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CCRN - My Flashcards > Cardiology > Flashcards

Cardiology Flashcards

1
Q

S1 Heart Sounds AND where are they loudest?

A

-The “lub” sound created by the closure of the mitral and tricuspid valves
-Loudest at the APEX
-Marks the end of diastole and beginning of systole

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2
Q

S2 Heart Sounds AND where are they the loudest

A

-The “dub” sound created by the closure of the aortic and pulmonic valves
-Loudest at the BASE
-Marks the end of systole and beginning of diastole
-May be louder with pulmonary emboli

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3
Q

S3 Heart Sounds. Normal or Abnormal? What causes an S3 heart sound?

A

-Abnormal! Caused by a rapid rush of blood in to a dilated ventricle, pulmonary HTN, or Cor pulmonale
-Think “KEN-TUC-KEE”

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4
Q

S4 Heart Sounds. Normal or abnormal? What causes an S4 heart sound?

A

-Abnormal! Caused by aortic stenosis, ventricular hypertension, and myocardial ischemia
-Think “TEN-UH-SEE”

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5
Q

Pericardial Friction Rub. What may make it worse?

A

-Due to pericarditis (swelling of the sac around the heart)
-May get worse with deep inspiration

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6
Q

Murmurs of Insufficiency (Regurgitation). Chronic or Acute? Valve opened or closed?

A

-Chronic OR Acute. Occurs when the valve is CLOSED
-MR ASS (Mitral Regurgitation Aortic Stenosis Systole)
-May cause large V waves on PAOP

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7
Q

Murmurs of Stenosis. Chronic or Acute? Valve opened or closed?

A

-Chronic problem. Occurs when the valve is OPEN
-MS ARD (Mitral Stenosis Aortic Regurgitation Diastolic)

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8
Q

Pulse Pressure

A

Systolic - Diastolic = Pulse Pressure
- Normal is 40-06

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9
Q

What does Systolic BP Measure

A

-An indirect measurement of cardiac output and stroke volume

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10
Q

What does diastolic BP Measure

A

-In indirect measurement of systemic vascular resistance (SVR)

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11
Q

When are the coronary arteries perfused?

A

-Diastole!
-Diastole is 1/3 longer than systole

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12
Q

What is a hypertensive EMERGENCY

A

-An acute elevation of BP that shows evidence of end organ damage
-Admit to ICU! Goal to lower BP using Nitroprusside or Labetalol

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13
Q

What is hypertensive URGENCY

A

-An acute elevation of BP with no evidence of end organ damage
-Goal to lower BP using Nitroprusside or Labetalol

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14
Q

What is the greatest risk of a hypertensive emergency or urgency?

A

-STROKE!
-Accelerated HTN = Diastolic >120
-Malignant HTN = Diastolic > 140

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15
Q

Peripheral Artery Disease? What is it? What are some signs/Symptoms? Diagnostic tests?

A

-The narrowing or blockage of the vessels that carry blood from the heart to your peripheral extremities
-Pain, pallor, pulse diminished, poikilothermia, paralysis
-Test with doppler ultrasound or arteriography

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16
Q

What to do for Peripheral Artery Disease?

A

-Do NOT elevate the extremity
-Place bed in reverse Trendelenburg
-Vasodilators (The vessels are narrowed, we want to open them)
-Anti-platelet Agents (tPa)
-Angioplasty

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17
Q

Aneurysm. What is it? When is surgery considered?

A

-Blood filled out pouching in the wall of an artery. The larger it is, the more likely it is to rupture
-Greater the 4cm, surgery indicated

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18
Q

Aneurysm - Abdominal Aortic (75%). Signs and Symptoms?

A

-Pulsations in the abdomen
-Low back pain
-Abdominal pain
-Nausea and vomiting
-Shock

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19
Q

Aneurysm - Thoracic Aortic (25%). Signs and Symptoms?

