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Medsurg cardiology > Med surg cardiology > Flashcards

Med surg cardiology Flashcards

1
Q

Fibrous Pericardium

A

Loose sac that outlines the heart

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2
Q

Parietal Pericardium

A

Serous membrane of fluid to decrease

friction

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3
Q

Visceral Pericardium (Epicardium)

A

Inner most protective layer that covers the
heart muscle directly
Additional protective layer to prevent
friction as the heart beats

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4
Q

Coronary Circulation

A 
– Coronary arteries (which stem 
from the aorta) provide the 
heart tissue and muscle with 
oxygenated blood
– Without appropriate coronary 
artery function, the heart 
muscle will not receive 
appropriate oxygen
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5
Q

The heart has:

A

Four Chambers

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6
Q

Superior Chambers

A

– Right Atrium

– Left Atrium

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7
Q

Inferior Chambers

A

– Right Ventricle

– Left Ventricle

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8
Q

Ventricles have thicker

walls than atria

A

True.

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9
Q

Left side of the heart pumps blood where?

A

Out to the body.

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10
Q

Cardiac valves:

A

Prevent backflow.

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11
Q

Atrioventricular (AV) Valves

A

– Right AV Valve:
■ Tricuspid
– Left AV Valve:
■ Mitral

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12
Q

Semilunar Valves

A

– Pulmonic/Pulmonary

– Aortic

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13
Q

Veins:

A

Blood flows towards the heart.

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14
Q

Arteries:

A

Blood flows away from the heart.

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15
Q

Blood flows through the heart by:

A 
Inferior/Superior Vena Cava »
Right Atrium » 
      Tricuspid Valve » 
Right Ventricle » 
Pulmonic/Pulmonary Valve » 
Pulmonary Artery » 
Lungs  (oxygenation  occurs) 
» 
Pulmonary Veins » 
Left Atrium » 
Mitral Valve » 
Left Ventricle » 
Aortic Valve » 
Aorta »
Body Tissue/Organs
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16
Q

The heart is:

A

an electrically driven pump.

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17
Q

The pump is comprised of muscle

A

If the muscle grows & hypertrophies – the pump

doesn’t function as well

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18
Q

The pump requires both electricity and oxygen to function

A

– Again, the pump is a muscle, muscle tissue needs
oxygen to survive
– Electricity is derived from electrolytes (potassium,
sodium, calcium, magnesium)
■ Electricity “fires” and sends conduction through
the chambers of the heart
■ If electrolytes are out of normal range, the pump
will not work appropriately
■ Electrical conduction system coordinates both contraction
and relaxation of the heart chambers

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19
Q

Pathway of electrical impulses that generates a heartbeat

A

Electrical impulses cause the heart to contract and pump blood to the rest
of the body

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20
Q

Sinoatrial (SA)

Node:

A 
Located in wall of 
Right Atrium
•Known as 
“pacemaker” of 
the heart 
•Paces heart rate 
to body’s current 
demands; where 
we develop HR 
ranges of 60-100 
bpm
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21
Q

Interatrial

Node/Pathway/Bundle:

A 
•Also called 
Bachmann’s 
Bundle
•Connecting fibers 
rapidly send an 
impulse from the 
right atrium to the 
left atrium
•Both atria begin to 
contract
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22
Q

Atrioventricular

(AV) Node:

A 
•Delays conduction 
briefly
•Gives atria time 
to contract and 
pump all blood 
into the 
ventricles
•If the SA Node fails 
to depolarize or 
becomes 
nonfunctional, the 
AV node can 
initiate each 
heartbeat at a slower rate of 40-60 bpm.
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23
Q

Bundle of His:

A 
Conduction 
passes from AV 
node and 
travels through 
Bundle of His
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24
Q

Right and Left

Bundle Branches

A 
Conduction 
bifurcates into 
the Right and 
Left Bundle 
Branches and 
travels through 
walls of 
ventricles
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25
Q

Purkinje Fibers

A 
•Fibers spread 
widely across 
the ventricles 
to cause all 
cells of the 
ventricles to 
contract 
quickly
•This is when 
blood is 
expelled from 
ventricles
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26
Q

A cardiac cycle is the sequence of mechanical events that occur during each heartbeat

A

Mechanical events occur because of the conduction of electricity

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27
Q

A single cycle of cardiac activity can be divided into two phases:

A

Systole, Diastole

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28
Q

Systole

A

– Systole = Squeeze
– Contraction of chambers
■ Blood empties out of the chambers
– Systole of the atria happens simultaneously
– Systole of the ventricles happens simultaneously

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29
Q

Diastole

A

– Diastole = Fill
– Relaxation of chambers
■ Blood fills into the chambers
– Diastole of the atria happens simultaneously
– Diastole of the ventricles happens simultaneously

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30
Q

Systole of a set of chambers is followed by

A

diastole of that same set of chambers

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31
Q

Atrial systole occurs at the same time as:

A

Ventricle diastole.

