1. HF 2. dysrhythmias - Vfib - Vtach

Nipride 1. dilates coronary and peripheral arteries 2. super powerful 3. photosensitive 4. max 48 hour admin b/c of cyanide poisoning

1. check for shellfish allergy and give benadryl if they have it 2. give alot of NS after b/c contrast is nephrotoxic 3. if patient is ESKF call dialysis before contrast is in 4. the contrast will make you flush and have a warm feeling you will also have the urge to urinate

week 3 lecture Flashcards by Hovik Keleshyan

what is a syndrome

multiple diseases occurring together

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what is acute coronary syndrome

HTN
Athlerosclerosis
unstable angina

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normal lipid panels

LDL below 100
HDL greater then 40
triglycerides less then 150
cholesterol less then 200

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what is prinzmetal angina

angina caused due to coronary artery spasm

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what is the first action if someone with stable angina is complaining of chest pain

give stress test

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what is the recommended exercise per week

3 days 30-45 mins of moderate to intense

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what is the priority intervention if lipid panel is to high

life style changes then do statins

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Nitro protocol

take one and call 911 right away, if chest pain doesnt go away within 5 mins take another one

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why do older people have a higher chance of surviving an MI

collateral circulation

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how long does ischemia have to last before injury to myocardium occurs? Necrosis?

injury occurs after 20 mins

Necrosis after 4 hours

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what is an MI

total occlusion of one of the coronary arteries

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complications of MI

HF
dysrhythmias
- Vfib
- Vtach

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drugs for health promotion for MI patients

Statins and aspirin(81mg) (325mg during MI)

-omega 3 fatty acids

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Statins major concern

Rhabdomylolysis

-monitor for muscle pain

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Why do patients have to take clopidogrel after an MI. How is it dosed?

to keep the stents open. loading dose is 300 mg in the cath lab then 75 mg daily until MD decides to stop

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what is another antiplatelet that can be used in place of clopidogrel

effient

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why is nitro used with vasopressors

to shunt blood to the heart

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What does nitro work on.

what is the main problem with nitro

coronary arteries and peripheral veins.

Nitro builds tolerance very quickly

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Sodium nitroprusside

Nipride

dilates coronary and peripheral arteries
super powerful
photosensitive
max 48 hour admin b/c of cyanide poisoning

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what can ECKO be used for

checking ejection fraction 55-70%

checking structure and size

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what is valve prolapse

valve does not fully close causing reguritation

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MI prioritizes

MONA

O2 is first

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Contraindications of trombolytics

bleeding
active stroke
recent surgery
6 hours post stroke

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TPA interventions

check for shellfish allergy and give benadryl if they have it
give alot of NS after b/c contrast is nephrotoxic
if patient is ESKF call dialysis before contrast is in
the contrast will make you flush and have a warm feeling you will also have the urge to urinate

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PCI intevention

1. keep entire body straight for a couple of hours to lower the pressure on the femoral artery 2. keep assessing pedal pulses, usually will have to use doppler. If you dont hear it with doppler call doctor STAT 3. Ask patient to move their toes if they're awake

what percentage of a coronary artery has to be occluded before chest pain is felt

70%

what does ischemia on EKG show up as

ST depression | T inversion

What does myocardial injury look like on ECG

ST elevation

what do we do for patients with chest pain who do not have ST elevation

1. admit and monitor for 24 hours. 2. Do cardiac enzymes Q8H and 3. have them on continous cardiac monitoring

Peak times of Myoglobins Troponin (tells you how bad the MI is) CK-MB

1-2 hours 6-8 hours 12 hours

what is another name for CK-MB

creatinine phosphokinase

what is a pathologic Q wave and what does it indicate

it is a Q wave which is "deeper" then normal | indicates old MI

how do you know TPA has worked

ST elevation goes away therefore you know the coronaries have opened

why are diabetics at high risk of mortality from MI

they may not feel chest pain due to neuropathy

what is the maximum number of stents you can place at one time

2 max after that you gotta do CABG

what do they supply RCA LAD circumflex

inferior wall anterior wallwhat do posterior wall

post CABG teaching

1. no heavy lifting (how long) 2. you ARE allowed to bend 3. no driving for about 3 months 4. restrict crazy sex for about 3 months

normal rates of SA node AV node Purkinjee

60-100 40-60 20-40

priority intervention for tachy arrhthmias

check pulse

how many large boxes are there in a 6 second strip what time interval does a large box represent what time interval does a small box represent

