Cardio #3 Flashcards
1
Q
What is an electrocardiogram
A
A recording of the electrical activity of the heart from various views
2
Q
Quick, fast, painless test that shows cardiac electrical activity in a moment of time
A
electrocardiogram
3
Q
Most common leads for electrocardiogram
A
12-lead EKG
4
Q
18-lead-EKG and 15 leads-
A
dependent where work
5
Q
An __ is usually performed as soon as the patient presents to the emergency department or complains of chest pain
A
EKG
6
Q
Can also be performed if the patient has acute cardiac complaints or arrhythmia noted on the cardiac monitor
A
EKG
7
Q
Place electrodes on the chest & extremities
A
EKG
8
Q
Connect wires to electrodes
A
EKG
9
Q
Electrical impulses will be transmitted to the ___ machine
A
EKG
10
Q
Instruct patient to uncross arms & legs, lay as still as possible
A
EKG
11
Q
The EKG machine will pick up “artifact” if there is movement
A
EKG
12
Q
Once an appropriate image is noted on the EKG screen, press “capture”
A
EKG
13
Q
Electrical impulses appear as waves on the graph paper
A
EKG
14
Q
Remove wires and electrodes from chest
A
EKG
15
Q
Similar to telemonitor. Legs on ankles and arms
A
EKG
16
Q
EKG placement
A
White on the right. Snow on grass
Dirt in the middle
Fire over smoke
17
Q
EKG V1
A
4th intercoastal space to the right of the sternum
18
Q
EKG V2
A
4th intercoastal space to the left of the sternum
19
Q
EKG V3
A
Directly between leads V2 and V4
20
Q
EKG V4
A
5th intercoastal space at the midclavicular line
21
Q
EKG V5
A
Level with V4 at left anterior axillary line
22
Q
EKG V6
A
Level with V5 at left midaxillary line (directly under the midpoint of the armpit)
23
Q
Leg leads on ankle not hips
A
EKG
24
Q
12 or 18 lead print
A
EKG
25
Different views on the heart, most normal lead is 2. Look at lead 2!
EKG
26
Every rhythm on the test will be lead 2.
6 second strips,
multiple choice and fill in the blank
27
Can use abbreviations,
A-fib, V-fib
28
Electrical impulses generates heartbeat
Cardiac Conduction System
29
Electrical impulses are affected by electrolytes:
Sodium, potassium, magnesium, calcium
30
SA node –
60-100 bpm
31
Interatrial bundles
Internodal bundles
32
AV node –
40-60 bpm
33
Bundle of His (right and left) –
20-40bpm, if it has to take over it wont be effective
34
Purkinje
fibers
35
If the SA node fails the
AV node takes over
36
If AV nodes fails-
Bundle of his takes over
37
The period from the beginning of one heartbeat to the beginning of the next
Cardiac Cycle
38
Depolarization
(Systole)= Contraction
39
Repolarization
(Diastole)= Rest
40
EKG: Each 1 mm (small) horizontal box corresponds to __ second,
0.04
41
EKG: with heavier lines forming larger boxes that include five small boxes and hence represent ___ sec intervals.
0.20
42
The ____ is straight line on paper where no positive or negative deflections
isoelectric line
43
Wave forms Printed on grid like paper- can maximize on computer
EKG
44
base line of the electrical activity, expect all wave forms to go back down
Isoelectric line-
45
P-waves and QRS
positively deflective
46
Negative deflection=
problem
47
Within normal cardiac cycle, there is a
P wave, QRS complex, and a T wave
48
not common unless potassium is off, we do not look for ___
U waves
49
Indicative of the SA node firing
P-wave
50
Indicates atrial depolarization
Should be rounded
P-wave
51
Are they present?
P-wave
52
Do they occur regularly?- is there a ____ for every QRS rhythm
P-wave
53
Do they look alike? Are they rounded and upright? Should be roundish and similar
P-wave
54
First positive deflection
Atria are depolarizing (contracting)
P-wave
55
Time it takes for impulse to travel from SA to AV node
PR-Interval
56
Identifies electrical delay
PR-Interval
57
Should be 0.12 – 0.20 seconds (3-5 horizontal squares)
PR-Interval
58
For “R” think “Respirations” (normal 12-20, put decimal before each number)
PR-Interval
59
Measured from beginning of increase of P to beginning of QRS complex
PR-Interval
60
If prolonged= taking longer for the SA node to go to the AV
PR-Interval
61
First degree AV block- PR interval is longer
PR-Interval
62
___ come after the P wave
QRS
63
Represents ventricular depolarization and atrial repolarization
QRS
64
Tall and skinny
QRS
65
It they are fat we have a problem
QRS
66
Minorly deflect, go up and then go down
QRS
67
Represents time it takes for electrical impulse to travel from AV node rapidly through ventricles
QRS
68
should measure 0.06-0.10 (1.5-2.5 little boxes)
QRS Interval
69
Measure from the beginning of Q to the end of S wave
QRS Interval
70
Count number of squares from end of PR interval to end of S wave
QRS Interval
71
The wider it is the ventricles aren’t contracting as forcefully as they should be
QRS Interval
72
If bigger than 2.5 boxes= concern
QRS Interval
73
If wider= ventricles are having problems, over excited and firing to early
QRS Interval
74
Time from completion of contraction to recovery
ST Segment
75
Starts at the end of QRS complex, ends at beginning of T wave
ST Segment
76
Checked for patients with chest pain
ST Segment
77
Don't measure segment
ST
78
Make sure it goes back to isoelectric line to determine MI, current or past Ischemia indication
ST segment
79
Stemi-
ST elevated myocardial infarction
80
Check troponin to check MI
ST segment
81
When the ST is elevated =
MI happening right now
82
ST depression or depression or T wave inversion-
MI/ischemia
83
The ___ follows the QRS complex
T wave
84
Represents repolarization (resting state) of the ventricles and atria
T wave
85
Rounded, medium-sized, upward deflection
T wave
86
Don’t worry about the __ wave
U
87
Should be positive
Don’t have to measure ___
T wave
88
Steps to analyze EKG
Regularity of the rhythm
HR
P-waves
PR-interval
QRS-interval
89
Is the rhythm regular or irregular?
Regularity of the rhythm
90
Marching out? (Equal distance)
Regularity of the rhythm
91
Regularly irregular or irregularly irregular?
Regularity of the rhythm
92
What is the rate? 60-100
HR
93
Is there a P wave for every QRS?
P Waves
94
Are the P waves upright and rounded?
P Waves
95
Do they look the same?
P Waves
96
Is PR interval normal and constant? 0.12-0.20 seconds?
