Cardiac Flashcards
What do arteries carry?
Oxygenated blood
What do veins carry?
Deoxygenated blood
What is the one artery that carries deoxygenated blood?
Pulmonary artery
What is the one vein that carries oxygenated blood?
Pulmonary vein
What delivers deoxygenated blood into the RA?
Inferior and superior vena cava
What carries oxygenated blood from the LV to the body?
Aorta
Preload
Amount of blood returning to the right side of the heart and the muscle stretch that the volume causes.
What is released with the stretch of preload?
ANP
Afterload
Amount of pressure in the aorta and peripheral arteries that the left ventricle has to pump against to get the blood out
Stroke volume
Amount of blood pumped out of the ventricles with each beat
CO formula
HR * SV
How does tachycardia decrease CO?
When you heart beats too fast, the ventricles don’t have enough time to fill
S/S of decreased CO
Decreased LOC Chest pain SOB, wet lung sounds Cold/clammy Decreased UOP Weak pulses
LV = ?
CO
Coronary artery dz includes what?
Chronic stable angina and acute coronary syndrome
Patho of chronic stable angina
Decreased blood flow to the myocardium leads to ischemia which causes temporary pain and pressure in the chest
What causes pain with stable angina?
Low O2, usually due to exertion
What relieves the pain caused by stable angina?
Rest, nitro
What are the 3 arrhythmias that are a big deal because they decrease CO?
Pulseless v tach
V fib
Asystole
*They’ll need CPR
How does nitro work?
Causes venous and arterial dilation which decreases preload and after load. Dilation of coronary arteries will increase blood flow o the myocardium
Decreases BP
How to take nitro
1 every 5 minutes x 3 doses (Take one, after 5 min if pain is still there or worse, activate emergency response) May or may not burn/fizz Do not swallow, put under tongue *Never leave unstable client
How to store nitro
In the dark, glass bottle, dry, cool
Don’t mix, don’t open bottle often
How often do you renew nitro?
Every 3-5 months
Spray every 2 years
What is the main SE caused by nitro?
HA-don’t call doc cause you expect this, not life threatening
Examples of Ca channel blockers for angina
Nifedipine, verapamil, amlodipine, diltiazem
If you take nitro prophylactically, what should you do after taking?
Sit down for a while bc BP will decrease
How do Ca channel blockers work?
Decrease BP by causing vasodilation of the arterial system. They decrease after load and increase the oxygen to the heart muscle
Average aspirin dose for angina
81-325mg
-Keeps blood flowing from keeping platelets from sticking together, doesn’t treat pain directly, will result from increased oxygen with increased blood flow
Client education for chronic stable angina
Wait 2 hours after eating to exercise
Dress warmly in cold weather (warm or cold temp extremes can cause an attack)
Take nitro prophylactically
Stop smoking
Avoid isometric exercise (make muscles squeeze and tense up, increases workload of heart)
Cardiac Catheterization
Procedure used to diagnose heart dz, most definitive, also most invasive
What do you ask the client if they’re allergic to pre cardiac cath?
Iodine/shellfish
-Iodine based dye is used
What function do you check before cardiac cath?
Kidneys, that’s how they excrete the dye. Acetylcysteine (mucomyst) is ordered to help protect the kidneys
Hot shot
Warn, while injecting dye, iodine causes warmth and flushing, palpitations are also normal
What do you watch the puncture site for post heart cath?
Bleeding/hematoma formation
Positioning post heart cath
Bed rest, flat, leg straight for 4-6 hours
How do you assess extremity distal to puncture site post heart cath?
5 P’s
- Pulselessness
- Pallor
- Pain
- Paresthesia
- Paralysis
Major complication of heart cath
Hemorrhage
Is pain normal after heart cath?
No, could mean hemorrhage, report immediately
How med do you stop 48 hours before heart cath?
Metformin. We are worried about the kidneys
Unstable chronic angina = ?
Impending MI
Patho of unstable angina
Decreased blood flow to myocardium leads to ischemia and necrosis. Client doesn’t have to be doing anything to bring this pain on, nitro will not relieve the pain
S/S of unstable angina/MI
Pain-crushing, elephant sitting on chest, pressure radiating to the left arm and left jaw, in between shoulder blades
N/V-Acute pain stimulates vomiting center in brain, when they vomit the vagus nerve is stimulated-decreased HR and CO
Cold/clammy
BP drops-CO is decreasing
ECG changes
Common time for MI
Morning, coming out of dreams, getting up leads to increased HR and BP
Pain for women for MI
GI s/s, epigastric pain or pain between shoulders, aching jaw, choking sensation
1 sign of MI in elderly
SOB, acute behavior change
STEMI
ST segment elevation MI indicates the client is having a heart attack and the goal is to get them to the cath lab for PCI in less than 90 minutes
CPK-MB
Cardiac specific isoenzyme
Increases with damage to cardiac cells
Elevates 3-12 hours and peaks in 24 hours
Troponin
Cardiac biomarker with high specificity to myocardial damage
Elevates within 3-4 hours and remains elevated for up to 3 weeks
Normal lab values for Troponin T
Normal lab values for Troponin I
Myoglobin
Increases within 1 hour and peaks in 12 hours
Negative results are a good thing
Which cardiac biomarker is the most sensitive indicator for an MI?
Troponin
Which enzymes or markers are most helpful when the client delays seeking care?
Troponin
Priority treatment for V-Fib
Defibrillate, do CPR in between shocks until you get an effective heart beat
If the first shock doesn’t work and the v fib client remains in v fib, what is the first vasopressor we give?
Epi
Amiodarone
Anti-arrhythmic, used in v fib or pulseless v tach when shocks and epi do not work, and also for fast arrhythmias
What anti arrhythmic drugs are commonly given to prevent a second episode of v fib?
Amiodarone and lidocaine (decreases irritability of heart)
Sign of lidocaine toxicity
Neuro changes
Important SE of amiodarone?
Hypotension, can lead to further arrhythmias
What drugs are used for chest pain when the client gets to the ED?
O2
Aspirin (165-325, chewable, if not given before arrival)
Nitro
Morphine
What position do you keep the MI patient in?
Head up, decreased workload on the heart and increases CO
Goal of fibrinolytics
Dissolve clot that is blocking blood flow to the heart muscle which decreases the size of the infarction
Fibrinolytic meds
Streptokinase, alteplase, tenecteplase, reteplase
How soon after the onset of myocardial pain should these drugs be administered?
Within 6-8 hours, sooner the better
Door to drug time for fibrinolytic?
30 minutes
Time is what?
Brain