Exam 2 Cardiac Flashcards
what is acute coronary syndrome?
unstable angina
NSTEMI
STEMI
what is the triad of I’s?
Ischemia
injury
infarction
what do the triad of I’s represent?
all represent an O2 supply problem:
ischemia = reversible
injury = acute period of both ischemia and infarction
infarction = irreversible cell death
a clinical syndrome usually resulting from disrupted atherosclerotic plaque, which subsequently results in an imbalance between myocardial oxygen supply and demand.
unstable angina (U/A)
U/A and _______ ___________ are closely related in presentation.
Non-STEMI
what do U/A ECG show?
May show ST depression or may be normal
cardiac enzymes are normal
Ischemia is reversible
differs from unstable angina mostly due to severity of ischemia, causes enough myocardial damage to release detectable cardiac markers indicating myocardial injury [Troponin I (TnI), Troponin T (TnT), and/or creatinine kinase (CK-MB)]
Non-ST elevation Myocardial Infarction (Non-STEMI)
what ECG changes occur with a Non-STEMI?
changes my occur, no sustained ST segment elevation.
can limit the area of infarction through medical and nursing interventions.
a loss of cardiac myocytes as a result of prolonged ischemia due to a perfusion-dependent imbalance between supply and demand.
ST elevation myocardial infarction (STEMI)
does not cause immediate cell death but rather it occurs over a finite period of time. it can take at least 4-6 H for complete necrosis of myocardial cells.
myocardial ischemia
what is dependent upon the presence of collateral blood flow into the ischemic zone or coronary artery occlusion?
STEMI
What is important to know about the cardiac marker Troponin (T,I)?
very specific and more sensitive than CK, rises 4-8 H after injury, may remain elevated for up to 2 wks, can provide prognostic info, and may be elevated with renal dz, poly/dermatomyositis
What is important to know about the cardiac marker CK-MB Isoenzyme?
rises 4-6H after injury and peaks at 24H, remains elevated 36-48H, positive if CK/MB >5% of total CK and 2 times normal, elevation can be predictive of mortality, and false positives with exercise, trauma, muscle dz, DM, and PE
what are the cardiac risk factors that cannot be changes?
heredity
gender
age
what are the cardiac risk factors that can be changed or controlled?
smoking
HTN
hypercholesterolemia
obesity
physical inactivity
stress
DM
What is the most important diagnostic info?
the patient’s “story”
- current symptoms
-time of onset
-pain assessment
-past med history/meds
what are the typical S/S of MI?
chest discomfort:
-crushing, pressure, tightness
-sustained
-unrelieved or partially relieved by rest
-unrelieved or partially relieved by nitroglycerin
pain may radiate to other areas
what are the cardiac care goals?
-decrease amt. of myocardial necrosis
-preserve LV function
-prevent major adverse cardiac events
-treat life threatening complications
-start fibrinolytic therapy quick
-percutaneous coronary intervention (Cath lab) –> goal: door to balloon <90M)
NOTE: any recent bleeds (GI, cerebral, surgical) or ischemic stroke within 3 months are ABSOLUTE CONTRAINDICATIONS to these treatments!
Cardiac treatments?
Morphine
Oxygen
Nitroglycerin
Aspirin
What is the percutaneous coronary intervention?
- given an IV and anesthetic
- tube (cath) is inserted through groin or arm to reach hearts blood vessels
- dye is injected into blood vessels so they’ll appear on x-ray
- DR will look for blockages and any other issues
- Cath can also be used to clear blockages and make repairs
what is the nursing management after cardiac cath?
