Chronic Cardiac Flashcards Preview

NURS 2501 > Chronic Cardiac > Flashcards

Flashcards in Chronic Cardiac Deck (135):
1

Beta-adrenergic blockers - Beta-blockers : action

block beta1 adrenergic receptors ( SNS ) found in cardiac muscle ; high dose - block beta2 in airways ( asthma & COPD !!! )

2

BB & HF

reverse effects of sympathetic stimulation

3

BB - SE

1. Dizziness
2. Hypotension & bradycardia

4

Angiotensin-converting enzyme (ACE) inhibitors - Key role in HF ( - pril )

inhibit renin-angiotensin-aldosterone mechanism - block conversion of angiotensin I to angiotensin II - prevents peripheral vasoconstriction; reduces blood volume ( inhibit aldosterone )

5

Angiotensin II receptor blockers (antagonists) (ARBs)

Losartan (Cozaar) - no cough

6

ACE inhibitors - SE

1. Headache, dizziness
2. Hypotension
3. Persistent dry cough
4. Hyperkalemia ( !!! K )

7

Vasodilators

Hydralazine ( Apresoline )

8

Vasodilators - action

act directly on arterial smooth muscles - produce peripheral vasodilation - lower BP , increase HR, increase CO

9

Nitrates

1. Isosorbide dinitrate ( Isordil )
2. Nitroglycerin ( Nitrostat )

10

Nitrates - action

increases oxygenated blood flow to myocardium by dilating coronary and systemic blood vessels - pooling of blood in peripheral BVs - reduce preload & afterload & myocardial O2 demand
SE: Headache !

11

Sympatholytics

1. Methyldopa ( Aldomet )
2. Clonidine ( Catapres )

12

Sympatholytics - action

stimulate alpha2 receptors in CNS to inhibit sympathetic cardio-accelerator and vasoconstrictor centers - decrease sympathetic outflow from CNS - decrease arterial pressure

13

Alpha-adrenergic blocker

Prazosin ( Minipress )

14

Alpha - adrenergic blocker - action

blocking the alpha1-receptors of vascular smooth muscle, thus preventing the uptake of catecholamines by the smooth muscle cells. This causes vasodilation and allows blood to flow more easily.

15

Calcium-Channel blockers

1. Nifedipine ( Procardia)
2. Diltiazem ( Cardizem )
3. Verapamil ( Isoptin )
4. Amlodipine ( Norvasc )

16

CCB - action

inhibit calcium ( contraction ) ion influx via slow channels into cells of myocardial and arterial smooth muscles - negative inotropic ; dilation !!!

17

Cardiac glycosides

Digoxin ( Lanoxin )

18

Cardiac glycosides

used primarily to treat HF ( & dysrhythmias); increase contractility - positive inotropic ; decrease conduction velocity via AV node ( negative dromotrope )

19

Anticoagulants

1. Heparin
2. LMWH - Enoxaparin ( Lovenox) - SQ
3. Warfarin (Coumadin )

20

Warfarin ( Coumadin ) - oral - action - PT + INR

prevent conversion of vitamin K - decreasing its production in liver - reducing several clotting factors ; vitamin K - role in extrinsic pathway ( forms fibrin ) in clotting cascade.

21

Foods high in Vitamin K

liver, cheese, egg yolk, leafy vegetables and oils

22

Heparin - IV ( PTT)

role in intrinsic pathway - inhibits conversion of fibrinogen to fibrin - prevents formation of fibrin clot - inhibits thrombin ; given IV

23

HF : DX

1. Echocardiogram - determines ejection fraction
2. EKG - electrical abnormalities
3. CXR - size
4. B-type Natriuretic Peptide ( BNP ) - elevated

24

B-type Natriuretic Peptide (BNP)

neurohormone released by stressed ventricles ( fluid overload) - promote vasodilation and diuresis via Na loss in the renal tubules. Not strong enough !

