CAD and CHF Flashcards by Rencevie Cate Bumanglag

Reveals MI, ischemic changes.

Electrocardiography (EKG)

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onset of acute episodes of dyspnea at night. The cause
is unknown; but thought to be due to improved cardiac

Paroxysmal Nocturnal dyspnea

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 –atrial contraction against the noncompliant ventricle

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s. Inflammation of heart muscle caused by
bacterial, viral, or other infection. Damages heart muscle and
impairs pumping ability

Myocarditis

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Reveals whether the heart is misshapen or enlarged due to disease and if
abnormal calcification (hardened blockage due to cholesterol build up) in the main
blood vessels exists.

Chest x-ray

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Release of Rennin from ** of the kidney.

juxtaglomerular cells

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prevent additional fluid retention

Low-sodium diet

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) refers to any narrowing or obstruction of arterial lumina
that interferes with cardiac perfusion. Deprived of sufficient blood, the myocardium can
develop various ischemic diseases, including angina pectoris, MI, heart failure, sudden
death, and cardiac arrhythmias

CORONARY ARTERY DISEASE (CAD)

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Precipitating (Secondary) Causes:

o Hypertension
o E - Infective Endocarditis
o Anemia
o Rheumatic –fever (Recurrence)
o Thyrotoxicosis
o Fetus (pregnancy)
o Arrhythmias
o Infections
o Lung problems (pathologies)
o Stress, salts, etc.

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reduce risk of heart attack

ACE inhibitors

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–the primary cause of right-sided heart failure because
of back ward effect of LHF which causes pulmonary vascular congestion
(hypertension)

Left-sided failure

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occurs when the output of the right ventricle is less than the input from
systemic venous circulation. As the result, the systemic venous circuit is
congested and the output to the lungs decreased.

RIGHT-SIDED HEART FAILURE

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binds bile acid in the intestine

Bile acid binding resins

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DIAGNOSIS for CAD

Acute pain
Activity intolerance
Impaired gas exchange

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Shows ischemia as “cold spots.

Myocardial perfusion imaging with thallium 201 during treadmill exercise

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CLINICAL MANIFESTATIONS

 Hepatomegaly and Splenomegaly
 Epigastric Tenderness
 Ascites
 Edema
 Anorexia, fullness, nausea
 Jugular venous distension (JVD)
 Weight gain
 Nocturia

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CLINICAL MANIFESTATIONS of LHF

 Moist, bibasilar crackles, rhonchi, and expiratory wheezing
Dyspnea
Nonproductive cough
Blood tinged, frothy sputum
Restlessness
Tachycardia
S3 gallop
S4
Paroxysmal Nocturnal dyspnea
Cool, pale skin

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LABORATORY/DIAGNOSTIC PROCEDURES for CHF

B-type natriuretic peptide (BNP) immunoassay : the level is elevated
Chest X-ray:
Electrocardiography (ECG):
Pulmonary Artery Pressure (PAP) :

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Views heart’s pumping activity. Parts that move weakly may have been damaged
during a heart attack or may be receiving too little oxygen. This may indicate CAD.

Echocardiography

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e most common causes of LHF are:

 Myocardial infraction (MI) –most common cause.
 Systemic Hypertension
 Aortic stenosis or insufficiency
 Cardiomyopathy
 Mitral stenosis and insufficiency

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n to ease breathing and enhance diaphragmatic excursion

High Fowler’s position

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Forward or low output syndrome dominate

Left-sided Heart Failure

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CLINICAL MANIFESTATIONS of CAD

Elevated blood pressure
Decreased peripheral pulses -
Nausea and vomiting
Fainting
Sweating
Cool extremities
Shortness of breath
Angina (Chest pain)
MI (Chest pain)

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most common causes of RHF are:

 Left-sided failure
 COPD (cor pulmonale)
 Pulmonary embolism
 Right ventricular infarction
 Congenital heart disease.

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formed from Angiotensinogen in the liver by the action of rennin)

* Formation of Angiotensin- I

Treatment of CHF is aimed to

improve left ventricular function by decreasing intravascular volume, decreasing venous return, deceasing afterload, improving gas exchange and oxygenation, increasing CO, and reducing anxiety.

In acute or short-term mechanisms, as the end-diastolic fiber length increases, the ventricular muscle responds with dilatation and increased force of contraction (Starling’s Law)

Myocardial dilatation

lower sodium, lower cholesterol and fat, decreased calorie intake, increased dietary fiber.

