MIS/Cardiogenicshock/aneurysms Flashcards Preview

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Flashcards in MIS/Cardiogenicshock/aneurysms Deck (91)
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1

What are DRGs

hospitals doing their best to prevent readmissions of patients... if they are readmitted then the insurance companies will not pay for stay

2

this risk factors for CAD are just

risk factors! they are not known to cause CAD

3

ACS refers to what?

unstable angina
NSTEMIS
STEMIS

4

what happens to people with unstable angina

put in observation bed for 24 hours

5

define after load

the pressure that the ventricles must over come in order to push blood out of the aorta

6

what is angina pectoris?

pain caused by ischemia due to poor blood flow caused by clogged up veins

7

what can cause chest pain

aortic disection
cholecystisis
anxiety and depression
muscle strain
costochondritis
esophegeal spasm
PE
herpes zoster
GERD
pericarditis
pneumonia
pneumothorax
pulmonary hypertension
pancreatisis

8

questions to ask about chest pain (the 5 Ws)

what does it feel like
where is it located
what makes it worse
what causes it
what makes it better

9

also ask about

quality
location
duration
intensity
accompanying symptoms
aggravating and relieving factors (ask about exercise to rule out any ischemic causes of pain)
ask family and self history
age (CAD is more common the older you get)

10

factor associated with chest pain

cold (men over 50 cover mouth when cold outside)
eating heavy
stress
physical exertion

11

stable angina

predictable and persistant angina relieved by rest or nitroglycerin

12

unstable angina

preinfarction/crescendo angina- caused by ischemia, may or may not be relieved with nitro/rest

13

how much nitro can you give

3 5 minutes apart, if not relieving chest pain call the doctor

14

variant angina

pain at rest that causes an ST elevation, thought to be caused by coronary vasospasm

15

clinical manifestations of an MI

impending sense of death
apprehension
neck
jaw
shoulders
innerportion of arm (normally left arm)
tightness
heavy choking
strangling feeling like a vice
diabetic neuropathy may be blunt pain
women have symptoms like indigestion

16

silent ischemia

clinical manifestations of an MI but patient reports no pain

17

gender role in chest pain

more common in women over 50 and men over 40
chest pain is different in women

18

signs and symptoms of mis that women experience

fatigue, tiredness, sleep disturbances before a cardiac event

19

red flags in the VS of a cardiac event

abnormal vital signs
bradycardia or tachycardia
tachypnea
hypertension
hypotension

20

red flag symptoms of an MI/ unstable angina

pallor
sweating
dyspnea
nausea
productive cough (caused by remodeled LV which means fluid backing into lungs, which means pt is going into HF)

21

assessment and diagnostic findings of CAD

ECG
Twave inversion
Cardiac biomarkers
echocardiogram
halter monitor
cardiac catheterization
nuclear scan

22

medical management of CAD

pharmacological therapy
reperfusion such as PTCA (percutaneous transluminal coronary angioplasty)

23

Treating angina
VIP slide

if pt has pain or prodromal symptoms (indegestion, choking, heaviness, weakness) take immediate action
stop all activity and bed rest in semi fowlers
measure vs
12 lead ecg
ST and T wave changes
Nitro sublingual tabs, give up to 3 times or as stated by provider
assess VS after each administation of nitro
give oxygen by 2 L of o2

24

identifying types of MIs

Nstemi
stemi
anterior wall
inferior wall
posterior wall
lateral wall
point in time
acute
evolving
old

25

sign of an old MI

Q wave

26

RCA/PDA occlusion

RV/RA infarct front and back
alters lung perfusion
may act as hypovolemic since it can't return blood to the heart

27

LAD/Circumflex occlusion

LA/LV circumflex occlusion - front to back
Alters perfusion to the rest of the body

28

Left main occlusion

"widow maker"
most critical- feeds the LV
many never make it to the hospital (fatal rhythm)
emergent CABG
cannot stent

29

acute inferior wall mi

leads II, III, and AvF represent ECG changes in ST elevation developing Q waves and T wave inversions

30

anterior wall MI

more serious and worst prognosis
ST segment elevation and leads I, aVL and precordial leads overlying the anterior lateral surfaces of the heart