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Critical Care week 1 > Cardiac Disease States > Flashcards

Cardiac Disease States Flashcards

(96 cards)

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1
Q

What is coronary artery disease?

A

Vessels become clogged with plaque reducing blood flow to heart

“Atherosclerosis”

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2
Q

What are nonmodifiable CAD risk factors?

A

Age
Gender
Race
Family hx

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3
Q

What are modifiable CAD risk factors?

A

Anything people did to themselves

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4
Q

Is plaque regression possible?

A

Yes, with change in modifiable risk factors

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5
Q

What are symptoms of acute coronary syndrome?

A

Angina!

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6
Q

What is angina caused by?

A

lack of oxygen causes myocardial ischemia which is felt as chest pain

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7
Q

What is stable angina?

A

predictable.

Fixed lesions

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8
Q

What is unstable angina?

A

Change in previously established pattern.

Indication of plaque instability

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9
Q

What patients don’t have traditional angina patterns?

A

Females
Elderly
Diabetics

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10
Q

What signs do females exhibit with angina?

A

nausea
fatigue
neck pain

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11
Q

What signs do elderly and diabetics exhibit with angina?

A

weakness and nausea

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12
Q

If there is ST elevation on the EKG, what does that mean?

A

infarction happening

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13
Q

If there is depression or t-wave inversion on EKG, what does that mean?

A

myocardial ischemia

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14
Q

What are nursing management of CAD and angina?

A

Recognize myocardial ischemia

Controlling chest pain

Maintain calm environment

Educate

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15
Q

How is chest pain assessed?

A 
Pain - intensity, location, duration
Quality
Radiation
Severity
Time
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16
Q

What leads are we looking at when evaluating 12 lead?

A

2, 3, AVF

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17
Q

If there is no ST elevation, how do we treat?

A

pharmacologically

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18
Q

How is chest pain treated?

A

MONA

Oxygen to get O2 sats in the 90s
Aspirin (anti platelet) Chew 325mg
Nitroglycerin (vasodilator)
Morphine (pain, relaxation,

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19
Q

When can nitro NOT be given?

A

Blood pressure <100 systolic
HR <60 or >100
Use of PDE5 (ed, revaito, pulm art HTN drugs)
R ventricle wall infarct (ST elevation on EKG)

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20
Q

What is myocardial infarction?

A

irreversible necrosis due to abrupt decrease or total cessation of coronary blood flow

plaque has ruptured
new coronary artery thrombosis
coronary artery spasm close to ruptured plaque

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21
Q

What measurements on EKG indicate infarction?

A

ST elevation >1 mm in 2+ continuous leads

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22
Q

If Q-waves are present, what does that indicate?

A

previously healed infarction.

electricity trying to go through damaged part of heart.

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23
Q

If nitro does not control pain, what is the next step?

A

Morphine 2-4mg q 20-30 min

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24
Q

Why do we use morphine with MI?