-cath site is observed for bleeding or hematoma
-temp and color of the affected extremity are elevated
-dysrhythmias are carefully assessed by observing the cardiac monitor
-bed rest must be maintained for 2-6H after the procedure
-observe for contrast agent induced renal failure
a blocked artery is bypassed within a vessel taken from another a vessel taken from another part of your body, this allows blood to flow freely to your heart again
coronary artery bypass grafting (CABG)
what do you need to understand with intra aortic balloon pump (IABP)?
the balloon pump operates on the principle of counter-pulsation
the pump inflates during diastole with increases coronary artery perfusion pressure, thus improving myocardial o2 supply
the pump deflates during systole which reduces afterload and augments cardiac output, thus reducing myocardial O2 supply.
what does a VAD pump do and what parts make up the VAD?
moves blood from the heart to the body, controller operates the pump and alerts the pt if the pump isn’t working correctly, 2 batteries pump power the pump and controller, and has a driveline connected to the heart.
what are the types of heart valve replacement?
mechanical valve
biological valve
infection of inner layer of heart, the endocardium, forms thrombotic vegetations on the valves.
most cases involve native heart valves especially mitral and aortic valves.
Endocarditis
what is the patho for endocarditis?
1st: bacteremia
2nd: adhesion
3rd: vegetation
what are the CM of endocarditis?
fever and chills
weakness and fatigue
malaise
anorexia
what are the vascular manifestations of endocarditis?
splinter hemorrhages in nail-beds
petechiae
osler’s node on fingertips or toes
janeway lesions on pads of fingers and toes
roths spots
new or changing systolic murmur
heart failure
embolism (CNS, extremities, spleen, kidney)
what is endocarditis classified by?
what caused it and where it is
causative organisms: bacterial, viruses, and fungi
what are the risk factors of endocarditis?
prosthetic valves, hemodialysis, and IV drug abuse
what are the diagnostic studies for endocarditis?
history
labs (blood cultures, CBC, ESR, C-reactive protein)
echocardiography
chest x-ray
ECG
what are the medical managements and complications of endocarditis?
preventive care:
-prophylactic ABX treatment for invasive procedures on high risk pts
management:
-accurate ID of organism, IV ABX, anti-fungals, repeat blood cultures, valve repair or replacement if needed
complications: embolic events
what is the nursing management for endocarditis?
assess for:
-impaired cardiac output
-activity intolerance
Risk for injury:
-emboli
-infection
Discover:
- history– drug use, dental, procedures, valve repair
-VS (temp)
-skin
Actions:
-admin ABX
-provide resources (social services)
-provide education
inflammation of the outer lining of the heart with possible fluid accumulation (pericardial effusion)
pericarditis
what are the causes of pericarditis?
infection
trauma
autoimmune
what are the CM of pericarditis?
pain: sudden, sharp, severe
dyspnea
pericardial friction rub
fever
anxiety
what are the complications of pericarditis?
pericardial effusion (treat with pericardial synthesis)
cardiac tamponade
hiccups
hoarseness
what is the medical management for pericarditis?
lab and diagnostic test
12 lead ECG
echocardiogram
CT, MRI
Chest x-ray
labs (CBC, CRP, ESR, troponins, blood cultures, culture of pericardial fluid)
pericardial biopsy
what are the interventions for pericarditis?
focus on underlying cause and relieve pain
bedrest
ABX
analgesics (NSAIDS)
Corticosteroids
invasive interventions:
pericardiocentesis
pericardial window
thickened walls between the lower chambers (ventricles) in the heart keep it from relaxing and filling up with blood normally
hypertrophic cardiomyopathy
usually begins when the muscle in the lower left chamber stretches and thins, which makes the inside become larger than it should be
dilated cardiomyopathy
scar tissue replaces muscle tissue in the lower right chamber of the heart
arrhythmogenic right ventricle dysplasia
the lower chamber (ventricles) stiffen, usually because scar tissue has replaced muscle tissue in the heart
restrictive cardiomyopathy
what is the management for cardiomyopathy?
treat underlying cause if known; palliative not curative
control HD
Meds:
nitrates
beta blockers
anti-arrhythmics
diuretics
inotropes
anticoagulants
other interventions:
VAD
Cardiac resynchronization therapy (bi-ventricular pacing)
ICD
heart transplant
palliative care and end-of-life care
what is important to know about aortic aneurysm and dissection?
-can occur in the thoracic aorta or the abdominal aorta
-can remain stable indefinitely
-can rupture (weakened vessel bursts)
-or dissect (inner layer of aorta tears causing other layers to dissect)
symptoms: sudden, severe chest pain and other symptoms common to cardiac disfunction
prognosis: poor
