Therapeutic interventions (CMC)

Question 1

describe echocardiography, a cardiac diagnostic procedure

Answer 1

US waves to create images of heart allowing for evaluation of cardiac structures and function

Question 2

describe cardiac catheterization, a cardiac diagnostic procedure.

what does it help identify?

Answer 2

catheter inserted into blood vessel and guided to the heart to measure pressures, obtain blood samples, or inject contrast dye for angiography.
-helps identify CAD, heart valve issues, congenital heart defects

Question 3

all on one card bc it is our bread and butter

describe the diagnostic procedure of a right heart catherization

2. how performed
3. blood samples
4. evaluates
5. risk

1. used to assess

Answer 3

aka pulmonary artery catheterization.

used to assess the hemodynamics of the right side of the heart and pulmonary circulation. (specifically measure pressure in RA (CVP), RV (RVP), PA (PAP), and PCWP which reflects LA pressure.

involves the insertion of a catheter into a vein, typically IJ, subclavian, or femoral vein, and advancing it through the RA and RV into PA. typically local anesthesia with sedation. using fluoroscopic guidance to ensure placement.

blood samples can be obtained for oxygen saturation analysis to deterine the presence of shunts or to quantify cardiac output using thermodilution or Fick’s principle.

evaluates cardiac function (CO, vascular resistance, fluid status) and dx heart failure, pHTN, and congenital heart defects

risks: arrhthymias, bleeding at insertion site, infection, pneumothorax, PA rupture or thrombosis

Question 4

describe the diagnostic procedure: left heart catheterization

used to dx and manage:

Answer 4

used to evaluate the function and strucutre of the left side of the heart, including the left atrium, left ventricle, aortic valve, and coronary arteries.

dx and manage cardiac conditions: CAD, valvular heart disease, cardiomyopathies

Question 5

how is a left heart cath performed?

-pressure that are measured, what they show
-complications

Answer 5

-local anesthesia and fluoroscopic guidance
-artery is accessed (usually fem or radial), advanced into aorta and then LV
-typically involves angiography to visualize coronary arteries on xray using contrast dye (assess stenosis, occlusions, or abnormalities)
-LV pressure and CO can be measured (and other pressures); provide insight into aortic stenosis and mitral regurgitation
-left ventriculography: evaluates LV function, wall motion abnormalities, and ejection fraction
-complications: bleeding at access site, vascular injury, arrhythmias, or contract-induced nephropathy

Question 6

primary goal of PCI

Answer 6

restore adequate blood flow to the heart by mechanically widening the obstructed artery, typically through balloon angioplasty, where small balloon is inflated at site of blockage, compressing the plaque against the arterial wall. Usually a stent is placed to keep artery open and prevent re-narrowing

Question 7

what cardiac condition does a PCI treat/manage

Answer 7

CAD

Question 8

describe PCI procedure

Answer 8

begins with cardiac cath, inserted into fem or radial artery, guided to coronary arteries under fluoro
-contrast day injected to visualize blockages via angiography
-interventional cardiologists decide on technique: simple balloon angioplasty or stent placement

Question 9

types of stents for PCI

Answer 9

bare metal or drug eluding (DES)

drug eluding: coasted with medication that helps prevennt restenosis by inhibiting cell proliferation at the stent site.

factors to decide: risk of bleeding, likelihdoof of restonsis.

Question 10

PCI risks

Answer 10

bleeding at cath site, arterial damage, kidney injury from constrast dye, heart attack or stroke.

long term: in-stent restonsis and stent thrombosis, needing dual antiplatelet therapy post procedure

Question 11

what is a pericardiocentesis?

Answer 11

procedure involving aspiration of fluid form pericardial sac (double walled sac containing the heart). Primarily performed to relieve cardiac tamponade. The fluid’s characteristics can be tested to dx underlying conditions.

Question 12

key indications for pericardiocentesis

and contraindications

Answer 12

hemodynamic instability due to cardiac tamponade, large symptomatic pericardial effusion, diagnostic evaluation of unexplained pericardial effusion,

contra: uncorrected coagulopathy, small effusions without clinical symptoms

Question 13

complications from pericardiocentesis

Answer 13

myocardial puncture, coronary artery injury, arrythmias, infection

Question 14

What is an IABP?

Answer 14

catheter-based device that is inserted into the aorta, typically through the femoral artery, to support cardiac function and improve myocardial oxygen delivery in patients with severe cardiac conditions. It has a long, thin tube with a balloon at its distal end.

the primary function is to augment diastolic blood pressure and decrease afterload, enhancing coronary perfusion and reducing myocardial oxygen demand.

