Combined Flashcards
1
Q
What are arrythmias?
A
Abnormal heart rhythms
2
Q
What are some Atrial Arrythmias?
A
Sinus tachy
Sinuc Brady
atrial arrythmia
3
Q
What is first priority when assessing arrythmias>
A
ECG
4
Q
What are some physical assessments of arrythmias?
A
Skin
Lung & heart sounds
Heart rate
Pulse & BP
5
Q
What can cardiac arrythmia lead to if left unmanaged?
A
Cardiac arrest
HF
Thrombolytic event ( A-fib)
6
Q
What medications would we use for Sinus Brady?
A
Atropine
Dopamine
Epinephrine
7
Q
What medications would we use for Sinus tachy?
A
Beta Blockers
Calcium Channel Blockers
Adenosine
8
Q
Why would we use vagal maneuver for sinus tachy?
A
Bearing down may slow HR
9
Q
What medications would we use for A-fib?
A
Beta Blockers
Warfarin (for clot prevention)
Amiodarone (to slow rate)
10
Q
What are some procedures that we can do for patients with a-fib?
A
Cardioversion (shock heart back to normal sinus)
Ablation (remove arrythmia causing tissue)
Watchman (For clots)
11
Q
With which sinus arrythmia are patients most likely to receive a pacemaker?
A
Sinus Brady
12
Q
Are pacemakers always permanent?
A
No, Can be permanent or temporary.
Temporary usually after open heart surgery and will be in place for a few days.
13
Q
Explain Cardioversion?
A
Used to treat tachycardia, A-fib.
Delivers synchronized shock to shock heart back into normal sinus rhythm.
14
Q
Explain defibrillation and when we would use it?
A
Used with V-fib, V-tach or SVT - emergency and fatal arrythmia. Will shock heart in an attempt to stop the arrythmia. Not syncronized.
15
Q
What is stable atherosclerosis?
A
Atherosclerosis with blood still being able to push through the vessel.
16
Q
What is unstable stable atherosclerosis?
A
Blood not able to be pushed through vessel and there is risk of the vessel rupturing.
17
Q
What are some complications that can arise from untreated atherosclerosis?
A
HF
MI
Acute Cardiac Death
18
Q
What medications will we use to treat Atherosclerosis?
A
Statins
19
Q
What length (time) of exercise is recommended for Atherosclerosis?
A
Intense 75 min
Moderate 150 min
20
Q
Explain Angina.
A
Disease where chest pain occur because there is a lack of oxygen to the heart muscle. The pain gets worse when there is an increased demand for oxygen to the heart such as with exercise.
With Atherosclerosis it is hard to meet the hearts demand for oxygen due to the narrowing of the vessels.
21
Q
Name some procedures that we use to treat Angina.
A
PCI
Stent
CABG
22
Q
What medications do we use to treat Angina?
A
Nitroglycerin
Beta Blockers
Calcium Channel Blockers
Aspirin
Clopidogrel
Heparin
23
Q
What collaborative problems can arise w/ Angina?
A
Acute coronary syndrome, MI or both
Arrythmias and Cardiac arrest
HF
Cardiogenic Shock - heart cannot push enough blood to perfuse the organs.
24
Q
What is Acute Coronary Syndrome?
A
Range of conditions associated w/ sudden reduced blood flow to the heart.
May lead to an MI.
Applies to patients w/ suspicion or confirmed acute ischemia or infarction.
25
What does an ECG show if we're suspecting an MI?
Wills how location of heart injury.
26
With a thrombus blocking the artery, how fast does injury happen?
Minutes to a few hrs.
27
What are symptoms of an MI?
* Sudden onset - continues despite meds.
* SOB, Tachypnea, dyspnea
* N/V, indigestion (Women in particular)
* anxiety, restlessness, feeling of impending doom, denial.
* Cool, pale skin
* Increased HR, BP, RR
28
What is the first thing we should do w/ suspicion of an MI
Get then patient on a 12 lead ECG
29
What cardiac biomarkers should we assess w/ suspicion of an MI?
Troponin
CK-MB
Myoglobulin.
30
How soon should an ECG be done after the patient present to the E.R w/ suspected MI?
Within 10 min
31
What might the ECG show if a patient is having an MI?
