VALVULAR HEART DISEASE

I.

• •

di"retics, digitalis

MITRAL VALVE PROLAPSE
Occurs when the cusps of the mitral valve billow upward into the atrium during systolic contraction • Diagnostics: echocardiography, stress test, chest x-ray, cardiac catheterization Manifestations: • asymptomatic; Management: • symptomatic treatment (aspirin to prevent TIA, antibiotics, beta-blockers

VII.

PULMONIC VALVE DISEASE
• Usually congenital defects Causes: o mitral stenosis, o p"lmonary emboli, o chronic l"ng diseases • Can lead to decreased cardiac output Manifestations: o m"rm"rs, o #atig"e, o dyspnea Management: o treat the "nderlying ca"se

II.

MITRAL VALVE STENOSIS
Mitral valve becomes calcified and immobile and the valvular orifice narrows • !an res"lt to heart #ail"re and decreased cardiac o"tp"t Manifestations: • atrial #ibrillation • decreased exercise tolerance, • dyspnea, • orthopnea, • m"rm"rs Management: • oral di"retics and $a % restricted diet in heart #ail"re, • anticoag"lants, • digitalis, • beta-blockers

INFECTIOUS DISORDERS OF THE HEART

1. PERICARDITIS

III.

MITRAL VALVE REGURGITATION

Occurs when much pressure is generated within the left ventricle to be generated to the aorta resulting to backflow of blood to the left atrium • &ress"re is re#lected back to the p"lmonary veins and arteries Manifestations: • asymptomatic "ntil cardiac o"tp"t #alls, • m"rm"rs, • atrial #ibrillation, • p"lmonary mani#estations Management: • restrict physical activities, • restrict sodi"m, • di"retics, • digitalis

• ac"te or chronic in#lammation o# the pericardi"m Assessment: • precordial pain • pain (inspiration, co"ghing ) s'allo'ing • pain 'orse 'hen s"pine • pericardial #riction r"b • #ever ) chills • elevated *(! ct+ Management: • &osition: side lying, high ,o'ler-s, "pright ) leaning #or'ard • Admin+ analgesic, corticosteroids, $.AID-s • Avoid aspirin ) anticoag"lants • Antibiotics • Di"retics ) digoxin • /onitor #or complications: !ardiac Tamponade

2. MYOCARDITIS

IV.

AORTIC STENOSIS
Caused by calcification of the valve and stiffening of the aortic valve Manifestations: • initially asymptomatic, angina pectoris, syncope, dyspnea Management: • avoid vigoro"s physical activity, antibiotics, digitalis, beta-blockers

V.

AORTIC REGURGITATION
Blood propelled into the aorta propels back to the left ventricle through an incompetent valve Manifestations: • initially asymptomatic, palpitations, m"rm"rs, lo' (& Management: • same #or aortic stenosis

• ac"te 0 chronic in#lammation o# the myocardi"m Etiology: • (acterial : staphylococc"s 0 pne"mococcal • 1iral : coxsackievir"s 0 m"mps 0 in#l"enza • &arasitic : Toxoplasmosis • 2adiation 0 3ead • /eds: 3ithi"m 0 !ocaine Assessment: • #ever • pericardial #riction r"b • gallop rhythm • m"rm"r • p"ls"s alternans (reg"lar alternation o# 'eak and strong beats 'itho"t changes in cycle length • .0. o# 4, • !hest pain Management: • &osition: (ed rest 0 sitting "p or leaning #or'ard • /onitor p"lse rate ) rhythm • Admin+ #or #ever ) pain • 3imit activities • Admin+ digoxin 0 antidysrhythmics 0 antibiotics as prescribed • $.AID-s 0 analgesics 0 salicylates

3. ENDOCARDITIS

VI.
• •

TRICUSPID VALVE DISEASE
Tricuspid stenosis or regurgitation Causes decreased cardiac output and increased right atrial pressure Manifestations: • neck distention, • peripheral edema, • m"rm"rs Management:

