CMC exam

CMC exam

Tricuspid regurgitation murmur - Harsh systolic murmur loudest at the lower left sternal border

Augmented during inspiration

Refuced in intensity and duration in a standing position and during a valsalva maneuver

Short early diastolic flow rumble may be present due to increased fliw across the teicuspud valve

Risk factors: infective endocarditis

Common causes of SCD in people under 30 - Pre existing cardiac abnormalities such as hypertrophic cardiomyopathy

Electric abnormalities caused by ion channel mutations in long QT syndrome and brugada syndrome

Ruptured ventricular Septum murmur - VSD patients develop a pansystolic murmur (ruptured septum will lead to the same crossing of blood

This is a high pitched loud blowing across the left sternal border

systolic murmur is holosystolic (sometimes called pansystolic) because the intensity is high throughout systole as shown in the figure. This type of murmur is caused by mitral or tricuspid valve regurgitation, or by a ventricular septal defect.

Ecg ruptured ventricular septum - Q waves in V1V2 V3

Ecg cardiac tamponade - Low voltage QRS with alternations in QRS height with each beat; electrical alternans due to swinging movement of herat in effusion-limb leads

Sinus tachycardia

Precordial st segment elevation

Pulmonic valve stenosis signs - R heart failure signs

Peripheral edema JVD Dyspnea w exertion Lightheadedness

Reteplase - fibrinolytic agent fir AMI when indicated

2

Lovenox - Alternate for heparin in patients with unstable angina , nstemi,or DVT

Streptokinase - Indicated for acute arterial thrombosis or embolism or occluded arteriovenous cannulas

Ateplase - Acute ischemic stroke or acute massive PE

Hypokalemia ecg - flattened T waves, prominent U waves, ST depression, prolonged PR interval

When might a patient with hemetemisis receiving warfarin not receive vitamin K? - With a mechanical valve

What is metabolic syndrome? - increased risk of DM, Stroke, and heart dz

Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states

Tikosyn ekg changes - Prolongation of the QT interval Normal QT is 350-450

Increased risk of torsades de pointes (especially with QT > 500)

Paop reads - Left ventricular end diastolic pressure

(Lv volume at the end of filling)

Normal 5-12

Normal PAOP (wedge) pressure - 5-12 mmHg

SvO2 - 60-80%

Reflection of the end result of the balance between oxygen delivery and oxygen consumption

Biggest risk of TEE - Bleeding

Especially with patients on heparin (so LVAD pts), with liver cirrhosis, or esophageal varices

Aortic stenosis signs - S4 on auscultation (atrial gallop)

Angina Syncope Other symptoms of heart failure

Diagnosed with an echo

3

Stress test is contraindicated

cor pulmonale - right-sided heart failure arising from chronic lung disease

Expect tricuspid regurgitation as a result if the high pulmonary pressures and resistance to forward flow of fluid outside the pulmonary system

EKG May show v waves

Eventually the right atrium and ventricle will enlarge

Hypokalemia EKG changes - Flattened T wave

Elevated U wave

Depressed ST segment

Hyperthyroidism arrhythmia - A fib

Loud systolic murmur within 24 hours of a STEMI indicates - Ventricular septal wall rupture

Typically within 24 hours if a MI and a loud systolic murmur will present with symptoms of heart failure

Hemos of pulmonary htn - High cvp (normal 2-8) High PAP (normal systolic 15-25 and diastolic 8-15) NORMAL PAOP (6-12) (can be elevated? if cardiac related?) Decreased CO (normal 4-8)

Cvp 12, PAP 70/28, PAP mean 42, PAOP 7, CO 2.5 indicates... - Pulmonary HTN

Reversal for benzocaine - Methylene blue

Causes of Low SvO2 (<60>

Which type of MI would make a nurse cautious with the usage of nitro in - Right ventricular infarct as indicated by st elevation in lead II, III, or aVF - inferior MI

Nitro decreases preload by decreasing venous return to the right heart-this can result in decreased right ventricular strike volume and hypotension

4

With an IABP a pt starts to report a tingling sensation to the left hand and lower arm. The radial pulse is decreased compared to the right. What should the nurse anticipate? - A CXR to ensure the balloon has not migrated into the subclavian artery

What valve condition is associated with a fib - Mitral valve stenosis

Holosystolic murmur post MI - Emergency

Could be papillary muscle rupture or Ventricular septal rupture

Hearing S3 or S4 after MI - Possible new onset heart failure

pulmonic valve stenosis - Signs of right sided heart failure

Peripheral edema JVD Dyspnea On exertion Lightheadedness

If a patient is a t high risk for HITT what drug will be used for PCI? - Angiomax

Metolazone (Zaroxolyn) - Distal tube diuretic

used when loop diuretics are not enough

hypovolemia PAOP, PAD - PAOP <6>

PAD <8>

Volume overload PAOP, PAD - PAD > 15 PAOP >12

Pulmonary HTN PAOP, PAD - PAD > 15 PAOP >12

WITH gradiant variance >3 on PA line insertion

hypovolemic shock ABG - metabolic acidosis

systolic murmur post MI

first 24 hours

2-7 days - first 24 hours- VSd

2-7 days- papilary muscle rupture