FP-C_CARDIAC

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Author:
tamarkp
ID:
275849
Filename:
FP-C_CARDIAC
Updated:
2014-06-01 19:46:12
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FPC FP CARDIAC
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FP-C Cardiac Test Preperation
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  1. What is the cardiac response to ↓ Contractility?
    ↑ HR
  2. What is the cardiac response to hypoxia?
    Pulmonary arteries constrict (pulmonary hypertension)
  3. What is the cardiac response to ↓ systemic perfusion?
    • Blood vessels constrict
    • Except in neurogenic, spinal, septic, & anaphylactic shock!
  4. With systemic ↑ in vasoconstriction what will happen to cardiac output?
  5. What is normal CO (Cardiac Output) and what is the equation to find this?
    • Normal CO is 4-8 L/min
    • CO=HR X SV
    • Lung minute volume (Ve) is also 4-8 L/m
  6. What effects SV (Stroke Volume)?
    • Preload
    • Contractility
    • Afterload
  7. What is Preload?
    • The load that stretches cardiac tissue BEFORE contraction
    • Amount of blood returned to the right heart from the body
    • Amount of blood returned to the left heart from the lungs.
  8. What is Contractility?
    The intrinsic ability of the heart/myocardium to contract
  9. What does Frank-Starling law state?
    • Stroke volume from the heart increases to an increase of the volume of blood filling the heart.
    • Bigger stretch... Bigger contraction.
  10. Define Afterload.
    The degree of vascular resistance to ventricular contraction
  11. What affects right heart afterload?
    Pulmonary Arteries (PVR)
  12. What affects left heart afterload?
    Systemic vascular resistance (SVR)
  13. What does Systemic Vascular Resistance measure?
    Afterload of the heart
  14. What is the normal Systemic Vascular Resistance (SVR) measurement?
    800 - 1200 dynes
  15. What conditions are associated with ↑ SVR?
    • Hypothermia
    • Hypovolemic shock
    • Decreased CO
  16. What conditions are associated with ↓ SVR?
    • Anaphylaxis
    • Neurogenic (distributive) Shock
    • Septic Shock
    • Vasodilating drugs
  17. What are your S1 & S2 heart sounds?
    • S1: Lub
    • S2: Dub
    • This is normal heart sounds
  18. What is associated with S3 heart sounds? What is a common cause of this?
    • S1: Ken
    • S2: Tuck
    • S3: Y
    • Congestive Heart Failure
  19. What do we associate with S4 heart sounds? What is a common cause?
    • S4: Tenn
    • S2: E
    • S2: See
    • Myocardial Infarction
  20. What does the Right Coronary Artery (RCA) supply?
    • Right Ventricle
    • 60% of populations SA Node
  21. What tripe of MI is associated with the RCA?
    Inferior MI
  22. Why is bradycardia associated with an Inferior MI?
    Due to SA node involvement
  23. Why is a complete blockage of the LCA called the "widow maker"?
    Because it would occlude both the LAD and LCX.
  24. Define a STEMI.
    ST elevation in 2 contiguous leads > 2mm
  25. What is often associated with a new onset LBBB?
    STEMI
  26. Will a STEMI have (+) cardiac markers/enzymes?
    Yes
  27. Will a Non-STEMI have (+) cardiac markers/enzymes?
    Yes
  28. Define a Non-STEMI.
    ST depression or dynamic T wave changes in 2 contiguous leads
  29. What causes ST wave depression?
    lack of O2 (either now or an old infarct)
  30. What are dynamic T waves?
    T wave inversion
  31. Define Unstable Angina.
    Angina NOT relieved by rest, nitro, or has different qualities than pt "normal" chest pain.
  32. What leads would show Inferior MI?
    • II
    • III
    • aVF
  33. What leads would show Anteroseptal MI?
  34. What leads would show Lateral MI?
    • I
    • aVL
  35. Define PAILS
    • Posterior
    • Anterior
    • Inferior
    • Lateral
    • Septal
  36. What EKG leads are associated with the posterior location?
    • Reciprocal changes in: 
  37. What EKG leads are associated with the anterior location?
  38. What EKG leads are associated with the Inferior location?
    • II
    • III
    • aVF
  39. What EKG leads are associated with the lateral location?
    I, aVL, 
  40. What EKG leads are associated with the septal location?
  41. What vessel is affected in a posterior MI?
    Left Circumflex (LCX)
  42. What vessel is affected in a anterior MI?
    Left Anterior Descending (LAD)
  43. What vessel is affected in a inferior MI?
    Right Coronary Artery RCA
  44. What vessel is affected in a lateral MI?
    Left Circumflex (LCX)
  45. What vessel is affected in a septal MI?
    Left Anterior Descending (LAD)
  46. What is the treatment for a posterior MI?
    MONA
  47. What is the treatment for an anterior MI?
    MONA
  48. What is the treatment for an inferior MI?
    • 2L Fluid Challenge
    • NO Nitro! NO Beta Blockers!
