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CCRN Barrons cardio

CCRN - Barrons cardiovascular

What heart sound is associated with heart failure (may occur before crackles? S3
S3 can be caused by what what? Pulmonary hypertension and cor pulmonale Mitral, aortic, or tricuspid insufficiency
Coronary arteries are perfused during what? diastole
What is variant or Prinzmetal's angina? A type of unstable angina associated with transient ST segment elevation
What is Variant or Prinzmetal's angina due to? coronary artery spasm with or without atherosclerotic lesions
When does variant or Prinzmetal's angina occur? At rest, may be cyclic (same time each day)
What may variant or Prinzmetal's angina be precipitated by? Nicontine, ETOH, cocaine ingestion
What does variant or Prinzmetal's angina troponin levels show? troponin negative
What is treatment for variant or Prinzmetal's angina? Nitroglycerin administration (results in relief of chest pain, STs return to normal)
ECG lead changes in II, III, aVF. Location of CAD? Right coronary artery (RCA), inferior LV
ECG lead changes in V1, V2, V3, V4. Location of CAD? Left anterior descending (LAD), anterior LV
ECG lead changes in V5, V6, I, aVL. Location of CAD? Circumflex, lateral LV
ECG lead changes in V5, V6. Location of CAD? Low lateral LV
ECG lead changes in I, aVL. Location of CAD? High lateral LV
ECG lead changes in V1, V2. Location of CAD? RCA, posterior LV
ECG lead changes in V3R, V4R. Location of CAD? RCA, right ventricular (RV) infarct
Reperfusion. chest pain relief due to: Fibrinolysis of clot
Reperfusion. Resolution of ST segment deviations due to: Return of blood flow
Reperfusion. Marked elevation of troponin/CK-MB due to: Myocardial 'stunning' when vessel opens
Reperfusion arrhythmias: VT, VF, accelerated idioventrical rhythm
Reperfusion arrhythmias due to: myocardial 'stunning' when vessel opens
Mitral insufficiency occurs when what valve is ___. open
When is the mitral valve closed? systole
Mitral stenosis occurs when what valve is ___. closed
Aortic insufficiency occurs when the valve is ___. closed
When is the aortic valve closed? Diastole
Aortic stenosis occurs when the valve is ___. open
When is the aortic valve open? systole
Papillary muscle dysfunction (grade I or II) is loudest at ___. apex
Papillary muscle rupture (grade V or VI) is loudest at ___. apex
Ventricular septal defect can be heard where? Sternal border, 5th ICS
A murmur due to VSD (ventricular septal defect) occurs during when? systole
What do Beta blockers actually BLOCK? The sympathetic stimulation of the heart
What do beta blockers reduce? myocardial oxygen demand
What 4 specific things do beta blockers reduce? systolic pressure, heart rate, heart contractility & output
Inferior MI is associated with occlusion of what? RCA
Inferior MI will see ST elevation in what leads? II, III, aVF
Inferior MI: what leads will reflect reciprocal changes in lateral wall? I, aVL
Inferior MI: associated with what AV conduction disturbances? 2nd degree type I, 3rd degree heart block, sick sinus syndrome & sins bradycardia
What rhythm has higher mortality with inferior MI? tachycardia
Inferior MI is also associated with what infarct? RV infarct
What meds should you use with CAUTION with an Inferior MI? beta blockers and nitroglycerine
The RCA also supplies the what wall of the left ventricle & the what ventricle? inferior wall & right ventrical
30% of inferior MI patients also have a ___ infarct. Right ventricular
A what sided ECG will demonstration the ST changes of a right ventricular infarct right
ECG showing an ST elevation in V4R shows an infarct where? right ventricular
S/S of right ventricular infarct: JVD at 45', high CVP, hypotension, usually clear lungs, bradycardia
Treatment of right ventricular infarct: fluids, positive inotropes
Positive Inotropes do what? increase the strength of muscular contraction
Negative inotropes do what? decrease the strength of muscular contraction
Why caution with beta blockers in a right ventricular infarct? often can not give due to hypotension
What meds should you avoid giving with a right ventricular infarct? preload reducers: nitrates & diuretics
Anterior MI associated with occlusion of ___. Left anterior descending
Anterior MI: ST elevation in what leads? V1-V4, precordial leads, V leads
Anterior MI. Will see reciprocal changes in what leads II, III, aVF (inferior wall)
Anterior MI. May develop what heart block. Second degree type II or RBBB (the LAD supplies the common bundle of HIS)
What block is an OMINOUS sign with anterior MI? Second degree type II or RBBB
Anterior MI. Development of what type of murmur? systolic murmur (possible ventricular septal defect)
Anterior MI has a higher mortality then inferior MI due to what? heart failure
What can occur acutely (within 24hrs of placement) or subacutely (within first 30 days) of stent placement? thrombosis
If chest pain, ST elevation occurs after PCI. Do what? call physician
Acute peripheral vascular insufficiency. Put bed in what position? Reverse Trendelenburg (feet down). Don't elevate - will decrease perfusion!
