Cardiac Flashcards
the flow of blood through arteries and capillaries delivering nutrients and oxygen to cells
perfusion
depolarization spreads cell-cell (P wave) followed by contraction
atrial systole
_____: heart cannot pump enough blood to meet the metabolic needs of the body
heart failure
what are three things that heart failure can result in
- volume overload
- inadequate tissue perfusion
- poor exercise tolerance
left sided heart failure clinical manifestations
- respiratory symptoms -
- dyspnea
- orthopnea
- pallor
- tachycardia
- cough
- crackles
- wheezing
- renal failure
- decreased loc
- s3, s4
- fear
- hypoxia
- fatigue
- blood tinged sputum
right sided heart failure clinical manifestations
- peripheral, non-respiratory
- venous congestion
- hepatpmegaly
- cirrhosis
- dependent edema
- anasarca
- fear
- elevated liver enzymes
- RUQ pain
- jugular vein distension
- venous insufficiency
name some diagnostic tests for heart failure
- chest x-ray
- echocardiogram (ECG)
- radionuclide imaging
- BNP (peptide released with excessive atrial/ventricular stretch)
____ is a medication that is orally given to heart failure patients to help increase the strength of contractions
digoxin
when giving loop diuretics (lasix) what should be monitored
potassium and blood pressure (bp can drop when losing fluid)
IV inotropic drugs can enhance ___ ___
stroke volume
(dopamine)
digoxin increases what
contractility and cardiac output
digoxin is ____ inotrope and ____ chronotrope
positive; negative
(increases force of contraction and decreases heart rate)
symptoms of digoxin overdose
N/V/D,anorexia, palpitations, heart block, visual changes, lethargy, ataxia
name three heart failure medications
digoxin, diuretics, antihypertensives
name the types of antihypertensives
- beta blockers: -olol
- ACE inhibitors: -prils
- angiotensin II receptor blockers: -sartan
heart valve disorders
- regurgitation/ incompetency, stenosis
- infective endocarditis (infection in the heart valves)
diagnostic tests for valve disorders
- endocardiography
- chest x-ray
- ECG
- cardiac catheterization
what are the types of valve replacement
- tissue, mechanical
- bovine, porcine
____ valves will require lifetime anticoagulation with coumadin but are less likely to fail, younger population
mechanial
____ valves don’t require anticoagulation, more likely to leak after a few years, older population
(can’t be on blood thinners bc there are too many risks)
tissue
inflammation of the parietal and visceral pericardium
pericarditis
acute pericarditis is usually _____
viral
normal pericardial fluid is 50 cc, in pericarditis you have _______
100-3000 cc
objective symptoms of pericarditis
pericardial friction rub, fever, elevated ESR, elevated WBC, cardiac enzymes normal or elevated
subjective symptoms of pericarditis
mimics MI pain, malaise, joint pain, N/V
interventions for pericarditis
sitting up to relieve pain, rest, NSAIDS
diagnostic tests for pericarditis
echocardiogram (transthoracic)
cardiac tamponade compresses the heart, causing what
hypotension, decreased cardiac output
______: blood/fluid accumulation in the pericardium
cardiac tamponade
____: a decrease in systolic pressure by 10 mmHg with inspiration
pulsus paradoxis
immediate intervention for cardiac tamponade
pericardiocentesis
_____ cardiomyopathy is the most common type
dilated
- involves dilation of both sides of heart, muscle fibers deteriorate and are replaced by fibrotic tissue
cardiomyopathy causes poor _____ and ____
contractibility and blood pooling
causes of cardiomyopathy
alcohol, toxins, pregnancy, connective tissue disorders, genetics
______: a range of conditions associated with sudden reduced blood flow to the heart
acute coronary syndrome
name two types of acute coronary syndrome
- unstable angina
- myocardial infarction
clinical manifestations of unstable angina
- new in onset
- occurs at rest
- increase in frequency, duration, or with less effort
- pain lasting > 10 minutes
- needs immediate treatment
- symptoms in women are often under-recognized
clinical manifestations of myocardial infarction
- Severe chest pain not relieved by rest, position change, or nitrate administration (heaviness, pressure, tightness, burning, constriction, crushing;
