1
Q
How does blood flow through the heart?
A
- Vena Cava
- Right Atrium
- Tricuspid valve
- Right Ventricle
- Pulmonic valve
- Lungs
- Left Atrium
- Mitral valve
- Left Ventricle
- Aortic valve
- Systemic Circulation
2
Q
Diastole
A
relaxation, blood fills ventricles
3
Q
Systole
A
when the ventricles contract
4
Q
Normal Cardiac Output
A
4-6 L/Min
5
Q
Preload
A
- volume coming into the ventricle (end diastolic pressure)
- increased in hypervolemia
6
Q
Frank Starling Law
A
as a larger volume of blood flows into the ventricle, the blood will stretch the walls of the heart, causing a greater expansion during diastole, which in turn increases the force of the contraction and thus the quantity of blood that is pumped into the aorta during systole.
7
Q
Afterload
A
- resistance the left ventricle must overcome to circulate the blood
- increased in hypertension
8
Q
Stroke Volume
A
amount of blood ejected by the left ventricle in one contraction (can be left or right)
9
Q
Positive Inotropic Agents
A
- medicines that increase the force of your heart’s contractions
- digoxin, calcium, dopamine, epinephrine, norepinephrine
10
Q
Negative Inotropic
A
- weaken the force of the heartbeat
- Acetylcholine from Vagus nerve
11
Q
P Wave
A
- atrial depolarization
- ## SA Node Initiates this
12
Q
QRS
A
- Ventricles contract
- 0.04
13
Q
QT
A
- repolarization (recovery)
- 0.42
14
Q
Cardiac Output
A
- the amount of blood pumped by each ventricle in 1 minute (normal 4-8 L/min)
- CO = HR x Stroke Volume
15
Q
Cardiac Index
A
- Cardiac Output/Body Surface Area
- Normal is 2.8-4.2 L/min/m2)
16
Q
Sympathetic Nervous System: Effects on the Heart
A
increases heart rate by the beta adrenergic receptors
17
Q
Peripheral Nervous System: Effects on the Heart
A
decreases heart rate by the vagus nerve
18
Q
Sympathetic Nervous System: Effect on Blood Vessels
A
increases vasoconstriction by a1-adrenergic receptors, decreases vasodilation by a1-adrenergic receptors
19
Q
Baroreceptors
A
sensitive to stretch or pressure with the arterial system (aortic arch and carotid sinus) Fast response in changes in blood pressure
20
Q
Chemoreceptors
A
capable of causing changes in respiratory rate and BP in response of increased CO2 (aortic/carotid bodies and medulla)
21
Q
Cardiovascular Disease Risk Factors
A
- elevated BP
- diabetes
- obesity
- smoking
- nutrition
- sedentary lifestyle
- family history
- adverse lipid profile
22
Q
Hypertension
A
- may need to measure both arms
- often symptom free
- typically the primary disease
23
Q
Hypertension: Patient Evaluation
A
- two consecutive blood pressure measurements over 2 weeks
- assess lifestyle and identify other CV risk factors
- reveal identifiable causes of high BP
- Assess the presence of absence of target organ damage and CVD
24
Q
Values: Mild Hypertension
A
140/90
25
Values: Moderate Hypertension
160/100
26
Values Severe Hypertension
180/110
27
Normal Blood Pressure
Systolic -
28
Prehypertension
Systolic - 120-139
Diastolic - 80-89
Need for lifestyle modification
29
Stage 1 Hypertension
Systolic - 140-159
Diastolic - 90-99
Need for lifestyle modification
Single agent drug therapy
30
Stage 2 Hypertension
Systolic >160
Diastolic > 100
Combo Drug therapy and lifestyle modification
31
DIURETIC
```
Daily Weight
I and O
Urine output
Response of BP
Electrolytes
Take Pulses
Ischemic Episodes (TIA)
Complications
```
32
Complications: 4 C's
Coronary Artery Disease
Chronic Renal Failure
Congestive Heart Failure
Cerebrovascular Accident
33
Antihypertensive Drugs: Ace Inhibitors
- end in pril
- captopril
- enalapril
- benzapril
- lisinopril
34
Antihypertensive Drugs: B-Blockers
- ends in olol
- propanolol
- atenolol
35
Antihypertensive Drugs: Calcium Antagonists
- verpamil
- diltiazem
- nifedipine
- amlodipine
36
Ace Inhibitors
decreases vascular resistance without increasing cardiac output, cardiac rate or cardiac contractility
37
Side Effects of Ace Inhibitors
- dizziness
- orthostatic hypotension
- GI distress
- non productive cough
- headache
38
Angiotensin II Receptor Antagonists (Blockers) = ARBS
- Losartan and Valsartan
- similar to ACE inhibitors
- cause vasodilation and decreased peripheral resistance
39
Beta Blockers
blocks beta receptors in the heart causing decreased heart rate, force of contraction and rate of AV conduction
40
Beta Blocker: Side Effects
- bradycardia
- lethargy
- GI Disturbance
- Congestive Heart Failure
- decreased BP
- depression
41
B1 Blockers
- selective
- works mainly in the heart
- metaprolol (lopressor)
42
B2 Blockers
- non-selective
- works in heart and lungs
- inderal/propanolol
- decreases heart rate and cardiac output
43
Calcium Antagonists
- blocks calcium access to cells
| - causes decrease in the contractility and conductivity of the heart which decreases demand for oxygen
44
Calcium Antagonists: Side Effects
- lowers BP
- Bradycardia
- May Precipitate AV Block
- headache
- abdominal discomfort (constipation, nausea)
- peripheral edema
45
LDL Cholesterol
- Bad cholesterol which is primarily fatty and carries cholesterol into your arteries.
