Exam 1 Flashcards
What is preload?
The amount of “stretch” the heart goes through before it gets ready to squeeze.
What is afterload?
The amount of resistance the heart must overcome to open the aortic valve and to push the blood through.
What is CVP (Central venous pressure) ?
The blood pressure in the venae cavae
How do you calculate cardiac output?
HR X SV
What is stroke volume ?
the amount of blood pumped out of the heart during a single contraction
What is ejection fraction ?
The PERCENTAGE of blood that leaves the heart during contraction
Acute Coronary Syndrome
Any condition that is brought on by a sudden reduction or blockage of blood flow to the heart
Tip: Syndrome means not specific
What are manifestations of ACS (acute coronary syndrome)
chest pain/ tightness
SOB
diaphoresis
Dizziness
Radiation of pain
What are risk factors for ACS?
-45+ and male
-postmenopausal women
-African American and Hispanic
-sedentary lifestyle
-Hypertension
-tobacco use
-Hyperlipidemia
-Obesity
-Diabetes
-Family History
-Stress
-Male Pattern Baldness
What is coronary artery disease?
Damage or disease of the blood vessels that supply oxygen to the heart itself.
What is Ischemia
Reduced blood flow
CAD and ischemia relationship
W/ CAD, blood vessels that supply o2 to the heart muscles become damaged or blocked. This leads to ischemia (reduced blood flow to the heart muscles). When blood flow is reduced, O2 is reduced. A reduction in O2 can lead to angina, and eventually MI.
What is an Myocardial infarction (MI)
Complete loss of blood and oxygen to part of the heart. After an MI, tissue death occurs.
What is stable Angina?
“Exertional angina” - anytime someone exerts themselves, they get chest pain.
However, pain is relieved with rest and/or nitroglycerin
What is unstable angina?
Chest pain that is not resolved by resting or taking nitro.
The pain can occur at any time and for any reason (not strictly exertion). This is a sign that MI is imminent.
What is variant angina?
Coronary arterial spasms - this is typically found in cocaine users. The angina comes and goes randomly.
What is a NSTEMI
Non Q-wave MI; only the endocardium is affected
What is STEMI
Most serious form of MI; Necrosis of the entire myocardium
What are the cardiac enzymes that are tested for after a suspected MI
Troponin 1 (this is the first sign of MI). These levels increase after an MI, and it can stay elevated for a few days after an MI
Troponin 2 (this enzyme does not increase during an attack, but shows up later and stays in a persons system for up to two weeks). This can be used as an indicator for long term heart disease.
Creatine Kinase: this is released by muscles that are stressed or dying.
Myoglobin: this is released by muscles that are stressed or dying.
What are the different diagnostic procedures for MI?
ECG (noninvasive)
Echo (noninvasive; basically an ultrasound of the heart)
stress test (exercise or nonexercised)
Thallium Scan (nuclear scan)
What are treatment options for MI
Medication; Anticoagulants, lower cholesterol, lower BP
Cardiac catheterization (angiography)
-invasive non-surgical
-angioplasty
-stenting
Coronary artery bypass graft
-done depending on more severe occlusions
-take a blood vessel from somewhere else and bypass the blockage
What are the two main heart sounds?
S1 = systole: “Lub” (caused by the closing of the mitral and tricuspid valves during contraction)
S2 - Diastole: “Dub” (caused by the closing of the aortic and pulmonic valves during relaxation)
What is a murmur?
Any extra heart sounds outside of S1 & S2; can be caused by turbulence through a valve (whooshing sounds)
What is a systolic murmur?
When the extra sounds happen between the “lub-dub”
“Lub” – “whoosh” – “Dub
What is a diastolic murmur?
when the extra sounds happen outside of the “lub-dub”
“Lub” – “Dub” – “Whoosh”
What type of murmur is more severe, systolic or diastolic?
Diastolic
What is an ejection murmur?
