Georgette Review. PMHNP- 388 QUESTIONS- WITH
COMPLETE SOLUTIONS
RIGHT CORONARY ARTERY - ANSWER Supplies blood to:
SA node
AV node
RA and RV muscle
Bundle of His
Inferiorposterior wall of LV
1/3 septum, posterior fascicle of left bundle branch
Inferior surface RV
LEFT ANTERIOR DESCENDING CORONARY ARTERY - ANSWER Supplies
blood to:
Anterior/lateral surface LV
Anterior 2.3 intraventricular septum
R bundle branch
Anterior L bundle branch
LV papillary muscle
ST DEPRESSION - ANSWER ISCHEMIA!
ST depression is considered significant if: depression > 1 mm below the baseline;
see in 2 or more leads facing the same area of the heart
- occurs in < 20 minutes of ischemia
ST ELEVATION - ANSWER INJURY!
if elevation is > 1 mm in the limb leads or > 2mm in the precordial leads
- occurs within 20 -40 minutes after injury occurs
Q WAVES - ANSWER Represents an area of dead tissue or infarction
Q waves is > 0.04 seconds wide
- usually take up to 24 hours to develop. DO NOT REVAL WHEN THE INFARCTION
OCCURRED.
Drug Therapy for CHF - ANSWER A - ACE inhibitors to block RAAS
B - Beta blockers to block SNS
C - Increase Contractility: Digitalis
D - Diuretics, VasoDILATORS: to decrease preload and afterload
BNP - ANSWER Marker for ventricular dysfunction
BNP > 100 is indicative of HF
May also be elevated in R sided failure due to pulmonary disease and ESRD
May see FALSE NEGATIVE in patients w flash pulmonary edema and HF due to
mitral regurgitation
, Myocarditis - ANSWER Inflammation of the myocardium
- cardinal sign: pain when supine; respiratory infection; pain w/ inspiration; S3 and
S4
- endomyocardial biopsy is the only definitive way to diagnose
- viral cause is common
Infective Endocarditis - ANSWER - Bacteria carried through system and deposited
into endocardial surfaces
- valves have irregular or "cauliflower" appearance
- Dental procedures/poor oral hygiene
-streptococcus most common
- MITRAL VALVE IS MOST AFFECTED
- AORTIC INSUFFICIENCY HEART MURMUR
- Pts w/ valve disease should receive abx prior to any invasive procedure
- abx for 6-8 wks
Pericarditis - ANSWER - Idiopathic
- Post MI
-SHARP, STABBING pain that radiates to left shoulder
- aggravated by inspiration, supine position
- relieved by sitting up or leaning forward
- pericardial friction rub
- Diagnostics: elevated troponin, elevated WBC, diffuse ST elevation in all leads
- Tx: NSAIDs, monitor for complications: tamponade
Cardiac tamponade - ANSWER -Cardiac effusion is the accumulation of fluid within
the pericardial space
-Most common cause: pericarditis (s/s: diffuse ST elevation in all leads, CP worse
when supine, pericardial friction rub)
- Beck's triad: JVD, narrow pulse pressure & hypotension, muffled heart sounds
- TEE (transesophageal echo) is usually necessary - most sensitive and specific
Kussmaul's sign - ANSWER increase in JVP seen during inspiration
Pulsus Paradoxus - ANSWER Difference of as much as >10 mmHg in SBP
between inspiration and expiration
- found in cardiac tamponade
Hypertensive crisis - ANSWER DBP > 120
causes risk of end organ damage
Hypertensive emergency - ANSWER DBP > 120 w/ acute or ongoing end organ
damage
- immediate BP reduction is required within a few hours to prevent or limit target
organ damage
- Tx: reduce the MAP by 25% within the first 2 hours in a controlled, predictable and
safe fashion and then toward 160/100 within 2-6 hours; Nipride, Corlopan, IV
vasodilators, IV adrenergic inhibitors (BBs),
-IF DBP >120 NEVER GIVE A DIURETIC
COMPLETE SOLUTIONS
RIGHT CORONARY ARTERY - ANSWER Supplies blood to:
SA node
AV node
RA and RV muscle
Bundle of His
Inferiorposterior wall of LV
1/3 septum, posterior fascicle of left bundle branch
Inferior surface RV
LEFT ANTERIOR DESCENDING CORONARY ARTERY - ANSWER Supplies
blood to:
Anterior/lateral surface LV
Anterior 2.3 intraventricular septum
R bundle branch
Anterior L bundle branch
LV papillary muscle
ST DEPRESSION - ANSWER ISCHEMIA!
