Flashcards in Cardiac Deck (68):
the amount of blood returning to the right side of the heart and the muscle stretch that the volume causes. ANP is released when we have this stretch.
the pressure in the aorta and peripheral arteries that the left ventricle has to pump against to get the blood out
with HTN there's even more ____ for the left ventricle to pump against. that's why ____ can eventually lead to HF and pulmonary edema, because high afterload ____ CO and ____ forward flow. plus, it wears your heart out
the amount of blood pumped out of the ventricles with each beat
HR times SV
less pressure = ___ CO
more pressure = ___ CO
If you CO is decreased,
will you perfuse properly?
brain: LOC will go ___
heart: client reports of ___
Lungs: SOB? Lung sounds?
Kidneys: UO ___
yes and lungs sound wet
cool and clammy
weak and thready
what are 3 arrhythmias that are a big deal?!
1. pulseless vtach
chronic stable angina
decreased blood flow to the myocardium---ischemia--temp. pain/pressure in the chest
pain comes on by low o2 usually due to excretion
rest relieves pain or nitro
____ preload and afterload.
take 1 every ___ , __ doses
okay to swallow?
renew how often?
5 mins, 3 doses
3-5months, spray 2 yrs
what should you do before giving beta blocker?
check HR and BP!!!
what is beta blocker?
for prevention of angina
-decrease BP,HR, myocardial contractility
-decreases the workload of the heart
calcium channel blockers?
prevention of angina
-decrease afterload and increase o2 to the heart muscle
use to keep platelets from sticking together
-dose it determined by the physician (81-225mg)
treatment for chronic stable angina
the 5 p's
preprocedure for cardiac cath:
ask if they are allergic to shellfish or iodine
also check kidney function (because you excrete dye through the kidney)
post procedure for cardiac cath:
bed rest, leg straight for ___ hours
watch for bleeding
5 p's extremity distal to puncture site
if the client is on metformin, you should?
4 to 6 hours
hold the medicine for 48 hours post procedure. we are worried about the kidneys
what is the women triad of symptoms for acute MI?
pain between the shoulders
when a patient is having an STEMI, this indicates that the client is having a heart attack and the goal is ___
is to get them to the cath lab for PCI in less than 90 mins
what increases with damage to the cardiac cells?
when does it elevate?
(cardiac specific iso-enzyme)
3-12 hours and peaks in 24 hours
troponin elevates within ____ and remains elevated for ___.
cardiac biomaker with high specificity to myocardial damage.
myoglobin increases within ____ hours and peaks in __ hours.
(negative results are a good thing)
which cardiac biomarker is the most sensitive indicator for an MI?
which enzymes or markers are most helpful when the client delays seeking care for an MI?
what untreated arrhythmias will put the client at risk for sudden death?
vfib (dfib the vfib!)
if the first shock doesn't work and the client remain in vfib, what is the first vasopressor we give?
lab value for troponin
T less than 0.10. I less than 0.03
____ is an anti-arrthythmic and is used when v-fib and pulseless VT are resistant to treatment, also for fast arrhythmias
amiodarone (drug of choice)
what anti-arrhythmic drugs are commonly given to prevent a second episode of v-fib?
amirodarone and lidocaine
lidocaine toxicity: _____
any neuro changes
amiodorone is _____.
important side effect is ____.
the first anti-arrhythmic of choice
what drugs are used for chest pain when they get to theED?
ASA (chewable, absorbs faster)
morphine (if pain isnt relieved)
head up position.. because decreases workload on the heart and increases CO
what are the fibrinolytics drugs?
how soon after the onset of myocardial pain should these drugs be administered?
-dissolves the clot that is blocking the blood flow to the heart muscle----decreased the size of the infarction
(exception to this is CVA, time loss is brain loss! 3hr with CVA)
what is the widow maker (sudden death)?
left main coronary artery occulsion
left side heart failure
the blood is not moving forward into the aorta and out to the body.... IF it does not move forward, then it will go backwards into the LUNGS!
s/s of left side heart failure
blood tinged frothy sputum
right side heart failure
the blood is not moving forward into the lungs...IF it does not move forward then it goes backwards into the VENOUS system
s/s of right side heart failure
distended neck veins
systolic heart failure
heart cant contract and eject
diastolic heart failure
ventricles cant relax and fill
BNP (b-type natriuretic peptide):
-secreted by the ventricular tissue in the heart when the ventricular volumes and pressure in the heart increased
-can be positive for HF when the CXR does not indicate the problem
-if the pt is on nesiritide, turn it off 2 hr prior to drawing BNP
how do you diagnose heart failure?
what is the standard medication for HF?
ACE inhibitors and ARBs
drug of choice for HF
suppress the renin angiotensin system
prevent conversion of angiotensin 1 to angiotensin 2
results in the arterial dilation and increased SV
-block angiotenin 2 receptors, and cause a decrease in arterial resistance and decreased BP
ace inhibitors and ARBS block ____.
aldosterone. when we block aldosterone, we lose sodium and water and retain potassium.
digoxin is used with ....
sinus rhythm or afib and accompanying chronic HF.
makes contractions stronger
slows HR down
kidney perfusion UP
normal digoxin level
s/s of digoxin toxicity
early: anorexia, N/V
late: arrhythmias and visual changes (halos around the lights)
_____ + digoxin= toxcity
diuretic decrease ___.
when should you give diuretic?
in the morning
loss of capture with pacemaker
no contraction will follow the stimulus
who is at risk for pulmonary edema?
any person :
receiving IV fluid really fast
very young and very old
any person with history of heart or kidney disease
what is pulmonary edema?
fluid is backing up into the LUNGD. the heart is unable to move the volume forward.
pulmonary edema usually occurs at night, when the client goes to lie down.
s/s of pulmonary edema?
productive cough (pink frothy sputum)
tx for pulmonary edema?
furosemide, you should give _____ to prevent hypotension and ototoxicity
40 mg IV push slowly over 1-2 mins
bumetanide can be given _____ to provide rapid fluid removal.
should be given ___ over 1-2 mins
IV push or as a continuous iv infusion
1-2 mg IV push
remember to turn the nesiritide infusion OFF ..... when?
2 hrs before drawing a BNP level
-blood ,fluid, or exudate have leaked into the pericardial sac resulting in compression of the heart
-this can happen if the client has had a motor vehicle collision, right ventricular biopsy, and MI, pericarditis, or hemorrhage post CABG/s of c
s/s of cardiac tamponade
cvp will go UP
BP will drop
(hallmark is increase cvp, decrease bp)
heart sounds will be muffled or distant
neck veins distended
pressure in all 4 chambers are the same
narrowed pulse pressure (bp 120/80...pule pressure is 40)
narrowed pulse pressure think:
widened pulse pressure think:
increased intracanial pressure
tx for cardiac tamponade
pericardiocentesis to remove blood from around the heart
intermittent claudication is hallmark sign for __.
we ELEVATE ___
we DANGLE ___
s/s of dissecting aorta
severe burning back pain, unlike anything
may feel pulsation