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Critical Care > Adult Cardiac > Flashcards

Adult Cardiac Flashcards

1
Q

Acute Coronary Syndromes

A

umbrella term :
-stable angina
-unstable angina
-non ST elevation ( NSTEMI )
-ST elevation MI ( STEMI )

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2
Q

stable angina

A

chest pain / discomfort with physical activity , ALLEVIATED with rest and medications

-nitroglycerin and rest

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3
Q

unstable angina

A

chest pain that occurs at rest , most concerning , NOT RELIEVED with rest or medications

-precursor for MI , tx as emergency

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4
Q

prinzmetal’s angina

A

caused by coronary artery spasm , normally occurs at night

-type of unstable angina

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5
Q

ACS dx test

A
  1. 12 lead EKG
  2. Cardiac Biomarkers
  3. Lipid profile
  4. Exercise Stress test
  5. Stress Echo
  6. coronary angiography
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6
Q

Cardiac Biomarkers (cardiac enzymes)

A

creatinine kinase
troponin I or T
myoglobin
levels rise after myocardial injury , measured every 6 hours after admission

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7
Q

lipid profile

A

triglycerides
total cholesterol
LDL
HDL

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8
Q

stress echo

A

those unable to use treadmill or bike , DOBUTAMINE can be used to increase HR mimicking effect of exercise

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9
Q

coronary angiography

A

GOLD STANDARD for ACS
-L sided heart cath

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10
Q

ACS medications

A
  1. OXYGEN
  2. Nitroglycerin
  3. Beta blockers
  4. CCB
  5. Antiplatelet drugs
  6. Morphine
  7. Antithrombin agents
  8. ACE inhibitors
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11
Q

ACS oxygen

A

ACUTE pain from angina is r/t decreased oxygen supply!!!

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12
Q

ACS nitroglycerin

A

causes vasodilation , given topically / sublingual / transdermal / IV

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13
Q

ACS beta blockers

A

used to tx angina , MI , dysrhythmias , HF , hypertension
-oral or IM

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14
Q

Beta blocker examples

A

Metoprolol
Labetalol
Carvedilol

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15
Q

ACS CCB

A

inhibits calcium ion flow across cellular membrane

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16
Q

Verapamil and Cardizem

A

calcium channel blockers

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17
Q

ACS antiplatelets

A

inhibits clotting or prevents platelet aggregation , used with UNSTABLE angina

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18
Q

Plavix and Aspirin

A

Antiplatelet agents

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19
Q

ACS antithrombins

A

inhibits antithrombin III , prevents fibrinogen to fibrin conversion
-IM or Sub q

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20
Q

Lovenox and Heparin

A

antithrombin agents

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21
Q

ACS morphine

A

used for pain relief and anxiety
-given IV

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22
Q

ACS ACE inhibitors

A

prevent angiotensin I to angiotensin II conversion
tx HTN and HF afteer MI

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23
Q

Enalapril / Captopril / Lisinopril

A

ACE inhibitors

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24
Q

myocardial infarction

A

leading cause of death among men and women in US

-increased risk b/t 6:00am and 12:00pm

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25
Q

MI modifiable risk factors

A

smoking
high LDLs
type II DM
obesity
HTN

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26
Q

MI non-modifiable risk factors

A

male gender
postmenopausal female
family hx

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27
Q

why are MI more common in the morning

A

blood pressure is at it’s highest and blood is most viscous

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28
Q

NSTEMI MI

A

partial occlusion of major coronary vessel

ST depression or T wave inversion without Q wave

will have elevated cardiac markers

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29
Q

STEMI MI

A

complete occlusion of major coronary vessel resulting in irreversible full thickness heart muscle damage

ST elevations

elevated cardiac markers

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30
Q

complete occlusion MI s/s

A

chest pain
shoulder / arm pain ( LEFT )
jaw / tooth pain
upper back pain
SOB
n/v
sweating
fatigue