Diet change

results of chest xray in LHF

* Pulmonary congestion * Enlarged left ventricle

CHF occurs in a ***, progressing from the left ventricle (LV) to the pulmonary system to the right ventricle (RV

retrograde fashion

f the coronary arteries narrow again after stent placement, radiation may be used to help open the artery again.

Coronary brachytherapy:

dilate blood vessels, decreasing afterload.

ACE inhibitors

t results in increase pre-load (fluid-over load) on the heart

aldosterone effect

Narrowing of heart valves causes backward flow of blood. The heart enlarges and cannot pump effectively. This decreases CO.

Congenital Valvular Heart Disease

Checks arteries for areas of narrowing or blockages—although the details may not be as clear as those provided by an angiogram.

Magnetic resonance angiography (MRA)

Cardiac compensatory mechanisms

Myocardial dilatation Myocardial Hypertrophy

CAUSES OF CHF

Underlying Causes Precipitating (Secondary) Causes:

results of chest xray in RHF

* Pulmonary congestion * Accumulation of fluid in the pleural cavity * Enlarged heart (cardiomegaly)

two types of compensatory mechanisms

Systemic compensatory mechanisms Cardiac compensatory mechanisms

Subsequent effects of compensatory mechanisms

Sympathetic Responses Rennin- Angiotensin-Aldosterone system Anaerobic metabolism Myocardial Hyper trophy and Myocardial Dilatation

lowers cholesterol.

HMG CoA reductase inhibitors (statins

strengthen myocardial contractility:  Digoxin

r inotrope

What law: In acute or short-term mechanisms, as the end-diastolic fiber length increases, the ventricular muscle responds with dilatation and increased force of contraction

Starling's Law

MGT for CHF

diuretics ACE inhibitors Beta blockers Anticoagulants Inotrope Vasodilator High fowler heart transplant

an extra heart sounds that occurs when the heart fails. It is described as a “floppy” sort of sound caused by extra fluid in the ventricles.

S3 gallop

Determines safe exercise prescription and presence of ischemia

Stress test

reduces production of VLDL

Nicotinic acid

the earliest manifestation of LHF

dyspnea

opens artery wall; some stents slowly release medication to help keep the artery open.

Angioplasty and stent placement (percutaneous coronary revascularization)

typically shows elevated pulmonary artery wedge pressures, left ventricular end-diastolic pressure in left sided heart failure, and elevated right atrial or central venous pressure in right-sided heart failure

Pulmonary Artery Pressure (PAP)

Valvular & Endocardial lesions

Endocarditis Congenital Valvular Heart Disease Rheumatic Heart Disease (RHD)

Systemic compensatory mechanisms

a. Reflex increase in sympathetic activity. b. Release of rennin from the kidneys. c. Anaerobic metabolism by affected tissues. d. Increased extraction of oxygen by the peripheral cells.

interfere with epinephrine and norepinephrine, thus reducing heart rate and blood pressure.

Beta-blockers

thin blood and decrease chances of clot

Antiplatelets

NURSING DIAGNOSES for CHF

 Impaired gas exchange  Decreased cardiac output  Excess fluid volume

e pressure during filling of the ventricles or tension on myocardium due to congestion.

Preload

when aggressive medical treatments are not effective.

Heart transplant

laser beam makes tiny new channels in the wall of the heart muscle. New vessels may grow through these channels and into the heart to provide additional paths for blood flow.

Laser revascularization:

reflect heart strain or enlargement or ischemia. It may also reveal atrial enlargement, tachycardia, extrasystole, or atrial fibrillation

Electrocardiography (ECG):

increased after-load due to vasoconstriction

Angiotensin-II.

dilate blood vessels; decrease pain.

Nitrates

Dye used in conjunction with x-ray outlines blockages.

Angiogram

changes in tissue metabolic rate, accelerating HR and work load of the heart.

Thyrotoxicosis

reduce synthesis and increase breakdown of VLDL particles

Fibric acid derivatives

prevent blood vessels from narrowing and counter coronary artery spasm.

Calcium-channel blockers:

Risk factors for CAD

Age Men Positive family history Diets high in cholesterol and fat Hypertension Smoking Diabetes Mellitus (DM) Chronic Kidney Disease (CKD Abdominal Obesity Sedentary lifestyle Autoimmune disorders

the arterial pressure against which the ventricles must contract.

