Cardio CCRN Flashcards
1
Q
Morphine reduces _______and ________
A
LV preload and LV afterload
2
Q
For a right sided EKG, precordial leads are placed to mirror _____And
A
left side; V7, V8, and V9 can be placed for a posterior view
3
Q
A systolic murmur is auscultated when regurgitant blood flows accross the _______and ________heart valves; It occurs when the ______and _________are closed and the _____ and ______valves are open
A
Mitral and tricuspid; Mitral and tricuspid; aortic; pulmonic
4
Q
In _______shock, the heart is unable pump enough blood to meet the oxygen and metabolic needs of the body
A
Cardiogenic
5
Q
What is the most common cause of Cardiogenic shock
A
CAD (MI)
6
Q
In cardiogenic shock, stroke volume is _______and cardiac output is _________
A
decreased; Decreased
7
Q
In cardiogenic Shock, the inadequate emptying of the ventricle leads to _______(inc/dec) left atrial pressure which inc/dec ________pulmonary venous pressure and this inc/dec pulmonary capillary pressure and ______edema
A
increase; increase; increase; pulmonary
8
Q
In _________shock, there is inadequate volume in the _______space
A
hypovolemic; vascular
9
Q
In -_____________shock there is abnormal placement of distribution of vascular volume
A
Distributive
10
Q
Auscultation heart sounds sequence: All physicians Take money
A
Aortic –> pulmonic –Tricuspid–>Mitral
11
Q
Where are murmurs of the mitral valve are loudest heard at the
A
Apex
12
Q
Mitral valve murmurs heard throughout systole is a______and indicates
A
Pansystolic murmur; Mitral regurgitation
13
Q
Diastolic murmur of the mitral valve is because of
A
Mitral stenosis
14
Q
The sound produced by murmur can be caused by turbulence of_______ _____within the heart. The sound of turbulence are termed ________ when they travel from passage of blood flow across _________heart valves
A
blood flow; murmurs; diseased
15
Q
12 lead EKG changes strongly suggestive of high-risk unstable angina_______
A
ST segment depression
16
Q
These 2 EKG changes are strongly suspicious for MI and suggestive of ST elevation MI : ______ and _______
A
New Left BBB; ST segment elevation
17
Q
When auscultating a heart murmur, the nurse should auscultate by listening in the __________ of the blood flow through the _______
A
direction of blood flow through the valve.
18
Q
Auscultate the Mitral valve at the ______ICS and R/L ______midclavicular line
A
5th; left
19
Q
Auscultate the tricuspid valve at the ______ICS and R/L ______upper /lower________sternal borders
A
5th; left lower
20
Q
Auscultate the pulmonic valve at the ______ICS and R/L ______ sternal border
A
2nd; left
21
Q
Auscultate the aortic valve at the ______ICS and R/L ______ sternal border
A
2nd; right
22
Q
Mitral Regurgitation can be a complication of
A
Myocardial ischemia ; inferior wall MI
23
Q
True of false : A rupture of an unstable plaque causes ACS
A
True
24
Q
True or False: Platelet adhesion leads to platelet aggregation and activation in a ruptured plaque
A
True
25
True of False: Inflammation in the sub endothelial layer of the coronary vessel predisposes an unstable plaque to rupture
True
26
What is the most important determinant of coronary artery blood flow to the myocardial Tissue?
Heart Rate
27
The amount of time in diastole affects coronary
perfusion
28
Afterload is the initial ________that the ______have to overcome to push _______out to the ________ and _______circulatory system
resistance; ventricles; pulmonary and systemic
29
Preload is the degree to which _________ or ______ are stretched by volume before _________
muscle fibers; myocytes; contraction
30
Both preload and after load affect the ______function and _________
LV; Cardiac output.
31
Both ________and ______are cardiac markers found in cardiac muscles and are used to diagnosed MI
Trop I and Trop T
32
What is the degree to which Trop I is considered elevated
>0.4
33
When does Troponin I peaks? When does it begin to increase?
14-18 hours; 3 hours
34
How long does Troponin I stays elevated for
5-7 days
35
When does troponin T begins to increase? how long does it stay elevated for?
3-5 hours: 14-21 days
36
When a segment of the chest wall is not connected to the thoracic cage?
Flail chest
37
Flail chest is fixed to synchronize ________ movement and promote ____exchange
chest wall; air
38
What mode of ventilation is used for flail chest?
