Cardiac Review part 3 Flashcards
Hypertensive emergency
elevated BP with evidence of end organ damage (needs critical care admission)
greatest risk is STROKE
hypertensive urgency
elevated BP without evidence of end organ damage (no Critical care admission)
treatment of hypertensive emergency includes:
nitroprusside (Nipride) - preload and afterload reducer; assess for cyanide toxicity (mental status changes, tachy, seizure, metabolic acidosis)
labetolol (300 mg max)
Peripheral Artery Disease (PAD) signs and symptoms
6 P’s: pain, pallor, pulse absent/diminished, paraesthesia, paralysis, poikilothermia
tests include:
ankle-brachial index (normal >0.9)
doppler ultrasound
arteriography
management for PAD
embolectomy, bypass graft, angioplasty
bed in reverse Trendelenburg to increase perfusion (DO NOT elevate extremity)
medications: tPA, anticoagulants (heparin), antiplatelets (ASA, clopidogrel), vasodilators
Acute symptomatic Carotid Artery Disease
s/s: TIA, monocular visual disturbances, aphasia, stroke
tests include: angiography (gold standard), carotid duplex, ultrasound, CTA, MRI
treatment: carotid endarterectomy, stent, asa, statin therapy
post-procedure: frequent neuro and motor checks, bp and HR monitoring, monitor for bleeding, monitor for hyperperfusion syndrome
Wolff-Parkinson-White syndrome
genetic conduction abnormality resulting in SVT
DO NOT give adenosine, digoxin, or CCB for pre-excited AF
Causes of Prolongation of the QT interval
drugs: amiodarone, quinidine, haloperidol, procainamide
electrolyte problems - hypokalemia, hypocalcemia, hypomagnesemia
pacemaker code
A = atria, V = ventricle, D = dual (both)
first initial = chamber paced (“invented” first)
second initial = chamber sensed
third initial = response to sensing
I = inhibits (detects cardiac activity and withholds pacing)
D = inhibits and triggers (pacer detects cardiac activity and fires a pacer)
O = none
example: DDD, VVI
ICD burst pace
senses tachyarrhythmia and provides a series of beats faster than the tachyarrhythmias, and then suddenly stop with the hope of the recovery of the SA node
heart failure
a clinical syndrome characterized by signs and symptoms associated with HIGH INTRACARDIAC PRESSURES and DECREASED CARDIAC OUTPUT
acute decompensated heart failure
abrupt onset of symptoms severe enough for hospitalization (usually a hx of chronic HF)
heart failure with systolic dysfunction
left ventricular systolic dysfunction (LVSD);
problem with EJECTION (EF <=40%); filling is OK
DILATED LEFT VENTRICLE, mitral valve insufficiency, pulmonary edema, S3, BP normal or low, BNP elevated
Large dilated heart
treatment: BB, ACEI/ARB, DIURETICS, aldosterone antagonists, POSITIVE INOTROPES
NO CCB
heart failure with diastolic dysfunction
EF >50% (ejection is OK)
problem with FILLING;
hypertrophied (thickened) chamber, normal ventricle size, thick ventricle walls, normal contractile function, normal EF, pulmonary edema, S4, BP high, BNP elevated
treatment: BB, ACEI/ARB, Calcium Channel Blockers, low dose diuretics, aldosterone antagonists
NO Inotropes, NO diuretics (high dose)
BNP
released by the ventricle when the ventricle is under stress
high with heart failure
how does the body react to Acute Decompensated HF?
increase systemic vascular resistance (norepi, vasopressin, angiotensin I) which leads to sodium and H2O retention (angiotensin II and aldosterone). More SVR and ventricular remodeling occurs.
beta blockers block effects of norepi,
ACEI prevent angiotensin I and ARBs prevent angiotensin II.
Aldosterone antagonists prevent effects of aldosterone.
HF classes
class I - no symptoms except EXTRAORDINARY activity
class II - comfortable at rest, but ORDINARY activity results in symptoms
class III - comfortable at rest, but MINIMAL activity causes symptoms
class IV - symptoms occur AT REST
cardiogenic shock
when mechanisms fail to maintain cardiac output resulting in
1. elevated left ventricular preload (PAOP)
2. elevated left ventricular afterload (SVR) d/t vasoconstrictive compensatory mechanisms
3. low CO such that organs are not adequately perfused
PRESENTATION:
compensatory: tachycardia, tachypnea, crackles, ABG resp alkalosis or early metabolic acidosis, anxiety, neck vein distention, S3, cool skin, low urine output, narrow pulse pressure, BP normal or low
progressive: hypotension, worsening tachycardia, tachypnea, oliguria, metabolic acidosis, worsening crackles, clammy and mottled skin, worsening anxiety
treatment of cardiogenic shock
- enhance effectiveness of pump:
positive inotropic support (levo, dopamine, dobutamine), vasodilators, possible intra-aortic balloon pump (IABP) - decrease demand of pump: preload reduction, afterload reduction, oxygenation, ventilation, treat pain, IABP (short term) or VAD (longer periods)
CABG complications
tamponade, pericarditis, chest tube output >100mL for 2 consecutive hours generally requires intervention
TAVR (transcatheter aortic valve replacement)
prosthetic valve over the diseased valve
complications: associated with femoral access, heart block, stroke, AKI, paravalvular regurgitation
dual antiplatelet therapy will be required for life
cardiac tamponade
etiologies: post-op cardiac surgery, medical related (pericarditis pericardial effusion), trauma
s/s: NARROWED PULSE PRESSURE, PULSE PARADOXUS, restlessness, increased JVD, muffled heart sounds, enlarging cardiac silhouette on chest radiograph
which valve is most at risk for rupture d/t trauma?
aortic (most anterior in the chest)
myocardial contusion has similar s/s to pericarditis
75% of all CV related aneurysms are what?
abdominal aortic aneurysms
s/s: pulsations in abdominal area, abdominal or low back pain, n/v, shock
25% of CV related aneurysms are what?
thoracic aortic aneurysms
s/s: sudden tearing, ripping pain in chest, cough, hoarseness, dysphagia, dyspnea, dizziness, widening mediastinum on a chest x-ray
25% of CV related aneurysms are what?
thoracic aortic aneurysms
s/s: sudden tearing, ripping pain in chest, cough, hoarseness, dysphagia, dyspnea, dizziness, widening mediastinum on a chest x-ray
aneurysm dissection
a medical emergency - immediate surgery
dressler’s syndrome
immune response after an MI, surgery, or traumatic injury
Late pericarditis
