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PPT 4 (Cardiac Conditions and Treatments)

Terms in this set (95)

SA node happens in the
conduction system
SA node is a
pace maker or the heart- right atrium
Electrical impulses get spread throughout the heart from what we call
bachmann
Heart Rate x Stroke Volume =
Cardiac Output
Stroke Volume
preload, after load, contractility
Preload-
how much blood are in the ventricles just before you are ready to eject- push it out

Preload, also known as the left ventricular end-diastolic pressure (LVEDP), is the amount of ventricular stretch at the end of diastole. Think of it as the heart loading up for the next big squeeze of the ventricles during systole. Some people remember this by using an analogy of a balloon - blow air into the balloon and it stretches; the more air you blow in, the greater the stretch.
Afterload-
force it takes to open it up, ejecting out against resistance against atrial node and gravity

Afterload, also known as the systemic vascular resistance (SVR), is the amount of resistance the heart must overcome to open the aortic valve and push the blood volume out into the systemic circulation. If you think about the balloon analogy, afterload is represented by the knot at the end of the balloon. To get the air out, the balloon must work against that knot.
Contractility-
Contractility is the inherent strength and vigour of the heart's contraction during systole.
Inotropic
* Force of contraction
Chronotropic
* Rate of heartbeat (increase or decrease)
Dromotropic
*Conduction of electrical impulse
Angina is
chest pain. MI can cause angina
What causes angina?
Decrease oxygenation to the heart muscle, so if heart is not getting fed it will start having pain
Classic (stable) -
predictable stress or exertion
Unstable (preinfarction) -
progressive severity unrelated to activity, unpredictable regarding stress/exertion and intensity Watch for impending Myocardial Infarction (MI)
Variant (Prinzmetal, vasospastic)
...
Non Pharm Treatment for Angina
Avoid heavy meals
Avoid Smoking
Avoid Extreme weather changes
Avoid Strenuous exercise
Avoid Emotional upset
Non Pharm Treatment for Angina
Proper nutrition
Mod exercise - MD referral
Adequate rest
Relaxation tech
Preventive measures
Anti Anginal Drugs - 3 Major Groups
Nitrates
Beta Blockers
Calcium Channel Blockers

Work by increasing O2 to heart muscle, or decreasing O2 demand of the heart
Nitrates
Vasodilator
Relaxes arteries
Decrease vasospasm
Increase blood flow
Increased O2 supply
Decrease preload
PO, SL, IV, Trans Dermal
Nitroglycerin
Nitrostat, Nitro-Bid, Transderm-Nitro Patch, NTG, Nitrogard SR
Action of NTG
Reacts directly on smooth muscles
Dilation
Decreases preload & afterload
Reduces myocardial O2 demands
Nitroglycerin forms:
Forms: PO, SL, IV, Trans Dermal SL most common - absorbed under tongue
Nitroglycerin
Side effects:
Headache
Hypotension
Dizziness
Weakness
Faintness
Reflex tachycardia if given too fast
Nitro SL
Sit or lay down
Stop all activity
3x5 Rule - Take up to 3 NTG SL 5 min apart
Do not excel more than 3
Do not crush or chew
Call 911 if first pill does not work

Dose: 0.3 to 0.6 mg every 5 minutes for maximum of 3 tablets in 15 minutes; most common is 0.4mg
Nitroglycerine
drug interactions:
Drug Interaction
Beta Blockers
Calcium channel Blockers
Vasodilators
Alcohol
nitroglycerine drug interactions:
Enhance hypotension effect
IV NTG may antagonize the effects of heparin
IV needs to be in glass bottle
IV is titrated to reach level needed
Nitroglycerin
Side effects
Nausea & or Vomiting
Blurred vision
Dizziness
Syncope
Weakness
Dry mouth
nitroglycerin
Adverse Reactions
Hypotension
Reflex tachycardia
Paradoxical bradycardia
Life-threatening: Circularly collapse
Beta Blockers
Decrease effect of sympathetic nervous system
Block action of catecholamine (epinephrine, and norepinephrine)
Decrease heat rate
Decrease blood pressure
Decrease myocardial contractility
Decrease need for O2
Reduce angina pain
Beta Blocker Category
Nonselective (beta1 & beta2)
Propanol (Inderal)
Nadolol (Corgard)
Pindolol (Visken)
Decrease HR
Can cause bronchoconstriction
Beta Blocker Category
Selective (Cardiac)
Atenolol (Tenormin)
Metoprolol (Lopressor, Toprol-XL)
Act more strongly on beta1
Decreased HR
Avoids bronchoconstriction
Preferred medication for Angina
Beta Blocker
side effects
Decrease in HR
Decrease B/P
Bronchospasm
Psychotic response
Impotence
beta blocker
Nursing Considerations
No longer first drug of choice for angina
Monitor HR
Monitor B/P
Monitor Resp Status
Tapered dose when D/C - could get rebound tachycardia
Calcium Channel Blockers
Treatment for stable and variant angina
Dysrhythmias
Hypertension
Relax coronary artery spasm & peripheral arterioles - decreasing O2 demand
Decrease cardiac contractility
Decrease work load of heart
Calcium Channel Blockers
Verapamil (Calan)
Nifedipine (Procardia)
Diltiazem (Cardizem)
Calcium Channel Blockers
First metabolized in liver then 90% absorbed in GI mucosa
Half life 2-9 hours

