Cardiovascular Flashcards
What are the components of a normal electrocardiogram?
P wave, QRS complex, T wave, PR interval, ST segment, QT interval
Understanding these components helps analyze heart rhythms and detect abnormalities.
What does the P wave represent on an EKG?
electrical impulse in the SA node causing depolarization of the atria leading to atrial contraction
What does the QRS complex represent on an EKG?
electrical depolarization of the ventricles
What does the T wave represent on an EKG?
Ventricular repolarization
What does the PR interval represent on an EKG?
Time between the start of the P wave and the start of the QRS complex; which represents the time it takes for the electrical signal to travel from the atria to the ventricles
What does the ST segment represent on an EKG?
early ventricular repolarization, lasts from the end of the QRS complex to the beginning of the T wave
What does the QT interval represent on an EKG?
total time for ventricular depolarization and repolarization
What are common causes of arrhythmias?
- Heart disease
- Electrolyte imbalances
- Structural abnormalities
- Infection
- Medications (prescribed & OTC)
- ETOH and recreational drugs
- Caffeine
- Exercise, stress, anxiety
These factors can lead to abnormal heart rhythms and require assessment.
What are signs of fluid retention during a physical assessment?
- Jugular venous distention (JVD)
- Lung auscultation
- Edema
These signs can indicate heart failure or other cardiac issues.
What is sinus bradycardia?
Regular rhythm with a rate less than 60 bpm
Common causes include vagal stimulation and certain medications.
What are some causes of sinus bradycardia?
Vagal stimulation, Beta-Blockers, Calcium Channel Blockers, increased Intracranial Pressure, CAD, HF, conditioning (athletes)
What are the effects of sinus bradycardia?
often decreased CO:
hypotension, fatigue, dizziness, SOB, syncope, confusion
What treatments are available for sinus bradycardia?
- Change medication
- Pacemaker
- Atropine
Treatment is based on the underlying cause and patient symptoms.
What characterizes sinus tachycardia?
Regular rhythm with a rate of 100-150 bpm
Causes include stress, exercise, and certain medical conditions.
What are some causes of sinus tachycardia?
Stress, exercise, medications, hypotension, hypertension, DM, thyroid
What are some effects of sinus tachycardia?
decreased CO, headache
What are some treatments for sinus tachycardia?
Vagal maneuver, medications (BB, CCB, adenosine, etc)
What is atrial fibrillation (A-fib)?
Rapid, disorganized twitching of the atrial muscle
Atrial rate is around 300, with a variable ventricular rate.
What is the rate of Atrial Fibrillation (A-fib)
Atrial rate (300), Ventricular rate varies (100-200*)
What are the causes of Atrial Fibrillation (A-fib)?
HTN, DM, heart disease, MI, obesity, age
What are potential complications of atrial fibrillation?
- Loss of atrial kick
- Hypotension
- Clot formation
These complications necessitate timely treatment to prevent stroke or other serious issues.
What are treatments for Atrial fibrillation (A-fib)?
Beta-Blockers, warfarin, amiodarone, cardioversion, ablation, watchman
What is the function of a pacemaker?
Provides electrical stimuli to the heart muscle
Pacemakers can be permanent or temporary based on patient needs.
What is the difference between cardioversion and defibrillation?
Cardioversion is synchronized with the ECG; defibrillation is unsynchronized
Each method is used for different types of tachyarrhythmias.
What rhythm(s) is cardioversion used for?
A-fib
What rhythm(s) is defibrillation used for?
V-fib, V-tach, Supraventricular Tachycardia (SVT)
What are non-shockable rhythm(s)?
PEA & asystole
What do cardioversion and defibrillation treat?
Treat tachyarrhythmias by delivering electrical current that depolarizes critical mass of myocardial cells
How do cardioversion and defibrillation work?
