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286 Cards in this Set

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I should be concerned about my child's blood cholesterol levels:


A. If I have angina

B. If my great aunt has high cholesterol

C. If my brother has a heart-valve defect

D. There is no need to be concerned about children's cholesterol levels
A. If I have angina. Children from families in which a parent or grandparent has developed heart disease, which includes a heart attack or the chest pain of angina, at an early age (before age 55 in father or grandfather, or before age 65 in mother or grandmother) should have their cholesterol levels tested.
To reduce high blood cholesterol, one should:


A. Follow a diet low in saturated fat and low in cholesterol

B. Be more physically active

C. Lose weight if overweight

D. All of the above
D. All of the above. Following a Step II Diet (low saturated fat, low cholesterol), being more physically active, maintaining a healthy weight and taking cholesterol-lowering medication, if prescribed, are all important to help you lower your blood cholesterol level and reduce your chance of heart attack or other heart disease.
Which food does not have a lot of saturated fat?


A. Coconut oil

B. Whole milk

C. Chicken, with skin

D. Whole wheat bread
D. Whole wheat bread. The other choices are all high in saturated fat. Foods high in saturated fat include foods from animals, such as fatty cuts of meat, poultry with the skin, whole-milk dairy products and lard. Even though they are vegetable products, tropical oils like coconut, palm kernel and palm oils are also high in saturated fat.
Which food does not have a lot of cholesterol?


A. Steak

B. Banana

C. Shrimp

D. Butter
B. Banana. Dietary cholesterol also can raise your blood cholesterol level, although usually not as much as saturated fat. So it is also important to choose foods low in dietary cholesterol as well as saturated fat. Dietary cholesterol is found only in foods that come from animals. Many of these foods also are high in saturated fat.
My LDL-cholesterol goal is:


A. Less than 200 mg/dl

B. 100 to 130 mg/dl

C. Less than 100 mg/dl

D. It depends on my heart health
D. It depends on my heart health. For the general population, a level of LDL-cholesterol below 130 mg/dl is desirable. But if you already have heart disease, your goal is lower -- less than 100 mg/dl. This is because patients with heart disease, even if they have relatively low cholesterol levels (say an LDL-cholesterol of 120 mg/dl), are more likely to have a heart attack or other heart disease complications.
The best type of fat to eat is:


