Exam 2, Deck 2 Flashcards
Hypoxia symptoms (4)
Light-headedness
Dizziness
Syncope
Change in LOC
Cardiac symptoms (3)
Chest pain
Tightness
Palpations
Arrhythmia symptoms (6)
Similar to…
**Similar to when cardiac output falls:
Decreased LOC Pale and cool skin Possible FVE with JVD distention and lung crackles Decreased urine output Decreased BP
Cardioversion / Defibrillation: Mechanism
Deliver electrical current to stop the heart; allow the SA node to take over as pacemaker.
How much pressure for hand-held defib paddles?
20-25 lbs vertically
Cardioversion synchronizes and discharges the ___ in order to avoid _______.
QRS Complex
To avoid the R on T problem
Which requires higher Joule levels: Defib or Cardioversion
Defib
What is the function of electrophysiological studies
To evaluate and treat arrhtyhmias
What is mapping and ablation?
Mapping: Finding the group of cells that induce anarrhythmia (irritable cells)
Ablation: Destroys the problem cells
Coronary artery disease (CAD) : Two pathophysiological causes
- Atherosclerosis
- Atheroma
Define atherosclerosis
An abnormal accumulation of lipid and fibrous tissue in the vessel wall
What is a danger of atherosclerosis?
A rupture signals body to send platelets –> Clot forms –> Further blockage to artery results.
Define atheroma
Blockage that narrows vessel wall and decreases blood flow to the myocardium. PLAQUE.
What are the dangers of atheroma?
- Ruptures and clot forms
- Vessel becomes completely occluded: Myocardial infarction
Three things that could potentially cause vasospasm of coronary arteries
- Big burst of energy
- Cold weather or cold beverages
- Trauma, acute blood loss
Define acute coronary syndrome
Umbrella term for any acute coronary issue from angina to MI
Four non-modifiable risk factors for CAD
- Family hx
- Gender
- Aging
- Race
Risk factors for CAD: Male versus female
Prior to menopause, men have 3x more myocardial incidents. After menopause, the numbers are even between men and women.
Seven modifiable risk factors for CAD
- High cholesterol
- Cigarettes
- Hypertension
- DM
- Lack of physical activity
- Obesity
- Stress
Define angina pain
Pain lasting for less than ten minutes; usually radiates to the neck or left arm and is alleviated by rest and/or nitroglycerine
Angina categories (3)
- Classic (“stable”) angina
- Unstable angina
- Prinzmetals / variant angina
Three characteristics of classic angina
- Pain or pressure lasting less than ten minutes (usually 3-5 minutes)
- Most common type of pain
- Predictable: Relieved by rest and/or nitroglycerine
Characteristic of unstable angina
UNPREDICTABLE. Pain with little or no activity.
Two characteristics of Prinzmetals / variant angina
- Second CA Vasospasm
- Not provoked by exercise
What can precipitate angina pain? (5)
- Physical exertion
- Exposure to cold
- Eating a heavy meal
- Stress, emotional factors
- Stimulants
What are three stimulants that may precipitate angina pain?
Cocaine
Coffee
Cold and cough meds with adrenergics in them
What causes angina pain, physiologically?
Occurs when the heart receives insufficient blood for oxygen demands at the time, such as in atherosclerosis and arteriosclerosis
Nature of angina pain (3)
- Localized
- Midsternal
- Possible radiation to shoulders, arms, neck, jaw
Four other assessments of an angina patient
Apprehension
Tightness or choking sensation
Weakness, fatigue
Numbness in arms
Four lab work components done on an angina patient
CK-MB
Troponin
Myoglobin
Chem 7
What position should an angina patient be in
FOWLER’S. Patient will assume this position automatically.
What happens to an ECG when a patient is in pain?
ST depression indicates ischemia – ST segment will be lower than isoelectric line when patient is in pain.
