Cardiac Flashcards
Preload
The amount of blood returning to the right side of the heart and the muscle stretch that the volume causes. ANP is released when we have this stretch.
Afterload
The pressure (resistance) in the aorta and peripheral arteries that the left ventricle has to pump against to get the blood out. (pumping against systemic blood resistence)
Stroke volume is
the amount of blood pumped out of the ventricles with each beat.
Cardiac output =
HRx SV
Normal cardiac output
4-6L/min
Assess what for cardiac output
Brain, heart, lungs, skin, kidneys, pulses.
No cardiac output with what arrythmias?
Pulseless v tach, v fib and asystole
What brings on pain with chronic stable angina and what relieves it?
Low o2 usually upon exertion; treat with Rest and/or Nitroglycerin sublingual
Nitro giving
Renewed every 3-5 months PO, or 2 years for spray. Give Q5min x 3 doses, blood pressure will drop, have headache (tylenol), may or may not burn or fizz in mouth, not ok to swallow.
What do beta blockers do?
They block the beta cells (receptor sites for ctecholamines) So decreases contractility, decreased CO, decreased workload of heart, need for oxygen is decreased.
What do CCBS do?
Vasodilates arterial system; dilate coronary arteries; drops BP, decrease afterload., increased oxygen to heart.
Why give aspirin?
Keeps platelets from sticking together which helps blood flow better.
Diet & exercise for chronic stable angina
High fiber, low fat, lower calories to lose weight, wait 2 hrs before exercising, avoid isometric exercises (tensing and squeezing muscles), reduce stress, NTG prophylactically, avoid extreme temp
What do MD give patient before cardiac cath
Mucomyst (acetylcysteine) preprocedure if they have kidney problems because it protects the kidneys.
Post op cardiac cath
watch for bleeding and hematoma, assess for 5ps, bed rest, flat and leg straight for 4-6hrs after, report pain asap, D/C glucophage (metformin) for 48 hrs after.
S/sx of MI
Pain, crishing pain, elephant sitting on chest, radiating to arm or left jaw, N/V, or pain between shoulder blades, women: GI s/sx epigastric complaints, aching jaw or choking symtpom, chronic fatigue, inability to catch breath, indigestion, cold and clammy, bp drops, cardiac output down (dead tissue doesnt pump well), ST elevation and Q waves
1 sign of MI in the elderly
Shortness of breath
CK MB
elevates in 3-12 hrsz after onset of symptoms and peaks in 24 hrs
Troponin levels
Remains elevated for up to 3 weeks. Most sensitive and specific to heart damage. Troponin T< 0.20 or Troponin I <0.03
Results for Myoglobin
Negative results are good thing to rule out MI
Treatment for V fib
Defib, CPR and epinephrine
What does amiodarone (cordarone) do?
Decreases BP and HR
What does vasopressors do?
Increase HR
What anti arrythmic drugs are commonly given to prevent a second episode of V fib
Amiodarone and lidocaine (numbs up heart and can stop PVCs)
Lidocaine dysrhtmias
numbs you up….so CNS changes. Any neuro changes
Side effect of amiodarone
Decreased BP which can lead to further arrtyhmias
Drugs used for chest pain
oxygen, aspirin, nitro, morpine (MONA) –> (morphine if pain not relieved by nitro)
Fibrinolytic therapy
Dissolves the clot that is blocking blood flow to the heart muscle–> decreases the size of infarction. Goal is within 30 min. Need within 6-8hrs for heart and 3-4 hrs for stroke. (-ase). Major complication is bleeding.
Contraindications for fibrinolytics
Stroke within 3 months, major surgery, bleeding ulcers, pregnancy, intracranial bleeding, suspected aorta dissection, intracranial neoplasm
Bleeding precautions with who and do what
fibrinolytics or anticoagulants, liver disease, thrombocytopenia, OD on tylenol; watch for bleeding gums, hematuria, black stools, use an electric razor, soft toothbrush, and NO IM injections, no ABGs
Where to put TPA? (or fibrinolytics)
Peripheral line (put IV in site where we can hold pressure if they have bleeding).
Major complication of angioplasty is what?
