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MED SURG TEST 3
| Question | Answer |
|---|---|
| Cardiomyopathy Ejection Fraction | Usually less than 50% |
| Dilated Cardiomyopathy (Congested) | Most Common, charcterized by cardiomegaly (not much thickening and hypertrophy) |
| Causes of Dilated Cardiomyopathy | Pregnancy, Viral Infections |
| Manifistations of Dilated Cardiomyopathy | Exercise intolerant, dry cough, dyspnea, palpitations, JVD< Anorexia, Extra Heart Sounds, Pulmonary Crackles, Edema, Pallor, Enlarged Liver |
| Cardiac Catheterization | Can determine pressure readings and ejection fraction |
| Endomyocardial Biopsy | May be used for diagnosis of cardiomyopathy. Will determine if tissue is damaged or not |
| Treatment for Dilated Cardiomyopathy | Similar as to CHF- control the damage to the heart- May need transplant |
| Implantable Cardoverter Defibrillator | Used for Low Ejection Fraction |
| Hypertrophic Cardiomyopathy | Walls and Septum Getting thicker, so no dilation of ventricle. Enlargement can obstruct blood flow |
| Hypertrophic Cardiomyopathy S/S | Maybe asymptomatic, or have dyspnes, fatigue, angina, syncope, and arrhythmias. PMI Moved down and lateral |
| Restrictive CMP | Least Common- damaged tissue that won't stretch- so requires high diastolic pressures |
| Hypertrophic CMP Tx | Trim off extra heart muscle or alcohol ablation |
| Alcohol Ablation | Destorys some of tissue to allow more room in ventricle |
| Manifestations of Endocarditis | Fever and Chills, Tachycardia, SOB, Clot Symptoms, Joint Pain, Osler's Nodes, Janeway Lesions, Roth's Spots, New Murmurs, CHF, Splinter Hemorrhages |
| Osler's Nodes | split pea-tender-transient on toes, fingers, palms, and soles |
| Janeway's Lesions | Nontender and hemorrhagic on soles and palms |
| Roth's Spots | Retinal Hemorrhages- rare and longitudinal |
| Treatment of Infective Endocarditis | Antibiotics, Antipyretics, rest, Repeat blood cultures, surgical repain |
| High Risk Patients of Infective Endocarditis | artificial valves or history of endocarditis |
| Moderate Risk Patients of Infective Endocarditis | Mitral Valve Prolapse |
| Acute Pericarditis | Fluid between layers increases pressure and restricts heart (may cause cardiac tamponade) |
| Causes of Pericarditis | Infection, Heart Attack, Cancer spreading, Radiation Treatment, Injury or Surgery, Drugs, Rheumatoid Arthiritis |
| Addresslers Syndrome | Pericarditis resulting from a heart attack a month after the heart attack |
| Clinical Manifestation of Pericarditis | Sharp Pain (worsens on deep breath), Friction Rub, Fever, Pain when swallowing |
| Complications of Pericarditis | Pericardial Effusion and Cardiac Tamponade |
| Beck's Triad | Seen in Cardiac Tamponade: JVD, Tachycardia, and Muffled Heart Sounds |
| Pulses Parodoxis | Decrease in systolic on inspiration > 10 mmHg (cardiac tamponade) |
| S/S pericardial Effusion | SOB, cough, Increased Respirations, S1 S2 muffled |
| Pain relief of pericarditis | Eased by sitting and leaning forward |
| Ischemia ECG change | localized ST elevation |
| Pericarditis ECG change | widespread changes in ST segement, T wave, and QR interval |
| Constrictive Pericarditis | Scarring of pericardial sac Similar to CHF symptoms |
| Pericardial Knock | Sign of Constrictive Pericarditis, auscultated on LSB |
| ECG Changes in Contrictive Pericarditis | Flattening of complexes |
| Myocarditis | Inflammation of heart muscle- no treatment- support heart |
| Casues of Myocarditis | Viral |
| Clinical Manifestation of Myocarditis | Fever, Fatigue, Sore Throat, Dyspnea, N&V, JVD, Extra Heart Sounds, CHF |
| Diagnoses of Myocarditis | ECK nonspecific, WBC may be increased, Endomyocardial Biopsy |
