CV Disease - Exam 3 Flashcards
Labs for MI
ACCCT
- ABG
- CK and/or CK – MB series - elevated
- CMP
- Coags
- Troponin - elevated
Labs for cardiomyopathy
- BNP - increased
- Renal & liver function – Increased
Labs for cardiogenic shock
- ABG – Metabolic acidosis
- Hemoglobin & hematocrit – to see if O2 is adequate
- CMP, LFT, Renal function – track organ function, fluid & electrolytes
- Lactate – increased levels = anerobic metabolism
- SvO2
Markers of acute cardiac damage or injury
- Brain natriuretic peptide (BNP)
- Creatinine kinase myocardial bands (CK-MB)
- Myoglobin
- Troponin
Values that are part of a lipid panel
o Total cholesterol
o LDL (low density lipoprotein)
o HDL ( high density lipoprotein )
o Triglycerides
What will a pt with cardiogenic shock’s ABG look?
Metabolic acidosis
Age related changes to the CV system
- Atrophy of left ventricle
- Decreased elasticity of Aorta
- Valve rigidity
- Stenosis of heart valances
- Stiffening vessels
- Increased fibrotic changes
- Atherosclerotic plaques
number 1 cause of death in older adults
Heart disease
- Provides info about (size , shape and position of heart)
- Cannot diagnose heart disease
- Highlight complications such as cardiac enlargement or pulmonary congestion
Chest X-ray
What type of cardiac testing is this?
Uses ultrasound to provide information on:
* The size and pumping function of the heart
* Blood-volume status
* Valve function and integrity
ECHOcardiography (ECHO)
ECHO use is used to test for what CV conditions?
- MI
- Cardiomyopathy
Type of ECHO that is performed by placing a transducer on the patients chest
Transthoracic ECHO
or
TTE
Type of ECHO that is Performed by placing a transducer in the patients esophagus
Transesophageal ECHO
or
TEE
What type of cardiac testing is this?
- Done to evaluate heart functioning during times of increased workload.
- Can also be used as a screening tool for symptoms of CV disease that are only apparent when heart is stressed.
Cardiac Stress test
Cardiac stress test is used to dx what CV conditions?
MI
What type of cardiac testing is this?
chemical stress test is done if patient is unable to exercise d/t physical limitations
Isotope (nuclear) stress test
- Invasive X-ray procedure
- Evaluates cardiac filling pressure, CO, and valve functions
- Studies can be done on both sides of the heart
Cardiac Catheterization
A cardiac Cath is done to dx what cardiac condition?
MI
What type of cardiac cath is this?
- Cath can be done through femoral , brachial or subclavian vein
- Catheter advanced to the right heart via the inferior or superior vena cava
R Heart Cath
What type of cardiac cath is this?
- Cath can be done through femoral, brachial, or radial artery
- Catheter advanced up through the aorta into the left heart.
L Heart Cath
Patient teaching for cardiac catheterization
o Fasting 6 to 8 hours prior to procedure
o Expected duration and activities to expect (IV insertion, sedation) during procedure
o Information regarding potential sensations that may be experienced during the procedure, such as a “hot flash” as the dye is injected or palpitations if dysrhythmias occur
o Maintaining adequate fluid intake after the procedure
o Avoiding strenuous activity until your provider gives the OK to resume normal activities
o Monitoring cannula insertion site for bleeding
How long should a patient fast before a cardiac cath?
6-8 hrs
Why is adequate fluid intake important for a patient undergoing a cardiac cath before and after the procedure?
The dye affects the kidneys
Pre-procedure care for a patient undergoing a cardiac cath
o Establish baseline vital signs
o Review blood work focusing on renal studies
o Complete pre-procedure checklist that includes obtaining consent, height and weight, and ensuring patient has been NPO
o Administer pre-procedure hydration
o Check glucose levels while NPO
o Anticipate holding diabetic medications
Intra-procedure care for a patient undergoing a cardiac cath
o Psychological support of the patient
o Vigilant cardiac monitoring during the procedure to observe for dysrhythmias
o Readiness and ability to respond with advanced cardiac life-support interventions should a lethal dysrhythmia occur
- Measurement of how much blood your heart is pumping out with each contraction
- Indicator of heart function
Ejection fraction
EJF testing is associated with what CV dx?
