Cardiovascular system - important things to know

[Zoe*aka*studentnurse]

Hi everyone,

I'm on break at the moment, semester 2 starts in a few weeks time. So I'm trying to get a bit of a head start wiht A&P 2. First subject is cardiovascular system. I was wondering if anyone who has done it could list a few

"important things to know"

Thanks, Zoe

[mylife101]

This website is like having a birthday everyday!! I find so much important and interesting info everyday!! Since discovering this website, the bags under my eyes are awful, but it's worth it. Thank you all so much for graciously sharing. You all make my day, everyday!!

[icurn11]

If you will PM me your e-mail addy, I can send you the notes from my graduate-level A&P/Pathophys class from the CV unit. I tried to upload here, but it's too big and they won't let me upload.

Hi Nursekitten!

Would you possibly email them to me, or PM to me?? I am starting NP school next year, and am weak in cardiac.

Thanks bunches!!!

[Sarah Hay]

i'm in med-surg ii and our first topic/system was the cardiovascular. at first i was like "nooo! i hate cardio!" but it turns out i actually enjoy it and scored a high a on the exam. w00t me! i'm going to attach my objectives for cardio and peripheral vascular so you can take a peek. a lot is pathophysiology but there is normal functioning listed as well. i hope this helps.

OBJECTIVES Cardiology.doc

OBJECTIVES Peripheral Vascular.doc

[icurn11]

i'm in med-surg ii and our first topic/system was the cardiovascular. at first i was like "nooo! i hate cardio!" but it turns out i actually enjoy it and scored a high a on the exam. w00t me! i'm going to attach my objectives for cardio and peripheral vascular so you can take a peek. a lot is pathophysiology but there is normal functioning listed as well. i hope this helps.

thank you soooo much!! anything will help. i hear that program is pretty kick butt.....i'm nervous already and i havent' even gotten in yet!!

[TessaMae]

