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Complex Exam 1 > HF > Flashcards

HF Flashcards

1
Q

Class 2 HF

A

Mild
Slight limitation of physical activity
Comfortable at rest but ordinary physical activity results in fatigue, palpitation, or dyspnea

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2
Q

Class 3 HF

A

Moderate
Marked limitation of physical activity
Comfortable at rest but less than ordinary physical activity causes fatigue, palpitations, and dyspnea

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3
Q

Class 4 HF

A

Severe
Unable to carry out any physical activity without discomfort
Symptoms of cardiac insufficiency at rest

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4
Q

Cardiopathies result from

A 
HTN
CAD
Substance abuse
MI
congenital defects
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5
Q

Filling disorders caused by

A

Mitral or aortic valvular disease
Cardiac tanponade
Restrictive pericarditis

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6
Q

AVblock first degree

A

All sinus impulses eventually reach the ventricles
AV conduction is slow

PR interval > 0.20 seconds

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7
Q

Causes for AV first degree block

A

AV node ischemia
Electrolyte imbalance
Drugs
Excessive vagal stimulation

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8
Q

Symptoms for AV first degree block

A

Usually aysomtomatic

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9
Q

Tx for AV first degree block

A

Usually none unless Rhythm due to drug therapy (withhold drug)

If symptoms are bradycardia then give oxygen and atropine

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10
Q

AV block second degree type 1

A

Successive sinus impulses take a little longer to reach ventricles; eventually blocked = dropped beat

More p waves than QRS complexes

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11
Q

Causes for AV second degree type 1 block

A

Drugs
Myocarditis
Inferior wall MI

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12
Q

Symptoms for AV second degree type 1 block

A

Asymtomatic unless cardiac output effected
Symptom bradycardia give oxygen and atropine
Maybe needs pacemaker

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13
Q

AV block second degree type 2

A

Infranodal
Occurs below the bundle of HIS
QRS is wide
Dropped beats

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14
Q

Causes for second degree block type 2

A

Anterior wall MI
Conduction problem
Rheumatic heart disease
Degenerative disease of conduction system

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15
Q

Symptoms for AV second degree block type 2

A

Bradydysthmia (decreased CO)

Can rapidly turn into third degree block

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16
Q

Tx for AV second degree type 2 block

A

Temporary pacing

Oxygen atropine and isoproterenol (isuprel)

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17
Q

AV Block third degree

A

Complete heart block
None of the sinus impulses reach the ventricles
An independent pacemaker paces the ventricles
Atrial and ventricle rhythms regular but independent
More P than QRS
PR interval not consistent

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18
Q

Causes for third degree AV block

A 
CAD
MI
degenerative disease of conduction system 
Hypoxia
Aortic stenosis
Congenital defects 
Drugs
Electrolyte imbalances 
Heart surgery
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19
Q

Symptoms of third degree AV block

A

Confusion lighthead syncope myocardial ischemia HF hypotension cardiac arrest VT VF asystole