Cardiomyopathy
Healthy EJF
55-65%
What will take place if the heart cannot pump effectively?
- Cardiac output & Tissue perfusion are decreased
- Ischemia will occur
- Necrosis
- Infarct will follow
What type of cardiac testing is this?
Left sided cardiac catheterization with purpose of inspecting the coronary arteries for blockage and determining the necessity of revascularization procedures such as Coronary bypass surgery or percutaneous coronary intervention.
Coronary Angiography
- Assess electrical conduction system
- Graphic recording of the hearts electrical activity
- ID’s: Dysrhythmias, New or old heart muscle damage, Electrolytes abnormalities, and Cardiac hypertrophy
EKG
EKG is used to test for what CV dx?
- Cardiogenic shock
- Cardiomyopathy
- MI
- Used to treat: symptomatic heart blocks, Sinus brady, Junctional rhythms, IVR
- Pacer spike prior to QRS on monitor
- Place pads on the patient’s chest and back.
- Medicate with sedative as ordered. Monitor patient: HR, BP, Rhythm
- Stay with patient until stable.
- Maintain continuous cardiac monitoring to ensure detection of rhythm change or pacer failure.
Transcutaneous Pacing
or
TCP
- Used to treat: Cardiomyopathy, 3rd degree heart block(symptomatic)
- Has pace wires in each ventricle is placed in order to coordinate simultaneous ventricular contraction.
- Used for patients with slow HR
Pacemaker
- Used to treat: Cardiomyopathy
- This device detects and stops irregular heart rhythms. It continuously monitors the rhythm, delivers an electric shock when needed to attempt to restore the regular heart rhythm.
- Recommended for pt’s w/ reduced EF (less than 30%)who are at high risk for lethal dysrhythmias.
Automatic Implantable Cardioverter Defibrillator
or
AICD
- Used to treat: Symptomatic but stable tachy dysrhythmias; SVT, A-fib, A flutter, Vtach with pulse
- Controlled shock and synced with R wave
- Pads sandwiched anterior and posterior
Cardioversion
- Used to treat V-tach w/o pulse & V-fib
- Uncontrolled shock during any part of cardiac cycle
- Pads placed anterior at apex and sternum because quicker application
Defibrillation
o Used to treat: cardiogenic shock
o balloon inflated during diastole to push blood into the coronaries, deflated during systole to decrease systemic vascular resistance.
Intra-aortic Balloon pump
or
IABP
o Used to treat: MI
o a catheter with a small balloon on its tip is inserted into an artery and advanced under fluoroscopy up to the left side of the heart and coronary arteries.
Percutaneous Coronary Interventions
or
PCI
Stent placement
- Used to treat: cardiomyopathy
- an open-heart surgery in which the surgeon removes part of the thickened, overgrown heart muscle wall (septum) that separates the ventricles. Removing part of this overgrown muscle improves blood flow.
- Is used when medications alone do not relieve symptoms.
Septal myectomy
- Used to treat: cardiomyopathy
- an open-heart surgical procedure that reduces the size of the left ventricle to improve the function of the heart.
- In this procedure, the surgeon either removes a section of the heart muscle or sutures a tuck into the muscle to reduce the overall size of the ventricle.
- reshapes the heart to increase filling capacity and improve heart function.
Surgical ventricular remodeling
- Used to treat: cardiomyopathy
- a surgical procedure that uses CO2 laser ablation to create transmural channels in the heart muscle to restore myocardial perfusion.
Transmyocardial revascularization
Types of Circulatory Support for CV disease
- ECMO
- RVAD
- LVAD
o Used to treat: Cardiogenic shock
o works by pulling blood from the right ventricle, then ejecting the blood into the pulmonary artery.
Right ventricular assist device
or
RVAD
o Used to treat: cardiomyopathy, cardiogenic shock
o an electrical device that is surgically attached to the patient’s ventricle to augment contraction in the weakened heart.
o High risk, only considered when all other medical & Surgical means have been exhausted
Left ventricle assist device
or
LVAD
- Used to treat: Cardiomyopathy, Cardiogenic shock
- High risk, only considered when all other medical & Surgical means have been exhausted
Heart transplant
A CABG is used to treat what CV condition?
MI
A cardiac cath is used to dx what?
