CARDIOVASCULAR REVIEW CCRN Exam Cram

CARDIOVASCULAR REVIEW CCRN Exam Cram Heart Sounds S1, S3, S4: Heard at apex S2: Heard at base S3: r/t heart failure S4: r/t MI, HTN, ventricular hypertrophy, & aortic stenosis ……………………………… Mitral stenosis is associated with atrial fibrillation due to atrial enlargement. ……………………………… Stenosis occurs with an OPEN valve. Insufficiency occurs with a CLOSED valve. ……………………………… NSTEMI: + troponin, ST depression, unrelenting chest pain. STEMI: + troponin, ST elevation, unrelenting chest pain. Prinzmetal’s (Variant) Angina: - troponin, nitroglycerin relieves chest pain and returns ST segment to normal Management of Acute Chest Pain STAT EKG done and read within 10 minutes, 325mg chewable aspirin ASAP, anticoagulant therapy, antiplatelet therapy, beta blocker administration. Use metoprolol, NOT propranolol. Treat chest pain with morphine or nitroglycerin. If symptoms have been present 12 hours, prepare for PCI. Door to balloon in 90 minutes. Door to fibrinolytic therapy in 30 minutes. ……………………………… After PCI Evidence of successful reperfusion includes chest pain relief, normalized ST segment, and reperfusion arrhythmias (VT, VF). Troponin and CK-MB remain elevated after reperfusion! Complications of PCI Monitor for signs of re-occlusion… chest pain and ST elevation similar to before PCI. Monitor for vasovagal response during sheath removal. Administer atropine and fluids, hold nitrates. Monitor for signs of retroperitoneal bleeding… back pain and hypotension. HTN Emergency BP 180/110 with evidence of end-organ damage. Needs critical care admission and emergent lowering of BP. Biggest risk is STROKE. Nitroprusside Drip: preload and afterload reducer. Assess for cyanide toxicity (thiocyanate)... mental status changes, tachycardia, seizure, need for increase in dose, metabolic acidosis. Labetalol IV Push: Intermittent IV pushes preferred over drip due to the possibility of continuing drip past max of 300mg. ……………………………… Acute Peripheral Vascular Insu