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Cardiac Flashcards

1
Q

Types of Antihypertensives Meds

What to do before giving them?

A

A - ACEIs (pril) - dilate bv, decrease hr, decrease bo
A - ARB (sartan)

B - beta blockers (olol) decrease contractility, hr, bp

C - calcium channel blockers (pine) dilate arteries including coronary arteries, decrease bp

*check BP and HR

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2
Q

Blood flow through the heart

A

Ddoxygenated blood from venous sytem to right atrium, tricuspid valve, right ventricle, pulmonary artery, gets oxygenated in the lungs, pulmonary vein, left atrium, mitral valve, left ventricle, aorta

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3
Q

What is preload?

What is starling’s law?

What is afterload?

What is stroke volume?

A

Volume of blood and the stretch that it causes in the right side of the heart

Stretch = tension. The more tension, the more stretch. More stretch -> heart weak and floppy -> HF

Pressure in the peripheral arteries and aorta that left ventricle needs to overcome to push blood forward. Higher in people with htn.

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4
Q

What is Cardiac Output?

When does body adjusts co?

Things that affect co?

How to assess for signs of decreased CO?

A

CO = hr x sv

  • increasing hr and stroke volume
  • contractility of the heart affected by MI, HF, certain meds, cardiac muscle disease)
  • rhythm of the heart.
  • volume of blood
  • heart rate - slow and fast decrease co. Fast coz no time to refill
  • mental status change, chest pain, weak pulses, SOB, cold clammy skin, decrease UO
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5
Q

3 dangerous arrythmias that lead to no CO.

A

Pulseless vtach - ventricles contract too fast there is no time to fill. Therefore no pulse. Shockable. Hr greater than 180 and qrs generally wide.

Vfib - shockable. Abnormal electrical activities in the upper chanbers or ventricles. They are chaotic therefore ventricles unable to pump nlood effectively. No bp and no pulse. In afib the abdnomal e activities occur in the atria causing irregular rhytm and fast hr
In afib ecg shows quivering before qrs like jagged lines
In afib abd vfib both are irregula

Asystole - nonshockable

Shock administration should be followed by immediate chest compressions (2 mins- 5 cycles) in between each shock. airway management with supplemental oxygen, and vascular access with administration of vasopressors (epinephrine etc) In cases of shock-resistant pulseless VT, the use of antiarrhythmic medications may be considered. IV amiodarone is the drug of choice.

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6
Q

Types of coronary artery disease and differences.

A

Chronic stable angina - chest pain dt ischemia, relieved with rest and nitro,

Acute coronary syndrome - chest pain dt necrosis, is not relieved rest, comes all of a sudden

  • MI - stemi is dangerous
  • unstable angina
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7
Q

Treatment of chronic stable angina

Preventing future attacks pharmacolgical

Nonpharmacological measures

A

Nitroglycerin SL, q5min up to 3 doses

C - calcium channel blockers

A - acetylsalysylic acid ASA - prevent platelets from sticking together, more blood flow - more o2.

B - beta blockers ( decreases bp and contractility thus dec workload and o2 requirement)

Prophylactic nitro

Don’t do anything that increase O2 equirement or o2 demand of the heart

  • diet and rest
  • low fat high fibre
  • avoid caffeine
  • avoid temp extremes
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8
Q

Cardiac catheterization

What to do pre and post procedure

A

Procedure to diagnose heart disease

Pre procedure

  • ask allergy to iodine and shelfish - dye has them
  • check creatinine clearance/kidney function coz dye is harsh on kidneys
  • metformin may be held until 48 hours after coz harsh on kidneys
  • tell pt injection of dye - warm, palpitations
  • baseline assessment of neuro cardiovascular status

Post procedure

  • check vitals, signs of bleeding, swelling, and hematoma on puncture site, extremity distal to site for pallor, pain, pulses, paresthesis, paralysis
  • bedrest and flat 4-6 hours
  • monitor for complications
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9
Q

