Archer: Cardiology EKG

blood flow through heart

deoxygenated blood from body:

1. superior inferior vena cava; 2. right atrium; 3. tricuspid valve; 4. right ventricle; 5. pulmonic valve; 6. pulmonary arteries; 7. out to lungs

oxygenated blood from lungs:

1. pulmonary veins; 2. left atrium; 3. mitral valve; 4. left ventricle; 5. aortic valve; 6. aorta; 7. out to body

preload

amount of blood returning to right side of the heart (from the body)

afterload

pressure against which the left ventricle must pump to eject blood

compliance

Compliance describing how easily the heart muscle expands when filled with blood, allowing it to pump effectively.

contractility

strength of contraction of heart muscle

stroke volume

volume of blood pumped out of the ventricles with each contraction

cardiac output

amount of blood the heart pumps through circulatory system in a minute

Cardiac output = ?

Cardiac output is the amount of blood pumped by the heart per minute, and it is determined by multiplying the heart rate (number of beats per minute) by the stroke volume (amount of blood pumped per beat). The cardiac output is important because it affects the delivery of oxygen and nutrients to the organs

with more preload - blood coming back to the heart more

higher cardiac output

more blood coming back to right side of heart, more stretch in right atrium leads to stronger contraction => ultimately leading to _____________

higher cardiac output

more afterload leads to?

When there is more afterload (resistance to blood flow), it becomes harder for the heart to pump blood, resulting in lower cardiac output.

compliance and contractility incr. then

When compliance (stretchiness) and contractility (strength) of the heart increase, it can pump more blood with each beat, increasing the overall amount of blood pumped by the heart.

incr. stroke volume =

incr cardiac output

causes of decrease cardiac output

-bradycardia

-arrhythmias

-hypotension

-myocardial infarction (heart attack)

-cardiac musc. disease

causes of increase cardiac output

-incr. blood volume

-tachycardia (high HR)

-meds - Ace inhibitors, ARBS, nitrates, inotropes

ekg's

normal sinus rhythm

Normal sinus rhythm that has heart beats regularly, with a narrow QRS complex, a consistent rate of 60-100 beats per minute, and each QRS complex is preceded by a P wave.

sinus bradycardia

p for every qrs, looks regular but rate is slower; rate less than 60

sinus tachycardia

p for every qrs, looks regular but rate is faster; rate greater than 100

tachycardia is a compensatory mechanism to hypotension

atrial flutter

"saw tooth"

no pr interval

still has qrs

atrial fibrillation

"wavy" lines smaller than saw tooth in atrial flutter

no pr interval

still has qrs

Supraventricular tachycardia (SVT)

p waves are hidden in T waves

rate: 150-250

regular waves (no variation)

ventricular tachycardia (V-tach)

"wide + bizarre"

qrs are no longer regular

no p waves

ventricular fibrillation (v-fib)

Ventricular fibrillation (v-fib) is like an electrical chaos in the heart where there is no organized rhythm, resulting in a quivering motion instead of a normal pumping action, and it can be treated with defibrillation.

asystole

Asystole is like a flat line on a heart monitor, and the priority nursing action is to assess the patient because in asystole there is no electrical activity, so CPR is needed.

Coronary artery disease

Coronary artery disease is the most common cardiovascular disease, which can be thought of as having two main types: chronic stable angina (like a predictable chest pain) and acute coronary syndrome (like a heart attack).

what is Chronic stable angina? (chronic type of coronary artery disease)

narrowing of coronary arteries with plaque build up=> decr. blood flow to heart => ischemia (inadequate blood flow to heart) => chest pain

treating Chronic stable angina? (chronic type of coronary artery disease)

To treat chronic stable angina, you can use rest or nitroglycerin, which works by dilating veins and arteries; think of it as a "magic pill" that opens up the blood vessels to relieve chest pain, but be careful with light exposure and expect a possible headache.

when nitroglycerine not helping chronic stable angina it becomes

acute coronary syndrome aka myocardial infarction

acute coronary syndrome aka myocardial infarction is

Acute coronary syndrome, also known as a heart attack, happens when there is reduced blood flow and oxygen to the heart, leading to tissue damage and necrosis.

assessment of myocardial infaction

Assessment of myocardial infarction involves intense chest pain, severe indigestion or discomfort, along with shortness of breath.

labs for myocardial infarction

elevated troponin with MI (troponin is a cardiac biomarker)

treatment for MI?

The gold standard treatment for myocardial infarction (heart attack) is taking a patient to a cath lab within 90 minutes to open the blocked artery, before that, giving them oxygen, aspirin, nitroglycerine, and morphine to help with symptoms and blood flow.

education for MI:

avoid isometric exercises; focus on aerobic exercises (ex. walking)

-diet: low fat, salt and cholesterol

Heart failure

heart muscle cannot pump enough blood to meet body's needs

2 types: left and right

Left sided heart failure

Left-sided heart failure is when the left side of the heart is unable to pump blood effectively to the body, causing blood to back up in the lungs, leading to symptoms like pulmonary congestion, wet lung sounds, difficulty breathing, coughing, blood-tinged sputum, a third heart sound (S3), and difficulty breathing while lying down (orthopnea).

