CV assessment and diagnostics Flashcards
Atrial kick
the phenomenon of increased force generated by the atria during contraction.
Three layers of heart
Three layers: endocardium, myocardium, epicardium
pericardium is how many layers?
2 layers, outer layer is parietal - really tough, inner layer is epicardium or visceral
mycardium is responsible for
the contractions of the heart
automasticity
the property of cardiac cells to generate spontaneous action potentials
SA node first
60-80 BMP
AV node (if SA node fails)
40-60 BPM
vetricular cells (if SA and AV nodes fail)
20-40 BPM
Ca cells perform what type of respiration?
aerobic respiration for ATP - which means they don’t produce lactic acid and get tired
hemodynamics (so much pressure with these dynamics)
the pressure in all heart systems. tells us fluid levels.
MAP - what is the formula? (easy as 1,2,3)
average pressure maintained through cardiac cycle - 1 systolic times 2 diastolic divided by 3
1st degree AV block (self explanatory)
conduction is off at the AV node
Depolarization
electrical activation of cell caused by influx of sodium into cell while potassium exits cell
Repolarization
return of cell to resting state caused by reentry of potassium into cell while sodium exits
Effective refractory period (absolutely effective)
phase in which cells are incapable of depolarizing
relative refractory period
phase in which cells require stronger-than-normal stimulus to depolarize
of cycles depends on
HR
if HR is too fast
you don’t have time to fill, not enough blood can eject
cardiac cycle - beginning phase
atriole systole begins: atrial contraction forces blood into ventricles.
Ejection fraction
percent of end diastolic volume ejected with each heartbeat (left ventricle)
Cardiac output (CO) (drink a liter in Co in one minute)
amount of blood pumped by ventricle in liters per minute
normal cardiac output (almost 48 in Co)
4-8 liters per minute
cardiac output equation (Co = stroking my heart)
CO = SV × HR
Preload (the preload stretched my sweater) when?
degree of stretch of cardiac muscle fibers at end of diastole
Afterload (Im resistant to afterloading the sweater)
resistance to ejection of blood from ventricle
Contractility (think contraction)
ability of cardiac muscle to shorten in response to electrical impulse
factors that decrease contractility (decrease the contractor’s O2 on acid)
Decreased by hypoxemia, acidosis, certain medications
influencing factors for cardiac output (My heart is not in Co, even laundry is not receptive)
Control of heart rate
Autonomic nervous system, baroreceptors
Control of stroke volume
Preload: Frank–Starling Law ( the force or tension developed in a muscle fiber depends on the extent to which the fiber is stretched)
Afterload: affected by systemic vascular resistance, pulmonary vascular resistance
what hormones increase contractility? think - what makes the heart pump harder - AND what med?
Contractility increased by catecholamines (epinephrine and dopamine), SNS (sympathetic nervous system), certain medications (digoxin)
Increased contractility results in increased stroke volume
amount of blood pumped by ventricle in liter per minute is called what? (drink a liter in Co)
CO
ability of cardiac muscle to shorten in response to electrical impulse
contractility
degree of stretch of the cardiac muscle fibers at the end of diastole
preload
assessment of cardiac system
Health history - risk factors, family, renal disease, dyslipedia, where they live, BP, martial (usually healthier), support systems.
Demographic information
Family/genetic history
Cultural/social factors
Risk factors
Modifiable (race sometimes)
Nonmodifiable
common symptoms of cardio problems
Chest pain/discomfort
Pain/discomfort in other areas - PQRST. angina differently in males and females, sometimes left sided neck pain, arm pain, gastric burning, of the upper body
SOB/dyspnea - any change.
Peripheral edema, wt gain, abd distention (right sided heart failure, fluid accumulates in GI tract)
Palpitations
Unusual fatigue, dizziness, syncope, change in LOC
fatigue with rest
past history
***really look for sleep and rest patterns. ppl usually haven’t slept well a few days before an MI, esp true in women.
Medications
Nutrition
Elimination
Activity, exercise
Sleep, rest
Self-perception/self-concept
Roles and relationships
Coping and stress
physical assessment
general appearance (diaphoretic), skin and extremities, pulse pressure, BP, orthostatic changes, arterial pressure, jugular venous pulsations, heart inspection, other systems. usually pale. HR - efficiency and strength. use an apical if HR is really high, low, or irregular. 5th intercostal space midclavicular.
if there is a pulse deficit and the apical is higher, it’s usually due to (Jimmy has a pulse deficit)
premature ventricular contractions that don’t perfuse.
low BP, assess for (think 1st semester)
baseline, postural hypotension - orthostatic. if 10% increase in HR or 20% drop in BP. pale or mottled, not enough BP.
