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Nursing 4 Exam 2 > Unit 7 Acute Coronary Syndromes/EKG > Flashcards

Unit 7 Acute Coronary Syndromes/EKG Flashcards

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1
Q

When speaking of location in the heart, where is the base and where is the apex?

A 
Base = Top
Apex = Bottom
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2
Q

What is ejection fraction and the norm?

A

Percentage of blood leaving your heart each time it contracts.

Normal EF is > 60 %
< 40% = left ventricle dysfunction and PT needs to be on ACE inhibitors

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3
Q

What is the pericardium?

A

Membrane enclosing the heart

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4
Q

What are the main coronary arteries of the heart and which one being obstructed usually results in MI and Death?

A

Left Coronary Artery

Right Coronary Artery

Circumflex Artery (branches laterally off of left coronary artery)

Left Anterior Descending Artery (branches downward from left coronary artery)

Left Coronary Artery block = MI or Death

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5
Q

What is the pacemaker of the heart? What is it’s rate? If it does not initiate what takes over and the rate, and if THAT fails, what takes over and the rate?

A

SA node is pacemaker of heart 60-100, if it fails

AV node takes over 40-60, if it fails,

Ventricle will take over 20-40.

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6
Q 
Definite the following terminologies. 
Starling's Rule.
Stroke Volume
Paroxysmal nocturnal dyspnea (PND; what's it an early sign of?)
Prelaod
Afterload
A

Starling’s rule = stroke volume increases in response to increase in the volume of blood in ventricles

Stroke Volume = amount of blood ejected with each beat (~70mL)

PND is a sensation of shortness of breath that awakens the patient; early sign of L sided HF

Preload = Degree of stretch in ventricles before systole/ amount of blood in heart at end of diastole

Afterload = pressure heart has to pump against (amount of resistance the left side of the heart has to overcome in order to eject blood)

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7
Q

What is the common side effect of a patient taking an ACE Inhibitor?

A

Dry cough

“pril” medications

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8
Q

Where is the apical pulse found?

A

MCL 5th intercostal space

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9
Q

What is the nemonic to help remember order of auscultating heart sounds?

A

All Physicians
Earn

    To
            Much
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10
Q

What narrows and blocks the coronary arteries?

A

Atherogenesis, (disorder of artery wall that clumps WBCs)

Plaque formation

Endothelial injury

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11
Q

What are the normal LDL and HDL levels?

A

LDL < 130

HDL > 45

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12
Q

What are modifiable and non-modifiable risk factors for CAD?

A

Modifiable:

  • Smoking
  • Dyslipidemiea
  • HTN
  • Diabetes (A1C < 7)
  • Obesity
  • Lack of Exercise
  • Personality
  • Stress

Non-Modifiable:

  • Sex
  • Age
  • Family Hx
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13
Q

CAD/HF is the leading cause of death for who?
Men tend to manifest CAD how many years prior?
Who has the highest incident of CAD?
Who has the earliest age onset?

A

Women

10 years

White middle aged men

AA’s

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14
Q

What is angina relieved with?

A

Rest and nitroglycerin

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15
Q

What are Acute Coronary Syndromes? How long do the episodes last?

A

Unstable Angine (change in duration of pain/ not relieved usual way anymore, needs treatment)

STEMI (A Myocardial Infarction, ST elevation)

NSTEMI (Sub-endorcadial MI, no ST elevation)

Sudden Cardiac Death (usually left main coronary artery blocked)

> 30 min episodes not relieved by nitroglycerin

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16
Q

What are diagnostic studies for CAD? What is used for diagnosis?

A 
Blood work (H/H, Lipid profile, CRP, Homocysteine level
EKG
Echocardiogram
CXR
Nuclear Stress Test
Cardiac catheterization

-12 lead EKG

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17
Q

What are pharmacological interventions for CAD?

A
  • Anti-platelets
  • Nitrates
  • Beta blockers “olol”
  • Lipid lower agents “statin”
  • Calcium channel blockers “ide and ine”
  • ACE inhibitors “prils”
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18
Q

What are the surgical interventions for CAD?

A

PTCA - catheter through femoral artery, balloon inflates to compress plaque and open vessel

PCI - catheter, balloon, plus stent at the end

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19
Q

Regarding EKG’s, what is Ischemia associated with? Injury? Necrosis?

