the cardiovascular system delivers oxygenated blood to
tissues
the cardiovascular system delivers deoxygenated blood to
heart
when are some times that cardiac output will increase?
- exercise (decreases with rest)
- fever
- other increases in metabolic demands
what makes up the vascular system?
- venous system
- arterial system
- capillary bed
what are the functions of the vascular system?
- oxygen delivery to tissues
- removal of cellular waste
- return of volume to R heart
- return of lymph fluid to general circulation
arteries carry oxygenated blood, except the
pulmonary artery
veins carry deoxygenated blood, except the
pulmonary vein
workhorse of the vascular system?
capillary bed
the amount of blood ejected from the left heart
cardiac output (CO)
what is delivered to the tissues and what is removed in the capillary bed?
- O2 and nutrients are delivered to the tissues
- cellular waste is removed
what is the blood flow through a capillary bed?
artery to arteriole to metarteriole into the capillary
what controls the blood flow through the capillary bed?
precapillary sphincter
what are the layers of the heart?
- epicardium
- myocardium
- endocardium
the thin outer layer of the heart that is continuous with the inner layer of the pericardial sac
epicardium
thick middle layer of the heart that is the muscular layer responsible for the mechanical, contractile function of the heart
myocardium
thin inner layer of the heart that is continuous with the inner layer, or endothelium, of the blood vessels
endocardium
what are the chambers of the heart?
- right atria
- left atria
- right ventricle
- left ventricle
which side of the heart has deoxygenated blood?
right
which side of the heart has oxygenated blood?
left
the heart needs valves to facilitate:
one-way flow
there are ______________ between the atria and ventricles on the right and left
atrioventricular (AV) valves
the AV valve between the R atrium and ventricle
tricuspid valve
the AV valve between the L atrium and ventricle
bicuspid, or mitral valve
during diastole, the AV valves are
open: allowing blood to flow into the ventricles
valves present between the ventricles and their respective arteries
semilunar valves: pulmonary and aortic
the pulmonary valve is located between the
R ventricle and pulmonary artery
the aortic valve is located between the
L ventricle and aorta
What is the composition of the heart?
A. Four chambers with four valves that control flow through the heart and lungs through changes in pressure
B. Four chambers and four valves that control flow through the heart and lungs through changes in oxygen levels
C. Two chambers on the right receiving blood from the high-pressure venous system and two chambers on the left sending blood into the low-pressure arterial system
D. Two chambers on the right receiving oxygenated blood from the venous system and two chambers on the left receiving deoxygenated blood from the pulmonary circuit
A
what is the blood flow through the heart?
- body
- vena cava
- R atrium
- tricuspid valve
- R ventricle
- pulmonary valve
- pulmonary artery
- lungs
- pulmonary veins
- L atrium
- mitral/bicuspid valve
- L ventricle
- aortic valve
- aorta
- body
what are the major vessels that supply blood to the heart?
left and right coronary arteries
if the left coronary artery (LCA) is clogged, it is called
widow maker
table 28.1
...
if the right coronary artery is clogged, you will have problems with?
heart rate
the normal pacemaker that has an inherent rate of 60 to 100 beats per minute
sinoatrial (SA) node
in the absence of an impulse from the SA node, the ____________ can generate impulses at rates of 40 to 60 bpm
atrioventricular (AV) node
the cells of the cardiac electrical conduction system that generate and conduct the action potential follow this pathway:
- SA node fires
- impulse spreads through atrial myocardium
- impulse travels to the AV node
- impulse leaves the AV node through the bundle of His
- impulse travels through the bundle branches (L and R)
- impulse extends into the ventricular tissue through the Purkinje fibers
what happens with the impulse at the Purkinje fibers?
fibers extend the impulse into the ventricular tissue, facilitating ventricular contraction
if the SA and AV nodes fail, _____________ can generate impulses at a rate of 20 to 40 bpm
ventricular cells
process in which the membrane potential changes or goes up and down in a consistent pattern
cardiac action potential
difference in charge between the interior and exterior of the cell
membrane potential
movement of ions preceding and facilitating cardiac mechanical contraction
depolarization
movement of ions back to the resting state to allow for the initiation of another action potential
repolarization
occurs during and immediately following depolarization; during this time, the cell is unresponsive to any stimulus
absolute refractory period
immediately following the absolute refractory period is the
relative refractory period
represents a time when a greater-than-normal stimulus may initiate an impulse
relative refractory period
steps of the action potential?
- opening of Na+ channels -> depolarization
- initial repolarization
- influx of Ca+, outflow of K+ -> plateau state
- closed Ca+ channels and outflow of K+ -> repolarization
- return to resting membrane potential
waveforms can be amplified and viewed on a paper tracing called
electrocardiogram (ECG)
what are the parts of an ECG?