Systolic murmur where blood flow through a narrowed vessel or irregular valve bc the valve is restricted.
What is a regurgitant murmur?
Systolic murmur where backward flow of blood into one of the chambers of the heart (back through a valve that my not have closed)
Phenetic trick to learn causes of systolic murmurs?
“Mr. Payton Manning as MVP”
- Mitral Regurgitation
- Physiologic Murmurs
- Arterial (valve)Stenosis
- Mitral Valve Prolapse
Types of diastolic murmurs
-Narrowing (stenosis_ of the mitral or tricuspid valves
-Regurgitation of the aortic or pulmonary valves
Phenetic trick to learn causes of diastolic murmurs?
“ARMS”
AR = Aortic Regurgitation
MS = Mitral stenosis
What are some other causes of murmurs?
Fever
Exercise
Pregnancy
Anemia
Overactive Thyroid
Rapid growth of children
ASD, PDA, TOF (infants)
What is ASD, PDA, TOF?
In utero, a baby’s heart does not beat to circulate blood… it just beats to beat. Blood is passed through the shunt in a baby’s heart. The shunts SHOULD closed (this happens at the baby’s first cry!!) Once these close, the baby’s heart takes over and starts to push blood. Then babies “pink up”
What is valvular disease?
An abnormality or dysfunction to any of the heart’s four valves
Mitral (left side)
Aortic (left side)
Tricuspid (right side)
Pulmonic (right side)
What is stenosis?
Stiffening - the stiffening of a valve does not allow it to open and close effectively.
What is insufficiency / Regurgitation
a floppy and weak valve that can allow for some backflow of blood back into the heart
What is valvular heart disease
When there is an issue with the valves of the heart
Congenital - you are born with a funky valve
Acquired - something causes it later in life (ex: infection)
What are the diagnostic procedures for heart valve issues?
chest xray
ECG (12 lead)
echo
TEE (transesophageal echocardiography)
What are the different medications and procedures for valvular heart disease?
-Diuretics (reduced fluid backup bc the heart cannot pump it out)
-Afterload reducing agents (since after load is the resistance the heart has to squeeze against, this med will make it easier for the heart to pump)
-Inotropic Agents - help the heart complete a deeper contraction “more squeeze”
-Anticoagulants (prevents blood clots)
-Percutaneous balloon valvuloplasty
-Valve replacement
What is important to educate your patient on regarding valvular heart disease?
-take prophylactic antibiotic
-daily weight
-coordinate activity with built-in rest
-DASH diet
-monitor anything out of ordinary or worsening
What is heart failure?
When the heart muscles are unable to pump effectively, can result in:
inadequate cardiac output
myocardial hypertrophy
pulmonary/systemic congestion
systemic hypertension
dysrhythmia
valvular heart disease
pericarditis
cardiomyopathy
What are the different classes of heart failure?
Class 1 = no symptoms w/ exertion
Class 2 = symptoms with ordinary exertion
Class 3 = symptoms with minimal exertion
Class 4 = symptoms at rest
What is low output heart failure
When the heart does not pump out enough
Can occur on either the right or left side
Left sided = inadequate output from the left ventricle (to the body)
Right sided = inadequate output from the right ventricle (leads to fluid build-up and peripheral edema)
Systolic heart failure (ejection fraction is below 40%)
Diastolic heart failure (inadequate relaxation or stiffening prevents ventricular filing)
What is high output heart failure?
When the heart is pumping out too much (above normal) *very rare
What is health promotion and disease prevention for heart failure?
exercise
low sodium diet (reduce fluids if HF is severe)
do not smoke
take meds properly
assessments
What are the risk factors for HF?
elevated systolic BP
some meds
What are the risk factors for LEFT-Sided HF?
hypertension, CAD, Angina, MI, Valvular disease (mitral and aortic)
What are the risk factors for RIGHT-Sided HF?
left ventricular failure, right ventricular MI, and pulmonary problems such as COPD & pulmonary fibrosis.
