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NCLEX > Cardiac Conditions > Flashcards

Cardiac Conditions Flashcards

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1
Q

Tx for clotting

- Drug classes + MOAs

A
  1. Antiplatelet: decreases platelet aggregation
  2. Anticoagulant: inhibit the coagulation cascade (blood thinners)
  3. Thrombolytics: post-clot lysis
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2
Q

What drug class does ASA belong to?

A
  1. Antiplatelet DRUG OF CHOICE
    - Blocks thromboxane A2 in degranulation
  2. NSAID
    - Blocks COX-1
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3
Q

Dipyridamole

A

Antiplatelet

- Blocks Thromboxane A2 in degranulation

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4
Q

Clopidogrel

What drug class? MOA? s/e?

A

Antiplatelet
- Blocks ADP in degranulation = decrease in platelet adhesion

s/e: easy bleeding, ulcerations

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5
Q

Heparin-induced thrombocytopenia (HIT)

A

An immune reaction to Heparin-Factor 4, resulting in disseminated coagulation.

Life-threatening:

  • 50% in patients
  • 30% in patients on Heparin X
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6
Q

Dabigatran (Pradaxa)

A

Anticoagulant (PRODRUG)

  • Blocks thrombin receptors + factors
  • *For stroke prevention
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7
Q

Warfarin (Coumadin)

A

Anticoagulant
- Inhibits hepatic formation of PF II, VII, IX, X (antagonizes Vit. K-dependent factors)

PK:
- Long t/12
- High PPB
- Narrow TI**

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8
Q

Alteplase, Reteplase

Describe PK.

A

Thrombolytics: clot lysis

  • Based on Plasmin
  • t1/2: 13-16 min (acute!)
  • IV
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9
Q

Plasmin

A

A protein that degrades fibrin.

  • Endogenously made
  • Part of Thrombolytics drug class
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10
Q

Clinical manifestations of atherosclerosis

A
  1. Narrowing of vessel
  2. Vessel obstruction d/t plaque
  3. Thrombosis
  4. Weakening of vessel wall
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11
Q

What drug class do these belong to?

  • Nitroglycerin (Nitro)
  • Isosorbide
A

Organic nitrates
1ST LINE OF ACUTE CAD/ANGINA

1 SL q5min x 3 doses => CALL EMS IF IT DOESN’T WORK

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12
Q

What is angioplasty (PTCA) used for?

A

Tx for obstruction by CAD

- Opens blocked coronary arteries + cerebral vessels (STENTING)

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13
Q

What is CABG used for?
(Coronary artery bypass graft)

- Describe meds used, candidates

A

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

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14
Q

Pulmonary embolism

- S/S, Dx, Tx

A

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
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15
Q

Thrombus vs Thromboembolism

- List RFs

A

Thrombus: clot
Thromboembolism: migrating clot (usually to deep veins)

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16
Q

Coronary Artery Disease (CAD)

A

the narrowing of coronary arteries d/t atherosclerosis
(50-77% occlusion = Sx)

> > Angina - Stable, Variant, Unstable

Tx: Nitroglycerin

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17
Q

Stable Angina

A

Fixed plaque in coronary arteries that causes intermittent pain, exacerbated with exertion, but relieved with rest

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18
Q

Variant Agina

A

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)
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19
Q

Ischemia

- Describe s/s, effect on body

A

When there is not enough blood flow for adequate oxygenation.

S&S (fast)
- sob, pain, hypoxemia, no contractility

Effect:

  1. Anaerobic metabolism
  2. Injury of myocardial cells (leaks intrinsic enzymes: troponin, CK, myoglobin)
  3. Cellular necrosis onset 20-40 min
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20
Q

Ischemia vs Hypoxemia vs Hypoxia vs Angina

A

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

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21
Q

Myocardial Infarction (MI)

A

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

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22
Q

Unstable Angina

A

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
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23
Q

Antioxidants

- Examples (2)

A

Neutralizes + eliminates ROS by giving up its electron.

  • Supports normal cellular enzyme fx
  • Proanthocyanidins (grape skin), Vit. C
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24
Q

Dyslipidemia

- Name drug classes + MOA

A

Elevated total or LDL cholesterol.

  1. Statins: lower LDL via HMG-CoA reductase inhibition + increasing hepatic metabolism
    * FIRST LINE TX: POST-MI
  2. Fibrates: lower vLDL via increasing lipolysis + metabolism
  3. Niacin: increases HDL via increasing clearance + lowering cholesterol synthesis (liver)
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25
Q

Where is cholesterol endogenously made?

A

Liver

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26
Q

What drug class do these belong to? What do they treat?

  • Lovastatin (Mevacor)
  • Atorvastatin (Lipitor)
  • Simvastatin (Zocor)
  • What are the s/e?
  • Contraindications?
A

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)
27
Q

What are heart healthy fats?

A

Foods that decreases LDLs + increases HDLs

Mono-saturated fats = Oils, nuts, avocados
Poly-unsaturated fats = Corn, soybean, safflower/sunflower, cottonseed oil, fish

28
Q

Saturated

A

Whole milk, butter, cheese, ice cream, red meat, chocolate, coconuts, egg yolks, chicken skin

  • Increases LDL + HDL
29
Q

Trans fat

A

Margarines, shortening, deep fried ships, fast food, commercial baked goods

  • Increases LDL
30
Q

LDL, vLDL, HDL are all ________

A

Lipoproteins (cholesterol transporters) produced by fat + apoproteins

31
Q

Energy source of fat vs carbs/proteins

A

Fat: 9 cal/g

Proteins/carbs: 4 cal/g

32
Q

Nitroglycerin/Isosorbide vs Nipride/Hydralazine

A

SIMILAR MOA

Nitroglycerin/Isosorbide

  • 1st line of acute CAD
  • 1 SL tablet q5min x 3 > EMS

Nipride/Hydralazine: HTN crisis; ER settings

33
Q

What is this lab test: PT/INR?
What is abnormal?