A. Polyunsaturated fat

B. Monounsaturated fat

C. Unsaturated fat

D. All of the above
D. All of the above. Your body needs fat for a variety of functions, so not all dietary fat is bad. However, it is true that some fats are better than others. Look for fats and oils that are unsaturated -- either polyunsaturated (safflower, sunflower, corn and soybean oils) or monounsaturated (olive and canola oils). Unsaturated fats help to lower blood cholesterol when they are substituted for saturated fat. Just be sure to limit the total amount of fats or oils, since even those that are unsaturated are a rich source of calories.
What is ECC?
Extracorporeal Circulation, also called a Heart-Lung Machine.
What are some complications of ECC?
-Bleeding Caused by Hemodilution and damage to RBC
-Longer Pump Times cause more complications.
What does a heart-lung bypass do?
Removes Co2
Oxygenates the blood
Warms or Cools the Blood
Filters the blood.
In CABG, name three donor sources.
IMA
Saphenous Vein
Radial Artery
What is an IMA, and how is it used?
Internal Mamary Artery. It is sewn distal to blockage, and has a better patency rate than saphenous.
What mus be done with a Saphenous Vein if it is to be used in CABG?
It must be reversed and dewn to Aorta distal to the blockage.
How is the Radial Artery used in CABG? What can be said about it patency?
It has good patency, and is used in Redo CABG when IMA is radiated.
What is Median Sternotomy
The operation of cutting through the sternium at its median.
What is Cardioplegia?
Intentional, temporary arrest of cardiac function by means of hypothermia, medication, or electrical stimuli to reduce the need of the myocardium for oxygen. It can be done with Iced Saline and K.
Give some specifics of an Off Bypass CABG.
There is a smaller incision for the median sternomoty. There are devices, like an octypus, or medications which reduce heart movement.
What is a MID-CABG?
Minimilly Invasive Direct Coronary Artery Bypass Graft.
What might the approach be for a MID-CABG?
Left Anterior Thoracotomy using the IMA.
What are the benefits of Off Bypass CABG?
The clients dont need to be on Heart Lung Machine, so there is loess cost, fewer complications with ventilation, stroke, AFib and Pulmonary Problems. This allows more candidates, as sicker people are able to handle the less invasive procedure.
What is the DaVinci Robot?
It is a machine that allows a surgeon to operate on a patient in a remote location.
What is the LAD?
Left Anterior Descending branch of the Left Coronary ARtery.
Do Men or Women have more complications in CABG, and Why?
Women have more complications, possibly because of the smaller arteries.
What is PTCA?
Percutaneous Transluminal Coronary Angioplasty.
What are some complications of CABG?
Post Op Bleeding
Wound Infection and dehiscence
Intraoperative Stroke
MI
Thrombus
Multiple Organ Failure
Death
Postcardiotomy Delirium
How might you know that a patient has had an MI while having CABG?
Their will be values in cardiac enzymes that would show that an MI had happened.
What are some preoperative care that should be given before CABG?
-A&P of Heart
-Details of the ICU experience, Noise, Lights,
-Ventilator experience, suctioning
-Tubes, NG, RC, IV, ECG
-Pain and Pain Management
-OOB on POD #1
-Tour if Possible
How Many Phases are there to Cardiac Rehabilitation after surgery?
Three
Name the Three Phases of Cardiac Rehabilitation
Phase I - Begins in the Hospital after a procedure
Phase II - Outpatient program that begins after discharge from hospital. Structured Heart Monitored program allows for safe and efficient exercise.
Phase III - A lifetime exercise and maintanance program with a group of people with similiar backgrounds, helping you achieve heart healthy behaviors to succeed.
What is CVP?
Central Venous Pressure
What is PCWP?
Pulmonary Capillary Wedge Pressue.
What does PCWP show?
Measured in R Pulmonary Artery, shows what is happening in L Ventrical.
How would an Intra Aortic Balloon pump be introduced?
Femoral Artery. Used for more compliated cases.
What are two medications that help control bleeding after heart surgery?
Pratamine
Aminocaproic Acid.
What is an important differentition to make about chest pain after cardiac surgery?
Is it incision pain, or anginal/MI pain?
When are the highest levels of pain present after cardiac surgery?
The first two days.
When should morphine be administered?
In andicipation or procedures and pain, rather than after it has happened.
Besides the chest, where else might a client experience pain after CABG?
In the leg after the removal of the saphenous vein.
What are some examples of postcardiotomy delirium?
The need to reorient frequently, explain procedures, secure all lines to prevent them being pulled out, but hopefully without restraints.
