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What is the cardiac response to ↓ Contractility?
What is the cardiac response to hypoxia?
Pulmonary arteries constrict (pulmonary hypertension)
What is the cardiac response to ↓ systemic perfusion?
- Blood vessels constrict
- Except in neurogenic, spinal, septic, & anaphylactic shock!
With systemic ↑ in vasoconstriction what will happen to cardiac output?
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
What effects SV (Stroke Volume)?
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.
What is Contractility?
The intrinsic ability of the heart/myocardium to contract
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.
The degree of vascular resistance to ventricular contraction
What affects right heart afterload?
Pulmonary Arteries (PVR)
What affects left heart afterload?
Systemic vascular resistance (SVR)
What does Systemic Vascular Resistance measure?
Afterload of the heart
What is the normal Systemic Vascular Resistance (SVR) measurement?
800 - 1200 dynes
What conditions are associated with ↑ SVR?
- Hypovolemic shock
- Decreased CO
What conditions are associated with ↓ SVR?
- Neurogenic (distributive) Shock
- Septic Shock
- Vasodilating drugs
What are your S1 & S2 heart sounds?
- S1: Lub
- S2: Dub
- This is normal heart sounds
What is associated with S3 heart sounds? What is a common cause of this?
- S1: Ken
- S2: Tuck
- S3: Y
- Congestive Heart Failure
What do we associate with S4 heart sounds? What is a common cause?
- S4: Tenn
- S2: E
- S2: See
- Myocardial Infarction
What does the Right Coronary Artery (RCA) supply?
- Right Ventricle
- 60% of populations SA Node
What tripe of MI is associated with the RCA?
Why is bradycardia associated with an Inferior MI?
Due to SA node involvement
Why is a complete blockage of the LCA called the "widow maker"?
Because it would occlude both the LAD and LCX.
Define a STEMI.
ST elevation in 2 contiguous leads > 2mm
What is often associated with a new onset LBBB?
Will a STEMI have (+) cardiac markers/enzymes?
Will a Non-STEMI have (+) cardiac markers/enzymes?
Define a Non-STEMI.
ST depression or dynamic T wave changes in 2 contiguous leads
What causes ST wave depression?
lack of O2 (either now or an old infarct)
What are dynamic T waves?
T wave inversion
Define Unstable Angina.
Angina NOT relieved by rest, nitro, or has different qualities than pt "normal" chest pain.
What leads would show Inferior MI?
What leads would show Anteroseptal MI?
What leads would show Lateral MI?
What EKG leads are associated with the posterior location?
- Reciprocal changes in:
What EKG leads are associated with the anterior location?
What EKG leads are associated with the Inferior location?
What EKG leads are associated with the lateral location?
What EKG leads are associated with the septal location?
What vessel is affected in a posterior MI?
Left Circumflex (LCX)
What vessel is affected in a anterior MI?
Left Anterior Descending (LAD)
What vessel is affected in a inferior MI?
Right Coronary Artery RCA
What vessel is affected in a lateral MI?
Left Circumflex (LCX)
What vessel is affected in a septal MI?
Left Anterior Descending (LAD)
What is the treatment for a posterior MI?
What is the treatment for an anterior MI?
What is the treatment for an inferior MI?
- 2L Fluid Challenge
- NO Nitro! NO Beta Blockers!
What is the treatment for a lateral MI?
What is the treatment for a septal MI?
Which lead do we look for Bundle Branch Blocks?
What will a RBBB look like in
What will a LBBB look like in ?
- QRS > 0.12
- Rabbit Ears
What is associated with a new onset LBBB?
What do I want to check with LBBB?
What do Beta Blockers do in treating an MI?
- Reduce HR
- Reduces myocardial O2 Demand
- Do not use for bi-fasicular blocks or BBBs
What is Adenosine used for in ACLS? What is the dose?
- Narrow complex SVT
- Dose: 6mg/12mg
What is Amiodarone used for in ACLS? What is the dose?
