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86 Cards in this Set
- Front
- Back
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in LV failure, the goal is to ___ preload and ____ contractility
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decrease preload, increase contractility
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What problem is this...loud S1, opening snap and diastolic murmur?
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mitral stenosis
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What sound indicates rapid ventricular filling into a distended ventricle?
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S3
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What kind of murmur will you have with acute mitral regurg related to papillary muscle dysfunction or rupture?
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A new holosystic murmur at apex that radiates to the axilla
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What kind of change on EKG do you have with left atrial enlargement?
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wide, notched P wave in lead II
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What's up with asthma and beta blockers?
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Don't give noncardioselective BB..they can cause bronchospasm
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What kind of drugs are Torsades de Pointes risk factors?
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Class 1A antidysrhythmics such as quinidine, procainamide, disopryramide; tricyclic antidepresants
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What electrolyte abnormalities put your pt at risk for Torsades?
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hypokalemia, hypomagnasemia, hypocalcemia
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______thermia puts your patient at risk for Torsades
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Hypothermia
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What kind of neurological insult puts your pt at risk for Torsades?
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SAH
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Hypertrophic cardiomyopathy...what drugs NOT to give?
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Nitrates and diuretics (they decrease venous return needed for adequate filling); positive inotropes (dobutamine, dopamine, digoxin) may increase the obstruction and can cause instant death :-(
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Your pt has had an anterior wall MI...what are you going to watch for on EKG?
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Watch for 2nd-degree Type II (Mobitz II). It is located at the Bundle of His which is fed by the LAD (located on anterior wall)
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What does the PR interval represent?
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Beginning of atrial depolarization to beginning of ventricular depolarization
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What does the PR segment represent?
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Time between P wave and QRS...represents delay in AV node
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What's the deal with Nesiritide and Heart Failure?
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It can cause hypotension in HF
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When would you expect to hear an S4?
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In Acute MI...may see in angina
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What organs does HTN target?
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heart, brain, kidneys, retina
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What drugs do you want to give in hypertrophic cardiomyopathy?
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BB and CCB to reduce contractility and reduce the outflow obstruction
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You hear a midsystolic click...what's up?
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Mitral valve prolapse
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You hear a paradoxical split of S2...what's up?
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Lbbb, right ventricle PVC, transvenous endocardial pacemaker or a valvular problem
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What ACLS drugs can be given via trachea?
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atropine, lidocaine, epi, narcan
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You need to give ACLS drugs via trachea...how are you going to do this?
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Increase dose by 2-2.5x, dilute with NS to 10 ml total volume
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What electrolyte abnormalities increase risk for digitalis toxicity?
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Hypokalamia, hypercalcemia, hypomagnasemia
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Beta-1 stimulants ___automaticity and _____ cardiac contractility
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increase and increase
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You suspect a AAA...what test do you need stat?
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Chext x-ray will show widening mediastinum, may also show calcified aortic knob with extension of aortic wall.
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What lead will you watch when monitoring the ST segment in suspected right coronary artery occlusion?
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Lead III
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What lead will you watch when monitoring the ST segment in acute coronary syndrome?
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Lead III, V3
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What's going on with your patient...S3 at apex, dyspnea, crackles at lung bases
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LV failure
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What are the compensatory mechanisms for heart failure?
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SNS innervation, tachyC, vasoconstriction, ventricular dilation, ventricular remodeling/hypertrophy
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What are the most common forms of bifascicular block?
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RBB and left anterior hemiblock
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What is the best hemodynamic parameter for assessing LV function?
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PAOP
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What is commotio cordis?
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The result of a fatal dysrhythmia
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Is Nesiritide used to block a maladaptive compensatory mechanism in HF?
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No
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What is the maintenance dose of nesiritide?
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0.01 mcg/kg/min
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Which hemodynamic parameter is a measure of the pulmonary circuit?
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PAd
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Which hemodynamic parameter measures L heart pressure?
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PAOP
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What timing areas are super bad if your pt has an intraortic balloon pump?
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Deflating late; Inflating early...these increase afterload
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What abnormal pulse pattern do you see in cardiac tamponade?
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Pulsus paradoxus
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Pale shiny skin, hair loss, ulceration at pressure points, decreased pulses
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PAD
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thick brown skin, ulceration at ankles, dependent Rubor
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PVD
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What is the inotropic agent of choice in LV failure with MI?