What are some interventions for Postcardiotomy delirium?
Explain that mental acuity, agitation, confusion, and hallucinations are temporary.
Organize nursing care to provide adequate sleep.
Liberalize visitations times with family.
How long should the chest incisoin take to heal?
About a week.
When does Phase II Rehab begin? How often does the client participate, and for how long do they participate.
1-2 Weeks /p Discharge
3 Times a Week
2-3 Months
What is the Goal of Phase II Rehab?
Restore or establish appropriate exercise ability including leisure and occupational needs. Give Dietary counseling
Is Phase II Rehab purely physical?
No, it also meets the psychological needs of clients and family and might include working with a Psychologist or Social Worker.
What is Phase III Rehab?
Community exercise in YMCA or Health Club with home exercise between sessions.
Name two indications for Valvular Surgery.
Stenosis which is scarring and thickening of valve which prevents adequate opening.
Regurgitation which is insufficiency from incomplete closure of valve.
What is Porcine?
Coming from swine.
What are two types of valve replacement donors?
Mechanical and Porcine Tissue.
What does a mechanical valve need /p surgery that a porcine does not?
Anticoagulation is required with the mechanical replacement.
Does Mechanical or Tissue valve replacement last longer.
Mechanical. Tissue may need to be replaced in 10 years.
What are two types of surgery for valve replacement?
Sternotomy (Traditional or Mini)
Right Thoracotomy Approach.
Besides Anticoagulation, what other lifelong medication is needed in valvular surgery?
Lifelong prophylaxis with ABX.
What is cardiomyoplasty?
Surgical implantation of skeletal muscle to either supplement or replace myocardial muscle.
What is needed in the ACLS Immediate Assessment?
Must be done in less than 10 Minutes.
-VS and automatic BP cuff
-O2 Sats
-Get IV Access /s volume
-12 Lead for MD Review
-Brief targeted physical exam with focus on fibrinolytics eligibility.
What are some tips for running a code?
=Stay Calm
=Identify Yourself as Code Leader
=Talk Out Load with processes and algorithms.
=Confirm Code Status - Right Chart?
=Appoint specific people to specific tasks
=Monitor Leads - White to the Right / Smoke over Fire.
How much O2 should be given as an ACLS Immediate General Intervention?
4L
What are specifics of Aspirin in ACLS.
Not Enteric Coated.
160-325mg
Chew It.
What is NTG?
Nitroglycerin.
What is the proper use of NTG with ACLS.
Give q5 minutes X 3 to relieve pain.
If NTG q5 min x3 is not successful in relieving angina pain, then what next?
Give Morphine.
What is the nmumonic for ACLS?
MONA Greats All Patients.
Morphone
Oxygen
NTG
Aspirin
What is AMI?
Acute Miocardial Infarction.
Whate are some Adjunctive Treatments for AMI.
Beta Blocker IV - Immediately
NTG - Immediately
Heparin - Immediately
ACE Inhibitors - After 6 hours or when stable.
What is an AMI Fibrolonic?
What is the door to drug time?
Reteplase.
Less than 30 minutes.
If Fibrinolytic is contraindicated, that what is alternative therapy?
PCI.
What is the door to balloon time for a PCI?
Door to Balloon is 90 Minutes +/- 30 minutes.
Name some High Risk AMI Patients.
-Recurrent Sx
-Recurrent Ischemia
-Depressed LV functoin
-Widespread EKG @'s
-Prior MI, CABG, PCI
What procedure needs to be done to a high risk MI patient before an intervention?
Coronary Angiography to see if Tx will be possible.
What will be the Tx for a High Risk AMI?
PCI or CABG
Patient has a Non Diagnostic EKG with Low or Intermediate Unstable Angina. The Angina is new. What is the disposition?
Treat as Non-ST elevation MI
Patient has a Non Diagnostic EKG with Low or Intermediate Unstable Angina. Troponin is Positive. What is the disposition?
Treat as High Risk.
What happens with a Recurring Angina client, who is Not Troponin positive?
-More EKG Monitoring in ED
-More Cardiac Enzymes in ED
-Echocardiography
-If no ischemia or infarction, then DC.
This drug, when given in the ED for cardiac issues must always be chewed.
Aspirin
This drug must be givin within 12 hours of ischemic symptoms including chest pain.
Reteplase.
What is Reteplase?
Thrombolytic agents are used to dissolve blood clots that have formed in certain blood vessels. These medicines are usually used when a blood clot seriously lessens the flow of blood to certain parts of the body.
This anticoagulant is given IV in an AMI.
Heparin
THis drug class is givin in AMI 6 hours after SX and if the client is stable.
Ace Inhibitor.
This cardiac enzyme is used to Dx an AMI.
Troponin.
Pulmonary Congestion is seen in which side of the heart?
Left
The amount of blood that the left ventricle has to pump against is called?
Afterload.
The amount of blood that fills the left ventricle is called the...?
Preload
Hyperthyroidism can cause what kind of heart failure?
