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S4 2539 > M5 Perfusion 2 > Flashcards

M5 Perfusion 2 Flashcards

1
Q

Layers of the 2 outer linings and 3 structural layers of the heart

A

Parietal pericardium (most outer)
Visceral pericardium

Epicardium
Myocardium
Endocardium (most inner)

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2
Q

Between the visceral and parietal pericardium there is a space that can fill up with fluids. This is called

A

pericardial effusion

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3
Q

Heart valves in order of blood travel

A

Tricuspid
Pulmonic
Bicuspid Mitral
Aortic

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4
Q

What controls the heart

A

Autonomic Nervous system
Baroreceptors

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5
Q

Frank Starling law

3 parts

A

The greater the myocardial stretch the greater the contraction force = increased stroke volume

Decrease in preload (blood return) decreases stretch = decreased stroke volume

Increase in afterload (systemic vascular resistance) due to high BP = decrease in stroke volume
Inversely low BP and drop in afterload = increase in stroke volume

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6
Q

Stroke volume

A

Amount of blood ejected with each heartbeat

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7
Q

Cardiac output

A

Amount of blood pumped in liters per minute

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8
Q

Preload

A

Blood return causing stretch in myocardium at end of diastole

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9
Q

Contractility

A

Ability of myocardium to shorten in response to electrical impulse

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10
Q

Afterload

A

Systemic vascular resistance to ejection of blood from ventricles

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11
Q

Ejection fraction

A

% of diastolic VOLUME ejected with each beat

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12
Q

EF = normal
EF = HF

A

50-70%
Less than 40%

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13
Q

Normal cardiac output in L/min

A

3-5L

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14
Q

CO cardiac output formula

A

CO = SV (stroke volume) x HR

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15
Q

Will digoxin help for low EF

A

NO

moving small amounts of blood at a stronger squeeze wont help perfusion

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16
Q

With low EF, goal is to increase preload, to do this give

A

Beta-blockers

slow heart rate and increase filling time

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17
Q

Older adults hearts may have what problems

A

widening aorta
atherosclerosis
this increases SVR

electrophysiologic decline
cascade efficiency drops

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18
Q

Cardiac action potential 101

3 parts

A

beat of heart measures in volts

depolarization
repolarization
refractory period

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19
Q

Depolazirasion

A

Contraction

influx of sodium and exit of potassium

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20
Q

Repolarization

A

returning to resting state

reentry of K+, exit of Na+

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21
Q

Refractory periods

2

A

effective - cells incapable of depolarizing (heart rest)

relative - cells require stronger than normal stimuli to depolarize

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22
Q

Most common Heart problem manifestations

A

Chest pain
Dyspnea
Edema WEIGHT GAIN
Fatigue
Syncope

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23
Q

Myocardial infarction 101

A

Death of myocardial tissue without blood flow to coronary arteries

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24
Q

3 types of MI stages

A

Ischemia
Injury
Infarction

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25
Q

Ischemia stage MI 101

A

T wave inverts

Starvation for blood and O2

Tissue turns pale

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26
Q

Injury stage MI 101

A

ST segment rise

ONGOING starvation for blood and O2

Tissue is now bluish

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27
Q

Infarction stage MI 101

A

Q wave present

Necrosis and black color

scarring and death of tissue

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28
Q

Due to heart switching to anaerobic metabolism since O2 is unavailable in MIs, it starts producing acidic waste resulting in _ and what lyte increase

A

Acidosis

K+
Mg+
Ca+

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29
Q

In response to MI hypoxia body releases Catecholamine (epi norepi) to increase HR & contractility.

