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100 Cards in this Set

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How does HR effect hemodynamic status
Faster rate decreases diastolic filling, lose atrial kick which decreases CO and BP
How does acidosis effect the heart
Makes it irritable causing PVCs
Which electrolyte (K+, Ca++, or Mg+) stabilizes the cell membrane
Magnesium
What portions of the heart does the right coronary artery feed
Right atrium and rt. ventricle, anterior and posterior wall of left ventricle, SA and AV node
What portions of the heart does the left anterior descending artery feed
Anterior and part of lateral surface of left ventricle, majority of right bundle branch and portions of left bundle branch
What portions of the heart does the left circumflex artery feed
Left atrium and portion of left ventricle, SA and AV node
How do you treat post surgical sinus bradycardia
Atropine
What causes sinus arrythmia
Increases with inspiration decreases with expiration. Should disappear on breath holding if not may may digitalis toxicity
What is the treatment for sinus arrest
Atropine, Isoproterenol, Pacemaker
What are some EKG signs of a wandering atrial pacemaker
PR interval stays the same but P wave changes
How do you treat MAT
CCB, BB, Amiodarone
What are the causes of Premature Atrial Contractions
Emotional stress, alcohol, tobacco, hyperthyroidism, cocaine. Patient may indicate they can feel it.
What is the treatment for atrial tachycardia
Oxygen, vagal maneuvers, CCB-Verapamil
How do you treat PSVT
Adenosine, Vagal maneuvers
How do you treat A-flutter
If asymptomatic use CCB, if symptomatic numb with Versaid then cardiovert at 25-50 joules
How do you treat A-fib
Cardiovert, CCB and give heparin and coumadin to prevent clot formation
How do you recognize a premature AV junctional beat on an EKG
Rhythm will be regular with a premature beat that has an inverted P wave before the QRS or a P wave after the QRS
Under what heart condition might you see junctional escape beats
Inferior wall MI in which right coronary artery is plugged which feeds SA and AV node.
How would you treat a junctional escape beat
Depending on symptoms - Atropine and possible transcutaneous pacing
What causes accelerated junctional rhythm/junctional tachycardia
Increased automaticity at bundle of HIS node which send wave impulse back thru atria causing retrograde P wave
How do you recognize and treat ventricular escape beats/idoventricular rhythm
Recognize by wide QRS and slow rate. Don't use lidocaine (suppresses). Use atropine or transcutaneous pacing
What are some causes of PVCs
Meds, Alchohol, Caffeine, Cocaine, Stress, Exercise, MI, Ischemia, Acid-Base Imbalance
How do you treat PVCs
Most don't require meds. If due to MI, provide pain relief, oxygen, correct acid-base imbalances
What is the difference between monomorphic and polymorphic Vent. Tach
Monomorphic - QRS's look the same and result from CAD with ischemia. Polymorphic - QRSs look different and result from long QT syndrome (an electrical problem)
What is the treatment for Ventricular Tachycardia
Stable but symptomatic - oxygen and drugs to slow rhythm; Unstable - cardiovert
How do you treat accelerated idioventricular rhythm
Atropine or transcutaneous pacing
How do you treat Wenkebach
Only if symptomatic use atropine
How do you treat Mobitz Type II
If symptomatic - transcutaneous pacing until pacemaker installed
What are some signs and symptoms of chronic stable angina
Pressure, burning, stabbing ache below sternum radiating to left face and arm with ST segment depression and possibly S4 and mitral regurg.
How would you treat chronic stable angina
Sublingual NTG, BB, Antiplatelets (ASA, Plavix), and Lipid lowering drugs
What are some catheter based treatment options for chronic stable angina
Percutaneous Coronary Intervention (PCI), Balloon Percutaneous Transluminal Coronary Angioplasty (PCTA)-restenosis rate of 30-40%, Stents (lower restenosis rate 20-30%, coated with antiplatelet)
What veins are used for coronary artery bypass graft
Saphenous vein or internal mammary artery
What might be the cause of prinzmetal angina or coronary artery spasm
Dysfunctional endothelian or hypersensitive smooth muscle (can evoke with acetylcholine)
What type of drugs are used in chemical stress tests
Dobudamine and positive inotropes (Adenosine)
How can you differentiate between an MI and unstable angina ischemia
MI shows cardiac enzymes, ischemia does not
An ECHO shows dyskinesia during an acute coronary syndrome, what does this mean
Irritable non-synchronized beating of the heart. The ECHO can also evaluate clots and fluid.
