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CCM > Cardio-Thoracic Surgery > Flashcards

Cardio-Thoracic Surgery Flashcards

1
Q

which cholesterol is most indicative of coronary disease

A

LDL - low density lipo-protein

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2
Q

***what level do I want my LDL

A

low - under 100

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3
Q

***What level do I want my HDL

A

high - over 50 - increase with exercise

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4
Q

what is first ordered (within 24 hrs) for cardiac patients

A

full cholesterol panel

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5
Q

what happens in coronary artery disease

A

lipids build up in intima lining causing the vessel to get bigger so lumen stays the same, eventually lipids take over obstructing blood flow
at rest lumen is okay
with activity plaques release

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6
Q

how long does it take for plaques to develop

A

develop over time - collateral’s form

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7
Q

what does pt look like when vessel occludes

A

chest pain - hopefully calls 911

rapid respiration’s - SOB - decreased perfusion (body not getting enough oxygen, stimulates sympathetic nervous system)

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8
Q

when do we realize we have coronary artery disease

A

when more than 70% of vessel diameter is decreased

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9
Q

1st trt for suspected coronary artery disease

A

aspirin - chewable baby aspirin 325mg

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10
Q

what does aspirin do

A

prevents platelets from sticking together

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11
Q

when pt gets to ER what do we give to make the vessel wall bigger, initially

A

vasodilator - nitroglycerin under the tongue

oxygen - give 2L

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12
Q

if pt is having an MI what will the EKG show

A

ST changes

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13
Q

**how long do we have to trt pt with EKG changes (MI)

A

90 minutes - to get to cath lab and open up blood vessels

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14
Q

what population are we most worried about having an MI

A

young men - don’t think they’re having an MI - don’t have collateral circulation - die at home
women - don’t have same presentation - blow them off - die at home
men>45
women>55

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15
Q

why do we make a distinction for women >55 being at risk for MI

A

estrogen depletion - heart protecting

risk for promoting growth of breast cancer if given

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16
Q

risk fxrs for heart disease (MI)

A

family hx, diabetes, peripheral arterial disease, family hx of stroke

  • smoking
  • HTN - increases after-load (resistance of the blood vessel)
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17
Q

***total cholesterol should be under

A

200

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18
Q

***triglycerides should be under

A

150

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19
Q

why are HDL’s important

A

carry bad stuff back to liver

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20
Q

what do LDL’s do

A

go into intima lining and narrow blood vessels

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21
Q

tell me about smoking r/t the heart (3 facts)

A

stimulant - makes heart beat harder and faster
potent vasoconstricter - damaged for life**
changes oxygenation

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22
Q

what is a BNP

A

how much stretch is on the heart

in heart failure levels go up

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23
Q

normal BNP that indicates Heart Failure is

A

400

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24
Q

dx studies for suspected MI

A

EKG (ST elevation)
holter monitor (worn for days at home with diary)
stress test (goal HR 140-150) exercise or medication
cardiac cath
echo (u/s) tells ejection fraction (how much blood is pumped with each beat 65-70%)
trans-esophageal echo (requires sedation)
ElectroPhysiology study (cath which stimulates funky rhythm)

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25
Q

***most dx test for an MI

A

**cardiac cath
visualize blood vessels to see damage
not an intervention, diagnostic - doesn’t treat

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26
Q

venous vs arterial catheters in cardiac cath procedure

A

venous catheter - views pressures in heart - system that carries blood back to heart is the only one that allows me in to the heart - great iv for fluids
arterial catheter - goes to coronary artery - hooked to pressure bags to measure BP during procedure

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27
Q

prep for cardiac cath procedure

A

NPO from midnight
baseline HR, Vitals, electrolytes
consent (incl. OR backup)
20 or 18G IV in place

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28
Q

if diabetic what medication must you be off before having cardiac cath procedure

A

metformin - interaction w/dye has potential to shut down kidneys its permanent - at least 24 hrs before and 48 hrs after procedure

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29
Q

post cath please check

A 
peripheral pulses - if no call Dr**
groin (pressure system)
flush with fluids -  if not urinating may have shut down kidneys with the dye
bed-rest for 6 hours, bed is flat
immobilize leg
monitor for bleeding/bruising
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30
Q

what medication may be given to diabetics to protect kidneys in cardiac cath procedure

A

mucomyst - given 24 hrs before and 48 hrs after procedure - protects kidneys

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31
Q

in an MI there is a discrepancy in the

A

oxygen i need vs what i have (supply and demand)

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32
Q

causes of MI

A

atherosclerosis
emboli
blunt trauma
spasm

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33
Q

types of MI

A 
Q wave (at least 1/2 of the size of QRS)
non Q wave
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34
Q

acute MI s/s

A 
chest pain (can be severe)
elephant on chest (can't get a deep breath)
pale/diaphoretic
dyspnea/tachypnea
syncope (dizzy)
n/v
dysrhythmias
35
Q

2 most common dysrhythmias of an MI

A

A Fib

PVC’s

36
Q

dx of MI

A

12 lead EKG

cardiac enzymes

37
Q

can an injury on an EKG be fixed

A

yes (fireman’s hat)

