AH Cardio Lecture

Key Definitions

  • Stroke Volume: Amount of blood ejected by a ventricle with every contraction.

  • Heart Rate (HR): Rate of ventricular contractions per minute.

  • Cardiac Output (CO): Amount of blood ejected by the heart every minute.

    • Formula: CO = HR x SV

  • Preload: Amount of blood in the ventricles at the end of diastole.

  • Afterload: Resistance against the ventricle during contraction.

  • Contractility: Force of the mechanical contraction of the heart.

Primary Goal of the Cardiac System

  • Perfusion: Deliver oxygenated blood to tissues and return deoxygenated blood to the heart.

  • Aim to maximize the efficiency of the heart as a pump.

Blood Vessel Function

  • Arteries: Carry oxygenated blood away from the heart.

  • Veins: Carry deoxygenated blood back to the heart.

  • Configured to

    • deliver oxygen-rich blood

    • remove waste

    • return blood to the right side of the heart.

Heart Structure Components

  • Pericardium: Protective sac containing serous fluid.

  • Myocardium: Heart muscle responsible for contraction.

  • Endocardium: Innermost layer includes the structures of heart valves.

Blood Supply to the Heart Muscle

  • Coronary Arteries:

    • Function: Fill during diastole to supply muscle with blood.

    • Branch off aorta

Pacemaker Nodes

  • SA Node: Normal pacemaker of the heart, located above the right atrium, generates 60-100 bpm.

  • AV Node: Backup pacemaker, located above the septum with a rate of 40-60 bpm.

  • Bundle Branches and Purkinje fibers also play critical roles in conduction.

Blood Pressure Dynamics

  • Systole: Peak arterial pressure during heart contraction.

  • Diastole: Minimal arterial pressure during heart relaxation.

  • Mean Arterial Pressure (MAP): Average blood pressure throughout the cardiac cycle.

    • Influencing factors include stroke volume, vasoconstriction, vasodilation, baroreceptors, and hormones like epinephrine and norepinephrine.

Health History Assessment

  • Evaluate past health, family, social history, current health issues, and modifiable risk factors.

  • Physical assessment involves general inspection, palpation, and auscultation.

Cardiac Cycle Valves

  • Valvular Closure Sounds:

    • S1: Closure of AV valves during ventricular systole.

    • S2: Closure of semilunar valves during ventricular diastole.

    • S3 and S4 suggest altered compliance of ventricles.

    • Additional sounds may include murmurs, clicks, and friction rubs.

Risk Factors for Heart Disease

  • Assess lipid panel:

    • LDL > 100, HDL < 40-50, Total Cholesterol > 200, Triglycerides > 150.

  • Increased blood glucose as a risk factor.

  • Cardiac Biomarkers: Include CK, CK-MB, Troponin, Myoglobin, and BNP.

Diagnostic Tests

  • Chest X-ray: Checks size, shape, and position of the heart.

  • Fluoroscopy with Angiography: Evaluates cardiac function using dye to visualize coronary arteries.

  • Electrocardiography (ECG): Assesses electrical conduction of the heart.

  • Cardiac Stress Test: Evaluates heart function during increased workload.

    • Variants include exercise stress tests (treadmill) and chemical stress tests (IV injection).

  • Echocardiography: Uses ultrasound to assess heart structure and function.

Transesophageal Echocardiography (TEE)

  • Process: Transducer is placed down the esophagus for high-quality images of the posterior heart.

    • Effective for evaluating atrial clots, particularly in cases of Afib risk for stroke.

  • Nursing Implications:

    • Informed consent, NPO pre-procedure, moderate sedation, vital sign monitoring, and return of gag reflex afterwards.

Angiography and Complications

  • Purpose: Identify blockages or perfusion issues in the coronary arteries using contrast dye.

  • Complications: Risks include dysrhythmia, bleeding, infection, myocardial infarction, and perforation complications.

Cardiac Catheterization

  • Procedure: Includes percutaneous transluminal coronary angioplasty (PTCA), using balloon or stent placement at occlusion sites.

Nursing Implications for Invasive Procedures

  • Considerations: Informed consent, NPO status, pre-procedure evaluations (labs), moderate sedation, vital sign monitoring, assess for insertion site bleeding, maintain bed rest, and monitor peripheral pulses.

***Where she starts in lecture***

Unique Diagnostics

  • Importance of recognizing unique symptoms or diagnostic features that stand out in each disease process.

Coronary Artery Disease (CAD) 🚦🚗 🚙 🚗 🚙 🚗 🚙 🚗 🚙

  • Pathophysiology: Coronary arteries become obstructed or dysfunctional, leading to myocardial ischemia or infarction, primarily due to atherosclerosis. blood cannot get through cause traffic jam*

  • Risk Factors:

    • Modifiable

      • diet and exercise

      • stress

      • alcohol use

    • non-modifiable factors contributing to CAD risk.

