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Adult 2 > Cardio part 2 > Flashcards

Cardio part 2 Flashcards

1
Q

Where do acute MI’s usually begin?

A

Subendocardial layer, then progress outward w/ continued ischemia

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2
Q

Zone of ischemia

A

Tissue is O2 deprived but not injured

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3
Q

Zone of injury

A

Tissue is damaged, but not dead

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4
Q

Zone of necrosis

A

Death of myocardial tissue

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5
Q

25% of all MIs and highest mortality rate

A

LAD anterior wall of LV

-Increased risk of heart failure and dysrhythmias

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6
Q

MI with increased risk of sinus dysrhythmias

A

LCX posterior wall of LV

-Due to SA and AV node perfusion

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7
Q

17% of MIs, second highest mortality

A

RCA or LCX inferior wall of LV

-Mitral dysfunction of papillary muscles and chordae tendinae

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8
Q

STEMI

A

ST elevation MI

  • Happening in real time, haven’t completed the infarct, still happening so you can still do something about it
  • Abrupt occlusion
  • More damage
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9
Q

NSTEMI

A

NonST elevation MI

  • Partial or temp occlusion
  • Ruptured plaque
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10
Q

What is a STEMI treated with?

A

PCI (percutaneous coronary intervention)

-Fibrinolytics (anticoagulant, clot buster)

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11
Q

What is a NSTEMI treated with?

A

Antiplatelets (aspirin, plavix)

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12
Q

Why does NSTEMI cause less damage than STEMI?

A

More ongoing process, body has time to generate collateral circulation

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13
Q

Leukocytosis with MI

A

Elevated WBC, usually 10-20,000

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14
Q

Cardiac enzymes with MI

A

CK-MB peak in 12-24 hrs, normal 48-72 hrs

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15
Q

Hallmark changes with AMI

A
  • Myocardial ischemia
  • Myocardial injury
  • Myocardial infarction
  • usually show no immediate ECG changes
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16
Q

Troponin 1 and T

A

Myocardial muscle protein, elevated 4-6 hrs after AMI, peaks 10-24 hrs, and remains for 5-7 days

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17
Q

Myocardial ischemia

A

T wave inversion, peaked T waves, ST segment depression (1 mm or one small box)

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18
Q

Myocardial injury

A

ST segment elevation in leads facing affected area show > or = 1 mm above baseline

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19
Q

Myocardial infarction

A

Q waves (pathologic) either >25% of the QRS complex height or >1mm wide

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20
Q

ACC goal for AMIs

A

Time from admit to ER to PCI should be less than 90 minutes

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21
Q

What is the recommended mode of treatment when PCI cannot be performed within 90 mins?

A

Fibrinolysis

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22
Q

Absolute contraindications for fibrinolysis

A
  • Intracranial hemorrhage
  • Known intracranial malignancy
  • Known AV malformation
  • Ischemic stroke within past 3 months
  • Aortic dissection
  • Active bleeding
  • Closed head injury
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23
Q

Relative contraindications for fibrinolysis

A
  • Uncontrolled HTN
  • Active PUD (GI bleed)
  • Recent surgery/trauma
  • Pregnancy
  • Concurrent anticoagulant use
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24
Q

Fibrinolytic meds

A
  1. Altepase (tPA)
    - bolus then infusion
  2. Streptokinase
    - infusion
    - can only be used once bc body develops antibodies, they’ll go into anaphylactic shock
    - allergic reactions
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25
Q

Pain management with AMI

A

M-morphine
O-oxygen
N-nitrates
A-aspirin

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26
Q

What position should you put your AMI pt in?

A

Semi-Fowler’s

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27
Q

How does morphine help with AMIs?

A

Relaxes smooth muscles and decreases myocardial O2 demand

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28
Q

Causes of Infective Endocarditis

A
  • IV drug abuse
  • Prosthetic valves
  • Systemic infections
  • Structural cardiac defects
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29
Q

Vegetation w/ infective endo

A
  • Vegetative lesions can develop due to accumulation of fibrin and platelets in abnormal area
  • Bacteria collects in vegetation
  • Vegetation continues to grow and can obstruct inflow/outflow
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30
Q

What might cause valvular insufficiency?

