cardio(exam2)

  1. stenosis
    • -valve disorder
    • -valve is stiff and the opening is small
  2. regurgitation
    • -valve disorder
    • -insufficient valve, does not close properly
  3. right heart
    receives blood from body and pumps it through pulmonary artery to the lungs where it picks up fresh o2
  4. left heart
    receives o2, pull blood from the ungs and pumps it through the aorta to the body
  5. pacemaker controls
    HR
  6. what is the normal pacemaker of the heart
    SA node
  7. av node
    bundle of his
    perkinje fibers

    normals
    • 40-60
    • 20-40
    • 20-40
  8. what is CAD
    • -blood vessel disease
    • -atherosclerosis
    • -hardening of the arteries
  9. why is CAD the silent killer
    • -asymptomatic for a while
    • -progressive
  10. CAD manifestation
    chronic stable angina
  11. what is the more serious manifestation of CAD
    -ACS(acute coronary syndrome)
  12. whats are the manifestations of ACS
    • -unstable angina
    • -MI(NSTEMI and STEMI)
  13. name this disease

    slow gradual narrowing of the coronary arteries that supply the blood and o2 to the heart
    CAD
  14. stages of athersclerosis
    • fatty: lipid filled smooth muscle, tx that lowers LDL may reverse
    • Fibrous plaque: progressive changes in endothelium of arterial wall. collegen covers fatty streaks, narrowing the lumen
    • complicatied lessions: platelet accumulate creating thrombus, total occlusion
  15. what is collateral circulation
    when plaque blocks normal flow, arteries bypass occlusion
  16. when is collateral circulation most likely to occur
    when blockage occurs over a long period of time
  17. collateral circulation factors
    • -inherited predisposition to develop new blood vessles
    • -presence of chronic ischemia
  18. what is considered healthy cholesterol
    HDL's
  19. what do HDL's do
    carry lipids away so an increase in HDL's is desireable
  20. CAD levels indicating risk
    • serum cholesterol: >200
    • triglyceride: ≥150
    • LDL: >160
    • HDL: <40(men) <50(women)
    • Fasting BG: ≥100
  21. CAD BP risk indicators
    • ≥ 140/90
    • if over 60, the goal is less than 150/90
  22. what do you watch for during metabolic syndrome if pt has CAD
    glucose
  23. who is more at risk for phyc risk factors
    type a
  24. what is elevated homocysteine
    • -CAD
    • -produced by the breakdown of essential amino acid methione
    • -damage inner line of blood vessel
    • -plaque build up
    • -increase clots
  25. dug therapy for CAD
    • - lipid lowering agents(use statins which inhibit synthesis of cholesterol in the liver)
    • -antiplatelets( aspirin, Plavix, berlenta)
  26. define angina
    • -chest pain
    • -it is the clinical manifestation of MI
    • -narrowing of 1 or more arteries from athersclerosis
  27. angina is caused by
    -increase in demand for o2 or decrese supply of o2
  28. what to asses with angina
    • health hx
    • pain(PQRST)
    • vitals
    • assucltate
    • periph circulation
  29. what does PQRST stand for
    • precipitating event
    • quality
    • radiation
    • severity
    • time of onset
  30. possible locations of chest pain
    • left arm
    • jaw
    • back
    • epigastric
    • neck
    • shouldere
    • sub sternal
  31. types of angina
    • silent ischemia
    • microvascular angina
    • prinzmetal
    • chronic stable
    • unstable
  32. what is silent ischemia
    • -angina
    • -no s/s
    • -diabetics d/t neuropathy
  33. what is microvascular angina
    chest pain that occurs in the absence of significant CAD or coronary spasm of a major coronary artery
  34. in microvascular angina chest pain is r/t
    • -myocardial ischemia
    • -physical exertion
  35. what is prinzmetal angina
    spasm of coronary artery
  36. prinzmetal angina

    occurs
    tx
    triggers
    • at rest
    • nitro, Ca chan blockers
    • smoking and increased levels of substance abuse
  37. what is chronic stable angina
    chest pain that occurs intermittentally over a long period of time with similar pattern of onset, duration and intensity of s/s
  38. chronic stable angina

