Adult Cardiac Flashcards
What does S1 sound like?
lub
What does S2 sound like?
dub
When is S3 normal?
kids and up to age 30 in adults
When does S3 become abnormal?
After 30!
What is blood flow across an obstruction?
stenosis
What will happen with backflow of blood from an incompetent valve?
regurgitation
What happens when there is a septal defect?
shunting
How are murmurs graded?
I-VI
What are rubs?
pericardial inflammation or effusion or pericarditis
When may rubs occur?
2-7 days s/p MI
What does a rub sound like?
grading, squeaking, or scratching sound (inspiration- friction w/ movement)
What is a murmur?
increased rate of flow through heart
Where is edema most common?
feet, ankles, legs, scrotum, hands
2 factors that influence blood pressure
cardiac output and SVR
What kind of hypertension is the majority of cases?
Primary or essential HTN
What percentage of hypertensive patients have secondary hypertension?
5-10%
What pain level is ideal for a cardiac patient?
0
A cardiac pt came in complaining of headache, blurred vision, and severe chest pain. Rated at a 7. The patient has been treated and now his pain level has gone down to a 1, which is tolerable for this patient. Is he okay to be discharged?
no. cardiac patients must have a pain level of 0 before being discharged
If a patient comes in with chest pain, what is that indicative of?
oxygen supply is not meeting oxygen demand
How does an infarction occur?
Ischemia first and continued o2 demand that does not meet the supply is infarction and that leads to muscle death that cannot be restored
What are the s/s of CM?
HA, blurred vision, fatigue, dizziness, palpitations, angina, dyspnea, nosebleeds
What is the first diagnostic study that should be done when assessing cardiac health?
NIBP
What are diagnostic studies that should be done after NIBP when assessing cardiac health?
Fasting BG, UA, BMP cGFR, CBC, Lipid Panel, 12-lead EKG
How does coronary artery disease progress?
stable angina–> unstable angina–> NSTEMI or STEMI
What is the leading cause of death in the world?
Coronary Artery Disease
What is the most common CVD?
CAD
What is the etiology behind CAD?
damaged endothelium (nicotine, HTN, toxins, DM, infection, inflammation)+ lipid deposits under endothelium= atherosclerosis–> fatty streak–> fibrous plaque–> complicated lesion
Is coronary artery disease reversible?
Yes. Meds, diet, and lifestyle changes can reverse CAD
What are risk factors for developing CAD?
gender, ethnicity, family hx, HLD, HTN, DM, Nicotine, sedentary lifestyle, obesity, depression/anxiety, hostility/bitterness, substance abuse, high homocysteine levels, those with autoimmune disease
What factors are indicative of stable angina when referencing pain?
follows similar onset, duration, and intensity
Why is unstable plaque a concern?
it can rupture and activate a clotting cascade and a thrombus may form at that spot
What factors are indicative of unstable angina?
rupture of unstable plaque exposing thrombogenic surface
What meds are used to treat angina in the hospital?
morphine and nitroglycerin
If a patient has chest pain that is relieved by NTG and/or rest, what may this be indicative of?
stable angina
If a patient presents with new onset angina or chronic angina that increases in frequency, duration, and/or severity, occurs at rest or minimal exertion, lasts more than 10 min, what may this patient be presenting with?
unstable angina
ABCs of angina treatment
Antiplatelet therapy, antianginal therapy, ACE?
Beta blocker, BP control
Cigarette smoking cessation, cholesterol mngmt, Ca++ blockers, Cardiac rehab
After addressing the ABCs of angina treatment, what are other things that should be assessed?
diet, DM management, Edu, exercise, Flu vaccine
What is a late indicator of an MI occurrence?
Troponin
What kind of EKG is used to address unstable angina/acute coronary syndrome?
12-lead
What can be used to treat UA-NSTEMI and STEMI?
MONA
What are some long-term medications that can be used to treat unstable angina/acute coronary syndrome?
