects the entire heart since the pericardium is like a protective layer of the heart
What medications are used to treat pericarditis?
NSAIDs
Corticosteroids
Antibiotics
Colchicine for 3 months for prevention (decreases the production of inflammatory fluids)
What are 2 surgical treatment options for pericarditis?
Pericardiectomy (total removal of pericardium)
Pericardial window (partial removal)
What’s the Beck’s triad for cardiac tamponade?
Hypotension
Muffled heart sounds
JVD
Treatment of dilated cardiomyopathy focuses on
Enhancing contractility and decreasing the workload for the heart
What medications are used to treat/manage dilated cardiomyopathy?
Digoxixn, positive inotropes (dopamine, dobutamine), milrinone
All these meds increases contractility
What are 2 surgical treatment/management options for dilated cardiomyopathy?
VAD, transplant
Why is it important for hypertrophic cardiomyopathy patients to drink lots of fluids and maintain hydration?
Hypertrophic CM is a volume issue; the cardiac wall is too thick so not much can be pumped out to the body. Therefore, to maintain and keep up with body’s needs, more fluids are needed to adequately perfuse the body
Why is beta blocker needed to treat/manage hypertrophic CM?
Beta blockers slows down the heart; hypertrophic CM patients already pumps less than normal people. If HR is too fast, not allowing that small left ventricle to fill up, body will not perfuse adequately. That’s why we want them to avoid strenuous activity
What are some interventions for PAD?
Gradual exercise
No vasoconstriction; avoid raising legs above heart, avoid crossing legs, etc
Inspect feet daily
Promote vasodilation; moist warmth to extremities, prevent long cold exposure, no direct heat
Avoid stress, caffeine, nicotine
When is exercise contraindicated to PAD patients?
If they have severe rest pain, venous ulcers, or gangrene
What medications are used to treat PAD?
Antiplatelets
Antihypertensives (more squeeze to blood vessels is not good)
Statins
Why is beta blocker not used to treat PAD?
Could worsen intermittent claudication
What are some post-op care for femoral bypass?
Check pulse and temp of extremity Q15 min for first hour then hourly check
Monitor BP (don’t want to ruin graft)
Report severe continuous, aching pain
Monitor s/s infection
Warmth, redness, and edema are expected
What are the differences between arterial vs venous ulcers?
Arterial usually a dry ulcer
Venous is open, weepy, wet
You compress the venous ulcer but not arterial
What are some interventions for thromboembolism?
Gradual increase in ambulation
Elevate extremity
Graduated compression stockings
Intermittent or continuous warm moist soaking
No massage
What are the 3 main causes of aneurysms?
Hypertension
Hyperlipidemia
Smoking
What are some aneurysm post-op restrictions?
No heavy lifting (6-12 lbs max; roughly no heavier than a gallon of milk)
No pushing, pulling, straining
Can’t drive
Why do we want to reduce BP in aortic dissection patients?
Aorta suddenly tears; squeezing blood vessels more does not help. They will bleed to death
For pt who are aware of aneurysm presence, what are some signs of rupture?
Abdominal, flank, back pain
