Final Flashcards

1
Q

Stable angina

A

Worse when physically active

RELIEVED BY REST

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2
Q

Unstable angina

A

Occurs with rest

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3
Q

What is treatment for STEMIs

A

PCI is the insertion of a catheter with a ballon tip that is inflated to open a artery

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4
Q

Who is a PCI more reserved for

A

More reserved for patients with STEMIs but, non STEMI patients may also have one

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5
Q

Stemi

A

Full occlusion of the coronary vessel

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6
Q

Non stemi

A

Platelets aggregate and cause blockage of smaller vessels leading to a non stemi

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7
Q

ACS

A

Is the clinical manifestation of coronary heart disease, which includes the developement of fatty plaques in the coronary arteries

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8
Q

What are biochemical markers that help diagnose an infarction

A

Troponin
Myoglobin
CPKMB

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9
Q

Cardiac catherization

A

Is performed to determine the exact location of the myocardial injury and specific obstructions to the coronary vasculature

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10
Q

What is cardiac catherization most commonly used for

A

For the diagnosis of CAD and ACS

IT is useful in determining whether a patient would benefit from a PCI or CABG

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11
Q

What is the most commonly used anticoagulant for patients with ACS

A

Heparin

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12
Q

What is aftercare of PCIs

A

Patients with stent placement usually require anti platelet therapy with aspirin or clopidogrel for up to 6 months to reduce the risk for vessel thrombosis

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13
Q

What are the 3 prominent signs of cardiac tamponade

A

Remember BECKS TRIAD

  1. Distended heart sounds
  2. Distended jugular veins
  3. Decreased arterial pressure
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14
Q

Cardiac tamponade

A

Is compression of the heart resulting from fluid or blood within the pericardial sac

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15
Q

What is cardiac tamponade are usually the result of

A

Blunt or penetrating trauma to the chest
Cardiac catherization
Angiographic procedures
Pacemaker insertion

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16
Q

What are other signs and symptoms of cardiac tamponade

A
Chet pain
Tachypnea
Dyspnea 
Tachycardia in response to low CO
pulsus paradoxus 
Hypotension
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17
Q

What is pulsus paradoxus

A

Systolic pressure that is markedly lower during inspiration

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18
Q

What are assessment findings of cardiac tamponade

A

A echocardiogram is performed to confirm the disease and quantify the amount of pericardial fluid
CXR

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19
Q

What is medical mgmt of cardiac tamponade

A

Pericardiocentesis

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20
Q

How is the HOB placed during a Pericardiocentesis

A

45-60 degrees, placing the heart in proximity to the chest wall so that the needle can be inserted directly into the pericardial sac

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21
Q

Pacemaker

A

Is a medical device designed to assist in stimulating the heart when the natural pacemaker is too slow or its impulses are blocked from reaching the ventricles

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22
Q

Demand pacemaker

A

Is synchronized with the persons HR, meaning that it fires when the HR drops below a preset amount

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23
Q

What are pacemakers used for

A

Severe bradycardia
Dysthymias
Sometimes ventricular dysthymias

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24
Q

What are complications of ICDs and pacemakers

A

Cardiac tamponade

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25
Q

ICDs are used in who

A

Used in patents who r at risk of sudden cardiac death due to VF, or those patients who have experienced one or more episodes of VTor VF unrelated to a MI

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26
Q

What do ICDs do

A

It is programmed to deliver an electric shock if the pt goes into VF
It monitors the patients HR and rhythm and is multi programmable to deliver pacing, cardioversion and or defibrillation according to the patients needs it can also pace the heart if severe bradycardia occurs

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27
Q

What is CABG

A

A procedure in which the patients diseased coronary arteries are bypassed with the patients own venous ( saphenous vein) or artery ( internal mammary or radial) vessels.

