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Test4 Flashcards

1
Q

Cardiac Output

A

CO = SV x HR

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2
Q

Preload

A

Coming into left ventricle = how much stretching is going on

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3
Q

Afterload

A

What the Left Ventricle is pumping out against.

-if aortic valve is stiff-increased afterload, also PVR (peripheral vascular resistance) affects afterload

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4
Q

BNP

A
  • Brain Naturetic Peptide
  • How much the heart is stretching
  • Should be <100
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5
Q

Troponin I

A
  • specific to cardiac tissue damage
  • released when there’s necrotic tissue
  • any elevation is + for MI
  • Gold Standard
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6
Q

Chemical Stress Test

A
  • adenosine (stops heart in large doses)-makes pt feel like they are having a heart attack-pain, pressure, SOB, can’t take a deep breath. or dobutamine
  • nuclear injection dye
  • Nuclear imaging
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7
Q

Post-Cath/Post PCI care

A
  • PCI=percutaneous cardiac interventions
  • assess for iodine/shellfish allergy
  • bleeding at sight-pressure dressing, hold pressure 10-15 minutes
  • infection
  • peripheral pulses
  • stay flat 6-8 hours (risk for aspiration, DVT)
  • Should NOT have chest pain post cath/PCI–stent didn’t take? closed off again?
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8
Q

Nitro

A
  • sublingual
  • 1 pill q5min
  • check BP-before and after 4.5 minutes (make sure it’s not too low)
  • pain-should be 0
  • Also: nitro drip, patch, paste (1-2 inches on arms), long-acting
  • interact with drugs for erectile dysfunction and pulmonary HTN
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9
Q

LDL and HDL

A

LDL < 100

HDL > 50

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10
Q

Cholesterol-lowering drug therapy

A
  • Statins (Zocor, Lipitor)-don’t work for everyone
  • Niacin (OTC in small amts) prescription-causes flushing
  • Bile acid sequestrants (Welchol)
  • Zetia (flatulence)
  • Omega-3 fatty acids (OTC)
  • Decrease saturated fats
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11
Q

Coronary Artery Disease

A

Chronic Stable Angina → Acute Coronary Syndrome

                                                                     l

                               - Unstable angina         ST elevation MI
                                  - Non-ST MI

ACS-MI-no blood flow-affects the way the ventricle pumps out blood.

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12
Q

Meds for Chronic Stable Angina

A

short acting nitrates

long acting nitrates (isrodil)

Beta Blockers

CCBs

ACE inhibitors

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13
Q

Digoxin

(Lanoxin)

A
  • antidysrhythmic-decreases conduction throught the AV node, reduce automaticity of SA node; prolongs PR interval, AV block
  • improves myocardial contractility and output
  • reduced ventricular rate
  • can cause dysrhythmias and toxicity
  • need apical pulse for 1 full minute (must be 60 bpm minimum)
  • Toxicity: n/v/d, blurred or yellow visual disturbance (2ng/ml is toxic)
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14
Q

CK-MB

A
  • elevation is specific for myocardial tissue injury
  • levels begin to rise about 6 hrs after symptoms
  • levels peak in about 18 hrs
  • return to baseline within 24-36 hrs
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15
Q

Hypertension Defined

A
  • systolic >140, diastolic >90
  • current use of antihypertensives
  • normal: <120/<80
  • pre-hypertension: 120-139 / 80-89
  • stage 1: 140-159 / 90-99
  • stage 2: >160 / >100
  • Risk factors for primary HTN (essential/ideopathic): age, ETOH, smoking, DM, hyperlipidemia, XS dietary Na, gender, family hx, obesity, ethnicity, sedentary lifestyle, socioeconomic status, stress
  • Super high (240/120) pt complains of blurry vision, H/A
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16
Q

Secondary Hypertension

A
  • known cause (5-10% of adult cases)
  • coarctation of aorta
  • renal disease
  • endocrine disorders
  • neurological disorders
  • cirrhosis
  • sleep apnea
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17
Q

