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CCRN > Cardiac > Flashcards

Cardiac Flashcards

1
Q

first valve of the heart

A

tricuspid

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2
Q

valve from which blood enters the heart from the lungs

A

mitral

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3
Q

Pressure in R atrium

A

2-6 (LOW)

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4
Q

Pressure in R ventricle

A

15-20 (LOW)

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5
Q

Pulmonary artery pressure

A

25/10

(quarter over dime)

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6
Q

L atrial pressure

A

8-12

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7
Q

L ventricle pressure

A

130/10

ONLY his pressure area of heart

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8
Q

AV valves are open during

A

Mitral + Tricuspid

Open diastole/Closed systole

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9
Q

SL valves are open during

A

Aortic + Pulmonic

Closed diastole/Open systole

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10
Q

What is preload

A

Myocardium stretch prior to contraction

High preload = fluid overload
Low preload = fluid deficit

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11
Q

How to measure R sided preload

A

CVP

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12
Q

How to measure L sided preload

A

PAOP (aka wedge pressure)

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13
Q

What closes during S1

A

Mitral and tricuspid close, systole

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14
Q

What closes during S2

A

Aortic and pulmonic close, diastole

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15
Q

S3

A

fluid overload, ventricular gallop

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16
Q

S4

A

atrial gallop, vibration of atria into non-compliant ventricles.

Caused by ischemia, hen, pulmonic stenosis, CAD, aortic stenosis, L vent hypertrophy

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17
Q

When do you hear most split heart sounds

A

During inspiration

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18
Q

What is a split heart sound

A

one valve closes before the other - could be wide QRS, PVCs etc

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19
Q

What valves do the chordae tendinae affect

A

AV valves (tricuspid + mitral)

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20
Q

In stenosis will you hear the murmur when valves are open or closed

A

StenOsis = Open valves. Flow through narrOw Open valves

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21
Q

When will you hear the murmur in mitral regurg

A

When the mitral valve is closed aka a systolic murmur

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22
Q

When will you hear mitral stenosis

A

When the mitral valve is open, during diastole, aka diastolic murmur

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23
Q

Mitral insufficiency/regurg symptoms

A

Systolic murmur, dyspnea, fatigue, angina, increase L atrial pressureM

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24
Q

Mitral stenosis symptoms

A

Diastolic murmur, pulmonary edema, increased atrial and PA pressures, pulmonary htn

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25
Q

STEMI emergent meds

A

Aspirin load 325
Nitroglycerin sublingual (can cause hypotension, caution in R vent infarct)

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26
Q

What does nitroglycerin do during acute STEMI

A

Vasodilates (increases collateral perfusion)
Reduces preload
Decreases O2 consumption

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27
Q

Big 5 discharge meds after ACS

A
  1. Aspirin
  2. PGY12 receptor blocker (plavix/brilinta)
  3. Beta blocker
  4. ACE inhibitor (or ARB)
  5. Statin

DAPT for 1 year!

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28
Q

Beta Blocker effects

A

Decrease HR, decrease contractility, decrease AV node conduction, decrease automaticity, decrease O2 consumption. Negative inotropes!

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29
Q

First degree heart block

A

R is far from P then you have a first degree

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30
Q

Second degree heart block Type 1

A

PR longer longer longer drop = Wenckebach

31
Q

Second degree heart block Type 2

A

If some Rs don’t get through, prepare to pace that Mobitz 2

32
Q

Third degree heart block

A

If Rs and Ps don’t agree prepare to pace that 3rd degree

33
Q

ST elevation in leads V1-V4 indicate occlusion of which vessel

A

LAD

34
Q

LAD occlusion would show elevation in which leads, and reciprocal changes in which leads

A

V1-V4

Reciprocal changes in II, III, and AVF

35
Q

Changes in leads V5, V6, I and AVL would indicate occlusion of which vessel

A

L circumflex - on the lateral wall

36
Q

Posterior wall MI would show reciprocal changes in which leads

A

V1-V2

37
Q

What will you see in cariogenic shock

A

Crackles, S3, hypotension d/t L ventricular failure, decreased cardiac output, increased preload, increased after load

38
Q

Treatment of cariogenic shock

A

Positive inotropes, diuretics, vasodilators

39
Q

What do positive inotropes do

A

Strengthen contractions of heart, allow increased cardiac output. Digoxiin, milrinone, dobutamine

40
Q

What do negative inotropes do

A

Reduce the force of the heart’s contractions to prevent heart from working too hard. Beta blockers, Ca channel blockers, antiarrhthmics

41
Q

What to do for SVT

A

Vagel - Adenosine - Diltiazem

42
Q

What to do for unstable SVT

A

Prepare to cardiovert

43
Q

Wolfe-Parkinson White Syndrome

A

Abnormal conduction between atria and ventricles. Cardiovert if unstable, otherwise beta blockers

44
Q

Polymorphic Ventricular Tachycardia is…

A

Torsades de pointes - prolonged qt in beat preceding rhythm. Can lead to v fib!

