Exam 3- Cardiac 1 Flashcards
1
Q
Systemic circulation-
what side of heart
what pressure
produces
A
Left side of heart to the rest of body with exception to the lungs
High pressure
Produces systolic blood pressure
2
Q
Pulmonary circulation-
what side of heart
what pressure
A
Right side of heart with lungs
its low pressure circulation
3
Q
“Widowmaker”
what side of heart
if blockage
Coronary Blood Supply
A
Left ventricle is most important for action
If blockage in LAD then that’s where we see sudden cardiac arrests from heart attack
4
Q
Cardiac cycle
uses what
contraction/followed by
A
Uses the- Atria //Ventricles
Contraction of atria, followed by contraction of ventricles a fraction of a second later
5
Q
Cardiac output-
amount
= to
A
amount of blood pumped in one minute
= to sv x hr
6
Q
Stroke volume-
amount
A
amount of blood in one beat
7
Q
Cardiac output is influenced by 4 factors
h
p
a
c
A
heart rate
preload
after laod
contractility
8
Q
Preload- increased with
f
r
Cardiac Output
A
fluid volume excess
regurgitation
9
Q
After load- increased by
h
v
Cardiac Output
A
hypertension
vasoconstriction
10
Q
Contractility- what is it
Cardiac Output
A
strength of the heart muscle
11
Q
pre load
what is it
end
A
volume coming into ventricles
end diastolic pressure
12
Q
afterload
what os it
A
resistance left ventricle must overcome to circulate blood
13
Q
What will happen if preload is increased?
heart needs
it will
A
heart needs stronger contractions
it will increase the stroke volume
14
Q
What about increased after load?
hard
so there
unless
A
–harder to pump
so there is less blood going out
unless contractions are increased
15
Q
How about decreased contractility? –
decreased
A
decreased stroke volume
16
Q
What happens when the heart is in optimal condition?
low
high
normal
A
low heart rate
a high contractility
normal cardiac output
17
Q
Ejection fraction
what is it
what normal
A
% of blood that is pumped out of ventricles during systole
Normal is 50-70
18
Q
what is it influenced by x3
Ejection fraction
A
after load,
preload
contractility.
19
Q
how to measure ejection fraction
looks at
A
Measure with echocardiogram.
Looks at left ventricle
20
Q
CXR-
what looking at
A
size and basic deformities of the heart
21
Q
before the Stress tests-
make sure
dress
mo
only
A
make sure pt is npo
dressed conformable,
no caffeine
only meds that they can take are the meds that they are told they can take
22
Q
stress test
do what
looking for
A
Walk/run on treadmill-
look for chest pain/ dyspnea with exertion
23
Q
MRI-
identify
A
identify ischemic tissue
24
Q
CT-
observe
A
observe for calcium deposits
25
PEt
look
look at myocardial perfusion
26
Echocardiogram
checks-
looks at(w/c/v)
checks motion of the heart
Looks at wall thickness, chamber size and velocity of blood flow
27
Ejection fraction-
what means issue
means what
also means
what's significant problem
Echocardiogram
when less then 55% there's an issue
Means a low cardiac output
Means decreased tissue perfusion
When less then 30% it’s a significant problem
28
Trans esophageal echocardiogram (TEE)-
what happens
looks for
camera down pts esophagus to look at heart-
looks for cardiac strictures and valves
29
Pericardiocentesis
does what
remove fluids from pericaridum
30
Cardiac catheterization- post cath
check
can go
apply
check
keep
check for bleeding
can go radial or femoral
apply direct pressure
check for distal pulses
keep the limb straight
31
if went through radial-
do what for how long
cardiac cath
pressure for 2-4 hrs after
32
if femoral- cardiac cath
held
on what-how ling -with what
use
needs
held straight
on bed rest /2-4 hrs/with hob flat-
use urinal and bedpan only
need fluids
33
Evaluating Cardiac Risk
genetic
health assessment
physical assessment
Genetic- hx of disease
Health assessment-, hyperlipeidemia, diet , smoking, exercise, drugs-follw up on dypnea, chest pain
Physical assessment- listen for sounds, gallops,
34
Cardiovascular disease-
any
leading
heart disease
any disorder of heart or blood vessel
leading cause of death and disability
35
Coronary artery disease
is what
can have
heart disease
- impaired blood flow to heart
Can have symptoms or be asymptomatic
36
Atherosclerosis-
progressive
correlated with
heart disease
progressive plaque accumulation and narrowing
Correlated with elevated blood lipid levels
37
LDL-
deposits of cholesterol in vessels
38
HDL
- transports to liver for excretion
39
Triglycerides-
excess fat
40
what age men/women
what gender
what for women
what race
what plays a role
non modifiable -Risk Factors for Cardiac Disease
Age –men 45+ women 55+
Gender-men
Women have increased risk in increased menstrual cycles
Genetics/ family history
black
41
Hyperlipidemia-
what is it
what's not bad
what is bad
modifiable Risk factors for Cardiac Disease
increased lipids,
LDH A- not so bad
, LDH B proven to oxidize and build up plaque.
