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\author{Maria K (mkravatz)}
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  /Title (pt-management-and-problems-of-the-cv-system-part-2.pdf)
  /Creator (Cheatography)
  /Author (Maria K (mkravatz))
  /Subject (Pt Management \& Problems of the CV System - Part 2 Cheat Sheet)
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        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Pt Management \& Problems of the CV System - Part 2 Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Maria K (mkravatz)} via \textcolor{DarkBackground}{\uline{cheatography.com/71404/cs/18107/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Maria K (mkravatz) \\
  \uline{cheatography.com/mkravatz} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 2nd December, 2018.\\
   Updated 2nd December, 2018.\\
   Page {\thepage} of \pageref{LastPage}.
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  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Cardiac Catheterization}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{What is the purpose?}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}The most definitive way to identify and diagnose CVD \{\{nl\}\} Can determine if any vessels are blocked, congenital issues, CAD, blood flow issues, valve issues, oxygenation \{\{nl\}\} May use US at the same time \{\{nl\}\} Con: expensive} \tn 
% Row Count 6 (+ 6)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Pre-Procedure}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Treat like surgery-{}-{\emph{cannot}} do without consent for cath AND heart surgery \{\{nl\}\} Use dye  to see how blood perfuses through the arteries \{\{nl\}\} Ask person to cough = changes intrathoracic pressure (helps to move dye \{\{nl\}\} Give fluid (dye is dehydrating \& damages kidneys)} \tn 
% Row Count 13 (+ 7)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Post-Procedure}}} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Less limitation w/ radial, lay flat \{\{nl\}\} Femoral: check pulses \& mark w/ X's, make sure same strength \{\{nl\}\} {\emph{Biggest complication}}: arrhythmias, {\bf{bleeding}} (check all around wrist/leg, every time heart is accessed = inc. risk for a fib) \{\{nl\}\} Pay close attention! High risk for problems!} \tn 
% Row Count 21 (+ 8)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{If pt is allergic to dye: give Benadryl (anti-histamine), Tylenol (anti-pyretic), Hydrocortisone (steroid)}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{L- vs. R-Sided Cardiac Cath}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{R-Sided Cath}}: inc. risk for PE or vagal nerve (= pass out)} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{L-Sided Cath}}: inc. risk for MI} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Both}}: inc. risk for cardiac tamponade} \tn 
% Row Count 4 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Cardiac Tamponade}}: {\emph{pericardial sac fills w/ blood = inc. pressure on heart}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Mean Arterial Pressure (MAP)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Systolic BP + {[} (2 x Diastolic BP) / 3 {]}}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Example: 125/75 \{\{nl\}\} 125 + {[} (2 x 75) / 3{]} \{\{nl\}\} MAP = 92 mm Hg} \tn 
% Row Count 3 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{MAP must be at least {\bf{60+ (60-70 mm Hg)}} for adequate coronary pressure!}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Monitoring}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bb\}\} {\bf{{\emph{Hemodynamic Monitoring}}}}: used to look at pressure in the heart \{\{nl\}\} - Pt must lie flat to zero out the heart} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Invasive vs. Non-Invasive}}} \tn 
% Row Count 4 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Central Venous Pressure (CVP)}}: R atrial pressure; mirrors fluid status in the body} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{bb\}\} {\bf{Arterial Lines}}: accurately monitor BP \& MAP; may be radial, brachial} \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{{\emph{Pulmonary Artery Catheter}}}}: R artium to R ventricle to pulmonary arteries \{\{nl\}\} - Can compare R and L side pressures \{\{nl\}\} - Example: SWAN catheter} \tn 
% Row Count 12 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Allen's Test}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{1. Hold both arteries. (Hand blanches white.)} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{2. Open hand and release ulnar artery. (Hand should pink up.)} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Pink hand = safe to use} \tn 
% Row Count 4 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Diagnostic Studies}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Electrophysiology Studies (EPS)}}: looks at intracardiac conduction system \{\{nl\}\} - Identify arrythmias \{\{nl\}\} - Differentiate between arrythmias, if person needs pacemaker/ICD, are meds effective = may need to take for surgery} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{PET Scan}}: compares cardiac perfusion \& metabolic functions \{\{nl\}\} - If mismatched = ischemia} \tn 
