Term
MAP
Mean arterial pressure |
|
Definition
80-100mmHg
>60mmHg needed for adequate perfusion
([2xDBP]+ SBP)/3 |
|
|
Term
CVP
Central venous pressure |
|
Definition
|
|
Term
Cardiogenic shock
Hemodynamic profile |
|
Definition
CVP and SVR are increased, all the rest are decreased:
CO (<4L/min) CI (<4L/min/m2
CVP (>6 mmHg) PAOP (>12 mmHg)
SVR (>1200 dynes/sec/cm5) SVRI (>2600 dynes/sec/cm5)
LVSWI <50 g/m/m2)
Svo2 <60%
DO2 <950 mL/min |
|
|
Term
Hypovolemic Shock
Hemodynamic profile |
|
Definition
Systemic Vascular resistance is the only one increased- the rest are decreased:
CO <4 L/min CI <2.5 L/min/m2
CVP <2 mmHg PAOWP <6 mmHg
SVR >1200 dynes/sec/cm5
SVRI >2390 dynes/sec/cm5/m2)
Svo2 <60%
DO2 < 950 mL/min |
|
|
Term
Anaphylactic shock/ Neurogenic shock
Hemodynamic profile |
|
Definition
ALL DECREASED
CO <4 L/min CI <2.5 L/min/m^2
CVP <2 mmHg PAOP <6 mmHg
SVR <950 dynes/sec/cm5 SVRI <1970 dynes/sec/cm^-5)
Svo2 <60%
DO2 < 950 mL/min |
|
|
Term
Cardiac Tamponade
Hemodynamic profile |
|
Definition
PAP > 25/10 mmHg PAOWP >12 mmHg
Large a and t waves on PAOWP waveform
Equalization of intracardiac pressures; CVP (RAP), PAD, PAOWP, will all be increased and within 5 mmHg variation.
Pulsus paradoxus (drop in BP more than 10 mmHg with inspiration) |
|
|
Term
PAP
Pulmonary artery pressure |
|
Definition
| 15-25/ 8-15 mmHg (quarter over dime) |
|
|
Term
PAOWP
Pulmonary artery occlusive wedge pressure
(AKA PAWP, PAOP, "Wedge") |
|
Definition
6-12 mmHg
Approximated by the PAD-Pulmonary artery diastolic
*some patients may require higher pressures of 15-20 mmHg to achieve optimal stretch on the myofibrils and optimal preload |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
SVR
Systemic vascular resistance |
|
Definition
|
|
Term
SVo2
Venous hemoglobin saturation |
|
Definition
|
|
Term
Sa02
arterial hemoglobin 02 saturation |
|
Definition
|
|
Term
DO2
DO2I
Amount of o2 delivered to the tissues in one minute |
|
Definition
Do2 950-1150 mL/min
Do2I 500-600 mL/min/m2 |
|
|
Term
Vo2
Vo2I
Amount of o2 consumed by the tissues in one minute |
|
Definition
Vo2 200-250 mL/min
Vo2I 120-160 mL/min/m2 |
|
|
Term
|
Definition
a- atrial contraction (occurs after P wave in EKG)
c- Closure of teh AV valve (occurs at RST junction)
v- Ventricular contraction. (Occurs at T wave) |
|
|
Term
|
Definition
>6mmHg
Hypervolemia
Poor contractility
COPD
PE
Tricuspid or pulmonic valve disease
Cardiac tamponade
Ventricular septal defect with L>R shunt
Right ventricular infarction
Constrictive pericarditis |
|
|
Term
|
Definition
<2mmHg
Hemorrhage
3rd spacing (day 2-3 post op)
Shock
Excessive diuresis
Beta 2 adrenergic stimulation |
|
|
Term
Pulmonary catheter ports
Which ones are which? |
|
Definition
Yellow= Mixed venous blood sample ONLY never put anything into this port
Blue= CVP- proximal port ok for IV meds
White= Various infusion port (VIP) at the subclavian- ok for IV meds
Red= Wedge/balloon port for 1.5mL air to obtain PAOWP (Wedge) |
|
|
Term
| PA wave form and associations |
|
Definition
PA systolic usually= RV systolic
PA diastolic usually> than RV diastolic
PAOWP (Wedge) usually= PA diastolic (PAD)
Read value at END of expiration. Spontaneous breaths =high wave
Machine breaths=low wave |
|
|
Term
A state of shock characterized by abnormal vasomotor response that occurs secondary to disruption of sympathetic impulses from the brain stem to the thoraco-lumbar area.
s/sx:
Orthostatic hypotension
Bradycardia (Signature sign)
Inability to sweat below level of injury
Warm/dry skin d/t pooling in extremities and loss of vasomotor control in surface vessels of the skin that control heat loss
Hypothermia d/t uncontrolled peripheral heat loss |
|
Definition
Neurogenic shock
Hemodynamic value changes:
Decreased CO, CI
Decreased Preload- d/t vasodilation
Decreased SVR- d/t vasodilation
Treatment:
Hypovolemia- fluid resuscitation
Hypotension- vasopressors
Bradycardia- atropine if necessary
Hypothermia- warming measures |
|
|
Term
Type of distributive shock which is characterized by hypotension despite adequate fluid resuscitation with evidence of perfusion abnoprmalities
May have AMS, Tachycardia, hypotension (initially widened pulse pressure), Increased resp rate, Decreased UO, Increased or decreased body temperature
S/Sx:
Lactic acidosis
Oliguria-d/t decreased renal perfusion
MS changes- d/t poor perfusion, immune mediator activation, hyperthermia, and lactic acidosis.
Hypotension- d/t massive arterial and venous dilation
Tachycardia- d/t increased SNS, metabolic, and adrenal gland stimulation
Increased RR- Pulm vasoconstriction & microemboli formation leading to hypoxemia
MODS- as a result of poor organ perfusion |
|
Definition
Septic shock
Hemodynamic value changes:
Decreased preload (CVP <2mmHg) d/t venous dilation and therefore decreased venous return resulting in decreased preload in R&L ventricles
Decreased afterload- d/t dilation in arterial system manifest as decreased SVR (<800 dynes/sec/cm5)
Decreased myocardial contractility- LVSWI (<50 g/m/m2)
Elevated SvO2 (>80%) d/t malabsorption of circulating blood and impaired cellular metabolism
Treatment:
Fluids: goal CVP 8-12, if ventilated 12-15.
Vasopressors- goal MAP >65. Drug of choice Levophed. Increase SVR/ Vasopressin as a second line if Levophed not working. May also use Dopamine.
Positive inotropic agents: Dobutamine
PRBCs if SvO2 <70. Goal HCT 30%.
Broad spectrum ABX |
|
|
Term
Shock characterized by a failure of forward flow of blood,
S/Sx:
Hypotension- worsening myocardial ischemia
Cool, pale, moist skin
UOP <30ml/hr
Chest pain
Tachycardia- d/t low CO (<4L/min)
Weak, thready pulse
Increased RR to improve o2 sat. Leads to resp alkalosis. |
|
Definition
Cardiogenic shock
Hemodynamic value changes:
Decreased CO (<4L/min) CI (<2.5 L/min/m2)
Increased SVR (>1200 dynes/sec/cm5) d/t vasoconstriction. Increased myocardial afterload.
Increased PAOWP (>12 mmHG) and CVP (>6mmHg)
Treatment:
Positive inotropic agent Doutamine: increase contractility
Diuretics- decrease preload
Vasodilator once BP controlled (need afterload reducer)- decrease SVR - Nipride
Balloon pump IABP
Antidysrhythmic agent such as amiodarone (if needed) |
|
|
Term
Type of shock characterized by a lack of fluid volume in the intravascular space thus decreased tissue perfusion (a 10% loss leads to sxs)
S/Sx:
Tachycardia
Hypotension
Decreased UOP
Flat jugular veins
Dysrhythmias- d/t myocardial ischemia, d/t poor perfusion
Cool clammy skin |
|
Definition
Hypovolemic shock
Hemodynamic value changes
Decreased CO (<4L/min) CI (<2.5 L/min/m2)
Decreased CVP (<2mmHg) PAOWP (<6mmHg)
Increased SVR >1200 dynes/sec/cm5 - due to arterial vasoconstriction (NOTE: arterial line my display high SBP d/t vasoconstriction. Best to look at MAP (70-105mmHg) for accuracy in low flow states.
Treatment:
Fluids- warmed with a level 1
Vasopressors only when tank is full (CVP @/= 12 mmHg) |
|
|
Term
Type of distributive shock characterized by a reaction to foreign substance
S/Sx
Cardiovascular collapse
Severe bronchospasm s/t histhamine release. This in turn leads to vasodilation
Increased capillary permeability- will see 3rd spacing d/t fluid leakage into interstitial space |
|
Definition
Anaphylactic shock
Hemodynamic value changes
Decreased SVR- <800 dynes /sec/cm2 d/t histhamines
Decreased preload CVP<2mmHg
Decreased CO (<4L/min) CI (<2.5 L/min/m2)
Treatment:
Epinephrine for vasoconstriction and broncho dilation
Fluids
Antihithamines
Corticosteroids |
|
|
Term
| What occurs with neurogenic shock that does not occur in other types of shock? |
|
Definition
|
|
Term
| Differentiate between hemodynamic values of hypovolemic and cardiogenic shock |
|
Definition
Both exhibit increased SVR >1200 dynes/sec/cm5
Cardiogenic exhibits increased PAOWP (>12 mmHg) and CVP (>6 mmHg)
Hypovolemic exhibits decreased PAOWP (<6 mmHg) and CVP (<2 mmHg) |
|
|
Term
| MI elevation versus depression of ST segment |
|
Definition
ST elevation = injury
ST depression = ischemia (may also see inverted T wave)
Necrosis = presence of Q wave and or 1/4 height of R wave
Subendocardial infarction (non-Q wave, non STEMI)= ST depression and loss of R wave height |
|
|
Term
Cardiac enzymes
Names and peaks |
|
Definition
Myoglobin- 1st to peak
CK: not specific to heart muscle or CPK creatine phosphokinase. Rise 3-6hrs. Peaks @24 hrs. Returns to normal in 3-4 days.
