Cardiac Emergency Nursing

Question 1

Clinical signs of cardiovascular disease (8)

Answer 1

1. Exercise intolerance or weakness
2. Tachy- or Dyspnea
3. Coughing
4. Syncope (fainting)
5. Abnormal HR or heart rhythm
6. Abnormal pulse quality or pulse deficit
7. CPR prolonged
8. Ascites or pleural effusion

Question 2

Heart failure
1. What is it?
2. Right side
3. Left side

Answer 2

1. Referring to any heart disease that leads to very significant “heart pump” insufficiency & compensatory mechanisms of the body cause fluid to accumulate in the tissues.
2. Free fluid accumulates in pleural &/or abdominal cavity
   - Common in cats
3. Fluid accumulates in the lungs
   - Common in dogs

Question 3

Three goals of emergency cardiac care

Answer 3

1. Restore oxygenation/ventilation
2. Restore perfusion
3. Minimize stress!

Question 4

Emergency care of heart: Dogs (3)

Answer 4

1. Oxygen therapy
   - Cage, tent, hood, or flow-by
2. Furosemide (IV or IM)
   - Diuretic treats pulmonary edema
3. Nitroglycerin ointment on pinna
   - Vasodilator treats pulmonary edema
4. Pt may need to wait 1-2hrs for drugs to work
5. Radiographs
   - DV, without stretching, initially due to Pt status

Question 5

Goals for first few hours of K9 cardiac improvement (5)

Answer 5

1. IVC for drugs & emergency use
2. Pulse Ox
3. EKG
4. Blood eval
5. Complete set of rads

Question 6

Cardiac K9
Therapy & diagnostics over first few days

Answer 6

1. Therapy
   - O2
   - Furosemide
   - Digoxin if cardiomyopathy
   - Low salt diet
2. Dx
   - Echocardiogram

Question 7

Dilated Cardiomyopathy (DCM)
1. What is it to dogs?
2. Pathology (3)

Answer 7

1. Hereditary disease
   - Doberman, boxer, cocker span, st bernards
2. Pathology
   - Heart muscle becomes thin & flabby
   - Heart chambers enlarge to compensate
   - Heart arrhythmias are common

Question 8

Mitral Valve dysfunction
1. Pathology
2. Diagnosis (3)

Answer 8

1. Nodular thickening of the heart valve causes leaking of the valve during systole and increased workload in the left atrium & the potential for heart failure.
2. Dx
   - Systolic heart murmur
   - Cough, esp at night or w exercise
   - Rads or ultra showing left atrial enlargement with or w/o heart failure (pulmonary edema)

Question 9

Cardiac Tamponade
1. Etiology
2. Diagnosis (3)
3. Treatment (3)

Answer 9

1. Pericardium fills with blood (often due to bleeding tumor) and the pressure prevents the right atrium from filling normally
2. Dx
   - EKG
   - Rads
   - Ultra of heart
3. Tx
   - Emergency Pericardiocentesis
   - IVF to restore preload pressure
   - May need surgery if problem keeps occurring

Question 10

Pericardiocentesis
What is it / How is it done? (3)

Answer 10

1. A large catheter is inserted in the pericardium from the right side to remove pericardium from the right side to remove pericardial fluid
2. All samples collected should be submitted for cytology (eval for cause)
3. Ideally, animal is on cont EKG during procedure, if needle touches heart, arrhythmias usually occur.

Question 11

Emergency care of Heart - Feline
Dyspnea due to feline heart disease is usually associated with…
Treatment includes… (3)

Answer 11

Pleural effusion
1. Emergency Thoracocentesis
2. Oxygen support
3. Minimize stress

Question 12

Hypertrophic Cardiomyopathy (HCM)
1. Disease relation to felines
2. Commonly due to…
3. Pathology
4. Diagnosis (2)

Answer 12

1. Heredirary in cats
   - Persian, maine coon, norwegian forrest
2. Hyperthyroidism
   - Rev if hyperthyr successfully treated
3. Thickened heart muscle with very small chamber size.
   - Thromboembolism to caudal aorta is possible fatal complication.
4. Dx:
   - Rads / ultra consistent with heart changes or failure

Question 13

Cardiomyopathy - Feline
Treatment (2)

Answer 13

1. Tx according to heart failure signs
2. If saddle thrombus - prog is poor
   - Dissolve clot (high risk)
   - Pain relief
   - Dilate arteries
   - Tx heart disease