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3512 > week 5: cardiac (pump) > Flashcards

week 5: cardiac (pump) Flashcards

1
Q

what are the two main requirements for adequate perfusion

A

strong heart (pump) and patent arteries (pipes)

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2
Q

what are the main factors that affect to perfusion specifically related to problems in the heart

A
  • congenital heart defects
  • muscle: cardiomyopathies and pericarditis
  • valve disorders like endocarditis
  • electrical conduction
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3
Q

what are the main cues of right sided heart failure

A

systemic congestion: edema, JVD, nausea, anorexia, polyuria at night

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4
Q

what are the two main symptoms of Left sided heart failure

A
  • decreased CO: fatigue, weak, dizzy, angina, tachycardia, etc.
  • pulmonary congestion: crackles, S3/S4 gallop
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5
Q

what is an S3/S4 gallop

A

a triple rhythm in diastole

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6
Q

what does elevated BNP mean

A

means the heart is being stretched, which means fluid overload and heart failure

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7
Q

what does an echo test for

A

ejection fraction

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8
Q

what is the worst case scenario for pump problems

A

decompensated heart failure (left ventricular failure)

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9
Q

if someone had decompensated heart failure, what would they look like

A

sitting up, eyes wide, struggling to breathe

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10
Q

a person with L sided heart failure is sitting up, eyes wide, struggling to breathe. what are the 4 main interventions in order

A

1) raise head of bed and reassure
2) administer O2 if sats are below 92%
3) assess vitals
4) administer meds as ordered

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11
Q

should you leave the patient if they have decompensated heart fialure

A

NO

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12
Q

what are the 4 meds that improve ejection fraction (fantastic 4)

A

ACE inhibitors /ARNI
Beta blockers
MRA
SLGT-2

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13
Q

what do MRAs do

A

minteralcorticoid receptor antagonist: blocks aldosterone and preserves K

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14
Q

why do SGLT-2 inhibitors help with cardiac stuff

A
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15
Q

whats the limit of salt per day in a cardiac patient

A

2-3 g of salt/day

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16
Q

whats the limit of water per day for a cardiac patient

A

1.5-2L

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17
Q

how many milligrams of sodium are in a tsp of salt

A

2300 mg

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18
Q

whats the difference between stenosis and regurgitation

A

stenosis: when valve is narrowed, blood is restricted from moving forward
regurgitation: valve is sluggish with closing and may cause back flow

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19
Q

which side of the heart does valvular heart disease usually develop

A

Left side most often (aortic and mitral)

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20
Q

what are the main causes of valvular heart dz

A

rheumatic heart disease, endocarditis, MI, CT disease, bicuspid aortic valve, arteriosclerosis of aortic valve

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21
Q

how does valvular heart diseases usually progress

A

it starts from left and moves to the right

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22
Q

what are symptoms of valvular heart disease in the mitral valve

A

fib, hemoptysis (because atria will be overfilled)

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23
Q

what are sx of valvular heart disease in the aortic valves

A

angina, syncope, nocturnal dyspnea (less overall cardiac output)

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24
Q

which illnesses will cause rheumatic fever

A

strep throat, scarlet fever

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25
Q

what is the difference between rheumatic fever and rheumatic heart disease

A

fever: inflammatory disease that can develop from strep throat and scarlet fever
rheumatic heart disease: chronic disease resulting from rheumatic fever, scarring and deformity in the heart valves

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26
Q

what is a trans esophegeal echo

A

looks at valves

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27
Q

what is infective endocarditis

A

microbial infection of the heart valves or the endocardial surface of the heart

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28
Q

what are some conditions that can cause infective endocarditis

A

rheumatic heart dx, IVDU (IV drug user), recent valve or dental surgery

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29
Q

what are the main cues of infective endocarditis

A

regurgitation
-youll see HF, arterial embolization, fever, cardiac murmur, anorexia and weight loss

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30
Q

what kind of symptoms would you see if a clot was carried to the kidneys

A
  • decreased urine output
  • increased urea and creatinine
    (it’ll be an infrarenal AKI)
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31
Q

which side of the heart would a clot most likely originate from

A

left side b/c the left side pumps blood into systemic curculation

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32
Q

what is aortic stenosis

A

aorta narrowed, won’t fully open

33
Q

which med decreases afterload

A

ACE inhibitors

34
Q

what meds decrease preloads,

A

beta blockers, diuretics, digoxin, nitrates

35
Q

when should you NEVER give nitro

A

pt has aortic valve stenosis OR hypertrophic cardiomyopathy

36
Q

which dysrhythmia should we monitor for a patient with MV disease

A

afib

37
Q

what is a TAVI

A

transcatheter aortic valve implantation: thread cath into heart, inflate ballon into valve