- P wave
- PR interval
- PR segment
- QRS complex
- QRS interval
- T wave
- QT interval
the P wave corresponds to
atrial depolarization
the PR interval is from the beginning of the _________ to the beginning of the ______
from the beginning of the p wave to the beginning of the QRS complex (size measurement)
what does the PR interval reflect?
time required for atrial depolarization and the delay of the impulse at the AV node (time measurement)
the PR segment is the time immediately following _______ to beginning of ______
immediately following P wave to beginning of QRS
the QRS complex corresponds to
ventricular depolarization
ventricular contraction occurs after the ______ in the ________
occurs after the QRS complex in the ST segment
the QRS interval reflects the time required for
ventricular depolarization
the T wave corresponds to
ventricular repolarization
the QT interval reflects time required for _______ and ______
ventricular depolarization and repolarization
Which is true of the electrical conduction system of the heart?
A. It is primarily controlled by the movement of uncharged ions
B. It has a positive resting membrane potential
C. It is reflected in the waveforms on the electrocardiogram
D. It requires cells that respond only to a stimulus from the autonomic nervous system
C.
ventricular relaxation (filling of ventricles is first 2/3 of cycle)
diastole
ventricular contraction (ejection of blood from the ventricles, last 1/3 of cycle)
systole
reflection of the pressure generated during the cardiac cycle; represent the force exerted against the vessel wall by blood flow
blood pressure
how is cardiac output calculated?
heart rate X stroke volume
amount of blood ejected with each ventricular contraction
stroke volume
stroke volume is affected by what 3 variables?
- preload
- afterload
- contractility
amount of blood in the ventricles at the end of diastole; also refers to the amount of stretch of the muscle tissue at the end of filling
preload
resistance to flow the ventricle must overcome to open the semilunar valves and eject its contents
afterload
refers to the force of the mechanical contraction
contractility
contractility decreases in the face of
- hypoxia
- acidosis
A patient with hypertension has which physical symptom?
A. Decreased resistance, which may increase CO
B. Increased resistance, which may decrease CO
C. Increased resistance, which may increase CO
Decreased resistance, which may decrease CO
B
what are some risk factors for cardiovascular disease (CVD)?
- family hx
- DM
- chronic renal disease
- HTN
- dyslipidemia
- weight
- diet
- alcohol consumption
- smoking hx
- age
- sex
- ethnicity
closing of the AV valves; signifies the beginning of the ventricular systole
S1
closing of the semilunar valves; signifies the beginning of diastole
S2
what is the cause of the S1 heart sound?
closure of AV valves
what is the description of the S1 heart sound?
lubb
what is the cause of the S2 heart sound?
closure of semilunar valaves
what is the description of the S2 heart sound?
dubb
what is the cause of a systolic murmur?
valvular dz such as aortic stenosis
what is the description of the systolic murmur sound?
turbulent flow heart
when do we hear the systolic murmur?
systole between S1 and S2
what is the cause of a diastolic murmur?
valvular dz such as aortic or pulmonic regurgitation
what is the description of a diastolic murmur?
turbulent flow heard
when do we hear a diastolic murmur?
diastole after S2
what is the cause of a friction rub?
pericarditis
what is the description of friction rub?
harsh, scratching sound
when do we hear a friction rub sound?
anywhere during the cardiac cycle
where is the aortic point?
R 2nd ICS
where is the pulmonic point?
L 2nd ICS
where is Erb's point?
L 3rd ICS
where is the tricuspid point?
L 4th ICS
where is the mitral point?
L 5th ICS/midclavicular line
A nurse is providing care for a patient newly diagnosed with heart disease. Which dietary, activity, or lifestyle modification(s) should be included in the plan of care? (Select all that apply).
A. Stopping smoking
B. Drinking lots of water
C. Limiting sedentary lifestyle
D. Eating a diet rich in red meat and protein
E. Limiting alcohol intake
A, C, and E
auscultation of _______, ________, or ______ in the lung fields indicates the presence of fluid
- rales
- rhonchi
- rubs
a lipid panel includes?
- total cholesterol
- LDL (low-density lipoprotein)
- HDL (high-density lipoprotein)
- triglyceride
normal value for LDL?
less than 100
normal value for cholesterol?
<200
normal value for HDL?
>40-60
normal value for triglycerides?
<150
what are the markers of heart disease?
- CK-MB
- trop
- myoglobin
- BNP (brain natriuretic peptide)
normal value for CK-MB?
0-3
normal value for trop?
less than 0.4
normal value for BNP?