25

Ejection fraction - to determine type of heart failure - echocardiogram - systolic vs diastolic

Volume of blood ejected with each contraction ; (EDV - ESV) / EDV ; normal 50-70 % ; systolic HF - drops below 40 %; diastolic - normal

26

HF: causes

1. Atherosclerosis - CAD - primary cause !!! - MI cause muscle necrosis and loss of contractility
2. HTN - increased afterload - increased workload of the heart
3. Valvular disease - difficult for blood to move forward
4. Severe anemia , hypoxia
5. Dysrhythmias

27

Right-sided HF causes

1. Left ventricular failure
2. Right ventricular MI
3. Pulmonary hypertension & COPD - cor pulmonale

28

HF - medications - IV drip

1. Nesiritide ( Natrecor )
2. Milrinone
3. Dobutamine - increase contractility and CO
4. Morphine
5. Nitrates

29

Phosphodiesterase 3 Inhibitor, positive inotropic + vasodilator ( decrease preload + afterload )

Milrinone

30

Natriuretic peptide; combats effects of epinephrine and norepinephrine ; vasodilator ; recombinant form of human B-type natriuretic peptide (hBNP)

Nesiritide ( Natrecor )

31

CAD - non-modifiable risk factors

1. Age - older
2. Gender - men up to age 65
3. Family hx
4. Race - Afro-Americans

32

CAD - modifiable risk factors

1. Elevated lipids
2. Hypertension
3. Smoking
4. Inactivity/ obesity

33

Lipids panel

Total < 200
1. triglyceride < 150
2. LDL < 130 ( < 100 high risk )
3. HDL > 45 ( higher better )

34

Smoking & CAD

1. Nicotine increases HR + causes vasoconstriction
2. Carbon monoxide circulating in the bloodstream - chemical injury to vessel wall

35

Exercise & CAD

1. AHA - 30 min/day
2. increase HDL + collateral circulation

36

CAD - contributing risk factors

1. Diabetes Mellitus
2. Stress - type A personality, hostility
3. High homocysteine levels - amino acid - damages lining of vessels
4. Metabolic syndrome - abdom. obesity, insulin resistance (FBS > 100 ) ; high lipids; hypertension .

37

CAD - DX

1. Exercise stress test
2. Echocardiogram
3. Transesophageal echocardiogram
4. Cardiac catheterization

38

Exercise stress test

EKG with exercise ; pt on treadmill - rate and incline gradually increased; drugs may be added to promote vasodilation and indicate compromised areas - Persantine + Dobutamine
Watch - ST elevation or depression - ischemia ; Stop - chest pain or EKG changes

39

Echocardiogram

ultrasound of heart ; assess ventricular walls, valves, cardiac output, ejection fraction of heart

40

Transesophageal Echocardiogram

Start IV
Tube passed down the throat into stomach ;
NPO prior
Check gag reflex ( tongue depressor) post test ;

41

Fluoroscopy

is an imaging technique that uses X-rays to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope.

42

Cardiac catheterization

invasive; fluoroscopy ; NPO; dye injected ( flushed, warm feeling) ; via groin or arm ( post - keep staright) ;
Shows blockages; can measure pressures and pumping ability of heart ; post - 4-6 hours in bed ; oral + IV fluids; monitor urine output (kidneys)

43

CAD - Diet recommendations

1. Fish - 2 x wk - omega-3 fatty acids
2. Salt < 2300 mg of sodium/day
3. Limit ETOH - 1 W; 2 M
4. Fiber 25 g

44

Antihyperlipidemics

1. Statins
2. Fibric acids
3. Bile acid sequestrants
4. Nicotinic acid

45

Statins ( - statin )

1. inhibit cholesterol synthesis in liver ( Monitor liver enzymes - baseline ; 6 mo later !!! ) ;
2. Reduce LDL + triglycerides
3. Increase HDL
SE - rare - muscle weakness; liver abnormalities ; take at night ( cholesterol synthesis)

46

Colestipol ( Colestid )
Cholestyramine ( Questran )

Bile acid sequestrants

47

Bile acid sequestrants ( - choles )

Work in GI tract to bind ( !! may interfere with absorption of drugs and nutrients ) with bile acids ( excreted in stool ) - liver cells respond by sending cholesterol to maintain bile acid synthesis, lowering plasma levels of LDL cholesterol ; SE: GI symptoms - N/V

48

Clofibrate ( Atromid )
Gemfibrozil ( Lopid )
Fenofibrate ( Tricor )

Fibric acids

49

Fibric acids ( - fibr )

decreases VLDL - hepatic synthesis + secretion - which will reduce triglycerides ; increase HDL; SE - GI; may increase effects of anticoagulants + hypoglycemics

50

Niacin, Vitamin B3

Nicotinic acid

51

Nicotinic acid

water-soluble vitamin ; inhibits synthesis of LDL, VLDL; increase HDL ;
SE: - GI ; flushing ( upper torso and face)
Caution !!! liver disease and DM - liver enzymes !!!
Lower risk of MI ( pts that had MI)

