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NURS 470 > Perfusion: Myocardial Hemodynamics, Perfusion & Cardiac Cycle > Flashcards

Perfusion: Myocardial Hemodynamics, Perfusion & Cardiac Cycle Flashcards

1
Q

perfusion

A
  1. the process of nutrient delivery of arterial blood to a cap bed
  2. supplying an organ or tissue with oxygen and nutrients
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2
Q

What is the purpose of invasive hemodynamic monitoring?

A
  1. The primary purpose of invasive hemodynamic monitoring is the early detection, identification, and treatment of life-threatening conditions such as heart failure and cardiac tamponade
  2. ii. By using invasive hemodynamic monitoring the nurse is able to evaluate the patient.
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3
Q

What are noninvasive assessments of perfusion?

A
  1. LOC
  2. Skin: Tenting of skin
  3. Urine output
  4. Low because GFR is reduced
  5. Color, BP, HR
    a. Cyanosis
    b. Hypotension
    c. Volume status is low so BP goes down
  6. Heart rate
    a. Tachycardia: The heart will try to beat really fast to try to compensate
  7. Capillary refill time
    a. Longer than 3 seconds
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4
Q

What are 3 types of perfusion scanning methods?

A
  1. CT
  2. MRI
    Nuclear medicine perfusion
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5
Q

Cardiac output is characterized by what 2 things?

A

HR, SV

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6
Q

What is stroke volume made up of?

A
  1. preload
  2. afterload
  3. contractility
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7
Q

What 2 things make up preload?

A
  1. Central venous pressure

2. PAWP

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8
Q

What 2 things make up after load?

A
  1. SVR

2. PVR

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9
Q

What 2 things make up contractility?

A
  1. EF %

2. SV

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10
Q

What is a normal CO?

A

4-8 liters/min.

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11
Q

Why is cardiac index a better indicator vs CO?

A

Because it corrects for body size - someone who is smaller is going to need less pump

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12
Q

What is a normal CI?

A

2.4-4.0 L/min

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13
Q

What is stroke volume?

A

volume of blood pumped with each heartbeat

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14
Q

What is a normal SV?

A

60-70 mL with each ventricular contraction

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15
Q

What will a change in the heart rate have an immediate change in?

A

Change in the CO if the SV stays constant

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16
Q

What does a severe increase in HR cause?

A

A decrease in stroke volume, due to decreased filling time. This causes the CO to decrease

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17
Q

Tachycardia with CO?

A

Reduced CO

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18
Q

AFIB with CO?

A

reduced CO

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19
Q

Bradycardia with CO?

A

Increase in CO

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20
Q

Why is having a slow heart rate ok with CO?

A

Rate is not enough but if they are athletic then their cardiovascular function is very efficient – heart rate doesn’t have to be that high to maintain good heart function.

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21
Q

Vtach with CO?

A

decrease in CO

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22
Q

Asystole with CO?

A

Reduced CO

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23
Q

What happens if the SV stays the same but HR goes up?

A

CO goes up

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24
Q

What is preload?

A
  1. the amount of blood in ventricle at the end of diastole

2. the amount of stretch in the myocardial fibers at the end of diastole.

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25
Q

What does high preload mean?

A

high volume; large volume of blood returns from the venous system to the ventricle, the myocardial fibers are stretched.

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26
Q

What does low preload mean?

A

low volume; small volume of blood returns from the venous system to the ventricle, the myocardial fibers aren’t stretched

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27
Q

What is contractility?

A

pump function. The force of myocardial contraction.

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28
Q

What is contractility an indication of?

A
  1. INDICATION OF EF

2. CI AND CO ARE INDICATIONS OF CONTRACTILITY

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29
Q

What is after load?

A

the resistance the ventricle must overcome to eject blood

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30
Q

What does high after load mean?

A

vasoconstriction; decreased SV

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31
Q

What does low after load mean?

A

vasodilation; increased SV

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32
Q

So if after load increases then SV does what?

A

decreases; because there is more resistance pushing against the pump

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33
Q

What does preload represent?

A

the end diastolic ventricular volume (EDVV)

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34
Q

Preload is a function of what 2 things?

A
  1. volume

2. ventricular compliance

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35
Q

What are 3 factors that affect preload.

A
  1. volume - venous return, total blood volume, atrial kick.
  2. compliance
  3. stiffness and thickness of ventricular wall
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36
Q

Decreased preload is evident with?

A

a. Tachycardia
b. Decreased U/O
i. Reduced perfusion to the kidneys
c. Increase in specific gravity–> Dehydration
d. Dry mucous membranes
i. Dehydration
ii. Pinch skin it will not return to its normal
e. Tented skin
f. Sunken eyes
g. Orthostatic hypotension

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37
Q

Increased preload is evident when?

