test one Flashcards by Nicole Athans

What is the treatment for chronic ischemia?

aspirin 81 mg for prevention and a statin

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What is the treatment for stable angina?

statin, aspirin, NTG, and maybe ACE inhibitor

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ACS (unstable angina or MI) treatment is…

MONABC
morphine, O2, nitro aspirin, bb, ccb
*in order: O2, EKG, assess CP, NTG, Morphine, aspirin, BB, CCB, lab work

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What should you do before giving NTG?

check BP and HR (don’t give if BP is less than 90, HR less than 60)

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What are some other types of pain in the chest? (not related to heart pain)

anxiety, muscle pain, heart burn, pulmonary related pan, carditis pain, valve problem

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What does morphine do (MI)?

reduce anxiety, reduces O2 demand, reduces sympathetic response, reduce HR, etc

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What do BB do?

block sympathetic response, decrease O2 demand, decrease HR, decrease workload of the heart and decrease preload

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What do CCB do??

dilate coronary arteries which decreases heart workload

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What K levels do you want heart patients to be at?

4.0!

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What are the 3 options for cardiac cath. procedures? (MI)

clot, balloon, stent

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What are the 2 thrombolytic options? (MI)

altraplase and strepokinase

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Once a pt with a MI is in the door, they have _____mins to PCI or thrombolytic therapy

30-90 minutes

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MONA-BC is only used for….

chest pain

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What is a normal CK range? (male and female)

30-135 female

55-170 male

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What are the s/s of endocarditis?

splinter hemorrhages, nodes, lesions on hands, abd. pain, fever, murmur, pleuritic CP, back pain, weight loss, clubbing

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What are the s/s of Pericarditis?

tx?

pleuritic chest pain (on inspiration), pericardial rub, Narrow Pulse Pressure
-fever, dyspnea and dyspahsia

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What are the s/s of myocarditis?

Gallop rhythm, reflects HF, fever and flu-like symptoms, wheezing, SOB fever, peripheral edema

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When would a pt get a medical induced stress test?

PVD, neuropathy, severe COPD, amputation

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What are the 2 main conditions of HF?

stenosis and regurgiation

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what are some symptoms of aortic stenosis?

narrowed pulse pressure, increased pulmonary hypertension (b/c it’s getting backed up), and pulmonary edema

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Pulmonary edema (increases/decreases) CO2?

increases CO2–> met, acidosis

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What is the normal range for Pulmonary arterial pressurees?

LOOK IT UPPPPPP

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Left regurgitation (mitral valve) leads to what kind of heart failure?

right sided HF (reduced CO–> pulmonary hypertension –> right sided HF)

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Right tricuspid stenosis means blood stays in the right atria –> …?

peripheral edema, low CO, activate RAAS system, water retension

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How does smoking lead to hypertension/HF?

causes vasoconstriction-->peripheral resistance

How does cocaine lead to HF?

increases BP --> vasoconstriction __> increased HR (sympathetic NS)

What is the value for BNP to be considered CHF?

over 700 | you also need to have s/s and high BNP to be considered CHF

What is the best type of diagnostic test for CHF?

echocardiogram

What does an echocardiogram do?

looks at the function of the heart, valve function, and ejection fraction

What is the normal CO range?

2-6 L

What is the normal ejection fraction?

50-70%

What rhythm is this? narrow QRT, T wave, but no P-wave, very fast

SVT, no p wave b/c it's too covered b/d too fast, low CO leads to MI and reduced organ perfusion

What do you give (med) when pt has SVT?

adenosine (antidysrhythmic, slows the HR), want to slow it down to see the underlying rhythm (a-flutter can reflect at SVT) -CCB: slows SVT but doesn't treat it

If a pt is in F-fib but has a pulse, what do you do? | without a pulse?

synchronized cardioversion, defib if no pulse

What do you give if it's a true SVT?

cardizem (but check HR and BP first)

Can you defib a flutter?

yes, synchronize defib.

