Cardiac

Question 1

Angina that is predictable and consistent. Occurs on exertion and relieved by rest or nitroglycerin

Answer 1

Stable Angina

Question 2

Angina that increases in frequency and severity, not relieved by rest or nitroglycerin

Answer 2

Unstable Angina

Question 3

Severe incapacitatin angina

Answer 3

Intractable or refractory Angina

Question 4

This angina is painful at rest. Reversible ST segment elevation. Caused by vasospasm.

Answer 4

Prinzmetals (aka Variant) angina

Question 5

Nitroglycerin vaso_____s. It _____ blood pressure.

Answer 5

vasodilates; decreases

Question 6

Acceptable SPO2 percentage?

Answer 6

> 90%

Question 7

STEMI is ___mm above the isoelectric line

Answer 7

1 mm (one big box)

Question 8

PR segments are usually __ to ___ small boxes

Answer 8

3 to 5

Question 9

QRS segments are usually ___ to ___ small boxes

Answer 9

1 to 3

Question 10

1500 divided by the number of boxes in the RR interval gives us what?

Answer 10

Heart Rate.

Question 11

What is the difference between STEMI and NSTEMI?

Answer 11

STEMI shows ST elevations

NSTEMI means that an MI has occured without changes on the ECG and is discovered through biomarkers (such as Troponin)

Question 12

WHich biomarker is the most reliable for MI diagnoses?

Answer 12

Troponin

Specific to cardiac muscle, released within a few hours of acute MI, and remain elevated for 3 weeks.

CK-MB is also specific to hear muscle. (NOT THE OTHER CK’s). Shows up within a few hours and peaks at 24 hours.

Question 13

HOw can myoglobin be used in diagnosing MI?

Answer 13

It is not specific to heart, but it is located in the heart. Therefore, if we DO NOT see it then it helps rule out MI. It should be present if MI.

Question 14

WHat is PCI?

Answer 14

percutaneous coronary intervention formerlay known as angioplasty with stent.

Question 15

How does morphine function during MI?

Answer 15

Vasodilates, reduces preload/afterload, reduces anxiety and pain.

Question 16

PCI should take place within ___ minutes of arrival to the ED

Answer 16

60

Question 17

Thrombolytics are used when PCI is not an immediate option. THey should be administered within ___ minutes of ED arrival

Answer 17

30.

After thrombolytics, should be referred for PCI because clot busted but the atheroscerosing has not been solved. PCI inserts stent

Question 18

Preffered vessel used for CABG?

Answer 18

Mammary artery because it does not develop atherosclerotic changes as quickly and remain patent longer.

NExt choice is saphenous vein or radial artery

Question 19

1 pound = ___ kilograms? Pounds?

Answer 19

1 kg, 2.2 lbs

Question 20

With what wave do we synch cardoversion with?

Answer 20

QRS. THe sync button should flash with each QRS complex (should see a bright green flag flash on the monitor).

Question 21

After valve replacement, a person may be put on warfarin aka coumadin. What it the target PT/INR for mitral valve replacement? Aortic valve replacement?

Answer 21

2-3.5 for mitral

1.8-2.2 for aortic

Question 22

What are overall consideration after valve replacement or repair?

Answer 22

Anticoagulants

Protecting against infective endocarditis (including prophylacctic antibiotics)

wound care

patient education

Question 23

What is the difference between primary and secondary cardiomyopathy?

Answer 23

Secondary is related to the influence of another disease. Primary is genetic, non genetic and acquired.

Question 24

Dilated Cardiomyopathy (DCM) has ventricles with overstretched muscle fibers that have lost contractility. This loosey tissue allows a big lazy ventricle to form. The muscle becomes weak. Imagine it like a post partum pregnancy belly…. So does this cause systolic or diastolic issues?

Answer 24

It causes both. BEcause it is too stretched and not contracting enough it cannot pump all the blood out (systolic issue). Blood left reduces the amount that can fill the space from the pulmonary system duing diastole. If the pulmonary system gets backed up, it also is effected and pressure rises. If the pressure builds and builds eventually you might get regurgitation.