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28
Q

Who is CABG indicated for

A

Patients with ACS to relieve symptoms, improve quality of life and to hopefully prolong life

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29
Q

Who is CABG indicated for

A

Ppl who have failed medical tx
Has more than 2 diseased coronary vessels with significant blockage
May not be a candidate for PCI
has failed a PCI attempt with ongoing chest discomfort

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30
Q

Post op care for CABG

A

Apply a cardiac monitor

Monitor the volume in the circulatory system which is reflected by RAP and PCWP

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31
Q

Cardiogenic shock

A

A hemodynamic problem

A problem within the heart itself

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32
Q

What is cardiac tamponade are usually the result of

A

Blunt or penetrating trauma to the chest
Cardiac catherization
Angiographic procedures
Pacemaker insertion

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33
Q

What are other signs and symptoms of cardiac tamponade

A
Chet pain
Tachypnea
Dyspnea 
Tachycardia in response to low CO
pulsus paradoxus 
Hypotension
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34
Q

What is pulsus paradoxus

A

Systolic pressure that is markedly lower during inspiration

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35
Q

What are assessment findings of cardiac tamponade

A

A echocardiogram is performed to confirm the disease and quantify the amount of pericardial fluid
CXR

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36
Q

What is medical mgmt of cardiac tamponade

A

Pericardiocentesis

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37
Q

How is the HOB placed during a Pericardiocentesis

A

45-60 degrees, placing the heart in proximity to the chest wall so that the needle can be inserted directly into the pericardial sac

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38
Q

Pacemaker

A

Is a medical device designed to assist in stimulating the heart when the natural pacemaker is too slow or its impulses are blocked from reaching the ventricles

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39
Q

Demand pacemaker

A

Is synchronized with the persons HR, meaning that it fires when the HR drops below a preset amount

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40
Q

Cardiogenic shock

A

A hemodynamic problem

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41
Q

What are signs and symptoms of cardiogenic shock

A

Decreased CO
Decreased BP
increased SVR

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42
Q

What is hypovolemic shock

A

A fluid deficit problem

Decreased fluid in the intravascular space

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43
Q

What are causes of hypovolemic shock

A

Decreased CO
Decreased BP
increased HR

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44
Q

What are causes of hypovolemic shock

A

Dehydration

Trauma

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45
Q

What is distributive shock

A

ADEQUATE BLOOD AND FLUIDS THAT ARE DISTRIBUTED ABNORMALLY, the patient will still have decreased CO, but not bc of decreased fluid

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46
Q

What is treatment for distributive shock

A

Fluid won’t help, you must correct the u deflating cause

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47
Q

What is obstructive shock

A

It is related to the heart
The ventricles don’t fill or empty adequately
It’s a ventricular problem

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48
Q

Cardiac tamponade causes which type of shock

A

Obstructive shock

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49
Q

What is anaphylactic shock

A

A hypersensitivity reaction to drugs or food

It affects CO bc of massive vasodilation

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50
Q

How do you treat anaphylactic shock

A

Treat the cause, epinephrine l, iv steroids and Benadryl won’t help

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51
Q

What is spinal shock

A

Shock resulting from SCI
There is adequate volume, nothing is wrong with the heart
It is a type of distributive shock

52
Q

What are the stages of shock

A

Mild- reversible
Moderate- reversible
Severe- body can’t compensate

53
Q

Causes of obstructive shock

A

Pulmonary embolism
Cardiac tamponade
Tension pneumothorax
Pericarditis

54
Q

What are causes of distributive shock

A

SCI
anaphylaxis
Severe sepsis

55
Q

What are causes of cardiogenic shock

A

Cardiac ischemia/ infarction
Valve dysfunction
Dysthymias
Blunt cardiac trauma

56
Q

What are causes of hypovolemic shock

A

Hemmorhage
Burns
Third spacing
DI

57
Q

What is collaborative care of a patient experiencing hypovolemic shock

A

Fluid resuscitation with colloids such as blood products

Or isotonic solutions such as 0.9% ns

58
Q

What is treatment of cardiogenic shock

A

Dopamine
Norepinephrine
* if pulmonary edema exists, provide diuretics or preload reducers such as nitroglycerin

59
Q

Name a preload reducer drug

A

Nitroglycerin

60
Q

What is treatment for spinal shock aka neurogenic shock

A

Crystalloids first

Dopamine, norepinephrine or phenylephrine… If necessary atropine for bradycardia

61
Q

What is treatment of anaphylactic shock

A

Epinephrine
Diphenhydramine
Ranitidine or famotidine

62
Q

What is treatment of septic shock

A

Norepinephrine
Dopamine
Phenylephrine
Vasopressin

63
Q

Prolapsed valve

A

The valve is weakened

It doesn’t shut completely

64
Q

What are the main valves that can be diseased

A

Aortic, mitral or both

Regurgitation can occur ( blood flows back up into the valves)