% Row Count 7 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{MRI/MRA}}: may use dye \& do angiography at the same time} \tn 
% Row Count 9 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Electronic-Beam Tomography}}: similar to CT scan but more for the heart} \tn 
% Row Count 11 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Disorders of Myocardial Perfusion}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bb\}\} {\bf{{\emph{Coronary Artery Disease}}}}: ACS \& atherosclerosis} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Acute Coronary Syndrome (ACS)}}: results from fibrous tissue \& plaque accumulation \{\{nl\}\} 1. Unstable angina \{\{nl\}\} 2. NSTEMI \{\{nl\}\} 3. STEMI} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Atherosclerosis}}: often takes years \{\{nl\}\} - Response to injury theory: fatty streaks \{\{fa-arrow-right\}\} fibrous plaques \{\{fa-arrow-right\}\} plaques rupture \& form thrombus \{\{fa-arrow-right\}\} inflammatory cells (clot forms on plaque \& clot breaks free)} \tn 
% Row Count 11 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Angina}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Causes}}: myocardial ischemia (dec. supply \& inc. demand), aortic stenosis, cardiomyopathies} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Assessment}}: pain, onset, duration, severity} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Types}}: \{\{nl\}\} - {\emph{Stable}}: at expected time (ex: w/ exercise) \{\{nl\}\} - {\emph{Unstable}}: pain "for no reason", no predictable pattern; indicates major coronary event \{\{nl\}\} - {\emph{Nocturnal Angina}}: wake up in the middle of the night} \tn 
% Row Count 8 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Diagnosis}}: get an EKG, change in ST segment = something going on \{\{nl\}\} * CHEW an aspirin} \tn 
% Row Count 10 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Pharmacological Interventions}}: \{\{nl\}\} - {\emph{Aspirin}} (dec. platelet aggregation) \{\{nl\}\} - {\emph{Nitrates/anti-anginals}} (coronary vasodilators, not selective for cardiac vessels (= MASSIVE HA, pass out = wear gloves!) \{\{nl\}\} - {\emph{Beta-blockers}} (dec. HR = dec. O`2` demand, open blood vessels = inc. circulation) \{\{nl\}\} - {\emph{Statins}} (dec. plaque buildup) \{\{nl\}\} - {\emph{CCB}} (dec. heart contractility {[}of smooth muscles in arteries = vasodilate{]} \& O`2` demand) \{\{nl\}\} - {\emph{ACEI}} (help to vasodilate = dec. BP = dec. afterload \& makes it easier for heart to work) \{\{nl\}\} {\bf{BIGGEST CONCERN}} = pain relief \{\{fa-arrow-right\}\} inc. O`2` demand and perfusion} \tn 
% Row Count 23 (+ 13)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Lifestyle Changes}}: \{\{nl\}\} - {\emph{Diet}}: no smoking, healthy diet (dec. sat fat \& processed foods), control cholesterol \{\{nl\}\} - {\emph{Exercise}} \{\{nl\}\} - {\emph{Lipids}}: control \& check levels \{\{nl\}\} - {\emph{Weight}}: lose if possible \{\{nl\}\} - {\emph{Comorbidities}}: control them! \{\{nl\}\} - Other: {\emph{avoid stress}} (= inc. plaque, constricts blood flow)} \tn 
% Row Count 30 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Myocardial Infarction (MI)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Assessment}}: CP unrelieved/unrelenting, nausea, dyspnea \{\{nl\}\} - Not everyone gets arm/jaw pain} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Diagnosis}}: EKG! (ST-seg changes) \& inc. enzymes (trop, CK-MB, others; WBC r/t inflammation)} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{Severity depends on which vessel is blocked}}} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{STEMI}}: complete occlusion of a major vessel w/ full thickness damage \{\{nl\}\} - Inc. risk for complications \{\{nl\}\} - 10-15\% mortality rate during admission \{\{nl\}\} 1. Inc. enzymes \{\{nl\}\} 2. Inc. \{\{nl\}\} 3. Inc. risk of complications} \tn 
% Row Count 10 (+ 5)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Non-STEMI}}: complete occlusion of a minor coronary artery OR partial occlusion of a major coronary artery \{\{nl\}\} - Mortality rate = 3-5\% \{\{nl\}\} - Happens more w/ vasospasm} \tn 
% Row Count 14 (+ 4)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{{\emph{Troponin level correlates to damage!}}}}} \tn 
% Row Count 15 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Heart Zones}} \{\{nl\}\} - Zone of ischemia: {\emph{T-wave inversion}} - can come back \{\{nl\}\} - Zone of injury: {\emph{ST elevation}} \{\{nl\}\} - Zone of necrosis: {\emph{abnormal Q}} = never coming back} \tn 
% Row Count 19 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Surgical MI Interventions}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bb\}\} {\bf{Coronary Artery Bypass Graft (CABG)}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{1. {\bf{On-Pump}}: put pt on bypass machine, reoxygenate blood and return to body \{\{nl\}\} - Heart stopped = inc. risk for complications (bleeding, stroke, etc.)} \tn 