A

Ischemia - ST depression and T wave inversion

Injury - ST elevation and T wave inversion

Necrosis - abnormal Q wave

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20
Q

Describe women and heart disease.

A

Post menopausal women risk of MI quadruples

Women suffer more silent MI’s, less classical symptoms

Women report more disability after cardiac event then Men

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21
Q

What are other causes of ACS?

A

Marfan’s Syndrome (connective tissue disorder, narrow arteries)

Coronary artery vassospasm

Coronary arterial stenosis

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22
Q

What is CABG?

A

coronary artery bypass grafting

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23
Q

What is the gold standard intervention for an acute MI?

A

PCI and the goal is to perform it within 90 minutes from the times of chest pain.

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24
Q

What essentially happens in ACS?

A

Severe and abrupt cessation of blood supply (O2) leads to ischemia

Ischemia when persists then causes injury

Cell death results if O2 supply is not restored which is irreversible

This is leads to necrosis which again is irreversible

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25
Q

How are MI’s classified?

A
  • Wall thickness affected
    1. Transmural (STEMI)
    2. Subendocardial (non-transmural, NSTEMI)
  • Coronary artery involved (LAD anterior wall, LCA lateral wall, RCA inferior and posterior wall)
  • From 12 lead EKG
  • Ventricle Involved
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26
Q

What do each of the 12 leads correspond with?

A

Anteroseptal/Anterior = V1, V2, V3, V4

Inferior = 2, 3, aVf

Lateral = 1, avl, V5, V6

Posterior = V2

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27
Q

What do Tombstone ST’s signify?

What do Fireman’s hat signify?

A

Tombstone = Anterior MI

Fireman’s hat = Inferior MI

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28
Q

What are factors affecting a MI?

A

Location of infarct

Degree of infarct

Collateral circulation (older PT’s have better collateral circulation)

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29
Q

Describe angina pain vs MI pain.

A

Angina pain:

  • Goes away in < 30 min
  • Precipitated by exercise
  • No damage to the heart
  • Relieved by rest and nitroglycerin

MI pain:

  • > 30 min episode
  • Radiates to other parts of the body
  • Not relieved by rest or nitroglycerin
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30
Q

What are diagnostic lab tests for a MI?

A

CPK (creatininephosphokinase, 55-175 normal)

Troponin (VERY early rise and peak, elevated for ~10 days

LDH (lactase dehydrogenase)

BNP (normal < 100, with HF > 1000’s!!

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31
Q

What diagnostic procedures can be done for MI’s?

A

Chest X-ray

Echocardiogram

Cardiac Catheterization:

  • Check for shellfish allergies since it uses contrast
  • Post procedure PT lays flat 4-6 hrs, neurovascular checks
32
Q

What are nursing interventions for a PT with chest pain?

A
  • O2 therapy
  • VS monitoring
  • 12 lead EKG
  • Multiple IV access
  • Medications: aspirin, plavix, nitroglycerin, lovenox
  • Thrombolytics
  • Sx
  • Interventional cardiology (PCI)
  • Bedrest with gradual increase of activity
33
Q

What are pharmacological Rx’s for MI/Chest Pain/CAD?

A
  • Vasodilators (Nitrates, Hydralazine)
  • Anti platelet (asa, plavix)
  • Beta blockers ( “olol”)
  • Opioid analgesics (morphine)
  • Anticoagulants
  • ACEis (prils)
  • Statins
  • Stool softeners
  • Anxiolytics
34
Q

What is a thrombolytic? Describe.

A

Purpose is to cause the dissolution of the clot resulting in re-profusion. “Clot buster”

With effective Rx:

  • Abrupt cessation of pain
  • Reprofusion of arrhythmias
  • Normalization of ST’s

ex: tPA

35
Q

What is the selection criteria for thrombolytics?

A

Age

Pain criteria (pain last > 1 hr not relieved by nitro

Time from onset of pain to initial evaluation with 6 hrs

EKG - ST elevation in at least 2 LEADS

36
Q

What are contraindications for thrombolytics?

A

Bleeding disorder

Hemorrhagic stroke

Recent surgical procedure

Peptic ulcer/ GI bleed/ hemoptysis

Uncontrolled HTN

Serious or advanced illness

Pregnancy

37
Q

What are major complications of thrombolytics?

A

Hemorrhage

Stroke

COMA (altered MS, pupils early indication something is wrong)

38
Q

What is IABP and what does it do?