Question 15

How does the IABP work?

Answer 15

counterpulsation. during diastole, balloon inflates, increasing aortic pressure and improving blood flow to coronary arteries. occurs just after the closure of the aortic valve, optimizing coronary perfusion when the heart muscle itself receives its blood supply. during systole, the balloon deflates rapidly, creating a vacuum effect that decreases resistance in the aorta. the reduction in afterload makes ventricular ejection easier and decreases myocardial workload.

Question 16

indications for IABP

contraindications

Answer 16

cardiogenic shock
acute MI with complications like MR or VSD
unstable angina refractory to medical therapy
bridge to PCI or surgery
hemodynamic support in high risk cardiac surgery patients

contraindications: severe PVD, aortic dissection

Question 17

potential complications of IABP

Answer 17

limb ischemia
bleeding at insertion site
infection
balloon rupture
kidney injury

Question 18

what is a LVAD?

Answer 18

mechanical pump that is surgically implanted to support heart function and blood flow in individuals with severe heart failure. It assists the LV by taking over its pumping action. it draws blood from the LV and delivers it directly into the aorta.

consists of several components: a pump implanted in the chest, external controller, and a power source (connect via driveline)

used as a bridge to transplantation, as destination therapy who are not heart transplant candidates, or as bridge to recovery in cases where myocardial function might improve.

anticoagulation therapy critical to minimize thromboembolic events due to non-pulsatile nature of most LVADs

Question 19

describe TAVR (Transcatheter Aortic Valve Replacement)

Answer 19

common percutaneous intervention used to treat severe aortic stenosis. a bioprosthetic valve is delivered via a catheter through the femoral artery or another access point and deployed within the diseased aortic valve, replacing it without removing the old valve.

beneficial for those who are considered high risk for conventional surgery

Question 20

describe the MitraClip procedure

Answer 20

for patients with MR who are not candidates for surgical repair or replacement. it is a device delivered through a transseptal approach the femoral vein to the left atrium where it clips together a portion of the mitral valve leaflets to reduce regurgitation

Question 21

what is used to seal ASD and PFOs?

Answer 21

a septal occluder via a percutaneous catheter

Question 22

what is peripheral angiography?

Answer 22

diagnostic procedure used to visualize the blood vessels outside of the heart to identify blockages or abnormalities in the peripheral arteries (which can lead to PAD). contrast dye is injected into the bloodstream and xrays are taken to provide detailed images of the blood vessels.

Question 23

interventions following peripheral angiography

Answer 23

angioplasty: small balloon inserted and inflated at side of blockage to widen the vessel. most times a stent is placed to keep open

atherectomy- removing plaque from artery using rotating blade or laser. useful for calcified lesions resistant to balloon angioplasty alone.

Question 24

complications of peripheral angiography and its interventions

Answer 24

bleeding, infection, allergic reaction to contrast dye, vessel damage or embolism

Question 25

describe carotid angiography

Answer 25

diagnostic procedure used to visualize the carotid arteries, which supply blood to the brain. contrast dye is injected through a catheter into the carotid arteries, xrays are taken to reveal blockages or narrowing. used to assess presence and severity of carotid artery disease (often caused by atherosclerosis) which can lead to strokes.

Question 26

interventions post carotid angiography

Answer 26

carotid endarterectomy (CEA): plaque removed from the arterial walls to restore normal blood. standard treatment for patients with significant stenosis, esp symptomatic or had TIAs or minor strokes. carotid artery stenting (CAS): less invasive, small mesh tube (stent) is placed inside the artery to keep it open. often recommended to high risk surgery patients. balloon catheter expands the narrowed section of the artery before placing the stent. both aim to prevent future strokes by improving cerebral blood flow

Question 27

what is an endovascular graft?

Answer 27

aka endografts, medical devices used in minimally invasive treatment of vascular diseases, particularly aneurysms. designed to reinforce the weakened sections of blood vessels, most commonly within the aorta, by creating a new pathway for blood flow. crucial in preventing aneurysm rupture.

Question 28

what is the procedure involving endovascular grafts?

Answer 28

endovascular aneurysm repair (EVAR). synthetic tube like graft is delivered to the site through catheter inserted via a small incision in femoral artery. graft is expanded and anchored in place using metallic stents, excluding aneurysm from circulation and reducing pressure on the weakened vessel wall. size, location, vessel tortuosity and neck length are factors to consider potential complications: graft migration or endoleaks (situations where blood leaks into aneurysm sac outside the graft)

Question 29

What is a catheter-directed thrombolysis (CDT)?

