1. Risk Factors for CV disease
    • – Smokers
    • • Second hand smoke
    • – Use of Drugs
    • • Legal / Street
    • – Diet
    • – Wearing tight clothes
    • • Experiencing leg cramps, numbness tingling
    • – HTN, Diabetes
  2. Pathophysiology of CV Disease
    • • Stroke Volume:
    • – Pre load
    • – After load
    • • (Automaticity/excitability)
    • • Heart Rate
    • – Fast heart rate
    • – Slow heart rate
    • • (Blockage Problems) AMI, CAD, Angina, PE
    • • (Flow Problems) valvular disease, arrthymia's,HTN, cardiomyopathy
  3. Cardiac Output (CO) =
    SV X HR
  4. Examples of blockage problems
    AMI, CAD, Angina, PE
  5. Examples of Flow problems
    valvular disease, arrthymia's,HTN, cardiomyopathy
  6. Stroke Volume is usually about how much blood
    70 mL
  7. Stroke Volume (def)
    - sames as?
    amount of blood ejected into blood out of left ventricle

    ejection fraction
  8. pre load (def)
    amount of blood in heart before pumped out
  9. after load (def)
    peripheral resistance - heart works harder to push blood against pressure
  10. Signs that someone is symptomatc of CV problems

    acute ex:

    chronic ex:
    SOB, hypotension, chest pains

    come in and something is clearly wrong with pt. at this time, needs treatment immediately

    c/o pain on and off that started day before
  11. Asymptomatic
    will show no signs of a problem
  12. Erb's point
    3rd ICS LSB
  13. chest pain assessment
    • • Precipitating factors
    • • Quality
    • • Region/radiation
    • • S/S associated with the CP
    • • Timing/response
  14. action for acute symptomatic symptoms
    treat immediately
  15. action for chronic symptoms
    complete head to toe assessment
  16. equipment for CV assessment
    • - Stethoscope
    • – Doppler (gel)
    • – Penlight
    • – 2 cm ruler
  17. ULAP can/cannot
    CANNOT - complete assessment

    CAN - instruct to report immediately anyincidence of CP, unusual fatigue, changes in heartrate, and blood pressure, dizziness
  18. for assessment HOB should be
    45 degree angle
  19. PMI
    point of maximum impulse
  20. new findings should be
    reported and recorded
  21. Each landmark should be
    inspected and palpated
  22. Landmarks
    • – Aortic area 2nd ICS RSB
    • – Pulmonic area 2nd ICS LSB
    • – Tricuspid area 4 ICS LSB
    • – Mitral area 5th ICS MidclavicularLine
    • – Epigastric tip of the sternum
  23. Palpate the carotid pulse and S1 should be
  24. S1
    - sounds like
    - occurs when
    - quality
    - louder where
    - best heard where
    - abnormal if

    – Sounds like “lub” and occurs after the long
    diastolic pause and preceding the short systolic
    – S1 is high‐pitched, dull in quality
    – Relatively louder in the pulmonic area than aortic
    – Best heard at the apex
    – Abnormal if hear splitting or two distinct sounds
    to S1
    • “lub”
    • occurs after the longdiastolic pause and preceding the short systolicphase
    • high‐pitched, dull in quality
    • in the pulmonic area than aorticarea
    • at the apex
    • hear splitting or two distinct sounds to S1
  25. S2
    - sounds like
    - occurs when
    - quality
    - louder where
    - best heard where
    - abnormal if
    • “dub”
    • follows short systolic phase
    • Precedes the long diastolic phase
    • High pitched
    • best heard at the aortic area; may have two audible components,best heard on inspiration
    • if there is delay in activation of contraction or valve stenosis wide splitting
  26. assessment of "heart beat"
    • Both sounds heard as “lub‐dub” combinationand is one heart beat
    • • Assess heart rate
    • • Assess heart rhythm (regular)
    • • Note the time between S1 and S2 (systolic pause) then time between S2 and S1 (diastolic pause)
  27. Extra Heart Sounds
    • S3 and S4
    • clicks and rubs
    • murmurs
  28. S3 and S4–
    - best heard where
    - sounds like
    - resembles
