If irregular or regular- count number of QRS complexes in 6 second interval and x10.

If regular- Count number of big blocks between 2 Rs and divide into 300.

or

Count number of small blocks between to Rs and divide into 1500

Sinus node fires <60 bpm. Normal in athletes and during sleep.

S&S- pale, cool skin, hypotension, weakness, angina, dizziness, confusion, SOB

Associated with- hypothermia, increased vagal tone, parasympathomimetic drugs, Hypothyroidism, increased Intracranial pressure, obstructive jaundice & Inferior wall MI

Treatment- Atropine (use caution if MI suspected), Pacemaker, O2 therapy as needed

Discharge rate from sinus node is increased as a result of vagal inhibition and is >100 bpm.

S&S- Dizziness and hypotension d/t decreased CO, Increased myocardial O2 consumption may lead to Angina.

Associations- exercise, pain, hypovolemia, Myocardial Ischemia, HF, fever, blood loss, anemia, caffeine, nicotine and illicit drugs.

Treatment: Determined by underlying cause. Beta blockers to reduce HR and myocardial O2 consumption. Antipyretics for fever. Analgesics for pain.

Manifests as shark teeth waves on ECG. Common in elderly, and 64% of S/P open heart surgery experience this. Originates from a single ectopic focus. High ventricular rates >100 and loss of Atrial kick.

S&S- SOB, palpitations, anxiety, fatigue. Increased risk for stroke and decreased CO can precipitate angina, HF.

Associations- CHF, Rheumatic HD, Pulmonary Embolism, mitral valve disorders, CAD, HTN, chronic lung disease, hyperthyroid, Digoxin, Quindine, epinephrine.

Treatment: Antidysrhythmics, radiofrequency catheter ablation can be curative.

Total disorganization of atrial electrical activity d/t ectopic foci resulting in loss of effective atrial contraction. Most common dysrhythmia. Prevalence increases w/ age. Manifests as saw tooth on ECG.

S&S- Decreased CO d/t ineffective atrial contractions and rapid ventricular response, thrombi may form in atria d/t blood stasis, Embolus may develop and travel to brain causing a stroke.

Associations- underlying HD (rheumatic HD, CAD), Cardiomyopathy, HF, pericarditis, thyrotoxicosis, alcohol intoxication, caffeine, electrolyte disturbance, cardiac surgery.

Treatment: Digoxin, beta blockers, calcium channel blockers, Coumadin, antidysrhythmics, cardioversion after 4 week coumadin treatment, radiofrequency catheter ablation, maze procedure

The amount of blood ejected from the left ventricle every minute.

HR x Stroke volume= CO

Usually 4-7 L/min

Perfusion pressure felt by the organs.

MAP=

Systolic Pressure+2Diastolic Pressure

--------------------------------

3

Onset

Location

Duration

Character

Associated Symptoms

Radiation

Treatment

Severity

Increased levels indicate risk factor for CAD. 12-15= moderate risk

15+= high risk

Causes damage to endothelium

Elevation indicates heart failure. Releases when myocardial fibers are over-stretched.

Normal is below 100, positive up to 3000. Useful to distinguish between cardiac and respiratory symptoms.

<130

<100 for CAD

<200 total w/ LDL and HDL

1. Is rhythm regular or irregular

2. Rate P wave, should only be one and it should be upright and rounded

3. Measure the PRI 0.12-0.20 seconds

4. Measure QRS  <0.12 seconds

5. Interpret

Cardiovascular disease.

Heart attacks are the leading cause of all cardiovascular disease and deaths in general.

Elevated Serum Levels

HTN (3x for men, 2x women)

Tobacco Use (2-6x)

Physical Inactivity (increases 20%)

Obesity

Diabetes (earlier age)

Metabolic Syndrome

Psychological States (stress, etc)

Homocysteine lEVEL

Age (55% are 65+)

Gender (Higher in men until women reach menopause)

Ethnicity (higher in African Americans)

Family History

Genetic Predisposition

Total occlusion --> anaerobic metabolism and lactic acid accumulation --> severe, immobilizing chest pain not relieved by rest, position change or nitrates

Described as heaviness, constriction, tightness, burning, pressure, crushing.

