Valve Disorders
Aortic Stenosis
Meds don't fix the valve, only replacement. Manage HR symptoms. Use diuretics/fluids cautiously.
These patients are preload dependent
Fibrinolytic Therapy
Urgent reperfusion is needed. PCI is preferred; fibrinolysis can be used when timely PCI isn't possible and the patient qualifies.
Fibrinolytic: Actively dissolves an existing clot by breaking down fibrin.
Adenosine 6mg + 20 mL flush (stopcock)
Stable Angina
•Nitrates (e.g., Nitroglycerin) to relieve chest pain.(Vasodilator)
•Beta-blockers (e.g., Metoprolol) to reduce heart rate and therefore 02 demand.
•Calcium channel blockers (e.g., Amlodipine) to improve blood flow.
•Aspirin to prevent blood clots.
•Statins (e.g., Atorvastatin) to lower cholesterol (dec risk of narrowed arteries that block blood flow/o2)
Administer prescribed antibiotics for Group A Strep
Administer anti-inflammatory medications as prescribed
Rheumatic Fever / Rheumatic Carditis
Aortic Regurgitation
Afterload-reducing medications (ACE inhibitors, hydralazine) to improve forward flow. Avoid bradycardia, because slower HR allow more regurgitation into the LV.
Anticoagulants
STEMI/NSTEMI
Anticoagulant: Prevents the clot from getting bigger and new clots from forming. It does not directly dissolve the existing clot.
AFIBB w/RVR, asymptomatic
Beta blocker or CCB (Diltiaziem - controls rate and can restore sinus rhythm)
If rate control takeng or already tried w/ + no reponse = start Amiodorone gtt on a pump.
Unstable Angina
Nitroglycerin: Relieves chest pain by widening blood vessels and reducing the heart’s workload.
Aspirin: Prevents platelets from clumping and forming blood clots.
Beta-Blockers: Slow the heart rate and reduce the heart’s oxygen demand.
Administer prescribed NSAIDs/analgesics to decrease inflammation and pain
Pericarditis
Mitral Stenosis
•Watch HR/R closely d/t AFIB risk. Meds may include beta-blockers, amiodarone, or digoxin.
•If the patient is in AFib, anticoagulation is essential to prevent stroke.
Morphine
Stable Vtach w/ a pulse
Amiodarone gtt on a pump.
Prinzmetals
•CCB: (e.g., Amlodipine, Diltiazem): These relax and widen blood vessels, preventing spasms and improving blood flow.
•Nitrates (e.g., Nitroglycerin): These help relieve CP by relaxing and dilating blood vessels.
Advise all providers, including dentists, of history of endocarditis so that antibiotic prophylaxis is prescribed if needed.
Infective Endocarditis
Mitral Regurgitation
Manage fluid and afterload with diuretics and ACE inhibitors.
Cardiogenic Shock
Dobutamine - Inotrope = contractility
Norepinephrine - Vasopressor = Support BP
Pulseless VT
Code meds: 1mg Epinephrine
Morphine: only for severe, persistent pain despite appropriate therapy
O₂: only if hypoxemic/low SpO₂ or respiratory distress
Anti-inflammatory medications (NSAIDs or corticosteroids), NSAIDs avoided if HF is present because they cause NA and water retention which→ worsens fluid overload & reduce kidney perfusion → which can worsen renal function.
Myocarditis
Nursing Considerations: Monitor for left-sided HF: dyspnea, fatigue, pulmonary edema" Which D/O?
Mitral Regurgitation:
•Acute MR causes sudden blood backup into the lungs, leading to rapid-onset pulmonary edema and respiratory distress)
•Encourage gradual activity to avoid overstressing the heart.
Nursing consideratiions: PDE-5 inhibitor use
Due to risk for severe hypotension.
Teaching: Nitro → think BP concerns
VFIB
1. Epinephrine 1 mg IV/IO: every 3–5 min after the second shock.
2. Amiodarone: (antiarrhythmic): 1st dose: 300 mg IV/IO after 3 shocks for refractory VF/pulseless VT
•2nd dose: 150 mg IV/IO if VF persists
3. Lidocaine: alternative to amiodarone for shock-refractory ventricular fibrillation or pulseless ventricular tachycardia (VT/VF)
NURSING INTERVENTION:
Pt arrives w/ CP > 15 min unrelieved by Nitro (3 doses). Hx of prev stent placed 2022. VSS, Diaphoretic. Priority intervention within 1st 10 min?
12 Lead EKG
Nursing Considerations: 🚨 ↓ BP, ↑ HR, JVD, muffled heart sounds, ↓ cardiac output are s/s of what complication?
Cardiac Tamponade