AH2 Cardio Lecture Flashcards
1
Q
serum lactate indicates
A
level of serum oxygen-hypoperfusion or hypoxia causes anaerobic metabolism and increased levels of serum lactate.
Serum lactate levels increase in lactic acidosis, severe dehydration, heart failure, respiratory failure, hemorrhage, ketoacidosis, severe infections, alcohol abuse, salicylate toxicity, shock, and liver disease. Most labs define normal as 0.5 to 2.2 mmol/L for venous blood and 0.5 to 1.6 mmol/L for arterial blood.
Administering metformin with intravascular iodinated contrast media for radiologic studies or procedures can cause lactic acidosis due to decreased kidney fxn r/t contrast medium. Metformin should be discontinued in select patients (according to facility policy and procedure) at the time of the study or procedure and for 48 hours afterward. - See more at: http://www.nursingcenter.com/lnc/journalarticle?Article_ID=933028#sthash.44B96AKZ.dpuf
2
Q
noninvasive assessments of hemodynamics
A
cap refill pulse rate and quality skin temp/color BP mentation urine output
3
Q
invasive hemodynamic monitoring
A
invasive intravascular catheters (CVP, RA, PA, Swan Ganz Catheter)
Arterial Catheter
4
Q
fluid overload
decreased HR
sympathetic venoconstriction
increased BP
A
increased preload-nitro (venous vasodilators), morphine, diurectics
5
Q
dehydration blood loss fluid loss loss of atrial kick increased HR positioning-gravity
A
decreased preload-crystalloid/colloid, vasopressors
6
Q
lung infection
chronic lung disease
pulmonary HTN
A
causes of increased PVR
7
Q
vasoconstriction
aortic stenosis
increased blood volume increased blood viscosity
A
increased afterload-give vasodilators
8
Q
vasodilation
allergic rxn
loss of vascular tone
sepsis
A
decreased afterload-give vasoconstrictors
9
Q
monitor flush system transducer high-pressure tubing (pump to 150-300) catheter
A
constant flow of sterile solution to maintain patency and avoid clots (saline vs heparin solution: low limb perfusion, extended time line in place, frequent blood draws, heparin sensitivity)
level and zero system every time the patient, the pole or the bed is moved
transducer position directly affects accuracy
10
Q
phlebostatic axis
A
level with Right atrium (fourth intercostal space); catheter tip and transducer must be at same level as phlebostatic axis when using hemodynamic monitoring
11
Q
snap shut of aortic valve
A
dicrotic notch
12
Q
atrial depolarization (contraction) 0.06-0.12s possible source of variation may be disturbance in conduction within atria
A
p wave
13
Q
ventricular depolarization
A
QRS
14
Q
repolarization
A
t wave
15
Q
MAP formula
A
MAP=Diastolic BP x2 + SBP/3
normal is 70-100 mm Hg
must be >60 mm Hg for the perfusion of vital organs
16
Q
R wave
A
represents the contraction of the LV and the mvmt of blood from the aortic valve out to the body
17
Q
S wave
A
represents the contraction of the RV and the mvmt of blood from the pulmonic valve to the lobes of the lung
18
Q
gives measure of LV pressure
A
Swanz Catheter, pulmonary artery pressure
19
Q
CVP
A
measures pressure in right atria
normal is 2-6 mmHg
20
Q
acute episodes of cardiac ischemia, electrolyte imbalances, and the use of cardiac meds
A
abnormal T waves
21
Q
hypokalemia, diabetes, ventricular hypertrophy, and cardiomyopathy
A
abnormal U waves
22
Q
The 300 method
A
300, 150, 100, 75, 60, 50
23
Q
PR intervals
A
0.12-0.20s
disturbance in conduction usually in AV node, bundle of His, or bundle branches, but can be in atria as well
24
Q
QRS duration
A
0.04-0.12s
time during which both ventricles contract (depolarization)
possible variations due to disturbance in bundle branches or in ventricles
25
big box and little box durations
0.2 s and .04 s
26
QT interval
.34-.43 seconds (less than 500milliseconds)
| possible variations due to drugs, electrolyte imbalances, and changes in heart rate
27
dobutamine
beta agonist-tx for bradycardia
28
frequent PAC's
catheter in right atria? too much fluid? heart irritated due to ischemia? too much caffeine? can be precursor to atrial fib
29
atrial flutter
sawtooth pattern observed with P wave, regular ectopic beats; precursor to atrial fibrillation-treat
30
atrial fibrillation
atrial chaos; irregular rhythm, F waves, ectopic beats
| give anticoagulation therapy
31
How much cardiac output comes from the atrial kick?
