Cardiac

Question 1

What does an ECG measure?

Answer 1

The collective electrical activity of the heart.

Question 2

Can prolonged tachycardia cause angina?

Answer 2

Yes, because coronary blood flow occurs during diastole. If systole occurs to fast, there is no time for the coronary blood to flow.

Question 3

What are two shockable rhythms?

Answer 3

Ventricular fibrillation and ventricular tachycardia.

Question 4

What is a myocardial infarction?

Answer 4

Any acute condition whereby the myocardium is irreversible damaged and becomes necrotic (infarcted) due to the lack of oxygen (ischemia) and hypoxia.
This is a result from acute obstruction of a coronary artery.

Question 5

What cardiac markers in the blood will be elevated after myocardial infarction?

Answer 5

Trooponin 1 or 2 and creatine kinase are elevated.
Creatine kinase is an enzyme found in your heart muscle, skeletal muscle and brain, when any of these get damaged, they leak creatine kinase into your bloodstream.
Troponin is a globular protein involved in muscle contraction. Any damage to cardiac muscle can cause troponin to spill into circulation.

Question 6

What is a NSTEMI?

Answer 6

Non ST elevated myocardial infarction.
Is evident by myocardial necrosis shown by cardiac markers in the blood but has not acute ST segment elevation. ECG changes such as ST segment depression or T Wave inversion - or maybe both.

Question 7

What is a STEMI?

Answer 7

ST elevation myocardial infarction.
Myocardial necrosis with ECG changes showing ST segment elevation that is not quickly reversed by nitroglycerine. Troponin 1 or creatine kinase are elevated.
ST elevation occurs within minutes of the onset of infarction and indicates the presence of ischaemic tissue.

Question 8

What does a Q wave indicate?

Answer 8

A infarct is virtually certain if Q Waves appear during the course of the illness.

Question 9

Where can MI pain radiate to?

Answer 9

Radiate to jaw, arm or back.

Question 10

What are the signs and symptoms of MI?

Answer 10

Nausea, diaphoresis, dyspnoea, fear, anxiety, dysrhythmias, chest pain, impeding sense of doom.

Question 11

What does each wave of an ECG represent?

Answer 11

P Wave - atrial depolarisation - initiated by the SA node.
QRS complex - ventricular depolarisation and atrial repolarisation occurs.
T Wave - ventricular repolarisation.

Question 12

What is atherosclerosis?

Answer 12

Atherosclerosis is a specific type of arteriosclerosis (hardening of the arteries), where lipid plaques cause arteries to become narrowed and harden. It often affects coronary arteries, which provides oxygen and nutrients to the hearts tissues. This can often lead to angina.

Question 13

What is the clinical indication for the use of nitrates?

Answer 13

Treat acute episodes of angina. Nitrates are very lipid soluble and can be absorbed quickly through various body surface areas. Nitrates are readily distributed and quickly metabolised.

Question 14

What is the pharmacological action of nitrates?

Answer 14

Nitrates are changed into nitric oxide in the smooth muscle of blood vessels. This alters the calcium in the cells. With less calcium in the cells, the blood vessels will dilate. These nitrate drugs are peripheral vasodilators and wok on both the arteries and veins. The effect if decreasing the preload and afterload is to decrease the workload of the myocardium, thus reducing the myocardial oxygen demand.

Question 15

What are most common nitrate drugs?

Answer 15

Glyceryl trinitrate and isosorbide dinitrate.

Question 16

How does diuretics such as furosemide assist in ischaemic heart disease?

Answer 16

Frusemide blocks sodium and potassium transport. The sodium and potassium are not reabsorbed but stay in the tubular fluid. This makes the extracellular fluid hypotonic (having a lower osmotic pressure) and creates an osmotic pull, increasing the volume of tubular fluid and therefore increase urine output. This therefore create a reduction in blood volume which will reduce the preload and thus the myocardial workload.

Question 17

What is diaphoresis?

Answer 17

excessive sweating

Question 18

What is diapedesis?

Answer 18

The passage of blood cells through the intact walls of the capillaries, typically accompanying inflammation.

Question 19

How do beta-blockers benefit ischaemic heart disease?

Answer 19

Betablockers are used to reduce the force of contraction of the myocardium (negative inotropic effect) and to reduce the heart rate (negative chronotropic effect). This reduces the myocardial oxygen demand and prevents myocardial ischemia

Question 20

How do ACE inhibitors benefit ischaemic heart disease

Answer 20

ACE inhibitors inhibits the dilation of blood vessels by preventing angiotensin converting enzyme from converting angiotensin 1 to angiotensin 2. It also increases sodium and water excretion and therefore decreases blood pressure.