Positive pressure ventilation
39
Fluid volume must be carefully controlled to prevent overhydration_______
For flail chest
40
EKG electrodes should be placed directly over
Soft tissues
41
The Intersociety Commission of Heart Disease (ICHD) for pacemaker: Letter I is ________, Letter II ________ and Letter III is ________ The response can be BOVA _____ _____ ____ ___
Chamber paced; Chamber sensed; Mode of response. Both-->None--> Ventricles --> Atrium
42
Sotalol, haloperidol, TCA, erythromycin, procainamide and quinidine, what ECG parameter should be monitored:
QT interval
43
____________decreases the immediate risk of death, MI, and stroke in patients with unstable angina
Low dose ASA
44
Why should CCB avoided in CHF ?
because of their action of reduced cardiac o contraction.
45
First line drugs in the treatment of acute HF? NAB
| And mechanism of action.
NAB
Nitrates: Reduces afterload and improve coronary artery blood flow
ACEI: anagonize the renin angiotensin-aldosterone system which reduces fluid volume overload and afterload.
Betablockers: Decreases myocardial O2 demand
46
5 Ps peripheral thromboembolism
```
Pallor
Pain
Paralysis
Paresthesia
Pulselessness
```
47
A major complication associated with PEEP is terms of Cardiac output is that ____________
reduces CO
48
When should fibrinolytics initiated for STEMI?
within 30 mns of arrival
49
For STEMI, PCI should be done within _____minutes
90
50
2nd degree and 3rd degree AV Block are dysfunctions of the ______. the ______node fails to carry electrical impulses to the ________
AV node; AV noted; ventricles
51
Early ______Shock associated with _____CO and low ______
Septic; High CO; low SVR
52
Low CO and High SVR seen in _______shock
Cardiogenic
53
In hypovolemic states, _________volumes is depleted. Therefore ______and contractility are reduced causes a drop in _____ and _______; Heart rate and _____increase in a compensatory measure to maintain CO, _____- and perfusion
circulating; preload; SV; CO; SVR; MAP
54
Radiologic findings in acute left-sided SYSTOLIC HF includes
```
Enlarged cardiac silhouette
Pleural effusion (bilateral)
```
55
In acute HF, BNP is > ______pg/ml
100
56
Below normal EF in systolic HF is because of impaired _____ ____ caused by loss of (right/left) ______ventricular contractility
forward output; left
57
Pericardial Friction rub is seen in ______
Pericarditis.
58
3 Classic signs of cardiac tamponade is called ______triad and consist of :______, _____ and ______
BECK's ; hypotension, muffled heart sounds; JVD
59
Hypotension in Beck's triad is due to ________ SV
Decreased
60
JVD in Beck's triad is due to impaired ____ _____ to the right heart
Venous return
61
Muffled Heart sounds in Beck's triad is due to _______effusion
pericardial.
62
Cushing's Triad is associated with which condition______
Increased Intracranial Pressure (ICP)
63
3 Classic signs of Cushing's Triad are
Elevated SBP, Bradycardia and a widened pulse pressure
64
Signs associated with meningeal irritation are:
Kernig and Brudzinski's
65
Which 2 IV fluids leave the most fluids in the intravascular space:
NS and LR
66
Since body cells have ______pump to keep salt out, LR and NS which has same concentration of ______ as human body, fluid distribute between the vascular space ______% and the interstitial space ______%
Sodium; sodium; 25% and 75%
67
D51/2NS; D5 1/4NS, D5W, D10W and D5 LR are mostly _____ and would distribute to the ______, ______ and _______spaces with most of the fluids going ________
Water; intracellular, intravascular, and interstitial. Intracellularly.
68
Absolute contraindication for THROMBOLYTIC therapy includes
Head injury within 6 MONTHS
69
Relative contraindication for thrombolytic therapy
GI bleed within 2 MONTHS
70
Vasopressin given in the setting of cardiac arrest as an ______ to _____in the treatment of _____ ______
alternative; epinephrine; ventricular fibrillation
71
Which of the following THROMBOLYTIC agent can be given as a SINGLE BOLUS?________and half life is ____mns. Max dose is
Tenecteplase; 20-24; 50mg
72
Alteplase (tpa) requires how many IV boluses? how many minutes apart
2; 30 minutes apart
73
The sound produced by a heart murmur can be caused by
Turbulence of abnormal blood flow.
74
Abnormal p wave amplitude, or duration may indicated
Atrial hypertrophy or Enlargement
75
SVT is characterized by HR from ______ to ______, Regular rhythm, ______p waves and _______QRS complexes
140-250; hidden; normal
76
Afib is characterized by HR from ____ to ____- with _____rhythm with _____p-waves
160-200; irregular; no
77
What is the goal management of acute pulmonary edema ?
