[Exam 2/NO] Chapter 25: Assessment of Cardiovascular Function (Page 671-705) Flashcards
Acute coronary syndrome definition
a constellation of signs and symptoms due to the rupture of atherosclerotic plaque and resultant partial or complete thrombosis within a diseased coronary artery; leads to unstable angina or acute myocardial infarction
Afterload definition
the amount of resistance to ejection of blood from the ventricle
Apical impulse definition
caused by contraction of left ventricle
Atrioventricular (AV) node definition
secondary pacemaker of the heart, located in the right atrial wall near the tricuspid valve
Baroreceptors definition
nerve fibers located in the aortic arch and carotid arteries that are responsible for control of the blood pressure
cardiac catheterization definiton
an invasive procedure used to measure cardiac chamber pressures and assess patency of the coronary arteries
Cardiac conduction system definition
specialized heart cells strategically located throughout the heart that are response for methodically generating and coordinating the transmission of electrical impulses to the myocardial cells
Cardiac output definition
amount of blood pumped by each ventricle in liters per minute
Cardiac stress test definition
a test used to evaluate the functioning of the heart during a period of increased oxygen demand
Contractility definition
ability of the cardiac muscle to shorten in response ot an electrical impulse
depolarization definition
electrical activation of a cell cause dby the influx of sodium into the cell while potassium exits the cell
diastole definition
period of ventricular relaxation resulting in ventricular filling
ejection fraction definition
percentage of the end-diastolic blodo volume ejected from the ventricle with each heartbeat
hemodynamic monitoring definition
the use of pressure monitoring devices to directly measure cardiovascular function
hypertension definition
blood pressure greater than 140//90
hypotension definition
decrease in blood pressure less than 100/60
murmurs definition
sounds created by abnormal, turbulent flow of blood in the heart
myocardial ischemia definition
condition in wich heart muscle cells receive less oxygen than needed
myocardium definition
muscle layer of the heart responsible for the pumping action of the heart
opening snaps definition
abnormal diastolic sound generated during opening of a rigid atrioventricular valve leaflet
postural (orthostatic) hypotension definition
significant drop in blood pressure (20 mm systolic or 10 diastolic) after an upright posture is assumed
preload definition
degree of stretch of cardiac muscle fibers at the end of diastole
pulmonary vascular resistance definition
resistance to blood flow out of the right ventricle created by the pulmonary circulatory system
pulse deficit definition
difference between apical and radial pulse rates
radioisotopes definition
unstable atoms that give off small amounts of energy in the form of gamma rays as they decay
repolarization definition
returns of the cell to resting state, caused by reentry of potassium into the cell while sodium exits
s1 definition
first heart sound produced by closure of atrioventricular (mitral and tricuspid) valves
S2 definition
the second heart sound produced by closure of the semilunar (aortic and pulmonic) valves
SA Node definition
primary pacemaker of the heart, in right atrium
stroke volume definition
amount of blood ejected from one of the ventricles per heartbeat
summation gallop definition
abnormal sounds created by the presence of an S3 and S4 during periods of tachycardia
systemic vascular resistance definition
resistance to blood flow out of the left ventricle created by teh systemic circulatory system
systole definition
period of ventricular contraction resulting in ejeciton of blood from the ventricles into the pulmonary artery and aorta
systolic click definition
abnormal systolic sound created by the opening of a calcified aortic or pulmonic valve duing ventricular contraction
telemetry definition
process of continuous electrocardiographic monitoring by transmission of radio waves
Layers of the heart?
Endocardium (inner) -> Myocardium -> Epicardium
What is the pericardium?
A thin, fibrous sac that the heart is encased in
What is the diastole phase?
All four chambers relax simultaneously, which allow the ventricles to fill in preparation for contaction
What is the systole phase?
Refers to the events in the heart during contraction of the atric and ventricles. Artrial systole first, then ventricular systole
What are the SA and AV node composed of?
Nodal cells
Heart rate is determined by?
The myocardial cells with the fastest inherent firing rate. Under normal circumatances, the SA node has the highest rate
Branches of the parasympathetic nervous system travel to the SA node by
the vagus nerve
Stimulation of the vagus nerve does what to the heart
slows the heart rate
sympathetic nervous system increases heart rate by
inervation of the beta-1 receptor sites located within the SA node
Stroke volume is determined by what three factors
Preload, afterload, and contractility
Preload is decreased by
Diuresis
Denodilating agents
Excessive loss of blood
Dehydration
Preload is increased by
increasing the reutrn of circulating blood volume to the ventricles
CAD development for men adn women
CAD development occurs around 10 years later in women , due to the female hormone estrogen
The three major effects of estrogen are
- An increase in HDL that transports cholesterol out of arteries
- Reduction in LDL that deposits cholesterol in the artery
- Dilation of the blood vessels, which enhance blood flow to the heart
What does an ED nurse due for a patient that arrives with acute coronary syndrome (ACS)
Performs rapid and focused assesment. Diagnosis and treatment must be started within minutes
Age Related Changes: History and Physical Findings of Atria
Irregular heart rhythm from atrial dysrhythmias
Age Related Changes: History and Physical Findings of Left Ventricle
Fatigue, Decreased exercise tolernce
S&S of heart failure
Age Related Changes: History and Physical Findings of Valves
Murmurs may be present
Age Related Changes: History and Physical Findings of Conduction System
Bradycardia
Heart Block
ECG changes
Age Related Changes: History and Physical Findings of Sympathetic nervous system
Fatigue
Diminished exercise tolerence
Decreased ability to respond to stress
Age Related Changes: History and Physical Findings of Aorta and arteries
Progressive increase in systolic BP
Widening pulse pressure
Age Related Changes: History and Physical Findings of Baroreceptor response
Postural BP changes and reports of feeling dizze, fainting when moving from lying to sitting
The signs and symptoms experienced by people with CVD are related to
dysrhythmias and conduction problems; structural, infectious, and inflammatory disorders of the heart
Most common S&S of CVD
Chest pain and discomfort
Pain or discomfort in other areas
Shortness of breath or dyspnea
peripheral edema, weight gain, abdominal distenion
Palpitations
Unusual Fatigue
How does a nurse differentiate among the causes of chest pain?
