Exam 1 Flashcards
the pressure or resistance that ventricles must overcome to eject blood through the semilunar valves and into the peripheral blood vessels
afterload
pulse located at the left fifth intercostal space in the midclavicular line (in the mitral area)
apical impulse, aka PMI
Sensory receptors in the arch of the aorta and at the origin of the internal carotid arteries that are stimulated when the arterial walls are stretched by an increased blood pressure.
baroreceptors
the force of blood exerted against the vessel walls
blood pressure
swishing sound that may occur from turbulent blood flow in narrowed or atherosclerotic arteries
bruit
most definitive, but most invasive test in the dx of heart disease; involves passing a small catheter into the heart and injecting contrast medium
cardiac catheterization
A calculation of cardiac output requirements to account for differences in body size; determined by dividing the cardiac output by the body surface area.
cardiac index
volume of blood ejected by the heart each minute
cardiac output (CO)
serum lipid that includes high-density lipoproteins and low-density lipoproteins
cholesterol
phase of cardiac cycle that consists of relaxation and filling of the atria and ventricles; normally 2/3 of cardiac cycle
diastole
amount of pressure or force against the arterial walls during the relaxation phase of the cardiac cycle
diastolic blood pressure
uses ultrasound waves to assess cardiac structure and mobility (esp. the valves)
echocardiography
An invasive procedure during which programmed electrical stimulation of the heart is used to cause and evaluate dysrhythmias and conduction abnormalities to permit accurate diagnosis and treatment.
electrophysiologic study (EPS)
test that assesses cardiovascular response to an increased workload
exercise electrocardiography aka exercise tolerance or stress test
part of the total cholesterol value that should be more than 45 mm/dL for men and more than 55 mg/dL for women
high-density lipoproteins (HDLs); good cholesterol
a serum marker of inflammation and a common and critical component of the development of atherosclerosis
highly sensitive C-reactive protein (hsCRP)
an amino acid that is produced when proteins break down; elevated values may be a risk factor for the development of cardiovascular disease
homocysteine
part of total cholesterol value that should be less than 130 mg/dL
low-density lipoproteins (LDLs) aka bad cholesterol
arterial blood pressure that is necessary (between 60 and 70 mm Hg) to maintain perfusion of major body organs such as kidneys and the brain
mean arterial pressure (MAP)
abnormal heart sound that reflects turbulent blood flow through normal or abnormal valves
murmur
the heart muscle
myocardium
decrease in BP that occurs the first few seconds to minutes after changing from sitting or lying position to standing position
orthostatic hypotension aka postural hypotension
of packs of cigarettes per day multiplied by # of years the patient has smoked; used to record a patient’s smoking hx
pack-years
feeling of fluttering in the chest, an unpleasant awareness of the heartbeat, or an irregular heartbeat
palpitations
An exaggerated decrease in systolic pressure by more than 10 mm Hg during the inspiratory phase of the respiratory cycle; also known as paradoxical pulse and pulsus paradoxus.
paradoxical blood pressure
an abnormal sound that originates from the pericardial sac that occurs with the movements of the heart during the cardiac cycle
pericardial friction rub
the degree of mycocardial fiber stretch at the end of diastole and just before contraction
preload
difference between the systolic and diastolic pressures
pulse pressure
the use of radionuclide techniques in cardiovascular assessment
radionuclide myocardial perfusion imaging (rMPI)
amount of blood ejected by the left ventricle during each contraction
stroke volume (SV)
phase of the cardiac cycle that consists of the contraction and emptying of the atria and ventricles
systole
the amount of pressure or force generated by the left ventricle to distribute blood into the aorta with each contraction of the heart
systolic blood pressure
a form of echocardiography performed through the esophagus that examines cardiac structure and function
transesophageal echocardiography (TEE)
serum lipid profile that includes the measurement of cholesterol and lipoproteins
triglycerides
myocardial muscle protein released into the bloodstream with injury to myocardial muscle
troponin
amount pumped by each heartbeat
60 mL, or 5 mL/min
part of cardiac cycle during which coronary artery blood flows to the myocardium
diastole
provides a route for blood to travel from the heart to nourish the various tissues of the body
vascular system
carries cellular waste to the excretory organs
vascular system
allows lymphatic flow to drain tissue back into circulation
vascular system
returns blood back to the heart for recirculation
vascular system
-autonomic nervous system
-kidneys
-endocrine system
mechanisms that mediate and regulate BP
excites or inhibits sympathetic nervous system activity in response to impulses from chemoreceptors and baroreceptors