Common locations- substernal, retrosternal, epigastric. Pain may radiate or not

"Pale, clammy and cool." Initially increase HR and BP then decreased BP (secondary to decreased CO), crackles, JVD, Abnormal heart sounds. Nausea, vomiting, fever.

Women- SOB, fatigue

Diabetics- SOB

Elderly- SOB, change in mental status

1) dysrhythmia- most common. 80% s/p MI. Most common cause of death in prehospital period. Life-threatening types seen most often w/ anterior MI, HF or shock

2) HF- pumping power of heart had diminished

3) Cardiogenic Shock- Inadequate O2 and nutrients  are supplied to tissues b/c of severe LV failure. Requires aggressive mgmt.

4) Papillary muscle dysfunction- mv regurg. Aggravates already compromised LV

5) Ventricular Aneurysm- infacted wall thins and bulges during contraction

6) Acute Pericarditis- inflammation of pericardium. See card

NYHA Functional Classification of Heart Disease

Class I

NYHA Functional Classification of Heart Disease

 Class II

NYHA Functional Classification of Heart Disease

Class III

NYHA Functional Classification of Heart Disease

Class IV

1) Written d/c instructions including activity level, diet, meds, follow-up appt, daily weights and symptom mgmt

2) Left ventricular function must be documented in record to indicate it has been (or will be) assessed

3) Ace Inhibitor or Angiotensin II receptor blockers for patients w/ known systolic dysfunction (ef <40%) rx at discharge.

4) Current smokers or smokers who quit w/in last 12 mos will be given cessation advice or counseling while in hospital

Increase venous capacity, inprove EF through improved ventricular contraction, slow the process of ventricular dysfunction, decrease heart size, avoid stimulation of the neurohormonal responses initiated by compensatory mechanisms of HF and enhance neurohormonal blockade. Proven to increase survival in HF. Includes:

Ace Inhibitors- "Gold standard" for HF. Also loosens the valve and decreases preload.

Angiotensin II receptor blockers

Nitrates- dilation

B-Adrenergic (Beta) Blockers- Block SNS response. Decreases BP, HR & contractility, so not ideal. Lopressor and Coreg do not decrease contractility.

Nesiritide

Digoxin- Improves contractility, increases CO.

Monitor vitals, cognitive status, skin color

ECG

High fowlers/ sitting position

Auscultate heart & lungs

O2, sats

I/O

Meds as ordered (usually IV Lasix, morphine to relax vasculature)

Monitor electrolytes

Provide calm, reassuring environment

CXR

Assess BNP level

High fowlers

O2 mask, biPap

BP, HR, RR, UO q1hour

Continuous ECG, pulse ox

Hemodynamic monitoring

Drugs as prescribed

Daily weights

Vent, cardioversion, VAD

Microbes colonize and attach to valves (usually prosthetic heart valves or in those w/ structural cardiac defects). Colonies break off and enter peripheral blood stream. Also occurs in IV drug users and in those w/ debilitating disease, indwelling catheters or prolonged IV therapy. Acute (onset w/in 2 weeks of infection) that is more virulent, or subacute (onset weeks-months) which is more common. Acute generally caused by Staph aureus, Strep viridians, virus or fungi while subacute caused by entercocci.

Treatment involves long term IV therapy via picc line for 6 weeks & prophalxis before different kinds of procedures.

fever (in 90%), chills, weakness, splinter hemorrhages in nail beds, petechiae, osler's nodes on fingers of toes, Janeway's lesions on palms or soles, Roth's spots, new onset murmur (d/t clumps on valves), HF in up to 80% w/ aortic valve type.

Arthralgia, myalgia, back pain, abd discomfort, wt loss, HA and clubbing of fingers (only w/ SA type).

Recent dental, urologic, surgical or gynecological procedures; heart disease; recent cardiac cath; skin, respiratory or urinary tract infection, IV drug use.

Labs- (2) blood cultures (+bacteria in 90%)

WBC w/ differential

Echocardiogram

CXR