cardiac

What causes cardiac tamponade

*idopathic causes (dresslers syndrome) *effusion (from cancer, bacterial infections, tb *hemorrhage due to tramua- (gunshot or stab wounds) *hemorrhage due to pericarditis (anticoag. therapy *viral or postirradiatoin pericarditis *chronic renal failure requiring dialysis

cardiac tamponade (Beck's triad)

*elevated CVP with jugular vein distention *muffled heart sounds *drop in systolic blood pressure

vascular repair complication Pulmonary infection s/s

*fever *cough *congestion *dyspnea

Loop diuretics

*furosemide (lasix) *bumetanide (bumex) *torsemide (demadex) *ethacrynic acid (edecrin) ****decreases preload. use to prevent symptoms of volume overload *all used to treat AHF (IV) *and used to treat CHF

ACE inhibitors- Chronic heart failure

*help decrease preload by preventing sodium and water reabsorption. *they indirectly vasodilate and decrease afterload by interfering with the conversion of angiogensin 1 to angiotension 2 *this interference brakes the cycle and prevents the release of aldosterone. *no vasoconstriction and no reabsorption of sodium and water occur. *ONE NUMBER DRUG-pt with heart failure

Right heart failure (systemic congestion) signs

*hepatosplenomegaly *positive HJ refulx *elevated CVP ******classic *jugular venous distension

Vasodilators

*hydralazine *minoxidil *nitroprusside (nipride) ****indications *used in com with other drugs to treat mod to severe hypertension *hypertensive crisis *************practice pointer *monitor bp and pulse before and and after admin *monitor pt receiving nitroprisside for signs of cyanide tox

Paroxysmal supraventricular tachycardia causes

*hypokalemia *Wolff-Parkinson ***may also occur with dig tox ***caffeine ***CNS stimulant **nicotine **alcohol

Vascular repair complication hemorrhage

*hypotension *tachycardia *restlessness and confusion *shallow resp *abdominal pain *increased abdominal girth

Explain Dopamine

A "pressor" NEED to be hydrated to use ******Used for hypotension Causes Vasoconstriction- Increases BP Titrate down when have a good pressure Increases Urinary Output- promotes NA secretion

Explain a T wave inversion?

A T wave is the repolarization of the ventrical If inverted it shows signs of ischemia

Explain a T wave inversion

A T wave is the repolarization of the ventrical If inverted it shows signs of ischemia

When is cardioversion used?

A fib A Flutter V Tach w/ a pulse

when is cardioversion used

A fib A flutter Vtach with a pulse

what does sinus rhythm need to be to be "sinus"

A p wave needs to be measured equally apart

Which is worse transmural infarction or subendocardial infarctoin

A transmural infarction impairs contracility to a greater extent than does a subendocardial infarction

What drugs are given to prevent cardiac remodeling?

ACE Inhibitors -"prils"

what drugs are given to prevent cardiac remolding

ACE inhibitors "prils"

what are good medical mgt meds?

ACE inhibitors Anitcoag Statins- Zetia absorbs cholesterol in the blood from what you eat Vitroan- comb anitplt stool softener to avoid straining

Name two signs or symptoms that would indicate to you that your patient is not perfusing their tissues adequately, without taking a vital sign or touching your patient.

AMS, shortness of breath or increased respiratory rate, complaints of chest pain, cool and clammy skin, signs of cyanotic nailbeds, anxiety, decreased urinary output in a foley bag

Left coronary artery

fun along the surface of the left atrium, where it splits into to major branches: the left anterior descending artery and the left circumflex of cardiac

explain cardiogenic

heart is a failing as a pump Acute MI acute heart failure acute episode of hypertension new atrial fib

why is a packemaker utilized

heart is unable to generate or conduct its own impulses

So if the SVR were elevated on a patient, their blood pressure would be

high

Causes of Peaked T Wave, Wide QRS, Prolonged PR, Shortened QT.

hyperkalemia. Treat with Calcium Chloride, glucose and insulin, or dialysis

what is a major problem with anesurism and/or diessection

hypertension

Digoxin (cardiac glycoside dobutamine) (lanoxin)

increases cardiac contracility used in CHF NOT used to treat AHF

Milrinone (dobutrex)

increases cardiac contractility used to treat AHF NOT used in CHF

Acute Coronary Syndrome .

is a name given to three types of coronary artery disease that are associated with sudden rupture of plaque inside the coronary artery: Unstable angina. Non-ST segment elevation myocardial infarction or heart attack (NSTEMI)-does not cause changes on an electrocardiogram (ECG). However, chemical markers in the blood indicate that damage has occurred to the heart muscle. In NSTEMI, the blockage may be partial or temporary, and so the extent of the damage relatively minimal. ST segment elevation myocardial infarction or heart attack (STEMI)-caused by a prolonged period of blocked blood supply. It affects a large area of the heart muscle, and so causes changes on the ECG as well as in blood levels of key chemical markers.

Systemic vascular resistance is primarily determined by

vessel diameter and compliance

what happens with pulmonary edema

wedge pressure will be high (Normal is 4-12)

Explain cardioversion?

"Synchronized" countershock HAS A PULSE Shocks on the "R" Wave TEE First

symptoms volume overload---Left heart failure (pulmonary congestion)

*************classic s/s *Dyspena *paroxysmal noctural dypsena *orthopena *fatigue ***** *dry cough, worse at night *nocturia

Sinus Bradycardia--Treatment

******Atropine (anticholinergic) if symptomatic -Possible pace maker -D/t drugs: d/c, reduce dose, hold

Sinus Tachycardia--Treatment

*****Treat the underlying cause -Pain: effective pain management -Hypovolemia: treat hypovolemia -If stable: vagal maneuvers, ********IV beta blockers given to reduce HR and myocardial o2 demand

Medications-- for heart failure

***loop diuretics-- *furosemide (lasix) *bumetandie (bumex) *ethacrynic acid (Edcrine) *toresmide (demadex) *decrease preload preload ***Venous vasodilators -- *Nitro-- to also decrease preload ***Morphine- not only decreases anxiety but help decrease preload by venous vasodilation. ***Nesiritide (Natercor) is a newer class of IV drug that is effective in acute exacerbation of heart failure that are refractory to diuretics. *it decreases both afterload and preload. ***positive inotropic *milrione (primacor) dobutamine (bobutrex) intropin (dopamine) **used to increase contractility in acute heart failure.

Cardiac Tampondae

**is a rapid, unchecked increased in pressure in the pericardical sac. **This compresses the heart, impairs diastolic filling and reduces cardiac output **the increase in pressure usually results from blood or fluid accumulation in the pericardical sac. **even a small amount (50-100 mL) can cause serious tamponade if it accumultes rapidly. **accumulates rapidly and requires emergency life saving msg *a slow accumulation and increase in pressure and increase in pressure may not produce immediate symptoms bc the fibrous wall of the pericardical sac can gradually stretch to accoummodate as much as 1-2 L of fluid

sinus bradycardia causes

**normal, in well conditioned heart, athlete or during sleep **ICP *vagal stimulation *vomiting *inferior wall MI *hypothpthermia *may also occur with ca channel blockers **neta adrengeric blocker **dig

additional treatments for cardiac tamponde

**traumatic injury- blood transfusion or a thoracotomy to drain reaccumlatoin fluid or tp repair bleeding sites *heparin- induced tampnade- admin of protamine sulfate *warfarin induced tamponade- admin of vit K *renal failure induced tamponade- hemodialysis

what does a negative inotropic drug do

*A neg inotropic drug DECREASES the force of the heart's contraction

What does a positive inotropic drug do

*A positive inotropic drug INCREASES the force of the heart's contraction

why dont you give ACE inhibitors for acute heart failure

*ACE inhibitors are preventive in nature and therefore not given in acute heart failure

What med is used to treat ventricular and supraventricular arrhythmias, particularly atrial fibrillation

*Amiodarone

what questions do you ask your pt about cardiac function

*Are you in pain? *where is the pain located? *does the pain feel like a burning, tight, or squeezing sensation? *does the pain radiate to your arm, neck, back or jaw? *when did the pain begin? *what relieves or aggravates it? *are you experiencing n/v/d or dizziness or sweating? *Do you have SOB *does your heart ever pound or skip a beat? *do you ever get dizzy or faint? when? *do you expereience swelling in feet or ankles? does anything relieve the swelling?

ARBs when used AT-1 is contraindicated due to COUGH NOT in renal insufficiency

*Candesartan (atacand) *irbesartan (Avapro) *losartan (Cozzar) *valsartan (diovan) ***Block AT-2 *decrease fluid retentoin *decrease afterload by vasodilation *prevent remodeling ***NOT used to treat AHF *used to treat CHF

ARB

*Candesartan (atacand) *irbesartan (avaprop) *losartan (cazaar) ******indications *hypertension *heart failure resistant to ACE

Angiotensin Converting Enzyme (ACE) inhibitors

*Captopril (capoten) *enalapril (Vasotec) *fosinopril (monporil) *Lisinopril (Zestril) *ramipril (Altace) *trandolapril (Aceon) ***prevent conversion of AT-1 to AT-2 *decrease fluid retention *decreased afterload by vasodilation *prevent remodeling **used to treat AHF (IV) NO **used to treat CHF- yes

signs volume overload---Left heart failure (pulmonary congestion)

*Caridiomegaly *Techypnea *Tachycardia ****classic s/s *Third heart sound (listen in left lateral decbuitus postion) *crackles bilaterally

sinus tachycardia causes

*Fever *excrise *shock *left sided heart failure *hyperthyrodism *Anterior wall MI *pulmonary embolsim *May also occur with ****atropine ****epi ****isoproterenol (isuperl) ***caffeine ***cocaine

What causes cardiogenic shock

*MI *most common) *myocardial ischemia *papillary muscle dysfuction *cardiomyopathy *chronic or acute heart failure *acidosis

What are the top three drugs usually used to great angia

*Nitirates (acute angia) *Beta-adrenergic blockers (for long term prevention of angina) *calcium channel blockers (used when other drugs fail to prevent angia)

First-Line and initial treatment for AMI

*O2 *obtain a 12 lead ECG within 10 mins of arrival *monitor v/s, and pulse ox *order lab test *monitor cont cardiac rhythm with ST-segment monitoring *conduct hx and physical exam *admin meds

The cardiac output (CO) and ______ directly affects the bp

*Vascular resistance *if pt bp decreases then either the flow CO or the systemic vascular resistance (SVR) has changed

What does an ICD system consist of

*a programmable pulse generator and one or more leadwiress. *the pulse generator is a small battery-powered computer that monitors the heart's electrical signals and delivers electrical therapy when abnormal rhythm is identified *it also stores info on the heart's activity before, during and after an arrhythmia, also with tracking which treatment was delivered and the outcome fo that treatment. *many devices also store electrocardiogram (electrical tracing) *downloaded to the dr.

