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Cardiac Arrthymias > Pages 674-727 Cardiac > Flashcards

Pages 674-727 Cardiac Flashcards

1
Q

What are findings frequently exhibited by patients with cardiac disorders

A 
Hemoptysis
Cough
Crackles
Wheezes
Abdominal distention
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2
Q

Hemoptysis

A

Pink, frothy sputum is indicative of acute pulmonary edema

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3
Q

Cough

A

A dry hacking cough from irritation of small airways is common in patients with pulmonary congestion from HF

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4
Q

Crackles

A

HF or atelectasis assoc with bed rest, splinting from ischemic pain, or the effects of analgesic, sedation, or anesthetic agents often results in the development of crackles. Typically crackles are first noted in the bases but they may progress to all lung fields.

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5
Q

Wheezes

A

Compression of the small airways by interstitial pulmonary edema may cause wheezing…beta blockers such as propanolol may cause airway narrowing, especially in patients with underlying pulmonary edema.

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6
Q

Abdominal distention

A

A protuberant abdomen with bulging flanks indicated ascites.

Ascites develops in patients with R ventricular or biventricular HF ( both right sided and left sided HF)

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7
Q

What occurs in the failing Right heart

A

Abnormally high chamber pressures impede the return of venous blood,as a result the liver and spleen become engorged ( hepatosplenomegally), as pressure in the portal system rises, fluid shifts from the vascular bed into the abdominal cavity. Ascites fluid found in the dependent or lowest points of the abdomen shifts with position change.

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8
Q

What is hepatojugular reflux

A

A test performed when right or biventricular HF is suspected.
The pt. is positioned so that the jugular venous pulse is visible in the lower part of the neck, while observing the jugular venous pulse, firm pressure is applied over the RUQ for 60 sec… An increase of 1cm or more is indicative of + hepatojugular reflux confirming the diagnosis of HF

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9
Q

Urine output is a important indicator of what

A

Cardiac function….reduced urinary output may indicate decreased renal perfusion

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10
Q

Kyphoscoliosis

A

A spinal deformity that occurs in many adults, may move the cardiac apex downward so that palpation of the apical pulse is obscured.

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11
Q

What is orthostatic hypotension a result of

A

Impaired baroreceptor function that normally regulates BP

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12
Q

Myocardial cells that become necrotic from prolonged ischemia or trauma release what specific enzymes

A

CK ( creatinine kinase)
CK-MB ( CK isoenzymes)
And the proteins myoglobin, troponin T, troponin I

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13
Q

What is the good lipid

A

HDL

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14
Q

What is the bad lipid

A

LDL

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15
Q

What does LDL do

A

It is the primary transporter of cholesterol and triglycerides into the cell. The harmful effect of LDL is that it deposits these substances into the walls of arterial vessels. Elevated LDL levels are assoc with a higher incidence of CAD.

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16
Q

In ppl with known CAD OR DIABETES, what are target LDL levels

A

Levels less than 70

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17
Q

What is a normal. LDL level

A

Less that 160

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18
Q

What is a normal cholesterol level

A

Less than 200

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19
Q

What are normal triglyceride levels

A

100-200

20
Q

What are triglycerides

A

They are composed of free fatty acids and glycerol which are stored in adipose tissue and are a source of energy. Triglyceride levels increase after meal and r affected by stress.

21
Q

What can affect triglyceride levels

A

Diabetes, alcohol use and obesity

22
Q

What is BNP

A

BRAIN (B-TYPE) NATRIURETIC PEPTIDE
Is a neurohormone that helps regulate BP and fluid volume. It is primarily secreted by from the ventricles in response to increased preload with resulting elevated ventricular pressure.

23
Q

BNP is useful in diagnosing what

A

HF

24
Q

What level of BNP is indicative of HF

A

Levels greater than 100

25
Q

What is CRP

A

C REACTIVE PROTEIN
Is a protein produced by the liver in response to systemic inflammation. Inflammation is thought to play a role in the develope net and progression of atherosclerosis

26
Q

What are the levels of CRP

A

Levels greater than 3 indicate great risk for CVD
Levels between 1-3 indicate moderate risk for CVD
Levels less than 1 indicate low risk

27
Q

What is homocysteine

A

An amino acid linked to the development of atherosclerosis because it can damage the endothelial lining of arteries and promote thrombus formation.. Therefore an elevated level of homocysteine indicated a high risk for CAD,STROKE, & PERIPHERAL VASCULAR DISEASE.