Answer 29

minimally invasive procedure used to dissolve blood clots in the vascular system (DVT, PE). catheter is inserted into the clot allowing for localized delivery of thrombolytic agents like tissue plasminogen activator (tPA) which breaks down the fibrin matrix of the clot catheter is navigated through vasculature until reaches site of clot. imaging techniques such as venography or angiography are used to confirm catheter placement and assess extent of thrombus. thrombolytic agent is then infused directly into the clot over a period ranging from several hours to days, depending on the size and location of the thrombus.

Question 30

CDT advantages

Answer 30

reduced risk of bleeding complications and increased efficacy (higher local concentrations of thrombolytic drug). beneficial for those with extensive DVT or massive PE, where rapid clot resolution is necessary to restore venous patency and improve hemodynamics

Question 31

CDT indications contraindications

Answer 31

those with severe symptoms, contraindications to AC alone, or high risk for post-thrombotic syndrome contra: active bleeding, recent surgery, significant coagulopathy

Question 32

complications of CDT

Answer 32

rare but bleeding at puncture site, hematoma formation embolization of clot fragments

Question 33

how many classes of antidysrhythmics are there?

Answer 33

four 1. sodium channel blockers 2. beta blockers 3. potassium channel blockers 4. calcium channel blockers

Question 34

MOA of Class 1 antiarrhythmic

Answer 34

(sodium channel blockers) slow down depolarization phase of cardiac action potential by blocking sodium channels. broken down into three subclasses

Question 35

MOA Class 2 antiarrhythmic

Answer 35

Beta Blockers reduce sympathetic nervous system stimulation of the heart by blocking beta-adrenergic receptors. this leads to decreased heart rate and contractility, which is useful in treating tachyarrhythmias. metoprolol, atenolol

Question 36

3 subclasses of antiarrhythmics

Answer 36

Class 1A: moderate sodium channel blockers, prolonging repolarization (Quinidine, Procainamide) Class 1B: weak sodium channel blockage, shortening repolarization. (Lidocaine, Mexiletine) Class 1C: strong sodium channel blockade with minimal effect on repolarization (Flexainide, Propafenone)

Question 37

MOA Class 3 antiarrhythmics

Answer 37

potassium channel blockers prolong repolarization by blocking potassium channels, extending the refractory period of cardiac cells. Effective in treating both atrial and ventricular dysrhythmias. amiodarone and sotalol

Question 38

MOA Class 4 antiarrhythmics

Answer 38

calcium channel blockers inhibit calcium ion influx through L-type calcium channels, primarily affecting AV node conduction and reducing heart rate Verapamil and diltiazem commonly used for rate control afib.

Question 39

two main types of anticoagulants

Answer 39

oral and parenteral

Question 40

oral AC examples and MOA

Answer 40

- vitamin K antagonists (warfarin) -DOACs (dabigatran, rivaroxaban, apixaban, endoxaban)

Question 41

how does warfarin work?

Answer 41

inhibits vitamin K epoxide reductase, an enzyme necessary for the synthesis of clotting factors II, VII, IX, and X

Question 42

how do DOACs work?

Answer 42

directly on specific factors within the coagulation cascade ex: dabigatran inhibits thrombin (factor IIa) Rivaroxaban, apixaban, edoxaban inhibit factor Xa.

Question 43

parenteral AC examples

Answer 43

UFH LMWHs Iike enoxaparin) fondaparinux

Question 44

how does unfractionated heparin work (UFH)?

Answer 44

enhances the activity of antithrombin III, which inactivates thrombin and factor Xa.

Question 45

how does LMWH work?

Answer 45

primarily inhibit factor Xa, with some effect on thrombin

Question 46

how does fondaparinux work?

Answer 46

it is a synthetic pentasaccharide that specifically inhibits factor Xa

Question 47

3 types of diuretics

Answer 47

based on site of action in the nephron -thiazide diuretics -loop diuretics -potassium sparing diretics

Question 48

how do thiazide diretics work?

Answer 48

on distal convoluted tubule to inhibit sodium reabsorption, leading to increased excretion of sodium and water commonly used for long term management of HTN hydrochlorothiazide

Question 49

how do loop diuretics work?

Answer 49

target ascending limb of loop of Henle. inhibit sodium-potassium-chloride co-transporter, resulting in significant diuresis. open used for rapid fluid removal in heart failure or pulmonary edema furosemide, bumetanide

Question 50

how do potassium sparing diuretics work?