Question 25

Is restrictive cardiomyopathy systolic or diastolic issue? Why?

Answer 25

Restrictive is a diastolic issue. The size that can fill is restricted. Systolic remains untouched because the muscle has grown so much it still pumps out pretty hard.

Question 26

What is the difference between the hypertrophy seen in restrictive cardiomyopathy versus actual hypertrophic cardiomyopathy?

Answer 26

In hypertrophic cardiomyopathy, mainly the left ventricle and asymetrical septal regions are affected. Hypertrophic is genetic and is the one that young athletes suddenly die from (not properly dx perhaps?) In both, the hypertrophic ventricles of HC and RC, diastolic filling is an issue. The giant muscles take up space.

Question 27

In _______ cardiomyopathy, arterioles decrease in diameter, restricting blood supply causing ischemia leading to necrosis

Answer 27

Hypertrophic

Question 28

In ______ cardiomyopathy, the right ventricle is infiltrated by scar and adipose tissue.

Answer 28

Arrhythmogenic Right Ventricular Cardiomyopathy ARVC

Question 29

Why is cyclosporine and tacrolimus important in cardiac?

Answer 29

these are the immunosuppressants that decrease rejection after heart transplant.

Question 30

When a person with cardiomyopathy is having an episode, rest is indicated. What is the best position for them to rest in?

Answer 30

In a seated position (NOT lying down). This pools venous blood to the periphery which reduces preload. (less work for heart)

Question 31

Hypertrophic Cardiomyopathy , patients should avoid diuretics. WHy?

Answer 31

These people should stay hydrated. Cardiac output is an issue, therefore we need volume!

Question 32

What is a normal ejection fraction?

Answer 32

55-65%

Question 33

What is pulsus paradoxus?

Answer 33

systolic BP is markedly lower during inhalation

Question 34

Fahrenheit to Celsius conversion equation | JIC test has C and not F, better to know how to figure that shit out

Answer 34

F = (C X 1.8) + 32 Example: ``` F = (38 deg C X 1.8) + 32 F = (68.4) + 32 F= 100.4 ``` 100.4 = (C X 1.8) + 32 100.4-32=C x 1.8 68.4= C x 1.8 68.4/1.8=C C=38

Question 35

What is the minimum mean arterial pressure to ensure tissue perfusion?

Answer 35

65mmhg

Question 36

What is a good number for pulse pressure?

Answer 36

30 to 40 mHg (systolic number - diastolic number) 100S-80D=20.... 90S-80D=10 even worse It correlates with stroke volume. Narrowing pulse pressure is a better sign than a change in systolic BP p.288 We are more likely to see an increase in Diastolic BP before a decrease in Systolic BP

Question 37

What does cHRonotropic mean?

Answer 37

Controls the HR ``` positive = increase negative= decrease ``` CHRonotropic -->CHR -->controls heart rate

Question 38

What does inotropic mean?

Answer 38

controls contraction contractION (pronounce shin..in) -->inotropic opposite of chronotropic positve -->increase negative -->decrease

Question 39

This med is vasopressor and inotropic (works on contraction). It is used in cardiac emergencies to increase BP and CO. Once vital signs are stable, we taper this medication to avoid sudden changes from sudden discontinuation of it. Gradual adjustments give us more control!

Answer 39

Dopamine 2 to 10 mcg/kg/min

Question 40

This medication is used for MI. It relieves pain and anxiety as well as vasodilates.

Answer 40

Morphine

Question 41

What is the key difference in neurogenic shock?

Answer 41

parasympathetic response. Sympathetic cannot respond. THe person will be warm and seem sort of normal on the exterior because fight or flight was unable to activate.

Question 42

This syndrome may happen when we rapidly infuse a large amount of fluids. It puts pressure on the abdomen and interferes with other organs due to the fluid pressure against them. 12mmHg is diagnostic pressure reading

Answer 42

ACS abdominal compartment syndrome