Cardiac Study Guide: Meds, Stenosis, Pulse Checks

• Study notes for cardiac-related topics
• Includes meds for return of spontaneous circulation (ROSC), valvular issues, murmurs, EKGs, tachycardia, anticoagulants, heart failure, myocardial infarction (MI), cardiac tamponade, pericarditis, and angina.

Meds for ROSC

• Lidocaine prevents dysrhythmias by delaying conduction and reducing automaticity of the heart.
• Epinephrine increases coronary and cerebral perfusion pressure during CPR to help achieve ROSC.
• Amiodarone treats ventricular fibrillation (VF) and ventricular tachycardia (VT), especially when other treatments fail.

Pulse Checks

• Pulse checks confirm the heart has resumed effective pumping after cardiac arrest.
• A detectable pulse indicates sufficient blood flow, which is an essential sign of successful resuscitation.
• Pulse quality insights include hemodynamic status, with weak pulses suggesting inadequate cardiac output or shock.

Valvular Stenosis

• Valvular stenosis involves the heart valve narrowing, restricting blood flow.
• Assessment finding: Loud, harsh murmurs are typically heard
• Symptoms involve fatigue, shortness of breath, and chest pain, especially during exertion.
• Other signs can encompass heart failure due to increased workload on the heart.

Valvular Regurgitation

• Valvular regurgitation occurs when the heart valve does not close properly, causing blood to flow backward.
• Assessment findings: Soft or blowing systolic or diastolic murmurs, depending on the affected valve
• Symptoms: May include palpitations, fatigue, and shortness of breath.
• Other signs can include heart failure due to volume overload on the heart.

Heart Murmurs

• Murmurs are abnormal heart sounds from turbulent blood flow.
• Systolic murmurs: Occur between S1 and S2 (e.g., aortic stenosis).
• Diastolic murmurs: Occur between S2 and S1 (e.g., mitral regurgitation).

EKG Components

• P Wave: Represents atrial depolarization and lasts 0.06-0.12 seconds.
• PR Interval: Time from the start of the P wave to the start of the QRS complex, normally 0.12-0.20 seconds.
• QRS Complex: Represents ventricular depolarization, with a duration of 0.06-0.10 seconds.
• T Wave: Indicates ventricular repolarization.

Tachycardia

• Rapid heart rate, over 100 bpm
• Causes: Includes physical/psychological stressors, hypotension, hyperthermia, hypovolemia, anemia, hypoxia, hypoglycemia, myocardial infarction, and hyperthyroidism.
• Interventions: Beta blockers (e.g., Metoprolol) slow the heart rate, Calcium Channel Blockers (e.g., Diltiazem) manage heart rate, Adenosine is used for supraventricular tachycardia (SVT)..
• Synchronized cardioversion is used if the patient is unstable.
• Symptoms: Dizziness, dyspnea, hypotension, increased heart workload, angina.

Anticoagulant Meds

• Meds: Warfarin, Heparin, Direct Oral Anticoagulants (DOACs) like apixaban, rivaroxaban, dabigatran.
• Problems: Include bleeding, thrombosis, and drug interactions.
• Blood tests for anticoagulants
  • Prothrombin Time (PT) / International Normalized Ratio (INR): Monitors Warfarin (INR goal is 2-3).
  • Activated Partial Thromboplastin Time (aPTT): Monitors heparin therapy (therapeutic range 1.5-2.5 times normal).
  • Complete Blood Count (CBC): Checks hemoglobin, hematocrit, and platelet levels.
• Reversal agents for anticoagulants
  • Warfarin: Reversed by Vitamin K; PCC or FFP used in significant bleeding.
  • DOACs: Reversed by andexanet alfa for rivaroxaban and apixaban.
  • Heparin: Reversed by protamine sulfate.

