Perfusion A Flashcards
Preload
volume of blood entering the ventricles at the end of diastolic
Afterload
resistance left ventricles must overcome to circulate blood (systolic) and eject the contents
Cardiac output
Heart Rate*Stroke Volume
Normal cardiac output
4-8 L/min
Ejection Fraction
if low, heart is failing
amount of blood pumped out of the ventricle/total amount of blood in the ventricle=EF
Normal 55-70%
MAP
Mean Arterial Pressure
SBP+2(DBP)/
3
Normal 60-70
Angina
“heart attack”
pain caused by insufficient coronary blood flow resulting in lack of oxygen
Chronic stable angina
pt needs rest; deep breaths
-deep chest pain pain radiates to neck jaw shoulders back and arms -pain radiates L side normally -n/v; indigestion -dyspnea, diaphoresis, lightheadness
Atypical Angina
Women
indigestion, aching jaw, fatigue, sleep disturbances, shob
may not have “chest pain”
Atypical Angina
Elderly
no chest pain
shob, disorientation/confusion
Unstable Angina
Acute Coronary Syndrome
Pre-infarction pain, WILL FEEL LIKE AN EMERGENCY -Usually lasts longer than 15 minutes -Causes severe activity limitations -Is not relieved by rest and nitroglycerin
people have this before a heart attack
Variant (Prinzmetal’s) angina
Due to coronary artery spasms
Similar to stable angina
Lasts for a longer period of time
Labs for Angina
Lipid profile
(triglyceride 35-160,
<200 cholesterol)
Na 135-145 K 3.5-5.3 Ca 8.5-10.5 Mg 1.5-2.5 BUN 6-20 CRT 0.7-1.7 Glucose 65-99
C-Reactive Protein
- shows inflammation in the body; not specific to the heart
- can have a role in the development and progression of atherosclerosis
Coagulation studies
want this to be high for blood to be thinner
PT 11-`13.5 seconds
PTT 20-35 seconds (Heparin)
INR 0.9-1.9 (Coumadin)
Troponins T and 1
found only in patients with myocardial muscle ischemia or necrosis, so any rise in value indicates possible MI (levels rise within 3-6 hours)
Creatinine Kinase MB(CK-MB)
most specific for MI (rises 2-3 hours after cardiac cells are injured and remains elevated for 12 hours)
Myoglobin
is a small oxygen-binding protein found in heart and skeletal muscled which is released when heart or skeletal muscles are injured
ECG
The electrocardiogram provides a graphic record of the heart’s electrical activity.
- dysrhythmias
- electrolyte imbalances
- conduction abnormalities
- enlarged heart
- effects of drugs
Exercise ECG (Stress Test)
- Non-invasive
- Patient should rest, avoid smoking and use of alcohol
- No food 2 hours before test
Pharmacological ECG (Stress Test)
- Invasive (used when patient cannot tolerate exercise)
- Must have IV access
- -Dobutamine- strengthen heart muscles
- -Dipyridamole- anticoagulant
Contraindications for CST
- Severe HTN
- HF
- Unstable angina
- Acute myocarditis
Goals for Cardiac Stress Test (CST)
- Target heart rate: 80-90% of maximum predicted heart rate
- Discontinue stress test if significant changes noted in the ECG especially changes in ST segment
Trans-Esophageal Echocardiography (TEE)
- Examines cardiac structure and function
- May be done with pharmacologic stress test
- NPO 4 to 6 hours before and 4 hours after procedure (avoid aspiration)
- IV access, moderate sedation
- Monitor for:
- –Bleeding
- –Sore throat
- –Aspiration
- –Vocal cord paralysis
- –Pain (could indicate perforation)
- monitor airway and swallow test
What questions to ask before a CT?