42
HTN---->
what numbers
whats best
modifiable Risk factors for Cardiac Disease
140/90,
diastolic <80 is best.
43
Diabetes----
why a risk factor
modifiable Risk factors for Cardiac Disease
2-4 times more likely to have heart disease or a stroke.
44
. Smoking-
what does carbon monoxide do
waht does nicotine cause
modifiable Risk factors for Cardiac Disease
carbon monoxide damages blood vessels- leads to plaque build up.
Nicotine causes-tachycardia, vasoconstriction.
45
Obesity causes- x3
considered with what///what size in men and women
modifiable Risk factors for Cardiac Disease
HTN,DMII,Hyperlipidemia
considered with waist circumference >40 for men, >35 for women
46
Lack of exercise- what does exercise do
modifiable Risk factors for Cardiac Disease
exercise does strengthens heart, decreases cardiac workload, lowers BP, lowers wt. Lowers lipids
47
7. Diet-
what diet are we promoting
high
low
modifiable Risk factors for Cardiac Disease
eat high fiber,
low fat, simple carbs and Na+
48
How do I decrease my risk for heart disease
5/7 of these
1-no
2-what bmi
3-how much exercise
4-what diet
5-what cholesterol
6-waht bp
7-what fasting glucose
1.No smoking
2. Bmi less then 25
3. 150 minutes per week of excercise
4. Healthy diet
5. Total cholesterol less then 200
6. Bp less then 120/80
7. Fasting glucose less then 100
49
Increased what levels
what helps lower
other risk factors of heart disease
Increased homocysteine levels
b vitamins- folate, b6 and b12
50
Metabolic syndrome-
other risk factors of heart disease
abdominal obesity- waist circumference of over 40 in men and over 35 in women///
51
Metabolic syndrome-
serum triglyceride
HDL- men/women
other risk factors of heart disease
serum triglyceride of 150 or above,
hdl 40 or lower in men or 50 or more in women
52
Metabolic syndrome-BP
other risk factors of heart disease
bp 130/85 or greater
53
Metabolic syndrome- fasting glucose
other risk factors of heart disease
fasting glucose of over 100
54
Premature menopause
causes
Risk factors unique to women
what hdl
what ldl
low hdl,
high ldl
55
Oral contraceptives-
bp
what risk
Risk factors unique to women
increase bp
clotting risk
56
Hormone replacement therapy-
increases
metabolized where
leads to
Risk factors unique to women
increase cad,
metalbozed in liver
leads to formation of clots
57
Cholesterol- what's normal
total
ldl
hdl
triglycerides
Diagnostic Tests
total less then 200
ldl less then120
, hdl greater then 35
triglycerides less then 150
58
C-reactive protein-
see what
Diagnostic Tests
inflammation on patient
59
Exercise ECG-
look for
which is a sign of
Diagnostic Tests heart disease
look for st depression
signs of ischemia
60
what smoking
how much exercise/how often
Risk management-heart disease
Smoking- quit