- less than 100 is good and anything over 190 needs immediate action
46
HDL Cholesterol
- good cholesterol consists of high density lipoprotein particals which are high in protein and low in fat. Help clear arterial plaque.
- reading over 60 is optimal and anything under 40 requires immediate action
47
Overall Total Cholesterol
- less than 200mg/dl
| - anything over 240 is considered high and needs immediate action
48
Artrovastatin (Lipitor)
- prevents the production of cholesterol in the liver by blocking HMG-CoA which makes cholesterol.
- taken once a day and can cause muscle fatigue, pain and break down and liver damage
49
Niacin
- can raise the HDL by 15-35%, most effective
| - it can decrease your LDL and triglyceride levels which prevents heart disease
50
Coronary Artery Disease
- narrowing of coronary arteries
- impaired blood flow
- ischemia
- pain
S/S: pain, N/V, diaphoresis and pallor
51
Atherosclerosis
- Injury to artery endothelial cells
- inflammation
- fibrous plaque with platelet adhesion
52
Chronic Stable Angina
form of chest pain that happens when your heart is working hard and needs more oxygen, such as during exercise
53
Unstable Angina
a condition in which your heart doesn't get enough blood flow and oxygen. It may lead to a heart attack.
54
Vasospastic /Prinzmetal's/ Variant Angina
only happens at certain times and only for a certain amount of time
55
Area of Infarction
- o2 deprived
- damage irreversible
- causes Q wave on EKG
56
Area of Injury
- next to infarction
- tissue is viable as long as circulation remains adequate
- increasing O2 may save this area from necrosis
- causes S-T segment elevation on EKG
57
Area of Ischemia
- viability may not be damaged as long as MI doesn't extend and collateral circulation is able to compensate
- Causes depressed ST Segment
58
MONA
Morphine
Oxygen
Nitroglycerine
Aspirin
59
Nitroglycerin
opens blood vessels to improve blood flow. It is used to treat angina symptoms, such as chest pain or pressure, that happens when there is not enough blood flowing to the heart. (vasodilator)
60
Nitroglycerin (Quick Acting)
- sublingual tablets
| - translingual spray
61
Nitroglycerin (Slow Acting)
- nitro-bid (patch)
- nitro ointments
- sustained release tablets
62
Side Effects of Slow or Quick Release Nitro
- severe hypotension
- tachycardia
- dizziness
- headache
- syncope
63
Left Sided Heart Failure
- Pulmonary Edema
- Shortness of Breath
- Crackles
- Pink, Frothy Sputum
- Cyanosis
- Restlessness
- Confusion
64
Right Sided Heart Failure
- Liver Engorgement
- Positive JVD
- Edema
- Ascites
65
Goals of Heart Failure
- decrease workload of heart
- increase force and efficiency of heart
- eliminate excess fluid
66
Treatment of Heart Failure
- Digoxin
- Diuretics
- Electrolyte Replacement
- Vasodilators
- Na Restriction
67
Treating Congestive Heart Failure
```
Upright Position
Nitrates
Lasix
Oxygen
ACE Inhibitors
Digoxin
```
Fluids (decrease)
Afterload (decrease)
Sodium Restriction
Test
68
Digoxin
- positive inotrope
- negative chronotrope
- negative dromotrope
- monitor drug levels
- check K levels first
- heart has to be at 60 bpm
69
Chronotrope
increases or decreases heart rate
70
Dromotrope
decreases or increases conduction veolocity
71
Safe Digoxin Levels
0.5-2 ng/mL
72
Diuretics
- Furosemide, Hydrodiuril
| - treatment for CHF, cirrhosis, renal disease and hypertension
73
Side Effects of Diuretics
- decreased BP
- decreased Na
- decreased Chloride
- decreased K
- Hyperglycemia
- weight loss
- decreased I & O
- Dehydration
74
Peripheral Arterial Diseases
- Thrombus or Embolus which obstructs arterial flow
- Mottled Extremity, Capillary Refill is prolonged, pain
- Chronic: Skin thin and shiny
- heparin, angioplasty, surgery
75
Venous Insufficiency
inadequate venous return over a long period of time that causes pathologic changed as a result of ischemia in the vasculature, skin and supporting tissues.
