Download Cardiac notes exam test 3 and more Study notes Cardiology in PDF only on Docsity!
Cardiac
Notes
❤️ MyocardialInfarction(MI) Definition: arteries → decreased blood & oxygen to the myocardium. Death of heart muscle tissue due to blockedcoronary
⚠️ ClassicSigns&Symptoms(TypicalPresentation) Remember:"CRUSHING"chestpain Mnemonic Description C crushing, – Chestpainpressure-like)(severe, Often radiates to left arm, jaw, neck, or back; unrelieved by rest or nitroglycerin. R – Radiatingpain Left arm, shoulder, neck, jaw, or epigastric area. U position – Unrelievedchange,byorrest,nitro Pain persists >20 minutes. S – Sweating(diaphoresis) Profuse, cold, clammy skin. H (dyspnea) – Hardtobreathe Due to decreased cardiac output and pulmonary congestion. I (initially) – IncreasedHR&BP Then may drop due to decreased cardiac output. N – Nausea&vomiting Especially in inferior wall MI. G – Goingtobeanxiousor Sense of impending doom, restlessness, or
Mnemonic Description scared denial. 💔AdditionalSymptoms Fatigue/weakness – especially in older adults or women. Palpitationsorirregularpulse (dysrhythmias). Pallorandcyanosis (from poor perfusion). Low-gradefever may occur later (inflammatory response). 💔💔AtypicalSymptoms(OftenSeeninWomen,Elderly,andDiabetics) May not have chest pain! Jaw,neck,shoulder,orbackpain Shortnessofbreath(SOB) without pain Indigestion/heartburn/epigastricpain Extremefatigue or weakness Nausea/vomiting/dizziness/fainting 💔AssociatedDiagnosticClues ECG: ST elevation (STEMI), T wave inversion, or Q waves. Labmarkers: o ↑ TroponinI/T (most specific & sensitive) o ↑ CK-MB (within 4–6 hrs after MI)
💔QuickTipforNCLEX: If a patient reports lasting>20minutes chest, treatpainasunrelievedMIuntilprovenbyrestotherwiseornitroglycerin — priority nursingaction:
💔2💔Ongoing/HospitalTreatment Treatment Purpose/NCLEXNotes Cardiac telemetry)Monitoring(ECG, Detect dysrhythmias early (esp. ventricular) IVAccess For rapid med admin Beta Atenolol)Blockers (Metoprolol, ↓ HR, ↓ BP, ↓ workload of heart ACE Enalapril)Inhibitors(Lisinopril, Prevent heart remodeling & heart failure Antiplatelet (Heparin,Clopidogrel)/Anticoagulants Prevent new clot formation Statins(Atorvastatin) Lower cholesterol & stabilize plaque Paincontrol Morphine or IV nitro MonitorLabs: ↑ Troponin, CK-MB; watch K and renal function ⁺, Mg²⁺,
💔 3️ 💔ReperfusionTherapy(RestoringBloodFlow) Goal: Open the blocked coronary artery ASAP! Method WhenUsed/KeyNursingRole Thrombolytics Alteplase,Reteplase)(tPA, Within clot. Monitor for 6 hours of symptom onset; dissolvebleeding. PCI Coronary(PercutaneousIntervention / Angioplasty+Stent)
Preferred minutes of arrival. Monitor fortreatment if available within chestpain (^90) return,bleedingatsite, and arrhythmias. CABG Bypass(CoronaryGraft) Artery Surgical revascularization if PCI fails or multiple blockages.
