Exam 1 Review- CV part Flashcards
this is an early rhythm complex that occurs for the next SA impulse
premature complexes
PVC/PAC that occurs every other beat / every 2 beats / every 3 beats?
bigeminy , trigeminy, quadrigeminy
sxs of prematures complexes
Palpitations or symptoms of low cardiac output –> check BP
*note: may be asxs as well
premature complexes can be generated by other parts of the heart, what do we see when the PAC starts in the atrium?
see P wave that is abnormal, narrow QRS complex
premature complexes can be generated by other parts of the heart, what do we see when the PAC starts in the ventricles?
no P wave, wider QRS complex
brady dysrthymia = HR < ____
60!
concerns with brady-dysrhythmia - what does it to diastole? what are 3 things we are checking in patient to assess their perfusion?
• Prolonged diastole → improved perfusion to heart
OR
• Decreased perfusion to heart if Cardiac Output decreases (low BP)
◦ check BP! to determine if CO is poor perfusion
◦ check LOC
◦ check urine output
tachy dysrhythmia = HR >_____
100!
what does tachy-dysthymia do to diastole? what do we need to assess?
• Shortens diastole –> heart itself doesn’t get as much O2
• Increased work of heart (heart needs more O2)
◦ uses too much energy
• get BP - low from decrease stroke volume
sinus brady s/s
• Low BP, Confusion, SHOB, chest pain, dizzy, syncope
who might naturally have a low HR?
arthletes
is sinus brady always bad?
has therapeutic benefit of reducing myocardial O2 demand and allws for increased perfusion time
when do we use pacing- HR too slow or HR too fast?
hr too slow! –> patient not perfusing
pacemakers can pace different parts of the heart -
◦ Atrial (Sick Sinus) - initiates p wave ◦ Ventricular ◦ Biventricular (Heart failure)
the take home from this is you need to know….
what your patient is pacing
wtf are pacer spikes?
= initiates something to happen in the heart
3 types of atrial dysrthymias
• Premature Atrial Complexes (see above)
• Supraventricular Tachycardia
• Atrial Fibrillation
this type of dysrhythmia =
• Rapid stimulation of atrial tissue
• 100 bpm to 280 bpm
- No visible P wave
Supraventricular Tachycardia (SVT)
what is • Paroxysmal Supraventricular Tachycardia
short run of SVT and got back to normal
interventions for SVT
- take BP
-identify cause
-Vagal maneuver
-Adenosine (6mg, 12mg, 12mg)
-Fluids - BB, CCB
-Cardioversion (= synchronous shock)
adenosine protocol for SVT?
◦ causes period of asystole.
◦ feels like you are getting kicked in the chest
◦ Give 6 then 20 cc fluid, 12 then 12 if needed
Atrial fibrilation- what are the main causes?
Related to atrial fibrosis and muscle mass
◦ Hypertension
◦ Heart Failure
◦ CAD
-mitralregurgitation
this dysrhythmia = irritable atria, multiple rapid impulses depolarizing the atria causing decreased cardiacoutput and NO P WAVE
atrial fibrillation
do you see a P wave with A fib?
no P wave on afib
A Fib interventions
- O2
-decrease anxiety
-Meds (dilt (drip) + amiodoarone (drip) + anticoag)
-Cardioversion (synchronized)
-Ablation
type of dysrhytmia with HR of 140-180 fired from ventricles
V tach
risk factors for V tach
◦ Myocardial Ischemia
◦ Cardiomyopathy
◦ Low K+
◦ Drugs
◦ Shock
type of dysrhythmia with electrical chaos is ventricles meaning the ventricles can’t contract =
v fib
V fib risk factors
• CAD
• MI
• Low K+
• Low Mg
• Surgery, Procedure
• Trauma
interventions fr V fib =
defibrilate
CPR
• Antidysrhythmic
you have a person in V fib and you shock their ass. Are they gonna be cool now?
must fix underlying cause— can go back into v fib after you defibrillate
type of dysrthymia with no impulses being conducted in the ventricle leading to no cardiac output =
ventricular asystole
interventions for ventricular asystole
CPR, ventilate, epinephrine
3 types of defibrillators
-AED
-Implantable
-Wearable
dysrhythmias are typically the result of another…..
pathology or disease state so we have to treat that!
list the mumur for each valve thing
mitral valve stenosis
Mitral Regurgitation
Mitral Valve Prolapse
Aortic Stenosis
Aortic regurgitation
mitral valve stenosis = diastolic murmur
Mitral Regurgitation = High pitched systolic murmur, S3
Mitral Valve Prolapse= late systolic murmur
Aortic Stenosis = systolic murumur
Aortic regurgitation = Diastolic murmur
stenosis vs regurgitation
stenosis = stiffening, narrowing, smaller
regurgitation = back flow
stenosis effects the heart velve when it is open or closed?
