Nursing Management of Clients with Alterations in Cardiac Function

Comprehensive practice flashcards reviewing cardiac anatomy, coronary artery disease, angina, acute coronary syndrome, surgical procedures, valvular disorders, cardiomyopathies, inflammatory heart diseases, and heart failure management.

What is the clinical definition of coronary atherosclerosis?

Coronary atherosclerosis is the abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen, causing narrowing or occlusion that reduces blood flow to the myocardium.

According to the cardiac formula shown, how is Cardiac Output calculated and what are its normal values?

Cardiac Output (CO) = Heart Rate (HR) $\times$ Stroke Volume (SV). Normal Cardiac Output is $4\text{--}8\,L/min$, and normal Heart Rate is $60\text{--}100\,bpm$.

How are preload and afterload defined in cardiac physiology?

Preload is the initial stretching of cardiac muscle fibers just before contraction, determined by blood volume returning to the heart during diastole. Afterload is the resistance the heart must overcome to eject blood during systole.

What is the primary lipoprotein target for cholesterol-lowering medication in Coronary Artery Disease (CAD)?

Elevated Low-Density Lipoprotein (LDL) is the primary target for cholesterol-lowering medication.

What are the mechanism of action and example drugs for HMG-CoA Reductase Inhibitors (Statins)?

Statins (such as atorvastatin and simvastatin) inhibit the enzyme involved in lipid synthesis to decrease lipid production.

What mechanism distinguishes Fibric Acids, Bile Acid Sequestrants, and Cholesterol Absorption Inhibitors?

Fibric Acids (gemfibrozil) decrease synthesis of triglycerides and other lipids; Bile Acid Sequestrants (colestipol) oxidize cholesterol into bile acids to lower fat absorption; Cholesterol Absorption Inhibitors (ezetimibe) inhibit absorption of cholesterol in the small intestine.

What is Angina Pectoris and what are its three clinical types?

Angina Pectoris is a syndrome characterized by anterior chest pain secondary to insufficient coronary blood flow during increased myocardial demand. The three types are stable, unstable, and variant (Prinzmetal's/vasospastic) angina.

How does the Angina Algorithm differentiate Stable Angina from Acute Coronary Syndrome (ACS)?

If chest pain is relieved with rest and/or nitroglycerin, it is stable angina. If chest pain is NOT relieved with rest and/or nitroglycerin, it is Acute Coronary Syndrome (ACS).

What is the diagnostic cutoff value for high-sensitivity Troponin T (hsTnT)?

The normal value for high-sensitivity Troponin T (hsTnT) is less than $22\,ng/L$.

What ECG change serves as a key diagnostic indicator for Myocardial Infarction (MI)?

Elevation in the ST segment in two contiguous leads (STEMI) is a key diagnostic indicator for MI.

What are the goal times for 12-lead ECG reading and door-to-thrombolytic therapy in acute MI management?

A 12-lead ECG should be read within $10\,minutes$. Door-to-thrombolytic therapy goal time is $30\,minutes$ (initiated if PCI is unavailable or transport to a PCI-capable hospital exceeds $120\,minutes$).

What three thrombolytic (fibrinolytic) medications are specified for acute MI treatment?

Reteplase, tenecteplase, and alteplase.

What are the three major vessel-disease indicators for Coronary Artery Bypass Graft (CABG) surgery?

1. Disease greater than $50\%$ in the left main artery; 2. $70\%$ or greater stenosis of three coronary arteries with or without involvement of the proximal left anterior descending artery (LAD); 3. Two-vessel disease including the LAD and one additional major artery.

Which donor blood vessels are harvested for bypass graft procedures?

Greater and lesser saphenous veins, radial artery, and internal mammary artery.

What post-operative mobility goals should be set following CABG surgery?

The client should be out of bed (OOB) into a chair within $24\,hours$, and ambulating $25\text{--}100\,ft$ three times daily (TID) by post-operative day 1 (POD 1).

How are valvular regurgitation, stenosis, and valve prolapse defined?

Regurgitation occurs when the valve does not close properly, causing blood backflow. Stenosis occurs when the valve does not open completely, reducing blood flow. Prolapse is the stretching of an atrioventricular valve leaflet into the atrium.

What underlying cause and clinical manifestations are associated with Mitral Stenosis?

Mitral stenosis is most often secondary to rheumatic endocarditis. Manifestations include dyspnea on exertion (DOE), progressive fatigue, atrial fibrillation, and a diastolic murmur.

What visual signs and pulse features are characteristic of Aortic Regurgitation?

Visible arterial pulsations in the carotid or temporal arteries, a widened pulse pressure, a diastolic murmur, and a bounding pulse on palpation (water hammer pulse).

Based on the structural diagram shown, how do Dilated, Hypertrophic, and Restrictive Cardiomyopathies differ in ventricular structure and function?

Dilated Cardiomyopathy features significant ventricular dilation without hypertrophy, diminished contractility, and poor systolic function. Hypertrophic Cardiomyopathy features asymmetrical muscle enlargement (especially along the septum) with disorganized cells that impair relaxation. Restrictive Cardiomyopathy features rigid ventricular walls that impair diastolic filling while systolic function remains unchanged.

What primary presentation and physical signs characterize Infective Endocarditis?

Primary presentation includes fever and a new onset heart murmur. Other signs include petechiae, Osler nodes, Janeway lesions, Roth spots, and splinter hemorrhages.

What chest pain characteristic and auscultatory sign distinguish acute Pericarditis?

Chest pain that increases with inspiration or lying flat and decreases when leaning forward, along with a pericardial friction rub auscultated at the left lower sternal border.

What key clinical findings differentiate Left-Sided Heart Failure from Right-Sided Heart Failure?

Left-sided heart failure causes pulmonary congestion, crackles, an $S_3$ ventricular gallop, dyspnea on exertion (DOE), low $O_2$ saturation, and oliguria. Right-sided heart failure causes peripheral congestion, jugular venous distention (JVD), dependent edema, hepatomegaly, ascites, and weight gain.

According to the NYHA classification, how are Classes I through IV Heart Failure categorized?

Class I: No symptoms with normal activity. Class II: Mild symptoms with normal activity, slight limitation of functional status. Class III: Moderate symptoms with less than normal activity, comfortable only at rest with marked limitation. Class IV: Severe symptoms at rest or with minimal activity, severe functional limitation.

What post-procedure teaching points must be provided to a patient receiving an Implantable Cardioverter Defibrillator (ICD)?

Keep incision dry for $4\text{--}5\,days$; do not lift the affected arm above shoulder height for $4\text{--}6\,weeks$; avoid tub baths, swimming, or hot tubs until healed; do not lift objects over $10\text{--}15\,lbs$; and avoid twisting, pushing, or pulling for $2\text{--}3\,weeks$.

What is the hallmark sputum presentation in Acute Pulmonary Edema?

Coughing up pink, frothy sputum.