Cardiac Flashcards
normal blood flow through the heart
RA RV PA lungs PV LA LV Aorta Body
the amount of blood returning to the right side of the heart and the muscle stretches that the volume causes
preload
_____ is released when the heart stretches
ANP
is the pressure in the aorta and peripheral arteries that the LV has to pump against to get the blood out
afterload
after load is referred to as ____
resistance
the amount of blood pumped out of the ventricles with each beat
stroke volume
___ ____ is dependent on adequate cardiac output
tissue perfusion
factors that affect CO
heart rate
blood volume
decreased contractility
meds to decrease preload
furosemide
nitro
meds to decrease afterload
ACE inhibitors
ARBS
hydralazine
nitrates
meds to improve contractility
inotropes (dopamine, dobutamine, milrinone)
meds for rate control
BB
CCBs
Digoxin
meds for rhythm control
anti-arrhythmics (amiodarone)
3 arrhythmias that are always a big deal
pulselessl v. tach
v. fib
asystole
the most common type of cardiovascular disease
coronary artery disease
coronary artery disease is a broad term that includes which 2 things?
chronic stable angina
acute coronary syndrome
chronic stable angina has pain that is brought on by?
low O2 on exertion
what relieves pain with chronic stable angina
rest and/or nitro
nitro causes venous and arterial _____
vasodilation
can you swallow nitro?
NO
where do you keep nitro?
in a dark glass bottle
most common sx of nitro
HA
renew nitro how often?
every 3-5 months
what to BB do to BP, HR, and myocardial contractility?
drops!
CCBs dilate the _____ arteries
coronary
2 benefits of CCBs are that they ?
decrease after load and increase Oxygen to the heart muscle
avoid what type of exercises for chronic stable angina?
isometric
pre-procedure for cardiac cath need to ask?
iodine/shellfish allergy
check ____ function before heart cath?
kidney
_____ is a med most HCP order prior to heart cath to protect the kidneys
acetylcysteine
main priority concern post op heart cath
bleeding
assess for the 5Ps post op heart cath
pulselessness pallor pain paresthesia paralysis
unstable chronic angina = impending _____
MI
acute coronary syndrome is also known as ____ and ___ ____
MI
unstable angina
does acute coronary syndrome have ischemia, necrosis or both?
both
does the client with acute coronary syndrome have to be doing anything to bring this pain on?
NO
will rest or nitro fix the pain with acute coronary syndrome?
NO
sx of acute coronary syndrome
pain cold/clammy/BP drops decreased CO ECG changes vomiting
with acute coronary syndrome they may describe pain as ____
crushing
1 sign of an MI in elderly?
SOB
this indicates that the client is having a heart attack
STEMI
the goal with STEMI is to get them to the cath lab for PCI in less than ____ minutes
90
cardiac specific isoenzyme
increases with damage to cardiac cells
CPK-MB
CPK-MB elevates within __-__ hours and peaks in __-__ hours
3-6
12-24
cardiac biomarker with high specificity to myocardial damage
troponin
troponin elevates within ___-___ hrs and remains elevated for up to ____ weeks
3-4 hrs
3 weeks
troponin T level
<0.10
troponin I level
<0.03
increases within 1 hour and peaks in 12 hours
myoglobin
with myoglobin ____ results are a good thing
negative
which cardiac biomarker is the most sensitive indicator for an MI?
troponin
which enzyme or biomarker are most helpful when the client delays seeking care?
troponin
treatment for V. fib
shock
defib the v.fib
if the first shock for v. fib doesn’t work….give?
epi
an anti-arrhythmic used when v. fib and pulseless VT are resistant to treatment, and also for fast arrhythmias
amiodarone
how to monitor for lidocaine toxicity
neuro changes
the first antiarrythmic of choice
amiodarone
important side effect for amiodarone?
hypotension
what meds are used for chest pain when they get to the ED?
O2
aspirin
nitro
morphine
goal for thrombolytic therapy
dissolve the clot that is blocking blood flow to the heart muscle
example of thrombolytics
streptokinase
alteplase
tenecteplase
reteplase
thrombolytics should be administered within __-__ hours of an MI
6-8
with a stroke…time is _____
brain
major complication with thrombolytic therapy
bleeding
absolute contraindications for thrombolytics
intracranial neoplasm
intracranial bleed
suspected aortic dissection
internal bleeding
antidote for thrombolytics
idacrucizumab
Percutaneous Coronary Intervention (PCI) includes all interventions such as ____ and ____
angioplasty and stents
major complication of an angioplasty is a ____
MI
if there is chest pain after PCI
call Dr
what could it mean if they have pain post op PCI?
reoccluding
used with multiple vessel disease or left main coronary artery occlusion
CABG
the ____ _____ coronary artery supplies the entire left ventricle
left main
when there is left main coronary artery occlusion think what????
