Acute+Chronic Heart Ds/ Heart Failure

Front 1

Amyl nitrate
use

Back 1

relief of acute anginalpain in adults

Front 2

Isosorbidemononitrate(ISMO, Imdur)
uses

Back 2

prevention and treatment of angina in adults

Front 3

Nitroglycerin (Nitro-Bid, Nitrostate)
uses

Back 3

treatment of acute angina attack; prevention of anginalattacks

Front 4

Beta Blockers
•Action

Back 4

–Block beta-adrenergic receptors in the heart and kidneys, decreasing the influence of the SNS on these tissues; decrease cardiac output and the release of renin

Front 5

Beta Blockers
•Indications

Back 5

–Treats stable angina pectoris and hypertension; prevents reinfarctionin MI patients; treats stable CHF

Front 6

Beta Blockers
Pharmacokinetics

Back 6

–Absorbed in the GI tract, undergoes hepatic metabolism, and is excreted in the urine

Front 7

Beat Blockers
•Contraindications

Back 7

–Bradycardia
–Heart block
–Cardiogenicshock
–Asthma and COPD
–Pregnancy and lactation

Front 8

Beta Blockers
•Cautions

Back 8

–DM
–PVD
–Thyrotoxicosis

Front 9

Beta Blockers
Adverse Effects

Back 9

–Related to their blockage of sympathetic nervoucsystem
–CNS: dizziness, fatigue, and emotional depression
–GI: N/V, colitis
–CV: CHF, decreased cardiac output, arrhythmias
–Bronchospasm, dyspnea, cough

Front 10

Beta Blockers
•Drug-to-drug interaction

Back 10

–Clonidine

Front 11

•Metoprolol(Toprol, ToprolXL)
Uses

Back 11

treatment of angina in adults, prevention of reinfarctionwithin 3-10 days after MI

Front 12

Nadolol(Corgard)
uses

Back 12

long term management of angina in adults

Front 13

Propranolol(Inderal)
uses

Back 13

long term management of angina and prevention of reinfarctionin patients 1 -4 weeks after MI in adult

Front 14

Calcium Channel Blockers
•Actions

Back 14

Inhibit the movement of calcium ions across the membranes of myocardial and arterial muscle cells, altering the action potential and blocking muscle cell contraction

Front 15

Calcium Channl Blockers
•Indication
–

Back 15

Prinzmetal’sangina

Front 16

CCB
Pharmocokenetics

Back 16

–Well absorbed
–Metabolized in the liver and excreted in the urine

Front 17

CCB
Contraindications

Back 17

–Allergy
–Heart block and sick sinus syndrome
–Renal or hepatic dysfunction
–Pregnancy and lactation

Front 18

Calcium Channel Blockers
•Adverse Effects

Back 18

–Hypotension
–Cardiac arrhythmias
–GI upset
–Skin reaction
–Headache
•Drug-to-drug interactions
–Vary with each drug

Front 19

Amlodipine(Norvasc),
uses

Back 19

treatment of chronic, stable angina and of Prinzmetal’sangina in adults

Front 20

Diltiazem(Cardizem, CardizemSR)
uses

Back 20

treatment of angina in adults

Front 21

Nicardipine(Cardene)
uses

Back 21

treatment of angina in adults

Front 22

Nifedipine(Adalat, Procardia)
uses

Back 22

treatment of angina in adults

Front 23

Verapamil(Calan, Isoptin)

Back 23

treatment of angina in adults.

Front 24

Risk Factors
CAD

Back 24

elevated blood lipid levels smoking
hypertension
diabetes mellitus
obesity
family history of premature cardiovascular disease (first-degree relative with cardiovascular disease at 55 years of age or younger for men and at 65 years of age or younger for women)
age> 45 years for men; >55 years for women.