<100
general marker of cellular injury
creatine kinase (CK)
preferred method for diagnosing cardiac injury
trop
released from overstretched ventricular tissue
BNP
what does a CXR tell us in regards to heart disease?
CXR cannot diagnose heart disease but can highlight complications such as cardiac enlargement
uses US to provide information on the size and pumping function of the heart, blood-volume status, and valve function and integrity
echocardiography
is done to evaluate heart functioning during time of increased workload
cardiac stress test
what is the alternate form of cardiac stress test done in which the radioisotope becomes bound to damaged tissue, creating "hot spots"
isotope (nuclear) stress test
invasive x-ray procedure during which a radiopaque catheter is advanced through an artery or vein to the heart under fluoroscopy in order to evaluate cardiac filling pressures, CO, and valvular function
cardiac catheterization
primary reason cardiac catheterization is performed
coronary angiography
What is the most likely procedure to determine the cause of severe chest pain in the patient newly admitted to the hospital?
A. Coronary angiography
B. Nuclear stress testing
C. Right heart catheterization
D. TEE
A
What is an important nursing action following a cardiac catheterization intervention?
A. Early mobilization to prevent clot formation
B. Fluid restriction to avoid fluid overload
C. Bedrest to avoid stress on cannula insertion site
D. Head of bed at 30 degrees for respiratory support
C.
Physical deconditioning with age leads to:
- atrophy of L ventricle
- decreased elasticity of the aorta
- rigidity of valves
what can happen to the heart valves with age?
stenosis
what can happen to the arterial walls with age?
narrow
the conduction system begins with the
SA node
the conduction system gives us waveforms which are:
- P wave
- QRS complex
- T wave
what are some risk factors for dysrhythmias?
- age
- MI
- HTN
- heart valve dz
- heart failure
- cardiomyopathy (CM)
- infections
- DM
- sleep apnea
- heart surgery
- electrolyte disturbances
- recreational drug use such as cocaine, alcohol, or tobacco
- medication toxicity such as dig toxicity
disruptions in the cardiac conduction pathway or disorders of the electrical impulse conduction within the heart
dysrhythmias
what are some clinical manifestations of dysrhythmias?
- palpitation
- hypotension
- diaphoresis
- shortness of breath
- syncope
- weakness
- faitgue
As the nurse, you know that the following can cause rhythm disorders: (Select all that apply.)
A. Exercise
B. Electrolyte imbalances
C. Myocardial hypertrophy
D. Myocardial damage
E. Eating red meat
B, C, and D
the height of the boxes on an ECG represent?
amplitude (each little box = 1mm)
the small boxes on an ECG are _____ sec
0.04
the bigger boxes on an ECG are ____sec
0.2
15 of the bigger boxes is _______ sec
3
list the waveforms in order as they normally appear on the ECG:
- P wave
- QRS complex
- T wave
- U wave
the P wave represents the SA node sending out an electrical impulse and represents
atrial depolarization
the QRS complex represents
ventricular depolarization
the T wave represents
ventricular repolarization
the U wave represents
Purkinje fiber repolarization & is rarely seen
measure the amount of time it takes for the impulse to travel from one waveform to the next
intervals
what are the different intervals?
- PR interval
- QRS interval
- QT interval
measure of time it takes an electrical impulse to depolarize the atria and travel to the ventricles
PR interval
measure of time to depolarize the ventricles
QRS interval
measure of time that it takes the ventricle to depolarize and then repolarize
QT interval
to measure the PR interval, start from the ____________ and count the number of small boxes to the beginning of the _________
start from the beginning of the P wave to the beginning of the QRS complex
the normal PR interval is from _______ to ______ in length
0.12 (3 small boxes) to 0.2 (five small boxes) sec
the QRS interval is measured from where to where?
from where the QRS complex waveform leaves the baseline to where the QRS returns to the baseline
the normal interval for QRS interval is
0.06 to 0.1 sec
to measure a QT interval start where and measure to where?
start where the QRS leaves baseline and measure to where the T wave returns to baseline
the QT interval is ______ dependent
heart rate
the QT interval should never be more than?
half the distance from one QRS to the next
a normal QT is usually less than or equal to
0.52 sec
steps in ECG interpretation?
- is the rate fast, slow, or normal?
- is the rhythm regular? (same space between QRS)
- are there P waves present?
- are there QRS complexes present?
- are there T waves present?
- are the intervals within normal limits?
- is there a P wave before every QRS?
- is there are QRS after every P wave?
6 seconds on an ECG equals ______ boxes
30 large
regularity can be determined by counting?
the waveforms being measured, such as P wave (P to P) or QRS complex to QRS complex (R to R)
determining the regularity on an ECG can also be called?
marching out the waveforms
As the nurse caring for a patient on a cardiac monitor, you understand that which of the following steps are necessary to correctly identify the rhythm? (Select all that apply.)
