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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

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
Etiology of Arrhythmias
- Hypoxemia - Ischemia - Electrolyte imbalance - Conduction dysorders
26
Treatment and management of PVC
Treat with oxygen and consider possible causes
27
Treatment and management of V-fib and pulseless V-tach
Immediate defib
28
Treatment and management of Atrial flutter, fibrillation and V-tach with a pulse
-Consider synchronized cardioversion Not life-threatening
29
Drug therapy for Arrhythmias
Anti Arrhythmic agents should be administered as indicated by ECG and bedside assessment
30
Primary assessment of Shock
- Past medical history - SOB - Respiratory pattern: tachypnea - Color - Physical appearance: diaphoretic, poor capillary refill - Vital signs: tachycardia, hypothermic, hypotensive
31
Secondary assessment of Shock
- ABG: hypoxemia - Hemodynamics: Decreased CVP, PAP, PCWP, Cardiac output - Urine output: Decreased
32
Hemodynamics - Shock
Decreased CVP, PAP, PCWP, Cardiac output
33
Treatment and management of Shock
- Mechanical ventilation for ventilatory failure - Drug therapy - Treat hypovolemia: IV fluids, blood transfusion
34
Drug therapy for Shock
- Vasopresssors: vasogenic hypovolemia - Digitalis, digoxin: heart failure - Antibiotics: infection
35
Etiology of Cor Pulmonale
- Increased right ventricular workload as a result of pulmonary hypertension that results in hypertrophy of the right ventricle - Often caused by COPD
36
Primary assessment of a patient with Cor Pulmonale
- 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
Secondary assessment of a patient with Cor Pulmonale
- Hemodynamics | - Electrocardiogram: Right ventricular hypertrophy
38
Hemodynamics - Cor Pulmonale
- Increased CVP | - Decreased Qt with exercise
39
Treatment and management of Cor Pulmonale
- Oxygen therapy - Closely monitor vital signs - Treat underlying cause - Decrease workload of the right ventricle by lowering PAP - Drug therapy
40
Drug therapy used to treat Cor Pulmonale
- Digitalis (Positive inotropic agents) - Diuretics - Pulmonary vasodilators (nitric oxide)
41
Etiology - Pulmonary Embolism
Deadspace condition - ventilation without perfusion - Blood clots - Fat/Air emboli - Fractures - Recent Surgery - Venous stasis (immobility)
42
Primary assessment - Pulmonary Embolism
- 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
Secondary assessment - Pulmonary Embolism
- CXR - ABG: respiratory alkalosis with hypoxemia - Sputum: blood tinged - Hemodynamics - Special Tests - Capnography: decreasing PeCO2 with normal PaCO2 - VD/VT ratio: increased
44
CXR - Pulmonary Embolism
May be normal or demonstrate a wedge shaped infiltrate
45
Hemodynamics - Pulmonary Embolism
Increased PAP
46
Special Tests - Pulmonary Embolism
- Spiral CT scan - V/Q scan (normal V with abnormal Q) - Pulmonary angiogram - D-dimer
47
Treatment and Management - Pulmonary Embolism
- 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
Drug Therapy - Pulmonary Embolism
- 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
Surgical Options - Pulmonary Embolism
- Emblolectomy - Vena cava interruption with sutures - Greenfield filter in IVC
50
Secondary Assessment - Peripheral Vascular Disease
- Routinely perform basic lab testing - Venography - Vascular ultrasound evaluation
51
Treatment and Management - Peripheral Vascular Disease
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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