Cardiac Lecture Anatomy PDF

Cardiac Lecture Anatomy It is Essential to understand the anatomy and the Physiology of the heart, which we will cover in a separate PowerPoint recording as it will help you understand heart disorders and perhaps even enable you to guess signs and symptoms that will occur When the heart is not wor...

Cardiac Lecture Anatomy It is Essential to understand the anatomy and the Physiology of the heart, which we will cover in a separate PowerPoint recording as it will help you understand heart disorders and perhaps even enable you to guess signs and symptoms that will occur When the heart is not working correctly. The heart is made up of four chambers. The four chambers of the heart are the right atrium, the right ventricle, the left atrium. And the left ventricle. The four chambers of the heart are separated by valves. Now let's discuss the valves and where they are located. This slide shows 2 hearts, not because humans have two hearts, but because it is easier to show the location of the valves and their associated names. The valve located between the right atrium. And the right ventricle is known as the tricuspid valve. The valve located between the left atrium and the left ventricle is known as the mitral valve or the bicuspid valve. The valve located between the right ventricle, and the pulmonary artery and is known as the pulmonary valve or the pulmonic valve. And the valve located right here between the left ventricle and the aorta, which is hard to see, it kind of goes behind the pulmonary artery and then continues up this way. This valve is known as the aortic valve. Often times these valves are grouped together so the mitral valve and the tricuspid valve, which is located between the Atria and the ventricles are together, known as the atrioventricular valves. The pulmonary valve or pulmonic valve along with the aortic valve together are sometimes referred to as the semi lunar valves because these valves look like Half Moon circles. The heart muscle is made-up of three layers. The outermost layer is the epicardium. The middle layer is the myocardium and the inner layer of the heart is known as the endocardium. As you can see in the picture, the myocardium is the thickest layer of the heart. Myo means muscle and cardium means heart. Therefore, the myocardium is the main heart muscle and is the layer that is contracting each time our heart beats. The heart is encased in a pericardial SAC. The pericardial SAC surrounds the heart. And it protects the arteries and veins around the heart as well as the heart. It is made-up of two layers, the parietal pericardium and the visceral pericardium, and between the parietal and the visceral pericardium is what is known as the pericardial space and there exists about 20 milliliters of fluid. In this pericardial space, this fluid serves to cushion and provide lubrication for the heart each time the heart fills and expands. So, to recap, the order of the layers of the heart, starting from the inside to outside, is the endocardium. The myocardium, The epicardium. The parietal pericardium. With the pericardial space in between with 20 milliliters of fluid and the visceral pericardium. Here is another picture showing the pericardium around the heart, as you can see right over here. The blood vessels that feed oxygen and nutrients to the heart muscle itself are known as coronary arteries, and what brings blood back from the heart muscle itself is known as the coronary veins. The coronary arteries start at the base of the aorta. So here's the aorta and you can see this right here is the start, this right here is the start of one coronary artery, and here is the start of the other coronary artery. On the face of the aorta, there are actually two holes or sinuses. You can see the hole or sinus in this picture right here. This is the hole or sinus. So this is the aorta and we are looking up and above into the aorta. Here is the. Coronary sinus for the left coronary artery. So this is where the left coronary artery starts. And if I could spin this picture around, you would see another hole right here for where the right coronary artery starts. The left and right coronary arteries branch even further, as you can see in this picture. So here's the left coronary artery, and then it's branching even further, and then those branches are branching even more into capillary beds. You don't need to know the names of all these different branches. Just know that there's a left coronary artery that comes off of the base of the aorta, and a right coronary artery that comes off of the base of the aorta. Notice how the coronary arteries and veins are located on the outside of the heart, and these have capillaries that feed into the deep layers of the heart. Physiology of the Heart Recording covers the Physiology of the heart before