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HURST > Cardiac > Flashcards

Cardiac Flashcards

1
Q

What two major veins bring blood to the right side of the heart? Is the blood oxygenated?

A

superior and inferior vena cava

no it is deoxygenated

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2
Q

How does blood normally flow through the heart?

A

superior and inferior vena cava bring blood to RIGHT ATRIUM

then it goes to RIGHT VENTRICLE

it is pumped into PULMONARY ARTERY then to lungs where blood is oxygenated

PULMONARY VEINS return blood to LEFT ATRIUM

then to LEFT VENTRICLE which pumps to aorta then to body

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3
Q

Preload

A

amount of blood returning to right side of the heart and the muscle stretch the volume causes

ANP is released when we have this stretch

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4
Q

Afterload

A

pressure in the aorta and peripheral arteries that LEFT VENTRICLE has to pump against

resistance

HTN = more resistance / afterload = why HTN can lead to HR and pulmonary edam

High afterload decreases CO and wears your heart out

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5
Q

Stroke volume

A

amount of blood pumped out of ventricles with each beat

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6
Q

CO = ___ x ___

A

CO = HR x SV

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7
Q

Factors that affect cardiac output

A

HR and certain arrhythmias (tachycardia = decreased CO)

Blood volume (less volume = less CO)

Decreased contractility (MI, meds, cardiac muscle disease)

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8
Q

Pathophysiology of decreased CO

A

poor perfusion

decreased LOC

chest pain

crackles / wet lung sounds / SOB

cold / clammy skin

UOP decreases

Peripheral pulses weak

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9
Q

Meds that effect Preload

A

diuretics and nitrates decrease preload by vasodilating and diuresing

diuretic (furosemide)
Nitrates (nitroglycerin)

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10
Q

Afterload Meds

A

vasodilation reduces afterload

ACE Inhibitors (enalapril, fosinopril, captopril)
ARBS (losartan, irbesartan
Hydralazine
Nitrates

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11
Q

Meds that Improve Contractility

A

Inotriopes (dopamine, dobutamine, milrinone)

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12
Q

Meds that help Rate Control

A

Beta Blockers (propranolol, metoprolol, atenolol, carvedilol)

Calcium Channel Blockers (diltiazem, verapamil, amlodipine)

Digoxin

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13
Q

Meds for Rhythm Control

A

antiarrhythmics (amiodarone)

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14
Q

Three Arrhythmias that are always a big deal

A

pulseless V-tach

V-Fib

Asystole

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15
Q

Coronary Artery Disease

A

includes both

CHRONIC STABLE ANGINA

and

ACUTE CORONARY SYNDROME

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16
Q

Chronic Stable Angina Pathophysiology

A

Chest pain upon exertion alleviated by rest or nitroglycerin SL.

intermittent decreased blood flow to myocardium = ischemia

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17
Q

Chronic Stable Angina Treatment

A

Nitroglycerin
Beta Blockers
Calcium Channel Blockers
Acetylsalicylic Acid (Aspirin)

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18
Q

Client Education for Chronic Stable Angina

A

rest frequently

avoid overeating (low fat / high fiber diet) / lose weight

avoid excess caffeine or drugs that increase HR

Dress warmly in cold weather / really cold drinks can precipitate attacks (vasoconstriction)

Take nitroglycerin prophylactically and then sit and rest

stop smoking

avoid isometric exercise (squatting, lifting weights)

reduce stress

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19
Q

Nitroglycerin

A

Sublingual

causes vasodilation (decreases preload and afterload)

dilation of coronary arteries to increase blood flow to myocardium

take 1 every 5 minutes with a max of 3 doses
** if first dose doesn’t treat pain, call 911 then take second dose

keep in DARK, GLASS BOTTLE and keep it dry and cool

may burn or fizz (if it doesn’t check expiration) / renew meds every 6 months

client will get headache

BP will DROP

** must be sitting when you take it (since BP drops) and only stand once headache is gone

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20
Q

Beta Blockers

A 
prevents angina (doesn't treat it)
Ex. propranolol, metoprolol, atenolol, carvedilol

decreases BP, HR, and myocardial contractility
**decreasing myocardial contractility decreases CO and decreases workload on heart

Block epi and norepi (no fight or flight)

  • also used to treat HF (along side ACE inhibitors)
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21
Q

Calcium Channel Blockers

A

prevention of angina (doesn’t treat)
Ex. nifedipine, verapamil, amlodipine, diltiazem

Decreases BP, vasodilates, decreases afterload, increases oxygen to myocardium

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22
Q

Acetylsalicylic acid

A

81 - 325 mg dose

81 is baby dose

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23
Q

Cardiac Catheterization

A

ask if allergic to shellfish or iodine (dye)

check kidney function (dye is excreted through kidneys)
** acetylcysteine helps protect kidneys and is given pre-procedure (esp w kidney probs)

Hot shot - due to vasodilation
Palpitations are NORMAL

Post-Procedure:

  • monitor VS
  • watch puncture site (bleeding / hematoma)
  • Assess extremity distal to puncture site (pulselessness / pallor / pain / paresthesia / paralysis / skin temp / cap. refill)
  • bed rest, flat, extremity straight for 4-6 hrs
  • report pain ASAP

**if client is on metformin, discontinue for 48 hrs post procedure (kidneys)

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24
Q

Acute Coronary Syndrome Patho

A

MI, Unstable Angina

decreased bloodflow to myocardium = ischemia, necrossis
happens randomly (acutely) w no exertion required
rest and nitroglycerin will NOT relieve pain
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25
Acute Coronary Syndrome S/sx
chest pain / discomfort / crushing - radiates to neck, jaw, one or both arms, shoulder blades tightness, pressure, dizziness, sweating, N/V cold / clammy / BP drops / decreased CO / ECG changes / vomiting - stimulation of vagus nerve (why BP and HR drops) Women: GI s/sx --> epigastric discomfort / pain between shoulder blades, aching jaw, choking sensation Elderly: SOB / behavior change
26
STEMI
ST-Segment Elevation Myocardial Infarction indicates that the client is having a heart attack and the goal is to get them to the cath lab for PCI in less than 90 min
27
NSTE-ACS
Non-ST-Segment Elevation Acute Coronary Syndrome these clients are usually less worriesome. Partial coronary vessel blockage by a thrombus
28
CPK - MB
Diagnostic Lab Work for Acute Coronary Syndrome cardiac specific iso-enzyme Levels increase with damage to cardiac cell ** elevates within 6 hours and peaks in 12-24 hrs; returns to normal within 24-36 hrs
29
Troponin
cardiac biomarker with high specificity to myocardial damage elevates within 3-4 hours, peaks at 10-24 hrs and remains elevated for up to 3 wks MOST SENSITIVE INDICATOR FOR AN MI also most helpful when client delays seeking care
30
Myoglobin
increases within 2 hrs and peaks in 3-15 hrs negative results are a good things
31
What arrhythmias require defibrillation?
PULSELESS v tach v fib
32
What meds do you use when V-Fib and pulseless VT are resistent to epi (vasopressor) and defibrillation?
amiodarone and lidocaine (both anti-arrhythmic drugs)
33
What do you monitor to tell if your patient has developed lidocaine toxicity?
CNS changes
34
What do you monitor for with Amiodarone?
hypotension --> can lead to heart arrhythmias
35
Treatment for Acute Coronary Syndrome
Oxygen 1st (if O2 less than 90%) aspirin 2nd (chewable) nitroglycerine 3rd morphine only if in pain * head up position to decrease workload on heart and increase CO * fibrinolytic therapy * PCI (percutaneous coronary intervention) * Coronary Atery Bypass Graft (CABG) * Cardiac Rehabilitation
36
Fibrinolytic Therapy
dissolve clot alteplase (t-PA) tenecteplase (TNKase / one time IV push) reteplase streptokinase administer within 12 hrs onset of myocardial pain Rules for STROKE: Time is Brain (only have 3 hrs) * *major complication = bleeding. (institute bleeding precautions) - draw blood when starting IVs to reduce punctures / no ABGs - no neck IVs (need to be able to compress) Contraindications: intracranial neoplasm or bleed, suspected aortic dissection, internal bleeding
37
PCI
Percutaneous Coronary Intervention (includes PTCA - percutaneous transluminal coronary angioplasty and stents) Angioplasty complication = MI client could bleed from heart cath or reocclude any problems = go back to surgery chest pain after procedure = surgery bc possible re-occlusion
38
Meds adjunctive with PCI
heparin bivalirudin clipidogrel & prasugrel IV nitroglycerin Beta Blockers abciximab & eptifibatide - keeps artery open after stent is placed or while waiting to get to cath lab
39
CABG
coronary artery bypass graft scheduled or emergency procedure used for multiple vessel dz or left main coronary artery occlusion *left main coronary artery occlusion = sudden death / widow maker
40
Cardiac Rehabilitation
smoking cessation stepped-care plan (increase activity gradually) diet changes (decreased fat, salt, and cholesterol) no isometric exercises no valsalva no straining, no suppository (can give docusate) sex after 7-10 days (best to do in the morning) walking / swimming is best exercise teach s/sx of heart failure
41
Causes of Heart Failure
coronary artery dz, cardiomyopathy, valvular heart dz, endocarditis, acute MI, HTN
42
Left Sided HF S/sx
``` pulmonary congestion dyspnea cough blood tinged frothy sputum restlessness tachycardia S-3 orthopnea nocturnal dyspnea ``` *left = lung
43
right sided heart failure
``` distended neck veins edema enlarged organs wt gain ascites ``` can be caused by PE, COPD, chronic bronchitis
44
systolic vs diastolic HF
systolic HF - heart can't contract and eject diastolic HF - ventricles can't relax and fill
45
Diagnosis of HF
B-type (BNP) natriuretic peptide Chest Xray echnocardiaogram ``` new york heart association functional classification of persons w HF *class 4 is worst ```
46
What will you see on a CXR with HF?
enlarged heart | pulmonary infiltrates
47
Echnocardiogram