Nurse asks pt to identify the quantity, location, and quality of pain
Asses for radiation of the pain to other areas of the body and determines if associated S&S are connected.
The location of chest symptoms is not well correlated with
the cause of pain
Dietary modifications, exercise, weight loss, and careful monitoring are important strategies for managing what three major cardiovascular risk factors?
Hyperlipidemia,
Hypertension
Diabetes
What diets are commonly prescribed?
Diets that restrict sodium, fat, cholesterol, or calories
Angina Pectoris definition
Uncomfortable pressure, squeezing, or fullness in substernal chest area. Can radiate acros chest ot the medial aspect.
Angina Pectoris duration
5-15 minutes
Angina Pectoris can radiate across
chest to the medial aspect of one or both arms and hands, jaw, shoulders, upper back, or epigastrium.
Numbness, tingling, or aching
Angina Pectoris Percipitating Events
Physical exertion, emotional upset, eating large meal, or exposure to extremes in temperature
Angina Pectoris Alleviating Factors
Rest, Nitroglycerin, and Oxygen
ACS Character
Same as angina pectoris.
Pain or discomfort from ild to severe
Associated with shortness of breath, diaphoresis, palpitations, unusual fatigue
ACS Duration
> 15 minutes
ACS Precipitating Events
Emotional upset or unusual physical exertion occurs within 24 hours of symptom onset.
ACS Alleviating Factors
Morphine
Reperfusion of coronary artery with thrombolytic agent or percutaneous coronary intervention
Pericarditis Character
Sharp, sever substernal or epigastric pain
Can radiate to neck, arms, and back
Pericarditis S&S
Fever
Malaise
Dyspnea
Cough
Nausea
Dizziness
Palpitations
Pericarditis Duration
Intermittent
Pericarditis Precipitating Events
Sudden onset
Pain increases with inspiration, swallowing, coughing, and rotation of trunk
Pericarditis Alleviating Factors
Siting upright,
Analgesia
Anti-inflammatory medications
Pulmonary Disorders (Pneumonia Pulmonary Embolism) Character
Shartp, severe substernal or epigastric pain arising from inferior portion of pleura.
Patient may be able to localize the pain
Pulmonary Disorders (Pneumonia Pulmonary Embolism) Duration
> 30 minutes
Pulmonary Disorders (Pneumonia Pulmonary Embolism) Precipitating Events
Follows infectious process
Pleuritis pain increases with inspiration, coughing, movement, and supine positioning
Occurs in conjuction with community or HAI’s or VTE
Pulmonary Disorders (Pneumonia Pulmonary Embolism) Alleviating Factors
Treatment of underlying cause
Anxiety and Panic Disorders Character
Pain described as stabbing to dull ache
Associted with diaphoresis, palpitations, shortness of nbreath, tingling of hands or mouth
Anxiety and Panic Disorders Duration
Peaks in 10 minutes
Anxiety and Panic Disorders Precipitating Events
Can occur at any time including during sleep
Can be associated with a specific trigger
Anxiety and Panic Disorders Aleviating Factors
Removal of stimulus, relaxation, medications to treat anxiety or underlying disorder
Esophageal Disorders (hiatal hernia, reflux esophagitis or spasm) Character
Substernal pain described as sharp, burning, or heavy
OFten mimics angina
Can radiate to neck, arm, or shoulders
Esophageal Disorders (hiatal hernia, reflux esophagitis or spasm) Duration
5-60 minutes
Esophageal Disorders (hiatal hernia, reflux esophagitis or spasm) Precipitating Events
Recumbency, cold liquids, exercise
Esophageal Disorders (hiatal hernia, reflux esophagitis or spasm) Alleviating Factors
Food or actacid
Nitroglycerin
Musculoskeletal Disorders (Costochondritis) Character
Sharp or stabbing pain localized in anterior chest
Most often unilateral
Can radiate across chest to epigastrium or back
Musculoskeletal Disorders (Costochondritis) Duration
Hours to days
Musculoskeletal Disorders (Costochondritis) Precipitating Events
Most often follows respiratory tract infections with sidnificant coughing
Exacerbated by deep inspiration, coughing, sneezing, and movement
Musculoskeletal Disorders (Costochondritis) Alleviating Factors
Rest, ice, or heat
Analgesic or anti-inflammatory medications
Nocturia is comon in patients with
HF
Because many cardiac medications can cause GI side effects or bleeding, the nurse asks about
bloating, diarrhea, constipation, stomach upset, heartburn, loss of appetite, nausea, and vomiting
Screening for bloody urine or stools should be done for patients taking
platelet-inhibiting medicatons such as aspirin and clopidogrel
Platelet aggregation inhibitors
Anticoagulants
Oral Anticoagulantns
Activity-induced angina or shortness of breath may indicate
CAD.
Occur when myocardialischemia is present, due to an inadequate arterial blood supply
Patients with worsening HF often experience orthopnea, which is
a term used to indicate the need to sit upright or stand to avoid feeling short of breath
Patients with orthopne will report that they need to
sleep upright in a chair, or add extra pillows to their bed
What is Paroxysmal Noctural Dyspnea is
sudden awakening with shortness of breath.