CKMB 2nd to peak: Very sensitive for myocardial injury/ Rise 18-24 hrs. Returns to normal in 3 days. Must be >4% of total CK for definite diagnosis of MI.
Troponin- 3rd to peak. Structural protein found in cardiac muscle. Rise: 4hrs. Peaks in 24hrs. Stays elevated for 5-10 days.
<0.05 negative
0.05-0.5 necrosis
> 0.5 MI |
|
|
Term
What hemodynamic parameters make up preload?
What are their value ranges?
What is done to increase them?
What is done to decrease them? |
|
Definition
CVP (2-6 mmHg) PAOWP (6-12 mmHg)
ESVI (50-100 mL/m2)
Increase Decrease
NS,LR, Diuretic
Albumin, Morphine
Blood NTG, Nipride,
Nesiritide |
|
|
Term
Intervention choices for HIGH preload states:
CVP >6mmHg PAOWP >12 mmHg |
|
Definition
Dilators:
Nitroglycerin
Nitroprusside
Amrinone
Diuretics:
Bumetinide
Furosemide
Ethocrinic acid
Mannitol |
|
|
Term
Intervention choices for LOW preload states:
CVP <2 mmHg PAOWP <8 mmHg |
|
Definition
Volume:
Crystalloids
Colloids
Blood
Hetastarch
Dysrhythmia Control:
Drugs
Pacemaker |
|
|
Term
Intervention choices for HIGH contractility states:
SVI >47 cc/m2/beat RVSWI >12 g/m2/beat LVSWI >85 g/m2/beat |
|
Definition
|
|
Term
Intervention choices for LOW contractility states:
SVI <33 cc/m2/beat RVSWI <7 g/m2/beat LVSWI <35 g/m2/beat |
|
Definition
Positive Inotropes:
Dopamine
Amrinone
Dobutamine
Milrinone |
|
|
Term
Intervention choices for HIGH afterload states:
SVR >250 dynes sec/cm5 PVR >1200 dynes sec/cm5 |
|
Definition
Dilators:
Nitroglycerin
Nitroprusside
Amrinone
Balloon pump:
Increased pump ratio of 1:1 |
|
|
Term
Intervention choices for LOW afterload states:
SVR <57 dynes sec/cm5 PVR <800 dynes sec/cm5 |
|
Definition
Vasopressors:
Epinephrine
Norepinephrine
Dopamine
Balloon pump:
Decreased pump ratio to 1:2 or 1:4 |
|
|
Term
| The dicrotic notch on the pulmonary artery wave form represents? |
|
Definition
| Closure of the pulmonic valve |
|
|
Term
|
Definition
| Used in pulseless Vtach/Vfib |
|
|
Term
|
Definition
| Used in Vtach with a pulse and cardioverting acute arrhythmia |
|
|
Term
|
Definition
stimulation of α receptors:
Increases arteriolar constriction |
|
|
Term
|
Definition
Stimulation of β1 increases myocardial contractility
β2 dilates coronary and peripheral vasculature & causes bronchial dilation |
|
|
Term
Receptor stimulation:
DA (dopaminergic) |
|
Definition
| DA stimulation causes renal and mesentaric vasodilation |
|
|
Term
| In the Starling curve, as preload increases so should CO or CI. When CO or CI is not increasing with enhanced preload, would further volume be beneficial? |
|
Definition
|
|
Term
| Indication and treatment of low preload |
|
Definition
Indication:
low LV filling pressire (low PAOWP), low CO/CI
Treatment:
Increase volume, improve CI, BP and perfusion |
|
|
Term
| Indication and treatment of high preload |
|
Definition
Indication:
High LV filling pressure (high PAOWP), in setting of adequate BP (SBP >95 mmHg)
Treatment:
Decrease circulating fluid volume>decrease venous return> decrease cardiac workload and symptoms of heart failure.
Diuretics:
Vasodilators: Morphine, NTG, Nitroprusside
Dopamine, Nesiritire |
|
|
Term
| Indication and treatment of high afterload |
|
Definition
Indication: high SVR in setting of normal or high BP and low CO or CI
Treatment: Induce arteriolar smooth muscle relaxation> decreasing impedance to LV ejection. Decrease workload of heart, improve SC and CI
Nitroprusside, Milrinone, CCB (verapamil, dilt, amlodipine), ACE-I captopril, enelapril, lisinopril, benazapril, rmaipril, ARB (valsartan, losartan), high dose NTG, Hydralazine. |
|
|
Term
| Indication and treatment of low afterload |
|
Definition
| Indicators: low BP in setting of adequate intravascular volume. Need to increase alpha adrenergic receptor stimulation (arteriolar constriction) increase SVR> increase BP. Drugs: Dopamine (8-20 mcg/kg/min), Norepinepherine (Levophed), Epeinephrine, Phenylepherine, Vasopressin. |
|
|
Term
| Indication and treatment of high contractility (desire to decrease) |
|
Definition
Indication: acute and post MI, angina, HTN. Decease myocardial workload, 02 consumprion. Cardio selective betablockers Metoprolol, atenolol, esmolol. (caution with depressed LV function, symptomatic bradycardia, high degree heart block, and PVD.
Non-selective: Propanolol, carvedilol
Alpha and Beta blocking: Labetalol. Ca++ channel blocking: verapamil, diltiazem, nifedipine, amlodipine. |
|
|
Term
| Indication and treatment of low contractility (desire to increase) |
|
Definition
Indication: low CO with adequate fluid volume status. Improve CO, contractility to decrease congestive symptoms.
Treatment: Digoxin> slows AV node> slows ventricular rate. Inotropic catecholamines: Stimulate B1 receptors> increase myocardial contractility, improve ventricular emptying, increase perfusion and HR: Dobutamine, Dopamine, Norepinepherine, Epinephrine, Isoproterenol, PDE |
|
|
Term
Pre-renal renal failure:
Cause
Identity
Treatment |
|
Definition
Cause: decreased blood flow to kidney resulting in kidney retaining Na+ and H2O this results in concentrated urine.
Identity: Oliguria, Urine Na+ <10, Protein negative, Spec grav >1.020, ↑BUN, Creatinine. BUN/Cr ratio > 25:1 up to 40:1. Urine Osmo >500 mOSm. ↓BP. Hypovolemia.
Treatment: Fluids, Diuretics if fluid status addressed first. Volume expanders, Treat HF, Decrease intracascular capacity. |
|
|
Term
Intrarenal renal failure:
Cause
Identity
Treatment |
|
Definition
Cause: Injury to kidney: ATN (drugs, infection, decrease BP> ischemia) resulting in kidney inability to retain Na+ and H2O this results in dilute urine.
Identity: Oliguria-normal or high UO, Urine Na+ 20-40, Protein positive, Spec grav <1.010, BUN >30, Creatinine elevated. BUN/Cr ratio < 20:1. Urine Osmo <300 mOSm. FeNa >1%. ↑P04, Mg, K+.↓Ca++, Na,
Treatment: Fluids, Diuretics, Renal replacement therapies (Dialysis), Treat hyperkalemia & acidosis. |
|
|
Term
Postrenal renal failure:
Cause
Identity
Treatment |
|
Definition
Cause: Obstruction of urinary out flow resulting in kidney results in normal to dilute urine.
Identity: Usually anuric, Urine Na+ 10-40, Protein negative, Spec grav 1.010 to normal,↑ BUN & Creat. BUN/Cr ratio 10:1-15:1. Urine Osmo >350 mOSm. FeNa >1%.
Treatment: KUB or US to locate obstruction, removal od obstruction, postobstruction removal diuresis. |
|
|
Term
|
Definition
| UOP: >/=30mL/hr. Urine Na+ 10-30 mEq/L, Protein absent, Spec grav 1.010-1.030. Osmmolality: 500-850. BUN/Creat ratio: 20:1, FeNa+: negative. |
|
|
Term
|
Definition
|
|
Term
| Creatinine clearance formula |
|
Definition
Creatinine clearance= (140-age) x Wt (kg)
Serum creatinine x72
(X 0.85 for women) |
|
|
Term
|
Definition
GFR= Urine concentration of substance X24hr urine flow
Plasma concentration of substance |
|
|
Term
What is CPP?
How to calculate CPP? |
|
Definition
CPP= Cerebral perfusion pressure.
MAP= BP ICP=brain pressure
MAP-ICP=CPP
Normal= 0-15 mmHg
Slight elevation= 15-20 mmHg
Significant elevation= >20 mmHg
Causes of elevation:
↑ CSF volume
Meiningitis
SAH
SDH or EDH (epidural hematoma) |
|
|
Term
|
Definition
“prils”
Lisinopril, Enalapril, Ramipril, Captopril
Indications:
HTN
CHF/Systolic failure
AMI
Diabetic renal nephropathy
Effects:
- Vasodilation
-↓ SVR
-Prevention of myocardial remodeling
-Reduce progress of diabetic nephropathy
Monitor:
BP
K+ levels
Alert:
Hypotension
Cough
Hyperkalemia
Angioedema |
|
|
Term
|
Definition
“olols”
Bisoprolol, Metoprolol SR, Atenolol, Esmolol (IV)
Alpha & Beta Blocking:
Labetalol, Carvedilol
Indications:
HTN
Secondary prevention of MI
Cardiac arrhythmias
Angina
A fib
CHF/Systolic failure
Effects:
-↓ HR, BP
-Negative inotrope, however, decreases myocardial workload
-block endogenous epi & norepi; “stress catecholamine”
-Reduces morbidity & mortality in HF
Monitor:
HR
BP
Alert:
Hypotension
Signs of shock
Bronchospasm;
Avoid in asthma!
