Cardio Flashcards (RANDOM)
Stenosis
•Narrowing of a valve causing issues with opening
•forward blood flow hindered
•increased cardiac workload
•decreased cardiac output
•increased pressure in affected chamber(s)
regurgitation
- insufficient valve closure, resulting in blood flow back up
prolapse
- abnormality in valve’s closure
- 1 or more flaps fails to close
- During ventricular systole, mitral valve flaps normally remain closed..If bulging flaps do not fit together (Flap too large or defective ), mitral regurgitation occurs
Common S/S of valve disorders
fatigue, murmur, malaise, angina, and possible palpitations
TRUE OR FALSE
an increased cardiac workload and increased chamber pressure is evident in all valve issues
true
common valve issue complications
heart failure, emboli, stroke r/t emboli, arrythmias
a PT with a prior strep A case are likely to get what as a result?
rheumatic fever
likely risk factors of valve disease/damage
rheumatic fever
which of the following are risk factors of mitral valve prolapse?
1. size
2. heredity
3. age
4. gender
2.,4.: women are 2x more likely to be diagnosed
backward blood flow into the LV with a risk of ischemia is a sign of
mitral valve prolapse
murmur (aka swoosh) from MVP can be heard on
2D echocardiogram with doppler
TEE test can be used to diagnose
mitral reguritation, MVP, aortic regurgitation
MVP can turn into
mitral regurgitation
for many valve disorders, PTs can generally be:
asymptomatic
with mitral stenosis, backwards pressure causes ____ ____ to dilate, causing failure
right ventricle
A nurse may educate a PT on prophylactics if they have
mitral regurgitation…prophylactics inhibit vegetation valve growth
Aortic and mitral stenosis dysrhythmias can cause right sided stroke by
causing an emboli to form which may travel to the brain
lying supine may cause a forced heartbeat in a pt with:
1. mitral reguritation
2. aortic reguritation
2.
valve narrowing resulting in LV forcefully contracting
aortic stenosis
TRUE OR FALSE
valve replacement is sometimes the only resoluton in PT with aotric stenosis
True
atrial fribillation can be seen on a
P wave
A Fib can also enlarge the atrium
TRUE OR FALSE
transthoracic 2D doppler ECG and doppler U.S. are the most common diagnostic tests
TRUE
blood backflow from L ventricle back to L atrium
mitral regurgitation
PT’s INR should be what prior to administering warfarin?
2.5-3.5
A PT on lifelong anticoagulants most likely had
- Catheter test
- Biological HVR
- Mechanical HVR
3.
Heart valve repairs
•Stenosis valve repair: balloon valvotomy …commissirotomy >valves adhere causing opening issue
•insufficient valve repair: annuloplasty…annulus reconstruction
Heart valve replacements
•mechanical: durable, creates turbulent flow …high thrombus risk=anticoagulants forever
•biological: i.e. pig, bovine…needs to be replaced more because it’s organic
Valve replacement complications
•biological valves : degenerative changes, calcification
•mechanical: bleeding risk=INR/PT watch, thrombus forming, hemolysis=anemia, valvular microorganisms=infective EC
Cardiac surgery pre-op
•assessment: CCSM, pain control, test, blood crossmatch
•acute/chronic pain
•anxiety
•deficient knowledge
•teaching: manage pain, endo tube/vent, communicating, chest tubes, deep breaths, IVs, catheters
•NPO
•antiseptic scrub showers
•Pre-OP meds
Post-OP cardiac surgery nursing care
•pain, check airway, impaired gas, decreased C.O., V.S., hear lungs, incision, lung expansion (R/P, cough), prevent infection, risk for infection, I/O
Valvular disorder meds
•diuretics: loop, thiazides ..watch K intake
•ACE inhibitors (-PRILs)
•Ca Channel Blocker (-PINEs)..Ca builds up causing deposits
•beta blockers: (-LOLs)
Evaluating treatment of valvular disorders
•PT has good pain relief
•V.S. normal …no H.F. Signs
•fatigue reduced
•no edema, wt. maintenance, good lungs
•PT understands teaching ..no recurring S/S
mitral stenosis
blood flows obstructed from LA and LV etc
LV hypertrophies from
aortic stenosis
LV failure leads to
increased workload
during exertional activity, PTs with valve issues should have
frequent breaks
afterload
resistance the LV must overcome to circulate blood; increased afterload=increased workload
