Show Menu
Cheatography

Pt Management & Problems of the CV System - Part 2 Cheat Sheet by

Cardiac Cathet­eri­zation

What is the purpose?
The most definitive way to identify and diagnose CVD
Can determine if any vessels are blocked, congenital issues, CAD, blood flow issues, valve issues, oxygen­ation
May use US at the same time
Con: expensive
Pre-­Pro­ced­ure
Treat like surger­y--­ca­nnot do without consent for cath AND heart surgery
Use dye to see how blood perfuses through the arteries
Ask person to cough = changes intrat­horacic pressure (helps to move dye
Give fluid (dye is dehydr­ating & damages kidneys)
Post­-Pr­oce­dure
Less limitation w/ radial, lay flat
Femoral: check pulses & mark w/ X's, make sure same strength
Biggest compli­cat­ion: arrhyt­hmias, blee­ding (check all around wrist/leg, every time heart is accessed = inc. risk for a fib)
Pay close attention! High risk for problems!
If pt is allergic to dye: give Benadryl (anti-­his­tam­ine), Tylenol (anti-­pyr­etic), Hydroc­ort­isone (steroid)

L- vs. R-Sided Cardiac Cath

R-Sided Cath: inc. risk for PE or vagal nerve (= pass out)
L-Sided Cath: inc. risk for MI
Both: inc. risk for cardiac tamponade
Cardiac Tampon­ade: peric­ardial sac fills w/ blood = inc. pressure on heart

Mean Arterial Pressure (MAP)

Systolic BP + [ (2 x Diastolic BP) / 3 ]
Example: 125/75
125 + [ (2 x 75) / 3]
MAP = 92 mm Hg
MAP must be at least 60+ (60-70 mm Hg) for adequate coronary pressure!

Monitoring

Hem­ody­namic Monito­rin­g: used to look at pressure in the heart
- Pt must lie flat to zero out the heart
Invasive vs. Non-In­vas­ive
Central Venous Pressure (CVP): R atrial pressure; mirrors fluid status in the body
Arterial Lines: accurately monitor BP & MAP; may be radial, brachial
Pul­monary Artery Cathet­er: R artium to R ventricle to pulmonary arteries
- Can compare R and L side pressures
- Example: SWAN catheter

Allen's Test

1. Hold both arteries. (Hand blanches white.)
2. Open hand and release ulnar artery. (Hand should pink up.)
Pink hand = safe to use

Diagnostic Studies

Elec­tro­phy­siology Studies (EPS): looks at intrac­ardiac conduction system
- Identify arrythmias
- Differ­entiate between arryth­mias, if person needs pacema­ker­/ICD, are meds effective = may need to take for surgery
PET Scan: compares cardiac perfusion & metabolic functions
- If mismatched = ischemia
MRI/­MRA: may use dye & do angiog­raphy at the same time
Elec­tro­nic­-Beam Tomogr­aphy: similar to CT scan but more for the heart

Disorders of Myocardial Perfusion

Cor­onary Artery Diseas­e: ACS & athero­scl­erosis
Acute Coronary Syndrome (ACS): results from fibrous tissue & plaque accumu­lation
1. Unstable angina
2. NSTEMI
3. STEMI
Athe­ros­cle­ros­is: often takes years
- Response to injury theory: fatty streaks fibrous plaques plaques rupture & form thrombus inflam­matory cells (clot forms on plaque & clot breaks free)
 

Angina

Caus­es: myocardial ischemia (dec. supply & inc. demand), aortic stenosis, cardio­myo­pathies
Asse­ssm­ent: pain, onset, duration, severity
Types:
- Stable: at expected time (ex: w/ exercise)
- Unsta­ble: pain "for no reason­", no predic­table pattern; indicates major coronary event
- Nocturnal Angina: wake up in the middle of the night
Diag­nos­is: get an EKG, change in ST segment = something going on
* CHEW an aspirin
Phar­mac­olo­gical Interv­ent­ions:
- Aspirin (dec. platelet aggreg­ation)
- Nitra­tes­/an­ti-­ang­inals (coronary vasodi­lators, not selective for cardiac vessels (= MASSIVE HA, pass out = wear gloves!)
- Beta-­blo­ckers (dec. HR = dec. O2 demand, open blood vessels = inc. circul­ation)
- Statins (dec. plaque buildup)
- CCB (dec. heart contra­ctility [of smooth muscles in arteries = vasodi­late] & O2 demand)
- ACEI (help to vasodilate = dec. BP = dec. afterload & makes it easier for heart to work)
BIGGEST CONCERN = pain relief inc. O2 demand and perfusion
Life­style Changes:
- Diet: no smoking, healthy diet (dec. sat fat & processed foods), control choles­terol
- Exercise
- Lipids: control & check levels
- Weight: lose if possible
- Comor­bid­ities: control them!
- Other: avoid stress (= inc. plaque, constricts blood flow)

