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Flashcards in Acute Cardiac (adults) Deck (65):
1

Coronary artery disease (CAD)

- chronic stable angina
- acute coronary syndromes
- affects arteries that provide blood, oxygen, nutrients to myocardium

2

Ischemia

Insufficient oxygen supplied to meet requirements of tissue

3

Infarction

- necrosis (cell death) occurring after prolonged ischemia.
- decreased perfusion causes irreversible damage.

4

Atherosclerosis

- narrowing of lumen
- decreased perfusion
-mtissue ischemia/infarction

5

angina pectoris is…

chest pain

6

angina pectoris cause

temporary imbalance between coronary arteries’ ability to supply oxygen and myocardium’s oxygen demand ischemia is limited, no permanent damage

7

classic angina characteristics

- predictable (stress or exertion)
- relieved by rest/ntg
- limited in frequency, duration, intensity
- fixed atherosclerotic plaque

8

acute coronary syndrome is…


- unstable angina
- acute myocardial infarction

9

acute coronary syndrome results in...

atherosclerotic plague in coronary artery ruptures
- platelet aggregation
- thrombus formation
- vasoconstriction

10

% plaque = blocked blood flow

40

11

unstable angina characteristics

- progressive severity
- unrelated to activity
- unpredictable (stress/exertions)
- prinzmetal’s angina

12

unstable angina is…

- chest pain/discomfort occurring at rest or with exertion
- causes severe activity limitation

13

Prinzmetal’s angina

"variant" angina
- caused by coronary vasospasm
- usually associated with ST segment elevation
- no troponin or creatine kinase?

14

SEVEN DIMENSIONS (symptom eval)

- timing/onset
- location
- quality
- quantity
- aggravating
- alleviating
- associated

15

management goals for angina

- decrease workload of heart
- increase supply
- decrease demand

16

acute myocardial infarction

- prolonged supply/demand imbalance
- not relieved by rest, ntg
- ruptured plaque (embolism)
- coronary spasm

17

nstemi characteristics

- myocardial infarction "light"
- subendocardial (doesn't go all the way through wall)

18

stemi characteristics

- transmural

19

cardiac biomarkers

- creatine kinase (ck)
- creatine kinase mb (ck-mb)
- troponin

20

increased CK but no MB =

not the heart, other catastrophic process

21

creatine kinase released by

brain
myocardium
skeletal muscles

22

creatine kinase-mb released by

myocardium band!
more specific to myocardium

23

troponin released by

myocardial specific

24

creatine kinase onset/peak/duration

2-6h/18h/72h

25

creatine kinase-mb onset/peak/duration

4-8h/24h/48-72h

26

troponin onset/peak/duration

3-12h/24-48h/5-14d

27

cardiac biomarker differentiating STEMI from NSTEMI

troponin!

28

acute MI assessment findings

- substernal chest pain
- crushing/squeezing/tightness/heaviness
- radiates (left arm most common)
- impending doom
- denial
- ashen pallor
- diaphoresis
- dyspnea
- pre-syncope

29

acute MI unaffected by (actions)

coughing
deep breaths
movement
swallowing

30

% experiencing "silent MI"

15

31

who experiences silent MI?

elderly
diabetic
women

32

heart disease symptoms for women often...

fatigue
insomnia
GI complaints
back cramps
unusual complaints

33

goal of acute MI management

re-establish oxygen supply to myocardium

34

MONA - what is it for?

management of acute MI!

35

MONA stands for

Morphine
Oxygen
Nitrates
Aspirin

goal: vasodilation!!

36

aspirin nota bene for MONA

- anti-platelet effects minimize clot
- chew, don't swallow

37

revascularization is...

restoration of perfusion to a body part or organ that has suffered ischemia

38

pharmacologic revascularization

- antiplatelets
- anticoagulants
- thrombolytics

39

mechanical revascularization

cardiovascular lab (CVL)
coronary artery bypass surgery (CAB)

40

antiplatelet meds

aspirin
plavix (clopidogrel)

41

anticoagulant meds

glycoprotein IIb/IIIa inhibitors
heparin/low molecular weight heparin (Lovenox)

42

thrombolytic meds

t-PA (tissue plasminogen activator)
retavase

43

percutaneous transluminal coronary angioplasty (PTCA)

THE BALLOON THING

access: femoral artery --> descending aorta --> aortic arch --> top of heart

balloon inserted into coronary artery to open vessel and improve blood flow

44

coronary artery bypass is...

"by-passing" occluded/diseased coronary arteries
typically saphennous veins, can also use arteries (radial, ulnar), mammary arteries can be used - arteries are not as plentiful as veins are for use. arterial graphs DO last longer.

45

on pump coronary artery bypass

hook up patient to heart/lung machine, stop heart, do bypass, shock heart and take off pump

(outdated/rare use now)

46

off pump coronary artery bypass

modern technique: do bypass on a beating heart. slow down heart from 80-100 bpm to 30ish bpm

body is cooled down so metabolic rate is lowered

47

PTCA stent placement

stent is in a second wire that goes after the balloon is inflated

permanent scaffolding

48

post-CVL priority and rationale

whatever artery used to acccess is #1 concern

problem in artery? watch the whole extremity related to that artery

49

post-CVL patient education

- patient must lie flat because artery was just accessed
- report slightest changes IMMEDIATELY; possible to bleed out into body without a single drop exiting body

50

post-CVL patient care: five P's

pulseless
pain
pallor
paresthesia
paralysis

51

sternotomy

?

52

thoracotomy

?

53

mechanical valve sound

click

54

prosthetic valve sound

murmur

55

post-CAB/valve replacement surgery patient care

- incision care
- neurologic assessment (heart starts to fail -> mental status first)
- dysrhythmias
- chest pain
- BOOM BOOM (4 hours after surgery)
- diet/meds compliance
- sternal wound infection = BAD!!!!

56

implanted cardiac devices

ICD or PPM (permanent pacemaker)

all ICDs are pacemakers but not all pacemakers contain ICDs

(ICDs are not covered by insurance!)

57

pacemaker indications

- symptomatic bradycardia
- heart blocks
- cardiac resynchronization (ventricles not pumping at same time)
- overdrive pacing for tachyarrhythmias

58

types of pacemakers (x3)

single-chamber (1 v)
dual-chamber (1 a 1 v)
biventricular (DELUXE) (1a 2v - coronary sinus to v)

59

ICD indications

- prevent sudden cardiac arrest (VT, VF)
- class I or II heart failure

60

post-pacemaker/ICD patient care

- incision care
- activity/position restriction
- pain
- pacemaker/ICD ID card
- electrical hazards/magnetic fields
- appliances (microwaves)
- notify provider

61

ICD components

additional programs
high gauge wire to conduct defibrillation
larger battery

62

defibrillation is..

nonsynchronized delivery of energy during any phase of cardiac cycle

63

cardioversion is...

delivery of energy that is synchronized to the R wave of the QRS complex

64

ablation therapy is...

- invasive
- destruction of faulty electrical pathway from sections of endocardium
- treatment of cardiac arrhythmias

hot or cold burn of heart tissue to kick back into normal rhythm

65

ablation therapy indications

- atrioventricular reentrant tachycardia (Wolff-Parkinson-White Syndrome WPW)
- atrial tachycardia
- idiopathic ventricular tachycardia
- atrial flutter/atrial fibrillation

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