A
  1. JVD
    a. Reliable indicator of volume/pressure in the right side of the heart
  2. Pedal edema
  3. S3 (increased fluid), S4
    a. S4 – S
  4. Crackles
  5. Fluid overload
  6. Dyspnea
  7. Pink frothy sputum
    a. Patient might need Lasix or any diuretic
  8. Ascities, hepatic engorgement
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38
Q

What does an increase in JVD tells us?

A

An increase in JVD tells us about the patient’s CVP (central venous pressure)

  • -> CVP low – hypovolemic
  • -> CVP high – hypervolemic
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39
Q

How to measure JVD:

A

a. HOB 45 degrees
b. Head turned to right
c. Identify sternal angle
d. Locate superior sternal notch
e. Measure distance between top pulsation and sternum in centimeters.

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40
Q

What is normal JVD?

A

4 cm or less

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41
Q

What meds affect preload?

A
  1. fluids
  2. diuretics –> low CO because they are losing volume.
  3. Venodilators –> vessels are dilated, pressure decreases, low CVP.
    a. Nitrates
    b. Morphine
    - -> Before giving, check vitals especially BP
    - -> They may become hypotensive
    - -> If their BP is too low, put them on something that doesn’t affect BP
  4. Ace inhibitors
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42
Q

What is the frank starling law of heart regarding preload?

A

the heart pumps the amount of blood it receives w/each beat. Preload increases, SV increases. Preload decreases, SV decreases.

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43
Q

What is the physiological limit of the heart according to the frank starling law of heart?

A

300 mL of filling

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44
Q

What can too much preload cause?

A

cause excessive stretching of the myocardial fibers.

  • the ventricles cannot effectively contract
  • the SV goes down.
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45
Q

What 4 things affect preload?

A
  1. aortic impedance –> 1. Stenosis or regurgitation, there will be an interruption of forward flow
  2. blood viscosity –> 1. Thicker blood will be more difficult to push out
  3. blood volume –> 1. Hypervolemic = harder to push out
  4. vascular tone –> 1. Vessels are constricted which makes it harder for the left ventricle to push the blood out because the diameter is so low.
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46
Q

What does a high after load mean?

A

vessels are constricted

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47
Q

What are meds that can help with vasodilation?

A

nitroglycerin

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48
Q

What does a low after load mean?

A

vessels are dilated

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49
Q

What are meds that help with vasoconstriction?

A

norepinephrine and epinephrine

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50
Q

What is systemic vascular resistance with after load?

A

Afterload of the left side of the heart

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51
Q

What does a Low SVR mean?

A

dilation, so you need vasoconstriction

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52
Q

What is the formula for SVR?

A

MAP – CVP/CO x 80

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53
Q

What is a normal SVR?

A

800 - 1200

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54
Q

What is pulmonary vascular resistance with after load?

A

Resistance to ejection from right side of the heart.

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55
Q

What is a normal PVR?

A

50 - 250

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56
Q

What are s/sx of increased after load? - constriction

A

a. Pale, cool, clammy skin
b. HTN
c. Non-healing wounds
i. Low perfusion
d. Thick, brittle nails
e. Slow cap refill
f. Decreased urine output

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57
Q

What are s/sx of decreased after load? - dilation

A

a. Warm, flushed skin
b. Increased CO
c. Decreased BP

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58
Q

What is ohm’s law?

A 
Pressure = flow x resistance 
Pressure = BP 
Flow = CO 
Resistance = after load
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59
Q

What is contractility?

A

the ability of a muscle to shorten when stimulated; the force of myocardial contraction.

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60
Q

What are 2 types of meds that are given to induce contractility?

A
  1. dopamine

2. digoxin

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61
Q

How is contractility measured? What is the formula?

A

a. EF

b. Ef = SV/EDV

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62
Q

What is a normal EF?

A

60-70%

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63
Q

What is the mineral used to control contractility?

A

calcium

  • hypertensive –> calcium channel blocker
  • hypotensive –> calcium
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64
Q

When do you see an increased contractility?

A

increased BP bc sympathetic nervous system stimulation

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65
Q

When do you see a decreased contractility?

A
  1. Hypotension
  2. Fatigue
  3. SOB
  4. Dizziness
  5. Low urine output
    bc parasympathetic nervous system stimulation.
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66
Q

When is hemodynamic monitoring indicated?

A

a. Alterations in CO
b. Alterations in fluid volume
c. Alterations in tissue perfusion

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67
Q

What is CVP w/hemodynamic monitoring?

A

Volume/pressure on the right side of the heart

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68
Q

Where do you want to take CVP from?

A

distal port because that is the closest to the right atrium

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69
Q

What does CVP w/hemodynamic monitoring reflect? What does it guide?

A

Reflects filling pressures in the right ventricle. Guides overall fluid balance.

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70
Q

What are 2 noninvasive hemodynamic technologies?

A

a. Impedance Cardiography
- -> Assesses cardiac function by measuring resistance to the blow of high-frequency, low-amplitude current. Measures SV, CO, SVR, and contractility
b. Doppler Ultrasound
- -> Measures blood flow velocity in the vessel. Helps to determine CO, preload, afterload, and contractility

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71
Q

What are 3 minimally invasive hemodynamic technologies?

