Podcast
Questions and Answers
What is the primary purpose of cardiac catheterization?
What is the primary purpose of cardiac catheterization?
Which of the following statements regarding the post-procedure care after cardiac catheterization is accurate?
Which of the following statements regarding the post-procedure care after cardiac catheterization is accurate?
What should be done prior to performing cardiac catheterization with contrast dye?
What should be done prior to performing cardiac catheterization with contrast dye?
Which of the following is NOT a medication category used for cardiovascular treatment?
Which of the following is NOT a medication category used for cardiovascular treatment?
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What dietary change is recommended to improve cardiovascular health?
What dietary change is recommended to improve cardiovascular health?
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Which assessment finding would most likely be indicative of left-sided heart failure?
Which assessment finding would most likely be indicative of left-sided heart failure?
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What lifestyle modification is most important for preventing hypertension?
What lifestyle modification is most important for preventing hypertension?
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Which medication class is primarily used to manage heart failure due to its ability to reduce preload?
Which medication class is primarily used to manage heart failure due to its ability to reduce preload?
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What is a common risk factor for developing coronary artery disease?
What is a common risk factor for developing coronary artery disease?
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Which of the following symptoms is characteristic of stable angina?
Which of the following symptoms is characteristic of stable angina?
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In the management of arrhythmias, which treatment is often the first-line approach?
In the management of arrhythmias, which treatment is often the first-line approach?
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Which laboratory finding would most likely indicate myocardial infarction?
Which laboratory finding would most likely indicate myocardial infarction?
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A patient has a heart rate of 50 beats per minute. Based on the information in the text, this is likely due to:
A patient has a heart rate of 50 beats per minute. Based on the information in the text, this is likely due to:
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Which of the following is NOT true regarding troponin levels in the blood?
Which of the following is NOT true regarding troponin levels in the blood?
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A patient presents with a dry cough. Based on the text, which of the following is the most likely reason for this symptom?
A patient presents with a dry cough. Based on the text, which of the following is the most likely reason for this symptom?
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A patient has a decreased systolic blood pressure of 20 mmHg and an increased pulse of 30 bpm when standing up from a lying position. What is the MOST likely reason?
A patient has a decreased systolic blood pressure of 20 mmHg and an increased pulse of 30 bpm when standing up from a lying position. What is the MOST likely reason?
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During a physical assessment, a nurse notes dependent rubor on a patient's legs. Which of the following is the most likely cause?
During a physical assessment, a nurse notes dependent rubor on a patient's legs. Which of the following is the most likely cause?
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A patient has a systolic blood pressure of 140 mmHg and a diastolic blood pressure of 90 mmHg. What is the most accurate classification of this blood pressure?
A patient has a systolic blood pressure of 140 mmHg and a diastolic blood pressure of 90 mmHg. What is the most accurate classification of this blood pressure?
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A nurse is preparing a patient for a trans-esophageal echocardiogram. Which of the following is essential to ensure the patient's safety during the procedure?
A nurse is preparing a patient for a trans-esophageal echocardiogram. Which of the following is essential to ensure the patient's safety during the procedure?
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A patient presents with a heart murmur. Which of the following is the MOST likely cause?
A patient presents with a heart murmur. Which of the following is the MOST likely cause?
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Which of the following is NOT a common finding associated with venous disorders?
Which of the following is NOT a common finding associated with venous disorders?
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A nurse is performing a physical assessment on a patient with a history of cardiovascular disease. Which of the following findings would be MOST concerning?
A nurse is performing a physical assessment on a patient with a history of cardiovascular disease. Which of the following findings would be MOST concerning?
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Study Notes
Cardiovascular Disorders - Curriculum Notes
-
Cardiac Function and Pathophysiology:
- The heart has three layers and four chambers, with four valves.
- The right side of the heart carries deoxygenated blood.
- The left side of the heart carries oxygenated blood from the lungs.