| Rheumatic Fever | Imflammation of all three heart layers- scars valves. usually begins as sore throat |
| Pancardits | In rheumatic fever- all layers of heart and the valves vegetate |
| Aschoff's Bodies | Lesions on myocardium of swollen collagen seen in Rheumatic Fever (can be in Lungs, Joints, and Brain) |
| Major Criteria for Rheumatic Fever | Carditis, Chorea, Nodules at joints, Rach of Chest, back, and ABD |
| Minor Criteria for Rheumatic Fever | Fever,HX of Rheumatic Heart Disease, Lab Findings, Prolonged PR interval |
| Erythrocyte Sedimentation Rate in Rheumatic HD | Increases with inflammation |
| C-Reactive Protein during Rheumatic HD | increases during systemic infection |
| Major Complication of Rheumatic Fever | Chronic Rheumatic Carditis (cordae tendinae damaged)and valve structure changed (mostly mitral) |
| Mitral Valve Stenosis Causes | Rheumatic Heart Disease, Rheumatoid Arthiritis, Lupus, and Genetic |
| Mitral Valve Stenosis | Left Atrial Pressure is higher than Left Ventricle= lungs compression |
| Clinical Manifestations of Mitral Valve Stenosis | Dyspnea, Palpitations, Hoarsness(caused by A Fib), Emboli, S1 Snap |
| Most frequent cause of Mitral Valve Regurgitation | MI (enlarged left ventricle and atrium) |
| Acute Mitral Valve Regurgitation | Pulmonary edema, shock (decreased BP) |
| Chronic Mitral Valve Regurgitation | Ventricular Failure- weakness and fatigue, SOB< peripheral edema, S3, murmur in apex |
| Mitral Valve Prolapse | Murmur, Clicks, PVCs and Tachycardias, Chest pain not responsive to nitrates, SOB, palpitations, syncope, Risk for infective endocarditis- May have Marffans. |
| Aortic Valve Stenosis Causes | Congenital Heart Disease, Rheumatic Heart Disease, and Degenerative Heart Disease |
| Symptoms of Aortic Valve Stenosis | Angina, Syncope,Abnormal Heart Sounds and heart Failure- NITROGLYCERIN CONTRAINDICATED |
| Causes of Aortic Valve Regu | |
| Cardiomyopathy Ejection Fraction | Usually less than 50% |
| Dilated Cardiomyopathy (Congested) | Most Common, charcterized by cardiomegaly (not much thickening and hypertrophy) |
| Causes of Dilated Cardiomyopathy | Pregnancy, Viral Infections |
| Manifistations of Dilated Cardiomyopathy | Exercise intolerant, dry cough, dyspnea, palpitations, JVD< Anorexia, Extra Heart Sounds, Pulmonary Crackles, Edema, Pallor, Enlarged Liver |
| Cardiac Catheterization | Can determine pressure readings and ejection fraction |
| Endomyocardial Biopsy | May be used for diagnosis of cardiomyopathy. Will determine if tissue is damaged or not |
| Treatment for Dilated Cardiomyopathy | Similar as to CHF- control the damage to the heart- May need transplant |
| Implantable Cardoverter Defibrillator | Used for Low Ejection Fraction |
| Hypertrophic Cardiomyopathy | Walls and Septum Getting thicker, so no dilation of ventricle. Enlargement can obstruct blood flow |
| Hypertrophic Cardiomyopathy S/S | Maybe asymptomatic, or have dyspnes, fatigue, angina, syncope, and arrhythmias. PMI Moved down and lateral |
| Restrictive CMP | Least Common- damaged tissue that won't stretch- so requires high diastolic pressures |
| Hypertrophic CMP Tx | Trim off extra heart muscle or alcohol ablation |
| Alcohol Ablation | Destorys some of tissue to allow more room in ventricle |
| Manifestations of Endocarditis | Fever and Chills, Tachycardia, SOB, Clot Symptoms, Joint Pain, Osler's Nodes, Janeway Lesions, Roth's Spots, New Murmurs, CHF, Splinter Hemorrhages |
| Osler's Nodes | split pea-tender-transient on toes, fingers, palms, and soles |
| Janeway's Lesions | Nontender and hemorrhagic on soles and palms |
| Roth's Spots | Retinal Hemorrhages- rare and longitudinal |
| Treatment of Infective Endocarditis | Antibiotics, Antipyretics, rest, Repeat blood cultures, surgical repain |
