Cardiovascular 255
Morphine
- for CP unrelieved by NTG -vasodilator -decreases cardiac workload by getting more blood to heart
BB
-decreased R -negative chromotropes
stenosed mitral valves
-gets overworked -build up pressure in the lungs
fight or flight (norepinephrine)
Beta 1 adrenergic receptors causes ____________ responses
renin effect
Beta 1 when stimulated causes +chronotropic, +inotropic, +dromotropic, & increased _______ (Ex. Sympathomimetics like dobutamine for acute hypotension)
no specific medication example
Beta 2 when blocked causes the opposite (Ex. Non selective beta blocker adverse effect,______________)
arteries, arterioles, capillaries, venules, veins
Blood circulates from the left side of the heart into __________, and then back into the right side of the heart.
liver
C- Reactive Proteins (CRP) are made n the ____ during periods of acute inflammation.
Sinus Tachycardia
>100 bpm Vagal maneuvers
hypokalemia
A large U wave may occur with ______
infective endocarditis
A patient at risk for CAD has splinter hemorrhages, which condition is with this finding?
Aortic
A patient has aortic stenosis. Where is this heard?
B-blockers
A patient scheduled for exercise testing, must hold which medication for 24 hours?
potassium
A patient with HTN, if taking potassium wasting diuretics, they should increase ____________ intake
0.5ml
A patient with atrial fibrillation is due for a first dose of digoxin 125 mcg intravenous (IV) push. The pharmacy issues a vial containing 0.25 mg/mL. How much medication should the nurse withdraw from the vial??
transvenous, epicardial, and transcutaneous
A temporary pacemaker is one that has the power source outside the body. There are 3 types of temporary pacemakers: _________________ pacemakers
12 lead ECG
An ECG that uses 12 leads attached to the patient's skin; these include the limb leads and chest leads
mobilizing cholesterol from tissues.
An increase HDL level is associated with a decreased risk of CAD. HDLs serve a protective role by _________
Blurry vision Urinary retention Dry mouth Constipation
Anticholinergics (Atropine) side effects are?
CHD Stroke
Complications of Increased Atherosclerosis
Systole
Contraction of the heart
Assess his adherence to therapy.
Despite a high dosage, a male patient who is taking nifedipine (Procardia XL) for antihypertensive therapy continues to have blood pressures over 140/90 mm Hg. What should the nurse do next?
edema, pulmonary venous pressure, and preload.
Diuretics can reduce______________
vascular response to catecholamines.
Diuretics for HTN promote sodium and water excretion, reduce plasma volume, and reduce the___________
Antidysrhythmic Drugs
Dysrhythmias most common complication post MI what med am i?
impulse formation, conduction of impulses
Dysrhythmias result from disorders of________________, or both.
Damage to walls of arterioles and Renal blood vessels Can lead to DIC and acute renal failure
Effect of prolonged severe hypertension
Cholesterol > 200mg/dl Fasting triglyceride > 150mg/dl LDL > 160 mg/dl HDL < 40mg/dl (men), <50mg/dl (women)
Elevated serum lipids
Clubbing of nail beds
Endocarditis, congenital defects, prolonged O2 deficiency
Semilunar valves close heard at base
Explain S2?
volume overload (early diastole) "rapid filling phase" Ventricular gallop -young is normal; elder patient is abnormal like in CHF
Explain S3?
blood comes back through the aortic valve when it's supposed to be closed
Explain what Aortic Regurgitation is?
none
First Degree AV Block adverse effects?
Depends on underlying rhythm
First Degree AV Block regularity?
Morphine
For CP unrelieved by NTG Vasodilator, decreases cardiac workload what med am i?
vent rate
HR is the same as what?
HR 45 bpm
In trauma patient with post spinal cord injury. Which finding will help confirm neurogenic shock dx?
zero to 250 bpm
In ventricular dysthymias , the HR ranges from
The priority is to stop the transfusion to prevent further hemolysis. The next action would be to change the IV administration set to prevent infusing any blood product remaining in the tubing. Running normal saline rapidly will help decrease shock and hypotension. Notifying the primary health care provider and blood bank would be the last step because these can be done after taking action to prevent further complications of hemolysis.
In which order will the nurse take these actions when caring for a client who is having a hemolytic reaction to a transfusion of packed red blood cells?
40-60 times/min
Intrinsic rate for AV node
high serum lipids, high BP, tobacco use, physical inactivity, obesity, diabetes, metabolic syndrome, psychologic states (e.g., anger, depression), high homocysteine level and substance use.
Modifiable risk factors of CAD include _________
decreased renal and hepatic function or electrolyte imbalance
Orthostatic hypotension often occurs in older adults because of impaired baroreceptor reflex mechanisms, volume depletion, and chronic disease states, such as
same time
PCI may be done at the___________ as the catheterization or late
R on T Phenomenon (PVC)
PVCs falling on the T wave
dual chamber pacemaker
Pacemaker that stimulates the atrium and ventricle. assessed in the subclavian vein
arterial ulcers
Pale ischemic base, well-defined edges usually found on toes, heels, lateral malleoli.
electrical instability of the scarred heart muscle that caused the first event to occur.
Patients who had a prior (old) MI and survive SCD are at risk for another SCD event because of the continued _________
increase; decrease
Pericardiocentesis have +Inotopes that _____ the squeeze and have - chronotopes (HR) that ____ the squeeze
high suspicion
Pericardiocentesis or pericardial window is often done for acute cardiac tamponade, purulent pericarditis, or a __________ of cancer.
increase
Physical activity, eating more healthy fats, losing weight, moderate alcohol intake and quitting smoking help ________ HDL levels.
Unusually warm extremities
Possible thyrotoxicosis
temporary pacemaker
Power source outside the body --Transvenous (inserted into a large vein and threaded into the right atrium or ventricle) --Transcutaneous (attached to skin by way of large electrodes; for emergency)
superior vena cava
Pressure on the right side of the heart effects the large veins called ____
narrow
QRS wave stays _______ for Atrial but not Vent.
ECG monitoring, vital signs, urinary output, level of consciousness, visual changes
Regular, ongoing assessment (e.g., ________________) is essential to evaluate the patient with severe hypertension
nervous, cardiovascular, endothelial, renal, and endocrine
Regulation of BP involves ________ functions.
kidney function
Routine urinalysis, BUN, serum creatinine, and creatinine clearance levels are used to screen for renal involvement and to provide baseline information about ________
NSTEMI or UA.
ST depression and/or T wave inversion in the leads facing the infarcted area is seen with __________
natural
Sacubitril breaks down _________ diuretics
we know the cause... drug abuse, ischemia, infections, alcohol
Secondary Cardiomyopathy
drug use pregnancy (Preclampsia) Sleep apnea hypothyrodism kidney disease
Secondary HTN usually has an identifiable cause, examples are?
LDL and HDL
Statins do not lower triglycerides, it only lowers?
HR 130 or higher
Supraventricular Tachycardia/Atrial Tachycardia (SVT)?
tachydysrhythmias.
Synchronized cardioversion using a defibrillator is the therapy of choice for the patient with ventricular (e.g., VT with a pulse) or supraventricular ____________
Blood Pressure
Tension or pressure exerted by the blood against the arterial walls
more volume
Thin walls =
Veins
Thin-walled, distensible vessels
sodium intake, the renin-angiotensinaldosterone mechanism
This persistent elevation in SVR may occur in several ways. Defects in any of the mechanisms involved in the maintenance of normal BP, including ___________________, and sympathetic nervous system (SNS) stimulation, can result in the development of hypertension.
Hypertension
Too much pressure in the arterial portion of systemic circulation
ASA
UA is treated with?
endocardium, myocardium, epicardium
What 3 layers is the heart composed of?
Captopril
What ACE Inhibitor should be taken on an empty stomach?
Hypertension
What are ARBs used for?
Management of: 1. HTN 2. Angina 3. AMI 4. SVT
What are BB used for?
Hypertension PVD Raunaud's disease
What are Peripheral Vasodilators used for?
HTN & edema associated with HF
What are Potassium Sparing Diuretics used for?
Edema and HTN
What are Thiazide Diuretics used for?
Pericardial Effusion and Cardiac Tamponade
What are the complications of Pericarditis?
Reflex Tachycardia & Fluid retention
What are the considerations for Peripheral Vasodilators?
captopril benazepril enalapril valsartan losartan
What are the meds of the RAAS?
Amiodarone or Ibutilide
What are the most common meds to treat Atrial Fibrillation?
Stable plaque ruptures
What begins the progression of Unstable Angina?
Lidocaine
What drug must be monitored for the OA for toxicity Post MI?
Infective Endocarditis (IE)
What gives of like flu like symptoms, and has a heart murmur?
Cardiac Cancer
What is CHF also referred to as?
Protamine
What is the antidote to Heparin?
control essential and primary HTN reduce edema in mild HF or CKD Promote reabsorption of Calcium
What is the purpose of Thiazide Diuretics?
prevent thromboembolism
What is the purpose of anticoagulants?
350-700
What is the rate for Atrial Fibrillation?
250-350
What is the rate of Atrial Flutter?
Pumping problem
What type of problem is Systolic HF associated with?
Filling Problem
What type of problem is associated with Diastolic HF?
Check for a pulse.
When a client's cardiac monitor shows ventricular tachycardia, which action would the nurse take first? Check for a pulse. Start cardiac compressions. Prepare to defibrillate the client. Administer oxygen via an Ambu bag
Dysrthythmia
When assessing a patient, you note a pulse deficit of 23 beats. This finding may be caused by?
during stressful events
When do s/s show with Mitral Valve Prolapse?
If the HR is less than 60
When do we hold BB?
early to avoid Nocturia
When should a Loop Diuretic be given?
heard best at Mitral
Where are S3 and S4 heard best?
Pulm. area
Where is the Pulmon Stenosis heard at?
right coronary artery
Which artery supplies the AV node and the Bundle of HIS?
Beta 1
Which receptors do BB affect in therapeutic doses?
Sinus Arrhythmia
Which rhythm is this?
Nitrates
________ may be used if the patient has persistent chest pain
inotrope
_________ increases force contraction, more with stroke volume
Hypertension (Stage 1)
___________ is defined as an SBP between 130-139 mm Hg and a DBP between 80- 89 mm Hg.
Endothelial dysfunction
____________ is a marker for CVD and primary hypertension.
• Inotropic therapy and hemodynamic monitoring
______________ may be needed in patients who do not respond to conventional drug therapy and/or those in cardiogenic shock.
vasoconstriction
a bluish tinge around ears of a patient with CAD, would exhibit ___________
stress echocardiogram
a sonogram that employs either exercise or a pharmacologic agent to increase heart rate in order to assess how the heart functions with exertion
The automaticity of pacemakers
ability of cardiac muscle to depolarize spontaneously
Excitability (irritability)
ability to receive and respond to stimuli
murmur
abnormal heart sound
Hypoxia
arterial O2 pressure
A fib
atrial fibrillation
A flutter
atrial flutter
atrium
atrial natriuretic peptide (ANP) is from the
Ventricles
b-type natriutetic peptide (BNP) is from the
low-density lipoprotein (LDL)
bad cholesterol
sympathetic nervous system
baroreceptors sense low pressure beta receptors epi and nor
premature beat (extrasystole)
beat that comes before the expected normal beat
reduced arterial capillary perfusion
blanching of the nails continues for three seconds after the release of pressure, this may be dealt with?
paroxysmal atrial tachycardia (PAT)
bursts of atrial contractions with little pause between them
endothelial and renal epithelial cells
c- type natriutetic peptide is from the
increase in workload, worsen ventricular dysfunctions, and force ventricular remodeling (all not good)
continuous activation of compensatory mechanisms =
Noninvasive hemodynamic monitoring
continuous finger cuff by thoracic bio-reactance method. measurements of stroke volume, cardiac output and systemic BP
shorten and contract an impulse
contractility has muscle fibers that _______________
little block method
count number of little blocks between QRS complexes and divide into 1,500
cardiac reserve
difference between resting and maximal cardiac output
Hormone therapy, oral contraceptives
effects: MI, thromboembolism, stroke, hypertension meds: (estrogren plus progestin (Prempro))
Psychostimulants
effects: Tachycardia, angina, MI, hypertension, dysrhythmias meds: (amphetamines, cocaine)
HR increase
fever=tachycardia BP decrease = _______
4th heart sound
forceful atrial contraction CAD HTN
High-density lipoprotein (HDL)
good cholesterol
Bumetanide (Bumex)
he nurse admits a 73-yr-old male patient with dementia for treatment of uncontrolled hypertension. The nurse will closely monitor for hypokalemia if the patient receives which medication?
Deflating the blood pressure cuff at a rate of 8 to 10 mm Hg/sec
he nurse supervises an unlicensed assistant personnel (UAP) who is taking the blood pressure of an obese patient admitted with heart failure. Which action by the UAP will require the nurse to intervene?
Tall, pointy T waves are typical of
hyperkalemia
chronotrpic
increase heart is a positive ____ effect
renin-angiotensin-aldosterone system
increased preload and ventricular contraction decreased renal perfusion
PAC
premature atrial contraction
nitric oxide and prostaglandin
relax arterial smooth muscle
V-tach
ventricular tachycardia
relaxing pressure for capillary perfusion
what is diastolic blood pressure?
measures
x axis on ECG paper represents
ACE inhibitors
-prevents ventricular remodeling and slows progression of heart failure
"If I develop a dry cough while taking this medication, I should notify my doctor."
A 44-yr-old man is diagnosed with hypertension and receives a prescription for benazepril (Lotensin). After providing teaching, which statement by the patient indicates correct understanding?
Providing comfort and relieving suffering
A male patient with a long history of heart failure qualifies for hospice care. The nurse identifies what priority goal?
The lipid levels are normal.
A male patient with coronary artery disease (CAD) has a low-density lipoprotein (LDL) cholesterol of 98 mg/dL and high-density lipoprotein (HDL) cholesterol of 47 mg/dL. What information should the nurse include in patient teaching?
Conductivity
A material's ability to allow heat or electric charges to flow.
pulmonic
A normal splitting of S2 is heard where?
Take vital signs and report any abnormal values.
A patient returns to the unit after a cardiac catheterization. Which nursing care would the registered nurse delegate to the unlicensed assistant personnel (UAP)?
24 hours.
A patient with hypertensive urgency who is not hospitalized should have outpatient follow-up care within_________
IV Lasix PO digoxin IV Metoprolol
A patient with mitral stenosis reports syncope, palpitations, and chest pressure. Which provider orders would the nurse anticipate?
Shock, unconsciousness, death
Adverse effects of Torsades de Pointes?
Blacks Pregnancy (issues with fetus)
All ACE inhibitors are less likely used in what patients ?
sodium and water
Angiotensin-converting enzyme (ACE) inhibitors prevent the conversion of angiotensin I to angiotensin II and reduce angiotensin II (A-II)-mediated vasoconstriction and ___________ retention.
Amiodarone
Anti-Arrhythmic Meds is ________
Warfarin
Anticoagulant that has multiple food interactions. Full anticoagulant effect takes 1 week, PT & INR routinely, INR goal usually 2.0-3.0. Antidote: vitamin K
Afib
Atrium overload =
ventricular remodeling
B blockers with ACE inhibitors improve survival and reverse ___________ in patients with HFrEF.
Diastolic filling time
CO + HR + Preload =
unstable angina
CP that lasts more than 10 minutes New onset increase in frequency occurs at rest happens during sleep Prompt treatment Chronic angina can turn into this In women it looks like GI issues
exertional dyspnea, fatigue, palpitations from atrial fibrillation, and a loud first heart sound and a low-pitched, diastolic murmur.
Clinical manifestations of mitral stenosis include
RAAS and SNS
Compensatory mechanisms, including activation of ________, are triggered to maintain adequate CO.
impaired ventricular pumping
Dilated CMO has scarring and atrophy of myocardial cells, thickening of ventricular wall, dilatation of heart chambers, and ___________
Brisk, hammering pulses(because it cant open) eg...pounding on a closed door
During the nursing assessment of a patient with an aortic stenosis, the nurse would expect to find:
Lower BP slowly (160/100 within 2-6 hours Monitor BP frequently
Goal of Care for Hypertensive Crisis
>160
LDL levels that are at risk for CAD?
Creatine kinase MB (CK-MB)
Levels increase 6 hours after MI Peak at 18 hours Return to baseline at 24-36 hours
2 or more
Most patients who are hypertensive will need_______ antihypertensive drugs to achieve their BP goals.
CO and BP
Natural peptide causes kidneys to diuretics' and lose Na and water then effecting __________
0.12-.020 seconds
Normal PR
MI
Pathologic Q wave =
Myoglobin
Tests for early indicator of decreased oxygen
contraction
The electrical impulse (action potential) impulses from the SA node travel through inter-atrial pathways to depolarize the atria, resulting in a ___________
SA node (pacemaker)
The electrical impulse (action potential) normally begins in the _________
heart muscle contraction
The electrical impulse (action potential) starts depolarization of the heart cells and leads to _____
2-3 times
The left ventricular wall is ____ thicker than the right
use pillows to prop yourself up while sleeping.
The nurse is assessing a patient for sleep patterns. The patient reports that he has trouble sleeping when lying flat. The best response from the nurse is
Biologic valve replacement The patient's cirrhosis increases the risk for bleeding. Biologic valve replacement is indicated.
The nurse is caring for a 72-year-old patient with a history of alcohol-related cirrhosis and who has been diagnosed with aortic stenosis. Previous drug therapy and valve repair were unsuccessful. Which procedure would the nurse anticipate?
Pathologic Q wave
The nurse is examining the electrocardiogram (ECG) of a patient just admitted with a suspected myocardial infarction (MI). Which ECG change is most indicative of prolonged or complete coronary occlusion?
CO is calculated by multiplying the patient's stroke volume by the heart rate.
The nurse is providing care for a patient who has decreased cardiac output due to heart failure. As a basis for planning care, what should the nurse understand about cardiac output (CO)?
Diuretics
The nurse recalls that which type of drug therapy is used to treat volume overload in patients with acute decompensated heart failure (ADHF)?
Canned chicken noodle soup
The nurse recognizes additional teaching is needed when the patient prescribed a low-sodium, low-fat cardiac diet selects which food?
bare metal stents and drug-eluting stents.
There are 2 types of stents:
wavy baseline between QRS
There is No P wave in Afib, but instead has _________
anticoagulation
Those at risk for thrombus formation receive __________ therapy.
PR interval
To determine whether there is a delay in impulse conduction within the ventricles, the nurse will measure the length of the patient's
STEMI (tombstones)
Total occlusion =
-adrenergic blockers , amiodarone, or lidocaine
Treatment is often based on the cause of the PVCs (e.g., oxygen therapy for hypoxia, electrolyte replacement). Drugs that can be used include _____________
Antiplatelet/anticoagulants, antianginals (NTG), ACE & ARBs Beta-blocker & BP control Cholesterol meds, cigarette smoking cessation, Ca- channel blockers, Cardiac rehab Diet & diabetes Education & exercise Flu vaccination
Tx of Chronic Stable Angina & Acute Coronary Syndrome
look the same
Unifocal PVCs?
rupture of the thickened plaque
Unstable angina occurs because of
structural
Valvular heart disease has ___ changes
drug abuse, myocarditis, autoimmune, genetic, alcohol
What are the causes of dilated CMO?
transient substernal/precordial pain that radiates to the left arm/shoulder Impending Doom
What are the characteristics of the angina associated with ischemia?
Physical, EKG, CXR Lipids and Cardiac Enzymes ( CPK-MB, Troponin) ECHO (doesn't always see blockage) Stress test Nuclear Med (perfusion studies) Angiogram (most invasive, IV dye is needed)
What are the diagnostic studies of Chronic Stable Angina?
slow progression reduce workload improve function control fluid retention
What are the goals of care for a pt. with heart failure?
persistent cough First dose hypotension hyperkalemia
What are the primary adverse effect of ARB use?
Aortic/ Pulm. Regurgitation Mitral/Tricuspid Stenosis
What are the right sided Heart murmurs?
edema JVD Splenomegaly
What are the s/s of right sided HF?
Lowers BP Increase HR Increase CO
What are the therapeutic effects of Peripheral Vasodilators?
A decrease in either CO or SVR
What causes the BP to fall?
Trisomy 21 - Down Syndrome
What genetic defect usually has congenital heart disease/cardiac defect?
Atenolol Sotalol Metoprolol Nadolol Propranolol Timolol
What group of meds are the BB?
causes neutropenia and hyperkalemia
What is a consideration for ARB meds?
Headache upon awakening that subsides as the day goes on
What is a manifestation of HTN?
Fluid from capillaries leaks into the pleural space
What is a pleural effusion?
The devices provide compression of the veins to keep the blood moving back to the heart.
What is an appropriate explanation for the nurse to give to a patient about the purpose of intermittent pneumatic compression devices after a surgical procedure?
Usually a terminal rhythm
What is the adverse effect of Asystole?
40
What is the normal Pulse Pressure?
Increase omega 3 fatty acids
What is the nutritional therapy for CAD?
using the 6 second strip method
What is the only way to measure irregular heart rates?
Digitalis, CCB, BB, Adenosine, cardioversion
What is the treatment for Atrial Flutter?
Conservative
What is the treatment of Aortic Regurgitation?
Valvuloplasty or Valve Replacement
What is the treatment of Aortic Stenosis?
Troponin, CK, CK-MB, Myoglobin, ECG
What labs confirm a patient having a MI?
BUN, creatinine, calcium, total protein
What labs should be monitored when treating a HTN crisis?
Garlic Omega 3 Fatty Acids
What lipid lowering agents are used for cholesterol?
Digoxin Diuretics ACE
What meds are used to treat Dilated CMO?
Nitro + rest
What relieves Chronic Stable Angina?
3lbs a day 5lbs in a week
When is weight concerning with HF?
Oxygen, nitroglycerin, aspirin, and morphine (ONAM)
When planning emergent care for a patient with a suspected myocardial infarction (MI), what should the nurse anticipate administering?
Consult with the primary health care provider. The usual dose of digoxin is 0.125 mg to 0.25 mg daily. A dose of 2.5 mg is excessive, and the prescription should be questioned.
When preparing to give medications to a client, the nurse notes a prescription for digoxin 2.5 mg by mouth daily. The digoxin is supplied as 0.125 mg tablets. Which action would the nurse take?
Blood backs up into the R. atrium which effects venous circulation
Where does blood go with Right Sided HF?
Give epinephrine 0.5 mg intramuscularly
Which action will the nurse take first when treating a client who is having an anaphylactic reaction?
Offer oral fluids at frequent intervals.
Which action will the urgent care clinic nurse anticipate taking for a 24-year-old client who is dehydrated after a long run and has a pulse rate of 103 and blood pressure 102/56 mm Hg?
new onset of SOB
Which assessment of a patient with right calf VTE requires immediate action by the nurse?
positive inotrope
Which is contraindicated in hypertrophic cardiomyopathy?
venous return
Which of the following affects preload?
I can't get my shoes on at the end of the day
Which patient statement is most supportive of a diagnosis of venous insufficiency?
ventricular tachycardia ventricular fibrillation
Which two dysrhythmias can cause Sudden Cardiac Death?
white males
Who are more prone to get CAD?
it carries cholesterol to the liver and gets rid of it
Why is HDL the good one?
Considered normal in the young and the old
Why is there no treatment for Sinus Arrhythmias?
MI
____ CP doesn't have sharp pain, but Pericarditis CP does have sharp pain
Late
________ cardiac signs relate to the development of HF and may include an S3 heart sound, crackles, jugular venous distention, syncope, peripheral edema, and angina
Decompensated HF
________ occurs when these mechanisms can no longer maintain adequate CO and inadequate tissue perfusion results.
Dopamine
________, not dobutamine, dilates renal blood vessels
Heart failure (HF)
_________ is an abnormal clinical syndrome that involves inadequate pumping and/or filling of the heart. This results in the inability of the heart to provide enough blood to meet the oxygen needs of the tissues.
Orthostatic hypotension
_________ is defined as a decrease of 20 mm Hg or more in SBP, a decrease of 10 mm Hg or more in DBP, and/or an increase of 20 beats per min or more in pulse from supine to standing
Unstable angina (UA)
____________ is chest pain that is new in onset, occurs at rest, or has a worsening pattern from the patient's chronic stable angina pattern. UA is unpredictable and must be treated immediately.
Type II AV block
____________ often progresses to third-degree AV block and is associated with a poor prognosis. Treatment before the insertion of a permanent pacemaker may be needed if the patient becomes symptomatic and involves the use of a temporary transvenous or transcutaneous pacemaker.
Intraaortic balloon pump
_____________ therapy and/or ventricular assist devices reduce the workload of the heart
Esmolol
__________is a B blocker used to slow down the heart during CABG
varicose veins
abnormally swollen, twisted veins with defective valves; most often seen in the legs
central cyanosis
bluish discoloration of the skin or mucous membranes due to hemoglobin carrying reduced amounts of oxygen
increased HR
decreased blood pressure =
give oxygen
increase workload of heart =
dysrhythmias.
Hypokalemia can precipitate ____________ Monitoring the serum potassium levels of patients receiving digitalis preparations and potassium-depleting diuretics is essential
because of rapid injection can cause hypotension
IV administration of Loop should be slow, why?
#1. Labetolol Nitride Apresoline Cardene Vasotec Brevibloc
IV meds for hypertensive crisis
Amiodarone Adenosine
- Potassium channel blocker, IV or PO. - Other Antidysrhythmics given by IV with rapid push for 1-2 sec monitoring ECG
"Labels on prepackaged food products should be evaluated before purchase."
A client with hypertension is to follow a 2-gram sodium diet. Which client statement provides evidence that the nurse's dietary instructions are understood?
Implantable cardioverter-defibrillator (ICD)
A patient experienced sudden cardiac death (SCD) and survived. Which treatment should the nurse expect to be implemented to prevent an SCD recurrence at home?
Epinephrine and vasopressin
A patient in asystole is likely to receive which drug treatment?
Alpha-adrenergic Blockers
Action: Block alpha-receptors in vascular smooth muscle, decreasing vasomotor tone & vasoconstriction.Use: HTN, PVD, benign prostatic hyperplasia (BPH).
idiopathic.
Acute pericarditis most often is____________ Other causes include uremia, viral or bacterial infection, acute myocardial infarction (MI), heart surgery, tuberculosis, cancer, inflammation from radiation to the chest, and trauma
Kidney disease, Endocrine disorders, Neuro issues, Drug Use, Pregnancy
Identifiable causes of Secondary HTN
BP, decrease edema of HF or CKD
All diuretics work by selectively excreting various electrolytes and water. Their intended action is to manage _______________
postural hypotension
Alpha 1 adrenergic agonists like midodrine for ________
Monitor BP, HR, RR, and SpO2 during and after ambulation
An RN is working with an LVN on the Telemetry unit and caring for a patient with aortic stenosis and a nursing diagnosis of activity intolerance r/t fatigue and exertional dyspnea. Which of these activities could be delegated to the LVN?
electrophysiologic study (EPS)
An _______________ identifies different mechanisms of tachydysrhythmias, heart blocks, bradydysrhythmias, and causes of syncope.
difficulty in isolating the apical pulse
An expected finding in the assessment of an 81 year old patient is
MI
An increased level of CRP is linked with the presence of atherosclerosis and the first occurrence of a heart event. The CRP level may predict the risk for future heart events in patients with ______
"The medication prevents blood clots from forming in your heart."
An older adult patient with chronic heart failure (HF) and atrial fibrillation asks the nurse why warfarin (Coumadin) has been prescribed to continue at home. What is the best response by the nurse?
Aortic Valve Disorders
As you age, you have a higher chance to get ___
"I will limit the amount of milk and cheese in my diet."