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Dobutamine...it decreases preload
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Why don't you use dopamine in LV failure?
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Dopamine would cause increased SVR and workload
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Why don't you use nitroprusside in LV failure?
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It has adverse effects of coronary artery steal
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What if your dobutamine doesn't help reduce preload in your pt with LV failure?
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Use a vasodilator or diuretic
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What are you going to use to guide fluid replacement in your pt with pulmonary HTN?
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PAOP; it will estimate L ventricular preload. You won't use PAd because it will be falseley elevated and not correlate with PAOP.
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What's going on with the QRS axis in VT?
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Left axis deviation or indeterminate axis
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What's going on with the QRS axis in aberrancy?
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Normal axis or rt axis deviation
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Morphine causes peripheral ______ and _____ preload
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Peripheral venodilation; reduces preload
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Pulses paradoxus, hypotension, JVD...what's up?
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Cardiac tamponade
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What is the most common complication of myocardial contusion?
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Dysrhythmias
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What are the 5 Es of angina?
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exercise, exertion, emotion, exposure, eating
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What type of exercise causes valsalva?
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Isometric such as weight lifting
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What part of the stethoscope is best used to hear tricuspid stenosis?
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Bell of stethoscope
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What part of the stethoscope is best used to lear low-pitched murmurs?
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Bell of stethoscope
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What are the only low-pitched murmurs?
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Tricuspid and mitral stenosis
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What does nitroglycerin do in acute angina?
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It decreases preload
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Your patient is going to get lidocaine....what do you assess for first?
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Hepatic function
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Normal PAOP
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8-12 mm Hg; 15-20 is optimal in cardiogenic shock due to dilated LV
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What's going on if your RAP, PAd and PAOP are equalized within 5 mm Hg?
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Cardiac tamponade
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What causes decreased cardiac output in cardiac tamponade?
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Compression of the chambers decreases ability to stretch and fill, and this decreases CO.
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What do you see on QRS with WPW syndrome?
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delta wave causes a widened QRS; slurring at the beginning of the QRS represents the pre-exitation (delta wave)
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Sotalol is also known as...
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Betapace
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What class of propoerties does satalol have?
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Class II and III properties
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What do class II properties do?
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beta blockade
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What do Class IV properties do?
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CCB
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What do Class III properties do?
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K blockade
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Pleuritic chest pain, fever, pericardial rub, non-specific ST changes
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acute pericarditis
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What does nesiritide do in regards to BNP?
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It augments BNP leading to increased renal excretion of Na and water
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What's up if you have a sudden drop in PAd?
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Usually because catheter has flipped back to RV
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What's up with an increase in PAd?
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Hypoxemia d/t pulmonary HTN
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What will you see if you have a proximal mitigation of the PA catheter?
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loss of dicrotic notch, onset of ventricular ectopy...it has moved into RV
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What is the most common complication of infective endocarditis?
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Emboli
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What's up...splinter hemorrhages, petechia, janeway lesions, roth's spots, osler's nodes
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Infective endocarditis
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What shape will the heart take with remodeling?
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More spherical
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Which nerve do you watch after carotid endarderectomy?
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Cranial Nerve VII, the facial nerve
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What drug do you NOT want to use in WPW?
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Verapamil
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What is...a drop in SBP by 10 or more during inspiration?
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Pulsus paradoxus
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What causes the drop in BP in pulsus paradoxus?
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Increased blood enters atrium during inspiration
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What is pulsus magnus...when do you see it?
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It is a bounding pulse; seen in HTN, thyrotoxosis, aortic regurg and PDA
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What is pulsus bisferiens?
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2 palpable pulses during systole
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When do you see pulsus bisferiens?
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hypertrophic cardiomyopathy, constrictive pericarditis, and aortic valve disease
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What will you see on QRS with mitral valve disease?
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Notched P wave
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What is P Pulmonale and where do you see it?
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Tall P wave (>2.5 blocks); seen in rt atrial enlargement, pulmonary embolism, COPD
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What is P Mitrale and when do you see it?
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P wave wider than 2.5 blocks; seen in L atrial enlargement
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What's up...JVD, hepatomegaly, peripheral edema
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RVF
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