A

Infective endocarditis

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31
Q

Common ports of injury for Infective Endo

A
  • Oral cavity during dental work
  • Skin rashes, lesions, abcesses
  • Surgery, placement of invasive lines
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32
Q

S/S of infective endo

A
  • Fever/chills/night sweats
  • Anorexia/weight loss
  • Cardiac murmur
  • Heart failure
  • Systemic embolization
  • Petechiae
  • Splinter hemorrhage-distal 1/3 of nail bed
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33
Q

How to diagnose infective endo

A

Blood cultures and echoes

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34
Q

Non-surgical treatment of infective endo

A
  • 4-6 wks of IV ABX, probably with PICC line and home health

- NOT anticoagulants

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35
Q

Surgical treatment of infective endo

A
  • Removal/replacement of infected valve/shunt (you can’t steralize a fake part w/ abx so it needs to be replaced)
  • Repair of chordae if needed
  • Complicated post op
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36
Q

Where will you hear a murmur with infective endo?

A

Depends on which valve is affected

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37
Q

Causes of acute pericarditis

A
  • Post acute MI
  • Pist-pericardectomy syndrome
  • Acute exacerbations of systemic connective tissue dz
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38
Q

Causes of chronic pericarditis

A
  • Renal failure
  • TB
  • Radiation
  • Trauma
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39
Q

Acute pericarditis s/s

A
  • Substernal precordial pain that radiates to neck, back, shoulder
  • Pain aggravated by breathing, coughing, swallowing
  • Worse pain supine
  • Friction rub
  • Fever
  • Elevated WBC
  • ST segment “spiking,” may develop Afib
  • Thickened pericardium compresses ventricles and restricts filling
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40
Q

Signs of right sided heart failure

A

JVD, hepatic engorgement, dependent edema, ascites

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41
Q

Diagnostic test for pericarditis

A

Echo

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42
Q

Interventions with pericarditis

A
  • NSAIDS
  • Corticosteroids if not bacterial in nature
  • Pt positioning: upright and lean forward slightly
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43
Q

Treatment of pericarditis

A
  • Bacterial: ABX
  • Malignant: chemo/rad
  • Uremic: dialysis for renal failure
  • Surgery: pericardiectomy
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44
Q

Care for pt with pericarditis

A
  • Auscultate for pericardial friction rub
  • Avoid anti-coagulants
  • Auscultate BP for paradoxical pulse, systolic BP will be 10+ higher on expiration
  • Monitor for signs of cardiac tamponade
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45
Q

Excess of fluid within pericardial cavity

A

Cardiac Tamponade, more than 10mL

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46
Q

Effect of fluid accumulation with cardiac tamponade

A

Compression of the heart’s chambers and can cause a sudden decrease in CO, rapidly fatal if not identified and treated quickly

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47
Q

S/S of cardiac tamponade

A
  • JVD
  • Paradoxical pulse
  • Decreased HR/BP
  • Dyspnea/Fatigue
  • Muffled heart sounds
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48
Q

Treatment of Cardiac Tamponade

A
  • Initial fluid resuscitation
  • Hemodynamic monitoring-all pressures equalize
  • Pericardiocentesis
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49
Q

Pericardiocentesis

A

Drainage of fluid with surgery to open up and drain or with a needle at the bedside, go into pericardium but not through muscle
-If you stick the needle too far you can cause a tamponade

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50
Q

HTN

A

Systolic >140

Diastolic >90

51
Q

What should diabetics with heart dz maintain their BP at?

A
52
Q

Malignant HTN

A

> 200 systolic
130 diastolic
*They don’t always look/feel sick

53
Q

Arterial baroreceptors

A

Located around carotid sinus, aorta, LV wall

-Responsive to changes in body fluid volume (increases venous return)

54
Q

Calcium channel blockers for HTN

A
  • Vasodilates
  • Reduces HR
  • Well tolerated
55
Q

ACE inhibitors for HTN

A
  • prils
  • Prevents vasoconstriction
  • Postural hypotension
  • Cough
  • Nephrotoxic
56
Q

1st line treatment for HTN

A

Diuretics (hydrachlorathiazide)

