Cardiac Alterations CH13 - Cardiovascular Alterations N4100 Med-Surg III Patricia Harris PhD RN CNS Plan for Today Brief review of cardiac circulation

Cardiac Alterations CH13 - Cardiovascular Alterations N4100...

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Cardiovascular Alterations N4100 Med-Surg III Patricia Harris PhD, RN, CNS
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Plan for Today Brief review of cardiac circulation Coronary artery disease Signs/symptoms Diagnostic tests Acute Coronary Syndrome Unstable angina Non ST-elevation myocardial Infarction ST-elevation myocardial Infarction Heart Failure
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Cardiac Circulation
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Coronary Artery Disease (CAD) Progressive narrowing of coronary arteries by atherosclerosis Coronary heart disease Atherosclerotic heart disease (inflammatory disease - progresses from endothelial injury)
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Risk Factors Age Men > 45 years Women > 55 years Family history Cholesterol High LDL Low levels of HDL Smoking Hypertension Inactivity Overweight Diabetes
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Chest Pain Classic symptom Often midsternal May radiate to arms, jaw, or back Angina - Myocardial ischemia: demand higher than supply HOWEVER, NOT ALL PATIENTS HAVE “CLASSIC” SYMPTOMS!
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Diagnosis of CAD - History Chest pain? PQRST Prior hospitalizations Shortness of breath, weakness, non- typical symptoms Medications Erectile dysfunction meds? Need to know if considering nitroglycerin Psychosocial history Include stressors
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Diagnostic Studies In acute care setting 12-lead electrocardiogram (ECG) Chest x-ray Echocardiogram – Ejection Fraction (EF) Transesophageal echocardiography Magnetic Resonance Imaging (MRI) Follow-up Holter monitor (outpatient 24-hour ECG analysis) Exercise tolerance test (stress test) Electrophysiology study (dysrhythmias, ablation)
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Cardiac Enzymes - Blood Tests CK (total) 2 to 6 hours; peak 18 to 36 hours CK-MB (cardiac specific) 4 to 8 hours; peak 18 to 24 hours Troponin I and T As early as 1 hour after myocardial injury Myoglobin 30 to 60 minutes after injury
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Additional Laboratory Blood Tests CBC Hemoglobin (women 12-16 gm/dL; men 14-18 gm/dL) Hematocrit - measured as a percentage Potassium (3.5-5.0 mEq/L) Magnesium (1.3-2.5 mEq/L) Calcium (8.8-10.2 mg/dL) Sodium (135-145 mEq/L) Total cholesterol HDL (≥60 mg/dL) LDL (<100 mg/dL)
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What’s happening here? Hyperkalemia
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Acute Coronary Syndrome Umbrella term for 3 distinct diagnoses Non-ST-elevation Myocardial Infarction Unstable Angina ST-elevation Myocardial Infarction MI UA
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Types of Angina Stable (chronic, exertional) = effort, classic T-wave inversion on ECG Treatment: rest and nitroglycerin Variant = Prinzmetal’s (vasospasms) T-wave inversion or ST depressin during pain episodes Treatment: calcium channel blockers Unstable (crescendo) = more often and severe, less relief May see T-wave inversion or ST depression on ECG Treatment: rest and nitroglycerin; drugs affecting platelets; revascularization
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Unstable Angina May occur at rest Most common cause is reduced blood flow to myocardium Coronary arteries are narrowed due to atherosclerosis Evidence of CAD ST segment depression
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  • Spring '17
  • Patricia Harris
  • acute myocardial infarction, infarction, Acute coronary syndrome

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