| High Risk Patients of Infective Endocarditis | artificial valves or history of endocarditis |
| Moderate Risk Patients of Infective Endocarditis | Mitral Valve Prolapse |
| Acute Pericarditis | Fluid between layers increases pressure and restricts heart (may cause cardiac tamponade) |
| Causes of Pericarditis | Infection, Heart Attack, Cancer spreading, Radiation Treatment, Injury or Surgery, Drugs, Rheumatoid Arthiritis |
| Addresslers Syndrome | Pericarditis resulting from a heart attack a month after the heart attack |
| Clinical Manifestation of Pericarditis | Sharp Pain (worsens on deep breath), Friction Rub, Fever, Pain when swallowing |
| Complications of Pericarditis | Pericardial Effusion and Cardiac Tamponade |
| Beck's Triad | Seen in Cardiac Tamponade: JVD, Tachycardia, and Muffled Heart Sounds |
| Pulses Parodoxis | Decrease in systolic on inspiration > 10 mmHg (cardiac tamponade) |
| S/S pericardial Effusion | SOB, cough, Increased Respirations, S1 S2 muffled |
| Pain relief of pericarditis | Eased by sitting and leaning forward |
| Ischemia ECG change | localized ST elevation |
| Pericarditis ECG change | widespread changes in ST segement, T wave, and QR interval |
| Constrictive Pericarditis | Scarring of pericardial sac Similar to CHF symptoms |
| Pericardial Knock | Sign of Constrictive Pericarditis, auscultated on LSB |
| ECG Changes in Contrictive Pericarditis | Flattening of complexes |
| Myocarditis | Inflammation of heart muscle- no treatment- support heart |
| Casues of Myocarditis | Viral |
| Clinical Manifestation of Myocarditis | Fever, Fatigue, Sore Throat, Dyspnea, N&V, JVD, Extra Heart Sounds, CHF |
| Diagnoses of Myocarditis | ECK nonspecific, WBC may be increased, Endomyocardial Biopsy |
| Rheumatic Fever | Imflammation of all three heart layers- scars valves. usually begins as sore throat |
| Pancardits | In rheumatic fever- all layers of heart and the valves vegetate |
| Aschoff's Bodies | Lesions on myocardium of swollen collagen seen in Rheumatic Fever (can be in Lungs, Joints, and Brain) |
| Major Criteria for Rheumatic Fever | Carditis, Chorea, Nodules at joints, Rach of Chest, back, and ABD |
| Minor Criteria for Rheumatic Fever | Fever,HX of Rheumatic Heart Disease, Lab Findings, Prolonged PR interval |
| Erythrocyte Sedimentation Rate in Rheumatic HD | Increases with inflammation |
| C-Reactive Protein during Rheumatic HD | increases during systemic infection |
| Major Complication of Rheumatic Fever | Chronic Rheumatic Carditis (cordae tendinae damaged)and valve structure changed (mostly mitral) |
| Mitral Valve Stenosis Causes | Rheumatic Heart Disease, Rheumatoid Arthiritis, Lupus, and Genetic |
| Mitral Valve Stenosis | Left Atrial Pressure is higher than Left Ventricle= lungs compression |
| Clinical Manifestations of Mitral Valve Stenosis | Dyspnea, Palpitations, Hoarsness(caused by A Fib), Emboli, S1 Snap |
| Most frequent cause of Mitral Valve Regurgitation | MI (enlarged left ventricle and atrium) |
| Acute Mitral Valve Regurgitation | Pulmonary edema, shock (decreased BP) |
| Chronic Mitral Valve Regurgitation | Ventricular Failure- weakness and fatigue, SOB< peripheral edema, S3, murmur in apex |
| Mitral Valve Prolapse | Murmur, Clicks, PVCs and Tachycardias, Chest pain not responsive to nitrates, SOB, palpitations, syncope, Risk for infective endocarditis- May have Marffans. |
| Aortic Valve Stenosis Causes | Congenital Heart Disease, Rheumatic Heart Disease, and Degenerative Heart Disease |
| Symptoms of Aortic Valve Stenosis | Angina, Syncope,Abnormal Heart Sounds and heart Failure- NITROGLYCERIN CONTRAINDICATED |
| Causes of Aortic Valve Reguurgitation | Rheumatic Fever, Congenitive, or Syphillis |