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32
Q

While systole is occurring with one set of chambers,

A

the other set of chambers is in diastole

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33
Q

Atrial Systole

A 
– Atria contract, blood flows from 
atria into ventricles
– Ventricles are in diastole, filling 
with blood sent from atria
– Atrioventricular valves are open
■ Blood flows freely from atria to 
ventricles
– Semilunar valves are closed
■ Blood is unable to pass into the 
pulmonary artery and aorta
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34
Q

Ventricular Diastole

A 
– Ventricles relax, filling with blood 
sent from atria
– Atria are in systole, contracting, 
squeezing blood into ventricles
– Atrioventricular valves are open
■ Blood flows freely from atria to 
ventricles
– Semilunar valves are closed
■ Blood is unable to pass into the 
pulmonary artery and aorta
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35
Q

Atrial Diastole

A 
– Atria relax, filling with blood 
from the superior and inferior 
vena cava
– Ventricles are in systole, 
contracting, squeezing blood into 
the pulmonary artery and aorta
– Semilunar valves are open
■ Blood flows freely from right 
ventricle to pulmonary artery
■ Blood flows freely from left 
ventricle to aorta
– Atrioventricular valves are 
closed
■ Blood is unable to pass from 
atria to ventricles
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36
Q

Ventricular Systole

A 
– Ventricles contract, squeezing 
blood into the pulmonary artery 
and aorta 
– Atria are in diastole, relaxing, 
filling with blood from the 
superior and inferior vena cava 
– Semilunar valves are open
■ Blood flows freely from right 
ventricle to pulmonary artery
■ Blood flows freely from left 
ventricle to aorta
– Atrioventricular valves are closed
■ Blood is unable to pass from atria 
to ventricles
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37
Q

Heart Sounds:

A 
■ Heart Sounds caused by valve closure
■ First sound
– Closure of AV Valves (tricuspid, mitral)
– Makes “lubb” sound
■ Second sound
– Closure of Semilunar Valves (aortic, 
pulmonary)
– Makes “dubb” sound
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38
Q

Cardiac Output

A

Stroke Volume x Heart Rate = Cardiac Output.
•SV = amount of blood pumped per beat (mL/beat)
•HR = # of heart beats in one minute (beat/min)
•Measured in L/min or mL/min  must use units when calculating!
•Average cardiac output for a healthy adult is about 5L/min
•Cardiac output increases with metabolic demand
•If HR increases, then cardiac output increased
•Stroke volume increases during exercise
•Increase in venous blood return, thus causing stretching of ventricular
myocardium

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39
Q

Factors Affecting Cardiac Output:

Preload

A 
Amount of pressure stretching the ventricle the end of 
ventricular diastole
Analogy: Blown up balloon
•More water in the balloon, the more it stretches
What can cause an increased preload?
•Increased central venous pressure 
•Fluid volume overload
•Heart Failure
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40
Q

Factors Affecting Cardiac Output:

Afterload

A

Systemic vascular resistance
Amount of resistance the heart/left ventricle must overcome
to open the aortic valve and push blood out into systemic
circulation
•Balloon must push, squeeze, and work against the knot to get the fluid out of
the balloon
Analogy: Knot at the end of the balloon
•Hypertension
•Increased pressure in the vessels, harder to push fluid into vessels with
increased pressure
•Vasoconstriction
•Narrow vessels, harder to push fluid into them
What can cause an increased afterload?
•Heart needs to work harder to push blood out against the resistance
The cardiac workload must increase if afterload is increased

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41
Q

Ejection Fraction

A

Amount/Percentage of blood the left ventricle pumps out with each contraction
(each ventricular systole cycle)
■ Measured in percentage;
– Example: Ejection Fraction is 60%, meaning 60% of the total amount of blood
in the left ventricle is pumped out with each squeeze of the ventricle
■ The ejection fraction value shows how well the heart is functioning
■ Normal range 55% to 70%
■ An ejection fraction under 40% may be evidence of heart failure or
cardiomyopathy
■ The most common test performed to determine the Ejection Fraction is an
echocardiogram (ultrasound of the heart, discussed later!)

