Cardiac, Pulm HTN, PE

Question 1

If you have Cor Pulmonale, a primary cause includes:

Answer 1

Primary Pulmonary HTN
Pulmonary Embolism
ARDS

Question 2

If a patient has valvular heart disease, the best way to observe this is with this test:

Answer 2

Echocardiography

Question 3

There’s two types of echocardiography. What are they and which one is preferred?

Answer 3

Transthoracic (TTE) (preferred)

Transesophageal (TEE)

Question 4

Treatment for patients with valve problems in the ICU includes ___ to treat ___.

Answer 4

Antibiotics to treat endocarditis

Question 5

For pericardial diseases, why would you want to do an ECG?

Answer 5

To identify pericardial tampinade

Question 6

Treat pericardial disease with ___ and this class of drugs.

Answer 6

Indomethacin and steroids

Question 7

For unexplained heart failure, this test is essential.

Answer 7

Echocardography

Question 8

What’s the treatment for pericardial effusion and cardiac tamponade? x4

Answer 8

Aggressive fluid resuscitation
Inotropics (Dobutamine, dopamine, isoproterenol, norepinephrine)
Percutaneous pericardiocentesis (Primary treatment)
Pericardial window done surgically

Question 9

How do you treat acute HTN?

Answer 9

Nitroprusside

Beta-blockers

Question 10

How high is Mean Pulmonary Arterial Pressure (MPAP) normally? How high is it when it’s Pulmonary HTN?

Answer 10

Normal is 14

Pulmonary HTN is greater than 25

Question 11

What is usually the cause of pulmonary hypertension?

Answer 11

Abnormalities of the pulmonary vasculature

Question 12

In cases of pulmonary HTN, what can give you information about internal pressures inside the heart?

Answer 12

A Swan-Ganz

Question 13

Describe vasodilator response testing when done in a pulmonary HTN patient.

Answer 13

Give a short-acting drug (Adenosine, iNO, or floLan)
MPAP should decrease by 10.
If no change, long term treatment is calcium channel blocker.

Question 14

What’s the treatment for pulmonary HTN?

What if the pt has COPD too?

Answer 14

Oxygen (Vasodilates pulm arteries)
Neutral fluid balance
Give Flo-Lan or iNO
Give oral vasodilators like Sildenafil (Viagra)
If hemodynamically unstable give Dobutamine
With COPD, give Digoxin.

Question 15

What are four things you need to remember about mechanical ventilation on a patient with pulmonary HTN?

Answer 15

Pos Pressure ventilation causes complex hemodynamic effects.
Right ventricular afterload increases
Right ventricular preload decreases
PEEP increases PAP and PVR
Avoid Permissive Hypercapnea

Question 16

The most common abnormality after a pulmonary embolism is ___. (Seen on EKG)

Answer 16

Anterior Twave inversion

Question 17

What test is done to diagnose a PE?

If unstable, you can use this instead:

Answer 17

Spiral CT

Echocardiogram

Question 18

When a patient has a PE, you have to break up the primary offending clot and stop more clots from occurring. To stop more clots, give these two drugs. Also this device can help.

Answer 18

Low Molecular Weight Heparin (Stop more clots)

Warfarin (Stop more clots)

Question 19

When a patient has a PE, you have to break up the primary offending clot and stop more clots from occurring. To break up existing clots, give these two drugs:

Answer 19

tPA (Tissue Plasminogen Activator)

Steptokinase

Question 20

If a patient has a PE and you can’t give heparin (like if they had a stroke or trauma), use this:

Answer 20

Inferior Vena Cava Filter (IVCF)

Question 21

What is the foundation treatment for R heart failure?

Answer 21

ACE inhibitors

Question 22

These findings on an EKG may indicate pulmonary hypertension: (x3)

Answer 22

R axis deviation
Large P wave
Right ventricular hypertrophy

Question 23

This finding on an EKG suggests PE:

Answer 23

Anterior T-wave inversion