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CCRN > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

S1 heart sound

A

Closure of AV (mitral, tricuspid) valve
Loudest at apex
Beginning of systole

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2
Q

S2 heart sound

A

Closure of semilunar (aortic, pulmonic)
Loudest at base
Beginning of diastole
Louder with PE

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3
Q

S3 heart sound

A

Rush into dilated ventricle

Associated with HF, pulm HTN, cor pulmonale, mitral/aortic/tricuspid insufficiency

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4
Q

S4 heart sounds

A

Caused by atrial contraction into non compliant ventricle

Associated with ischemia, infarct, HTN, vent hypertrophy, aortic stenosis

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5
Q

Pericardial friction rub

A

Due to pericarditis

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6
Q

Murmurs

A

Valvular disease, septal defects

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7
Q

When are coronary arteries perfused?

A

Diastole

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8
Q

Systolic BP is an indirect measurement of?

A

CO and stroke volume

Narrowing pulse pressure often see. With hypovolemia or severe drop of CO

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9
Q

Diastolic BP is an indirect measurement of?

A

systemic vascular resistance

Widening pulse pressure may indicate vasodilation, drop is SVR or severe sepsis

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10
Q

Causes of valvular heart disease

A 
coronary artery disease, ischemia, MI
Dilated cardiomyopathy 
Degeneration 
Bicuspid aortic valve (genetic)
Rheumatic fever
Infection 
Connective tissue disease
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11
Q

Murmurs of insufficiency:

A

Occurs when valve is CLOSED

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12
Q

Murmurs of stenosis:

A

Occurs when valve is OPEN

Chronic problem

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13
Q

Systolic murmurs

A

Semilunar valves are OPEN during systole
Aortic stenosis and pulmonic stenosis
AV valves are CLOSED during systole
Mitral and tricuspid insufficiency
Ventricular septal defect

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14
Q

Diastolic murmurs

A

Semilunar valves are CLOSED during diastole
Aortic and pulmonic insufficiency
AV valves are OPEN during diastole
Mitral and tricuspid stenosis

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15
Q

ECG lead changes & location

A 
II, III, aVF - RCA, interior LV
V1, V2, V3, V4 - LAD, anterior LV
V5, V6, I, aVL - circumflex, lateral LV
V5, V6 > low lateral LV
I, aVL > high lateral LV
V1, V2 - RCA, posterior VL
V3R, V4R - RCA, RV infarct
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16
Q

Treatment of STEMI criteria

A

ST elevation in 2 or more continuous leads OR new onset LBBB
Onset of CP < 12 hours
Chest pain of 30 mins
CP unresponsive to nitro

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17
Q

Inferior MI

A 
RCA occlusion 
ST elevation in II, III, aVF
Associated with AV conduction disturbances, RV infarct, posterior MI
Development of systolic murmur
Tachy
Use BB & NTG with caution!!!
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18
Q

RV infarct

A

30% have of inferior wall MI have RV infarct

S/S - JVD at 45, high CVP, hypotension, Brady, V4R ST elevation

Give - positive inotropes, fluids

Avoid - preload reducers: nitrates, diuretics

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19
Q

Anterior MI

A

LAD occlusion
V1-V4 ST elevation
May develop second degree type 2 or RBBB ***
Systolic murmur
Higher mortality than inferior: HEART FAILURE

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20
Q

Complications of MI

A

Arrhythmias!

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21
Q

Complications of PCI

A

Coronary artery perf
Stent thrombosis **
Stroke
Retroperitoneal bleed **

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22
Q

Vasovagal response during sheath removal

A

Hypotension with/without bradycardia
Absence of compensatory tachycardia
Pallor, nausea, yawning, diaphoresis

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23
Q

Vasovagal management

A

Hold nitrates
Atropine (even if not brady)
IV bolus if unresponsive to atropine

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24
Q

Hypertensive emergency def

A

Elevated BP with evidence of end organ damage

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25
Q

Hypertensive urgency def

A

Elevated BP without evidence of end organ damage

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26
Q

PAD S/S

A

Pain, pallor, pulse absent, paresthesia, paralysis, poikilothermia (loss of hair, glossy)

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27
Q

Ankle-brachial index

A

Normal > 1

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28
Q

Patient care management of PAD

A

Bed in reverse trendelenburg

Do NOT ELEVATE

29
Q

Prolonged QT

A

Causes - drugs (amio, quinidine, haldol, procainimide), electrolyte problems (hypo)

30
Q

Systolic dysfunction

A

EF <40%, problem with ejection

31
Q

Diastolic dysfunction

A

EF >50%, problem with filling

32
Q

Pathophysio of acute decompensated systolic dysfunction

A

CAD, cardiomyopathy, arrhythmia, valvular dysfunction >
Wall motion abnormality, LV unable to eject >
Pulm edema, hypoxemia >
^SVR, vCO >
vBP, ^SVR

33
Q

Pathophysio of HF with diastolic dysfunction

A

HTN, valvular disease, hypertrophic cardiomyopathy >
Stiff LV, impaired filling >
Pulm edema

34
Q

Signs of systolic HF

A

Ejection problem

Dilated LV, valve insufficiency, EF<40, pulm edema, s3, BP norm/low, enlarged on imaging

35
Q

Treatment of systolic HF

A

BB, ACEs/ARB, diuretics, dilators, aldosterone antagonist, positive inotropes

36
Q

Signs of diastolic HF

A

Filling problem

Normal vent size, thick walls or septum, normal EF, pulm edema, s4 with HTN

37
Q

Treatment of diastolic HF

A

BB, ACE/ARB, calcium channel blockers, diuretics, aldosterone antagonist

38
Q

Causes of R sided HF

A

Acute RV infarct, massive PE, septal defects, pulm stenosis/insufficiency, COPD, pulm HTN, LV failure