how the autonomic nervous system mediates and regulates BP
sense a change in blood flow and activate the renin-angiotensin-aldosterone mechanism (RAS)
how kidneys mediate/regulate BP
releases various hormones to stimulate sympathetic nervous system at tissue level
how endocrine system mediates/regulates BP
completes the circulation of blood by returning blood from the capillaries to the right side of the heart
venous system
inflammation or alteration of the pericardium (the membranous sac that encloses the heart); may be fibrous, hemorrhagic, purulent, or neoplastic
acute pericarditis
flow of blood from the aorta back into the left ventricle during diastole; occurs when the valve leaflets do not close properly during diastole and the annulus (valve ring that attaches to the leaflets) is dilated or deformed
aortic regurgitation
narrowing of the aortic valve orifice and obstruction of left ventricular outflow during systole
aortic stenosis
in patients with some types of heart failure, the use of permanent pacemaker alone or in combination with an implantable cardioverter/defibrillator (ICD) to provide biventricular pacing
cardiac resynchronization therapy
compression of the myocardium by fluid that has accumulated around the heart; compresses the atria and the ventricles, preventing them from filling adequately and reducing cardiac output
cardiac tamponade
enlargement of the heart
cardiomegaly
heart failure that occurs when the left ventricle is unable to relax adequately during diastole, preventing the ventricle from filling adequately to ensure adequate cardiac output
diastolic heart failure
inability of the heart to pump effectively due to enlargement (dilation) and weakening of ventricles
dilated cardiomyopathy (DCM)
% of blood ejected from the left ventricle with each contraction
ejection fraction (EF)
breathlessness or difficulty breathing that develops during activity or exertion
exertional dypsnea
general term for inadequatepumping of blood throughout the body by the heart, causing insufficient perfusion of body tissues with vital nutrients and O2
heart failure (HF)
inability of the heart to pump blood effectively due to thickening (hypertrophy) of the heart muscle
hypertrophic cardiomyopathy (HCM)
a microbial infection involving the endocardium
infective endocarditis
inability of the mitral valve to close completely during systole, allowing the backflow of blood into the left atrium when the ventricle contracts
mitral regurgitation
Thickening of the mitral valve due to fibrosis and calcification. The valve leaflets fuse and become stiff, and the valve opening narrows, which prevents normal blood flow from the left atrium to the left ventricle.
mitral stenosis
dysfunction of the mitral valve that occurs because the valvular leaflets enlarge and prolapse into the left atrium during systole
mitral valve prolapse
enlargement of the cardiac muscle
myocardial hypertrophy
accumulation of fluid in the pericardial space
pericardial effusion
withdrawal of pericardial fluid through a catheter inserted into the pericardial space to relieve the pressure on the heart
pericardiocentesis
pinpoint red or purple spots on the mucous membrane, palate, conjunctivae. or skin caused by bleeding within the dermal or submucosal layers
petechiae
type of pulse in which weak pulse alternates with a strong pulse despite a regular rhythm; seen in pts. w/ severely depressed cardiac fx
pulsus alternans
inability of the heart to pump effectively due to restrictive filling of the ventricles
restrictive cardiomyopathy
sensitivity response that develops after an upper respiratory tract infection with group A beta-hemolytic streptococci that can damage heart valves
rheumatic carditis
third heart sound; an early diastolic filling sound that indicates an increase in left ventricular pressure and may be heard on auscultation in pts. w/ HF
S3 gallop
black, longitudinal line or small red streak on the distal third of the nail bed; seen in pts. with infective endocarditis
splinter hemorrhage
HF that results from the heart being unable to contract forcefully enough during systole to eject adequate amounts of blood into circulation
systolic heart failure
mechanical pump that is surgically inserted and has an external power source that supports the fx of the ventricles and heart
ventricular assist device (VAD)
sudden blockage of an artery, typically in the lower extremity, in patient with chronic peripheral arterial disease
acute arterial occlusion
permanent localized dilation of an artery that enlarges the artery to at least two times its normal diameter
aneurysm
measurement of arterial insufficiency based on ratio of ankle systolic blood pressure to brachial systolic BP
ankle-brachial index (ABI)
surgical procedure most commonly used to increase arterial blood flow in the affected limb of a pt with PAD
arterial revascularization
painful ulcers caused by diminished blood flow through an artery that develop on the toes (often the great toe), between the toes, or on the upper aspect of the foot)
arterial ulcers
