Cardiology Flashcards
1
Q
Indications of Reperfusion following PCI or fibrinolysis
A
- Pain cessation
- Reversal of ST segment elevation with return to baseline
- short runs of ventricular tachycardia
2
Q
Anterior Wall MI
A
- Acute Anterior STEMI
- LAD occlusion
- Likely results in ventricular septal defect (VSD)
- Murmur at Left Sternal Border
- ST elevation in V2, V3, and V4
- Rhythm change
- Second degree, Type II heart block possible (Mobitz)
- Medications
- Beta Blocker (cardioselective) beneficial (Metoprolol)
- Anti-platelet (aspirin)
- Anticoagulant (heparin)
3
Q
Propanolol (Inderal)
A
- Beta-adrenergic blocker (NOT cardioselective)
- Affects beta receptors in heart muscle and lung tissue
- More likely to cause bronchoconstriction
4
Q
Second Degree, Type II (Mobitz)
A
- Often develops after acute anterior MI, generally due to occlusion of LAD (left anterior descending artery)
- LAD supplies the HIS-Purkinje system (HIS bundle)
- Conduction disease in HIS bundle is irreversible (not subject to autonomic tone or AV blocking medications)
- Permanent pacemaker indicated
5
Q
Inferior Wall MI
A
- Acute inferior STEMI
- RCA occlusion may result in an RV infarct
- Right Coronary Artery (RCA) occlusion
- Result in papillary muscle dysfunction or rupture of the mitral valve
- Supplies area of the left ventricle where mitral valve is attached
- Acute mitral regurgitation
- Does NOT result in systolic murmur at apex of heart or lung crackles
- RIght-sided ECG may help confirm RV infarct
- Rhythm change
- Due to SA node or AV node ischemia
- Sinoatrial block
- Second degree, type I (Wenkebach)
- Third degree, complete
- Due to SA node or AV node ischemia
- Treatment
- Development of complete heart block : Assess. If serious S/S develop, begin transcutaneous pacing (TCP)
6
Q
Dilated Cardiomyopathy
A
- Results in systolic dysfunction
- ↓ contractility
- Compensatory arterial constriction
- Results in higher left ventricular preload
- Therapy aimed at…
- ↑ contractility
- ↓ afterload (arterial constriction)
- ↓ preload that is too high
7
Q
Electrolytes that may cause QT prolongation
A
- ↓ magnesium
- ↓ potassium
- ↓ calcium
- QT prolongation may result in torsades de pointes ventricular tachycardia
- If self limiting, may result in transient syncopal episode
8
Q
Retroperitoneal Bleeding
A
- Causes signs of hypovolemia and hypovolemic shock
- Complication of a PCI
- Femoral artery access site
- Back Pain
9
Q
Dressier’s Syndrome
A
- Type of pericarditis
- Inflammation of the sac surrounding the heart (pericardium)
- Results after an acute MI
- Believed to be an immune system response after damage to heart tissue or to pericardium
10
Q
Mitral Valve Regurgitation
A
- Murmur at the apex of the heart (midclavicular, 5th ICS)
- Occurs when the valve should be closed
- S/S
- Shortness of breath
- Recurrence of chest pain
- Loud systolic murmur at apex of heart
- Mitral valve should be closed during systole
11
Q
Permanent Pacemaker
A
- First letter indicates chamber paced
- Second letter indicates chamber sensed
- Third letter indicates response to sensing
12
Q
Cardiogenic Shock
A
- Results in ↓ CO with resultant drop in coronary artery perfusion and compensatory vasoconstriction
- IABP therapy
13
Q
Intra Aortic Balloon Pump (IABP Therapy)
A
- Deflation of balloon placed into descending aorta is beneficial
- Deflation = ↓ afterload & ↓ work of the left ventricle
- Inflation of the balloon is beneficial because it “boluses” blood into the coronary arteries
- Inflation = ↑ diastolic augmentation & ↑ perfusion
14
Q
Percutaneous Coronary Intervention (PCI)
A
- Addresses cause of the problem, not only treat signs and symptoms
15
Q
Hypertrophic Cardiomyopathy
A
- Problem with filling
- Diastolic dysfunction
- NOT a problem with ejection, EF is normal
- Drug therapy
- Beta blocker (Metoprolol)
- Decrease heart rate to ↑ filling time
- Beta blocker (Metoprolol)
16
Q
Ventricular Septal Defect (VSD)
A
- Holosystolic murmur @ Left Sternal Border
17
Q
Right Ventricular Infarct
A
- Right-sided ECG may help confirm
- S/S:
- hypotension
- clear lungs
- jugular vein distention (JVD)
18
Q
Acute Inferior STEMI Treatment
A
- Definitive treatment: Emergent PCI
- Fluid administration
- ↑ coronary artery perfusion
- correcting hypotension
- ensure adequate RV preload
- ↑ coronary artery perfusion
19
Q
What medication is contraindicated for a patient with heart failure due to diastolic dysfunction?
