week 5: cardiac (pump) Flashcards
what are the two main requirements for adequate perfusion
strong heart (pump) and patent arteries (pipes)
what are the main factors that affect to perfusion specifically related to problems in the heart
- congenital heart defects
- muscle: cardiomyopathies and pericarditis
- valve disorders like endocarditis
- electrical conduction
what are the main cues of right sided heart failure
systemic congestion: edema, JVD, nausea, anorexia, polyuria at night
what are the two main symptoms of Left sided heart failure
- decreased CO: fatigue, weak, dizzy, angina, tachycardia, etc.
- pulmonary congestion: crackles, S3/S4 gallop
what is an S3/S4 gallop
a triple rhythm in diastole
what does elevated BNP mean
means the heart is being stretched, which means fluid overload and heart failure
what does an echo test for
ejection fraction
what is the worst case scenario for pump problems
decompensated heart failure (left ventricular failure)
if someone had decompensated heart failure, what would they look like
sitting up, eyes wide, struggling to breathe
a person with L sided heart failure is sitting up, eyes wide, struggling to breathe. what are the 4 main interventions in order
1) raise head of bed and reassure
2) administer O2 if sats are below 92%
3) assess vitals
4) administer meds as ordered
should you leave the patient if they have decompensated heart fialure
NO
what are the 4 meds that improve ejection fraction (fantastic 4)
ACE inhibitors /ARNI
Beta blockers
MRA
SLGT-2
what do MRAs do
minteralcorticoid receptor antagonist: blocks aldosterone and preserves K
why do SGLT-2 inhibitors help with cardiac stuff
whats the limit of salt per day in a cardiac patient
2-3 g of salt/day
whats the limit of water per day for a cardiac patient
1.5-2L
how many milligrams of sodium are in a tsp of salt
2300 mg
whats the difference between stenosis and regurgitation
stenosis: when valve is narrowed, blood is restricted from moving forward
regurgitation: valve is sluggish with closing and may cause back flow
which side of the heart does valvular heart disease usually develop
Left side most often (aortic and mitral)
what are the main causes of valvular heart dz
rheumatic heart disease, endocarditis, MI, CT disease, bicuspid aortic valve, arteriosclerosis of aortic valve
how does valvular heart diseases usually progress
it starts from left and moves to the right
what are symptoms of valvular heart disease in the mitral valve
fib, hemoptysis (because atria will be overfilled)
what are sx of valvular heart disease in the aortic valves
angina, syncope, nocturnal dyspnea (less overall cardiac output)
which illnesses will cause rheumatic fever
strep throat, scarlet fever
what is the difference between rheumatic fever and rheumatic heart disease
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
what is a trans esophegeal echo
looks at valves
what is infective endocarditis
microbial infection of the heart valves or the endocardial surface of the heart
what are some conditions that can cause infective endocarditis
rheumatic heart dx, IVDU (IV drug user), recent valve or dental surgery
what are the main cues of infective endocarditis
regurgitation
-youll see HF, arterial embolization, fever, cardiac murmur, anorexia and weight loss
what kind of symptoms would you see if a clot was carried to the kidneys
- decreased urine output
- increased urea and creatinine
(it’ll be an infrarenal AKI)
which side of the heart would a clot most likely originate from
left side b/c the left side pumps blood into systemic curculation
what is aortic stenosis
aorta narrowed, won’t fully open
which med decreases afterload
ACE inhibitors
what meds decrease preloads,
beta blockers, diuretics, digoxin, nitrates
when should you NEVER give nitro
pt has aortic valve stenosis OR hypertrophic cardiomyopathy
which dysrhythmia should we monitor for a patient with MV disease
afib
what is a TAVI
transcatheter aortic valve implantation: thread cath into heart, inflate ballon into valve
what is a TAVR
transcatheter aortic valve replacement
when should we use anticoagulants with endocarditis
if patient has a prosthetic valve
between valve repair and valve replacement: which is the better option
valve repair because the body is less likely to reject it
what are the two types of valve replacement
mechanical valves (synthetic material)
biologic valve: animal valve
what are important points about mechanical valves
can last up to 20 years
lifelong anticoagulants (increased risk of thromboembolism)
what are the main points about biologic valve
don’t need anticoagulants
failure rate increases after 7-10 years (not as long as mechanical)
less durable- can calcify
why do patients need a dental exam before open heart surgery
risk of infective endocarditis if wounds in the mouth
how long prior to open heart surgery does one stop anticoagulants
72 hours prior to surgery
what is a cardiac tamponade
bleeding in the heart sack which increases pressure and decreases pumping
what is the main information to give for a patient with endocarditis post valve surgery
-avoid ppl with infection
- good oral hygiene
- inform HCP about condition
- prophylactic antibiotics before procedures
- fatigue is normal after surgery
- importance of taking anticoagulants
what is SCD
sudden cardiac death
what are cardiomyopathies
chronic disease of the heart muscle
what are the two types of cardiomyopathy
dilated: too loose
hypertrophic: too tight/thick
what are the main symptoms of dilated cardiomyopathy
-heart failure
- dysrhythmias
- emboli
- SCD
what are the main issues with hypertrophic cardiomyopathy
-heart failure
- dysrhythmias
- emboli
- SCD
AND andina and syncope (only diff from dilated)
what does an angiography do
injects dye into coronary arteries and looks for blockages
what is the worst case scenario for cardiomyopathy’s
- acute decompensated heart failure and SCD
what do you do with acute decompensated heart failure
LMNOP
lasix
morphine
nitro (don’t give with hypertrophic)
oxygen
positioning
what is the only way to help with SCD
defibrilator or AED
which CMO should you never give with digoxin and why
hypertrophic because if you squeeze it anymore it may obstruct the coronary arteries
what is an ICD (internal cardiac defibrillator)
it monitors rhythm and sends shocks through heart if it detects weird rhythm
what is pericarditis
inflammation of sac that surrounds the heart
what are the main cues of pericarditis
sharp chest pain (radiates to L neck/shoulder/back)
gets worse with respiration (taking deep breath and lying flat)
what is a hallmark sign of pericarditis
pericardial friction rub
what would you see in an EKG for a person with pericarditis
ST elevation on all leads
why would you want to monitor urea and creating for pericarditis
could be ureic pericarditis due to ESRD
what are two main complications with pericarditis
pericardial effusion
cardiac tamponade
what is a pericardial effusion
increased fluid accumulating in the pericardial sac
what is a cardiac tamponade and what are the main assessment findings
pressure from fluid surrounding the heart interferes with ability to pump
findings:
JVP
tachycardia and hypotansion
muffled heart sounds
pulses paradoxus
what is pulsus paradoxus
drop in systolic BP with inspiration
what are the two main causes of pericarditis
infection
kidney issues
how should you position someone with pericarditis
sit upright and lean foreward slightly
what is the main treatment for cardiac tamponade
pericardiocentesis
what is the MOA of amiodarone
potassium channel blocker, prolongs the effective refractory period to decrease atrial and ventricular arrhythmias
what is a synchronised cardio version
shock patients with arrhythmia (synchronise shock with R waves)
what is a pre ventricular contraction
a beat that’s suddenly different from the others
what could PVC turn into
ventricular tachycardia and ventricular fibrillation (both a medical emergency
what are the first two things you do if a patient has Vfib
1) determine if they have a pulse
2) defibrillate (code blue) PRIORITY
(also try and find care to see if its reversible)
whats the most effective way to terminate Vfib or pulses VT
defibrillate
what is Asystole
- complete absence of any ventricular rhythm
how do you treat ASystole
CPR + epinephrine
NO DEFIBRILATION
