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Pulm Art Wedge Pressure Monitoring - Correct Answer SHould see a waveform with two small hill that correspond to the ecg Labeled a and v. ais LV EDP normal is 1-6 mmHg vis LA filling and normal is <5 mmHg balloon inflation only takes 1.5 cc fluid NORMAL is 6-12 mmHg PRIOR to IABP placement, what must be assessed? What value is very important for iabp? normals? - Correct Answer Collateral Circ Via doppler or ALLEN test MAP. Mean arterial pressure. MAP is [diastoleX2]+ Systole normal is 70-100 What is CVP? what does it measure, where, and normals? - Correct Answer Central Venous Pressure- looks at pressure in the RA. assesses the Fx of the RV. Normal is 2-5 mmHg After surgery may be elevated to 6-8 High CVP could show fluid overload, RV failure, cardiac tamponade, tricuspid stenosis, regurgitation, or thrombus obstruction Low CVP could mean shock or vasodilation, low volume cabg vs midcab - Correct Answer cabg is traditional. longer, larger incision, heart/lung bipass use, longer rehab midcab shorter procedure, may not go on bypass. sometimes pain may be worse after this but pain doesn't last as long as cabg followup for carotid endarterectomy - Correct Answer 1 week after. check for cranial nerve tests. assess vocal cord fx dopplers done at 3,6,12 mo flwup followup after thromboembolectomy - Correct Answer at 1 week. dopplers are also done here risks during hypothermic therapy - Correct Answer may be at higher risk for bleeding d/t extended clotting times. can safely go down to 33 C Aneurysm size vs followup time - Correct Answer 5 or larger..likely surgery 3-4 cm and non symptomatic--6 months to a year followup under 3 cm..checks every 5-10 yrs depending on problems treatment for Buerger's disease - Correct Answer stop smoking may need to revascularize sometimes amputation anticoagulation/antiplatelet drugs major amputations are common for those who won't quit smoking Treatments for CHF - Correct Answer Main goals are to manage fluid overload, improve cardiac function, and reducing cardiac workload overall Less than 2000 mg Na per day Less than 2L fluids per day Diuretics ACE inhibs Digoxin BBs and CCBs Anticoags Antiarrhythmics Antibiotics Corticosteroids Surgeries like CABG/MIDCAB Stenting angioplasty VADs ICDs/PMs Treatments for Cor Pulmonale - Correct Answer Treatment depends on whether its acute or chronic Vasodilators-nifedipine and other CCBs Diuretics anticoags cardiac glycosides like Dig Theophylline Bosentan O supplementation is big avoid smoking/drugs/alcohol, anything that would raise pulm pressure DM II drugs - Correct Answer insulins Sulfonylureas---glipizide, glyburide, glimedpiride Meglitinides—-repaglinide Biguanides--Metformin Thiazolidinediones==pioglitazone and rosiglitazone Dipeptidyl inhibs like sitagliptin Incretin mimetics====exenatide Amylin analogs===pramlitide acetate Alpha glucosidase inhibs like===Acarbose and Miglitol Metabolic syndrome treatments - Correct Answer Control weight, BP, lipids, DM. Endothelial Dysfunction causes and treatments - Correct Answer Can be caused from hyperlipidemia, septic shock, htn, chf, pad, chronic renal failure, DM, smoking anticoags Anti HTN drugs Lipid lowering drugs Pharm agents for high LDL - Correct Answer Statins Niacin Bile acid sequestrants like Cholestyramine-Colestipol--and Colesevelam Fibrates--Gemfibrizil, Clofibrate, Fenofibrate Cholesterol ab sorption agents like Ezetimibe Combo agents like extended release niacin/lovastatin Pharm agents for high TriGs - Correct Answer Fibrates--Gemfibrozil, ciprofibrate, fenofibrate, bezafibrate Nicotinic acid--NIACIN Tertiary..reduction in risk factors for those who've already had a stroke or TIA/CVA Drugs/Treatments for PAD pts - Correct Answer stop smoking more activity Antiplatelets Lipid lowering drugs Anti-HTN drugs Diabetic drugs Antithrombolytic agents Symptom relief meds Angioplasty bypass procedures Stenting Treatments for those with inflammatory diseases - Correct Answer Lifestyle modifications drugs-- Analgesics NSAIDS Corticosteroids Antimalarial agents like hydroxychloroquine Methotrexate and Leflunomide Anti tumor necrosis meds..Cyclophosphamide General inflammation is typically found in what marker - Correct Answer C-reactive protien. What meds may be used for those with pericarditis - Correct Answer NSAIDS antifungals narcotics...morphine and colchicine diuretics antibiotics ASA Corticosteroids