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Cardiac Flashcards

1
Q

Coronary arteries are perfused during?

A

Diastole

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2
Q

S1 signals

A

Closure of mitral and tricuspid valves

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3
Q

S2 signals

A

closure of pulmonic and aortic valve

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4
Q

S3 (ventricular gallop) is caused by?

A

Fluid overload, cardiomyopathy, mitral or tricuspid regurgitation

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5
Q

S4 (Atrial gallop) is caused by?

A

Ischemia, HTN, pulmonary stenosis, CAD, aortic stenosis, left ventricular hypertrophy

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6
Q

What is split S1 heart sounds?

A

Mitral valve closes before tricuspid valve occurs during RBBB, PVCs, or ventricular pacing

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7
Q

What is split S2 heart sounds?

A

Aortic valve closes before pulmonic valve occurs due to overfilled right ventricle or atrial septal defect

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8
Q

Troponin elevates in

A

3-6 hours

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9
Q

Troponin peaks in

A

14-20 hours

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10
Q

Troponin returns to normal in

A

1-2 weeks

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11
Q

Which medications should you avoid in suspected right ventricular infarction?

A

Medications that reduce pre-load (Morphine & Nitro!)

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12
Q

What are the big 5 medications prescirbed post MI?

A

Aspirin, Beta blockers, P2Y12 Inhibitor (plavix), ACEI or ARB, and statin

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13
Q

Inferior MI Artery

A

RCA

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14
Q

Inferior MI ST Elevation

A

II, III, aVF

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15
Q

Inferior MI Reciprocal changes

A

I, aVL

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16
Q

Inferior MI Symptoms

A

Bradycardia, First degree AVB, 2nd degree AVB Type I, Hypotension, N/V, diaphoresis

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17
Q

Right Ventricle MI Artery

A

Proximal RCA

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18
Q

Right Ventricle MI ST Elevation

A

V1 V2R-V4R

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19
Q

Right Ventricle MI Symptoms

A

Tachycardia, Hypotension, JVD

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20
Q

Right Ventricle MI Treatment

A

IV fluids (maximize pre-load), + inotrope (dobutamine)

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21
Q

Anterior Septal MI Artery

A

LAD or L main

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22
Q

Anterior septal MI ST elevation

A

V1-V4

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23
Q

Anterior Septal Reciprocal changes

A

II, III, aVF

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24
Q

Anterior septal MI symptoms

A

S3 heart sound, shock, heart blocks (2nd degree II, 3rd degree), BBB, new loud murmur (papillary muscle rupture)

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25
Q

Lateral wall MI artery

A

L circumflex, LAD

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26
Q

Lateral wall MI ST elevation

A

I, aVL, V5-V6

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27
Q

Posterior Wall MI Artery

A

RCA (90%), LAD (10%)

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28
Q

Posterior wall MI ST elevation

A

posterior leads V7-V9, tall broad R wave in V1-V2

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29
Q

Pericarditis symptoms

A

Chest pain, pain improved when sitting up/leaning forward, pain worse with cough and position changes

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30
Q

Papillary muscle rupture associated with which MI?

A

Anterior or inferior wall MI

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31
Q

Papillary muscle rupture symptoms

A

hemodynamic instability, new loud systolic murmur, large V wave on PAOP waveform

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32
Q

Ventricular septal rupture associated with which MI?

A

anterior/septal wall MI

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33
Q

Ventricular septal rupture symptoms

A

acute SOB, S3 heart sound, crackle, holosystolic murmur

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34
Q

Cardiogenic shock clinical signs

A

S3, JVD, pulmonary edema, tachycardia, dysrhythmias, signs of decreased perfusion, decreased UO

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35
Q

Cardiogenic shock hemodynamics

A

MAP <65, decreased CO/CI, Increased SVR >1600, elevated RAP/CVP. increased PAOP >16, decreased SVO2

36
Q

Cardiogenic shock treatment

A

vasopressors, +inotrope, loop diuretics, afterload reduction, mechanical support IABP

37
Q

Alpha receptors

A

blood vessels

38
Q

Beta1 receptors

A

located on the heart

39
Q

Beta2 receptors

A

located in the bronchial and vascular smooth muscle

40
Q

Phenylephrine receptors

41
Q

Norepinephrine receptors

A

Mostly alpha but some Beta1

42
Q

Epinephrine receptors

A

Alpha, Beta1, and some Beta2

43
Q

Dopamine receptors

A

Mostly Beta1, some Alpha, little Beta2

44
Q

Dopamine effects

A

Increase HR, BP, and SVR

45
Q

Dopamine nursing consideration

A

watch out for tachy arrhythmias and ventricular ectopy

46
Q

Norepinephrine effects

A

increase BP and HR (sometimes)

