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Clinical Simulation > Cardiovascular Diseases > Flashcards

Cardiovascular Diseases Flashcards

1
Q

Etiology of Chest pain/Myocardial Infarction

A
  • Heart disease
  • Hypertension
  • Thrombus
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2
Q

Primary assessment of Chest pain/Myocardial Infarction

A
  • Past medical history/history of current event (most significant finding)
  • SOB
  • Respiratory pattern
  • Color
  • Breath sounds
  • Physical appearance
  • Vital signs: elevated BP, pulse
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3
Q

Secondary assessment of Chest pain/Myocardial Infarction

A
  • ABG: hypoxemia
  • Electrolytes
  • Special tests
  • Electrocardiogram
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4
Q

Electrolyte - Chest pain/Myocardial Infarction

A

Hyperkalemia or hypokalemia

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5
Q

EKG (Electrocardiogram)- Chest pain/Myocardial Infarction

A

Arrhythmias with significant Q waves and S-T segment changes

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6
Q

Special tests performed for Chest pain/Myocardial Infarction

A
  • Cardiac enzymes (CPK,LDH,SGOT)

- Increased Troponin level

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7
Q

Treatment and management of Chest pain/Myocardial Infarction

A
  • Immediate oxygen therapy at 100%
  • Closely monitor vital signs
  • Drug therapy
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8
Q

Drugs used to treat Chest pain/Myocardial Infarction

A
  • Aspirin
  • Anti-arrhythmic agents (Amiodarone, Atropine-bradycardia, Procainamide)
  • Nitrates for chest pain
  • Maintain BP with fluid or vasopressors (dopamine: increases BP)
  • Defibrillate for pulseless V-tach or fibrillation
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9
Q

Etiology of Congestive heart failure

A
  • MI
  • Ischemic heart disease
  • Cardiomyopathy
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10
Q

Etiology of Cardiogenic Pulmonary Edema

A
  • Increased pulmonary capillary hydrostatic pressure

- -usually due to CHF

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11
Q

Etiology of Non-Cardiogenic Pulmonary Edema

A
  • Increased capillary permeability

- ARDS

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12
Q

Primary assessment of Congestive heart failure/Pulmonary Edema

A
  • Past medical history
  • Cough: Pink frothy secretions
  • Respiratory pattern: Orthopnea
  • Color
  • Diagnostic chest percussion: flat or dull
  • Breath sounds: Crackles, rhonchi
  • Physical appearance: Pedal edema, Venous distention, diaphoresis, anxious
  • Vital signs: tachycardia
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13
Q

Secondary assessment of Congestive heart failure/Pulmonary Edema

A
  • CXR
  • ABG: respiratory alkalosis with hypoxemia
  • Pulmonary Function: reduced volumes and capacities
  • Sputum: pink frothy secretions
  • Electrolytes
  • Hemodynamics
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14
Q

CXR findings in Congestive heart failure/Pulmonary Edema

A
  • Fluffy opacities
  • Butterfly or bat wing pattern
  • Kerley lines
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15
Q

Electrolyte findings in Congestive heart failure/Pulmonary Edema

A

Decreased K+ and Na+

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16
Q

Hemodynamic findings in

A
  • Increased PCWP with CHF

- Increased PAP

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17
Q

Special Tests - Congestive heart failure/Pulmonary Edema

A

Elevated brain natriuretic peptide (BNP) with CHF

  • normal = < 100
  • > 300 = mild heart failure
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18
Q

Treatment and management of Congestive heart failure/Pulmonary Edema

A
  • Immediate O2 therapy at 100%
  • Monitor vitals and place patient in Fowler’s position
  • IPPB with 100% oxygen
  • Drug therapy
  • CPAP to support oxygenation
  • Mechanical ventilation with PEEP for ventilatory failure
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19
Q

Diuretics - Congestive heart failure/Pulmonary Edema

A

To promote fluid excretion

  • Furosemide (Lasix)
  • Bumex
  • Aldactone
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20
Q

Positive inotropic agents - Congestive heart failure/Pulmonary Edema

A
  • Digitalis
  • Digoxin
  • Dopamine
  • Low dose amiodarone
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21
Q

Analgesic/Sedative - Congestive heart failure/Pulmonary Edema

A

Morphine

22
Q

Afterload reduction agents - Congestive heart failure/Pulmonary Edema

A
  • Morphine
  • Nitroglycerin
  • Nitroprusside
  • ACE inhibitors
23
Q

Antidysrhythmic agents - Congestive heart failure/Pulmonary Edema

A

Bradycardia
-Atropine

Tachycardia

  • Procainamide
  • Metoprolol
  • Bretylium
24
Q

Electrolyte replacement - Congestive heart failure/Pulmonary Edema

A
  • Potassium

- Sodium

25
Q

Etiology of Arrhythmias

A
  • Hypoxemia
  • Ischemia
  • Electrolyte imbalance
  • Conduction dysorders
26
Q