• In#lammation # the inner lining o# the heart Assessment: • #ever, anorexia, 't loss, #atig"e • cardiac m"rm"rs • 5ane'ay-s lesions • 6ssler-s nodes • &etechiae, splinter hemorrhages in nailbeds • .plenomegaly Management • balance activity '0 rest

pregnancy.ever Arthralgia :levated :rythrocyte . 'hich are pathognomonic o# in#ective endocarditis Ossler!s nodes  pain#"l. ne"rom"sc"lar problems. • ade="ate #eeding and #l"id balance CARDIOMYOPATHY • Unkno'n ca"se > ma9or types • $ilated %congestive& cardiomyopathy • 'ypertrophic cardiomyopathy • Restrictive cardiomyopathy 2isk #actors • (lcohol abuse • #regnancy Diagn !"i# T$!"% +. small erythemato"s or hemorrhagic mac"les or nod"les in the palms or soles. raised lesions on the #inger p"lps.  hemat"ria  poly"ria • • 'ypertension )nfections 1) DILATED CARDIOMYOPATHY • • @s"ally both ventricles dilate.• • antiembolism stockings monitor emboli: o Splenic  s"dden abd+ pain radiating to 3 sho"lder 0 rebo"nd tenderness on palpation o Renal  #lank pain radiating to groin."bc"taneo"s nod"les . 0. toxins. nitroglycerin. . RHEUMATIC FEVER/RHD • • &ericarditis that #ollo's expos"re o# child to throat and skin in#ection ca"sed by 7ro"p A (-hemolytic organisms 82epeated bo"ts 'ith permanent scarring o# the valvesà 24D à heart failure Management: Jones’ Criteria /a9or • • • • • /inor • • • • • TERMS • !arditis &olyarthritis !horea :rythema marginat"m . anticoag"lants. metabolic problems. idiopathic Manifestations* • may lead to death . connective tiss"e disorders and genetic predisposition • • • • • • • similar in heart #ail"re 2est and avoid stress 2estrict sodi"m in diet Di"retics. myocardial #ibers degenerate and replaced by #ibrotic tiss"e Associated 'ith in#ections.econdary &rophylaxis: &enad"r = >-? 'eeks • &henobarbital or haloperidol #or chorea • Digoxin #or heart #ail"re • Di"retics #or heart #ail"re • 2est. "CCardiac Catheteri/ation Blood lipid level Medical Management* • 1itrates • (ntiplatelets .< days • . indicative o# the heart disease s"bac"te bacterial endocarditis+ "rythema marginatum  pink rings on the tr"nk and inner s"r#aces o# the arms and legs C Reactive #rotein  a plasma protein that increases d"ring in#lammation CORONARY ARTERY DISEASE $arro'ing or obstr"ction o# one or more coronary arteries as a res"lt o#: o (therosclerosis o (rteriosclerosis RISK FACTORS /odi#iable  !igarette smoking  hypertension  :levated ser"m cholesterol  Diabetes mellit"s  &hysical inactivity  6besity  !hronic stress % Type A personality $on-modi#iable  4eredity and race % African Americans  Advancing age  7ender % men and postmenopausal women Sign & Symptoms: • normal d"ring asymptomatic period • chest pain • palpitations • dyspnea • syncope • co"gh or hemoptysis • excessive #atig"e • • • • Management of RF/RHD • Aspirin or steroid • Initially &enicillin #or ."rgery: myotomy 3) RESTRICTIVE CARDIOMYOPATHY • • !a"sed by #ibrosis and thickening in the heart that ca"ses the ventricles to lose their ability to stretch /anagement: no speci#ic interventions b"t goals are aimed to diminish heart #ail"re disorder ca"sing invol"ntary movement o# spasms • aneway!s lesion  non-tender. avoid alcohol • 8.edimentation 2ate &ositive ! 2eactive &rotein &rolonged &-2 interval Chorea  2) HYPERTROPHIC CARDIOMYOPATHY • $isproportionate thickening of the myocardium that leads to obstruction of blood flow Causes* o genetically transmitted.. antidysrhythmics as ordered !ardiac de#ibrillation Avoid alcohol 4eart transplant 4. red.asymptomatic Management: • medications as ordered.

