Adult Heart Flashcards
Weight gain to report
three to five pounds or more within one week
Congestive Heart Failure (CHF) diagnostic test
confirmed by an elevation of the B-type natriuretic peptide (BNP)
- increased risk for pulmonary edema
- tachypnea
- hypoxia
- tachycardia
Complication of acute pericarditis
cardiac tamponade
Minimize complications in tPA therapy
- Implementing bleeding precautions
- avoiding invasive procedures
- caution with anticoagulant medications
Unexpected manifestation of atrial fibrillation
- Blurred vision
- may be sign of stroke
Heart structure
- double pump
- 4 chambers, 4 valves
- conduction begins in right atrium
- SA>AV>bundle of his>left and right bundle branches>Purkije fibers
Blood flow of heart
Try Pulling My Arm
Superior and Inferior vena cavas →
→ Right atrium →
→ Tricuspid valve →
→ Right ventricle →
→ Pulmonary valve →
→ Pulmonary artery →
→ Lungs →
→ Pulmonary veins →
→ Left atrium →
→ Mitral valve →
→ Left ventricle →
→ Aortic valve →
→ Aorta →
→ Systemic circulation
Vena Cava → RA → TV → RV → PValve → PA → Lungs → PVein → LA → MV → LV → Aorta
Varicose veins management
✓ Wear compression hose/stockings
✓ Keep the legs elevated to promote venous return
Left-sided heart failure
- orthopnea (Shortness of breath when lying flat)
- pulmonary congestion
- productive cough
- fatigue
- acute confusion
- S3 gallop
systolic
Right-sided heart failure
- ascites
- anorexia
- nausea
- jugular venous distention
- weight gain
- peripheral edema
- S4 gallop
diastolic
S3 gallop
- expected finding in heart failure
Increased intracranial pressure finding
- widened pulse pressure
- anisocoria
- unequal pupil size
- can be a sign of stroke
- sun setting sign
- eyes appear driven downwards
Cardiac output (CO)
- volume pumped by the heart over one minute
- CO = HR x SV
Preload
- “filling pressure”
- volume being returned to the heart
- blood in ventricles
- end of diastole
- measured by central venous pressure (CVP 4-8mmHg)
Unconscious CPR
- 2 minutes of CPR at a compression-ventilation ratio of 30:2
- 100 to 120 per minute
- infants = 1.5 inches
- check BRACHIAL pulse
- children = 2 inches
- adolescent = 2-2.4 inches
Arterial insufficiency
- decreased hair growth
- absent peripheral pulses
Venous insufficiency
- Swelling around the ankles
- edema
- hyperpigmentation
- edema!!!
Infective endocarditis (IE) treatment
- blood cultures
- empirical antibiotics
- give through PICC line
- diagnose with echocardiography
- vegetation on mitral valve
Infective endocarditis (IE)
- Immune
- fever/malaise
- night sweats
- Cardiac
- murmur
- stroke
- HF
- Skin
- petechiae
- splinter hemorrhages
- Oslar nodes
- palms of hands and feet
- Janeway lesions
- flat, reddened maculae on hands and feet
- Roth spots
- round/oval hemmorage lesions on retina
- Respiratory
- nonproductive cough
- pulmonary emboli
- Renal = ADVERSE EFFECTS
- anorexia
- abdominal/flank pain ADVERSE
- high creatine**
- monitor renal function**
- hematuria
- IV drug use increases risk
Exercise electrocardiography (ECG)
- diagnose myocardial ischemia
Ejection fraction (EF)
- less than 50% is BAD
- 55%+ is normal
Acute coronary syndrome
- Atypical (gastric/back)
- nausea/vomiting
- dyspnea
- significant fatigue
- epigastric pain
- Typical (chest/arm/jaw)
- gradual onset chest pain
- not relieved with rest
- ST + troponin elevation
- pain radiating to arm or jaw
- diaphoresis + pallor
- gradual onset chest pain
- Albuterol = CONTRAINDICATED
- over 55, dyspnea, fatigue, indigestion
- EKG PRIORITY
Cardiac tamponade + cardiogenic shock
- tachycardia
- tachypnea
- narrow pulse pressure
- after myocardial infarction
- priority is to increase cardiac output
- increase stroke volume
- priority is to increase cardiac output
Cardiac tamponade
- jugular vein distention
- history of Lupus and pulmonary hypertension
- hypotension!