When cells repolarize, SA node is usually able to recapture role as heart pacemaker
Safety measures for defibrillation/cardioversion
*Good contact between skin and pads
* Place pads so they do not touch bedding or clothing and are not near medication patches or oxygen flow
*If cardioverting, turn synchronizer on
*If defibrillating, turn synchronizer off
*Do not charge device until ready to shock
*Call “clear” three times; ensure no one is in contact
What are the nonmodifiable risk factors for coronary artery disease (CAD)?
- Family history
- Age
- Gender
- Race
- Premature menopause
- Primary HLD
These factors cannot be changed and contribute to CAD risk.
What are the modifiable risk factors for coronary artery disease (CAD)?
- Tobacco use
- HTN
- DM
- Obesity
- Physical activity
- CKD
What is coronary atherosclerosis?
Abnormal accumulation of lipid deposits and fibrous tissue in arterial walls reducing blood flow to the myocardium
This condition leads to blockages and narrowing of coronary vessels.
Pathophysiology of atherosclerosis
Injury to vascular system (smoking, HTN, HLD, etc) to the vascular endothelium results in the inflammatory response (macrophages)
What is stable atherosclerosis?
Able to resist blood flow and movement
What is unstable atherosclerosis?
fibrous cap thin susceptible to rupture
What are the clinical manifestations of coronary atherosclerosis?
- Angina pectoris
- Epigastric distress
- Weakness/numbness
- Pain radiating to jaw or left arm
- Shortness of breath
Symptoms are caused by myocardial ischemia.
What are atypical clinical manifestations of coronary atherosclerosis in women?
Indigestion
Nausea
Palpitations
Numbness
Sweating
Fatigue
What are complications from coronary atherosclerosis?
Heart failure
Myocardial infarction
Sudden cardiac death
What causes the symptoms of coronary atherosclerosis?
myocardial ischemia (inadequate blood supply)
Prevention of coronary artery disease
Control cholesterol, diabetes, HTN
ADA, vegetarian, Mediterranean diet, limit red meat
Physical activity; stop if CP
Medications (statins)
Cessation of tobacco use (Hgb prefers CO to O2)
What is angina pectoris?
episodes or paroxysmal pain or pressure in the anterior chest caused by insufficient coronary blood flow
Pathophysiology of angina pectoris
Myocardial oxygen demand increased by physical exertion or emotional stress; coronary vessels are unable to supply sufficient blood flow to meet the oxygen demand
What are clinical manifestations of angina
Central chest pain or tightness, choking, heavy sensation
May radiate to the neck, jaw, shoulders, back or arms
Anxiety, dyspnea, SOB, dizziness, diaphoresis, N/V
Impending doom
What gerontologic considerations for angina?
Diminished pain sensation
“Silent” ischemia/CAD
Education on “chest pain-like” symptoms
Stress testing or cardiac catherization
What is stable angina?
Predictable pain occurring with exertion, relieved by rest or nitroglycerin
It is the most common type of angina.
What is unstable angina?
symptoms increase in frequency & severity; not relieved by rest or nitroglycerin (may occur at rest); Requires medical intervention!
What is variant angina?
pain at rest (coronary artery vasospasm)
What is silent ischemia?
EKG changes but no symptoms
What is the primary goal of angina treatment?
Decrease cardiac oxygen demand and increase oxygen supply
Managing risk factors is also critical in treatment.
What is the treatment for angina?
Reduce and control risk factors
Oxygenation
Medications
Reperfusion therapy (PCI, stents, CABG)
What medications are used to treat angina?
Nitroglycerin
Beta-adrenergic blocking agents
Calcium channel blocking agents
Antiplatelet and anticoagulant medications
Aspirin
Clopidogrel and ticlopidine
Heparin
What are complications of angina?
Acute coronary syndrome, MI, or both
Arrhythmias and cardiac arrest
Heart failure
Cardiogenic shock
What medications are used to control cholesterol?
Statins
Fibric acids
Bile acid sequestrants
Cholesterol absorption inhibitors
What is acute coronary syndrome (ACS)?
Range of conditions associated with sudden, reduced blood flow to the heart.