What events are taking place with an ST segment elevated MI
Complete occlusion of an epicardial coronary artery that must be resolved in 3 hrs before a transmurial infarct develops
What causes a "Stunned Myocardium"
Coronary artery is occluded then reopened. During occlusion some areas may receive collateral circulation and there is transient periods of no muscular activity. If treated early, the heart can regain functional status
What can cause an ischemia at a distance
Occlusion in an artery at a bifurcation
What occurs in the process of infarct remodeling
Thinning, dilation and dyskinesis at area of infarct. Angiotensin II causes heart cells to undergo remodeling but they do not heal properly leading to CHF.
What drugs can be used to stop the infarct remodeling process
ACEI (help reduce afterload and tissue changes)
What percentage of MI's are silent
25-30%. Elderly and Diabetics don't feel same symptoms until progressed to CHF
Why would you not use NTG with a right side heart infarct
Knock out SA node activity
What percent of people die from denial of MI
50%
Early reperfusion therapy decreases MI mortality by how much
27%. Give drug to dissolve blood clot
When are thrombolytics contraindicated during an MI
After 12 hours and without evidence of ischemia or pain or if the person has a bleeding condition
List some complications resulting from an MI
Cardiogenic shock, free wall rupture (2-14 days post MI)
What tests should be run prior to hospital discharge
ECHO (left ventricle status), treadmill stress test to determine ischemia, and EKG (to spot arrhythmias)
What are the discharge medication for an MI patient
ASA, Statin, BB, and ACEI
What is a common side effect of statins
Muscle aches
What is a drug type that lowers the effectiveness of statins
Abx
Heart failure most commonly results from..
Left ventricular impairment
What factors characterize systolic dysfunction in Heart Failure
Impaired contractility (MI, Ischemia (stiff ventricle), CAD, Volume overload (Mitral regurg and aortic regurg) and increased afterload (HTN and aortic stenosis)
What factors characterize diastolic dysfunction in Heart Failure
Impaired relaxation (LV hypertrophy, Hypertrophic cardiomyopathy, Restrictive Cardiomyopathy) and Obstruction to filling (mitral stenosis and pericarditis/tamponade)
What are some factors that may precipitate symptoms of heart failure
Factors that increase metabolic demand, afterload, preload and decrease contractility
What causes the rales/crackles in the lungs with heart failure
Fluid build up in alveolar spaces (alveoli snap open with each breath)
What causes a white out on an lung x-ray with heart failure
Once left atrial pressure exceeds 15mm/Hg pulmonary blood shifts upward (cephalization) to apex creating white out.
What causes Kerly B-lines on lung x-ray with heart failure
Accumulation of interstitial fluid that looks patchy on x-ray
Describe the classifications of heart failure
Class I (No physical limits), Class II (Dyspnea and fatigue with moderate activity), Class III (Dyspnea with minimal activity), Class IV (Severe limitations-symptoms at rest)
What are the mortality rates with the different classification of heart failure
Class I and II (50%), Class III and IV (70%)
What lab test marker is a good indicator of CHF
Beta Naturietic Peptide (BNP) - released from atria and ventricle in response to stretch-signals kidneys to dump fluid. Not effective because in CHF the kidneys are not receiving much blood flow.
