death of heart muscle-permanently destroyed

aka heart attack

doesn't happen immediately, takes several hours

partial/complete coronary artery blockage

decreased cardiac blood supply

at risk: men over 40 with atherosclerosis; women who smoke and use oral contraceptives

non-ST segment elevation MI (NSTEMI): aka non-Q-wave MI

ST segment elevation MI (STEMI): aka Q-wave MI; deadliest type b/c is usually a complete blockage

L coronary artery feeds anterior wall of heart, which includes L ventricle

when L ventricle is affected, severe loss of L ventricular function can happen

R coronary artery feeds the inferior wall of heart and parts of the AV node and SA node

can lead to abnormal impulses and conductions

dysrhythmias can occur early that may be fatal

L circumflex coronary artery feeds lateral wall and part of posterior wall of heart

lesion in circumflex artery leads to an infarction of L ventricle

triggered by ventricular dysrhythmias or asystole from abrupt occlusion of a coronary artery

must seek treatment immediately

crushing/viselike/radiating pain (arm, shoulders, neck, jaw)

 SOB

restlessness

dizziness

fainting

nausea

sweating

*absence of pain

*dyspnea

*fatigue

*anxiety

*chest cramping

*epigastric/abdominal pain

*restlessness

*falling

SOB

fatigue

fast/slow heartbeats

chest discomfort

silent MI

*leading cause of death

*African American women at higher risk

*higher mortality rate/more complications than men

*fatigue/sleep disturbances/dyspnea the month before MI occurs

 *delay treatment

 *less aggressive treatment given

serial ECG

cardiac troponin

myoglobin

CK-MB

c-reactive protein

magnesium

MONA

*thrombolytics

*vasodilators

*BB

*antidysrhythmic

*bedrest

*glucose control

*daily wts

*low sodium clear liquids

*low fat/low cholesterol/low sodium diet

*no caffeine

*fluid restriction

*weight loss

*smoking cessation

*"fab four"

antiplatelets

statins

ACEIs

BBs

*data collection: hx of risk factors, assess for depression

*pt teaching: info about disease, meds, diet, activity, rehab needs, stress reduction, regular exercise, smoking cessation

*monitor pain using a pain scale

*monitor BP, pulse, respirations

*obtain ECG

*administer O2

*remain with patient until any chest pain is relieved

*medicate as ordered

*monitor BP, HR, urine output

*listen to lung sounds

*monitor pulses, capillary refill, edema, color, temp

*monitor ECG

*administer meds as ordered

*promote/provide for adequate rest (semi-fowler's position)

elderly:

*observe for atypical pain (jaw pain, no pain, dyspnea, fatigue)

*observe for side effects of meds

*obtain VS before activities

*observe pts before and after activities and document any abnormal responses

*position pt for comfort and ease in breathing

*ADLs, dangling for 15 mins, using commode with assistance

elderly:

*slow pace of care

*refer pt to cardiac rehab

*encourage families to let pt be independent as much as possible

obstruction or occlusion of arterial circulation caused by chronic, progressive narrowing of arterial vessels

usually affects lower extremities

atherosclerosis is the leading cause

*many times asymptomatic

*intermittent claudication

*muscle ischemia

*pale color when extremity is elevated

*cyanotic/reddish-purple when extremity is in use

*cool to touch

*hair loss

*dry/flaky/scaly/mottled skin

*thickened toenails

*diminished pulses

meds: vasodilators, thrombolytics

diet management: no red meats, fried foods, whole milk, or cheese, surgery

*encourage rest when pain is present: prevents further ischemia

*keep lower extremities below heart level: increases arterial flow

*protect extremities from cold and trauma: decreased circulation=decreased sensation

*importance of relaxation techniques: decreases stress response and vasoconstriction

*keep extremities lower than heart: increases blood flow

*avoid bending knees/prolonged sitting/crossing legs: impede blood flow

*inspect lower extremities frequently/clean feet regularly/protect from injury: cleaning protects feet from things that can lead to ulcers