At a clinic visit, the nurse provides dietary teaching for a patient recently hospitalized with an exacerbation of chronic heart failure. The nurse determines that teaching is successful if the patient makes which statement?
intimal wall
Atherosclerosis is the major cause of coronary artery disease (CAD). It is characterized by a focal deposit of cholesterol and lipids, primarily within the ______ of the artery
Calcium channel blockers β-adrenergic blockers Digoxin Antidysrhythmic drugs Electrical cardioversion
Atrial dysrhythmias are common and are treated with:
Biologic valve replacement
Bovine, porcine, and human No anticoagulation required Less durable
Force or contraction
CO+ SV + Contractility =
Stimulants, hypoxia, heart disease
Causes of SVT?
increased arterial CO2 pressure (hypercapnia), decreased plasma pH (acidosis), and arterial O2 pressure (hypoxia).
Chemoreceptors can cause changes in respiratory rate and BP in response to __________
papillary
Chordae are anchored in the ____ muscles of the ventricles.
exertion
Chronic Stable Angina - predictable, consistent, occurs on _________ and is relieved by rest & NTG (Nitroglycerin) Pain lasts a few minutes Intermittent, similar pattern Pressure, heaviness or discomfort Controlled with meds
scarring
Chronic constrictive pericarditis results from __________with consequent loss of elasticity of the pericardial sac. The result is that the pericardium impairs the ability of the atria and ventricles to stretch adequately during diastole • Occurs over time and mimics HF and cor pulmonale. Jugular venous distention (JVD) is common.
Angina
Clinical manifestation of reversible myocardial ischemia
Fever, fatigue, malaise, myalgias, pharyngitis, dyspnea, lymphadenopathy, and nausea and vomiting are early systemic manifestations of the viral illness.
Clinical manifestations of Myocarditis include the following:
Adenosine administration
Continuous cardiac monitoring is required when administering any IV medications to treat dysrhythmias. Because of the short half-life of adenosine, the IV bolus should be administered rapidly. The initial dosage of adenosine is rapid IV bolus of 6 mg followed by a saline flush.
Beta Blockers
Decreases myocardial O2 demand by dec. HR, BP and contractility Reduces the risk for reinfarction and heart failure Given in 1st 24 hours what med am i?
reduce preload
Diuretics', like furosemide, gives what physiological affect?
it decreases inflammation, pain and fever
For the action of ASA, what happens when it suppresses the production of prostaglandins?
IV morphine sulfate and supplemental oxygen.
Gas exchange is improved by giving______________
to correct the electrical activity of the heart
Goal of defibrillation:
P
HR is the number of QRS complexes per minute; same with ventricular rate. Atrial rate is the number of ___ waves per minute
Often called the "silent killer" because it is often asymptomatic until it becomes severe and target organ disease occurs.
HTN
cerebrovascular disease
HTN targets the brain by creating
Anticoagulants
Heparin SQ or IV , enoxaparin (Lovenox) SQ Used for UA and NSTEMI pts Prevents extension of clot & stop formation of new clots what med am i?
vessel disease or stenosis
High cholesterol can contribute to _______
low-density lipoprotein (LDL)
High_________ levels correlate most closely with an increased incidence of atherosclerosis and CAD. Therefore, low serum LDL levels are desirable.
low sat fat and increase fiber and omega (salmon, avocado) Lipid lowering meds (cholesterol meds) Physical activity (30 mins/5 days a week) smoking cessation monitor BP at home
How do we treat CAD?
The left ventricle thickens which limits its ability to fill
How does Aortic Stenosis cause Diastolic HF?
weakens or damages the heart muscle which impairs its ability to pump
How does MI or CAD lead to Systolic HF?
10 seconds of occlusion
How long does it take for myocardial cells to become ischemic?
would further lower the rate.
If given dilitiazem for sinus bradycardia, what would happen?
Vagal maneuvers BB
In a patient with Sinus Tachycardia what are the treatments?
Lifestyle modifications are needed for all persons with elevated BP
In teaching a patient with HTN about controlling the illness, the nurse recognizes that
increase oxygen demand.
Increasing preload, contractility, and afterload increases the workload of the heart muscle, resulting in _______
smooth muscle
Large arteries contain _______
Dysrthymia Death
Left sided heart blockage means conduction problems and ____ can occur
morphine, oxygen, nitroglycerin, aspirin
MONA:
Arterial Dilators Antihypertensives Ca Channel Blockers ACE & ARBs Nitroprusside Milrinone
Meds that cause Decreased Afterload
Betablockers Ca Channel Blockers Digoxin Adensine Antiarrhythmics
Meds that cause Decreased HR:
Diuretics Venous Dilators NTG ACE & ARBs Morphine
Meds that cause Decreased Preload
look different
Multifocal PVCs?
ST depression and/or T wave inversion
NSTEMI, caused by a nonocclusive thrombus, often causes __________ in the ECG leads facing the area of infarction. Patients usually undergo cardiac catheterization with possible PCI within 12 to 72 hours if there are no contraindications.
venous ulcers
Necrotic crater-like lesion usually found on lower leg at medial malleolus. Characterized by slow wound healing
decreased HR
Negative chronotropes =
myocardial infarction
No collateral flow worst damage than having flow 100% blockage STEMI= ST seg elevation affects left ventricle ABRUPT
Normal T wave
No more then 10 small blocks high
ischemia.
Normally, some arterial collateral circulation exists within the coronary circulation. The growth and extent depends on the inherited predisposition to develop new blood vessels and the presence of chronic _________
monitor strict intake/output
Nursing action included in plan of care for pt post endovascular repair of abd aortic aneurysm?
Decreased cardiac output
Paroxysmal Atrial Tachycardia has what manifestation?
squeezing
Positive Inotropes is a ____ problem only
Contractility
Positive inotropes increase myocardial ____ and help in dilating renal blood vessels by enhancing renal output.
decrease in BP of at least 20 mm Hg that occurs within 75 minutes after eating.
Postprandial Hypotension occurs in healthy adults,
QRS =
Pulse (ventricular contraction)
Electrical activity can be observed on the ECG, but no mechanical activity of the ventricles is evident, and the patient has no pulse
Pulseless Electrical Activity?
resting potential
Re-polarization occurs last, when the contractile and conduction pathways cells regain their _________ condition
Tachydysrhythmias CHF CMO
Reasons to want to Decrease HR
Diastole
Relaxation of the heart
diastolic
Restrictive CMP, the least common CMP, impairs _________ filling and stretch, although systolic function is unaffected
ACE inhibitors
Reverse remodeling of the heart =
heart attacks
StEMI and NSTEMI are both _
Tachycardia and it vasoconstricts
Stimulants like cocaine and amphetamines cause
"time bomb"
Survivors of SCD may develop a _______ mentality, fearing the recurrence of cardiac arrest. They and their caregivers often become anxious, angry, hopeless, and depressed. They may need to deal with other issues, such as driving restrictions, role reversal, and change in occupation.
perfusion
Syncope doesnt produce enough _______
hot showers and alcohol
Taking Nicotinic Acid (Niacin), what can make symptoms worse?
Hyperkalemia
Tall, pointy T waves =
Interprofessional Care
Target goals take into consideration both age and comorbidities when recommending treatment options
electrodes
The electrical activity of the heart can be detected on the body surface using _________
low-density lipoprotein (LDL)
The endothelial lining of the coronary arteries becomes inflamed from the presence of unstable plaques and the oxidation of ____________ cholesterol
Afterload
The force or resistance against which the heart pumps.
Clear lung sounds and decreased heart rate
The nurse determines that treatment of heart failure has been successful when the patient experiences
increase intake of soluble fiber to 10 to 25 grams per day
The nurse is providing instructions to a 68 year old client who is at high risk for development of coronary heart disease. Which intervention should the nurse include?
Ashen skin Diaphoresis Nausea and vomiting S3 or S4 heart sounds
The nurse would assess a patient with reports of chest pain for which clinical manifestations associated with a myocardial infarction (MI)? (Select all that apply.)
reducing BP and adhering to the treatment plan.
The primary nursing responsibility for long-term management of hypertension is to help the patient in _________
Ensure maintenance of the closed system
The primary responsibility of a nurse when caring for a client with a chest tube attached to a three-chamber underwater-seal drainage system is to:
systemic
The thickness of the left ventricle is needed to make the force needed to pump the blood into the ____ circulation.
oxygen demand and/or increasing oxygen supply
The treatment of chronic stable angina is aimed at decreasing _________________________________ and reducing CAD risk factors.
palliative care and hospice.
Therapies for stage D HF include mechanical circulatory assist devices, such as VADs, as well as ___________
What are antihypertensive drugs?
Thiazide BB CCB Angiotensin Inhibitor (ACE) Angiotensin II (ARB) Alpha blocker
elevated
Troponin can stay ___________ after an MI occurred, but it has to be starting to show trends of going downward.
Unstable
Unstable Angina or Chronic Angina is worse?
Carvedilol Metorprolol
What are the only 2 BB approved to treat CHF?
Raise the HOB Keep calm
What are the two main nonpharmacological management options of Pulmonary edema?
CO and Stroke Volume
What decreases with Dilated CMO?
P wave and QRS wave are matching and upright
What do the waves look like in NSR?
Normal S1 Loud S4
What do we hear with Aortic Stenosis?
HTN and CAD
What is CHF caused by?
Transcutaneous pacing
What is known as the sandwich of the heart?
101-160
What is the rate of Sinus Tachycardia?
invasive procedure to fix blockage
When Chronic Stable Angina progress to becoming sicker, what has to be done right away?
Pulmonary artery wedge pressure
When a critically ill client has a pulmonary artery catheter inserted, which measurement provides the most useful information about the client's left ventricular pressure?
Stenosis
When the valve impedes or prevents the flow of blood from one chamber to the next
Heparin Enoxaprin
Which anticoagulants are used Post MI?
BNP (>100) Electrolytes (Na/K) LFT CBC
Which labs are used to diagnose Heart Failure?
Pericardial tamponade Pericardial Constriction
Which pericardial diseases can lead to Diastolic HF?
Diabetes mellitus Low levels of high-density lipoprotein (HDL) cholesterol
Which significant risk factors for coronary heart disease carry a greater risk for women than for men?
Anticoagulation therapy
Which topic would be included in discharge teaching for a 22-year-old client who has had mitral valve replacement with a mechanical valve?
Symptoms of infection Use of pain medications Purpose of anticoagulant medications
Which topics will the nurse include in discharge teaching for a client who has had a mitral valve replacement with a mechanical valve?
Microvascular
Which type of angina occurs in the absence of CAD?
because friction isn't being reduced
Why does CP happen in Pericarditis?
Increases workload on heart Alters the structure of the vessels Negatively affects sensitive body tissues
Why is hypertension a problem?
diffuse ST seg elevations
With Pericarditis, what will you see in a EKG?
BNP
_______ is the marker of choice when distinguishing between a cardiac and respiratory cause of dyspnea.
Chronotrope
___________ effects HR causing it to increase, impulses rapid conduction
cardiac catheterization
a diagnostic procedure in which a catheter is passed into a vein or artery and then guided into the heart
Lipoprotein-associated phospholipase A2 (Lp-PLA2)
a lipoprotein-bound enzyme that generates potent pro-inflammatory and pro-atherogenic products such as oxidized free fatty acids and lysophosphatidylcholine. this is a specific marker of plaque inflammation.
Cardiac Index (CI)
a measure of the cardiac output of a patient per square meter of body surface area.
Positron Emission Tomography (PET)
a method of brain imaging that assesses metabolic activity by using a radioactive substance injected into the bloodstream
originate an impulse
automaticity and pacemakers have cardiac cells to _____________
nuclear imaging
images document the structure and function of organs being examined
absent
lack of pulse
magnetic resonance angiography (MRA)
magnetic resonance imaging of the heart and blood vessels for evaluation of pathology
no clinical evidence
• Hypertensive urgency has ____________ of target organ disease.
antibradycardia, antitachycardia
• Pacemakers provide ________________, and overdrive pacing.
STEMI.
• ST elevation in the leads facing the infarcted area is seen with __________
vasoconstriction
Alpha-adrenergic receptors result in ________
Physiologic Q wave
Also known as a normal Q wave,it will measure less than 0.04 second in duration and less than 1/3 the height of the R wave in that lead
No
Are P waves seen in Premature Ventricle Contraction?
away
Arteries, except for the pulmonary artery, carry oxygenated blood ____ from the heart.
smooth muscle and little elastic tissue
Arterioles are made up of ______
low oxygen and increasing of carbon dioxide
Arterioles serve as the major control of arterial BP and distribution of blood flow. The respond readily to local conditions such as ___________ and ________, by dilating or constricting.
albuterol
Beta 2 when stimulated causes smooth muscle relaxation of the bronchus, bronchioles, & detrusor muscle (Ex. Beta 2 agonist (bronchodilators) like __________ for asthma)
metoprolol (if given this medication, other problems such as CAD and HR problems are occurring; not just BP problems)
Beta Blocker med examples?
walls of the blood vessel
Blood pressure (BP) is the force exerted by the blood against the __________. Maintaining tissue perfusion during activity and rest must be adequate.
parasympathetic
Blood vessels in skeletal muscle do not receive _______ input
falls
Both orthostatic and Postprandial Hypotension may be related to ___ in the older adult
extracellular calcium
Calcium channel blockers increase sodium excretion and cause arteriolar vasodilation by preventing the movement of ________ into cells
Lipid-Lowering Drugs
Pts with ACS or CAD should receive
autonomic nervous system
The HR is controlled mainly by the ____ system
HR and rhythm
The ICD sensing system monitors the_____________and identifies VT and VF.
Depolarization of the atria
The P wave represents ____
Depolarization
The process during the action potential when sodium is rushing into the cell causing the interior to become more positive.
HA, N/V, visual disturbances, hallucinations
What are the common s/s of Dig toxicity?
decrease in BP Decrease in UO
What are the late manifestations of an MI?
CO and systemic vascular resistance
What are the major factors influencing BP?
weakness, severe dyspnea, hypotension
What are the manifestations of Aortic Regurgitation?
Dizziness, Dyspnea, Hypotension, Angina in pt with CAD
What are the manifestations of Sinus Tachycardia?
Clofibrate Fenofibrate (most common) Gemifibrozil
What are the meds for Fibric Acid?
anything ending in KINASE
What are the meds for Thrombolytics(breaks down a thrombus)?
Angina, MI, Sudden Cardiac Death Heart Failure Arrhythmias Conduction Problems
What can CAD lead to?
ineffective health management risk for decreased cardiac tissue perfusion risk for ineffective renal perfusion
What can be a nursing dx for HTN?
Myocarditis *producing contractions)
What can happen a week after having a viral infection?
acute conditions (infective endocarditis) Chronic conditions (Rheumatic Heart Disease)
What can valvular heart disease result from?
Pulmonary embolus Valvular Heart Disease Lung disease Thyrotoxicosis
What causes Atrial Flutter?
CAD, HTN, CMO
What causes Left Sided Heart Failure?
volume overload
What do we get as a result of Aortic Regurgitation?
degree of ventricular remodeling
What does the progression of Systolic HF depend on?
Tobacco causes vasoconstriction
What does tobacco use have to do with heart failure?
diuretics or ultrafiltration.
Decreasing intravascular volume with the use of __________
volume returned to the left ventricle (LV).
Decreasing venous return (preload) to reduce the amount of _________
AV valves close heard at apex
Explain S1?
systole (lub) sound of AV closure (mitral and tricuspid) (squeeze) pressure increases
Explain S1?
diastole (dub) relaxation AV opened, SL closure (aortic, pulmonic)
Explain S2?
heard in Heart Failure or regurgitation
Explain S3?
heard in Resistance with Ventricular filling
Explain S4?
Unstable Angina
Form of angina with new onset or progressive increase in frequency, intensity, and duration of of attack, occurs at rest
The increased blood volume stretches the heart which weakens the muscle
How does Mitral Regurgitation lead to Systolic HF?
Anti-Xa inhibitor
How does Rivaroxaban (anticoagulant) work?
The heart must work harder to pump against increased resistance which weakens the muscle
How does Uncontrolled HTN lead to Systolic HF?
Decreases Vitamin K
How does Warfarin (anticoagulant) work?
pacemaker
ICD delivers a defibrillator shock or acts as a __________ as needed.
intrascapular epigastric Mid sternum Substernal Neck, Jaw, Left arm
Locations of Chest Pain R/T MI or Angina
toxic
Low serum levels of potassium enhance the action of digitalis, causing a therapeutic dose to achieve _________ levels
Cardiovascular magnetic resonance imaging
noninvasive imaging technique - obtains info about cardiac tissue integrity, cardiac output, and patency of coronary arteries
PVC
premature ventricular contraction
causes renal vasodilation, increases diuresis and contractility
What is the action of Dopamine at low doses?
Blocks reabsorption of sodium and chloride Prevents reabsorption of water
What is the action of Loop diuretics?
prevent or delay blood coagulation
What is the action of anticoagulants?
excrete sodium and water, and chloride and potassium of kidney
What is the action of thiazide diuretics?
Ototoxicity
What is the adverse effect of Loop Diuretics?
Do not require long term anticoagulation therapy
What is the benefit of biologic valve replacement?
Troponin
What is the gold standard test for Acute Coronary Syndrome?
Troponin
What is the gold standard to dx heart attack?
HF
What is the most common reason for hospital admissions?
Heparin + TEE (rule out clots) + cardioversion
What is the treatment for Atrial Fibrillation if the duration is >48 hours and emergent?
Digitails CCB BB Adenosine Cardioversion Ablation
What is the treatment for Atrial Flutter?
Atropine oxygen Pacemaker hold bradycardia-inducing meds
What is the treatment for Sinus Bradycardia?
CPR + epinephrine/vasopressin Intubation
What is the treatment of Asystole?
SVT/Atrial Tachycardia
What is this?
ECHO and Cardiac Cath
What labs measure EF?
ESR and CRP
What labs to look at for inflammation of IE, these labs can also be seen in Arthritis patients?
Mannitol (Osmitrol)
What med is for Osmotic Diuretic?
BB, negative chromotropes
What medication is given with Afib?
ACE/ARB BB Loop Diuretic Aldactone
What medications are used to treat Systolic HF?
Collateral Circulation
What occurs if the progression of CAD is slow?
ST depression or T wave inversion
What on an EKG shows heart muscle damage?
all layers of the heart
What part of the heart does Rheumatic Fever/Heart disease affect?
immunosuppression therapy
What treatment would a patient be put on after a heart transplant?
Drugs to treat/control HF - Vasodilators (e.g., nitrates, ACE inhibitors) - Positive inotropes (e.g., digoxin) - Diuretics - β-blockers Sodium restriction Anticoagulation therapy Anti-dysrhythmic drugs
What treatment would you expect the health care provider to order for severe mitral regurgitation?
P, E, T (left sternum border) (early diastolic)
Where is the murmur heard in Aortic Regurgitation?
diastolic filling and perfusion
With rapid HRs, there is less time for _____ and _____________of the coronary arteries.
dyspnea, unusual fatigue, and sleep disturbances
Women more commonly experience ____________ in UA
Myocarditis
__________ is a focal or diffuse inflammation of the myocardium caused by viruses, bacteria, fungi, radiation therapy, and pharmacologic and chemical factors.
coronary artery disease (CAD)
__________ is a type of blood vessel disorder included in the general category of atherosclerosis.
Surgical intervention
__________ is based on the valves involved, the pathology and severity of the disease, and the patient's clinical condition.
• Ambulatory BP monitoring (ABPM)
______________ measures the BP at preset intervals over a 24-hour period.
cessation of all tobacco use
highest teaching priority for a patient with thromboangilitis obliterans (Buergers disease)
unstable
A patient is experiencing 2 days of severe chest pain, the patient is having what kind of angina?
Regurgitant mitral valve
- ventricles squeezing -blood goes back to aorta - CO is decreased because SV is decreased -Atrium is overworked
Morphine
-helps with CP -Blunts the SNS
stomach and absorption
Cephalosporins affects PF of the ____ and ___
hypercapnia
Chemoreceptors experience ___________ making changes in RR and BP
thready peripheral pulses; cool, clammy extremities; and a new systolic murmur
Clinical manifestations of acute MR include ______________
Hydrolazine Nitroprusside - Most common Pranzosin
Common Peripheral Vasodilator meds
Spironolactone (Aldactone) Amiloride (Midamor) Triamterene (Dyrenium)
Common Potassium-Sparing Diuretics/Aldosterone Receptor Antagonists:
syncope
Diagnostic tests used to determine the cause of __________ include echocardiography, stress testing, EPS, head-up tilt-test, Holter monitors, and event/loop recorders
β-adrenergic agonist
Dobutamine has a positive inotropic effect (improves contractility). It is used for patients who, despite conventional therapies, have a very low CO. It is a selective _________ and works primarily on the β1-adrenergic receptors in the heart
Coronary revascularization: percutaneous coronary intervention, PCI
Gold standard to identify and localize CAD. Involves angioplasty and or stenting
Men <40 Women < 50
HDL levels that are at risk for CAD?
fluid retention
HF can cause kidney problems = No CO = Renin. The kidneys hold on to Na and H2O making to worse in _____ creating pulm edema
B6, B12, or folate.
Homocyteine is an amino acid made during protein catabolism. High Hcy levels can be either hereditary or from dietary deficiencies of vitamin _________
Irregular rhythms reduce the pumping effectiveness
How do Arrhythmias leas to Systolic HF?
indirect- vital organs direct- chemo cath
How do we measure CO?
Digitalis CCB BB Amiodarone Cardioversion Slow HR
How do you treat Afib if <48 hours
on an empty stomach
How should Catopril (ACE) be taken?
oral therapy.
Hypertensive urgencies usually do not need IV drugs but can be managed with ______
negative
Hypertrophic CMO have______ inotropes
ECG ECHO
Hypertrophic CMO is found by what labs?
HR 20-40
Idioventricular Rhythm? regular
Blood pressure 141/89
In caring for a pt with descending aortic dissection, which finding is Most important to report to provider?
P wave
Junctional dysrhythmias refer to dysrhythmias that begin in the area of the AV node, in which the AV node becomes the pacemaker of the heart. The ________ is inverted, absent, or behind the T wave. Junctional dysrhythmias include junctional premature beats, junctional escape rhythm, accelerated junctional rhythm, and junctional tachycardia. Treatment depends on the type, patient's tolerance of the rhythm, and patient's clinical condition.
Dehydration, orthostatic hypotension, N/V, abdominal pain, diarrhea, constipation, frequent urination
Major SE of thiazide diuretics
Triglycerides
Male: 40-160 mg/dL Female: 35-135 mg/dL mixtures of fatty acids. can be obtain through fasting or nonfasting
the highest pressure is in the beginning
Mitral Stenosis is known as "Rapid Filling" because?
High Na intake Low Ca, K, and Mg intake Obesity (central) Excess alcohol Insulin resistance
Modifiable Risk factors for HTN
Genetics Family history Age Race
Non Modifiable Risk factors for HTN
Propranolol Carvedilol Sotalol Timolol
Non-Cardioselective meds, BB 2, (Lung conditions like COPD and Asthma should be used with caution)
sinoatrial (SA) node
Normal sinus rhythm starts in the __________ and follows the normal conduction pattern of the cardiac cycle.
arterial
The arterial system differs from the venous system by the amount and type of tissue that make up _______ walls.
heart rate.
The corrected QT (QTc) is calculated to adjust for ______
Right sided HF
The heart failure that gives out systemic symptoms?
Sinus tachycardia
The nurse assesses a patient and notes a temperature of 101.6° F. Which type of dysrhythmia is associated with a fever?
normal heart function, improved activity intolerance, and an understanding of health maintenance measures.
The overall goals for a patient with valve disease include ____________
Cystic fibrosis
Thick mucous gland secretions, elevated sweat electrolytes, meconium ileus, and difficulty maintaining and gaining weight are associated with this autosomal recessive disorder:
RF or who are IV drug
Tricuspid stenosis occurs almost exclusively in patients with ___________ users. It results in right atrial enlargement and increased systemic venous pressures.
increase
Uric acid can _________ with diuretic use
Asymmetry in limb circumference
Venous thromboembolism, varicose veins, lymphedema
Right ventricle
What fails with Right Sided HF?
STEMI
What is a total occlusion with Unstable Angina called?
CABG
What is the surgical treatment of MI?
mitral valve
Which heart valve sound is heard best at the left midclavicular line at the level of the fifth ICS?
Home BP Monitoring (HBPM)
___________ measures the BP at home to confirm hypertension diagnosis and for titration of oral agents. HBPM should be done in conjunction with regular follow up visits with the HCP.
Tobacco, alcohol, amphetamines, and cocaine
_____________ use may precipitate coronary artery spasm
rheumatic fever
chronic scarring and deformality of the heart valves
decreased blood pressure
decreased blood volume =
mechanical
deporalization triggers ____ activity
distended neck veins or liver enlargement
elevated right atrial pressure can cause ___________ or _________ because of resistance to blood flow.
Grade 2 heart murmur
quiet but clearly audible
ECG event monitor or loop recorder
records rhythm changes. Aids in diagnosing chest pain.
Epinephrine
stress response releases _________ to restore heart that causes tachycardia
compensate fluid
ventricular dilation =
age, gender, ethnicity, and genetics.
• Nonmodifiable risk factors of CAD include_________
international normalized ratio (INR)
• Patients on anticoagulation therapy (warfarin [Coumadin]) after valve replacement surgery must have the ____________ checked regularly.
chronotropes
Paroxysmal Atrial Tachycardia have what kind of tropes?
ventricular hypertrophy
Prone to dysthymia's =
the impulses from the SA node
Stimulation of the parasympathetic system (mediated by the vagus nerve) slows the HR by decreasing __________ and thus conduction through the AV node.
HR, speed of impulses through AV node, and the force of atrial and ventricular contractions
Stimulation of the sympathetic nervous system increases the ________, ____________, and ____________
beta-adrenergic receptors
Stimulation of the sympathetic nervous system mediates specific sites in the heart called ________
Valsalva maneuver.
Stool softeners are given to aid bowel movement and prevent straining and the resultant vagal stimulation from the ________
Irritable Foci
Term for a cardiac cell that is irritated and trying to send a signal
assessing the patient's response to the dysrhythmia.
The ECG monitor of a patient in the cardiac care unit after an MI indicates ventricular bigeminy with a rate of 50 beats/min. The nurse would anticipate
depolarization and repolarization
The QT interval represents the total time for _____________ of the ventricles.
Take BP and HR with patient standing.
The UAP is taking orthostatic vital signs. In the supine position, the blood pressure (BP) is 130/80 mm Hg, and the heart rate (HR) is 80 beats/min. In the sitting position, the BP is 140/80, and the HR is 90 beats/min. Which action should the nurse instruct the UAP to take next?
venous
The ______ system is a low pressure, high volume system,
T wave
The ________ represents repolarization of the ventricles.
ST segment
The ___________ represents the time between ventricular depolarization and repolarization. This segment should be flat or isoelectric and represents the absence of any electrical activity between these 2 events
PR interval
The ___________ represents the time period for the impulse to spread through the atria, atrioventricular (AV) node, bundle of His, and Purkinje fibers.
QRS complex
The ____________ represents depolarization of the ventricles (ventricular contraction).
displacement point of maximal impulse (apical pulse)
cardiac enlargement
Ventricular Remodeling in HF
change in the structure of the hart over time, shape becomes more spherical becomes larger but less effective
prolonged QT syndrome
changes in the conduction system (e.g., _________).
sodium and water retention
chronic stimulation of the RAAS and SNS lead to _____________, inflammatory mediator activity, ventricular remodeling, and interruptions in the electrical conduction of the heart
The S2 heart sound represents:
closing of the aortic and pulmonic valves
What causes normal heart sounds?
closure of the heart valves
syncope, language, and memory
dysrthrthmias, htn, and stroke may cause difficulties with
gravity, varicosities, or right sided heart failure
edema in the legs can be caused by
biologic
if the patient cannot take anticoagulants (e.g., women of childbearing age), a __________ valve is considered. A mechanical valve may be best for a younger patient because it is more durable. For patients older than 65 years, maintaining valve durability is less important than avoiding the risks of bleeding from anticoagulants, so most receive a biologic valve.
gradient
in stenosis, the valve opening is smaller which impedes the forward flow of blood and creates a pressure difference on the two sides of the open valve. The degree of the constriction is reflected by the pressure differences (i.e., the higher the ___________ the greater the stenosis).
