Cardio Vascular Flashcards
Explain S1
Tricuspid and mitral closure heard best at the apex of the heart. This marks the end of diastole and the beginning of systole
Explain S2
Closure of the pulmonic and aortic valve that is heard best at the base of the heart. This is the end of systole and beginning of diastole. S2 can possibly split on inspiration which can cause a RBBB
You hear a loud S2 what could be the answer
Pulmonary embolism.
Auscultation points on the chest
A, P, (E)T, M
Explain what an S3 sound is
Associated with HF and can be heard before crackles S3 a rush of blood into the ventricles. This is heard best at the apex of the heart
Other causes of S3
HF, Cor Pulmonale, pulmonary HTN, M, A,or T insufficiency
Explain S4
Atrial contraction in a non compliant ventricular which is heard best at the apex of the heart.
What is S4 associated with
MI, Infarction, HTN, ventricular hypertrophy, AORTIC stenosis
Pt complaint of pain with deep inhalation
Pericarditis
What is a normal pulse pressure
40-60 mmHg
What is a narrowing pulse pressure
Decrease in systolic pressure or increase in diastolic seen most often in Hypovolemia, drop in CO, or tamponade
Systolic BP is an indirect measurement of what value
CO, Stroke volume
Diastolic BP is an indirect measurement of what value
SVR
Diastolic BP decreases when
Vasodilation, drop in SVR, sepsis
When do the coronary arteries fill
Diastole which is 1/3 longer then systole
A murmur of insufficiency suggests what
The valve is closed and it could be an acute or chronic problem
A murmur of regurgitation suggest what
The same as insufficiency the valves are closed and could be acute or chronic
A murmur of stenosis suggests what
That the valves are open and is a chronic NOT acute pathology
Mitral insufficiency murmur is heard when
Systole (giant V waves on the PAOP)
Mitral stenosis is heard when
Diastole
Aortic insufficiency is heard when
Diastole
Aortic stenosis is heard when
Systole
VSD murmur is heard when and where
Systole, sterna boarder 5th ICS
A papa papillary muscle ruptures. What valve and space do you listen to
Mitral valve and at the apex
Stable angina
Predictable chest pain with fixed or calcified lesions
Unstable angina
Unpredictable CP negative for troponin and positive for ST depression or T wave inversion, may be relieved with nitro
NSTEMI
Troponin positive ST depression or T inversion, unrelieved CP
STEMI
Positive troponin ST elevation in 2 leads and unrelieved CP
Variant or Prinzmetal
Transient ST elevation due to coronary artery spasm that is cyclic or occurs at rest. Troponin negative and nitro relieves CP and ST elevation
TX of CP
ECG within ten minutes, ASA, anticoagulant, anti platelets, beta blockers (unless cocaine induced), preferably cardio selective (metoprolol), nitro, morphine
Changes is II III aVf
RCA inferior LV
Changes in V1 V2 V3 V4
LAD anterior LV
Changes in V5 V6 I aVL
Circumflex lateral LV
Changes in V5 V6
Low lateral LV
Changes in I aVL
High lateral LV
Changes in V1, V2
RCA posterior LV
Changes in V3R V4R
RCA RV
What are signs of reocclusion
CP ST elevation contact physician
During death removal your pt vasovagals what do you do
Fluids and atropine in presents of <90 SBP regardless of HR unless reflex tachycardia
Vado vagel signs
<90 SBP, bradycardia, pallor nausea, yawning, diaphosesis
After sheath removal a pts urine output drops
Suspect RP bleed get fluids and blood ready assess site for active bleed
Fibrinolytic contraindications
Inter cranial hemorrhage, cerebral vascular lesion, cranial neoplasm, ischemic strake within 3 months unless acute stroke within 3 hours, aortic dissection, active bleeding (unless menses), closes head trauma
Your patient has marked elevation in troponin and CK MB after cardiac catheterization what is a possible explanation
Myocardial stunning from reperfusion continue to monitor assuming there are no other re infarcts signs
Reperfusion Arrythmias
VT VF accelerated idioventricular rhythm
A patient has elevated II III and aVF leads what do you expect
Inferior MI
Complication associated with an inferior MI
2nd degree heart block type 1, 3rd degree heart block, sick sinus syndrome, sinus bradycardia, mitral regurgitation, papillary muscle rupture
A patient presents with ST elevation in the 11, 111, and aVF leads. What type of MI is this patient having and what should be avoided
Inferior MI abound NTG and beta blockers
Signs of a right vertical infarct
JVD, high CVP, hypotension, clear lungs, brandy arrhythmia, ST elevation in V4R
What should a nurse expect to do for a patient with ST elevation in V4R
Give fluids and positive inotropes (dig, amino, dobutamine, epi, norepinephrine, glucagon), and avoid diuretics nitrates and be careful with beta blockers
Anterior MI
LAD occlusion as evidence by V1-v4. Higher mortality in heart failure
After an MI in leads V1-v4 a pt develops second degree type 2 heart block
This or a RBBB is an ominous sign Along with a heart murmur is possible
A pt has sustained VT after adenosine administration and is deteriorating. What should a nurse set up for next?