Medications for HTN

A
  • Stage 1; thiazide diuretics (hydrochlorthiazide) for most, maybe ACE inhib, ARB, BB, CCB, or combo
  • Stage 2: two-drug combo for most; usually thiazide diuretic + ACE inhibitor (or ARB, BB, CCB)
  • With complications (post-MI, HF, DM, CKD, stroke prevention): loop diurectics (Lasix, torsemide), K-sparing (Amiloride, Spironolactone), ACE inhibitors, ARB, BB, CCB as needed.
  • Lower BP=lower stroke incidence, lower MI, lower HF
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18
Q

Hypertensive Crisis

A
  • lost vision, kidney function, HD, HF, stroke
  • give O2, tele, assess neuro (grip equal bilaterally, move legs)
  • acute target organ damage
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19
Q

ACS-MI

(acute coronary syndrome)

A
  • no blood flow-affects the way the ventricle pumps out blood.
  • PCI
  • Fibrinolytic therapy (if no cath lab)
  • Drug therapy: MONA
  • get pt on a monitor (3 or 5 lead) to see QRS’s, for tachy give BB
  • Coronary surgical revascularization: CABG
  • ICD (implantable cardiac defibrilator
  • ALWAYS check BP bf nitro (if too low give morphine)
  • can delegate 12 lead
  • cannot delegate O2
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20
Q

Heart Failure

A
  • Characterized by ventricular dysfunction
  • Associated with long-term HTN and coronary artery disease, DM
  • Most common reason for hospitalizations in adults >65
  • Systolic failure is most common
  • Usually decrease in left ventricular EF caused by: ** impaired contractile function** (MI), increased afterload (HTN), cardiomyopathy, mechanical abnormalities (valve disease)
  • Normal EF is 65-70%
  • Compensatory mechanisms: Hypertrophy/Ventricular Dilation
  • ashy skin, edema, auscultate fluid in lungs=diminshed breath sounds, peripheral pulses-weak, may hear S3, S4,electrolyte imbalances, ascites
  • BNP should be <200 can be 400-500
  • BUN/creatinine elevated bc kindeys working OT
  • ECHO to monitor EF
  • daily weights, Na restriction, conserve energy
  • Classified functionalyl (I-IV-based on ADLs, daily Sx), and structurally (A-D)-EF
  • complications: XS fluid-decompensation
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21
Q

Types of HF

A
  • Left-sided-most common-MI, HTN, CAD, cardiomyopathy–back-up into LA and pulmonary veins–pulmonary congestion, edema: SOB, anxiety….leads to RHF
  • Right-sided-JVD, hepatomegaly, slenomegaly, ascites, peripheral edema
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22
Q

Meds for HF

A

Coreg (BB) can increase EF a few % points

ACE inhibitors (captopril)–first dose orthostatic hypotension

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23
Q

Management of HF

A
  • fluid management (I&O), daily weights
  • oxygen for SOB
  • physical/emotional rest
  • drug therapy
  • heart transplant-for refractory, end stage HF, inoperable CAD and cardiomyopathy
  • LVAD
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24
Q

ADHF

(acute decompensated HF)