- give saline
- narrow pulse pressure
- muffled cardiac sounds
- low CO
- x-ray/echocardiogram
- enlarged heart
- pericardial effusion
- treat with pericariocentesis, NOT thoracentesis
- done at bedside
- Positive pressure is DETRIMENTAL
Acute myocardinal infarction
- denial
- normo/hypotension
- orthopnea
- tachypnea
- oliguria
- women
- dyspnea
- jaw pain
- fatigue
- ASAP percutaneous coronary intervention (PCI)
Myocardial infarction enzyme
- CK-MB isoenzyme
- elevated 3-6 hours after
- peak in 18 hours
Apex location
- infant
- 4th intercostal space
- left of the sternum at the midclavicular line
- adult
- 5th intercostal space
- left of the sternum at the midclavicular edge
Polycythemia
- increased red blood cells
- occurs due to hypoxia
3rd degree heart block
Complete heart block
- p-waves independent of QRS
- HR less than 60
- can result in hypotension
- give oxygen and atropine
- prepare for transcutaneous pacing
- cure is pacemaker
- critical care unit
SVT care
- preform Valsalva maneuver
Aortic stenosis
- narrowing of heart valve
- heat murmur = wooshing sound
- heard in 2nd intercostal space in right upper sternal border (aortic area)
Mitral stenosis
- heard at apex
U-wave
seen in hypokalemia
Variant angina
- AKA prinzmetal’s angina
- occurs at same time every day
- usually at rest
- can raise ST and resemble heart attack
- give CCB
Vasovagal response
- decreased HR
- decreased BP
Premature ventricular contractions (PVCs)
- normal sinus rhythm with occasiional PVC
- wide, bizarre complexes
- p-wave hidden with QRS
- review labs
- low magnesium and potassium may cause PVC
Synchronized cardioversion
- delivers a timed electrical current to reset electrical activity
- tachydysrhythmias
- atrial fibrillation
- atrial flutter
Transesophageal echocardiogram (TEE)
- detects clots in heart
- views left atrial appendage
- major reservoir for thromboembolism
- done before cardioversion
- determines if anticoagulation is needed
Peripheral arterial disease
- caused by
- hypertension
- hyperlipidemia
- diabetes mellitus
- causes atherosclerosis
- causes
- intermittent claudication
- sleep with legs dependent (below heart) to facilitate blood flow
- do not wear restricitve clothes
- intermittent claudication
- decreased pulses
Torsades de pointes
- emergency
- can progress to v. fib/death
- prolonged QT interval
- rapid, irregular QRS complex
- give magnesium sulfate
Imbalances that prolong QT interval
- hypomagnesemia
- hypokalemia
- hypocalcemia
- hypothermia
- hypothyroidism
Buerger’s disease
- arterial and venous inflammation
- causes blood flow impediement
- SMOKING MAKES IT WORSE, MUST QUIT
Hyperlipidemia diet
- replace vegetable oil with canola oil
- eat more fish and fiber
- avoid red meat!!
Ventricular fibrillation
- can be fatal
- first action is to assess
Atrial fibrillation
- irregular rhythm
- above 100 BPM is major concern
- no p-waves
Ventricular tachycardia
- can be fatal
- assess
- LOC
- breathing
- check carotid pulse
- if no pulse = DEFIB
Electroencephalography (EEG)
- given for unexplained seizure activity
- or to exclude certain neurological disorders such as epilepsy
Asystole care
- EPINEPHRINE
- CPR
- REPEAT STEPS 1 AND 2
- NO DEFIB OR CARDIOVERT FOR ASYTOLE
- no heart rhythm left to shock
