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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
What happens during L heart failure?
↓ pumping Fails metabolic demands, blood backup from LV =Fluid in lungs = Backflow leads to R HF
26
What does stroke volume depend on?
Preload Afterload Contractility
27
L sided heart failure is also known as? What causes it?
CHF Causes: hypertension, cad, valular disease
28
What are the causes of right sided heart failure?
LV failure, RV MI, pulmonary HTN, COPD.
29
What is hepatosplenomegaly?
Enlarged liver/spleen R sided heart failure
30
What is high output failure? Causes?
Output remains normal/above Caused by ↑ metabolic needs ( septicemia, anemia, hyperthyroidism)
31
What are the compensatory mechanisms of heart failure?
Sympathetic nervous system stimulation Renin-angiotensin Chemical response (bnp) Myocardial hypertrophy
32
What drugs reduce afterload
Ace, arb, arni
33
Interventions that reduce preload?
Diuretics Venous vasodilator
34
Drugs that enhance contractility?
Inotropic ( digoxin ) Beta blockers Aldosterone antagonists CCB
35
How to prevent/manage pulmonary edema
Assess for early s/sx ( crackles, dysphea, confusion) High fowlers O2, nitro, diuretics, morphine
36
What things are considered valvular heart disease?
stenosis regurgitation Mitral valve prolapse
37
What are the types of temporary pacemakers.
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)
38
Modes of permanent pacemakers
Fixed rate (asynchronous) - constant firing w/o regard for hearts electrical activity Demand (synchronous) - detects electrical activity, fires at ↓ hr Tachyclysthythmia : over pacing
39
Why are pacemakers needed?
TX of symptomatic bradycardia, complete heart block, sick sinus syndrome, sinus arrest, systole, atrial tachydysrhythymias
40
Why are implantable cardioverter/ defibs needed?
Ventricular tachydyshrythrias, MI w/LV dysfunction
41
What is a cardioversion? When do we do it?
Delivery of direct countershock to heart sychomied w/QRS complex Atrial dysrhythmias, SVT, Vtach w/pulse
42
What is defibrillation? When do we use it?
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
43
What antidysrhythmic medication do we give for... - Bradycardia?
Atropine, dopamine, epinephrine
44
What antidysrhythmic medication do we give for... Afib, SVT, and Vtach w/pulse
Amiodarone, adenosine, verapamil
45
What antidysrhythmic medication do we give for... VTach w/o pulse or Vfib
Lidocaine, epinephrine
46
What is cardiomyopathy? What are the types?
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
What drugs do we give for pts with cardiomyopathy?
Diuretics-vasodilators, cardiac glycoside Avoid etoh and toxins
48
Surgical management of cardiomyopathy
Venticulomyoectomy Ablation Heart transplant
49
What is pericarditis? What are the types?
Inflammation/alteration of pericardium Acute: infection, post MI, post periocardiotomy syndrome Chronic constrictive: inflammation causes thickening of pericardium
50
S/sx of pericarditis
- 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
Pericarditis can lead to what emergency?
Cardiac tampanode
52
What is cardiac tamponade? What are the s/sx? How do we treat it?
Fluid accumulates in pericardium S/sx: JVD, paradoxical pulse ( bp ↓ on inhalation), ↑ hr, muffled heart sounds, decreased CO, circulatory collapse Pericardiocentesis
53
What is rheumatic carditis?
Sensitivity after upper respiratory tract infection from group A strep. inflammation in all layers of heart forms Aschoff bodies
54
S/sx of rheumatic carditis
↑ hr, cardiomegaly, murmur, friction nb. Precordial pain, ecg changes (prolonged PR), heart failure
55
What hemodynamics monitoring is elevated w/ L heart failure ?
Positive airway pressure (PAP) Pulmonary artery wedge pressure (pawp)
56
What do we do to ↑ gas exchange in pts?
Ventilator Monitor rr Auscultate breath sounds Position in high bowlers Maintain O2 sat of 90%
57
In heart failure, what SBP is too high?
<100, give nitro if above
58
What is ineffective endocarditis? What causes it?
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
What are the s/sx of ineffective endocarditis?
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
Signs of worsening/ recurrent heart failure?
Rapid weight ↑ (edema) ↓ in exercise tolerance Cold symptoms (cough) Nocturia Dyspnea/ angina at rest
61
Valvular heart disease What are the 5 groups?
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
Valvular disease Nonsurgical vs surgical management
Nonsurgical: rest, drug therapy, balloon valvuloplasty, trancather aortic value replacement Surgical: direct commissiotomy, mitral value annuloplasty, heart valve replacement
63
What can a beta blocker do for mild heart fail
Improve activity tolerance and Orthopnea
64
To absorb aspirin faster, tell pt to...