42
Q 
Epinephrine & Norepinephrine – defined 
as catecholamines (act as both 
hormones & neurotransmitters)
A 
•Secreted by Adrenal Medulla: act as 
hormones
•Secreted by the medulla (CNS): act as 
neurotransmitter
•Secreted in stressful situations or 
whenever the sympathetic nervous 
system needs to activate
•When these catecholamines act on beta 
one, they cause:
•Increased Force of Contraction
•Increased Cardiac Output
•Increased Impulse Conduction (think 
cardiac conduction pathway we just 
discussed!)
•Increased Heart Rate
•Increase in Systolic BP (due to increased cardiac output.)
43
Q

Aldosterone

A 
•A mineralocorticoid that comes from 
the Adrenal Cortex
•Regulates serum sodium & potassium 
levels
•Electrolytes required from electrical 
conductivity of heart
•When aldosterone is released, kidneys 
hold onto sodium and releases 
potassium via urine
•Fluid follows sodium, thus increasing 
intravascular volume in the body
44
Q

Blood Pressure

A 
Defined as force of blood 
against blood vessel walls
Blood pressure is 
measures in millimeters 
of mercury (mmHg)
Average blood pressure is 
around <120/80 mmHg
45
Q

As heart pumps, left
ventricle pushes blood
out into aorta

A

Pressure exerted by blood on
walls of blood vessels is
defined as blood pressure

46
Q

Blood pressure is greatest

in the arteries

A

As blood enters the veins, it
decreases and eventually
approaches zero as blood
enters into the right ventricle

47
Q

Arteries and arterioles
are usually slightly
constricted to maintain
normal blood pressure

A

This contributes to peripheral

resistance

48
Q

BP is affected by many

factors

A 
•Will increase if heart rate and 
force of contraction increases
•If heart rate is increased but 
ventricles are not filling prior to 
contraction, cardiac output will 
be decreased, thus resulting in 
a decreased blood pressure
49
Q

What is Blood Pressure?

A 
Determined/Influenced by:
– Cardiac output
– Peripheral vascular resistance 
■ Ability of vessels to stretch
– Blood viscosity
– Blood volume
– Sympathetic nervous system
– Kidney Fuction: Renin-Angiotensin-Aldosterone 
System
50
Q

Mean Arterial Pressure

MAP

A

■ MAP is defined as:
– The average pressure within the arteries throughout one
cardiac cycle (systole and diastole)
■ The MAP is considered a better indicator of perfusion to vital
organs than the blood pressure
■ MAP should be ≥ 65 mmHg and ≤ 100 mmHg
– If the MAP is below 65 mmHg for prolonged periods of time,
vital organs are not receiving adequate blood flow and
oxygen
– If the MAP is above 100 mmHg for prolonged periods of time,
the heart workload is increased which leads to various
complications

51
Q

Mean Arterial Pressure (MAP)

A

■ MAP = SBP + 2(DBP)
3
■ If the MAP results as a number with decimals, round to the nearest
whole number
– Example: 86.7  Round to 87
■ Example: Blood Pressure is 146/86 mmHg, calculate the MAP
■ MAP = 146 + 2(86)= 146 + 172 = 318 = 106 mmHg
3 3 3
■ Example: Blood Pressure is 90/56 mmHg, calculate the MAP
■ MAP = 90 + 2(56)= 90 + 112 = 202 = 67.333 mmHg = 67 mmHg
3 3 3

52
Q

Hypotension

A 
Defined if blood 
pressure is <90/60
Always attempt to 
determine patients baseline
A systolic reading of 
90 mm Hg is an acceptable 
value for some patients.
53
Q

Causes of hypotension:

A

Dehydration
Hypovolemia
Bleeding
Medications

54
Q

Signs and Symptoms of hypotension:

A 
Lightheaded, Fatigue
Dizziness, Weakness
Syncope
Possible confusion
Decreased O2 to brain!
Tachycardia 
Heart compensating to 
increase blood flow to target 
organs
Weak, thready pulse upon 
palpation
Poor circulation/perfuson
Orthostatic hypotension may 
be present
Cool, pale, dusky, cyanosis 
(extreme hypotension)
55
Q

