Cardiovascular and Circulatory Function Flashcards
Risk factors for CV disease:
- Modifiable: hyperlipidemia, HTN, cigarettes, diabetes, obesity, physical inactivity
- Non-modifiable: older age, male gender, heredity, race
What are some common complaints of CV disease?
- chest pain/discomfort
- pain/discomfort in: upper body, arms, back, jaw, stomach
- dizziness, syncope, changes in LOC
- intermittent claudication
- palpitations or tachycardia
- peripheral edema, weight gain, ascites, abdominal distention
- SOB/dyspnea
- unusal fatigue
Heart sounds:
Snaps and clicks
- opening and closing of diseased valve leaflets, murmurs-turbulent blood flow across ridged, calcified values, allows backward flow (regurgitation), or defects
Heart sounds:
friction rub
- harsh, grating sound, heard best when the patient is sitting up and leaning forward.
What do you assess in CV assessment (physical):
- skin
- vital signs
- pulses
- respiratory
- abdominal
- auscultation of the heart
Pulsating masses in the abdomen can indication?
abdominal aortic aneurysm
Gerontological considerations for CV assessment:
- peripheral pulses have decreased elasticity
- intermittent claudication (limping)
- increased risk for postural hypotension
- risk for ulceration
- infection in toes/feet (prolonged pressure compromises arterial perfusion.
Cardiac biomarkers are useful in diagnosing?
- acute MI
What are the cardiac biomarkers?
- troponin T and I
- CK-MB
- Myoglobin
Cardiac biomarkers are leaked into?
the blood stream when heart muscle cells are injured.
What cardiac biomarker rises within 3 -4 hours, peak 4 - 24 hours and returns to normal in 1 - 3 weeks?
Troponin T and I
Which cardiac biomarker is helpful in early diagnosis of acute MI and for late diagnosis for patients who delay getting treatment?
Troponin T and I, because it rises early and last longer.
What cardiac biomarker rises within 4 to 8 hours, peaks in 12 to 14 hours, and returns to normal in 3 -4 days?
CK-MB
CK-MB is released for three different types of damaged tissues what are they?
- myocardium
- skeletal muscle
- brain
What cardiac biomarker rises within 1 to 3 hours, peaks in 4 to 12 hours and returns to normal in 24 hours?
- myoglobin
Which biomarker is not used alone to diagnose MI?
- myoglobin b/c it rises with other disease as well.
lipid profile labs:
LDL, HDL, cholesterol, triglycerides
Normal level for LDL:
- optimal < 100 gm/dL
- near optimal 100 - 129 mg/dL
Elevated LDL levels are associated with?
CAD
Normal level for HDL:
levels greater than 60 mg/dL
Risk factors for lowering HDL are?
- smoking
- diabetes
- obesity
- physical inactivity
Elevated cholesterol increases the risk of?
atherosclerosis
Normal cholesterol levels are?
140 - 199mg/dl
Triglyerides normal value?
<150mg/dL
Triglyerides have a direct correlation with?
LDL
aPTT is used for?
heparin
PT/INR is used for?
warfarin
An BNP greater than 100mg/mL is an indicator of?
heart failure
A C-reactive protein (CRP) greater than 3.0mg/dL is an indicator of the progression of?
atherosclerosis and CAD
ECG is used to diagnose?
- arrhythmias
- conduction abnormalities
- enlarged heart chamber
- MI or infractions
What test evaluates the response of the cardiovascular system to increased demands for oxygen and nutrients.
- stress testing
Stress testing is used to determine?
- atherosclerosis
- functional capacity of the heart after MI or heart surgery
- effectiveness of medical regimen
What is the procedure for stress testing?
- walks of treadmill
- pedal bike/arm pedals
- intensity increases
If the patient is unable to exercise for a stress test what do that do?
inject a vasodilation agent to mimic the physiologic effects
dipyridamole or adenosine
What do you monitor for signs and symptoms of myocardial or leg ischemia (claudication) during a stress test?
- ECG
- BP
- physical appearance
- perceived exertion and symptoms: including chest pain, dyspnea, dizziness, leg cramping, and fatigue
- *positive indications for additional testing
Instructions for stress testing:
- fast 4 hours before test
- avoid tabacco
- avoid caffeine
- avoid stimulants
(take meds with a sip of water) - wear clothes suitable for exercise
**if vasodilator is given patient my having nausea or flushing
What is a noninvasive ultrasound test, painless, patient may be asked to turn on the left side and hold breath at times:
echocardiography
What is test uses a transducer thread through the mouth into the esophagus for a clearer image?
trandesophageal echocardiography
What is the procedure of the trans esophageal echocardiography?
