Cardiovascular Flashcards

Question

PA waveform

Answer 1

a - left atrial contraction c- Closure of mitral valve v- left ventricular systole; passive left atrial filling during atrial diastole A large "V" wave indicates an increase in left ventricular pressure (e.g., mitral regurgitation)

Answer 2

**60-75%** True mixed venous O2 saturation *Global* balance btw DO2 & VO2 Only obtained from a PA catheter Normal oxygen extraction ratio (O2ER) = 25-30%; 70-75% oxygen still bound to Hgb and returns to the right side of the heart

Answer 3

- Increased O2 supply/delivery - Decreased demand: anesthesia, sedation, paralysis, hypothermia - Decreased extraction at tissue level: early sepsis, cyanide toxicity **Left shift** on oxyhemoglobin dissociation curve "sticky" hgb to O2, alkaLOsis (high pH), hypothermia, decreased 2,3 DPG

Answer 4

- Inefficient O2 supply/demand - Increased metabolic needs: sz, restlessness, shivering, hyperthermia **Right shift** "less affinity" hgb for O2, acidosis (low pH), muscles, increased temperature, increased 2,3 DPG

Answer 5

- Treats refractive cardiac failure and cardiogenic shock until surgery - Increases/augments diastolic BP - Improves coronary blood flow - Improves CO up to 15% - Requires arterial line and EKG signal for time of cardiac cycle - Inserted via femoral artery and tip rests in the descending aorta. - Avoid occluding subclavian, carotid, and renal arteries. **Inflates** at the beginning of the **diastole** when the aortic valve closes at *dicrotic notch* to augment diastolic filling and coronary blood flow. **Deflates** before the beginning of the **systole** *R-wave* of ECG or upstroke of arterial pressure wave - Sudden loss of aortic pressure reduces afterload --> lowers heart work to push blood thus myocardial O2 demand. Contraindications: aortic valve insufficiency/regurgitation, aortic aneurysms, suspected aortic dissection.

Answer 6

- Vasospastic angina - spasms in coronary arteries - Usually during rest; at the same time every day - Results from cold weather, stress, med, smoking, cocaine -Relieved with CCBs, nitrates -Dx with provocative testing & ECG

Answer 7

30 min from door-to-needle

Answer 8

90 min from door-to-open vessel

Answer 9

- 1st negative deflection before QRS - Pathologic: current of necrosis/infarction - Result from the absence of electrical activity - Several hours to develop and rarely goes away - width >30 ms (0.04 sec) - 1 small square; depth >25% of the height of the R wave - If contiguous leads, indicative of myocardial necrosis

Answer 10

- Vasodilator that reduces preload - Decreases myocardia O2 consumption - 0.4 mg SL Q5min X3 (SL, IV titration, transdermal) - Monitor hypotension - HA is common - Careful with Inferior MI or RV involvement - Contraindicated w/ concurrent use of PDE5 inhibitor & RV infarct

Answer 11

Acute impairment of the heart to pump blood effectively d/t: - *decrease in contractility*: acute MI, contusion, myocarditis, acute decompensated HF, drug OD; meds - BB, CCB, barbituates - *impaired filling*: dysrhythmias - electrolyte imbalance, cardiac tamponade, noncompliant ventricles - *impaired emptying*: valvular dysfunction (stenosis/regurg, papillary muscle rupture), ventricular/septal rupture, massive pulmonary embolus, tension pneumothorax, dissecting aortic aneurysm S/S: tachycardia, dysrhythmias, cool/clammy, S3, crackles, JVD, peripheral edema, decreased perfusion - mottled skin, decreased UOP Dx: lactate, ABG, hypoxemia, CXR (pulmonary congestion/edema), elevated troponin, ECG (ST changes + Qwave), Echo (decreased wall motion, valvular abnormality, cardiac tamponade) Hemodynamic values: - Hypotension; decreased MAP <60 - Decreased CO/CI <2L/min/m^2 - Increased preload (CVP/PAOP) (w/ associated pulmonary sx) - Increased SVR >1600 (d/t vasoconstrictive compensatory mechanisms) - Decreased SvO2 <65% Tx: **Oxygen**, CV support (*Vasopressor* to increase MAP & SVR, *Inotropes* - dobutamine to increase contractility, *diuretic and nitro* to decrease preload, *vasodilator* - nitro and Nipride - to reduce afterload), *mechanical support* (IABP, LVAD, Impella), treat the cause