A. Determine the rate
B. Determine the regularity
C. Determine if there is a QRS for every P wave
D. Determine if there is a P wave for every QRS
E. Determine if there is a U wave for every QRS
A, B, C, and D
regular rhythm that has the same characteristics as NSR except the HR is <60bpm
sinus bradycardia
what are some causes of sinus bradycardia?
- hypoxia
- hypothermia
- medication
when do we treat dysrhythmias?
if the patient is symptomatic
how do we treat sinus bradycardia if the pt is symptomatic?
atropine (0.5mg IVP)
regular rhythm that has the same characteristics as NSR except the HR is greater than 100 bpm
sinus tachycardia (ST)
what are some causes of ST?
- fever
- anemia
- hypovolemia
- hypotension
- pulmonary embolism (PE)
- MI
treatment for ST?
treatment depends on the cause, but could be:
- beta blockers
- calcium channel blockers
non-life-threatening dysrhythmias that can be seen in NSR
premature atrial contractions (PACs)
in a premature atrial contraction, what has happened with a pacemaker cell?
a pacemaker cell close to the SA node fires earlier than expected
what are some causes of PACs?
- hypoxia
- excessive stimulant ingestion
- infection
- dig toxicity
- CAD
treatment for PACs?
- monitor frequency
- eliminate cause
has no P waves; best described as multiple pacemaker cells generating independent electrical impulses and causing chaos within the atria; characterized as irregularly irregular
atrial fibrillation (AF)
what are some causes of a-fib?
- age
- cardiomyopathy
- pericarditis
- hyperthyroidism
- HTN
- valvular disease
- obesity
- diabetes
- chronic kidney dz
- cardiac procedures or surgery
- coronary artery dz
treatment for a-fib?
- rate control-dig, beta blockers, calcium channel blockers
- antiarrhythmic meds
- cardiac ablation
- cardioversion
what are some possible complications of a-fib?
- loss of cardiac output
- clots
dysrhythmia produced by a pacemaker cell other than the SA node; does not have any P waves
atrial flutter (AFL)
what are some causes of atrial flutter?
- acute MI
- mitral valve dz
- thyrotoxicosis
- COPD
treatment for atrial flutter?
- rate control: beta blocker, calcium channel blocker, dig
- antiarrhythmic
- cardioversion
controlled electrical discharge of energy at the peak of the R wave
cardioversion
uncontrolled electrical discharge of energy anywhere during the cardiac cycle
defibrillation
when is cardioversion indicated?
symptomatic tachy dysrhythmias with a pulse:
- SVT rhythms
- AF with RVR (with caution)
- AFL with RVR
- VT with a pulse
when is defibrillation indicated?
tachy dysrhythmias without a pulse:
- VT
- VF
think saw tooth with atrial flutter
...
rapid heart rhythm that originates above the ventricles; appears as a regular, narrow QRS complex tachycardia
supraventricular tachycardia (SVT)
treatment for supraventricular tachycardia (SVT)?
- treat the cause
- cardioversion
- adenosine
patients receiving adenosine may experience prolonged periods of _________ after administration
asytole
prior to the administration of adenosine, the pt should be on a ?
cardiac monitor
what should be readily available for patients who have been given adenosine?
transcutaneous pacemaker; should pacing of the pt be necessary
similar to ST except the electrical impulse is not generated from the sinus node, it's generated somewhere in the atria and can have uniform or nonuniform appearance
atrial tachycardia (AT)
rhythms that begin with the AV node at a rate of 40-60 bpm and have an inverted P wave
junctional rhythms
Which of the following is not an appropriate intervention for all atrial dysrhythmias?
A. An ECG
B. A pulse check
C. Blood pressure
D. Cardioversion
D. Cardioversion
wide and atypical (or bizarre-looking) QRS complexes that fire earlier than expected from within the ventricles
premature ventricular contraction (PVCs)
what are the causes of premature ventricular contractions (PVCs)?
- hypoxia
- MI
- cardiomyopathy
- electrolyte imbalance
uniform appearance
unifocal
nonuniform appearance
multifocal
3 or more PVCs (wide and fast impulses originating from the ventricles) in a row
ventricular tachycardia (VT)
a PVC that occurs every other beat
bigeminy
PVC falling every third beat
trigeminy
what are some causes of ventricular tachycardia (VT)?
- hypovolemia
- hypoxia
- acidosis
- hypokalemia
- hyperkalemia
- hypoglycemia
- hypothermia
- toxins
- cardiac tamponade
- MI
- PE
the treatment for VT is based on the patient's presentation, which is either:
- VT with a pulse
- pulseless VT
VT with a pulse treatment?
