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Medsurg 2 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Left sided heart failure
S/sx? S

A

S3 -when in overload
↑ hr, weak pulses, cyanosis, cool extremities
Nocturnal/exertional dyspnea
Orthopnea, ↑ rr

Elevated pulmonary capillary wedge pressure
Pulmonary congestion ( cough, crackles, wheezes, blood tinged sputum)
Restless, dizzy, confusion, AMS

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2
Q

Right side heart failure
What is the other name? Why?
What are the s/sx?

A

Cor pulmonale, due to being secondary to chronic pulmonary problems

JVD (RV cannot pump more venous blood into lungs)
Loud S2 pulmonic component (lubDUB)
RV heave on palpitation

RUQ pain, Fatigue, ascites, enlarged liver/spleen, polyuria/nocturia
-Weight gain, dependent edema, anorexia, gi distress

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3
Q

Where is heart attack pain located?

A

Upper chest, substeral, epigastic, neck, jaw, both arms and intrascapular

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4
Q

Heart attack s/sx
Men vs women

A

Men: n/v, jaw/neck/back pain, chest pressure, sob

Women: n/v, jaw, neck, upper back pain, chest pain but NOT always, pain/pressure in low chest or abdomen, sob, fainting, indigestion, extreme fatigue

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5
Q

What lab values do we look at for MI vs Heart failure?

A

Troponin, myoglobin, creative kinase, potassium, mag, cholesterol

BUN/Cr/BNP = heart failure

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6
Q

Semi vs non nstemi

A

Stemi: St elevation, increased troponin = infarction and necrosis

Nonstemi: ST depression, t wave inversion = myocardial ischemia. Troponin ↑ can occur, both happening = myocardial cell death/ necrosis

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7
Q

Stemi pathophysiology

A

Rupture of fibrous atherosclerotic plaque = plt aggregation / thrombi form at site

Begins w/infarction of subendocardial layer of heart muscles which has greatest 02 demand and ↓ supply

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8
Q

Define
Zone of injury
Zone of ischemia

A

Zone of injury: Tissue injured not necrotic

Zone of ischemia: Tissue that is o2 deprived

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9
Q

What metabolic process occurs during mi?

A

K+, calcium, mag = changes in conduction and contraction
Catecholmines (epi/norepinephrine) released in response= ↑ hr, afterload and contraction
-increase 02. Requirements = ventricular rhythms

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10
Q

Ml risk factors?

A

Smoking, HTN, DM 2, obesity, alcohol, sedentary, stress, cholesterol ↑, metabolic syndrome, hyperlipemia
Race (black), age (65 yr), gender (male), family hx

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11
Q

What is MI?
What occurs in blood flow?

A

Myocardial infarction
Occlusion of blood flow = ischemia → injury → necrosis

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12
Q

What is Mona?,
What order do we give it in?

A

Morphine, oxygen, nitro, aspirin

O2 first
Nitro: 3x every 5 min
Morphine: ↓ pain, relax smooth muscle, & catecholmines
-2-4 mg IV push Q5-15 min
Asa - antiplatelet

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13
Q

What is a contraindication of nitro? What is a common side effect?

A

Viagra / pulmonary hypertension, “afil” drugs= fatal interaction;

Headache and orthostatic Hypotension

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14
Q

What medications do we give for mi?
What is one surgical intervention?

A

Vast dilator (nitro)
Analgesics ( morphine)
Beta blockers ( carvedilol, metoprolol )
Antiplatelets ( Asa, clopidogrel, varapraxor)
Thrombolytic therapy ( Alteplase)
Anticoags heparin, enoxaprin)
Glycoprotein inhibitors (eptifibatide)

Percutaneous coronary intervention (PCI)

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15
Q

What is the s/sx of cardiogenic shock?

A

, Cold, clammy skin
↓ pulses
Agitation
Pulmonary congestion

↑ RR, ↓ bp, ↑ hr, ↓ UOA

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16
Q

What is coronary artery disease?
What does it lead to?
What does it include?

