Test 2 Outline

Cardiac Enzymes
CAD
Troponin- General category of atherosclerosis
• Highly specific Slow occurring = collateral circulation
• 1st to increase with specificity
Myoglobin- Drug Therapy- administer separate times from other meds
• Increase 1-2hr after MI to decrease adverse effects
• First to increase buts lack specificity • Resins
CK-MB- o Questran
• >5% of total CK = highly indicative of MI o Colestid
• Increase 3-12 hr after MI o Welchol
o Colybar
Serum Lipids: • Statin’s
• Cholesterol • Fibric Acid derivatives
o Norm 120-200 o Atromid
• Triglycerides o Tricor (don’t take with Statin’s)
o Norm 40-190 o Lopid
• Lipoproteins • Niacin with diet therapy
o LDL = <130 • Zetia
o HDL = 37-70 (men)
 40-88 (women) Nutritional Therapy
• Step 1 diet
o Decrease saturated fats
o Decrease cholesterol
o Decrease ETOH
o Decrease simple sugars
• Step 2 diet
o Further restricts saturated fats and cholesterol
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2

o ACE inhibitors

MI Complications of MI:
• Arrhythmias (Lethal)
• Angina = easily relieved by Nitro, O2, rest • CHF
o Stable Angina • Cardiogenic Shock
o Unstable Angina • PE
• Occurs @ rest or minimal exertion • Dressler’s (Pericarditis c effusion & fever 1-4 wks p
o Prinzmetal’s Angina MI)
• Primarily @ rest, triggered by smoking • Pericarditis
o Nocturnal Angina
• @ night
o Angina Decubitus Heparin= antidote Promatine Sulfate
• Occurs when lying down Coumadin = Vit. K
• ACS (Acute Coronary Syndrome) = prolonged and not Ptt= 1 ½ - 2 ½ the control
immediately reversible
o STEMI
o NSTEMI

• Normal heart can withstand lack of O2 for 20 mins =

cellular death occurs

• TX when presents to ED
o MONA
o 2 IV’s KVO
o Inotropic’s- Dig (caution b/c increase workload)
o Beta blockers- dilates, blocks epi & norepi
o Ca+ channel blockers- calms cells (Norvasc,
Cardizem)
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Tx: lidocaine

Premature Atrial Contractions Ventricular Tachycardia

(PAC)

• a normal QRS complex

• a normal T wave repolarization (not inverted to the
other T waves)
• an odd, misshapen P wave depolarization 100-200 bpm
• P-wave hidden in t-wave >200 = SVT= narrow QRS
• vagal down
• adenocard (squeeze IV bag when pushing)
causes asystole

Agnol

Premature Ventricular Contraction

(PVC)

• QRS T wide
• Aystole quickly follows
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Pulseless Electrical Activity

(PEA)
• Looks like NSR but NO PULSE TX: CPR Valvular Disorders
Murmur
Sinus Bradycardia • Vibratory sounds
Mitral Stenosis
• Dyspnea, Hemoptysis
Mitral Regurgitation
• Backflow from LV  LA
• Pulmonary edema
Mitral Valve Prolapse
• Normal in athletes and during sleep
• Murmur increasing thru systole
• TX: atropine for pt’s with sx’s (increase HR)
• Recommend prophylactic antibiotic for dental or
Pacemaker therapy may be used
surgical procedures
Aortic Stenosis
Sinus Tachycardia
• Leads to LV hypertrophy
• Angina, syncope, heart failure
• TX: decrease Na+, fats, and increase protein.

TX for all valvular disorders

• Diuretics
• Dig
• TX: underlying cause • Antibiotics
• Beta blockers (decrease HR) • Decrease Na+
• Anticoagulants
• Antidysrhythmics
• Nitrates
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• Beta blockers
• Surgical procedures for valve opening and replacement

Edocarditis
Bacterial growth around valves
Pacemakers IV drug users, rheumatic fever, valve disorders
Can pace atria or ventricles (both= dual chambered) Manifestations:
2 types: • Petechiae
1. Fixed Rate • Olsers nodes (painful red-purple on fingers/toes)
a. Set for amount • Janeway’s lesions (flat painless on palms/soles)
2. Demand Rate DX:
a. Fires only when needed • Recent dental procedure
• Infection
ICD: detects LETHAL DSYRRHYTHMIAS & FIRES TX:
• Heparin
• Antibiotics (VANCO , peak and troph)
• Lung sounds
• Pulses
• WBC – inflammation
• Blood cultures
• Sed rate – inflammation
• Echocardiograph
• Aseptic technique
• Rest and frequent position changes
• Decrease fever- antipyretics
• TED hose
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Acute Pericarditis
Manifestations:
• Chest pain
• Dyspnea
• Pericardial friction rub
• Pain aggravated by lying supine, DB &C, swallowing
DX:
• ECG, CXR, labs (BUN, Creatinine, TB test)
TX:
• Antibiotics if needed
• Anti-inflammatory (NSAID’s)
• Pericardiocentesis

Chronic Constrictive Pericarditis

From scarring with loss of elasticity
Manifestations:
• Mimic CHF & Cor Pulmonale
DX:
• ECG, CXR, cardiac cath, CT, MRI
TX:
• Pericardiectomy
• Increase protein
• Decrease Vit. K (green leafy veggies) b/c hep/coumadin
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• Impairs diastolic filling and stretch

• TX:
o No specific tx
o Therapy for CHF & arrhythmias
o Heart transplant
Cardiomyopathy (CMP)
Dilated Cardiomyopathy
Cardiac Transplantation:
• Most common 4-6 hrs
• Cardiomegaly with ventricular dilation Immunosuppressive therapy begun in surgery
• s/sx’x of CHF
• TX: Artificial Heart:
o Control CHF External battery pack allows 6-8hrs of power
o Mostly palliative Can be charged during sleep
o Dig for A-fib Requires no immunosuppresion
o Diuretics
o ACE inhibitors
o Beta blockers
o Terminal- transplants
Hypertrophic Cardiomyopathy (HCM)
• Hypertrophic with ventricular dilation
• Forceful contraction, impaired relaxation
• TX:
o Beta blockers
o Ca+ Channel blockers
o Antiarrhythmics
o AICD (internal Defib)
o Ablation
o Ventriculomyotomy & myectomy
Restrictive Cardiomyopathy