Symptoms of heart attack

A

Symptoms of MI

  1. crushing chest pain, radiates to left arm, shoulder jaw
    - women, elderly diabetics less typical - e.g. women pain between shoulder blades, discomfort in jaw, GI complaints, epigastric complaints, choking sensation. Elderly - pass out, SOB
  2. Signs of decreased CO
  3. Increased WBC, fever
  4. ECG changes

5 vomitting - pain stims vomitting centre. Vomitting stims vagus nerve -> decrease hR - > decreased CO

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10
Q

What are serum Cardiac markers

A

• proteins released into blood when there is necrosis of heart tissue after an MI
• Troponin
◦ Most specific and sensitive
◦ Increases after 4-6 hours of MI, peaks at 10-24 hours and return to baseline after 10-14 days. Can stay up to 3 weeks
◦ Normal : troponin I <0.5 mcg/L, troponin T <0.1 mcg/L

Cpk mb - increase after 3-12 hours of onset, peaks at 24

Myoglobin - increase within an hour, peaks in 12. Not specific but negative means no acute MI

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11
Q

Who are at risk for HF

A

MI, htn, endocarditis, cardiomyopathy

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12
Q

Symptoms of HF

A 
Confusion
SOB, crackles in lungs
Decreased UO,
Weight gain
Edema
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13
Q

Left vs right side heart failure

A

Left side - left side of heart can’t pump blood to aorta. Blood backs up to lungs. Causes pulmonary symptoms

Right failure - caused by problem with left side or hypoxia (pulmonary embolus, copd) coz they cause pulmonary htn. right side of the heart unable to pump blood to lung. Blood acks up to venous system. Causes enlargement of spleen, liver, jvd, peripheral edema.

• Left sided failure
◦ Caused by conditions like MI, HTN
◦ Causes: cardiomegaly, S3 sound, pulmonary edema (crackles in lung bases, dyspnea, orthopnea, productive cough with pink frothy sputum, SOB)
• Right sided failure
◦ Caused by: pulmonary conditions like pulmonary HTN, COPD, right side MI, left side HF
◦ Causes:
‣ hepatomegaly, splenomegaly, ascites —> increased abdo girth, anorexhia, N+V
‣ peripheral and dependent edema, JVD

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14
Q

Procedures to diagnose HF

A

BNP - brain natriuretic peptide - secreted by ventricles when vokume and pressure are increased

Chest xray - check size of heart and infiltrates

ECG - check ejection fraction or pumping action pf heart and backflow and valve disease. Classification 1-4, 4 is the worst

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15
Q

Classic signs of hypovolemia

A

• classic signs: hypotension, tachycardia
• Signs of abnormal hydration:
◦ Cap refill more than 3 seconds
◦ Urine output less than 30 ml/hr
◦ Urine specific gravity out of normal range (1.003 to 1.030)
◦ Narrowed pulse pressure (systole minus diastole)

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16
Q

What is hypovolemic shock?

How does it affect cells in the body?

Symptoms

What is mean arterial pressure

A
  • anything that reduces intravascular volume
  • Reduced intravascular volume leads to -> reduced venous return -> less stroke volume -> less cardiac output -> less tissue perfusion -> impaired cellular metabolism
  • Symptoms are linked to low tissue perfusion: mental status change, tachycardia with weak pulse, tachpnea, cool clammy skin, decreased urine outpute (<0.5 ml/kg/hr)
  • Mean arterial pressure (diastolic x2 + systolic / 3) average pressure in artery in one cardiac cycle. >60. Is needed for adequate tissue perfusion.
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17
Q

How can MI lead to dysrythmia?

Why there is a need to check for electrolytes after MI?

