CHA- Cardiac

Restrictive Cardiomyopathy: causes

primary condition or caused by endocardial or myocardial disease

Hypertrophic Cardiomyopathy

symmetric ventricular hypertrophy & disarray of myocardial fibers lead to left ventricular stiffness; this results in abnormal diastolic filling & obstruction in the left ventricle outflow tract

Restrictive Cardiomyopathy

this rarest type results in stiff ventricles restricting filling during diastole

Aortic Stenosis: s/s

-Dyspnea -Angina -Syncope with exertion -Marked fatigue -Peripheral cyanosis -Narrow pulse pressure with BP -Crescendo-decrescendo murmur with auscultation

Mitral Regurgitation: s/s

-Fatigue -Chronic weakness -Dyspnea on exertion -Anxiety -Atypical chest pain -Palpitations -Normal BP -Atrial fibrillation -Respiratory changes Symptoms related to Right-Sided HF: -Neck vein distension -Hepatomegaly -Dependent pitting edema -High-pitched systolic murmur at the apex -Severe regurgitation results in an S3

Valve d/o: surgical repair/valve replacement

replacement valves Prosthetic valves Biologic xenografts (from other species) using pig or cow valves **artificial valves are more prone to blood clots

Mitral Valve stenosis: Causes

rheumatic carditis (most common cause) congenital anomalies

CAD risk factors

Non-modifiable risk factors: Hereditary/genetic Age Race Gender Modifiable risk factors: ↑serum lipid levels Tobacco use Sedentary life-style Hypertension Diabetes (control of) Obesity Excessive alcohol Stress

Restrictive Cardiomyopathy: s/s

same as left or right-sided HF; poor prognosis

Digoxin

slows AV conduction; treats chronic Afib (will not put rhythm back to NSR)

Lifes essential 8

-eat better -be more active -quit tobacco -get healthy sleep -manage weight -control cholesterol -manage blood sugar -manage BP

ventricular remodeling

2-3 months after the infarction: the necrotic area shrinks and develops into thin, form scar tissue which permanently changes the shape and size of the entire left ventricle (ventricular remodeling)

Hypertrophic Cardiomyopathy: causes

50% are single-gene autosomal dominant trait (common cause of sudden death in athletes)

Angioplasty

A deflated balloon is inserted into the blockage area of the coronary artery The balloon is inflated, flattening the blockage against the sidewalls of the artery The balloon is then removed

a. Confusion rationale; Bradydysrhythmia can cause decreased systemic perfusion, which can lead to confusion. Therefore, the nurse should monitor the client's mental status.

A nurse in an emergency department is assessing a client who has a bradydysrhythmia. Which of the following findings should the nurse monitor for? a. Confusion b. Friction rub c. Hypertension d. Dry skin

b. Persistent cough rationale: A persistent cough is an adverse effect of ACE inhibitors. The client should report this finding to the provider and discontinue the medication.

A nurse is teaching a client who has a new prescription for an ACE inhibitor to treat hypertension. The nurse should instruct the client to notify their provider if they experience which of the following adverse effects of this medication? a. Tendon pain b. Persistent cough c. Frequent urination d. Constipation

Asystole

Absolutely no electrical conduction occurring = no heart pumping Patient cannot survive this rhythm CPR and meds (epinephrine/vasopressin) Defibrillation not effective

Post MI nursing diagnoses

Activity Intolerance related to fatigue secondary to impaired cardiac output Acute Pain related to impaired tissue perfusion Ineffective Health Maintenance related to deficient knowledge of disease process Anxiety related to potential threat of death

CAD nursing considerations

Administer oxygen with complaints of chest pain - an increased O2 requirement is happening in myocardial tissues

Ablation

An area of the heart that is firing sporadic impulses can be surgically stopped using a radiofrequency electricity (heat source) to build scar tissue in the area

endocarditis

An infection of the inner lining of the heart (endocardium) Infection occurs from bacteria and microorganisms in other parts of the body that travel to the heart via the circulatory system Vegetations (clump of debris) can break off and be a foreign material in the blood stream -Risk for CVA Treatment will include antibiotics

HF labs

BNP, ABG's

CAD - LABS

CK CK-MB Troponin Myoglobin Cholesterol

HF imaging

CXR echo EKG

CAD- Diagnostics

Cardiac catheterization stress test

Cardiac rehab

Cardiac rehab is intended to actively assist a patient with cardiac disease in achieving and maintaining a vital and productive life while remaining within the limits of the heart's ability to respond to increases in activity and stress.

A Fib

Chaotic rhythm, no real atrial contraction with irregular ventricular response (can be rapid ventricular rate/response) RVR = decreased ventricular filling = decreased cardiac output Slow rate = decreased cardiac output Meds: antiarrhythmic calcium channel blockers anticoagulants antiplatelet Cardioversion; ablation; bi-ventricular pacing

pericardial effusion s/s

Chest pain Fever Fatigue Muscle aches Shortness of breath Palpitations Light-headedness Cool, clammy skin

CAD - GERONTOLOGIC CONSIDERATIONS

Chest pain may not be evident in older adults Reduction in death from myocardial infarction with the use of a thrombolytic Dysrhythmias may be part of the normal aging process Beta-blockers can cause more severe side effects Need to plan longer warm-up & cool-down periods with exercise programs to allow for slower changes in heart rate

stable angina pectoris

Chest pain that typically occurs with activity & subsides with rest Frequency, duration and intensity of symptoms remains the same for extended periods of time Results in slight limitations for the patient Usually associated with fixed atherosclerotic plaque

Aortic Stenosis: Causes

Congenital bicuspid or unicuspid aortic valves Rheumatic disease Atherosclerosis Degenerative calcification of the aortic valve

Cardiomyopathy: diagnosis

DCM: x-ray will show enlarged ventricle dilation HCM: dysrhythmias on EKG Echocardiogram, radionuclide imaging, angiocardiography during cardiac catheterization are used to differentiate types of cardiomyopathy

Mitral Regurgitation: causes

Degenerative changes due to aging & infective endocarditis Papillary muscle dysfunction or rupture from ischemic heart disease Congenital anomalies

infective endocarditis: complications

Heart failure Heart valve damage Stroke Seizure Pulmonary embolism Kidney damage Sepsis

Mitral Valve stenosis

Valve thickening by fibrosis & calcification Valve leaflets fuse & become stiff, chordae tendon contract & shorten causing the valve opening to narrow, preventing normal blood flow from the left atrium to the left ventricle Left atrium pressure increases, left atrium dilates, pulmonary pressure increases & right ventricle hypertrophies

V Tach

Ventricular origin - tachy Life threatening rhythm. Low cardiac output. Stable: meds (amiodarone); elective cardioversion Unstable: Defibrillation

V Fib

Ventricular origin with quivering ventricles Life threatening not awake No cardiac output. Defibrillation