52

Food sources high in niacin

dairy, meats, tuna, egg

53

Stable angina - classic

predictable - occurs with activity; consistent; relieved with rest

54

Unstable angina - preinfarction

can occur at rest; unpredictable

55

Prinzmetal's angina

occurs ta rest ; due to spasm of coronary artery and not plaque

56

Compensation - HF

1. Stimulation of the sympathetic NS
2. Vasopressin (ADH ) - post pituitary ( decreased cerebral perfusion)
3. Renin-Angiotensin System Activation - Aldosterone

57

HF - DX

1. Echocardiogram - EF
2. EKG
3. CXR - size of heart
4. BNP - elevated

58

Digoxin toxicity

level > 2 ng/ml ( 0.5-2 ) halos, nausea, anorexia; Monitor K ( provide foods if takes loop diuretic) ; apical 1 min;

59

Digoxin antidote for extreme toxicity

digoxin immune Fab - Digibind

60

Diuretics :

1. Thiazide - Hydrochlorothiazide (HCTZ)
2. Loop - Furosemide ( Lasix )
3. Potassium sparing - Spironolactone ( Aldactone)

61

CCB + HF

contraindicated with systolic HF

62

PE and HF - interventions - Prevent !!!

1. High-fowlers with legs dangling - decrease venous return
2. O2 - mask or intubated
3. Diuretics - Lasix - rapid
4. Morphine - small doses - decrease peripheral resistance, venous return, anxiety
5. Emotional support
6. Monitor - telemetry, I/O, VS

63

Stenosis

opening narrows

64

Regurgitation

valve does not completely close

65

Mitral stenosis

obstruction of blood from LA to LV - LA stretches ( hypertrophies - pulmonary conjestion - RHF

66

Mitral stenosis + regurgitation - cause

Rheumatic heart disease - rheumatic endocarditis

67

Mitral regurgitation

LA + LV dilate + hypertrophy - LHF - RHF

68

Mitral valve prolapse

functions normally - isn't closing properly ; PVCS, tachycardia; risk for endocarditis ; can progress to regurgitation; most asymptomatic

69

Aortic stenosis

difficult for LV to eject blood; sudden death; vascular collapse - angina, syncope, exertional dyspnea ! NTG is contraindicated

70

Aortic regargitation

blood flow back into LV - LV hypertrophy - decrease SV - weakness, SOB, fatigue ...

71

Valvular disorders DX

1. Echocardiogram
2. Transesophageal echo - detect stenosis or regurgitation
3. CXR - size of ventricles

72

Valvular disorders - reparative procedures - buys time

1. Balloon valvuloplasty
2. Valve commissurotomy
3. Annuloplasty

73

Balloon valvuloplasty

invasive ( cardiac cath lab ) ; catheter via groin or femoral vein - balloon inflated to enlarge mitral or atrial opening ; Monitor - bleeding, regurgitation, thrombi

74

Valve commissurotomy

open heart surgery ; only damaged area of valve removed ; thrombi ; debride calcium from leaflets

75

Annuloplasty

repair of annulus ( ring that is attached to leaflets) and leaflets - regurgitation is eliminated or greatly reduced

76

Valvular disorders - replacement procedures

1. Biological ( tissue ) valves
2. Mechanical valves

77

Biological ( tissue ) valves

cow or pig - Xenograft ; 6 weeks on Coumadin post op; life span for valve 7-10 years

78

Mechanical valves

Coumadin for the rest of the life; much more durable

79

Coumadin - INR - therapeutic range

2-3

80

Valvular disorders - post op teaching

1. Regular blood work to titrate Coumadin
2. Vitamin K foods teaching - keep steady
3. Report bleeding or bruising
4. Care of sternal incision
5. Avoid invasive dental procedures for 6 mo
6. Report changes in cardiac status
7. Medical alert bracelet

81

Protamine sulfate

antidote for heparin

82

INR - normal

1.3-2

83

aPTT - partial thromboplastin time, activated - heparin

30-40 sec

84

Dilated cardiomyopathy (DCM) - men + AA

chambers are larger - decreased contractile function; no increase in muscle wall size - blood remains in ventricle - causes backup
TX as for heart failure

85

Dilated cardiomyopathy causes

alcohol abuse; chemotherapy, viral infection; pregnancy; inflammation; poor nutrition

86

Hypertrophic cardiomyopathy (HCM)- genetic

heart muscle asymmetrically increases in size + mass - reduces size of ventricles - poor filling ; can block aorta - athletes who die suddenly