38
Q

what cardiac enzymes do we screen for

A

CPK - can take 8 hrs to show damage

**troponin levels (standard) rise more quickly than CPK

39
Q

goal of mgmt for acute MI

A

improve cardiac output/perfusion (oxygen demand/supply problem)
***pain relief (nitroglycerin sub-lingual)
check for dysrhythmia
slowly increase activity
relieve anxiety
place pt. on beta blockers/ace inhibitors

40
Q

what do we check after giving sub-lingual nitro

A

blood pressure (potent vasodilator) low BP = High HR

41
Q

what does an ace inhibitor do

A

prevent ventricular remodeling

42
Q

what is TPA

A

a potent clot buster - no labs for 48hrs

43
Q

what does heparin do

A

blood moves more smoothly around blockages

44
Q

when must TPA be administered within

A

a 6 hour window from onset of pain

45
Q

what must be in place before administering TPA

A

2 IV lines

46
Q

who can’t have TPA

A

recent surgical procedure

47
Q

what is the same procedure as a cardiac cath but in addition fixes where the blockage is

A

interventional angioplasty

will be on anti-coagulation therapy after the procedure

48
Q

**who would get open heart (indications)

A 
left main coronary occlusion >50%
triple vessel disease
unstable angina pectoris
left ventricular failure
lesions not amenable to PTCA
PTCA failure
chronic stable angina that is refractory to other therapies
49
Q

process during traditional CABG

A 
traditional incision - saw open sternum - open chest
2 catheters into heart (R/L)
cool body to slow HR
hook-up to coronary artery bypass (machine) 
reanastomos vessel (internal mammary)
re-warm body 
defibrillator 
chest tubes
pacer wires
close incision
50
Q

preparing for CABG

A 
NPO before midnight
extensive teaching (ventilator after surgery, weaned in 12 hrs)
wires/tubes hooked up when returns
within 12 hours out of bed
walking within 24 hrs
51
Q

goals post CABG

A

increase blood flow
watch/sternal and leg wound
relieve symptoms

52
Q

what meds must a pt be off of prior to CABG

A

diuretics (few days prior)
aspirin (1 week)
anticoagulants (coumadin)

53
Q

process of MID-CAB surgery

A

small incision
fix vessel while your own heart is still beating
much less invasive
must be certain blood vessels to do it

54
Q

what does MID-CAB stand for

A

minimally invasive direct coronary artery bypass surgery

55
Q

immediate (24hr) post-op care after CABG

A

monitor for hypo/hypertension - want normotensive
assess for dehydration - freq 0.5ml/kg/hr
rewarm pt during 1st 24hrs
wean from ventilator
watch wounds
pain relief
emotional support
increase activity
cough and deep breath w/hug me pillow (incentive spirometer)

56
Q

***most common complication of CABG

A

dysrhythmias - A FIB most common

57
Q

complications of CABG

A 
dehydration - hypovolemia
tamponade
resp insufficiency
renal impairment
gi dysfunction
impaired circulation
infection 
dysrhythmia
pain 
emboli
death
58
Q

sinus Brady

A

HR less than 60, everything else is normal

59
Q

sinus tachy

A

HR above 100

60
Q

what can make your HR go down (brady)

A

sleep
beta blockers
exercise

61
Q

care for pt with Brady

A

give fluids
try atropine
may need pacer

62
Q

what can make your HR go up

A 
exercise
fight or flight/stress
low BP
decreased cardiac output
dehydration
fever
63
Q

care for pt with Tachy

A

**treat the cause
give fluids
possible beta blocker if nothing else has worked

64
Q

SVT

A

HR over 150

65
Q

difference between sinus tach and SVT

A

a narrow QRS complex

66
Q

care for SVT

A

vagal maneuvers
try adenisine 6-12-12
if nothing works do cardio-version

67
Q

how is adenisine given

A

6-12-12

68
Q

what is cardio-version

A

slight sedation

synchronize to QRS - charge machine - defibrillation 50-100 jewels on the QRS

69
Q

difference between cardio-version and defibrillation

A

cardio-version pt is awake - synchronize R waves - less jewels - controlled

70
Q

***trt for v-tach

A

if awake/BP - cardio-vert

if not awake/no BP - defibrillator

71
Q

trt for v-fib

A

give epi

defibrillator

72
Q

trt for a-fib

A

anticoagulation - blood pools

73
Q

a-flutter

A

saw-tooth waves

74
Q

PVC’s (premature ventricular contraction)

A

a heart flutter - extra beat

75
Q

first thing you should think of with a PVC

A

oxygenation and electrolytes

76
Q

1st degree heart block

A

prolonged pr interval

77
Q

2nd degree heart block

A

dropping QRS’s

78
Q

what does QRS mean

A

perfusion

79
Q

2nd degree mobitz II

A

PR gets long stays long and drop a beat

80
Q

2nd degree wenkebach

A

pr gets longer

81
Q

3rd degree heart block

A

p and qrs are not in sync, doing their own thing

82
Q

treatment for 3rd degree heart block

A

pacer

83
Q

who gets an implantable defibrillator

A

pt w/ejection fraction

84
Q

pt with balloon pump - care

A

anti-coagulation
watch wave form to ensure placement of balloon
strict bed-rest with frequent turning
log rolled for turning
peripheral pulses every 30 minutes
experiences decreased pain increased output
monitor for bleeding

CCM (13 decks)

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