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31
Q

R coronary MI s/s

A

JVD
hypotension
bradycardia : damaged SA node
n/v

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32
Q

L coronary artery MI ( WIDOW MAKER ) s/s

A

worst prognosis w / high risk of sudden death
dyspnea
tachycardia
hypertension

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33
Q

Women MI s/s

A

fatigue
diaphoresis
indigestion
arm / shoulder pain
nausea
vomiting

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34
Q

geriatric MI s/s

A

dyspnea
confusion
weakness
syncope

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35
Q

MI tests

A
  1. CK
  2. Troponin I and Troponin T
  3. Myoglobin
  4. Complete Metabolic profile
  5. CBC
  6. Coagulation Studies
  7. ABG
  8. EKG : GOLD STANDARD
  9. echo
  10. L sided heart cath
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36
Q

CK lab with MI

A

rise 6 hours post MI
peak at 18 hours
baseline 10-14 days after

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37
Q

Troponin MI test

A

preferred blood test to dx an MI , proteins are almost exclusively in heart

increase 6 hours post MI
peak 10-24 hours
baseline 10-14 days

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38
Q

EKG MI

A

GOLD STANDARD
-reveal ST depression or elevation

***WOMEN ARE LESS likely than men to have typical EKG change

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39
Q

echo MI

A

used to evaluate ventricular function like ejection fraction

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40
Q

MI L sided heart cath

A

GOLD STANDARD FOR FLOW DX
-inserted through radial or femoral

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41
Q

MI medications

A
  1. Oxygen
  2. MONA
  3. Heparin
  4. Beta Blockers
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42
Q

MONA

A

Morphine
Oxygen
Nitroglycerin
Aspirin

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43
Q

MI nitroglycerin

A

dilates coronary arteries

one tablet administered every 5 minutes w/ maximum of 3 doses

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44
Q

MI aspirin

A

help prevent platelets from enlarging or forming

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45
Q

MI morphine

A

control pain, relax coronary arteries, improve blood flow

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46
Q

MI heparin

A

started to prevent new clot formation

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47
Q

MI beta blockers

A

decrease heart workload

DO NOT USE WITH R CORONARY ARTERY MI w/ bradycardia

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48
Q

MI reperfusion therapy

A
  1. Fibrinolytic therapy
  2. percutaneous coronary intervention
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49
Q

MI Fibrinolytic Therapy

A

dissolve clot in coronary artery , symptoms MUST be present for less than 12 hours

NOT tx for unstable angina or NSEMI

3 IV sites

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50
Q

fibrinolytic therapy complications

A

excessive bleeding and hemorrhagic stroke

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51
Q

MI percutaneous coronary intervention

A

preferred method for opening blocked vessels causing and MI
-catheter with small balloon is inserted , inflated and deflated to open blocked artery
-stent may be placed
-radial or femoral insertion site

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52
Q

MI surgery

A

CABG

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53
Q

CABG

A

revascularization bypassing blockages
-typically uses saphenous vein or internal thoracic artery is used

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54
Q

CABG complications

A

bleeding
dysrhythmias
MI
stroke
nonunion of sternum
sternal infection
renal failure
HF

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55
Q

CABG : bypass complication

A

induction of systemic inflammatory response = shock
heparin induced thrombocytopenia
activation of platelets
complications of cross clamping aorta

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56
Q

post CABG care

A

monitor HR and BP continuously
hemodynamic monitor
cardiac monitor
s/s of infection
assess heart tones
core temperature
hourly I / O
skin color , pulses , edema
chest tube output / color / volume
hgb / hct / electrolytes / creatinine / BUN

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57
Q

post MI teaching

A

cardiac rehab
low cholesterol and sodium diet
avoid stress
report s/s of MI
angina
purpose / dose / SE of meds
nitroglycerin edu
no smoking
weight

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58
Q

cardiomyopathy

A

heart muscle becomes weak, enlarged, thickened and develop structural changes

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59
Q

cardiomyopathy risk factors

A

diabetes
hypertension
high cholesterol
high fat
obesity
family hx heart disease
sedentary lifestyle
smoking
alcohol
cocaine
viral infection
lyme disease
nutritional deficit
pregnancy
respiratory failure

