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CCRN > CV > Flashcards

CV Flashcards

1
Q

QT prolongation may lead to…

A

torsades de pointes

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2
Q

causes of prolonged QT include

A

drugs - amiodarone, quinidine, haloperidol, procainamide

electrolyte problems - hypokalemia, hypocalcemia, hypomagnesemia

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3
Q

treatment for torsades VT

A

magnesium

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4
Q

what is the first letter of a pacemaker code?

A

chamber paced

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5
Q

what is the second letter of a pacemaker code?

A

chamber sensed

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6
Q

what is the third letter of a pacemaker code?

A

response to sensing

I = inhibits (pacer detects intrinsic cardiac activity and withholds its pacing stimuli)...demand
D = inhibits and triggers (pacer detects intrinsic cardiac activity and fires a pacing stimulus in response)
O = none
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7
Q

what does failure to pace look like?

A

no spikes when expected

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8
Q

what does failure to capture look like?

A

spikes without a QRS for ventricular pacing

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9
Q

what does failure to sense look like?

A

pacing in native beats

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10
Q

ICDs programmed to shock can…

A

defibrillate or synchronized cardiovert

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11
Q

ICDs programmed to burst pace can…

A

sense tachyarrhythmias, provide a series of beats faster than the tachyarrhythmia, then stop suddenly with hopefully the SA node recovering

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12
Q

ICDs can provide pacing for which arrhythmia?

A

bradyarrhythmias

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13
Q

S1 is caused by closure of which valves?

A

AV (mitral and tricuspid) valves

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14
Q

S1 is loudest where?

A

at apex of heart (midclavicular, 5th ICS)

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15
Q

which valves open during S1?

A

pulmonary and aortic valves

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16
Q

S2 is caused by closure of which valves?

A

semilunar valves (aortic and pulmonic)

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17
Q

S2 is loudest where?

A

at base of heart (right sternal border, 2nd ICS)

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18
Q

S2 splits when?

A

on inspiration; wide fixed splitting of S2 caused by RBBB

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19
Q

S2 is louder with what pulmonary issue?

A

PE

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20
Q

S3 is caused by…

A

a rapid rush of blood into a dilated ventricle

  • pulmonary HTN and cor pulmonale
  • mitral, aortic, or tricuspid insufficiency
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21
Q

S3 is associated with…

A

heart failure

ventricular gallop “Kentucky”

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22
Q

S4 is caused by…

A

atrial contraction of blood into a noncompliant ventricle

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23
Q

S4 is associated with…

A

myocardial ischemia, infarction, HTN, ventricular hypertrophy, aortic stenosis

atrial gallop “Tennessee”

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24
Q

pulse pressure is…

A

systolic - diastolic

normal is 40-60mmHg. i.e.,120/80

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25
Q

SBP is an indirect measurement of …

A

CO and SV

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26
Q

narrowing pulse pressure is…

A

a decrease of SBP with little change or increase in diastolic pressure

seen with severe hypovolemia or severe drop in CO

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27
Q

DBP is an indirect measurement of …

A

SVR

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28
Q

widening of pulse pressure is…

A

decrease in DBP

may indicate vasodilation, drop in SVR; seen in severe sepsis, septic shock; i.e.,100/38

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29
Q

coronary arteries are perfused when?

A

during diastole

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30
Q

murmurs of insufficiency (regurgitation) occur when valve is…

A

closed

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31
Q

murmurs of stenosis occur when valve is…

A

open

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32
Q

what valves are open/closed during systolic murmurs?

A

semilunar valves (A&P) are OPEN during systole (stenosis)

AV valves (M&T) are CLOSED during systole (insufficiency)

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33
Q

ventricular septal defect (which is most common with acute MI) may cause what kind of murmur?

A

systolic murmur

heard at sternal border, 5th ICS

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34
Q

what valves are open/closed during diastolic murmurs?

A 
semilunar valves (A&P) are CLOSED during diastole (insufficiency)
AV valves (M&T) are OPEN during diastole (stenosis)
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35
Q

papillary muscle dysfunction and rupture are heard loudest where?