    • Best heard at the apex, client on the left side
    • Sounds are quiet, difficult to hear
    • Resemble a gallop
  29. clicks and rubs
    - clicks sound like
    - rubs sound like
    - normally absent when
    • short, high pitched extra sounds
    • squeaky or rubbing sounds
    • with cardiac valves opening noiselessly
  30. Murmurs
    - where to listen
    - quality
    - use what part of stethoscope to hear
    • Erb’s point 3rd ICS LSB
    • low pitched sounds
    • Use the bell of the stethoscope
  31. Murmurs
    - sounds like
    - occurs where (systolic/diastolic)
    • Heard as a swishing or blowing sound at the beginning,middle or end of the cycle
    • between S1 and S2 is systolic
    • between S2 and S1 is diastolic
  32. Murmur Intensity
    - grade I/VI
    - grade II/VI
    - grade III/VI
    - grade IV/VI
    - grade V/VI
    - grade VI/VI
    • barely audible
    • Audible immediately but faint
    • Loud without thrust or thrill
    • Loud with thrust or thrill
    • Very loud, with lift/heave or thrill, audible with stethoscope only partially applied
    • Louder, may be heard without stethoscope
  33. Loud S1 heart sound
    - significance
    - next step
    • May be caused by anemia, fever, hyperthyroidism,vigorous exercise
    • Reassess patient, review labs (elevated TSH, lowH,H) Ask about prior activity
  34. Faint S1
    - significance
    - next step
    • Obese, fluid over heart(emphysema, pericardial effusion) Can indicate diminishedvalve flexibility such asthose with rheumatic heartdisease
    • New finding in person withappropriate weight height,report to HCP
  35. Loud S2
    - significance
    - next step
    • Heard with systemic hypertension, aortic valve syphilis, exercise,pulmonary HTN, mitral stenosis, CHF
    • Record and report findings Correlate with history and other assessment findings
  36. Diminished S2
    - significance
    - next step
    • Obese, fluid over heart aortic or pulmonic stenosis
    • Review chart for priorfinding of Aortic orPulmonic stenosisReport finding to MD Document finding
  37. Split S2
    - significance
    - next step
    • Closure of aortic valve slightly ahead of pulmonic valve, Best heard on inspiration, disappears during inhalation or breath holding
    • Ask to hold breath to validate sound heard is split S2 Report and record finding Does not require intervention
  38. S3 gallop
    - significance
    - next step
    • Combination of S1, S2, S3 sounds like “Ken‐tuc‐ky”
    • New finding should be reported Reassess CV system
  39. S4 gallop
    - significance
    - next step
    S4 is atrial gallop, occurring just before S2 orventricular systole. It sounds like “Ten‐nes‐see”When S3 or S4 become easy to hear, may be from increased resistance to filling because of loss of ventricular wall compliance (HTN, CAD) increased stroke volume (anemia, pregnancy, hyperthyroid)

    Reassess patien tReview Fluid volume status/vital signs Report and record finding
  40. Murmur
    - significance
    - next step
    Can be asymptomatic, or indicative of heart disease Usually indicates disruption of blood flow into,through or out of the heart

    Record and report finding, note intensity,location, radiation Assess for radiation listen for murmur at the neck or back
  41. clicks
    - significance
    - next step
    May be cause by old artificial heart valve Extra heart sounds may also occur with murmurs and usually indicate pathology such as mitral valve prolapsed or aortic stenosis

    Record and report
  42. Rub
    - significance
    - next step
    Result from rubbing of inflamed pericardial tissue

    Report finding to MD Record assessment finding
  43. Lift or heave
    - significance
    - next step
    May indicate increased cardiac output or left ventricular hypertrophy, along left sternal boarder indicates right ventricular hypertrophy

    Record report findings
  44. Peds
    - PMI - located
    - sinus arrthymia, variation in heart
    - murmurs
    - palpate where
