Study Guide ASH

Question 1

Medications to slow the heart down? Non medications that slow down the heart?

Answer 1

• Amiodarone, Lidocaine, digoxin, cardizem

- Vaso maneuver

Question 2

What speeds up the heart? Medications? Non medications that increase heart rate?

Answer 2

Atropine
Epinephrine
Inotropic - Dobutamine

• Caffeine - stimulants

Question 3

Manifestations of Cardiac Tamponade?

Answer 3

Cardiac tamponade findings:

• JVD
• Paradoxical pulse
• Decreased CO
• Muffled heart sounds
• Circulatory collapse
• Hypotension

-

Question 4

Disease states that affect Afterload? Drugs used to improve?

Answer 4

Disease states that increase resistance makes it harder for the heart to pump blood

• Hypertension
• Aortic stenosis
• Increased blood viscosity

**Antihypertensives - Beta Blockers, Vasodilators

Question 5

What is ATRIAL FIBRILLATION? Rhythm? P waves?

Answer 5

Occurs when the atria beat chaotically and irregularly — out of coordination with the two lower chambers (the ventricles) of the heart

Question 6

What is the atrial/ ventricular rhythm for a person in Atrial Fibrillation?

Answer 6

Irregular

Question 7

Signs and Symptoms of Atrial Fibrillation?

Answer 7

• irregular rapid heart rate
• lower blood pressure
• ortho-hypotension
• low 02 stat
• anxious
• change in level of consciousness

Question 8

What do the P waves look like in AFIB?

Answer 8

• Wavy with no prominent P wave

Question 9

Treatment of stable Atrial Fibrillation vs treatment of unstable atrial fibrillation?

Answer 9

• Medications: Antidysrhythmics (Amiodarone, procainamide, lidocaine), beta blockers, calcium channel blockers, procainamide, digoxin)
• Cardioversion

Question 10

Manifestations of Atrial Fibrillation?

Answer 10

• No P waves
• irregular rhythm
• Decreased cardiac output (loss of 25-30% CO)

Question 11

What are PREMATURE VENTRICULAR CONTRACTIONS?

Answer 11

• Results from increased irritability of ventricular cells

- lower chambers of the heart contract before they should. When this happens, your heartbeat becomes out of sync.

Question 12

How does a PVC appear on the EKG? What is the rate?

and Rhythm?

Answer 12

• seen as early ventricular complexes followed by a pause
• QRS wide (greater than 0.12 sec ), bizarre appearance (uniform or multiform)

Rate = variable; 
Rhythm=  atrial regular, ventricular irregular;

Question 13

What are the typical causes when PVC is frequent and sustained? Treatment

Answer 13

• ventricular irritability due to hypoxia
• heart disease
• drug toxicities

Question 14

Treatment of PVC ?

Answer 14

• Treatment = antidysrhythmics if symptomatic (amiodarone, lidocaine, procainamide, B-blockers)

Question 15

Describe VARIANT Angina?

Answer 15

Variant - chest pain or discomfort resulting from coronary artery spasm and typically occurs after rest. EKG = ST changes but no changes in troponin or CK levels b/c no tissue has be damaged yet. * begins to block oxygen flow to the tissues

Question 16

What is the normal EJECTION FRACTION? What does the EF measure?

Answer 16

• 50-70%

- Contractility

Question 17

Who is at high risk for Endocarditis?

Answer 17

• IV drug abusers
  
  • Valve replacement recipients
  • People who have had systemic infections
  • People with structural cardiac defects

Question 18

Medications for Valvular disease?

Answer 18

• ACE inhibitor - blood pressure
• Digoxin- decrease contractility
• Beta Blockers - protects the heart
• Antibiotics
• Anticoagulant
• Diuretics
• Vasodialators

Question 19

Medications for shock?

Answer 19

Insulin
Steroids
Antibiotics
Vasopressors

Question 20

What does Digoxin do?

Answer 20

• increases vagal tone, slowing AV nodal conduction.

Question 21

Treatment of Cardiac Tamponade?

Answer 21

-Pericardiocentesis - removes fluid

Pericardial window - involves removing a portion of the pericardium to permit excessive pericardial fluid to drain into the pleural space.

-Pericardiectomy

Question 22

Most common cause of CARDIOGENIC SHOCK?

Answer 22

-Myocardial infarction is the most common cause of direct pump failure.

Question 23

what is Hemodynamic monitoring?

Answer 23

Invasive system used in critical care areas to provide quantitative information about vascular capacity, blood volume, pump effectiveness, and tissue perfusion

types:
Pulmonary artery catheter
Invasive arterial catheter and monitoring
Pulmonary capillary wedge pressures

Question 24

Interventions for sepsis/septic shock:

Answer 24

• Correct the cause!
• Use of sepsis resuscitation bundle within 6 hours
• Oxygen therapy
• IV therapy: Normal saline (NS) or Lactated Ringers (LR)
• Drug therapy: Vasoconstrictors: Dopamine, Epinepherine etc.
• Agents to enhance contractility and perfusion/CO
• Blood replacement therapy
• Identify those at risk, early detection!