T wave inversion
ST segment elevation
32
After an MI - how soon may we be able to detect Troponin, how long does it stay elevated?
Within a few hrs, elevated 8-10 days
33
What is CK-MB
Cardiac specific for muscle - increased CK-MB is an indication of an acute MI.
34
After an MI - how soon may we be able to detect CK-MB, how long does it stay elevated?
within a few hrs- peaks at 24 hrs
35
After an MI - how soon may we be able to detect Myoglobin, how long does it stay elevated? Is it cardiac specific?
Myoglobin will increase within 1-3 hrs & peak at 12 hrs after an MI.
Myoglobin is not cardiac specific but negative result will rule out an MI.
36
What would be the initial management of an MI?
* Supp. o2
* Aspirin
* Nitroglycerin
* Beta Blockers
* Heparin
* Morphine.
37
Is Morphine the first line of treatment for MI?
No. It used to be, however no anymore.
38
What are some collaborative problems that can arise with an MI?
* Acute Pulmonary Edema
* HF
* Cardiogenic Shock
* Arrythmias and Cardiac Arrest
* Pericardial Effusion and Cardiac Tamponade
39
Explain Pericardial Effusion.
Fluid buildup in the pericardial sac around the heart
40
Explain Cardiac Tamponade.
Fluid buildup is so much that the heart cannot effectively pump.
41
Explain the PCI procedure.
* Procedure to open occluded vessel
* Preferred treatment of MI
* For STEMI patient they will go straight to cath lab
* Door to balloon time <60 min
42
What are Thrombolytics and when would we use them?
Medications that dissolve all clots in the body. We would use Thrombolytics if a PCI procedure is not available or contraindicated.
The vessel will however still remain damaged.
Patient w/ bleeding disorders contraindicated.
43
What are the names of Thrombolytic medications that we would use?
Alteplase
Reteplase
44
What medications would we give to patients with MI?
Aspirin & Clopidogrel
BB
ACE & ARBs
Stool softeners
45
What does all arrythmias cause?
Reduction in CO.
46
What are some adverse symptoms of sinus brady?
SOB, Palpitations
47
What are some adverse symptoms of A-fib?
Clots
48
What are some adverse symptoms of sinus tachy?
Weakness, Palpitations
49
What is the first thing a patient should do if they are experiencing Angina pain?
Stop activities and take NTG.
50
What are some important things to know about the medication Nitroglycerin?
* Vasodilator - increased blood flow to the heart and reduces pain since the pain is a result of impaired oxygen to the heart.
* Should not be given if patient has severe fluid deficit and this may cause severe hypotension & decrease CO.
* Contraindicated w/ Viagra use
51
Why would we give BB to treat Angina?
* Blocks sympathetic stimulation of the heart - reduces HR, BP and contractility which reduces O2 demand.
52
What are the names of the BB usually given to treat Angina?
Metoprolol and Atenolol
53
Why would we give CCB to treat Angina?
* decreases SA & AV node action by lowering HR & Contractility
* Dilates coronary arterioles to decrease O2 demand.
54
What are the names of the CCB's usually given to treat Angina?
Amlodipine & Diltiazem
55
What are some adverse reactions that can happen w/ CCB's?
They can lower BP too much or cause an AV block.
56
What antiplatelets would we give to treat Angina?
Aspirin
Clopidogrel
Ticagrelor
57
What medication should we give in addition to Aspirin to avoid GI upset?
PPI
58
After a patient has had a PCI, what are some adjunct therapies that we would do? Are there any side effects?
Give the patient Glycoproteins IIb/IIIa - this prevent platelet aggregation.
Bleeding is a major side effect of this.
59
What Anticoagulant would we give for Angina, what would be a side effect of this medication?
Heparin.
Side effect : HIT (Heparin Induced Thrombocytopenia) " a reaction to heparin that may result in thrombosis.
60
What determines the severity of an MI?
* Degree of occlusion
* How long since symptoms started
* Advanced age
* Previous Vascular diseases
61
If after taking the ECG, we see that the patient has a STEMI, would we wait for labs such a cardiac biomarkers before proceeding with anything?
No. For STEMI patients they will be sent straight to Cath. lab for a PCI if available.
62
For an unstable angina, what may we see on a ECG?
Inverted T wave.
63
For an NSTEMI - what may we see on the ECG?