Answer 50

work on collecting ducts and distal tubules to prevent potassium loss while promoting sodium excretion beneficial for those at risk of hypokalemia or those requiring aldosterone antagonism. spironolactone and eplerenone

Question 51

why monitor renal function while pt on diuretics?

Answer 51

can decrease kidney perfusion

Question 52

categories of inotropes

Answer 52

positive and negative, based on effects on myocardial contractility

Question 53

how do positive inotropes work?

Answer 53

increase strength of heart's contractions, enhancing CO. by increasing intracellular calcium concentrations, which are essential for muscle contraction. common: dobutamine, dopamine, milrinone

Question 54

how does dobutamine work?

Answer 54

primarily stimulates B1- adrenergic receptors, leading to increased myocardial contractility with minimal effects on heart rate

Question 55

how does dopamine work?

Answer 55

dose dependent moderate doses: stimulates B1 receptors to enhance CO higher: also acts on alpha-adrenergic receptors, causing vasoconstriction

Question 56

how does milrinone work?

Answer 56

phosphodiesterase inhibitor that increases cyclic adenosine monophosphate (cAMP) levels, leading to enhanced calcium influx and stronger myocardial contractions

Question 57

how do negative inotropes work?

Answer 57

decrease myocardial contractility and often used to reduce cardiac workload in conditions such as hypertrophic cardiomyopathy or certain forms of angina ex: BB like metop and CCB like verapamil

Question 58

considerations for inotropes

Answer 58

prolonged use can lead to -increased myocardial oxygen demand -potential for arrythmias

Question 59

primary MOA of platelet inhibitors in the most basic sense

Answer 59

blocking specific pathways that active platelets

Question 60

how does aspirin work?

Answer 60

irreversibly inhibits the cyclooxygenase-1 (COX 1) enzyme in platelets. this prevents the formation of thromboxane A2, a potent promoter of platelet aggregation and vasoconstriction

Question 61

how do P2Y12 receptor antagonists work?

Answer 61

block P2Y12 component of the ADP receptor on the platelet surface, preventing ADP-mediated activation and aggregation of platelets ex: clopidrogrel, prasugrel, ticagrelor

Question 62

how do glycoprotein IIb/IIIa inhibitors work?

Answer 62

prevent fibrinogen from binding to the glycoprotein IIb/IIIa receptor on activated platelets, inhibiting the final common pathway for platelet aggregation ex: abciximab, eptifibatide, tirofiban used primarily in ACS setting

Question 63

indications for platelet inhibitors

Answer 63

-ACS -PCI -secondary prevention of MI or ischemic stroke -prevention of stent thrombosis

Question 64

classes of platelet inhibitors

Answer 64

-cox 1 inhibitors -P2Y12 inhibitors - glycoprotein IIb/IIIa inhibitors

Question 65

what is a fibrinolytic /thrombolytic agent? how do they work?

Answer 65

class of drugs used to dissolve blood clots that have acutely formed in blood vessels (MI, ischemic stroke, PE) involves conversion of plasminogen to plasmin, an enzyme that breaks down fibrin, the structural component of blood clots

Question 66

most commonly used thrombolytics

Answer 66

alteplase, reteplase, tenecteplase

Question 67

how does alteplase work?

Answer 67

it is a tissue plasminogen activator (tPA) that has a high affinity for fibrin-bound plasminogen, making it effective in clot-specific therapy. reduces systemic bleeding risks compared to older agents like streptokinase.

Question 68

contraindications for thromoblytic therapy

Answer 68

recent surgery, active internal bleeding or hx of hemorrhagic stroke

Question 69

vasoactive agents can be broadly categorized into

Answer 69

vasodilators and vasoconstrictors

Question 70

how do vasodilators work (vaguely)? common meds?

Answer 70

relax the smooth muscle in the blood vessels, leading to vessel dilation, decreased SVR, reduced BP -nitroglycerin, sodium nitroprusside, hydralazone

Question 71

how do vasoconstrictors work (vaguely)? common meds?

Answer 71

increase vascular tone by stimulating alpha-adrenergic receptors or through other mechanisms that lead to vasoconstriction. result is increased SVR and BP common: norepinephrine, epinephrine, phenylephrine

Question 72

excessive vasodilation can lead to

Answer 72

hypotension and reflex tachycardia

Question 73

excessive vasoconstriction can lead to

Answer 73

tissue ischemia due to reduced perfusion

Question 74

components of a temporary pacemaker

Answer 74

external pulse generator and pacing lead pulse generator is a battery-operated device that delivers electrical impulses to simulate cardiac contraction pacing leads can be transvenous, epicardial, or transcutaneous

Question 75

describe transvenous pacing

Answer 75

involves insertion of a pacing lead through a central vein, usually subclavian or internal jugular vein, into RV. effective and low complication

Question 76

where do epicardial leads go?