($ o "nresponsive to treatment 4. b"rning.erapamil %Calan&: $iltia/em %Cardi/em& Types of Angina 1. no necrosis Transient chest pain ca"sed by )1SU55)C)"1T B6OO$ 56O7 to the myocardium resulting in myocardial ischemia.tress E+ Allo' ade="ate time #or rest and relaxation :##ects:  $irect rela3ing effect on vascular smooth musle. In"&a# & na&* !"$n"ing o Collaborative Management of (1-)1( #"CTOR)S Me"i#ation:  VASODILATORS C & na&* a&"$&* . Angina 0$#'. s="eezing+ 2adiating to the le#t sho"lder and "pper arm and may travel do'n to the elbo'.  . !icumarol o Inhibit hepatic synthesis o# 1it+H G 1URS)1. P !"6in/a&#"i n o occ"rs a#ter /I Causes: E!s  "3ertion  "motion  "3posure to cold  "3cessive smoking  "3cessive eating Assessment: • &ain pattern:  /ild % moderate :##ects:  o o o  P(a"$($" Agg&$ga"i n In-i."bsternal or &recordial pain choking.isken& o "smolol %Brevi2bloc& o Medication*  CALCIUM CHANNEL .a(( n angi +(a!"* CORONARY ARTERY .($ o triggered by an @$&2:DI!TA(3: degree o# exertion or emotion 3.i"'! o occ"rs 'hen the client reclines and lessens 'hen the client sits or stands "p 5. pressing. lose 'eight C+ .LOC7ERS ANGINA PECTORIS • • chest pain res"lting #rom myocardial ischemia.T 4. In"&a#"a. :##ects:  $ecrease myocardial o3ygen demand by decreasing heart rate: B#: myocardial contractility and calcium output o (tenolol %Tenormin& o #ropanolol %)nderal& o Metoprolol %6opressor& o 1adolol %Corgard& o #indolol %.YPASS GRAFTING 1CA.ETA6 . a symptom o# an existing disease. S"a.)1T"R.• • • (ntilipemics Beta2(drenergic Blockers Calcium Channel Blockers   Surgical Management a."1T)O1S )n $RU.i" &! o o o (S(%(cetylsalicylic (cid& $ipyridamole %#ersantin& Ticlopidine  ANTICOAGULANTS G Heparin Sodium o Inactivates thrombin and other clotting #actors inhibiting conversion o# #ibrinogen #ibrin. mammary artery or radial artery as conduits or replacement vessels t"bes that act as mechanical scaffold to reopen the blocked artery 0. N #"'&na( o associated 'ith 2:/ sleep d"ring dreaming 6. A"-$&$#" )* o    &allor . c.+ Daily management o# hypertension8 A+ . Un!"a. res"lting in vasodilation o isosorbide dinitrate %)sordil& 9 nitroglycerin o transdermal nitrodisk %patch& 9 1itrol: 1itrobid %Ointment&: (myl 1itrate.. f.aintness &alpitation Dizziness Diaphoresis Dyspnea . there#ore #ibrin clot #ormation is prevented+ Warfarin Sodium Sodium .T'"R(#> 1itroglycerine Therapy o (ssume sitting or supine position 'hen taking the dr"g+ o Take a maxim"m o# 0 doses at ? minute interval o -radual change of position o 6##er SO7%sip of water& before giving S6 nitrates o Instr"ct client to avoid drinking alcohol: smoke . 'rist and #ingers 6evine!s sign Aggravated by activity 2elieved by rest Diagn !"i# T$!"% "CCardiac Catheteri/ation8 "3ercise testing CT scan Myocardial scintigraphy Coronary angiography #.ollo' a healthy heart diet+ D+ 2ed"ce . e. C & na&* A&"$&* . heartb"rn. P&in2)$"a(/3a&ian" o similar to classic angina b"t longer and /AF 6!!@2 AT 2:.($ o triggered by a &2:DI!TA(3: degree o# exertion or emotion (eg+ *alking A< #eet 2.*+a!! G&a/"ing o involves the bypass of a blockage in one or more of the coronary arteries "sing the saphenous veins.top smoking as soon as possible+8 >+ Avoid passive smoke8 ?+ &lan a reg"lar exercise "nder medical s"pervision B+ I# over'eight. b.LOC7ERS .asodilation < reduce myocardial contractility < spasm= decreasing cardiac workload+ 1ifedipine %#rocardia: (dalat: Calcibloc&: . d. P$&#'"an$ '! T&an!(')ina( C & na&* Angi +(a!"* o a balloon2tipped cathether is "s"ally inserted into the femoral artery and inflated several times to reshape the lumen reduces coronary stenosis by e3cising and removing atheromatous pla4ues • • • • • • a. .G) 8$"rsing /anagement: .

