Week 2 (exam 2) Flashcards
Cardiac
Heart failure
- The inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients
- A syndrome characterized by fluid overload or inadequate tissue perfusion
- The term heart failure indicates myocardial disease, in which there is a problem
with the contraction of the heart (systolic failure) or filling of the heart (diastolic
failure). - Some cases are reversible.
- Most HF is a progressive, lifelong disorder managed with lifestyle changes and
medications.
Clinical manifestations of RIGHT sided heart failure
Viscera and peripheral
congestion
Jugular venous distention
(JVD)
Dependent edema
Hepatomegaly
Ascites
Weight gain
Clinical manifestations of LEFT sided heart failure
Pulmonary congestion,
crackles
S3 or “ventricular gallop”
Dyspnea on exertion (DOE)
Orthopnea
Dry, nonproductive cough
initially (possibly coughing up. blood)
Oliguria
Cyanosis
Increased RR
Elevated pulmonary capillary wedge pressure
Medical Management of HF: Medication
Angiotensin-converting enzyme inhibitors
Angiotensin II receptor blockers
Beta-blockers
Diuretics
Digitalis
Intravenous infusions
-Dobutamine
-Milrinone
Other medications
- Hydralazine
- Isosorbide
medical management of HF includes
Nutritional therapy
- Following a low sodium (no more than 2 g/day) diet and avoiding excessive fluid intake
(p.803)
Supplemental O2
ICD
Cardiac resynchronization therapy
Elevate HOB
Acronym for congestive HF
Up-right position
Nitrates
Lasix
Oxygen
Ace Inhibitors
Digoxin
Fluids
Afterload decreases
Sodium restriction
Test (dig levels, ABGs, and Potassium levels)
HF complications
Pulmonary edema
Cariogenic shock
Thromboembolism
Pericardial Effusion and Cardiac Tamponade
Pulmonary edema manifestations
- Pink frothy sputum
- SOB / difficulty breathing
- crackly lungs
Pulmonary edema assessments and diagnostics
- listen to lungs
- are they having difficulty maintaining O2 status
- chest x-ray
Pulmonary edema prevention
- Diuretics (in-between giving blood)
- sit them up in bed
- have them dangle their feet
Pulmonary edema medical management
O2 therapy (non-rebreather, oxy mask, BiPap)
Diuretics
Vasodilators
both diuretic and vasodilator will impact blood pressure
Patho of cariogenic shock
Cardiac output is compromised → BP falls and tissue profusion is decreased → Blood supply for tissues and organs and for the heart muscle itself is inadequate → this impaired tissue profusion weakens the heart and impairs its ability to pump → the ventricle does not fully eject its volume of blood during systole → fluid accumulates in the lungs
this can occur suddenly or over a period of days
(p. 287)
Intra-Aortic Ballon Pump
If cardiac output does not improve, the IABP is a catheter with an inflatable balloon at the end. The catheter is usually inserted through the femoral artery and threaded toward the heart, and the balloon is positioned in the descending thoracic aorta. It inflates during diastole, and deflates just before systole.
(p. 289)
Takes workload off the heart
Cardiac Tamponade
Compression of the heart resulting from fluid or blood within the pericardial sac
- looks like RHF
- muffles heart sounds
- Hypotensive
- Diastolic and systolic BP get closer together
DX: echo
Tx: pericardialcentesis or pericardial window
Medications Used in
Cardiopulmonary
Resuscitation
Epinephrine
Vasopressin
Norepinephrine
Dopamine
Atropine
Amiodarone
Sodium bicarbonate
Magnesium
Acute coronary artery syndrome
Myocardial Infarction
Factors affecting heart rate
Autonomic intervention (medications, lifestyle changes, and wearing compression garments)
Hormones
Fitness level
Age
Factors affecting stroke volume
Heart size
Fitness level
Gender
Contractility
Duration of contractility
Preload
Afterload
Stroke volume = ___________ - _____________
End Diastolic Volume - End Systolic Volume
Invasive modalities of Hemodynamics monitoring ANDDDD possible complications
CVP
Pulmonary Artery Pressure (Swan Ganz catheter)
Intra-arterial pressure
Infection
pneumothorax
Ari embolism
Minimally invasive hemodynamics monitoring devices
Pulse Pressure Analysis
Esophageal Doppler
Probes
Fick Principle
Central venous pressure shows the…
normal pressure is…
pressure of the right atrium, normal pressure is 2-6
if it is above 6 they have fluid volume overload
if it is below 2 they have fluid volume deficit
Pulmonary Artery Catheter
Sits in the pulmonary artery and provides pulmonary artery pressure and wedge pressure.
Shows Left Ventricle function
Normal range is 15-25/8-15
Pulmonary Artery Occlusion pressure normal is (PAOP)
8-12
An increase in PAP (pulmonary arterial pressure) indicates what?