39
Q

Causes of L sided HF

A

CAD, ischemia, MI, cardiomyopathy, fluid overload, uncontrolled HTN, aortic or mitral stenosis/insufficiency, tamponade

40
Q

S/S of R sided HF

A

Hepatomegaly, splenomegaly, dependent edema, JVD distention, elevated CVP, tricuspid insufficiency, abdominal pain

41
Q

S/S of L sided HF

A

Orthopnea, dyspnea, hypoxemia, tachycardia, crackles, cough, elevated PA, diaphoresis, anxiety

42
Q

Dilated cardiomyopathy

A

SYSTOLIC dysfunction, problem ejecting

Signs - thinning, enlargement of LV, mitral regurg

Symptoms similar to systolic HF

May need VAD or transplant

43
Q

Hypertrophic cardiomyopathy

A

DIASTOLIC dysfunction, problem filling

Signs - increased thickening of muscle and septum

Symptoms similar to diastolic HF - fatigue, dyspnea, CP, palpitations

Increased right of sudden cardiac death ***

44
Q

Causes of cardiogenic shock

A

EXTREME DROP IN STROKE VOLUME secondary to systolic dysfunction

Acute MI, CHF, cardiomyopathy, dysrhythmias, tamponade, papillary muscle rupture (emergency)

45
Q

Compensatory cardiogenic shock

A

Tachycardia, tachypnea, crackles, resp alkalosis, anxiety, JVD, S3, cool skin, decreased UO, NARROW PULSE PRESSURE, BP norm/low

46
Q

Progressive cardiogenic shock

A

Hypotension, worsening tachycardia, oliguria, metabolic acidosis, worse crackles, hypoxemia, skin clammy, lethargy

47
Q

Treatment of cardiogenic shock

A

Identify, manage arrhythmia, repercussions if STEMI, surgery if ruptured papillary or VSD

48
Q

Cardiogenic shock: enhancing pump effectiveness

A

Positive inotropes (Levo, dopamine, dobutamine)

AVOID neg inotropes

Vasodilators may be used in conjunction with IABP

49
Q

Cardiogenic shock: decrease demand

A 
Preload reduction 
After load reduction 
Optimize oxygenation 
Mechanical ventilation 
Treat pain 
IABP short term
VAD for long term
50
Q

VAD used for?

A

LV HF, cardiogenic shock, and cardiac myopathies or those awaiting transplant

51
Q

Benefits of IABP: inflation

A

Increases coronary artery perfusion

Inflates at dicrotic notch of art waveform, beginning of diastole

52
Q

Benefits of IABP: deflation

A

Decreases afterload

Deflates before systole begins

53
Q

Reasons for CABG

A

Chronic angina unresponsive to medical therapy, not candidate for PCI
Left main lesion
3 vessel disease

54
Q

Post op CABG complications

A

Hemodynamic abnormalities, arrhythmia, TAMPONADE, PERICARDITIS, bleeding, pulm, renal, endocrine (BG)

55
Q

Chest tube management of CABG

A

Mediasternal tubes remove serosang fluid for operative site

Pleural remove air, blood, or serous fluid

If output >100 for 2 hours consecutively > stability, correct volume status, blood products

56
Q

Causes of cardiac tamponade

A

Post op surgery, pericarditis, trauma

57
Q

S/S of tamponade

A

Restlessness, agitation, hypotension, increased JVD, equalization of CVP, pulm artery diastolic and PAOP, muffled heart tones, enlarge on imaging

NARROWED PULSE PRESSURE

58
Q

Pulsus paradoxus

A

Excessive drop is SBP during inspiration > with inspiration intrathoracic pressure increases and venous return decreases

Caused by cardiac muscle restriction due to tamponade

59
Q

Etiology of pericarditis

A

Trauma, viral, MI, post op, radiation, Dressler’s syndrome

60
Q

S/S of pericarditis

A

CP, pain worsens with inspiration, dyspnea, low grade temp, increased sed rate, ST elevation in all leads, tamponade

61
Q

Treatment of pericarditis

A

Analgesics, anti inflammatory agents, NSAIDS, steroid, antibiotics, monitor for worsening, constriction, and tamponade

62
Q

Etiology of myocardial contusion

A

TRAUMA - worse outcome than pericarditis, similar to MI, dysrhythmias, death within 48 hrs

63
Q

Signs of cardiac trauma

A

CP, pain worse with inspiration, dyspnea, low grade temp, ST elevation

64
Q

Etiology of aneurysms

A

Arteriosclerosis, HTN, smoking, obesity, bacterial infection, congenital anomalies, trauma, Marfans syndrome

65
Q

Abdominal AA

A

75%

Asymptomatic if small, pulsations in abdominal area, abdominal/low back pain, N/V, shock

66
Q

Thoracic AA

A

25%

Sudden tearing pain in chest radiating to shoulders, back, neck

Cough, dysphagia, dyspnea, dizziness, difficulty walking, widening mediastinum

67
Q

Treatment of aneurysms <5 cm

A

Monitor regularly (US/CT), treat HTN with BB

68
Q

Treatment of aneurysms causing symptoms or >6 cm

A

Surgical repair, aggressive treatment of HTN and HR control

69
Q

Aortic dissection

A

Tear is spiral, sudden or gradual, ascending aorta or aortic arch, life threatening

CCRN (2 decks)

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