Reduce preload and afterload
78
Morphine causes arterial ______ and veno______ which ______volume of blood returning to the _______ while reducing _______ ventricular resistance.
Vasodilation; venodilation; reduces; heart; left
79
What medicaiton would a STABLE WIDE complex arrhythmias typically respond to: ___________dose is
Lidocaine; 0.5mg/kg; max dose 3mg /kg
80
For patient with a pulse, amiodarone is initially pushed at _______mg over ___minutes followed by IV infusion of ____mg/min for _____hours then ____mg/min for ____hours
150; 10 minutes
1mg/min; 6 hours
0.5mg/min; 18 hours
81
Closure of the AV valves (mitral is _____) (tricuspid is _____) produces which heart sound?
left; right; S1
82
Closure of the ______ and _______valve produced the ______heart sound
pulmonic; aortic; S2
83
When does the S3 sound occurs: __________aka________
during the EARLY ventricular filling phase ; ventricular gallop
84
The S3 is often the first clinical sign of ________
Congestive Heart Failure (CHF)
85
When dose the S4 sound occurs ______________during _________ also known as
During the LATE ventricular filling phase; atrial contraction; atrial gallop
86
Three conditions with S4 heart sounds are
Heart failure, HTN, hyperthyroidism
87
AEDs are designed to identify what 2 rhythms
Ventricular fibrillation
| Pulseless Vtach
88
Three things that SV depends on
preload, afterload, and contractility
89
For hypertensive crisis, _______ infusion is the first drug of choice
Nitroprusside
90
Nitroprusside metabolize to ____________which can lead to change in _______, ______ or death. Monitor______levels.
cyanide: mental status; lactic acidosis ; thiocyanate levels
91
Cyanide toxicity is treated with
Hydroxocobalamin; sodium thiosulfate
92
Half life of Amiodarone is ______and because of that, put patient at risk for _________ and
59 days; hepatotoxicity; pulmonary fibrosis
93
What does the PCWP reflects________and used in the assessment of _____ valve disease
Left atrial pressure; mitral
94
The atria are responsible for about _____% of cardiac output and the ventricles for about _______% of cardiac output
30; 70
95
In which area of the heart would the pulmonary artery catheter most likely cause dysrhythmias?
Right ventricle;
96
When right ventricular waveform is identified, the catheter must be promptly______
repositioned
97
POOR indicators of adequate fluid volume resuscitation
BP and MAP
98
Which class of medications is shown to reduce MORTALITY in patients following an MI:
Beta Blockers
99
Which class of medications is shown to reduce SYMPTOMS in patients following an MI:
loop diuretics; nitrates; digoxin (cardiac glycosides)
100
When is hyperlipidemia a concern? Triglycerides > _______and LDL > ______ HDL < _____
200; 130; 40
101
In cardiac tamponate, other than JVD, hypotension and muffled heart sounds, you should know that there is _______CVP, _______PCWP pressures and _________
elevated CVP; elevated PCWP and Pulsus paradoxus.
102
Aortic dissection is MOST COMMONLY associated with which valvular dysfunction?
Aortic Regurgitation
103
Aortic regurgitation is associated with which other condition:
Chronic HTN, LUPUS, APPETITE SUPPRESSANTS
104
AS a result of aortic regurgitation , the _____ ventricle would _____
left; dilate
105
The MOST COMMON complication with FIBRINOLYTIC therapy is _______and the MOST DANGEROUS complication is _______
Bleeding; cerebral bleeding
106
______are Indicators that reperfusion is occurring
CARDIAC DYSRHYTHMIAS
107
The RCA supplies the _____node in ______percent of all hearts
SA node ; 55%
108
What are the 3 physiological effects of cardiopulmonary bypass:
- Hemodilution
- clotting abnormalities
- third-space fluid shifts
109
What may occur as a side effect of Cardiopulmonary bypass?
Proteinuria
110
What foster third-space fluid shifting into the interstitial spaces?
Decreased level of proteins
111
Why does clotting abnormalities occur in cardiopulmonary bypass machine use? especially_____
Because machine is traumatic to the blood cells; platelets
112
During cardiopulmonary bypass, platelets drop _______ to ____ of the perioperative level
40-50%
113
DVI pacemakers are used to treat clinically significant AV block such as
Second degree AV Block type I
114
EKG changes strongly suggestive of high-risk unstable angina?