    - absence of femoral pulse could mean
    • located just lateral to MCLand 4th intercostals space in children <7 years
    • common in children
    • frequent in newborns until about 48 hours of age, most benign
    • Brachial, radial and femoral pulses
    • sign of coarctatation of aorta
  45. Geriatric
    - heart rate
    - SV
    - CO
    - PMI
    - heart reacts diff to stress causing
    - early signs of CHF
    - heart sounds not as
    - dependent edema
    • slows,
    • decreases,
    • decreases by 30‐40
    • more difficult to palpate as the AP diameter as age deepens
    • Heart failure
    • Fatigue, restlessness, syncope,confusion
    • loud
    • common
  46. Cultural Considerations
    - CV disease occurs most frequently in the
    - HTN low among
    • non‐Hispanic blacks followed by Mexican Americanand whites
    • Higher among Jews from Israel
    • Asians
  47. African Americans Cardio considerations
    • - highest occurrence of HTN
    • - Age onset is earlier
    • - HTN more severe
    • - less prone to varicose veins than whites
  48. Blood Pressure Assessment
    - auscultate using
    - normal
    - Reading between arms may vary (amt)
    - tendsto be higher in the
    - If differ more than 15 mm HG suggest
    - Compare sitting BP with
    - Orthostatic Hypotension indicated by
    • brachialartery
    • Should be 130/80 mm Hg or less
    • 10 mm Hg/
    • right arm
    • atherosclerosis or aortic disease
    • pressure measured lying and standing
    • by drop in systolic BP of 15mmHG or more and a fall in diastolic pressure
  49. Vascular Assessment - carotid arteries
    - inspection
    - palpation
    - compare what on both sides
    - characteristics of carotid pulse
    - both should be equal in
    - rate is the same as
    • neck on both sides of obvious pulsations Examine only one at a time;
    • do not vigorously palpate the carotid artery to prevent carotid stimulation which causes drop in BP and HR
    • rate, rhythm, strength of pulse
    • localized, strong, thrusting, unchanged by inspiration
    • rate, rhythm, strength
    • apical pulse
  50. Bell stethoscope over carotid artery where?
    turn head and
    if bruit or blowing sound is heard
    • artery at lateral end of the clavicle and psoterior margin of sternocleidomastoid muscle
    • hold breath - normall no sound is heard
    • palpate for thirll, should not be one, if felt have severe artery narrowing
  51. Vascular Assessment
    - JVD exam (right atrium, indirect measurment)
    - Measure by assessing
    - supplies needed, do what with them
    - how to measure
    - normal range
    • - Sitting at 90 degree angle – see no veins flat, no pulsation; If distended while sitting indicates heart disease
    • –vertical distance between angle of Louis andhighest level of visible point of the internal jugular vein pulsation
    • – Need two rulers, line the bottom with top of the pulsation of jugularvein
    • – Take a cm ruler and align perpendicular to the first ruler at the level ofthe sternal angle
    • – Measure in cm the distance between the second ruler and the sternalangle
    • – Measure both sides; less than 2 cm is normal
  52. Peripheral arteries
    • radial
    • ulnar
    • brachial
    • femoral
    • popliteal
    • dorsalis pedis
    • posterior tibial
  53. Scale for pulse measuring strenght
    - 0
    - 1+
    - 2+
    - 3+
    - 4+
    • - absent
    • - diminished, barely palpable, easy to obliterate
    • - easily palpable, normal pulse
    • - full pulse, increased
    • - strong, bounding pulse can not be obliterated
  54. Angina Pectoris
    - Comments
    Unstable angina, acutecoronary syndrome,treated as AMI
  55. Angina
    - comments
    - precipitating factor
    - alleviating factor
    • - Uncomfortable pressure, squeezing, fullness, substernal, can radiate to hands,numbness, tingling,aching
    • - Physical exertion,emotional upset,eating large meal, exposure toextreme temps.