NSR

What's happening? - SA to AV to Bundle Branches - all "normal" No patient impact No interventions/tx

Implanted pacemaker

Wires attach from a generator on one end to direct contact in the heart on the other end. Electrical impulses are sent through a lead wire stimulating cardiac cells to depolarize. Risks: infection at insertion site, ectopic beats, loss of capture, electromagnetic interference Nursing considerations: report HR <set rate, carry an ID card and medical alert bracelet, if patient has c/o chest pain or dizziness - check apical pulse to ensure the pacer is functioning; remember that a patient's HR can be higher than set rate (heart is working correctly without assist or going into another dysrhythmia that the pacer cannot help with)

Arrhythmogenic Right Ventricular cardiomyopathy: causes

familial association (heredity); most often in young adults

epinephrine

first-line agent in cardiac arrest, alpha-adrenergic effects to increase vasomotor tone for myocardial and cerebrovascular perfusion

CAD

affects the arteries that provide blood, oxygen and nutrients to the myocardium. Broad term that includes chronic stable angina and acute coronary syndromes

Dilated Cardiomyopathy: Causes

alcohol abuse, chemotherapy, infection, inflammation, poor nutrition

Arrhythmogenic Right Ventricular cardiomyopathy

there is a replacement of myocardial tissue with fibrous & fatty tissue; 1/3 of the patients have left ventricle involvement

Valve d/o treatment

balloon valvuloplasty surgical repair/valve replacement medications

pericardial effussion tx

if it is causing complications = pericardiocentesis; if the patient is stable, diuretics can be used to attempt to allow the body to resolve the effusion on it's own

norepinephrine

increases vasomotor tone and perfusion pressure

Aschoff bodies

inflammatory lesions

Ischemia

insufficient oxygen is available based on the current need; limited in duration and does not cause permanent tissue damage

Valve d/o: Balloon valvuloplasty

catheter inserted to inflate a balloon and "loosen" stiff valve leaflets Watch for bleeding at insertion site after procedure

chronic constrictive pericarditis

causes a fibrous thickening of the pericardium causing it become rigid and prevents adequate ventricular filling; results in cardiac failure Causes: -Tuberculosis -Radiation therapy -Trauma -Renal failure -Metastatic cancer

Arrhythmogenic Right Ventricular cardiomyopathy: s/s

may or many not have symptoms similar to other cardiomyopathies

Infarction

necrosis or cell death due to a lack of oxygen when severe ischemia is prolonged and decreased perfusion causes irreversible damage to cardiac tissue

Valve d/o: medications

diuretics beta blockers digoxin and oxygen may be administered to improve the symptoms of HF If the patient is in Afib, meds used to treat that will also be used (refer to dysrhythmias)

Dilated Cardiomyopathy: s/s

dyspnea on exertion, decreased exercise capacity, fatigue, palpitations

Magnesium sulfate

electrolyte given to treat refractory VT or VF (may be low); also used to treat torsades de pointes which can result from certain antidysrhythmic meds such as amiodarone

Adenosine

endogenous nucleoside, slows AV conduction; treats SVT

3 rationale: The nurse should examine this area, the P wave, of the rhythm strip to evaluate for atrial depolarization.

A nurse is reviewing the ECG rhythm strip of a client who is receiving telemetry. Which of the following areas of the strip should the nurse examine to observe for atrial depolarization? (You will find hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.)

c. Cholesterol 190 mg/dL, HDL 25 mg/dL, LDL 160 mg/dL

A nurse is reviewing the laboratory results of several male clients who have peripheral arterial disease. The nurse should plan to provide dietary teaching for the client who has which of the following laboratory values? a. Cholesterol 180 mg/dL, HDL 70 mg/dL, LDL 90 mg/dL b. Cholesterol 185 mg/dL, HDL 50 mg/dL, LDL 120 mg/dL c. Cholesterol 190 mg/dL, HDL 25 mg/dL, LDL 160 mg/dL d. Cholesterol 195 mg/dL, HDL 55 mg/dL, LDL 125 mg/dL

c. Cholesterol 190 mg/dL, HDL 25 mg/dL, LDL 160 mg/dL rationale: These laboratory values for HDL and LDL are outside of the expected reference range and indicate that the nurse should provide dietary teaching to the client. The expected reference range for cholesterol is less than 200 mg/dL; for HDL is above 45 mg/dL for males and above 55 mg/dL for females; and for LDL is less than 130 mg/dL.

A nurse is reviewing the laboratory results of several male clients who have peripheral arterial disease. The nurse should plan to provide dietary teaching for the client who has which of the following laboratory values? a. Cholesterol 180 mg/dL, HDL 70 mg/dL, LDL 90 mg/dL b. Cholesterol 185 mg/dL, HDL 50 mg/dL, LDL 120 mg/dL c. Cholesterol 190 mg/dL, HDL 25 mg/dL, LDL 160 mg/dL d. Cholesterol 195 mg/dL, HDL 55 mg/dL, LDL 125 mg/dL

b. Persistent cough rationale: A persistent cough is an adverse effect of ACE inhibitors. The client should report this finding to the provider and discontinue the medication.

A nurse is teaching a client who has a new prescription for an ACE inhibitor to treat hypertension. The nurse should instruct the client to notify their provider if they experience which of the following adverse effects of this medication? a. Tendon pain b. Persistent cough c. Frequent urination d. Constipation

CAD treatment

Angioplasty Stent placement CABG

MI sx

Chest pain with a sudden onset, lasting >15 min and not relived by rest or nitroglycerin Often radiates to the left arm, shoulder, and jaw and sometimes described as "crushing" Dyspnea and cyanosis due to ↓ cardiac output Poor organ perfusion due to an insufficient amount of O2 being pumped to the body Watch for urine output <30 ml/hr *Women tend to have more flu-like symptoms with an MI

A flutter

Less chaotic than Afib, atria beating quickly but rhythm is regular Potential lack of perfusion Meds: antiarrhythmic calcium channel blockers beta blockers anticoagulants Cardioversion; ablation

CAD Pt. education

-Report any changes in the chest pain pattern -If chest pain occurs, stop the activity and rest to see if the pain subsides -Dietary changes to decrease sodium, fat and cholesterol intake -Change modifiable risk factors: quit smoking, increase activity, control blood sugars if diabetic, take medications to reduce BP, avoid alcohol, decrease stress

Rheumatic endocarditis s/s

-Tachycardia -Cardiomegaly -New murmur -Pericardial friction rub -Precordial pain -Prolonged PR interval -Heart failure -Evidence of existing strep infection

a. Confusion rationale: Bradydysrhythmia can cause decreased systemic perfusion, which can lead to confusion. Therefore, the nurse should monitor the client's mental status.

