Cardiovascular terms, HF, PAD/CAD, MI, HLD, medications

What is cardiac output

Volume of blood pumped by the heart per minute

Average cardiac output

4-6 L/min

Cardiac output formula

HR x SV

What is stroke volume

Amount of blood ejected by the left ventricle with each heartbeat

Approximate stroke volume

70 mL per beat

Preload

Amount of ventricular filling and stretch at the end of diastole, just before contraction

Afterload

The resistance the ventricles must overcome to eject blood during systole

Contractility

Strength of the heart muscles contraction

Whats a positive inotrope

A substance/medication that increases the force of cardiac contraction

True or false: calcium increases contractility

true

What is heart failure

Condition in which the heart cannot fill or pump effectively enough to meet the body’s needs

What is systolic heart failure

Left ventricle weakens and cannot squeeze hard enough (impaired ventricle contraction)

What is diastolic heart failure

Left ventricle becomes stiff and fails to relax properly between beats (impaired ventricle filling)

Left-sided heart failure

Left ventricle cannot pump blood out to body, so blood backs up into pulmonary circulation/lungs

Manifestations of left sided heart failure

• SOB

• Crackles/cough

• Orthopnea

• Tachycardia

• Frothy sputum

Right sided heart failure

Right ventricle cannot pump blood to lungs effectively, causing backup in systemic circulation and fluid accumulation in the body

Manifestations of right sided heart failure

• Peripheral edema

• JVD

• Abdominal swelling / ascites

• Weight gain

Diagnostic test to assess heart failure

Echocardiogram

Nursing considerations in patients with heart failure

• Low sodium diet

• Fluid restrictions

• Strict I & Os

• Monitor electrolytes

• Obtain daily weights

• Frequently assess vitals and report changes

Heart failure medications

• Diuretics

• ACE inhibitors

• ARBs

• Beta blockers

• Cardiac glycosides (digoxin)

Digoxins effect in heart failure

Increases force of cardiac contraction, improving ventricular emptying

Digoxin mechanism of action

Inhibits sodium-potassium pump, increasing calcium, resulting in stronger contractions

does digoxin increase or decrease heart rate

Decrease

Prior to administration of digoxin, the nurse must do what

Assess apical pulse for 1 minute- if below 60 bpm, withhold digoxin

Signs of digoxin toxicity

• N/V

• Headache

• Visual disturbances

• *Hypokalemia increases risk

1st line of drug treatment for heart failure

ACE inhibitors/ARBs

What is coronary artery disease

Narrowing/blockage of the coronary arteries usually caused by atherosclerotic plaque

Manifestations of CAD

• Angina

• SOB

• Decreased exercise tolerance

• Can lead to MI

CAD risk factors

• Smoking

• HTN

• Elevated lipids

• Older age

• Obesity

• Physical inactivity

CAD diagnostic tests

• ECG/EKG

• Exercise stress test

• Echocardiogram

• Cardiac catheterization/angiography

Medications used for CAD

• Antiplatelet (aspirin)

• Beta blocker (atenolol)

• Calcium channel blocker (amlodipine)

• Statins

• Antianginal (ranolazine)

How do atherosclerotic plaques form

1. Injury to vascular endothelium

2. LDL accumulates inside

3. Macrophages engulf LDL

4. Fibrous cap formation

5. Plaque buildup

Hyperlipidemia

Elevated levels of blood lipids (contributes to atherosclerosis and increased cardiovascular risks)

LDL (low density lipoprotein)

“bad” cholesterol, contributes to cholesterol deposition in arterial walls

HDL (high density lipoprotein)

“good” cholesterol, helps transport cholesterol from peripheral tissues back to the liver

Risk factors for hyperlipedemia

• Obesity

• Diet high in fats

• Genetics / family history

• Hypothyroidism

• Diabetes

• Certain medications

Medications used to treat hyperlipidemia

• Statins

• Cholestyramine

• Niacin

• Ezetimibe (absorption inhibitor)

Statins / HMG-CoA reductase inhibitors mechanism of action

Inhibits HMG-CoA reductase, reducing cholesterol production in liver and lowering LDL

Adverse effects of statins

• muscle pain/weakness

• headaches

• GI upset

Cholestyramine mechanism of action

Binds to bile acids, forces them out through the feces, lowering LDLs

Mechanism of action of ezetimibe

Inhibits intestinal cholesterol absorption, lowering amount of cholesterol delivered to liver, reducing LDL

Niacin’s affects

Increases HDL, decreases LDL

Niacin adverse effects

• Flushing

• Itching

• GI upset

Immediate treatment goals for myocardial infarction

• Restore blood flow to the heart

• Relieve pain

• Reduce cardiac workload

• Prevent complications (arrhythmias, HF)

MONA

• Morphine

• Oxygen (if SpO2 <90%)

• Nitroglycerin

• Aspirin

Medications used after MI (once pt is stabilized)

• Beta blockers

• Antiplatelets

• ACE inhibitors

• ARBs

• Statins

• Anticoagulants

Why are beta blockers prescribed after MI

Reduces HR and myocardial oxygen demand

Why are ACE inhibitors/ARBs prescribed after MI

Help reduce adverse cardiac remodeling, decreases cardiac workload by managing HTN

Why are statins prescribed after an MI

Lowers LDL and stabilizes atherosclerotic plaques

HR control meds

• Beta blockers

• Calcium channel blockers

Which antiarrhythmic medications may may arrhythmias worse?

Amiodarone and sotalol

PAD vs CAD

CAD restricts blood flow to the heart, while PAD restricts blood flow to the limbs (usually legs)

Peripheral artery disease

Narrowing of arteries, usually do to atherosclerosis; reduces blood flow to the limbs (especially legs/feet)

PAD risk factors

• Diabetes

• Smoking

• HTN

• High cholesterol

Manifestations of PAD

• Pain in legs walking/exercise (intermittent claudication)

• Muscle atrophy

• Weak pulses

• Cool feet

PAD primary medication treatment

Statins or antiplatelets

7 P’s of acute arterial occlusion

1. Pallor

2. Polar (cold)

3. Pain

4. Paresthesia

5. Paralysis

6. Pulselessness

7. Pistol shot (acute onset)

Acute arterial occlusion treatment goals

Restore blood flow, prevent tissue damage

acute arterial occlusion medications

Anticoagulants and thrombolytics

What is Raynaud's disease?

A condition involving vasospasm and narrowing of small arteries and arterioles, especially in the fingers and toes

Triggers of Raynaud’s disease

Cold temperatures, stress

Raynaud’s disease treatments

• Vasodilators

• Calcium channel blockers

What is chronic venous insufficiency?

Impaired venous return that causes blood to pool in the tissues, leading to congestion and swelling

what is hemosiderin staining

Brown skin discoloration caused by iron-rich deposits

Why do veins depend on skeletal muscle activity to move blood forward

Veins operate under relatively low pressure against gravity, and rely on the skeletal muscle pump and venous valves to help return blood to the heart