Exam 1 Cardiac Continued Flashcards
Classification of heart failure (4 of them)
- Class I: no symptoms with activity
- Class II: symptoms with ordinary activity
- Class III: symptoms with minimal exertion
- Class IV: symptoms at rest
Left-sided heart failure (congestive heart failure) symptoms
- Weakness
- Pallor
- Fatigue
- Dizziness
- Acute confusion (low flow)
- Pulmonary congestion
- tachycardia
- S3 heart sound
- Breathlessness
- Oliguria during day/nocturia at night
Right sided heart failure symptoms
- Jugular vein distention
- Increased abdominal girth
- Dependent edema
- Hepatomegaly
- Hepatojugular reflux
- Ascites
- Weight most reliable indicator of fluid gain/loss
Causes of Right heart failure
- left ventricular failure, right ventricular MI, pulmonary hypertension
- Right ventricle cannot empty completely
- `Increased volume and pressure in venous system and peripheral edema
Causes of Left heart failure
- hypertension, coronary artery, valvular disease
- Not all cases involve fluid accumulation
- Two types:
systolic (ventricles pump out less than 40-50% of the blood) and diastolic (The stiff ventricles fill with less blood than usual)
MAWDS education for Heart failure
- Medications: Take your medications as prescribed by your doctor.
- Activity: Stay active every day.
- Weight: Weigh yourself each day.
- Diet: Follow your diet.
- Symptoms: Recognize your symptoms and know when to call for help.
Preventing or Managing Pulmonary Edema in heart failure
- Assess for early signs (e.g., crackles in bases)
- Weight gain
- Dyspnea at rest, disorientation, confusion
- High Fowler’s position
- Oxygen therapy
- Nitroglycerin
- Rapid-acting diuretics
- IV morphine sulfate
- Continual assessment
Heart transplant complications
- Shortness of breath
- Fatigue
- Weight gain
- Decrease in blood pressure
- Persistent cough
- Irregular heart beat
- Low-grade fever – 99 to100 degrees Fahrenheit
Long term complications of a heart transplant
- Denervated heart
- Cannot feel chest pain
- Reinnervation does sometime occur - Chronic immunosuppression
- Osteoporosis, fragile skin, obesity
- HTN, liver and kidney disease - Graft vasculopathy
- Diffuse, rapidly progressing CAD
- Result of chronic rejection
Different types of valvular disease
- Mitral stenosis (murmur during diastole
- Mitral regurgitation (insufficiency)
- Mitral valve prolapse
- Aortic stenosis
- Aortic regurgitation (insufficiency)
Symptoms of mitral stenosis (valve fail to fully open) (listen at the Fifth ICS, left mid-clavicular line)
- Dyspnea on exertion (DOE), Fatigue
Palpitations - Hemoptysis
- Hoarseness
- Dysphagia
- JVD
- Orthopnea
- PND, Cough
- Atrial Fib
- S1, opening snap
- Right Ventricular hypertrophy and failure
- Pulmonary Congestion
- Low CO
- diastolic murmer
Symptoms of mitral regurgitation (valve fail to fully close) (listen at the Fifth ICS, left mid-clavicular line)
- Dyspnea on exertion (DOE), Fatigue Palpitations - Crackles in lungs - PND - Atrial Fib - S3 and/or S4 - Left Ventricle & Atrial dilation & hypertrophy -Pulmonary congestion -Low CO - Systolic murmer
Symptoms of aortic stenosis (valve fail to fully open) (listen at the Second right intercostal space (ICS), right sternal border)
- Dyspnea of exertion (DOE), fatigue
Palpitations - LV Heart failure
- Syncope
- Narrow pulse pressure
- Angina
- S3 and/or S4
- Left ventricular hypertrophy,
-Pulmonary congestion
-Sudden cardiac death - systolic murmer
Symptoms of aortic regurgitation (valve fail to fully close) (listen at the Second right intercostal space (ICS), right sternal border)
- Dyspnea of exertion (DOE), Fatigue
Palpitations - Widened pulse pressure
- Angina
- S3
- Left Ventricular dilation& hypertrophy
- diastolic murmer
Nonsurgical management for valvular disease
- Rest
- Drug therapy:
- Heart failure
- Control symptoms with medication
- Diuretics, Beta blockers, Digoxin, Oxygen
- Nitrates, Vasodilators
- Prophylactic antibiotics
- Arrhythmias
- More then 50% will have atrial fibrillation
- Anticoagulants
Surgical management for valvular disease
Valve Replacement
Mechanical: Durable, Lifelong anticoagulant
Tissue: Less durable, No anticoagulant needed
Different types of cardiomyopathy
- Dilated cardiomyopathy
- Hypertrophic cardiomyopathy
- Restrictive cardiomyopathy
- Arrhythmogenic right ventricular cardiomyopathy
Symptoms of dilated cardiomyopathy
- Heart Failure
- Arrhythmias
Treatment for dilated cardiomyopathy
- Low Na Diet,
- Diuretics, Dig Ace Inhibitor, Vasodilators,
- Anticoagulate
Symptoms of hypertrophic cardiomyopathy
- Dyspnea on exertion (DOE)
- Heart Failure
- SVT (supraventricular tachycardia)
- VT (ventricular tachycardia)
- Syncope,
- SCD
Treatment for hypertrophic cardiomyopathy
- Decrease Activity,
- Beta Blocker
- Calcium Channel Blockers
- Antiarrhythmias
- ICD
Symptoms of restrictive cardiomyopathy
- Backward Heart Failure
- Dyspnea
- Orthopnea
- Liver engorgement
Treatment for restrictive cardiomyopathy
- Low Na Diet
- Diuretics
- Digoxin
- Ace Inhibitors
- Vasodilators,
- Anticoagulate
Different types of angina
