Cardiac Review part 3

Question 1

Hypertensive emergency

Answer 1

elevated BP with evidence of end organ damage (needs critical care admission)

greatest risk is STROKE

Question 2

hypertensive urgency

Answer 2

elevated BP without evidence of end organ damage (no Critical care admission)

Question 3

treatment of hypertensive emergency includes:

Answer 3

nitroprusside (Nipride) - preload and afterload reducer; assess for cyanide toxicity (mental status changes, tachy, seizure, metabolic acidosis)

labetolol (300 mg max)

Question 4

Peripheral Artery Disease (PAD) signs and symptoms

Answer 4

6 P’s: pain, pallor, pulse absent/diminished, paraesthesia, paralysis, poikilothermia

tests include:
ankle-brachial index (normal >0.9)
doppler ultrasound
arteriography

Question 5

management for PAD

Answer 5

embolectomy, bypass graft, angioplasty

bed in reverse Trendelenburg to increase perfusion (DO NOT elevate extremity)

medications: tPA, anticoagulants (heparin), antiplatelets (ASA, clopidogrel), vasodilators

Question 6

Acute symptomatic Carotid Artery Disease

Answer 6

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

Question 7

Wolff-Parkinson-White syndrome

Answer 7

genetic conduction abnormality resulting in SVT

DO NOT give adenosine, digoxin, or CCB for pre-excited AF

Question 8

Causes of Prolongation of the QT interval

Answer 8

drugs: amiodarone, quinidine, haloperidol, procainamide

electrolyte problems - hypokalemia, hypocalcemia, hypomagnesemia

Question 9

pacemaker code

Answer 9

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

Question 10

ICD burst pace

Answer 10

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

Question 11

heart failure

Answer 11

a clinical syndrome characterized by signs and symptoms associated with HIGH INTRACARDIAC PRESSURES and DECREASED CARDIAC OUTPUT

Question 12

acute decompensated heart failure

Answer 12

abrupt onset of symptoms severe enough for hospitalization (usually a hx of chronic HF)

Question 13

heart failure with systolic dysfunction

Answer 13

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

Question 14

heart failure with diastolic dysfunction

Answer 14

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)

Question 15

BNP

Answer 15

released by the ventricle when the ventricle is under stress

high with heart failure

Question 16

how does the body react to Acute Decompensated HF?

Answer 16

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.

Question 17

HF classes

Answer 17

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

Question 18

cardiogenic shock

Answer 18

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

Question 19

treatment of cardiogenic shock

Answer 19

1. enhance effectiveness of pump:
   positive inotropic support (levo, dopamine, dobutamine), vasodilators, possible intra-aortic balloon pump (IABP)
2. decrease demand of pump: preload reduction, afterload reduction, oxygenation, ventilation, treat pain, IABP (short term) or VAD (longer periods)

Question 20

CABG complications

Answer 20

tamponade, pericarditis, chest tube output >100mL for 2 consecutive hours generally requires intervention

Question 21

TAVR (transcatheter aortic valve replacement)

Answer 21

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

Question 22

cardiac tamponade

Answer 22

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

Question 23

which valve is most at risk for rupture d/t trauma?

Answer 23

aortic (most anterior in the chest)

myocardial contusion has similar s/s to pericarditis

Question 24

75% of all CV related aneurysms are what?

Answer 24

abdominal aortic aneurysms

s/s: pulsations in abdominal area, abdominal or low back pain, n/v, shock

Question 25

25% of CV related aneurysms are what?

Answer 25

thoracic aortic aneurysms

s/s: sudden tearing, ripping pain in chest, cough, hoarseness, dysphagia, dyspnea, dizziness, widening mediastinum on a chest x-ray

Question 25

25% of CV related aneurysms are what?

Answer 25

thoracic aortic aneurysms

s/s: sudden tearing, ripping pain in chest, cough, hoarseness, dysphagia, dyspnea, dizziness, widening mediastinum on a chest x-ray

Question 26

aneurysm dissection

Answer 26

a medical emergency - immediate surgery

Question 27

dressler’s syndrome

Answer 27

immune response after an MI, surgery, or traumatic injury

Late pericarditis