A
  1. CVP
  2. Arterial access line
  3. MAP
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72
Q

What is the formula for MAP?

A

Mean Arterial Pressure (MAP) MAP = ((SBP) + 2 (DBP))/3

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73
Q

When is an arterial line indicated?

A

a. Monitoring blood pressure
- -> Arterial line to measure because if a patient is taking a vasoactive medication you don’t want to have to take BP all the time.
b. Frequent ABG’s, labs

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74
Q

What is the difference between intra-arterial blood pressure monitoring and cuff monitoring?

A

a. A-line measures flow inside artery; cuff from outside artery

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75
Q

What are the number differences between intra-arterial blood pressure monitoring and cuff monitoring?

A

5-10 mmHg

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76
Q

When is a cuff unreliable?

A

shock or low CO

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77
Q

What is the Vigileo monitoring device system?

A

Minimally invasive; connects to existing arterial line; requires no manual calibration; automatically calculates hemodynamic values every 20 seconds; accurate when validated against swan catheter.

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78
Q

What does the Vigileo monitoring device system provide?

A

Data on…

a. CO – Cardiac Output
b. CI – Cardiac Index
c. Central Venous Oxygen Saturation: Determine oxygen extraction vs demand. Oxygen utilization.
d. Stroke Volume: Assessment of ventricular performance
e. Stroke volume variation: Variation in stroke volume given as a percentage. >15% may indicate hypovolemia
- -> Reaches 10-12 - stop giving fluids.
f. Systemic Vascular Resistance (SVR): Indicator of afterload.

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79
Q

What kind of measurements does the swan PA Cath provide?

A

a. Pulmonary artery pressure (PAP) (systolic, diastolic, mean)
i. Pulmonary hypertension
b. Pulmonary artery wedge pressure (PAWP , PCWP, wedge, LVEDP)
c. Central venous pressure (CVP, RAP, RVEDP)
d. Cardiac output (CO), cardiac index (CI)
e. Systemic Vascular resistance (SVR)
f. Pulmonary vascular resistance (PVR)

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80
Q

What are the advantages of a swan Cath?

A

a. Real-time data
b. Simultaneously measures a variety of hemodynamic parameters
c. Able to rapidly assess pts. Response to interventions.

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81
Q

What are the disadvantages of a swan Cath?

A

a. Infection
b. Insertion complications: pneumothorax, bleeding, damage to blood vessels or heart, dysrhythmias
c. Air emboli, exsanguination (loose connections)
d. Balloon rupture (rare)
e. Pulmonary artery rupture (rare)

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82
Q

What is a normal PAWP? What does it reflect?

A

4-12 mmHg; reflects left sided preload

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83
Q

What is a normal CVP? What does it reflect?

A

2-6 mmHg; reflects right sided preload

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84
Q

What is a normal PAP? What does it reflect?

A

20-30/10’s mm; reflects blood pressure in the lungs

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85
Q

What is a normal CO? What does it reflect?

A

4-8 L/min; volume ejected/minute with each beat

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86
Q

What is a normal CI? What does it reflect?

A

2.4 - 4.0 L/min; Volume ejected/minute with each beat

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87
Q

What is normal PVR? What does it reflect?

A

50-250 dynes/sec/cm-5; Reflects right sided afterload

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88
Q

What is normal SVR? What does it reflect?

A

800-1200 dynes/sec/cm-5; Reflects left sided afterload

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89
Q

What are 2 causes of elevated PA pressures?

A
  1. Pulmonic valve stenosis/calcification

2. pulmonary hypertension

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90
Q

What does pulmonic valve stenosis/calcification cause?

A

increased after load on the right ventricle

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91
Q

What does pulmonary hypertension cause?

A

increased after load on the right ventricle, which impacts right vent. emptying

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92
Q

What are interventions for PH?

A
  1. Find the cause/root of problem.
  2. Reduction in Preload (circulating volume).
  3. Decrease venous return to the right side.
  4. Increase/improve contractility.
  5. MEDS: Vasodilators (Viagra), diuretics, Na and fluid restriction, valve replacement/repair.
    a. Aortic valve disease – fluid overload
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93
Q

KNOW THIS

A

i. Perfusion – supply of oxygen & nutrients
ii. Cardiac Output – Heart Rate X Stroke Volume
iii. Cardiac Index – Best indicator of cardiac function
iv. Preload – Blood presenting to both right & left side of heart
v. Afterload – resistance to contraction both right & left side of heart

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94
Q

What is ANP?

A

a hormone released during atrial stretch

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95
Q

What is BNP?

A

a hormone released during ventricular stretch

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96
Q

What is heart failure?

A
  1. a condition where the heart can not pump blood at a volume required to meet the body’s needs.
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97
Q

Heart failure occurs due to either…

A
  1. systolic dysfunction - poor contraction

2. diastolic dysfunction - poor filling. Or increased increased afterload

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98
Q

What are 5 possible causes of heart failure?