After load

Right-sided failure can occur without preceding LV failure as a result of

ventricular MI or cor pulmonale.

Blockage of coronary artery impedes forward blood flow, resulting in cardiac tissue ischemia. This reduces cardiac contraction and cardiac output.

Myocardial Infarction

graft created to bypass blocked coronary arteries using a vessel from another body part. This allows blood to flow around the blocked or narrowed coronary artery. Because this requires open heart surgery, its most often reserved for cases of multiple narrowed coronary arteries.

Coronary artery bypass surgery (CABG):

refers to fluid build-up in the heart from myocardium that can’t provide sufficient cardiac output. It also refers to a constellation of signs and symptoms that result from the heart’s inability to pump enough blood to meet the body’s metabolic demands. The pump itself is impaired and unable to supply adequate blood to meet the cellular needs.

HEART FAILURE (HF) / CONGESTIVE HEART FAILURE (CHF)

o In long-term mechanisms, ventricular hypertrophy increases the ability of the heart muscle to contract and push its volume into the circulation.

Myocardial Hypertrophy

NURSING INTERVENTION for CHF

 Monitor vital signs and look for changes.  Record fluid intake and output—weigh daily to assess for fluid overload.  Position patient in semi-Fowler’s position to ease breathing.  Administer oxygen as ordered because it helps to decrease workload of heart  Client teachings: o Eat foods low in sodium to avoid fluid retention. (For these patients, there is no such thing as “low-salt” cold cuts.) o Raise legs when sitting to lessen dependent edema. o Call the HCP if experiencing fluid retention, such as a weight gain of several pounds in 1 to 2 days

Underlying Causes

o Myocardial lesions o Valvular & Endocardial lesions o Pericardial – lesions

Pericardial – lesions

Pericarditis Cardiac-tamponade

Reveals MI

Holter monitoring for 24 hours

(by enzyme reaction in the pulmonary-capillary bed)

Formation of Angiotensin –II

help to raise ejection fraction, and decrease ventricular size, and slow the heart rate.

beta blockers

congestive phenomenon dominates.

Right-sided Heart Failure

t occurs when the output of the left ventricle is less than the total volume of blood received from the right side of the heart through the pulmonary circulation. As a result, the pulmonary circuit becomes congested with blood that cannot be moved forward and the systemic blood pressure falls

LEFT-SIDED HEART FAILURE

NURSING INTERVENTIONS for CAD

 Monitor vital signs—signs of hypertension, irregular heart rate  Monitor electrocardiogram—look for end organ damage, signs of heart disease  Monitor labs—periodic lipid panel, liver function for patients on statins  Monitor for myalgias (muscle aches)  Explain to the patient: * Stop smoking * Reduce alcohol consumption * Change to a lower-fat, lower-cholesterol diet, as well as increased dietary fiber intake * Increase daily activity * Weight reduction * Stress management

reduce preload, relieve dyspnea:

vasodilator

Myocardial lesions

Cardiomyopathy Myocarditis Myocardial Infarction

for symptom control resulting in patient comfort by reducing blood volume.  Furosemide, bumetanide, metolazone, hydrochlorothiazide, spironolactone —be aware of electrolyte imbalance—these medications may alter the K+ level.

diuretics

A large amount of liquid accumulates in the pericardium, creating pressure on the heart that reduces the filling of ventricles with blood. This results in a low volume of blood being pumped with each contraction.

Cardiac-tamponade

MEDICAL MANAGEMENT for CAD

Beta-blockers: Nitrates Antiplatelets: Calcium-channel blockers: ACE inhibitors: HMG CoA reductase inhibitors (statins Fibric acid derivatives Bile acid binding resins Nicotinic acid Angioplasty and stent placement (percutaneous coronary revascularization) Coronary artery bypass surgery (CABG): Coronary brachytherapy: Laser revascularization Diet change:

Detects calcium within fatty deposits that narrow coronary arteries. If a substantial amount of calcium is discovered, CAD is likely.

Electron beam computerized tomography (EBCT)/Ultrafast CT scan

ASSESSMENT AND DIAGNOSTIC FINDINGS for CAD

Chest x-ray Electrocardiography (EKG) Holter monitoring for 24 hours Echocardiography Stress test Angiogram Electron beam computerized tomography (EBCT)/Ultrafast CT scan Magnetic resonance angiography (MRA) Myocardial perfusion imaging with thallium 201 during treadmill exercise