Week 1 PP Flashcards
By ethnicity & sex which are most likely to die from heart disease…
Black Most Deaths for Males & Females
White male most likely
1 in 2 men
1 in 3 women
Will die of HD befire age 40
T or F
T
Percent of deaths caused by heart disease
25%
Risk factors for heart disease (5)
Weight
BP
Glucose
Cholesterol
Tobacco
In USA about how many die from Heart Disease annually…
1 million
Half men / Half women
Most fatal type of cardiovascular disease
Coronary Heart Disease
Most likely age group to die from cardiovascular disease…
80+
Blood flow through the heart
How & where does Unoxygenated blood enter the heart?
Superior Vena cava Upper Body
Inferior vena cava Lower Body
Blood flow through the heart
- Unoxygenated blood enters (this portion of the heart) ___ from the Superior & Inferior Vena Cava
- After it travles through this valve.
- Unoxygenated blood in the right ventricle is then sent to the lungs. Through this Valve & this blood vessels…
- Blood is sent back from the lungs via this blood vessels…
- Oxygenated blood reaches this part of the heart first…
- Then, oxygenated blood is sent through this valve to this part of the heart.
- Finally oxygenated blood is sent through this valve & blood vessel to be distributed to the body.
- Right Atrium
- Tricuspid
- Pulmonary Valve & Pulmonary Artery (Unoxygenated)
- Pulmonary Vein
- Left atrium
- Mitral / bicuspid valve & Left Ventricle
- Aortic valve / aorta
The Aorta has 3 arteries that extend from it.
Name them & their function
Starting most leftward
Left subclavian
Supply oxygen-rich blood to the upper body, including the left arm, neck, head, and part of the brain
Left common carotid artery (LCCA)
Supplies oxygen-rich blood to the head and neck, including the brain
Brachiocephalic
Carry oxygenated blood to the upper right side of the body, specifically supplying blood to the right arm, head, and neck.
Brachiocephalic branches into 2 arteries.
The right subclavian artery (for the arm)
Right common carotid artery (for the head and neck).
Purpose of Chordea Tendineae
Attaches to the Atrioventricular Valves (AV) and prevents them from prolapsing into the Atrium with contractions
Accomplished by anchoring the Valve leaflets to the papilary muscles.
Located near the temples on the side of the head.
Supplies blood to parts of the forehead and scalp.
Used to assess a pulse in infants or when other sites are inaccessible.
Temporal Artery
Found on both sides of the neck.
Supplies oxygenated blood to the brain, neck, and face.
Commonly checked during CPR for pulse assessment.
Carotid Artery
Not an artery but refers to the heartbeat heard over the apex of the heart using a stethoscope.
Reflects the left ventricular contraction.
Assessed for irregularities in rhythm or rate.
Apical Pulse (Heart)
Runs along the upper arm.
Supplies blood to the arm and hand.
Used to measure blood pressure or pulse in infants.
Brachial Artery
Located on the thumb side of the wrist.
Supplies blood to the forearm and hand.
Common site for measuring pulse in adults.
Radial Artery
Found in the groin area.
Supplies blood to the lower abdomen, thighs, and legs.
Checked during trauma or emergencies to assess circulation to the lower body.
Femoral Artery
Located behind the knee.
Supplies blood to the knee joint, thigh, and calf.
Assessed for circulation in the lower leg.
Popliteal Artery
Runs along the inner side of the ankle.
Supplies blood to the foot.
Checked to assess circulation to the foot.
Posterior Tibial Artery
Located on the top of the foot.
Supplies blood to the foot and toes.
Assessed to evaluate peripheral circulation, particularly in patients with vascular disease.
Pedal (Dorsalis Pedis) Artery
Types of Semilunar Valves:
_________
Located between the right ventricle and the pulmonary artery.
Prevents backflow of blood from the pulmonary artery into the right ventricle during diastole (heart relaxation).
______
Located between the left ventricle and the aorta.
Prevents backflow of blood from the aorta into the left ventricle during diastole.
Pulmonary Valve
Prevents backflow of blood from the pulmonary artery into the right ventricle during diastole (heart relaxation).
Aortic Valve
Located between the left ventricle and the aorta.
Prevents backflow of blood from the aorta into the left ventricle during diastole.
Composed of three cusps (or leaflets).
Open during ventricular systole (contraction) to allow blood to flow out of the heart.
Close during ventricular diastole to prevent blood from flowing back into the heart.
Semilunar Valves
Pulmonary & Aortic Valve
Cardiac Conduction System
Location: Upper right atrium, near the opening of the superior vena cava.
Function:
Acts as the heart’s natural pacemaker.
Initiates electrical impulses that set the heart’s rhythm (normal rate: 60–100 beats per minute).
Causes the atria to contract, pushing blood into the ventricles.
Sinoatrial (SA) Node
Sinoatrial (SA) Node
Location….
Function… (3)
Location:
Upper right atrium, near the opening of the superior vena cava.
Function:
Acts as the heart’s natural pacemaker.
Initiates electrical impulses that set the heart’s rhythm (normal rate: 60–100 beats per minute).
Causes the atria to contract, pushing blood into the ventricles.
Electrical Conduction System
____________
Location: Lower part of the right atrium, near the interatrial septum.
Function:
Receives impulses from the SA node and delays them slightly.
This delay allows the ventricles to fill with blood before contracting.
Passes the impulses to the bundle of His.
Atrioventricular (AV) Node
Electrical Conduction System
Atrioventricular (AV) Node
Location…..
Function…. (3)
Location
Lower part of the right atrium, near the interatrial septum.
Function
Receives impulses from the SA node and delays them slightly.
This delay allows the ventricles to fill with blood before contracting.
Passes the impulses to the bundle of His.
Electrical Conduction System
___________
Location: Runs from the AV node through the interventricular septum.
Function:
Transmits electrical impulses from the AV node to the ventricles.
Divides into the left and right bundle branches for each ventricle.
Bundle of His (Atrioventricular Bundle)
Electrical Conduction System
Bundle of His (Atrioventricular Bundle)
Location….
Function….. (2)
Location
Runs from the AV node through the interventricular septum.
Function
Transmits electrical impulses from the AV node to the ventricles.
Divides into the left and right bundle branches for each ventricle.
Electrical Conduction System
_______________
Location: Extend from the bundle of His along the interventricular septum.
Function:
Conduct impulses to the left and right ventricles.
Ensure synchronized contraction of both ventricles.
Left & Right Bundle Branches
Electrical Conduction System
Left and Right Bundle Branches
Location…..
Function….. (2)
Location:
Extend from the bundle of His along the interventricular septum.
Function:
Conduct impulses to the left and right ventricles.
Ensure synchronized contraction of both ventricles.
Electrical Conduction System
________
Location: Spread throughout the walls of the ventricles.
Function:
Distribute electrical impulses to the ventricular muscle cells.
Trigger the ventricles to contract, pumping blood to the lungs (via the right ventricle) and the rest of the body (via the left ventricle).
Purkinje Fibers
Electrical Conduction System
Purkinje Fibers
Location….
Function……
Location:
Spread throughout the walls of the ventricles.
Function:
Distribute electrical impulses to the ventricular muscle cells.
