San Juan College 15

Overview of Presentation

  • Planned Topics:

    • Peripheral Artery Disease

    • Valvular Disorders

    • Cardiogenic Shock

    • Lifespan of Heart Failure

    • Group Activities

Myocardial Infarction (MI) Treatment

  • All MIs are graded by BotMona: Fentanyl, Morphine, Oxygen, Nitro, Aspirin.

  • Aspirin: Can be chewed for quicker efficacy; doses are typically 162 or 325 mg.

  • EKG Tools: Templates can help identify ST elevations indicative of myocardial infarction locations.

Understanding Electrocardiograms (EKGs)

  • ST elevations in leads V4, V5, and V6 indicate occlusions in arteries such as the left anterior descending or circumflex.

  • Importance of recognizing complete heart blocks on 12 lead EKGs.

Starling’s Law of the Heart

  • Rubber bands as a metaphor for the heart under stress (like cardiomyopathy and hypertrophy).

  • Importance of medications (like beta blockers) to help the heart relax.

  • Beta Blockers: Do not hold metoprolol for heart rates below 60 in cardiac patients; they might need lower heart rates.

Patient Monitoring

  • Monitor vital signs, skin color, temperature, hemodynamics, pulses, and mental status for changes in oxygenation.

  • Urine output, heart sounds (murmurs), and pulse oximetry need regular assessment.

  • Troponin Levels: Elevated troponin I and T are indicative of cardiac muscle stress and injury. Normal troponin I is less than 0.04 ng/mL.

    • Troponin may elevate with conditions like trauma, pneumonia, or sepsis.

Electrolytes & EKGs

  • Look out for ST segment changes (depression vs. elevation).

  • Recognize pathological Q waves as indicators of previous infarction; ST elevation indicates current MI.

Coronary Interventions

  • Stents: Commonly drug-eluting to prevent occlusion.

  • Angioplasty: Procedure using balloons to open occluded arteries; high-risk but frequently performed.

  • Cardiac Cath: Used for diagnosis and potential curve correction via angioplasty or stenting.

    • Hydration: Important for renal protection during procedures.

Post-Cath Monitoring

  • Monitor for bleeding, vital signs, and re-occlusion.

  • If patients complain of chest pain post-procedure, conduct a 12 lead EKG.

Peripheral Artery Disease (PAD)

  • PAD is a common form of vascular disease, often presenting as intermittent claudication.

    • Symptoms: Includes cool, pale extremities, diminished pulses, and pain with exertion.

    • Outflow vs. Inflow: Outflow affects the lower legs; inflow involves the aorta.

Clinical Presentation of PAD

  • Physical examination reveals shiny, taut skin, absent pulses, ulcers, and potential for amputation.

  • Important to distinguish between arterial (PAD) and venous insufficiencies.

Risk Factors for PAD

  • Leading to limb ischemia: Atherosclerosis, diabetes, hypertension, obesity, sedentary lifestyle, and smoking.

Cardiogenic Shock

  • Defined as the heart's inability to maintain adequate circulation; key complications include infarction and tamponade.

    • Symptoms: Hypotension, elevated heart rate, jugular vein distension, and reduced urine output.

Treatment Approaches for Cardiogenic Shock

  • Use of balloon pumps and Impellas for mechanical support; emergent catheterization may be necessary.

  • Pharmacological management includes vasopressors, diuretics, and inotropes.

Valvular Disorders

  • Disorders like mitral stenosis, regurgitation, and prolapse can significantly affect cardiac output.

  • Surgical interventions may be required for severe cases.

Infective Endocarditis

  • Serious condition often caused by strep, staph, viruses; can lead to heart failure if untreated.

    • Increased risk with prosthetic valves, IV drug use, and dental procedures.

Pneumococcal and Influenza Vaccinations

  • Recommend vaccinations to prevent infections that could exacerbate heart conditions.

Anticoagulant Therapy

  • Importance of education regarding anticoagulant therapy, especially in post-surgical patients.

Pediatric Heart Conditions

  • Pregnancy, maternal heart health, and congenital defects should be evaluated.

  • Ensure mothers are informed about potential impacts on their health.