What does MONA stand for in the context of myocardial infarction treatment?
Morphine, Oxygen, Nitroglycerin, Aspirin
Recent guidelines have updated the use of these medications.
What is the pathophysiology of myocardial infarction (MI)?
Plaque rupture and thrombus formation block the artery, leading to myocardial ischemia and necrosis
Urgent treatment is critical to preserve heart muscle.
What are risk factors for MI?
Lifestyle – inactive physically, poor nutrition
Smoking
HTN
HLD
Obesity
Male
Lack of patient & family knowledge
Lack of adherence to plan of care
What are diagnostics for MI?
Based on presenting symptoms
EKG (ST elevation)
Cardiac biomarkers (, troponin, creatine kinase, myoglobin )
ECHO
Past medical History
What are the initial management steps for a patient with MI?
- Supplemental oxygen
- Aspirin
- Nitroglycerin
- Beta-blocker
- Heparin
These interventions aim to restore blood flow and alleviate pain.
What are complications of MI?
Acute pulmonary edema, Heart failure, Cardiogenic shock, Arrhythmias and cardiac arrest, Pericardial effusion and cardiac tamponade
What is the preferred treatment for STEMI patients?
Emergent Percutaneous Coronary Intervention (PCI) with a door-to-balloon time of less than 60 minutes
What is a percutaneous coronary intervention (PCI)?
Procedure to reopen occluded vessels
What are thrombolytics used for in MI?
Alteplase/reteplase are used to dissolve/minimize thrombus to allow reperfusion when PCI is not readily available
What medications are included in inpatient management for MI?
- ASA & clopidogrel
- Beta-blockers
- ACE / ARB
- Stool softeners
What are the nursing goals for the patient with MI?
- Relieve pain and S&S of ischemia
- Improve respiratory function
- Promote adequate tissue perfusion
- Reduce anxiety
- Monitor and manage potential complications
- Educate patient and family
- Provide continuing care
What are invasive coronary artery procedures?
- Percutaneous transluminal coronary angioplasty (PTCA)
- Coronary artery stent
- Coronary artery bypass graft (CABG)
- Cardiac surgery
What are potential complications of cardiac surgery?
- Decrease in cardiac output
- Bradycardia, tachycardia, arrhythmias
- Loss of fluid volume, vasodilation
- Fluid & electrolyte imbalance
- Impaired gas exchange
- Impaired cerebral perfusion
What is the formula for cardiac output (CO)?
CO = Stroke Volume (SV) x Heart Rate (HR)
What is cardiac preload?
initial stretching of cardiac myocytes prior to contraction; volume of blood in ventricles at end of diastole
What is cardiac afterload?
resistance to ejection – pressure L ventricle must pump against; affected by systemic vascular resistance (SVR)
What is Ejection Fraction (EF)?
amount of blood ejected from the L ventricle during systole; normal range is 50-70%
What is heart failure with preserved ejection fraction (HFpEF)?
Diastolic failure
What is heart failure with reduced ejection fraction (HFrEF)?
Systolic failure
What can high Ejection Fraction (>75%) result in?
Hypertrophic cardiomyopathy
What is heart failure (HF)?
structural or functional cardiac disorders that impair the ability of a ventricle to fill or eject blood
What are common causes of heart failure?
- Coronary artery disease (CAD)
- Diabetes mellitus (DM)
- Hypertension (HTN)
- Pulmonary artery hypertension (PAH)
- Cardiomyopathy
- Valvular disorders
What are nonmodifiable heart failure risk factors?
Age >60
Male
African American or Hispanic
What are modifiable heart failure risk factors?
Smoker
Obesity
Diabetes
ETOH
Poor diet
Sedentary lifestyle
What is the pathophysiology of systolic HF?
Left ventricular contraction impaired (EF < 40%)
What is the pathophysiology of diastolic HF?
Left ventricular relaxation impaired (EF > 50%)
What are clinical manifestations of left-sided heart failure?
