NC4 Cardiovascular Problems
Terms
undefined, object
copy deck
- Risks of cardiac catheterization
- hemorrhage fr entry site, low grade fever, nausea, vomiting, loss of pulse in the catherized extremity, (usually transient, resulting from a clot, hematoma, or intimal tear, transient dysrhythmias, rear risks include, stroke, seizures, tamponade and death.
- In fetal circulation right & left atrium is connected by
- the foramen avale
- In fetal circulation the pulmonary artery and aortic artery is connected by
- the ductus arteriosus
- when does the forament ovale close
- the fomamen ovale closes when the pressure in the let atrium exceeds the pressure in the right atrium
- when does the ductus arteriosus close
- starts to close in the presence of increased O2 concentration in the blood
- Pedi: obstruction on the L side of the heart
- results in CHF
- Pedi: obstruction on the R side of the heart
- results in cyanosis
- coarctation
- narrowing
- Atrial Septal defect
- abnormal opening between the atria, allowing blood from the higher pressure left atrium to flow into lower pressure right atrium
- Ventricular septal defect
- abnormal opening between the right and left ventricles,
- Clinical manifestions of ASD (atrial septal defect)
- can be asymptomatic, may develope CHF, there is a characteristic murmer, at risk for atrial dysrhythmias, pulmonary vascular obstructive disease and emboli formation later in life from chronic increase pulmonary flow
- clinical manifestations of Ventricular septal defect
- CHF is common, murmer, at risk for bacterial endocarditis, and pulmonary vascular obstructive disease, in severe cases eisenmenger syndrome may develope
- patent ductus arteriosus
- failure of the fetal ductus arteriosus to close within the first weeks of life. (causes left to right shunt)
- Clinical manifestations of patent ductus arteriosus
- may be asymptomatic, or show signs of CHF, murmer, widened pulse pressure and bounding pulses, at risk for bacterial endocarditis and pulmonary vascular obstructive disease later in life
- Atrioventricular canal defect
- incomplete fusion of endocardial cushions.
- clinical manifestations of atrioventricular canal defect
- moderate to severe CHF, there is characteristic of murmur, mild cyanosis that increases with crying. pts are at high risk for developing pulmonary vascular obstructive disease
- aortic stenosis
- narrowing or stricture of the aortic valve, causing resistance ot blood flow in the left ventricle, decreased cardiac ouput
- pulmonic stenosis
- narrowing at the entrance of the pulmonary artery
- clinical manifestations of aortic stenosis
- infants with severe defects demonstrate signs of decreased cardiac ouput with faint pulses, hypotension, tachycardia and poor feeding. children show signs of excersise intolerance, chest pain and dizziness when standing for a long period, murmer, at risk for bacterial endocarditis, coronary insufficiency and ventricular dsyfunction
- Tetralogy of Fallot
- includes ventricular defect, pulmonic stenosis, overriding aorta, and right ventricular hypertrophy
- CHF
- inability of the heart to pump an adequate amt. of blood to the systemic circulation at normal filling pressures to meet the metabolic demands of the body.
- Tricuspid atresia
- failure of the tricuspid valve to develop, consequently, ther is no communication frm the right atrium to the right ventricle
- Clinical manifestations of tricuspid atresia
- cyanosis, tachycardia and dyspnea, older children have signs of chronic hypoxemia with clubbing, at risk for bacterial endocarditis,
- Heart failure is described in two ways
- right-sided and left-sided heart failure
- R-sided heart failure
- inability of the of the right ventricle to pump blood effectively into the pulmonary artery, resulting in increased pressure in ther right atrium and systemic venous circulation
- L-sided heart failure
- the L ventricle is unable to pump blood in the the systemic circulation, resulting in increased pressure in the L atrium and pulmonary veins, the lungs become congested with blood, causing elevated pulmonary pressures and pulmonary edema
- Impaired Myocardial function
- tachycardia, sweating, decreased urine output, fatigue, weakness, restlessness, anorexia, pale, cool extremities, weak peripheral pulses, decreased blood presure, gallop rhythm, cardiomegaly
- Pulmonary congestion
- tachypnea, dyspnea, retractions, flaring nares, excercise intolerance, orthopnea, cough, hoarseness, cyanosis, wheezing, grunting
- Systemic venous congestion
- weight gain, hepatomegaly, peripheral edema, especially periorbital, ascites, neck vein distention
- True/False
- noturia is a sign of heart failure (true) fluid collected in the dependent tissues (extremities) during the day redistributes into the circulatory system once the patient is recumbent at night, the increased circulatory volume is excreted by the kidneys
- Eisenmenger complex
- refers to the clinical situation in which a left to right shunt becomes a right to left shung because of a progressive increase in pulmonary vascular resistance.
