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Cardio Disorders
PPT 2 Cardio
| Term | Definition |
|---|---|
| Infective Endocarditis risk factors | age over 60, immunodeficiency, diabetes, IV drug use, prosthetic valves, prior IE, congenital heart disease, poor oral hygiene, hemodialysis, implanted cardiac devices, rheumatic heart disease |
| Infective Endocarditis patho | Endocardial injury from turbulent blood flow, implanted device, congenital heart disease. Injured endothelium allows for bacterial adhesion. Inflammatory response with platelets and fibrin adhere to injury site. Nonbacterial thrombus is formed |
| IE clinical manifestations | Cardiac: heart murmur, HF, arrhythmias. infectious: fever/rigor, fatigue, night sweats, weight loss, confusion (elderly). Skin: Osler's nodes (red, painful nodules), Janeway lesions (red, painless spots), Splinter hemorrhages (vertical streaks on nails) |
| IE Diagnosis | 2 BLOOD CULTURES. Echocardiogram (TTE/TEE) which detects valve dysfunction, vegetations, abscesses, change in heart. Labs (increased WBC is infection) |
| IE treatment | identify cause; IV antibiotics for 4-6 weeks with follow up blood cultures. Valve repair or replacement for pts that do not respond to abx |
| Nursing management of IE | prevent complications (TIA, CVA, PE), heart failure, dysrhythmias, and sepsis |
| Teaching for IE | complete entire abx, encourage oral hygiene, patient needs to inform MD/DDAS prior to procedures. Prophylactic abx recommended in high risk patients (no proven benefit) |
| Myocarditis patho | Leading cause of dilated cardiomyopathy and sudden cardiac death in young pts. Viral infection causes direct myocardial damage with secondary injury from immune response. Can be acute, chronic or subacute. May progress to HF/ cardiogenic shock |
| Myocarditis causes | most common is viral (coxsackie, adenovirus, parovirus, herpes, COVID), autoimmune hypersensitivity, toxins (clozapine, chemo, cocaine), bacteria, parasites, fungi |
| Myocarditis symptoms | chest pain, dysrhythmias, dyspnea and palpitations, syncope, HF (edema, JVD, pulmonary congestion), fever, fatigue, myalgia, and loss of appetite |
| Treatment of myocarditis | Some resolve within days or could progress to HF. Advanced: heart transplantation, ICDs, mechanical circulatory support, treat HF/dysrhythmias/dilated cardiomyopathy. Remove causative agents |
| Meds for myocarditis | Use immunosuppressants, corticosteroids, azathioprine, cyclosporine, methotrexate, IVIG |
| Complications of myocarditis | Most common: dilated cardiomyopathy; HF, cardiogenic shock, dysrhythmias, sudden cardiac death (young pts) |
| Nursing management for myocarditis | MONITOR / DOCUMENT / REPORT. VS (HTN, high HR/RR), hypoxia, fever, dysrhythmias, crackles, edema, JVD, weight gain, decreased urine output (s/s of HF) |
| Actions for myocarditis | administer antivirals, antimicrobials, immunosuppressants, IVIG. Give HF meds and provide emotional support. Teach: avoid strenuous activity, reeval in 3-6 months before return to sports (decrease risk of sudden cardiac death) |
| Pericarditis s/s | HALLMARK: PLUERTIC CHEST PAIN. Relieved by sitting up or leaning forward. worsens with inspiration/coughing. Pericardial friction rub, new or worsening pericardial effusion, ECG changes, low grade fever |
| Diagnostics of pericarditis | ECG (diffuse ST segment elevation or PR segment depression), chest xray (cardiomegaly with clear lungs), echo, CT, CMR (pericardial effusion), Labs (CBC, cardiac biomarkers, pos blood cultures, increased C reactive protein, ESR for inflammation) |
| Pericarditis management | Goals: pain and inflammation (NSAIDs/aspirin), antimicrobials, rapid identification and management |
| Pericarditis treatment | first line therapy: NSAIDs (aspirin, ibuprofen, indomethacin). Adjunct therapy (colchicine with NSAIDs). If inadequate response, give corticosteroids. Antimicrobials given for bacterial pericarditis |
| Complications of pericarditis | pericardial effusion (risk of cardiac tamponade seen with hypotension, muffled heart sounds and JVD). immediate pericardiocentesis if present |
| Pericarditis assessments | VS (hypotension, high HR/RR), pulsus paradoxus c/f tamponade, fever. Pain relieved by sitting up or leaning forward. Heart sounds include friction rub and muffled heart sounds. ECG shows ST elevation or PR depression on multiple leads. |
