PCCN Exam With 100% Correct Answers 2023

PCCN Exam With 100% Correct Answers 2023 S1 Mitral and tricuspid "lub" of "lub dub" S2 Aortic and pulmonic "dub" of "lub dub" S3 Ventricular Gallup. Beginning of diastole after S2. Too much volume S4 Rare. Atrial Gallup. Resistance to filling. End of diastole 1/avl/V5/v6 Lateral (Circumflex): AVL- High Lateral V6 Low Lateral Less common/ less severe II/III/avf Inferior V1/v2/ v3/ v4 Anterior V4R/ V5R RV CO HRXSV SV Preload/ after load/ contractility SVO2 from central line ~=70% Is increased SVO2 good or bad? Bad- it means that the tissues are not up taking O2. This should be "used blood" so the number should be lower Parasympathetic response Slows things down/ vagal response/ atropine blocks the vagas nerve and speeds up HR Betablockers ⬇️HR ⬇️contractility=⬇️BP/ ⬇️myocardial O2 demand Used in acute coronary syndrome. Can cause HF. Look for crackles and S3 One of the first drugs we give with angina because it decreases myocardial O2 consumption Sympathetic response Speeds things up/ epi/ dopamine Calcium Channel Blockers ⬇️HR and contractility us in rapid rhythm. Don't use in ACS. Amlodapine, dilt, nicardipine Reduce afterload by lowering intracellular Ca+ which inhibits smooth muscle contraction. Decreases contractility Digoxin Increase contractility= increased myocardial O2 demand. Takes 6 hrs to work. Don't use in ACS Pulse Pressure Difference between Diastolic and Systolic pressures. Must be at least 40. 40 patient is not being filled properly (dry) or has vasoconstriction. Preload Volume. Measured by CVP. How full in the ventricle before contraction. How to reduce Preload Reduce volume (diuretics)/ vasodilation (when you cant get rid of volume: Nitro, dilt, morphine)/ dialysis Replace preload Crystalloids: NS, isotonic, fluid bolus Colloids: Hetastarch, albumin, blood products:Expand intravascular volume. Use with caution in pulmonary edema Blood: ⬇️H&H, can increase afterload. Potential blood admin problems Can increase afterload Hyperthermia and coagulopathy in massive transfusions Hyperkalemia (RBCs break) and hypocalcemia (preservative in blood binds with Ca+) Afterload SVR (800-1200), resistance to ventricular ejection The more resistance the higher the myocardial O2 demand BP is indicator in tele How to reduce afterload Reduce resistance: ACE, ARBs, Alpha agonists (prazosin, phentolamine, clonidine) Beta Blockers, Calcium Channel Blockers (Nicardipine, diltiazem) Negative Inotropes Decrease HR and force of contraction: beta blockers, calcium channel blockers Positive inotropes Whip the heart into shape. Increase Contractility: Digoxin, Dopamine, Dobutamine, Milrinone, Amrinone lactate Last choice, try to decrease pre & afterload first Drug commonly used for vasospasm Calcium Channel Blockers Intended consequences of +Inotrope therapy Increased SV, Increased EF, Increased CO, increased tissue oxygenation