- V/F & Pulseless V-Tach
- 300mg (1st dose)/150mg (2nd dose)
What is Dopamine used for in ACLS? What is the dose?
- Second line for bradycardia & hypotension
What is Vasopressin used for in ACLS? What is the dose?
- Alternate pressor to Epi/Septic Shock
- 40 Units (only 1 dose)
Name 3 Sodium Channel Blockers. What do they do?
- Lidocaine, Phenytoin, Procainamide
- Interferes with Sodium (Na+) Channels
Name 6 Beta Blockers.
What two cardiac issues would you not use a Beta Blocker?
What electrolyte does Amiodarone affect?
Potassium (K+) efflux
What drug is used for patients in profound hypotension?
What does Nitroprusside do? What can it cause?
- Reduces preload and after load by dilation
- Can cause cyanide toxicity
What affects do Levophed have on the vascular?
- Increase SVR
- increases preload
What affect does Nitroprusside (Nipride) have on the vasculature?
What drugs decrease preload (vasodilator)
What is the main absolute contraindication to Fibronolytics?
What is PTCA?
What is a GP2B3A inhibitor?
- Prevents platelet activity.
- Can be titrated
- Half-life of 8 hours
What are 3 examples of GP2B3A inhibitors?
What do we do after cardiac catheter is removed?
Keep leg straight and hold pressure for 30 minutes.
What is a CABG?
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
What is Silent angina?
- No pain
- Evidence of ischemia on EKG (ST depression)
What should be done if a heart transplant patient is decompensating?
- Immediate cardioversion
- Normal Saline & Dopamine with bradycardia
- NO Atropine (it won't work)
What is Endocarditis?
Inflammation on the inside of the heart
What is the #1 cause of Endocarditis?
IV drug use
What are signs of Endocarditis?
- New Murmur
- Osler Nodes (painful red fingertips)
- Janeway Lesions (Red lesions on palm and soles)
What is pericarditis?
- Inflammation on the outside of the heart
- Substernal chest pain when breathing or laying supine (pericardium rubs against the sternum)
What is the most common cause of pericarditis?
When do you see Uremic Pericarditis?
Pt who is undergoing dialysis due to renal failure
What is Dressler's Syndrome?
Pericarditis occurring post MI/ post cardiac surgery
What EKG finding is true of Pericarditis? What do we use to treat it?
- Global ST Elevation
- NSAIDS (IndocinColchicine)
How do CHF pts present?
- progressive dyspnea
- coughing up pink frothy sputum
What is the most common cause of right heart failure?
Left heart failure
What would you see on a CHF pts X-ray?
Butterfly pattern/ Kerley B Lines, Bilateral Diffuse Infiltrates
What will you see on a CHF pt blood work?
- BNP (B-type Natriuretic Peptide) increase
- BNP = CHF
What is the most important drug therapy for the CHF pt?
What is the tell tale description of an Aortic Dissection?
- Ripping or Tearing between shoulder blades
- Could also present in stomach or chest
Where is the most common site for an aortic dissection?
What would a pt X-ray show in an Aortic Dissection?
- Widened mediastinum
- Loss of aortic knob
- pleural effusion
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
What does a Swan-Ganz catheter used to measure?
How much pressure blood is under when it enters the Pulmonary artery.
What part of the Swan-Ganz catheter is used to measure pressures?
How much air is in the distal cuff of the Swan-Ganz catheter?
1.5cc of air
How long can we take wedge pressure readings?
No longer than 15 seconds or 3 breaths
When do we take our PAWP readings?
At the end of respirations
When transporting a pt with a PA cath what should we do with the distal cuff?
Prevents inadvertent wedge pressure
What is the difference between PAWP, PAOP, & PACP?
Nothing. They are the same thing.
What is CVP (Central Venous Pressure)? What is the normal value?
- Right atrial pressure
- 2-6 mmHg
What is RV (Right Ventricular)? What is the normal value?