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CCRN > Cardiovascular > Flashcards

Cardiovascular Flashcards

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1
Q

S1 heart sound

A

Closure of AV (mitral, tricuspid) valve
Loudest at apex
Beginning of systole

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2
Q

S2 heart sound

A

Closure of semilunar (aortic, pulmonic)
Loudest at base
Beginning of diastole
Louder with PE

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3
Q

S3 heart sound

A

Rush into dilated ventricle

Associated with HF, pulm HTN, cor pulmonale, mitral/aortic/tricuspid insufficiency

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4
Q

S4 heart sounds

A

Caused by atrial contraction into non compliant ventricle

Associated with ischemia, infarct, HTN, vent hypertrophy, aortic stenosis

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5
Q

Pericardial friction rub

A

Due to pericarditis

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6
Q

Murmurs

A

Valvular disease, septal defects

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7
Q

When are coronary arteries perfused?

A

Diastole

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8
Q

Systolic BP is an indirect measurement of?

A

CO and stroke volume

Narrowing pulse pressure often see. With hypovolemia or severe drop of CO

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9
Q

Diastolic BP is an indirect measurement of?

A

systemic vascular resistance

Widening pulse pressure may indicate vasodilation, drop is SVR or severe sepsis

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10
Q

Causes of valvular heart disease

A 
coronary artery disease, ischemia, MI
Dilated cardiomyopathy 
Degeneration 
Bicuspid aortic valve (genetic)
Rheumatic fever
Infection 
Connective tissue disease
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11
Q

Murmurs of insufficiency:

A

Occurs when valve is CLOSED

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12
Q

Murmurs of stenosis:

A

Occurs when valve is OPEN

Chronic problem

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13
Q

Systolic murmurs

A

Semilunar valves are OPEN during systole
Aortic stenosis and pulmonic stenosis
AV valves are CLOSED during systole
Mitral and tricuspid insufficiency
Ventricular septal defect

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14
Q

Diastolic murmurs

A

Semilunar valves are CLOSED during diastole
Aortic and pulmonic insufficiency
AV valves are OPEN during diastole
Mitral and tricuspid stenosis

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15
Q

ECG lead changes & location

A 
II, III, aVF - RCA, interior LV
V1, V2, V3, V4 - LAD, anterior LV
V5, V6, I, aVL - circumflex, lateral LV
V5, V6 > low lateral LV
I, aVL > high lateral LV
V1, V2 - RCA, posterior VL
V3R, V4R - RCA, RV infarct
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16
Q

Treatment of STEMI criteria

A

ST elevation in 2 or more continuous leads OR new onset LBBB
Onset of CP < 12 hours
Chest pain of 30 mins
CP unresponsive to nitro

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17
Q

Inferior MI

A 
RCA occlusion 
ST elevation in II, III, aVF
Associated with AV conduction disturbances, RV infarct, posterior MI
Development of systolic murmur
Tachy
Use BB & NTG with caution!!!
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18
Q

RV infarct

A

30% have of inferior wall MI have RV infarct

S/S - JVD at 45, high CVP, hypotension, Brady, V4R ST elevation

Give - positive inotropes, fluids

Avoid - preload reducers: nitrates, diuretics

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19
Q

Anterior MI

A

LAD occlusion
V1-V4 ST elevation
May develop second degree type 2 or RBBB ***
Systolic murmur
Higher mortality than inferior: HEART FAILURE

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20
Q

Complications of MI

A

Arrhythmias!

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21
Q

Complications of PCI

A

Coronary artery perf
Stent thrombosis **
Stroke
Retroperitoneal bleed **

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22
Q

Vasovagal response during sheath removal

A

Hypotension with/without bradycardia
Absence of compensatory tachycardia
Pallor, nausea, yawning, diaphoresis