- antiarrhythmic medication
- electrolyte replacement
- cardioversion
pulseless VT treatment?
- cardiopulmonary resuscitation
- defibrillation
lethal dysrhythmia requiring immediate treatment; occurs when the ventricle has multiple chaotic impulses firing rapidly
ventricular fibrillation (VF)
what are some causes of ventricular fibrillation?
- hypovolemia
- hypoxia
- acidosis
- hypokalemia
- hyperkalemia
- hypoglycemia
- hypothermia
- toxins
- cardiac tamponade
- MI
- PE
how is ventricular fibrillation treated?
- chest compressions
- defibrillation
when the SA and AV nodes fail; rate will be 20-40
idioventricular rhythm (IVR)
no measurable electrical activity from the heart
asystole
treatment for asystole?
start CPR
The nurse understands that rhythms originating in the ventricle have which of the following characteristics? (Select all that apply)
A. Wide QRS complexes
B. Narrow QRS complexes
C. Only QRS complexes
D. Only fast rates
E. Only slow rates
A and C
delay or blockage of electrical conduction at the AV node
heart blocks
causes of heart blocks?
- acute coronary syndrome
- electrolyte imbalance
- medication toxicity
looks very similar to an NSR except the PR interval is prolonged (>0.2 sec or 5 blocks long)
first-degree AV block
treatment for first-degree AV block?
monitor
more P waves than QRS complexes and the PR interval gets progressively longer until a QRS complex is dropped
type I second-degree AV block
also drops QRS complexes but the PR intervals are exactly the same length with each complex
type II second-degree AV block
what is the treatment for second-degree AV block type I and II?
temporary pacing
when the AV node is completely blocked and prevents any impulses from entering or exiting; ECG records more P waves than QRS complexes
third-degree AV block
treatment for third-degree AV block?
- supportive care
- treat cause (such as hypotension and SOB)
- pacing
What do second-degree and third-degree heart blocks have in common?
A. Wide QRS complexes
B. Narrow QRS complexes
C. Dropped QRS complexes
D. No commonalities
D
Transcutaneous pacing should be considered for which of the following dysrhythmias?
A. VF
B. VT
C. Symptomatic heart block
D. AF
C
symptoms of cardiac dysrhythmias?
- SOB
- pain
- hypotension
- fatigue
what are some modifiable risk factors of coronary artery disease?
- increased total cholesterol
- HTN
- DM
- obesity
- smoking
- physical activity
what are some nonmodifiable risk factors of coronary artery disease?
- gender (males are higher)
- race
- heredity
- age (increased risk w/ increased age)
atherosclerosis forms and occludes _____________
coronary arteries
what can occur as a result of atherosclerosis?
- unstable angina
- myocardial infarction
- sudden cardiac death
chest pain that occurs at rest
unstable angina
plaque within the lumen of the vessels
atherosclerosis
initial injury with atherosclerosis?
injury to the vessel wall & then inflammatory response
clinical manifestations of coronary artery disesase?
- stable angina
- unstable angina
- Prinzmetal's angina
chest pain alleviated with rest
stable angina
coronary artery spasm that can occur at rest
Prinzmetal's angina
what labs are drawn to diagnoses coronary artery disease diagnosed?
- total cholesterol (<200)
- triglycerides (<150)
- LDL <100
- HDL >40-60
- CK
- CK-MB
- Trop
what tests are done to diagnose coronary artery disesae?
- ECG
- exercise stress test
- coronary angiography
possible manifestations of coronary artery disease?
- dizziness
- difficulty speaking
- sudden changes in vision
- sudden weakness on one side of the body
what is the purpose of administering medications to patients with coronary artery disease?
- stop aggregation of blood components to endothelium
- control factors leading to endothelial damage
- relief of symptoms
meds on pg. 596 & 597 (17:00)
statins, anticoagulants, antiplatelet, beta blockers, ACE inhibitors, calcium channel blockers, & vaso-dilators
surgical management for coronary artery disease?
- percutaneous transluminal coronary angioplasty
- coronary artery bypass graft
complications with coronary artery disease?
- acute coronary syndrome (unstable angina & MI)
- dysrhythmia
what are some lifestyle management things for patients with CAD?
- maintain healthy body weight
- diet
- physical activity
- smoking cessation
- screening & treatment for depression
- refraining from excessive alcohol use
- cardiac rehabilitation
what foods should CAD patients avoid?
- saturated fat
- high sodium content foods
complications of CAD?
MI
nonspecific symptoms of CAD?