What can prolongation of QT lead to? torsades de pointes
What drugs can lead to prolonged QT? amiodarone, haloperidol, procainamide
What electrolyte problems can lead to prolonged QT hypokalemia, hypocalcemia, hypomagnesemia
What is the treatment for torsades de pointes? magnesium
In pacemaker code. First initial means what? chamber paced
In pacemaker code. Second initial means what? sensed
In pacemaker code. Third initial means what? response to sensing
Failure to pace means? no spike at all when expected
Failure to capture means? spikes without a QRS for V pacing
Failure to sense means? pacing in native beats
4 Medications given with acute peripheral vascular insufficiency? thrombolytics, anticoagulants, antiplatelets, vasodilators
Primary problem with systolic heart failure? ejection problem, dilated chamber.
Primary problem with diastolic heart failure filling problem, hypertrophied chamber or septum.
EF of systolic HF < or= 40%
EF of diastolic HF Normal EF
In systolic HF, BP is what? normal or low (usually)
In diastolic HF, BP is what? often high
In systolic HF, what heart murmur do you hear? S3
In diastolic HF, what heart murmur do you hear? S4 with hypertenion
In systolic HF, pulmonary edema is due to what? poor ventricular emptying
In diastolic HF, pulmonary edema is due to what? high ventricular pressure
In systolic HF, what is wrong with the ventricle? dilated left ventricle
In diastolic HF, what size is the ventricle? normal ventricle
In systolic HF, what 6 meds are given? beta blockers, ACEI/ARB, diuretics, dilators, aldosterone antagonists, positive ionotropes
In diastolic HF, what 5 meds are given? beta blockers, ACEI/ARB, calcium channel blockers, diuretics (low dose), aldosterone antagonists
What are aldosterone antagonists for? Aldosterone causes coronary inflammation, cardiac hypertrophy, myocardial fibrosis, ventricular arrhythmias and ischemia and necrotic lesions.
What are calcium channel blockers for Increase diameter of blood vessels, reduce for of contraction on the heart, slow heart rate (all reduce workload on the heart)
What meds are contraindicated in systolic HF? negative inotropes (calcium-channel blockers and, in acute phase, beta blockers)
What meds are contraindicated in diastolic HF? Positive inotropes
Systolic HF may be evidenced by ___ on a chest xray. large, dilated heart OR normal heart size
If a large, dilated heart is seen on a HF patient, it is often associated with what? a shift of the point of maximal impulse (PMI) from midclavicular to the LEFT
IABP. When balloon inflates it does what? Increases coronary artery perfusion
IABP. When balloon deflates it does what? decreases afterload
When does the IABP balloon inflate? beginning of diastole (at dicrotic notch of the arterial waveform)
When does the IABP balloon deflate? right before diastole begins (determined by set TRIGGER for deflation, R-wave of ECG or upstroke of the arterial pressure wave)
What is cardiac tamponade? pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle and the outer covering sac of the heart
What is pericarditis? Inflammation of the pericardium (sac that surrounds the heart)
What happens to the BP during cardiac tamponade? narrowed pulse pressure (ie 82/68)
What is pulsus paradoxus? excessive drop in SBP during inspiration
When can pulsus paradoxus happen: during cardiac tamponade
S/S of pericarditis: chest pain - worse with inspiration, dyspnea, low-grade temp, ST elevation in ALL leads, cardiac tamponade, Post-MI, Dressler's symptom (may last months)
Treatment of pericarditis: symptom relief, analgesics, anti-inflammatory agents, NSAIDS, steroids, antibiotics
What is Dressler's syndrome? Believed to be an immune system response after damage to heart tissue or to the pericardium, from events such as a heart attack, surgery or traumatic injury
Created by: leidsmoe