-
Inotropic
Strength of Conduction
-
Chronotropic
Speed of heart beat
-
Dromotropic
Conduction of the impulse
-
Cardiac Glycoside
Digoxin
-
Digoxin
(Inotrope, Chronotrope, Dromotrope)
+ Inotrope, - Chronotrope, - Dromotrope
-
What does Digoxin do to the heart rate
Slow and Strengthens
-
Digoxin increases or decreases Cardiac output?
Increases
-
Digoxin is used for
CHF, Supraventricular tachyarrhythmias, Prevention of A-fib and flutter
-
Normal level of Digoxin?
0.5 to 2.0 mg/ml
-
First sign of Digoxin toxicity
Anorexia
-
SE of Dig
Visual distrubances blurred, yellow green halo, spots, confusion
-
Decreased potassium level can cause?
Toxicity
-
Before giving Dig should check what?
Apical HR for full min If below 60 hold and call
-
Pt will have increased or decreased Urinary output when Dig is working correctly?
Increased
-
How to prevent Dig toxicity?
Alternate dosage
-
Calcium Channel Blockers end in what?
dipine
-
2 Groups of Ca Channel Blockers
Decrease BP, Decrease HR
-
Effects of Ca Channel Blocker
- Block Ca
- Decrease HR as conduction is slow through SA and AV Nodes (-Dromotrope)
- Coronary Artery vasodilation
- Vasodilation of peripheral arteries
- Negative Inotrope inhibits smooth muscle contraction, decrease HR, Decrease contraction
-
Uses of Ca Channel Blocker
- Angina
- Prevent Tachycardia Dysrhythmia
- Treat HTN
-
SE of Ca Channel Blockers
Decrease BP, May cause headache, dizzy, rash, ankle edema, complaint of dry mouth
-
Always check what before giving a Ca channel blocker?
BP if systole is below 90 hold or HR below 50 hold and call
-
Ca Channel blockers do not work well with what?
Smokers
-
Nitrates are
Vasodilaters
-
Effects of Nitrates
- Dilate vascular smooth vessels
- Decrease peripheral arterial vascular resistance
- (reduce afterload)
- Decrease venous blood return to heart
- (reduce preload)
-
Uses of Nitrates
- Anti-anginal
- Hypertension crisis
-
SE of Nitrates
- Postural HTN
- Flushed face
- Headache
- Vertigo with faintness
-
Considerations before taking Nitrates
- Check BP and Pulse
- Do not mix with other drugs
- Take Nitro patch off at night so don't become tolerant
-
Beta Blockers will ____ HR and ____contractibility
Decrease, Decrease
-
Beta Blockers Effects
- Decrease sympathetic stimulation (stress response)
- to heart and major blood vessels
- Decrease HR (- chronotrope) (-Inotrope) (- dromotrope) Decrease O2 consumption
-
Uses of Beta-Blockers
- Decrease HR with Tachy dysrhythmias
- Anti-anginals
- Prevention of second MI
- Treatment of HTP
-
SE of Betablockers
- Bradycardia
- Beta 2 effects can cause bronchospasms (especially asthma pts)
- Penile dysfunction, relaxes urianry sphinchter
- Can cause Fatigue and Nightmares
-
Non Selective Beta 2 Drugs don't give to who?
Those with respiratory problems
-
Considerations before giving a beta Blocker
Assess BP and HR Below 50 or BP Systolic below 90 hold
-
Beta 1 is
Beta 2 is
- Beta 1 selective (Only Heart)
- Beta 2 Non selective (Heart and Lungs)
-
Beta 2 Use cautiously in pts with?
Diabetes
-
ACE Inhibitors drugs ending in?
PRIL
-
Action of ACE Inhibitors
- Inhibit angiotensing converting enzymes (ACE)
- Converts Angiotensin 1 to Angiotensin 2
-
Angiotension 2 is a powerful what?
Vasoconstrictor
-
Angiotension 2 effects on the body
- Vasoconstriction (Increase BP)
- Causes release of Aldosterone (NA and water retention)
- Urinary output decreased
-
Uses of ACE Inhibitors
- Reduce the workload of the heart
- antihypertensive
- Renal protective helps protect the kidney from failure
-
SE of ACE Inhibitors
- Dry Cough, Lost of taste, Decrease BP,
- CHECK renal, Kidney and Liver Function
- Can cause Neutropenia (decrease WBC) so Risk for infection
- Kidney Failure
-
Angiotensin 2 Receptor Antagonist ends in
Sartans
-
Angiotensin 2 Receptor Antagonist action
- Blocks the effect of angiotensin 2
- Blocks vasconstriction and releases aldosterone
-
Uses of Angiotensin 2 Receptor Antagonist
Treat HTN
-
SE of Angiotensin 2 receptor Antagonists
Check BP, Check Renal Function
-
Drugs of Angiotensin 2 receptor antagonist
Losartan, Valsartan, Candesartan, Irbesartan
-
Anticholinergics
(drug)
Atropine
-
If someone has a slow HR (bradycardia) they will receive which med?
