Cardiac Exam 1 Flashcards
(143 cards)
1
Q
Acute Coronary Syndrome
A
- stable angina
- unstable angina
- non-ST elevation (NSTEMI)
- ST elevation (STEMI)
2
Q
ACS patho
A
begins with rupture / erosion of plaque
-thrombus progresses and occludes blood flow
3
Q
stable angina
A
chest pain that occurs with physical activity but is RELIEVED WITH REST / MEDS (nitroglycerin)
4
Q
unstable angina
A
chest pain that occurs at rest NOT RELIEVED WITH REST OR MEDS
-scary kind!! could mean MI
5
Q
prinzmetal’s angina
A
type of unstable angina , due to coronary artery spasm
-occurs at night
6
Q
ACS non-modifiable risk
A
male
postmenopausal female
family hx
7
Q
ACS modifiable risk
A
smoking
obesity
high fat diet
sedentary lifestyle
HTN
type II DM
8
Q
MI occurence
A
normally happen in the morning, BP is highest and blood most viscous
9
Q
ACS meds
A
- OXYGEN!!!
- nitro
- beta blockers
- CCB
- antiplatelets
- antithrombins
- morphine
- ACE inhibitors
10
Q
MI modifiable risk
A
smoking
high LDL
type II DM
obesity
HTN
11
Q
MI nonmodifiable risk
A
male
postmenopausal female
family hx
12
Q
MI s/s
A
ches pain
L shoulder / arm pain
tooth / jaw pain
n/v
sweating
fatigue
SOB
upper back pain
13
Q
MI female s/s
A
achiness in arms (elbows)
fatigue
SOB
indigestion
n/v
stress level
14
Q
MI questions
A
- how long have symptoms occurred
- chest pain , location , scale 1-10
- n/v
- surgical hx
- family hx
- smoking
- meds
15
Q
MI assessment
A
neuro assessment
skin assessment
respiratory assessment
vitals
pulses
heart sounds
16
Q
MI tests
A
- Oxygen !!
- 12 lead EKG
- CXR
- ABGs
- CBC
- CMP
- lipid panel
- cardiac enzymes
- coag studies
IV access
17
Q
cardiac enzymes
A
- myoglobin
- creatinine kinase
- troponin I and T
18
Q
coag studies
A
PT / PTT
international normalized ratio
19
Q
STEMI
A
ST elevation indicating one or more vessels are blocked
20
Q
NSTEMI
A
ST depression , only partial occlusion of vessel
21
Q
MI MONA
A
morphine
oxygen
nitroglycerin
aspirin
22
Q
MI meds
A
- O2
- MONA
- betal blockers
- heparin drip
23
Q
MI cardiac enzymes
A
will show elevation
24
Q
MI lipids
A
elevated , most MI are secondary to atherosclerosis
25
MI therapy
tPA (fibrinolytic therapy)
PCI
26
tPA
-symptoms must be present for < 12 hours
-not effective on NSTEMI
27
MI PCI
cardiac cath , uses balloon to open lumen of blocked artery
-radial artery preferred
-2-6 hours heal time
28
door to balloon time
90 MINUTES
29
MI coronary artery stent
wire mesh is placed to prevent blocked artery from renarrowing
30
MI home meds
aspirin
plavix
lisinopril
metoprolol
atorvastatin
nitroglygerin
stool softener
31
MI education
follow up w/ cardiologist
med education
cardiac rehab
MI s/s
low cholesterol diet
high fiber diet
healthy weight
32
CABG
alternative MI tx , major surgery
-bypass blockages of coronary arteries
-unsuccessful PCI or 3 vessel disease
33
CABG complication
bleeding
dysrhythmias
MI
stoke
nonunion of sternum
sternal infection
renal failure
HF
34
post CABG assessment
monitor HR and BP continuously
hemodynamic monitor
cardiac monitor
s/s of infection
assess heart tones
core temp hourly
intake / output
pulses, skin , cap refill
chest tube
H and H
electrolytes
BUN / creatinine
35
Valvular heart disease
1. stenosis
2. regurgitation
3. prolapse
36
valvular stenosis
stiffening / thickening of valve , caused by calcium deposits or scarring
37
valvular regurgitation
blood flows or leaks backwards because of incomplete closing of valves
38
valvular prolapse
valves bulge backwards and do not close
-normally not tx unless needed
39
valvular disease risk
1. infective endocarditis
2. STREP INFECTIONS
3. CAD
4. MI
5. HF
6. congenital defect
7. cardiomyopathy
8. older age
9. pregnancy
40
valvular disease s/s
1. MURMUR (systolic or diastolic )
2. dyspnea
3. SOB
4. orthopnea
5. dizziness
6. palpitations
7. weight gain
8. decrease physical activity ability
9. palpitations
10. crackles
11. angina
41
valvular disease questions
1. medical hx
2. smoke / drink / illicit drugs
3. meds
4. family hx
5. social hx
42
valvular disease drugs
most seen with COCAINE USE
43
valvular disease assessment
vitals
pain assessment
breath sounds
heart sounds
vascular assessment
activity tolerance
44
valvular disease test
EKG
CBC
CXR
CMP
cardiac enzymes
TEE
45
valvular disease meds
beta blockers
ACE inhibitors
ARBS
anticoagulants
nitroglycerin
46
valvular disease education
1. medication
2. low sodium / caffeine
3. s/s of HF
4. daily weights
5. bleeding precautions
6. follow up
-prophylactic ABX for dental procedures
47
daily weight education
use same scale and check at same time everyday
48
carotid artery disease
wall thickening , plaque formation , progressive narrowing of carotid artery
-no s/s until almost completely occluded
49
carotid artery disease modifiable risk
smoking
HTN
DM
dyslipidemia
sedentary lifestyle
obesity
ineffective stress management
50
carotid artery disease nonmodifiable risk
age
gender
ethnicity
family hx
51
coronary artery disease pts have high risk of developing ....