thickening or hardening of the arterial wall, often associated with aging
arteriosclerosis
surgical opening into an artery
arteriotomy
an invasive nonsurgical technique in which a high-speed, rotating metal bur uses fine abrasive bits to debulk the inside of the artery while minimizing damage to the vessel
atherectomy
a type of arteriosclerosis that involves the formation of plaque within the arterial wall; the leading contributor to coronary artery and cerebrovascular disease
atherosclerosis
belonging to the person, ie. when a person’s artery is moved from one part of the body to another instead of using someone else’s
autogenous
circulation that provides blood to an area with altered perfusion through smaller vessels that develop and compensate for occluded vessels
collateral circulation
blood clot that forms in one or more of the deep veins in the body, usually the legs
deep vein thrombosis (DVT)
blood clot or other object (like air bubbles, fatty deposits) that is carried in the bloodstream and lodges in another area
embolus
the repair of an abdominal aortic aneurysm using a stent made of flexible material
endovascular stent graft
potentially devastating immune-mediated adverse drug reaction caused by the emergence of antibodies that activate platelets in the presence of heparin
heparin-induced thrombocytopenia (HIT)
elevation of serum lipid levels in the blood
hyperlipidemia
severe elevation in BP (>180/120) that can damage organs such as kidneys or heart
hypertensive crisis
type of vascular filter inserted by a surgeon percutaneously into the inferior vena cava; indicated for DVT or PE when anticoagulation tx is contraindicated
inferior vena cava filtration
obstructions in the distal end of the aorta and the common, internal, and external iliac arteries that result in pain or discomfort in the lower back, buttocks, or thighs
inflow disease
characteristic leg pain experienced by patients with chronic peripheral arterial disease
intermittent claudication
decrease in BP (20 mm Hg systolic or 10 mm Hg diastolic) that occurs when a pt changes position from lying to sitting or standing
orthostatic hypotension
obstruction in the femoral, popliteal, and tibial arteries and below the superficial femoral artery (SFA) that cause burning or cramping in the calves, ankles, feet, and toes
outflow disease
disorders that change the natural flow of blood through the arteries and veins of the peripheral circulation, causing decreased perfusion to body tissues
peripheral vascular disease (PVD)
inflammation of a vein, which can predispose pts to thrombosis
phlebitis
the most common type of HTN, not caused by an existing health problem
primary hypertension
dusky red discoloration of the skin
rubor
HTN related to a specific disease or mediation
secondary HTN
in pts with venous insufficiency, changes in skin pigmentation along the ankles; may extend up calves
stasis dermatitis
associated with long-term venous insufficiency; ulcer formed as a result of edema or minor injury to the limb; typically occurs over malleolus
stasis ulcers
vascular lesions with red center and radiating branches; commonly referred to as spider veins or spider angiomas
telangiectasias
surgical procedure used to remove deep thrombosis, or blood clots that have formed in the deep veins
thrombectomy
thrombus that is associated with inflammation
thrombophlebitis
blood clot believed to result from an endothelial injury, venous stasis, or hypercoagulation
thrombus
distended, protruding veins that appear darkened and tortous
varicose veins
alteration of venous efficiency by thrombosis or defective valves; caused by prolonged venous HTN, which stretches the veins and damages the valves, resulting in further venous HTN, edema, and eventually venous stasis ulcers, swelling, and cellulitis
venous insufficiency
term that refers to both DVT and PE; obstruction by a thrombus
venous thromboembolism (VTE)
describes the three factors that contribute to thrombosis:
-stasis of blood flow
-endothelial injury
-hypercoagulability
Virchow triad
Valve opening narrows, preventing normal blood flow from the left atrium to the left ventricle
mitral stenosis
Caused by rheumatic fever, rheumatic carditis (causes valve thickening by fibrosis and calcification)
mitral stenosis
S&S: asymptomatic (mild), pulmonary congestion, right-sided HF
mitral stenosis
Incomplete closure of the valve, which allows the backflow of blood into the left atrium when the left ventricle contracts
mitral regurgitation (insufficiency)
Causes by mitral valve prolapse, rheumatic heart disease, infective endocarditis, myocardial infarction (MI), connective tissue diseases such as Marfan syndrome, and dilated cardiomyopathy
mitral regurgitation (insufficiency)
S&S: fatigue, weakness, right-sided HF (JVD, liver enlarges, pitting edema)
mitral regurgitation (insufficiency)
Valvular leaflets enlarge and prolapse into the left atrium during systole
mitral valve prolapse (MVP)
S&S: asymptomatic, atypical chest pain, dysrhythmias
mitral valve prolapse (MVP)
Caused by Marfan syndrome and other congenital cardiac defects
mitral valve prolapse (MVP)