A

• Complication: dangerous dysryhthmias during MI and after reperfusion therapy like stenting - e.g. heart block, vtach, vfib
◦ MI damages cardiac muscle cells thus causing electrical irritability like premature ventricular contractions which can be worssened by electrolyte imbalances. Hypokalemia hyperpolarizes heart electrical conduction pathways increasing risk for dysrythmias and cardiac arrest
◦ priority action when client is admitted to step down is: to attach cardiac monitor coz we want to monitor heart rhythms.

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18
Q

Vfib

A

‣ rhythm irregular, p wave absent, qrs not recognizable chaotic wavy like squigly lines
‣ Most common dysryhtmia following MI and cause of sudden cardiac death
‣ Pvc and vtach usually come before vfib. Pt should be ttreated right away with antidysrhythmic e.g. amiodarone

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19
Q

Vtach

A

• Vtach
◦ rhythm regular but can sometimes be irregular. Looks like pointy spikes
◦ Ventricular rate is 100-250/min
◦ QRS complexes wider than 0.12 seconds and P is hidden into QRS so PR is not measurable
◦ Treatment for pulseless VT is CPR and defibrillation

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20
Q

PVC

A

• PVC
◦ Contraction starts from the ventricle. These are extra beats.skip a beat
◦ irregular rhythm, wide distorted qrs, large inverted t
◦ Consecutive run of > or equal 3 PVCs is considered VT
◦ Occassional PVC usually do not cause hemodynamic instability but monitor client’s potassium levels as hypokalemia can exacerbate dysrythmias
-

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21
Q

Pulmonary edema sypmtoms

A

◦ Sudden air hunger, dyspnea, SOB, crackles at lung bases, pink frothy sputum (from ruptured bronchial veins due to high back pressure, blood and lung fluids mix)

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22
Q

When does Hypertensive crisis occur?

What are the symptoms?

A
  • the biggest problem to managing chronic htn is adherence to meds due to cost and side effects like fatigue, dizziness, reduced libido
  • Abrupt stopping any antihypertensives can cause rebound htn and possibly hypertensive crisis - blurred vision, severe headache, dizziness, sob
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23
Q

Venous thromboembolism 2 types

Most common of two

Virchow’s triad

Treatment

A

Dvt, pulmonary embolism

Virchow’s triad: 3 most common theories of pathophys of venous thrombosis
A. Venous stasis
B. Endothelial damage
C. Hypercoagulability of blood

Anticoagulation therapy e.g. heparin, for dvt initially bedrest and limb elevation for pain and edema, ambulation encourage, no massage and sequential compression stocking coz clot can dislodge

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24
Q

Risk factors for dvt

A

• Virchow’s triad: 3 most common theories of pathophys of venous thrombosis
A. Venous stasis
B. Endothelial damage
C. Hypercoagulability of blood
• Risk factors for dvt
◦ trauma, surgery (2, 1 from immbolity)
◦ Prolonged immobility e.g. stroke, long travel causing 1
◦ Pregnancy (1 coz of pressure on inferior vena cava, and 3)
◦ Oral contraceptibes (estrogen caused 3)
◦ Cancer cells release procoagulants
◦ Smoking (2)
◦ Obesity, varicose veins (1)old age

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25
Q

Complication of heart or any organ transplant that is the most common cause of death after transplant

A

• Complication
◦ pts with transplanted organs get lifelong imuunosupressants like cyclosporine, mycophenolate to prevent rejection.
• Most common cause of death after transplant is oosttransplant infection. Due to immunosuppresants some signs of infection like redness and swelling might be absent
• Priority is infection prevention

26
Q

Chronic venous insufficiency

Treatment

A

• valves in veins can’t let blood flow forward causing increased venous pressure. The pressure pushes fluid into surrounding tissues -> tissue enzymes break down red blood cells -> release of hemosiderin a reddish brown protein that stores iron _> causes brownish skin ->

• chronic edema and inflammation causes tissue to harden -> skin prone to ulcers (large, irregular)usually in inner ankle (venous leg ulcers)
• Treatment of venous leg ulcers
◦ compression stockings

27
Q

Peripheral artery disease

Symptoms and treatment

A

• due to hardening of artery walls - impairs blood flow and transport of nutrients to tissues
• Cool, Shiny hairless extremities, ulcer on toe (punched out), diminished pulses
• Interventions
◦ Dangling limb over side of the bed - gravity helps maimize blood flow

28
Q

What is the most important symptom to report for someone with thoracic aortic aneurysm?