listening to this recording, it is essential that you know the anatomy of the heart. The Physiology of the heart will cover blood flow through the heart, the contracting chambers of the heart what happens to the. Valves, when the heart contracts, the amount of blood ejected from the heart, and so much more. Let's start with the pathway of blood flow through the heart. The pathway of blood flow starts in the vessels that return the blood back to the heart. These vessels are the superior vena cava and the inferior vena cava. The superior and inferior vena cava. They're connected to the right atrium, so blood coming back into the heart goes straight into the right atrium. From the right atrium, blood goes through the tricuspid valve and into the right ventricle. From the right ventricle, blood goes through the pulmonic. Valve into the pulmonary artery. The pulmonary artery then splits into the left pulmonary artery and the right pulmonary artery. These arteries feed the left lungs and the light and the right lungs after the blood circulates through the lungs and picks up. Oxygen and releases the used carbon dioxide. Blood returns back into the heart via the pulmonary veins. So these are the left pulmonary veins and the right pulmonary veins, and that blood returning back into the heart dumps into the left atrium. From the left atrium, blood goes through the mitral valve, also known as the bicuspid valve, into the left ventricle. The left ventricle then pumps blood through the aortic valve into the aorta, and from the aorta, the blood circulates throughout the body. The blood on the right side of the heart, as you can see in this picture, is in blue because all of this blood on this side of the heart is deoxygenated blood. It is blood that is coming back from the body. The blood on the left side of the heart and in the aorta is in red. This depicts oxygenated blood because the blood that's flowing through this part of the heart has returned from the lungs, picking up oxygen on its way. The contracting heart keeps the blood flowing through the body and the lungs. The heart is not always contracted. The heart actually has a relaxation phase and a contraction phase. The relaxation phase, also known as diastole. Is the filling phase where all chambers of the heart filled with blood. The contraction phase, also known as systole, is where that blood is forcefully moved out of one Chamber of the heart into another or out of one Chamber of the heart into the body and lungs or lungs. Let's look at this in detail, this first picture. It's a heart in the relaxed state, or diastole in diastole, blood coming back to the heart via the superior vena cava and inferior vena cava is passively flowing into the right atrium. Think about it like a domino effect. The muscles in our legs are contracting and pushing the blood in the veins of our legs up towards our abdomen, and that pushed blood is pushing the next blood cell and the one after that, and so on and so forth. Until blood is passively moving into the right atrium. At the same time the pushing along of blood in the lungs is moving blood from the lungs into the left atrium. The blood in the right atrium and left atrium is then. Being bumped along and is flowing from the right atrium into the right ventricle and from the left atrium into the left ventricle. Notice how the tricuspid and bicuspid or mitral valves are open. Allowing this blood to flee freely flow through these valves. Also notice how the pulmonic valve and the aortic valve are closed. Now let's discuss sisterly. The heart has 2 systolic phases. The atrial systolic phase and the ventricular systolic phase. In the atrial systolic phase, the left and right Atria contract. And blood from these two chambers is forcefully pushed down into the ventricles. So from the right atrium, blood is forcefully pushed down into the right ventricle, and from the left Atria, blood is forcefully pushed down into the left ventricle. In fact, 75% of the blood in the ventricles comes from the Atria in the diastolic phase, but the remaining 25% blood is forcefully pushed into the ventricles when the Atria contract. This extra 25% blood is known as the atrial kick. This is important because when the Atria are sick and not contracting properly, the ventricle loses this 25% blood that would have otherwise been ejected into the lungs. And into the aorta. Once the Atria contract. The ventricles contract and so now when the ventricles contract, we are in the ventricular systole phase. When the ventricles contract, the squeezing of the ventricles closes the tricuspid valve and the mitral valve. Notice how these valves are. Lowest If these valves would not have closed, blood would go back up into the Atria, which is not what we want. When the ventricles contract, the squeezing of these ventricles force the tricuspid