Answer 76

placed directly on heart's surface during cardiac surgery and used postop

Question 77

describe transcuteanous pacing

Answer 77

involves placing electrodes on the skin and used as immediate, non-invasive method for temporary pacing

Question 78

indications for temporary pacemaker placement

Answer 78

symptomatic bradycardia, CHB, certain tachyarrhythmias that require overdrive pacing drug induced bradycardia procedures that compromise the heart's conduction system

Question 79

complications of temporary pacemaker placement

Answer 79

infection lead displacement failure to capture etc

Question 80

What is a permanent pacemaker?

Answer 80

a medical device implanted under the skin, typically near the collarbone, that helps regulate abnormal heart rhythms. it consists of a pulse generator (battery powered) and one or more leads that deliver electrical impulses to the heart. these impulses prompt the heart to maintain an adequate rate and rhythm, which is crucial for effective circulation and overall CV health.

Question 81

permanent pacemakers are primarly used in patients with

Answer 81

bradycardia also in certain cases of heart block

Question 82

single chamber vs dual chamber pacemaker

Answer 82

single chamber stimulates either the atrium or the ventricle dual: stimulates both chambers (not both ventricles) leads typically stimlulate the right side of the heart.

Question 83

potential complications with PPM

Answer 83

infection lead dislodgement device malfunction

Question 84

what is cardiac resynchronization therapy (CRT)?

Answer 84

procedure designed to improve the heart's efficiency and coordination by electrically stimulating the heart muscle to contract in a more synchronized manner. invovles implantation of specialized pacemaker device, known as biventricular pacemaker, which delivers electrical impulses to both the left and right ventricles. typically includes three leads, one in RA, one in RV, and one placed via coronary sinus to stimulate the LV. by synchronizing contractions between venctricles, CRT aims to enhance CO, reduce MR, and improve overall cardiac function

Question 85

who is the primary population to use CRT?

Answer 85

patients with HF who exhibit **dyssynchronous ventricular contraction**, often evidenced by wide QRS complex on ECG. this can lead to inefficient CO, worsening HF symptoms, and increased mortality.

Question 86

candidates for CRT usually have the following criteria:

Answer 86

-moderate to severe HR -reduced EF (typically less than 35%) -QRS duration greater than 120 milliseconds

Question 87

potential complications of CRT

Answer 87

lead displacement infection venous thrombosis inappropriate pacing or sensing

Question 88

what is an implantable cardioverter defibrillator (ICD)?

Answer 88

a surgically implanted device, typically place near left clavicle. consists of pulse generator and leads. pulse generator houses a battery and electronic circuitry that continuously monitors the heart's electrical activity. the leads (insulated wires) extend from pulse generator into the heart chambers. dual purpose: sensing cardiac electrical activity and delivering therapeutic shocks or pacing pulses designed to monitor heart rhythms and deliver life-saving therapy in event of life-threatening arrhythmias, such as VT or VF. critical in preventing sudden cardiac death in patients with hx of cardiac arrest or those at high risk of developing malignant arrhythmias.

Question 89

how can a ICD respond to an abnormal rhythm? | based on slow vs fast

Answer 89

-for slower arrhythmias: may deliver anti-tachycardia pacing (ATP) which involves rapid pacing to interrupt the arrhythmia. for dangerous rhythms like VF, delivers high energy shock to restore normal rhythm

Question 90

ICDs have evolved to have additional features such as

Answer 90

biventricular pacing for HF management (CRT) or remote monitoring capabilities that allow real-time data transmission to healthcare providers

Question 91

what is an external wearable defibrillator?

Answer 91

portable device designed to continuously monitor patient's heart rhythm and deliver shock of life-threatening arryhythmias occur. consists of three main components: a vest that contains electrodes, a monitor/defibrillator unit, a battery pack. the vest is equipped with electrodes that both monitor the heart's electrical activity and deliver defibrillation shocks when necessary. if arrhythmia is detected, device alerts the patient with audible and visual alarms before delivering a shock, allowing the patient to stop the treatment if they are conscious and do not require intervention.

Question 92

who are external wearable defibrillators especially beneficial for?

