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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
***most dx test for an MI
***cardiac cath visualize blood vessels to see damage not an intervention, diagnostic - doesn't treat*
26
venous vs arterial catheters in cardiac cath procedure
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
27
prep for cardiac cath procedure
NPO from midnight baseline HR, Vitals, electrolytes consent (incl. OR backup) 20 or 18G IV in place
28
if diabetic what medication must you be off before having cardiac cath procedure
metformin - interaction w/dye has potential to shut down kidneys its permanent - at least 24 hrs before and 48 hrs after procedure
29
post cath please check
``` 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 ```
30
what medication may be given to diabetics to protect kidneys in cardiac cath procedure
mucomyst - given 24 hrs before and 48 hrs after procedure - protects kidneys
31
in an MI there is a discrepancy in the
oxygen i need vs what i have (supply and demand)
32
causes of MI
atherosclerosis emboli blunt trauma spasm
33
types of MI
``` Q wave (at least 1/2 of the size of QRS) non Q wave ```
34
acute MI s/s
``` chest pain (can be severe) elephant on chest (can't get a deep breath) pale/diaphoretic dyspnea/tachypnea syncope (dizzy) n/v dysrhythmias ```
35
2 most common dysrhythmias of an MI
A Fib | PVC's
36
dx of MI
12 lead EKG | cardiac enzymes
37
can an injury on an EKG be fixed
yes (fireman's hat)
38
what cardiac enzymes do we screen for
CPK - can take 8 hrs to show damage | **troponin levels (standard) rise more quickly than CPK
39
goal of mgmt for acute MI
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
what do we check after giving sub-lingual nitro
blood pressure (potent vasodilator) low BP = High HR
41
what does an ace inhibitor do
prevent ventricular remodeling
42
what is TPA
a potent clot buster - no labs for 48hrs
43
what does heparin do
blood moves more smoothly around blockages
44
when must TPA be administered within
a 6 hour window from onset of pain
45
what must be in place before administering TPA
2 IV lines
46
who can't have TPA
recent surgical procedure
47
what is the same procedure as a cardiac cath but in addition fixes where the blockage is
interventional angioplasty | will be on anti-coagulation therapy after the procedure
48
****who would get open heart (indications)
``` 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
process during traditional CABG
``` 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
preparing for CABG
``` 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
goals post CABG
increase blood flow watch/sternal and leg wound relieve symptoms
52
what meds must a pt be off of prior to CABG
diuretics (few days prior) aspirin (1 week) anticoagulants (coumadin)
53
process of MID-CAB surgery
small incision fix vessel while your own heart is still beating much less invasive must be certain blood vessels to do it
54
what does MID-CAB stand for
minimally invasive direct coronary artery bypass surgery
55
immediate (24hr) post-op care after CABG
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
***most common complication of CABG
dysrhythmias - A FIB most common
57
complications of CABG
``` dehydration - hypovolemia tamponade resp insufficiency renal impairment gi dysfunction impaired circulation infection dysrhythmia pain emboli death ```
58
sinus Brady
HR less than 60, everything else is normal
59
sinus tachy
HR above 100
60
what can make your HR go down (brady)
sleep beta blockers exercise
61
care for pt with Brady
give fluids try atropine may need pacer
62
what can make your HR go up
``` exercise fight or flight/stress low BP decreased cardiac output dehydration fever ```
63
care for pt with Tachy
**treat the cause give fluids possible beta blocker if nothing else has worked
64
SVT
HR over 150
65
difference between sinus tach and SVT
a narrow QRS complex
66
care for SVT
vagal maneuvers try adenisine 6-12-12 if nothing works do cardio-version
67
how is adenisine given
6-12-12
68
what is cardio-version
slight sedation | synchronize to QRS - charge machine - defibrillation 50-100 jewels on the QRS
69
difference between cardio-version and defibrillation
cardio-version pt is awake - synchronize R waves - less jewels - controlled
70
***trt for v-tach
if awake/BP - cardio-vert | if not awake/no BP - defibrillator
71
trt for v-fib
give epi | defibrillator
72
trt for a-fib
anticoagulation - blood pools
73
a-flutter
saw-tooth waves
74
PVC's (premature ventricular contraction)
a heart flutter - extra beat
75
first thing you should think of with a PVC
oxygenation and electrolytes
76
1st degree heart block
prolonged pr interval
77
2nd degree heart block
dropping QRS's
78
what does QRS mean
perfusion
79
2nd degree mobitz II
PR gets long stays long and drop a beat
80
2nd degree wenkebach
pr gets longer
81
3rd degree heart block
p and qrs are not in sync, doing their own thing
82
treatment for 3rd degree heart block
pacer
83
who gets an implantable defibrillator
pt w/ejection fraction
84
pt with balloon pump - care
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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