Substernal or epigastric;
May radiate to neck, lower jaw, arms, back) - Often occurs in early morning
- Atypical in women, elderly
- No pain if cardiac neuropathy (diabetes)
- Diaphoresis (sweating)
most common complication of MI
dysrhythmias
- can be caused by ischemia, electrolyte imbalance, SNS stimulation
_____ occurs when pumping power of heart has diminished
heart failure
name four complications of MI
dysrhythmias, heart failure, cardiogenic shock, acute pericarditis
diagnostic studies of MI
- detailed health history
- 12 lead ECG
- cardiac enzymes
- coronary angiography
- pharmacologic stress testing
initial interventions for ACS
M - morphine
O - oxygen (keep O2 sat > 93%)
N - nitroglycerin
A - aspirin
(ECG, upright position, IV access, statin)
thrombolytic therapy is only for patients with a ______
STEMI
______: coronary surgical revascularization
coronary artery bypass graft (CABG)
nursing care for CABG
- assess for bleeding
- assess fluid status
- replace blood and electrolytes
- *monitor for AFib
- pulmonary hygiene (encourage coughing and deep breathing)
sudden cardiac death
- no warning signs or symptoms if no MI
- prodromal symptoms if associated with MI (chest pain, palpitations, dyspnea; death usually in 1 hr)
pacemaker of the heart, inherent rate 60-100 bpm
SA node
responsible for delaying impulses from the atria, inherent rate 40-60 bpm - junctional rhythm
AV junction
___: impulse leaves AV junction, travels to bundle of His and divides into R bundle and L bundle, inherent rate <40
ventricles
the phase of readiness - the muscle is relaxed and the cardiac cells are ready to receive an electrical impulse
polarization
the phase of contraction - the cardiac cells have transmitted an impulse, causing the cardiac muscle to contract
depolarization
PR interval
the time of transmission of the electrical impulse through AV node, through bundle of his
the recovery phase - the muscle has contracted and the cells are returning to a ready state
repolarization
on an EKG paper how many squares = 3 seconds
15 large squares (30 = 6 seconds)
p wave
depolarization of the atria
(upward deflection before the QRS complex)
QRS complex
ventricular depolarization
(electrical impulse has traveled through the ventricles)
ST segment
beginning of ventricular repolarization (relaxation)
(end of s wave to beginning of t wave)
T wave
completion of ventricular repolarization
atrial rate is determined by the number of ____ seen in one minute
P waves
ventricular rate is determined by the number of _____ seen in one minute
R waves
characteristics of NS rhythm
- SA node initiates all the electrical impulses that travel through the heart
- Upright P wave precedes every QRS complex
- All PR intervals range from 0.12 - 0.20
- QRS is less than 0.12
- All P waves look alike
- all QRS complexes are the same shape & size
- Rate is 60-100 beats per minute
how to calculate by a 6-second rhythm strip
count the number of R waves in a 6-second rhythm strip and multiply by 10
sinus rhythms = _____ initiated
SA node
what is the only rhythm that is considered normal
normal sinus rhythm
name the four artial rhythms
- atrial premature contraction
- atrial tachycardia
- atrial flutter
- atrial fibrillation
name the ventricular rhythms
- Ventricular Premature Beat
- Ventricular Tachycardia
- Ventricular Fibrillation
- Asystole
- Agonal Rhythm
- Electrical Mechanical Dissociation
When SA node, atria, and AV junction fail to initiate an electrical impulse, the _____ become the pacemaker of the heart
ventricles
Because impulse occurs in lower portion of heart, the impulse travels _____ to depolarize the atria and _____ to depolarize ventricles
retrograde (backward); forward
characteristics of ventricular dysrhythmias
- Since atria depolarize at about the same time as ventricles, P wave is usually hidden in the QRS and will not be seen
- The QRS complex is wide, bizarre, and > 0.12 seconds
- Rate- 20-40 bpm
When a ____ stimulus is delivered to the heart, a pacemaker spike will be seen on the EKG (ECG) strip followed by a P-wave (atrial pacing) or a QRS complex (ventricular pacing)
pacemaker
