Week 8: Cardiac Emergencies.. Part 2 Flashcards

Question

Stemi vs NonStemi

Answer 1

* ST elevation= stemi. Elevation in the t "firemans cap" * ST depression= non-stemi.

Answer 2

* _Appearance_: Anxious, restless, pallor, diaphoresis * Blood Pressure/Pulses * Breathing * JVD (Jugular Vein Distension) * Auscultation/heart and lung * Abnormal heart sounds S3, S4 * _Shortness of Breath_ (SOB): Orthopnea * _Chest Discomfort:_ Pleuritic-point tenderness?, Localized vs. diffuse, Palpitaion

Answer 3

A= Associated Symptoms Dyspnea, nausea, diaphoresis, palpitations, feeling of impending doom P= Precipitating Factors Exertion, Cold Exposure, meals, movement Relieved by: rest, NTG, or position? Q= Quality Heaviness, tightness, sharp, stabbing, burning R= Region, Radiation, Risk Factors Radiates to: arm, jaw, back, below diaphram Region: substernal, left lateral, right chest Risk factors: HTN, DM, Obesity, Dyslipidemia, Smoking S= Severity Rate pain on scale 0-10 T= Timing Onset and duration of pain, nocturnal?, constant? Intermittent?

Answer 4

Right Coronary Artery Leads II, III, AVF (see st elevation)

Answer 5

Left Anterior Descending Leads V1-V4 (st elevations)

Answer 6

Circumflex Leads I, AVL, V5, V6 (st elevations)

Answer 7

CPK MB: rises 4-8 hours, peaks 12-24, remains elevated for a day Troponin: (breakdown in cardiac muscle) rises in 3 hours, peaks 12-18 hours, stays elevated for 14 days Troponin t: 0.1 or less micrograms per liter Troponin I: less than 10 micrograms

Answer 8

* View coronary arteries * Incr. risk if done after MI * Need creatinine: Dye can cause renal failure

Answer 9

Safe, non-invasive, wall motion abnormalities

Answer 10

Produced by liver w/ inflammation Rules out stable angina Good o get pt. baseline Reference range Low- \< 1.0 mg/dL Average- 1.0-3.0 mg/dL High- \> 3.0 mg/dL

Answer 11

130-170 ml/min

Answer 12

* Peak levels occur 1-4 hours * Doubling in 2 hours ++ MI * Reference range: \< 90 mcg/L

Answer 13

- Pt. placed in semi-fowlers position - ECG and Cardiac Enzyme Assessment - IV line started (at least 18 guage) - ASA 325 mg given: Four baby ASA, Clopidogrel (Plavix) 300 mg (becomes an issue if they need to go to surgery) - Oxygen - Beta Blockers - ACE inhibitors (if CHF present): watch out for asthma patients -NTG titrate to releive chest pain but keep SBP above 90 mm/Hg - start drip 5 mics per min, can titrate as high as 400 - Works as a vasodilator - Decreases peripheral resistance - Increased coronary blood flow _Heparin vs Lovenox_ - Neither lyse the clot only prevents new clots - Heparin increased risk of HTP - Lovenox longer more predictable action - Not preferred if Surgery anticipated

Answer 14

* Procedure which involves placement of a catheter into RT or LT side of heart. * Invasive * Coronary angiography is often included together with cardiac catheterization * Diagnostic procedure and/or * a therapeutic procedure * Adults & Children

Answer 15

* This procedures provides the doctor with a "road map" of the arteries in the heart * To find any areas of blockage in the arteries that supply the heart with blood. * May also look at the valves, chambers & heart muscle * Can help in making decisions about the treatment of heart disease.