30% CO results from atrial (LUB) kick
32
SA node rate
60-100bpm
33
AV node rate
40-60bpm
34
Purkinje fibers rate
20-40 beats/minute
35
loudest at apex of heart
| AV valves close
S1 LUB
36
semilunar valves close
| loudest at base of heart
S2 DUB
37
present if ventricular wall compliance is decreased and structures in the ventricular wall vibrate; this can occur in conditions such as heart failure, valvular regurgitation, fluid overload, or HTN. heard in early diastole
S3; may actually be normal in those younger than 30 years
38
may be heard on atrial systole if resistance to ventricular filling is present; this is an abnormal finding, and the causes include cardiac hypertrophy, CAD, aortic stenosis, HTN, or injury to the ventricular wall; heard in late diastole
S4
39
isoelectric
flat-ST segment
0.12 s
possible variations due to disturbances usually caused by ischemia, injury, or infarction
40
ventricular repolarization
T waves 0.16 s
| possible variations due to electrolyte imbalances, ischemia, or infarction
41
Dysrhythmias Emergency Management
Initial: Ensure ABC's, Administer O2, obtain vitals, obtain 12lead EKG and continuous monitoring, ID underlying rate and rhythm, ID dysrhythmia, Establish IV access
Ongoing: Vitals, LOC, O2 saturation, cardiac rhythm; anticipate need for antidysrhythmic meds and analgesics, anticipate need for intubation, prepare to initiate advanced cardiac life support (CPR, defibrillation, or transcutaneous pacing)
42
Nursing considerations for Adenoside
give for PSVT (paroxysmal supraventricular tachycardia)
administer IV dose rapidly over 1-2 seconds followed by a rapid NS flush
Brief period of asystole is common
observe pt for flushing, dizziness, chest pain, or palpitations
43
What is the impact of Ach on the heart?
PNS; slows rate and decrease contractility; PNS is stimulated when BP increase is detected
44
Where are the baroreceptors?
in the walls f the aortic arch and carotid sinuses
45
an elevation indicates myocardial damage and peaks at 18 hours following an acute ischemic attack.
Normal value is
CK-MB
| normal value is 0-5% of total; total CK is 26-174 units/L
46
this cardiac enzyme rises within 3 hours or ischemic attack and persists for up to 7-10 days
Trop-1
0.6ng/mL
(Trop T: 0.1ng/mL)
47
this is an oxygen-binding protein found in cardiac and skeltal muscle that rises within 2 hours after cell death, with a rapid decline in the level after 7 hours
myoglobin
48
How is the RBC affected by the cardiovascular system?
RBC decreases in rheumatic heart disease and infective endocarditis and increases in conditions characterized by inadequate tissue oxygenation
49
How does the cardiovascular system affect WBC?
WBC increases in infectious and inflammatory diseases of the heart and after myocardial infarction bc large numbers of WBCs are needed to dispose of the necrotic tissue resulting from the infarction
WBC increase to 20,000 day after MI and remain elevated up to a week
50
What makes the Hct increase?
vascular volume depletion
51
What does a decreases H&H indicate?
anemia
52
What does a serum lipids test measure?