PR Interval
97
Is there a QRS complex for each P wave?
QRS Interval
98
Is the QRS interval 0.06-0.1 seconds?
QRS Interval
99
Left to right
EKG
100
How to quick count heart rate
In between the black lines at the top is 15 boxes which equals 3 seconds.
A sheet is 6 seconds
101
Heart rate second method
6 seconds = 30 big boxes
Count number of complexes in 6 sec strip x =10
102
Calculating HR
300 divided by the of big boxes between the R waves (QRS) or 1500 divided by the number of small boxes between the R waves
103
Sinus rhythm? Regularity of the rhythm
Regular (March out)
104
Sinus rhythm? Heart rate
60-100 bpm (means SA node firing)
105
Sinus rhythm? P Waves
P wave present, rounded and upright
P wave for every QRS complex
106
Sinus rhythm? PR Interval
0.12-0.20 seconds (3-5 boxes)
107
Sinus rhythm? QRS Interval
QRS interval less than or equal to 0.1 seconds.
108
Also called dysrhythmia
Arrhythmias
109
An abnormal rhythm of the heart
Arrhythmias
110
Arrhythmias can result in increased or decreased
HR, early or late beats, or atrial or ventricular fibrillation
111
Rhythms arising from SA node referred to as
sinus rhythms
112
Normal Sinus Rhythm, can abbreviate
Sinus tachycardia
Sinus bradycardia
113
Sinus Bradycardia Regularity of the rhythm
Regular
114
Sinus Bradycardia Heart rate
< 60 bpm
115
Sinus Bradycardia P Waves
P wave present, rounded and upright
P wave for every QRS complex
116
Sinus Bradycardia PR Interval
0.12-0.20 seconds
117
Sinus Bradycardia QRS Interval
QRS interval less than or equal to 0.1 seconds.
118
Sinus Bradycardia only abnormality
<60 HR
119
Sinus Bradycardia: Causes
Medications, Electrolyte imbalances, MI, Hypothyroidism, Hypothermia, Sleep apnea, SA node problems
120
SB Causes: Medications
Beta Blockers, Ca Channel Blockers, Digoxin
121
SB Causes: Electrolyte imbalances
Potassium, Magnesium, Sodium and calcium
122
SB Causes: MI, Hypothyroidism,
Hypothermia, Sleep apnea
123
SB Causes: Problems with SA node
sick sinus syndrome- put pacemaker in to fix
124
Past MI can stay in a bradycardia,
ischemia=myocardial infarction
125
Sinus Bradycardia: Symptoms
Hypotension, Diminished pulses, Fatigue, Syncope (fainting)
126
Athletes and older people can have
Sinus Bradycardia
127
Sinus Bradycardia: Treatment Asymptomatic
no treatment
128
Sinus Bradycardia: Treatment Symptomatic
Atropine IV, Dopamine IV, Transcutaneous pacing and Pacemaker
129
Atropine IV
Anticholinergic/Antispasmodic
130
Dopamine IV
Inotropic
131
Transcutaneous pacing
Temporary pacing
Deliver pulses of electric current through patient’s chest
132
Pacemaker
generates electrical pulses delivered by electrodes to one or more of the chambers of the heart, the upper atria or lower ventricles.
133
Sinus Tachycardia Regularity of the rhythm
Regular
134
Sinus Tachycardia Heart rate
> 100 bpm
135
Sinus Tachycardia P Waves
P wave present, rounded and upright
P wave for every QRS complex
136
Sinus Tachycardia PR Interval
0.12-0.20 seconds
137
Sinus Tachycardia QRS Interval
QRS interval less than or equal to 0.1 seconds.
138
Sinus Tachycardia only abnormality
HR >100
139
Sinus Tachycardia: Causes
Physical activity, Hemorrhage, Shock, Medications, Dehydration, Infection, Anxiety, Electrolyte imbalances
140
Sinus Tachycardia Cause Physical
activity
141
Sinus Tachycardia Cause Hemorrhage
Initial response as compensation
142
Sinus Tachycardia Cause Shock
Compensation mechanism
143
Sinus Tachycardia Cause Medications
Inhaled corticosteroids, SABAs, LABAs, pseudoephedrine, phenylephrine, levothyroxine (Inhalers)
144
Sinus Tachycardia Cause Dehydration
Compensation
145
Sinus Tachycardia Cause Infection and
Anxiety
146
Sinus Tachycardia Cause Electrolyte imbalances
Potassium, magnesium, sodium, calcium
147
Common Sinus Tachycardia: Symptoms
Angina, Dyspnea, Syncope, Dizziness, Anxiety, Palpations
148
Could be asymptomatic but symptoms are more common in
Sinus Tachycardia
149
Sometimes- sweating, diaphoresis
Sinus Tachycardia
150
Sinus Tachycardia: treatment
Correct the cause and Medications
151
Sinus Tachycardia: treatment Medications
Beta Blockers
Calcium Channel Blockers
Adenosine
152
Decrease SNS response
Beta Blockers
153
___ bind to beta-adrenoceptors and thereby block the binding of norepinephrine and epinephrine to these receptors
Beta Blockers
154
When these bind blood vessels constrict, HR, BP, CO, and force of contraction increase
Epinephrine and Norepinephrine
155
Heart has both β1 and β2 adrenoceptors, although the predominant receptor type is ___
β1
156
Β1 adrenoreceptors found in the heart and also found in the
kidneys
157
β2 adrenoceptors are found in the smooth muscle like the
lungs and blood vessels
158
In the kidneys, activation of adrenoreceptors causes release of
renin into the blood
159
Blocks epinephrine and norepinephrine
Beta Blockers
160
We want cardiac selective beta blockers if
lung problems are present
161
Reduce cardiac output thus decrease blood pressure
Beta Blockers
162
Cause decrease in HR and contractility
Beta Blockers
163
Decrease myocardial oxygen requirements
Beta Blockers
164
Have many uses such as hypertension, angina, myocardial infarction, arrhythmias and heart failure
Beta Blockers
165
Cardio-selective beta blockers
bind specifically to beta-1 receptors (heart kidneys)
166
Cardio-selective beta blockers: MANBABE
M etoprolol (lopressor) or Metoprolol ER (Toprol XL)
A tenolol (Tenormin)
N ebivolol
B isoprolol
A cebutotol
