Cardiovascular Emergencies and Conditions

• Exam 1 Study Guide covers Cardiac topics, including medications, valvular issues, murmurs, EKGs, anticoagulants, heart failure, MI, cardiac tamponade, pericarditis, and angina vs. MI.

Cardiac Arrest & ROSC Meds

• Lidocaine is used post-cardiac arrest to prevent dysrhythmias by slowing conduction and reducing heart tissue automaticity.
• Epinephrine can help achieve Return of Spontaneous Circulation (ROSC) by increasing coronary and cerebral perfusion pressure during CPR.
• Amiodarone treats Ventricular Fibrillation (VF) and Ventricular Tachycardia (VT), especially when other treatments fail, thus managing arrhythmias during and post-arrest.
• Pulse checks after resuscitation confirm the heart's effective pumping, with pulse quality indicating hemodynamic status.

Valvular Stenosis & Regurgitation

• Valvular Stenosis is when the heart valve narrows and restricts blood flow.
• Valvular Stenosis leads to loud murmurs from turbulent blood flow and causes symptoms like fatigue, shortness of breath, and chest pain.
• Valvular Regurgitation is when the heart valve doesn't close properly, causing backward blood flow
• Valvular Regurgitation may result in soft murmurs with symptoms such as palpitations, fatigue, and shortness of breath, potentially leading to heart failure.

Heart Murmurs

• Murmurs are abnormal heart sounds caused by turbulent blood flow through the heart valves.
• Systolic murmurs occur between S1 and S2, while diastolic murmurs occur between S2 and S1.

EKG Components

• P wave indicates atrial depolarization, lasting 0.06-0.12 seconds.
• PR interval spans from the beginning of the P wave to the start of the QRS complex, lasting 0.12-0.20 seconds.
• QRS complex represents ventricular depolarization, lasting 0.06-0.1 seconds.
• ST segment indicates the period between ventricular depolarization and repolarization, lasting 0.12 seconds.
• T wave represents ventricular repolarization, lasting 0.16 seconds.
• QT interval measures the total time for ventricular depolarization and repolarization, with a normal duration of 0.34-0.43 seconds.

Tachycardia

• Tachycardia is a heart rate greater than 100 bpm.
• Tachycardia can be caused by physical/psychological stressors, hypotension, hyperthermia, hypovolemia, anemia, hypoxia, hypoglycemia, myocardial infarction, heart failure, or hyperthyroidism.
• Beta Blockers and Calcium Channel Blockers are interventions for tachycardia to slow heart rate.
• Adenosine is used for supraventricular tachycardia (SVT).
• Synchronized Cardioversion may be used if tachycardia patients are unstable.
• Tachycardia Symptoms: Dizziness, dyspnea, and hypotension, increased oxygen demand leading to angina.

Anticoagulant Meds

• Anticoagulant Medications: Warfarin, Heparin, and Direct Oral Anticoagulants (DOACs) like apixaban, rivaroxaban, and dabigatran.
• Problems: Bleeding, thrombosis, drug interactions are all potential problems with anticoagulants.
• Prothrombin Time (PT) / International Normalized Ratio (INR) monitors warfarin, with a target INR of 2-3.
• Activated Partial Thromboplastin Time (aPTT) monitors heparin, with a therapeutic range typically 1.5 to 2.5 times the normal value (25-35 seconds).
• Complete Blood Count (CBC) checks hemoglobin, hematocrit, and platelet levels to assess bleeding or clotting issues.
• Warfarin reversal agent: Vitamin K, prothrombin complex concentrates (PCC), or fresh frozen plasma (FFP).
• DOACs reversal agent: andexanet alfa used for rivaroxaban and apixaban.
• Heparin reversal agent: protamine sulfate.

