Module 6 - Chronic Cardiovascular Illness Flashcards
What are the 4 chambers of the heart?
Right and Left Atria // Right and Left Ventricles
What are the 2 types of heart valves?
Atrioventricular (tricuspid and mitral) and semilunar valves.
How can an aortic aneurysm cause a myocardial infarction?
A bulge of blood in the aorta can cause an MI by blocking blood flow
How can a coronary artery dissection cause a myocardial infarction?
Spontaneous tearing of the arterial wall can cause MI when fluid builds up between layers of the heart, preventing blood flow.
Starting with the vena cava, what is the pathway for blood?
Vena cavae –> right atrium –> tricuspid valve –> right ventricle –> pulmonary semilunar valve –> pulmonary arteries –> lungs –> pulmonary veins –> left atrium –> mitral valve –> left ventricle –> aortic semilunar valve –> aorta –> systemic circulation
What is the purpose of the SA node?
Initiate heartbeat and synchronize atrial and ventricular contractions
What is the purpose of the AV nodes?
To delay the signal from the SA node to allow the ventricles to fully fill and prevent atria and ventricles from contracting at the same time
What is the purpose of the bundle of His?
Rapid conduction of the signal to the ventricles
What is the purpose of the Purkinje fibres?
Rapid transmission of the signal through the ventricles, allowing them to contract simultaneously
How do we represent the electrical activity of the heart to determine any problems?
ECG
How do parasympathetic neurotransmitters affect heart rate and blood pressure?
Tend to lower heart rate and blood pressure (vasodilation)
How do sympathetic neurotransmitters affect heart rate and blood pressure?
Tend to increase heart rate and blood pressure (vasoconstriction)
What effect does the renin-angiotensin-aldosterone system have on blood pressure?
Work to increase BP
How do ACE inhibitors lower blood pressure?
They inhibit angiotensin converting enzyme from the lungs and prevent it from converting angiotensin I to angiotensin II. Angiotensin I is not active, therefore cannot increase blood pressure.
What is considered normal heart rate?
60-100 bpm
What is the danger of a slow heart rate?
Stasis and clots forming as blood does not move as quickly through the body
What is the danger of a high heart rate?
Can lead to fatigue that can eventually cause slowing of the heart rate
What does systolic blood pressure represent?
Contraction of the ventricles, opening of the semilunar valves to eject blood
What does diastolic blood pressure represent?
Relaxation of the ventricles, opening of the mitral valve to fill vents
What factors can increase systemic vascular resistance?
- smaller blood vessel diameter
- longer blood vessels
- increased blood viscosity
What is the formula for measuring systemic vascular resistance?
SVR = (MAP - CVP) / CO
MAP = mean arterial pressure
CVP = central venous pressure
What is stroke volume?
The amount of blood ejected by the left ventricle with each contraction, measured in mL
What factors can influence stroke volume?
Heart rate, contractility, preload
What is preload?
The initial stretching of cardiac myocytes before contraction, which depends on ventricular filling
How does increasing preload impact cardiac output?
Will increase cardiac output
Why would we give vasopressers to a patient experiencing hypovolemic shock?
To cause vasoconstriction, which increases the volume of blood during the filling phase (preload)
Would we give nitroglycerin to increase or decrease preload?
Decrease bc it causes vasodilation, which decreases venous return to the heart
What is afterload?
The pressure the heart must work against to eject blood –> resistance that needs to be overcome during contraction
What can increase afterload?
pulmonary HTN, valve issues
What can decrease afterload?
Drugs that decrease vascular resistance
What can happen if we have altered contractility in the heart?
Heart failure
What is cardiac output?
The amount of blood pumped out by each ventricle in one minute.
What formula do we use to measure cardiac output?
CO = HR x Stroke Volume
What does a blood pressure monitor tell us about hemodynamics?
Cardiac output and conditions of the vasculature
What does a pulse oximeter tell us about hemodynamics?
How efficiently the heart is pumping blood/oxygen to the rest of the body
What are 4 hemodynamic disorders?
1) hypertension –> can impair cardiovascular function
2) shock –> inadequate blood flow to organs
3) heart failure –> heart unable to pump enough blood to meet body needs
4) atherosclerosis –> plaques build up in blood vessels, reducing blood flow
What are hemodynamic disorders?
Any condition that can impact blood flow to the organs.