*wear shoes that fit well: prevents irritation and tissue breakdown

*progressive exercise: promotes circulation

*keep extremity warm: prevents vasoconstriction/promotes comfort

pain in the calves associated with activity or exercise

symptom of PAD, PVD

pain is relieved with rest, until PAD/PVD worsens; then pain remains constant

walk 30 mins per day, every day: promotes circulation w/o greatly increasing O2 demand

walk until intermittent claudication happens, then rest

increase walking distance gradually

elongated, tortuous, dilated veins

exact cause unknown

condition is familial

caused by structural defect in vessel wall

can lead to venous valve failure

most often involves superficial veins

caused by an acquired/congenital condition of deep venous system

 dilation of collateral and superficial veins interferes with blood returning to heart, causes stasis of blood in deep venous system->increases pressure in system, pushing blood into collateral vessels, causing varicosities in superficial veins

disfigurement of lower extremities

dull pain after prolonged standing

edema or ulceration (secondary varicosities)

common vasodilator for HF

LPNs cannot give it IV, only oral/sublingual/topical

decreases BP, decreases workload of heart

antiplatelet

uses: CAD, heart attack, angina, stroke, PAD

cardiac glycoside

increase heart contraction, slow HR, increase CO

use: HF

vasodilator

used in ER for HF pts

uses: improve blood supply to tissues, relieve chest pain, fissures

decreases BP

beta blocker

uses: HTN

decrease HR, decrease force of contraction, decrease BP

cardioselective

beta blocker

uses: HTN

decrease HR, decrease force of contraction, decrease BP

noncardioselective

beta blocker

uses: HTN

decrease HR, decrease force of contraction, decrease BP

noncardioselective

beta blocker

uses: HTN

decrease HR, decrease force of contraction, decrease BP

noncardioselective

ACE inhibitor

decreases fluid volume, decreases Na+, decrease BP, decreases workload of heart

uses: HF, kidney disease, diabetes, HTN

invasive

measures pressures in heart chambers, great blood vessels, and coronary arteries

provides info on CO and O2 sat

catheter is guided into heart by an xray->dye is

injected->heart chambers and vessels can be visualized 

often done before heart surgery

*assess for allergies to iodine and dyes

*NPO

*pt teaching: they will be awake for procedure, warm/flushing sensation might be felt when dye is injected, procedure takes 2-3 hours

*remove catheter->apply firm pressure at insertion site to prevent hemorrhage or hematoma

*check VS

*assess puncture site and peripheral pulses

*pt on bedrest

*modify pt position/use pillows to provide for comfort and rest

*pt discharged after few hours if they are stable

*pt teaching: do not move extremity that was used for insertion for several hours, eat/drink as soon as possible to remove dye from system

*allergic reaction

*breaking of catheter

*hemorrhage

*thrombus formation

*emboli

*dysrhythmias

*MI

*CVA

*puncture of heart chambers/lungs

regular ambulation

low-dose heparin or warfarin

intermittent compression stockings

swelling in legs

pain/tenderness in legs

warmth

red/discolored skin

visible surface veins

leg fatigue

*administer O2 as ordered to dilate vessels

*monitor PT/INR labs

*assess for respiratory distress

*auscultate lung sounds

*monitor ABGs and O2 sat

*monitor heart sounds

*protect yourself from injury

*wear shoes/slippers when ambulating to protect feet

*use soft toothbrush

*use electric razor

*do not receive IM injections

*immediately report any signs of bleeding (such as bruising)

vasoconstrictive response causing ischemia from exposure to cold and/or stress

more common in women who live in cold climates

primarily affects hands, but can occur in feet/ears/nose

pt must have ischemic attacks for 2 years to be diagnosed

*scleroderma

*lupus

*rheumatoid arthritis

*disease of arteries: atherosclerosis, buerger's disease, primary HTN

*carpal tunnel syndrome

*injury due to overuse

*smoking

*medications

*chemical exposure

*thyroid gland disorders

*ischemic pain

*hyperemia (intense reddening)

*pts go through phases: blanching, pain, reddening, blanching, pain, reddening...

