Cardiac

Question 1

Arrhythmias are no big deal until they affect ________.

Answer 1

Cardiac output

Question 2

Decreased blood flow to the myocardium that results in temporary pain/pressure in the chest. Low oxygen that is usually due to excretion. Pain is relieved by rest and nitroglycerin.

Answer 2

Chronic stable angina

Question 3

How often should you replace nitroglycerin tablets? Spray?

Answer 3

Tablets: 3-6 months
Spray: 2 years

Question 4

What do calcium channel blockers cause?

Answer 4

Vasodilation

Question 5

Are palpitations normal with contrast dye?

Answer 5

Yes

Question 6

What does unstable chronic angina mean?

Answer 6

Impending MI

Question 7

Should you hold Glucophage (Metformin) for a cardiac catheterization?

Answer 7

Yes hold for 48 hours post procedure - worried about kidneys

Question 8

Does nitro relieve MI or unstable angina pain?

Answer 8

No

Question 9

What is the number sign of an MI in an elderly person?

Answer 9

Syncope

Question 10

What is the goal for a STEMI patient to get to the cath lab?

Answer 10

90 minutes

Question 11

Cardiac biomarker with high specificity to myocardial damage. Elevates within 3-4 hours and remains elevated for up to 3 weeks.

Answer 11

Troponin

Question 12

Cardiac specific isoenzyme. Increases with damaged to cardiac cells and elevates in 3-12 hours and peaks in 24 hours.

Answer 12

CPK-MB

Question 13

What 4 drugs are used for chest pain when they get to the ED? (In order)

Answer 13

1. Oxygen
2. Aspirin - chewable
3. Nitro
4. Morphine

Question 14

What position should you put a chest pain patient in?

Answer 14

Head up - decreases workload and increases cardiac output

Question 15

How soon after the onset of myocardial pain should fibrinolytics be administered?

Answer 15

Within 6-8 hours

Question 16

What are 4 absolute contraindications for fibrinolytic therapy?

Answer 16

1. Intracranial neoplasm
2. Intracranial bleed
3. Suspected aortic dissection
4. Internal bleeding

Question 17

How long after fibrinolytic therapy is administered do we take bleeding precautions?

Answer 17

At least 72 hours

Question 18

What is the best exercise for an MI patient?

Answer 18

Walking

Question 19

Left sided heart failure: The blood is not moving forward into the aorta and out of the body. This will cause the blood to go backwards into the ______.

Answer 19

Lungs

Question 20

What are 8 symptoms of left sided heart failure?

Answer 20

1. Pulmonary congestion
2. Dyspnea (at night too)
3. Cough
4. Blood tinged sputum
5. Restlessness
6. Tachycardia
7. Orthopnea
8. S-3

Question 21

Right sided heart failure: the blood is not moving forward into the lungs. It causes the blood to back up into the _______.

Answer 21

Venous sytem

Question 22

What are 5 symptoms of right sided heart failure?

Answer 22

1. Distended neck veins
2. Edema
3. Enlarged organs
4. Weight gain
5. Ascites

Question 23

Heart can’t contract and eject

Answer 23

Systolic heart failure

Question 24

Ventricles can’t relax and fill

Answer 24

Diastolic heart failure

Question 25

What happens if the cardiac output is decreased: Brain: LOC ______ Heart: ______ pain Lungs: Short of breath and lungs sound ______ Skin: ______ and _____ Kidneys: Urinary output goes _____ Peripheral pulses: _______

Answer 25

``` Brain: LOC goes down Heart: chest pain Lungs: Short of breath and lungs sound wet/crackles Skin: cool and clammy Kidneys: Urinary output goes down Peripheral pulses: weak/thready ```

Question 26

What classification of medications are the drug of choice for heart failure?

Answer 26

ACE inhibitors (then ARBS)

Question 27

Type of catheter that is floated into the right side of the heart and pulmonary artery. It provides information to rapidly determine hemodynamic pressures, cardiac output, and provided access to mixed venous blood sampling.

Answer 27

Swan Ganz catheter (pulmonary artery pressure)

Question 28

What's a normal digoxin level?

Answer 28

0.5-2.0

Question 29

What are 4 signs of digoxin toxicity?

Answer 29

1. Anorexia 2. NV 3. Arrhythmias 4. Visual changes

Question 30

_________ + digoxin = digoxin toxicity

Answer 30

Hypokalemia

Question 31

What daily weight gain should be reported to a heart failure patient's doctor?

Answer 31

2 pounds or more

Question 32

Fluid is backing up into the lungs. The heart is unable to move the volume forward. Symptoms include sudden onset, breathless, restless, anxious, productive cough, and severe hypoxia. Treated with oxygen, diuretics, nitro, and morphine.

Answer 32

Pulmonary edema

Question 33

How should oxygen be administered to a patient in pulmonary edema?

Answer 33

Nonrebreather

Question 34

What position is best for a patient in pulmonary edema?

Answer 34

Reverse trendelenberg (promotes pooling of blood in lower extremities; don't care if feet are big, want fluid away from heart)

Question 35

Blood, fluid, or exudates have leaked into the pericardial sac resulting in compression of the heart. Treatment includes a pericardiocentesis to remove fluid/blood from around the heart. Surgery is used to repair the hole.

Answer 35

Cardiac Tamponade | MI, Pericarditis, MVC, hemorrhage

Question 36

What are the 2 hallmark signs for cardiac tamponade?

Answer 36

1. Increased CVP | 2. Decreased BP

Question 37

What does pain at rest mean when a patient has an arterial disorder?

Answer 37

Severe obstruction - medical emergency

Question 38

_______ veins | _______ arteries

Answer 38

Elevate veins | Dangle arteries

Question 39

What 4 things should you watch for when a patient is on an ACE inhibitor (-pril)?

Answer 39

1. Hyperkalemia 2. Orthostatic syncope 3. Hypotension 4. Renal dysfunction

Question 40

What 3 things should you watch for when someone is on an ARB (-sartan)?

Answer 40

1. Hypotension 2. Hyperkalemia 3. Renal dysfunction

Question 41

Should you give beta blockers to asthmatics or diabetics?

Answer 41

No BB can constrict bronchioles BB blocks the symptoms of hypoglycemia