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CCRN > Cardiovascular > Flashcards

Cardiovascular Flashcards

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1
Q

Normal cardiac output, or volume of blood ejected by the heart in 1 minute is how much?

A

4-8L/min

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2
Q

Which is more accurate CI or CO and why?

A

CI because it adds the body surface area of the individual into the equation. So size doesn’t matter

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3
Q

What is the normal Cardiac Index?

A

2.5-4.3L

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4
Q

What is the concern when a patient becomes tachycardic? Who is this especially dangerous for?

A
  • The heart is unable to fill due to rapid rate so it decreases cardiac output
  • The coronary arteries are unable to perfuse

If someone has CAD and tachycardia they will develop ischemia rapidly

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5
Q

What is the normal stroke volume and what does that tell you?

A

Stroke Volume- the volume of blood ejected with each heart beat

  • normal 60-100 ml/beat
    Or

SVI (with BSA)
35-60mL

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6
Q

What is preload?

A

The volume of blood in the ventricles at the end of diastole
Or

Pressure generated by the volume of blood in the ventricles at the end of diastole

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7
Q

What are two ways to determine preload?

A

RV: CVP RA Pressure

LV: PAOP LA pressure

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8
Q

What is the normal CVP?

A

0-5

Optimal varies 10

*if a patient is hypotensive they want the optimal level

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9
Q

What is the normal PAOP?

A

6-12

Optimal 14-18

  • if the patient is critically ill and hypotensive they want the CVP/PAOP higher
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10
Q

What medications reduce preload?

What would then increase preload

A

Vasodilators
Diuretics

Think Lasix and Nitroglycerin

Vasoconstriction and volume

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11
Q

What is afterload?

A

The pressure the ventricle must generate to open the semilunar valve and eject its contents

*the higher the afterload the greater the work
Increase myocardial oxygen demands

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12
Q

How to you assess afterload?

A

Left ventricle: SVR

Right ventricle: PVR

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13
Q

What is SVR? What is the normal SVR?

A

It reflects the overall resistance against systolic ejection.

The greatest resistance lies in the small arteries and arterioles

Normal SVR 800-1200

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14
Q

What are some things that decrease SVR? Think meds and disease?

A

Diuretics
Vasodilators (nitropruside/nicardipine)
Sepsis
End stage shock d/t loss of vasomotor tone

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15
Q

What increases SVR

A 
Vasopressors
Volume infusions
Peripheral vasoconstriction
LV failure
Increased blood viscosity
Hypothermia
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16
Q

What meds reduce afterload?

A 
Nitroglycerin
Nicardipine
Hydralazine
Isosorbide
CCB
Nitropruside
ACEI/ARB
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17
Q

What medications increase afterload?

A 
Epinephrine
Phenylephrine
Levophed
Dopamine
Vasopressin
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18
Q

What is the range for PVR?

A
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19
Q

What medications treat increased PVR?

A

Nitroglycerin
Hypoxia correction
Prostaglandins
Prostacyclin

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20
Q

What can cause increased PVR?

A 
Hypoxia
Pulmonary edema
Pulmonary embolism
ARDS
Sepsis 
Valvular heart disease
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21
Q

What is contractility

A

The ability of the heart to modulate its contractile performance independent of preload and afterload

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22
Q

What is a normal PAOP?

A

6-12

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23
Q

Normal PAP?

A

15-25/6-12

Systolic/diastolic

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24
Q

What can cause a high PAP?