87

Hypertrophic cardiomyopathy TX

Beta- Adrenergic Blockers and Calcium Channel Blockers
Contraindicated - vasodilators, diuretics, nitrates, cardiac glycosides

88

Restrictive cardiomyopathy

impaired ventricular stretching - stiff ventricles restrict filling during diastole ; No TX; SX- heart transplant; < 12 mo to live

89

DCM - SX

1. Cardiac transplant - preferred
2. Cardiomyoplasty - muscle wrapped around ventricles

90

HCM - SX

Ventricular septal myectomy - excision of hypertrophied tissue ; can take out mitral valve and replace it with smaller

91

Transplanted heart - is denervated

no longer connected via vagus nerve to autonomic NS; keeps consistent HR and responds slowly to exercise, stress, position changes - !!! orthostatic hypotension

92

Heart transplant - signs of rejection

SOB, fatigue, fluid gain, hypotension, decreased activity tolerance

93

Heart Transplant - immunosuppressants for life

Infection is major cause of death

94

Endocarditis - causes

1. Valvular disease
2. Prosthetic valves
3. Older pts
4. IV drug use
5. High risk invasive procedures

95

Endocarditis S/s

1. Fever with chills, night sweats, fatigue
2. Cardiac murmur
3. Anorexia and weight loss

96

Endocarditis - systemic embolization

1. Petechiae
2. Osler's nodes - PAINFUL, on pads of fingers or toes
3. Janeway's lesions - PAINLESS; red, purple, macules on fingers or toes

97

Pericarditis causes

1. Following MI - Dressler's syndrome ; or open heart surgery
2. Autoimmune cause - lupus
3. Lung cancer - result of chemo or radiation
4. Lung infection

98

Pericarditis S/s

1. Chest pain - left side neck, shoulder
2. Pain worse with deep inspiration
3. Eased when sitting and leaning forward
4. PERICARDIAL FRICTION RUB
Chronic - S/s of RHF

99

Pericarditis TX

1. NSAIDS, corticosteroids;
2. Antibiotics
3. Comfort - sitting upright, leaning forward
4. Pericardial drainage ( window)

100

Pericardila Effusion

fluid in pericardial space - constricts myocardium + impair ability to pump - can lead to cardiac tamponade

101

Cardiac Tamponade - S/s

1. Sudden onset - SOB, chest tightness, restless
2. Pulsus Paradoxus - SBP drops ( during inspiration) + DBP remains same
3. Distant heart sounds
4. Tychycardia
5. Decreased CO
6. Blood backing up - JVD
7. Circulatory collapse

102

Cardiac Tamponade - DX

EMERGENCY
1. Echocardiogram or x-ray to confirm
2. CVP, PA, PCWP all similar and elevated

103

Cardiac Tamponade - TX

Pericardiocentesis - needle inserted to drain fluid ; monitor for recurrence of tamponade following procedure

104

Myocarditis causes

may be associated with pericarditis, infection or due to metabolic or connective tissue disorder - Lupus

105

Myocarditis S/s

1. Fatigue, dyspnea, palpitations
2. Flu-like symptoms

106

Venous stasis ulcers - TX

1. Hydrocolloid dressings
2. Artificial skin products
3. Unna boot

107

Unna boot

for ambulatory pts; with venous stasis ulcers ; applied - affected limb from toes to knee; covered with elastic wrap ( hard like a cast); change 1/week;May be too tight ; bandage works because it is infused with a thick, creamy mixture of zinc oxide and calamine. This mixture helps to promote healing.

108

Peripheral arterial disease ( PAD) - cause,

1. atherosclerosis
2. blockage of the arteries that supply the lower legs + feet

109

PAD - S/s

1.Intermittent claudication - cramping pain; with activity; gone with rest; 50 % obstructed
2. Rest pain - late sign ; better when legs are down
3. Skin - rubor ( dpendent position), cyanotic, pallor, loss of hair, brittle nails, dry skin, ulcers, edema, gangrene (elderly)

110

PAD - DX

1. Arteriography - similar to cardiac cath; dye used
Noninvasive
2. segmental systolic BP - normal - BP in thigh + calf > BP in upper extremities ; arterial disease - BP in thigh and calf are lower.
3. Ankle-brachial index - ankle BP / brachial BP
4. Exercise tolerance test - asses when leg pain starts

111

PAD - non-surgical management

1. Exercise ( collateral circulation) - walk - pain - stop + rest - walk further ; contraindicated - severe pain, venous ulcers, gangrene
2. Position - keep legs below level of the heart ( swelling - elevate feet)
3. Don't cross legs, restrictive clothing; inspect feet daily