Myocardial Infarction (MI)

Asse­ssm­ent: CP unreli­eve­d/u­nre­len­ting, nausea, dyspnea
- Not everyone gets arm/jaw pain
Diag­nos­is: EKG! (ST-seg changes) & inc. enzymes (trop, CK-MB, others; WBC r/t inflam­mation)
Severity depends on which vessel is blocked
STEMI: complete occlusion of a major vessel w/ full thickness damage
- Inc. risk for compli­cations
- 10-15% mortality rate during admission
1. Inc. enzymes
2. Inc.
3. Inc. risk of compli­cations
Non-­STE­MI: complete occlusion of a minor coronary artery OR partial occlusion of a major coronary artery
- Mortality rate = 3-5%
- Happens more w/ vasospasm
Tro­ponin level correlates to damage!
Heart Zones
- Zone of ischemia: T-wave inversion - can come back
- Zone of injury: ST elevation
- Zone of necrosis: abnormal Q = never coming back

Surgical MI Interv­entions

Coronary Artery Bypass Graft (CABG)
1. On-P­ump: put pt on bypass machine, reoxyg­enate blood and return to body
- Heart stopped = inc. risk for compli­cations (bleeding, stroke, etc.)
2. Off-­Pump: risks w/ beating heart
Venous graft & placem­ent: mammary vessels are best, preferred for off-pump
Mini­mally Invasive Direct Coronary Artery Bypass (MIDCAB)
- Dec. healing time
- Dec. time in critical care
- Off-pump procedure

MI Interv­entions

Reva­scu­lar­iza­tion: first choice treatm­ent
Perc­uta­neous Coronary Interv­ention (PCI): invasive; a catheter is placed in a coronary artery to remove a blockage
- Includes: balloon angiop­lasy, ather­ectomy
- Revasc­ularize & reoxyg­enate
- Want to do ASAP for STEMI
- May treat NSTEMI a bit more medically
Perc­uta­neous Transl­uminal Coronary Angiop­lasty (PCTA): inflated balloon compresses plaque against artery walls
- May need to premed­itate for allergies
- May bleed
- May have MI (dislodge clots)
- May worsen kidney problems
- May have a fib, V-tach
Athe­rec­tomy
Stent: a metal cage holding plaque against the vessel
- Not a permanent fix, must change lifestyle
- Various types
Thro­mbo­lytic Therapy: used w/ pt contra­ind­icated for surgery
- Want to give within 12 hr
- Tissue plasmi­nogen activator (TPA)
- Worry about hemorr­hagic strokes - will cause bleeding = carefully monitored
Laser: burns out plaque
- Next choice if can't do within minutes
Tran­smy­oca­rdial Laser
Intr­a-A­ortic Balloon Cathet­er: artificial L ventricle; can pump blood
- Inc. contra­­ct­ility of heart & workload by pumping for heart
- MI: balloon can pump and heart can rest
- In sync w/ conduction system
- Frequ­ently check and compare pulses
- Comp­l­ic­­ati­­ons: dissected aorta, plaques can break if in aorta, ________, can burst
 

Pharma­col­ogical Interv­entions

Hepa­rin­/Co­uma­din (prevent clot formation)
Nitr­ates (inc. circul­ation, area well-p­erf­used)
Narc­otics (morphine - dec. O2 demand and pain control)
Adjunct meds: Beta­-bl­ock­ers­A­CEI, stat­ins
Oxy­gen (Always; issue of supply & demand)

Post-Op Care

Highest risk for...
Dec. CO
Pulmonary edema
Dysrhy­thmias
Perica­rditis
Cardio­genic shock
Cardiac tamponade
CHF

Post-Op Assess­ments

(BOLT Handout)
Pacer wires connected just in case
Cardiac Tampon­ade: change in HR & BP; filling of perica­rdial sac with blood/­fluid
- BIGGEST RISK!
Beck's Triad =
1. Muffled heart sounds
2. JVD w/ neck assessment
3. Hypot­ension (can't effect­ively contract)
After 6 hr, lines pulled and extubated

Post-Op Evaluation

Improved tissue perfusion
Pain diminished or absent
Anxiet­y/fear diminished
Cardiac Rehab:
Phase 1 - in hospital, walk w/ telemetry
Phase 2 - D/C to rehab exercise program
Phase 3 - Follow-up & continue w/ exercise
               

Help Us Go Positive!

We offset our carbon usage with Ecologi. Click the link below to help us!

We offset our carbon footprint via Ecologi
 

Comments

No comments yet. Add yours below!

Add a Comment

Your Comment

Please enter your name.

    Please enter your email address

      Please enter your Comment.

          Related Cheat Sheets

          More Cheat Sheets by mkravatz