- assess for die allergy (iodine and seafood)
- assess for Metformen (for DM) do not take 48H before
MONA for pt with heart attack
- Morphine
- Oxygen
- Nitrates
- Aspirin
Nitroglycerin
- Short acting sublingual
- given to reduce cardiac muscle oxygen demand through vasodilation which decreases ischemia, relaxes blood vessels and relieves pain
- Prevents pain in patients with angina when climbing stairs, having sexual relations, or going outside in cold weather
- Decreases afterload, creating a more favorable balance between oxygen supply and demand
PT education with Nitro
- Keep nitroglycerin in original dark capped bottle and renew supply every 3-5 months
- Do not eat, drink or smoke while nitroglycerine is dissolving
- Lie down when taking sublingual nitroglycerin to prevent falls resulting from sudden hypotension
Long Acting Nitrates
- Isosorbide dinitrate
- Isosorbide mononitrate
- Nitroglycerin patch or paste
- Used to reduce the incidence of angina attacks
- Apply to clean, dry, hairless area
- Remove after 12-14hours
- Rotate application sites
Beta-Blockers (LOL)
Metoprolol
Carvedilol
- block cardiac stimulating hormones
- reduces HR, BP, O2
- wheezing, crackles, cough, edema, weight gain (HF)
Calcium Channel Blockers (PINES)
Amlodipine
Verapamil (no grapefruit juice)
- Action of drugs:
- -Decreases afterload (resistance in vascular)
- -Decreases HR
- -Decreases peripheral vascular resistance
- -Promotes vasodilation, thus lowering BP
- -Improves myocardial perfusion
- Check BP and pulse prior to administration
Anti-Platelet Agents(GREL)
Prevent platelet aggregation
Aspirin (bleeding)
- 81-325mg
- no herbal remedies
- ringing in the ears; ototoxicity
Clopidrogrel
- Take with food
- Report s/s bleeding
- avoid grapefruit juice
Prasugrel
- Do not give to patients with history of stroke
- Watch for s/s bleeding
Clopidrogrel
- Take with food
- Report s/s bleeding
- Anti-Platelet Agents
Prasugrel
- Do not give to patients with history of stroke
- Watch for s/s bleeding
- Anti-Platelet Agents
Peripheral Vascular Diseases (PVD)
- lower and upper extremities
- Arteries and arterioles transport oxygenated blood from the heart to the body tissues
- Veins and venules return unoxygenated blood back to the heart
S/S of Peripheral Artery Disease (PAD)
- intermittent claudication (too little blood flow to legs and arms)
- rest pain
- paresthesias (numbness)
- diminished peripheral pulses
- pallor w/ extremity elevation
- rubor w/ extremities
Peripheral Artery Disease (PAD)
result of systemic atherosclerosis
-can cause gangrene, extremity amputation, rupture of aneurysms, infection/sepsis
Stage I: Asymptomatic PAD
- No claudication is present
- Bruit or aneurysm may be present
- Pedal pulses diminished
***Stage II: Claudication PAD
- Muscle pain, cramping or burning with exercise relieved by rest
- Symptoms return with exercise
Stage III: Rest pain PAD
- Pain while resting(often awakens patient at night)
- Numbness, burning or toothache like
- Pain relieved by placing the extremity in dependent position
StageIV:Necrosis/ Gangrene PAD
- Ulcers and blackened tissue occur on the toes
- Gangrenous odor
best way to manage PAD?
EXCERCISE
Stains
-lower cholesterol
-monitor liver enzymes
AST 10-40
ALT 7-57
-avoid grapefruit juice
-take with food (GI disturbances)
Arterial thrombosis/embolism
6Ps -pain -pallor -paresthia (numbness/tingling) -pulselessness -paralysis poikilothermia (coldness)
Chronic Venous Insufficiency
Chronic Venous insufficiency is inadequate venous return for a period of time, resulting in stagnation most commonly in the lower leg
Virchow’s triad:
Blood stasis (pooling)
Vessel wall injury
Hyper coagulation
Diagnosis of DVT
-D-dimer test (fibrin coagulation activation)
Helps determine risk
-Compression ultrasonography
Allows rapid and clear visualization of thrombi
-DVT risk classification (page 742 Iggy)
