Cardiovascular System Flashcards
Blood Flow through the Heart
- Deoxygenated blood enters the right Atrium through the superior and inferior Vena cava
- Flows through the tricuspid valve
- Into the right ventricle
- Through the pulmonary valve
- Into the lungs
- Oxygenated blood enters the left atrium through the pulmonary veins
- Through the Mitral valve
- Into the left ventricle
- Through the aortic valve
- Out to the body
Preload
Amount of blood returning to right side of the heart
Afterload
Pressure against which the left ventricle must pump to eject blood
compliance
How easily the heart expands when filled with blood
Stroke volume
Volume of blood pumped out of the ventricles with each contraction
Cardiac output
Amount of blood heart pumps through the circulatory system in a minute
Ejection Fraction
Amount of blood ejected per heartbeat
Stroke Volume (SV)
Volume of blood pumped out of the ventricles with each contraction
Cardiac Output (CO) Formula
CO = Stroke Volume x HR
Cause of Dec Cardiac Output
- Bradycardia
- Arrhythmias
- Pusless v-tach
- V-fib
- Asystole
- SVT
- Hypotension
- MI
Cardiac muscle disease
Cause Inc CO
- Inc blood volume
- Tachycardia
- Medications
- ACE inhibitors
- ARBs
- Nitrates
Inotropes
Chronic Venus Insufficiency /
Peripheral Vascular Disease
What
· Inadequate venous return over a long period
Causes
· pathologic ischemia
· Blood flow back to the heart is affected
· Brown discoloration
· Uneven wound edges around ankle
· Swelling
· Pedal pulse IS present
Treatment
· Elevate legs
Focus on proper wound care
Deep Venous Thrombosis (DVT)
What
* Thrombus - A clot that remains attached to the vascular wall
Causes
* Venous stasis
○ Immobility
○ Age
○ LHF
* Vein wall damage
* Hypercoagulable states
○ Pregnancy, oral contraceptives, malignancy
Prevention
* Assess at-risk individuals
* Promote venous return
* SCD’s, ted hose, encourage mobility
Treatment
* Anticoagulants
Superior Vena Cava Syndrome
What
* Tumor compressing SVC - blood cant drain from upper body
Side effects
* Headache
* Blurry vision
* Non-pulsatile distended neck veins
* Distention of thoracic veins
* Facial plethora
* Glossitis
* Dyspnea
* Upper extremity edema
Atherosclerosis
What
* Inflammatory disease
* Begins with endothelial injury
* Evolves into a fibrotic plaque
* Plaques build up and decrease blood flow to the areas they are located
* Most common cause of coronary artery disease and cerebrovascular disease
Cause
* Plaques can rupture and cause:
○ Thrombosis
○ Vasoconstriction
○ Ischemia
Hypertension
What
* High blood pressure
Assessment
* Dizziness
* Headaches
* Vision changes
* Angina
* Shortness of breath
* Nosebleeds
Causes
* Stress
* Smoking
* High salt intake
Risk factor
* Family hx
* African American race
* Advanced age
* Obesity
* Hyperlipidemia (HLD)
* Coronary Artery Disease (CAD)
* Caffeine
Complications
* Stroke
* MI
* Renal failure
* Heart Failure
* Vision loss
Treatment
* Medications
○ ACE inhibitors
○ Beta Blockers
○ CCB
Diuretics
Orthostatic (postural) hypotension
What
* BP drop that occurs when the client changes from lying, to sitting, to standing
Nursing considerations
* Client may faint
Falls can cause serious injury
Aneurysm
What
* Localized dilation of a vessel wall
* Most common - aorta
Causes
* Atherosclerosis
* HTN
* Smoking
* Family history
Rupture
· Life threatening
· Severe pain
· Do not palpate pulsating mass
Abdominal Aortic Aneurysm (AAA)
* Most common
* Abdominal, back pain
* Gnawing/sharp pain
Thoracic Aortic Aneurysm
* Shortness of breath
* Hoarseness/struggling with swallow
* Back pain
Embolism
What
○ Embolus - clot that dislodges and is mobile and can occlude the vasculature
○ Can be made of many substances: Air, Bacteria, Fat, Blood clot, Amniotic fluid
At-risk clients
○ Pregnancy
○ Hypercoagulable - can form a thrombus that dislodges and causes embolism
○ Amniotic fluid can be forced into the bloodstream during labor causing an
○ A-fib embolism
○ Clot can form in the blood pooling in the atria and be dislodged
○ Long bone fracture
○ Fat can be released from the bone marrow after trauma
Air embolism
Air embolism
* Air bubble enters a vein or artery
* Very rare
Complication of surgical procedure
* High risk: placement of CVC or arterial catheter
* If your client suddenly desaturates during one of these procedures - suspect an air embolism!