- epigastric discomfort
- N/V
- diaphoresis
- syncope
- SOB
MONA
- morphine
- oxygen
- nitroglycerin
- aspirin
when should statins be taken?
in the evening b/c that's when the liver works to make cholesterol
inflammation/infection of the valves (most commonly mitral & aortic)
infective endocarditis
risk factors of infective endocarditis:
- age (>60)
- IV drug use
- immunodeficiency
- DM
- prosthetic heart valves
- prior hx endocarditis
- congenital/structural heart defect
- IV access or cardiac device
infection of endocardium affecting heart valve; usually bacterial in origin
infective endocarditis
clinical manifestations of infective endocarditis?
- Osler's nodes
- Janeway lesions
- splinter hemorrhage
- murmur
- fever
- fatigue
- confusion
painful nodes of the pads of the fingers and the toes
Osler's nodes
red painless spots on the palms of the hands and the soles of the feet
Janeway lesions
seen under nails; vertical looking splinters
splinter hemorrhage
how is infective endocarditis diagnosed?
- blood cultures
- echocardiogram (TEE, TTE)
- ECG
- elevated WBC
medical management of infective endocarditis?
IV abx
surgical management of infective endocarditis?
valve repair or replacement
complications of infective endocarditis?
- embolic events
- transient ischemic attack or stroke
- pulmonary emboli
- heart failure
- dysrhythmia
what is a big teaching thing for your patients with infective endocarditis?
good oral hygiene; the mouth is a breeding ground
damage to myocardium; usually caused by virus
myocarditis
who is most affected by myocarditis?
men and young persons
clinical manifestations of myocarditis?
- heart failure
- cardiogenic shock
- chest pain
- dysrhythmias
- dyspnea
- palpitations
- syncope
how is myocarditis diagnosed?
- labs (CRP, ESR, Trop, BNP)
- echocardiogram
- MRI
- myocardial biopsy
BNP tells me directly?
how significant heart failure it
treatment for myocarditis?
- heart failure (decrease volume)
- dysrhythmias (heart transplant)
- dilated cardiomyopathy
- immunosuppressants
complications that can arise from myocarditis?
- dilated cardiomyopathy
- heart failure
- dysrhythmias
- sudden cardiac death
inflammation around the heart
pericarditis
clinical manifestations of pericarditis?
- pleuritic chest pain
- new or worsening pericardial effusion
- ECG changes
- fever
sac around the heart
pericardium
plaque build-up?
atherosclerosis
inflammatory process of the innermost portion of the heart?
endocarditis
inflammation of the outermost portion or the sac of the heart?
pericarditis
stuff in and around the sac of the heart (can be fluid, blood, etc.)
pericardial effusion
how is pericarditis diagnosed?
- ECG
- chest x-ray
- echocardiogram
- cardiac CT scan
- MRI
what do we do for patients who have SOB?
elevate HOB
medications given to pericarditis patients help to?
- alleviate pain
- stop inflammatory process
- aspirin, NSAIDs, anti-inflammatories
complications of pericarditis?
pericardial effusion
cardiac tamponade
squeezing of the parts of the heart which ultimately give us our cardiac output
what is one of the most common manifestations seen with pericarditis?
pericardial friction rub
HOB with pericarditis?
elevated
chest pain relieved by sitting up and leaning forward is found in?
pericarditis
necessary teaching with steroids?
- never stop taking them abruptly
- if diabetic, monitor BS
L or R sided heart failure; regurgitation & stenosis
valvular disease
clinical manifestations of valvular disease?
- murmur
- SOB
- crackles
- angina
- syncope
- dysrhythmias
- palpitation
- fatigue
- weight gain
- edema
- cool, pale extremities with weak pulses
how is valvular disease diagnosed?
- echocardiogram (TEE or TTE)
- chest x-ray
- stress test
- cardiac catheterization
- CT
- MRI
medications to treat valvular disease?
- ACE inhibitors (affect afterload)
- diuretics (decreases preload)
what are the valves of the heart?
- tricuspid
- bicuspid/mitral
- pulmonic
- aortic
possible complications of valvular disease?
- heart failure
- cardiogenic shock
- thromboembolism
- endocarditis
- dysrhythmias
surgical management for valvular disease?
- valve replacement
- valve repair
you will need to be on anticoagulants for a lifetime with one of these***
failure of the valves to work properly can lead to: (in regards to VS)
- hypertension
- tachycardia
- tachypnea
- fever
- decreased SP02
what should we monitor for in patients taking -prils?
- cough
- angioedema (swelling of the lips, tongue, mouth)
- BP
what should we monitor for in patients taking beta blockers?
- decreased heart rate
- BP
risk factors of heart failure?