in"s Tachycardia 6 . weeks Coumadin o (ssess for signs and symptoms of bleeding o Antidote: . 'ar#arin0co"madin 'u&sing Management:  &romoting Tiss"e 6xygenation and Tiss"e &er#"sion  &romoting Ade="ate !ardiac 6"tp"t  &romoting !om#ort  &romoting rest  &romoting Activity  &romoting $"trition and :limination  &romoting 2elie# o# Anxiety and *ell.. Total C@ levels .:: nausea: vomiting: mental depression: mild diarrhea: fatigue and impotence Calcium2Channel Blockers o (ssess 'R and B# o /onitor 'epatic and Renal 5unction o (dminister + hour ac or . back ) le#t arm o 3:1I$:-. 6$' 0.2? minutes without O3ygen supply %brain& causes death 0?2A? minutes without O3ygen supply %heart& causes death Collaborative Management for Myocardial )nfarction %oals of T&eatment G #revention of further tissue damage an" limitation of infarct si/e G Ma3imi/e myocardial tissue perfusion an" reduce myocardial tissue demands a+ Ac"te .ever  6lig"ria  Anxiety and Apprehension  &allor 0 cyanosis 0 coolness o# ext+0 *eak p"lse  Ac"te &"lmonary :dema  :levated !H-/(. #latelet (ggregation )nhibitors o Assess #or signs and symptoms of bleeding o $o not give (S( with coumadin o Observe for (S( to3icity2 T)11)TUS 'eparin Sodium o Assess #or signs and symptoms of bleeding o Antidote: #ROT(M)1" SU65(T" o I# administered . palpitations. hrs pc. (ST A. Beta2 (drenergic Blockers o (ssess pulse rate be#ore administration o# the dr"g o Administer 'ith #ood o $o not administer #RO#(1O6O6 to clients with asthma and hypoglycemia o 7ive extreme ca"tion in clients 'ith heart #ail"re o 6bserve #or .ual A#ti-ity: o 2es"me i# able to climb A #lights o# stairs o (e#ore: rest is impt+ 0 avoid large meals 0 'ear loose #itting clothes 0 nitro be#ore sex 0 "s"al environment 0 sex at room temperat"re 0 #oreplay o D"ring: com#ortable position 0 sel#-stim"lation 0 oralgenital 0 avoid anal o 3emale position: side lying or rear entry position o Male #osition : reverse missionary or sitting position MYOCARDIAL INFARCTION . (fter meals. kni#elike that may radiate to 9a'. 1ote* .@ o Monitor #T o Minimi/e green leafy vegetables in the diet."dden decrease o# oxygenation d"e to red"ced coronary blood #lo' that res"lts to destr"ction o# myocardial tiss"e in regions o# the heart+ Causes: o Thromb"s o :mboli o Atherosclerosis $o#ation: • 6eft anterior descending artery % anterior or septal 'all /I or both • Circumfle3 artery% posterior 'all /I or lateral 'all /I • Right coronary artery % in#erior 'all /I o Three areas 'hich develop in /I: a+ T wa"e in"ersion (zone o# hypoxia b+ ST ele"ation (zone o# in9"ry c+ #atholo$ic % wa"e (zone o# in#arction $iagnostic Studies +. "CAssessment  &ain pattern: o .acilitating 3earning  Teaching and !o"nseling Re(a)ilitation *Dis#(a&ge afte& MI+: .irst Degree A1 block .ers  %RS comple) 5 "entricular depolari6ation  ST se$ment 5 plateau of action potential  T wa"e 5 "entricular repolari6ation  U wa"e 5 indicates electrolyte im.in"s (radycardia 6 &remat"re Atrial !ontraction 6 &remat"re 1entric"lar !ontraction 6 Torsades de &ointes o 6 Conduction . $o not aspirate: and do not massage o Monitor #TT or (#TT levels o @sed #or a ma3imum of .I+.olytics (streptokinase. elavated 3D4.eta-.alance  %T inter"al 5 "entricular refractory time G CARDIAC DYSRHYTHMIAS • Abnormal heart rhythms o#ten detected beca"se o# associated mani#estations o# dizziness.+ Discontin"e smoking A+ Diet >+ *eight 2ed"ction ?+ &rogressive exercise B+ /aintenance /edication C+ 2es"mption o# sex"al activity is 1-2 wee/s #rom discharge D+ . and syncope ETIOLOGY • Dist"rbance in the > ma9or mechanisms: o Automaticity 6 .loc/ers (propranolol.(eing  . prolonged cr"shing s"bsternal pain.tress /anagement Techni="es Tea#(ing %ui"elines in Resuming Se.T E($#"& #a&0i g&a) an0 i"! # )+ n$n"! C'M#'(E(TS '3 EC4  # wa"e 5 atrial depolari6ation  #R inter"al 5 impulse tra"el from atria to pur/in7e fi.evere.:: 'eadache: flushed face: di//iness: faintness and tachycardia. "rokinase  Anticoa$ulants (heparin. . A. timolol  0Throm.o 6bserve #or .)T.tage:  Admin+ prescribed medications :  M& '& (& A& G Morphine Sulfate G ')y$en #A*( G (itrates G Aspirin  +idocaine (Jylocaine  .I7$  .