and mitral valves closed, while the force of the squeeze of these ventricles caused the pulmonic valve and the aortic valve to open the. Right ventricle forces blood into the pulmonary artery through the pulmonic valve, and the left ventricle forces blood through the aortic valve into the aorta. So let's recap the contraction of the heart. Look at the two pictures on this slide. This picture right here depicting this heart is the diastolic phase where all chambers of the heart are relaxed. This picture right here is also depicting the diastolic phase where all chambers of the heart are relaxed. This picture is depicting atrial systole which pairs with this picture depicting atrial systole. This picture is depicting ventricular contraction paired with this picture that shows ventricular contraction. The pink that you see in this picture is actually depicting the movement of. Blood OK, so now let's recap this. In the diastolic phase. All chambers of the heart are relaxed. The trike has spit and mitral valves are open, and blood is passively flowing from the left and right Atria into the left and right ventricles. The pulmonic and aortic valves are closed in the atrial systolic. Is the Atria are contracting and forcing blood into the ventricles. This is known as the atrial kick and adds 25% lead volume into the ventricles. The mitral and tricuspid valves are open and the pulmonic and aortic valves. Are closed in the ventricular systolic phase, the ventricle squeeze, which forces the tricuspid and mitral valves to close and the pulmonic and aortic valves to open. The squeezing of the ventricle moves blood from the right. Ventricle into the pulmonary artery and from the left ventricle into the aorta. Let's do a quick knowledge check, pause the recording and read the question and answer on the slide. Did you pick blood flows from the lungs into the left atrium? If not, go back to the previous slides and review the blood flow through the heart. Let's do another knowledge check. Pause the recording and read the question and answer on this slide. This is a select all that apply. There are two answers here. The Atria are contracting and adding 25% extra blood volume into the ventricles and the second answer is the tricuspid and mitral valves are open. If you did not answer this question correctly, go back to the. Previous slides and reveal the cardiac cycle. Now that we understand something about the hearts contraction cycle or cardiac cycle, let's discuss the love dub sounds that we hear when the heart contracts. The sounds of the heart are not the sounds of the Atria and ventricles contracting actually. It is the sounds of the valves closing. The love sound occurs when the tricuspid and mitral valves close as the ventricle starts to squeeze and then as the ventricle squeeze becomes harder. The aortic and pulmonic valves are forced. Once the ventricle finishes squeezing, the tricuspid and mitral valves open and the aortic and pulmonic valves snapshot, the dub sound is the snapping shut of the aortic and pulmonic valves. So to recap, the love sound occurs when the tricuspid and the mitral valve snaps shut during ventricular contraction, and the dub sound occurs when the pulmonic and aortic valve snapshot at the end of the ventricular. Attraction. Now that we understand how the heart works and circulates blood throughout the body, let's turn our attention to how much blood the ventricles eject from the heart with each heartbeat. Before we get into the nitty gritty, let's become familiar with some terminology. The stroke volume is the amount of blood pumped out of the ventricles with each heartbeat. The normal stroke volume in adults is 70 milliliters. The normal heart rate in adults is 60 to 100 beats per minute. If we know the heart rate of a person, we can approximately. Calculate the cardiac output, which is the amount of blood pumped out of the heart each minute. For example, let's say a person has a heart rate of 74 beats per minute. We can calculate their cardiac output by multiplying the average stroke volume of 70 milliliters. Times the number of times the heart beats in a minute, which is this case is 74 and we get 5180 milliliters. This means that each minute if their heartbeats it's 74 beats per minute. The heart pumps out 5100 and. 80 milliliters of blood. You might wonder why this is important. We'll cardiac output is related to blood pressure. If the cardiac output falls, so does the blood pressure. Imagine what the cardiac output would be if the heart rate were 60 beats per minute with a stroke volume of 70 or 30. Beats per minute with a stroke volume of 70 At 30 beats per minute, would that be enough blood volume circulating around the body to sustain life for any long amount of time? So then you must ask yourself, where does the stroke volume come from? Stroke volume is