76
Venous Insufficiency Findings
- history of DVT/thrombophlebitis
- Hypertension
- Varicose Veins
- Edema
- thick, coarse, brownish skin around the ankles/feet
- stasis ulcers
77
Deep Vein Thrombosis
- thrombus formation
- swelling tenderness/redness
- D-Dimer
- elevate extremity, bedrest, heparin
78
DVT: Risks and Interventions
- Movement of the clot!
- Anticoag: heparin, coumadin, lovenox, catheter directed thrombolysis
- Vena Cava Filter
79
A vs V: Color
A - Pale
| V - Ruddy; cyanotic if dependent
80
A vs V: Edema
A - None or Minimal
| V - Usually Present
81
A vs V: Nails
A - Thick and brittle
| V - Normal
82
A vs V: Pain
A - worse with elevation and exercise; may be sudden or severe; claudication
V - better with elevation, dullness or heaviness
83
A vs V: Pulses
A - decreased, weak or absent
| V - Normal
84
A vs V: Temperature
A - Cool
| V - Warm
85
A vs V: Extremities
A - Dry and Necrotic
| V - Moist
86
Warfarin Sodium (Coumadin)
- reduces the amount of blood clots by thinning out the blood
- reduces the liver's ability to produce vitamin K
- PT + INR
87
Coumadin Overdose
can cause hemorrhage, headache, bruising or back pain
88
Heparin
- inhibits clotting time
- prevents clots in the arteries, veins and lungs.
- doesn't break them up, just delays formation
- check PTT and APTT labs
89
What does Heparin do?
interferes with the conversion of fibrinogen to fibrin and prothrombin to thrombin, which creates the product for clotting.
90
Heparin Side Effects
can cause spontaneous bleeding starting in the mucus membranes. vasospasm, ecchymosis and hypersensitivities
91
Plavix
- platelet aggregation inhibitor
| - inhibits platelet aggregation by dilating the vascular bed
92
Instructions on Giving Plavix
- given PO w/ or w/o aspirin
- give with food
- use cautioulsy with asthma patients and hypertension, hepatic or renal problems, and a history of bleeding.
93
Plavix Side Effects
- skin disorders
- URI
- flu like symptoms
94
Plavix Labs
Platelet counts before beginning and every 2 days for a week, then weekly
95
Bleeding Precautions
```
Razor Electric
Aspirn NO
Needles Small Gauge
Decrease needle sticks
Injury protect from
```
96
Bleeding Precautions: Observation
- Hematuria or Melena
- Nosebleeds
- Gingival Bleeding
- Bruising
97
When would you implement bleeding precautions?
- using anticoagulants
- liver disease
- platelets are less than 150,000
- hemophilia present
- using thrombolytic meds
98
Normal sinus rhythm
Rhythm interpretation: regular
Rate: 60-100 beats/min
P Waves: Normal in size, shape, direction, positive in lead II, one P wave precedes each QRS complex
PR interval: Normal (0.12 - 0.20 second)
QRS Complex: Normal (0.10 second or less)
99
Sinus bradycardia
Rhythm interpretation: regular
Rate: 40-60 beats/min
P Waves: Normal in size, shape, direction, positive in lead II, one P wave precedes each QRS complex
PR interval: Normal (0.12 - 0.20 second)
QRS Complex: Normal (0.10 second or less)
Intervention: atropine sulfate
100
Sinus tachycardia
Rhythm interpretation: regular
Rate: 100-180 beats/min
P Waves: Normal in size, shape, direction, positive in lead II, one P wave precedes each QRS complex
PR interval: Normal (0.12 - 0.20 second)
QRS Complex: Normal (0.10 second or less)
Intervention: PRN order to decrease heart rate- pain/anti-anxiety medication
101
Atrial fibrilation with uncrontrolled/controlled ventricular rate
Rhythm interpretation: Grossly irregular (unless ventricular rate is very rapid, in which case the rhythm becomes more regular)
Rate:
-Atrial: 400 beats/min or more; not measurable on surface ECG
-Ventrical: varies with number of impulses conducted through atrioventricular node to ventricles; ventricular rate is controlled if rate is less than 100 beats/min, uncontrolled if it is greater than 100 beats/min
P Waves: Wave deflections that affect entire baseline
PR interval: Not measurable
QRS Complex: Normal (0.10 second or less)
Intervention: Ablation
102
Ventricular tachycardia
```
Rhythm interpretation: regular
Rate: 140-250 beats/min
P Waves: None associated
PR interval: Not measurable
QRS Complex: Normal (0.10 second or greater)
Intervention: Medications
```
103
Ventricular fibrillation
Rhythm interpretation: Chaotic, irregular deflections
Rate: 0 (P waves and QRS complexes absent)
P Waves: Absent; wavy, irregular deflections are present that vary in size, height, and shape
PR interval: Not measurable
QRS Complex: Absent
Intervention: CPR Defibrillation
104
Asystole
Flatline
| Intervention: Compressions
Test 2 AH Cardiac
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