Conditions & Treatment

What is coronary artery disease (CAD)?

Diseases that affect the arteries of the heart

What is a thrombus?

Clot formed of blood and plaque attached to the inner wall of an artery

What is an embolus?

Blockage of a vessel by a clot brought to the site by blood flow

What is atherosclerosis?

Calcium and cholesterol buildup inside blood vessel walls leading to ischemia

What is arteriosclerosis?

Hardening of arterial walls preventing adequate vasoconstriction and vasodilation

What is angina?

Chest pain when the heart’s demand for oxygen exceeds the blood’s oxygen supply

What commonly causes angina?

Atherosclerosis, CAD, and coronary artery spasm

What are the three types of angina?

Stable angina, unstable angina, and variant angina

What is stable angina?

Angina that typically occurs with exertion, lasts 3–5 minutes, and subsides with rest or nitroglycerin

When does stable angina usually occur?

With physical activity or exertion

How long does stable angina usually last?

3–5 minutes

What relieves stable angina?

Rest and/or nitroglycerin

What is unstable angina?

Angina that may occur at rest, lasts greater than 20 minutes, and may not respond to nitroglycerin

Can unstable angina occur at rest?

Yes

How long does unstable angina typically last?

More than 20 minutes

Does unstable angina always respond to nitroglycerin?

No

What is variant angina also called?

Prinzmetal or spasmotic angina

What causes variant angina?

Coronary vessel vasospasm

Can variant angina occur at rest?

Yes

How may variant angina resolve?

Spontaneously or with medication

What does MONA stand for?

Morphine, Oxygen, Nitroglycerin, Aspirin

What medications are included in MONA?

Morphine, Oxygen, Nitroglycerin, Aspirin

What additional treatments should be provided for angina?

Relieve anxiety/pain, position of comfort, IV access, and 12-lead EKG

Which analgesic is gaining popularity over morphine for angina?

Fentanyl

What percentage of MIs are STEMIs?

Approximately 30%

What percentage of MIs are NSTEMIs?

Approximately 70%

What is a subendocardial MI?

MI that extends partially through the thickness of the myocardium

Can a subendocardial MI produce pathological Q-waves?

May or may not

What is a transmural MI?

MI that extends completely through the thickness of the myocardium

What EKG finding is left behind by a transmural MI?

Pathological Q-waves

How is a STEMI identified?

1 mm or more of ST elevation in two or more anatomically contiguous or numerically consecutive leads

What are the treatment goals for MI?

Reperfusion and pain relief

What is the treatment protocol for MI?

Oxygen, 12-lead EKG, Aspirin, Nitroglycerin, Morphine or Fentanyl

When can nitroglycerin be given in MI?

If systolic BP is greater than 90 mmHg and there is no RVI

What is the earliest EKG change in an MI?

Tall, peaked T-wave

What characterizes the hyperacute phase of MI?

T-wave up to 10 mm and 2/3 the size of the QRS

What does ST-segment elevation indicate?

Current myocardial injury

What does ST-segment elevation suggest is occurring?

Occluded coronary artery causing injury

What happens if ST-segment elevation is not corrected?

Tissue necrosis

What does a pathological Q-wave with ST elevation indicate?

Some myocardium is salvageable while other portions are necrotic

What EKG finding indicates an old MI?

Pathological Q-wave without active injury pattern

What is a physiologic Q-wave?

Q-wave less than 0.04 seconds wide

What is a pathological Q-wave?

Q-wave greater than 0.04 seconds wide

Which patients commonly present with atypical MI symptoms?

Elderly, females, chronic hypertensive patients, and diabetics

What are atypical MI symptoms?

Fatigue, weakness, or not feeling right

What is the leading cause of death in MI?

Lethal dysrhythmias

What is a 4-lead EKG primarily used for?

Detecting lethal dysrhythmias

What is a 12-lead EKG used for in MI?

Identifying ST elevation, ST depression, inverted T-waves, and pathological Q-waves

What are the two primary types of heart failure?

Right-sided and left-sided heart failure

What causes right-sided heart failure?

Cor pulmonale, right ventricular infarct, tricuspid valve damage, pulmonic valve damage, pulmonary embolism

What is the number one cause of left-sided heart failure?

Myocardial infarction

What causes left-sided heart failure?

Pulmonary edema, hypertension, left ventricular infarct, mitral valve damage, aortic valve damage, cardiomyopathy, myocardial infarction

What are the signs and symptoms of right-sided heart failure?