Trigger the ventricles to contract, pumping blood to the lungs (via the right ventricle) and the rest of the body (via the left ventricle).
SA Node → 2. _____ contract → 3. AV Node → 4. Bundle of His → 5. Bundle Branches → 6. Purkinje Fibers → 7. ______ contract.
SA Node → 2. Atria contract → 3. AV Node → 4. Bundle of His → 5. Bundle Branches → 6. Purkinje Fibers → 7. Ventricles contract.
Function: Supplies oxygenated blood to the left side of the heart, including the left atrium and ventricle.
Left Coronary artery
Left Coronary Artery
Branches:
Left Anterior Descending (LAD) Artery:
Circumflex (Cx) Artery:
Left Anterior Descending
Supplies blood to the front of the left ventricle and the interventricular septum.
Critical for maintaining function in the heart’s pumping chambers.
Circumflex Artery:
Supplies blood to the left atrium and the side and back of the left ventricle.
_____________
Function: Supplies oxygenated blood to the right side of the heart, including the right atrium, right ventricle, and parts of the conduction system.
Branches:
Right Marginal Artery:
Supplies the right ventricle.
Posterior Descending Artery (PDA):
Supplies blood to the bottom part of the ventricles and the back of the interventricular septum.
Right Coronary Artery
Cardiac output range
4 / 8 L per minute
Cardiac Output depends on….
HR × SV
Heart rate times Stroke Volume
Volume of blood ejected by the left ventricle per beat (normal: ~70 mL/beat).
Normal HR Adult
60 - 100
Which nervous system controls the HR
Autonomic
Stroke volume (SV) is the amount of blood ejected by the ____ ventricle with each heartbeat.
It is influenced by several factors:
Left Ventricle
HR, Preload, Afterload, contractility
Explain HR relationship with SV
At high heart rates, stroke volume may decrease because there is less time for ventricular filling (diastole).
A balanced heart rate allows optimal ventricular filling and maximum stroke volume.
At high heart rates, stroke volume may decrease because there is less time for ventricular filling aka…..
Ventricular emptying aka…
(diastole)
Systole
Afterload:
Definition: The resistance the ventricles must overcome to eject blood during systole.
Relationship to SV:
Increased afterload ….
Decreased afterload….
Increased Afterload:
(e.g., in hypertension or aortic stenosis): Makes it harder for the heart to pump blood, reducing stroke volume.
Decreased afterload:
Reduces the resistance, allowing the ventricles to eject blood more easily, increasing stroke volume.
Define:
- The resistance the ventricles must overcome to eject blood during systole.
- The degree of stretch of the ventricular walls at the end of diastole, before contraction.
- Afterload
- Preload
Contractility:
Definition: The strength of the heart’s contraction, independent of preload and afterload.
Relationship to SV:
Increased contractility….
Decreased contractility
Increased contractility (e.g., from sympathetic stimulation or inotropic drugs): Enhances the force of contraction, increasing stroke volume.
Decreased contractility (e.g., in heart failure or myocardial ischemia): Weakens the contraction, reducing stroke volume.
_____ = Preload (↑) + Contractility (↑) - Afterload (↓)
Stroke Volume (SV)
Ejection Fraction (EF) is….
Percentage that reflects the efficiency of the heart’s pumping ability
Specifically the proportion of blood pumped out of the left ventricle with each heartbeat.
It is a key indicator of heart function, especially in diagnosing heart conditions such as heart failure.
StrokeVolume ÷ End-DiastolicVolume
× 100 =
Ejection Fraction
Determined by left ventricular end-diastolic volume
Preload
Degree of myocardial fiber stretch at the end of diastole…
Preload
Starling’s law is associated with Preload
Define…
More the heart is filled during diastole the more forcefully it contracts.
(Upto a point)
Preload
Excessive filling = Excessive Left Ventriclar End-Diastolic Volume - (LVEDV) = Overstretched = (High/ Low) Cardiac Output
Low CO
Pressure ventricles must overcome to eject blood into the peripheral blood vessels
Define….
Afterload
Afterload
Pressure ventricles must overcome to eject blood into the peripheral blood vessels
Is influenced by this valve….
Aortic
Increased demand to meet tissues metabolic needs will have this effect on blood vessels & blood pressure….
Vasodilation in active tissues, which increases blood flow.
Cardiac output increases to meet this demand, leading to a temporary increase in systolic blood pressure while diastolic pressure may remain unchanged or decrease slightly.
Force exerted against the blood vessels wall is…
Blood pressure
Autonomic NS & _____ regulate blood pressure
Kidneys
Autonomic NS (Sympathetic/ Parasympathetic)
Have these types of sensory receptors….
Chemo: respond to chemical changes ie. Hypoxemia
Baroreceptors: Respond to pressure
Stretch receptors: Sense low blood volume
Autonomic NS
Location:
Chemoteceptors
Baroreceptors
Stretch receptors
Chemoteceptors: Aortic arch & Carotid bodies
Baroreceptors: Aortic Arch & Carotid sinus
Stretch receptors: Vena Cava & Right Atrium
Affects of Alpha ¹ & Beta ¹ response in the sympathetic NS.
A¹ = Vasoconstriction = Increased BP
B¹ = Increased HR, AV Conduction, Contractility
Renal system does what when BP decreases…
Hold Sodium & Water
They renal system may activate this in response to low bp…
RAAS
Renin-Angiotensin-Aldostrone system
Increases Fluid / Blood Volume, increasing BP
Renal system to combat hypotension…
- _____ release triggers the conversion of angiotensinogen to angiotensin I, which is then converted to angiotensin II.
- Angiotensin II causes ____ and stimulates aldosterone release, leading to sodium and water retention in the kidneys.
- Renin
- vasoconstriction
Renal System Influencing factors
Antidiuretic hormone
Increase BP
Causes kidney to reabsorp H2O
Renal System Influencing factors
Natriuretic peptides
Lowers BP
Diuresis & Renal Vasodilation
Bradykinin & Histamine
Affect on BP…
Vasodilation Lower BP
Increase capillary permeability
Name the 3 main arteries located on the heart.
Left Anterior Descending
Right Coronary Artery
Circumflex
Which part of BP does blood flow…
Systolic (Primary)
What often causes a heart murmur ( a sound heard between heart beats)
Blood flowing through a restriction
Ie. Aortic stenosis/ mitral stenosis
Labs
Creatine Kinase (CK):
Normal Values…
Relevance…
Men: 38–174 U/L
Women: 26–140 U/L
Relevance: CK levels rise in muscle damage, including cardiac or skeletal injury. Non-specific for heart conditions.
Labs
Creatine Kinase-MB (CK-MB):
Normal Values….
Relevance….
Critical Values…
Norms:
0–7 ng/mL or 0–5% of total CK.
Relevance:
CK-MB rises 3–6 hours after a heart attack, peaks at 12–24 hours, and returns to normal within 48–72 hours.
Critical Values:
Levels greater than 10 ng/mL strongly suggest myocardial infarction.
Labs
Lactate Dehydrogenase (LDH):
Normal Values….
Relevance…
Critical Values…
Normal Values: 140–280 U/L (varies by lab).
