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Undeleted > Acute Cardiac (adults) > Flashcards

Acute Cardiac (adults) Flashcards

1
Q

Coronary artery disease (CAD)

A
  • chronic stable angina
  • acute coronary syndromes
  • affects arteries that provide blood, oxygen, nutrients to myocardium
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2
Q

Ischemia

A

Insufficient oxygen supplied to meet requirements of tissue

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3
Q

Infarction

A
  • necrosis (cell death) occurring after prolonged ischemia.

- decreased perfusion causes irreversible damage.

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4
Q

Atherosclerosis

A
  • narrowing of lumen
  • decreased perfusion
  • mtissue ischemia/infarction
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5
Q

angina pectoris is…

A

chest pain

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6
Q

angina pectoris cause

A

temporary imbalance between coronary arteries’ ability to supply oxygen and myocardium’s oxygen demand ischemia is limited, no permanent damage

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7
Q

classic angina characteristics

A
  • predictable (stress or exertion)
  • relieved by rest/ntg
  • limited in frequency, duration, intensity
  • fixed atherosclerotic plaque
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8
Q

acute coronary syndrome is…

A
  • unstable angina

- acute myocardial infarction

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9
Q

acute coronary syndrome results in…

A

atherosclerotic plague in coronary artery ruptures

  • platelet aggregation
  • thrombus formation
  • vasoconstriction
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10
Q

% plaque = blocked blood flow

A

40

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11
Q

unstable angina characteristics

A
  • progressive severity
  • unrelated to activity
  • unpredictable (stress/exertions)
  • prinzmetal’s angina
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12
Q

unstable angina is…

A
  • chest pain/discomfort occurring at rest or with exertion

- causes severe activity limitation

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13
Q

Prinzmetal’s angina

A

“variant” angina

  • caused by coronary vasospasm
  • usually associated with ST segment elevation
  • no troponin or creatine kinase?
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14
Q

SEVEN DIMENSIONS (symptom eval)

A
  • timing/onset
  • location
  • quality
  • quantity
  • aggravating
  • alleviating
  • associated
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15
Q

management goals for angina

A
  • decrease workload of heart
  • increase supply
  • decrease demand
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16
Q

acute myocardial infarction

A
  • prolonged supply/demand imbalance
  • not relieved by rest, ntg
  • ruptured plaque (embolism)
  • coronary spasm
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17
Q

nstemi characteristics

A
  • myocardial infarction “light”

- subendocardial (doesn’t go all the way through wall)

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18
Q

stemi characteristics

A
  • transmural
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19
Q

cardiac biomarkers

A
  • creatine kinase (ck)
  • creatine kinase mb (ck-mb)
  • troponin
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20
Q

increased CK but no MB =

A

not the heart, other catastrophic process

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21
Q

creatine kinase released by

A

brain
myocardium
skeletal muscles

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22
Q

creatine kinase-mb released by

A

myocardium band!

more specific to myocardium

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23
Q

troponin released by

A

myocardial specific

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24
Q

creatine kinase onset/peak/duration

A

2-6h/18h/72h

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25
Q

creatine kinase-mb onset/peak/duration

A

4-8h/24h/48-72h

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26
Q

troponin onset/peak/duration

A

3-12h/24-48h/5-14d

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27
Q

cardiac biomarker differentiating STEMI from NSTEMI

A

troponin!

28
Q

acute MI assessment findings

A
  • substernal chest pain
  • crushing/squeezing/tightness/heaviness
  • radiates (left arm most common)
  • impending doom
  • denial
  • ashen pallor
  • diaphoresis
  • dyspnea
  • pre-syncope
29
Q

acute MI unaffected by (actions)

A

coughing
deep breaths
movement
swallowing

30
Q

% experiencing “silent MI”

A

15

31
Q

who experiences silent MI?

A

elderly
diabetic
women

32
Q

heart disease symptoms for women often…

A 
fatigue
insomnia
GI complaints
back cramps
unusual complaints
33
Q

goal of acute MI management

A

re-establish oxygen supply to myocardium

34
Q

MONA - what is it for?

A

management of acute MI!

35
Q

MONA stands for

A

Morphine
Oxygen
Nitrates
Aspirin

goal: vasodilation!!