JVD, peripheral edema, ascites, sacral/scrotal edema, orthopnea, hepato-jugular reflex, pulsus paradoxus, pulsus alternans

What are the signs and symptoms of left-sided heart failure?

Anxiety, tachycardia, hypertension, pale sweaty skin, PND, orthopnea, rales/crackles, pink frothy sputum

What is pink frothy sputum a sign of?

Late left-sided heart failure

What is the treatment for right-sided heart failure?

Position of comfort, oxygen, 12-lead EKG, and fluid administration

What is the treatment for left-sided heart failure?

Position of comfort, oxygen, 12-lead EKG, nitroglycerin, CPAP, and furosemide

What should always be monitored when administering fluids?

Lung sounds and abdomen

What is cardiac tamponade?

Excess fluid accumulation in the pericardial sac causing pressure on the heart

What is the normal amount of pericardial fluid?

25 mL

Why does cardiac tamponade impair cardiac function?

The pericardial sac does not expand well and compresses the heart

What type of shock can cardiac tamponade cause?

Cardiogenic or obstructive shock

What causes cardiac tamponade?

Trauma, MI, pericarditis, and neoplasms

What are the signs and symptoms of cardiac tamponade?

Chest pain, dyspnea, orthopnea, narrowing pulse pressure, electrical alternans, pulsus paradoxus, altered LOC

What is the management of cardiac tamponade?

Oxygen, IV access, fluid bolus, and vasopressor

What fluid bolus is recommended for cardiac tamponade?

20 mL/kg

What causes cardiogenic shock?

MI, left-sided heart failure, tension pneumothorax, cardiac tamponade, and cardiac contusion

What are the signs and symptoms of cardiogenic shock?

SBP less than 80 mmHg, respiratory distress, chest pain, weakness, altered mental status, hypotension, tachycardia

What is the management of cardiogenic shock?

Rapid transport, position of comfort, oxygen, treat underlying cause, IV access, fluids if appropriate, positive inotropes and vasopressors

When should fluids be given in cardiogenic shock?

When lung sounds are dry

How much fluid should be given if lung sounds are dry?

100–200 mL boluses

When should fluids be avoided in cardiogenic shock?

When lung sounds are wet

What is the most common aortic catastrophe?

Dissecting aortic aneurysm

What are the signs and symptoms of a dissecting aortic aneurysm?

Syncope, absent or reduced pulses, unequal blood pressures, unequal pulse strengths, heart failure, tearing chest or back pain, flank pain, scapular pain, pain radiating into the legs

What is a significant finding in a dissecting aortic aneurysm?

Tearing sensation in the chest or back

What is the management of a dissecting aortic aneurysm?

Rapid transport to a hospital with emergency surgery capabilities

What causes chronic hypertension?

May be hereditary or related to the renal system

What complications can chronic hypertension cause?

Increased afterload, hypertrophy, left-sided heart failure, and atherosclerosis

What is a hypertensive crisis?

Uncontrolled hypertension that fluctuates and is unpredictable

What blood pressure is typically associated with hypertensive crisis?

Greater than 180/120 mmHg

What is the treatment for hypertensive crisis?

Calm patient, IV, oxygen, ECG, and treat underlying causes

What medications may be used for hypertensive encephalopathy?

Nitroglycerin, Morphine Sulfate, Phenergan or Ondansetron, Beta Blockers, and Calcium Channel Blockers

Stable angina duration

3–5 minutes

Unstable angina duration

Greater than 20 minutes

Variant angina cause

Coronary vasospasm

MONA

Morphine, Oxygen, Nitroglycerin, Aspirin

STEMI criteria

≥1 mm ST elevation in two contiguous or consecutive leads

Leading cause of death in MI

Lethal dysrhythmias

Pink frothy sputum indicates

Left-sided heart failure

JVD, peripheral edema, and ascites indicate

Right-sided heart failure

Cardiac tamponade shock type

Cardiogenic or obstructive shock

Normal pericardial fluid volume

25 mL

Cardiogenic shock fluid bolus if lungs are dry

100–200 mL

Pathological Q-wave width

Greater than 0.04 seconds

Physiologic Q-wave width

Less than 0.04 seconds

Most common cause of left-sided heart failure

Myocardial infarction

Hypertensive crisis blood pressure

Greater than 180/120 mmHg