- polycythemia
- increased amount of RBC
- squatting
- characteristic of children with tetralogy of fallot, seen in toddlers and older children as an unconscious attempt to relieve chronic hypoxia, especially during excercise
- hypercyanotic spells
- aka blue spells, seen in infants with Tetralogy of Fallot, they are preceded by feeding, crying, defecation or any stressful procedures
- right to left shunting and air
- right to left shunting allows air in the venouse system to go directly to the brain, resulting in an air embolism, all lines should have filters, in place to prevent air from entering the system
- median sternotomy
- splits the sternum
- lateral thoracotomy
- extends from midaxillary line to the scaplula
- ministernotomy
- opening the lower half of the sternum
- signs of renal failure
- elevated bun, creatinine, and decreased urine output of less than 1ml/kg/hr
- Restenosis
- recurrence of stenosis
- nursing considerations for bacterial/infective endocarditis
- prophylactic antibacterial /a dental procedures, pts must report any change in behavior, lethargy, malaise, anorexia
- nursing considerations with Rheumatic fever
- encourage compliance with meds, facilitate recovery from illness, provide emotional support, prevent the disease
- manifestation of Rheumatoid fever
- chorea (involuntary movements)
- action of cholestyramine and colestipol
- act by binding bile acids in the intestinal lumen
- AV block aka
- complete heart block
- Reasons for bradycardia
- influence of the autonomic nervous system, as with hypervagal tone, or in response to hypoxia and hypotension
- Reasons for tachycardia
- fever, anxiety, pain, anemia, dehydration
- Non drug -Treatment for tachycardia in children
- vagal maneuvers, s/a applying ice to the face, massaging the carotid artery, or having an older child perform a valsalva maneuver, eg exhaling agains a closed glottis, blowing on a thumb as if it was a trumpet for 30-60 seconds, if these fail other therapies are implemented
- pulmonary artery pressure
- group of disorders that result in an elevation of pulmonary artery pressure above 25mm Hg at rest
- causes of pulmonary artery pressure
- cardiac causes- rght to left shunt producing increased blood flow, hypoxic lung disease, thromboembolic disease, pulmonary vascular obstruction, collagen vascular diseases and exposure to toxic substances
- clinical manifestations of Pulmonary artery hypertension
- dyspnea with excercise, chest pain and syncope
- kawaski disease
- acute systemic vasculitis (inflammation of the vessel walls) of unknown cause
- hallmark of kawasaki disease
- irritability
- shock
- aka circulatory failure
- shock/circulatory failure
- inadequate tissue perfusion to meet the metabolic demands of the body, resulting in cellular dysfunction and eventual organ failure
- Treatment of shock
- ventilation, fluid administration and improvement of the pumping action of the heart
- early signs of shock in a child
- apprehension, irritability, normal BP, narrowing pulse pressure (difference between diastolic and systolic Bp), thirst, pallor, diminished urine output, unexplained mild tachycardia, and a decrease in perfusion of the hands and feet
- vaso-occlusive crisis
- painful episode in sickle cell disease
- sequestration crisis
- a pooling of blood in the liver and spleen /c decreased blood volumen and shock
- aplastic crisis
- diminished RBC production resulting in profound anemia,
- hyperhemolytic crisis
- accelerated rate of RBC destruction characterized by anemia, jaundice and reticulocytosis
- cooleys anemia
- severe anemia that leads to cardiac failure and death
- Chelation therapy
- Chelation therapy is a process involving the use of chelating agents to remove heavy metals from the body
- Thalassemia
- aka "Cooley's anemia", is an inherited disease of the RBCs, classified as a hemoglobinopathy. The genetic defect results in synthesis of an abnormal hemoglobin molecule. The blood cells are vulnerable to mechanical injury and die easily. To survive, many people /c thalassemia need blood transfusions at regular intervals.