A decrease in left sided heart function
Treatment for Increased PAP
Dolbutomine and diuretics
Tx for decreased PAP
Fluids, vasopressors
Dythrhythmias
disorders or the formation, conduction, or both of the electrical impulses in the heart
they can cause disturbances of rate rhythm or both
can alter blood flow and cause hemodynamics changes
diagnosed by EKG
Potential complications/collaborative problems of dysrhythmias
Cardiac arrest
Heart failure
Thromboembolic
event, especially
with atrial
fibrillation
Cardioversion and defibrillation
Treat tachydysrhythmias by delivering an
electrical current that depolarizes a critical
mass of myocardial cells. When cells
repolarize, the sinus node is usually able
to recapture its role as heart pacemaker.
In cardioversion, the current delivery is
synchronized with the patient’s ECG.
In defibrillation, the current delivery is
unsynchronized.
Possible complication of pacemaker use
Infection
Bleeding or hematoma formation
Dislocation of the lead
Skeletal muscle or phrenic nerve stimulation
Cardiac tamponade
Pacemaker malfunction
get chest x-ray to make sure leads are placed in the correct spot
Invasive methods to diagnose and treat recurrent dysrhythmias
Electrophysiological
studies
Cardiac conduction
surgery
Maze procedure
Catheter ablation
therapy
Electrophysiological
studies
cardiac catheter that assesses the function or dysfunction of the SA and AV nodal areas and identifies the location of the conduction issue
Maze procedure
open heart surgical procedure for refractory atrial fibrillation.
Because the procedure requires significant time and cardiopulmonary bypass, its use is reserved only for those patients undergoing cardiac surgery for another reason
Catheter ablation
therapy
Catheter ablation destroys specific cells that are the cause of a tachyarrhythmia
Cariogenic shock
occurs when the heart’s ability to contract and to pump blood is impaired and the supply of oxygen is inadequate for the heart and the tissues. fluid accumulated in the lungs
Cariogenic shock symptoms
angina pain
arrhythmias
fatigue
feelings of doom
signs of hemodynamics instability
(P.287)
Cardiac Tamponade
compression of the heart resulting from fluid or blood within the pericardial sac
pericardiocentesis can be done to treat
Causes of cardiac arrest can be
MI
Arrythmias
Progressive bradycardia
Hypothermia
Medication overdose
Pulmonary Embolism
Hyperkalemia
Sever Hypoxia
Signs of cardiac arrest
Unresponsive, no pulse, no breathing
Agents for cardiac arrest
Epinephrine
Vasopressin
Norepinephrine
Dopamine
Atropine
Amiodarone
Sodium bicarbonate
Magnesium Sulfate
Treatment of Acute Coronary Syndrome(MI)
Nitro
Aspirin/Plavix (if you can’t give nitro due to low BP)
Morphine/Fentanyl
Oxygen (only if O2 sat below 94%)
Anticoagulants
Beta Blockers (within 24 hours)
PCI (60 min door to balloon)
Thrombolytic agents (30 min door to needle)
Three zones of damage with Acute Coronary Syndrome(MI)
Infarction, injury, ischemia
aortic valve is best heard…
at the second intercostal space to the right of the sternal boarder
Pulmonic valve is best heard…
over the second intercostal space to the left of the sternal border
Tricuspid valve is heard over…
the 5th intercostal space to the lower left sternal border
Mitral valve is heard over…
Apex, 5th intercostal space
Infarction
MI, cells are dead
beyond hope of recovering those cells but you can attempt to stop the spread of necrosis
Injury
Some recovery is possible
can still perfuse and restore it to become viable
Ischemia
Full recovery is possible
Valvular Stenosis
Valvular Regurgitation
Valvular Prolapse
Stenosis - narrowing of the vessel blood will become backed up (LHF)
Regurgitation- backwards flow of blood (can be result of a prolapse)
Prolapse - Leaflets do not close properly allowing blood to flow backwards
Dilated cardiomyopathy
most common – ventricles enlarge and weaken and it primarily effect systolic function
Hypertrophic cardiomyopathy
ventricles and septum enlarge and thicken which effects diastolic function and also restricts blood outflow
Restrictive cardiomyopathy
ventricles become stiff and rigid which restricts filling during diastole
S&S of cardiomyopathy
SOB
Fatigue
Dizziness
Arrthmias
Murmurs
Dx for cardiomyopathy
Echo
EKG
Chest MRI
Chest X-Ray
Medications given for cardiomyopathy
Diuretics
Digoxin
Antidysrhythmic agents
Antihypertensive agents
Procedures done for cardiomyopathy
Procedures
Septal myectoy –part of heart muscle is removed
Septal ablation
Pacemake or LVAD
Heart transplant
Abdominal aortic aneurysm S&S
Abdominal or back flank pain
Pulsating abdominal mass (bruit over the area as well)
Do not palpate the area
Thoracic aortic aneurysm S&S
Severe back or chest pain
SOB
Difficulty swallowing and a cough