Sudden cardiac death (SCD)
is a sudden unexpected death occurring within 1 hour of symptom onset.
Doxorubicin
is an anticancer medication that causes cardiomyopathy
rest and digest
parasympathetic nervous system deals with the vagus nerve in ____________
STEMI (tombstones)
pic of _________
petechiae
pinpoint purple or red spots from minute hemorrhages under the skin on trunk, conjunctiva
transesophageal echocardiography (TEE)
placement of the ultrasonic transducer inside the patient's esophagus to assess cardiac function and examine cardiac structure
monomorphic ventricular tachycardia
presents with wide QRS complexes of a common shape. Patient may or my not have a pulse Check LOC Levels
oxygen saturation
priority assessment finding in patient with anaphylactic shock shows if statement has been effective?
What is Ejection Fraction (EF)?
proportion of blood pumped from the left ventricle during each cardiac cycle
Paraxysmal nocturnal dyspnea
sudden awakening from sleeping with shortness of breath
Copeptin
<10 pmol/L influenced by fasting and water overload
NT-proBNP
<400pg/mL (values increase with age higher in women than men)
The patient has impaired central perfusion.
A 72-year-old man presents to the emergency room. The patient appears diaphoretic and anxious, and has noted peripheral edema. The patient's vital signs are blood pressure of 100/40, heart rate of 130 and irregular, and respiratory rate of 26. How does the nurse interpret these findings?
Temporary episodes of neurological dysfunction
A client has a history of progressive carotid and cerebral atherosclerosis and experiences transient ischemic attacks (TIAs). The nurse explains to the client that TIAs are:
Occipital headache in the morning
A nurse is assessing a client with the diagnosis of primary hypertension. What clinical finding does the nurse identify as an indicator of primary hypertension?
A chest x-ray is needed to verify placement after the procedure
A nurse is orienting a newly licensed nurse on the care of a patient who is to have a line placed for hemodynamic monitoring. Which of the following statements by the newly licensed nurse indicates effectiveness of the teaching?
a wide distorted QRS complex
A patient has a dx of acute MI, and his cardiac rhythm is sinus bradycardia with 6-8 premature ventricular contraction (PVCs) per minute. The pattern that the nurse recognizes as the most characteristics of PVCs is?
AV node Left ventricle Right ventricle
A patient has a severe blockage in his right coronary artery. Which heart structures are most likely to be affected by this blockage (select all that apply)?
av node, left ventricle, right ventricle
A patient has a severe blockage in his right coronary artery. Which heart structures are most likely to be affected by this blockage?
Presence of chest pain
A patient has received a bolus dose and an infusion of alteplase (Activase) for an ST-segment elevation myocardial infarction (STEMI). Which patient assessment would determine the effectiveness of the medication?
Tissue plasminogen activator (t-PA) 100 mg IV infused over 3 hours
A patient is admitted to the coronary care unit following a cardiac arrest and successful cardiopulmonary resuscitation. When reviewing the health care provider's admission orders, which order should the nurse question?
A. Measuring hourly urine output C. Continuous BP monitoring with an arterial line E. Assessing the patient for signs and symptoms of heart failure and changes in mental status
A patient is admitted to the hospital in a hypertensive emergency 244/142. Sodium nitroprusside is started to treat the elevated BP. Which management strategies would be most appropriate for this patient?
Ventricular fibrillation
A patient states, "I feel tired all the time, and I struggle with activities of daily living." When auscultating the patient's heart rate, the nurse notes disorganization of atrial electrical activity and records a rate of 120 bpm. Which rhythm does the nurse anticipate observing?
Does the patient have a headache or confusion?
A patient with a history of chronic hypertension is being evaluated in the emergency department for a blood pressure of 200/140 mm Hg. Which patient assessment question is the priority?
Bronchospasm Sleep disturbance Nightmares Heart block Acute Heart Failure
Adverse Effect of BB
ACS.
Anxiety is common after ________ Your role is to identify the source of anxiety, assist the patient in reducing it, and provide appropriate patient teaching.
regurgitating
Chordae's support system within the heart valves, prevents the eversion of the leaflets into the aortic valves preventing blood from _______ into the ventricles at the end of each ventricular contraction
reducing SVR
Direct vasodilators decrease the BP by relaxing the vascular smooth muscle and _______
sends that person to V-tach
During cardioversion, If a patient is shocked on a different wave other than R, what can happen?
nsidious process
HF can have an abrupt onset as with acute myocardial infarction, or it can be an _____________ resulting from slow, progressive changes.
ventricular failure
HF is characterized by _________, reduced exercise tolerance, decreased quality of life (QOL), and shortened life expectancy
remodeling
HF leads to _________ (which is not a good thing) and develops in response to myocardia injury and results in decreased heart function.
Pressure remains higher in the ventricles
In Mitral Regurgitation, what does the pressure do in the heart?
controlling or changing
Management risk starts with __________________ the additive effects of modifiable risk factors.
Dizziness Dyspnea Hypotension Angina in patients with CAD
Manifestations of sinus tachycardia?
diastole blood pressure
Minimum blood pressure during relaxation.
systemic lupus erythematosus (lupus)
Most adult mitral valve stenosis results from rheumatic heart disease. Less often, it can occur congenitally, from rheumatoid arthritis, or from ____________
Holter monitoring, event monitoring (or loop recorder), exercise treadmill testing, and signal-averaged ECG.
Noninvasive diagnostic tests used to evaluate heart dysrhythmias and the effectiveness of antidysrhythmic drug therapy include _____________________
The Frank-Starling law
The greater the stretch, the stronger is the heart's contraction. This increased contractility results in an increased volume of blood ejected (Increased SV)
endothelium
The innermost lining of the arteries is the _______
left and right atrium
The inter-atrial septum creates a _________
left and right ventricles
The inter-ventricular seputum creates a ________
elastic
The large arteries have thick walls composed mainly of ____ tissue. This tissue cushions the impact of the pressure created by the ventricular contraction and provides recoil that propels blood forward into the circulation.
Staphylococcus aureus, Streptococcus viridans or Coagulase negative staphylococci.
The most common causative organisms of IE are ______________
2.8 to 4.2 L per minute per meter squared (L/min/m2)
The normal Cardiac Index (CI) is ______
Bilateral edema
The nurse compares the signs and symptoms of right-sided heart failure and left-sided heart failure. Which symptom is unique to right-sided heart failure?
Atherosclerosis
The nurse determines that a patient's pedal pulses are absent. What factor could contribute to this finding?
MI
The nurse is assessing a female patient at the neighborhood clinic. The patient is complaining of "feeling tired all the time." The nurse knows that fatigue may be an underlying symptom of which condition?
Sinus rhythm with a depressed ST segment
The nurse is monitoring the ECG of a patient admitted with ACS. Which ECG characteristics would be most suggestive of myocardial ischemia?
Turbulent blood flow across a heart valve
The nurse is performing an assessment for a patient with fatigue and shortness of breath. Auscultation reveals a heart murmur. What does this assessment finding indicate?
Advanced cerebral or peripheral vascular disease not amenable to correction
The nurse recognizes that which condition is an absolute contraindication for cardiac transplantation?
"I can lower my blood pressure by switching to smokeless tobacco."
The nurse teaches a 28-yr-old man newly diagnosed with hypertension about lifestyle modifications to reduce his blood pressure. Which patient statement requires reinforcement of teaching?
"I will take garlic instead of my prescription medication to reduce my cholesterol."
The nurse teaches a patient with high cholesterol about natural lipid-lowering therapies. The nurse determines further teaching is necessary when the patient makes which statement?
different
The thickness of the walls of each chamber is ______
capillary
The thin ______ wall, made up of endothelial cells, has no elastic or muscle tissue.
forward
The valves of the heart keep blood flowing in a ___ direction
helpful
The way the heart tries to compensate(help) itself is not always _______
Hypertension and cigarette smoking.
Two risk factors for coronary artery disease that increase the workload of the heart and increase myocardial oxygen demand are
mitral valve problems (causes emboli)
Vegetations =
Dilated CMO
Ventricle dilates without the increase in CO to match
Pt exercises indoors during the winter months
What action demonstrates effective teaching in a newly diagnosed Raynauds phenomenon patient?
Reverse remodeling
What affect does ACE Inhibitors have on Systolic HF when taken at optimal dose?
Systolic murmur Diminished pedal pulses Decreased maximal heart rate Increased recovery time from activity
What age-related cardiovascular changes should the nurse assess for when providing care to an older adult patient? (Select all that apply.)
Hypertension Drug of Choice for CHF
What are ACE Inhibitors used for?
Prevention or treatment of MI, stroke, or cardiac surgery
What are antiplatelets used for?
HA, Emesis
What are clinical manifestations of hypertensive crisis?
stroke, vision loss, heart attack, kidney failure, heart failure, sexual dysfunction
What are complications of HTN?
Elevated serum lipids (cholesterol levels) Blood pressure Tobacco use Physical inactivity Obesity
What are major modifiable risk factors of CAD?
Arrhythmias - PVC and V-FIb
What are potential complications of CAD?
furosemide (Lasix) bumetanide (Bumex) torsemide (Demadex)
What are some examples of Loop diuretics?
arteries, veins, capillaries
What are the 3 major blood vessels?
dilated, hypertrophic, restrictive
What are the 3 types of Cardiomyopathy?
Losartan Valsartan Candesartan Irbesartan Olmesartan
What are the ARBs medication?
atenolol (Tenormin) metoprolol (Lopressor)
What are the BB 1 Cardioselective meds?
MS AR D Mitral Stenosis(MS) Aortic Regurgitation (AR)
What are the Diastolic heart murmurs?
RUQ tenderness, Ascites, N/V, Bloating, Anorexia, Epigastric Pain
What are the GI manifestations associated with CHF?
Isosorbide Dinitrate Isosorbide Mononitrate DO NOT CHEW OR CRUSH
What are the LONG ACTING Nitrate meds that prevents angina?
Active bleed Neoplasm Uncontrolled HTN Pregnancy Recent history of CVA Trauma
What are the contraindications of thombolytics?
dyspnea, fatigue, chest pain, syncope, sudden death
What are the manifestations of Hypertrophic CMO?
Obtain baseline vitals weigh clients daily check electrolytes before administering Monitor ECG Instruct patient to report GI upset, excessive thirst, altered LOC Treat hyperkalemia Assess for weight loss and decrease Edema Monitor blood pressure
What are the nursing considerations with Potassium Sparing Diuretic?
Hypokalemia Hyperglycemia Dehydration Hypomagnesemia
What are the side effects of Thiazide Diuretics?
Bruising GI problems Hypotension Thrombocytopenia (low platlet count)
What are the side effects of anticoagulants?
Bruising ( same as anticoagulants ) Hematuria Tarry Stools BUT ASA CAN ALSO HAVE GI symptoms ( same as anticoagulants ) Blood dyscrasias (body fluids)
What are the side effects of antiplatelets?
1. Fatty streak (reversible) 2. Fibrous plaque (can happen by 30 years) 3. Complicated lesion (occlusion can occur)
What are the stages of atherosclerosis development?
CAD and HTN
What are the top two causes for HF?
Smoking Alcohol Amphetamines
What are the triggers for Prinzmetal Angina?
DVT, PE, AMI Heart valve replacement (life long ASA, mechanical ) A fib
What are the uses of Anticoagulants?
acute MI, Arterial thrombus, DVT, PE, Occlusion of catheter or shunts
What are thrombolytics used for?
Troponin Homocystiene C-reactive protein
What blood studies are most likely to be seen with cardiac disease?
Myocardial Infarction Long Standing Uncontrolled HTN Aortic Stenosis/Mitral Regurgitation CMO Viral Myocarditis Arrhythmias
What can cause Systolic HF?
myocardial fibrosis and infiltrative processes such as radiation
What causes Restrictive CMO?
An increase in either CO or SVR
What causes the BP to rise?
Class III Potassium Channel Blockers (Amiodarone)
What class of Antidysthmic Meds are given for Afib?
MI
What does Prinzmetal Angina cause a high risk for?
Dilate venules and arterioles increase renal blood flow Relieve sx of HF
What does RAAS inbihit?
opposite of what you think would happen
What does paradox mean?
hypotension
What is a side effect of amlodipine?
Client is drowning in fluid in all interstitial spaces
What is acute pulmonary edema?
Tachy Rhythms
What is atrial dysthymias'?
Not for immediate diuresis
What is important to know when using thiazide diuretics?
Don't stop taking meds
What is important to teach regarding blood pressure medications?
Dissolve or break down a thrombus
What is the action of thrombolytics?
Rheumatic Heart Disease
What is the cause of Mitral Valve Stenosis?
Spironolactone, used for detection of primary hyperaldosteronism, hirsutism, premenstrual syndrome
What is the common med and use of Potassium Sparing Diuretic ?
The average of 3 or more readings taken on separate occasions
What is the diagnosis of hypertension based on?
Spirinolactone (Aldoctone)
What is the med for Potassium Sparing Diuretic?
decrease afterload inhibit SNS Promote reverse remodeling ex. metoprolol
What is the purpose of B Blockers?
Tremors, hair, coughing, moving
What makes an artifact on EKG?
Caredeilol Labetalol
What medications are a BB and Alpha Blocker?
Systolic
What murmur can you feel in the radial pulse?
Food (avoid GI upset) + cold water
What should Nicotinic Acid be taken with?
HYPOkalemia HYPERglycemia HYPERuricemia
What should be monitored for when taking thiazide diuretics?
Third degree AV block (complete heart block) In complete heart block, the atria and ventricles beat independently of each other because the AV node is completely blocked to the sinus impulse and is not conducted to the ventricles. One hallmark of third- degree heart block is that the P waves have no association with the QRS complexes and appear throughout the QRS waveform.
When a client's cardiac rhythm strips shows more P waves than QRS complexes and there is no relationship between the atria and the ventricles, how would the nurse document the rhythm?
When BB are contraindicated or atrial dysrhythmias
When are Diltiazem and Verapamil used post MI?
ACS
When ischemia is prolonged and not immediately reversible, ___________ develops
Roasted duck
When providing dietary teaching to a patient with hypertension, the nurse would teach the patient to restrict intake of which meat?
During Asystole
When should you never shock a patient?
fibrin clot
When the endothelial surface is disrupted (rupture of an atherosclerotic plaque), the coagulation cascade is initiated and results in the formation of a _____
ischemia
When__________ is prolonged and not immediately reversible, ACS develops
in the GI tract to bind with bile acids
Where and how to Bile Acid Sequestrates work?
diastole because its filling and squeezing effects
Where can the heart perfuse itself?
Liver to affect cholesterol synthesis
Where do HMG-CoA Reductase Inhibitors work?
left atrium and left ventricle
Which area is the site of impaired blood flow for a patient who has mitral valve disorder?
ACE inhibitors
Which category of medications help reduce afterload in patients with HF?
excess alcohol intake
While obtaining subjective assessment data from a patient with hypertension, the nurse recognizes that a modifiable risk factor for the development of HTN is?
erectile dysfunction (ED)
_________ may be a symptom of peripheral vascular disease and/or a side effect of drugs used to treat CVD (B-blockers, diuretics)
Aortic Valve Stenosis
_________________ is characterized by agina, syncope, dyspnea, fatigue, HF, absence of S2
Cheyne-Stokes respiration
a pattern of alternating periods of hypopnea or apnea, followed by hyperpnea. are assoc. with HF
percardial friction rub
a scratching, a scraping, crackling, an typically fleeting, high pitched sounds caused by inflammation of the two pericadial layers. Can be heard throughout the precordium but tend to be louder along the left sternal border using the diaphragm.
increases contractility increases CO decreases afterload
Dobutamine does what?
CAD
Elevations in triglycerides and LDL are strongly associated with ______
Blacks.
HTN It is one of the leading causes of end-stage renal disease, especially in_________
ACE inhibitors
HTN and CHF is the drug preferred tx of?
retinopathy
HTN targets the eyes by creating
hypertensive heart disease
HTN targets the heart by creating
nephrosclerosis
HTN targets the kidneys by creating
peripheral vascular disease
HTN targets the peripheral vessels by creating
Thiazide or CCB
HTN treatment of African Americans w/ or w/o diabetes
Prevents fibrin clot
How does Heparin (anticoagulant) work?
20-40 times/min
Intrinsic rate for Bundle of His/Purkinje Fibers
NO. many are asymptomatic for entire life
Is mitral valve prolapse deadly?
causes tissue irriation/sloughing
Why should you never give Cardiac Glycosides?
normal to cardiomegaly
With Pericarditis, what will you see in a CXR?
pericardial effusion and tamponade
With Pericarditis, what will you see in a Echo?
pulse pressure
difference between systolic and diastolic pressure
the cause of the myocardial disease is known and is a result of another disease process
(CMP )Cardiomyopathy is classified as primary (conditions in which the cause of the heart disease is unknown) or secondary (_________________________).
Paroxysmal Atrial Tachycardia
1. Antidysrthmic 2. Chemically pauses heart and restarts it 3. electrical shock is needed to have SA node take back over What is this explaining?
Ejection click Crescendo Decreasdo murmur)
Where do murmurs occur in Aortic/Pulm Stenosis?
Inherited predisposition to develop new blood vessels (angiogenesis) The presence of chronic ischemia
2 factors contribute to the development of CAD:
large block method
300/ # of large blocks between 2 R waves
Elevated serum lipids Hypertension (>/= 140/90mmHg) Tobacco Use Physical Inactivity
4 major factors in development of CAD
Homocysteine
4 to 17 mmol/L (fasting). an amino acid, is a by product of protein and is found in eggs, chicken, beef, and cheddar cheese. A high level of homocysteine has been linked to cardiovascular disease, stroke, and the possibility of Alzheimer's disease, may promote blood clotting.
The brown spots results from small blood vessel damage; the blood contains iron, which leaves a brown spot
A DM patient ask how does the brown spots on her skin keep appearing, the nurse answers how>?
SA node and depolarizing the atria.
A P wave on an ECG represents an impulse arising at the
SA node depolarizating the atria
A P wave on an ECG represents an impulse arising at the
MI
A big Q wave represents ________
Agonal rhythm
A cardiac dysrhythmia seen just before the heart stops altogether; essentially asystole with occasional QRS complexes that are not associated with cardiac output.
angiotensin II
A-II receptor blockers (ARBs) prevent __________ from binding to its receptors in the walls of the blood vessels.
angiotensin receptor blockers
ACE inhibitors are added after an MI if there are no contraindications. ACE inhibitors may help prevent ventricular remodeling after an MI. For patients intolerant of ACE inhibitors, _________ should be used
Lisinopril
ACE inhibitors med example?
ACE Inhibitors
ACE tx should begin in 1st 24 hours Prevents ventricular remodeling and slows progression of heart failure what med am i?
absorption
Acid blockers affect _________ of other meds; give 2 hours apart
Antiplatelets
Action: Aspirin: inhibits COX-1 thereby suppressing the production of prostaglandins (dec. inflammation, pain, fever) and thromboxanes (dec. platelet aggregation). Others: prevent or disrupt aggregation of platelets.Use: prevention & treatment of MI, stroke, & cardiac surgery.
Symptoms
CO is low when _____ occur
Atherosclerosis
CAD =
unstable angina (UA) and myocardial infarction (MI)
CAD can evolve to acute coronary syndrome (ACS) known as ___________________
symptomatic
CAD is a progressive disease that develops in stages over many years. When it becomes ________, the disease process is usually well advanced
Lipoproteins
CAD shows genetic links related to ______ genes
Atherosclerosis
CAD=
antihypertensive Antianginal Antidysrthymics (diltiazem and verapmril)
CCB is listed as ?
>200
Cholesterol levels that are at risk for CAD?
ACE I or ARBs.
Combination therapy with hydralazine and isosorbide dinitrate decrease mortality in Black patients with HFrEF. This drug is an option for any patient with HFrEF who cannot tolerate __________
Doxazosin (Cardura) Terzosin (Hytrin) Prazosin (Minipress) Carvedilol (Coreg) & Labetalol (Normodyne)
Common Alpha-adrenergic blockers:
Digoxin (Lanoxin)
Common Cardiac Glycosides:
Clofibrate (Abitrate, Atromin-S) Fenofibrate (Tricor) Gemfibrozil (Lopid)
Common Fibric Acid Derivatives:
Bumetanide (Bumex) Furosemide (Lasix) Toresemide (Demadex)
Common Loop Diuretics:
Failed medical management CAD in 3 coronary arteries Failed PCI DM, CKD and LV dysfunction patients
Coronary surgical revascularization (CABG) is recommended if
blurring of vision, retinal hemorrhage, and loss of vision.
Damage to retinal vessels indicates concurrent vessel damage in the heart, brain, and kidney. Manifestations of severe retinal damage include ______
not maintaining CO
Decompensated HR =
fluid retention, such as weight gain, exertional dyspnea, or orthopnea
Decompensation of chronic HF usually begins with signs of__________________. Patients with a new diagnosis of HF are more likely to present with pulmonary edema.
ECHO CXR ECG BNP
Dilated CMO is found by what labs?
IV nitroglycerin (NTG) (Tridil) Morphine Antidysrhythmic drugs
Drug Therapy: ACS & MI
-blockers or calcium channel blockers
Drug therapy for hypertrophic CMP includes_____________ . Digitalis preparations are contraindicated unless the patient has atrial fibrillation. Dysrhythmias are treated with the appropriate antidysrhythmic.
(1) decreasing the volume of circulating blood and/or (2) reducing SVR.
Drugs currently available for treating hypertension work by
permanent pacemaker
Dual chamber used when a dysrhythmia is thought to be permanent implanted through sx battery packed pacing cath batteries last 5-15 years
ECHO (U/S of heart)
EF measure by ___
Mitral Valve Prolapse
Failure of one of both leaflets of the mitral valve which cause them to billow or bulge into the left atrium
>150
Fasting triglyceride levels that are at risk for CAD?
Systolic Blood Pressure
Felt as the peripheral pulse and heard as the Korokoff's sounds during blood pressure measurement
Loop Diuretics
Furosemide =
PTT only
Heparin ( injectable Anticoagulant) is monitored by what blood test?
serum HDL
High ________ levels are desirable.
distant heart sounds
Kyhosis will have ________, altered chest landmarks for palpitations, percussion and auscultation.
Dilated
Most common type of CMO
dizziness, vertigo, HA, weakness
Neuro side effects of thiazide diuretics
CCB
Nicardipine SR is a ?
peripheral blood vessels, coronary arteries, and collateral vessels.
Nitrates dilate ___________
Aortic Stenosis
Obstruction of the flow from the left ventricle to the aorta during systole
Triglycerides
Omega 3 fatty acids have been shown to decrease ___________
Atrium
Where does the P wave originate from?
angiogram
Right sided heart blockage means not functioning or pumping well, and patient needs an _________
the lungs
Right sided heart embolization's deals with
CAD, HTN, and advancing age
Risk factors of HF nclude _____________ . Diabetes, tobacco use, obesity, and high serum cholesterol also contribute to the development of HF
PO
Route for ARBs:
PO
Route of ACE Inhibitors:
PO, IV
Route of Thiazide Diuretics:
IV
Route of Thrombolytics:
left atrium
SA node depolarizes ____ first
HR >200
Torsades de Pointes?
ARB
Valsartin is a
ASA
What antiplatelet is used to prevent CAD?
Anemia
Which cause of fatigue is associated with HF?
uncontrolled HTN
Which is a contraindication to thrombolytic use?
0.12 seconds
You want the QRS interval to be less than what?
BiPAP
___ is good for HF is oxygen doesn't help
NSAIDS
___ meds can cause HTN, stroke, or MI
hydrostatic
___ pressure prevents 3rd spacing from happening
Action Potential (AP)
an electrical impulse changing the permeability of a membrane
muscle strengthening activities twice a week
an older patient with HTN should be exercising how often?
thrill
aneurysm, aortic regurgitation
ACE Inhibitors (vasocontriction)
angiotension II =
Asystole
flat line
Chylomicrons
primarily exogenous triglycerides from dietary fat
Intravascular Ultrasound (IVUS)
tiny ultrasound probe at tip of catheter provides image of vessels from the inside out
BIPASS Machine
to stop the heart and work on it then start heart again. pumped through an oxygenator and heat exchanger.
hydralzaine
vasodilators med examples?
endophilic damage increases workload of heart ventricles need more oxygen
why is blood pressure a problem?
Hypertrophic CMO
-filling problem -diastolic problem -well trained athlete will get this -Vtach and V-fib (unconscious w/o a pulse) -Asymp -apical pulse displaced to left -Dyspnea on exertion
Dilated CMO
-squeezing problem -systolic problem -decreased CO -decreased SV -improve contractility -decrease afterload and preload -dry cough -emboli -NEED POSITIVE INOTROPES
Cholesterol
<200 mg/dL assoc, with ateriosclerosis
Keep Hgb A1C less than 7%.
A female patient with type 1 diabetes has chronic stable angina controlled with rest. She states that over the past few months, she has required increasing amounts of insulin. What goal should the nurse use in planning care to prevent cardiovascular disease progression?
CO and hypotension
A fever may cause tachycardia with a decrease in
friction rub.
A hallmark finding in acute pericarditis is a pericardial _________
Assess for return of gag reflex. Monitor vital signs and oxygen saturation.
A nurse is caring for a patient immediately following a transesophageal echocardiogram (TEE). Which assessments are appropriate for this patient? (Select all that apply.)
Women are more likely to have noncardiac symptoms of heart disease.
A nurse is preparing to teach a group of women in a community volunteer group about heart disease. What should the nurse include in the teaching plan?
Pt needing wound care for chronic venous stasis ulcer
A nurse working in vascular clinic should assign which patient for an LPN?
Dysrhythmias
A patient admitted to the emergency department 24 hours ago with reports of chest pain was diagnosed with a ST-segment-elevation myocardial infarction (STEMI). What complication of myocardial infarction should the nurse anticipate?
observe for symptoms of hypotension or angina.
A patient admitted with ACS has continuous ECG monitoring. An examination of the rhythm strip reveals the following characteristics: atrial rate 74 beats/min and regular; ventricular rate 62 beats/min and irregular; P wave normal shape; PR interval lengthens progressively until a P wave is not conducted; QRS normal shape. The priority nursing intervention would be to
Synchronized cardioversion
A patient develops atrial flutter with a rapid ventricular response. The nurse anticipates that what treatment will be prescribed?
Start CPR
A patient in the coronary care unit develops ventricular fibrillation. After initiating the emergency call system (Code Blue), the next priority action the nurse should take is to:
Initiate cardiopulmonary resuscitation.
A patient in the coronary care unit develops ventricular fibrillation. The first action the nurse should take is to
Perform defribillation
A patient in the coronary care unit develops ventricular fibrillation. The first action the nurse should take is to
Report a weight gain of 3 lb (1.4 kg) in two days, or 3 to 5 lbs (2.3 kg) in a week.
A patient with heart failure is being discharged from the hospital. Which instructions should the nurse include in the patient's teaching plan?
Auscultate lung sounds Left- sided HF will cause blood to back up so you need to auscultate blood sounds
A patient with left-sided heart failure has oxygen at 4 L/min per nasal cannula, furosemide (Lasix) 40 mg PO daily, spironolactone (Aldactone) 25 mg PO daily, and enalapril (Vasotec) 5 mg PO twice daily. Which of the following actions is most important for the nurse to carry out?