Aortic valve orifice narrows and obstructs left ventricular outflow during systole
aortic stenosis
Most common cardiac valve dysfunction in the US and is often considered a disease of “wear and tear”
aortic stenosis
Caused by congenital bicuspid/unicuspid aortic valves; atherosclerosis
aortic stenosis
S&S: dyspnea, angina, and syncope occurring on exertion; fatigue, debilitation, and peripheral cyanosis; a narrow pulse pressure is noted when the BP is measured; a diamond-shaped, systolic crescendo-decrescendo murmur
aortic stenosis
Aortic valve leaflets do not close properly during diastole; and the annulus (the valve ring that attaches to the leaflets) may be dilated, loose, or deformed
aortic regurgitation (insufficiency)
Caused by nonrheumatic conditions such as infective endocarditis, congenital anatomic aortic valvular abnormalities, hypertension, and Marfan syndrome
aortic regurgitation (insufficiency)
S&S: asymptomatic; exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea; palpitations; nocturnal angina and diaphoresis; bounding arterial pulse; a high-pitched, blowing, decrescendo diastolic murmur
aortic regurgitation (insufficiency)
valve that is rarely affected by disease
tricuspid valve
Results from structural abnormalities of any part of the tricuspid valve
tricuspid regurgitation/insufficiency
Complications: pulmonary HTN, HF, death, cardiac cirrhosis, ascites, thrombus, embolus
tricuspid regurgitation/insufficiency
Complications of operative interventions: heart block, thrombosis of prosthetic valve, infection, arrhythmias
tricuspid regurgitation/insufficiency
Diagnostics: echo, CT, MRI, cardiac stress test
tricuspid regurgitation/insufficiency
S&S: HF symptoms and thrombus
tricuspid regurgitation/insufficiency
Nursing interventions: HF, anticoagulant, and post-operative care plans; focused cardiovascular and pulmonary assessment
tricuspid regurgitation/insufficiency
Surgery: for severe TR; usually during L sided valve surgery
tricuspid regurgitation/insufficiency
Medications: furosemide, antiarrhythmics, digoxin, ACE-I, anticoagulants
tricuspid regurgitation/insufficiency
Pulmonic valve separates the R ventricle form the pulmonary artery
pulmonic valve disease
Etiology: 7-10% of congenital heart disease; females>males; rare later in life
pulmonic valve disease
S2 is heard
pulmonic valve disease
more likely to have significant reductions in cardiac output after surgery
pts with heart valve replacement
S&S: fevers w chills, night sweats, malaise, and fatigue; anorexia, weight loss; new cardiac murmur; development of heart failure; evidence of systemic embolization; petechiae; splinter hemorrhages; nodular lesions on palms of hands and soles of feet; hemorrhagic lesions on the retina; ; + blood cultures
infective endocarditis
Occurs primarily in patients w injection drug use and those who have had valve replacements, systemic alterations in immunity, or have structural cardiac defects
infective endocarditis
Ports of entry: oral cavity, skin rashes/lesions/abscesses, infections, surgery/ invasive procedures
infective endocarditis
Diagnostics: blood cultures, new regurgitant murmur, and evidence of endocardial involvement by ECHO
infective endocarditis
Interventions: Antibiotics, rest with balanced activity, supportive therapy for HF; surgery
infective endocarditis
Definition: inflammation of the myocardium (heart muscle is swollen and thick)
myocarditis
Caused by: infective organism; drugs or chemicals
myocarditis
S&S: chest pain, SOB, arrhythmias, swelling, flu-like symptoms
myocarditis
Complications: heart failure, heart attack, stroke, arrhythmias
myocarditis
Diagnostics: blood test, CXR, ECG, ECHO, MRI
myocarditis
Interventions: ACE inhibitor, beta blockers, diuretics, corticosteroids; pacemaker or implantable cardioverter defibrillator (ICD); heart transplant
myocarditis
Definition: inflammation or alteration of the pericardium
Problem may be: fibrous, serous, hemorrhagic, purulent, or neoplastic
pericarditis
Commonly associated w: infective organisms; post-MI syndrome; post-pericardiotomy syndrome; acute exacerbations of systemic connective tissue disease
pericarditis
S&S: substernal precordial pain radiates to the L side of neck, shoulder, or back; pain aggravated by breathing (mainly on inspiration), coughing, and swallowing; pain is worse in supine position; may hear a pericardial friction rub when positioned at the LL sternal border (scratchy, high-pitched sound); elevated WBC, fever; new ST elevation in all ECG leads or PR-segment depression; new or worsening pericardial effusion
pericarditis
Diagnostics: physical, echocardiography or CT scan
pericarditis
Monitor for pericardial effusion which puts the patient at risk for cardiac tamponade
pericarditis
interventions
-pain management
-Treat cause of pericarditis
-If bacterial: antibiotics and pericardial drainage
-If chronic caused by malignant disease: radiation/chemotherapy
-If uremic: hemodialysis
-If chronic constrictive pericarditis: pericardiectomy
pericarditis
Definition: excessive fluid within the pericardial cavity which causes a sudden decrease in cardiac output; A MEDICAL EMERGENCY!