A

at apex

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36
Q

varient/Prinzmetal’s angina - what is it? what causes it? when does it occur? what can precipitate it? troponin +/-? what medication can relieve chest pain?

A
  • type of unstable angina associated with ST segment elevation
  • due to coronary artery spasm with or without atherosclerotic lesions
  • occurs at rest, may be cyclic
  • may be precipitated by nicotine, ETOH, cocaine
  • troponin (-)
    NTG relieves CP, STs return to normal
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37
Q

where is the location of CAD if there are changes in II, III, aVF

A

RCA, inferior LV

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38
Q

where is the location of CAD if there are changes in V1, V2, V3, V4

A

LAD, anterior LV

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39
Q

where is the location of CAD if there are changes in V5, V6, I, aVL

A

circumflex, lateral LV

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40
Q

where is the location of CAD if there are changes in V5, V6

A

low lateral LV

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41
Q

where is the location of CAD if there are changes in I, aVL

A

high lateral LV

42
Q

where is the location of CAD if there are changes in V1, V2

A

RCA, posterior LV

43
Q

where is the location of CAD if there are changes in V3R, V4R

A

RCA, RV

44
Q

what are some signs of reperfusion?

A
  • CP relief due to fibrinolysis of clot
  • resolution of ST segment deviations due to return of blood flow
  • elevated troponin/CK-MB due to myocardial stunning when vessel opens
  • repercussion arrhythmias (VT, VF, AIVR) due to stunning
45
Q

what type of MI is associated with AV conduction disturbances: 2nd degree type I, 3rd degree heart block, sick sinus syndrome, and sinus bradycardia?

A

inferior MI

46
Q

which type of MI may develop systolic murmur, mitral valve regurgitation secondary to papillary muscle rupture?

A

inferior MI

47
Q

use beta blockers and NTG with caution in which MI?

A

inferior MI

48
Q

S&S of RV infarct?

A

JVD, high CVP, hypotension, usually clear lungs, bradyarrhythmias, ECG with ST elevation in V4R

49
Q

how to treat RV infarct?

A

fluids, positive inotropes

avoid preload reducers (nitrates, diuretics)
caution with BB due to hypotension

50
Q

which type of MI will have reciprocal changes in lateral wall (I, aVL)?

A

inferior MI

51
Q

which type of MI will have reciprocal changes (ST depression) in inferior wall (II, III, aVF)?

A

anterior MI

52
Q

which type of MI may develop 2nd degree type II heart block or RBBB

A

anterior MI

53
Q

which type of MI may develop systolic murmur and possible VSD?

A

anterior MI

54
Q

Anterior/inferior MI has higher mortality?

A

anterior –> heart failure

55
Q

bradycardia or tachycardia with inferior MI has higher mortality?

A

tachycardia

56
Q

what are some complications of PCI?

A

STENT THROMBOSIS, RETROPERITONEAL BLEED, coronary artery perforation, distal coronary artery embolization, failure of stent deployment, intramural hematoma, stroke/TIA, arrhythmias, renal failure, MI, death

57
Q

nitroprusside…when to use, what does it do, what to watch for when using?

A

used for hypertensive crisis/emergency
preload and after load reducer
watch for cyanide toxicity secondary to drug metabolite (thiocyanate); mental status change, tachycardia, sz, need for increase dose, unexplained metabolic acidosis

58
Q

what are signs of systolic heart failure?

A
  • dilated LV
  • PMI shift to left
  • mitral valve insufficiency
  • EF <40%
  • pulmonary edema due to poor ventricular emptying
  • S3
  • BP normal/low
  • BNP elevated
59
Q

what is the treatment for systolic heart failure?

A
  • BB
  • ACE inhibitors
  • diuretics
  • dilators
  • aldosterone antagonists
  • positive inotropes (increase strength of muscular contractions)
60
Q

what are signs of diastolic heart failure?