Answer 16

* Peptic Ulcer * Anticoagulants * Ischemic stroke * Dementia * Recent surgery * Internal bleeding recent

Answer 17

* Internal Bleeding * Cerebral Aneurysm * AV malformation * Previous Cerebral Hemorrhage * Pregnant * CVA recent * Uncontrolled HTN * Aortic Dissection * Traumatic CPR

Answer 18

* femoral, brachial or carotid artery to the knob of the aorta for coronary arteries * It may be advanced to the left heart to look at the LT ventricle

Answer 19

* Balloon Angioplasty is a technique used to dilate an area of arterial blockage with the help of a balloon catheter. * It is a way of opening a blocked blood vessel * Not highly effective, can rupture wall of vessel, or the plaque can just move right back

Answer 20

* Usually a metal stent is placed in the opened artery to make sure restenosis does not reoccur * Following the procedure, the balloon is deflated and additional x-rays are taken to determine how much blood flow has increased. * usually covered in a heparanized solution

Answer 21

* Lifestyle Change * Healthy diet * adequate exercise * No Smoking * Medicine coated stents (apirin, plavix, cholesterol medicine)

Answer 22

_INDICATIONS_ * Atrial Fibrillation * Atrial Flutter * AV Nodal Reentrant Tachycardia * AV Reentrant Tachycardia * Atrial Tachycardia Most often, cardiac ablation is used to treat rapid heartbeats that begin in the upper chambers, or atria, of the heart. As a group, these are know as supraventricular tachycardias, or SVTs. Types of SVTs are: Minimally invasive treatment for arrhythmias Live fluoroscopy and angiography techniques are used along with special electro physiologic equipment and catheters

Answer 23

* Minimally invasive surgery does not use CPB * Smaller incision * Emerging as a replacement for conventional CABG * Starting in 1990’s, MIDCAB has gained popularity * Usually conducted for LIMA to LDA grafts Advantages * no sternotomy or CPB * operating time is 2-3 hours * recovery time 1-2 weeks * effectiveness 90% * incision only 10cm * reduced need for blood transfusion * less time on anesthesia * less pain * less expensive

Answer 24

* New instruments must be developed * Requires highly skilled surgeon and learning curve for surgeons limits number performed * Small incision * Beating heart * Blood in field * Can only be used with patients having blockages in one or two coronary arteries on the front of the heart * Attempts at operating on other arteries have been moderately successful, but requires even greater skill and practice

Answer 25

* Uses CPB * Balloon catheter system for aortic occlusion and cardioplegic arrest * 5-8 cm left anterior thoracotomy incision * No sternotomy!!! * uses LIMA Benefits: * Bloodless field * Heart arrested * allows more accurate anastomoses than MIDCAB * Smaller incision than CABG * No sternotomy Drawbacks * Uses CPB * Technically very difficult

Answer 26

\*Most important thing we look at is hemodynamics * Assess for signs of hemodynamic compromise * Hypotension * Decreased cardiac output * Shock * Monitor VS, ECG, MAP (70-110 mm Hg) * I&O – fluid and electrolyte imbalance * Early weaning from ventilator * Monitor ABGs * Encourage effective post-operative pulmonary toileting * Chest splintingPain management * Pharmacological management * Assess chest tube drainage * Encourage early ambulation * Monitor for complications of procedure * Advance diet as tolerated * Cardiac diet * Emotional support of patient and family

Answer 27

* good oral care every 2 hours * when extubated: incentive spirometer, turning, ambulating, sitting up, deep breathing and coughing, splinting with binder and pillow, pre-medication

Answer 28

* medial-stinal chest tubes placed right behind heart * drain excess fluid and blood that comes off * several hundred the first hour is normal, want to see drainage steadily decreases and goes from sanguinous to sero-sanguinous. Also dump a lot of fluid when the sit up as well * If getting a lot of blood, do an H&H, if less than 6 transfuse * Also think about auto-transfusion. Chest tube has an extra chamber. Take the blood draining off and put back in. Big problem with this is hyperkalemia (bc of K+ bath of heart with surger)

Answer 29

* Hypothermia (warming) * Anesthetics * Electrolyte imbalance * Acidosis * MI * normally given lanoxin (iv version of digoxin) IV psuh

Answer 30

Inotropic support (increase contractility of the heart, dobutamine! 5mics per kg) & replacement Fluid

Answer 31

(means periphery is dilated) Check for Hypothermia (vasodilation related to temperatures) or volume issues

Answer 32

* What to expect at home * Pain in your chest around the incision area * Swelling in the leg at harvest site * Itchiness or tingling feeling at incision site * Weakness * Cardiac rehabilitation * Lifestyle & diet modification * Smoking cessation * Cardiac diet (Low salt, low cholesterol, low fat)