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60
Q

ischemic cardiomyopathy

A

reduced ejection fraction caused by CAD such as MI or loss of myocardium

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61
Q

nonischemic cardiomyopathy

A
  1. dilated
  2. hypertonic
  3. restrictive
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62
Q

dilated cardiomyopathy

A

most common cause of HF , dilation of muscle in L ventricle causing enlargement and poor CO

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63
Q

hypertrophic cardiomyopathy

A

excessive myocardial hypertrophy , heart muscle thickens and enlarges , contraction is not weakened but filling is impaired

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64
Q

restrictive cardiomyopathy

A

stiff ventricular muscle resulting in impaired filling , results from another disease

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65
Q

cardiomyopathy angina s/s

A

chest pain
dizziness
indigestion
n/v
sweating
palpitations
SOB
fatigue

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66
Q

cardiomyopathy HF s/s

A

rapid / irregular HR
SOB
edema of legs , feet , abd.
pulmonary congestion
abnormal heart sounds
JVD
enlarged liver
fatigue
loss of appetite
cough

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67
Q

cardiomyopathy labs

A
  1. BNP
  2. CMP
  3. thyroid function
  4. CBC
  5. iron level
  6. CXR
  7. EKG
  8. R heart cath
  9. doppler echo
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68
Q

CMP lab

A

evaluates liver / renal function

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69
Q

Heart cath ejection fraction

A

55 - 65 % = normal
< 45 % = some disease
< 30 % = severe disease

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70
Q

cardiomyopathy medications

A
  1. ACE inhibitors
  2. ARBS
  3. Beta blocker
  4. Digoxin
  5. CCB
  6. diuretics
  7. nitrates
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71
Q

ACE inhibitors

A

reduce afterload , makes it easier for heart to eject blood

ex : lisinopril

72
Q

ACE inhibitor SE

A

coughing

73
Q

ARBS

A

for individuals who are unable to tolerate ACE inhibitors and SE

ex : losartan , valsartan

74
Q

beta blocker

A

decrease workload of the heart

ex : metoprolol

75
Q

beta blocker caution

A

use caution in asthma , kidney disease , COPD

76
Q

digoxin

A

not primary cardiomyopathy tx , watch for toxicity

77
Q

digoxin consideration

A

take apical pulse for one minute , HOLD MED when HR is < 60 bpm

78
Q

CCB

A

reduce calcium entering the heart , decreasing stiffness

ex : verapamil , nifedipine

79
Q

CCB effects

A

reduces :
chest pain
breathlessness
palpitations

80
Q

nitrates

A

reduce cardiac preload

ex : nitroglycerin

81
Q

pacemaker placement

A

wire placed in both R and L ventricle coordinating contractions ,

82
Q

ICD

A

implantable cardioverter defibrillator recommended for patients with < 30% EF and high risk for lethal rhythms

83
Q

cardiomyopathy surgery

A
  1. septal myectomy
  2. surgical ventricular remodeling
  3. Transmyocardial revascularization
  4. heart transplant
  5. left ventricular assist device
84
Q

cardiomyopathy complications

A
  1. Heart Failure
  2. Dysrhythmias
85
Q

complication of cardiomyopathy

A

heart failure

86
Q

cardiomyopathy a-fib

A

places patient at risk of stroke , PE or MI

87
Q

a-fib meds

A

prescribed antiplatelet agents and anticoagulants

88
Q

cardiomyopathy teaching

A
  1. monitor exercise : cardiac rehab
  2. medication
  3. palliative service
  4. s/s of HF
  5. no alcohol , caffeine , stimulants
  6. caregiver knows CPR
  7. less fluid / sodium
89
Q

Heart failure

A

inadequate pumping / filling of the heart
-classified on ejection fraction

90
Q

left sided HF

A

dysfunction of left ventricle

91
Q

right sided HF

A

inability of right side to pump blood to pulmonary vaculature

92
Q

HF risk factors

A

HTN : particularly untreated
CAD
cardiomyopathy
MI hx
DM
obesity
smoking
high sodium diet
valvular dysfunction
cardiotoxic exposure

93
Q

cardiotoxic exposure

A

heavy alcohol use
chemotherapy
illicit drugs : COCAINE

94
Q

left sided HF

A

poor peripheral perfusion and backflow of blood causing fluid on the lungs

95
Q

left sided HF s/s

A

SOB
orthopnea (discomfort lying flat)
fatigue
crackles
weight gain
poor color
weak pulses

96
Q

what would you hear in L sided HF

A

S3 , S4 gallop!!!!