affected by three things, preload, afterload and contractility. Let's first talk about preload and afterload, then we will discuss contractility. So what is preload? Preload is the amount of blood that fills in the ventricles before they contract. I mean, that makes sense right? If the ventricles don't fill with blood, what will be pumped out when it contracts? So what could cause the preload to increase or decrease? Increases in preload, or the amount of blood returning back to the heart can occur with a blood transfusion or an infusion of isotonic fluids. Preload decreases due to blood loss, vomiting, diarrhea, vasodilation of blood vessels, etc. Remember, with preload it's all about the amount of blood that fills in the ventricles. Afterload is the resistance against which the heart must pump to circulate blood around the body. The resistance can increase due to increased blood pressure from too much fluid in the arteries or due to vasoconstriction of the blood vessels. The higher the afterload, the harder the heart has to contract to pump blood out now. Let's apply it with stroke volume. Pre load decreases, then there will be less blood to pump out so that the stroke volume will decrease. If the stroke volume decreases then the cardiac output decreases, which means that the blood pressure decreases. If the after load is too high, the heart has to pump really hard to push blood past that resistance. This will cause the heart to pump out less blood with each heartbeat, thus decreasing stroke volume. Again, the cardiac output decreases. Which means the blood pressure decreases. OK, let's now talk about contractility. So contractility is the ability of the heart to contract. The heart has to stretch just enough to be able to contract. The stretch comes from the filling of the heart. As the heart fills with blood, the ventricles stretch. So if the preload decreases, the stretch also decreases, which causes the contractility to decrease. However, if the stretch is too much, the preload increases, but the overly stretched heart cannot bounce back and contract with its usual force. Therefore, contractility decreases in this case as well. I think the best way to understand this is to think of a slingshot. We load a stone in the slingshot, but you don't pull hard enough before you let go of the slingshot. Does the stone travel very far? However, if you pull too hard, the slingshot overtime loses its elasticity and no longer functions like it should. The same thing applies for the heart. Therefore, the heart has to fill optimally to contract optimally with each and every heartbeat. So we've given a lot of thought to preload, afterload and contractility affecting cardiac output. There are other factors that can affect the stroke volume. For example, fitness level affects the stroke volume. Athletes have conditioned their heart such. That with each heartbeat the amount of blood ejected from the heart is higher than 70 mils. So for example Lance Armstrong stroke volume was 188 mils per heartbeat. Imagine that 188 mills is more than twice the normal stroke volume. His his resting heart rate was 42 beats per minute. That means his heart only had to beat 42 * a minute and it was still circulating enough blood volume to keep him more than alive. Cardiac output, stroke volumes and heartbeats are extremely important factors that are measured in acutely sick patients and are important to be aware of is the ejection fraction. The ejection fraction is the calculated percent of blood ejected from the ventricle. It is calculated. By taking the stroke volume and dividing it by the amount of blood that was in the ventricle before it contracted, known as the end diastolic volume, the normal ejection fraction is 55 to 65%. There is only one other physiological concept we need to discuss for this lecture. I hope you are wondering when does the heart muscle get oxygen and nutrients? Think back to the anatomy of the heart. Do you remember where the coronary arteries start? Look at the two pictures on this slide. The coronary arteries are located at the base of the aorta. So here's the aorta and here's the right coronary artery and the left coronary artery. It's really interesting how they get blood supply so when the left ventricle contracts. Blood into the aortic valve, up into the aorta. That goes up into the aorta. The blood that doesn't make it over the hump falls back down towards the Arctic valve, which are now closed because the ventricle is done contracting. So that blood that falls back down towards the base of that aortic valve, as it falls, it enters the left coronary artery and the right coronary artery and it feeds the heart with oxygen and nutrients. Look at this picture again on this slide. Again, this is the cross. Section of the cut AR tab. Here is the hole for the left coronary artery. And