also called point of maximal impulse PMI, located 5th intercostal space left side midclavicular
the first heart sound closure of the atrioventricular valves the mitral and tricuspid lub
the second heart sound produced by the semilunar aortic and pulmonic valves dub
an abnormal heart sound detected in early diastole as resistance is met to blood entering either ventricle, it is associated with left ventricular failure, a potential life threating complication of an MI
an abnormal heart sound in late diastole as resistance is met to blood entering either ventricle during atrial contraction caused by hypertrophy of one ventricle
the heart weighs
10.6 oz. located in the center of the thorax between lungs "mediastum" and rests on diaphram
middle layer of heart made up of muscle fibers respondsible for pumping
the heart is encased in a thin, fibrous sac, composed of two layers inner epicardium layer outer visceral cardium, about 20 ml of fluid between layers
relaxation phase all four chambers relax simultaneously, period of ventricular filling
If the SA and the AV node fail their pacemaker function the heart will still pump via
a pacemaker site in the ventricles at 30 -40 impulses per minute
composed of both systole and diastole from one heart beat to the next
chamber pressure can be measured with
catheter for hemodynamic monitoring
5 Liters/ minute
degree of ventricular stretch at the end of diastole
amount of blood remaining in ventricle after systole
for generated by myocardium. Drugs that increase contractility digoxin "Lanoxin", dopamine "Intoponin", or dobutamine "Dobutrex"
contractility is reduced by acidosis, hypoxemia, and beta-adrenergic blocking agents.
normally between 55 and 65 percent 40 percent indicates a problem 20 percent is a cardiac cripple, it is the amount of blood ejected with each heart beat.
A woman's heart is smaller than a man's
and has smaller coronary arteries
can become enlarged, irregular heart rhythm
can become stiff and uncompliant, fatigue, exercise intolerance
abnormal blood flow across valves, S4 may be present or murmurs, bradycardia
Acute coronary syndrome
rupture of atheromatous plaque in diseased corornary artery
Symptom of ACS experienced by people with CAD or CVD
chest pain, angina, dysrhythmias, shortness of breath, peripheral edema, wt. gain, palpitations, vital fatigue, is an early warning sign, dizziness, sycope, hypotension
angina pectoris , uncomfortable pressure, squeezing, lasts 5 -15 min. on physical exertion, or eating, rest O2, nitro.
ACS less than 15 min. can occur while sleeping, morphine
Pericarditis sharp substernal pain,radiates, intermittent, sudden increases with inspiration, sit up right, analgesics, antiflammatory
Pulmonary disorder less than 30 min. sharp, substernal or epigastric, treat underlying cause
Esophageal disorders, substernal pain, burning 5-60 min. can be caused by cold liquids, food or antacid or nitro.
Anxiety disorders stabbing to dull, peaks in 10 min, anytime, removal of stimulus, meds, treat anxiety
Musculoskeletal sharp stabbing, hours, days, respiratory infection, ice, heat, analgesic, antiinflammatory meds.
Acute Coronary Syndrome Symptoms
symptoms up to a month prior, fatigue, shortness of breath, sleep disturbances, chest symptoms, up to 4 symptoms, neuropathies in the elderly may prevent them from feeling discomfort, use a 12 lead electrocardiogram
body weight, mass, how often does patient self monitor blood pressure, glucose, cholesterol, eating habits, canned foods dietary intake of fats.
Clues to worsening HF
can be sleep disturbance, is the patient sleeping up right in a chair instead of a bed with numerous pillows, awakening by PND or nocturnal angina
occurs when BP decreases significantly after patient sits upright.
postion patient supine and flat for 10 min. prior to BP
Postural BP changes should be assessed with patient sitting on edge of bed allow 1 to 3 mins. of time to elapse after each postural change
left 5th intercostal space
questions to ask?
onset, precitating, what relieves, duration, location, intensity,
signs of mi
skin color clubbing x tra heart sounds murmurs,
peri friction rub, unstable angina
intereferes or blocks circulation to the heart muscle. Decreased blood supply to the heart causes muscle ischemia, diminished oxygen results in chest pain or angina.