- CAD
- HTN
- DM (elevated fasting blood glucose >200)
- metabolic syndrome
- obesity
- smoking
- high sodium intake
- sedentary lifestyle
- valvular dysfunction
- cardiomyopathy
- endocarditis, myocarditis, and pericarditis
- cardiotoxic substances (alcohol, chemo, illicit drugs)
myocardial cell dysfunction; inability of heart to meet needs of body
heart failure
clinical manifestations of heart failure?
- fatigue
- weight gain
- tachycardia
- hypo or hypertension
- murmurs
R sided heart failure manifestations?
* think R ventricle not working appropriately
- JVD
- dependent edema
- hepatomegaly
- ascites
L sided heart failure manifestations?
* think L ventricle not working appropriately
- lack of oxygenated blood to tissues
- activity intolerance
- SOB
- dyspnea or orthopnea
- crackles
- pale
- weak pulses
- cool extremities
- delayed cap refill
- fatigue & weakness
how is heart failure diagnosed?
- physicals assessment
- chest x-ray
- echocardiogram
- ECG
- mitigated acquisition scans (help determine ejection fraction)
- laboratory tests (CK, CK-MB, trop, electrolytes (think hypervolemia), CBC, UA, glucose, BNP (<100)
percentage of blood that is able to be ejected from ventricles (50-70% is normal)
ejection fraction
treatment for heart failure?
- reduction of risk factors
- manipulation of cardiac output
medical management for heart failure?
- beta blockers (-lol, -ilol)
- aldosterone antagonist
- diuretics
- ACE inhibitors
- calcium channel blockers
- digoxin
surgical management of heart failure?
- internal cardiac defibrillator
- ventricular assist device
the amount or what is before the ventricles
preload
what the ventricles have to overcome to get the blood out of the heart and into the body
afterload
how well the ventricles pump
contractility
a gain of 1 kg is equivalent to _______ mL of fluid
1,000
appropriate diet for heart failure patients?
fluid and sodium restriction
complications R/T heart failure?
- pulmonary edema
- renal failure (decreased blood flow to kidneys)
hallmark manifestation of pulmonary/flash edema?
pink, frothy sputum
affects the afterload by decreasing BP
ACE inhibitors
block sympathetic nervous system response
beta blockers
biggest side effect of beta blockers?
bradycardia
patients taking spironolactone are at risk for hyper/hypokalemia?
hyperkalemia
patients taking hctz or furosemide, patients are at risk for hyper/hypokalemia?
hypokalemia
patients taking dig have increased risk for?
dig toxicity
vessels contribute to overall healthy by transporting:
- blood for metabolic activities
- waste
risk factors for atherosclerosis/arteriosclerosis?
- high cholesterol
- high triglycerides
- high LDLs
- high HDLs
- HTN
- DM
- smoking (enhance atherosclerosis)
normal cardiac output range?
4-8L
L/min that your heart ejects in order for the body to function
cardiac output
plaque buildup
atherosclerosis
hardening/thickening of vessels
arteriosclerosis
total cholesterol range?
<200
triglyceride range?
<150
LDL range?
<100
HDL range?
>40-60
most significant cause of atherosclerosis?
injury to the vessel wall
clinical manifestations of atherosclerosis/arteriosclerosis?
- critical narrowing of artery resulting in emergency
- MI
- sudden cardiac death
- stroke
- gangrene
atherosclerosis leads to many other disorders such as
- HTN
- carotid artery disease
- PVD
risk factors for HTN?
- race
- gender
- socioeconomic status
- smoking
- obesity (BMI >30)
- physical inactivity
- excessive alcohol
- diet (increased sodium because Na+ increases our volume)
- stress
- dyslipidemia
- DM
- decreased GFR
- family hx
cigarettes are a vaso?
vasoconstrictor
aldosterone controls?
sodium and water
clinical manifestations of HTN?
- headaches
- chest pain
- vision changes
- SOB
- renal dysfunction
- dizziness
- fatigue
- nosebleeds
primary or essential HTN?
HTN with no identifiable cause
secondary HTN?
HTN as a result of some cause
how is HTN diagnosed?
two or more BP readings in more than 2 office visits
medications prescribed for HTN?
- diuretics
- antihypertensive
lifestyle management for HTN?
- weight
- diet
- alcohol consumption
- exercise
- stress
possible complications of HTN?
- dilated cardiomyopathy
- systolic dysfunction
- renal failure
- stroke
- hypertensive crisis
what labs do we assess with HTN?
- BUN & creatinine
- GFR
- albumin
- BMI
modifiable risk factors for peripheral arterial disease?
- atherosclerosis
- smoking
- HTN
- DM
- dyslipidemia
- sedentary lifestyle
- ineffective stress management
nonmodifiable risk factors for peripheral arterial disease?