    • - Rest, NTG, Oxygen
  56. AMI
    - comments
    - precipitating factor
    - alleviating factor
    • - Similar symptom presentation as angina, but with associated SOB,diaphoreses,palpitations, fatigue,nausea, and vomiting pain lasts for greater than 15 minutes
    • - Emotional upset orunusual physical exertion occurring within 23 hours of symptom onset, can occur at rest or while asleep
    • - Morphine sulfate,reperfusion of coronary arteries
  57. pericarditis
    - comments
    - precipitating factor
    - alleviating factor
    • - Sharp severe substernal or epigastric pain, can radiate to neck, arm, o rback other associated symptoms fever, malaise,dyspnea, cough, nausea,dizziness, palpitations,duration is intermittent
    • - Sudden onset, pain increased with inspiration,swallowing,coughing and rotation of the trunk
    • - Sitting upright,analgesia, antiinflammatory medications
  58. Pulmonary Disorders
    - comments
    - preciptating factor
    - alleviating factor
    • - Sharp severe substernal pain arising from inferior portion of pleura, may be able to localize the pain,duration greater 30 minutes
    • - Follows an infection or noninfectious process(AMI, Cardiac Surgery,Cancer, Immunedisorder, uremia) Pleuric pain increases with inspiration,coughing, movement and supinepositioning. Occurs inconjunction withacquired lunginfections, pneumonia,Pulmonary Emboli
    • -Treat the cause
  59. Esophageal
    - comments
    - precipitating factor
    - alleviating factor
    • - Substernal pain sharp,burning or heavy often mimics angina, can radiateto arm, neck or shoulder,duration 5-60 minutes
    • - Lying down, coldfluids, exercise
    • - Food, antacid, nitroglycerinerelieves spasm
  60. anxiety, panic disorder
    - comments
    - precipitating factor
    - alleviating factor
    • Describe pain as stabbing to dull ache, associated with diaphoresis,palpitations, shortness of breath, tingling of hands or mouth feeling of unreality or fear of losing control duration peak in 10minutes
    • Know associated trigger, unexpected or situational where symptoms are associated
    • Removal of stimuli, relaxations,medication to treat anxiety, or antidepressants
  61. musculoskeletal
    - comments
    - precipitating factor
    - alleviating factor
    • - Costochrondritis; sharp stabbing pain localized in anterior chest most often unilateral. Can radiateacross the chest to epigastric or back patientable to localize the pain duration hours to days
    • - Most often follows respiratory tract infection with significant cough,vigorous exercise,post trauma, somecause idiopathic.exacerbated by deepbreath, coughing,sneezing and movement of upper torso or arms
    • - Rest ice or heat, analgesic or antiinflammatorymedication
  62. Cardiovascular Meds
    - act on what systems
    - affect what
    - used to control what (main purposes)
    - General SE
    • - vascular, cardiac, renal, sympathetic nervous system
    • - blood pressure, cardiac output, peripheral vascular resistance, heart rate
    • –moderate tosevere HTN
    • - hypotension, sexual dysfunction, sedation
  63. Beta blockers
    - end in
    - examples
    - block beta receptors in the heart causing
    - side affects
    - nursing priority
    - safety
    • - Metroprolol (Lopressor) Atenolol (Tenormin) Propranolol (Inderal)Nadolol (Corgard)
    • – decreased heart rate– decreased force of contraction– decreased rate of AV conduction
    • - BRADYCARDIA, BRONCHOSPASM, Lethargy,CHF, Decreased BP, Depression
    • - Assess pulse rate – Assess respiratory status especially first dose– Hold if systolic <90 or symptomatic bradycardia
    • - contraindicated with brady dysrhythmia’s, AVblocks, Beta 2 chronic respiratory problems
  64. Ace Inhibitors
    - ends in
    - used in
    - Examples
    - Action: decrease PVR without increasing...
    - side effects
    - nursing priority number 1
    - safety
    • - HTN, Heart Failure
    • - Lisiniopril, Captopril, Enalapril, Benazepril
    • - cardiacoutput; without increasing heart rate; without increasing cardiac contractility
    • - Orthostatic hypotension, Cough,Headache, Dizziness, Angioedema, Altered sense of taste
    • - Nursing Priority: 1. regularly monitor b/p especially with 1st dose hypotension, 2. teach to rise slowly, 3.Avoid potassium supplements or potassium containing substitute salt. 4. administer on a empty stomach
    • - Safety: History angioedema; 2nd / 3rd trimesterpregnancy, renal artery stenosis
  65. CA+ Channel Blocker
    - examples (Very Nice Drug)
    - Action: block ca access to cells causing decreased...
