Exam 2 - Cardio Flashcards
(172 cards)
1
Q
White lead placement
A
R 2nd ICS, MCL
2
Q
Green lead placement
A
R 8th ICS, MCL
3
Q
Black lead placement
A
L 2nd ICS, MCL
4
Q
Red lead placement
A
L 8th ICS, MCL
5
Q
Brown lead placement
A
R 4th ICS, sternal border
6
Q
Should you put a lead over a bone?
A
No
7
Q
SA node BPM
A
60-100
8
Q
AV node BPM
A
40-60
9
Q
Ventricular rate if SA and AV nodes fail
A
20-40 bpm
10
Q
what occurs during ventricular systole?
A
depolarization = contraction
11
Q
what occurs during ventricular diastole?
A
rest, repolarization
12
Q
what does and EKG determine?
A
electrical impulse
13
Q
best lead to determine heart rhythm
A
lead 2
14
Q
P wave shows…
A
atrial depolarization/contraction
15
Q
QRS shows…
A
ventricular depolarization/contraction
16
Q
T wave shows…
A
ventricular repolarization/relaxation
17
Q
when is atrial repolarization lost?
A
in the QRS complex
18
Q
red hash marks at the top of an EKG strip is ___ seconds
A
3 seconds
19
Q
large squares on an EKG strip are ___ seconds
A
0.2 seconds
20
Q
small squares on an EKG strip are ___ seconds
A
0.04 seconds
21
Q
5 steps to determine rhythm analysis
A
determine regularity
calculate HR
examine P-QRS-T wave
measure intervals
identify rhythm
22
Q
grid method for determining HR
A
1500 / # small boxes between R wave
23
Q
scan method to determining HR
A
R waves in 6 seconds x 10
24
Q
PR interval should be ___ - ___ seconds
A
0.12 - 0.2 seconds
25
QRS duration should be ___ - ___ seconds
0.04 - 0.1 seconds
26
what is the J point?
point at which the S wave returns to baseline and the ST segment begins
27
causes of bradycardia
electrical issues in the heart
OD of beta blockers
organic phosphate poisoning
hypothyroidism
OSA
hypo, hyperkalemia
hypoxia
hypothermia
increased ICP
sleeping adults, children
well-conditioned athletes
present in up to 35% of people < 25 y/o at rest
28
bradycardia treatment
drugs to speed the heart
pacemakers
atropine
29
causes of tachycaria
exercise
stimulants
--caffeine, cocaine, etc
fever
pain
fear, anxiety
CHF
acute MI
infection
sympathetic stimulation
shock
dehydration, hypovolemia
PE
nicotine
30
HR for infant (1-12 months)
100-160 bpm
31
HR for toddler (1-3 y/o)
90-150 bpm
32
HR for preschooler (4-5 y/o)
80-140 bpm
33
HR for school-aged (6-12 y/o)
70-120 bpm
34
HR for adolescent (13-18 y/o) and adults (18+ y/o)
60-100 bpm
35
HR for a sleeping child may decrease by ___%
10%
36
HR commonly seen with acute MI
bradycardia
37
vagal stimulation can cause bradycardia. What can cause vagal stimulation?
coughing
vomiting
straining during BM
sudden exposure of the face to cold water
carotid sinus pressure
-tight collar is worn
38
a decrease in CO will eventually result in ___ ___
hemodynamic compromise
39
s/sx of hemodynamic compromise
mental status change
low BP
chest pain
SOB
s/sx of shock
CHF
pulmonary congestion
decrease urinary output
cold, clammy skin
40
symptomatic bradycardia treatment
O2
IV access
atropine
transcutaneous pacing (TCS)
41
tachycardia rate in adults
101 - 180 bpm
42
tachycardia rate in infants
> 200 bpm
43
tachycardia in child > 5/yo
> 160 bpm
44
tachycardia treatment
treat the underlying cause
45
ACS is aka ___ ___
MI
46
volume of blood ejected per minute
CO
47
end of diastolic volume (relaxation/preload) MINUS end of systolic volume
SV
48
preload amount is about ___ mL
130 mL
49
amount of blood at end of systolic is about ___ mL
60 mL
50
primary reason for decrease in supply of O2 to the heart muscle is narrowing of the arteries cause by ___
atherosclerosis
51
artery is ___% occluded before symptoms occur
75%
52
types of angina
silent
nocturnal
prinzmetal's
chronic
unstable
53
2 most common types of angina
chronic
unstable
54
silent angina is commonly seen in pts with ___
DM
55
silent angina is seen on which 2 diagnostic test?
EKG
stress test
56
is there chest pain with silent angina?
no
will report "feeling bad"
nausea, fatigue
57
nocturnal angina occurs mostly ___ ___
at night
58
what is nocturnal angina r/t
nothing
"just occurs"
59
Prinzmetal's angina is cause d/t ___
vasospams
60
when does Prinzmetal's angina occur
at rest
61
do you have to have CAD to have Prinzmetal's angina?