Therapeutic Interventions for hypotension:

A
  • Lay patient supine (if tolerated)
  • Will improve blood flow to brain & improve overall circulation
  • Encourage rest/restrict activity
  • Encourage & provide fluids
  • Monitor signs and symptoms
  • Reassess frequently
  • Vitals and focused assessment
  • Keep patient safe!
56
Q

Treatment for hypotension:

A

•Determine cause
•If on medications that decrease blood pressure – decrease dose, change
medications
•Give medications to increase blood pressure
•Alpha one agonist: promote alpha one and vasoconstriction of large peripheral
arteries  increase blood pressure

57
Q

If hypotension is acute, body should activate:

A

Renin Angiotensin

Aldosterone System to increase blood pressure

58
Q

Renin-Angiotensin-Aldosterone

System/Mechanism/Pathway (RAAS)

A 
Regulated by the 
kidneys
•Kidneys play a vital 
role in blood pressure 
regulation
•Kidneys release renin 
to activate the RAAS
59
Q

Renin-Angiotensin-Aldosterone
System/Mechanism/Pathway (RAAS): What activates this
system?

A 
•Decreased blood flow 
to kidneys/renal 
perfusion (renal 
ischemia)
•Decreased arterial 
blood pressure 
(hypotension)
•Decreased blood 
volume (extracellular 
fluid/intravascular 
volume)
•Decreased serum 
sodium (hyponatremia)
•Increased urine sodium
60
Q

Purpose of the RAAS?

A 
•Increase blood 
pressure, blood 
volume, blood flow to 
kidneys, serum sodium 
levels
61
Q

(RAAS) What is involved in this system?

A

•Renin: Produces and released by the kidneys
•Angiotensinogen: Secreted into the blood from the liver
•When renin and angiotensinogen meet, a chemical reaction occurs and Angiotensin I
is created
•Angiotensin I: No biological activity, exists solely as a precursor to Angiotensin II
•Angiotensin-Converting Enzyme (ACE) converts Angiotensin I to Angiotensin II
•Angiotensin II: Causes increased peripheral vasoconstriction  increases blood pressure
•Also stimulates the release of aldosterone from the adrenal cortex
•Aldosterone: Acts on the kidneys to increase sodium and fluid retention
•Thus increasing serum sodium levels and extracellular fluid (blood volume)  which increases blood pressure.

62
Q

Kidneys will stop release of renin when:

A

BP is elevated, fluid volume is
appropriate, kidney’s are perfused appropriately, or sodium levels are
within normal limits

63
Q

Excessive renin production:

A

cause by impaired renal perfusion may be a

contributing factor to HTN

64
Q

Blood vessels begin to

age

A

Starts during childhood, but effects are not seen until later in life

65
Q

Atherosclerosis

A

Atherosclerosis increases risk for developing cardiovascular disease; increases with age
Build of of fats, cholesterol, & other substances on artery walls
Reduced/restricted blood flow

66
Q

Resting blood

pressure increases

A

Increased afterload

Left ventricle workload increases, increased risk for left sided heart failure

67
Q

Vein valves more

incompetent

A

Backflow of blood, varicosities

Dependent edema

68
Q

Decreased HR

A

Conduction cells less effective

Dysrhythmias Common

69
Q

Kyphosis

A

Changes shape of chest wall

Heart sounds distant

70
Q

Cardiovascular Assessment: Subjective Data: Health History

A

•Follow up with appropriate questions and assessments based on
patient’s complaints
•If there are cardiac related issues (dizziness, fatigue, chest
tightness/pain, SOB, dyspnea)
•Vital Signs
•Thorough pain assessment
•Ausculate heart sounds and determine heart rhythm
•Ask more details about SOB and dyspnea

71
Q

Weight

A 
Compare to baseline weight
Acute weight gain? Possible 
fluid overload secondary to 
heart failure
•2-3 lbs. in 24-48 hours
72
Q

Blood pressure:

A 
Read box 21-1 on accurate 
blood pressure 
measurements
“Normal” <120/80 mmHg
Always ask patient their 
baseline
Assess both extremities for 
comparison
•Use extremity with higher 
reading
Can assess in leg if 
necessary
73
Q

