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Adult 2 > Cardio part 2 > Flashcards

Cardio part 2 Flashcards

(123 cards)

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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
Pain management with AMI
M-morphine O-oxygen N-nitrates A-aspirin
26
What position should you put your AMI pt in?
Semi-Fowler's
27
How does morphine help with AMIs?
Relaxes smooth muscles and decreases myocardial O2 demand
28
Causes of Infective Endocarditis
- IV drug abuse - Prosthetic valves - Systemic infections - Structural cardiac defects
29
Vegetation w/ infective endo
- 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
30
What might cause valvular insufficiency?
Infective endocarditis
31
Common ports of injury for Infective Endo
- Oral cavity during dental work - Skin rashes, lesions, abcesses - Surgery, placement of invasive lines
32
S/S of infective endo
- Fever/chills/night sweats - Anorexia/weight loss - Cardiac murmur - Heart failure - Systemic embolization - Petechiae - Splinter hemorrhage-distal 1/3 of nail bed
33
How to diagnose infective endo
Blood cultures and echoes
34
Non-surgical treatment of infective endo
- 4-6 wks of IV ABX, probably with PICC line and home health | - NOT anticoagulants
35
Surgical treatment of infective endo
- 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
36
Where will you hear a murmur with infective endo?
Depends on which valve is affected
37
Causes of acute pericarditis
- Post acute MI - Pist-pericardectomy syndrome - Acute exacerbations of systemic connective tissue dz
38
Causes of chronic pericarditis
- Renal failure - TB - Radiation - Trauma
39
Acute pericarditis s/s
- 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
40
Signs of right sided heart failure
JVD, hepatic engorgement, dependent edema, ascites
41
Diagnostic test for pericarditis
Echo
42
Interventions with pericarditis
- NSAIDS - Corticosteroids if not bacterial in nature - Pt positioning: upright and lean forward slightly
43
Treatment of pericarditis
- Bacterial: ABX - Malignant: chemo/rad - Uremic: dialysis for renal failure - Surgery: pericardiectomy
44
Care for pt with pericarditis
- 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
45
Excess of fluid within pericardial cavity
Cardiac Tamponade, more than 10mL
46
Effect of fluid accumulation with cardiac tamponade
Compression of the heart's chambers and can cause a sudden decrease in CO, rapidly fatal if not identified and treated quickly
47
S/S of cardiac tamponade
- JVD - Paradoxical pulse - Decreased HR/BP - Dyspnea/Fatigue - Muffled heart sounds
48
Treatment of Cardiac Tamponade
- Initial fluid resuscitation - Hemodynamic monitoring-all pressures equalize - Pericardiocentesis
49
Pericardiocentesis
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
50
HTN
Systolic >140 | Diastolic >90
51
What should diabetics with heart dz maintain their BP at?
52
Malignant HTN
>200 systolic >130 diastolic *They don't always look/feel sick
53
Arterial baroreceptors
Located around carotid sinus, aorta, LV wall | -Responsive to changes in body fluid volume (increases venous return)
54
Calcium channel blockers for HTN
- Vasodilates - Reduces HR - Well tolerated
55
ACE inhibitors for HTN
* prils - Prevents vasoconstriction - Postural hypotension - Cough - Nephrotoxic
56
1st line treatment for HTN
Diuretics (hydrachlorathiazide) | -cheap
57
Example of vasodilator meds
Nitrates
58
ARBs
Sartans
59
Why do people get put on ARBs instead of ACE inhibitors
Nephrotoxicity
60
When to take diuretics
In the morning
61
Common problem with calcium channel blockers
Orthostatic hypotension
62
PVD inflow obstructions
Above inguinal ligament
63
PVD outflow obstructions
Below inguinal ligament
64
Stage 1 PVD
- Asymptomatic | - Pedal pulses decreased or absent
65
Stage 2 PVD
- Muscle pain/burning with exercise | - S/s reproducible-happens every time you do a certain thing
66
Stage 3 PVD
- 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
Stage 4 PVD
- Necrosis | - Gangrene
68
What do you do if you can't find a pulse with a doppler
Move up one and let someone know
69
Ankle-Brachial index w/ PVD
Compare BP in arm and in leg, pressures should be equal, PVD will be >0.9
70
Arteriogram w/ PVD
Heart cath of legs
71
Anti platelet med for PVD
Baby aspirin or Persantine
72
Surgical management for PVD
Angioplasty or bypass grafts
73
Where can you have an aneurysm
Any artery
74
Injury or trauma to vessel wall
False aneurysm
75
Fusiform aneurysm
Normal artery, reverse hourglass shape
76
Saccular aneurysm
Comes off on one side
77
True aneurysm
Happens naturally
78
Aortic dissection
Aorta has 3 layers, one layer splits apart. Blood doesn't go to the right spot
79