High Output
Morphine is given in heart failure to cause...?
Vasodilation.
Diuretics are given to reduce the.....
Preload.
X
X
X
X
The nurse is evaluating a client with chest pain. In what way does angina usually differ from symptoms associated with myocardial infarction (MI)?
Angina pain lasts less than 30 minutes.
A client describes substernal chest pain that radiates to the jaw and is relieved by sublingual (SL) nitroglycerin. For what condition should the nurse plan care?
Angina
A client, age 78, is admitted to the medical unit with arrhythmias. It is determined that he is experiencing left ventricular failure. What symptom should the nurse most associate with left ventricular failure?
Dyspnea
Ms. M. is taking multiple medications including digoxin, diuretics, and an oral iron preparation. Ms. M. begins to experience a ventricular arrhythmia. What factor should the nurse consider as a possible cause of this problem?
Hypokelemia
An EPS study is performed to...
enable the physician to reproduce dysrhythmias and evaluate the effects of antiarrhythmic drugs
A pulmonary artery catheter is inserted into a complicated myocardial infarction patient to mainly monitor
the cardiac output
Which determination is essential for the nurse and physician to evaluate when caring for a client who is considering mechanical valve mitral replacement?
Can the client comply with the lifelong requirement for anticoagulant therapy?
The nurse is assisting a patient to cough 10 hours after open-heart surgery. A small gush of drainage is noted in the chest tube during coughing. What action is required by the nurse?
Reassure the client that this is normal.
Mr. L. has high levels of high-density lipoproteins (HDLs) in proportion to low-density lipoproteins (LDLs). How does this relate to the development of CAD?
He is less likely to develop CAD. HDL is Happy!
Mr. J. is admitted to the intensive care unit with severe pink-tinged frothy sputum, dyspnea, fear, noisy respirations, sweating, and tachypnea. These symptoms most likely indicate
acute pulmonary edema
The nurse explains to a client with heart failure that the most important action of digoxin on the heart is to
increase venticular contractility
With a high potassium level, the EKG will show which of the following?
The T Wave Will Be Tall
Mrs. H., who is admitted to the hospital for treatment of atrial fibrillation but has just converted to NSR, complains of dyspnea and chest pain. Which of the following would the nurse suspect is occurring?
Pulmonary Emboli
The nurse notes that a patient's electrocardiogram shows sudden ventricular fibrillation. The intervention below that would be provided first is:
Precordial Thump
The nurse is assisting with a client who is in ventricular fibrillation. Another nurse is ready to defibrillate. The assisting nurse should be sure to:
Stand away from the bed
The nurse is instructing a client in the proper administration of sublingual nitroglycerin (NTG). Which of the following is correct and should be included in the teaching plan?
Repeat dosage after 5 minutes if pain is not relieved for a total of three doses.
The nurse is preparing a client with a recently inserted permanent pacemaker for discharge. The client should be told to...
Use the microwave in the home
The nurse is attempting to identify the timing of a murmur detected in a 40-year-old woman. What additional assessment is necessary in order to make this assessment?
Identification of S1 and S2
The nurse is participating in the assessment of a client with a myocardial infarction. An elevation in which isoenzyme is most associated with damage to the myocardial muscle?
Troponin
If you find a client with chest pain that is relieved by NTG. What might the medical Dx be?
Stable Angina
What factors might make an MI patient not experience any chest pains?
They are sometime absent in women, diabetics, or elderly.
What are CKMB and Treponin T?
When are they visible in an acute MI?
Blood tests that are sensitive to myocardial injury.
In the first 3-6 hours after an acute MI.
What is the most common site for an MI?
Anterior wall MI.
What is elevation of the ST segment an indication of?
EKG evidence of an acute MI.
What happens with thrombolytics?
Reperfusion dysrhythmias can occur
What is the period when most life threatening dysrhythmias can occur in an MI?
In the First, also called the Golden Hour.
What is the mortality rate for an Anerior MI?
30 Percent
What is Phase II Rehabilitation?
The first phase when a client is discharged. It included medically supervised exercise, often times connected to various monitoring devices.
What is directional coronary atherectomy
Excises and removes atheromatous plaque
Concerning Phase II Rehab...
How long does it last?
How often should the client exercise?
Two to three months.

