Cardiac Flashcards
Cardiac Output Importance s/s
Tissue perfusion!
● End organ function
● Delivery of oxygen and nutrients to each and every cell in the body!
● Poor cardiac output??
○ Decreased LOC (not enough blood flow to the BRAIN)
○ Chest pain, weak peripheral pulses (not enough blood flow to the HEART)
○ SOB, crackles, rales (not enough blood flow away from the LUNGS)
○ Cool, clammy, mottled extremities (not enough blood flow to the SKIN)
○ Decreased UOP (not enough blood flow to the KIDNEYS)
Deep Vein Thrombosis (DVT)
Thrombus - A clot that remains attached to the vascular wall
● Causes
○ Venous stasis
■ Immobility
■ Age
■ LHF
○ Vein wall damage
○ Hypercoagulable states
■ Pregnancy, oral contraceptives, malignancy
● Prevention
○ Assess at-risk individuals
○ Promote venous return
■ SCD’s, ted hose, encourage mobility
● Treatment
○ Anticoagulants
Peripheral vascular disease
Inadequate venous return over a long period
● Causes pathologic ischemia
○ Blood flow back to the heart is affected
○ Brown discoloration
○ Uneven wound edges around ankle
○ Swelling
○ Pedal pulse IS present
● Treatment
○ Elevate legs
○ Focus on proper wound care
Superior Vena Cava Syndrome
Tumor compressing SVC
headache, blurry vision, facial plethora, dyspnea, non-pulsitile distended neck veins, upper extremity edema, glossitis, puffy face/neck, stridor, nasal congestion
Diseases of the Arteries
Atherosclerosis
● Hypertension
● Orthostatic (postural) hypotension
● Aneurysm
● Embolism
● Peripheral arterial disease
● Coronary artery disease
● Chronic stable angina
● Acute coronary syndromes
○ Unstable angina
○ Myocardial infarction
Atherosclerosis
● Inflammatory disease
● Begins with endothelial injury
● Evolves into a fibrotic plaque
● Plaques build up and decrease blood flow to the areas they are located
● Plaques can rupture and cause:
○ Thrombosis
○ Vasoconstriction
○ Ischemia
● Most common cause of coronary artery disease and cerebrovascular disease
HTN Assessment findings
dizziness, angina, headache, vision changes, SOB, nosebleeds
often asymptomatic until severe
Blood pressure ranges
normal <120/80
elevated 120-129/80
hypertension >130/>80
hypertensive crisis >180/>120
HTN complications
stroke, MI, renal failure, heart failure, vision loss
HTN treatment and education
Treatment & Education
● Medications
○ ACE inhibitors
○ Beta Blockers
○ CCB
○ Diuretics
● Diet
○ DASH
○ Low salt
○ Avoid caffeine and alcohol
○ Weight loss
○ Smoking cessation
● Lifestyle
○ Less sitting more walking
Aneurysms
Localized dilation of a vessel wall
○ Most common - aorta
● Causes
○ Atherosclerosis
○ HTN
○ Smoking
○ Family history
Abdominal Aortic Aneurysm (AAA)
● Most common
● Abdominal, back pain
● Gnawing/sharp pain
Thoracic Aortic Aneurysm
● Shortness of breath
● Hoarseness/struggling with swallow
● Back pain
Rupture -
● Life threatening
● Severe pain
● Do not palpate pulsating mass
Embolism types
● Embolus - clot that dislodges and is mobile and can occlude the vasculature
● Can be made of many substances
○ Air
○ Bacteria
○ Fat
○ Blood clot
○ Amniotic fluid
● At-risk clients: ○ Pregnancy
■ Hypercoagulable - can form a thrombus that dislodges and causes embolism
■ Amniotic fluid can be forced into the bloodstream during labor causing an
○ A-fib embolism
■ Clot can form in the blood pooling in the atria and be dislodged ○ Long bone fracture
■ Fat can be released from the bone marrow after trauma
Air embolism
● Air embolism:
○ Air bubble enters a vein or artery
○ Very rare
○ Complication of surgical procedure
■ High risk: placement of CVC or arterial catheter
● If your client suddenly desaturates during one of these procedures - suspect an
air embolism!
● Positioning:
○ Durant’s maneuver
■ Left lateral trendelenburg
○ This should prevent an air embolism from lodging in the lungs - will stay in the right heart
Fat embolism
Symptoms:
▪ Hypoxia
▪ Dyspnea
▪ Tachypnea
▪ Confusion
▪ Altered level of consciousness
▪ Petechial rash (does not always occur)
Associated with orthopedic fractures such as long bone and pelvic fractures
Peripheral Arterial Disease
● Atherosclerosis of arteries that perfuse the limbs
○ Especially the lower extremities
● Causes decreased perfusion to the lower extremities
● Assessment findings:
○ Pallor
○ Pulselessness
○ Hairlessness
○ Intermittent claudication
■ Pain that occurs in legs when walking
■ Pain gets better with rest
● Treatment
○ Dangle legs
○ Antiplatelet therapy
Coronary Artery Disease
● Occlusion of the coronary arteries
● Most often results from atherosclerotic plaques
● Risk factors:
○ Advanced age
○ Hypertension
○ Dyslipidemia
○ Smoking
○ Obesity
○ Sedentary lifestyle
● Can cause myocardial ischemia
○ Chronic stable angina - reversible
Myocardial infarction
● Prolonged decreased blood flow to the heart results in irreversible damage to the muscle of the heart
● Goal is to act quickly and limit the damage
● Subendocardial infarction
○ No ST-segment elevation ○ Non-STEMI
● Transmural infarction
○ ST-segment elevations on EKG
○ STEMI
○ Require immediate intervention
Chronic Stable Angina
● Chronic disease caused by narrowing of coronary arteries and plaque build up
● There are periods of decreased blood flow to the heart muscle
● Decreased blood flow leads to
decreased oxygen and ischemia
● Ischemia causes chest pain
● Pain is predictable and goes away
with rest or nitroglycerin
Treatment
● Nitroglycerin
○ Venous and arterial dilation → decreased afterload → increased CO
○ Given sublingual
○ Administer 1 pill q5 minutes for 3 doses
○ Do not swallow
○ Keep in a dark bottle in dry, cool place
○ Expected side effect = headache
Education
● DECREASE THE WORKLOAD OF THE HEART!