Caused by the reabsorption of fluid from dependent areas of the body back into the circulatory system within hours of lying in bed
This increases preload and places increased demand o the heart of patients with HF causing pulmonary congestion
What is sleep-disordered breathing (SDB)?
This is an abnormal respiratory pattern due to intermittent episodes of upper airway obstruction causing apnea and hypopnea
This causes intermittent hypoxemia, sympathetic nervous system activation, and increased intrathoracic pressure
Untreated SDB has been linked to
CAD, hypertension, HF and dysrhythmias
SDB is treated by
use of continuous positive airway pressure (CPAP) and mandibular advancment devices (MAD).
THey maintain an open airway during sleep, prevent hypoxemia
Patients with CVD are being managed with complex medical regimens and sophisticated technology such as
implantable cardioverter defibrillators (ICDs) and left ventricular assist devices
High levels of anxiety are associated with
an increased incidience of CAD and in-hospital complication rates after MI
Patients with CAD and HF should be assesed for what mental issue?
Depression
Patients who have depresion exhibit common signs and symptoms such as
feelings of worthlessness or guilt, problems falling asleep, or staying asleep, having little pleasure, difficulty concentrating, and recent changes in appetite and weight
Stres initiates a variety of responses, such as
increased levels of catecholamines and cortisol and has been strongly linked to cardiovascular events
During a physical assessment, the nurse evaluates teh cardiovascular system for any deviations from normal with regard to the following
the heart as a pump
Atrial and ventricular filling volumes nad pressures
Cardiac Output
Compensatory mechanisms
With general appearance, patients are observed for what signs
Signs of distress, which include pain or discomfort, shortness of breath, or anxiety
For assessment of the skin and extremities, what are the 6 P’s
Pain
Pallor
Pulselessness
Paresthesia
Coldness
Paralysis
What sites of the body may be used for catheter insertion?
Major blood vessels of the arms and legs
What medicine must be used with catheter insertion?
During these procedures, systemic anticoagulation with heparin is necessary
What is peripheral edema?
Edema of the feet, ankles, or legs
What is pulse pressure?
The diffference between the systolic and the diastolic pressures
A reflection of stroke volume, ejection velocity, and systemic vascular resistance
Normally 30-40 mm Hg, indicated how well the patient maintains cardiac output
Posturual hypotension in patients with CVD is most often due to
a significant reduction in preload, which compromises cardiac output.
Reduced preload from postural hypotension is reflective of
intravascular volume depletion and is caused by dehydration from overdiuresis, bleeding (due to antiplatelet or anticoagulant medications) or medications that dilate the blood vessels
What is the pulse like in a patient with stenosis of the aortic valve
The valve opening is narrowed, reducing amount of blood ejected.
Pulse pressure is narrow, and pulse feels feeble
What is the pulse like in a patient in aortic insufficiency?
The aortic valve doe snot close completely, allowing blood to flow back from teh aorta into the left ventricle
Right-sided heart function can be estimated by observing the pulsations of the
jugular veins of the neck which reflects central venous pressure (CVP).
What is central venous pressure?
The pressure in the right atria or right ventricle at the end of diastole.
Normal heart sounds are referred to as
S1 and S2, and produce dby closure of the AV valves and teh semilunar valves.
S1 - First heart Sound: What creates this sound?
Tricuspid and mitral valve closure creates the first heart sound. Lub is used to repliacte this sound
S1 - First heart Sound: Heard loudest in what area?
The apical area.
S1 - First heart Sound: This serves at the pint of reference for
the reminader of the cardiac cycle
S1 - First heart Sound: Intensity of S1 increases during
tachycardias or with mitral stenosis. AV valves are wide open during ventricular contraction
S2 - The Second heart Sound : What creates this sound?
Closure of the pulmonic and aortic valves producue this sound, also known as the dub
S2 - The Second heart Sound : Aortic component of S2 is heard loudest over
the aortic and pulmonic areas
Abnormal Heart Sounds: These develop during
systole or diastole when structural or functional heart problems are present . These are called S3 or S4 gallops, opening snaps, systolic clicks, or murmurs.
Abnormal Heart Sounds: What are S3 and S4 gallop sounds?
Heart during diastole. These sounds are created by the vibration of the ventricle and surrounding structures as blood meets resistance during ventricular filling. Gallop evolved from cadence that is produced by the addition of a third or fourth heart sound
S3 - Third Heart Sound: Heard when?
S3 (Dub) is heard early in diastole during the period of rapid ventricular filling as blood flows from atrium into a noncompliant ventricle.
S3 - Third Heart Sound: Why is this important in older adults?
Significant finding, and suggests HF.
S4 - Fourth Heart Sound: Occurs when?
Occurs late in diastole. Heart just before S1 and generated during atrial contraction as blood enters noncompliant ventricle.
S4 - Fourth Heart Sound: What causes S4 resistance?
Hypertension
CAD
Cardiomyopathies
Aortic Stenosis
Opening Snaps and Systolic Clicks: How can abnormal sounds occur here?
Diseased valve leaflets create abnormal sounds as they open during diastole or systole
Opening Snaps and Systolic Clicks: Mid to late systolic clicks may be heard in patients with
mitral or tricuspid valve prolapse as the malfunctioning valve leaflet is displaced into the atrium during ventricular systole. Murmurs expected to be heard following htese sounds
Murmurs: What may cause this turbulence?