Three times a week.
What are the phase I criteria for BP and pulse with or after activity?
Systolic BP should not increase more than 20 mm or decrease more than 10-15 mm after exercise.

Heart rate should not increase more than 20 above the resting.
What is a ratio of Lipoproteins that protect against CAD?
High HDL to LDL ratios are beneficial.
What are the maximum caloric percentages of food types for a AHA step I diet?
What are 30% fat (10% saturated)
55% carbohydrate (half or more complex)
and 15% protein?
How does smoking affect a womans risk for Heart Attack?
It Triples It!
What is the target level for LDL with two or more risk factors?
Less than 130.
LDL is Lousey!
What are some of the benefits of Exercise on Heart Disease?
Increases Happy DL
Decreases Lousey DL
Decreases Triglycerides.
Lowers Blood Pressure
Lowers Blood Glucose.
How many MI's anually in the US?
1 Million
Why do women have a higher mortality rate of MI in the hosptial?
They receive less Tx.
What three races have higher death rates from MI?
African American, Native Americans, Hispanics.
What is ACS?
Acute Coronary Syndrome, and it includes both Angina and MI.
What is the difference between NSTEMI and STEMI?
Non ST Elevated Micoardial Infacrtion.
What is the difference between Angina, and an MI?
MI is the complete or nearly complete occlusion of a coronary artery by plaque and subsequent thrombus formation.
Stable Angina is a short term, partial occlusion. MI pain lasts for more than an hour.
Name some Internal Factors leading to MI.
Lipid core, fibrous caps, coagulation status, arterial vasoconstriction.
Name some External Factors leading to MI.
Strenous physical activity, servere emotional distress, cold exposure, timee of day.
What about the longterm differences between MI and Angina?
Stable Angina is a temporary ischemia of the heart tissue.
MI is irreversible damage, and death of heart tissue. Cells die after 15 minutes.
When the heart tissue dies in an MI, what does the resulting lactic acidosis cause?
Conduction and contractility disorders.
What is Remodeling of the ventricle?
Changes the structure and function of the ventricle. It increases preload and may last for years, causing CHF.
What does Infarction mean?
Death of tissue that results from deprivation of its blood supply.
What is the most common site of AMI?
LV Anterior wall, near the apex. It is an occlusion of the LAD.
What is the LAD?
Left Anterior Descending artery.
What are the clinical manifestations of AMI?
Chest pain, similiar to Angina, but not relieved by NTG.
Radiate to nexk, jaw, shoulder, back. Left Arm
Pain may be present near epigastrium, simulating indigestion.
Besides pain, what are some of the other clinical manifestations of MI?
Nausea, Dizziness, SOB, Dyspnea, Unexplained Anxiety, Weakenss, Fatigue, Palpitations, cols sweat.
What are the progression of ECG Changes that are seen in MI?
First: ST Elevation or Depression
Next: T Wave Inversion
Later: Larege Q waves (which are normally small or absent".
What are the Onset, Peak, and Duration on Troponin T?
Onset 3-6 Hours
Peak 24 Hours
Duration 14-21 Days
What are the Onset, Peak, and Duration on Troponin I
Onset 7-14 Hours
Peak 24 Hours
Duration 5-7 Days
What are the Onset, Peak, and Duration on CK-MB?
Onset 3-6 Hours
Peak 12-18
Duration 3-4
What are the Onset, Peak, and Duration on Myoglobin?
Onset 2 Hours
Peak 8 Hours
Duration 24 Hours
Other than MI, when might you see an increased CK-MB?
PTCA
Thrombolytics like TPA.
If your patient had Heart Failure and Pulmonary Edema, what heart sound would you hear?
S3
Describe some interventions of Acute MI at Home.
Call First, Call Fast
Chew Aspirin
Elevate Head, Loosen Neck Clothing
What is the Door to Needle time for Thrombolytic therapy from start of pain?
30 Minutes
What is the door to angioplasty time?
One Hour
How is pain treated in an AMI?
Morphine, which relieves the Ischema by reducing sympatheic stimulation and preload, which reduces the demand for O2.
What is a TEE?
Trans Esophageal Echocardiogram.
What are the Absolute Contraindicators of using Thrombolytics?
Active Bleed
Any Intracranial bleed or tumor
CVA in past year
Aortic Aneurysm
What is another name for TPA?
Alteplase.
Which is better streptokinase or TPA?
TPA, Strepto is older.
Name 4 Thrombolytics.
Streptokinase
TPA Alteplase
Reteplase
anistreplase
What is RheoPro and what is it used for?
It is a platelet glycoprotein which when given with 1/2 dose of thrombolytic gives better profussion.
What are reperfusion effects?
Normal ECG
Relief of Pain.
Might also trigger PVC or other arythmias as the heart reprofuses.
What two things help determine the location of the MI?
12 Lead ECG and Angiogrophy.
What is the initial weight loss target that should be aimed for?
10%
What are the Four Phases of Cardiac Rehab?
Phase I Inpatient
Phase II Immediate Outpatient
Phase III Intermediate Outpatient
Phase IV Maintainence Outpatient
When can sex be resumed after MI?
4-8 Weeks
2 Flights of Stairs
Avoid food and drink before sex.
NTG OK, but not with Viagra
What is the limit that should be lifted during phase II Rebha?
20 pounds.
What isthe goal for walking in phase II?
@ miles in less than 1 hour.
How long should someone plan to be off work after an AMI?
8-9 Weks
Describe Phase II Large Muscle Exercise.
20-30 minutes
3-4 Times each week.
Warm up and Cool Down
WHat is a complication with transmural MI?
Ventricular Rupture.
After an MI, the ventricle structure can change which reduces pumping. This is called...
Remodeling.
The Normal for this is less than 0.12 seconds?
QRS
When a PVC lands on ____________ it can lead to Ventricular Tachycardia or Ventricular Fibrillation.
T Wave
This wave has disorganized chaotic waves, no Ps, No QRS's or T waves.
Ventricular Fibrillation
What is the normal time frame for a PR Interval?
0.12 to 0.20
The P wave occurs at about the same time as the:
Atrial Contraction
Describe 3rd Degree Heart Block.