cardiac tamponade
Caused by: fluid accumulation in the pericardium and causes a sudden decrease in cardiac output
cardiac tamponade
can occur with pericarditis, as well as other conditions such as ventricular wall rupture from acute MI, cancer, and aortic dissection, and as a complication from invasive cardiac procedures
cardiac tamponade
S&S: jugular venous distention; paradoxical pulse, or pulsus paradoxus; tachycardia; muffled heart sounds; hypotension
cardiac tamponade
Diagnostics: echocardiogram, xray; hemodynamic monitoring
cardiac tamponade
Interventions:
-Increase fluid volume administration
-Pericardiocentesis
-If recurrent, then surgical pericardial window, which involves removing a portion of the pericardium to permit excessive pericardial fluid to drain into the pleural space
-In severe cases, pericardiectomy
cardiac tamponade
Definition: A subacute or chronic disease of cardiac muscle
cardiomyopathy
4 categories:
-dilated __________________
-hypertrophic ________________
-restrictive _________________
-arrythmogenic right ventricular ___________________
cardiomyopathy
interventions:
-Drug therapies:
-Use of diuretics, vasodilating agents, and cardiac glycosides to increase CO
-Antidysrhythmic drugs or implantable cardiac defibrillators may be used to control life-threatening dysrhythmias
-Beta blockers: to block inappropriate sympathetic stimulation and tachycardia
-Negative inotropic agents such as beta-adrenergic blocking agents (carvedilol) and calcium antagonists (verapamil): to decrease the outflow obstruction that accompanies exercise; decrease heart rate resulting in less angina, dyspnea, and syncope
cardiomyopathy
interventions:
-surgical: ablation, heart transplant
cardiomyopathy
Definition: a permanent localized dilation of an artery which enlarges the artery to at least twice its normal diameter
aneurysm
Forms when the middle layer of the artery is weakened producing a stretching effect in the inner later and outer layers of the artery
aneurysm
Risk for: arterial rupture!
aneurysm
Causes: atherosclerosis (most common); HTN; hyperlipidemia; and cigarette smoking; age, gender, and family history also play a role
aneurysm
type of aneurysm: gnawing pain w abdominal, flank, or back pain; pulsation in upper abdomen; if ruptures, sudden severe back pain
Abdominal Aortic Aneurysm (AAA):
type of aneurysm not as common and frequently misdiagnosed; back pain, SOB, difficulty swallowing; various locations: descending, ascending, and transverse sections of the aorta
thoracic aneurysm (TAA)
type of aneurysm: differ in that they are formed when blood accumulates in the wall of an artery; sudden tear in the aortic intima and blood enters aortic wall; lethal
dissecting aneurysm
assessment:
-Assess for abdominal/flank/back pain
-Auscultate for a bruit over the mass but do NOT palpate it as it may rupture!
-Rupturing AAA are at risk for hypovolemic shock (hypotension, diaphoresis, decreased LOC, oliguira, loss of pulses distal to the rupture, and dysrhythmias; abdominal distension
AAA aneurysm
Assess for back pain; SOB, hoarseness, difficulty swallowing
TAA aneurysm
Sharp, ripping, tearing, stabbing pain chest, back, neck, throat, jaw, or teeth; diaphoresis, n/v, faintness, HTN unless complicated by cardiac tamponade/rupture
dissecting aneurysm
Diagnostics: CT with CONTRAST is the standard tool for assessing size and location of an abdominal or thoracic aneurysm OR Ultrasonography
aneurysm
differences between angina and MI occurance
MI- occurs without cause, usually in AM
angina- brought on by stess/exertion (or rest in vasospastic
differences between angina and MI relief
angina: relieved by rest or nitroglycerin
MI: relieved by opiods only
differences between angina and MI: associated sx
angina: few if any associated sx
MI:
-n/v
-diaphoresis
-dyspnea
-feelings of fear/anxiety
-dysrhythmias
-fatigue
-palpitations
-epigastric distress
-anxiety
-dizziness
-shortness of breath
-disorientation/confusion
differences between angina and MI: duration
angina: less than 15 minutes
MI: 30+ minutes
NSTEMI and STEMI
two kinds of MI: ST segment elevation MI and non ST segment elevation
-EKG changes: ST depression and T-wave inversion, which indicates MI
-Labs: Troponin levels elevate over 3-12 hours
Causes: coronary vasospasm, spontaneous dissection, sluggish blood flow due to narrowing of th coronary artery
NSTEMI
-EKG changes: ST elevation in two contiguous leads on a 12-lead ECG, which indicates MI/necrosis
-Labs: elevated troponin
-Attributed to rupture of the fibrous atherosclerotic plaque leading to platelet aggregation and thrombus formation at the site of the rupture
-the thrombus causes an abrupt 100% occlusion to the coronary artery
-medical emergency
-requires immediate revascularization of the blocked coronary artery
STEMI
-chest pain: onset? location? radiation? intensity? duration? precipitating and relieving factors?