A nurse in an emergency department is assessing a client who has a bradydysrhythmia. Which of the following findings should the nurse monitor for? a. Confusion b. Friction rub c. Hypertension d. Dry skin

d. Assisting with thrombolytic therapy

A nurse in an emergency department is caring for a client who had an anterior myocardial infarction. The client's history reveals they are 1 week postoperative following an open cholecystectomy. The nurse should identify that which of the following interventions is contraindicated? a. Administering IV morphine sulfate b. Administering oxygen at 2 L/min via nasal cannula c. Helping the client to the bedside commode d. Assisting with thrombolytic therapy

b. A client who has diabetes mellitus rationale: Diabetes mellitus places the client at risk for microvascular damage and progressive peripheral arterial disease.

A nurse is providing health teaching to a group of clients. Which of the following clients is at risk for developing peripheral arterial disease? a. A client who has hypothyroidism b. A client who has diabetes mellitus c. A client whose daily caloric intake consists of 25% fat d. A client who consumes two 12-oz (0.35-L) bottles of beer a day

b. A client who has diabetes mellitus rationale: The nurse should identify that vagal stimulation might temporarily convert the client's heart rate to normal sinus rhythm. The nurse should have a defibrillator and resuscitation equipment at the client's bedside because vagal stimulation can cause bradydysrhythmias, ventricular dysrhythmias, or asystole.

A nurse is providing health teaching to a group of clients. Which of the following clients is at risk for developing peripheral arterial disease? a. A client who has hypothyroidism b. A client who has diabetes mellitus c. A client whose daily caloric intake consists of 25% fat d. A client who consumes two 12-oz (0.35-L) bottles of beer a day

P wave

A nurse is reviewing the ECG rhythm strip of a client who is receiving telemetry. Which of the following areas of the strip should the nurse examine to observe for atrial depolarization?

infective endocarditis: tx

Antibiotics Managing of symptoms Antipyretics for fever Fluids to prevent dehydration Analgesics for pain Oxygen if necessary for shortness of breath Diuretics for edema Preventative antibiotics in the future prior to invasive medical, dental or surgical procedures

HF psychosocial effects

Anxiety Frustration High risk for depression Hope is a major indicator of well-being for patients with heart failure!

Aortic Regurgitation

Aortic valve leaflets do not close properly during diastole & the annulus (valve ring that attaches to the leaflets) may be dilated, loose or deformed This allows backflow of blood from the aorta back into the left ventricle during diastole The left ventricle compensates be dilating to accommodate increased blood volume & will hypertrophy

Aortic Stenosis

Aortic valve orifice narrows & obstructs left ventricular outflow during systole leading to ventricular hypertrophy (↑ resistance to ejection or afterload) CO becomes fixed & cannot change during exertion, eventually leading to left ventricular failure and blood backing up in the left atrium & the pulmonary system becomes congested → (then leads to) Right-sided HF! Most common valve dysfunction in the U.S. and is often due to wear & tear

infective endocarditis: risk factors

Artificial heart valves (microorganisms attach more easily to artificial valves) History of endocarditis Damaged heart valves Congenital heart defects Illegal drug use (injection) Needles used with tattoos and body piercing Catheters Everyday oral activities (rare, but possible especially with unhealthy gums)

CAD Meds

Aspirin Nitro Morphine Beta blockers ACE's CCB's fibrinolytics

Aortic Regurgitation: s/s

Asymptomatic for many years due to compensation until left ventricular failure occurs - THEN... Exertional dyspnea Orthopnea Paraxysmal nocturnal dyspnea Palpitations Nocturnal angina with diaphoresis Bounding arterial pulses Widened pulse pressure with elevated systolic & diminished diastolic Classic high-pitched, blowing, decrescendo diastolic murmur

HF gerontological considerations

Common elderly diagnosis Certain meds can contribute to the development of or exacerbation of HF NSAIDS: can cause peripheral vasoconstriction and fluid/sodium retention Thiazolidinedines (TZDs): cause fluid/sodium retention and acute MIs in patients with Type 2 Diabetes Most common reason for hospitalization in patients >65 years old

HF treatments

Continuous Positive Airway Pressure (CPAP) -Improves CO and EF by ↓ afterload and preload, BP, and dysrhythmias Cardiac resynchronization therapy (CRT) [also known as biventricular pacing] -Uses a permanent pacer and implanted cardioverter/defibrillator (ICD) -Electrical stimulation causes more synchronous ventricular contractions which improves EF, CO & mean arterial BP Heart transplant -Ultimate choice for end-stage HF

Valve d/o diagnostics

Echocardiogram: noninvasive view of the structure & function of the heart EKG: detects related heart dysrhythmias Chest x-ray: shows heart enlargement only

SVT

Electrical impulses occurring above the ventricles - no P waves Tachycardia = decreased cardiac output Meds: antiarrhythmic (adenosine), beta blockers calcium channel blockers Radiofrequency catheter ablation

Pericarditis nursing considerations

Encourage comfortable positioning (sitting upright & leaning slightly forward) Monitor for signs of a pericardial effusion or cardiac tamponade

Stent placement

Expandable mesh is used to maintain patency created by an angioplasty Nursing considerations: -Observe for bleeding at the puncture site -requent vital sign, cardiac rhythm, & chest pain monitoring -Frequent monitoring of bilateral peripheral pulses -Administer ordered anticoagulants -Chest pain 3-6 months following the stent placement can indicate stent closure or artery occlusion

Systolic HF

Heart cannot contract forcefully enough during diastole to eject adequate amounts of blood into the circulation Preload ↑ with ↓ contractility AND afterload ↑ as a result of ↑ peripheral resistance Ejection fraction drops to <40% with ventricular dilation As EF ↓, tissue perfusion diminishes and blood accumulates in the pulmonary vessels - high risk for sudden cardiac death Treatment: EF <30% = candidate for ICD

MI complications

Heart failure is a serious post-MI complication that can occur quickly Dysrhythmias are the most common complication after an MI

HF- children

Heart failure is possible in children Most common due to a congenital heart defect Symptoms: -Weight below normal (body is exerting more energy in normal body functions) -Infants: nasal flaring, become diaphoretic and fatigued with feeding -Toddlers and school-age: fatigue easily, become increasingly short of breath with activity, need to breaks when playing with friends -Edema: seen periorbital along with peripherally -Cough and congestion in the lungs

Aortic Regurgitation: Causes

Infective endocarditis Congenital anatomic aortic valve abnormalities Hypertension Marfan syndrome (rare systemic disease of connective tissue)

acute pericarditis

Inflammation of the pericardium Causes: -Infection (typically respiratory) -Post-MI syndrome -Post-pericardiotomy syndrome -Acute exacerbations of systemic -connective tissue disease

Inflammatory d/o

Inflammatory disorders of the heart will affect the ability of the heart to contract and relax against the added pressure of inflammation in the surrounding layers of the heart.

