Cardiac - Unit 2 - Cardiac Assessment Flashcards
(106 cards)
1
Q
What happens during diastole?
A
Ventricles fill and they’re relaxed. pressure is low.
2
Q
What valves are open during diastole?
A
AV valves are open, aorta/pulmonary valve are closed.
3
Q
What makes the S1 sound?
A
Closure of AV (Mitral, Tricuspid) Valves
4
Q
What happens during systole?
A
L/R Ventricles contract - Blood goes to aorta/pulmonary artery to leave the heart. AV Valves close.
5
Q
Which valves are open during systole?
A
Aorta/Pulmonary Valve
6
Q
What makes the S2 sound?
A
Closing of the Semi-lunar (Pulmonary, Aorta) valves
7
Q
What is S3?
A
Ventricular gallop - “Kentucky” - Heard after S2 - Associated with heart failure.
8
Q
Is S3 normal or abnormal?
A
Can be normal in people up to age 30
9
Q
What is S4? Is it normal or abnormal?
A
Atrial gallop - heard priot to S1 - ALWAYS ABNORMAL.
10
Q
Gallops heard better with ___ of stethoscope.
A
Bell.
11
Q
What are murmurs?
A
Increased or turbulent blood flow through the heart. It’s a whooshy sound sound caused by incompetent or stenosed valves.
12
Q
A murmur is heard better with the ___ of a stethoscope.
A
Diaphragm.
13
Q
Murmur heard S1–>S2 =
Murmur heard S2–>S1 =
A
Murmur heard S1–>S2 = Systolic Murmur
Murmur heard S2–>S1 = Diastolic Murmur
14
Q
Cardiac Output =
A
The amount of blood pumped out of the heart each minute.
CO = SV X HR
15
Q
What’s the normal cardiac output?
A
4-8 liters/min.
16
Q
What is the cardiac index?
A
The cardiac output in relation to body size.
CI = CO / Body Surface Area (BSA)
17
Q
What is the normal Cardiac Index?
A
2.5-5.2 liters/min.
18
Q
What are some factors that increase or decrease cardiac output?
A
Tachycardia or Bradycardia (at first, tachy increases it but then it decreases it over time) Hypertension or Hypotension, Exercise (Increase) Stress (Increase) Calcium (Increase) Epinephrine (Increase) Ventricular Hypertrophy (Decrease)
19
Q
What is preload?
A
Degree of myocardial fiber stretch at the end of diastole (PRIOR to contraction).
20
Q
What does ventricular hypertrophy mean?
A
The ventricle is stretched out too much.
21
Q
What determines preload?
A
Left ventricular end-diastolic volume.
22
Q
What is starling’s law?
A
the more the heart is filled during diastole the more forcefully it contracts.
23
Q
Excessive filling = excessive LVED volume & pressure = Increased or decreased CO?
A
Decreased.
24
Q
What is the afterload?
A
The amount of pressure the heart has to pump against to eject blood into the peripheral blood vessels - like how much pressure to open the valves up!
25
Afterload - amount of resistance is directly related to arterial BP and the diameter of the blood vessels. T/F?
True!
26
Afterload - Impedence - def
the pressure the heart much overcome to open the aortic valve depends on aortic compliance and total systemic vascular resistance.
27
Which med is good for decreasing afterload?
Nitroglycerin
28
What are some of the effects on aging in the heart?
Increased sclerosis and calcium (stenosis, conduction delays), decreased pacemaker cells (slowed HR, increased ectopy), lost pacemaker pathway (blocks), heart muscle is slower (S4, poor compliance)
29
What is ectopy?
Abnormal beats/dysrhythmia's
30
What are some modifiable cardiac risk factors?
HTN, Lipids, Smoking, Exercise, Diabetes, Stress
31
What are some non-modifiable cardiac risk factors?
Race, Gender, Family history
32
What are some risk factors for CVD in women?
Waist and abdominal obesity, Postmenopausal, Diabetes
33
Do women have different symptoms for a heart attack?
Yes, sometimes! They might only have dyspnea on exertion, along with back pain, indigestion, N/V, anorexia, etc.
34
What are some medical history questions we should ask cardiac patients?
Childhood history (Strep? Rheumatic Fever?), medical disorders, cardiac studies, meds, allergies, family history, psycho-social, etc.
35
What should we ask about cardiac symptoms?
What are the precipitating factors? What relieves the symptoms? Pain rating scale
36
The absence of symptoms doesn't guarantee the absence of heart disease - T/F?
The magnitude of symptoms doesn't necessarily parallel the severity of heart disease. T/F?
TRUE TRUE!
37
What are some cardiac causes of chest pain? What are some non-cardiac causes?
Cardiac = angina, MI, pericarditis.
Non-cardiac = pulmonary embolism, pleurisy, dissection of the aorta, esophagitis, hiatal hernia, peptic ulcer, cholecyctitis, etc.
38
What questions should we ask someone who comes in with chest pain?
How long does it last for and how often does it happen?
Is the pain different from pain you have had before?