97
Q

R sided HF

A

poor contraction of R ventricle leading to backflow of blood into R atrium and venous circulation

**affects organs

98
Q

R sided HF s/s

A

JVD
generalized edema
hepatomegaly
ascites
loss of appetite , n/v
increased abdominal girth

99
Q

HF labs

A
  1. H & P
  2. EKG
  3. CXR
  4. echo
  5. MUGA
  6. ABG
  7. CBC
  8. metabolic profile
  9. coronary angiography
  10. BNP
100
Q

MUGA

A

used to calculate ejection fraction
-uses radioactive tracer injected into vein

101
Q

BNP levels

A

< 100 = no HF
> 400 = HF likely

102
Q

HF medications

A
  1. beta blockers
  2. ACE inhibitors
  3. ARBS
  4. Digoxin
  5. ARNIs
  6. diuretics
  7. nitrates
  8. inodilators
  9. vasodilators
103
Q

ARNIs med

A

combines ARBS with neprilysin inhibitor
-reduces preload and afterload

ex: sacubitril / valsartan

104
Q

spironolactone

A

decreases preload

use cautiously with renal insufficiency b/c hyperkalemia

105
Q

nitrates

A

decrease preload and afterload

ex : nitroglycerin

106
Q

inodilators

A

increase contractility and decrease afterload

ex : hydralazine, isosorbide dinitrate

107
Q

HF actions

A
  1. O2
  2. elevate HOB
  3. give meds
  4. monitor vitals
  5. assess breath sounds
  6. fluid restriction
  7. comfort intervention
  8. assess skin color
  9. reduce anxiety
  10. monitor labs
108
Q

HF weight change

A

> 2.5 lbs / day can be indicative of fluid retention

109
Q

HF teaching

A
  1. medication management
  2. education on oxygen use
  3. rest and pace
  4. education on fall prevention
  5. s/s of worsening HF : FACES
  6. daily weight
  7. no smoking , alcohol use, mild exercise , decrease sodium , moderate caffeine, less fat
  8. reduce high sodium
  9. cardiac rehab
  10. potassium rich diet
110
Q

potassium rich foods for HF

A

banana
orange juice

**one a day

111
Q

FACES scale for worse HF

A

Fatigue
limitation of Activity
Cough and Congestion
Edema
SOB

112
Q

HF daily weights

A

use the same scale every time
take weights at same time every day

** > 2.5 lbs / day OR 5 lbs / week = CALL DR

113
Q

valvular heart disease

A

3 types :
1. stenosis
2. regurgitation
3. prolapse

114
Q

valvular stenosis

A

stiffening and thickening of valves caused by calcium deposits , narrowing the opening and obstructing flow

115
Q

valvular regurgitation

A

blood flows or leaks backwards because of incomplete closing of the valve

116
Q

valvular prolapse

A

valve leaflets bulge backward and do not close , usually remains untreated unless there are symptoms

117
Q

valvular heart disease risk

A
  1. infective endocarditis
  2. untreated strep infections
  3. CAD
  4. MI
  5. cardiomyopathy
  6. HF
  7. congenital defects
  8. older age
    9.pregnancy
  9. drug use : COCAINE
118
Q

untreated strep infections….

A

cause havoc on the heart

119
Q

valvular heart disease most common s/s

A

MURMUR
-systolic
-diastolic

120
Q

systolic murmur

A

heard during LUB (s1)
pulmonic valves open
mitral / tricuspid are closed

**heard w/ aortic / pulmonary stenosis or tricuspid regurgitation

121
Q

diastolic murmur

A

heard during DUB (s2)
mitral and tricuspid valves open
pulmonic values closed

**heard w/ aortic / pulmonary stenosis OR tricuspid regurgitation

122
Q

valvular heart disease s/s

A

murmur
SOB , dyspnea , orthopnea
crackles
angina
syncope or dizziness
dysrhythmias ( A-FIB)
palpitations
fatigue
weight gain
edema
cool pale extremities