65
Q

Mitral valve prolapse is more common in who

A

Females

66
Q

Signs and symptoms of valve disease

A

Palpitations

Bruit which is best heard when the pt. is laying on the left side

67
Q

What diagnostic can detect valve disease

A

Echocardiogram can show regurgitation

68
Q

What is surgical repair of a diseased valve

A

A commissurotomy or surgical repair which is either a porseine or St. Jude’s valve

69
Q

What is a porseine

A

A pig valve

70
Q

What are advantages of porseine valves

A

No need for anticoagulants for life

The patient may be on Coumadin or clopidogrel to decreased the risk for clots but, it won’t be for life

71
Q

What are disadvantages of the porseine valve

A

Lasts from 10-15 years

Seems to have a high rate of failure

72
Q

What are advantages of the St. Jude’s valve

A

It can last 20 yrs or more

73
Q

What are disadvantages of the St. Jude’s valve

A

Increased risk for clots

The patient will need to be on Coumadin or clopidogrel for life

74
Q

What is repair of a diseased valve

A

A valvuloplasty
In general, valves that undergo valvuloplasty function longer than prosthetic valve replacements and patients do not require continuous anticoagulation therapy

75
Q

Complications of CABG

A

Cardiogenic shock

76
Q

If cardiogenic shock is left untreated, what will occur

A

S3 heart sounds ( gallop) a xtra sound that shouldn’t be there
Pulmonary edema

77
Q

What does the cerebrum control

A

Intelligence
Sensory function
Motor control

78
Q

What does the cerebellum control

A

Posture
Balance
Motor movements

79
Q

What does the brain stem control

A
Respiratory rate ( medulla)
Vomiting, coughing reflexes,
80
Q

What does the pons control

A

Cranial nerves

81
Q

What is a definitive dx for stroke

A

MRI

82
Q

Before tx of a stroke, what info must be known

A

Is it hemmorhagic or ischemic

If it is hemmorhagic DO NOT GIVE ANTICOAGULANTS

83
Q

What’s a basilar skull fracture

A

Fracture at base of skull. A change is facial characteristics

84
Q

What’s a coup injury

A

Injury to the front of the head

85
Q

What’s a counter coup injury

A

Injury to the back of the head

86
Q

What is the criteria that must be met for a TBI

A

Severe loss of consciousness for more than 6 hours

87
Q

What is a extradural hematoma

A

The person bleeds a lot it is very dangerous

88
Q

What is helpful to reduce inflammation in a TBI

A

Steroids watch for hyperglycemia

89
Q

What are seizures a complication of

A

Increased ICP

stoke

90
Q

ICH is considered what type of stroke

A

A hemmorhagic stroke

91
Q

ICH usually derives from what

A

Bleeding of small arteries or arterioles directly into the brain

92
Q

What are common causes of ICH

A

HTN
TRAUMA
ILLICIT DRUG USE

93
Q

What is a subarachnoid hemorrhage

A

Rupture of an aneurysm that releases blood directly into the CSF under arterial pressure. The blood spreads rapidly within the CNS immediately increasing ICP
If bleeding continues deep coma or death may occur

94
Q

What’s a thrombotic stroke

A

Occlusions promote thrombus formation in the arteries

Atherosclerosis is the most common cause

95
Q

What is a embolic stroke

A

It is caused by particles that arise from another part of the body resulting in blockage of arterial blood flow to a area of the brain

96
Q

Are the onset of symptoms for a embolic stroke fast or slow

A

A embolic stokes onset of symptoms is a brunt and rapid as a sudden blockage has occurred

97
Q

What’s a embolic stroke

A

From emboli like in a fib

98
Q

What will the patient complain of with a ruptured cerebral aneurysm

A

Severe headache

99
Q

What’s the clinical profile of a acute ischemic stroke

A

The person I’d sedentary when the symptoms arise

100
Q

What’s the clinical profile of a embolic stroke

A

Sudden onset
Occurs when the pt is awake and active
Maximin deficit within minutes

101
Q

What r causes of a embolic stroke

A

Cardiogenic embolism
A fib
Valvular disease
MCA most often affected

102
Q

What are risk factors for a hemmorhagic stroke

A
HTN
AVM 
TRAUMA 
DRUGS 
TUMOR, ENDOCARDITIS
103
Q

What are symptoms of a anterior stroke

A

Affects one side of the body
Both motor and sensory
Left side of brain causes aphasia
Usually not conscience