A

controls pain
vasodilation properties
anxiolitic

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25
What is a main side effect of nitro?
headache
26
What cardiac biomarkers are we looking for with labs?
CK/MB relative index | Troponin I
27
What does CKMB look for?
if elevated ratio of CKMB damage, that means portion of heart has died
28
If CK is elevated, but not CKMB, what does that mean?
Muscle has died, but not heart muscle
29
If Troponin I is elevated, it means....
heart muscle damaged
30
Why do we do 2 different cardiac enzyme tests?
CPKMB reaches peak in 12 hours Troponin reaches peak in 30 hours
31
What is the pharmacological treatment for AMI?
Fibrinolytics (clot buster.
32
What drugs are fibrinolytic?
Streptokinase | Alteplase
33
What do we watch for in patients on fibrinolytic?
bleeding LOC changes for head bleed
34
What contraindications to taking fibrinolytic?
Surgery or trauma in last 6 weeks Pregnancy or postpartum Therapeutic on blood thinner
35
What are required before fibrinolytics can be given?
adequately controlled blood pressure and blood sugar ST elevation or enzymes definitive of MI
36
When onset of symptoms of cardiac arrest are sudden, the most likely mechanism of death is
VTach which degenerates into VFib
37
What is therapeutic hypothermia?
Patient cooled off for 24-48 hours that will prevent a lot of brain damage
38
What is heart failure?
Heart cannot pump blood at a volume required to meet the body's needs
39
What can cause heart failure?
Any condition that impairs the ability of ventricles to fill or eject blood
40
What are the most frequent causes of heart failure?
Coronary heart disease and MI (myocardial infarction)
41
What is class 1 heart failure?
Clean house, take bath, all is fine. They mow lawn, they get symptoms
42
What is class 2 heart failure?
Normal ADL's cause symptoms, but subside with rest
43
What is class 3 heart failure?
Any activity causes symptoms, but if they are sitting, they're fine.
44
What is class 4 heart failure?
Any type of activity initiates symptoms, and symptoms are present at rest.
45
How is heart failure evaluated?
Asking how many pillows they sleep on (orthopnea).
46
If the LEFT side of the heart is not pumping forward, the blood is backing up into the ___
lungs
47
What are some signs/symptoms of LEFT sided heart failure?
``` Tachypnea Tachycardia Cough Crackles Gallop rhythms (S3 S4) Increases PAP Hemoptysis Cyanosis Pulmonary edema ``` ``` SYMPTOMS Fatigue Dyspnea Orthopnea Paroxysmal nocturnal dyspnea ``` ALL LUNG RELATED
48
If the RIGHT side of the heart is not pumping forward, the blood is backing up into ___
the body
49
What are signs/symptoms of RIGHT sided heart failure?
``` Peripheral edema Hepatomegaly Splenomegaly Hepatojugular reflux Ascites JVD Increased CVP Pulmonary hypertension ``` ``` SYMPTOMS Weak Anorexic Indigestion Weight gain Mental changes ``` PRETTY MUCH ALL RELATED TO SWELLING OF SOME SORT
50
What is systolic heart failure?
Decreased contractility of left ventricle systolic=problem with squeeze
51
What is diastolic heart failure?
Decreased relaxation, stretching, or filling of left ventricle during diastole diastolic= problem with relaxation
52
What is acute heart failure?
Sudden onset Body cannot compensate Occurs immediately after MI
53
What is chronic heart failure?
Ongoing syndrome. Body has had this for so long that it compensates Can deteriorate into acute heart failure
54
What is acute-on-chronic heart failure?
People not taking care of heart failure. People with chronic HF go and eat a ton of salt, that ends up causing acute heart failure.
55
What drug class is given to HF patients?
ACE inhibitors or ARBS helps circumvent the RAAS response
56
What is cardiomyopathy?
Disease/disorder of the heart muscle
57
What are the three kinds of cardiomyopathy?
Hypertrophic Restrictive Dilated
58
Why is the left ventricle of the heart more muscular than the right?
pumping harder and pumping more blood
59
What happens in dilated cardiomyopathy?
Gross dilation of both ventricles without hypertrophy Happens a few ways: Ischemic (chronic ACS, muscle thins out) Familial (genetic) Acquired (connective tissue disorders, lupus, scleroderma, infection or disease)
60
What is restrictive cardiomyopathy?
Ventricular wall rigidity d/t myocardial fibrosis. Muscle is bigger, but with disordered healing. Big and thick, but cannot expand/stretch/contract S4
61
What is hypertrophic cardiomyopathy?
Left ventricle becomes stiff, noncompliant and hypertrophied **genetic** Heart working so hard, muscle bulks up and blood cannot move.
62
What is ejection fraction?
percentage of blood in heart ejected with each contraction
63
What is normal ejection fraction?
60% - 65%
64
What is normal stroke volume
60-150ml per stroke
65
Anyone with an ejection fraction below ___ is considered to be in heart failure
50%
66
Anyone with an ejection fraction below ____ is eligible for a heart transplant
15%
67
What is the treatment for cardiomyopathy?
Positive inotropes Control blood pressure Heart transplant (when med mgmt fails)
68
What is valvular heart disease?
Structural and/or functional abnormalities of single or multiple cardiac valves. Results in blood flow alteration across valves.
69
What is stenotic heart disease?
Restricts flow through it
70
What is regurgitant heart disease?
Does not fully close so blood flows backwards during contraction
71
We see stenosis the most in the
aortic valve then mitral valve (both left side)
72
If there is aortic stenosis, what symptoms?
They cannot respond to increasing demand because blood has to go through smaller hole.
73
What is valve incompetency?
Valve does not close, regurgitation ensues. Seen most in mitral valve
74
What are causes for heart valve problems?
``` Rheumatic fever Degenerative valve changes (with age) Infective endocarditis Inborn congenital defects Dysfunctions/ruptures of papillary muscle (after MI) ```
75
Medical management of valvular disease?
Fluid restriction Positive inotrope surgery is last resort
76
What do we assess for when assessing a patient with valvular disease?
heart failure
77
What do we teach patient with valvular disease?
``` S/sx of heart failure. Watch for weight gain. Loss of energy Shortness of breath Fluid balance ```
78
If a patient has heart valve problem and need to go to dentist, what do we teach?
Make sure you see your doctor and get antibiotics before any treatment
79
What is endocarditis?
Infection transmitted to heart. Infection on inner lining of heart
80
What are signs/symptoms of endocarditis?
Osler nodes (painful sores on hands/feet) Fever/chills New heart murmur or current murmur will change/get worse Dyspnea, pallor, SOB Petechiae
81
Endocarditis is most common in people with ___ problems or ___
heart valve murmurs
82
What are common causes for endocarditis?
dental work/dental hygiene issues tooth/mouth infection tattoos/piercings
83
What are complications of endocarditis?
Bacteria and cell fragments form clumps in bloodstream that cause valvular insufficiency Heart tissue swells Valve insufficiency and swollen linings increase heart failure Clumps can block blood flow to organs
84
What is nursing intervention for endocarditis?
Monitor: S/s worsening infection Heart failure emboli Give pain meds/pain mgmt Teach: home abx therapy possible cardiac rehab
85
What is myocarditis?
Inflammation of middle wall of heart (myocardium)
86
What is myocarditis caused by?
usually a viral infection
87
What happens in myocarditis?
Pain | Reduced filling/pumping ability - can cause clot d/t pooling
88
What will you hear in myocarditis?
Friction rub
89
What are s/sx of myocarditis?
Chest pain fluid retention SOB fatigue
90
What are causes of myocarditis?
``` Viral infection Bacterial infection Parasite infection (foreign travel) Allergic drug rxn Cocaine Meth Connective tissue disorders (Lupus, scleroderma, etc...) ```
91
What are complications of myocarditis?
Heart failure Blood pooling (heart attack, stroke, blood clots) Arrhythmias Sudden cardiac death
92
Nursing intervention for myocarditis?
Monitor: worsening infection heart failure emboli Manage: pain Begin d/c planning home IV possible cardiac rehab
93
What is malignant HTN?
Dramatic increase in BP that it becomes life-threatening
94
What do calcium channel blockers do?
Relax smooth muscle and allow vasculature to provide less back pressure
95
What does beta blocker do?
reduces force of contraction in heart rate careful giving to people with reactive airway disease d/t beta 2 in lungs - cardioselective/non-selective. drugs
96
What are the two main classes of drugs they use for malignant HTN?
beta blocker | calcium channel blocker

Critical Care week 1 (6 decks)

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