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Flashcards in cardiac Deck (94):
1

preload

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

- ANP released upon stretch

2

afterload

pressure in the aorta and peripheral arteries that the left ventricle has to pump against to get blood out
- referred to as resistance

3

stroke volume

amount of blood pumped out of ventricles with each beat

4

factors that affect cardiac output x3

heart rate, certain arrhythmias
blood volume
contractility

5

decreased cardiac output: impact on brain

LOC down

6

decreased cardiac output: impact on heart

chest pain

7

decreased cardiac output: impact on lungs

short of breath, wet sounds

8

decreased cardiac output: impact on skin

cold and clammy

9

decreased cardiac output: impact on kidneys

uop down

10

decreased cardiac output: impact on peripheral pulses

weaker

LESS VOLUME LESS PRESSURE

11

arrhythmias are no big deal until

they impact your cardiac output

12

3 arrhythmias that are always a big deal

pulseless v tach
v fib
asystole

CPR ASAP

13

coronary artery disease includes x2

chronic stable angina
acute coronary syndrome

14

chronic stable angina

decreased blood flow to myocardium = ischemia = temporary pain/pressure in chest

15

what brings on pain of chronic stable angina?

low O2 usually due to exertion

16

what relieves pain of chronic stable angina?

rest and/or nitro

17

single largest killer of americans

coronary artery disease

18

chronic stable angina tx: meds

nitro
beta blockers
Ca channel blockers
aspirin

19

nitroglycerin (Nitrostat)

causes venous and arterial dilation resulting in decreased preload and afterload
- includes dilation of coronary arteries therefore increasing blood flow to myocardium

for chronic stable angina

20

beta blockers

block beta cells aka receptor sites for catecholamines = decrease BP, HR, contractility = decrease workload of the heart

for prevention of angina

21

Ca channel blockers

vasodilate arterial system (increase oxygen to heart) = decrease BP
- includes coronary arteries

decreased arterial resistance (afterload) = decreased workload of left ventricle

for prevention of angina

22

aspirin

for angina is for platelet aggregation, not pain

23

most common type of cardiovascular disease

cad

24

prior to cardiac catheterization

check for iodine, shellfish allergy
(iodine based dye used)

check kidney function
(renal excretion of dye)

25

normal responses to injection of cardiac cath dye

"hot shot"
palpitations

26

post heart cath, monitor

vitals, puncture site for bleeding or hematoma

27

post-heart cath assessment - where & what

assess extremity distal to puncture site
p ulse
p allor
p ain
p aresthesia
p aralysis

28

post-heart cath bed rest - how & how long

flat, leg straight
4-6 hours

29

major complication post heart cath

bleeding

30

hold what medication post-heart cath, how long, why?

glucophage (Metformin) - renal excretion and dye = eye on kidney function

47 hours post procedure

31

associate unstable chronic angina with

impending MI

32

acute coronary syndrome

disorder including unstable angina and acute myocardial infarction - results from obstruction of coronary artery by ruptured atherosclerotic plaque

- plaque = platelet aggregation, thrombus formation, vasoconstriction

33

acute coronary syndrome: ischemia or necrosis?

BOTH

34

acute coronary syndrome: pain!

described as crushing
pressure radiating to left arm and left jaw
n/v
pain between shoulder blades

35

acute coronary syndrome: pain version xx

typically present with
GI issues
epigastric complaints
pain between shoulders
aching jaw
choking sensation

36

what is the #1 sign of MI in the elderly?

SOB

37

acute coronary syndrome: s/s

pain
cold, clammy, BP drops
cardiac output going down
EKG changes (heart irritated - PVCs, v tach)
vomiting

38

STEMI

ST-Segment Elevation Myocardial Infarction: indicates the client is having a heart attack

goal: get to catch lab for PCI in under 90 minutes

39

NSTEMI

Non-Elevation ST Segment Myocardial Infarction: usually less worrisome

40

acute coronary syndrome: diagnostic lab work

CPK-MB
troponin
myoglobin

41

CPK-MB

cardiac specific isoenzyme that increases with damage to myocardium

elevates within 3-12 hours, peaks in 24 hours

diagnostic lab for acute coronary syndrome

42

troponin

cardiac biomarker with highest specificity to myocardial damage

elevates within 3-4 hours and remains elevated for up to 3 weeks

diagnostic lab for acute coronary syndrome

43

myoglobin

not very specific to myocardial damage: negative results are a good thing

increases within 1 hour and peaks in 12 hours

diagnostic lab for acute coronary syndrome

44

which cardiac biomarker is the most sensitive indicator for an MI?

tropnonin

45

which enzymes or markers are most helpful when the client delays seeking care?

troponin

46

what untreated arrhythmias will put the acute coronary syndrome client at risk for sudden death?

pulseless v tach
v fib
asystole
post-MI bradycardia

47

priority treatment for v fib?

defib the v fib!
no AED? CPR until one is available.

