Cardiac PCCN Test questions and Answers 2023

Cardiac PCCN Test questions and Answers 2023 EKG records the electrical activity of the heart and can identify an abnormal cardiac rhythm and sometimes cardiac muscle damage Stress test Monitors cardiac activity while exercising or after medications are given to increase the heart rate. it detect whether there is a change in rhythm or signs of cardiac ischemia echocardiogram an ultrasound of the heart to evaluate contractility and valve function. Can be done through the chest wall or transesophageal. PET scan a nuclear scan that evaluates the flow of blood through the coronary arteries to the heart muscle. Can also be done with a form of glues to determine whether specific areas of the heart tissues are damaged. More expensive than a CT scan but detects changes faster Thallium or perfusion scans Nuclear scans that evaluate areas of the heart muscle that are not being properly perfused. Can be done with different contrast mediums. Holter Monitor a small device that is worn over 24 hours up to several weeks. it runs continuously, while an even recorder allows the patient to start the ECG recording when they experience symptoms. In order to diagnose right ventricular infarction... right sided leads are placed on the right side in a mirror image of the left leads. S1 the first heart sound "lub" closure of the mitral and tricuspid valves (heards at apex/left ventricular area of the heart, the pointy bottom of the heart) S2 the second heart sound "dub" closure of the aortic and pulmonic valves. heard at the base of the heart (top near the aortic arch etc) Systole the time between S1 and S1 Diastole time from S2 and the next S1 Gallop Rhythms S3 (occurs after S2 in children and young adults) but may indicate heart failure or LVF in older adults (heard when patient is lying on left side) S4 occurs before S1 and occurs with ventricular hypertrophy uch as from CAD, HTN, or aortic valve stenosis Opening snap an unusual high pitched sound occurring after S2 withe stenosis of mitral valve from rheumatic heart disease Ejection click a brief high pitched sound occurring immediately after S1 with stenosis of aortic valve Friction rub a harsh grating sound heard in systole and diastole with pericarditis Murmur cause by turbulent blood flow from stenotic or malfunctioning heart valves, congenital defects, or increased blood flow. They are characterized by location, timing in the cardiac cycle, intensity, pitch, quality, and radiation. To assess jugular venous pressure Elevate the patients head to 45 degrees (up to 90 if necessary) with patients head turned to the right. Position light at an angle to illuminate veins and shadows. measure the height of the jugular vein pulsation about the sternal joint using a ruler. Normal is less than 4cm above sternal angle. QT interval when the ventricles complete contraction to when they begin to contract again (the resting phase of the ventricles) Shorter when the heart rate is faster and longer when the heart rate is slower. (QTc is the corrected Qt interval) QTc greater than 0.5 seconds... indicates pt is at risk for developing v-fib or torsades de pointes Troponin preferred markers for myocardial injury, high sensitivity and specificity for MI. if there is injury, trop increases 3-12 hours from onset of chest pain, peaks at 24-48 hours, returns to baseline within 2 weeks. CK Creatinine kinase (CK-MB is specific to cardiac muscle) normal 5-25. increases 3-12 hours from onset of chest pain, reaches peak within 24 hours, and returns to baseline 48-72 hours. Myoglobin found in cardiac and skeletal muscle, released much more rapidly from the cardiac muscle than troponin when infarction occurs may be detected as early as 2 hours after symptoms begin. Normal 0-85. High sensitivity, low specificity. WBCs high white blood cell count (leukocytosis) may be seen within a few hours of an MI, though sensitive, low specificity. Contractility amount of force exerted by myocardium during contraction. Directly related to preload and afterload Increased contractility occurs... due to changes in body chemistry or the sympathetic nervous system. Digoxin and dopamine increase it too. leads to increased stroke volume and cardiac output. Decreased contractility occurs... potentially when a patient is hypoxic or acidotic. some drugs like atenolol also decrease it How does the heart respond to need for increased stroke volume during exercise or periods of stress? by increasing preload through increased venous return, by increasing contractility through stimulation of the sympathetic nervous system, and decreasing afterload with vasodilation. What is cardiac output? The amount of blood pumped through the ventricles during a specified period of time. What is normal cardiac output for an adult at rest? 5L per minute. (volume may multiply by 3-4 times during exercise or stress) What is the formula for calculating CO? CO=HRxSV The heart rate is controlled by the _____ nervous system autonomic Normally if the heart rate decreases _____ increases to compensate SV SV may not compensate in the case of CM so bradycardia can result in.... decrease in CO. Preload the amount of elasticity in the myocardium when the ventricles are filled to their greatest volume. (volume of blood in the ventricles) Frank Starling Law The greater the stretch, the stronger is the heart's contraction. This increased contractility results in an increased volume of blood ejected (Increased SV) Preload can be decreased from dehydration, diuresis, and vasodilation Preload can be increased from increased venous return, controlled fluid loss, transfusion, or IV fluids. Afterload the systemic vascular resistance, Afterload is determined by the size and elasticity of the vessels and the functioning of the pulmonic and aortic valves. Afterload increases with