Download Cardiac Conditions & Interventions: A Healthcare Professional's Guide and more Study Guides, Projects, Research Medicine in PDF only on Docsity!
Comprehensive Overview of
Cardiac Conditions and
Interventions
Dysrhythmias
Diagnostic and Reversal Agents
RV (right ventricular) for diagnostics RV reversal agents for anticoagulants: Warfarin reversal = Vitamin K Heparin reversal = Protamine sulfate Warfarin interactions = Ginkgo, garlic, ginger (3 G's)
Cardiac System Concepts
Veins = low pressure, Arteries = high pressure Cardiac system has: Automaticity (generating impulses independently) Excitability (responding to stimulus) Conductivity (transmitting impulses) ECG (Electrocardiogram) = action potential Cardiac perfusion occurs during diastole Systole (contraction) and Diastole (relaxing) Normal cardiac output = 4-8 L/min
Cardiac Output Factors
Preload = amount of blood in ventricles at end of diastole Medications that help decrease preload = Diuretics Afterload = resistance ventricles overcome to eject blood Medications that help decrease = ACEi (for angioedema/cough), ARBs, Calcium channel blockers Contractility = force of contractions Medication that helps with contractility = Digoxin Hold if HR < 60, take apical pulse for entire minute Monitor toxicity = nausea/vomiting, anorexia, visual disturbances, potassium Avoid with antacids
Other Cardiac Medications
Dopamine, Dobutamine, Milrinone administered via IV
Signs and Symptoms of Low Cardiac Output
Clammy, Shortness of Breath, Diaphoresis, Syncope, Hypotension, Thready pulses, Fatigue, Chest pain
Risk Factors for Cardiac Disease
High fat diet, African Americans, Smoking, Age, High homocysteine levels, Vitamin deficiencies
Monitoring
Coagulation, Glucose, Lipids, Cardiac markers Lipid levels: HDL > 60, LDL < 100, Total cholesterol < 200
ECG Interpretation
P wave = Atria depolarizing (contracting) QRS = Ventricles depolarizing T wave = Ventricular repolarization (resting) PR interval = Time for atrial contractions to reach ventricles (Normal = 3-5 small boxes) QRS interval = Time for ventricular contractions (Normal = < 3 small boxes) QT interval = Time for ventricles to depolarize and repolarize
ECG Testing
Gold standard test for MI (Myocardial Infarction), 10 electrodes (first line diagnostic) Proper tracing = P wave > U if present Set up = Inform patient, undress from waist up, lay supine, clean spots, place electrodes, shave if needed, tell patient to lay still
Other Cardiac Diagnostic Tests
Chest X-ray = Extra diagnostic Echocardiogram = Transthoracic (most common) or Transesophageal 6-8 hours NPO, Moderate sedation, IV access, Monitor gag reflex post- procedure Cardiac Stress Test = Not first line, exercise induced or medication induced (for angina patients, not MI) Pre = NPO 2-4 hours, Signed consent Cardiac Catheterization and Angiography = Nonsurgical invasive, evaluates degree of blockages Interventions = Stent Pre = Consent, NPO 8 hours, Assess for allergies, IV Educate patient about hot flash with contrast dye Monitor renal function due to nephrotoxic contrast dye Complications = Dysrhythmias, Bleeding, Infection Post = Flat bed rest 2-6 hours to prevent pressure, Pulse checks
Pulmonary Artery Catheter
Measures pulmonary artery pressures, Pulmonary hypertension, Right heart function
Heart Failure
Pathophysiology
Decreased cardiac output due to ineffective pumping Risk factors = African American males, Hypertension (top cause for CHF)
Stages of Heart Failure
Varies from no symptoms to hospice-level
Signs and Symptoms
Low cardiac output = Hypotension, Oliguria, Cool extremities, Murmur Left-sided = Lung (Fatigue, Crackles, SOB, Exertional dyspnea, Pale, Paroxysmal nocturnal dyspnea, Frothy sputum) Educate patient to sit up at edge of bed for paroxysmal dyspnea Right-sided = Rest of body (JVD, Edema, Swelling organs, Ascites)
Diagnosis
Physical exam, X-ray, Echocardiogram, ECG, MUGA scan (Ejection fraction), BNP, Troponin
Interventions
Reduce sodium and fluids (1500 mg Na/day), Report > 5 lbs/week weight gain Medications = Diuretics (reduce preload), ACEi (reduce afterload), ARBs, Beta blockers ACEi side effects = Cough, Angioedema Non-surgical = CPAP Surgical = ICD, Ventricular pacemaker, Ventricular assist device (for transplant)
Complications
Pulmonary Embolism (Pink frothy sputum, SOB, Orthopnea, Chest pain) Interventions = Diuretics, IV, Oxygen Early = Oliguria/Polyuria Late = Distended abdomen, Confusion
Myocardial Infarction
Pathophysiology
Complete damage to cells due to lack of oxygen Risk factor = Atherosclerosis (Plaque buildup from fats)
Signs and Symptoms
Chest pain, Shoulder/arm pain, Nausea/vomiting Women present differently = Indigestion Elderly = Loss of consciousness Diabetic = Shortness of breath, Fatigue
Diagnosis
ECG first (accessible), Labs (Troponin every 3-4 hours)
Interventions
MONA (Morphine, Oxygen, Nitro, Aspirin) Thrombolytics (Alteplase, Reteplase, tPA) = Dissolve active clots Complications = Hemorrhage Different from anticoagulants (Decrease future clots) Percutaneous Coronary Intervention (Balloon placement) CABG (Coronary Artery Bypass Graft) = Last resort
Anticoagulants for Stent Patients
Contraindicated with garlic
Education
Sternal precautions post-CABG (Exercise limitations, Cardiac rehab, Don't bend, Signs of infection) Expect 2-5 weeks post-procedure = Lack of appetite, Insomnia, Fatigue, Chest discomfort
Cardiomyopathy
Pathophysiology
Structural changes to the heart resulting in decreased cardiac function Risk factor = African American males (2x mortality rate)
Diagnosis
Ejection fraction = 55-65% is normal Signs and symptoms = Similar to angina/Heart Failure
Internal Cardioverter Defibrillator (ICD)
For lethal dysrhythmias/previous heart problems Pre-procedure = Consent, Prepare skin Post-procedure = Chest X-ray for placement, Minimize shoulder movement, Assess for hiccups Educate patient = ID card, No sexual activity/movement for 1-2 weeks, Feels like blow to chest if misfires, No magnets near pacemaker, Notify dentist, No contact sports/lifting for 2 months
Additional Notes
Homocysteine = Increased levels are a risk factor for heart disease, associated with decreased dietary intake of folic acid and B vitamins T wave elevation (Peak T waves) = Hyperkalemia
