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Flashcards in cardiac Deck (63)
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1

blood flow of heart

superior and inferior vena cava (deoxygenated)--R atrium--R ventricle--pulmonary artery--goes to lungs and becomes oxygenated--pulmonary veins (oxygenated now)-- L atrium--L ventricle--aorta-- body

2

preload

blood returning to the R side of the heart
muscle stretch (strength) that the volume causes
ANP released during stretch

increased preload = increased strength (workload)

3

afterload

pressure in aorta and PERIPHERAL arteries that the L ventricle has to pump against to get blood out

aka resistance

high afterload = low cardiac output and low forward flow

4

stroke volume

amount of blood pumped out of the ventricles with each beat

5

cardia output

HR x SV

tissue perfusion is dependent on adequate CO

CO changes according to body's needs

6

factors that affect CO

HR
arrhythmia (brady and tachy)
blood volume (less volume = less CO) (more volume = more CO)
decreased contractility

7

meds that affect preload

vasodilator/diurese to decrease preload

diuretics (furosemide)
nitrates (nitroglycerin)

8

meds that affect afterload

vasodilator to decrease afterload

ACE inhibitors (enalapril) "pril"
ARBS (losartan) "sartan"
hydralazine
nitrates (nitroglycerin)

9

meds that improve contractility

inotropes (dopamine) "amine"

10

meds that control rate

beta blockers (propranolol) "olol"
calcium channel blockers (diltiazem, verapamil, amlodipine)
digoxin

11

meds that control rhythm

antiarrhythmics (amiodarone)

12

patho of low CO

will not perfuse properly
LOC goes down
chest pain
crackles
SOB
cold and clammy
urine output goes down
weak peripheral pulses

13

arrhythmias that are always a big deal

pulseless vtach
vfib
asystole

14

coronary artery disease

broad term

chronic stable angina
acute coronary syndrome

15

chronic stable angina patho

intermittent decreased blood flow
ischemia so pain/pressure in chest
low O2 r/t exertion
rest or nitro to relieve pain/pressure

16

chronic stable angina treatment

nitroglycerin
beta blockers
calcium channel blockers
acetylsalicylic acid (aspirin)

17

nitroglycerin

causes venous and arterial dilation
decreased preload and afterload
dilation of coronary arteries which increases blood flow to the heart muscle (myocardium)

take 1 q 5min x 3doses

DONT SWALLOW
keep in dark, glass bottle, dry, cool
will get a headache
renew every 6 months
renew spray every 2 years

BP drops so make them sit when taking

18

beta blockers

prevention of angina

check BP and pulse before giving
"olol"

decrease BP, pulse, and myocardial contractility
decreases workload of heart
CO decreases

19

calcium channel blockers

prevention of angina

"pine"
nifedipine
verapamil
amlodipine
diltiazem

decrease BP
vasodilate arterial system
dilate coronary arteries
decrease afterload and increase O2 to the heart muscle

20

acetylsalicylic acid

aka aspirin
dose determined by provider

21

teaching for chronic stable angina

rest
avoid overeating
avoid excess caffeine
avoid drugs that increase HR
wait 2 hours after eating to exercise
dress warm in cold weather
nitro prophylactically
smoking cessation
weight loss
isometric exercise
reduce stress
*****do everything you can to decrease the workload of the heart

22

cardiac catheterization

ask if they are allergic to iodine or shellfish

check kidney function because dye is excreted through the kidneys

hot shot (warm, flush, sweaty)
palpitations are normal
get baseline VS and 5Ps

after:
monitor VS
watch puncture site ******for bleeding and hematoma formation
assess extremity distal to puncture site (5 Ps)
puleslessness
pallor
pain
paresthesia
paralysis
temp CRT
bedrest-- flat, extremity straight x4-6hours
*****major complication is bleeding/hemorrhage
report pain ASAP
hold metformin 48hours after

23

unstable chronic angina

impending MI

24

acute coronary syndrome patho

aka MI
aka unstable angina

decreased blood flow to myocardium-- ischemia and necrosis
can happen at any time
rest and nitro do NOT relieve pain

25

acute coronary syndrome symptoms

pain (crushing)
pressure radiating to the L arm and L jaw
N/V
pain between shoulder blades

women:
GI s/s
epigastric discomfort
pain between shoulders
aching jaw or choking sensation
unusual fatigue
inability to catch a breath

****SOB is the number one sign for elderly
cold, clammy
BP drops
CO down
ECG changes
vomiting

26

labs for troponin isomers

troponin T <0.10
troponin I <0.03

27

stemi vs nstemi

*****worry about stemi client

stemi:
ST segment elevation myocardial infarction
having a heart attack
get them to cath lab for PCI (percutaneous coronary intervention) in less than 90min

nstemi:
non-st segment elevation myocardial infarction
less worrisome

28

labs for acute coronary syndrome

CPK-MB
cardiac specific isoenzyme
high w/ damage to cardiac cells
elevates within 3-6hours and peaks in 12-24 hours

troponin:
cardiac biomarker w/ high specificity to myocardial damage
elevates within 3-4 hours and remains elevated for up to 3 weeks

myoglobin:
increases with 1 hour and peaks in 12 hours
negative results are a good thing

troponin is the most sensitive for an MI or delays seeking care

29

untreated arrhythmia that can kill

pulseless vtach
vfib
asystole

30

vfib

treatment:
defibrillate
epinephrine or vasopressor
amiodarone or lidocaine