This further

A

Increases O2 demand

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30
Q

What infarction effects all 3 layers

A

Transmural

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31
Q

If myocardial tissue is deprived of O2 up to an 80% reduction in flow it is called a

A

Heart Attack

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32
Q

Etiology of MI Heart attack

A

Atherosclerosis of CA

plaque ruptures, becomes thrombus and occludes flow

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33
Q

Other MI Heart attack causes

A

Coronary spasms
Platelet aggregation
Emboli

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34
Q

CK Creatine Kinase lab during MI

A

Rise and fall during 3 days
Peak at 24h

Detected 2h post MI

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35
Q

Myoglobulin lab during MI

A

detected 2h post MI

early and non-specific marker

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36
Q

Troponin T and I lab during MI

A

GOLD standard
Myocardial injury specific

4-6h

used if pt delayed treatment

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37
Q

Lactate Dehydrogenase LDH lab during MI

A

found in liver heart kidney and brain

elevates at 12-14h

used if pt reports symptoms after days

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38
Q

Lipid profile for MI

A

cholesterol greater than 200 = CAD

HDL good
LDL LETHAL

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39
Q

What labs indicate CAD risk factors

A

Brain Natriuretic Peptide BNP
C-reactive protein
Homocysteine

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40
Q

Visual diagnostic tests for MI/CAD

A

CXR
EKG
Cardiac stress test (exercise or med induced)
Heart cath
Echocardiography

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41
Q

Echocardiography

A

2 dimensional view
Transesophageal

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42
Q

6 lead telemetry placement guide

A

Salt Pepper
Hamburger x2
Lettuce Tomato

white black
brown brown
green red

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43
Q

Telemetry monitoring basics

A

Shave chest hair
ALWAYS let telemetry know before removing pt
NEVER remove unstable pt
monitor for 60 cycle interference

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44
Q

60 cycle interference

A

wires are crossing or electronic devices are on bed

ECG strip stops interpreting

caused by laptop, cellphone, etc.

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45
Q

P wave problems =

A

SA node or atria problems

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46
Q

PR interval problems =

A

AV node
Bundle of His, bundle branches
Atria

problems

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47
Q

QRS complex problems =

A

Bundle branches conduction problem

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48
Q

ST segment problem =

A

MI
ACS Acute coronary syndrome

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49
Q

Elevated voltage of ST =

A

STEMI
ST elevated MI

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50
Q

T wave problems =

A

MI

old myocardial injurys may INVERT the T

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51
Q

QT interval =

A

Repolarization disturbance problems

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52
Q

EKG strip = _sec

A

6

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53
Q

Interval from p to p is

A

Atrial rate

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54
Q

Interval from r to r is

A

Ventricular rate

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55
Q

To determine HR multiply R peaks in a EKG strip by

A

10

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56
Q

Emergency management of heart problems

A

Respond to ALL alarms
Assess lead placement
Stay with PT
ABCs

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57
Q

Treatment of choice for ventricular tachycardia and Afib-RVS (rapid ventricular reponse)

A

Defibrilation

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58
Q

Defibrillation 101

A

Synchronized cardioversion
Delivers shock
Measured in joules per second

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59
Q

Does defibrillation have to be done on an emergent basis

A

NO

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60
Q

Defibrillator used to deliver a hands free shock in emergent and nonemergent setting

A

AED

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61
Q

Imlantable cardioverter defibrillator ICD 101

A

pulse generator
similar size-pacemaker

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62
Q

ICD Risks

A

future dysrhythmias

ICDs should have antitachycardia and antibradycardia pacemakers

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63
Q

Pacemaker 101

A

Artificial electric impulse generator used for cardiac resynchronization therapy

Temporary and permanent

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64
Q

Temporary pacemakers are used for

A

Acute MI
Prophylaxis after open heart surgery

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65
Q

Permanent pacemakers are used for

A

2nd and 3rd degree heart block
Bundle branch blocks
Cardiomyopathy
HF
SA node problems

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66
Q

V lead placement

A

-u shape around mid sternum

v1-4th right intercostal space
v2-4th left intercostal space
v3 to v6 5th left intercostal space (right after v2 to axillary area)

