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HRT: hormone replacement therapy
- once standard therapy for treating menopausal symptoms
- includes estrogen for women without uterus or estrogen and progesterone for women with uterus
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Infarct (Myocardial infarction)
- occurs d/t sustained ischemia, causing irreversible myocardial cell death
- degree of altered fx depends on area of the heart involved and size of infarction
- most MIs involve some portion of left ventricle
- presence of cardiac markers confirms an infarction and is called STEMI
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Injury (myocardial injury)
- reps a worsening stage of ischemia that is potentially reversible but may evolve to infarction of myocardial cells
- typical ECG change during injury: ST segment elevation
- if prompt and effective tx: it is possible to restore O2 to myocardium and avoid infarction
- absence of serum cardiac markers confirms this
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Ischemia (myocardial ischemia)
- typical ECG changes: ST segment depression and/or T wave inversion
- Once tx (adequate blood flow is restored) the ECG changes will resolve, and the ECG will return to patient's baseline
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ST elevation
- typical ECG change seen during myocardial injury
- if presence of serum cardiac markers= confirms infarction and STEMI
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Anterior MI
result from occlusions in left anterior descending artery
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inferior MI
result from occclusions in right coronary artery
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SA node
- pacemaker of the heart
- where a normal cardiac impulse begins
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Atrial fibrillation (A fib)
- total disorganization of atrial electrical activity d/t multiple ectopic foci resulting in loss of effective atrial contraction
- the most common, clinically significant dysrhythmia
- results in decreased CO d/t ineffective atrial contractions and or a rapid ventricular response
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Troponin
- myocardial muscle protein released into circulation after myocardial injury
- highly specific to cardiac tissue
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CPK-MB
- elevation is specific for myocardial tissue injury
- levels start to rise about 6 hours after symptom onset, peak in about 8 hours, and return to baseline within 24-36 hours after MI
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Thrombolytic
- use of drugs to break up or dissolve blood clots, which are main causes of heart attacks and stroke
- ideally, pts should receive meds within first 30 minutes after arriving at hospital for tx
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Reperfusion dysrhythmias
- accelerated idioventricular rhythm
- less reliable marker of repercussion
- generally self-limiting and don't require aggressive treatment
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Dopamine
- positive inotrope, beta adrenergic agonist
- short-term tx ADHF in ICU or intermediate care units with ECG monitoring capability
- dopamine dilates renal blood vessels and enhances urine output
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Dobutamine
- selective beta adrenergic agonist
- preffered short term tx for ADHF
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Diuretic
- used for chronic heart failure
- used to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload
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ACE inhibitors
- primary drug for blocking RAAS system in HF patients with systolic dysfx
- monitor potassium level, hypotension
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ARBs- angiotensin II receptor blockers
- pts who are unable to tolerate ACE inhibitors
- prevents vasoconstriction
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Aldosterone antagonists
- Aldactone and Inspra
- avoid foods high in potassium
- monitor potassium levels
- potassium sparing diuretic- promotes sodium and water excretion while retaining potassium
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Beta blockers
- reduce myocardial contractility
- care must be taken to start gradually
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Digoxin
- increases force of contractility
- monitor potassium levels
- prior to admin, obtain apical pulse
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Lidocaine
- sodium channel blocker
- accelerates repolarization
- little to no effect on ECG
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Prodysrhythmic
- given for life-threatening dysrhythmias
- examples: digoxin
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IABP- intra-aortic balloon pump
- purpose: decrease work of heart to improve cardiac output
- decreases after load, decreases pressure in aorta during systole
- improves renal perfusion, (renal arteries during diastole)
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IABP management
- monitor anticoagulation
- prevent infection
- check for proper fx of IABP- wave form, BP, pain, dysrhythmias
- monitor for complications: occlusion of femoral artery, migration of balloon
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Tachydysrhythmias
cardiac rhythm higher than 100 beats per minute
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Electrical cardioversion
- when doc restores regular rhythms by sending an electrical shock to the heart
- treats arrhythmias
- treats a flutter, a tachy, and v tach
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Conscious sedation
- combo of meds to help pt relax (sedative) and to block pain during medical or dental procedure
- protect airway
- o2 delivery
- prevent pressure to area
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Adenosine
- decreases conduction via AV node
- Effects on ECG: prolonged PR interval, AV block
- give over 5 seconds IV push
- monitor rhythm after tx (medical cardioversion)
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Pacemaker temporary
- used after open heart surgery or MI
- lead into right ventricle via superior vena cava
- generator is external to patient
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Natural disaster
caused by natural or environmental forces
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Man-made disaster
- complex
- technologic
- not natural but occurs in human settlements
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Clostridium botulinum
- food-born- primarily in adults
- Spores- if found in infants
- occurs 18-36 hours after ingestion
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Clostridium botulinum manis
- double vision
- blurred vision
- ptosis
- slurred speech
- xerostomia
- muscle weakness- common in infants
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C. Botulinum tx
- antitoxin
- early diag required
- mechanical ventilation
- may require weeks
- debridement for wound botulism
- education for prevention
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