ST depression (mild hear attack)
This signifies a partial block of a major coronary artery or blockage of a minor artery. Will be accompanied by positive biomarkers.
64
For an STEMI - what may we see on the ECG?
ST elevation
This signifies acute total occlusion of a coronary vessel.
will be accompanied by positive cardiac biomarkers which will rule in an MI.
65
What patient conditions would contraindicate the use of Trhombolytics?
* CVA
* Intercranial abnormalities
* Recent trauma
* Severe uncontrolled HTN
* Active internal bleeding
* Pregnancy
66
What is the goal of thrombolytic tratment?
Limit MI size
67
When a patient is undergoing a PCI, what approach do we use (location) ?
Usually radial approach, however femoral approach can be used as well.
A small incision is made into the vessels using a needle puncture, guidewire and sheath to provide access to diagnose and treat.
68
Explain PTCA.
Procedure to locate and assess blockage and to determine the extent of collateral circulation along w/ left ventricular function.
69
What does a balloon angioplasty do?
Widens a blocked or narrowed vessel.
70
When placing a stent, what is it normally made out of?
Bare metal or contains medication.
71
What medications should we know, that are used during cardiac catheterization?
* Midazolam (for sedation)
* Fentanyl (for pain)
72
What are the Pro's of PCI over a CABG?
* PCI is faster than a CABG
* Minimally invasive
* Quicker recovery
* Lower complication risk
73
What is the goal of the PCI?
To open arteries to allow blood flow.
74
What are the priorities for post-op PCI patients?
* Monitor for signs of bleeding
* Patient need to lay flat for several hrs after femoral approach
* Angino-seal or vasoseal instead of sheath.
75
What are some complications after a femoral PCI?
Risk of internal bleeding - Retro perineal bleeding. First sign is drop in BP and incr. HR.
76
How often should we check Cardiac Biomarkers?
Q6H - should no increased past highest measured level.
Peak within 12 hrs max
Necrotic cells may make it increase post surgery
77
What would be the reason we would move on from a PCI to a CABG?
* Dissection
* Rupture
* Acute Stent Thrombosis
* Reclusion
* Coronary Spasm
* Bleeding
* Stroke
* Infection
78
How long is Cardiac tissue viable for?
20 min
79
What is Pre-Load?
Stretch of ventricle before contracting
80
What is After- Load?
Resistance against blood that the heart must overcome.
81
What is Ejection Fracture?
Amount ejected from L/ ventricle each contraction.
82
What type of problem is reserved ejection fraction?
Diastolic failure - failure w/ filling
83
What type of problem is reduced ejection fraction?
Systolic failure - failure w/ contraction
84
What is high ejection fraction?
pumping over 70% - Usually due to Hypertrophic Cardiomyopathy.
85
What are some ways that the body compensate for HF?
* Sympathetic response - Incr. HR and force
* Incr. Pre- load - Incr. stretch
Myocardial hypertrophy - Increaser in muscle tissue. This increases the hearts need for oxygen.
86
What are causes of HF?
* CAD
* DM
* HTN
* PAH
* Cardiomyopathy - Dilated and Hypertrophy
87
Explain systolic HF.
L. Ventricle and consequently contraction is impaired. This leads to a reduced ejection fraction (HFrEF) of less than 40%
88
What are causes of Systolic HF?
* CAD
* Volume Overload - due to dilation and regurgitation
* Incr. Afterload ( aortic or pulmonary stenosis)
* arrythmias (due to stretching of nerve fibers)
89
Explain Diastolic HF.
L. ventricle and consequently relaxation/filling is impaired leading to preserved ejection fraction (HFpEF). The heart pumps out normal precent of blood >50% but heart muscle is stiff and non-compliant leading to poor filling of the heart.
90
What are some causes of Diastolic HF?
* Hyper Cardiomyopathy
* Restricted Cardiomyopathy
* Myocardial Fibrosis
* Pericardial constriction
91
What is ADHF?
Acute Decompensated Heart Failure.
Deuteriation of a structure of system previously working w/ help of compensatory mechanisms.
92
What are signs of ADHF?
* Tachypnea and SOB
* Pulm. Edema/ Flash PE
We may need to intubate the patient as this is a medical emergency.
93
Explain Left HF.
2/3 of L sided HF are due to systolic failure (pumping).
