CARDIOVASCULAR Management of Acute HTN Emergency BP
Chest Pain STAT EKG >180/110 with evidence
REVIEW of end-organ damage.
done and read within 10
minutes, 325mg chewable Needs critical care
CCRN Exam Cram aspirin ASAP, admission and emergent
Review anticoagulant therapy, lowering of BP. Biggest
antiplatelet therapy, beta risk is STROKE.
blocker administration.
Nitroprusside Drip:
Heart Sounds Use metoprolol, NOT
preload and afterload
propranolol. Treat chest
reducer. Assess for
S1, S3, S4: Heard at apex pain with morphine or
cyanide toxicity
nitroglycerin.
S2: Heard at base (thiocyanate)... mental
If symptoms have been status changes,
S3: r/t heart failure present <12 hours, tachycardia, seizure, need
prepare for PCI. Door to for increase in dose,
S4: r/t MI, HTN, metabolic acidosis.
balloon in 90 minutes.
ventricular hypertrophy, &
Door to fibrinolytic therapy
aortic stenosis Labetalol IV Push:
in 30 minutes.
Intermittent IV pushes
………………………………
……………………………… preferred over drip due to
Mitral stenosis is the possibility of
associated with atrial continuing drip past max
After PCI Evidence of of 300mg.
fibrillation due to atrial
successful reperfusion
enlargement. ………………………………
includes chest pain relief,
……………………………… normalized ST segment,
and reperfusion
Stenosis occurs with an Acute Peripheral Vascular
arrhythmias (VT, VF).
OPEN valve. Troponin and CK-MB Insuciency Normal
Insufficiency occurs with remain elevated after ankle-brachial index is
a CLOSED valve. reperfusion! >1. Put bed in reverse
trendelenburg to increase
………………………………
blood flow. Do NOT
NSTEMI: + troponin, ST elevate the extremity!
depression, unrelenting
Complications of PCI
chest pain. Monitor for signs of re-
Medical Management:
occlusion… chest pain
STEMI: + troponin, ST tPA, thrombolytics,
and ST elevation similar to
elevation, unrelenting heparin, anticoagulants,
before PCI.
chest pain. antiplatelets, vasodilators.
Monitor for vasovagal
Prinzmetal’s (Variant) response during sheath
Angina: - troponin, removal. Administer
nitroglycerin relieves atropine and fluids, hold
chest pain and returns nitrates.
ST segment to normal
Monitor for signs of
retroperitoneal
bleeding… back pain
and hypotension.
1
,QT Prolongation Systolic Heart Failure: Symptoms of Right-
Normal QT interval is Ejection problem, EF < Sided Heart Failure:
0.36 to 0.4 seconds. 40%. Dilated ventricle. Hepatomegaly,
S3 heart sound. Large, splenomegaly, dependent
Prolongation of the QT dilated heart or normal edema, increased CVP,
interval can lead to heart size on CT scan. tricuspid insufficiency,
Torsades de Pointes! abdominal pain.
Treatment: Beta
Treatment of Torsades blockers, ACE/ARBs,
de Pointes is positive inotropes. VS
magnesium.
Contraindicated: Symptoms of Left-Sided
Drugs that prolong QT: Calcium channel Heart Failure: Orthopnea,
amiodarone, quinidine, blockers & negative dyspnea, tachypnea,
haloperidol, inotropes. hypoxemia, tachycardia,
procainamide. crackles, cough with
VS
pink/frothy sputum,
Electrolytes that prolong
diaphoresis, anxiety,
QT: hypokalemia, Diastolic Heart Failure:
confusion, increased PAP
hypocalcemia, Filling problem, EF >
& PAOP.
hypomagnesemia. 50%. Thick,
hypertrophic ventricle. ………………………………
……………………………… S4 heart sound with
hypertension. Normal
heart size on CT scan. NYHA Heart Failure
3 Pacemaker
Treatment: Beta Classification
Malfunctions
blockers, ACE/ARBs,
calcium channel Class I: Symptoms
Failure to Pace: No
blockers. caused by extraordinary
pacer spike when
activity.
expected.
Contraindicated:
Positive inotropes (no Class II: Symptoms
Failure to Capture:
digoxin, dopamine, or caused by ordinary
Pacer spike occurs
dobutamine for these activity.
without QRS complex.
patients).
Class III: Symptoms
Failure to Sense: Pacing
……………………………… caused by minimal activity
in native beats.
(such as walking to the
……………………………… Systolic heart failure can bathroom).
cause valvular
Class IV: Symptoms at
insufficiency r/t a dilated
Heart Failure Elevated rest.
ventricle.
LVEDP. High intracardiac
Both systolic and diastolic
pressures & decreased
heart failure cause
CO.
pulmonary edema r/t poor
ventricular emptying.
