Cardiac Conditions Flashcards
Tx for clotting
- Drug classes + MOAs
- Antiplatelet: decreases platelet aggregation
- Anticoagulant: inhibit the coagulation cascade (blood thinners)
- Thrombolytics: post-clot lysis
What drug class does ASA belong to?
- Antiplatelet DRUG OF CHOICE
- Blocks thromboxane A2 in degranulation - NSAID
- Blocks COX-1
Dipyridamole
Antiplatelet
- Blocks Thromboxane A2 in degranulation
Clopidogrel
What drug class? MOA? s/e?
Antiplatelet
- Blocks ADP in degranulation = decrease in platelet adhesion
s/e: easy bleeding, ulcerations
Heparin-induced thrombocytopenia (HIT)
An immune reaction to Heparin-Factor 4, resulting in disseminated coagulation.
Life-threatening:
- 50% in patients
- 30% in patients on Heparin X
Dabigatran (Pradaxa)
Anticoagulant (PRODRUG)
- Blocks thrombin receptors + factors
- *For stroke prevention
Warfarin (Coumadin)
Anticoagulant
- Inhibits hepatic formation of PF II, VII, IX, X (antagonizes Vit. K-dependent factors)
PK:
- Long t/12
- High PPB
- Narrow TI**
Alteplase, Reteplase
Describe PK.
Thrombolytics: clot lysis
- Based on Plasmin
- t1/2: 13-16 min (acute!)
- IV
Plasmin
A protein that degrades fibrin.
- Endogenously made
- Part of Thrombolytics drug class
Clinical manifestations of atherosclerosis
- Narrowing of vessel
- Vessel obstruction d/t plaque
- Thrombosis
- Weakening of vessel wall
What drug class do these belong to?
- Nitroglycerin (Nitro)
- Isosorbide
Organic nitrates
1ST LINE OF ACUTE CAD/ANGINA
1 SL q5min x 3 doses => CALL EMS IF IT DOESN’T WORK
What is angioplasty (PTCA) used for?
Tx for obstruction by CAD
- Opens blocked coronary arteries + cerebral vessels (STENTING)
What is CABG used for?
(Coronary artery bypass graft)
- Describe meds used, candidates
Tx for obstruction = re-routes/bypasses myocardial BF around blocked coronary arteries
- “Open heart surgery”
- INDUCES CARDIAC ARREST or beating heart
Meds: high CCB, beta-blockers, K+
Candidates: No high atherosclerosis
Pulmonary embolism
- S/S, Dx, Tx
Thrombus that has travelled to the lungs. Most commonly from DVT.
S/S: sob, low O2sat, chest pain, compensatory mechanisms (increase HR)
Dx: CT scan
Tx: prevention is key!
- Early mobilization
- Compression stocking
- Anticoagulation pre/during/post-Sx (Heparin, LMWH)
- ER: thrombolytics
Thrombus vs Thromboembolism
- List RFs
Thrombus: clot
Thromboembolism: migrating clot (usually to deep veins)
Coronary Artery Disease (CAD)
the narrowing of coronary arteries d/t atherosclerosis
(50-77% occlusion = Sx)
> > Angina - Stable, Variant, Unstable
Tx: Nitroglycerin
Stable Angina
Fixed plaque in coronary arteries that causes intermittent pain, exacerbated with exertion, but relieved with rest
Variant Agina
Chronic angina characterized by persistent contractions/spasms of coronary arteries that often occur at rest/sleep.
- Triggered by smoking
- ECG shows STE (but NOT MI, only temporary occlusion)
Ischemia
- Describe s/s, effect on body
When there is not enough blood flow for adequate oxygenation.
S&S (fast)
- sob, pain, hypoxemia, no contractility
Effect:
- Anaerobic metabolism
- Injury of myocardial cells (leaks intrinsic enzymes: troponin, CK, myoglobin)
- Cellular necrosis onset 20-40 min
Ischemia vs Hypoxemia vs Hypoxia vs Angina
Ischemia: not enough blood flow for adequate oxygenation
Hypoxemia: lower than average O2 in blood
Hypoxia: inadequate O2 in tissues
Angina: chest pain/discomfort d/t hypoxic tissues
Myocardial Infarction (MI)
Ischemia of the heart
(d/t blockage of BF = rupture of plaque or anything constricting)
- Duration of chest pain w/o precipitating event is >30 min
- STEMI = thrombus fully occludes
- NSTEMI (depresses) = partial occlusion
Prioritize RE-PERFUSION
Interventions
- Percutaneous Coronary Interventions (PCI) = to visualize artery
- CABG = to reroute BF
Unstable Angina
Acute rupture of plaque + blood clot in coronary arteries causing severe and prolonged pain at rest + exertion.