ALL pulses
check. circulation, sensation, mobility during assessment. do cap refill, edema.
jugular venous pulsations
patient should be at 30%. count up in cm. don’t need to know how to measure.
pale grey or blue color - central cyanosis is what? (artery goes down the center)
central cyanosis - arteries. peripheral - not arteries.
mottled skin - not good what? (not perfusion)
(webbed) not enough CO
palpation is really
checking skin temp, should be warm.
hair
brittle, dry
eyes (yellow is…)
raised yellow or orange plaque under eyelids. may indicate cholesterol.
abdomen
ascites
sacrum - check for what?
check for edema
lower extremeties - hair? and what else about skin?
absence of hair lower legs and thin skin = poor circulation. arterial.
effects of aging on cardio system - heart valves? (valves get stiff over time)
Age alters the cardiovascular response to physical and emotional stress
Heart valves become thick and stiff
Frequent need for pacemakers
normal age related changes - collagen and elasticity? (opposite of what you think)
Loss of elastin
Increase collagen
Increase of fibrous tissue, fatty deposits, cholesterol
normal***age changes - hypertrophy causes decrease in what? (hypertrophy stroking in Co)
Cardiac hypertrophy causes decrease in SV and CO
arrthymias related to aging (old - too fast or too slow in PE outfit)
Arrhythmias
Atrial fibrillation
Brady-arrhythmias
PSVT (Paroxysmal supraventricular tachycardia)
Aortic Stenosis
Valvular disease
Stroke
PE/DVT
lab tests
Cardiac biomarkers
Blood chemistry, hematology (anemic, etc, infection), coagulation
Lipid profile
Brain (B-type) natriuretic peptide (stress on heart and how hard it works)
C-reactive protein
Homocysteine (inflammation in body)
troponin test - trop is gold (not heart failure)
Troponin <0.03 ng/mL (stays elevated longer, can diagnose acute injury) - gold standard for myocardial infarction (don’t need to memorize these values)
CK-MB (creatinine kinase) (CK headbands suck)
CK-MB 0-3 ng/mL - myocaridal bands (don’t need to memorize these values)
BNP - Brain natriuretic peptide (too much bumpin makes the vents fail)
BNP <100 pg/mL (>100pg/mL positive for HF)
ventricular heart failure (released from overstretched ventricles) tells us if pt is in heart failure (don’t need to memorize these values)
ANP - what heart disorder? (A for ANP, A for atrial)
ANP 22-77 pg/mL (>77 pg/mL positive for HF)
atrial heart failure (don’t need to memorize these values)
c-reactive (c-reactive, c for coronary inflammation)
C-reactive protein (CRP) < mg/dL (> 3mg/L positive for MI
Detects inflammation
coronary arteries. can be elevated with inflammation or athleosclerosis. (don’t need to memorize these values)
Triglycerides
Triglycerides < 160 mg/dL (> 400 mg/dL CAD + risk) - identify cardiac risk (don’t need to memorize these values)
Homocysteine indicates what?
Homocysteine 3.7-12.9 micromole/L (> 14 micromole/L CAD +) - inflammation (don’t need to memorize these values)
Phospholipids (floss is 1 plus 3 plus 1)
Phospholipids 131-276 ng/mL
total cholesterol
DL <100 mg/dL (> 160 mg/dL CAD + risk)
HDL > 4- mg/dL (< 40 mg/dL CAD + risk) (don’t need to memorize these values)
hypokalemia - symptoms (little kalema makes me weak)
Muscle weakness, cardiac cells can’t repolarize
hyperkalemia - what about polarization? (you know this - think what K+ does)
Causes decrease depolarization and early repolarization
hyponatremia - may indicate what? (heart can’t get rid of fluid = hyponatremia)
Occurs with overuse of diuretics, loss of sodium, excessive water
ECG: Unspecified conduction defects usually with underlying cardiac disease
May indicate fluid overload, heart failure (check weight)
hypocalcemia - what causes it? (not enough milk for kidney pancakes)
Occurs with renal disease (increased phosphorus and decreased production of vitamin D), malnutrition, pancreatitis
hypercalcemia - what causes it? (Thia is dehydrated from too much milk)
Occurs with dehydration, thiazide diuretics
12-lead ECG- used when pts experience what? (12 pains, 12 monkeys)
Non-invasive diagnostic tool used to clients with chest pain
12 lead or rhythm strip, serial ECG for AMI times with Troponins
Leads must be placed in specific locations VERY IMPORTANT, client must lie still (reduces artifact)
5 lead ECG - how it’s transmitted? (5 g wireless continously)
Wireless, transmitted from a distance with radio signals, continuous ECG monitoring.