○ Rest
○ Do not overeat
○ No caffeine
○ Avoid temperature extremes
○ No smoking
○ Promote weight loss
○ Reduce stress
Unstable Angina
● Pain DOES NOT go away with rest or nitroglycerin
● Reversible myocardial ischemia
● If not treated very quickly, will progress to a myocardial infarction
MI Assessment
Assessment
● Chest pain
○ Crushing
○ Radiating to left arm or jaw
○ Between shoulder blades
● Epigastric discomfort/indigestion
● Fatigue
● SOB
● Vomiting
● Elevated troponin
MI Treatment
Treatment
● Cath lab within 90 minutes for PCI ○ Especially important if it’s a STEMI!
● ON-TIME
○ O: Oxygen
○ N: Nitroglycerin
○ T: Thrombolytics (if appropriate)
○ I: Antiplatelets (e.g., aspirin or other medications)
○ M: Monitoring and Medical care
○ E: EKG to assess heart activity
MI Education
Education
● Quit smoking
● Diet
○ Low fat
○ Low salt
○ Low cholesterol
● Exercise
○ Avoid isometric exercises
○ Walking is a good choice
Disorders of the heart wall
● Pericarditis
● Pericardial effusion
● Cardiomyopathies ○ Dilated
○ Restrictive
○ Hypertrophic
● Valve disorders
● Endocarditis
Pericarditis
Pericarditis
● Inflammation of the pericardium
● Causes
○ Infection
○ Tumor
○ Drugs
● Assessment findings
○ Sharp chest pain
○ Tachypnea
○ Fever, chills
○ Weakness
● Treatment
○ NSAIDs
Pericardial Effusion
Pericardial Effusion
● Collection of fluid in the pericardial sac
● Impairs cardiac function if severe
○ Obstructive cardiogenic shock
● Assessment findings
○ Chest pain
○ Muffled heart sounds
● Treatment
○ Pericardiocentesis
Cardiac tamponade
Cardiac tamponade
● Blood, fluid, or exudate have leaked into pericardial sac
● Causes: MVC, R ventricular biopsy, pericarditis, CABG
Assessment
● Chest pain
● Shortness of breath
● Decreased CO
● Muffled/distant heart sounds
● JVD
● Narrowed pulse pressure (<40)
Treatment - pericardiocentesis and surgery!
Cardiomyopathies
● Disease of the myocardial tissue
○ Dilated
○ Restrictive
○ Hypertrophic
Disorders of the heart valves
Types of heart valves
● Tricuspid ● Mitral
● Aortic
● Pulmonic
Stenosis
Narrowing, blocks blood flow
Regurgitation
Valves don’t close properly causing backflow
Endocarditis
● Infection and inflammation of the endocardium
○ Valves
● Can lead to:
○ Valve abnormalities
■ Stenosis
■ Regurgitation
○ Poor cardiac output
○ Bacteremia
○ Bacterial emboli
● Treatment:
○ Antibiotics
Complications of Heart Disease
Dysrythmias, HF
Dysrhythmias
● Dysrhythmia = Arrhythmia
○ Disturbance of heart rhythm
● Range in severity from occasional missed beats or rapid beats to disturbances that impair myocardial contractility and are life-threatening
● Caused by:
○ SA node generates abnormal rate
○ Impulse is not conducted properly.
Arrhythmias:
● Sinus Bradycardia
● Sinus Tachycardia
● Heart Blocks
● A-fib
● A-flutter
● Supraventricular Tachycardia (SVT) ● V-tach
● V-fib
Heart failure
The inability of the heart muscle to pump enough blood to meet the body’s needs for blood and oxygen
● Often results as a complication of other diseases
● #1 cause of HF is hypertension
● Other causes:
○ Cardiomyopathy
○ Endocarditis ○ MI
● Two types: Left and Right
Left-sided Heart Failure
Left-sided Heart Failure
Left side of the heart cannot move blood forward to the body. Blood is backing up in the LUNGS.
Assessment:
● Pulmonary congestion
● Wet lung sounds
● Dyspnea
● Cough
● Blood tinged sputum
● S3
Left-sided Heart Failure
Fatigue
Orthopnea
Rales/restlessness
Cyanosis/confusion
Extreme weakness
Dyspnea
Right Heart Failure
Right side of the heart cannot move blood forward to the lungs. Blood is backing up in the BODY.
Assessment:
● Jugular venous distention
● Dependent edema
● Hepatomegaly
● Splenomegaly
● Ascites
● Weight gain
● Fatigue
Right HF Symptoms
Bloating
Anorexia
Cyanosis
Oliguria
Nausea
Edema
Distended neck vein JVD
HF Tx
Treatment
● DECREASE THE WORKLOAD OF THE HEART!
● Primary strategy is to decrease afterload:
○ ACE Inhibitors
■ Arterial dilation→ decreased afterload → increased stroke volume
○ ARBs
■ Decrease BP → decreased afterload → increased CO
● Increase contractility
○ Digoxin
● Diuresis
○ Client needs help reducing excess fluid
