Cardio- heart

-pumping blood and supplying

your system with oxygen; delivers your
blood to the tissues.
A small organ that weighs 300 grams.
(age, body size, gender, physial
exerise, heart diseases!
"oated in the middle o# the
mediastinum.
Approximately the size o# your $st.
%eriardial avity- & to '0 ml o# (uid in
the periardial sa whih prevents
#rition between the two periardial
layers.
)t serves as ushion to avoid
#rition.
%eriardium
*yoardium- middle layer, musle
responsible #or pumping ation o# your
heart.
+ndoardium- inner layer o# the heart
CHAMBERS OF THE HEART:
,ight Atrium; ,ight -entrile; "e#t
Atrium; "e#t -entrile
-entrile is thi.er and has greater
pressure than the atrium/
-A"-+0/ prevents ba.(ow; ma.es blood
(ow in one diretion
Atrioventriular valves/ aorti semilunar
valve
0emilunar -alves/ %ulmonary semilunar
valves
-alves loses one the blood moves
towards the other side
Coronary Artery- supplies blood in the
heart.
,ight Coronary Artery
"e#t Coronary Artery
C1234C5)12 16 7"113/
0A 213+- 0inoatrial 2ode (%ae *a.er!;
where the impulse starts
5riggers eletrial impulses
Atria are depolarized and the impulse
are transmitted to the A- 2ode
3epolarization- eletrial ativation o#
ell
%olarization- bringing ba. the ell to
resting state
)mpulse is delayed ( it will allow time to
ontrat in the atrium by $lling in by
blood!
5ransmitted into the bundles o# 8is
(right bundle branh- onduting the
impulse to your right ventrile and le#t
bundle branh- onduting the impulse
to your le#t ventrile! and %ur.in9e
$bers- terminal end; the myoardial
ells will trigger ontration
+"+C5,1%8:0)1"1;)C %,1%+,5)+0 16
58+ 8+A,5/
)s the one responsible #or the
synhronization and ontration o# the
heart
<. Automaticity- ability o# the
heart to initiate impulses
repetitively and
spontaneously.
'. Excitability- ability o# your
ardia ells to respond to a
stimulus by initiating an
impulse.
3. Condutivity- ability to respond to
an impulse by transmitting the
impulse along ell membranes.
=. Contratility- is the ability o#
ardia ells by responding to an
imulse by ontrating.
&. ,e#ratoriness- )nability o# ardia
ells to respond to a new stimulus
while it is still in ontration in
response to a previous stimulus;
protets the heart #rom sustained
ontration that may result #rom
sudden ardia death.
CA,3)AC C:C"+/
0:051"+/
Contration
+mptying o# the atria and
ventriles
3)A051"+/
,elaxation
6illing o# the atria and ventriles
CA,3)AC 145%45- volume o# blood
e9eted #rom the le#t ventrile into the
aorta per minute
C1> 8, x 0tro.e volume
-average ardia output (C1!/ &
"?minute
05,1@+ -1"4*+- amount o# blood
e9eted by the le#t ventrile into the
aorta per beat. Ave/ A0 ml
Bays stro.e volume is ontrolled/
<. %reload- degree o# myoardial
streth be#ore ontration; period
where-in $lling time?volume o#
ventriles is highest, and streth
is greatest.
)t is governed by Fran Starlin! la"-
the greater the myoardial $ber streth,
the more #ore#ul the ventriular
ontration thereby inreasing stro.e
volume. 0trethed gd to promote
#ore#ul e9etion.
'. Contartility- hange in inotropi
state o# the musle without a
hange in myoardial $ber
length.
3. A#terload- amount o# tension that
it must develop during
ontration to e9et blood in the
aorta. 0o that ardia output will
inrease.
A45121*)C )26"4+2C+0 12 CA,3)AC
AC5)-)5:/
0ympatheti 2ervous 0ystem-
2orepinephrine- inreases heart rate
%arasympatheti 2ervous system-
Aetylholine- derease heart rate
<. 8eart diseases
'. *ediations
"A71,A51,: 5+050/
Complete blood count- evaluation o#
general health status.
6or heart diseases/
3ereased ,7C- inadeCuate tissue
oxygenation
8ypoxia stimulates renal seretion o#
erythropoietin (hormone in .idney that
promotes erythropoiesis!
0timulates the bone marrow to inrease
,7C prodution.
)nreased B7C- in#etious heart
diseases and myoardial )n#artion.
%latelets- prone to bleeding;
ER#THROC#TE SE$%ME&TAT%O&
RATE
Abnormal protein present in blood
"'en t'ere is in(ammation or
in)ection*
*easures o# the rate at whih ,7Cs
settle out o# antioagulated blood in an
hour.
+levated in in#etious heart disorders or
myoardial in#artion.
2ormal ,ange/
*ales/ <&-'0 mm?hr
6emale/ '0-30 mm?hr
Blood Coa!ulation Test:
%er#ormed be#ore invasive proedures.
%rothrombin 5ime (%5, %rotime!