Right sided heart failure

Right sided heart failure is when the heart is unable to pump blood effectively to the lungs, causing a backup of blood in the body, leading to symptoms like swollen jugular veins, edema, enlarged liver and spleen, fluid accumulation in the abdomen, weight gain, fatigue, and loss of appetite. The main cause of right sided heart failure is left sided heart failure.

Treatment for HF (left and right)

The treatment for heart failure involves reducing the workload of the heart by decreasing the afterload with ACE inhibitors and ARBs, increasing contractility with digoxin, and promoting diuresis with diuretics to reduce excess fluid.

education w/ HF

Education with heart failure involves following a low sodium diet to release excess fluids, and monitoring daily weight to detect sudden increases of 2-3 pounds in one day, which should be reported.

high blood pressure values

normal being 120/80, elevated being 120-129/80, high blood pressure being greater than 130/80, and hypertensive crisis being greater than 180/120.

non modifiable risk factors for hypertension

fam history, african american race, incr. age

modifiable risk factors with hypertension

obesity, HLD, stress, smoking, high salt intake, caffeine

assessments of hypertension

vision changes, headache, dizzy, nosebleeds, SOB, angina

complications of hypertension

-stroke

-MI

-renal failure

-heart failure

-vision loss

treatment for hypertension

The flashcard is about the treatment for hypertension, which includes taking medications like ACE inhibitors, beta blockers, calcium channel blockers, and diuretics, as well as making dietary changes like reducing salt intake and avoiding caffeine and alcohol, quitting smoking, losing weight, and adopting a more active lifestyle with more walking.

Shock

where the vital organs are not getting enough oxygen, so cells resort to a backup energy source, producing lactate, and the type of shock depends on which part of the cardiovascular system is disrupted.

types of shock

hypovolemic, cardiogenic, distributive

"heart" sends "blood" thru "vasculature"

three things determine type of shock

hypovolemic shock

Hypovolemic shock - there's not enough blood circulating in the body, leading to low blood flow and decreased cardiac output.

causes of hypovolemic shock

Hypovolemic shock occurs when there is a significant decrease in blood volume, which can be caused by bleeding, severe injury, excessive fluid loss from vomiting or diarrhea, or burns.

hypovolemic shock assessment

Hypovolemic shock assessment: Your body initially compensates by speeding up your heart rate, but as it worsens, you'll experience low blood pressure, weak pulses, slow heart rate, decreased consciousness, cool and clammy skin, and reduced urine output.

treatment for hypovolemic shock

The treatment for hypovolemic shock involves fixing the cause and replacing lost fluids with IV fluids, isotonic or blood products. And supporting blood flow with vasopressors that constrict blood vessels.

Cardiogenic shock

-PUMP failure

-heart not pumping blood to body

causes of cardiogenic shock

Cardiogenic shock occurs when the heart is unable to pump enough blood to meet the body's needs, and it can be caused by conditions like heart attack, heart failure, blood clots, or a buildup of fluid around the heart (cardiac tamponade).

assessment cardiogenic shock

Assessment of cardiogenic shock involves looking for signs of decreased perfusion (like low blood pressure, weak pulses, cool and clammy skin, decreased urine output, and altered mental status) as well as signs of volume overload (such as jugular vein distension, crackles in the lungs, shortness of breath, muffled heart sounds, and an S3 heart sound).

treatment of cardiogenic shock

treat the cause:

-if MI: take to cath lab for PCI

-if Pulmonary embolism: use thrombolytics to free of clot

-if tamponade: perform pericardiocentesis: needle inserted into pericardial sack to pull out fluid

in meantime:

-improve contractility with dopamine

-decr. afterload: same meds as hypertension

distributive shock

Distributive shock is like a sudden collapse of the body's blood vessels due to an immune or autonomic response, causing a drop in blood pressure and inadequate oxygen delivery, similar to a deflated balloon unable to distribute air properly.

causes of distributive shock

Distributive shock can be caused by different factors, like an allergic reaction (anaphylactic), a spinal cord injury (neurogenic), or a systemic infection (septic) that triggers inflammatory responses in the body.

assessment of distributive shock

Assessment of distributive shock is similar to cardiogenic and hypovolemic shock, but the skin is warm and flushed instead of cool and clammy, and it can be caused by anaphylactic reactions (hives, rash, swelling, wheezing), neurogenic factors (spinal cord injury), or septic conditions (fever due to infection).

Treatment of distributive shock

Treating distributive shock involves specific interventions for different types: anaphylactic shock requires epinephrine and other medications like corticosteroids, and bronchodilators. Neurogenic shock needs cooling and supportive care, and septic shock involves IV antibiotics and fluids.

when a nclex questions says restless (or restlessness) think of

When a NCLEX question mentions restlessness, think of hypoxia, which means not enough oxygen reaching the brain, leading to decreased blood flow and decreased level of consciousness.