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Adult Health I final > Exam 1 Cardiac Continued > Flashcards

Exam 1 Cardiac Continued Flashcards

1
Q

Classification of heart failure (4 of them)

A
  • Class I: no symptoms with activity
  • Class II: symptoms with ordinary activity
  • Class III: symptoms with minimal exertion
  • Class IV: symptoms at rest
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2
Q

Left-sided heart failure (congestive heart failure) symptoms

A
  • Weakness
  • Pallor
  • Fatigue
  • Dizziness
  • Acute confusion (low flow)
  • Pulmonary congestion
  • tachycardia
  • S3 heart sound
  • Breathlessness
  • Oliguria during day/nocturia at night
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3
Q

Right sided heart failure symptoms

A
  • Jugular vein distention
  • Increased abdominal girth
  • Dependent edema
  • Hepatomegaly
  • Hepatojugular reflux
  • Ascites
  • Weight most reliable indicator of fluid gain/loss
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4
Q

Causes of Right heart failure

A
  • left ventricular failure, right ventricular MI, pulmonary hypertension
  • Right ventricle cannot empty completely
  • `Increased volume and pressure in venous system and peripheral edema
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5
Q

Causes of Left heart failure

A
  • hypertension, coronary artery, valvular disease
  • Not all cases involve fluid accumulation
  • Two types:
    systolic (ventricles pump out less than 40-50% of the blood) and diastolic (The stiff ventricles fill with less blood than usual)
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6
Q

MAWDS education for Heart failure

A
  • Medications: Take your medications as prescribed by your doctor.
  • Activity: Stay active every day.
  • Weight: Weigh yourself each day.
  • Diet: Follow your diet.
  • Symptoms: Recognize your symptoms and know when to call for help.
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7
Q

Preventing or Managing Pulmonary Edema in heart failure

A
  • Assess for early signs (e.g., crackles in bases)
  • Weight gain
  • Dyspnea at rest, disorientation, confusion
  • High Fowler’s position
  • Oxygen therapy
  • Nitroglycerin
  • Rapid-acting diuretics
  • IV morphine sulfate
  • Continual assessment
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8
Q

Heart transplant complications

A
  • Shortness of breath
  • Fatigue
  • Weight gain
  • Decrease in blood pressure
  • Persistent cough
  • Irregular heart beat
  • Low-grade fever – 99 to100 degrees Fahrenheit
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9
Q

Long term complications of a heart transplant

A
  • Denervated heart
    - Cannot feel chest pain
    - Reinnervation does sometime occur
  • Chronic immunosuppression
    - Osteoporosis, fragile skin, obesity
    - HTN, liver and kidney disease
  • Graft vasculopathy
    - Diffuse, rapidly progressing CAD
    - Result of chronic rejection
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10
Q

Different types of valvular disease

A
  • Mitral stenosis (murmur during diastole
  • Mitral regurgitation (insufficiency)
  • Mitral valve prolapse
  • Aortic stenosis
  • Aortic regurgitation (insufficiency)
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11
Q

Symptoms of mitral stenosis (valve fail to fully open) (listen at the Fifth ICS, left mid-clavicular line)

A
  • Dyspnea on exertion (DOE), Fatigue
    Palpitations
  • Hemoptysis
  • Hoarseness
  • Dysphagia
  • JVD
  • Orthopnea
  • PND, Cough
  • Atrial Fib
  • S1, opening snap
  • Right Ventricular hypertrophy and failure
  • Pulmonary Congestion
  • Low CO
  • diastolic murmer
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12
Q

Symptoms of mitral regurgitation (valve fail to fully close) (listen at the Fifth ICS, left mid-clavicular line)

A 
- Dyspnea on exertion (DOE), Fatigue
Palpitations
- Crackles in lungs
- PND    
- Atrial Fib
- S3 and/or S4
- Left  Ventricle & Atrial dilation & hypertrophy
-Pulmonary congestion
-Low CO
- Systolic murmer
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13
Q

Symptoms of aortic stenosis (valve fail to fully open) (listen at the Second right intercostal space (ICS), right sternal border)

A
  • Dyspnea of exertion (DOE), fatigue
    Palpitations
  • LV Heart failure
  • Syncope
  • Narrow pulse pressure
  • Angina
  • S3 and/or S4
  • Left ventricular hypertrophy,
    -Pulmonary congestion
    -Sudden cardiac death
  • systolic murmer
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14
Q