May be a critically narrowed valve, a malfunctioning vcalve that allows regurgitant blood flow, a congenital defect of the ventricular wall, a defect between the aorta, or increased flow of blood
Friction Rub: What is this?
A harsh, grating sound that can be heard in boths ystole and diastole . Caused by abrasion of the inflamed pericardial surfaces from pericarditis.
Lungs: Findings frequently exhibited by patients with cardiac disorders include
Hemoptysis (Pink, frothy sputum)
Cough
Crackles
Wheezes
Abdomen: A protuberant abdomen with bulging flanks indicates
Ascites.
Devlopes in patients with right ventricular or biventricular HF. This impedes the returnr of venous blood. Liver and spleen become engorged with excessive venous blood . As pressure rises, fluid shifts from vascular bed into the abdominal cavity
Abdomen: Hepatojugular REflux
This test is performed when right ventricular or biventricular HF is suspected. Patient is positoned so that the jugular venous pulse is visible to the lower pat of the neck. When observing, firm pressure applied to right upper quadrant of the abdomen
Abdomen: Bladder Distention. Urine output reduction may indicate
inadequate renal perfusion or a less serious problem such as one caused by urinary retention
What lab tests are performed on someone with cardiovascular conditions?
Cardiiac Biomarker Analysis
Blood Chemistry, Hematology, and Coagulation Studies
Lipid Profiles
Brain Natriuretic Peptide
C-Reactive Protein
Homocysteine
The diagnosis of MI is made by evaluating
the history and physical examination, the 12-lead ECG, and results of lab tests that measure serum cardiac biomarkers.
In MI, why would someone analyze serum cardiac biomarkers
Myocardial cells that become necrotic from prolonged ischemia or trauma release specific enzymes and proteins. These leak into the intersitital spaces of the myocardium and are carried by the lymphatic system into circulation. This is why it can be detected in blood samples
Normal BUN range?
10-20
What is BUN?
BUN and Creatine are end products of protein metabolism
What does elevated BUN mean?
Reflects reduced renal perfusion from decreased cardiac output or intravasular fluid volume deficit
Normal calcium range?
8.5-10.5
Why is Calcium necessary?
Necessary for blood coagulability, neuromuscular activity, and automaticity of the nodal cells
What happens in Hypocalcemia?
Decreased calcium levels slow nodal function and impair myocardial contractility. Increases risk for HF
What happens in Hypercalcemia
THis potentiates digitalis toxicity, causes increased myocardial contractility, and increases the risk for varying degrees of heart block and sudden death
Normal creatinine range?
0.7-1.4
What is creatinine used for?
Used to assess renal function. Normal creatinine and elevated BUN suggests an intrasvascular fluid volume deficit
Magnesium range
1.8-3.0
What is magnesium used for
Necessary for absoprtion of calcium, maintenance of potassium stores, and metabolism of adenosine triphosphate. Playes major role in protein and carbohydrate synthesis
What happens in Hypomagnesemia
Decrease magnesium levels due to enhanced renal excretion of magneseium from use of diuretic or digitalis therapy. Predisposes patients to atrial or ventricular tachycardias
What happens in Hypermagnesemia
Increased magnesium levels are commonly cause dby cathartics or antacids.
Depress contreactility and excitability of myocardium, causing heart block and asystole
Potassium range
3.5-5
What does potassium do
Major role in cardiac electrophysiologic function
What happens in Hypokalemia
Due to administration of potassium-excreting diuretics.
Causes many forms of dysrhythmias, includng life-threatening ventricular tachycardia or ventricular fibrilation
What happens in Hyperkalemia
From increased intake of potassium, decreased K+ excretion.
Heart block, aystole, and life-threatening ventricular dysrhythmias can occur
Sodium range
135-145
What does sodium do?
Does not affect cardiac function
What happens in Hyponatremia
Can indicate fluid excess and can be caused by heart failure or thiazide diuretics
What happens in Hypernatremia
Indicated fluid deficits and results from decrease water intake or loss of water through sweating or diarrhea.
Why are Coagulation Studies done?
Occurs when an injury to the vessel occurs. Has two pathways: intrinsic and extrinsic pathways.
Routinely performed before invasive procedures, such as cardiac catheterization, electrophysiology testing, and cardiac surgery
Coagulation Studies: Partial Thromboplastin Time (PTT) duration
60-70 seconds
Coagulation Studies: Partial Thromboplastin Time (PTT) measures what?
PTT or aPTT Measures the activity of the intrinsic pathway and is used to assess the effects of unfractioned heparin.
Therapeutic range is 1.5-2.5 times baseline values.
Coagulation Studies: What is Activcated Partial Thromboplastin Time (aPTT)
Takes 20-39 seconds
Coagulation Studies: APTT adjustement doses are
Increase of dose for <50s or decrease of dose for >100 seconds
Coagulation Studies: What is Prothrombin Time (PT)?
Takes 9.5 - 12 seconds.
Measure the extrinsic pathway activity and is used to monitor the level of anticoagulation with warfarin (Coumadin)
Coagulation Studies: What is International Normalized Ratio (INR)
Provides a standard method for reporting PT levels and eliminates the variation of PT results from different labs.
INR used to monitor the effectiveness of warfarin. Therapeutic range is 2-3.5
Hematologic Studies: What does Complete Blood Count identify?
Identifies the total number of white and red blood cells and platelets and measures hemoglobin and hematocrit. CBC is carefully monitored in patients with CVD
Hematologic Studies: Hematocrit range for males?
42-52 %
Hematologic Studies: Hematocrit range for females
35-47%
Hematologic Studies: Hemoglobin range for males
13-18
Hematologic Studies: Hemoglobin range for females
12-16
Hematologic Studies: What does hematocrit represent?
