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Critical Care week 1 > Cardiac Disease States > Flashcards

Cardiac Disease States Flashcards

1
Q

What is coronary artery disease?

A

Vessels become clogged with plaque reducing blood flow to heart

“Atherosclerosis”

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2
Q

What are nonmodifiable CAD risk factors?

A

Age
Gender
Race
Family hx

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3
Q

What are modifiable CAD risk factors?

A

Anything people did to themselves

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4
Q

Is plaque regression possible?

A

Yes, with change in modifiable risk factors

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5
Q

What are symptoms of acute coronary syndrome?

A

Angina!

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6
Q

What is angina caused by?

A

lack of oxygen causes myocardial ischemia which is felt as chest pain

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7
Q

What is stable angina?

A

predictable.

Fixed lesions

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8
Q

What is unstable angina?

A

Change in previously established pattern.

Indication of plaque instability

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9
Q

What patients don’t have traditional angina patterns?

A

Females
Elderly
Diabetics

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10
Q

What signs do females exhibit with angina?

A

nausea
fatigue
neck pain

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11
Q

What signs do elderly and diabetics exhibit with angina?

A

weakness and nausea

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12
Q

If there is ST elevation on the EKG, what does that mean?

A

infarction happening

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13
Q

If there is depression or t-wave inversion on EKG, what does that mean?

A

myocardial ischemia

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14
Q

What are nursing management of CAD and angina?

A

Recognize myocardial ischemia

Controlling chest pain

Maintain calm environment

Educate

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15
Q

How is chest pain assessed?

A 
Pain - intensity, location, duration
Quality
Radiation
Severity
Time
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16
Q

What leads are we looking at when evaluating 12 lead?

A

2, 3, AVF

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17
Q

If there is no ST elevation, how do we treat?

A

pharmacologically

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18
Q

How is chest pain treated?

A

MONA

Oxygen to get O2 sats in the 90s
Aspirin (anti platelet) Chew 325mg
Nitroglycerin (vasodilator)
Morphine (pain, relaxation,

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19
Q

When can nitro NOT be given?

A

Blood pressure <100 systolic
HR <60 or >100
Use of PDE5 (ed, revaito, pulm art HTN drugs)
R ventricle wall infarct (ST elevation on EKG)

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20
Q

What is myocardial infarction?

A

irreversible necrosis due to abrupt decrease or total cessation of coronary blood flow

plaque has ruptured
new coronary artery thrombosis
coronary artery spasm close to ruptured plaque

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21
Q

What measurements on EKG indicate infarction?

A

ST elevation >1 mm in 2+ continuous leads

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22
Q

If Q-waves are present, what does that indicate?

A

previously healed infarction.

electricity trying to go through damaged part of heart.

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23
Q

If nitro does not control pain, what is the next step?

A

Morphine 2-4mg q 20-30 min

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24
Q

Why do we use morphine with MI?

A

controls pain
vasodilation properties
anxiolitic

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25
Q

What is a main side effect of nitro?

A

headache

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26
Q

What cardiac biomarkers are we looking for with labs?

A

CK/MB relative index

Troponin I

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27
Q

What does CKMB look for?

A

if elevated ratio of CKMB damage, that means portion of heart has died

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28
Q

If CK is elevated, but not CKMB, what does that mean?

A

Muscle has died, but not heart muscle

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29
Q

If Troponin I is elevated, it means….

A

heart muscle damaged

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30
Q

Why do we do 2 different cardiac enzyme tests?

A

CPKMB reaches peak in 12 hours

Troponin reaches peak in 30 hours

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31
Q

What is the pharmacological treatment for AMI?

A

Fibrinolytics (clot buster.

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32
Q

What drugs are fibrinolytic?

A

Streptokinase

Alteplase

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33
Q

What do we watch for in patients on fibrinolytic?

A

bleeding

LOC changes for head bleed

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34
Q

What contraindications to taking fibrinolytic?

A

Surgery or trauma in last 6 weeks
Pregnancy or postpartum
Therapeutic on blood thinner

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35
Q

What are required before fibrinolytics can be given?

A

adequately controlled blood pressure and blood sugar

ST elevation or enzymes definitive of MI

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36
Q

When onset of symptoms of cardiac arrest are sudden, the most likely mechanism of death is

A

VTach which degenerates into VFib

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37
Q

What is therapeutic hypothermia?