Diastolic HF

Left ventricle cannot relax adequately during diastole Inadequate relaxation or "stiffening" prevents ventricular filling with insufficient blood to ensure cardiac output EF >40%, but he ventricle becomes less compliant over time because more pressure is needed to move the same volume of blood Most common in elderly and women with chronic HTN & CAD Same symptoms as systolic HF

Left sided HF sx

Left-Sided Heart Failure (includes systolic & diastolic) Decreased Cardiac Output Pulmonary Congestion Fatigue Hacking cough Weakness Dyspnea/breathlessness Oliguria (day)/Nocturia (night) Crackles or wheezes Angina Frothy, pink sputum Confusion, restlessness S3/S4 gallop Dizziness Tachycardia palpitations Pallor Weak peripheral pulses Cool extremities

Cardiomyopathy: nursing considerations

Maintain patient safety at all times Plan activities around activity tolerance level allowing for rest Closely monitor for cardiovascular changes in HR, rhythm, heart sounds, and EKG changes Closely monitor for pulmonary HTN and congestion through respiratory assessments of lung sounds, respiratory rate and O2 sats Education regarding lifestyle changes, medications, when to notify the PHP

inflammatory d/o Nursing considerations

Maintain safety at all times Manage pain with pharmacological and non-pharmacological interventions Monitor heart rate, rhythm, heart sound, and EKG changes Monitor for an increased temperature (infection) Educate patient/family on ways to prevent reoccurrence, life changes

cardiac tamponade

Medical Emergency!!! Cardiac tamponade is when as little as 20-50 mL of fluid quickly accumulates in the pericardium causing a sudden decrease of CO Symptoms: jugular vein distension, paradoxical pulse, ↓ HR, dyspnea, fatigue, muffled heart sounds, hypotension Treatment: pericardiocentesis [needle placed in the pericardial space to withdraw the fluid]

High output HF

Not common Cardiac output remains normal or above normal (not like left or right sided HF, which are typically low output disorders) Causes: increased metabolic needs or hyperkinetic conditions Septicemia, high fever, anemia, hyperthyroidism

HF treatments

Oxygen therapy: maintain O2 sats; ventilator may be necessary in extreme cases Nutritional therapy: low sodium (reduce to 2-3 g daily) Fluid restrictions: usually 2000 mL daily Daily weights: 1 kg weight gain or loss = 1 liter retained or loss - BEST indicator of fluid status

MI treatment

Oxygen: to keep O2 sats >95% to increase oxygen to body tissues and myocardial tissue Medications: -Nitroglycerine -Aspirin -Morphine *Since an MI is a life-threatening form of CAD, refer to all of the previous medications listed for CAD in previous slides

PAC

P wave is not present since it originates in the ventricles - large ,wide, misshapen

PVC

P wave is present since it originates with the SA node, looks like every other beat just occurs earlier than expected Common with low potassium levels

2nd Degree, Type 2 HB

PR interval stays the same with dropping of QRS - can be consistent or sporadic pattern Syncope - decreased cardiac output Meds: atropine Oxygen, temporary or permanent pacemaker

Pericarditis tx

Pain management: NSAIDS and if needed corticosteroids Treat the underlying cause (antibiotics if bacterial) monitor for pericardial effusion and cardiac tamponade

Cardioversion

Pharmacological: meds are used in an attempt to bring the heart back to a normal rhythm Electrical: specific amount of electrical shock is delivered to the heart in a "sync" mode to correlate with R portion of the QRS complex -Typically will not work if a patient has been in Afib for >12 months -Anticoagulants prescribed up to 6 weeks prior to cardioversion to prevent a thrombolytic event -Review potassium and magnesium levels prior (since abnormal levels make the heart more prone to dangerous dysrhythmias)

Rheumatic endocarditis: Tx

Prevention is most important! Antibiotic therapy (penicillin) Manage fever Maintain hydration Antibiotic prophylaxis may be necessary for rest of life essential prior to invasive procedures

CABG

Procedure: -Arteries are taken from other areas of the body to reroute coronary circulation around an area of damage Post-op care: -Induration, erythema, tenderness, warmth, edema, & drainage at the site can be evidence of infection - Check temperature and WBC count -Risk for Ineffective Breathing Pattern is a priority ND

2nd Degree, Type 1 HB (wenckebach)

Progressive, elongating PR interval with a dropped QRS - repeat cycle Usually asymptomatic - can be brady, doesn't always need tx If symptomatic: oxygen, possible pacemaker

1st Degree HB

Prolonged PR interval - does not impact rate or rhythm No cardiac rhythm issue Monitor pt

3rd degree HB

QRS independent of P waves - no connection between atriums and ventricles Rate will be 20-40 based on being a ventricular origin Decreased cardiac output. Meds: atropine Oxygen; pacemaker (necessary)

HF educations

Recognizing signs of an exacerbation Daily weights - same scale, same time of day Nutritional impact Medication scheduling Stay active, but don't over do it - balance!

Rheumatic endocarditis: Causes

Rheumatic fever - strep infection

Right sided HF

Right ventricle cannot empty completely Increased volume and pressure in the venous system and peripheral edema May be caused by left ventricular HF, right ventricular MI, or pulmonary HTN

HF nursing considerations

Safety, safety, safety! Medication side effects: Assess for acute confusion, orthostatic hypotension, hypokalemia, poor peripheral perfusion Monitor urine output & fluid intake Assess lung & heart sounds every 4 hours minimally Assess edema Plan activities around fatigue and weakness Ensure CNA understanding of the "why" behind the interventions - increases compliance! Ensure advanced directives are complete and known

Rheumatic endocarditis

Sensitive response that develops after an upper respiratory infection with group A beta-hemolytic strep Inflammatory lesions (Aschoff bodies - nodules) in all layers of the heart resulting in impaired contractile function of the myocardium, thickening of the pericardium & valve damage Cause: Rheumatic fever - strep infection

Sinus Bradycardia

Slowed sinus rhythm Fatigued, low O2 due to decreased cardiac output Atropine; fluids

HF risk factors

Smoking/tobacco use Family history Obesity Sleep apnea Hyperkinetic conditions Systemic hypertension (most common) Myocardial infarction Structural heart changes (valve disorders) CAD Cardiomyopathy Substance abuse Congenital defects Cardiac infections & inflammations Dysrhythmias Diabetes mellitus Severe lung disease

unstable angina pectoris

Stable angina that has increased in frequency & intensity of pain may have developed into unstable angina. Occurs at rest or with exertion causing severe activity limitations 12 lead EKG changes will be present, but cardiac labs [CK or Troponin] will not be elevated

Right sided HF

Systemic Congestion Jugular distension Enlarged liver and spleen Anorexia and nausea Dependent edema (legs and scrotum) Distended abdomen Swollen hands and fingers Polyuria at night Weight gain Increased BP (from excess volume) OR decreased BP (from HF)

Pericardial effusion

The space between the parietal & visceral layers of the pericardium fills with fluid The pericardium can stretch to hold several hundred mL of fluid IF it happens slowly Patient is at risk for Cardiac Tamponade - medical emergency! Cardiac tamponade is when as little as 20-50 mL of fluid quickly accumulates in the pericardium causing a sudden decrease of CO Treatment: pericardiocentesis [needle placed in the pericardial space to withdraw the fluid]

Cardiac Rehab phases

There are 3 phases of cardiac rehab Phase 1: promote rest & limit mobility Phase 2: re-strengthening of heart muscle Phase 3: long-term maintenance *Always watch for dyspnea with activity as evidence of a lack of cardiac tolerance!