47
Q

Norepinephrine adverse effects

A

bradycardia, dysrhythmias, HTN, renal artery vasoconstriction

48
Q

Epinephrine effects

A

increase BP HR

49
Q

Epinephrine adverse effects

A

tachycardia, dysrhythmias, chest pain, hyperglycemia

50
Q

phenylephrine effects

A

increase BP

51
Q

phenylephrine adverse effects

A

reflexive bradycardia, dysrhythmias, HTN, chest pain

52
Q

Dobutamine receptors

53
Q

Dobutamine effects

A

increase CO, HR

54
Q

Dobutamine adverse effects

A

tachycardia, hypo or hypertension, ectopy, hypokalemia

55
Q

Milrinone effects

A

increase CO, decrease PAOP and SVR

56
Q

Milrinone adverse effects

A

vasodilator with long half life!

57
Q

Cardiac tamponade symptoms

A

Elevated CVP with JVD, hypotension, muffled heart sounds, wide mediastinum on CXR, sudden drop in chest tube output, narrow pulse pressure, tachycardia, electrical alternans, pulsus paradoxus, PEA

58
Q

What is pulsus paradoxus?

A

> 10 mm Hg drop in BP during inspiration.

59
Q

Left sided HF=

A

blood backs up to the lungs

60
Q

Left sided HF s/s

A

decreased CO/CI, tachypnea, tachycardia, S3 heart sound, mitral regurgitation, crackles, cough frothy sputum, increased PA pressures, increased PAOP, increased SVR

61
Q

Right sided HF=

A

blood backs up to the venous periphery

62
Q

Right sided HR s/s

A

JVD, hepatojugular reflux, peripheral edema, hepatomegaly, anorexia, N/V, ascites, tricuspid regurgitation, increased CVP RAP, increased liver enzymes

63
Q

HF meds

A

ACEI, ARB, Beta blocker, aldosterone antagonist, vasodilator, diuretics

64
Q

Acute HF meds

A

dobutamine or milrinone, diuretics, nitroglycerin

65
Q

What is hypertrophic cardiomyopathy

A

Thickened interventricular septum resulting in diastolic dysfunction andd ventricular hypertrophy

66
Q

Hypertrophic cardiomyopathy symptoms

67
Q

Hypertrophic cardiomyopathy treatment

A

Beta blockers and CCBs (avoid inotropes)

68
Q

What is Takotsubo cardiomyopathy?

A

Weakening & ballooning of the left ventricle

69
Q

Takotsubo symptoms

A

chest pain, SOB

70
Q

What is stenOsis?

A

forward flow of blood through narrow, stenotic open valves

71
Q

What is insuffiency/regurgitation?

A

Backward flow through incompetent closed valves

72
Q

Mitral stenosis?

73
Q

Mitral regurg

74
Q

aortic stenosis

75
Q

Aortic regug

76
Q

Mitral insufficiency/regurgitation causes

A

MI, ruptured chordae tendineae, severe left HF, L ventricular hypertrophy, mitral valve prolapse, endocarditis, rheumatic heart disease

77
Q

Mitral insufficiency/regurgitation symptoms

A

systolic murmur, orthopnea/dyspnea, fatigue, angina, increased left atrial pressure, right heart failure, left heart failure

78
Q

Mitral stenosis symptoms

A

pinkish cheeks, pulmonary edema, increased right heart pressures, pulmonary hypertension

79
Q

Aortic insufficiency/regurgitation causes

A

chronic hypertension, rhematic heart disease, endocarditis, marfans syndrome

80
Q

Aortic insufficiency/regurgitation symptoms

A

DeMusset sign-head bobbing, brisk carotid upstroke, wide pulse pressure

81
Q

Aortic stenosis symptoms

A

heart failure, activity intolerance, SOB

82
Q

What is pericarditis?

A

Inflammation of the pericardial sac

83
Q

What is myocarditis?

A

focal or diffuse inflammation of the myocardium

84
Q

What is endocarditis?

A

infection of the endocardium or valve

85
Q

Endocarditis symptoms

A

stabbing sharp pain, SOB, cough, JVD, pulsus paradoxus, pericardial friction rub, ST elevations, narrow pulse pressure

CCRN (4 decks)

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