Relevance: LDH levels rise in tissue damage, including the heart. LDH-1 and LDH-2 isoenzymes are heart-specific, with LDH-1 > LDH-2 often indicating myocardial infarction.
Critical Values: LDH levels >400 U/L may indicate significant tissue injury.
Troponin (I and T):
Normal Values:
Troponin I…
Troponin T…
Relevance….
Critical Values…
Troponin (I and T):
Normal Values:
Troponin I: <0.04 ng/mL.
Troponin T: <0.01 ng/mL.
Relevance: Troponin rises 4–6 hours after myocardial injury, peaks at 12–24 hours, and remains elevated for 7–10 days.
Critical Values: Levels >0.40 ng/mL strongly indicate a myocardial infarction.
Natriuretic Peptide (BNP):
Normal Values….
Relevance….
Critical Values…..
Natriuretic Peptide (BNP):
Normal Values: <100 pg/mL.
Relevance: Elevated BNP indicates heart failure severity. Levels >400 pg/mL are highly suggestive of heart failure, while 100–400 pg/mL warrants further investigation.
Critical Values: >900 pg/mL is associated with severe heart failure.
Homocysteine:
Normal Values….
Relevance…..
Critical Values….
Homocysteine:
Normal Values: 4–15 µmol/L.
Relevance: Levels >15 µmol/L indicate an increased risk of atherosclerosis and cardiovascular disease.
Critical Values: Levels >30 µmol/L suggest severe risk for vascular disease.
C-Reactive Protein (CRP):
Normal Values:
Relevance:
Low risk….
Moderate risk….
Critical Values….
C-Reactive Protein (CRP):
Normal Values: <3.0 mg/L.
Relevance:
Low risk: <1.0 mg/L.
Moderate risk: 1.0–3.0 mg/L.
High risk: >3.0 mg/L for cardiovascular events.
Critical Values: High-sensitivity CRP (hs-CRP) >10 mg/L indicates acute inflammation.
Serum Lipids:
Normal Values:
Total Cholesterol: ____ mg/dL.
LDL (Bad Cholesterol): ____ mg/dL.
HDL (Good Cholesterol): ____mg/dL.
Triglycerides: ____ mg/dL.
Relevance….
Critical Values: LDL _____/dL or total cholestrol ____ mg/dL is high risk for coronary artery disease.
Normal Values:
Total Cholesterol: <200 mg/dL.
LDL (Bad Cholesterol): <100 mg/dL.
HDL (Good Cholesterol): >60 mg/dL.
Triglycerides: <150 mg/dL.
Relevance: Elevated LDL or low HDL increases cardiovascular risk.
Critical Values: LDL >190 mg/dL or total cholesterol >240 mg/dL is high risk for coronary artery disease.
Electrolytes:
Normal Values:
Sodium (Na+)……
Potassium (K+)…
Calcium (Ca2+)…..
Magnesium (Mg2+)….
Relevance: Imbalances can cause arrhythmias and impact heart contractility.
Critical Values….
Electrolytes:
Normal Values:
Sodium (Na+): 135–145 mmol/L.
Potassium (K+): 3.5–5.0 mmol/L.
Calcium (Ca2+): 8.5–10.2 mg/dL.
Magnesium (Mg2+): 1.7–2.2 mg/dL.
Cardiac Enzymes
cTnT; cTnl (Troponin)
Onset, Peak, Duration
4 - 6
18 - 24
Up to 10 days
Cardiac Enzymes
CKMB
Onset, Peak, Duration
4 - 12
18 - 24
36 - 48
Cardiac Enzymes
LDH
Onset, Peak, Duration
6 - 12
24 - 48
6 - 8 days
Cardiac Enzymes
Myoglobin
Onset, Peak, Duration
1 - 2 hrs
8 - 10 hrs
24 hrs
BNP
VALUES
<100
100 - 300
>300
>600
>900
<100: No heart failure
100 - 300: Suggests possible
> 300: Mild HF
> 600: Mod HF
> 900: Severe HF
____ is secreted from the heart when stretched.
BNP
Elevations > 300 mild HF
>600 Mod HF
>900 Severe HF
Difference between 12 & 18 lead ELE cardio testing
18 can detect problems with Right Ventricular & Posterior Myocardial Infarction
Leads are placed on Chest, Arms, Legs
12 / 18 leads can diagnosis… (5)
Key data provided… (5)
Describe basically what it is and used for…
Diagnoses arrhythmias, ischemia, myocardial infarction, electrolyte imbalances, and structural abnormalities.
Data:
Heart rate, rhythm, axis, conduction delays, and ischemic changes (e.g., ST-segment elevation).
medical test that measures the electrical activity of the heart and is a key tool in diagnosing cardiovascular conditions:
Ambulatory ECG (Holter Monitor or Event Recorder) - Difference between them…
Type of data it records…
Holter Monitor: Portable device worn for 24–48 hours - Continuous monitoring
Event Recorder: Weeks - Records only during symptoms- Manuel & Automatic
Data:
Detects intermittent arrhythmias, monitors heart rate variability, and evaluates symptoms like palpitations or dizziness.
Exercise/ Drug induced Stress Test (dobutamine).
Purpose:
Identifies…(4)
Ischemia (Reduced Blood Flow) or
Coronary artery disease that may not be evident at rest.
Advantage: Detects exercise-induced changes such as ST-segment depression or arrhythmias.
Electrophysiologic Study (EPS)
Description….
Purpose:
Diagnoses arrhythmias and identifies their origins.
Evaluates conduction pathways and determines the effectiveness of treatments like ablation.
Procedure…
Invasive procedure uses catheters inserted into blood vessels and guided to the heart to record electrical activity from within.
Procedure
Electrical impulses are delivered to provoke arrhythmias under controlled conditions, allowing mapping of abnormal pathways.
Resting ECG/EKG
Purpose….
Prep:
Procedure….
Post-Procedure Care:
Purpose:
Detects arrhythmias, myocardial infarction, ischemia, and structural heart issues.
Provides a baseline heart electrical activity
Prep:
No specific preparation required.
Avoid heavy meals, caffeine, and smoking before the test to reduce interference.
Wear loose, comfortable clothing.
Procedure:
Electrodes are placed on the chest, arms, and legs.
Patient lies still while the ECG machine records heart activity for a few minutes.
Post procedure
No recovery needed; the test is non-invasive.
Resume normal activities immediately.
Exercise Stress Test
Purpose:
Prep:
Procedure:
Post-Procedure Care:
Purpose:
Evaluates heart function under stress (exercise).
Detects ischemia, arrhythmias, or exercise intolerance.
Prep:
Avoid caffeine, smoking, and heavy meals 2–4 hours before the test.
Wear comfortable exercise clothing and shoes.
Inform the provider of any medications being taken.
Procedure:
Patient walks on a treadmill or pedals a stationary bike with increasing intensity.
ECG, blood pressure, and symptoms are monitored.
Post-Procedure Care:
Rest and rehydrate after the test.
Report any persistent chest pain, dizziness, or discomfort.
Chemical Stress Test
Purpose:
Prep:
Procedure:
Post-Procedure Care:
(Meds withheld?)
Chemical Stress Test
Purpose:
Simulates the effects of exercise on the heart using medication (e.g., dobutamine, adenosine).
Used for patients unable to exercise.