- Increases risk of MI
- Tx: Nitroglycerin q5min x3 max
Antioxidants
- Examples (2)
Neutralizes + eliminates ROS by giving up its electron.
- Supports normal cellular enzyme fx
- Proanthocyanidins (grape skin), Vit. C
Dyslipidemia
- Name drug classes + MOA
Elevated total or LDL cholesterol.
- Statins: lower LDL via HMG-CoA reductase inhibition + increasing hepatic metabolism
* FIRST LINE TX: POST-MI - Fibrates: lower vLDL via increasing lipolysis + metabolism
- Niacin: increases HDL via increasing clearance + lowering cholesterol synthesis (liver)
Where is cholesterol endogenously made?
Liver
What drug class do these belong to? What do they treat?
- Lovastatin (Mevacor)
- Atorvastatin (Lipitor)
- Simvastatin (Zocor)
- What are the s/e?
- Contraindications?
Statin
- Lowers LDL via HMG-CoA reductase inhibition + increasing hepatic metabolism
- *1st line of tx: POST-MI
- *Pregnancy Cat. X
- Liver fx dependent
- s/e: MYOPATHY, drug interactions (CYP3A4, 2C9)
What are heart healthy fats?
Foods that decreases LDLs + increases HDLs
Mono-saturated fats = Oils, nuts, avocados
Poly-unsaturated fats = Corn, soybean, safflower/sunflower, cottonseed oil, fish
Saturated
Whole milk, butter, cheese, ice cream, red meat, chocolate, coconuts, egg yolks, chicken skin
- Increases LDL + HDL
Trans fat
Margarines, shortening, deep fried ships, fast food, commercial baked goods
- Increases LDL
LDL, vLDL, HDL are all ________
Lipoproteins (cholesterol transporters) produced by fat + apoproteins
Energy source of fat vs carbs/proteins
Fat: 9 cal/g
Proteins/carbs: 4 cal/g
Nitroglycerin/Isosorbide vs Nipride/Hydralazine
SIMILAR MOA
Nitroglycerin/Isosorbide
- 1st line of acute CAD
- 1 SL tablet q5min x 3 > EMS
Nipride/Hydralazine: HTN crisis; ER settings
What is this lab test: PT/INR?
What is abnormal?
Prothrombin time (Warfarin)
What is this lab test: aPTT?
Activated partial thromboplastin time (Heparin)
What do these values hint - CBC, Hgb, Plt, Hct?
Bleeding risk
Abdominal Aortic Aneurysm
distended artery/bulge in the abdominal aorta
- Monitor for “bruits” (turbulent flow)
- If it ruptures = hypovolemic shock/systemic bleed
Cerebral Aneurysm
distended artery/bulge in the cerebral
If ruptured = hemorrhagic CVA = increased ICP
- Immediately give osmotic diuretics
Thoracic Aneurysm
distended artery/bulge in the chest
If ruptured = systemic bleed
Aortic Dissection
Aorta is stretched and a tear develops within the “intima”, creating a false lumen where blood pools into.
- Can be caused by Marfan syndrome
If ruptured = cardiac tamponade
Type A = heart and above most fatal
Type B = below heart
Sx: significant difference in BP b/w arms
Cardiac Tamponade
Bleeding into the pericardium, compressing the heart and decreasing CO
= Shock / HF
PULSUS PARADOXUS = SBP decreases with inhalation
- Narrow PP
- Hypotension
- Muffled heart sounds
- JVP distention
Pericardiocentesis
Inserting a needle into pericardium to withdraw blood
Pericarditis
How to relieve pain?
Inflammation of the pericardium
Acute = pericardial effusion / cardiac tamponade
Chronic = Pericardium hardens»_space; higher pressure on ventricles»_space; low CO
Sx:
1. Pleuritic pain (sharp) on inhalation + coughing
2. Pleuritic friction rub (scratchy/squeaky sound)
- Relieve by SITTING UP + LEANING FORWARD
Endocarditis
Inflammation inside the myocardium chambers d/t infectious organisms commonly from dirty needles + dental visits
= heart valve dyfx»_space; low CO
Sx: flu-like, emboli, heart murmur. arthritic pain
Peripheral Artery Disease
narrowing of arteries d/t atherosclerosis, impeding peripheral perfusion.