in fact could spin this picture around. You would see a hole over here for the right coronary artery. Again, as the left ventricle pumps blood, it shoots up the aorta. Some of most of the blood makes it over the hump. The arch of the aorta, but what doesn't make it up over the arch of the aorta falls back down onto these closed valves. And because this left coronary artery opening is just basically a hole, the blood falls down here and some of it goes down this hole and some of it goes down the hole. On the right side, that's feeding the left and right coronary arteries with blood. Heart assessment and diagnostics This lecture recording covers assessment and diagnostic evaluation in the cardiac system. When conducting a cardiac health history, there are some symptoms that commonly occur in many cardiac disorders. Let's first discuss these symptoms. Chest pain or discomfort is common. Remember when working with patients experiencing cardiac issues. Always ask if chest pain is occurring. If the patient is experiencing chest pain, remember to rate the pain and ask questions related to that pain. Old Charts was an acronym we used in fundamentals to help assess all aspects of pain. There are many such pneumatics. Pick whichever 1 you like, but remember to do a comprehensive pain assessment. Shortness of breath or dyspnea may occur. The patient may have peripheral edema. Weight gain, abdominal distension or ascites, palpitations, unusual fatigue, and changes in activity tolerance. When discussing changes in activity tolerance, compare the patient's current activity levels to that. With the last 6 to 12 months. Business and fainting Sleep History Ask patients if they sleep flat at night or need to sleep by reclining on pillows, and also ask if they have used more pillows recently to elevate their head while sleeping. Nocturia voiding at night is a symptom in some heart conditions. Waiting at night once in a while is OK, but patients who avoid every night and are now avoiding more than once per night may it may be experiencing cardiac issues. When conducting a physical assessment, note the position in which the patient is sitting. If they are orthopedic, then they are experiencing shortness of breath. You can probably also conclude shortness of breath based on respiratory rate, oxygen saturation, use of accessory muscles. And their speech pattern. Assess edema and their feet, ankles, calves and thighs and also in their arms. Is it pitting or non pitting? Rate their edema using inches or centimeters. If it is pitting, are they experiencing asides you? When assess their level of societies by checking abdominal guard, check their capillary refill type in all four extremities. Is it under 3 seconds? Listen to their apical pulse for one whole minute or longer if needed. Is there heart beating regularly? Irregularly. Or is it regularly irregular? What does that help? It sound like it's a strong distant? Or muffled or weak. Palpate radial pulses in both arms and pedal pulses in both feet. Compare and contrast these pulses in terms of amplitude. Is the pulse bounding strong, brisk, weak, faint, or absent? Access their neck for jugular vein distension. There are multiple lab tests that can be performed to evaluate the cardiac system. Let's start with the lipid panel. A lipid panel is conducted to test a patient's risk of cardiovascular disease. The patient needs to fast. For 12 hours prior to the blood draw, the lipid panel gives the following information. Total cholesterol and their levels should be less than 200 milligrams per deciliter. LDL, which is bad cholesterol and it should be under 100 milligrams per deciliter. HDL, which is good cholesterol and in men it should be above 40 and women above 15 milligrams per deciliter and their triglyceride level which should be below 150 milligrams per deciliter. Cardiac biomarker analysis is useful in diagnosing myocardial infarct. Though the book discusses myoglobin, creatine kinase, and proponents, the only one used clinically today is troponins. Troponins are proteins. That are released from heart cells that are damaged and dying. The troponin level starts to increase within a couple hours of heart damage. Often when a provider suspects a myocardial infarct, serial troponins are ordered, which means that troponin levels are ordered three times. About two hours apart. If the levels increase from 1 troponin test to the next, it means that the heart might still be imparting. BNP, or beta naturopathic peptide, is a hormone that is released when the ventricles are overly stretched or when the preload increases too much. This often occurs in heart failure and therefore BNP levels are used diagnostically and therapeutically for heart failure. Normal BNP level is less than 100 picograms per milliliter. See Reactive Protein or CRP is a test that you are