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z Here you go, Alexis! > cardiac > Flashcards

cardiac Flashcards

1
Q

preload

A

amount of blood returning to the right side of the heat and the muscle stretch that the volume causes

  • ANP released upon stretch
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2
Q

afterload

A

pressure in the aorta and peripheral arteries that the left ventricle has to pump against to get blood out
- referred to as resistance

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3
Q

stroke volume

A

amount of blood pumped out of ventricles with each beat

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4
Q

factors that affect cardiac output x3

A

heart rate, certain arrhythmias
blood volume
contractility

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5
Q

decreased cardiac output: impact on brain

A

LOC down

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6
Q

decreased cardiac output: impact on heart

A

chest pain

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7
Q

decreased cardiac output: impact on lungs

A

short of breath, wet sounds

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8
Q

decreased cardiac output: impact on skin

A

cold and clammy

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9
Q

decreased cardiac output: impact on kidneys

A

uop down

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10
Q

decreased cardiac output: impact on peripheral pulses

A

weaker

LESS VOLUME LESS PRESSURE

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11
Q

arrhythmias are no big deal until

A

they impact your cardiac output

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12
Q

3 arrhythmias that are always a big deal

A

pulseless v tach
v fib
asystole

CPR ASAP

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13
Q

coronary artery disease includes x2

A

chronic stable angina

acute coronary syndrome

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14
Q

chronic stable angina

A

decreased blood flow to myocardium = ischemia = temporary pain/pressure in chest

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15
Q

what brings on pain of chronic stable angina?

A

low O2 usually due to exertion

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16
Q

what relieves pain of chronic stable angina?

A

rest and/or nitro

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17
Q

single largest killer of americans

A

coronary artery disease

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18
Q

chronic stable angina tx: meds

A

nitro
beta blockers
Ca channel blockers
aspirin

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19
Q

nitroglycerin (Nitrostat)

A

causes venous and arterial dilation resulting in decreased preload and afterload
- includes dilation of coronary arteries therefore increasing blood flow to myocardium

for chronic stable angina

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20
Q

beta blockers

A

block beta cells aka receptor sites for catecholamines = decrease BP, HR, contractility = decrease workload of the heart

for prevention of angina

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21
Q

Ca channel blockers

A

vasodilate arterial system (increase oxygen to heart) = decrease BP
- includes coronary arteries

decreased arterial resistance (afterload) = decreased workload of left ventricle

for prevention of angina

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22
Q

aspirin

A

for angina is for platelet aggregation, not pain

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23
Q

most common type of cardiovascular disease

A

cad

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24
Q

prior to cardiac catheterization

A

check for iodine, shellfish allergy
(iodine based dye used)

check kidney function
(renal excretion of dye)

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25
Q

normal responses to injection of cardiac cath dye

A

“hot shot”

palpitations

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26
Q

post heart cath, monitor

A

vitals, puncture site for bleeding or hematoma

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27
Q

post-heart cath assessment - where & what

A 
assess extremity distal to puncture site
p ulse
p allor
p ain
p aresthesia
p aralysis
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28
Q

post-heart cath bed rest - how & how long

A

flat, leg straight

4-6 hours

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29
Q

major complication post heart cath

A

bleeding

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30
Q

hold what medication post-heart cath, how long, why?

A

glucophage (Metformin) - renal excretion and dye = eye on kidney function

47 hours post procedure

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31
Q

associate unstable chronic angina with

A

impending MI

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32
Q

acute coronary syndrome

A

disorder including unstable angina and acute myocardial infarction - results from obstruction of coronary artery by ruptured atherosclerotic plaque

  • plaque = platelet aggregation, thrombus formation, vasoconstriction
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33
Q

acute coronary syndrome: ischemia or necrosis?

A

BOTH

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34
Q

acute coronary syndrome: pain!

A

described as crushing
pressure radiating to left arm and left jaw
n/v
pain between shoulder blades

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35
Q

acute coronary syndrome: pain version xx

A 
typically present with
GI issues
epigastric complaints
pain between shoulders
aching jaw
choking sensation
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36
Q

what is the #1 sign of MI in the elderly?

