cardiovascular emergencies

Question 1

Aspirin: Indication

Answer 1

New onset chest pain suggestive of acute myocardial infarction. Sign and symptoms suggestive of recent cerebrovascular accident.

Question 2

Aspirin: class

Answer 2

platelet inhibitor, anti inflammatory agent

Question 3

Aspirin: contraindication

Answer 3

Hypersensitivity and is relatively contraindicated in patients with active ulcer disease or asthma.

Question 4

Aspirin: Dosage and administration

Answer 4

81mg-325mg PO

Question 5

Largest artery in the body:

Answer 5

The aorta begins at the top of the left ventricle, the heart’s muscular pumping chamber. The heart pumps blood from the left ventricle into the aorta through the aortic valve. Three leaflets on the aortic valve open and close with each heartbeat to allow one-way flow of blood

Question 6

Layers of the heart:

Answer 6

Pericardium: the membrane enclosing the heart

Fibrous Pericardium: external layer of the pericardium, consisting of dense fibrous tissue.

Parietal Pericardium (parietal layer) : It lines the inner side of the fibrous pericardium and is difficult to separate from the structure.

Space: the potential space between the parietal and visceral layers of the pleura

Visceral Pericardium ( visceral layer) : It adheres to the cardiac surface.

Myocardium (muscle layer)

Question 7

Nitroglycerin: class

Answer 7

Vasodilator

Question 8

Nitroglycerin: Indications

Answer 8

Acute angina pectoris, ischemic chest pain, hypertension, CHF, and pulmonary edema

Question 9

Nitroglycerin: Contraindications:

Answer 9

Hypotension, hypovolemia, syncope, reflex tachycardia, flushing, nausea, vomiting, diaphoresis, and muscle twitching

Question 10

Nitroglycerin: Dosage and administration:

Answer 10

Adult: Tablets: 0.4 mg SL; may repeat in 5 minutes to a maximum of 3 doses
Adult: Paste: 1/2 - 1 inch topical
Peds: not recommended

Question 11

Tricuspid valve:

Answer 11

This valve is located between the right atrium and the right ventricle.

Question 12

Pulmonary valve

Answer 12

The pulmonary valve is located between the right ventricle and the pulmonary artery.

Question 13

Mitral valve

Answer 13

This valve is located between the left atrium and the left ventricle. It has only 2 leaflets.

Question 14

Aortic valve

Answer 14

located between the left ventricle and the aorta.

Question 15

Systolic blood pressure: definition

Answer 15

Is the amount of pressure that blood exerts on vessels while the heart is beating.

Question 16

Pulmonary arteries:

Answer 16

Begins at the right side of the heart and carries oxygen- depleted blood to the lungs

Question 17

Right Coronary artery filling:

Answer 17

supplies blood to the right atrium and right ventricle and, in the most people, the bottom part, or inferior wall, of the left ventricle.

Question 18

Left coronary artery filling:

Answer 18

supplies blood to the left atrium and left ventricle and divides into two major branches, just a short distance from the aorta.

Question 19

Ventricular Tachycardia:

Answer 19

This rhythm usually appears on the monitor as a wide, regular, and very rapid rhythm. Ventricular tachycardia is a poorly perfusing rhythm; patients may present with or without a pulse. Most patients are unconscious and pulseless with this rhythm and defibrillation is needed to ‘stun’ the heart so that the primary pacemaker (usually the S-A node) can take over.

Question 20

Ventricular Fibrillation:

Answer 20

The heart quivers ineffectively and no blood is pumped out of the heart. On the monitor, v-fib will look like a frantically disorganized wavy line.

Question 21

Aortic dissection

Answer 21

a serious condition in which the inner layer of the aorta, the large blood vessel branching off the heart, tears.