A
  • # 1 complication of HF=lungs fill up with fluid; no gas exchange possible (pulmonary edema)
  • pt is SOB
  • Listen to lungs-monitor for changes-know baseline
  • crackles, wheezes, diminished
  • Management: decrease intravascular volume, decrease venous return (preload), decrase afterload, improve gas exchange and oxygenation, reduce anxiety
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25
EKG Strips
* Each box is 0.04 seconds, dark box is 0.2 seconds * PR interval should be \< 0.2 * ST segment should be isoelectric line (problem if it's not at the baseline) * normal sinus rhythm-50 to 90 bpm, follows normal conduction pattern (sinus brady, sinus tachy)
26
Sinus Brady
* sinus node fires \<50 bpm * concerned if symptomatic: decreased LOC, fatigued, SOB * try to wake them * **atropine** * pacemaker may be required (internal/external)-on crash cart, can cause burns (AEDs can't do this)
27
Sinus Tachycardia
* discharge from sinus node is \>90 (result of vagal inhibition) * causes: meds, fever, decrease in BP, psych stressors, pain * symptoms: dizzy, low BP (hypotension) due to decreased CO, angina (due to increased myocardial oxygen consumption) * Treat underlying problem (pain?) * BB's and adenosine to lower HR
28
First Degree Heart Block
* PR interval is \> 0.2 sec * AV conduction is prolonged * Risk factors: BB's, previous Hx * usually asymptomatic * may be a precursor to higher degrees of AV block (start dropping QRS's) * Tx-check meds, continue to monitor
29
Atrial Fibrillation
* disorganization of atrial electrical activity-multiple ectoopic foci, resulting in loss of effective atrial contraction * most common dysrhythmia * prevalence increases with age * **no consistent P wave** * QRS is present, but irregular * can decrease CO due to loss of atrial kick * can cause RVR (rapid ventricular response)-ventricles try to keep up * thrombi may form in the atria * embolus may develop--stroke * Coumadin-**-INR 2-3** * Goals-decrease ventricular response, prevent stroke * digoxin, BBs, CCBs * conversion to sinus rhythm: amiodarone * radiofrequency catheter ablation * cardioversion
30
A-Flutter
* atrial dysrhythmia * recurring, regular, saw-tooth-shaped flutter waves * usually occurs in a disease state * QRS can be regular or irregular * decreased CO * precipitates HF, angina * Risk for stroke (give coumadin) * Tx-same as afib: meds, cardioversion, ablation
31
Abnormal Beats
Premature Atrial Contraction (PAC) Premature Ventricular Contractions (PVC)
32
Premature Atrial Contraction
* contraction originates from ectopic focus * may be stopped, delayed or conducted normally at the AV node * atria fires before it's supposed to * causes: stress, caffeine, tobacco, alcohol,, hypoxia, electrolyte imbalances (K+), COPD, valvular disease * give O2 * look for 2 QRS complexes closer together, followed by a gap * "sinus rhythm with PACs" * can occur in normal, healthy heart
33
Premature Ventricular Contractions
* **Wide and distorted QRS complex** * contraction originating in ectopic focus of the ventricles * premature occurence of a wide and distorted QRS complex * multi-focal (each looks different) or unifocal (look the same) * bigeminy (every other), trigeminy, couplet (2 in a row), triplets * Do NOT count PVCs as part of HR (only getting 50% of CO) * "sinus rhythm with unifocal PVCs" * associated with stimulants (caffeine, epinephrine, isoproterenol, aminophylline) * also associated with digoxin, electrolyte imbalances, hypoxia, fever, disase states-MI, mitral valve prolapse, HF, CAD * more diseased heart, more likely PVCs * \>3 PVCs = V-tach * in a normal heart-usually benign * in heart disease, PVCs may decrease CO and precipitate angina and HF * Tx-O2, electrolyte replacement, BBs, amiodarone
34
Ventricular Tachycardia
* Run of **4+ PVCs**-sustained or unsustained * considered life-threatening bc of **decreased CO** and possibility of deterioration into v-fib * **no P-wave, QRS is weird** * risk factors: diseased heart, electrolyte problems (K+) * can be stable (pt has pulse)-give antidysrhythmics (BBs) * or unstable (no pulse)-crash cart, AED-CODE!!! organs not perfused * sustained Vtach-decreased CO--hypotension, pulmonary edema, decreased central blood flow, cardiopulmonary arrest * 150-250 bpm
