Cardiac Flashcards
Angina that is predictable and consistent. Occurs on exertion and relieved by rest or nitroglycerin
Stable Angina
Angina that increases in frequency and severity, not relieved by rest or nitroglycerin
Unstable Angina
Severe incapacitatin angina
Intractable or refractory Angina
This angina is painful at rest. Reversible ST segment elevation. Caused by vasospasm.
Prinzmetals (aka Variant) angina
Nitroglycerin vaso_____s. It _____ blood pressure.
vasodilates; decreases
Acceptable SPO2 percentage?
> 90%
STEMI is ___mm above the isoelectric line
1 mm (one big box)
PR segments are usually __ to ___ small boxes
3 to 5
QRS segments are usually ___ to ___ small boxes
1 to 3
1500 divided by the number of boxes in the RR interval gives us what?
Heart Rate.
What is the difference between STEMI and NSTEMI?
STEMI shows ST elevations
NSTEMI means that an MI has occured without changes on the ECG and is discovered through biomarkers (such as Troponin)
WHich biomarker is the most reliable for MI diagnoses?
Troponin
Specific to cardiac muscle, released within a few hours of acute MI, and remain elevated for 3 weeks.
CK-MB is also specific to hear muscle. (NOT THE OTHER CK’s). Shows up within a few hours and peaks at 24 hours.
HOw can myoglobin be used in diagnosing MI?
It is not specific to heart, but it is located in the heart. Therefore, if we DO NOT see it then it helps rule out MI. It should be present if MI.
WHat is PCI?
percutaneous coronary intervention formerlay known as angioplasty with stent.
How does morphine function during MI?
Vasodilates, reduces preload/afterload, reduces anxiety and pain.
PCI should take place within ___ minutes of arrival to the ED
60
Thrombolytics are used when PCI is not an immediate option. THey should be administered within ___ minutes of ED arrival
30.
After thrombolytics, should be referred for PCI because clot busted but the atheroscerosing has not been solved. PCI inserts stent
Preffered vessel used for CABG?
Mammary artery because it does not develop atherosclerotic changes as quickly and remain patent longer.
NExt choice is saphenous vein or radial artery
1 pound = ___ kilograms? Pounds?
1 kg, 2.2 lbs
With what wave do we synch cardoversion with?
QRS. THe sync button should flash with each QRS complex (should see a bright green flag flash on the monitor).
After valve replacement, a person may be put on warfarin aka coumadin. What it the target PT/INR for mitral valve replacement? Aortic valve replacement?
2-3.5 for mitral
1.8-2.2 for aortic
What are overall consideration after valve replacement or repair?
Anticoagulants
Protecting against infective endocarditis (including prophylacctic antibiotics)
wound care
patient education
What is the difference between primary and secondary cardiomyopathy?
Secondary is related to the influence of another disease. Primary is genetic, non genetic and acquired.
Dilated Cardiomyopathy (DCM) has ventricles with overstretched muscle fibers that have lost contractility. This loosey tissue allows a big lazy ventricle to form. The muscle becomes weak. Imagine it like a post partum pregnancy belly…. So does this cause systolic or diastolic issues?
It causes both. BEcause it is too stretched and not contracting enough it cannot pump all the blood out (systolic issue). Blood left reduces the amount that can fill the space from the pulmonary system duing diastole. If the pulmonary system gets backed up, it also is effected and pressure rises. If the pressure builds and builds eventually you might get regurgitation.
Is restrictive cardiomyopathy systolic or diastolic issue? Why?
Restrictive is a diastolic issue. The size that can fill is restricted.
Systolic remains untouched because the muscle has grown so much it still pumps out pretty hard.
What is the difference between the hypertrophy seen in restrictive cardiomyopathy versus actual hypertrophic cardiomyopathy?
In hypertrophic cardiomyopathy, mainly the left ventricle and asymetrical septal regions are affected.
Hypertrophic is genetic and is the one that young athletes suddenly die from (not properly dx perhaps?)
In both, the hypertrophic ventricles of HC and RC, diastolic filling is an issue. The giant muscles take up space.
In _______ cardiomyopathy, arterioles decrease in diameter, restricting blood supply causing ischemia leading to necrosis
Hypertrophic
In ______ cardiomyopathy, the right ventricle is infiltrated by scar and adipose tissue.
Arrhythmogenic Right Ventricular Cardiomyopathy ARVC
Why is cyclosporine and tacrolimus important in cardiac?
these are the immunosuppressants that decrease rejection after heart transplant.
When a person with cardiomyopathy is having an episode, rest is indicated. What is the best position for them to rest in?
In a seated position (NOT lying down). This pools venous blood to the periphery which reduces preload. (less work for heart)
Hypertrophic Cardiomyopathy , patients should avoid diuretics. WHy?
These people should stay hydrated. Cardiac output is an issue, therefore we need volume!
What is a normal ejection fraction?
55-65%
What is pulsus paradoxus?
systolic BP is markedly lower during inhalation
Fahrenheit to Celsius conversion equation
JIC test has C and not F, better to know how to figure that shit out
F = (C X 1.8) + 32
Example:
F = (38 deg C X 1.8) + 32 F = (68.4) + 32 F= 100.4
100.4 = (C X 1.8) + 32
100.4-32=C x 1.8
68.4= C x 1.8
68.4/1.8=C
C=38
What is the minimum mean arterial pressure to ensure tissue perfusion?
65mmhg
What is a good number for pulse pressure?
30 to 40 mHg
(systolic number - diastolic number)
100S-80D=20….
90S-80D=10 even worse
It correlates with stroke volume. Narrowing pulse pressure is a better sign than a change in systolic BP
p.288
We are more likely to see an increase in Diastolic BP before a decrease in Systolic BP
What does cHRonotropic mean?
Controls the HR
positive = increase negative= decrease
CHRonotropic –>CHR –>controls heart rate
What does inotropic mean?
controls contraction
contractION (pronounce shin..in) –>inotropic
opposite of chronotropic
positve –>increase
negative –>decrease
This med is vasopressor and inotropic (works on contraction). It is used in cardiac emergencies to increase BP and CO.
Once vital signs are stable, we taper this medication to avoid sudden changes from sudden discontinuation of it. Gradual adjustments give us more control!
Dopamine
2 to 10 mcg/kg/min
This medication is used for MI. It relieves pain and anxiety as well as vasodilates.
Morphine
What is the key difference in neurogenic shock?
parasympathetic response.
Sympathetic cannot respond. THe person will be warm and seem sort of normal on the exterior because fight or flight was unable to activate.
This syndrome may happen when we rapidly infuse a large amount of fluids. It puts pressure on the abdomen and interferes with other organs due to the fluid pressure against them. 12mmHg is diagnostic pressure reading
ACS abdominal compartment syndrome