The left anterior descending artery supplies blood to the:

*anterior wall of the left ventricle *interventicular septum *right bundle branch (a branch of the bundle of HIS) *left anterior fasciculus (small cluster) of the left bundle branch The branches of the left anterior descending artery- the septal perforators and the diagonal arteries- supply blood to the walls of both ventricles.

Sinus tacycardia features

*atrial and vent rhythm reg *rate >100 bpm *normal P waves preceding each QRS complex

ACE

*benazepril (lotension *captopril (capoten *enalapril (vasotec) *lisinopril (prinivil) *auinapril (Accupril) *ramipril (attace) ***********indications *hypertension *heart failure

how do Class II antiarrhythimcs work (Beta blockers)

*block beta-adrenergic receptor siters in the conduction system of the heart *As a result the ability of the SA node to fire spontaneously (auto) is slowed. *the ability of the AV node and other cells to receive and conduct and electrical impulse to nearby cells (conductivity) is also reduced. *also reduce the strength of the heart's contractions. *when the heart beats less forcefully, it doesn't require as much oxygen to do its work.

Beta-blockers

*carvedilol (coreg) *metoprolol (toprol XL) *succinate bisporolol (Zebeta) ***block sympathetic response *prevent excessive increases in HR and BP *vasodilate to improve symptoms and clinical status *prevent remodeling *decrease mortality NOT used to treat AHF used to treat CHF

Sympatholtyic drugs

*central-acting sympathetic nervous system inhibitors *clonidine (catapres) *guanabenz *guanfacine (tenex **alpha blockers *doxazosin (carduar) *phentolamine *prazosin (minipress terasoin (trandate) *******indications *hypertension *****practice pointers *monitor bp and pulse before and after admin *****adverse reactions *hypotension (alpha blockers) *depression *drowsiness *edema *vertigo (central-acting drugs) *bradycardia *hepatic necrosis *arrhythmias

Dx test for cardiac tampondae

*chest x-ray shows a slightly widened mediastinum and an enlarged cardiac silhouette *ECG show low amplitude QRS complex and electrical alternates and alternating beat to beat change in amplitude P wave *PA catheterize discloses increased CVP, right vent diastolic pressure, PAWP, and decreased cardiac output/cardiac index *electrocardiograph may reveal pericardial effusion with sing of right vent and atrial compression *CT scan or MRI may be used to id pericardial effusion or pericardial thickening caused by constrictive pericardidits

Coronary artery bypass graftp

*circumvents an occluded coronary artery with an autogenous graft (usually a segment of the saphenous vein from the leg or internal mammary artery) thereby restoring blood flow to the myocardium *most commonly performed surgeries b/c its done to prevent MI in pt with acute or chronic myocardial ischemia. *the need is determined from the results of cardiac catherrizaation and pt symptoms.

S/S of cardiogenic shock

*cold, pale, clammy skin *drop in systolic bp to 30 mmHg below base line or substantiated reading below 90 mmHg that isn't r/t meds *tachycardia *rapid resp *oligura (urine output less than 20 mL/hr) *anxiety *confusion *narrowing pulse pressure *crackles heard in the lungs *neck vein distention *S3 faint heart sounds, and poss holosystolic murmur

BETA blockers--chronic heart failure

*considered the standard of care of treatment of heart failure- reduce mortality *block the effects of the SNS so that the compensatory tachycardia, hypertension and vascoonstriction can not occur and therefore the workload of the heart decreases and hypertrophy and remodeling can not occur **some are more effective and safer than other **ONLY carvedilol (coreg), sustained-release metoprolol (toprol XL) bisoprlol (Zebeta) have been approved for heart failure---reduce mortality *S/E esp titration up- fatigue *Contraindicated in pt was asthma

What are some common causes of heart faliure

*coronary artery disease--- sluggish blood flow due to narrowed artery can decrease the pumping ability of the heart *Previous heart attack (MI)--prolonged ischemia to the myocardium can cause muscle injury and cell death, which weakens the heart muscle *hypertension- long-standing high bp causes the heart to work extra hard to overcome the resistance and can , over time weaken the muscle *cardiomyopathy- a generalized degeneration and enlargement of the heart muscle linked to heredity, excessive alcohol intake, infections, pregnancy, drug tox including chemo or idiopathic *valvular heart disease- a damage heart valve forces the heart to work harder to keep the blood flowing in the right direction. Heart valves may be damaged by rheumatic fever, congenital defect, calcification buildup or infective endocarditits

Sinus tachycardia treatment

*correction of underlying cause *Beta-adrenergic blockers *calcium channel blocker

Sinus bradycardia treatment

*correction of underlying cause *for low cardiac output, dizziness, weakness, altered level of consciousness or low bp ACLS *temp or permanent pacemaker *Dopamine (inotrpin) or epi

what meds are used for cardiogenic shock

*dopmaine phenylephrine or norepi to increase bp and blood flow to the kidneys *Inamrinone or dobutamine- inotropic agents that increase mypcardial contracitilty and cardiac output

What does the Left coronary Artery (LAD) feed?

Feeds the septal wall, and left ventrical

Paroxysmal supraventricular tachycardia treatment

*if pt is unstable, immediate cardioversion *if pt is stable, vagal stimulation, valaslva's maneuver and carotid sinus massage or adenosine *after rhythm convert use ca channel blockers or beta blockers

Diastolic Heart failure

*impairment of the heart's ability to relax *the myocardial wall becomes stiff and thickened, impairing the heart's ability to fill *EF is not decreased in diastolic heart failure.

Tarnscutaneous temp pacemaker

*in a life threatening situation, is the best choice *works by sending an electrical impulse form the pulse generator to the pts heart by way of two electrodes, which are placed on the front and back of the pts chest *quick and effective, but only used until dr can institute transvenous pacing

Systolic Heart failure

*in an impairment in the ability of the heart to contract and empty. *if is defined as an ejection fraction (EF) <40 *Neurohormoanal influences cause the kidney to hold on to sodium and water and cause the blood vessel to constrict. *pharmocolgoic treatment is aimed at counteracting the body's own compensatory mech

cardiogenic shock

*is a condition of diminished cardiac output that severly impairs tissue perfusion. AKA pump failure

aortic aneurysm repair

*is done to remove an aneurysmal segment of the aorta *the surgeon first makes an incision to expose the aneurysm site *the pt is placed on a cardiopulmonary bypass machine, if needed *the surgeon then clamps the aorta z *the aneurysm is resected and the damaged protion of the aorta is repaired.

Embolectomy

*is done to remove an embolism from an artery. *The surgeon inserts a balloon-tipped indwelling catheter into the artery and passes it through the thrombus (top) *then inflates the balloon and withdraws the catheter to remove the thrombus (bottom)

implantable cardioverter-defibrillator

*is implanted to continually monitor a pts heart for bradycardia, ventricular tachycardia, and ventricular fibrillation *the device also admin either shocks or paced beats *generally indicated when drug therapy, surgery or catheter ablation fails to prevent the pt dangerous arrhythmia.

Vena caval filter insertion

*is inserted to trap emboli in the vena cava, preventing them from reaching the pulmonary vessels *filter or umbrella is inserted transversely by catheter *after in place, the umbrealla or filter traps emboli but allows venous blood flow.

What happen initially when blood flow to the myocardium is prevented

*ischemia ensues in the area distal to the obstruction; *if blood flow is not soon restored the ischemia progresses to infarction

how cardiogenic shock happens

*left vent dysfunctions initiates a serious of compensatory mechanisms that attempt to increase cardiac output and in turn, maintain vital organ functions. *as cardiac output all, baroreceptors in the aorta and carotid arteries initiate responses in the sympathetic nervous system----These increase heat rate, left vent filling pressure and after-load to enhance venous return to the heart. *These compensatory responses initially stabilize the pt but later cause the pt to deteriorate the O2 demands of the already compromised heart increase

vascular repair complication renal dysfuction

*low urine output *elevated blood urea nitrogen (BUN) and creatinine (cret)

What is the purpose of temp transvenous pacemaker

*maintain circulatory integrity by providing for standby pacing in case of sudden complete heart block *to increase heart rate during periods of symptomatic bradycardia *occasionally,to control sustained supraventricular or ventricular tachycardia

Indications for a transvenous pacemeker

*mgt of braydcarida *presence of tachyarrhythnias *Other conduction system disturbances

Transcenous temp pacing

*more comfortable for the pt *more reliable than a trancutaneous pacemaker *involves threading an electrode catheter through a vein into the pt right atrium or right ventricular *The electrode is attached to an external pulse generator that can provide an electrical stimulus directly to the endocardium

S/S of cardiac tamponade (not Beck's triad)

*narrowed pulse pressure *orthopnea *anxitey *restlessness *JVD with inspiration *mottling *clear breath sounds (helps distinguish cardiac tamponade from heart failure)

Pulmonary vascular resistance

*normal values 20-200 dynes/sec/cm-5 **formula- PVR= MPAP-PAWP/COx 80 ******cases of increased values *hypoxemia *pulmonary embolism *pulmonary hypertension ****causes of decreased values *pulmonary vasodilating drugs (morphine)

What is an acute myocardial infarction

*occurs when the heart muscle is deprived of O2 and nutrient-rich blood. *occurs as the result of an acute plaque rupture or as a sustained espisdoe of decrased O2 delivery to the point of irreversible cell death and necrosis.

vascular repair complication infections

*redness *warmth *drainage *increased pain *fever

Vascular repair complication occlusion

*reduced or absent peripheral pulses *paresthesia *severe pain *cyanosis

how do you treat cardiac tampondae

*relieve intrapericardial pressure and cardiac cardiac compression by removing accumulated blood or fluid ***Pericardiocentesis (needle asp of the pericardial cavity) ***surgical creation of an opening called a pericardial window ***insertion of a drain into the pericardial sac to drain the effusion

Who is more likely to have a more serious impairment from a MI, a younger or older person? And why??

