Medsurge cardiac part 2

Systolic blood pressure

Peak pressure against arteries during ventricular contraction. Normal = less than 120 mm Hg

diastolic blood pressure

Residual pressure in arteries during ventricular relaxation. Normal is less than 80 mm Hg

cardiac output x systemic vascular resistance

what are the influencing factors for blood pressure

pulse pressure

the difference between systolic BP and diastolic BP. its normally about 1/3 of the SBP.

exercise and atherosclerosis

what things will increase pulse pressure

heart failure, hypovolemia

what will decrease pulse pressure

mean arterial pressure

this is the average pressure within the arterial system. equation is: (SBP + 2 DBP) ÷ 3. (must be >60 to perfuse vital organs)

cardiac natriuretic peptide markers

hormones that help regulate blood pressure and fluid balance by promoting natriuresis (sodium excretion), vasodilation, and diuresis.

echocardiogram

a noninvasive ultrasound test that evaluates the structure and function of the heart by recording the movement of cardiac structures.

determine abnormalities of valves, heart chambers, ventricular and septal motion and thickness, pericardial sac, ascending aorta, also measures EF

what can echocardiograms do?

Ejection fraction

% of end-diastolic blood volume ejected during systole. should be >55

pericarditis

positional chest pain that improves when leaning forward and worsens when lying back indicates:

Heart failure

Complex clinical syndrome resulting in insufficient blood supply/oxygen to tissues and organs

hypertension

what is the most modifiable risk factor for heart failure

diabetes, metabolic syndrome, advanced age, tobacco use, vascular disease

what things can contribute to development of HF

primary causes

Conditions that directly damage the heart

precipitating causes

Conditions that increase workload of the heart

left sided heart failure

Most common form of HF. LV doesn’t empty adequately or fill enough, resulting in pulmonary congestion and edema

impaired contractile function, increased afterload, mechanical abnormalities (weak heart)

what is HF with reduced EF (systolic HF) caused by

afterload

 the amount of pressure the heart needs to exert to pump blood out of the ventricles. It's the force that opposes the heart's contraction. 

HF with preserved EF (diastolic HF)

The inability of the ventricles to relax and fill during diastole

Resulting in decreased stroke volume and CO. often due to stiffened heart muscle

>50%

what is the ejection fraction in diastolic HF (Heart failure with preserved EF)

Right sided HF

when fluid backs up into the venous system, moves into tissues and organs. most common cause of this is left sided HF

cor pulmonale

right ventricle dilation and hypertrophy

biventricular failure

both ventricles fail. Fluid build-up and venous engorgement decreased perfusion to organs

peripheral edema, ascites, JVD

what are ss of right sided HF

hypertrophy

Adaptive increase in muscle mass and heart wall thickness which overtime leads to poor contractility, increased O2 needs and poor coronary artery circulation. risk for dysrhythmias

cardiac remodeling

 a structural change in the heart due to chronic RAAS and SNS activation, leading to ventricular hypertrophy, dilation, impaired pumping, and increased risk of dysrhythmias and sudden cardiac death (SCD).

Acute Decompensated Heart Failure

a SUDDEN worsening of heart failure symptoms, leading to fluid buildup, pulmonary congestion, and decreased oxygen levels, often requiring hospitalization and urgent treatment. 

early signs: mild SOB and increased RR. later: pulmonary edema, tachypnea, dyspnea, low O2, then respiratory acidosis

what are signs of acute decompensated HF

severe dyspnea, blood-tinged frothy sputum, crackles, wheezes, anxious, pale, cyanotic, accessory muscle use

what are some Pulmonary Edema Clinical Manifestations

ultrafiltration (aquapheresis)

treatment for patients with ADHF who have volume overload and resistance to diuretics

reduces preload and afterload. dilates coronary arteries, relieves dyspnea and anxiety

what does morphine do for severe heart failure

nitroglycerin, sodium nitroprusside, nesiritide

what drugs can be used for ADHF to vasodilate

digitalis (digoxin)

used in sever HF, increases contractility, slows heart rate, but is used cautiously due to toxicity risk.