Auscultate lung sounds
A patient with left-sided heart failure is prescribed oxygen at 4 L/min per nasal cannula, furosemide (Lasix), spironolactone (Aldactone), and enalapril (Vasotec). Which assessment should the nurse complete to best evaluate the patient's response to these drugs?
cough and angioedema
ARBs have the same things as ACE except doesnt have the?
Antiplatelets
ASA (low dose 81mg) is
Antiplatelet Agents
ASA, clopidogrel (Plavix), prasugrel (Effient), ticagrelor (Brilenta) Inhibits platelet aggregation what med am i?
Beta Blockers
Action: Block Beta 1 in therapeutic uses. Block Beta 2 in higher doses or noncardioselective. Decrease effects of sympathetic nervous system. Reduction in renin activity resulting in - reduction in systolic & diastolic BP; -Inotropic & Chronotropic effects.Use: Manage HTN, angina, MI, HF, tachydysrhythmias, anxiety, migraines.
ACE Inhibitors
Action: Block conversion of angiotensin 1 to angiotensin 2 preventing vasoconstriction & sodium & water retention. Blocks vasoconstriction & aldosterone. Decreases SVR, Afterload, & Preload.Use: HTN, Drug of choice for CHF
Loop Diuretics
Action: Blocks sodium & water reabsorption, rapid volume depletion. Inhibit electrolyte reabsorption in the thick ascending loop of Henle promoting excretion of sodium, water, chloride, and potassium. Renal vasodilation increasing GFR & decreasing PVR.Use: Low GFR & hypertensive emergencies. Edema, pulmonary edema, CHF, CRF, and hepatic cirrhosis. Drug overdose.
Calcium Channel Blockers
Action: Class IV antidysrhythmic. Inhibit flow of calcium ions across cell membrane of vascular tissue and cardiac cells - they decrease myocardial contraction decreasing cardiac workload; dilate coronary arteries & arterioles & prevent coronary artery spasm; myocardial O2 delivery increased preventing angina; -Chronotropic & inotropic effects; decreased afterload by dilating peripheral arterioles.Use: Angina, Prinsmetal angina, Primary HTN, AF, flutter, SVT, Vaso-occlusion disorders.
Cardiac Glycosides
Action: Decrease the conduction velocity through AV node (neg. chronotrope). Increases contractility & efficiency of myocardial contraction (pos. inotrope). Increase CO.Use: CHF & Atrial Dysrhythmias
Anticoagulants
Action: prevent/delay blood coagulation, varies with different drugs.Uses: DVT, PE, AMI, heart valve replacement, Atrial Fibrillation
Right-sided HF
After having a myocardial infarction (MI), the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of 108 beats/min. What should the nurse suspect is happening?
Atrial fibrillation The irregularity occurs because impulses from multiple atrial sites depolarize the atria in a disorganized fashion.
After noting that a client in the clinic has an irregularly irregular pulse rhythm at a rate of 88 beats/ minute, the nurse will anticipate further testing for which possible dysrhythmia?
"I can take up to 5 tablets every 3 minutes for relief of my chest pain."
After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient makes which statement?
Take the client's apical pulse for a full minute
After the home health nurse obtains a radial pulse rate of 136 beats/minute in a client with chronic atrial fibrillation, which action would the nurse take next?
shock them
After you determine no pulse on a patient with V-Tach, what should you do?
vasoconstrictors
Alpha 1 adrenergic receptors are ________
soft fat deposits that harden with age
Atherosclerosis is:
flutters
Atrial flutter has no P wave, but has ____ instead SIMILAR TO AFIB Atrial flutter is treated when HR increases
Atrial flutter
Atrium >200 bpm Ventricles <70 bpm Can be Reg or Irreg. "saw tooth patterns"
Hypotension Bradycardia (Negative chromatrope) Bronchospasms (from Beta 2) Worsening CHF Hypoglycemia
BB side effects?
heart failure
BNP levels are not directly reflective of myocardial infarction, but might increase if the client develops __________ as a complication of myocardial infarction.
loss of elasticity in arterial walls
BP of a 71 year old is 180/70, which age related changes contribute to this finding?
>180/120
BP reading for a Hypertensive Crisis
vasomotor center
Baroreceptors are sensitive within the arterial system, Stimulation of these receptors (volume overload) sends information to the _______ in the brain stem. this causes decreased HR and peripheral vasodilation. decreased arterial pressure causes the opposite effect from this.
dehyrdation
Barorecptors have volume overload in _____________
(1) identify or rule out causes of secondary hypertension, (2) evaluate target organ disease, (3) determine overall cardiovascular risk, or (4) establish baseline levels before starting therapy.
Basic laboratory studies are done for HTN to :
What makes a Regular beat on EKG?
Because the R stays the same
8 to 12 hours
Bed rest may be ordered for the first few days after an MI involving a large portion of the ventricle. A patient with an uncomplicated MI may rest in a chair within ________ after the event.
nephrotoxic
Before an angiogram, the kidney function must be checked getting getting the dye because the dye is ?
chronotrope inotrope dromotrope
Beta 1 adrenergic receptors have what tropes?
metoprolol
Beta 1 when blocked causes the opposite (Ex. Beta adrenergic blockers like __________ for HTN)
cardiac
Blockage of the AV node can cause serious defects in ____ conduction
Diastole
Blood flow into the 2 major coronary arteries occurs primarily during_______
Amlodipine
CCB med examples?
cardiac muscle
CK-MB is found in ________________ and levels increase with myocardial cell death.
Ventricular ejection
CO + Afterload =
oxygen delivery
CO is reduced in HF, which in turn reduces perfusion to organs and decreases ___________to tissues leading to fatigue.
tachycardia refractory
Catheter ablation is the nonpharmacologic treatment of choice for atrial dysrhythmias resulting in rapid ventricular rates and AV nodal reentrant _____________ to drug therapy.
STEMI (ST-elevation MI)
Cause: Occlusive thrombus EMERGENCY SITUATION!!! Artery must be opened within 90 minutes of presentation By PCI or thrombolytic tx "Door to Balloon Time" PCI is first-line tx if hospital is capable of performing PCI this is?
AV node ischemia, digitalis toxicity, medication side effects
Causes of First Degree AV Block?
aortic and carotid
Chemoreceptors are found in the _________ bodies and the medulla.
BP
Chemoreceptors in the medulla stimulate the vasomotor center to increase ______
Color changes in extremities with postural change
Chronic decreased arterial perfusion
nitroglycerin
Chronic stable angina is chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms. The chest pain is relieved by rest or by rest and medication (e.g., ________). The ischemia is transient and does not cause myocardial damage
early in the morning
Circadian rhythms usually happen ____________ for pts with CAD (at rest then all sudden up)
Procainamide, Quinidine Lidocaine Propafenone
Class I: Sodium Channel Blockers :Class I-A ??? Class I-B ??? Class I-C ???
Isosorbide Dinitrate (Isordil) Isosorbide Mononitrate (Imdur) Nitroglycerin SL (Nitrostat) Nitroglycerin SR (Notro-bid) Nitroglycerin Topical Nitroglycerin Transdermal
Common Nitrates & Nitrites:
primary dysrhythmias
Common cardiovascular causes of syncope include vasovagal syncope and ___________ Noncardiovascular causes can include hypoglycemia, hysteria, seizure, stroke, and transient ischemic attack.
renin angiotensin aldosterone system (RAAS).
Compensatory mechanisms in both chronic and acute HF include fluid and sodium retention and edema resulting from activation of the _________
STEMI
Complete occlusion =
CHD Dysrhythmias Heart Failure
Complications of Increased Workload on LV causing the Ventricle to hypertrophy
socioeconomic conditions and gender and ethnic
Contributing factors to the development of hypertension include cardiovascular risk factors combined with __________ differences.
CO
Decrease SV will decrease ___
CO and decrease pulmonary congestion
Decreasing afterload (the resistance against which the LV must pump) to improve __________ with the use of vasodilators
History, Physical, CXR, EKG Lab - Lipids & Cardiac Enzymes (CPK-MB & Troponin) Echocardiogram Stress test Nuclear Med - perfusion studies Angiogram (for increasing angina)
Diagnostic Studies: Chronic Stable Angina
Low in saturated fat, increase fiber & omega-3
Dietary Modification for people with CAD
dilation can happen because the chamber gets too full hypertrophy can happen because the chamber muscles are working extra hard to get the blood out
Difference between cardiac hypertrophy and dilation:
afterload and preload plus inotopes
Dilated CMO improves contractility and decreases both _______
squeeze
Dilated CMO is aka as a ___ problem. (if it is stretched it can't squeeze properly)
orthopnea
Diminished breath sounds at bottom occurs with?
absolute refractory period; relative refractory period
During ventricular contraction, there is an ____________ period during which heart muscle does not respond to any stimuli. After this period, heart muscles gradually recovers and a __________ period occurs by early DIASTOLE.
tx for HR reduce workload of the heart
Enalapril (ACE inhibitor) =
creatine kinase MB (CK-MB)
Enzyme released in increased amounts from cardiac muscle cells following myocardial infarction (MI). Serum assays help diagnose MI and determine the extent of muscle damage 4%-6%
Pressure overload ex HTN (hypertrophy inward making it stiff in Atrium) Atrial Gallop Always Pathological
Explain S4?
24 to 36 hours,
For patients having CABG surgery, care is provided in the ICU for the first ___________. where ongoing monitoring of the patient's ECG and hemodynamic status is critical.
it decreases platelet aggregation
For the action of ASA, what happens when it suppresses the production of thromboxanes?
Acute myocardial infarction
For which problem is percutaneous coronary intervention (PCI) most clearly indicated?
Chronic Stable Angina
Form of angina in which it is predictable and consistent, occurs on exertion
automaticity, excitability, conductivity, and contractility
Four properties of heart cells ___________________________ enable the conduction system to start an electrical impulse, send it through the heart tissue, and stimulate the heart tissue to contract.
valve
Fungal IE is hard to treat, and a patient will need a ____________ replacement
replaced with sx
Fungus endocarditis is harder to treat because the valve is infected, and may need to be __________
ventricles to relax and fill during diastole
HFpEF results from an impaired ability of the ________
relaxation and filling
HFpEF results from impaired ventricular _________
to pump blood effectively
HFrEF results from an inability of the heart _________
on skin and eyes (Jaundice) drinking alcohol should also be limited or avoided (why? vasodilator )
HMG-CoA Reductase Inhibitors (Statins) can elevated liver functions, and the results can show on a patient where?
Flatulence (gas) Myalgias (body aches) Elevated liver functions Dyspepsia (indigestion) GI upset (NV)
HMG-CoA Reductase Inhibitors (Statins) side effects?
Lowers LDL dose dependent on HDL no effects on lipoprotein
HMG-CoA Reductase Inhibitors (Statins) work in the liver to affect cholesterol by doing what to LDL and HDL?
Any meds that end with STATIN
HMG-CoA Reductase Inhibitors (Statins), what are the meds?
180 beats/min
HR can reach as high as _______ for short periods without harmful effects.
Thiazides, CCB, ACE, ARB
HTN treatment of Non African Americans w/ or w/o diabetes
echocardiography
Heart failure is a common complication after myocardial infarction, and a low urine output may indicate left ventricular failure, which would require immediate collaborative actions such as administration of diuretics or diagnostic testing such as ____________
systolic failure
Heart failure is classified as heart failure with reduced ejection fraction (HFrEF) (formerly known as _____________)
Hypertrophic CMO
Heart gets huge and thick but the ventricles don't dilate
serum lipid
High ___________ levels are one of the most firmly established risk factors for CAD
Signal-averaged ECG
High resolution ECG can identify electrical activity called LATE POTENTIALS
density lipoproteins (HDLs)
High-_______ levels carry lipids away from arteries to the liver for metabolism.
Increasing Diastole
How do BB increase the good supply to the heart post MI?
dilates arteries and veins
How do alpha adrenergic blockers decrease peripheral resistance?
have the patient lean forward while sitting upright
How do you listen for friction rubs on a patient?
have patient lean forward and hold breath to listen
How do you position a patient with Pericarditis to listen?
with food to prevent GI upset
How do you take ASA?
Anticoagulant TEE Cardioversion
How do you treat Afib is >48 hours?
beta blockers to decrease HR Monitoring, with hold stimulants
How do you treat Premature Atrial Contractions?
heart must work harder to pump blood through a narrowed valve
How does Aortic Stenosis lead to Systolic HF?
Low blood flow to the heart muscle prevents filling and relaxation
How does CAD lead to Diastolic HF?
Thick heart muscle prevents blood from filling the left ventricle
How does Hypertrophic CMO lead to Diastolic HF?
The inflammation in the heart affects the ability to pump
How does Viral Myocarditis lead to Systolic HF?
1. happens progressively w/ damaging endothelium blood vessels in heart and throughout body 2. Builds up in the lumen of vessels "clogging in the pipes" 3. keeps building 4. heart attack
How does atherosclerosis happen in steps?
wide and bizarre in shape
How does the QRS look in Premature Ventricle Contraction?
it shows opposite of QRS
How does the T wave present itself in Premature Ventricle Contraction?
happens on diastole when heart relaxes
How does the heart perfuse itself?
U/S, CT scan, arteriography
How is Aortic Aneurysm found?
ECG, no P wave seen
How is Atrial Fibrillation found?
ECG, catheterization, blood lipids
How is Coronary Artery Disease found?
EKG can detect increased voltage
How is Hypertrophic CMO diagnosed?
ECHO
How is Mitral valve Stenosis diagnosed?
CPR + Defibrillation
How is Ventricular Tachycardia treated if the pt is pulseless?
Where the pain is
How is an MI described?
antidysrhythmic meds + cardioversion
How is ventricular tachycardia treated if the pt has a pulse?
nitrates, ACE inhibitors, -blockers, and calcium channel blockers.
In addition to antiplatelet and lipid-lowering drug therapy, the most common drugs used to manage chronic stable angina are _____________
aortic mitral valves
In aging, what murmurs are most often affected?
Serum creatinine of 2.6 mg/dL
In caring for a patient admitted with poorly controlled hypertension, which laboratory test result should the nurse understand as indicating the presence of target organ damage?
"In what areas did you feel this pain?"
In caring for the patient with angina, the patient said, "While I was having a bowel movement, I started having the worst chest pain ever, like before I was admitted. I called for a nurse, then the pain went away." What further assessment data should the nurse obtain from the patient?
asymptomatic.
In first-degree AV block, every impulse is conducted to the ventricles, but the duration of AV conduction is prolonged. First-degree AV block is usually not serious but can be a precursor of higher degrees of AV block. Patients with first-degree AV block are __________ There is no treatment.
incompetence or insufficiency
In regurgitation (also called____________), incomplete closure of valve leaflets results in a backward flow of blood.
blocked (missing).
In second-degree AV block, type I (Mobitz I or Wenckebach heart block), there is a gradual lengthening of the PR interval until an atrial impulse is nonconducted and a QRS complex is __________
SBP.
In some older people, there is a wide gap between the first Korotkoff sound and subsequent beats (auscultatory gap). Failure to inflate the cuff high enough may result in an inaccurate ______
Adrenic receptors- Alpha 1
Increased contractility in blood vessels and heart. Vasoconstrict =increase
Bradycardia
Metoprolol (Toprol-XL) is prescribed for a client with hypertension. For which side effect should the nurse monitor the client?
postmenopausal women
Microvascular Angina - chest pain in absence of CAD or spasm Associated with small vessels Seen with physical exertion More common in ___________ Treated with meds
rheumatic heart disease
Mitral Valve Stenosis can have 3rd spacing that can lead from_____________
systemic lupus erythematosus (SLE).
Most cases of adult mitral valve stenosis result from rheumatic heart disease. Less common causes include congenital mitral stenosis, rheumatoid arthritis, and _______________.
ischemic papillary muscle dysfunction
Most cases of mitral valve regurgitation are caused by myocardial infarction (MI), rheumatic heart disease, mitral valve prolapse, _____________-, and infective endocarditis (IE).
inferior vena cava
Most of the blood from the coronary system drains into the coronary sinus (a large channel), which empties into the right atrium near the entrance of the ________
ischemic
Myocardial Cells become___________ in 10 seconds of occlusion
normal sinus rhythm
NSR
vasodilated
Nitroglycerin=
exercise stress nuclear imaging
Nuclear imaging images are taken at rest and after exercise. Injection is given at maximum HR (usually 85% of age-predicted maximum) on bicycle or treadmill. Patient is then required to continue exercise for 1 min to circulate the radioactive isotope. Scanning is done 15-60 min after exercise. A resting scan is performed 60-90 min after initial infusion or 24 hr later.
Obtain vital signs
Nurse caring for a patient with critical limb ischemia post balloon angioplasty. Priority action is
therapeutic effectiveness, detecting and reporting any adverse treatment effects, assessing and enhancing adherence, and patient and caregiver teaching.
Nursing actions for HTN include evaluating
Angina; MI; sudden cardiac death, HF, Arrhythmias, Conduction problems
Once a patient is on a cholesterol med, educate them to always take it so it doesn't lead to?
increased
Patient with CAD have ____ LDL and HDL
ICD
Patients at risk for sudden cardiac death (SCD) need an ________• Atrioventricular pacing can be beneficial for patients with hypertrophic CMP and outflow obstruction.
colchicine
Patients who have recurrent pericarditis may receive _____________, an anti-inflammatory agent used for gout.
Abnormal capillary refill
Possible reduced arterial capillary perfusion, anemia
Atrial Dysrhythmias: Atrial Flutter
Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for which common complication?
dry mouth photosensivity gynecomastia Vasodilators
Potassium Sparing Diuretic can cause what side effetcs?
"I will report any abdominal distress."
Potassium supplements are prescribed for a client receiving diuretic therapy. What client statement indicates that the teaching about potassium supplements is understood?
Spironolactone
Potassium-Sparing Diuretics/Aldosterone Receptor Antagonist that is also used for detection of primary hyperaldosteronism, hirsutism, and premenstrual syndrome.
multifaceted
Prevention and early treatment of CAD involve a ______ approach and must be ongoing throughout the lifespan.
we don't know the cause, only the muscle is affected
Primary Cardiomyopathy
idopathic
Primary HTN is known to be _________
ECG and serum cardiac biomarkers.
Primary diagnostic studies used to determine whether a person has a STEMI, an NSTEMI or UA include an __________
ECG
Primary way to dx UA, NSTEMI or STEMI
migraine headaches and Raynaud's phenomenon.
Prinzmetal's angina may be seen in patients with a history of_________
Protein, CPK, CK-MB, Troponin
Serum Cardiac Biomarkers
MI
Severe, immobilizing chest pain not relieved by rest, position change, or nitrate administration may mean the patient is having an________
Loss of elasticity in arterial vessels
The blood pressure of an older adult patient admitted with pneumonia is 160/70 mm Hg. What is an age-related change that contributes to this finding?
pulmonary congestion and edema.
The most common form of HF is left-sided HF from left ventricular dysfunction. Blood backs up into the LA and into the pulmonary veins, causing __________
Rapid institution of emergency services and procedures.
The most significant factor in long-term survival of a patient with sudden cardiac death is
Eating a healthy diet and exercising most days of the week
The nurse knows that primary prevention strategies to prevent impaired perfusion in the patient include which of the following recommendations by the American Heart Association (AHA):
Elevated serum lipids
The nurse prepares a discharge teaching plan for a patient who has recently been diagnosed with coronary artery disease (CAD). Which priority risk factor should the nurse plan to focus on during the teaching session?
Serum potassium level
The nurse prepares to administer digoxin 0.125 mg to a patient admitted with influenza and a history of chronic heart failure. What should the nurse assess before giving the medication?
Defibrillation is the treatment of choice for ventricular fibrillation.
The nurse prepares to defibrillate a patient in a life-threatening rhythm. The nurse recalls that defibrillation differs from synchronized cardioversion in which aspect?
Maximizing cardiac output
The nurse recognizes that a primary goal for a patient with chronic heart failure is what?
Hypertension promotes atherosclerosis and damage to the walls of the arteries.
The nurse teaches a patient with hypertension that uncontrolled hypertension may damage organs in the body primarily by which mechanism?
Left ventricular function is documented Prescription for angiotensin-converting enzyme inhibitor at discharge Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen
The patient has heart failure (HF) with an ejection fraction of less than 40%. What core measures should the nurse expect to include in the plan of care for this patient? (Select all that apply.)
valve disease.
The patient needs ongoing antibiotic prophylaxis if RF caused ___________
"The LAD supplies blood to the left side of the heart and part of the right ventricle."
The patient tells the nurse that he does not understand how there can be a blockage in the left anterior descending artery (LAD), but there is damage to the right ventricle. What is the best response by the nurse?
Take medications as prescribed.
The patient with chronic heart failure is being discharged from the hospital. What information should the nurse emphasize in the patient's discharge teaching to prevent progression of the disease to acute decompensated heart failure (ADHF)?
endothelial layer of the arteries.
The portion of the vascular system responsible for hemostasis is the
55.
The prevalence of hypertension increases with age. The lifetime risk of developing hypertension is around 90% for normotensive men and women over age_____
venous
The right atrium receives _____ blood from the INFERIOR and SUPERIOR vena cava and the CORNARY SINUS.
right atrium, right ventricle, and part of the posterior wall of the left ventricle.
The right coronary artery also arises from the aorta and its branches supply the _________
ChloroTHIAZIDE (kidney proble? don't use) HydrocholoroTHIAZIDE (most common, blacks) (kidney problem? dont use) MetolZONE (kidney problem patients)
Thiazide Diuretics meds are?
HF patients thats full of fluid
Thiazide diuretic is a vasodilator and decreased PVR by reducing the blood volume, the use is for Edema and HTN; it is NOT used for patients with ________
Treat with immediate CPR and ACLS measures -Epinephrine and/or vasopressin -Intubation
Treatment for asystole?
lethal dysrhythmia.
VT is a life-threatening dysrhythmia because of decreased CO and the possibility of deterioration to ventricular fibrillation, which is a________________
dependent edema
Venous tortuosity increased has __________, and is mostly inflamed, painful, or cord-like varicosities.
Increased risk of Coronary Heart Disease
What is associated with an increased level of Homocysteine in the blood?
chol, and sodium
What is considered the nutritional therapy for dilated CMO?
-Block vasoconstriction and sodium and water retention -reverse ventricular remodeling -decrease SVR, afterload and Preload
What is the action of ACE?
Pink, Frothy Sputum
What is the hallmark S/S of Flash Pulmonary Edema?
PAC
What is the premature beat?
no gas exchange because of a lot of fluid
When 3rd spacing goes into Alveoli =
Stop the blood transfusion
When a client reports flank pain halfway through receiving a unit of packed red blood cells, which action would the nurse take first?
ASA, Plavix
When a patient has a stint, what is usually given together?
Multiple dental caries
When assessing a client who has aortic stenosis and is scheduled for aortic valve replacement, which finding by the nurse is most important to communicate to the health care provider?
dysrhythmias.
When assessing a patient, you note a pulse deficit of 23 beats. This finding may be caused by
Infuse normal saline at 100 mL/h. Because the likely cause of hypotension, tachycardia, and lung crackles in this client is decreased cardiac output and increased pulmonary congestion caused by heart failure, infusing normal saline would worsen the symptoms of fluid overload and should be questioned by the nurse.
When caring for a client who has heart failure, with blood pressure 102/70 mm Hg, pulse 106 beats/minute, and bilateral lung crackles, which prescribed action would the nurse question?
proteins
When the heart is damaged, ___ is released
Kidneys
Where do Thiazide diuretics work?
Assess the client's pulse.
Which action would the nurse take first after noting a flat line on a client's cardiac monitor?
Hypokalemia
Which condition would the nurse suspect is the U wave is present on the patients EKG?
Dysrhythmias
Which is the most common complication of an acute myocardial infarction (AMI)?
SA node (sinoatrial node)
Which structure initiates the action potential in the heart?
hypotension
Why is Nesteride not frequently used?
Rapid onset with little time for the heart to hypertrophy
Why is the death rate high for Dilated CMO?
Prinzmetal's angina
_______- is a rare form of angina that often occurs at rest, usually in response to spasm of a major coronary artery. When spasms occur, the patient has angina and transient ST segment elevation
Fibrous plaque
________ causes progressive changes in the endothelium of the arterial wall. The result is a narrowing of the vessel lumen and a reduction in blood flow to the myocardial tissue.
Afterload
_________ = the amount of pressure the ventricle most overcome to pump blood forward
Stool Softeners
_________ Prevent straining and vagal stimulation from Valsalva maneuver Vagal stimulation = bradycardia and dysrhythmias
myocarditis
_________________ is characterized by peripheral edema, distended neck veins, and lung crackles
• In third-degree AV block, or complete heart block
_________________, no impulses from the atria are conducted to the ventricles, resulting in variable PR intervals. • It almost always results in reduced CO with subsequent ischemia, HF, and shock. For symptomatic patients, a transcutaneous pacemaker is used until a temporary transvenous pacemaker can be inserted followed by a permanent pacemaker.
Angiotensin-converting enzyme (ACE) inhibitors
__________________ are the primary drug for patients with chronic HFrEF. They reduce mortality, morbidity, hospitalizations, and improve symptoms and QOL.
Second-degree AV block, type II (Mobitz II heart block)
____________________, involves a P wave that is nonconducted, with consistent PR intervals for every conducted beat. This almost always occurs when a block in 1 of the bundle branches is present (e.g., anterior MI).
Myocardial infarction (MI)
___________occurs because of an abrupt stoppage of blood flow through a coronary artery, causing irreversible myocardial cell death. Serum cardiac biomarkers are released into the blood.
cardiac resynchronization therapy (CRT)
a treatment for heart failure in which a device paces both ventricles to synchronize contractions (pumping action)
"I should reduce the amount of green leafy vegs that I eat"
additional teaching is needed for patients taking Warfarin if patient states?
The S1 heart sound represents:
closure of the mitral and tricuspid valves
transmits
conductivity ____________to other cells
multigated acquisition (MUGA) scan
creates video images of the ventricles to see whether they are pumping blood normally
peripheral cyanosis
cyanosis on the fingers and toes due to cold exposure, anxiety, or inadequate circulation.
will have a problem filling time
decrease preload in dehydration =
vasodilation
decreased stimulation of Alpha-adrenergic receptors causes ____
very low density lipoproteins (VLDL)
deliver fat made in liver to cells Primarily endogenous triglycerides
pulse deficit
difference between the apical and radial pulse rates
positive inotropes (increase squeeze of heart; the only pill to do this)
digoxin =
Tricyclic Antidepressants (TCAs)
effects: Dysrhythmias, orthostatic hypotension meds: (amitriptyline, doxepin (Silenor))
nonsteroidal anti-inflammatory drugs (NSAIDs)
effects: MI, Stroke, hypertension, HF meds: (Diclofenac, Ibuprofen)
Anticancer agents
effects: dysrhythmias, cardiomyopathy meds: (daunorubicn, doxorubicin)
Antipsychotics
effects: dysrthythmias, orthostatic hypotension meds: (chlorpromazine, haloperidol)
Corticosteroids
effects: hyoptension, edema, potassium depletion meds: (cortisone, prednisone)
implantable cardioverter defibrillator (ICD)
electrical device implanted in chest cavity with electrodes to heart; applies shock to heart to stop potentially life-threatening arrhythmias such as fibrillation
aorta and pulmonary artery
example of large arteries are the ________ and ______
responsive to an impulse
excitability (irritability) has the ability to be __________
HRpEF
heart failure with preserved ejection fraction
diastolic failure
heart failure with preserved ejection fraction (HFpEF) (formerly known as ___________).