Question 22

s/s Aortic dissection

Answer 22

• Sudden severe chest or upper back pain, often described as a tearing, ripping or shearing sensation, that radiates to the neck or down the back
• Sudden severe abdominal pain
• Loss of consciousness
• Shortness of breath (dyspnea)
• Sudden difficulty speaking, loss of vision, weakness or paralysis of one side of your body, similar to those of a stroke (dysarthria)
• Weak pulse in one arm or thigh compared with the other
• Leg pain/Leg paralysis/ difficulty walking

Question 23

Arterioles:

Answer 23

anatomy any of the small subdivisions of an artery that form thin-walled vessels ending in capillaries

Question 24

S/s CHF

Answer 24

• The patient finds it easier to breathe when sitting up
• the patient is agitated
• Chest pain may or may not be present.
• The patient often has distended neck veins
• swollen ankles from dependent edema (backup of fluid).
• accessory breathing muscles of the neck and ribs, reflecting the additional hard work of breathing.
• Skin is usually pale or cyanotic and sweaty
• (crackles)

Question 25

S/s of cardiogenic shock:

Answer 25

• first sign - anxiety or restlessness
• “air hunger.”
• pale, cool, clammy skin
• is greater than 120 beats/min weak ad irregular
• rapid and shallow breathing, nausea and vomiting, and a decrease in body temperature.
• late sign : A systolic blood pressure less than 90mg hg is easy to recognize

Question 26

A mastectomy

Answer 26

surgery to remove a breast. Sometimes other tissues near the breast are also removed

Question 27

Left-sided heart failure:

Answer 27

is a reduction in the output from the left ventricle. The pressure in the left atrium increases as the oxygen-rich blood from the lungs are backed up since the left ventricle is not pushing out this blood fast enough or efficiently.

Question 28

Right-sided heart failure:

Answer 28

is a reduction in the blood output from the right ventricle. The pressure in the right atrium may be decreased, normal or increased depending on the return of blood from the rest of the body.

Question 29

Left-sided heart failure: s/s

Answer 29

• Pitting edema (legs, hands)
  Mild to moderate

- Fluid Retention 
Pulmonary edema (fluid in lungs) and pleural effusion (fluid around lungs)

• Organ enlargement
  Heart

-Neck veins
Mid to moderate raised jugular venous pressure

-Shortness of breath
Prominent dyspnea. Paroxysmal nocturnal dyspnea .

• Gastrointestinal
  Present but not prominate.

Question 30

Right-sided heart failure: s/s

Answer 30

• Pitting edema (legs, hands)
  Moderate to severe
• Fluid Retention
  Abdomen ascites
• Organ enlargement
  Liver. Mild jaundice may be present

-Neck veins
Severe jugular venous pressure. Neck veins visible distended

-Shortness of breath
Dyspnea present but not as prominent

• Gastrointestinal
  Loss appetite, bloating

Question 31

Hypertensive crisis:

Answer 31

systolic blood pressure greater than 140 mm Hg or a diastolic blood pressure greater than 90 mm Hg.

Question 32

Hypertensive crisis: s/s

Answer 32

• severe headache “the worst headache i’ve ever felt”
• cerebral hemorrhage, strong bounding pulse, ringing in the ears, nausea, and vomiting, dizziness, warm skin (dry or moist), nose bleed, altered mental status, sudden development of pulmonary edema.

Question 33

Epigastric area:

Answer 33

Epigastric pain is pain that is localized to the region of the upper abdomen immediately below the ribs

Question 34

S/s of an acute MI:

Answer 34

Onset of pain : Gradual, with additional symptoms
Quality of pain : Tightness or pressure
Severity of pain : Increases with time
Timing of pain: May wax and wane
Region/ radiation: Substernal; back is rarely involved
Clinical signs: Peripheral pulses equal

Question 35

Best position of the hypotensive patient:

Answer 35

Trendelenburg’s position involves lowering the head of the bed and raising the foot of the bed of the patient.
Patient’s who have hypotension can benefit from this position because it promotes venous return.

Question 36

Causes of acute coronary syndrome:

Answer 36

Caused by a blockage in the coronary arteries. Smoking, high blood pressure, high blood cholesterol, diabetes, physical inactivity, being overweight or obese, family history of chest pain, heart disease, or stroke.

Question 37

Angina pectoris:

Answer 37

For a brief time, heart tissues are not getting enough oxygen.
Angina can result from spasm of an artery, it is most often a symptom of atherosclerotics coronary artery disease.

Question 38

Best position of a patient with SOB and hypotension:

Answer 38

fowlers postion