Atropine
-
Effects of Anticholinergics
Increase rate of SA node (+ chronotropic) Increases conduction through AV Node (+dromotropic)
-
Uses of Anticholinergics
- Sinus brady cardia
- Pre procedure prep for pt
- -bronchoscope
- -esophagram
-
SE of Anticholinergics
Dry Mouth, Flushing, Dilation of Pupils, Decrease in bronchial secretions, Inability to void especially with prostate enlargement
-
Atropine is give to ___ the pt's HR
Increase
-
Antihypertensive drugs purpose
Reduce blood pressure to normal or near normal
-
Alpha blockers (Alpha 1 to treat hypertension and to reduce -____
Peripheral resistance
-
Alpha blockers should be taken when? and why?
Night because it can cause orthostatic hypertension
-
Antiarrhythmic drug is
Lidocaine
-
Lidocaine must have
EKG monitor
-
What is lidocaine give for?
Ventricular dysrhythmias
-
EKG monitors what?
Electrical activity of heart ongoing basis (impulses) No pain while doing this test
-
12 Lead EKG looks at what?
- Electrical activity of heart from 12 different views
- DX of MI, It can tell us if the pt has hyper or hypokalemia Decrease or increase potatisum levels, Ca levels and dysrhythmias
-
Holter Monitor
EKG on a outpatient base (telemetry) recorded for 12-24 hrs looking for dysrhythmias or abnormalities , keep diary or log for all activities
-
Stress test
No caffeine prior to test for 24 hrs, NPO for 4 hrs before the test, when exercise the cornary arteries dilate 4 x
-
Chest X-ray
Measures heart size, location, pulmonary infiltrates
-
Echocardiography (Sonogram)
Non invasive, shows wall motion, Contractility, ejection fraction, stroke volume, valve function, can look for size, shape, beating
-
rapid fast CAT scan
Good for Coronary arteries disease
-
Cardiac Cath or angiogram
- NPO 8-12 hrs before, IV Access, teaching, Draw BUN to check Kidney Function, PT, PTT, INR (evaluate clotting factors), Platelets and electrolytes
- Continous EKG, IV Heparin
-
Cardiac Cath Pt should be
- Flat, bedrest for 2-6 hrs, Neurochecks, look for bleeding at cath site
- Potential problems Allergy to dye, hematoma, hemorrhage
- Kidney failure due to dye (increase fluids to flush)
- Urinary retention
-
Vasovagal reaction
The HR and BP drops this can occur just by distended bladder and pain, may need to give IV atropine to increase HR and BP
-
Cholesterol
Less than 200
-
-
Fatty triglycerides
45-150
-
-
When the heart is damaged it releases what?
Enzymes
-
Depolarization
Electrical activation of cell caused by influence of NA going in cell while K exits
-
Repolarization
Return of cell to resting state Na goes out and K goes in cell
-
P Wave
Conduction of impulse through atrium (atrium in depolarization) SA spreading in atria
0.11 sec or less
-
QRS Complex
Conduction of impulse from (ventricular depolarization) SA Node to AV Node (ventricular depolarization)
Less tahn 0.12 secs
-
PR Interval
O.12 -0.20 secs
-
ST segment
Refelects end of ventricle depolarization (QRS) thru end of Ventricle repolarization (T wave)
-
T wave
Repolarization of ventricle (resting state)
-
-
1 Big box (5 small)
0.20 secs
-
Ventricle Contraction:
Begin with S1 (systole) depolarization electrical stimulation
-
Ventricle emptying and relaxing (Dilate) S2
Repolarization electrical relaxation Dystole
-
Factors that affect stroke volume
After load
-
Ejection fraction
The perecnt of blood ejected with each beath of the heart should be greater than 50 percent
-
Factors affecting Cardiac Output
- Length of Diastole
- Force of contractility of muscle
- Venous Return
- Peripheral vascular Res (BP)
- Ventricular Compliancy
-
Diastole=
Filling, relaxation of the heart
-
Systolic=
Pumping the contraction of the heart
-
Which ventricle pumps the blood to the aorta to go to the rest of the body?
Left Ventricle
-
Cardiac preload is
a stretching of the ventricle of atria while they are filling with the blood (diastole)
-
Afterload is
The work required by the heart to move blood into systemic circulation you could be even more specific say the left ventricle
-
What happens during S1 and S2?
Preload- The strength of the ventricles to atrium filling of the blood (diastole) relaxation
Afterload- the work load it takes teh heart to pump (syst) contraction
-
s1 heard best
Closer T M , apex (sys) Lub
-
S2 heard best at
A P , Base (diast) Dub
-
Superior and Inferior Vena Cava
Rt Atrium
Rt Ventricle
Pulmonary Artery
Lungs
Pulmonary Veins
Left Atrium
Left Ventricle
-
Aortic
Pulmonic
Erbs point
Tricupsid
Mitral
-
S1 is the closer of Tricupsid and Mitral, heard best at apex (sys) S1 lub
-
S2 is the closer of the Aortic and Pulmonic (dys) heard best at the base of the heart
-
Systole
Mechanical contraction (blood pushes out of the ventricle)
-
Diastolic
Mechanical relaxation
-
Coronary arteries fill during when?
