Cardiology Flashcards

Question

Hypertension Pharmacology Diuretics

Answer 1

Diuretics Decrease BP Drain Fluid (urinate) Dehydrate (dried body)

Answer 2

Potassium sparing (caution: Avoid potassium) S - SpironolACTONE S- Spares potassium Blocks aldosterone Avoid salt substitutes

Answer 3

K+ wasting (caution: hypokalemia 3.5 or less) FurosemIDE HydrochlorathiazIDE DrIED *only give potassium wasters if potassium is normal (3.5-5.0) * not isorbIDE (nitrate used for chest pain) Eat foods high in potassium

Answer 4

Dilators decrease BP by dilating the blood vessels D: Decrease BP D: Dilates Vessels D: Decrease vascular Resistance Nitro = pillow for the heart Never give if a patient is on viagra or erectile drugs - significant drop in BP will kill pt ex. Sildenafil

Answer 5

Help to prevent clots and help with plaque build up in the arteries Anti Platelet ASA Clopidogrel (plavix) Caution: Bleeding Cholesterol Lowering lovaSTATIN “stay clean” cleans out arteries Caution: Liver Toxic, no grape fruit

Answer 6

coronary arteries deliver a constant supply of blood to the heart muscle begin to develop fatty plaques that can lead to restriction of blood flow to the heart Fatty plaques are caused by a condition called ATHEROSCLEROSIS Happens overtime Limits blood supply to the heart muscle and can rupture which can lead to thrombosis formation (hence causing a myocardial infarction) Atherosclerosis can also lead to hypertension, chest pain, and heart failure.

Answer 7

Build up of plaque on the artery walls asymptomatic until the plaque becomes so big the artery starts to become narrow and blood flow to the heart becomes restricted. The patient can experience stable angina but the patient only has the chest pain during ACTIVITY. The activity increases the heart rate and puts strain on the heart which already has compromised blood flow, but when the activity STOPS the pain STOPS too.

Answer 8

This can develop if chronic ischemia is experienced. This is where more than one artery forms to re-route blood to the heart muscle to make up for the decreased blood flow due to the blockage.

Answer 9

The left main coronary artery supplies blood to the left side of the heart (left ventricle and left atrium)

Answer 10

Right coronary artery provides blood to the right atrium and ventricle and the SA (sinoatrial) and AV (atrioventricular) nodes which regulatethe heart rhythym. The right coronary artery divides into smaller branches including the Right posterior descendng artery Acute marginal atery

Answer 11

Smoking Unhealthy: obese or overweight High cholesterol Sedentary lifestyle Diabetes Family history

Answer 12

Chest pain Shortness of Breath Fatigue

Answer 13

Blood test: Lipoprotein profile: total cholesterol, LDL, HDL, triglycerides Stress test: monitor the heart rate and rhythm during exercise and see if there are any EKG changes Heart Cath: a special catheter is inserted into the femoral or radial artery to assess for blockages in the artery. Dye is injected into the coronary arteries to assess if they are blocked (coronary angiography)…moderate sedation is used and the patient breathes on their own.

Answer 14

Cardiac doctor makes the decision if the artery needs: PCI (also called angioplasty): Percutaneous Coronary Intervention Balloon angioplasty: inflates a balloon in the blocked artery to compress the plaque against the artery wall and a stent is placed to allow blood to flow back through the artery. Atherectomy: removal of plaque from the artery

Answer 15

Educate the patient about the significance and complications of CAD Modifying lifestyle: How to manage with diet (low fat, low calorie) Exercise program Smoking cessation and why it is important Weight loss Monitoring heart rate and blood pressure Signs and symptoms and when to seek help

Answer 16

Pain during exercise or stress Stable (chronic) angina is the most common type of angina Usallyuindicates 70% of the artery is blocked by plaque build up Chest pain during times of exertion or emotional stress because the body needs more blood then the artery can supply Pain usually goes away with rest

Answer 17

Reduced blood flow which causes ischemia (lack of blood flow and oxygen) to the heart, almost like the heart is being strangled which causes terrible chest pain Underlying cause of stable angina is atherosclerosis of one or more of the coronary arteries