Procedure:
Medication is administered intravenously to stress the heart.
ECG, blood pressure, and symptoms are monitored during the test.
Post-Procedure Care:
Rest after the test.
Monitor for any lingering side effects like headache, nausea, or palpitations.
Prep:
Avoid caffeine, smoking, and heavy meals for at least 4 hours before the test.
Certain medications (like beta-blockers) may need to be withheld—consult your provider.
Ambulatory ECG (Holter Monitor)
Purpose:
Prep:
Procedure:
Post-Procedure Care:
Ambulatory ECG (Holter Monitor)
Purpose:
Monitors heart rhythm continuously for 24–48 hours to detect intermittent arrhythmias or evaluate symptoms like palpitations.
Prep:
Shower before the appointment (as the monitor cannot get wet).
Avoid using lotions or oils on the skin.
Procedure:
Electrodes are attached to the chest and connected to a small recording device worn on the body.
Patient resumes normal daily activities while recording symptoms and activities in a diary.
Post-Procedure Care:
Return the monitor to the healthcare provider for analysis.
Follow up with results and next steps as advised.
Electrophysiologic Study (EPS)
Purpose:
Prep:
Procedure:
Post-Procedure Care:
Description: A catheter is sent to your heart and a Dr. triggers electric induced arythmias to: Determine cause of Arythmias, Determine Trouble with Electrical Pathway, & need for ablation (Creating Scars in the heart to prevent abnormal Arrhythmia)
Purpose:
Diagnoses arrhythmias, evaluates conduction pathways, and determines the need for treatments like ablation or pacemaker implantation.
Prep:
Avoid food and drink for 6–8 hours before the test.
Inform the provider about medications and stop certain drugs as directed.
Arrange for someone to drive you home post-procedure.
Procedure:
Catheters are inserted through veins (e.g., femoral vein) and guided to the heart.
Electrical impulses are delivered to provoke arrhythmias for mapping.
Procedure is performed under local anesthesia and conscience sedation.
Post-Procedure Care:
Monitor puncture site for bleeding or swelling.
Avoid strenuous activity for 24–48 hours.
Report any severe pain, swelling, or fever to the provider.
Evaluates size & posistion of heart
Remove metal jewelry from chest area
Contraction in Preggers.
No aftercare
X ray
Echocardiogram (Echo)
Purpose…
Prep….
Procedure…
Post-Procedure Care…
Contraindications…
Echocardiogram (Echo)
Purpose:
Assesses heart structure, function, and blood flow using Ultrasound
Detects valve disorders, heart failure, or congenital heart defects.
Prep:
No specific preparation for a transthoracic echo.
For transesophageal echo (TEE): Avoid eating or drinking 6 hours before the test.
Procedure:
Transthoracic Echo (TTE): A probe is placed on the chest to capture images.
Transesophageal Echo (TEE): A probe is passed down the esophagus for clearer images.
Takes about 30–60 minutes.
Post-Procedure Care:
For TEE: Avoid eating or drinking until the throat numbing wears off.
Contraindications:
For TEE: Esophageal abnormalities or swallowing difficulties.
Ultrasound (General Cardiovascular Ultrasound)
Purpose:
Prep:
Procedure:
Post-Procedure Care:
Contraindications:
Purpose:
Non-invasive imaging of blood vessels and surrounding tissues.
Evaluates blood flow, blockages, and vessel structure.
Prep:
No specific preparation for most ultrasounds.
For abdominal vessel imaging: Fasting may be required.
Procedure:
A transducer is moved over the skin, emitting sound waves to create images.
Takes 30–60 minutes.
Post-Procedure Care:
No recovery needed; it’s non-invasive.
Contraindications:
None; safe for most patients, including pregnant individuals.
Arteriogram (Angiogram)
Purpose:
Prep…
Procedure:
Post-Procedure Care:
Contraindications:
Purpose:
Visualizes blood flow in arteries to detect blockages, aneurysms, or malformations.
Procedure:
A catheter is inserted into a blood vessel (usually in the groin or arm).
Contrast dye is injected, and X-rays are taken to map blood flow.
Completed in 1–2 hours.
Post-Procedure Care:
Monitor insertion site for bleeding or swelling.
Avoid strenuous activity for 24–48 hours.
Prep:
Avoid eating or drinking for 6–8 hours before the test.
Inform the provider about allergies (especially to contrast dye) or blood-thinning medications.
Contraindications:
Kidney dysfunction (risk from contrast dye).
Severe allergies to contrast dye.
Coronary Arteriogram (Cardiac Catheterization)
Purpose…
Prep…
Procedure:
Post-Procedure Care:
Coronary Arteriogram (Cardiac Catheterization)
Purpose:
Identifies blockages in coronary arteries and evaluates heart function.
Guides interventions like stent placement or angioplasty.
Prep:
Fast for 6–8 hours before the procedure.
Inform the provider about allergies or current medications.
Discontinue blood thinners if instructed.
Procedure:
A catheter is guided through a blood vessel to the coronary arteries.
Contrast dye is injected to visualize blockages.
Completed in 30–60 minutes.
Post-Procedure Care:
Monitor for bleeding at the catheter site.
Lie flat for several hours to reduce bleeding risk.
Report any chest pain, swelling, or difficulty breathing.
Cardiac Catheterization
Dye is injected into…
Coronary arteries
Cardiac Catheterization
Is for Diagnosis & Evacuation of… (4)
Great vessel disease
Coronary artery occlusion
Valvular disease (Stenosis, insufficiency, regurgitation)
Atrial or Ventriclar Septal Defect
Cardiac Catheterization measures which kind of pressure…
Cardiac & Pulmonary
Contradictions for Cardiac Catheterization
Renal insufficiency
Coagulopathy
Fever / Systemic infection
Ventricular instability
Uncompensat3d heart failure
Contrast dye allergies
Pre Cardiac Catheterization
- Consent needed?
- Hold…
- Yes
- Food & Fluids 4 - 6 hrs
Nephrotoxic meds 48hrs - 2 wks
(Metformin? NSAIDs: Ibuprofen, Naproxen
ACE Inhibitors: Lisinopril
ARBs: Losartan
Proton Pump Inhibitors (PPIs): Omeprazole, Pantoprazole
Diuretics: Furosemide (Loop Diuretic), Hydrochlorothiazide (Thiazide)
Anticoagulantion meds maybe with held
Warfarin
Apixaban
Rivaroxaban
Dabigatran
Enoxaparin
Left heart cath
Assess: left sided pressure, mital/ aortic valves, coronary artery circulation
Describe the path of the cath procedure: Femoral, radial, Brachial artery to….
Aorta, across aortic valve, LV,
Coronary angiography
Evaluates which arteries…
RCA Right Coronary Artery: Supplies blood to All Right side, AV & SA node, Left Ventricle Anterior wall.
LCA Left Coronary Artery
Branches:
Left Anterior Descending (LAD): Supplies the front of the left ventricle and the interventricular septum.
Circumflex Artery (LCX): Supplies the left atrium and the outer portion of the left ventricle.
Right heart cath (Evaluates valves & intracardic pressures)
Will enter either of the 2 vena cava.
Which vein allows access to each…
Femoral - Inferior vena cava
Basilic - Superior
Key differences between Right & Left Cardiac Catheterization.
