M5 Perfusion 2 Flashcards
(193 cards)
1
Q
Layers of the 2 outer linings and 3 structural layers of the heart
A
Parietal pericardium (most outer)
Visceral pericardium
Epicardium
Myocardium
Endocardium (most inner)
2
Q
Between the visceral and parietal pericardium there is a space that can fill up with fluids. This is called
A
pericardial effusion
3
Q
Heart valves in order of blood travel
A
Tricuspid
Pulmonic
Bicuspid Mitral
Aortic
4
Q
What controls the heart
A
Autonomic Nervous system
Baroreceptors
5
Q
Frank Starling law
3 parts
A
The greater the myocardial stretch the greater the contraction force = increased stroke volume
Decrease in preload (blood return) decreases stretch = decreased stroke volume
Increase in afterload (systemic vascular resistance) due to high BP = decrease in stroke volume
Inversely low BP and drop in afterload = increase in stroke volume
6
Q
Stroke volume
A
Amount of blood ejected with each heartbeat
7
Q
Cardiac output
A
Amount of blood pumped in liters per minute
8
Q
Preload
A
Blood return causing stretch in myocardium at end of diastole
9
Q
Contractility
A
Ability of myocardium to shorten in response to electrical impulse
10
Q
Afterload
A
Systemic vascular resistance to ejection of blood from ventricles
11
Q
Ejection fraction
A
% of diastolic VOLUME ejected with each beat
12
Q
EF = normal
EF = HF
A
50-70%
Less than 40%
13
Q
Normal cardiac output in L/min
A
3-5L
14
Q
CO cardiac output formula
A
CO = SV (stroke volume) x HR
15
Q
Will digoxin help for low EF
A
NO
moving small amounts of blood at a stronger squeeze wont help perfusion
16
Q
With low EF, goal is to increase preload, to do this give
A
Beta-blockers
slow heart rate and increase filling time
17
Q
Older adults hearts may have what problems
A
widening aorta
atherosclerosis
this increases SVR
electrophysiologic decline
cascade efficiency drops
18
Q
Cardiac action potential 101
3 parts
A
beat of heart measures in volts
depolarization
repolarization
refractory period
19
Q
Depolazirasion
A
Contraction
influx of sodium and exit of potassium
20
Q
Repolarization
A
returning to resting state
reentry of K+, exit of Na+
21
Q
Refractory periods
2
A
effective - cells incapable of depolarizing (heart rest)
relative - cells require stronger than normal stimuli to depolarize
22
Q
Most common Heart problem manifestations
A
Chest pain
Dyspnea
Edema WEIGHT GAIN
Fatigue
Syncope
23
Q
Myocardial infarction 101
A
Death of myocardial tissue without blood flow to coronary arteries
24
Q
3 types of MI stages
A
Ischemia
Injury
Infarction
25
Ischemia stage MI 101
T wave inverts
Starvation for blood and O2
Tissue turns pale
26
Injury stage MI 101
ST segment rise
ONGOING starvation for blood and O2
Tissue is now bluish
27
Infarction stage MI 101
Q wave present
Necrosis and black color
scarring and death of tissue
28
Due to heart switching to anaerobic metabolism since O2 is unavailable in MIs, it starts producing acidic waste resulting in _ and what lyte increase
Acidosis
K+
Mg+
Ca+
29
In response to MI hypoxia body releases Catecholamine (epi norepi) to increase HR & contractility.
This further
Increases O2 demand
30
What infarction effects all 3 layers
Transmural
31
If myocardial tissue is deprived of O2 up to an 80% reduction in flow it is called a
Heart Attack
32
Etiology of MI Heart attack
Atherosclerosis of CA
plaque ruptures, becomes thrombus and occludes flow
33
Other MI Heart attack causes
Coronary spasms
Platelet aggregation
Emboli
34
CK Creatine Kinase lab during MI
Rise and fall during 3 days
Peak at 24h
Detected 2h post MI
35
Myoglobulin lab during MI
detected 2h post MI
early and non-specific marker
36
Troponin T and I lab during MI
GOLD standard
Myocardial injury specific
4-6h
used if pt delayed treatment
37
Lactate Dehydrogenase LDH lab during MI
found in liver heart kidney and brain
elevates at 12-14h
used if pt reports symptoms after days
38
Lipid profile for MI
cholesterol greater than 200 = CAD
HDL good
LDL LETHAL
39
What labs indicate CAD risk factors
Brain Natriuretic Peptide BNP
C-reactive protein
Homocysteine
40
Visual diagnostic tests for MI/CAD
CXR
EKG
Cardiac stress test (exercise or med induced)
Heart cath
Echocardiography
41
Echocardiography
2 dimensional view
Transesophageal
42
6 lead telemetry placement guide
Salt Pepper
Hamburger x2
Lettuce Tomato
white black
brown brown
green red
43
Telemetry monitoring basics
Shave chest hair
ALWAYS let telemetry know before removing pt
NEVER remove unstable pt
monitor for 60 cycle interference
44
60 cycle interference
wires are crossing or electronic devices are on bed
ECG strip stops interpreting
caused by laptop, cellphone, etc.
