Tachyarrhythmias
True or false: During a GXT, suppression of a PVC with exercise means it is benign.
True
Who usually has bradyarrhythmias?
Usually occurs in 70-80 yr olds
What 3 things are you looking for in a pt c/o CP?
1. STEMI
2. NSTEMI
3. Arrhythmia
Ischemic heart disease is the same as ___.
Atherosclerotic Coronary Artery Disease (ASCAD)
What is the initial intervention for acute coronary syndrome by nurse triage?
•Vital Signs with pulse oximetry
•IV access (usually labs are drawn)
•O2 via Nasal cannula: 2-4 liters per minute if O2 sat ≤ 90%
•Monitor: continuous telemetry and O2 sat monitoring
•12 Lead ECG
•ASA 81mg X 3 (baby aspirin) if no C/I
PAC: comes from foci other than sinus node; could be single or multiple foci
- Narrow complex QRS
PVC: cardiac beat arising from the ventricle usually with a wide complex QRS reflecting the ventricular origin
What is the 1st line tx for bradyarrhythmias?
Atropine 1 mg
Why is a STEMI the most concerning condition w/ CP?
Due to risk of entire muscle death
What is the pathophysiology of ischemic heart disease?
Inadequate supply of blood and oxygen to a portion of the myocardium; it typically occurs when there is an imbalance between myocardial oxygen supply and demand
What is the average age of one's 1st MI in women and men?
The average age of first myocardial infarction is 65.6 years old for men and 72.0 years old for women.
What are risk factors for a PAC?
•Increasing age
• Stress
• Stimulants: Caffeine, tobacco, alcohol
•Heart disease: HTN, VHD, CAD
•Abnormal blood levels of magnesium and/or
potassium
What are the reversible causes of bradyarrhythmias?
5 H's:
Hypothermia, hypovolemia, hypoxia, hydrogen ions (acidosis), & Hyper/hypokalemia
5 T's:
Tamponade, Toxins, Tension pneumothorax, Thrombosis (heart: acute, massive MI), Thrombosis (lungs: massive PE)
What is included in the HEART Score calculation?
Hx
ECG
Age
Risk Factors
Troponin
What is the result of stable and unstable plaques?
•Stable plaque with vessel narrowing: Stable angina
•Unstable plaque with rupture or erosion: Unstable angina, Non ST elevation MI (NSTEMI), ST elevation MI (STEMI)
What is the atypical presentation of Non-ST-acute coronary syndrome, and who is this most common in?
Dyspnea, epigastric discomfort, jaw pain, nausea, or weakness may occur instead of chest discomfort
•Common presentation in women, older patients, and patients w/ DM
Who are nonphysiologic sinus tachycardias seen in?
Older pts
What are the functional and structural causes of AV node dysfunction?
Functional:
• Metabolic: hyper/hypo kalemia
• Endocrine: hypothyroidism
• Infection: Lyme carditis
• CAD
• Drug related: Beta blocker, Ca channel blockers, Antiarrhythmics
Structural:
• Infection: Syphillis
• Amyloidosis
• CAD
• Idiopathic
• ACC/AHA Risk Calculator:
• Framingham 10 yr risk assessment
• Reynolds Risk Score
• HEART score
• TIMI score
• Grace score
What sign is commonly seen when there's substernal discomfort?
Levine’s Sign
What is the pathophysiology of Non-ST-acute coronary syndrome (NST-ACS)?
Disruption of an unstable coronary plaque due to plaque rupture, erosion, or a calcified protruding nodule that leads to intracoronary thrombus formation
• Paroxysmal A-fib (PAF): episodes < 7 days; tends to be recurrent
• Persistent Atrial fibrillation: Episodes > 7 days that respond to treatment
• Permanent Atrial Fibrillation (Longstanding Persistent): A-fib that does not respond to treatment
What is the patho, epidemiology, presentation, & tx for sick sinus syndrome (SSS)?
• Patho: inability of the heart's natural pacemaker (sinus node) to create a heart rate that's appropriate for the body's needs.
• Epidemiology: most common in 70’s
• Presentation: Sinus bradycardia, sinus arrest, alternating bradycardia and tachycardia
• Treatment: pacemaker
What are the nontraditional Risks of CVD and their levels?
•Fasting triglycerides ≥175 mg/dl
•Elevated lipoprotein(a) ≥50 mg/dL
•Elevated apoB ≥130 mg/dL
•C-reactive protein (CRP) ≥2 mg/L
•Ankle-brachial index (ABI) <0.9
•Coronary artery calcium score (CACs): 0 Agatston units= No identifiable disease
Name and describe the two primary means of revascularization.
•Coronary Artery Bypass Grafts (CABG)
Venous grafts comes from the leg. Arterial grafts comes from the left internal mammary artery
- May confer additional morbidity or mortality benefit compared to venous grafts
•Percutaneous coronary intervention
1.Percutaneous Transluminal Coronary Angiography (PTCA); works better when you also use a stent
2.Coronary artery stents
•Bare metal: requires 1 month of dual antiplatelet therapy
•Drug eluding: preferred; requires dual anti-platelet therapy for 6 months
3.Atherectomy (Roto-Rooter): Rarely used
What are conditions that cause increased myocardial demand or decrease supply?
•Anemia
•Fever
•Tachycardia
•Thyrotoxicosis (extreme of hyperthyroidism)