A

Plaque buildsup in artery

Angina: hard for blood to go through artery
Heart attack: plaque cracks and a blood clot blocks artery

Includes: stable angina, ischemia, infarction

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17
Q

Define ischemia and infarction

A

Ischemia: Insufficient O2 for myocardium
Infarction: necrosis & cell death occurs when severe ischemia is prolonged and ↓ perfusion = irreversible damage

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18
Q

Types of angina?

A

Stable
Unstable
Variant (prinzmetals)

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19
Q

Describe stable angina

A

Occurs on exertion, exercise or emotional stress
Relieved by nitroglycerin
Last less than 15 min

Not associated w/n, epigastric pain, dyspnea, anxiety, diaphoresis

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20
Q

Describe unstable angina

A

Considered pre-infarction. Occurs w/wo exertion (even at rest)
Progressively gets worse

S/sx: diaphoresis, sob,

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21
Q

Describe variant (prinzmetal) angina

A

. Due to coronary artery spasm, occurs at rest

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22
Q

Describe EKG of pts w/angina

A

ST changes but no troponin/ ck levels

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23
Q

How does blood flow through heart? What is the acronym that helps?

A

Try
Performing
Better
Always

(Tricuspid, pulmonary, bicuspid, aortic valve)

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24
Q

What are the 2 subcategories of heart failure

A

Systolic (impaired contractility)
Diastolic (impaired filling)

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25
Q

What happens during L heart failure?

A

↓ pumping
Fails metabolic demands, blood backup from LV =Fluid in lungs =
Backflow leads to R HF

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26
Q

What does stroke volume depend on?

A

Preload
Afterload
Contractility

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27
Q

L sided heart failure is also known as?
What causes it?

A

CHF
Causes: hypertension, cad, valular disease

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28
Q

What are the causes of right sided heart failure?

A

LV failure, RV MI, pulmonary HTN, COPD.

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29
Q

What is hepatosplenomegaly?

A

Enlarged liver/spleen
R sided heart failure

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30
Q

What is high output failure? Causes?

A

Output remains normal/above
Caused by ↑ metabolic needs ( septicemia, anemia, hyperthyroidism)

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31
Q

What are the compensatory mechanisms of heart failure?

A

Sympathetic nervous system stimulation
Renin-angiotensin
Chemical response (bnp)
Myocardial hypertrophy

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32
Q

What drugs reduce afterload

A

Ace, arb, arni

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33
Q

Interventions that reduce preload?

A

Diuretics
Venous vasodilator

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34
Q

Drugs that enhance contractility?

A

Inotropic ( digoxin )
Beta blockers
Aldosterone antagonists
CCB

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35
Q

How to prevent/manage pulmonary edema

A

Assess for early s/sx ( crackles, dysphea, confusion)
High fowlers
O2, nitro, diuretics, morphine

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36
Q

What things are considered valvular heart disease?

A

stenosis
regurgitation
Mitral valve prolapse

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37
Q

What are the types of temporary pacemakers.

A

External: transcutaneous - delivered w 2 electrodes on skin
Epicardial: lead attached directly to heart during open heart surgery
Endocardial: transvenous, pacing wires threaded through large central vein (subclav, jugular, cephalic)

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38
Q

Modes of permanent pacemakers

A

Fixed rate (asynchronous) - constant firing w/o regard for hearts electrical activity

Demand (synchronous) - detects electrical activity, fires at ↓ hr

Tachyclysthythmia : over pacing

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39
Q

Why are pacemakers needed?

A

TX of symptomatic bradycardia, complete heart block, sick sinus syndrome, sinus arrest, systole, atrial tachydysrhythymias

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40
Q

Why are implantable cardioverter/ defibs needed?

A

Ventricular tachydyshrythrias, MI w/LV dysfunction

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41
Q

What is a cardioversion?
When do we do it?

A

Delivery of direct countershock to heart sychomied w/QRS complex

Atrial dysrhythmias, SVT, Vtach w/pulse

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42
Q

What is defibrillation?
When do we use it?