A
  • normal ventricular size
  • hypertrophied ventricular walls and/or thick septum
  • normal contractile function
  • normal EF
  • pulmonary edema due to high ventricular pressure
  • S4 with HTN
  • high BP
  • BNP elevated
61
Q

what is the treatment for diastolic heart failure?

A
  • BB
  • ACE inhibitors/ ARBs
  • CCBs
  • low dose diuretics
  • aldosterone antagonists
62
Q

what are some causes of right sided heart failure?

A
  • acute RV infarct
  • massive PE
  • septal defects
  • pulmonary stenosis/insufficiency
  • COPD
  • pulmonary HTN
  • LV failure
63
Q

what are some causes of left sided heart failure?

A
  • CAD, ischemia
  • MI
  • cardiomyopathy
  • fluid overload
  • chronic, uncontrolled HTN
  • aortic stenosis/insufficiency
  • mitral stenosis/insufficiency
  • cardiac tamponade
64
Q

what are some signs of right sided heart failure?

A
  • hepatomegaly
  • splenomegaly
  • dependent edema
  • venous distention
  • elevated CVP/JVD
  • tricuspid insufficiency
  • abdominal pain
65
Q

what are some signs of left sided heart failure?

A
  • orthopnea, dyspnea, tachypnea
  • hypoxemia
  • tachycardia
  • crackles
  • cough with pink, frothy sputum
  • elevated PA diastolic/PAOP
  • diaphoresis
  • anxiety, confusion
66
Q

what is the issue with dilated cardiomyopathy?

A
  • systolic dysfunction, problem ejecting
  • thinning, dilation, enlargement of LV chamber
  • mitral valve regurgitation due to ventricular dilation
67
Q

what symptoms can be seen with dilated cardiomyopathy?

A
  • similar to systolic heart failure

- may need ventricular assist device (VAD), heart transplant

68
Q

what is the issue with hypertrophic cardiomyopathy?

A
  • diastolic dysfunction, problem filling

- increased thickening of the heart muscle and septum at the expense of the LV chamber

69
Q

what symptoms can be seen with hypertrophic cardiomyopathy?

A
  • symptoms similar to diastolic heart failure

- fatigue, dyspnea, chest pain, palpitations, s3, s4, pre syncope/syncope

70
Q

dilated or hypertrophic cardiomyopathy is at increased risk for sudden cardiac death?

A

hypertrophic

71
Q

S&S of cardiogenic shock in compensatory stage

A
  • NARROW PULSE PRESSURE
  • tachycardia
  • tachypnea
  • crackles, mild hypoxemia
  • ABG with respiratory alkalosis or early metabolic acidosis
  • anxiety, irritability
  • neck vein distention
  • S3, S4
  • cool skin
  • decreased UO
  • lower than baseline BP
72
Q

S&S of cardiogenic shock in progressive stage?

A
  • hypotension
  • worsening tachycardia, tachypnea, oliguria
  • metabolic acidosis
  • worsening crackles ad hypoxemia
  • clammy, mottled skin
  • worsening anxiety, or lethargy
73
Q

cardiogenic shock treatment?

A

enhance effectiveness of pump:
- positive inotropes (avoid negative isotropy agents), vasodilators

decrease demand on pump:

  • preload reduction
  • after load reduction
  • optimize oxygenation
  • mechanical ventilation
  • treat pain
  • IABP for short-term support
  • VAD may be used to longer periods of time than IABP
74
Q

what is a ventricular assist device (VAD) used for?

A

used in the management of LV heart failure, cardiogenic shock, cardiac myopathies, and used in patients awaiting heart transplant

75
Q

what are the benefits of IABP therapy?

A

inflation - increases coronary artery perfusion; inflates are dicrotic notch of the arterial waveform, beginning of diastole

deflation - decreases after load; deflates right before systole begins; determined by set trigger for deflation, R-wave of ECG or upstroke of the arterial pressure wave

76
Q

what are some post-op CABG complications to look for?

A 
TAMPONADE
PERICARDITIS
hemodynamic abnormalities
arrhythmias
electrolyte abnormalities
bleeding
pulmonary, renal, endocrine, GI
pain, anxiety
infection
77
Q

what do you do during post op chest tube management?