- Valves include: tricuspid (between right atrium and ventricle), pulmonic (right ventricle and pulmonary artery), mitral (left atrium and ventricle), and aortic (left ventricle and aorta).
- The chapter describes the heart's function and its different components in detail.
Cardiac Output
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Cardiac output: The amount of blood pumped by the left ventricle in one minute.
- Calculated by multiplying stroke volume by heart rate.
- Affected by preload, afterload and contractility.
- Ejection fraction is the percentage of blood ejected from the left ventricle with each beat (normally 55-70%).
- Venous return (preload) is the amount of blood returning to the right atrium.
- Contractility is how forcefully the heart contracts and this can be influenced by hormones and venous return.
- Afterload is the force the left ventricle must overcome to eject blood.
Pathophysiology - Aging and Cardiovascular System
- Atherosclerosis: Causes narrowing of arterial lumen increasing afterload and blood pressure. Rough surface increases the risk of clot formation, and decreases blood flow to organs.
- Heart Muscle Inefficiency: Heart rate and maximum cardiac output decline. Atypical symptoms accompany myocardial infarctions, and conduction cells become less efficient.
- Valves: Valves thicken and calcify, causing murmurs.
Health Data Collection
- Health history
- Physical examination
- Subjective data
Measuring Blood Pressure
- Normal average blood pressure is 120/80.
- Measure in both arms for baseline.
- Report differences.
- Use arm with higher pressure for future measurements.
Orthostatic Blood Pressure
- Orthostatic blood pressure involves taking measurements while lying, sitting, and standing.
- A decrease in systolic pressure greater than 15 mmHg, and an increase in pulse greater than 20 bpm during such transitions may signify certain conditions, including fluid volume deficit, diuretics use, pain, or other factors.
- Common associated symptoms: lightheadedness, syncope, and others.
Pulses
- Count apical pulse for a full minute, documenting regularity or irregularity.
- Normal range for healthy adults is 60-100 bpm. Well-conditioned athletes may have a lower rate.
- Compare apical and radial pulses.
- Assess quality of peripheral pulses: 0=non-palpable, 1+=weak, 2+=normal, 3+=bounding.
- Identify bruits and thrills.
Respirations
- Assess rate and work of breathing.
- Pink, frothy sputum may suggest pulmonary edema (acute heart failure).
- Dry cough is a possible sign of heart failure.
Inspection
- Assess shortness of breath, and skin color and mucous membranes for signs of hypoxia (pale, cyanotic, or dark skin showing a gray discoloration around the mouth in darker-skinned individuals).
- Note pallor (anemia or decreased arterial blood flow) and dependent rubor, or brown/purple discoloration of lower extremities.
Inspection - Arterial and Venous Disorders
- Arterial Disorders: Look for decreased hair, thick/brittle nails, shiny/taut skin, pale legs when elevated, and reddish-purple discoloration in dependent positions.
- Venous Disorders: Assess for stasis ulcers, varicose veins, scars around ankles, swelling, redness, or hard/tender veins (thrombophlebitis).
Inspection - Other Findings
- Inspect for jugular venous distention (volume overload or right-sided heart failure), capillary refill, and clubbing (congenital heart disease or long-term smoking).
Palpation
- Palpate point of maximum impulse (PMI), temperature, and edema.
Auscultation
- Auscultate for S1, S2 heart sounds (normal), and presence of S3, S4, murmurs (turbulent blood flow), valve disorders, and pericardial friction rubs.
Blood Tests - Cardiac Biomarkers
- Assess troponin and CK-MB. These proteins and enzymes released into the blood by damaged cardiac cells. Useful in diagnosing myocardial infarction.
- Troponin is more specific and sensitive to cardiac muscle damage; levels elevate within 2-6 hours, peaking in 15-20 hours and remaining elevated for 5-7 days.
