What are the types of acute coronary syndromes?
unstable angina
myocardial infarction
acute MI
unstable angina
warning that MI is coming
new onset
at rest
increased severity or frequency
What is the pathophysiology of a myocardial infarction?
ischemia (ECG changes, cyanosis, and decreased temperature)
loss of O2 reservoirs (loss of potassium, calcium, magnesium, and contractability)
catecholamine release (dysrrhythmias, increased fatty acids and glycerol, hyperglycemia)
angiotensin II release
What are the post-MI changes?
myocardial remodeling
decreased contractility
altered left ventricular compliance
decreased stroke volume
decreased ejection fraction
increased left ventricular pressure
sinoatrial node malfunction
acute MI
coronary occlusion
heart attack
What are the clinical manifestations of an acute MI?
pain- sudden onset, may radiate to back, neck, jaw, shoulder, or arm
substernal crushing
tightness- severe
dyspnea
syncope (decreased BP)
nausea
vomiting
denial is common
diaphoresis
some weakness
increased heart rate
What are some important nursing interventions for acute MI?
dietary restrictions- decrease cholesterol, sodium, and caffeine
Tx: O2 and IV meds
What are some laboratory and diagnostic assessments for acute MI?
Troponin (<0.4)
CPK, CK-MB, relative index
ECG
What are some complications of an acute MI?
cardiomyopathy
heart failure
dysrhythmias
recurrent symptoms (continued chest pain)
cardiomyopathy
dysfunction of the heart wall; can be dilated, hypertrophic and restrictive (amyloid)
What are the different types of valvular disease?
stenosis
regurgitation
prolapse
stenosis
narrow, constrictive valve
regurgitation
leaflets on valves do not close completely allowing blood to flow backwards
prolapse
leaflets of valve close upward instead of downward
What are some causes of aortic stenosis?
aging (valves lose compliance with age)
congenital bicuspid valve (2 valves instead of 3)
inflammation from rheumatic heart disease (not getting treated from strep)
What is the pathophysiology of aortic stenosis?
narrowed aortic valve--> decreased blood flow--> outflow obstruction--> increased left ventricular pressure--> heart failure
What are the clinical manifestations of aortic stenosis?
decreased systolic BP
narrowed pulse pressure
ischemia
angina
cresendo-decresendo murmur
faint pulses
left ventricular hypertrophy
dysrhythmias
heart failure
What are some causes of mitral valve prolapse?
autosomal dominant inheritance
hyperthyroidism
What are the clinical manifestations of Mitral Valve Prolapse?
palpitations
tachycardia
syncope
fatigue
weakness
dyspnea
chest tightness
anxiety
panic attacks
depression
hyperventilation
What diagnostic test is used for Valvular Heart Diseases?
Echocardiography
Atrial fibrillation
increased automaticity of the atria
What are some of the causes of atrial fibrillation?
age
digoxin toxicity
electrolyte abnormalities
Heart failure
cardiac dysfunction that prevents adequate perfusion of tissues
Preload
volume of blood in the ventricle at the end of diastole (pressure that remains in the heart)
Ventricular end-diastolic volume (VEDV)
Ventricular end-diastolic pressure (VEDP)
Afterload
resistance to ejection of blood from left ventricle (any pressure outside of the heart)
aortic pressure
systemic vasculature
ventricular remodeling
Left heart failure
systolic heart failure
What causes left ventricular heart failure?
increased preload
-decreased contractility
-ventricular remodeling
-increased VEDV
increased preload
-increased peripheral vascular resistance
-hypertrophy
-increased oxygen demand
-ischemia
-ventricular remodeling
What are the clinical manifestations of left heart failure?
crackles
dyspnea
orthopnea
cough with frothy sputum
cyanosis
fatigue
decreased urine output
edema
pleural effusion
hypotension
S3 gallop
What is the pathophysiology of diastolic heart failure?
ventricular ejaculation--> decreased compliance of left ventricular--> abnormal diastolic relaxation--> increased left VEDP--> pulmonary edema
What are some of the causes of right ventricular heart failure?
left ventricular heart failure
cor pulmonale (hypoxia and pulmonary hypertension)
What are the clinical manifestations of right heart failure?
peripheral edema
ascites (swelling of the abdomen)
hepatosplenomegaly
What are the clinical manifestations of both right and left heart failure?
dilated pupils
dyspnea
orthopnea
crackles/ wheeze
cough
decreased BP
nausea and vomiting
confusion
jugular vein distention
ascites
dependent, pitting edema
anxiety
falling O2 saturation
infarction
fatigue
weak pulse
S3 gallop, tachycardia
enlarged spleen