Respirations

A 
Observe rate and quality
If patient is having 
respiratory complications or 
struggling to breathe, 
perform focused respiratory 
assessment (see appropriate 
lecture)
74
Q

Assessing Pulse: Apical

A

■ Determine heart rate and rhythm through auscultation
■ If rate and rhythm are regular, listen to the heart for 15 seconds and multiply times four
■ Rate:
– Documented as regular if between 60-100 bpm
– Documented as irregular if <60 bpm or >100 bpm
■ Rhythm:
– Documented as regular or irregular
■ If the rate or rhythm is irregular when assessing vital signs  what is your priority?!
– Assess apical pulse for one minute
■ Is it accurate to assess a pulse using a pulse ox?
■ Athletic individuals may have HR between 40bpm -50bpm
■ Heart pumps more efficiently, does not need to pump as fast.
■ Perform thorough assessment to determine patient is stable.

75
Q

Assessing
Pulse:
Peripheral
Pulses

A

Palpate for rate: •If rate is regular (60-100), palpate for 15
seconds and multiply by four
•If rate is irregular (<60, >100), must listen
to an apical pulse for one minute

76
Q

Arterial pulses palpated for

volume and strength equality

A

•Most common: Radial, Pedal – if issues,
assess other locations
•Absent: 0
•Weak: 1+
•Strong: 2+
•Bounding: 3+
•Palpate bilaterally, compare for equality
•Bilateral radial pulses strong and equal
•Left radial pulse strong, 2+, right radial
pulse weak, 1+

77
Q

Blood Pressure and Postural

Position Changes

A

Before you assess your patient’s blood pressure, be sure they are in an
appropriate position•Do not assess a patient’s blood pressure while they are leaning to one side, curled up, asleep,
etc.
•Try to reposition the patient or get them up and out of bed for the day, ensure your reading is
accurate!Blood pressure changes slightly as a patient changes positions
•If the blood pressure changes and decreases too much, it may cause syncope and collapse
•Brain is not receiving enough blood and oxygen!
•Always anticipate possible vital sign changes with position changes, safety first!
Normal blood pressure and heart rate variations with postural position
changes:•Decrease in systolic up to 15mmHg is normal
•Decrease in diastolic up to 10mmHg is normal
•Increase in HR up to 15 to 20 bpm is normal
•This occurs to maintain cardiac output
Example: BP 125/80 while supine changes to 115/76 sitting
•Systolic changed 10 mmHg
•Diastolic changed 4 mmHg
•Appropriate compensation

78
Q

Assessing for Orthostatic

Hypotension

A

■ Orthostatic hypotension is also known as postural hypotension
– Hypotension with position changes
■ Causes of orthostatic hypotension
– Deficient fluid volume
– Diuretics
– Analgesics
– Pain
■ If the patient complains of feeling dizzy/lightheaded with position changes,
the nurse should critically think and perform an assessment for orthostatic
hypotension

79
Q

Assessing for Orthostatic Hypotension

A

Before performing orthostatic vitals: •Utilize gait belt, stand close to patient.
Blood pressure and heart rate
taken with patient lying, sitting,
and then standing– •Detects abnormal changes with postural
positioning
•Along with assessing BP & HR with position
changes, must ask patient about feeling
lightheaded and/or dizzy with each position
change.
Orthostatic hypotension is present
when: •The systolic BP drops greater than 15 mmHg
•The diastolic BP drops greater than 10 mmHg
•The HR increases more than 20 bpm

80
Q

Inspection:

A

■ Remember – inspection begins the moment you lay eyes on the patient! Be
observant, collect data while collecting
■ Inspect the color of the skin, mucous membranes, lips to help determine
oxygenation status
– Pink
■ Appropriate oxygenation and blood flow to area
– Pallor
■ Decreased arterial blood flow or decreased oxygen to tissues, possible anemia
– Cyanosis
■ Gas exchange and/or perfusion issue
■ Tissues are oxygen deficient

81
Q

More Inspection:

A

■ Lower extremity skin color changes
– Decreased arterial blood flow to lower
extremities:
■ Causes dependent rubor: legs turn deep
red color in dependent position
■ Shiny, taut, dry skin and decreased hair
distribution may indicate reduced arterial
blood flow
– Venous blood flow problems; venous blood
cannot return to the heart as efficiently
■ Brown discoloration & purple/blue skin of
lower extremities in dependent position
■ Jugular Venous Distention (JVD)
– Veins in neck are distended/visible when
sitting 45-90 degrees
– Caused by increase in venous volume;
fluid overload

