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Flashcards in Cardio 4 Deck (85):
0

Troponin levels that are not significant, are grayish,a nd indicate an MI.

• < 0.04 not significant
• 0.04 - 0.20 grey area
• > 0.20 possible/positive

So there really is only two numbers here, .04 and .2, so know that below 0.04 is nothing, in between 0.04-0.2 is grayish, and above 0.2 is where the trouble is.

1

Troponin to go up when there is an MI? Is that the only time that Troponin will go up? If not, then when else?

Yes,
No,
Anytime that there is heart damage, surgery, stenting, even defibrillation.

2

RHABDOMYOLYSIS•

Will cause very high CPK values when ...

– Overexertion

– Heat Stroke

– FALLS

– Side Effect From Statins (rare)

3

Total cholestrol is supposed below?

Less than 200

4

Ldls are supposed to be less than

100

5

Ldls above ______ is at risk for CAD

130

6

hdlS below _____ is at risk for CAD

40

7

HDLs above ________ is good

60

8

Triglycerides above _______ is at risk for aboloc syndrome

150

9

Normal triglyceride levels are?

Below 150

10

Cholestral ratio is

Total chol/HDL,

If
total chol = 200 and
HDL = 50
Ratio would be
200/50 or 4:1

11

AHA recommends ratio < 5:1, with the idealbeing close to 3.5:1

.

12

New recommendation: consider risk profile
(computed by a risk assessment calculator) not just lipidpanel

Previously emphasis was placed heavily on
cholesterol values esp LDL # in deciding whoshould take statins

13

Statins Now Recommended For:

People 40 to 75 years old,
without CVD,
with a ≥ 7.5percent risk (computed by a risk calculating tool) for stroke or MI W/I
10 years

• Anyone with a history of a cardiovascular event (MI,
stroke, stable or unstable angina, PAD, TIA, or post any revascularization
procedure)

• People 21 and older who have a very high LDL level
(190 mg/dL or higher)

• People 40 to 75 years old with Type 1 or Type 2
diabetes

14

CBC names and ranges.

Wbc 5-10
Hgb10-20
Hct 40-50
Plt 50 is too low

15

Hgb is supposed to be what and if below what you hold exercise?

10-20 and below 8.

16

Hct is supposed to be what and if below what is bad?

40-50, and below 25 is bad.

17

WBC is supposed to be what and if it is too much waht does it indicate.

5-10, infection.

18

Fish bone is what?

Look at a fish,

Do you add salt, Na+, cl-,
Do you eat it on a BUN
Is it sweet, GLUCOSE, at its tail
cr eat I nine, I eat nine fish
Have some buffer HCO3-
And
Its oK+

19

If the fasting blood glucose is above what and how many tines so will it indicate a problem?

126mg/dl twice

20

Casual blood glucose of 200mg/dl indicates what?

Hyoerglycmia

21

If the electrolytes are altered what can change?

Mental status and heart rhythms.

22

What at the fish bone indicates either heart or kidney dysfunction?

Increased BUN, blood urea nitrogen.

Just think of urea, that it is what the kindneys make, so if it is at the blood, bad news.

23

Creatinine more than how much indicates renal failure?

> 4

24

Two things that indicate renal failure...

BUN and creatinine.

25

Below what and above what for glucose levels is exercise contraindicated?

<75 >300

Above three hundred because it shows that the body is breaking down the fats for energy and it will just get more.

And below 75 because it is just too low.

26

HbA1c (glycolated hemoglobin)

average amount of sugar in blood over 3 months

27

Normal HbA1C

(between 4 and 5.6, > 5.6 can lead to dx of DM)

28

Pts who have known DM should try to keep HbA1c

< 7

29

ABG shows what?

(pH / CO2 / PO2 / HCO3 / O2 Sat)

All the things that you want to know.
Acidity
Oxygen/carbon dioxide
Buffers
And oxygen sat

30

PT

prothrombin time

31

PT prothrombin time nl

11.3 – 13.7 (coumadin)

32

PTT

partial thromboplastin time

33

PTT partial thromboplastin time

25-35 (heparin)

34

D-Dimer: mostly a R/O test

DVT

35

– ≤ 250 ng/mL D-Dimer Units (DDU)
– ≤ 0.5 mcg/mL Fibrinogen Equivalent Units (FEU)

= 95% likelihood there is no thrombus

36

• INR – international normalization ratio• the higher the #,

the thinner the blood

Like gauges, the higher the thinner the wire.

37

What happens if the INR is too high?

Hemorraghe

38

Nl for INR

0.8-1.2

39

INR for therapeutic

2.5

40

What is high INR?

3

41

At INR is too high to even get out of bed OOB

5

42

0.8-1.2
2.5
3
5

Normal value
Therapuetic range
High
No OOB

For the INRs

43

CRP – C Reactive Protein indicates what?

Blood test gives
non-specific evidence of inflammation, acts as “marker”

44

Crp is a blood marker that would indicate what?

Infection, illness, or a serious flare-up of arthritis, can all raise CRP levels

45

Is CRP correlated with heart disease?

Yes

46

What are the values that are correlated with heart disease for CRP?

• < 1.0 mg/L = low risk
• > 3.0 mg/L = high risk

47

Noninvasive Testing

• Pulse Ox
• EKG
• Stress Test
• Echo
• TEE Transesophageal echocardiogram
• MRI
• PET, CT, SPECT, MUGA
-Tilt Table

48

Stress Test

• A + stress test indicates that pt became
symptomatic or had EKG changes at less than their predicted max heart rate

49

220-age=max heart rate

.