When do you have surgery for an aneurysm
Nothing till its >5cm in diameter...then risk of rupture is greater than surgical risk
80
How to treat thoracic aneurysm
Not with surgery
81
Buerger's Dz
Uncommon, young men who smoke - Affects hands/feet - Fibrosis binds arteries together resulting in impaired circulation - Typically involves smaller arteries and arterioles
82
Treatment of buerger's dz
- Stop smoking - Avoid cold temps - Surgical revascularization
83
Vasospasm of arterioles in upper or lower extremities, unilateral, >30 yrs, either gender
Raynaud's phenomenon
84
Vasospasm of arterioles, bilaterally, ages 17-50, more common in women
Raynaud's Dz
85
Manifestations of Raynaud's
- Skin blanches w/ vasospasm, hyperemic (really red, flushed) when vasospasm goes away - Int attacks - Extremities feel cold, tingling, numb - Ulcers may develop
86
Treatment of Raynaud's
Calcium channel blockers to prevent spasm, vasodilators, avoid cold, stress
87
Thrombosis/thrombus
Blood clot
88
Phlebitis
Inflammation of the vein
89
Thrombophlebitis
Thrombus associated w/ inflammation
90
Most common site of thrombophlebitis
Deep veins of lower extremities
91
Virchow's Triad
- Venous stasis - Hypercoagulabity (caused by dehydration) - Endothelial injury
92
DVT
Closely associated w/ - Hip/knee replacement sx - Immobility - Ulcerative colitis - HF - Prolonged sitting
93
Clinical man of DVT
Calf/groin pain, unilateral swelling
94
Diagnostic procedures
Venous US
95
Medical management of DVT
- Prevention (dorsiflex) - Bedrest - Extremity elevation - Anticoagulants - Surgery
96
Anticoagulant therapy for DVT
- 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
Venous insufficiency
- Prolonged venous HTN - Stretches veins/damages valves - Venous stasis (edema, inability to remove waste products, ulcer formation)
98
Normal PTT
20-30
99
Clinical manifestations of venous insufficiency
Edema, stasis dermatitis (reddish brown discoloration extending up from ankles, chronic ulcers)
100
Management of venous insufficiency
Reduce edema, normal venous return, localized ulcer care
101
Pt education for venous insufficiency
- Avoid long standing periods - Leg elevation - Don't cross legs - Don't wear restrictive clothing - Ulcer care (unna bood, surgical debridement)
102
Left sided HF
Systolic: heart can't contract forcefully Diastolic: Loss of ventricular wall compliance, can't fill
103
Right sided HF
RV doesn't empty completely and "backs up" into venous system causing peripheral edema
104
#1 cause of right sided HF
Left sided HF
105
High output failure
Less common, associated with sepsis
106
S/S left sided HF
*Systemic* -Fatigue ^HR -DOE -Crackles, wheezes -Cool extremities -Weak pulses
107
S/S right sided HF
- JVD - Enlarged liver/spleen - Anorexia - Peripheral edema - Polyuria (night) - Weight gain
108
Classification of HF ACC
A-pts w/ high risk B-structural problems, no symptoms C-symptoms D-refractory HF
109
Classification of HF New York
1: without limiting symptoms 2: slight limitation of activity 3: marked limitation 4. inability to move w/o symptoms, symptoms at rest
110
Meds for HF
- ACEI or ARB - Beta blockers controversial - Diuretics - Nitrates: vasodilate coronary arteries - Inotropes (Digoxin: lowers HR and increases contractility)
111
Intra-aortic balloon pump for HF
- 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
Pulmonary Edema
Severe HF w/ volume overload, AMI, mitral valve disorders. Fluid leaks across capillaries into lung tissues
113
S/S of pulmonary edema
- Crackles - Dyspnea at rest - Confusion - Anxiety - Reduced UOP - Cough - Frothy, pink sputum
114
Treatment for pulmonary edema
Oxygen, diuresis, nitrates, inotropes
115
Most common cause of mitral stenosis
Rheumatic fever
116
Mitral stenosis
Valve doesn't open fully, increased pressure in LA, then PA, then RV - Pulmonary congestion - Right sided heart failure
117
Mitral regurgitation/insufficiency
- 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
Aortic stenosis
- Most common valve dz - Congential/age related - Doesn't open and obstructs LV outflow - CO becomes fixed - LV failure leads to RV failure
119
Aortic regurgitation/insufficiency
- Endocarditis, congenital - Remain asymptomatic for years - LV overload leading to LV failure, then RV failure - Bounding pulse w/ wide pulse pressure
120
Systolic murmurs occur with what?
- Mitral regurgitation | - Aortic stenosis
121
Diastolic murmurs occur with what?
- Mitral stenosis | - Aortic regurgitation
122
Medical management for valvular heart dz
- Diuresis | - Atrial fib management
123
Surgical repair of valvular dz
Metal valves/porcine valves, annuloplasty, balloon dilation

Adult 2 (8 decks)

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