Dilated Cardiomyopathy

This most common type develops from extensive damage to the myofibrils & inference with myocardial metabolism; there is normal wall thickness of both ventricles while both ventricles dilate causing impaired systolic function - poor pumping

MI diagnostics

Troponin

Cardiac catheterization (angiogram)

Usually inserted through the femoral or brachial arteries and threaded to the coronary arteries Test done to determine the location & extent of CAD Post-procedure nursing considerations: Watch for bleeding at the insertion site Monitor peripheral pulses, skin temperature Straight extremity

Hypertrophic Cardiomyopathy: s/s

often die without any symptoms; dyspnea on exertion, syncope, dizziness, palpitations

Atropine

parasympathetic agent; treats symptomatic bradycardia

Inflammatory d/o labs

pericarditis - elevated WBC endocarditis -elevated WBC, heart murmur

vasopressin

potent vasoconstricting effects used in VF and pulseless VT

a. Absence of adventitious breath sounds rationale: Adventitious breath sounds occur when there is fluid in the lungs. The absence of adventitious breath sounds indicates that the pulmonary edema is resolving.

A nurse is assessing a client who has pulmonary edema related to heart failure. Which of the following findings indicates effective treatment of the client's condition? a. Absence of adventitious breath sounds b. Presence of a nonproductive cough c. Decrease in respiratory rate at rest d. SaO2 86% on room air

d. Assisting with thrombolytic therapy rationale: The nurse should recognize that major surgery within the previous 3 weeks is a contraindication for thrombolytic therapy.

A nurse in an emergency department is caring for a client who had an anterior myocardial infarction. The client's history reveals they are 1 week postoperative following an open cholecystectomy. The nurse should identify that which of the following interventions is contraindicated? a. Administering IV morphine sulfate b. Administering oxygen at 2 L/min via nasal cannula c. Helping the client to the bedside commode d. Assisting with thrombolytic therapy

c. Elevate the head of the client's bed. rationale: The greatest risk to this client is organ injury due to severe hypertension. Therefore, the first action the nurse should take is to elevate the head of the client's bed to reduce blood pressure and promote oxygenation.

A nurse in an emergency department is caring for a client who has a blood pressure of 254/139 mm Hg. The nurse recognizes that the client is in a hypertensive crisis. Which of the following actions should the nurse take first? a. Initiate seizure precautions. b. Tell the client to report vision changes. c. Elevate the head of the client's bed. d. Start a peripheral IV.

c. Inquire about the presence or absence of claudication. rationale: Knowing if the client is experiencing claudication helps differentiate venous from arterial ulcers. Clients who have arterial ulcers experience claudication, but those who have venous ulcers do not.

A nurse is admitting a client who has a leg ulcer and a history of diabetes mellitus. Which of the following focused assessments should the nurse use to help differentiate between an arterial ulcer and a venous stasis ulcer? a. Explore the client's family history of peripheral vascular disease. b. Note the presence or absence of pain at the ulcer site. c. Inquire about the presence or absence of claudication. d. Ask if the client has had a recent infection.

c. Inquire about the presence or absence of claudication. rationale: Knowing if the client is experiencing claudication helps differentiate venous from arterial ulcers. Clients who have arterial ulcers experience claudication, but those who have venous ulcers do not.

A nurse is admitting a client who has a leg ulcer and a history of diabetes mellitus. Which of the following focused assessments should the nurse use to help differentiate between an arterial ulcer and a venous stasis ulcer? a. Explore the client's family history of peripheral vascular disease. b. Note the presence or absence of pain at the ulcer site. c. Inquire about the presence or absence of claudication. d. Ask if the client has had a recent infection.

d. INR 2.0 rationale: The nurse should identify that an INR of 2.0 is within the desired reference range of 2.0 to 3.0 for a client who has a deep-vein thrombosis and is receiving warfarin to reduce the risk of new clot formation and a stroke.

A nurse is assessing a client who has a history of deep-vein thrombosis and is receiving warfarin. Which of the following findings should indicate to the nurse that the medication is effective? a. Hemoglobin 14 g/dL b. Minimal bruising of extremities c. Decreased blood pressure d. INR 2.0

d. INR 2.0 rationale: The nurse should identify that an INR of 2.0 is within the desired reference range of 2.0 to 3.0 for a client who has a deep-vein thrombosis and is receiving warfarin to reduce the risk of new clot formation and a stroke.

A nurse is assessing a client who has a history of deep-vein thrombosis and is receiving warfarin. Which of the following findings should indicate to the nurse that the medication is effective? a. Hemoglobin 14 g/dL b. Minimal bruising of extremities c. Decreased blood pressure d. INR 2.0

a. Dyspnea on exertion rationale: The nurse should identify dyspnea on exertion as an expected manifestation of dilated cardiomyopathy. Dyspnea on exertion is due to ventricular compromise and reduced cardiac output.

A nurse is assessing a client who has dilated cardiomyopathy. Which of the following findings should the nurse expect? a. Dyspnea on exertion b. Tracheal deviation c. Pericardial rub d. Weight loss

b. Weak peripheral pulses rationale: Weak peripheral pulses are related to decreased cardiac output resulting from left-sided heart failure.

A nurse is assessing a client who has left-sided heart failure. Which of the following manifestations should the nurse expect to find? a. Increased abdominal girth b. Weak peripheral pulses c. Jugular venous neck distention d. Dependent edema

b. Weak peripheral pulses

A nurse is assessing a client who has left-sided heart failure. Which of the following manifestations should the nurse expect to find? a. Increased abdominal girth b. Weak peripheral pulses c.Jugular venous neck distention d. Dependent edema

a. Absence of adventitious breath sounds

A nurse is assessing a client who has pulmonary edema related to heart failure. Which of the following findings indicates effective treatment of the client's condition? a. Absence of adventitious breath sounds b. Presence of a nonproductive cough c. Decrease in respiratory rate at rest d. SaO2 86% on room air

a. "I can't get rid of these hiccups." rationale: Hiccups can indicate that the pacemaker is stimulating the chest wall or diaphragm, which can occur as a result of a lead wire perforation.

