cardio exam Flashcards
Ace Inhibitors
Antihypertensives; end in “pril”
Ex: Lisinopril, Enalapril
Side effects of Ace Inhibitors
A-Angioedema
C-Cough
E-Elevated K+
What is angioedema?
Rapid swelling of deep layers of skin, mucus membranes, and sub q tissues
What are beta blockers?
Antihypertensives; end in “olol”
Ex: Metoprolol, Atenolol
Side effect of beta blockers
Orthostatic Hypotension; teach patient to change positions slowly and to dangle feet on the side of the bed before standing
What is digoxin?
antiarrhythmic
Before giving digoxin:
Check cardiac glycoside (0.5-2.0) and take apical pulse, holding if HR <60
What are some symptoms of dig toxicity?
Vision changes including halos around lights, headache, malaise, insomnia
What is a statin?
Antihyperlipidemic; ending with “statin”
Ex: Simvastatin, Lovastatin
What are patients at risk for with statins?
Rhabdomyolyses (break down of muscle tissue, released into blood stream) and liver issues
When do patients need to take statins?
HS (bedtime)
What is aspirin?
NSAID; treats pain, fever, and can be used as a blood thinner
Who should not take aspirin?
Those at high risk of bleeding and children d/t risk of Reye’s syndrome
S/s of Hyperkalemia (>5)
N/V, fatigue, tingling, elevation of ST segment
Treatment of Hyperkalemia
Dextrose, Insulin, Calcium Gluconate (protects the heart), Kayexalate, Sodium Bicarb
S/s of hypermagnesemia (>2.5)
High magnesium, low symptoms. Drowsiness, decreased HR, BP, RR, bowel sounds, and deep tendon reflexes
s/s of hypomagnesemia (<1.5)
Hyperreflexia, increased hr, bp, shallow respirations, muscle twitching and paresthesia, tetany, seizures, irritability, and confusion
Calcium has relationships with which other electrolytes?
Calcium and phosphorus are inverse, calcium and magnesium rise and fall together
Management of Atrial Fibrillation
A-Anticoagulate
B-Beta Blockers
C-Cardioversion
D-digoxin or antiarrhythmic
What is troponin?
Cardiac Biomarker; indicates if a person is or has recently had an MI. Troponin is released with cardiac muscle damage.
What is Creatine Kinase?
Cardiac Biomarker: enzyme that is released with heart, brain, or skeletal muscle damage. IM injection causes elevation.
What is Creatine Kinase-MB?
Specific to the heart; if it is over 5, the heart has been deprived of oxygen
What is beta natriuretic peptide?
Cardiac Biomarker indicating heart failure. Normal <100. Higher the number the more fluid the pt has built up.
Two types of Premature Ventricular Contractions
Bigeminy-PVC every other beat
Trigeminy-PVC every 3rd beat
Treatments for Supraventricular Tachycardia
Vagal maneuvers, IV adenosine (6mg then 12mg if no change), diltiazem, esmolol, metorprolol
What is Coronary Artery Disease (CAD)?
Build up of plaque in coronary arteries (stable or unstable angina, can cause N/STEMI)
Angioplasty
Thin catheter with balloon inserted into artery; balloon opened to push plaque back
Coronary Artery Bypass Graft (CABG)
Vessel taken from arm or leg and used to bypass blocked artery/vein.
Types of valvular dysfunction:
Aortic regurgitation-blood regurgitates d/t improper closing
Stenosis-hardening of valve
Left sided Heart Failure s/s
JVD, SOB, hypotension, tachycardia, orthopnea, exertional dyspnea, edema in lower extremities, weight gain, increased abdominal girth, pulmonary congestion
S/s of right sided heart failure
JVD, SOB, chest discomfort, S3 murmurs, palpitations, ascites, peripheral edema, enlarged liver and spleen
Types of cardiomyopathy (condition effecting hearts ability to pump)
dilated, hypertrophic, restrictive, arrthymogenic
Pericarditis
Pericardial sac becomes inflamed; can be caused by infections, viruses, cancer, or autoimmune disorders
Hallmark finding of pericarditis
Pericardial friction rub
What is pericardial effusion?
Fluid accumulates in the pericardial sac and compresses the heart causing insufficient cardiac output
3 layers of the heart
endocardium, myocardium, epicardium
What does the atria of the heart do?
Receives blood from the body and lungs
What do the ventricles do?
pumps blood to the body and lungs
SA Node
Body’s pacemaker
If SA node fails,
AV node takes over
Systole of BP
Contraction phase
Diastole
Relaxation phase
What is cardiac output?
Amount of blood ejected from the heart.
Normal is 5-6L/min
Where do you hear pericardial friction rub?
Lt sternal border-it will sound like a grating
Criteria for 1st degree AV block on EKG
P wave longer than .20 seconds
What does atropine do?
Raises the heart rate
How is atropine administered?
