Cardiac

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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

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

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