| Pericarditis actions and teaching | Elevate HOB, administer NSAIDs/meds, provide emotional support. Avoid strenuous exercise until symptoms normalize (HR less than 100). Educate differentiate between MI pain and pericarditis pain |
| Pulsus paradoxus | Exaggerated drop in systolic BP during inspiration. Increased pressure on the heart (cardiac tamponade, pericardial effusion). impairs cardiac filling |
| Hypertensive urgency | Diastolic is greater than 120, s/s of severe BP elevation may be asymptomatic. Need to lower BP gradually over 24-48 hours (PO antihypertensives). Monitor outpatient or ED |
| Hypertensive emergency | Diastolic 120+, severe headache, blurred vision, dizziness, disorientation, epistaxis. Lower BP by 20-25% in first hour but not below 140/90. IV antihypertensive meds (nitroprusside, nicardipine, labetalol). ICU level care, monitor BP q5-15min |
| Hypertensive crisis assessment | Neuro (stroke/aneurysm), auscultate pulses, palpate extremities for edema and pulses, Labs (creatinine, BUN, GFR, urine CR clearance). BMI and waist circumference. |
| HTN crisis teaching | Adherence to med/diet: DASH diet, moderate exercise (150 min/week), limit alcohol, stress reduction, stop smoking, BP monitor at home, watch for s/s of stroke/TOD/aneurysm |
| Aortic artery disease patho | Permanent, localized dilation of an artery. Occurs when the arterial media weakness. Widening increases wall tension leading to progressive enlargement. |
| Causes of aortic artery disease | HTN (tension and arterial wall stress) congenital conditions (Marfan's), acquired conditions |
| Risks of aortic artery disease | Family history, advanced age, male, smoking, atherosclerosis, treated/untreated HTN, CAD, high cholesterol, genetic abnormalities |
| Signs and symptoms of aortic aneurysm | Often asymptomatic until rupture or dissection. Abdominal: palpable pulsatile mass, back/abd pain, cyanosis, blood clots. Thoracic: constant pan, HF, dyspnea, cough, hoarseness, dysphagia. |
| aortic aneurysm management | Determined by size, location and symptoms. Usually managed medically if less than 6 cm. Use CT/MRI and transthoracic echo for diagnosis. BP control (ACE inhibitors, ARBs, beta blockers). |
| Endovascular Aneurysm Repair (EVAR) | Sutureless endothelial stent graft placed. Risks of bleeding, infection, MI, renal failure, or graft occlusion. |
| Aortic Dissection | EMERGENCY. loss of circulation to arteries distal to the dissection; caused by media degeneration/HTN. Sites include ascending and descending thoracic aorta (as well as abd). |
| S/S of Aortic Dissection | Sudden onset of severe and persistent pain (tearing or ripping) within the chest/back that can extend to the shoulders, epigastric area, or abd. Will see diaphoresis, N/V, syncope and increased HR. BP VARIES ON EACH ARM |
| Aortic Aneurysm Rupture | Most life-threatening complication due to the sudden and extreme loss of blood. Can present same as aortic dissection (pain, tachycardia, BP differing in arms, LOC due to shock from blood loss). Most patients die (80%). |
| Nursing care of Aortic Aneurysm/Dissection | assess VS, neuro status, pain, peripheral pulses, sensation and motor, abdominal exam. Admin antihypertensives, statins, tetracyclines/macrolides, stool softeners. Teach warning signs and strict adherence |
| Hemodynamic Stability | Cardiac output (CO = stroke volume x HR. Normal is 4-6 L/min). High CO: early septic shock hypervolemia, hyperthermia. Low CO: shock, MI. Stroke volume: blood pumped by LV each beat |
| What to do for increased Cardiac Output | Fluid bolus, inotropic meds (epi/dobutamine), treat underlying cause |
| Preload | End diastolic volume or pressure stretching ventricles influenced by blood volume, HR, body position, intrathoracic pressure, venous return, atrial contraction and valvular regurgitation. |
| Afterload | Force or resistance ventricles overcome to eject blood into pulmonary circuit / aorta |
| Contractility | Heart muscle's intrinsic ability to contract. Poor contractility decreases CO. Positive inotropes (epi, dobutamine) enhance heart's contractility |
| Arterial Lines | Provides BP monitoring for critically ill pts. Used to obtain ABGs. Radial artery most commonly used. Inserted by trained providers, do allen test. Removal: need to apply pressure 3-5 min after (longer if on anticoags), hold arm above heart. |
| Aline complications | blood loss from tubing becoming disconnected or accidentally dislodged, damage to artery or occlusion, infection |
