CARDIO Flashcards
A hollow muscular organ that resembles like a closed fist?
Heart
Where is the heart located?
Middle of the mediastinum
The heart weighs approximately ______.
300-400 grams
It is the largest chamber of the heart.
Left Ventricle
- Located between right ventricle and pulmonary artery.
- semilunar valve
Pulmonic valve
- located between the left atrium and left ventricle
- atrioventricular valve
Bicuspid/Mitral valve
- located between right atrium and right ventricle
- atrioventricular valve
Tricuspid valve
- located between left ventricle and aorta
- semilunar valve
Aortic valve
middle/muscular layer of the heart
Myocardium
innermost layer of the heart
Endocardium
outermost layer of the heart
Epicardium
Sac the surrounds and protect the heart
Pericardium
Which inner pericardial layer also forms a part of the wall?
Visceral pericardium
The outer layer of the pericardium
Parietal pericardium
A buildup of excess fluid in the sac that surrounds the heart:
Pericardial sac
To prevent friction the amount of fluid in the pericardial sac is ______.
5-20 ml
Modifiable Risk Factors
- Stress
- Diet
- Exercise
- Smoking & Alcohol
- HPN
- Obesity
- Lifestyle/Behavior
Non – Modifiable Risk Factors
- Age
- Sex
- Race
- Family history
Physical examination of the heart: IPPA
- Inspection
- Palpation
- Percussion
- Auscultation
Electrical conductivity of the heart:
Conduction system
Upon inspection the skin color of the patient is?
Pallor, Cyanotic
Upon inspection the respirations of the patient is?
Dyspnea
Upon inspection what do you expect to assess in the peripheral edema of the patient?
Venous insufficiency
Upon inspection what do you expect to assess in the neck vein of the patient?
Venous congestion
Normal cardiac percussion:
Dullness (thudlike sound)
Normal heart sounds are ____, and ____.
S1 (“lubb”) and S2 (“dubb”)
Auscultated upon closure of AV valve (TV & BV)
S1 (“lubb”)
Auscultated upon closure of semilunar valve (PV & AV)
S2 (“dubb”)
This heart sound is considered normal in children, young adult, and pregnant women
S3 (ventricular gallop)
Hearing this heart sound in older adult indicate an early indication for CHF?
S3 (ventricular gallop)
Heart sound that is abnormal in all ages and present in CHF
S4 (atrial gallop)
Dyspnea on Exertion
DOB r/t activity
DOB in lying position
Orthopnea
DOB upon sleep onset
Paroxysmal nocturnal dyspnea
Elevated RBCs suggest _______.
Hypoxia
Elevated WBCs may indicate ______.
Infections, heart disease, or MI
3 Cardiac Enzymes:
- Aspartate Aminotransferase (AST)
- Dehydrogenase (LDH)
- Creatinine Phosphokinase (CK-MB)
Cardiac enzyme produce by liver
Aspartate Aminotransferase (AST)
Cardiac enzyme produce by skeletal muscle
Lactic Dehydrogenase (LDH)
Most cardiac specific enzyme
Creatinine Phosphokinase (CK-MB)
- most important, most indicative
- protein found in myocardial cells; reliable critical markers of myocardial injury
Troponin I
Normal value of Troponin I:
0-0.04 mg/ml
Troponin I remains elevated for as long as _______.
2 weeks
- protein found in cardiac & skeletal muscle
- Not very specific (negative result can rule out MI)
Myoglobin
Records electrical activity of the heart
Electrocardiogram (ECG)
Atrial depolarization
P wave
Ventricular Depolarization
QRS Complex
Ventricular Repolarization
T wave
- Transient chest pain caused by insufficient blood flow to the myocardium resulting in myocardial ischemia
- fancy name for chest pain
Angina Pectoris
What causes Angina Pectoris?