These are my notes/facts from a med surg lecture... [B][FONT=Elementary SF]Coronary Artery Disease (CAD) – Facts[/B]- [FONT=Elementary SF]Most common acquired cardiac disease- [FONT=Elementary SF]Associated with many risk factors that are controllable & uncontrollable- [FONT=Elementary SF]Incidence:o [FONT=Elementary SF]1.2 million people will have an MI [FONT=Elementary SF]25% will die in the ED or before reaching the hospitalo [FONT=Elementary SF]Women diagnosed later in life than men [FONT=Elementary SF]Have higher mortality rates [FONT=Elementary SF]After menopause have the same incidence as men- [FONT=Elementary SF]Menopause causes:o [FONT=Elementary SF]Increase in LDLo [FONT=Elementary SF]Decrease in HDL[B][FONT=Elementary SF]Coronary Artery Disease – Risk Factors[/B][B][FONT=Elementary SF]Nonmodifiable (uncontrollable)[/B]- [FONT=Elementary SF]Family history- [FONT=Elementary SF]Age- [FONT=Elementary SF]Sex- [FONT=Elementary SF]Race[B][FONT=Elementary SF]Modifiable (controllable)[/B][B][FONT=Elementary SF]Major:[/B]- [FONT=Elementary SF]Hyperlipidemia- [FONT=Elementary SF]High blood pressure o [FONT=Elementary SF]140/90 mmHg or higher- [FONT=Elementary SF]Obesityo [FONT=Elementary SF]Waist circumference: [FONT=Elementary SF]Men: >102 cm/39.8 in [FONT=Elementary SF]Women: > 88 cm/34.3 in- [FONT=Elementary SF]Tobacco Use (#1 risk factor)- [FONT=Elementary SF]Sedentary life style[B][FONT=Elementary SF]Contributing:[/B]- [FONT=Elementary SF]Psychologic states:o [FONT=Elementary SF]Type A personalitieso [FONT=Elementary SF]Emotional stresso [FONT=Elementary SF]Multiple role expectations- [FONT=Elementary SF]Diabetes mellituso [FONT=Elementary SF]Fasting blood sugar > 110 mg/dL- [FONT=Elementary SF]Oral contraceptive useo [FONT=Elementary SF]Promotes clotting- [FONT=Elementary SF]Homocysteine levels that are higho [FONT=Elementary SF]Normal levels are 5-15 micromoleso [FONT=Elementary SF]Folic acid and B vitamins help to break down homocysteine[B][FONT=Elementary SF]Coronary Artery Disease – Signs & Symptoms[/B]- [FONT=Elementary SF]Depend on severity of diseaseo [FONT=Elementary SF]In early stages: [FONT=Elementary SF]Asymptomatic but has many risk factors- [FONT=Elementary SF]Angina- [FONT=Elementary SF]SOB- [FONT=Elementary SF]Fatigue with activity[B][FONT=Elementary SF]Coronary Artery Disease – Diagnostic Procedures[/B]- [FONT=Elementary SF]Tests may include:o [FONT=Elementary SF]Chest X-ray [FONT=Elementary SF]Determines the size of the heart [FONT=Elementary SF]Looks for hypertrophyo [FONT=Elementary SF]Fluoroscopy [FONT=Elementary SF]Allows visualization & analysis of the heart & lungs in motion- [FONT=Elementary SF]How they work togethero [FONT=Elementary SF]Electrocardiogram (ECG) [FONT=Elementary SF]Graphic recording of the heart’s electrical activity [FONT=Elementary SF]Shows the past, can’t predict the futureo [FONT=Elementary SF]Exercise stress test [FONT=Elementary SF]Sestamibi/thallium testing [FONT=Elementary SF]Dye is injected into the veins to see how the blood moves through the heart [FONT=Elementary SF]Evaluates heart’s response to activity & rest [FONT=Elementary SF]With thallium testing, thallium concentrates in healthy myocardial cells- [FONT=Elementary SF]Cold-spots or areas free of thallium have decreased perfusiono [FONT=Elementary SF]Electrophysiology (EPS) [FONT=Elementary SF]Evaluates conduction abnormalities in patients with dysrhythmias that do not respond to conventional therapieso [FONT=Elementary SF]Gated heart studies [FONT=Elementary SF]Radioactive tracers determine size and location of infarcts [FONT=Elementary SF]Evaluate ventricular function by assessing motion in arterial wallo [FONT=Elementary SF]Cardiac catheterization [FONT=Elementary SF]Invasive procedure [FONT=Elementary SF]Provides information about functional status of the heart [FONT=Elementary SF]Used to diagnose:- [FONT=Elementary SF]Congenital heart disease- [FONT=Elementary SF]Valvular disease- [FONT=Elementary SF]Myocardial disease [FONT=Elementary SF]Catheter inserted into artery in leg [FONT=Elementary SF]Dye highlights arteries and exposes blockages [FONT=Elementary SF]Patient needs to lie still for 4-6 hours to allow blood vessels to healo [FONT=Elementary SF]Positron emission tomography (PET) [FONT=Elementary SF]Distinguishes between ischemic tissue and necrotic nonviable tissueo [FONT=Elementary SF]Echocardiogram [FONT=Elementary SF]Noninvasive procedure [FONT=Elementary SF]Uses high frequency waves [FONT=Elementary SF]Provide information about:- [FONT=Elementary SF]ejection fraction (amount of blood ejected during each ventricular contractiono [FONT=Elementary SF]Normal is 50-65%o [FONT=Elementary SF]Lower levels increase risk of death- [FONT=Elementary SF]Ventricular volumes- [FONT=Elementary SF]Cardiac wall motion- [FONT=Elementary SF]Valve/structure competency- [FONT=Elementary SF]Presence of thrombi o [FONT=Elementary SF]Electron-beam computed tomography (EBCT) to look for calcium in the lining of the arteries [FONT=Elementary SF]The more calcium, the higher your chance for CHD o [FONT=Elementary SF]Magnetic resonance imaging (MRI) [FONT=Elementary SF]Noninvasive method for diagnosing CAD [FONT=Elementary SF]Uses magnets so people with implantable devices cannot use [FONT=Elementary SF]Does not pick up calcium deposits o [FONT=Elementary SF]Hemodynamic monitoring via:- [FONT=Elementary SF]Four-lumen pulmonary artery catheter (swans-ganz or thermodilution catheter) [FONT=Elementary SF]Pulmonary artery diastolic pressure & pulmonary artery wedge pressure are good indicators of:- [FONT=Elementary SF]fluid volume status - [FONT=Elementary SF]Cardiac function [FONT=Elementary SF]They are increased in: - [FONT=Elementary SF]Fluid volume overload- [FONT=Elementary SF]Heart failure [FONT=Elementary SF]They are decreased in:- [FONT=Elementary SF]Fluid volume deficit [FONT=Elementary SF]Monitoring PA allows for:- [FONT=Elementary SF]Precise management of preload and fluid balance, which:o [FONT=Elementary SF]Ensures adequate cardiac outputo [FONT=Elementary SF]Prevents pulmonary edemao [FONT=Elementary SF]Blood studies: [FONT=Elementary SF]CBC- [FONT=Elementary SF]Increased WBC indicate inflammation- [FONT=Elementary SF]Necrotic tissue cause WBC’s to rise- [FONT=Elementary SF]Lacks specificity [FONT=Elementary SF]Electrolytes [FONT=Elementary SF]Lipids [FONT=Elementary SF]Serum cardiac markers- [FONT=Elementary SF]Released into blood in large quantities from necrotic tissue after an MI- [FONT=Elementary SF]Increased amount can indicate:o [FONT=Elementary SF]Whether there is cardiac damage ANDo [FONT=Elementary SF]The extent of damage- [FONT=Elementary SF]Creatine Kinase (CK)o [FONT=Elementary SF]Used to diagnose MIo [FONT=Elementary SF]Begin to rise 3 hours after an MIo [FONT=Elementary SF]Peak at 12 hourso [FONT=Elementary SF]Return to normal after 24 hourso [FONT=Elementary SF]Normal CK levels: [FONT=Elementary SF]Men: 15-105 U/L [FONT=Elementary SF]Women: 10-80 U/Lo [FONT=Elementary SF]Can further be broken down into bands [FONT=Elementary SF]CK-MB band is specific to myocardial damage [FONT=Elementary SF]Helps identify severity of damage- [FONT=Elementary SF]Troponin o [FONT=Elementary SF]Preferred test for suspected MIo [FONT=Elementary SF]Specific to heart injuryo [FONT=Elementary SF]Stay elevated for longer period of timeo [FONT=Elementary SF]Is a myocardial muscle protein released after myocardial injuryo [FONT=Elementary SF]There are two subtypeso [FONT=Elementary SF]Rises 3-12 hours after an MIo [FONT=Elementary SF]Peaks at 24-48 hourso [FONT=Elementary SF]Returns to normal after 5-14 days- [FONT=Elementary SF]Myoglobino [FONT=Elementary SF]Released into circulation within a few hours after MIo [FONT=Elementary SF]It is one of the first serum cardiac markers to increaseo [FONT=Elementary SF]Lacks specificityo [FONT=Elementary SF]Rapidly excreted in urineo [FONT=Elementary SF]Returns to normal within 24 hours- [FONT=Elementary SF]Additional cardiac biomarker tests:o [FONT=Elementary SF]BNPo [FONT=Elementary SF]Hs-CR[B][FONT=Elementary SF]Coronary Artery Disease – Goals[/B]- [FONT=Elementary SF]Prevent coronary events- [FONT=Elementary SF]Identify at risk patients- [FONT=Elementary SF]Manage high risk patients- [FONT=Elementary SF]Promote lifestyle modifications:o [FONT=Elementary SF]Smoking cessationo [FONT=Elementary SF]Weight reduction [FONT=Elementary SF]Low fat diet [FONT=Elementary SF]Exercise programo [FONT=Elementary SF]Reduce stresso [FONT=Elementary SF]Reduce salt/sidium intakeo [FONT=Elementary SF]Decrease blood lipid levels- [FONT=Elementary SF]Normal cholesterol levels:o [FONT=Elementary SF]Men: LDL <130 mg/dl, HDL >45 mg/dlo [FONT=Elementary SF]Women: LDL 130 mg/dl, HDL >55 mg/dl [FONT=Elementary SF]If LDL is >190 mg/dl OR [FONT=Elementary SF]If LDL is >160 mg/dl with 2 or more risk factors AND [FONT=Elementary SF]Not responsive to dietary control, drug therapy is ordered in addition to diet therapy[B][FONT=Elementary SF]Antilipemics & cholesterol lowering drugs[/B]- [FONT=Elementary SF]The statins are the most widely used- [FONT=Elementary SF]Inhibit synthesis of cholesterolo [FONT=Elementary SF]Most commonly used:o [FONT=Elementary SF]Zocor (simivastatin) [FONT=Elementary SF]Reduces serum triglycerides [FONT=Elementary SF]Reduces LDL [FONT=Elementary SF]Modestly increased HDL [FONT=Elementary SF]Most commonly used in hospitals (cheaper)o [FONT=Elementary SF]Lipitor (atorvastatin calcium) [FONT=Elementary SF]Reduces LDL [FONT=Elementary SF]Reduces total triglyceride production [FONT=Elementary SF]Increases plasma levels of HDL [FONT=Elementary SF]Better med – more expensiveo [FONT=Elementary SF]Other drugs [FONT=Elementary SF]Cholesterol absorption inhibitor- [FONT=Elementary SF]Inhibits intestinal absorption of cholesterol- [FONT=Elementary SF]Zetia (ezetimibe) [FONT=Elementary SF]Bile acid sequestrants- [FONT=Elementary SF]Increase conversion of cholesterol to bile acids- [FONT=Elementary SF]Decrease hepatic cholesterol content- [FONT=Elementary SF]Not used as frequently- [FONT=Elementary SF]Not well tolerated- [FONT=Elementary SF]Questran (cholestyramine)- [FONT=Elementary SF]Colestid (colestipol)- [FONT=Elementary SF]WelChol (colsevelam) [B][FONT=Elementary SF]Angina Pectoris - Facts[/B]- [FONT=Elementary SF]Acute pain in the chest caused by reversible myocardial ischemia- [FONT=Elementary SF]Supply and demand imbalance with oxygen- [FONT=Elementary SF]Usually happens with activity- [FONT=Elementary SF]Usually goes away with rest- [FONT=Elementary SF]Not evident on EKG’s when pain is not present- [FONT=Elementary SF]Occurs gradually:o [FONT=Elementary SF]Because of atherosclerosis (most common) OR- [FONT=Elementary SF]Occurs suddenly:o [FONT=Elementary SF]Because of vasospasm[B][FONT=Elementary SF]Angina – Types[/B][B][FONT=Elementary SF]Chronic Stable Angina – Facts[/B]- [FONT=Elementary SF]Pain follows a regular patterno [FONT=Elementary SF]Occurs intermittently over a long period of timeo [FONT=Elementary SF]Has same pattern of onset, duration, and intensity of symptoms- [FONT=Elementary SF]Frequently occurs:o [FONT=Elementary SF]After physical exertion (including sexual activity)o [FONT=Elementary SF]With stresso [FONT=Elementary SF]During consumption of a large mealo [FONT=Elementary SF]With exposure to hot or cold temperatures or temperature extremeso [FONT=Elementary SF]With tobacco useo [FONT=Elementary SF]With the use of stimulants- [FONT=Elementary SF]Is relieved by rest or Nitroglycerine- [FONT=Elementary SF]Indicative of mid-stage CAD when about 75% of coronary artery is occluded[B][FONT=Elementary SF]Angina – Signs & Symptoms[/B]- [FONT=Elementary SF]Indigestion or burning sensation in epigastric region substernally (most common)- [FONT=Elementary SF]Pain may occur in the neck and radiate to various locations including:o [FONT=Elementary SF]Jawo [FONT=Elementary SF]Shoulderso [FONT=Elementary SF]Down armso [FONT=Elementary SF]Between shoulder blades- [FONT=Elementary SF]Pain:o [FONT=Elementary SF]generally only lasts a few minutes – rarely no longer than 20 minuteso [FONT=Elementary SF]Is suddeno [FONT=Elementary SF]Not common at resto [FONT=Elementary SF]Subsides when precipitating factor is relieved- [FONT=Elementary SF]EKG reveals ST segment depression during paino [FONT=Elementary SF]Indicates ischemia (angina)- [FONT=Elementary SF]Associated symptoms:o [FONT=Elementary SF]Often none – but could include: [FONT=Elementary SF]Weakness [FONT=Elementary SF]Dizziness [FONT=Elementary SF]Diaphoresis [FONT=Elementary SF]Nausea [FONT=Elementary SF]Vomiting [FONT=Elementary SF]Uneasiness [FONT=Elementary SF]Dyspnea[B][FONT=Elementary SF]Unstable Angina – Facts[/B]- [FONT=Elementary SF]Less predictable and more serious- [FONT=Elementary SF]Pain:o [FONT=Elementary SF]Usually severe and prolonged (greater than 20 minutes)o [FONT=Elementary SF]Uccurs with increasing frequency & severityo [FONT=Elementary SF]Can occur with or without activityo [FONT=Elementary SF]During rest or sleep- [FONT=Elementary SF]Occurs because >90% of coronary arteries is occluded- [FONT=Elementary SF]Stable chronic angina can develop into unstable angina OR - [FONT=Elementary SF]Occur without previous symptoms[B][FONT=Elementary SF]Variant or Prinzmetal’s Angina – Facts[/B]- [FONT=Elementary SF]Rare- [FONT=Elementary SF]Seen in patients with a history of Migraines or Raynauds- [FONT=Elementary SF]Not precipitated by increased physical demand- [FONT=Elementary SF]Often caused by coronary artery spasm as opposed to blockage in the vessel- [FONT=Elementary SF]When the spasm occurs the patient experiences angina ANDo [FONT=Elementary SF]ST segment elevation (during pain)- [FONT=Elementary SF]Pain is usually relieved by moderate exercise OR- [FONT=Elementary SF]May disappear spontaneously- [FONT=Elementary SF]Treated with calcium channel blockers[B][FONT=Elementary SF]Angina – Diagnosis[/B]- [FONT=Elementary SF]History & physical- [FONT=Elementary SF]Characteristic chest pain that is relieved by rest and Nitro- [FONT=Elementary SF]Transient ST segment changes