Cardic Exam Review Slide *Medium*

Cardiac Exam Review - May 2024

• Cardiovascular Problems: Chest pain, heart murmurs (valve disorders), dyspnea on exertion, dizziness, poikilothermia (peripheral arterial disease), orthostatic hypotension, dependent rubor, edema

Diagnostic Tests

• Stress Test: NPO 2-4 hours, no smoking/caffeine, comfortable clothing, walking
• EKG (ECG): Lie still, normal breathing, accurate lead placement, clean/dry skin
• Holter Monitor: 24-72 hour continuous monitoring (for low risk, intermittent symptoms)
• Echocardiography: Shows heart motion
• Duplex Ultrasound: Shows blood flow through arteries and veins, identifies blockages
• Cardiac Catheterization/Angioplasty: Check for prior contrast dye reactions, invasive, signed consent needed, NPO 6-8 hours, local anesthesia, warm/flushed feeling, post-op: increase fluids, maintain bedrest, pressure dressing, monitor neurovascular status (circulation, motion, sensation), vital signs, heart rate, rhythm, no flexion of extremity

Patient Teaching for Hypertension

• Take medications as directed, do not stop abruptly
• Take meds even if BP is normal and feeling well
• Decrease sodium
• Monitor blood pressure
• Check pulse and blood pressure before beta-blockers or calcium channel blockers
• Change positions slowly to prevent orthostatic hypotension

Cardiac Surgery

• Hold anticoagulants up to a week before surgery
• Hold diuretics for 24 hours before surgery
• Diabetics should not take insulin or antidiabetic medications before surgery
• Post-op: monitor vital signs, rhythm, urine output, and lung sounds
• Sternotomy dressing changes under sterile technique
• Medicate for pain before ambulation
• Incentive spirometry

Medications

• Beta-blockers and calcium channel blockers: check pulse and blood pressure before administering, do not administer if pulse or BP is below 100mmHg systolic or 60 beats per minute
• ACE inhibitors and other antihypertensives: check BP before administration
• Digoxin: check pulse, hold if below parameter (usually 60 beats per minute)
• Diuretics (Hydrochlorothiazide, furosemide, bumetanide): check potassium levels, hold if hypokalemic, Spironolactone can increase potassium
• Give antihypertensives even if BP is normal
• Warfarin: monitor PT, INR, consume consistent amounts of vitamin K (mostly green leafy vegetables), monitor for bleeding, no over-the-counter medications (Aspirin, NSAIDs) without consulting healthcare provider., bleeding precautions, don't go barefoot. Carry medical alert identification.

Math

• Cardiac output: stroke volume x heart rate, convert to liters per minute and round to the nearest 10th.
• Drop factors (drops per minute): mL x drop factor/time (minutes)
• Hourly rate (infusion runs less than an hour): mL x 60/time (minutes)
• Hourly rate (infusion runs over an hour): mL x 60/time (hours)
• Duration of infusions: mL to infuse/hourly rate
• Volume (mL) to infuse/hourly rate

Valve Disorders

• Etiology: congenital, aging, endocarditis, rheumatic fever
• Signs and symptoms: heart murmur, dysrhythmias, palpitations, chest pain
• Complications: heart failure, stroke, endocarditis
• Interventions: medications to manage dysrhythmias and heart failure, prevent stroke; valve repair or replacement
• Valve replacement: Biologic (lasts 7-10 years, no anticoagulant required), Mechanical (durable, lifelong anticoagulation required)

NCLEX Question

• Which finding is common to all valve disorders? Heart murmur

Endocarditis

• Risk factors: valve disorders, IV drug use, gum disease, prior endocarditis, and rheumatic fever
• Signs and symptoms: heart murmur, fever, malaise, petechiae, Janeway lesions, Osler's nodes, splinter hemorrhages
• Treatment: antibiotics for several weeks (intravenous penicillin most often)
• Complications: heart failure, valve dysfunction, and stroke

Pericarditis

• Inflammation of pericardial lining
• Signs and symptoms: pleuritic chest pain (sharp, heavy, worse when coughing, better when sitting up & leaning forward), friction rub, dyspnea
• Complications: heart failure, cardiac tamponade (jugular venous distention, tachycardia, hypotension, muffled heart sounds)

Cardiomegaly

• Enlargement of the heart
• Types: Dilated (most common, stretched & less contractile), Restrictive (rigid walls, don't expand/contract normally), Hypertrophic (enlarged heart muscle, decreasing volume).
• Common etiologies: hypertension, pregnancy, alcoholism
• All types can cause heart failure

Deep Vein Thrombosis (DVT)

• Clots in a vein
• Risk factors: venous stasis (immobility), oral contraceptives, smoking, vessel injury, hyper-coagulability (dehydration)
• Signs & symptoms: redness, warmth, edema, pain, hard (indurated) distended vein
• Treatment: anticoagulants, compression stockings, elevation of leg above heart, warm compresses
• Complications: pulmonary embolism, recurrent DVTs, venous insufficiency