Cardiovascular

• Mechanical (inotropic +/-): contration *hard or relax heart*
• Electrical (chronotropic (+/-): timing/HR
• dromotropic (+/-)-conduction of impulses

• automaticity-heart on table still able to beat
• conductivity-conducts impulses in an orderly fashion
• refactory-heart must finish impulse (beat) can't do the next one til done

SA node->AV node->Bundle of His->R&L Bundle Branches->Purkinje Fibers

• inside positive
• action potential & conduction are electrolyte dependent esp. Na, K, Ca, and Mg

inside negative

• promotes impulse formation & conduction
• increases rate & contractility
• vasodilates coronary arteries
• vasoconstricts peripheral arteries except skeletal
• +chronotropic, +inotropic, +dromotropic

• inhibits impulse formation & conduction
• decreases HR
• vasoconstricts coronary arteries

drugs used to diminish rhythm disturbances & hopefully achieve normal sinus rhythm

• Class 1: used for ventricular tachyarrhythmias
• Class 2: slows HR
• Class 3: amiodarone (Cordarone) #1 drug of choice in most tachyarrhythmias. SE: bluish discoloration
• Class 4: reduces SA, delays AV, and reduces contractility

• 10 sec. half-life, warn pt HR will go down quickly
• pt may feel bad for a few min.
• requires very rapid IV straight push (<3 sec.)

• digoxin (Lanoxin): used primarily to treat HF
• (+ inotropic)-increases contractility
• (- chronotropic)
• (- dromotropic)
• long half-life
• maintenance therapy: 0.125 mg recommended PO daily

• almost all drugs can cause "proarrhythmic" (dysrhythmia) esp. heart block
• check HR before and after med. admin.
• SE: of most is hypotension
• check BP
• instruct slow position changes

• impaired emptying resulting in inadequate CO
• heart "remodels" itself-->ventricles dilate & hypertrophy
• s/sx: decreased tissue perfusion & volume overload; edema; dyspnea
• "rubber band is over stretched"

• preload-left ventricle diastolic volume (volume of blood in heart)
• afterload- resistance of heartload (how constricted or dilated vessles are)

• + inotropic agents such as cardiac glycosides (Digoxin) to improve contractility
• (decrease preload)

ACEIs and ARBs decrease vasoconstrictive effect of angiotensin (decrease afterload); dilate veins; and decrease aldosterone (decrease preload)

• diuretics to decrease volume and decrease preload
• vasodilators to decrease resistance (decrease afterload &/or decrease venous return) and decrease preload
• beta blockers (- inotropic) to decrease myocardial workload

• SE: anorexia, heart block, yellow/green halos
• ANTIDOTE: Digibinde. rarely used
• apical pulse must be taken for 1 min. withhold if <60bpm
• check if dig level is ordered- >2 then withhold
• check electrolye levels
• milk and bran may interfere w/ absorption
• Therapeutic Level: 0.5-2.0 ng (nanograms)/mL

• commonly used to reduce workload of heart
• not given if showing s/sx of acute heart failure

• natural (synthetic) form of BNP
• decrease in afterload and preload
• improvement in CO

• result of myocardial ischemia: most commonly secondary to coronary artery disease secondary to athlerosclerosis.
• stable angina relieved by rest and/or nitrates
• unstable angina-not relievved by rest or nitrates (<--RED FLAG-headed for MI)

• Angina: Decreased supply, ^ in demand
• Drug therapy: ^ supply, decreases demand

• hypotension
• check BP & teach slow position changes

• increases supply (oxygen) & decreases demand
• vasodilators (decrease preload) & decreases afterload
• headache diminishes over time

• 1 tab-if pain goes away, notify physician
• 1 tab-if pain lessens but still there, take 2nd, 3rd if needed (5 min. apart)
• 1 tab-if pain doesn't lessen call 911! take 2nd while waiting for EMS & 3rd if needed

• topical in cream or patch. apply in same general area
• not recommended at night
• NTG sublingual tab or spray

• improve supply and decrease demand
• vasodilate

• decrease demand
• SE: hypotension
• (-) inotropic effect
• (-) chronotropic effect

• antiplatelet med that's given to pt w/ unstable angina
• used for cath. pts

• reduces cholesterol levels, LDLs, and triglycerides
• ^ HDLs

• "statin" family
• block enzymes needed to make cholesterol
• helps stabalize the plaque that is already there
• SE: hepatotoxic-monitor liver function
• myostits-muscle weakness, muscle cramps. taken in evening

• decreases synthesis of cholesterol
• settle powder before mixing
• vitamin K not absorbed

• decrease triglycerids & ^ HDLs
• SE: hepatotoxicity

SE: extreme itching & vasodilation

• risk for MI & stroke
• meds used for claudication (leg pain)

anticoagulants to prevent & treat