Symptoms of CAD

  • Common symptoms include angina (chest pain), especially in women and diabetics.

  • Associated symptoms: chest pressure, shoulder pain, shortness of breath, jaw pain, fatigue, nausea/vomiting, diaphoresis, syncope, and reflux/indigestion.

Immediate Intervention for Angina

  • Steps for treatment include:

    • Cease current activity (rest).

    • Assess the patient (vital signs, pain assessment, EKG).

    • Administer Aspirin and Nitroglycerin (up to 3 doses).

    • Provide oxygen if symptomatic, and Morphine as needed after nitroglycerin.

Diagnosis and Treatment of CAD

  • Diagnostic methods include labs, EKG changes, cardiac stress tests, and cardiac catheterization.

  • Treatment options involve lifestyle changes and medications, including nitroglycerin, antiplatelets, antihypertensives, anticoagulants, antidiabetics, and cholesterol-lowering agents.

  • Surgical options include heart catheterization and CABG for severe cases.

Medications for CAD

  • Nitroglycerin: Vasodilator increasing blood flow to the heart; available in sublingual, oral, topical, and IV forms.

  • Antihypertensives: Reduces workload of the heart including beta-blockers and calcium channel blockers.

  • Antiplatelets: Prevent platelet aggregation, such as Aspirin and Clopidogrel.

  • Anticoagulants: Used to prevent thrombus formation.

Nursing Considerations for CAD

  • Focus on important assessments and interventions regarding patients with CAD and how to manage them effectively using the nursing process.

Myocardial Infarction Overview

  • Definition: Damage to heart muscle from prolonged ischemia leading to tissue death.

  • Categories: Unstable angina, NSTEMI (non-ST elevation MI), and STEMI (ST elevation MI).

  • Atherosclerosis: Most common cause of myocardial infarction.

Characteristics of Myocardial Infarction

  • Irreversibility: Damage from lack of oxygen leads to long-term complications including heart failure.

  • Visualize arterial blockage and its effects on the heart muscle (identified in diagrams).

STEMI vs. NSTEMI

  • Differences:

    • STEMI: ST elevation on ECG.

    • NSTEMI: ST depression.

  • Define damage variability: STEMI produces extensive damage while NSTEMI is less extensive.

Diagnostic and Treatment of Myocardial Infarction

  • Diagnosis involves various methods: labs, EKG, cardiac stress test, and angiography.

  • Treatment strategies include symptomatic oxygen, medications, and surgical intervention options like PCI and CABG.

Coronary Artery Bypass Grafting (CABG)

  • Procedure: Bypass blocked coronary arteries, requiring careful recovery in an ICU setting.

  • Decision-making for PTCA versus CABG involves a healthcare team assessment.

Review of Myocardial Blood Flow

  • Reference to Lippincott CoursePoint+ for additional study on myocardial blood flow and related concepts.

Complications from Heart Disease

  • Overview of Chapter 25 related to complications arising from heart disease and their implications.

Heart Failure Overview

  • Clinical Manifestations: Includes impaired contraction (systolic heart failure) leading to decreased output and impaired filling (diastolic heart failure) leading to increased pressures.

Ejection Fraction

  • Definition: Percentage of blood ejected from the left ventricle during each contraction.

  • Normal range: 50-70%.

  • Reduced ejection fraction classifications to be understood: 40%, 41-49%, and 50-70%.

Right vs Left Heart Failure

  • Right Heart Failure: Blood unable to pump into the lungs, causing systemic congestion (edema, ascites) and symptoms.

  • Left Heart Failure: Blood backs up into lungs leading to shortness of breath and pulmonary symptoms like crackles and pulmonary edema.

Congestive Heart Failure (CHF)

  • Definition: Congestion in the body from both right and left heart failure leads to fluid build-up.

Symptoms and Complications of Heart Failure

  • Symptoms may differ between right and left-sided failure; symptoms can include fatigue, peripheral edema, tachycardia, dyspnea, and more.

Diagnosis and Goals for Heart Failure

  • Diagnosis involves multiple tests; focus on reducing risk factors, decreasing symptoms, and increasing cardiac function.

Management of Heart Failure

  • Emphasize symptom management and self-care through lifestyle changes (diet, sodium restriction, weight management) and medication adherence.

Heart Failure Medication Classes

  • Include categories such as diuretics, ACE inhibitors, beta-blockers, and positive inotropes.

  • Important to assess before and after administration of these medications.

Nursing Process for Heart Failure

  • Important nursing assessments and interventions surrounding heart failure management are detailed within the nursing process framework.