familiar with as it was discussed with RA and lupus. It is a protein produced by the liver and is found in the blood when there is systemic inflammation occurring in the body. It doesn't point to any particular disease or even body system, just lets us know that inflammation is occurring. And lastly, homocysteine is an amino acid linked directly to atherosclerosis and increases the risk of coronary artery disease. A patient needs to fast for 12 hours before the test. Multiple diagnostic tests are used to evaluate the cardiac system. Let's start with a simple chest X-ray. A chest X-ray can tell us that a heart is enlarged and show calcifications in the heart. The fancy medical term for enlarged heart is cardiomegaly. Cardio meaning heart and megaly meaning abnormally large. So here you have the silhouette of a normal heart on a chest X-ray and here is the silhouette of an enlarged heart again known as cardiomegaly. This patient just happens to also have. Pacemaker. So you can see the pacemaker right here in this chest X-ray and this wire that you see are the pacemaker leads going into the heart. Oftentimes patients experience cardiac symptoms but are not able to get an appointment to see a doctor in that moment when cardiac symptoms are occurring. So it is necessary to somehow stress out the heart and catch it in the act of being bad. The cardiac stress test does just that. It is a test that stresses out the heart in a medically supervised environment. There are two types of cardiac stress tests. Let's discuss The Walking stress test 1st and then we will discuss the pharmacological stress test in a walking stress. Test The patient is given instructions to fast for three to four hours before the test and to not consume any products containing caffeine or chocolate for 12 hours prior to the stress test. The provider may also ask the patient to stop taking certain medications. 24 to 48 hours before the test, the patient is also given instructions to wear comfortable clothes with sneakers or shoes appropriate for walking or running on a treadmill. On the day of the stress test, the patient checks into the outpatient facility where the test is occurring. If the patient reports drinking caffeine or chocolate within 12 hours of the test, the test is rescheduled. Electrodes are placed on the patient and the patient is connected to an EKG machine. A blood pressure cuff is placed on the patient along with a pulse oximeter. That monitors pulse and oxygen saturation, and IV may be inserted for administration of medications in case it is needed. The patient is then asked to step onto the treadmill. The treadmill starts out slow and on a flat incline, but every 3 to 5 minutes the speed and incline is increased. The test continues until the patient verbalizes symptoms or the EKG vital signs. Machine indicates issues or until the patient's target heart rate is reached. In total, the being on the treadmill part lasts about 8 to 10 minutes. All of the data is recorded and reviewed by the cardiologist after the patient gets off the treadmill. The patient is monitored for 10 to 15 minutes until vital signs are back to baseline and stable. This slide contains an embedded video video which you can watch in the PowerPoint presentation. Although The Walking treadmill stress test is awesome, there are patients who are unable to tolerate the test or cognitively unable to follow directions or physically unable to do The Walking stress test. For all of these patients, a pharmacological stress. Test is conducted. The idea is the same to catch the heart being bad. In the pharmacological stress test, a medication is given intravenously that stresses out the heart. The patient is asked to be NPO three to four hours before the test and to avoid caffeine or chocolate. For 24 hours before the test. The provider may also ask the patient to stop taking certain medications 24 to 48 hours before the test. These meds may be cardiac meds or other medications as well. On the morning of the test, the patient checks into the facility. If the patient reports drinking caffeine or chocolate within 24 hours of the test, the test is rescheduled. The patient is asked to wear a gown and again connected to electrodes and EKG, blood pressure cuff and pulse oximeter for rhythm and vital signs monitoring. An IV is inserted so that medications can be given to stress out the heart. A reversal agent is also kept on hand to use if needed. The patient is informed that as the medication is injected, the patient may feel flushed and nauseous. The patient. That's to report any symptoms that occur during the test. The test usually lasts for one hour and may last longer if additional imaging is conducted. All the data is again recorded and given to the cardiologist for review. As before, the patient is monitored. After the test to make sure all