Why must caution be used with diuretics in treating right heart failure
Don't want to drop volume so low that kidney are not perfused
What is the treatment for left ventricular dyfunction
Correct the underlying condition, give diuretics, limit salt and alcohol, use vasodilators and inotropics
What is the treatment for right ventricular dysfunction
Oxygen to relax pulmonary vessels and diuretics
How does digoxin increase contractility in heart failure
Keeps calcium inside the cell longer by inhibiting the sodium pump
Why might a loops diuretic (Lasix) be better than Thiazide in heart failure treatment
Thiazide needs normal renal function to work which may not be available in heart failure. Loops work at lower renal levels
Why should the electrolytes be monitored in heart failure
The use of diuretics can cause hypokalemia while kidney failure can cause a rise in potassium
Name a commonly used inotropic drug for heart failure
Digitalis glycosides (Digoxin)
Name the 3 dosing levels of Dopamine (IV) B-andrenergic agonist
Level I -2-5mcg increases renal blood flow, Level II - 5-10mcg increase rate and contraction of heart, Level III-10mcg+ increases systemic constriction via alpha1
Why are inotropic drugs of limited value in diastolic dysfunction
Inotropic drugs increase contractility, whereas diastolic dysfunction is a relaxation problem
Name 2 venous dilators and there purpose in heart failure
Nitrates and Morphine. Decrease preload stress
How does Hydralazine help in heart failure
Dilates arterioles decreasing afterload. Be careful of hypotension
What function do ACEI serve in heart failure
Dilate venous and arterioles and prevent cardiac remodeling
What is the treatment for diastolic dyfunction
Pericardectomy for constrictive pericarditis, correction of transient ischemia
What are signs of acute pulmonary edema
Tachypnea, cold clammy skin, coughing up frothy sputum
What is the treatment for acute pulmonary edema
Sit upright, morphine, lasix, NTG, possible positive inotrope, improve Oxygen saturation
What forms of testing and monitoring is available for syncope
Tilt table testing, Holter monitor, EKG
What types of treatment are used for syncope
Once cause is more understood, could use pacer, vasoconstrictors, BB or measures to prevent venous pooling
How does kidney failure effect BP
Without the kidneys regulating water BP skyrockets
What is the BP goal in patients with HTN and Diabetes or Renal Disease
<130/80
What should you check albumin levels in diabetics
Sugar pulls water into kidneys causing cell destruction which leaks protein out in urine
What values classify pre-hypertension
130-139/80-89 (No drug treatment)
What values classify Stage 1 hypertension
140-159/90-99 (Thiazide)
What values classify Stage 2 hypertension
>160/>100 (Thiazide plus another drug-ACEI, BB, CCB)
What should you look for during a physical exam on a patient with HTN
Check BP, Optic fundi (flame hemorrhages), Bruits in carotids and abdominal (renal area), Examine heart and lungs, Check for edema and pulses of upper and lower body
What laboratory tests would you run on a patient with HTN
EKG, Urinary albumin, Glucose, Hematocrit (if high, increases blood thickness, if low the heart increases to increase CO), Lipids, Electrolytes, Creatinine and GFR
True or False. When combining drugs for HTN choose from the same class
False. Never choose from the same class and always have one of the drugs be a diuretc
True or False. Most people will need 2 drugs to control HTN
True. Give first drug for 6-8weeks plus lifestyle changes then consider adding second drug. Plus have them monitor their BP at home and record values throughout the week.
How do oral contraceptives effect BP
Initial increase then come down. If don't come down, find alternative
What organ systems are effected in a hypertensive emergency
Brain initially constricts vessels in response to HTN then dilates which leads to seizures and coma, the optic disc swells cutting off blood supply causing visual loss and get headaches.
What is the treatment for hypertensive emergency
Admit to ICU, put in arterial line and administer Sodium Nitroprusside, also use NTG, Labetalol, Hydralazine
What side effects exist with sodium nitroprusside
Nitroprusside is metabolized to cyanide in RBC's so may need to infuse sodium nitrite or hydroxycobalamin to avoid toxicity
How does a hypertensive emergency differ from a hypertensive urgency
Emergency has organ damage and need for immediate lowering. Urgency does not have organ damage and can be lowered slowly over 24 hours with medications
What situation may lead to hypertensive emergencies and urgencies
Neglected HTN, Sudden stopping of meds (Clonidine, BB), Renovascular disease, Pheochromocytoma, Intercerebral or subarachnoid bleeding
What is the pathophysiology of hypertensive emergencies and urgencies
Vasospastic disorder with large increase in peripheral vascular resistance and over production of renin and angiotensin II which casues vessel wall necrosis in target organs
How is resistant hypertension defined
Failure to achieve BP goals in patient following 3 drug regimen that includes diuretic
How do you manage resistant hypertension
Rule out all secondary causes of hypertension and refer to specialist
Where would you see an infarct if the Left Anterior Descending Artery was blocked
Anterior wall of LV near apex, Anterior two-thirds of IV septum
Where would you see an infarct if the Right Coronary artery was blocked
Posterior wall of LV, Posterior one-third of IV septum
Where would you see an infarct if the Left Circumflex artery was blocked
Lateral wall of LV