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afterload resistance the left heart overcomes during contraction
aneurysm a weakening in the wall of an artery
ascites edema in the abdomen
cardiac hypertrophy enlargement of the heart, often due to hypertension
cardiac output volume of blood ejected by left ventricle in one minute(stroke volume x HR)
chronotrope rate of contraction
dromotrope speed of conduction velocity
endocarditis infection of the endocardium, usually involving the heart valves
ejection fraction percentage of blood ejected from a filled ventricle
failure to capture ventricles fail to respond to an impulse. on an ECG, the pacemaker spike will appear, but it will not be followed by a QRS complex.
failure to sense pacemaker malfunction that occurs when the pacemaker does not detect the pts myocardial depolarization. may be seen on an ECG tracing as a spike following a QRS complex too early.
inotrope force of contraction
orthopnea difficulty breathing when lying down
paroxysmal nocturnal dyspnea acute onset of difficulty breathing at night, usually while sleeping
pericarditis inflammation of the pericardium
preload volume of fluid returning to the right heart
prinzmetal's angina variable angina caused by coronary artery spasms
starling's law the more the heart is stretched w/in limits, the greater the resulting force of contraction
stroke volume the amount of blood ejected by the left ventricle in one contraction
layers of the heart endocardium myocardium epicardium pericardium
bloodflow through the heart vena cava R atrium R ventricle pulmonary arteries lungs pulmonary veins L atrium L ventricle aorta body
Systemic Vascular Resistance (SVR) resistance to blood flow throughout the body
L coronary artery perfuses L ventricle, interventricular septum, portion of the R ventricle, and the cardiac conduction system
mainbranches of the LCA L anterior descending L circumflex artery
R coronary artery perfuses part of the R atrium and ventricle and part of cardiac conduction system
mainbranches of RCA posterior descending artery R marginal artery
SA node heart primary pacemaker; beats between 60-100bpm
AV node hearts 1st backup pacemaker; beats between 40-60bpm
Bundle of His hearts final pacemaker; beats between 20-40bpm
sinus rhythms and dysrhythmias sinus rhythm sinus brady sinus tach sinus block sinus arrest
atrial rhythms and dysrhythmias SVT PSVT AFlutter AFib PACs WAP MAT
AV blocks 1st degree 2nd degree type 1 2nd degree type 2 2nd degree block 2:1 conduction 3rd degree
juctional rhythms and dysrhythmias junctional escape junctional brady accelerated junctional PJC junctional escape complexes junctional escape
ventricular rhythms and dysrythmias accelerated IVR VTach VFib Torsades ventricular escape complexes ventricular escape PVC
additional rhythms asystole artificial pacemaker rhythms
common s/s of cardiac emergencies chest pain or pressure dyspnea palpitations diaphoresis restlessness, anxiety feeling of impending doom nausea/vomiting weakness edema syncope denial
general management of cardiac emergencies assess ABCs BLS & ACLS interventions as indicated for cardiac arrest O2 above 94% continuous ECG monitoring IV access & pharmacological interventions rapid transport to closest appropriate facility
management of cardiac dysrhythmias determine stable vs. unstable follow appropriate ACLS algorithm >vagals for tachydysrhythmias >pharmacological interventions >appropriate electrical interventions
acute coronary syndrome (ACS) angina, unstable angina, and acute myocardial infarction
stable angina transient chest pain due to myocardial ischemia often provoked by exertion or stress typically lasts less than 30min. and resolved w/rest or nitro
unstable angina new onset angina angina for atleast 20min while at rest frequent angina episodes or increasing duration of angina
Acute Myocardial Infarction (AMI) irreversible nerosis of myocardial muscle and diagnosed by ECG changes and elevated myocardial blood enzymes
CHF- L heart failure L ventricular dysfunction causes backpressure into pulmonary circulation dyspnea and pulmonary edema are common w/L heart failure myocardial infarction is a common cause of L heart failure
CHF- R heart failure R ventricular dysfunction causes backpressure into systemic venous circulation JVD and pedal edema are common w/R heart failure L heart failure is the most frequent cause of R heart failure
s/s of CHF pulmonary edema(L) dyspnea(L) paroxysmal nocturnal dyspnea(L) orthopnea(L) mottled skin weakness ascites(R) JVD(R) bilateral pedal edema(R) pt w/hx of CHF are often prescribed meds such as digoxin, a diuretic, and ACD inhibitor, and a potassium supplement.
management of CHF avoid placing pt supine supplemental o2 CPAP ECG monitoring IV access nitro use of narcotics and diuretics in CHF pts has been ineffective and possible harmful
cardiac tamponade excess fluid accumulation in the pericardial sac impairing diastolic filling and reducing cardiac output
S/S of a Cardiac tamponade chest pain dyspnea beck's triad(JVD,narrowing pulse pressure,muffled heart tones)
Management of cardiac tamponade highflow o2 IV fluids consider vasopressors, such as dopamine rapid transport
s/s hypertensive emergencies elevation in BP hx of hypertensive disorder noncompliance w/anti-hypertensive meds pregnancy nosebleed
management of hypertensive emergencies manage ABCs supplemental o2 place in position of comfort IV access transport
Abdominal Aortic Aneurysm (AAA) weakened wall of artery that is prone to rupture and massive bleeding
AAA s/s most common in older males tearing back pain possible hx of hypertension, smoking, atherosclerosis, family hx of AAA possible pulsating abd mass varying BP between L and R arm of atleast 15-20mmHg s/s of hypovolemic shock
AAA management general management of ALS pt keep pt still caution when palpating abd transport rapidly to appropriate facility w/surgical capabilities
cardiogenic shock persistent, severe L ventricular pump failure despite correction of existing dysrhythmias, hypovolemia, or widespread vasodilation
S/S of cardiogenic shock hypotension tachycardia chest pain dyspnea ALOC weakness hx of trauma or MI
Management of cardiogenic shock ABCs position of comfort if possible o2 consider CPAP consider vasopressor meds, like dopamine rapid transport
highlights of current AHA BLS guidelines rate:100-120bpm depth of adult compressions: 2-2.4' depth of child compressions: 2' depth of infant compressions: 1.5' adult compression/ventilation ratio:30-2 infant and child comp:vent ratio:30-2(1 rescuer) 15-2(2 rescuer) vent. rate w/advanced airway- 10min-adults; 12-20min-peds ensure full chest recoil between compressions minimize interruptions in compressions avoid hyperventilation utilize AED to determine need for defibrillation ASAP o2 to maintain 94%
highlights of current AHA ALS guidelines vasopressin no longer recommended for cardiac arrest amiodarone or lidocaine may be used for VF or pulseless VT after CPR, defibrillation, and epi consider termination of efforts if unable to obtain ETCO2 above 10mmHg in an intubated pt after 20min of CPR atropine indicated for symptomatic bradycardia consider dopamine or epi infusion or TEP for symptomatic bradycardia unresponsive to atropine 12 lead ECG should be obtained prehospital for suspected acute coronary syndrome to assess for STEMI
highlights of current AHA PALS guidelines early, rapid admin of isotonic IV fluids at 20mL/kg recommended for pedi pts w/hypovolemia or sepsis amiodarone or lidocaine can be used for shock-refractory VT or pulseless VT admin. o2 as indicated to maintain SpO2 between 94-99%
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