Answer 12

- Compression of the heart d/t fluid in the pericardium - **Beck's Triad**: elevated CVP/JVD, hypotension, muffled heart sounds - Other s/s: tachycardia, wide mediastinum on CXR, sudden drop in chest tube output, **narrowed pulse pressure** (normal 40), **pulsus paradoxes** (>10 drop in BP during inspiration), PEA, electrical tremens - Tx: pericardiocentesis for pericardial effusion, median re-sternotomy for myocardial compression

Answer 13

- Ventricular gallop Rapid rush of blood into the *dilated* ventricle - Early in diastole, right after S2 - Normal in young, high cardiac output, and 3rd trimester of pregnancy - Associated w/ HF; may occur before crackles - Caused by: fluid overload/elevated preload (pulmonary HTN, cor pulmonale; mitral, aortic, tricuspid insufficiency; VSD; cardiomyopathy)

Answer 14

- Atrial gallop Atrial contraction of blood into the *noncompliant* ventricle - Right before S1 - Associated with myocardial ischemia, infarction, HTN, ventricular hypertrophy, and aortic stenosis

Answer 15

- Damage to myofibrils resulting in decreased contractility and systolic dysfunction --> global dilation of the heart chambers - Cardiac remodeling (ACE inhibitor reduces severity) - Tako-tsubo-stress cardiomyopathy - Dx: CXR (cardiomegaly, pulmonary congestion), ECG (afib), echo (decreased ventricular motion, decreased EF, enlarged chambers)

Answer 16

- Hypertrophy of heart muscle, ventricular septum, and walls --> rigid & non-compliant ventricles (diastolic dysfunction) --> *sudden cardiac death* - Mitral regurgitation d/t stretching of papillary muscles and mitral valve; V4, mumur - Decreased CO - Inotropes contraindicated - Tx: BB, CCB, ICD for sudden cardiac death and ventricular arrhythmias, surgical interventions

Answer 17

- HFrEF <40% - AKA "congested heart failure"; acute decompensated HF - Dilated, thin walls; damage to myofibrils; elevated BNP d/t the stretch of ventricles - Increase preload & afterload (CVP/RAP, PAOP, SVR, PVR) - Tx: ACEI/ARBS; Angiotensin receptor blocker/Neprilysin inhibitor (Entreso); Beta blocker; Aldosterone antagonist (spironolactone); hydralazine (afterload reducer) + Isosorbide dinitrate (preload reducer); vasodilator (nitrates)l diuretics; cardiac glycosides (digoxin) - Long-term Tx: biventricular pacing if BBB, cardiac transplant, LVAD/RVAD/BiVAD, (+) inotropes

Answer 18

- HFpEF>40% - Stiff, thickened walls; LV hypertrophy - Tx focus on treating HTN

Answer 19

- Inflammation of pericardial sac - Causes: post-MI, *Dressler's syndrome* (2-12 weeks after MI, caused by an autoimmune response or viral infection), uremic, viral, neoplastic - S/S: sharp stabbing CP; pain better sitting up, worse with coughing; pericardial friction rub; diffuse ST changes on ECG (ST elevation in ALL leads including I & II); pericardial effusion; fever - Tx: pain improved by leaning forward; NSAIDs, Abx, pericardiocentesis, pericardial window

Answer 20

- separation of the layers of the arterial wall --> blood enters btw layers --> expands the tear and creates false lumen - high BP & HR

Answer 21

- Complete perforation of the arterial wall; Medical emergency! - Causes: HTN, pregnancy-induced HTN, atherosclerosis, smoking, COPD, male >65, connective tissue disorders (i.e., Marfan's syndrome), congenital - S/S: sudden, severe, central CP; acute *hypotension*; tachycardia; syncope; shock - Tx: surgery; if high BP - Nipride (watch for thiocyanate toxicity), Beta blocker, CCBs; if low - IV bolus, blood tx

Answer 22

left sternal border, 2nd intercostal space

Answer 23

right sternal border, 2nd intercostal space

Answer 24

Apex Left mid-clavicular, 5th intercostal space

Answer 25

Left sternal border, 4th intercostal space

Answer 26

- Retroperitoneal bleeding - "soft BP" responsive to fluid: tachycardia; late sign - flank ecchymosis (Grey-Turner's sign); assess coags; control bleeding - Monitor renal fxn 2/2 IV dye