A nurse is caring for a client following insertion of a permanent pacemaker. Which of the following client statements indicates a potential complication of the insertion procedure? a. "I can't get rid of these hiccups." b. "I feel dizzy when I stand." c. "My incision site stings." d. "I have a headache."

a. "I can't get rid of these hiccups." rationale; Hiccups can indicate that the pacemaker is stimulating the chest wall or diaphragm, which can occur as a result of a lead wire perforation.

A nurse is caring for a client following insertion of a permanent pacemaker. Which of the following client statements indicates a potential complication of the insertion procedure? a. "I can't get rid of these hiccups." b. "I feel dizzy when I stand." c. "My incision site stings." d. "I have a headache."

c. Creatine kinase-MB rationale: Creatine kinase-MB is the isoenzyme specific to the myocardium. Elevated creatine kinase-MB indicates myocardial muscle injury.

A nurse is caring for a client who had an onset of chest pain 24 hr ago. The nurse should identify that an increase in which of the following values is diagnostic of a myocardial infarction (MI)? a. Myoglobin b. C-reactive protein c. Creatine kinase-MB d. Homocysteine

c. Creatine kinase-MB rationale: creatine kinase-MB indicates myocardial muscle injury.

A nurse is caring for a client who had an onset of chest pain 24 hr ago. The nurse should identify that an increase in which of the following values is diagnostic of a myocardial infarction (MI)? a. Myoglobin b. C-reactive protein c. Creatine kinase-MB d. Homocysteine

d. "I smoked a cigarette this morning to calm my nerves about having this procedure." rationale: Smoking prior to this test can change the outcome and places the client at additional risk. The procedure should be rescheduled if the client has smoked before the test.

A nurse is caring for a client who has a history of angina and is scheduled for exercise electrocardiography at 1100. Which of the following statements by the client requires the nurse to contact the provider for possible rescheduling? a. "I'm still hungry after the bowl of cereal I ate at 7 a.m." b. "I didn't take my heart pills this morning because the doctor told me not to." c. "I have had chest pain a couple of times since I saw my doctor in the office last week." d. "I smoked a cigarette this morning to calm my nerves about having this procedure."

d. Valvular disease

A nurse is caring for a client who has endocarditis. Which of the following findings should the nurse recognize as a potential complication? a. Ventricular depolarization b. Guillain-Barré syndrome c. Myelodysplastic syndrome d. Valvular disease

d. Valvular disease rationale: Valvular disease or damage often occurs as a result of inflammation or infection of the endocardium.

A nurse is caring for a client who has endocarditis. Which of the following findings should the nurse recognize as a potential complication? a. Ventricular depolarization b. Guillain-Barré syndrome c. Myelodysplastic syndrome d. Valvular disease

a. Slurred speech rationale: The greatest risk to this client is injury from an embolus caused by the pooling of blood that can occur with atrial fibrillation. Slurred speech can indicate inadequate circulation to the brain because of an embolus. Therefore, the nurse should report this finding to the provider immediately.

A nurse is caring for a client who has heart failure and is experiencing atrial fibrillation. Which of the following findings should the nurse plan to monitor for and report to the provider immediately? a. Slurred speech b. Irregular pulse c. Dependent edema d. Persistent fatigue

a. Slurred speech rationale: The greatest risk to this client is injury from an embolus caused by the pooling of blood that can occur with atrial fibrillation. Slurred speech can indicate inadequate circulation to the brain because of an embolus. Therefore, the nurse should report this finding to the provider immediately.

A nurse is caring for a client who has heart failure and is experiencing atrial fibrillation. Which of the following findings should the nurse plan to monitor for and report to the provider immediately? a. Slurred speech b. Irregular pulse c. Dependent edema d. Persistent fatigue

c. Urine output of 20 mL/hr rationale: Urine output less than 30 mL/hr is a manifestation of shock. Urine output is decreased due to a compensatory decreased blood flow to the kidneys, hypovolemia, or graft thrombosis or rupture.

A nurse is caring for a client who is 1 hr postoperative following an aortic aneurysm repair. Which of the following findings can indicate shock and should be reported to the provider? a. Serosanguineous drainage on dressing b. Severe pain with coughing c. Urine output of 20 mL/hr d. Increase in temperature from 36.8° C (98.2° F) to 37.5° C (99.5° F)

c. Urine output of 20 mL/hr rationale: Urine output less than 30 mL/hr is a manifestation of shock. Urine output is decreased due to a compensatory decreased blood flow to the kidneys, hypovolemia, or graft thrombosis or rupture.

A nurse is caring for a client who is 1 hr postoperative following an aortic aneurysm repair. Which of the following findings can indicate shock and should be reported to the provider? a.Serosanguineous drainage on dressing b. Severe pain with coughing c. Urine output of 20 mL/hr d. Increase in temperature from 36.8° C (98.2° F) to 37.5° C (99.5° F)

b. Blood pressure 160/80 mm Hg rationale: The nurse should report an elevated blood pressure following a CABG because increased vascular pressure can cause bleeding at the incision sites.

A nurse is caring for a client who is 8 hr postoperative following a coronary artery bypass graft (CABG). Which of the following findings should the nurse report? a. Mediastinal drainage 100 mL/hr b. Blood pressure 160/80 mm Hg c. Temperature 37.1° C (98.8° F) d. Potassium 4.0 mEq/L

b. Lightheadedness

A nurse is caring for a client who is being treated for heart failure and has a prescription for furosemide. The nurse should plan to monitor for which of the following adverse effects of the medication? a. Shortness of breath b. Lightheadedness c. Dry cough d. Metallic taste

b.Lightheadedness rationale: Furosemide can cause a substantial drop in blood pressure, resulting in lightheadedness or dizziness.

A nurse is caring for a client who is being treated for heart failure and has a prescription for furosemide. The nurse should plan to monitor for which of the following adverse effects of the medication? a. Shortness of breath b.Lightheadedness c. Dry cough d. Metallic taste

d. Stop the heparin infusion rationale: The nurse should identify that the client's aPTT is above the critical value and the client is displaying manifestations of bleeding. Therefore, the nurse should discontinue the heparin infusion immediately and notify the provider to reduce the risk of client injury.

A nurse is caring for a client who is receiving heparin therapy and develops hematuria. Which of the following actions should the nurse take if the client's aPTT is 96 seconds? a. Increase the heparin infusion flow rate by 2 mL/hr. b. Continue to monitor the heparin infusion as prescribed. c. Request a prothrombin time (PT). d. Stop the heparin infusion.

d. Stop the heparin infusion. rationale: The nurse should identify that the client's aPTT is above the critical value and the client is displaying manifestations of bleeding. Therefore, the nurse should discontinue the heparin infusion immediately and notify the provider to reduce the risk of client injury.