- Pulmonary congestion
- Crackles/rales
- S3 or “ventricular gallop”
- Tachycardia
- SOB, Dyspnea on exertion, Orthopnea
- Dry, nonproductive cough
- Oliguria
- paroxysmal nocturnal dyspnea (PND)
- Fatigue/lethargy
What are clinical manifestations of right-sided heart failure?
- Visceral and peripheral congestion
- Increased central venous pressure (CVP)
- Jugular venous distention (JVD)
- Peripheral edema
- Hepatomegaly (enlarged liver)
- Ascites
- Weight gain
What is acute decompensated heart failure (ADHF)?
Sudden onset, severe deterioration of heart function
What are the signs of pulmonary edema?
- Restlessness
- Anxiety
- Tachypnea (RR>20)
- Dyspnea (SOB)
- Cyanosis
- Cough
What are the nursing interventions for managing fluid volume in heart failure?
- Assess for symptoms of fluid overload
- Daily weight
- Monitor intake and output (I&O)
- Diuretic therapy
- Fluid intake management
- Sodium restriction
What medications are commonly used to treat heart failure?
- Diuretics
- ACE inhibitors
- Angiotensin II receptor blockers (ARBs)
- Beta-blockers
- Ivabradine
- Hydralazine and isosorbide dinitrate
- Digitalis
What IV medications are used to treat heart failure?
Dopamine, Dobutamine, Milrinone, Vasodilators
What is the role of diuretics in heart failure treatment?
Decreases fluid volume and manages symptoms of fluid overload
What are gerontologic considerations in heart failure management?
- Atypical signs and symptoms
- Decreased renal function
- Monitoring for bladder distention in older men
What is the purpose of patient education in heart failure management?
- Medication adherence
- Diet management
- Monitoring for signs of fluid overload
- Exercise and activity program
- Stress management
What are common clinical manifestations of hypoxemia?
Restlessness, anxiety, tachypnea, dyspnea, cool and clammy skin, cyanosis, weak and rapid pulse, cough, lung congestion, increased sputum production, decreased level of consciousness
Sputum may be frothy and blood tinged.
How is pulmonary edema treated?
Minimize exertion and stress, oxygenation, diuretics or vasodilators
Early recognition is key for effective management.
What are early recognition strategies for pulmonary edema management?
Monitor lung sounds, signs of decreased activity tolerance, increased fluid retention
Minimizing exertion and stress is also important.
What is an important nursing intervention for a patient with pulmonary edema?
Positioning the patient to promote circulation
Positioning upright with legs dangling is often effective.
What is cardiogenic shock?
Decreased CO leads to inadequate tissue perfusion and initiation of shock
It results from decreased cardiac output leading to inadequate tissue perfusion.
What common event can lead to cardiogenic shock?
Acute myocardial infarction (MI)
A large area of myocardium becomes ischemic and hypokinetic.
What are some causes of cardiogenic shock?
- End-stage heart failure
- Cardiac tamponade
- Pulmonary embolism
- Cardiomyopathy
- Arrhythmias
These conditions can compromise heart function.
What is thromboembolism?
The development of blood clot in an artery or vein
Patients with cardiovascular disorders are at increased risk.
What is a pulmonary embolism?
A blood clot that travels to the lungs and obstructs the pulmonary vessels
It is a serious complication of venous thromboembolism.
What is pericardial effusion?
Accumulation of fluid in the pericardial sac
It can lead to cardiac tamponade.
What is cardiac tamponade?
Restriction of heart function due to pericardial fluid
It results in decreased venous return and cardiac output.
What are cardinal signs of cardiac tamponade?
- Sudden chest pain
- Falling systolic BP
- Narrowing pulse pressure
- Rising venous pressure
- Distant heart sounds
These signs can indicate a critical situation.
What is pericardiocentesis?
Puncture of the pericardial sac to aspirate fluid
It is a medical management technique for pericardial effusion.
What is pericardiotomy?
Surgical excision of a portion of the pericardium
It allows exudative pericardial fluid to drain into the lymphatic system.