Assess site…
Focus:
Risk Level:
Assess site
Right: Veins (venous system).
Left: Arteries (arterial system).
Focus:
Right: Evaluates pressures and flow on the right side and pulmonary circulation.
Left: Focuses on coronary arteries and left ventricle function.
Risk Level:
Right: Lower risk, less invasive.
Left: Higher risk, involves dye and arterial puncture.
Describe the directional path foe Right Cath
Femoral vein (Inferior vena cava) or
Basilic vein (Superior vena cava)
To…..
RA, RV, PA
Biggest alert post procedure for Cardiac Catheterization…
Resuscitation equipment needed
Ventricular arythmias may occur
How often to monitor VS post procedure cardiac Catheterization…
Q15Min first 1hr
Q30min for next hour
Post cardiac Catheterization
Evaluate…
Peripheral pulse
Skin Color
Temp
Sensation
Post cardiac Catheterization
Ensure to assess this site…
Site for assess for cather
Bleeding
Hematoma
Pseudoaneurysm
After cardiac Catheterization ensure that patient is in semi fowlers position…
Flase
May need to lay flat 1 - 6 hrs
Describe the differences in complications for Rigjt & Left Cardiac Catheterization.
What complications do they have in common…
Right:
Embolus
Vagal Response
Artial Dysrhthmias
Left:
MI
CVA
Ventricular Arrhythmia
Artery bleeding
BOTH:
Tamponade
Hypovolemia
Hematoma
Pseudo aneurysms
Contrast dye reaction
Infection
Death
Contrast induced Nephropathy
Best Prevention (4)
Harmful (2)
Best
ID patient at risk
Hydration
Limit contrast exposure
Withhold Nephrotoxic Meds
Harmful
Furosemide
Haemodialysis
There are also Not Helpful Strategies
Sodium bicarbonate
Ascorbic acid
Acetylcysteine
Statin plus fluid
Amimophylline
Heart sounds
Position the Patient….
A left lateral decubitus position may be used for better auscultation of ….
Position the Patient:
Ensure the patient is in a comfortable position, typically supine or sitting upright.
A left lateral decubitus position may be used for better auscultation of low-pitched sounds (e.g., mitral stenosis).
low-pitched sounds (e.g., mitral stenosis).
Heart sounds
Aortic Valve Area:
Location….
Sound….
Aortic Valve Area:
Location: 2nd ICS, right of the sternum.
Sound: Best for high-pitched sounds like aortic stenosis or regurgitation.
Heart sounds
Pulmonic Valve Area:
Location….
Sound…
Pulmonic Valve Area:
Location: 2nd ICS, left of the sternum.
Sound: Best for pulmonic stenosis or regurgitation.
Heart sounds
Erb’s Point:
Location….
Sound…
Erb’s Point:
Location: 3rd ICS, left of the sternum.
Sound: Good for listening to overall heart sounds and murmurs
Heart sounds
Tricuspid Valve Area
Location….
Sound…..
Location: 4th or 5th ICS, left of the sternum.
Sound: Best for low-pitched murmurs of tricuspid stenosis or regurgitation.
Heart Sounds
Mitral Valve Area (Apical):
Location….
Sound….
Mitral Valve Area (Apical):
Location: 5th ICS, midclavicular line.
Sound: Best for mitral stenosis, regurgitation, and S1 sounds
Heart Sounds
Listen for Specific Sounds:
Normal Heart Sounds… Name
Extra Heart Sounds… name / cause
Murmurs: Graded 1–6 for intensity, caused by turbulent blood flow.
Pericardial Friction Rub: A scratchy sound from pericarditis.
Listen for Specific Sounds:
Normal Heart Sounds: S1 (“lub”) and S2 (“dub”).
Extra Heart Sounds: S3 and S4, often heard in heart failure or stiff ventricles.
Murmurs: Graded 1–6 for intensity, caused by turbulent blood flow.
Pericardial Friction Rub: A scratchy sound from pericarditis.
What procedure uses US waves to visualize cardiac structures & measure ejection Fraction ( Percentage of blood pumped out of ventricles with each contractions- 50 - 70% )
Echocardiogram
Which lab values are used to assess kidney function prior to Cardiac Catheterization?
Why assess kidney function?
BUN
Creatinine
Assess due to the contrast dye needs to be urinated out or else is toxic to kidneys.
Patient posistion after cardiac Catheterization
Flat 4 - 6 hrs after
Preload, Contractility, Afterload
Describe using the balloon analogy
Preload: Refers to the stretchyness of the ballon in relation to the amount of air (blood) that was in it at the End of Filling (Diastole).
Sterling’s law states Preload the more stretch in the ventricles in Diastole the great the contraction during systole (Ejection)
Contractility: Ballons inherit ability to stretch - IS IT DEPENDENT ON PRE / AFTERLOAD
Afterload: The knot in the end of the ballon closing it. Afterload is the force systole must overcome to enter into the aorta
Angiogram & Cardiac Catheterization are closely related but different
Scope:
Broad diagnostic/interventional tool
Imaging test for blood vessels
Purpose
Measures heart function and pressures
Visualizes blood vessel abnormalities
Invasiveness
Involves catheter placement
Performed as part of catheterization
Use of Contrast Dye
Optional depending on purpose
Always involves dye injection
Common Applications
Diagnosing or treating heart disease
Detecting coronary artery blockages
Scope:
Broad diagnostic/interventional tool
Cardiac Catheterization
Imaging test for blood vessels
Angiogram
Purpose
Measures heart function and pressures
Cardiac Catheterization
Visualizes blood vessel abnormalities
Angiogram
Invasiveness
Involves catheter placement
Cardiac Catheterization
Performed as part of catheterization
Angiogram
Use of Contrast Dye
Optional depending on purpose
Cardiac Catheterization
Always involves dye injection
Angiogram
Common Applications
Diagnosing or treating heart disease
Cardiac Catheterization
Detecting coronary artery block
Angiogram
LCA Left Coronary Artery
Branches….
Left Anterior Descending (LAD): Supplies the front of the left ventricle and the interventricular septum.
Circumflex Artery (LCX): Supplies the left atrium and the outer portion of the left ventricle.
What are the two main branches of the left coronary artery in most people? Select all that apply:
A. posterior descending artery
B. left anterior descending artery
C. right marginal branch
D. circumflex artery
B: Left anterior descending artery
D: Circumflex
The left anterior descending artery and circumflex artery are the TWO main branches of the left coronary artery.
Which artery circles around onto the posterior side of the heart and supplies the left atrium and ventricle?
A. right marginal artery
B. posterior descending artery
C. circumflex artery
D. diagonal branches
C: The Circumflex artery wraps around the left coronary artery onto the posterior side of the heart and supplies the left atrium and ventricle.
What structure in the heart does the right marginal artery supply?
A. left atrium
B. right ventricle
C. SA node
D. right atrium
B: Right Marginal Artery supplies the right ventricle & extends to the apex of the heart
What artery supplies the interventricular septum, left ventricular, some of the right ventricle and bundle branches?
A. left anterior descending artery
B. posterior descending artery
C. left marginal branches (obtuse)
D. right marginal artery
A: Left anterior descending artery supplies the interventricular septum, left ventricle, some of the right ventricle and bundle branches in most people.