Heart block
Avoid with cocaine use
Overdose: Glucagon |
|
|
Term
| Angiotensin II Receptor Blockers (ARBs) |
|
Definition
“sartans”
Valsartan, Losartan, Olmesartan, Telmisartan
Indications:
HTN
CHF/Systolic failure
Diabetic renal nephropathy
Intolerance of ACE Inhibitors
Effects:
-Vasodilation
-Reduces secretion of vasopressin
Monitor:
BP
K+ levels
Alert:
Dizziness
Headache
Hyperkalemia
Caution: MI |
|
|
Term
|
Definition
Spironolactone
Indications:
Adjunctive therapy in heart failure
Effects:
-Diuresis
-Blocks Na reabsorption
-In combo with other diuretics, reduces cardiac workload
-K+ sparing
Monitor:
K+ levels
Alert:
Hyperkalemia – especially when used with ACE Inh or ARBs |
|
|
Term
| Calcium Channel Blockers (CCBs) |
|
Definition
“pines”
Amlodipine, nimodipine, nicardipine (IV)
Phenylalkylamine class: Verapamil, Calan
Benzothiazepine class: Diltiazem
Indications:
HTN
Reduce HR
A fib/flutter
Angina
Prevent cerebral artery vasospasm
Effects:
-Arterial vasodilation, ↓ SVR
-Reduce the force of myocardial contraction
-Negative chronotropy
Monitor:
HR
BP
Alert:
Heart block
Bradycardia
Reflexive tachycardia
Caution when used with BB
Overdose:
Calcium Chloride & Atropine |
|
|
Term
|
Definition
Nitroglycerin
Isosorbide dinitrate (Isordil), Isosorbide mononitrate (Imdur)
Indications:
Angina
Heart failure
Effects:
-Vasodilation
-Venodilation
Monitor:
Low BP
Headaches
Alert:
Hypotension |
|
|
Term
|
Definition
Hydralazine
*Usually prescribed in combo with a BB & diuretic
Indication:
Heart failure
HTN
Effects:
-Vasodilator
-↓ SVR & PVR
Monitor:
BP
Headaches
Alert:
Reflexive tachycardia
MI/angina |
|
|
Term
|
Definition
effect on contractility
Positive inotrope improves contractility
Negative inotrope decreases contractility. |
|
|
Term
|
Definition
effect on heart rate
Positive chronotrope increases the heart rate
Negative chronotrope decreases the heart rate. |
|
|
Term
Coronary arteries are
perfused during |
|
Definition
|
|
Term
Both the right & left coronary
arteries arise |
|
Definition
at the base of
the aorta (Sinus of Valsalva)
Immediately above the aortic
valve |
|
|
Term
| Auscultation points of heart sounds: |
|
Definition
Aortic valve: Right, 2nd ICS
Pulmonic valve: Left, 2nd ICS
Tricuspid valve: 4-5th ICS, LSB
Mitral valve: 5th ICS, MCL |
|
|
Term
S1 “LUB”
beginning of systole |
|
Definition
-closure of the mitral & tricuspid valves
-Loudest over mitral area |
|
|
Term
S2 “DUB”
Beginning of diastole |
|
Definition
-closure of pulmonic & aortic valve
-Loudest over aortic area
-2nd ICS |
|
|
Term
|
Definition
S1-S2-S3, S1-S2-S3 "Slosh-ing-in"
Fluid overload
Auscultated when preload is ↑
Normal in kids,
high cardiac output,
3rd trimester of pregnancy |
|
|
Term
| S4 – Atrial Gallop (pre-systolic) |
|
Definition
S4-S1 -S2, S4-S1 -S2 (Ten-ne-ssee) or "A Stiff Wall"
Sound caused by vibration of atria ejecting into noncompliant
ventricles
Auscultated during ischemia (increased resistance to
ventricular filling)
Other causes: Ischemia, HTN, pulm stenosis, CAD, Aortic
stenosis, LVH |
|
|
Term
|
Definition
When 1 valve closes later than the other
**best heard during inspiration
Split S1-Mitral closes before tricuspid valve
RBBB or PVC
Split S2-Aortic closes before pulmonic valve
Overfilled right ventricle
Atrial septal defect (ASD) |
|
|
Term
| Acute Coronary Syndrome (ACS) |
|
Definition
ST Elevation MI (STEMI):
• Q wave MI
• Non-Q wave MI
Non-ST Elevation (NSTEMI):
• Unstable Angina
• Non-ST Elevation MI
- Non-Q wave MI or
- Q wave MI
Pathophysiology: Progressive atherosclerosis with plaque rupture leading to an imbalance of
O2 supply & demand |
|
|
Term
|
Definition
Non-modifiable:
Age
Gender
Family history
Race
Modifiable:
Smoking
Cholesterol/Lipids
Overweight/Obesity
Diabetes mellitus
Diet
Physical inactivity
HTN |
|
|
Term
|
Definition
Onset
Location
Duration
Characteristics
Associated s/s
Relieving factors
Treatment |
|
|
Term
|
Definition
Stable
Exertional
Unstable
Increasing frequency, time, duration
10-20% have a MI
Variant (Prinzmetal’s)
Sudden pain caused from coronary
vasospasm
Occurs at rest or when sleeping
Treat with NTG, Ca Ch blockers
Get 12 Lead ECG with & without pain! |
|
|
Term
|
Definition
Partial occlusion of coronary artery
Pain occurs at rest
Hallmark sign** pain with ↑ frequency, heaviness or
pressure
Chest pain > 20 min.
12 lead ECG: ST dep./T wave inversion
Cardiac biomarkers elevated
Treatment: Early PCI if high risk
Early PCI if not high risk is also acceptable |
|
|
Term
A patient presents with chest pain for 6 hours. Her
12 lead ECG is unchanged from 4 months ago. Which of the following would be the most appropriate for ruling out a MI?
A. Cardiac catheterization
B. Stress test
C. CK-MB/Troponin I
D. Transthoracic echocardiogram |
|
Definition
|
|
Term
|
Definition
Origin:Myocardium
Normal Range: <1.5 mcg/L
Rises: 3-6 hrs.
Peak: 14-20 hrs.
Return to normal: 1-2 weeks |
|
|
Term
|
Definition
Plaque rupture
• Platelets aggregate to the
atherosclerotic site
• Occlusive thrombus formation
• ~70% occlusion of arterial lumen
before s/s |
|
|
Term
Timing of ECG Changes
Immediate:
Within a few hours:
Several hours:
Several hours - days: |
|
Definition
Immediate: ST ↑ in leads over
the area of infarction
Within a few hours: Large
upright T waves
Several hours: ST normalizes, T
waves invert
Several hours – days: Q waves,
reduced R waves, low
voltage R wave (sometimes
for life) |
|
|
Term
STEMI
Findings on ECG:
Hallmark signs:
Treatment: |
|
Definition
ST elevation
≥1mm (Inferior) or
≥2 mm (Anterior) and/or
New Left BBB
Hallmark signs*** Chest pain > 20min.
SOB, diaphoresis
+ Cardiac biomarkers
Complete occlusion
Treatment:
Reperfusion - PCI or fibrinolytics |
|
|
Term
|
Definition
Aspirin
162 mg – 325 mg PO
load
Nitroglycerin
0.4 mg SL Q 5min x 3
Monitor for hypotension
Avoid in right ventricular
infarction
May use IV if continued
chest discomfort
Supplemental O2 if sats
< 94%
Hyperoxemia lends to
oxidative stress
Morphine
2 – 8 mg IV Q 5 -15 min
if CP unrelieved by NTG
Beta Blockers
within 24°
Hold if hypotension or
signs of
hypoperfusion/shock |
|
|
Term
|
Definition
ASA
Used indefinitely post MI
Inhibits cyclooxygenase-1 within platelets
prevents formation of thromboxane A2
Disables platelet aggregation
Monitor for intolerance
Dose 81mg daily
Onset of action 1 – 7.5 min |
|
|
Term
|
Definition
Potent vasodilator
Reduces preload & ventricular wall tension
Decreases myocardial O2 consumption
Sublingual, spray or intravenous
Monitor for hypotension
Do NOT give to patients with
right ventricular infarction |
|
|
Term
|
Definition
Use as adjunct therapy to NTG
Potent analgesic & anxiolytic
Causes venodilation & reduces preload
Decreases workload of heart
Use cautiously in UA & NSTEMI!!
Increased mortality in a large registry
More research needed
Avoid in right ventricular MI |
|
|
Term
|
Definition
Metoprolol & carvedilol
Blocks catecholamines
Decreases HR & contractility
Decreases myocardial O2 consumption
Long term, decreases morbidity & mortality
Administered within 24 hours, continued indefinitely |
|
|
Term
Acute STEMI
Gold standard for treatment: |
|
Definition
Revascularization
Cardiac Cath Lab
Fibrinolytics |
|
|
Term
|
Definition
TNKase (tenecteplase)* - new fast rapid bolus
tPA (Activase)
Bolus followed by infusion
Will still need to go to the cath lab
Indications:
Pain < 6 hours
ST elevation > 1mm in 2 or more leads
Contraindications:
Active bleeding, hx. hemorrhagic stroke, AVM,
BP>200/120, prolonged CPR |
|
|
Term
| Fibrinolytic Contraindications: |
|
Definition
Absolute:
Intracranial hemorrhage (0.9%)
Known cerebral vascular lesion
Ischemic stroke in last 6 mos.
(except acute CVA within 3
hours)
Malignant intracranial
neoplasm
Suspected aortic dissection
Active bleeding
Closed head or facial trauma
within 3 mos.
Relative:
Chronic, severe, poorly tolerated
HTN
SBP >180 mm Hg or DBP > 110
mm Hg
Ischemic CVA > 3mos.
Dementia
Traumatic or prolonged CPR
(> 10 min.)