A

Intra Aortic Balloon Pump

Decreases O2 demand, Increases O2 supply

  • Inserted through femoral artery
  • Intermittin inflation (check for blockage)
  • PT needs foley to monitor urine output and to make sure balloon is not blocking renal artery
  • PT needs to lay flat
39
Q

What is the goal of cardiac rehabilitation and the three phases?

A

Goal = well being pf PT

Phase 1 = CCU admission to transfer/discharge
Phase 2 = discharge to convalescence and home
Phase 3 = Long term recovery and conditioning. Involvement of community rehabilitation program

40
Q

What are complications of MI’s?

A

Sudden death

Arrhythmias

Heart Failure

Pump Failure

Papillary muscle dysfunction

Dressler’s syndrome (pleural pericardial effusion ~6 weeks after MI)

Ventricular aneurysm and rupture

41
Q

What is the core measure for a MI?

A

PCI within 90 minutes of arrival to hospital

Thrombolytic therapy Received Within 30 Minutes of Hospital Arrival

Aspirin at admission and discharge

ACEi’ (prils) and ARBs (artan)

Statin prescribed at discharge

42
Q

Describe Sudden cardiac death.
What are the causes?
What are the interventions?

A

Unexpected collapse with cardiopulmonary arrest

Causes: Massive MI, dysrhythmias, LV outflow obstruction

Statistically most don’t survive

Rx:
-EMS immediate CPR, ACLS, PTCA, IABP, CABG

-Therapeutic hypothermia

43
Q

Briefly describe broken heart syndrome.

A

Presents like MI, except arteries are normal

Triggered by stressful event

44
Q

What is the time frame of one small box on an EKG?

What about one big box (5 small boxes)

A

1 small box = .04 seconds

1 big box (5 small boxes) = .20 seconds

45
Q

In 1st degree heart block on an EKG, what length is shortened and what is the PR interval regarding it?

A

The T to P break (where EKG ends and starts again)

PR interval is > .20

46
Q

What wave represents arterial depolarization leading to arterial contraction?

A

P wave

47
Q

What is the inner layer of the heart called?

A

endocardium

48
Q

What is myoglobin?

A

Heme protein that transports oxygen

49
Q

What is CRP (C-reactive protein)?

A

Protein released in blood during inflammatory states

50
Q

What medication is given to PT’s who are allergic to Aspirin?

A

clopidogrel (Plavix)

51
Q

What lead is the most common used for continuous cardiac monitoring?

A

Lead 2

52
Q

How do you calculate HR on an EKG strip?

A
  • Count the number of small boxes in between R-R intervals and divide them from 1500.
  • Another method is to count the number of QRS complexes in one minute, or in 6 seconds and multiply by 10
53
Q

What does depolarization mean? Re-polarization?

A

Depolarization = Contraction

Re-polarization = Relaxation

54
Q

What does the R-R measure on an EKG?

P-P?

A

R-R measures ventricular rate

P-P measures arterial rate

55
Q

What is the normal PR interval, normal QRS, and QT interval?

A

PR interval normal is .12-.20

QRS normal < .12

QT interval normal .36-.44 (2 large boxes plus or minus one small box)

56
Q 
Explain what each associated pattern corresponds with.
P wave.
PR segment.
QRS complex.
T wave.
Isoelectric line.
A

p wave = atrial depolarization

pr segment = Delay at AV node

QRS complex = ventricular depolarization

T wave = ventricular re-polarization

Isoelectric line = no electric activity

57
Q

What are the causes of Sinus Tachycardia and what is the treatment? What does the rate have to be?

A

Rate has to be > 100

Causes:
-Tachypnea 
-Elevated BP
-Pain/fever
-Excersise
-Stimulant use:
Caffeine
Tobacco
Medications

Treatment: Anti-anxiety meds if anxious, fluid replacement, If in pain give pain med, essentially treat the cause- notify nurse

58
Q

What are the causes of Sinus Bradycardia and what is the treatment? What does the rate have to be?

A

Rate has to be < 60

Causes:

  • Is PT an athlete?
  • Meds such as beta blockers, CCB, digoxin

Treatment:

  • Treat cause
  • Atropine if symptomatic (stimulates SA node)
  • Pacemaker
59
Q

What are the causes and treatments of A-fib?