*the younger who has a severe MI and has not had sufficient time to develop preestablished collateral circulation is often more likely to have more serious impairment than older person with the same degree of occulsion

How do Class IV antiarrhythmics work (calcium channel blocker)

*these block the movement of calcium during phase 2 of the action potential and slow conduction and the refractory period of calcium-dependent tissues, including the av node. *the calcium channel blockers used to treat pt with arrhythmias are Verapamil (Calan) diltiazem (Cardizem)

Temporary pacemaker (three types)

*transcutandous *transvenous *epicardial

When a pt has CAD the danger of plaque rupture can happen at anytime. What are the two disastrous consequences

*up rupture the embolic plaque travels into the coronary vasculature and obstructs blood flow *If the plaque does not become a embolus, the irregular surface of the damned endothelum causes platelet aggregation and fibrin deposits, which lead to thrombus formation and result in the partial or total occlusion of the artery. The area of mycradium served by this coronary artery branch is hen subjected to lack of perfusion

bypass grafting

*used to bypass an arterial obstruction resulting from arteriosclerosis *after exposing the affected artery, the surgeon anastomoses a synthetic or autogenous graft to divert blood flow around the occluded arterial segment. *The autogenous graft may be a vein or an artery harvested from elsewhere in the pt body.

Right heart failure (systemic congestion) Symptoms

*weight gain *ascites *liver engorgement or discomfort *anorexia, nausea *abdominal bloating *nocturia ****classic *peripheral pitting edema

With ACE interference

*work by preventing the conversion of angiotension I to angiotnesion II. *as angiotension II is reduced, arterioles dilate, reducing peripheral vascular resistance *by reducing aldoesterone secretion, ACE inhibitors promote the excretion of sodium and water reducing the amount of blood the heart need to pump, resulting in a lowered bp

Atrial Flutter--ECG Characteristics

-HR: Atrial: 200-350 bpm; Vent: varies r/t conduction ratio -Rhythm: Regular (A and V) -P wave: None (F waves- more F waves than QRS complexes) -PR Int: Variable/not measurable -QRS: usually Normal

Atrial Fibrillation ---ECG Characteristics

-HR: Atrial: up to 600 bpm; Vent: varies 60-100 controlled, >100 Rapid, <60 slow vent response -Rhythm: Irregular -P wave: Replaced by fibrillatory waves -PR Int: Not measurable -QRS: normal shape/duration

Asystole-ECG Characteristics

-HR: None -Rhythm: None -P wave: None, Occasionally seen -PR Int: None -QRS: None

Sinus Tachycardia--Clinical Associations

-Exercise, fever, pain, hypotension, hypovolemia, anemia, hypoxia, hypoglycemia, MI, HF, hyperthyroidism, anxiety, fear -Drugs: epinephrine, norepinephrine, atropine, caffeine, theophylline, Procardia, hydralazine

Ventricular Fibrillation (VF)--ECG Characteristics

-HR: Not measurable -Rhythm: Irregular and Chaotic -P wave: Not visible -PR Int: Not measurable -QRS: Not measurable

on an EKG how is each little box broken down into other little boxes

0.04

how long is a normal P wave (PR interval)

0.12-2 seconds is normal

on an EKG how is each little box counted

0.2

what is the normal time from the Q to the T

0.35-0.45

Atrial Fibrillation --Treatment

-Goal: ↓vent response (<100), prevent cerebral embolism, convert to NSR if possible -Drugs (rate control): CCB, ***** B-blockers, digoxin, dronedarone ******Antidysrhythmia drugs: Amiodarone, ibutilide -Cardioversion or Ablation

Explain Diastolic HF?

Filling Problem EF is normal

Sinus Tachycardia---ECG Characteristics

-HR: 101-200 bpm -Rhythm: regular -P wave: normal, before each QRS -PR Int: normal -QRS: normal shape/duration

Supraventricular Tachycardia--ECG Characteristics

-HR: 150-220 bpm -Rhythm: regular/slightly irregular -P wave: hidden in T wave or irregular shape -PR Int: shortened or normal -QRS: usually normal

Asystole- Rhythm

-Absence of ventricular electrical activity (no depolarization occurs) -Pt unresponsive, pulseless, apneic -VF may look like Asystole, so rhythm assessed in >1 lead

Ventricular Fibrillation (VF)--Clinical Associations

-Acute MI -Myocardial Ischemia -HF -Cardiomyopathy -During pacing/caths -Accidental shock -Hyperkalemia -Hypoxemia -Acidosis -Drug toxicity

Atrial Flutter---Rhythm

-Atrial tachydysrhythmia -ID by recurring, regular, sawtooth shaped flutter waves -Originate from single ectopic focus in R atrium (or L but uncommon)

Asystole-Treatment

-CPR -ACLS initiation with definitive drug therapy, including: Epi and Atropine, intubation and possible transcutaneous temporary pacemaker

Ventricular Fibrillation (VF)--Treatment

-CPR -ACLS protocols with defibrillation and definitive drug therapy

Sinus Tachycardia---Rhythm

-Conduction path same as NSR -D/c rate from sinus node increases b/c vagal inhibition or sympathetic stimulation -Sinus rate is 101-200 bpm

Sinus Bradycardia-Rhythm

-Conduction path same as NSR -SA node fires at <60 bpm -Symptomatic- HR <60 resulting in symptoms (chest pain, syncope

Premature Vent Contraction--Rhythm

-Contractions from ectopic focus within ventricles -Premature wide/distorted QRS -Diff foci: diff shape (multifocal) -Same foci: same shape (unifocal) -Couplet, trigeminy, bigeminy -VTach if 3+ consecutive PVCs -Can initiate VTach or VFib

Supraventricular Tachycardia--Clinical Significance

-Depends on associated symptoms -Prolonged episode and HR >180 may precipitate decreased CO d/t reduced stroke volume -Sx often include hypotension, dyspnea, angina

Sinus Tachycardia--Clinical Significance

-Depends on pt tolerance of ↑ HR -Sx: dizziness, dyspnea, hypotension due to decreased cardiac output -↑ myocardial o2 consumption associated with ↑HR -Angina or ↑infarction size may accompany in pt w CAD or acute MI

Premature Atrial Contraction--Treatment

-Depends on sx -Withdrawal of caffeine or sympathomimetic drugs -B-blockers may decrease PACs

Sinus Bradycardia--ECG Characteristics

-HR: <60 bpm -Rhythm: regular -P wave: normal, before each QRS -PR Int: normal -QRS: normal shape/duration

Premature Vent Contraction--ECG Characteristics

-HR: Varies r/t intrinsic rate, # PVCs -Rhythm: Irregular d/t pre beats -P wave: Usually lost in QRS of PVC -PR Int: Not measurable -QRS: Wide, Distorted, >0.12 sec -T wave: Large, Opposite direction to direction of QRS

Ventricular Tachycardia (VT)--ECG Characteristics

-HR: Vent: 150-250 bpm -Rhythm: Regular or Irregular -P wave: Usually buried in QRS *Possible AV dissociation with P wave independent of QRS complex -PR Int: Not measurable -QRS: *Distorted in appearance *Duration >0.12 sec *ST-T opposite direction as QRS *R-R interval regular or irregular

Premature Atrial Contraction--ECG Characteristics

-HR: varies with underlying rate and frequency of PAC -Rhythm: irregular -P wave: different shape (notched, downward, hidden in T wave) -PR Int: longer or shorter but WNL -QRS: usually normal, if >0.12 abnormal conduction via vents

Atrial Flutter--Clinical Significance

-High ventricular rates and loss of atrial "kick" (sinus P wave) decrease CO and cause serious consequences such as HF, esp if heart disease hx -↑ Stroke risk d/t risk thrombus formation in atria from stasis of blood -Warfarin given to prevent stroke

Ventricular Fibrillation (VF)--Rhythm

-Irregular waveforms varying shapes and amplitudes -Firing of multiple ectopic foci in ventricle (quivering) -No vent contraction.. NO CO

Ventricular Tachycardia (VT)--Clinical Associations

-MI -CAD -Electrolyte imbalance -Cardiomyopathy -Mitral valve prolapse -Long QT syndrome -Drug toxicity -CNS disorders -Pts w no hx CV dx

Premature Atrial Contraction---Clinical Associations

-Normal Heart: emotional stress, physical fatigue, caffeine, tobacco, alcohol -Electrolyte imbalance, hyperthyroidism, COPD, -Heart disease: CAD, valvular disease

Supraventricular Tachycardia--Clinical Associations

-Normal Heart: overexertion, emotional stress, deep inspiration, stimulants (caffeine and tobacco) -Rheumatic heart disease, digitalis toxicity, CAD, cor pulmonale