Hypomagnesemia - what causes it? Low maggie flushes the 3 Ds
Hypomagnesemia - serum magnesium < 1.5 mEq/L
Caused by malnutrition, diabetes, diuretics, diarrhea
Irritates cardiac muscle
Hypermagnesemia - what causes it? (kidneys can’t flush maggie)
Hypermagnesemia – Serum magnesium > 2 mEq/L
Caused by renal failure and MgSO4 administration
electrocardiography
Telephone/Facsimile/Ambulatory Electrocardiography
Transtelephonic event recorder
Phone checks for clients with pacemakers, complete ECGs can be read in 10-15 minutes
Holter monitor
Ziopatch
cardiac stress test
Exercise stress test
Pt walks on treadmill with intensity progressing according to protocols
ECG, V/S, symptoms monitored
Terminated when target HR is achieved
Pharmacologic stress testing
Vasodilating agents given to mimic exercise
imaging tests
Radionuclide imaging:
Myocardial perfusion imaging
Positron emission tomography
Test of ventricular function, wall motion
Computed tomography
Magnetic resonance angiography
echocardiogram - done where? and what types? (echo in my thorax and eosophagus at the bedside)
done at bedside. Transthoracic and Transesophageal
cardiac catheterization - and what is the risk?
Invasive procedure. valve function. risk for bleeding. can perforate the heart.
right heart cath - measures what? (think, right side)
Pulmonary artery pressure and oxygen saturations may be obtained; biopsy of myocardial tissue may be obtained.
left heart cath - remember…and at risk for what?
Involves use of contrast agent. at risk for a stroke with this.
nursing interventions for cardiac cath - and what about dye? (cath is just bleeding or in pain)
observe site for bleeding, hemotma. . screen for dythrytmias, pt to report chest pain or bleeding, monitor for contrast-induced nephropathy, pt safety. well hydrated.
Is hemodynamic invasive?
hemodynamic monitoring (hemodynamic is a VIP)
Central venous pressure
Pulmonary artery pressure
Intra-arterial B/P monitoring
Minimally invasive cardiac output monitoring devices
diagnostic studies summary - Nuclear cardiology (MUGA) (the nuclear wall has effing valves)
non-invasive. looks at wall motion, valves & EF
coronary angioplasty- (percutaneous coronary intervention (PCI) - types (angie with a balloon and stent)
Balloon angioplasty
Stent placement
heart blocks - where is it at? (Av is a block)
blockage is always at AV node
if left ventricle only ejects 40% - what is ejection fraction? (easy)
ejection fraction is 40% (check this)
know how to read
a six second strip
sinus = (S for sinus, S for SA)
SA node, if it’s fast or slow, nothing wrong with SA node. just fast or slow.
always give o2 with
dysrrthymia
dysrhythmia nursing interventions (Dysrhythmias make me dizziness)
assess VS, assess lightheadedness, dizziness. minimize anxiety, stay with patient, maximize pt control.
dysrhythmia interventions
treatment options, how to take pulse, plan - family knows CPR. referrals, socioeconomic, comorbities, self-management skills, implanted device.
late stage heart disease (late stage is a bunch of fef)
frail, fatigued, with edema
enlarged or tender liver may be
right-sided heart failure
pulsating mass in abdomen might be
AAA (abdominal aortic aneurysm)
aging - more or less sensitive to β-adrenergic agonist drugs?
Less sensitive to β-adrenergic agonist drugs
aging - changes in systole and diastole
Increase in SBP; decrease or no change in DBP
less reserve, can’t respond to increased needs as well
aging - does the heart swell or shrink? (aging heart breaks)
heart atrophies, esp left ventricle.
elasticity becomes poor.
aging - arteries?
arterties narrow due to plaque. heart disease #1 killer among older.
heart walls and aging?