Exercise- 30 mins- 5-6 times a week
61
Diet-
add
have
high
low
Risk management-heart disease
add vitamin b,
have alcohol in moderation,
eat high fiber,
low fat, simple carbs and Na
62
how to lower HTN
decrease
increase
decrease
Risk management-heart disease
decrease sodium
, increase exercise
, decrease stress
63
manage what
daily aspirin-only when-does what
risk management heart disease
Diabetes- manage appropriately
Daily aspirin- only if prescribed- decreased inflammation and prevent clots
64
Statins-
most
does what
monitor what lab
watch for what
Medications to Lower Lipids
most common-
reduces total and ldl-
monitor LFT liver function
watch for rhabdomyolosys
65
why avoid green tea and grapefruit juice in statins
increase level of medication
increase diabetes risk in women
66
OTHERS-Medications to Lower Lipids
Bile acid sequesters-Questran, prevaide
Nicotinic acid-
Fibric acid derivatives-
67
d/e
what helps
Complementary Therapies heart disease/lipids
Diet exercise
Stress management can help
68
give what 3 vitamins
take what -3gs
3g of what
Complementary Therapies heart disease/lipids
Give vitamins- c, e , b6
Take garlic, gingko, green tea
3 g daily of omega acids
69
Ischemia-
tissues that are starved for oxygen
70
Infarction
- dead tissue
71
Myocardial ischemia-
what is it
insufficient oxygen to meet hearts metabolic needs
72
what is myocardial ischemia influenced by
c
m
b
coronary artery perfusion
myocardial workload
blood oxygen concertation
73
Coronary perfusion
is what
can be decreased by(p/c/h/v)
Myocardial Ischemia
how much blood the vessels get
can be decreased by plaque, clots , hypotension, vasospasm,
74
Myocardial workload-
made up from
h
p
a
Myocardial Ischemia
hr contractility,
preload
afterload
75
Blood oxygen concentration- can be reduced in
high
in
a
Myocardial Ischemia
high altitudes
in impaired gas exchange
anemia
76
Angina Pectoris
what is it
what happens if over 30 mins
Chest pain due to imbalance between blood supply and demand
Blood flow lasting greater then 30 minutes leads to infarction
77
Decreased blood flow to tissues causing
I
low
low
what metabolism
what buildup
angina pectoris
Ischemia,
low blood flow
, low oxygen
Anerobic metabolism,
lactic acid buildup
78
Stable-
most
what pain/with
Types of Angina
most common,
predictable pain with increased workload of the heart
79
Stable-happen due to x3
Types of Angina
cold, stress or exercise//
80
Stable-treat w
Types of Angina
rest and nitrogylcerin
81
Prinzmetals or atypical-
un
un
happens when
caused by
Types of Angina
unpredicatbale
unrealated to activity
happens at night
, caused by coronary artery spasms
82
Unstable-
increasing in
pain is/can be
Types of Angina
increasing in frequency, severity, duration
pain is unpredictable and can be at rest.
