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Cardiac Conditions Flashcards

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1
Q

Tx for clotting

- Drug classes + MOAs

A
  1. Antiplatelet: decreases platelet aggregation
  2. Anticoagulant: inhibit the coagulation cascade (blood thinners)
  3. Thrombolytics: post-clot lysis
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2
Q

What drug class does ASA belong to?

A
  1. Antiplatelet DRUG OF CHOICE
    - Blocks thromboxane A2 in degranulation
  2. NSAID
    - Blocks COX-1
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3
Q

Dipyridamole

A

Antiplatelet

- Blocks Thromboxane A2 in degranulation

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4
Q

Clopidogrel

What drug class? MOA? s/e?

A

Antiplatelet
- Blocks ADP in degranulation = decrease in platelet adhesion

s/e: easy bleeding, ulcerations

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5
Q

Heparin-induced thrombocytopenia (HIT)

A

An immune reaction to Heparin-Factor 4, resulting in disseminated coagulation.

Life-threatening:

  • 50% in patients
  • 30% in patients on Heparin X
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6
Q

Dabigatran (Pradaxa)

A

Anticoagulant (PRODRUG)

  • Blocks thrombin receptors + factors
  • *For stroke prevention
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7
Q

Warfarin (Coumadin)

A

Anticoagulant
- Inhibits hepatic formation of PF II, VII, IX, X (antagonizes Vit. K-dependent factors)

PK:
- Long t/12
- High PPB
- Narrow TI**

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8
Q

Alteplase, Reteplase

Describe PK.

A

Thrombolytics: clot lysis

  • Based on Plasmin
  • t1/2: 13-16 min (acute!)
  • IV
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9
Q

Plasmin

A

A protein that degrades fibrin.

  • Endogenously made
  • Part of Thrombolytics drug class
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10
Q

Clinical manifestations of atherosclerosis

A
  1. Narrowing of vessel
  2. Vessel obstruction d/t plaque
  3. Thrombosis
  4. Weakening of vessel wall
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11
Q

What drug class do these belong to?

  • Nitroglycerin (Nitro)
  • Isosorbide
A

Organic nitrates
1ST LINE OF ACUTE CAD/ANGINA

1 SL q5min x 3 doses => CALL EMS IF IT DOESN’T WORK

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12
Q

What is angioplasty (PTCA) used for?

A

Tx for obstruction by CAD

- Opens blocked coronary arteries + cerebral vessels (STENTING)

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13
Q

What is CABG used for?
(Coronary artery bypass graft)

- Describe meds used, candidates

A

Tx for obstruction = re-routes/bypasses myocardial BF around blocked coronary arteries

  • “Open heart surgery”
  • INDUCES CARDIAC ARREST or beating heart

Meds: high CCB, beta-blockers, K+
Candidates: No high atherosclerosis

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14
Q

Pulmonary embolism

- S/S, Dx, Tx

A

Thrombus that has travelled to the lungs. Most commonly from DVT.

S/S: sob, low O2sat, chest pain, compensatory mechanisms (increase HR)

Dx: CT scan

Tx: prevention is key!

  • Early mobilization
  • Compression stocking
  • Anticoagulation pre/during/post-Sx (Heparin, LMWH)
  • ER: thrombolytics
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15
Q

Thrombus vs Thromboembolism

- List RFs

A

Thrombus: clot
Thromboembolism: migrating clot (usually to deep veins)

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16
Q

Coronary Artery Disease (CAD)

A

the narrowing of coronary arteries d/t atherosclerosis
(50-77% occlusion = Sx)

> > Angina - Stable, Variant, Unstable

Tx: Nitroglycerin

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17
Q

Stable Angina

A

Fixed plaque in coronary arteries that causes intermittent pain, exacerbated with exertion, but relieved with rest

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18
Q

Variant Agina

A

Chronic angina characterized by persistent contractions/spasms of coronary arteries that often occur at rest/sleep.

  • Triggered by smoking
  • ECG shows STE (but NOT MI, only temporary occlusion)
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19
Q

Ischemia

- Describe s/s, effect on body

A

When there is not enough blood flow for adequate oxygenation.