-cheap

57
Q

Example of vasodilator meds

A

Nitrates

58
Q

ARBs

A

Sartans

59
Q

Why do people get put on ARBs instead of ACE inhibitors

A

Nephrotoxicity

60
Q

When to take diuretics

A

In the morning

61
Q

Common problem with calcium channel blockers

A

Orthostatic hypotension

62
Q

PVD inflow obstructions

A

Above inguinal ligament

63
Q

PVD outflow obstructions

A

Below inguinal ligament

64
Q

Stage 1 PVD

A
  • Asymptomatic

- Pedal pulses decreased or absent

65
Q

Stage 2 PVD

A
  • Muscle pain/burning with exercise

- S/s reproducible-happens every time you do a certain thing

66
Q

Stage 3 PVD

A
  • Pain at rest
  • Distal portion of extremities
  • Hang their leg off the bed, sit up w/ legs off bed
  • Pain relieved when in dependent position
67
Q

Stage 4 PVD

A
  • Necrosis

- Gangrene

68
Q

What do you do if you can’t find a pulse with a doppler

A

Move up one and let someone know

69
Q

Ankle-Brachial index w/ PVD

A

Compare BP in arm and in leg, pressures should be equal, PVD will be >0.9

70
Q

Arteriogram w/ PVD

A

Heart cath of legs

71
Q

Anti platelet med for PVD

A

Baby aspirin or Persantine

72
Q

Surgical management for PVD

A

Angioplasty or bypass grafts

73
Q

Where can you have an aneurysm

A

Any artery

74
Q

Injury or trauma to vessel wall

A

False aneurysm

75
Q

Fusiform aneurysm

A

Normal artery, reverse hourglass shape

76
Q

Saccular aneurysm

A

Comes off on one side

77
Q

True aneurysm

A

Happens naturally

78
Q

Aortic dissection

A

Aorta has 3 layers, one layer splits apart. Blood doesn’t go to the right spot

79
Q

When do you have surgery for an aneurysm

A

Nothing till its >5cm in diameter…then risk of rupture is greater than surgical risk

80
Q

How to treat thoracic aneurysm

A

Not with surgery

81
Q

Buerger’s Dz

A

Uncommon, young men who smoke

  • Affects hands/feet
  • Fibrosis binds arteries together resulting in impaired circulation
  • Typically involves smaller arteries and arterioles
82
Q

Treatment of buerger’s dz

A
  • Stop smoking
  • Avoid cold temps
  • Surgical revascularization
83
Q

Vasospasm of arterioles in upper or lower extremities, unilateral, >30 yrs, either gender

A

Raynaud’s phenomenon

84
Q

Vasospasm of arterioles, bilaterally, ages 17-50, more common in women

A

Raynaud’s Dz

85
Q

Manifestations of Raynaud’s

A
  • Skin blanches w/ vasospasm, hyperemic (really red, flushed) when vasospasm goes away
  • Int attacks
  • Extremities feel cold, tingling, numb
  • Ulcers may develop
86
Q

Treatment of Raynaud’s

A

Calcium channel blockers to prevent spasm, vasodilators, avoid cold, stress

87
Q

Thrombosis/thrombus

A

Blood clot

88
Q

Phlebitis

A

Inflammation of the vein

89
Q

Thrombophlebitis

A

Thrombus associated w/ inflammation

90
Q

Most common site of thrombophlebitis

A

Deep veins of lower extremities

91
Q

Virchow’s Triad

A
  • Venous stasis
  • Hypercoagulabity (caused by dehydration)
  • Endothelial injury
92
Q

DVT

A

Closely associated w/

  • Hip/knee replacement sx
  • Immobility
  • Ulcerative colitis
  • HF
  • Prolonged sitting
93
Q

Clinical man of DVT

A

Calf/groin pain, unilateral swelling

94
Q

Diagnostic procedures

A

Venous US

95
Q

Medical management of DVT

A
  • Prevention (dorsiflex)
  • Bedrest
  • Extremity elevation
  • Anticoagulants
  • Surgery
96
Q

Anticoagulant therapy for DVT

A
  • Heparin bolus/infusion to dissolve clot
  • Goal is PTT 1.5-2 x normal level
  • Serial monitoring (CBC, PTT, PLT)
  • Lovenox (1mg/kg) for prevention, not treatment
  • Warfarin long term
97
Q

