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Bundle of His Signals Purkinje Fibers to Contract Ventricles
Tricuspid Valve Closes
Pulmonary Valve Opens
Mitral Valve Closes
Aortic Valve Opens
2 mins
Cardiac Cycle - Diastole
Characteristics
Aortic Valve Closes
Pulmonary Valve Closes
Ventricles Relax
Mitral Valve Opens
Tricuspid Valve Opens
Ventricles Fill
Sinoatrial (SA) Node Fires
Atrial Contraction
3 mins
Hypertension Assessment
Mechanism
Essential Hypertension
Secondary Hypertension
Assessment
Headache
Vision Changes
Nosebleed (Epistaxis)
Chest Pain
Syncope (Fainting)
Diagnosis
Average 2 Sets, 2 Minutes Apart
After 2 or More Visits (within 1-4 weeks)
Nursing Considerations
Take BP Both Arms
Common in African Americans
2 mins
Mitral Regurgitation
Characteristics
Holosystolic
Blowing Murmur
Loudest at Apex
Radiates toward Axilla
Louder by Squatting
Hand Grip
Expiration
1 min
Acute Pericarditis Causes
Idiopathic
Infection
Trauma
Cardiac
Myocardial Infarction
Autoimmune Diseases
Uremia
Tumor
Radiation
2 mins
Angiotensin-Converting Enzyme (ACE) Inhibitors
"-pril" Suffix
Mechanism of Action
Block Renin Angiotensin-Aldosterone System (RAAS)
Indications
Hypertension
Heart Failure
Side Effects
Dry Non-productive Cough
Hypotension
Dizziness
Possible Hyperkalemia
Angioedema
Nursing Considerations
Slowly Change Position
Do Not Stop Abruptly
2 mins
Severe Sepsis and Septic Shock Assessment
Microthrombi
DIC
Decreased Oxygen Saturation
Decreased WBC
Oliguria
High Output Heart Failure
Multiple Organ Failure
2 mins
Cardiac Enzyme Evaluation: Troponin
Measures
Cardiac Muscle Injury
Time Ranges
Detection in Blood: 4 Hours
Peak: 24 - 36 Hours
Return to Normal: 5 - 14 Days
Considerations
Most Specific for Cardiac Muscle
Treat Aggressively
2 mins
Cardiac Tamponade
Mechanism
Fluid in the Pericardial Sac
Pericarditis
Decreased Cardiac Output
Signs/Symptoms
Beck's Triad
Hypotension
Jugular Venous Distention (JVD)
Distant Heart Sounds
Pulsus Paradoxus
Electrical Alternans
Treatment
Pericardiocentesis
1 min
Cardiac Catheterization
Considerations
Fluttering Sensation
Contrast Media
NPO 6-12 Hours
After Procedure
Bed Rest
Assess Circulation
Assess for Bleeding
Monitor Vital Signs
2 mins
Cardiac Enzyme Evaluation: Myoglobin
Measures
Skeletal or Cardiac Muscle Injury
Time Ranges
Onset: 1 - 4 Hours
Peak: 12 Hours
Return to Normal: 24 Hours
Considerations
Elevation After 24 Hours: Reinfarction
2 mins
Cardiac Enzyme Evaluation: Creatine Kinase CK-MB
Measures
Skeletal or Cardiac Muscle Injury
Time Ranges
Onset: 4-8 Hours
Peak: 12-24 Hours
Return to Normal: 2-3 Days
1 min
Cardiac output
During the early stages of exercise, CO is maintained by HR and SV. During the late stages of exercise, CO is maintained by HR only (SV plateaus). Diastole is preferentially shortened with incr HR; less filling time decr CO (eg, ventricular tachyc
Incr pulse pressure in hyperthyroidism, aortic regurgitation, aortic stiffening (isolated systolic hypertension in elderly), obstructive sleep apnea ( sympathetic tone), exercise (transient). Decr pulse pressure in aortic stenosis, cardiogenic shock, ca
In conditions that results in high cardiac output like anemia the increased cardiac output produces a systolic murmur best heard at the right upper chest region (aorta)
Sudden cardiac death
Death from cardiac causes within 1 hour of onset of symptoms, most commonly due to a lethal arrhythmia (eg, VF).
Associated with CAD (up to 70% of cases), cardiomyopathy (hypertrophic, dilated), and hereditary ion channelopathies (eg, long QT syndrome, Brugada syndrome). Prevent with implantable cardioverter-defibrillator (ICD).
Troponin Lab Values
Troponin T (cTnT)
< 0.1 ng/mL Normal
Troponin I (cTnI)
< 0.5 ng/mL Normal
> 2.3 ng/mL Myocardial Injury
2 mins
Digoxin Toxicity Treatment
Activated Charcoal
Slowly Normalize K+
Digibind (Anti-Digoxin Fab)
Magnesium Sulfate
Lidocaine
Cardiac Pacing
2 mins
Acute Pericarditis Interventions
Interventions
Treat Underlying Disorder
Antibiotics
Colchicine + NSAIDs
Corticosteroids
Place Patient Upright with Head of Bed at 45°
Pericardiocentesis
Pericardial Window
2 mins
Acute Pericarditis Assessment
Pericardial Sac Inflammation
Assessment
Sharp Chest Pain
Increased with Inspiration
Pain Decreased by Leaning Forward
Pericardial Friction Rub
Diffuse ST-Elevation
T Wave Inversion
Fever
Considerations
May Be Asymptomatic
Cardiac Tamponade
2 mins
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