| Central Venous Pressure (CVP) | Placed into internal jugular/subclavian. Measures preload (normal is 2-6mHg). Low means hypovolemia, peripheral vasodilation, sepsis; give fluids and vasopressors). High means increased volume from Rsided HF, tension pneumo, pulmonary HTN, tamponade |
| Central line maintenance | Ensure line is anchored. Maintain patency with saline flushes, IV fluids. KEEP TRANSDUCER AT PHLEBOSTATIC AXIS. Monitor for dampened waveforms (air, blood or line malfunction). Use aseptic technique. Assess site daily and maintain occlusive dressing. |
| What to report to dr regarding central line | pressures outside parameters, persistent dampened waveform, impaired circulation, signs of infection, catheter dislodgment or bleeding/swelling at site |
| MI risk factors | Modifiable: smoking, hyperlipidemia, type 2 diabetes, obesity, sedentary, elevated adrenaline, HTN. Nonmodifiable: male, postmenopausal, or family hx |
| MI stable angina | intermittent chest pain from narrowed coronary artery. Triggered by activity / exercise and is relieved by rest. no heart muscle damage but warning of possible MI |
| Acute Coronary Syndrome (ACS) | umbrella term for myocardial ischemia. Unstable angina is pain at rest not relieved by rest, ECG changes, no cardiac marker elevation. MED EMERGENCY |
| NSTEMI | non-ST elevation MI; partial occlusion of major vessel or complete occlusion of minor vessel. causes partial thickness muscle damage |
| STEMI | ST Elevation MI. Complete occlusion of major vessel causing full thickness muscle damage |
| s/s of MI | Chest pain (stable/unstable), radiating pain, SOB, N/V, diaphoresis fatigue. Usually early morning onset. Left Coronary Artery: dyspnea, increased HR, HTN. Right Coronary Artery: JVD, hypotension, bradycardia |
| MI diagnostics | Cardiac markers (troponin: rises 4 hours of onset, elevated for 10 days after), CK, CKMB (creatine kinase myocardial band; increased levels seen at 3 hrs and up to 36 hrs after), CMP, CBC, coag, ABG. EKG, echo, coronary angiography (dye/GOLD STANDARD) |
| Treatment of MI | Oxygen, nitroglycerin Sublingual (1 tablet every 5 minutes up to 3 doses), IV nitro if persists - will drop BP. Aspirin makes clots slippery and pain meds (morphine sulfate). Beta blockers, heparin, clopidogrel/ticagrelor/cangrelor, fibrinolytic therapy |
| PCI: Percutaneous Coronary Intervention for MI | preferred method to open coronary arteries. Door to balloon time needs to be within 90 min of arrival. Stent may be placed. Radial artery preferred. Femoral: pt lays flat 2-6 hrs, higher risk of internal bleeding. 12 months of antiplatelet therapy w/stent |
| Coronary Artery Bypass Graft (CABG) | revascularization that bypasses blockage in coronary arteries. healthy artery/vein is grafted. Watch for complications of bleeding, MI, stroke, infection, renal failure, etc after surgery |
| Complications of MI | stroke / HF due to extensive myocardial damage. Arryhtmias (asystole, asymptomatic bradycardia, heart block, ventricular ones, etc. May need pacemaker). |
| Post CABG management | Maintain BP control, administer fluids/meds (vasodilators and constrictors, inotropes/diuretics), rewarm pt slowly, pulmonary hygiene (oral care q4hrs, repositioning, suctioning), wound care, cardiac rehab for after |
| Cardiomyopathy risk factors | diabetes, high fat diet, obesity, family hx of heart disease, HTN, high cholesterol, sedentary lifestyle, smoking, alc/cocaine, genetic, ESRF, chemo, viral infections (HIV, lyme), pregnancy |
| Cardiomyopathy s/s | chest pain, palpitations, dizziness, indigestion, N/V, diaphoresis, SOB, fatigue, rapid/irregular HR, edema, pulmonary congestion with overload, gallops/murmurs, JVD, enlarged liver, cough, fainting, sleepy, depression, loss of appetite |
| Cardiomyopathy patho | Most common: dilated cardiomyopathy (decreased CO). Hypertrophic: left ventricle thickens/enlarges (diastolic dysfunction). Restrictive: still ventricular muscle (HF/dysrhythmias). Causes structural changes to heart muscle due to enlarged/weak |
| cardiomyopathy diagnosis | chest xray (enlarged heart), echo (size and motion of heart), ECG, MRI, b-type BNP, chem panel, renal/liver function, thyroid function, iron, cbc |
| Treatment for cardiomyopathy | ACE-I, ARB, beta blockers, digoxin, diuretics |
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