CARDIAC NOTES Goal of cholesterol levels= less than 200 Lipid profile lab, CMP, EKG, CBC (complete blood count or red, white, hemoglobin, platelets counts) What is A1C? = glycated hemoglobulin – a good indicator of how someone’s glucose has been controlled over time Brian natriuretic peptide = peptide released from the ventricles in response to stretch (characteristics of heart failure) What is left ventricular hypertrophy? = when the heart works harder leading to hypertrophy What is our good cholesterol? HDL Hypertension is not diagnosed via a single BP reading; u need another one. What is metabolic syndrome? Metabolic syndrome increases your risk for stroke, heart attack. Medications work but works better with therapeutic lifestyle modifications Angiotensin receptor blocker for hypertension Statins for hyperlipidemia Metformin = typical starting drug for patients with diabetes These drugs will control someone’s metabolic syndrome it but won’t treat it! If someone is on Statins monitor with liver function test! Teach patient to stop drinking alcohol while taking those meds, periodic eye exams for the statins, educate on orthostatic hypertension, report muscle aches and pain Nitroglycerin - Monitor hypotension - Sends messages to baroreceptors and increases heart rate to try to maintain his cardiac output - Give IV fluids - DO EKG or ECG, draw blood to look for the enzymes first ( before giving the drug) Cardiac biomarkers help us to track progress of cardiac damage. Creatine kinase - Bb – brain - General muscle - CK mb** heart Troponin - Can be done on the bedside and is quick - BEST LAB to use LOOK AT BLOOD FLOW TO THE HEART VIDEO ESR -> nonspecific markers of inflammation CRP nonspecific markers of inflammation Anterior wall myocardial infarction related to the blood The big 3 coronary arteries: - Left main (widow maker): divides into - Left anterior discending, left circumflex - Right coronary Artery What is Preload? - Amount of blood returning to the heart What is afterload? the force that the heart (LV) has to overcome to eject blood (PVR) Metoprolol = A beta blocker that slows the heart and prolongs the time that the heart is in diastole (the resting, filling time) Our coronary arteries are only perfused or fills during DIASTOLE What is an infarction? = A blockage caused by atherosclerotic plaque with a thrombus ( this leads to clot formation) What is the definitive treatment for Infarction? – Interventional cardiology treatment like PCI What is a Stent? – keeps the vessels open GPIIb/IIIa drugs = prevent platelet aggregation ex: Abciximab, eptifibatide These drugs are given after the PCI is finished CABG- coronary artery bypass graft is a surgical procedure The difference between stable angina and unstable angina and MI Stable angina= (stable plaque that is not getting worst and is not associated with thrombus formation) ; chest discomfort that goes away when you rest or by NTG Unstable angina= progressing, new onset or unrelenting, frequent, does not go away with rest or NTG / we have enlarging or DAMAGED PLAQUE MI = death of tissues from blockage Difference between unstable anginas and MI= you can differ them via Serum biomarkers (troponin, ckmb) and ECG SERUM BIOMARKERS ARE NOT ELEVATED IN ANGINA compared to MI How to treat Stable Angina? Nitroglycerine (nitrates), lifestyle modifications, control it How to treat unstable angina? Give heparin, NTG, PCI. CABG to be done before it becomes an MI ANGINA in general is reversible ischemia How to treat MI? Heart failure RELISTEN TO LECTURE from beginning to- Left ventricular hypertrophy is due to What is the mode of action of Digoxin? Class= cardiac glycosside Dromotrope affect rate of conduction thus slows the heart rate Teach patient to take their pulse before taking Digoxin! Difference between left sided heart failure vs right sided heart failure BNP= comes from the Ventricles What do the natriuretic peptides do? - They are released in response to stretch on the baroreceptors (found in the aortic arch). Help gets rid of sodium RENAL What is urodynamic testing? - Intended to look at the functionality of the lower urinary tract Renal artery stenosis= decrease renal perfusion How to prepare a patient that is going to get a renal artery angiogram? - Pre-assessment = allergies (ask if allergic to contrast medium) List the renal function test Serum creatine, BUN, GFR, Albumin levels Creatine test is a better test of renal function in renal function. It looks at the 24-hour urine collection How to do 24-hour urine collection? Discard the first void and then the clock starts and keep the remaining voids. How is urinalysis different than culture? - We need a separate order for each. Do clean catch midstream, whatever u get from the cup, u divide it into 2 containers for 2 different tests. - Clean catch= give 3 wipes to females and clean one side, the other side and the middle and instruct to not touch the inside of the container. For males= start at the uretral uretis, clean outward… Treatment for UTI - Increase fluid intake - Take antimicrobials - Analgesics (phenazopyridine) Side effects of phenazopyridine= Can she still get a culture 3 days later after taking this med = can still do a clean catch urine and get culture because phenazopyridine does not remove the bacteria, it just removes discomfort. Bladder infection (lower urinary tract infection) = Pyelonephritis= infection of the kidney. HALLMARK= pain in the flank, fever How does a person with pyelonephritis differ? The #1 at risk group for urinary tract infection is: post-menopausal woman - Because they don’t have the classic symptom of a urinary tract infection and only presents with confusion There are four types of kidney stones: calcium oxalate, uric acid, struvite, and cystine.