28
Q

What are homocysteine levels

A

Less than 12 is optimal
12-15 borderline
Greater than 15 indicated a high risk for CAD

29
Q

What is necessary before drawing homocysteine levels

A

A 12 HR fast is necessary

30
Q

What is a chest X Ray useful in

A

Determining the size, contour, and position of the heart.

It reveals cardiac and pericardial calcifications and demonstrates physiologic alterations in the pulmonary circulation.

31
Q

What is a fluoroscopy

A

An X-ray imaging technique that allows visualization of the heart

32
Q

What is the standard ECG composed of

A

12 leads ( or views of the heart) although it is possible to record 15 or 18 leads.

33
Q

What is the 12 lead ECG used to diagnose

A

Dysrhythmias, conduction abnormalities, chamber enlargement, as well as myocardial ischemia, injury or infarction. It can also suggest cardiac effects of electrolyte imbalances ( high or low calcium or k+ levels) and the effects of anti arrhythmic meds.

34
Q

What is the 15 lead ECG useful in

A

It adds 3 additional chest leads across right pericordium and is used for early diagnosis of right ventricular and left posterior ventricular infarction.

35
Q

What is the 18 lead ECG useful in

A

Early detection of myocardial ischemia and injury

36
Q

Changes in ST segments is useful in determining what

A

The presence of myocardial ischemia or injury

37
Q

Hardwire cardiac monitoring

A

Is used to continuously observe the heart for dysrhythmias and conduction disorders using 1 or 2 ECG leads

38
Q

How much do coronary arteries typically dilate to

A

4 times their usual diameter in response to increased metabolic demands for oxygen and nutrients, however coronary arteries affected by atherosclerosis dilate less compromising blood flow to the myocardium causing ischemia.

39
Q

What does the cardiac stress test help determine

A
  1. The presence of CAD
  2. cause of chest pain
  3. Functional capacity of the heart after a MI or surgery
  4. Effectiveness of anti aginal or antiarrthymic meds
  5. Occurrence of dysrhythmias
  6. Specific goals of the fitness program
40
Q

What must b done in preparation to the stress test

A

Fast for 4 hours before the test
Avoid stimulants such as tobacco and caffeine
Provider may instruct not to take certain meds such as beta blockers before the test.
Patient monitored for 10-15 min after test, then may resume normal activities.

41
Q

What is the pharmacologic stress test

A

Ppl who r physically disabled or deconditioned will not b able to reach there target HR level by exercising, are given 2 vasodilation agents which are used to mimic the effects of exercising by maximally dilating the coronary arteries.

42
Q

What 3 meds are given in the pharmalogical stress test

A
  1. Dipyridamole ( lasts about 15-30 min)
  2. Adenosine ( extremely short half life of less than 10 sec)
  3. Dobutamine may also be used if the person cannot exercise and can’t tolerate theophylline withheld as in the other 2 meds
43
Q

What must be done in preparation for the pharmalogic stress test

A

Do not eat or drink anything for 4 hours

44
Q

How long is the stress test performed

A

1-3 hours if imaging is performed

45
Q

What is echocardiography

A

A non invasive ultrasound test that is used to measure the EF and examine the size, shape, and motion of cardiac structures.
It is particularly useful in diagnosing pericardial effusions, determining chamber size and etiology of heart murmurs, evaluating the function of heart valves, including prosthetic heart valves.

46
Q

Radionuclide imaging

A

Involves the use of radioisotopes to noninvasively evaluate coronary artery perfusion, to detect ischemia and infarction and to assess left ventricular function

47
Q

Myocardial perfusion imaging

A

Is used in combination with stress testing to compare images obtained when the heart is resting to images of the heart in a stress state resulting from exercise or medications. Results of the test aid in determining if CAD is the cause of chest pain…. Commonly done after a MI

Cardiac Arrthymias (3 decks)

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