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20
Q

Tx for their degree AV block

A

Oxygen and atropine
Isoproterenol (isuprel)
Pacemaker

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21
Q

Bundle branch block

A

Can be temporary or permanent
Conduction delay or block below the bundle of HIS

USUALLY no symptoms
Give oxygen and pacemaker if block progresses

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22
Q

Temporary pacing

A

Synchronous (demand) pacing

Asynchronous (fixed rate) pacing

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23
Q

Complications of temporary pacemakers

A

Discomfort
Skin irritation
Loss of capture
Inappropriate pacing

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24
Q

Heart failure manifestations

A 
Increased intravascular volume 
Displaced PMI
precordial heave/lift
Breath sound changes
Extra heart sound
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25
Left side HF
Dyspnea orthopnea cough crackles extra heart sounds Cheyenne stokes Weakness fatigue difficulty concentrating decreased exercise tolerance palpitations anxiety restlessness
26
Right side HF
``` Progressive fatigue Difficulty concentrating Peripheral edema Weight gain Increased abdominal girth (helatomeagly, ascites, jaundice) JVD anorexia, nausea, nocturia, weakness ```
27
Grade 1 edema
Infection up to 1/4 and quickly returns to baseline
28
Grade 2 edema
Intention 1/4-1/2 returns to baseline in 10-15 seconds
29
Grade 3 edema
Intention 1/2-1 inch returns to baseline in 1-2 mins
30
Grade 4 edema
Intention more than 1 inch and returns to baseline longer than 2 mins
31
Normal ejection fraction
>50%
32
Heart failure ejection fraction
<40%
33
Severe heart failure ejection farction
<30%
34
Dynamic cardiomyopasty
Surgery to wrap a flap of skeletal muscle around failing heart- conduction of the muscle to perform as cardiac muscle
35
Ventricular assist device
Receive blood from failing left ventricle and pump the blood to the aorta
36
Only cure for heart failure
Transplantation
37
Cardiogenic shock
Vicious cycle of death Failure of heart to pump forward 40% loss of ventricular myocardium function Decreased tissue perfusion and cell death Decreased myocardial functioning Increased release of myocardial suppressant factor leading to depression and death
38
Indications for worsening HF
``` Weight gain Decrease in exercise tolerance Excessive awakening at night to urinate Development of dyspnea or angina at rest Cough lasting more than 3-5 days ```
39
Coronary artery bypass graft
Areas of the myocardium are revascularized by implantation of the internal mammary artery or bypassing of the coronary occlusion with saphenous vein graft or radial artery graft
40
Check neuro how many times after patient wakes up from surgery
Every 30-60 mins until awake and then every 2-4 hours according to policy
41
Cardiac output=
Stroke volume x heart rate
42
Each smallest square equals
.04 second
43
Each large block equals
.20 seconds
44
P wave
Atrial depolarization
45
PR interval
Impulses conducted across Atria from SA to AV node (0.12-.20)
46
QRS complex
Ventricular depolarization (0.06-0.10 seconds)
47
St segment
Beginning of ventricular depolarization
48
T wave
Ventricular depolarization
49
QT interval
Ventricular depolarization and re polarization
50
R to R interval
Total time between ventricular contractions
51
How to analyze strip rate rhythm
``` P wave present? QRS present? P-QRS ratio 1:1? QRS complex same configuration? Rate # p/QRS Complex in 6 seconds Rhythm of R-R regular? ```
52
Normal sinus rhythm
``` Rate 60-100 P waves: small round P-QRS ratio- 1:1 R-R- equal QRS complex- narrow Regular rhythm ```
53
Sinus bradycardia
``` Rate 40-59 P wave- sinus p-QRS ratio- 1:1 QRS normal configuration (0.6-.12) R-R- equal Regular rhythm ```
54
Sinus tachycardia
``` Rate 101-160 P waves sinus P-QRS ratio- 1:1 QRS complex- normal R-R- equal Regular rhythm ```
55
Sinus arrhythmia
``` Rate: 45-100 P waves: sinus P-QRS ratio: 1:1 QRS complex: normal R-R: irregular Rhythm: irregular ```
56
Atrial flutter
``` Rate: atrial 250-350; ventricular variable P waves: saw tooth P-QRS ratio: inconsistent QRS complex: narrow R-R: equal Rhythm is usually regular ```
57
Atrial fibrillation
``` Rate: atrial 400-650; ventricular variable P wave: not present "wavy baseline" P-QRS ratio: indeterminate QRS complex: normal Rhythm: usually irregular ```
58
Premature ventricular contractions (PVCS)
``` Rate: variable QRS complex: obviously different wide P wave: visible only with normal complex P-QRS ratio: 1:1 with normal cycles R-R: irregular Rhythm: irregular ``` Can be bigeminy, trigeminy, or quadrigeminy
59
V tach
``` Rate: ventricular 100-220 P wave: obscured if present QRS complex: wide R-R ratio: variable Rhythm: regular or irregular Life threatening! ```
60
V fib
``` Rate: unattainable P wave: obscured if present QRS complex: not apparent R-r: unattainable Rhythm is irregular ``` Life threatening Can have course or fine v fib
61
Idioventricular rhythm
``` Rate: 20-40 P wave: absent QRS complex: wide R-R: regular Rhythm: regular ``` Life threatening
62
Artififact common causes
Muscle tremor or movement Loose electrode Broken lead wire Respiratory artifact
63
Causes for sinus tachycardia
Stress Exercise Stimulants (caffeine and smoking) Also fever, anemia, hyperthyroidism, hypoxemia, heart failure, shock
64
Treatment for sinus tachycardia
Directed at eliminating the underlying cause Sedation, oxygen, digitalis, and diuretics if heart failure is present Give beta blockers if caused by thyrotoxicosis
65
Causes for sinus bradycardia
Can be healthy Sleep, severe pain, inferior wall MI, acute spinal cord injury, certain drugs If too low or diseased heart treat with atropine or cardiac pacing
66
Causes for sinus arrhythmia
Caused by irregularity in sinus node discharge often in association with phases of the respiratory cycle Sinus node increases with inspiration and decreases with expiration Seen in young people who are healthy and active
67
Tx for sinus arrhythmia
Nothing since it doesnt hint to underlying disease
68
Atrial flutter causes
CAD, cor pulmonale, and rheumatic heart disease Can Quickly lead to pulmonary embolism, cerebral embolus, or MI because atrial kick cannot prevent thrombi from forming
69
Atrial flutter tx
Reestablish sinus rhythm or to achieve ventricular rate control If pharmacological conversion is not successful than electrical cardioversion can be used Long term management is ablation, pacing, and implantable devices
70
Atrial fib causes
Atrial muscle disease or atrial distention Heart failure, ischemia, rheumatic heart disease, congenital heart disease Same with atrial flutter these patients have lose their atrial kick which causes them to be at risk for thrombi formation leading to embolisms and MI
71
Tx for atrial fib
Same as with atrial flutter The goal is to achieve rate control and convert the rhythm to sinus Chronic patients need anticoagulant therapy just like a flutter. If drug therapy fails then cardioversion is indicated Ablation, pacing, and implantable devices
72
Causes for PVC
People with myocardial disease (ischemia or infarction), or with myocardial irritability (hypokalemia, increased levels of catecholamines) Pvcs are signs of ventricular irritability and can lead to v tach or v fib
73
Tx for PVCS
In emergency situations amiodarone, and lidocaine can be used
74
V tach causes
Common complication of MI | V TACH is a precursor to V fib
75
V tach tx
If the patient is hemodynamically stable than lidocaine can be used if the patient is unstable then use synchronized cardioversion In emergency situations use unsychronized defibrillation Long term management can be ICD
76
V fib causes
Myocardial ischemia and infarction, catheter manipulation in the ventricles, There is no pulse and NO CO
77
Tx for v fib
Rapid defibrillation Cardiopulmonary resuscitation and drugs ICD for long term management
78
Class 1 HF
Mild No limitation of physical activity Ordinary activity does not cause fatigue, palpitation, or dyspnea

Complex Exam 1 (1 decks)

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