Answer 92

those who are at high risk of sudden cardiac arrest but are not immediate candidates for an ICD typically prescribed for temporary use in patients who have recently experienced a MI, undergone CABG, or have newly diagnosed CM with severely reduced EF. bridge to more permanent solutions until patient's condition stabilizes

Question 93

what is an ablation?

Answer 93

medical procedure used to treat certain arrhythmias by destroyed small areas of heart tissue that are responsible for the abnormal electrical signals. this intervention is typically performed when medications are ineffective or not well tolerated by the patient. ablation can be conducted using different energy sources, such as radiofrequency or cryotherapy, to achieve desired therapeutic effect both aim to create scar tissue in the heart which disrupts the pathway of abnormal electrical signals, thus restoring normal rhythm

Question 94

how does radiofrequency ablation work?

Answer 94

involves delivering high-frequency electrical energy through a catheter to heat and destroy the targeted tissue.

Question 95

how does cryoablation work?

Answer 95

utilizes extreme cold to achieve tissue destruction.

Question 96

describe an ablation procedure

Answer 96

there is insertion of catheters into blood vessels, usually through groin or neck, which are guided into heart under fluoro guidance. electrophysiological mapping is performed to pinpoint the exact location of the arrhythmogenic focus. once identified, the ablation catheter delivers energy to modify or eliminate the aberrant conduction pathway

Question 97

what rhythms are typically treated with ablation?

Answer 97

AF, a flutter, SVT, some forms of VT most successful with SVT and atrial flutter. AF may require repeat procedures

Question 98

what is cardioversion?

Answer 98

medical procedure used to restore normal heart rhythm in patients experiencing certain types of abnormal heartbeats. effective for treating afib, atrial flutter, and some VT

Question 98

potential complications of an ablation

Answer 98

bleeding infection at catheter site cardiac perforation damage to adjacent structures such as blood vessels or nerves rarely, stroke or heart block

Question 99

two main types of cardioversion

Answer 99

electrical and pharmacological

Question 100

describe electrical cardioversion

Answer 100

involves delivering a controlled electrical shock to the heart through electrodes placed on chest or back. this shock momentarily stops all electrical activity in the heart, allowing the sinoatrial node to regain control and establish a regular rhythm. typically performed under sedation or anesthesia to minimze discomfort for the patient.

Question 101

describe pharmacological cardioversion

Answer 101

uses antiarrhythmic medications to chemically restore normal heart rhythm commonly used: amiodarone, flecainide, and propafenone

Question 102

considerations prior to cardioversion

Answer 102

assess for presence of blood clots in the atria -using TEE. anticoagulation therapy may be intiated several weeks before and continued after procedure to reduce risk of stroke associated with clot dislodgement during rhythm restoration

Question 103

success rate of cardioversion depends on several factors

Answer 103

-type and duration of arrhythmia -underlying heart conditions -patient-specific characteristics

Question 104

complications from cardioversion

Answer 104

-skin burns from electrode pads -arrhythmias induced by the shock itself -thromboembolic events if AC is inadequate

Question 105

what is defibrillation?

Answer 105

the delivery of a therapeutic dose of electrical energy to the heart using a defibrillator. primary goal is to depolarize a critical mass of heart muscle, terminating arrhythmia and allowing SA node to reestablish effective rhythm. specifically used in VF and pulseless VT **rapid** defib is crucual. significantly increases chances or ROSC

Question 106

what are the two options for pad placement for defib? typical range of joules for biphasic defibrillators?

Answer 106

anterior-lateral or anterior-posterior 120-200 joules

Question 107

what can orthopnea or paroxysmal nocturnal dyspnea indicate?

Answer 107

pulmonary congestion/ increased pulmonary venous pressure due to left sided heart dysfunction (HF)

Question 108

how does non-invasive ventilation work?

Answer 108

delivers positive pressure through a mask that fits over the nose, mouth, or both to provide ventilatory support (improve gas exchange/ decrease WOB) to patients without need for invasive artificial airways.

Question 109

describe continuous positive airway pressure (CPAP)

Answer 109

provides a constant level of pressure throughout the respiratory cycle, which helps keep the airways open and prevents alveolar collapse particularly useful with OSA and CHF where upper airways collapse or pulmonary edema may occur

Question 110

describe bilevel positive airway pressure (BiPap)

Answer 110

offers two levels of pressure: a higher inspiratory positive airway pressure (IPAP) and a lower expiratory positive airway pressure (EPAP). beneficial for patients who require assistance with both inhalation and exhalation (COPD exacerbations and certain neuromuscular conditions)

Question 111

how is NIV useful in cardiac patients?