Question 21

How do antiplatelet drugs benefit ischaemic heart disease

Answer 21

When blood vessels are damaged, platelets adhere to the damaged surface and secrete a platelet activating factor called thromboxane A2 the platelet aggregation is also dependent on the activation of glycoprotein llb/llla receptors. This causes platelet aggregation, thus platelets play an important role in thrombus formation. This process of platelet aggregation is not beneficial to a patient with ischaemic heart disease. To prevent intravascular thrombus formation, antiplatelet drugs are prescribed. In ischaemic heart disease, the drugs of choice are aspirin, clopidogrel and sometimes heparin.

Question 22

Why is morphine the drug of choice when treating chest pain

Answer 22

Morphine had added benefits for use in ischaemic heart disease. It causes vasodilation which reduces preload. Angina pectoris is chest pain by definition and thus it would make sense to give the patient analgesia. The pain is due to the build-up of lactic acid and may result in inflammation of the myocardium and may or may not cause tissue injury.
The first choice of analgesia is the narcotic morphine.

Question 23

What is the difference between stable and unstable angina

Answer 23

Stable – relationship between workload or demand and ischemia is usually relatively predictable. Goes away when exercise is stopped.
Unstable – clinically worsening angina. Angina at rest or with increasing frequency and/or intensity of episodes. Doesn’t go away when exercise has stopped.

Question 24

What is the benefit of using calcium channel blockers with ischaemic heart disease?

Answer 24

Calcium channel blockers are used to treat angina and hypertension. The drugs stop calcium entering the cells by blocking the calcium channels. The result is muscle relaxation, which causes vasodilation. When coronary arteries dilate, more oxygenated blood can flow to the myocardium. Angina is relieved because calcium channel blockers both increase oxygen supply to the myocardium and reduce myocardial oxygen demand.

Question 25

What are some examples of calcium channel blockers

Answer 25

Commonly used calcium channel blockers include: felodipine, nifedipine, diltiazem and verapamil.

Question 26

What are some examples of beta blockers

Answer 26

Atenolol, metoprolol, propranolol, atenolol

Question 27

What are some examples of antiplatelet drugs

Answer 27

Aspirin, heparin, clopidogrel

Question 28

What are some examples of ACE inhibitors?

Answer 28

Quinapril, lisinopril and benazepril

Question 29

Whats the difference between telemetry and an ECG?

Answer 29

Telemetry is an observation tool that allows continuous ECG, RR and SpO2 monitoring while the patient remains active without the restriction of being attached to a bedside cardiac monitor. Whereas ECG is one of reading of the heart

Question 30

What are some nursing diagnosis that would be related to a patient presenting with MI?

Answer 30

Acute pain related to tissue ischemia
Anxiety related to change in health status or fear of death.
Knowledge deficit relating to lack of understand of MI.
Risk of ineffective tissue perfusion.
Risk of decreased cardiac output.
Activity intolerance related to imbalance between oxygen supply and demand.

Question 31

A patient asks what the difference is between cardiac arrest and MI. What would you tell them?

Answer 31

Myocardial infarction occurs when there is a blockage in blood flow to the heart muscles.
Cardiac arrest is a sudden stop in peripheral blood circulation due to the failure of the heart to contract.

Question 32

What is a defibrillator and how does it work?

Answer 32

Defibrillation is an intervention for life threatening cardiac arrhythmias. Defibrillation delivers a therapeutic dose of electrical energy to the heart. This depolarises the hear muscles, stopping the dysrhythmia and allowing the normal sinus rhythm to be re-established by the body’s natural pacemaker- the sinoatrial node.

Question 33

What are the layers of the heart?

Answer 33

Endocardium
Myocardium
Epicardium
Pericardium

Question 34

Describe the flow of blood through the heart and the structures it flows through.

Answer 34

Blood enters the heart through the superior and inferior vena cava into the right atrium. It flows through the tricuspid valve into the right ventricle. It then goes up through the pulmonary semi lunar valve into the pulmonary arteries where blood is transported to the lungs. It returns to the heart through the pulmonary veins into the left atrium and flows into the left ventricle through the bicuspid valve. The left ventricle contracts and pumps the blood through the aortic semi lunar valve to the rest of the body.