A

-Widening of mediastinum on chest x-ray
-SUDDEN tearing, ripping pain in chest (may radiate to neck, shoulders, and back)
-Dyspnea, cough
-Dysphagia, hoarseness
-Difficulty walking

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20
Q

Aneurysm Treatment

A
  • LESS than 5cm
    • Monitor regulary (CT, ultrasound)
      -HTN give beta blockers
      -GREATER than 6cm or Causing symptoms
    • Surgical repair!
    • Beta blocker drip (likely Labetalol)
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21
Q

Aortic Dissection. Surgical intervention?

A

LIFE THREATENING! Tear of the aorta leading to bleeding within the aortic wall
-The tear is spiral, can be sudden or gradual. Commonly in the ascending aorta or aortic arch.
-Requires immediate surgical Intervention

22
Q

What part of the heart is most likely to suffer from cardiac trauma?

A

The aortic valve because it is most anterior in the chest

23
Q

Cardiac Trauma - Myocardial Contusion

A

-Damaged blood vessels bleeding in to the heart. WORSE OUTCOMES THEN PARICARDITIS
-ST elevation in the area of the injury

24
Q

Cardiac Trauma - Pericarditis

A

-Swelling and irritation of the thin sac tissue surrounding the heart
-Treat with NSAIDs, steroids, antibiotics
-ST elevation in ALL leads (This differentiates Pericarditis and myocardial contusion)

25
Q

Cardiac Tamponade. What is it? Signs and symptoms?

A

-Abnormal amounts of fluid accumulate in the pericardial sac compressing the heart and leading to a decrease in cardiac output and shock
-Hypotension, increased JVD, Widening of mediastinum on chest x-ray
- Pulseless Paradox
- ** Narrowed Pulse Pressure**

26
Q

Pulseless Paradox

A

Systolic blood pressure drop >12mmHg upon inhalation

27
Q

Coronary Artery Bypass Graft (CABG)

A

-Reroutes blood around blocked or narrowed coronary arteries to improve perfusion
-Patient put in hypothermic state
-Enhance oxygenation by hemodilution (isotonic)
-Stop the heart via cardioplegic agent
-The longer the bypass time, the higher complication rates are

28
Q

Abnormal Heart Symptoms of a CABG procedure

A

Tamponade, Pericarditis

29
Q

Post CABG Chest Tube Considerations

A

-Output > 100mL for 2 consecutive hours requires intervention
-No dependent loops
-Do not clamp unless changing set
-Keep lower than the chest

30
Q

Pacemaker! What do the initials mean?

A
  • First initial - Paced
  • Second initial - Sensed
  • Third initial - Response

Responses:
- I - Inhibits
- D - Inhibits and Triggers
- O - None

31
Q

Heart Failure (Broad Topic)

A
  • Can be acute, chronic, or an acute exacerbation of a chronic condition
  • High intracardiac pressures with decreased output
32
Q

Heart Failure - BNP Lab

A
  • Brain Natriuretic Peptide
  • Released by the ventricles when the ventricular wall is under stress. Attempts to dilate and decrease intr-ventricular pressure
33
Q

Systolic Heart Failure VS> Diastolic Heart Failure

A
  • Systolic: Ejection Fraction of left ventricle is 40% or less. **Problem with ejection
  • Diastolic: Ejection Fraction > 50% or normal. Problem with filling
34
Q

RIGHT sided heart failure - Signs/Symptoms/Causes

A
  • Dependent edema. Venous distention. Elevated CVP/JVD
  • Caused by PE, RV infarct, septal defect, Pulmonary stenosis/insufficiency
  • Right sided HF effects the REST of the body (systems)
35
Q

LEFT sided heart failure - Signs/Symptoms/Causes

A
  • Hypoxemia. Tachycardia. Crackles. Cough. Pink frothy sputum. Elevated PAD/PAOP
  • Caused by fluid overload, chronic HTN, Cardiac tamponade, cardiomyopathy
  • Left sided HF effects the LUNGS
36
Q

Cardiomyopathy - Dilated VS. Hypertrophic

A
  • Dilated: Systolic Dysfunction (Problem ejecting). Thinning/dilation of left ventricle
  • Hypertrophic: Diastolic Dysfunction (Problem filling). Thickening of the heart muscle and septum
    -Increased risk of sudden cardiac death
37
Q

