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CCRN > Cardio Vascular > Flashcards

Cardio Vascular Flashcards

1
Q

Explain S1

A

Tricuspid and mitral closure heard best at the apex of the heart. This marks the end of diastole and the beginning of systole

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2
Q

Explain S2

A

Closure of the pulmonic and aortic valve that is heard best at the base of the heart. This is the end of systole and beginning of diastole. S2 can possibly split on inspiration which can cause a RBBB

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3
Q

You hear a loud S2 what could be the answer

A

Pulmonary embolism.

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4
Q

Auscultation points on the chest

A

A, P, (E)T, M

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5
Q

Explain what an S3 sound is

A

Associated with HF and can be heard before crackles S3 a rush of blood into the ventricles. This is heard best at the apex of the heart

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6
Q

Other causes of S3

A

HF, Cor Pulmonale, pulmonary HTN, M, A,or T insufficiency

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7
Q

Explain S4

A

Atrial contraction in a non compliant ventricular which is heard best at the apex of the heart.

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8
Q

What is S4 associated with

A

MI, Infarction, HTN, ventricular hypertrophy, AORTIC stenosis

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9
Q

Pt complaint of pain with deep inhalation

A

Pericarditis

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10
Q

What is a normal pulse pressure

A

40-60 mmHg

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11
Q

What is a narrowing pulse pressure

A

Decrease in systolic pressure or increase in diastolic seen most often in Hypovolemia, drop in CO, or tamponade

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12
Q

Systolic BP is an indirect measurement of what value

A

CO, Stroke volume

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13
Q

Diastolic BP is an indirect measurement of what value

A

SVR

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14
Q

Diastolic BP decreases when

A

Vasodilation, drop in SVR, sepsis

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15
Q

When do the coronary arteries fill

A

Diastole which is 1/3 longer then systole

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16
Q

A murmur of insufficiency suggests what

A

The valve is closed and it could be an acute or chronic problem

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17
Q

A murmur of regurgitation suggest what

A

The same as insufficiency the valves are closed and could be acute or chronic

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18
Q

A murmur of stenosis suggests what

A

That the valves are open and is a chronic NOT acute pathology

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19
Q

Mitral insufficiency murmur is heard when

A

Systole (giant V waves on the PAOP)

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20
Q

Mitral stenosis is heard when

A

Diastole

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21
Q

Aortic insufficiency is heard when

A

Diastole

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22
Q

Aortic stenosis is heard when

A

Systole

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23
Q

VSD murmur is heard when and where

A

Systole, sterna boarder 5th ICS

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24
Q

A papa papillary muscle ruptures. What valve and space do you listen to

A

Mitral valve and at the apex

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25
Q

Stable angina

A

Predictable chest pain with fixed or calcified lesions

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26
Q

Unstable angina

A

Unpredictable CP negative for troponin and positive for ST depression or T wave inversion, may be relieved with nitro

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27
Q

NSTEMI

A

Troponin positive ST depression or T inversion, unrelieved CP

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28
Q

STEMI

A

Positive troponin ST elevation in 2 leads and unrelieved CP

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29
Q

Variant or Prinzmetal

A

Transient ST elevation due to coronary artery spasm that is cyclic or occurs at rest. Troponin negative and nitro relieves CP and ST elevation

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30
Q

TX of CP

A

ECG within ten minutes, ASA, anticoagulant, anti platelets, beta blockers (unless cocaine induced), preferably cardio selective (metoprolol), nitro, morphine

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31
Q

Changes is II III aVf

A

RCA inferior LV

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32
Q

Changes in V1 V2 V3 V4

A

LAD anterior LV

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33
Q

Changes in V5 V6 I aVL

A

Circumflex lateral LV

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34
Q

Changes in V5 V6

A

Low lateral LV

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35
Q

Changes in I aVL

A

High lateral LV

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36
Q

Changes in V1, V2

A

RCA posterior LV

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37
Q

Changes in V3R V4R

A

RCA RV

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38
Q

What are signs of reocclusion

A

CP ST elevation contact physician

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39
Q

During death removal your pt vasovagals what do you do

A

Fluids and atropine in presents of <90 SBP regardless of HR unless reflex tachycardia

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40
Q

Vado vagel signs

A

<90 SBP, bradycardia, pallor nausea, yawning, diaphosesis

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41
Q

After sheath removal a pts urine output drops

A

Suspect RP bleed get fluids and blood ready assess site for active bleed

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42
Q

Fibrinolytic contraindications

A

Inter cranial hemorrhage, cerebral vascular lesion, cranial neoplasm, ischemic strake within 3 months unless acute stroke within 3 hours, aortic dissection, active bleeding (unless menses), closes head trauma