Left vs. Right-Sided Heart Failure

• Decreased perfusion signs include hypotension, decreased urine output, cool extremities, altered mentation, heart murmur, dysrhythmias, and worsening renal/liver function.
• Right-Sided Heart Failure Signs: Increased HR, murmur, jugular vein distention, edema, weight gain, ascites, hepatomegaly, fatigue, anxiety/depression, right upper quadrant pain, anorexia, and GI symptoms.
• Left-Sided Heart Failure Signs: Increased HR, poor O2 exchange (low PaO2 and elevated PaCO2), crackles in the lungs, S3 & S4 heart sounds, pleural effusion, change in mental status, restlessness/confusion, dizziness, shallow rapid respiration, dry/hacking cough, frothy/pink tinged sputum. Weakness, fatigue, anxiety/depression, dyspnea, paroxysmal nocturnal dyspnea, orthopnea.
• Heart Failure Complications: pleural effusion, dysrhythmias, hepatomegaly, cardiorenal syndrome, anemia Symptom relief, optimizing volume status, supporting oxygenation, ventilation, CO, and end-organ perfusion are common. Goals of HF Therapy include identifying and addressing the cause, avoiding complications, and providing teaching on diet, exercise, and medication adherence.
• Medical interventions and prioritization (ABC) for MI.

Cardiac Tamponade

• Cardiac Tamponade is fluid accumulation in the pericardial sac, compressing the heart and preventing complete filling.
• Fluids in the sac could be pus, blood etc.
• Cardiac Tamponade Symptoms: dyspnea, dizziness, "tightness" in the chest, increasing restlessness, pulsus paradoxus (>10mmHg drop in systolic BP during inspiration), tachycardia, muffled heart sounds, jugular vein distention
• Treatment considerations: administering fluids for hypotension and preparing for pericardiocentesis.

Pericarditis

• Pericarditis is inflammation of the pericardium.
• The cause can be infections such as Viral, bacterial and fungal infections, cancer, HIV including AIDS, kidney failure, TB etc.
• Pericarditis Symptoms: chest pain (increased pain with laying flat or deep breathing, sharp/stabbing pain), muffled heart sounds, fever, chills, swelling in lower extremities, difficulty breathing, dry cough, and fatigue.
• Sitting up and slightly forward often relieves the chest pains.
• Auscultate heart sounds to see if they are distant and muffled and assess for a pericardial rub.
• If the buildup of fluid makes the heart function poorly, treatment may include draining the fluid from the sac or cutting a small hole in the pericardium to allow the infected fluid to drain into the abdominal cavity.

Angina vs. Myocardial Infarction (MI)

• Angina is chest pain.
• Stable Angina occurs predictably, is triggered by exertion/stress, relieved by rest/nitroglycerin
• Unstable Angina is more serious, unpredictable, can occur at rest, and could lead to MI.
• Variant Angina (Prinzmetal's) is from coronary artery spasms, can occur at rest, and may lead to complications.
• Typical Angina Pain: chest discomfort, pressure, squeezing, burning, tightness, can affect the arms, neck, jaw, shoulder, or back, usually lasts for a few minutes, relieved by rest or nitroglycerin.
• Stable Angina Pectoris is chronic pain, relieved with nitroglycerine.
• Unstable Angina is a new episode and may increase in severity, it is an emergency.
• Angina Management: lifestyle changes, medications (nitroglycerin, beta-blockers, calcium channel blockers, antiplatelet agents), and revascularization procedures.
• Myocardial ischemia causes include blood clot (coronary thrombosis) or atherosclerotic plaque.
• Acute Coronary Syndrome (ACS) includes unstable angina, NSTEMI, and STEMI, caused by plaque rupture and blood clot formation.
• Unstable Angina is ACS without permanent heart damage.
• NSTEMI involves myocardial damage indicated by cardiac biomarkers and partial or transient artery blockage.
• STEMI is a severe heart attack displaying ST-segment elevation, caused by complete artery blockage.
• ACS Symptoms: Chest pain or discomfort (squeezing or pressure), shortness of breath, nausea and vomiting, sweating, fatigue, dizziness.
• ACS Treatment: Medications (aspirin, nitroglycerin, anticoagulants), reperfusion therapy (PCI or thrombolytic therapy), and oxygen therapy.
• Immediate action is needed if ACS is suspected.
• MONA (Morphine, Oxygen, Nitro, Aspirin) is used to treat MI.
• Nitrates are vasodilators.
• Aspirin reduces platelet adherence (limits clotting).
• Beta blockers decrease myocardial oxygen demand.
• Calcium antagonists dilate arterioles (decreased systemic vascular resistance).
• ACE inhibitors decrease BP and resistance, preventing heart remodeling in heart failure patients.

Questions covering cardiovascular emergencies, including CPR drug administration and post-resuscitation assessment. Also tests knowledge of valvular heart diseases such as stenosis and regurgitation, their symptoms, and EKG interpretations.