B etaxolol
E smolol
167
Non-cardio selective beta blockers (do not specifically target beta-1 receptors):
Propranolol
Nadolol
Labetalol- combo alp/beta
Carvedilol- combo alp/beta
Sotalol
168
Beta Blockers Nsg Considerations
Check HR and BP prior to administration
Monitor for bronchospasm/SOB
Education- rise slowly (can cause orthostatic hypotension), do not stop abruptly
African Americans not as sensitive to BB
169
Beta Blockers HR and BP
Less than 60 hold
Systolic is less than 100
170
African Americans not as sensitive to BB
Increase Dosages
171
Calcium channel blockers work to block the L-type calcium channels in the: Vascular smooth muscle cells:
coronary arteries and peripheral arteries
172
Calcium channel blockers work to block the L-type calcium channels in the: Cardiac myocytes:
cells that control the strength of the heart’s contractions
173
Calcium channel blockers work to block the L-type calcium channels in the: Cardiac nodal tissue:
cells that are responsible for the electrical conduction of the heart
174
Causes vasodilation (decreased BP) and decreased HR
CCBs
175
Have anti-anginal effects
Can be used for arrhythmias
CCBs
176
Causes vasodilation
CCBs
177
Can be used with tachycardia with angina = vasodilation causes less angina
CCBs
178
Calcium Channel Blockers Medications
Diltiazem (Cardizem)
Verapamil (Calan SR)
Amlodipine (Norvasc)
Clevidipine (Cleviprex)
Nifedipine (Procardia)
Hydralazine (Apresoline)
179
Calcium Channel Blockers Nsg considerations: Check
HR and BP
180
Calcium Channel Blockers Nsg considerations: Assess for
angina
181
Calcium Channel Blockers Nsg considerations: Monitor digoxin levels and signs of toxicity
Vision changes, N/V, diarrhea, confusion, arrhythmias, loss of appetite (anorexia)
182
Calcium Channel Blockers Nsg considerations: Side effects can include
headaches and flushing
183
Calcium Channel Blockers Nsg considerations: Edema is common side effect with
Amlodipine
184
Any BP medication can cause
Orthostatic (Postural) Hypotension
185
Antiarrhythmic
Adenosine
186
Restores NSR by interrupting re-entrant pathways in the AV node
Adenosine
187
Slows conduction time through the AV node
Adenosine
188
Produces coronary artery vasodilation
Adenosine
189
Need telemonitor
Adenosine
190
Use cautiously in patients with asthma
May cause bronchospasms
Adenosine
191
Adenosine Monitor
HR
EKG
BP
Respiratory status
192
Adenosine Educate
Change positions slowly for at least 24 hrs
193
Emergent drug- IV
Adenosine
194
Atria initiate impulses faster than SA node
P wave looks different
Atrial Arrhythmias
195
Usually faster than 100bpm
Atrial Arrhythmias
196
Atrial Arrhythmias types
Premature Atrial Contractions (PAC)
Atrial Flutter (A-flutter)
Atrial Fibrillation (A-fib)
197
Not from SA node but from interatrial bundle
More p waves than QRS
Atrial Arrhythmias
198
Most common arrhythmia
Premature Atrial Contraction (PAC)
199
Premature electrical impulse in atrium- think “early” beat
Premature Atrial Contraction (PAC)
200
First determine underlying rhythm
Premature Atrial Contraction (PAC)
201
P wave morphology is different than other P waves
Premature Atrial Contraction (PAC)
202
Look at distance between R waves
Premature Atrial Contraction (PAC)
203
Atria contracting too soon, most common, early beat
Premature Atrial Contraction (PAC)
204
Know if it is a PAC
Premature Atrial Contraction (PAC)
205
Picture does not march out(even)
Premature Atrial Contraction (PAC)
206
Premature Atrial Contraction (PAC) only abnormal is
P-wave
207
Premature Atrial Contraction (PAC): Causes
Hypoxia, Cigarette Smoking, HF, Electrolyte imbalances, Caffeine, Alcohol, Meds, Fatigue, Anxiety, Stress
208
Premature Atrial Contraction (PAC): Causes, Electrolyte imbalances
Sodium, Calcium, Potassium, Magnesium
209
Premature Atrial Contraction (PAC): Causes, Caffeine
Coffee, soda, energy drinks
210
Premature Atrial Contraction (PAC): Causes, Meds
Asthma medications
211
Premature Atrial Contraction (PAC): Symptoms
Palpitations
Dizziness, lightheadedness, syncope more severe
212
Premature Atrial Contraction (PAC): Tx
Asymptomatic- No treatment
Symptomatic- Beta blockers, CCBs
Figure out cause
SA node firing to quick
213
Premature Atrial Contraction (PAC) abnormaility
Early P wave- Does not march out
P waves look abnormal
214
Electrical impulses initiated randomly from ectopic sites= atria quiver
Atrial Fibrillation
215
Stroke risk is increased due to stasis of blood
Atrial Fibrillation
216
Can be persistent or paroxysmal(sudden and uncontrolled)
Atrial Fibrillation
217
Afib Rapid Ventricular Rate (unstable Afib)
HR greater than 100
218
Still have p waves
Atrial Fibrillation
219
Multi-atrial firings with interatrial bundle, does not actually contract
Atrial Fibrillation
220
Stasis, clotting, aspirin=81mg chewable
Atrial Fibrillation
221
Stroke risk elevated
Atrial Fibrillation
222
HR could be normal
Atrial Fibrillation
223
A-fib(stuttering) with rapid ventricular rate=
ventricles are beating raiding, HR greater than 100-150 = ICU
224
Atrial Fibrillation Regularity of the rhythm
Irregularly Irregular
225
Atrial Fibrillation Heart rate
Atrial rate of 350-600
Ventricular rate much slower
A-fib with RVR = ventricular rate >100
226
Atrial Fibrillation P Waves
No P waves
Wavy pattern on EKG
227
Atrial Fibrillation PR Interval
Unable to determine
228
Atrial Fibrillation QRS Interval
QRS interval less than or equal to 0.1 seconds.