Major surgery (< 3 weeks)
Internal bleeding (within 2-4
weeks)
Pregnancy
Active peptic ulcer disease
Current use of anticoagulants |
|
|
Term
| Post PCI: Anti-Platelet Therapy |
|
Definition
Thienopyridines (P2 Y12 Inhibitors) - DES or BMS:
Plavix (Clopidogrel) 300-600 mg load; continue 75 mg
daily for 12 months or
Effient (Prasugrel) 60 mg load; continue 10 mg for 12
months or
Ticagreolor (Brilinta) 180 mg load; 90 mg BID
Unfractionated Heparin (UFH) or
Bivalirudin (Angiomax) – during PCI; finish in cath lab
GP IIb/IIIa Inhibitors (at time of PCI)
Abciximab (Reopro)
Eptifibatide (Integrilin)
Tirofiban (Aggrastat) |
|
|
Term
|
Definition
Dual anti-platelet therapy
Beta blockers
Statins
Nitrates - pain control
Balancing myocardial O2 supply and demand
ACE inhibitors-prevent cardiac remodeling
EF < 40%, new HF
Complication management
Groin site management
Renal function (secondary to dye load) |
|
|
Term
| Nursing Considerations with fibrinolytics: |
|
Definition
Frequent neurological assessment
Avoid punctures
Monitor urine output & BUN/creatinine
Avoid invasive devices
Avoid compressive devices |
|
|
Term
|
Definition
Not needed for patients without evidence of
respiratory distress (2013 AHA guideline)
Use if oxyhemoglobin saturation is ≤ 94%
Hyperoxemia perpetuates oxidative injury after MI |
|
|
Term
| Long Term & Secondary Prevention |
|
Definition
Beta-blocker – “olol”
Metoprolol (Lopressor,
Toprol XL)
Carvedilol
ACE-Inhibitor – “pril”
Ramapril (Altace)
Lisinopril (Zestril, Prinivil)
Enalapril (Vasotec)
Captopril (Capoten)
Statins – Lipid lowering
Atorvastatin (Lipitor)
Rosuvastatin (Crestor)
Simvastatin (Zocor)
Dual Anti-platelet
Aspirin – 81 mg
Clopidogrel (Plavix) or
Prasugrel (Effient)
Ticagrelor (Brillinta) |
|
|
Term
Statins (HMG CoA Reductase Inhibitors)
Why?
Who? |
|
Definition
Why?
cholesterol levels by interfering with body’s ability to
produce cholesterol
inflammatory response that theoretically may be
responsible for atherosclerotic process
Who?
Recommended for all patients with
LDL cholesterol > 100
Atovastatin (Lipitor), Rosuvastatin (Crestor),
Lovastatin (Mevacor), Simvastatin (Lipitor)
Give at night
Myopathies & Myocitis |
|
|
Term
|
Definition
|
|
Term
|
Definition
| AV conduction time (0.12 – 0.20) |
|
|
Term
|
Definition
| Ventricular depolarization (0.06 – 0.10) |
|
|
Term
|
Definition
| Ventricular repolarization |
|
|
Term
|
Definition
|
|
Term
Q-waves
Considered pathologic if: |
|
Definition
Width > 30 ms (0.04)
Width ≥ 25% of the height of the R wave
If present in contiguous leads, indicative of myocardial necrosis |
|
|
Term
BBB
where to look on ECG?
Right or Left? |
|
Definition
QRS > 0.10 in V1
Upright=right
Low=Left |
|
|
Term
Lateral lead locations
Reciprocal changes (in 2 contiguous leads)
Associated coronary artery |
|
Definition
I, aVL, V5, V6
No reciprocal changes
(LCA & LAD) |
|
|
Term
Inferior lead locations
Reciprocal changes (in 2 contiguous leads)
Associated coronary artery |
|
Definition
II, III, aVF
Reciprocal:I, aVL (will show depression early)
RCA (65%)
LCA (35%)
*Do R Sided ECG to assess V2R-V4R |
|
|
Term
Septal lead locations
Reciprocal changes (in 2 contiguous leads)
Associated coronary artery |
|
Definition
V1-V3
Reciprocal: ST depression II, III, aVF
LAD
Watch out for heart blocks & Vtach |
|
|
Term
Anterior lead locations
Reciprocal changes (in 2 contiguous leads)
Associated coronary artery |
|
Definition
V2-V4
Reciprocal ST depression II, III, aVF
LAD/Left Main |
|
|
Term
Posterior lead locations
Reciprocal changes (in 2 contiguous leads)
Associated coronary artery |
|
Definition
Posterior leads V7-V9 (placed on posterior)
V1-V2 ST depression in normal lead placement
L circumflex/RCA
Tall upright T waves may be seen |
|
|
Term
Right ventricle lead locations
Reciprocal changes (in 2 contiguous leads)
Associated coronary artery |
|
Definition
V2R-V4R (right sided ECG)
No Reciprocal changes
Proximal RCA |
|
|
Term
Inferior wall MI presentation
**Signs of RV Failure |
|
Definition
*If RCA occlusion suspected monitor lead III.*
Bradycardia, AV block 2nd degree type 1. (may need pacer) Hypotension, N/V, Diaphoresis
RV Failure: Tachycardia with hypotension (Don't give NTG, morphine, diuretics or Beta blocker)
JVD (with clear lungs)
Treatment: Give IV fluid to max preload & Inotrope
Note: Occurs high in the AV node
Lengthening PR interval
Rarely progresses to CHB |
|
|
Term
|
Definition
|
|
Term
|
Definition
RV Failure: Tachycardia with hypotension (Don't give NTG, morphine, diuretics or Beta blocker)
JVD (with clear lungs)
Treatment: Give IV fluid to max preload & Inotrope
Note: Occurs high in the AV node
Lengthening PR interval
Rarely progresses to CHB |
|
|
Term
|
Definition
Changes noted in V1 - V4
Reciprocal changes in II, III, AVF
Loss of R wave progression
LAD/L main occlusion
Symptoms: L ventricular failure,
shock
Monitor for:
Heart failure
Heart block
Bundle branch block
loud murmur > suspect
ventricular septal rupture |
|
|
Term
| Anterior Wall ECG changes |
|
Definition
-Occurs below the AV node
-Can progress to CHB
-Constant PR interval
-2:1 difficult to diagnose
-Place a trancutaneous pacer
-Prepare for transvenous pacer
Complete heart block/Third degree AV Block: -No atrial impulses pass through
the AV node
-Ventricles generate their own
rhythm |
|
|
Term
|
Definition
Changes in V5, V6, I, AVL
Occlusion of the left
circumflex
Associated with other MI
locations (inferior, anterior) |
|
|
Term
|
Definition
Changes in V1-V2
Tall, broad R wave
(>0.04) & ST depression
(reciprocal change)
Posterior leads V7 - V9
Associated with
inferior/lateral wall MI
Occlusion of RCA or left
circumflex |
|
|
Term
|
Definition
Assess posterior leads V7 – V9
for ST elevation |
|
|
Term
A patient presents with chest pain and ST segment
elevations in leads II, III and AVF. You know the
patient is experiencing an infarction of which wall of
the heart?
A. Anterior wall
B. Inferior wall
C. Posterior wall
D. Lateral wall |
|
Definition
|
|
Term
Which type of heart block would you monitor for if
your patient has an anterior wall MI?
A. 1st degree AV block
B. 2nd degree Type I (Wenckebach)
C. 2nd degree Type II
D. Sinus bradycardia |
|
Definition
| C. 2nd degree Type II (or 3rd degree) |
|
|
Term
A 56 year old female presents with sub-sternal
chest pain radiating to her left arm and jaw.
After initial assessment, a 12 lead ECG is
performed and reveals ST segment elevation in leads II, III, & AVF. You would expect reciprocal changes in which leads?
A. V1, V2
B. I, AVL
C. AVR, AVL, V1
D. V3, V4 |
|
Definition
| B. I, AVL (may show early ST depressions) |
|
|
Term
A patient with an inferior wall MI and right ventricular
infarction develops tachycardia and hypotension.
What would be the best initial treatment for
hypotension?
A. Nitrogylcerin infusion
B. Dopamine infusion
C. Dobutamine
D. Normal saline boluses |
|
Definition
| D. Normal saline boluses (then a positive inotrope) |
|
|
Term
A patient with an anterior wall MI should be
monitored for which of the following complications?
A. Right BBB & 2nd degree Type 2 heart block
B. 1st degree heart block
C. Aberrantly conducted rhythms
D. Supraventricular tachycardia |
|
Definition
| A. Right BBB & 2nd degree Type 2 heart block |
|
|
Term
Which of the following complications would the nurse
assess for after an arteriogram?
A. Impaired renal function
B. Acid-base imbalance
C. Elevated liver enzymes
D. Increased mean arterial pressure |
|
Definition
| A. Impaired renal function (due to contrast) |
|
|
Term
A patient experiencing ST segment elevations in leads
V1 – V4 likely has an occlusion in which coronary
artery?
A. Left Anterior Descending
B. Right Coronary Artery
C. Circumflex Artery
D. Posterior Descending Artery |
|
Definition
| A. Left Anterior Descending |
|
|
Term
|
Definition
Inflammation of the pericardial sac
Acute or chronic
Chest pain – sharp, stabbing, or dull & achy
Pain improved when sit-up, lean forward
Left sided radiation
Pain worse with cough, positional changes & inspiration
Pericardial friction rub
Treatment:
NSAIDS – high dose Ibuprofen
Antibiotic if bacterial, antifungal if fungus |
|
|
Term
|
Definition
Clinical signs:
Hemodynamic
instability
LOUD systolic murmur
MITRAL REGURG!!!