A
  • Most important symtom to report is difficulty swallowing

* Aneurysm can put pressure on esophagus and cause dysphagia. Meaning the aneurysm hAs gotten bigger

29
Q

What is aneurysm

A

Outpouching or dilation of vessel wall

30
Q

What to assess in someone with abdominal aortic aneurysm?

A

Periumbilical lf epigastric bruit - whooshing sound of turbulent blood flow

31
Q

Procedures to repair abdominal aortic aneuryms. And what to monitor after

A

• Endovascular Repair involves placement of stent graft inside aneurysm via femoral artery or via open surgical incision of the aneurysm and placement of graft
• For percutaenous -> Monitor puncture sites for bleeding and hematoma,peri pulses, urine ouput and kidney fnx as renal artery can be occluded by graft or thrombosis
• For both procedure monitor for graft leakage or separation, signs are:
◦ Eccchymosis of the groin, penis, scrotum, or perineum
◦ Increased abdo girth
◦ Hypotension - Tachycardia and weak or absent peri pulses
◦ Decreasing htc and hgb
◦ Painin pelvis, back, groin
◦ Decreased UO due to decreased perfusion to kidneys

32
Q

Sinus rhythym

A
  • constant R to R interval
  • P wave present and comes before QRS
  • QRS less than 3 squares (0.12 sec)
  • PR interval less than 5 squares (0.12-0.20 sec)
33
Q

Sinus bradycardia and treatment

Sinus tachycardia

A

• Sinus Bradycardia
◦ SA node fires at a rate of less than 60/min
◦ Symptomatic: dizziness, syncope, chest pain and hypotension
◦ Treatment: atropine via IV push , if not working then transcutaneous pacing, or dopamine or epinephrine infusion
• Sinus Tachycardia
◦ 101-200 / min regular
◦ P wave, PR interval, QRS normal
◦ Many causes like hypovolemia, pain, anxiety stress etc…

34
Q

1st degree AV block

A
  • impulse conducted to ventricles through AV node is prolonged
  • So PR interval greater than 0.20 sec but R to R is constant and P wave always comes before every QRS
35
Q

3rd degree heart block or complete. Heart block

A
  • Occurs when impulse from atria to ventricle is blocked causing decreased CO
  • Lonely P waves —> far from QRS, chaotic PR intervals
  • Requires temporary or permanent pacing to restore normal conduction and hemodynamic stability
36
Q

Asystole

A

• flatline - no electrical activity
• Pt will have no pulse or respiration and unresponsive
• Treatment
◦ CPR then ACLS including epinephrine, advanced airway placement, treating the reversible causes ( these are also for pulseless electrica lactivity)
‣ 5 Hs
• Hypovolemia, hypoxia,hydrogen ions (acidosis), hypokalemia/hyperkalemia, hyperthermia
‣ 5 Ts
• Tension pneumothorax, tamponade cardiac, thrombosis (pulmonary or cardiac0, toxins (benzo, narcotics), trauma

37
Q

Afib and treatment

A

Afib
• results in decreased CO and hemodynamic instability - dvt
• Characterized by irregular rhythm and fibrillatory waves like jagged waves before QRS
• Treatment:
◦ Reduce ventricular rate to <100/min with meds like CCB - diltiazem
◦ Prevent thrombotic events like stroke with anticoagulants like warfarin
◦ Possibly antiarryhtmics to convert to normal sinus rhythm e.g. amiodarone