vital signs return to baseline. A transthoracic echocardiography is a very fancy way of saying ultrasound of the heart and is also referred to commonly as an echo. It is conducted over the skin using a transducer and an ultrasound gel. No preparation is required. On the part of the patient during the test, the patient may be asked to turn onto the left side or hold their breath for a few seconds. The echo gives information regarding the amount of blood filling in the chambers of the heart, the ejection fraction, and any potential problems with the. Thoughts of the heart. A transesophageal echo, as the name implies, is done by passing a transducer through the mouth and into the esophagus. The biggest advantage of this is the pictures are far superior compared to a transthoracic echo. Not every patient needs a TDE. This is conducted for acutely sick patients. It can be done outpatient or inpatient and is done mostly before cardiac surgeries. Pre nursing interventions include NPO for six hours and informed consent On the day of the procedure. The patient wears a gown and IV. Access is established, electrodes are placed on the patient and connected to ECG. The patient is also connected to a vital signs monitor and VP's, oxygen saturation, heart rate and respirations are monitored. The room is also stocked with oxygen supply. Construction equipment in case needed. A topical anesthetic is used at the back of the throat so that the patient doesn't gag on the transducer as it is passed through the back of the throat and into the esophagus. Conscious sedation may be used post procedure. The nurse monitors the patient. To return to baseline vital signs, food and fluids are held until gag reflex returns. A patient is informed that they may have a sore throat for 24 hours after the procedure. A family member or friend must drive the patient home after the procedure. This slide contains an embedded video which you can watch in the PowerPoint presentation. A cardiac catheterization is a procedure that allows the cardiologist to determine the amount and location of blockages in the coronary vessels of the heart. The coronary vessels are accessed either via the femoral artery in one of the legs or in the radial artery. Of one of the arms, when the femoral arteries accessed the catheter is inserted and advanced towards the heart, so it travels from the femoral artery to the abdominal aorta through up into the thoracic aorta. Over the aortic arch and then it is. Put downward into one of the coronary arteries of the heart. Usually both left and right coronary arteries are checked during this procedure. When the radial artery is used, the catheter is inserted and advanced towards the heart through the brachial artery. So here's the radial site. The catheter is inserted and advanced towards the brachial artery. From the brachial artery, it goes into the subclavian artery. From the subclavian artery, it enters the aorta and then down into the coronary arteries of the heart. Again. Both left. And right coronary arteries are checked for blockages. Whether cardiac Cath is performed via the femoral artery or the radial artery is dependent on the patient's condition and the cardiologist preference. The cardiac catheter is advanced using fluoroscopy. Fluoroscopy is an X-ray imaging technique that shows the internal body structures in real time. It is sort of an X-ray movie. This image shows a catheter near the heart via fluoroscopy. Once the catheter. Which is the order to the cardiologist inserts the tip of the catheter into the left coronary artery and then injects the contrast dye, after which the right coronary artery is done. Every block had just present. The contrast dye will either not be visible past that point of blockage or will show a narrowed pathway which will mean that there is a partial occlusion. Look at the images on this slide. They show a partial occlusion right over here and a total. Blockage right over here. Before we discuss what occurs in this procedure any further, let's discuss some terms. So the cardiac Cath is the process of inserting the tip of the catheter and advancing it up into the heart and highlighting blockages by injecting contrast dye a PCI. Our practitioners coronary intervention is the part of the procedure that treats the blockage by either breaking the plaque apart and thus widening the artery, or by Blake breaking the plaque apart and inserting a stent in the artery to keep it open, a percutaneous. Transluminal coronary angioplasty, also known as a balloon angioplasty, is the part of the PCI procedure where a balloon is threaded through the catheter and, once in the area of the blockage, is inflated and deflated to break the plaque. You will see all these terms thrown around together. No matter which of these terms is used, called cardiac catheterization, PCI, PTCA, or