45
P wave problems =
SA node or atria problems
46
PR interval problems =
AV node
Bundle of His, bundle branches
Atria
problems
47
QRS complex problems =
Bundle branches conduction problem
48
ST segment problem =
MI
ACS Acute coronary syndrome
49
Elevated voltage of ST =
STEMI
ST elevated MI
50
T wave problems =
MI
old myocardial injurys may INVERT the T
51
QT interval =
Repolarization disturbance problems
52
EKG strip = _sec
6
53
Interval from p to p is
Atrial rate
54
Interval from r to r is
Ventricular rate
55
To determine HR multiply R peaks in a EKG strip by
10
56
Emergency management of heart problems
Respond to ALL alarms
Assess lead placement
Stay with PT
ABCs
57
Treatment of choice for ventricular tachycardia and Afib-RVS (rapid ventricular reponse)
Defibrilation
58
Defibrillation 101
Synchronized cardioversion
Delivers shock
Measured in joules per second
59
Does defibrillation have to be done on an emergent basis
NO
60
Defibrillator used to deliver a hands free shock in emergent and nonemergent setting
AED
61
Imlantable cardioverter defibrillator ICD 101
pulse generator
similar size-pacemaker
62
ICD Risks
future dysrhythmias
ICDs should have antitachycardia and antibradycardia pacemakers
63
Pacemaker 101
Artificial electric impulse generator used for cardiac resynchronization therapy
Temporary and permanent
64
Temporary pacemakers are used for
Acute MI
Prophylaxis after open heart surgery
65
Permanent pacemakers are used for
2nd and 3rd degree heart block
Bundle branch blocks
Cardiomyopathy
HF
SA node problems
66
V lead placement
-u shape around mid sternum
v1-4th right intercostal space
v2-4th left intercostal space
v3 to v6 5th left intercostal space (right after v2 to axillary area)
67
What 12 lead ECG pqrst change indicate ischemia
Flatt ST segment
ST-T depression
T inversion
Abnormally tall T
Inverted U
68
What 12 lead ECG pqrst change indicates injury
ST-T wave elevation
69
What 12 lead ECG pqrst change indicates infarction
Pathological Q waves
greater than 0.03sec and deper than 2mm
70
Problems with right coronary artery
Inferior wall MI
71
Problems with left main coronary artery
Sudden death
72
Problems with left anterior descending coronary artery
Anterior wall MI
necrosis of left ventricle and bundle branches
widow-maker
73
What does an exercise stress test determin
Functional capacity of heart
Effectiveness of anidysrhythmic drugs
74
before exercise stress test
No alcohol
no smoking
no caffeine
Dr. will decide which meds to hold
75
When to stop exercise stress test
Chest pain
SOB
hypotension
dysrhythmias
ST changes
or
Predetermined heart rate is reached
76
To start exercise stress test you need
Cardiologist to be preset
Crash cart available
77
Meds used for a pharmacologic stress test
Adenosine
Dipyridamole
(vasodilating agents)
Often done in association with radionucleotide imaging - thallium
78
ATST
Adenosine Thallium Stress Test
79
For pharm stress tests also have
Cardiologist
Crash cart
80
Nursing considerations for ATST
Renal function
Chest pain
Meds before test
Consent
81
2D echocardiography
Painless ultrasound
Spatial view of heart
Results squed by COPD and Obesity
82
Transesophageal (TEE) Echocardiography
Examines posterior of heart
NPO 6h prior
nothing to drink 2h post
Meds with small sips of water
83
Cardiac cath 101
Invasive procedure
Assesses chamber pressure and coronary artery patency
84
Things required before a cardiac cath
ECG
Hemodynamic monitoring
Emergency equipment
85
Post cardiac cath
Bedrest supine 4-6h
No flexing of extremity
Vitals
86
Pre cardiac cath
Consent
Iodine allergy check
Baseline vitals
87
Does cardiac cath involve using fluoroscopy and contrast media
YES
check for iodine allergy
88
Myocardial Nuclear Perfusion Imaging
Use radioactive tracer substances
Detects MI and left ventricular ejection
89
AONM
Aspirin
Oxygen
Nitro
Morphine
90
Other heart meds
Beta blockers lol
Calcium channels ipines
Clopidogrel
ACE pril
Heparin
91
Infarction
Blockage
92
Emergency infarction treatment
tPA
93
Firing rate for
SA node
AV node
Perkinjay fibers
100-60
60-40
40-20
94
Amount of blood pumped by ventricle with each pump
Stroke Volume
95
Percentage of blood leaving heart in each contraction
Ejection fraction
96
is STEMI or NSTEMI worse
STEMI
ACUtE
97
How many images does a 12 lead EKG give
12!!!
