Med Surg 2 - Cardio

• Preload

  Measure of stretching/filling pressure in the heart at the end of diastole
• Afterload

  Pressure/resistance the heart has to pump against in order to eject blood
• Acute coronary syndrome results from

  prolonged ischemia
• Unstable angina

  1. Occurs with exertion or stress and rest
  2. > 30 mins
  3. NOT RELIEVED by NTG
• What are signs and symptoms of ACS?

  tachycardia, HoTN, dysrhythmia, dyspnea, fever
• Which testing is used to diagnose MI?

  troponin > 0.04, CK-MB, myoglobin
• What is the test used if they're unable to do the cardiac stress test?

  Lexiscan
• What is a Lexiscan?

  Vasodilates coronary arteries, induces cardiac hyperemia
• Antiplatelet: ASA

  Give chewable tab for MI
• Vasodilator: NTG

  Give for angina

  Ask if taking Sildenafil d/t vasodilation
• ACE inhibitor (lisinopril)

  Give for HF

  Dry cough, switch to ARB if long term

  Stop taking if angioedema appears
• Antilipemic (atorvastatin)

  Adverse effects include joint pain, arthralgia
• B-blocker (-LOL)

  Cause the heart to beat more slowly with less force so chambers can be filled
• What are selective B-blockers?

  metoprolol, atenolol
• What are nonselective B-blockers?

  propranolol, sotalol
• Which patients do you not give to nonselective B-blockers?

  Asthma & COPD
• Calcium channel blocker

  IV Diltiazem for dysrhythmias

  Not tolerating well = BIL lower ext edema
• What is pericarditis?

  Inflammation of the visceral or parietal pericardium
• What are signs & symptoms of pericarditis?

  • Pulsus paradoxus
  • Pleuritic CP
  • Dysphagia
  • Hiccups
• What are the diagnostic tests of pericarditis?

  WBC, ESR, CRP
• What is infective endocarditis?

  Infection of inner layer of heart + cardiac valves
• What are signs & symptoms of infective endocarditis?

  Fever, chills, fatigue, systolic murmur, splinter hemorrhages, Janeway lesions, Osler nodes, Roth spots, acute glomerulonephritis, emoboli
• What is cardiomyopathy?

  A disease of the heart muscle that affects the pumping mechanism of the heart → decreased CO, oxygen, blood supply to the body
• What is dilated cardiomyopathy?

  Left HF with weak and enlarged LT ventricle
• Dilated cardiomyopathy enhance myocardial contractility, decrease preload/afterload. Signs & Symptoms include:

  • ↓BP, ↑HR
  • ↓ O2 → syncope, agitation, SOB
  • ↑BNP
  • Give digoxin
• What is restrictive cardiomyopathy?

  The heart with stiffened muscle wall, trouble with diastole & refilling
• Restrictive cardiomyopathy to improve diastolic filling & prevent tachycardia. Signs & Symptoms include:

  • ↓ O2 → syncope, agitation, SOB
  • Swelling
  • Crackles
• What is hypertrophic cardiomyopathy?

  Hypertrophy or thickening of the left ventricular walls & septum
• Hypertrophic cardiomyopathy symptoms are asymptomatic that include:

  • Syncope
  • Fatigue
  • Dizziness
  • SOB
  • Death