things to ask if MI suspected
indigestion, pain between the shoulders, aching jaw, choking sensation occurring with exertion, unusual fatigue, SOB, dizziness, palpitations, generalized anxiety or weakness, flu-like sx
signs of cardiac ischemia in females
nausea, vomiting, diaphoresis, dizziness, weakness, palpitations, SOB
signs of MI
nursing interventions for MI (10)
-Pt. hx and assessment
-vital signs
-12-lead ECG
-troponin levels
-provide pain relief meds and aspirin as prescribed
-administer supplemental O2 greater than 90%
-remain calm, stay with pt.
-assess vital signs including pain 5 minutes after meds given
-re-medicate with prescribed drugs if VS stable and check pt. every 5 minutes
-notify HSP if VS deteriorate
MI tx (8)
MONA TASS
Morphine
O2
Nitroglycerin
Aspirin
Thrombolytics
Anticoagulants
Stool Softeners
Sedatives
why stool softeners given to treat MI
prevent straining during BMs
why sedatives given to treat MI
limit size of infarction and give rest to pt. (usually valium)
-nitro
-isosorbides
nitrates
-ASA (aspirin, an NSAID)
-Clopidogrel
-vorapaxar
antiplatelets
-carvedilol
-metoprolol
beta blockers
use of metoprolol
used to control HR in AFIB
SE to watch for with beta blocker
SOB, wheezing caused by bronchoconstriction
tPA, alteplase
thrombolytic/fibrinolytic therapy
why you should assess for wheezing or SOB
beta2-blocking effects in the lungs can cause bronchoconstriction
NTG tablet admin instructions
-hold under the tongue and drink 5mL of water if necessary to allow to dissolve
-tablets can be taken every 5 minutes for pain, up to 3 tablets
NTG spray admin instructions
-pain relief should begin within 1 to 2 minutes and should be clearly evident in 3 to 5 minutes
-after 5 minutes, recheck pt. pain and VS (if BP is less than 100mm Hg systolic or 25 mm Hg diastolic lower than previous reading, lower head of bed and notify HCP)
NTG transdermal admin instructions
-apply patch to a clean, dry, hairless area; rotate application sites
-remove before defibrillation
-remove patch after 12-14 hours/day
invasive but nonsurgical technique that is the treatment of choice (for most pts. with STEMI) to reopen the clotted coronary artery and restor perfusion
percutaneous coronary intervention (PCI)
surgical procedure in which occluded arteries are bypassed with the pt’s own venous or arterial blood vessels or synthetic grafts
Coronary artery bypass graft (CABG)
clot retrieval, coronary angioplasty, and stent placement
PCI
goal is to perform ________ within 90 minutes of an acute STEMI
PCI
when is it important to monitor acute closure of the vessel (causes chest pain and potential ST elevation on 12-lead ECG), bleeding from the insertion (sheath) site, and reaction to contrast medium used in angiography. also monitor for and document hypotension, hypokalemia, and dysrhythmias
PCI
pts who undergo _____ are required to take Dual Antiplatelet Therapy (DAPT) consisting of aspirin and a platelet inhibitor
PCI
long-term nitrate and beta blocker, and an ACE inhibitor or ARB is added for patients who have had primary angioplasty after an MI
post PCI
potassium supplement may be added
post PCI
criteria for __________:
-angina with greater than 50% occlusion of the left main coronary artery that cannot be stented
-unstable angina with severe two-vessel disease, moderate three-vessel disease, or small-vessel disease in which stents could not be introduced
-ischemia w/HF
-acute MI with cardiogenic shock
-signs of ischemia or impending MI after angiography or PCI
-valvular disease
-coronary vessels unsuitable for PCI
CABG
saphenous vein grafts and internal mammary artery graft
methods of CABG
-dysrhythmias
-fluid and electrolyte imbalane
-hypotension
-hypothermia/hypotension
-bleeding
-cardiac tamponade
-decreased level of consciousness
anginal pain
complications of CABG
a variety of monitoring techniques designed to provide quantitative information about vascular capacity, blood volume, pump effectiveness, and tissue perfusion
hemodynamic monitoring
-noninvasive ________ (ex. BP cuff reading)
hemodynamic monitoring
invasive:
-intra-arterial BP monitoring
-central venous pressure (CVP) monitoring
-Pulmonary artery catheter aka Swan-Ganz catheter
Hemodynamic monitoring
catheter is placed into the radial artery to obtain repeated arterial samples, monitor various hemodynamic pressures continuously, and infuse chemotherapy agents or fibrinolytics
arterial monitoring