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67
Q

What 12 lead ECG pqrst change indicate ischemia

A

Flatt ST segment
ST-T depression
T inversion
Abnormally tall T
Inverted U

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68
Q

What 12 lead ECG pqrst change indicates injury

A

ST-T wave elevation

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69
Q

What 12 lead ECG pqrst change indicates infarction

A

Pathological Q waves
greater than 0.03sec and deper than 2mm

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70
Q

Problems with right coronary artery

A

Inferior wall MI

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71
Q

Problems with left main coronary artery

A

Sudden death

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72
Q

Problems with left anterior descending coronary artery

A

Anterior wall MI

necrosis of left ventricle and bundle branches

widow-maker

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73
Q

What does an exercise stress test determin

A

Functional capacity of heart
Effectiveness of anidysrhythmic drugs

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74
Q

before exercise stress test

A

No alcohol
no smoking
no caffeine

Dr. will decide which meds to hold

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75
Q

When to stop exercise stress test

A

Chest pain
SOB
hypotension
dysrhythmias
ST changes

or

Predetermined heart rate is reached

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76
Q

To start exercise stress test you need

A

Cardiologist to be preset
Crash cart available

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77
Q

Meds used for a pharmacologic stress test

A

Adenosine
Dipyridamole
(vasodilating agents)

Often done in association with radionucleotide imaging - thallium

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78
Q

ATST

A

Adenosine Thallium Stress Test

79
Q

For pharm stress tests also have

A

Cardiologist
Crash cart

80
Q

Nursing considerations for ATST

A

Renal function
Chest pain
Meds before test
Consent

81
Q

2D echocardiography

A

Painless ultrasound
Spatial view of heart

Results squed by COPD and Obesity

82
Q

Transesophageal (TEE) Echocardiography

A

Examines posterior of heart
NPO 6h prior
nothing to drink 2h post

Meds with small sips of water

83
Q

Cardiac cath 101

A

Invasive procedure

Assesses chamber pressure and coronary artery patency

84
Q

Things required before a cardiac cath

A

ECG
Hemodynamic monitoring
Emergency equipment

85
Q

Post cardiac cath

A

Bedrest supine 4-6h
No flexing of extremity
Vitals

86
Q

Pre cardiac cath

A

Consent
Iodine allergy check
Baseline vitals

87
Q

Does cardiac cath involve using fluoroscopy and contrast media

A

YES

check for iodine allergy

88
Q

Myocardial Nuclear Perfusion Imaging

A

Use radioactive tracer substances

Detects MI and left ventricular ejection

89
Q

AONM

A

Aspirin
Oxygen
Nitro
Morphine

90
Q

Other heart meds

A

Beta blockers lol
Calcium channels ipines
Clopidogrel
ACE pril
Heparin

91
Q

Infarction

A

Blockage

92
Q

Emergency infarction treatment

A

tPA

93
Q

Firing rate for
SA node
AV node
Perkinjay fibers

A

100-60
60-40
40-20

94
Q

Amount of blood pumped by ventricle with each pump

A

Stroke Volume

95
Q

Percentage of blood leaving heart in each contraction

A

Ejection fraction

96
Q

is STEMI or NSTEMI worse

A

STEMI
ACUtE

97
Q

How many images does a 12 lead EKG give

A

12!!!