229
Atrial Fibrillation (A-Fib) abnormality
Does not march out
Atrial HR- 350-600 or 100-200
Multiple P-waves
Cannot determine PR-interval
230
Atrial Fibrillation: Causes
Age, Heart Disease, Hyperthyroidism, Sleep apnea, Cardiac surgery, Medications, Unknown
231
Atrial Fibrillation: Causes, Age
Risk increases after age 65
232
Atrial Fibrillation: Causes, Heart disease
HF, HTN, MI, valvular disease
233
Atrial Fibrillation: Causes, Medications
Cardiac stimulants: digoxin, increase SNS activity
234
Atrial Fibrillation: Causes, Electrolytes
Potassium, Calcium, Magnesium, Sodium
235
Atrial Fibrillation: S/sx
Hypotension, dizziness, pulse deficit (Hard to palpate), Chest pain (NO O2), palpations, fatigue
236
Radial pluse can be different than atrial= notify physican
Atrial Fibrillation
237
Atrial Fibrillation: Treatments
Anticoagulants, Rate and rhythm control, Cardioversion, Cardiac ablasion, Surgery
238
Atrial Fibrillation: Treatments, Anticoagulants
Warfarin
Eliquis
Xarelto
Lovenox and heparin (Hospital)
Plavix and Asprin (Home)
239
Warfarin Antidote
Vitamin K
240
Therapeutic range for INR (Warfarin)
2-3
241
Lovenox and Heparin Antidote
Protamine sulfate
242
Plavix antidote
NONE
243
Aspirin Antidote
Sodium bicarbonate
244
Eliquis (Apixaban) and Xarelo Antidote
Andexanet alfa (Andexxa)
245
Atrial Fibrillation: Treatments, Rate and rhythm control= slow and control the heart
Beta Blockers
Ca Channel Blockers
Digoxin
246
Atrial Fibrillation: Treatments, Cardioversion-
shock the pt. 150 volts, could put in worse rhythm, not an option for a pt that already has a clot
Anticoagulation prior
247
Atrial Fibrillation: Treatments, Cardiac ablation-
cauterizing, chemically or physically. procedure requiring informed consent, cutting off electrical impulse from the area
248
Atrial Fibrillation: Treatments, Surgery
Maze procedure- reroute the electrical activity, rare, serious a-fib and rvr, last resort
249
Aflutter is less likely to turn into __
A-fib
250
Digoxin: increase CO
Strengthens ventricular contraction
251
Digoxin: Slows ventricular rate
Decreases conduction through the SA and AV node
252
Digoxin: Therapeutic range
0.5 – 2 ng/mL
253
Digoxin: S/SX
vision changes, N/V, diarrhea, confusion, arrhythmias, decreased appetite
254
Digoxin: Monitor Potassium levels
Hypokalemia increases toxicity risk
255
Digoxin: Monitor Calcium levels
Hypercalcemia increases toxicity risk
256
Digoxin: Monitor Magnesium levels
Hypomagnesemia increases toxicity risk
257
Digoxin: Nsg implications
Monitor apical pulse for 1 full min before administration
Hold if HR < 60 bpm
Monitor ECG during IV administration and 6hr after each dose
258
Coordinated electrical activity in the atria
Atrial Flutter
259
Not every impulse goes to ventricles
Atrial Flutter
260
Fire forms the interatrial bundle, fire consistently
Atrial Flutter
261
Can see 3-5 p waves
Atrial Flutter
262
Atria contracting each time and then ventricles contract, can worry about preload in ventricle
Atrial Flutter
263
HF, cannot pump effectively
Atrial Flutter
264
Atrial Flutter: Regularity of the rhythm
Atrial rhythm regular,
ventricular rhythm regular or irregular depending on AV conduction impulses
265
Atrial Flutter: Heart rate
Atrial rate 250-350 bpm
Ventricular rate depends on underlying rhythm
266
Atrial Flutter: P Waves
Rapid coordinated P waves
Sawtooth pattern
267
Atrial Flutter: PR Interval
Unable to determine= too many
268
Atrial Flutter:
QRS interval less than or equal to 0.1 seconds.
269
Atrial Flutter abnormality
Regularity of the rhythm
HR
P-waves
PR interval
270
Atrial Flutter: Causes
CHF, MI, Valve disorders, HTN, Rheumatic or ischemic heart disease, PE, COPD, Post-CABG
271
Atrial Flutter: Causes
Chronic=asymptomatic
Paroxysmal=palpitations
Angina=decrease in O2
Dyspnea
272
Atrial Flutter Tx
Same as Atrial Fibrillation
273
Abnormal beats originating in ventricles
Ventricular Arrhythmias
274
Often cause heart to beat too fast
Ventricular Arrhythmias
275
Types of Ventricular Arrhythmias
Premature Ventricular Contractions (PVCs)
Ventricular tachycardia(V-Tec)
Ventricular fibrillation(V-fib)
276
Very common
Premature Ventricular Contractions (PVCs)
277
Extra abnormal heartbeat of the ventricle
Premature Ventricular Contractions (PVCs)
278
Ventricles fire prematurely before the SA node causing wide QRS
Premature Ventricular Contractions (PVCs)
279
2nd most common dysrhythmias
Premature Ventricular Contractions (PVCs)
280
Ventricular fire prematurely before atria
Premature Ventricular Contractions (PVCs)
281
Wide QRS problem in the ventricles
Premature Ventricular Contractions (PVCs)
282
Bundle of his or purkinje fibers, fire too early
Premature Ventricular Contractions (PVCs)
283
Can have every other beat or every 3rd beat
Premature Ventricular Contractions (PVCs)
284
Premature Ventricular Contractions (PVCs) risk factors
Caffeine, Tobacco, Alcohol, Exercise, Hypertension, Anxiety, Stimulant use, Underlying heart disease
285
Premature Ventricular Contractions (PVCs) risk factors, Stimulant use
- speed, methamphetamines
286
Premature Ventricular Contractions (PVCs) risk factors, Underlying heart disease
congenital heart disease, coronary artery disease, heart attack, heart failure and a weakened heart muscle (cardiomyopathy)
287
Premature Ventricular Contractions (PVCs) S/Sx
“Flip-Flops”- skipped beats
Skipped beats
Missed beat
Cyanosis, headache, anemia
If 1 PVC may not notice
288
Premature Ventricular Contractions (PVCs) Tx
Lifestyle changes- energy drinks, Tobacco, Alcohol, Stimulant
Beta Blockers
Calcium Channel Blockers
Amiodarone- common drug for PVC
Cardiac Ablation
289
Premature Ventricular Contractions (PVCs) types
Unifocal, Multifocal, Bigeminy, Trigeminy, Couplet, Run/V-Tach
290
Premature Ventricular Contractions (PVCs) Unifocal
Come from the same irritable ventricular area
