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Cardiac Flashcards

1
Q

Cardiac Output (shock) for Pediatrics

A

Initial: Tachycardia
Late: Hypotension
Threatening: Bradycardia

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2
Q

Stroke Volume is influenced by

A

Contractility
Preload
Afterload

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3
Q

What is preload?
How is it decreased & increased?

A

Volume! Measured by central venous pressure on right.

< decreases from hypovolemia and vasodilators ie Lasix

> increases with fluid, blood, vasoconstrictors

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4
Q

What is afterload?
How is it decreased and increased?

A

Ventricular emptying evaluated by systemic vascular resistance

<decreased> increased with HTN and vasopressin’s ie norepinephrine
</decreased>

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5
Q

What increases your heart rate in response to shock?

A

Sympathetic nervous system (SNS) cause the release of epi and norepi

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6
Q

What decreases heart rate in shock? (seen in neurogenic shock)

A

Parasympathetic nervous system

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7
Q

Mean Arterial Pressure (MAP)
Equation

A

DBP x 2 + SBP / 3

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8
Q

Narrow Pulse Pressure

A

Early Shock

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9
Q

Widened Pulse Pressure

A

Seen in ICP

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10
Q

Cushing Triad
An indication of >ICP

A

Widening pulse pressure
Bradycardia
Irregular breathing pattern

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11
Q

Chronotropes

A

Affect the heart rate at the SA node
ex: cardizem

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12
Q

Inotropes

A

Affect contractility by force of contraction
Ex: Dopamine

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13
Q

Dromotropes

A

Affect automaticity of electrical impulses at the AV node

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14
Q

ACE inhibitors
(angiotensin-converting enzyme)

A

Reduces BP by blocking conversion of angiotensin 1 to angiotensin 2

Ex: Lisnopril

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15
Q

beta-blockers
(olols)

A

*Mask signs of shock & hypoglycemia

Beta 1 meds affect the heart
Beta 2 meds affect the heart & lungs

Ex: Labetalol, metoprolol, propranolol

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16
Q

adverse effects of ACE Inhibitors

A

Dry nonproductive cough which leads to noncompliance

Angioedema

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17
Q

ARBS
(angiotensin receptor blockers)

A

*Reduces BP by inhibiting angiotensin 2 receptors

Ex: Avapro, Cozaar, Diovan

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18
Q

calcium channel blockers

A

Controls ventricular rate in Afib and HTN

Ex: Cardizem, Norvasc, Nifedipine

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19
Q

What does Nitroglycerin
do?

A

*Vasodilates
< preload & afterload
< BP
< O2 consumption
-contradicted with Cialis

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20
Q

What does Nitroprusside do?

A

*Vasodilates
<preload & afterload used in HTN crisis

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21
Q

What are examples of vasopressors?

A

Epi & Norepi

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22
Q

stable angina pectoris

A

-occurs with physical exertion
-short duration
-relieved by rest
- neg trop

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23
Q

unstable angina

A

-chest pain with little physical exertion,
-longer duration
-not relieved by rest
-neg trop

