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
2
Q
Ischemia
A
Insufficient oxygen supplied to meet requirements of tissue
3
Q
Infarction
A
- necrosis (cell death) occurring after prolonged ischemia.
- decreased perfusion causes irreversible damage.
4
Q
Atherosclerosis
A
- narrowing of lumen
- decreased perfusion
- mtissue ischemia/infarction
5
Q
angina pectoris is…
A
chest pain
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
7
Q
classic angina characteristics
A
- predictable (stress or exertion)
- relieved by rest/ntg
- limited in frequency, duration, intensity
- fixed atherosclerotic plaque
8
Q
acute coronary syndrome is…
A
- unstable angina
- acute myocardial infarction
9
Q
acute coronary syndrome results in…
A
atherosclerotic plague in coronary artery ruptures
- platelet aggregation
- thrombus formation
- vasoconstriction
10
Q
% plaque = blocked blood flow
A
40
11
Q
unstable angina characteristics
A
- progressive severity
- unrelated to activity
- unpredictable (stress/exertions)
- prinzmetal’s angina
12
Q
unstable angina is…
A
- chest pain/discomfort occurring at rest or with exertion
- causes severe activity limitation
13
Q
Prinzmetal’s angina
A
“variant” angina
- caused by coronary vasospasm
- usually associated with ST segment elevation
- no troponin or creatine kinase?
14
Q
SEVEN DIMENSIONS (symptom eval)
A
- timing/onset
- location
- quality
- quantity
- aggravating
- alleviating
- associated
15
Q
management goals for angina
A
- decrease workload of heart
- increase supply
- decrease demand
16
Q
acute myocardial infarction
A
- prolonged supply/demand imbalance
- not relieved by rest, ntg
- ruptured plaque (embolism)
- coronary spasm
17
Q
nstemi characteristics
A
- myocardial infarction “light”
- subendocardial (doesn’t go all the way through wall)
18
Q
stemi characteristics
A
- transmural
19
Q
cardiac biomarkers
A
- creatine kinase (ck)
- creatine kinase mb (ck-mb)
- troponin
20
Q
increased CK but no MB =
A
not the heart, other catastrophic process
21
Q
creatine kinase released by
A
brain
myocardium
skeletal muscles
22
Q
creatine kinase-mb released by
A
myocardium band!
more specific to myocardium
23
Q
troponin released by
A
myocardial specific
24
Q
creatine kinase onset/peak/duration
A
2-6h/18h/72h
25
creatine kinase-mb onset/peak/duration
4-8h/24h/48-72h
26
troponin onset/peak/duration
3-12h/24-48h/5-14d
27
cardiac biomarker differentiating STEMI from NSTEMI
troponin!
28
acute MI assessment findings
- substernal chest pain
- crushing/squeezing/tightness/heaviness
- radiates (left arm most common)
- impending doom
- denial
- ashen pallor
- diaphoresis
- dyspnea
- pre-syncope
29
acute MI unaffected by (actions)
coughing
deep breaths
movement
swallowing
30
% experiencing "silent MI"
15
31
who experiences silent MI?
elderly
diabetic
women
32
heart disease symptoms for women often...
```
fatigue
insomnia
GI complaints
back cramps
unusual complaints
```
33
goal of acute MI management
re-establish oxygen supply to myocardium
34
MONA - what is it for?
management of acute MI!
35
MONA stands for
Morphine
Oxygen
Nitrates
Aspirin
goal: vasodilation!!
36
aspirin nota bene for MONA
- anti-platelet effects minimize clot
| - chew, don't swallow
37
revascularization is...
restoration of perfusion to a body part or organ that has suffered ischemia
38
pharmacologic revascularization
- antiplatelets
- anticoagulants
- thrombolytics
39
mechanical revascularization
```
cardiovascular lab (CVL)
coronary artery bypass surgery (CAB)
```
40
antiplatelet meds
```
aspirin
plavix (clopidogrel)
```
41
anticoagulant meds
glycoprotein IIb/IIIa inhibitors
| heparin/low molecular weight heparin (Lovenox)
42
thrombolytic meds
t-PA (tissue plasminogen activator)
| retavase
43
percutaneous transluminal coronary angioplasty (PTCA)
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
coronary artery bypass is...
"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
on pump coronary artery bypass
hook up patient to heart/lung machine, stop heart, do bypass, shock heart and take off pump
(outdated/rare use now)
46
off pump coronary artery bypass
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
PTCA stent placement
stent is in a second wire that goes after the balloon is inflated
permanent scaffolding
48
post-CVL priority and rationale
whatever artery used to acccess is #1 concern
problem in artery? watch the whole extremity related to that artery
49
post-CVL patient education
- 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
post-CVL patient care: five P's
```
pulseless
pain
pallor
paresthesia
paralysis
```
51
sternotomy
?
52
thoracotomy
?
53
mechanical valve sound
click
54
prosthetic valve sound
murmur
55
post-CAB/valve replacement surgery patient care
- 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
implanted cardiac devices
ICD or PPM (permanent pacemaker)
all ICDs are pacemakers but not all pacemakers contain ICDs
(ICDs are not covered by insurance!)
57
pacemaker indications
- symptomatic bradycardia
- heart blocks
- cardiac resynchronization (ventricles not pumping at same time)
- overdrive pacing for tachyarrhythmias
58
types of pacemakers (x3)
single-chamber (1 v)
dual-chamber (1 a 1 v)
biventricular (DELUXE) (1a 2v - coronary sinus to v)
59
ICD indications
- prevent sudden cardiac arrest (VT, VF)
| - class I or II heart failure
60
post-pacemaker/ICD patient care
- incision care
- activity/position restriction
- pain
- pacemaker/ICD ID card
- electrical hazards/magnetic fields
- appliances (microwaves)
- notify provider
61
ICD components
additional programs
high gauge wire to conduct defibrillation
larger battery
62
defibrillation is..
nonsynchronized delivery of energy during any phase of cardiac cycle
63
cardioversion is...
delivery of energy that is synchronized to the R wave of the QRS complex
64
ablation therapy is...
- 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
ablation therapy indications
- atrioventricular reentrant tachycardia (Wolff-Parkinson-White Syndrome WPW)
- atrial tachycardia
- idiopathic ventricular tachycardia
- atrial flutter/atrial fibrillation