Symptoms of aortic regurgitation (valve fail to fully close) (listen at the Second right intercostal space (ICS), right sternal border)

A
  • Dyspnea of exertion (DOE), Fatigue
    Palpitations
  • Widened pulse pressure
  • Angina
  • S3
  • Left Ventricular dilation& hypertrophy
  • diastolic murmer
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15
Q

Nonsurgical management for valvular disease

A
  • Rest
  • Drug therapy:
    - Heart failure
    - Control symptoms with medication
    - Diuretics, Beta blockers, Digoxin, Oxygen
    - Nitrates, Vasodilators
    - Prophylactic antibiotics
    - Arrhythmias
    - More then 50% will have atrial fibrillation
    - Anticoagulants
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16
Q

Surgical management for valvular disease

A

Valve Replacement
Mechanical: Durable, Lifelong anticoagulant

Tissue:  Less durable, No anticoagulant needed
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17
Q

Different types of cardiomyopathy

A
  • Dilated cardiomyopathy
  • Hypertrophic cardiomyopathy
  • Restrictive cardiomyopathy
  • Arrhythmogenic right ventricular cardiomyopathy
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18
Q

Symptoms of dilated cardiomyopathy

A
  • Heart Failure

- Arrhythmias

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19
Q

Treatment for dilated cardiomyopathy

A
  • Low Na Diet,
  • Diuretics, Dig Ace Inhibitor, Vasodilators,
  • Anticoagulate
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20
Q

Symptoms of hypertrophic cardiomyopathy

A
  • Dyspnea on exertion (DOE)
  • Heart Failure
  • SVT (supraventricular tachycardia)
  • VT (ventricular tachycardia)
  • Syncope,
  • SCD
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21
Q

Treatment for hypertrophic cardiomyopathy

A
  • Decrease Activity,
  • Beta Blocker
  • Calcium Channel Blockers
  • Antiarrhythmias
  • ICD
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22
Q

Symptoms of restrictive cardiomyopathy

A
  • Backward Heart Failure
  • Dyspnea
  • Orthopnea
  • Liver engorgement
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23
Q

Treatment for restrictive cardiomyopathy

A
  • Low Na Diet
  • Diuretics
  • Digoxin
  • Ace Inhibitors
  • Vasodilators,
  • Anticoagulate
24
Q

Different types of angina

A
  • stable angina (Predictable, frequently induced by exercise and relieved by rest)
  • unstable angina (May awaken the patient from sleep)
  • variant angina (Can occur while at rest, can be cyclic, the same time every day)
  • myocardial infarction (heart attack)
25
Q

Desired total cholesterol level

A

For both male and female: Less than 200 mg/dL

26
Q

Desired High density lipoprotein (HDL)

A

Male; 35 – 65 mg/dL

Female: 35-80 mg/dL

27
Q

Desired Low density lipoprotein (LDL)

A

Both male and female: Less than 130 mg/dL

**or lower if higher risk for CAD

28
Q

Desired HDL:LDL ratio

A

Both male and female: 3:1

29
Q

very low density lipoprotein (VLDL)

A

Both male and female: 7-32 ng/dL

30
Q

Desired triglycerides

A

Male: 40-160 mg/dL
Female: 35- 135 mg/dL

31
Q

pathophysiology of Acute coronary syndrome

A

any condition attributed to obstruction of the coronary arteries which reduces blood flow to the heart

32
Q

Anterior MI major vessel and leads

A
  • LAD (left anterior descending coronary artery)
  • V3-V4
  • ST elevation
33
Q

Inferior MI major vessel and leads

A
  • RCA (Right coronary artery)
  • Lead II, III, aVF
  • ST elevation
34
Q

Ischemia (MI) on ECG

A
  • T wave inversion or
  • Tall peaked T wave, or
  • ST depression
    due to changes in tissue repolarization
35
Q

Injury (MI) on ECG

A
  • ST elevation

due to decreased blood supply (Returns to normal as injury heals

36
Q

Infarction (MI) on ECG

A
  • pathological Q wave (deeper or wider)
    due to scar tissue that cannot depolarize
    will usually remain on 12 lead ECG
37
Q

Anticoagulation management of MI

A
  • ASA (Aspirin)
    - decrease platelet aggregation
  • Anticoagulant: Heparin
    - prevent re-occlusion
  • Glycoprotein IIb/IIIa Inhibitors
    - prevents platelet aggregation
  • prevents fibrinogen from binding to receptors on platelet surface
    - Integrelin, Aggrastat, ReoPro
38
Q