Paced atrial rhythm means the spike occurs...

right before the P-wave

Paced ventricular rhythm means spike occurs...

right before QRS

What is the force against which heart has to pump (peripheral resistance) to eject blood from LV?

afterload

What is the normal PAWP?

pulmonary artery wedge pressure, 4-12 | decrease=hypovolemia, increase=hypervolemia

What is the normal pulse pressure?

30-40

Where is the SA node?

right atrium (60-100 bpm)

AV node produces ___ bpm?

40-60 bpm

pukinje fibers (beneath ventricular endocardium) produces ___ bpm

20-40 bpm

What does the right main coronary artery supply?

right atrium, right vent, inferior left vent, posterior septal wall, SA and AV nodes

What does the left anterior descending artery supply?

anterior wall of Left vent, anterior septum and apex of LV

What does the circumflex artery supply?

left atrium, and lateral and posterior surfaces of LV

Which coronary artery supplies the SA and AV nodes?

right main coronary artery

When does CK-MB elevate after MI? how long does it last for?

within hours, peaks 18 hrs after

When does troponin I elevate? how long does it last for?

within 3 hrs, lasts 7-10 days

What happens to coagulation values during and after MI?

they increase causing increased risk for clot

What is an echocardiography?

ultrasound of the heart

What does a stress test detect and evaluate?

CAD

What are the 3 drugs used for IV stress test?

adenosine,dipyridamole. and dobutamine hcl

What is a PTCA?

percutaneous transluminal coronary angioplasty | -one or more arteries are dilated with a bool catheter to open the vessel (take ASA permanently)

What is an atherectomy?

removes plaque from coronary artery (rotor rooter), also used in PAD to improve blood flow to ischemic limbs)

What is transmyocardial revascularization?

used if too many for balloon catheterization, so a laser creates 24 channels through LV muscle leading to oxygenated LV

What is peripheral arterial revascularization?

bypass arterial occlusion, to increase arterial blood flow to affected limb

Why do you have 2 p-waves after a heart transplant?

b/c a portion of atria to anchor new heart, 2 unrelated P-waves

100-180 bpm is...

sinus tach

A fib: atria beat ___bpm, quiver--> ____, p waves? | treatment?

350-600 bpm, quiver--> thrombi, no definitive p-waves | -tx: O2, anticoags, meds, cardioversion

PVCs: ___ QRS | tx?

early QRS | tx: O2 if needed, check electrolytes (hypoKalmeia can cause PVCs)

V. Tach: ___ bpm | tx: stable with pulse, unstable with pulse, pulseless?

140-250 bp, repetitive firing of ventricle tx: -stable with pulse: O2, antidysrhythmic meds - unstable with pulse: O2, antidysrhythmic meds, synchronized cardioversion, cough CPR - Pulseless: defib and CPR

V. Fib: description? tx?

impulses from irritable ventricle in disorganized manner, ventricle quiver (no CO), fatal if more than 3-5 minutes -tx: CPR, defib, CPR, O2, antidysrhythmics

What is cardioversion?

synchronized chock for ventricular dysrhythmias, lower amount of energy used than with defibrilation, synchronized to the R-wave (avoid the T wave)

What happens if you cardiovert on a T wave?

it could lead to V-fib

What is the difference between synchronous and asynchronous pacemakers?

synchronous: paces only if pt HR falls below certain rate Asynchronous: paves at certain rate regardless of pt rhythm

-prils=?

lisinopril, ACE inhibitor

-pine=?

CCB!, vasodilator

Pericarditis can lead to...

cardiac tamponade (constricts the heart)

s/s of..? | decreased CO, muffled heart sounds, narrowing pulse pressure, pulses paradoxus, increased CVP

cardiac tamponade

Valves can't fully open: ___ | Valves can't fully close: ____

stenosis | regurgitation/insufficiency