Cardiovascular Flashcards
What is preload?
Volume of blood in ventricles at the end of diastole
What can increase preload?
hypervolemia
regurgitation of valves
Heart failure
What is Afterload?
resistance the left ventricle must overcome to circulate blood
What can increase afterload?
hypertension
vasoconstriction
An increased afterload can increase…?
cardiac workload
What are chemoreceptors?
receptors that are sensitive to changes in partial pressure
What are baroreceptors?
receptors that are sensitive to stretch and pressure
What 3 things affect stroke volume?
preload
afterload
contractility
What is cardiac output?
volume of blood ejected from the heart per minute
CO =
heart rate x Stroke volume
What is the range of Cardiac output?
4-8 L/min
What is ejection fraction?
fraction of blood ejected with each beat
What is the normal EF?
60-70%
What is cardiac index?
an assessment based on body size
Cardiac index parameters?
2.8-4.2 L/min
How is Cardiac index calculated?
Cardiac output / body surface area
What is contractility?
the force of ventricular contraction
What is systemic vascular resistance?
the resistance the blood flow has to overcome in the blood vessels
higher SVR = more constriction
How is arterial BP calculated?
Cardiac output x systemic vascular resistance
What are some cardiac considerations when it comes to older adults?
more sensitive to meds
monitor effectiveness
reinforce teaching
circulation decreases with aging
increase monitoring post procedures
Nursing assessment for patients with an A-line?
neuro vascular
assess q hour: pulse, pallor, cap refill, no bleeding or hematoma
What are some A-line complications?
thrombosis
embolism
hemorrhage
infection
What is Angina?
chest pain/ squeezing associated with myocardial ischemia
can be a precursor to a heart attack
What is stable angina? ECG presentation?
chronic and occurs with exertion
relieved by rest
May see T-wave inversion
What is unstable (crescendo) angina? ECG presentation?
more often and more severe
not easily relieved by rest
May see ST elevation
Symptoms of angina
left pectoral, epigastric, or retrosternal pain
can radiate
pain associated with dyspnea, diaphoresis, or lightheadedness
lasts 1-5 minutes
What is the dosage for sublingual nitroglycerin?
0.4 mg q 5 minutes for up to 3 doses
What is acute coronary syndrome?
an imbalance between myocardial oxygen supply and demand
result of decreased coronary artery perfusion
Atherosclerosis vs arteriosclerosis
Arteriosclerosis is a general term for thickening of blood vessels
atherosclerosis is a specific type of arteriosclerosis involves fatty deposits in the arteries, i.e. clogged arteries
causes of ACS?
atherosclerosis
emboli
blunt trauma
spasm
what are the atypical symptoms women have with ACS?
N&V
dyspnea
diaphoresis
syncope
fatigue
palpitations
Assessment for someone with ACS?
crushing, tight, squeezing feeling
precordial, substernal or back
radiate to arms, neck, or jaw
clammy, cool, pale, diaphoretic
elevated Troponin
What should you inspect for on the ECG for an AMI?
ST elevation
ST depression
new onset of left bundle branch block
What are some labs to assess for AMI?
Troponin T and I
Myoglobin
CKMB
Serum lipids
What are some complications of AMI?
cardiac dysrhythmias
HF
thromboembolism
What is percutaneous transluminal coronary angioplasty?
procedure to compress plaque to increase blood flow to the myocardium
What is the criteria for PTCA?
uncompromised collateral flow
noncalcified lesions
lesions not on bifurcations of vessels
What is RAP/CVP? Normal value?
direct measurement of pressure in right atrium
2-6 mm Hg
Assessment for a RAP/CVP?
Zero/balance
waveform analysis
PEEP
Positioning
monitor for complications
Complications of a RAP/CVP
infection
pneumothorax/hemothorax
carotid puncture
heart perforation
dysrhythmias
What is variant (Prinzmetal’s)? Treatment?
Vasospasms
MAY see ST elevation
Calcium channel blocker
What are modifiable factors for CAD?
Smoking
obesity
cholesterol
diabetes
hypertension
What is the number 1 intervention for a patient that comes in with chest pain?
12-lead EKG
What medication must you have if you have a stent?
Anticoagulation therapy
What is the post cath care?
bed rest
bed no higher than 30 degrees
monitor site
antiplatelet drugs after procedure
What is the medical management for hyperlipidemia?
low cholesterol, low salt
stop smoking
exercise aerobic
weight loss
lipid-lowering agents
management HTN and diabetes
What is a CABG?
Coronary artery bypass graft
ischemia areas of the myocardium are revascularized
What are some complications of cardiac surgery?
low cardiac output
renal impairment
G.I. dysfunction
mediastinal bleeding
infection
hypovolemia
atrial dysrhythmias
Complications of a CABG?
resp insufficiency
shock
death
AMI
emobli
stroke
pain
What is Pericarditis?
inflammation of the pericardium
can be from an MI
What is the assessment for pericarditis?
friction rub
pulses paradoxus
ST elevation
Precordial pain
What is endocarditis?
inflammation of the endocardium
typically infective
s/s of right sided heart failure
fatigue
ascites
N/V
JVD
edema
increased CVP
s/s of left sided heart failure
paroxysmal nocturnal dyspnea
cough
crackles
wheezes
blood-tinged sputum
tachypnea
restlessness
exertional dyspnea
cyanosis
What are some diagnostics used to diagnose HF?
Echo (for EF)
ABG’s
Serum electrolytes
BUN/creatinine
CBC
BNP
ECG
Heart failure treatment/goals
improve pump action
reduce cardiac workload
optimize gas exchange
What are some heart failure complications?
pulmonary edema
cardiogenic shock
What is an aneurysm?
dilation or thinning of the wall
Aortic dissection
tear of intimal layer of the vessel
sudden
sharp
shifting pain
life threatening
what are some abnormal physical findings for endocarditis?
Janeway lesions
Osler nodes
Splinter hemorrhages
Roth spots