| Backwords blood flow in Aortic Valve Regurgitation | Decreased Cardiac Output, dilated ventricle, and decreased contractibility |
| S/S of aortic valve regurgitation | Weakness, dyspneas, hypotension, water-hammer pulse, austin-flint murmur, soft s1; s3 and s4 present |
| Austin-Flint Murmur | Apex. Mitral Valve getting hit from aorta and atrium at same time |
| Tricuspid Regurgitation | Overload to right side of heart and results from Pulmonary HTN or right ventricular dysfunction |
| P wave | Represents SA node stimulation and atrial depolarization |
| Causes of abnormal P waves | Atrial Hypertrophy - Increased amplitude or width |
| PR Interval | Time impulse to tavel from Atria to AV node- Norm: 0.12-0.2 |
| Prolonge PR interval indications | diseased AV node, Ischemia, drug effects, or increased vagal tone |
| QRS Complex | Ventricular depoloarization- Norm: 0.06-0.10 |
| QRS > 0.12 | intraventricular conduction delay- may be caused by bundle branch block, WPW syndrome, and hyperkalemia |
| ST Segment | On isoelectric line- represents initial phase of ventricular repolarization |
| Prolonged ST Segement cause | Hypocalcemia |
| Elevated ST Segment | Pericarditis, MI, or left ventricular aneurysm |
| Depressed ST Segment | Subendocardial ischemia, electrolyte disturbance, drug effect |
| T Wave | Ventricular Repolarization Completed |
| Inverted T Wave | Infarctions, Ischemia, Injury, Hypertrophy |
| Tall, Peaked T Wave | Hyperkalemia or acute injury |
| U wave | Not normally present, may be present in hypokalemia |
| QT interval | complete duratiion of ventricular depolarization and repolarization Norm: 0.20-0.40 |
| Prolonged Qts | antiarrhythmic drugs (amiotarone, allegra, and claritis |
| Complication of prolonged QT | polymorphic V Tach (torsades de pointes) |
| Causes of Shortened QT | digitalis and tachycardia |
| Sinus Tach Hemodynamic Consequence | Decreased SV= Decreased CO due to shortened diastole |
| Respiratory Reflex | R-R interavl shortens during inspiration due to increased venous return at this point |
| Treatment of sinus bradycardia | Underlying cause treated- ACLS-atropine |
| Treatment of Sinus Tachycardia | Underlying cause treated, beta blockers |
| Causes of SA block, pauses, and arrest | Increased vagal stimulation (suctioning), MI, Myocarditis, drug effects (digitalis) |
| Causes of PACs | Stimulants, hypoxia, digitalis, enlarged atria |
| Treatment of Atrial Tackycardia | Vagal/Valsalvar manuever, carotid massage, adenosine IV, cardizem bolus, synchronoized cardioversion |
| SVT | Supraventricular Tachycardias |
| Wide QRS | Ventricular |
| Narrow QRS | Atrial Tachycardia |
| Paroxysmal Tach | Sudden onset or cessation |
| Atrial Fib | Chaotic with NO p waves |
| A FIB- if ventricular rate become regular | Suspect digitaliz toxicity |
| Junctional Escape Rhythm | AV node pacing at 40-60 bpm |
| Treatment of Junctional Escape Rhythm | usually none- atropine, TCP, d/c caustive drug |
| Premature Ventricular Contractions | Wide QRS (maybe double R's) Bigeminy, trigeminy, couplet, |
| V TACH | Three or more PVCs in a row |
| Causes of PVC | ischemia, hypoxia, acidosis, electrolyte imbalance |
| Treatment of PVC | not usually treated- correct electrolytes, optimize O2, d/c causative drug, administer amiodarone or lidocaine |
| Treatment of V-Tach | VT with pulse- antidysrhythmias Pulseless VT- immediate debibrillation |
| Shock during VTACH | Never On T wave. only on QRS |
| Polymorphic V Tach | Torsades de pointes- irregular and wide QRS (hurricane effect) |
| Rate of Torsades de pointes | 150-250 bpm |
| Causes of Torsades de pointes | hypo- mag and hypo-kalemia, antiarrhythmic drug therapy |
| Treatments of Torsades de pointes | MgSO4 |
| VFIB | NO pulse, No BP |