45
Q

Amiodarone

A

For atrial and ventricular arrhythmias. Does not decrease contractility. Side effects: bradycardia, increased QTC, long 1/2 life, long term pulmonary toxicity

46
Q

Medication load for a fib

A

150 amiodarone load, then IV infusion

47
Q

Med for V fib

A

300 mg Amiodarone PUSH

48
Q

How do Ca channel blockers work

A

Diltiazem. Relaxes smooth muscle in vessel walls, leads to decreased BP and resistance/afterload

49
Q

What is Atropine used for

A

Symptomatic bradycardia. Inhibits the parasympathetic nervous system.

0.5 mg IV push, repeat q 3-5 minutes

50
Q

Signs of L heart failure

A

Tachypnea, tachycardia, crackles, S3, mitral regurg (wet lungs)

Usually starts with L heart failure, R fails over time

51
Q

signs of R heart failure

A

JVD, peripheral edema, ascites, tricuspid regurg, clear lungs

52
Q

What is BNP

A

Brain nautriuretic peptide - released in to blood when ventricles are over-stretched. Allows for rapid diagnosis of heart failure. Under 100 = no heart failure

53
Q

Three meds for chronic heart failure

A
  1. Beta Blockers (olol)
  2. Ace inhibitors (pril) -> move to Arbs if cough
  3. Aldosterone antagonists

Goal is to block sympathetic nervous system and the renin-angiotensin-aldosterone system

54
Q

What does Angiotensin 2 do in the body

A

Vasoconstricts, encourages holding on to salt and water.

55
Q

What are the effects of decreasing Angiotensin 2 in the body

A

-Increased excretion of Na and H20
-Decreased after load
-Increased vasodilation
-Decreased workload of heart

56
Q

What do Ace Inhibitors do

A

Decrease workload fo heart by vasodilating and decreasing afterload

57
Q

What body system will ACEs likely impact

A

Kidneys - watch for increased creatinine, ACEs decrease GFR

58
Q

What electrolyte will ACEs impact

A

Potassium - may cause hyperkalemia

59
Q

Loop Diuretics include…

A

Furosemide, torsemide, bumex

60
Q

Thiazides include….

A

hctz, metolazone

Used mostly for BP control

61
Q

Loop diuretics will cause…

A

Loss of everything - water, K, mag, Ca. Less blood volume = less BP.

Can’t give with sulfa allergy!

62
Q

Spironolactone is a…

A

Alodsterone Antagonist

Blocks aldosterone to prevent Na and H20 retention. Commonly used WITH loop diuretics so less K+ is lost

63
Q

Isosorbide dinatrate

A

Venodilator, decreases preload

64
Q

Digoxin

A

Positive inotrope!

Increased myocardial contractility, slows conduction of impulse through AV node, used to control ventricular rate in Afib/Aflutter

65
Q

Dobutamine

A

Positive inotrope

Stimulates beta receptors, improves contractility and cardiac output, quick on/off

66
Q

Milrinone

A

Phosphodiesterase inhibitor (bridge to transplant)

Increases myocardial contractility, vasodilator, long 1/2 life, no change in HR but decreases SVR and improves CO so need some BP to play with

67
Q

What drug will not work after cardiac transplant

A

Atropine! Vagus nerve is cut

68
Q

What is HOCM

A

Hypertrophic Obstructive Cardiomyopathy - thick septum between R and L ventricle, decreased compliance, outflow obstruction. Diastolic dysfunction. Need to slow down HR since vents can’t fill as much

69
Q

Takotsubo

A

Reversible, more common in women, weakening and ballooning of L ventricle d/t severe stress/catecholamine release. Balloons at apex. Causes chest pain/SOB.

Treat with HF meds - beta blockers, Aces (or arbs), and aldosterone antagonist (spironolactone)

70
Q

Restrictive Cardiomyopathy

A

Rigid ventricles, ventricular filling is restricted, leads to heart failure over time. Treated with diuretics, Na and H20 restriction, then transplant

71
Q

Pericarditis

A

Will see diffuse ST changes, concave ST segment elevation. ECG with a :)

72
Q

Complications of pericarditis

A

Effusions, tamponade, constrictive pericarditis

73
Q
A

CCRN (2 decks)

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