A
  • maintain patency - no dependent loops, only milk/strip if clots appear
  • mediastinal tubes remove serosanguinous fluid from the operative site; pleural chest tubes remove air, blood, or serous fluid from the pleural space
  • keep chest tubes lower than pt
  • don’t clamp system unless changing the drainage system or there is a system disconnect
  • if output >100 x 2hrs maintain hemodynamic stability, correct volume status, give blood products
78
Q

what are some S&S to look for in cardiac tamponade?

A
  • NARROWED PULSE PRESSURE
  • PULSUS PARADOXUS - excessive drop in SBP during inspiration, cardiac muscle restriction due to tamponade, with inspiration, intrathoracic pressure increases, decreases venous return
  • equalization of CVP, pulmonary diastolic and PAOP
  • restlessness, agitation
  • hypotension
  • increased JVD
  • muffled heart tones
  • enlarged cardiac silhouette and mediastinum on CXR
79
Q

which valve is at most risk for rupture due to trauma?

A

aortic valve because it’s most anterior in chest

80
Q

what are some etiologies of pericarditis?

A 
trauma (rare)
viral
after MI
post-op cardiac surgery
radiation
idiopathic
Dressler's syndrome - immune response after an MI, surgery, or traumatic injury
81
Q

what are some S&S of pericarditis?

A 
chest pain that worsens with inspiration
dyspnea
low grade temp
increased sed rate
*ST elevation in ALL leads
cardiac tamponade
post-MI, Dressler's syndrome
82
Q

what is the treatment for pericarditis?

A 
treat symptoms
analgesics
anti-inflammatory agents
NSAIDs
steroids
abx
monitor for worsening symptoms
monitor for constrictive pericarditis
monitor for cardiac tamponade
83
Q

what are some etiologies for myocardial contusion?

A

trauma; worse outcome than pericarditis, broken vessels bleed into heart, cardiac dysrhythmias, death can occur within first 48 hours

84
Q

what are some S&S of myocardial contusion?

A 
signs of trauma
chest pain that worsens with inspiration
dyspnea
low grade temp
*ST elevation in area of injury
85
Q

what is the treatment for myocardial contusion

A

monitor or arrhythmias

analgesics as needed

86
Q

inferior MI is associated with what occlusion?

A

RCA

87
Q

ST elevation is seen in which leads for inferior MI?

A

II, III, aVF

88
Q

what blood vessel supplies the RV?

A

RCA (also supplies inferior wall of LV)

about 30% of inferior wall MI patients also have RV infarct

89
Q

anterior MI is associated with what vessel occlusion?

A

LAD

90
Q

ST elevation is seen in which leads for anterior MI?

A

V1-V4 precordial leads

91
Q

myocardial ischemia or infarction can affect which valve function and lead to what?

A

mitral valve function and lead to acute mitral valve regurgitation

92
Q

papillary muscle dysfunction is loudest where?

A

apex

93
Q

papillary muscle rupture is loudest where?

A

apex

94
Q

ventricular septal defect is be heard where?

A

sternal border, 5th ICS

95
Q

class 1 heart failure is what?

A

extraordinary activity results in heart failure symptoms; ordinary activity doesn’t cause fatigue, dyspnea, palpitation, or anginal pain; no limitation of physical activity

96
Q

class 2 heart failure is what?

A

ordinary activity results in heart failure symptoms; comfortable at rest; some limitation of physical activity

97
Q

class 3 heart failure is what?

A

minimal activity results of heart failure symptoms; comfortable at rest, but less than ordinary activity causes HF symptoms; marked limitation of physical activity

98
Q

class 4 heart failure is what?

A

resting causes HF symptoms; severe limitation of physical activity

99
Q

what is the main cause of death for HF patients?

A

sudden arrhythmia; patients with class 2-4 HF are candidates for ICD

100
Q

what will cause large, giant V-waves on the PAOP pressure tracing if the patient has a PA Cath?

A

mitral insufficiency

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