carotid artery disease
52
carotid artery disease s/s
symptoms resembling TIA
weakness
dizziness
loss of coordination
slurred speech
facial droop
vision problems
HA
53
carotid artery disease test
1. carotid duplex ultrasonography
2. computed tomography angiogram
3. CTA / MRI / MRA
4. carotid angiography
5. cardiac echo
6. heart cath
7. EKG
8. CBC
9. lipid profile
10. CMP
54
carotid artery disease med
1. antiplatelets
2. antihypertensive
3. satins
55
carotid artery disease BP
needs to be below 140 / 90
56
carotid artery disease major sign
BRUIT when listening over side of neck
57
carotid artery disease education
s/s of stroke
medication
lifestyle change
limit alcohol
DASH diet
58
heart failure
inadequate pumping / filling of heart and cannot meet oxygenation needs of tissues
59
HF classifications
based off of ejection fraction
60
left sided HF
weakened contraction --> poor peripheral perfusion
-backflow of blood accumulating fluid in lungs
61
left sided HF s/s
SOB
orthopnea
fatigue
weight gain
poor color
tachypnea
blood tinged sputum
CRACKLES
S3 , S4 GALLOP
62
right sided HF
inability of R side of heart to pump blood to pulmonary vasculature
63
right sided HF s/s
JVD
generalized edema
hepatomegaly
ascites
loss of appetite
n/v
increased abdominal girth
64
HF primary test
1. CXR!!!
2. EKG
3. CMP
4. CBC
5. cardiac enzymes
6. ABGs
7. BNP and NT-pro BNP
65
BNP
biomarkers elevated due to overstretching of ventricles
66
lactic acidosis
reduction of blood flow throughout the body
-formed as by-product of ANAEROBIC METABOLISM
-lead to cell death and organ failure
67
dysrhythmias and HF
these are and adverse effect of HF , a-fib is the MOST COMMON
68
ischemic cardiomyopathy
secondary to MI
69
nonischemic cardiomyopathy
dilated cardiomyopathy
hypertrophic cardiomyopathy
restrictive
70
rapid intubation
1. induction agents
-ketamine
-fentanyl
-propofol
-etomidate
-midazolam
2. neuromuscular blockers
-vecuronium
-succinycholine
71
cardiomyopathy meds
beta blocker
diruetics
nitroglycerin
heparin drip
morphine
digoxin
72
digoxin consideration
DO NOT given when HR < 60
73
shocking joules
120 - 200
74
post shock meds
atropine
dopamine OR
norepinephrine OR
epinephrine
75
cardiogenic shock
happens from diminished CO , ventricular dysfunction initiates compensatory mechanisms
-initially stabilize pt but later cause deterioration as O2 demands increase
76
intra-aortic balloon pump
used to increase myocardial oxygen supply and demand
-used in major occlusion of coronary artery and low ejection fraction
77
AICD
recommended for pts with < 30% ejection fraction and high risk for lethal dysrhythmias
78
post cardiogenic shock meds
1. beta blockers
2. ACE inhibitors
3. nitroglycerin
4. digoxin
5. ARBS
6. ARNIs
7. inodilators
8. vasodilators
9. diuretics
79
cardiomyopathy / HF education
1. management
2. oxygen use
3. rest / pace activity
4. fall precaution
5. FACES
6. daily weight
7. no smoking
8. reduce sodium
9. cardiac rehab
10. potassium rich foods
80
potassium rich foods
banana
orange juice
81
weight concerns
> 2.5 lbs in a day
> 5lbs in a week
82
FACES for HF
fatigue
activity limitation
cough / congestion
edema
SOB
83
shock
life threatening syndrome occurs when circulatory system is unable to supply O2
84
aneurysm dissection s/s
chest , back , flank pain
tearing or ripping feeling
sweating
n/v
faintness
tachycardia
pain gets progressively worse
BP can vary from one limb to another
85
aneurysm questions
1. onset of pain
2. description of pain
3. severity of pain
4. pain radiation
5. medical hx
6. family hx
7. peripheral sensation
8. smoking
9. n/v
10. trauma
86
aneurysm risks
SMOKING
family hx
male
atherosclerosis
HTN
high cholesterol
CAD
genetic disorders : Marfan's syndrome
87
aortic dissection
sudden tear in aortic intima creating false lumen where blood can enter aortic wall
88
aneurysm labs
CBC
lipids
coagulation
cardiac enzymes
EKG
CT abd with contrast
abd US / TEE
89
aneurysm pre -surgery
blood type and crossmatch
two large IVs
O2
IV fluids
90
hypovolemic shock
rapid fluid loss resulting in poor circulation volume
-r/t ruptured AAA
91
hypovolemic shock intervention
prepare for ventilation
cardiac monitor
ABGs
rapid fluid / blood transfusion
hemodynamic monitor