looks at pumping action or ejection fraction of the heart also info about backflow and valve disease
48
B-type (BNP) natruiretic peptide
blood test its secreted by ventricular tissues in heart when volumes and pressures in heart are increased sensitive indicatory can be positive for HF when CXR doesn't show a problem nesiritide can give false high (turn off 2 hrs before drawing for BNP)
49
ACE Inhibitors and HF
**dry naggy cough suppresses renin-angiotensin system arterial dilation and increased stroke volume Block aldosterone (lose sodium and water and retain potassium)
50
ARBs and HF
cause a decrease in arterial resistance and decreased BP Block aldosterone (lose sodium and water and retain potassium)
51
Beta Blockers and HF
first-line therapy (prescribed in addition to ACE inhibitors) relaxes vessels, decrease BP, decrease afterload, decrease workload on heart
52
Digoxin
monitor for drug toxicity, esp in elderly used when client is in sinus rhythm or atrial fibrillation and has chronic HF strengthens contractions, decreases HR, increases CO, increases kidney perfusion * check apical pulse (5th intercostal space) Monitor electrolyte levels (imbalances can lead to digoxin tox. ESP potassium) Normal levels: 0.5-2.0 ng/mL S/sx of digoxin toxicity: early - anorexia, N/V late - arrhythmias and vision changes (HALOS w/ light and yellowing vision)
53
What meds do you give for severe heart failure or decompensating HF?
IV inotropes (milrinone, dobutamine) Vasodilators (nitroprusside, nesiritide, nitroglycerin)
54
What wt gain would you report in a patient with heart failure?
2-3 pounds per day
55
What is the most common complication post-op for a pacemaker implantation?
electrode displacement we immobilize arm post op to try and prevent this; don't life arm above shoulder when doing passive ROM
56
loss of capture
when no contraction follows the stimulus
57
failure to sense
when pacemaker fires at inappropriate times
58
What causes lose of capture, failure to sense, or other malfunctions in pacemakers?
pacemaker programmed incorrectly electrodes can dislodge battery can die
59
What is client teaching for pacemaker clients?
check pulse daily ID card or bracelet avoid electromagnetic fields (cell phones use on other side, large motors) avoid MRIs ICD - implantable cardioverter defibrillator care of ICD is same as pacemaker
60
Who is at risk for PE?
any person receiving fluids quickly very young / very old person w hx of heart or kidney dz
61
S/sx of PE
sudden onset breathlessness restless / anxious severe hypoxia productive cough (pink frothy sputum)
62
Treatment for PE
High flow oxygen (keep above 90%) diuretics nitroglycerin morphine nesiritide positioning (upright, legs down) (improves cardiac output / promotes pooling in lower extremities)
63
Furosemide and PE
diuresiss and vasodilation (traps more blood in arms and legs and reduces preload) 40 mg IV push slowly over 1-2 min to prevent hypotension and ototoxicity
64
Bumetanide and PE
IV push or continuous IV infusion to provide rapid fluid removal 1-2 mg IV push given over 1-2 min
65
Nitroglycerine and PE
vasodilation (reduce afterload) which increases CO
66
Morphine and PE
2 mg IV push to vasodilate to decrease preload and afterload
67
Nesiritide and PE
IV infusion (short term therapy / don't give more than 48 hrs) Vasodilates veins and arteries w diuretic effect
68
Cardiac Tamponade
blood, fluid, or exudate leaking into pericardial sac resulting in compression of the heart Causes: MVC, right ventricular biopsy, MI, pericarditis, hemorrhage post CABG
69
Cardiac Tamponade S/sx
decreased CO (can lead to shock) CVP will be increased Hallmark signs for Cardiac Tamponade (increased CVP w decreased BP) heart sounds muffled / distant neck veins distened / CLEAR lungs Pressure in all 4 chambers = same narrowed pulse pressure (difference bw systolic and diastolic)
70
narrowed pulse pressure =
cardiac tamponade
71
widened pulse pressure =
increased intracranial pressure
72
Treatment for cardiac tamponade
pericardiocentesis to remove fluid/ blood from around heart surgery
73
Arterial Insufficiency
medical emergency = acute arterial occlusion numbness / pain / cold extremity / no pulse / atrophy / bruit / ulcerations Pain at rest = SEVERE obstruction Intermittent claudication ``` ************ intermittent caludication pain (pain at rest) decreased / absent pulses cool temp absent or mild edema thin, shiny, loss of hair over foot/toes, nail thickening ulceration on toes or on feet gangrene possible do not use compression socks ```
74
Arterial Insufficiency Treatment
don't elevate / dangle angioplasty or endarterectomy
75
Venous Disorders
inflammation and chronic ulcers DVT - wall lean if you suspect so you don't risk a PE ELEVATE!! ``` ************* no or achy pain normal pulses (edema possible) petechia or brown coloration possible normal temp edema brown pigmentation possible around ankles / thickening of skin ulceration possible on sides of ankles Use compression socks ```

HURST (15 decks)

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