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Cardiac - 1 video (8 minutes) = 1 chapter Anatomy, Blood Flow, cardiac Output, Preload afterload, MI, CAD, CABG, Hemodynamics, Pharmacology - Ace, ARBs, Diuretics, Beta Blocker, CHF drugs, MI drugs. http://www.youtube.com/playlist?list=PL8zFPglvM-dwcEsJYX-ZJFkhvX8ymhgJV 4 step study system 1. Gather notes from power point/ instructor 2. Watch playlist and take more notes 3. Go over your note 10-14x ( cardiac) 5-7 everything else 4. Practice NCLEX questions! 60/60minutes Diagnostics - CK-MB: cardiac specific ISO enzyme, an elevation in value indicates myocardial damage, an elevation occurs within hours and peaks at 18hr. Returns to normal within 3-4 days w/o treatment normal range 0%-5% of total CK, total CK 26-174 unit/l -CPK: non cardiac specific creatine, phosphokianse, damage to skeletal muscle will increase these numbers, goes back to normal within 3-4 days without treatment. Heart , skeletal muscle and brain -Troponin: tropoinin is a protein in the muscle that regulates contraction of my myocardium. Rises within 3 hours and stays high for7-10 days post myocardial injury. 0.01ng/ml is normal anything higher will indicate myocardial injury ( myo cell damage) - myoglobin: oxygen binding protein in the cardiac and skeletal muscle, level rises within 2 hours ( early indicator) post cell death ( can also be increased with rhabdomyloisis) a negative result yeids non cardiac relation. -serum lipids: measures HDL/LDL triglyceride and lipoproteins. Used to assess the risk of coronary artery disease. The desireable range for cholesterol is < 200 mg/dl LDL <130 HDL<3070. High LDL will increase the risk of atherosclerosis. Risk factors: gender ( male) , age, genetics, intake of animal fat, menopause, tobacco, stress. - Homocystine: elevated levels may increase the risk of cardiovascular disease. <14mmol/dl. Highly sensitive C-reactive protein (liver/ atherosclerosis) detects an inflammatory response that can trigger thrombus formation. -BNP: brain naturetic peptide, enzyme that responds to the ventricles when fluid overload is present.acts as a diuretic( HF) value of 100-300 indicates HF is present. -ANP: atrial naturetic peptide, released from the atria in response to atrial stretch . ^ will be seen in any event that causes atrial stretch or vascular increase in volume. ( pregnancy/ HF) Overview of the cardiovascular system/ vocabulary to know Automaticity: Ability to initiate electrical response Excitability: ability to respond to electrical response Chronotrope: heart rate Dromotrope: AV conduction Inotrope: force of myocardial contraction Cardiac output: amount of blood leaving the ventricles/ min normally AV node doing the work 4-6l/ min Stroke volume : amount of blood ejected per HB SVXHR=C/O MAP: Av pressure in the arteries per cycle. Indicates perfusion normally 70-110mmg. Must maintain > 60 to maintain perfusion true preload requires invasive monitor. S+ 2 D/3=MAP afterload: the amount of resistance to ejection of blood from the ventricle preload: degree of stretch of the cardiac muscle fibers at the end of diastole contractility: ability of the cardiac muscle to shorten in response to an electrical impulse. Increased by catcecholemines , medication, SNS. Decreased by : hypoxemia, acidosis, some medications. Ejection fraction: % of end diastolic vol ejected with each HB from the left ventricle. Normal 5565% < 40% = left ventricle dysfunction ( needs further treatment Cardiac conduction system SA NODE: Pacemaker of the heart 60-100 BP AV NODE: Takes over when pacemaker is broken 40-60 BP BUNDLE BRANCH/PERKINJE : last resort , takes over when everyone else fails ( the Donald trump of the conduction system) 30-40 BP Keep in mind a very healthy / athletic client may have a normal resting rate of 40 BPM do not get excited! Just ask more HX. Cardiac action potential Depolarization: electrical activation of action potential caused by an influx of sodium going into the cell and K coming out of the cell Repolarization: return of cell to rest in state caused by reentry of k while sodium exits . Refractory periods: phase in which cells are in capable of repolarizing ( effective) Phase in whic cells require a stronger than normal action potential to depolarize ( relative) Manifestations Chest pain Dyspnea Peripheral edema Fatigue Dizziness syncope, loc changes Assessment Physical exam Palate, auscultation, Medications: ACE/ARB/DIURETIC/BETA BLOCKER. Nutrition/elimination Activity/exercise/rest Health promotion What type of health issues do you have? Do you have any family HX? What are your risk factors for heart disease? Do you smoke? How do you stay healthy? How is your health, any changes? Do you have a cardiologist? How often do you go for check ups ? What medications do you take? Testing ECG 12 lead non invasive diagnostic test records electrical activity of the heart. 3D look at the heart on paper. Each lead looks at each section of the heart. Important that the electrodes are in the right spot Intervention: have the client lie still, breathe normally, refrain from talking. Continuous monitor Telemetry , hard wired Halter monitor Continuous ambulatory monitoring, electrocardiopgraphic image is recorded while the client wears the evict 24/7. Identifies dysrrythmias and evaluates effects of antidysrrythmics or pacemaker therapy. Intervention : instruct the client to resume normal daily living, maintain a diary documenting activities and symptoms. Client should avoid bath tubs and showers , they will interfere with monitoring . Trans telephonic monitoring Sends a signal via telephone Pharmacological stress test out patient Adenosine/ dipyridmol Interventions: avoid caffeine, tobacco and other stimulants Exercise stress test out patient Measures cardiac workload via excercise Echocardiography Transthorasic ( non invasive) ultrasound determines ejection fraction takes 45-1 hour Transesophageal ( invasive) A small transducer gets threaded down the throat. Better image. Pt will be sedated. Interventions: NPO for 6 hrs before procedure, may give throat anesthetic, will need an IV access. Remove dentures before procedure, ^ HOB for several hours post procedure @ 45* angle. NPO until gag reflex returns may have a sore throat. If they get SOB report to the HCP immediately. Cardiac cathetrization Invasive procedure that measures Patency of coronary arteries. Requires hemodynamics monitoring, ECG, and emergancy equipment ready. Gold standard to DX coronary artery disease. Feed catheter through femoral artery. Assess allergies and blood work prior to test. Homecare: do not let them bend at the waist, do not lift heavy objects, no bath tub educate on s/sx of infection. , notify HCP I'd bleeding or bruising or ^ temp. Interventions: assess site for bleeding or hematoma, dysrythmia, pulse deficit. Raise head of bed 30* . Give plenty of H20, PT may have reflex bradycardia and hypotension. Elevate feet. 2-6 bed rest, watch coagulation status. Leg that the cath was performed on should remain straight. Radionuclide testing Myocardial perfusion test: thallium, takes several hours PET: contrast/ IVP dye injected MRA: use of magnetic field for the heart vessels, contraindicated in patients with metal plates, pacemakers, jelwery , metal prosthesis , some transdermal patches ( nicoderm) Hemodynamic monitoring Done in the ICU Nurse should specialize and it takes special training to do these tests. CVP PULMONARY ARTERY PRESSURE INTRA-ARTERIAL BP MONITORING Very important to maintain aseptic technique