No
62
Prinzmetal's angina is associated with ___ and ___ ___
migraine
Raynaud's phenomenon
63
Prinzmetal's medication choice
CCB
64
Prinzmetal's will have __ elevation on an EKG
ST
65
T or F. Prinzemetal's variant angina is reversible
True
66
CP that occurs intermittently over a long period with the SAME pattern of onset, duration, and intensity of symptoms
Chronic Stable angina
67
How long does chronic stable angina last?
only a few minutes; will subside when the precipitating factor is removed
68
T or F. Pain at rest is normal for chronic stable angina.
False
69
Chronic stable angina medication choice
Nitro
70
arteries must be clogged __ to __% before surgery
90-95%
71
angina precipitating factors
physical exertion
temp extremes
strong emotions
eating a heavy meal
tobacco use
sexual activity
stimulants (caffeine)
72
angina pain assessment acronym
PQRST
73
PQRST
Precipitating factors
Quality of pain
Radiation of pain
Severity
Timing
74
cardiac lab indicators with angina
troponin
75
cardiac tests to know
cardiac cath (gold standard)
echo
EKG
stress test
holter monitor
76
cholesterol should be < ___
< 200
77
triglycerides should be < ___
< 150
78
HDL should be > ___
> 60
79
LDL should be > ___
> 50
80
CK-MB range
0-3
81
myoglobin should be < or equal to ___
< or equal to 90
82
troponin should be < ___
< 0.04
83
LDH range
122-222
84
post-op care for PCA
observe site for bleeding, hematoma
BP, HR
keep flat 2-4 hours after procedure
continue IVF, encourage water to flush dye
85
how often to assess temperature and neurovascular check after PCA
q15 minutes x1 hour
q30 minutes x1 hours
q1h x4 hours
86
ASA contraindication
GI bleed
allergy to ASA
asthma pt with sensitivity to NSAIDs
87
what med to administered as soon as a MI is suspected
ASA
88
first line treatment for angina episode
Nitrates (short-acting)
89
nitro education
do not take with viagra
monitor for orthostatic hypotension
keep accessible at all times
may take prophylactically
should tingle when under tongue
must replaced q6months
90
nitro side effects
HA
dizzy
flushing
91
long-acting nitrate examples
Isordil (isosorbide dinitrate)
Imdur (isosorbide monitrate)
Nitro bid
Nitro dur
92
long-acting nitrate side effects
HA (decrease over time)
*educate to take Tylenol
93
how long does nitro bid work?
3-6 hours
94
nitro bid considerations re: placement
flat, muscular area
avoid hair, scars
keep above umbilicus
95
nitro dur last how long?
24 hours
96
preferred drug for angina managment
beta blockers
97
who should not take beta blockers?
asthmatics
98
beta blocker side effects
hypoglycemic unawareness
bradycardia
hypotension
wheezing
GI symptoms
weight gain
sexual dysfunction
99
what is given if beta blockers can not be administered
CCB
100
CCB potentates which drug during the first week of therapy?
Digoxin
101
when are ACE-I Rx?
pts at high risk for a cardiac event
102
ACE-I side effects
cough
angioedema
hyperkalemia
hypotension
dizzy
rash
loss of taste
103
what is administered if ACE-I can not be taken?
ARB
104
Na current inhibitor example
Ranexa (ranolazine)
105
Na current inhibitor contraindication
Prozac (fluoxetine)
106
Na current inhibitor side effects
nausea
weakness
constipation
107
manifestations of ACS
prolonged, not immediately reversible ischemia
108
these 4 things are associated with once stable angina
atherlosclerotic plaque ruptures
platelet aggregation
vasoconstriction
thrombus
109
ACS risk factors
age
gender
heredity
HTN
DM
abnormal lipids
smoking
obesity
physical inactivity
diet
110
ACS risk factors unique to women
premature menopause
oral contraceptive use
HRT
111
ACS can create these types of feelings
pressure
anxious
restless
feeling sense of doom
112
atypical ACS s/sx in women
indigestion
heartburn
SOB
N/V
back, jaw pain
113
results from cardiac disorders that impair the ventricles ability to fill the blood and effectively pump it out
causes a decrease in CO, tissue perfusion
CHF
114
CHF risk factors
HTN, CAD, MI, angina, diseased valves
DM
COPD, pulmonary fibrosis
age, race
HIV, AIDS
too much Vitamin E
^ metabolic demand
septicemia
anemia
hyper, hypothyroidism
obesity
cardiomyopathy
arrhythmias
alcohol, drug OD
radiation, chemo
children with congenital heart defects
115
what are the 2 types of L sided HF
Systolic
Diastolic
116
what is systolic HF
when the ventricle fails to contract adequately to eject a sufficient amount of blood into the arterial system
117
EF should < ___% indicates HF
< 40%
want EF to be 60%
118
what is diastolic HF
heart cannot completely relax in diastole
ventricle can not adequately fill
119
L sided HF s/sx are r/t
pulmonary problems
120
what extra heart sound is heart with L sided HF
S3 gallop
121
Cause of R sided HF
L sided HF
COPD
122
R sided HF present s/sx of
fluid overload
123
how to assess for JVD
sit pt up in a chair at 45 degrees
124
CHF complications
liver failure (d/t prolonged R CHF)
pleural effusion
PE
PNA
Respiratory acidosis
Hepatomegaly
Splenomegaly
malnutrition
dysrhythmias
cardiogenic shock
sudden cardiac death
125
BNP measures what?
