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34 Cards in this Set

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Digoxin, or Digitalis
strengthens the contraction of the heart muscle, slows the heart rate and helps eliminate fluid from body tissues. Is a competitive antagonist for same receptor as K+, so watch out if patient is hypokalemic, can cause deadly drop in BP
Atrial Fibrilation, or A-fib

Give cause, EKG signs, and Rx
1. ventricular rhythm irregular

2. P-waves absent, PR interval absent

3. C-channel blockers, B-blockers
Atrial Flutter

Give EKG signs and Rx
1. Sawtooth EKG

2. Slow ventricular response, give C-channel blockers, B-blockers
Ventrical Tachycardia

Give EKG and Rx
1. P-waves absent, QRS interval widened, EKG massive peaks/valleys

2. Reset heart before V-fib!
Ventricular Fibrilation, or V-fib

Give cause, EKG and Rx
1. Electrical chaos in ventricles

2. No EKG recognizable, no pattern

3. Reset within 3-5 min or RIP
Sinus Bradychardia

Give HR and Rx
1. HR <60bpm, no Rx unless pt is uncomfortable, then pacemaker
Sinus Tachycardia

Give HR, EKG and Rx
1. HR between 100-180bpm

2. P-waves encroach on preceeding T-waves

3. Give B-blockers, C-channel blockers
Give P-wave definition
Atrial contraction
Give QRS complex definition, timing
Ventricle contraction, should be between .04 to .12 second
Give T-wave definition
Resting period for ventricles
Give PR interval timing
.12 to .2 second, will be prolonged in 1st degree heart block
Give QT interval definition and timing
Depolarization and Repolarization of ventricles, should be between .34 to .43 second
Atrial and Ventricular rate
Between 60-100 BPM for both
Left-sided heart failure

Causes, S/S, Rx
Most common heart failure. (Backs to the lungs)

1. High BP, coronary heart disease

2. Irritating cough, tachycardia, fatique, wet lung sounds, irregular, weak, thready pulse

3. ACE inhibitor, B-blocker, Digoxin
Right-sided heart failure

Causes, S/S, Rx
backs to the juggular vein

1. Left ventricular failure, Right ventricle MI, pulmonary hypertension

2. Peripheral edema, weight gain, GI issues (liver engorgement) Ascites, elevated BUN/creatinine

3. ACE inhibitor, B-blocker, Digoxin
Starling's Law
The more the ventricle is filled with blood during diastole (end-diastolic volume), the greater the volume of ejected blood will be during the resulting systolic contraction
Acute MI:

S/S, Labs, Tests, Rx
Anterior wall: 25% of time
Inferior wall: 17% of time

S/S: increased HR, shortness of breath, pain in chest, jaw, back, arms, nausea, diaphoresis, confusion, disorientation, irritability, crackles and wheezes,

Labs: Troponin, CK-MB, WBC, LDH increases; acidosis & electrolyte imbalances

Tests: T-wave inversion, ST elevation (ST and T return to normal after incident), wide Q-wave (remains)

Rx: SAAB: Statin (lower cholesterol) ACE inhibitor, Asprin (blood thinner) Beta-blocker (reduce BP)

lower O2 demand, improve circulation via (reduce preload) nitrates, b-blockers, c-chan blockers, diuretics and (reduce afterload) ACE inhibitors, vasodilators also decrease pain: analgesies, and thin blood: heparin, asprin
PCTA

Percutaneous Transluminal Coronary Angioplasty
Less sick than CABG

1. Discrete blockage of 1-2 vessels

2. Thread catheter w/ balloon, then inflate

3. Issues: acute closure, bleeding at site, reaction to dye, decreased BP
CABG

Coronary Artery Bypass Graft
1. >70% occlusion of vessels

2. Use of patient artery/vein to bypass blockage

3. Many tubes post-op, chest tubes, foley, IV, hemodynamic monitoring lines

4. Issues: decreased CO, CVA (strokes), renal failure, GI issues
3 types of Angina
1. Stable (symptoms absent when resting)

2. Unstable (unpredictable, gets worse, needs immediate Rx)

3. Variant (occurs in sleep/rest. High risk of MI, cocaine use in young)

Rx: Increase O2. Nitrates (dilate vessels), B-blocker (decrease HR by reduce contractillity) C-channel blocker (increase O2 supply, vasodilate)
Cardiomyopathy

Discuss 3 types
1. Dilated (most common) caused by alcohol abuse, auto-immune disorders, post-partum issues, leads to CHF

2. Hypertrophic: thickening of heart walls, especially in septum, S/S = chest pain

3. Restrictive (least frequent) stiff heart muscles, cannot expand/contract

Rx: Dilated/Restrictive: treat like CHF, Hyper: myocardial ischemia

Overall, need new heart for all three issues
Rheumatic carditis
caused by strep throat that was not treated when younger. Needs long-term penicillin and surgery to replace damaged valves
Pericarditis
Inflimation of pericardial sac around heart.

s/s: friction rub (heard L sternal border), pain, better with sitting up/forward. Elevated WBC, T-wave inversion

Rx: analgesics, anti-inflamatory agents, antibiotics, chronic: digoxin or pericardial window needs to be cut
Stent

VS

Angioplasty
Stent: leaves metal behing

Angioplasty: balloon only to push plaque against wall
Atheroma

VS

Ischemia
Atheroma: blockage of vessel

Ischemia: lowered vessel diameter
#1 cause of RV failure
Lung disease
3 factors that control BP
1. cardiac output

2. peripheral resistance

3. blood volume
Troponin VS CK
Troponin: good <.5, bad >.8
Surge before, peaks @ 6 hours, stays 10-12 days

CK: good M<160, F<130
Surge 4-6 hours before, peaks w/in 24 hrs, returns w/in 48 hrs
Cholesterol

LDL & HDL

Normal values
Total: 115-200

LDL: 80-190
HDL: 30-60

Want LDL/HDL to be 3/1
Beta-Blockers

use and mechanism of action
Used within first 24 hours of MI to decrease HR, decrease ventricular dysrhythmias, decrease size of infarct
Calcium Channel Blockers

Use and Mechanism of Action
Used more with Angina than MI. Increase myocardial perfusion and dilate the coronary arteries. Also decrease contractility and rate, therefore decreasing O2 demand.
Angiography

proceedure and nursing considerations
Uses dye to show vessels

Nursing considerations:
1. Bleeding at site
2. Stroke from artery breaking away
3. kidneys reacting to dye
4. shellfish allergies
Cardiac Catheterization

proceedure
No dye like in the angiography, takes pictures instead
Endiocarditis

Define, S/S, Rx
infection of endocardium valves. usually w/ IV drug users, valve replacemnts, dental bacterials, e-coli, strep throat

s/s: fever, fatique, joint pain, weight loss, heart failure

Rx: valve replacement, penicillin for 6 weeks, prophalactics before dental work