look the same
291
Premature Ventricular Contractions (PVCs) Multifocal
Originate from several different irritable areas in the ventricle
do not look the same
292
Premature Ventricular Contractions (PVCs) Bigeminy- normal, PVC
Every other beat is a PVC
293
Premature Ventricular Contractions (PVCs) Trigeminy- normal, normal, PVC
Every third beat is a PVC
294
Premature Ventricular Contractions (PVCs) Quadgeminy- normal, normal, normal, PVC
Every fourth beat is PVC
295
Premature Ventricular Contractions (PVCs) Couplet- some normals
2 PVCs back to back in a row, likely to get 3 or 4
296
Premature Ventricular Contractions (PVCs) Run/Vtach
3 or more PVCs in a row (FATAL)
297
When naming the rhythm when PVC and not saying specific type =
list if its a PVC
298
Originates in the ventricles
Ventricular Tachycardia (VTACH)
299
3 or more Premature Ventricular Contractions (PVCs)
Ventricular Tachycardia (VTACH)
300
Ventricles become the pacemaker instead of SA node
Ventricular Tachycardia (VTACH)
301
Ventricular Tachycardia (VTACH) Regularity of the rhythm
Regular
302
Ventricular Tachycardia (VTACH) Heart rate
150-250 bpm
303
Ventricular Tachycardia (VTACH) P Waves
Absent
304
Ventricular Tachycardia (VTACH) PR Interval
Unable to determine
305
Ventricular Tachycardia (VTACH) QRS interval
>0.1 seconds
Bizarre appearance
wide
306
PVC fatal if they turn into
V-tech
307
Lethal rhythms, shockable –
V-tech, V-fib
308
Tombstone rhythm
Ventricular Tachycardia (VTACH)
309
Vtach: common causes
Mi, Cardiomyopathy, Hypokalemia, Respiratory acidosis, Myocardial irritability, Drugs, Medications
310
Vtach: s/sx
Dyspnea, Lightheaded, Angina, Feeling of fast HR, Pulselessness
T-tach, awake and talking, may turn unconscious
311
Vtach: treatment with pulse
Meds, Synchronized cardioversion, ICD(not best practice), Ablation
312
Vtach: treatment with pulse, Meds
Lidocaine
Adenosine-stop electrical activity to restart rhythm
Beta Blockers- slow hrt down, lobatolol IV
Amiodarone- antidysrhythmic
Diltiazem- CCB- blood flow to the heart
313
treatment with no pulse
CPR (call for help)
Defibrillation
Meds
AED- synchronize, follows the beat where the P wave should be
ACLS protocol- meds-not pulse
314
Vtach: treatment with no pulse, Meds
Epinephrine
Lidocaine
Amiodarone
315
Tombstone-
V-tach
316
Cardio aversion-
low shock
317
Defibrillation-
high shock
318
Vagal down- act like bowel movement until meds into the room
Wide QRS
V-tach leads to V-fib untreated
Deterioration of the heart, V-fib
Vtach
319
Mrs. Parker, age 76, is admitted to the long-term care unit where you are working. She has been transferred from the hospital after treatment for a recent myocardial infarction and several episodes of ventricular tachycardia (VT). At 1600 hours, you find her unresponsive, with no palpable pulses and shallow respirations. Vital signs are blood pressure 80/40 mm Hg, apical pulse 150 bpm, and respiratory rate 6 breaths per minute.
Is this patient hemodynamically stable?
No
320
Why are there no palpable pulses?
Blood is being rerouted to vital organs
321
What is happening to the heart when VT is occurring?
Ventricles constantly contraction
322
What action should you take?
Call 911, bring crash cart, cpr when losing pulse completely
323
Ventricular activity is chaotic, ventricles quiver
Ventricular Fibrillation (V-Fib)
324
No discernible waves
Ventricular Fibrillation (V-Fib)
325
No Pulse, will not be responsive
Ventricular Fibrillation (V-Fib)
326
ACT FAST
Ventricular Fibrillation (V-Fib)
327
If you see VFIB=DFIB
Always defibrillate these patients
Ventricular Fibrillation (V-Fib)
328
Start with CPR, epinephrine, and Amiodarone or Lidocaine may be given
Ventricular Fibrillation (V-Fib)
329
Ventricular Fibrillation (V-Fib) Causes
V-tach, Hyperkalemia, hypomagnesemia, CAD, MI, electrocution
330
ACLS protocol meds
Ventricular Fibrillation (V-Fib)
331
Ventricular Fibrillation (V-Fib) Regularity of the rhythm
Irregularly irregular
332
Ventricular Fibrillation (V-Fib) Heart rate
Unmeasurable
333
Ventricular Fibrillation (V-Fib) P Waves
Absent
334
Ventricular Fibrillation (V-Fib) PR Interval
Unable to determine
335
Ventricular Fibrillation (V-Fib) QRS Interval
None
336
QRS are small
V-Fib= death
Cannot shock systole
Ventricular Fibrillation
337
Absence of electrical activity
Asystole
338
VF usually precedes asystole= sudden cardiac death
Asystole
339
Unconscious and unresponsive
Hard to bring back
Asystole
340
Start CPR immediately
Asystole
341
Asystole causes
Hyperkalemia
V-fib
Massive MI
Shock
342
hardening of wall and loss of elasticity
Arteriosclerosis
343
Arteriosclerosis Patho
thickening, loss of elasticity, and calcification of arterial walls
Part of aging process
344
Plaque
Arteriosclerosis
345
Atherosclerosis Patho
formation of plaque within arterial wall
Injury to endothelial cells
Lipids, platelets, and clotting factors accumulate
Scar tissue
346
Atherosclerosis: Growth of smooth muscle cells which secrete:
Collagen and fibrous proteins
347
Formation of atheroma's (plaques of lipid material)
Athersclerosis
348
Thickening of the inner wall and the central wall of the artery
Arteriosclerosis
349
A fatty streak forms on the lining of the artery- known as plaque
Atherosclerosis
350
Plaque has jagged edges that allow blood cells and other materials to adhere to wall
Atherosclerosis
351
Fibrous cap forms- Can tear or rupture and a blood clot forms which can block artery
Atherosclerosis
352
Vessel can also become narrowed from plaque buildup
Atherosclerosis
353
Injury to endothelial wall
Clotting and obstruction risk
Perfusion risk
Atherosclerosis
354
Development of Plaque
Atherosclerosis
355
Atherosclerosis: Non-modifiable Risk Factors
Age-Men after 50, women after menopause
Gender- Men
Ethnicity- African Americans
Genetics- Family hx. of hyperlipidemia
356
Atherosclerosis: Modifiable Risk Factors