- Aplastic anemia
- failure of the bone marrow to carry out its hematopoietic functions
- hemostasis
- the process that stops bleeding when a blood vessel is injured.
- finbrinolysis
- ensure clot formation only in the presence of blood vessel injury and to limit the clotting process the the site of vessel wall injury
- hemophilia
- group of bleeding disorders in which there is a deficiency of one of the factors necessary for coagulation of the blood
- hemarthrosis
- Hemarthrosis is a bleeding in joint spaces, often occurring in life-threatening cases such as hemophilia where the bleeding does not stop.
- supportive measures for a hemophelia (RICE0
- rice- rest, ice, compression and elevation
- disseminated intravascular coagulation
- Disseminated intravascular coagulation (DIC) is a pathological process in the body where the blood starts to coagulate throughout the whole body. This depletes the body of its platelets and coagulation factors, & there is a paradoxically increased r/o hemorrhage.
- leukemia
- Leukemia is a cancer of the blood or bone marrow characterized by an abnormal proliferation of white blood cells (leukocytes).
- combine immunodeficiency disease
- Combined immunodeficiencies (or combined immunity deficiency) are immunodeficiency disorders that involve multiple components of the immune system, including both Humoral immunity and Cell-mediated immunity.
- severe combined immunodeficiency disease- infection
- susceptibility to infection occurs early in life, most often in the 1st month of life, suffers fr. chronic infection, fails to completely recover from an infection, is frequently infected with unusual agents, failure to thrive is a consequence of persistent illnesses
- apheresis
- removal of blood from and individual Apheresis (Greek: "to take away") is a medical technology in which the blood of a donor or patient is passed through an apparatus that separates out one particular constituent and returns the remainder to the circulation. It is thus an extracorporeal therapy. (procedure which is carried outside the body)
- digitalis use
- CHF
- cardiac glycosides
- digitalis glycosides are a group of drugs that inhibit the sodium-potassium pump, thus they increase intracellular, which causes the cardiac muscle fibers to contract more efficiently
- cardiac glycosides- positive-inotropic action
- increases myocardial contracion
- negative chronotropic action
- decreases heart rate
- negative dromotropic action
- decreases conduction of the heart cells
- other uses of cardiac glycosides
- atrial fibriliation and atrial flutter
- digitalis toxicity
- overdose or accumulation of digoxin causes digitalis toxicity
- Signs and symptoms of digitalis toxicity
- anorexia, diarrhea, nausea and vomiting, bradycardia, pulse rate below 60, PVC, cardia dysrhythmias, headaches, malaise, blurred vision, visual illusions, confusion and delirium
- antidote for cardiac/digitalis glycosides
- ovine and digibind
- Lanoxin- cardiac glycoside
- treat CHF, atrial tachycardia, flutter or fibrillation
- eg of rapid acting digitalis
- digoxin (lanoxin)
- eg of long-acting digitalis
- digitoxin (Crystodigin0
- antianginal drugs
- used to treat angina pectoris, a condition of acute cardiac pain caused by inadequate blood flow to the myocardium resulting from either plaque occlusions within or spasms of the coronary arteries
- Three types of angina
- stable, unstable and variant
- stable angina
- occurs /c stress or excertion
- unstable angina
- occurs frequently over the course of a day with progressive severity
- variant angina
- occurs during rest
- Three types of antianginals
- nitrates, beta blockers and calcium channel blockers
- action of antianginal
- decrease myocardial demand for oxygen, decreasepreload by dilating veins thus indirectly decreasing afterload
- preload
- In cardiac physiology, preload is the volume of blood present in a ventricle of the heart, after passive filling and atrial contraction, usually the left ventricle.