Question 25

Manifestations of sepsis/septic shock:

Answer 25

Early symptoms of sepsis: - fever usually higher than 101˚F (38˚C) - low body temperature (hypothermia) - fast heart rate - rapid breathing, or more than 20 breaths per minute Severe sepsis: - noticeably lower amounts of urine - acute confusion - dizziness - severe problems breathing - bluish discoloration of the digits or lips (cyanosis)

Question 26

Pathophysiology of SHOCK:

Answer 26

``` -Cells forced to produce energy with anaerobic (w/o 02) metabolism This causes: Low yield of energy and ATP Produces lactic acid (why we draw lactic acids) Acidotic cell environment Membrane more permeable Electrolytes and fluid seep in and out Na-K pump fails Cell structures damaged Cell death ``` 3 major components: - Volume - Pump - Vasculature Must respond to feedback systems: (3 compensatory responses) - Neural (sympathetic vs parasympathetic, baroreceptors/epi/norepi) - Chemical( RAAS and kidneys that are trying to make adjustments in order to maintain adequate blood volume and flow ) - Hormonal (aldosterone NA/water retention in order to maintain blood volume and increase blood volume to increase CO) When one fails, the others compensate Eventually no longer able to compensate Tissues are then not perfused adequately Shock occurs

Question 27

Initial (early) stage of SHOCK?

Answer 27

- Difficult to detect! - Baseline MAP decreased by less than 10 mm Hg - Heart and respiratory rate increased from the baseline or a slight increase in diastolic blood pressure - Adaptive responses of vascular constriction and increased heart rate - Compensatory mechanisms effective - Overall metabolism still aerobic

Question 28

Nonprogressive (compensatory) Stage of SHOCK?

Answer 28

- BP stays WDL - MAP falls 10 t0 15 mm/hg below baseline - Kidney, baroreceptors, and hormonal adaptive mechanisms activated. - Stimulates sympathetic NS - Kidneys sense decreased MAP - Renin/angiotensin system activated - Pituitary kicks in with ADH - Tissue hypoxia in nonvital organs. - Acidosis and hyperkalemia. - Stopping conditions that started shock and supportive interventions can prevent shock from progressing - Can have no permanent damage - Best time to intervene Still have some clinical signs that indicate poor organ perfusion: Anxiety, restlessness, thirst Resp: increased resp rate, decrease in O2 sat Cardiac: tachycardia, falling systolic pressure, rising diastolic pressure, narrow pulse pressure, cool extremities, decreased UO

Question 29

Nonprogressive (compensatory) interventions:

Answer 29

- ID cause: Correct underlying disorder - Compare changes to baseline - Support by: Help maintain BP and adequate perfusion - Vasoconstrictors, inotropic, enhance CO - Fluid replacement: Crystalloids, colloids, blood products - Medication - Oxygen - Monitor tissue perfusion, vitals - Patient safety - Reduce anxiety for pt and family

Question 30

Progressive Stage (intermediate) of SHOCK:

Answer 30

MAP falls more than 20 mm Hg from baseline Compensation functioning, no longer adequate Vital organs develop hypoxia Less vital ischemia Life-threatening emergency-critical rescue! Immediate interventions are needed. Vital organs can only tolerate so long Survival depends on age and overall health

Question 31

Progressive stage manifestations:

Answer 31

- Laboratory data: Low blood pH, rising lactic acid, hyperkalemia - Cardiac: Rapid, weak pulse, Hypotension, Pallor, cool, moist skin, anuria - Pulmonary: Cyanosis, Hypoxemia - Neuro: Decreased cerebral perfusion, Mental status deteriorates, Feeling of doom

Question 32

Progressive Stage Medical Management:

Answer 32

-Depends on type of shock and cause -Based on degree of decompensation -Some interventions are common to all: Appropriate IV fluids Prevent complications Close, continuous monitoring -Medications to restore perfusion: Support pumping action of heart (inotropics-dobutamine) Vasoconstrictors (dopamine, norepi) Perfusion through dialation (Sodium nitroprusside) Support resp system-ABGs Hemodynamic monitoring-CVP, Art line, PCW

Question 33

Refractory (Irreversible) Stage of SHOCK:

Answer 33

Rapid loss of consciousness, nonpalpable pulse, cold, dusky extremities; slow, shallow respirations; unmeasurable oxygen saturation MODS can occur here or as separate syndrome Therapy ineffective, death imminent

Question 34

What is the primary factor in the development of Coronary Artery Disease ?

Answer 34

Atherosclerosis

Question 35

What are the modifiable risk factors for Coronary Artery Disease?

Answer 35

* Elevated serum cholesterol * Smoking/ tobacco use * Limited physical activity * Hypertension * Diabetes mellitus * Obesity * Excessive alcohol * Excessive stress/ decreased coping skills

Question 36

Right sided heart failure

Answer 36

- Characterized by insufficient force of cardiac contraction and/or inadequate filling of the heart with blood. Symptoms: Peripheral edema, JVD, weight gain, ascites, hepatomegaly, S3 gallop on auscultation

Question 37

Contributing factors to vessel damage

Answer 37

``` Elevated BP Elevated lipid levels Turbulent blood flow (hypertension) Increased amounts of catecholemines Irritants from cigarette smoke Impaired glucose tolerance, DM ```