The percentage of red blood cells found in 100 mL of whole blood.
Hematologic Studies: Normal Platelets range?
150,000 - 450,000
Hematologic Studies: What are platelets?
Are the first line of protection against bleeding. They form a thrombus. Several medications inhibit platelet function.
Hematologic Studies: Normal WBC Count?
4500 - 110,00
Hematologic Studies: When are WBC counts monitored?
In immunocompromised patients, including patients with heart transplants or when there is concern for infection
Laboratory Tests - Lipid Profile: What is measured here and why?
Cholesterol, TRiglycerides, and Lipoproteins measured to evaluate a person’s risk of developing CAD
Laboratory Tests - Lipid Profile: How are cholesterol and triglycerides transported?
In the blood by combining with plasma proteins to form lipoproteins called LDL and HDL
Laboratory Tests - Lipid Profile: Blodo specimen for lipid profile should be obtained after what
A 12-hour fast
Laboratory Tests - Lipid Profile and Cholesterol Levels: Cholesterol is a lipid required for
hormone synthesis and cell membrane formation. FOund in large quantities in brain and nerve tissue
Laboratory Tests - Lipid Profile and Cholesterol Levels: Two major sources of cholesterol are
diet (animal products) and in the liver.
Laboratory Tests - Lipid Profile and Cholesterol Levels: Total cholesterol level is calculated by adding
the HDL, LDL, and 20% of the triglyceride level
Laboratory Tests - Lipid Profile and Cholesterol Levels: What does medical management fofcus on?
Determining the individuals 10 year risk for atherosclerotic vascular disease to identify those most likely to benefit from taking prescribed statins
Laboratory Tests - Lipid Profile and Cholesterol Levels: LDL s the primary transporter of
cholesterol adn triglycerides into the cell.
Laboratory Tests - Lipid Profile and Cholesterol Levels: Harmful effect of LDL is
the deposition of these substances in the walls of arterial vessels.
Laboratory Tests - Lipid Profile and Cholesterol Levels: HDL has a protective action because
it transports cholesterol away from the tissuse and cells of the arterial wall to the liver for excretion
Laboratory Tests - Lipid Profile and Triglycerides: They arestored where?
In adipose tissue and are a source of energy
Laboratory Tests - Lipid Profile and Triglycerides: Triglycerides Levels increase after
meals and are affected by stress.
Diabetes, alcohol, and obesity can elevate triglyceride levels. These levels have a direct corrlection with LDL and inverse one with HDL
Laboratory Tests - Brain (B-Type) Natriuretic Peptide): What is BNP?
A neurohormone that helps regulate BP and fluid volume. Primarly secreted from the ventricles in response to increased preload with resulting elevated ventricular pressure
Laboratory Tests - Brain (B-Type) Natriuretic Peptide): Level of BNP in blood increases as
the ventricular walls expand from increased pressure, making it a helpful diagnostic, monitoring, and prognostic tool in setting of HF
Laboratory Tests - Brain (B-Type) Natriuretic Peptide): BNP levels are useful for prompt diagnosis of
HF in settings such as ED
Laboratory Tests - Brain (B-Type) Natriuretic Peptide): Elevations of BNP can occur from
number of other conditions such as :
Pulmonary embolus
MI
Ventricular Hypertrophy
Laboratory Tests - C-Reactive Protein: What is this??
A protein produced by the liver in response to systemic inflammation. Inflammation thought to play role in athersclerosis.
Laboratory Tests - C-Reactive Protein: High - sensitivity CRP test is used as an adjunct to other tests to predict
CVD Risk. People with high hs-CRP levels have be at greatest risk for CVD compared to those with moderate or low
Laboratory Tests - Homocysteine: What is this?
An amino acid that is linked to the development of athersclerosis because it can damage the endothelial lining of arteries and promote thrombus formation
Laboratory Tests - Homocysteine: Elevated blood level of homocystein is thought to indicate
high risk for CAD, stroke, and peripheral vascular disease
Laboratory Tests - Homocysteine: What is associated with elevated homocysteine levels?
Genetic factors and a diet low in
Folate, Vitamin B6 and Vitamin B12.
Laboratory Tests - Homocysteine: What is necessary before drawing blood?
A 12-hour fast for an accurate serum management.
What other tests can be performed for those with cardiovascular dysfunctions?
Chest X-Ray and FLuoroscopy
Electrocardiography
Telemetry
LEad Systems
Ambulatory Electriocardiography
Continuous Monitors
Conintuous-REal-Life Monitors
Cardiac Event REcorders
Cardiac Implantable Electronic Devices
Cardiovascular Condition Test - Chest X-Ray and FLuroscopy: Chest X-Ray obtained to
determine the size, contour, and position of the heart.
Also determine correct placement of pacemakers and pulmonary artery catheters
Cardiovascular Condition Test - Chest X-Ray and FLuroscopy: What does Chest X-Ray revel?
Cardiac and pericardial calcifications and demonstrates physiologic alterations in the pulmonary circulation
Cardiovascular Condition Test - Chest X-Ray and FLuroscopy: Fluroscopy, what is this?
An x-ray imaging technique that allows visulation of the heart on a screen. It shows cardiac and vascular pulsations and unusal cardiac contours.
Cardiovascular Condition Tests - Chest X-Ray and FLuroscopy: Fluroscopy useful for
positioning transvenous pacing electrodes and for guiding the insertion of arterial and venous catheters during cardiac catheterization and other cardiac procedures
Cardiovascular Condition Tests - Electorcardiography: What is this?