    - side effects
    - nursing priority
    - safety
    • - (Verapamil, Nifedipine, Diltiazem)
    • - in contractility; decreased conductivity ofthe heart; decreased demand for oxygen
    • - Bradycardia, May precipitate AV block,Head ache, Constipation, Nausea, Peripheral edema
    • - DO not crush or allow to chew sustainedrelease, Monitor for hypotension, Weigh client report edema,Teach to avoid grapefruit; increase dietary fiber, fluid• Safety: Monitor edema and for dysrhythmias
  66. Nitroglycerine (NGT)
    - uses
    - quick acting
    - slow acting
    - action
    - side effects
    - nursing priority
    - safety
    • - anginal pain, conjunction with beta blocker or ca channel blocker to suppress tachy rhythm
    • - NTG IV (glass bottle special tubing), SL, Translingual Spray
    • - Nitro‐bid, NTG Patch, Nitro Ointment, Sustained Release tablets
    • - Relax vascular (arterial and venous) with more prominent effects on veins, which decrease preload. Arteriole relaxation reduces systemic vascular resistance, which reducesafterload
    • - Orthostatic hypotension, Headache, Tachycardia, Dry mouth, Blurred vision
    • - 1. Teach to carry with at all times if angina 2. Teach proper storage for freshness; tingling, fizzling sensation under tongue) discard every 24 months; teach call 911 not relieved within 5 minutes taking medication X33. Rotate transdermal patches and remove after 12‐14 hours to have a “patch free” interval of 10‐12 hours daily
    • - Monitor both quick or slow for severe hypotension, tachycardia, dizziness, headache and syncope; use of Viagra other erectile dysfunction medications; compounds the effect of the drop in blood pressure
  67. Beta Blockers
    - affect beta sites in
    - bronchospasms will occur when
    - number one side effect
    - can worsen _________ and cause _________
    - contraindicated in
    - assessing what is most important
    • - heart and lungs
    • - patient is first put on the drug
    • - bradycardia
    • - CHF, depression
    • - COPD
    • - pulse rate
  68. PVR
    peripheral vascular resistance
  69. Ace Inhibitors
    - doesn't decrease
    - increases
    - teach patient
    • - HR
    • - SV
    • - sit up slowly when coming up from lying position (causes orthostatic hypotension)
  70. Ca+ Blocker
    - teach patient the importance to monitor what side effect
    - what to teach
    • - peripheral edema
    • - weigh daily
  71. Nitroglycerine (NGT)
    - IV form is stored and admined how?
    - decreases preload by ______, in _____ and _____
    - teach patient to _______ in emergency
    - do what to prevent skin irritation
    • - in a glass bottle with special tubing
    • - vasodilation, veins and artery
    • - call 911 do not let someone drive them
    • - rotate sites
  72. Antidysrhythmics
    - used to treat
    - example
    - action
    - side effect
    - nursing priority
    - safety
    • - tachy dysrhythmias, SVT, PAT, Atrial Fibrillation
    • - Diltiazem (cardizem), Propranolol (Inderal)Quinidine sulfate (Novoquinine), Amiodarone (Cordarone)
    • - Each medication acts differently to reduce or slow impulses throughout the heart
    • - Quinidine; Cinchonism effects; tinnitus, headache, nausea,dizziness: Generally all cause: hypotension, Fatigue, bradycardia.Amiodarone causes pulmonary toxicity, visual issues
    • - Monitor cardiac rhythm, especially initially, report anypulse <60 bpm, Report hypotension, dysrhythmias, Instruct to take all doses, not catch up on missed doses, Report any SOB, irregular fast or slowheart beats
    • - Monitor risk for falls
  73. Digitalis - cardiac glycoside
    - used to
    - example
    - side effects
    - report if...
    - administer IV slowly
    - loading dose
    - nursing priortiy
    - safety
    • - HF, Improves CO, Atrial Fibrillation or Atrial Flutter
    • - Digoxin, Lanoxin
    • - Affects mechanical and electrical action of the heart which increases contractility.
    • - Fatigue, Visual disturbance, Anorexia, Hypokalemia,Bradycardia, dysrhythmias
    • - Monitor serum dig level check toxicity 2 ng/ml is too high, Teach to monitor pulse; report if < 60 for adult;
    • – Report if < 100 child; hold dose and report to MD, Teach recognize s/stoxicity; nausea vomiting diarrhea, blurred or yellow visual disturbance
    • – Administer IV slowly >5 minutes
    • – Loading Dose; usually 0.5‐1 mg, give 50% dose at first or 0.25‐0.5 mg IV slowly then in 6 hours 0.125 mg and repeat in 6 hours 0.125 mg
    • - Know s/s of toxicity and antidote for digoxin
  74. Digitalis
    - before giving check
    - anything over what is too high of a level
    - give how through IV
    - loading dose
    - aka
    - antidote
    • - if digoxin level was ordered for pt.; know what the level is before giving
    • - 2
    • - slow push
    • - 50% of 1st dose then 25% in 6hrs then 25% in another 6hrs
    • - digitalizing
    • - digibind, digiband
  75. Lidocaine
    - used
    - action
    - side effects
    - nursing priority
    - safety
    • – suppress ventricular arrthymia
    • ‐ Blocks sodium channels and slowsconduction, reduces automaticity in ventricles and perkinje system
    • –Toxicity, Drowsiness, Confusion, Parenthesis’, Seizure, Heart block and arrest, Respiratory arrest
    • ‐ Assess LOC, Protect Monitor seizures, Monitor ECG, vital signs
    • – Seizure precautions
  76. Drugs given for bradycardia, low BP (IDEA)
    isoprterenol, dopamine, epinephrine, atropine
  77. Isoproterenol (isuprel)
    - action
    - side effects
    • - increases heart rate and CO causes bronchodilation
    • - tachycardia angina, hyperglycemia in diabetics
  78. Dopamine
    - action
    - low dose
    - high dose
    - side effects
    • - low dose - causes renal vasodilation. Moderate dose increases cardiac contractility, stroke volume and CO.