Answer 111

useful in managing acute heart failure by reducing preload and afterload, which decreased workload of heart and improves CO hels alleviate symptoms of dyspnea, improve oxygenation, and reduce need for intubation

Question 112

complications of NIV

Answer 112

skin breakdown gastric distention from air swallowing

Question 113

contraindications of NIV

Answer 113

severe hypoxemia requiring immediate intubation, facial trauma, deformities that prevent proper mask fitting, uncooperative behavior

Question 114

primary goal of mechanical ventilation

Answer 114

ensure adequate oxygenation and carbon dioxide removal. achieved by delivering controlled breaths to the patient, either fully or partially supporting their respiratory efforts. can be delivered invasively (intubation) or noninvasively with mask.

Question 115

describe assist control AC ventilation

Answer 115

ventilator provides a set tidal volume at a predetermined rate while allowing spontaneous breaths

Question 116

describe synchronized intermittent mandatory ventilation (SIMV)

Answer 116

permits sponteneous breathing between mandatory breaths

Question 117

desribe pressure support ventilation (PSV)

Answer 117

auguments spontaenous breaths with preset pressure

Question 118

how does mechanical ventilation impact hemodynamics?

Answer 118

positive pressure ventilation can affect venous return and CO by increasing intrathoracic pressure -reduces LV preload and afterload -think about pHTN and intubation. increased risk to code | add more later

Question 119

potential complications with mechanical ventilation

Answer 119

-barotrauma from excessive airway pressures -volutrauma due to high tidal volumes -VAP

Question 120

functions of the renal system

Answer 120

regulates fluid and electrolyte balance acid base balance removes waste products controls blood pressure

Question 121

the functional unit responsible for filtering blood in the kidneys is called

Answer 121

nephron

Question 122

the nephron consists of ________

Answer 122

a glomerulus and a tubular componenet

Question 123

where does filtration occur in the nephron?

Answer 123

the glomerulus. blood enters through afferent arterioles. substances like glucose and electrolyes are reabsorbed. waste products like urea and creatine are excreted.

Question 124

how does the RAAS system work? renin angiotensin aldosterone system

Answer 124

when blood pressure drops, juxtaglomerular cells in the kidneys release renin, which converts angiotensinogen to angiotensin I. further converts to angiotensin II, leading to vasoconstriction and increased BP. angiotensin II also stimulates aldosterone release from the adrenal glands, promoting sodium and water excretion

Question 125

the kidneys regulate the levels of which electrolyes?

Answer 125

sodium, potassium, calcium, and phosphate by adjusting their reabsorption and excretion

Question 126

kidneys also play a role in acid base balance by

Answer 126

excreting hydrogen ions and reabsorbing bicarbonate from urine

Question 127

the kidneys produce erythropoietin,

Answer 127

a hormone that stimualates red blood cell production in response to hypoxia

Question 128

kidneys convert vitamin D to its active form,

Answer 128

calcitriol, which is essential for calcium absorption from the GI tract

Question 129

what is renal replacement therapy? name the modalities

Answer 129

procedure used to replace the normal blood-filtering function of the kidneys when they are no longer able to perform adequately. filter waste products, excess fluids, and toxins from the blood. several modalities: HD, peritoneal dialysis, renal transplantation

Question 130

what is peritoneal dialysis?

Answer 130

uses patient's peritoneum in the abdomen as a natural filter. a catheter is surgically placed into the peritoneal cavity, allowing dialysis fluid to be infused. waste products and excess fluids pass from the blood vessels in the peritoneum into this fluid, which is then drained and replaced with fresh solution.

Question 131

describe hemodialysis

Answer 131

blood is diverted from the patient's body through a machine known as a dialyzer or artificial kidney. the dialyzer contains a semi-permeable membrance that facilitates the exchanges of solutes between the blood and a specially formulated dialysis solution called dialysate. as flood blows from the dialyzer, waste products such as urea and creatinine, along with excess electrolytes like potassium and phosphate, diffuse across the membrance into the dialysate. simultaneously, certain essential electrolyes may be returned to the blood to maintain physiological balance

Question 132

patients undergoing HD often experience rapid fluid removal and electrolyte shifts, which can lead to

Answer 132

hypotension, arrhythmias, or cardiac arrest

Question 133

what is disquilibrium syndrome?