Treatment:
Mechanical support
Hemodynamic support
Surgical repair/valve
Left ventricle replacement
Chordae |
|
|
Term
| Ventricular septal rupture |
|
Definition
Oxygen rich blood shunts to
the right side of the heart
Risk: Anterior wall MI
Symptoms: Acute SOB
S3
Crackles
Holosystolic murmur
PA catheter insertion:
Increased C.O.
falsely elevated on PA cath
Increased SVO2
Large “v” waves |
|
|
Term
|
Definition
Clinical signs:
S3, +JVD, pulmonary edema
Tachycardia
Dysrhythmias
Decreased perfusion
Decreased UOP (oliguria
< 0.5 ml/kg/hr)
Hemodynamics:
Hypotension (MAP < 60)
CI < 2 L/min/m2
SVR >2000 dynes/sec/cm-5
Elevated RAP/CVP
PAOP >18 mm Hg
Decreased SVO2
ABG – Mixed respiratory acidosis, metabolic acidosis;hypoxemia
Lactic acidosis
CXR: pulmonary congestion
Echo: decreased wall motion
Supportive Treatment:
Vasopressors/ + Inotrope
Diuretics (as perfusion allows)
Afterload reduction / venous vasodilators (i.e. NTG)
Mechanical support (ie. IABP, Impella) |
|
|
Term
|
Definition
Fluid in the alveolus
Impaired gas
exchange
Hypoxemia
Cardiogenic vs. noncardiogenic
Treatment: diuretics |
|
|
Term
Drug Alpha Beta1 Beta2
Phenylephrine
Norepinephrine
Epinephrine
Dopamine
Isoproterenol |
|
Definition
Drug Alpha Beta1 Beta2
Phenylephrine ++++ - -
Norepinephrine ++++ ++ -
Epinephrine ++++ ++++ ++
Dopamine ++ <5 mcg/kg/min
+++ >10 mcg/kg/min
++++<10mcg/kg/min
Dobutamine + ++++ ++
Isoproterenol - ++++ ++++ |
|
|
Term
Location of receptors:
Alpha-
Beta1-
Beta2- |
|
Definition
Location of receptors:
Alpha- vessels
Beta1- Heart
Beta2- Bronchial & vascular smooth muscle |
|
|
Term
|
Definition
- Classified as a catecholamine
- Acts on the SNS
‐ ↑HR, ↑BP
‐ Avoid extravasation
‐ Stimulates beta1 & some beta2, alpha
Dosing:
0.5 - 3 mcg/kg/min – dopaminergic receptors
3 - 10 mcg/kg/min – beta effects
>10 mcg/kg/min – alpha effects
Max. 20 mcg/kg/min |
|
|
Term
| Norepinephrine (Levophed) |
|
Definition
Effect: ↑ BP
Alpha & beta1
Adverse effects: bradycardia, dysrhythmias, HTN,
renal artery vasoconstriction
Dosing: 0.5 – 30 mcg/min
Monitor closely for extravasation |
|
|
Term
|
Definition
Effect: ↑ BP, ↑HR
Alpha, Beta 1, some beta 2
Adverse effects: tachycardia, dysrhythmias, chest
pain
Dosing: 2‐10 mcg/min – titrate to effect
Monitor closely for extravasation
Hyperglycemia |
|
|
Term
| Phenylephrine (Neo-Synephrine) |
|
Definition
Effect: ↑ BP
Alpha
Adverse effects: Reflex bradycardia, dysrhythmias,
HTN, chest pain
Dosing: 2‐10 mcg/kg/min
Monitor for extravasation |
|
|
Term
|
Definition
Antihypertensive of nitrate origin
Dosing:
0.5 – 8 mcg/kg/min
Closely monitor for:
Hypotension (check BP Q 1-2 min until BP is stabilized)
Arterial line preferred
Hypoxia (from intrapulmonary shunt)
Increased HR (Stimulation of baroreceptors)
Thiocyanate poisoning (esp. > 72 hrs.)
Methemoglobinemia (Hgb can get converted) |
|
|
Term
The rationale for using dobutamine in cardiogenic shock is to:
A. Decrease myocardial ischemia
B. Improve urine output
C. Improve myocardial contraction
D. Decrease oxygen consumption |
|
Definition
| C. Improve myocardial contraction |
|
|
Term
The most common cause of death after a myocardial infarction is:
A. Ventricular septal defect
B. Cardiogenic shock
C. Dysrhythmias
D. Heart failure |
|
Definition
|
|
Term
Mary is a 58 year old who experienced an anterior
wall MI 2 days ago. Mary c/o chest pain and
dizziness. Upon auscultation you note a new, loud
systolic murmur. What do you suspect may be the
issue?
A. Acute mitral stenosis
B. Acute aortic stenosis
C. Left ventricular outflow obstruction
D. Acute papillary muscle dysfunction |
|
Definition
| D. Acute papillary muscle dysfunction |
|
|
Term
Clinical signs of cardiogenic shock secondary to acute
left ventricular failure include:
A. Hypotension, S4 heart sound, pericardial friction rub
B. S3 heart sound, Hypotension, systolic murmur
C. Diastolic murmur, S4 heart sound, Hypertension
D. Crackles, S3 heart sound, hypotension |
|
Definition
| D. Crackles, S3 heart sound, hypotension |
|
|
Term
A 48 year old male is admitted with the diagnosis of
acute anterior wall MI. He is on Dopamine &
Dobutamine and is mechanically ventilated. His family
is visibly upset. What would be your best action to
assist them?
a. Teach them about cardiac risk factors
b. Counsel the family about diet changes
c. Listen to their concerns & answer questions in a way
that is easy to understand
d. Discuss cause of a myocardial infarction |
|
Definition
c. Listen to their concerns & answer questions in a way
that is easy to understand |
|
|
Term
The family of a 79 year old female was just told she
passed away after unsuccessful cardiac resuscitation.
They view her body and are crying. Your best
immediate action would be:
a. Provide a private quiet room so they can spend time alone
b. Ask them if they would like you to call the medical examiner
c. Ask if they would like her wedding rings removed
d. Provide names of some good funeral homes |
|
Definition
| a. Provide a private quiet room so they can spend time alone |
|
|
Term
Coronary Artery Bypass Graft
(CABG)
Arteries are harvested from ? 3 sites |
|
Definition
Artery harvested from:
Saphenous vein (Leg)
Internal mammary
Radial artery |
|
|
Term
| CABG Post-op considerations: |
|
Definition
**Longer pump time = increased risk of bleeding
Monitor:
BP (↑ BP = risk for bleeding)
Pain
Electrolytes
Bleeding
Post op ischemia
Dysrhythmias/blocks |
|
|
Term
|
Definition
Clinical signs/symptoms
**Beck’s Triad**:
1) Elevated CVP w/JVD
2) Hypotension
3) Muffled heart sounds
Sudden drop in chest tube output
Narrowed pulse pressure
Tachycardia
Pulsus paradoxus
(>10 mm Hg during insp.)
Pulseless Electrical Activity (PEA)
Treatment
Pericardiocentesis
Risk: Laceration of
coronary artery
Thoracotomy
Median sternotomy
Goal: Locate & control source of bleeding |
|
|
Term
| Risk factors for developing Afib/aflutter: |
|
Definition
CABG
Valvular disease
MI
Atherosclerosis
Rheumatic Heart Disease
Lung Disease |
|
|
Term
Post op complications:
Afib/Aflutter |
|
Definition
Rates can vary:
<100
>100 “Rapid ventricular
response”
Lose atrial kick
↓ in CO by up to 20-25%
Management:
Rate control vs. conversion
Cardioversion if unstable
Digoxin
Beta blockers*
Ca channel blockers*
Amiodarone
Anticoagulation
*Use cautiously in pts with reduced EF |
|
|
Term
Signs of cardiac tamponade include:
A. Increased CVP, narrow pulse pressure & hypertension
B. Wide mediastinum on chest x-ray, narrow pulse pressure & hypotension
C. Widening pulse pressure, hypotension & elevated CVP
D. A fall in systolic BP >10 mmHg during inspiration, decreased CVP & hypotension |
|
Definition
| B. Wide mediastinum on chest x-ray, narrow pulse pressure & hypotension |
|
|
Term
A 68 year-old patient presents to your unit 9 days after a 3 vessel CABG complaining of chest pain. A 12 lead
ECG reveals non-specific ST elevation in leads V1-6. Cardiac enzymes are not elevated. He states the pain is better when he sits up and leans forward. This
scenario is most consistent with:
A. Acute inferior wall MI
B. Post-operative cardiac Tamponade
C. Pleural effusions
D. Pericarditis |
|
Definition
|
|
Term
A major goal for a patient who is 48 hours s/p
valve replacement surgery is to:
A. Administer antibiotics
B. Stabilize hemodynamics
C. Prevent thrombus formation
D. Promote diuresis |
|
Definition
| C. Prevent thrombus formation |
|
|
Term
Mark, a 52 year old just underwent a 3 vessel CABG. He has been in NSR and suddenly converts to atrial fibrillation at a rate of 160. His BP
suddenly drops to 72/46 & is feeling short of breath. You anticipate which of the following?
A. Adenosine 6 mg rapid IVP
B. Defibrillation with 100 joules
C. Synchronized cardioversion with 100 joules
D. Diltiazem bolus followed by an infusion |
|
Definition
| C. Synchronized cardioversion with 100 joules |
|
|
Term
Ibutilide (Corvert) 1mg IV over 10 min. is started for a
patient in rapid atrial fibrillation. You know you must
discontinue the Ibutilide for which of the following
reasons?
A. Prolonged PR interval
B. Development of PJCs
C. Narrowing QRS
D. Prolonged QT interval |
|
Definition
|
|
Term
| Heart Failure with preserved EF (HFpEF) |
|
Definition
Diastolic Heart Failure
Ejection Fraction ≥ 50%
Borderline EF 41 – 49% |
|
|
Term
| Heart Failure with reduced EF (HFrEF) |
|
Definition
Systolic Heart Failure
Ejection Fraction ≤ 40% |
|
|
Term
|
Definition
Tachypnea
Tachycardia
S3
Mitral regurg
Displaced PMI
Crackles, wheezes
Cough, frothy sputum
↑ PA pressures
↓CO/CI |
|
|
Term
| Right ventricular failure |
|
Definition
JVD
Hepatojugular reflux
Peripheral edema
Hepatomegaly
Anorexia, N/V
Ascites
Tricuspid regurg
↑CVP
↑Liver enzymes |
|
|
Term
PMI
Location
Cause of shift |
|
Definition
Location: Normally palpated:
5th ICS, MCL @ apex
Cause of shift:
LVH
Heart failure
Right pneumothorax
Right pleural effusion |
|
|
Term
|
Definition
Supine position, HOB 30º
Measure from right side
Turn head slightly to left
Observe for pulsations
Note highest point
Measure distance between the
pulsation and sternal angle
4 cm above sternal angle is NL |
|
|
Term
| HFrEF - Reduced EF (Dilated) |
|
Definition
-Damage to myofibrils
‐↑ Preload & a |
|
|
Term
HFrEF - Reduced EF (Dilated)
Treatment strategies |
|
Definition
Medical management:
ACE inhibitor OR
Angiotensin Receptor Blocker
(ARB)
Beta-blocker
Aldosterone antagonist (i.e.
spironolactone)
Alpha/beta blocker (i.e.