| VFIB Treatment | Immediate Debrillation followed with antiarrhythmics |
| Ventricular Asystole | No ventricular Activity- may still see P wave |
| V-Asystole Treatment | Epinephrine- No point in defibrilation- usually fatal |
| Hypokalemia ECG | flattened and inverted T wave, U Wave, and ST depression |
| Hyperkalemia ECG | Tall T waves, Widened QRS, Prolonged PR, Flat P waves |
| PVC causes | Hypokalemia and Hypoxemia |
| Cough CPR | Unstable clint in V Tach |
| Vagal Maneuvers | Used for Supraventricular Tachydysrhythmias |
| Cardioversion | Lower version of defib used for tachycardias- synchronized with R wave |
| Defibrillation | Used for pulseless V Tach and VFIB |
| Stable Angina | Exertional |
| Unstable Angina | Preinfaction angine- pain not relieved with nitroglycerin |
| Variant Angina | Prinzmetal's or Vasospastic Angina- May occur at rest |
| Intractable angina | Chronic, incapactitation, and unresponsive to interventions |
| Myocarditis Causes | Pericaditis, systemic infection, allergic response |
| Complications of Myocarditis | Thrombus, heart failure, and cardiomyopathy |
| Endocarditis Risk Factors | IV drug users, valve replacements, mitral valve prolapse |
| Harch Systolic Crescendo-decrescendo Murmyr | Aortic Stenosis |
| Blowing decrescendo diastolic murmur | Aortic Insufficiency |
| Tricuspic Stenosis S/S | Fluttering Sensation at neck due to obstructed venous flow, Cyanosis, Rumbling diastolic murmur |
| Fusiform aneurysms | diffuse dilation that involves the entire circumference of the arterial segment |
| Saccular aneurysms | localized outpouching of artery wall |
| Dissecting Aneurysms | blood seperates the layers of the artery wall forming a cavity between them |
| Thoracis Aneurysm Pain | Neck shoulders lower back and ABD |
| ABD aneurysm | Pain in abd or lower back |
| S/S Rupturing Aneurysm | Severe ABD and back pain, lumbar fain radiating to flank and growin, Hypotension, increased pulse, signs of shock, hematoma at flank |
| Idioventricular Rhythm | AV NODE Response: Absent P wave Widened QRS > 0.12 sec. Also called " dying heart" rhythm Pacemaker will most likely be needed to re-establish a normal heart rate. |
| Virchow's Triad | Affect Venous Thrombosis Development: Endotherlial injury, Venous Stasis, Hypercoagulable blood |
| Valve Cusps | Common site of thrombus formation |
| DVT Treatment | Bedrest, Elevation of extremity, anticoagulants |
| Risk Factors for PAD | Smoking, Hyperlipidemia, Hypertension, Diabetes |
| Inlet Flow | Trunk More damage |
| Outlet Flow | Legs- less tissue damage |
| PAD: Stage I | No pain, begin having build ups; pulses present |
| PAD: Stage II | Intermittent Claudication |
| PAD: Stage III | Worsened IV, Rest Pain- hang feet off bed |
| PAD: Stage IV | Necrotic Tisses |
| Common Sites for PAD | Illiac, Femoral, Renal |
| Most common site for diabets for PAD | arteries below knees |
| Complications of PAD | Atrophy, non-healing ischemic ulcers, amputations |
| Diagnostics for PAD | Ankle Brachial Index (perferred 1 +) |
| Antherotomy | Similar to heart cath- but shaves plaques and vacuums |
| Endarterectomy | Blockage and vessel is cut open and plaques removed then sewn back up- USUALLY IN CAROTID |
| Signs and Symptoms of Aneurysm Rupture | Severe back pain, shock signs, blue toe syndrome, and grey turner's sign |
| Blud Toe Syndrom | Shower of clots moves to extremities |
| Grey Turner's | ABD bleed- skin appears grey |
| NU interventions for endovascular graft | keep still to avoid leaking, BP in narrow range |
| Complications of Dissection Aneurysm | Cardiac Tamponade |
| Goal of Aneurysm Care (priority) | Decrease BP and cardiac contractility |
| First Line Meds for Aneurysm | Vasodilators and Beta Blockers |
Created by:
mcheflin