A

Delivery of unsynchronized, direct shock to heart. Stops all electrical activity, allowing sinoatrial node to take over and reestablish perfusing rhythm

V fib, pulse less Vtach

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43
Q

What antidysrhythmic medication do we give for…
- Bradycardia?

A

Atropine, dopamine, epinephrine

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44
Q

What antidysrhythmic medication do we give for…
Afib, SVT, and Vtach w/pulse

A

Amiodarone, adenosine, verapamil

45
Q

What antidysrhythmic medication do we give for…
VTach w/o pulse or Vfib

A

Lidocaine, epinephrine

46
Q

What is cardiomyopathy?
What are the types?

A

Hypertrophied ventricular septum

Dilated: decreased systolic function

Hypertrophic: asymmetrical ventricles + stiff LV =. Diastolic filling abnormalities (unable to relax/fill with blood)

Restrictive: rarest, stiff ventricles = no diastole filing (caused by build up of fatty deposits/fibrous tissue on R ventricle)

47
Q

What drugs do we give for pts with cardiomyopathy?

A

Diuretics-vasodilators, cardiac glycoside
Avoid etoh and toxins

48
Q

Surgical management of cardiomyopathy

A

Venticulomyoectomy
Ablation
Heart transplant

49
Q

What is pericarditis?
What are the types?

A

Inflammation/alteration of pericardium

Acute: infection, post MI, post periocardiotomy syndrome
Chronic constrictive: inflammation causes thickening of pericardium

50
Q

S/sx of pericarditis

A
  • Substernal precordial pain (radiate to L neck, back, shoulder)
    Pain worsening by breathing, coughing, swallowing
    pt can NOT lay in supine position, worsens pain
    Pericardial friction rub
51
Q

Pericarditis can lead to what emergency?

A

Cardiac tampanode

52
Q

What is cardiac tamponade?
What are the s/sx?
How do we treat it?

A

Fluid accumulates in pericardium

S/sx: JVD, paradoxical pulse ( bp ↓ on inhalation), ↑ hr, muffled heart sounds, decreased CO, circulatory collapse

Pericardiocentesis

53
Q

What is rheumatic carditis?

A

Sensitivity after upper respiratory tract infection from group A strep.
inflammation in all layers of heart
forms Aschoff bodies

54
Q

S/sx of rheumatic carditis

A

↑ hr, cardiomegaly, murmur, friction nb. Precordial pain, ecg changes (prolonged PR), heart failure

55
Q

What hemodynamics monitoring is elevated w/ L heart failure ?

A

Positive airway pressure (PAP)
Pulmonary artery wedge pressure (pawp)

56
Q

What do we do to ↑ gas exchange in pts?

A

Ventilator
Monitor rr
Auscultate breath sounds
Position in high bowlers
Maintain O2 sat of 90%

57
Q

In heart failure, what SBP is too high?

A

<100, give nitro if above

58
Q

What is ineffective endocarditis?
What causes it?

A

Microbial infection of endocardium. Blood flows rapidly from ↑ pressure zone to ↓ pressure zone = eroded endocardium. Plts/fibrinogen adhere to site, forming vegetation. Bacteria traps in ↓ pressure zone, vegetation grows. Valve appears stenotic = embolism

Caused by IV drug use, valve replacements w/alteration in immunity, structural defects

59
Q

What are the s/sx of ineffective endocarditis?

A

Neurological changes,

Fever, malaise, fatigue, night sweats, (+) blood cultures

s3, s4, murmu

Petchiae, Splints hemorrhage, Osler nodes, jaineway lesions (hands, feet), Roth spots

sudden abd/flank pain = renal infection, hematites, pyuria (WBC in urine)

60
Q

Signs of worsening/ recurrent heart failure?

A

Rapid weight ↑ (edema)
↓ in exercise tolerance
Cold symptoms (cough)
Nocturia
Dyspnea/ angina at rest

61
Q

Valvular heart disease
What are the 5 groups?

