cardiac Flashcards
What is preload
the amount of blood returning to the right side of the heart
what is afterload
the pressure in the aorta and peripheral arteries that the left ventricle has to pump against to get the blood out
pressure is resistance
why does hypertension lead to HF and pulmonary edema
with hypertension there is more resistance for the left ventricle to pump against
what is stroke volume
the amount of blood pumped out of the ventricles with each beat
factors that affect cardiac output
heart rate and certain arrhythmias
blood volume
decreased contractility
how does blood volume affect cardiac output
less volume= decreased CO
more volume= increased CO
what decreases cardiac contractility
MI
medication
cardiac muscle disease
medication to help preload
diuretics
nitrates
how do medications help preload
vasodilator or diurese to reduce preload
how do medications help afterload
vasodilator to reduce afterload
medications to help afterload
ACE inhibitors (enalapril, Posinopril, Catopril)
ARBS (losartan, irbesartan)
hydralazine
nitrates
what drugs improve contractility
inotropes (dopamine, dobutamine, milrinone)
what medication control heart rate
beta blockers, LOLs
calcium channel blockers (diltiazem, verapamil, amlodipine
digoxin
what drugs control rhythm
antiarrhythmics (amiodarone)
Cardiac output assessment
if CO is decreased poor perfusion
LOC will go down
chest pain
wet lungs, short of breath
cool and clammy
low urine output
weak peripheral pulses
arrhythmias that are always a big deal
pulsless vtach
v-fib
asystole
what is coronary artery diesease
broad term that includes, stable chronic angina and acute coronary syndrome
what is chronic stable angina
intermittent decrease blood flow to the myocardium leading to ischemia that can lead to temporary pain or pressure in chest,
what causes pain in chronic stable angina
low O2 usually due to exertion
what relieves pain in chronic stable angina
rest, nitro
how does nitro help chronic stable angina
causes vaso and arterial dilation decreasing pre and afterload
causes dilation of coronary arteries increasing flow to actual heart
how often do you take nitro
1 every 5 min x 3
side effects of nitro
may burn or fizz
headache
how often do you replace nitro
every six months, spray 2 years
what happens to bp after administering nitro
drops
what do beta blockers due to MP, P and myocardial contractility, CO
decrease
what happens when you decrease the workload on the heart
the need for oxygen is decreased, increasing angina,
what do calcium channel blockers do
cause vaso dilation of the arterial system including coronary arteries, increase afterload and o2 to a heart muscle
What is another name for asprin
acetylsalicylic acid
pt education for chronic stable angina
rest frequently
avoid over eating
avoid excess caffeine or any drugs that increase HR
wait 2 hours after eating to exercise
dress warmly in cold weather
take nitro prophylactically
smoking cessation
lose weight
avoid isometric exercise (weight lifting)
reduce stress
cardia catheterization pre procedure requirements
ask if allergic to iodine or shelfish
check kidney function
take acetylcysteine pre procedure to protect kidneys
warm fluttery feeling and palpitations are normal
post cardiac catheterization
monitor VS
watch puncture site (bleeding, hematoma)
assess extremity distal to site
bed rest, flat, extremity straight 4-6 hours
report bleeding asap
hold metformin 48 hours post procedure
what happens with acute coronary syndrome
decreased blood flow to myocardium leading to ischemia and necrosis
does not need to do anything to precipitate
nitro will not help
signs and symptoms of acute coronary syndrome
pain (crushing, elephant sitting on Chet, pressure radiating to the left arm and jaw,
nausea and vomiting
pain between shoulder pain
cold clammy
bp drops
cardiac output is down
ECG changes
vomiting
MI symptoms in women
epigastric discomfort
pain between shoulder blades
aching jaw
choking sensation
unusual fatigue
unable to catch breath
what is CPK-MB
cardiac specific iso enzyme
increased with damage to cardiac cells
elevates within 2-6 hours and peaks in 12-24 hours
what is troponin
cardiac biomarker with high specificity to myocardial damage
elevates wishing 3-4 hours and remains elevated up to 3 weeks
troponin lab values
troponin T <0.10ng/ml
troponin I < 0.03ng/ml
medications used for chest pain in ED
Oxygen
ASA
intro
morphine
elevated HOB
