NU 310: Cardiovascular Alterations

What does a standard ECG rhythm strip usually show?

6 seconds

How long is a small square (tiny box) on an ECG?

0.04 seconds

What does the P wave represent in an ECG?

Atrial depolarization (SA node firing)

What is the normal range for the PR interval?

0.12-0.20 seconds (3-5 small boxes)

What is the normal range for the QRS interval?

0.06-0.12 seconds (1.5-3 small boxes)

What does the T wave represent in an ECG?

Ventricular repolarization

What is the significance of the ST segment in an ECG?

It should be flat (isoelectric); depression/elevation indicates ischemia/injury.

What is the normal sinus rate range?

60-100 bpm

What characterizes Sinus Bradycardia?

Rate < 60 bpm, rhythm regular, P, PR, QRS normal but slow.

What are common causes of Sinus Bradycardia?

Athletes, vagal stimulation, medications (beta-blockers), hypothyroidism.

What is the treatment for symptomatic Sinus Bradycardia?

Atropine IV to increase heart rate.

What characterizes Sinus Tachycardia?

Rate > 100 bpm, rhythm regular, P, PR, QRS normal but fast.

What are common causes of Sinus Tachycardia?

Exercise, anxiety, pain, fever, hypovolemia.

What is Atrial Fibrillation (A-fib)?

Irregularly irregular rhythm with no identifiable P waves.

What are the clinical manifestations of Atrial Fibrillation?

Palpitations, fatigue, SOB, dizziness, risk of thromboembolism.

What is the treatment for Atrial Fibrillation?

Rate control with beta-blockers, rhythm control with antiarrhythmics, anticoagulation.

What is the characteristic appearance of Atrial Flutter on an ECG?

Classic 'sawtooth' flutter waves (F waves).

What are Premature Atrial Contractions (PACs)?

Occasional early beats with abnormal P wave followed by normal QRS.

What are common causes of Premature Ventricular Contractions (PVCs)?

Stimulants, hypoxia, electrolyte imbalances, heart disease.

What is Ventricular Tachycardia (V-tach)?

Rate usually 100-250 bpm, wide QRS, no visible P waves.

What is the immediate treatment for pulseless Ventricular Tachycardia?

CPR and defibrillation immediately.

What is Ventricular Fibrillation (V-fib)?

Chaotic, irregular waves with no identifiable P, QRS, T.

What is the treatment for Ventricular Fibrillation?

CPR and defibrillation immediately, ACLS medications.

What is angina?

Temporary myocardial ischemia due to decreased oxygen supply vs demand.

What characterizes stable angina?

Predictable pain that occurs with exertion or stress, relieved by rest or nitroglycerin.

What characterizes unstable angina?

Occurs at rest or with minimal exertion, not relieved by usual nitroglycerin pattern.

What is Prinzmetal's angina?

A type of angina caused by coronary vasospasm, often occurring at rest and may cause transient ST elevation during pain.

What are the non-modifiable risk factors for angina and CAD?

Age (men >45, women >55), sex, family history of premature CAD, and ethnicity.

What are some modifiable risk factors for angina and CAD?

Hyperlipidemia, hypertension, smoking, diabetes, obesity, sedentary lifestyle, high saturated fat diet, and stress.

What are common clinical manifestations of angina?

Chest discomfort described as pressure, squeezing, heaviness, or tightness, possibly radiating to the jaw, neck, shoulder, arm, or back, along with SOB, diaphoresis, nausea, fatigue, and dizziness.

What is the gold standard diagnostic test for visualizing blockages in CAD?

Coronary angiography.

What is the primary goal of angina treatment?

To decrease oxygen demand, increase supply, and prevent myocardial infarction (MI).

What does the acronym MONA stand for in the context of chest pain management?

Morphine, Oxygen, Nitroglycerin, Aspirin.

What defines Acute Coronary Syndrome (ACS)?

A spectrum that includes unstable angina, non-ST elevation MI (NSTEMI), and ST elevation MI (STEMI).

What are the clinical manifestations of an MI?

Chest pain lasting more than 20 minutes, diaphoresis, pale and clammy skin, SOB, nausea, vomiting, and anxiety.

What are the ECG changes associated with ischemia in MI?

T-wave inversion and ST depression.

What lab marker is most specific for myocardial infarction?

Troponin I/T.

What is the primary treatment goal for STEMI/NSTEMI?

To relieve pain, restore perfusion, and limit infarct size.

What are the common causes of left-sided heart failure (LHF)?

Hypertension, coronary artery disease (CAD), and valvular disease.

What are the manifestations of right-sided heart failure (RHF)?

Peripheral edema, jugular venous distention (JVD), hepatomegaly, and ascites.

What is the significance of BNP in heart failure?

BNP is elevated in heart failure and is released when ventricles stretch.

What are the treatment goals for congestive heart failure (CHF)?

To decrease volume overload, increase pump function, and decrease workload.

What lifestyle changes are recommended for patients with heart failure?

Low sodium diet, fluid restriction, daily weights, and regular moderate exercise.

What should patients be educated about regarding nitroglycerin?

Take 1 tablet sublingually every 5 minutes up to 3 doses; if pain persists, call 911.

What are the phases of cardiac rehabilitation?

Phase I: Inpatient, Phase II: Early Outpatient (Monitored), Phase III: Maintenance.

What is the role of beta-blockers in the treatment of heart failure?

They slow heart rate, allow better filling, and improve survival.

What are common side effects of ACE inhibitors?

Cough, hyperkalemia, and angioedema.

What is the recommended action if a patient gains more than 2-3 lbs in a day?

Call the healthcare provider.

What are atypical symptoms of ACS in women and older adults?

Fatigue, dyspnea, syncope, and epigastric pain without obvious chest pain.

What is the initial nursing intervention for a patient with chest pain?

Stop activity and sit the patient down, then perform a quick assessment.

What is the significance of continuous cardiac monitoring in acute MI?

To detect dysrhythmias and assess for heart failure or cardiogenic shock.

What should be monitored after administering thrombolytics?

Watch for bleeding and monitor vital signs.

What is the purpose of using anticoagulants in MI treatment?

To prevent clot formation and improve blood flow.

What are the signs of pulmonary congestion in left-sided heart failure?

Crackles, cough, dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.

What is the effect of diuretics in heart failure treatment?

They decrease preload and help treat pulmonary and peripheral edema.