Cardiac

Question 1

Heart chamber hemodynamic pressures:

Answer 1

CVP / RA: 0-5 (nickle)
RV: 25 (quarter)
PAWP: 5 - 12 
LA: 10 (dime)
LV: 120 (buck and change)

Question 2

PRELOAD is the amount of blood ___ to the ___ side of the heart and the muscle ___ that the volume causes.
___ is released when the RA is ___.
(Remember what ANP leads to?)

Answer 2

returning
right
stretch
ANP
overstretched
(ANP is opposite of aldosterone...it excretes Na and H20 to lower BP)

Question 3

Name 3 drugs that can decrease preload:

Answer 3

(Vasodilate or diurese)
Diuretics
Nitro
Morphine

Question 4

AFTERLOAD is the pressure in the ___ and ___ ___ that the ___ ___ has to pump against to get the blood out.

Answer 4

aorta
peripheral arteries
left ventricle

Question 5

Name 4 types of drugs that decrease afterload:

Answer 5

(Vasodilate)
ACE inhibitors
ARBs
Calcium channel blockers
Hydralazine (this is a nitrate...treats severe HTN)
Nitrates

Question 6

What is stroke volume?

Answer 6

Amt of blood pumped out of LV with EACH STROKE

Question 7

CO = HR x SV

What is average cardiac output?

Answer 7

5 L/ min

Question 8

3 types of drugs to DECREASE HR

Answer 8

calcium channel blockers (-dipine)
beta blockers
digoxin

Question 9

3 drugs to increase CONTRACTILITY

Answer 9

Inotropes

• dopamine
• dobutamine
• milrone

Question 10

3 types of drugs to control RHYTHM

Answer 10

Antiarrhythmics

• amiodarone
• sotalol

Question 11

With beta blockers, it decreases HR and thus contractility and CO…what should we watch for with pts on BB?

Answer 11

Heart failure

indicates, BB is suppressing the heart too much!

Question 12

Name some common calcium channel blockers:

Answer 12

(the -dipines) Also…
verapamil
diltiazem

Question 13

Verapamil is contraindicated in what population…why?

Answer 13

elderly b/c of significant constipation

Question 14

Calcium channel blockers do what 3 things

Answer 14

dilate coronary arteries
decrease afterload
increase O2 to heart muscle

Question 15

What are the 5 Ps

Answer 15

Pulselessness
Pallor
Pain
Paresthesia
Paralysis

Question 16

How long must a pt be on supine bedrest post cath?

Answer 16

4 - 6 hrs

Question 17

Unstable chronic angina = ____ ____

Answer 17

impending MI

Question 18

Acute Coronary Syndrome (ACS)

• ___ angina
• Relieved or not relieved by NTG?

Answer 18

unstable angina

NOT relieved by NTG

Question 19

Normal troponin T and I values

Answer 19

Troponin T < 0.10

Troponin I < 0.03

Question 20

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

Answer 20

SOB

also think about sudden confusion

Question 21

CPK-MB increases when:

Elevates within ___ - ___ hrs and peaks in ___-___ hrs

Answer 21

damage to cardiac cells
elevates within 3 - 6 hrs
peaks in 12 - 24 hrs

Question 22

Troponin is a cardiac biomarker with high specificity to ___ damage.
Elevates within ___-___ hrs and remains elevated for up to ___ ___.

Answer 22

myocardial
elevates within 3 - 4 hrs
remains elevated for up to 3 wks

Question 23

Myoglobin is not as a preferred lab b/c:

Increases within ___ hr and peaks in ___ hrs

Answer 23

not specific enough to diagnose MI
Increases within 1 hr
Peaks in 12 hrs

Question 24

How soon after the onset of myocardial pain should thrombolytics be administered?
(Also, how long for stroke…why?)

Answer 24

Heart 6-8 hrs

Brain 3 hrs…b/c “time is brain”

Question 25

If the thrombolytic steptokinase causes an allergic rxn, what should you do?

Answer 25

Still give, but treat rxn with benadryl

Question 26

What are the ABSOLUTE contraindications for thrombolytics?

Answer 26

- intracranial neoplasm - intracranial bleed (hemorrhagic stroke) - aortic dissection - internal bleeding

Question 27

What is the difference between systolic and diastolic HEART FAILURE?

Answer 27

Systolic HF --> heart can't contract and eject | Diastolic HF --> ventricles can't relax and fill

Question 28

Systolic is ___ (S___) Diastolic is ___ (S___) ___ is when the carotid artery pulses

Answer 28

systolic is EJECTION (S1) diastolic is REFILLING (S2) Systole

Question 29

3 Standard types of meds for heart failure are

Answer 29

``` ACE INHIBITOR (drug of choice for HF!) - arterial dilation and increased SV ARBs - decrease in arterial resistance DIGOXIN - decreases HR, increases contractility... + inotrope ```

Question 30

Most common complication after placement of permanent pacemaker

Answer 30

electrode displacement | keep pt from raising arm above shoulder

Question 31

Who is at risk for pulmonary edema?

Answer 31

- receive fluids too fast (like burn, DKA) - very young/very old - hx of heart or kidney disease

Question 32

What time of day/night does pulmonary edema usually occur?

Answer 32

Night (pt lays down)

Question 33

5 signs of pulmonary edema

Answer 33

1) sudden onset 2) breathless 3) restless/anxious 4) severe hypoxia 5) pink frothy sputum

Question 34

Priority action for treatment of pulmonary edema

Answer 34

High flow O2 | Titrate to keep SpO2 > 90%

Question 35

What meds given for pulmonary edema:

Answer 35

- diuretics (furosemide, bumetanide) - NTG - morphine - nesiritide (synthetic BNP)

Question 36

What to remember about nesiritide (synthetic BNP)

Answer 36

IV infusion...short term, not more than 48 hrs Vasodilates veins and arteries and has a diuretic effect Turn off 2 hrs before drawing a BNP level

Question 37

Positioning for pulmonary edema

Answer 37

Sit upright with legs down...moves fluid to lower extremities and away from lungs

Question 38

Hallmark signs for cardiac tamponade

Answer 38

CVP increased | BP decreased

Question 39

Other S/S of cardiac tamponade

Answer 39

- muffled / distant heart sounds - pressures in all 4 chambers are the same - shock - narrowed pulse pressure

Question 40

Narrowed pulse pressure...think ___ | Widened pulse pressure...think ___

Answer 40

narrowed --> cardiac tamponade | widened --> increased ICP

Question 41

Intermittent claudication is a hallmark sign of ___ ___; | Pain at rest means ___ ___

Answer 41

arterial disorders | severe obstruction