Cardiac Critical Care Nursing

Heart Walls

Endocardium

Myocardium

Pericarium

Heart Chambers

Superior/Inferior Vena Cava

Right Atrium

Right Ventricle

Pulmonary Artery

Left Atrium

Left Ventricle

Aorta

Heart Valves

Tricuspid

Pulmonary

Bicupsid (Mitral)

Aortic

Systole

Ventricles contract, atria relax

Diastole

Atria contract, ventricles relax

Veins

Low pressure systems, return deoxygenated blood to the heart

Capillaries

The site where waste and nutrients are exchanged

Arteries

High pressure system, carries oxygenated blood away from the heart

Pericarditis

Inflammation of the pericardium

Myocarditis

Inflammation of the myocardium

Endocarditis

Inflammation of the endocardium

Pericarditis Signs/Symptoms

Decreased pain when sitting/leaning forward, increases when laying back or deep breathing

Pericarditis Causes

Heart Surgery

Myocarditis Signs/Symptoms

Irregular HR

Syncope

Mimics MI

Elevated Troponins

Pain, headache, body ache, joint pain, sore throat

Myocarditis Causes

Viral, Bacterial (strep), Fungal Infection

Autoimmune disorders

Cardiotoxins

Endocarditis Signs/Symptoms

Fever

+blood cultures

Emboli

Petechiae visible on hands/feet

Tachycardia

Fatigue

Joint Pain

Cough

Swelling in lower extremities and abdomen

Endocarditis Causes

Introduction of Bacterial (oral infection/surgery, IV drug use)

S1 Heart Sounds

AV valves closing

Beginning off Ventricle Systole/Atrial Diastole

“Lub” Sound

S2 Heart Sounds

Semilunar Valves closing

Beginning off Ventricle Diastole/Atrial Systole

“Dub”

S3 Heart Sounds

Abnormal Heart Sound

Occurs after S2

Flow of blood from atria into a dilated or compliant ventricle

Heard during HF, Fluid Overload, Cardiomyopathy, MR, TR

ken-tuck-Y

S4 Heart Sounds

Occurs before S1

Due to atrial contraction into a noncompliant ventricle

Heard during Ventricle hypertrophy, AV Blocks, AS, PS

TEN-nes-see

Stenotic Murmur

Heard when valves are open

Harsh grunting sound

Regurgitant Murmur

Heard when valves are closed

Soft blowing sound, Whoo

Mitral regurgitation can cause

Dyspnea

PE
Emboli

AF

Fatigue

Mitral stenosis can cause

Dyspnea

Hemoptysis

Fatigue

RV Failure

Aortic insufficiency can cause

Dyspnea

Orthopnea

LV failure

Paroxysmal nocturnal dyspnea

Fatigue

Aortic stenosis can cause

Angina

Syncope

Failure

Pulse Pressure

SBP - DBP

Reflects SV

Measures the force your heart generates each time it contracts and serves as a key indicator of arterial stiffness and overall heart health

Normal Pulse Pressure

30-40 mmHg

Decreased Pulse Pressure

Hypovolemia

CHF

AS

Cardiac Tamponade

Increased Pulse Pressure

Exercise

Stiff arteries

AI

AV malformation

Hyperthyroid

JVP looks at which vein?

EJV

JVD looks at which vein?

IJV

Which lab is the gold standard for cardiac?

Troponin

Myoglobin release time

1-3 hours

Myoglobin peak time

6-7 hours

Myoglobin returns to baseline

24 hours

Troponin release time

3-12 hours

Troponin peak time

24 hours

Troponin returns to baseline

5-10 days

CK release time

3-12 hours

CK peak time

24 hours

CK normalizes after

48-72 hours

Cardiac Tamponade

Excessive fluid build up in the pericardium

Beck’s Triad

Hypotension

Muffled heart sounds

Increased JVP (Increased JVD during inspiration)

Cardiac Tamponade

Pericardiocentesis

Surgery

Systolic Failure

HFrEF

A contractility issue with lack of forward blood flow EF <40%

LV Enlargement

Diastolic Failure

HFpEF EF> 50%

Relaxation issue challenge with filing the ventricle.

LV Hypertrophy

Systolic Failure Symptoms

Tachypnea and Dyspnea

Tachycardia

S3

Mitral Regurgitation

Crackles, cough, and frothy sputum

BNP Levels

Wet Lungs

Elevated PAP

Diastolic Failure Symptoms

JVD
Peripheral edema

Hepatomegaly

Hepatojugular reflux

Anorexia, nausea, and vomiting

Ascites

Tricuspid Regurgitation

Increased CVP

Increase liver enzymes

Clear lungs

Patient is warm and dry

Fluid Status and Perfusion are normal

Patient is warm and wet

Perfusion is normal

Fluid Status is elevated, needs diuretics/vasodilators

Patient is cool and dry

Perfusion is low

Fluid Status is okay or dry, needs passive leg raise, fluid challenge, Beta Adrenergic + Beta 1

Patient is cool and wet

Perfusion and Fluid Status are low

+Beta 1, Beta 2, Diuretics, and/or Vasodilators

Acute exacerbation management includes

Diuretics

Nitro

Dobutamine/Milrinone

BiPAP

BNP

Why do we use diuretics for acute exacerbation?

First priority for fluid overload

Why do we use nitroglycerin for acute exacerbation?

Decrease preload and myocardial workload

Why do we use dobutamine/milrinone for acute exacerbation?

Positive inotropic support

Why do we use BiPAP for acute exacerbation?

Used to treat respiratory failure for hypercapnia or hypoxia and decrease preload

Why do we order BNP during acute exacerbation?

Hormone secreted by ventricles in response to being stretched. Allows for rapid diagnosis

Long Term Management of HFrEF

Ace Inhibitors

ARBs

Beta Blockers

SGLT2 Inhibitors

Mineral Corticoid

Long Term Management (ACE-Inhibitor)

Decrease afterload (and preload indirectly)

What to monitor with ACE-Inhibitors?

Blood Pressures

K+

Creatinine

Cough

Angioedema

Long Term Management (ARBs)

Decrease afterload

What to monitor with ARBs?

Blood pressure

K+

Creatinine

Long Term Management (Beta Blockers)

Decreases HR

Decreases BP

Decreases Preload and myocardial workload

What to monitor with SGLT2 Inhibitors ?

Blood Pressure

Creatinine

Glucose

Long Term Management (SGLT2 Inhibitors)

Reduce preload and afterload

Diuretic

Stabilizes glucose

Decreases myocardial work