💔 4️ 💔Post-MINursingCare
Focus NursingActions Cardiacmonitoring Watch for arrhythmias (esp. PVCs, VT, VF) Assesschestpain Report recurrence immediately Monitorvitalsigns BP, HR, O₂ sat Strict weightsI&O,daily Detect fluid overload or heart failure Bedrestinitially ↓ oxygen demand Low-sodium, fatdiet low- Heart-healthy Emotionalsupport Reduce anxiety, explain care plan Gradualactivity Cardiac rehab referral after discharge
💔 5️ 💔Long-TermManagement/DischargeTeaching Remember: | H – Heart-healthy diet | Low fat, low sodium, no smoking or alcohol excess |"HEART"forMIrecovery | | EA – Exercise gradually | Cardiac rehab or light walking |– Adhere to meds | Beta-blockers, ACE inhibitors, statins, aspirin | | | RT – Take nitroglycerin properly | Sit before taking, up to 3 doses 5 min apart– Report symptoms | Chest pain, SOB, fatigue, weight gain | → call 911 if unrelieved | 💔NCLEXTip If chest pain persists andcall 9 1️ 1️. after1️ nitroglycerindose, stopactivity,sitdown, Never wait or drive yourself to the hospital. 💔WhenYouShouldNOTGiveNitroglycerin ⚠️ 1️ 💔LowBloodPressure
⚠️ 5️ 💔HypersensitivityorAllergytoNitrates Rare headache, collapse) →, but if the patient has a history of reaction (rash, hypotension, holddoseandnotifyprovider.
💔NursingChecksBeforeGivingNitroglycerin 👉 👉 CheckAsk about BP andEDmedHRuse 👉 👉 AssessReview chestECG if available (especially for inferior MI)pain (location, duration, quality) 👉 Reassess painandBP after each dose 💔NCLEXTip If the patient’s holdthenitroglycerin BPislowand, tooknotifyViagratherecentlyprovider., or has inferiorwallMI, Giving it could cause suddenhypotension→cardiacarrest. Perfect — let’s break down easyNCLEX-PNterms 👉 STEMI(ST-ElevationMyocardialInfarction) in
❤️ STEMI—ST-ElevationMyocardialInfarction 💔Definition: A part of the heart muscle → completeblockage of a full-thickness coronaryartery(transmural) → totallossdamageofblood to theflow to myocardium. 👉 It’s a truemedicalemergency — “time is muscle!”
⚡WhattheECGShows: ST-segmentelevation in at least 2 ormorecontiguousleads May also show: o T-waveinversion o PathologicQwaves (develop later — sign of necrosis)
👉 👉 STT-waveelevationinversion=“injury”=“ischemia” 👉 Qwave=“infarction/necrosis” 💔Pathophysiology(Simple):
- Plaque in coronary artery ruptures
- Clot (thrombus) forms → complete occlusion
- No oxygen → myocardial cell death begins within 20–4️ 0 minutes
- Permanent damage within 4️ –6hours ⚠️ ClassicSigns&Symptoms(CRUSHINGmnemonic) Mnemonic Descripti on C – Chest pain (crushing, pressure, heavy) R – Radiates to left arm, jaw, back U – Unrelieved by rest or nitro S – Sweating (diaphoresis) H – Hard to breathe (dyspnea) I – Increased HR & BP (initially) N – Nausea & vomiting G of doom) – Going to be anxious or scared (sense
💔DiagnosticFindings Test Findings ECG ST-segment elevation (key feature!)
👉 👉 Goal:Door-to-needle “Door-to-balloon” time ≤(thrombolytic) (^90) ≤minutes 3️ 0 minutes
3️ 💔MedicationsAfterReperfusion BetaBlockers – ↓ HR, ↓ oxygen demand ACEInhibitors/ARBs – prevent heart remodeling Antiplatelets(Aspirin,Clopidogrel) – prevent reocclusion Statins – lower cholesterol Heparin – prevent new clots 💔NursingCareAfterSTEMI Continuous cardiacmonitoring Assess for dysrhythmias (esp. VT/VF) Monitor vitalsigns,O₂sat,painlevel Watch for bleeding if on thrombolytics or heparin Bedrestinitially, then gradual increase in activity Emotionalsupport and patientteaching on lifestyle changes 💔NCLEXTip: If a patient presents with reperfusiontherapyASAP. chestpain+STelevationonECG, priority= Never delay for labs — ECGfirst,thennotifyprovider/activatecathlab. Perfect — these two are tested on NCLEX-PNand thrombolyticMed-Surgexams(“clot-busting”) for MI,stroke,drugsand, oftenPE.