Sinus Bradycardia--Clinical Associations

-Normal in some aerobic athletes and some pts during sleep -Carotid sinus massage, Vasalva maneuver, Hypothermia, Increased intraocular pressure, Vegal stimulation -Drugs (b-blockers, CCB)

Premature Atrial Contraction--Clinical Significance

-Not significant if isolated PAC in healthy heart -Pt report "palpitations" "skip a beat" -Heart disease: freq PAC- enhanced automaticity of atria, or reentry (may warn of more serious dysrhythmias- supraventricular tachycardia)

Premature Atrial Contraction--Rhythm

-Originates at site other than SA -Starts L/R atrium travels across atrium by abnormal path creating distorted P wave -At AV it may be stopped, delayed (long PR interval) or go normally

Supraventricular Tachycardia--Rhythm

-Originates in ectopic focus above bundle of His -Occurs d/t reexcitation of atria when there's a one-way block -Abrupt onset and termination followed by brief asystole -Some degree AV block possible

Ventricular Tachycardia (VT)--Treatment

-Precipitating cause must be ID and treated *Monomorphic VT -Stable w/ L vent function: IV Procainamide, Stalol, Amiodarone or Lidocaine -Unstable, poor L vent function: IV Amiodarone or Lidocaine then cardioversion *Polymorphic VT -Normal baseline QT interval: Beta-blockers, Lidovaine, Amiodarone, Procainamide, or Sotalol, Cardiovert if no change

Atrial Fibrillation---Clinical Associations

-Primarily in pts w/ underlying heart disease (CAD, rheumatic heart dx, cardiomyopathy, HTN, HF, pericarditis) -Often develops acutely w/ thyrotoxicosis, ETOH intox, caffeine use, electrolyte imbalances, stress, cardiac surgery

Atrial Flutter--Treatment

-Primary goal: slow ventricular response by increasing AV block -Cardioversion if an emergency -Antidysrhythmia drugs: Amiodarone, propafenone, ibutilide, flecanide -Radiofreq catheter ablation

Atrial Flutter--Clinical Associations

-Rarely occurs in healthy heart -Diseased states: CAD, HTN, mitral valve disorders, PE, chronic lung disease, cor pulmonale, cardiomyopathy, hyperthyroidism -Drugs: digoxin, quinidine, epinephrine

Premature Vent Contraction--Treatment

-Relates to cause PVCs -Assess hemodynamics r/t need for drug tx -Drug tx: Beta-blockers, Procainamide, Amiodarone, Xylocaine -PVCs in CAD or acute MI indicate vent irritability so monitor pt response

Ventricular Fibrillation (VF)--Clinical Significance

-Results in an unresponsive, pulseless, apneic state -Tx rapidly or pt will die

Ventricular Tachycardia (VT)--Rhythm

-Run of ≥3 PVCs -Ventricles take control as pacer -Different forms r/t QRS conf -Monomorphic: QRSs equal -Polymorphic: QRS gradually change size/shape/direction -Torsades de pointes: polymorphic VT r/t prolonged QT interval of underlying rhythm -Sustained (>30 sec) -Nonsustained (<30 sec) -Life threatening d/t ↓CO and possible development of VFib

Atrial Fibrillation --Rhythm

-Total disorganization of atrial electrical activity due to multiple ectopic foci resulting in loss of effective atrial contraction -Paroxysmal or persistent (>7 Days) -Sometimes, atrial flutter and atrial fibrillation may coexist

Premature Vent Contraction--Clinical Significance

-Usually benign in pt w/ normal heart -If hx heart dx: may ↓CO and precipitate angina and HF (depends on frequency) -Monitor apical pulse b/c PVCs usually aren't strong enough to illicit peripheral pulses possibly leading to pulse deficit

Asystole-Clinical Significance

-Usually cannot be resuscitated

Ventricular Tachycardia (VT)--Clinical Significance

-VT stable (pt has pulse) or can be -VT unstable (pt has no pulse) -Sustained VT causes severe ↓CO d/t ↓vent diastolic filling times and loss of atrial contraction -Results in hypotension, pulmonary edema, ↓cerebral blood flow and cardiopulmonary arrest -Must treat quickly even if occurs briefly and stops -May reoccur if no prophylaxis -VFib may also develop

Supraventricular Tachycardia--Treatment

-Vegal stimulation: Vasalva maneuver and coughing -Drug tx: IV adenosine (1st), IV b-blocker, CCB, amiodarone -If pt remains unstable, cardioversion is used -Radiofrequency catheter ablation (burn foci generating ectopic rhythm)

what are important s/s to remember to look for worsening of heart failure

Fatigue limited activities chest congestion or cough edema or swelling in feet/legs/belly SOB

Explain Troponin?

100% specific to cardiac muscle Proteins released with cardiac damage and measured in the blood Level should be 0 Peaks in 24 hours Elevated for 7-14 days post MI

Explain troponin

100% specific to cardiac muscle Proteins released with cardiac damage and msg in the blood Level should be 0 Peaks in 24 hrs. Elevated for 7-14 days post MI

Explain the right coronary artery?

Feeds he SA and AV Nodes Feeds the inferior wall of the heart

what is a normal urine output

30 mL/hr OR 0.5-1 mL/kg/hr

Explain Dopamine

A "pressor" NEED to be hydrated used for hypotension causes vasoconstriction- increases BP titrate down when have a good pressure increases urinary output-promotes NA secretion

normal EF

55-70%

explain the right coronary artery

Feeds the SA and AV nodes Feeds the inferior wall of the heart

What should be assessed with acute arterial occlusions

5 p's Pallor Pulses paralysis paresthesia pain

Normal EF?

55-70%

what are the two best antiplt aggregation that work together

ASA and plavix

When must defib be done

ASAP CPR until reach a defib ( must be within 4 minutes)

Class II antiarrhythics

Acebutolol (Sectral) Esmolol (Brevibloc) prprpanolol (Indreal) *********indications *atrial flutter *atrial fibrillation *paroxysmal atrial tachycardia *vent arrhythmias *******practice pointers *monitor apical hr and bp *abruptly stopping these drugs can exacerbate angina and precipitate MI ********adverse reactions *arrhythmias *bradycardia *heart failure *hypotension *n/v *bronchospasm

what happens with an acute decrease in cardiac output

Activation of the SNS HR up Vasoconrtriction afterload incrases kidney secrete aldosterone- hold on salt/water bad for heart

What happens with an acute decrease in cardiac output?

Activation of the SNS HR up Vasoconstriction Afterload increases Kidneys secrete aldosterone- hold onto salt/water- bad for heart

Explain Sympathetic Nervous System?

Also called Adrenergic Stimulates ALL receptor sites at once"Fight or Flight"

Explain Variant Angina?

Also called Prinzmetals Angina Due to coronary artery spasm Does not usually occur with activity or stress Tends to occur in patients with some degree of stenosis or evidence of a fibrous plaque Happens mainly during the night Subsides with Nitroglycerin

Class III anitarrhysthmics

Amidoarone (Coradorone) ibuilide fumurate (Corvert) ******indications *life-threatening arrhythmias resistant to other anitarrhythmics ***********practice pointers *increases the risk of dig tox in pt also taken dig *monitor bp, hr, and rhythm for change *monitor for signs of pulmonary tox (dyspena, nonproductive cough, and plueritic chest pain)

What is the second drug to give for cardiac arrest?

Amioderone (or Lidocaine)

what is the second line drug that is given for cardiac arrest

Amioderone (or Lidocaine) h

what is an A-line

An A-line is direct arterial access

What else might be given in add. along with an ACE in chronic heart failure

An aldosterone blocker such as spirpnolactone (Aldactone) may also be given along with ACE inhib. for a more sustained effect in chronic heart failure.

What is Amioderone?

An antidysrhythmic Blocks SNS Works on atrial and ventricular tissue ***V fib

Reason for MI

Anemia Hypotension Hypoperfusion

What is the difference between an aneurism and dissection

Aneurism- is an enlargement of the aorta, causing weakness Diessection- is a tear in the wall of the aorta, creating a false channel for blood

What is the difference between an aneurism and dissection?

Aneurism-Is an enlargement of the aorta, causing weakness Dissection- is a tear in the wall of the aorta, creating a false channel for blood

What is heparin and what does it do

Anitcoag prevents thrombus formation and the extension of existing thrombi; they do not lyse (dissolve) existing thrombi

Explain Variant Angina AKA Prinzmetals Angina

Due to coronary artery spasm Does not usually occur with activity or stress Tend to occur in pt with some degree of stenosis or evidence of fibrous plaque Happen mainly during the night Subsides with Nirto

What is the biggest complication of a MI?

Dysrhythmias

What is a classic manifestation of cardiac tamponade

BECKS TRIAD hypotension muffled heart sounds JVD

Explain a fresh MI with PCV

BIG Problem

what nursing care comfort needs to be done after receiving a pacermaker

CXR- to verify placement EKG check pulses watch for hiccups

How is diastolic heart failure treated?

Calcium channel blockers---to help relax the work of the left ventricle

Beta Blocker Non-selective.

Antagonized Beta-1 and Beta-2 adrenergic receptors (heart and lungs). Indications - HTN, Angina, SVT, Migraine prophylaxis. Contraindications - Uncompensated HF, cardiogenic shock, bradycardia. Adverse Effects - Bradycardia, hypotension, bronchospasm, fatigue, depression, impotence, loss of libido.

why give Plavix

Anti platelet aggregate increases risk of bleeding used along with ASA Avoid PPI

Explain Lidocaine?

Antidysrhthmic ******ONLY used for ventricular dysrhythmias *PVCs *Ventricular tachy *V fib

Coronary Artery Disease

Atherosclerosis of the coronaries. Presents first with increased luminal narrowing, presenting as angina. Chronic progressive ischemia results in hypoperfusion of the myocardium and slowly evolving pump failure (CHF) Acute coronary thrombosis is more common in arteries already narrowed.