2
, Cardiogenic Shock Post-Op CABG Nursing Cardiac Trauma The
Extreme decrease in Care Monitor for aortic valve is most
stroke volume r/t systolic complications of cardiac likely to be ruptured
dysfunction. tamponade and because it is most
pericarditis. anterior. Pain is worse
Increased PAOP r/t with inspiration. ST
increased LV preload. Do not clamp or milk chest elevation present in the
tubes, maintain dependent area of injury only.
Increased SVR r/t
drainage with Worse outcome than
compensatory
NO LOOPS IN TUBING. pericarditis.
vasoconstriction.
Monitor for chest tube VS
Decreased CO means
output > 100mL for two
that perfusion to organs
consecutive hours. Pericarditis ST
is inadequate.
……………………………… elevation in ALL LEADS
Narrow pulse pressure. (aka “global” ST
elevation). Pain is worse
Treatment: Give
Valve Replacement with inspiration.
positive inotropes!
High risk for blood clots, Dressler’s Syndrome is
Give norepinephrine,
need anticoagulation! pericarditis that occurs
dopamine < 10 mcg,
after MI, surgery, or injury.
dobutamine, or
Avoid a drop in preload!
milrinone.
May result in dangerous
………………………………
Also, reduce preload & hypotension.
afterload with
Conduction disturbances
Thoracic Aneurysms
vasodilators in Aneurysms >6 cm needs
r/t surgery near SA/AV
conjunction with surgery and blood
nodes. May need a
positive inotropes, pressure control with a
temporary or permanent
IABP, or VAD.
pacemaker. labetalol drip.
Ventricular Assist Device ……………………………… Sudden tearing, ripping
pain in chest, radiating to
(VAD) Used in the shoulders/back, cough,
management of left Cardiac Tamponade and widening
ventricular heart failure, Symptoms: mediastinum on X-ray
cardiogenic shock, and Hypotension, JVD, indicate a RUPTURE,
cardiomyopathy. Used for muffled heart tones, which is a surgical
patients awaiting a heart equalization of emergency!
transplant. CVP/PAOP, narrowed
pulse pressure, pulsus
Intra Aortic Balloon Pump paradoxus, enlarged
cardiac silhouette.
(IABP) Inflates during
diastole to increase Pulsus Paradoxus is a
myocardial oxygen drop in SBP during
supply. Deflates during inspiration.
systole to reduce left
ventricular afterload.
3
Chest Pain STAT EKG >180/110 with evidence
REVIEW of end-organ damage.
done and read within 10
minutes, 325mg chewable Needs critical care
CCRN Exam Cram aspirin ASAP, admission and emergent
Review anticoagulant therapy, lowering of BP. Biggest
antiplatelet therapy, beta risk is STROKE.
blocker administration.
Nitroprusside Drip:
Heart Sounds Use metoprolol, NOT
preload and afterload
propranolol. Treat chest
reducer. Assess for
S1, S3, S4: Heard at apex pain with morphine or
cyanide toxicity
nitroglycerin.
S2: Heard at base (thiocyanate)... mental
If symptoms have been status changes,
S3: r/t heart failure present <12 hours, tachycardia, seizure, need
prepare for PCI. Door to for increase in dose,
S4: r/t MI, HTN, metabolic acidosis.
balloon in 90 minutes.
ventricular hypertrophy, &
Door to fibrinolytic therapy
aortic stenosis Labetalol IV Push:
in 30 minutes.
Intermittent IV pushes
………………………………
……………………………… preferred over drip due to
Mitral stenosis is the possibility of
associated with atrial continuing drip past max
After PCI Evidence of of 300mg.
fibrillation due to atrial
successful reperfusion
enlargement. ………………………………
includes chest pain relief,
……………………………… normalized ST segment,
and reperfusion
Stenosis occurs with an Acute Peripheral Vascular
arrhythmias (VT, VF).
OPEN valve. Troponin and CK-MB Insuciency Normal
Insufficiency occurs with remain elevated after ankle-brachial index is
a CLOSED valve. reperfusion! >1. Put bed in reverse
trendelenburg to increase
………………………………
blood flow. Do NOT
NSTEMI: + troponin, ST elevate the extremity!
depression, unrelenting
Complications of PCI
chest pain. Monitor for signs of re-
Medical Management:
occlusion… chest pain
STEMI: + troponin, ST tPA, thrombolytics,
and ST elevation similar to
elevation, unrelenting heparin, anticoagulants,
before PCI.
chest pain. antiplatelets, vasodilators.
Monitor for vasovagal
Prinzmetal’s (Variant) response during sheath
Angina: - troponin, removal. Administer
nitroglycerin relieves atropine and fluids, hold
chest pain and returns nitrates.