💔ThrombolyticTherapy:Streptokinasevs.Alteplase(tPA)
Feature Streptokinase(Streptase) Alteplase (Activase,tPA)
DrugClass Thrombolytic (1st generation) Thrombolytic (tissue plasminogen activator, newer generation)
Source^ Derived from bacteria reactions) (can cause allergic^ streptococcal
Human recombinant enzyme risk) (no allergy
Mechanism Action of Converts which dissolves fibrin clots plasminogen→plasmin, Directly activates plasminogen→ plasmin site; more at the clot clot- specific Use Indications/ - Acute MI (if PCI unavailable) - Pulmonary embolism - DVT^ - Acute MI (within 6 hrs) - Ischemic stroke (within 3–4.5 hrs) - Pulmonary embolism Onset Duration/ Onset: 30–60 min Duration: 4–6 hrs^ Onset: Immediate Duration: Short (minutes) Allergic ReactionRisk ⚠️ may cause^ High (from bacterial protein) — fever,rash, anaphylaxis
👉 protein; no Low (human antibodies formed) RepeatUse 👉 (antibody formation)^ Cannotreusewithin^6 months^ 👉 needed (no immune reaction)^ Can be reused if Antidote Reversal / Aminocaproic acid (Amicar) Aminocaproic acid (Amicar) Major Effect Side Bleeding (internal or external) Bleeding intracranial) (especially Contraindicati ons - Active bleeding or recent surgery - History of hemorrhagic stroke - Same as Streptokinase
Letter Meani ng B – Bleeding (major side effect) U 3–4.5 hrs) – Use within time window (MI: 6 hrs, Stroke: S – Signs of neuro changes = STOP infusion T needed) – Type & cross blood (in case transfusion C hx) – Contraindications (bleeding, surgery, stroke L – Labs (PT, aPTT, INR, Hgb, Hct) O – Observe for bruising, gums, hematuria T procedures – Teach patient to avoid injury & invasive
💔NursingPriorityAfterAdministration
- Monitor confusion, vomiting)forbleeding (especially cerebral → sudden headache,
- AvoidIMinjections/unnecessaryIVsticks
- Reassessvitalsfrequently(q1️ 5️ –3️ 0 min)
- Cardiacmonitoring (for reperfusion arrhythmias)
- KeepAminocaproicAcid(Amicar) available for bleeding reversal ❤️ NSTEMI—Non–ST-ElevationMyocardialInfarction 💔Definition: NSTEMI = thickness Partialdamageblockage to the heart muscle. of a coronaryartery, causing partial
👉 blood It’s still aflow heartcontinuesattack. , but lesssevere than a STEMI because some
Think: *NSTEMI = partial blockage STEMI = full blockage ⚠️ 👉
⚡Pathophysiology(Simple): A vessel. plaque in the coronary artery partiallyrupturesornarrows the Blood flow decreases → fullnecrosis. ischemia → heartmuscleinjury, but not NoSTelevation on ECG (unlike STEMI). 💔ECGFindings ECGChange Meaning 👉 NOSTelevation Key difference from STEMI 👉 inversion STdepression or T-wave Indicates ischemia or injury 👉 No Q waves (Develop only with full-thickness infarct)
💔DiagnosticLabs Test Findings Troponin I/T ↑ Elevated (confirming myocardial injury) CK-MB ↑ Elevated but returns to normal within 2–3 days Myoglobi n Early but nonspecific 👉 mild! Troponin elevation = confirms heartmuscledamage, even if ECG looks
💔2💔Medications Medication Purpose Antiplatelets Clopidogrel) (Aspirin, Prevent clot growth Anticoagulants Enoxaparin) (Heparin, Prevent new clots BetaBlockers ↓ HR, ↓ workload, ↓ oxygen demand ACEInhibitors/ARBs Prevent heart failure & remodeling Statins Lower cholesterol, stabilize plaque Nitrates Relieve ischemic pain 💔 3️ 💔NOThrombolytics! 👉 Thrombolytictherapy(tPA,Streptokinase) is NOTused in NSTEMI.
