LO1 and 6 Cardiac Pt Assessment and Care Flashcards
Deep Vein Thrombosis (DVT)
A thrombosis is a blood clot that remains attached to a vessel wall.
what is the cause of Deep Vein Thrombosis (DVT)
Intimal irritation, roughening, inflammation, traumatic injury, infection, low blood pressures, or obstructions that cause blood stasis
Inflammation is the usual cause of DVT
causes of DVT
History of trauma Sepsis Stasis or inactivity Recent immobilization Pregnancy Birth control pills Malignancy Coagulopathies Smoking Varicose veins
signs and symptoms of DVT
Pain Edema Increase temp extremity Erythema Tenderness
Atherosclerosis
Fatty build up
Affects the inner lining of the aorta, cerebral, and coronary blood vessels.
Abnormal thickening and hardening of vessel walls
what is Atherosclerosis caused by
Caused by soft deposits of intra-arterial fat and fibrin which harden over time
Risk Factors for atherosclerosis
Hypertension (HTN)
Cigarette smoking: thickens vessel walls making it hard for blood to pass through
Diabetes
High serum cholesterol levels
Lack of exercise
Obesity
Family history of heart disease or stroke
Male sex
Effects of Arteriosclerosis
loss of elasticity in vessel walls
Partial obstruction of vessel lumen (Ischemia)
Complete obstruction of vessel lumen (Infarction, Necrosis)
Thrombosis
Embolism (Obstruction,
Infarction (Heart and Brain)
—Infarction: complete obstruction
Aneurysm (Rupture, Exsanguination)
Vessel calcification (Rigidity, Rupture)
Aneurysm
“dilation of a vessel”
Artery wall weakness
most common cause for AAA
Atherosclerosis
Signs and Symptoms of a ruptured aneurysm
Shock
Pain, usually describe as sharp stabbing in nature.
Back pain
Difference in blood pressure
between arms
Absent radial or femoral pulse
Mottling of extremities below
aneurysm
modeling: spider veins, bluish white skin
absent radial or femoral pulses
Hypertension
Known as lanthanic (silent) disease
Characterized by a consistent elevation of systemic arterial blood pressure
Often defined by a resting BP consistently greater than 140/90 mm Hg
Risk Factors of hypertension
Family history
Advancing age
Gender (men younger than 55, women older than 74): structural changes of vessels
Black race: social status
High dietary sodium intake
Glucose intolerance: higher cholesterol
Cigarette smoking
Obesity
Heavy alcohol consumption
Low dietary intake of potassium, calcium and magnesium
Pathophysiology of hypertension
Damages walls of systemic blood vessels
Prolonged vasoconstriction and high pressures with in the arteries and arterioles stimulate the vessels to thicken and strengthen
End result is a permanently narrowed blood vessel
Treatment Plans
Arteriosclerosis Peripheral Vascular Disease Hypertension Deep Vein Thrombosis Aneurysm
*symptomatic only
Endocarditis
Inflammation of the inner lining of the heart, and/or heart valves
causes of endocarditis
Can be caused by either bacteria or virus, bacteria being the most common
risk factors of endocarditis
Acquired valvular heart disease (mitral valve prolapse)
Implantation of prosthetic heart valves
Congenital lesions
Previous attack
Male gender
Intravenous drug use: dirty needles
Long term indwelling catheterization
Signs and Symptoms of endocarditis
May involve a number of organ systems
Classic findings
Fever
Cardiac murmur
Petechial lesions of skin, conjunctiva, and oral mucosa
Chest pain- SOB
myocarditis
Is an inflammation of the heart muscle (myocardium)
Results from infection (bacteria or viral) or toxic inflammation (drugs or toxins from infectious agents)
Cocaine users are 5x more likely to get it
myocarditis causes
Chest infection
Auto immune disease
Fungal viral infection
signs and symptoms of myocarditis
Flulike
Pain in epigastric region or under sternum (substernal)
Dyspnea
Cardiac arrhythmias
Stabbing chest pain
pericarditis
Inflammation of the pericardium, two thin layers of a sac-like tissue surround the heart, hold it in place and help it work.
Normally, a small amount of fluid keeps the layers separate so that there’s no friction between them.