Physical Inactivity
Obesity
Diabetes Mellitus type 2
Alcohol use
Sedentary lifestyle
Stress
Elevated cholesterol
Hypertension
Nicotine Use
357
Atherosclerosis: Diagnosis:
Lipid profile, C-reactive protein, Blood glucose levels, Stress Test, Cardiac Catheterization
358
Atherosclerosis: Diagnosis: Labs- Lipid Profile
Total Cholesterol, Triglycerides, LDL, HDL
359
Range: <200mg/dL
>200 associated with CAD
Measurement of HDL, LDL, and VLDL
Total Cholesterol
360
Range: <150mg/dL
Critical value > 400mg/dL
>150 mg/dL at risk
Triglycerides
361
Range: <130mg/dL
contains both cholesterol and trigs and may deposit cholesterol directly onto walls of arteries
LDL
362
Range: >45mg/dL-men; >55mg/dL-women
Carry LDL to liver to be broken down and excreted
HDL
363
Atherosclerosis: Diagnosis: Labs- C-Reactive protein
1.0-3.0mg/L
>3.0 mg/L Indicates low-grade inflammation
364
Atherosclerosis: Diagnosis: Labs- Blood Glucose levels
elevated levels can increase the risk for atherosclerosis
365
Shows how heart works during physical activity
Atherosclerosis: Diagnosis: Stress Test
366
Can be on a treadmill/bike
Atherosclerosis: Diagnosis: Stress Test
367
If patient unable to exercise adenosine or another vasodilator used to open up vessels
Atherosclerosis: Diagnosis: Stress Test
368
Nuclear stress test- not common
Atherosclerosis: Diagnosis: Stress Test
369
Small amounts of radioisotopes given IV
Atherosclerosis: Diagnosis: Stress Test
370
Photos taken and compared
Atherosclerosis: Diagnosis: Stress Test
371
Handles increase activity and O2 demand
Atherosclerosis: Diagnosis: Stress Test
372
Procedure done to visualize anatomy of heart
Atherosclerosis: Diagnosis: Cardiac Catheterization
373
Thin catheter inserted
Atherosclerosis: Diagnosis: Cardiac Catheterization
374
Fluoroscopy used to produce real-time images
Atherosclerosis: Diagnosis: Cardiac Catheterization
375
Contrast dye can be injected
Atherosclerosis: Diagnosis: Cardiac Catheterization
376
Cardiac Catheterization Nsg implications
Assess for allergies prior
Obtain consent
When patient returns from cath check labs
Keep on bedrest
assess vitals
entry site- bleeding, dressing
6 Ps
Activity restriction, cannot climb more than 2 flights of stairs for minimum for 3 weeks, unable to engage in sexual activity
377
24-48 hours minimum= 48-72 hrs before cardiac cath- metformin, nephrotoxic
Groin or wrist
insert stent to inflate balloon
Cardiac Catheterization
378
Atherosclerosis: Therapeutic Measures
Diet- Heart-healthy diet. DASH diet
Smoking Cessation
Exercise
Low-dose aspirin 81 mg chewable
Medications
Assess vitals, continuous q15 blood pressure on monitor
379
Atherosclerosis: Therapeutic Measures, Diet- Heart-healthy diet. DASH diet
Fruits and veggies, avoid trans fats, reduce saturated fats, reducing sugar and sodium (nothing fried, coconut oil)
380
Atherosclerosis: Therapeutic Measures, Exercise
Increases HDL and can lower insulin resistance, can lead to development of collateral circulation.
30 mins a day most days can be intervals
381
Atherosclerosis: Therapeutic Measures, Medications
Often needed to reduce lipid levels, can take up to 4-6 weeks.
382
Atherosclerosis: Drug Therapy
Statins, Fibrates, Bile Acid Sequestrants, Cholesterol Absorption Inhibitor, Niacin
383
Reduce cholesterol synthesis (4-6 weeks), rhabdomyolysis. #1 medication for atherosclerosis
Statins
384
Atorvastatin (Lipitor)
Pravastatin (Pravachol)
Simvastatin (Zocor)
Rosuvastatin (Crestor)
Statins
385
Reduce triglycerides
Fibrates
386
Fenofibrate (TriCor)
Gemfibrozil (Lopid)
Fibrates
387
Increase conversion of cholesterol to bile acids, if statins aren’t fully working
Bile Acid Sequestrants
388
Cholestyramine (Questran)
Colesevelam (WelChol)
Colestipol (Colestid)
Bile Acid Sequestrants
389
Inhibits Cholesterol Absorption
Cholesterol Absorption Inhibitor
390
Ezetimibe (Zetia)
Cholesterol Absorption Inhibitor
391
Prevents conversion of fats into VLDLs
Niacin:
392
Caused by atherosclerosis
Coronary Artery Disease (CAD)
393
Plaque buildup in the walls of coronary arteries causing blockage
Coronary Artery Disease (CAD)
394
Progressive disease
Coronary Artery Disease (CAD)
395
Coronary Artery Disease (CAD) risk factors
Same as atherosclerosis
396
Coronary Artery Disease (CAD) can cause
Age- Men over 50
Woman after menopause
Angina- ischemia or decreased O2 supply
MI
Death
397
Angina is chest pain due to ischemia
CAD: S/SX: Angina
398
Narrowed blood vessels unable to dilate
CAD: S/SX: Angina
399
Carry less blood/oxygen for heart muscle
CAD: S/SX: Angina
400
Types of angina
Stable, Unstable, Variant or Vasospastic (Prinzmetal) and Microvascular
401
Occurs in pattern familiar to patient, only lasts a few minutes. Goes away with rest/Nitro. Pattern familiar. Less than 10 mins.
Stable Angina
402
Increases unpredictably in frequency, occurs at rest, during sleep. Not relieved by meds or rest
Should be treated as emergency, can lead to MI
Can last longer than 10 mins
Unstable Angina
403
Caused by coronary artery spasms. Pattern is cyclical, lasts longer than stable. In cycles, can treat with nitro
Variant or Vasospastic angina (Prinzmetal angina)
404
Spasms in walls of tiniest arteries. Pain may be more severe. Brings to knees right away, very painful
Microvascular angina
405
Tight pressure, crushing=
angina
406
Discomfort, burning, fullness, pressure, squeezing
CAD: S/SX: Angina
407
Pain may radiate down arms, to neck and scapula
CAD: S/SX: Angina
408
Heaviness in arms
CAD: S/SX: Angina
409
Women may have atypical symptoms: SOB, fatigue, nausea
CAD: S/SX: Angina
410
Lasts 5-15 minutes
CAD: S/SX: Angina
411
Nitroglycerin- direct vasodilator Tx
Angina
412
Nitroglycerin
CAD: S/SX: Angina: Treatment
413
Dilates arteries thereby reducing workload of heart
Nitroglycerin
414
Sublingual
Acts in 1-2 minutes
Last 30-40 min.
