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Critical Care > 🫀Cardiac > Flashcards

🫀Cardiac Flashcards

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1
Q

Acute Coronary Syndrome

A

results from damage/disease of coronary artery (CAD)
Cannot supply blood or o2 to heart :(

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2
Q

When do the coronary arteries fill?

A

During diastole

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3
Q

What is the main purpose of coronary artery?

A

supply blood and oxygen to heart

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4
Q

ECG shows:

A

damage to coronary arteries

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5
Q

Angina Pectoris

A

chest pain caused by decreased cardiac blood flow
(oxygen imbalance)

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6
Q

Stable Angina

A

pain with activity which improves with rest

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7
Q

Unstable Angina

A

pain that does not improve with rest
EMERGENT
risk AMI, dysrhythmia/SCD

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8
Q

Which patients might have atypical angina

A

women
>65
diabetic

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9
Q

Gold standard diagnostic for MI

A

ECG

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10
Q

ST elevation is indicative of:

A

STEMI

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11
Q

What finding could you see on an ECG of a patient with a previous history of MI

A

Q wave

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12
Q

Treatment goals for acute MI (4)

A

Maintenance of cardiac output
Minimize workload
Prevent complication (DYSRHYTHMIA)
Education

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13
Q

Immediate assessment Cardiac MI

A

ECG, pain, v/s, history, cardiac bios, cxray

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14
Q

Immediate treatment Cardiac MI

A

O2 therapy if under 90%
NITRO

DAPT
Morphine

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15
Q

Pain score for chest pain should be

A

ZERO

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16
Q

Three components of stroke volume

A

Preload
Afterload
Contractility

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17
Q

Pain assessment

A

Normal
Onset
Relieving factors
Quality
Region/radiation
Severity/other sx
Timing
Understanding/perception

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18
Q

Initial treatment cardiac

A

Bedrest
Semi/High fowlers
avoid valsalva maneuver

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19
Q

Nitroglycerin

A

Potent art vasodilator, decreases preload/afterload/o2 demand

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20
Q

What vital sign should you obtain before Nitro administration

A

Blood pressure
DO NOT ADMIN IF SYS <90

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21
Q

Nitro is fatal when combined with

A

Viagra, slidenifil 🍆🍆🍆🍆🍆
48hr+ d/c

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22
Q

Morphine

A

pain relief
preload/afterload reduction
decrease o2 demand

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23
Q

ACE-I

A

Vasodilation, afterload reduction
inhibits renin, aldosterone
limits sodium reabsorption

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24
Q

Selective Beta Blocker (Metoprolol)

