T2: Arrhythmias and Cardiomyopathy Flashcards
permanent localized dilation of an artery; enlarging artery 2x or more of its normal diameter
aneurysm
arterial wall is weakened by congenital or acquired problems
True aneurysm
occurs as a result of vessel injury or trauma to all three layers of the arterial wall
False aneurysm
formed when blood accumulates in the wall of an artery
dissecting aneurysm
Most common aneurysm, usually asymptomatic, frequently ruptures
abdominal aortic aneurysm
Abdominal aortic aneurysm is located between the _____ arteries and the aortic ______ (dividing area)
-renal arteries
-aortic bifurcation
aneurysm frequently misdiagnosed, often found when imaging is used for other purposes
Thoracic aortic aneurysm
TAAs are found between the _______ and _______
-origin of the left subclavian artery
-diaphragm
Thoracic aortic aneurysms are located in the _____, _____, and _____ areas of the aorta or the aortic arch
descending, ascending, and transverse
T/F: surgical management is most common form of TAA management
False; surgical management is very difficult
Symptoms of Abdominal Aortic Aneurysm (4)
-abdominal pain
-flank pain
-back pain
-some will report heartburn
Abdominal Aortic Aneurysm can be observed by looking for:
pulsation in the upper abdomen slightly left of the midline between the xiphoid process and umbilicus
When patient has an abdominal aortic aneurysm, auscultate for:
bruit over the mass
Critical consideration of abdominal aortic aneurysms
-Do NOT palpate or auscultate a pulsating mass because it could rupture
Assess for ____ in pts with an abdominal aortic aneurysm (7)
-pain in lower back or abdomen
-hypertension
-diaphoresis
-decreased LOC
-Oliguria
-Loss of pulse distal to the rupture dysrhythmias
If pt with abdominal aortic aneurysm has pain in lower back, as if pain radiates to __, ___, or ____
-groin
-buttocks
-legs
TAA Assessed: (4)
-back pain or chest pain that is very severe
-SOB
-Hoarseness
-Difficulty swallowing
T/F: Physical assessment does not usually detect TAA
True
________ may occur if a TAA ruptures
Hypovolemic shock
AA Assessed: (2)
-CT with contrast used for assessing size and location
-Ultrasonography
AA Nursing actions:
Monitor (3)
-blood pressure
-pulse
-peripheral circulation
AA Nursing actions:
Nonsurgical management (3)
-Regulate blood pressure if client has hypertension
-Frequent CT or ultrasound to monitor
-Educate client on s/s of possible ruptures
AA surgical management (2)
-Cardiothoracic surgeon
-Small aneurysm may be done as elective, larger may be emergency surgery
Surgical management AAA (2)
-Commonly a resection
-Endovascular stent grafts
AAA surgery with high mortality rate
Resection
Endovascular stent grafts have a _______ mortality rate compared to resections,
making it:
-improved
-procedure of choice
Possible complications of Endovascular stent grafts
-bleeding
-rupture
-peripheral embolization
-stent misplacement
-endoleak
-infection
blockage of blood flow
peripheral embolization
blood flow occurs within aortic aneurysm
endoleak
Aortic aneurysm post surgical client education (3)
-lifting restriction for 6-12 weeks
-caution when pushing , pulling, or straining
-Avoid driving for several weeks
Aortic aneurysm cues: (7)
-Pain describes as sharp. tearing, ripping, or stabbing
-sweating
-Nausea/vomiting
-Fainting
-Pallor
-Rapid weak pusle
-Feeling of impeding doom, apprehension, anxiety
Aortic dissection emergency care (5)
-2 large bore IVs
-0.9% sodium chloride
-indwelling catheter
-Pain relief: morphine
-HTN management: IV beta blockers
chronic disease of cardiac muscle
cardiomyopathy
4 types of cardiomyopathy
-Dilated
-Hypertrophic
-Restrictive
-Arrhythmogenic right ventricular
most common type of cardiomyopathy
Dilated
With Dilated Cardiomyopathy, extensive damage is done to _______, interfering with myocardial ________
-myofibrils
-metabolism
most of the energy for the contraction of the heart comes from:
oxidative phosphorylation of ADP
Dilated Cardiomyopathy:
-_________ ventricle(s) are dilated
-_________ function impaired
-Decreased CO2 r/t:
-both ventricles
-systolic function
-inadequate pumping of the heart
S/S of dilated cardiomyopathy (7)
-SOB with exertion
-Decreased ability to exercise
-Fatigue
-Palpitations
-Systemic or pulmonary emboli
-Moderate to severe cardiomegaly
-A-fib in some clients
Cause of Dilated cardiomyopathy (7)
-alcoholism
-chemo
-infection
-inflammation
-nutritional deficit
-heredity
-CAD
Diagnosis of dilated cardiomyopathy (2)
-xray
-echocardiography
treatment of dilated cardiomyopathy (5)
-vasodilators
-surgery
-dysrhythmia control
-treatment of HF
-beta blockers
Treatment of HF that can be applied to cardiomyopathy (4)
-diuretics
-cardiac glycosides
-antidysrhythmic drugs
-implantable cardiac defibrillator
Asymmetric ventricular hypertrophy (thickening) cousin g ti to be harder for the heart to pump blood; reduced cardiac output and stroke volume
hypertrophic cardiomyopathy
Hypertrophic Cardiomyopathy:
-Obstruction in ________ tract most common
-_____ valve abnormalities common
-Genetic trait
-left ventricular outflow
-mitral valve
-single gene autosomal-dominant (1:500ppl)
S/S of hypertrophic cardiomyopathy (10)
-May be asymptomatic in adolescence or early adulthood
-Shortness of air on exertion
-Syncope
-Dizziness
-Palpations
-Mild cardiomegaly
-Ventricular dysrhythmias
-Sudden death
-Heart failure
-Chest pain at rest, prolonged, not relieved by nitrates
Treatment of hypertrophic cardiomyopathy
-HF treatment
-Beta blockers
-AFib conversion
-Surgery
Surgical treatment of hypertrophic cardiomyopathy: (2)
-ventriculomyotomy
-muscle resection w/ mitral valvue replacement
Hypertrophic cardiomyopathy diagnosis: (3)
-Echocardiography
-X-ray
-Angiocardiography durino a catheterization
Stiffening of the lower chambers of the heart making it harder for them to fill with blood
Restrictive cardiomyopathy
Restrictive cardiomyopathy:
-_______ prognosis
-_______ diagnosis
-poor
-rare
S/s of restrictive cardiomyopathy:
similar to HF
Cause of restrictive cardiomyopathy: (3)
endocardial or myocardial disease
-sarcoidosis
-amyloidoisis
patches of red swollen tissue
sarcoidosis
amyloid build up in the organ
amyloidosis
Surgical treatment of restrictive cardiomyopathy (2)
-percutaneous alcohol septal ablation
-heart transplant
replacement of myocardial tissue with fibrous and fatty tissue
arrhythmogenic right ventricular cardiomyopathy
arrhythmogenic right ventricular cardiomyopathy:
-may also occur in:
-______ associated: most often affects:
-left ventricle
-familial associated- most often affects young adults
Medical Energy that needs to be assessed after heart transplant/why
-bleeding onto the pericardial sac with potential for cardiac tamponade
-pressure from fluid prevents heart from pumping
bleeding onto the pericardial sac with potential for cardiac tamponade:
S/S (3)
-low blood pressure
-distention of the jugular veins
-muffled heart sounds
S/S of heart transplant rejection
-SOB
-fatigue
-fluid gain
-abdominal bloating
-new bradycardia
MOST IMPORTANT part of heart transplant post-op care
infection control