MI
TCP is used to treat what conditions?
- symptomatic heart blocks
- Sinus brady
- Junctional rhythms
- IVR
What condition does a pacemaker treat?
3rd degree heart block (symptomatic)
What is an AICD used to treat?
Cardiomyopathy
What does cardioversion treat?
- Symptomatic but stable tachy dysrhythmias
- SVT
- A-fib
- A flutter
- Vtach with pulse
Defibrillation is used to treat what?
- V-tach w/ pulse
- V-fib
Reperfusion procedures
IABP
PCI
Coronary Bypass
What is an IABP used to treat?
Cardiogenic shock
What is an PCI used to treat?
MI
To avoid cath migration post IABP placement what should be done?
- Assure the IABP catheter is secured
- The head of bed is elevated no more than 30 degrees
- The affected leg is kept straight at all times
Post IABP placement, what can brown flecks or blood in the catheter indicate?
Balloon rupture
IABP can cause what to the affected extremity?
decreased perfusion
When a pt has an MI when should the PCI be done?
Within 90 mins
Septal myectomy is used to treat what?
Cardiomyopathy
Surgical ventricular remodeling is used to treat what?
Cardiomyopathy
Transmyocardial revascularization is used to treat what?
Cardiomyopathy
ECMO is used to treat what?
Cardiogenic Shock
An RVAD is used to treat what?
Cardiogenic shock
An LVAD is used to treat what?
Cardiomyopathy and cardiogenic shock
What CV conditions is a heart transplant used to treat?
Cardiomyopathy and Cardiogenic shock
When is a heart transplant considered?
when all other medical and surgical means are exhausted
A CABG is done to treat what?
MI
Post-Cardiac cath Interventions
- Maintain the patent on flat bedrest for 2-6 hours (depends on site used), prevents stress on the insertion site , which may cause bleeding
- Observe catheter insertion site for bleeding or hematoma formation
- Cardiac monitoring- frequent vital signs
- Monitor for chest pain
- Assess for signs of stroke: Weakness, Confusion, Slurred speech
- Monitor peripheral pulses, color and temp in affected extremity
- Monitor urine output – dye can affect kidneys
- Maintaining sufficient oral and or IVF intake to ensure renal clearance of the dye & to maintain adequate hydration status
chest pain caused by a trigger (stress, exercise, etc.)
* Predictable (each time you work out super hard, you get some chest pain)
* Lasts a short time, 5 min or less
* Resolves
Stable angina
or predictable angina
chest pain that may not have a trigger
* Medical emergency
* Unpredictable
* Occurs at rest
* Continues despite resting
Unstable angina
pre-infartion
S/S of cardiomyopathy
§ Chest pain
§ Dizziness
§ Indigestion
§ N/V
§ Sweating
§ Fatigue
§ Palpitations
§ SHOB
§ Edema of the legs, feet, and abdomen
§ Pulmonary congestion
§ Abnormal heart sounds
§ JVD
§ Enlarged Liver
§ Sleeplessness
§ Cough
§ Fainting
§ Loss of appetite
All of the following are S/S of what?
§ Chest pain
§ Dizziness
§ Indigestion
§ N/V
§ Sweating
§ Fatigue
§ Palpitations
§ SHOB
§ Edema of the legs, feet, and abdomen
§ Pulmonary congestion
§ Abnormal heart sounds
§ JVD
§ Enlarged Liver
§ Sleeplessness
§ Cough
§ Fainting
§ Loss of appetite
Cardiomyopathy
Medications to treat cardiomyopathy
§ ACE inhibitors (angiotensin- converting enzyme inhibitors)
§ ARB (Angiotensin-receptor blockers)
§ Beta Blockers
§ Diuretics
Surgical tmnt for cardiomyopathy
- Pacemaker
- Automatic implantable cardioverter defibrillator (AICD)
- Septal myectomy
- Surgical ventricular remodeling
- Transmyocardial revascularization
- Left ventricular assist device.
Heart transplant
- Synchronized shock delivered only during the R wave of the QRS complex.
- Not done with CPR
- For stable patients
- Used for pt’s in A-fib
Cardioversion
- Done with automated external defibrillator (AED)
- Resume CPR after shock
- Unstable patients
- Used on pt’s with VT or V-Fib
Defibrillation