- stable angina (Predictable, frequently induced by exercise and relieved by rest)
- unstable angina (May awaken the patient from sleep)
- variant angina (Can occur while at rest, can be cyclic, the same time every day)
- myocardial infarction (heart attack)
Desired total cholesterol level
For both male and female: Less than 200 mg/dL
Desired High density lipoprotein (HDL)
Male; 35 – 65 mg/dL
Female: 35-80 mg/dL
Desired Low density lipoprotein (LDL)
Both male and female: Less than 130 mg/dL
**or lower if higher risk for CAD
Desired HDL:LDL ratio
Both male and female: 3:1
very low density lipoprotein (VLDL)
Both male and female: 7-32 ng/dL
Desired triglycerides
Male: 40-160 mg/dL
Female: 35- 135 mg/dL
pathophysiology of Acute coronary syndrome
any condition attributed to obstruction of the coronary arteries which reduces blood flow to the heart
Anterior MI major vessel and leads
- LAD (left anterior descending coronary artery)
- V3-V4
- ST elevation
Inferior MI major vessel and leads
- RCA (Right coronary artery)
- Lead II, III, aVF
- ST elevation
Ischemia (MI) on ECG
- T wave inversion or
- Tall peaked T wave, or
- ST depression
due to changes in tissue repolarization
Injury (MI) on ECG
- ST elevation
due to decreased blood supply (Returns to normal as injury heals
Infarction (MI) on ECG
- pathological Q wave (deeper or wider)
due to scar tissue that cannot depolarize
will usually remain on 12 lead ECG
Anticoagulation management of MI
- ASA (Aspirin)
- decrease platelet aggregation - Anticoagulant: Heparin
- prevent re-occlusion - Glycoprotein IIb/IIIa Inhibitors
- prevents platelet aggregation - prevents fibrinogen from binding to receptors on platelet surface
- Integrelin, Aggrastat, ReoPro
Reperfusion therapy for MI with Fibrinolytic therapy
- Onset of sx < 12 hours
- Less than 30 minutes of admission
- Tissue plasminogen activator (t-PA)
- Clot specific
- Alteplase (t-PA), Retaplase (r-PA)
- Tenectoplase (TNKase)
- Non-clot specific
- Streptokinase (SK)
- Complication: Hemorrhage
Reperfusion therapy for MI with Percutaneous coronary intervention (PCL)
- Door to needle: < 90 minutes
- Angioplasty
- Stenting
Pulmonary edema from MI symptoms
- Persistent cough w/ pink frothy sputum
- Tachypnea, dyspnea, orthopnea
- Restlessness
- Hypoxemia
- Crackles
- Cyanosis
- S3 heart sound
- Increased PAOP
Management of pulmonary edema from MI
- Suction, maintain airway
- HOB in high-fowlers
- Oxygen, high flow
- Fluid restriction
- Medications
- Diuretics
- Morphine
- Vasodilators
- Inotropic agents
- Antihypertensives - Emotional support
Post-Op care for CABG procedure
- Psychosocial
- Body image disturbance
- Pain
- Knowledge deficit
- Patient Education
- Cardiac rehab
- Lifestyle modification
- Diet: low sodium, low cholesterol
- Smoking cessation
- Exercise
- Medications
Complications of CABG procedure
- Altered tissue perfusion, cerebral (Stroke)
- Risk for infection, Mediastinitis
- Altered tissue perfusion, Renal (ATN)
Cardiogenic shock symptoms (failure of blood to move forward)
- SBP < 90 mm Hg
- Weak thready pulse
- HR > 100/min
- Decreased sensorium
- Cool, pale moist skin
- UOP < 30 mL/hr
- Decreased CO/CI
- CI <2.2 L/min/m
- Increased PAWP
- Increased CVP
- JVD
- Increased SVR
- compensatory - Tachycardia
- Tachypnea
Drugs for shock
- Dopamine / Inotropic
- Dobutamine /Dobutrex
- Norepinephrine
- Vasodilators
- Nipride
- Diuretics
Dopamine/inotropic for shock
- Drug of choice for cardiogenic shock, hypotension, CHF
- increases contractility
- increases cardiac output
- increases oxygen delivery
- vasoconstriction
Dobutamine/Dobutrex for shock
- stimulates beta adrenergic receptors causing positive inotrope effect
- causes increased CO
- usually short term treatment with cardiogenic shock, CHF, AMI
Norepinephrine for shock
- Stimulates Beta and Alpha receptors
- increases contractility and CO
Vasodilators for shock
- to decrease LV end diastolic pressure and decrease SVR
Nipride for shock
- may be used for this to dilate veins and arteries, decrease preload, and decrease afterload
Diuretics for shock
- decrease filling pressures and decrease pulmonary venous pressure
Mechanical circulatory assist devices
- impella
- Intra-aortic balloon pump (IABP)
- Ventricular assist device (VAD)
Impella assist device action
- Directly unloads the left ventricle
- Reduces myocardial workload and oxygen - consumption
- Increases cardiac output and coronary and end-organ perfusion (kidney, brain, gut.. Another organ to make sure get perfused)
Intra-aortic balloon pump (IABP) assist device action
- Inflatable balloon inserted via femoral artery and positions in the descending thoracic aorta.
- Improves coronary circulation
- Reduces afterload
Balloon counterpulsation
- Inflates during diastole (perfuse coronaries)
- Creates space in aorta
- Deflates before systole (Reduce afterload)
Ventricular assist device (VAD) action
- Diverts blood around failing heart by means of extracorporeal pump
- Set to deliver particular flow rate ( 1-6L/minute)
- Reduces cardiac workload while maintaining circulation