Diastole
-
If you have a pt who has tachycardia, Increase HR, Shorten diastole mycardial perfusion will -----
Decrease.. Coronary arteries will not perfuse
-
ICD (automatci) Implantable cardioverter defibillator
Mechanism that is implanted in the pt to provide a shock directly to the heart for recurring v tach or v fib uncontrolled by medication
-
ICD what does it do?
Gives repetitive shocks directly to the heart
-
Statin are
- Antiplatelets aggregation
- Plavix, ASA
-
MVO2
Mixed venous oxygen saturation
-
PTCA (percutaneous transluminal coronary angioplasty)
Balloon on a wire is inserted into artery feed back uup aorta (against the flow) and into coronary arteries to a lesion. The ballon is inflated the plaque is pressed into the walls of the vessel
-
PTCA
- NPO
- Consent sign
- IV
- Pt is awake
- Will have angina
-
Post PTCA
- Stay overnight
- Receive heparin during procedure
- Check for bleeding in the groin
- affected leg should be straight
- Pt flat
- Apply pressure if bleed
- on ASA rest of life
-
Stent: a wire mesh that holds the wall lumen open
-
CABG (Coronary artery bypass grafting)
- Bypasses the blocked area and uses a vessel
- The heart is not opened
- The sternum is cut open to have acess to the heart from top to bottom
- The blood that normally flows through the heart given through a machine
- The heart is stopped, using strong potassium adn other electrolyte solution
- Bypass grafts are sewn onto the coronary artery
-
ACE
(Inotrope, Chronotrope, Dromotrope)
-
Angina is usually caused by?
CAD
-
CABG can have pain and swelling where?
Leg
-
S4 is always abnormal
S3 is not
-
-
Graham Crackers and Apple Juice
No Cheese
-
Blood Clot in Rt Ventricle goes in?
Pulmonary artery
-
Coronary artery fills during?
Diastole
-
Chest Pain-mowing
CABG Leg pain normal
-
Coffee away nothing else
Drug at night
-
Stool softner, Decreases HR BP
Ca Blocker, Decrease HR BP, Angina
-
PTCA- Normal if having pain
Check bleeding in groin
-
Affected leg straight, pt flat
ACE Inhib reduced afterload
-
Echo No prep
Risk for decrease Cardiac Output
-
Apical= Pulse pressure
Ejection fraction should be greater than 50
-
Coronary artery difuses during Diastole
Sinus Tachycardia is one of the strips
-
ICD- Bradycardia prepare for surgery
Telemetry-Damage to heart
-
Alpha 1- Orthostatic HTN
Atropine decreases urine output
-
Nitrates -vasodilator
Lidocaine for V Tac
-
-
HDL Good want high, helps reduce LDL
LDL bad want it low
-
Low fat, Low cholesterol Diet
-
Beta 2 don't give to pts with
Asthma
-
Atrial Kick
Last part of Diastole and ventricular filling accounts for 25-30 of cardiac output
-
Stroke Volume
Amount of blood ejected from ventricle per heart beat (about 70)
-
Increase strength of contraction cardiac output will
Increase
-
Beta Blockers end in
Olol
-
isometric
Has increased tension while maintaing length of muscle fibers
-
Isotonic
shortening of muscle fibers while tension remains constant
-
Pulse Pressure
Difference between systolic and diastolic pressure
-
Sympathetic (adrenergic) Epinephrine Norepinerpherine
Parasymathetic (cholinergic) Mediated by vagus nerve secretes acetycholine
-
Sympathetic Increases SA node rate
Increases Conductivity and Contractilility
- Parasympathetic decreases SA Node rate
- Decreases Conductivity and Contractility
-
If ejection fraction is lower than 50 percent pt is not getting oxygenated
-
If pt is Tachycardia will
Shorten diastole myocardial perfusion will decrease
-
Aorta
Right 2nd ICS close to sternum
-
Pulmonic
Left 2nd ICS sternal border
-
ERBS Pt
L 3rd ICS sternal border
-
Tricupsid
L 5th ICS sternal border
-
Mitral
L 5th ICS Mid Clavicular Line
-
Apical Pulse is taken at
Left 5th Intercostal Space Mid Clavicular Line
-
S3 Normal in children young adults, heart failure pts
S4 Always abnormal , stenosis of aortic valve, heart pt, HTN, CAD
-
Internal Jugular Vein distention indicates
High preload
-
Metabolic Acidosis indicates
Poor peripheral perfusion
-
CBC monitor ?
Blood viscosity and inflammatory process
-
Bundle of His and Purkinjes fibers conduct
electrical impulses through the ventricles
-
-
-
Too low K+ causes
Toxicity
-
Normal PR Interval
0.12-to 0.20 sec
-
Diagnostic ultrasound won't interfere with ICD
-
Enzyme inhibiting antilipemics end with the suffix?
Statin
-
Increase HR causes increased 02 consumption, decreased amount o ftime in diastole
There is the potential for a decrease in the myocardial oxygenation related to the increase demand, and decreased time during diastole
|
|