98
Factors that contribute to ST elevation
IMPORTANT
Hyperkalemia
Pericarditis
MI
99
Factors that contribute to ST depression
IMPORTANT
Hypokalemia
Ventricular hypertrophy
MI
100
Normal PR interval time
0.12-0.20 sec
101
small EKG box time =
large EKG box time =
0.04
0.2
102
Normal QRS complex time
0.06-0.10
103
Is afib or aflutter worse
A fib
104
A fib = clot =
LUNG EMBOLI
105
Atrial flutter looks like
small saw tooths
QRS still present
106
Afib looks like
Arabic, lower case
QRS still present
107
What lead does telemetry monitor
Lead II
108
Med to speed up heart rate
Atropine
109
What manouver can pt perform to break tachycardia
Valsalva
110
#1 Cardiac value to look at
TROPONIN
111
How often to look at troponin
3 times
will raise in 2-3 h after attack
112
For how long does troponin stay up
2-3 Weeks
113
V fib looks like
medium size waves
no QRS
114
V tach looks like
large waves/teeth
no QRS
115
treatment for Vfib
DEFIB the VFIB
CPR
116
Dfib setting is only used for
Vfib
Vtech problems
117
Synchronized Cardioversion is used for
Afib
Aflutter
118
Jules for
Dfib
Synchronized cardioversion
360J dfib
100J and going up with every shock
Synchronized cardioversion
119
Preload = _ side of heart
RIGHT
120
HORMONE released at HF
2 types
BNP - ventricular
ANP - atrial
121
Sterlings law
Stretching heart fibers results in overstretching and hypertrophy
think of balloon being stretched and not returning to original shape
122
Afterload = _ ventricle
Left
aortic pressure
123
Stroke volume is volume per a
BEAT
x HR to get CO
124
Perfusion = cardiac
OUTPUT
125
Less volume = _ CO
More volume = _ CO
Decreased
Increased
126
with L HF listen to lungs where
POSTERIOR lower lobes
127
If you cant perfuse your kidneys
urinary output will
Decrease
128
Arrhythmias are no big deal unless they affect
CO
129
3 BIG arrhythmias
V fib
Pulseless V tach
Asystole
NO CO AT ALL
130
CAD types
can have both
Chronic stable angina
Acute coronary Syndrome
131
Chronic stable angina
Decreased flow to myocardium
ISCHEMIA
Pain and pressure in chest
132
Chronic stable angina simple exacerbation
Exercise
133
Standard dose of Nitroglycerine
3 q5 min
Go to hospital if no relief
134
Nitroglycerine MOA
decreases both...
Vasodilator
Preload and afterload
135
Goal of treatment for heart problems is to always _ workload
DECREASE
136
#1 side effect of Nitroglycerine
HEADACHE
no need to call DR.
