Perfusion

Venous Thromboembolism (VTE)

A condition that collectively includes deep vein thrombosis (DVT) and pulmonary embolism (PE).

D-dimer assay

A blood test used to find evidence of blood clots, often markedly elevated in patients with severe illness related to COVID-19.

Virchow triad

Three factors that play a significant role in the development of venous thrombosis: endothelial damage, venous stasis, and altered coagulation.

Phlebitis

Inflammation of the vein walls that frequently accompanies the formation of a thrombus.

Phlebothrombosis

The development of a thrombus as a result of stasis or hypercoagulability but without inflammation.

Paget-Schroetter syndrome

Also known as effort thrombosis, this upper extremity condition is caused by repetitive motion that irritates the vessel wall, leading to inflammation and thrombosis.

Recanalization

The process of reestablishing the lumen of a vein after an acute deep vein thrombosis (DVT).

Post-thrombotic syndrome

A complication of venous thrombosis that results in skin changes and edema of the extremity, often predicted by a lack of recanalization within the first $6$ months.

Thrombectomy

A mechanical method of clot removal involving the use of intraluminal catheters with a balloon or other devices to break down or remove the thrombus.

Pulmonary embolism (PE)

The obstruction of the pulmonary artery or one of its branches by a thrombus (or thrombi) originating in the venous system or the right side of the heart.

Pulmonary infarction

Ischemic necrosis of part of the lung caused by a pulmonary embolism.

Alveolar dead space

An area of the lung that continues to be ventilated but has reduced or absent blood flow due to an obstructing thrombus, impairing gas exchange.

Tachypnea

A rapid respiratory rate, which is the most frequent sign of a pulmonary embolism.

MDCTA (Multidetector-Row Computed Tomography Angiography)

The standard diagnostic test for diagnosing pulmonary embolism, providing high-quality visualization of the lung parenchyma.

V/Q scan

A diagnostic test that uses IV contrast to compare ventilation ($V$) and perfusion ($Q$) in different regions of the lung.

Thrombolytic therapy

The use of agents such as t-PA or reteplase to quickly lyse thrombi or emboli and restore hemodynamic functioning of the pulmonary circulation.

IVC filter

An inferior vena cava (IVC) filter, such as a Greenfield filter, used to trap large emboli traveling from the pelvis or lower extremities to the lung.

DOACs (Direct Oral Anticoagulants)

A class of long-term treatment medications, such as dabigatran or rivaroxaban, that do not require regular blood test monitoring but are costlier than warfarin.

Quinidine

A Class IA medication that can cause hypotension; nursing considerations include monitoring blood pressure and for widening of the PR, QRS, or QT intervals.

Procainamide

A Class IA medication that can cause heart failure; nursing considerations include monitoring for widening of the PR, QRS, or QT intervals.

Disopyramide

A Class IA anti-dysrhythmic medication that has limited use due to toxic effects; nurses must monitor for widening of the PR, QRS, or QT intervals.

Lidocaine

A Class IB anti-dysrhythmic medication that can cause CNS adverse effects such as slurred speech, confusion, drowsiness, confusion, and seizures, as well as hypotension and bradycardia.

Flecainide

A Class IC anti-dysrhythmic medication that can cause bradycardia, hypotension, and dysrhythmias.

Propafenone hydrochloride

A Class IC anti-dysrhythmic medication that can cause dysrhythmias and CNS adverse effects such as anxiety, insomnia, confusion, and seizures.

Class IA Nursing Considerations

Monitor blood pressure and monitor for widening of the PR, QRS, or QT intervals; note that this class has limited use due to toxic effects.

Class IB Nursing Considerations

Monitor for CNS adverse effects, BP, heart rate, and cardiac rhythm.

Class IC Nursing Considerations

Monitor for increasing dysrhythmias, heart rate, blood pressure, and CNS effects.

Lidocaine CNS Adverse Effects

A range of symptoms including slurred speech, confusion, drowsiness, confusion, and seizures.

Class IC CNS Adverse Effects

Symptoms including anxiety, insomnia, confusion, and seizures that may occur with Flecainide or Propafenone hydrochloride.

Adverse Effects of Beta Blockers

• Bradycardia and Hypotension

• Bronchospasm

• Increase in heart failure

• fatigue and sleep disturbances

Adverse effects of Class 3 antidysrhythmic medications

• Hypotension

• Bradycardia and AV block

• Muscle Weakness and tremors

• Photosensitivity and photophobia

• Liver toxicity

Adverse effects of calcium channel blockers (Class IV)

• Bradycardia

• Hypotension

• Dizziness and orthostatic hypotension

• Heart failure

Common Beta-blockers

• Propanolol

• Acebutolol

• Metoprolol

• Esmolol hydrochloride

• Carvedilol

• Timolol

• Nadolol

Common Class III antidysrhythmic medications

• Amiodarone

• Ibutilide fumarate

Common Calcium Channel Blockers

• Diltiazem

• Verapamil

• Amlodipine

Nursing Considerations for Beta Blockers

• Monitor apical heart rate, cardiac rhythm, and blood pressure

• Assess for Shortness of breath and wheezing

• Assess for fatigue and sleep disturbances

• Assess apical heart rate 1 minute before administration

• Avoid abrupt withdrawal to prevent rebound hypertension or ischemia.