👉 bleeding Why? — There isrisk without benefit. nototalocclusion to dissolve; using them increases
💔 4️ 💔PossibleProcedures Cardiaccatheterization/angioplasty(PCI) o To identify the degree of blockage o Usually performed within 2 4️ –72hours CABG(Bypasssurgery) o If multiple arteries are involved
💔NursingCare
Focus Action Monitorchestpain Report recurrence or change immediately Continuous monitoring ECG Watch for ST changes or arrhythmias Monitor sat vitals&O₂ Detect early signs of shock Monitorlabs Troponin trends, CBC, coagulation Bedrestinitially Reduce cardiac workload Educate Lifestyle changes, medication adherence, diet, smoking cessation
💔DischargeTeaching—“HEART” Letter Teaching Focus H – Healthy diet (low fat, low sodium) E – Exercise gradually (cardiac rehab) A blocker, Statin) – Adhere to meds (Aspirin, Beta- R immediately – Report new chest pain or SOB T – Take nitroglycerin as prescribed 💔NCLEXTip: NSTEMI = DoNOTgive partialthrombolyticsblockage,no — instead useSTelevation, antiplateletselevatedtroponin.+ anticoagulants and prepareforcardiaccath.
Treatment Method TimeGoal Purpose needle”) reperfusion 👉 minutes The total(2 symptom-to-reperfusionhours) from onset. time should ideally be ≤1️ 20
💔💔Malevs.FemaleDifferences
Biologically, sexes — the 20–40–60 minute rule applies to theheartmuscle’sischemictolerance everyone.isthesame in both
However, symptom clinicaldifferencesoutcomes 👉 differ because of presentationdelays and Factor Males Females Symptom onset Often sudden, classic “crushing chest pain”^ Often gradual, with atypical symptoms (fatigue, indigestion, jaw pain, back pain) Response time Seek care faster Often delay care (mistake symptoms for GI upset or stress) Average timetoER ~1–2 hours 2–3️ timeslonger (many >3–4 hours) Result Higher early detection, faster reperfusion^ More ischemic damage before treatment, higher mortality
💔Insummary: Reversibleischemia: up to 20–4️ 0 min Irreversibleinjury: begins around 4️ 0–60min Reperfusion min from onset(PCIorthrombolytic): should occur within 90–1️ 20 Biologicaldifference: none between men & women Outcome forreversaldifference: women often present later, so lesschance
💔NCLEXTip: Time = Muscle. Myocardial cell death begins within 20– 4️ 0 min of ischemia. Goal: (thrombolytics) Reperfusion. within 90 minutes(PCI) or 3️ 0 minutes Women often have delayedrecognition, leading to worseoutcomes. STEMIandNSTEMI: 💔LaboratoryTestsandDiagnosticToolsinMI 1️ .CardiacBiomarkers Troponin myocardial injury. Elevated levels indicate myocardial damage and areIorT: The most specific and sensitive markers for used to diagnose acute myocardial infarction (AMI). (NCBI) Creatine levels rise within 4–6 hours of myocardial injury and return to baselineKinase-MB(CK-MB): An enzyme found in heart muscle; within 36–48 hours. It's useful for detecting reinfarction. (NCBI) Myoglobin It rises within 1–2 hours of injury but lacks specificity for cardiac tissue.: An early marker of muscle injury, including heart muscle. (NCBI) 2.BasicMetabolicPanel(BMP) Assesses kidney function and electrolyte balance, which are vital for patient management, especially when considering the use of contrast agents or medications that affect renal function. 3️ .CompleteBloodCount(CBC)andHemoglobin Hemoglobin indicate anemia, affecting tissue perfusion.: Measures oxygen-carrying capacity; low levels may White or infection, which may complicate MI diagnosis.BloodCells(WBC): Elevated levels can indicate inflammation Platelets considering antiplatelet therapy.: Essential for assessing bleeding risk, particularly when 4️ .ChestX-ray
