Unit 1 Med Surg II

MI Labs

Troponin

C Reactive Protein

CKMB

Troponin

Normal - <0.5

Critical - >1.5

C Reactive Protein

Normal - <1.0

CKMB

Normal - 0-3

CVD Labs

HbA1c

HDL

LDL

Triglycerides

Cholesterol

HbA1c

<7

HDL

Male - 35-70

Female - 35-85

LDL

<160

Triglycerides

100-200

Total Cholesterol

150-200

BNP

<100

PTT

Normal - 25-35

Therapeutic - 1.5-2.5 times normal

INR

2-3

Anti Xa

0.6-1.0

Sinus Bradycardia Treatment

Atropine

Sinus Tachycardia

Treat Cause

PAC Treatment

Treat Cause

SVT

If Stable:

• Vagal Manuever

• Cold Packs on Neck

• Adenosine

PVC

Amiodarone

V-Tach

Amiodarone

PEA

Treat Cause

Angina Treatment

Nitrates (Nitroglycerin), antiplatelet

MI Treatment

Nitrates, Aspirin, Morphine

No viagra

MI Discharge Regimen

Statin

Aspirin

ACE Inhibitor or ARB

Beta Blocker

Thrombolytic Inclusion Criteria

• PCI center within 2 hours

• Chest pain longer than 20 minutes unrelieved by nitroglycerin

• ST Elevation in 2 leads

• Less than 6 hours from onset of pain

Thrombolytic Exclusion Criteria

• Active Bleeding

• Bleeding Disorder

• Hx of Hemorrhagic Stroke

• Pregnancy

• Uncontrolled HTN

• Recent Surgery

Math

Left Sided HF S/S

Lungs

• Tachycardia

• Cyanosis

• Pulmonary Congestion

• Elevated Pulmonary Wedge Pressure

• Nighttime Dyspnea

• Exertional Dyspnea

• Restlessness

Right Sided HF S/S

Body

• Fatigue

• Increased Peripheral and Central Venous Pressure

• Distended Jugular Vein

• Anorexia

• GI Distress

• Weight Gain

• Dependent Edema

• Enlarged Liver or Spleen

Cardiogenic Shock Treatment

Oxygen

Contractility increase

• Dobutamine, dopamine, norepinephrine

Rate

• Check for arrhythmia

Afterload decrease

• Nitroglycerin, nitroprusside

Preload decrease

• Nitroglycerin, diuretics

Mitral Stenosis Risk Factor

Rheumatic Fever

Mitral Regurgitation Risk Factor

• Mitral Valve Prolapse

• Mitral Stenosis

• Endocarditis

• Rheumatic Fever

Aortic Stenosis Risk Factor

• Congenital Disease

• Age

• Hypercholesterolemia

Aortic Regurgitation Risk Factors

• Congenital Disease

• Endocarditis

• Rheumatic Heart Disease

Mitral Stenosis S/S

Lungs

• Pulmonary Congestion, PND, DOE

• Atrial Fibrillation

• S/S of Right Side HF

Mitral Regurgitation S/S

Lungs

• Fatigue, tachycardia

• Orthopnea, DOE, PND

• Palpitations and Atrial Fibrillation

• S/S of Left and Right Side HF

Aortic Stenosis S/S

• Syncope

• Angina

• Dyspnea

• Narrow Pulse Pressure

Aortic Regurgitation S/S

• Dyspnea, Orthopnea, PND

• Widened Pulse Pressure

• SBP higher in lower extremities

• Head bobbing with heart palpitations/Pulsing neck veins

Mitral Stenosis Treatment

• Avoid strenuous exercise

• Digoxen, BB, CCB

• Anticoagulation

• Diuretics

• Balloon Valvuloplasty

• Mitral Valve Replacement

Mitral Regurgitation Treatment

• ACE Inhibitors, Vasodilators, Diuretics

• Anticoagulation

• Annuloplasty with leaflet repair and chordoplasty

Aortic Stenosis Treatment

• Nitrates

• Digoxin

• Diuretics

• Avoid Exercise

• Aortic Valve Repair/Replacement

Aortic Regurgitation Treatment

• Echocardiography

• Vasodilators

• NO Beta Blockers

• NO Calcium Channel Blockers

• Aortic Valve Repair/Replacement

Cardiomyopathy Treatment

• ACE Inhibitors

• Diuretics (Furosemide)

• Aldosterone Agent (Spironolactone)

Heart Transplantation Considerations

• Atropine will not work

• Immunosupression therapy (Tacrolimus)

Endocarditis S/S

FROM JANE

Fever

Roth Spots

Olsers Nodes

Murmur

Janeway Lesions

Anemia

Nailbed Splinter Hemorrhage

Emboli

Pericarditis S/S

• Friction Rub

• Chest pain with inspiration

• ST elevation

• Elevated WBC

Treat w/NSAID