A

Patient cooled off for 24-48 hours that will prevent a lot of brain damage

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38
Q

What is heart failure?

A

Heart cannot pump blood at a volume required to meet the body’s needs

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39
Q

What can cause heart failure?

A

Any condition that impairs the ability of ventricles to fill or eject blood

40
Q

What are the most frequent causes of heart failure?

A

Coronary heart disease
and
MI (myocardial infarction)

41
Q

What is class 1 heart failure?

A

Clean house, take bath, all is fine. They mow lawn, they get symptoms

42
Q

What is class 2 heart failure?

A

Normal ADL’s cause symptoms, but subside with rest

43
Q

What is class 3 heart failure?

A

Any activity causes symptoms, but if they are sitting, they’re fine.

44
Q

What is class 4 heart failure?

A

Any type of activity initiates symptoms, and symptoms are present at rest.

45
Q

How is heart failure evaluated?

A

Asking how many pillows they sleep on (orthopnea).

46
Q

If the LEFT side of the heart is not pumping forward, the blood is backing up into the ___

A

lungs

47
Q

What are some signs/symptoms of LEFT sided heart failure?

A 
Tachypnea
Tachycardia
Cough
Crackles
Gallop rhythms (S3 S4)
Increases PAP
Hemoptysis
Cyanosis
Pulmonary edema
SYMPTOMS
Fatigue
Dyspnea
Orthopnea
Paroxysmal nocturnal dyspnea

ALL LUNG RELATED

48
Q

If the RIGHT side of the heart is not pumping forward, the blood is backing up into ___

A

the body

49
Q

What are signs/symptoms of RIGHT sided heart failure?

A 
Peripheral edema
Hepatomegaly
Splenomegaly
Hepatojugular reflux
Ascites
JVD
Increased CVP
Pulmonary hypertension
SYMPTOMS
Weak
Anorexic
Indigestion
Weight gain
Mental changes

PRETTY MUCH ALL RELATED TO SWELLING OF SOME SORT

50
Q

What is systolic heart failure?

A

Decreased contractility of left ventricle

systolic=problem with squeeze

51
Q

What is diastolic heart failure?

A

Decreased relaxation, stretching, or filling of left ventricle during diastole

diastolic= problem with relaxation

52
Q

What is acute heart failure?

A

Sudden onset

Body cannot compensate

Occurs immediately after MI

53
Q

What is chronic heart failure?

A

Ongoing syndrome.

Body has had this for so long that it compensates

Can deteriorate into acute heart failure

54
Q

What is acute-on-chronic heart failure?

A

People not taking care of heart failure.

People with chronic HF go and eat a ton of salt, that ends up causing acute heart failure.

55
Q

What drug class is given to HF patients?

A

ACE inhibitors or ARBS

helps circumvent the RAAS response

56
Q

What is cardiomyopathy?

A

Disease/disorder of the heart muscle

57
Q

What are the three kinds of cardiomyopathy?

A

Hypertrophic
Restrictive
Dilated

58
Q

Why is the left ventricle of the heart more muscular than the right?

A

pumping harder and pumping more blood

59
Q

What happens in dilated cardiomyopathy?

A

Gross dilation of both ventricles without hypertrophy

Happens a few ways:
Ischemic (chronic ACS, muscle thins out)
Familial (genetic)
Acquired (connective tissue disorders, lupus, scleroderma, infection or disease)

60
Q

What is restrictive cardiomyopathy?

A

Ventricular wall rigidity d/t myocardial fibrosis.

Muscle is bigger, but with disordered healing.

Big and thick, but cannot expand/stretch/contract

S4

61
Q

What is hypertrophic cardiomyopathy?

A

Left ventricle becomes stiff, noncompliant and hypertrophied

genetic

Heart working so hard, muscle bulks up and blood cannot move.

62
Q

What is ejection fraction?

A

percentage of blood in heart ejected with each contraction

63
Q

What is normal ejection fraction?

