Cardiac Flashcards
preload
the amount of blood returning to the right side of the heart and the muscle stretch that the volume causes. ANP is released when we have this stretch.
afterload
the pressure in the aorta and peripheral arteries that the left ventricle has to pump against to get the blood out
with HTN there’s even more ____ for the left ventricle to pump against. that’s why ____ can eventually lead to HF and pulmonary edema, because high afterload ____ CO and ____ forward flow. plus, it wears your heart out
resistance
HTN
decreases
decreases
stroke volume
the amount of blood pumped out of the ventricles with each beat
CO= ____
HR times SV
less pressure = ___ CO
more pressure = ___ CO
decrease
increase
If you CO is decreased, will you perfuse properly? brain: LOC will go \_\_\_ heart: client reports of \_\_\_ Lungs: SOB? Lung sounds? Skin: Kidneys: UO \_\_\_ peripheral pulses:
No down chest pain yes and lungs sound wet cool and clammy down weak and thready
what are 3 arrhythmias that are a big deal?!
- pulseless vtach
- vfib
- asystole
chronic stable angina
decreased blood flow to the myocardium—ischemia–temp. pain/pressure in the chest
pain comes on by low o2 usually due to excretion
rest relieves pain or nitro
nitroglycerin: \_\_\_\_ preload and afterload. take 1 every \_\_\_ , \_\_ doses okay to swallow? renew how often?
decreases
5 mins, 3 doses
no
3-5months, spray 2 yrs
what should you do before giving beta blocker?
check HR and BP!!!
what is beta blocker?
[propanolol,metoprolol,]
for prevention of angina
-decrease BP,HR, myocardial contractility
-decreases the workload of the heart
calcium channel blockers?
[verapamil,amlodipine] prevention of angina -decreases BP -causes vasodilation -decrease afterload and increase o2 to the heart muscle
aspirin
use to keep platelets from sticking together
-dose it determined by the physician (81-225mg)
treatment for chronic stable angina
- nitro
- beta blocker
- calcium channel
- asa
the 5 p’s
pulselessness pallor pain paresthesia paralysis
preprocedure for cardiac cath:
ask if they are allergic to shellfish or iodine
also check kidney function (because you excrete dye through the kidney)
post procedure for cardiac cath: bed rest, leg straight for \_\_\_ hours watch for bleeding 5 p's extremity distal to puncture site major complication?\_\_\_ if the client is on metformin, you should?
4 to 6 hours
hemmorage
hold the medicine for 48 hours post procedure. we are worried about the kidneys
what is the women triad of symptoms for acute MI?
GI S/S epigastric complaints pain between the shoulders aching jaw choking sensation
when a patient is having an STEMI, this indicates that the client is having a heart attack and the goal is ___
is to get them to the cath lab for PCI in less than 90 mins
what increases with damage to the cardiac cells?
when does it elevate?
CPK-MB
(cardiac specific iso-enzyme)
3-12 hours and peaks in 24 hours
troponin elevates within ____ and remains elevated for ___.
cardiac biomaker with high specificity to myocardial damage.
3-4 hours
3 weeks
myoglobin increases within ____ hours and peaks in __ hours.
1 hour
12 hours
(negative results are a good thing)
which cardiac biomarker is the most sensitive indicator for an MI?
troponin
which enzymes or markers are most helpful when the client delays seeking care for an MI?
tropinin
what untreated arrhythmias will put the client at risk for sudden death?
pulseless v-tach
vfib (dfib the vfib!)
asystole
bradycardia
if the first shock doesn’t work and the client remain in vfib, what is the first vasopressor we give?
epinephine
lab value for troponin
T less than 0.10. I less than 0.03
____ is an anti-arrthythmic and is used when v-fib and pulseless VT are resistant to treatment, also for fast arrhythmias
amiodarone (drug of choice)
what anti-arrhythmic drugs are commonly given to prevent a second episode of v-fib?
amirodarone and lidocaine
lidocaine toxicity: _____
any neuro changes
amiodorone is _____.
important side effect is ____.
the first anti-arrhythmic of choice
hypotension
what drugs are used for chest pain when they get to theED?
oxgyen
ASA (chewable, absorbs faster)
nitro
morphine (if pain isnt relieved)
head up position.. because decreases workload on the heart and increases CO
what are the fibrinolytics drugs?
how soon after the onset of myocardial pain should these drugs be administered?
