Cardiac Disorders

Atherosclerosis

Plaque builds up in arteries and reduces bloodflow to the heart

Untreated atherosclerosis leads to

ischemia and MI

Leading cause of coronary artery disease?

atherosclerosis

Atherosclerosis risk factors

HTN, diabetes, smoking, obesity

good cholesterol

HDL (happy)

bad cholesterol

LDL

Metabolic syndrome

Cluster of conditions increasing heart disease risk

Lipid lowering meds

statins,

Statins MOA

lower cholesterol by blocking liver enzyme that makes cholesterol

Statins harm what organ?

Liver

What labs do you check before starting statins?

Liver enzymes AST/ALT

Statins cause what adverse reaction?

rhabdomylosis (skeletal muscle breakdown)

Nicotinic Acids (Niacin)

s/e: increase blood sugar

do not take if severe gout or peptic ulcers

Fibric acids

given with statins, GI upset and rnhabdomylosis

Bile Acid Sequestrants (Cholestyramine)

adjunct therapy, GI upset

Cholesterol Absorption Inhibitors (Ezetimibe)

Less GI upset than fibrates, OTC fish oil capsules

Angina Pectoris

recurrent chest pain caused by heart ischemia

no permanent damage or cell death

caused by atherosclerosis of major artery

Stable angina

caused by exertion or stress

Relieved by rest and/or NTG

Unstable angina

occurs at rest

NOT relieved with NTG (nitroglycerin), can lead to MI

AKA acute coronary syndrome (ACS)

Variant angina

coronary arteries spasm, occurs at rest

triggered by smoking

Angina interventions

stop activity and rest, nitroglycerin tablet under tongue every 5mins up to 3 doses

Call 911 if not relieved

What are cardiac enzymes?

chemicals released into the blood when heart is damaged

blood is measured to look for MI

3 Major Cardiac enzymes?

Troponin, CK-MB, Myoglobin

Troponin

most specific protein for MI, remains elevated 7-14 days

Normal = < 0.5 ng/mL

Positive = > 2.3 ng/mL

Most important cardiac biomarker

Highly specific for cardiac muscle injury

Begins rising: 3-6 hours

Peaks: 12-24 hours

Remains elevated: 7-14 days

Used with ECG and clinical symptoms to diagnose MI

Key point: Troponin = most specific + stays elevated longest

Elevated troponin indicates myocardial injury, not automatically an MI.

CK-MB

less specific than troponin; returns to normal in 48-72 hours; useful for reinfarction

Because it returns to normal quickly, a second rise can indicate reinfarction.

Myoglobin

rises first but is not cardiac-specific; returns to normal in about 24 hours

C Reactive Protein

marker for inflammation

elevated in ACS

normal

Angina Meds

- Nitrates

- Beta blockers (-olol)

- Ca channel blockers (-pine)

How to take SL nitroglycerin?

place under tongue every 5 mins, 3 doses

GO TO ER after 3rd dose

NEVER take nitroglycerin with __, leads to shock

Sildenafil (Viagra)

Beta blockers

lower HR and BP by blocking beta receptors

Ca channel blockers

Antiplatelets MOA (aspirin, clopidogrel)

stops platelets from sticking together and prevents blood clots

Anticoags MOA (heparin IV)

target clotting factors and stops blood clot from progressing

MI Tx: MONA stands for

Morphine

Oxygen

Nitroglycerin

Aspirin

Myocardial Infarction (MI)

coronary artery is blocked, causing ischemia and death of heart muscle tissue

Types of MI

STEMI and NSTEMI

ST-elevation MI (STEMI) - EMERGENCY

complete blockage of coronary artery, rapid MI death

ST elevation on EKG

Non-ST Elevation MI (NSTEMI)

partial blockage of coronary artery

Most common cause of MI?

Rupture of atherosclerotic plaque causes blood clot to block artery

MI Meds

MONA, beta blockers, ACE inhibitors, Anticoags, Thrombolytics

What is the IMMEDIATE intervention for a STEMI?

Cath lab within 1 hour for immediate PCI

(balloon inflates artery and stent is placed to keep it open)

Thrombolytics (-plase)

Clot busters dissolve clot, give within 30 mins

Alteplase (tPA)

MAJOR risk of thrombolytics?

Intracranial hemorrhage and severe bleeding

ACE inhibitors MOA (-pril)

Blocks conversion of angiotensin I to angiotensin II

ex. Lisinopril

ACE inhibitors: 3 side effects?

A: Angioedema

C: Cough

E: Elevated K+

ARBS (angiotensin II receptor blockers) (-sartan)

Blocks action of angiotensin II at receptor

ex. Losartan

PTCA Post Op Care

Same as cardiac cath

Vitals q30mins for 2 hours

LAY FLAT in bed with affected leg straight

Monitor site for hematoma

CABG (Coronary Artery Bypass Graft)

Vein taken out of body and used to bypass blocked artery

CABG Pre Op Care

inform about chest tubes, ventilator, foley cath

CABG post op care

Heart → rhythm + cardiac output

Chest tubes → bleeding/drainage

Lungs → incentive spirometry + coughing/deep breathing

Incisions → infection

Kidneys → urine output + renal function

Recovery → pain control

Chest tube >200ml indicates __ ?

Internal bleeding, check for fluid overload from HF

What does Hemodynamic Monitoring measure?

Pressure, flow, and oxygenation within the heart

Types of hemodynamic monitors

- PAC (Pulm artery catheter)

- CVP (Central venous pressure cath)

- Arterial BP monitor

PAC (Swan-Ganz catheter) measures __

Left sided heart pressure (PAWP)

Normal PAWP (Pulmonary Artery Wedge Pressure)?

6-12 mmHg

CVP (central venous pressure) measures __

Right-sided heart pressure and fluid volume

Normal CVP

2-6 mmHg

High CVP indicates __?

fluid overload

Low CVP indicates __?

not enough fluid

Arterial blood pressure monitoring care

immobilize body part, ROM, assess site every 1 hour

Heart Failure

Heart is unable to pump blood efficiently

HF Diagnostic Labs

Ejection fraction

Left sided HF (LUNGS)

pulmonary edema, dyspnea, crackles

Right sided HF (BODY)

peripheral edema, JVD, weight gain

LifeVest

Wearable cardioverter defibrillator for high risk heart failure patients

Ventricular Assist Devices

Manually pumps the ventricle while waiting for heart transplant

Intra-Aortic Balloon Pump (IABP)

balloon inserted into aorta that inflates and deflates with the cardiac cycle in order to decrease afterload and increase coronary perfusion.

Cardiogenic Shock

Shock caused by inadequate function of the heart, or pump failure.

Cardiogenic Shock signs

Low BP, rapid weak pulse, rapid respirations, cool/pale skin, decreased urinary output