Where is the pain? What does it feel like?
Do you have any other signs and symptoms?
39
Palpitations - def
feeling your heart beat
40
DOE - what is it?
Dyspnea on exertion
41
What is othopnea?
Dyspnea when laying down.
42
What is PND - Paroxysmal Nocturnal Dyspnea?
Happens with heart failure patients - it occurs at night - they have fluid build up and it feels like they're drowing so it's harder to breathe.
43
What is the edema scale?
1+ - Slight 2mm indentation that rapidly disppears.
2+ - 4mm indentation - no marked leg changes.
3+ - 6mm indentation, legs look full and swollen.
4+ - 8mm indentation, slowly disappears and legs are very swollen.
44
Peripheral Edema occurs in the ___.
| Dependent edema occurs in the ___.
```
Peripheral = extremities.
Dependent = lower extremities.
```
45
1 liter of fluid = __ lb's = __ kg!
1 liter of fluid = 2.2 lb's = 1 kg!
46
Dizziness vs. syncope
Both have to do with a lack of cerebral blood flow, but with dizziness you feel like you're going to faint but with syncope you DO faint.
47
What is claudication?
Muscles not getting enough oxygen. The pt. will have cramping in legs/butt when walking - it's relieved by rest unless it's severe.
Or, they might wake at night with "rest pain" - yikes! Has to do with arterial/peripheral vascular disease as well.
48
What is a good way to treat claudication?
Have the patient rest the legs in a dependent position - it brings the blood to the legs!
49
What causes fatigue?
No cardiac reserve - decreased cardiac output and blood flow to the muscles.
50
Pallor vs. cyanosis (peripheral and central)
```
Pallor = decreased blood flow.
Cyanosis = poorly oxygenated blood.
```
Central Cyanosis = pulmonary problem.
Peripheral Cyanosis = circulatory problem.
51
What is cardiac cachexia?
Weakness and muscle wasting.
52
What are the typical cardiac vital signs?
Apical/radial pulse, bilateral BP & radial pulse, peripheral pulses.
53
What do we look for in chest appearance?
Outward bulge (old MI, aneurysm)
Pulsations (enlarged heart)
Thrill (pulsation, murmur)
Rubbing (friction rub)
54
What could a pulsation in the gut be?
Aortic enlargment
55
What do we look for in the extremities?
Edema, CSM, warmth, clubbing.
56
What are oslers nodes?
Tender erythemous lesions on fingers. Related to ineffective endocarditis.
57
What are janeway spots?
Non-tender hemorrhagic lesions on palms/soles. Related to immune system - septic emboli.
58
1. Dyspnea can occur with both cardiac disease and pulmonary disease. T/F?
2. Cardinal symptom of heart disease is dyspnea. T/F?
3. PND occurs when the client has been lying down for several hours. T/F?
4. Indigestion, discomfort, and heaviness are terms used by clients to describe chest pain. T/F?
1. T
2. F
3. T
4. T
59
Creatine Kinase - Onset, Peak, Duration
```
Onset = 4-8 hours.
Peak = 12-36 hours.
Duration = 3 days.
```
60
CK MB & CK MB2 - differences?
CK-MB is cardiac specific. 2 is normally equal to 1, but 2 rises more quickly. CK can increase from CPR, Contusion, Angioplasty, etc.
61
Myoglobin - is it specific? Onset, Peak, Duration
It is not cardiac specific.
Onset - early - 1/2-1 hours.
Peak = 2 hours
Duration = 36 hours.
62
What is HBD? Key points? Onset, peak, duration.
Hydroxybutyrane dehydrogenase - cheap and easy for lab, but it can't distinguish between liver and myocardial damage.
Onset = 12 hours.
Peak = 2-3 days.
Duration = 12-21 days.
63
Troponin T & I - info? Onset, peak, duration.
```
Proteins releases from irreversibly damaged myocardial tissue cells.
Troponin I = Cardiac Specific.
Onset = 2-4 hours.
Peak - 24 hours.
Duration = 120 hours.
Troponin T = elevated longer.
```
64
Troponin will rise if the person reinfarcts. T/F?
False - it will not change
65
What should the serum lipid levels be?
Total Cholesterol = 40 mg/dL
| LDL
66
What is the homocysteine level?
Amino acid that is produced when protein breaks down. Normal is less than 14 - possible risk factor for development of CVD but it hasn't really been proven.
67
What is the highly sensitive c-reactive protein?
Marker of inflammation, seen with hypertension, infection & smoking - 3 mg/dL = high risk of heart disease.
68
What are some other lab assessments we might see with a cardiac patient?
H&H, erythrocyte count, lekocyte count, microalbuminuria, ABG's, F&E, Blood Coagulation studies (PT/INR & PTT)
69
INR - what is it?
International Normalized Ratio - more consistent than PT. Used when initiating and maintaining therapy with oral anticoagulants (COUMADIN).
70
What's the normal value and therapeutic value of INR?
```
Normal = 1
Therapeutic = 1.5-2
```
71
PT - what is it?