What are some hemodynamic interventions that can be implemented?
- lifestyle changes to improve cardiovascular health
- medications to lower blood pressure
- surgical interventions like a stent to improve blood flow
- device implantation to regulate heart rhythm
What is hypertension?
Persistent high blood pressure
What are common consequences of untreated hypertension?
stroke, heart disease, kidney disease (end organ issues)
What blood pressure is considered stage 1 hypertension? What blood pressure is considered stage 2 hypertension?
stage 1: 130-139 mmHG systolic OR 80-89 mmHg diastolic
stage 2: >140 mmHg systolic OR >90 mmHg diastolic
What are the 2 types of hypertension, and which is more common?
Primary (essential) hypertension and secondary hypertension. Primary is more common
What is the difference between primary and secondary hypertension?
Primary HTN cause is unknown while secondary HTN is known to be caused by another condition (renal disease, sleep apnea etc.)
True or false? Hypertension always has specific symptoms
False. Most hypertension is asymptomatic and only becomes symptomatic with organ dysfunction when uncontrolled.
What are some symptoms of uncontrolled hypertension?
- fatigue
- reduced activity tolerance
- dizziness
- palpitations
- angina
- dyspnea
What are some treatment options for hypertension?
- regular exercise
- weight management
- cessation of smoking
- alcohol restriction
- antihypertensive drugs
- nutritional therapy
Which types of drugs are recommended for hypertension treatment?
ACE inhibitors, diuretics, Ca channel blockers (dilate blood vessels), Beta blockers (block epinephrine)
If we suspect hypertension during a nursing assessment, what types of questions should we ask?
Ask about family history of htn and cardiovascular diseases, medical history of diabetes, renal disease, and lifestyle choices, check vital signs, and do a focused cardiac assessment
What is a hypertensive crisis?
A severe and rapid increase in blood pressure. The rate is the most important for determining severity
What is heart failure?
inability of the heart to pump blood to meet metabolic needs of tissues, usually resulting in cardiac output changes and pulmonary and systemic congestion
What are the risk factors for heart failure?
F: faulty heart valves (backup of fluid)
A: arrhythmias
I: infarction
L: lineage (family history)
U: uncontrolled htn
R: recreational drug use
E: influenzas that evade treatment
Which of the following patients is most at risk for developing HF?
A) 73 y/o man recovering from recent MI
B) 30 y/o pt with stage 3 colon cancer
C) 40 y/o pt with uncontrolled HTN being treated for influenza
D) 60 y/o pt with asthma and diabetes
A and C
Colon cancer not necessarily a risk factor, neither are asthma or diabetes
True or false: most heart failure starts as left-side heart failure?
True. It can develop into right side if uncontrolled
Where does blood back up in left side heart failure?
To the lungs. Blood is not adequately pumped through systemic circulation but is fine through pulmonary, causing a backup in the lungs
Where does blood back up in right side heart failure?
Venous circulation. Blood is not adequately pumped through pulmonary vessels, leading to a backup at systemic circulation
What is a peripheral symptom of both left and right sided heart failure?
Weight gain (due to fluid retention)
What can cause right sided heart failure?
COPD, left sided heart failure
How can heart failure cause hepatomegaly?
The hepatic veins are connected to the vena cavae, so right sided heart failure can lead to backup in the liver (hepatomegaly)
What ejection fraction indicates heart failure?
Less than 40%
How can we measure ejection fraction?
Using an echocardiogram to trace blood flow through the heart
What is the difference between systolic and diastolic dysfunction (in terms of heart failure)?
Systolic is an issue with ventricular contractions, lead to backup of blood behind the pump (heart), either in the lungs or system while diastolic is an issue with ventricular filling.
With left sided diastolic dysfunction, where will blood flow back up?
The lungs.
Is ejection fraction abnormal for both systolic and diastolic dysfunction?
It’s abnormal for systolic but not diastolic
What are the signs and symptoms of left sided HF?
D: dyspnea
R: rales
O: orthopnea
W: weakness
N: nocturnal paroxysmal dyspnea
I: increase heart rate
N: nagging cough
G: gaining weight
What are the signs and symptoms of right sided HF?
S: swelling of hands, body edema
W: weight gain
E: edema
L: large neck vein
L: lethargic
I: irregular heart rate
N: nocturia
G: girth changes
You are caring for a 63 year old pt. Which of the following are not symptoms of right sided HF?