What artery or branches come off the left anterior descending artery and supply the left ventricle?
A. anterior ventricle branches
B. left marginal branches (obtuse)
C. atrial branches
D. diagonal branches
D: Diagonal branches come off the left anterior descending artery and supply the left ventricle.
What artery can originate from either the right or left coronary artery, is found on the posterior side of the heart, and supplies the AV node in some people along with supplying the right and left ventricle, and the interventricular septum?
A. right marginal artery
B. posterior descending artery
C. circumflex artery
D. left anterior descending artery
The answer is B. The posterior descending artery most commonly arises from the right coronary artery. It supplies the AV node in some people along with supplying the right and left ventricle, and the interventricular septum.
What are the branches that come off of the circumflex artery and supply the left ventricle?
A. right marginal branches
B. diagonal branches
C. right anterior ventricle branches
D. left marginal branches (obtuse)
The answer is D. The left marginal branches (obtuse) come off of the circumflex artery and supply the left ventricle.
The left anterior descending artery is part of the __________ coronary artery.
Right
Left
LEFT
In most people, the posterior descending artery mostly originates from the ___________ coronary artery.
Right
Left
Right
The right anterior ventricle branch is part of the __________ coronary artery.
Right
Left
Right
Left Anterior Descending (Supplies blood where)
Circumflex Artery (Supplies blood where)
WHICH ARTERY DO THEY BOTH COME FROM
LAD Supplies blood to the Anterior Left Ventricle and the interventricular septum.
Critical for maintaining function in the heart’s pumping chambers.
Circumflex
Left Atrium
Posterior & Lateral Left ventricle
Left Coronary Artery LCA
Which artery is aka widow maker
Left Anterior Descending
Blockages can cause Anterior wall mycardio infaction.
Stroke volume is…
The amount of blood ejected by left ventricle in a single contraction
Percentage of blood ejected from the left ventricle with EACH heartbeat compared to the total amount of blood in the ventricle at the end of diastole (filling phase).
Ejection Fraction 55 - 70%
(Electrophysiologic Study (EPS) / Cardiac Catheterization) : Focuses on blood flow and structural issues of the heart.
(Electrophysiologic Study (EPS) /Cardiac Catheterization) : Focuses on the heart’s electrical activity, primarily for diagnosing and managing arrhythmias.
Cardiac Catheterization focus on blood flow and structural issues
Electrophysiologic Study focus on electrical activity- Diagnoses & treats arrhythmias
Name procedure:
Diagnosing coronary artery disease (blockages).
- Performing interventions like stenting or angioplasty.
- Assessing valve function. - Diagnosing arrhythmias.
Name procedure
- Identifying areas for ablation therapy.
- Evaluating syncope or palpitations
Cardiac Catheterization
Diagnosing coronary artery disease (blockages).
- Performing interventions like stenting or angioplasty.
- Assessing valve function. - Diagnosing arrhythmias.
Electrophysiologic Study
- Identifying areas for ablation therapy.
- Evaluating syncope or palpitations
This procedure
Measures electrical signals from the heart
Used to evaluate the following
Diagnosing arrhythmias (e.g., atrial fibrillation, ventricular tachycardia).
Detecting myocardial infarction (heart attack) or ischemia.
Evaluating heart function in conditions like heart failure or cardiomyopathy.
Monitoring treatment effectiveness (e.g., pacemaker, medications).
Pre-operative cardiac risk assessment.
ECG
Echocardiogram measures…
Which structure…
Ejection Fraction.
Total Percent of blood ejected from left ventricle in 1 contraction, in relation to amount of blood in left ventricle after diastole (Filling)
Heart valves Aortic
Normal percentage of ejection Fraction
55 - 70%
Difference between stroke volume & ejection Fraction
Stoke volume: Amount of blood ejected from 1 contraction of the left ventricle. 50 - 100mL
Ejection Fraction: Percent of blood ejected from LV in relation to how much it was filled during diastole
Electrophysiologic Study
What type of problems are they looking for…
Where in the heart is the catheter placement….
What type of treatment that will be given if problem is found….
Electrical problem
Right side with the SA, AV, Bundle of His, Branches, fibers
Ablation
Cardiac Output (CO) measures the volume of blood the heart pumps out in …..
Volume
1 minute
CORRECT
4- 7 L / minute
CO depends on relationship between…
HR & Stroke Volume
Echocardiogram (Echo) OR Electrocardiogram (ECG/EKG)
Purpose Assesses heart structure and function.
Records the electrical activity of the heart.
Focus Provides images of the heart’s chambers, valves, walls, and blood flow.
Monitors heart rhythms and detects electrical abnormalities.
Procedure Uses ultrasound to create detailed images of the heart.
Uses electrodes attached to the skin to measure electrical signals.
Common Uses - Evaluate heart function (e.g., ejection fraction)
- Detect valve diseases, clots, or structural abnormalities
- Assess blood flow in heart and vessels
- Diagnose arrhythmias
- Detect ischemia, heart attack, or conduction disorders
- Monitor heart rhythm over time
Imaging Produces real-time images of the heart (ultrasound).
Does not produce images; outputs a graph of electrical activity.
Invasiveness Non-invasive (or minimally invasive with transesophageal echo).
Non-invasive.
Duration 15–45 minutes.
5–10 minutes.
Outcome Visual and functional assessment of the heart.
Detection of electrical or rhythm abnormalities.
Conditions Diagnosed
- Heart failure
- Valve diseases
- Congenital defects -
-Arrhythmias
- Myocardial infarction
- Heart block
Top = Echocardiogram
Bottom = ECG/EKG
Ejection Fraction is measured by…
Echocardiogram
determined by L ventricular end-diastolic volume (LVEDV)
Preload in Ejection Fraction
Increased preload will have this affect on CO
Increased
CO = Cardiac output
Medications to decrease afterload…
Ace inhibitors & ARBS
Interventions to increase preload….
Legs elevated : increase Venus return
SCD / TED Hose
Meds: Vasoconstrictors Norepinephrine
Positive inotropic drugs
Which valve most affects afterload
Aortic semilunar valve
force of cardiac contraction independent of preload
Contractility
Meds for afterload…
BP meds
ACE INHIBITORS
ARBS
CCB
Diuretics
BB
Increased Afterloads affect on CO
Decreased
Afterload is the force left ventricle must overcome come in the aortic valve to enter the systemic system
Sympathetic NS: Describe Alpha ¹ affects….
Describe its affects on Afterload…
Describe Beta¹ affects (3)
Alpha¹: Causes vasoconstriction of coronary blood vessels, increasing blood pressure and afterload.
Beta¹
Increased Heart Rate (Chronotropy): Stimulates the sinoatrial (SA) node, increasing the rate of depolarization.
Increased Contractility (Inotropy): Enhances the force of contraction in ventricular myocardium.
Increased Conduction Velocity (Dromotropy): Speeds up electrical conduction through the atrioventricular (AV) node.
RAAS
Renin to Angiotensin 1
Angiotensin 1 - Angiotensin II
What Angiotensin II do….