A nurse is caring for a client who is receiving heparin therapy and develops hematuria. Which of the following actions should the nurse take if the client's aPTT is 96 seconds? a. Increase the heparin infusion flow rate by 2 mL/hr. b. Continue to monitor the heparin infusion as prescribed. c. Request a prothrombin time (PT). d. Stop the heparin infusion.

c. "I took my warfarin last night according to my usual schedule." rationale: Clients who are scheduled for a CABG should not take anticoagulants, such as warfarin, for several days prior to the surgery to prevent excessive bleeding.

A nurse is caring for a client who is scheduled for a coronary artery bypass graft (CABG) in 2 hr. Which of the following client statements indicates a need for further clarification by the nurse? a. "My arthritis is really bothering me because I haven't taken my aspirin in a week." b. "My blood pressure shouldn't be high because I took my blood pressure medication this morning." c. "I took my warfarin last night according to my usual schedule." d. "I will check my blood sugar because I took a reduced dose of insulin this morning."

c. "I took my warfarin last night according to my usual schedule."

A nurse is caring for a client who is scheduled for a coronary artery bypass graft (CABG) in 2 hr. Which of the following client statements indicates a need for further clarification by the nurse? a. my arthritis is really bothering me because i haven't taken my aspirin in a week b. my BP shouldn't be high because i took my BP medication this morning c. "I took my warfarin last night according to my usual schedule." d. "I will check my blood sugar because I took a reduced dose of insulin this morning."

b. Review serum electrolyte values. rationale: Weakness and irregular heart rate indicate that the client is at the greatest risk for electrolyte imbalance, an adverse effect of loop diuretics. The first action the nurse should take is to review the client's electrolyte values, particularly the potassium level, because the client is at risk for dysrhythmias from hypokalemia.

A nurse is caring for a client who was admitted for treatment of left-sided heart failure and is receiving intravenous loop diuretics and digitalis therapy. The client is experiencing weakness and an irregular heart rate. Which of the following actions should the nurse take first? a. Obtain the client's current weight. b. Review serum electrolyte values. c. Determine the time of the last digoxin dose. d. Check the client's urine output.

b. Review serum electrolyte values. rationale: Weakness and irregular heart rate indicate that the client is at the greatest risk for electrolyte imbalance, an adverse effect of loop diuretics. The first action the nurse should take is to review the client's electrolyte values, particularly the potassium level, because the client is at risk for dysrhythmias from hypokalemia.

A nurse is caring for a client who was admitted for treatment of left-sided heart failure and is receiving intravenous loop diuretics and digitalis therapy. The client is experiencing weakness and an irregular heart rate. Which of the following actions should the nurse take first? a. Obtain the client's current weight. b. Review serum electrolyte values. c. Determine the time of the last digoxin dose. d. Check the client's urine output.

B. Vagal stimulation rationale: The nurse should identify that vagal stimulation might temporarily convert the client's heart rate to normal sinus rhythm. The nurse should have a defibrillator and resuscitation equipment at the client's bedside because vagal stimulation can cause bradydysrhythmias, ventricular dysrhythmias, or asystole.

A nurse is monitoring a client's ECG monitor and notes the client's rhythm has changed from a normal sinus rhythm to supraventricular tachycardia. The nurse should prepare to assist with which of the following interventions? A. Initiate chest compressions B. Vagal stimulation C. Administration of atropine IV D. Defibrillation

b. Vagal stimulation rationale: The nurse should identify that vagal stimulation might temporarily convert the client's heart rate to normal sinus rhythm. The nurse should have a defibrillator and resuscitation equipment at the client's bedside because vagal stimulation can cause bradydysrhythmias, ventricular dysrhythmias, or asystole.

A nurse is monitoring a client's ECG monitor and notes the client's rhythm has changed from normal sinus rhythm to supraventricular tachycardia. The nurse should prepare to assist with which of the following interventions? a. Initiate chest compressions b. Vagal stimulation c. Administration of atropine IV d. Defibrillation

Mitrial. rationale: Inspection of this location allows the nurse to assess for pulsations of the apex area of the heart, which is considered the apical pulse or point of maximal impulse. The point of maximal impulse is located at the left fifth intercostal space in the midclavicular line.

A nurse is performing a cardiac assessment on a client. Identify the area the nurse should inspect when evaluating the point of maximal impulse.

a. Limited alcohol intake b. Regular exercise program e. Tobacco cessation

A nurse is planning a presentation for a group of clients who have hypertension. Which of the following lifestyle modifications should the nurse include? (Select all that apply.) a. Limited alcohol intake b. Regular exercise program c. Decreased magnesium intake d. Reduced potassium intake e. Tobacco cessation

d. Previous allergic reaction to iodine

A nurse is preparing a client for coronary angiography. Which of the following findings should the nurse report to the provider prior to the procedure? a. Hemoglobin 14.4 g/dL b. History of peripheral arterial disease c. Urine output 200 mL/4 hr d. Previous allergic reaction to iodine

b. Place the patch on an area of skin away from skin folds and joints.

A nurse is providing discharge teaching to a client who has a prescription for transdermal nitroglycerin patches. Which of the following instructions should the nurse include in the teaching? a. Apply the new patch to the same site as the previous patch. b. Place the patch on an area of skin away from skin folds and joints. c. Keep the patch on 24 hr per day. d. Replace the patch at the onset of angina.

b. Place the patch on an area of skin away from skin folds and joints. rationale: The nurse should instruct the client to apply the patch to an area of intact skin with enough room for the patch to fit smoothly.

A nurse is providing discharge teaching to a client who has a prescription for transdermal nitroglycerin patches. Which of the following instructions should the nurse include in the teaching? a. Apply the new patch to the same site as the previous patch. b. Place the patch on an area of skin away from skin folds and joints. c. Keep the patch on 24 hr per day. d. Replace the patch at the onset of angina.

a. Weight gain of 0.9 kg (2 lb) in 24 hr rationale: When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is a weight gain of 0.5 to 0.9 kg (1.1 to 2 lb) in 1 day. This weight gain is an indication of fluid retention resulting from worsening heart failure. The client should report this finding immediately.

A nurse is providing discharge teaching to a client who has heart failure. The nurse should instruct the client to report which of the following findings immediately to the provider? a. Weight gain of 0.9 kg (2 lb) in 24 hr b. Increase of 10 mm Hg in systolic blood pressure c. Dyspnea with exertion d. Dizziness when rising quickly

a. Weight gain of 0.9 kg (2 lb) in 24 hr rationale: When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is a weight gain of 0.5 to 0.9 kg (1.1 to 2 lb) in 1 day. This weight gain is an indication of fluid retention resulting from worsening heart failure. The client should report this finding immediately.

A nurse is providing discharge teaching to a client who has heart failure. The nurse should instruct the client to report which of the following findings immediately to the provider? a. Weight gain of 0.9 kg (2 lb) in 24 hr b. Increase of 10 mm Hg in systolic blood pressure c. Dyspnea with exertion d. Dizziness when rising quickly

a. "You might no longer be able to feel chest pain." rationale: Heart transplant clients usually are no longer able to feel chest pain due to the denervation of the heart.

