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Adult Health Test 1 > Cardiac Complications > Flashcards

Cardiac Complications Flashcards

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1
Q

_________________ is the build up of ACS plaque inside coronary vessels.

A

Coronary Artery Disease

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2
Q

CAD risk factors include:

A

DM, age, heredity, male, dyslipidemia, obesity

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3
Q

_____________ and ________ are two populations who have issues with HTN and lipids.

A

African Americans and Hispanics

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4
Q

Estrogen is ________

A

Cardioprotective

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5
Q

_____ angina is the most common type and occurs with stress and activity. It is relieved by ____.

A

Stable, rest

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6
Q

Prinzmetal’s angina is caused by ________. In between spasms, tissue gets hypoxic.

A

vasospasm

alters calcium flow and reduces prostaglandins

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7
Q

Unstable angina occurs more frequently and lasts longer. It can occur with or without _____. Heralds an MI.

A

activity

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8
Q

Angina pectoris is decreased ___.

A

O2

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9
Q

Causes of angina:

A

Hypotension (can be exercise induced), cocaine, HF, pulmonic diseases.

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10
Q

Clinical manifestations of angina include:

A

Chest pain, Description of pain – very important
Dyspnea, pallor, tachycardia, anxiety, and fear
Atypical symptoms – indigestion
Precipitating factors
Relieving factors – what made it go away? Nitro, bed rest, O2
Sense of “doom”

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11
Q

Diagnostic tests:

A 
EKG --> most important
Troponin --> lab of choice. CHF can bump levels
CK and CK-MB 
Stress test - Lexiscan and Dobutamine 
Echo or TEE
Coronary angiogram (Cath Lab)
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12
Q

Serum Cholesterol and Triglyceride Values

A

Total Cholesterol Under 200
LDL Less than 100
Tricglycerides < 150

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13
Q

Meds for angina:

A

Nitrates (don’t give to patients who take Viagra)
Aspirin - antiplatelet
Beta-blockers –> work by decreasing workload of heart (decreases HR) Ex: Lopressor. Decreases O2 demands which limits ischemia. **c/a in COPD/asthma patients. Can send them into a bronchospasm.
Calcium Channel Blocker - for prinzmetals angina, bradycardia, conduction defects or certain types of HF

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14
Q

Primary goal for angina:

A

increase oxygen. Put PT on 02 and 2L/min. Or if home, lay down and take deep breaths.

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15
Q

Nursing interventions:

A

Perform 12 Lead for acute CP – truly diagnostic
Have SL Nitro available
Continuous cardiac monitoring
4-6L/min of oxygen per NC
Space activities
Reduce risk factors: physician follow up, Na restriction, diet change, cholesterol meds

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16
Q

MONA is what?

A

morphine, oxygen, nitrates, aspirin

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17
Q

Acute coronary syndrome is what?

A

collaborations of s/s of sudden myocardial ischemia

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18
Q

Causes:

A

unstable angina, STEMI, N-STEMI

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19
Q

Clinical Manifestations:

A

chest pain – most defining characteristic. Sub-sternal or epigastric. Can radiate to L arm, radiate to jaw and neck. Pain lasts 10-20 mins. Dyspnea, diaphoresis, pallor, tachycardia.

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20
Q

Diagnostic tests:

A

EKG & cardiac enzymes

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21
Q

Treatment Modalities:

A

If blocked, revascularize. Do percutaneous!

Meds: tPA –> 2-3 large bore IV’s to draw labs off of

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22
Q

Acute MI

A

Blood flow is completely blocked
Results in death of myocardial cells – goes through ischemia and then death
N-STEMI is a partial occlusion – minor elevation of cardiac enzymes
STEMI – abrupt disruption of blood flow – no way that the body can compensate
Elevated ST segments or Q wave on 12 lead. Once you’re “healed,” you will always keep your Q wave.
Damage usually occurs in 1 out of the 3 coronary arteries
Lethal arrythmias (v-fib and v-tach) and death can occur (more so than because of necrotic tissues.

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23
Q

Coronary Arteries:

A

Left Anterior Descending (widow maker) -> left ventricle pump failure
Right coronary artery -> supplies R atria and ventricle
Circumflex -> supplies the back of the heart
Left Main Coronary Artery -> divides into circumflex and LAD

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24
Q

Resulting Damage to Walls of the Heart – can be full or partial

A

Subendocardium – non Q wave MI – only takes 20 mins for damage to show
Epicardium
Transmural – Q wave MI – through all layers of cardiac muscle. ST elevation
Remodeling