HFrEF
heart failure with reduced ejection fraction
how do you measure Cardiac Output?
heart rate x stroke volume
Premature Ventricle Contraction
heart skips a beat due to a spot in the ventricle that gets agitated
Flattened T waves
hypokalemia
Natriuretic peptides
include BNP and ANP and are elevated in patients with HF to promote vasodilation and diuresis due to increased stretching of the mycoardium (volume overload causing frank-starling mechanism for maximal contraction). Both activated guanylate cyclase to increased cGMP
Stroke Volume (SV)
increase HR (fill and pump) not filling enough leads to ____ decreasing
ventricular dilation
increase preload overstretched
Inverted T wave
indicates ischemia
artifact
is nothing concerning have to fix patients monitors (typically because patient is moving)
left atrium, left ventricle, interventricular septum, and part of the right ventricle
left anterior descending artery and the left circumflex artery supply the _______
3rd heart sound
left ventricle failure. volume overload mitral, aortic or triscupid regurgitation HTN
30%
left ventricular dysfunction (EF less than _______,
NSTEMI
less severe nonocclusive thrombus shows ST depression or T wave inversion
40
less than ____ % is HF
blockage
lipids =
Grade 4 heart murmur
loud with palpable thrill
Cardiac Output (CO)
measurement of the amount of blood ejected per minute from either ventricle of the heart
ejection fraction
measurement of the volume percentage of left ventricular contents ejected with each contraction
Grade 3 heart murmur
moderately loud
Cell resting potential
more negatively charged inside than is its surrounding environment
Atrial Fibrillation
most common dysrhythmia
cardiac reserve S4
myocardial hypertrophy may have difficulty in isolating an apical pulse, and a _________ may be present
Janeway lesions
nontender hemorrhagic lesions - fingers, toes, nose, earlobes - associated with endocarditis
dysrhythmias
normal and abnormal heart rhythms, called
baroreceptor
orthostatic hypotension may be related to drugs or _________ functions.
Stroke Volume (SV)
preload and afterload are part of what determines ____
Mean Arterial Pressure (MAP)
pressure forcing blood into tissues, averaged over cardiac cycle
single photon emission computed tomography (SPECT)
radioactive tracer is injected intravenously and a computer reconstructs a 3D image based on a composite of many views
Contractility of the heart
rate and strength of contraction
Splinter hemorrhages
red-brown linear streaks from damage to nail bed capillaries
systemic vascular resistance
resistance to blood flow created by the elastic arterial walls
Hyperkalemia
salt substitutes can be high in K+, so monitor for signs of ____________
Korotkoff sounds
series of sounds that correspond to changes in blood flow through an artery as pressure is released
STEMI
severe (to the cath lab) emergency situation artery must be opened within 90 minutes PCI is the first fine tx if hospital doesn't have cath lab (they will get thrombolytic tx if cath lab is not available)
CLinical manifestations of MI
severe chest pain not relieved by rest substernal or epigastric region Ashen cool sweating skin decreased CO NV Crackles, murmurs, JVD
ventricular hypertrophy
slow increase in muscle mass prone to dysrhythmias
coronary angiography
specialized type of angiography that helps diagnose stenosis or obstruction of the arteries that supply blood to the heart muscle
acute coronary syndrome (ACS)
sudden symptoms of insufficient blood supply to the heart indicating unstable angina or acute myocardial infarction
Centesis
surgical puncture to remove fluid
Heaves
sustained lifts of the chest wall in the precordial area that can be seen or palpated.
Cardiac Computerized Tomography (CT Scan)
test which is often used to check for heart problems through an x-ray of the heart
collateral circulation
the alternative route of blood flow to a body part through an anastomosis. Body is not getting the O2 it needs so "detours" and builds new vessels. Blockage fixed with stents if found on time
treatment
the cause of a dysrhythmia influences the __________
Oster's nodes
the o in pathogens (s&s of IE) tender red lesions on hands and feet
Point of maximal impulse (PMI)
the point where the apex of the heart touches the anterior chest wall and heart movements are most easily observed and palpated
systolic blood pressure
the pressure created when the heart contracts and forces blood out into the arteries
arteries
thick elastic walled vessels
afterload
too much ___ will cause a systolic problem
Cardiac Valve Disorders
turbulent heart sounds between normal heart sounds, is known as
Nor-epinephrine and epinephrine
two types of beta-adrenergic receptors
echocardiogram
ultrasound of the heart
Coronary CT angiography (CTA)
use of CT with injected IV contrast medium to obtain images of blood vessels and diagnose CAD metal objects should be removed before examination. patients should have a regular heart rhythm to allow for accurate testing. A b-adrenergic blocker may be need to be administered before the test to control HR. the patient may need to be NPO for several hours before the procedure.
Grade 1 heart murmur
very faint
40-60
-AV node _______ beats/min -Located in the floor of the interatrial septum -Slows the transmission of impulses to the ventricle -Impulse then travels through bundle of HIS and across Purkinje fibers
Aortic Valve Regurgitation
-Aortic valve isn't closing -LV causing stress (overload) -diastolic murmur -Asymp for years -BP (diastolic low, systolic high) -widen pulse pressure
Mitral Valve Prolapse
-Asymptomatic -comes from dehydration -can lead to mitral regurgitation -"billow" -palpitation's -young women
Pharmacologic nuclear imaging
-Dipyridamole or adenosine used to produce vasodilation when patients are unable to tolerate exercise. Vasodilation will increase blood flow to well-perfused coronary arteries -May need to hold some meds -No caffeine for 12 hrs prior to procedure
arterial bruit
-Turbulent flow sound in peripheral artery -Arterial obstruction or aneurysm
mitral regugitation
-atrium gets bigger and dilates -pressure remains higher in ventricle -best heard in mitral or apex
Beta Blockers
-decrease myocardial O2 demand by decreasing HR, BP, and contractility -reduces risk of MI -given in 1st 24 hours
Antidysrhythmic Agents
-dysthymias most common complication post MI
Pacemaker cells in the SA node
78 year old patient is experiencing sinus dysthymias; a reduction in what cells leads to this condition?
Sinus Bradycardia
<60 bpm SA node Atropine
Emboli associated with atrial fibrillation
A nurse is caring for a client with a history of hypertension and aphasia. A family member states that a complete occlusion of the branches of the middle cerebral artery resulted in the client's aphasia. What is a common cause of this type of occlusion?
Unstable Angina Non ST Segment Elevation MI (NSTEMI) ST Segment Elevation MI (STEMI)
ACS Acute Coronary Syndrome
20
ACS damage is IRREVERISBLE and starts in ____ minutes
blood vessels.
Adrenergic inhibitors include drugs that work centrally on the vasomotor center and peripherally to inhibit norepinephrine release or to block the adrenergic receptors on _________
Esmolol Metoprolol Propranolol
Class II: Beta-Blockers:
Diltiazem Verapamil
Class IV: Calcium Channel Blockers
Unstable Angina
Classified as new onset of anginal pain or significant change to chronic stable angina
auscultatory gap
Disappearance of sound when obtaining a blood pressure; typically occurs between the first and second Korotkoff sounds.
the increased pressure in the lungs
How does COPD lead to Right Sided HF?
Direct thrombin inhibitor
How does Dabigatran (anticoagulant) work?
hearing loss
IV Furosemide (Loop- most common) if given too fast can cause?
Acute MR (mitral regurgitation)
In ______________, there is a sudden increase in pressure and volume that is transmitted to the pulmonary bed, resulting in pulmonary edema and life-threatening cardiogenic shock.
dyspnea and tachycardia.
In a severely anemic patient, the nurse would expect to find
murmurs
Infective Endocarditis causes inflammation of inner lining of heart valves that cause _______
cold extremities
Intermittent claudication, peripheral arterial disease, low cardiac output, severe anemia
C-reactive protein (CRP)
Marker for inflammation, predict the risk of cardiac disease Low Risk: < 1 mg/dL High Risk: > 3 mg/dL
arterial blood pressure
Measure of the pressure exerted by the blood as it flows through the arteries.
Vasopressors Norepinephrine Dopamine Epinephrine Phenylephrine Vasopressin
Meds that cause Increased Afterload:
Atropine Pacing Dopamine Dobutamine Epinephrine Norepinephrine
Meds that cause Increased HR:
light-headedness, dizziness, syncope
Orthostatic changes in BP and pulse should be measured in older adults, in patients taking antihypertensive drugs, and in patients who report symptoms consistent with reduced BP upon standing (e.g.,__________________________).
angina and HF.
PVCs are usually a benign finding in the patient with a healthy heart. In heart disease, depending on frequency, PVCs may reduce the CO and precipitate ___________
The hemodynamic hallmark of hypertension is persistently increased systemic vascular resistance (SVR).
Pathophysiology of Primary Hypertension
Cardiac Arrest/Shock/Dying
Reasons to want to increase afterload
Dehydration, Hypovolemic Shock
Reasons to want to increase preload
thinner
The atrial myocardium is ____ than the ventricles
Mitral
The auscultatory area in the left midclavicular line at the level of the fifth ICS is the best location to hear sounds from which heart valve?
Diastolic Blood Pressure
The minimum pressure that the arterial walls maintain during diastole to maintain blood flow
mortality and morbidity.
Therapy for those with HFrEF should concentrate on medications shown to reduce ________ These drugs may also be appropriate for patients with HFpEF, especially for those who need optimal BP control.
Treatment or Prevention of angina in clients with CAD
What are Nitrates/Nitrites used for?
HTN Cardiomyopathy CAD
What are the primary causes of HF?
Lowers LDL Raises HDL
What effect does Estrogen have on cholesterol?
Left ventricle
What fails w/ Left Sided Heart Failure ?
Purjinke fibers
What feature of the heart directly stimulates ventricular contractions?
ventricles depolarize in a completely disorganized way
What is Ventricular Fibrillation?
160-250
What is the Rate for Paroxysmal Atrial Tachycardia?
DASH, fruits, veggies, and low fat dairy
What is the dietary approach to stop HTN?
Ventricular dysrhythmias
What is the most lethal of all rhythms?
assess pulses distal to puncture site
What is the priority assessment on a patient after a PCI?
Peripheral edema
What is the specific side effect of CCB?
Get some rest Avoid caffeine
What is the treatment for Mitral Valve prolapse?
Watch for signs of HYPOvolemia Watch for dysrhythmia
What should be monitored when on Dobutamine?
baroreceptors that inhibit the sympathetic nervous system, causing vasodilation.
When a person's blood pressure rises, the homeostatic mechanism to compensate for an elevation involves stimulation of
Severe Left Ventricular Failure
When does Cardiogenic shock become a complication?
Oliguria Bleeding leads to poor renal perfusion and compensatory mechanisms that cause sodium and water retention, leading to decreased urine output.
When the nurse in the postanesthesia care unit is caring for a client who had major abdominal surgery, which finding may indicate postoperative bleeding?
Purkinje fibers
Which anatomic feature of the heart directly stimulates ventricular contractions?
Depolarization from atrioventricular (AV) node throughout ventricles
Which aspect of the heart's action does the QRS complex on the ECG represent?
Digoxin
Which med is NOT used for Hypertrophic CMO?
Nitroglycerin
Which med is contraindicated to administer with phosphodiesterase 5 inhibitors?
BB
Which med is used for Premature Atrial Contraction?
Tacrolimus
Which medication tries to prevent acute rejection?
A 45-yr-old man with a high-stress job who is depressed
Which person would the nurse identify as having the highest risk for coronary artery disease (CAD)?
A common characteristic of diastolic failure is resistance to ventricular filling A primary risk factor for heart failure is coronary artery disease (CAD). -- Diastolic failure is characterized by abnormal resistance to ventricular filling. Coronary artery disease(CAD), advanced age, and hypertension are all risk factors for heart failure (HF).
Which statements accurately describe heart failure (select all that apply)?
transesophageal echocardiography (TEE)
Which study detects the presence of vegetation on the heart valves?
morning headache
Which symptom is associated with hypercapnia?
Third heart sound (S3)
While auscultating the patient's heart sounds with the bell of the stethoscope, the nurse hears a ventricular gallop. How should the nurse document what is heard?
dysrhythmias can occur
Why is a temporary pacemaker at bedside needed for post op CABG?
measure perfusion of kidneys
Why is strict hourly I&O needed for Post op of CABG?
rapid injection could cause hypotension
Why should IV administration be slow?
Digitalis
_________ can be used in low doses in patients who still are symptomatic despite ACE inhibitors and β-blocker therapy.
Valvular regurgitation
______________, also called insufficiency, occurs with incomplete closure of the valve leaflets and results in the backward flow of blood
Diltiazem
_______________ is used to treat rapid atrial fibrillation
Pleural effusion, AF, thrombus formation, renal insufficiency, hepatomegaly, and sudden cardiac death (SCD)
________________ are complications of HF.
assessing the presence of arterial blockage
what is the primary purpose of using a coronary angiogram?
voltage
y axis on ECG paper represents
pericardial effusion and cardiac tamponade.
• Complications of pericarditis include____________-
ST elevation
• STEMI, caused by an occlusive thrombus, results in ___________ in the ECG leads facing the area of infarction. It requires immediate treatment with PCI (first line) or thrombolytic (fibrinolytic) therapy (in hospitals not capable of performing PCI) to limit the infarct size.
ECG Holter Monitor
-ECG that records electrical activity for 24 to 48 hours -Identifies irregularities that would be missed with a regular ECG
Aortic Valve Stenosis
-LV gets bigger to try to force contraction -SV increases -CO decreased -backup into lungs causing pulm congestion -CP would be a new s/s - has both systolic and diastolic murmurs
Cardiomyopathies
-Not squeezing or filling up well -affect the structure and function -has primary and secondary -all lead to HF and often death
B-type natriuretic peptide (BNP)
< 100 pg/mL (or ng/L) -marker of cardiac stress -higher values indicate higher likelihood of HF when consistent with HF sxs (not disease specific); can also be high with renal failure
Idioventricular Rhythm
<40 *looks like vtach but slow* - no P waves (from vent foci) - Wide QRS (serious, death like rhythm) - called "dying heart" rhythm...occasional ventric beat b4 death (asystole)
Biologic valve replacement Female patients of childbearing age typically receive biologic valve replacements because they are not candidates for anticoagulation therapy.
A 32-year-old female patient with valvular heart disease has been treated with metoprolol and digoxin for several years. After undergoing transcutaneous valvuloplasty, the patient continues to experience dyspnea and pulmonary edema. Which treatment would the nurse anticipate next?
Having a MI
A 67 yrs old female is admitted to the ED & c/o mid-back pain & SOB for the last 2 hrs.She also c/o nausea and she states that she vomited twice before coming to ED. She denies any chest discomfort or arm pain. The presenting symptoms suggest that this patient may be:
Stop the nitroprusside infusion and assess the patient for potential complications.
A 67-yr-old woman with hypertension is admitted to the emergency department with a blood pressure of 234/148 mm Hg and was started on nitroprusside (Nitropress). After 1 hour of treatment, the mean arterial blood pressure (MAP) is 55 mm Hg. Which nursing action is a priority?
Obtain a 12-lead electrocardiogram (ECG).
A 74-yr-old man with a history of prostate cancer and hypertension is admitted to the emergency department with substernal chest pain. Which priority action will the nurse complete before administering sublingual nitroglycerin?
Swallow the capsule whole
A client is discharged with a prescription for sustained-release nitroglycerin. What should the nurse teach the client about sustained-release nitroglycerin?
Synchronized cardioversion
A client who has paroxysmal supraventricular tachycardia reports a mild "fluttering feeling" in the chest and has a blood pressure of 110/55 mm Hg. Which potential treatment by the health care provider would the nurse question?
Petechiae
A client with a distal femoral shaft fracture is at risk for developing a fat embolus. The nurse considers that a distinguishing sign that is unique to a fat embolus is:
Presence of a cough and pulmonary secretions
A client with a history of rheumatic fever and a heart murmur reports gaining weight in spite of nausea and anorexia. The client also reports shortness of breath several times each day and when performing minor tasks. Which additional information should the nurse obtain?
Spironolactone
A male patient with chronic heart failure develops enlarged breasts. The nurse reviews the patient's medication profile and suspects that which medication is the cause of the patient's condition?
non-rebreather mask
A nurse is caring for a client in respiratory distress. The health care provider prescribes oxygen via a non-rebreather mask. Which mask should the nurse use to implement the oxygen prescription?
Administer ordered morphine sulfate. Position patient in a semi-Fowler's position. Instruct patient on the use of relaxation techniques. Use a calm, reassuring approach while talking to patient.
A patient admitted with heart failure is anxious and reports shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety? (Select all that apply.)
Sudden cardiac death
A patient attends a follow-up visit at a clinic, six months after receiving a heart transplant. The nurse recognizes that the patient is at risk for what major cause of death?
Hx Intracranial hemorrhage recent stroke within 3 months head trauma within 3 months uncontrolled HTN active bleeding prior thrombolytics within 6 months
A patient can not have thrombolytic's if positive for what things?
Creatine kinase-myoglobin (CK-MB) and C-reactive protein (CRP)
A patient informs the nurse that he is having severe chest pain. He took two nitroglycerin tablets more than 1 hour ago with no relief. On further assessment the nurse notices that the patient is diaphoretic and also complains of feeling dizzy. The nurse would expect which diagnostic test or tests to be ordered:
ACE inhibitors Antiplatelet therapy Intravenous nitroglycerin
A patient is admitted to the ICU with a diagnosis of unstable angina. Which medications would the nurse expect the patient to receive (select all that apply)?
Intravenous (IV) furosemide 40 mg every six hours
A patient is admitted with acute decompensated heart failure. Which part of the treatment plan will increase fatigue in this patient?
Systolic murmur
A patient is being admitted for valve replacement surgery. Which assessment finding is indicative of aortic valve stenosis?
Radiofrequency catheter ablation
A patient is experiencing atrial flutter. The nurse anticipates that what treatment will be included in the patient's plan of care?
"Your father may be having mini-strokes; I will notify his physician."
A patient is experiencing periods of confusion, and the family is concerned. The patient's son asks the nurse for an explanation and recommendation. What is the nurse's best response?
Perfusion assists the cell by delivering oxygen and removing waste products.
A patient is questioning the nurse about circulation and perfusion. What is the nurse's best response?
Blood pressure
A patient is receiving a drug that decreases afterload. To evaluate the patient's response to this drug, what is the most important for the nurse to assess?
Cardiac vasculopathy
A patient is scheduled for a heart transplant. What is a major cause of death beyond the first year after a heart transplant?
Troponin
A patient presents to the emergency department reporting chest pain for 3 hours. What component of the blood work is most clearly indicative of a myocardial infarction (MI)?
Administer intravenous (IV) antibiotics
A patient presents with chest pain, shortness of breath, syncope, fever, chills, and myalgias. Which health care provider order would the nurse implement first to prevent valvular heart disease? Administer oxygen therapy Administer acetaminophen Administer intravenous (IV) antibiotics Obtain STAT electrocardiogram (ECG)
Morphine Sulfate
A patient received the max dose of nitrate and is still experiencing CP, which med would be given?
Isoproterenol
A patient that is being tested for syncope has undergone the head-up tilt-test. After 30 minutes of testing, the patient's blood pressure and heart rate did not respond and no clinical symptoms were reproduced. The nurse anticipates that what medication will be given in a low dose intravenously (IV), to provoke a response?
Assist the patient to a sitting position with arms on the overbed table.
A patient who had bladder surgery 2 days ago develops acute decompensated heart failure (ADHF) with severe dyspnea. Which action by the nurse would be indicated first?
Prepare for transcutaneous pacing this is a third degree block so you would perform pacing
A patient with a history of heart failure is admitted for syncope has a BP 85/50 mmHg and is becoming less responsive. An ECG reveals P waves at a rate of 75/min and a QRS rate of 30/min; there is no correlation between the P waves and the QRS complex. A priority nursing intervention would be to
IV sedation may be administered to help the patient relax.
A patient with a history of myocardial infarction is scheduled for a transesophageal echocardiogram to visualize a suspected clot in the left atrium. What information should the nurse include when teaching the patient about this diagnostic study?
Choose interventions to promote comfort and prevent suffering.
A patient with a long-standing history of heart failure recently qualified for hospice care. What measure should the nurse now prioritize when providing care for this patient?
Reduction of preload.
A patient with a recent diagnosis of heart failure has been prescribed furosemide (Lasix). What outcome would demonstrate medication effectiveness?
right atrium and right ventricle.
A patient with a tricuspid valve disorder will have impaired blood flow between the
Hypokalemia
A patient with heart failure (HF) takes digoxin. The nurse recognizes that the patient is at risk for digitalis toxicity if what condition exists?
Anemia
A patient with heart failure complains of fatigue. The nurse understands that which causes of fatigue are associated with heart failure?
"Biologic valves cause less patient bleeding than mechanical valves do."
A patient with mitral valve stenosis has not responded well to drug therapy and the health care team is considering valve replacement. Which statement to the patient best describes the differences between a biologic and mechanical valve?
Drug therapy will be needed because the BP is still not at goal
A patient with newly discovered high BP has an average reading of 158/98 after 3 months of exercise and diet modifications, Which management strategy will be a priority for this patient?
Hold metoprolol (Lopressor) and call the health care provider.
A patient's cardiac monitor shows sinus rhythm, rate 60-70/bpm. The P-R interval is 0.18 seconds at 1:00 am, 0.22 sec at 2:30 pm, and 0.26 sec at 4 pm. Which action should the nurse take at this time?
Shortness of breath.
A patient's cardiac rhythm is sinus bradycardia with a heart rate of 34 beats/minute. If the bradycardia is symptomatic, the nurse would expect the patient to exhibit
Dizziness or syncope
A patient's cardiac rhythm is sinus bradycardia with a heart rate of 34 beats/minute. If the bradycardia is symptomatic, the nurse would expect the patient to exhibit:
SOB because not enough perfusion
A patient's cardiac rhythm is sinus bradycardia with a heart rate of 34. If the bradycardia is symptomatic, the nurse would expect the patient to exhibit?
HR 110
A patients baseline HR is 85. which HR would indicate sympathetic nervous system stimulation in a patient?
Bubbling crackles and tachycardia
A physical finding that the nurse would expect to be present in the patient with acute left-sided heart failure is:
friction; contracts
A small amount of pericardial fluid lubricates the space between the pericardial layers and prevents _________ between the surfaces as the heart _________.
They cannot be in contact with equipment connected to the client
A student nurse is observing a cardioversion procedure and hears the team leader call out, "stand clear". The student should recognize the purpose of this action is to alert personnel that
ezetimibe
A student nurse is rounding with the bedside nurse. The nurse is giving medication education to the patient. The student knows the medication in question is the following based upon this statement: "this medication will decrease absorption of cholesterol in your intestine, is best for you with a family history of high cholesterol, and has minimal side effects?"
Nitrates & Nitrites
Action: Dilate coronary arteries & systemic blood vessels increasing blood flow. Decrease workload of LV. Decrease preload & afterload. Decrease myocardial oxygen demand.Use: Treatment or prevention of angina in clients with CAD and treat symptoms of HF.
Potassium-Sparing Diuretics/Aldosterone Receptor Antagonist
Action: Inhibits aldosterone, sodium excreted on exchange for potassium. Acts directly on the distal convoluted tubule to increase sodium excretion and decrease potassium secretion.Use: HTN, edema associated with heart failure.
Fibric Acid Derivatives
Action: Stimulate cellular fatty acid uptake, conversion to acyl-CoA derivatives, and catabolism by the B-oxidation pathways resulting in decreased triglycerides levels.Use: Elevated triglycerides levels & whose cholesterol levels have been resistant to0 dietary management.
HMG-CoA Reductase Inhibitors
Action: work in the liver to affect cholesterol synthesis. Act by competitively inhibiting this rate-limiting enzyme in the liver that leads to a decrease in cholesterol concentration.Use: Lowering LDL cholesterol levels in client whom dietary therapy has not been effective. Effect on HDL cholesterol is dose dependent. No effect on lipoprotein levels.
SNS (sympathetic nervous system)
Adrenergic-inhibiting agents act by decreasing the______effects that increase BP.
"Sometimes after ACS, people feel dizzy and fall."
After an admission for acute coronary syndrome (ACS), a client is asked to notify the nursing staff before getting out of bed. After finding the client up walking alone in the hallways an hour later, which response by the nurse is best?
HTN or BPH
Alpha 1 when blocked causes the opposite (Ex. Alpha adrenergic blockers like doxazosin for ____________
vasoconstriction of blood vessels in the skin, kidney, & brain; & contraction of smooth muscles of ureter, urethral sphinchter, & uterus.
Alpha 1 when stimulated causes:
norepinephrine release
Alpha 2 when blocked causes an increase in _______ (Ex. Alpha 2 blockers like mirtazapine, used as an antidepressant)
norepinephrine norephinephrine
Alpha 2 when stimulated: inhibits release of _________, which is a neurotransmitter that stimulates Alpha 1 & Beta 1. By inhibiting _________, its vasocontrictive, + inotropic, & +chronotropic effect is inhibited (blocked). (Ex. Centrally acting sympatholytics like clonidine are also referred to as Alpha 2 agonists which stimulates alpha 2 receptors thereby blocking norepinephrine release, used for HTN).
Doxazosin
Alpha blockers medication example for HTN?
smooth muscle
Alpha-adrenergic receptors are found in vascular _______
food or milk
Amiloride and Triamterene (Potassium Sparing Diuretic ) are taken with ?
Heart Failure
An abnormal clinical syndrome that involves inadequate filling and/or pumping of the heart
percutaneous transluminal balloon valvuloplasty (PTBV)
An alternative treatment for some patients with valvular heart disease is the ____________ procedure. PTBV is used more often for pulmonic, aortic, and mitral stenosis. It involves threading a balloon-tipped catheter from the femoral artery to the stenotic valve so that the balloon may be inflated in an attempt to separate valve leaflets.
Blood pressure
An asymptomatic patient with acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before dangling the patient on the bedside, what should the nurse assess first?
brisk walking
An example of health-promoting regular physical activity is ________ (3 to 4 miles/hr) for at least 30 minutes 5 or more times each week.
An activated partial thromboplastin (APTT) twice the usual value
An older adult with cerebral arteriosclerosis is admitted with atrial fibrillation and is started on a continuous heparin infusion. What clinical finding enables the nurse to conclude that the anticoagulant therapy is effective?
Statins
An outpatient has a new diagnosis of peripheral artery disease PAD. Which medications will the nurse teach about?
O2 in blood
Angina doesnt produce enough ____
at rest
Angina is worse at rest or while doin something like cutting the grass?
Prinzmetal Angina
Angina with longer duration and usually occurs w/o regard to physical activity
surgical cut to chest and leg
Angiogram gives a puncture cite, whereas CABG gives a
Heparin
Anticoagulant that forms complex that inhibits conversion of fibrinogen to fibrin
Enoxaparin (Lovenox)
Anticoagulant that has low molecular weight than heparin --- prefilled syringes
LVH (left ventricular hypertrophy) found by tricuspid
Apical impulse palpable in the 4th IC, MCL means?
Hypertrophy to go against the increased resistance Thickened Heart muscle limits ability to relax and fill with blood
How does Hypertension lead to Diastolic HF?
slow
If progression of CAD is __________...collateral circulation may form
90 minutes
If the patient is experiencing a STEMI, the patient must get to the cardiac catheterization laboratory within ____________ of presentation in a PCI capable hospital or receive thrombolytic therapy within 30 minutes in agencies without PCI capability.
atropine
If the patient is symptomatic for AV Block, __________ is used to increase HR, or a temporary pacemaker may be needed.
the procedure will destroy areas of the conduction system that are causing rapid heart rhythms.