SUDDEN DEATH
it’s the widow maker
diet changes for cardiac rehabilitation
decreased fat, salt, and cholesterol
why can’t cardiac patients do isometric exercises?
they increase workload of the heart
when can sex be resumed after a heart issue?
when they can walk around the block or up a flight of stairs with no discomfort
what is the safest time of day for sex?
morning
best exercise for MI client?
walking
teach sx of HF
weight gain
ankle edema
SOB
confusion
HF is a complication that can result from problems such as ?
cardiomyopathy valvular heart disease endocarditis acute MI HTN
in LHF the blood is not moving forward into the aorta and out to the body….if it does not move forward, then it will go backward into the ______
lungs
sx of LHF
pulmonary congestion dyspnea cough blood tinged frothy sputum restlessness tachycardia S3 orthopnea nocturnal dyspnea
RHF is when the blood is not moving forward into the lungs….if it does not move forward then it goes backward into the ____ system
venous
sx of RHF
distended neck veins edema enlarged organs weight gain ascites
term that means the heart can’t contract and eject
systolic heart failure
ventricles can’t relax and fill
diastolic heart failure
secreted by ventricular tissues in the heart when ventricular volumes and pressures in the heart are increased
BNP
BNP can be positive for HF when the ____ doesn’t indicate a problem
CXR
if the client if the client is on nesteritide, turn if off ____ hrs before drawing a BNP
2 hours
the CXR shows what with HF
enlarged heart pulmonary infiltrates (edema)
looks at the pumping action or ejection fraction of the heart.
Echocardiogram
an ECG can also give you information about ____ and ___ ____
back flow and valve disease
is a balloon flotation catheter that can be floated into the R side of the heart and pulmonary artery.
swap-ganz catheter
standard medication therapy for HF is ___ and ____
ACE inhibitors and ARBs
ACE inhibitors and ARBs both block ______.
aldosterone
when we block aldosterone we do what?
lose Na and water and retain K+
med used when the client is in sinus rhythm or a. fib and has accompanying chronic HF
digoxin
what does digoxin do to contraction of the heart and the heart rate
stronger contraction
slows down the HR
normal dig level
0.5-2.0
how do yo know the dig is working?
the CO goes up
early sx of dig toxicity
anorexia
nausea
vomiting
lare sx of dig
arrhythmias
vision changes
before you admin dig check?
apical pulse 1 min
digoxin + _____ = toxicity
hypokalemia
diuretics decrease ____
preload
when do you give diuretics?
morning
low Na diet decreases fluid retention and helps decrease _____
preload
salt substitutes can contain excessive ___-_
K+
your natural pacemaker is the ___ ___
SA Node
if you heart rate drops to 60 or below cardiac output can ______
decrease
pacemakers are used to increase the heart rate with _______ bradycardia
symptomatic
_______ is when the ventricles are resting and are filling up with blood
repolarization
a _____ pacemaker kicks in only when the client needs it to
demand
most common complication post-op with permanent pacemakers?
electrode displacement
you need to make sure to do passive ROM to prevent what after permanent pacemakers?
frozen shoulder
can’t raise your arm higher than ___ ____ after pacemaker placement
shoulder height
what is it called when no contraction follows the stimulus
loss of capture
what is it called when the pacemaker fires at inappropriate times
failure to sense
what can cause loss of capture, failure to sense or any malfunction?
not programmed correctly
electrodes can dislodge
battery may be depleted
will they set of alarms at airports with pacemakers?
YES
may be used to pace the heart, or it might be used to defibrillate people in v-fib
ICD
who’s at r/f pulmonary edema
receive IV fluids very fast
very young and very old
hx of heart or kidney disease
pulmonary edema usually occurs at ____, when the client goes to bed
night
sx of pulmonary edema
sudden onset breathless restless/anxious severe hypoxia pink frothy sputum
the priority nursing action is to administer ____ to the patient with pulmonary edema
high flow oxygen
meds for pulmonary edema
diuretics
nitro
morphine
nesiritide
an IV infusion used for short term therapy with pulmonary edema
vasodilates veins and arteries and has a diuretic effect
nesiritide
remember to turn off the nesiritide infusion ____ hrs before drawing a BNP
2
never give nesiritide for longer than ____ hrs
48
positioning for pulmonary edema
upright position
legs down
________ is when blood, fluid, or exudates have leaked into the pericardial sac resulting in compression of the heart
cardiac tamponade
cardiac tamponade can happen if the client had
a motor vehicle collision, right ventricular biopsy, an MI, pericarditis, or hemorrhage post CABG
sx of cardiac tamponade
narrowed pulse pressure decreased CO CVP increased BP drops distended neck veins
hallmark signs for cardiac tamponade
increased CVP
decreased BP
treatment for cardiac tamponade
pericardiocentesis
surgery
narrowed pulse pressure: think ???
cardiac tamponade
widened pulse pressure: think???
increased intracranial pressure
it is a medical emergency if you have an acute arterial _____
ooclusion
with an arterial disorder the patient will report?
numbness/pain
cold extremity
no pulse
hallmark sign of arterial disorders
intermittent claudication
with arterial disorders….pain at rest means _____ obstruction
severe
treatment of arterial disorder
dangle the legs
_____ the veins
elevate