OPEN –>can’t open enough and blood is having a hard time getting through the valve
regurgitation effects the heart valve when it open or closed?
CLOSED –> valve is not closed well enough and blood flows backwards
how is mitral valve stenosis different then mitral valve prolapse?
stenosis = • Valve leaflets fuse, become stiff and chordae tendineae shorten • Narrow valve opening
prolapse = • Enlarged valvular leaflets that prolapse into left atrium during systole (should turn in towards the ventricle but don’t!)
what will mitral valve stenosis lead to?
• Prevents normal blood flow from left atrium to left ventricle
◦ Increased atrial pressure
◦ Dilated left atrium
◦ Increased pulmonary pressure
◦ Right ventricle hypertrophy
◦ Pulmonary congestion
◦ Right sided HF –>Left sided HF (Reduced Preload)
assessment findings for mitral valve stenosis?
• May be asymptomatic
• Difficulty breathingPulmonary edema
• Coughing
• JVD
• Edema in extremities
• Development of A-fib?
• Diastolic murmur
what does mitral valve regurgitation lead to ?
• Backflow of blood into left atrium during left ventricle contraction
◦ Hypertrophy of left ventricle and atrium
causes of mitral valve regurgitation?
• Fibrotic and calcific changes that prevent the mitral valve from closing during systole
• Caused by aging process, endocarditis, congenital abnormalities, RHD
assessment findings for mitral valve regurgitation
• Asymptomatic for many years
• Symptoms occur when the left ventricle can no longer overcome the blood volume
• Decreased Cardiac output
• Fatigue
• Weakness
• Anxiety
• Difficulty breathing
• Palpitations
• Chest pain
• **Afib – highest risk of all the valvular disorders
• Right sided failure…
• **High pitched systolic murmur, S3
mitral valve prolapse causes?
• Often congenital (downs syndrome, marfans syndrome)
mitral valve prolapse assessment findings
• Asymptomatic or Symptomatic
◦ Chest pain
◦ Dizziness
◦ Palpitations
◦ Midsystolic click, late systolic murmur
what will aortic stenosis lead to?
• Ventricular hypertrophy
◦ Over time, left ventricle cannot meet the needs of body on exertion
**Left sided HF –> Right sided failure
–> may need surgery
assessment findings for aortic stenosis
• Fixed cardiac output (can’t accommodate increased demand)
◦ poor perfusion abilities (decreased pulses, kidney function)
• Angina
• Difficulty breathing
• Syncope
• Fatigue
• Debilitation
• Peripheral cyanosis
• Systolic murmur –> aortic valve is open during systole
what happens in aortic regurgitation?
• Aortic valve leaflets don’t close well during diastole
• Blood flows back from aorta to left ventricle
◦ Dilated ventricle/ Hypertrophy
causes of aortic regurgiation?
• Infective Carditis
• Congenital anatomic abnormalities
what will aortic stenosis lead to?
left sided heart failure
assessment finding for aortic stenosis
• Left failure symptoms
• Difficulty breathing
• Nocturnal dyspnea/ angina
• Diaphoresis
• Bounding pulse –> development of R side HF –> later finding
• Widened pulse pressure
• Diastolic murmur
drugs we give to help with heart valve stuff?
◦ Diuretics- preload
◦ Beta Blockers - slow heart rate to reduce heart demand
◦ Digoxin- contractility
◦ Oxygen
◦ CCB’s - afterload
◦ Anticoagulants -afib and risk for clot
prosthetic vs biologic valves- duration? anticoags?
‣ prosthetic valve lasts longer –> increased risk of clotting –> anticoagulation for life
‣ biologic –> don’t last as long –> don’t require anticoagulation (old person)
after surgery for valve stuff patient is at great risk for
ENDOCARDITIS! ABX is have dental procedure
Clots –> anticoags
most common culprits of infective endocarditis?
◦ Streptococcus viridans
◦ Staphylococcus aureus
risk factors for infective endocardiits?