A

SOB

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37
Q

acute coronary syndrome: s/s

A 
pain
cold, clammy, BP drops
cardiac output going down
EKG changes (heart irritated - PVCs, v tach)
vomiting
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38
Q

STEMI

A

ST-Segment Elevation Myocardial Infarction: indicates the client is having a heart attack

goal: get to catch lab for PCI in under 90 minutes

39
Q

NSTEMI

A

Non-Elevation ST Segment Myocardial Infarction: usually less worrisome

40
Q

acute coronary syndrome: diagnostic lab work

A

CPK-MB
troponin
myoglobin

41
Q

CPK-MB

A

cardiac specific isoenzyme that increases with damage to myocardium

elevates within 3-12 hours, peaks in 24 hours

diagnostic lab for acute coronary syndrome

42
Q

troponin

A

cardiac biomarker with highest specificity to myocardial damage

elevates within 3-4 hours and remains elevated for up to 3 weeks

diagnostic lab for acute coronary syndrome

43
Q

myoglobin

A

not very specific to myocardial damage: negative results are a good thing

increases within 1 hour and peaks in 12 hours

diagnostic lab for acute coronary syndrome

44
Q

which cardiac biomarker is the most sensitive indicator for an MI?

A

tropnonin

45
Q

which enzymes or markers are most helpful when the client delays seeking care?

A

troponin

46
Q

what untreated arrhythmias will put the acute coronary syndrome client at risk for sudden death?

A

pulseless v tach
v fib
asystole
post-MI bradycardia

47
Q

priority treatment for v fib?

A

defib the v fib!

no AED? CPR until one is available.

48
Q

if first shock doesn’t work and client remains in v fib, what is the first vasopressor given?

A

epi

49
Q

v fib and pulseless v tach: treatment then back up if resistant to treatment

A

treatment: epi, defibrillation

back up: amiodarone (anti-arrhythmic)

50
Q

amiodarone (Cordarone)

A

anti-arrhythmic

  • given when v fib and pulseless v tach not responsive to treatment
  • also given for fast arrhythmias
51
Q

what anti-arrhythmic drugs are continuously given to prevent a second episode of v fib?

A

amiodarone (first choice)

lidocaine (not really used as much but still on ACLS protocol)

52
Q

lidocaine toxicity looks like

A

any neuro changes

53
Q

important side effect of amiodarone

A

hypotension - can lead to further arrhythmias

54
Q

ED treatment for chest pain in order of least to most invasive

A

oxygen
aspirin (chewable)
nitro
morphine (IV)

55
Q

after MONA, patient with chest pain in head up position - why?

A

decreases workload on heart and increases cardiac output

56
Q

fibrinolytics

A

use for acute coronary syndrome: dissolve clot blocking blood flow to heart muscle; this decreases the size of the infarction

the sooner the better - door to drug ideally 30 minutes or less

57
Q

acute coronary syndrome: treatment

A 
ED drugs (MONA)
fibrinolytics (ASAP if cath unavailable)
percutaneous coronary intervention (PCI)
coronary artery bypass graft (CABG)
cardiac rehab
58
Q

how soon after onset of myocardial pain should fibrinolytics be administered?

A

within 6 to 8 hours

59
Q

major complication of fibrinolytics

A

bleeding

60
Q

absolute contraindications for fibrinolytic use

A

intracranial neoplasm
intracranial bleed
suspected aortic dissection
internal bleeding

massive hemmorhage could result!

61
Q

fibrinolytic follow up therapy: class and examples

A

anti-platelet meds

  • acetylsalicylic acid (aspirin)
  • clopidogrel (Plavix)
  • abciximab (ReoPro IV - continuous infusion to inhibit platelet aggregation)
62
Q

percutaneous coronary intervention (PCI)

A

treatment for acute coronary syndrome

includes all interventions such as angioplasty and stents

63
Q

major complication of angioplasty is

A

MI

but also important: client may bleed from heart cath site or reocclude

any problems: go to OR ASAP

64
Q

eptifibatide (Integrilin IV)
abciximab (ReoPro IV)

in context of PCI, given why?