123
Q

valvular heart disease labs

A
  1. CXR
  2. echo
  3. heart cath : stenosis
  4. stress test
  5. CT or MRI
  6. CBC
  7. EKG
124
Q

valvular heart disease surgery

A
  1. ballon valvuloplasty
  2. commissurotomy
  3. TAVR and TMVR
  4. open heart surgery w/ valve replacement
125
Q

balloon valvuloplasty

A

transcatheter procedure to repair stenosis valves , balloon opens valve

126
Q

TAVR

A

prosthetic valve replacement

127
Q

valvular heart disease meds

A
  1. beta blockers
  2. ARBS
  3. ACE inhibitors
  4. diuretics
  5. nitroglycerin
  6. warfarin
  7. antibiotics
128
Q

valvular heart disease complications

A
  1. mitral stenosis : A-fib / emboli
  2. mitral regurgitation : L ventricle hypertophy / HTN
  3. aortic stenosis : aortic dissection
  4. infective endocarditis
  5. balloon valvuloplasty : bleeding / PE
129
Q

valvular heart disease intervention

A
  1. provide O2 / elevate HOB
  2. give meds
  3. restrict sodium
  4. pain assessment
  5. breath sounds
  6. heart sounds
  7. daily weights / I and O
  8. peripheral vascular assessment : pulses, extremities , cap refill , edema
  9. cardiac monitor
  10. monitor INR on Warfarin
130
Q

valvular heart disease education

A
  1. medication
  2. prophylactic abx for DENTAL PROCEDURE
  3. restrict sodium and caffeine
  4. s/s of HF
  5. anticoagulant precautions
  6. intake of leafy greens on warfarin
  7. daily weight at home
  8. no smoking
131
Q

anticoagulant precautions

A

adherence to regimen
avoid sports w/ high injury risk
electric razor w/ shaving
soft toothbrush
limit alcohol : causes falls

132
Q

carotid artery disease

A

vessel wall thickening , plaque formation , progressive narrowing of the carotid artery

133
Q

carotid artery disease risks

A

smoking
hypertension
diabetes
dyslipidemia
sedentary lifestyle
obesity
ineffective stress management

134
Q

people with coronary artery disease….

A

have an increase risk for developing carotid artery disease

135
Q

carotid artery disease severity

A

< 50 % is mild
50 - 69 % is moderate
70 - 99% is severe

136
Q

carotid artery disease s/s

A

asymptomatic until almost completely occluded

BRUIT is #1 s/s
sudden weakness
dizziness
difficulty talking
facial droop
sudden vision problems
sudden severe HA

137
Q

carotid artery disease test

A
  1. carotid duplex ultrasonography
  2. computed tomography angiography : CTA
  3. MRA
  4. carotid angiography
  5. MRI
138
Q

carotid duplex ultrasonography

A

uses high frequency sound waves to measure blood flow and detect blockages

139
Q

CTA

A

uses IV contrast to highlight carotid artery
-faster results than MRA

140
Q

MRA

A

uses IV contrast dye , uses radio waves to show blockages inside arteries

141
Q

carotid angiography

A

invasive , uses catheter normally inserted femorally and guided up to carotids

-contrast dye injected
**test not normally used

142
Q

MRI

A

essential for acute stroke assessment with carotid artery disease , shows acute ischemia

143
Q

carotid artery meds asymptomatic

A

-healthy lifestyle
-limit alcohol
-control diabetes / HTN
-use meds to manage cause of atherosclerosis

144
Q

carotid artery meds symptomatic

A
  1. antiplatelets = aspirin or plavix
  2. antihypertensives = CCB , ACE inhibitors, ARBs
  3. statins = atorvastatin , simvastatin , pravastatin , rosuvastatin
145
Q

carotid artery BP to maintain….