A

Blocks Beta ONE
decreases dromo, chrono, inotropic action

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25
Calcium Channel Blockers (Diltiazem and Verapamil)
decrease o2 demand
26
Preload Reduction Meds (CVP/Wedge pressure)
NITRO Morphine
27
Afterload Reduction Meds (SVR)
ACE-I/ARBS Nitro, morph, ccb
28
Contractility Meds (HR)
Beta Blockers ccb
29
Anti-Thrombotic Therapy
prevention Antiplatelet/Anticoagulation
30
Fibrinolytic Therapy
STEMI ONLY Lyse/Destroy
31
Anti-Platelet
Aspirin P2y12 inhibitor (Clopidogrel, Ticagrelor) **risk for bleeding
32
Anti-Platelet GCP11 inhibitor
Post cath lab intervention Eptifibatide, Tirofiban
33
Anti-Coagulants
Heparin - alters clotting cascade Lovenox - low weight, more effective, less control, half life is longer
34
Labs for Heparin
PTT,APTT IV continuous monitoring
35
Desired effect of heparin PTT
increase! more time to clot
36
Reversal agent for heparin
Protamine sulfate
37
Drugs for thrombocytopenia
c/b heparin Bivalrudin, Argatroban
38
MONA BASH
Morphine Oxygen Nitrates Aspirin Beta Blocker ACE-I Statin Heparin
39
Reperfusion therapy Medical
Fibrinoloytic therapy (STEMI patients)
40
Reperfusion therapy Interventional
PCI CABG
41
Successful reperfusion findings
0/10 angina ST returned to baseline Reperfusion dysrhythmia --> still have to treat but reassuring Early and marked peaking of troponin
42
Fibrinolytic Therapy
Goal : Limit MI, clot bust, 30min of arrival reperfusion Criteria: STEMI, when cath lab not accessible t-PA
43
Nursing management: Fibrinolytic therapy (3)
IV access reperfusion (AxO) prevent/monitor for complications
44
Cardiac Cath
Coronary Angiography, Percutaneous Coronary Intervention, Stents
45
Complications post PCI
Coronary spasm, artery dissection, thrombosis bleeding, low perfusion to extremity abd/back pain contrast induced renal failure ventricular dysrhytmia vasovagal response --> brady, loc, hypotension
46
Nursing management: Post PCI
head-to-toe <30 degrees HOB prevent/minimize complications --> pain? site check? compression device? renal protection
47
Coronary Artery Bypass Graft (CABG)
reroute piping (radial or mammary) indicated when multiple arteries are occluded (multi vessel disease) seen with: NSTEMI, unstable angina diagnose via: cath
47
Patient Teaching: Post PCI
bedrest 4-6hr HOB under 30 degrees if femoral straight extremity report pain, numbness, angina education --> if bleeding provide pressure
48
Complications with AMI
Ventricular Dysrhythmia *** HF Pulmonary Edema Cariogenic Shock
49
Discharge meds MI
Beta Blocker Statin (decrease plaque) Aspirin ACE-I Nitro
50
Heart Failure
inability of ventricle to fill or eject blood effectively **pump issue
51
Ventricle Remodeling
heart stiffens and enlarges post MI
52
Left sided heart failure
Lungs SOB, crackles, S3. elevated PAWP, PAOP, PAP
53
Right sided heart failure
Body lower extremity edema JVD HJR Elevated CVP
54
B-Type Natriuretic Peptide (BNP)
Marker of cardiac dysfunction, LV preload compensatory mechanism responding to excessive cardiac stretch Increases GFR, decreases sodium, inhibits renin and aldosterone secretion
55
Heart Failure Med: Hydralazine
strict arterial vasodilator
56
Heart Failure Med: Diuretics
decrease preload
57
Heart Failure Med: Digoxin
decrease HR to increase contractility
58
Heart Failure Med: Statin
decrease plaque formation
59
Implantable cardioverter defibrillator
senses lethal rhythm and shocks cardiac tissue to reset
60
Heart Failure: Self management
Drug compliance Daily weights Low Na+ diet Exercise Smoking and alc cessation
61
Nursing Management Acute Heart Failure
NO BETA BLOCKER Preload/afterload reduction +Inotropic meds
62
Intraaortic Balloon Pump
decrease afterload, increase arterial blood flow
63
Left ventricular assistive devices (LVAD)
sits in aorta to help pump blood bridge to transplant
64
Preload Reduction Med therapy Acute Heart Failure
Diuretic Nitrates
65
Afterload reduction Med therapy Acute Heart Failure
Nitroprusside --> IV monitor BP ACE-I Hydralazine
66
Inotropic Support Med therapy Acute Heart Failure
Dobutamine (B1 agonist) Dopamine Milrinone (decrease afterload)
67
Goals for Heart Failure Therapy
Cardiac output will be maximized Patient's symptoms will be managed Euvolemia achieved Prevent rehospitalization
68
Abdominal Aortic Aneurysm (AAA)
localized dilation of aorta >1.5
69
AAA risks
smoking, age, HTN, lipid disorders, atherosclerosis, MARFAN SYNDROME
70
Staple AAA symptoms
palpable, pulsatile mass at umbilical ABD/lower back pain
71
Acute AAA rupture
SEVERE ABD PAIN Hypotensive with loss of consciousness
72
Surgical repair AAA
rapidly expanding, >4.5-5.5cm, symptomatic aneurysm Stent prefered
73
Aortic Dissection
weakened aortic medial layer causes tear creating false channel of blood
74
SX aortic dissection
SEVERE HTN Pain between shoulder blades, ripping and tearing sensation, unequal pulses
75
Management of aortic dissection
Reduce with IV beta blockers (Esmolol) or B+A combo labetalol IV Nitroprusside
76
Post op Aortic dissection repair
IV Nitroprusside to keep sys <120mmHg Strict monitoring (labs, v/s, i/o) Complication monitoring (Acute renal failure, ischemic colon, spinal cord ischemia)
77
Peripheral Artery Disease
Processes obstruct blood supply to lower/upper extremities
78
Risks for peripheral artery disease
atherosclerosis, smoking, diabetes, >70, male gender, hypertension, hyperlipidemia, family hx, history MI, heart failure, TIA/Stroke
79
Clinical manifestations of PAD
Pain *intermittent claudication* cramping , burning aching relieved with rest pulseless, pallor, paresthesia, paralysis
80
*intermittent claudication* PAD SX
Early Cramping, burning, aching pain in the legs, activity relieved with rest Late pain at rest is sign anoxic limb
81
Pulse strength
0-Absent 1-Palpable, thready, weak 2-normal 3- bounding NONPALP=DOPPLER
82
Pallor skin PAD
lower extremity cool, atrophic, alopecia, red (more when dependent), thick brittle nails, ulcers not healing delayed cap refill
83
Paralysis and paresthesia
limb threatening ischemia and mandate emergent evaluation consultation
84
PAD Bedside diagnostic evaluation
Ankle brachial index Apply blood pressure cuff to upper arm and above ankle systolic ankle pressure divided by systolic brachial pressure
85
Managing PAD
Antiplatelets -- pentoxifylline, cilostazol aspirin and clopidogrel --- statins PTCA and stenting Surgical vascular bypass for severe/diffuse arterial obstruction
86
Chronic Venous Insufficency
Pooling of blood to legs brown pigmentation, edema, thick flaky skin, ulcerations

Critical Care (9 decks)

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