83
unstable angina
risk for
what troponin/what impaired
High risk for mi
chest pain with normal troponin but impaired cardiac output
84
S/S of Angina
what pain
what pressure
can be
increased
increased
f
women may have
Chest pain
Tight squeezing pressure
Can be sob
Increased hr
Increased anxiety
Fear
Women may have nausea and vomiting
85
how long does angina last
what Relieved it
Lasts for 2-3 minutes
Relieved with rest and nitroglycerin
86
ECG
stress ECG
Diagnostic Tests- angina
ECG- normal, or st depression if long term ischmeia
Stress ECG- exercise may bring on angina
87
Radionuclide testing-
shows what
Diagnostic Tests- angina
shows ischemic cells that light up on x ray
88
Echocardiogram-
evaluates what
Diagnostic Tests- angina
evaluate structures and function of the heart
89
Coronary angiography-
looks for
end up with
that does
Diagnostic Tests- angina
looks for arterial stenosis- 50% is bad and 70% is problem
will end up with implanted caridioverter debrifilater-
shock out of arrythmia,
90
Nitrates-
keep where
where give
acts how fast
decreases what
Medications to Relieve Angina
keep in dark
, give sublingual
acts in 1-2 minutes
will decrease preload/after load and oxygen demand
91
nitrates-nitrogylcerin
when x3
do what before/after
taken before what
contraindications x2
Medications to Relieve Angina
when- mi/ angina/ acs
check bp and pulse before/ after doses
can be taken before exercise to prevent angina
contridinications- hypotensive and viagra
92
nitro
how long free before stress test
call when
given how often
pts need to be nitrate free for 8-10 hrs before a stress test
call 911 if first dose doesn't work
given once evert 5 minutes 3 times
93
Long acting nitroglycerin. -available in
sife effects
Medications to Relieve Angina
patches, capsules
side effects – headache, low bp
94
Beta blockers proproanolol, Metoprolol
when x3
assess x2
contrindications- x4
education-does what// make
Medications to Relieve Angina
when- angina, a fib and mi
assess apical and bp
contraindications- bradycardia, hypotension, hf, and COPD propranolol
education- decreases workload of heart and make slow positional changes
95
Calcium channel blockers-
increase
increase
decrease and
used for
Medications to Relieve Angina
increase blood flow to heart ,
increases 02 supply,
decreases bp and vasodilates–
used for Prins metals angina
96
Calcium channel blockers-first class
what med
works where
good for
Medications to Relieve Angina
verapamil-
works only on heart
good for angina
97
Calcium channel blockers-second class
what med
does what
good for x3
Medications to Relieve Angina
dilitiazem-
dilates vessels,
good for angina, hypertension and a fib
98
Calcium channel blockers- third class
what med
good for x2
Medications to Relieve Angina
amlopdine-
good for hypertension and angina
99
aspirin
what's preventative
when mi/acs
contridicated in
what med also works for angina
preventative is 81 mg
mi/acs is 325 mg
contraindicated with gi bleed and if benefits outweigh the risks
100
nitro-keep where
oxygen -how much
activities-
education-
exercise-
quitting-
neffective Tissue Perfusion-angina
Nitro- keep with pt, dark, cool, dry
Oxygen- 4-6 L NC
Activities- rest, pace themselves
Education- medications and risk factors for MI
Exercise- progressive
Smoking
101
denial-
asses
provide
give
Risk for ineffective therapeutic regimen management
Denial- forgetting medications, aggressive behavior when educating about the disease
Asses Knowledge level
provide Education
give Referrals
102
Acute Coronary Syndrome- ACS
untable
acute
Unstable angina
acute myocardial ischemia
103
precipitated by one or more processes
__plaque
spasms
I
increased
decreased
Acute Coronary syndrome
rupture/ erosion of plaque,
spasms of coronary arteries,
inflammation,
increased oxygen demand.
Decreased supply of oxygen from blood loss
104
S/S of ACS
what pain
d
d
p
hr
bp
Substernal/ Epigastric Chest pain-
Dyspnea,
Diaphoresis
Pallor
Increased hr
hypotension
105
Substernal/ Epigastric Chest pain ACS
can
occurs
longer
more
- can radiate
occurs at rest
longer then 10—20 minutes
more severe then angina
106
Unstable angina- ACS
ecg/ cardiac enzyme
does not see ecg or cardiac enzyme changes
107
myocardial infarction- ACS
ecg/ cardiac enzyme
enzyme changes
some st elevation or t wave inversion.