Paroxysmal supraventricular tachycardia

Atrial and vent rhythms are reg *heart >160 bpm rarely exceeds 250 bmp *p waves regular but aberrant; difficult to diferntiate from preceding T waves *P waves preceding each QRS complex *sudden onset and term of arrhythmia

Explain a P wave?

Atrial contraction Indicates atrial depolarization

What is a classic manifestation of cardiac tamponade?

BECKS TRIAD Hypotension Muffled heart sounds JVD

Systole

Begins with S1 Contraction

Diastole

Begins with S2 Relaxation

ACE inhibitor

Blocks conversion of angiotensin I to angiotensin II. Indications - heart failure, HTN, and as a renal protectent in DM. Contraindications - hx of angioedema, pregnancy. Adverse Effects - angioedema, hypotension, cough, hyperkalemia.

ARB

Blocks receptors in peripheral vasculature and adrenals for angiotensin II. Indications - HTN, T2DM nephropathy. Contraindications - pregnancy Adverse Effects - angioedema, hypotension, URI s/s.

explain a myocardial contusion

Blunt force trauma such as a steering wheel

What happens if the right coronary artery infarct?

Bradycardia

S/S of right sided MI

Bradycardia N/V "I have to have a bm" hypotension

S/S of right sided MI?

Bradycardia N/V "I have to have a bowel movement" Hypotension

what is an ablation

Burn or freeze

Explain CRP

C-reactive proteins released by the liver in response to inflammation Predictive Values <1=low risk MI 1-3= average risk MI >3= high risk MI

Which cardiac enazyme would the nurse exect to elevate first in a pt dx with MI 1. Creatine kinase (CK-MB) 2. Lactate dehydrogenase (LDH) 3. Troponin 4. White blood cells (WBC)

CPK-MB- elevates in 12-24 hrs LDH elevates in 24-36 hrs ****Troponin is the enzyme that elevates within 1-2 hrs WBC elevate as a result of necrotic tissue, but this is not a cardiac enzyme

What care and comfort needs to be done after receiving a pacer?

CXR to verify placement EKG Check Pulses Watch for hiccups (BAD)

What are side effects of Amioderone?

Can cause sinus arrest Heart blocks Bradycardia Hypotension Hepatotoxicity Pulmonary Toxicity

what are indications for a pacemaker

Cant maintain BP bradycarida Bradycardia unresponsive to drugs (IDEA) tachy/brady syndrome can pass out

What are indications for a pacemaker?

Cant maintain BP- bradycardia Bradycardia unresponsive to drugs (IDEA) Tachy/ brady Syndrome Can pass out

What is the biggest complication of a CABG

Cardiac Tamponade soon as see bright red blood in chest tube

Differentiate between cardioselective and non-selective beta blocker medications. What group of patients cannot use non-selective beta blockers and why?

Cardioselective blocks only beta 1 receptors. Non-selective beta blockers blocks beta 1 and beta 2 receptors, possibly causing bronchoconstriction in the COPD population.

This calcium channel blocker, _______________, is used frequently with patients diagnosed with new onset atrial fibrillation.

Cardizem (diltiazem)

Pericarditis

Caused by tenacious deposits of fibrin, found on both surface layers and resembles the shaggy surfaces of two slices of buttered bread after being pulled apart. Recognized clinically by a pericardial friction rub or adhesion in severe cases.

Mitral Stenosis

Causes stagnation of the blood in the left atrium, with possible clot formation. Leads to left atrial, pulmonary, and right ventricular hypertension, all leading to Cor Pulmonale.

Adenosine

Causes transient heart block in the AV nodes. ******Used primarily for SVT. ***Can be used to cardiovert irregular heart function back to normal. Can be used to stress test the heart in patients unable to exercise.

What med should give for ishemica

Cells in the ischemic area are salvageable if reperfusion therapies and inotropic support support is promptly instituted

CABG surgery

Cirumventing an occluded artery with an autogenous graft---- may be a viable option for our pt with acute or chronic myocardial ischemia

explain a CABG

Coronary Artery Bypass site is LIMA (left internal mammory artery) use of the sapherous vein PAINFUL dont want to get out of bed go home in less than 4 days

What is the main cause of acute myocardial infarction (AMI)

Coronary Artery disease (CAD) Atherosclerosis is the underlying cause

Causes of Flattened or Inverted T waves

Coronary Ischemia, Hypokalemia, LVH, Digoxin toxicity, some drugs.

Class IA anitarrhymtheics

Dispolyarmide (norpace) procainamide, Quindine sulfate Quinidine gluconate ****Indications *ventricular tachycardia (V tach) *atrial fibrillation (A-fib) *paroxysmal atrial tachycardia **** practice pointers *check apical pulse before admin *use cautiously in pt with asthma *******adverse reactions *n/v/d *arrhythmias *ECG changes *hepatotoxicty *resp arrest

Explain Acute Heart Failure?

Does not stand alone Results from hearts inability to generate an adequate cardiac output

Explain acute Heart Failure

Does not stand alone results from hearts inability to generate an adequate cardiac out

Increased S1

Due to Mitral Stenosis or Hyperkinesis.

you are not having a MI if

EKG is normal the pain is reproducible the pt is young and has no risk factors the pt is female There are associated symptoms the pain is not exertional

What could happen with Amioderone?

Could cause another arrhythmia

Cardiac Enzyme Tests

Creatine Phosphokinase (CPK) Creatine Kinase (CK) Troponin I and T Linked with injury to the heart muscle

A pericardial effusion can result in which complication after CABG surgery? a.Heart block b. Atelectasis c. Pleural effusion d.Cardiac Tamponade

D- cardiac tamponade

In right sided heart failure, you may note all of the following except? a. JVD. b. weight gain. c. sacral edema. d. rales.

D- rales

A client relates to the nurse during the admission process that she used to take an evening walk for years, but lately has been experiencing leg and muscle pain. Once she rests, the pain seems to be relieved. The most likely cause of this condition is ____ a. thrombophlebitis secondary to blood clots b. varicose veins due to chronic venous insufficiency c. an acute embolic event proximally d. intermittent claudication due to oxygen demand exceeding the supply

D. intermittent claudication due to oxygen demand exceeding the suppy

What is the best indicator of fluid loss or gain

Daily weight *Significant weight changes can indicate problems before symptoms occur. *App. 10 lb of extra fluid must accumulate before symptoms of increased volume development

morphine sulfate (duramporph)

Decreases preload by dilating venous capctitance vessel used to treat AHF NOT used in CHF

Explain DUMBBBELS

Defiaction Urination Miosis-excessive smallness or contraction of the pupil of the eye Bronchoconstriction Bronchorrhea- excessive discharge of mucus from the air passages of the lung Bradycardia Emesis Lacrimation Lethargy Salivation/sweating

Systemic vascular resistance

Degree of left vent resistance, or afterload **normal values-- 800-1,400 dynes/sec/cm-5 *formula- SVR= MAP-CVP/CO x 80 ******causes of increased values *hypothermia *hypovolemia *vascoconstriction ****Causes of decreased values *vasodilation *vasodilators *shock (anaphylatic, neurogenic, or septic)

Sinus Bradycardia--Clinical Significance

Depends on how pt hemodynamically tolerates -S/sx of symptomatic Bradycardia: pale, cool skin; hypotension; weakness; angina; dizziness or syncope; confusion or disorientation; shortness of breath

Stroke volume index

Determines if the SV is adeq for pt body size ***normal values 30-65 mL/beat/m2 **formula--SVI= SV/BSA or SVI=CI/HR

What are some S/S of an MI?

Diaphoretic Cool skin Altered mental status Palpations N/V Dysrythmias Signs of left/ right sided heart failure AMS (rare disease)

what are some s/s of an MI

Diaphoretic cool skin altered mental status palpations N/V dysrythmias S/S of left/right heart failure AMS (rare disease)

Class IV anitarrhyshthmics

Diltiazem (Cardizem) verapamil (Calan) ******indications *superaventricular arrhythmias *************practice pointers *monitor hr, bp and rhythm carefully when initiating or increasing dose *calcium supplements may reduce effectiveness

What is a pacemaker?

Electrical stimulus externally applied to the heart

what is a pacemaker

Electrical stimulus externally applied to the heart

What causes most ventricular dyrhysthmia?

Electrolyte abnormalities/ imbalance Increased/Decreased K Hypoxia

What is the first drug to give in cardiac arrest?

Epinepherine (every 3-5 minutes until code is called)

what is the first drug that is given during cardiac arrest

Epinephrine ( every 3-5 mintues until code is called)

Nitrates should not be taken with this category of drugs.

Erectile dysfunction drugs

Dissecting aortic aneurysm

Excruciating, tearing pain; may be accompanied by blood pressure difference between right and left arm; sudden onset *Retrosternal, upper abdominal or epigastric; may radiate to back, neck, or shoulders *what makes it worse- n/a *what makes it better- analgesics, surgery

what are some potential problems with a pacer

Failure to capture Pacer sends an impulse but heart does not respond Pacer fires all over the place ultimate insult

Atherosclerosis Etiology

First damage occurs at the interface between the blood and the arterial wall. Endothelial cell injury, consequent of metabolic derangements (Diabetes) or Physical force (Hypertension), is accompanied by the deposition of platelets and serum lipoproetins (LDLs) under the endothelium which stimulates macrophages. Growth factor released from platelets stimulate proliferation of smooth muscle in the wall of the artery, promoting accumulation of cholesterol and other lipids in their cytoplasm. Trapped LDLs inside macrophages are transformed into foam cells. Some lipid-laden smooth muscle cells die, releasing lipid into the interstitial spaces that gets degraded and deposited in the form of cholesterol crystals.