98
Q

Factors that contribute to ST elevation
IMPORTANT

A

Hyperkalemia
Pericarditis
MI

99
Q

Factors that contribute to ST depression
IMPORTANT

A

Hypokalemia
Ventricular hypertrophy
MI

100
Q

Normal PR interval time

A

0.12-0.20 sec

101
Q

small EKG box time =
large EKG box time =

A

0.04
0.2

102
Q

Normal QRS complex time

A

0.06-0.10

103
Q

Is afib or aflutter worse

A

A fib

104
Q

A fib = clot =

A

LUNG EMBOLI

105
Q

Atrial flutter looks like

A

small saw tooths
QRS still present

106
Q

Afib looks like

A

Arabic, lower case
QRS still present

107
Q

What lead does telemetry monitor

A

Lead II

108
Q

Med to speed up heart rate

A

Atropine

109
Q

What manouver can pt perform to break tachycardia

A

Valsalva

110
Q

1 Cardiac value to look at

A

TROPONIN

111
Q

How often to look at troponin

A

3 times

will raise in 2-3 h after attack

112
Q

For how long does troponin stay up

A

2-3 Weeks

113
Q

V fib looks like

A

medium size waves
no QRS

114
Q

V tach looks like

A

large waves/teeth
no QRS

115
Q

treatment for Vfib

A

DEFIB the VFIB

CPR

116
Q

Dfib setting is only used for

A

Vfib
Vtech problems

117
Q

Synchronized Cardioversion is used for

A

Afib
Aflutter

118
Q

Jules for
Dfib
Synchronized cardioversion

A

360J dfib

100J and going up with every shock
Synchronized cardioversion

119
Q

Preload = _ side of heart

A

RIGHT

120
Q

HORMONE released at HF
2 types

A

BNP - ventricular
ANP - atrial

121
Q

Sterlings law

A

Stretching heart fibers results in overstretching and hypertrophy

think of balloon being stretched and not returning to original shape

122
Q

Afterload = _ ventricle

A

Left

aortic pressure

123
Q

Stroke volume is volume per a

A

BEAT

x HR to get CO

124
Q

Perfusion = cardiac

A

OUTPUT

125
Q

Less volume = _ CO
More volume = _ CO

A

Decreased
Increased

126
Q

with L HF listen to lungs where

A

POSTERIOR lower lobes

127
Q

If you cant perfuse your kidneys
urinary output will

A

Decrease

128
Q

Arrhythmias are no big deal unless they affect

A

CO

129
Q

3 BIG arrhythmias

A

V fib
Pulseless V tach
Asystole

NO CO AT ALL

130
Q

CAD types
can have both

A

Chronic stable angina
Acute coronary Syndrome

131
Q

Chronic stable angina

A

Decreased flow to myocardium
ISCHEMIA

Pain and pressure in chest

132
Q

Chronic stable angina simple exacerbation

A

Exercise

133
Q

Standard dose of Nitroglycerine

A

3 q5 min

Go to hospital if no relief

134
Q

Nitroglycerine MOA

decreases both…

A

Vasodilator

Preload and afterload

135
Q

Goal of treatment for heart problems is to always _ workload

A

DECREASE

136
Q

1 side effect of Nitroglycerine

A

HEADACHE

no need to call DR.

137
Q

Before giving beta blockers check

A

BP and pulse

this is what it does
dont want to bottom out

138
Q

Beta blockers block

A

Epi/Norepi

139
Q

Calcium Chanel Blockers MOA

A

Vasodilation of arterial system
Blocking of Calcium

140
Q

2 benefits of Calcium chanel blockers

A

decrease AFTERLOAD
increase oxygenation of HEART

141
Q

Aspirin is given for

A

prevention of PLATELET AGREGATION

142
Q

Chronic stable angina pt edu

A

Moderate exercise
Wait 2H after eating to exercise
No caffeine
Dress warm in cold weather