A
  1. CAD
  2. Valvular dysfunction
  3. Infection
  4. cardiomyopathy
  5. uncontrolled hypertension
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99
Q

What are 3 ways that heart failure may be discovered?

A
  1. acute MI
  2. Decreased exercise tolerance
  3. fluid retention
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100
Q

What 2 things are decreased with left HF?

A
  1. contractile function of the left ventricle

2. cardiac ouput

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101
Q

What are 2 things that are increased with left sided HF?

A
  1. SVR

2. after load

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102
Q

How does Left HF affect the lungs?

A

pulmonary congestion and edema. Crackles, rhonci, pink tinged sputum

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103
Q

What are manifestations of left HF?

A

i. Dyspnea
ii. Restlessness
iii. Confusion
iv. Tachycardia
v. Fatigue
vi. Cyanosis
vii. Orthopnea
viii. Nocturnal dyspnea
ix. Pulmonary edema
- decreased CO
- extra heart sounds
- pale, cool extremities

104
Q

What is right heart failure?

A

defined as ineffective right ventricular contractile function

105
Q

What are 3 causes of right heart failure?

A
  1. PE
  2. right ventricular infarct
  3. LVF
106
Q

What are signs and symptoms of RVF?

A

a. JVD
b. Congestive hepatomegaly
c. Ascites
d. Periperhal edema (dependent)
e. Enlarged liver and spleen
f. Weight gain
g. Increased venous pressure
h. elevated CVP
- extra heart sounds

107
Q

What is systolic heart failure?

A

decreased contractility of the heart muscle during systole

108
Q

What are manifestations of systolic HF?

A

normal S/sx of HF combined with low EF

109
Q

What are 2 causes of systolic HF?

A
  1. CAD

2. Non-ischemic cardiomyopathy

110
Q

What happens with ventricles in systolic HF?

A

ventricular remodeling or hypertrophy

111
Q

What are the effects of SHF to hemodynamics?

A
  1. LVEDV is high
  2. LVEDVP is high
  3. rise in left atrial pressure and pulmonary venous pressure
  4. increase in pressure in right heart
  5. right sided heart failure
    and
    pulmonary congestion and pulmonary edema
112
Q

What is diastolic heart failure?

A

inability of the heart muscle (left ventricle) to relax, stretch, or fill during diastole

113
Q

What patients are at risk of developing diastolic heart failure?

A
  1. CAD
  2. Myocardial Ischemia
  3. A.Fib
  4. Uncontrolled hypertension
  5. left ventricular hypertrophy or dysfunction
  6. cardiomyopathy
  7. infiltrative disease
  8. aging process
114
Q

What is preserved in diastolic heart failure?

A

EF of 45% and above

115
Q

What are clinical findings of diastolic heart failure?

A

a. Signs & Symptoms of Heart Failure
b. Normal or mildly abnormal LV Systolic Dysfunction
i. EF is a little low but ok
c. Abnormal Left ventricular relaxation, filling, diastolic distensibility, or diastolic stiffness

116
Q

What are the hemodynamic effects of diastolic heart failure?

A
  • increase in LVEDP –> decrease in LVEDV
    During exercise
  • increase in LVEDP –> decrease in SV and CO
117
Q

What is acute heart failure?

A

sudden heart failure, with no compensatory mechanism

118
Q

What are s/sx of acute heart failure?

A

a. Symptoms similar to chronic heart failure, but more severe and start or worsen suddenly
b. Sudden fluid buildup
c. Rapid or irregular heartbeat (palpitations)
d. S3
e. Sudden, severe shortness of breath and coughing up pink, foamy mucus
f. Chest pain, if heart failure is caused by a heart attack

119
Q

Why do you hear s3 with acute heart failure?

A

caused by oscillation of blood back and forth between walls of ventricles of blood from atria

120
Q

What is a big difference between acute and chronic heart failure?

A

chronic heart failure patients have a structural heart chamber that is changing

121
Q

true or false: patients with chronic heart failure are hypovolemic

A

false; hyper and they need a diuretic

122
Q

What is the staple test for heart failure?

A

BNP

123
Q

What suggests heart failure with BNP?

A

anything more than 100

124
Q

What does a chest x-ray help with?

A

looking for enlarged and fluid buildup

125
Q

What does an echocardiogram measure?

A

measures ejection fraction and structure

126
Q

What are 3 other tests that can be done for HF?

A
  1. Stress test
  2. CT and MRI
  3. Coronary catheterization
127
Q

What are 3 compensatory mechanisms for decreased CO associated with HF?