ST segment to normal
Monitor for signs of
retroperitoneal
bleeding… back pain
and hypotension.
1
,QT Prolongation Systolic Heart Failure: Symptoms of Right-
Normal QT interval is Ejection problem, EF < Sided Heart Failure:
0.36 to 0.4 seconds. 40%. Dilated ventricle. Hepatomegaly,
S3 heart sound. Large, splenomegaly, dependent
Prolongation of the QT dilated heart or normal edema, increased CVP,
interval can lead to heart size on CT scan. tricuspid insufficiency,
Torsades de Pointes! abdominal pain.
Treatment: Beta
Treatment of Torsades blockers, ACE/ARBs,
de Pointes is positive inotropes. VS
magnesium.
Contraindicated: Symptoms of Left-Sided
Drugs that prolong QT: Calcium channel Heart Failure: Orthopnea,
amiodarone, quinidine, blockers & negative dyspnea, tachypnea,
haloperidol, inotropes. hypoxemia, tachycardia,
procainamide. crackles, cough with
VS
pink/frothy sputum,
Electrolytes that prolong
diaphoresis, anxiety,
QT: hypokalemia, Diastolic Heart Failure:
confusion, increased PAP
hypocalcemia, Filling problem, EF >
& PAOP.
hypomagnesemia. 50%. Thick,
hypertrophic ventricle. ………………………………
……………………………… S4 heart sound with
hypertension. Normal
heart size on CT scan. NYHA Heart Failure
3 Pacemaker
Treatment: Beta Classification
Malfunctions
blockers, ACE/ARBs,
calcium channel Class I: Symptoms
Failure to Pace: No
blockers. caused by extraordinary
pacer spike when
activity.
expected.
Contraindicated:
Positive inotropes (no Class II: Symptoms
Failure to Capture:
digoxin, dopamine, or caused by ordinary
Pacer spike occurs
dobutamine for these activity.
without QRS complex.
patients).
Class III: Symptoms
Failure to Sense: Pacing
……………………………… caused by minimal activity
in native beats.
(such as walking to the
……………………………… Systolic heart failure can bathroom).
cause valvular
Class IV: Symptoms at
insufficiency r/t a dilated
Heart Failure Elevated rest.
ventricle.
LVEDP. High intracardiac
Both systolic and diastolic
pressures & decreased
heart failure cause
CO.
pulmonary edema r/t poor
ventricular emptying.
2
, Cardiogenic Shock Post-Op CABG Nursing Cardiac Trauma The
Extreme decrease in Care Monitor for aortic valve is most
stroke volume r/t systolic complications of cardiac likely to be ruptured
dysfunction. tamponade and because it is most
pericarditis. anterior. Pain is worse
Increased PAOP r/t with inspiration. ST
increased LV preload. Do not clamp or milk chest elevation present in the
tubes, maintain dependent area of injury only.
Increased SVR r/t
drainage with Worse outcome than
compensatory
NO LOOPS IN TUBING. pericarditis.
vasoconstriction.
Monitor for chest tube VS
Decreased CO means
output > 100mL for two
that perfusion to organs
consecutive hours. Pericarditis ST
is inadequate.
……………………………… elevation in ALL LEADS
Narrow pulse pressure. (aka “global” ST
elevation). Pain is worse
Treatment: Give
Valve Replacement with inspiration.
positive inotropes!
High risk for blood clots, Dressler’s Syndrome is
Give norepinephrine,
need anticoagulation! pericarditis that occurs
dopamine < 10 mcg,
after MI, surgery, or injury.
dobutamine, or
Avoid a drop in preload!
milrinone.
May result in dangerous
………………………………
Also, reduce preload & hypotension.
afterload with
Conduction disturbances
Thoracic Aneurysms
vasodilators in Aneurysms >6 cm needs
r/t surgery near SA/AV
conjunction with surgery and blood
nodes. May need a
positive inotropes, pressure control with a
temporary or permanent
IABP, or VAD.
pacemaker. labetalol drip.
Ventricular Assist Device ……………………………… Sudden tearing, ripping
pain in chest, radiating to
(VAD) Used in the shoulders/back, cough,
management of left Cardiac Tamponade and widening
ventricular heart failure, Symptoms: mediastinum on X-ray
cardiogenic shock, and Hypotension, JVD, indicate a RUPTURE,
cardiomyopathy. Used for muffled heart tones, which is a surgical
patients awaiting a heart equalization of emergency!
transplant. CVP/PAOP, narrowed
pulse pressure, pulsus
Intra Aortic Balloon Pump paradoxus, enlarged
cardiac silhouette.
(IABP) Inflates during
diastole to increase Pulsus Paradoxus is a
myocardial oxygen drop in SBP during
supply. Deflates during inspiration.
systole to reduce left
ventricular afterload.
3