- INTERMITTENT CLAUDIFICATION = ischemic pain in LE during exertion, but relieved with rest
- Cool, dry, shiny skin
- Abnormally high BP in arms > legs
Chronic Venous Insufficiency
Incompetent venous valves = retrograde BF = varicose veins (d/t venous HTN) = edema/ulceration
- Edema
- Reddish-brown discoloration
- Leathery, thick skin
- Ulcers
mostly in calves
DVT
A thrombus that is lodged in deep veins that blocks BF.
Virchow Triad (3 predispositions):
- BF stasis
- Endothelial damage
- Hypercoaguable state
Sxs are often unilateral.
“d-dimer” (protein released on dislodgement of thrombus)
Monitor for PE + ambulate asap
Considerations for Orthostatic Hypotension
Abnormal parameters?
Positional BP = 2-5 min in between
Notify HCP if difference in…
- SBP >20 mmHg
- DBP > 10 mmHg
Metabolic Syndrome
When 3 or more metabolic health factors are present that increases the risk for T2DM + CVD
- Waist circumference
- Triglyceride increase
- BP increase
- HDL decrease
- Glucose increase (abdominal obesity = insulin resistance)
General presentation of shocks
- Poor BF/perfusion
- Low O2 delivery
- Cold, clammy skin
Left-sided Heart Failure
When the heart’s CO is unable to meet metabolic demands
LS = pulmonary congestion
» crackles, dyspnea, pink frothy sputum
Right-sided HF
When the heart’s CO is unable to meet metabolic demands.
RS = peripheral congestion
» ascites, peripheral edema, hepatomegaly
BNP
Hormone that is released during HF when the heart is stretched abnormally much
What does an echocardiogram do?
Measures EF (% of blood leaving the heart w/ each contraction)
Systolic HF
When the heart’s CO is unable to meet metabolic demands.
Systolic = thin myocardial wall causes increase in BV filling the chambers, but unable to pump it all out (HF w/ REDUCED EF)
Diastolic HF
When the heart’s CO is unable to meet metabolic demands.
Diastolic = R ventricle muscle thickens»_space; ineffective pumping (HF w/ PRESEVERED EF)
Hypovolemic shock
Large intravascular volume loss
Body reacts with overall vasoconstriction.
Tx: Give blood (hemorrhagic) or fluids (dehydration)
Cardiogenic shock
Inability for the heart muscle to contract.
- Strength and frequency of contraction is insufficient
Septic Shock
Widespread infection from Gram -/+ bacteria that causes vasodilation»_space; increased cap permeability»_space; altered BF
*Persistent hypotension despite fluid resuscitation
Transfusion-Associated Circulatory Overload (TACO)
Blood transfusion reaction d/t rapid rate + large volume.
- Stop transfusion
- High fowlers
- Diuretics
Kawasaki Disease
PEDS
Systemic inflammation/vasculitis of arterial walls (especially coronary)
- Common in Asians
- Immunocompromised
Sx: Mucocutaneous lymph node syndrome
- Strawberry tongue
- Maculopapular rash
- Redness in eyes + mouth
- Swollen lymph nodes
Tx: Baby aspirin + IVIG
Marfan Syndrome
PEDS
Aortopathy or Autosomal dominant genetic disorder that causes general weakness to CT
- Ocular = myopia, decreased visual acuity
- Skeletal = thin, long limbs and physique/double jointed/scoliosis
- CV - weak, dilated aorta and leaky valves
Tetraology of Fallot (TOF)
PEDS
Cyanotic congenital heart defect categorized by 4 defects.
- VSD
- Pulmonary stenosis
- Overriding aorta
- Right ventricle hypertrophy
- “TRouBLe” = blood shunts R»_space; L + cyanotic (“tet spells”)
Murmur
Abnormal heart valves that causes aggressive shunting/turbulent BF through valves or heart
Femoral cardiac catherization precautions
- Remain supine w/ HOB at 30
- NO HIP FLEXION to avoid disrupting clot formation