143
Q

Nitroglycerine pt edu

A

ORTHOSTATIC HYPOTENSION
call 911, dont get up

144
Q

Isometric exercise and unstable angina

A

Contracting muscle increases cardiac workload

AVOID

145
Q

Definitive diagnosing of almost all HFs

A

Cardiac cath

146
Q

CONTRADICTION to cardiac cath

A

Shellfish
Iodine
allergies

Kidney failure

147
Q

Drug to protect kidneys during heart cath

A

Acetylcysteine

148
Q

BIG side effects of heart cath

What to check

A

BLeeding
Hematoma formation
Circulation issue

Check site often
Check pulse, skin color, cap refil

149
Q

If pt is on _, hold it 48h before and after heart cath

WHY

A

Metformin

LACTIC ACIDOSIS
will kill

150
Q

Acute coronary syndrome like MI result in both…

A

Ischemia
Necrosis

151
Q

What time of day do most MIs occure

A

EARLY MORNING

152
Q

Main complain in MI ACS

A

Chest discomfort
radiating to jaw, arm etc
sob, lower back pain

153
Q

Elderly MI pts S/S

A

SOB
Passing out

will not feel pain

154
Q

After AONM put pt on

A

ECG monitor

155
Q

Timeframe to get pt to Cath Lab to reastablish perfusion

A

90 MIN
on test

156
Q

Vomiting with MI

A

Stimulates Vagus Nerve
Will decrease heart rate

DROPS HR AND BP

VERY BAD SIGN

157
Q

MOST significant lab value of Muscle Tissue Death
aka MI necrosis

A

MYOGLOBIN

158
Q

Will increase 6h after onset of MI symptoms

A

CPKNB

159
Q

Troponin is specific to
MOST SENSITIVE INDICATOR

A

HEART MUSCLE

160
Q

Major arrhythmia to worry about with MIs

A

Vfib = Dfib

perform CPR until AED is set up

161
Q

1st med to give if Dfib does not work

if that does not work, give

A

EPINEPHRINE

AMIODARONE and LIDOCAINE

162
Q

Amiodarone and lidocaine are

A

Antiarrhythmic agents

163
Q

Lidocaine toxicity S/S

A

Neuro changes!

164
Q

Amiodarone toxicity S/S

A

Fast BP drop

165
Q

Body position for MI

A

Semi fowler

blood goes from core
decreases work load

166
Q

Next drug to give after AONM

A

tPA

ISCHEMIA IS BLOCKAGE

need to break it up

167
Q

tPA requirements

A

Bleeding history

168
Q

tPA names

A

Altiplace
Kinectiplace

end i place

169
Q

tPA time frames

A

within 30 min preferred
max of 12h

170
Q

tPA contraindications

A

preexisting bleeding issues

171
Q

1st surgical treatment
2nd surgical treatment

A

Angioplasty (balloon to expand vessel)
STENT (mesh to open vessel)

172
Q

Biggest complication of Angioplasty

A

2ND MI

173
Q

CABG surgery

A

Coronary artery bypass

174
Q

Old pts are more likely to survive MIs due to

A

collateral circulation

more vessels are interconnected

175
Q

Other than lung problems, opioids also cause

PT needs a Rx for

A

Constipation

carthotics

176
Q

When can pt have Sex after MI

A

after climbing 2 flights of stairs without being exhausted

177
Q

Safest time of the day for sex after MI

A

8 or 9 in the AM

178
Q

Best exercise after MIs

A

WALKING

179
Q

Signs of impending failure, ON TEST

A

SOB
Edema of lower extremities
Weight gain

180
Q

_ is the LEADING cause of HF

A

Hypertension

181
Q

BNP is secreted by what tissue

When

A

Ventricles

When pressure is increased

182
Q

NY heart classification

A

Higher number = worst failure
1-4

183
Q

HF CXR of lungs will have

A

infiltrates

184
Q

EF
ejection fraction goals

A

60-75%

185
Q

Standard treatment for HF

A

1st ACE inhibitors
Stops RAAS system

186
Q

Other standard treatment meds for HF

A

ARB
Beta blockers
Calcium CB

Diuretics
Digoxin

187
Q

How do you know digoxin is working

A

Increase in cardiac output

188
Q

Elderly +
Lyte disorder +
Digoxin =

A

DIG TOXICITY

189
Q

Aldosterone =, ON TEST

A

LOOSING SODIUM and WATER
RETAINING POTASSIUM

190
Q

Before giving digoxin check

where

A

HR

Apical pulse
(5th intercostal mid clavicular)

191
Q

HF and sodium intake
fluid intake

A

less than 2mg

2000ml

192
Q

Low sodium diet decreases

A

Preload

193
Q

Fluid retention = what problems first

A

HEART

S4 2539 (11 decks)

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