Half life 5 hours
Calcium Channel Blockers
side effects
Side Effects
Headache
Hypotension
Dizziness
Flushing of skin
Changed in liver & kidney function
calcium channel blocker
Adverse Reactions
Reflex tachycardia
Sudden cardiac death seen with Nifedipine immediate -release form (only used in hospital setting)
Not true for the sustained-released form
Antidysrhythmics
(help heart beat regular)
Antidysrhythmics
Dysrhythmias - frequently follow MI or results from hypoxia
EKG recognition of dysrhythmia
Depress excitability
Block stimulation
Decrease conduction
Increase recovery of repolarization
Suppress automaticity -
Cardiac Wave Forms
P wave -
Atrial depolarization (atrial contraction)
Cardiac Wave Forms
QRS wave form -
Ventricular depolarization (ventricle contraction)
Cardiac Wave Forms
T wave -
Ventricle repolarization (ventricle resting state)
Cardiac Wave Forms
PR Interval -
AV conduction time (measuring time that it starts down to my AV node, right before it gets to the ventricles)
Cardiac Wave Forms
QRS Interval -
Ventricular conduction time (measure the width because that tells the conduction till it contracts, want to know how long that takes)
QT Interval -
Ventricular conduction to relaxation time (if this starts increasing patient will go into torsades de point a type of v-tac)
Electrical happens before
mechanical *
Classes of Antiarrhythmic Drugs
Class I Sodium Channel Blockers
Decrease Na influx into cell


Lidocaine - ventricular dysrhythmias (75- 100 mg Ivp then start an IV dtrip at usually 2mg per min)**
Procainamide (Pronestly)
Both lidocaine and procainamide are only for
ventricular not atrial rhythms *****
Classes of Antiarrhythmic Drugs
Class II Beta-Adrenergic Blockers
Decrease conduction automaticity and recovery time
Prevent sympathetic nervous system
reaction

Propranolol (Inderal)
Flecaindine (Tambocar)
Esmolol (Brevibloc)
Classes of Antiarrhythmic Drugs
Class III
Calcium channel blockers
Potassium Prolong repolarization
Classes of Antiarrhythmic Drugs
class III
Used in emergency tx of ventricular dysrhythmias
Classes of Antiarrhythmic Drugs
Class III
Amiodarone (Cordarone) - increases refractory period & prolong the action potential duration

Adenosine (Adenocard) -SVT
Classes of Antiarrhythmic Drugs
...
Classes of Antiarrhythmic Drugs
Amiodarone (Cordarone) - indications
(class III)
Indications
shock-refractory VF/pulseless VT
wide-complex tachycardia of unknown origin
stable VT w/ unsuccessful cardioversion (useful w/ LV dysfunction)
adjunct to electrical cardioversion of SVT, PSVT
treat both atrial and ventricular dysrhythmias
used to treat life threading ventricular dysrhythmias



Ventricular tachycardia- VT
Ventricular fibrillation- VF
Left ventricular dysfunction- LV dysfunction
Classes of Antiarrhythmic Drugs
Amiodarone (Cordarone) - dosage
class III
Dosage
cardiac arrest: IVP 300mg; consider repeat 150mg in 2-5 minutes
Not cardiac arrest: half the dose which is 150
Classes of Antiarrhythmic Drugs
Amiodarone (Cordarone)
continuous infusion: 900mg/500 D5W to run at 33ml/hr (1 mg/min) for 6 hours, then reduce to 17ml/hr (0.5mg/min) for (remaining) 18 hours
maximum cumulative dose is 2.2gm IV in 24 hours
Classes of Antiarrhythmic Drugs
Amiodarone (Cordarone) - precautions
Precautions
hypotension
renal failure present
Classes of Antiarrhythmic Drugs
Amiodarone (Cordarone)- nursing pearls
Nursing Pearls
*Need to call Pharmacy - not stock on unit for IV drip
*Needs to be in special IV bag, in normal bad it will adhere to the side of the bag.
Classes of Antiarrhythmic Drugs
Adenosine (Adenocard) - indiciations
Indications
Regular narrow-complex tachycardia and PSVT
Classes of Antiarrhythmic Drugs
Adenosine (Adenocard) - dosage
Dosage
6 mg IV over 1-3 seconds followed by 20 ml NS flush
Immediate injection of medication and flush (utilize stopcock)
Repeat with 12mg IV over 1-3 seconds followed by 20 ml NS flush
Classes of Antiarrhythmic Drugs
Adenosine (Adenocard) - precautions and pregnancy
Precautions
Do not convert A-fib, A-flutter, or VT

