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What is the 2 most common causes of Heart Failure?
Coronary artery disease and uncontrolled hypertension
4 goals for HF treatment
1. reduce the workload of the heart/reduce oxygen demand
2. strengthen the heart's pumping action
3. relieve congestion in lungs
4. minimize sodium/water retention
Calcium channel blockers
-amlodipine, diltiazem, nifedipine, verapamil, nicardipine
-Vasodilation and reduces heart rate
-monitor HR & rhythm, BP, watch for s/s of heart failure
Ventricular fibrillation
CPR, defibrillation
Coronary artery disease
-narrowing of arteries, causing decreased blood flow/oxygen to heart
-chest discomfort, tightness, pressure, angina dyspnea, palpitations, N/V, fatigue
-stable angina- predictable pain- happens with exertion/exercise
-unstable- sudden onset pain with rest
-diagnosis- ekg, cardiac angiography (heart cath)
-treatment- low fat diet, weight loss, smoking cessation, meds to lower cholesterol,
-CAD can lead to MI if not treated
Factors that can precipitate heart failure
anemia
sepsis
MI
PE
thyroid disorders
infection of heart
stress
uncontrolled hypertension
Loop diuretics
Furosemide, bumetanide
removes excess fluid & wastes potassium
Dobutamine & Dopamine
Classification and action/use??
Inotropics
Increases cardiac contractility and cardiac output
Heart failure
Atropine
-blocks vagal tone--> increasing heart rate
-monitor HR and rhythm
-used for Sinus bradycardia
Myocardial infarction
ISCHEMIA in coronary arteries
EMERGENCY- outcomes depend on how fast treatment is started
-severe chest pain that radiates, dyspnea, sweating, tachycardia or bradycardia, N&V, syncope
-Diagnosis- EKG (st elevation), cardiac angiography (heart cath), elevated Troponin, CKMB
Tx- MONA, if SOB give oxygen first, IV heparin, beta blocker, stent/balloon, CABG, monitor cardiac enzymes and coagulation labs
Right sided heart failure signs/symptoms
fatigue, edema in sacrum, legs, feet ankles, hepatomegaly, ascites, weight gain, dyspnea
Potassium sparing diuretics
Triamterene (turns urine blue), amiloride, spironolactone
Remove fluid but NOT potassium
Acute pulmonary edema
emergency
place in high fowler, admin o2, diuretics, morphine
severe dyspnea, productive cough, pink-tinged sputum, tachycardia
Digoxin
-increased contractility, decreased heart rate
-check apical pulse 60 sec., hold <60
dig toxicity- blurred, halo vision, anorexia, nausea/vomiting, diarrhea, confusion
magnesium sulfate- used to correct dig toxicity- monitor for hypermagnesemia
Coronary artery bypass grafting (CAB or CABG)
-done when ischemia in artery can not be controlled medically or to prevent larger occlusion and consequential MI
-vein or artery are taken from saphenous vein in leg, radial artery in arm or mammary artery in chest and used to BYPASS the affected artery in the heart
-midsternal incision and incision from vein harvest (extraction)
-get pt ambulating, uses IS, and deep breathing, offer pain medication to help take deeper breaths, incision care, monitor labs and urine output
Left-sided heart failure signs/symptoms
wheezing/crackles, dyspnea, fatigue, orthopnea, pulmonary edema, pallor, clammy skin
Angiotensin-converting enzyme inhibitors (ACE)
Enalapril, captopril, lisinopril
Prevents vasoconstriction
Atrial fibrillation
Atria not pumping, just quivering- no P wave, irregular rhythm
s/s: lightheadedness, dizziness, SOB
blood pulls and clots, a dislodged clot can lead to STROKE or pulmonary embolus - (depends if right or left atrium is involved)
need anticoagulant
need anticoagulant
Pacemakers
avoid lifting the arm
monitor incision for infection
monitor pulse daily
can use microwave
NO MRI
carry pacemker ID card at all times
Nitroglycerin
-dilate arteries
one tab SL- can take every 5 minutes x3- then call 911
-keep in dark container
-expires 6 months after opened
-make cause dizziness, headache
Diagnostic testing for HF
CXR- shows enlarged heart/fluid accumulation in lungs
Echocardiogram- shows ejection fraction (50-70%)
Electrocardiogram- shows arrhythmias
BNP- brain natriuretic peptide- measures the level of a protein that released when myocardial (heart) cells are stretched (from enlarged heart) - <100
Beta-adrenergic blockers
-Atenolol, metoprolol, nadolol
-Reduce blood pressure, slows heart rate
-assess BP, HR, pulmonary history/status, monitor electrolytes, monitor blood glucose in diabetic patients
Ventricular tachycardia
POTENIALLY life-threatening
CHECK YOUR PATIENT for a pulse
pulse--> stay with patient but NOTIFY RN or physician, have pt cough or bare down (vagal response)
pulseless--> Start CPR, call for help, amiodarone, synchronized cardioversion
Endocarditis
-infection of inner lining of the heart/vales
-caused by infections from dental procedures, IV drug use with dirty needle, bacteria entrance into the body from skin, invasive procedure etc, rheumatic fever
-elevated C-reactice protein (CRP), elevated WBC (leukocytosis), fever, positive blood culture, new murmur, weakness, etc
-antibiotics (IV), monitor for dysrhythmias and heart failure, surgical intervention (valve replacement), prophylactic antibiotics before dental procedures
Labs
KNOW ALL LABS ON ASUTR sheet :)
*you should already know all these, seniors