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HURST > Cardiac > Flashcards

Cardiac Flashcards

1
Q

What two major veins bring blood to the right side of the heart? Is the blood oxygenated?

A

superior and inferior vena cava

no it is deoxygenated

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2
Q

How does blood normally flow through the heart?

A

superior and inferior vena cava bring blood to RIGHT ATRIUM

then it goes to RIGHT VENTRICLE

it is pumped into PULMONARY ARTERY then to lungs where blood is oxygenated

PULMONARY VEINS return blood to LEFT ATRIUM

then to LEFT VENTRICLE which pumps to aorta then to body

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3
Q

Preload

A

amount of blood returning to right side of the heart and the muscle stretch the volume causes

ANP is released when we have this stretch

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4
Q

Afterload

A

pressure in the aorta and peripheral arteries that LEFT VENTRICLE has to pump against

resistance

HTN = more resistance / afterload = why HTN can lead to HR and pulmonary edam

High afterload decreases CO and wears your heart out

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5
Q

Stroke volume

A

amount of blood pumped out of ventricles with each beat

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6
Q

CO = ___ x ___

A

CO = HR x SV

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7
Q

Factors that affect cardiac output

A

HR and certain arrhythmias (tachycardia = decreased CO)

Blood volume (less volume = less CO)

Decreased contractility (MI, meds, cardiac muscle disease)

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8
Q

Pathophysiology of decreased CO

A

poor perfusion

decreased LOC

chest pain

crackles / wet lung sounds / SOB

cold / clammy skin

UOP decreases

Peripheral pulses weak

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9
Q

Meds that effect Preload

A

diuretics and nitrates decrease preload by vasodilating and diuresing

diuretic (furosemide)
Nitrates (nitroglycerin)

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10
Q

Afterload Meds

A

vasodilation reduces afterload

ACE Inhibitors (enalapril, fosinopril, captopril)
ARBS (losartan, irbesartan
Hydralazine
Nitrates

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11
Q

Meds that Improve Contractility

A

Inotriopes (dopamine, dobutamine, milrinone)

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12
Q

Meds that help Rate Control

A

Beta Blockers (propranolol, metoprolol, atenolol, carvedilol)

Calcium Channel Blockers (diltiazem, verapamil, amlodipine)

Digoxin

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13
Q

Meds for Rhythm Control

A

antiarrhythmics (amiodarone)

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14
Q

Three Arrhythmias that are always a big deal

A

pulseless V-tach

V-Fib

Asystole

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15
Q

Coronary Artery Disease

A

includes both

CHRONIC STABLE ANGINA

and

ACUTE CORONARY SYNDROME

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16
Q

Chronic Stable Angina Pathophysiology

A

Chest pain upon exertion alleviated by rest or nitroglycerin SL.

intermittent decreased blood flow to myocardium = ischemia

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17
Q

Chronic Stable Angina Treatment

A

Nitroglycerin
Beta Blockers
Calcium Channel Blockers
Acetylsalicylic Acid (Aspirin)

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18
Q

Client Education for Chronic Stable Angina

A

rest frequently

avoid overeating (low fat / high fiber diet) / lose weight

avoid excess caffeine or drugs that increase HR

Dress warmly in cold weather / really cold drinks can precipitate attacks (vasoconstriction)

Take nitroglycerin prophylactically and then sit and rest

stop smoking

avoid isometric exercise (squatting, lifting weights)

reduce stress

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19
Q

Nitroglycerin

A

Sublingual

causes vasodilation (decreases preload and afterload)

dilation of coronary arteries to increase blood flow to myocardium

take 1 every 5 minutes with a max of 3 doses
** if first dose doesn’t treat pain, call 911 then take second dose

keep in DARK, GLASS BOTTLE and keep it dry and cool

may burn or fizz (if it doesn’t check expiration) / renew meds every 6 months

client will get headache

BP will DROP

** must be sitting when you take it (since BP drops) and only stand once headache is gone

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20
Q

Beta Blockers

A 
prevents angina (doesn't treat it)
Ex. propranolol, metoprolol, atenolol, carvedilol

decreases BP, HR, and myocardial contractility
**decreasing myocardial contractility decreases CO and decreases workload on heart