Nitroglycerin
415
1 dose Q5min x 3
Nitroglycerin
416
Nitroglycerin Side effects:
Hypotension, headache (rush of blood to heart and brain)
417
Assess pain and BP because it dilates
Nitroglycerin
418
Educate pts to assess bp and keep nitro on them or close
Nitroglycerin
419
Kept in cool, dry, dark, area because of photosensitivity keep in pockets
Nitroglycerin
420
Under 100 systolic and 40 diastolic
Nitroglycerin
421
IV or Patch
Remove patch to give sublingual
Nitroglycerin
422
12 hrs is cut off-
Nitroglycerin
423
CAD: Angina: Medications/treatment
CCBs, Anti-ischemic agents, Nitrates
424
Amlodipine- most common
Felodipine
Calcium channel blockers- vasodilates, check BP and HR
425
Ranexa
Anti-ischemic agent
426
Isosorbide mononitrate
Nitro
Avoid erectile dysfunction meds- causes vasodilation ask if Viagra (tidalifil) or Sialis
Nitrates
427
Includes unstable angina and MI
Acute Coronary Syndrome (ACS)
428
Caused by sequence of inflammatory processes
Acute Coronary Syndrome (ACS)
429
80% caused by Thrombus or clot formation leading to reduced blood flow (Unstable angina)
Acute Coronary Syndrome (ACS)
430
Partial or complete occlusion of coronary artery (MI)
Acute Coronary Syndrome (ACS)
431
NSTEMI (not ST elevation still myocardial infarction) or STEMI (ST elevated myocardial infarction)
Acute Coronary Syndrome (ACS)
432
Caused by CAD or atherosclerosis
Acute Coronary Syndrome (ACS)
433
12 lead EKGs- which coronary artery is effected, fireman's hat,
nitro, get physician
434
Chest pain-
New
Worse
Sudden
Occurs at rest, while asleep, with little exertion
Lasts longer than stable angina (over 10 mins)
Not relieved by medicine
Unstable Angina
435
Usually caused by atherosclerosis, which can rupture leading to blood clot
Unstable Angina
436
Should be treated as an emergency, can lead to MI
Should be coming to ED
Unstable Angina
437
Results in death of heart muscle
Myocardial Infarction
438
80-90% of time caused by thrombus formation
Myocardial Infarction
439
Ischemic injury happens over hours before complete necrosis takes place
Myocardial Infarction
440
Area of heart affected depends on coronary artery affected
Myocardial Infarction
441
STEMI- Most serious, affects full thickness of heart
Myocardial Infarction
442
NSTEMI- Less serious, blockage is usually partial
Myocardial Infarction
443
Time is muscle!!!=act quickly. 4 hours time frame from start of symptoms
Myocardial Infarction
444
Scar tissue may form in the damaged area
Myocardial Infarction
445
Can give TPA for stroke and MI also (not common)
To break up thrombus
CTA- to see type of stroke
Myocardial Infarction
446
Typical Myocardial infarction S/Sx:
Heaviness, pressure, tightness, burning, constriction, or crushing pain- “elephant sitting on my chest”
Substernal or retrosternal, may radiate
Fatigue
Weakness
SOB
Anxiety
SNS is activated
Low BP
Elevated HR
Diaphoresis caused by anxiety
Cool, Clammy, gray skin
Nausea/vomiting
447
Myocardial Infarction/Heart attack symptoms in men
N/V, Jaw, neck, and back pain, Squeezing chest pressure or pain, SOB
448
Myocardial Infarction/Heart attack symptoms in women
N/V, Jaw, neck, and back pain, chest pain but not always, pain or pressure in the lower chest or upper abdomen, SOB, fainting, indigestion, extreme fatigue
449
Low Bp
Elevated HR
N/V typical in women
Myocardial Infarction
450
Denial common
Wait to seek care (no tPA)
Myocardial Infarction: Treatment
451
“Time is muscle”
Call 911
Do not drive self or ride with others
Reperfusion time critical
Myocardial Infarction: Treatment
452
Chew one uncoated adult aspirin (324mg= adult aspirin)
If in LTC chew enteric coated
Myocardial Infarction: Treatment
453
STEMI TX
Educate on nitro and angina
May have atherosclerosis or CAD and not know they had a MI
Myocardial Infarction: Treatment
454
Diagnostic Tests for MI
Troponin, Myoglobin and creatine kinase, EKG, Magnesium and Potassium
455
Troponin
The more damage the higher number will be
456
Myoglobin and creatine kinase
(CK)-MB- not as sensitive as troponin
457
EKG-
Look at ST segment
458
Magnesium and Potassium
NOT AS CRITICAL
459
ST elevation
MI
460
ST depression
Ischemia
461
STEMI (HAPPENING NOW) AND
NSTEMI (COULD HAVE HAPPENED) = ISCHEMIA
462
Myocardial Infarction: emergency Drug Therapy
IV nitro, Antiplatelet Therapy, Systemic anticoagulation, pain management, thrombolytic
463
Reduces pain
vasodilates which improves blood flow
IV nitro-
464
Reduce platelets from forming clots
Antiplatelet therapy-
465
IV Heparin (PROTAMINE SULFATE=ANT)
Systemic anticoagulation-
466
Usually IV Morphine
Decreases preload and afterload
Decreases BP and HR
Pain management-
467
Used to dissolve blood clot
STEMI
O2 if O2 is less than 92%
Thrombolytic-
468
MI- MONA TASS
M orphine
O xygen
N itroglycerin
A spirin
T hrombolytics
A nticoagulants
S tool softeners
S edatives
469
Myocardial Infarction: Treatment Cardiac catheterization
Balloon angioplasty
Percutaneous coronary intervention (PCI)- can pull out clot
470
Coronary Artery Bypass Graft (CABG)
Myocardial Infarction: Treatment
471
Post operative concerns-
perfusion, clots, HR, BP, sites for bleeding, below sites for 6 P’s
472
Myocardial Infarction: Post Medications
Beta Blockers, ACE inhibitors, (2nd line), Statins, Antiplatelet, Vasodialators
473
If MI for the rest of their life. Decrease HR, BP, prevent release of renin, reduce preload and afterload. Decrease O2 demand
Beta Blockers
474
Metoprolol (heart specific)
Carvedilol, or propranolol asthma or COPD should not be on it
Beta Blockers
475
Lowers BP, reduces workload on heart (hypotension, cough)
ACE inhibitor (2nd line)-
476
Lisinopril, Ramipril
ACE inhibitor (2nd line)-
477
Lowers cholesterol
Statin-
478
Crestor, Lipitor
Statin-
479
Reduce preload and afterload, reduce oxyIsosorbide mononitrate
en consumption of myocardium
Vasodilators-
480
Isosorbide mononitrate
Vasodilators-
481
MI is also called
acute coronary syndrome
