Exam 1 Flashcards
(80 cards)
If a patient is experiencing chest pain (CP) that is relieved by nitroglycerin, what is that telling you?
That it’s not a total block because by dilating the vessels, the heart is now getting more flow.
What do we call a set of signs and symptoms due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies?
Acute Coronary Syndrome
Ischemia that is prolonged and not immediately reversed.
What % of stenosis is needed to create the sensation of chest pain?
75% block creates chest pain.
What are the 3 Dx under ACS?
- UA - unstable angina
- NSTEMI - non ST (segment) elevated MI
- STEMI - ST (segment) elevated MI
What is the normal conduction time for QRS complex is?
<0.12 seconds (less than 3 small squares)
What is the normal PR interval range?
What IS the PR interval?
0.12 - 0.20 seconds, 3 - 5 sm squares.
The PR interval is the time it takes the impulse to travel from the SA node to the ventricles.
Which wave represents the atrial depolarization?
P wave, this happens RIGHT B4 the atria contract.
What does the QRS complex represent?
Ventricular depolarization (and hidden atrial repolarization).
This depolarization is from the conduction of the electrical impulse from the bundle of His throughout the ventricles.
What does the T wave represent?
Ventricular REpolarization (the resting phase of the cardiac cycle).
What do we call the phase of the cardiac cycle when the ventricles are repolarizing and all valves (bicuspid, tricuspid, and semilunar) are closed?
The resting phase. Characterized by the T wave.
What type of therapies are emergent PCI, CABG, and Thrombolytics?
Reperfusion therapy.
These are used to Tx STEMI or NSTEMI with positive cardiac markers.
These markers indicate possible cardiac injury/ischemia.
What does Emergent PCI mean and what can the patient expect?
PCI: Per-cutaneous Coronary Intervention
Goes to cath lab within 90 minutes, and receives a PCI with drug eluding stent.
A drug eluding stent is a peripheral or coronary stent placed into narrowed, diseased peripheral or coronary arteries that slowly releases a drug to block cell proliferation.
cardiac: AV malformation
Hx of cerebral aneurism or hemorrhage
Suspected aortic aneurism…
These are all reasons to not treat a patient with what type of reperfusion therapy?
Thrombolytic Therapy.
More exclusions:
- Active internal bleeding
- Intracranial neoplasm
- Ischemic stroke within the last 3 months
- Significant closed head/facial trauma within the last 3 months.
Aortic dissection: a serious condition in which the inner layer of the aorta, the large blood vessel branching off the heart, tears. Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect). If the blood-filled channel ruptures through the outside aortic wall, aortic dissection is often fatal.
cardiac: How are thrombolytics given (route) for reperfusion therapy?
What time-frame is this therapy most effectively administered?
IV
Ideally within the hour but the risk of mortality decreases by 25% if re-perfusion is achieved within 6 hours.
After receiving this reperfusion therapy, the patient will also receive cardiac rehab, just like PCI’s and CABG’s.
Why would thrombolytic therapy be used for STEMI or NSTEMI-with positive cardiac markers?
- If a cath lab is unavailable
- Thrombolytics are easily available
- Easy and rapid administration
These are used to keep vessels open and break up clots (+ heparin is given) then they are shipped off to a better Tx facility.
cardiac: What circumstances (2) would require a patient to receive a CABG for reperfusion therapy?
1) 3 + arteries are blocked
2) OR if the emergent PCI fails.
Would you treat UA or NSTEMI (with + cardiac markers) with thrombolytics?
No.
Only Tx STEMI with thrombolytics.
A creatinine test reveals important information about your kidneys… Creatinine is a chemical waste product that’s produced by your muscle metabolism and to a smaller extent by eating meat. Healthy kidneys filter creatinine and other waste products from your blood. The filtered waste products leave your body in your urine.
If your kidneys aren’t functioning properly, an increased level of creatinine may accumulate in your blood. A serum creatinine test measures the level of creatinine in your blood and provides an estimate of how well your kidneys filter (glomerular filtration rate). A creatinine urine test can measure creatinine in your urine.
“Normal” GFR is usually >90 ml/min/1.73m2
What concerns and teaching should we consider when about to give PCI in cath lab?
- Ask about iodine ALLERGY since the contrast is iodine-based.
- Get creatinine labs (GFR-glomerular filtration rate) to make sure their kidneys are healthy enough to handle the contrast that is filtered through the kidneys otherwise may incur an acute kidney injury.
- Teach: may experience a warm or large “hot flash” during the procedure, will be receiving ongoing medications and IV fluids as well as monitoring their vital signs during the procedure.
PCI aka “coronary angioplasty” (formerly called balloon angioplasty), is a nonsurgical technique for treating obstructive coronary artery disease, including unstable angina, acute myocardial infarction (MI), and multivessel coronary artery disease (CAD).
PCI involves non-surgical widening of the coronary artery, using a balloon catheter to dilate the artery from within. A metallic stent is usually placed in the artery after dilatation. Antiplatelet agents are also used. Stents may be either bare metal or drug-eluting.
Afterward, they will be receiving cardiac rehab.
When the ST segment returns to baseline, what does that indicate?
That reperfusion has occured. Once this has happened, sometimes they may experience arrhythmias due to the reperfusion.
Heparin is also given to prevent re-occlusion of the artery.
What do we need to be looking out for when using thrombolytics?
Bleeding.
For a CABG, we need to teach about them losing a day of memory, that they’ll be intubated and in the ICU for a little while and to be prepared for what? What things do we need to consider for post op care?
Lots of swelling. Bandages on their chest and legs with possible chest tubes (or their sites) to care for.
They will also have sternal precautions due to their chest being cracked open and wired back together.
They will also be receiving cardiac rehab.
What is cardiogenic shock and what treatment options are there (this is a complication of MI)?
Severe LV failure (like ventricle tachycardia).
Tx: usu will get an intra-aortic balloon pump and vaso-active drugs…
High mortality rate.
intra-aortic balloon pump is when a balloon is inserted into the aorta and a machine on the outside of the body helps it pump blood.