• IV Drug Use
• History of valve replacement
• Systemic Infection
• Structural cardiac defect
infective endocarditis populations are risk examples
• Post operative patient with insufficient venous access (and subsequent PICC line insertion)
• A mother of four with strep throat
• A patient with sepsis related to a UTI
• A patient who had his molars removed
when does sxs onset of infective endocarditis occur?
2 weeks after exposure
sxs of infective endocarditis
◦ Fever (might not show up in elderly)
◦ Murmurs
◦ S3 and S4
◦ Heart failure
• Organ dysfunction
• PE/ Pulmonary infarct
• Stroke
• Petechiae
• Splinter hemorrhages
_____ occurs in about 50% of infective endocaridits cases
emoblization
right vs left endocarditis- what is it associated with?
◦ right side with IV drug –> first place it hits when introduced to body
◦ left side used to be more common
1 diagnostic for infective endocarditis?
blood cultures
interventions for infective endocardiits?
• Antibiotics–>administered IV/ 4-6 weeks
• Rest/ Activity
• Support Heart Failure
• Surgery (if neccessary)
◦ Remove infected valve
◦ Repair injured valve
◦ Drain abscesses
most common type of cardiomyopathy that involves both ventricles being dilated
dilated cardiomyopthy
dilated cardiomyopthhy results in impaired ______ function
systolic
causes of dilated cardiomyopthy
Alcohol, Chemotherapy, Infection, Inflammation, Poor Nutrition
type of cardiomyopathy common in athletes?
Hypertrophic Cardiomyopathy
type of cardiomyopathy with asymmetric ventricular hypertrophy –>Stiff Left Ventricle causes Obstruction in left ventricular outflow?
Hypertrophic Cardiomyopathy
sxs of Hypertrophic Cardiomyopathy
-Asymptomatic until death (Athletes)
• DOE
• Palpitations
• Dizziness
-Rarest Cardiomyopathy, poorest prognosis of the cardiomyopathy
-Stiff ventricles that restrict filling =
Restrictive Cardiomyopathy
s/s of Restrictive Cardiomyopathy
• Symptoms of R/L HF
causes of Restrictive Cardiomyopathy
Sometimes related to Sarcoidosis or Amyloidosis
type of cardiomyopthy where Myocardial tissue replaced with fibrous and fatty tissue
Arrhythmogenic Right Ventricular Cardiomyopathy
(family association)
(usually R ventricle)
HCM has a high rate of….
ventricular dysrhythmias
interventions for dilated and restrictive cardiomyopthy
Treat for Heart Failure
• Diuretics
• Vasodilators
• Digoxin
HCM intervetnions
• ICD (implanted cardiac defib)
• Beta Adrenergic Blockers
• Calcium Channel Blockers
–>Reduce outflow obstruction
–>Decrease HR/ Symptom relief
HCM interventions- what cant we give them? what can’t they do?
No vasodilators, diuretics or digoxin
No Extreme Exercise
type of cardiomyopthy that usually ends with heart transplant?
DCM/ Restrictive
shock is our bodies response to a lack of ______ in the tissue
oxygen
shock is classified by what the cause is- what are the types of shock?
-hypovolemic
-cardiogenic
-distributive (sepsis, neurogenic, anaphylactic)
-obstructive
what is mean arterial pressure? how do we calculate the mean arterial pressure?
we want the map to be > _____
what is the MAP for 120/80 and 90/50?
Average arterial pressure in one cardiac cycle
◦ (Systolic Pressure + Diastolic + Diastolic) / 3
◦ want it >65 (means organs are being perfused)
• 120/80 (MAP = 93)
• 90/50 = (MAP = 63)
causes of hypovolemic shock
• Blunt trauma
• GI bleeds/ ulcers
• Post surgery bleeding
• Dehydration
• Bleeding
assessment findings for hypovolemic shock
•History
•Tachycardia
•Tachypnea –> trying to blow off CO2
•Restlessness, anxiety
•Low Urinary output
•Decreased MAP
•Weak pulses
•Cool, moist skin
•Mottling
•Increased Capillary refill time
•Thirst
•Confusion/ unconscious
re hypovolemic shock - what ABG do we expect ? what will H&H be?
