• •

di"retics, digitalis

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


• 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


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





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



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


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


• •

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' 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 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"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.