A

Pulmonary HTN

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25
What can cause a low PAP?
Hypovolemia
26
What is the MAP? What is a normal MAP?
It is used to determine perfusion of vital organs 70-105
27
What is the first to suffer from a decreases MAP?
The gut and then the kidneys
28
Inotropic therapy can do what to your map (dobutamine/milronone)
Decrease it.
29
What are the determinants of SV? A. HR, CO, systolic BP B. Preload, afterload, contractility C. Cardiac Index, diastolic BP, HR D. MAP, CO, HR
B
30
Afterload is defined as... A. Decreased resistance B. Vasodilation C. Increased resistance D. Mean arterial pressure
C- due to vasoconstriction of the vascular bed
31
What two important things occur during diastole?
Ventricular filling and coronary artery perfusion
32
Name 2 inotropes
Dobutamine and milronone
33
Which inotropes is a phosphodiasterase inhibitor?
Milronone
34
Which inotropes is receptor dependent?
Dobutamine
35
Where are beta 1 and beta 2 cells?
Beta 1 heart, beta 2 lungs
36
Name catecholamines. How do they work?
Epinephrine and norepinephrine They work by stimulating beta 1 receptor sites, making CAMP which allows calcium into the cell
37
Dopamine is unique in that it has 2 effects which vary by dosing. What are these effects
2-10mcg/kg/min = increased contractility (beta effects) >10mcg/kg/min = vasoconstriction (alpha effects)
38
What medications can you never use through a peripheral line?
Vasopressors! Levophed phenylepherine, and dopamine
39
What are indications for dopamine use?
Shock states: Cardiogenic or septic Post cardiac surgery
40
Is dopamine first Line for shock? Why or why not
No Levophed is. This is due to higher incidence of tachyarrythmias using dopamine
41
What are SE from dopamine?
Tachyarrythmias and vasoconstriction
42
How does dobutamine work?
Increases contractility and HR with slight vasodilation
43
What should never run with dobutamine?
Alkaline solutions like sodium bicarbonate. *sodium bicarbonate should run alone in its own line
44
What are indications for dobutamine?
CHF | Shock states
45
Name some positive inotropes. What do they do?
They increase contraction Digoxin, phosphodiasterase inhibitors, catecholamines, Amiodorone, prostaglandins
46
What are negative inotropes? What do they do?
Weaken contraction, slow heart BB, CCB, quinine, procainamide
47
What are some indications for use of epinephrine?
``` Low output states Cardiac arrest Shock states Asthma Anaphylaxis ```
48
SE of epinephrine?
Severe hypertension Tachyarrythmias Restlessness and fear
49
Indications for Levophed?
Hypotension Cardiac and septic shock GI lavage
50
When using Levophed for a gastric lavage, what should you be sure to do?
Draw it in and back out. Never leave down an NGT
51
What makes phenyl ephedrine different than other catecholamines?
It's purely an alpha stimulator It won't increase HR like the other meds in its class, can actually cause bradycardia It's effects are primarily vascular by increasing SBP, DBP, and PAP
52
Milronone is a phosphodiasterase inhibitor indicated for what conditions?
Low CO Acute CHF Cardiomyopathy
53
Nitroglycerin works how?
``` Systemic and pulmonary vasodilation Decreases preload Decreases afterload Dilates the for coronary arteries Makes it harder for heart to fibrilate ```
54
Why is a 12 hour free time important with nitrates?
To decrease nitrate tolerance!
55
When giving nitropruside what must you watch for?
Cyanide poisoning Confusion Hyperreflexia Seizures *sodium thiosulfate is the antidote
56
Nesiritide is BNP. What does this do and what is it used for?
Vasodilates Diuresis HF patients
57
Nesiritide is incompatible with many medications and should be administered on its own. What are some MAJOR medications it interacts with?
Lasix, insulin, heparin
58
What are the 2 classes of CCB?
Nondihydropyridines (diltiazem, cardizem, verapamil) - stronger for arrhythmias dihydropyridines (nicardipine)- stronger vasodilators
59
Name pressor agents...
Levo, phenylepherine, vasopressin dopamine, epinephrine
60
What is the major effect of inotropes?
Increase contractility by facilitating the transport of calcium into the cell
61
What is the concern of giving nitropruside for greater than 72 hours?
Cyanide toxicity
62
This is a state caused by inadequate tissue perfusion in which cells are deprived of oxygen and anaerobic metabolism causes a production of lactic acid and an acidotic state
Shock
63
What happens to preload, afterload, and contractility during hypovolemix shock?
Preload- decreases Afterload increases (vasoconstriction) CO- decreases
64
What happens to preload, afterload, and SVR during carcinogenic shock?
Preload increases, afterload increases, and increase in SVR
65
How to manage cardiogenic shock
Pharm: inotropes to increase contractility and vasodilators to decrease SVR IABP VAD ECMO Transplant
66
Explain how IABPs work.
The IABP is inserted just below the subclavian artery. The balloon fills from the bottom to the top, pushing blood back up through the aortic arch and back towards the coronary arteries. This improves both coronary and cerebral perfusion. It deflates right before the aortic valve opens, greatly reducing afterload by sucking blood from the left ventricle
67
A patient in cardiogenic shock has a hemodynamic profile of: BP 90/56 HR 110. CO/CI: 1.4/0.8 PA: 36/20 PAOP: 18 SVR: 3000 RAP (CVP): 10 What is the BIGGEST concern? What would the next intervention be?
The SVR is very high The CO/CI is very low The SVR has increased the workload of the heart so much that the ventricle is unable to contract effectively, causing the low CO/CI Decrease SVR by adding nitropruside to vasodilate and reduce afterload

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