high CVP
fluid build up from ineffective pumping
between 60 and 70 mmHg
MAP necessary to maintain perfusion to major body organs such as kidneys and brains
low CVP
likely bleeding
indicator of fluid volume status; normal _____ is 2 to 5 mmHG
Central Venous Pressure (CVP)
indicator of fluid volume status; normal CVP is _____ - _____ mmHG
2 - 5
indicative of myocardial contractile dysfunction and/or fluid retention
high CVP
volume depetion or decreased venous tone
low CVP
[SBP+(2 x DBP)]/3 =
SBP is systolic BP
DBP is diastolic BP
MAP
medical intervention with the aim of relieving pain and decreasing myocardial O2 requirements through the reduction of preload and afterload
vasoactive therapy
may be attempted cautiously with diuretics or nitroglycerin (monitor systolic BP continuously because may result in further decline of BP)
preload reduction
to enhance ventricular preload…
give sufficient fluids to increase right atrial pressure to 20 mmHg
The nurse is providing community education regarding myocardial infarction. What teaching will the nurse include? Select all that apply.
A. Denial is common reaction to chest pain.
B. A myocardial infarction can occur in minutes.
C. Exercise at least 20 minutes three to four times per week.
D. Age is a significant risk factor in the development of CAD.
E. Women are more likely to experience atypical chest pain.
F. Atherosclerosis is a primary factor in the development of CAD.
A D E F
A client who is 9 days post–coronary artery bypass graft presents to a follow-up appointment. Which client statement requires nursing action?
A. “My chest hurts when I sneeze or cough.”
B. “If I get tired when I walk, then I stop and rest for a bit.”
C. “I have a bandage on my sternum to collect the drainage.”
D. “I haven’t had my normal appetite since the surgery.”
C
The nurse is preparing to discharge a client who recently experienced a STEMI. Which client statement indicates understanding of nitroglycerin use?
A. “The nitroglycerin should tingle when I put it in my mouth.”
B. “I will keep nitroglycerin in the glove compartment of my car.”
C. “Since the pills are small, they won’t be hard to swallow.”
D. “The nitroglycerin should relieve the pain immediately.”
A
The nurse assesses a client who had a coronary artery bypass graft yesterday. Which assessment finding will cause the nurse to suspect cardiac tamponade?
A. Incisional pain with decreased urine output
B. Muffled heart sounds with the presence of JVD
C. Sternal wound drainage with nausea
D. Increased blood pressure and decreased heart rate
B
which is worse, STEMI or NSTEMI
STEMI
sequence of cardiac conduction
-sa node
-av node
-bundle of His
-left and right bundle branches
-Purkinje fibers
represents atrial polarization
P wave
represents the time required for the impulse to through the AV node, where it is delayed, and through the bundle of His, bundle branches, and Purkinje fiber network, just before ventricular polarization
PR segment
represents the time required for atrial polarization as well as impulse travel through the conduction system and Purkinje fiber network, inclusive of the P wave and PR segment. It is measured from the beginning of the P wave to the end of the PR segment
PR interval
represents ventricular depolarization and is measured from the beginning of the Q (or R) wave to the end of the S wave
QRS complex
represents the junction where the QRS complex ends and the ST segment begins
J point
represents early ventricular repolarization
ST segment
represents ventricular repolarization
T wave
represents late ventricular polarization
U wave
represents the total time required for ventricular depolarization and repolarization and is measured from the beginning of the QRS complex to the end of the T wave
QT interval
first step of ECG interpretation
rhythm: P to P and R to R, is it a regular or irregular rhythm
2nd step to ECG interpretation
HR:
-6 second on a ten 6-sec strip= 1 minute, count Ps or Rs and multiply by 10
-1500 method: count number of small boxes in between two consecutive R waves and divide by 1500
3rd step to ECG interpretation
P wave: does a QRS follow each P wave
4th step to ECG interpretation
PR interval: measuring all constantly and 0.12 - 0.20 seconds
5th step to ECG interpretation
QRS: measuring end of PR to S and 0.06 to 0.10 seconds
6th step to ECG interpretation
T wave: evaluate and ask “are they round, smooth, and upright?”