112

PAD - promote vasodilation

1. Warmth to extremity
2. No direct heat
3. Avoid cold, stress, caffeine, nicotine

113

PAD - Trental

1. Antiplatelet
2. Increase flexibility of RBC
3. Decrease blood viscosity

114

PAD - nonsurgical interventions

1. Percutaneous Transluminal Angioplasty - balloon
2. Laser assisted angioplasty
3. Atherectomy - rotary burr
Post procedure - bed rest 6-8 hrs; bleeding; distal pulses, vitals

115

PAD - surgical management and post-op care

Arterial revascularization : inflow ( larger) + outflow (smaller) - bypass graft (GABA)
1. Pain !!! throbbing - OK; ischemic ( like before) - clotted graft
2. Bed rest for 1 day - no bending ( hip or knee)
3. Vascular (neuro) checks - 1st hr - every 15 min ; then every hour !!!

116

Aneurysm - bulging out

localized dilation of a portion of an artery - abdominal aortic ( common) and thoracic aortic.

117

Aneurysm - causes

1. Arteriosclerosis - 85 %
2. Hypertension
3. Smoking
4. Hyperlipidemia
5. Genetic
6. Marfan syndrome - disorder of the connective tissue

118

Thoracic aortic aneurysm - S/s

1. SOB, hoarseness, difficulty swallowing
2. Rupture - sudden back or chest pain

119

Abdominal aortic aneurysm - S/s

1. Pain - abdominal, flank, back
2. Pulsation in upper abdomen - listen for bruit. Don't palpate !!!
3. Feeling of fullness after eating
4. Malaise + weight loss

120

Aneurysm - impending rupture - S/S

1. Sudden, severe back, abdominal pain
2. Pulsating abdominal mass
3. Hypovolemic shock
Sx !!! right away

121

Ruptured aneurysm - S/s

1. Hypotension
2. Diaphoresis
3. Decreased LOC
4. Oliguria
5. Loss of pulses
6. Retroperitoneal bleeding

122

Aneurysm - nonsurgical management

1. Monitor growth - CT scan every 6 mo
2. Maintain BP - antihypertensives

123

Aneurysm - surgical

Stent graft - to strengthen arterial wall !!! to avoid Aneurysmectomy - resection.

124

Aneurysm - post op

1. Graft occlusion - hypovolemia or renal failure
2. Rupture - hypovolemic shock
3. Paralytic ileus - abdominal distention ; N/V
4. MI
5. Spinal cord ischemia ( thoracic ) - asses sensation + motion
6. No heavy lifting or driving for 6 weeks
7. No pushing, pulling or straining

125

Aortic dissection

aorta tears and splits apart ; Due to poorly controlled hypertension ; blunt chest trauma, cocaine use.

126

Aortic dissection - S/s

1. Sudden - tearing chest pain radiating to back ( mistaken for MI )
2. Diaphoresis, pale, tachycardia
dx - ct scan ;
Complications - paraplegia ( decreased blood flow to spine ; renal failure ; CVA, MI.

127

Buerger's disease - Smoking

Inflammatory thrombotic disorder - affects small and medium arteries in distal arms and legs ; early sign - claudication in arch of foot, intermittent shock-like pain ; TX - Procardia (CCB)

128

Raynaud's disease

Vasospastic disorder - vasospasm precipitated by cold, emotional upset, caffeine, smoking ; Fingers - white then cyanotic with pain; TX: Procardia (CCB)
SX: sympathectomy ( cuts nerve fibers) ; can lose fingers

129

Venous disorders :

1. DVT
2. Chronic venous insufficiency ; complication - venous stasis ulcers

130

Chronic venous insufficiency - interventions

due to prolonged venous hypertension - stretches veins + damages valves - edema
1. Elevate legs 20 min 4-5 x per day ; elastic or compression stockings , sequentials
2. Buildup of waste - ulcers - Vitamin A+C and high protein to promote healing

131

Protamine sulfate

antidote for heparin

132

DVT - risk for PE ( if above knee )

due to venous stasis and endothelial damage; hypercoagulability of blood ;

133

DVT - S/s

1. Tenderness + pain - calf or groin
2. Unilateral edema
3. Warmth, redness, pain
4. Upper extremity - cyanosis

134

DVT - DX

1. Duplex - noninvasive - combines ultrasound and doppler
2. Venogram - invasive

135

DVT - TX

1. Anticoagulants
2. legs elevated
3. Compression hose
4. Measure calves and thighs