Answer 133

characterized by neurological symptoms caused by rapid removal of urea during hemodialysis. This can lead to an imbalance in the level of fluid inside the cells of the brain, causing swelling and symptoms such as headache, nausea, restlessness, confusion, or in severe cases, seizures, coma, and death.

Question 134

why must nurses collaborate with pharmacists and nephrologists?

Answer 134

HD can influence pharmacokinetics of drugs by altering the drug clearance rates. will need medication dosage adjustments

Question 135

what is continuous renal replacement therapy (CRRT)?

Answer 135

a form of dialysis used to treat patients with AKI particularly in ICU to provide continuous, gentle removal of waste products and excess fluid from the blood, mimicking natural function of the kidneys. operates over 24 hours, allowing for flow and steady solute clearance and fluid removal. reduces risk of hypotension and otehr complications associated with rapid fluid shifts

Question 136

who is CRRT beneficial for?

Answer 136

hemodynamically unstable patients who cannot tolerate the rapid fluid shifts associated with traditional iHD

Question 137

describe CVVH continuous venovenous hemofiltration

Answer 137

solutes are primarly removed by convection where a large fluid volume is filtered out and replaced with substitution fluid

Question 138

describe CVVHD continueous venovenous hemodialysis

Answer 138

relies on diffusion across semipermeable membrane where dialysate flows countercurrently to blood flow, promoting solute clearance

Question 139

describe CVVHDF continuous venovenous hemodiafiltration

Answer 139

combines both convection and diffusion, offering comprehensive solute removal

Question 140

CRRT involves AC to prevent clotting within the circuit, these meds are often used

Answer 140

heparin or citrate

Question 141

what is SCUF? slow continuous ultrafiltration

Answer 141

a RRT primarily used to manage fluid overload in patients with acute HF or CKD. a form of CRRT that focuses on the removal of excess fluid without significant solute clearance, making it distinct from other modalities like HD or hemofiltration

Question 142

how does SCUF work?

Answer 142

using a semipermeable membrance to facilitate the movement of plasma water across the membrance due to a pressure gradient. allows for extraction of fluid at a controlled rate, typically from 100 to 500 mL per hour. blood is pumped through extracorpeal circuit containing the ultrafiltration device where ultrafiltration occurs across the membrane. the filtered fluid, known as ultrafiltrate, is collected and discarded, while the remaining blood components are returned to the patient's circulation

Question 143

primary goal of SCUF

Answer 143

volume control rather than solute removal

Question 144

who is SCUF beneficial for?

Answer 144

cardiac patients who present with fluid overload and are unresponsive to diuretics. offers gentle and continuous approach to fluid removal, reducing the risk of hemodynamic instability often associated with rapid fluid shifts in traditional dialysis methods.

Question 145

nurses involved in SCUF most monitor several parameters

Answer 145

including blood flow rates, ultrafiltration rates, and patient hemodynamics and assess electrolytes and hematocrit levels

Question 146

What is targeted temperature management (TTM)?

Answer 146

intervention used in the management of patients who have experienced cardiac arrest. it involves deliberate reduction of a patient's core body temperature to optimize neurological outcomes following rescuscitation. primary goal is to mitigate neurological damage by reducing metabolic demand and inhibiting determental biochemical processes that occur after ischemic injury. beneficial to patients who remain comatose after ROSC following cardiac arrest

Question 147

describe the process of TTM

Answer 147

cooling patient to targeted temp usually between 32 and 36 C (89.6-96.8 F) for a specific duration (often 24 hours) followed by a controlled rewarming phase.

Question 148

physiological rationale behind TTM

Answer 148

based on its ability to reduce cerebral metabolic rate, thereby decreasing oxygen demand and limiting cascade of events leading to neuronal injury. cooling helps stabilize cell membrances, reduce excitotoxicity, and limit inflammatory responses. can also prevent or minimize reperfusion injury, which can exacerbate brain damage after blood flow is restored.

Question 149

methods for inducing hypothermia

Answer 149

surface cooling with ice packs or cooling blankets endovascular cooling devices cold IV fluids

Question 150

during TTM be sure to monitor

Answer 150

shivering electrolyte imbalances coagulopathy infections shivering must be managed as it can increase metabolic rate and counteract benefits of cooling

Question 151

why must rewarming by gradual after TTM?

Answer 151

to prevent rapid shifts in electrolytes and hemodynamics that could lead to complications such as rebound hyperthermia or hypotension. should proceed at a rate of approx 0.25 C to 0.5 C per hour until normothermia achieved

Question 152

palliative care involves managing symptoms such as

Answer 152

pain, dyspnea, fatigue, and anxiety