Carvedilol)
Vasodilators (nitrates)
Diuretics (usually loop)
Cardiac glycosides (i.e.
digoxin)
Long Term:
Biventricular pacing
Cardiac Assist Devices
Cardiac transplant
Inotropes (i.e. dobutamine) -
palliative |
|
|
Term
|
Definition
Stimulates beta receptors, ß1 (some alpha)
Improves contractility & cardiac output
Also used in cardiac surgery & septic shock
Dosing:
2.5 – 20 mcg/kg/min IV (up to 40 mcg/kg/min)
Onset 1‐2 minutes, up to 10 min.
Plasma half life 2 min.
Monitor for:
tachycardia, hypertension, ectopy, hypokalemia |
|
|
Term
|
Definition
Phosphodiesterase (PDE) inhibitor
Increases myocardial contractility
Vasodilator
Dosing:
Bolus 50 mcg/kg over 10 min.
Maintenance: 0.375 – 0.75 mcg/kg/min
Long half life!!!!
Bridge to transplant
Effects:
↑CO, ↓paop & SVR, no change in HR |
|
|
Term
|
Definition
Acute decompensated HF without cardiogenic shock
Potent vasodilator
Dilates arteries and ↓SVR, ↓paop, ↑ C.O.
Inhibits the renin‐angiotensin‐aldosterone system
Dosing:
Bolus 2 mcg/kg over 1 minute
Maintenance: 0.01 mcg/kg/min
Short half life (~18 minutes)
Monitor for:
hypotension |
|
|
Term
| Ventricular Assist Device |
|
Definition
VADs:
-Left, right or both
-Short term:
Bridge to transplant
-Long term: Destination
therapy |
|
|
Term
|
Definition
Vagal nerve is severed
Atropine will not work if bradycardia
develops
Immunosuppression to prevent rejection |
|
|
Term
Effect of Bi-ventricular Pacing on QRS
Duration |
|
Definition
Prolonged QRS
before therapy
Bi-ventricular
pacing resulting in
shortening of QRS
duration
Goals:
Complement medical therapy
Improve quality of life
Give hope to those who are suffering with moderate to severe heart failure |
|
|
Term
| Cardiac Resynchronization Therapy Bi-ventricular Pacing |
|
Definition
Benefits:
-Synchronized ventricular
contraction
-Increased EF/CO
-Symptom improvement
-Increased QOL |
|
|
Term
| Cardiomyopathy management: |
|
Definition
Optimize heart function:
Preload
Afterload
Contractility
Beta blocker, ACE inhibitor
ARB - Angiotensin
Receptor Blocker (ie.
Losartan, valsartan)
Diuretics
VAD-bridge to transplant
Transplant
Patient education!!!
Diagnostics:
12 Lead ECG
CXR
ECHO
TEE
Heart cath
Myocardial biopsy
(restrictive) |
|
|
Term
| Cardiomyopathy management: Discharge care |
|
Definition
Medication adherence
Activity
Weight (Daily)
Diet (Sodium restricted*)
Smoking (and other health habits – quit smoking,
limit alcohol intake, lose weight)
Prevent infection – flu & pneumococcal vaccines
*Na & fluid restriction debateable;
fluid restrict if hyponatremic, Na if congestion |
|
|
Term
Hypertrophic Cardiomyopathy
2 types |
|
Definition
HOCM (Hypertrophic Obstructive CM)
IHSS (Idiopathic Hypertrophic Subaortic Stenosis) |
|
|
Term
Hypertrophic Cardiomyopathy
Physiologic changes: |
|
Definition
Thickened septum
Diastolic dysfunction
Decreased compliance & outflow obstruction
Many present with sudden cardiac death |
|
|
Term
| Hypertrophic Cardiomyopathy Assessment |
|
Definition
Assessment: S4, Murmur, displaced PMI,
Treatment: beta blockers, calcium channel blockers
Prolong diastole & filling time!
Avoid inotropes!!! (i.e. Digoxin/Dobutamine)
Surgical: Percutaneous transluminal septal myocardial
ablation (PTSMA)
Myomectomy |
|
|
Term
A pt. admitted with HF develops hypotension,
tachycardia, decreasing LOC, cool clammy skin,
decreasing UOP & tachypnea. Which of the
following would be included in the pts. plan of
care?
A. Positive inotropic agents, diuretics & vasodilators
ensuring BP & perfusion are adequate
B. ACE Inhibitors, adenosine, Beta blockers
C. Beta blockers, diuretics, calcium channel blockers
D. Negative inotropic medications, digoxin,
antidysrhythmics |
|
Definition
| A. Positive inotropic agents, diuretics & vasodilators ensuring BP & perfusion are adequate |
|
|
Term
A medication regimen for a patient with hypertrophic
cardiomyopathy would include:
A. Cardiac glycosides & beta blockers
B. Beta blockers & vasopressors
C. Calcium channel blockers & beta blockers
D. Vasopressors & Inotropes |
|
Definition
| C. Calcium channel blockers & beta blockers |
|
|
Term
Long term medical management for heart failure
include which of the following?
A. Beta blockers, ACE inhibitors & Aldosterone
antagonists
B. ACE inhibitors, ARBs and vasopressors
C. ARBs, beta blockers & calcium channel blockers
D. Vasopressors, ACE inhibitors & calcium channel blockers |
|
Definition
A. Beta blockers, ACE inhibitors & Aldosterone
antagonists |
|
|
Term
A patient presents to your unit, POD 3 for a cardiac
transplant. During the night the patient develops
symptomatic bradycardia. Your best action would
be:
A. Administer Atropine 1 mg IV and apply 100% O2
B. Connect epicardial pacing wires to a generator and
pace the patient
C. Give Atropine and start an Isuprel infusion
D. Start a Dopamine infusion |
|
Definition
B. Connect epicardial pacing wires to a generator and
pace the patient |
|
|
Term
A 76 year-old patient has end-stage heart failure
and has decided that he does not want to be
resuscitated. Which of the following statements
indicates he is accepting & preparing for end of
life?
a. “I wish I would have done more with my life”
b. “If I could live long enough to watch my grandchildren
graduate from college, I would feel complete”
c. “I feel I have done all the talking I need to do”
d. “I am not going to bother taking these medications anymore,
they don’t help” |
|
Definition
| c. “I feel I have done all the talking I need to do” |
|
|
Term
A patient with end-stage heart failure is becoming
more depressed and withdrawn. You feel music
therapy may help. What steps should you take
prior to instituting music therapy?
a. Ask the patient if he likes music & what type
b. Get a physician’s order
c. Ensure all nursing tasks have been completed
d. Consult the psychiatry team because he is depressed |
|
Definition
| a. Ask the patient if he likes music & what type |
|
|
Term
|
Definition
Forward flow of blood through stenotic open valves
Backward flow through
incompletely closed
valves
Murmurs are high pitched
**except aortic stenosis |
|
|
Term
|
Definition
Between S1 and S2 (during systole)
Mitral & tricuspid valves are closed
insufficiency
Aortic & pulmonic valves are open
stenosis
S1 - murmur - S2 |
|
|
Term
|
Definition
After S2 (during diastole)
Mitral & tricuspid valves are open
stenosis
Aortic & pulmonic valves are closed
Insufficiency
S1 - S2 - murmur |
|
|
Term
Mitral Stenosis
Type of murmur Systolic or Diastolic? Location |
|
Definition
|
|
Term
Mitral Regurg
Type of murmur Systolic or Diastolic? Location |
|
Definition
|
|
Term
Aortic Stenosis
Type of murmur Systolic or Diastolic? Location |
|
Definition
|
|
Term
Aortic Regurg
Type of murmur Systolic or Diastolic? Location |
|
Definition
|
|
Term
Which of the following is most likely the cause of a
systolic murmur auscultated at the right sternal
border, 2nd ICS?
A. Mitral stenosis
B. Aortic stenosis
C. Mitral insufficiency
D. Aortic insufficiency |
|
Definition
|
|
Term
A murmur associated with mitral stenosis is best
auscultated:
A. At the left mid-clavicular line, during diastole
B. At the left mid-clavicular line, during systole
C. At the right sternal border, during diastole
D. At the right sternal border, during systole |
|
Definition
| A. At the left mid-clavicular line, during diastole |
|
|
Term
A patient presents in heart failure with acute shortness of breath. When auscultating lung sounds
you observe crackles through all the lung fields. You also expect to hear what heart tone?
A. S4
B. Split S1
C. Pericardial friction rub
D. S3 |
|
Definition
D. S3
A. S4 (LVH,MI)
B. Split S1 (BBB)
C. Pericardial friction rub (Pericarditis) |
|
|
Term
Which of the following murmurs is best heard with
the bell of the stethoscope?
A. Holosystolic Mitral regurgitation
B. Mitral regurgitation
C. Aortic stenosis
D. Aortic regurgitation |
|
Definition
|
|
Term
A S4 heart sound is expected in which of the following?
A. Pericarditis
B. Left ventricular failure
C. Ventricular hypertrophy
D. Bundle branch block |
|
Definition
C. Ventricular hypertrophy
A. Pericarditis (rub)
B. Left ventricular failure (S3)
D. Bundle branch block (split) |
|
|
Term
| Mitral insufficiency/regurgitation |
|
Definition
Causes:
MI
ruptured chordae tendineae
severe L heart failure
hypertrophic
cardiomyopathy
MV prolapse
Rheumatic fever
Symptoms:
Orthopnea/dyspnea
Fatigue
Angina
Left heart failure
Right heart failure
Systolic murmur
Prone to afib |
|
|
Term
|
Definition
Occurs when the mitral valve is OPEN
Diastolic murmur
Pinkish cheeks
Pulmonary edema
Prone to afib
Causes: RHD
Treatment:
Medical mgmt
Surgical replacement
Balloon Valvuloplasty |
|
|
Term
|
Definition
Occurs when the valve doesn’t close completely
Results in a backflow of blood & reduced diastolic
pressure
Causes:
HTN
Rheumatic fever
Endocarditis
Syphilis
Idiopathic
Associated with:
Marfan’s syndrome
Ventricular septal defect (VSD)
Signs:
head bobbing
Brisk carotid upstroke
Wide pulse pressure - >40 mmHg
“Water-hammer” pulse – rapid upstroke &
downstroke with a shortened peak |
|
|
Term
|
Definition
Systolic ejection is
impeded
Pressure gradient between
LV & aorta
50% 2-year mortality if
HF develops
Symptoms: Heart failure
Treatment: Valve
replacement |
|
|
Term
Aortic Stenosis
Diagnosis/Treatment |
|
Definition
Echocardiogram
Cardiac catheterization
(↑LVEDP, ↑atrial
pressure, ↑paop, ↓CO)
12 lead ECG: left atrial
& ventricular
hypertrophy
Chest x-ray: left atrial
& ventricular
enlargement, pulm
venous congestion
Treat heart failure if
present: ACE inhibitor,
diuretics, digoxin, Na
restriction
Beta blocker if EF>25%
Afterload reduction
Valve
repair/replacement |
|
|
Term
In a patient with aortic stenosis you can expect which
of the following upon exam:
A. Narrowed pulse pressure
B. Diastolic murmur
C. Systolic murmur
D. Widened pulse pressure |
|
Definition
C. Systolic murmur
A. Narrowed pulse pressure
B. Diastolic murmur (in regurg)
D. Widened pulse pressure (in regurg) |
|
|
Term
A patient with mitral insufficiency is prone to which
of the following dysrhythmias?