S&S (fast)
- sob, pain, hypoxemia, no contractility

Effect:

  1. Anaerobic metabolism
  2. Injury of myocardial cells (leaks intrinsic enzymes: troponin, CK, myoglobin)
  3. Cellular necrosis onset 20-40 min
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20
Q

Ischemia vs Hypoxemia vs Hypoxia vs Angina

A

Ischemia: not enough blood flow for adequate oxygenation
Hypoxemia: lower than average O2 in blood
Hypoxia: inadequate O2 in tissues
Angina: chest pain/discomfort d/t hypoxic tissues

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21
Q

Myocardial Infarction (MI)

A

Ischemia of the heart
(d/t blockage of BF = rupture of plaque or anything constricting)

  • Duration of chest pain w/o precipitating event is >30 min
  • STEMI = thrombus fully occludes
  • NSTEMI (depresses) = partial occlusion

Prioritize RE-PERFUSION

Interventions
- Percutaneous Coronary Interventions (PCI) = to visualize artery
- CABG = to reroute BF

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22
Q

Unstable Angina

A

Acute rupture of plaque + blood clot in coronary arteries causing severe and prolonged pain at rest + exertion.

  • Increases risk of MI
  • Tx: Nitroglycerin q5min x3 max
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23
Q

Antioxidants

- Examples (2)

A

Neutralizes + eliminates ROS by giving up its electron.

  • Supports normal cellular enzyme fx
  • Proanthocyanidins (grape skin), Vit. C
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24
Q

Dyslipidemia

- Name drug classes + MOA

A

Elevated total or LDL cholesterol.