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25
Goal of all nursing interventions r/t MI
re-establish oxygen supply to area of MI
26
Door to ___ is 10 mins, to need IN artery is 90 mins.
EKG
27
Clinical Manifestations
Chest pain, nausea & vomiting, diaphoresis, tachycardia & tachypnea, hypotension or hypertension, dysrhythmias, signs of left heart failure, decreased LOC, fear and anxiety Hiccupping – diaphormatic irritation, cool/clammy, mottled skin
28
Nursing Interventions
``` 12 Lead EKG Assess Chest Pain (CP) Vitals & cardiac monitoring IV access and labs Watch for dysrhythmias Monitor I & O – fluid balance and kidney fx (decreases GFR) ```
29
Tx for MI
Revascularization: PTCI – cath lab, femoral approach. Can do angioplasty. Drug-eluding stents or bare metal stent. CABG – seen less and less. Usually take the saphenous vein from leg. Flip it upside down (because of valves)
30
Types of Cardiomyopathies
Dilated, hypertrophic, & restrictive
31
Cardiomyopathy definition:
enlarged, thickened, or rigid. Regular heart muscle is replaced with scar tissue (which is not functional). As the heart gets weaker due to nonfunctional cardiac muscle, it decreases the ability to pump the blood and maintain normal sinus rhythm. Most people get HF.
32
Etiology
usually uknown, recurrent MI, small genetic component, high mortality rate
33
Dilated cardiomyopathy definition
when heart chambers (atria and ventricles) are dilated…stretched thin. Chest X-ray shows enlarged heart – takes up most of chest. Usually starts in L ventricle and spreads to R ventricle.
34
Incidence
in pts with heart failure. The thinner the muscle wall gets, the less pumping that occurs. The L ventricle wall is typically thicker. Most dilated pts are between the ages of 20-60. Men ^.
35
Diagnosis
symptoms of HF. Echo, chest xray, stress test, murmur – valve – either rupture of cordi tendi or stretched valve.
36
Clinical Manifestations
``` SOB on exertion Weakness S3, S4, & AV murmur Dysrhythmias – because of overload (same as arrhythmias) Activity intolerance R and L heart failure signs ```
37
Treatment
``` Heart failure management Beta blockers, anti-arrhythmic, ACE’s – decrease afterload (reduces work of heart), & ARBS Diureticss Anticoagulants Inotropes – contractility Pacing therapies Pacemaker/AICD – implantable defib/Bi-V Revascularization therapies ```
38
Hypertrophic Cardiomyopathy definition and incidence
thickening of muscle fiber, characterized by decreased compliance. Impairs ventricular filling, which decreases cardiac output mostly genetic. Affects 600,000-1.5 million patients.
39
Diagnosis
H&P, murmur, chest x-ray, Echo – can measure thickness of left ventricle
40
Clinical Manifestations
Asymptomatic – for years! Sudden death, SOB, angina, syncope – decreased cardiac output, Ventricular arrhythmias, Fatigue, palpitations, S3 – marker for fluid overload
41
Treatment
``` • Medications  Beta blockers  Calcium channel blockers  Anti-arrhythmics • Non-surgical/surgical procedures  Ablations  AICD  Septal myectomy ```
42
Restrictive cardiomyopathy defintion
rigid, wont expand with filling. Pumping or systolic can be normal, filling or diastolic is abnormal. Least common type.
43
Diagnosis
Diagnosis – H&P, EKG, chest x-ray, TEE
44
Clinical Manifestations
``` S3 & S4 Dyspnea on exertion Increased jugular venous pressures - JVD Exercise intolerance Lungs crackly ```
45
Treatment
``` • Lifestyle changes  Diet, sodium restriction  Exercise! • Medications  ACE inhibitors  Digoxin  Beta blockers (cautiously)  Anticoagulants  Anti-dysrhythmics ```
46
Cardiogenic Pulmonary Edema
Definition-severe form of heart failure. Due to severe cardiac decompensation. Usually caused by MI, acute HF, or valvular disease. Contractility of ventricle is decreased. Ejection is decreased, lots of pressure in lungs. Large volume of fluid. Impaired gas exchange. Can be due to cardiac or lungs MEDICAL EMERGENCY!
47
Clinical Manifestations
* Respiratory: tachypnea, labored respirations, dyspnea, pink frothy sputum, crackles and wheezes * Cardiac-tachycardia, hypotensive, cyanotic, hypoxic, cool, clammy skin * Neuro: restless, anxious, impending doom – life-threatening medical emergency
48
Interventions
Sit upright legs dangle ABG’s – RESPIRATORY ACIDOSIS Manage pain tripod Oxygen applied & sats continuously monitored (CPAP or BI-PAP or vent) Morphine sulfate – alleviates air hunger Chest X-ray Meds – lasixs, 3-D’s  digoxin, dobutamine, & dopamine. Sometimes aminophylline. Narcan 0.4mg-2mg initial doses, up to 10mg I&O Suction or coughing secretions – pink frothy sputum.
49
Rheumatic Heart Disease is caused by
occurrence of abnormal immune response to group A strep  Rheumatic fever  Carditis Risk factors: crowded living conditions, poor hygiene, poor access to medical care