Dissociation of the Atria and Ventricals with a very slow ventricular rate.
What is the most common monitoring lead in an ECG?
Lead Two.t
When there is no electrical activity in the heart.
Ventricular Asystole
Same as NSR except the heart rate is above 100.
Sinus Tachycardia.
How many seconds does a small box on and ECG represent?
0.04 Seconds
This rhythm has a different looking P Wave, but the QRS are normal.
PVC
This rhythm is more than 3 PVS.
Ventricular Tachycardia.
This type of heart block happens when the PR gets progressively longer, until a QRS is dropped or not present.
Second Degree Mobitz Type I Wenkebach.
Atrial Flutter is best described as an ECG with...
Sawtooth Waves.
This rhythm has a NSR except P-R Intervals are prolonged. How long would they be?
Longer than 0.2 seconds.
This drug is used to treat prequent PAC's which can lead to Atril Fib or Atrial Flutter.
Procainamide
What intervention is used in Atrial Flutter with a Fast Ventricular Rate?
Cardiovresion.
This drug is used to treat Hyperlipidemia and can cause flushing.
Niacin
Hyocardial Hypoxia can cause what?
PVC
These are dangerous on the T Wave, Dangerous when coupled, Dangerous when more than 6 per minute.
PVC
This therapy is used first in VF to stop all electrical activity.
Defibrillation
This drug is used as a vasodilator in Pulmonary Edema and lowers preload.
Morphine
This drug is used in Ventricular Tachycardia.
Lidocaine.
What happens during S1?
Onset of Systole.
Tricuspid and Mitral Valves Close
How and where is S1 heard best?
At the Apex over the Mitral area with the diaphragm of stethoscope
What is happening during S2?
Onset of Diastole
Closing of Pulmonic and Aortic valves
Best heard at base (aortic and pulmonic) areas with diaphragm.
What is an S3 heart sound?
Early passive and rapid filling during diastole.
How old can someone be and still have an S3 be considered normal?
30
What word sound do we associate with an S3 sound?
ken-tuc-KY
What position would a patient be in to best hear an S3 sound?
On the left side.
What is VSD?
Ventricular Septal Defect
An abnormal opening in the septum between the ventricles of the heart that may produce shunting of blood from left to right, or other diseases.
What is PDA?
Patent Ductus Arteriosus
Persistence, after birth, of a communication between the main pulmonary artery and the aorta.
What can an S3 indicate in people over 30?
MI
Valvular Insufficiency
PDA
VSD
What is a pericardial friction rub?
Caused by inflammation of pericardial sac or pericarditis
What does a Pericardial Friction Rub sound like?
Scratchy, Leathery Sound.
What can a Pericardial Friction Rub indicate?
MI
CHF
Autoimmune like Rhumatic Fever
What is valvular stenosis?
Stuck closed valve
What is valvular insufficiency
Floppy valves that cannot close.
What are some causes of Murmors?
Vigorous Muscle Contractions
Enlarged Heart Chambers
Scarring of chambers (as in MI)
Valvular Stenosis or Insufficiency
Septal Defect.
When do most murmors happen?
During Systole. Early Middle or Late.
What are the Intensity Levels of Murmors?
I-VI
I-Very Faint
II-Faint
III-Moderatly Loud Vibration Thrill
IV-Loug
V-Very Loud
VI-Very Loud without Stethoscope
Murmors are best heard with this part of the stethoscope.
Bell
An S2 is best heard over what part of the heart?
Base
What abnormal heart sound might you hear with a patient with an MI?
S3
Which side should the patient turn to in order to hear the heart best?
Left
What is LVAD?
Left Ventricular Assist Device. Used for a limited time, but is an extra pump to help the ventricle.
What is the donor tissue for a cardiomyoplasty?
Latissamus Dorsi.
Define Preload..
The Amount of blood in ventricle at the end of diastole.
Define Afterload...
Pressure against which the left ventricle ejects.
List some Right Sided Heart Failure Assessments seen with Increased Preload.
JVD
Increased CVP
Liver Engorgement
Peripheral Edema
Ascites
List some Left Sided Heart Failure Assessment Findings.
Pulmonary Edema
Elevated Wedge Pressure
Cardiogenic Shock/Decreased Tissue Perfusion
Increased ADH/Aldosterone
What are some CHF Diagnostic Findings?
BNP >100
Echocardiagram
Xray
ECG
Doppler Flow
ABG
Liver Enzymes, BUN, and Creatine
Treatment of CHF
O2 with Vent if needed.
What are medications in CHF.
Diuretics
Ace Inhibitors
Nitrated (reduce pre/post load)
Beta Blockers
Inotropics: Digoxin/Dobutamine
Anticoagulants
Treatment of CHF Afterload inludes
Reduce Stress
Avoid Isometic/Valsalva
Vasodialator
Intra Aortic Baloon Pump
Avoid Caffeine
Treatment of CHF Preload inludes
Diurtics
Vasodilators (Morphine)
BNP
Fluid Montiroing
Reduce Sodium
With an IABP when does the balloon inflate and deflate?
Inflates at Diastole and deflates at Systole.
What are approprite Digoxin Levels?
0.9 to 2.0. Watch for signs of toxicity.
Name Two Inotropics?
Digoxin
Dobutamine.
What is TMR?
Transmyocardial Revascularization.
Laser on outside of heart causes chanels to form allowing blood to pump out to outer areas.
What is the desired HR when treating CHF?
60-100 in NSR.
Pulmony Edmema and Congestion is seen in which kind of CHF?
Left
What is the name for the amount of blood that the left ventricle has to pump against?
Afterload.
The amount of blood that fills theleft ventricle is called the..
Preload
Morphine is given in heart failure to cause...
Vasodilation.
Diuretics are given to redunce what in CHF?
Preload
What are some indicators for pacemakers?
2nd 3rd Degree Heart Block
Atrial Fib/flutter
Cardiac Surgery
What are the two parts of a pacemaker?
Silver part is the pulse generator
Two silver lines are called pacing leads.
What are the tissue inside the ventricles where the pacing leads attach to called?
Trabiculai.
Name two different types of Pace Makers
Transvenous or Endocardial
Transthoracic or Epicardial
How do Transvenous and Transthoracic Pacemakers differ?
Transvenous are put in trhough the subclavian via local anasthetic.