Pregnancy Category C
Classes of Antiarrhythmic Drugs
class IV
Calcium Channel Blockers
Blocks Ca influx
Decrease excitability & contractility
Verapamil (Calan, Isoptin)
Diltiazem (Cardizem)
Antiarrhythmic Complications
Systemic Lupus (procainamide)
Neutropenia
Widening of QRS - 50% or more
Hypotension (lidocaine)
Altered mental status
Respiratory arrest
Paresthesia seizures
Bradycardia
Antiarrhythmic Nursing Indications
Monitor for antigens of lupus
Monitor CBC
Cardiac Monitor
Assess VS - B/P, HR
Emergency equipment
Assess for Chest Pain
Assess for edema
Assess mental status
Angina is
chest pain. MI can cause angina
What causes angina?
Decrease oxygenation to the heart muscle, so if heart is not getting fed it will start having pain
Classic (stable) -
predictable stress or exertion
Unstable (preinfarction) -
progressive severity unrelated to activity, unpredictable regarding stress/exertion and intensity Watch for impending Myocardial Infarction (MI)
Variant (Prinzmetal, vasospastic)
...
Non Pharm Treatment for Angina
Avoid heavy meals
Avoid Smoking
Avoid Extreme weather changes
Avoid Strenuous exercise
Avoid Emotional upset
Non Pharm Treatment for Angina
Proper nutrition
Mod exercise - MD referral
Adequate rest
Relaxation tech
Preventive measures
Anti Anginal Drugs - 3 Major Groups
Nitrates
Beta Blockers
Calcium Channel Blockers

Work by increasing O2 to heart muscle, or decreasing O2 demand of the heart
Nitrates
Vasodilator
Relaxes arteries
Decrease vasospasm
Increase blood flow
Increased O2 supply
Decrease preload
PO, SL, IV, Trans Dermal
Nitroglycerin
Nitroglycerin Nitrostat, Nitro-Bid, Transderm-Nitro Patch, NTG, Nitrogard SR
Angina is
chest pain. MI can cause angina
What causes angina?
Decrease oxygenation to the heart muscle, so if heart is not getting fed it will start having pain
Classic (stable) -
predictable stress or exertion
Unstable (preinfarction) -
progressive severity unrelated to activity, unpredictable regarding stress/exertion and intensity Watch for impending Myocardial Infarction (MI)
Variant (Prinzmetal, vasospastic)
...
Non Pharm Treatment for Angina
Avoid heavy meals
Avoid Smoking
Avoid Extreme weather changes
Avoid Strenuous exercise
Avoid Emotional upset
Non Pharm Treatment for Angina
Proper nutrition
Mod exercise - MD referral
Adequate rest
Relaxation tech
Preventive measures
Anti Anginal Drugs - 3 Major Groups
Nitrates
Beta Blockers
Calcium Channel Blockers
Angina is
chest pain. MI can cause angina
What causes angina?
Decrease oxygenation to the heart muscle, so if heart is not getting fed it will start having pain
Classic (stable) -
predictable stress or exertion
Unstable (preinfarction) -
progressive severity unrelated to activity, unpredictable regarding stress/exertion and intensity Watch for impending Myocardial Infarction (MI)
Variant (Prinzmetal, vasospastic)
...
Non Pharm Treatment for Angina
Avoid heavy meals
Avoid Smoking
Avoid Extreme weather changes
Avoid Strenuous exercise
Avoid Emotional upset
Angina is
chest pain. MI can cause angina
What causes angina?
Decrease oxygenation to the heart muscle, so if heart is not getting fed it will start having pain
Classic (stable) -
Unstable (preinfarction) - progressive severity unrelated to activity, unpredictable regarding stress/exertion and intensity Watch for impending Myocardial Infarction (MI)
Variant (Prinzmetal, vasospastic)
predictable stress or exertion
Angina is
chest pain. MI can cause angina
What causes angina?
Decrease oxygenation to the heart muscle, so if heart is not getting fed it will start having pain
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