ST-segment depression
115
Systolic HF is caused by _______ _____and diastolic HF caused by _____ ______of _____ventricle to ____
impaired contractility; decreased compliance; left; relax
116
BEST medication for a symptomatic bradycardia in a patient with HEART TRANSPLANT ? _______ because they have a ______ _____
ISOPROTERNOL; de-nerved vagus.
117
Indicate of MI: list 4 labs and normal parameters:
- Myoglobin > 225ng
- Troponin I that increased to 0.9 -- 4 hours after symptoms occur
- Troponin T 0.5
- CK >150
118
A patient with accelerated idioventricular rhythm with HR in 70bpm needs immediate _________To allow for _____ ____
Immediate transcutaneous pacing. organ perfusion
119
Drugs that can lead to idioventricular rhtym includes
CCB, Bblockers, TCA, electrolyte imbalances.
120
Characteristic of plaque that is at risk for rupture
location, size of the lipid pool; infiltration of plaque with macrophages.
121
What help differentiate MI from an acute MI
Absence of Q waves; presence of R waves in V leads and general distribution of ST -segment changes.
122
MOST definitive test for dissecting aortic aneurysm____sensitivity and specificity of ____%
MRI; 98
123
Most common finding in a dissecting aortic aneurysm
Leukocytosis and elevated LDH
124
EKG findings in dissecting aortic aneurysm may show
LV enlargement
125
New onset ________ would identify a patient as high risk for having had an ______
MI
126
New onset of LBBB whether Left or right should be assumed to be from an _____until proven otherwise
AMI
127
How do we recognized LBBB
Wide QS complex in V1
Wide R waves
No Q waves in V6, I, aVL
128
ASA prevents _____ ______and inhibit the production of __________ ____ a substance that stimulates _____ ______
platelet aggregation; Thromboxane A2; Platelet aggregation
129
Define pulxus pardoxus and when is it seen?
Drop in systolic BP of at least 10 mmHg with inspiration
130
What are 2 things that causes cardiogenic pulmonary edema?__________ __________ which increases _______ ______pressure
Increased left atrial and left ventricular pressures
131
The MOST common cause of cardiogenic pulmonary edema is
Left Ventricular Failure
132
TOP 3 Major risk factors for NSTEMI
1. High serum cholesterol level
2. HTN
3. DM
4. Cigarette smoking
133
First degree AV block is characterized by
prolonged PR interval
134
Aortic dissection is associated with
HTN
135
The highest incidence of Aortic dissection is seen in ______ ages --- to -- years
men; 50-70
136
Connective tissue disorders associated with Aortic dissection:
Marfan's syndrome
Turner syndrome
Vasculitis
Congenital Aortic valve disease
137
What is the purpose of the IABP counter-pulsation?
Provide mechanical assistance to Left ventricle
138
The IABP work on the principles of
Counter-pulsation
139
In IABP, gas (______or _____) moves back and forth from the IABP console to the IABP ______ causing the balloon to _______and _______
helium; CO2; Catheter; inflate; deflate
140
When does the IABP balloon inflates?__________-increasing ________ _____pressure and ______to the coronary arteries
Ventricular diastole; intra-aortic; blood flow
141
When does the IABP balloon deflates?__________-decreasing ________ _____pressure . This pressure decrease help how?
just prior to ventricular systole; intra-aortic; it decreases the resistance to left ventricular ejection , or afterload.
142
Where does the RCA supply blood to?
RA, RV, AV node in 90% of hearts, inferior and posterior wall of Left ventricle.
143
The anterior wall of the left ventricle is supplied by the _________
LAD
144
Which HF shows signs of hepatic congestion?
Right
145
Signs of Right HF (JEDLA)
JVD: Edema Dependent , liver enlargement; Ascites (JEDLA)
146
Signs of Left HF (REP-DC)
Rales; Edema Pulmonary; Dyspnea; Cough
147
Intracellular leakage of potassium is due to
Hyperkalemia
148
First degree HB caused by: RheuBetCalCAD
Rheumatic heart disease
BetaBlockers
Calcium Channel Blockers
Coronary Artery Disease
149
In initial stage of shock; there are no visible____________; progressive stage of shock, patient is ______ and has inadequate ____ and _____ and ______. Refractory state is ______ _____due to _______damage
signs; patient is unconscious ; BP; pulse; Shallow respirations; imminent death; irreversible
150
Name the 4 stages of shock
initial, progressive, refractory and compensatory
151
Name all the indications for CABG:
- 90% Left main occlusion
- Significant LAD and Left circumflex blockage
- Proximal LAD w/ >75% occlusion, plus another vessel
- Survivors of sudden death with LAD and multi-vessel disease in DIABETICS
152
All postoperative cardiac surgical patients are expected to develop_________because of the _____________- which causes inflammation
PERICARDITIS; pericardiotomy;
153
Digitalis toxicity associated with
sinus arrhythmia
154
Post immediate complications after CABG
Hypertension, dysrhythmias, and bleeding.