Explain the Coronary artieries

First set of arteries to receive oxygenated blood flow right from the aorta

Explain the Coronary Arteries?

First set of arteries to receive oxygenated blood flow right from the aorta.

Explain Asystole?

Flat line V fib will turn to this Treat w/ CPR, Epi, Atropine

Class IC antiarrhythics

Flecainide (Tambocor), Propafenone (Thytmol) *****indications *ventricular tachycardia *ventricular fibrillation supraventricular arrhythmia ***** practice pointers *correct electrolyte imbalances before admin *monitor pt electrocardiogram before and after dosage adjustments. *******adverse reactions *new arrhythmia *heart failure *cardiac death

What can happen for a period after an AMI

For a period after AMI, a pseudodiabetic state frequently develops bc of glycogenlysis

explain polarization

Gearing up

Increased S2 Sound

Heard at the Base Due to stiff valves or stenosis (A2), hypertrophy, HTN, PE, Cor Pulmonale (P2) Normal in children due to having a thin chest wall and faster heart rates. Straight Back Syndrome (loss of thoracic curvature, pushing thoracic organs forward)

What controls blood flow thorough the coronary arteries

Heart Rate Aortic pressure Metabolic acidosis- automatically decreases contractility Collateral circulation Diameter of the vessels Plaque

Explain cardiogenic?

Heart is failing as a pump Acute MI Acute heart Failure Acute episode of hypertension New atrial fibrillation

Why is a pacemaker utilized?

Heart is unable to generate or conduct its own impulses

Right ventricle

Pumps blood to lungs for oxygen. O2 saturation 60-75% blood is bluish black

Explain non-cardiogenic

Heroin ARDS sepsis

Causes of Shortened QT interval

Hypercalcemia, Hyperkalemia, some drugs, some genetic abnormalities.

Causes of Prolonged QT interval

Hypocalcemia, some drugs, some genetic abnormalities.

What s the protocol for bradycardia? IDEA

I- Isoproterenol D- Dopamine E- Epi A- atropine

What is the protocol for bradycardia

I- Isuprel D- Dopamine E- Epi A- Atropine

why a bypass?

If successful, can relieve anginal pain, improve cardiac function, and poss enhance pt quality of life.

Phosphodiesterase inhibitor (Primacor)

Increase cardiac contractility Used to treat AHF NOT used in CHF

Explain Debutamine

Increase squeeze BP should go up

Left Heart Failure-Lung Pathology

Increased pressure in the pulmonary veins is transmitted retrograde to the capillaries and arteries, resulting in pulmonary congestions and edema with heavy, wet lungs. Accumulating fluid causes cough, fatigue, limb weakness, dyspnea on exertion, and orthopnea.

what is pericarditis

Inflammation of the pericardium

What happens when a plaque ruptures

Inflammatory response causes MI plt aggregation causes 100% occlusion ASA is a great drug to decrease plt aggregation and an NSAID

what is glycoprotein used for

Inhibtors of plt aggregation watch for bleeding

What happens if there is an obstruciton

It is less likely to blood gets to the aorta

What does am EKG tell

It tell about the electrical activity BUT NOT about pump as with a cardiomyopathy

What are S/S of right sided heart failure?

JVD Peripheral edema Hepatomagely Abdoninal pain Loss of appitite Ascites Increased CVP

S/S of right sided heart failure

JVD Peripheral edema Hepatomagely abdoninal pain loss of appitite Ascites increased CVP

What causes angina

Lactic acid causes the pain and reduces cardiac output Means not enough oxygenated blood

What causes the angina?

Lactic acid causes the pain and reduces cardiac output Means not enough oxygenated blood

Pulmonary Artery

Large artery that takes deoxygenated blood from right ventricle to lungs Only artery that carries deoxygenated blood

Inferior vena cava

Large vein that returns deoxygenated blood from lower body

Explain Norepinephrine (Levophed)

Last resort med To treat hypotension Vasopressor have to be hydrated

Left Bundle Branch Block

Left Bundle Branch Block Prolonged QRS complexes Large and wide R waves

infarction of this artery, ________________, frequently results in tachycardia and possible pulmonary edema.

Left coronary artery

What does a Swan Ganz measure?

Left side of heart Normal PAWP 4-12 High- need Lasix Low-need fluids

Class IB antiarrhythics

Lidocaine (Xylocaine) mexiletine *****indications * ventricular tachycardia *ventricular fibrillation ****practice pointers *may potentate the effects of other antiarrhythics *admin IV infusion using an IV pump *****adverse reactions *drowsiness *hypotension *bradycardia *arrhythmias *widened QRS complex

Atrioventricular AV valves

Located between atrium and ventricle supported by chordae tendoneae attached to muscles that outpouch from ventricle muscles. These structures anchor valve cusps to keep closed AV valves from inverting and allowing back flow of blood

explain A fib

Loss of atrial kick can become hypotensive

what anticoag should be given prophalactic

Lovenox

Right Heart Failure - Peripheral Edema

MC in lower extremities and over sacrum (in bedridden patients). External jugular veins become distended and visual. Pleural effusions may appear and cause partial atelectasis. May cause anorexia, pain and weight loss.

Causes of Left Heart Failure

MC ischemic heart disease. HTN Aortic and Mitral valve disease Non-ischemic myocardial disease (myocarditis) Clinical effects primarily result from profressive damming within the pulmonary circulation and consequences of peripheral blood flow.

Left Ventricle

Major pumping chamber of the heart. Pumps the blood to the entire body. Has 3 times the muscle bulk of the right ventricle

what syndrome is aortic dissection commonly seen

Marfan syndrome

What does it mean if the T wave is inverted (flipped upside down)

Means ishemia

BNP (Brain Nitriuretic Peptide)

Measures a hormone made by the heart which determines overall function of the heart. Should be very low. If elevated, it represents a period of prolonged dysfunction.

CRP (C-reactive Protein)

Measures general levels of inflammation within the body. Can track infection and disease

Selective Beta Blocker?

Metoprolol Atenolol Esmolol

explain an acute left sided heart failure

Most common usually a prob. with left vent acute MI acute HTN Afib pulmonary edema

explain defibrillation

Must be ACLS certified electric current to heart muscle hoping that normal heart takes over NOT synchronized- shock is delivered randomly THE ONLY EFFECTIVE TREATMENT FOR V FIB

Explain Defibrillation

Must be ACLS certified to use Electric current to heart muscle hoping that normal heart takes over NOT Synchronized- Shock is delivered randomly THE ONLY EFFECTIVE TREATMENT for V FIB

When does cell death begin for ishemia

Myocardial cell death begins after 20 mintues of ischemia; the damage is not complete and irreversible until after 3-4 hrs

what med should be admin around the clock

NSAIDS until inflammation is relieved

This coronary artery, ________________, feeds the SA and the AV node, and with infarct, you will frequently see sinus bradycardia, nausea, vomiting and abdominal cramping

RCA

Non Selective Beta Blockers?

Nadolol Propanolol Inderal Coreg

explain SA Node

Natural pacemaker of the heart Fastest node-firing at about 60-100 times per min

What are the 4 things you need to have to get blood to the heart muscle

Need to have enough O2 No bronchonconstrction Need to have enough hemoglobin to carry it Need to have a good pump to get it to the tissues Need for the hemoglobin to unload oxygen to the tissues

Niacin

Nicotinic Acid Inhibits lipolysis at the cellular level. Lipolysis produces free fatty acids which the liver uses to make triglycerides, VLDLs and ultimately LDLs. Also increases HDL levels. Indications - Hypercholesterolemia (lowers trigs and raises HDL mostly, also lowers LDL somewhat) Contraindications - Active peptic ulcers or arterial bleeding, active liver disease. Adverse Effects - Flushing, pruritis, GI distress, glucose intolerance, hyperuricemia.

what should not be used for right inferior MI

Nirto

What should not be used for right inferior MI?

Nitro

How can you tell A fib on a EKG strip

No P wave irregular rhythm

How can you tell if A fib?

No P wave, Irregular rhythm

what drugs can be given for acute mgt of MI

O2 ASA Nitro sublinqual Morphine Loading dose of plavix 300mg Beta blockers Thrombolytics Anti-dysrhythmics

Treatment for Acute Heart failure?

O2 Lasix ACE Inhibitors

treatment for acute heart failure

O2 Lasix ACE inhibitors- prevents cardiac remodeling ends in pril debutamine and pulmicort help with the pump Dig takes too long takes 12 hrs to work

What is unstable angina

Occurs at rest with min. activity Warning sign for a MI Medical emergency At risk to progess, and at risk for dysrhythmias

What questions need to be asked to better understand the pain?

Onset- When did it start? Pallitive or Provoking- What makes it better or worse? Quality- What does it feel like? Region- Where is the pain? Severity- on a scale of 0-10 Timing- How often do you have it?

What is a classic mainfestation of cardiac tamponade

Pulses pardoxus --an abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration. The normal fall in pressure is less than 10 mm Hg. Pulses that decrease during inspiration

Explain Systolic Heart failure?

Pumping problem EF is low

PTT Test

Partial Thromboplastin Time Determines if Heparin (or blood thinning therapy) is effective, and can detect clotting problems. It cannot detect LMW Heparin. Normal value - 30-45 seconds.

CBC

Platelets WBCs Hemoglobin Hematocrit RBCs

what is stable angina

Predictable usually activity related cold or stressed

what is PVC

Premature Ventricular contraction

Explain a PAC

Premature atrial contraction Usually benign Can go into a fib

What description of the pain is given during an MI?