Treatment and management of PVC

A

Treat with oxygen and consider possible causes

27
Q

Treatment and management of V-fib and pulseless V-tach

A

Immediate defib

28
Q

Treatment and management of Atrial flutter, fibrillation and V-tach with a pulse

A

-Consider synchronized cardioversion

Not life-threatening

29
Q

Drug therapy for Arrhythmias

A

Anti Arrhythmic agents should be administered as indicated by ECG and bedside assessment

30
Q

Primary assessment of Shock

A
  • Past medical history
  • SOB
  • Respiratory pattern: tachypnea
  • Color
  • Physical appearance: diaphoretic, poor capillary refill
  • Vital signs: tachycardia, hypothermic, hypotensive
31
Q

Secondary assessment of Shock

A
  • ABG: hypoxemia
  • Hemodynamics: Decreased CVP, PAP, PCWP, Cardiac output
  • Urine output: Decreased
32
Q

Hemodynamics - Shock

A

Decreased CVP, PAP, PCWP, Cardiac output

33
Q

Treatment and management of Shock

A
  • Mechanical ventilation for ventilatory failure
  • Drug therapy
  • Treat hypovolemia: IV fluids, blood transfusion
34
Q

Drug therapy for Shock

A
  • Vasopresssors: vasogenic hypovolemia
  • Digitalis, digoxin: heart failure
  • Antibiotics: infection
35
Q

Etiology of Cor Pulmonale

A
  • Increased right ventricular workload as a result of pulmonary hypertension that results in hypertrophy of the right ventricle
  • Often caused by COPD
36
Q

Primary assessment of a patient with Cor Pulmonale

A
  • Past medical history
  • Shortness of breath
  • Appearance of chest: increased AP diameter with obstructive disease
  • Physical appearance: distended neck veins, chest apin, peripheral edema
37
Q

Secondary assessment of a patient with Cor Pulmonale

A
  • Hemodynamics

- Electrocardiogram: Right ventricular hypertrophy

38
Q

Hemodynamics - Cor Pulmonale

A
  • Increased CVP

- Decreased Qt with exercise

39
Q

Treatment and management of Cor Pulmonale

A
  • Oxygen therapy
  • Closely monitor vital signs
  • Treat underlying cause
  • Decrease workload of the right ventricle by lowering PAP
  • Drug therapy
40
Q

Drug therapy used to treat Cor Pulmonale

A
  • Digitalis (Positive inotropic agents)
  • Diuretics
  • Pulmonary vasodilators (nitric oxide)
41
Q

Etiology - Pulmonary Embolism

A

Deadspace condition - ventilation without perfusion

  • Blood clots
  • Fat/Air emboli
  • Fractures
  • Recent Surgery
  • Venous stasis (immobility)
42
Q

Primary assessment - Pulmonary Embolism

A
  • Past medical history
  • SOB
  • Cough: hemoptysis
  • Respiratory pattern: tachypnea
  • Color
  • Breath sounds: wheezing, crackles, pleural friction rub
  • Physical appearance: anxious, diaphoretic
  • Vital signs: tachycardia, chest pain, decreased BP
43
Q

Secondary assessment - Pulmonary Embolism

A
  • CXR
  • ABG: respiratory alkalosis with hypoxemia
  • Sputum: blood tinged
  • Hemodynamics
  • Special Tests
  • Capnography: decreasing PeCO2 with normal PaCO2
  • VD/VT ratio: increased
44
Q

CXR - Pulmonary Embolism

A

May be normal or demonstrate a wedge shaped infiltrate

45
Q

Hemodynamics - Pulmonary Embolism

A

Increased PAP

46
Q

Special Tests - Pulmonary Embolism

A
  • Spiral CT scan
  • V/Q scan (normal V with abnormal Q)
  • Pulmonary angiogram
  • D-dimer
47
Q

Treatment and Management - Pulmonary Embolism

A
  • O2 therapy at 100% to maintain PaO2 > 80 mmHg
  • Closely monitor vital signs and ABG
  • Coagulation studies
  • Drug therapy
  • Active and passive exercises
  • Early ambulation
  • Anti-embolism stockings
  • Intermitten pneumatic compressions devices
  • Surgical options
48
Q

Drug Therapy - Pulmonary Embolism

A
  • Low dose heparin (IV, SQ), warfarin (Coumadin), dicoumarol for anticoagulation
  • Analgesics to relieve chest pain
  • Digitalis, Digoxin to maintain circulation
  • Thrombolytic agents: streptokinase, tPA, urokinase
49
Q

Surgical Options - Pulmonary Embolism

A
  • Emblolectomy
  • Vena cava interruption with sutures
  • Greenfield filter in IVC
50
Q

Secondary Assessment - Peripheral Vascular Disease

A
  • Routinely perform basic lab testing
  • Venography
  • Vascular ultrasound evaluation
51
Q

Treatment and Management - Peripheral Vascular Disease

A

Severe cases: amputation of gangrenous body parts

Less severe: eliminating contributing factors, especially cigarette smoking, and administering various drugs- salicylates and anticoagulants

Clinical Simulation (7 decks)

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