Nursing Considerations for Class III antidysrhythmic medications

• Continuous monitoring of cardiac rhythm during IV administration

• Monitor QT interval during IV administration

• Monitor HR, BP during initiation of therapy

• Instruct client to wear sunglasses and sunscreen

Nursing Considerations for Class IV antidysrhythmic meds

• Monitor apical heart rate and blood pressure

• Instruct clients about orthostatic hypotension

• Instruct clients to report signs of heart failure to health care provider

• Monitor for peripheral edema and constipation

• Advise avoiding grapefruit juice

Rate responsiveness pacemaker

A device that allows faster pacing rates to meet increased bodily demands.

Demand pacemakers

Pacemakers that fire only when necessary to stimulate ventricular contraction; they are advantageous for clients who frequently have normal sinus rhythm but suffer periods of bradycardia or syncope.

Heart Failure (HF)

A clinical syndrome resulting from structural or functional cardiac disorders that impair the ability of a ventricle to fill or eject blood.

Orthopnea

Shortness of breath occurring when the client is in a recumbent position.

Paroxysmal nocturnal dyspnea

Shortness of breath that occurs when the client is asleep.

Cheyne-Stokes respirations

A breathing pattern believed to occur as a result of prolonged circulation time between the pulmonary circulation and the central nervous system, affecting the respiratory center.

Cardiac asthma

A cough productive of large amounts of frothy, blood-tinged sputum resulting from edema fluid trapped within the pulmonary tree and irritating the lung mucosa.

Cerebral anoxia

Development of irritability, restlessness, and a shortened attention span because of a decrease in cardiac output to the brain.

S3 gallop

An abnormal heart sound that is a symptom of left-sided heart failure.

Right-sided heart failure

Development of backward flow from a diseased right ventricle to the right atrium and venous circulation, usually following left-sided failure.

Dependent edema

An early sign of right-sided heart failure characterized by swelling of the ankles and lower extremities.

Cachexia

A state of malnutrition of tissues and weight loss resulting from low cardiac output and venous congestion, though the client may appear bloated due to edema.

Starling’s law

A principle stating that a stretched muscle contracts more forcefully; it explains how ventricular dilation causes increased systolic output within limits.

Ventricular hypertrophy

An increase in the diameter of muscle fibers creating a thickening of the chamber walls and increase in heart weight as a compensatory mechanism.

Digitalis (e.g., digoxin)

A cardiac glycoside that increases the force of myocardial contraction and slows the heart rate by stimulating the vagus nerve and blocking the AV node.

Digitalis toxicity symptoms

Symptoms including nausea, vomiting, anorexia, diarrhea, abdominal pain, confusion, drowsiness, and visual disturbances such as halos around dark objects.

Digoxin immune fab (Digibind)

Medication administered for the treatment of life-threatening digitalis toxicity.

Thiazide Diuretics

Medications that inhibit the reabsorption of sodium and chloride in the distal renal tubule.

Loop diuretics

Medications like Furosemide that inhibit the reabsorption of sodium and chloride in the loop of Henle and distal renal tubules.

Potassium sparing diuretics

Medications like Spironolactone that block the effect of aldosterone on renal tubules, causing loss of sodium and water while retaining potassium.

Osmotic Diuretic

A medication like Mannitol that pulls fluid from tissues due to a hypertonic effect.

Myocardial Infarction (MI)

Formation of localized necrotic areas within the myocardium following sudden occlusion of a coronary artery and abrupt cessation of blood and oxygen to the heart muscle.

Oliguria

Urine output of less than $20\,mL/hour$, indicative of renal hypoxia.

Troponin

A cardiac enzyme that peaks in $4-6$ hours after an MI and remains elevated for up to $2$ weeks.

Angina Pectoris

A condition occurring when oxygen supply to the heart is not sufficient, usually due to atherosclerotic changes in the coronary arteries.

Percutaneous transluminal coronary angioplasty (PTCA)

A procedure where a balloon-tipped catheter is inserted into a diseased coronary artery to apply pressure to the stenosed area, possibly involving stent placement.

Stage 1 hypertension

Persistent elevation of systolic blood pressure between $130-139\,mm\,Hg$ or diastolic blood pressure between $80-89\,mm\,Hg$.

Stage 2 hypertension

Systolic blood pressure of at least $140\,mm\,Hg$ or diastolic blood pressure of at least $90\,mm\,Hg$.

Intermittent claudication

Decreased adequacy of blood supply to the legs during periods of activity, often associated with hypertension.