on EKG during pain- [FONT=Elementary SF]In all types of angina, the EKG may be normal when pain is absent- [FONT=Elementary SF]Exercising stress test- [FONT=Elementary SF]Nuclear imaging using thalium- [FONT=Elementary SF]Cardiac catheterization (coronary angiography) – to determine the percentage of occlusion [B][FONT=Elementary SF]Angina Management – Drug Therapy[/B]- [FONT=Elementary SF]Oxygen – during paino [FONT=Elementary SF]2-4 liters a minute via nasal cannula- [FONT=Elementary SF]Nitro – dilates blood vessels o [FONT=Elementary SF]Sublingual is short acting for acute paino [FONT=Elementary SF]Pills, ointments, patches are long acting [FONT=Elementary SF]Prophylactic Tylenol to prevent headaches until body adjusts. [FONT=Elementary SF]Store in cool dry place (brown glass bottle) [FONT=Elementary SF]Sublingual form should tingle- [FONT=Elementary SF]If it does produce a tingling sensation under tongue – the pill is not good [FONT=Elementary SF]Replace every 3 months [FONT=Elementary SF]Dangle legs before getting up - [FONT=Elementary SF]Beta blockers – decrease oxygen requirements & workload of hearto [FONT=Elementary SF]Atenolol, metaprolol, propranolol- [FONT=Elementary SF]Calcium channel blockers – coronary artery dilation & decreased workload of hearto [FONT=Elementary SF]Lessens contractilityo [FONT=Elementary SF]Especially helpful for patients who have vasospasms as the cause of anginao [FONT=Elementary SF]Nifedipine (lessens contractility), diltiazem, verapamil [I](very nice drugs)[/I]- [FONT=Elementary SF]Anti-lipids – increases LDL removal & restrict LDL productiono [FONT=Elementary SF]Zocor, Lipitor- [FONT=Elementary SF]ACE inhibitors – block conversion of angiotensin I to angiotensin IIo [FONT=Elementary SF]Potent vasoconstrictorso [FONT=Elementary SF]Captopril, lisinopril- [FONT=Elementary SF]Aspirin 81-160 mg – to prevent clots[B][FONT=Elementary SF]Angina Management – Invasive Procedures[/B]- [FONT=Elementary SF]PCTA (percutaneous transluminal coronary angioplasty) – increases inner diameter of coronary arteryo [FONT=Elementary SF]Balloon-like catheter advanced to area of atherosclerotic plaqueo [FONT=Elementary SF]Often needs to be repeated within a short period of time [FONT=Elementary SF]Patient put on [B]Integrilin[/B] during procedure – an antithrombotic agent [FONT=Elementary SF]Inhibits platelet aggregation by preventing binding of fibrinogen to receptor [FONT=Elementary SF]Improves perfusion to the myocardium- [FONT=Elementary SF]Coronary artery stents – increases inner diameter of artery my physically compressing plaque against the wall with a spring-like structureo [FONT=Elementary SF]Placed during angioplastyo [FONT=Elementary SF]Permanent o [FONT=Elementary SF]Many types availableo [FONT=Elementary SF]Complications similar to PTCAo [FONT=Elementary SF]Restenosis rates lower than PCTA when placed by experienced operator- [FONT=Elementary SF]CABG (coronary artery bypass graft) – bypasses blockageo [FONT=Elementary SF]Anastamosis of: [FONT=Elementary SF]Saphenous vein, internal mammary artery, radial artery [FONT=Elementary SF]For patients that:- [FONT=Elementary SF]Do not respond to other therapy- [FONT=Elementary SF]Failed PCTA OR- [FONT=Elementary SF]When the blockage is too great to respond to PCTA[B][FONT=Elementary SF]Angina Management – Nursing [/B]- [FONT=Elementary SF]During Pain:o [FONT=Elementary SF]Elevate HOB #1o [FONT=Elementary SF]Oxygen – 2-4 L via nasal cannula during pain (priority)- [FONT=Elementary SF]General:o [FONT=Elementary SF]Review pain history: [FONT=Elementary SF]What brings on the pain? [FONT=Elementary SF]When does it occur? [FONT=Elementary SF]What is the pattern? [FONT=Elementary SF]What helps relieve the pain? o [FONT=Elementary SF]Risk factor assessment (comprehensive)o [FONT=Elementary SF]Activity level & toleranceo [FONT=Elementary SF]Patient teaching regarding medications[B][FONT=Elementary SF]Myocardial Infarction – Causes[/B]- [FONT=Elementary SF]Occlusion of a major artery, causing a decreased flow of oxygen to the heart (most common)- [FONT=Elementary SF]Increased oxygen demand beyond supply caused by sudden increase in BP, acute stress[B][FONT=Elementary SF]Myocardial Infarction – Pathophysiology[/B]- [FONT=Elementary SF]Necrosis occurs 20-30 minutes after total occlusion of a major artery & spreads in a wave over 3-6 hours- [FONT=Elementary SF]First tissue to become ischemic is innermost layer – subendocardium o [FONT=Elementary SF]Subendocardium, endocardium, myocardiumo [FONT=Elementary SF]If ischemia persists it takes 4-6 hours for necrosis of all three layerso [FONT=Elementary SF]Necrosis cannot be reversedo [FONT=Elementary SF]Size of the area may be limited by restoration of oxygen to affected tissue within 3-6 hours[B][FONT=Elementary SF]Myocardial Infarcion – Signs & Symptoms[/B]- [FONT=Elementary SF]SOB- [FONT=Elementary SF]Dyspnea- [FONT=Elementary SF]N/V- [FONT=Elementary SF]May be silent- [FONT=Elementary SF]Sudden acute chest pain that persists and may radiate- [FONT=Elementary SF]Pain is not relieved by nitro- [FONT=Elementary SF]Diaphoresis- [FONT=Elementary SF]Pale or ashen grey color- [FONT=Elementary SF]Levine’s sign – patient localizes pain by clenching fist over sternum[B][FONT=Elementary SF]Myocardial Infarction – Diagnosis[/B]- [FONT=Elementary SF]History- [FONT=Elementary SF]EKG changeso [FONT=Elementary SF]ST segment elevationo [FONT=Elementary SF]ST segment depressiono [FONT=Elementary SF]Appearance of Q waves- [FONT=Elementary SF]Elevated CK & CK-MB- [FONT=Elementary SF]Elevated Troponin – most specific- [FONT=Elementary SF]Elevated myoglobin- [FONT=Elementary SF]Elevated WBC & ESRo [FONT=Elementary SF]Necrotic tissue causes WBC to increase[B][FONT=Elementary SF]Myocardial Infarction – Classifications & Treatments[/B]- [FONT=Elementary SF]Most MI’s occur in the left ventricleo [FONT=Elementary SF]Infarctions described on the location of damageo [FONT=Elementary SF]Can occur in more than one locationo [FONT=Elementary SF]Location of the infarct correlates with the involved coronary circulation [FONT=Elementary SF]Inferior wall infarctions occur from occlusions in the right coronary artery- [FONT=Elementary SF]Heart block (AV block) may occur following MI- [FONT=Elementary SF]Bradydysrhythmias may occur [FONT=Elementary SF]Anterior wall infarctions occur from occlusions in the left anterior descending artery- [FONT=Elementary SF]Associated with BP issues and PC cardiogenic shock – output is not enough to supply enough oxygen to the body. May occur within the first few weeks after MI- [FONT=Elementary SF]Heart block (AV bock) may occur- [FONT=Elementary SF]Pump Failure [FONT=Elementary SF]Lateral and/or posterior infarctions occur from occlusions in the left circumflex artery - [FONT=Elementary SF]Transmural MI – all three layers of the heart have become ischemico [FONT=Elementary SF]Associated with atherosclerosis involving 1 or more major arteries- [FONT=Elementary SF]Subendocardial MI – involves a small area in the subendocardial