```
serum cholesterol (<130, HDL=30-70) levels
**used to assess the risk of developing CAD
```
53
a small amount of protein in the urine (microalbuminuria)
has been a marker for endothelial dysfunction in cardiovascular disease
54
What increases risk for digoxin toxicity?
hypokalemia
55
flatten and inverted T wave, appearance of U ave, and St depression
hypokalemia
56
tall, peaked T waves, widened QRS complexes, prolonged PR intervals, or flat P waves
hyperkalemia
57
What happens to sodium during Heart Failure?
serum sodium will decrease to indicate water excess
58
tall T waves and depressed ST segments
hypomagnesemia
59
muscle weakness, hypotension, and bradycardia
hypermagnesemia
60
Which heart disorders increase BUN?
heart failure or cardiogenic shock
61
What is BNP a marker for?
BNP is released in response to atrial and ventricular stretch and serves as a marker for heart failure
levels should be lower than 100pg/mL-higher levels indicate more severe HF
62
Holter monitor
id's dysrhythmias if they occur and evaluates the effectiveness of antidysrhythmics or pacemaker therapy.
63
What are some drug considerations to be aware of prior to a stress test?
theophylline is usually withheld 12 hours prior
CCBs and Beta Blockers are usually withheld on the day of the test to allow the HR to increase during the stress portion of the test
64
What special drug-related consideration must be made if a procedure uses iodine dye?
withhold metformin (Glucophage) for 24 hours prior due to risk of lactic acidosis
65
What are nursing responsibilities for cardiac catheterization?
check for iodine sensitivity
withhold food and fluids for 6-18 hours before procedure
inform pt of use of local anesethsia, insertion of catheter, feeling of warmth when dye injected and possible fluttering sensation in heart when catheter is passed. Pt may be directed to cough or deep breathe when dye is injected and pt is monitored by ECG throughout procedure.
After procedure, assess circulation to extremity-check peripheral pulses q15mins for first hour, and then with decreasing frequency. Observe puncture site for hematoma and bleeding. Do not elevate HOB >15 degrees
66
an invasive, nonsurgical technique in which one or more arteries is dialted with a balloon catheter to open the vessel lumen and improve arterial blood flow
PTCA percutaneous transluminal coronary angioplasty
67
What do we need from the patient prior to performing a PTCA?
a firm commitment to stop smoking, adhere to diet restrictions, lose weight, alter his or her exercise pattern, and stop any other behaviors that lead to progression of artery occlusion
68
Which two veins are commonly used for CABG?
saphenous vein or internal mammary vein
69
When do you Dc diuretics prior to CABG?
2-3 days before surgery
70
when do you DC digoxin prior to CABG?
12 hours before surgery
71
when do you DC ASA and other Anticoags prior to CABG?
1 week before surgery
72
How long is a patient mechanically ventilated following a CABG?
6-24 hours post op
73
What drainage amount from chest tubes is reported?
drainage exceeding 100-150mL/hour
74
pulsus paradoxus, JVD with clear lung sounds
signs of cardiac tamponade
75
Hone care instructions for patients who have had cardiac surgery
avoid push/pull for 6 weeks
avoid crossing legs, restrictive clothing
elevate limb used for graft
resume sex only when client can walk one block or climb two flights of stairs without symptoms
76
When med do you give if sinus bradycardia?
atropine sulfate to increase HR, oxygen via nasal cannulla
apply a transcutaneous pacemaker if pt is unresponsive to atropine sulfate
monitor for hypotension
77
atrial and ventricular rates are 100-180 beats/minute
sinus tachycardia
78
multiple rapid impulses from many foci depolarize in the atria in a totally disorganized manner at a rate of 350-600 times/minute
atrial fibrillation (atrial quiver)-->leads to thrombus formation-->anticoag therapy!!
