nctc med surg cardia
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| What is the function of the heart? | The heart is a muscle that maintains the flow of blood to and from the brain and the body.
It sends deoxygenated blood to the lungs to become oxygenated. It then sends the oxygenated blood to the brain and the body.
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| * What are the four valves in the heart and where are they located? | * Tricuspid valve - between the right atrium and right ventricle
* Pulmonic valve- between the right ventricle and pulmonary artery
* Mitral valve- between the left atrium and left ventricle
* Aortic valve - left ventricle and the aorta
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| S1-lub | formed when the ventricle contracts and the mitral and tricuspid valves close
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| S2-dub- | formed during ventricular relaxation when the aortic and pulmonic valves close
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| S3- ventricular gallop | normal in children and young adults, usually indicates CHF in adults >30.
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| S4- atrial gallop | usually indicative of impending MI
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| How is blood supplied to the myocardium? | 3 main vessels- Right Coronary Artery, Left Anterior Descending & Circumflex
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| Arteriosclerosis | lining of walls of arteries and arterioles becomes thickened and hardened and lose elasticity, which leads to inability to stretch
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| Atherosclerosis | a form of arteriosclerosis where thickening of the artery walls is caused by soft deposits in the intima that harden over time. Ex: LDL cholesterol
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| What causes CAD? | * Arteriosclerosis
* Atherosclerosis
* Clot formation
* Vascular spasm
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| What are some of the S/S of CAD? | * CP called angina pectoris
* Pain is due to lack of O2 to the tissues
* HTN
* *Patients are usually asymptomatic until blood supply reduced by 60%
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| List some common s/s of angina. | “elephant on chest”
chest pressure or chest tightness
radiation of pain to left arm or jaw
pale
diaphoretic
SOB
N/V
“Stable” angina may be relieved with rest
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| Stable - 75% coronary occlusion | coronary arteries can’t dilate anymore
increased activity increases workload and O2 demands on heart, which leads to CP
* pain decreases with decreased activity
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| Unstable (crescendo) - 90% coronary occlusion | shows up as CAD worsens
CP increases in frequency and severity
does not decrease with rest or PO Nitro
high risk of AMI & death within 18 months
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| Prinzmetal’s angina (variant) | pain same as stable but lasts longer and occurs at rest
caused by coronary artery spasm
May occur despite absence of atherosclerosis
no damage to myocardium
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| Microvascular angina (Cardiac Syndrome X) | constriction of myocardial capillaries
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| Cardiac Glycosides | increases force of contraction-positive inotropic effect, slows heart rate by delaying impulse through the AV node
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| Vasodilators | relaxes all smooth muscles causing dilation of blood vessels, increases blood flow to coronary arteries
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| Calcium Channel Blockers | relaxes smooth muscle-decreases afterload
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| Beta Blockers | decreases workload on heart by decreasing CO
* decreases effects of epinepherine and norepinepherine-decreases vasoconstriction
DO NOT use with heart failure or pt’s with COPD
* May cause bronchial constriction
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| Analgesics | Morphine Sulfate (MSO4)
* MONA Morphine,O2, Nitro,Asprin - Chest pain
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| Describe a MI and how it occurs. | Actual death of myocardial tissue from complete and total loss of O2, due to obstruction of blood flow to a coronary artery
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| * Cardiac Troponin I | specific for cardiac injury when increased
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| * CK & CK-MB | increased due to damage seen with cell death
* rise in 4-12 hr
* peak in 24 hr
* normal in 3-4 days
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| Angiography | apply pressure for 30 min when cath removed
assess VS, pulses, and check for hemorrhage q 15 min
encourage fluids to flush dye
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| What care will the nurse provide after a cardiac cath/angioplasty? | * VS q 15 min x 4, then q 30 min
* Monitor site for bleeding with VS
* Check distal neurovascular status with VS
* Keep leg straight, may use soft restraint
* May use a sandbag to groin
* Must lay flat for 6 hours
* Use bed pan or urinal-NO BSC
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| What is the purpose of a CABG? | * coronary artery bypass graft surgery is performed to improve the blood supply to the myocardium
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| What medication reverses Coumadin? | Aquamephyton or Vitamin K
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| What is the antidote for Heparin? | * Protein sulfate or Protamine
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| What is cardiogenic pulmonary edema and what is the cause? | Fluid accumulation in the lungs
caused by left sided heart failure
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| What does the left side of the heart have to do with the lungs? | Blood empties into the left side of the heart from the lungs. This blood is oxygenated.
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| What causes left-sided heart failure? | * HTN is a major cause of left-sided heart failure
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| What are the classic S/S of cardiogenic pulmonary edema (left-sided CHF)? | * restlessness, agitation
* pale, cyanosis
* tachycardia, increased BP
* severe SOB
* orthopnea
* use of accessory muscles
* rapid respirations, cough
* crackles, wheezes, pink frothy sputum
* increased CVP with JVD
* pink, frothy sput
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| What symptoms would indicate a worsening of CHF? | * decreased LOC
* cyanosis
* quiet, shallow respirations
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| What is ventricular hypertrophy? | Enlargement (dilation) of the left ventricle due to long term HTN
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| right-sided failure? | * engorged organs
* total body swelling
* dependent edema
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| left-sided failure? | * pulmonary symptoms
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| Cardiomyopathy | Chronic condition due to structural changes in the heart muscle
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| Dilated Cardiomyopathy | decreased contractility leads to back up of blood in all 4 chambers which leads to left ventricular failure and CHF
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| Hypertrophic Cardiomyopathy | thickening of left ventricular septum and mitral valve leads to increased size of left atrium
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| Restrictive Cardiomyopathy | myocardium becomes rigid, CO & ventricular filling decreases, back up occurs and congestion results-chambers all decrease in size
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| What is bacterial endocarditis? | may also be called infective endocarditis- Infectious microorganisms invade the endocardium, primarily the valves
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| What are the usual causative agents for bacterial endocarditis? | * Beta-hemolytic streptococci, E-coli, streptococcus viridans, fungi
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| What are the S & S of bacterial endocarditis? | * Fever - most common sign
* CP, dyspnea
* Chills, night sweats, fatigue, malaise
* Weight loss, weakness, abdominal pain
* Anorexia, generalized pain in joints
* Murmur, pericardial rub
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| What do petechiae indicate? in endocarditis | * Petechiae due to embolization of microorganisms
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| What teaching will you do regarding Coumadin, and what is the therapeutic range? | * reduces risk of emboli
* avoid sharp objects, use electric razor, soft tooth brush, call for any abnormal bleeding
* PT: 1.5 to 2.0 times the normal/control
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| What is myocarditis? | an inflammation of the myocardium.
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| Number one drug used in cardiac arrest | epinephrine
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| Cardiac rehab |
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| compensation occurs when BP starts dropping | HR will increase
* Baroreceptors in heart stimulate the increase in HR to compensate for decrease in BP
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