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CEN > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Cardiac Output (shock) for Pediatrics

A

Initial: Tachycardia
Late: Hypotension
Threatening: Bradycardia

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2
Q

Stroke Volume is influenced by

A

Contractility
Preload
Afterload

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3
Q

What is preload?
How is it decreased & increased?

A

Volume! Measured by central venous pressure on right.

< decreases from hypovolemia and vasodilators ie Lasix

> increases with fluid, blood, vasoconstrictors

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4
Q

What is afterload?
How is it decreased and increased?

A

Ventricular emptying evaluated by systemic vascular resistance

<decreased> increased with HTN and vasopressin’s ie norepinephrine
</decreased>

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5
Q

What increases your heart rate in response to shock?

A

Sympathetic nervous system (SNS) cause the release of epi and norepi

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6
Q

What decreases heart rate in shock? (seen in neurogenic shock)

A

Parasympathetic nervous system

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7
Q

Mean Arterial Pressure (MAP)
Equation

A

DBP x 2 + SBP / 3

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8
Q

Narrow Pulse Pressure

A

Early Shock

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9
Q

Widened Pulse Pressure

A

Seen in ICP

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10
Q

Cushing Triad
An indication of >ICP

A

Widening pulse pressure
Bradycardia
Irregular breathing pattern

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11
Q

Chronotropes

A

Affect the heart rate at the SA node
ex: cardizem

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12
Q

Inotropes

A

Affect contractility by force of contraction
Ex: Dopamine

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13
Q

Dromotropes

A

Affect automaticity of electrical impulses at the AV node

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14
Q

ACE inhibitors
(angiotensin-converting enzyme)

A

Reduces BP by blocking conversion of angiotensin 1 to angiotensin 2

Ex: Lisnopril

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15
Q

beta-blockers
(olols)

A

*Mask signs of shock & hypoglycemia

Beta 1 meds affect the heart
Beta 2 meds affect the heart & lungs

Ex: Labetalol, metoprolol, propranolol

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16
Q

adverse effects of ACE Inhibitors

A

Dry nonproductive cough which leads to noncompliance

Angioedema

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17
Q

ARBS
(angiotensin receptor blockers)

A

*Reduces BP by inhibiting angiotensin 2 receptors

Ex: Avapro, Cozaar, Diovan

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18
Q

calcium channel blockers

A

Controls ventricular rate in Afib and HTN

Ex: Cardizem, Norvasc, Nifedipine

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19
Q

What does Nitroglycerin
do?

A

*Vasodilates
< preload & afterload
< BP
< O2 consumption
-contradicted with Cialis

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20
Q

What does Nitroprusside do?

A

*Vasodilates
<preload & afterload used in HTN crisis

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21
Q

What are examples of vasopressors?

A

Epi & Norepi

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22
Q

stable angina pectoris

A

-occurs with physical exertion
-short duration
-relieved by rest
- neg trop

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23
Q

unstable angina

A

-chest pain with little physical exertion,
-longer duration
-not relieved by rest
-neg trop

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24
Q

NSTEMI

A

*plaque rupture
*absent ST elevation
- pos trop

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25
Q

STEMI

A

*obstruction with thrombosis
*ST elevation
- pos trop

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26
Q

Prinzmetals
(variant angina)

A

-cyclical pain at rest
-ischemia d/t coronary vasospasm which is precipitated by stress or stimulants

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26
Q

Prinzmetals
(variant angina)

A

-cyclical pain at rest
-ischemia d/t coronary vasospasm which is precipitated by stress or stimulants

27
Q

limb lead placement

A

I, II, III, aVR, aVL, aVF

28
Q

chest lead placement

A

V1-V6

*V4R needs to be at the 5th intercostal space at the right midclavicular line

29
Q

inferior leads

A

II, III, aVF

30
Q

anterior leads

A

V1 - V4

31
Q

lateral leads

A

I, aVL, V5, V6

32
Q

posterior lead
(when ST depression occurs in V1 & V2)

A

V7 - V9

33
Q

inverted ST waves,
ST depression, &
Tall T waves are signs of

A

Ischemia

34
Q

ST elevation (STEMI)
and inverted T waves are signs of

A

Injury

35
Q

deep & wide Q waves are signs of

A

old infarction

36
Q

inferior STEMI’s presents in what leads

A

II, III, aVF

-right coronary artery which supplies SA an AV nodes

-presents with bradycardia, second degree heart block, epigastric pain, N/V

37
Q

anterior STEMI’s presents in what leads

A

V1 - V4

-*widowmaker

-presents with crushing pain, tachycardia, crackles, impending doom, cardiogenic shock, second degree mobitz 2

38
Q

right ventricle MI

A

*get right sided EKG

-JVD, hypotension, shock, ST elevation at V4R

-give IVF bolus, dobutamine, and sustain from morphine

39
Q

What leads are elevated in lateral MI?