ABG –> lactic acid causes metabolic acidosis
H &H –> depends on if they are bleeding (low) or dehydrated (high)
interventions for hypovolemic shock:
•Identify and manage the cause
•Restore blood volume
•Prevent complications
•Oxygen
•IV fluids
•Blood products
2 drug classes in particular we give for hypovolemic shock - give examples of each
Inotropes and Vasopressors
vasopressors:
•Dopamine
•Norepinephrine (Levophed)
◦ use in sepsis -first line
•Phenlephrine (Neosynephrine)
•Epinephrine
Induce vasoconstriction → Raise MAP
inotropes:
•Dobutamine
•Milrinone
•Activate Beta Adrenergic receptors → Improve Contractility
what kind of line do we give vasopressors through?
central line
> > risk of necrosis and limb loss in peripheral line
cardiogenic shock is most commonly cause by what? What happens?
= Heart muscle can’t pump blood adequately
•Decreased Cardiac Output that leads to —>Decreased MAP (Blood pressure)
•Most commonly caused by myocardial Infarctions
what happens in distributive shock? where is the blood/fluid?
=There is enough blood, it just isn’t where it is supposed to be
• Blood vessel dilation (no afterload)
• Capillary leakage (less blood going back to heart)
• Blood leaks into interstitial tissue
• Pooling of blood in capillary beds
what happens in obstructive shock? where is the blood? main cause(s)?
• Heart is normal, but blood cannot get to heart or get out of heart for another reason
• Most commonly caused by Cardiac Tamponade –> fluid building up and pressing on heart
◦ can also be caused by tension pneumothorax
cardiac tamponade is associated with which type of shock?
obstructive shock
type of shock:
• MAP is lost because of loss/ reduction in Sympathetic Nerve impulse
• Smooth muscles relax → vasodilation
neural induces distributive shock
what happens to HR and BP in neurogenic shock
bradycardia and hypotension
chemical induced shock is caused by what?
• Chemicals cause the blood vessel wall to change
• Chemicals may be endogenous or exogenous
• Most commonly caused by Anaphylaxis or Sepsis
Why do you get acidosis in shock? what is a normal lactic acid?
• build up of lactic acid
• kidneys are not being perfused to make bicarbonate
• normal lactic acid = <2
how does SIRS relate to sepsis
SIRS leads to sepsis
sirs = Widespread Inflammation: WBC’s, cytokines, vasodilation, capillary leakage
◦ Microthrombi form in organ capillaries –> hypoxia
code sepsis criteria =
• 2 or more signs of SIR + suspected infection
SIRS criteria (not sure if we need to know this?)
temp > 38 or <36
HR > 90
RR >20
WBC >12,000 or <4,000
need 2 o these 2 have sirs
s/s of septic shock
•In the setting of infection or suspected infection
•Tachypnea
•Altered mental status
•Reduced blood pressure
•Other Signs of organ dysfunction
•Infection
◦ Fever
◦ Tachycardia
◦ Rigors
•Poor Perfusion
◦ Cool extremities
◦ Mottling
• cool vs warm sepsis
◦ warm (compensating) comes before cool
interventionsfor septic shock (3)
•Pan Cultures (sputum, urine, blood)
•Antibiotics within one hour (after cultures)
•ABG with lactate and/or lactic acid
interventions for shock - what do we need to do w/in 1 hour
◦ Measure lactate
◦ Obtain cultures and administer antibiotics
◦ Administer crystalloid fluids for hypotension or lactate > 4
interventions for septic shock
•Treat underlying cause
•Support
◦ Oxygen
◦ fluid
◦ glucose management
•Within 1 hour
◦ Measure lactate
◦ Obtain cultures and administer antibiotics
◦ Administer crystalloid fluids for hypotension or lactate
>4
•Use vasopressors to maintain MAP > 65 During or after fluid administration
what are the 3 stages of sepsis
sepsis = sirs + infection
severe sepsis = sepsis + organ failure
septic shock = severe sepsis + refractory hypotension
go to page 767 of the 7ed Saunders and look at the EKG strips for Vfib (lil irregular squiggles) and V tach (big rapid regular spikes)
yay….
when are valves open and closed?
mitral valve: diastole/systole
aortic valve: diastole/ systole
mitral valve: diastole OPEN /systole CLOSED
aortic valve: diastole CLOSED/ systole OPEN
it helps if you draw a picture of the heart with the valves
SSystolic / SSqueeze –> big # on top = big energy to SSSSqueeze it out of the heart
dIastolic / fILL
