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Critical Care > 🫀Cardiac > Flashcards

🫀Cardiac Flashcards

1
Q

Acute Coronary Syndrome

A

results from damage/disease of coronary artery (CAD)
Cannot supply blood or o2 to heart :(

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2
Q

When do the coronary arteries fill?

A

During diastole

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3
Q

What is the main purpose of coronary artery?

A

supply blood and oxygen to heart

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4
Q

ECG shows:

A

damage to coronary arteries

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5
Q

Angina Pectoris

A

chest pain caused by decreased cardiac blood flow
(oxygen imbalance)

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6
Q

Stable Angina

A

pain with activity which improves with rest

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7
Q

Unstable Angina

A

pain that does not improve with rest
EMERGENT
risk AMI, dysrhythmia/SCD

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8
Q

Which patients might have atypical angina

A

women
>65
diabetic

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9
Q

Gold standard diagnostic for MI

A

ECG

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10
Q

ST elevation is indicative of:

A

STEMI

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11
Q

What finding could you see on an ECG of a patient with a previous history of MI

A

Q wave

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12
Q

Treatment goals for acute MI (4)

A

Maintenance of cardiac output
Minimize workload
Prevent complication (DYSRHYTHMIA)
Education

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13
Q

Immediate assessment Cardiac MI

A

ECG, pain, v/s, history, cardiac bios, cxray

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14
Q

Immediate treatment Cardiac MI

A

O2 therapy if under 90%
NITRO

DAPT
Morphine

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15
Q

Pain score for chest pain should be

A

ZERO

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16
Q

Three components of stroke volume

A

Preload
Afterload
Contractility

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17
Q

Pain assessment

A

Normal
Onset
Relieving factors
Quality
Region/radiation
Severity/other sx
Timing
Understanding/perception

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18
Q

Initial treatment cardiac

A

Bedrest
Semi/High fowlers
avoid valsalva maneuver

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19
Q

Nitroglycerin

A

Potent art vasodilator, decreases preload/afterload/o2 demand

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20
Q

What vital sign should you obtain before Nitro administration

A

Blood pressure
DO NOT ADMIN IF SYS <90

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21
Q

Nitro is fatal when combined with

A

Viagra, slidenifil 🍆🍆🍆🍆🍆
48hr+ d/c

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22
Q

Morphine

A

pain relief
preload/afterload reduction
decrease o2 demand

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23
Q

ACE-I

A

Vasodilation, afterload reduction
inhibits renin, aldosterone
limits sodium reabsorption

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24
Q

Selective Beta Blocker (Metoprolol)

A

Blocks Beta ONE
decreases dromo, chrono, inotropic action

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25
Q

Calcium Channel Blockers (Diltiazem and Verapamil)

A

decrease o2 demand

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26
Q

Preload Reduction Meds (CVP/Wedge pressure)

A

NITRO
Morphine

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27
Q

Afterload Reduction Meds (SVR)

A

ACE-I/ARBS
Nitro, morph, ccb

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28
Q

Contractility Meds (HR)

A

Beta Blockers
ccb

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29
Q

Anti-Thrombotic Therapy

A

prevention
Antiplatelet/Anticoagulation

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30
Q

Fibrinolytic Therapy

A

STEMI ONLY
Lyse/Destroy

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31
Q

Anti-Platelet

A

Aspirin
P2y12 inhibitor (Clopidogrel, Ticagrelor)

**risk for bleeding

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32
Q

Anti-Platelet GCP11 inhibitor

A

Post cath lab intervention
Eptifibatide, Tirofiban

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33
Q

Anti-Coagulants

A

Heparin - alters clotting cascade
Lovenox - low weight, more effective, less control, half life is longer

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34
Q

Labs for Heparin

A

PTT,APTT
IV continuous monitoring

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35
Q

Desired effect of heparin PTT

A

increase! more time to clot

36
Q

Reversal agent for heparin

A

Protamine sulfate

37
Q

Drugs for thrombocytopenia

A

c/b heparin
Bivalrudin, Argatroban

38
Q

MONA BASH

A

Morphine
Oxygen
Nitrates
Aspirin

Beta Blocker
ACE-I
Statin
Heparin

39
Q

Reperfusion therapy Medical

A

Fibrinoloytic therapy (STEMI patients)

40
Q

Reperfusion therapy Interventional

A

PCI
CABG

41
Q

Successful reperfusion findings

A

0/10 angina
ST returned to baseline
Reperfusion dysrhythmia –> still have to treat but reassuring
Early and marked peaking of troponin

42
Q

Fibrinolytic Therapy

A

Goal : Limit MI, clot bust, 30min of arrival reperfusion

Criteria: STEMI, when cath lab not accessible

t-PA

43
Q

Nursing management: Fibrinolytic therapy (3)

A

IV access
reperfusion (AxO)
prevent/monitor for complications

44
Q

Cardiac Cath

A

Coronary
Angiography, Percutaneous Coronary Intervention, Stents

45
Q

Complications post PCI

A

Coronary spasm, artery dissection, thrombosis
bleeding, low perfusion to extremity
abd/back pain
contrast induced renal failure
ventricular dysrhytmia
vasovagal response –> brady, loc, hypotension

46
Q

Nursing management: Post PCI

A

head-to-toe
<30 degrees HOB
prevent/minimize complications –> pain? site check? compression device? renal protection

47
Q

Coronary Artery Bypass Graft (CABG)