What are the risk factors for high-output HF?
increased metabolic needs, Septicemia (fever), anemia, hyperthyroidism
What are the risk factors for Cardiomyopathy?
CAD, Infection or inflammation of heart muscle, various cancer treatments, prolonged alcohol use, heredity
What are the expected finding of LEFT sided heart failure?
Dyspnea
Orthopnea (positional dyspnea: if you are laying flat it might be hard to breathe).
nocturnal dyspnea
fatigue
S1 heart sounds
frothy sputum (blood tinged)
altered mental status (not getting enough O2)
What are the expected findings of RIGHT sided heart failure?
JVD
Edema
Abdominal distention
fatigue
weakness
nauseam polyuria at rest
enlarged liver
What are the expected findings of cardiomyopathy?
four types:
-Dilated (most common)
-Hypertrophic
-Arrhythmogenic right ventricular
-Restrictive
What are the manifestations of heart failure
fatigue, weakness
heart failure
dysrthythmias (heart block)
S! Gallop
Cardiomegaly more severe with dilated type
angina
What lab is used to test for HF?
BNP (Human B-type natriuretic peptide)
What diagnostic procedures are used for HF?
Hemodynamic monitoring
ultrasound of heart
right ventricular ejection fraction volume measurement
TEE
chest Xray
What medications are used for HF?
Diuretics
Afterload-reducing agents
ACE
ARB
CCB
Phosphodiesterase-3 inhibitors
Inotropics
Beta blockers
Vasodilators
What are the different inflammatory disorders of the heart?
Pericarditis
Myocarddits
Rheumatic endocarditis
infective endocarditis
What increases someones risk for an inflammatory disease of the heart?
congenital heart defect / cardiac anomalies
IV drug use
heart valve repalcement
immunosuppression
Rheumatic fever or other infections
malnutrition
overcrowding
lower socioeconomic status
What are expected findings with Pericarditis?
-Sounds like friction rub
-typically comes after a respiratory infection.
-lower left sternal boarder chest pain
What are expected findings with Myocarditis?
Inflammation of myocardium
Can be caused by viral, fungus, or bacteria
tachycardia
murmur
friction rub
cardiomegaly
What are expected findings of rheumatic endocarditis?
Infection of endocardium due to complications of rheumatic fever (autoimmune often caused by strep infection)
lesions on heart, chest pain, joint pain, tachycardia, SOB, rash on trunk and extremetites (scarlet fever, muscle spasms
What is infective endocarditis?
infection of the endocardium due to streptococci, fungi, or other infections organism
What are tests and diagnostic procedures for inflammatory diseases of the heart?
blood cultures
WBC
cardiac enzymes
ESR & CRP (this shows signs of inflammation and is a precursor that indicates we need to look at rheumatoid labs)
Throat cultures -check for strep
ECG
Echo
What are nursing interventions for inflammatory diseases of the heart?
lung sounds
ABGs
O2
Vital Signs
ECG
Monitor for cardiac tamponade (fluid around the heart) and HF
antibiotics
pain meds
emotional support
What is an aneurysm?
Bulge of a blood vessel
Two forms:
-Saccular - only affecting one side
-Fusiform - complete circumference
What is aortic dissection?
After a tear occurs in the lining of the artery (due to HTN), and blood accumulated within the artery wall.
What are the different types of aneurysm?
Abdominal aortic aneurysm (AAA) *most common, related to atherosclerosis
Thoracic aortic aneurysm
Aortic dissections
How do we care for a pt with an aneurysm?
Assess:
-VS
-onset
-oxygen
obtain IV access
Administer meds & O2
What medications are used for aneurysm?
medications that keep systolic BP between 100-120 (130-140 for long term)
What are therapeutic procedures for aneurysm?
abdominal aortic aneurysm resection
percutaneous aneurysm repair
thoracic aortic aneurysm repair