Thrans thoracic are a general anesthesia with chest surgery and chest tubes.
What is TCP?
transcutaneous pacing The application of an electrical current between electrodes placed on the skin to stimulate the heart to beat.
Where are pacing leads normally placed?
R Ventrical
What is Rate Reponsive?
They will speed up when client is doing some activity.
What are Epicardial Leads?
Placed on the outside of the heart.
Whare are steroids on some pacling leads?
It helps they stay attached inside the heart.
What are the two modes of pacemaker pacing?
Demand and Fixed
Describe Demand Pacing
The pacemaker senses the clients own heart gbeat and fires and impulse only when needed. Most common mode.
Describe Fixed Pacing
The pacemaker does not sense, but only fires at a set rate.
This causes competition with the clients own rate which could result in ventricular arrhythmia if landing on a T Wave.
Where are the sensors for a pacemaker placed?
R Ventrical
L Ventrical
Both Ventricals
Where is the pulse generator in a Temporary pacemaker?
Outside the client on the bed someplace else. The lead goes inside.
What are three common dials on an external pacemakers Pulse Generator?
Rate Dial - Sets BPM
Milliamp Dial - Amout of Electiricty to stimulate contraction
Sensitivity Dial-Amout of sensing the clients own heart beat.
Demand On/Off Switch
What are four things to think about with Electrical Safety of Pulsing Leads?
-Dont touch leads together or with bare hands. Wear Gloves.
-Keep System Dry
-Use separate grounded outlet/circuits
-Keep pacing wires which are not attached to a pulse generator insulated with a glove and dry.
Differentiate between Defibrillation and Cardioversion.
Defibrillation is emergency and needs no consent. Uses more electricity than Cardioversion.