    where is pain
    provoked by
    relived by
    • epigastric
    • exertion
    • rest or nitro
  39. diagnostics for CAD and chronic stable angina
    • -EKG
    • cxr
    • stress test
    • ECHO
    • EBCT
    • Cardiac cath
    • LABs
  40. what does ekg monitor
    heart rythm
  41. what does cxr show
    size of heart
  42. what does stress test evaluate and what meds to hold
    • -evaluates hearts response to stress
    • -hold beta blockers
  43. what is an ECHO
    ultra sound of the heart
  44. what is the EBCT
    measures calcium calcification
  45. what is cardiac cath
    • -dye into vessles
    • -radiation and IV
    • -Id circulation and blockage
  46. what drug should you hold if pt is getting dye
    metformin
  47. chronic stable angina tx
    • antiplatelet
    • anticoagulant
    • ACE and ARBS
    • BBlocker
    • BP control
    • stop smoking
    • cholesterol management
    • Ca2+ chan blockers
    • cardiac rehab
  48. chronic stable angina main ponit
    • predictable
    • exertion
  49. define ACS
    when ischemia is prolonged and not immediately reversable
  50. define unstable angina
    • -unpredictable
    • -pain at rest or with minimal exertion
    • -easily provoked
    • -RESISTANT TO NITRO
    • -fatigue
  51. what is MI
    • abrbt stoppage of blood flow through a coronary artery from a thrombus caused by platlet aggregration
    • -HEART ATTCK
    • -CELL DEATH
  52. s/s of MI
    • "sitting on my chest"
    • SNS s/s: diaphoretic, high BP
    • cool, clamy, ashen
    • no blood flow, bp tanks, low urine, crackles
    • n/v
    • fever
  53. what is the priority for MI
    open vessles and save the heart
  54. STEMI
    • -an MI
    • -caused by occlusive thrombus
    • -st ELEVATION
    • -emergent
    • -open artery w/in 90min
  55. NSTEMI
    • caused by non occlusive thrombus
    • -NO st elevation
    • -non emergent to cath lab
    • -markers are (+)
  56. complications of MI
    • DYSRYTHMIAS
    • -HF
    • -cardiogenic shock
    • papillary muscle dysfunction
    • LV aneurysm
    • ventricular spetal wall and LV free wall rupture
    • pericarditis
    • dressler syndrom
  57. cardiogenic shock
    • MI complication
    • o2 and nurtients are inadequate
  58. papillary muscle dysfunction
    • MI complication
    • if near pap muscle you will hear a new murmur near apex
  59. left ventricular aneurysm
    • complication of MI
    • buldge out during contraction
  60. ventricular spetal wall and LV free wall rupture
    • complication of MI
    • new loud systemic murmer
  61. pericarditis
    • MI complication
    • inflammation
    • chest pain w/ inspiration
  62. dressler syndrom
    • MI complication
    • pericarditis and fever
  63. diagnostics for UA and MI
    • EKG is #1
    • serum cardiac biomarkers
    • coronary angiography
    • stress test
  64. what are serum cardiac markers
    released into the blood from necrotic heart muscle after an MI
  65. what are serum cardiac markers used to determine
    • UA
    • MI
  66. what are the serum cardiac markers
    • CK- rises after 6 hours
    • CKMB- specific to myocardial cells, >4-6% of total CK
    • Troponin- greater specificity to MI, 4-6 hour increase after MI onset
    • Myoglobin-  w/in 2 hours, peak 3-15hrs, lacks cardiac specificity
  67. troponin levels
    • (-) <0.5
    • suspicious 0.5-2.3
    • (+) >2.3
  68. myoglobin levels
    • male: 15.2-91.2
    • femalw: 11.1-57.5
  69. SA node is = to which wave
    P wave
  70. ST shows
    o2 stats
  71. ST depression=
    ischemia
  72. T wave inversion =
    ischemia
  73. ST elevation =
    • Injury
    • MI
  74. ST elevation and T wave inversion =
    infarction
  75. what is PCI
    • evaluates coronary arteries
    • cath lab
    • for confirmed STEMI
  76. what is done in PCI
    • angioplasty(balloon)
    • stent
  77. what is the first line of treatment for MI
    PCI
  78. important checks for PCI
    • pulse
    • cap refill
  79. goal of PCI
    open artery w/in 90 min of ED arrival
  80. when would you use thrombolytic therapy
    • when PCI is not available
    • chest pain for less than 12 hrs
    • EKG shows STEMI
    • no bleeding contraindications
  81. types of fibrinolytic therapy
    retavasel(rpa), alteplase(tpa), tenecteplase(tnkase)
  82. what is CABG
    • graphing veins to create new vessles
    • requires sternoectomy(open chest)
  83. indications that a pt may need a CABG
    • -failed medical management or PCI
    • -left main CAD
    • -3 vessel disease
    • -not a candidate for PCI
  84. post op care for CABG
    • -icu 24-36hrs
    • -drug
    • -hemo status
    • -monitor bleeding
    • -chest tube
    • -dysarythmias are common
    • -neuro checks
    • -wound care
    • -early mobilization
    • cough and deep breath
  85. TX for pt with angina
    • balance o2 supply demand
    • M-morphine(vasod)
    • O-oxygen
    • N-nitroglycerin(vasod)
    • A- aspirin(antiplatelet)
  86. Nitroglycerine

    route
    dose
    SE
    • -mostly sublingal but sometimes iv, PO or paste
    • -give 1 dose q5 min x3
    • -vital q5 min
    • -HA, tingling, flushing, dizzy, hypotension
  87. what do you need to know about pt meds before you give nitro
    if theey take Viagra, Cialis or other meds
  88. what will you teachpt about nitro
    ligh sensitive, 6mo experiation, don't chew
  89. what is the acronam for blood flow through heart
    tissue paper my assests

    • tricuspid
    • pulmonic
    • mitral
    • aortic
Author
ChelseaL
ID
342884
Card Set
cardio(exam2)
Description
cardio(exam2)
Updated