Front 25

CAD
Prevention (modifiable)

Back 25

cholesterol abnormalities tobacco use
hypertension
diabetes mellitus
Lack of estrogen in women
Obesity
Physical inactivity

Front 26

CAD
non mosdifiable risk factors

Back 26

Family history of coronary heart disease
Increasing age
Gender (men develop CAD at an earlier age than women)
Race (higher incidence of heart disease in African Americans than in Caucasians)

Front 27

LDL Goal
for patients with one or no risk factors

Back 27

Less than 160 mg/dL

Front 28

LDL Goal
for patients with two or more risk factors

Back 28

Less than 130 mg/dL

Front 29

LDL goal
patients with CAD or at high risk for CAD.

Back 29

Less than 100 mg/dL

Front 30

LDL Goal
patients at very high risk for an acute coronary event

Back 30

Less than 70 mg/dL is

Front 31

HDL Goal

Back 31

> 40 mg/dL and should ideally be > 60 mg/dL.

Front 32

Triglycerides

Back 32

< 200

Front 33

Stable angina:

Back 33

predictable and consistent pain that occurs on exertion and is relieved by rest

Front 34

Unstable angina (also called preinfarction angina or crescendo angina):

Back 34

symptoms occur more frequently and last longer than stable angina. The threshold for pain is lower, and pain may occur at rest
Unstable angina is characterized by attacks that increase in frequency and severity and are not relieved by rest and nitroglycerin. Patients with unstable angina require medical intervention.

Front 35

Intractable or refractory angina:

Back 35

severe incapacitating chest pain

Front 36

Variant angina (also called Prinzmetal's angina):

Back 36

pain at rest with reversible ST-segment elevation; thought to be caused by coronary artery vasospasm

Front 37

Silent ischemia:

Back 37

objective evidence of ischemia (such as ECG changes with a stress test), but patient reports no symptoms

Front 38

CC Blockers
ex

Back 38

(Norvasc) and diltiazem

Front 39

MI
EKG changes

Back 39

The classic ECG changes are T-wave inversion, ST-segment elevation, and development of an abnormal Q wave

Front 40

PTCA

Back 40

invasive interventional procedure, a balloon-tipped catheter is used to open blocked coronary vessels and resolve ischemia

Front 41

The major indications for CABG

Back 41

Alleviation of angina that cannot be controlled with medication or PCI
Treatment of left main coronary artery stenosis or multivessel CAD
Prevention and treatment of MI, dysrhythmias, or heart failure
Treatment for complications from an unsuccessful PCI

Front 42

Post op chest tube amoutns

Back 42

. Bloody drainage should not exceed 200 mL/h for the first 4 to 6 hours post op

Front 43

postpericardiotomy syndrome:
s/s

Back 43

fever, malaise, pericardial effusion, pericardial friction rub, arthralgia

Front 44

Right-sided failure
def

Back 44

–RV cannot eject sufficient amounts of blood, and blood backs up in the venous system.

Front 45

Left-sided failure
def

Back 45

LV cannot pump blood effectively to the systemic circulation. Pulmonary venous pressures increase,

Front 46

Right-sided failure
s/s

Back 46

edema, hepatomegaly, ascites, anorexia, nausea, weakness, and weight gain.

Front 47

Left-sided failure
s/s

Back 47

pulmonary congestion with dyspnea, cough, crackles, and impaired oxygen exchange.

Front 48

Classification of Heart Failure

Back 48

NYHA classification of HF
–Classification I, II, III, IV
•ACC/AHA classification of HF
–Stages A, B, C, D
•Treatment guidelines are in place for each stage.

Front 49

Nursing Process:

Back 49

The Care of the Patient with HF: Planning
•Goals may include promoting activity and reducing fatigue, relieving fluid overload symptoms, decreasing anxiety or increasing the patient’s ability to manage anxiety, encouraging the patient to make decisions and influence outcomes, teaching the patient about the self-care program.

Front 50

Orthopnea

Back 50

difficulty breathing when lying flat, is a clinical manifestation of left-sided heart failure.