alcohol.l"tter Atrial .ibrillation 1entric"lar Asystole o PREMATURE VENTRICULAR CONTRACTION 6 &remat"re ventric"lar beats associated 'ith /I. atrial cham. increase the heart rate as appropriate 6 Isoproterenol o G ATRIAL DYSRHYTHMIAS • • • • &remat"re Atrial complex (&A! Atrial . heart failure. shape and size Management: 6 I"inidine or procainamide AV n 0$ D*!&-*"-)ia! o o o . etc . erratic imp"lse #ormation and cond"ction 'hich ca"ses a.ibrillation &aroxysmal Atrial Tachycardia VENTRICULAR FI. fati$ue.B20?B bpm 6 A1 node cannot cond"ct all the atrial imp"lses that bombard it 3*RST !E4REE A8 .ame toother atrial 'ave #ormation ca"sed by rapid reentry in the atria 6 (trial rate ranges from .er enlar$ement. 6 !alci"m !hannel (lockers. 6 De#ibrillation Clinical Manifestations • • • • • • • • • &alpitations . electrolyte imbalance Management: 6 De#ibrillation. 6 ca##eine. 6 beta-blockers. congenital anomalies and digitalis administration 6 2e="ires observation and monitoring since it can progress to higher-degree A1 block . 6 !ardioversion o Management: 6 aimed at treating the "nderlying ca"se..RILLATION 6 2apid. 6 $a (icarbonate. 6 :pinephrine • PREMATURE ATRIAL CONTRACTION 6 :arly beats arising #rom the atria and interr"pting the normal rhythm 6 Associated 'ith "al"ular disorders. !AD.ibrillation Management: 6 !ardioversion. CA!. pulmonary hpn 6 & 'aves are premat"re and di##erent #rom the normal sin"s & 'ave in appearance.e constantly chan$in$ 6 Usually results from dru$ to)icity or electrolyte im. 6 De#ibrillation. electroc"tion. 6 heart #ail"re. stress.irst degree heart block .A node #ires less than C< times per min"te o $ormal in some people (eg+ Athletes Management: 6 treat the "nderlying ca"se. 8meds as ordered • SINUS . heart #ail"re.efore its anticipated time& 6 Dangero"s Management: 6 lidocaine 6 other antidysrhythmics TORSADES DE POINTES 6 . 6 hypercalcemia.RADYCARDIA o 8.RILLATION 6 3i#e-threatening dysrhythmia characterized by rapid.6 6 o 6 6 6 . oxygen.l"ggish !2T Decreased "rine o"tp"t :!7 changes G SINUS DYSRHYTHMIAS • o o SINUS TACHYCARDIA 2apid. M*. chaotic atrial depolarization #rom a reentry disorder 6 ABB2DBB bpm 6 A1 node is bombarded 'ith more imp"lses than it can cond"ct Management: 6 Antidysrhythmics. 6 /obitz type A Third degree heart block • ATRIAL FLUTTER 6 . At&opine/ nit&ates/ epinep(&ine+.rupt cessation of cardiac output0 6 2es"lts #rom severe /I.alance 6 *t is an emer$ency Management: 6 3idocaine. 6 (eta adrenergic blockers • ATRIAL FI.orm o# ventric"lar tachycardia in 'hich the %RS comple)es appear to . digitalis toxicity. 6 #ever. 6 anti-dysrhythmics (digitalis. ="inidine. hypermetabolic states 6 a cardiac irreg"larity in 'hich the "entricled contracts . 6 hyperthyroidism.econd degree heart block 6 /obitz type . increased vagal stim"lation.l"tter Atrial . 6 medications (eg. nicotine.econd Degree A1 block Third Degree A1 block Reentry of impulses Atrial .ibrillation 1entric"lar . acidosis.yncope &allor Diaphoresis Altered mentation 4ypotension . reg"lar rhythm at a rate of +BB2+CB bpm 6cc"rs in response to : 6 increased sympathetic stimulation or decreased parasympathetic stimulation.+'C9 6 !elay in the passa$e of impulse from the atria to "entricles usually occurs at the le"el of the A8 node 6 2es"lts #rom !AD. 6 nicotine. bed rest. 6 #l"id vol"me loss G VENTRICULAR DYSRHYTHMIAS o o o o &remat"re 1entric"lar !ontraction 1entric"lar Tachycradia 1entric"lar . 6 stress.