wall- [FONT=Elementary SF]STEMI (ST-elevation) MIo [FONT=Elementary SF]Prolonged or complete occlusiono [FONT=Elementary SF]Main treatment is reperfusion with thrombolytic agents (if not contraindicated) or coronary angiography within 90 minutes- [FONT=Elementary SF]NSTEMI (Non ST-elevation) MIo [FONT=Elementary SF]Sudden narrowing of coronary artery with diminished blood flow to the myocardiumo [FONT=Elementary SF]Transient thrombosis or incomplete coronary occlusiono [FONT=Elementary SF]Stabilize with antiplatelets and anticoagulants- [FONT=Elementary SF]AHA protocol – guidelines for treatment of MIo [FONT=Elementary SF]Oxygen therapy 2-4 l/min (key)o [FONT=Elementary SF]Aspirino [FONT=Elementary SF]Nitro sublingual 0.4 mg tab Q5min x 3 doseso [FONT=Elementary SF]IV morphineo [FONT=Elementary SF]12 lead EKGo [FONT=Elementary SF]IV line in quicklyo [FONT=Elementary SF]T-PA, r-PA, or streptokinase (STEMI) within 3 hours unless [FONT=Elementary SF]High BP [FONT=Elementary SF]Cardiogenic shock [FONT=Elementary SF]Bleeding [FONT=Elementary SF]Recent surgery, treatment with blood thinnerso [FONT=Elementary SF]Reperfusion therapy (coronary angiography within 60-90 minutes (STEMI)o [FONT=Elementary SF]Heparin, LMWHo [FONT=Elementary SF]Beta blockerso [FONT=Elementary SF]Ace inhibitorso [FONT=Elementary SF]Plavixo [FONT=Elementary SF]Statin’so [FONT=Elementary SF]Complete bedrest for at least 12 hours if stableo [FONT=Elementary SF]Antiarrythmics for PVC’s VTach – lidocaine, procainamide, amiodaroneo [FONT=Elementary SF]Clear liquids for 24 hourso [FONT=Elementary SF]No caffeine[B][FONT=Elementary SF]Myocardial Infarction – Complications[/B]- [FONT=Elementary SF]Dysrhythmia’s o [FONT=Elementary SF]PVC’s – common(more than 90%) not dangerous unless [FONT=Elementary SF]Occur on T wave [FONT=Elementary SF]Come in couplets [FONT=Elementary SF]Come from different areas of the ventricle (multifocal PVC’s) [FONT=Elementary SF]Can be predictive of more dangerous dysrhythmiaso [FONT=Elementary SF]V-Fib – the risk is greatest in the first hour after MI [FONT=Elementary SF]Frequent cause of sudden cardiac deatho [FONT=Elementary SF]Heart Block (AV Block) – impaired electrical activity between the atria and ventricle [FONT=Elementary SF]S&S lightheadedness, fainting, palpitationso [FONT=Elementary SF]Bradydysrhythmias – abnormally slow rhythms- [FONT=Elementary SF]Heart failure/pump failure – higher risk in patients with diabetes mellituso [FONT=Elementary SF]More severe with anterior wall MI- [FONT=Elementary SF]Extension of the infarcto [FONT=Elementary SF]Occurs in first 10-14 days after MIo [FONT=Elementary SF]Occurs in 10% of patientso [FONT=Elementary SF]Can result in heart failure or cardiogenic shock- [FONT=Elementary SF]Structural defects – necrotic tissue is replaced by scar tissue that is thinner than ventricular muscle masso [FONT=Elementary SF]Causes ventricular wall aneurysmo [FONT=Elementary SF]Ruptured ventricle or septum [FONT=Elementary SF]most common 3-5 days post MI [FONT=Elementary SF]life threatening - may lead to cardiac tamponadeo [FONT=Elementary SF]Papillary muscle dysfunction- [FONT=Elementary SF]Cardiogenic shock – impaired tissue perfusion due to pump failureo [FONT=Elementary SF]Occurs when functioning myocardial muscle decreases by more than 40%o [FONT=Elementary SF]Rareo [FONT=Elementary SF]Associated with poor outcomes – mortality rate is more than 70%o [FONT=Elementary SF]Occurs in acute stage up to weeks after- [FONT=Elementary SF]Pericarditis – inflammation of the heart o [FONT=Elementary SF]Prompted by tissue necrosiso [FONT=Elementary SF]Causes chest pain that is aggravated by: [FONT=Elementary SF]Lying supine [FONT=Elementary SF]Deep inspiration or coughingo [FONT=Elementary SF]Chest pain is relieved by: [FONT=Elementary SF]Sitting up [FONT=Elementary SF]Leaning forwardo [FONT=Elementary SF]Can hear pericardial friction rubo [FONT=Elementary SF]Treatment is steroids, NSAID’s- [FONT=Elementary SF]Dresslers syndrome – pericarditis that is a hypersensitivity response to necrotic tissue or an autoimmune responseo [FONT=Elementary SF]Develops 4-6 weeks after MIo [FONT=Elementary SF]Signs & Symptoms: [FONT=Elementary SF]Fever [FONT=Elementary SF]Pain [FONT=Elementary SF]Pericardial friction rubo [FONT=Elementary SF]Treatment: short-term steroids [B][FONT=Elementary SF]Heart Failure – Facts[/B]- [FONT=Elementary SF]Heart failure is generally manifested by biventricular failure although one ventricle may precede the other in dysfunction- [FONT=Elementary SF]Heart failure may affect just one side- [FONT=Elementary SF]Failure typically occurs most commonly in the left side of the heart- [FONT=Elementary SF]Signs and symptoms:o [FONT=Elementary SF]Depends if failure is acute or chronico [FONT=Elementary SF]Acute: [FONT=Elementary SF]Sudden onset [FONT=Elementary SF]As result of an MI [FONT=Elementary SF]May present as pulmonary edemao [FONT=Elementary SF]Chronic: [FONT=Elementary SF]Develops gradually over time [FONT=Elementary SF]Symptoms are less severe[B][FONT=Elementary SF]Heart Failure – Pathophysiology[/B]- [FONT=Elementary SF]Heart fails to pump enough blood to meet metabolic demands during activity & at rest- [FONT=Elementary SF]Results in:o [FONT=Elementary SF]Vasoconstrictiono [FONT=Elementary SF]Fluid retention[B][FONT=Elementary SF]Heart failure – Causes[/B]- [FONT=Elementary SF]Increase in preload o [FONT=Elementary SF]Mitral regurgitationo [FONT=Elementary SF]Aortic regurgitationo [FONT=Elementary SF]Left to right shunts through atrial or septal defects- [FONT=Elementary SF]Increase in afterloado [FONT=Elementary SF]Systemic hypertensiono [FONT=Elementary SF]Aortic stenosis- [FONT=Elementary SF]Decrease in contractility from:o [FONT=Elementary SF]Myocardial damageo [FONT=Elementary SF]Myocardial infarctono [FONT=Elementary SF]Myocarditiso [FONT=Elementary SF]Cardiomyopathy- [FONT=Elementary SF]Decrease in filling of cardiac chambers from:o [FONT=Elementary SF]Constricted ventricleo [FONT=Elementary SF]Cardiac tamponadeo [FONT=Elementary SF]Pericarditis [B][FONT=Elementary SF]Heart failure - Compensatory Mechanisms[/B]- [FONT=Elementary SF]An overloaded heart depends on compensatory mechanisms to maintain an adequate cardiac output- [FONT=Elementary SF]Sympathetic nervous system activationo [FONT=Elementary SF]First mechanism triggered in low cardiac output stateso [FONT=Elementary SF]Least effective compensatory mechanismo [FONT=Elementary SF]Increases release of epinephrine and norepinephrineo [FONT=Elementary SF]Signs & symptoms: [FONT=Elementary SF]Increases heart rate [FONT=Elementary SF]Increases contractility [FONT=Elementary SF]Peripheral vasoconstrictiono [FONT=Elementary SF]Over time leads to an increase oxygen demand and workload of the heart- [FONT=Elementary SF]Neurohormonal responseso [FONT=Elementary SF]Renin-angiotensin-aldosterone system is activatedo [FONT=Elementary SF]Posterior pituitary releases ADH causing water retention (increased blood volumeo [FONT=Elementary SF]Endothelin is released causing