A

a. The Sympathetic Nervous System (SNS)
b. The Renin-Angiotensin-Aldosterone System (RAAS)
c. Ventricular Hypertrophy if hypertension is present

128
Q

Describe the baroreceptor response:

A

a. Triggers brain
b. SNS activation
c. increase in HR, increase in contractility
d. increase in CO

129
Q

Describe the RAAS response:

A

a. SNS (hypotension, sodium depletion, dehydration, serum albumin depletion, cardiac failure) signal kidney to release renin
b. Renin activates the conversion of the plasma glycoprotein from the liver to form angiotensin II by an enzyme in lung.
c. Angiotensin II is a very potent vasoconstrictor and stimulates aldosterone secretion.
d. Aldosterone acts on kidneys to retain water and sodium
e. Angiotensin II also stimulates the posterior pituitary gland to secrete ADH signaling kidneys to retain water increasing vascular volume.
f. increase in preload
g. increase in CO

130
Q

Describe response to increase ventricular wall tension:

A

a. increase wall tension
b. myocyte growth
c. hypertrophy

131
Q

What does ventricular remodeling do in regards to stiffness and compliance?

A

increase in stiffness, decrease in compliance

132
Q

What are 3 groups of meds used to halt or reduce the progression of HF?

A

a. ACEI or ARB
b. Aldactone
c. Beta Blocker
- -> LOL
- -> Reduces HR and BP

133
Q

What is the I NYHA functional classification for HF?

A

Normal ADLs do not initiate

134
Q

What is the II NYHA functional classification for HF?

A

Normal ADLs initiate onset of sx, although sx resolve with rest

135
Q

What is the III NYHA functional classification for HF?

A

Minimal activity initiates sx, no sx at rest

136
Q

What is the IV NYHA functional classification for HF?

A

Any activity initiates sx and sx present at rest

137
Q

What is a disease of the heart muscle affecting its ability to contract and adequately perfuse the body’s vital organs, a leaking and/or inflammation of the heart muscle?

A

cardiomyopathy

138
Q

Cardiomyopathy is not often curable, so what are some ways that can help it?

A

a. Stop or slow the progression of damage to heart
b. Improve the function of the heart
c. Reduce or eliminate symptoms
d. Prevent sudden death
e. Treat comorbidities associated conditions that worsen heart function such as sleep apnea or CAD blockages

139
Q

What is the most common test done for cardiomyopathy?

A

echocardiogram

140
Q

What does an EKG show in cardiomyopathy?

A

wide QRS

141
Q

Why is a ventriculogram used to diagnose cardiomyopathy?

A

A MUGA scan. Done in nuclear medicine and looks at pumping chambers of heart
–> Look at size, shape, and function of the ventricles

142
Q

What are the 3 types of caridomyopathy?

A
  1. hypertrophic
  2. dilated
  3. restrictive
143
Q

What is hypertrophic cardiomyopathy?

A
  1. thickening of inter ventricular septum

2. enlargement of heart and heart cells

144
Q

What is the likelihood of inheriting hypertrophic cardiomyopathy?

A

50%

145
Q

What is an idiopathic cause of hypertrophic cardiomyopathy>

A

uncontrolled hypertension

146
Q

What makes a pt. more likely to inherit hypertrophic cardiomyopathy?

A

genetic mutation occurs in the gene that codes for the sarcomere contractile protein in the heart.

147
Q

How does hypertrophic cardiomyopathy affect flow of blood?

A
  1. increased resistance to flow from left atrium

2. left ventricle outflow restriction

148
Q

How does hypertrophic cardiomyopathy affect the left ventricle?

A

hypertrophy and stiffness

149
Q

How does hypertrophic cardiomyopathy affect hemodynamics?

A

a. LVEDP increase

b. increase in PA pressures/wedge venous pressure

150
Q

What kind of symptoms will a patient have with hypertrophic cardiomyopathy?

A

a. Dyspnea –most common
b. Angina is common
c. Fatigue
d. Syncope
e. Palpitations/Sudden cardiac death SVT/Vtach.
f. Nocturnal dyspnea
g. SOB with exertion

151
Q

What diagnostic tests would you see done on a patient with hypertrophic cardiomyopathy?

A

i. Echo: Determine extent of ventricular septum/ventricle thickening
ii. Holter Monitor: Presence of dysrhythmias and activity intolerance

152
Q

What would an x-ray show for someone who has hypertrophic cardiomyopathy?

A

mild/moderate cardiomegaly

153
Q

What would you hear with someone who has hypertrophic cardiomyopathy?

A

S4 heart sound. systolic murmur

154
Q

What would an EKG show with someone who has hypertrophic cardiomyopathy?

A
  • ST segment and T wave abnormalities

- AV dysrhythmias

155
Q

What is the treatment goal for someone with hypertrophic cardiomyopathy?

A

to reduce contractility and relieve left ventricular outflow obstruction

156
Q

What kind of meds would expect to see given to someone with hypertrophic cardiomyopathy?

A
  1. Beta blocker
  2. Ca channel blocker
  3. Anticoagulant if in Afib
  4. Antidysrhythmic
157
Q

What meds do you want to avoid with someone who has hypertrophic cardiomyopathy?

