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What is cardiac output affected by?
- Its affected by preload
- Heart rate
- Metabolic needs- increased calcium, decreased potassium
What is preload? What occurs during preload? What factors can affect preload?
Everything that occurs before the heart contracts
Ventricular stretch. Ventricle fills with blood and stretches.
Preload can be met by high resistance due to Cholesterol and High Sodium
Preload can be affected by: Blood Loss (less blood available to contract and pump) Increases HR. Exercise and slow HR (make more blood available for contraction and pumping)
What is stroke volume? What affects stroke volume?
Stroke volume is the amt of blood ejected from the ventricles with each heart beat
SV can be affected by preload
Afterload or resistance
Strength of the cardiac muscle
Where is the best place to assess a pulse?
The best place to assess a pulse is by checking the Apical pulse. Check this against radial. Both for 1 minute
If a cardiac patient is exhibiting edema, what part of the heart is experiencing the failure?
The patient is experiencing Right Sided Failure
If a cardiac patient has fluid in the lungs, what side of the heart has the failure?
The patient is experiencing left sided failure
What is the most common cause of chest pain
Lack of O2
What can cause a lack of Oxygen in arteries?
Atherosclerosis- build of plaque, narrowing of vessels
What types of medications are given for the treatment of Angina?
Nitroglycerin and a Calcium Channel Blocker
What is ischemia?
lack of O2 to tissue, no damage to tissue
What is an infarction?
Lack of O2 with permanent tissue damage
What are the effects of Nitroglycerin?
- Venous pooling
- Reduces the amount of workload
- Reduces the amount of blood returning to the heart- affects preload and afterload
- Relieves pain
When Nitroglycerin is given sublingual, how much time does it take to have an effect?
What does an inverted T wave and elevated S wave mean?
This means that the patient has suffered an MI
What is CK-MB? Where is it found? When does it rise and peak?
CKMB is an enzyme found in cardiac cells and it is released when cardiac muscles have sustained injury.
The level of CKMB rises about 4 hrs after injury
Peaks in 24 hrs.
How often are cardiac enzymes checked?
Q 8hrs x3
In an ECG what does the P mean?
- P- Depolarization of Atria- Contraction
- Q,R,S- Depolarization of Ventricle- Contraction
- T- Repolarizatio of Ventricle- Rest
What tests can help differentiate between and MI and Angina?
Blood work for enzymes and ECG
What has occurred to a patient that has a positive Troponin level and a negative CKMB?
It means that the patient had an MI weeks ago
What is Troponin? How long does it stay in the blood?
Troponin is a protein found in cardiac muscle that is released when the muscle has sustained injury. The levels can stay high in the blood for 3 weeks
What is the primary goal for the patient that has suffered an MI?
The primary goal is to reduce the workload of the heart
What can be done to reduce the workload of the heart in a patient with a recent MI?
- Stool softeners
- Bed Rest, slowly progress to activities
- Help with bathing
- NO HEAT- so that vasodilation does not take place
What medication regimen is given to a patient with an MI?
- Initially- Nytroglycerin- sublingual
- Then- Nitroglycerin drip
- Morphine to help manage fluid (affects preload and afterload, less fluid going out means more rest for the heart
What effects to Beta Blockers "LOL" MEDS have on the heart? What are the side effects? Which is the most common side effect?
- Carvedilol- Coreg
- Metoprolol- Lopressor
All Beta Blockers have a direct effect on the SA node
Beta Blockers reduce the amount of Oxygen consumed and lowers the blood pressure
DO NOT STOP SUDDENLY!
MUST CHECK PULSE 1 HR BEFORE ADMINISTERING A BETA BLOCKER
- Hypotension- Most common