7th step to ECG interpretation
QT interval
-measuring beginning of QRS to the end of T and < 0.40 -0.46 seconds
-varies with HR, gnder, age, and medications
-QTc > 500: if prolonged, then at risk for Torsades to Pointes
automaticity, excitability, conductivity, and contractility
electrophysiologic properties of cardiac conduction system
the pacemaker, fires automatically
SA node
stimulation, systole
depolarization
relaxation, diastole
repolarization
atrium contracts
P wave
ventricle contracts
QRS complex
SE that Haldol, zofran, some antibiotics may cause
prolonged QT interval
time required for atrial and ventricular repolarization
QT interval
QT interval normal range
< 500
caused by prolonged QT interval
torsades de pointes
electrolytes associated with QT interval
Magnesium,
how long strip should be to be interpreted
6 seconds
P wave criteria
one before each QRS complex
PR interval criteria
0.12 to 0.20 seconds and constant
QRS complex criteria
0.06 to 0.10 or 0.08 to 0.12 seconds and constant
R to R
space between R peaks; regular if consistent
prolonged QT
at risk for Torsades de Pointes
two sinus dysrhythmias
sinus bradycardia (<60 bpm)
sinus tachycardia (>100 bpm)
S/S: syncope, dizzy, weak, confused, hypotension, diaphoresis, SOB, CP
S/S of sinus bradycardia
atropine; temporary pacing for patients who are symptomatic and do not respond to atropine of for pts. with asystole
interventions for sinus bradycardia
physical activity, anxiety, pain, stress, fever, anemia, hypoxemia, hyperthyroidism, epinephrine, atropine, caffeine, alcohol, nicotine, cocaine, aminophylline, thyroid meds, dehydration, hypovolemia, MI, infection, HF
sinus tachycardia
S/S: increased pulse rate, decreased urinary output, decreased BP, dry skin, dry mucous membranes
sinus tachycardia
intervention for sinus tachycardia
find underlying cause and monitor VS
most common atrial dysrhythmias (4)
-premature atrial complexes/contractions (PAC)
-supraventricular tachycardia
-atrial fibrillation
-atrial flutter
occurs when atrial tissue becomes irritable
premature atrial complex/contraction (PAC)
premature P wave
premature atrial complex/contraction (PAC)
caused by stress, fatigue, anxiety, inflammation, infection, caffeine, nicotine, alcohol, drugs (epinephrine, sympathomimetics, amphetamines, digoxin, or anesthetic agents)
premature atrial complex/contraction (PAC)
may result from myocardial ischemia, hypermetabolic states, electrolyte imbalance, atrial stretch
premature atrial complex/contraction (PAC)
if occurs frequently, may lead to more serious atrial tachydysrhythmias
premature atrial complex/contraction (PAC)
fast heart beat above the ventricles; an atrial issue
supraventricular tachycardia (SVT)
rapid stimulation of atrial tissue at a rate of 100 to 280 bpm in adults
supraventricular tachycardia (SVT)
assess for palpitations, chest pain, weakness, SOB, nervousness, anxiety, hypotension, syncope
pt w/ a sustained rapid ventricular response
can result in angina, HF, cardiogenic shock
supraventricular tachycardia (SVT)
preferred tx for this is radiofrequency catheter ablation
supraventricular tachycardia (SVT)
other tx: vagal maneuvers (carotid sinus massage, Valsalva maneuvers), adenosine followed by NS bolus
supraventricular tachycardia (SVT)
most common dysrhythmia
Atrial fibrillation (AF or Afib)
sawtooth on ECG
atrial flutter
Vfib or pulseless Vtach
defibrillate
if R is far from P
then you have a first degree
longer, longer, longer, drop!
then you have a Wenckebach
if some Ps don’t get through,
then you have Mobitz II
If Ps and Qs don’t agree
then you have 3rd degree
T-wave inversion
pulmonary embolism (verify with CT scan)
or
pulmonary edema
pt. has chest pain and trouble breathing
suspect pulmonary embolism or pulmonary edema
med for afib
beta blocker and anticoagulant
complications of afib
stroke, PE
cause of PVC
low magnesium, low potassium, infection
complications of v tach
heart failure
med for v tach
amiodarone
stable v tach tx
electro cardioversion
v fib tx
defibrillation
PEA stands for
Pulseless Electrical Activity
PEA causes
advanced HF, severe MI, severe untreated PE, high potassium related to acidosis
PEA immediate intervention
CPR
d-dimer tests for
blood clot (finds a product of blood clot breakdown)
confirm ecg reading on at least how many leads
2
APE To Man
Aortic valve
Pulmonic valve
Erb’s Point
Tricuspid Valve
o
Mitral valve
a
n