Block epi and norepi (no fight or flight)

  • also used to treat HF (along side ACE inhibitors)
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21
Q

Calcium Channel Blockers

A

prevention of angina (doesn’t treat)
Ex. nifedipine, verapamil, amlodipine, diltiazem

Decreases BP, vasodilates, decreases afterload, increases oxygen to myocardium

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22
Q

Acetylsalicylic acid

A

81 - 325 mg dose

81 is baby dose

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23
Q

Cardiac Catheterization

A

ask if allergic to shellfish or iodine (dye)

check kidney function (dye is excreted through kidneys)
** acetylcysteine helps protect kidneys and is given pre-procedure (esp w kidney probs)

Hot shot - due to vasodilation
Palpitations are NORMAL

Post-Procedure:

  • monitor VS
  • watch puncture site (bleeding / hematoma)
  • Assess extremity distal to puncture site (pulselessness / pallor / pain / paresthesia / paralysis / skin temp / cap. refill)
  • bed rest, flat, extremity straight for 4-6 hrs
  • report pain ASAP

**if client is on metformin, discontinue for 48 hrs post procedure (kidneys)

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24
Q

Acute Coronary Syndrome Patho

A

MI, Unstable Angina

decreased bloodflow to myocardium = ischemia, necrossis
happens randomly (acutely) w no exertion required
rest and nitroglycerin will NOT relieve pain
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25
Q

Acute Coronary Syndrome S/sx

A

chest pain / discomfort / crushing
- radiates to neck, jaw, one or both arms, shoulder blades

tightness, pressure, dizziness, sweating, N/V

cold / clammy / BP drops / decreased CO / ECG changes / vomiting - stimulation of vagus nerve (why BP and HR drops)

Women: GI s/sx –> epigastric discomfort / pain between shoulder blades, aching jaw, choking sensation

Elderly: SOB / behavior change

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26
Q

STEMI

A

ST-Segment Elevation Myocardial Infarction

indicates that the client is having a heart attack and the goal is to get them to the cath lab for PCI in less than 90 min

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27
Q

NSTE-ACS

A

Non-ST-Segment Elevation Acute Coronary Syndrome

these clients are usually less worriesome. Partial coronary vessel blockage by a thrombus

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28
Q

CPK - MB

A

Diagnostic Lab Work for Acute Coronary Syndrome

cardiac specific iso-enzyme

Levels increase with damage to cardiac cell
** elevates within 6 hours and peaks in 12-24 hrs; returns to normal within 24-36 hrs

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29
Q

Troponin

A

cardiac biomarker with high specificity to myocardial damage

elevates within 3-4 hours, peaks at 10-24 hrs and remains elevated for up to 3 wks

MOST SENSITIVE INDICATOR FOR AN MI

also most helpful when client delays seeking care

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30
Q

Myoglobin

A

increases within 2 hrs and peaks in 3-15 hrs

negative results are a good things

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31
Q

What arrhythmias require defibrillation?

A

PULSELESS v tach

v fib

32
Q

What meds do you use when V-Fib and pulseless VT are resistent to epi (vasopressor) and defibrillation?

A

amiodarone and lidocaine (both anti-arrhythmic drugs)

33
Q

What do you monitor to tell if your patient has developed lidocaine toxicity?

A

CNS changes

34
Q

What do you monitor for with Amiodarone?