- family hx
- age
- gender
- ethnicity
obstruction of blood flow through large peripheral arteries cause partial or total occlusion
peripheral arterial disease
stage 1 PAD clinical manifestations?
- bruit may be auscultated
- pedal pulses decreased or possible absent
stage 2 PAD clinical manifestations?
- intermittent claudication
- muscle pain
- burning and cramping with exercise & relieved by rest
stage 3 (rest pain) PAD clinical manifestations?
- pain awakens pt at night
- pain described as numbness/burning usually in distal portion of extremity
- pain often relieved by putting extremity in dependent position
stage 4 PAD clinical manifestations?
- necrosis/gangrene
- ulcers and blackened tissue occur on the foot
- gangrenous odor may be present
how is PAD diagnosed?
- ankle-brachial index
- US
- CT
- MRI
- angiography
medications for PAD?
- antihypertensive
- antiplatelet
- statins
surgical management for PAD?
- percutaneous transluminal angioplasty
- laser-assisted angioplasty
- rotational artherectomy
non-surgical management for PAD?
- legs dangling
- exercise to increase blood flow
- wear appropriate shoes and examine feet daily
complications of PAD?
- critical limb ischemia
- acute limb ischemia
risk factors for carotid artery disease?
- smoking
- HTN
- DM
- dyslipidemia
- sedentary lifestyle
- obesity
- ineffective stress management
vessel wall thickening and plaque formation occluding blood in carotid artery
carotid artery disease
clinical manifestations of carotid artery disease?
- asymptomatic until cerebral perfusion is impaired
- stroke or TIA
- dizziness
- loss of consciousness
- facial droop
- difficulty talking
- sudden vision changes
- sudden severe headache
how is carotid artery disease diagnosed?
- auscultate bruit
- carotid duplex scan
- CT angiography
- MRI
- carotid angiography
surgical management for carotid artery disease?
- carotid endardectomy
- carotid artery stenting
medications for carotid artery disease?
- clopidogrel
- antihypertensives
symptoms of stroke?
- slurred speech
- weakness
- severe headache
- sudden vision loss
- facial droop
- dizziness
following a CEA or CAS if the pt becomes hypotensive, what position should we put them in?
flat with the HOB down to increase the blood flow which increases cerebral perfusion
risk factors for aortic artery disease (aneurysm)?
- family hx
- advanced age
- male gender
- smoking; known CAD
- atherosclerosis
- HTN; high cholesterol
- genetic/metabolic abnormalities
middle layer(media) of artery is weakened, stretching inner layer (intima); artery widens, tension increases, further widening occurs
aortic artery disease (aneurysm)
clinical manifestations of aortic artery disease (aneurysm)?
asymptomatic until dissection or rupture
- palpable mass
- chest, back, or flank pain
how is aortic artery disease diagnosed?
- CT (gold standard)
- transthoracic echo
- cardiac MRI
- ECG
medical management of aortic artery disease?
- antihypertensive (ACE inhibitors, arbs, beta blockers, calcium channel blockers)
- statins
complications that can occur from aortic artery disease?
- aortic dissection
- aneurysm rupture
risk factors for deep vein thrombosis (DVT)?
- increased age
- active cancer
- varicose veins
- prior venous thrombosis
- pregnancy or postpartum
- oral contraceptive or hormone therapy
- immobility
Virchow's triad?
- decreased flow rate of blood (stasis)
- damage to blood vessel wall (endothelial injury)
- increased tendency to clot (hypercoagulability)
clinical manifestations of DVT?
- pain
- swelling
- tenderness
- discoloration
- redness
- warmth
how is a DVT diagnosed?
- D-dimer (if + then you have high indication of probability of clot somewhere)
- compression ultrasonography
medical management prevention for DVT?
- ambulation (in low risk patients)
- venous thromboembolism prophylaxis (increased risk patients)
- low molecular weight heparin (increased risk patients)
medical management for development of DVT?
- unfractionated heparin
- low molecular weight heparin
- warfarin
- directed factor Xa inhibitors (xarelto, eliquis)
what labs have to be checked when on heparin?
PTT
what labs have to be checked when on warfarin?
PT/INR
antidot for warfarin?
vit. K
antidote for heparin?
...
surgical management for DVT?
rarely used
- thrombectomy
- balloon angioplasty
- stent placement
- vena cava filter
possible complications from DVT?
- pulmonary embolism
- post thrombotic syndrome
medications to know:
- statins
- anticoagulants
- antiplatelet agents
- beta-blockers
- ACE inhibitors
- ARBs
- CCBs
- diuretics
- cardiac glycosides
- inotropes (dig, dopamine)
- vasodilators
- NSAIDs
- corticosteroids
...