38
Q

Dilutional hyponatremia and treatment

A

◦ Heart cannot pump enough blood -> reduced CO -> less perfusion to vital organs including kidneys -> kidneys activate RAS which promotes resorption of water in the kidneys -> increase of blood volume or FVE -> dilutional hyponatremia (more free water than sodium)
◦ Treatment for dilutional hyponatremia
‣ Fluid restrict
‣ Loop diuretics like furosemide which promotes free water excretion
‣ ACEi e.g. the prils
‣ NACL won’t work coz its hypotonic. Would result in more free water
‣ Sodium polystyrene sulfonate (Kayexalate) wont work coz its for hyperkalemia - exchanges sodium for potassium across mucous membranes of the bowel then potassium is excreted in stool

39
Q

Patient teaching for PPM

A

◦ Avoid MRI’s, anti-theft detectors
◦ Tell airport security - handheld screening wand should not be held over device
◦ Cellphone should not be directly over it
◦ Don’t move arms up above head until DR says its ok - might get dislogged
◦ Monitor pulse daily, report fever and signs of infection
◦ Carry pacemaker ID card and medical alert bracelet

40
Q

Acute pericarditis

Cause

Symptoms

Treatment

A
  • Inflammation of the visceral and/or parietal pericardium
  • Often caused by recent viral infection
  • Symptoms: sharp chest pain worsened when breathing in and coughing and relieved by sitting up and leaning forward, friction rub on auscultation (scratchy or squeky sound)
  • Treatment: NSAIDs or aspirin (its also antiinflammatory) + colchicine
41
Q

Central venous pressure and what does it reflect

Normal

A
  • reflects right ventricular preload (volume in right ventricle at end of diastole) and reflects fluid volume problems
  • Normal : 2-8 mmHg
42
Q

Signs of Fluid volume overload

A 
‣ High BP, bounding pulse
		‣ Peripheral edema
		‣ Crackles, SOB
		‣ Increased urine that is dilute
		‣ Acute weight gain
		‣ JVD, S3 heart sound in adults and elderly (normal in young adults, children, pregnant, athletes)
43
Q

Aortic stenosis and symptoms

A 
• narrowed aortic valve -> left ventricle cannot pump enough blood to the aorta thus cannot meet body’s needs 
• Symptoms: Many are asymptomatic except
	◦ Narrowed pulse pressure coz of decreased ejection fraction
	◦ Weak thready pulse
	◦ Systolic murmur over aortic area
	◦ With exertion can cause
		‣ Dyspnea
		‣ Chest pain
		‣  syncope and/or sudden death
44
Q

Mitral valve prolapse and treatment

A

• Can cause plapitations, dizziness and lightheadedness. Some can have chest pain which do not normally respond to antianginal meds like nitrates
• Treatment:
◦ Beta blockers - the olols
◦ Eat healthy, start aerobic exercise reduce stress, and avoid alcohol, avoid caffeine coz it is a stimulant

45
Q

Aortic dissection and treatment

A

• occurs when there is a tearr in the inner lining of the aorta -> blood goes in between layers of aorta separating and weakening aortic wall -> decreased perfusion, may also lead to cardiac tamponade or aortic rupture which are life threatening
• Symptom: acute sharp or ripping chect pain that radiates to the back
• Treatment:
◦ Priority is decrease risk for aortic rupture by maintaining normal pressure in the aorta -> IV beta blocker - the olols which lowers HR and BP
◦ Emergency surgical repair

46
Q

Angina pectoris and causes

A

• chest pain caused by myocardial ischemia
• Caused by anything that increase O2 demand of heart or decreases O2 supplied to the heart
◦ Physical exertion
◦ Extreme temperatures - hyperthermia ( causes constriction of BV) hypothermia (dilation and blood pooling)
◦ Cigarette or second hand smoking - O2 replaced by carbon monoxide, nicotine causes vasoconstriction and release of catecholamine
◦ Stimulants e.g. cocaine, amphetamines
◦ Narrowing of coronary arteries e.g. atherosclerosis

