Cardiac Flashcards
CVP:
Measures
Normal parameter
Which port to use
Measures: preload (right atrial pressure)
Norm: 2-6 mm Hg
Port: proximal port
Catheter placement outside line markers:
RA/CVP = 25-30cm
RV= 35-45 cm
PA= 50-55 cm
Contraindications for thrombolytics
History of hemorrhagic stroke, CVA last 12 months, SBP over 180, pregnancy or 1 month postpartum
Normal values:
CVP/RAP
CVP: 2-6
Normal values:
Cardiac output
CO:SV x HR (4-8 L/min)
Cardiac index
CI: 2.5-4.2
Pulmonary artery systolic/diastolic
PAS/PAD: 15-25/8-15
Wedge (PAWP/PCWP)
8-12
SVR
800-1200 dynes/sec/cm-5
-when assessing CVP or PA, pressures on a mechanically ventilated patient, assess pressures at the end of exhalation
Cardiogenic shock: CVP Cardiac output PAS/PAD PAWP SVR Heart rate
CVP:high CO:low CI: low PAS/PAD: high PCWP: high SVR: high Heart rate: initially fast, then slows down
CHF considerations:
Preload
Lab test
Medications
Many CHF patients are relatively hypovolemic. Careful with diuretics and medications that can decrease preload
BNP= lab test nonspecific >500
No beta-blockers, except for carvidolol(Coreg)
Natracor(neseritide)= synthetic version of BNP
Digoxin
- class
- causes what electrolyte imbalance
- ECG changes
- cardiac glycoside
- hypokalemia
- “dig dip” ST depression
PAWP/PCWP
- Function
- Normal
Pulmonary artery wedge pressure/Pulmonary capillary wedge pressure
- looks at the left side of the heart, if high can indicate pulmonary congestion, CHF, and cardiogenic shock
- PAWP/PCWP:8-12mmHg
- do not keep wedge for more than 15 seconds, make sure that balloon is deflated and have patient cough forcefully
Arterial line
- sites
- purpose
Radial, femoral
Monitor pressure, blood draw, ABGs
Maintain pressure bag at 300 mmHg
-under dampening:caused by having air in the system, loose connection, low pressure bag, and altitude changes
-over dampening: caused by kinking, increased bag pressure, and tip against the wall
ECG
- Most common reperfusion dysrhythmia
- Most common hypothermia dysrhythmia
- Hypokalemia on ECG
- Hyperkalemia on ECG
- Reperfusion: AIVR
- Hypothermia: VF, (Osborn wave)
- Peaked P’s, flat T’s
- Flat P’s, peaked T’s (treat with calcium)
12-lead ECG Inferior Septal Anterior Lateral Posterior
"I See All Leads"=inf/sept/ant/lat Inferior:II, III, aVF Septal: V1, V2 Anterior: V3, V4 Lateral: I, aVL, V5, V=Posterior:ST segment depression or reciprocal changes noted in V1-V4, ST elevation V6
Cardiac
- Ischemia
- Injury
- Infarct
Ischemia:ST depression (1 mm in 2 leads)
Injury: ST elevation ( 1 mm in 2 leads)
Infarct: Q wave>25% the height of the R wave
Normal cardiac index
CI: 2.5-4.3
Thrombolytics must be administered within?
Three hours of onset of chest pain
Tetralogy of Fallot (TOF)
Remember PROV P= pulmonary stenosis R= right ventricular hyper trophy O= overriding aorta V= ventricular septal defect
What is a tet spell?
During a “tet” spell, blood flow across the right ventricular outflow tract is significantly decreased, resulting in shunting right-to-left through the VSD out of the aorta, thus bypassing in the lungs.
Causes include: spasms, sudden decrease in systemic vascular resistance secondary to hypovolemic, dehydration, hot weather, or defecation. Tet spells are usually seen in the neonatal period, and peak in incidence between two and four months of life.
Cardiac output
Heart rate x stroke volume = CO
CPK> 20,000
CPK (muscle enzyme) levels greater than 20,000 is ominous and is an indication of later DIC, acute renal failure and is potentially dangerous hyperkalemia in the heatstroke patient
Drugs for AAA
Nipride and beta-blockers