104
Q

What are symptoms of a posterior stroke

A

THE 4 Ds

Diplopia, dysarthria, dysphagia, dizziness (vertigo)

105
Q

What’s medical treatment of a stroke

A

Anti platelet and antithrombotic therapy
Treat HTN
Neuroprotectives such as CCB nimodipine
THROMBECTOMY
CEA

106
Q

Lab findings of Addison’s disease

A

Decrease cortisol
Decreased glucose
Decreased Na

Increased K+

107
Q

Lab findings of cushings disease

A

Increased Na
Increased glucose
K+ increased
Ca decreased

108
Q

S&S of pheochromocytoma

A

Intermittent symptoms like HTN, headaches, tachycardia, vertigo, vision changes,postural hypotension, tremors, ringing of ears

109
Q

What are the 5 Hs of pheochromocytoma

A
HTN
HEADACHE
HYPERMETABOLISM
HYPERGLYCEMIC
HYPER HYDROSIS ( Diaphoresis)
110
Q

What is pheochromocytoma

A

Benign tumors
Usually dx in the 50-60s
If undiagnosed potentially fatal,
INTERMITTENT SYMPTOMS

111
Q

What is surgical tx for pheochromocytoma

A

Surgery to resect tumor

112
Q

What are medications for pheochromocytoma

A
Regitine
Doxazosin
Prazosin to decrease spiked BP
CCB, BETA BLOCKERS 
Glucocorticoids pre and post op.
113
Q

What’s the clonidine suppression test

A

If catecholamines are not suppressed, it is positive for pheochromocytoma

114
Q

Neurological patients are on what kind of drip

A

Drips to control glucose because blood glucose increases in brain damage/ tissue/ hypoxia.

115
Q

What are V tach medications

A

IV lidocaine
CCB
BETA BLOCKERS
IV ADENOSINE IF UNRESPONSIVE TO BETA BLOCKERS

116
Q

Patho of pulmonary HTN

A

If the pulmonary vascular bed is damaged, or obstructed as in PH the ability to handle whatever flow or volume of blood it receives and is impaired the increased blood flow increases pulmonary artery pressure… the increased workload deceases right ventricular function, the myocardium cannot handle this increased workload.

117
Q

Signs and symptoms of pulmonary HTN

A

Dyspnea is the main symptom, it occurs with exertion and eventually with rest
Substernal chest pain
Weakness, fatigue, syncope, ocassional hemoptysis, signs of fight sided HF ( edema, ascites, Distended jugular veins,liver engorgement, crackles, heart murmurs) anorexia and pain in RUQ

118
Q

Indications of mechanical ventilation

A

Evidence of respiratory failure or compromised airway, decreased o2 and increased CO2

119
Q

Signs and symptoms of DIC

A

Cyanosis and or gangrene especially of the digits
Diminished pulses
Inadequate perfusion to the brain result in altered LOC
inadequate renal perfusion leading to decrease in urine output, increased Cr and or
costovertenral angle pain
Abdominal tenderness, diminished or absent bowel sounds

120
Q

A platelet count of what is suggestive of DIC

A

A value less than 50,000
Elevated PT
PTT greater than 70 is critical

121
Q

Most common cause of ARDS

A

SEPSIS in the setting of pneumonia

122
Q

Early symptoms of ARDS

A

Dyspnea, tachypnea,
Rapid. Shallow breaths, use of accessory muscles, mottling or cyanosis of skin,abnormal breath sounds, dry cough, change in level of consciousness, restlessness, retrosternal discomfort, tachycardia, fever

123
Q

Dx of ARDS

A

ABGs will demonstrate hypoxia despite o2 delivered
CXR
CT
P/F ratio is important in dx

124
Q

What’s the key tx for ARDS

A

Mechanical ventilation with positive pressure and high peep to increase oxygenation

125
Q

What is ARDS characterized by

A

Non cardiogenic pulmonary edema

126
Q

What is ventilator Mgmt goals in ARDS

A

Tidal volume between 4-8
Fio2 less than or equal to 60
Judicious use of peep at 5-15 cm h2o
Maintain sao2 between 88-95%