Cardiovascular Diseases Flashcards
Etiology of Chest pain/Myocardial Infarction
- Heart disease
- Hypertension
- Thrombus
Primary assessment of Chest pain/Myocardial Infarction
- Past medical history/history of current event (most significant finding)
- SOB
- Respiratory pattern
- Color
- Breath sounds
- Physical appearance
- Vital signs: elevated BP, pulse
Secondary assessment of Chest pain/Myocardial Infarction
- ABG: hypoxemia
- Electrolytes
- Special tests
- Electrocardiogram
Electrolyte - Chest pain/Myocardial Infarction
Hyperkalemia or hypokalemia
EKG (Electrocardiogram)- Chest pain/Myocardial Infarction
Arrhythmias with significant Q waves and S-T segment changes
Special tests performed for Chest pain/Myocardial Infarction
- Cardiac enzymes (CPK,LDH,SGOT)
- Increased Troponin level
Treatment and management of Chest pain/Myocardial Infarction
- Immediate oxygen therapy at 100%
- Closely monitor vital signs
- Drug therapy
Drugs used to treat Chest pain/Myocardial Infarction
- Aspirin
- Anti-arrhythmic agents (Amiodarone, Atropine-bradycardia, Procainamide)
- Nitrates for chest pain
- Maintain BP with fluid or vasopressors (dopamine: increases BP)
- Defibrillate for pulseless V-tach or fibrillation
Etiology of Congestive heart failure
- MI
- Ischemic heart disease
- Cardiomyopathy
Etiology of Cardiogenic Pulmonary Edema
- Increased pulmonary capillary hydrostatic pressure
- -usually due to CHF
Etiology of Non-Cardiogenic Pulmonary Edema
- Increased capillary permeability
- ARDS
Primary assessment of Congestive heart failure/Pulmonary Edema
- Past medical history
- Cough: Pink frothy secretions
- Respiratory pattern: Orthopnea
- Color
- Diagnostic chest percussion: flat or dull
- Breath sounds: Crackles, rhonchi
- Physical appearance: Pedal edema, Venous distention, diaphoresis, anxious
- Vital signs: tachycardia
Secondary assessment of Congestive heart failure/Pulmonary Edema
- CXR
- ABG: respiratory alkalosis with hypoxemia
- Pulmonary Function: reduced volumes and capacities
- Sputum: pink frothy secretions
- Electrolytes
- Hemodynamics
CXR findings in Congestive heart failure/Pulmonary Edema
- Fluffy opacities
- Butterfly or bat wing pattern
- Kerley lines
Electrolyte findings in Congestive heart failure/Pulmonary Edema
Decreased K+ and Na+
Hemodynamic findings in
- Increased PCWP with CHF
- Increased PAP
Special Tests - Congestive heart failure/Pulmonary Edema
Elevated brain natriuretic peptide (BNP) with CHF
- normal = < 100
- > 300 = mild heart failure
Treatment and management of Congestive heart failure/Pulmonary Edema
- Immediate O2 therapy at 100%
- Monitor vitals and place patient in Fowler’s position
- IPPB with 100% oxygen
- Drug therapy
- CPAP to support oxygenation
- Mechanical ventilation with PEEP for ventilatory failure
Diuretics - Congestive heart failure/Pulmonary Edema
To promote fluid excretion
- Furosemide (Lasix)
- Bumex
- Aldactone
Positive inotropic agents - Congestive heart failure/Pulmonary Edema
- Digitalis
- Digoxin
- Dopamine
- Low dose amiodarone
Analgesic/Sedative - Congestive heart failure/Pulmonary Edema
Morphine
Afterload reduction agents - Congestive heart failure/Pulmonary Edema
- Morphine
- Nitroglycerin
- Nitroprusside
- ACE inhibitors
Antidysrhythmic agents - Congestive heart failure/Pulmonary Edema
Bradycardia
-Atropine
Tachycardia
- Procainamide
- Metoprolol
- Bretylium
Electrolyte replacement - Congestive heart failure/Pulmonary Edema
- Potassium
- Sodium
Etiology of Arrhythmias
- Hypoxemia
- Ischemia
- Electrolyte imbalance
- Conduction dysorders
Treatment and management of PVC
Treat with oxygen and consider possible causes
Treatment and management of V-fib and pulseless V-tach
Immediate defib
Treatment and management of Atrial flutter, fibrillation and V-tach with a pulse