79
bigeminy
PVC every other heartbeat
80
Trigeminy
PVC every third heartbeat
81
Quadrigeminy
PVC every fourth heartbeat
82
Couplet or pair
two sequential PVCs
83
Unifocal
uniform upward or downward deflection, arising from the same ectopic focus
84
multifocal
different shapes, with the impulse generation from different sites
85
R-onT phenomenon
PVC falls on the T wave of the preceding beat-may proceed vfib
86
What may be a cause of PVC?
hypoxemia-evaluate oxygen saturation
| electrolytes-hypokalemia may cause PVCs
87
ventricular tachycardia
140-250 beats/minute or more
88
a chaotic rapid rhythm in which the ventricles quiver and there is no cardiac output
vfib-fatal if not terminated within 3-5 mins
| client lacks pulse, BP, respirations, and heart sounds
89
Interventions for Vfib
CPR
defibrillate with 120-200 joules (biphasic defibrillator) or 360 joules (monophasic defibrillator)
CPr for two mins and then reassess cardiac rhythm for further defibrillation needs
administer oxygen and antidysrhythmic therapy
90
What are Vagal maneuvers for?
to terminate supraventricular tachydysrhythmias
91
What are some techniques besides meds to manage dysrhythmias?
vagal maneuvers
carotid massage
valsalva maneuver
cardioversion
92
When do we used cardioversion?
for stable tachydysrhythmias resistant to medical therapies or an emergent procedure for hemodynamically unstable ventricular or supraventricular tacydysrhythmias
*defibrillator is synchronized to pt's R wave to avoid discharging the shock during the vulnerable period (Twave)-if this precaution is not observed, a shock during T wave could incite vfib
93
What are some considerations for elective cardioversion for atrial fibrillation?
pt on anticoag for 4-6 weeks preprocedure and a transesophageal echocardiogram should be performed to rule out clots in the atria prior to the procedure
94
What about oxygen and cardioversion/defibrillation?
DC oxygen prior to shock to avoid fire!
95
Implantable cardioverter defibrillator patient education
ICD senses VT or VF and delivers 25-30J up to four times
96
what on an ECG indicates ischemia?
ST depression and T wave inversion
97
what indicates infarction on an ECG?
ST elevation followed by T wave inversion and an abnormal Q wave
98
occurs with activities that involve exertion or emotional stress, relieved with rest of nitroglycerin
stable angina (exertional angina)
99
occurs with an unpredicatble degree of exertion or emotion and increases in occurrence, duration, and severity over time; lasts longer than 15 mins; characterized by chest pain that occurs days to weeks before MI; pain may not be relieved by nitroglycerin
unstable angina (preinfarction angina)
100
angina resultant from coronary artery spasm and may occur at rest; ST segment elevation may be present of ECG
Variant angina (Prinzmetals or vasospastic angina)
101
a chronic, incapacitation angina unresponsive to interventions
intractable angina
102
occurs when myocardial tissue is abruptly and severely deprived of oxygen
myocardial infarction; obvious physical changes do not occur in the heart until 6 hours after the infarction, when the infarcted area appears blue and swollen
103
What are signs of MI in a female?
atypical discomfort, SOB, fatigue, NSTEMI or T wave inversion
104
What are signs of MI in elderly?
SOB, pulmonary edema, dizziness, altered mental status, or a dysrhythmia
105
crushing substernal pain that may radiate to jaw. back, and left arm. Pain may occur without cause, primarily early in the morning and is unrelieved by rest or nitroglycerin but IS relieved by opioids. Pain lasts 30 mins +
n/v, diaphoresis, dyspnea, dysrhythmias, feelings of fear and anxiety, pallor, cyanosis, coolness of extremities
signs of MI
106
dresslers syndrome
a combination of pericarditis, pericardial effusion and pleural effusion which can occur several weeks to month following a myocardial infarction
107
signs of heart failure
presence of crackles or wheezes and dependent edema
108
When do you lower the HOB and notify a HCP?