50
Clinical Manifestations Diagnosis Treatment
Clinical Manifestations: chest pain, heart murmur, rash, migratory polyarthritis • Diagnosis – H&P, labs: ESR, CBC, elevated WBC, C reactive protein – inflammatory marker, positive throat culture for strep • Treatment  Medications – antibiotic of choice is PCN, clindamycin or arythromycin -manage joint pain, etc.
51
Carditis
Occurs in 50% of rheumatic fever Affects all three layers of heart Clinical manifestations: Chest Pain, Tachycardia, Pericardial friction rub- can hear it at L, lower sternal border on expiration** Endocardial affects valve structure – murmur and additional scarring HF symptoms Treatment: Medications
52
Endocarditis affects:
valves! Definition-Inflammation of the endocardium Diagnosis – TEE damaged endothelium via valve damage, surgery, previous endocarditis, entry for pathogen. IV drug abuse… Central line. Foley catheter. Dental procedures.
53
Clinical Manifestations
``` Fever >101.5 Flu like symptoms and cough SOB and joint pain Heart murmurs heard in 90% Anorexia & abdominal pain Splenomegaly -if spleen is removed, immunizations need to be up to date! ```
54
Interventions
Medications – ABX (amoxicillin) Anti-inflammatory Anti-pyretics Teaching – dentist, abx prior to procedure Surgery Valve replacements (regurgitation – back flow) Removal of large vegetations
55
Myocarditis can occur to an _________ response.
immunologic Definition-Inflammation of the heart muscle. Causes – due to a virus – coxsackie B (rules out ABX) Incidence and risk factors – radiation, toxins, or drugs *** Diagnosis – CBC, WBC, C reactive protein Clinical manifestations – (depends on amount of tissue damage) HF symptoms Asymptomatic for a while Fever, fatigue, general malaise SOB, palpitations, arthralgias Sore throat, muffled S1, S3 murmur if caught early, may not have a lot of symptoms
56
Treatment
Medications Antibiotics Antiviral Corticosteroids - swelling ACE inhibitors, anti-arrhythmics, and anti-coagulants – no blood clots and make the blood less viscous Bedrest (for a couple weeks) and activity restrictions Dietary modifications – low salt diet “heart healthy” Tx goal is for cause of inflammation – keep in mind myocardial O2 demand
57
Pericarditis is the inflammation of the
pericardium! Usually viral. High risk: end-stage renal disease pts, cancer pts
58
Diagnosis
CBC Cardiac enzymes-elevated but not as high as MI EKG- ST segment elevation Echo Chest x-ray CT and/or MRI Hemodynamic monitoring – arterially monitor BP, decreasing window btwn systolic and diastolic. Why? Still have resistance r/t inflammation
59
Clinical Manifestations
``` Abrupt chest pain – usually the 1st sign Pericardial friction rub Low grade fever Dyspnea Reflex Tachycardia ```
60
Treatments
``` • Medications  Aspirin  Acetaminophen  NSAIDS – anti-inflammatory  Corticosteroids Incentive spirometer Oxygen Positioning Pericardiocentesis – aspirate the fluid Surgery – pericardectomy (large section of the pericardium is removed, done in severe cases, keep going into cardiac tamponade) ```
61
Complications
Pericardial effusion Cardiac tamponade – increase in pressure inside the heart (heart is trying to compensate for not filling, using more pressure to try to fill. Decreased diastolic filling – no room  drop in BP!) Pulsus paradoxus – pulses diminish during expiration. Chronic Constrictive pericarditis – scar tissue develops between pericardial layers
62
Valvular Heart Disease
• Aortic Valve Disease  Aortic Stenosis  Aortic Regurgitation ``` • Mitral Valve Disease  Mitral Stenosis  Mitral Regurgitation  Mitral Valve Prolapse  Tricuspid Stenosis ```
63
Diagnosis & Tx
Echo, Chest X-ray, EKG, cardiac cath, and exercise testing Medications – diuretics, ACE inhibitors, vasodilators, anticoagulants Teaching Percutaneous balloon valvotomy Surgery- Valve replacement
64
Abdominal Aortic Aneurysms
(AAA) more common in men, aging, and smoking
65
Clinical Manifestations
depends on where the AAA is. If it is thoracic (above the diaphragm – pretty uncommon. 10% are aortic) Neck pain, jaw pain, back pain. Non-descript. AAA is usually below the renal arteries. Urine output is decreased. Usually called the silent killer
66
Diagnosis and Treatment
``` CT/MRI Arteriogram TEE – can sometimes see the dissection Ultrasound – out pouching Medications Beta blockers – decrease HR Anti-hypertensives  HTN will kill these patients, keep systolic under 120. Surgery Open Endovascular stent grafts (EVSG) S3 --> heart failure (murmur after the lub-dub  diastolic murmur) kentuc-ky S4 --> stiff ventricle (happens before S1, S2  systolic murmur) Tennessee – takes more effort ```

Adult Health Test 1 (3 decks)

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