Left vs Right Sided Heart Failure

• Decreased perfusion signs consist of hypotension, reduced urine output, cool extremities, altered mentation, heart murmur, dysrhythmias, and worsening renal/liver function.
• Right-Sided Heart Failure
  • Signs: Increased HR, murmur, jugular vein distention, edema, weight gain, ascites, hepatomegaly.
  • Symptoms: Fatigue, anxiety/depression, RUQ pain, anorexia, GI symptoms, nausea.
• Left-Sided Heart Failure
  • Signs: Increased HR, poor O2 exchange, crackles in lungs, S3 & S4 heart sounds, pleural effusion, altered mental status, shallow rapid respiration, dry cough, pink-tinged sputum.
  • Symptoms: Weakness, fatigue, anxiety/depression, dyspnea, paroxysmal nocturnal dyspnea, orthopnea.
• Heart Failure Complications: Pleural effusion, dysrhythmias, hepatomegaly, cardiorenal syndrome, anemia.
• Goals of heart failure therapy: Symptom relief, optimizing volume status, supporting oxygenation, CO, addressing the cause, avoiding complications, and providing discharge instructions.

Cardiac Tamponade

• Fluid accumulates in the pericardial sac, "squishing" the heart and preventing complete filling.
• Fluid can be pus or blood.
• Symptoms: dyspnea, dizziness, chest tightness, increasing restlessness, pulsus paradoxus, tachycardia, muffled heart sounds, jugular vein distention.
• Nursing actions: administer fluids for hypotension, prepare for pericardiocentesis.

Pericarditis

• (Inflammation of the pericardium)
• Symptoms: chest pain, which increased pain with laying flat or deep breathing, sharp stabbing pain that is often relieved by sitting up and leaning forward.
• Assessment: auscultate have muffled or distant heart sounds, pericardial rub
• Pericarditis is often the result of an infection, cancer, HIV, kidney failure, or tuberculosis
• Additional symptoms: fever, chills, swelling in lower extremities, difficulty breathing, dry cough, fatigue
• Treatment: Draining fluid from the sac (pericardiocentesis or subxiphoid pericardiotomy) to allow the infected fluid to drain into the abdominal cavity

Angina

• Stable Angina: Predictable, triggered by exertion/stress, relieved by rest or nitroglycerin.
• Unstable Angina: More serious, unpredictable, can occur at rest, may precede an MI.
• Variant Angina (Prinzmetal's): Caused by coronary artery spasm, occurs at rest, not linked to typical triggers.
• Location of discomfort: Chest, arms, neck, jaw, shoulder, or back with sensation is often described as pressure, squeezing, burning, or tightness. Duration is Temporary, usually lasting minutes.
• Relieved by: Rest or nitroglycerin
• Risk Factors: Atherosclerosis, Age, Gender, Smoking, High Blood Pressure, High Cholesterol, Diabetes & Family History
• Lifestyle Modifications: diet, exercise, smoking cessation, weight management.
• Medications: Nitroglycerin, beta-blockers, calcium channel blockers, and antiplatelet agents.
• Revascularization Procedures: Angioplasty or CABG may be recommended.
• Angina patients do not have a sudden emergent need to go to the catheterization lab for reperfusion therapy.
• Nitro has a rapid onset and causes vasodilation to improve blood flow to the heart.
• Angina Pectoris: Stable – consistent, chronic pain, able to relieve with Nitroglycerine
• Angina: Unstable – new episode that may increase in severity with new areas of the heart experiencing ischemia EMERGENCY

Myocardial Infarction (MI)

• Myocardial ischemia causes are a blood clot (coronary thrombosis) or atherosclerotic plaque.
• Acute Coronary Syndrome (ACS)
• MI can occur from: unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI).
• Common Symptoms: ---Chest pain, Shortness of breath, Nausea & Vomiting, Sweating, Fatigue, Dizziness
• Diagnosis: Made through clinical evaluation, ECG findings, and blood tests to assess cardiac biomarkers.
• Medical treatment to restore blood flow:
• MONA = Morphine, Oxygen, Nitro, Aspirin
  • Nitrates: Vasodilators
  • Aspirin: Decreases platelet adherence, limiting clotting
  • Beta blockers: Decreases myocardial oxygen demand
  • Calcium antagonists: Arteriole dilation
  • ACE inhibitors: Decreases BP and resistance
• Reperfusion Therapy restores blood flow with Percutaneous coronary intervention (PCI) or Fibrinolytic therapy (thrombolytic therapy.

Study notes covering cardiac medications for ROSC, pulse check techniques, valvular stenosis, murmurs, EKGs, and tachycardia. Also included are notes on anticoagulants, heart failure, myocardial infarction (MI), cardiac tamponade, pericarditis and angina. Pulse check insights include hemodynamic status.