HTN, stenotic valves, and vasoconstriction. MAP to perfuse coronary arteries greater than 60 MAP to perfuse brain and other organs like kidneys and to maintain cardiac patients and decrease workload of left ventricle 70-90 MAP to increase cerebral perfusion pressure after neurological procedures like a carotid endarterectomy 90-110 Pulse Ox measures the percentage of pts hemoglobin that is saturated with oxygen. Do not provide info on CO2 monitoring Thoracic Electrical Bioimpedance monitoring noninvasive method of monitoring hemodynamics ( CO, blood flow, contractility, preload and afterload, pulmonary artery pressure) using electrodes on the chest. Asynchronous Pacer fixed rate pacing Synchronous pacer on demand pacing delivers impulse if pulse rate falls below a set level Dual Chamber pacer AV sequential and delivers and impulse to the atrium and ventricle in sequence allowing time for the ventricles to fill properly. Possible complications from pacemakers infection, bleeding, hematoma, puncture of subclavian vein or mammary artery that may cause hemothorax. Irritation from electrode that causes ectopy to tachycardia. dislocation of leads (may be evident in hiccuping) cardiac tamponade, dislodgement of leads that may lead to perforation of myocardium. Transcutaneous Oxygen Pressure Management non-invasive test that measures dermal oxygen, using contact gel and electrodes. Skin is then heated to increase blood flow. two or three sites should be tested. Uses for TOPM Determining if there is enough oxygen transport for effective hyperbaric oxygen therapy treatments, determining the degree of oxygenation and peripheral vascular disease, establishing the degree of hypoxia in venous diseases, identifying the optimum site for amputation of severely hypoxic limbs. TOMP test results greater than 40 adequate oxygen for healing 20-40 eqivocal finding less than 20 marked ischemia that will affect healing Cardioversion a timed electrical stimulation to the heart to convert tachy dysrhythmia to a normal sinus rhythm. How long before and elective cardioversion is anticoagulation therapy done? 3 weeks How long before and elective cardioversion must digoxin be stopped? at least 48 hours What may be used in conjunction with the shock to convert a tachy rhythm? Drugs like amiodarone, or cardezim. Emergency defibrillation done to treat V-fib to V-tach when there is no audible or palpable pulse. Higher voltage used than for cardioversion. intra-aortic balloon pump most commonly used circulatory assistive device. Cath with inflatable balloon, inflates during diastole and deflates during systole. Cardiac cath cath inserted into radial or femoral artery, fluroscopy guided, contrast dye injected What to monitor post cardiac cath? insertion site for redness, swelling, bleeding, affected limb for temperature, color, pulse. vital signs. Monitor for chest pain, dysrhythmias, IV flow and output to ensure contrast dye is excreted. CABG for angina that does not respond to medical treatment, for blockage more than 60% in the left main artery, blockage of multiple coronary arteries that include the LAD, LV dysfunction and previously unsuccessful PCI. Midsternal incision. CBP. Sites for CABG grafts internal mammary artery (best choice but more time consuming) Saphenous vein Radial artery and Gastroepiploic artery MIDCAB minimally invasive direct coronary artery bypass. applies bypass graft on beating heart through 10cm incision mid chest rather than midsternally, No By-pass. Only suitable for bypass of one or two arteries. A small portion of the rib is removed to allow access to the heart and internal mammary artery used for graft. Post-op CABG care monitor chest tubes (avoid milking), cardiovascular support may be needed, regulation of temperature (remwarming but not above 37.) Early extubation (4-8 hours) Neuro monitoring, watch for wound infections, monitor vitals, output etc. Ambulation as soon as possible. Heart transplant requires CPB (bypass), after chest is opened, the pericardial sac is opened to expose the heart Orthotopic procdure heart transplant most common method, the posterior portion of the left and right atrium are left for attachment to the new heart, once new heart is in place CPB is d/c'ed, PAC may be placed to aid in monitoring. Post-Op for Heart transplants monitoring respiratory status, especially if the donor heart is larger than the original, resulting in compression of the lungs. IV fluids and various medications. Immunosuppression therapry Iv at first then PO, Prostaglandins cont. if used pre-operatively to preclude pulm HTN. Unstable angina progression of CAD, unstable if pain increases, does not respond to nitro, or persists for more than 5 minutes. May occur at rest and may indicate the rupture of an atherosclerotic plaque and the beginning of thrombus formation. Variant angina Prinzmetals angina. results from spasms of the coronary arteries, with or without plaques, often related to smoking, alcohol, or illicit stimulants. ST elevation usually occurs. occurs cyclically (same time each day, often while at rest) Nitro and calcium channel blockers used to treat. MI occurs when there is an imbalance between supply and demand of oxygen to the heart, part of the continuum of ACS. Damage of to myocardium occurs in three stages... Ischemia: develops as oxygen levels fall creating zone of ischemia in viable cells Cellular injury: occurs to those cells surrounding the infarcted area in the zone of injury Infarction with necrosis: occurs in the zone of infarction, cells are destroyed and eventually replaced with scar tissue, irreversible damage occurs with complete occlusion for 15-20 minutes Q-wave MI series of abnormal Q waves, infarction is usually prolonged and results in necrosis, coronary occlusion is complete in 80-90%. Often but not always transmural. mortality rates about 10%