35
Ventricular Fibrillation
* severe derangement of the heart rhythm-irregular, varying contour and amplitude * NO effective contraction or CO occurs * can be "fine" or "course" * pt will be unresponsive, pulseless, apneic * CODE!!!!!/BLS * defibrillate!
36
Asystole
* TOTAL absence of ventricular electrical activity * No ventricular contractions or CO because depolarization does not occur * MI's, electrocution * unresponsive, pulseless, apneic * poor prognosis * BLS (can't shock them--AED will say, "continue CPR") * Meds: atropine, epi
37
PEA (pulseless electrical activity)
* electrical activity is observed on EKG, but no mechanical activity of the ventricles * patient has no pulse * start CPR-no CO! * associated with: hypovolemia, hypoxia, metabolic acidosis, hyperkalemia, hypothermia, drug OD, cardiac tamponade, MI, tension pneumothorax, PE * CPR, epi, atropine (if ventricular rate is slow)
38
Pacemakers
* pace the heart when normal conduction pathway is damaged/diseased * #1 reason is symptomatic bradycardia * also antitachycardia and overdrive pacing * can be atrial paced or ventricle paced "A paced" or "V paced" * NO MRI's * carry card at all times with type of pacemaker and settings
39
ICD (Implantable Cardioverter-Defibrillator)
* Pts at high risk for V-fib and V-tach (massive MI, low EF, HF) * sensing system monitors the HR and rhythm and id's VT and VF * equipped with antitachycardia and antibradycardia pacemakers (all ICDs are pacemakers as well)
40
Defibrillation
* most effective method for terminating VF and pulseless VT * depolarizes cells to allow the myocardium to allow the SA node to resume role of pacemaker * monophasice (more joules) or biphasic (newer technology, better outcomes0
41
Catheter Ablation Therapy
* ablation catheter burns accessory pathways or ectopic sites in the atria, AV node and ventricles
42
EKG changes in ACS (acute coronary syndrome)
* in response to ischemia, injury or infarction of myocardial cells * changes seen in the leads that face the area involved * provides info about the coronary artery involved in ACS * ST-segment: too high (worse) or too low-heart muscle is dead, signal going around
43
Syncope
* lapse in consciousness accompanied by loss in postural tone (fainting) * Cardiovascular causes: Vtach (non-sustained), Bradycardia, MI * Non-Cardiovascular: stroke, breathing, hypoglycemia * Elderly with syncope-mortality rate 40% over next few years
44
Infective Endocarditis
* inner layer of heart-usually affects valves-valves don't work well, vegetation breaks free--goes to lungs (R) or body (kidney, limbs, liver, spleen)-stroke (L) * vegetation: fibrin, leukocytes, platelets, microbes * may cause local damage to valves and infiltrate to supporting structures: sepsis, HF (heart works hard against valves), heart block * SOB, fatigue, fever, chest pain, tachy * get EKG, blood culture, CBC, electrolytes, ECHO * IV drug users at risk * splinter hemorrhages, petechiae, murmurs * clubbing may be present
45
Acute Pericarditis
* inflammation of pericardial sac * heart sounds diminished-muffeled, sand-paper **friction rub** * SOB because heart takes up lung space, confused, chest pain, anxious, restless (LOW CO) * High risk-post MI * idiopathic-or coxsakie virus, bacterial infection (strep), acute MI, TB, trauma * SHARP chest pain, may radiate, worse with inspiration and laying flat-alleviated by tri-pod * ECHO * complications: cardiac tamponade * Tx-diuretics, pull fluid with syringe, O2, tripod * Pulsus paradoxus (drop in systolic BP)-indicates cardiac tamponade
46
Rheumatic Fever
* endocardium, myocardium, pericardium * strep-related--attaches to valves * full course of antibiotics for strep infection * IE is likely to recur * permanent damage to valves; worried about vegetation breaking free
47
Valvular Heart Disease
* Stenosis (stiff) * Regurgitation (valve is too flimsy) * seen on ECHO * Meds: diuretics, digoxin (+ionotrope), antidysrhythmics for atrial issues * Tx: replacement--either open heart or percutaneous * mechanical vs. biological **valve replacement**-must be on coumadin post-op; **INR must be 3-4** * prophylactic antibiotics for any procedures to prevent IE * activity intolerance, excess fluid volume, decreased CO * if pulmonic valve is faulty-usually taken care of in peds.