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23
Q

Vasovagal management

A

Hold nitrates
Atropine (even if not brady)
IV bolus if unresponsive to atropine

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24
Q

Hypertensive emergency def

A

Elevated BP with evidence of end organ damage

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25
Hypertensive urgency def
Elevated BP without evidence of end organ damage
26
PAD S/S
Pain, pallor, pulse absent, paresthesia, paralysis, poikilothermia (loss of hair, glossy)
27
Ankle-brachial index
Normal > 1
28
Patient care management of PAD
Bed in reverse trendelenburg | Do NOT ELEVATE
29
Prolonged QT
Causes - drugs (amio, quinidine, haldol, procainimide), electrolyte problems (hypo)
30
Systolic dysfunction
EF <40%, problem with ejection
31
Diastolic dysfunction
EF >50%, problem with filling
32
Pathophysio of acute decompensated systolic dysfunction
CAD, cardiomyopathy, arrhythmia, valvular dysfunction > Wall motion abnormality, LV unable to eject > Pulm edema, hypoxemia > ^SVR, vCO > vBP, ^SVR
33
Pathophysio of HF with diastolic dysfunction
HTN, valvular disease, hypertrophic cardiomyopathy > Stiff LV, impaired filling > Pulm edema
34
Signs of systolic HF
Ejection problem Dilated LV, valve insufficiency, EF<40, pulm edema, s3, BP norm/low, enlarged on imaging
35
Treatment of systolic HF
BB, ACEs/ARB, diuretics, dilators, aldosterone antagonist, positive inotropes
36
Signs of diastolic HF
Filling problem Normal vent size, thick walls or septum, normal EF, pulm edema, s4 with HTN
37
Treatment of diastolic HF
BB, ACE/ARB, calcium channel blockers, diuretics, aldosterone antagonist
38
Causes of R sided HF
Acute RV infarct, massive PE, septal defects, pulm stenosis/insufficiency, COPD, pulm HTN, LV failure
39
Causes of L sided HF
CAD, ischemia, MI, cardiomyopathy, fluid overload, uncontrolled HTN, aortic or mitral stenosis/insufficiency, tamponade
40
S/S of R sided HF
Hepatomegaly, splenomegaly, dependent edema, JVD distention, elevated CVP, tricuspid insufficiency, abdominal pain
41
S/S of L sided HF
Orthopnea, dyspnea, hypoxemia, tachycardia, crackles, cough, elevated PA, diaphoresis, anxiety
42
Dilated cardiomyopathy
SYSTOLIC dysfunction, problem ejecting Signs - thinning, enlargement of LV, mitral regurg Symptoms similar to systolic HF May need VAD or transplant
43
Hypertrophic cardiomyopathy
DIASTOLIC dysfunction, problem filling Signs - increased thickening of muscle and septum Symptoms similar to diastolic HF - fatigue, dyspnea, CP, palpitations Increased right of sudden cardiac death ***
44
Causes of cardiogenic shock
EXTREME DROP IN STROKE VOLUME secondary to systolic dysfunction Acute MI, CHF, cardiomyopathy, dysrhythmias, tamponade, papillary muscle rupture (emergency)
45
Compensatory cardiogenic shock
Tachycardia, tachypnea, crackles, resp alkalosis, anxiety, JVD, S3, cool skin, decreased UO, NARROW PULSE PRESSURE, BP norm/low
46
Progressive cardiogenic shock
Hypotension, worsening tachycardia, oliguria, metabolic acidosis, worse crackles, hypoxemia, skin clammy, lethargy
47
Treatment of cardiogenic shock
Identify, manage arrhythmia, repercussions if STEMI, surgery if ruptured papillary or VSD
48
Cardiogenic shock: enhancing pump effectiveness
Positive inotropes (Levo, dopamine, dobutamine) AVOID neg inotropes Vasodilators may be used in conjunction with IABP
49
Cardiogenic shock: decrease demand
``` Preload reduction After load reduction Optimize oxygenation Mechanical ventilation Treat pain IABP short term VAD for long term ```
50
VAD used for?
LV HF, cardiogenic shock, and cardiac myopathies or those awaiting transplant
51
Benefits of IABP: inflation
Increases coronary artery perfusion Inflates at dicrotic notch of art waveform, beginning of diastole
52
Benefits of IABP: deflation
Decreases afterload Deflates before systole begins
53
Reasons for CABG
Chronic angina unresponsive to medical therapy, not candidate for PCI Left main lesion 3 vessel disease
54
Post op CABG complications
Hemodynamic abnormalities, arrhythmia, TAMPONADE, PERICARDITIS, bleeding, pulm, renal, endocrine (BG)
55
Chest tube management of CABG
Mediasternal tubes remove serosang fluid for operative site Pleural remove air, blood, or serous fluid If output >100 for 2 hours consecutively > stability, correct volume status, blood products
56
Causes of cardiac tamponade
Post op surgery, pericarditis, trauma
57
S/S of tamponade
Restlessness, agitation, hypotension, increased JVD, equalization of CVP, pulm artery diastolic and PAOP, muffled heart tones, enlarge on imaging NARROWED PULSE PRESSURE
58
Pulsus paradoxus
Excessive drop is SBP during inspiration > with inspiration intrathoracic pressure increases and venous return decreases Caused by cardiac muscle restriction due to tamponade
59
Etiology of pericarditis
Trauma, viral, MI, post op, radiation, Dressler’s syndrome
60
S/S of pericarditis
CP, pain worsens with inspiration, dyspnea, low grade temp, increased sed rate, ST elevation in all leads, tamponade
61
Treatment of pericarditis
Analgesics, anti inflammatory agents, NSAIDS, steroid, antibiotics, monitor for worsening, constriction, and tamponade
62
Etiology of myocardial contusion
TRAUMA - worse outcome than pericarditis, similar to MI, dysrhythmias, death within 48 hrs
63
Signs of cardiac trauma
CP, pain worse with inspiration, dyspnea, low grade temp, ST elevation
64
Etiology of aneurysms
Arteriosclerosis, HTN, smoking, obesity, bacterial infection, congenital anomalies, trauma, Marfans syndrome
65
Abdominal AA
75% Asymptomatic if small, pulsations in abdominal area, abdominal/low back pain, N/V, shock
66
Thoracic AA
25% Sudden tearing pain in chest radiating to shoulders, back, neck Cough, dysphagia, dyspnea, dizziness, difficulty walking, widening mediastinum
67
Treatment of aneurysms <5 cm
Monitor regularly (US/CT), treat HTN with BB
68
Treatment of aneurysms causing symptoms or >6 cm
Surgical repair, aggressive treatment of HTN and HR control
69
Aortic dissection
Tear is spiral, sudden or gradual, ascending aorta or aortic arch, life threatening

CCRN (2 decks)

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