% Row Count 5 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{2. {\bf{Off-Pump}}: risks w/ beating heart} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Venous graft \& placement}}: {\emph{mammary vessels}} are best, preferred for off-pump  \newline {\bf{Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)}}  \newline - Dec. healing time  \newline - Dec. time in critical care  \newline - Off-pump procedure}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Column Break}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{} \tn 
% Row Count 0 (+ 0)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{MI Interventions}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Revascularization: first choice treatment}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Percutaneous Coronary Intervention (PCI)}}: invasive; a catheter is placed in a coronary artery to remove a blockage \{\{nl\}\} - Includes: {\emph{balloon angioplasy}}, {\emph{atherectomy}} \{\{nl\}\} - Revascularize \& reoxygenate \{\{nl\}\} - Want to do ASAP for STEMI \{\{nl\}\} - May treat NSTEMI a bit more medically} \tn 
% Row Count 7 (+ 6)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Percutaneous Transluminal Coronary Angioplasty (PCTA)}}: inflated balloon compresses plaque against artery walls \{\{nl\}\} - May need to premeditate for allergies \{\{nl\}\} - May bleed \{\{nl\}\} - May have MI (dislodge clots) \{\{nl\}\} - May worsen kidney problems \{\{nl\}\} - May have a fib, V-tach} \tn 
% Row Count 13 (+ 6)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{bb\}\} {\bf{Atherectomy}}} \tn 
% Row Count 14 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Stent}}: a metal cage holding plaque against the vessel \{\{nl\}\} - Not a permanent fix, must change lifestyle \{\{nl\}\} - Various types} \tn 
% Row Count 17 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Thrombolytic Therapy}}: used w/ pt contraindicated for surgery \{\{nl\}\} - Want to give within 12 hr \{\{nl\}\} - {\bf{Tissue plasminogen activator (TPA)}} \{\{nl\}\} - Worry about hemorrhagic strokes - will cause bleeding = carefully monitored} \tn 
% Row Count 22 (+ 5)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Laser}}: burns out plaque \{\{nl\}\} - Next choice if can't do within minutes} \tn 
% Row Count 24 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Transmyocardial Laser}}} \tn 
% Row Count 25 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Intra-Aortic Balloon Catheter}}: artificial L ventricle; can pump blood \{\{nl\}\} - Inc. contractility of heart \& workload by pumping for heart \{\{nl\}\} - MI: balloon can pump and heart can rest \{\{nl\}\} - In sync w/ conduction system \{\{nl\}\} - {\emph{Frequently check and compare pulses}} \{\{nl\}\} - Complications: dissected aorta, plaques can break if in aorta, \_\_\_\_\_\_\_\_, can burst} \tn 
% Row Count 33 (+ 8)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Pharmacological Interventions}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Heparin/Coumadin}} (prevent clot formation)} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Nitrates}} (inc. circulation, area well-perfused)} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Narcotics}} (morphine - dec. O`2` demand and pain control)} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Adjunct meds: {\bf{Beta-blockers}},{\bf{ACEI}}, {\bf{statins}}} \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{{\emph{Oxygen}}}} (Always; issue of supply \& demand)} \tn 
% Row Count 8 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Post-Op Care}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{\{\{bb\}\} Highest risk for...} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
{\bf{Dec. CO}} & Pulmonary edema \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
Dysrhythmias & Pericarditis \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
Cardiogenic shock & Cardiac tamponade \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{CHF} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Post-Op Assessments}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{(BOLT Handout)} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Pacer wires connected just in case} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Cardiac Tamponade}}: change in HR \& BP; filling of pericardial sac with blood/fluid \{\{nl\}\} - {\bf{BIGGEST RISK!}} \{\{nl\}\} {\bf{Beck's Triad}} = \{\{nl\}\} 1. {\emph{Muffled heart sounds}} \{\{nl\}\} 2. {\emph{JVD}} w/ neck assessment \{\{nl\}\} 3. {\emph{Hypotension}} (can't effectively contract)} \tn 
% Row Count 8 (+ 6)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{After 6 hr, lines pulled and extubated} \tn 
% Row Count 9 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Post-Op Evaluation}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Improved tissue perfusion} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Pain diminished or absent} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Anxiety/fear diminished} \tn 
% Row Count 3 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Cardiac Rehab}}:  \newline Phase 1 - in hospital, walk w/ telemetry  \newline Phase 2 - D/C to rehab exercise program  \newline Phase 3 - Follow-up \& continue w/ exercise}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}