137
Before giving beta blockers check
BP and pulse
this is what it does
dont want to bottom out
138
Beta blockers block
Epi/Norepi
139
Calcium Chanel Blockers MOA
Vasodilation of arterial system
Blocking of Calcium
140
2 benefits of Calcium chanel blockers
decrease AFTERLOAD
increase oxygenation of HEART
141
Aspirin is given for
prevention of PLATELET AGREGATION
142
Chronic stable angina pt edu
Moderate exercise
Wait 2H after eating to exercise
No caffeine
Dress warm in cold weather
143
Nitroglycerine pt edu
ORTHOSTATIC HYPOTENSION
call 911, dont get up
144
Isometric exercise and unstable angina
Contracting muscle increases cardiac workload
AVOID
145
Definitive diagnosing of almost all HFs
Cardiac cath
146
CONTRADICTION to cardiac cath
Shellfish
Iodine
allergies
Kidney failure
147
Drug to protect kidneys during heart cath
Acetylcysteine
148
BIG side effects of heart cath
What to check
BLeeding
Hematoma formation
Circulation issue
Check site often
Check pulse, skin color, cap refil
149
If pt is on _, hold it 48h before and after heart cath
WHY
Metformin
LACTIC ACIDOSIS
will kill
150
Acute coronary syndrome like MI result in both...
Ischemia
Necrosis
151
What time of day do most MIs occure
EARLY MORNING
152
Main complain in MI ACS
Chest discomfort
radiating to jaw, arm etc
sob, lower back pain
153
Elderly MI pts S/S
SOB
Passing out
will not feel pain
154
After AONM put pt on
ECG monitor
155
Timeframe to get pt to Cath Lab to reastablish perfusion
90 MIN
on test
156
Vomiting with MI
Stimulates Vagus Nerve
Will decrease heart rate
DROPS HR AND BP
VERY BAD SIGN
157
MOST significant lab value of Muscle Tissue Death
aka MI necrosis
MYOGLOBIN
158
Will increase 6h after onset of MI symptoms
CPKNB
159
Troponin is specific to
MOST SENSITIVE INDICATOR
HEART MUSCLE
160
Major arrhythmia to worry about with MIs
Vfib = Dfib
perform CPR until AED is set up
161
1st med to give if Dfib does not work
if that does not work, give
EPINEPHRINE
AMIODARONE and LIDOCAINE
162
Amiodarone and lidocaine are
Antiarrhythmic agents
163
Lidocaine toxicity S/S
Neuro changes!
164
Amiodarone toxicity S/S
Fast BP drop
165
Body position for MI
Semi fowler
blood goes from core
decreases work load
166
Next drug to give after AONM
tPA
ISCHEMIA IS BLOCKAGE
need to break it up
167
tPA requirements
Bleeding history
168
tPA names
Altiplace
Kinectiplace
end i place
169
tPA time frames
within 30 min preferred
max of 12h
170
tPA contraindications
preexisting bleeding issues
171
1st surgical treatment
2nd surgical treatment
Angioplasty (balloon to expand vessel)
STENT (mesh to open vessel)
172
Biggest complication of Angioplasty
2ND MI
173
CABG surgery
Coronary artery bypass
174
Old pts are more likely to survive MIs due to
collateral circulation
more vessels are interconnected
175
Other than lung problems, opioids also cause
PT needs a Rx for
Constipation
carthotics
176
When can pt have Sex after MI
after climbing 2 flights of stairs without being exhausted
177
Safest time of the day for sex after MI
8 or 9 in the AM
178
Best exercise after MIs
WALKING
179
Signs of impending failure, ON TEST
SOB
Edema of lower extremities
Weight gain
180
_ is the LEADING cause of HF
Hypertension
181
BNP is secreted by what tissue
When
Ventricles
When pressure is increased
182
NY heart classification
Higher number = worst failure
1-4
183
HF CXR of lungs will have
infiltrates
184
EF
ejection fraction goals
60-75%
185
Standard treatment for HF
1st ACE inhibitors
Stops RAAS system
186
Other standard treatment meds for HF
ARB
Beta blockers
Calcium CB
Diuretics
Digoxin
187
How do you know digoxin is working
Increase in cardiac output
188
Elderly +
Lyte disorder +
Digoxin =
DIG TOXICITY
189
Aldosterone =, ON TEST
LOOSING SODIUM and WATER
RETAINING POTASSIUM
190
Before giving digoxin check
where
HR
Apical pulse
(5th intercostal mid clavicular)
191
HF and sodium intake
fluid intake
less than 2mg
2000ml
192
Low sodium diet decreases
Preload
193
Fluid retention = what problems first
HEART
