Cardiac interactive lecture Flashcards
what are 6 subjective s/s of heart issue
chest pain/coughing (water retention)
dyspnea
palpitations
syncope - rapid drop in HR/BP
weight gain/edema (pitting)
paroxysmal nocturnal dyspnea (PND)
what is paroxysmal nocturnal dyspnea
SOB after 1-2 hrs of sleep relieved by sitting up typically
what is syncope
orthostatic hypotension of changes in 20-30 mmHg in BP
acute drop in BP/HR
objective s/s of heart issue
BP -> JVD
chest shape/sounds
HR/pulses
extremities
what is precordial movement
point of maximal pulse visible in intercostal space 5 midclavicular line
functions of cholesterol
cell membranes
vit. D formation
hormones
bile acids for digesting fat
energy
what is healthy amount of total cholesterol
less than 200
what is healthy amount of LDL
less than 100
what is healthy amount of HDL
greater than 60
what is bad amount of total cholesterol
above 240
what is bad amount of LDL
above 160
what is bad amount of HDL
greater than 40-50 depends on F/M
function of triglycerides
energy used between meals
what is good amount of triglycerides
around 150
what is bad amount of triglycerides
above 200
where are triglycerides found in
fatty foods
refined foods
simple sugar foods
alcohol
things to change to lower triglycerides
exercise
avoid sugars/refined carbs
lose weight
limit alcohol
significance of C-reactive protein
liver produced when inflammation in body or infection/injury
good amount of C-reactive protein and bad
less than 1mg/L good and
more than 3 mg/L bad
what does fasting lipoprotein profile test do and how to do it
tests total cholesterol, HDL, LDL, triglycerides
after fasting for 9-12 hours blood test
what is the 1st cardiac enzyme to test and what’s the normal level
troponin less than 0.04
released from myocardium injury
hx of heart issue <3 pt lives with high troponin
how frequently are troponin levels tested
q6hrs
what does Creatinine kinase - MB test and normal level
enzyme found when there damage to the heart
less than 5% is ideal
what does myoglobin test
damage to skeletal muscle tissue but not specific to the heart
how does WBC change based on heart issues
inflammation - pericarditis, myocarditis, endocarditis
so increase in WBC (4,500 - 11,000)
how does RBC change based on heart issues
increase in dehydration (HCT)
increase in decreased tissue perfusion
decreased in anemia
decrease in rheumatic heart dx, endocarditis
electrolytes that are related to cardiac
K, Ca &P , Mg
hyperkalemia causes
increase width of QRS asystole -> MI
hypokalemia
digoxin toxicity
normal potassium level
3.5-5.3
hypercalcemia
hypocalcemia
hyper: prolonged QT, dysrhythmias
hypo: AV blocks, cardiac arrest
hypermagnesium
hypomagensium
hyper: bradycardia, low BP, weakness
hypo: pts going through withdrawl, drinks alcohol regularly
ventricular tachycardia, V.fib, lots of arrhythmias
prothrombin time normals
10-15s normal
25-30s increased bleed
international normalized ration
normals
for high risk of clots
uses typically
1.0
2.5-3.5 for those at risk for clots, they’ll bleed easier
used for warfarin (Coumadin)
normal PTT, APTT time
when is it used
how often taken
PTT: 25-35secs normal; 60-70secs increased bleed
APTT: 30-40 secs
used when pt on heparin, lovenox, enoxaparin
q6hrs
what to monitor and do during invasive catheter insertion/stent procedure
cath lab w/ mostly radial access or femoral,
dye infusion - warm hot flush feeling
monitor dysrhythmias, vitals, pain
what to monitor post surg
re-occlusion, pain, position
5 P’s - pain, pallor, pulse, paresthesia, paralysis
where to find all the valves when auscultating
aortic 2nd right
pulmonary 2nd left
tricuspid 4th left
mitral 5th left
equation for CO
CO = SV (stroke volume) x HR
SV typically sound using ultrasound
what does CVP (central venous pressure) measure
if too much blood going into heart which is bad
what does PAWP (pulmonary artery wedge pressure) measure
edema
what does cardiac index tell you
how much blood pumped per min
purpose of ADH vs. Aldosterone
ADH - hold fluids