*easures the time reCuired #or lotting
to our.
+valuates the eDetiveness o# Coumadin
5herapeuti hange is <.& to ' times the
normal value or ontrol.
2ormal range/ <<- <E seonds
%nternational normali+e ratio/
provides a standard method #or your
protime level.
%artial 5hromboplastin 5ime (%55!
7est single sreening test #or disorders
o# oagulation
+valuate the eDetiveness o# 8eparin
5,/ '- '.& times
2,/ E0- A0 seonds
Ativated %artial 5hromboplastin time
((A%55!
0ame purpose as %55
*ost spei$ test to evaluate
eDetiveness o# 8eparin
2,/ is 30-=& seonds
B,OO$ -REA &%TRO.E&
)ndiator o# your renal #untion
)ndiates the #untion o# your hydration
proess
3ereased ardia output leads to low
renal per#usion and redution in
glomerular $ltration rate. 742 beomes
elevated. Congestive heart #ailure, *)
- dereased 742/ overhydration;
2ormal ,ange/ <0-'0 mg?d"
Creatinine- most spei$ in testing
.idney #untions.
B,OO$ ,%/%$S: Serum C'olesterol
Cholesterol- hormone synthesis and ell
membrane #untion.
2%1- #or <0-<' hours
2ormal ,ange- <&0-'00 mg?d"
Serum Tri!lycerides
1bserve #asting #or <0-<' hours
2ormal ,ange <=0-'00 mg?d"
B,OO$ C-,T-RES:
Assist in the diagnosis o# in#etious
diseases og the heart (periarditis!
Culture and sensitivity test- test be#ore a
person must be given an antibioti
SER-M E&0#ME ST-$%ES:
Serum en+ymes are Released
durin! myocardial cell in1ury* For
M%*
Aspartate Aminotrans)erase 2AST3
S.OT4
+levated level indiates tissue nerosis
2ormal range/ A-=0 mu?ml
,ange with *yoardial )n#artion
)nitial evaluation/ =-E hours
%ea.s/ '=-3E hours
,eturn to normal/ =-A days
Creatine %hospho.inase (C@-*7!
- most ardia spei$ enzyme
- aurate indiator o# myoardial
hange.
- *ost spei$ ardia enzyme to
determine *)
- *ales/ &0-3'& mu?ml
- 6emales/ &0-'&0 mu?ml
,ange with myoardial in#artion
1nset/ 3-E huours
%ea.s/ <'-<F hours
,eturns to normal/ 3 to = days
"atate dehydrogenase ("38!/
-done #or patients with delayed see.ing
medial attention.
-"38<- is the most sensitive indiator o#
myoardial damage to delayed see.ing
medial attention.
2ormal ,ange/ <00 to ''& mu?ml
,ange with *)/
1nset- <' hours
%ea.s- =F hours
,eturns to normal;- <0-<= days
8ydroxybutyrate dehydrogenase (873!
+levation in 873 is always
accompanied by elevated ,$H
levels
-aluing in deteting Gsilent *)H
beause it remains elevated #or a
long period o# time.
873?"38 ratio may be inreases
in *)
2ormal ,ange/ <=0-3&0 ,ange
with *yoardial )n#artion/
1nset/ <0-<' hours
%ea.s/ =F-A' hours
Returns to normal:
5,1%12)2/
*ost spei$ laboratory test to
detet *)
5roponin )- spei$; modulates
the ontratile state
5roponin C- binds alium
5roponin 5- binds ) and C
+levated troponin 5 is as sensitive
as C@-*7 #or the detetion o#
myoardial ativity
5roponin ) persists as = to A days
1nset/ 3 to = hours
%ea./ =- '= hours
3uration- < to 3 wee.s
4,)2A":0)0/
A00+00 the ardiovasular
diseases on renal #untion and
the existene o# onurrent renal
or systemi disease.
Albuminuria- signi#y heart or
.idney disease
*yoglubinuria
0+,4* +"+C5,1":5+0/
+letrolytes aDet ardia ontratility.
2a/ <3& to <=&
%otassium- 3.&-&
Calium- =.&- &.& or F.E to <0
3iagnosti 5est/
+C;- graphial reording o# the
eletrial ativities o# the heart.
Baves, omplexes and intervals
/ "ave4 depolarization o# atria
0.0= to 0.<< seonds
%, interval- time o# impulse
transmission #orm 0A node to your A-
node.
0.<' to 0.'0 seonds
I,0 C1*%"+J- depolarization o# your
ventriles
0.0& to 0. <0 seonds
05 0egment- plateau phase o# the ation
potential.
5 wave- ventriular repolarization
2ot exeed & mm amplitude
8olter *onitoring/
'= 8 +C; monitoring
%ortable monitoring system is
alled telemetry unit
Attempts to assess the ativities
and time p# day when lient will
experiene dysrrhtimias.
2urse must ta.e note the ativity
that aused dysrrythimias
)2-A0)-+ 8+*13:2A*)C *12)51,)2;/
C-%- supine position- =& degrees angle.