A. Complete heart block
B. AV Dissociation
C. Atrial fibrillation
D. Second degree AV Block, Type I |
|
Definition
|
|
Term
Symptoms most commonly associated with mitral
insufficiency include:
A. Systolic murmur
B. Pulsus pardoxus
C. Mid-diastolic click
D. Jugular venous distention |
|
Definition
|
|
Term
Your patient has been in surgery all day for an
aortic valve replacement. The husband is angry
because he thought the surgery would be 4 hours.
What would be your best response to him?
a. Call security in case his anger escalates
b. Call the OR to get a status report and notify him of the reason for the delay
c. Tell him you are unsure of the cause of the delay
and ask him to return to the waiting room
d. Call his family to be with him |
|
Definition
| b. Call the OR to get a status report and notify him of the reason for the delay |
|
|
Term
| Acute Cardiac Inflammatory Disease |
|
Definition
Myocarditis
Endocarditis
Pericarditis |
|
|
Term
|
Definition
Focal or diffuse inflammation of the
myocardium
Viral or bacterial infection
Clinical signs: fever, chest pain,
heart failure, dysrhythmias, sudden
cardiac death
May be accompanied by
pericarditis
Treatment: Antibiotics
(if bacterial), NSAIDs, diuretics,
inotropes, ACE inhibitor |
|
|
Term
|
Definition
Inflammation of the pericardial sac
Constrictive: fibrous deposits on the pericardium
Restrictive: effusions into the pericardial sac
Causes: Acute MI, post-CABG, connective tissue
disease, infection
Dressler’s syndrome 2-12 weeks after MI caused
from an autoimmune response or viral infection
Inflammation of the pericardial sac
Constrictive: fibrous deposits on the pericardium
Restrictive: effusions into the pericardial sac
Causes: Acute MI, post-CABG, connective tissue
disease, infection
Dressler’s syndrome 2-12 weeks after MI caused
from an autoimmune response or viral infection
Inflammation of the pericardial sac
Constrictive: fibrous deposits on the pericardium
Restrictive: effusions into the pericardial sac
Causes: Acute MI, post-CABG, connective tissue
disease, infection
Dressler’s syndrome 2-12 weeks after MI caused
from an autoimmune response or viral infection
10-15% develop this 2-7 days after AMI
Fever
Chest pain worse with deep breath, relieved by
leaning forward
Non-specific (diffuse elevation) ST segment changed in the precordial leads |
|
|
Term
|
Definition
Scratching, grating, squeaking leather quality… LLSB,
leaning forward or lying supine in deep expiration…
high frequency… diaphragm
3 sounds are present
One systolic – occurs anywhere in systole
Two diastolic – occurs w/ ventricular stretch at early and late
diastole
MI, pericarditis, autoimmune, trauma, s/p cardiac
surgery, autoimmune |
|
|
Term
|
Definition
Infection of the
endocardium or valve
Common organisms:
Streptococcus
Staphylococcus
Gram negative bacilli
Fungi (ie candida)
Administer appropriate antibiotics
Damaged leaflets
Causes: trauma, bacteria
from other sources
@ Risk: cardiac surgery,
rheumatic heart disease,
dental procedures, IV
drug abuse |
|
|
Term
|
Definition
Endocarditis
decrease in systolic pressure during inspiration>
10 mmHg caused by cardiac tamponade,
pleural effusion, pericarditis or dehydration |
|
|
Term
|
Definition
Endocarditis
Every other beat is weak, indicating advanced LV failure |
|
|
Term
Acute Cardiac Inflammatory Disease
Treatment goals |
|
Definition
Prevent/relieve symptoms (lean forward)
NSAIDs (ASA or indomethacin)
Treat infection
Corticosteroids
Chronic: partial pericardiectomy
-window is created allowing fluids to drain into pleural space
Constrictive pericarditis: total pericardiectomy |
|
|
Term
A focal or diffuse inflammation of the cardiac muscle
is known as:
A. Endocarditis
B. Pericarditis
C. Myocarditis
D. Myocardial infarction |
|
Definition
|
|
Term
Which of the following is a complication of infective
endocarditis?
A. Myocarditis
B. Heart failure
C. Emboli
D. Pericarditis |
|
Definition
|
|
Term
Chest pain is best described as pleuritic when it:
A. Resolves with sublingual nitroglycerin
B. Occurs only during sleep
C. Increases with deep inspiration and decreases when the patient sits up and leans forward
D. Resolves with a deep breath |
|
Definition
| C. Increases with deep inspiration and decreases when the patient sits up and leans forward |
|
|
Term
A patient with bacterial endocarditis should be
closely observed for which of the following clinical
changes?
A. Pulmonary edema
B. Neurologic impairment
C. Oliguria
D. Rising liver enzymes |
|
Definition
|
|
Term
| Ventricular fibrillation treatment |
|
Definition
Shock (if readily available); Repeat Q 2 min.
CPR for 2 min
Rhythm check-shock if warranted
Epi 1mg IV/IO Q 3-5 min or
Vasopressin 40 units IV/IO instead of 1st or 2nd Epi
Amiodorone 300 mg IV/IO; repeat bolus 150 mg IV/IO
in 3-5 min if still in VF/VT
Medications (other): Lidocaine1.0-1.5 mg/kg IV/IO, MR X 2, q5-10 min.
0.5-0.75 mg/kg, (3mg/kg max. loading dose) if VF/PVT persists. |
|
|
Term
|
Definition
Caused by hypomagnesemia, prolonged QT, multiple
medications
Also caused by Methadone & some quinolones
Treatment: Magnesium Sulfate 1-2 grams IV/IO
(diluted)
Magnesium antagonist: Calcium Chloride |
|
|
Term
| PEA (pulseless electrical activity) |
|
Definition
Pump: Start compressions
Epinephrine 1mg IV Q3-5 min or
Vasopressin 40 units IV instead of
1st or 2nd Epi
Assess: Differential diagnosis
5 H’s:
Hypovolemia
Hypoxia
Hypo/Hyperkalemia
H+ ion (acidosis)
Hypothermia
5 T’s:
Thrombus: MI
PE
Tension pneumothorax
Tamponade
Toxicology (Drug OD) |
|
|
Term
|
Definition
No cardiac output
Pump (Same as PEA)
Epinephrine 1 mg IV/IO Q 3-5 min
Assess differential diagnosis
Consider termination |
|
|
Term
| Capnography during resuscitation |
|
Definition
Used as a marker of perfusion
Goal >10 mm HG
Normal PETCO2 > 40 mm HG
If less than 10, improve quality of compressions
If rapid increase in PETCO2, may be a sign of
ROSC
If consistently < 10 in the setting of adequate
compressions, discuss termination of resuscitation
efforts |
|
|
Term
| Tachycardia – Narrow complex |
|
Definition
Stable vs. unstable
Unstable: Prepare for cardioversion!
Stable? Narrow & regular complex?
Vagal maneuvers
Adenosine 6 mg IV-Rapid!!!
(Repeat 12 mg x 2, q 1-2 min)
Diltiazem IV |
|
|
Term
| Tachycardia – Wide complex |
|
Definition
QRS > 0.12 sec.: consult an expert
Amiodarone 150 mg IV over 10 min.
Can also use Lidocaine for monomorphic wide
complex tachycardia
New in 2010 guidelines:
Adenosine 6 mg IV
May repeat |
|
|
Term
Antidysrhythmic class IA
Quinidine (Cardioquin)*
Procainamide (Pronestyl)* |
|
Definition
Prolongs
repolarization
Atrial dys.
Vent tach |
|
|
Term
Antidysrhthmic class IB
Lidocaine (Xylocaine)*
Tocainamide (Tonocard)
Mexiletin (Mexitil) |
|
Definition
Shortens action
potential duration
Ventricular
Dysrhythmias |
|
|
Term
Antidysrhythmic class IC
Flecainamide (Tambocor)
Propafenone (Rhythmol) |
|
Definition
Blocks Na channels Ventricular
Dysrhythmias |
|
|
Term
Antidysrhythmic class II
Propanolol (Inderal)
Esmolol (Brevibloc)* |
|
Definition
Decreases HR & SA
node automat.
