Flashcards in cardiac Deck (63)
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1
blood flow of heart
superior and inferior vena cava (deoxygenated)--R atrium--R ventricle--pulmonary artery--goes to lungs and becomes oxygenated--pulmonary veins (oxygenated now)-- L atrium--L ventricle--aorta-- body
2
preload
blood returning to the R side of the heart
muscle stretch (strength) that the volume causes
ANP released during stretch
increased preload = increased strength (workload)
3
afterload
pressure in aorta and PERIPHERAL arteries that the L ventricle has to pump against to get blood out
aka resistance
high afterload = low cardiac output and low forward flow
4
stroke volume
amount of blood pumped out of the ventricles with each beat
5
cardia output
HR x SV
tissue perfusion is dependent on adequate CO
CO changes according to body's needs
6
factors that affect CO
HR
arrhythmia (brady and tachy)
blood volume (less volume = less CO) (more volume = more CO)
decreased contractility
7
meds that affect preload
vasodilator/diurese to decrease preload
diuretics (furosemide)
nitrates (nitroglycerin)
8
meds that affect afterload
vasodilator to decrease afterload
ACE inhibitors (enalapril) "pril"
ARBS (losartan) "sartan"
hydralazine
nitrates (nitroglycerin)
9
meds that improve contractility
inotropes (dopamine) "amine"
10
meds that control rate
beta blockers (propranolol) "olol"
calcium channel blockers (diltiazem, verapamil, amlodipine)
digoxin
11
meds that control rhythm
antiarrhythmics (amiodarone)
12
patho of low CO
will not perfuse properly
LOC goes down
chest pain
crackles
SOB
cold and clammy
urine output goes down
weak peripheral pulses
13
arrhythmias that are always a big deal
pulseless vtach
vfib
asystole
14
coronary artery disease
broad term
chronic stable angina
acute coronary syndrome
15
chronic stable angina patho
intermittent decreased blood flow
ischemia so pain/pressure in chest
low O2 r/t exertion
rest or nitro to relieve pain/pressure
16
chronic stable angina treatment
nitroglycerin
beta blockers
calcium channel blockers
acetylsalicylic acid (aspirin)
17
nitroglycerin
causes venous and arterial dilation
decreased preload and afterload
dilation of coronary arteries which increases blood flow to the heart muscle (myocardium)
take 1 q 5min x 3doses
DONT SWALLOW
keep in dark, glass bottle, dry, cool
will get a headache
renew every 6 months
renew spray every 2 years
BP drops so make them sit when taking
18
beta blockers
prevention of angina
check BP and pulse before giving
"olol"
decrease BP, pulse, and myocardial contractility
decreases workload of heart
CO decreases
19
calcium channel blockers
prevention of angina
"pine"
nifedipine
verapamil
amlodipine
diltiazem
decrease BP
vasodilate arterial system
dilate coronary arteries
decrease afterload and increase O2 to the heart muscle
20
acetylsalicylic acid
aka aspirin
dose determined by provider
21
teaching for chronic stable angina
rest
avoid overeating
avoid excess caffeine
avoid drugs that increase HR
wait 2 hours after eating to exercise
dress warm in cold weather
nitro prophylactically
smoking cessation
weight loss
isometric exercise
reduce stress
*****do everything you can to decrease the workload of the heart
22
cardiac catheterization
ask if they are allergic to iodine or shellfish
check kidney function because dye is excreted through the kidneys
hot shot (warm, flush, sweaty)
palpitations are normal
get baseline VS and 5Ps
after:
monitor VS
watch puncture site ******for bleeding and hematoma formation
assess extremity distal to puncture site (5 Ps)
puleslessness
pallor
pain
paresthesia
paralysis
temp CRT
bedrest-- flat, extremity straight x4-6hours
*****major complication is bleeding/hemorrhage
report pain ASAP
hold metformin 48hours after
23
unstable chronic angina
impending MI
24
acute coronary syndrome patho
aka MI
aka unstable angina
decreased blood flow to myocardium-- ischemia and necrosis
can happen at any time
rest and nitro do NOT relieve pain
25
acute coronary syndrome symptoms
pain (crushing)
pressure radiating to the L arm and L jaw
N/V
pain between shoulder blades
women:
GI s/s
epigastric discomfort
pain between shoulders
aching jaw or choking sensation
unusual fatigue
inability to catch a breath
****SOB is the number one sign for elderly
cold, clammy
BP drops
CO down
ECG changes
vomiting
26
labs for troponin isomers
troponin T <0.10
troponin I <0.03
27
stemi vs nstemi
*****worry about stemi client
stemi:
ST segment elevation myocardial infarction
having a heart attack
get them to cath lab for PCI (percutaneous coronary intervention) in less than 90min
nstemi:
non-st segment elevation myocardial infarction
less worrisome
28
labs for acute coronary syndrome
CPK-MB
cardiac specific isoenzyme
high w/ damage to cardiac cells
elevates within 3-6hours and peaks in 12-24 hours
troponin:
cardiac biomarker w/ high specificity to myocardial damage
elevates within 3-4 hours and remains elevated for up to 3 weeks
myoglobin:
increases with 1 hour and peaks in 12 hours
negative results are a good thing
troponin is the most sensitive for an MI or delays seeking care
29
untreated arrhythmia that can kill
pulseless vtach
vfib
asystole
30