ACE Inhibitors
help blood pump easier
vegetation from IE is potentially dangerous because
it could break off and cause an emboli; we get damaged valves the more vegetation is present
those at highest risk of IE are
MVP, rheumatic HD, Valve replacements
S/S and Complications of IE
S/S: fever, murmur, splinter hemorrhage, petechiae, Janeway lesions, Olser’s nodes
complications: vge. emboli, heart valve stenosis, heart failure
diagnostics, therapy and management of IE
- Diagnostics: Blood culture-pathogens, ECHO–sees endocarditis
- therapy: IV antimicrobial, valve repair/replacement, rest
- managament: V.S AND CARDIAC FUNCTION!!, teach oral hygiene importance
pericarditis
acute or chronic; pericardium inflammation with reduced ventricular filling
pericarditis causes and diagnostics
- causes: rheumatic disorder, post-MI, med reaction, renal disease, uremia, Dressler’s, trauma
- diagnostics: EKG, ECHO (effusion), CT (thickening), MRI, CBC (elevated), c-reactive (increased..inflammation)
1
pericarditis S/S, complications and management
- S/S: angina, dyspnea, friction rub
- complications: effusion>lung pressure, cardiac tamponade–major issue, can be from non-penetrating trauma, Becks triad (low BP, JVD, muffled heart sounds)
- management: VS/CARDIAC FUNCTION!!!, tamponade signs,
myocarditis
- rare
- from a virus (should take C&S)
- Damage depends on damage to heart
myocarditis S/S and complications
- S/S: none-severe, angina tachycardia, malaise, fever, fatigue
- complications: cardiomyopathy, HF
Myocarditis Interventions, Dignostics, and Nursing Care
- diagnostics: ECHO, Xray, MRI, ECG
- INTERVENTIONS: reduce cardiac workload(NASIDs), O2, TREAT CAUSE(antimicorbial), Treat HF (ACE inhibitors, inoptropic meds)
- Nursing Care: MAINTAIN CARDIAC FUNCTION/V.S., conserve energy, diversions, education
Nonpenetrating vs penetrating Cardiac Trauma
NP: blunt trauma, can cause cardiac tamponade
P: external chest injury, can cause tamponade, hemo/pnuemothorax
Cardiomyopathy
- enlarged heart muscle>ineffective pumping>HF
- 3 types: dilated, hypertrophic, restricitive— ALL 3 CAN CAUSE HF, ISCHEMIA, OR MI
Dilated
- ventricular enlarges, walls thin so heart weakens
- contricility decreases
- most common form
- stasis
- commonly caused by CAD post-MI
Hypotrophic
- ventricle muscle walls enlarge/thicken; doesnt relax like normal
- decreased ventricular filling
- MITRAL VALVE CAN BE AFFECTED
- overall: left vetricle thickened>harder for heart to pump
restrictive cardiomyopathy
- cardiac muscle stiffens
- ventricular stretch impaired
- limited ventricular filling
rarest form
cardiomyopathy interventions
- hypertrophic: beta blockers..decrease contraction, Ca channel blockers..PINEs allow for more filling time, hydration, myectomy, septal ablation (non surgery PTs)
- restrictive: anticoagulants
- dilated: ICD, ACE inhibitors, diuretics
Cardiomyopathy S/S, diagnostics, and Interventions
- S/S: H.F. for all, dyspnea and fatigue (dialated), angina & dyspena (hypertrophic), syncope/dyspnea & arrythmias (restrictive)
- 3 types: dilated/congestive, Hypertrophic, Restrictive
- Chest X-Ray: (cardiomegaly) Echocardiography (See thickening
ECG, Shows arrhythmias) Cardiac catheterization with biopsy, Blood test:, BNP increased shows heart failure - ACE inhibitors, beta blockers, diuretics, digoxin, Biventricular pacing, Implantable defibrillators
Rheumatic heart disease
- Results from permanent damage to valves by rheumatic fever
- Autoimmune reaction to upper respiratory infection
- Group A beta-hemolytic streptococci
- all heart layers inflamed
- mitral valve most affected, vegetations
A pt with a digoxin level of 7 can be expected to complain of “blueish greenish” vision as a result of ____
Digoxin toxicity, 0.5-2 is normal lvl
Thrombophlebitis Pathophysiology and definition
- Clot formation followed by: Inflammation within vein
- patho: Clot formation and inflammation within vein
Superficial veins, Deep veins (DVT), Emboli danger, Especially if PE forms
Coumadin may be with held if a PTs INR is
- 1.2
- 3.7
- 4.2
- A PTs INR should be ~2.5-3.5 seconds…anything above 5 is a hemorrhage sign, anything below 2 is a thrombus sign
