1. Chapter 29 Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders

2. Pericarditis Inflammation of the pericardium Many causes
Nursing diagnosis: pain
Potential complications
Pericardial effusion
Cardiac tamponade

3. Chapter 30 Management of Patients With Complications From Heart Disease Self-Review

4. Cardiac Hemodynamics
CO = SV × HR
Preload
Afterload
Contractility

5. Pathophysiology of Heart Failure

6. Collaborative Problems/Potential Complications
Cardiogenic shock
Dysrhythmias
Thromboembolism
Pericardial effusion and cardiac tamponade

7. Cardiogenic Shock
A life-threatening condition with a high mortality rate
Decreased CO leads to inadequate tissue perfusion and initiation of shock syndrome.
Clinical manifestations: symptoms of heart failure, shock state, and hypoxia

8. Management of Cardiogenic Shock
Correct underlying problem
Medications
Diuretics
Positive inotropic agents and vasopressors
Circulatory assist devices
Intra-aortic balloon pump (IABP)

9. Intra-Aortic Balloon Pump

10. Thromboembolism
Decreased mobility and decreased circulation increase the risk for thromboembolism in patient with cardiac disorders including those with Heart Failure.
Pulmonary embolism: blood clot from the legs moves to obstruct the pulmonary vessels.
The most common thromboembolic problem with heart failure
Prevention
Treatment
Anticoagulant therapy

11. Pulmonary Emboli

12. Chapter 30 Management of Patients With Complications From Heart Disease

13. Pericardial Effusion and Cardiac Tamponade
Pericardial effusion is the accumulation of fluid in the pericardial sac.
Cardiac tamponade is the restriction of heart function due to this fluid resulting in decreased venous return and decreased CO.
Clinical manifestations: ill-defined chest pain or fullness, pulsus parodoxus, engorged neck veins, labile or low BP, shortness of breath.
Cardinal signs of cardiac tamponade: falling systolic BP, narrowing pulse pressure, rising venous pressure, distant heart sounds.

14. Medical Management
Pericardiocentesis
Pericardiotomy

15. Sudden Cardiac Death/Cardiac Arrest
Emergency management: cardiopulmonary resuscitation
A- airway
B- breathing
C- circulation
D- defibrillation for VT and VF

16. Question
What is the most reliable sign of cardiac arrest in an adult and child?
Blood pressure
Brachial pulse
Breathing
Carotid pulse

17. Answer
D The most reliable sign of cardiac arrest is the absence of a pulse. In an adult or child, the carotid pulse is assessed. In an infant, the brachial pulse is assessed.