What do thrombolytics do
dissolve the clot that is blocking blood flow of the heart decreasing risk of infarction
complication of thrombolytics
bleeding
what is included in bleeding precautions
watch for gum bleed
hematuria
black stools
use electric razor and soft tooth brush
no IMs
medications requiring bleeding precautions
abciximab
acetaminophen
acetylsalicylic acid
apixaban
clopidogrel
dabigartan
enoxaparin sodium
eptifibatide
heparin rivaroxaban
warfarin
what is percutaneous coronary intervention (PCI)
includes all interventions such as PTCA and stents
major complication of an angioplaty
MI
client may bleed from heart Cath site or they could reocclude
if any problems go to surgery
signs of reoccluding
chest pain after procedure
when is a coronary artery bypass
with multiple vessel disease or left main coronary artery occlusion
what does left main coronary artery supply
entire left ventricle
what happens with left main coronary artery occlusion
sudden death
cardiac rehabilitatin
smoking cesations
increase activity gradually
low fat, low salt, low cholesterol
no isometric exercise (increases work load)
no valsalva (will bottom out)
no straining
resume sex in one week to 10 days
morning is safest time for sex
best exercise is walking
signs and symptoms of heart failure
weight gain
ankle edema
shortness of breath
confusion
causes of heart failure
complication of cardiomyopathy, valvular heart disease, endocarditis, acute mi and hypertentsion
what happens with left sided heart failure
blood is not moving forward into the aorta and to body and backs into the lungs
signs of left sided heart failure
pulmonary congestion
dyspnea
cough
blood tinged frothy sputum
restlessness
tachycardia
S-3
orthopnea
nocturna dyspnea
what is right sided heart failure
distended neck veins
edema
enlarged organs
weight gain
ascites
what does systolic HF mean
hear cannot contract and eject
what does diastolic hf mean
ventricles can’t relax and fill
standard medications for HF
ace inhibitors
ARBS
what do ACE inhibiters do for HF
suppress renin angiotensin system
prevent conversion of angiotensin 1-2
results in arterial dilation and increased stroke volume
what do arbs do
block angiotensin 2 receptors and cause a decrease in arterial resistance and decreased BP
when is digoxin used
when the client is in sinus rhythm or A-fib and has accompanying chronic H
what does digoxin do
makes contraction stronger
slows heart rate(ventricles have more time to fill)
cardiac output goes up
kidney profusion goes up
normal digoxin levels
0.5-2 ng/ml
symptoms of digoxin toxicity
early: anorexia, nausea, vomiting
late arrhythmias and vision changes
potassium effects it most
examples of diuretics
furosemide
hydrochlorothiazide
bumetanide
triamterene
spriolactone
when do you give diuretics
morning
what do low sodium diets do
decrease fluid retention and decrease preload
what is a consideration when using salt substitutes
contain excess potassium
What is the natural pacemaker
SA node
what happens if hr drops below 60
cardiac output is decreased
what do you do post-procedure for permanent pacemaker
monitor inceision
immobilize arm
assisted passive range of motion to prevent frozen shoulder
keep the client from raising the arm higher than right shoulder
most common complication of permanent pacemaker
electrode displacement
cardiac pacemaker client education
check pulse daily
ID card or bracelet
avoid electromagnetic fields
avoid MRI’s
signs of acute arterial occlusion
numbness and pain
cold extremity
no palpable pulses
more symptomatic in lower extremities
intermittent claudication -hallmark sign
pain at rest
treatment of arterial disorders
dangle vein
angioplasty or endarterectomy
Pain artery vs chronic venous insufficiency
artery-intermittent claudication progresses to rest pain
vein- none to aching pain or depending on dependency of area
pulses arterial vs venous insufficiency
artery- decreased or absent
vein- normal
color
artery-pale when elevated red with lowering of leg
vein- normal (may see petechiae or brown pigmentation with chronic condition)
temperature arterial vs venous insufficiency
artery- cool
vein-normal
edema artery vs venous insufficiency
artery absent or mild
vein present
skin changes arterial vs venous insufficiency
artery- thin, shiny, loss of hair over foot, toes, nail thickening
vein- brown pigmentation around ankles possible thickening of skin, scarring may develop