Positioning:
* Durant’s maneuver
○ Left lateral trendelenburg
* This should prevent an air embolism from lodging in the lungs - will stay in the right heart
Fat embolism
Symptoms
* Hypoxia
* Dyspnea
* Tachypnea
* Confusion
* Altered level of consciousness
* Petechial rash (does not always occur)
* Associated with orthopedic fractures such as long bone and pelvic fractures
Peripheral arterial disease
What
* Atherosclerosis of arteries that perfuse the limbs - Especially the lower extremities
* Causes decreased perfusion to the lower extremities
Assessment findings
* Pallor
* Pulselessness
* Hairlessness
* Intermittent claudication
○ Pain that occurs in legs when walking
○ Pain gets better with rest
Treatment
○ Dangle legs
○ Antiplatelet therapy
Coronary artery disease
What
○ Occlusion of the coronary arteries
○ Most often results from atherosclerotic plaques
Risk factors:
○ Advanced age
○ Hypertension
○ Dyslipidemia
○ Smoking
○ Obesity
○ Sedentary lifestyle
○ Can cause myocardial ischemia
Chronic stable angina - reversible
Chronic stable angina
What
* Chronic disease caused by narrowing of coronary arteries and plaque build up
* There are periods of decreased blood flow to the heart muscle
* Decreased blood flow leads to decreased oxygen and ischemia
* Ischemia causes chest pain
* Pain is predictable and goes away with rest or nitroglycerin
Treatment
* Nitroglycerin
○ Venous and arterial dilation → decreased afterload → increased CO
○ Given sublingual
○ Administer 1 pill q5 minutes for 3 doses
○ Do not swallow
○ Keep in a dark bottle in dry, cool place
○ Expected side effect = headache
Education
* DECREASE THE WORKLOAD OF THE HEART!
○ Rest
○ Do not overeat
○ No caffeine
○ Avoid temperature extremes
○ No smoking
○ Promote weight loss
○ Reduce stress
Unstable angina
What
* Pain DOES NOT go away with rest or nitroglycerin
* Reversible myocardial ischemia
* If not treated very quickly, will progress to a myocardial infarction
Myocardial infarction
What
* Prolonged decreased blood flow to the heart results in irreversible damage to the muscle of the heart
Goal
* Act quickly and limit the damage
Subendocardial Infarction
* No ST-segment elevation
* Non-STEMI
Transmural Infarction
* ST-segment elevations on EKG
* STEMI
* Require immediate intervention
Assessment
* Chest pain
○ Crushing
○ Radiating to left arm or jaw
○ Between shoulder blades
* Epigastric discomfort/indigestion
* Fatigue
* SOB
* Vomiting
* Elevated troponin
Treatment
* Cath lab within 90 minutes for PCI
○ Especially important if it’s a STEMI!
* ON-TIME
○ O: Oxygen
○ N: Nitroglycerin
○ T: Thrombolytics (if appropriate)
○ I: Antiplatelets (e.g., aspirin or other medications)
○ M: Monitoring and Medical care
○ E: EKG to assess heart activity
Education
* Quit smoking
* Diet
○ Low fat
○ Low salt
○ Low cholesterol
* Exercise
○ Avoid isometric exercises
Walking is a good choice