A

hypotension –> can lead to heart arrhythmias

35
Q

Treatment for Acute Coronary Syndrome

A

Oxygen 1st (if O2 less than 90%)
aspirin 2nd (chewable)
nitroglycerine 3rd
morphine only if in pain

  • head up position to decrease workload on heart and increase CO
  • fibrinolytic therapy
  • PCI (percutaneous coronary intervention)
  • Coronary Atery Bypass Graft (CABG)
  • Cardiac Rehabilitation
36
Q

Fibrinolytic Therapy

A

dissolve clot

alteplase (t-PA)
tenecteplase (TNKase / one time IV push)
reteplase
streptokinase

administer within 12 hrs onset of myocardial pain

Rules for STROKE: Time is Brain (only have 3 hrs)

  • *major complication = bleeding. (institute bleeding precautions)
    • draw blood when starting IVs to reduce punctures / no ABGs
    • no neck IVs (need to be able to compress)

Contraindications: intracranial neoplasm or bleed, suspected aortic dissection, internal bleeding

37
Q

PCI

A

Percutaneous Coronary Intervention (includes PTCA - percutaneous transluminal coronary angioplasty and stents)

Angioplasty complication = MI

client could bleed from heart cath or reocclude

any problems = go back to surgery

chest pain after procedure = surgery bc possible re-occlusion

38
Q

Meds adjunctive with PCI

A

heparin

bivalirudin

clipidogrel & prasugrel

IV nitroglycerin

Beta Blockers

abciximab & eptifibatide - keeps artery open after stent is placed or while waiting to get to cath lab

39
Q

CABG

A

coronary artery bypass graft

scheduled or emergency procedure

used for multiple vessel dz or left main coronary artery occlusion

*left main coronary artery occlusion = sudden death / widow maker

40
Q

Cardiac Rehabilitation

A

smoking cessation
stepped-care plan (increase activity gradually)
diet changes (decreased fat, salt, and cholesterol)
no isometric exercises
no valsalva
no straining, no suppository (can give docusate)
sex after 7-10 days (best to do in the morning)
walking / swimming is best exercise
teach s/sx of heart failure

41
Q

Causes of Heart Failure

A

coronary artery dz, cardiomyopathy, valvular heart dz, endocarditis, acute MI, HTN

42
Q

Left Sided HF S/sx

A 
pulmonary congestion
dyspnea
cough
blood tinged frothy sputum
restlessness
tachycardia
S-3 
orthopnea
nocturnal dyspnea

*left = lung

43
Q

right sided heart failure

A 
distended neck veins
edema
enlarged organs
wt gain
ascites

can be caused by PE, COPD, chronic bronchitis

44
Q

systolic vs diastolic HF

A

systolic HF - heart can’t contract and eject

diastolic HF - ventricles can’t relax and fill

45
Q

Diagnosis of HF

A

B-type (BNP) natriuretic peptide

Chest Xray

echnocardiaogram

new york heart association functional classification of persons w HF
*class 4 is worst
46
Q

What will you see on a CXR with HF?

A

enlarged heart

pulmonary infiltrates

47
Q

Echnocardiogram

A

looks at pumping action or ejection fraction of the heart

also info about backflow and valve disease

48
Q

B-type (BNP) natruiretic peptide

A

blood test

its secreted by ventricular tissues in heart when volumes and pressures in heart are increased

sensitive indicatory

can be positive for HF when CXR doesn’t show a problem

nesiritide can give false high (turn off 2 hrs before drawing for BNP)

49
Q

ACE Inhibitors and HF

A

**dry naggy cough

suppresses renin-angiotensin system

arterial dilation and increased stroke volume

Block aldosterone (lose sodium and water and retain potassium)

50
Q

ARBs and HF

A

cause a decrease in arterial resistance and decreased BP

Block aldosterone (lose sodium and water and retain potassium)

51
Q

Beta Blockers and HF

A

first-line therapy (prescribed in addition to ACE inhibitors)

relaxes vessels, decrease BP, decrease afterload, decrease workload on heart

52
Q

Digoxin

A

monitor for drug toxicity, esp in elderly

used when client is in sinus rhythm or atrial fibrillation and has chronic HF

strengthens contractions, decreases HR, increases CO, increases kidney perfusion

  • check apical pulse (5th intercostal space)

Monitor electrolyte levels (imbalances can lead to digoxin tox. ESP potassium)

Normal levels: 0.5-2.0 ng/mL

S/sx of digoxin toxicity:
early - anorexia, N/V
late - arrhythmias and vision changes (HALOS w/ light and yellowing vision)

53
Q

What meds do you give for severe heart failure or decompensating HF?