A

Causes:

  • Heart disease
  • Pulmonary disease
  • Excessive alcohol or caffeine

Treatment:
-Anticoagulation w/ asa, heparin, warfarin

-HR control using, beta-blockers, CCB (cartizem), Digoxin
(seeking to get to 60-100 w/o conversion)

-Rhythm control
amiodarone (anti-arrhythmic for abnormal rhythms)

OR with,
Cardioversion
uses electricity or chemical means for rhythm control (dronedarone)

OR with,
Ablation (radio frequency destroying tissue in the pathways that cause abnormal rhythm)

60
Q

What is the treatment for Supra-ventricular Tachycardia (PSTV)? Is the rhythm technically regular or irregular? What are the causes?

A

Rhythm is normal! Just ventricle firing extremely fast. Can’t measure PR interval. Can’t tell if P or T wave.

Causes: chronic health problems, high levels of heart medications

Treatment:
-Physical maneuver affecting the vagus nerve called Valsalva maneuver. (PT takes deep breath and then bears down with mouth closed)

-Rx [adenosine] which reduces the normal flow of electrical impulses through the AV node.
Given very quickly
Half life of 2 minutes
6mg, 12mg, 12mg

-Cardioversion

61
Q

When are PVC (premature ventricular contractions) dangerous and you’d want to report to MD?

A
  1. > five in a minute
  2. Two or more in a row
  3. Multifocal (coming from different areas)
  4. R wave on T wave (R on T)
62
Q

When are PVC’s in a rhythm considered Ventricular tachycardia?

A

When there are 4 or more

63
Q

What are the causes and treatments of PVC? What will the PT feel?

A

Causes:

  • Caffeine
  • Electrolyte imbalance (hypo/hyperkalemia, hypomagnesium)
  • Ischemia/hypoxia

(PT will feel lightheadedness)

Treatment:

  • Replace electrolytes
  • Rx, amiodarone
  • lidocaine/novocain
64
Q

What is the treatment for ventricular tachycardia? What is seen in V-Tach?

A
  • Oxygen
  • Lidocaine
  • Rx, amiodarone
    (mix in solution and give rapidly)
  • Cardioversion
  • Restoring electrolyte imbalances

QRS one after the other. No pauses.

65
Q

What are the causes and treatment for Ventricular Fibrillation? What are the most common signs of V-Fib?

A

Causes:

  • Acute MI
  • Electrolyte disturbances
  • Drugs

Treatment:

  • ASSESS UNRESPONSIVENESS
  • Call 911/code blue
  • Initiate CPR
  • Defibrillation
  • Medications: epinephrine, amiodarone, lidocaine, vasopressin

Most common signs:

  • Absent peripheral pulses
  • Unconscious
66
Q

What are causes and treatments of Asystole?

A

Causes:

  • Acute MI
  • Cardiac Arrest

Treatment:

  • ASSESS UNRESPONSIVENESS
  • Call 911/code blue
  • Initiate CPR
  • Defibrillation
  • Medications: epi, amiodarone, lidocaine, vasopressin
67
Q

What medication for a PT is monitored on telemetry and why?

A

Digoxin because they could slip into a 1st degree heart block due to digoxin toxicity

68
Q

What is the treatment for 3rd degree heart block?

A

Atropine first (to try and increase heart rate)

Pacemaker

69
Q

What is considered 1st degree and 3rd degree heart block?

A

1st degree = PR interval >.20

3rd degree = more p waves than QRS’s

70
Q

What is the therapeutic effect of nitroglycerin and how do you know it was effective? What is the initial standard dose?

A

Dilates blood vessels
Decreases O2 demand

Effective if pain is relieved

50mg/250mL

71
Q

What EKG reading would you expect with digoxin toxicity and why?

A

1st degree heart block.

SA impulse is delayed to the AV, longer PR interval.

72
Q

Where are the SA and AV node located in the heart?

A

Sa node is at the junction of the aorta and RA

AV is in the intraarterial septum

73
Q

How can you tell if an EKG rythmn is regular or irregular?

A

The interval between the R waves would be regular or irregular

74
Q

Does does BNP indicate?

A

Hear failure

BNP normal < 100, with HF > 1000’s!!

helps combat adh and aldosterone to prevent overload of fluid

75
Q

What is MONA for?

A

MI Interventions

Morphine
Oxygen
Nitrates
Aspirin

76
Q

What does an S3 heart sound indicate?

A

Left-sided heart failure

Nursing 4 Exam 2 (6 decks)

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