A

Prothrombin time (Warfarin)

34
Q

What is this lab test: aPTT?

A

Activated partial thromboplastin time (Heparin)

35
Q

What do these values hint - CBC, Hgb, Plt, Hct?

A

Bleeding risk

36
Q

Abdominal Aortic Aneurysm

A

distended artery/bulge in the abdominal aorta

  • Monitor for “bruits” (turbulent flow)
  • If it ruptures = hypovolemic shock/systemic bleed
37
Q

Cerebral Aneurysm

A

distended artery/bulge in the cerebral

If ruptured = hemorrhagic CVA = increased ICP

  • Immediately give osmotic diuretics
38
Q

Thoracic Aneurysm

A

distended artery/bulge in the chest

If ruptured = systemic bleed

39
Q

Aortic Dissection

A

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

40
Q

Cardiac Tamponade

A

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

41
Q

Pericardiocentesis

A

Inserting a needle into pericardium to withdraw blood

42
Q

Pericarditis

How to relieve pain?

A

Inflammation of the pericardium
Acute = pericardial effusion / cardiac tamponade
Chronic = Pericardium hardens&raquo_space; higher pressure on ventricles&raquo_space; low CO

Sx:
1. Pleuritic pain (sharp) on inhalation + coughing
2. Pleuritic friction rub (scratchy/squeaky sound)

  • Relieve by SITTING UP + LEANING FORWARD
43
Q

Endocarditis

A

Inflammation inside the myocardium chambers d/t infectious organisms commonly from dirty needles + dental visits
= heart valve dyfx&raquo_space; low CO

Sx: flu-like, emboli, heart murmur. arthritic pain

44
Q

Peripheral Artery Disease

A

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
45
Q

Chronic Venous Insufficiency

A

Incompetent venous valves = retrograde BF = varicose veins (d/t venous HTN) = edema/ulceration

  • Edema
  • Reddish-brown discoloration
  • Leathery, thick skin
  • Ulcers
    mostly in calves
46
Q

DVT

A

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

47
Q

Considerations for Orthostatic Hypotension
Abnormal parameters?

A

Positional BP = 2-5 min in between
Notify HCP if difference in…
- SBP >20 mmHg
- DBP > 10 mmHg

48
Q

Metabolic Syndrome

A

When 3 or more metabolic health factors are present that increases the risk for T2DM + CVD

  1. Waist circumference
  2. Triglyceride increase
  3. BP increase
  4. HDL decrease
  5. Glucose increase (abdominal obesity = insulin resistance)
49
Q

General presentation of shocks

A
  • Poor BF/perfusion
  • Low O2 delivery
  • Cold, clammy skin
50
Q

Left-sided Heart Failure

A

When the heart’s CO is unable to meet metabolic demands

LS = pulmonary congestion
» crackles, dyspnea, pink frothy sputum

51
Q

Right-sided HF

A

When the heart’s CO is unable to meet metabolic demands.

RS = peripheral congestion
» ascites, peripheral edema, hepatomegaly

52
Q

BNP

A

Hormone that is released during HF when the heart is stretched abnormally much

53
Q

What does an echocardiogram do?

A

Measures EF (% of blood leaving the heart w/ each contraction)

54
Q

Systolic HF

A

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)

55
Q

Diastolic HF

A

When the heart’s CO is unable to meet metabolic demands.

Diastolic = R ventricle muscle thickens&raquo_space; ineffective pumping (HF w/ PRESEVERED EF)

56
Q

Hypovolemic shock

A

Large intravascular volume loss

Body reacts with overall vasoconstriction.

Tx: Give blood (hemorrhagic) or fluids (dehydration)

57
Q

Cardiogenic shock

A

Inability for the heart muscle to contract.
- Strength and frequency of contraction is insufficient

58
Q

Septic Shock

A

Widespread infection from Gram -/+ bacteria that causes vasodilation&raquo_space; increased cap permeability&raquo_space; altered BF

*Persistent hypotension despite fluid resuscitation

59
Q

Transfusion-Associated Circulatory Overload (TACO)

A

Blood transfusion reaction d/t rapid rate + large volume.

  1. Stop transfusion
  2. High fowlers
  3. Diuretics
60
Q

Kawasaki Disease

A

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

61
Q

Marfan Syndrome

A

PEDS
Aortopathy or Autosomal dominant genetic disorder that causes general weakness to CT

  1. Ocular = myopia, decreased visual acuity
  2. Skeletal = thin, long limbs and physique/double jointed/scoliosis
  3. CV - weak, dilated aorta and leaky valves
62
Q

Tetraology of Fallot (TOF)

A

PEDS
Cyanotic congenital heart defect categorized by 4 defects.

  1. VSD
  2. Pulmonary stenosis
  3. Overriding aorta
  4. Right ventricle hypertrophy
  • “TRouBLe” = blood shunts R&raquo_space; L + cyanotic (“tet spells”)
63
Q

Murmur

A

Abnormal heart valves that causes aggressive shunting/turbulent BF through valves or heart

64
Q

Femoral cardiac catherization precautions

A
  • Remain supine w/ HOB at 30
  • NO HIP FLEXION to avoid disrupting clot formation

NCLEX (19 decks)

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