The ECG is a graphic representation of the electrical currents of the heart. Obtained by placing disposable electrobes in standard positions on skin.
Cardiovascular Condition Tests - Electorcardiography: Standard ECG composed of
12 leads or 12 different views
Cardiovascular Condition Tests - Electorcardiography: 12 - lead ECG used to diagnose
dysrhythmias, conduction abnormalities, and chamber enlargement, as well as Myocardial Ischemia, injury, or infarction
Cardiovascular Condition Tests - Electorcardiography: What is 15-lead ECG used for?
Adds three aditional chest leads and used for early diagnosis of right ventricular and left posterior infarction
Cardiovascular Condition Tests - Electorcardiography: What is the 18-lead ECG used form?
Useful for early detection of myocardial ischemia and injury
Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring: This is the standard of care for patients who are
at high risk for dysrhythmias. Detects abnormalities in heart rate and rhythm.
Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring: Many systems have capacity to monitor for changes in ST segments, who are used to ifentify the presence of
myocardial ischemia or injury
Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Hardwire Cardiac Monitoring: Why is this used?
To continuously observe the heart for dysrhythmias and conduction disorders using 1 or 2 ECG legs.
Displayed on bedside monitor
Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Telemetry: What is this?
ECG can be continuously observed, by using the transmission of radio waves from a battery-operated transmitter to a central bank of monitors
Electrodes placed on the chest with a lead cable that connects to transmitter. Transmitter can be placed in a disposable pouch and worn around neck.
Batteries changed every 24-48 hours.
Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Telemetry: Benefit of this?
System is wireless, which allows patients to ambulate while one or two ECG leads are monitored.
Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Lead Systems: What does lead system determine?
Determines the number of electrodes needed for hardwire cardiac monitoring and telemetry
Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Lead Systems: Lead II provides teh best visualization of
atrial depolarizations (represented by the P wave)
Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Lead Systems: Lead V1 best records
ventricular depolarization and is most helpful when monitoring for certain dysrhythmias
Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Ambulatory Electrocardiography: What is this?
Form of continuous or intermittent ECG home monitoring. Used to identify the etiology of syncope or palpitations caused by dysrhythmias, detect episodes of MI, evaluate effectivenes of treatment of HF and dysrhythmias
And evaluate pacemakers.
Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Ambulatory Electrocardiography: Where is it placed?
Can be worn externally or implanted under the skin. ECG is transmitted ot a centralized monitoring station via telephone
Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Continuous Monitors: What are these?
Holter Monitors. Small portable recorders that are connected to chest electrodes that record the ECG using several leads onto a digital memory device.
Patient wears recorder for 24-48 hours up to 2 weeks
Do not provide real-time ECG recordings
Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Continuous Monitors: Effectiveness is dependent upon
Patient’s adherence with keeping a diary and marking events.
Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Continuous Monitors: Alternative of Holter monitoring is
ECG patch monitoring, uses blueooth. ECG patch placed over left pectoral area. Patient wears patch for 14 days and returns to manufacture for analysis.
Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Continuous Monitors: Downside of ECG Patch Monitoring?
Capable of monitoring just one ECG lead, which makes it less sensitive to dysrhythmia detection
Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Continuous Real-Time Monitors: What is this?
ECG monitored continuously at a remote central monitoring station.
Patient has three electrodes applied to the chest or wears an electrode belt.
When Dysrhythmia detected, system automatically transmit the ECG to a monitoring center
Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Cardiac Event Recorders: What are these?
Allow patients to record the electrical activity of the heart when they experience symptoms. Recorded ECGS transmitted to doctor by telephone.
Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Cardiac Event Recorders: Downside to this?
Record and store the ECG during only times when the patient is experiencing symptoms by manually turning it on
Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Cardiac Implantble Electronic Device: What are these used for?
Used to manage patients with serious cardiac illness.
Uses remote wireless monitoring.
Cardiovascular Condition Tests - Continuous Electrocardiographic Monitoring, Cardiac Event Recorders: What is an implantable loop recorder?
Injected under skin. Records ECGS continuously for up to 3 years. Patient doesnt have to wear anything.
Recommended for those who have infrequent symptoms
Cardiovascular Condition Tests - Cardiac Stress Tesing: What does this test evaluate?
Its a noninvasive way to evaluate the response of the cardiovascular system to stress.
Determines:
- Presence of CAD
- Cause of chest pain
- Functional capacity of heart after MI or surgerye
- Effectiveness of antianginal or antiarrhythmic medication
- Occurence of dysrhythmias
- Specific goals for physical fitness program
Cardiovascular Condition Tests - Cardiac Stress Tesing: Contraindications of stress taking include
MI within 48 hours
Angina
Uncontrolled Dysrhythmias with hemodynamic compromise
Severe aortic stenosis
Acute myocarditis
Decompensated HF
Cardiovascular Condition Tests - Cardiac Stress Tesing: Often combined with
echocardiography or radionuclide imaging, techniques used to capture images of the heart
Cardiovascular Condition Tests - Exercise Stress Tesing, Procedure: What is the procedure?
PT walks on treadmill. Exercise intesnsity progresses.
This is for 10-15 minutes
Cardiovascular Condition Tests - Exercise Stress Tesing, Procedure: What is monitored?
2 or more ECH leads for heart rate
Rhythm and Ischemic changes
BP
Skin Temperature
Physical Appearance
Perceived Exertion
Symptoms (Chest pain, dyspnea, dizziness, leg cramping)
Cardiovascular Condition Tests - Exercise Stress Tesing, Procedure: When is the test terminated?
Target heart rate is achieved or experiences signs of MI.