Important teaching for the patient scheduled for a radiofrequency catheter ablation procedure includes explaining that
Right Coronary Artery (RCA)
In 90% of people, the AV node and the bundle of HIS receive blood supply from the ______
dilate
In Mitral Regurgitation, the atrium gets bigger then starts to ________, making it more compliant, meaning, it accepts the blood coming back into it at a lower pressure, so it can accept more volume at a lower pressure.
back on tract.
In Premature Ventricle Contraction, the heart is trying to give the SA node time to get __________
pulse and awake
In Ventricular Tachycardia, IV amiodrone is given for ?
Chronic MR (Mitral regurgitation)
In __________, the added volume load results in atrial enlargement (placing the patient at risk for atrial fibrillation), ventricular dilation, and eventual ventricular hypertrophy
microvascular angina,
In ___________ chest pain occurs in the absence of significant CAD or coronary spasm of a major coronary artery. The pain is related to myocardial ischemia associated with atherosclerosis or spasm of the small distal coronary vessels
Pitting edema of lower extremities or sacral area
Interruption of venous return to heart, right sided HF
1 area of the heart to another
Intervals between the waves (PR, QRS, and QT) reflect the time it takes for the signal to travel from ____ YOU CAN MEASURE THESE TIME INTERVALS
murmurs
Left sided valve problems are more common with ?
HMG-CoA Reductase Inhibitors -Statins (Atorvastatin, Simvastatin) Niacin (B vitamin; causes flushing) Fibric Acid Derivatives (Gemfibrozil, fenofibrate) Omega-3 fatty acid Bile-acid sequestrants Cholesterol absorption inhibitor (Ezetimibe)
Lipid lowering agents
Anterior, inferior, lateral, septal, or posterior wall infarction
MIs are described based on the location of the damage, which can occur?
hypotension
Males taking Viagral can contraindicate if the patient is taking a nitrate because the combination can cause significant ________
Rapid onset Blurred vision, papilledema HA Confusion Motor/Sensory deficits
Manifestations of Hypertensive Crisis
anxiety and depression.
Many patients with HF are at high risk for ___________
Fluids Blood products Volume Expanders
Meds that cause Increased Preload
(1) nutritional therapy, (2) drug therapy, (3) lifestyle modification, and (4) home monitoring of BP.
Patient and caregiver teaching includes:
avoid giving IM injections
Patient with VTE is on heparin drip and daily partial thromboplstin time (PTT) Nurse plans to?
without regard to physical activity
Prinzmetal's Angina - longer duration & usually occurs _______________ S/T coronary artery spasm - HIGH RISK for MI - will see transient ST segment elevation
Assessing the patient's decisional capacity
Prior to requesting the family to make health care decisions for the patient, the nurse identifies that what is the priority action?
heart failure.
Progressive LVH, especially in association with CAD, is associated with the development of _________
IE.
Prophylactic antibiotic therapy is needed to prevent ______
Assess for presence of DP pulses
Pt complains of pain while walking. which resolves upon rest, The nurse should
chronic stable angina
Pt has been having CP for a long period of time. stable/ less critical Not enough O2 (anemia) ? CP! Predictable Consistent Occurs on exertion relieved by rest and NTG
check the blood pressure
Pt with hx of abd aortic aneurysm arrives at ED with severe back pain and absent pedal pulses. First action is to
HTN, CMO, Post-MI, CHF, Valve Dz
Reasons to want to decrease afterload
HTN, CHF, Pulmonary edema, Post-MI, CMO
Reasons to want to decrease preload
IV nitroglycerin (NTG) (Tridil)
Reduces pain and improves coronary blood flow Monitor BP for hypotension what med am i?
myocardial workload
Reducing patient anxiety is an important nursing function since anxiety may increase the SNS response and further increase ____________
scarring and deformity of the heart valves.
Rheumatic heart disease is a chronic condition resulting from RF. It is characterized by __________
Hypotension, Bradycardia, Dizziness, Worsen CHF
Side Effects of BB
therapeutic
Side effects and adverse effects of antihypertensive therapy may be so severe or undesirable that the patient does not adhere to therapy. Patient and caregiver teaching related to drug therapy is needed to identify and minimize side effects and to cope with _____________effects.
reversible
Significant CAD may be a ______ cause, so patients may be referred for PCI or CABG surgery.
presence of S3 and S4 PND displacement of PMI
Signs of left sided HF?
heart disease
Strep throat that is now treated by a doctor can turn into _______
left ventricular hypertrophy (LVH).
Sustained high BP increases the cardiac workload and produces________
bradycardia and atrioventricular blocks
Teach patients taking digitalis preparations how to measure their pulse rate because___________ are late signs of digitalis toxicity
atrial contraction.
The P wave represents the depolarization of the atria (passage of an electrical impulse through the atria), causing _______________
behind the T wave
The P wave sometimes may be hidden where in Premature Atrial Contraction (skips a beat)?
Depolarization from the AV node throughout the ventricles
The QRS complex represents ____
Repolarization of the ventricles
The T wave represents _____
Repolarization of the purkinje fibers
The U wave, if seen, may represent ______
autonomic nervous
The ___________________ system plays a vital role in the rate of impulse formation, the speed of conduction, and the strength of cardiac contraction.
damaged or diseased.
The artificial cardiac pacemaker is an electronic device used to pace the heart when the normal conduction pathway is ____________
sympathetic nervous system and parasympathetic nervous system
The autonomic system consists of the
inhibits blood coagulation.
The endothelium maintains homeostasis, promotes blood flow, and under normal conditions ____________
fight or flight response
The heart rate changes during exercise, increasing it, this is from the sympathetic system known as ___________
Notify the health care provider immediately.
The home care nurse visits a patient with chronic heart failure who is taking digoxin (Lanoxin) and furosemide (Lasix). The patient complains of nausea and vomiting. Which action is most appropriate for the nurse to take?
Severe dyspnea and blood-streaked, frothy sputum
The home care nurse visits a patient with chronic heart failure. Which assessment findings would indicate acute decompensated heart failure (pulmonary edema)?
Purkinje fibers
The left branches have two divisions: anterior and posterior The action potential moves through these left branches through the walls of both ventricles aka ______
left anterior descending artery left circumflex artery
The left coronary artery arises from the aorta and divides into 2 branches called ______ and ________
acute MI or a prior (old) MI.
The majority of SCD is caused by acute ventricular dysrhythmias (e.g., ventricular tachycardia, ventricular fibrillation). They may be associated with an ________
bed rest with the head of the bed elevated to 45 degrees, providing an overbed table for support, and anti-inflammatory drugs.
The management of the patient's pain and anxiety during acute pericarditis is a key nursing consideration. Pain relief measures include maintaining _____________
implantable cardioverter-defibrillator (ICD)
The most common approach to preventing a recurrence and improving survival is the use of an _______
coronary
The myocardium has it's own blood supply, known as ____ circulation.
"Most of my fat intake should be from olive oil or the oils in nuts."
The nurse determines that teaching about implementing dietary changes to decrease the risk of CAD has been effective when the patient says,
Guidelines for a low-sodium diet
The nurse develops dietary education for a patient with heart failure (HF) and should include what information?
Inspect the patient's right side and back.
The nurse in the recovery room assesses the right femoral artery puncture site after the patient had a stent inserted into a coronary artery. The insertion site is not bleeding or discolored. What should the nurse do next to ensure the femoral artery is intact?
a. Loss of appetite with slight bradycardia
The nurse is administering a dose of Digitalis (digoxin) to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which symptom?
Iodine
The nurse is admitting a patient who is scheduled to undergo a cardiac catheterization. What allergy information is most important for the nurse to assess and document before this procedure?
BP 128/78 mm Hg
The nurse is caring for a patient admitted with a history of hypertension. The patient's medication history includes hydrochlorothiazide daily for the past 10 years. Which parameter would indicate the optimal intended effect of this drug therapy?
Bronchospasm
The nurse is caring for a patient admitted with chronic obstructive pulmonary disease (COPD), angina, and hypertension. Before administering the prescribed daily dose of atenolol 100 mg PO, the nurse assesses the patient carefully. Which adverse effect is this patient at risk for given the patient's health history?
Give IV normal saline bolus The patient is hypotensive, and should be given a fluid bolus to prevent further complications.
The nurse is caring for a patient after valve replacement surgery. The patient reports chest pain 6/10 and mild dyspnea. The nurse notes oxygen saturation 92% on 2L via NC, HR 68 bpm, BP 86/42 mmHg, and respirations 16 per minute. Which action is most important for the nurse to take?
. Atropine Dopamine Epinephrine
The nurse is caring for a patient that is experiencing symptomatic sinus bradycardia. Which drugs are used to treat this rhythm?
Transesophageal echocardiogram An echocardiogram will allow visualization of the cardiac valves.
The nurse is caring for a patient who reports frequent angina, dyspnea on exertion, and peripheral edema. The nurse notes a systolic murmur on auscultation and crackles in the lungs. Which diagnostic test would the nurse anticipate?
"Your family members should learn how to perform CPR and practice these skills regularly."
The nurse is caring for a patient who survived a sudden cardiac death. What should the nurse include in the discharge instructions?
Untreated strep pharyngitis Mitral valve disease is often associated with rheumatic heart disease, which can be attributed to untreated strep infections.
The nurse is caring for a patient with diagnosed aortic regurgitation. Which patient history finding would the nurse note as a possible cause?
Pulse 48 beats/min
The nurse is caring for a patient with hypertension who is scheduled to receive a dose of metoprolol (Lopressor). The nurse should withhold the dose and consult the prescribing provider for which vital sign taken just before administration?
Hold the PO digoxin The patient's symptoms indicate digoxin toxicity. The nurse would hold the patient's dose of digoxin. Also, digoxin administration is contraindicated with bradycardia.
The nurse is caring for a patient with mitral stenosis and who experiences nausea, muscle weakness, and chest heaviness. The nurse notes an apical pulse of 58 bpm. Which action is most important for the nurse to take?
Avoid drugs to treat erectile dysfunction.
The nurse is preparing to administer a nitroglycerin patch to a patient. When providing teaching about the use of the patch, what should the nurse include?
Withhold the dose and report the potassium level.
The nurse is preparing to administer digoxin to a patient with heart failure. In preparation, laboratory results are reviewed with the following findings: sodium 139 mEq/L, potassium 5.6 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dL. What is the priority action by the nurse?
Discussed along with other physical activities
The nurse is teaching a patient recovering from a myocardial infarction. How should resumption of sexual activity be discussed?
Limit beef consumption. Limit sodium and fat intake. Increase fruits and vegetables. Exercise 30 minutes most days.
The nurse is teaching a women's group about ways to prevent hypertension. What information should the nurse include? (Select all that apply.)
A smoking cessation plan should be in place
The nurse knows that including teaching on modifiable risk factors for impaired perfusion in the patient's plan of care includes which of the following:
patients should be sedated if cardioversion is done on a non-emergency basis.
The nurse prepares a patient for synchronized cardioversion knowing that cardioversion differs from defibrillation in that
vertically
The septum ____ divides the heart
implantable cardioverter defibrillator (ICD)
The_______________ is used for patients who have survived SCD, have spontaneous sustained VT, have syncope with inducible ventricular tachycardia/fibrillation during EPS, and are at high risk for future life-threatening dysrhythmias.
impulse transmission
There is a delay of ________ through the AV node that accounts for the time between the beginning of the P wave and the beginning of the QRS wave.
cardiovascular disease (CVD)
There is a direct relationship between hypertension and ___________. Hypertension is a major risk factor for coronary artery disease (CAD), stroke, and cerebral atherosclerosis
Vasodilator (HA, dizziness, weakness, hypotension, falling problem) may cause issues with uric acid (Gout)
Thiazide Diuretic side effects?
central nervous system
VT is associated with myocardial infarction (MI), CAD, significant electrolyte imbalances, cardiomyopathy, mitral valve prolapse, long QT syndrome, digitalis toxicity, and _________________ disorders.
mitral
Valve repair is usually the surgical procedure of choice for patients with valvular heart disease. It is often used in _________ valvular heart disease.
can not be counted
Ventricular Fibrillation rate?
slowly
Ventricular dysrhythmias has impulses that originate in one or more irritable foci and travels___________, cell by cell, through the ventricular tissues
decreased CO Cardiac standstill
Ventricular dysrhythmias will cause what symptoms?
ectopic focus or foci
Ventricular tachycardia (VT) is a run of 3 or more PVCs. It occurs when an ____________ fire repetitively and the ventricle takes control as the pacemaker
muscle and connective
Venules are smaller vessels made up of small amount of _____ and _______ tissue.
larger veins
Venules collect blood from the capillary beds and channel it to the _____________
Benazapril (Lotensin)
What ACE in more common to cause angioedema?
Timolol (Timoptic)
What BB is an eye drop that's used for Glaucoma?
hypertrophic cardiomyopathy
What CMO is hereditary?
ST elevation
What ECG change do we look for to see if chest pain is related to ischemia?
Lidocaine or Amiodarone
What IV antiarrhythmics are used to care for MI?
Angina, Primary hypertension, AFib, AFlutter, SVT
What are CCBs used for?
CHF Atrial Dysrhythmias
What are Cardiac Glycosides used for?
Low GFR, hypertensive emergencies Edema, Pulmonary Edema, CHF, CRF, hepatic cirrhosis Drug Overdose
What are Loop Diuretics used for?
DVT, PE, AMI, Heart valve replacement, Atrial Fibrillation
What are anticoagulants used for?
Systolic Diastolic
What are the 2 types of heart failure?
Doxazosin Terzosin Prazosin
What are the Alpha Meds?
Fatigue, weakness, exertional dyspnea, palpitation, S3 gallop
What are the Manifestations of Chronic Mitral Valve Regurgitation?
Usually idiopathic; may be secondary to chronic alcoholism or myocarditis
What are the causes of Dilated CMO?
Confusion, Restlessness - Altered Mental Status
What are the cerebral manifestations associated with CHF?
laying down and deep breathing makes it worse. sitting up and leaning forward makes it better.
What are the characteristics of Pericarditis?
N/V Ashen color on skin/Cool and clammy JVD Murmur Rales
What are the clinical manifestations of MI?
JVD, Peripheral Edema, Hepatosplenomegaly
What are the clinical manifestations of Right Sided HF?
Enalapril Benzapril Catopril Lisinopril Ramipril Quiapril Fosinopril
What are the common ACE Inhibitor meds?
Losartan Valsartan
What are the common ARB meds?
Doxazosin Terzosin
What are the common Alpha Adrenergic Blocker meds?
Diltiazem (Cardizem) Verapamil (Calan SR) Amlodipine (Norvasc) Nifedipine (Procardia) Felodipine (Plendil)
What are the common CCB meds?
Digoxin Digitoxin
What are the common Cardiac Glycoside meds?
Clofibrate Fenofibrate Gemfibrozil
What are the common Folic Acid Derivative meds?
Clopidogrel Eptifibatide Ticagreglor Prasugrel
What are the common Glycoproteins (antiplatelets)?
Active bleeding Recent hx of CVA within 3 months Uncontrolled HTN Pregnancy
What are the contraindications of using Thrombolytics?
Vessel length Blood viscosity Vessel diameter/distensibility
What are the contributing factors for systemic vascular resistance?
Fatigue, Malaise, Decreased Activity Intolerance, Postural Dizziness, Edema, Cool extremities, Weight Gain
What are the generalized manifestations associated with CHF?
-symptomatic sinus bradycardia - junctional rhythms -slow ventricular rhythms -AV Blocks -Tachydysrhythmia's - if meds don't work
What are the indications for a pacemaker?
Contraindicated in pregnancy and should not be given to patients with impaired renal function
What are the interactions with Thiazide Diuretics?
Aortic Stenosis Pulm. Stenosis Mitral/ Tricuspid Regurgitation Mitral Valve Prolapse
What are the left sided Heart murmurs?
Dyspnea Fatigue Hoarseness Loud S1 Low, pitched rumbling diastolic murmur
What are the manifestations associated with Mitral Valve Stenosis?
fatigue, dyspnea on rest, orthopnea, dry cough, NV, emboli, JVD
What are the manifestations of Dilated CMO?
asymptomatic DOE angina, fatigue, syncope apical pulse displacement systolic murmur
What are the manifestations of Hypertrophic CMO?
CP and Friction Rub
What are the manifestations of Pericarditis?
Nocturia Confusion N/V Visual disturbances Retinal changes
What are the manifestations of target organ damage caused by HTN?
Hydrochlorathiazide (Microzide) Chlorathiazide (Diuril) Methyclothiazide (Enduron)
What are the med examples for Thiazide Diuretics?
ASA (most common) Glycoproteins (Clopidogrel) (most common) Ticagrelor Prasugrel
What are the meds of antiplatelets?
Immunosuppressive (Cyclosporine) Anti-proliferative (Azathioprine) Corticosteroids (prednisone)
What are the meds per transplant protocol?
Thiazides ACE inhibitors Calcium channel blockers
What are the most common HTN medications?
Erythrocyte Sedimentation Rate (ESR) C-Reactive Protein (CRP) Myoglobin Homocysteine
What are the nonspecific tests to check for inflammation?
obtain baseline vitals and electrolytes weight client daily admin furosemide 20mg/min IV replace K+ if it drops <3.5 mEg/L instruct patient to report tinnitus Assess for decreased edema, weigh loss, decrease BP, or increase urine output
What are the nursing considerations with Loop diuretics?
use a filter needle to draw up IV instruct pt to report change in LoC, HA, NV, ICP Monitor BP, weight and ECG Track input and output
What are the nursing considerations with Osmotic Diuretic?
Obtain Baseline Vital Signs and electrolytes Weigh clients daily give with meals to avoid GI upset Replace electrolytes when needed Advise patient to rise slowly to minimize orthostatic hypotension Track input and output
What are the nursing considerations with Thiazide Diuretics?
Severe dyspnea, Orthopnea, Tachycardia, Rales, Cyanosis (late)
What are the other manifestations of Flash Pulmonary Edema?
Left sided HF Pulmonary HTN
What are the primary causes of Right Sided HF?
CO + SVR
What are the primary factors that determine BP?
monitor renal and liver Give separate of antacids, blockers, and iron DEEP IM Cross-sensitive with PCN *May take with food GI, PT/INR, lethargy NO alcohol ** take all antibiotics prescribed because of drug resistance**
What are the principles for Cephalosporins?
check allergies GI upset (diarrhea) No juices, milk or soda monitor renal, liver, and electrolytes (K) DEEP IM ** culture and sensitivity before any antibiotic**
What are the principles with Penicillin's (PCN)?
Allergies Patient must be NPO check kidney function women need UPT Always check at risk for bleeding with their H/H Assess for dye allergy; if allergic -Benadryl
What are the requirements before a patient enters the cath lab?
Dyspnea, Orthopnea, PND, Persistent Hacking Cough, Cheyne-Stokes, Rales, Pulmonary Edema
What are the respiratory manifestations associated with CHF?
Male Family history of CAD Smoker + DM High cholesterol EF <40% History of arrhythmias
What are the risk factors for Sudden Cardiac Death?
Stress, Arrhythmias, Infection, Hyperthyroidism, Pregnancy, OA, Nutritional Deficiency, Pulmonary Disease, Hypervolemia
What are the risk factors for Systolic HF?
SOB, tachypnea, rales, Liver enlargement, JVD, anorexia, Nausea
What are the s/s associated with CHF?
Thoracic- neck, should and back pain, increased HR, dyspnea Abdominal- pulsating mass in abs, abd/back pain Ruptures- severe abd/back pain, shock and decreased BP
What are the s/s of Aortic Aneurysm?
General: fever flu like symptoms heart murmur Vascular: Petechia Splinter hemorrhages Oslers Nodes Janeway lesions Roths spots
What are the s/s of IE?
CP, SOB, Nausea, low back pain, diaphoresis, pallor, fear, anxiety
What are the s/s of MI?
no pulse, BP, or RR. pt is unconcious
What are the s/s of Ventricular Fibrillation?
hypotension, pallor, tachy, disorientation, CP, cool clammy skin
What are the s/s of cardiogenic shock?
pulmonary congestion tachypnea increased blood pressure
What are the s/s of left sided HF?
Hyperkalemia, Impotence, Dysmenorrhea, Drowsiness
What are the side effects for Potassium Sparing Diuretic?
dry cough Vasodilates (HA, dizziness, fatigue) altered taste (dysgeusia)
What are the side effects from ACE?
Peripheral edema (elderly females) Vasodilatation (HA, Fatigue, Hypotension) Negative Chronotropic effects may induce hyperglycemia
What are the side effects of CCB?
hypokalemia, ototoxicity, hypotension, dehydration, hyperglycemia
What are the side effects of Loop diuretics?
flushing (vasodilation) Pruitis (itchy skin) Nausea
What are the side effects of Nicotinic Acid (Niacin)?
HF and pulmonary edema Electrolyte imbalances
What are the side effects of Osmotic Diuretic?
Sudden occlusion of coronary artery Abrupt cessation of blood and oxygen flow to the heart muscle
What can cause an MI?
Stress, fatigue, caffeine, tobacco, alcohol, hypoxia, electrolyte imbalance, disease states
What causes Premature Atrial Contraction?
Heart disease, breathing pattern
What causes Sinus Arrhythmia?
Vagal Stimulation MI Hypoxia digitalis toxicity well trained athletes
What causes Sinus Bradycardia?
Atropine, emotions, pulmonary embolus, MI, CHF, Fever, Vagus nerve inhibition, thyrotoxicosis
What causes Sinus Tachycardia?
Atrial cells
What cells over power the SA node and sends the message fast?
Phosphodiesterase Inhibitors
What class does Milrinone belong to?
Blood pressure changes from 154/90 to 126/72
What client response indicates to the nurse that a vasodilator medication is effective?
Thrombus formation, stroke
What complication can come from Atrial Fibrillation?
Pericardial Effusion and Cardiac Tamponade
What complications can arise from Pericarditis?
decrease perfusion, HTN, angina, MI
What complications can come from Coronary Artery Disease?
Drug abuse Ischemia Infection Alcohol
What could be a cause of secondary cardiomyopathy?
CHF, COPD, asthma
What disease are BB contraindicated w/?
decrease afterload decrease blood pressure increase cardiac output increase perfusion and fluid loss Relieve dyspnea
What do Vasodilators do?
decrease fluid volume decrease preload decreased PVP Relieve edema
What do all diuretics do ?
Some degree of diastolic HF
What do pt. with Systolic HF develop overtime?
Shock
What does Acute Aortic Regurgitation cause?
full blown pulmonary edema Shock
What does Acute Mitral Valve Regurgitation lead to?
Aspirin/antianginals/ACE BB/Blood pressure Cholesterol/Cigarettes'/CCB Diet/Diabetes Education/Exercise Flu Vaccine
What does the ABCDEF management of angina stand for?
P- Precipitating events Q- Quality of pain R- Radiating pain S- Severity of pain T- Timing
What does the PQRST assessment of angina stand for?
Admin Oxygen Vitals 12 lead EKG Pain relief (Nitrate + Morphine)
What does the acute intervention of angina care consist of?
activate emergency response, administer CPR, defibrillate and admin oxygen as ordered
What does the nurse do when a patient is having ventricular fibrillation?
Reduction in BB Negative Inotropic/Chronotropic
What does the reduction in renin activity caused by BB result in?
Atrial Fibrillation
What dysrhythmia is someone with severe mitral regurgitation at risk for?
Tablet, SL, Spray, Ointment, patch, IV
What forms for Nitrates/Nitrites come in?
New vessels are generated when there is chronic ischemia
What happens during collateral circulation?
can cause an acute obstruction (heart attack) to happen suddenly
What happens to the platelets in CAD?
The ventricle changes shape decreasing its effectiveness as a pump
What happens to the ventricle as it remodels?
Slows transmission
What happens when the AV node has problems?
Blood flows backward from the aorta into the left ventricle
What happens with Aortic regurgitation?
pericarditis
What has multiple organisms and it's complications can come from MI or chest trauma?
-blocks vasoconstriction -may cause syncope
What is Alpha Meds Action?
stretching of the medial wall of an artery caused by vessel weakness
What is Aortic Aneurysm?
multiple depolarizations from the atrium occur in a disorganized way causing the atria to quiver
What is Atrial Fibrillation?
shows protein released from necrotic heart muscle
What is CPK-MB?
narrowing or obstruction of a coronary artery due to plaque buildup/atherosclerosis
What is Coronary Artery Disease?
the heart can no longer pump enough blood to perfuse the tissue adequately
What is Heart Failure?
The breakdown of protein
What is Homocysteine produced by?
cardiac tissue no longer has oxygen supply which can lead to necrosis
What is Myocardial Infarction?
Potent Vasodilator
What is Nesteride?
Aldosterone
What is Potassium Sparing Diuretic Chem Class?
Cor Pulmonale
What is Right Sided HF called when it is caused by COPD?
NSTEMI
What is a partial occlusion with Unstable Angina called?
Heart Transplant
What is a possible treatment for Restrictive CMO?
Myectomy - take out some of the thickened septum
What is a surgical treatment for Hypertrophic CMO?
thickened toe nails
What is an assessment finding associated with PAD>
increased demand for oxygen and decreased supply of oxygen
What is angina due to?
SVT
What is another name for Atrial Tachycardia?
Holosytolic or Pansystolic murmur (flat murmur)
What is another name for Mitral Regurgitation?
reduced cardiac output and tissue perfusion usually caused by a coronary artery blockage
What is cardiogenic shock?
the ventricle does not fill properly
What is diastolic HF (filling)?
Atropine, this is an anticholenergic
What is given to pts with bradycardia?
quivering (its always irreg.)
What is happening to the Atrium in Atrial Fibrillation?
Mid systolic click
What is heard with Mitral Valve Prolapse?
CAD, Heart Failure, Stroke, Renal Failure
What is hypertension a risk factor for?
cardiac muscle is stiff and resist filling so high pressure is mandated to fill the ventricles
What is restrictive CMO?
fluid backs up into the venous system
What is right ventricle failure?
Premature Atrial Contraction (PAC) (not much blood pumping, heart squeezes and nothing comes out) caused by stimulants "skips a beat"
What is sinus tachycardia with PACs?
Microwaves
What is something people with an implantable defibrillator must avoid that people with a pacemaker do not need to avoid?
preload, afterload, contractility
What is stroke volumes 3 factors?
the ventricle does not eject properly
What is systolic HF (ejection)?
contracting ventricles
What is systolic blood pressure?
Arrhythmias (PVC, V-Fib)
What is the #1 Complication of MI?
Pain - worse than angina
What is the #1 symptom of MI?
BP= HR x SV x TPR Blood pressure = Cardiac output x systemic vascular resistance
What is the BP equation?
Affects the early distal convoluted tubule Blocks chloride and Na reabsorption Works when there is no Renal impairment
What is the action for Thiazide Diuretics?
Block alpha receptors in vascular smooth muscle decreasing vasomotor tone and vasoconstriction
What is the action of Alpha adrenergic blockers?
-reduction in renin activity (Renin reduces BP, while aldosterone hold onto sodium and water) -Negative Inotropic and Chronotropic effects (reduce squeeze of heart, reduce HR)
What is the action of BB?
Decrease the effects of sympathetic nervous system + reduction in Renin activity
What is the action of BB?
-Negative inotropic and negative chronotropic effect (decrease squeeze of heart and decrease HR) -vasodilates and relaxation of smooth muscle (antianginal med)
What is the action of CCB?
Inhibit the flow of Ca ions across the cell membrane of vascular tissue and cardiac cells (Vasodilation)
What is the action of CCB?
Positive inotropic (increase the squeeze) Negative chronotropic (decrease HR)
What is the action of Cardiac Glycosides?
Increase contractility Decrease afterload Increases CO Increase O2 demand
What is the action of Dobutamine?
decreases triglycerides (stimulate fatty acid)
What is the action of Fibric Acid Derivatives?