A

Avoid inotropes and preload reduction meds

158
Q

What kind of electronic implant devices would you with someone who has hypertrophic cardiomyopathy?

A
  1. AICD

2. permanent pacemaker

159
Q

What might someone get replaced with hypertrophic cardiomypothay?

A

there mitral valve

160
Q

What is patient education for someone who has hypertrophic cardiomyopathy?

A

i. Cardiac rehabilitation consult for less intense exercise
ii. Family genetic screening
iii. AICD
iv. Heart Transplant in small percentage
v. No Basketball!
1. At risk for infective endocarditis
vi. Prophylactic Antibiotics - prevent infective endocarditis.

161
Q

What is the most common form of cardiomyopathy?

A

dilated

162
Q

What are changes in the heart structure associated with dilated cardiomyopathy?

A
  1. dilation of the ventricles
  2. deign of myocardial fibers
  3. increased fibrotic tissue
  4. fibrotic tissue not pliable
163
Q

Are SV and CO increased or decreased with dilated cardiomyopathy?

A

decreased w/low ejection fraction

164
Q

What is grossly impaired with dilated cardiomyopathy?

A

systolic function

165
Q

What is going to increase to compensate in dilated cardiomyopathy?

A

HR

166
Q

What are some of the s/sx you would see in someone who has dilated cardiomyopathy?

A
  • Syncope
  • Fatigue
  • Angina
  • Pulmonary congestion
  • Extra heart sounds, murmurs
  • Atrial & Ventricular dysrhythmias
  • Emboli formation within the heart muscle or pulmonary vasculature
167
Q

Why is it common for pt.’s to experience clots in dilated cardiomyopathy?

A

a. Blood pools in the heart because it isn’t being pumped out, so it is very common for it to clot.
b. Clots will move to different parts of the body especially the lungs – causes pulmonary emboli.

168
Q

What is a structural change associated with dilated cardiomyopathy?

A

cardiomegaly

169
Q

What would you hear with a stethoscope in someone who has dilated cardiomyopathy?

A
  • Aortic and mitral valve regurgitation = murmurs

a. Aortic – 2nd intercostal space right sternal border

170
Q

What would an x-ray show for a patient who has dilated cardiomyopathy?

A

cardiac enlargement; left ventricular hypertrophy

171
Q

What would an EKG show for a patient who has dilated cardiomyopathy?

A
  1. Sinus tachycardia
  2. Atrial/ventricular dysrhythmias
  3. ST segment and T wave abnormalities
  4. Conduction defects due to myocardial enlargement.
  5. V-Tach/ V-Fib
172
Q

Most patients with cardiomyopathy require what?

A

a pacemaker

173
Q

What are common meds you will see prescribed to someone who has cardiomyopathy?

A

a. Diuretics
b. Na restriction: Reduces preload
c. Ace inhibitors –vasodilator, lower BP improve blood flow and decrease work of heart
d. Beta Blockers – slow HR and increase filling time
e. Blood Thinners –> Because blood pools
f. Antidysrhythmics
a. Amiodarone b. Diltiazem
g. Nitroglycerine - Vasodilator
h. Inotropic agents – increase contractility
1. CO and CI are good indicators of contractility

174
Q

What kind of electronic implant devices would you with someone who has dilated cardiomyopathy?

A

Pacemakers, AICDS, LVADS

175
Q

What is the least common form of cardiomyopathy?

A

restrictive cardiomyopathy

176
Q

What is restrictive cardiomyopathy?

A

Infiltrative process that results in fibrosis and thickening of myocardium due to fibrotic infiltration into the myocardium, endocardium, and subendocardium, which decreases ventricular stretch.

177
Q

What is important distinction between hypertrophic and restrictive cardiomyopathy?

A

ventricles become stiff, but not necessarily thickened – basically the opposite of hypertrophic

178
Q

How does restrictive cardiomyopathy impair diastole?

A

a. Ventricular filling effected during diastole.

ib. Ventricles unable to relax during diastole

179
Q

How is CO affected in restrictive cardiomyopathy?

A

decreases because filling pressure increases

180
Q

What is usually not affected in restrictive cardiomyopathy?

A

contraction

181
Q

What is heard with a stethoscope in restrictive cardiomyopathy?

A

S4 heard (occurs after atria contract, at end of diastole – gallop) –> bc heart is not compliant

182
Q

What are common s/sx you would see in a patient with restrictive cardiomyopathy?

A
  1. CHF
  2. Cardiomegaly
  3. Refractory Dysrhythmias
  4. Fatigue
  5. Persistent cough
  6. Activity Intolerance
183
Q

What would be some pharmacological interventions you would see with restrictive cardiomyopathy?

A
  1. Diuretics –> only given for restrictive and dilated

2. Vasodilators

184
Q

What kind of electronic implant devices would you with someone who has restrictive cardiomyopathy?

A
  1. Pacemaker

2. AICD

185
Q

What would you restrict with someone who has restricted cardiomyopathy?