Phosphodiesterase Inhibitors: Milrinone 

drugs that Enhance contraction and vasodilation with severe HF

dopamine, dobutamine, norepinephrine  

positive inotropes used on beta receptors to increase contractility and boost heart function in severe HF

RAAS inhibitors

drugs that inhibit sodium and fluid retention lowering workload on heart

angioedema

what side effect can ACE inhibitors cause

2g/day

what should sodium be restricted to for chronic HF diet

fluid

Stage D HF patients may need to have a _________ restriction

3-5 lbs

how much weight gain a week should be reported to HCP

higher doses of aspirin, ephedrine, pseudoephedrine, diet pills

what drugs may increase sodium retention

transplant

what as the gold standard for end stage HF with a 75% survival rate at 3 yrs

brain dead

in heart transplants, the donor must be:

immunosuppressive meds

heart transplant patients have to take what for the rest of their life?

infection, cancer

what risks do immunosuppressant drugs ahve

weekly

how often are endomyocardial biopsies done for the first month

monthly

how often are endomyocardial biopsies done for the next 6 months after the first month

atropine

this should not be used to treat bradycardia in heart transplant patients

Intra aortic balloon pump

a mechanical device that helps the heart pump more blood and Provides TEMPORARY circulatory assistance by reducing afterload.

Ventricular Assist Devices (VADs)

provides short- and long-term support for a failing heart by shunting blood from the Left atrium or ventricle to a device and then to the aorta. can be internal or external and support the left, right, or both ventricles. it allows MORE mobility than IABP

hemodynamic monitoring

Measuring pressure, flow and oxygenation of cardio system. Assess heart function, fluid balance, cardiac output

CVP (Central Venous Pressure)

Measures pressure in the right atrium or superior vena cava, indicating venous return and right heart function.increased with HF/shock, decreased with hypovolemia (normal 4-8)

cardiac output

 The volume of blood pumped by the heart per minute, indicating overall heart function.

Systemic Vascular Resistance (SVR)

Measures the resistance to blood flow in the systemic circulation (afterload).

cardiac index

Cardiac output adjusted for body surface area (more accurate indicator of cardiac function for different body sizes).

arterial blood pressure

continuous BP monitoring thats more accurate than manual. must watch for bleeding/infection at site, nerve damage.

pulmonary art wedge pressure

will be increased in HF bc left-sided HF causes a backup of blood in the pulmonary circulation and it will be decreased with volume depletion (normal is 6-12)

infective endocarditis

disease of the endocardium innermost layer of heart. associated with poor prognosis and is more likely in IV drug users

splinter hemorrhages, petechiae, oslers nodes, janways lesions, roth spots, systolic murmur, HF,

what are some clinical manifestations of infective endocarditis

septic embolism

infective endocarditis can lead to _______________ where infected clots break off from the heart valves and travel to various organs, causing damage.

prophylactic antibiotic tx, blood cultures, Longterm IV antibiotics, valve replacement, antipyretics, fluids, rest

what is some interprofessional care for pts with endocarditis

stenosis

valvular constriction causing increased pressure and impeded blood flow.

regurgitation

incomplete closure of valve leaflets results in backflow of blood

3-D echocardiography, TEE, doppler color flow, chest x-ray, ECG, heart cath

what are some tests for valvular heart disease

mechanical

which type of valve replacement requires longterm anticoagulation

biologic

which type of valve replacement is more natural but less durable

pallor, jaundice, itching

what are some anemia skin manifestations

increased HR and stroke volume. systolic murmurs and bruits, angina, MI, and HF may occur

what are some anemia cardiopulmonary manifestations

iron deficiency anemia

most common anemia usually in young or women in reproductive age, or anyone with duodenum surgery. tx is supplements, diet changes, transfusions.

thalassemia

a genetic disorder affecting hemoglobin production. may see growth retardation, skeletal deformities. can get blood transfusions and bone marrow transplant

megaloblastic anemia

can be deficiency of vitamin B12 or folic acid. see fatigue, glossitis. neuro assessments for B12 deficiency. Often caused by diet

sickle cell diseases

genetic mutation. treated with Fluids, oxygenation, high dose narcotics, blood transfusions

2-3 months

how long do iron deficiency anemia patients need to take iron supplement after HgB returns to normal

thrombocytopenia

reduction of platelets below 150000. results in abnormal hemostasis, prolonged or spontaneous bleeding. primarily an acquired disorder

thrombotic thrombocytopenia purpura

a rare, life-threatening blood disorder that causes blood clots to form in small blood vessels. bleeding and clotting at the same time.

Plasma exchange, corticosteroids, immunosuppressants

First treat underlying disorder or remove cause

how do you treat thrombotic thrombocytopenia purpura

Corticosteroids, IVIG, rituximab, splenectomy in refractory cases

how do you treat Immune Thrombocytopenia Purpura (ITP) (an autoimune destruction of platelets)

Disseminated Intravascular Coagulation (DIC)

blood clotting factors become overactive and then body uses them all up which leads to uncontrollable bleeding. its caused by an underlying disease

D-dimer, decreased platelets, fibrinogen, clotting times prolonged, fragmented RBCs in blood smears

what diagnostic studies are used for disseminated intravascular coagulation

blood products

When patient with DIC is bleeding, ______________ are given while treating underlying cause