when systolic BP is <100mm Hg or 25 mm Hg lower than previous measurement
109
the inability of the heart to maintain adequate cardica output to meet the metabolic needs of the body bc of impaired pumping ability
heart failure
110
an inadequate output of the affected ventricle cuases decreased perfusion to vital organs
forward failure
111
blood backs up behind the affected ventricle, causing increased pressure in the atrium behind the affected ventricle
backward failure
112
leads to problems with contraction and ejection of blood
systolic failure
113
leads to problems with the heart relaxing and filling with blood
diastolic failure
114
dependent edema, JVD, abdominal discomfort, hepatomegaly, splenomegaly, anorexia and nausea, weight gain, nocturnal diuresis, swelling of fingers and hands
right-sided failure
115
signs of pulmonary congestion, dyspnea, tachypnea, crackles, dry, hacking cough, paroxysmal nocturnal dyspnea
left sided heart failure
116
severe dyspnea and orthopnea, pallor, tachycardia, expectoration of large amounts of blood tinged frothy sputum, wheezing and crackles, gurgling respirations, acute anxiety, apprehension, restlessness, profuse sweating, cold, clammy skin, cyanosis, nasal flaring, use of accessory breathing muscles, tachypnea, hypocapnia (evidenced by muscle cramps, weakness, dizziness, and paresthesias)
signs of acute pulmonary edema
117
Nursing Actions for pulmonary edema
```
high fowler's
oxygen
vitals, lung sounds
IV access
diuretic+morphine (morphine reduces preload, decreases anxiety, and reduces work of breathing)
foley
intubation or ventilator?
doc event, actions taken, and client response
```
118
Which activities might a heart patient want to avoid as they increase pressure in the heart?
isometric activities
119
hypotension
| urine output
signs of cardiogenic shock
120
What will a Swan-Ganz catheter record if pt has cardiogenic shock?
increased pulmonary capillary wedge pressure (PCWP) and a decreased CO
121
what is central venous pressure?
pressure within the superior vena cava on its way to right atrium; normal is 3-8 mm Hg
122
What may cause CVP to increase?
increased blood volume, sodium/water retention, excessive IV fluids, alterations in fluid balance, kidney failure
123
What may cause a decrease in CVP?
decrease in circulating volume due to fluid imbalance, hemorrhage, severe vasodilation with pooling of blood in the extremities that limits venous return
124
where is the right atrium?
midaxillary line at the fourth intercostal space
125
what position must you place the client for hemodynamic monitoring?
HOB 45 degrees, transducer at level of right atrium; to maintain patency of the line, a small amount of fluid is delivered under pressure
126
what is the pulmonary artery wedge pressure an indicator of?
left ventricular end diastolic pressure
normal is 4-12 mm Hg
elevations indicate LV failure, hypervolemia, mitral regurgitation, or intracardiac shunt
decreases may indicate hypovolemia or afterload reduction
127
What is normal PAP (pulmonary artery pressure)?
15-26mmHg systolic/5-15mmHg diastolic
128
What is the target MAP for optimal organ tissue perfusion?
60-70 mm Hg
129
pain is grating and aggravated by breathing (particularly inspiration), coughing, and swallowing; pain is worse in supine position and may be relieved by leaning forward; pericardial friction rub is heard upon auscultation, fevers, chills, fatigue, malaise, elevated WBC, ST elevation, afib, signs of right HF
pericarditis-may lead to HF or cardiac tamponade
130
acute or chronic inflammation of the myocardium as a result of pericarditis, systemic infection, or allergic resposne
myocarditis
131
fever, pericardial friction rub, gallop rhythm, murmur, pulsus alternans, signs of HF, fatigue, dyspnea, tachycardia, chest pain
signs of myocarditis-assist client to high fowlers or leaning forward
132
inflammation of inner lining of heart and valves and occurs primarily in pts who are IV drugs abusers, have had valve replacements or repair of valves with prosthetic materials, or other structural cardiac defects
endocarditis
133
fever, anorexia, weight loss, fatigue, cardiac murmurs, HF, embolic complications from vegetation fragments travelling through the circulation, petechiae, splinter hemorrhages in nail beds, Osler's nodes (reddish, tender lesions) on the pads of fingers, hands, toes, Janeway lesions (nontender hemorrhage lesions) on the fingers, toses, nose, or earlobes, splenomegaly, clubbing of the fingers
signs of endocarditis
134
Client education r/t endocarditis