Reperfusion therapy for MI with Fibrinolytic therapy

A
  • Onset of sx < 12 hours
    • Less than 30 minutes of admission
    • Tissue plasminogen activator (t-PA)
      - Clot specific
      - Alteplase (t-PA), Retaplase (r-PA)
      - Tenectoplase (TNKase)
      - Non-clot specific
      - Streptokinase (SK)
      - Complication: Hemorrhage
39
Q

Reperfusion therapy for MI with Percutaneous coronary intervention (PCL)

A
  • Door to needle: < 90 minutes
  • Angioplasty
  • Stenting
40
Q

Pulmonary edema from MI symptoms

A
  • Persistent cough w/ pink frothy sputum
  • Tachypnea, dyspnea, orthopnea
  • Restlessness
  • Hypoxemia
  • Crackles
  • Cyanosis
  • S3 heart sound
  • Increased PAOP
41
Q

Management of pulmonary edema from MI

A
  • Suction, maintain airway
  • HOB in high-fowlers
  • Oxygen, high flow
  • Fluid restriction
  • Medications
    - Diuretics
    - Morphine
    - Vasodilators
    - Inotropic agents
    - Antihypertensives
  • Emotional support
42
Q

Post-Op care for CABG procedure

A
  • Psychosocial
  • Body image disturbance
  • Pain
  • Knowledge deficit
  • Patient Education
    - Cardiac rehab
    - Lifestyle modification
    - Diet: low sodium, low cholesterol
    - Smoking cessation
    - Exercise
    - Medications
43
Q

Complications of CABG procedure

A
  • Altered tissue perfusion, cerebral (Stroke)
  • Risk for infection, Mediastinitis
  • Altered tissue perfusion, Renal (ATN)
44
Q

Cardiogenic shock symptoms (failure of blood to move forward)

A
  • SBP < 90 mm Hg
  • Weak thready pulse
  • HR > 100/min
  • Decreased sensorium
  • Cool, pale moist skin
  • UOP < 30 mL/hr
  • Decreased CO/CI
  • CI <2.2 L/min/m
  • Increased PAWP
  • Increased CVP
  • JVD
  • Increased SVR
    - compensatory
  • Tachycardia
  • Tachypnea
45
Q

Drugs for shock

A
  • Dopamine / Inotropic
  • Dobutamine /Dobutrex
  • Norepinephrine
  • Vasodilators
  • Nipride
  • Diuretics
46
Q

Dopamine/inotropic for shock

A
  • Drug of choice for cardiogenic shock, hypotension, CHF
  • increases contractility
  • increases cardiac output
  • increases oxygen delivery
  • vasoconstriction
47
Q

Dobutamine/Dobutrex for shock

A
  • stimulates beta adrenergic receptors causing positive inotrope effect
  • causes increased CO
  • usually short term treatment with cardiogenic shock, CHF, AMI
48
Q

Norepinephrine for shock

A
  • Stimulates Beta and Alpha receptors

- increases contractility and CO

49
Q

Vasodilators for shock

A
  • to decrease LV end diastolic pressure and decrease SVR
50
Q

Nipride for shock

A
  • may be used for this to dilate veins and arteries, decrease preload, and decrease afterload
51
Q

Diuretics for shock

A
  • decrease filling pressures and decrease pulmonary venous pressure
52
Q

Mechanical circulatory assist devices

A
  • impella
  • Intra-aortic balloon pump (IABP)
  • Ventricular assist device (VAD)
53
Q

Impella assist device action

A
  • Directly unloads the left ventricle
  • Reduces myocardial workload and oxygen - consumption
  • Increases cardiac output and coronary and end-organ perfusion (kidney, brain, gut.. Another organ to make sure get perfused)
54
Q

Intra-aortic balloon pump (IABP) assist device action

A
  • Inflatable balloon inserted via femoral artery and positions in the descending thoracic aorta.
    - Improves coronary circulation
    - Reduces afterload

Balloon counterpulsation

        - Inflates during diastole (perfuse coronaries)
          - Creates space in aorta
       - Deflates before systole (Reduce afterload)
55
Q

Ventricular assist device (VAD) action

A
  • Diverts blood around failing heart by means of extracorporeal pump
  • Set to deliver particular flow rate ( 1-6L/minute)
  • Reduces cardiac workload while maintaining circulation

Adult Health I final (16 decks)

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