Slight enlargement (thicker walls, larger cells)
normal ages changes - conducting cells
Fewer conducting cells cause an inability for the HR to increase during times of stress
normal age changes - loss of elasticity does what to the heart? (you guessed correctly)
Loss of arterial elasticity causes increase resistance & increase HR
Arteriosclerosis
hypokalemia - ECG (T lays down with little kalema)
ECG: Flat or inverted T wave, ST depression
hypokalemia - what heart problems? AND (little kalema can’t dig)
Ventricular dysrhythmias
Increase digoxin toxicity
hyperkalemia - ECG
ECG: Tall peaked T waves, wide QRS, prolonged PR intervals or flat P waves
Ventricular fibrillation, asystole
hypocalcemia ecg (a little milk on the long street)
Prolonged ST segment
Ventricular dysrhythmias, cardiac arrest
hypercalcemia - ECG (too much milk makes my T wide)
ECG: Wide T waves
Tachycardia or bradycardia, cardiac arrest
what still needs to be assessed with 5 lead ECG? (the basics)
Nurses still need to assess mechanical events (cardiac output, VS, skin, etc.)
hypomagnesia - ECG (little maggie with tall T)
ECG Tall T wave with depressed ST segment
Ventricular tachycardia/fibrillation
hypermagnesemia - symptoms - muscles? (sheriff makes my legs weak)
Causes muscle weakness, hypotension
hypermagnesemia - ECG (big maggie makes a prolonged purr)
ECG: Prolonged PR interval and wide QRS
Bradycardia
what does echocardiogram measure? (E for echo, e for ejection)
Measure the ejection fraction
echocardiogram examines..(SMH at the echo (SSM)
the size, shape, and motion of cardiac structures
cardiac cath - how long is bedrest afterwards? (cathy needs to rest for 2 - 6 hours)
maintain bed rest 2 -6 hours (until clot forms)
diagnostic - CV Magnetic Resonance Imaging (MRfI) (Mr. 3D)
3D without radiation
diagnostic - Cardiac catheterization used to measure…(cath in Co with effing O2)
used to measure O2/pressures, CO & EF
diagnostic - CXR (you need a chest xray bc you SLPD)
used to visualize density, position, size, lungs
diagnostic - Electrophysiology (EPS) (just electricity) used for what? (electra obliterates the chambers)
looks at and can initiate heart rhythm from electrodes placed into the heart chambers (like a right heart catheterization), used for ablation
coronary angioplasty - Complications (THHOS who complicate Angie get blocked) All blood related
re-occlusion, thrombus, stroke, hemorrhage, hematoma
coronary angioplasty - Nursing assessment priorities (assess Angie’s BNCK account) YOU always forget this one…
assess for bleeding, hematoma, change in MS/neurological status, chest pain, ECG for arrhythmias, renal function
coronary angioplasty - bed rest for how long?
BR for at least 4 hours post procedure
coronary angioplasty complications (Angie’s heart and kidneys are complicated)
catheter related complications, , MI, AKI
assess what when a pt has a cardiac catheter? (same stuff)
assess perpipheral pulses. temp, color, cap refill of affected limb
12-lead ECG differentiates between what? (12 g know heart attack from ishmail)
differentiates between myocardial ischemia and infarction, or other cardiac symptoms and arrhythmias
cardiac catherization - used to diagnose what? (Cath diagnoses structure and functions of plants)
used to diagnose structural and functional diseases of the heart and great vessels
cardiac catheterization - looks at what? AND what else?
look at vessels (CAD) & valves
cardiac catheterization - checks which side of the ventricles?
and Left ventricle function
cardiac catheterization - uses dye? (Cathy dyes her hair)
Uses contrast, fluoroscopy
chest x-ray can diagnose what? (x-ray makes me puffy)
pulmonary edema
cardiac cycle - ventricular systole (1st phase)
ventricular contraction pushes AV valves closed
cardiac cycle - ventricular systole (2nd phase)
semilunar valves open and blood is ejected
cardiac cycle - ventricular diastole (early)
semilunar valves close and blood flows into atria
cardiac cycle - ventricular diastole (late)
chambers relax and blood fills ventricles passively
cardiac catheter - how soon can the pt ambulate?
The patient may be permitted to ambulate within 2 hours.
age related - baroreceptors?
Decrease baroreceptor sensitivity causes a decrease in ability to regulate BP