36
Q

aspirin nota bene for MONA

A
  • anti-platelet effects minimize clot

- chew, don’t swallow

37
Q

revascularization is…

A

restoration of perfusion to a body part or organ that has suffered ischemia

38
Q

pharmacologic revascularization

A
  • antiplatelets
  • anticoagulants
  • thrombolytics
39
Q

mechanical revascularization

A 
cardiovascular lab (CVL)
coronary artery bypass surgery (CAB)
40
Q

antiplatelet meds

A 
aspirin
plavix (clopidogrel)
41
Q

anticoagulant meds

A

glycoprotein IIb/IIIa inhibitors

heparin/low molecular weight heparin (Lovenox)

42
Q

thrombolytic meds

A

t-PA (tissue plasminogen activator)

retavase

43
Q

percutaneous transluminal coronary angioplasty (PTCA)

A

THE BALLOON THING

access: femoral artery –> descending aorta –> aortic arch –> top of heart

balloon inserted into coronary artery to open vessel and improve blood flow

44
Q

coronary artery bypass is…

A

“by-passing” occluded/diseased coronary arteries
typically saphennous veins, can also use arteries (radial, ulnar), mammary arteries can be used - arteries are not as plentiful as veins are for use. arterial graphs DO last longer.

45
Q

on pump coronary artery bypass

A

hook up patient to heart/lung machine, stop heart, do bypass, shock heart and take off pump

(outdated/rare use now)

46
Q

off pump coronary artery bypass

A

modern technique: do bypass on a beating heart. slow down heart from 80-100 bpm to 30ish bpm

body is cooled down so metabolic rate is lowered

47
Q

PTCA stent placement

A

stent is in a second wire that goes after the balloon is inflated

permanent scaffolding

48
Q

post-CVL priority and rationale

A

whatever artery used to acccess is #1 concern

problem in artery? watch the whole extremity related to that artery

49
Q

post-CVL patient education

A
  • patient must lie flat because artery was just accessed

- report slightest changes IMMEDIATELY; possible to bleed out into body without a single drop exiting body

50
Q

post-CVL patient care: five P’s

A 
pulseless
pain
pallor
paresthesia
paralysis
51
Q

sternotomy

A

?

52
Q

thoracotomy

A

?

53
Q

mechanical valve sound

A

click

54
Q

prosthetic valve sound

A

murmur

55
Q

post-CAB/valve replacement surgery patient care

A
  • incision care
  • neurologic assessment (heart starts to fail -> mental status first)
  • dysrhythmias
  • chest pain
  • BOOM BOOM (4 hours after surgery)
  • diet/meds compliance
  • sternal wound infection = BAD!!!!
56
Q

implanted cardiac devices

A

ICD or PPM (permanent pacemaker)

all ICDs are pacemakers but not all pacemakers contain ICDs

(ICDs are not covered by insurance!)

57
Q

pacemaker indications

A
  • symptomatic bradycardia
  • heart blocks
  • cardiac resynchronization (ventricles not pumping at same time)
  • overdrive pacing for tachyarrhythmias
58
Q

types of pacemakers (x3)

A

single-chamber (1 v)
dual-chamber (1 a 1 v)
biventricular (DELUXE) (1a 2v - coronary sinus to v)

59
Q

ICD indications

A
  • prevent sudden cardiac arrest (VT, VF)

- class I or II heart failure

60
Q

post-pacemaker/ICD patient care

A
  • incision care
  • activity/position restriction
  • pain
  • pacemaker/ICD ID card
  • electrical hazards/magnetic fields
  • appliances (microwaves)
  • notify provider
61
Q

ICD components

A

additional programs
high gauge wire to conduct defibrillation
larger battery

62
Q

defibrillation is..

A

nonsynchronized delivery of energy during any phase of cardiac cycle

63
Q

cardioversion is…

A

delivery of energy that is synchronized to the R wave of the QRS complex

64
Q

ablation therapy is…

A
  • invasive
  • destruction of faulty electrical pathway from sections of endocardium
  • treatment of cardiac arrhythmias

hot or cold burn of heart tissue to kick back into normal rhythm

65
Q

ablation therapy indications

A
  • atrioventricular reentrant tachycardia (Wolff-Parkinson-White Syndrome WPW)
  • atrial tachycardia
  • idiopathic ventricular tachycardia
  • atrial flutter/atrial fibrillation

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