ec/’s triad: distended neck veins 0 m"##led heart so"nds 0 hypotension o !hest pain o !ardiogenic shock o Increased !1& Management: o !!@ #or hemodynamic monitoring o &:2I!A2DI6!:$T:.elow the A8 node 6 2e="ires :!7 monitoring Management: a"minist&ation of at&opine/ inse&tion of pa#ema1e&/ 2it((ol"ing #a&"ia# "ep&essant "&ugs TH*R! !E4REE A8 . press"re on s"rro"nding str"ct"res.o'ler-s position 6 $RU-S* M(. viral in#ections and /I 0 types: 6 Mobit/ Type + Block %7enckebach& 6 Mobit/ Type .+'C9 6 /ore serio"s and some impulses are .sence of conduction of electrical impulses d"e to a block in the A1 node. B6OC@ 6 +e"el of the .ility& Hyper"olemia Arteriosclerosis Myocardial *nfarction Cardiomyopathies 8al"e disorders Ri$ht-sided CH3 Systemic S)< 6 3ati$ue 6 distended 7u$ular "eins 6 Ascites 6 pittin$ edema 6 Cyanosis 6 hepatome$aly 6 increased peripheral "enous pressure 6 anore)ia = 4* distress 6 polyuria = wt& $ain ANEURYSMS 6 6 6 &ermanent localized dilation o# an artery that enlarges grad"ally !a"ses: atherosclerosis."1TR)CU6(R #(C"M(@"R Complication: Rupture • T&ia" manifestations of &uptu&e: • &ain • &"lsating mass • . 36!.hock • 6ther mani#estations: • . etc++ • 6 7ross appearance: . rhe"matic #ever.uate circulation to meet the meta. thrombosis and embolization Classification of (neurysms according to* • 3ocation 6 1eno"s or arterial 6 Aortic."si#orm (localized dilations o# an artery +eft-sided CH3 #ulmonary S)< 6 Cardiome$aly 6 .46!H.+'C9 6 Complete a. o Admin+ I1 #l"ids as prescribed HEART FAILURE 6 Causes: a< .ec& of an impaired pumpin$ capa. hypertension !omplications: r"pt"re.a$ • MOR#')1" • (M)1O#'>66)1" • .asodilators2 1itroprusside: 1itroglycerine  )notropic (gents2 $igitalis: $opamine  $iuretics2 5urosemide 6 /onitor ho"rly "rine o"tp"t.olic needs of the .ility of the heart to maintain ade. of CHOICE: . in#ection. Block • 6 6 6 MOB)TE T>#" + B6OC@ Caused . b"ndle o# 4is or b"ndle branches 6 Danger o# ventric"lar standstill or asystole Management: T.ody .aortic balloon catheter 6 A/I. resultin$ in increased perfusion of the coronary arteries and myocardium and a decrease in left "entricular wor/load Assessment: o .!A2DI67:$I! . arrythmias 6 &rovide