vasoconstriction, increased contractility, and hypertrophy- [FONT=Elementary SF]Ventricular dilationo [FONT=Elementary SF]Occurs in response to the increased blood volume - [FONT=Elementary SF]Ventricular hypertrophy[B][FONT=Elementary SF]Heart Failure - Diagnosis[/B]- [FONT=Elementary SF]History & physical- [FONT=Elementary SF]Chest x-ray- [FONT=Elementary SF]EKG- [FONT=Elementary SF]Echocardiogram to measure ejection fraction – to determine if HF is systolic & diastolic- [FONT=Elementary SF]Stress test- [FONT=Elementary SF]ABG’s- [FONT=Elementary SF]Cardiac enzymes, BNP (over 100 indicative of HF not SOB), electrolytes, CBC, liver function tests, thyroid function tests, BUN, creatinine- [FONT=Elementary SF]Hemodynamic monitoring – pulmonary artery catheter (PA catheter) used to measure PA pressure, pulmonary capillary wedge pressure and cardiac output[B][FONT=Elementary SF]Heart Failure - Diagnostic Findings[/B]- [FONT=Elementary SF]Chest x-ray – increased pulmonary congestion, left ventricular hypertrophy- [FONT=Elementary SF]Echocardiogram – increased size of cardiac chambers & decreased wall motion, decreased EF is consistent with systolic failure- [FONT=Elementary SF]Hemodynamic monitoring – increased pulmonary capillary wedge pressure and pulmonary artery pressure and decreased cardiac output- [FONT=Elementary SF]ABG’s hypoxia, and hypercapnia (norm 35-45)- [FONT=Elementary SF]EKG left ventricular hypertrophy, ST-T wave changes- [FONT=Elementary SF]Serum blood levels – decreased potassium (3.5-5.0), sodium (135-145), increased BUN (10-30), creatinine (0.5-1.5)- [FONT=Elementary SF]Elevated BNP (normal is less than 100) correlates positively with the degree of left ventricular dysfunction and can help to differentiate dyspnea caused by COPD exacerbation[B][FONT=Elementary SF]Heart Failure – Staging Systems/Classifications[/B][B][FONT=Elementary SF]American College of Cardiology/American Heart Association[/B] [FONT=Elementary SF]Based on patient risk factors, symptoms, and any cardiac structural defects [FONT=Elementary SF]Aim’s to promote prevention as well as guide treatment[B][FONT=Elementary SF]Stages A-D[/B] [FONT=Elementary SF]Stage A – the patient is at risko [FONT=Elementary SF]Control HTN using the following: [FONT=Elementary SF]thiazide diuretics [FONT=Elementary SF]ACE inhibitors [FONT=Elementary SF]angiotensis receptor blockers AND [FONT=Elementary SF]beta blockerso [FONT=Elementary SF]Control dyslipidemiao [FONT=Elementary SF]Control diabeteso [FONT=Elementary SF]Treat underlying disorderso [FONT=Elementary SF]Encourage healthy living [FONT=Elementary SF]Stage B – the patient with structural troubleo [FONT=Elementary SF]Slow disease progressiono [FONT=Elementary SF]Improve survivalo [FONT=Elementary SF]Minimize risk factorso [FONT=Elementary SF]ACE inhibitor & beta blockers unless contraindicated [FONT=Elementary SF]Stage C – the patient who has had a start of symptomso [FONT=Elementary SF]Build on treatments from stage A & B, add therapies to slow disease progression, decrease symptoms, and improve survivalo [FONT=Elementary SF]Diuretics – used for patients with fluid retentiono [FONT=Elementary SF]Digoxin – used for patients who are still symptomatic despite therapy with ACE inhibitors, beta blockers, and diureticso [FONT=Elementary SF]Aldosterone antagonists (Spironolactone)o [FONT=Elementary SF]Vasodilators (hydralazine and isosorbide) – used in patients who continue to be symptomatic despite treatment with ACE inhibitors, beta blockers OR who can’t tolerate ACE inhibitorso [FONT=Elementary SF]Discontinue medications that interfere with heart failure treatment such as: [FONT=Elementary SF]NSAID’s, Calcium Channel Blockers, and antiarrythmicso [FONT=Elementary SF]Patients with HF have an increased risk for sudden cardiac death, can be reduced by: [FONT=Elementary SF]Beta blockers [FONT=Elementary SF]Aldosterone antagonist therapy [FONT=Elementary SF]Implantable cardioverter defibrillator - [FONT=Elementary SF]Indicated for patients with ejection fraction below 30%o [FONT=Elementary SF]Device therapy - 15 to 30% of patients with HF also have conduction disease [FONT=Elementary SF]Cardiac Resynchronization Therapy, also called biventricular pacing- [FONT=Elementary SF]Uses a battery operated implantable device that is implanted under the skin of chest, similar to a pacemaker to treat HF- [FONT=Elementary SF]Three leads deliver tiny impulses that help both ventricles beat together in a more synchronized pattern to:o [FONT=Elementary SF]Improve the hearts ability to pump blood and oxygen to the bodyo [FONT=Elementary SF]Reverse ventricular remodelingo [FONT=Elementary SF]Improve functional abilityo [FONT=Elementary SF]Reduce symptomso [FONT=Elementary SF]Improve quality of life- [FONT=Elementary SF]Expensive but therapeutic treatment [FONT=Elementary SF]Ventricular remodeling- [FONT=Elementary SF]Refers to dilatation and hypertrophy that cause the heart to contract less efficiently [FONT=Elementary SF]Stage D – the patient with end-stage heart failureo [FONT=Elementary SF]Patients are symptomatic at rest and with minimal exertiono [FONT=Elementary SF]Hospitalized frequently for clinical deteriorationo [FONT=Elementary SF]Requires intermittent IV diureticso [FONT=Elementary SF]Ionitropic support with dopamine, dobutamine, vasodilatorso [FONT=Elementary SF]ACE inhibitors and beta blocker doses are decreasing because of hypotension and worsening renal failure[B][FONT=Elementary SF]The New York Heart Association (NYHA) Functional Classification of Heart Failure[/B]- [FONT=Elementary SF]Subjective ranking based on the patients functional ability- [FONT=Elementary SF]Classification can change is symptoms improve with therapy[B][FONT=Elementary SF]Class I-IV[/B]- [FONT=Elementary SF]Class I - no limitation of physical ability- [FONT=Elementary SF]Class II – slight limitation of physical abilityo [FONT=Elementary SF]Patient is comfortable at resto [FONT=Elementary SF]Ordinary physical activity causes HF symptoms- [FONT=Elementary SF]Class III – marked limitation of physical activityo [FONT=Elementary SF]Comfortable at resto [FONT=Elementary SF]Less than ordinary physical activity causes HF symptoms- [FONT=Elementary SF]Class IV – severe limitationso [FONT=Elementary SF]Patient has symptoms of heart failure at resto [FONT=Elementary SF]Any physical activity increases the discomfort [B][FONT=Elementary SF]Heart Failure – Classification[/B]- [B][FONT=Elementary SF]Systolic Failure[/B][FONT=Elementary SF] – defect in the ventricles ability to pump or contracto [FONT=Elementary SF]The most common cause of heart failureo [FONT=Elementary SF]Results from the hearts inability to pump bloodo [FONT=Elementary SF]Left ventricle is unable to generate enough pressure to eject blood forward to the aorta [FONT=Elementary SF]The ventricle becomes thin walled, dilated, and hytropiedo [FONT=Elementary SF]Decrease in left ventricle ejection fraction – the percentage of total ventricle contraction [FONT=Elementary SF]Normal EF is greater than 