pulmonary congestion
126
BNP should be < ___
< 100
127
BNP 100-300 is indicative of
HF
128
BNP >300 is indicative of
mild HF
129
BNP >600 is indicative of
moderate HF
130
BNP >900 is indicative of
severe HF
131
what is atrial natriuretic factor (ANF)?
antibody protein to help infection
hormone that promotes dilation; atrial stretch
132
What ANF range is indicative of HF
22-77
133
will troponin be affected during CHF
No
134
Why does albumin need to be WNL during CHF
Albumin transports proteins. Meds are distributed via protein
135
What does EF show?
% blood pumped out of the heart compared to amount of blood left in the chamber
60% = 60% of the blood is pushed out of the chamber
136
heart healthy diet
1.5-2 G of sodium
low fat
limit fluid per MD order
137
how much for HF pts to exercise weekly
3-5 x's
30-40 minutes
pace out events
avoid extreme weather
wait 2 hours after meals
138
when is sx needed for CHF
end-stage HF
valve replacement
HF transplant
139
what to monitor for/educate with ACE-I
BUN
Crt
angioedema
dry cough
140
When to administer catopril or moexipiril
1 hour before meals
141
ACE-I, ARB dry cough education
drink water
sip on lozenge (sugar free if diabetic)
should not last > 10 days
142
what electrolyte imbalance can ACE-I cause?
hyperkalemia
143
diuretics fluid restriction
limit 2000 mL/daily
drink 6-8 glasses daily
144
therapeutic serum digoxin level
0.5-2
145
which electrolyte imbalance can cause digitalis toxicity
hypokalemia
146
foods high in K+
fresh OJ, tomato juice
fruits
raisins
dates
figs
prunes
spinach
cauliflower
potatoes
peanuts
almonds
147
s/sx of digitalis toxicity
anorexia
N/V
abdominal pain
weakness
vision changes (blurred vision)
-diplopia, yellow, green, white halos
new on-set dysrhythmias
148
what to not take at the same time as digoxin
antacids
149
Sympathomimetic agents (inotropin, dobutrex) drug-drug interactions
tricyclics
MAOIs
150
S/E of phosphodiesterase inhibitors (inocor, primacor)
hiccups
dysrhythmias
hypotension
hepatotoxicity
jaundice
thrombocytopenia
hypoxemia
hypokalemia
anorexia
151
BiDil is a combo of which 2 drugs?
hydralazine + isosorbide
152
who is BiDil typically Rx'd for?
severe HTN in African Americans
153
caution given BiDil with which drug group
MAOI
154
Do not give BiDil if a pt has taken which drugs?
Viagra
Cialis
Levitra
155
BiDil assessment
VS
fluid volume status
156
CHF weight gain to report
3# over 2 days
3-5 # over a week
157
abnormal accumulation of fluid in interstitial tissue and alveoli of the lungs
pulmonary edema
158
causes of pulmonary edema
acute MI
acute CHF
valvular disease
fluid overload
inhaled toxins
near drowning
respiratory distress syndrome
159
s/sx of pulmonary edema
dyspnea, SOB, AMU
orthopnea
cyanosis
cool, clammy; diaphoretic
productive cough
crackles
pink, frothy sputum
JVD
160
what are the 2 types of aneurysms
A: ascending
B: descending
161
when is an aneurysm surgically treated
> 6cm in male
> 5 cm in female
162
lifting restrictions with an aneursym
no more than 5#
163
aortic aneurysms are classified by their ___
shape
164
review the different shapes of aneurysms
review the different shapes of aneurysms
165
what is considered a small aneurysm?
4-5.5 cm
166
how does a endovascular graft work?
blood flows through the graft >
aneurysm wall will begin to shrink
**must meet strict criteria to be a caniate
167
sexual activities guidelines should be referred to the
doctor
168
aortic dissection occurs more commonly in which gender?
men
most frequently 60-70 y/o
169
Is an aortic dissection a type of aneurysm?
No
it is a false lumen which blood flows
170
aortic dissection s/sx
sudden, severe anterior CP that radiates down spine or abdomen
sharp, "worst ever"
mimic MI
elderly - confused, vague symptoms
171
what is cardiac tamponade?
blood escapes from dissection into pericardial sac
172
s/sx of cardiac tamponade
hypotension
narrowed pulse pressure
distended neck veins
muffled heart sounds
