Angina & Dysrhythmias

A & P OF THE CARDIAC SYSTEM Cardiac output  CO=SV(stroke volume) X HR(heart rate) Preload  Volume of blood in the ventricles at the end of diastole Afterload  Peripheral resistance against which the left ventricle must pump. Affected by the size of the ventricle, wall tension and arterial blood pressure.

ANGINA PECTORIS Definitions Signs and Symptoms Stable vs Unstable Silent Ischemia Precipitating factors Diagnostic studies

Lewis Page 812 Precipitating Factors of Angina PRECIPITATING FACTORS OF ANGINA

CARDIAC DRUGS Nitrates Beta Blockers Calcium Channel blockers Ace inhibitors

Lewis fig Decision tree Collaborative care Coronary Artery Disease Collaborative care decision tree

MYOCARDIAL INFARCTION Definition Signs and Symptoms Complications Diagnostics PTCA (Percutaneous Coronary Angioplasty) CABG (Coronary Artery Bypass)

MYOCARDIAL INFARCTION

NURSING DIAGNOSIS Acute pain Ineffective Tissue perfusion (cardiac) Anxiety Activity intolerance Ineffective Therapeutic regimen management

PTCA

CORONARY ARTERY BYPASS GRAFT

CARDIOMYOPHATHY Dilated (congestive) Hypertrophic

Types of cardiomyopathies See differences in ventricle muscles Types of Cardiomyopathies

CARDIAC TRANSPLANT Drug therapies Lifestyle changes Support Systems Teaching

INFLAMMATORY HEART DISEASE NURSING DIAGNOSIS Hyperthermia Decreased Cardiac Output Activity Intolerance Ineffective Health Maintenance Pain Anxiety

Layers of the heart Page 886

INFLAMMATORY HEART DISEASES Infective Endocarditis  Clinical manifestations  Diagnostic studies

INFLAMMATORY HEART DISEASE ACUTE PERICARDITIS  Etiology and Pathophysiology  Clinical Manifestations  Complications  Collaborative Care

MYOCARDITIS Etiology Clinical Manifestations Diagnostic Studies Nursing Management

VALVULAR DISEASE

NURSING DIAGNOSIS Activity Intolerance Excess Fluid Volume Decreased Cardiac Output Ineffective Therapeutic Regimen Management

MITRAL VALVE Stenosis and Regurgitant

MITRAL VALVE STENOSIS Etiology Clinical Manifestations Teaching Diagnostic findings  ECG  Echocardiogram  Cardiac Catheterization

RELATIONSHIP OF ECG TO CARDIAC CYCLE Page 767, Chapter 31

ATRIAL STENOSIS & REGURGIATION Etiology Clinical Manifestation Diagnostic Findings  ECG  Echocardiogram  Cardiac Catheterization

VALVULAR HEART DISEASE COLLABORATIVE CARE (PTBV) Percutaneous transluminal balloon valvuplasty Surgical therapy

TYPES OF PROSTHETIC AND TISSUE VALVES

ARRHYTHMIAS

ELECTRICAL BASIS FOR ECG

Chapter 31, pages 758 & 759 Normal sinus rhythm NORMAL SINUS RHYTHM

ELECTRICAL BASIS FOR ECG

NORMAL SINUS RHYTHM TIMING Page 865

Normal Sinus Rhythm in Lead II Artifact, loose leads or movement Rate of conduction systems NSR, ARTIFACT, CONDUCTION SYSTEM RATES

Calculating Rhythm and Rate Using 6 second cardiac strip

REGULAR RHYTHM & RATE

Sinus bradycardia Sinus Tachycardia Premature Atrial Contraction (PAC) Paroxysmal SVT SINUS BRADYCARDIA TACHYCARDIA, PAC, SVT

HEART BLOCKS PAGE 871

Atrial Flutter Atrial Fibrillation Page 870 What medications would you anticipate the patient to be taking chronically for this rhythm? Why? ATRIAL FLUTTER AND FIBRILLATION

Multifocal PVC PVC’s couplets, runs PVC bigeminy PVC Trigeminy What would you assess first? PVC, BIGEMINY, TRIGEMINY

Ventricular Tachycardia Ventricular Fibrillation Page 873 V-TACH, V-FIB

Pulseless Electrical Activity

PORTABLE MONITOR Contains Monitor, Defibrillator, Transcutaneous Pacemaker, Page 875

Placement of defibrillation pads

Implantable Defibrillator (ICD) and Dual Chamber Pacemaker

Temporary Pacemaker Insertion