Front 51

Pulmonary Edema
def

Back 51

•Acute event in which the LV cannot handle an overload of blood volume. Pressure increases in the pulmonary vasculature, causing fluid to move out of the pulmonary capillaries and into the interstitial space of the lungs and alveoli.
•Results in hypoxemia

Front 52

Pulmonary Edema
s/s

Back 52

Clinical manifestations: restlessness, anxiety, dyspnea, cool and clammy skin, cyanosis, weak and rapid pulse, cough, lung congestion (moist, noisy respirations), increased sputum production (sputum may be frothy and blood-tinged), decreased level of consciousness

Front 53

HF
Class1

Back 53

No limitation of physical activity
Ordinary physical activity does not cause undue fatigue,palpitations or dyspnea

Front 54

HF
Clss2

Back 54

slight limitation of physical actvitiy. Comfortable at rest, but ordinary physical activity results in fatigue, palpiation or dyspnea.

Front 55

HF
Class 3

Back 55

Marked limitation of physical activity. Comfortable at rest., but less than ordinary activity causes fatigue, palpiation or dyspnea.

Front 56

HF
Class 4

Back 56

Unable to carry out any physical activity without discomfort. Symptoms of cardia insufficiency at rest. If any ohysical activity, discomfort is increased.

Front 57

afterload

Back 57

the amount of resistance to ejection of blood from a ventricle

Front 58

urine output of less than 50 mL per 24 hours

Back 58

anuria

Front 59

the amount of blood pumped out of the heart in 1 minute

Back 59

cardiac output (CO)

Front 60

a treatment for heart failure in which a device paces both ventricles to synchronize contractions

Back 60

cardiac resynchronization therapy (CRT)

Front 61

contractility

Back 61

the force of ventricular contraction; related to the number and state of myocardial cells

Front 62

ejection fraction (EF)

Back 62

percentage of blood volume in the ventricles at the end of diastole that is ejected during systole; a measurement of contractility

Front 63

the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients; signs and symptoms of pulmonary and systemic congestion may or may not be present

Back 63

heart failure (HF)

Front 64

implantable cardioverter defibrillator (ICD)

Back 64

a device implanted in patients with ventricular dysrhythmias that detects and treats dysrhythmias

Front 65

left-sided heart failure (left ventricular failure)

Back 65

inability of the left ventricle to fill or pump (empty) sufficient blood to meet the needs of the tissues for oxygen and nutrients; traditional term used to describe patient's symptoms of heart failure

Front 66

oliguria

Back 66

diminished urine output; less than 400 mL per 24 hours

Front 67

orthopnea

Back 67

shortness of breath when lying flat

Front 68

preload

Back 68

the amount of myocardial stretch just before systole caused by the volume of blood presented to the ventricle

Front 69

pulseless electrical activity (PEA)

Back 69

condition in which electrical activity is present but there is not an adequate pulse or blood pressure because of ineffective cardiac contraction or circulating blood volume

Front 70

pulsus paradoxus

Back 70

systolic blood pressure of more than 10 mm Hg higher during exhalation than during inspiration; difference is normally less than 10 mm Hg

Front 71

right-sided heart failure (right ventricular failure)

Back 71

inability of the right ventricle to fill or pump (empty) sufficient blood to the pulmonary circulation

Front 72

stroke volume (SV)

Back 72

amount of blood pumped out of the ventricle with each contraction

Front 73

systolic heart failure

Back 73

inability of the heart to pump sufficiently because of an alteration in the ability of the heart to contract; current term used to describe a type of heart failure

Front 74

Cardiac tamponade
s/s

Back 74

feeling of fullness within the chest
substantial or ill-defined pain
pressure in the chest may result from stretching of the pericardial sac.
venous pressure increased
engorged neck veins
shortness of breath
labile or low blood pressure. pulsus paradoxus
falling systolic blood pressure narrowing pulse pressure rising venous pressure (increased JVD
distant (muffled) heart sounds