acts as an analgesic, reduces myocardial oxygen consumption, blood pressure and heart rate, also reduces fear and anxiety
if a client is having a myocardial infarction
the first action is to prevent platelet formation and block prostaglandin syntheisis, a nitro tablet will be absorbed faster if the pt. chews it.
by pump requires percise contol of medication, Blood pressure monitoring would be done with a continuous system.
antipyretic, antiplatelet, and analgesic, primary reason to administer to a client experiencing an MI is its antithrombic action
are shown by a longer than normal QRS more tha 0.10 and by a wide, notched or slurred QRS complex, no p waves.
normal conduction and regular rhythm, but rate exceeding 100 bpm. A P wave precedes each QRS and the QRS is normal. ^nn^nn^
are often a precursor of a life-threatening arrythmias, including ventrical tachycardia and ventrical fibrillation. More than 6 a minute is serious and needs decreasing ventricular irritability by medication give Lidocaine.
is administer IV, it lyses the clot blocking the artery, most effective with in 6 hours. Clients who recieve a tpa are often given heparin to prevent closure of the artery. Assess for signs of bleeding, and monitor PTT. Tpa can cause hypotension and arrythmias.
A client with a history of hypertension complains of indigestion the nurse should?
Assess location, onset, duration,severity, percipitating factors, connect him to an EKG, administer 2 L of O2 and start an IV line.
generally detected one hour after an MI peaks 4 - 6 hours after infarction.
is done in patients with angina to detect the extent and severity of coronary artery blockage.
the dye acts as an osmotic diuretic, client may experience diuresis, potassium levels may drop, check pt. for allergies to idodine prior, and nothing by mouth 6 -18 hrs. prior
Risk factors for Atherosclerosis
smoking, family history, hypertension, high blood cholersteral, male gender, diabetes, obesity and physical inactivity
Side effects of Nitroglycerin
headache, hypotension, facial flushing and dizziness, sublingual nitroglycerin should work in 2 -3 minutes.
Foods rich in potassium
bananas, spinach, orange juice, cantalope and melons, grapefruit, nectarines, potatoes, dried prunes, raisins, and figs.
After a cardiac catheter assess
circulatory status, observe puncture site
A precursor to Mitral Stenosis
is a history of rheumatic fever and bacterial endocarditis. When mitral stenosis is present the left atrium has difficulty emptying into the left ventrical.
A common sign of mitral regurgitaion
weight gain due to fluid retention and worsening heart failure, causes exertional dyspnea in clients with mitral regurgitation.
INR is to check the effect of
warafin/ coumadin the INR should normally be between 2 and 3 (3.5)5
elevates in 1 to 2 hours after an MI
Signs and symptoms of an MI include
crushing pain, diaphoresis "sweating" and cool clammy skin because circulation has been effected, and blood has been shunted away from the periphery
If a client is walking and experiences chest pain the person should
stop their activity and sit down immediately.
After a PTCA
the client should keep their leg straight for 6 hours to prevent any arterial bleeding, a neurovascular assessment should be done to assess for any numbness or lack of pulses since the PTCA involves the femoral artery.
Client teaching for CAD
low fat and cholesteral diet, walk 30 minutes each day, salt should be restricted, stress reduction is important, a diet high in fiber will help get remove cholesteral.
Dyspnea on exertion can indicate
mitral valve stenosis
is associated with mitral valve insufficiency, it will make a loud high pitched, rumbling, holosystolic sound heard through the whole apex of the heart.
Signs and symptoms of long term valvular disease
orthopnea "an abnormal condition in which the client must sit or stand to breath comfortably", Paroxysymal nocturnal dyspnea is a sudden respiratory attack that occurs at night, coughing occurs over the long term with valvular disease.
the drug for premature ventricular contractions and for ventricular dysrthymias,
the drug of choice for A Fib it slows the heart rate and increases cardiac contractility
for A systole, decrease vagal stimulation
for supra ventricular tachycardia