- topical anesthetic and moderate sedation.
- ask patient to swallow several times until the transducer is positioned in the esophagus
What is the post procedure for the esophageal echocardiography?
- elevate HOB
- assess for swallowing ability
- VS
- O2 stat
To identify the areas of decreased myocardial perfusion more precisely what type of imaging do you do?
- radionuclide imaging
the first sets of images are taken right after radioisotopes are injected and the second is taken 3 hours later
Doppler ultrasound studies are used to?
- detect blood flow to extremities or head due to thrombus
- determine if atherosclerosis is present in the lower extremities with patients who have intermittent claudication
What is an invasive procedure using fluoroscopy, visualizes the heart on an x-ray to guide catheter placement into the heart to view chambers and coronary arteries?
- heart cath
What is a heart cath gold standard for diagnosing?
- CAD
What do you do pre-procedure for a heart cath?
- blood tests: BUN, creatinine, CBC, electrolytes, PT/INR or aPTT.
- IV catheter
- assess for allergies
- BP and tele
- may experience: palpitations, flushing, sensation to void d/t contrast
right heart cath for?
-evaluation of heart chambers and the function of the tricuspid and pulmonary valves
left heart cath for?
- evaluation of latency of the coronary arteries and the function of the left ventricle and the mitral and aortic valves
heart cath procedure:
- IV sedation
- meds and fluids
- ECG
Post heart cath procedure:
- assess insertion site for bleeding/hematoma
- assess for arrhythmias, pulses
- maintain bedrest 2 to 6 hours
- analgesics for discomfort
- *must report CP, bleeding, sudden discomfort at catheter insertion site
- asses for contrast induced renal failure
- up with assistance
- avoid letting for 24 hours
What are common causes of valvular disorders?
- degenerative disease
- rheumatic heart disease
- infective endocarditis
Progression of valvular disorders can lead to?
- sudden death
- HF
- arrhythmias
- stroke
Management and treatment of valvular disorders?
- prevention
- avoid thromboembolism
- treat a fib
- treat HF
- treat pulmonary artery hypertension
What is it called when the opening of the valve is narrow making blood flow reduced?
- stenosis
Usually the mitral valve it as wide as the diameter of three fingers; marked stenosis would be the width of a?
- pencil
With mitral valve stenosis what happens?
- left atrial pressure increases d/t slowed blood flow into the LV
- left atrium dilates and hypertrophies d/t increase blood volume *can cause clot formation/thromboembolism
- pulmonary venous pressure rises and circulation becomes congested
- RV must contract against an abnormally high pulmonary pressure
- RV and and RA become enlarged
- the ventricle will eventually fail
- LOUD s1 and a low-pitched, rumbling, diastolic murmur heard of s2
Manifestations of mitral stenosis:
- DOE
- fatigue
- paroxysmal nocturnal dyspnea
- a-fib
- dyspnea at rest
- heavy coughing
- hemotypsis
- hoarseness
- palpitations
- orthopnea
- recurrent resp, infections
- HF
- edema
- ascites
Treatment for mitral stenosis:
- treat symptoms
- monitor severity
- antiarrhythmics
- electrical cardio version (to restore SR)
- digoxin
- beta blockers
- calcium channel blockers
- diuretics
- surgery if severe
Aortic stenosis:
- progress occurs?
- which ventricular overcomes the stenosis? HOW?
- over several years to decades
- LV overcomes stenosis by contracting more slowly and more strongly than normal.
When the LV overcomes aortic stenosis by working harder to compensate the increased pressure causes?
- LV failure
- elevated LA pressure
- pulmonary congestion
- RIGHT HF**
Treatment of aortic stenosis?
- prevent complications
- nitrates for angina
- for severe cases avoid: strenuous exercise
- digoxin
- diuretics
- valve repair/replacement
What is regurgitation?
when a valve does not close completely, blood flows back through the valve.
What is the most common regurgitation?
aortic
Regurgitation put you at risk for?