Signs and Symptoms Pericarditis
Low cardiac output
Low SPO2
Chest pain
causes of pericarditis
Trauma
Heart attacks
Acute Coronary Syndrome (ACS)
refers to distinct conditions caused by a similar sequence of pathologic events involving abruptly reduced coronary blood flow
Acute Coronary Syndrome (ACS) conditions
Unstable Angina (UA
Non-ST-segment elevation myocardial infarction (NSTEMI),
ST-segment elevation myocardial infarction (STEMI)
Ischemia
Lack of oxygen to the tissues
ST depression or T inversion
Ischemic Heart Disease
Myocardial ischemia is usually the route of the blockage or gradual narrowing of one or more of the coronary arteries by atheromatous plaque.
Narrowing or blockage of a coronary artery can disrupt the oxygen supply to the area of the heart supplied by the affected vessel.
If the cause of the ischemia is not reversed and blood flow restored to the affected area of the heart muscle, ischemia may lead to cellular injury and ultimately, cellular death
Clinical Features of Ischemic Heart Disease
retrosternal chest pain, pressure, heaviness squeezing lasting 10 minutes or longer that usually occurs at rest or with minimal exertion
Can be accompanied by angina equivalents such as unexplained new-onset or increased exertional dyspnea, unexplained fatigue, diaphoresis, nausea/vomiting, or syncope
atypical presentation of Ischemic Heart Disease
may include pleuritic chest pain, epigastric pain, acute-onset indigestion, or increasing dyspnea without chest pain.
Atypical presentations are most often observed in younger(25 to 40 years of age) and older(over 75 years) patients, women, and patients with Diabetes Mellitus, chronic renal insufficiency, or dementia
what does schema lead to
Injury
prolonged ischemia
ST elevation
infarct
death of tissue
may or may not show in Q wave
angina Three types:
Stable Angina (Exertional Angina)
Unstable Angina (Preinfarction Angina)
Prinzmetal’s Angina
Prinzmetal’s Angina
Vasospastic angina: no blockage or clot just spasm of segment of coronary artery
Cause: cocaine
Treatment: nitro
Angina
Imbalance between myocardial O2 supply and demand
choking pain in the chest” Burning Tightness Pressure Crushing heavy
The coronary arteries can spasm as a result of :
Exposure to cold weather Stress Medicines- Anti-migraines, Chemo, Antibiotics Smoking Cocaine use
Myocardial Infarction
Sudden and total occlusion or near‐ occlusion of blood flowing through an affected coronary artery to an area of heart muscle
Results in ischemia, injury, and necrosis of the area of myocardium distal to the occlusion.
If blood flow is not restored to the affected artery
myocardial cells within the sub-endocardial area begin signs of injury within 20 to 40 minutes.
ACS Management/ Treatment
Reduce physical activity, calm reassurance
O2 if WOB increased and SPO2 less than 94%, if pale, if SOB
If clinically indicated ASA 160-325mg PO
–81mg X2= 162mg
3 Lead followed by 12 Lead ECG noted
IV BEEFORE NITRO
- -0.4mg spray
- -1 every 3-5 mins
- -At 3 min mark vitals and re assess
If clinically indicated, Nitro 0.4mg SL, titrate to effect
Consider calling ALS
Notify receiving hospital if ST elevation
ACS CALL vs NON ACS CALL
ACS CALL
Heavy, burning tight
NON ACS CALL
Sharp pain
Increases with palpation
Increase with inspiration
angina signs and symptoms
“choking pain in the chest”
Burning
Tightness
Pressure
Crushing
Heavy
Radiates
Lasts less than 20 min
Sob
Occurs with activity
Is better with rest
UNSTABLE angina signs and symptoms
Lasts longer than 20mins
Can occur at rest
MI: STEMI, NSTEMI signs and symptoms
At rest
Doesn’t get better
Shock symptoms
- -Nausea vomiting
- -Pale cool clammy
Cardiomyopathies
Diverse group of diseases that affect the myocardium
Most result from underlying disorders
In response to injury, the heart may undergo dilation or hypertrophy
Cardiomyopathies are incurable diseases and the only hope is heart transplantation
Cardiomyopathies are divided into three forms:
Dilated Cardiomyopathy
Hypertrophic cardiomyopathy
Restrictive cardiomyopathy
cardiac output
stroke volume
Formula
Cardiac output (CO): amount of blood ejected by each ventricle in 1 minute
Stroke volume (SV): amount of blood pumped by each ventricle in 1 beat (mL/beat)
CO=SV X HR
70ml/beat x 75 bpm+ 5250mL/min