A

reroute piping (radial or mammary)

indicated when multiple arteries are occluded (multi vessel disease)

seen with: NSTEMI, unstable angina diagnose via: cath

47
Q

Patient Teaching: Post PCI

A

bedrest 4-6hr
HOB under 30 degrees if femoral
straight extremity
report pain, numbness, angina

education –> if bleeding provide pressure

48
Q

Complications with AMI

A

Ventricular Dysrhythmia ***
HF
Pulmonary Edema
Cariogenic Shock

49
Q

Discharge meds MI

A

Beta Blocker
Statin (decrease plaque)
Aspirin

ACE-I
Nitro

50
Q

Heart Failure

A

inability of ventricle to fill or eject blood effectively
**pump issue

51
Q

Ventricle Remodeling

A

heart stiffens and enlarges post MI

52
Q

Left sided heart failure

A

Lungs
SOB, crackles, S3. elevated PAWP, PAOP, PAP

53
Q

Right sided heart failure

A

Body
lower extremity edema
JVD
HJR
Elevated CVP

54
Q

B-Type Natriuretic Peptide (BNP)

A

Marker of cardiac dysfunction, LV preload

compensatory mechanism responding to excessive cardiac stretch

Increases GFR, decreases sodium, inhibits renin and aldosterone secretion

55
Q

Heart Failure Med: Hydralazine

A

strict arterial vasodilator

56
Q

Heart Failure Med: Diuretics

A

decrease preload

57
Q

Heart Failure Med: Digoxin

A

decrease HR to increase contractility

58
Q

Heart Failure Med: Statin

A

decrease plaque formation

59
Q

Implantable cardioverter defibrillator

A

senses lethal rhythm and shocks cardiac tissue to reset

60
Q

Heart Failure: Self management

A

Drug compliance
Daily weights
Low Na+ diet
Exercise
Smoking and alc cessation

61
Q

Nursing Management Acute Heart Failure

A

NO BETA BLOCKER
Preload/afterload reduction
+Inotropic meds

62
Q

Intraaortic Balloon Pump

A

decrease afterload, increase arterial blood flow

63
Q

Left ventricular assistive devices (LVAD)

A

sits in aorta to help pump blood

bridge to transplant

64
Q

Preload Reduction Med therapy Acute Heart Failure

A

Diuretic
Nitrates

65
Q

Afterload reduction Med therapy Acute Heart Failure

A

Nitroprusside –> IV monitor BP
ACE-I
Hydralazine

66
Q

Inotropic Support Med therapy Acute Heart Failure

A

Dobutamine (B1 agonist)
Dopamine
Milrinone (decrease afterload)

67
Q

Goals for Heart Failure Therapy

A

Cardiac output will be maximized
Patient’s symptoms will be managed
Euvolemia achieved
Prevent rehospitalization

68
Q

Abdominal Aortic Aneurysm (AAA)

A

localized dilation of aorta >1.5

69
Q

AAA risks

A

smoking, age, HTN, lipid disorders, atherosclerosis, MARFAN SYNDROME

70
Q

Staple AAA symptoms

A

palpable, pulsatile mass at umbilical
ABD/lower back pain

71
Q

Acute AAA rupture

A

SEVERE ABD PAIN
Hypotensive with loss of consciousness

72
Q

Surgical repair AAA

A

rapidly expanding, >4.5-5.5cm, symptomatic aneurysm

Stent prefered

73
Q

Aortic Dissection

A

weakened aortic medial layer causes tear creating false channel of blood

74
Q

SX aortic dissection

A

SEVERE HTN
Pain between shoulder blades, ripping and tearing sensation, unequal pulses

75
Q

Management of aortic dissection

A

Reduce with IV beta blockers (Esmolol) or B+A combo labetalol

IV Nitroprusside

76
Q

Post op Aortic dissection repair

A

IV Nitroprusside to keep sys <120mmHg
Strict monitoring (labs, v/s, i/o)
Complication monitoring (Acute renal failure, ischemic colon, spinal cord ischemia)

77
Q

Peripheral Artery Disease

A

Processes obstruct blood supply to lower/upper extremities

78
Q

Risks for peripheral artery disease

A

atherosclerosis, smoking, diabetes, >70, male gender, hypertension, hyperlipidemia, family hx, history MI, heart failure, TIA/Stroke

79
Q

Clinical manifestations of PAD

A

Pain intermittent claudication cramping , burning aching relieved with rest

pulseless, pallor, paresthesia, paralysis

80
Q

intermittent claudication PAD SX

A

Early
Cramping, burning, aching pain in the legs, activity relieved with rest

Late
pain at rest is sign anoxic limb

81
Q

Pulse strength

A

0-Absent
1-Palpable, thready, weak
2-normal
3- bounding

NONPALP=DOPPLER

82
Q

Pallor skin PAD

A

lower extremity
cool, atrophic, alopecia, red (more when dependent), thick brittle nails, ulcers not healing

delayed cap refill

83
Q

Paralysis and paresthesia

A

limb threatening ischemia and mandate emergent evaluation consultation

84
Q

PAD Bedside diagnostic evaluation

A

Ankle brachial index

Apply blood pressure cuff to upper arm and above ankle

systolic ankle pressure divided by systolic brachial pressure

85
Q

Managing PAD

A

Antiplatelets
– pentoxifylline, cilostazol aspirin and clopidogrel
— statins
PTCA and stenting
Surgical vascular bypass for severe/diffuse arterial obstruction

86
Q

Chronic Venous Insufficency

A

Pooling of blood to legs

brown pigmentation, edema, thick flaky skin, ulcerations

Critical Care (9 decks)

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