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NURS 470 > Cardiac Disorders > Flashcards

Cardiac Disorders Flashcards

1
Q

heart failure occurs due to…

A

systolic dysfunction (poor contraction)
diastolic dysfunction (poor filling)
increased afterload

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2
Q

heart failure causes

A

coronary artery disease
valvular dysfunction
infection: myocarditis, endocarditis
cardiomyopathy
uncontrolled hypertension

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3
Q

manifestations of left ventricular heart failure

A

respiratory manifestations:
dyspnea/orthopnea
restlessness
confusion
tachycardia
fatigue
cyanosis
nocturnal dyspnea
pulmonary edema
crackles
extra heart sounds
weak pulses
decreased CO
pale, cool extremities
increased venous pulmonary and capillary pressures
interstitial edema

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4
Q

left ventricular heart failure

A

decreased contractile of the left ventricle
decrease in cardiac output
vasoconstriction of the arterial bed
increased SVR and afterload
pulmonary congestion and edema

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5
Q

right ventricular heart failure

A

defined as ineffective right ventricular contractile function
caused by PE, RV infarct, LVF

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6
Q

right ventricular HF manifestations

A

systemic congestion
JVD
congestive hepatomegaly
ascites/hepatic engorgement
peripheral edema (dependent)
enlarged liver & spleen
weight gain
increased venous pressure
peripheral edema
weakness
elevated CVP
extra heart sounds

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7
Q

systolic heart failure

A

decreased contractility of the heart muscle during systole
s/s of HR with EF <50%

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8
Q

causes of systolic HF

A

CAD
non-ischemic cardiomyopathy (dilated CYMO)

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9
Q

effects of SHF

A

ventricular remodeling
increased LV end diastolic volume
increased left atrial pressure
increased pulmonary venous pressure
right sided HF
pulmonary congestion and pulmonary edema

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10
Q

diastolic heart failure

A

inability of the heart muscle to relax, stretch, or fill during diastole
has preserved EF of 45% and above

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11
Q

causes of diastolic HF

A

CAD
myocardial ischemia
A. fib
uncontrolled HTN
LV hypertrophy or dysfunction
CYMO (hypertrophic & restrictive)
infiltrative diseases (amyloidosis & neoplastic)
aging process

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12
Q

clinical findings for DHF

A

s/s of HF
normal or mildly abnormal LV systolic dysfunction
abnormal left ventricular relaxation, filling, diastolic distensibility, or diastolic stiffness

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13
Q

acute heart failure

A

has sudden onset
no compensatory mechanism
patient may experience acute pulmonary edema, low CO, or even cardiogenic shock

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14
Q

s/s of acute heart failure

A

severe and worsen quickly
sudden fluid buildup
rapid or irregular heartbeat
S3
sudden, severe shortness of breath
pink frothy sputum with cough
chest pain (if caused by a heart attack)

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15
Q

chronic heart failure

A

ongoing process with symptoms that made tolerable by medication, diet, reduced activity level
pts are hypervolemic, have water and sodium retention
have structural heart chamber changing such as dilation and hypertrophy

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16
Q

HF diagnostic tests

A

blood tests: BNP
CXR
ECG
Echo
EF
stress test
CT
MRI
coronary catheterization (angiogram)

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17
Q

atrial natriuretic peptide

A

secreted by atrial myocardium in response to atrial stretch

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18
Q

brain natriuretic peptide

A

secreted by ventricular myocardium in response to ventricular stretch
measured to confirm diagnosis of HF

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19
Q

roles of peptides

A

vasodilation
increase nutrients
stimulate SNS & RAAS

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20
Q

compensatory mechanisms for decreased CO

A
  1. SNS
  2. RAAS
  3. Ventricular hypertrophy
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21
Q

RAAS system basics

A

angiotensinogen (from liver) + renin (from kidney) = angiotensin 1 + ACE (from lungs) = angiotensin 2

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22
Q

effects of RAAS

A

increased SNS
tubular NaCl and H2O reabsorption
aldosterone secretion
arteriolar vasoconstriction
ADH secretion