482
Narrowing of arteries that leads to occlusion or obstruction
Peripheral Arterial Disease (PAD)
483
Strongly related to other CVD (likely to have PAD)
Peripheral Arterial Disease (PAD)
484
Usually in lower extremities
Peripheral Arterial Disease (PAD)
485
Reduces blood supply
Leads to ischemia distal to obstruction
Peripheral Arterial Disease (PAD)
486
Can have one or multiple occlusions
Peripheral Arterial Disease (PAD)
487
PAD: Risk factors
Smoking, Hyperlipidemia, Hypertension, Diabetes Mellitis, Elevated BMI, Family history of athersclerosis, Age, Ethnicity-African americans
488
PAD: S/SX
Intermittent Claudication- Pain in calves with activity (causes PT to seek TX)
Paresthesia
Thin, shiny, and taut skin (Rubor)
Loss of hair on the lower legs
Diminished (is okay if they have PAD) or absent pedal, popliteal, or femoral pulses
Pallor of extremity when elevated, reddish-purple when dependent
Cool skin
Thickened toenails
Dry, flaky, scaly skin
Decreased sensation
Pain at rest (Severe PAD)
489
Atrophy of the skin and underlying muscles (blood and O2 supply inadequate= weak)
PAD: Complications
490
Delayed healing (blood supply)
PAD: Complications
491
Wound infection (gangrene, can lead to amputations')
PAD: Complications
492
Tissue necrosis (caused by gangrene or no blood supply, occlusion, leads to amputations)
PAD: Complications
493
Arterial ulcers (difficult to heal, different than PVD ulcers)
PAD: Complications
494
Amputation
PAD: Complications
495
Jagged edge not perfect shape, hard to heal bc of
blood supply
496
On ankles but can be anywhere in lower extremities-
PAD
497
PAD: Diagnostic Studies
Ankle-brachial index (ABI), Arterial ultrasound, CT or MRI, Angiography
498
Ankle-brachial index (ABI)
trying to find pulse
Done using a hand-held Doppler
Take systolic of leg and divide by systolic of arm
499
Angiography-
important, scan of the vessels, uses. Push fluids, allergies, metformin
PVI
500
No compression socks for
PAD
501
= balloon-like bulge in vessel
Aneurysm
502
Aortic aneurysms may involve the
aortic arch,
thoracic aorta
abdominal aorta. (AAA)
503
Aorta >3cm is considered
aneurysm
504
Outpouching of the wall of the artery
aneurysm
505
Aortic Aneurysms: Risk Factors
Age, Male, Smoking, HTN, Atherosclerosis, Family history, High cholesterol, Elevated BMI
506
Can lead to rupture- HTN control
aortic aneurysm
507
Types of Aneurysms
Saccular, Fusiform, and Dissecting
508
Bulges on one side of arterial wall
Saccular
509
dilation of entire circumference
Fusiform
510
Cavity is formed from tear in artery wall
Dissecting- not a true aneurism *
511
Aortic Aneurysm: S/Sx, Thoracic aortic aneurysms
Often asx, SOB, CP, pain that radiates to back
SOB, Chest pain if its bigger, radiates
512
Aortic Aneurysm: S/Sx, Abdominal Aorta Aneurysm (AAA)
Often asx, Pulsatile mass-no touching, Bruit (bowel sounds- swishing sounds), Back or flank pain, Abdominal pain, feeling of fullness
513
Hoarseness pushing against the vocal area
dysphagia
Aortic Aneurysm: S/Sx
514
Aneurysms: Diagnostic Tests
Abdominal Ultrasound
CT
MRI
Aortography
515
Aortogram or Arteriogram
Definitive test for aneurisms – golden standard
516
Aneurysms: Treatment Lifestyle changes-
stop smoking, dash diet, increase cardiac activity (little)
517
Aneurysms: Treatment Surgery- super asymptomatic or large enough
Dilated aorta section is removed, graft sutured in place
518
Aneurysms: Treatment Endovascular aneurysm repair (EVAR)
Minimally invasive
Catheter threaded through femoral artery, stent and graft placed to support aneurysm
519
Bigger than 3 cm but they wait about 5 cm to intervene
Aneurysms
520
Monitor 6 P’s (bilaterally), BP. Every 30 mins to an hour every 4 hours to assess
Aneurysms
521
Notify physical and anesthesiologist if no pulse
Aneurysms
522
Aortic dissection- tear of the inner lining of the wall and blood flowing in between
Aortic Aneurysm: Complications
523
Rupture—serious complication
Aortic Aneurysm: Complications
524
into retroperitoneal space: if it ruptures
into retroperitoneal space: if it ruptures
525
into thoracic or abdominal cavity:
Massive hemorrhage
Usually don’t make it to the hospital
Medical emergency
526
Do not palpate if seeing a pulsating mass
Aneurysm
527
Monitor for indications of rupture
Cool, Clammy skin. Diaphoresis
Pallor
Weakness
Tachycardia
Hypotension
Abdominal, back, groin, or periumbilical pain
Changes in level of consciousness
Pulsating abdominal mass
527
Sudden severe pain, sharp
Weakened or absent pulse
Decrease of LOC depend son how much it dissects
Aortic Dissection
528
Geriatric- more likely to present with hypotension and vague symptoms
Aortic Dissection
529
Thoracic- tamponade (hypotension, muffled heart sounds
Aortic Dissection
530
Aortic Dissection: Patho
Tear occurs
Blood “tracks” between inner and middle layer
Inner and middle layers separate (dissect)
Systolic pulsation ↑ pressure on damaged area
Further ↑ dissection
May occlude major branches of aorta
531
Aortic Dissection: S/Sx
Pain, Cardiovascular, Neurologic, Respiratory, Geriatric presentation
532
sudden, severe
Something is sharp or tearing in chest
Pain
533
weakened or absent pulses
Cardiovascular
534
decreased LOC
dizziness
syncope
Neurologic
535
dyspnea
Respiratory
536
More likely to present with hypotension and vague symptoms.
Geriatric presentation
537
Aortic Dissection: Complications
Cardiac tamponade, Rupture of Aorta, Occlusion of arterial supply to organs
538
Life-threatening
Blood escapes from dissection into pericardial sac
Hypotension, muffled heart sounds , narrowed pulse pressure
Cardiac tamponade
539
Hemorrhage, can lead to death
Can hemorrhage into mediastinal, pleural, or abdominal cavity, retroperitoneal space
Rupture of Aorta
540
(spinal cord, renal, abdominal)
Occlusion of arterial supply to organs
541
Systolic should be <160 when having an ___
Heart feels like it had to compensate- control hypertension
aneurysm
