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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
cardiomyopathy
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
26
goal of treatments of for CYMO
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
27
CYMO diagnostic tests
EKG -> wide QRS, takes longer time for impulse to travel CXR -> enlarged heart Echocardiogram TEE Cardiac catheterization/arteriography ventriculogram
28
3 types of cardiomyopathy
hypertrophic dilated restrictive
29
dilated cardiomyopathy
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
dilated CYMO symptoms
syncope fatigue angina pulmonary congestion extra heart sounds, murmurs atrial and ventricular dysrhythmias emboli formation in heart muscle or pulmonary vascualture
31
dilated CYMO assessment findings
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
dilated CYMO treatments
diuretics Na restriction ACE inhibitors beta blockers blood thinners antidysrhythmics nitroglycerin for vasodilation intotropic agents for contractility pacemakers, AICDs, LVADs, heart transplant
33
hypertrophic CYMO
thickening of intraventricular septum enlargement of heart and heart cells
34
hypertrophic CYMO etiology
prolonged uncontrolled HTN genetics
35
hypertrophic CYMO manifestations
dyspnea angina fatigue syncope palpitations sudden cardiac death SVT/Vtach nocturnal dyspnea SOB with extertion
36
hypertrophic CYMO diagnostics
echocardiogram holter monitor CXR: cardiomegaly S4 heart sound presence of systolic murmur EKG: ST segment and T wave abnormalities AV dysrhythmias
37
hypertrophic CYMO treatment goal
reduce contractility and relieve left ventricular outflow obstruction
38
hypertrophic CYMO treatments
beta blockers Ca channel blockers Coumadin if in Afib antidysrhythmic no inotropes and preload reduction meds AICD, pacemaker mitral valve replacement
39
hypertrophic CYMO patient education
cardiac rehab consult family genetic screening AICD care potential heart transplant no basketball/strenuous activities prophylactic antibiotics to prevent infective endocarditis
40
restrictive CYMO
least common infiltrative process that results in fibrosis and thickening of myocardium due to fibrotic infiltration which decreases ventricular stretch
41
restrictive CYMO symptoms
CHF cardiomegaly refractory dysrhythmias fatigue persistent cough activity intolerance
42
restrictive CYMO treatments
Na restriction pacemaker, AICD diuretics vasodilators symptom management
43
AICD indications
recognizes ventricular arrythmias cardiovert or defibs ability to pace ability to store retrievable data implanted like a pacer
44
AICD nursing care
patient support know if device is on/off, place sign magnet to turn off mild shock with CPR follow ACLD
45
AICD patient education
extensive difference between MI and cardiac arrest call MD/keep a diary driving, cell phones, MRI, arc welding shock (to self and others)
46
left ventricular assist device (LVAD)
bridge to transplant takes over or assists the pumping role of left ventricle pneumatic/electric powered long-term LVAD trials in progress
47
types of valvular lesions
stenotic regurgitant
48
aortic valve disease
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
aortic valve disease etiology
pulmonary HTN rheumatic fever group A strep
50
aortic stenosis etiology
congenital bicuspid aortic valve rheumatic aortic valve disease calcific (senile/aging) aortic stenosis
51
s/s aortic valve stenosis
slow onset chest pain sudden death from exertion syncope fatigue nocturnal dyspnea palpitations systolic murmur
52
aortic valve stenosis diagnostic tests
echo CXR EKG heart catheterization
53
aortic valve stenosis management
close observation avoid strenuous exercise antibiotic therapy for valve infection balloon valvuloplasty or aortic valve replacement
54
aortic regurgitation
allows some blood that was just pumped out of your heart back into the left ventricle
55
aortic valve regurgitation etiology
congenital heart defects infectious illnesses trauma
56
aortic regurgitation s/s
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
aortic regurgitation treatment
surgery LVED pressure reduction dobutamine/primacor inotropes (dopamine) prevent infection intra-aortic balloon pump
58
mitral valve regurgitation
weak mitral valve weaken blood leaks backward into left atrium common cause: mitral valve prolapse
59
mitral valve stenosis
mitral valve becomes stiff or scarred fails to open completely during diastolic filling
60
s/s mitral valve regurgitation
heart murmur SOB fatigue lightheadedness cough heart palpitations swollen feet or ankles excessive urination
61
mitral valve regurgitation management
restriction of activities that produce fatigue/dyspnea preload reduction with diuretics ACE inhibitors, nitrates, digitalis
62
mechanical valve mangement
increase durability need anticoagulant therapy used in clients less than <65 or 70 yrs old
63
tissue valve mangement
from porcine or bovine NO anticoagulation therapy don't last as long
64
mitral valve stenosis mangement
blood thinners valve replacement/repair percutaneous balloon valvuloplasty ABX therapy
65
priorities of care for valvular heart disease
maintaining adequate cardiac output optimizing fluid overload providing patient education
66
infective endocarditis
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
who is at risk for infective endocarditis
congenital disease valvular heart disease prosthetic heart valves pacemakers, AICDs body piercings IV drug use degenerative valve disease
68
common pathogens for infective endocarditis
streptococcus staphylococcus enterococci
69
complications of infective endocarditis
HF embolic complications: stroke, PE, in other organs
70
medical management of infective endocarditis
IV therapy of anti-microbial agents (4--6wks) cardiac surgery
71
infective endocarditis nursing management
timely administration of abx prevent complication pain meds patient education

NURS 470 (28 decks)

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