155
In the postoperative patient, as hormone kicks in and diuresis occur, what happens to Na+, Mag and Ca2+
They all decrease.
156
Why is BP tend to be elevated in post op CABG patient?
There is elevated SVR, which increases afterload.
157
IABP counterpulsation alters what?
Systemic arterial BP
158
What is the goal of treatment for IABP?
REDUCE assisted systolic pressure
| AUGMENT diastolic pressure.
159
Diastolic augmentation should be ___________because it
maximized; increases coronary artery perfusion
160
Atrial hypertrophy is most commonly associated with which arrhythmia?
Atrial Fibrillation.
161
List the 3 categories of Afib
Paroxysmal
Persistent
Permanent
162
Paroxysmal afib last less than ______Days and often less than ______hours
7; 24
163
Persistent afib last more than ______Days and often require what?
7 ; electrical or pharmacological cardioversion
164
Permanent Afib is ________ AF and is usually present for more than ____year where_____ has failred
Longstanding; 1 year; cardioversion
165
Post heart cath, patient hemorrhaging, name 3 top actions
Keep HOB <30 deg
Compression of artery above incision
Monitor for HYPOTENSION, TACHYCARDIA or arrhythmia
DC heparin.
166
NOT indicated for primary management of acute heart failure is
Calcium Channel Blockers.
167
__________not a symptom of hypovolemic shock
Neurological damage
168
In cardiogenic Shock ( COMD) some causes
Cardiomyopathy
Other cardiac diseases
Myocardial Infaction
Decreased LV function
169
In hypovolemic shock, some causes are
Decreased Intravascular volume
Bleeding
Fluid shifts
Dehydration
170
In Distributive shock, some causes are (VANS)
Vadilation
Sepsis
Neurological damage
Anaphylaxis
171
Set of labs indicative of HF
| Cr is ________, RBC_______ , Albumin ______ , Sodium ________, Potassium ________
elevated, low, decrease, decrease, decrease.
172
Ausculating a murmur at the apex might indicate
Mitral valve defect
173
Murmurs of the Mitral valve are loudest at where? ______
Apex
174
IABP should _______systolic BP and decrease _____ _______
decrease; End diastolic BP
175
A goal of IABP counter pulsation is to maximize ______ ________ _______ pressure
Aortic diastolic augmentation
176
In Neurological control of the heart, Norepinephrine has 2 effects: _____ and _______
Alpha and Beta adrenergic
177
Beta adrenergic would ____________ _____ node discharge.
Increase
178
Alpha adrenergic stimulation causes peripheral arteriol _______
vasoconstriction.
179
A positive chronotropic effect would
increase cardiac myocardial contraction
Increase heart
Accelerate AV conduction time.
180
Bipap delivers continuous ______ airway pressure with different levels for _____ and _______
positive; inspiration; expiration.
181
Pansystolic murmur heard loudest at the apex
Mitral insufficiency or regurgitation
182
When the tricuspid and mitral valves open, there is a rapid filling of blood from the atria into the ventrices. What percentage of blood flills the ventricles during this phase of diastole? __________
80%
183
In fluids given, isotonic NS or LR, which percentage goes to the vascular? what percentage goes into the interstitium?
25% ; 75%
184
What cardiac enzymes stay elevated for 14-21 DAYS?
Troponin T
185
Nitroglycerin should not be used within 24 hours after having used which medication ? Because it is _________
VIAGRA; potent vasodilator.
186
So lactic acidosis is present at the cellular level when the SVO2 drop below how much?
60%
187
normal SVO2 is
60-80%
188
The drop is SVO2 below 60% with a normal arterial saturation indicate
increased tissue extraction
189
The increase in oxygen extraction causes the SVO2 to fall below _______ and then what happens?
60% ; lactic acidosis become present at the cellular level.
190
3 immediate treatment for Ventricular asystole:
CPR
IV epi
Vasopressin
191
Seven days after infarction, acute onset of MR is most likely due to _________ _____ ______, as ventricular dysfunction due to myocardial stunning should be improving rather than becoming acutely worse.
Papillary muscle rupture
192
__________ most commonly occurs in the early post-MI period within 24 to 48 h.
VSR
193
____________ is the recommended treatment for three-vessel coronary disease and cardiogenic shock in the setting of acute myocardial infarction
CABG
