Cardiac Flashcards
Arrhythmias are no big deal until they affect ________.
Cardiac output
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.
Chronic stable angina
How often should you replace nitroglycerin tablets? Spray?
Tablets: 3-6 months
Spray: 2 years
What do calcium channel blockers cause?
Vasodilation
Are palpitations normal with contrast dye?
Yes
What does unstable chronic angina mean?
Impending MI
Should you hold Glucophage (Metformin) for a cardiac catheterization?
Yes hold for 48 hours post procedure - worried about kidneys
Does nitro relieve MI or unstable angina pain?
No
What is the number sign of an MI in an elderly person?
Syncope
What is the goal for a STEMI patient to get to the cath lab?
90 minutes
Cardiac biomarker with high specificity to myocardial damage. Elevates within 3-4 hours and remains elevated for up to 3 weeks.
Troponin
Cardiac specific isoenzyme. Increases with damaged to cardiac cells and elevates in 3-12 hours and peaks in 24 hours.
CPK-MB
What 4 drugs are used for chest pain when they get to the ED? (In order)
- Oxygen
- Aspirin - chewable
- Nitro
- Morphine
What position should you put a chest pain patient in?
Head up - decreases workload and increases cardiac output
How soon after the onset of myocardial pain should fibrinolytics be administered?
Within 6-8 hours
What are 4 absolute contraindications for fibrinolytic therapy?
- Intracranial neoplasm
- Intracranial bleed
- Suspected aortic dissection
- Internal bleeding
How long after fibrinolytic therapy is administered do we take bleeding precautions?
At least 72 hours
What is the best exercise for an MI patient?
Walking
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 ______.
Lungs
What are 8 symptoms of left sided heart failure?
- Pulmonary congestion
- Dyspnea (at night too)
- Cough
- Blood tinged sputum
- Restlessness
- Tachycardia
- Orthopnea
- S-3
Right sided heart failure: the blood is not moving forward into the lungs. It causes the blood to back up into the _______.
Venous sytem
What are 5 symptoms of right sided heart failure?
- Distended neck veins
- Edema
- Enlarged organs
- Weight gain
- Ascites
Heart can’t contract and eject
Systolic heart failure
Ventricles can’t relax and fill
Diastolic heart failure
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: _______
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
What classification of medications are the drug of choice for heart failure?
ACE inhibitors (then ARBS)
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.
Swan Ganz catheter (pulmonary artery pressure)
What’s a normal digoxin level?
0.5-2.0
What are 4 signs of digoxin toxicity?
- Anorexia
- NV
- Arrhythmias
- Visual changes
_________ + digoxin = digoxin toxicity
Hypokalemia
What daily weight gain should be reported to a heart failure patient’s doctor?
2 pounds or more
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.
Pulmonary edema
How should oxygen be administered to a patient in pulmonary edema?
Nonrebreather
What position is best for a patient in pulmonary edema?
Reverse trendelenberg (promotes pooling of blood in lower extremities; don’t care if feet are big, want fluid away from heart)
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.
Cardiac Tamponade
MI, Pericarditis, MVC, hemorrhage
What are the 2 hallmark signs for cardiac tamponade?
- Increased CVP
2. Decreased BP
What does pain at rest mean when a patient has an arterial disorder?
Severe obstruction - medical emergency
_______ veins
_______ arteries
Elevate veins
Dangle arteries
What 4 things should you watch for when a patient is on an ACE inhibitor (-pril)?
- Hyperkalemia
- Orthostatic syncope
- Hypotension
- Renal dysfunction
What 3 things should you watch for when someone is on an ARB
(-sartan)?
- Hypotension
- Hyperkalemia
- Renal dysfunction
Should you give beta blockers to asthmatics or diabetics?
No
BB can constrict bronchioles
BB blocks the symptoms of hypoglycemia