1mg every 3-5 min, not to exceed 3 mg
S/s of sinus bradycardia
fatigue, SOB, dizziness, changes in LOC, syncope
S/s of sinus tachycardia
palpitations, dizzy, lightheaded, increased temp, chest pain, dyspnea
Treatment for sinus tachycardia
pt should be on fall precautions; vasovagal maneuvers, then medication (adenosine or beta blocker-such as metoprolol)
What is a Premature Ventricle Contraction (PVC)?
out of sync heart beat
S/s of PVC
sob, anxiety, chest pain, palpatations, light headed
Causes of PVC
potassium, magnesium, thyroid levels
Lifestyle changes for pt with PVC
smoking cessation, minimize alcohol and caffeine, eliminate drug use
What is a premature atrial contraction?
atria gets extra beat-can show on EKG as irregular shaped P wave
Lifestyle changes for pt with first degree AV block
Low cholesterol diet, avoid smoking and alcohol
Atrial Fibrillation
irregular rythmn, no p wave; pt is at risk of stroke and bleeding
s/s of atrial fibrillation
irregular pulse, hypotension, palpitation, high HR, chest pain, SOB
AFib with HR over 100
Rapid ventricular response (RVR)
Atrial Flutter
Saw tooth appearance on EKG; atria beating irregularly
S/s of atrial flutter
lightheadedness, palpitations, SOB, low BP
Supraventricular Tachycardia
Hidden P wave on EKG; Rapid heartrate d/t disrupted electrical impulses in heart
Treatments for SV Tach
vagal maneuver, meds: adenosine, diltiazem (Cardizem), esmolol, metoprolol (Lopressor)
What do calcium channel blockers do?
Prevents calcium from entering certain cells (specifically heart or vessels); relaxes and widens blood vessels, lowers BP, slows down HR
Examples: Diliatezem, “-pines”
Stable angina
Goes away with rest or medication (nitro)
Unstable angina
Does not go away with rest; due to heart muscle not getting the oxygen and blood flow it needs
Nitroglycerin (sublingual) for angina
one dose every 5 minutes if pain does not relieve; up to 3 doses
What is C-reactive protein?
CRP elevates with inflammation in the body
With stress test, the nurse should inform the pt to:
not take beta blockers as it can lower the HR and effect the testing
Normal ejection fraction
65-70%
Treatment for Cardiomyopathy
heart transplant, LVAD, septal myectomy, alcohol septal ablation, ICD
With statins, what bloodwork should be monitored regularly?
Liver enzymes, as statins can be hepatotoxic
When a pt has chest pain unrelieved by nitro and rest, they should
immediately go to the ER
T wave depression on EKG signifies
Ischemia
Remind a pt on nitro to:
keep medicine cool and out of the sun
Do pts with mitral valve prolapse need prophylactic ABX prior to dental work?
no
How to measure pulse pressure?
Subtract diastolic from systolic; normal difference is 40-60
Pulsus paradoxus
decrease of BP and increase of HR with deep breath
Infectious diseases of the heart require
IV antibiotics
Rheumatic endocarditis
infection of the heart most common in school-aged children who have had strep
Infective endocarditis
Common in IV drug users or those with prosthetic heart valves
Complications of pericarditis
pericardial tamponade, pericardial effusion
Myocarditis causes
can be viral, cardiomyopathy, or heart failure
s/s of myocarditis
fever, new heart murmur, tachycardia, cardiomegaly, fatigue, syncope
How are heart infections dx?
blood cultures, CBC, echo, CRP, EKG, Cath, TEE
IUDs and catheters can:
increase the risk of heart infections
Pts with restrictive cardiomyopathy are at risk for:
digoxin toxicity
Meds used to treat heart failure:
Diuretics, ace inhibitors, beta-blockers
What electrolyte imbalance can increase the risk of digoxin toxicity?
Hypokalemia
With lasix, you should review what bloodwork?
renal function (BUN, Creatinine)
What does the failure of the lt ventricle cause?
Blood to back up into pulmonary circulation: pulmonary edema
Treatments for lt ventricle failure pulm edema?
Vasodilators and diuretics
Symptoms of cardiac tamponade
falling systolic BP, low pulse pressure. muffled heart sounds
Primary cause of PVD
atherosclerosis (build up of plaque)
PAD can cause
Acute limb ischemia
6 P’s of PAD
pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia (significant temperature difference from rest of body)
Hs and Ts of sudden cardiac arrest
hypoxia, hypovolemia, hypothermia, hyper/hypokalemia, Hydrogen ion (acidosis), tension pneumothorax, tamponade, toxins, thrombosis
What is BNP?
a neurohormone that helps regulate BP and fluid volume; secreted in response to increased preload. Level higher than 100 suggestive of HF
What is Homocysteine?
An amino acid that is linked to the development of atherosclerosis; high risk of CAD, stroke, and PVD with elevated levels
Hypercalcemia (>10.5)
Decreased HR, BP, RR; heart muscle spasms, muscle weakness, constipation, SOB, Bone pain d/t excess calcium taken from bone
Hypocalcemia (<8.5)
seizure/convulsions, VTach, Prolonged QT/ST segment, vomiting and diarrhea, Trousseau’s, Chovostek’s, Increased clotting time-bleeding risk