there are no tests to diagonse raynaud's, but a combination of other tests and observation of the s/s may support the diagnosis of raynaud's disease

nail fold capillaroscopy: look at capillaries under nails to  find deformities

blood tests: antinuclear antibodies test, erythrocyte sedementation rate

keep hands warm

vasodilators: procardia, minipress, nitro

surgery: block sympathetic reflex by interrupting the sympathetic nerve impulses from the spinal cord to the hand (sypathectomy)

*wear gloves when going outside/cleaning fridge/preparing cold foods

*protect hands from injury

*avoid vasoconstrictors: smoking, alcohol, caffeine

*reduce stress levels

buerger's disease

(thromboangiitis obliterans)

recurring inflammation and thrombosis of small and medium arteries and veins of hands and feet

cause unknown, possibly autoimmune disorder

most common in men between 25-40, but increasing in women

primary contributing factor is tobacco use

cessation of smoking ASAP and avoiding second-hand smoke

no cure or effective treatment

can treat symptoms: CCBs (cardizem)

*reduce complications of ulceration, gangrene, and amputation by careful inspection of extremities

*monitor peripheral circulation

*report absent pulses immediately

administer meds as ordered

*position lower extremities below heart level

*walk every day, as tolerated

*smoking cessation

*low-fat diet

*do not walk barefoot

*inspect lower extremities daily for cracking/redness/sores/blisters

ballooning/bulging/dilating at a weakened point of an artery

unknown cause

can occur in any artery, but most commonly in abdominal aorta

men over 50 are most at risk

can be a complication of:

*atherosclerosis

*HTN

*smoking

*trauma

*congenital abnormalities

*back/flank pain (most common)

*abdominal pain

*feeling of fullness

*nausea

*pulsating mass in abdomen

*drop in BP, shock (if aneurysm ruptures)

meds for HTN

surgery: bypass graft, endovascular graft

CT scan

abdominal ultrasound

aortography

monitor pt carefully

pt teaching: know meds and how to take them, eliminate stress, avoid lifting heavy objects

hypotension

proteinuria

taste disturbances

hyperkalemia

dry cough

diarrhea/nausea/fatigue

*headache

*dizziness

*flushing

*restlessness

*blurred vision

*dry mouth

*rash

*constipation

*nausea

*headache

*flushing

*rash

*edema

*hypotension

*drowsiness

*dizziness

*gynecomastia (enlargement of male breasts)

*decreased sexual ability

*dizziness

*drowsiness

*insomnia

*fatigue

*dyspnea

*SOB

*bradycardia

*swelling

*depression

primary pacemaker of heart

firing rate: 60-100 bpm

if SA fails, AV firing rate: 40-60 bpm

if AV fails, bundle of his firing rate: 20-40 bpm

blood goes from atria to ventricles while ventricles are relaxed->AV node delays impulse briefly->impulse travels to bundle of his and divides down through bundle branches

no electrical activity is occuring in the heart

the flat lines between PQRST

[image]

atrial depolarization

SA node fires

disorders affecting atrial size cause changes in P wave

[image]

amount of time it takes the impulse to travel from SA node to AV node

beginning of P->beginning of QRS

normal interval: 0.12-0.20 seconds

[image]

ventricular depolarization

QRS is longer than P because ventricles have more muscle mass

[image]

amount of time it takes for impulse to travel from AV node through the ventricles

beginning of Q->end of S

normal interval: 0.10 seconds

[image]

*ventricular repolarization

*resting state of heart

*ventricles are filling with blood

*normal T wave: upward deflection

*abnormal T wave: downward deflection (coronary ischemia)

[image]

*start of Q->end of T

*amount of time it takes for ventricular depolarization and repolarization

*normal interval: 0.34-0.43 seconds (can vary r/t age/gender/HR)

*long/short intervals can lead to ventricular dysrhythmias

 [image]

small, often unseen

usually seen in pts with hypokalemia

*amount of time between the completion of a contraction to recovery of myocardial muscle

*end of QRS->beginning of T

*examined in pts with chest pain

*abnormal segment: inverted downward (ischemia), elevated (cardiac injury)

[image]

1) rhythm: R-to-R spacing; same spacing with a variation less than 2 small boxes is considered regular; if spacing varies more than 2 small boxes, it is considered irregular

