MS cardio

CARDIAC STUDY NOTES

Instructor Information

  • Julie Fomenko, PhD, MSN, RN, CHSE

Initial Scenario

  • First Shift in ER

    • Patients:

      • Jane: 64-year-old Caucasian female, Chief Complaint (CC): Indigestion, Neck Pain, Dizziness

      • Roger: 87-year-old Caucasian male, CC: Chest Pain, Shortness of Breath (SHOB)

      • Steve: 62-year-old African American male, CC: Chest Pain, SHOB

Patient History and Medications

1. Steve M.

  • CC: Chest Pain, SHOB

  • History & Physical (H&P):

    • Hypertension (HTN)

    • Hyperlipidemia (HLD)

    • Previous smoker (quit 5 years ago)

    • Stomach ulcer

    • Hip replacement (2009)

  • Medications:

    • Propranolol

    • Simvastatin

2. Roger F.

  • CC: Chest Pain, SHOB

  • H&P:

    • HLD

    • Congestive Heart Failure (CHF)

    • Diabetes Mellitus II (DM II)

    • 1 pack per day smoker

    • Previous stroke

    • Left Below-Knee Amputee (L BKA)

    • Previous malignant melanoma

  • Medications:

    • Simvastatin

    • Furosemide

    • Digoxin

    • Metoprolol

    • Insulin sliding scale

3. Jane W.

  • CC: Indigestion, Neck Pain, Dizziness, Chest Pain

  • H&P:

    • HTN

    • HLD

    • Cholecystectomy

    • Total Knee Replacement (TKR) (2011)

    • Total Hip Replacement (THR) (2013)

    • Depression

    • Coronary Artery Disease (CAD)

    • Stable Angina

  • Medications:

    • Metoprolol

    • Simvastatin

    • Cymbalta

    • Daily vitamin

Cardiac Anatomy and Physiology

Coronary Artery Anatomy

  • Right Coronary Artery

  • Left Coronary Artery

    • Left Anterior Descending Artery

    • Left Circumflex Artery

  • Main Structures:

    • Superior Vena Cava (SVC)

    • Aorta

    • Pulmonary Trunk

    • Coronary Arteries: Right Marginal Artery, Left Marginal Artery, etc.

  • Cardiac Cycle:

    • Diastole: Rapid filling, Slow filling

    • Systole: Isometric contraction, Ejection, Isometric relaxation

Clinical Presentation of Chest Pain

Symptoms in Men

  • Discomfort or tingling in arms, back, neck, shoulder, or jaw

  • Sudden dizziness

  • Heartburn-like feeling

  • Chest pain

  • Shortness of breath

  • Nausea or vomiting

  • Unusual tiredness

  • Cold sweat

Symptoms in Women

  • Additional symptoms: Most commonly experience discomfort in the neck, jaw, shoulder or back.

Laboratory and Diagnostic Workups

  • EKG Review: Importance of EKG in evaluating cardiac issues.

EKG Interpretation

Components of EKG

  • P-Wave: Atrial Depolarization

  • QRS Complex: Ventricular Depolarization

  • T-Wave: Ventricular Repolarization

  • Intervals:

    • PR Interval

    • ST Segment

Cardiac Cycle Pressures

  • Aortic Pressure: Peak at 120 mmHg during systole

  • Atrial Pressure: Influences blood flow dynamics during diastole.

Immediate Nursing Management of Myocardial Infarction

Mnemonic: MONA TASS

  1. Morphine:

    • Analgesic to reduce pain and anxiety.

    • Acts as a vasodilator, decreasing heart workload.

  2. Oxygen:

    • Improves oxygenation of ischemic tissue; facilitates myocardial recovery.

  3. Nitroglycerin:

    • First-line treatment for angina/MI, causes vasodilation, increasing coronary blood flow.

  4. Aspirin:

    • Prevents thromboxane A2 formation, reducing platelet aggregation.

  5. Thrombolytics:

    • Dissolves clots in coronary arteries, preserving heart function.

  6. Anticoagulants:

    • Prevents clot enlargement.

  7. Stool Softeners:

    • Prevent straining that may cause arrhythmias.

  8. Sedatives:

    • Provides patient rest to limit the size of infarction.

Patient Education

Discharge Planning for Each Patient
1. Jane

  • Follow-up with:

    • Primary Care Provider (PCP)

    • Cardiologist

  • Tests/Exams Needed:

    • Cardiac Stress Test

    • Echocardiogram

    • Coronary Angiography

  • Education Topics:

    • Diet/Exercise Plan

    • Medication Management

2. Roger

  • Diagnosis and Treatment:

    • Percutaneous Coronary Revascularization (PCR) for blockage.

  • Postoperative Care:

    • Continuous EKG monitoring.

    • Bleeding precautions and vital signs monitoring.

    • Patient education on monitoring for complications and activity restrictions post-surgery.

3. Steve

  • Surgery:

    • Coronary Artery Bypass Grafting (CABG) to address multiple blockages.

  • Post-CABG Recovery and Education:

    • Gradual return to activities, monitor incision sites for infection, and keep follow-up appointments for cardiovascular health.

Potential Complications of Acute Coronary Syndrome (ACS)

  • Dysrhythmias

  • Heart Failure

  • Infarct Extension

  • Papillary Muscle Rupture (valvular dysfunction)

  • Pericarditis

Concluding Remarks

  • Comprehensive assessments, understanding pharmacological options, and interventional strategies are crucial for optimal outcomes in patients experiencing cardiac events.

End of Study Notes