- afterload
- afterload is the tension produced by a chamber of the heart in order to contract usually the left ventricle
- action of nitroglycerin
- acts directly on the smooth muscle of blood vessels causing relaxation and dilation. It decreases cardiac preload and afterload and reduces myocardial oxygen demand. With dilation of the veins, there is less blood return to the heart and with dilation of the arteries there is less vasoconstriction and resistance
- SE of nitroglycerin
- headaches, hypotension, dizziness weakness, and faintness
- beta blockers action
- decrease the effects of the SNS by blocking the release of the catecholamines epinephrine and norepinephrine thereby decreasing the heart rate and blood pressure
- beta blockers are used as
- antianginals, antidysrhythmic and antihypertensive
- eg of beta blockers
- propranolol (Inderal), nadolol (Corgard) and pindolol (Vesken)
- eg of calcium channel blockers
- verapamil (Canal), nifedipine (Procardia), diltiazem (cardizem)
- action of calcium channel blockers
- calcium channel blockers decrease cardiac contractility and the workload of the heart thus decreasing O2
- side effects of calcium channel blockers
- headache, hypotension, dizziness and flushing of the skin
- Antidysrhythmic drugs
- used to restore cardiac rhythm to normal
- Norpace- fast calcium channel blockers IA, Napamide, disopyramide
- prevention suppression of unifocal and multifocal premature ventricular contractions, ventricular dysrythmias
- procainamide,(Pronestyl, Procan) quinidine sulfate, polygalacturonate, gluconate (Quinidex, Cardioquin)
- Atrial. ventricular and supraventricular dysrhythmias
- Fast (Na+) calcium channel blockers IB, licocaine (Xylocaine)
- acute ventricular dysrhythmias following MI and cardiac surgery
- Fast (Na+) calcium channel blockers IB- mexiletine HCL (Mexitil)
- Analogue of lidocaine, treatment for acute and chronic ventricular dysrhythmias, taken with food
- Fast (Na+) calcium channel blockers IC- flecainide (Tambocor)
- for life-threatening ventricular dysrhythmias prevention of paroxysmal supraventricular tachycardia and paroxysmal atrial fibrilation or fluttter
- paroxysmal
- outburst of symptom: a sudden onset or intensification of a pathological symptom or symptoms, especially when recurrent
- propafedone HCL (Rythmol)
- treatment of life-threatening ventricular dysrhythmias
- tocainide HCL (Tonocard)
- for ventricular dysrhythmias, especially PVC similar to lidocaine except in oral form
- moricine (Ethmozine)
- to treat life-threatning ventricular dysthythmias, blocks sodium channels decreases conduction velocity in atria and ventricles and prolongs reffractory period in the AV node
- Beta adrengergic- acebutolol HCL (Sectral)
- management of ventricular dysrhythmias, used for anginal pectoris and hypertension, primarily PVC,
- esmolol (Brevibloc)
- to conrol atrial flutter and fibrilllation, for short term use only, for clients who have dysrhthmias during surgery
- propranolol
- ventricular dysrhythmias, PAT and atrial and ventricular ectopic beats
- sotalol HCl (betapace)
- for life threatening ventricular dysrhthmias, initially dosage is greater and then decreases over time
- bretylium tosylate bretylol
- for ventricular tachycardia and fibrillation to convert to a normal sinus rhythm
- phenytoin (Dilantin)
- treatment of digitalis-induced dysrhythmias
- SE of Quinidine
- nausea, vomiting, diarrhea, confusion and hypotension, can cause heart block and neurologic psychiatric symptoms
- SE of lidocaine
- cardiovascular depressin, bardycardia, hypotension, seizures, blurred vision and double vision
- SE of beta-blockers
- bradycardia and hypotension and neurologic prlomes
- SE of calcium channel blockers
- nausea, vomiting, hypotension and bradycardia
- Furomeside works on which part of the kidney
- loop of henle
- thiazides affect what part of the kidney
- they affect the distal tubule
- potassium sparing diuretics act on what part of the body
- acts on the collecting tubule in the kidney
- what part of the kidney does the osmotics affect
- they affect the proximal tubule
- Action of thiazides
- Act on the distal convoluted renal tubule, beyond the loop of Henle, to promote Na+, chloride and water excretion.
