Cardiac

Question 1

Normal heart rate

Sinus tachycardia rate

Sinus bradycardia rate

Answer 1

Normal heart rate: 60-100 bpm

Sinus tachycardia: >100 bpm

Sinus bradycardia: <60 bpm

Question 2

Cardiac Markers (CIP).. Sensitivity and peak

Troponin

CK-MB

Myoglobin (Mb)

Answer 2

Troponin: most sensitive to cardiac damage, peaks around 12 hours

CK-MB: sensitive when skeletal damage isn’t present, 10-24 hours

Myoglobin: low specificity to infarction, 2 hours

Question 3

Cardiac labs:

Potassium range

Hypokalemia

Hyperkalemia

Answer 3

Potassium range: 3.5-5

Hypokalemia: <3.5… ventricular dysrhythmias, ⬆️ digoxin toxicity, U wave, ST depression

Hyperkalemia: >5… Peaked T waves, wide QRS, ventricular dysrhythmias

Question 4

Cardiac labs:

⬆️ Hematocrit

⬇️ Hematocrit and hemoglobin

Answer 4

⬆️ Hematocrit: dehydration!

⬇️ Hematocrit and hemoglobin: indicates anemia

Question 5

Cardiac labs:

Lipids

Answer 5

Lipids:

🔸 Total cholesterol ⬇️200 mg/dl
🔸 LDL ⬇️130 mg/dl (bad cholesterol)
🔸 HDL 30-70 mg/dl (good cholesterol)

Question 6

Cardiac labs:

BNP

Answer 6

BNP: brain natriuretic peptide. Normal is <100. Indicates ⬆️ ventricular stretching and heart failure

Question 7

Holter Monitoring

Answer 7

🔸 Important for patients having angina
🔸 24 hour continuous EKG monitor is stored, the patient records the times they’re having chest pain
🔸 helps physician identify what is causing abnormalities in the EKG

Question 8

Holter Monitor placement

Answer 8

5 lead monitor

White on right
Snow over trees
Smoke over fire
Ground in the middle

Question 9

Cardiogenic shock

❤️ What is it?

❤️ Assessment

Answer 9

❤️ Heart is unable to maintain effective cardiac output… Heart failure/ disruptions in cardiac function = ⬇️ oxygen delivery to tissues = ⬇️ tissue function

❤️ Assessment: low urine output, ⬇️ BP, assess CVP (right atrial pressure preload)

Question 10

Which elements determine blood pressure?

Answer 10

🔸 Heart rate
🔸 Stroke volume (amount of blood pumped out of the ventricle with each heartbeat)
🔸 Total peripheral resistance (resistance of the muscular arteries to the blood being pumped through)

Question 11

Hypertension classification:

🔺 Normal blood pressure
🔺 Prehypertension
🔺 Stage 1 Hypertension
🔺 Stage 2 Hypertension

Answer 11

🔺 Normal: S <120 / D <80
🔺 Prehypertension: S 120-139 / D 80-89
🔺 Stage 1 Hypertension: S 140-159 / D 90-99
🔺 Stage 2 Hypertension: S >160 / D >100

Question 12

P wave

PR Segment

QRS complex

T wave

Answer 12

P wave- atrial depolarization

PR segment- delay at AV node

QRS Complex- ventricular depolarization

T wave- ventricular repolarization

Question 13

What is blood pressure equal to?

Answer 13

Blood pressure is equal to the cardiac output (cardiac output = volume pumped out of the heart per minute x arterial resistance)

Question 14

What organ systems are damaged by hypertension?

Answer 14

🔺 ❤️ must work harder to pump against resistance = need for more oxygen = angina or heart attack
🔺 Arteries/arterioles are damaged =arteriosclerosis =WBC plaques
🔺 Kidney capillaries can become permeable to proteins/other molecules = clogging of tubules = decreasing ability to filter blood and make urine
🔺 Retinas are damaged when capillaries hemorrhage = scarring
🔺 thrombotic or hemorrhagic strokes

Question 15

Cardiovascular Diseases (CVD):

History Assessment

Answer 15

🔸 Medical and surgical Hx
🔸 Family Hx (cardiac issues, diabetes, kidney problems?)
🔸 Medication Hx (including vitamins, herbals, OTCs)
🔸 Social Hx (nutrition🍩 (Sodium and fat intake), bowel and bladder habits (Urine output? Straining? Blood in stool?), activity level, sleep (orthopnea??? How many pillows?)

Question 16

Cardiovascular Diseases (CVD):

Risk factors (Non Modifiable and Modifiable)

Answer 16

Non modifiable- Older age, male gender, heredity (including race)

Modifiable- Hyperlipidemia, HTN, cigarette smoking, diabetes, obesity, physical inactivity

Question 17

Cardiovascular Diseases (CVD):

Physical Assessment

Answer 17

▪️ Inspection and palpation (skin color, temperature, capillary refill, peripheral pulses, edema, ulcers)
▪️ Vitals (BP.. Hypertension (>140/ 90), hypotension (<90/60), Orthostatic hypotension)
▪️ Auscultation of ❤️ (s1s2, rate, rhythm)
▪️ Respiratory (crackles, cough, wheezes, hemoptysis)
▪️ Abdominal (ascites, pulsatile mass (aneurysm))

Question 18

Cardiovascular Diseases (CVD):

Gerontologic considerations

Gender considerations

Answer 18

Gerontologic- peripheral pulses readily palpable due to decreased elasticity (bounding 🐰), intermittent claudication, ⬆️ risk for postural hypotension

Gender- men are at greater risk for CVD. Women have smaller blood vessels and estrogen

Question 19

Valvular Disorders:

Stenosis

Answer 19

Thickened valve = narrower space for blood to pass through = decrease flow and increased work for ❤️

Question 20

Valvular Disorders:

Prolapse

Answer 20

Valve leaflets balloon up as the ventricle collapses

Question 21

Valvular Disorders:

Regurgitation

Answer 21

Valve leaflets don’t close properly = blood leaks back into atrium = can lead to blood clotting inside the ❤️

Question 22

Valve Repair:

Mechanical Valves vs. Tissue Valves

Answer 22

Mechanical Valves- more durable but require anticoagulant therapy (ex. Warfarin… Want INR between 2 and 3.5), risk for endocarditis

Tissue Valves- less durable and lacks longevity, doesn’t require anticoagulants, risk for endocarditis

Question 23

Infective Edocarditis

Answer 23

🔸 Usually bacterial (strep!!! Also staph in acute IE!)
🔸 common in IV drug users, patients w/ a central line, invasive procedures r/t ❤️
🔸 Vegetations of bacteria destroy heart valves and can become dislodged from valve causing emboli