A

I, aVL, V5, V6

40
Q

What are the signs of posterior MI?

A

ST evelvation in V7 & V9

or depression of V1 & V2

41
Q

STEMI Treatment

A
  • O2 4LNC
  • Nitro
  • ASA
  • percutaneous catheterization goal <90 mins
  • fibrinolytic therapy within 90-120 mins
  • beta blockers for HTN
  • ACE inhibitios for reduce infarct size
  • anticoags- heparin, lovenox, coumadin, elizuis, xarelto, pradaxa
42
Q

S/S Aortic Dissection

A
  • tearing/ripping chest, shoulders, flanks, and back pain not relieved by analgesis

-20 mm BP difference between arms

43
Q

ascending aortic dissection presents

A
  • stroke like symptoms
  • Horners Syndrome: ptosis (drooping of upper eyelid), anhidrosis (absence of sweating), & miosis (constricted pupils)
44
Q

descending aortic dissection presents

A
  • loss of distal pulses
    -lower extremity weakness
  • decreased urine output
45
Q

diagnosis tools of aortic dissection

A
  • TTE or TEE (transesophageal echocardiogram)
  • CTA
  • widened mediastinum and obscure aortic knob on films
46
Q

BLS CPR

A
  • 100-12O compressions per min
  • 30:2
  • do delay def for advance
    airway
    -switch compressors q 2mins
    *ETCO2 > 10mm HG
47
Q

shockable cardiac rythms

A
  • VF & pulseless VT
  • adult 120-200 joules
    monophasic 200-360 joules
  • pediatric 2-4 joules/kg
48
Q

medications for cardiac arrest

A
  • epi
  • amiodarone 300mg
  • Bicarb 1 mEq/kg
49
Q

ROSC

A
  • secure airway with ET CO2 35-45
  • targeted temperature management 32-36 C for *24hrs
50
Q

H’s & T’s FOR CARDIAC ARREST

A
  • hypovolemia
  • hypoxemia
  • hydrogen ion
  • hypo/hyperkalemia
  • hypothermia
  • toxins
  • trauma
  • tension pneumo
  • tamponade
  • thrombosis
51
Q

stable tachycardia

A
  • slam adenosine 6mg with rapid flus to slow SA & AV node
  • cardizem
  • labetalol
  • amiodarone
  • lidocaine
52
Q

unstable tachycardia
(consious, pulse, SVT or VT)

A

-synchronized cardioversion
- implantable cardioverter defib

53
Q

AFib

A
  • atria is quivering
  • rapid ventricular rate (RVR)
  • risk for stroke
    -saw tooth like waves
54
Q

Wolff-Parkinson White Syndrome (WPW)

A
  • extra conduction presenting as delta wave (short PR interval leading up to QRS)
55
Q

Torsades de pointes

A
  • polymorphic VT due to prolonged QT
  • cardioversion and slow IV Mag
56
Q

pericarditis

A
  • inflammation of the pericardial sac from infection, MI, or renal failure
  • retrosternal cp exacerbated by inspiration or supine
  • friction rub heard while leaning forward
  • relieved by leaning forward
57
Q

endocarditis

A
  • inflammation of endocardium from IV drug use, cardiac sx, body piercing
    -fever, cills, new onset murmur, conjunctival petechia
  • > WBC, +blood cxs, >ESR
58
Q

left sided heart failure

A

*think left lung
- SOB, dyspnea, crackles
-pulmonary edema
-nocturnal dyspnea
-s3 hear sound

59
Q

right sided hear failure

A

*rest of body
*JVD
-ascites
peripheral edema

60
Q

HTN crisis

A
  • > SBP 180
  • impending organ damage ex: aortic dissection, heart failure, pulmonary edema, encephalopathy
    -AMS, cp, dizziness, epistaxis, headache, seizures, visual disturbance
  • consider an art line
61
Q

cardiac tamponade

A
  • pericardial sac accumulates additional fluid from pericarditis, taumas, MI leading to obstructive shock

*Beck’s triad: JVD, hypotension, muffles heart sounds, kussmaul breaths

  • needle pericardicoentesis
62
Q

peripheral artery disease
(PAD)

A
  • shiny skin, lhair loss, constant burning pain, cold extremties, decreased pulses
    ankle brachial inde (ABI) 0.9-1.3
    -do not elevate extremity
63
Q

deep vein thrombosis
(DVT)

A
  • blood clot in peripheral vein
  • Virchow’s triad: venous stais (immobility, air travel), fractures, pregnancy
    -achy, throbbing pain with walking
    -    elevat, compression, anitcoags
64
Q

Raynaud’s disease

A

intense vasospasm of the digits, nose or ear in response to stress

65
Q

blunt cardiac injury

A

-blunt force to chest, especially right ventricle due to positioning of the heart
- sinus tach, PVS, ST elevaion

CEN (13 decks)

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