%lae it in right midaxillary =
th
interostals spae in line with zero;
every hour it is read; '0-'& m water;
lose the )- line, open the side o#
patient, see i# when the ball goes steady
*onitors the pressure in the right atrium
*onitors blood volum
AdeCuay o# the venous return to the
heart
%ump #untion o# the right side o# the
heart
Kugular anteubital, #emoral vein
0upine position
0trit asepsis
,esult/ 0-<' m water
,ight Atrium/ &-<' m 8'0
Chest Jray- on$rms the orret site
/-,MO&AR# ARTER# /RESS-RE 5
/-,MO&AR# CA/%,,AR# 6E$.E
/RESS-RE
0wan ;anz Catheter- is inserted via
anteubital vein into the right side o# the
heart and is (oated into the pulmonary
artery.
,e(ets pressure in the le#t heart.
6low direted, balloon tipped, = lumen
atheter.
5he atheter allows ontinuous
monitoring o#/
,ight and le#t ventriular #untion
%ulmonary artery pressure
Cardia output
Arterial venous oxygen diDerene
2ormal range/ %A%/ =-<' mm8g
%CB%/ =-<' mm8g
%CB% reading above '& mm8g
suggests impending pulmonary
edema.
2)/ in(ate balloon only #or %CB%
readings; de(ate between
readings
1bserve atheter insertion site
every =F hours as presribed
Assess extremity #or olor,
temperature, apillary $lling and
sensation.
012)C 0543)+0/
+hoardiography- uses ultrasound to
asses ardia struture and mobility.
5ransespohageal +hoardiography
(5++!- allows ultrasoni imaging o# the
ardia strutures and great vessels via
esophagus.
2. ). be#ore 5++
8istory o# esophageal surgery,
malignany or allergy to
anesthetis or sedatives
2%1 (=-E hours!
+nourage to void
,emove dentures and other oral
prosthetis
Administer sedatives as ordered
@eep sution and resusitation
+Cuipment readily available
Cardia monitoring
5opial spray anestheti
"e#t side lying
2%1 until gag re(ex ours
"ateral or semi#olwers post
+nourage to vough
5hroat lozenges or rinses may be
used
1bserve #or signs and symptoms
o# ompliations.
05,+00 5+05)2; 1, +J+,C)0+ 5+05/
+C; is monitored during exerise on a
treadmill or a biyle li.e devie
%urpose/
)denti#y ishemi heart disease
+valuates hest pain
+valuate eDetiveness o# therapy
3evelop individual $tness
program during ardia
rehabilitation.
2ursing )nterventions/
AdeCuate sleep the night be#ore
the test
Avoid/ tea, oDee, alohol,
smo.ing, and ta.ing nitroglyerin
Bear om#ortable, loose $tting
lothes
2%1 = hours be#ore
Bear low heeled rubber soled
pair o# shoes
)n#orm physiian i# any unusual
sensations develop
,est a#ter the test
,adiologi test/
Chest Jray/ determines the overall size
and on$guration o# the heart and
overall hambers
Cardia Catheterization/ assess oxygen
levels, pulmonary blood (ow ardia
output, heart strutures.
Coronary artery visualization
,ight 8eart Catheterization/ insertion
#orm your anteubital or #emoral to right
side o# heart
"e#t/ #rom your brahial artery or
#emoral artery to your le#t side o# heart
dysrrythmias
)n#etion is one ommon ompliation
2)/
%rovide psyhosoial support
Assess allergy to iodine or
sea#ood
1btain vital signs
Bithhold meals be#ore the
proedure
8ave lient void
Administer sedative as ordered
*ar. distal pulses
Cardia monitoring
"oal anesthesia
*ay experiene warm or (ushing
sensation as ontrast medium is
in9eted
(uttering sensation
a#ter the proedure/
upper extremity/ bed rest until
stable
lower extremity/ bed rest #or E-F
hours
monitor vital signs, espeially
peripheral pulses
monitor +C;
apply pressure dressing and a
small sand bag or ie over the
punture site
immobilize aDeted extremity in
extension
do not elevate head o# bed more
than 30 degrees #emoral site was
used
monitor extremities, olor temp
pulse and sensation.
Angiography?arteriography
)nvolves introdution o# ontrast
medium into the vasular system to
outline the heart and blood vessels.
*aybe done during ardia
atheterization
2ursing interventions are similar to
ardia atheterization
1bserve #or hypotension a#ter the
proedure.
*,)
0trong magneti $eld and radio waves
are used to detet and de$ne
diDerenes between healthy and
diseased tissues.
Can show the heart beating and blood
(owing in any diretion
4sed #or examination o# the aorta,
detetion o# tumors, ardiomyopathies
and periardia diseases.
2)/
0eure written onsents
"asts #or =& to E0 minutes
Assess #or laustrophobia
,emove all items
)nstrut lient to remain still
)n#orm lient that *,) unit ma.es a loud
.no.ing noise
Clients with paema.ers or reently
implanted lips or wires are not eligible.