Angiotensin II To Aldosterone
Aldosterone does…
Angiotensin II increases Vasoconstriction (Increased BP)
& Releases Aldosterone
Aldosterone increases sodium & water
Ace inhibitor will lower BP by interference with the RAAS By blocking angiotensin 1 - 2 conversion.
Name SE…
Dry cough
Hyperkalemia
Hypotension
Angioedema Death
Renal Dysfunction
Losartan (Cozaar)
Valsartan (Diovan)
Irbesartan (Avapro)
Olmesartan (Benicar)
Candesartan (Atacand)
Telmisartan (Micardis)
Examples of…
ARBS Medications
( This type of medication ) prevent angiotensin II from binding to its receptor, thus causing blood vessels to relax and widen, which lowers blood pressure.
ARBS
Losartan (Cozaar)
Valsartan (Diovan)
Irbesartan (Avapro)
Olmesartan (Benicar)
Candesartan (Atacand)
Telmisartan (Micardis)
Blood flows to the coronary arteries from the ____, primarily during ____.
Aorta / diastole
Age Related Changes
valves: calcification=
Murmurs ( favor left side)
Age Related
Conduction: SA fibrotic=
increase time, dysrhythmias
Age Related Changes
LV: hypertrophy=
Decreased filling time, Decreased ability to meet demands
Age Related Changes
large arteries: stiff, increase SVR (Systemic Vascular Resistance- Hard to push blood through blood vessels) leads to:
HTN, wide pulse pressure
Age Related Changes
baroreceptors:
Less sensitive, postural and postprandial hypotension
Pulse pressure define
Normal/ Abnormal
Example
Difference between Systolic & Diastolic BP
NORMAL 30 - 40
Wide pulse pressure >40
Aortic regurgitation or arteriosclerosis (stiffening of the arteries).
Narrow pulse pressure <30
Heart failure or significant blood loss.
Can S³ be a normal finding
S3 can be normal in young people e.g. 15 year old)
Common abnormal finding in elderly
aortic murmur
*calcification in 80% of older adults
Define basic
Homocysteine
protein that increases the risk of heart disease
C reactive protein
blood test used to measure the level of inflammation in the body; may indicate conditions that lead to cardiovascular disease
Hypo/Hyperkalemia
EKG
Hypo U waves
Hyper Tall T waves
Mg 1.8 - 2.2
Describe low / high effects
low: dysrhythmias
high: low BP, cardiac arrest
CA 8 - 10
DESCRIBE AFFECT ON THE HEART
Low
Prolonged QT - Torsade de pointe
Decreased contractility
Hypotension
Tetany
High
Shortened QT Ventriclar Arythmias
Increased contractility
Hypertension
Vascular calcification
elevations associated with heart failure
secreted from the heart when stretched *
BNP
Pre Procedure for Cardiac Catheterization (5)
consent
hold: food, oral fluids (4-6 hrs prior)
nephrotoxic meds: 48 hours to 2 weeks prior (metformin and contrast due to kidney injury; lasix also hurt kidneys with contrast)
anticoagulation meds may be withheld
must have IV access
pre-procedure: versed: follow direction; some not remember much from the procedure
Length of time for Cardiac Catheterization
1 - 3 hrs
Left Cardiac Catheterization Flow - Aorta - Aortic valve - Left Ventricle assesses… (3)
left sided pressures
mitral/aortic valves
coronary artery circulation
Biggest concern post cardiac Catheterization
Alert!! ventricular arrhythmias may occur
resuscitation equipment MUST be available
How to detect hematoma post cardiac Catheterization
Feel for it, Not look for it
Right Catheterization complications (3)
embolus
vagal response
atrial dysrhythmias
Left Catheterization Complications
MI
CVA
ventricular dysrhythmias
arterial bleeding
Risk in either side of cardiac Catheterization (6)
tamponade
hypovolemia
hematoma
pseudo aneurysms
contrast dye reaction
infection
death: risk is <1%: 0.1%
Contrast induced Nephrotoxicity
Best prevention…
identify pt at risk
hydration: before and after
limit contrast exposure
withhold nephrotoxic meds: METFORMIN and LASIX
Types of medications given 1 hr before patient goes into the cath lab
Aspirin
Heparin
Versed
BB
Nitroglycerin
Type of echocardiogram used to identify disease of the mitral valve, left atrium, or aortic arch…
Transesophageal
Heart is incapable of maintaining a CO adequate to accommodate metabolic requirements and the venous return
NOT a disease; unable to pump to meet body’s needs
Heart failure
heart failure: muscle works harder
(What happens to the heart muscle), stretched out, exhausted
apoptosis: cells die
CO: decreased
hypertrophy
1/3 of the time is systolic (contracting), 2/3 diastole (relaxing)
T or F
T
Formula for CO (Cardiac output)
HR × Stroke Volume
Stretch receptors on the vena cava and right atrium do what..
sense decrease volume
Type of medication that works on the RAAS system
Caution….
ACE INHIBITORS -Pril
ARBS- Sartin
Aldosterone blocker
CANT GIVE MORE THAN 1 AT A TIME
Which of the following is not a Beta1 response?
-Increased heart rate
-Stronger contractility
-Faster conduction
-Vasoconstriction
-Vasoconstriction
This is Alpha ¹
Sclera (Xanthelasma)=
yellow spots (cholesterol build up) on the eyes
edema- (this side) heart failure
Right
PMI (Apical Pulse)
Location
Potential problems…
5th intercostal space, mid-clavicular line; if it shifts to the left, indicates left ventricular hypertrophy (enlarged)=> Heart failure
Heart Sounds
S1- closure of tricuspid and mitral (AV) valves
Best heard…
Best heard: At the apex of the heart (left 5th intercostal space, midclavicular line).
Stethoscope: Use the diaphragm.
Closure of tricuspid & mitral valve
Best heard: At the apex of the heart (left 5th intercostal space, midclavicular line).
Stethoscope: Use the diaphragm.
Name heart sound
S¹
Closure of the aortic and pulmonary valves at the beginning of diastole.
Aortic area: Right 2nd intercostal space, near the sternum.
Pulmonic area: Left 2nd intercostal space, near the sternum.
Stethoscope: Use the diaphragm.
Name heart sounds
S2
S2
Closure of the aortic and pulmonary valves at the beginning of diastole.
Best heard….
At the base of the heart, particularly at the:
Aortic area: Right 2nd intercostal space, near the sternum.
Pulmonic area: Left 2nd intercostal space, near the sternum.
Stethoscope: Use the diaphragm.
A low-frequency sound occurring during early diastole due to rapid ventricular filling.
Often associated with volume overload or heart failure.
Best heard: At the apex, with the patient lying in the left lateral decubitus position.
Stethoscope: Use the bell (low-pitched sound).
Name heart sound…
S3
S3
What it is: A low-frequency sound occurring during early diastole due to rapid ventricular filling. Often associated with volume overload or heart failure.
Best heard…..
At the apex 5th IC Midclavicular line with the patient lying in the left lateral decubitus position.
Stethoscope: Use the bell (low-pitched sound).
A low-frequency sound occurring during late diastole due to atrial contraction against a stiff or non-compliant ventricle (e.g., in left ventricular hypertrophy or hypertension).
Best heard: At the apex, with the patient in the left lateral decubitus position.