tell patient to inform all HCPs of hx of endocarditis and ask about the use of prophylactic antibiotics prior to invasive respiratory procedures and dentistry
135
flank pain radiating to the groin, hemturia, and pyuria
renal emboli-potential complication r/t endocarditis
136
sudden abdominal pain radiating to left shoulder and the presence of rebound abdominal tenderness on palpation
splenic embolic-potential complication of endocarditis
137
confusion, aphasia, dysphasia
potential central nervous system emboli-potential complication of endocarditis
138
pleuritic chest pain, dyspnea, cough
pulmonary emboli-potential complication of endocarditis
139
```
pulsus paradoxus
increased CVP
JVD with clear lungs
distant, muffled heart sounds
decreased CO
narrowing pulse pressure
```
cardiac tamponade
140
cardiac tamponade interventions
place client in critical care for hemodynamic monitoring
admin fluids to manage decreased CO
prepare client for pericardiocentesis
141
heart valves cannot fully open
stenosis (diastolic murmurs)
142
heart valves cannot close completely
regurgitation or insufficiency (systolic murmurs)
143
What is the window for tPA therapy with DVT?
within 5 days after onset of symptoms
144
what do you monitor during Coumadin therapy?
PT/INR
145
what do you monitor during heparin therapy?
aPTT
146
stasis dermatitis or brown discoloration along the ankles extending up to the calf, edema, ulcer formation (edges uneven, ulcer bed is pink and granulation is present)
venous insufficiency
147
sclerotherapy
a solution is injected into a varicose vein, followed by the application of a pressure dressing
incision and drainage of the trapped blood in the sclerosed vein is performed 14-21 days after the injection, followed by the application of a pressure dressing for 12-18 hours
148
chronic disorder in which partial or total arterial occlusion deprives the lower extremities of oxygen and nutrients-most commonly caused by atherosclerosis
PAD
149
intermittent claudication, REST PAIN relieved by placing extremity in dependent positon, lower back or buttock discomfort, loss or hair and dry scaly skin on the LE, thickened toenails, cold and gray-blue color of skin in LE, elevational pallor and dependent rubor in LE, decresased or absent peripheral pulses, signs of arterial ulcer formation occurring on or between toes or on the upper aspect of the foot that are painful
PAD signs
150
what is rest pain?
associated with PAD; characterized by numbness, burning, or aching in the distal portion of the LE which awakens the client at night and is relieved by placing the extremity in depended position
151
Do you advise a patient with PAD to elevate affected extremity?
bc swelling of the extremities prevents arterials blood flow, the client with PAD is instructed to elevate the feet at rest, but not above heart level bc extreme elevation slows blood flow to feet. In severe cases of PAD, clients with edema may sleep with the affected limb hanging from the bed or they may sit upright (without leg elvation) in a chair for comfort
152
fusiform
type of aortic aneurysm with diffuse dilation that involves the entire circumference of the arterial segment
153
saccular
type of aortic aneurysm with distinct localized outpouching of the artery wall
154
dissecting
type of aortic aneurysm created when blood separates the layers of the artery wall, forming a cavity between them
155
false or pseudoaneurysm
occurs when the clot and connective tissue are outside the arterial wall as a result of vessels injury or trauma to all three layers of the arterial wall
156
pain extending to neck, shoulders, lower back, or abdomen, syncope, dyspnea, increased pulse, cyanosis, weakness, hoarseness, diff swallowing
thoracic aneurysm
157
prominent, pulsating mass in abdomen at or above the umbilicus, systolic bruit over the aorta, tenderness on deep palpation, abdominal or lower back pain
abdominal aneurysm
158
severe abdominal or back pain, lumbar pain radiating to the flank and groin, hypotension, increased pulse rate, signs of shock, hematoma at flank area
rupturing aneurysm
159
insertion of an intracaval filter (umbrella) that partially occludes the inferior vena cava and traps emboli to prevent pulmonary emboli
vena caval filter
160
suturing or placing clips on the inferior vena cava to prevent pulmonary embolic; done via abdominal laparotomy
ligation
161
prehypertension
120-139/80-89
162
Stage 1 hypertension
140-159/90-99
163
Stage 2 hypertension
160/100 or higher
164
HA, visual disturbances, dizziness, chest pain, tinnitus, flushed face, epistaxis
htn s/sx
165
Whats the big deal about a hypertensive crisis?
