BNP Levels: Normal? Failure? Moderate Failure? Severe Failure? Where is it produced?
N: 0-100 F: 100-300 MF: >300 SF: >900 Produced in Lft Ventricle when in distress.
Pulmonary Artery Wedge Pressure (PAWP)
Left or Right of the Heart?
Normal?
Sick heart pawp and why?
- Left
- 6-14
- 18; Big Floppy heart; Chambers are larger/ stretched out so they need more volume to help fill the added space and not stress the heart out further
Normal CVP?
4-6 (0-8)
The primary function of the pulmonary artery catheter is to help evaluate what?
Left ventricular pressure/volume & function
Starling’s Law?
The more the heart is filled during diastole, the more forcefully it contracts.
Preload=______=_______
Preload=Volume=Workload
Things to alter preload?
- Diuretics: Lasix, Bumex, Diuril
- Vasodiltors: Nitrates (Relocate volume to periphery)
Afterload=________
Resistance
To alter afterload?
Arterial Vasodilators:
ACE/ARBS, Ca Channel Blockers (also Lowers HR), Nipride (IV only)
What are the 4 Determinants of cardiac output?
- Heart Rate
- Preload/Volume/Workload
- Afterload/Resistance
- Contractility/Strength
To alter Contractility?
To increase:
- Beta Adrenergic agonists: Epi, Dopamine, Dobutamine
- Phosphodiesterase Inhibitors
- Digoxin
To Decrease:
Beta-blockers
Intra Aortic Balloon Pump (IABP)?
a. Decreases afterload
b. Increases coronary perfusion
c. Placed in the aorta
d. Inflates during diastole
e. Deflates during systole
f. Decreases myocardial o2 demand, increases myocardial O2 supply
Ventricular Assist Device (VAD)?
a. Can partially or totally support circulation until heart recovers or donor is found
b. Blood is shunted away from the L atrium or ventricle to the VAD, then back to aorta
c. Pts that get VAD: trouble weaning from cardiopulmonary bypass, awaiting transplant or not a candidate, or those w/acute MI w/cardiogenic shock
_______ ________occurs b/c of sustained ischemia causing irreversible myocardial cell death
Myocardial Infarction
Does Angina resolve in an MI with rest/drugs?
No. There is a total blockage. Pain will not resolve until blockage is cleared.
3 Layers of heart tissue?
- Subendocardium
- Myocardium
- Endocardium
Zones of Injury in the Heart?
- Infarction: Dead, scarred, cannot be helped
- Injured: swollen, but can heal, must be protected
- Ischemic: no permanent damage unless prolonged
Diagnosis of an MI:
Serum Markers?
- Troponin: Norm:0-0.1
- Creat/Kinase (CK): Norm:35-170
- CK/MB Bands: Norm 0-7 (Specific to cardiac tissue)
EKG changes with an MI:
Infarction?
Ischemia?
Old infarction?
infarction: Elevated ST segment
ischemia: ST segment Depression
Old MI: Q wave
Give these 4 things to manage an MI…
Give in this order:
- Oxygen
- Nitrate
- Aspirin
- Morphine
The “King” of antiarrythmics?
Amiodarone
When is the only time you WANT to see arrythmias?
During re-perfusion
:can last 6-12hrs
When to stop during thrombolytic Therapy?
- Increase is HR, fall in BP
- GI Bleeding: throwing up blood
- Brain Bleed, Stroke: sudden decrease in LOC
If >40% of the heart is affected during an MI, then likely going to go into what?
Cardiogenic Shock: Reduced and effective CO