This may lead to PE as fluid is backing up into the pulmonary circulation and can consequently lead to right sided HF.
94
Explain Right HF.
Fluid will back up into the systemic circulation as right ventricle is unable to pump blood into pulmonary circulation.
Fluid will back up into the liver leading to Hepatomegaly, the Abdomen leading to Ascites and will increase venous pressure leading to JVD.
It can also eb caused by COPD or Cor Pulmonale.
95
Explain congestive HF.
Usually both L&R sides are failing. This leads to congestion in lungs (PE), Liver (Portal HTN) and Abdomen (Ascites)
96
What labs would we preform w/ HF?
BNP, CNP and Urinalysis
97
What medication do we give for HF?
* Diuretics (monitor lytes)
* ACE (vasodilates - monitor for hypoTN)
* ARBs : alternative to ACE
* BB: In addition to ACE - may take weeks to work
* Ivabrandine : Decreases conduction rate through the SA node - monitor for decreased HR and BP
* Hydralazine : Alternative to ACE - observe for decreased BP
* Digitalis : Improves contractility - monitor for toxicity esp in patients w/ hypokalemia
98
What IV medications would we give for ADHF?
* Dopamine : Vasopressor to incr. BP & Contraction - adjunct to loop diuretics.
* Dobutamine : Given w/ left ventricle dysfunction. Incr. Cardiac contraction and renal perfusion - stronger heart contraction.
* Milrinone : Decreases pre-load and afterload - causes hypotension and may increase risk of dysrhythmias.
* Vasoilators : IV nitro, nitropusside - given for symptom relief.
99
What is Pulmonary Edema a reflection of?
Breakdown of physiological compensatory mechanisms.
100
What usually causes Pulmonary Edema?
L. Ventricle failure. Blood will back up into pulm. circulation.
101
What is the result of Pulmonary Edema?
Hypoxemia
102
What are the clinical manifestations of Pulmonary Edema?
* Tachypnea
* Dyspnea
* cool, clammy skin
* Cyanosis
* Weak, rapid pulse
* Lung congestion
* Increased sputum production (blood tinges show that its in a progressed state)
* Higher CO2 levels makes patient somnolent
103
Which medications do we give for Pulmonary Edema?
Diuretics and Vasodilators
104
What is the first thing we should do if we suspect Pulmonary Edema with a patient?
Sit them up right (high fowler) w/ feet dangling
105
What are risk factors of Thromboembolisms?
* Cardia disorders
* Decreased mobility
* a-fib can lead to intracardiac trombi
* Blood clot moving from legs can lead to obstruction of pulmonary vessels.
106
What can A-fib lead to?
A stroke
107
What are a tell tale sign of Cardiac Tamponade when doing a physical assessment?
Distant heart sound and diffuse pain.
108
Explain Pulsus Paradoxus?
When the pulse you're hearing isn't what you're feeling. This may often happen with Pericardial effusion and Cardiac Tamponade.
109
What is narrowing pulse pressure
Pulse pressure is the difference between systolic and diastolic blood pressure. When it narrows such as with Pericardial effusion and Cardiac Tamponade the numbers will start to be close together.
110
What is Pericardiocentesis?
Pericardiocentesis is a procedure to remove fluid from the pericardial sac (the membrane surrounding the heart) using a needle and catheter. This is done to treat pericardial effusion.
111
What is a Transesophageal echocardiogram?
A Transesophageal Echocardiogram (TEE) is a specialized ultrasound test that provides detailed images of the heart by inserting a probe into the esophagus. this test gives clearer and closer images than a standard echocardiogram done on the chest wall.
112
Explain Virchow's Triad.
Virchow’s Triad describes the three main factors that contribute to the development of venous thromboembolism.
* endothelium damage
* Venous stasis
* altered coagulation.
When these factors are present, the risk of clot formation increases.
113
What medications would we give for DVT?
* Subq Heparin or Enoxaparin
* Warfarin
* Factor Xa inhibitor
114
What is the main diagnostic tool used for Pulmonary Embolism?
MDCTA - Multidetector Computed Tomographic Angiography
115
What is used with Pulmonary angiogram?
Contract dye
116
What is a D-Dimer?
What is produced when a clot dissolves. If levels are high then clot is dissolving.
117