A) crackles
B) weight gain
C) persistent cough
D) pitting edema
A and C –> crackles are usually due to fluid in the lungs, which is caused by LS HF. Same with the cough, pt is trying to clear fluid from lungs by coughing.
According to the NYHA, if a patient is experiencing a marked reduction in physical activity, symptoms of HF with normal activities, but no symptoms at rest, what class of HF would this be and what would be the assessment?
Class III HF, assessment would be moderately severe cardiovascular disease, with marked limitation in activity due to symptoms but comfortable at rest.
What are some things we want to specifically look at during a focused HF assessment?
Take vital signs to compare to baselines/normal, with focus on work of breathing. Check perfusion (cap refill, skin colour/warmth, pulses, edema)
What type of medication can be used to treat HF?
Diuretics, ACE inhibitors, ARBs (angiotensin receptor blocker), B1 blocker
What are some nursing interventions we can do for HF?
- HOB >30 degrees
- fowler’s position
- fluid balance monitoring
- check oxygenation status
- check for edema
What are some diagnostic tests we can run for HF?
- Chest x ray to see congestion
- hemoglobin and electrolyte balance to assess fluid levels
- brain natriuretic peptide (released when we have HTN)
- echocardiogram
What is coronary artery disease?
Condition where coronary arteries are narrowed or blocked due to plaque buildup
What are some risk factors for CAD?
- diabetes
- heart failure
- previous MI
- hyperlipidemia
- hypertension
- smoking
- obesity
- physical inactivity
- diet
- stress
- excessive alcohol
- substance use
- male
- family history
- > 65 years old
How do raised fibrous plaques develop?
Start with fatty streaks, which everyone has to some extent, then plaques form as we age when lipids adhere to blood vessel walls. Later, smooth muscle fills with fat to cover the lesion, causing a raised fibrous plaque.
Which enzyme is released during coronary artery disease?
Troponin
What happens when a coronary artery is blocked?
platelet rich thrombus blocks the artery, depriving the myocardium of oxygen, which leads to necrosis and release of cardiac enzymes
What is angina?
A type of coronary artery disease that leads to pain caused by reduced blood flow to the heart
What are the 4 types of angina?
1) stable
2) unstable
3) Prinzmetal’s
4) Microvascular
What medication is typically given to treat angina?
Nitroglycerin for rapid relief + vasodilation
What is the difference between stable and unstable angina?
Stable angina has a predictable pattern, and relief can occur with rest or nitroglycerin while unstable angina is unpredictable in its onset and is not easily relieved by rest and nitroglycerin.
Which is more serious, stable or unstable angina?
Technically both, as stable is a sign of CAD that is a risk for future MI, but an unstable angina can precede a heart attack, so it’s more dangerous.
What is Prinzmetal’s angina?
pain that occurs at rest due to spasms in the coronary arteries, not caused by exercise or exertion.
What is microvascular angina?
pain in the heart that is not due to coronary artery blockages but by the small arteries of the heart
What is the acute coronary syndrome spectrum?
A spectrum of coronary conditions brought about by abrupt reduced blood flow to heart. Range in severity from unstable angina to non ST elevation MI to ST elevation MI
What is the difference between an NSTEMI and STEMI?
An NSTEMI indicates incomplete occlusion by a coronary thrombus and some cardiac cell damage while a STEMI indicates complete occlusion and ischemia to the myocardium.
What would you expect to see in labs for an unstable angina?
Normal cardiac enzymes (CK, Troponin)
What is a common difference between a cardiac event in males vs a cardiac event in females?
In males, the pain tends to radiate while it doesn’t always in females.
If a patient has a STEMI, what does this mean for cardiac tissue?
It’s likely that there’s a large amount of myocardial tissue damage
What is one of the most common medications to give a patient experiencing an MI?
Aspirin because it blocks platelet aggregation, which reduces clots
Why would we give glycerol trinitrate to a patient experiencing an MI?
to cause vasodilation and reduce pain (analgesia)
Once an MI or HF is managed, where would you want your patient to be referred?
Cath lab! They can get a stent inserted and have heart monitored
If a patient develops shortness of breath post catheter insertion, what might be the cause?
A) HF
B) pneumothorax
C) anxiety
Most likely HF because they would have received the catheter due to an MI, which likely caused cardiac cell death