- SE of thiazides
- electrolyte imbalance,(hypokalemia, hypercalcemia, hypomagnesemia, and bicarbonate loss) hyperglycemia, hyperuricemia (elevated serum uric acid level and hyperlipidemia
- Action of loop diuretics
- act on the ascending loop of Henle by inhibiting chloride transport of sodium
- furomeside (Lasix)
- treat fluid retention/fluid overload caused by CHF, renal dysfuntion, cirrhosis, hypertension, acute pulmonary edema
- Action of Lasix
- inhibition of Na+ and water reabsorption from the loop of Henle and distal renal tubules; potassium, magnesium and calcium are excreted
- SE of Lasix
- Nausea, diarrhea, electrolyte imbalances, vertigo, cramping, rash, headache, weakness, ECG changes, blurred vision, photosentivity
- (Bumex)bumetanide
- treatment of renal disease and hypertension and edema assoc. with CHF, similar to Lasix
- ethacrynic acid (Edecrin)
- for severe edema (pulmonary and peripheral. It is a potent diuretic and has rapid action, also use for hypercalcemia. Moderate to high doses may cause ototoxicity
- Osmotic - Mannitol
- for oliguria and decreasing ICP, to prevent acute renal failure, used in narrow angle glaucoma reducing ICP
- Osmotic- (Ureaphil)
- for oliguria and decreasing ICP, to prevent acute renal failure, used in narrow angle glaucoma, reducing IOP
- Action of Osmotics
- increase the osmolality (concentration) of the plasma and fluid in the renal tubules
- SE of osmotics
- fluid and electrolyte imbalance, pulmonary edema, from rapid shift of fluids, nausea, vomiting, tachycardia from rapid fluid loss and acidosis
- Carbonic Anhydrase Inhibitors
- used primarily to decrease IOP in clients with open-angle (chronic glaucoma, used also for diureses, mgmnt of epilepsy, and treatment of high altitude or acute mountain sickness, may be used for a client in metabolic alkalosis whi needs a diuretic
- SE of Carbonic Anhydrase Inhibitors
- electrolyte imbalance, metabolic acidosis, nausea, vomiting, norexia, confusion, orthostatic hypotension and crystaluria, hemolyutic anemia and renal calculi
- Carbonic Anhydrase Inhibitors- acetazolamide (Diamox)
- for edema, treating abscence (petit mal) seizures, and open-angle glaucoma
- dichlorphenamide (Daranide, Oratrol)
- Treatment of open-angle glaucoma by reducing the IOP and for narrow-angle glaucoma befoe surgery
- methazolimide (Neptazane)
- treatment of open-angle glaucoma by reducing the IOP and for narrow-angle glaucoma before surgery
- K+ sparing diuretics,
- weaker than thiazides and loop diuretics, also used as mild diuretics or in combination with another diuretic
- spironolactone (Aldactone)
- used for hypertension, edema K+ sparing
- triamterene (Dyrenium)
- increae urine output to treat fluid retension/overload associated with CHF, hepatic cirrhosis and nephrotic syndrome
- SE of triamterene (Dyrenium)
- nausea, vomiting, diarrhea, rash dizziness, headache, weakness, dry mouth photosensitivity
- SE of k+ sparing diuretic
- the main SE of these drugs is hyperkalemia
- What are the five sympatholytic drug classification (sympathetic depressants)
- five groups 1:beta-adrenergic blockers, 2, centrally acting sympatholytics (adrenergic blockers), 3. alpha-adrenergic blockers, 4. adrenergic neuron blockers (peripherally acting sympatholytics) and 5. alpha 1 and beta 1 adrenergic blockers.
- beta adrenergic blockers aka
- beta blockers
- action of beta blockers
- reduce cardiac output by diminishing the sympathethic nervous system response, they reduce HR, contractility and renin release
- know that African Americans do not respond to this type of antihypertensive
- beta blockers
- Effective HTN control in AA is better with
- beta blockers and diuretics
- beta 1
- heart receptors
- beta 2
- bronchial receptors
- Drugs that block beta 1 receptors
- Lopressor, atenelol, Zebeta, Kerlone, Sectral
- Beta 1 what caution should be considered when using these drugs
- caution in pulmonary disorders, CHF, sinus brady cardia, 2nr /3rd degree AV block
- Can beta blockers be stopped abruptly?