82
Q

Auscultation:

A

■ Heart rate and rhythm (if not previously performed)
■ Heart Sounds
– S1
■ Heard at the beginning of ventricular systole
■ Closure of AV Valves
■ “Lubb” Sound
– S2
■ Heard at the start of ventricular diastole
■ Closure of Semilunar Valves
■ “Dubb”
– Murmurs
■ Caused by narrowed value opening or a valve that doesn’t close tightly
■ Prolonged swishing sound
■ Heart sounds can be increased if patient leans forward or lies on left side
– Brings heart closer to chest wall
■ Cluster your care and auscultate lung sounds at same time  respiratory and cardiac
assessments are performed back to back usually!

83
Q

Palpation:

A

■ Capillary Refill
– <3 seconds: indicates appropriate arterial blood flow to extremities
– >3 seconds indicates a decrease in arterial blood flow to the extremities
■ Edema
– Review edema slides from lecture 2 (fluid imbalances lecture)
– Swelling in dependent extremities due to fluid build up/fluid overload
– Swelling is caused by fluid accumulation in a particular area or fluid leaking from vascular system to
tissues (think of a sponge full of water)
■ Fluid then gets stuck, cannot get back into vascular system without help
– If present, fluid volume overload
■ Patient may have heart failure
– Non-Pitting or Pitting Edema?
■ Pulses (discussed previously)
– Assess arterial blood flow to area; determine rate, volume, strength
– How do we document a peripheral pulse strength that is within defined limits?
■ Temperature
– Assess arterial blood flow to extremity: warm, cool, cold, hot?

84
Q 
Neurovascular Assessment (6 
P’s)
A

Assess for peripheral vascular disease & blood flow
issues within the extremities
These symptoms occur due to lack of oxygen and blood
flow to an extremity
•Pain
•Paresthesia (Numbness)
•Pallor (Pale)
•Pulselessness (No pulse)
•Paralysis (Can’t move limb)
•Poikilothermia (Lack of temperature/cool temperature)
If these findings are present, what does it tell us?
•If any of the 6 P’s are present; hypoxemia may be present 
emergency

85
Q

Noninvasive Diagnostic

Studies:

A

Review of diagnostic Imaging (review lecture one on these specific imaging tests)
■ Chest X-Ray
– Shows size, position, structures of heart
■ CT Scan
– View calcified plaque in the coronary arteries
■ If there is plaque build up in the coronary arteries, what is this called?
■ CTA Scan
– View blood flow within coronary arteries
■ Magnetic Resonance Imaging
■ Can identify ischemia and heart damage
– Ultrasound of extremities:
■ Arterial ultrasound will look at blood flow and any related problems within the arteries
■ Venous ultrasound will look at blood flow and any related problems within the veins
■ Discussed on following slides:
– Echocardiogram
– Cardiac Monitor
– Electrocardiogram

86
Q

Echocardiogram

A

■ Ultrasound test specific for the heart
■ A specialized tech performs this test using an
ultrasound probe
■ The machine records:
– The motion of heart structures (valves &
chambers)
– Heart size, shape & position
– Visualize blood flow through heart
– Determine ejection fraction of left ventricle
■ This test does not show blood flow through the
coronary vessels
– What test would show that?
■ CT Angio of Chest

87
Q

Cardiac Monitoring

A

■ Also known as telemetry
■ Continuous monitoring of heart activity
■ Consists of 5 leads with electrodes that connect to
a central cardiac monitor
■ Detects changes in heart rate and rhythm
immediately
■ May be worn if patient has:
– Cardiac complaints
– Receiving medications that can change cardiac
activity
– During acute illness
– Electrolyte imbalances
– IV electrolyte replacement

88
Q

Electrocardiogram (EKG)

A 
■ Also known as: ECG or EKG
■ Quick, fast, painless test that shows cardiac 
electrical activity in a moment of time
– Once image is captured, leads are 
removed
■ The EKG will reflect abnormalities related 
to:
– Conduction (Cardiac Conduction 
Pathway)
– Heart Rate & Rhythm
– Heart chamber enlargement
– Myocardial ischemia and/or infarction
– Electrolyte imbalances
89
Q

