cardiac med surg

• Central perfusion


  Cardiac output = stroke volume x heart rate
• Peripheral (local) perfusion


  Blood flow to a specific body tissue
• Atherosclerosis


  • Fatty plaque build up in the arteries causing diminished blood flow
• Arteriosclerosis


  • Hardening of the artery walls
• Preload


  Total amount of blood in the ventricles after diastole
• Too much preload

  Will stretch out the heart muscles
• Afterload


  Resistances ventricles must overcome to contract against
• Too much resistance

  Requires a vasodilator
• Peripheral tissue disorders (arterial)

  • Poor oxygenation to body tissue
  • Tests: treadmill test, CT scan, MRI, angiography
• Manifestations of peripheral tissue disorders

  • Loss of hair
  • Thin, shiny skin
  • Intermittent claudication
  • Necrosis of the toes
  • Skin and temperature changes
• Treatment for peripheral arterial disorders

  1. Dangle feet below the heart

  2. Peripheral arterial bypass - graft is inserted to open up blood flow

  3. Monitor site for occlusion

  4. Signs/symptoms of infection

  5. 18-24 hours of rest

  6. Pain report
• Raynaud's disease

  • Exaggeration of constriction due to cold exposure (only hands and feet)
  • Wear gloves
  • Vasodilators - BP hypotension
• Buerger's disease


  • Recurrent vasocclusion disorder
  • Tobacco and marijuana use
• Venous thrombosis


  Formation of a blood clot in a vein
• superficial vein thrombosis 


  formation of thrombus in superficial vein

  benigns
• deep vein thrombosis

  most concerning

  can disloge into heart or brain
• venous thromboembolism


  -swelling

  -pain

  -tenderness

  -asymptomatic
• venous thromboembolism preventative care

  • fluid intake
  • early ambulation
  • leg elevation
  • compression socks during ambulation
• venous manifestations


  ulcers

  + pulses

  swelling
• venous perfusion disorder


  the problem is getting the blood to move away from the tissue unlike arterial where the problem is getttting blood perfusion TO the tissue
• venous management

  • avoid prolonged sitting and standing
  • exercise
  • varicose vein treatment
• heart failure

  left and right sided

  acute decompensated heart failure- life threatening
• left sided heart failure

  D- Difficulty breathing

  R-ales/crackles

  O-orthopnea

  W-weakness

  N-nocturnal paroxysmal- awakening from inability to breath

  I-increased HR

  N- nagging cough

  G-gaining weigh
• right sided heart failure (body)

  swelling

  weight gain

  enlarged liver and spleen

  large neck vein

  lethargic

  irregular heart beat

  nausea

  growth of abdomen- ascetics
• digoxin


  increase contractility= increase cardiac output
• cardiac myopathy 


  hypertrophic

  dilated

  restrictive
• coronary artery disease


  ischemia= lack of oxygen to heart
• cad management(ABCDEF)

  antiplatlets

  beta blockers

  cigarrette cessatio

  diet

  exercise

  flu vaccination
• cardiac rehab


  sexual activity can be resumed 1 week after MI after uncomplicated MI

  avoid erectile dysfunction meds with nitrates= decrease BP and have an MI

  chest pain during is expected

  certain positions= less oxygen

  no sex after a full meal
• cardiac rehab

  static exercises- should be limited

  increases HR and BP rapidly

  involves straining muscles
• cardiac rehab


  low impact exercises- walking, jogging, bike riding

  improves circulation
• pericarditis


  swelling of the thin sac surrounding the heart

  chest pain when laying flat or deep breathing

  pericardial friction rub

  pericardial effusion- fluid in sac

  cardiac tamponade- too much fluid compression of heart
• bacterial endocarditis


  inflammation of the inner most layer of the heart

  vascular signs- osler node, janeway lesion

  antibiotics

  microclots form
• myocardial interventions

  • 12 lead ekg
  • MONA- morphine, o2, nitroglycerin, aspirin chewable ( increase absorption)
  • iv acces
  • semi fowlers
  • blood studies- troponin, electrolytes, abg, creatine,
• myocarditis

  • basketball athletes
  • acute or chronic - asymptomatic
  • chest pain, fever, syncope
  • c- reactive protein= inflammation
  • troponin= on chest pain
• cardiac tamponade


  needle will aspirate fluid in sac

  bp will increase, jvd decrease

  complications- pneumothorax
• cardiac rehabilitation education

  pt in denial is not a good time to do teaching

  dont want to increase the demand

  3 met is needed for discharge-

  do not shovel snow!!
• phyiscal exercise

  increase co

  walking

  decrease lipids