can lead to death caused by stroke, kidney failure, or cardiac disease
166
HIgh BP, HA, drowsiness and confusion, blurred vision, changes in neurological status, tachycardia and tachypnea, dyspnea, cyanosis, seizures
hypertensive crisis
167
What do you do if your client develops hypotension during antihypertensive medication therapy?
put client in supine position
168
digoxin toxicity
GI are eary symptoms, aong with confusioin and fatigue. additiona manifestations incude HA, hypotension, and cardiac dysrhythmias
169
Ulcer is pale and deep and surrounding tissue is cool to touch. Skin is dry and there is often a loss of hair.
Arterial ulcer caused by tissue ischemia a from inadequate arterial blood supply of oxygen and nutrients.
170
Ulcer with a dark red base and is surrounded by brown skin with local edema
Venous stasis ulcer is caused by the accumulation of waste products of metabolism that are not cleared as a result of venous congestion
171
Treatment for DVD
Bed rest, limb elevation, relief of discomfort with warm, moist heat, and analgesics as needed. Ambulatory is contraindicated because such activity can cause the thrombus to dislodge and travel to the lungs
172
First degree heart block
Prolonged pr interval
173
What does the development of a waves signify?
Myocardial necrosis
174
What finding on an EKG indicates a bbb?
A widened qrs complex
175
Which cardiac med is best for variant angina?
CCBs
176
What is an early indication of decreased blood volume?
Early decreases in fluid volume are compensated for by an increase in pulse rate
177
What is the purpose of carotid massage?
To decrease heart rate and bp
178
What is the physiological effect of stimulating alpha 1 receptors?
Found in peripheral arteries and veins, alpha 1 adrenergic receptors cause a powerful vasoconstriction when stimulated
179
What is the physiological effect of stimulating beta 1 receptors?
Found In arterial and bronchial walls, beta 1s cause vasodilation and bronchodilator when stimulated
180
What is the physiological effect of stimulating beta 2 receptors?
Found in the heart, the beta 2 receptors increase hr av node conduction, and contractility when stimulated (that's why we use cardio-selective beta blockers for hf and mi pts)
181
WhT is the physiological effect of stimulating alpha 2 adrenergic receptors?
Found in several tissues, alpha 2 receptors cause smooth muscle contraction, inhibition of lipolysis, and promotion of platelet aggregation
182
What is the therapeutic effect of digoxin?
Increases strength and contraction of the heart-hold if apical rate is less than 60
183
what does the pr interval represent?
Travel time for impulse for. as node to purkinje fibers
184
A loss of communication between the atrium and ventricles from av node dissociation
Third degree heart block
185
Slower heart rate with exhalation and increased heart rate with inhalation
Sinus dysrhythmias
186
A gradual lengthening of pr interval until a qrs is dropped.
Wenckebach heart block
187
Early occurrence of a wide, distorted qrs complex
PVC s
188
A sinus rate above 100 beats/min with normal p waves
Sinus tachycardia
189
What is a common diagnostic test following episodes of syncope?
Head up tilt test
190
A patient in a systole is likely to receive which drug treatment?
Epi or atropine
191
What drugs are given for PVC ?
Lidocaine and amiodorone
192
What drugs are given to control ventricular rate?
Digoxin and procainamide
193
What drug is given to slow heart rate?
Beta blockers
194
What drug is given to increase heart rate?