A
Digoxin
20
Q
Heart Failure (Diastolic dysfunction)
A
- Problem with FILLING, not ejecting
- S/S
- hypertension
- left ventricular hypertrophy
- EF > 40%
21
Q
Digoxin
A
- Positive inotrope
- ↑ wall stress
- Worsen filling of the left ventricle
22
Q
NYHA Heart Failure Class
A
23
Q
Chronic Right-Sided Heart Failure
A
- Clinical S/S
- Jugular Venous Distention (JVD)
- Peripheral edema
- Abdominal discomfort
- *** JVD occurs in Acute RS HF but not peripheral edema and abdominal discomfort. Those are due to liver engorgment.***
24
Q
Cardiac Tamponade
A
- S/S
- Sudden drop in B/P
- Distended neck veins (JVD)
- Muffled heart tones
- Pulsus paradoxus
- Minimal chest tube output (S/P CABG patient)
- Treatment
- Emergent pericardiocentesis to drain fluid
- Emergent return to OR (S/P CABG patient)
25
Q
Left Ventricular Failure S/S
A
- Bibasilar crackles
- Tachypnea
- Frothy Sputum
26
Q
Pulsus Paradoxus
A
- Systolic pressure that fluctuates with breathing pattern by more than 12 mmHG
- Best seen with arterial line
- Inspiration increases thoracic pressure
- Combined with fluid surrounding the heart in cardiac tamponade, inspiration further decreases venous return to the heart, leading to drop systolic pressure by > 12mmHg during the inspiratory phase
27
Q
Pulsus Alternans
A
- Change in amplitude of the systolic waveform from beat to beat
- Indicative of severe left ventricular failure
28
Q
Pulsus Magnus
A
Bounding pulse
29
Q
Atrial Fibrillation
A
- Even with normal B/P, development of Afib drops CO by 20% to 25%
- loss in “atrial kick” provided by normal sinus rhythm
- Treatment/therapy
- Cardiac glycoside (such as digoxin)
- Weak positive inotrope
- May compensate for loss of atrial kick
- Calcium-channel blockers
- Keep the rate controlled
- Cardiac glycoside (such as digoxin)
30
Q
Left Ventricular Systolic Dysfunction S/S
A
- S3
- Indicative of high left ventricular pressure
- Cough
- Bibasilar crackles
- Sign of pulmonary edema secondary to ↑ left ventricular end diastolic pressure (PAOP)
- EF < 40%
31
Q
Acute Coronary Syndrome
A
- Interventions
- Start fluid bolus
- Give chewable aspirin
- ECG (needed to help make diagnosis)
32
Q
Heart Valves during Systole (left ventricular ejection)
A
Aortic Valve = Open (allowing for ejection)
Mitral Valve = Closed
33
Q
Heart Valves during Diastole (filling)
A
Aortic Valve = Closed
Mitral Valve = Open
34
Q
Dopamine
A
Low dose ( < 10 mcg/kg/min) = Affect mainly beta-1 receptors in the heart, producing a positive inotropic effect
High dose ( > 10 mcg/kg/min) = Stimulates alpha receptors in artiers and causes vasoconstriction