47
Q

Mitral valve regurgitation

Caused by

Can cause…

Symptoms

A
  • backflow of blood from left ventricle to left atrium through the mitral valve
  • Caused by: ruptured chordae tendinae or papillary muscle
  • Backflow can cause: dilation of left atrium, reduced CO and pulmonary edema
  • Symptoms: often asymptomatic but should report if there are signs of HF like SOB, cough, weight gain, fatigue
48
Q

Radiofrequency catheter ablation

What happens if ablation occurs neasr Av node

A
  • performed through transvenous cardiac catheterization to ablate eltrical pathways that cause tachydysrhythmias.
  • If ablation occurs near AV node it can damage electrical conduction and cause AV block which caused decreased CO
49
Q

Orrthostatic hypotension how to take

Values

A
  • take one sitting, lying then standing

* Deviation must be at least 20 mmHg of systolic or more than 10 mmHg diastolic decrease

50
Q

Signs that HF has develoPed as a complication of MI

A

report these signs of HF — pulmonary congestion on Cxray, crackles, new S3 sound, JvD

51
Q

Failure to capture telemetry reading in someone with PPM - shows as what on telemeter monitor

Caused by

Symptoms

tMt priority

A

appears like spikes with no QRS complexes

  • caused by a problem in the pacemakers Batteries, lead wires, or fibrosis omtouching the tip of the lead wires
  • symptoms : hypotension, dizziness dt inadequate perfusion
  • tmt : priority: transcutaneous pacing to normalize bp, perfusion until ppm is replaced or repaired. Notify MD. Admin analgesic/sedation as needed as itnis uncomfortable.
52
Q

Life threatening complication of pericardial effusion

Symptoms that it is developing

A

cardiac tamponade — buildup of fluid compresses the heart. Symptoms that it’s developing : narrowed pulse pressure, hypotension, JVD

53
Q

Infective endocarditis - when can it develop

What to do before dental procedure

A

can develop in pts with hx of IE, have any prosthetics in their heart, congenital heart disease repaired or unrepaired cyanotic, and cardiac transplant who developed heart valve disease
- should take prophylactic antibiotics prior to dental procedures to prevent IE

54
Q

Priority actions pt leaning forward on chair, somnolent, having SOB

A

Priority actions pt leaning forward on chair, somnolent, having SOB

  1. Lay flat on stretcher, open airway
  2. Raise hob to semi fowlers
  3. Partial rebreather at 10L per minute
  4. Monitor o2 sat
  5. Auscultate lung sounds
55
Q

What is aortic regurgitation

A
  • aortic valve fails to close completely causing leakage of blood
  • Symptoms: fatigue with activity, sob, edema, chest pain or discomfort, palpitations
56
Q

Effects of aortic regurgitation

A
  • left ventricular hypertrophy due to increased contractions to increase CO
  • Pulmonary edema from backup of blood
  • SOB due to the pulmonary edema
  • Congestive Heart failure - due to consolidation from dilated pulmonary vessels, buildup of fliids in pleural and interstitial space, and alveoli
  • Anemia
57
Q

Losartan is hypersensisitive to which med

A

Ace i

58
Q

Chest xray for pt with chf due to aortic regurgitation

A
  • consolidation in lower bases
  • Scattered infiltrates - areas of lungs with decreased breath sounds due to plumonary edema
  • Left ventricular hypertrophy
59
Q

What is Anemia and what are cbc results that are los in anemia

A

• lack of rbc fo crry enough o2

  1. RBC 3.8-5.10
  2. HgB - ability of rbc to carry o2
  3. Mcv - size of rbc
  4. Mch - amount of HgB in the Rbc
  5. Mchc - concentration of hgb in the rbc
60
Q

What needs to be assessed before giving furosemide IV

A
  • baseline bp and pulse

* Lung sounds

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