Cardiovascular Condition Tests - Exercise Stress Testing, Nursing Interventions: What must be instructed before test?
Fast for at least 3 hours before test and avoid stimulants such as tobacco or caffeeine.
Cardiovascular Condition Tests - Exercise Stress Testing, Nursing Interventions: What medications might they not take before test
Beta-Adrengeric blocking agents before the test
Cardiovascular Condition Tests - Pharmacologic Stress Testing, Procedure: Why would this be used?
For those whoa re cognitively impaired and unable to follow directly or physically disabled.
Cardiovascular Condition Tests - Pharmacologic Stress Testing, Procedure: What is done here?
Vasodilating agents such as dipyridamole(Persantine), Adenosine (aDenocard, or regadenoson (Lexiscan) given as IV infusion to mimic effects of exercise by maxilmally dilating coronary arteries
Cardiovascular Condition Tests - Pharmacologic Stress Testing, Procedure: Side effects of these medications?
Related to vasodilating action and include
chest pain, headache, flushing, nause, heart block, dyspnea.
Cardiovascular Condition Tests - Pharmacologic Stress Testing, Procedure: Effects of drug can be reversed with
Aminophylline.
Cardiovascular Condition Tests - Pharmacologic Stress Testing, Procedure: Vasodilating agents used in conjunction with
radionuclide imaging techniques
Cardiovascular Condition Tests - Pharmacologic Stress Testing, Procedure: Why is Dobutamine used?
Its a synthetic sympathomimetic agent that increases HR, myocardial contractility and blodo pressure increasing demands of heart. Used when Echocardiography is used because its effecting on altering myocardial wall motion
Cardiovascular Condition Tests - Pharmacologic Stress Testing, Nursing Interventions: Preparation for these tests?
Patient will not eat or drink anything for at least 3 hours.
Refrain from eaitng any liquids or food that contain chocolate or caffeine for 24 hours.
Stop medications 24-48 hours before test.
Cardiovascular Condition Tests - Radionuclide Imaging: What is this?
Noninvasive tests that use radioisotopes to evaluate coronary artery perfusion, detect myocardial ischemia, and ifaraction and or asessleft ventricular function
Cardiovascular Condition Tests - Radionuclide Imaging: What are radioisotopes
Unstable atoms that give off small amounts of energy in the form of gamma rays as they decay.
Injected into the blood strem
Cardiovascular Condition Tests - Radionuclide Imaging, Myocardial Perfusion Imaging: Imaging is performed using what two types of techniques?
Single Photon Emission Computed tomography (SPECT)
Positron Emission Tomography (PET).
Commonly performed after an acute MI to determine if arterial perfusion to the heart is comrpomised during activity
Nursing Interventions of ECG
Assess for allergies to adhesives
Rote sites for electrodes
Ensure electrodes are positioned correctly
Keep leads free form artifact
Two leads should be selected that provide the best tracing for dysrhythmias (LEad II and Chest Lead V)
Avoid placing electrodes over body areas of chest
Cardiovascular Condition Tests - Radionuclide Imaging, Myocardial Perfusion Imaging: These images combined with
stress testing to compare images obtained when the heart is resting to images of the heart in a stressed state resulting from exercise.
Cardiovascular Condition Tests - Radionuclide Imaging, Myocardial Perfusion Imaging: An area of the myocardium that shows no perfusion or reduced perfusion is said to have
a “defect” present.
A defect that does not change in size before and after stress is called a fixed defect. Theres no perfusion which is the case after an MI
Cardiovascular Condition Tests - Radionuclide Imaging, Myocardial Perfusion Imaging: What is a reversible defect?
Defects that appear or that get larger after the stress test. Cardiac Catheterization is recommended after a positive test result to determine the severity of obstructions to blood flow caused by CAD
Cardiovascular Condition Tests - Radionuclide Imaging, Myocardial Perfusion Imaging:How is the test done?
Resting images taken first
IV is inserted to administer radioisotope and electrodes placed on chest to monitor the heart rate and rhyth,.
Cardiovascular Condition Tests - Radionuclide Imaging, Single Photon Emission Computed Tomography (SPECT): Why is this used?
Used most often because it is more widely available and is technically easier to perform than PET
Cardiovascular Condition Tests - Radionuclide Imaging, Single Photon Emission Computed Tomography (SPECT): What is the procedure?
Painless, noninvaise. Involves injection of tracer.
Patient positioned supine with arms over their head.
Gamma camera circles around chest area converting singles from teh traces into pictures
Cardiovascular Condition Tests - Radionuclide Imaging, Single Photon Emission Computed Tomography (SPECT): What are some Nursing Interventions?
Ensure the patient knows that the radiation is the same as any other X-ray
Cardiovascular Condition Tests - Radionuclide Imaging, Positron Emission Tomography (PET): Why is this used?
Produces better pictures than SPECT, faster, using lower doses of radiation.
Limited because not all facilities have a PET scanner
Cardiovascular Condition Tests - Radionuclide Imaging, Positron Emission Tomography (PET): Procedure?
TRacers give by injection. One to determine blood flow, another for metabolic function
Provides 3D images.
Cardiovascular Condition Tests - Radionuclide Imaging, Positron Emission Tomography (PET): Nursing Interventions include
Instruct pt to refrain from alcohol and caffeine for 24 hours before undergoing PET.
For those with diabetes and insulin, dicuss insulin doses and food restrictions.
Insert IV site before hand. Baseline scan takes 30 minutes and scan takes 1-3 hours to complete.
Cardiovascular Condition Tests - Radionuclide Imaging, Test of Ventricular Function and Wall Motion: What tests are included here?
