Cardiovascular dysfunctions

Question 1

Acute Coronary Syndrome

Answer 1

ACS
UA
NSTEMI
STEMI
MI

Question 2

UA

Answer 2

Unstable Angina

• PCI usually not indicated
• Not candidates for thrombosis

Question 3

NSTEMI

Answer 3

non ST segment elevation MI
ST depression
No thrombolytics
May require PCI

Question 4

STEMI

Answer 4

ST elevation
**Need prompt reperfusion
Assess for thrombolysis PCI or CABG
- Give tPA?

Question 5

MI

Answer 5

Sustained Ischemia

Question 6

Rapid Dx and Management of ACS to reduce complications

Answer 6

O2
ASA
NTG
12 lead EKG
IV access
Serum cardiac biomarkers repeat in 6-12 hrs
CXR
Hx/Risk assessment

Question 7

UA and NSTEMI

Answer 7

Fibrinolytic therapy is not recommended (used to break up clots)
1. Assess Risk
Low: prob no PCI
Intermediate: 1 of the following: CP>20 min, T wave inversion, elevated biomarkers, >70yo = Possible PCI
High: Prompt PCI
2. Tx

Question 8

Assess Risk: Low

Answer 8

No intermediate or high risk features but there is at least one of the following:
new onset of cp not prolonged
nml EKG during cp
nml cardiac biomarkers

Probably NO PCI

Question 9

Assess Risk: Intermediate

Answer 9

1 of the following;
Cp> 20 min
T wave inversion
Q qaves
Elevated cardaic biomarkers
Age>70

POSSIBLY PCI

Question 10

Assess Risk: High

Answer 10

1 of the following:
Angina
Ischemia at rest
CP> 20 min
New ST depression
recurrent angina
CHF s/sx
<40% EF
SBP <100
HR>100 or less than 60
prior CABG 
>75 yo

PROMPT PCI

Question 11

Tx of UA and NSTEMI

Answer 11

1. O2, continuous ECG, monitor, IV
2. ASA, NTG
3. Beta blockers
4. IV NTG, MS
5. Heparin
6. Clopidogrel (plavix), anti-platelets

Question 12

STEMI

Answer 12

Requires reperfusion

Question 13

STEMI assess

Answer 13

Assess R/F complications:
Adv age, DM
Prior MI, 
A Fib, 
AVB
Mitral Valve dysfunction
ST elevation despite reperfusion
Anterior MI
Incr HR
Dec BP
Renal insufficiency

Question 14

STEMI TX

Answer 14

O2, monitor, IV
ASA< NTG, MS
Fibrinolytic or PCI
B Blockers
Heparin
Plavix
ACE-I/ARB
MgSo4
Ca 2+ blocker

Question 15

Possible complications of MI

Answer 15

Arrythmias
Rupture: Papillary muscle, ventricular septal or cardiac
Papillary muscle dysfunction
Ventricular aneurysm
Pericarditis
HF
Pulm Edema
Cardiogenic Shock
Recurrent ischemia

Question 16

Drug of choice for arrhythmias

Answer 16

Amiodorone

Question 17

Pacemaker Indications:

Answer 17

Bradydysrythmias

Tachydysarrythmias

Question 18

Demand Pacemaker

Answer 18

When HR less than “X” the pacemaker will fire

Question 19

Fixed pacemaker

Answer 19

HR set at certain amount

Question 20

Nursing care with pacemaker:

Answer 20

1. Assess pacemaker function
2. Pt teaching
   - keep dry x 1 week
   - take pulse
   - carry pacemaker ID card
   - Avoid direct blows to pacer

Question 21

Implanted Cardiovertor Defibrillator: ICD Indications

Answer 21

1. Survivors of sudden cardiac arrest

2. Documented life threatening medication resistant ventricular dyshythmias

Question 22

With ICD, avoid lifting for ____.

Answer 22

one week

Question 23

When the ICD fires:

Answer 23

Lie down.
If pt has LOC, call 911
Defibrillate with external paddles prn
if fires and not feeling well, contact MD

Question 24

Call the MD within 24 hours of shock and immediately if you experience a second shock in _____ hours

Answer 24

24 hours

Question 25

Have routine ICD checks with MD every _____

Answer 25

2-3 months

Question 26

Structural Defects after Acute MI

Answer 26

Papillary muscle rupture

Ventricular septal rupture

Question 27

Papillary muscle rupture

Answer 27

Mitral regurgitation

Shock and death may occur

Question 28

Ventricular septal rupture

Answer 28

Hypotension
cp
holosystolic murmur