psychosocial s"pport 6 Decrease p"lmonary edema 6 A"sc"ltate l"ng #ields 6 &lace in . congenital mal#ormations. digitalis toxicity.y a lon$ refractory period that occurs at the A8 node &2 interval lengthens "ntil a & 'ave is not cond"cted Interventions is not re="ired as long as the ventric"lar rate remains ade="ate #or per#"sion 6 6 .loc/ is .SEC'(! !E4REE A8 .(SO$)6(TORS • $)UR"T)CS o o o @tilize Counterpulsation to red"ce ventric"lar 'ork o# the client 'ith severe shock Counterpulsation 6 involves introd"ction o# intra.< c< d< e Types:  *na. @$. iliac.yncope • 3ight headedness • hypotension Me"i#al Management: (ntihypertensives as ordered: ultrasonography every F months Su&gi#al Management: Resection and graft replacment CARDIAC TAMPONADE 6 &ericardial e##"sion occ"rs 'hen the space bet+ the parietal ) visceral layers o# the pericardi"m #ill 'ith #l"id+8 CARDIOGENIC SHOC7 1PO8ER/PUMP FAILURE) 6 is a shock state 'hich res"lts #rom pro#o"nd left "entricular failure "s"ally #rom massi"e M* (ursin$ *nter"entions 6 &er#orm hemodynamic monitoring 6 Administer oxygen therapy 6 !orrect 4ypovolemia 6 &harmacotherapy:  . connective tiss"e disorders.I.lood tin$ed sputum 6 Cou$h 6 acute pulmo edema 6 E)ertional dyspnea 6 cyanosis 6 'rthopnea 6 wt& +oss Management 6 Rest 6 Hi$h-3owler’s or sittin$ 6 !ecrease fluids > (a? 6 Medications:  .TA(3: A$7I$A a"gments diastole.loc/ed while others are not 6 Develops #rom !AD.acc"lar (an o"tpo"ching o# an artery 'here the medial coat is thinned Dissecting (hematoma in the artery 'all #rom a localized enlargement o# the involved artery • MOB)TE T>#" .

o #(e#1 "istal pulses o &emo-e 5 at a time 7 5 mins. Inte&-al .o o o o o o o o o !ardiac 7lycosides % (K inotropy 0 (chronotropy digitalis 0 digoxin (3anoxin 0 digitoxin (!rystodigin 0 lanatoside (!edilanid-! Di"retics % 4A6 ) $aK excretion 3oop di"retics % .+ 1asodilators 2otating To"rni="et • #rinciples: o apply 3 tou&ni4uets o inflate #uff 56 mm a)o-e "iastoli# p&essu&e o &otate 4 5 mins."rosemide (3asix Thiazide di"retics % chlorthiazide (Di"ril &otassi"m sparing % spironolactone (Aldactone Inotropics % increases the strength o# contraction s"ch as "opamine *Int&opin+/ "o)utamine *Do)ut&e.