Module 5: Problems of the Cardiovascular System

What is the purpose of a cardiac stress test?

To see how the heart functions under stress (through exercise)

What are important nursing interventions prior to a cardiac stress test?

• No caffeine

• No blood pressure medications (beta blockers - “-lol”)

Why shouldn’t a patient take their blood pressure medications before a cardiac stress test?

They can provide a false reading by decreasing the cardiac workload

What is the purpose of a cardiac catheterization?

To diagnose and treat coronary artery disease 

If an artery has an occlusion blocking 50% or more of it…

A PCI stent would be inserted to promote revascularization

Where is a cardiac catheter inserted?

In the right or left side of the heart, usually through the radial or femoral vein

How do we prepare a patient for a cardiac catheterization?

• Make sure informed consent is obtained

• Make sure the patient is hydrated

• Have the patient fast 

• Labs should be taken (kidney, creatinine/BUN, CBC)

• Check vital signs

What are contraindications for a cardiac catheterization?

• The dye can harm the kidneys

• Check for shellfish/iodine allergies

What are nursing priorities after a cardiac catheterization

• On bed rest, in a supine position

• Keep the affected extremity extended and flat

• Check the dressings for saturation

• Monitor for a hematoma

• Check vital signs every 15 minutes after the procedure

• Check the pedal pulses of the affected extremity

What is an electrocardiogram (EKG/ECG)?

12 electrodes that capture the rhythm of the heart

What is an echocardiography?

An ultrasound of the heart

What is the purpose of a chest x-ray for the heart?

It can reveal cardiac enlargement (pregnant women may recieve)

Can CT-Scans and MRIs of the heart be done with or without dye?

Yes, for pregnant patients, patients with renal damage, and patients with shellfish/iodine allergies

What is the key indicator serology marker for heart attacks?

Troponin

What is tropinin?

Protein in the heart muscle that is released into the circulation when the heart muscle is damaged

What are the serology markers used to detect a heart attack?

Troponin, CK, and CK-MB

What are the serum lipids of cardiac laboratory tests?

Cholesterol, lipoproteins (HDL, LDL), and triglycerides

What can hypertension increase the risk of?

Myocardial infarction (MI), heart failure (HF), stroke, and renal disease

What is the most modifiable risk factors that can lead to cardiovascular disease?

Hypertension

What is essential hypertension?

High blood pressure developed due to lifestyle or genetics (age, smoking, lack of exercise, etc.)

What is secondary hypertension?

High blood pressure identified with a specific disease and/or drugs (kidney disease, pregnancy, Cushing’s disease, etc.)

What are the manifestations of hypertension?

There are none, it is often called the “silent killer”

What is a hypertensive crisis?

A severe type of elevated BP (greater than 160/100)

What sets a hypertensive crisis apart from normal hypertension?

It is symptomatic (blurred vision, SOB) and uncontrolled

What is a normal blood pressure?

<120 AND <80 mm Hg

What is an elevated blood pressure?

120-129 AND <80 mm Hg

What is a pre-hypertensive blood pressure?

120-139 OR 80-89 mm HG

How many readings does it take to diagnose hypertension?

At least two elevated readings at two different times

What is the key teaching point with medications treating hypertension?

They are a life-long therapy

What do beta blockers end in?

“-lol”

What is the biggest concern with beta blockers?

Hypotension (drug works too well) —> dizziness —> falls

What do diuretics end in?

“-ide”

What is the biggest conern with diuretics?

Electrolyte imbalance, dehydration (orthostatic hypotension —> falls)

What is an example of a potassium-sparing diuretic?

Spironolactone

What is the biggest concern with spironolactone?

Hyperkalemia

What do calcium channel blockers (CCB) end in?

“-pine”

What do angiotensin-converting enzyme (ACE) inhibitors end in?

“-pril”

What is the most common AE of ACE inhibitors?

Dry cough

What do angiotensin II receptor blockers (ARBs) end in?

