Cardiovascular PDF

Cardiovascular Blood Flow Tricuspid → Pulmonic → Mitral → Aortic Toilet Paper My Ass Listening to Heart Sounds APE To Man Aortic valve, pulmonary valve, Erb’s point, tricuspid valve, mitral valve Acute Coronary Syndromes Unstable Angina Minor occlusion → pain T...

Cardiovascular Blood Flow Tricuspid → Pulmonic → Mitral → Aortic Toilet Paper My Ass Listening to Heart Sounds APE To Man Aortic valve, pulmonary valve, Erb’s point, tricuspid valve, mitral valve Acute Coronary Syndromes Unstable Angina Minor occlusion → pain Typically relieved by meds PCI (percutaneous coronary intervention) may be diagnostic NSTEMI Partial occlusion leads to ischemia and damages heart muscle Labs: elevated biomarkers Requires PCI or thrombolytic STEMI Full occlusion → infarction or death of heart muscle Labs: elevated biomarkers ST elevation on EKG PCI needed Angina Chest pain caused by reduced blood flow to heart NI for active angina: have pt rest, take vitals, ECG, give no more than 3 nitroglycerin (vasodilator) tablets 5 minutes apart, get help if no pain relief after med administration Prinzmental’s Angina (aka variant, angina inversa) Chest pain that occurs at rest, usually at night or early morning Triggered by emotional stress, cold weather, smoking, medications that narrow blood vessels NI: Nitrates, calcium channel blockers Myocardial Infarction Blockage of blood flow to heart; ECG shows ST Meds for MI elevation M Morphine S/sx: severe chest pain/pressure, dyspnea, diaphoresis O Oxygen Women s/sx: neck, shoulder or jaw pain, fatigue, SOB, N Nitroglycerine n/v, heartburn A Aspirin Meds to give: MONA Morphine, oxygen, nitrates, aspirin Tests: Myoglobin, CK, and Troponin Heart Failure Heart is unable to pump enough blood to meet the body’s oxygen demands Blood backs up into body (right sided HF) or into lungs (left sided HF) NI: O2 if needed, diuretics, monitor vital signs and I&O’s, listen to heart and lung sounds, assess for hypoxia and edema, daily weights, fluid and sodium restriction Right-sided HF/ Cor Pulmonale Caused by left ventricular failure Normal Heart Failure S/sx: peripheral edema, JVD, weight gain, hepatomegaly Left Sided HF S/sx: pulmonary edema, dyspnea, orthopnea crackles, cough  Cardiovascular Cardiac Tamponade Fluid buildup in the pericardium → creates pressure → heart unable to pump effectively Medical emergency → cardiac arrest and circulatory shock Beck’s Triad - hypotension, JVD, muffled heart sounds Pericardiocentesis needed to remove pericardial fluid Pericarditis Inflammation of outer layer of the heart Indicator: presence of a friction rub. S/sx: pleuritic chest pain ECG finding: ST elevation and T-wave inversion NI: pain control, NSAID’s, corticosteroids, monitor for s/sx of tamponade Myocarditis Inflammation of the myocardium; typically caused by viral infection S/sx: fever, fatigue, chest pain, SOB NI: O2 as needed, bed rest, diuretics, ACEi, sodium restriction (if heart failure develops) Endocarditis Inflammation of inner lining of heart Causes: Infection (TB or Staph), autoimmune conditions (lupus) S/sx: SOB, fever, palpitations, night sweats, chest pain NI: IV abx, promote oral hygiene, assess for signs of emboli, surgery if needed Peripheral Arterial Disease (PAD) Chronic atherosclerotic disease caused by buildup of plaque within the arteries Commonly affects lower extremities → tissue necrosis (gangrene) Management: lower extremities below heart, moderate exercise to promote circulation, daily skin care, maintain mild warmth (socks, blankets), stop smoking, avoid stress and tight clothing, take prescription meds (vasodilators, antiplatelets) to increase blood flow Coronary Artery Disease (CAD) Plaque buildup causes coronary arteries to narrow → limits blood flow to heart S/sx: angina, fatigue, SOB, heart attack NI: control BP, low fat and low salt diet, quit smoking, exercise, encourage healthy lifestyle Scleroderma Causes abnormal blood flow in response to cold → Raynaud phenomenon Fat Embolism Usually occurs after fractures of long bones At risk: femur fracture S/sx: SOB, confusion, tachycardia, lethargy Diagnostic/labs: “snow storm” on chest x-ray, increased ESR (detects inflammation in the body), hypocalcemia, respiratory alkalosis NI: Oxygen, IV fluids, bed rest, assess respiratory status Deep Vein Thrombosis (DVT) Thrombus forms in vein; typically legs Risk → Virchow’s Triad Virchow's Triad S/sx: warm skin, calf pain, edema S Stasis of venous circulation NI: bed rest (prevent clot dislodgment), elevate H Hypercoagulability extremity, compression stockings, administer E Endothelial damage anticoagulants and/or thrombolytics, measure circumference of affected area  Cardiovascular Additional Notes: Improve perfusion → EleVate Veins, dAngle Arteries Assess BP in both arms of patients who have new diagnosed hypertension If pt has mechanical valves → need anticoagulation therapy for life to prevent thromboembolism If your patient has fluid retention, think heart issue first BNP (lab) is made by the heart and is released when the heart is under stress, trying to meet the demands of the body BNP >100 pg/mL = heart failure