A

Mitral stenosis: afib, systolic murmur

Mitral regurgitation: afib, palpitations, high pitched holostylic Murmur

Mitral valve prolapse: atypical chest pain, palpitations, atrial tachycardia, Vtach, systolic click

Aortic stenosis: angina, harsh systolic crescendo murmur

Aortic regurgitation: angina, sinus tach, blowing diastolic murmur

62
Q

Valvular disease
Nonsurgical vs surgical management

A

Nonsurgical: rest, drug therapy, balloon valvuloplasty, trancather aortic value replacement

Surgical: direct commissiotomy, mitral value annuloplasty, heart valve replacement

63
Q

What can a beta blocker do for mild heart fail

A

Improve activity tolerance and Orthopnea

64
Q

To absorb aspirin faster, tell pt to…

A

Chew it

65
Q

What is a S3 gallop?

A

Low frequency, in early diastole at end of rapid drastic filling = ventricular dysfunction

66
Q

New York association classification

A

Class I: symptom onset w/ more than ordinary level of activity
Class II: symptom onset w/ordinary level of activity
Class III: symptom w/minimal activity
Class iv: symptoms at rest

67
Q

Post op complications of pacemaker?

A

Pneumothorax (collapsed lung)
Hemotherax (collection of blood in pleural cavity)
Cardiac tamponade

68
Q

What are the causes of AFIB
Intrinsic vs extrinsic

A

Inhinsic: Atrial dilation (valve regurge/stenosis, restrictive cardiomyopathy) and sick sinus syndrome

Extrinsic: age 80+, heart/lung disease, hyperthyroidism, sleep apnea, surgery, alcohol, HTN

69
Q

What is afib?

A

Multiple disorganized re entry loops within atria, triggered by abnormal impulse initiation around pulmonary veins of left atrium

70
Q

What are the symptoms of afib?

A

Palpitations, Dyspnea, fatigue, syncope (decreased diastolic filling time = decreased preload/Cardiac output)

71
Q

What are signs of afib

A

Irregular pulse
NO S4 sound (no atrial kick)
Variable s1 loudness
Panasonic murmur (regurgitation in mitral/tricuspid valve)

72
Q

Treatment of afib

A

Stroke reduction

Anticoagulants : aspirin and warfarin (3+ weeks before cardio version)

Treat underlying cause: HX, PE, TSH test, echocardiogram.
Ras inhibitor (HTN), statins for CAD, cpap for OSA, stop drinking

Rate control: <110 bpm
- beta blockers (class 3 AAD)
- Ca2+ channel blockers (Class 4 AAD)
- Digoxin (high toxicity)

  1. rhythm control
    -antidysrhythmics:
    •propafenone (decrease rate of conduction)
    • class 3 (amioderone, sotalol) increase refractory period
  2. Anticoagulants
    Calculate Chads 2 score
73
Q

What is the therapeutic range for Digoxin ?

A

1.5

74
Q

If rate control drugs fail, what nonpharmacological Tx do we do?

A

AV node ablation W/pacemaker

75
Q

If rhythm control drugs fail, what non pharmacological tx do we do?

A

Catheter ablation, surgical maze procedure

76
Q

CHADS2 scoring w clot prevention med score

A

CHADS 2
-CHF: +1
-HTN: + 1
-Age (>70): + 1
-DM: +1
-Stroke (past) : +2

Prevent clotting based on score
-0: ASA only
-1: LT anticoagulant w/ ASA/warfarin
>2: indefinite anticoagulation

77
Q

Advise pt on Responsible ER use with afib. What do we say?

A

Afib has no immediate threat to life, ONLY RVR. Only go to ER if symptoms get bad (pt may receive this due to meds)

78
Q

Afib with RVR tx?

A

Cardioversion or Beta blockers

79
Q

Atrial Tachycardia tx

A

Monitor unless or shows s/sx (dizzy, fatigue, SOB, HA, diaphoresis)

80
Q

Aflutter tx?