30 0. 2 seconds 0. 04 seconds

what does PQ interval represent

Atrial depolarization

what is the normal PR interval and when is it elevated

.12-.2 | Heart block

what does the QT interval represent

ventricular cycle

white is right

yup

what does vagus nerve stimulation do and how can you do it

activates PNS | valsalva

interventions when D/Cing a central line

it stimulates the vagus nerve and can cause a vasovagal attack

how can you save a life during a vasovagal attack

push 0.5 atrophine

what does a sawtooth pattern indicate

atrial flutter not really dangerous in of itself but it can lead to afib

what is a vasovagal attack

a sudden drop in HR and BP

where else are there baroreceptors present that when activated lower HR and BP

carotid sinus but nurses arent aloud to do a carotid massage to lower HR because it may dislodge a clot in patients with athlersclerosis

pre heart surgery intervention

doppler of carotids to check for plaques if plaques are present then we gotta clear them before the surgery

pulse = QRS = mechanical contraction

true

how do you count heart rate

count R-R intervals in 6 second strip multiple by 10 or take the #of large boxes in 1 min and divide by the # of large boxes in one R-R interval OR take the number of small boxes in 1 min (1500) and divide by the number of small boxes in one R-R interval

what does an artifact indicate

misplaced electrotrodes it looks like vfib

why do we call a rhtyhm sinus for example sinus bradycardia. when is sinus bradycardia normal

if there is no P wave then we dont say sinus. it is normal during sleep and in athletes

what are the causes of sinus tachycardia

1. pain 2. fever 3. anxiety

what does the word Paroxysmal mean what is Paroxysmal supraventricular tachycardia (PSVT) and what is your priority intervention

it starts and stops 1. HR above 160 2. check pulse and then look at rhythm to check if it is regular or irregular

what are you do if you have a regular rhythm for PSVT

1. Valsalva 2. adenosine (half life 5 seconds 6 12 12) 3. cardioversion

Atrial fibrillation

1.no p waves 2.f waves (caused by focci generating conduction) can be controlled (HR less then 100) or uncontrolled (HR greater then 100)

what is your priorities when dealing with Afib

1. Heparin 2. Amiordarone (Amio) give loading dose 300 mg over 10 min then 1 mg/kg per min for 6 hours then 0.5 mg/kg per min over 18 hours 3. digoxin (lower HR and increase contractility, decrease workload) 4. cardioversion

Heart blocks

1st degree =prolonged PR 2nd degree -Mobits 1= Gradual prlongation of PR with some dropped beats (no QRS) -Mobits 2=PR might be normal but you have dropped beats 3rd degree-Atrium and ventricles go rogue

how do you manage the different heart blocks

just monitor or give atropine for 1st degree and mobits 1 | for mobits 2 and 3rd degree you have to put a pacemaker

why are premature ventricular contractions bad

can cause vtach

what is bigeminty what is trigeminity which one is worse

bi-1 normal beat 1 PVC tri-2 normal beats 1 PVC Bi is worse

what is a cardiac ablation

Cauterization of focci

how do you know you have PVC

weird feeling in your chest right before bed

Vtach priorities

check pulse if present then check vitals if not call code

what are the types of transvenous pacemakers

atrail ventricular both/dual

what does failure to capture mean and how do you know this is the case

power is to low to cause contraction. You will see a spike on ECG

what is failure to sense and how do you fix it

the pacer cannot sense the HR. Increase sensitivity

what is an Aneurysm and how do you manage it

it is a buldging vessel you gotta keep the BP low

when do you hear reguritation vs stenosis

If a valve is opening and makes a sounds it is stenosis if it is closing and makes a murmur it is reguritation.