- They should not be stopped abruptly
- SE of beta blockers
- rebound hypertension, angina, dysrhythmias, and MI, insomnia, depressin, nightmares, sexual dysfunction
- Sympatholytics
- decrease the sympathetic response from the brainstem to the peripheral vesels
- Sympatholytics stimulate which alpha
- Alpha 2
- action by Alpha 2
- decreases sympathetic activity, increases vagus activity, decreases serum epinephrine, norepinephrine and renin release the goal to reduce peripheral vascular resistance
- Sympatholytic drugs
- Methyldopa (Aldomet), clonidine, Guababenz and guanfacine
- SE of Sympatholytics
- drowsiness, dry mouth, dizziness and slow heart rate
- Alpha adrenergic blockers
- used to treat HTN with indivuduals who have lipid abnormalities
- Drug of choice for diabetics
- Alpha-adrenergic blockers, prazosin, terazosin and doxazosin
- Other uses of Prazosin
- BPH
- Action of Alpha adrenergic blockers
- block the alpha-adrenergic receptors resulting in vasodilation and decreased blood pressure (arterioles and venules are dilated, decreasing peripheral resistance and lowering the blood pressure
- SE of Alpha adrenergic blockers- prazosin, terazosin and doxazosin
- dizziness, faintness, lightheadedness, increased HR, (can occur with first dose)
- Adrenergic Neuron Blockers aka
- Peripherally acting sympatholytics
- Adrenergic Neuron Blockers are used for
- they are a potent antihypertensive drug that block norepinephrine release from the sympathetic nerve ending, causing a decrease in norepinephrine release that results in lowering of blood pressure (cardiac output and vascular resistance
- SE of Adrenergic neuron blockers
- hypotension, suicidal ideation, nightmares
- Alpha 1 and Beta 1 Adrenergic blockers
- blocks alpha 1 and beta 1 receptors
- action of blocking beta 2 receptors
- increases airway resistance
- Eg of alpha 1 and beta 1 adrenergic blockers
- Labetalol (Normodyne) nad carteolol (Cartrol)
- Common SE of alpha 1 and beta 1 adrenergic blockers
- orthostatic (postural) hypotension, GI disturbances, nervousness, dry mouth and fatigue, large doses may cause AV block
- Vasodilators
- potent HTN drugs, they act by relaxing smooth muscle of the blood vessels, mainly the arteries causing vasodilation, promotes blood flow to brain and kidneys
- True/False diuretics are given with vasodilators
- true- vasodilators decreases BP, NA+ and H20 is retained resulting in peripheral edema
- eg of vasodilators
- hydralazine and minoxidil, Nitroprusside is used to treat severe HTN
- SE of hydralazine
- tachycardia, palpitations, edema, nasal congestion, headache, dizziness, GI bleeding, lupuslike symptoms, and neurologic symptoms (tingling numbness).
- SE of minoxidil
- same as hydralazine including edema, excess hair growth, can pricipitate and anginal attack
- Angiotensin Antagonists (Angiotensin Converting Enyme Inhibitors) ACE
- inhibits the formation of angiotensin II a vasoconstrictor and blocks the release of aldosterone
- Hormone aldosterone
- promotes sodium retension and potassium excretion, when aldosterone is blocked, sodium is excreted water and potassium is retained
- Eg of ACE inhibitors
- Captopril (Capoten), benazepril (Lotensin), enalapril maleate (Vasotec), fosinopril (Monopril), lisonpril (Prinivil, Zestril), moexpril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik)
- True/False African Americans respond better when an Ace Inhibitor is combined with a diuretic
- True- AA do not respond well to ACE inhibitors, when combined with a diuretic, therapeutic levels are reached
- SE of ACE inhibitors
- cough, nausea, vomiting, diarrhea, HA, dizzines, fatigue, insomnia, serum potassium excess (hyperkalemia, and tachycardia
- Angiotensin II blockers (new drugs)
- prevent the release of aldosterone
- Eg of Angiotensin II blockers
- Losartan (Cozaar), valsartan (Diovan), irbesartan (Avapro), candesartan cilexitil (Atacand), eprosartan (Teveten) and telmisartan (Micardis)
- SE of Angiotensin II blockers
- angioedema
- Calcium channel blockers
- block decrease calcium levels and promote vasodilation
- True/False Calcium channel blockers work better in AA
- True they lower blood pressure in AA than any other regimen
- platelet aggregation
- clumping together of platelets to form a clot