Synchronized cardioversion
Signs of an retroperitoneal bleed
Hypotension and sever lower back pain
After sheath removial your pt complains of severe back pain
Stop anticoagulant. Apply pressure if needed and call dr
Nitro prissier toxicity
Mental status changes, tachycardia, seizures, needing an increased dose, metabolic acidosis
What differentiates HTN crisis vs urgency
Presents of acute end organ damage. Risk of stroke
Name the 6 p’s
Pain, pluslessness, pallor, parenthesis, paralysis, poikilothermia,
What is a normal ankle brachial index
Normal is >1
Management of acute peripheral vascular disease
Bed in reverse trendelenburg but do not elevate the extremity. Medicate with thrompolytics, anticoagulant, antiplatelets and vasodilators
What electrolytes prolong QT
Hypokalemia, hypocalcemia, hypomagnesium
Drugs that prolong QT
Amiondarone, quinidine, haldol, procainamide
Treatment for polymorphic VT
Torsades de pointes
Magnesium
1st initial of a pacer
Chamber paced
2nd initial of pacer
Chamber sensed
3rd initial of pacer
Response
What are the 3 responses possible by a pace maker
I=Inhibits demand
D= inhibits and triggers
O= none
Explain the three pacer malfunctions
Failure to pace (no spike when expected)
Failure to capture (spike and no response)
Failure to sense (pace native beets)
ICD tiered therapy
Shock- defib and cardiovert
Burst- senses tachy and burst more tachy to break rhythm
Brady- paces brady rhythms
A pt with a pacer shows VT on the monitor. The pacer does not correct the rhythm what do you do
Place pads and shock as normal. Do not place them over the pacemaker though
What is acute decompensated heart failure
Abrupt onset requiring hospitalization
Systolic dysfunction ejection fraction
<40%
Diastolic heart failure ejection fraction
EF >50%
What does a high BNP suggest
Stress on the walls of the heart
Primary problem and systolic heart failure
Ejection problem heart can fill okay
Primary problem and diastolic heart failure
Hypertrophied chamber or septum heart can eject OK
Signs of systolic heart failure
Deviated PMI, dilated LV, mitral insufficiency, S3, pulmonary edema, BP normal to low, BNP elevated, large heart on chest x Ray, PMI shift
Treatment for systolic HF
Beta blockers, ACE, ARB, diuretic, dilators, aldosterone antagonists, positive inotropes,
Signs of diastolic heart failure
Thick ventricular wall, normal contractility, normal EF, pulmonary edema, S4 with HTN, BP high, elevated BNP, normal chest x Ray, possible LV hypertrophy pattern on ECG
Treatment for diastolic HF
Beta blockers, ACE ARB, Ca channel blockers, low dose diuretic, aldosterone antagonist
Causes of right sided HF
Acute RV infarct, PE, septal defects, pulmonary stenosis/ insufficiency, COPD, Pulmonary HTN, LV failure
Causes of left sided HF
CAD, ischemia, MI, cardiomyopathy, fluid overload, HTN, Aortic or Mitral stenosis/insufficiency, tamponade
Signs of right sided HF
Hepatomegaly, Splenomegaly, dependent edema, elevated CVP/JVD, tricuspid insufficiency, abd pain
Signs of left sided HF
Orthopnea, dyspnea, tachypnea, hypoxemia, tachycardia, crackles, pink sputum, frothy sputum, elevated PA diastolic and PAOP, diaphoresis, anxiety, confusion
Class 1 HF
HF signs with extraordinary activity
Class 2 HF
Signs of HF with ordinary activity
Class 3 HF
HF symptoms with minimal activity
Class 4 HF
Signs of HF at rest
What is dilated cardiomyopathy
This is a systolic problem. The heart isn’t ejecting enough blood
What is hypertrophy cardiomyopathy
This is a diastolic heart problem. The heart needs help filling
Dilation of the LV May lead to what heart murmur
Mitral regurgitation
S3 and S4 can be heard in what type of cardiomyopathy and heart failure
Hypertrophic and diastolic
Clinical presentation of the compensatory stage of cardiogenic shock
Tachycardia tachypnea crackles mood hypoxemia respiratory alk or early metabolic acidosis anxiety irritability JVD S3 S4 cool skin low urine output narrow pulse pressure BP maintained or lower
Clinical presentation if the progressive stage of cardiogenic shock
Hypotension worsening tachycardia tachypnea oliguria metabolic acidosis worsening crackles and hypoxemia clammy mottled skin worsening anxiety and lethargy
Name positive inotropes
Norepi dopamine 4-10mcg/kg/min dobutamine and milrinone
IABP inflation does what
Increases coronary artery perfusion at the diacritic notch
IABP deflation does what
Decreases after load and deflates at systole. Triggered by R wave or upstroke of a line
What should a nurse expect to do when prepping a pt for a CABG
Hemodilute with isotonic crystalloids
Post CABG complications
Hemodynamic abnormalities arrhythmias Tamponade Pericarditis (Dresslers syndromes) Electrolyte abnormalities bleeding pulmonary renal glycemic control gastrointestinal infection
What is the upper limit for a chest tube to put out after a CABG
> 100 mL in 2 consecutive hours
After valve replacement what is important for a nurse to consider
Avoid dropping preload because a chronic high SBP may lead to hypotension
ASA and clopidogrel
Temporary pacing for arrythmias
Signs of tamponade
Restlessness and agitation hypotension JVD equalization of CVP and pulmonary artery diastolic and PAOP muffled heart tones and enlarging on a xray narrow pulse pressure and pulses paradox
What is pulses paradoxes
> 12mmHg drop in SBP during inspiration
A pt recipes trauma to their chest. Which valve is most likely to be involved
Aortic valve is most superficial
AAA symptoms
Usually asymptotic it pulsating abdomen and and low back pain nausea vomiting and shock
TAA symptoms
Sudden rip or tear pain in chest radiating to shoulders and back cough hoarseness dysphasia dyspnea difficulty walking and speaking dizziness widened mediastinum on X-ray
Heart rhythms that develop from an anterior MI
Second degree type 2 or RBBB
Heart rhythm that develops in inferior MI
2nd degree type 1 3rd degree sick sinus and sinus bradycardia