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43
Q

Your patient has marked elevation in troponin and CK MB after cardiac catheterization what is a possible explanation

A

Myocardial stunning from reperfusion continue to monitor assuming there are no other re infarcts signs

44
Q

Reperfusion Arrythmias

A

VT VF accelerated idioventricular rhythm

45
Q

A patient has elevated II III and aVF leads what do you expect

A

Inferior MI

46
Q

Complication associated with an inferior MI

A

2nd degree heart block type 1, 3rd degree heart block, sick sinus syndrome, sinus bradycardia, mitral regurgitation, papillary muscle rupture

47
Q

A patient presents with ST elevation in the 11, 111, and aVF leads. What type of MI is this patient having and what should be avoided

A

Inferior MI abound NTG and beta blockers

48
Q

Signs of a right vertical infarct

A

JVD, high CVP, hypotension, clear lungs, brandy arrhythmia, ST elevation in V4R

49
Q

What should a nurse expect to do for a patient with ST elevation in V4R

A

Give fluids and positive inotropes (dig, amino, dobutamine, epi, norepinephrine, glucagon), and avoid diuretics nitrates and be careful with beta blockers

50
Q

Anterior MI

A

LAD occlusion as evidence by V1-v4. Higher mortality in heart failure

51
Q

After an MI in leads V1-v4 a pt develops second degree type 2 heart block

A

This or a RBBB is an ominous sign Along with a heart murmur is possible

52
Q

A pt has sustained VT after adenosine administration and is deteriorating. What should a nurse set up for next?

A

Synchronized cardioversion

53
Q

Signs of an retroperitoneal bleed

A

Hypotension and sever lower back pain

54
Q

After sheath removial your pt complains of severe back pain

A

Stop anticoagulant. Apply pressure if needed and call dr

55
Q

Nitro prissier toxicity

A

Mental status changes, tachycardia, seizures, needing an increased dose, metabolic acidosis

56
Q

What differentiates HTN crisis vs urgency

A

Presents of acute end organ damage. Risk of stroke

57
Q

Name the 6 p’s

A

Pain, pluslessness, pallor, parenthesis, paralysis, poikilothermia,

58
Q

What is a normal ankle brachial index

A

Normal is >1

59
Q

Management of acute peripheral vascular disease

A

Bed in reverse trendelenburg but do not elevate the extremity. Medicate with thrompolytics, anticoagulant, antiplatelets and vasodilators

60
Q

What electrolytes prolong QT

A

Hypokalemia, hypocalcemia, hypomagnesium

61
Q

Drugs that prolong QT

A

Amiondarone, quinidine, haldol, procainamide

62
Q

Treatment for polymorphic VT

A

Torsades de pointes

Magnesium

63
Q

1st initial of a pacer

A

Chamber paced

64
Q

2nd initial of pacer

A

Chamber sensed

65
Q

3rd initial of pacer

A

Response

66
Q

What are the 3 responses possible by a pace maker

A

I=Inhibits demand
D= inhibits and triggers
O= none

67
Q

Explain the three pacer malfunctions

A

Failure to pace (no spike when expected)
Failure to capture (spike and no response)
Failure to sense (pace native beets)

68
Q

ICD tiered therapy

A

Shock- defib and cardiovert
Burst- senses tachy and burst more tachy to break rhythm
Brady- paces brady rhythms

69
Q

A pt with a pacer shows VT on the monitor. The pacer does not correct the rhythm what do you do

A

Place pads and shock as normal. Do not place them over the pacemaker though

70
Q

What is acute decompensated heart failure

A

Abrupt onset requiring hospitalization

71
Q

Systolic dysfunction ejection fraction

A

<40%

72
Q

Diastolic heart failure ejection fraction

A

EF >50%

73
Q

What does a high BNP suggest

A

Stress on the walls of the heart

74
Q

Primary problem and systolic heart failure

A

Ejection problem heart can fill okay

75
Q

Primary problem and diastolic heart failure

A

Hypertrophied chamber or septum heart can eject OK

76
Q

Signs of systolic heart failure

A

Deviated PMI, dilated LV, mitral insufficiency, S3, pulmonary edema, BP normal to low, BNP elevated, large heart on chest x Ray, PMI shift

77
Q

Treatment for systolic HF

A

Beta blockers, ACE, ARB, diuretic, dilators, aldosterone antagonists, positive inotropes,