Atrial dys. & SVT |
|
|
Term
Antidysrhythmic class III
Amiodarone (Cordarone)**
Bretylium (Bretylol)
Sotalol (Betapace) |
|
Definition
Blocks K+ channels,
slows conduction
Ventricular
Dysrhythmias |
|
|
Term
Antidysrhythmic class IV
Verapamil (Calan)*
Diltiazem (Cardizem)* |
|
Definition
Ca channel antagonist Atrial tachycardia &
atrial flutter |
|
|
Term
Antidysrhythmic Other
Digoxin (Lanoxin)*
Adenosine (Adenocard)* |
|
Definition
Slows AV node
conduction, depresses
SA node
Afib, Aflutter & SVT |
|
|
Term
| Wolfe-Parkinson-White (WPW) |
|
Definition
Pre-excitation
Abnormal conduction
pathway between the
atria & ventricles
Accessory pathways
conduct faster than the
AV node
PR interval <0.12
Delta wave |
|
|
Term
|
Definition
Symptomatic bradycardia, 2nd Degree
AV Block (Mobitz II), Third Degree AV Block
Patients admitted with “Syncope”
Will require f/u EP study
Modes: Synchronous or Asynchronous
Temporary:
Transcutaneous, transvenous, epicardial |
|
|
Term
|
Definition
Pad placement
Anterior – posterior
Anterior – lateral
Settings
Demand (synchronous)
Fixed (asynchronous)
More energy required vs. transvenous (start @ 50 mA
& increase until capture) |
|
|
Term
|
Definition
Atria/Ventricle paced, Atria/ventricle sensed, pacing inhibited with
intrinsic rhythm/beat |
|
|
Term
|
Definition
Ventricle paced, ventricle sensed, pacing inhibited with intrinsic
rhythm/beat |
|
|
Term
|
Definition
| Atria paced, Atria sensed, pacing inhibited with intrinsic rhythm/beat |
|
|
Term
|
Definition
Ventricle paced, ventricle sensed, will pace regardless of intrinsic
rhythm/beat (dangerous!!! – possible R on T) |
|
|
Term
|
Definition
Causes:
Improper position
Low voltage
Battery failure
Inadequate connection
Fibrosis of catheter tip
Trouble-shooting:
Check connections
Increase mA (energy) |
|
|
Term
|
Definition
Common Causes:
Position of the lead
Battery failure
Improper settings
Troubleshooting:
Assess thresholds |
|
|
Term
| Magnet Operation with Pacers |
|
Definition
Magnet over pacemaker causes asynchronous
pacing at a designated “magnet” rate
Over an ICD, inhibits defibrillation |
|
|
Term
The emergency drug therapy of choice for
polymorphic ventricular tachycardia is:
A. Atropine
B. Amiodarone
C. Adenosine
D. Magnesium |
|
Definition
|
|
Term
A patient suddenly experiences ventricular
fibrillation. Your immediate treatment plan would
include:
A. Chest compressions, amiodorone, & atropine
B. Defibrillation, magnesium & chest compressions
C. Chest compressions, airway management & epinephrine
D. Defibrillation, chest compressions & airway management |
|
Definition
| D. Defibrillation, chest compressions & airway management |
|
|
Term
The chance of regaining a pulse after ventricular
fibrillation depends on:
A. How quickly the patient was intubated
B. The cause of the arrest
C. How quickly the patient received defibrillation
D. The amount of epinephrine administered |
|
Definition
| C. How quickly the patient received defibrillation |
|
|
Term
A patient with an acute anterior wall MI develops 2nd
Degree Type II heart block. A temporary
transvenous pacing wire is inserted. You notice
pacing spikes indiscriminately during all phases of
the cardiac cycle. Your best action would be:
A. Increase the sensitivity value (mV)
B. Decrease the sensitivity value (mV)
C. Increase the milliamps (mA)
D. Decrease the milliamps (mA) |
|
Definition
| B. Decrease the sensitivity value (mV) |
|
|
Term
A patient returns to the PCU after implantation of a
permanent dual chamber pacemaker. You note the
patient is in atrial fibrillation. What would be the
pacing mode indicated for this patient?
A. DDD
B. VVI
C. DVI
D. VAT |
|
Definition
|
|
Term
Which of the following patients requires emergent
pacing?
A. 2nd degree heart block Type 2 with 5 second
pauses
B. 82 year old with complete heart block with rate of
38 & BP 108/68
C. Sinus bradycardia with 1st degree AV block
D. Junctional rhythm with a rate of 52 bpm |
|
Definition
| A. 2nd degree heart block Type 2 with 5 second pauses |
|
|
Term
|
Definition
Formerly called “Cardiac
contusion”
Right atrium & ventricle
most at risk
Monitor for:
Dysrhythmias
Heart block/R BBB
Medical mgmt:
Prevent complications
Antidysrhythmics
Heart failure
Temporary pacing |
|
|
Term
Which of the following is initially indicated for blunt
cardiac trauma in the setting of hypoperfusion?
A. Inotropes
B. Afterload reducers
C. IV fluids
D. Intra-aortic balloon counterpulsation |
|
Definition
|
|
Term
|
Definition
Diagnosis:
Echo
12 Lead ECG
CXR
CT Scan
MRI
Trans Esophageal Echo
Cardiac enzymes
Other labs: Coags,
electrolytes, CBC |
|
|
Term
A pt. who sustained blunt chest injury is admitted to
the PCU. The pt. develops dyspnea & confusion
and now has distant heart tones. 2 hours post
admission the BP has changed from 140/78 to
92/78. There is now + JVD. The most likely cause
is:
A. Hypovolemia
B. Cardiac tamponade
C. Cardiogenic shock
D. Pulmonary edema |
|
Definition
|
|
Term
|
Definition
Usually > 240/140
Acute elevation associated with organ damage:
Kidney: decreased blood flow, hematuria, proteinuria
Brain: hypertensive encephalopathy
Heart: LVH, LVF, MI
Eyes: retinal hemorrhages
Vascular system: vessel damage |
|
|
Term
|
Definition
≥ 60 years of age:
SBP < 150 mmHg and DBP < 90 mmHg
≤ 60 years of age:
SBP < 140 mmHg and DBP < 90 mmHg
4 Types of medications recommended:
Thiazide diuretic
Calcium Channel Blocker
ACE Inhibitor
Angiotensin Receptor Blocker (ARB) |
|
|
Term
|
Definition
≥ 60 years of age:
SBP < 150 mmHg and DBP < 90 mmHg
≤ 60 years of age:
SBP < 140 mmHg and DBP < 90 mmHg
4 Types of medications recommended:
Thiazide diuretic
Calcium Channel Blocker
ACE Inhibitor
Angiotensin Receptor Blocker (ARB) |
|
|
Term
| Treatment: Hypertensive Crisis |
|
Definition
BP in both arms (r/o
aneurysm or steal
syndrome)
Consider 12 Lead
ECG
Decrease BP by 25%
in 1-2 hrs
IV anti-hypertensives
(vasodilators, diuretics,
etc)
Nitroprusside
Labetolol
Esmolol
Nicardipine |
|
|
Term
Aneurysms
Thoracic (TAA)
Abdominal (AAA)
Aortic dissection
Rupture |
|
Definition
Definition: permanent localized dilation of aorta
1.5 times diameter
Patients will describe “ripping” chest pain radiating
to the back
> 6 cm associated with increased risk of rupture |
|
|
Term
|
Definition
At risk: HTN, smoking,
Dilatation of the aorta >50% of
its normal diameter
Goal: Prevent rupture or dissection
Treatment: BP control/HR
reduction
Surgical repair |
|
|
Term
BP control
Esmolol (Brevibloc) |
|
Definition
- short acting, beta blocker
Initial dose: 250-500 mcg/kg IV over 1 min
Maintenance dose: |
|
|
Term
BP control
Labetalol (Trandate) |
|
Definition
- Blocks alpha, B1 & B2
Initial dose: 20 mg IV over 2 min;
follow with 20-80 mg IV q10-15min until BP is controlled
Maintenance dose: 2 mg/min IV continuous infusion; titrate up to 5-20 mg/min; not to
exceed total dose of 300 mg |
|
|
Term
|
Definition
| Dose: 5 mg IV q 2min, up to 3 times |
|
|
Term
Bp Control
Nitroprusside (Nipride) |
|
Definition
Arteriolar & venous vasodilation
0.5-3 mcg/kg/min IV |
|
|
Term
|
Definition
Nicardipine (Cardene)
Calcium channel blocker
5 – 15 mg/hr |
|
|
Term
|
Definition
Hypertension is a
risk factor
Signs: BP
difference of 25
mmHg or greater
between left &
right arm |
|
|
Term
|
Definition
At risk for Ao insuff.
Diastolic murmur
Widened pulse
pressure
Type A
Type B |
|
|
Term
|
Definition
Medical mgmt
If dissected, administer
vasodilators to keep
BP controlled
Endovascular stent |
|
|
Term
|
Definition
BP control
Pain management
Wean from ventilator
Monitor chest tube output
Closely monitor urine output
BUN/creat (aortic cross-clamp)
Monitor for bleeding
Other post-op practices |
|
|
Term
|
Definition
Pulsation in the
abdomen
Control HTN
Surgical repair
Signs of rupture:
Hypotension
Tachycardia
Shock |
|
|
Term
|
Definition
>60% have CAD
Atherosclerosis
Most common cause of death after vascular surgery
is a MI
Risk factors: Smoking, DM, Dyslipidemia, HTN, age
>70
Claudication
Limb ischemia |
|
|
Term
|
Definition
Pain
Pallor
Paresthesia
Paralysis
Pulseless
Poor temperature
Poor healing |
|
|
Term
| Ankle/Brachial Index (ABI) |
|
Definition
SBP-brachial artery
SBP-posterior tibial &
dorsalis pedis arteries
Divide ankle pressure by
arm
ABI Value > 0.9 Normal
< 0.4 severe obstruction |
|
|
Term
Lower extrem PAD
Diagnostics/Treatment |
|
Definition
Doppler studies
Arteriography
Management:
Anticoagulation
Antiplatelet agents
Vasodilators
Thrombolytic agents
Angioplasty
Stents
Surgery - bypass
Amputation |
|
|
Term
|
Definition
+ Homans’ sign
Pain in calf with abrupt dorsiflexion of the foot
while the knee is flexed at 90°
Poor reliability d/t false positive |
|
|
Term
A pt. is admitted for trmt of acute ischemia to the
right leg requiring surgical embolectomy. During
the procedure extra dye is used for arteriography.
Post-op the pt. is anuric with elevated CVP &
+JVD. What immediate treatment would the nurse
expect?
A. Vasodilators
B. Vasopressors
C. Fluid challenge
D. Diuretics |
|
Definition
|
|
Term
Nipride is started on a patient admitted with
hypertensive crisis. Which of the following
assessments is most important to monitor?
A. BP every 1-2 minutes until stabile
B. Blood glucose every 2-4 hours
C. Thiocyanate levels within 12 hours of
implementing therapy
D. Symptoms of nausea |
|
Definition
| A. BP every 1-2 minutes until stabile |
|
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