48
Mitral Valve Stenosis
* Left side * Most common * hard to move blood from LA to LV * LA backs up...backs up into lungs * SOB * risk for afib, aflutter, pulmonary congestion, fatigue
49
Mitral Valve Regurgitation
* blood flows back into LA--lower CO * Heart pumps harder, faster to compensate--stresses LV * auscultate whooshing * can replace the valve
50
Aortic Valve Regurgitation
* flimsy * blood falls back into LV * stresses LV * blood can back up into lungs
51
Aortic Valve Stenosis
* Big deal--usually needs to be replaced * stiff * blood backs up in LV...LA....Lungs * decreased CO * LV stressed * SOB, dizzy, decreased peripheral pulse * listen for fluid in lungs * valve--whoosh-murmur
52
Tricuspid Valve Stenosis
* RA stressed-has to push harder * RA hypertrophies * backs up to body * peripheral edema, liver, ascites, JVD * murmur, pitting edema that can restrict blood flow in lower extremities, pedal pulses
53
Cardiomyopathy
Dx with ECHO **dilated**: fatigue, decreased EF give: + ionotropes (dig, BBs), O2, pacemaker, ICD (@ risk for Vfib and Vtach **hypertrophic**: decreased CO ALL: low Na diet, avoid stimulants, balance activity/rest, stress reduction, report wt gain, edema, SOB and fatigue (changes), family learn CPR, notify provider bf procedures
54
PAD (peripheral artery disease)
* fatty streak build-up * Risk factors: damage to endothelial lining=smoking, HTN, DM, obesity * Carotid artery disease * Renal artery disease * superficial femoral artery, popliteal artery, anterior tibial, peroneal, posterior tibial * **Lower extremeties**: intermittent claudication-should go away after 10 mins rest, poor circulation-feels cold, muscle fatigue, slow capillary refill, cyanotic, delayed healing. **Dx**-angiogram, doppler, US. **Tx**-stents or bi-pass. NO-smoking, TED hose, don't put legs up, amputations
55
Disorders of the Aorta
* **Aneurysm** (pouching)-weak spot in wall; CAT scan,MRI,angiograph, US for AAA; CAT scan, TEE for thoracic aneurysm. Assess for rupture (decreased BP, increased HR and RR, abd distension, abd pulsations, can have pain) Tx-endovascular graft, surgery. * Assess kidneys* post-make sure peeing, I&O's * **Aortic Dissection** (hole)-blood trickles--painful, CO diminished, MRI/CAT scan, TEE, angiography, CXR (if high), keep BP as low as possible. Tx-graft over dissection, keep calm, telemetry, meds to decrease HR and BP, post-op: peripheral pulses, BP. At risk for future dissections
56
Raynaud's Phenomenon
* vasoconstriction in hands/feet * burns/pain * pale, blotchy * avoid cold weather, vibrations (lawn mower) * luke warm tap water for relief
57
Venous Thrombosis
* superficial or deep * Virchow's Triad: venous stasis, damaged endothelium (smokers, HTN, DM, needle sticks), hypercoagulabiltiy of blood (PG) * **Deep**: heparin drip (PTT-next AM after 2 therapeutics)...coumadin (INR 2-3); pain edema (unilateral), skin-warm, red, +Homans, bed rest, no TED hose, leg feels heavy. **Dx**-US, d-dimer (shows fibrin breakdown of clot). If DVT breaks free...RA...RV...lungs...PE (SOB--ER!!); prevention=lovenox (=low MW heparin) sub Q, soft tooth brush, electric razor, restrict exercise. Return for any SOB
58
Vericose Veins
* genetic * more common-female * pedal pulse, venous return to heart, and capillary refill are unaffected * cosmetic, but insurance will cover for pain * remove-laser, saline * post-compression stockings
59
Chronic Venous Insufficiency
* valves in veins fail * fluid pools * lower extremity edema * ulcers * leathery, brown, painful, itchy * infection, cellulitis,rarely-amputaions * TED hose if arterial flow is sufficient * elevate legs
60
Heparin ---------------------------------- Coumadin
* IV * measure PTT * protamine sulfate is antidote ---------------------------------------------------------------------- * PO * measure INR (3-4 for valve repl, 2-3 for afib) * vitamin K is antidote

Adult Health (9 decks)

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