Lab Values specific to Cardiovascular

System

A

Troponin, CK-MB, Brain Naturetic Peptide,

90
Q

Troponin

A

•Gold star test, ordered for acute cardiac issues
•The more cardiac damage present, the higher the troponin value
•Remember, small changes in troponin can be very concerning!
•Troponins are drawn in serial increments every few hours to see if cardiac
damage is persistent/continuing

91
Q

CK-MB

A

•Supports the diagnosis of myocardial injury, will be ordered in
conjunction with Troponin

92
Q

Brain Naturetic Peptide

A

•Ordered to diagnose and monitor progression of chronic heart failure

93
Q

Electrolytes

A 
•Potassium, Calcium, Magnesium, 
Sodium
•Assess specific electrolytes and 
determine if an imbalance is 
present
•Are s/s of an imbalance shown?
94
Q

Lipid Panel

A

Total Cholesterol, HDL, LDL,

Triglycerides

95
Q

Therapeutic Measures

A

■ Improve Diet
– Increase fruits and vegetables
– Decrease saturated fats
■ Promote Exercise
– Walking program to promote and improve blood
flow
■ May improve peripheral vascular disease
– Exercise will assist in optimum cardiac function
■ Weight loss if needed
■ Smoking Cessation
– Smoking causes vasoconstriction which reduces
blood flow

96
Q

More Therapeutic Measures

A

■ TED Hose/Stocking (commonly called Compression Socks)
– Improve arterial blood flow and venous blood return
– Preventing blood clots and edema
– Put these on in the morning before you patient gets out of bed!
– Used in patients with peripheral vascular disease, on bedrest, or after
surgery/trauma
■ Sequential Compression Devices (SCDs)
– Used to prevent blood clots in the lower extremities
– Devices wrap around the lower extremities and tubing connects to a
machine
– Devices then intermittently squeeze the lower extremities to maintain
blood flow and venous return
– Used commonly after surgery and when a patient is on bedrest
– Be sure these are on your patient and the machine is turned

97
Q

Therapeutic Measures 3:

A

■ Leg Elevation
– Venous Insufficiency
■ Elevate legs above the level of the heart
– Arterial blood flow problems
■ Do not elevate lower extremities above the level
of the heart when the patient has with arterial flow
issues
■ Keep in dependent position
■ Supplemental Oxygen
– Administered to ensure heart receives adequate
amount of oxygen to function appropriately
■ Medications
– Various medications may be administered based
on patient’s history and symptoms; these will
discussed in the next lecture

98
Q 
Atherosclerosis & Coronary 
Artery Disease (CAD)
A

Atherosclerosis is the formation of plaque buildup in the walls of the arteries throughout
the body
•Narrowed arteries lead to decreased blood flow & oxygen delivery to organs and tissues
•Decreased blood flow can eventually lead to ischemia of the organ/tissue
Coronary artery disease is caused by plaque buildup in the wall of the coronary arteries,
which narrows the coronary arteries
•Narrowed coronary arteries lead to decreased blood flow & oxygen delivery to cardiac tissue
•Obstruction of coronary artery blood flow typically from atherosclerosis
•Decreased blood flow can eventually lead to ischemia of cardiac muscle and tissue
Risk Factors:
•Older adult
•Poor Diet
•Elevated total cholesterol, LDL, and triglycerides
•Decreased HDL levels
•Obesity
•Sedentary Lifestyle
•Excessive Alcohol use &/or Tobacco use

99
Q

More Coronary Artery Disease (CAD)

A 
■ Prevention 
– Limit modifiable risk factors
■ Therapeutic Measures
– Promote Healthy Lifestyle 
■ Smoking & Alcohol Cessation
■ Low fat & low cholesterol diet 
■ Exercise
– Increased activity can raise HDL levels and improve 
blood flow/circulation
■ Medications
– Lipid lowering medication (statin)
■ Statins are first line drugs to reduce LDL levels in the body 
by reducing cholesterol synthesis
■ Where does cholesterol synthesis occur?
– Antiplatelet Aggregator
■ Inhibit platelet activation and adhesion which assists in 
preventing the formation of a thrombus
– Vasodilators
■ Prevent angina (chest pain) caused by CAD and decreased 
blood flow to myocardial tissue
100
Q

Study pages 67-70 of the power point

A

important!

Medsurg cardiology (2 decks)

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