78
Q

Signs of diastolic heart failure

A

Thick ventricular wall, normal contractility, normal EF, pulmonary edema, S4 with HTN, BP high, elevated BNP, normal chest x Ray, possible LV hypertrophy pattern on ECG

79
Q

Treatment for diastolic HF

A

Beta blockers, ACE ARB, Ca channel blockers, low dose diuretic, aldosterone antagonist

80
Q

Causes of right sided HF

A

Acute RV infarct, PE, septal defects, pulmonary stenosis/ insufficiency, COPD, Pulmonary HTN, LV failure

81
Q

Causes of left sided HF

A

CAD, ischemia, MI, cardiomyopathy, fluid overload, HTN, Aortic or Mitral stenosis/insufficiency, tamponade

82
Q

Signs of right sided HF

A

Hepatomegaly, Splenomegaly, dependent edema, elevated CVP/JVD, tricuspid insufficiency, abd pain

83
Q

Signs of left sided HF

A

Orthopnea, dyspnea, tachypnea, hypoxemia, tachycardia, crackles, pink sputum, frothy sputum, elevated PA diastolic and PAOP, diaphoresis, anxiety, confusion

84
Q

Class 1 HF

A

HF signs with extraordinary activity

85
Q

Class 2 HF

A

Signs of HF with ordinary activity

86
Q

Class 3 HF

A

HF symptoms with minimal activity

87
Q

Class 4 HF

A

Signs of HF at rest

88
Q

What is dilated cardiomyopathy

A

This is a systolic problem. The heart isn’t ejecting enough blood

89
Q

What is hypertrophy cardiomyopathy

A

This is a diastolic heart problem. The heart needs help filling

90
Q

Dilation of the LV May lead to what heart murmur

A

Mitral regurgitation

91
Q

S3 and S4 can be heard in what type of cardiomyopathy and heart failure

A

Hypertrophic and diastolic

92
Q

Clinical presentation of the compensatory stage of cardiogenic shock

A

Tachycardia tachypnea crackles mood hypoxemia respiratory alk or early metabolic acidosis anxiety irritability JVD S3 S4 cool skin low urine output narrow pulse pressure BP maintained or lower

93
Q

Clinical presentation if the progressive stage of cardiogenic shock

A

Hypotension worsening tachycardia tachypnea oliguria metabolic acidosis worsening crackles and hypoxemia clammy mottled skin worsening anxiety and lethargy

94
Q

Name positive inotropes

A

Norepi dopamine 4-10mcg/kg/min dobutamine and milrinone

95
Q

IABP inflation does what

A

Increases coronary artery perfusion at the diacritic notch

96
Q

IABP deflation does what

A

Decreases after load and deflates at systole. Triggered by R wave or upstroke of a line

97
Q

What should a nurse expect to do when prepping a pt for a CABG

A

Hemodilute with isotonic crystalloids

98
Q

Post CABG complications

A

Hemodynamic abnormalities arrhythmias Tamponade Pericarditis (Dresslers syndromes) Electrolyte abnormalities bleeding pulmonary renal glycemic control gastrointestinal infection

99
Q

What is the upper limit for a chest tube to put out after a CABG

A

> 100 mL in 2 consecutive hours

100
Q

After valve replacement what is important for a nurse to consider

A

Avoid dropping preload because a chronic high SBP may lead to hypotension
ASA and clopidogrel
Temporary pacing for arrythmias

101
Q

Signs of tamponade

A

Restlessness and agitation hypotension JVD equalization of CVP and pulmonary artery diastolic and PAOP muffled heart tones and enlarging on a xray narrow pulse pressure and pulses paradox

102
Q

What is pulses paradoxes

A

> 12mmHg drop in SBP during inspiration

103
Q

A pt recipes trauma to their chest. Which valve is most likely to be involved

A

Aortic valve is most superficial

104
Q

AAA symptoms

A

Usually asymptotic it pulsating abdomen and and low back pain nausea vomiting and shock

105
Q

TAA symptoms

A

Sudden rip or tear pain in chest radiating to shoulders and back cough hoarseness dysphasia dyspnea difficulty walking and speaking dizziness widened mediastinum on X-ray

106
Q

Heart rhythms that develop from an anterior MI

A

Second degree type 2 or RBBB

107
Q

Heart rhythm that develops in inferior MI

A

2nd degree type 1 3rd degree sick sinus and sinus bradycardia

CCRN (2 decks)

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