50

Tilt table treats

Orthostatic hypotension

51

Invasive Testing/Treatment

• Left Cardiac Cath

• Right Cardiac Cath

• EPS (electrophysiology study)

If there exists more in the world, surely they do, but these are the ones that we are responsible for.

Right and Left cardiac catneter and electrophysiology study.

52

Left cardiac catheter is:

Goes and studies the left ventricles and the coronary arteries.

So it need a mojor artery to come back tto the aorta, it will make use of the femoral artery.

53

R Cardiac Cath looks for

Obtain pulm art Pulm wedge Pressures,
Used as Dx for Pulm HTN

54

Another name for the right cardiac catheter

Swan ganz,

Its yellow and its in the heart, so no pulling.

55

EPS

Find ectopic sites
ABLATE them
RFA = radio frequency ablation
Freezing = Cryoablation

56

PTCA stands for

PercutaneousTransluminal Coronary
angioplasty

57

PTCA Balloon can be used for:

Angiography = Looking

Angioplasty = Intervening

They stick in a balloon, and they either do something to the athrosclerotic plaque, if they see it, or they just take a look around to see if they need to intervene.

58

PCI Stent

Similar to the PTCA in the sense that they both can address plaques, but here by the PCI they don't just inflate the balloon and then allow the vessel to return back to the original occlusion but they leave in a stent to physicaly keep this vessel opened.

59

Stents are permanent?

Yes

60

PCI Brachytherapy is?

Radiation Seeds Implanted In stent

61

PCI Cutting Balloon

Is like another PCI but here we can cut away the plaque.

Arthrectomy

I wonder how careful one needs to be in order to avoid embolus formation?

62

Open ♥ sx has the incision from where to where?

Supraernal notch to the ziphoid process

63

After the incision of the open heart sx what oeeps the chest cavity open?

Sternal retractors

64

Wires are used to close the _________ after the open heart surgery.

The sternum

65

Chest tubesa re inserted where and where?

Interpleural and intermediastinal.

66

After open heart surgery, now that e chest has been broken into and rewired shut, are there any sternal precautions?

Yes.

67

What are these sternal precautions that are sto be observed after the open heart surgery?

• ≈ SIX WEEKS
• Ø heavy lifting > 10 lbs
• Ø pushing or pulling with force
• Ø driving or sitting in front seat of car
• Ø raising both arms overhead, or bringing them to the back simultaneously


(Pt is cleared for ↑ activity by cardiac surgeon at a follow-up visit)

68

CDI is:

Clean
Dry
And
Intact
Incision wounds

69

What are two most common vlaces that require replacement?

Mitral, left av valve, and tricuspid, right av valve.
Maybe because they need to be able to withstand rhe pressure of the ventricles to not open up and regurgitate the blood, by the pulmonic and aorta, they open at the systolic and they close at the diastolic, which is lower pressure than at systolic, but the mv and tv they need to stay put at the systolic.

70

(s/p valve Pts are placed on blood thinners)What will happen to the INR?

Will go up
Will become thinner
More than 3 is elevated and
More than 5 is no OOB

71

Myectomy

They shave the heart muscle to change back the remodeling.

72

CEA

They remove the athrosclerosis from the carotid arteries

73

What sound wound one hear in the carotid artery if it is occluded?

A bruit, like a coffee brewer that it sends liquids through a tight area and there will be lots of turbulence.

74

AAA requires surgery at what size

More than 5 cm

75

Fem Pop Bypass

Similar to a cabg, but here it is FPBG.

And who can name that machine that made rain into food from "Cloudy with a Chance of Meatballs"?

76

PPM

Permanent pace maker

Placed over the pec ort he axillary

77

PPM precautions

• no heavy lifting or stretching 7-10 d, similar to Sternal precautions.

• Do no lift arm on PPM side > 90° until clearedby MD

• Check incision for signs of infection daily. Normal incisional check ups.


NO MRI

78

AICD

Automatic, imp,antable, cardioverter, defibrillator.

79

AICD precautions

• no heavy lifting or stretching 7-10 d
• Do not lift arm on PPM side > 90° until cleared by MD
• Check incision for signs of infection daily. NO MRI • PLUS: Call doctor if device discharges
–Avoid contact sports
–No driving for 3 mos

Similar to the PPM but if it goes off then a doctor needs to be contacted, also no driving for 3 minths, or sports.

80

Cardioversion

What you see on ER or Any other knock off ED drama show, clear, fmump, give me 8 ccs, good job!

• Synchronized shock is administered to theheart via electrode pads to correct an
arrhythmia

81

LVAD

Left ventricular assistive device

Like a bypass oft he left ventricle to the aorta, if the LV is too weak to be able to kee p and do the job.

Look up the cow without the pulse.

82

• Some patients undergo REVERSE
REMODELING after LVAD is implanted
• In some cases pt’s heart recovers enough that LVAD is explanted and patient no longer
requires transplant
• Research is ongoing in this area

Molecular Changes After Left Ventricular Assist Device Support for HeartFailure, Emma J. Birks, Circulation Research [Circ Res] 2013 Aug 30; Vol.
113 (6), pp. 777-91

.

83

Heart Transplant

• Cardiac Transplant: last resort

• heterologous: from non-human primate

• homologous: from human donor

• PERFORMED AT SPECIALIZED CENTERS

84

With heart transplants, they are on lifelong immunosuppressant drugs.

They will have diminshed sympathetic and parasympathetic innervations.

This relying more on the blood circulatng catecholamines.

.