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Published by mara5140

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Published by: mara5140 on Dec 22, 2008
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Test 2 Outline 1

Cardiac Enzymes Troponin• Highly specific • 1st to increase with specificity Myoglobin• Increase 1-2hr after MI • First to increase buts lack specificity CK-MB• >5% of total CK = highly indicative of MI • Increase 3-12 hr after MI Serum Lipids: • Cholesterol o Norm 120-200 • Triglycerides o Norm 40-190 • Lipoproteins o LDL = <130 o HDL = 37-70 (men)  40-88 (women) CAD General category of atherosclerosis Slow occurring = collateral circulation Drug Therapy- administer separate times from other meds to decrease adverse effects • Resins o Questran o Colestid o Welchol o Colybar • Statin’s • Fibric Acid derivatives o Atromid o Tricor (don’t take with Statin’s) o Lopid • Niacin with diet therapy • Zetia Nutritional Therapy • Step 1 diet o Decrease saturated fats o Decrease cholesterol o Decrease ETOH o Decrease simple sugars • Step 2 diet o Further restricts saturated fats and cholesterol

Test 2 Outline 2

o ACE inhibitors MI • Angina = easily relieved by Nitro, O2, rest o Stable Angina o Unstable Angina • Occurs @ rest or minimal exertion o Prinzmetal’s Angina • Primarily @ rest, triggered by smoking o Nocturnal Angina • @ night o Angina Decubitus • Occurs when lying down ACS (Acute Coronary Syndrome) = prolonged and not immediately reversible o STEMI o NSTEMI Normal heart can withstand lack of O2 for 20 mins = cellular death occurs TX when presents to ED o MONA o 2 IV’s KVO o Inotropic’s- Dig (caution b/c increase workload) o Beta blockers- dilates, blocks epi & norepi o Ca+ channel blockers- calms cells (Norvasc, Cardizem) Complications of MI: • Arrhythmias (Lethal) • CHF • Cardiogenic Shock • PE • Dressler’s (Pericarditis c effusion & fever 1-4 wks p MI) • Pericarditis Heparin= antidote Promatine Sulfate Coumadin = Vit. K Ptt= 1 ½ - 2 ½ the control

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Test 2 Outline 3

Tx: lidocaine Premature Atrial Contractions (PAC) • • • • a normal QRS complex a normal T wave repolarization (not inverted to the other T waves) an odd, misshapen P wave depolarization P-wave hidden in t-wave Ventricular Tachycardia

100-200 bpm >200 = SVT= narrow QRS • vagal down • adenocard (squeeze IV bag when pushing) causes asystole Agnol

Premature Ventricular Contraction (PVC)

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QRS T wide Aystole quickly follows

Test 2 Outline 4

Pulseless Electrical Activity (PEA) Looks like NSR but NO PULSE TX: CPR Sinus Bradycardia

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Normal in athletes and during sleep TX: atropine for pt’s with sx’s (increase HR) Pacemaker therapy may be used Sinus Tachycardia

Valvular Disorders Murmur • Vibratory sounds Mitral Stenosis • Dyspnea, Hemoptysis Mitral Regurgitation • Backflow from LV  LA • Pulmonary edema Mitral Valve Prolapse • Murmur increasing thru systole • Recommend prophylactic antibiotic for dental or surgical procedures Aortic Stenosis • Leads to LV hypertrophy • Angina, syncope, heart failure • TX: decrease Na+, fats, and increase protein. TX for all valvular disorders • Diuretics • Dig • Antibiotics • Decrease Na+ • Anticoagulants • Antidysrhythmics • Nitrates

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TX: underlying cause Beta blockers (decrease HR)

Test 2 Outline 5

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Beta blockers Surgical procedures for valve opening and replacement Edocarditis Bacterial growth around valves IV drug users, rheumatic fever, valve disorders Manifestations: • Petechiae • Olsers nodes (painful red-purple on fingers/toes) • Janeway’s lesions (flat painless on palms/soles) DX: • Recent dental procedure • Infection TX: • Heparin • Antibiotics (VANCO , peak and troph) • Lung sounds • Pulses • WBC – inflammation • Blood cultures • Sed rate – inflammation • Echocardiograph • Aseptic technique • Rest and frequent position changes • Decrease fever- antipyretics • TED hose

Pacemakers Can pace atria or ventricles (both= dual chambered) 2 types: 1. Fixed Rate a. Set for amount 2. Demand Rate a. Fires only when needed ICD: detects LETHAL DSYRRHYTHMIAS & FIRES

Test 2 Outline 6

Acute Pericarditis Manifestations: • Chest pain • Dyspnea • Pericardial friction rub • Pain aggravated by lying supine, DB &C, swallowing DX: • ECG, CXR, labs (BUN, Creatinine, TB test) TX: • Antibiotics if needed • Anti-inflammatory (NSAID’s) • Pericardiocentesis Chronic Constrictive Pericarditis From scarring with loss of elasticity Manifestations: • Mimic CHF & Cor Pulmonale DX: • ECG, CXR, cardiac cath, CT, MRI TX: • Pericardiectomy • Increase protein • Decrease Vit. K (green leafy veggies) b/c hep/coumadin

Test 2 Outline 7

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Cardiomyopathy (CMP) Dilated Cardiomyopathy • Most common • Cardiomegaly with ventricular dilation • s/sx’x of CHF • TX: o Control CHF o Mostly palliative o Dig for A-fib o Diuretics o ACE inhibitors o Beta blockers o Terminal- transplants Hypertrophic Cardiomyopathy (HCM) • Hypertrophic with ventricular dilation • Forceful contraction, impaired relaxation • TX: o Beta blockers o Ca+ Channel blockers o Antiarrhythmics o AICD (internal Defib) o Ablation o Ventriculomyotomy & myectomy Restrictive Cardiomyopathy

Impairs diastolic filling and stretch TX: o No specific tx o Therapy for CHF & arrhythmias o Heart transplant

Cardiac Transplantation: 4-6 hrs Immunosuppressive therapy begun in surgery Artificial Heart: External battery pack allows 6-8hrs of power Can be charged during sleep Requires no immunosuppresion

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