Answer 18

Epicardium (outermost) Myocardium (middle) Endocardium (inside heart)

Answer 19

Chest pain during exercise or rest aswell as at REST, doesn’t go away Emergency: High risk of progressive to MI (heart attack) Unstable angina = heart tissue is alive but ischemic (starving for oxygen and blood) Myocardial Infarction = tissues have already began too necrose or die

Answer 20

Caused by rupture or astheroscerlotic plaque or thrombosis (blood clot forms on top of plaque) Although the occlusion might not block the entire vessel there is now even less room for blood to flow by and the heart tissue is starting to feel starved for oxygen even while pumping at a normal rate

Answer 21

Nitroglycerin is typically given to open up coronary artery Pill or Spray: Stable angina - take before strenuous activity Call 911 if there is still pain after 1st dose 3 doses max 5 min apart No swallowing: Sublingual Keep in dark original container, avoid light and heat, replace every 6 months Nitro patch: Unstable angina, can happen at anytime Apply 1 time per day not PRN Never use two patches Patches are shower safe Rotate locations daily. Clean, dry, shaven area If patch falls off: (over 1 hour ago) take pill/spray, patch can take 40-60min to work Nurses - always wear gloves, very potent to the skin

Answer 22

Describes a range of conditions related to sudden, reduced blood flow to the heart. These conditions include a heart attack and unstable angina

Answer 23

SODDA Stress, stimulants (caffeine, amphetamines) Smoking Obesity (BMI over 25) Diabetes and Hypertension (140/90) Diet High cholesterol African American male Age (over 50) Men more common than women

Answer 24

Heart need oxygen to pump, during an MI there is a blockage in the coronary arteries so the heart muscle suffocates to death 500 cells die per minute, if blocked over 45 minutes these cells can die permanently called necrosis Narrowing and blockage is called by plaque build up (CAD, Atherosclerosis)

Answer 25

when the heart dies it releases enzymes called Troponin #1 Indicator of an MI Trop over 0.5 indicates trauma to the heart. when the heart muscle dies This protein leaks out into the blood along with potassium so patients will also have high potassium

Answer 26

Disease causing low oxygen to the heart. Can start as Coronary Artery Disease, Stable Angina (chest pain) and progress to Acute Coronary Syndrome which encompasses unstable angina and MI

Answer 27

Key Words: Chest pain: “sudden, Crushing, radiating, heavy pressure” Pain: Substernal Chest pain Jaw pain Left arm Mid back/shoulder pain Heartburn (epigastric pain) SOB: Dyspnea, laboured breathing Nausea Vomiting “abdominal pain” Sweating: Diaphoresis Pale cool skin “dusky” Anxiety MI in diabetics and Women often go unnoticed

Answer 28

Any new chest pain always requires an EKG first ST elevation: if ST is high then heart muscles have died if ST is low we think low O2 ST depression (low O2) T wave inversion caused by low O2 or ischemia, meaning only partial blockage or it could be hypokalemia ST segments usually go back to normal when we get reperfusion

Answer 29

Goal is to unclog the coronary artery within 45 minutes, patients are taken to the Cath lab immediately to locate and fix the blockages we call it the ABCs of MI surgery Angioplasty: PCI used to visualize and move aside the blockages with either ballon for stent Bypass CABG: goes around more severe blockages using piece of vein or artery from another part of the body usually the leg Cut out the fatty Blockage - Endarterectomy

Answer 30

use thrombolytics AKA clot blusters if surgery is not immediately available TPA (amionolase) or Streptokinase usually not routinely given as first-line since they can cause massive bleeding have to be given two to six hours of initial MI Bleeding Risk 8 hour window no injections (IV, SQ, IM, ABG) Not given through central line

Answer 31

Non MI Different test to diagnose the narrowing Stress test seeing how it does with low oxygen, done to help pinpoint potential blockages so two types of stress tests are given