Answer 27

- cardioprotective (i.e., metoprolol tartate); reduce arrhythmias - reduce HR & contractility - decrease myocardial O2 consumption

Answer 28

- Used if <40%, new heart failure - decrease intra-cardiac pressures - prevents cardiac remodeling - decrease preload & afterload

Answer 29

- ST elevation in the posterior leads V7-V9 - Reciprocal changes in V1-V2 (ST depression & tall, broad R wave) - RCA or left circumflex occlusion

Answer 30

- associated w/ anterior or inferior wall MI - hemodynamic instability; acute mitral regurgitation --> new LOUD systolic murmur heard loudest at the APEX (left midclavicular line, 5th intercostal) - Dx by Echo - Large "v" waves on PAOP

Answer 31

- Associated with anterior/septal wall MI - O2-rich blood shunts from left to right - S/S: acute SOB, S3, crackles, holosystolic murmur - loudest at the sternal border, 5th intercostal - Falsely elevated CO on PA d/t left to right shunt; increased SvO2 - Large "v" waves in CVP

Answer 32

- Catecholamine that acts on SNS; positive inotropic effect; stimulates B1 and some B2 & alpha - Increase HR, BP, SVR - Monitor for tachyarrhythmias & ventricular ectopy

Answer 33

- Act on alpha and beta 1 - Increase BP - Adverse effects: bradycardia, dysrhythmias, HTN, renal artery vasoconstriction - 1st line for sepsis

Answer 34

- Alpha, Beta 1 & 2 - Increase BP & HR - Adverse effects: tachycardia, arrhythmia, CP, hyperglycemia

Answer 35

- Pure alpha - Increase BP - Adverse effects: reflexive bradycardia, dysrhythmias, HTN, CP

Answer 36

- Positive inotrope; stimulate B1 (some alpha) - Increase CO & HR - Side effects: tachycardia, hypo- or hypertension, ectomy, hypokalemia

Answer 37

- PDE inhibitor - Increase CO, decrease preload; no effect on HR - Vasodilator - Long half-life

Answer 38

- Vasodilator; decrease SVR - antihypertensive - Monitor: hypotension, A-line to titrate, hypoxia d/t intrapulmonary shunt, increased HR from stimulation of baroreceptor, thiocyanate poisoning if given >72hr, methemoglobinemia

Answer 39

"WET LUNGS" - blood backs up to the lungs - Decreased CO/CI - Tachypnea, tachycardia - S3, MVR - Displaced PMI (point of maximum impulse) - 5th ICS, MCL - Crackles, cough, frothy sputum - Increased PAP, PAOP, SVR

Answer 40

"CLEAR LUNGS" - blood backs up to the venous periphery - JVD, increased CVP/RAP - Hepatojugular reflex, elevated LFT, hepatomegaly - Peripheral edema, ascites - Anorexia, N/V - Tricuspid regurgitation

Answer 41

- Diastolic murmur; results in back flow of blood & reduces diastolic pressure --> over time, LV hypertrophy - Causes: chronic HTN, rheumatic heart disease, endocarditis, Marfan's syndrome, idiopathic - S/S: DeMusset sign - head bobbin d/t brisk carotid upstroke, wide pulse pressure (high systolic, low diastolic); "water-hammer" pulse (rapid upstroke & down stroke w/ shorted peak)

Answer 42

- Systolic murmur; pressure gradient between LV & aorta - S/S: HF, SOB, activity intolerance - Tx: surgical valve replacement, TAVR - monitor signs of stroke, femoral access site bleeding, bradycardia & heart block

Answer 43

- Delayed repolarization can cause Torsade de Pointes (polymorphic VT) - QTc >450 msec - Causes: drugs - amiodarone, quinidine, haloperidol, procainamide; electrolytes - hypokalemia, hypocalcemia, hypomagnesemia - Tx: Magnesium sulfate; antiarrhythmic based on the cause

Answer 44

- Monitor signs of re-occlusion: CP, ST elevation → Contact physician - Vasovagal rxn during sheath removal → Atropine, fluids - Retroperitoneal bleeding → fluid, blood products Sudden hypotension, severe lower back pain - Vascular complications → pulse check Complications: - Stent thrombosis - most occurs acutely (w/in 24hrs of stent placement) or subacutely (within the first 30 days) - Retroperitoneal bleed