    • - High dose increase PVR, blood pressure, renal vasoconstriction
    • - tachycardia, dysrhythmias, vasoconstriction leading to tissue necrosis and extravasations
  79. Epinephrine (adrenalin)
    - action
    - side effects
    • - Causes vasoconstriction and increases heart rate,bronchodilator and is the treatment of choice for anaphylactic reactions
    • - Hypertension, dysrhythmia, anginal pain, restlessness
  80. Atropine
    - action
    - side effects
    • - Acts on smooth muscle of the heart to increase cardiac rhythm
    • - tachycardia, dry mouth, drowsiness, urinary hesitancy
  81. Drugs given for bradycardia, low BP
    - nursing priority
    - safety
    • - Monitor blood pressure, pulse, respirations, Monitor IV side for extravasations, Monitor ECG
    • - titrated to blood pressure, patient condition, use large veins, monitor access site for extravasations cause necrosis
  82. Antihyperlipidemics - statin family
    - uses
    - example
    - action
    - side effects
    - nursing priority
    - safety
    • - Hypercholesterolemia, Primary and secondary prevention of cardiac events, Clients with Type 2 diabetes and coronaryartery disease
    • - Atorvastatin (lipitor), Simvastatin (zocor), Pravastatin(pravachol), Lovastatin (mevacor),rosuvastatin (crestor)
    • - Lower cholesterol levels by inhibiting the formation of HMG_COa reductase which is an enzyme that is required for the liver to synthesize cholesterol
    • - Myopathy (rhabdomyolysis severe), hepatoxicity
    • - Monitor liver studies, Teach to report muscle pain, tenderness, women potential harm to unborn fetus, teach low cholesterol diet, Administer in evening without regard to meals
    • - Liver toxic
  83. Midazolam - Versed
    - used as
    - action
    - nursing priority
    - safety
    • - Used as induction agent for anesthesia orconscious sedation
    • ‐produces unconsciousness andamnesia
    • - Administer slowly IV wait for full effect;Unconsciousness develops quickly 60‐80 seconds, persists for1 hour; Constant cardiac/respiratory monitoring with resuscitative equipment; Must be accompanied home not remember post DC instructions
    • - Monitor ABC, Must be accompanied home
  84. Adenosin
    - example
    - used to
    - action
    - side effects
    - nursing priority
    - safety
    • - adenocard, adenoscan, adenosin
    • - to treat or reduce Tachy arrthymia’s; Used as a chemical defibrillation
    • - slows conduction through AV node; can interrupt reentry pathways through the AV node; can restore NRS in patient with SVT
    • - chest pain, light headedness, nausea,flushing
    • - Assess respiratory status, monitortransient dysrhythmia, tell patient to rise slowly fromlying sitting to standing after
    • - do not give in blocks, sick sinus syndrome, atrialflutter and atrial fibrillation, Note herb drug interactionaloe, angelica, buckthorn, senna increase effects
  85. LDH diagnostic studies
    LDH‐1 specific to cardiac damage (normal14‐26% of the total LDH; increases 24‐48hours; peaks 48‐72 hours returns normal in5‐10 days
  86. CK verses CKMB
    CK‐MB is specific, increases in 3‐6 hours after MI; peaks 12=24 hours, return normal12‐48 hours
  87. Triponin T and I
    Cardiac Troponin I and Troponin I; onlyenzyme only specific to cardiac muscle; goldstandard for diagnosis of early and lateAMI; level elevates in 4‐6 hours and peaksin 10‐24 hours
  88. Myoglobin
    Myoglobin is an early marker for AMI, but isnon specific; increases 1‐3 hours peaks in 4‐12 hours normal in 24 hours, Not used todiagnosis alone because will be elevatedwith renal and skeletal disease also
  89. Lipids; total cholesterol
    - normal range
    - comments
    - prior to test
    • - <22 mg/dl100-200 mg/dl
    • - Lipids are measured to determinethe risk of development ofatherosclerotic disease
    • - fast for 8 hrs
  90. Triglycerides
    - normal
    - comments
    • - 100-200mg/dL
    • -LDL is primary transporter ofcholesterol and triglyceride into the cells
  91. LDL
    - normal
    - comments
    - must do what before being tested
    • - < 160 mg/dl
    • - HDL protective action transport cholesterol away from the cell
    • - fast for 8 hrs
  92. HDL
    - normal range
    - comments
    • - women 35-85/ men 35-70
    • - Cholesterol main source are diet(animal produces) and liverElevated cholesterol is know toincrease risk of CADTriglycerides have a directcorrelation with and inverse onewith LSL and inverse one with HDL
  93. C Reactive Protein
    - Normal range
    - comments