Chew it
65
What is a S3 gallop?
Low frequency, in early diastole at end of rapid drastic filling = ventricular dysfunction
66
New York association classification
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
Post op complications of pacemaker?
Pneumothorax (collapsed lung) Hemotherax (collection of blood in pleural cavity) Cardiac tamponade
68
What are the causes of AFIB Intrinsic vs extrinsic
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
What is afib?
Multiple disorganized re entry loops within atria, triggered by abnormal impulse initiation around pulmonary veins of left atrium
70
What are the symptoms of afib?
Palpitations, Dyspnea, fatigue, syncope (decreased diastolic filling time = decreased preload/Cardiac output)
71
What are signs of afib
Irregular pulse NO S4 sound (no atrial kick) Variable s1 loudness Panasonic murmur (regurgitation in mitral/tricuspid valve)
72
Treatment of afib
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) 4. rhythm control -antidysrhythmics: •propafenone (decrease rate of conduction) • class 3 (amioderone, sotalol) increase refractory period 5. Anticoagulants Calculate Chads 2 score
73
What is the therapeutic range for Digoxin ?
1.5
74
If rate control drugs fail, what nonpharmacological Tx do we do?
AV node ablation W/pacemaker
75
If rhythm control drugs fail, what non pharmacological tx do we do?
Catheter ablation, surgical maze procedure
76
CHADS2 scoring w clot prevention med score
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
Advise pt on Responsible ER use with afib. What do we say?
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
Afib with RVR tx?
Cardioversion or Beta blockers
79
Atrial Tachycardia tx
Monitor unless or shows s/sx (dizzy, fatigue, SOB, HA, diaphoresis)
80
Aflutter tx?
Monitor
81
What is more life threatening? Atrial or ventricular dysthymia’s?
Ventricular
82
Vtach tx?
Check pulse, start compressions, are you okay? Shock rhythm
83
Vtach tx?
Check pulse, start compressions, are you okay? Shock rhythm
84
VFib tx?
Pt is dead dead, code, AED, shock. Epi
85
Torsades de pointes, what level do we check. Can we shock?
Magnesium level, bolus pt over 30 min Nonshockable rhythm
86
Normal PR interval Normal QRS interval normal QT interval
0.12-0.20 0.04-0.12 .32-.44
87
Normal PR interval Normal QRS interval normal QT interval
0.12-0.20 0.04-0.12 .32-.44
88
Electrical conductivity of heart
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
Electrical conductivity of heart
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
ECG complexes P wave represents what? QRS represents what? T wave represents what?
Atrial depolarization Ventricular depolarization Resting phase
91
ECG complexes P wave represents what? QRS represents what? T wave represents what?
Atrial depolarization Ventricular depolarization Resting phase
92
Define automaticity
Cardiac cell generates action spontaneously without stimuli
93
Define excitability
polarization or generate action potential
94
Define conductivity
Electrical impulses in heart = beating
95
Define contractility
Performance of heart at pre/afterload, constant HR
96
How many PVCs are considered VTACH
5 to 7
97
What is the heart rate in Vtach? What is Vtach?
100 to 280 BPM Repetitive firing of irritable, ventricular ectopic focus (bundle branches)
98
Where does the Vfib rhythm come from?
Purkinje fiber PEA with inconsistent waves
99
Treatment of second-degree heart block
Only monitor, electrodes may be causing it
100
What is the treatment of second-degree heart block?
Pacemaker needed
101
What will the blood pressure be like with a patient with a second-degree heart block?
SBP lower than 60
102
What is asytole? What should we check?
Flatline non-shockable rhythm Check second lead, could be be VFib
103
What is preload? When does it increase?
Volume of blood in ventricles at end of diastole (end diastolic pressure) ↑= hypervolemia, regurgitation, heart failure
104
What is afterload? When does it ↑? ↑ afterload =↑ _____
Resistance LV must overcome to circulate ↑ in HTN and vasoconstriction ↑ afterload =↑ Cardiacworkload
105
Epinephrine Low doses? High doses?
Low dose: ↑ CO, neutral SVR High dose: ↑ SVR/CO
106
What 2 meds do we use for cardiogenic shock?
Dobutamine: ↑ CO, ↓SVR Milrinone: ↑cAMP/ CO/ vasodilation, ↓ SVR/PVR
107
What does dopamine do?
Low dose: ↑ CO, UOP High dose: ↑ CO/SVR/HR
108
What are the best 2pressers?
Levo and Vaso
109
Acronym for knowing what causes heart murmurs?
SPAMS Stenotic valve Partial obstruction Aneurysms Mitral/aortic regurgitation Septal defect

Medsurg 2 (8 decks)

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