Equilibrium radionuclide angiocardiography (ERNA) , or MUGA, common noninvasive technique that uses a conventional scintillation camera interfaced with a computer to record images of the heart.
Cardiovascular Condition Tests - Computed Tomography: What is this?
Form of cardiac imaging that uses x-rays to provide accurate cross-sectional “virtual” slices of specific areas of the heart and surorunding structures. Create a 3D image
Cardiovascular Condition Tests - Computed Tomography: What is Coronary CT Angiography?
Requires use of an IV contrast agent to enhance the X-Rays and improve visualization of cardiac structures. Evaluates coronary artiers for stenosis. Used in caution in those with renal insufficiency.
Cardiovascular Condition Tests - Computed Tomography: What may patient receive before Coronary CT Angiography
Beta-Blockers to control heart rate and rhythm and reduce artifact.
Cardiovascular Condition Tests - Computed Tomography: What is Electron Beam CT (EBCT)?
Used to calculate a coronary artery calcium score that is based on the amount of calcium deposits in teh coronary arteries. Score used to predict likelihood of cardiac aevents.
Cardiovascular Condition Tests - Computed Tomography: What is EBCT recommended for?
Reasonable test to offer for individuals with low to intermediate risk for future CAD related events
Cardiovascular Condition Tests - Computed Tomography: Nursing Interventions
Details of procedure for pt.
PT holds breath at certain time during procedure.
Cardiovascular Condition Tests - Magnetic Resonance Angiography (MRA): What is this?
Is noninvasive, painless technique that is used to examine both the physiologic and anatomic properties of th heart. Uses magnetic field and computer generated picture to picture heart and vessels
Cardiovascular Condition Tests - Magnetic Resonance Angiography (MRA): Why is this valueable?
Valueable for diagnosing diseases of the aorta, heart muscle, and pericardium, as well as congenital heart lesions
Cardiovascular Condition Tests - Magnetic Resonance Angiography (MRA): Nursing Interventions
Can’t have pacemaker.
Positioned supine on table and enclosed in tube.
Cardiovascular Condition Tests - Echocardiography, TRansthoracic Echocardiography: What is thisi?
Noninvasive ultrasound test that is used to measure the ejection fraction and examine the size, shape, and motion of cardiac structures.
Also used to assess for leaking valves
Cardiovascular Condition Tests - Echocardiography, TRansthoracic Echocardiography: Using for diagnosing
pericaridal effusions, determining chamber sisze, and etiology of heart murmurs.
Cardiovascular Condition Tests - Echocardiography, TRansthoracic Echocardiography: How does this work?
Involves transmission of high-frequency sound waves into heart.
With use of doppler techniques, it can show the direction and velocity of blood flow .
Cardiovascular Condition Tests - Echocardiography, TRansthoracic Echocardiography: Nursing Interventions
Gel applied to skin. Takes about 30-45 minutes.
What is a DASH Diet?
A low fat, low salt diet. high in fiber and no cholic excess. A healthy diet.
Cardiovascular Condition Tests - Echocardiography, Transesophageal Echocardiography: Limitation of Transthoracic echocardiography?
Poor quality of the images produced. Ultrasound loses its clairty as it passes through tissue, lunch, and bone
When is cK-Creatinine Kinase release?
Released when there is any muscle damage
What is Troponin T?
Released when there is heart damage.
BNP tells the heart
That there is too much fluid in the left ventricle. Anything above 100 suggests HF
Triglyceridea range that you want?
100-200
LDL level that we want?
Less than 160
FOr HDL, what level do we want?
We want it high. For men its 35-80
Cardiovascular Condition Tests - Echocardiography, Transesophageal Echocardiography: Why is TEE Transesophageal Echocardiography bbetter?
Provies clearer images because ultrasound waves pass through less tissue. Moderate sedation used.
Important first line diagnostic tool for many types of CVD, including HF, valvular heart disease, dysrhythmmias and many other conditions
Cardiovascular Condition Tests - Echocardiography, Transesophageal Echocardiography: Nuring Interventions
No eat/drinking for 6 hours prior
Insets IV lineAnd stays by the patient for support.
Cardiovascular Condition Tests - Cardiac Catheteraization: What is this?
Common invasive procedure used to diagnose structural and functional diseases of the heart and great vessels.
Cardiovascular Condition Tests - Cardiac Catheteraization: How does this procedure work?
Involvves percutaneous insertion of radiopaque catheters into a large vein and artery. Fluroscopy guides to the right and left heart
Cardiovascular Condition Tests - Cardiac Catheteraization: How do you prepare for this test?
Patients have blood tests performed to evaluate metabolic functioning and renal .
Cardiovascular Condition Tests - Cardiac Catheteraization: How is this performed?
Patient has one or more IV catheters for administration of fluids. Continuously monitored for chest pain or dyspnea.
Cardiovascular Condition Tests - Right Heart Catheterization: Why is this done?
Right before left. Performed to assess the function of the right ventricle and tricuspid and pulmonary valves.
Cardiovascular Condition Tests - Right Heart Catheterization: How does this work?
Passage of catheter from an antecubital or femoral vein into the right atrium, right ventricle. PRessure and O2 sat obtained and recorded. Pressures used to diagnose pulmonary hypertension
Cardiovascular Condition Tests - Left Heart Catheterization: Why is this performed?
Performed to evaluate the aortic arch and its major branches, patency of the coronary arteries, and the function of the left ventricle and mitral and aortic valves
Cardiovascular Condition Tests - Left Heart Catheterization: Nursing interventions
Fast 8-12 hours