108
ACS
if ecg changes then what
STEMI
109
ACS
if no ecg changes and cardiac markers raised then what
NSTEMI
110
ACS
no ecg changes and no cardiac markers raised
unstable angina
111
ECG-
Diagnostics for ACS
ischemia, elevation, depression or blocks
112
Cardiac muscle troponins-
Diagnostics for ACS
normal unless mi
113
Creatinine kinase-
Diagnostics for ACS
beirfly elevated
114
Medications for ACS
anti-
n-
b-
pain relief-
Anti platelets- aspirin or clopidogrel
Nitrates- nitroglycerin
Beta blockers- metorpolol
Pain relief- morphine- decreases anxiety, pain and 02 consumption
115
When patient is having mi
M
O
N
A
M- morphine
O- oxygen-FISRT priority
N- nitro
A- aspirin
116
Percutaneous coronary revascularization-
restores
with
Revascularization-Treatment Measures for ACS
restores blood flow
with a balloon angioplasty
117
Percutanious translumenal coronary angioplasty-
placement of
Revascularization Treatment Measures for ACS
stent placement
118
cut
harvest
what machine- puts pt at risk for
will bypass
watch for
need
Treatment Measures for ACS CABG
cut sternum,
harvest saphenous vein in leg
uses a heart-lung bypass machine in procedure-risk for air embolism
Will bypass blockage by attaching vein to artery
Watch for Infection, bleeding
need to warm slow
119
Post op care- CABG
want them
watch for
can return to normal sexual activity when
want them up and moving,
watch for urine output, vs,
can return to normal sexual activity when they can climb 2 flights of stairs without being winded
120
MI
death
can be
condition based
Death of myocardial cells
Can be due to blockage from clots and vasoconstriction
Condition based on location of infarction
121
s/s of mi
what pain
not releived by
what skin
n
v
a
t
Severe sudden, crushing burning and radiating chest pain
not releived by rest/nitro
Cold clammy skin
Nausea,
vomiting
Anxiety
tachycardic
122
MI in women
chest
s
what pain
flush
sweat
n
s
unusal
chest sensations
SOB
shoulder blade pain
hot flush
cold sweat
nausea
dizziness
unusal fatiuge
123
why dysrtyhmias
why heart failure
Complications of MI
Dysrhythmias- cannot conduct electricity
Heart failure- dead muscle cannot pump
124
Cardiogenic shock-
what happens
Complications of MI
cardiac output less then 40%- high morality rate
125
Infarct extension-
what happens
Complications of MI
rethrow a clot and infarct again
126
Structural defects-
can be
Complications of MI
can be from damaged valves in arteries
127
Pericarditis-
how long after
what happens
complications of MI
-2-3 days afterwards-
increased chest pain with movement and breathing
128
Care of MI Patient
receive
reduce
maintain
decrease
prevent
Relieve pain
Reduce extent of damage
Maintain cardio stability
Decrease cardiac workload
Prevent complications
129
CK- Creatinine Kinase-
CK-MB- Creatinine Kinase Myoglobin
Troponin-
CBC
Diagnostics to Detect MI
CK- elevated
CK-MB- - greater then 5%
Troponin- increased- greater then 0.2
CBC- elevated wbc count
130
ABG
ECG
echocardiogram -what see
Diagnostics to Detect MI
ABGs- metabolic acidosis
ECG- st elevation and depression
Echocardiogram- infarcted tissue that doenst contract
131
Aspirin-
decreases what
reduces
Medications for MI
decreases inflammation
reduces risk of clots
132
Nitrates-
will/won't
do what
Medications for MI
will decrease pain but wont take it away-
dilate vessels
133
Morphine-
decreases
receives
Medications for MI
decreases oxygen demand
relieves pain
134
Fibrinolytic therapy- TPA-
given when
do not give to
Medications for MI
given if onset is less the 6 hrs-
do not give to recent bleed, surgery or recent fall or trauma
135
Anti dysrhythmics-
what for bradycardia
what for a fib
Medications for MI
atropine for bradycardia,
verapamil- afib
136
Beta blockers-
decreases
limits
Medications for MI
decrease pain,
limits damage and cardiac remodeling
137
Anticoagulants- what
Medications for MI
heparin
138
ACE inhibitors- prils- Lisinopril
decreases risk of
can increase
decreases i
decrease what risk
decreases risk for
decreases blood
Medications for MI
Decreases risk of diabetes comlications
Can increase potassium
Decreases inflammation
decreases clotting risk
Decreases risk for remodeling
Decreases blood glucose
139
MI Ace inhibitors
Se-
cough,
orthostatic hypotension,
life threatening angioedema
140
Treatment for MI
close
bed
o
revascualrizion-within/examples
Close monitoring
Bed rest
Oxygen
Revascularization within 90 minutes- angioplasty, place a stent, cabg, intraaortic ballon pump
141
three phases- first Inpatient-
do what
bed
Cardiac Rehab
ambulation and ADLs
bedrest
142
three phases- second Immediately post discharge-
do what
Cardiac Rehab
gradually increase activity and cardiac rehab
143
third stage to cardiac rehab
do what
check how often
Cardiac Rehab
Transition to independence
check every 3 months
144
Assessment of Client With MI
hx
what pain
is there
what is
do they
e
Hx in them or fam?