Seven nursing interventions for an angina patient
1) Rest
2) O2
3) Nitroglycerine
4) Other meds
5) Patient education
6) Psychological support
7) Stress Reduction
ARB Mechanism
Block angiotensin II receptors
Patient education: Angina: Lifestyle changes (5)
- Stop smoking
- Lose weight
- Exercise
- Take meds as directed
- Avoid cold weather
Patient education: Angina: Dietary changes (6)
- If diabetic, control blood sugar
- Alcohol in moderation
- More fruits, veggies
- More lean meats
- Less sodium
- Less trans fats
Etiology of Myocardial Infarction (3)
1) Reduced blood flow or 2) Complete arterial occlusoin or 3) Reduces cardiac blood flow
Two things that could reduce blood flow ending in MI
Ateroma
Vasospasm
Two things that could cause complete arterial occlusion ending in MI
Thrombi
Emboli
Two things that could reduce CADIAC blood flow ending in MI
Hemorrhage
Shock
Takotsubo
Broken heart syndrome – death of grief with clear cardiac arteries.
Nature of MI pain (5)
- Substernal pressure
- Crushing
- Radiating
- Often not related to exercise / stress
- Not relieved by rest or nitro
How often are MIs “silent”?
30% of the time
From the onset of chest pain, how long do you have to reverse the damage?
Six hours. TIME IS TISSUE.
What other symptoms might a patient experience with MI (besides pain) -2
- Anxiety, feeling of impending doom
- NV
Leading cause of death from MI
Dysrhythmia / arrhythmia 2/2 alteration in function
Objective changes provider will observe with MI (6)
- Pulse changes
- Diaphroetic
- Pale skin
- Increased temp and WBCs 2/2 inflammation
- Change in LOC
- Signs of cardiogenic shock
Two lab indications of an MI
Increased CK-MB
Increased Troponin
If you’re not sure whether the patient is having an MI, when should you keep them in the hospital anyway?
- Pain unrelieved by nitro
- Vomiting
- Diaphoresis
What differences would you see on an ECG between angina, a STEMI and a non-STEMI
- Angina only alters ECG when patient is in pain
- NSTEMI has no changes in ST
- STEMI has ST segment elevation, T wave changes
What do the ECG changes on a STEMI indicate?
Severe tissue necrosis and the need for emergency revascularization
What interventions constitute emergency re-vascularization?
- PTCA with or without a stent
- CABG
Labs for angina vs NSTEMI vs STEMI
Angina - normal CK-MB and Troponins
NSTEMI and STEMI - elevated CK-MB and Troponins
What four systems are altered by an MI?
- Cerebral
- Cardiac
- Peripheral
- Kidneys
Effect of MI: Cerebral
LOC
Effect of MI: Cardiac (2)
Chest pain
Arrhythmias
Effect of MI: Peripheral (3)
Edema
Decreased pulses
Effect of MI: Kidneys
Increased creatine
Decresaed urine output
Four goals of MI care
- Minimize myocardial damage
- Prevent complications
- Restore circulation
- Reduce myocardial oxygen demand
Why should an MI patient avoid Valsalva?
Bearing down increases thoracic pressure, decreases BP slightly
When can an MI patient have sex again?
Once a patient can walk up 2 flights of steps and be asymptomatic –> Ready for sex
Medical interventions for an MI (3)
1) PTCA
2) Coronary Stent
3) CABG
What does PTCA stand for?
Percutaneous Transluminal Coronary Angioplasty
What patients are candidates for PTCA?
- Must be a CABG candidate
- Patients who are contraindicated for thrombolitics
- Patients at hospitals who have this capacity
- Patients whose vessels are 70-80% occluded
How is a PTCA performed? (3)
- Catheter through femoral artery
- Dye injected to find narrowing
- Inflate catheter balloon fora few seconds at a time to push plaques to the side
What must you have a patient sign before a PTCA is performed?
Consent for a CABG
Six complications of a PTCA
- Dissection, perforation or vasospasm of the coronary artery
- MI
- Dysrhythmias
- Cardiac arrest
- Hemorrhage
- Thrombus
Why would PTCA cause an MI?
If balloon is inflated for too long
Post PTCA (4)
- Observe for 24 hours
- Assess for chest pain
- Nitroglycerine
- Anticoagulants
What is the biggest risk with a coronary stent?
Clot formation post-placement
How is heart stopped for CABG?
Cold slurry with a lot of potassium put into chest cavity
How is blood oxygenated during CABG?
- Catheter in the vena cava that brings blood to pump to oxygenate
How much is patient cooled for bypass?
4-6 degrees celsius
What vessel is harvested for CABG?
Either greater or lesser saphenous vein from leg