Answer 32

Different test to diagnose the narrowing Stress test seeing how heart does with low oxygen done to help pinpoint potential blockages so two types of stress tests are given Exercise or treadmill stress test: looking for ST changes ALWAYS Stop for chest pain or ST changes Non Exercise called nuclear pharmacological: radioactive dye is injected into the vessels acting like a highlighter to pinpoint potential blockages *teach the patient to avoid meds and stimulants that can alter the test 24-48 hours before: Avoid cigarettes and caffeine: tea, soda, coffee NO DECAF Avoid Meds: Nitro, beta blockers Theophyline (stimulant causing narrowing) Not eating for drinking 4 hours before and after the test

Answer 33

OANM Oxygen Aspirin Nitro Morphine: helps heart to relax * any chest pain after morphine indicates MI More pain = more tissue death

Answer 34

Next: Clot Cath lab (PCI - percutaneous coronary Intervention) or one of thre treatment procedures, balloon, bypass etc. Clot buster: TPA to dissolve the clot Fibrinolytics AKA clot busters one time push drugs

Answer 35

After: Rest and Prevent Clots Prevent/stabilize clots Heparin IV: heparin does not dissolve clots, only clot busters dissolve clots (TPA) Prevent clots by thinning the blood, huge bleed risk Therapeutic range for coagulation therapy PTT 46-70 (standard is 3x max range) Antidote: protamine sulfate Heart Rest: Nitro IV Drip Beta blocker CCB avoid high sodium foods

Answer 36

Acute: Cardiogenic Shock: Severe low BP Dysrhythmias (V-fib/V-tach) Chronic: Heart Failure Other Complications Pericarditis Mitral Valve Prolapse

Answer 37

The inflammation to the sacs around the heart can lead to deadly pericardial effusion or cardiac tamponade Priority S/S Remember BEC B: Big JVD E: extremely low BP C: Cant hear heart sound (muffled or distant)

Answer 38

Heart squished to death by its own blood sac causing the heart to stop beating

Answer 39

The little cords holding the valves can suddenly snap loose from a dead heart muscle patients will have a heart murmur and even develop atrial fibrillation from blood backing up stretching out those atria

Answer 40

Heart Failure: Think heavy fluid. The Heart fails to pump blood forward and now backs up into the lungs and our body eventually drowning the patient. HF results from a dysfunctional pump that causes fluid to back up As a result of less cardiac output and less O2 circulating the body the kidneys get less blood low and think that the body has low blood pressure (low blood volume) The body then mistakenly increased the already high blood volume by stimulating the sympathetic nervous system too increased the HR and constrict the blood vessels

Answer 41

(reinin angiosensin Aldosterone System) HF activates the RAAS system which retains fluid. by locking the kidneys and constricting the blood vessels no now there are two problems 1. Already weak pump with increasingly high blood volume high blood pressure 2. Increased fluid and fluid unable to be excreted *to fix this give drugs that block or cut the communication lines to aldosterone prills, sartre, actone ending drugs

Answer 42

Adds sodium and water to the body which increases blood pressure and let's potassium out of the body. Without aldosterone we lose too much water and have too much potassium in the body

Answer 43

Leading to high. potassium over 5.0 Lisinopril (ACE) LoSartan (ARBs) Spironolactone (Diuretic)

Answer 44

Always Report: Rapid weight gain Worsening crackles Sudden Edema/JVD New S3 heart sounds or murmurs

Answer 45

Left sided HF can cause Right sided HF pulmonary Hypertension Disease of lungs like COPD Distructive sleep apnea

Answer 46

Rocks the body with fluid "Peripheral Edema" Weight Gain = Water gain Over 3 lbs in 1 day or 5 lbs in 7 days is very bad Edema (pitting) JVD Abdominal growth: Ascities, hepatomegaly (big liver), Splenomegaly (big spleen)

Answer 47

Think L for lungs Lungs build up with fluid "Pulmonary Edema” More serious affects ABCS Crackles “rales” (not rhonci or wheezes) Frothy pink - blood tinged sputum Dyspnea Orthopnea

Answer 48

Damage to the myocardial heart muscle, making the heart weak = weaker pump, usually from MI or ischemic heart disease