  1. Statins: lower LDL via HMG-CoA reductase inhibition + increasing hepatic metabolism
    * FIRST LINE TX: POST-MI
  2. Fibrates: lower vLDL via increasing lipolysis + metabolism
  3. Niacin: increases HDL via increasing clearance + lowering cholesterol synthesis (liver)
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25
Where is cholesterol endogenously made?
Liver
26
What drug class do these belong to? What do they treat? - Lovastatin (Mevacor) - Atorvastatin (Lipitor) - Simvastatin (Zocor) - What are the s/e? - Contraindications?
Statin - Lowers LDL via HMG-CoA reductase inhibition + increasing hepatic metabolism * *1st line of tx: POST-MI * *Pregnancy Cat. X - Liver fx dependent - s/e: MYOPATHY, drug interactions (CYP3A4, 2C9)
27
What are heart healthy fats?
Foods that decreases LDLs + increases HDLs Mono-saturated fats = Oils, nuts, avocados Poly-unsaturated fats = Corn, soybean, safflower/sunflower, cottonseed oil, fish
28
Saturated
Whole milk, butter, cheese, ice cream, red meat, chocolate, coconuts, egg yolks, chicken skin - Increases LDL + HDL
29
Trans fat
Margarines, shortening, deep fried ships, fast food, commercial baked goods - Increases LDL
30
LDL, vLDL, HDL are all ________
Lipoproteins (cholesterol transporters) produced by fat + apoproteins
31
Energy source of fat vs carbs/proteins
Fat: 9 cal/g | Proteins/carbs: 4 cal/g
32
Nitroglycerin/Isosorbide vs Nipride/Hydralazine
*SIMILAR MOA* Nitroglycerin/Isosorbide - 1st line of acute CAD - 1 SL tablet q5min x 3 > EMS Nipride/Hydralazine: HTN crisis; ER settings
33
What is this lab test: PT/INR? What is abnormal?
Prothrombin time (Warfarin)
34
What is this lab test: aPTT?
Activated partial thromboplastin time (Heparin)
35
What do these values hint - CBC, Hgb, Plt, Hct?
Bleeding risk
36
Abdominal Aortic Aneurysm
distended artery/bulge in the abdominal aorta - Monitor for "bruits" (turbulent flow) - If it ruptures = hypovolemic shock/systemic bleed
37
Cerebral Aneurysm
distended artery/bulge in the cerebral If ruptured = hemorrhagic CVA = increased ICP - Immediately give osmotic diuretics
38
Thoracic Aneurysm
distended artery/bulge in the chest If ruptured = systemic bleed
39
Aortic Dissection
Aorta is stretched and a tear develops within the "intima", creating a false lumen where blood pools into. - Can be caused by Marfan syndrome If ruptured = cardiac tamponade Type A = heart and above *most fatal* Type B = below heart Sx: significant difference in BP b/w arms
40
Cardiac Tamponade
Bleeding into the pericardium, compressing the heart and decreasing CO = Shock / HF PULSUS PARADOXUS = SBP decreases with inhalation - Narrow PP - Hypotension - Muffled heart sounds - JVP distention
41
Pericardiocentesis
Inserting a needle into pericardium to withdraw blood
42
Pericarditis How to relieve pain?
Inflammation of the pericardium Acute = pericardial effusion / cardiac tamponade Chronic = Pericardium hardens >> higher pressure on ventricles >> low CO Sx: 1. Pleuritic pain (sharp) on inhalation + coughing 2. Pleuritic friction rub (scratchy/squeaky sound) - Relieve by SITTING UP + LEANING FORWARD
43
Endocarditis
Inflammation inside the myocardium chambers d/t infectious organisms commonly from dirty needles + dental visits = heart valve dyfx >> low CO Sx: flu-like, emboli, heart murmur. arthritic pain
44
Peripheral Artery Disease
narrowing of arteries d/t atherosclerosis, impeding peripheral perfusion. - INTERMITTENT CLAUDIFICATION = ischemic pain in LE during exertion, but relieved with rest - Cool, dry, shiny skin - Abnormally high BP in arms > legs
45
Chronic Venous Insufficiency
Incompetent venous valves = retrograde BF = varicose veins (d/t venous HTN) = edema/ulceration - Edema - Reddish-brown discoloration - Leathery, thick skin - Ulcers *mostly in calves*
46
DVT
A thrombus that is lodged in deep veins that blocks BF. Virchow Triad (3 predispositions): - BF stasis - Endothelial damage - Hypercoaguable state Sxs are often unilateral. "d-dimer" (protein released on dislodgement of thrombus) Monitor for PE + ambulate asap
47
Considerations for Orthostatic Hypotension Abnormal parameters?
Positional BP = 2-5 min in between Notify HCP if difference in... - SBP >20 mmHg - DBP > 10 mmHg
48
Metabolic Syndrome
When 3 or more metabolic health factors are present that increases the risk for T2DM + CVD 1. Waist circumference 2. Triglyceride increase 3. BP increase 4. HDL decrease 5. Glucose increase (abdominal obesity = insulin resistance)
49
General presentation of shocks
- Poor BF/perfusion - Low O2 delivery - Cold, clammy skin
50
Left-sided Heart Failure
When the heart's CO is unable to meet metabolic demands LS = pulmonary congestion >> crackles, dyspnea, pink frothy sputum
51
Right-sided HF
When the heart's CO is unable to meet metabolic demands. RS = peripheral congestion >> ascites, peripheral edema, hepatomegaly
52
BNP
Hormone that is released during HF when the heart is stretched abnormally much
53
What does an echocardiogram do?
Measures EF (% of blood leaving the heart w/ each contraction)
54
Systolic HF
When the heart's CO is unable to meet metabolic demands. Systolic = thin myocardial wall causes increase in BV filling the chambers, but unable to pump it all out (HF w/ REDUCED EF)
55
Diastolic HF
When the heart's CO is unable to meet metabolic demands. Diastolic = R ventricle muscle thickens >> ineffective pumping (HF w/ PRESEVERED EF)
56
Hypovolemic shock
Large intravascular volume loss Body reacts with overall vasoconstriction. Tx: Give blood (hemorrhagic) or fluids (dehydration)
57
Cardiogenic shock
Inability for the heart muscle to contract. - Strength and frequency of contraction is insufficient
58
Septic Shock
Widespread infection from Gram -/+ bacteria that causes vasodilation >> increased cap permeability >> altered BF *Persistent hypotension despite fluid resuscitation
59
Transfusion-Associated Circulatory Overload (TACO)
Blood transfusion reaction d/t rapid rate + large volume. 1. Stop transfusion 2. High fowlers 3. Diuretics
60
Kawasaki Disease
*PEDS* Systemic inflammation/vasculitis of arterial walls (especially coronary) - Common in Asians - Immunocompromised Sx: Mucocutaneous lymph node syndrome - Strawberry tongue - Maculopapular rash - Redness in eyes + mouth - Swollen lymph nodes Tx: Baby aspirin + IVIG
61
Marfan Syndrome
*PEDS* Aortopathy or Autosomal dominant genetic disorder that causes general weakness to CT 1. Ocular = myopia, decreased visual acuity 2. Skeletal = **thin, long limbs and physique**/double jointed/scoliosis 3. CV - weak, dilated aorta and leaky valves
62
Tetraology of Fallot (TOF)
*PEDS* Cyanotic congenital heart defect categorized by 4 defects. 1. VSD 2. Pulmonary stenosis 3. Overriding aorta 4. Right ventricle hypertrophy - "TRouBLe" = blood shunts R >> L + cyanotic ("tet spells")
63
Murmur
Abnormal heart valves that causes aggressive shunting/turbulent BF through valves or heart
64
Femoral cardiac catherization precautions
- Remain supine w/ HOB at 30 - NO HIP FLEXION to avoid disrupting clot formation

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