A

Monitor

81
Q

What is more life threatening? Atrial or ventricular dysthymia’s?

A

Ventricular

82
Q

Vtach tx?

A

Check pulse, start compressions, are you okay? Shock rhythm

83
Q

Vtach tx?

A

Check pulse, start compressions, are you okay? Shock rhythm

84
Q

VFib tx?

A

Pt is dead dead, code, AED, shock. Epi

85
Q

Torsades de pointes, what level do we check. Can we shock?

A

Magnesium level, bolus pt over 30 min
Nonshockable rhythm

86
Q

Normal PR interval
Normal QRS interval
normal QT interval

A

0.12-0.20
0.04-0.12
.32-.44

87
Q

Normal PR interval
Normal QRS interval
normal QT interval

A

0.12-0.20
0.04-0.12
.32-.44

88
Q

Electrical conductivity of heart

A

1.Sinoatrial (60-100 BPM, P wave)
2. Atrioventricular (40-60 BPM, PR, atrial kick contraction)
3. bundle of His (R/L bundle branch system)
4. purkinje fibers (20-40 BPM)

89
Q

Electrical conductivity of heart

A

1.Sinoatrial (60-100 BPM, P wave)
2. Atrioventricular (40-60 BPM, PR, atrial kick contraction)
3. bundle of His (R/L bundle branch system)
4. purkinje fibers (20-40 BPM)

90
Q

ECG complexes
P wave represents what?
QRS represents what?
T wave represents what?

A

Atrial depolarization
Ventricular depolarization
Resting phase

91
Q

ECG complexes
P wave represents what?
QRS represents what?
T wave represents what?

A

Atrial depolarization
Ventricular depolarization
Resting phase

92
Q

Define automaticity

A

Cardiac cell generates action spontaneously without stimuli

93
Q

Define excitability

A

polarization or generate action potential

94
Q

Define conductivity

A

Electrical impulses in heart = beating

95
Q

Define contractility

A

Performance of heart at pre/afterload, constant HR

96
Q

How many PVCs are considered VTACH

A

5 to 7

97
Q

What is the heart rate in Vtach?
What is Vtach?

A

100 to 280 BPM
Repetitive firing of irritable, ventricular ectopic focus (bundle branches)

98
Q

Where does the Vfib rhythm come from?

A

Purkinje fiber
PEA with inconsistent waves

99
Q

Treatment of second-degree heart block

A

Only monitor, electrodes may be causing it

100
Q

What is the treatment of second-degree heart block?

A

Pacemaker needed

101
Q

What will the blood pressure be like with a patient with a second-degree heart block?

A

SBP lower than 60

102
Q

What is asytole?
What should we check?

A

Flatline non-shockable rhythm
Check second lead, could be be VFib

103
Q

What is preload?
When does it increase?

A

Volume of blood in ventricles at end of diastole (end diastolic pressure)

↑= hypervolemia, regurgitation, heart failure

104
Q

What is afterload?
When does it ↑?
↑ afterload =↑ _____

A

Resistance LV must overcome to circulate

↑ in HTN and vasoconstriction

↑ afterload =↑ Cardiacworkload

105
Q

Epinephrine
Low doses?
High doses?

A

Low dose: ↑ CO, neutral SVR

High dose: ↑ SVR/CO

106
Q

What 2 meds do we use for cardiogenic shock?

A

Dobutamine: ↑ CO, ↓SVR
Milrinone: ↑cAMP/ CO/ vasodilation, ↓ SVR/PVR

107
Q

What does dopamine do?

A

Low dose: ↑ CO, UOP
High dose: ↑ CO/SVR/HR

108
Q

What are the best 2pressers?

A

Levo and Vaso

109
Q

Acronym for knowing what causes heart murmurs?

A

SPAMS
Stenotic valve
Partial obstruction
Aneurysms
Mitral/aortic regurgitation
Septal defect

Medsurg 2 (6 decks)

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