Beta Blockers, ACE, ARB, Statin
When should O2 be administered to a patient?
less than 92% O2 saturation on room air
Why should O2 not be immediately administered when angina occurs?
oxygen toxicity may occur
What is the most common anticoagulant that is used to prevent more clots from forming?
heparin
When would a CABG be used?
Plaque is too solidified for a stent
Is a STEMI or a NSTEMI more emergent?
STEMI
How long should it take for a PCI once a patient walks in the door?
90 minutes
5 ways to treat a UA-NSTEMI
MONA, stress testing, Anticoagulant, PCI-stent, CABG
5 ways to treat a STEMI
MONA, PCI, thrombolytic therapy, CABG, Antiplatelet/anticoag
What is a therapy that is common to strokes and STEMI treatment?
thrombolytic therapy
What is the difference in treatment for a right-sided MI vs a left-sided MI?
DO NOT administer nitroglycerin for a right sided MI
What can cause a dysrhythmia from ischemia?
dead muscle can’t send signals
What are the benefits of using a 12 lead EKG?
tells exactly where heart is blocked
What can PCI stenting potentially cause?
Acute kidney injury
What can happen if an artery is completely (100%) occluded?
collateral arteries form to feed tissues around the blockage
What does CABG stand for?
Coronary artery bypass graft
Is an artery or a vein graft more problematic?
vein graft
What is the number one reason for hospital admission?
heart failure
How many patients die within 5 years once being diagnosed with HF?
50%
What is the normal EF%?
55-70%
If EF% is less than __% in the either ventricle or both, it is considered heart failure
45%
What does the EF% have to be to qualify for a transplant?
less than 30%
what does cor pulmonale cause?
Right-sided heart failure
What kind of heart failure can pregnancy induce?
left sided heart failure
Why can pregnancy induce heart failure?
high volumes of fluids build up during pregnancy
Why does hyperthyroidism cause left sided heart failure?
too much stimulation of the heart
Why is it important to treat sleep apnea?
untreated can lead to cor pulmonale which can lead to right-sided heart failure which can lead to death
What is a late sign of left-sided heart failure?
cyanosis
If you are assessing a patient who has left sided heart failure, what would you expect to find?
Decrease BP
Crackles, wheezes
Dyspnea
S3 (new onset under 30 yo) & S4
Gallop
Decrease UO
Tachycardia, dysrhythmias
What is an important question to ask patients about their sleep if they have left sided heart failure?
How many pillows are they sleeping with
Why is there a decrease in urine output for a patient with left sided heart failure?
kidneys shunt blood to the brain
If a patient is experiencing right sided heart failure, what would be expected findings on an assessment?
Fluid retention
JVD
Peripheral edema
Abd tenderness, ascities
Hepatomegally, splenomegally
N/V, anorexia
Bounding pulses
Which kind of heart failure can lead to liver failure?
Right sided heart failure
Why might a QRS segment be elevated in a patient with heart failure?
more electricity going through ventricles because of hypertrophy of heart muscles
Labs that are diagnostic of heart failure
Na+/Cl- decreased
BUN/Cr/LFT elevated
RBC decreased
PaO2/PaCO2 decreased
BNP
Specific to HF
Heart stretching causes release
Diruetic
>100 = HF
Always checked on admit & PRN
What is the ONLY lab that is specifically related to heart failure?
BNP
What BNP level is indicative of heart failure?
> 100
What kind of weight gain is seen in patients with heart failure?
2 lbs in 1-2 days or 5 lbs per week
What should a Mg level be for a cardiac patient?
2
What should K level be for a cardiac patient?
4
How long do you have to open an artery if there is an infarction?
90 minutes
How can an artery be opened when there is a myocardial infarction?
A PCI or a thrombolytic (fibrinolytic) therapy
When is ST elevation significant?
if it is 1mm or more above the isoelectric line in at least 2 contiguous leads
Is a STEMI or NSTEMI more of an emergency?
STEMI
What causes a STEMI?
an occlusive thrombus
What causes a NSTEMI?
a non-occlusive thrombus
How long do NSTEMI patients have to receive PCI treatment?
usually will be done within 12-72 hours