what would be a major procedure used for pts with restrictive pericarditis - Correct Answer pericardectomy Meds used for vasculitis - Correct Answer corticosteroids cytotoxic drugs..azathioprine and cyclophosphamide NSAIDS Anticoagulants Immunomodulators. ...immune globulin Antibiotics. TMP-SMX Methotrexate HEP B prevention is key HIV preventions. No IV drugs. Safe sex practices Maintain proper BP and lipid levels healthy weight Treatments for endocarditis - Correct Answer antibiotics NSAIDS Valve surgery Higher risk patients may have artificial heart valves, previous endocarditis, congenital defects, or heart transplant Good dental hygiene is needed Tattoos are contraindicated and piercings Treatment details for pts with renal artery occlusion - Correct Answer Balloon angio Stenting Revascularization--- is an option in these conditions: bilateral stenosis stenosis with only 1 kidney [1 has been removed] Increased risk for passing it on Increased risk for aortic dissection during pregnancy Atrial septal defects treatment - Correct Answer If symptomatic, surgical closure. May not need sugery if it's small and pt is a-symptomatic Prophylactic antibiotics may be used for very young or very old pts to prevent endocarditis BBs, Digoxin, diuretics, anticoags, and anti platelts like ASA PE treatments - Correct Answer Fibrinolytic therapy for pts with right heart strain or those who are hemodynamically unstable Long term anticoagulation Preventive care DVT treatment - Correct Answer fondaparinux sodium dalteparin warfarin thrombolytics like alteplase tenecteplase, streptokinase Most common preventive approaches to venous insufficiency - Correct Answer avoid standing or sitting for extended periods of time graduated stockings bed rest to alleviate swelling surgical--- valvuloplasty radio ablation vein stripping wiligation sclerotherapy endovenous laser therapy meds---sclerosing agents like tetradecyl sulfate antibiotics corticosteroids most common cause of vascular valvular disease? - Correct Answer rheumatic fever meds to help with venous valve disease - Correct Answer vasodilators ACE inhibs Antiarrhythmic agents anticoagulants diuretics inotropes Treatments for angina pectoris - Correct Answer ASA BBs Antilipids Anticoags like heparin NTG and isosorbide CCBs Whatis a common cause of Afib in the elderly? - Correct Answer Chronic Resp problems like COPD Which type of arrhythmias respond better to catheter ablation? - Correct Answer Aflutter vs afib Meds used for VT - Correct Answer amiodarone lidocaine procainamide sotalol mexiletine atenolol acebutolol metop flecainide propafenone quinidine Meds used for cases of Vfib - Correct Answer Epinephrine What's the most effective treatment for compartment syndrome? - Correct Answer Surgical..fasciotomy Preventive--patient education Make sure casts aren't too tight Make sure bandages aren't too tight Acute pulm edema. Administer. ? - Correct Answer O2 Meds given for pulmonary edema - Correct Answer reduce preload...NTG, isosorbide Diuretics like lasix morphine afterload reducers like nitroprusside, enalapril, captopril ASA Blood pressure agents Pulmonary edema assoc with elevation changes may be treated with a what teaching can be given to these patients? - Correct Answer Acetazolamide above 8000 feet, travel up only 1000-2000 per day to get acclimated Carry oxygen Stay well-hydrated 1st degree HB--what is treatment? - Correct Answer If asymptomatic, nothing For those with s/s, may need to add in: Atropine lsoproterenol May need a pacemaker What is typically done for 2nd degree type 1 heart blocks? - Correct Answer Many times, nothing, if pt is not symptomatic or if vitals are stable. If s/s or if greater than 3 second pauses, may administer ATROPINE but most likely PM implantation is advised. Treatment of Second degree type 2 HB - Correct Answer If clinical signs or if s/s, likely pacemaker if needed, these are used: Atropine Isoproterenol Dopamine Complete HB treatment - Correct Answer PM implantation Atropine Isoproterenol What are some treatments for cardiogenic shock - Correct Answer Vasopressors-- dopamine/dobutamine Milrinone and inamrinone vasodilators like NTG Morphine furosemide surgical approaches- IABP and angioplasty, LVAD, heart transplant How soon after a PCI can acute stent thrombosis occur? - Correct Answer In the first 24 hours When does restenosis occur after a PCI - Correct Answer Usually 3 to 12 months after 