A

Na

186
Q

What is important patient education for someone who has restricted cardiomyopathy?

A

i. Disease
ii. Medications
iii. Diet
iv. Exercise
v. Smoking cessation
vi. Signs & symptoms to monitor/report
vii. Daily weights
viii. Support groups
ix. Possible Transplantation

187
Q

What is primary restricted cardiomyopathy associated with?

A

unknown

188
Q

What is secondary restricted cardiomyopathy associated with?

A

CAD, MI, valvular disease, ETOH, severe HTN, viral infections, autoimmune disease

189
Q

What does the AICD recognize?

A

Ventricular arrhythmias.

190
Q

If pt. goes into v. fib what does the AICD do?

A

If pt. goes into V fib the AICD will shock them at a higher voltage.

191
Q

What is the AICD do?

A
  1. Ability to pace

2. Ability to store retrievable data

192
Q

What is the battery life for an AICD? When might it be needed to changed earlier?

A

3-5 years; battery change earlier if it is shocking the patient a lot of times

193
Q

What is insertion like for an AICD?

A

frightening

194
Q

What comes with the AICD that helps to turn off the defibrillator component? What does it continue to do though?

A

Magnet; pace the patient

195
Q

What is important patient education with an AICD?

A

i. Extensive
ii. Know difference b/t MI and Cardiac Arrest
iii. Call MD / Keep a diary
iv. Driving, cell phones, MRI, arc welding
v. Shock (self & others)

196
Q

What is the LVAD?

A

Bridge to implant

197
Q

What does the LVAD help do?

A

takes over and assists the pumping role of left ventricle

198
Q

What is the Intra-aortic balloon pump?

A

inflates during systoles so it can perfuse the organs. Deflates during diastole.

199
Q

Where is the Intra-aortic balloon pump placed?

A

either the left or right groin

200
Q

What does the artificial heart helped to do?

A

Preserve perfusion by taking over both ventricles and valves

201
Q

What does the artificial transplant act as a bridge for??

A

Bridge to transplant for individuals who do not respond to treatment

202
Q

What is total implanted permanent artificial heart intended for?

A

people not eligible for heart transplantation

203
Q

What is a valvular disease?

A

When the heart valves that move the blood efficiently through the heart chambers do not fully “open” or “close”

204
Q

What is impaired with valvular disease?

A

distal perfusion to the heart and tissues is impaired, which puts a strain on the myocardium.

205
Q

What are the 2 valves that are most commonly affected?

A
  1. aortic

2. mitral

206
Q

What are the 2 types of valvular disease?

A
  1. stenotic

2. Regurgitant

207
Q

What does aortic valvular disease cause?

A

Causes a decrease in the blood flow from the left ventricle into the aorta and systemic circulation.

208
Q

How does aortic valvular disease affect the left ventricle?

A

Causes increased left ventricular pressures –> causing left ventricular hypertrophy

209
Q

What is the most common cause of aortic valvular disease?

A

pulmonary hypertension

210
Q

What is another cause of aortic valvular disease?

A

rheumatic fever group A

211
Q

Who is more likely to experience aortic stenosis:

a. patient with Congenital bicuspid aortic valve
b. patient with Rheumatic aortic valve disease
c. Patient with congenital tricuspid aortic valve
d. patient with Calcific (senile) aortic stenosis

A

a, b, d

212
Q

Does aortic valvular disease have a slow onset or fast onset?

A

slow

213
Q

What symptoms would you find in patients who have aortic valvular disease?

A
  1. Chest pain
  2. syncope due to decrease in CO
  3. Fatigue
  4. Nocturnal dyspnea
  5. Palpitations
  6. Systolic murmur(more commonly heard)
214
Q

What would an echo of a patient with aortic valvular disease show?

A

show thickened and calcified valve that opens poorly, also heart chamber size

215
Q

What would an X-ray of a patient with aortic valvular disease show?

A

dilation of the aorta

216
Q

What would an EKG reflect of a patient with aortic valvular disease show?

A

heart thickening

217
Q

What is considered the gold standard for diagnosis the severity of aortic valvular disease?

A

heart catheterization; there is a gradient to see if it needs replacement or repair

218
Q

What is done annually on patients with aortic valvular disease?

A

echocardiogram

219
Q

What do you want to avoid with aortic valvular disease? why?

A

strenuous exercise; i. decreases oxygen demand. Don’t want the heart to work hard

220
Q

What might a doctor order for a patient aortic valvular disease?

A

antibiotic due to concern for infection

221
Q

What does significant stenosis with aortic valvular disease require?

A

balloon valvuloplasty or aortic valve replacement

222
Q

What is aortic regurgitation?

A

backward flow, so leaflets are not fully closed during diastole

223
Q

What does aortic regurgitation allow?

A

allows some of the blood that was just pumped out of your heart’s main pumping chamber (left ventricle) to leak back into it.

224
Q

What are s/sx associated with aortic regurgitation?