Answer 49

#1 IDE ending drugs Furosemide Bumetanide “HOPE” H - HOB 45% semi or high fowlers O - Oxygen P - Push Furosemide + morphine (morphine decreased workload on the heart). E - Ending all sodium and fluids, no drinking fluids, stopping IV fluids

Answer 50

Clear lung sounds Decreased HR

Answer 51

Always question DR. order that wants to give fluids even maintenance fluids for worsening HF Always reassess pt if being transferred to another floor Sodium swells body - nothing from a package, not salad dressings, sauces, meats, cheeses. Nothing over the counter, no Tylenol for cold and flue meds

Answer 52

BNP B-type Natriuretic Peptides Echocardiography Hemodynamic Monitioring “Swans Ganz Cath” : measures CVP central venous pressure (Normal 2-8) Over 8 = BAD

Answer 53

Diet: Low sodium and Fluid 2L or less, 2g off salt or less No canned or packaged foods No OTC meds (cold and flu, acetaminophen, antacids, NSAIDs) Risk for falls (change position slowly) BP and BNP (should NOT be increasing)’Elevate legs (with. pillows). high fowlers DAILY WEIGHTS (3lbs/day or 5lbs/7 days = worsening) Sex (2 flights of stairs with no SOB) Stockings. (decrease blood pooling, remove daily) Never massage calves of CHF patients

Answer 54

HF = heart failure = heavy fluid Sodium = Swells

Answer 55

Walking Increase Fibre Stool Softeners NO drinking extra water!!!

Answer 56

Give Bumetanide IV push

Answer 57

Inflammation of the inner lining of the heart, mainly the chambers and the valves Infective indicates caused by bacteria or fungi Inflammation more common on left side of heart where aortic and mitral valve are (bicuspid valve)

Answer 58

Three main layers of the heart Epicardium: outer layer that protects the heart Myocardium: muscle layer inside the heart Endocardium: Inner layer where blood gets pushed around (this layer gets inflamed during endocarditis) Bacteria builds up around valves and grows bigger and bigger eventually clogging the valve doors in the heart which impairs pumping = less cardiac output = less oxygen to the body. Can be heard in a swooshing heart sound

Answer 59

Inflammation = Murmurs and clots Infectious mold (bacteria, viral or fungal) = fever Low cardiac output = low oxygen, could lead to HF Lung fluid heard as crackles and spleen enlarged due to infection Very Specific and Classic Symptoms: Splinter Hemorrhages (finger nails) Oslers Nodes (hands) Roth Spots (eyes) Janeway Lesions Symptoms due to low oxygen Fatigue Pain in the chest when breathing Clubbing of fingers (hypoxia) Anorexia and weight loss Petechiae (red bumps)

Answer 60

Staphylococcus Steptococci These can start as strep throat and move into the lungs and heart causing pneumonia and endocarditis leading to death

Answer 61

Stroke, caused by piece of mold that breaks off and clogs the arteries of the brain Embolic CBA Monitor for changes of LOC confusion, agitation

Answer 62

IV drug and dirty needles Valve replacement surgery Dental Visits

Answer 63

3 different types of cardiomyopathy Dilated: Distended heart muscle Restrictive: Rock hard heart muscle Hypertrophic: Huge heart muscle

Answer 64

Disease of the Heart Muscle (myocardium) which inhibits effective pumping pump failure = less cardiac output = less oxygen to the body

Answer 65

Most common Distended heart muscle Heart muscle being stretched = lose valves so they don't close all the way = weak squeeze for systolic pressure = pump failure Blood will back up into the lungs Signs and symptoms are similar to HF Low O2, syncope and ALOC, narrow pulse pressure (numbers are closer together, S3 Murmur

Answer 66

Increase Cardiac output which will increase O2 into the body These meds clam the heart and lower BP and heart rate Ace inhibitors: Drop BP Beta Blockers: Slow HR Calcium Channel Blockers: Decreases BP, lowers HR Digoxin: Deep contraction, slows HR, hold med if apical pulse less than 60, check potassium levels., monitor for toxicity over 2.0 (vision changes are first sign of toxicity) Diuretics: Decreases BP by removing fluid from the body, potassium wasting (keep potassium intake high) If medications do not fix condition, surgery is the next fix LVAD (left ventricular assist device) helps the ventricle pump Heart Transplant