-blocks sodium and water in the loop of kidney -increases GFR and decreasing PVR -used in drug overdose -Loops get immediate reactions, NOT Thiazide
What is the action of Loop Diuretics?
peripheral vasodilation increases HDL
What is the action of Nicotinic Acid (Niacin)?
Lowers most lipoproteins Increases HDL Causes peripheral vasodilation
What is the action of Nicotinic acid?
dilated coronary arteries and systemic blood vessels which increases blood flow
What is the action of Nitrates/Nitrites?
vasodilation decrease workload, preload and afterload decrease oxygen demand
What is the action of Nitrates?
increase in serum osmolality and draw fluids into vascular extravascular space
What is the action of Osmotic Diuretic?
Direct on vascular smooth muscles of arteries
What is the action of Peripheral Vasodilators?
Blocks aldosterone which results in Na+ and H2O secretion
What is the action of Potassium Sparing Diuretic?
Increased urinary excretion of Na and H2O by inhibiting Na reabsorption
What is the action of Thiazide Diuretics?
inhibits Aldosterone, sodium is excreted in exchange for potassium
What is the action of a Potassium Sparing Diuretic?
Blocks sodium and water reabsorption, rapid volume depletion
What is the action of a loop Diuretic?
Blocks conversion of Angiotensin I to angiotensin II preventing vasoconstriction
What is the action of an ACE Inhibitor?
Block the effect of angiotensin II on receptors preventing the vasoconstriction and Na & H2O retention
What is the action of an ARB?
Prevent or disrupt aggregation
What is the action of antiplatelets?
Decreased CO
What is the adverse effect of Sinus Tachycardia?
Death is untreated
What is the adverse effect of Ventricular Fibrillation?
elevated blood cells of this protein may be predictive of Coronary heart Disease
What is the benefit of CRP?
Cardiac Tamponade has a narrowed pulse, muffled heart tones and pulses paradoxus Pericardial Effusion has muffle tones
What is the difference between Pericardial Effusion and Cardiac Tamponade?
• cardioversion is timed, defibrillation is not • cardioversion is synchronized • pt is already unconscious when defibrillated • pt is sedated for a cardioversion
What is the difference between defibrillation and cardioversion?
Pulmonic does not radiate to the neck and carotid and Aortic does. Pulmonic is heard in pulm area. Aortic is heard in Aortic area.
What is the difference between the Systolic murmurs Aortic and Pulmonic Stenosis?
Biological- doesn't last as long and doesn't need anticoagulants Mechanical- need anticoagulants for life and long lasting
What is the difference of Biologic and Mechanical Valve replacement types?
ACE Inhibitors
What is the drug of choice for CHF?
Slows HR Decreases Oxygen demand Increases perfusion time during diastole
What is the effect of CCB post MI?
scars the leaflets
What is the effect of Mitral Valve Stenosis?
The heart failure worsens
What is the end effect of the R-A-A and SNS systems with CHF?
improve ventricular pumping reduce the workload of the heart
What is the goal of care for Pulmonary Edema?
described as a mid-systolic click
What is the late systolic click described as?
2g/day or less
What is the limit salt intake for HTN?
Hypertrophic
What is the main CMO associated with Diastolic HF?
Dilated CMO
What is the main CMO that leads to Systolic HF?
Hypertension
What is the main cause of Diastolic HF?
Do not stop abruptly
What is the major consideration for BB?
Beta blockers Antidysrhythmic agents ICD, dual chamber pacing
What is the management of Hypertrophic CMO?
exercise restriction no tx except to improve diastole filling time
What is the management of Restrictive CMO?
-ICD (implantable cardioverter defibrillator) -transplant list -CPR teaching -life vest -anti-arrhythmic meds (amiodarone)
What is the management of SCD (Sudden Cardiac Death-walking ticking time bomb)
implantable cardioverter defibrillator (ICD) Cardiac transplantation Encourage family to learn CPR
What is the management of dilated CMO?
assess the pain using PQRST
What is the most appropriate initial action for a patient with chronic stable angina having CP?
Spironolactone
What is the most common Potassium Sparing Diuretic?
Hypertrophic CMO
What is the most common cause of SCD( sudden cardiac death)?
Improve quality of life
What is the most important goal of caring for a pt. with heart failure?
Impaired relaxation, decrease filling, decreased CO, left ventricular asymmetric
What is the patho for Hypertrophic CMO?
diffuse inflammation and rapid of heart fivers and ventricle dilates
What is the patho of Dilated CMO?
diuretics/digoxin Coumadin Prophylactic Antibiotics
What is the pharmacological treatment of Mitral Valve Stenosis?
Blood pressure
What is the priority assessment by the nurse caring for a patient receiving IV nesiritide (Natrecor) to treat heart failure?
increase contractility increase cardiac output increase HR and SV promote vaso dilation ex. digoxin mirione dobutamine
What is the purpose of Inotropes?
used to rapidly remove fluid to treat conditions such as Pulmonary edema, HF, CKD, of HTN
What is the purpose of Loop diuretics?
decrease anxiety decrease preload decrease afterload
What is the purpose of Morphine?
Prevents kidney failure Decreases ICP and intraocular pressure
What is the purpose of Osmotic Diuretic?
combined with loop diuretics to decrease K+ loss
What is the purpose of Potassium Sparing Diuretic?
Anticoagulation 2-3 weeks + cardioversion
What is the treatment for Atrial Fibrillation if the duration is >48 hours and non emergent?
DEFIBRILLATION + epinephrine/vasopressin
What is the treatment for Ventricular Fibrillation?
Treat the underlying cause
What is the treatment of Diastolic HF?
Vagal maneuvers CCB BB Amiodarone Oxygen Cardioversion -> ablation
What is the treatment of Paroxysmal Atrial Tachycardia?
supplement K oxygen amiodarone procainamide
What is the treatment of Premature Ventricle Contraction?
defibrillation
What is the treatment of choice for VF or VT?
Dilated CMO HF Atrial Dysrthymias
What is treated with Cardiac Glycosides?
Grapefruit juice
What juice must you avoid with Potassium Channel Blockers?
Pericardium
What kind of fibroserous sac is the heart covered in?
ER (enter coated)
What kind of pill does ASA come in?
ESR CRP TEE CXR Vegetations
What labs are done to dx Infective Endocarditis?
orthostatic hypotension reflex stimulation of the heart (tachycardia/palpitations)
What may vasodilation caused by alpha adrenergic blockers result in?
Anticholinergics (Atropine)
What med can cause tachycardia and would be used in a patient with bradycardia?
BB Prophylactic antibiotics
What med is used for Mitral Valve Prolapse?
Morphine to blunt the SNS response and decreased afterload
What med is used with Flash Pulmonary Edema?
Potassium Channel Blockers
What medication do you try to sedate the patient if have time to?
Antiplatelets
What medication helps blood to flow better?
Loop diuretics
What medication is given with HR?
HMG-CoA Reductase Inhibitors (Statins) Fibric Acid
What medication is known as Antilipidemics?
Nicotinic Acid (Niacin)
What medication is known as Vitamin B3(water soluble vitamin)?
Statins and Fibric Acid
What medications are often used together to treat CAD?
atorvastatin, simvastatin, rosuvastatin
What meds are Statins?
Diogoxin Dobutamine
What meds are considered positive inotropes?
BB CCB Anticoagulants Antiplatelets Glycoprotein IIB/IIIA Inhibitors
What meds are used Post MI?
Digoxin, Diuretics, Anticoagulants, Nitrates, BB
What meds are used for Aortic Regurgitation?
Lipid lowering agents Antiplatelets
What meds are used for CAD?
HMG-CoA Reductase inhibitors Bile Acid Sequestrates Folic Acid Derivatives Nicotinic Acid Estrogens
What meds are used for Cholesterol?
Cardiac Glycosides Loop Diuretic Potassium Sparing Diuretic Inotropes and Sympathomimetics Natriuretic Peptides Dopamine Agonist
What meds are used for Congestive Heart Failure?
Nitrates/Nitrites AntiplateletsAnticoagulants Thrombolytics
What meds are used for Coronary Artery Disease?
BB and CCB, anticoagulant therapy
What meds are used to treat Hypertrophic CMO?
Digitalis, CCB, BB, amiodarone, adenosine, oxygen
What meds are used to treat Paroxysmal Atrial Tachycardia?
antihypertensive- monitor closely for hypotension NSAIDS- decrease blood flow to kidneys which decreases diuretics' effetcs
What meds can interact with Loop diuretics?
BB or Verapamil
What meds may be used to treat Sinus Tachycardia?
Diltiazem Verapamil
What meds of CCB are antidysthmthics?
Nitrates Digoxin Diuretics ACE Diet Antidysrhythmic Anticoagulant's
What meds to use for dilated CMO?
there must be a critical deficit of blood supply to the heart in proportion to the demands placed on it
What must happen for a symptom of CAD to develop?
V Fib
What never has a pulse and pt is always unconscious?
heart pumping function decreases
What occurs after several minutes of myocardial ischemia?
Formation of localized necrotic areas
What occurs during an MI?
Hearing loss
What occurs if IV Furosemide (Lasix) is given too quickly?
Get Mitral valve Regurgitation
What occurs when Papillary Muscle Dysfunction/Rupture is a complication?
Sitting and leaning forward
What position should the nurse place the patient in to auscultate for signs of acute pericarditis?
any rate
What rate can Premature Ventricle Contraction occur at?
hypertrophy Decreased CO Pulmonary HTN
What results from Aortic Stenosis?
Decrease workload of LV Decreased preload/afterload Decrease myocardial oxygen demand
What results from the action of Nitrates/Nitrites?
LDL and VLDL
What serum levels does Alpha Adrenergic blockers reduce?
monitor V/s, check peripheral pulses, assess for abdominal tenderness, ask pt if abdominal or back pain is present
What should a nurse do for a patient with Aortic Aneurysm?
call the doctor
What should be done if the 3 rounds of Nitroglycerin does not relive the CP?
Record accurate weight for accurate dosing
What should be done prior to admin of Dobutamine?
HYPOkalemia HYPERglycemia HYPERuricemia
What should be monitored when on Loop Diuretics?
educate about decreasing kcal/fat, increase fiber diet and exercise
What should the nurse do to a patient with Coronary Artery Disease?
educate about a low sodium low fat diet instruct the client to weigh themselves daily and report changes of more than 2lbs educate about fluid restriction and safe exercise
What should the nurse do to a patient with HF?
Hypotension and tachycardia
What should the nurse recognize as an indication for the use of dopamine in the care of a patient with heart failure?
Blood clots causing stroke or PE
What should you be concerned about in a patient with Afib?
eat foods high in K restrict Na intake Report Tinnitus (ringing in the ears) Monitor K, Na, Ca, and Mg
What should you teach a patient taking Loop?
Preload
What stroke volume factor is the Starling Law and stretch of the ventricles?
The exchange of cellular nutrients and metabolic end products
What takes place in the capillaries?
eat foods with HIGH potassium restrict sodium take early to avoid nocturia change positions slowly
What to teach while taking Thiazides?
V-Tach or V-Fib (ventricular dysrhythmias)
What two arrhythmias are risk factors for Sudden Cardiac Death?
the inner (visceral) layer the outer (parietal) layer
What two layers does the pericardium consist of?
R-A-A SNS
What two systems activate in response to hemodynamic instability?
Thoracic
What type of aneurysm is associated with the possible symptom of hoarseness?
Diastolic
What type of murmur is heard with Aortic Regurgitation?
R wave
What wave should you shock the person doing Cardioversion?
always having a risk to catching it again because they still have the endothelial damage
What will a patient always be at risk for when having IE (Infective Endocarditis)?
assess O2 Sats, monitor anticoag. and electrolytes as ordered
What would the nurse do for a patient with premature ventricular contraction?
Same throughout except it does not radiate to axilla
What's the difference between Mitral and Tricuspid Regurgitation?
Increase the quantity of complex carbohydrates. The fiber component of complex carbohydrates helps bind and eliminate dietary cholesterol and fosters growth of intestinal microorganisms to break down bile salts and release the cholesterol component for excretion. It is what, not when, the client eats that is important. Saturated fats should be decreased. Fat-binding fiber should be increased.
When a client is at high risk for heart disease, which instruction would the nurse include in the teaching plan? Avoid eating between meals. Limit unsaturated fats in the diet. Decrease the amount of fat-binding fiber. Increase the quantity of complex carbohydrates.
Daily iron supplement The nurse would question the use of iron supplements in sickle cell anemia because sickle cell disease is not caused by iron deficiency. In addition, many clients with sickle cell anemia receive blood transfusions and iron toxicity can develop secondary to frequent transfusions.
When a client who has sickle cell anemia has been admitted with acute chest syndrome, which prescribed treatment would the nurse question?
"The ECG will show if there has been damage to the heart muscle."
When a client with a possible past history of myocardial infarction has an electrocardiogram (ECG) prescribed and asks the nurse the purpose of the ECG, which response by the nurse is accurate?
ST-segment depression
When a client with chest pain is having an exercise electrocardiogram (ECG), which finding by the nurse would require the most rapid action?
barareceptors that inhibit the sympathetic nervous system, causing vasodilation
When a person's blood pressure rises, the homeostatic mechanism to compensate for an elevation involves stimulation of
Dependent edema in the evening Decreased cardiac output causes fluid retention, which results in dependent edema; this is often noticed in the evening after the client has been standing or sitting for prolonged periods
When assessing a client with chronic heart failure, which clinical finding would the nurse expect to find?
difficulty in isolating the apical pulse.
When assessing the cardiovascular system of a 79-year-old patient, you may expect to find
Change in level of consciousness A normal sodium level is between 135 and 145 mEq/L (135-145 mmol/L) of sodium. As sodium levels drop below 140 mEq/L, symptoms reflect cellular overhydration, which results from water movement from the relatively hypotonic serum into cells. Symptoms affect primarily the central nervous system (CNS) and musculoskeletal systems. CNS effects range from headache, fatigue, and anorexia to lethargy, confusion, disorientation, agitation, vomiting, seizures, and coma. Musculoskeletal symptoms may include cramps and weakness. Vital signs will reflect an increased, weak, thready pulse, shallow respirations, and a low urine output.
When caring for a client who has hyponatremia, the nurse would monitor for which symptom?
Rectal suppository as needed for constipation Rectal stimulation can stimulate the vagus nerve and cause bradycardia and is avoided in clients who have had myocardial infarction.
When caring for a client who is hospitalized for an acute myocardial infarction, which prescription by the health care provider would the nurse question?
Elevated serum troponins I and T Elevations of troponin I and T levels are indicative and specific for cardiac muscle damage as would occur with STEMI.
When caring for a client who presents to the emergency department with an ST-segment-elevation myocardial infarction (STEMI), which laboratory result will the nurse expect?
b. Smoking history c. Religious preference d. Number of pillows used to sleep
When collecting subjective data related to the cardiovascular system, which information should be obtained from the patient (select all that apply)?
Decompensated HF
When compensatory mechanisms don't work together to keep adequate CO =
Compensated HF
When compensatory mechanisms work to keep adequate CO=
Unexplainable profuse diaphoresis Indigestion not relieved by antacids Acute chest pain after rigorous exercise Continued chest pain after nitroglycerin use
When discharging a client who has had insertion of a coronary artery stent, the nurse will instruct the client to seek immediate medical attention for which signs and symptoms?
Creatinine clearance less than 30
When do Thiazide diuretics become ineffective?
BP less than 90/60
When do we hold CCB?
If they are not able to take an ACE
When does a pt. with Systolic HF get place on an ARB?
when they are symptomatic
When is treatment required for Sinus Bradycardia?
Restrict sodium intake.
When teaching a patient about dietary management of stage 1 hypertension, which instruction is appropriate?
valvular heart disease.
When teaching a patient about the long-term consequences of rheumatic fever, the nurse should discuss the possibility of
It is very important that you stop smoking cigarettes
When teaching a patient newly diagnosed with PAD, what instructions should the nurse include?
Inhibits conversion of angiotensin I to angiotensin II.
When teaching how lisinopril (Zestril) will help lower the patient's blood pressure, which mechanism of action should the nurse explain?
QRS duration of 0.28 seconds Widening of the Q waves is a potentially fatal manifestation of hyperkalemia (because it may lead to cardiac arrest) and would be communicated rapidly to the health care provider so that the infusion can be stopped and the potassium level can be rechecked. U waves are an expected manifestation of hypokalemia because of changes in ventricular repolarization. Decreased bowel sounds may occur because of decreased peristalsis caused by low potassium levels but should improve with potassium administration.
When the nurse is administering intravenous potassium to a client with hypokalemia, which finding is most important to communicate to the health care provider
one of the 3 layers of the arteries called intima
Where does Atherosclerosis happen at?
Back into the Left Atrium
Where does Blood go with Mitral Valve Regurgitation?
axilla
Where does Mitral Regurgitation murmur radiate to?
backs up into the pulmonary system
Where does blood go in Left Sided HF?
in the LV @ the end of systole
Where does blood stay with systolic HF?
S1 all the way through S2
Where does the murmur in Mitral Regurgitation occur at?
Mitral or Apex area
Where is Mitral Regurgitation best heard at?
Apex heard as a rumbling sound
Where is Mitral Stenosis best heard at?
within the thorax in the mediastinal space that separates the right and left pleural cavities.
Where is the heart located?
OS (opening snap) "mid-diastolic rumble" and Apex
Where is the murmur Mitral Stenosis heard at?
non-ejection click ( late systolic click)
Where is the murmur heard in Mitral Valve Prolapse
Carvedilol
Which Alpha Adrenergic blocker is also a beta blocker?
release of norepinephrine stimulation of the SNS activation of the renin-angiotensin aldosterone system
Which BP- regulating mechanisms can result in the development of hypertension if defective?
hydrolazine, magnesium sulfate
Which Peripheral Vasodilator has a side effect of Lupus-like syndrome?
nurse ejects the air bubble from the syringe before administeration
Which action by a new nurse giving Enoxaparin indicates need for more teaching?
Set synchronizer switch on defibrillator to the "on" position.
Which action by the nurse is most important when preparing for cardioversion of a client with atrial fibrillation?
Palpate the radial pulse while auscultating the apical pulse.
Which action should the nurse implement with auscultation during a patient's cardiovascular assessment?
Obtain the transcutaneous pacemaker
Which action would the nurse anticipate taking when a client develops third degree atrioventricular block with a heart rate of 30 beats/minute?
Have the client sit down and rest
Which action would the nurse take first when a client who has heart failure reports fatigue and has an increase in heart rate from 90 beats/minute to 120 beats/minute while ambulating?
Assist the client to sit on the edge of the bed. Because PND is caused by reabsorption of fluid from dependent body areas when the client lies flat, sitting on the edge of the bed will decrease venous return and improve the ability to take deep breaths. The oxygen saturation level would be assessed, but the first action would be to relieve the dyspnea by helping the client sit up.
Which action would the nurse take first when a client with heart failure has an episode of paroxysmal nocturnal dyspnea (PND)?
Obtain the client's blood pressure.
Which action would the nurse take next after observing this rhythm in a client who came to the emergency department after experiencing "skipped heartbeats"?
Niacin Ezetimibe (Zetia) Gemfibrozil (Lopid) Atorvastatin (Lipitor)
Which antilipemic medications should the nurse question for a patient who has cirrhosis of the liver? (Select all that apply.)
Fatigue may be the first symptom.
Which assessment finding should be considered when caring for a woman with suspected coronary artery disease?
Shortness of breath on minimal exertion and a diastolic murmur
Which clinical finding would most likely indicate decreased cardiac output in a patient with aortic valve regurgitation?
Cardiac rhythm
Which clinical parameter will be most important for the nurse to assess when administering warmed intravenous fluids to a client with hypothermia?
12-lead electrocardiogram (ECG)
Which diagnostic test is most important to obtain rapidly when caring for a client who has just arrived in the emergency department with possible acute coronary syndrome (ACS)?
Serum potassium Large U waves suggest possible hypokalemia, which should be corrected to decrease dysrhythmia risk.
Which diagnostic test result will the nurse review after noticing large U waves on the electrocardiogram (ECG) for a client who was just admitted to the cardiac unit?
Hamburger with bun, lettuce, and tomato
Which diet choice by a client who has been prescribed a 2-g sodium diet indicates that diet teaching has been effective?
Alteplase
Which drug breaks up the fibrin mesh work in the clots?
Client report of feeling very thirsty
Which finding by the nurse who is caring for a client after major abdominal surgery may indicate impending hypovolemic shock? Urine output 1000 mL in 8 hours Oral temperature 101°F (38.3°C) Client report of feeling very thirsty Bounding radial and femoral pulses
Right arm weakness
Which finding for a client who has a diagnosis of paroxysmal atrial fibrillation is most important to report quickly to the health care provider?
irregular heart rate
Which finding for a client who has a potassium level of 2.8 mEq/L (2.8 mmol/L) would be of most concern to the nurse?
Angina episodes are occurring more frequently
Which finding in a client with a diagnosis of stable angina is most important for the nurse to communicate to the health care provider?
Cool skin temperature
Which finding will the nurse expect when caring for a client who is in hypovolemic shock? Slow heart rate Cool skin temperature Bounding radial pulses Increased urine output
Pulsus paradoxus Muffled heart sounds Jugular vein distention
Which findings will cause the nurse to suspect cardiac tamponade in a client who has had cardiac surgery?
Tofu Walnuts Tuna fish
Which foods would the nurse encourage patients at risk for coronary artery disease (CAD) to include in their diets? (Select all that apply.)
Systolic blood pressure increases with aging. White coat syndrome is prevalent in older patients. Volume depletion contributes to orthostatic hypotension. Blood pressures should be maintained near 120/80 mm Hg. Blood pressure drops 1 hour after eating in many older patients.
Which information should the nurse consider when planning care for older adult patients with hypertension? (Select all that apply.)
Mild sedation is maintained during the procedure
Which information would the nurse include in the preprocedure teaching for a client who requires emergency cardiac catheterization?
Administration of antibiotics as ordered
Which is a priority nursing intervention for a patient during the acute phase of rheumatic fever?
blood counts
Which lab test is most important to assess prior to a CABG?
Activated partial thromboplastin time (APTT) is 70 seconds
Which laboratory value would the nurse use to determine whether a client is receiving a therapeutic dose of intravenous heparin?
Ezetimibe
Which med inhibits the absorption of Cholesterol?
Beta blocker Beta blockers reduce cardiac output and are contraindicated for clients with acute heart failure, although they are frequently used to prevent progression of chronic heart failure. Diuretics are used in acute heart failure to decrease hypervolemia and congestion. Long-acting nitrates are used in heart failure to reduce preload. Angiotensin receptor blockers are used in heart failure to decrease fluid overload and afterload.
Which medication prescribed for a client with an acute episode of heart failure would the nurse question?
Thiazide Diuretics CCB BB ACE inhibitors ARB Peripheral Vasodilators Alpha-adrenergic blockers Centrally acting sympathomimetics
Which meds are used to treat HTN?
BNP
Which natriuretic peptide is released from the ventricles?
monitoring vital signs ans ECG checking the cath insertion site and distal pulses
Which nursing responsibilities are priorities when caring for a patient returning from a cardiac cath?
a. Monitoring vital signs and ECG b. Checking the catheter insertion site and distal pulses
Which nursing responsibilities are priorities when caring for a patient returning from a cardiac catheterization (select all that apply)?
NSTEMI
Which one is worse: STEMI or NSTEMI?
A 52-yr-old black man with left ventricular failure
Which patient is at greatest risk for sudden cardiac death (SCD)?
a. A hypertensive patient who smokes cigarettes
Which patient is most at risk for developing coronary artery disease? a. A hypertensive patient who smokes cigarettes b. An overweight patient who uses smokeless tobacco c. A patient who has diabetes and uses methamphetamines d. A sedentary patient who has elevated homocysteine levels
Release of aldosterone Activation of angiotensin II Sympathetic nervous system activation
Which physiological factors help maintain blood pressure in the client with hypovolemia?
Incomplete closure of the valve leaflets and backward flow of blood Regurgitation involves incomplete closure of the valve leaflets; this results in a backflow of blood.
Which statement best describes the pathophysiological changes associated with valvular regurgitation? Pressure changes on the pulmonary side of the valve Dysfunction of the left ventricle and decreased cardiac output Incomplete closure of the valve leaflets and backward flow of blood Narrowing of the space between the valves and impeded blood flow
smoking hx religion preference number of pillows used for sleep
Which subjective data related to the Cardio system should be obtained from the patient?
measure the radial and apical pulse together
Which technique would the nurse use to detect a pulse defect?
Automaticity
Which term is used for the property of heart cells to initiate an impulse spontaneously and continuously?
hemorrhagic shock
Which type of shock would the nurse suspect when a client is admitted to the emergency department after a motor vehicle accident with abdominal pain, a blood pressure decrease from 120/76 mm Hg to 60/40 mm Hg, and a heart rate increase from 82 beats/minute to 121 beats/minute?
Hemolytic
While receiving a blood transfusion, a client develops flank pain, chills, fever, and hematuria. What type of transfusion reaction does the nurse conclude that the client probably is experiencing?
Notify the surgeon immediately.
While waiting in the preoperative holding area for endovascular repair of an abdominal aortic aneurysm, a client suddenly reports lightheadedness and blood pressure drops. Which action would the nurse take first?
prevention of rheumatic fever and infective endocarditis
Why are antibiotics used to treat Aortic Regurgitation?
Prevent extension of clot and stop formation of new clots
Why are anticoagulants used post MI?
Inhibits platelet aggregation
Why are antiplatelets used post MI?
They are long lasting
Why are mechanical valves preferred over biologic valves?
Reducing tachy can get a rebound tachy if the med is stopped quick
Why do we not stop BB abruptly?
The increased pressure forced the capillary to move fluid into the tissue and alveoli
Why does Pulmonary congestion or edema result from Left Sided HF?
Prevents fibrinogen from binding to platelets
Why is Glycoprotein IIB/IIIA used post MI?
it connects to cholesterol and pushes it to the artery (building blockages)
Why is LDL the bad one?
Most sensitive to detect very small infarcts Faster results than CPK-MB
Why is Troponin preferred over CPK-MB?
because it drys you out, that increases the HR
Why is a pt with bradycardia given an anticholenergic?
Maintain open vessels Capillary Perfusion Oxygenation of all body tissues
Why is blood pressure necessary?
flu virus can cause exacerbation of heart attack because its an infection. flu can trigger blockage for heart attack
Why is the flu vaccine(primary prevention) recommended for a patient to take with heart problems?
cold water might cause vasoconstriction therapy (what we want bc Niacin causes vasodilation)
Why should Nicotinic Acid (Niacin) by taken with cold water?
Infiltration can cause sloughing of the skin
Why should the IV site for Dopamine be monitored?
may indicate edema or onset of CHF
Why should the client report gradual weight gain when taking CCB?
WBC elevated CRP/ESR elevated Trop increased
With Pericarditis, what will you see in a blood cx?
rapid
With ___________ onset CAD or spasm, there is NO TIME to develop collaterals = reduced coronary blood flow = infarction/ischemia
Early
_________ cardiac signs appear 7 to 10 days after viral infection and include pleuritic chest pain with a pericardial friction rub and effusion.
• Primary (essential or idiopathic)
_________ hypertension is elevated BP without an identified cause. It accounts for 90% to 95% of all cases of hypertension
Hypertension
_________ increases the risk of CAD, stroke, peripheral vascular disease, heart failure, and death.
Hypertensive crisis
_________ is a term used to indicate either a hypertensive urgency or emergency. Diagnosis is determined by the presence of target organ disease and the type of treatment the patient will receive.
Atherosclerosis
_________ is characterized by lipid deposits within the intimal wall of an artery.
• Secondary hypertension
_________ is elevated BP with a specific cause. It accounts for 5% to 10% of hypertension in adults
Resistant hypertension
_________ is the failure to reach goal BP in patients who are adhering to full doses of an appropriate 3-drug therapy regimen that includes a diuretic.