ST depression is considered significant if: depression > 1 mm below the baseline;
see in 2 or more leads facing the same area of the heart
- occurs in < 20 minutes of ischemia
ST ELEVATION - ANSWER INJURY!
if elevation is > 1 mm in the limb leads or > 2mm in the precordial leads
- occurs within 20 -40 minutes after injury occurs
Q WAVES - ANSWER Represents an area of dead tissue or infarction
Q waves is > 0.04 seconds wide
- usually take up to 24 hours to develop. DO NOT REVAL WHEN THE INFARCTION
OCCURRED.
Drug Therapy for CHF - ANSWER A - ACE inhibitors to block RAAS
B - Beta blockers to block SNS
C - Increase Contractility: Digitalis
D - Diuretics, VasoDILATORS: to decrease preload and afterload
BNP - ANSWER Marker for ventricular dysfunction
BNP > 100 is indicative of HF
May also be elevated in R sided failure due to pulmonary disease and ESRD
May see FALSE NEGATIVE in patients w flash pulmonary edema and HF due to
mitral regurgitation
, Myocarditis - ANSWER Inflammation of the myocardium
- cardinal sign: pain when supine; respiratory infection; pain w/ inspiration; S3 and
S4
- endomyocardial biopsy is the only definitive way to diagnose
- viral cause is common
Infective Endocarditis - ANSWER - Bacteria carried through system and deposited
into endocardial surfaces
- valves have irregular or "cauliflower" appearance
- Dental procedures/poor oral hygiene
-streptococcus most common
- MITRAL VALVE IS MOST AFFECTED
- AORTIC INSUFFICIENCY HEART MURMUR
- Pts w/ valve disease should receive abx prior to any invasive procedure
- abx for 6-8 wks
Pericarditis - ANSWER - Idiopathic
- Post MI
-SHARP, STABBING pain that radiates to left shoulder
- aggravated by inspiration, supine position
- relieved by sitting up or leaning forward
- pericardial friction rub
- Diagnostics: elevated troponin, elevated WBC, diffuse ST elevation in all leads
- Tx: NSAIDs, monitor for complications: tamponade
Cardiac tamponade - ANSWER -Cardiac effusion is the accumulation of fluid within
the pericardial space
-Most common cause: pericarditis (s/s: diffuse ST elevation in all leads, CP worse
when supine, pericardial friction rub)
- Beck's triad: JVD, narrow pulse pressure & hypotension, muffled heart sounds
- TEE (transesophageal echo) is usually necessary - most sensitive and specific
Kussmaul's sign - ANSWER increase in JVP seen during inspiration
Pulsus Paradoxus - ANSWER Difference of as much as >10 mmHg in SBP
between inspiration and expiration
- found in cardiac tamponade
Hypertensive crisis - ANSWER DBP > 120
causes risk of end organ damage
Hypertensive emergency - ANSWER DBP > 120 w/ acute or ongoing end organ
damage
- immediate BP reduction is required within a few hours to prevent or limit target
organ damage
- Tx: reduce the MAP by 25% within the first 2 hours in a controlled, predictable and
safe fashion and then toward 160/100 within 2-6 hours; Nipride, Corlopan, IV
vasodilators, IV adrenergic inhibitors (BBs),
-IF DBP >120 NEVER GIVE A DIURETIC