-Consider synchronized cardioversion
Not life-threatening
Drug therapy for Arrhythmias
Anti Arrhythmic agents should be administered as indicated by ECG and bedside assessment
Primary assessment of Shock
- Past medical history
- SOB
- Respiratory pattern: tachypnea
- Color
- Physical appearance: diaphoretic, poor capillary refill
- Vital signs: tachycardia, hypothermic, hypotensive
Secondary assessment of Shock
- ABG: hypoxemia
- Hemodynamics: Decreased CVP, PAP, PCWP, Cardiac output
- Urine output: Decreased
Hemodynamics - Shock
Decreased CVP, PAP, PCWP, Cardiac output
Treatment and management of Shock
- Mechanical ventilation for ventilatory failure
- Drug therapy
- Treat hypovolemia: IV fluids, blood transfusion
Drug therapy for Shock
- Vasopresssors: vasogenic hypovolemia
- Digitalis, digoxin: heart failure
- Antibiotics: infection
Etiology of Cor Pulmonale
- Increased right ventricular workload as a result of pulmonary hypertension that results in hypertrophy of the right ventricle
- Often caused by COPD
Primary assessment of a patient with Cor Pulmonale
- Past medical history
- Shortness of breath
- Appearance of chest: increased AP diameter with obstructive disease
- Physical appearance: distended neck veins, chest apin, peripheral edema
Secondary assessment of a patient with Cor Pulmonale
- Hemodynamics
- Electrocardiogram: Right ventricular hypertrophy
Hemodynamics - Cor Pulmonale
- Increased CVP
- Decreased Qt with exercise
Treatment and management of Cor Pulmonale
- Oxygen therapy
- Closely monitor vital signs
- Treat underlying cause
- Decrease workload of the right ventricle by lowering PAP
- Drug therapy
Drug therapy used to treat Cor Pulmonale
- Digitalis (Positive inotropic agents)
- Diuretics
- Pulmonary vasodilators (nitric oxide)
Etiology - Pulmonary Embolism
Deadspace condition - ventilation without perfusion
- Blood clots
- Fat/Air emboli
- Fractures
- Recent Surgery
- Venous stasis (immobility)
Primary assessment - Pulmonary Embolism
- Past medical history
- SOB
- Cough: hemoptysis
- Respiratory pattern: tachypnea
- Color
- Breath sounds: wheezing, crackles, pleural friction rub
- Physical appearance: anxious, diaphoretic
- Vital signs: tachycardia, chest pain, decreased BP
Secondary assessment - Pulmonary Embolism
- CXR
- ABG: respiratory alkalosis with hypoxemia
- Sputum: blood tinged
- Hemodynamics
- Special Tests
- Capnography: decreasing PeCO2 with normal PaCO2
- VD/VT ratio: increased
CXR - Pulmonary Embolism
May be normal or demonstrate a wedge shaped infiltrate
Hemodynamics - Pulmonary Embolism
Increased PAP
Special Tests - Pulmonary Embolism
- Spiral CT scan
- V/Q scan (normal V with abnormal Q)
- Pulmonary angiogram
- D-dimer
Treatment and Management - Pulmonary Embolism
- O2 therapy at 100% to maintain PaO2 > 80 mmHg
- Closely monitor vital signs and ABG
- Coagulation studies
- Drug therapy
- Active and passive exercises
- Early ambulation
- Anti-embolism stockings
- Intermitten pneumatic compressions devices
- Surgical options
Drug Therapy - Pulmonary Embolism
- Low dose heparin (IV, SQ), warfarin (Coumadin), dicoumarol for anticoagulation
- Analgesics to relieve chest pain
- Digitalis, Digoxin to maintain circulation
- Thrombolytic agents: streptokinase, tPA, urokinase
Surgical Options - Pulmonary Embolism
- Emblolectomy
- Vena cava interruption with sutures
- Greenfield filter in IVC
Secondary Assessment - Peripheral Vascular Disease
- Routinely perform basic lab testing
- Venography
- Vascular ultrasound evaluation
Treatment and Management - Peripheral Vascular Disease
Severe cases: amputation of gangrenous body parts
Less severe: eliminating contributing factors, especially cigarette smoking, and administering various drugs- salicylates and anticoagulants