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23
Q

ventricular remodeling

A

changes in shape and dimension in an attempt to enhance contractility
hypertrophy of myocytes, increase in myocardial mass & fibrosis of interstitium
results in increased stiffness and decreased compliance
ventricular dys-synchrony

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24
Q

medications for reduce the progression of HF remodeling

A

ACEI or ARB
aldactone
beta blocker

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25
Q

cardiomyopathy

A

disease of the heart muscle affecting its ability to contract and adequately perfuse the body’s vital organs
the weakening and/or inflammation of the heart muscle itself
can be acute or chronic in nature

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26
Q

goal of treatments of for CYMO

A

not curable so…
stop/slow progression of damage to heart
improve the function of the heart
reduce or eliminate symptoms
prevent sudden death
treat associated conditions

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27
Q

CYMO diagnostic tests

A

EKG -> wide QRS, takes longer time for impulse to travel
CXR -> enlarged heart
Echocardiogram
TEE
Cardiac catheterization/arteriography
ventriculogram

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28
Q

3 types of cardiomyopathy

A

hypertrophic
dilated
restrictive

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29
Q

dilated cardiomyopathy

A

most common
dilation of ventricles
degeneration of myocardial fibers
increased fibrotic tissue, not pliable
contractile dysfunction: decreased SV and CO, impaired systolic function, increases HR to compensate, 75% morbidity in 5 yrs

30
Q

dilated CYMO symptoms

A

syncope
fatigue
angina
pulmonary congestion
extra heart sounds, murmurs
atrial and ventricular dysrhythmias
emboli formation in heart muscle or pulmonary vascualture

31
Q

dilated CYMO assessment findings

A

cardiomegaly
murmurs
CXR: cardiac enlargement
LV hypertrophy
pulmonary HTN
sinus tachy
atrial/ventricular dysrhythmias
ST segment and T wave abnormalities
conduction defects
v-tach/v-fib

32
Q

dilated CYMO treatments

A

diuretics
Na restriction
ACE inhibitors
beta blockers
blood thinners
antidysrhythmics
nitroglycerin for vasodilation
intotropic agents for contractility
pacemakers, AICDs, LVADs, heart transplant

33
Q

hypertrophic CYMO

A

thickening of intraventricular septum
enlargement of heart and heart cells

34
Q

hypertrophic CYMO etiology

A

prolonged uncontrolled HTN
genetics

35
Q

hypertrophic CYMO manifestations

A

dyspnea
angina
fatigue
syncope
palpitations
sudden cardiac death
SVT/Vtach
nocturnal dyspnea
SOB with extertion

36
Q

hypertrophic CYMO diagnostics

A

echocardiogram
holter monitor
CXR: cardiomegaly
S4 heart sound
presence of systolic murmur
EKG: ST segment and T wave abnormalities
AV dysrhythmias

37
Q

hypertrophic CYMO treatment goal

A

reduce contractility and relieve left ventricular outflow obstruction

38
Q

hypertrophic CYMO treatments

A

beta blockers
Ca channel blockers
Coumadin if in Afib
antidysrhythmic
no inotropes and preload reduction meds
AICD, pacemaker
mitral valve replacement

39
Q

hypertrophic CYMO patient education

A

cardiac rehab consult
family genetic screening
AICD care
potential heart transplant
no basketball/strenuous activities
prophylactic antibiotics to prevent infective endocarditis

40
Q

restrictive CYMO

A

least common
infiltrative process that results in fibrosis and thickening of myocardium due to fibrotic infiltration which decreases ventricular stretch

41
Q

restrictive CYMO symptoms

A

CHF
cardiomegaly
refractory dysrhythmias
fatigue
persistent cough
activity intolerance

42
Q

restrictive CYMO treatments

A

Na restriction
pacemaker, AICD
diuretics
vasodilators
symptom management

43
Q

AICD indications

A

recognizes ventricular arrythmias
cardiovert or defibs
ability to pace
ability to store retrievable data
implanted like a pacer