Review of Congestive Heart Failure

  • Reference to CoursePoint+ for enhanced learning about CHF, including practical assessments and interactive tutorials.

Overview of Structural, Infectious, Inflammatory Disorders

  • Focus on disrupted flow over cardiac valves with common issues like aortic stenosis and mitral regurgitation.

Symptoms of Valvular Diseases

  • Associated symptoms include murmurs, dyspnea, crackles, and angina which can mimic heart failure symptoms.

Diagnosis & Treatment of Valvular Disease

  • Involves echocardiography alongside other cardiac diagnostic tests.

  • Treatment may include medications, surgical interventions, and monitor for potential complications.

Infective Endocarditis

  • Infection most frequently affects heart valves, particularly in high-risk patients, leading to serious complications.

Clinical Manifestations of Endocarditis

  • Symptoms like Osler’s nodes, Janeway lesions, splinter hemorrhages, murmurs, and dysrhythmias can indicate infection.

Diagnosis and Treatment of Endocarditis

  • Blood cultures, echocardiograms, and labs are vital in diagnosis; treatment typically involves IV antibiotics and possibly surgical intervention.

Nursing Assessment for Valvular Disease

  • Focus on assessments needed for patients with diagnosed valvular diseases and their nursing implications.

Myocarditis Overview

  • Inflammatory disease of the myocardium commonly caused by infection or autoimmune disorders.

  • May present asymptomatically or lead to severe complications.

Diagnosis and Treatment of Myocarditis

  • Diagnosis through labs and echocardiograms; treatment focuses on managing symptoms and addressing underlying cause.

Pericarditis Overview

  • Inflammation of the pericardium presents with chest pain and may result from various causes, including infectious and non-infectious origins.

Diagnosis and Management of Pericarditis

  • Evaluate through EKG, CXR, labs; treatment focuses on alleviating symptoms and reducing inflammation.

Pericardial Effusion

  • Accumulation of fluid in the pericardial sac can lead to serious complications like cardiac tamponade and requires careful diagnosis and treatment.

Myocarditis/Pericarditis Nursing Considerations

  • Important nursing assessments and actions to manage patients effectively throughout their treatment process.

Chapter Overview

  • Overview of Chapter 26 related to the discussion of inflammatory heart diseases.

Goals of the Vascular System

  • Focus on distributing blood for tissue perfusion and returning blood to the right side of the heart.

Atherosclerosis Overview

  • Build-up of plaque in arterial walls from high cholesterol, calcium deposits, and excess fibrin; risk factors should be monitored closely.

Clinical Manifestations of Peripheral Arterial Disease

  • Asymptomatic in early stages; can lead to severe complications like myocardial infarctions or limping due to intermittent claudication.

Peripheral Arterial Disease Symptoms

  • Major signs include asymptomatic periods, cold extremities, and skin changes.

Diagnosis and Treatment of Peripheral Arterial Disease

  • Emphasizing vascular assessments and lifestyle changes to alleviate symptoms and prevent progression of disease.

Treatment Options for Peripheral Artery Issues

  • Includes non-surgical options like positioning and catheterization, as well as surgical interventions such as bypass grafting or amputations.

Chronic Venous Insufficiency Overview

  • Characterized by weak vein walls and affected valves leading to symptoms like swelling and pain, necessitating thorough assessment.

Venous Ulcers Diagnosis and Management

  • Addressing skin color changes and ulcerations through physical assessments and Doppler ultrasound; treatment includes lifestyle changes and compression therapy.

Deep Vein Thrombosis (DVT) Overview

  • Defined by blood clots in large veins, with increasing risks associated with immobility, cancer, pregnancy, and obesity.

Clinical Manifestations of DVT

  • Symptoms can be asymptomatic or include pain and swelling of the extremities, requiring clinical prudence.

Diagnosis and Treatment for DVT

  • Focus on preventive measures, medication administration, and options for surgical intervention.

Nursing Process for DVT Patients

  • Emphasizing important assessments and nursing actions to ensure patient safety and healthcare effectiveness with DVT risks.

Hypertension Overview

  • Chronic condition characterized by high blood pressure impacting cardiac output and vascular resistance; distinguish between primary and secondary hypertension.

Complications of Hypertension

  • Can lead to organ damage, including heart failure, kidney failure, stroke, and more if left untreated.

Diagnosis and Treatment of Hypertension

  • Multiple BP readings indicating >130/80; goal involves lifestyle changes and medications to lower blood pressure.

Heart-Healthy Diet Considerations

  • Suggestions for maintaining a balanced diet including a variety of fruits, vegetables, whole grains, and lean proteins while limiting unhealthy fats and sugars.