-dissolves the clot that is blocking the blood flow to the heart muscle—-decreased the size of the infarction
streptokinase,alteplase
within 6-8hours
(exception to this is CVA, time loss is brain loss! 3hr with CVA)
what is the widow maker (sudden death)?
left main coronary artery occulsion
left side heart failure
the blood is not moving forward into the aorta and out to the body…. IF it does not move forward, then it will go backwards into the LUNGS!
s/s of left side heart failure
left=lungs!! pulmonary congestion dyspnea cough blood tinged frothy sputum restlessness tachycardia S-3 orthopnea nocturnal dyspnea
right side heart failure
the blood is not moving forward into the lungs…IF it does not move forward then it goes backwards into the VENOUS system
s/s of right side heart failure
right=venous thing distended neck veins edema enlarged organ weight gain ascities
systolic heart failure
heart cant contract and eject
diastolic heart failure
ventricles cant relax and fill
BNP (b-type natriuretic peptide):
- secreted by the ventricular tissue in the heart when the ventricular volumes and pressure in the heart increased
- sensitive indicator
- can be positive for HF when the CXR does not indicate the problem
- if the pt is on nesiritide, turn it off 2 hr prior to drawing BNP
how do you diagnose heart failure?
BNP
CXR
echocardiogram
what is the standard medication for HF?
ACE inhibitors and ARBs
ACE inhibiotors:
drug of choice for HF
suppress the renin angiotensin system
prevent conversion of angiotensin 1 to angiotensin 2
results in the arterial dilation and increased SV
ARBs
-block angiotenin 2 receptors, and cause a decrease in arterial resistance and decreased BP
ace inhibitors and ARBS block ____.
aldosterone. when we block aldosterone, we lose sodium and water and retain potassium.
digoxin is used with ….
sinus rhythm or afib and accompanying chronic HF.
makes contractions stronger
slows HR down
CO up
kidney perfusion UP
normal digoxin level
0.5-2
s/s of digoxin toxicity
early: anorexia, N/V
late: arrhythmias and visual changes (halos around the lights)
_____ + digoxin= toxcity
hypoglycemia
diuretic decrease ___.
when should you give diuretic?
preload
in the morning
loss of capture with pacemaker
no contraction will follow the stimulus
who is at risk for pulmonary edema?
any person :
receiving IV fluid really fast
very young and very old
any person with history of heart or kidney disease
what is pulmonary edema?
fluid is backing up into the LUNGD. the heart is unable to move the volume forward.
pulmonary edema usually occurs at night, when the client goes to lie down.
s/s of pulmonary edema?
sudden onset breathless restless/anxious severe hypoxia productive cough (pink frothy sputum)
tx for pulmonary edema?
diuretics
nitro
morphine
nesiritide
furosemide, you should give _____ to prevent hypotension and ototoxicity
40 mg IV push slowly over 1-2 mins
bumetanide can be given _____ to provide rapid fluid removal.
should be given ___ over 1-2 mins
IV push or as a continuous iv infusion
1-2 mg IV push
remember to turn the nesiritide infusion OFF ….. when?
2 hrs before drawing a BNP level
cardiac tamponade
- blood ,fluid, or exudate have leaked into the pericardial sac resulting in compression of the heart
- this can happen if the client has had a motor vehicle collision, right ventricular biopsy, and MI, pericarditis, or hemorrhage post CABG/s of c
s/s of cardiac tamponade
decreased CO cvp will go UP BP will drop (hallmark is increase cvp, decrease bp) heart sounds will be muffled or distant neck veins distended pressure in all 4 chambers are the same shock narrowed pulse pressure (bp 120/80...pule pressure is 40)
narrowed pulse pressure think:
widened pulse pressure think:
cardiac tamponade
increased intracanial pressure
tx for cardiac tamponade
pericardiocentesis to remove blood from around the heart
-surgery
intermittent claudication is hallmark sign for __.
arterial disorders
postion:
we ELEVATE ___
we DANGLE ___
veins
arteries
s/s of dissecting aorta
severe burning back pain, unlike anything
may feel pulsation
if vein problems, dont answer with an ____.
oxygen!