- CK-MB, an isoenzyme found in heart muscle, elevates within 4-6 hours, peaks in 15-20 hours, and remains elevated for 24-36 hours.
Blood Tests - Lipids
- Measures risk for coronary artery disease (CAD).
- A 6-12 hour fast is typically needed, with alcohol abstinence for 24 hours.
- High levels of LDL and triglycerides raise CAD risk.
Electrocardiogram
- Records cardiac electrical activity.
- Used to diagnose dysrhythmias, enlarged heart chambers, myocardial ischemia or infarction, electrolyte imbalances, and pericarditis.
- Includes ambulatory electrocardiogram monitoring (Holter monitoring).
Echocardiogram
- Uses ultrasound to generate images of blood vessels, diagnose occlusions and clots, arterial-peripheral arterial disease, and venous thrombosis.
- It includes trans-esophageal ultrasound (throat anesthetized).
- NPO 6 hours before the test.
- Records motion of heart structures, valves, heart size, shape, and blood flow.
Exercise Stress Test
- Evaluates heart's ability to respond to increased oxygen demands or degree of peripheral vascular disease.
- May use treadmill, stairs, or bicycle.
- Peripheral vascular stress test - treadmill for 5 minutes at 1.5 mph. Stop if intermittent claudication develops.
- Non-exercise stress tests use drugs (dipyridamole or adenosine) to stress the heart for patients unable to exercise
Doppler Studies
- Uses ultrasound to create images of blood vessels to detect occlusions and clots, and to diagnose arterial-peripheral arterial disease, and venous thrombosis.
Invasive Studies - Cardiac Catheterization
- Involves inserting a flexible tube into an artery or vein and threading it to the heart.
- Determine the extent of occlusions and open occluded arteries, measure pressure, oxygen saturation, and cardiac output.
- Common insertion sites are wrist, groin, forearm, and neck.
Angiography and Cardiac Catheterization
- Pre-procedure considerations include asking about prior reactions to contrast dye.
- NPO (8 hours before cardiac catheterization) and hydration (IV).
- Patient teaching - local anesthesia with sedation.
- Monitor vital signs and EKG continuously.
Cardiac Catheterization (Post-procedure)
- Post-procedure: pressure to the site (to prevent hematoma or retroperitoneal bleeding), monitoring vital signs at the insertion site, pedal pulses, and bedrest (if the groin was used).
- Prescribed time avoiding leg flexion. Fluids to flush the dye.
Medications for the Cardiovascular System
- Common medications include antihypertensives, antianginals, anticoagulants, cardiac glycosides, thrombolytics, and vasodilators.
- Grapefruit and certain citrus fruits can inhibit enzymes metabolizing medications, potentially raising the risk of toxicity.
Evidence-Based Therapeutic Measures
- Antiembolism devices (antiembolism stockings, medical graduated compression stockings, and non-medical support hosiery).
- Intermittent pneumatic compression devices.
- Oxygen.
- Medications.
- Cardiac surgery (as a treatment option).
Health Teaching
- Recommendations include a healthy diet (limiting saturated and sodium fats, and taking in more fruits, vegetables, and fish.), and routine exercise.
- Smoking cessation and oxygen safety precautions are emphasized. No open flames.
- Proper application of antiembolism stockings.
Cardiovascular Disease in the U.S.
- 121.5 million Americans have some type of cardiovascular disease.
- Lifestyle choices significantly impact.
- Death rate by 33 seconds.
- Access to high-quality healthcare and education is crucial.
Review - Summary
- Cardiac anatomy and physiology.
- Health history.
- Data collection.
- Diagnostic tests.
- Medications.
- Evidence-based practice.
- Health teaching.
- Cardiac disease prevalence in the United States.
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Description
Explore the fundamental concepts of cardiac function and pathophysiology in this enlightening quiz. Learn about the heart's anatomy, the role of valves, and cardiac output calculations. Prepare to test your understanding of how cardiovascular disorders impact heart performance.