“-sartan"

Hypertension target organ damage - the heart

• Hypertensive heart disease

• Heart failure

• MI

Hypertension target organ damage - the brain

Cerebrovascular disease via stroke

Hypertension target organ damage - peripheral vessels

Peripheral vascular disease (vessels of the lower extremities)

Hypertension target organ damage - the kidneys

Chronic kidney disease

Hypertension target organ damage - the eyes

Retinal damage: retinopathy (the vessels in the eyes become damaged)

What is the biggest concern when taking furosemide with HTN?

Electrolyte imbalance - hypokalemia (potassium wasting)

What is the biggest concern when taking beta blockers with HTN?

Hypotension —> dizziness —> falls

What do beta blocker medications end in?

-lol

What is done when a patient with hypertensive crisis is admitted to the hospital?

• Critical!

• Patient is given an IV vasodilator nitrate (nitroprusside)

• Gradually reduce BP (no more than 25% within the first hour - 160/100)

• Oral antihypertensives can be given once stable (beta blocker - labetalol)

What are the manifestations of a hypertensive crisis?

• Severe headache

• Dizziness

• Diaphoresis

• Blurred vision

• Shortness of breath

• Epistaxis

• Severe anxiety

What are non-invasive interventions for hypertensive crisis?

• Place the patient in semi-Fowler’s position

• Administer oxygen

How often do you monitor blood pressure with hypertensive crisis?

Every 5-15 minutes

What is peripheral artery disease (PAD)?

A vascular disease with changes in the normal blood flow due to thickening of artery walls of the upper and lower extremities

What are the findings of peripheral artery disease (PAD)?

Weak pulses, patient will not have a bounding 2+

What should you do if you cannot feel a peripheral pulse with PAD?

Use a doppler ultrasound

What is an acute arterial occlusion?

A sudden occlusion caused by an embolism in the upper and lower extremities

What are the six P’s of ischemia with acute arterial occlusion?

1. Pain

2. Pallor

3. Pulselessness

4. Paralysis

5. Paresthesia (tingling, numbness, etc.)

6. Poikilothermy (coolness)

What is a venous thromboembolism?

The formation of a thrombus (blood clot) in association with inflammation of the vein

What is Virchow’s triad?

1. Stasis of blood flow

2. Endothelium injury

3. Hyper coagulability

(Environment for a clot to form)

What can cause stasis of blood flow?

Immobility, often post-op

What can cause endothelium injury?

Fracture of any large bones due to a car accident/major fall

What can cause hypercoagulability?

Birth control and pregnancy (hormonal changes)

What are the s/s of a VTE/DVT?

• Calf/groin tenderness

• Unilateral leg swelling

• Warm to the touch

• Discolored

(Can be asymptomatic)

What are the diagnostic assessments of a VTE/DVT?

• D-dimer: a blood test to show clot breakdown

• Venous duplex ultrasound: an ultrasound to show clot

How do you prevent injuries with a VTE/DVT?

• Do not apply compression boots

• Do not massage extremities

What is the drug therapy for VTE/DVTs?

• IV anticoagulants (heparin)

• Once they stabilize, they will be put on an oral agent (Eloquis)

What is aspirin used for with complications of the heart?

As an antiplatelet agent to prevent clots

If someone is on warfarin (or other anticoagulants), they should avoid…

• NSAIDs to prevent bleeding

• Dark leafy greens (high in vitamin K, which will alter the efficacy)

What is the antidote of warfarin?

Vitamin K

If a patient has angina…

They often have coronary artery disease

How is coronary artery disease diagnosed and treated?

With a cardiac catheterization

Coronary artery disease (CAD) is also called…

Coronary heart disease (CHD)

What are the risk factors of coronary artery disease?

• Smoking

• Obesity

• Lack of physical activity

• Hyperlipidemia

What is angina?

Chest pain; substernal chest pain that radiates down the left arm

What is stable angina?

Predictable chest pain that is caused by coronary artery disease

Does nitroglycerin help stable angina?

Yes

What is unstable angina?

Chest pain that is not predictable, and can occur at rest or with exertion

Does nitroglycerin help with unstable angina?

No