    • - High 3.0 greatest riskHD; Moderate 1‐3 mg.dl; Low < 1 mg/dl
    • - Protein product produced by the liver to measure systemic inflammation,inflammation is thought to play a role in atherosclerosis
  94. Brain NatriureticPeptide(BNP)
    - normal range
    - comments
    - to do before test
    • - 51.2 pg/ml or > correlates with mild HF; Levels > 1000 pg/ml correlates with severe HF
    • - Neurohormone that helps regulates blood pressure and fluid volume. Secreted from the ventricles in response to increased preload Levels increase asventricular walls expand from increased filling pressures making it an excellent tool for HF treatment and HF diagnosis
    • - May draw in series
  95. Homocysteine
    - normal range
    - comments
    - to do prior
    • - 5‐15 umo/l
    • - Assess patients risk of CVD if Elevated think indicates CAD, stroke,peripheral vascular disease risk is present
    • - Fast 12 hours prior to test
  96. Coagulation Studies; PTT&PT; PT&INR
    - normal range
    - comments
    - to do prior
    • - 25-28 seconds
    • - When a vessel wall or tissue is injured thrombus tries to form to stop the bleeding; this activates the clotting cascade of which there are two pathways;Intrinsic which is the PTTand aPTT (partial thrombo plastin time)Extrinsic pathway is the PT or Prothrombin time
    • - PTT and aPTT used to assess effects of heparin therapy Therapeutic heparin therapy want the level at 1.5‐2.5 times the patients baseline value; PT is used to assess effects of Coumadin (warfin) INR is a standardized method of reporting PTs; INR 2.0‐3.0 times normal forDVT, PE, Atrial FibINR 2.5‐3.5 times with mechanical prosthetic heart valves
  97. 12, 15, 18 lead EKG
    - comments
    - prior to procedure
    • - 12 lead is the most common; used to dx dysrhythmias,conduction abnormalities, enlarged heart chambers,Myocardial ischemia, ,high or low Ca or Potassium levels
    • - explain the procedure, non invasive, make sure electrodes adhere
  98. Telemetry
    - comments
    - prior to procedure
    • -continuous monitoring; placed on atthe bedside monitored at the central nurses station or remote location
    • - clean surface with soap and water to remove oils from skin, dry area well. may need to shave hair. may need to apply small amount of benzoin to the skin if diaphoretic. change out every 48-72 hrs; watch for irritation of skin, dried out or loose
  99. Holter Monitor
    - comments
    - prior to procedure
    • - placed on the patient usually done out patient;wear monitor for 24hours, keep diary of activity and symptoms
    • - explain how to keep diary, when and where to turn in the monitor
  100. Stress Test: exercise
    - comments
    - prior to procedure
    - post procedure
    • - Client exercises, usually on treadmill, increasing speed and incline to increase heart rate, response of the client and heart is evaluated
    • - Provide explanation of test.Establish base line vital signs/ECG rhythm Instruct client to Avoid smoking, 4 hours prior to test Avoid stimulants,Medication taken with sip of water; MD may tell not to take certain medication such as beta blockers Advise to wear comfortable clothes, bra,rubber sole shoes Explain what to expect what to report, will need an IV placed Reason of termination of the exercise test CHEST PAIN, GREATLY INCREASED HEART < ECG Depression or ELEVATION = positve test
    • - avoid eating immediately after and avoid extreme temperature changes
  101. stress test: chemical
    - comments
    - prior to procedure
    • - Pharmacological stress test is done for the deconditioned, physically disabled who cannot achieve their target heart rate Use 3 vasodilating agents: persantine and adenosine,now primarily use adenosine because of the short half life of the medication (10 seconds)(effects last about 15-30 minutes side effect of chest discomfort, dizziness,headache, flushing, nausea)
    • - If pharmacological test:Not eat drink 4 hours prior No Stimulants (coffee, tea, chocolate…_If taking aminophylin or theophyline should stop taking medication 24-48 hours prior instruct what to expect and side effects will disappear early Instruct what to report to cardiologist or nurse Can take up to 3 hours
  102. echocardiogram
    - comments
    - prior to procedure
    • - Non invasive Used to determine;size, shape, motion of cardiac structures esp.valvular function Positive is abnormalities inventricular wall motion found during stress but not during rest. If found follow with cardiac cauterization.