55% of the ventricular volumeo [FONT=Elementary SF]Caused by [FONT=Elementary SF]impaired contractility (because of MI) [FONT=Elementary SF]increased afterload (because of HTN or cardiomyopathy) [FONT=Elementary SF]mechanical abnormalities (such as with valvular heart disease)- [B][FONT=Elementary SF]Diastolic Failure [/B][FONT=Elementary SF]– an impaired ability of the ventricles to relax and fill during diastoleo [FONT=Elementary SF]Decreased filling of the ventricles results in decreased stroke volume and cardiac outputo [FONT=Elementary SF]Diastolic failure is characterized by: [FONT=Elementary SF]High filling pressure due to still or noncompliant ventricleso [FONT=Elementary SF]Diastolic failure results in: [FONT=Elementary SF]Venous engorgement in both the pulmonary and systemic vascular systemso [FONT=Elementary SF]Diagnosis is made on basis of: [FONT=Elementary SF]Hypertension [FONT=Elementary SF]Ventricular hypertrophy [FONT=Elementary SF]Normal ejection fractiono [FONT=Elementary SF]Usually a result of: [FONT=Elementary SF]Left ventricular hypertrophy (as a result of chronic HTN) [FONT=Elementary SF]Aortic stenosis [FONT=Elementary SF]Hypertrophic cardiomyopathyo [FONT=Elementary SF]Commonly seen in: [FONT=Elementary SF]Older adults, predominately women [FONT=Elementary SF]Secondary to myocardial fibrosis & hypertensiono [FONT=Elementary SF]Less commonly seen in: [FONT=Elementary SF]Isolated right ventricular diastolic failure (as a result of pulmonary hypertension) & Reduced right ventricular emptying – resulting in Low left ventricular filling pressure and reduced cardiac output [FONT=Elementary SF]Can cause rapid patient mortality despite a normal left ventricle- [B][FONT=Elementary SF]Mixed Systolic & Diastolic Failure[/B][FONT=Elementary SF] – seen in dilated cardiomyopathy (DCM)o [FONT=Elementary SF]DCM – a condition in which poor systolic function (as a result or weakened muscle function) is compromised by dilated left ventricular walls that are unable to relaxo [FONT=Elementary SF]Patients present with some or all of the following: [FONT=Elementary SF]Poor EF – less than 35% [FONT=Elementary SF]High pulmonary pressures [FONT=Elementary SF]Biventricular failure (dilated with poor filling and emptying capacity) [FONT=Elementary SF]Low blood pressure [FONT=Elementary SF]Low cardiac output [FONT=Elementary SF]Poor renal perfusion [FONT=Elementary SF]Poor exercise tolerance [FONT=Elementary SF]Has ventricular dysrhythmias[B][FONT=Elementary SF]Chronic Heart Failure – Clinical Manifestations[/B]- [FONT=Elementary SF]Fatigueo [FONT=Elementary SF]One of earliest symptoms- [FONT=Elementary SF]Dyspneao [FONT=Elementary SF]Persistent dry cough – may be first clinical symptomo [FONT=Elementary SF]Need to sleep elevated- [FONT=Elementary SF]Tachycardiao [FONT=Elementary SF]Early sign- [FONT=Elementary SF]Edema- [FONT=Elementary SF]Nocturia- [FONT=Elementary SF]Skin changes o [FONT=Elementary SF]Dusky appearanceo [FONT=Elementary SF]Cool and damp from diaphoresiso [FONT=Elementary SF]Lower extremities shiny and swollen with no hairo [FONT=Elementary SF]Ankles appear brown or brawny- [FONT=Elementary SF]Behavioral changeso [FONT=Elementary SF]Restlessnesso [FONT=Elementary SF]Confusiono [FONT=Elementary SF]Decreased attention or memory- [FONT=Elementary SF]Chest pain- [FONT=Elementary SF]Weight changes[B][FONT=Elementary SF]Heart Failure – Types[/B][B][FONT=Elementary SF]Left-sided Heart Failure[/B]- [FONT=Elementary SF]Blood backs up into the left atria and into the pulmonary veins - [B][FONT=Elementary SF]Causes[/B][FONT=Elementary SF]:o [FONT=Elementary SF]Reduced cardiac outputo [FONT=Elementary SF]Poor perfusiono [FONT=Elementary SF]Accumulation of blood in the hearto [FONT=Elementary SF]Congestion increases pressure in the pulmonary vessels and causes fluid to move out of vessels and in to the interstitial tissueso [FONT=Elementary SF]Excessive fluid in the tissues of the lungs leads to pulmonary edema [FONT=Elementary SF]Emergency complication of left-sided heart failure [FONT=Elementary SF]Must be assessed quickly and aggressively managed [FONT=Elementary SF]Keep feet low (dangle) [FONT=Elementary SF]Patient will be gasping for air- [B][FONT=Elementary SF]Left-sided Heart Failure - Signs[/B]o [FONT=Elementary SF]Dyspneao [FONT=Elementary SF]Orthopnea (SOB in recumbent position)o [FONT=Elementary SF]Paroxysmal nocturnal dyspneao [FONT=Elementary SF]Moist crackleso [FONT=Elementary SF]Tachypnea (32-40 BPM)o [FONT=Elementary SF]Tachycardia [FONT=Elementary SF]Early signo [FONT=Elementary SF]S3 gallop and S4 heart soundo [FONT=Elementary SF]Fatigueo [FONT=Elementary SF]Anxiety, restlessness, confusiono [FONT=Elementary SF]Nocturiao [FONT=Elementary SF]Pulse alterations (strong/weak)o [FONT=Elementary SF]Have a feeling of impending doom- [B][FONT=Elementary SF]Left-sided Heart Failure - Symptoms[/B]o [FONT=Elementary SF]Weakness, fatigueo [FONT=Elementary SF]Anxiety, depressiono [FONT=Elementary SF]Dyspneao [FONT=Elementary SF]Shallow respirationso [FONT=Elementary SF]Dry hacking cougho [FONT=Elementary SF]Nocturiao [FONT=Elementary SF]Frothy pink sputum[B][FONT=Elementary SF]Right-sided Heart Failure[/B]- [FONT=Elementary SF]Blood backs up in the right atrium and then venous circulation- [B][FONT=Elementary SF]Causes:[/B]o [FONT=Elementary SF]Primary cause is left-sided heart failureo [FONT=Elementary SF]Venous congestion in the systemic circulation results in: [FONT=Elementary SF]Jugular vein distension (JVD) [FONT=Elementary SF]Hepatomegaly [FONT=Elementary SF]Splenomegaly [FONT=Elementary SF]Congestion of the GI tract [FONT=Elementary SF]Peripheral edema- [B][FONT=Elementary SF]Right-sided Heart Failure - Signs[/B]o [FONT=Elementary SF]Distended neck veinso [FONT=Elementary SF]Peripheral edemao [FONT=Elementary SF]Hepatomegalyo [FONT=Elementary SF]Increased liver function testso [FONT=Elementary SF]Prolonged prothrombin timeo [FONT=Elementary SF]Asciteso [FONT=Elementary SF]Anasarca (massive body edema)o [FONT=Elementary SF]Weight gaino [FONT=Elementary SF]Tachycardiao [FONT=Elementary SF]Fatigueo [FONT=Elementary SF]Anorexiao [FONT=Elementary SF]Murmur- [B][FONT=Elementary SF]Right-sided Heart Failure - Symptoms[/B]o [FONT=Elementary SF]Fatigueo [FONT=Elementary SF]Anxiety depressiono [FONT=Elementary SF]Dependant edemao [FONT=Elementary SF]Right upper quadrant paino [FONT=Elementary SF]GI bloatingo [FONT=Elementary SF]Nausea[B][FONT=Elementary SF]Heart Failure – Management[/B]- [FONT=Elementary SF]Oxygen- [FONT=Elementary SF]Correct underlying problems- [FONT=Elementary SF]Ionitropic agents o [FONT=Elementary SF]Digoxin, dopamine, epinephrine, norepinepherineo [B][FONT=Elementary SF]Digoxin[/B] [FONT=Elementary SF]Maximize cardiac function [FONT=Elementary SF]Increases contractility, SV, and cardiac output [FONT=Elementary SF]Slows ventricular response in atrial fibrillation/atrial flutter- [FONT=Elementary SF]Need to start with a loading dose (1.0-1.5 mg) to get an adequate blood level- [FONT=Elementary SF]Then a maintenance