Blood Pressure Alterations and Cardiac Alterations Focus Flashcards
what is the top number of BP called and what is it measuring
systolic - the maxium pressure the heart exudes while contracting
what is the bottom number of BP called and what is it measuring
diastolic - measuring the residual pressure in the arteries
what is the goal for diastolic BP
60-80
what is mean arterial pressure
the average pressure in the arterial system
what is the mean arterial pressure goal
60-90
what is cardiac output
how much blood volume is pumped out of the hart each minute
what is cardiac output goal
4-6L/min
what is stroke volume
the volume of the blood pumped out of the LV during each contraction
what is elevated BP/ hypertension stage 1 range
130-139 / 80-89
what is hypertension stage 2 range
> 140/ >90
what is a hypertension crisis range generally
> 180/>120
what is a hypertensive crisis for people over 50
150/90
what is a hypertensive crisis for people under 50
same has hypertension stage 2 >140/>90
what is a hypertensive crisis
Severely high BP that rapidly progresses
what could be the cause of a hypertensive emergency
head bleed, heart failure, heart attack, renal failure, dissecting aneurysm
what are some ss of hypertension
fatigue, dizziness, palpitations, angina, dyspnea
what labs will you take to diagnosis hypertension
BMP, lipid panel, TSH, ECG,
what kind of lifestyle changes can someone do to decrease hypertension
lose weight, change diet (DASH) decrease ETOH (alcohol), dont smoke, decrease stress, exercise atleast 30min a day
what is a DASH diet
less red meat, salt, less sweets
what are the 1st line drugs for hypertension
ACE, ARB, calcium channel blockers, and diuretics
what meds end in dipin and what are some other examples
calcium channel blockers, also diltiazem and verapamil
what are some common SE of caclium channel blockers
peripheral edema
who should not take calcium channel blockers and what should you not take with calcium channel blockers
CHF or with grape juice
what are some side effects of ACE
dry cough (lisinopril), decrease potassium, decreased HR
what are some second line drugs for hypertension
beta blockers, potassium sparing diuretics, direct vasodialators, adrenegic inhibiting agents
are are some cardioselective beta blockers
bisoprolol, metoprolol, esmolol
what are some non-cardioselective beta blockers and where do they work
propanolol - lungs
what are some side effects for cardioselective beta blockers
mask hypoglycemia, increased HR
what are some se for non cardio selective beta blockers
bronchospasms
what are some mixed cardioselective beta blockers
caredilol and labetalol
what happens if you take hypertensive meds with NISAIDs
renal damage and retain fluid
what are some potassium sparing diuretics
sprinolactone and eplernone
what are some direct vasodilators medications
hydralazine, nitroglycerin, sodium nitropursside
what are some adrenergic inhibiting agents
clonidine - last resort
what could be the cause someone goes into hypertensive crisis
non compliant, head injury, pheochromocytoma, illegal drugs, preeclampsia
what is the goal for hypertensive crisis management
decrease in map by 20% and DBP of 110-115 w/ antihypertensives in 1st 2-6 hours
what is the labs for kidney disease caused by hypertension
creatine over 1.5 and proteinuria
what is the P wave on ECG and what is the normal bpm
SA node 60-100
what is the PR segment on ECG and what is happening
AV node the energy travels to atrium to make it contract and push blood into ventricles
what are the secondary pacemakers of the heart and what are there normal bpm
AV node 40-60 bmp
his purkinje fibers 20-40bpm
who is bradycardia normal in
athletes
what could be some causes for bradycardia
hypothermia, vagal stimulation, beta-blockers, calcium channel blockers, hypothyroidism , increased intracranial pressure, MI
what could be some causes for tachycardia
stressors, drugs like norepinephrine and epinephrine, theo-durr, or OTC cold remedies
what are some ss of brady cardia
decreased BP, cold skin, weakness, angina, dizziness, confusion, SOB
what are some ss of tachycardia
dizziness, dyspnea, decreased BP, angina( in patients with CAD)
what is atropine med used for and how does dosing work
for bradycardia -> 1mg every 3-5 minutes for a total of 3 mg
what are some interventions for bradycardia
pacemaker (temp or permanent), stop offending drugs
what is something someone can do to help with tachycardia
vagal manuever (bear down)
what meds decrease HR for tachycardia
beta blockers, calcium channel blockers
what is paroxysmalsupra - ventricular tachycardia
abrupt onset and ending starting above bundle of his - recitation of atria
who is mostly effected by paroxysmalsupra - ventricular tachycardia
