Cardiovascular Medications: Thrombosis & Arrhythmia

• Commonly used medications affecting thrombosis in the CV system include fibrinolytics, anticoagulants, and platelet inhibitors.

Fibrinolytics

• Act by breaking down existing clots
• Examples: Alteplase (tPA), Tenecteplase (TNK-tPA)

Anticoagulants

• Prevent new clots from forming or existing clots from growing
• Examples: Heparin, Warfarin, Enoxaparin (LMWH)

Platelet Inhibitors

• Prevent platelets from clumping together to form clots
• Examples: Aspirin, Clopidogrel (Plavix)

Antiarrhythmic Drugs

• Four classes exist

Class I: Sodium Channel Blockers

• Affect the rate of cardiac conduction

Class II: Beta-Blockers

• Block adrenergic receptors, slowing heart rate and decreasing blood pressure, which can help with rhythm control

Class III: Potassium Channel Blockers

• Prolong repolarization, which can help with arrhythmias

Class IV: Calcium Channel Blockers

• Slow conduction through the AV node

Cardiovascular Disease (CVD) Medications

Inotropes

• Strengthen the heart's contractions
• Used in heart failure
• Example: Digoxin

Phosphodiesterase III Inhibitors

• Increase cardiac contractility and cause vasodilation
• Example: Milrinone

Renin–Angiotensin Inhibitors

• Lower blood pressure and reduce strain on the heart
• Examples: ACE inhibitors, ARBs

Vasodilators

• Relax blood vessels, reducing blood pressure and workload on the heart
• Example: Nitroglycerin

Antihyperlipidemic Drugs

• Lower cholesterol levels to prevent or slow the progression of atherosclerosis
• Examples: Statins

Percutaneous Coronary Interventions (PCIs)

Indications

• Angina
• Acute myocardial infarction

Nursing Care

• Monitoring vital signs
• Assessing the insertion site for bleeding
• Ensuring patient comfort

Complications of PCI Procedures

• Bleeding
• Hematoma
• Arterial occlusion

Interventions for PCI Complications

• Applying pressure to the insertion site
• Monitoring distal pulses

PCI for Peripheral Arterial Disease (PAD) and Valvular Heart Disease

• PCI can be used to open blocked peripheral arteries and to repair or replace heart valves

Intra-Aortic Balloon Pump (IABP) Therapy

• Involves the insertion of a balloon into the aorta that inflates during diastole and deflates during systole
• This increases coronary perfusion and reduces afterload

Ventricular Circulatory Assistance

• Mechanical devices that support heart function

Indications for IABP Therapy

• Cardiogenic shock
• Unstable angina

Contraindications for IABP Therapy

• Aortic insufficiency
• Aortic dissection

Nursing Interventions for IABP Therapy

• Monitoring vital signs
• Ensuring proper balloon timing

Nursing Interventions for Ventricular Circulatory Assistance

• Preventing infection
• Monitoring for bleeding

Extracorporeal Membrane Oxygenation (ECMO)

• Provides cardiac and respiratory support by oxygenating blood outside of the body

Indications for ECMO

• Severe respiratory failure
• Cardiogenic shock

Nursing Care for ECMO

• Monitoring for bleeding
• Preventing infection

Electrical Cardioversion

• Delivery of an electrical shock to reset the heart's rhythm

Indications for Electrical Cardioversion

• Unstable atrial fibrillation
• Ventricular tachycardia

Procedure for Electrical Cardioversion

• Sedating the patient
• Delivering a synchronized shock

Nursing Management for Electrical Cardioversion

• Monitoring vital signs
• Assessing skin condition

Complications of Pacing

• Infection
• Lead dislodgement

Interventions for Pacing Complications

• Antibiotics for infection
• Repositioning or replacing leads

Nursing Management of the Patient with a Pacemaker

• Monitoring the incision site
• Educating the patient on pacemaker function

Implantable Cardioverter-Defibrillator (ICD)

• Device that monitors heart rhythm and delivers a shock to correct life-threatening arrhythmias

Indications for ICD

• Ventricular tachycardia
• Ventricular fibrillation

Components of ICD

• Pulse generator
• Leads

Functions of ICD

• Antitachycardia pacing
• Cardioversion
• Defibrillation

Nursing Management of a Patient with an ICD

• Monitoring the incision site
• Educating the patient on ICD function

Causes of Cardiopulmonary Arrest

• Myocardial infarction
• Respiratory failure

Steps of Cardiopulmonary Resuscitation (CPR)

• Chest compressions
• Airway management
• Breathing support

Role of Resuscitation Team Members

• Ensuring effective chest compressions
• Administering medications

Chronic Aortic Aneurysm

• Gradual bulging of the aorta over time
• Often asymptomatic until rupture

Acute Aortic Dissection

• Sudden tear in the aorta's wall
• Severe pain
• Can be life-threatening

Clinical Findings of Chronic Aortic Aneurysm

• Pulsating mass in the abdomen

Clinical Findings of Acute Aortic Dissection

• Sudden, severe chest or back pain

Indications for Coronary Artery Bypass Grafting (CABG) Surgery

• Significant blockages in multiple coronary arteries

Indications for Valvular Surgery

• Stenosis or regurgitation of heart valves

Nursing Care Before CABG and Valve Surgery:

• Preoperative teaching
• Ensuring patient stability

Nursing Care After CABG and Valve Surgery

• Monitoring vital signs
• Managing pain

Mitral and Aortic Valves

Stenosis

• Valves that don't open fully
• Obstructing blood flow

Insufficiency

• Regurgitation
• Valves that don't close properly
• Causing blood to leak backward

Pathophysiologic Implications of Stenosis

• Increased workload on the heart

Pathophysiologic Implications of Insufficiency

• Decreased cardiac output

Nursing Interventions to Prevent Complications After Cardiac Surgery:

• Early ambulation
• Respiratory support

Carotid Endarterectomy

• Surgical procedure to remove plaque from the carotid artery

Indications for Carotid Endarterectomy

• Significant carotid artery stenosis

Nursing Care Before Carotid Endarterectomy

• Neurological assessment

Nursing Care After Carotid Endarterectomy

• Monitoring for signs of stroke