48

if first shock doesn't work and client remains in v fib, what is the first vasopressor given?

epi

49

v fib and pulseless v tach: treatment then back up if resistant to treatment

treatment: epi, defibrillation
back up: amiodarone (anti-arrhythmic)

50

amiodarone (Cordarone)

anti-arrhythmic
- given when v fib and pulseless v tach not responsive to treatment
- also given for fast arrhythmias

51

what anti-arrhythmic drugs are continuously given to prevent a second episode of v fib?

amiodarone (first choice)
lidocaine (not really used as much but still on ACLS protocol)

52

lidocaine toxicity looks like

any neuro changes

53

important side effect of amiodarone

hypotension - can lead to further arrhythmias

54

ED treatment for chest pain in order of least to most invasive

oxygen
aspirin (chewable)
nitro
morphine (IV)

55

after MONA, patient with chest pain in head up position - why?

decreases workload on heart and increases cardiac output

56

fibrinolytics

use for acute coronary syndrome: dissolve clot blocking blood flow to heart muscle; this decreases the size of the infarction

the sooner the better - door to drug ideally 30 minutes or less

57

acute coronary syndrome: treatment

ED drugs (MONA)
fibrinolytics (ASAP if cath unavailable)
percutaneous coronary intervention (PCI)
coronary artery bypass graft (CABG)
cardiac rehab

58

how soon after onset of myocardial pain should fibrinolytics be administered?

within 6 to 8 hours

59

major complication of fibrinolytics

bleeding

60

absolute contraindications for fibrinolytic use

intracranial neoplasm
intracranial bleed
suspected aortic dissection
internal bleeding

massive hemmorhage could result!

61

fibrinolytic follow up therapy: class and examples

anti-platelet meds
- acetylsalicylic acid (aspirin)
- clopidogrel (Plavix)
- abciximab (ReoPro IV - continuous infusion to inhibit platelet aggregation)

62

percutaneous coronary intervention (PCI)

treatment for acute coronary syndrome
includes all interventions such as angioplasty and stents

63

major complication of angioplasty is

MI

but also important: client may bleed from heart cath site or reocclude

any problems: go to OR ASAP

64

eptifibatide (Integrilin IV)
abciximab (ReoPro IV)

in context of PCI, given why?

for high risk clients who have been stented to keep artery open

also for clients waiting to go to cath lab

65

coronary artery bypass graft

occluded coronary arteries bypassed with client’s own venous or arterial blood vessels
- saphenous vein, internal mammary artery, others

performed when client does not respond to medical management of coronary artery disease or when vessels are severely occluded

66

the widowmaker and why

left main coronary artery occlusion

left main coronary artery supplies the entire left ventricle

67

why teach acute coronary syndrome client about s/s heart failure (and what are they)

post unstable angina or AMI, heart is in weakened state so heart failure is always a potential

s/s: weight gain, ankle edema, shortness of breath, confusion

68

heart failure

complication that can result from problems such as cardiomyopathy, valvular heart disease, endocarditis, acute MI, and hypertension (leading cause)

69

left sided heart failure

looks very pulmonary in nature

blood not moving forward into aorta and out into body - it goes backwards into lungs

systolic vs diastolic

70

left sided heart failure: s/s

pulmonary congestion
dyspnea, orthopnea, cough, blood tinged frothy sputum, nocturnal dyspnea
restlessness
tachycardia
S3

71

right sided heart failure

blood is not moving forward into lungs - it moves backwards into the venous system

PS. cor pulmonale

72

right sided heart failure: s/s

distended neck veins
edema
enlarged organs
weight gain
ascites

73

systolic heart failure

heart can't contract and eject

74

diastolic heart failure

ventricles can't relax and fill

75

SBP / DBP mnemonic for heart failure

SBP = contraction = ejection = depolarize
DBP = relaxation = filling = repolarize

76

cor pulmonale

abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels

77

heart failure: diagnostics

B-type natriuretic peptide
CXR (enlarged heart, pulm infiltrates)
Echocardiogram
New York Heart Association Functional Classification of Persons with HF

78

BNP

b-type natriuretic peptide; secreted by ventricles when ventricular volumes/pressures increased

79

pacemaker

increase heart rate with symptomatic bradycardia

depolarize myocardium = contraction

80

HR drops below 60, cardiac output...?

decreases

81

pacemakers: always worry if...?

HR drops below set rate

rate increase okay

82

most common post-op complication of pacemaker

electrode displacement

keep client from raising arm higher than shoulder height

83

before giving digoxin check

apical pulse

84

implantable cardiac device

can be used to pace

OR

defibrillate v-fib

85

pulmonary edema: at risk patients

- receiving IVF very fast
- very young, very old
- hx of kidney or heart disease

86

pulmonary edema

fluid backing up into lungs; usually occurs at night abruptly (bedtime)

87

pulmonary edema priority nursing intervention

administer high flow O2, titrate to keep above 90%

88

pulmonary edema tx

VASODILATION!!!
diuretics (furosemide, bumetanide)
nitro, morphine, nesiritide (Natrecore)

89

cardiac tamponade

blood, fluid, or exudates have leaked into pericardial sac resulting in compression of the heart (as little as 20-50mL!!)

causes: MVA, RV biopsy, MI, pericarditis, hemorrhage post CABG

90

cardiac tamponade: hallmark signs

increased CVP
decreased BP

91

an arterial problem is a ? problem

O2

92

if you have atherosclerosis in one place...

you have it EVERYWHERE

93

acute arterial occlusion

MEDICAL EMERGENCY!
numb, pain, cold, no pulse - intermittent claudication

pain at rest means SEVERE obstruction

94

intermittent claudication

hallmark sign of acute arterial occlusion - pain!!