- rheumatic heart disease
- infective endocarditis
S/S of regurgitation:
- palpitations
- visible neck pulsations
- dyspnea
- fatigue
- angina
- orthopnea
- widening pulse pressure
what is the best option for regurgitation?
surgical valvular replacement
When a valve does not close properly and the valve leaflets ballon back what is it called?
prolapse
What type of valve repair is this:
- more durable
- need anticoagulation therapy such as warfarin and you want INR between 2 and 3.5
- risk for thromboembolism and endocarditis
mechanical valves
What type of valve is this:
- less durable
- does not require anticoagulation
- lack longevity
- risk for endocarditis
tissue valve
Endocarditis is infection of the?
endocardium
What are some causes of endocarditis?
- prosthetic heart valves
- structural cardiac defects
- IV drug use
- NOSOCOMIAL IV therapy
What are some vague symptoms of endocarditis?
What are some other symptoms?
- anorexia
- myalgia
- fever chills
- weight loss
- back and joint pain
- night sweats
other: - fever
- HF
- embolic events
- new murmur
What should you monitor for with endocarditis?
- arrhythmias
- hemolytic anemia
With endocarditis there are certain things to note when assessing what are they?
- Osler nodes
- Janeway lesions
- Roth spots
- splinter hemorrhages
- petechiae
What are Osler nodes?
- painful, erythematous nodules on pads of fingers or toes
What are Janeway lesions?
- painless, red or purple macule on palms and soles
What are Roth spots?
- oval retinal hemorrhages with pale centers
Where are splinter hemorrhages?
- under finger nails and toes.
What are some further complications of endocarditis?
- cardiomegaly
- HF
- tachycardia
- splenomegaly
What are some diagnostic tests for endocarditis?
- echocardiography: detection of presence or absence of vegetations or abscesses, prosthetic valve dehiscence, new regurgitation, or HF
- ECG: AV block, BBB, and fascicular blocks
What are some labs that indicate endocarditis?
- elevated WBC
- elevated RBC sedimentation rate
- elevated C-reactive protein
Remember prevention is KEY for endocarditis EX:
- long term antibiotics
- prophylaxis antibiotics
What is it called when you have inflammation of the pericardium, the same surrounding the heart?
pericarditis
What is pericarditis most frequently caused by?
viral illness
Pericarditis may lead to accumulation in the space between the layers of the heart, resulting in increased pressure on the heart what is this called?
pericardial effusion
pericarditis restrict the hearts ability to?
fill with blood
With less filling of the heart with blood pericarditis leads too decreased?
cardiac output
Pericarditis may lead to increased systemic venous pressure causing?
- peripheral edema
- hepatic failure
Clinical manifestation of pericarditis:
- pericardial friction rub
- chest pain: aggravated by coughing, deep inspiration, lying down, or turning **MAY BE RELIEVED BY LEANING FORWARD
- mild fever
- increased WBC
- elevated ESR
- elevated CRP
- anemia
- non productive cough
- SOB
Pericardial friction rub:
- sounds like:
- is best heard:
- have the patient _____ to better hear.
- creaky/scratchy sounds heard at the end of exhalation
- sitting leaning forward
- hold there breath
Diagnosis of pericarditis:
- echocardiography
- ECG changes
- HX: S/S
Management of pericarditis:
- NSAID’s
- corticosteroids
- if constructive* surgical removal of the pericardium
- positioning
- psychological support
What is inflammation of the heart muscle, commonly cause by viral infection?
(can also be caused by bacterial infection, autoimmune, or toxic agents)
myocarditis
Clinical manifestations of myocarditis:
- DX: is DIFFICULT
- fever
- myalgia
- fatigue
- dyspnea
- ventricular arrhythmias*
- cardiogenic shock
- DCM*
- S3 gallop*
- tachycardia
- orthopenia
- palpatations
- HR
- sudden cardiac death*
Nursing management for myocarditis:
- supportive care
- oxygenation
- telemetry
- fluid status
- VAD/transplant
What is a disorder of the myocardium associated with mechanical and or electrical dysfunction?
cardiomyopathy
What are the s/s of cardiomyopathy?
- impaired cardiac output
- decreased stroke volume
- sodium and fluid retention
- severe HR possible
- lethal arrhythmias
- death
How do you DX cardiomyopathy?
echocardiography
How do you care for cardiomyopathy?
- HF therapy
- ACE inhibitors
- aldosterone antagonists
- diuretics
How do you prevent cardiomyopathy?
- avoid complications such as life threatening arrhythmias and thrombi
Cardiomyopathy may require?
- LVAD
- heart transplant