Answer 67

Heart muscles thick and stiff, hard like a rock. Stops ventricles from stretching making it hard to refill. Less blood in Less cardiac output = less oxygen to the body pump failure Signs and Symptoms similar to HF

Answer 68

Genetics Damage - from radiation

Answer 69

Decrease radiation exposure Heart Transplant

Answer 70

Thick, huge heart Septum enlarged limits the heart from filling Less blood in Less cardiac output Less oxygen out to the body The heart muscle starts to grow and obstructs the aortic valve blocking all the Oxygenated blood going out to the body, happens during exercise (sudden strain) = sudden death in a matter of minutes

Answer 71

No signs and symptoms and is usually undiagnosed Common in young active children Deadly Diagnosed early in child hood Only Cause is Genetic

Answer 72

Heart Murmur detection, systolic ejection murmur pt will be asked to bare down as Dr. listens to the heart Echo will show septal wall thickening

Answer 73

Surgery is the best option if on medications: Only give beta blocker and calcium channel blockers Never give Dilators (nitro) Digoxin Diuretics

Answer 74

Avoid (deadly) Heavy lifting (bearing down to poop) Burst of activity (sprints) Sudden position changes

Answer 75

Inflammation of the fibrous sac surrounding the heart pericardium = layer around the heart Acute pericarditis = lasts several weeks Chronic pericarditis = lasts over 6 months (constructive pericarditis) sac around the heart becomes thick and hard Can lead too pericardial effusion, cardiac tamponade

Answer 76

Narrow arteries oxygen can’t get down to the distal extremities fingers and toes Oxygen problem, narrow arteries making the pumping off oxygen away from heart difficult = ischemia and narcosis Cold legs and weak pulses Sharp calf pain

Answer 77

Hang leg over the bed, helps blood flow

Answer 78

Signs and Symptoms Absent of pulses and air (shiny) cool legs Round red sores Pale toes and feet, Black Eschar Sharp calf pain during exercise or elevation Intermittent claudication = calf pain = warning sign for low oxygen

Answer 79

Causes: smoking Diabetes High cholesterol High BP

Answer 80

No heating pads Dont elevate legs Swelling of legs is not expected

Answer 81

Narrow veins Veins bring oxygen back to the heart = problem brining blood back to the heart = blood pools in the leg Not an oxygen problem Sign and Symptoms Voluptuous pulses = warm legs Edema where blood starts pooling Irregular shaped sores (exotic pooling) No sharp pain, dull pain Yellow and brown ankles

Answer 82

Sign and Symptoms Voluptuous pulses = warm legs Edema where blood starts pooling Irredgular shaped sores (exotic pooling) No sharp pain, dull pain Yellow and brown ankles

Answer 83

Treatment Veins = Elevate limbs helps bring blood back to heart

Answer 84

6 P’s = O2 assessment Pain: unrelieved at rest Parasthesia: numbness and tingling Prioritization = oxygen problem Pulses: diminished weak pallor: Pale Polar: Cold Paralysis: inability to move limb

Answer 85

a balloon-like bulge in the aorta the large artery that carries blood from the heart through the chest and torso. Aortic aneurysms can dissect or rupture

Answer 86

Normal 2-8 Above 8 = fluid overload, right ventricular failure

Answer 87

Count Clients HR

Answer 88

Bruit is turblent blood flow Blood flowing througha narrwed Artery

Answer 89

Symptoms associated with HF Crackles Heart murmur Decreased urinary output Diaphoresis during feedings SOB

Answer 90

Atrial paced rhythm

Answer 91

Pain affecting the calf that is induced by exercise and relieved by rest

Answer 92

PTT levels and ECHO

Answer 93

Combination of 4 heart defects present at birth Oxygen poor blood to flow out of heart and into the rest of the body Cyanosis when crying = put infant in knee to chest position, helps improve oxygenation

Answer 94

Carvedilol

Answer 95

Maintain adequate potassium

Cardiology Flashcards

(120 cards)