Stethoscope: Use the bell (low-pitched sound).
Name heart sound…
S4
S4 What it is: A low-frequency sound occurring during late diastole due to atrial contraction against a stiff or non-compliant ventricle (e.g., in left ventricular hypertrophy or hypertension).
Best heard….
At the apex, with the patient in the left lateral decubitus position.
Stethoscope: Use the bell (low-pitched sound).
Tips for listening to heart sounds
Position the patient appropriately:
____ for S1 and S2.
_______ for S3 and S4.
Use light pressure with the bell for low-pitched sounds (____)
firm pressure with the diaphragm for high-pitched sounds (_____).
Supine
Light pressure & bell S3 & 4
Firm pressure & diaphragm S1 & 2
Indicates the closure of the mitral and tricuspid valves at the start of systole.
Common Associations:
Loud: Mitral stenosis, tachycardia.
Soft: Mitral regurgitation, heart block.
Name Sound & Nickname
S1 Lub
Represents the closure of the aortic and pulmonary valves at the start of diastole.
Common Associations:
Split: Can be physiological or pathological (e.g., pulmonary hypertension, right bundle branch block).
Accentuated: Hypertension (aortic or pulmonary).
Name sound & Nickname
S2 & Dub
Clinical Significance:
Normal in children, young adults, and athletes.
Pathological in adults over 40, typically indicating heart failure or volume overload (e.g., dilated cardiomyopathy).
S3 lub-dub-ta, Ventriclar gallop
Clinical Significance:
Always abnormal, indicating a stiff or non-compliant ventricle (e.g., left ventricular hypertrophy, hypertension, aortic stenosis
Name sound amd nickname
S4 ta-lub-dub Atrial Gallop
common assessment finding in the older adult is…
-Decreased ventricular size
-Leg edema
-Postprandial hypertension
-Aortic murmur
Aortic murmur
K- low-> arrhythmia,
high-> slow conduction/electrical,
K will not correct….
Low = arrhythmia
High = slow conduction / electrical
If Mg is low, Correct Mg first then L
Ca- low-> …
High->…..
Low: Arrhythmia
High: block, slowing down of electrical activity
Mg- low-> …
High -> …
Low: arrhythmia
High: hypotension/cardiac arrest
Direct injuries involve bleeding at the puncture site
-Arterial dissection
-Vasovagal response-hypotension, decrease HR, decrease BP
-Renal, cardiac, or neurological complications
-Allergic reaction to dye- radioactive contrast, can cause kidney damage
Risks for…
Angiography Risks
Great vessel disease
-Coronary artery occlusion
-Valvular disease ( stenosis, insufficiency, or regurgitation)
-Atrial or ventricular septal defects
Measurement of cardiac and pulmonary pressures
Indications for…
Cardiac Catheterization
Contradictions for Cardiac Catheterization (6)
Renal insufficiency-pretreatment necessary to prevent further injury
-Coagulopathy-can give vitamin K
-Fever or systemic infection
-Ventricular irritability
-Uncompensated heart failure
-Contrast dye allergies-pretreatment
Renal insufficiency-pretreatment necessary to prevent further injury
-Coagulopathy-can give vitamin K
-Fever or systemic infection
-Ventricular irritability
-Uncompensated heart failure
-Contrast dye allergies-pretreatment
Contradictions for…
Cardiac Catheterization
AFib and PVC’s
Good candidates for this procedure…
Electrophysiologic Study
Used to assess peripheral vessel perfusion
-Pulses or sounds are evaluated to assess
Doppler
Used to:
-Size of ventricles, wall motion
-For valve conditions, estimate EF
2 types
Only 1 has these precautions..
-Trans esophageal echocardiography-
*Must be NPO, can look at the top part of the heart, atrium, aorta. Have to be under anesthesia so check gag reflex post-procedure.
***Best test to look at valves
**Noninvasive to measure EF
Technetium Pyrophosphate Scan
(technetium scan)
-Isotope accumulates in damaged myocardial tissue
-Hotspot
Thallium Imaging
-Stress test and then Thallium injected
-Scan to assess myocardial perfusion
-Cold spot-goes to healthy tissue
Are this type of test…
Used for…
Myocardial Nuclear Perfusion Imaging
Myocardial Perfusion Imaging (MPI) is primarily used to diagnose and assess coronary artery disease (CAD), evaluate chest pain, determine heart function, and guide treatment decisions. It is a critical tool in preventing heart attacks and improving cardiovascular outcomes.
Stress test and then ____ injected
Thallium
Examples:
Lisinopril
Enalapril
Captopril
Ramipril
Benazepril
Common Uses….
ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors)
These medications lower blood pressure by blocking the conversion of angiotensin I to angiotensin II, a vasoconstrictor.
Common Uses:
Hypertension
Heart failure
Post-myocardial infarction
Chronic kidney disease
Examples:
Metoprolol (selective beta-1 blocker)
Atenolol (selective beta-1 blocker)
Propranolol (non-selective beta blocker)
Carvedilol (non-selective beta blocker with alpha-blocking activity)
Bisoprolol
Common Uses…..
Beta-Blockers
These drugs reduce heart rate, blood pressure, and myocardial oxygen demand by blocking beta-adrenergic receptors.
Common Uses:
Hypertension
Angina and coronary artery disease
Heart failure (specific beta-blockers like metoprolol, carvedilol)
Atrial fibrillation (rate control)
Post-myocardial infarction
Migraine prevention (propranolol)
Examples:
Dihydropyridines (Primarily Vasodilators):
Amlodipine
Nifedipine
Felodipine
Non-Dihydropyridines (Cardioselective):
Verapamil
Diltiazem
Calcium Channel Blockers (CCBs)
These medications inhibit calcium influx into vascular smooth muscle and cardiac cells, leading to vasodilation and reduced cardiac workload.
Common Uses:
Hypertension (dihydropyridines like amlodipine)
Angina (both classes)
Atrial fibrillation or flutter (non-dihydropyridines like diltiazem, verapamil for rate control)
Raynaud’s phenomenon (dihydropyridines)
Why will a fib take beta blockers…
To control rate
Which coronary cath is looking for breathing issues
Right / Left
Right
What happens if patient talks during ECG
Invalid
Causes Errors / Artifacts
Pre procedure instructions for Stress Tests (3)
No beta blockers
NPO 4 - 8 hrs
No caffeine
Uncompensated heart failure
Take these meds
Diuretics (e.g., Furosemide): Reduce fluid overload, preload, and pulmonary congestion. Monitor electrolytes and renal function.
Vasodilators (e.g., Nitroglycerin): Lower preload and afterload, improve cardiac output. Watch for hypotension.
Inotropes (e.g., Dobutamine): Enhance contractility and cardiac output in severe cases. Monitor for arrhythmias.
Anticoagulants (e.g., Heparin): Prevent clot formation.
Beta-Blockers (e.g., Metoprolol): Reduce heart rate and oxygen demand if stable; avoid in shock.
ACE Inhibitors/ARBs (e.g., Lisinopril): Decrease afterload if stable; avoid in kidney injury or hyperkalemia.
Nursing Tips: Ensure stability, monitor vitals and fluid status, and educate the patient on pre-procedure care.