Answer 45

- A genetic condition in an abnormal conduction pathway between atria & ventricles that allows re-entry of tachycardia to *bypass normal AV node* pathway resulting in SVT or pre-excited AFib. - During SVT: palpitation, dizziness, CP, SOB, and syncope - In SR, short PR interval & delta wave (slow rise of initial upstroke of QRS) Tx: - *Radiofrequency ablation* to eliminate the reentrant pathway - Unstable SVT: *Synchronize cardioversion* or adenosine - Pre-excited afib: *beta-blockers*, amiodarone, procainamide IV - DO NOT give adenosine, digoxin, or CCBs → may enhance antegrade conduction through the abnormal pathway by increasing the refractory period in AV node → VF

Answer 46

- Increase myocardial contractility - Slows conduction of impulses through the AV node - Control ventricular rate in afib or aflutter - Know apical HR & K+ prior to administration b/c hypokalemia increase risk of Digoxin toxicity - Digoxin toxicity: bradycardia, prolonged PR interval - 1st degree AV, prolonged QT, vision changes - yellow halos, N/V, dizziness

Answer 47

- First letter: Chamber paced (A, V, or D) - Second: Chamber sensed (A, V, or D) - Third: Response to sensing (I - inhibits pacing if QRS is sensed, D - Inhibits & triggers, O - none)

Answer 48

- Failure to pace (no spike at all when expected) - Failure to capture (spikes w/o QRS for ventricular packing) - Failure to sense (pacing in native beats)

Answer 49

- Acute BP elevation with organ damage (kidney, retina, heart, brain) - Biggest risk of HTN crisis: STROKE - SBP>180, DBP >120 - BP both arms r/o aneurysm or steal syndrome - 12 lead ECG - Decrease BP by 25% in 1-2 hrs - Beta-blockers (Esmolol, Labetalol - max 300mg total, Metoprolol) -Nitrates (*Nitroprusside* - reduce preload & afterload, assess for Thiocyanate toxicity, mental status change, tachycardia, sz, metabolic acidosis - renal impairment) - CCBs ( Nicardipine, Clevidipine) - Hydralazine

Answer 50

- S/S (6 P's): Pain, Pallor, Pulse - diminished/absent, Paresthesia, Paralysis, Poikilothermia (Chronic) -Dx: Doppler, arteriography - **Ankle-brachial index**: Normal >0.9 Ankle pressure/brachial pressure on the same side - Tx: Do not elevate extremity, Reverse Trendelenburg, Med - vasodilators, antiplatelet, thrombolytic, embolectomy, bypass graft, angioplasty

Answer 51

- Causes: Atherosclerosis, HTN, smoking, obesity, bacterial infxn, congenital abnormalities, trauma, Marfan Syndrome: inherited d/o affective connective tissue - Abdominal Aortic Aneurysms (75%): pulsation in the abdominal area; abdominal or low back pain; N/V; shock - Thoracic Aortic Aneurysms (25%): *sudden tearing/ripping in the chest* that radiates to the shoulders, neck, and back; cough; hoarseness, dysphagia, dyspnea, dizziness; difficulty walking, and speaking; *Widening mediastinum on CXR* - less than 5cm in diameter & no sx: monitor regularly (US or CT); tx HTN - Beta blocker may slow growth - Marfan Syndrome often tx sooner - Thoracic aortic aneurysm causing symptoms >6 cm: surgical repair; aggressive BP & HR control - labetalol gtt - Dissection: SURGERY

Answer 52

- damaged blood vessels bleed into the heart. Worse outcome than pericarditis - S/S similar to MI: CP, dyspnea, low-grade fever, ST elevation in the area of injury, death can occur w/in the first 48 hrs - Aortic valve most risk for trauma - most anterior in the chest

Answer 53

- aka Swan-Ganz - Contraindications: tricuspid/pulmonic prosthetic valve, right heart mass, tricuspid or pulmonic valve endocarditis, LBBB - Waveforms: **a** - upstroke of atrial systole (after PR interval), **c** - often not visible (closure of tricuspid valve for CVP, mitral valve for PAOP), **v** - atrial diastole (after atrial diastole/tricuspid closure, QRS complex)