Lipid profiles
_________ provide information about risk factors that predispose to atherosclerosis and cardiovascular disease.
• Dual antiplatelet
_________ therapy should continue for 1 year after an MI whether the patient receives a stent or not.
Aldosterone
__________ antagonists reduce mortality and hospitalization in patients with HFrEF.
Valvular rigidity
__________ may present with a systolic murmur (aortic or mitral) possible without a sign of CVD.
ACE inhibitors
__________ result in vasodilation and decreased blood volume as well as reduction in the risk of MI, stroke, and death. They have a role in limiting ventricular remodeling in patients who have had a myocardial infarction (MI)
• Ivabradine,
__________, a sinus node inhibitor, can decrease hospitalizations in patients with HFrEF who have a HR > 70 bpm in sinus rhythm and continue to be symptomatic despite optimal doses of other evidence-based medications.
Preload
___________ = the stretch of the heart, which is influenced by ventricular compliance and volume of blood
Type I
___________ AV block is usually a result of myocardial ischemia or inferior MI. It is almost always transient and usually well tolerated. However, it may be a warning signal of a more serious AV conduction problem.
Vegetation
___________ adheres to the valve surface or endocardium and can embolize to various organs and to the extremities, causing ischemia and infarction.
Ventricular tachycardia and ventricular fibrillation
___________ and ____________ the most common cause of death for patients in the prehospital period.
Short-acting nitrates
___________ are first-line therapy for the treatment of an acute episode of angina
Cardiac-specific troponin, copeptin, and creatine kinase (CK)-MB
___________ are sensitive indicators of early myocardial injury and infarction.
Calcium channel blockers and/or nitrates
___________ are used to treat angina associated with coronary artery spasm.
Acute aortic valve regurgitation
___________ is caused by infective endocarditis (IE), trauma, or aortic dissection and constitutes a life-threatening emergency.
• Acute coronary syndrome (ACS)
____________ develops when ischemia is prolonged and not immediately reversible. ACS includes the spectrum of non-ST elevation acute coronary syndrome (unstable angina and non-ST-segment-elevation myocardial infarction [NSTEMI]) and ST-segment-elevation myocardial infarction (STEMI).
• Mitral regurgitation (MR)
____________ is caused by MI, chronic rheumatic heart disease, mitral valve prolapse, ischemic papillary muscle dysfunction, and IE.
pericardial effusion
____________ is excess fluid where is doesn't belong, and it's manifestation is CP
Chronic aortic valve regurgitation
____________ is generally the result of chronic hypertension, rheumatic heart disease, a congenital bicuspid aortic valve, syphilis, or chronic arthritic conditions such as ankylosing spondylitis or reactive arthritis.
Cellular aging and fibrosis of conduction system
____________ may present with irregular cardiac rhythms, amplitude of QRS complex and slight lengthening of PR, QRS, and QT intervals; HR variability.
Anticoagulant therapy
____________ prevents and treats systemic or pulmonary embolization.
Valvular stenosis
____________ refers to a constriction or narrowing of the valve opening.
Immunosuppressive
____________ therapy to reduce myocardial inflammation and prevent irreversible myocardial damage may be considered.
Angiotensin-converting enzyme (ACE) inhibitors and -blockers
_____________ are used to manage chronic stable angina.
Angiotensin II receptor
_____________ blockers may be used in patients who are ACE inhibitor intolerant
• Infective endocarditis (IE)
_____________ is an infection of the endocardial surface of the heart that affects the heart valves
Rheumatic fever (RF)
_____________ is an inflammatory disease of the heart that occurs as a complication following group A streptococcal pharyngitis.
Nitroglycerin, morphine, and supplemental oxygen
_____________ should be given as needed to eliminate or reduce chest pain.
Cardiac resynchronization therapy (CRT)
______________ is a pacing technique that resynchronizes the cardiac cycle by pacing both ventricles, thus promoting improvement in ventricular function.
Percutaneous transluminal balloon valvuloplasty
______________ to split open the fused commissures is an alternative treatment for stenotic valvular heart disease.
• Sacubitril/valsartan,
_______________ a neprilysin-angiotensin receptor inhibitor, is an alternative to ACE inhibitors and ARBs in patients meeting criteria with symptomatic HFrEF to reduce CV death and hospitalization.
Calcium channel blockers
_______________ can be used if patients are intolerant of -blockers
• Premature ventricular contraction (PVC)
_______________ is the premature occurrence of a QRS complex, which is wide and distorted in shape compared with a QRS complex initiated from the normal conduction pathway.
Automatic external defibrillators
_________________ have rhythm detection capability and the ability to tell the operator to deliver a shock using hands-free defibrillator pads
Exercise or Stress Testing
various protocols are used to evaluate the effect of exercise tolerance on cardiovascular function. a common protocol uses 3-min stages at set speeds and elevation of the treadmill belt. the patient can exercise to either predicted peak HR (calculated by subtracting the person's age from 220) or to peak exercise tolerance, at which time the test is terminated. the test is also terminated for chest discomfort, significant increase or decrease in vital signs from baseline, or significant ECG changes indicating cardiac ischemia. vital signs and ECG are monitored. the ECG is monitored after exercise for rhythm disturbances or if ECG changes occurred with exercise, for return to baseline. continual monitoring of vital signs and ECG rhythms for ischemic changes is important in diagnosis of CAD. an exercise bike may be used if the patient is unable to walk on the treadmill. b-adreneric blockers may be held 24 hours before the test because they blunt the HR and limit the patient's ability to achieve maximal HR. caffeine-containing foods and fluids are held for 24 hr. patients must refrain from smoking and strenous exercise for 3 hr before test.
amiodarone
ventricular tachycardia; a medication such as __________ or synchronized cardioversion would be prescribed.
Grade 6 heart murmur
very loud can be heard without stethoscope
Grade 5 heart murmur
very loud, with stethoscope
Preload
volume of blood in ventricles at end of diastole
HR and/or SV
we can increase or decrease CO by increasing or decreasing _________, respectively
place on a cardiac monitor
what is the first action to be taken for a patient diagnosed with hyperkalemia?
Polymorphic ventricular tachycardia (Torsades de Pointes)
what is this image?
acute coronary syndrome (ACS)
when cells are injured, they release their contents, including enzymes and other proteins, into the circulation, called biomarkers. These biomarkers are useful in the diagnosis of ________
orthostatic hypotension
which complication would occur with a patient taking amitriptyline?
promotion of atherosclerosis and damage to the walls of the arteries
which mechanism of HTN causes target organ damage?
capillary vessels
which portion of the vascular system exchanges cellular nutrients and metabolic end products?
Roth's spots
white areas in the retina surrounded by areas of hemorrhage
Aveolar edema
worsening PaO2, acidosis, gas exchange
heart
β1 receptors are found in the ________
blood vessels, lungs, and liver.
β2 receptors are found in__________
anginal
• -blockers decrease myocardial contractility, heart rate, systemic vascular resistance, and BP, which reduce myocardial oxygen demand and relieve ___________ symptoms.
life.
• Aspirin should be continued for ___________
• 12-lead ECG to look for any changes that may show ACS • Laboratory tests (e.g., cardiac biomarkers) to identify if the patient is experiencing an ACS • Echocardiogram to look for resting left ventricular wall motion abnormalities • Exercise or pharmacologic stress test if the ECG and cardiac biomarkers are negative • Cardiac catheterization with possible balloon angioplasty and stent (percutaneous coronary intervention [PCI])
• Common diagnostic tests for a patient who describes chest pain or when a patient with chronic stable angina has a change in the anginal pattern include:
tissue perfusion.
• Compensated HF occurs when compensatory mechanisms support an adequate CO needed for ________
severe HF and renal insufficiency.
• Diet teaching and weight management are critical to the patient's control of chronic HF. Edema is often treated by restricting dietary sodium. Fluid restrictions are not often prescribed for the patient with mild to moderate HF. They may be used in _________
MAP.
• Hypertensive emergencies have evidence of target organ disease. It needs hospitalization with intensive care monitoring and the IV administration of antihypertensive drugs, including vasodilators, adrenergic inhibitors, ACE inhibitors, and/or calcium channel blockers. Drugs are titrated based on the ____
electrophysiology study (EPS)
• If no reversible cause of SCD is identified, an __________ may be done.
(1) manage blood pressure, (2) control cholesterol, (3) reduce blood sugar, (4) get active, (5) eat better, (6) lose weight, and (7) stop smoking. Other modifications by the taskforce on hypertension address sodium restrictions and alcohol intake.
• Lifestyle modifications are directed toward reducing the patient's BP and overall cardiovascular risk. The AHA's "Life's Simple 7" steps support ways to modify and improve health. These are:
high
• The definitive answer to distinguish between UA and NSTEMI comes from the cardiac biomarkers. They are ________ with an NSTEMI and normal with UA
diabetes, even those with well-controlled blood glucose levels.
• The incidence of CAD is 2 to 4 times greater among people who have ____________
Warfarin (decreases vitamin K) Dabigatran (direct thrombin inhibitor) Rivaroxaban (anti Xa) Apixaban (anti Xa)
What are the common oral anticoagulants?
Hemorrhage, hematuria, epistaxis, bleeding gums, thrombocytopenia
What are the common side effects of Anticoagulants?
HA, fatigue, constipation, postural hypotension
What are the common side effects of CCB?
Bruising, Hematuria, Tarry stools
What are the common side effects of antiplatelets?
Pleural Effusion Arrhythmias (lethal)
What are the complications of Flash Pulmonary edema?
Less effective in Black Clients Pregnancy
What are the contraindications for ACE Inhibitors?
liver disease and hypotension
What are the contraindications for Nicotinic Acid?
Bradydysrhythmias
What are the potential complications of Blocked Circumflex?
Bundle Branch Blocks Left Side Heart failure Rupture of Septum
What are the potential complications of Blocked LAD?
ACE inhibitors increase K+ Dont give to patient with severe kidney failure Use with caution in patient with liver disease or acidosis Salt Sub. increases K+ levels
What are the precautions with Potassium Sparing Diuretic?
stroke
What does Atrial Flutter increase the pt risk for?
Left sided heart failure
What does Dilated CMO look like?
Pre infarction or Crescendo
What does Unstable Angina indicate?
Greater damage to muscle (skeletal or cardio)
What does a high CPK level show?
there is an inflammatory process going on
What does an increase in ESR indicate?
w/ severe Left Ventricle Failure
What does flash pulmonary edema occur?
the amount of blood coming in, volume of blood like in diuretics, and HR
What does the preload effect?
Potassium ; Sodium ACE holds on to K a lot, so yes it blocks NA and H2O and then lets it go, but the K is retained bc of that and hyperkalemia can then occur
What electrolyte is held more in ACE? What electrolyte is lost of more?
Potassium and creatinine
What electrolytes should be monitored when on Potassium Sparing Diuretics?
emotionally stressing situation Intercourse Physical Exertion
What events require Nitro to be taken before?
Tablet or IV
What forms do BB come in?
HR (negative chromatropes) Apical pulse is listened to for 1 minute, if HR is less than 60, you will not give this med.
What is important to access with Cardiac Glycosides?
Auscultatory gap
What is important to assess for in the OA regarding BP?
Systolic clicks (murmur) opening snap (murmur) S3 (not murmur) S4 (not murmur)
What is known as extra heart sounds?
Left Atrium and Ventricle
What is overworked with Mitral Valve Regurgitation?
Left Atrium
What is overworked with Mitral Valve Stenosis?
Valve repair
What is preferred over surgical treatment of Aortic Regurgitation?
ventricles contract prematurely due to impulse initiation by purkinje fibers instead of the SA node
What is premature ventricular contraction?
Migraines Raynaud's Disease
What is prinzmetal angina frequently associated with?
when taking a deep breath, BP should increase, but instead a deep breath makes BP drop (causing no CO)
What is pulses paradoxus?
Anticoagulation therapy for life
What is required with mechanical valve replacement surgery?
HYPERkalemia; especially when taken with an ACE Inhibitor
What should be monitored when taking Spironolactone?
BP and HR; to prevent sudden hypotension
What should be monitored while on Peripheral Vasodilators? Why?
not to stop abruptly change positions slowly Hold if HR is less than 60
What should be taught with BB?
Diet should limit saturated fats and cholesterol and emphasize complex carbohydrates (e.g., whole grains, fruits, vegetables) and fiber.
What should the diet be for CAD?
administer O2, establish IV access, obtain EKG, administer thrombolytic therapy, assess pulses, monitor for blood pressure changes
What should the nurse do to a patient having a MI?
RAAS
What system is the ARBs medication in?
Mitral valve prolapse (MVP)
___________ is an abnormality of the mitral valve leaflets and the papillary muscles or chordae that allows the leaflets to prolapse, or buckle, back into the left atrium during systole. The cause of MVP is unknown.
Arterial stiffening
___________ may cause possible widened pulse pressure, pedal pulses diminished, and intermittent claudication.
• 12 lead ECG and echocardiography
___________ provide information about the heart status.
Radiofrequency catheter ablation
___________ therapy is used to destroy or ablate accessory pathways or ectopic sites in the atria, AV node, and ventricles.
Nitroglycerin (all forms)
What are the SHORT ACTING Nitrate meds for vasodilation?
inotropic
increase stroke volume and cardio output is a positive ______ effect
Angiotensin Receptor Blockers (ARBS)
-used for patients intolerant of ACE inhibitors -vasodilator
IV nitroglycerin
-vasodilates -reduces pain and improves coronary blood flow -monitor bp for HTN
administer O2 and anticoagulants as ordered. Educate pt about therapy
How would a nurse treat a patient with Atrial Fibrillation?
diuretic
Hydrocholorthiazide (thiazides) is a ____ and is mainly treated in Blacks; first line of tx for HTN
Mr. AS S Mitral Regurgitation (MR) Aortic Stenosis (AS)
What are the Systolic Heart murmurs?
prevent or delay blood coagulation
What are the actions of anticoagulants?
dizziness, pallor, weakness, syncope, diaphoresis, hypotension
What are the adverse effects of Sinus Bradycardia?
Streptokinase Alteplase Urokinase TNKase tPA
What are the common Thrombolytic medications?
Warfarin Dabigatran Rivaroxaban Heparin Enxoaparin
What are the common anticoagulant meds?
Acetylsalicylic Acid glycoproteins
What are the common antiplatelet meds?
Digoxin
What are the common med for Cardiac Glycosides?
Angiotensin Receptor Blockers (ARBs)
used for patients intolerant of ACE Inhibitors vasodilator what med am i?
6 minute walk test
used on patients who are unable to perform a treadmill or exercise bike testing.
Lovastatin Samvastatin Pravastatin Fluvastatin Atorvastatin Cerivastatin
What are the common HMG-CoA Reductase Inhibitor meds?
Butemide Etharcrynic acid Furosemide Torsemide
What are the common Loop Diuretic meds?
Niacin Niaspan ER
What are the common Nicotinic Acid meds?
B-adrenergic receptors
usually inhibitory, but does excite the cardiac muscle Vasodilation= decrease
Chlorothiazide (Diuril) Hydrochlorothiazide (Hyrodiuril) - most common Metolazone (Zaroxylin)
What are the common Thiazide Diuretic meds?
myocardial hypertrophy
-with age, the heart itself shows an increase in fibrous tissue and size. Atrophy of the cells of the conduction system results in the increased incidence of cardiac dysrhythmias.
QRS interval time
0.12
PR interval time
0.12-0.20
Angina, JVD, Tachycardia, Decreased Systolic BP, Increased Diastolic BP, S3 or S4, A-Fib
What are the cardiovascular manifestations associated with CHF?
heart disease and breathing problems
What are the causes caused from Sinus arrhythmias?
Stable angina
A patient reports during a routine check-up that he is experiencing chest pain and shortness of breath while performing activities. He states the pain goes away when he rests. This is known as:
trigger
Hypertension in genetics can result from a complex between genetic and environmental factors. Lifestyle choices (smoking, lack or exercises) may ______ genetic tendencies to hypertension
Regular but interrupted rhythm
No QRS EARLY BEAT
help pt to use a splint while coughing
Pt with surgical repair of AAA. Which nursing intervention is appropriate to delegate to UAP?
ST segment elevation
A patient reports having crushing chest pain that radiates to the jaw. You administer sublingual nitroglycerin and obtain a 12 lead EKG. Which of the following EKG findings confirms your suspicion of a possible myocardial infraction?
Marfan syndrome Acute aortic dissection
What are the causes of Aortic regurgitation?
ST-segment elevation develops on the ECG
A patient returns to the cardiac observation area following a cardiac catheterization with coronary angiography. Which assessment would require immediate action by the nurse?
Enoxaparin works right away while Warfarin takes several days to work
Pt with venous thromboembolism is started on Enoxaparin and Warfarin. Patient ask why two meds are necessary?
sinus arrthymia (no treatment)
QRS with respirations may indicate?
Na and water
R.A.A system, holds on to _________, more circulating SV
Hypoxia Profound cardiac or other damage
What are the causes of Asystole? (NO RATE)
B-type natriuretic peptide (BNP)
A patient who has a history of heart failure and chronic obstructive lung disease is admitted with severe dyspnea. Which value would the nurse expect to be elevated if the cause of dyspnea was cardiac related?
cardioselective β-blockers
Some β-blockers are referred to as _________ because they only block β1 receptors.
sudden cardiac death
-heart muscle thickens (example, athletes ) -hx of hypertrophic CMO -prolonged QT -Aortic stenosis -mostly seen in Blacks -LV dysfunction -V-tach or V-fib -AED is needed -high incidence of recurrence
RAAS (renin-angiotensin-aldosterone system)
-increase preload -Renin -hold on to Na and H2O
mechanical valve replacement
-long lasting -will require anticoagulation long term
sympathetic nervous system
-low pressure -SNS -increase workload (BB)
comes out
Stents will be there for life while balloons ___
Mitral Valve Stenosis
-overloaded left atrium can cause A-fib -Diastolic murmur -Hemoptysis -increase atria and pulm. pressure
cardioversion
-restoration of a normal heart rhythm by electric shock. -used for supraventricular dysrhythmias and pulsatile Vent tachy - usually a small shock -requires synchronization with cardiac cycle
Defribrillation
- Larger shock -tx of choice for ventricular fib and pulseless v-tach - NOT synchronized -Three kinds (Monitor, AICD, AED)
Antidysrhythmic Drugs
- at risk for arrhythmias - most common after MI
Lipid lowering drugs
-Patients with ACS or CAD should receive - take along with statins
keep the patient in bed in supine position
A 73 year old with chronic atrial fib develops sudden severe pain and pulselessness in the R leg. Nurse should
Crackles Cyanosis Dyspnea Frothy sputum
A client had thoracic surgery. The nurse should monitor for what clinical manifestations that may indicate acute pulmonary edema?
lipid profile
A complete__________ is recommended every 5 years beginning at age 20.
Stimulating peristalsis
A health care provider prescribes bisacodyl (Dulcolax) for a client with cardiac disease. The nurse explains to the client that this drug acts by:
uncontrolled HTN
63 yo with 5cm abd aortic aneurysm. Nurse will focus on teaching about which risk factor?
Troponin (cardiac)
<0.1 ng/mL Cardiac injury/ischemia
Percutaneous transluminal balloon valvuloplasty PBTV is considered a conservative treatment. It involves threading a balloon-tipped catheter from the femoral artery to the stenotic valve so that the balloon may be inflated in an attempt to separate valve leaflets.
A nurse is assessing an older adult patient with mitral valve stenosis and a history of unstable angina. Which therapy would the nurse anticipate as a conservative therapy for this patient?
right atrium and right ventricle
A patient with a tricuspid valve disorder has impaired blood flow between the
use precise technique in assessing the BP of the patient because of the possible presence of an auscultatory gap
A priority consideration in the management of the older adult with HTN is to
Reduction in circulating blood volume.
After sustaining multiple internal injuries when hit by a motor vehicle, a client has a sudden drop in blood pressure to 80/60 mm Hg. What does the nurse determine probably caused this response?
HF Mitral valve defect overload of Atrium
Atrial Flutter and A fib is seen in patients with?
athletes, sleep
BB cause bradycardia rhythm in?
no
Can you see atrial depolarization on an EKG?
4-6 hours; 6 hours
Cardiac Biomarkers : Troponin- is specific to heart, levels increase ___ after MI CK-MB- is not specific to heart, levels increase ____ after MI
hypertrophic cardiomyopathy; X-linked; and autosomal dominant mutations
Cardiomyopathy in genetics can cause ________
cardiac catheterization.
Care of the patient after ablation therapy is similar to that of a patient undergoing ____________
glucose, insulin, and lipoprotein metabolism
Defects in __________are common in primary hypertension
Jugular Venous Distention
Engorged appearance of jugular veins seen when pressure on the right side of the heart is elevated.
by any alteration to cardiac output
Heart failure can be caused by what?
130 mm Hg; 80 mm Hg.
Hypertension, or high BP, is defined as either a persistent systolic BP (SBP) greater than or equal to ______ or a diastolic BP (DBP) greater than or equal to ________
digitalis
Hypokalemia, which can be caused by using potassium-depleting diuretics (e.g., thiazides, loop diuretics), is a common cause of ________ toxicity
20
IRREVERSIBLE DAMAGE of ACS starts in______minutes
60-100 times/min
Intrinsic rate for SA node
regular
Is the rhythm of SVT regular or irregular?
ST depression and T wave inversion
Ischemia = what on ekg?
brain limb kidney liver spleen
Left sided heart embolization's deals with
dehydration GI bleeding copious emesis meds (diuretic) HF sodium overload
Less stroke volume means a patient will be experiencing?
Troponin: highly specific for MI
Levels increase 4-6 hours after MI Peak at 10-24 hours Return to baseline at 10-14 days Negative < 0.5 mcg/L
Little
Little or Large Block most accurate on EKG? Both only used for regular rhythms
severe heart failure Often death
No matter the category or cause, All CMO lead to...
HFrEF
Nonpharmacologic therapies for HF, including CRT and ICDs to prevent SCD, are important EBTs for qualifying patients with ________
0.04-0.12 seconds
Normal QRS
UA or NSTEMI
Partial occlusion =
Progressive, often severe chest pain that is sharp and pleuritic in nature and worse with deep inspiration and when lying supine. The pain is relieved by sitting up and leaning forward. It may be referred to the shoulder and upper back.
Pericarditis in the acute MI patient Clinical manifestations include the following:
the mitral value doesn't close so the blood goes backwards
Physical examination of A.L. reveals a loud systolic murmur at the fifth ICS, left midclavicular line. A chest x-ray shows fluid in his lungs. The health care provider suspects A.L. may have mitral regurgitation. Describe the pathophysiology of mitral regurgitation.
Bradydysrhythmias Shock Dying heart
Reasons to want to Increase HR
R.A.A
Renin affects SV in the ____ system
CXR and ECHO
Restrictive CMO is found by what labs?
stenosis or regurgitation.
Rheumatic endocarditis is found primarily in the valves. Vegetation forms and valve leaflets may fuse and become thickened or even calcified, resulting in ______________
dysrhythmias, ischemia, or infarction
Telemetry monitoring involves the observation of a patient's heart rate (HR) and rhythm to help rapidly diagnose ____________________
Transverse pacemaker
Temporary Electrical lead introduced through subclavian, external or internal jugular or cephalic vein
SA node
The P wave, begins with the firing of the ____
Does not involve reconstruction Is used to delay open heart surgery or valve replacement Is indicated for older patients and those who are poor surgical candidates
The PTBV procedure:
electrical impulse
The conduction system consist of specialized tissue responsible for creating and transporting the ______, or action potential
chordae tendineae
The cusps of the mitral and tricuspid valves are attached to thin strands of fibrous tissue called _______
internodal pathways
The electrical impulse (action potential) travels from the atria to the AV node through _____ pathways. The signal then moves through the bundle of HIS and the left and right branches.
preload, contractility, afterload
The factors affecting the SV are ____, ____, and ______
Total cholesterol, triglycerides, LDL/HDL
The lipid panel consist of what ?
factor VIII.
The nurse would anticipate that a patient with von Willebrand disease undergoing surgery would be treated with administration of vWF and
endothelial layer of the arteries
The part of the vascular system responsible for homeostasis is the
Activity level is gradually increased under cardiac rehabilitation team supervision and monitoring.
The patient is being dismissed from the hospital after acute coronary syndrome (ACS) and will be attending rehabilitation. What information would be taught in the early recovery phase of rehabilitation?
pericardiectomy.
Treatment of choice for chronic constrictive pericarditis is a_____________
drug therapy, valvuloplasty, valve repair and valve replacement.
Treatment of valvular heart disease includes ______________ The selected treatment depends on the valve involved and the severity of disease. It focuses on preventing exacerbations of heart failure, acute pulmonary edema, thromboembolism, and recurrent endocarditis.
unstable angina
Unstable Angina - New onset or progressive increase in frequency, intensity, and duration of attack, Occurs at rest, Pain even after NTG Pain lasts 10 mins or more UNPREDICTABLE Occurs with minimal exertion or during sleep The patient with chronic stable angina can progress to ___________ PROMPT TREATMENT!!!!!!
unstable
VT can be stable (patient has a pulse) or ______________(patient is pulseless). Precipitating causes are identified and treated (e.g., electrolyte imbalances, ischemia).
right atrium
Veins are large diameter, thin walled vessels that return blood to the ______
toward
Veins, except for the pulmonary veins, carry deoxygenated blood ______ the heart.
30 minutes before morning and evening meals
When is Fibric Acid adminstered?
Adjunctive therapy and cardioprotective for postmenopausal women
When is estrogen used to treat cholesterol?
With and Ejection Fraction <45%
When is systolic HF diagnosed?
"You will need to keep a diary of your activities and symptoms."
Which instruction by the nurse to a patient who is about to undergo Holter monitoring is accurate?
"Sexual activities can be safely resumed after an exercise stress test with no heart symptoms."
Which response by the nurse is best when a client who has had an ST segment elevation myocardial infarction (STEMI) asks about the resumption of sexual activity?
Angina Orthopnea Exertional dyspnea
Which signs and symptoms are associated with aortic valve regurgitation?
TEE
____ goes through the esophagus to look at the back side of the heart for A-fib
Prednisone
____ meds can cause hypotension, edema, and potassium depletion.
Hypertension (Stage 2)
_____ is defined as an SBP > 140 mm Hg and a DBP > 90 mm Hg.
Drug-eluting
______ stents reduce the risk of in-stent re-stenosis (overgrowth of the intimal lining) but need a minimum of 12 months of dual antiplatelet therapy.
Lipid lowering
_______ drugs are continued indefinitely if the patient can tolerate the drug
Chronic stable angina
_______ refers to chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms.
Chronic stable angina
________ can progress or develop into unstable angina or an acute coronary syndrome. Therefore, any change in the usual pattern of angina should be evaluated.
Pulmonary edema
alveoli filled with serosanguineous fluid, NO EXCHANGE
Acidosis
decreased plasma pH
decreased cardiac output
increased HR =
hypercapnia
increased arterial CO2 pressure .
MI
increased labs of CK-MB would indicate a
Bounding pulse
sharp, brisk, pounding pulse
V fib
ventricular fibrillation
angiotensin-converting enzyme (ACE) inhibitors, - blockers, digoxin, and diuretics.
• Treatment for myocarditis consists of managing the associated heart symptoms. • Drug therapy includes the use of ________________ • Vasodilators may be used if hypotension is not present.
30-40
•Bundle of His_______ beats/min
20-30
•Purkinje Fibers__________ beats/min
60-100
•SA node ________ beats/min -Initiates an impulse (pacemaker) -Located at junction of superior vena cava and right atrium -Impulses move via internodal pathways to AV node
Increased blood pressure
•Valve and blood vessels changes ___________