Coronary Arteries
- Aortic Root
- Right Coronary Artery (RCA)
- Right (Acute) Marginal Artery
- Posterior Descending Artery (PDA)
- Left Coronary Artery (LCA)
- Left Anterior Descending (LAD) Artery
- Circumflex Artery
- Left Marginal Artery
Cardiac Enzyme Evaluation: Myoglobin
- Skeletal or Cardiac Muscle Injury
- Onset: 1 - 4 Hours
- Peak: 12 Hours
- Return to Normal: 24 Hours
- Elevation After 24 Hours: Reinfarction
Cardiac Enzyme Evaluation: Troponin
- Cardiac Muscle Injury
- Detection in Blood: 4 Hours
- Peak: 24 - 36 Hours
- Return to Normal: 5 - 14 Days
- Most Specific for Cardiac Muscle
- Treat Aggressively
Cardiac Enzyme Evaluation: Creatine Kinase CK-MB
- Skeletal or Cardiac Muscle Injury
- Onset: 4-8 Hours
- Peak: 12-24 Hours
- Return to Normal: 2-3 Days
WBC Differential Lab Value
- White Blood Cells (WBC)
- 5-10 (5,000-10,000)
- Neutrophils (50%-70%)
- Bands (2%-5%)
- Segs (50%-70%)
- Lymphocytes (20%-40%)
- Monocytes (4%-8%)
- Eosinophils (2%-4%)
- Basophils (0.5%-1.5%)
Magnetic Resonance Imaging (MRI)
- Internal Body Images
- Detects Variations of Soft Tissues
- No Metal Objects
- No Pacemakers
- Contrast is Non-Iodine
- Safe During Pregnancy
- Long Procedure
- Antianxiety Medications
Myocardial Infarction Assessment
- Substernal Chest Pain
- Crushing or Dull Sensation
- Arm, Jaw, and Neck
- > 20 Minutes
- Unrelieved by Nitro
- Palpitations
- Diaphoresis
- Fear of Impending Doom
- Nausea and Vomiting
- Shortness of Breath
- Monitor for Arrhythmias
Myocardial Infarction Diagnosis
- 12 Lead ECG
- ST Elevation
- Q Wave
- T Wave Inversion
- Troponin T and I
- CK-MB
- Early ECG
- Cardiac Stress Test
Myocardial Infarction Interventions
- Morphine
- Oxygen
- Nitrates
- Aspirin
- Thrombolytics (tPA)
- Cardiac Catheterization
- Stent Placement
- Angioplasty
- Coronary Artery Bypass Grafting (CABG)
- Decrease Modifiable Risk Factors
- Resuming Activity (Physical, Sexual)
Types of Heart Failure
- Left Sided
- Pulmonary Congestion
- Right Sided
- Peripheral Edema
- High Output
- Unable to Meet Metabolic Needs
Right Heart Failure Assessment
- Jugular Venous Distention (JVD)
- Peripheral Edema
- Hepatosplenomegaly
- Nocturia
- Weight Gain
- Ascites
- Fatigue
Left Heart Failure Assessment
- Pulmonary Congestion
- Pink Frothy Sputum
- Wheezing or Crackles
- Dyspnea with Exertion
- Cough
- Fatigue
- Tachycardia
- Weak Peripheral Pulse
- S3, S4 Heart Sounds
Heart Failure Interventions
- Echocardiogram
- Invasive Hemodynamic Monitoring
- High Fowler's Position
- Oxygen
- Advanced Airway
- Diuretics
- Beta Blockers
- Angiotensin II Receptor Blockers (ARBs)
- ACE Inhibitors
- Digoxin (Lanoxin)
- Pacemaker
Types of Shock
- Hypovolemic
- Depleted Volume
- Cardiogenic
- Pump Failure
- Obstructive
- Indirect Pump Failure
- Distributive
- Lost Vascular Tone
- Neurogenic
- Anaphylactic
- Septic
Acute Pancreatitis Causes
- "GET SMASHHED" Mnemonic
- Gallstones
- (Ethanol) Alcohol
- Trauma
- Steroids
- Mumps
- Autoimmune
- Scorpion Sting
- Hypercalcemia
- Hypertriglyceridemia > 1000
- ERCP
- Drugs
Acute Pancreatitis Assessment
- Heavy Alcohol Use and Gallstones
- Abdominal Pain
- Nausea/Vomiting/Anorexia
- Abdominal Rigidity/Guarding
- Decreased or Absent Bowel Sounds
- Hypotension and Tachycardia
- Jaundice
- Increased White Blood Cells
Acute Pancreatitis Interventions
- NPO with NG Tube to Suction
- Pain Management
- Albumin
- Lactated Ringers Solution
- Proton Pump Inhibitor (PPI)
- Antibiotics
- Surgery
- Nutrition
Cardiac Tamponade
- Fluid in the Pericardial Sac
- Pericarditis
- Decreased Cardiac Output
- Beck's Triad
- Hypotension
- Jugular Venous Distention (JVD)
- Distant Heart Sounds
- Pulsus Paradoxus
- Electrical Alternans
- Pericardiocentesis
Venous Thromboembolism (DVT) Assessment
- Venous Wall Inflammation caused by Thrombus
- Tenderness
- Edema
- Warmth
- Asymmetry
- Could be Asymptomatic
- Monitor for Pulmonary Embolism
Venous Thromboembolism (DVT) Interventions
- Anticoagulants
- Prevention Education
- Frequent Ambulation
- Leg Exercises
- Compression Stockings or SCD's
- Avoid Nicotine and Oral Contraceptives
- Surgery
Aortic Stenosis
- Age-related Calcifications
- Bicuspid Aortic Valve
- Crescendo-decrescendo Murmur
- Systolic Murmur
- Ejection Murmur
- Ejection Click
- Radiates to Carotids and Apex
- Pulsus Parvus et Tardus
- Syncope
- Helmet Cells
Aortic Regurgitation
- Diastolic Murmur
- Immediate High-pitched
- Blowing Murmur
- Wide Pulse Pressure
- Water Hammer Pulse
- Head Bobbing
- Pulsating Nail Bed
- Can Cause Austin Flint Murmur
Tricuspid Regurgitation
- Holosystolic
- Blowing Murmur
- Radiates to Right Sternal Border
- Enhanced by Inspiration
Mitral Regurgitation
- Holosystolic
- Blowing Murmur
- Loudest at Apex
- Radiates toward Axilla
- Louder by Squatting
- Hand Grip
- Expiration
Abdominal Aortic Aneurysm (AAA) Assessment
- Atherosclerosis
- Bruit
- Pulsation in Abdomen
- Abdominal or Lower Back Pain
- Tearing Pain
- Ultrasound
- Rupture
- Shock
- Surgical Repair
Hypertension Assessment
- Essential Hypertension
- Secondary Hypertension
- Headache
- Vision Changes
- Nosebleed (Epistaxis)
- Chest Pain
- Syncope (Fainting)
- Average 2 Sets, 2 Minutes Apart
- After 2 or More Visits (within 1-4 weeks)
- Take BP Both Arms
- Common in African Americans
Hypertension Intervention
- Weight Reduction and Exercise
- Diet Changes
- Relaxation Techniques
- Smoking Cessation
- Medications
- Encourage Self Monitoring