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ECCO Caring for Patients with Cardiovascular Disorders part 3

Terms in this set (59)

Goals: Aimed at relieving symptoms, improving ventricular filling, optimizing stroke volume, reducing any obstruction to ventricular ejection, prevent complications, reduce risk of SCD

Increase Ventricular Filling
Provide beta blocker to decrease HR and increase diastolic filling time
Provide calcium channel blocker to decrease ventricular wall tension
Maintain adequate preload to support ventricular filling
Convert AFib to normal sinus. AFib most common arrhythmia with HC

Optimize stroke volume
Decrease contractility for symptomatic patients with or without obstruction
Beta block 1st line (Metoprolol tartrate, Metoprolo sucicnate)
Calcium channel blockers 2nd line (Verapamil)

Amiodarone is useful to tx ventricular or atrial arrhythmias

Insertable cardiac monitor, identify arrhythmia for possible ICD placement

AVOID meds that increase contractility or decrease afterload: digoxin, dobutamine, dopamine, milrinone, epinephrine and norepinephrine

Ventricular septal myectomy: surgically enlarges outflow tract and alleviates outflow obstruction by removing a portion of the septum
Percutaneous Alcohol Septal Ablation: Non surgical alternative alleviated outflow obstruction by shrinking septum
- Cath is placed in the LAD and advanced into a septal branch providing blood flow to the septum, and ethyl alcohol is injected
- Ethyl alcohol infiltrates the surrounding myocardial tissue, causing a controlled myocardial infarction of the septum, tissue becomes necrosis and fibrotic
- Reduction in tissue size does not occur immediately and may continue to have effects on ventricular outflow for up to one year post procedure
Auscultation: Pulmonary congestion and edema will produce crackles in the bases or in all lung fields. Diminished bases may indicate pleural effusion. Cardiac auscultation may identify S3 for S4 heart sounds and a systolic murmur at or lateral to the 5th intercostal space left sternal border indication mitral regurgitation
(crackles, diminished base, S3 left sternal, systolic murmur at PMI: 6th intercostal space, 1 inch lateral of left mid clavicular line)

Chest Xray: Reveal cardiomegaly, pulmonary vascular congestion, pleural effusions and left ventricular hypertrophy. In severe, the cardiothoracic ratio can become greater than 0.5, meaning the heart occupies more than half of the chest diameter

ECG: tachycardia, low voltage, LVH, Atrial FIb, budle branch block, Q waves from previous MI, acute ST changes, especially if ischemic disease is present

ECHO: Dilated LV and Left Atria, hypokinesis or dyskinesis, wall motion abnormalities, valvular regurgitation and a low EF

Hemodynamics: decreased cardiac output, increased systemic vascular resistance/systemic vascular resistance index, increased pulmonary artery (PA) pressures and increased PAOP
- Cool pale skin slow cap refill hypotension arterial vasoconstriction),, weak thready pulse (decrease cardiac output , pedal edema ascites fluid volume overload

Blood panels
CBC lipid panel LFTs cardiac biomakers and thyroid function values will identify factors contributing to or complicating HF
- LFTs may be elevated as a result of venous congestion of the liver
- Positive biomarkers indicate an ischemic trigger for acute decompensation

Blood tests: metabolic panel for electrolytes and renal function along with BNP and UA values
- Higher BNP more severe, normal less than 100
- Elevated BUN and creatinine levels will be present if there is underlying renal disease or impaired renal function from decrease cardiac output