Protime - measures the extrinsic clotting system (the time it takes for fibrin to form a clot). COUMADIN & Prodaxa act on the extrinsic clotting system and vitamin K is the antidote.
72
What is the normal value for PT? What is the therapeutic value?
```
Normal = 11-12.5 seconds
Therapeutic = 15-20 seconds
```
73
What is PTT? Antidote?
Partial Thromboplastin Time - measures the intrinsic clotting system (HEPARIN).
Antidote = Protamine Sulfate
74
What is the normal value for PTT? Therapeutic Value?
```
Normal = approximately 30 seconds
Therapeutic = approximately 45-60 seconds.
```
75
What is a CXR?
Chest x-ray. Visualizes vascular and cardiac shapes.
76
What is a fluoroscopy?
Slow moving x-ray. Shows deep structures in motion line placement.
77
What is cardiac catheterization?
Determines the diagnosis of coronary artery disease. Determines the diagnosis of valve disease or muscle dysfunction!
78
What is the different between a right sided cath and a left sided cath?
Left sided goes up the arteries.
| Right goes up the inferior vena cava.
79
What are some pre-op responsibilities for a heart cath?
Pre-consent, teaching, how they might feel (like with the dye they might suddenly feel like they wet themselves), do they have any allergies?, mark where pulses are in feet
80
What are some intraoperative things to do for a cath?
Monitor Vitals, rhythm, allergic reaction monitoring
81
What are some post-op considerations for a heart cath?
vitals, site assessment, dressing, hematoma (hard if it is currently bleeding, soft if it is not currently bleeding)
82
What are some complications of a cardiac cath?
Site bleeding, dysrythmia's, pain, allergic reaction, osmotic diuresis, perforation of myocardium/aorta, CVA (because of the risk of clotting!)
83
What is electron-beam computed tomography (EBCT)?
Fast form of x-ray imaging. Might show bypass graft patency, heart lesions, spasms, chamber volumes, calcium deposits, etc.
84
What is an EKG?
Diagnostic test that records the heart electrical activity - identifies problems with conduction and cardiac abnormalities.
85
What is a 12 lead EKG?
Shows the hearts electrical activity from 12 different angles (leads).
86
What are the standard leads?
Lead 1 - Measures the difference between the left arm and the right arm.
Lead 2 measures the difference between the left leg and the right arm.
Lead 3 measures the difference between the left arm and the left leg.
87
What are the unipolar Augmented Voltage Leads?
aVr - measures the difference between the heart and the right arm.
aVL - measures the difference between the heart and the left arm.
aVf - measures the difference between the heart and the left foot.
88
What are the unipolar precordial leads (V Leads) ?
V1 - measures horizontally at the 4th intercostal space at the right sternal border
V2 - measures horizontally at the fourth intercostal space at the left sternal border.
V3 - measures horizontally midway between V2 and V4
V4 - measures horizntally at the 5th intercostal space at the midclavicular line.
V5 - measures horizontally at the 5th inercostal space at the anterior axillary line.
V6 - measures horizontally at the 5th space at the midaxillary line.
89
Which are right side leads?
AvR
90
Which are L Lateral leads?
Lead 1, AvL, V5, V6
91
Which are inferior leads?
Lead 2, Lead 3, AvF
92
Which are anterior leads?
V1, V2, V3, V4
93
What does an exercise EKG assess for?
CAD, atypical angina, PVD and lungs.
94
Exercise EKG - no ___ or __ 2 hours prior to procedure.
Smoking or eating!
95
Holter monitor - what do we do for it? what does it do?
Tests heart rhythm for 24 hours. Tell patients to update the diary with their activities!
96
What is an EPS study?
Electro-physiology study - assesses intra-cardiac electrical activity. Done in cath lab. 4 electrodes placed on the right side of the heart - assesses or stimulates dysthythmia's.
97
What is echocardiography?
Noninvasive procedure - like an ultrasound - used to evaluate STRUCTURE and FUNCTION of the heart.
98
What is TEE?
Trans-esophageal echocardiogram - transducer at the end of endoscope - patient needs to be NPO 6 hours prior to the procedure and will have mild sedation.
99
What is technitium pyrophosphate (PYP)?
Hot spot imaging useful 12 hours - 6 days after MI.
100
What is a thalium treadmill imaging test?
Cold spot imaging - wait 3-4 hours and defective area will become warm.
101
What is the MUGA scan?
Multiple Gated Acquisition scan - measures the ventricles ability to eject blood (Normal EF > 55%) Assesses wall motion and contractility.
102
What might cause an increase in Central Venous Pressure (CVP)?
Hypervolemia, venous congestion, vasoconstriction.
103
What might cause a decrease in Central Venous Pressure (CVP)?
Hypovolemia, Vasodilation
104
What is PAP?
Pulmonary Artery Pressure
105
What might cause an increase in PAP?
Pulmonary hypertension, left heart failure, pulmonary disease, pulmonary embolus
106
What might cause a decrease in PAP?
Vasodilation, Hypovolemia