38
Q

what is a TAVR

A

transcatheter aortic valve replacement

39
Q

when should we use anticoagulants with endocarditis

A

if patient has a prosthetic valve

40
Q

between valve repair and valve replacement: which is the better option

A

valve repair because the body is less likely to reject it

41
Q

what are the two types of valve replacement

A

mechanical valves (synthetic material)
biologic valve: animal valve

42
Q

what are important points about mechanical valves

A

can last up to 20 years
lifelong anticoagulants (increased risk of thromboembolism)

43
Q

what are the main points about biologic valve

A

don’t need anticoagulants
failure rate increases after 7-10 years (not as long as mechanical)
less durable- can calcify

44
Q

why do patients need a dental exam before open heart surgery

A

risk of infective endocarditis if wounds in the mouth

45
Q

how long prior to open heart surgery does one stop anticoagulants

A

72 hours prior to surgery

46
Q

what is a cardiac tamponade

A

bleeding in the heart sack which increases pressure and decreases pumping

47
Q

what is the main information to give for a patient with endocarditis post valve surgery

A

-avoid ppl with infection
- good oral hygiene
- inform HCP about condition
- prophylactic antibiotics before procedures
- fatigue is normal after surgery
- importance of taking anticoagulants

48
Q

what is SCD

A

sudden cardiac death

49
Q

what are cardiomyopathies

A

chronic disease of the heart muscle

50
Q

what are the two types of cardiomyopathy

A

dilated: too loose
hypertrophic: too tight/thick

51
Q

what are the main symptoms of dilated cardiomyopathy

A

-heart failure
- dysrhythmias
- emboli
- SCD

52
Q

what are the main issues with hypertrophic cardiomyopathy

A

-heart failure
- dysrhythmias
- emboli
- SCD
AND andina and syncope (only diff from dilated)

53
Q

what does an angiography do

A

injects dye into coronary arteries and looks for blockages

54
Q

what is the worst case scenario for cardiomyopathy’s

A
  • acute decompensated heart failure and SCD
55
Q

what do you do with acute decompensated heart failure

A

LMNOP
lasix
morphine
nitro (don’t give with hypertrophic)
oxygen
positioning

56
Q

what is the only way to help with SCD

A

defibrilator or AED

57
Q

which CMO should you never give with digoxin and why

A

hypertrophic because if you squeeze it anymore it may obstruct the coronary arteries

58
Q

what is an ICD (internal cardiac defibrillator)

A

it monitors rhythm and sends shocks through heart if it detects weird rhythm

59
Q

what is pericarditis

A

inflammation of sac that surrounds the heart

60
Q

what are the main cues of pericarditis

A

sharp chest pain (radiates to L neck/shoulder/back)
gets worse with respiration (taking deep breath and lying flat)

61
Q

what is a hallmark sign of pericarditis

A

pericardial friction rub

62
Q

what would you see in an EKG for a person with pericarditis

A

ST elevation on all leads

63
Q

why would you want to monitor urea and creating for pericarditis

A

could be ureic pericarditis due to ESRD

64
Q

what are two main complications with pericarditis

A

pericardial effusion
cardiac tamponade

65
Q

what is a pericardial effusion

A

increased fluid accumulating in the pericardial sac

66
Q

what is a cardiac tamponade and what are the main assessment findings

A

pressure from fluid surrounding the heart interferes with ability to pump

findings:
JVP
tachycardia and hypotansion
muffled heart sounds
pulses paradoxus

67
Q

what is pulsus paradoxus

A

drop in systolic BP with inspiration

68
Q

what are the two main causes of pericarditis

A

infection
kidney issues

69
Q

how should you position someone with pericarditis

A

sit upright and lean foreward slightly

70
Q

what is the main treatment for cardiac tamponade

A

pericardiocentesis

71
Q

what is the MOA of amiodarone

A

potassium channel blocker, prolongs the effective refractory period to decrease atrial and ventricular arrhythmias

72
Q

what is a synchronised cardio version

A

shock patients with arrhythmia (synchronise shock with R waves)

73
Q

what is a pre ventricular contraction

A

a beat that’s suddenly different from the others

74
Q

what could PVC turn into

A

ventricular tachycardia and ventricular fibrillation (both a medical emergency

75
Q

what are the first two things you do if a patient has Vfib

A

1) determine if they have a pulse
2) defibrillate (code blue) PRIORITY
(also try and find care to see if its reversible)

76
Q

whats the most effective way to terminate Vfib or pulses VT

A

defibrillate

77
Q

what is Asystole

A
  • complete absence of any ventricular rhythm
78
Q

how do you treat ASystole

A

CPR + epinephrine
NO DEFIBRILATION

3512 (19 decks)

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