A nurse is providing teaching to a client who is 2 days postoperative following a heart transplant. Which of the following statements should the nurse include in the teaching? a. "You might no longer be able to feel chest pain." b. "Your level of activity intolerance will not change." c. "After 6 months, you will no longer need to restrict your sodium intake." d. "You will be able to stop taking immunosuppressants after 12 months."

a. "You might no longer be able to feel chest pain." rationale: Heart transplant clients usually are no longer able to feel chest pain due to the denervation of the heart.

A nurse is providing teaching to a client who is 2 days postoperative following a heart transplant. Which of the following statements should the nurse include in the teaching? a. "You might no longer be able to feel chest pain." b. "Your level of activity intolerance will not change." c. "After 6 months, you will no longer need to restrict your sodium intake." d. "You will be able to stop taking immunosuppressants after 12 months."

Sinus Tachycardia

Faster sinus rhythm Heart racing, SOB, flushed, anxious- decreased cardiac output Meds: calcium channel blockers (diltiazem), beta blockers, antiarrhythmic (digoxin) Vagal maneuvers, ablation, fluids

Mitral Valve stenosis: s/s

Fatigue Dyspnea on exertion Orthopnea Hemoptysis Pulmonary edema Hepatomegaly Neck vein distension Pitting edema Atrial Fibrillation (contact PHP if new AFib) Rumbling, apical diastolic murmur

infective endocarditis: s/s

Fever (102-104 F) & Chills Tachycardia New or changed heart murmur Chest pain with breathing Fatigue Night sweats Aching joints & muscles Persistent cough Shortness of breath Swelling in the feet, legs or abdomen

Mitral Regurgitation

Fibrotic & calcification changes prevent mitral valve from closing completely during diastole Incomplete closure of the mitral valve allows backflow of blood into the left atrium when the left ventricle contracts Due to increased blood in the left atrium resulting in more than normal blood volume in the left ventricle, the atrium & ventricle have to work harder to push the extra volume resulting in dilating & hypertrophy of both of these chambers

HF compensatory mechanisms

May initially increase cardiac output, but eventually have damaging effect on the pump function of the heart if HR becomes too rapid, diastolic filling time is limited & CO may start to ↓; increased HR ↑ O2 demand by the myocardium after a critical point is reached within the cardiac muscle, further volume & stretch reduces the force of contractions & CO arterial constriction causes increased afterload requiring more energy for the heart to eject blood and SV may decline Renin-Angiotensin System (RAS) activation Low CO causes ↓ blood flow to the kidneys which activates the RAS. Angiotensin II causes ↑ vasoconstriction Aldosterone secretion causes sodium & water retention = ↑ preload & afterload Angiotensin II also contributes to ventricular remodeling [progressive myocardial cell contractile dysfunction happens over time] Pro-inflammatory cytokines are released (esp. in left-sided HF) - contributes to ventricular remodeling Natriuretic peptides - neurohormones that promote vasodilation and diuresis through sodium loss in the renal tubules (BNP lab is used an indicator of HF Vasopressin (antidiuretic hormone/ADH) is secreted by the posterior pituitary gland when CO ↓ causing ↓ cerebral perfusion. This causes vasoconstriction & fluid retention which worsens HF. Endothelin is a potent vasoconstrictor which ↑ peripheral resistance and HTN that is secreted by endothelial cells hen stretched, such as myocardial fibers in HF Myocardial Hypertrophy The walls of the heart thicken to provide more muscle mass and more forceful contractions, increasing CO Cardiac muscle may hypertrophy more rapidly than collateral circulation can provide adequate blood supply to the muscle Hypertrophied heart muscle is often slightly oxygen deprived

Cardiomyopathy: treatment

Meds: Diuretics, vasodilating agents, and cardiac glycosides to increase CO Beta blockers to block inappropriate sympathetic stimulation & tachycardia Inotropics such as beta-adrenergic blocking (carvedilol) and calcium antagonists (diltiazem) for obstructive HCM to decrease outflow obstruction with exercise and decrease HR to lessen angina, dyspnea, & syncope Surgical: HCM: ventriculomyomectomy [removing a portion of the hypertrophied ventricular septum to create a larger outflow tract DCM: biventricular pacemaker implantation Percutaneous alcohol septal ablation: absolute alcohol injected into a targeted septal branch to create a small septal MI & cause muscle necrosis

Post MI nursing considerations

Monitor for reoccurrence of original symptoms - if they occur, check the heart rate and blood pressure immediately and notify PHP Monitor for dysrhythmias and heart failure as possible complications Provide education - -Report any changes in the chest pain pattern -If chest pain occurs, stop the activity and rest to see if the pain subsides -Dietary changes to decrease sodium, fat and cholesterol intake -Change modifiable risk factors: quit smoking, increase activity, control blood sugars if diabetic, take medications to reduce BP, avoid alcohol, decrease stress

ICD

Monitors HR and will deliver a shock to the patient with a history of Vtach or Vfib at times the heart indicates these rhythms have returned Patients will feel a "kick in the chest" when a shock occurs and should notify their PHP Post-insertion education: Avoid strenuous activity and lifting the side of the arm on the affected side for a few weeks Keep the incision dry for a week to allow to heal

HF meds

Morphine - pain and anxiety nitro - reduce preload diuretics -fluid overload ACE's - decreace BP, decrease fluid, increase stroke volume ARB's -reduce arterial resistance, arterial dilation, decreases fluid retention Digoxin - tx's angina beta blockers - lower HR and BP

MI Basics

Myocardial tissue is abruptly and severely deprived of oxygen, quickly reducing blood flow by 80-90% = ischemia Most MIs result from atherosclerosis of a coronary artery, rupture of the plaque, subsequent thrombosis, and blood flow occlusion

stress test

Stress Test (exercise or medication based) The heart is stressed through exercise or medication injected into a vein Vital signs and cardiac rhythms are monitored closely for changes An elevation of the ST segment on the heart monitor would be of immediate concern

Cardiomyopathy

Subacute or chronic disease of cardiac muscle classified into four categories Mortality rate for patients who develop HF with the cardiomyopathy: 1 year = 20% 8 years = 70-80% *dilated cardiomyopathy *hypertrophic cardiomyopathy *restrictive cardiomyopathy *arrythmogenic right ventricular cardiomyopathy

s/s pericarditis

Substernal precordial pain that radiates to the left side of the neck, shoulder or back that worsens with breathing, coughing, or swallowing Pericardial friction rub High WBC count Fever Atrial fibrillation Pulsus paradoxus (BP drop of at least 10 mm Hg with inspiration) Additional symptoms associated with Chronic Constrictive Pericarditis: -Right-sided HF -Elevated systemic venous pressure -Jugular vein distension -Hepatic engorgement -Dependent edema