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This article discussed a mneumonic that was "BLAAST those MIs" which abbreviated Beta blockers, asprin, arb/ace, smoking cessation and talk to health care provider
beta blockers and asprin were given to patients within 24 hours of arrival
Beta blockers, lipid lowering drugs, apsrin, and Ace/arb were prescribed at discharge
beta blockers were shown to prevent further damage to heart if given at beginning of heart attack
Ace/arb prevent pumping action from weakening further after an MI |
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nelectrical activation of a cell caused by the influx of sodium into the cell while potassium exits the cell
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| return of the cell to resting state caused by rentry of K+ into the cell while Na exits |
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| effective refractory period |
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| phase in which cells are incapable of depolarizing |
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| relative refractory period |
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| period in which cells require a stronger than normal stimulus to depolarize |
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| amount of blood ejected with each heartbeat |
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| amount of blood pumped by the ventricles in liters per minute |
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| deggree of stretch of the cardiac muscle to shorten in response to electrical activity |
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| ability of the cardiac muscle to shorten in response to an electrical impulse |
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| the resistance to ejection of blood from the ventricle |
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| the percent of the end diasolitc volume ejected with each heartbeat |
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| variations do not affect cardiac function but H2O retention |
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| can cause dysrythmias, vtach, vfib, digitalis tox |
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| can cause heart block, asystole, vent dysrhytmias |
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slow nodal function
impair cardiac contractility
CHF |
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potentiates dig toxicity
increased cardiac motility
increased risk for heart block
V fib
sudden death |
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magnesium-effects absoroption of Ca
depresses cardiac contraciltity and exciteability of myocardium
cause heart block or asystole |
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| elevation reflects reduced renal perfussion form dec CO |
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| most sensitive measure of renal function |
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| reflects blood glucose for 120 days |
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cardiac biomakers
most specific cardiac enzymes
1st levels to increase |
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cardiac biomaker
specific to cardiac muscle
evelvated quickly-allows for faster dx
peak 2-4 hours, remains elevated for 1-3 weeks |
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cardiac biomaker
not cardiac speci (renal, muscle)
small molecule-rapid inc
early inc in 1-3 hours
peaks 4-12 hours
returns to normal in 24 hours
if neg MI is r/o
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cardiac biomaker
neurohormone which regulates BP and fluid vol
secreted from ventricles in response to inc preload
BNP inc as vent walls expand
BNP inc in severity with of HF
BNP > 51 is mild heart failure
>1000 is severe heart failure |
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cardiac biomaker
produced by liver in response to inflamm and predict CVD risk
increase in levels of CRP greater than 3 are inc risk
elevated CRP proteins in patients with ACS @ high risk for reccurent cardiac events
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an AA which as it elevates indicates inc risk for CAD/stroke/PVD
linked to dev of arthersclerosis/damages endothelial lining of arteries, promotes thrombus formation
normal 5-15
mod 16-30
intermed risk is 31-100
high is over 100 |
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measures intrinsic pathway of clotting mech and the effect of heparin
ther range is 1.5-2.5
heparin rate adjusted <50 sec (inc heparin) or over 100 (dec heparin)
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measures extrinsic pathways
effects of coumadin/warfarin
not often used an independent measure |
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reported with PT, provides standard method for PT
used to monitor effect of warfarin
ther range is 2-3 for a fib
2.5-3.5 for valve replacement |
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nNon-invasive ultra-cound test
nUsed to examine heart size, shape & motion of cardiac structure
nAlso determines chamber size & etiology of heart murmurs (valve structure/function)
nAlso evaluates ventricular motion
nUses high-frequency sound waves generated thru chcest wall by a hand-held transduceràtransducer picks up echos & converts them to electrical impulsesàtransmits them thru ECHO machineà for display on a oscilloscopeàrecoding unto videotape
nTypes of images:
nM-mode: one dimensional mode àprovides info re: cardiac structure & motion
n2-Dimensional/Cross-Sectional: creates spatially correct images of the heart
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nUsed todetermine heart size, contour & position of heart
nAlso show physiologic alterations in pulmonary circulation
nIndicates positioning of cardiac catheters, pacemakers, pulmonary art. Catheters
nFluoroscopy allows visualization of heart on x-ray
nShows cardiac & vascular pulsations & cardiac contours
nUsed for proper positioning of pacing electrodes & guiding catheter insertion during cardiac cath.
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nProvides for graphic recording of the electrical activity of heart
nHardwire
nTelemetry
nContinuous ECG (Holter Monitor)
nCommonly used for outpatients
nSmall tape recorded carried & run for 10-24 hrs. during normal ADL
nIdentifies dysrhythmias or evidence of ischemia thru routine activities of day & night
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nCoronary arteries normally dilate 4 times their normal diameter in response to increased metabolic demands for O2 & nutrients
nArtherosclerotic vessels are less able to dilateà impaired blood flowà ischemia
nCardiac Stress Testing:
nExercise Stress Test
nPatient walks on treadmill
nBruce Protocol: increase treadmill speedà until pt. achieve target heart rate or becomes symptomatic
nPharmacologic Stress Test
nDrugs including dipyridamole & adenosine are administered to mimic effects of exerciseà maximum dilatation of the coraonary vessels
nNo caffeine or caffeine related products 2-4 days prior to test(interfere with drug)
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ndisorders of the formation or conduction (or both) of the electrical impulses in the heart
nThese disorders can cause disturbances of:
nRate
nRhythm
nBoth rate and rhythm
nPotentially can alter blood flow & cause hemodynamic changes
nDiagnosed by analysis of ECG waveform
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