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?

1. body
2. vena cava
3. R atrium
4. tricuspid valve
5. R ventricle
6. pulmonary valve
7. pulmonary artery
8. lungs
9. pulmonary veins
10. L atrium
11. mitral/bicuspid valve
12. L ventricle
13. aortic valve
14. aorta
15. 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:

1. SA node fires
2. impulse spreads through atrial myocardium
3. impulse travels to the AV node
4. impulse leaves the AV node through the bundle of His
5. impulse travels through the bundle branches (L and R)
6. 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?

1. opening of Na+ channels -> depolarization
2. initial repolarization
3. influx of Ca+, outflow of K+ -> plateau state
4. closed Ca+ channels and outflow of K+ -> repolarization
5. 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?

1. preload
2. afterload
3. 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:

1. P wave
2. QRS complex
3. T wave
4. 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?

1. is the rate fast, slow, or normal?
2. is the rhythm regular? (same space between QRS)
3. are there P waves present?
4. are there QRS complexes present?
5. are there T waves present?
6. are the intervals within normal limits?
7. is there a P wave before every QRS?
8. 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?

1. decreased flow rate of blood (stasis)
2. damage to blood vessel wall (endothelial injury)
3. 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