Venous insufficiency

A
  • Prolonged venous HTN
  • Stretches veins/damages valves
  • Venous stasis (edema, inability to remove waste products, ulcer formation)
98
Q

Normal PTT

A

20-30

99
Q

Clinical manifestations of venous insufficiency

A

Edema, stasis dermatitis (reddish brown discoloration extending up from ankles, chronic ulcers)

100
Q

Management of venous insufficiency

A

Reduce edema, normal venous return, localized ulcer care

101
Q

Pt education for venous insufficiency

A
  • Avoid long standing periods
  • Leg elevation
  • Don’t cross legs
  • Don’t wear restrictive clothing
  • Ulcer care (unna bood, surgical debridement)
102
Q

Left sided HF

A

Systolic: heart can’t contract forcefully
Diastolic: Loss of ventricular wall compliance, can’t fill

103
Q

Right sided HF

A

RV doesn’t empty completely and “backs up” into venous system causing peripheral edema

104
Q

1 cause of right sided HF

A

Left sided HF

105
Q

High output failure

A

Less common, associated with sepsis

106
Q

S/S left sided HF

A

Systemic
-Fatigue
^HR
-DOE
-Crackles, wheezes
-Cool extremities
-Weak pulses

107
Q

S/S right sided HF

A
  • JVD
  • Enlarged liver/spleen
  • Anorexia
  • Peripheral edema
  • Polyuria (night)
  • Weight gain
108
Q

Classification of HF ACC

A

A-pts w/ high risk
B-structural problems, no symptoms
C-symptoms
D-refractory HF

109
Q

Classification of HF New York

A

1: without limiting symptoms
2: slight limitation of activity
3: marked limitation
4. inability to move w/o symptoms, symptoms at rest

110
Q

Meds for HF

A
  • ACEI or ARB
  • Beta blockers controversial
  • Diuretics
  • Nitrates: vasodilate coronary arteries
  • Inotropes (Digoxin: lowers HR and increases contractility)
111
Q

Intra-aortic balloon pump for HF

A
  • Placed percutaneously
  • Increases coronary perfusion
  • Decreases after load
  • Increases CO
  • Positioning: high enough in aorta that its above superior mesenteric, below carotid and great vessels, stick artery, they’ll be on bedrest
  • Timing: inflates during diastole, deflates just before systole
112
Q

Pulmonary Edema

A

Severe HF w/ volume overload, AMI, mitral valve disorders. Fluid leaks across capillaries into lung tissues

113
Q

S/S of pulmonary edema

A
  • Crackles
  • Dyspnea at rest
  • Confusion
  • Anxiety
  • Reduced UOP
  • Cough
  • Frothy, pink sputum
114
Q

Treatment for pulmonary edema

A

Oxygen, diuresis, nitrates, inotropes

115
Q

Most common cause of mitral stenosis

A

Rheumatic fever

116
Q

Mitral stenosis

A

Valve doesn’t open fully, increased pressure in LA, then PA, then RV

  • Pulmonary congestion
  • Right sided heart failure
117
Q

Mitral regurgitation/insufficiency

A
  • Degeneration/infarct of papillary muscle
  • Doesn’t close: allows for back flow of blood into LA and LV until LV begins to fail due to chronic volume overload
  • RV failure results too
118
Q

Aortic stenosis

A
  • Most common valve dz
  • Congential/age related
  • Doesn’t open and obstructs LV outflow
  • CO becomes fixed
  • LV failure leads to RV failure
119
Q

Aortic regurgitation/insufficiency

A
  • Endocarditis, congenital
  • Remain asymptomatic for years
  • LV overload leading to LV failure, then RV failure
  • Bounding pulse w/ wide pulse pressure
120
Q

Systolic murmurs occur with what?

A
  • Mitral regurgitation

- Aortic stenosis

121
Q

Diastolic murmurs occur with what?

A
  • Mitral stenosis

- Aortic regurgitation

122
Q

Medical management for valvular heart dz

A
  • Diuresis

- Atrial fib management

123
Q

Surgical repair of valvular dz

A

Metal valves/porcine valves, annuloplasty, balloon dilation

Adult 2 (8 decks)

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