Cardiovascular Disorders Flashcards
What are the 3 main risk factors for CAD?
Hyperlipidemia, hypertension, and smoking
What are the 3 characteristics of unstable angina?
- new onset with usual activity
- abrupt increase in severity of stable angina
- angina at rest, hard to control w/ drugs developing 1 month post-MI
How high above the isometric baseline must a ST elevation be to be considered a STEMI?
Greater than 1mm
A total occlusion is most likely to result in what type of infarction?
Transmural; all 3 layers of heart are affected
What is the biggest concern with a right coronary artery block?
Heart block d/t SA and AV node being supplied by this artery in MOST hearts
A block in the left anterior descending artery might affect what part of an ECG?
The QRS complex d/t bundle branches being supplied by this artery
A patient will go into emergency surgery if they have a blockage in which coronary artery?
Left main
How long after the onset of a MI is troponin I & T present? How long does it remain elevated?
3 hrs; 1-2 weeks
How long after the onset of a MI is CK-MB present? How long does it remain elevated?
4-8hrs; peaks within 15-24 hrs
True or false; after 4-6 weeks, necrotic tissue will be functional
False; it will heal into scar tissue which will maintain structural integrity, but will not be functional
What are the two zones that surround the zone of infarction?
Injury and ischemia
Ideally, the time from when a MI patient enters the ER and gets to the cath lab should be what?
Less than 90 minutes
What are the 4 objectives of MI treatment
Reduce preload, after load, contractility, and heart rate
Integrilin, Reopro, and Aggrastat belong to what class of drugs?
Glycoprotein IIb/IIIa Inhibitors (anti-thrombolytics)
True or false; GP IIb/IIIa inhibitors are not to be given to STEMI patients
True; they are only for NSTEMI or unstable angina b/c the platelets have not already aggregated in these conditions
What type of patients are ADP receptor inhibitor drugs for?
Patients who have had mechanical devices inserted, like a stent
How long must a patient be on ADPs if they have a drug-eluding stent?
At least one year
What drug antagonizes the effects of heparin ?
Protamine sulfate
What are the four criteria that must be met to be eligible for fibrinolytic therapy?
<12 from onset of chest pain
chest pain unresponsive to SL nitroglycerin
ST segment elevation on 12 lead EKG
no conditions that predispose to hemorrhage
What is the difference between clot plasminogen-specific agents and non-clot specific agents?
Clot plasminogen-specific agents target ALL CLOTS; non-clot specific agents target plasminogen in clots AND circulating blood (not widely used b/c of this)
What are the 3 clot-specific agent?
alteplase (t-PA)
reteplase (r-PA)
tenecteplase (TNKase)
True or false; ventricular dysrhythmias are a sign that reperfusion has not occurred
False; this is expected d/t sudden washing out of anaerobic materials, but it does require immediate defibrillation
If you must place an IV on a fibrinolytic therapy patient, where should you place it?
Into a COMPRESSIBLE blood vessels (no arterial punctures!)
True or false; nurses should be very cautious about using automatic BP cuffs on fibrinolytic therapy patients
True; sudden pressure could cause hematoma
Why might a physician inject dye into the aortic valve during a coronary angiography?
To collect info about the left ventricle
A patient who had a PCI is experiencing back pain, but his insertion site looks okay. What should the nurse suspect?
retroperitoneal bleeding
Which of the following would the nurse not do for a patient who had a PCI; keep the HOB at 30 degrees, give plenty of fluids, keep atropine at the bedside
HOB 30 degrees- HOB should be flat
What is the number one complication of AMI?
ventricular dysrhythmias- can occur immediately after reperfusion
What will most likely be the treatment for an individual with a left main coronary artery occlusion?
CABG
BNP is well correlated with what hemodynamic measurement?
LVEDP (preload)
How does BNP affect preload?
Attempts to reduce it by inhibiting renin and aldosterone secretion, inhibiting sodium retention, and increases GFR
Which drug mimics the actions of BNP?
nesiritide (NATRECOR)
What two things should be limited in the diet of HF patient?
Sodium and fluids
What would a physician test to differentiate between heart failure and pulmonary disease in a patient with acute dyspnea?
BNP
What are the two main risk factors for AAA?
smoking and uncontrolled HTN
Generally, when is surgery recommended for AAA?
When it is greater than 5cm in size, becomes symptomatic, or the person is hemodynamically unstable
Which type of aortic dissection requires emergency surgery?
Proximal/ascending- pt can abruptly die from cardiac tamponade
Which type of aortic dissection is associated with pain between the shoulder blades, in the chest and arms?
Proximal/ascending
Which type of aortic dissection is associated with pain in the abdomen and lower back?
Distal/descending
True or false; aortic dissection may lead to unequal pulses
True
Why would a beta and alpha blocker such as Labetalol be given for aortic dissection?
To reduce the force of blood ejected from the left ventricle on the aorta; reduce contractility
What drug is given post-operatively for a aortic dissection repair?
IV nitroprusside; titrated to decrease afterload/systolic pressure below 120
True or false; aortic dissection often is mistaken for a MI
True; must do CT, TEE, or MRI to diagnose aortic dissection
What are the 3 main risk factors for PAD?
smoker, diabetes, old
The 5 Ps: pulselessness, paraesthesia, pallor, pain, and paralysis are symptoms of what?
PAD
How does claudication progress as PAD worsens?
Starts out w/ pain in legs or buttocks during activity but is relieved at rest; eventually gets worse to the point where pain is experienced at rest, which is a sign of an anoxic limb (emergency!)
What is a normal ABI?
0.9-1.0
The nurse will want to ask the patient to hold their breath and use the bell of their stethoscope when…
They are listening over the carotid artery for a bruit
