Cardiac Flashcards
Heart chamber hemodynamic pressures:
CVP / RA: 0-5 (nickle) RV: 25 (quarter) PAWP: 5 - 12 LA: 10 (dime) LV: 120 (buck and change)
PRELOAD is the amount of blood ___ to the ___ side of the heart and the muscle ___ that the volume causes.
___ is released when the RA is ___.
(Remember what ANP leads to?)
returning right stretch ANP overstretched (ANP is opposite of aldosterone...it excretes Na and H20 to lower BP)
Name 3 drugs that can decrease preload:
(Vasodilate or diurese)
Diuretics
Nitro
Morphine
AFTERLOAD is the pressure in the ___ and ___ ___ that the ___ ___ has to pump against to get the blood out.
aorta
peripheral arteries
left ventricle
Name 4 types of drugs that decrease afterload:
(Vasodilate) ACE inhibitors ARBs Calcium channel blockers Hydralazine (this is a nitrate...treats severe HTN) Nitrates
What is stroke volume?
Amt of blood pumped out of LV with EACH STROKE
CO = HR x SV
What is average cardiac output?
5 L/ min
3 types of drugs to DECREASE HR
calcium channel blockers (-dipine)
beta blockers
digoxin
3 drugs to increase CONTRACTILITY
Inotropes
- dopamine
- dobutamine
- milrone
3 types of drugs to control RHYTHM
Antiarrhythmics
- amiodarone
- sotalol
With beta blockers, it decreases HR and thus contractility and CO…what should we watch for with pts on BB?
Heart failure
indicates, BB is suppressing the heart too much!
Name some common calcium channel blockers:
(the -dipines) Also…
verapamil
diltiazem
Verapamil is contraindicated in what population…why?
elderly b/c of significant constipation
Calcium channel blockers do what 3 things
dilate coronary arteries
decrease afterload
increase O2 to heart muscle
What are the 5 Ps
Pulselessness Pallor Pain Paresthesia Paralysis
How long must a pt be on supine bedrest post cath?
4 - 6 hrs
Unstable chronic angina = ____ ____
impending MI
Acute Coronary Syndrome (ACS)
- ___ angina
- Relieved or not relieved by NTG?
unstable angina
NOT relieved by NTG
Normal troponin T and I values
Troponin T < 0.10
Troponin I < 0.03
What is the #1 sign of MI in the elderly?
SOB
also think about sudden confusion
CPK-MB increases when:
Elevates within ___ - ___ hrs and peaks in ___-___ hrs
damage to cardiac cells
elevates within 3 - 6 hrs
peaks in 12 - 24 hrs
Troponin is a cardiac biomarker with high specificity to ___ damage.
Elevates within ___-___ hrs and remains elevated for up to ___ ___.
myocardial
elevates within 3 - 4 hrs
remains elevated for up to 3 wks
Myoglobin is not as a preferred lab b/c:
Increases within ___ hr and peaks in ___ hrs
not specific enough to diagnose MI
Increases within 1 hr
Peaks in 12 hrs
How soon after the onset of myocardial pain should thrombolytics be administered?
(Also, how long for stroke…why?)
Heart 6-8 hrs
Brain 3 hrs…b/c “time is brain”
If the thrombolytic steptokinase causes an allergic rxn, what should you do?
Still give, but treat rxn with benadryl
What are the ABSOLUTE contraindications for thrombolytics?
- intracranial neoplasm
- intracranial bleed (hemorrhagic stroke)
- aortic dissection
- internal bleeding
What is the difference between systolic and diastolic HEART FAILURE?
Systolic HF –> heart can’t contract and eject
Diastolic HF –> ventricles can’t relax and fill
Systolic is ___ (S___)
Diastolic is ___ (S___)
___ is when the carotid artery pulses
systolic is EJECTION (S1)
diastolic is REFILLING (S2)
Systole
3 Standard types of meds for heart failure are
ACE INHIBITOR (drug of choice for HF!) - arterial dilation and increased SV ARBs - decrease in arterial resistance DIGOXIN - decreases HR, increases contractility... + inotrope
Most common complication after placement of permanent pacemaker
electrode displacement
keep pt from raising arm above shoulder
Who is at risk for pulmonary edema?
- receive fluids too fast (like burn, DKA)
- very young/very old
- hx of heart or kidney disease
What time of day/night does pulmonary edema usually occur?
Night (pt lays down)
5 signs of pulmonary edema
1) sudden onset
2) breathless
3) restless/anxious
4) severe hypoxia
5) pink frothy sputum
Priority action for treatment of pulmonary edema
High flow O2
Titrate to keep SpO2 > 90%
What meds given for pulmonary edema:
- diuretics (furosemide, bumetanide)
- NTG
- morphine
- nesiritide (synthetic BNP)
What to remember about nesiritide (synthetic BNP)
IV infusion…short term, not more than 48 hrs
Vasodilates veins and arteries and has a diuretic effect
Turn off 2 hrs before drawing a BNP level
Positioning for pulmonary edema
Sit upright with legs down…moves fluid to lower extremities and away from lungs
Hallmark signs for cardiac tamponade
CVP increased
BP decreased
Other S/S of cardiac tamponade
- muffled / distant heart sounds
- pressures in all 4 chambers are the same
- shock
- narrowed pulse pressure
Narrowed pulse pressure…think ___
Widened pulse pressure…think ___
narrowed –> cardiac tamponade
widened –> increased ICP
Intermittent claudication is a hallmark sign of ___ ___;
Pain at rest means ___ ___
arterial disorders
severe obstruction