    • - Explain the exam, lay on table on their side,test is non invasive
  103. Transesophageal Echo (TEE)
    - comments
    - prior procedure
    - post procedure
    • - TEE thread small transducer through mouth into esophagus produce higher quality
    • - NPO 6 hours prior totest, Will have an IVstarted for conscious sedation, numb the back of the throat
    • - Monitor conscious sedationKeep until alert and gag reflex has returned not fluids.Must have someone take them home
  104. Radionuclide Imaging
    - comments
    - prior
    • - Used to detect Myocardial ischemia and infarction, assess left ventricular failure Cardiolite tracer is excellent for assessing perfusion to the myocardium
    • - Prep depends on type of stressor and type of imaging Reassure about use of radioactive material No post procedure radiation precautions needed
  105. Electrophysiology (EPS)
    - comments
    - prior to procedure
    - post procedure
    • - Invasive procedure catheter threaded via rt femoral artery done to diagnose and manage serious dysrhythmias; may do it for syncope, palpitations, or both for survivors of cardiac arrest from VF (sudden death)Study can distinguish atrial from ventricular tachycardia Can evaluate how lifethreatening the arrthymia’s is Evaluate AV node function Evaluate how effective antiarrthymic medications are Determine need for other interventions pacemaker,implantable defibrillators orablation of the area of foci
    • - 8 hour prior Antiarrthymic medications held 24 hours prior to the study,other meds with sip water Monitor cardiac rate, rhythm Explain procedure Require a permit for IVconscious sedation and procedure consent Medicate for anxiety, discomfort
    • - Monitor vital signs,ECG monitoring,assess apical pulse,breath sounds(looking for pericardial friction rub indicatesbleeding)Inspect cath site, for hematoma, bleeding,feeling pulses in legs fee tBed rest extremity straight and HOB elevated 30 degrees4-6 hours
  106. Cardiac Catheterization
    - comments
    - prior to procedure
    - post procedure
    • - Invasive procedure Catheter introduced into the heart via groin rarely brachial; dye is infused – see cardiac circulation,measure ejection fraction, muscle function, valvular function, Diagnosis CAD, assess patency vessels,determine extent of blockage
    • - Review the BUN CreatinelevelExplain procedure 8 hours May take some meds per orders Sign permit for conscious sedation and procedure Check for dye allergy/food allergy Record pre quality of pulses Record height and weight to determine amount ofdye to useTell patient will be awake for the procedure, will use mild sedatives, IV started,experience warm sensation with the dye,may be asked to cough or deep breath,May have to view video
    • - Check site for hematoma,bleeding, every 15 minutes for hour then every 1-2 hours till stable If angiocele used for hemostats advise not to have any other femoral sticks for minimum of 3months Monitor for dysrhythmias,assess apical pulse, not any change in rhythm Brady cardiac-vagal response, raise only Feet and knees do not drop their head Administer fluids,administer atropine Inform patient of any restrictions Avoid flexion, head at 30degrees or less Encourage to drink lot of fluid to flush dye Monitor creatine and BUN Ensure safety not to get OOB with our assistance Discharge instruction if applicable
Card Set
CV Assessment