A

a. Fatigue and weakness with exertion
b. Shortness of breath with exertion or when you lie flat
c. Chest pain (angina) increasing during exercise
d. Syncope
e. Irregular pulse (arrhythmia)
f. Heart murmur not as commonly heard
g. Heart palpitations
h. Swollen ankles and feet (edema)

225
Q

What is recommended for treatment of aortic regurgitation?

A

Early surgical intervention recommended due to increased risk of ventricular dysrhythmias and death

226
Q

What are pharmacological interventions used for treatment of aortic regurgitation?

A

a. Dobutamine/Primacor

b. Inotropes (Dopamine)

227
Q

What needs to be reduced in aortic regurgitation?

A

LVED pressure reduction

228
Q

What is mitral valve regurgitation?

A

The flaps (leaflets) of the mitral valve weaken, causing blood to leak backward into the left atrium of your heart.

229
Q

What is the most common cause of blood leakage in the mitral valve?

A

The most common cause of blood leakage is mitral valve prolapse, in which the leaflets bulge back into the left atrium as your heart contracts.

230
Q

What happens when the mitral valve becomes stiff or scarred, and fails to open during diastolic filling?

A

mitral valve stenosis

231
Q

Is mitral valve regurgitation going to have a slow onset or rapid onset?

A

slow onset

232
Q

What will you hear using a stethoscope of someone with mitral valve regurgitation?

A

heart murmur

233
Q

What are the symptoms that you would find in a patient who has mitral valve regurgitation?

A

c. Shortness of breath, especially with exertion or when you lie down
d. Fatigue, especially with exertion
e. Lightheadedness
f. Cough, especially at night or when lying down
g. Heart palpitations
h. Swollen feet or ankles
i. Excessive urination

234
Q

What is a non-pharmacological way of a patient who has mitral valve regurgitation?

A

Restriction of activities that produce fatigue/dyspnea; optimize oxygenation

235
Q

What is a pharmacological way of treating a patient who has mitral valve regurgitation?

A
  1. diuretics
  2. ACE inhibitors
  3. Nitrates
  4. Digitalis
  5. Might need a beta blocker at some point
236
Q

Do younger patients or older patients get mechanical valves usually?

A

younger; younger than <65 or 70 years old.

237
Q

What is a medication a patient would be on with mechanical valves?

A

anticoagulant therapy

238
Q

What do mechanical valves increase?

A

increase durability

239
Q

What are tissue valves made out of?

A
  1. porcine or bovine
240
Q

What two medications would a patient with tissue valves be taking?

A
  1. lisinopril

2. metoprolol

241
Q

Would someone with tissue valves receive anticoagulant therapy?

A

NO

242
Q

Which last longer, tissue valves or mechanical valves?

A

tissue valves

243
Q

How is mitral valve stenosis managed pharmacologically?

A
  1. blood thinners

2. antibiotics before procedures

244
Q

How is mitral valve stenosis managed surgically?

A
  1. mitral valve repair or replacement

2. percutaneous balloon valvuloplasty

245
Q

When would a percutaneous balloon valvuloplasty be contraindicated?

A

Not appropriate with too much calcium buildup or if clot present

246
Q

What are the priorities of care when treating a patient with mitral valve stenosis? (4 things)

A
  1. Refer to POC for Cardiomyopathy
  2. Maintaining adequate cardiac output
  3. Optimizing fluid balance
  4. Providing patient education
247
Q

What is an inflammation on the endothelial surface of the heart?

A

infective endocarditis

248
Q

What is infective endocarditis the 4th most common cause of?

A

4th most common cause of life-threatening infectious syndromes (after urosepsis, PNA, & Intra-abdominal sepsis)

249
Q

What patients are most at risk for mitral valve stenosis?

A
  1. Patients with congenital disease
  2. Valvular heart disease
  3. Prosthetic heart valves
  4. PMR & AICD
  5. Body piercing
  6. Intravenous Drug Use
  7. Degenerative Valve Disease
250
Q

Which is the most common valve to be affected in infective endocarditis?

A

tricuspid valve

251
Q

What are the 3 pathogens associated with infective endocarditis?

A
  1. Streptococcus
  2. Staphylococcus
  3. Enterococci
252
Q

What is a common complication of infective endocarditis?

A

heart failure

253
Q

What are 3 embolic complications of infective endocarditis?

A

a. Stroke – Emboli in the CNS
b. Pulmonary Embolism
c. Other Organs – liver, spleen, kidney, abdominal mesenteric artery, & peripheral vessels

254
Q

How is infective endocarditis treated pharmacologically?

A
  1. IV Therapy of Anti-microbial Agents (4-6 weeks)
255
Q

How is infective endocarditis treated surgically?

A

cardiac surgery

256
Q

How to manage infective endocarditis as a nurse:

A
  1. timely antimicrobial administration to resolve the infection,
  2. prevent complication,
  3. provide pain medication, and
  4. Individualized patient education

NURS 470 (7 decks)

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