A

IV inotropes (milrinone, dobutamine)

Vasodilators (nitroprusside, nesiritide, nitroglycerin)

54
Q

What wt gain would you report in a patient with heart failure?

A

2-3 pounds per day

55
Q

What is the most common complication post-op for a pacemaker implantation?

A

electrode displacement

we immobilize arm post op to try and prevent this; don’t life arm above shoulder when doing passive ROM

56
Q

loss of capture

A

when no contraction follows the stimulus

57
Q

failure to sense

A

when pacemaker fires at inappropriate times

58
Q

What causes lose of capture, failure to sense, or other malfunctions in pacemakers?

A

pacemaker programmed incorrectly

electrodes can dislodge

battery can die

59
Q

What is client teaching for pacemaker clients?

A

check pulse daily

ID card or bracelet

avoid electromagnetic fields (cell phones use on other side, large motors)

avoid MRIs

ICD - implantable cardioverter defibrillator

care of ICD is same as pacemaker

60
Q

Who is at risk for PE?

A

any person receiving fluids quickly

very young / very old

person w hx of heart or kidney dz

61
Q

S/sx of PE

A

sudden onset

breathlessness

restless / anxious

severe hypoxia

productive cough (pink frothy sputum)

62
Q

Treatment for PE

A

High flow oxygen (keep above 90%)

diuretics

nitroglycerin

morphine

nesiritide

positioning (upright, legs down) (improves cardiac output / promotes pooling in lower extremities)

63
Q

Furosemide and PE

A

diuresiss and vasodilation (traps more blood in arms and legs and reduces preload)

40 mg IV push slowly over 1-2 min to prevent hypotension and ototoxicity

64
Q

Bumetanide and PE

A

IV push or continuous IV infusion to provide rapid fluid removal

1-2 mg IV push given over 1-2 min

65
Q

Nitroglycerine and PE

A

vasodilation (reduce afterload) which increases CO

66
Q

Morphine and PE

A

2 mg IV push to vasodilate to decrease preload and afterload

67
Q

Nesiritide and PE

A

IV infusion (short term therapy / don’t give more than 48 hrs)

Vasodilates veins and arteries w diuretic effect

68
Q

Cardiac Tamponade

A

blood, fluid, or exudate leaking into pericardial sac resulting in compression of the heart

Causes: MVC, right ventricular biopsy, MI, pericarditis, hemorrhage post CABG

69
Q

Cardiac Tamponade S/sx

A

decreased CO (can lead to shock)

CVP will be increased

Hallmark signs for Cardiac Tamponade (increased CVP w decreased BP)

heart sounds muffled / distant

neck veins distened / CLEAR lungs

Pressure in all 4 chambers = same

narrowed pulse pressure (difference bw systolic and diastolic)

70
Q

narrowed pulse pressure =

A

cardiac tamponade

71
Q

widened pulse pressure =

A

increased intracranial pressure

72
Q

Treatment for cardiac tamponade

A

pericardiocentesis to remove fluid/ blood from around heart

surgery

73
Q

Arterial Insufficiency

A

medical emergency = acute arterial occlusion

numbness / pain / cold extremity / no pulse / atrophy / bruit / ulcerations

Pain at rest = SEVERE obstruction

Intermittent claudication

************
intermittent caludication pain  (pain at rest)
decreased / absent pulses
cool temp
absent or mild edema
thin, shiny, loss of hair over foot/toes, nail thickening
ulceration on toes or on feet
gangrene possible
do not use compression socks
74
Q

Arterial Insufficiency Treatment

A

don’t elevate / dangle

angioplasty or endarterectomy

75
Q

Venous Disorders

A

inflammation and chronic ulcers

DVT - wall lean if you suspect so you don’t risk a PE

ELEVATE!!

*************
no or achy pain
normal pulses (edema possible)
petechia or brown coloration possible
normal temp
edema
brown pigmentation possible around ankles / thickening of skin
ulceration possible on sides of ankles
Use compression socks

HURST (15 decks)

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