foley
repeat CBC
lactate level
92
hypovolemic shock meds
dobutamine
dopamine
epinephrine / norepinephrine / phenylepinephrine
vasopressin
93
distributive shock
result of diseased state such as
-sepsis
-anaphylaxis
94
anaphylaxis
give EPINEPHRINE
then ANTIHISTAMINE
95
arterial line
transducer must be in line with midpoint of R atrium
-can give wrong reading if too high or low
96
obstructive shock
caused by mechanical barrier to ventricular filling / emptying
-tension pneumothorax
-cardiac tamponade
97
central venous catheter advantage
CVP and ScvO2 monitor
monitor preload
volume resuscitation
frequent blood draws
long term IV abx
parenteral nutrition
transvenous pacemaker insertion
98
what is done before an arterial line insertion
allen's test
99
CVP reading
can indicate low volume states or high volume
100
hypovolemic shock values
1. decreased CO
2. decreased CVP
3. decreased PCWP / PAOP
4. decreased central venous oxygenation
5. decreased mixed venous oxygenation
6. increased systemic vascular resistance
7. decrease MAP
8. hypotension and tachycardia
101
shock interventions
1. vitals
2. hemodynamic reading
3. neuro status
4. monitor UO
5. skin color and temp
6. ABGs
7. venous O2 sat
8. H and H
9. metabolic profile
10. lactic acid
11. IV fluids
102
anaerobic metabolism
cells use anaerobic (without O2) pathway to produce energy
-blood is more acidic
-leads to cell death
103
ARDS
leading cause of sepsis
104
sepsis
life-threatening organ dysfunction caused by a deregulated host response to infection
105
septic shock
occurs when circulatory and metabolic abnormalities are profound
106
sepsis and septic shock complications
MODS and DIC
107
DIC
widespread clotting
108
MODS
involves two or more organ systems not working
-initial organ is typically the lungs
-GI / hepatic / renal follow
109
sepsis tx
treat underlying cause ( IV abx)
maximize O2
IV fluids
blood products
110
DIC diagnosis
based off of clinical picture of cyanosis and ischemia plus labs
111
DIC tx
treat underlying cause
maximize O2
volume replacement
-NS
-blood
-plasma
-FFP
-replacement clotting factors
112
swan catheter
measures L heart preload or amount
-can also draw venous oxygen samples
113
CVP low
hypovolemia
peripheral vasodilation
114
CVP low tx
fluid bolus
vasopresser
115
CVP high
R heart failure
tension pneumothorax
HTN
pericardial tamponade
116
CVP high tx
inotropic or vasodilator therapy
117
PA high
pulmonary hypertension
R sided HF
118
PA high tx
inotropic and vasodilator
diuretics
119
Pulmonary capillary wedge pressure (PCWP)
high :
-HTN
-cardiogenic shock
-hypoxia
-ARDS
120
PCWP high tx
inotropic and vasodilator therapy
diuretics
121
low CO
MI , all shock forms
-except early septic shock
122
low CO tx
fluid bolus
inotropic therapy
treat MI cause
123
CO high
septic shock (early)
hypervolemia
hyperthermia
124
CO high tx
only if concerned
125
systemic vascular resistance (SVR) low
vasodilation
-distributive shock (anaphylaxis and sepsis)
126
SVR low tx
fluid bolus
vasopressors
tx underlying cause
127
SVR high
vasoconstriction
-hypovolemia
-hypotension
-cardiogenic shock
128
SVR high tx
vasodilators
129
pulmonary vascular resistance high
HTN
130
PVR high tx
vasodilators
131
mixed venous O2 low
increased oxygen needs of tissue
low CO
low hemoglobin
low O2
132
SvO2 low tx
increase CO
increase oxygenation
increase hemoglobin
133
lactate level
increased lactate and negative base are evidence of poor perfusion and cellular level
134
sepsis bundle of care
1. measure lactate
2. obtain blood culture
3. administer abx
4. administer NS
5. administer vasopressors if BP unresponsive after fluids
135
v-tach
pulseless = shock
pulse = cardioversion
136
v-fib
always shock , start CPR without pads
137
cannot feel pulse in carotid
feel for femoral pulse
138
R heart cath
go into vein , looking at R heart pressure
-valve disorders, ejection fraction
139
L heart cath
femoral or radial entrance
-MI or angioplasty
140
cardiogenic shock
forms from high wedge pressure
141
ARDS cannot happen without....
acute respiratory failure because it creates scar tissue
142
pts with this HF are at high risk for blood clots
R sided HF
143
R and L sided HF
both create extra strain can go into v-fib
-VERY COMMON