A

for high risk clients who have been stented to keep artery open

also for clients waiting to go to cath lab

65
Q

coronary artery bypass graft

A

occluded coronary arteries bypassed with client’s own venous or arterial blood vessels
- saphenous vein, internal mammary artery, others

performed when client does not respond to medical management of coronary artery disease or when vessels are severely occluded

66
Q

the widowmaker and why

A

left main coronary artery occlusion

left main coronary artery supplies the entire left ventricle

67
Q

why teach acute coronary syndrome client about s/s heart failure (and what are they)

A

post unstable angina or AMI, heart is in weakened state so heart failure is always a potential

s/s: weight gain, ankle edema, shortness of breath, confusion

68
Q

heart failure

A

complication that can result from problems such as cardiomyopathy, valvular heart disease, endocarditis, acute MI, and hypertension (leading cause)

69
Q

left sided heart failure

A

looks very pulmonary in nature

blood not moving forward into aorta and out into body - it goes backwards into lungs

systolic vs diastolic

70
Q

left sided heart failure: s/s

A 
pulmonary congestion
dyspnea, orthopnea, cough, blood tinged frothy sputum, nocturnal dyspnea
restlessness
tachycardia
S3
71
Q

right sided heart failure

A

blood is not moving forward into lungs - it moves backwards into the venous system

PS. cor pulmonale

72
Q

right sided heart failure: s/s

A 
distended neck veins
edema
enlarged organs
weight gain
ascites
73
Q

systolic heart failure

A

heart can’t contract and eject

74
Q

diastolic heart failure

A

ventricles can’t relax and fill

75
Q

SBP / DBP mnemonic for heart failure

A 
SBP = contraction = ejection = depolarize
DBP = relaxation = filling = repolarize
76
Q

cor pulmonale

A

abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels

77
Q

heart failure: diagnostics

A

B-type natriuretic peptide
CXR (enlarged heart, pulm infiltrates)
Echocardiogram
New York Heart Association Functional Classification of Persons with HF

78
Q

BNP

A

b-type natriuretic peptide; secreted by ventricles when ventricular volumes/pressures increased

79
Q

pacemaker

A

increase heart rate with symptomatic bradycardia

depolarize myocardium = contraction

80
Q

HR drops below 60, cardiac output…?

A

decreases

81
Q

pacemakers: always worry if…?

A

HR drops below set rate

rate increase okay

82
Q

most common post-op complication of pacemaker

A

electrode displacement

keep client from raising arm higher than shoulder height

83
Q

before giving digoxin check

A

apical pulse

84
Q

implantable cardiac device

A

can be used to pace

OR

defibrillate v-fib

85
Q

pulmonary edema: at risk patients

A
  • receiving IVF very fast
  • very young, very old
  • hx of kidney or heart disease
86
Q

pulmonary edema

A

fluid backing up into lungs; usually occurs at night abruptly (bedtime)

87
Q

pulmonary edema priority nursing intervention

A

administer high flow O2, titrate to keep above 90%

88
Q

pulmonary edema tx

A

VASODILATION!!!
diuretics (furosemide, bumetanide)
nitro, morphine, nesiritide (Natrecore)

89
Q

cardiac tamponade

A

blood, fluid, or exudates have leaked into pericardial sac resulting in compression of the heart (as little as 20-50mL!!)

causes: MVA, RV biopsy, MI, pericarditis, hemorrhage post CABG

90
Q

cardiac tamponade: hallmark signs

A

increased CVP

decreased BP

91
Q

an arterial problem is a ? problem

A

O2

92
Q

if you have atherosclerosis in one place…

A

you have it EVERYWHERE

93
Q

acute arterial occlusion

A

MEDICAL EMERGENCY!
numb, pain, cold, no pulse - intermittent claudication

pain at rest means SEVERE obstruction

94
Q

intermittent claudication

A

hallmark sign of acute arterial occlusion - pain!!

z Here you go, Alexis! (23 decks)

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