Cardiac Flashcards
Normal heart rate
Sinus tachycardia rate
Sinus bradycardia rate
Normal heart rate: 60-100 bpm
Sinus tachycardia: >100 bpm
Sinus bradycardia: <60 bpm
Cardiac Markers (CIP).. Sensitivity and peak
Troponin
CK-MB
Myoglobin (Mb)
Troponin: most sensitive to cardiac damage, peaks around 12 hours
CK-MB: sensitive when skeletal damage isn’t present, 10-24 hours
Myoglobin: low specificity to infarction, 2 hours
Cardiac labs:
Potassium range
Hypokalemia
Hyperkalemia
Potassium range: 3.5-5
Hypokalemia: <3.5… ventricular dysrhythmias, ⬆️ digoxin toxicity, U wave, ST depression
Hyperkalemia: >5… Peaked T waves, wide QRS, ventricular dysrhythmias
Cardiac labs:
⬆️ Hematocrit
⬇️ Hematocrit and hemoglobin
⬆️ Hematocrit: dehydration!
⬇️ Hematocrit and hemoglobin: indicates anemia
Cardiac labs:
Lipids
Lipids:
🔸 Total cholesterol ⬇️200 mg/dl
🔸 LDL ⬇️130 mg/dl (bad cholesterol)
🔸 HDL 30-70 mg/dl (good cholesterol)
Cardiac labs:
BNP
BNP: brain natriuretic peptide. Normal is <100. Indicates ⬆️ ventricular stretching and heart failure
Holter Monitoring
🔸 Important for patients having angina
🔸 24 hour continuous EKG monitor is stored, the patient records the times they’re having chest pain
🔸 helps physician identify what is causing abnormalities in the EKG
Holter Monitor placement
5 lead monitor
White on right
Snow over trees
Smoke over fire
Ground in the middle
Cardiogenic shock
❤️ What is it?
❤️ Assessment
❤️ Heart is unable to maintain effective cardiac output… Heart failure/ disruptions in cardiac function = ⬇️ oxygen delivery to tissues = ⬇️ tissue function
❤️ Assessment: low urine output, ⬇️ BP, assess CVP (right atrial pressure preload)
Which elements determine blood pressure?
🔸 Heart rate
🔸 Stroke volume (amount of blood pumped out of the ventricle with each heartbeat)
🔸 Total peripheral resistance (resistance of the muscular arteries to the blood being pumped through)
Hypertension classification:
🔺 Normal blood pressure
🔺 Prehypertension
🔺 Stage 1 Hypertension
🔺 Stage 2 Hypertension
🔺 Normal: S <120 / D <80
🔺 Prehypertension: S 120-139 / D 80-89
🔺 Stage 1 Hypertension: S 140-159 / D 90-99
🔺 Stage 2 Hypertension: S >160 / D >100
P wave
PR Segment
QRS complex
T wave
P wave- atrial depolarization
PR segment- delay at AV node
QRS Complex- ventricular depolarization
T wave- ventricular repolarization
What is blood pressure equal to?
Blood pressure is equal to the cardiac output (cardiac output = volume pumped out of the heart per minute x arterial resistance)
What organ systems are damaged by hypertension?
🔺 ❤️ must work harder to pump against resistance = need for more oxygen = angina or heart attack
🔺 Arteries/arterioles are damaged =arteriosclerosis =WBC plaques
🔺 Kidney capillaries can become permeable to proteins/other molecules = clogging of tubules = decreasing ability to filter blood and make urine
🔺 Retinas are damaged when capillaries hemorrhage = scarring
🔺 thrombotic or hemorrhagic strokes
Cardiovascular Diseases (CVD):
History Assessment
🔸 Medical and surgical Hx
🔸 Family Hx (cardiac issues, diabetes, kidney problems?)
🔸 Medication Hx (including vitamins, herbals, OTCs)
🔸 Social Hx (nutrition🍩 (Sodium and fat intake), bowel and bladder habits (Urine output? Straining? Blood in stool?), activity level, sleep (orthopnea??? How many pillows?)
Cardiovascular Diseases (CVD):
Risk factors (Non Modifiable and Modifiable)
Non modifiable- Older age, male gender, heredity (including race)
Modifiable- Hyperlipidemia, HTN, cigarette smoking, diabetes, obesity, physical inactivity
Cardiovascular Diseases (CVD):
Physical Assessment
▪️ Inspection and palpation (skin color, temperature, capillary refill, peripheral pulses, edema, ulcers)
▪️ Vitals (BP.. Hypertension (>140/ 90), hypotension (<90/60), Orthostatic hypotension)
▪️ Auscultation of ❤️ (s1s2, rate, rhythm)
▪️ Respiratory (crackles, cough, wheezes, hemoptysis)
▪️ Abdominal (ascites, pulsatile mass (aneurysm))
Cardiovascular Diseases (CVD):
Gerontologic considerations
Gender considerations
Gerontologic- peripheral pulses readily palpable due to decreased elasticity (bounding 🐰), intermittent claudication, ⬆️ risk for postural hypotension
Gender- men are at greater risk for CVD. Women have smaller blood vessels and estrogen
Valvular Disorders:
Stenosis
Thickened valve = narrower space for blood to pass through = decrease flow and increased work for ❤️
Valvular Disorders:
Prolapse
Valve leaflets balloon up as the ventricle collapses
Valvular Disorders:
Regurgitation
Valve leaflets don’t close properly = blood leaks back into atrium = can lead to blood clotting inside the ❤️
Valve Repair:
Mechanical Valves vs. Tissue Valves
Mechanical Valves- more durable but require anticoagulant therapy (ex. Warfarin… Want INR between 2 and 3.5), risk for endocarditis
Tissue Valves- less durable and lacks longevity, doesn’t require anticoagulants, risk for endocarditis
Infective Edocarditis
🔸 Usually bacterial (strep!!! Also staph in acute IE!)
🔸 common in IV drug users, patients w/ a central line, invasive procedures r/t ❤️
🔸 Vegetations of bacteria destroy heart valves and can become dislodged from valve causing emboli