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24
Q

NSTEMI

A

*plaque rupture
*absent ST elevation
- pos trop

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25
STEMI
*obstruction with thrombosis *ST elevation - pos trop
26
Prinzmetals (variant angina)
-cyclical pain at rest -ischemia d/t coronary vasospasm which is precipitated by stress or stimulants
26
Prinzmetals (variant angina)
-cyclical pain at rest -ischemia d/t coronary vasospasm which is precipitated by stress or stimulants
27
limb lead placement
I, II, III, aVR, aVL, aVF
28
chest lead placement
V1-V6 *V4R needs to be at the 5th intercostal space at the right midclavicular line
29
inferior leads
II, III, aVF
30
anterior leads
V1 - V4
31
lateral leads
I, aVL, V5, V6
32
posterior lead (when ST depression occurs in V1 & V2)
V7 - V9
33
inverted ST waves, ST depression, & Tall T waves are signs of
Ischemia
34
ST elevation (STEMI) and inverted T waves are signs of
Injury
35
deep & wide Q waves are signs of
old infarction
36
inferior STEMI's presents in what leads
II, III, aVF -right coronary artery which supplies SA an AV nodes -presents with bradycardia, second degree heart block, epigastric pain, N/V
37
anterior STEMI's presents in what leads
V1 - V4 -*widowmaker -presents with crushing pain, tachycardia, crackles, impending doom, cardiogenic shock, second degree mobitz 2
38
right ventricle MI
*get right sided EKG -JVD, hypotension, shock, ST elevation at V4R -give IVF bolus, dobutamine, and sustain from morphine
39
What leads are elevated in lateral MI?
I, aVL, V5, V6
40
What are the signs of posterior MI?
ST evelvation in V7 & V9 or depression of V1 & V2
41
STEMI Treatment
- O2 4LNC - Nitro - ASA - percutaneous catheterization goal <90 mins - fibrinolytic therapy within 90-120 mins - beta blockers for HTN - ACE inhibitios for reduce infarct size - anticoags- heparin, lovenox, coumadin, elizuis, xarelto, pradaxa
42
S/S Aortic Dissection
- tearing/ripping chest, shoulders, flanks, and back pain not relieved by analgesis -20 mm BP difference between arms
43
ascending aortic dissection presents
- stroke like symptoms - Horners Syndrome: ptosis (drooping of upper eyelid), anhidrosis (absence of sweating), & miosis (constricted pupils)
44
descending aortic dissection presents
- loss of distal pulses -lower extremity weakness - decreased urine output
45
diagnosis tools of aortic dissection
- TTE or TEE (transesophageal echocardiogram) - CTA - widened mediastinum and obscure aortic knob on films
46
BLS CPR
- 100-12O compressions per min - 30:2 - do delay def for advance airway -switch compressors q 2mins *ETCO2 > 10mm HG
47
shockable cardiac rythms
- VF & pulseless VT - adult 120-200 joules monophasic 200-360 joules - pediatric 2-4 joules/kg
48
medications for cardiac arrest
- epi - amiodarone 300mg - Bicarb 1 mEq/kg
49
ROSC
- secure airway with ET CO2 35-45 - targeted temperature management 32-36 C for *24hrs
50
H's & T's FOR CARDIAC ARREST
- hypovolemia - hypoxemia - hydrogen ion - hypo/hyperkalemia - hypothermia - toxins - trauma - tension pneumo - tamponade - thrombosis
51
stable tachycardia
- slam adenosine 6mg with rapid flus to slow SA & AV node - cardizem - labetalol - amiodarone - lidocaine
52
unstable tachycardia (consious, pulse, SVT or VT)
-synchronized cardioversion - implantable cardioverter defib
53
AFib
- atria is quivering - rapid ventricular rate (RVR) - risk for stroke -saw tooth like waves
54
Wolff-Parkinson White Syndrome (WPW)
- extra conduction presenting as delta wave (short PR interval leading up to QRS)
55
Torsades de pointes
- polymorphic VT due to prolonged QT - cardioversion and slow IV Mag
56
pericarditis
- inflammation of the pericardial sac from infection, MI, or renal failure - retrosternal cp exacerbated by inspiration or supine * friction rub heard while leaning forward * relieved by leaning forward
57
endocarditis
- inflammation of endocardium from IV drug use, cardiac sx, body piercing -fever, cills, new onset murmur, conjunctival petechia - >WBC, +blood cxs, >ESR
58
left sided heart failure
*think left lung - SOB, dyspnea, crackles -pulmonary edema -nocturnal dyspnea -s3 hear sound
59
right sided hear failure
*rest of body *JVD -ascites peripheral edema
60
HTN crisis
- >SBP 180 - impending organ damage ex: aortic dissection, heart failure, pulmonary edema, encephalopathy -AMS, cp, dizziness, epistaxis, headache, seizures, visual disturbance - consider an art line
61
cardiac tamponade
- pericardial sac accumulates additional fluid from pericarditis, taumas, MI leading to obstructive shock *Beck's triad: JVD, hypotension, muffles heart sounds, kussmaul breaths - needle pericardicoentesis
62
peripheral artery disease (PAD)
- shiny skin, lhair loss, constant burning pain, cold extremties, decreased pulses ankle brachial inde (ABI) 0.9-1.3 -do not elevate extremity
63
deep vein thrombosis (DVT)
- blood clot in peripheral vein - *Virchow's triad: venous stais (immobility, air travel), fractures, pregnancy -achy, throbbing pain with walking -*elevat, compression, anitcoags
64
Raynaud's disease
intense vasospasm of the digits, nose or ear in response to stress
65
blunt cardiac injury
-blunt force to chest, especially right ventricle due to positioning of the heart - sinus tach, PVS, ST elevaion

CEN (13 decks)

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