Cardiac Lecture Flashcards
a condition that occurs when blood blow is decreased or blocked in the heart
acute coronary syndrome
what is the objective for acute coronary syndrome
decrease O2 demand and increase O2 supply
death or necrosis of myocardial cells caused by blood flow blockage
myocardial infarction
what are the 2 problems that occur in an MI
STEMI or NSTEMI
non occlusive blockage, is a block but not 100% blocked
non STEMI
100% occlusion of an artery
STEMI
which pt should be seen first a STEMI or NSTEMI
STEMI
*emergent and intervention with in 90 minutes or mortality goes up
damage in the heart starts from ______ to the ______ and after ___ minutes you have to many cells that have died
inside; outside; 90
what happens to the necrotic tissue of the heart once it has died
replaced with scar tissue
*hypoxia begins in 10 seconds and damage occurs 20 minutes of O2 deprivation
what are cardinal symptoms of an MI
chest pain elevated blood glucose N/V diaphoresis increased HR/BP S3/S4 heart sounds peripheral vasoconstriction fever SOB dizziness altered mental status dysrhythmias pulmonary edema
how is an MI diagnosed
elevated cardiac enzymes PLUS
typical symptoms
ST segment changes
HX of cardiac intervention
alternate circulation around a blocked artery or vein via another route
collateral circulation
*develops in response to prolonged coronary artery disease or even with old age because as we age new routes are created and build new arteries
what lab is SPECIFIC to cardiac
troponin T or I
what level do you WANT to see on a troponin
non existent. 0 will make us happy
anything above that is a red flag
why is troponin lab preferred
it tells me that there is a CARDIAC injury or ischemia
what does the lab creatine kinase tell me
there is muscle injury somewhere just not sure where
*it is NOT cardiac specific
what does the lab myoglobin tell me
tells us there is cardiac injury but will NOT tell me if there is ischemia
what is the treatment for an MI
REPERFUSION
*give meds that dissolve the clot (thrombolytic therapy)
then if that doesn’t work they will go to cath lab then if that doesn’t work then they will go for cardiac bypass (most invasive)
if your pt complains of chest pain what do you do
assess and figure out whats wrong get an EKG IV access draw labs most important initiate MONA *if there is an ST elevation send to cathlab
if pt is getting sent to cath lab what should we do to prepare pt
portable cardiac monitor, O2, ambu bag
result of pump failure
cardiogenic shock
*decrease cardiac output leads to decreased oxygenated nutrients to the tissues leads to initiation of the shock syndrome
what is the most common cause of cardiogenic shock
acute MI
what else could cause cardiogenic shock
blunt injury to heart, heart failure, dysrhythmia, any abnormality to the heart
what manifestations would we expect to see in cardiogenic shock
pale, diaphoretic, clammy skin, tachycardia at start then bradycardia, crackles in lungs, altered mental status, lightheadedness
why is fluid detrimental to cardiogenic shock pt
because there heart is not pumping well so adding more fluid will just overload them with fluid
only give ______ inotropic drugs to the cardiogenic shock pt
positive
*norepinephrine shunts blood where its needed so keep an eye on peripheries
*dopamine increased heart contractility to get every drop of blood with every pump
will see pt’s with both of these drips going at the same time
if pt is having a massive MI throwing them into cardiogenic shock we want to make sure they don’t have an ______ and want to ____ it up so these pt will be on anticoagulants, anti platelets, and GP IIb/IIa inhibitors
occlusion; break
how does TPA work
pt has a clot and binds to fibrinogen killing the clot
*antidote is amniocarbacid
in a code blue what are the steps
check for responsiveness
call for help
start CPR
*person who found the person is the “leader”
what is important to tell the pt who had an MI
it is normal that you don’t want to eat and that you feel fatigues
rest is so important
avoid red meats, salty foods, fried foods
quit smoking
diet and meds are important
if the blockage can not be fixed by anything the last resort is
cardiac bypass
a pt post of of cardiac bypass will have chest tubes and what kind of blood will be draining immediately after surgery
frank blood
what type of blood should be draining an hour after cardiac bypass
serosanguinous >1 hr post op
drainage after cardiac bypass should not be more than
100ml/hr
what should be done if chest tube disconnects from set up or breaks
put in sterile water to keep pressure from building in cavity
if chest tube is pulled out what should be done
cover puncture site with NON occlusive dressing to allow air to escape (when in doubt)
if a blood transfusion is needed because of major surgery it should be started within ___ minutes and infused within __ hours
30 min; 4hrs
RBC transfusion is a
2 nurse check
*consent is necessary
when giving a RBC transfusion what should be infusing with it
normal saline
*help to keep line patent
when should vital signs be taken BEFORE blood transfusion
30 minutes before (also get vitals after transfusion)
*remain with the patient for the first 15 minutes of transfusion
when an artery wall weakens causing it to widen abnormally or balloon out
aneurysm
what are S/S of a non ruptured aneurysm
abd, back, or flank pain
pulsating abd
pain or discoloration in the feet
what are S/S of a ruptured aneurysm
severe pain
hypotension (bleeding out)
pulsatile abd mass
*medical emergency
aorta tears and blood flows between the artery layers
aortic dissection
- type A- affects the ascending aorta and arch
- type B- begins in the descending aorta
what would you expect to see with an aortic dissection at the aortic arch
altered mental status
what would you expect to see with an aortic dissection at the kidney level
back pain, decreased urine output
what would you expect to see with an aortic dissection at the ‘Y’ before the legs
pale legs, decreased pulses
how can we evaluate for a dissection
MRI, CT, TEE
how can we manage or treat a dissection
surgery, BP meds
a pericardial effusion extends the sac beyond its limits
cardiac tamponade
what would be expected to see in a pt with cardiac tamponade
HR will increase to overcome, go into dysrhythmia, hypotension, anxious, chest pain