A

60% - 65%

64
Q

What is normal stroke volume

A

60-150ml per stroke

65
Q

Anyone with an ejection fraction below ___ is considered to be in heart failure

A

50%

66
Q

Anyone with an ejection fraction below ____ is eligible for a heart transplant

A

15%

67
Q

What is the treatment for cardiomyopathy?

A

Positive inotropes

Control blood pressure

Heart transplant (when med mgmt fails)

68
Q

What is valvular heart disease?

A

Structural and/or functional abnormalities of single or multiple cardiac valves.

Results in blood flow alteration across valves.

69
Q

What is stenotic heart disease?

A

Restricts flow through it

70
Q

What is regurgitant heart disease?

A

Does not fully close so blood flows backwards during contraction

71
Q

We see stenosis the most in the

A

aortic valve
then
mitral valve
(both left side)

72
Q

If there is aortic stenosis, what symptoms?

A

They cannot respond to increasing demand because blood has to go through smaller hole.

73
Q

What is valve incompetency?

A

Valve does not close, regurgitation ensues.

Seen most in mitral valve

74
Q

What are causes for heart valve problems?

A 
Rheumatic fever
Degenerative valve changes (with age)
Infective endocarditis 
Inborn congenital defects
Dysfunctions/ruptures of papillary muscle (after MI)
75
Q

Medical management of valvular disease?

A

Fluid restriction
Positive inotrope

surgery is last resort

76
Q

What do we assess for when assessing a patient with valvular disease?

A

heart failure

77
Q

What do we teach patient with valvular disease?

A 
S/sx of heart failure.
Watch for weight gain. 
Loss of energy
Shortness of breath
Fluid balance
78
Q

If a patient has heart valve problem and need to go to dentist, what do we teach?

A

Make sure you see your doctor and get antibiotics before any treatment

79
Q

What is endocarditis?

A

Infection transmitted to heart. Infection on inner lining of heart

80
Q

What are signs/symptoms of endocarditis?

A

Osler nodes (painful sores on hands/feet)

Fever/chills

New heart murmur or current murmur will change/get worse

Dyspnea, pallor, SOB

Petechiae

81
Q

Endocarditis is most common in people with ___ problems or ___

A

heart valve

murmurs

82
Q

What are common causes for endocarditis?

A

dental work/dental hygiene issues

tooth/mouth infection

tattoos/piercings

83
Q

What are complications of endocarditis?

A

Bacteria and cell fragments form clumps in bloodstream that cause valvular insufficiency

Heart tissue swells

Valve insufficiency and swollen linings increase heart failure

Clumps can block blood flow to organs

84
Q

What is nursing intervention for endocarditis?

A

Monitor:
S/s worsening infection
Heart failure
emboli

Give pain meds/pain mgmt

Teach: home abx therapy
possible cardiac rehab

85
Q

What is myocarditis?

A

Inflammation of middle wall of heart (myocardium)

86
Q

What is myocarditis caused by?

A

usually a viral infection

87
Q

What happens in myocarditis?

A

Pain

Reduced filling/pumping ability - can cause clot d/t pooling

88
Q

What will you hear in myocarditis?

A

Friction rub

89
Q

What are s/sx of myocarditis?

A

Chest pain
fluid retention
SOB
fatigue

90
Q

What are causes of myocarditis?

A 
Viral infection
Bacterial infection
Parasite infection (foreign travel)
Allergic drug rxn
Cocaine
Meth
Connective tissue disorders (Lupus, scleroderma, etc...)
91
Q

What are complications of myocarditis?

A

Heart failure

Blood pooling (heart attack, stroke, blood clots)

Arrhythmias

Sudden cardiac death

92
Q

Nursing intervention for myocarditis?

A

Monitor:
worsening infection
heart failure
emboli

Manage:
pain

Begin d/c planning
home IV
possible cardiac rehab

93
Q

What is malignant HTN?

A

Dramatic increase in BP that it becomes life-threatening

94
Q

What do calcium channel blockers do?

A

Relax smooth muscle and allow vasculature to provide less back pressure

95
Q

What does beta blocker do?

A

reduces force of contraction in heart rate

careful giving to people with reactive airway disease d/t beta 2 in lungs - cardioselective/non-selective. drugs

96
Q

What are the two main classes of drugs they use for malignant HTN?

A

beta blocker

calcium channel blocker

Critical Care week 1 (6 decks)

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