Crushing, stabbing type pain?
Is there other symptoms like nausea, vomiting, anxiety, dyspnea?
What is medical hx- HTN, CAD, diabetes, angina, lipids
Do they use drugs- meds, cocaine
ECG
145
Acute pain-
what is high priority
what decreases workload
how much of what
Nursing Diagnoses and Interventions in mi
Pain relief is high priority// morphine and nitro
rest decreases workload
oxygen- 2-6 liters decreases ischemia and pain
146
Ineffective Tissue Perfusion-
assess for/1st
monitor what
anti
serial
plan for
Nursing Diagnoses and Interventions
Assess- for change in mental status-1st sign of decreased tissue
perfusion, no O2 to brain
Monitor- watch the urine output, skin color and temp
Anti dysrhythmics
Serial enzymes
Plan for invasive hemodynamic monitoring
147
Fear of death and disability
I
a
e
m
reduce
Identify
Acknowledge
Encourage
Medications
Stress reduction
148
Women and MIs
what is leading cause of death
more likely to have
more likely to have
CAD is leading cause of death in women
More likely to have atypical symptoms
more likely to have NSTEMI
149
WOMEN and mi
increased risk w/
what med
early
what therapy
oral contraceptives,
early menopause
, hormone replacement therapy
150
Elderly with MIs
Usually have atypical symptoms:
s
c/d
d
what pain
what mi
SOB
Confusion and disorientation- new abrupt onset
Dizziness
Abdominal pain
Silent MIs
151
PVCs/PACs-
is what
reduce
know what levels
Arrythmias
irregular heart rhythm-
reduce caffeine intake
want to know k/electrotlye level
152
1st degree Heart block/BBB –
can signify-do what
pr interval
Arrythmias
can signify issues- will investigate if new
pr interval longer then.2
153
2nd Degree Block- type 1
what pr interval
consult w who
Arrythmias
pr interval gets longer and longer until it skips a beat
consult cardiology
154
2nd Degree Block- type 2
has what
consult w who
Arrythmias
has a normal p-qrs and then just a random p wave that does not have a qrs
consult cardiology
155
3rd degree block
very
has what ecg
a/v
get
may need
Arrythmias
- very slow hr,
has lots of p waves but not a lot of qrs
atria and ventricles are working at different paces
get bp/ loc
may need pacemaker
156
Atrial fib/flutter-
assess x2
unstable means-what hr and bp
try to
if chronic give
Arrythmias
assess bp/loc
if high hr then unstable //also then a low bp
try to convert with med or cardioversion with really fast rate
if chronic give rate controller and blood thinners
157
V tach-
assess pt for x4
low bp means
if pulse->
if no pulse
if cardioversion->might
Arrythmias
assess pt for bp/ o2 / loc/ pulse
low bp means unstable
if pulse- if pulse try to convert with meds or cardioversion,
if no pulse cpr and defib
, if cardioversion- might sedate so monitor airway and vitals and 02
158
V fib-
make sure
what rhythm
start
Arrythmias
make sure monitor is correct,
shockable rhythm,
start cpr,
159
st elevation
what looks like on ecg
in emergency- get x3
treat w
send to
not everything is on same plane in st elevation
in emergency- get loc/ bp/ 02
treat with mona
send to Cath lab
160
morphine
when x2
assess x2
contraindications x3
releives
when- mi and acs
assess rr and loc
contraindications- low loc, bp, rr
receives pain and 02 demand