A MI
What to do with chest pain after PCI?
chest pain–> call physician at once–> it is reoccluding
What will happen ifl client has complications during procedure of PCI, ike having an MI
they will go directly to surgery
Diet changes for CABG patient
Low fat, low salt, low cholesterol, no more than 1 x per month of fried foods. Outer isles at grocery store.
When can sex be resumed after MI
once they can walk up the stairs or walk around the block with no discomfort, usually within 1 week or 10 days; safest time is in the morning when they are well rested.
Best exercise for MI patient
walking! No isometric exercises
S/sx of heart failure
weight gain, ankle edema, SOB, and confusion
S/sx of left sided heart failure
Left=lungs. pulmonary congestion, dyspnea, cough, blood tinged frothy sputum, restlessness, tachycardia, S-3 murmur, orthopnea, nocturnal dyspnea
S/sx of right sided heart failure
Distended neck veins, edema, enlarged organs, weight gain, ascites
BNP
secreted by ventricular tissue in the heart when ventricular volumes and pressures in the heart are increased. Can be positive for heart failure when the CXR does not indicate a problem. If the client is on Natrecor, turn it off for 2 hrs prior to drawing BNP
Drugs of choice for heart failure
Ace inhibitors and ARBS
Ace inhibitors do what
Suppress the RAS, prevent conversion of angiotensin 1 to angiotensin 2. Results in arterial dilation and increase stroke volume
ARBS do what
Block angiotensin 2 receptors and cause a decrease n arterial resistance and decreased BP
Monitor ARBS and Ace inhibitor patients for what?
Hyperkalemia because they block aldosterone (which makes you retain Na&H20 & secrete K)
Digoxin does what?
stronger contraction, slows HR, Increases CO, increased kidney perfusion.
Normal dig levels
0.5-2.0
How do you know if digoxin is working?
Because the cardiac output goes up
S/sx of dig toxicity
anorexia, N/V, arrythmias, and vision changes like halos, yellos.
Where is apical pulse measured?
5th intercostal space mid-clavicular line
Diuretics do what?
Decrease volume, decrese preload
Depolarization is when
electricity is going through the heart muscle and a contraction will occur
Repolarization
ventricles are resting and are filling up with blood
Post procedure for permanent pace makers
monitor incision, electrode displacement-wires pulled out, immobilize arm, assisted passive ROM to prevent frozen shoulder, keep client from raising their arm higher than shoulder height.
S/sx of malfunction of pacemaker
failure to capture (no contraction follows the stimulus), pacemaker not programmed correctly, battery depleted or electrodes dislodged. Watch for any sx of decreased CO or decreased rate.**
Client education for pacemaker
Check pulse daily, wear ID bracelet or card, avoid eletromagetic fields (large motors, MRIS, cell phone on opposite field), avoid contact sports, go through special door at air port because they will cause alarm or turned off
At risk for Pulmonary edema
recieving IV fluids fast, very young, very old, hx of heart of kidney disease
What is pulmonary edema
Fluid is backing up into the lungs. The heart is unable to move the volume forward. Usually occurs at night, when the client goes to bed.
S/sx of pulmonary edema
sudden onset, breathless, restless, anxious, hypoxia, productive cough (pink, frothy sputum).
How to give lasix & what does it do?
40 mg IV push slowly over 1-2 minutes to prevent hypotension and ototoxicity. It causes diuresis and vasodilation which traps more blood out in the arms and legs and reduces preload and afterload
Neseritide (Natrecor)
IV infusion, not given more than 48 hrs, vasodilates veins and arteries and has diuretic phase.
What is cardiac tamponade
Blood, fluid or exudate have leaked into the pericardial sac resulting in compression of heart. Decreased CO, CVP increased, BP decreased, neck vein distended, shock, heart sounds muffled or distant, narrowed pule pressure,
Hallmark sx of cardiac tamponade
increaed CVP with decreasing BP
Narrowed pulse pressure
Pulse pressure <40
Acute arterial occlusion s/sx
Numb, pain, cold and no pulse
Intermittent claudication is hallmark sign
PAtho of DVT
The blood can get to the tissue, it just cant get awa. Edema, tenderness and warmth are sx.
Normal aPTT
30-40 seconds
Normal PT
11-12.5 seconds
Avoid what in diet on coumadin
Green leafy veges, no more than 3 x per week; they have alot of vitamin K (antidote)