Pressure Squeezing Substernal or epigastric pain Dull ache Does not increase with deep breath or palpation "Elephant sitting on my chest" Nausea Indigestion Weakness/ Fatique Upper back pain

What do pts description of pain during a MI

Pressure Squeezing Susternal or epigastic pain dull ache does not increase with deep breath or palpation "elephant sittin on my chest" Nausea Indigestion Weakness/Fatigue Upper back pain

What should be used for left anterior MI?

Primacort

what should be used for left anterior MI

Primacort

PT Test

Prothrombin Time Evaluates blood for how long it takes to clot. Normal value - 10-12 seconds.

What is another classic manifestation of cardiac tamponade?

Pulses Paradoxus Pulse that decreases during inspiration

Acute Myocardial Infarction

Rapid, sudden occlusion of a coronary artery, 80-90% of transmural infarcts are caused by thrombosis of coronary artery. May also be caused by ulceration of an embolized atherosclerotic plaque or prolonged vasospasm.

Left Atrium

Receives blood returning from the lungs O2 saturation is about 100% CO2 removed by lungs

What is the biggest goal for an MI?

Reduce the pain- means you have enough oxygenated blood MONA= OANM (in order of giving) Oxygen Aspirin Nitro sublinqual Morphine

what is a major worry post CABG

Renal insufficiency

Asystole-Clinical Associations

Result of: -Advanced cardiac disease -Severe conduction disturbance -End stage HF

Atrial Fibrillation--Clinical Significance

Results in ↓CO d/t ineffective atrial contractions and/or rapid ventricular response -Thrombi form in atria d/t blood stasis -Thrombi may embolize and cause stroke (A Fib responsible for 20% all)

Four chambers

Right atrium- low O2 Right Ventricle- High CO2 Left Atrium- Low CO2 Left Ventricle- High O2

Where is the P wave coming from?

SA Node

where is a the P wave coming from

SA node

Days after MI

ST Elevation Pathologic Q Wave Inverted T waves

Hours after MI

ST Elevation Only

Weeks after MI

ST Flattening off Pathologic Q wave remains Inverted T waves

What EKG changes show ischemia

ST segment depression or T wave inversion Can indicate partial blockage

What EKG changes show ischemia?

ST segment depression or T wave inversion Can indicate partial blockage

What EKG can be seen with an MI?

STEMI

What EKG can be seen with an MI

STEMI- is where there are EKG changes with a Q wave and there is a transmural infarction which means the entire thickness of the myocrardium has undergone necrosis

STEMI vs NSTEMI

STEMI- is where there are EKG changes with a Q wave, and there is a transmural infarction ( which means the entire thickness of the myocardium has undergone necrosis NSTEMI- is where there is no change in the Q wave and not all of the myocardium has undergone necrosis

Explain a STEMI

STEMi is where there are EKG changes with a Q wave, and there is a transmural infarction (which means the entire thickness of the myocardium has undergone necrosis)

What should be given before a cardioversion?

Sedation Versed Fentenal

Beta Blocker

Selectively antagonizes beta-1 adrenergic receptors in the heart, reducing rate and contractility. Indications - Acute MI, HTN, Angina Contraindications - Uncompensated HF, cardiogenic shock, bradycardia. Adverse Effects - Bradycardia, hypotension, bronchospasm, fatigue, depression, impotence, loss of libido.

explain a cardioverter defibrillator (ICD)

Shocks fast Given to doc. low EFs prior cardiac arrest also acts a pacer delivers an electric shock

Explain CPK diagnostic testing?

Sign of muscle damage Could be cardiac or skeletal Elevated up to 72 hours post MI

What are indications for a pacemaker?

Significant bradycardia Bradycardia unresponsive to drugs

What are indications for a pacemaker

Significant bradycardia Bradycardia that is unresponsive to drugs

Explain CPK dx testing

Signs of muscle damage could be cardiac or skeletal Elevated up to 72 post MI

Mgt of stable angina in the hopsital

Sit the down, rest give O2 give nitro (if doesn't stop)

What needs to be done for stable angina in the hospital?

Sit them down Give O2 Give Nitroglycerin (if doesn't stop)

Months after MI

Slight ST elevation remains Pathologic Q waves remain Normalized T waves

CMP

Sodium Potassium Calcium Chloride CO2 BUN Creatinine Glucose Total Protein Albumin Total Bilirubin Alkaline Phosphatase (ALP) Aspartate Aminotransferase (AST) Alanine Aminotransferase (ALT)

BMP

Sodium Potassium Calcium Chloride CO2 BUN Creatinine Glucose

Premature Vent Contraction--Clinical Associations

Stimulants -Caffeine -ETOH -Nicotine -Aminophylline -Epinephrine -Isoproterenol -Digoxin -Electrolyte Imb -Hypoxia -Fever -Exercise -Emotion stress Disease States -MI -Mitral prolapse -HF -CAD

Explain Sympathetic Nervous System AKA adrenergic

Stimulates ALL receptor sites at once Fight or Flight opposite from DUMBBBELS

Explain Epinephrine?

Stimulates the Beta 1 receptor site ***********Use for Cardiac Arrest Give 1:10,000 IV Increases Contraction, Increases HR

Explain Epinephrine

Stimulates the Beta 1 receptor site Use for cardiac arrest give 1:10,000 IV increases contraction increases HR

What presentation may be seen with aneurism and dissection

Sudden chest pain Pain that may migrate to back Pain "ripping, tearing" May have diminished pulses in a extremity May have differences in blood pressure between each arm

Right Coronary artery

Supplies blood to the right atrium, the right ventricle, and part of the left ventricle. If also supplies blood to the bundle of HIS (muscles that connect the atria with the ventricles) and the AV node (fibers at the base of the interatial septum that transmit the cardiac impulses from the sinoarial (SA) node

What does an infarction result from

Sustained ischemia and is irreversible, causing cellular death and necrosis

how are systolic and diastolic heart failure the same

Systolic and diastolic heart failure can both present with symptoms of fluid overload

S/S of left sided MI?

Tachycardia Hypertension SOB Pulmonary Edema

S/S of left sided MI

Tachycardia hypertension SOB Pulmonary Edema

explain the AV node

Takes over the SA node when needed

Hyperkalemia EKG

Tall Peaked T Waves Non, or small, indiscernible P waves in V5 and V6

explain a QRS

Ventricular contraction ventricular depolarization

True or False Coronary arteries get perfused during ventricular systole.

false

Explain Pericardial Effusion?

The slow accumulation of fluid in the pericardial sac Can cause a cardiac tamponade if compressing the heart

what need to be done for mgt of angina at home

Told to stop activity and REST If it doesn't go away give Nitro If still have 5 min later take another Nitro and call 911

What needs to be done for stable angina at home

Told to stop activity and rest If doesn't go away, give Nitroglycerine If still have then call 911

what does it mean if QRS is too wide or too narrow

Too wide- Ventricular Too narrow- atrial

explain depolarization

Trigger-action

Right Vent pressure

Typically the dr msg right vent pressure only when initially inserting a pulmonary artery catheter. normally equals pulmonary artery systematic pressure; right vent end diastolic pressure, which reflects right vent function equals RAP. *normal systolic pressure ranges from 20-30mmHg *******causes of increased pressure *Mitral stenosis or insufficiency *pulmonary disease *hypoxemia *constrictive pericardidits *chronic heart failure * atrial and vent septal defects * patent ductus arterious ********causes of decreased pressure *reduced circulating blood volume *vasodilatoin

What are the three types of Acute Coronary Syndrome

Unstable Angina Sudden Cardiac Death Acute MI

What can happen with Acute Coronary syndrome

Unstable cardiac ischemia Significant stenosis usually present Rupture of plaque Vasospasm Obstruction of plaque or re-stenosis Inflammation of coronary artery increased O2 demand

what s/s are seen with an aneursim

Usually asymptomatic may see hoarse voice, difficulty swallowing, angina

what rhythm is most common with sudden cardiac death

V Fib

What rhythm is most common with sudden cardiac death?

V fib

who gets defibrillatoin

V fib V tac without pulse

what does Alpha 1 do

Vasoconstricts so BP goes-up

How is systolic heart failure treated?

Vasodilators

Stroke Volume

Volume of blood pumped by the ventricles in one contraction ****normal values--- 60-130 mL/beat ***formula---SV= CO x 1,000/HR ******causes of increased values *sepsis *hypervolemia *inotrope admin ******causes of decreased values *arrhythmias *hypovolemia *decreased contractility *increased afterload

Explain ParaSympathetic Nervous System AKA cholenergic

When stimulated, only affect 1 body system at once DUMBBELS

Can you have an MI without an acute occlusion

Yes

What does the Left coronary Artery (LAD) feed

feeds the septal wall, and left venrtical

A client is admitted with pulmonary edema secondary to aortic valve disease and end stage CHF. The nurse is preparing to administer morphine sulfate. What beneficial effect does morphine have in the treatment of pulmonary edema? a. Decreases anxiety, work of breathing, and vasodilation. b. Decreases respiratory rate. c. Provides an analgesic and sedative effect. d. Decreases anxiety and vasoconstricts.

a. decreases anxiety, work of breathing, and vasodilation

Angina pectoris

aching, squeezing, pressure, heaviness, burning pain, heaviness, usually subsides within 10 mins. *substernal; may radiate to jaw, neck, arms, and back *what makes it worse- eating, physical effort, smoking, cold weather, stress, anger, hunger, lying down *what makes it better- rest, nitro, (note: unstable angina appears even at rest)

explain a biventricular pacer

allow ventricals to beat together for advanced heart failure

what is amioderone

an antidysrhythmic blocks SNS works on atrial and venticular tissue V-fib

when would you use lidocaine

antidysrthmic ONLY used for ventricular dysrhythmais Ventricular tachy V Fib

A client is admitted to the emergency department with acute shortness of breath. In order to confirm a differential diagnosis of CHF, the nurse anticipates that the physician will order which of the following laboratory tests? a. CK-MB% b. BNP c. BUN/creatinine d. Troponin I

b. BNP

A client with a history of angina tells the nurse that he usually gets chest pain while climbing stairs. Recently, his chest pain has gotten worse, and it has occurred while eating, watching television, and driving his car. The nurse interprets that the client is now experiencing a. stable angina b. unstable angina c. intractable angina d. prinzmetal's angina

b. unstable angina

what mgt is used for an anesurism and/or diessection

bring down bp if hypertensive surgery high flow oxygen bedrest/calm environment

The client with CHF has a poor appetite because of dyspnea and becomes fatigued with minimal exertion. The nurse formulates which of the following nursing diagnoses for this client? a. Impaired Physical Mobility b. Ineffective Breathing Pattern c. Activity Intolerance d. Ineffective Airway Clearance

c. activity intolerance

Explain diastolic HF

filling problem EF is normal

what are side effects of amoderone

can cause sinus arrest heart blocks bradycardia hypotension hepatotoxicity pulmonary toxicity

explain a permanet pacer

can pace on or both ventricals

Chronic venous insufficiency

check for ulceratons around ankles pulses are present but hard to find b/c pitting edema foot may be cyanotic when dependent brown scaly skin

explain Pulmonary artery pressure monitoring

cont PAP and intermittent PAWP, msg provide important information about left vent function and preload.