Essential hypertension

High blood pressure diagnosed when there is no evidence of coarctation of the aorta, adrenal disease, or primary renal disease; constitutes $90\%$ of all cases.

Heparin

An anticoagulant that inhibits the synthesis of clotting factors and blocks the conversion of fibrinogen to fibrin; monitored via partial thromboplastin time (PTT).

Warfarin

An anticoagulant that interferes with liver synthesis of vitamin $K$-dependent clotting factors; monitored via prothrombin time (PT) or international normalized ratio (INR).

Reteplase and Alteplase

Thrombolytic medications that break down plasminogen into plasmin, which dissolves the fibrin network of a clot.

Nifedipine

A calcium channel blocker used to treat hypertension and angina by relaxing blood vessels and reducing heart workload of left ventricle.

Adverse effects include hypotension, dizziness, liver dysfunction, and GI distress

Heparin

An anticoagulant that inhibits the synthesis of clotting factors; the dose is dependent on partial thromboplastin time (PTT), which is monitored at $1.5-2.5$ times the control.

Protamine sulfate

The antidote for Heparin, which should be administered within $30\,\text{minutes}$.

Enoxaparin

A low-molecular-weight heparin that is less allergenic than heparin, has a fixed dose, and requires deep SQ administration (never IV or IM).

Warfarin

An anticoagulant that requires monitoring therapeutic PT at $1.5-2.5$ times the control or monitoring of the international normalized ratio (INR).

Normal PTT (Partial Thromboplastin Time)

The lower limit of normal is $20-25\,s$ and the upper limit of normal is $32-39\,s$.

Normal PT (Prothrombin Time)

The normal range is $9.5-12\,s$.

International Normalized Ratio (INR)

A monitoring test for Warfarin with a typical normal range of $2-3.5$.

Warfarin Onset, Peak, and Duration

Onset is $36-72\,\text{hours}$, peak is $1.5-3\,\text{days}$, and duration is $3-5\,\text{days}$.

Vitamin K

The antidote for Warfarin; also a dietary component found in green vegetables, pork, rice, yogurt, cheeses, fish, and milk that clients should avoid.

Fondaparinux

An anticoagulant administered SQ only for which PT and PTT are not suitable monitoring tests.

Heparin IV Peak and Duration

When administered via IV, the peak occurs at $5\,\text{minutes}$ and the duration is $2-6\,\text{hours}$.

Heparin SQ Onset and Duration

When administered deep SQ, the onset is $20-60\,\text{minutes}$ and the duration is $8-12\,\text{hours}$.

Thrombocytopenia

A potential adverse effect associated with both Heparin and Fondaparinux.

Warfarin Antidotes

Substances used to reverse Warfarin include Vitamin K, whole blood, and plasma.

Enoxaparin Lab Monitoring

This medication does not require lab test monitoring.

Hypertension Risk Factors

• Advancing age

• diabetes

• black race

• obesity

• Family History

• Poor diet

• Sedentary lifestyle

DVT Risk Factors

Risk factors for deep vein thrombosis (DVT) include prolonged inactivity (such as long flights or bed rest), certain medical conditions (like cancer or obesity), hormone therapy, and previous history of DVT.

Peripheral Artery Disease (PAD)

A condition characterized by narrowed arteries reducing blood flow to the limbs, often caused by atherosclerosis and resulting in pain or cramps in the legs during physical activities.

Stable Angina

A type of chest pain that occurs with activity or stress due to reduced blood flow to the heart, typically relieved by rest or nitroglycerin.

Unstable Angina

A form of angina that occurs unexpectedly and lasts longer, indicating that the heart is not getting enough blood flow and can precede a myocardial infarction.

Myocardial Infarction (MI) Symptoms

Common symptoms of a myocardial infarction include chest pain or discomfort, shortness of breath, nausea, sweating, and pain in the arms, back, neck, or jaw.

Heart Failure Types

Heart failure can be classified as systolic (the heart can't pump effectively) or diastolic (the heart can't fill properly), and includes left-sided, right-sided, and congestive heart failure.

Heart Failure Risk Factors

Risk factors for heart failure include high blood pressure, coronary artery disease, previous heart attacks, diabetes, obesity, and a family history of heart disease.

Heart Failure Symptoms

Symptoms of heart failure may include fatigue, breathlessness, swollen legs and ankles, persistent coughing, and decreased exercise tolerance.

Ischemia

Insufficient blood flow to tissues causing damage; often associated with angina and myocardial infarction.

Cardiac Biomarkers

Proteins released into the blood when the heart is damaged; key markers include troponin, creatine kinase (CK-MB), and myoglobin, used to diagnose myocardial infarction.

Atherosclerosis Risk Factors

• High cholesterol and triglyceride levels

• Hypertension

• Smoking

• Diabetes

• Obesity

• Sedentary lifestyle

• Family history of heart disease

• Age (increased risk in older adults)