Cardiac Emergencies Flashcards
When traditional therapies of oxygen, nitrates, lasix and morphine prove unsuccessful in treating congestive heart failure, what other non-invasive technique may be added to the treatment regimen?
CPAP (continuous positive airway pressure) or BiPAP
How does intravenous nitroglycerin work to improve ischemic chest pain?
Directly vasodilates the systemic and coronary blood vessels to improve blood flow
What can be administered to a patient suffering from a right ventricular myocardial infarction to increase central venous pressure?
Intravenous fluid bolus
What is the standard anti-platelet medication used in acute coronary syndrome?
Aspirin
Where does the tip of a transvenous temporary pacer terminate?
Right ventricle
Why is it imperative to correct rapid ventricular rate in patients with anomalies of the mitral valve?
Susceptibility to congestive heart failure
What is the relationship between the QRS complex and ejection fraction?
The greater the width of the QRS complex the lower the ejection fraction
How is a non-ST elevation myocardial infarction diagnosed?
Elevation of serum cardiac enzymes
How does nitroglycerin achieve decreasing myocardial oxygen demand?
By reducing preload and afterload
Why are patients with atrial fibrillation or flutter with a rapid ventricular response often hypotensive?
Decreased atrial kick and cardiac output
A septal wall acute myocardial infarction (AMI) will show ST segment elevation in what leads?
V1 and V2
What is the proper needle placement for pericardiocentesis?
Insert the needle at the left costal arch and advance towards the tip of the left shoulder or directly cephalad
When attempting to treat malignant hypertension, what is the target when reducing the blood pressure?
20-25% of the mean arterial pressure or diastolic blood pressure of 100-110mmHg
What are the three signs of Beck’s triad for identification of cardiac tamponade?
Hypotension, jugular venous distention, and muffled heart tones
What are the definition and equation that represent cardiac output?
Amount of blood pumped by the heart in one minute: CO (cardiac output) = SV (stroke volume) x HR (heart rate)
Why are nitrates and opioids used with caution in patients with right ventricular infarction?
Nitrates and opioids will reduce preload which will ultimately diminish pulmonary perfusion and left sided cardiac output thus dropping blood pressure.
How does the lead placement vary in a right-sided EKG?
The precordial leads are placed in a mirrored position on the right sided of the chest rather then the left
How do beta blockers decrease myocardial oxygen demand?
By decreasing heart rate and contractility
Transportation of what device involves monitoring for complications such as limb ischemia, infection, thrombus formation, arterial damage and malpositioning of the balloon?
Intraaortic balloon pump (IABP)
The method of mechanically restoring perfusion to blocked or constricted coronary arteries is known as?
Percutaneous transluminal coronary angioplasty (PTCA)
What additional findings do women present with to make their presentation of acute coronary syndrome differ from that of men?
Indigestion, dizziness, nausea, vomiting, discomfort between the shoulder blades, sense of impending doom, unexplained fatigue
A patient who displays diminished femoral pulses with hypotension should pose a high index of suspicion for what?
Abdominal aortic aneurysm
If cardiogenic shock stems from the right side of the heart, what medications do you want to avoid and why?
Medications that reduce preload such as diuretics, morphine and nitroglycerin since they will cause further hypotension
When attempting to delineate between cardiac emergencies, your history and physical exam reveals recent chest pain that improves while leaning forward and a pericardial friction rub on auscultation. Which cardiac emergency do you believe the patient is suffering from?
Pericarditis
Where is the infarction if ST segment elevation occurs in Leads II, III, and AVF?
Inferior wall
Tall or peaked T waves on an electrocardiogram are indicative of what electrolyte imbalance?
Hyperkalemia (elevated potassium)
Patients with congestive heart failure will exhibit what changes in central venous pressure(CVP) and systemic vascular resistance (SVR)?
Increased
What does an imbalance between myocardial oxygen supply and demand cause?
Myocardial ischemia and eventually infarction if not corrected
During what portion of the cardiac cycle does the intraaortic balloon pump (IABP) inflate?
Diastole
What is the major difference between aortic dissection and aortic aneurysm?
Aortic dissection causes bleeding where a false lumen is created between the layers of the vessel whereas an aneurysm tears through all three layers of the lumen and bleeds into the thoracic or abdominal cavity