- Atherosclerosis plaques obstruction
- HPN
- DM (viscous blood) insufficient blood flow
Pain manifestation of Angina Pectoris SAVERS
Substernal (below the sternum)
Anterior chest (pericordial)
Vague: radiates➡️jaw, neck,back,L shoulders both arms
Exertion: related
Relieved by Rest & NTG
Short-duration (>30mins)
Precipitating Events of Angina Pectoris 4 E’s
Exertion: NO vigorous exercise
Emotions: excitement; sexual activity
Eating heavy meal
Environment: cold exposure
Direct Vasodilators (Nitrates)
- directly relax smooth muscles of blood vessels = vasodilation
- Nitroglycerine
- ISMN (Isosorbide Mononitrate)
- ISDN (Isosorbide Dinitrate)
Beta-Blockers
- blocks SNS that slows HR and lower BP
- “-olol” “Bolol”
- Nitroglycerine
- ISMN (Isosorbide Mononitrate)
- ISDN (Isosorbide Dinitrate)
Calcium - Channel blockers
- indirect vasodilators
- “dipine” “Cdipine”
- Nifedipine (Procardia)
- Amlodipine (Norvasc) tablet
- Nicardipine (Cardene) IV
drug of choice for pain relief
Nitroglycerine Therapy
Direction in taking Nitroglycerine Therapy:
Take maximum of 3 doses at 5 mins interval; if not relieved call physician
Nitroglycerine Therapy indication of potency: ____________________ under the tongue when taken sublingually
burning/stinging
Nitroglycerine Therapy dry of mouth inhibit absorption. As nurse what will you offer?
Offers sips of water prior admission
You are educating pt. under nitroglycerine therapy he/she should avoid?
- Alcohol prevent Hypotension
You are educating pt. under nitroglycerine therapy how will he/she would rise from bed?
Gradual change of position
R: prevent Orthostatic hypotension
Pt. under nitroglycerine therapy should Always carry _____ in pocket
3 tabs
Instruction: take 1 tablet before exercise
Nitroglycerine tablet are destroyed by heat, light or moisture.How to store nitroglycerine tablet?
- cool, dry place
- used dark/amber colored air tight container
- do not store in refrigerator
How often will the pt. change his/her nitroglycerine tablet stock?
Change stock every 3 mons
What are the side effects of nitroglycerine therapy?
headache, flushed face, dizziness, faintness, tachycardia
- common: during 1st few doses
- instruct to: do not discontinue medication
Beta-Blocker Therapy
⬇️HR and ⬇️BP
Prior the admission of Beta-Blockers, what will you assess first?
Assess HR and BP
R: If mababa WITH HOLD
To prevent GI upset while taking Beta-Blockers it should be taken with?
A. Without meals
B. With meals
B. With meals
Beta- Blockers were contraindicated with _______.
Propanolol (Inderal)
Why beta-blockers contraindicated in asthma?
cause bronchoconstriction
Why beta-blockers contraindicated in DM patients?
cause hypoglycemia
Antidote for BB poisoning:
Glucagon
Calcium Channel Blocker
Prior admission assess HR and BP
Calcium channel blockers causes **food delay absorption:
Empty stomach
- early morning upon waking
- 1hr prior meal
- 2hrs after meal
Antidote for CCB poisoning:
Calcium gluconate
Formation of localized necrotic areas within the myocardium
Myocardial Infarction (Heart Attack)
Most common site of MI:
Left ventricle
What causes MI?
- Coronary occlusion
- Cessation of blood supply
3 Types of Coronary occlusion?
- Atherosclerosis: fat accumulation
- Thrombosis: clot formation
- Embolisms: dislodged/foreigner
A classification of MI **necrosis “endocardium”
Subendocardial
A classification of MI **patchy areas myocardium”
Intramural
A classification of MI **from endo to epicardium “
Transmural
Pain manifestion of MI?
- crushing, severe pain
- radiating arms, neck and back
- not relieved by rest and nitroglycerine
- lasting >30 mins
MI’s universal sign of distress in pain:
Levine’s Sign
MI ECG:
- STEMI – ST segment elevation MI (Deadliest!)
- NSTEMI – Non ST segment elevation
MI Laboratories:
- increased Cardiac Enzymes: AST, LDH, CK-MB
- elevated Troponin levels: most definitive finding for MI
MI’s Management: MONA
Morphine: Opioid Analgesic - DOC for pain relief in MI
Oxygen Therapy by cannula: Increase myocardial O2 supply
Nitroglycerine: for vasodilation
Aspirin (ASA): Antiplatelet
Oxygen therapy by cannula, Why in cannula?
Stop feeling of suffocation “6 lpm”
_______ commode; ________ bed pan
use commode; avoid bed pan
Ratio: Valsalva Maneuver
Reiterate the use of stool softener to avoid straining.
what would be the diet of MI patients:
- LSLF: low salt, low fat
- SFF: small frequent feeding
What are the complications of MI?
- Dysarthria: most common PVC
- Cardiac arrest: “premature ventricular contraction”