Cardiogenic Shock - The worst presentation of heart failure

A
  • Compensatory mechanisms fail to maintain cardiac output
  • Results in drop in cardiac output that can not adequately perfuse the organs
  • Increased preload and afterload due to vasoconstriction of compensatory mechanisms
38
Q

Ventricular Assist Device (VAD)

A

Helps manage LEFT ventricular heart failure, cardiac myopathy, and cardiogenic shock

39
Q

Intra Aortic Balloon Pump (IABP)

A
  • Helps manage heart failure, cardiomyopathy, and cardiogenic shock
  • INFLATES at the beginning of diastole, noted by the dicrotic notch. Increases coronary artery perfusion
  • DEFLATES at the upward mark on an arterial line pressure wave OR on the upward mark of the R-wave. Decreases afterload
40
Q

Pulmonary Artery Catheter (PAC)
Swan-Ganz Catheter

A

-Used as a diagnostic tool to measure pulmonary artery pressures in the right atrium.
-Pulmonary Artery Systolic Pressure ranges from 20-30
-Pulmonary Artery Diastolic Pressure ranges from 6-12
-For pressure think “quarters over dimes” ie: 25/10

41
Q

Acute Coronary Syndrome Risk Factors - Modifiable and Non-modifiable

A

-Modifiable - Smoking, alc. intake, diet, obesity, hypertension, diabetes, HLD, metabolic syndrome
-Non-modifiable - Age, sex, genetics, family hx

42
Q

Unstable Angina

A

-Troponin Negative! Unpredictable chest pain at rest. Symptoms relieved with nitroglycerin.
-ST depression or T-wave inversion

43
Q

Non-ST Elevation Myocardial Infarction (NSTEMI)

A

-Troponin Positive? Sudden chest pain that is unrelieved with nitroglycerin
-ST depression or T-wave inversion

44
Q

ST Elevated Myocardial Infarction (STEMI)

A

-Troponin Positive! Sudden chest pain that is unrelieved with nitroglycerin
-ST elevation in 2 or more continuous leads

45
Q

Variant Angina aka Prinzmetals

A
  • Troponin negative!
  • ST elevation with symptoms
  • Pain relieved with nitroglycerin
  • Brought on by alcohol, smoking, or cocaine ingestion
  • Give Beta blockers UNLESS this is caused by cocaine use
46
Q

Chest Pain Management - Medications and EKG

A
  • 12 lead EKG STAT and interpreted within 10 minutes
  • Aspitin - Give ASAP and chew it
  • Anti-platelet Agent - Clopidogrel
  • Beta Blocker - Usually metoprolol. Do not give if cause is cocaine
  • Pain management: Nitroglycerin and morphine
  • O2 supplementation if needed
47
Q
  1. STEMI Treatment and Intervention Timing
  2. Door to Balloon Time?
  3. Door to Drug Time?
A

-Requirements: Symptoms new (less than 12 hours). No response to nitro. ST elevation in 2+ continuous leads.New onset BBB
- Reperfusion! Door to balloon within 90 minutes
- Door to drug within 30 minutes (fibrolytic therapy)

48
Q

Sheath Removal Monitoring

A

-Hold for 2 finger widths above insertion site for 20 minutes OR 30 minutes if patient is on anti-platelet drugs
-Retroperitoneal Bleed: Sudden hypotension, sudden severe low back pain. Give fluids and blood products
-Monitor pulses
-Monitor chest pain and ST elevation (This would indicate re-occlusion)

49
Q

Contraindications to Fibrolytic Therapy Post-MI

A
  • Ischemic stroke within the last 3 months
  • Closed head or facial trauma within the last 3 months
  • Active bleeding
  • Prior intracranial hemorrhage
50
Q

Dresslers Syndrome - What is it?

A

Often follows pericarditis. Presents with a Fever

51
Q
A

CCRN - My Flashcards (5 decks)

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