Dopamine
195
Atrial fibrillation with a rapid ventricular response
Supra ventricular tachydysrhythmias; perform synchronized cardio version
196
St depression and t wave inversion
Myocardial ischemia
197
St elevation
Myocardial injury
198
St elevation with a widened and deep q wave
Previous mi
199
torsade de pointes
twisty rhythm; give magnesium!! looks like a double helix; -shock after giving mag
200
asystole
CPR, give EPI (1mg q3-5 mins) look for the cause of asystole
201
Pulseless electrical activity
EPI, CPR, look for cause
202
o2, IV, monitor
priorities when an arrhythmia is present
203
sinus bradycardia
atropine
| less than 60 bpm
204
sinus tachycardia
give beta blocker
| greater than 100 bpm
205
PACs
give beta blockers
206
PSVT
150-222bpm
| vagal stimulation and adenosine!!
207
Atrial flutter
200-350
ccb, beta blcokers
cardioversion or radiofrequency catheter ablation
COUMADIN to decrease stroke risk
208
Atrial fibrillation
350-600
CCBs, Beta Blockers, Digoxin, Dronedarone, Amiodarone
Coumadin 3 weeks before elective cardioversion and for 2 weeks after
radiofrequency catheter ablation
Maze procedure (cryoablation)
209
Second Degree Heart Block Type 1
give atropine and/or temp pacemaker
210
Second Degree Type II and Third Degree Heart Block
pacemaker
211
PVC
lidocaine or amiodarone
212
Vtach
digoxin or procainamide
| cardioversion of defirillation (defib if no pulse)
213
torsades de pointe
give magnesium and shock
| twisty vfib
214
roths spots, splinter hemorrhages, oslers nodes, janeways lesions
Infective Endocarditis
215
complications of Infective endocarditis
stroke, pulmonary edema, and HF
216
pericardial friction rub
| complications include pericardial effusion and cardiac tamponade
pericarditis
217
compression of heart due to fluid in pericardial sac. hallmark sign is pulsus paradoxus
cardiac tamponade, a common complication of pericarditis. assess for pulsus paradoxus q4h if pericarditis
218
colchicine
antiinflammatory for gout, is sometimes given to pts with pericarditis
219
clinical manifestations mimic HF and cor pulmonale (hypertrophy of right heart with or without HF due to pulmonary HTN)
Chronic constrictive pericarditis-treat with pericardectomy
220
ACEI, beta blockers, digoxin, and diuretics
vasodilators if no hypotension
anticoags
immunosuppressive therapy to redcue myocardial inflammation and to prevent myocardial damage
oxygen, bed rest, restricted activity
intraaortic balloon pump therapy or ventricular assist devices to reduce workload of heart
treatment for myocarditis
221
Aschoff's bodies
nodes present in rheumatic heart disease and that turn to fibrous scar tissue with age
222
carditis (murmurs, cardiac enlargement, pericarditis)
monoarthritis or polyarthritis
sydenham's chorea (Major CNS involvement)
Erythema marginatum lesions (worse in warm water, maplike macular lesions)
elevated ESR, WBC, CRP
Rheumatic heart disease
223
enhance cardiac contractility and decrease preload and afterload
cardioversion, ICDs, and ventricular assist devices
dilated cardiomyopathy
224
impaired ventricular filling as the ventricle becomes noncompliant and unable to relax
hypertrophic cardiomyopathy-reduce ventricular contractility and relieve ventricular outflow obstruciton with beta blockers or CCBs
ICD is option if risk for SCD
225
impaired diastolic filling and stretch with unaffected systolic function.
fatigue, exercise intolerance, dyspnea
heart transplant is considered
restrictive cardiomyopathy
226
Ventricular gallop
S3 I. Occurs with decreased compliance of either ventricle
227
Atrial gallop
S4. Occurs later is diastole during atrial contraction and active filling of the ventricles. Stiff ventricles, mi, hypertension, hyper trophy, fibrosis, cardiomyopathy, Cor pulmonale, aortic stenosis, pulmonic stenosis
