CAD and CHF Flashcards
Reveals MI, ischemic changes.
Electrocardiography (EKG)
onset of acute episodes of dyspnea at night. The cause
is unknown; but thought to be due to improved cardiac
Paroxysmal Nocturnal dyspnea
–atrial contraction against the noncompliant ventricle
S4
s. Inflammation of heart muscle caused by
bacterial, viral, or other infection. Damages heart muscle and
impairs pumping ability
Myocarditis
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
- Release of Rennin from ** of the kidney.
juxtaglomerular cells
prevent additional fluid retention
Low-sodium diet
) 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)
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.
reduce risk of heart attack
ACE inhibitors
–the primary cause of right-sided heart failure because
of back ward effect of LHF which causes pulmonary vascular congestion
(hypertension)
Left-sided failure
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
binds bile acid in the intestine
Bile acid binding resins
DIAGNOSIS for CAD
Acute pain
Activity intolerance
Impaired gas exchange
Shows ischemia as “cold spots.
Myocardial perfusion imaging with thallium 201 during treadmill exercise
CLINICAL MANIFESTATIONS
Hepatomegaly and Splenomegaly
Epigastric Tenderness
Ascites
Edema
Anorexia, fullness, nausea
Jugular venous distension (JVD)
Weight gain
Nocturia
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
LABORATORY/DIAGNOSTIC PROCEDURES for CHF
- B-type natriuretic peptide (BNP) immunoassay : the level is elevated
- Chest X-ray:
- Electrocardiography (ECG):
- Pulmonary Artery Pressure (PAP) :
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
e most common causes of LHF are:
Myocardial infraction (MI) –most common cause.
Systemic Hypertension
Aortic stenosis or insufficiency
Cardiomyopathy
Mitral stenosis and insufficiency
n to ease breathing and enhance diaphragmatic excursion
High Fowler’s position
Forward or low output syndrome dominate
Left-sided Heart Failure
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)
most common causes of RHF are:
Left-sided failure
COPD (cor pulmonale)
Pulmonary embolism
Right ventricular infarction
Congenital heart disease.
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
