Drugs
non selective BB, do not give if COPD
propanolol (Inderal)
related to sulfa, check for allergies
Loop and thiazide diuretics
most common reason for hospital admit over 65 yrs
what is HF? 25% pts readmitted to hospital within 30 days
Lab to check for fluid overload
BNP (brain natriuretic peptide) normal less than 100 severe HF greater than 700
Echocardiogram
Useful in evaluating size, shape, and position of structures and movement within the heart
▪ Test of choice for valve problems
▪ Can evaluate blood flow through the heart and determine ejection fraction
▪ An ultrasound probe that emits sonar waves is guided over the chest wall while the patient is supine or turned on the left side.
Pulsus paradoxus
Pulses paradoxus is therefore an exaggeration or an increase in the fall of systolic BP beyond 10 mmHG during inspiration. Normally during inspiration, a person's systolic blood pressure decreases by ≤10 mmHg and pulse slightly increases.
ends in pril
what is ACE lisinopril
hyperkalemia, angioedema, cough, no NSAID, can decrease neutrophils
potassium sparing
what is Aldactone triamterene
no potassium supplements
Rt sided HF
JVD, ascites, weight gain, hepatomegaly, dependent edema
non invasive , 12 lead precordial and 6 limb leads
what is 12 lead EKG?
MRI safety- contraindications CAUTION
Check pacer/ICD, mechanical valve, cochlear implant, some med patches with metal backing (nicotine, nitro), implantable pumps (insulin, neuro stimulators) pregnancy
pulse pressure
difference between systolic and diastolic BP
losartan
what is ARB, monitor for hyperkalemia, angioedema
no cough
why use BB after MI
cardioprotective, block catecholamines (less excitability, decrease SNS stimulation lower Heart rate)
Infective or bacterial endocarditis
•The mitral valve is the most common location of infection
•Repair of congenital cardiac problems, such as atrial or ventricular septal defect, may be performed.
•Streptococcus viridans, a bacterium found in the mouth, is responsible for about 50% of cases of infective endocarditis. Regular dental care is very important.
IVDA- can lead to sepsis
No more than 12-24 hours, pt keeps diary, checks for arrhythmias, no shower
what is holter monitor
TEE (transesophageal echo)
Provides images of the wall thickness, heart valve structure and function, atrial septum, and presence of clots, and can calculate ejection fraction
▪ Pharynx is anesthetized with topical agent.
check gag reflex after procedure before food or water
Cardiomyopathy
•A group of diseases that affect the structure or function of the heart.
Sx: •Dyspnea, activity intolerance, angina, dizziness, hypertension, and palpitations.
ends in osin, first dose syncope
prazosin, tamsulosin alpha adrenergic blockers
BPH- flomax Tamsulosin)
anticoagulation for afib, no blood test, no antidote
what is apixaban (eliquis)
diastolic/systolic HF
heart is too stiff to relax and fill normally with blood. Very concerning, poor cardiac output
systolic heart failure becomes too weak to squeeze normal amounts of blood out of the heart when it pumps
NPO or light meal, no caffeine or BB prior to test, good walking shoes, check for hearts ability to be stressed
what is stress test?
hsCRP
Level increased with inflammation
▪ Hs-CRP specific to heart
Valve disorders increase with age, calcification and stiffening, regurgitation of blood, prolapse
•Mitral and aortic valve disorders are the most common cardiac valve disorders
Cardiac Glycoside and Positive inotrope
what is digoxin? check apical for 1 full minute
antiplatelet, after PCI (stents) name 2
aspirin (ASA) and clopidogrel
HF NANDA
activity intolerance, fluid volume excess, ineffective perfusion
angiography look at coronary arteries for blockage
what is rt or left sided catheterization
Most often femoral, brachial or radial arteries
Cardiac biomarkers to dx heart attack
Troponin I and T, myoglobin and CK-MB
show cardiac skeletal muscle damage
Baseline then serial enzymes every 6 hrs for 24 hours will increase in 24 hours
detects extent of damage and stay high for up to 1 week
Pacemaker/ ICD
Treat lethal arrythmias (VT and VF) sinus node failure (tach/brady)
Sling for 48 hrs, No heavy lifting
No driving for 30 days or more (lethal arrhythmia)
negative chronotropic
BB, CCB, digoxin
they decrease heart rate and conduction of impulse from SA-AV node
this electrolyte can trigger dig toxicity if levels are low
hypokalemia
review signs and sx dig toxicity and hypokalemia
Measure effectiveness of HF meds and RX (E in ADPIE)
•Increased urinary output
•Decreased edema, shortness of breath, dyspnea, crackles, fatigue
•Resolution of paroxysmal nocturnal dyspnea
•Improved peripheral pulses, skin color, temperature
complication after PCI, cardiac catheterization
hemorrhage, apply pressure monitor pulses (DVT)
Lipids profile (fasting)
Total cholesterol should be less than 200
▪ HDL- HDL: 30–80 g/dL (heart healthy)
▪ LDL less than 130 or less than 100 if heart disease
▪ Triglycerides less than 150
Treat dysrhythmias
Drug therapy
Synchronized cardioversion for AF and AFib
Cardiac pacemakers
Medications rhythm control
Implantable cardiac defibrillators (ICDs)
Radiofrequency catheter ablation
Pos Inotropic
Positive inotropic drugs: increase the force of myocardial contraction
Dopamine, Dobutamine, Epinephrine, Digoxin, CCB and BB
HTN/HF drugs for ethnic specific population
•Hydralazine and isosorbide dinitrate became the first drug approved for a specific ethnic group. Hydralazine/isosorbide dinitrate (BiDil) was approved specifically for use in the African-American population
NO BB/ACE or ARB for above
Causes of HF
Myocardial infarction (MI)
Coronary artery disease
Cardiomyopathy
Valvular insufficiency
Atrial fibrillation
Infection
Tamponade
Ischemia
loop recorder, internal or external
A portable device to record the heart's electrical activity (ECG) to
monitor symptoms and record cardiac events.
▪ Type: Monitoring (both internal or external)
▪ Duration: External: Usually 15-30 days
Internal: up to 3 years monitor for a fib
Anorexia, nausea, vomiting, diarrhea. Visual disturbances (blurred vision, seeing green or yellow halos around objects) Pt taking Digoxin
Hold dose call provider for further orders
P's and Q's don't agree, heart rate less than 40 BPM
pacemaker will be needed to prevent further heart block
What is third degree HB?