2) HR: count the # of R waves in a 6-second strip and multiply by 10

3) P waves: if all P waves are present/regular/similar, it's considered sinus

4) PR interval: normal and constant

5) QRS interval: within normal range

6) QT interval: not shortened/prolonged

1) rhythm: regular

2) HR: 60-100 bpm

3) P waves: rounded, upright, similar

4) PR interval: 0.12-0.20 seconds

5) QRS interval: 0.10 seconds or less

abnormal rhythm

causes: disturbance in formation of an impulse or disturbance in conduction of impulse (impulse starts somewhere other than SA node)

sinus = originating from SA node

bradycardia = slow HR

sinus bradycardia = slow HR originating from SA node

causes: MI, electrolyte imbalances, well-conditioned hearts (athletes)

s/s: rarely show symptoms, decreased CO, fatigue, fainting

treatment: no symptoms=no treatment, pacemaker, atropine/dopamine/epinephrine

sinus = originating in SA node

tachycardia = HR greater than 100 bpm

sinus tachycardia = HR greater than 100 bpm originating in SA node

causes: physical activity, hemorrhage, shock, epinephrine/atropine/nitrates, dehydration, fever, MI, electrolyte imbalance, fear, anxiety

s/s: angina, dyspnea

treatment: digoxin/CCBs/BBs, decrease cardiac workload

"early" beat

atria fire an impulse before SA node fires

causes: hypoxia, smoking, stress, ischemia, meds, electrolyte imbalances, a-fib, HF

s/s: asymptomatic usually

treatment: not dangerous/no treatment required usually, BBs

atrias flutter/contract at 250-350 bpm

multiple P waves-appear as flutters (bunny hills)

causes: rheumatic/ischemic heart diseases, CHF, pericarditis, PE, CABG surgery, meds

s/s: if ventricular rate is normal-no symptoms usually, if ventricular rate is fast-palpitations, angina, dyspnea

treatment: control ventricular rate, cardioversion (electrical shock), rapid atrial pacing, meds

*atrial rate is rapid and chaotic

*rate of 350-600 bpm

*AV node blocks most impulses, so ventricular rate is lower than atrial rate

*no P waves, irregular R waves

*stroke risk increased r/t stasis of blood from atria not contracting

*causes: smoking, aging, rheumatic/ischemic heart diseases, HF, HTN, pericarditis, PE, CABG surgery, meds

s/s: irregular HR, palpitations, faint pulses

treatment: cardioversion (electrical shock), meds, ablation, surgery, device therapy

ventricles fire prematurely before the SA node

causes: caffeine, alcohol, anxiety, hypokalemia, cardiomypathy, ischemia, MI

bigeminy: PVC occurs every other beat

trigeminy: PVC occurs every third beat

s/s: palpitations, decreased CO, fatigue, dizziness

treatment: antidysrhythmic meds

3 or more PVCs in a row

continuous firing of ectopic beat

ventricles become pacemaker instead of SA node

causes: MI, cardiomyopathy, respiratory acidosis, hypokalemia, digoxin toxicity

s/s: dyspnea, palpitations, light-headedness, angina

treatment: CPR, defibrillation, meds, magnesium

many ectopic ventricular beats fire at the same time

ventricle quivers

no CO

immediate death, if not defibrillated

causes: hyperkalemia, hypomagnesemia, electrocution, CAD, MI

s/s: loss of consciousness, no heart sounds/pulses/BP, respiratory arrest, cyanosis, pupil dilation

treatment: defibrillation immediately, CPR, intubation/ventillation, epinephrine/atropine/vasopressin

can be temporary or permanent

epicardial, transcutaneous, transvenous

generates a beat, takes over as primary pacemaker

small spike in either P wave, T wave, or both on ECG

*check incision daily, report signs of infection

*check radial pulse, report if pulse is less than pacemaker's set rate

*report symptoms of dizziness/fainting/palpitations

*carry pacemaker info card

*avoid radiation/magnetic fields/high voltages/antitheft devices/large running motors

*tell airport security about pacemaker

*resume normal activity 6 weeks after surgery

*keep all scheduled appts