CMC - miscellaneous Flashcards by Serena Stevens

What is the sign of pulsus paradoxus?

Arterial wave tracing that varies 10+ points with inspiration/exhalation.

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What should be suspected with pulsus paradoxus?

Tamponade

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What organ clears the BNP?

Kidney clearance

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Where should the tip of the IABP be placed for optimal perfusion?

Between 2nd and 3rd intercostal space.

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What does the delta wave represent? Which arrhythmia is it seen in?

Delta wave - seen in WPW. It is the “slurring” upstroke seen before QRS complex that represents early depolarization of part of the ventricles.

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Nipride - arterial or venous vasodilator?

Strong arterial vasodilator (used to reduce afterload.)

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Nitroglycerin - arterial or venous vasodilator?

Venous (use to reduce preload). It will reduce afterload at high doses. However, it will also dilate coronary arteries.

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What is the purpose of spironolactone in systolic CHF?

What is the side effect?

Slows hypertrophy and fibrosis of myocardium.

Hyperkalemia

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Staph in the valves - what is the surgical treatment?

Early surgical debridement/replacement without full course of antibiotics.

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In septic shock, will SvO2 be increased or decreased?

Decreased (hypermetabolic state characterized by increase in metabolic consumption.)

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When a patient is in v-fib, the IABP should be in which mode?

Internal or Pressure support.

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What is obstructive shock?

Blockage in the great vessels leading into or out of the heart. (decreased venous return or excessive afterload. - as caused by dissecting aortic aneurism.)

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ST segment elevation in all heart areas is associated with what condition? What is the treatment?

Pericarditis - NSAIDS

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What type of medication is used in treatment of aortic aneurysm?

calcium channel blocker - Clevidipine

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Is a lack of radial pulses and no pulse oximetry normal in a patient on an LVAD?

Yes this is normal but it is not normal if you can’t auscultate the pump.

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Metformin may increase serum creatinine levels true or false

true

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What type of patient is most at risk for contrast-induced nephropathy?

diabetics, hypertensives, pts with heart failure, pre-existing renal insufficency, pts on nephrotoxic meds (ACE-I, NSAIDS), dehydrated people

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what can happen to people who take metformin whose kidneys are dysfunctional?

lactic acidosis

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Which endocrine disorder may cause a-fib?

hyperthyroidism

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What is normal wedge pressure?

8-12

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What are the absolute contraindications to ablation?

apical thrombus, unstable angina, bacteremia

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hyperphosphatemia will cause what symptoms?

muscle spasm, prolonged QtC, and joint pain.

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PVR

pulmonary vascular resistance

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low magnesium will present how on the EKG?

pronged QT, prolonged PR

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which medicine can cause pulmonary toxicity?

Amiodarone

Which valve is the most common valvular pathologic cause of AFIB?

Mitral valve stenosis

Patients in hypovolemic shock will have mild (acidosis/alkalosis)?

Mild acidosis

How can diuretics hurt a person with restrictive cardiomyopathy?

They lower ventricular filling pressure and can decrease cardiac output.

Why is amiodarone used cautiously in pts with thyroid disease?

It has high iodine content and can cause hypo- and hyper-thyroid I am.

Difference between SCUF, CVVH, and CVVHDF

SCUF-clearance of plasma water only. CVVH-clears solutes(BUN, Cr) CVVHDF-clears solutes and potassium.

Svo2 decrease with:

Increased oxygen consumption and decreased oxygen delivery.

What is the gradient variance?

PAD pressure - PCWP | Gradient above 3 on swan insertion indicates pHTN.

What does the pathological Q wave signify?

A previous infarct.

Inferior Leads

II, III and aVF

Lateral Leads

I, aVL, V5 and V6

Septal leads

V1, V2

Anterior leads

V3 and V4

Lateral leads correlate to which coronary arteries?

Left Circumflex or diagonal of LAD.

Inferior leads correlate to which coronary arteries?

Left circ or RCA

Anterior or septal leads correlate to which coronary artery?

LAD

chest pain, shortness of breath with minimal exertion, and syncope are the classic symptoms of which valvular disorder?

Aortic stenosis

symptoms of PE

Shortness of breath, tachycardia, tachypnea, low O2 sat, dry cough, chest pain, anxiety, dizzness

Mean PAP above 25 on RHC indicated?

Pulmonary hypertension

Why are ACE-I’s withheld from pts receiving CRRT?

They can cause anaphylactic reactions

Shoulder blade pain for patient on an IABP May indicate what?

Poor perfusion to the arterial vessels - balloon removal is indicated.

Cloudy urine can be a sign of what type of AKI? Why?

Intra-renal AKI, proteinuria can cause urinary casts that obstruct the renal tubules.

What is mechanism of action of Isuprel?

Accelerated AV conduction and shortens the QT interval.

Normal QT interval

Less than or equal to 0.12 seconds

When serum albumin is low, serum ______ will be low also. Why?

Calcium - half of total blood calcium is bound to protein (mostly albumin.)

Pts with LVADS have anticoagulation yes or no

Yee (heparin gtt)

Endocarditis usually affects which valve?

Tricuspid valve

P2Y12 drugs are what type of drugs? | Common adverse effect?

Anti-platelet. | Neutropenia

Benzocaine administration can cause what condition, associated with blue coloring, air hunger and decreased spo2?what is the treatment?

Methemoglobinemia | IV methylene blue

Most common cause of sudden cardiac death in those under 30?

A preexisting cardiac abnormality, such as hypertrophic cardiomyopathy.

signs of epidural hematoma (bleeding on the dura between dura mater and skull, increased intracranial pressure) What is the treatment?

``` AMS, confusion, enlarged pupil on one side, severe headache, loss of consciousness followed by a period of alertness, then decreased LOC Clot evacuation (crani) ```

First line treatment for HF with reduced EF?

Ace inhibitors (block angiotensin 2, therefore lowering BP. also, lowers salt and water retention.)

Mechanism of action of amiodarone

Blocks potassium channels.

What is a q wave?

Any negative deflection that precedes an R WAVE.

A serious side effect of amiodarone use that warrants discontinuation is?

Pulmonary fibrosis

First line treatment for symptomatic bradycardia

Atropine

First line treatment for complete heart block

Transcutaneous pacing

What causes prinzmetal’s angina? What is the treatment?

Coronary artery vasospasm - calcium channel blockers.

How can you differentiate between pericarditis and STEMI on EKG?

PR depression is generally transient in pericarditis.

Where to hear the mitral valve?

5th intercostal space in the midclavicular line

In a stable patient with tachycardia, regular QRS, which should be attempted first, Adenosine or Cardioversion?

Adenosine first (6mg bolus, followed by 12 mg if unsuccessful.)

When a patient is on an LVAD, what is the highest priority complication?

Cvp 1 (low circulating volume)

What is normal Vt in a spontaneously breathing person?

5 ml/kg

What’s the difference between peak airway pressure and plateau pressure?

What is the most important safety precaution for a patient with an LVAD?

Always be connected to a power source, never disconnect both batteries simultaneously.