A

< 140 / 90

146
Q

carotid artery disease surgery

A
  1. carotid endarterectomy
  2. carotid artery stenting
147
Q

CEA

A

surgery to remove plaque causing artery occlusion , wide fluctuations in BP are common

**must have arterial line in place

148
Q

carotid artery stenting

A

uses guiding catheter up to carotid , balloon is inflated compressing fatty plaque allowing stent to be placed maximizing blood flow

149
Q

carotid artery disease actions

A
  1. administer antihypertensives
  2. administer lipid lowering meds
  3. administer antiplatelets
  4. manage DM / blood glucose
150
Q

post CEA or CAS

A

keep systolic BP within orders

151
Q

hypotensive post carotid surgery

A

reposition pt flat
anticipate vasoactive drip or IV bolus

152
Q

hypertensive post carotid surgery

A

HOB 30 degrees to allow drainage

153
Q

post CEA

A

keep in neutral position
-decreases strain on site and carotid artery

154
Q

post CAS

A

fluid intake / IV fluids
-aids in flushing out contrast

155
Q

carotid artery disease assessment

A
  1. monitor virals closely
  2. neuro assessment : change in function can be s/s of stroke , CHECK after surgery to ensure no nerve damage
  3. auscultate carotids
  4. renal function post CAS
  5. respiratory rate , O2 , stridor
156
Q

post carotid surgery nerve check

A

VII = facial nerve (smiling)
X = vagus (swallowing , gag reflex , “ah)
XI = spinal accessory (shrug shoulders)
XII = hypoglossal (tongue control)

157
Q

carotid artery discharge

A
  1. DASH diet
  2. exercise
  3. no smoking
  4. limit alcohol
  5. stroke s/s
158
Q

stroke s/s

A

headache
facial droop
slurred speech
loss of strength in one side
inability to shrug shoulders or stick out tongue

159
Q

aneurysms (aortic artery disease)

A

localized dilation of an artery that forms when the middle layer of the artery is weakened

160
Q

ascending aortic aneurysms

A

located in arch of aorta

161
Q

descending aortic aneurysms

A

located above the diaphragm

162
Q

abdominal aortic aneurysms (AAA)

A

located below the diaphragm in abdomen

-most common

163
Q

true aneurysms

A

all 3 layers of arterial wall are weakened

164
Q

false / pseudoaneurysm

A

not a distortion of the vessel wall but a leak from the artery and an eventual blood clot forms

165
Q

aneurysm risk

A
  1. family hx
  2. advanced age
  3. male
  4. SMOKING
  5. atherosclerosis
  6. HTN
  7. high total serum cholesterol
  8. CAD
  9. genetics - marfan’s syndrome
166
Q

aneurysms s/s

A

normally asymptomatic and found when looking for another medical condition

-complications happen with dissection or rupture

167
Q

ruptured / dissection s/s

A

ripping feeling
chest / back / flank pain
normally spontaneous and gets worse

168
Q

aneurysm tests

A
  1. CT abdomen with contrast
  2. abdominal US and TEE
  3. cardiac MRI
  4. EKG
169
Q

CT for aneurysms

A

gold start test for assessing size and location

170
Q

aneurysm meds

A
  1. ACE inhibitors
  2. ARBs
  3. Beta blockers
  4. antibiotics : macrolides , tetracyclines
  5. statins
171
Q

aneurysm surgery

A

size and location determine surgery
< 5cm cannot have immediate surgery
> 5.5 or 6cm are surgically repaired

172
Q

aneurysm complications

A

aortic dissection - sudden tear

173
Q

aortic dissection s/s

A

sudden ripping or tearing feeling !!!!
-chest / back / shoulders / abdomen
diaphoresis
n/v
faintness
tachycardia
BP decrease

174
Q

aneurysm assessments

A
  1. vitals
  2. neuro assessment
  3. pain
  4. peripheral pulses, skin , temp
  5. peripheral sensation
  6. gentle abd auscultation / palpation
175
Q

aneurysm action

A
  1. administer antihypertensives
  2. administer statins
  3. administer antibiotcs
  4. administer stool softeners : NO STRAINING
  5. calm environment
176
Q

aneurysm teaching

A
  1. s/s of dissection
  2. marfan’s syndrome should be encouraged to do regular screening
  3. strict regimen : med compliance, smoking, exercise, dx testing , regular US , avoid crossing legs

Critical Care (15 decks)

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