Aldosterone - hold Na & H2O, release K
purpose of ANP & BNP
released by heart to decrease BP
increases Na & H2O output
increase vasodilation
what is considered sustained hypertension
over 140/90
normal BP
120/80
elevated BP
120-139 over
80-90
HTN stage 1
140-159 over
90-99
HTN stage 2
160+ over
100+
hyypertensive crisis number
180+ over
110+
what is the first sign of hypertension
headache
complications HTN can lead to
MI/stroke
aneurysm
HF
weakened/narrowed vessels in kidneys
messed up optical blood vessels
metabolic syndrome
what is metabolic syndrome
HTN, obesity, increased unhealthy lipids, diabetes
the more it checks off the higher chance of dying
equation for BP
BP = CO x SVR (systemic vascular resistance)
what does essential/idiopathic hypertension mean
no known cause
primary hypertension
what is primary HTN at risk for
CAD, stroke
how often to check BP for hypertensive crisis
q 2-3 mins
what medications to give for hypertensive crisis
vasodilators:
nitroprusside, nitroglycerin, hydralazine
labetalol
what are modifiable factors that increases chance of CAD
smoking, diet, diabetes, metabolic syndrome, stress
use of stimulants like cocaine or amphetamines that increase BP rapidly
what meds to give for those at risk of CAD
81mg/day aspirin
Plavix if aspirin not tolerated
what is given for blood clot (thrombus)
IV TPA within 6 hrs of onset symptoms
ideally within 30mins at ER
S/S of PVD
warm legs
edema
irregularly shaped sores
dull pain NOT sharp
yellow/brown ankles
S/S of PAD
absent pulse, no leg hair/shinny
round, red sores
toes and feet pale or with black eschar
sharp pain in calves
causes for aneurysms
atherosclerosis, trauma, congenital
when is surgery considered for aneurysms
if greater than 5cm in diameter or 0.5cm growth/yr
most common type of aneurysm
AAA
abdominal
infrarenal vs. pseudoaneurysm in abdomin
infrarenal: below kidneys
pseudoaneurysm: enlargement of outer layer caused by prior surgery or trauma
dissection aneurysm
tearing of new false lumen along aorta blood vessel wall
fusiform vs. saccular aneurysm
fusiform: all around vessel
saccular: pouch like bulge on side
infrarenal/suprarenal/juxtarenal meaning
infra: below kidneys
supra: above kidneys
juxtarenal: arteries in kidneys
S/S of AAA
often none
back/epigastric pain, pulsatile mass @ umbilicus, cardiovascular collapse, hypotension/shock, weak pulses, N&V, hoarseness
S/S of aneurysm rupture
sudden intense abdominal/back pain with “tearing” sensation
tachycardia with hypotension
what test to use for finding aneurysm
CT with contrast to see location, false lumens, dissections, and size
treatment of aneurysm
endovascular grafting (EVAR) similar to stent
Allen’s test
make first so blood flow out of hands
press on arteries on wrist
open fist to assess blood flow
what does HTN leads to?
AABC acronym
A: atherosclerosis
A: aneurysms
B: broken kidneys, eyes, & heart
C: clots: PE, CVA, MI
what can cause HTN?
SODA:
S - stress, sedentary lifestyle, stimulants
O: obesity, oral contraceptives
D: diet in high Na & cholesterol; Diabetes, HF, Hyperlipidemia
A: african men & age over 50
first symptoms for hypertension
ABC
A: achy head
B: blurred vision (retinopathy)
C: chest pain (angina)
hypertensive urgency vs. hypertensive crisis
urgency if BP over 180/120
crisis if BP is high as well as end organ damage
what are the steps to treat HTN urgency/crisis
BCDE:
B - beta blockers
C - CCBs
D - dilators i.e. nitroglycerin
E - transfer from ER to ICU
Tests for PAD or PVD
doppler ultrasound
D-dimer test (0.5< clot)
raise toe & if pain in calf could mean clot
ABI pressure between arm and leg (1> bad)
elevate or put down legs between PAD vs. PVD
PAD is leg down
PVD is elevated legs
what is sharp pain in calf from PAD called
intermittent claudication unrelieved at rest
most important symptoms to address with PAD/PVD
pain & paresthesia could mean decreased circulation & O2
what’s the condition called when a pt goes under anesthesia and reacts to it that causes HTN and can result in death
malignant hypertension