young healthy females
what is the normal heart rate paroxysmal supra - ventricular tachycardia
150-220bpm
what could be some causes for paroxysmal supra - ventricular tachycardia
over excertion, emotional stress, stimulants, stimulants like caffeine and tobacco
what are the ss of paroxysmal supra - ventricular tachycardia
feeling unwell, weak, fatigue, heart racing, prolonged decrease in BP, dyspnea, angina
what are some vagal stimulants you can do for paroxysmal supra - ventricular tachycardia
carotid massage, valsalva, coughing
what is IV adenosine for and how does dosing work
1st drug for paroxysmal supra - ventricular tachycardia , 6mg->12mg->12mg->20ml flush
what needs to be monitored for IV adenosine
continued monitor on ECG
what are the SE IV adenosine
flushing, chest pain
if hemodynamically unstable and on IV adenosine what is required
direct current cardioversion
what does atrial flutter look like
saw toothed originating from single ectopic focus in atrium
what is a fib
the disorganized atrial activity caused by multi ectopic folci which causes ineffective atrial contraction and no p waves
how do you rate control for a fib/flutter
calcium channel blockers, beta blockers
what are some procedures for a fib
maze procedures with cryoblation, LA appendages occlusion
if someone is experiencing a fib/flutter for over 48 hours what needs to be done
anticoagulants for 3-4 weeks before cardioversion then several weeks after
what does a transesophogeal echocardiogram detect
sees if there are any clots in the atrium
what is a 1st degree AV block
impulse to AV node (send blood from atrium to ventricles) is prolonged but once through the rest is normal
what is the ss of 1st degree av block
Asymptomatic
how do you diagnosis 1st degree av block
ECG, TSH, BMP,
what is the treatment for 1st degree AV block
just monitor
what is 2nd degree av block
since that AV prolongation now its not blocking the QRS so its missing on the ECG
whats the difference of type 1 and 2 2nd degree av block
type 1 has a p wave
type 2 is no p wave
what are the 2 meds used for 2nd degree type 1 av block
digoxin or beta blockers
what is the med of choice of 2nd degree type 2 av block
atropin it increases hr
what are some other treatment options for 2nd degree type 2 av block
if they are symptomatic ->temporary pacemaker especially if they have experienced an MI is asymptomatic monitor and have a transcutaneous pace maker on standby
what are some ss of 2nd degree type 2 av block
decreased cardiac output, decreased BP and myocardial ischemia
what is 3rd degree AV block
no impulse to AV node
what does a 3rd degree av block look like on an ECG
2 missing QRS back to back
what is premature ventricular contraction
QRS is happening too soon
what could be some causes for premature ventricular contraction
stimulants, electrolyte imbalances, hypoxia, fever, exercise, stress, cardiac disease -> so treat the cause
what are some ss of premature ventricular contraction for a normal heart
not harmful
what are some ss of premature ventricular contraction for heart disease
decreased CO, angina, HF
what is an R on T phenomenon and what condition is it seen in
premature ventricular contraction - QRS happening on T wave when the heart is suppose to be recovering
what does R on T phenomenon cause
VT and V fib
what is ventricular fibrillation
run of 3 or more premature ventricular contraction can be stable (pulse) or unstable (no pulse) sustained (longer then 30 seconds) or non sustained (less then 30 seconda)
what is monomorphic VF
QRS has the same shape/size/ direction
how do you treat monomorphic VF
antidysrhythmias
what is polymorphic VF (torsades de pointes)
QRS gradually changes back and forth from one shape and size to another
what meds do you use to treat polymorphic VF (torsades de pointes)
beta blockers, aminodarone, procainamide, magnesium
what is pulse less electrical activity
you can see electrical activity but no mechanical activity = no pulse
what are the risk for pulses electrical activity
hypovolemia, hypoxia, acidosis, hypo/hyperkalemia, hypoglycemia, hypothermia, toxins, tamponade, thrombus, tension pneumothorax, trauma
what doe most cardiac related death result from
ventricular dysrhythmias
what could be the risk for stage 2 hypertension
renal disease, primary aldosterone, pheochromocytoma, Cushings syndrome, Medication
why would having primary aldosterone increase your risk of having stage 2 hypertension
(retaining fluid so high sodium and low vitamin K)
why would having pheochromocytoma increase your risk of having stage 2 hypertension
(tumor on the adrenal causing excretion of epinephrine and norepinephrine)
why would cushings syndrome increase your risk of having stage 2 hypertension
increase cortisol = retaining fluid)
