week 3 lecture Flashcards
what is a syndrome
multiple diseases occurring together
what is acute coronary syndrome
- HTN
- Athlerosclerosis
- unstable angina
normal lipid panels
LDL below 100
HDL greater then 40
triglycerides less then 150
cholesterol less then 200
what is prinzmetal angina
angina caused due to coronary artery spasm
what is the first action if someone with stable angina is complaining of chest pain
give stress test
what is the recommended exercise per week
3 days 30-45 mins of moderate to intense
what is the priority intervention if lipid panel is to high
life style changes then do statins
Nitro protocol
take one and call 911 right away, if chest pain doesnt go away within 5 mins take another one
why do older people have a higher chance of surviving an MI
collateral circulation
how long does ischemia have to last before injury to myocardium occurs? Necrosis?
injury occurs after 20 mins
Necrosis after 4 hours
what is an MI
total occlusion of one of the coronary arteries
complications of MI
- HF
- dysrhythmias
- Vfib
- Vtach
drugs for health promotion for MI patients
Statins and aspirin(81mg) (325mg during MI)
-omega 3 fatty acids
Statins major concern
Rhabdomylolysis
-monitor for muscle pain
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
what is another antiplatelet that can be used in place of clopidogrel
effient
why is nitro used with vasopressors
to shunt blood to the heart
What does nitro work on.
what is the main problem with nitro
coronary arteries and peripheral veins.
Nitro builds tolerance very quickly
Sodium nitroprusside
Nipride
- dilates coronary and peripheral arteries
- super powerful
- photosensitive
- max 48 hour admin b/c of cyanide poisoning
what can ECKO be used for
checking ejection fraction 55-70%
checking structure and size
what is valve prolapse
valve does not fully close causing reguritation
MI prioritizes
MONA
O2 is first
Contraindications of trombolytics
- bleeding
- active stroke
- recent surgery
- 6 hours post stroke
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
PCI intevention
- keep entire body straight for a couple of hours to lower the pressure on the femoral artery
- keep assessing pedal pulses, usually will have to use doppler. If you dont hear it with doppler call doctor STAT
- 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
- admit and monitor for 24 hours.
- Do cardiac enzymes Q8H and
- 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
- no heavy lifting (how long)
- you ARE allowed to bend
- no driving for about 3 months
- 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
- 2 seconds
- 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
- pain
- fever
- anxiety
what does the word Paroxysmal mean what is Paroxysmal supraventricular tachycardia (PSVT) and what is your priority intervention
it starts and stops
- HR above 160
- 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
- Valsalva
- adenosine (half life 5 seconds 6 12 12)
- 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
- Heparin
- 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
- digoxin (lower HR and increase contractility, decrease workload)
- 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.