44
Q

AICD nursing care

A

patient support
know if device is on/off, place sign
magnet to turn off
mild shock with CPR
follow ACLD

45
Q

AICD patient education

A

extensive
difference between MI and cardiac arrest
call MD/keep a diary
driving, cell phones, MRI, arc welding
shock (to self and others)

46
Q

left ventricular assist device (LVAD)

A

bridge to transplant
takes over or assists the pumping role of left ventricle
pneumatic/electric powered
long-term LVAD trials in progress

47
Q

types of valvular lesions

A

stenotic
regurgitant

48
Q

aortic valve disease

A

causes a decrease in the blood flow from the left ventricle into the aorta and systemic circulation
causes increased left ventricular pressures, causing left ventricular hypertrophy

49
Q

aortic valve disease etiology

A

pulmonary HTN
rheumatic fever group A strep

50
Q

aortic stenosis etiology

A

congenital bicuspid aortic valve
rheumatic aortic valve disease
calcific (senile/aging) aortic stenosis

51
Q

s/s aortic valve stenosis

A

slow onset
chest pain
sudden death from exertion
syncope
fatigue
nocturnal dyspnea
palpitations
systolic murmur

52
Q

aortic valve stenosis diagnostic tests

A

echo
CXR
EKG
heart catheterization

53
Q

aortic valve stenosis management

A

close observation
avoid strenuous exercise
antibiotic therapy for valve infection
balloon valvuloplasty or aortic valve replacement

54
Q

aortic regurgitation

A

allows some blood that was just pumped out of your heart back into the left ventricle

55
Q

aortic valve regurgitation etiology

A

congenital heart defects
infectious illnesses
trauma

56
Q

aortic regurgitation s/s

A

fatigue and weakness exertion
SOB with exertion or laying flat
chest pain
syncope
arrythmias
maybe a heart murmur
heart palpitations
swollen ankles and feet

57
Q

aortic regurgitation treatment

A

surgery
LVED pressure reduction
dobutamine/primacor
inotropes (dopamine)
prevent infection
intra-aortic balloon pump

58
Q

mitral valve regurgitation

A

weak mitral valve weaken
blood leaks backward into left atrium
common cause: mitral valve prolapse

59
Q

mitral valve stenosis

A

mitral valve becomes stiff or scarred
fails to open completely during diastolic filling

60
Q

s/s mitral valve regurgitation

A

heart murmur
SOB
fatigue
lightheadedness
cough
heart palpitations
swollen feet or ankles
excessive urination

61
Q

mitral valve regurgitation management

A

restriction of activities that produce fatigue/dyspnea
preload reduction with diuretics
ACE inhibitors, nitrates, digitalis

62
Q

mechanical valve mangement

A

increase durability
need anticoagulant therapy
used in clients less than <65 or 70 yrs old

63
Q

tissue valve mangement

A

from porcine or bovine
NO anticoagulation therapy
don’t last as long

64
Q

mitral valve stenosis mangement

A

blood thinners
valve replacement/repair
percutaneous balloon valvuloplasty
ABX therapy

65
Q

priorities of care for valvular heart disease

A

maintaining adequate cardiac output
optimizing fluid overload
providing patient education

66
Q

infective endocarditis

A

inflammation on the endothelial surface of the heart
can be related to infectious or non-infectious sources
4th most common cause of life-threatening infectious syndromes

67
Q

who is at risk for infective endocarditis

A

congenital disease
valvular heart disease
prosthetic heart valves
pacemakers, AICDs
body piercings
IV drug use
degenerative valve disease

68
Q

common pathogens for infective endocarditis

A

streptococcus
staphylococcus
enterococci

69
Q

complications of infective endocarditis

A

HF
embolic complications: stroke, PE, in other organs

70
Q

medical management of infective endocarditis

A

IV therapy of anti-microbial agents (4–6wks)
cardiac surgery

71
Q

infective endocarditis nursing management

A

timely administration of abx
prevent complication
pain meds
patient education

NURS 470 (28 decks)

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