dose (0.125-0.25 mg) per day to maintain blodd levels in a therapeutic range of 0.5-2.0 ng/mL [FONT=Elementary SF]Not a first line drug because of common toxic effects which are frequently associated with serious arrhythmias [FONT=Elementary SF]Factors promoting dig toxicity:- [FONT=Elementary SF]Hypokalemia- [FONT=Elementary SF]Hypomagnesemia- [FONT=Elementary SF]Hypercalemia- [FONT=Elementary SF]Impaired renal function- [FONT=Elementary SF]Ace inhibitors o [FONT=Elementary SF]Reduce mortality and improve LV dysfunction in post MI patients, delay progression of HF, decrease sudden death and recurrent MI [FONT=Elementary SF]Lisinopril, captopril, enalapril- [FONT=Elementary SF]Diuretics o [FONT=Elementary SF]Increase urine production which reduces the volume and pressure of blood to be pumped by the heart [FONT=Elementary SF]Furosemide, spironolactone- [FONT=Elementary SF]Beta Blockers o [FONT=Elementary SF]Inhibit chronic activation of the sympathetic nervous system. [FONT=Elementary SF]Most common metoprololo [FONT=Elementary SF]Need to be started at a low dose – monitor patient carefully for adverse effects: [FONT=Elementary SF]Fluid retention [FONT=Elementary SF]Worsening heart failure symptoms [FONT=Elementary SF]Fatigue [FONT=Elementary SF]Reduce or discontinue for symptomatic Bradycardia or heart blocko [FONT=Elementary SF]Vasodilators [FONT=Elementary SF]Used to reverse the vasoconstriction that occurs as a compensatory mechanism in response to reduced cardiac output. - [FONT=Elementary SF]Can reduce pulmonary congestion without affecting systemic blood pressure- [FONT=Elementary SF]Some vasodilators (hydralazine) primarily affect arterioles to reduce systemic vascular resistance (afterload) and increase cardiac output- [FONT=Elementary SF]Some vasodilators (nitroprusside, [B]IV[/B] prazosin) affect both venous and arterial dilation – reduce both preload and afterloado [FONT=Elementary SF]Diet [FONT=Elementary SF]2 gram sodium [FONT=Elementary SF]In cases of severe heart failure, fluid intake may be restricted to 1000ml or less per 24 houro [FONT=Elementary SF]Bed rest [FONT=Elementary SF]To allow fluid from periphery to enter the systemic circulation and increase venous returno [FONT=Elementary SF]Prophylactic anticoagulant therapy to reduce the risk of thromboembolism[B][FONT=Elementary SF]Heart Failure - Nursing Management [/B]- [FONT=Elementary SF]Position of patient- [FONT=Elementary SF]Improve gas exchange and oxygenation- [FONT=Elementary SF]Reduce anxiety- [FONT=Elementary SF]Frequent rest periods- [FONT=Elementary SF]Patient teaching regarding medications- [FONT=Elementary SF]Patient teaching as needed- [FONT=Elementary SF]Diet teaching- [FONT=Elementary SF]Advise patient not to strain at stool- [FONT=Elementary SF]Supplemental oxygen as ordered- [FONT=Elementary SF]Organize care to provide needed rest- [FONT=Elementary SF]Monitor hemodynamic measurements- [FONT=Elementary SF]Administer meds as ordered[B][FONT=Elementary SF]Heart Failure - Nursing Diagnoses [/B]- [FONT=Elementary SF]Decreased cardiac output- [FONT=Elementary SF]Risk for ineffective breathing pattern- [FONT=Elementary SF]Activity intolerance- [FONT=Elementary SF]Fluid volume excess- [FONT=Elementary SF]Knowledge deficit[B][FONT=Elementary SF]Heart Failure - Complications [/B][B][FONT=Elementary SF]Pulmonary Edema[/B]- [FONT=Elementary SF]Acute, life threatening situation- [FONT=Elementary SF]Fluid accumulation- [FONT=Elementary SF]Most common cause is acute left ventricular failure secondary to CAD[B][FONT=Elementary SF]Pulmonary Edema – Signs & Symptoms[/B]- [FONT=Elementary SF]Foamy blood tinged sputum – classic sign- [FONT=Elementary SF]Air hunger- [FONT=Elementary SF]Sense of impending doom- [FONT=Elementary SF]Pale (could be cyanotic)- [FONT=Elementary SF]Cold and clammy skin- [FONT=Elementary SF]Tachypnea- [FONT=Elementary SF]Tachycardia- [FONT=Elementary SF]Hypertension or hypotension depending on severity- [FONT=Elementary SF]Wheezes on auscultation, progressing to diffuse crackles[B][FONT=Elementary SF]Pulmonary Edema - Diagnosis[/B]- [FONT=Elementary SF]History, physical- [FONT=Elementary SF]Chest x-ray- [FONT=Elementary SF]Pulmonary capillary wedge pressure 22-24 mmHg[B][FONT=Elementary SF]Pulmonary Edema – Nursing Actions[/B]- [FONT=Elementary SF]Get the patient out of bed, sit them up and dangle their legs- [FONT=Elementary SF]Obtaining blood gases [B]not[/B] a priority[B][FONT=Elementary SF]Pulmonary Edema - Management[/B]- [FONT=Elementary SF]Oxygen to relieve hypoxia- [FONT=Elementary SF]High fowlers position – dangle feet- [FONT=Elementary SF]Morphine sulfate IV to reduce preload and afterload (high dose)- [FONT=Elementary SF]Lasix IV to reduce volume and preload and promote dieresis (high dose)- [FONT=Elementary SF]Vasodilators to reduce afterloado [FONT=Elementary SF]Nitroprusside (Nesiritide) - [FONT=Elementary SF]BiPAP or intubation and mechanical ventilation, if needed to improve gas exchange and oxygenation- [FONT=Elementary SF]Suction if needed to keep airway patent- [FONT=Elementary SF]Oxygen to keep paO2 >60 mmHg- [FONT=Elementary SF]Record intake and output- [FONT=Elementary SF]Provide emotional support for patient and their family[B][FONT=Elementary SF]Heart Failure – Complications [/B][B][FONT=Elementary SF]Pleural Effusion[/B]- [FONT=Elementary SF]Results from increasing pressure in the pleural cavities[B][FONT=Elementary SF]Heart Failure - Complications[/B][B][FONT=Elementary SF]Dysrhythmias[/B]- [FONT=Elementary SF]Chronic HF causes enlargement of the chambers of the heart o [FONT=Elementary SF]This may lead to alterations in the normal electrical pathway, especially the atria. When numerous sites in the atria fire spontaneously and rapidly (atrial fibrillation), normal atrial depolarization does not occur. This may reduce Cardiac output by 10-20%.o [FONT=Elementary SF]Atrial fibrillation promotes thrombus formation within the atriao [FONT=Elementary SF]Patients are at risk for strokeo [FONT=Elementary SF]Require treatment with: [FONT=Elementary SF]Cardiversion [FONT=Elementary SF]Antidysrhythmics [FONT=Elementary SF]Anticoagulantso [FONT=Elementary SF]Patients with HF and EF less than 35% have a high risk of fatal dysrhythmias [FONT=Elementary SF]About 50% experience sudden cardiac death[B][FONT=Elementary SF]Heart Failure - Complications[/B][B][FONT=Elementary SF]Hepatomegaly[/B]- [FONT=Elementary SF]Highest risk in right sided heart failure- [FONT=Elementary SF]Liver nodules become congested with blood leading to impaired liver function[B][FONT=Elementary SF]Heart Failure - Complications[/B][B][FONT=Elementary SF]Renal Failure[/B]- [FONT=Elementary SF]The decreased cardiac output that occurs with chronic HF results in decreased perfusion to the kidneys and can lead to renal insufficiency

[TessaMae]

just reviewing my notes and realized I made a typo...nitro tabs should tingle under tongue.

[icurn11]

Awesome notes!!! Thanks for posting.

[BrokePHIBroke]

Oh, this was so helpful! Thanks for posting, you're awesome.