Which nursing diagnosis should receive the highest priority for a client admitted into the emergency department complaining of chest pain? a. Anxiety b. Ineffective Coping c. Activity Intolerance d. Ineffective Tissue Perfusion

d. ineffective tissue perfusion

A client is being admitted with acute heart failure. The nurse realizes that acute heart failure is associated with an abrupt onset of?? a. cardiomyopathy. b. valve disease. c. coronary heart disease. d. myocardial infarction.

d. myocardial infarction

nitroglycerin (Nitrobid)

decreases preload by dilating venous capacitance vessel Used to treat AHF NOT used in CHF

what is the common complication associated with MI

dysrhythmia

Coronary ostium

is an opening in the aorta above the aortic valve. IF feeds blood to the coronary arteries.

Angina

is caused by reduced blood flow to your heart muscle. Your blood carries oxygen, which your heart muscle needs to survive. When your heart muscle isn't getting enough oxygen, it causes a condition called ischemia. The most common cause of reduced blood flow to your heart muscle is coronary artery disease (CAD).

What is ejection fraction (EF)

is the % of blood ejected with each contraction. *normal EF is 55%-75% *the heart enlarges in systolic heart failure in attempt to pump more blood

preload

is the stretching of muscle fibers in the ventricles. This stretching results results form blood volume in the ventricles at end-diastole. According to Starling's law the more the heart muscles stretch during diastole, the more forcefully they contract during systole. Think of preload as the balloon stretching as air is blown into it. The more air, the greater the stretch

hemodynamic monitoring

is used to assess cardiac function and determine the effectiveness of therapy by msg *cardiac output *mixed venous blood *oxygen sat *intracardiac pressures *blood pressure

What does it mean if T wave is inverted (flipped down)?

ischemia

what precautions should be taken when taking amioderone

it can cause another arrhytmia

Superior vena caca

large vein that returns deoxygenated blood from upper body

what does a Swan Ganz msg

left side of the heart normal PAWP 4-12 high- need lasix low- need fluids

what is a normal length of time for a QRS

less than 0.12 seconds

Tricuspid valve

located between right atrium and right venticle, three cusps

What do you have to be careful of when admin thrombolyic

may cause reperfusion arrhythmias

What is heart failure

means that the heart muscle is weakened. *the pumping chambers (vent) cannot pump forcefully enough to send blood out to meet the metabolic need of the body *Blood backs up from the left vent into the vein of the lungs, causing SOB and lung crackles *Blood backs up from the right vent into the veins of systemic circulation, causing edema as a result of fluid retention and volume overload

explain Central Venous Pressure monitoring

msg on the right side of the heart Advantage- less risk for blood clots Disdav. more risk for Afib msg fluid volume status normal is 2-6 too high- too much voulme too low- needs fluids

PA systolic pressure

msg right vent systolic ejection or simply put, the amount of pressure needed to ope the pulmonic valve and eject blood into the pulmonary circulation. When the pulmonic valve is open, PA systolic pressure should be the same as right vent pressure

explain giving Beta blockers?

need to be really careful with acute MI b/c could reduce work to the heart too much contraindicated in HF, Elderly, hypotension, HR greater than 100 or less than 60

Nrs care for right sided MI

no straining Give fluid bolus

Arterial insufficiency

pulses may be decreased or absent skin is cool, pale, and shiny and have pain in legs and feet ulceration typ. occur around toes and on foot and usually turns deep red when depenedent Nails may be thick and ridged shiny hair less legs

explain systolic heart failure

pumping problem EF is low

Right atrium

receives deoxygentated blood returning from the systemic circulation. Color of blood is bluish black.

afterolad

refers to he pressure that the ventricluar muscles must generate to overcome the higher pressure in the aorta to get the blood out the heart. Resistance is the knot on the end of the balloon, which the balloon has to work against to get the air out

Contractility

refers to the inherent ability of the myocardium to contract normally. is influenced by preload. The greater the stretch, the more forceful the contraction- or the more air in the balloon, the greater the stretch, and the farther the balloon will fly when air allowed to expel.

Pulmonary artery wedge pressure

reflects left atrial and left vent pressures unless the pt has mitral stenosis. Changes in PAWP reflect changes in left vent filling pressure. *the mean pressure normally ranges from 6-12 mmHg ********************causes of increased pressure *left-sided heart failure *mitral stenosis or insufficiency *pericardial tamponade ********causes of decreased pressure *reduced circulating blood volume

explain a T wave

repolarization of the ventricle rest

PA diastolic pressure

represents the resistance of pulmonary vascular bed as msg when the pulomic valve is closed and the tricuspid valve is open. To a limited degree (under absolutely normal conditions) PA diastolic pressure also reflects left vent end-diastolic pressure.

explain repolarization

rest

what should be done before a cardioverson that isnt a TEE

sedation Versed Fentenal

what should happen after giving debutamine

should improve contractiltiy and more blood should move forward BNP should go down **If the EF is less than 40 a pt should be on ACE or ARB

Pulmonary artery pressure

shows right vent function and pulmonary circulation pressures. reflects left vent pressure specifically left end diastolic pressure, in a pt without sig pulmonary disease *systolic pressure normally 20-30 mmHg. Then mean pressure usually ranges from 10-15mmHg **********causes of increased pressure *left-sided heart failure *increased pulmonary blood flow (left or right shunting, as in atrial or vent septal defects) *any condition causing increased pulmonary hypertension, volume overload, mitral stenosis, or hypoxia *******causes of decreased pressure *reduced cirulating blood volume *vasodilation

Central venous pressure or right atrial pressure

shows right ventricular function and end diastolic pressure *normal mean pressure ranges from 1 to 6 mmHg *******causes of increased pressure *right sided heart failure *volume overload *tricuspid valve stenosis or insufficiency *constrictive pericarditis *pulmonary hypertension *cardiac tampondae *right vent infraction ********causes of decreased pressure *reduced circulating blood volume *Vasdilation

explain epicardial pacer

status post CABG due to swelling

what presentation may be seen with anesurism and diessection

sudden chest pain pain that may migrate to back pain "ripping, tearing" May have diminished pulses in a extremity may have differences in bp between each arm

explain cardioversion

synchornized countershock HAS A PULSE shocks on the R wave TEE first

Circumflex- ability

the circumflex artery supplies oxygenated blood to the lateral walls of the left ventricle, the left atrium and, in about 50% of the population, the SA node.

explain venous pressure

the dr inserts a catheter through a vein and advances it until the its tip lies on or near or the right atrium. *b/c no major valves lie at the junction of the vena cava and right atrium pressure at end diastole reflects back to the catheter. When connected to the transducer or manometer, the catheter measures CVP, and index of right ventricular function

explain Arterial Blood pressure motioning (A-Line)

the practitioner inserts a catheter into the radial or femoral artery to msg blood pressure or obtain samples of ABG *a transducer transforms the flow of blood during systole and diastole into a wave form, which appears on an osilloscope.

What does the SA node do?

the right coronary artery also supplies blood to the SA node of the right atrium. consists of atypical muscle that establish the rhythm of cardiac contractions

explain percardial effusion

the slow accumulation of fluid in the percardial sac Can cause a cardiac tamponade if compressing the heart

systole

the ventricles contract and send blood on it outward journey.

diastole

the ventricles relax and fill with blood; the mitral and tricuspid valves are open, and the aortic and pulmonic valves are closed.

what is the purpose of giving Thrombolytic enzymes

they chew up plaque end in "ase"

Acute myocardial infarction

tightness or pressure; burning, aching pain, possibly accompanied by SOB diaphoresis, weakness, anxiety, or nausea; sudden onset; last 1/2 hour to 2 hrs *typically across chest but may radiate to jaw, neck, arms or back *what makes it worse- exertion, anxiety *what makes it better- opioid analgesics such as morphine, nitro

what is the goal for noncadiogenic

treat the cause

depolarization occurs

when the electrical system if the heart stimulates a myocardial cell, ____________, resulting in the contraction of the stimulated heart muscle

Ostium action

when the left ventricle is pumping blood through the aorta, the aortic valve is open and the coronary ostium is partly covered. When the left ventricle is filling with blood, the aortic valve is closed and the coronary ostium is open, enabling blood to fill the coronary arteries.

diastolic heart failure-

when the mitral valve opens, the left vent cannot relax to let blood in. Left (LV) and left atrial (LA) pressures increase which back up into the pulmonary circulation EF is normal

A MIDCAB procedure

will have your pt back home much quicker. It usually results in a shorter hospital stay and fewer complications than traditional CABG surger