balloon angioplasty. With or without standard stenting, the procedure is the same a catheter is being. Blocked arteries are blocked. This slide contains a video of the cardiac catheterization procedure with PCI, PTCA balloon and GSD with statement. Please play the video in the PowerPoint file, it will greatly enhance your understanding of this procedure. Now that we have discussed the procedure and what it does, let's on to pre and post nursing interventions. A cardiac catheterization may be conducted in an outpatient or inpatient facility. It's conducted outpatient patients are asked to complete several blood tests, including. Kidney function tests and coagulation tests if performed inpatient. Those tests are in the hospital. Reviewing kidney function tests essential as class dye is injected. Abnormal kidney function tests means that the patient may be unable to excrete the dye quickly from the body. The provider may order IV normal state infusion prior to and after the procedure to help the kidney be well hydrated before the procedure and to increase the amount of fluid going through the kidney. Stylite dye for the procedure. This will hide excrete better and decrease the chances of. Kidney injury since contrast dies being injured, the patient should also be screened for allergies to shellfish. If tick provide, order the patient to take or be given diphenhydramine also has mental or Droid prior to the major. Alternatively, provider may opt. To use a non iodine dye. The nurse conducts pre nursing interventions with the patient. These include education about the procedure being NPO for 8:00 to 12:00 hours prior, needing a ride home after the procedure letting the patient know that the procedure. Will involve laying down on a hard table for about an hour. The need to remain laying down for at least two hours with a radial artery used or at least six hours with the floral reuse as the procedure to expect a flush warm feeling. The contrast dye is injected to expect a sensation to avoid to avoid the patient. Think they will? Their pants actually not, may feel occasional pounding and may be asked to hold their breath during the test. That they may be asked to cough to help clear the contract out from the heart. Patients are also informed that they may have one or more IV sites inserted just for the procedure starts to administer any medications. Because an artery is punctured for this procedure, the risk of bleeding is high. For radial artery puncture, manual pressure B enough to stop the bleeding, or it may be accompanied with the use of a device that applies pressure. The terumo TR band may be used to. Real please. Bleeding post procedure at the femoral site may be stopped by nothing but blood pressure or may be used in combination. The feminine stop A fence stop is a device plate over the femoral portrait. The device has a balloon lattice inflated pressure at the The nurse must make sure that pedals and capital affected extremity. Present with the staff applied provider may order killer closure the puncture site bleeding settings of such a device a quick solve after nature. The people be placed an option or be to their hospital room. The nurse will receive report from the cardiac Cath lab letting nurse the puncture site used then. Number of coronary arteries that were blocked, companies were placed and their locations. The nurse bringing the patient and the nurse receiving the patient should ideally assess the catheter site and the acted extremity together. Assessment flew palpating cattle for hematoma. Sent out hematoma with them with the hematoma greasy to spot. The catheter site should be soft, though it may be tender. Assessing the affected extremity for temperature. Color blurry real and assessing peoples if the file site was used. The radial pulse if the radial site was used. Asking the patient about any pain in the extremity or changes in sensation, such as numbness and tingling. The assessment will also include checking blood pressure and heart rate. All of these assessments will be carried out every 15 minutes of the first hour, every minute for the next hour and every after. Hour after at least the next 4 hours, the patient is also on telemetry and the EKG is monitored for abnormal rhythm. The patient is asked to report any just bleeding or southern sudden discomfort at the catheter site after the 26 have passed and if the knot. Experiencing symptoms the patient get out of the first time they get out of bed in nurse must be present. If all goes well, the patient may be discharged home. Discharged instructions include reporting any chest pain, extremity changes in sensation, fever. Or swelling patients who had a real concern activity the next day patient had a femoral must not bend at the waist, strain or lift any heavy objects for 1st 24 hours after the procedure.