- Thrombosis
- formation of a clot at the arterial or venous level
- Action of anticoagulants-warfarin and heparin
- prevents venous thrombosis (inhibit clot formation)
- Action of antiplatelet drugs
- prevent arterial thrombosis
- Eg of low molecular weight heaparin
- enoxaprin sodium (lovenox)
- INR
- international normalized ratio
- oral anticoagulants
- coumadin, licomano & anisindoine (Miradon)
- Action of oral anticoagulants
- oral anticoagulants inhibit hepatic synthesis of vitakmin K+
- normal INR
- 1.3 - 2.0
- Therapeutic warfarin
- 2.0-3.0
- Food and warfarin
- food delays absorption but does not inhibit
- what is the half life of coumadin
- .5- 3 days
- 1/2 life of heparin
- 1-2 hours
- warfarin is contraindicated in
- pregnancy can cause the placental barrier
- Vit K counteracts the effect of
- coumadin
- antiplatelet drugs
- (Persantine) dipyridamole, ticolopidine (Tichil), clopidogrel (Plavix)
- Eg of Thrombolytics
- streptokinase, lenokinase, tissue plasminogen activator (t-PA, alteplase) reteplase (Ritavase)
- fibinolysis
- fibrin breakdown
- Antilepemics
- closetipol (Colestid), Clofibrate (Atromid S), genfibrozil (Lopid)
- Eg Vastatins/Statins
- Artovastatin calcium (Lipitor), Lovastatin (Mevacor), fluvastastin (Liscol)
- Action of nitrobid
- acts by dilating the veins and in high doses, dilate arteries, prevents vasospasms
- contractility
- force generated by the heart muscle under any condition
- Creatinine kinase
- lab test used to dignose MI
- Troponin
- a protein found in the myocardium, regulate the myocardial contractile process
- Mygolobin
- the heme protein that helps to transport oxygen
- PTCA (percutaneous Transluminal Coronary Angioplasty)
- Improves blood flow to the myocardium breaks down atheroma
- atheroma
- is an abnormal inflammatory accumulation of macrophage white blood cells within the walls of arteries
- stent
- a woven mesh that provdes structural support to a vessel ar risk of acute closure
- brachytherapy
- involves the delivery of gamma or beta radiation by placing radioisotope close to the lesion
- afterload also described as
- the pressure that the chamber of the heart has to generate in order to eject blood out of the chamber.
- stroke volume
- amt of blood ejected per heartbeat
- ejection fraction
- the fraction of blood pumped out of a ventricle with each heart beat. the term ejection fraction refers specifically to that of the left ventricle.
- end diastolic
- the volume of blood within a ventricle
- end-systolic volume
- the volume of blood left in a ventricle at the end of contraction
- left ventricle ejection time
- prolonged systole
- Signs of worsening heart failure
- can be revealed by sleep related events, sleeping upright in a chair instead of bed, increasing the number of pillows used, awakening SOB at night, or awakening with angina
- Reasons for pallor
- lack of oxy hemoglobi, result of anemia or decreased arterial perfusion
- peripheral cyanosis
- bluish tinge, most often of the nail beds
- central cyanosis
- bluish tinge on the tongue and buccal mucosa, sign of cardiac disorders (pulmonary edema and congenital anamolies,) (venous blood passes through the circulation /s being oxygenated
- Xanthelesma
- yellowish raised areas on the skin, or noted on the eyelids (denotes increased cholesterol)
- Clammy or diaphoretic skin
- stress, cardiogenic shock, and acute MI the skin becomes diaphoretic
- excessive bruising on a patients skin receiving anticoagulant therapy
- could be a sign of prolonged clotting times (dosage may be too high)
- thinning of the skin around the area of a pace maker would be a sign of
- erosion of the device through the skin
- pulse pressure
- difference between systolica and diastolic
- what is the meaning of pulse pressure in regards to the work of the heart
- it is a reflection of stroke volume, ejection velocity and systemic vascular resistance.
- What is the normal measurement of pulse pressure
- 30-40mg Hg
- What causes pulse pressure to increase
- anwity, exercise, brady cardia, fever, atherosclerosis, aging hypertension, shock, HF, hypovolemia, mitral regurgitation, mitral stenosis
- Significance of pulse pressure below 30mm Hg
- sign of serious reduction in cardiac output which requires further assessment