  49. What is the treatment for a lateral MI?
    MONA
  50. What is the treatment for a septal MI?
    MONA
  51. Which lead do we look for Bundle Branch Blocks?
  52. What will a RBBB look like in  ?
    • UP
    • QRS > 0.12
    • Rabbit Ears
  53. What will a LBBB look like in  ?
    • DOWN
    • QRS > 0.12
    • Rabbit Ears
  54. What is associated with a new onset LBBB?
    AMI
  55. What do I want to check with LBBB?
    Cardiac markers/enzymes
  56. What do Beta Blockers do in treating an MI?
    • Reduce HR 
    • Reduces myocardial O2 Demand
    • Do not use for bi-fasicular blocks or BBBs
  57. What is Adenosine used for in ACLS? What is the dose?
    • Narrow complex SVT
    • Dose: 6mg/12mg
  58. What is Amiodarone used for in ACLS? What is the dose?
    • V/F & Pulseless V-Tach
    • 300mg (1st dose)/150mg (2nd dose)
  59. What is Dopamine used for in ACLS? What is the dose?
    • Second line for bradycardia & hypotension
    • 2-20mcg/kg/min
  60. What is Vasopressin used for in ACLS? What is the dose?
    • Alternate pressor to Epi/Septic Shock
    • 40 Units (only 1 dose)
  61. Name 3 Sodium Channel Blockers. What do they do?
    • Lidocaine, Phenytoin, Procainamide
    • Interferes with Sodium (Na+) Channels
  62. Name 6 Beta Blockers.
    • Carvedilol
    • Labetolol
    • Propanolol
    • Timolol
    • Esmolol
    • Metoprolol
  63. What two cardiac issues would you not use a Beta Blocker?
    • Heart Block
    • Inferior MI
  64. What electrolyte does Amiodarone affect?
    Potassium (K+) efflux
  65. What drug is used for patients in profound hypotension?
    Levophed (NorEpi)
  66. What does Nitroprusside do? What can it cause?
    • Reduces preload and after load by dilation
    • Can cause cyanide toxicity
  67. What affects do Levophed have on the vascular?
    • Increase SVR
    • Vasoconstricts
    • increases preload
  68. What affect does Nitroprusside (Nipride) have on the vasculature?
    • Decreases SVR
    • Vasodilator
  69. What drugs decrease preload (vasodilator)
    • Morphine
    • Lasix
    • Nitro
  70. What is the main absolute contraindication to Fibronolytics?
    Non-compressible hemorrhage
  71. What is PTCA?
    • Percutaneous
    • Trans
    • Luminal
    • Coronary
    • Angioplasty
  72. What is a GP2B3A inhibitor?
    • Prevents platelet activity.
    • Can be titrated
    • Half-life of 8 hours
  73. What are 3 examples of GP2B3A inhibitors?
    • Reopro
    • Integrilin
    • Aggrastat
  74. What do we do after cardiac catheter is removed?
    Keep leg straight and hold pressure for 30 minutes.
  75. What is a CABG?
    • Cardiac 
    • Artery
    • Bypass
    • Graft
  76. What is variant angina?
    • Chest pain at rest, has circadian rhythm (mostly in the morning)
    • Most often seen in women
    • Treated with Nitro and CCBs
  77. What is Silent angina?
    • No pain
    • Evidence of ischemia on EKG (ST depression)
  78. What should be done if a heart transplant patient is decompensating?
    • Immediate cardioversion
    • Normal Saline & Dopamine with bradycardia
    • NO Atropine (it won't work)
  79. What is Endocarditis?
    Inflammation on the inside of the heart
  80. What is the #1 cause of Endocarditis?
    IV drug use
  81. What are signs of Endocarditis?
    • New Murmur
    • Osler Nodes (painful red fingertips)
    • Janeway Lesions (Red lesions on palm and soles)
  82. What is pericarditis?
    • Inflammation on the outside of the heart
    • Substernal chest pain when breathing or laying supine (pericardium rubs against the sternum)
  83. What is the most common cause of pericarditis?
    Idiopathic (80%)
  84. When do you see Uremic Pericarditis?
    Pt who is undergoing dialysis due to renal failure
  85. What is Dressler's Syndrome?
    Pericarditis occurring post MI/ post cardiac surgery
  86. What EKG finding is true of  Pericarditis? What do we use to treat it?
    • Global ST Elevation
    • NSAIDS (IndocinColchicine)
  87. How do CHF pts present?
    • progressive dyspnea
    • coughing up pink frothy sputum
  88. What is the most common cause of right heart failure?
    Left heart failure
  89. What would you see on a CHF pts X-ray?
    Butterfly pattern/ Kerley B Lines, Bilateral Diffuse Infiltrates
  90. What will you see on a CHF pt blood work?
    • BNP (B-type Natriuretic Peptide) increase
    • BNP = CHF
  91. What is the most important drug therapy for the CHF pt?
    Lasix
  92. What is the tell tale description of an Aortic Dissection?
    • Ripping or Tearing between shoulder blades
    • Could also present in stomach or chest
  93. Where is the most common site for an aortic dissection?
    Ascending Aorta
  94. What would a pt X-ray show in an Aortic Dissection?
    • Widened mediastinum
    • Loss of aortic knob
    • pleural effusion
  95. What is the drug treatment for Aortic Dissection?
    • 1st with Beta Blockers (Labetalol)
    • 2nd with Vasodilators (Nitroprusside)
    • Pain Meds (Morphine, Fentanyl, Ketamine)
    • Restrict fluids unless hypotensive
  96. What does a Swan-Ganz catheter used to measure?
    How much pressure blood is under when it enters the Pulmonary artery.
  97. What part of the Swan-Ganz catheter is used to measure pressures?
    Distal tip
  98. How much air is in the distal cuff of the Swan-Ganz catheter?
    1.5cc of air
  99. How long can we take wedge pressure readings?
    No longer than 15 seconds or 3 breaths
  100. When do we take our PAWP readings?
    At the end of respirations
  101. When transporting a pt with a PA cath what should we do with the distal cuff?
    Prevents inadvertent wedge pressure
  102. What is the difference between PAWP, PAOP, & PACP?
    Nothing. They are the same thing.
  103. What is CVP (Central Venous Pressure)? What is the normal value?
    • Right atrial pressure
    • 2-6 mmHg
  104. What is RV (Right Ventricular)? What is the normal value?

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