Cardioversion is elective procedure and needs informed consent. Uses less electrical.
What does the synchronization button do when Cardioverting?
It see that the shock does not come on a T wave.
A Pacemaker consists of a pulse generator and...
Pacing Leads.
What is themost common type of pacemaker insertion?
Transvenous
Another name for transthoracic pacemaker is...
Epicardial.
When are cell phones a problem with a pacemaker?
When they are held directly over the pulse generator.
Pulsing only when the heart needs it is called...
Demand Pacing
The amount of electircity ths is needed to cause a contraction is called the....
Threshold.
What are three types of Angina?
-Chronic Fixed Atherosclerotic Lesion Plaque.
-Acute Atherosclerotic Lesion or Embolus
-Coronary Artery Spasm
Which race of women are more at risk of CAD and angina?
African American Women
How does smoking affect CAD in Men and Women?
Men it doubles the rate, Women it Triples the Rate.
Describe HTN in African Americans.
Seen at younger ages and is more severe.
What should total cholesterol be less than?
200
In regard to LDL and you have less than 2 risk factors, what is your target LDL levels?
160.
In regard to LDL and you have 2 or risk factors, what is your target LDL levels?
Less than 130
How high should triglycerides be?
Less than 150
How does exercise affect CAD?
Inc HDL
Lowers LDL, Trig and BCG
Hightens insulin sensitivity
lowers BMI.
What is the goal for BMI?
18-25
How doe H Pyloria and Chlamydia Pneumonia figure into CAD?
These infections can increase plaque instability.
What is Stable or Classic Angina?
Stable pattern relieved with stress and or NTG.
What is Unstable Angina.
Pre Infarction/Crescendo is triggered by unpredictable exertion increasing in frequency and severity. May occur at night.
What is Variant Angina?
Similar to stable, but happens 0000-0800
What is Nocturnal or Angina Deucatous?
Happens while lying down.
What are the drugs from the Anti Agninal Bank?
Beta Blockers
Ace Inhibitors
Nitrates
Calcium Channel Blockers
What is Nitroglycern?
A Nitrate which is a vasodilator. Use for MI or Angina.
Decreases pre/after load.
When are Ace Inhibitors used?
Ace like Captopril use in Angina and MI.
Decreases afterload, increases contractility and cardiac output, vasodilates and decreases BP.
What are two things that Calcium Chanel Blockers are used for?
Antianginal and Antirrhythimc.
When is Dlitaizem used?
Angina and MI. Dilages Coronary arteries and decrases pain.
When is Verapamil used?
Atrial Fib and Atrial Flutter by prolonging conduction.
What is Brachotherapy?
Radioactive seeds are inserted in coronary artery to prevent plaque buildup. Usually performed with angioplasty and stent placement.
What is Transmyocardial Revascularization?
TMR. Laser the outside which creates channels that allow blood to "leak" to outer chambers.
Combined with LDL this is a better pridictor of CHD in women.
Triglycerides.
An elevation of this amino acid is a contributing factor in CHD.
Homocysteine
Coronary artery blockages without pain are called
Silent Ischemai.
What is the name of the fat found in colives and encouraged for cardiac patients?
Monosaturated.
Ane ACE Inhititor used to treat angina.
Captopril.
What is 1st Degree Heart Block?
NSR with prolonged P-R Interval > 0.20 Seconds
What is Second Degree Heart Block Motize I Wenkebach?
P-R Interval get progressively longer until QRS is missed.