Classifica- Ca+ Channel

tion ACE Inhibitors Beta Blockers K+ Channel Blockers Cardiotonics

Blockers

↓ conversion of slows action potential decreasses conduction

MOA
A-I to A-II; vasodilator decreases HR decreases conduction (fibrillation) of electrical impulses

*captopril *atenolol *verapamil *amiodarone *adenosine

*enalapril *carvedilol *diltiazem ↑ effects of digoxin
Drug *lisinopril *metoprolol *amlodipine *propafenone *digoxin
Names *ramipril *nifedipine *procainamide (0.8 - 2 ng/mL)
*sotalol
*trandolapril *Alpha's dine & sin *felodipine *ibutilide *digitoxin
*fosinapril *clonidine, *prazosin *nicardipine *sotalol (14 - 26 ng/mL)

HTN, CAD, SVT,

HTN, AV block, SVT, HTN, a.fib/flutter, SVT, A.fib,
A.fib/flutter,
Cardiac A.fib/flutter, bradycardia, impaired
SVT, junctional A.fibw/RVR CHF/HF
dysthythmia, CONTRAINDICATED
Treat-
ment
junctional peripherial circulation,
chronic stable
SVT, heart block, V.tach/fib,
dysrhythmia, chronic stable angina pregnancy

stable angina
CAUTION - in asthma pt's -
bronchospasms; & DM pts - can
angina VT/VF CAUTION
advanced HF &
mask s/s of hypoglycemia
CAUTION - in HF
renal insuffieiency

digoxin toxicity:
hypoT, dizziness, fatigue, AV block (prolonged PR HF, AV block, pulmonary
N/V, brady, P hypoT, KCL - IV or PO
headache, ARF, ↑K+, interval), bradycardia, toxicity, painful breathing,
Side fatigue, bronchospasms, early s/s - N/V/D,
Effects
angioedema, skin rash, hypoT, pulmonary edema, cough, SOB, weakness in
hyperglycemia, head/dizz, brady/tachy, PVC's,
cough, loss of taste, CHF, headache, dizziness, arms/legs, trouble walking,
drowsiness, CHF, ED bi/trigeminy
N/V/C, GI irritation flushing, rash, fever,chills dizziness, lightheadedness
late s/s - visual changes

*assess BP, HR, skin, *ortho BP, LFT's, *I/O, s/s of CHF, *assess BP, AP, lung
weight (daily or weekly) pulm.edema/lungs, *assess BP, RR, apical &
facial edema, K+ radial pulses, renal & LFT sounds, JVD, weight,
serum, renal tests *hold if apical < 60 daily weight, pain level sputum, extremity
*hold HR>120 or <60
*hold SBP <100 *hold if SBP < 100 *BP & HR q3-4h *safety/safety/safety edema, renal & LFT's
Nursing
Manage- *ASA/NSAIDs may *avoid EtOH, OTC's, *hold if apical < 60 *keep all aptmts-MD, labs, *teach pt's s/s of
ment reduce effectivness & hazardous tasks if *hold if SBP < 100 etc. & follow diet plan digoxin toxicity
*full effect on BP dizzy; rise slowly *may cause 1° HB *avoid EtOH, smoking, *no herbal drugs
*do not stop abruptly *take with meals OTC's, swallow whole,
may not be seen wax may be found in stool *K+ rich diet; monitor
*caution use with *pines are for BP; varapimil
for 3-6 wks African Americans & diltiazem for dysrhythmias* K+ levels
Classifica-
tion Direct Vasodilators Statin Drugs Antiplatelet Anticoagulation Anticholinergenic

relax arteriolar smooth decrease platelet antiparasympathetic;

MOA muscle, causing
inhibit synthesis of aggregation & inhibit
prolong the formation
transient
blood vessel dilation cholesterol in liver of blood clotting
thrombus formation phase of stimulation

*warfarin
*hydrazaline *atorvastain
*ASA Antidote = Vitamin K

Drug
*nitroglycerin *lovastatin PT- 9.6-11.8seconds
Names
(sublingual, patch, & paste) *clopidogrel INR- 2-3x norm (1.5-2.0) *atropine
*isosorbide mononitrate *simvastatin *heparin, *enoxaprin
*sodium nitroprusside bisulfate Antidote = Protamine Sulfate
*fluvastatin aPTT therapeutic - 60-80

MI or re-infarction, A.fib/flutter, MI,

CAD, stroke DVT, PE, stroke
HTN, chronic HDL
Cardiac
Treat- stable angina, HF
CONTRAINDICATED
pregnancy (3rd trimester), CONTRAINDICATED bradycardia,
thrombocytopenia
ment
after MI CAD bleeding disorders or
thrombocytopenia CAUTION Mobitz II
CAUTION PUD, severe HTN,
PUD, hepatic/renal disease hemophelia

headache, dizziness, HR, BP, bruising,

palpitations/tachy,
Side
Effects N/V, hypoT, flushing
*reactions lessen with
prolonged use/dose adjust
NVCD, elevated liver hematuria, bruising, can't see, can't pee
petechiae, black/tarry
enzymes, myopathy, epistaxis, confusion, GI can't spit, can't sh*t
stools, bleeding in
rhabdomylosis, ulcers or upset, tachycardia, agitation,
urine/gums, vasculitis,
GI disturbances, rash hemorrhage delirium, NVC, ED
hemorrhage

*take on an empty stomach *take with food/milk *assess for

*monitor LFT's prior to *avoid all IM injections
*if headache develops treat *advise patient of
& q6-12wks after *inspect & teach for tachycardia; may
w/ASA or acetaminpohen prolonged bleeding time;
start of therapy abnormal bleeding
*advise patient to take an
*use in adjunction with
notify HCP of unusual
*teach a diet consistent in lead to V.fib
Nursing additional dose prior to bleeding *monitor I/O; may
diet therapy; restrictions of vitamin K is essential
Manage- anticipated stress & have *may cause dizziness or
ment drug accessible at all times
saturated fat & cholesterol *med ID bracelet, electric cause urinary
drowsiness
*review dietary habits, razor, soft toothbrush
*keep record of attacks
weight, & exercise patterns
*inform HCP before
*contact HCP prior to retention
*assess pregnancy status undergoing any procedures
*avoid EtOH
*CK - if muscle pain or
or new drug therapy
taking any OTC or *give IV over
weakness occurs herbal therapy 1 minute
*do not mix w/other drugs *NO ASA or NSAIDs
 Dx Tests Description & Purpose Nursing Considerations
EKG recording for 24-48 hours
encourage to stimulate conditionsthat
correlating rhythm changes
Holter produce symptoms; keep an accurate
w/symptoms in diary; recorder is used
Monitoring diary of activities & symptoms; no bath
to store, recall, print & analyzeinfo for
or shower
rhythm disturbances

ultrasound of chest & heart; assess for allergy to shellfish; supine

Echocardiogr measures position on left side of equipment; no
am EF% - IV contrast may be used to contraindications to procedure
enhance images; also records direction unless contrast is being used
of blood flow across valves

Used as substitute for exercise stresstest start IV infusion; monitor VS

in people unable to exercise; dobutamine before/during/after until baseline
Pharmacologi or dipyridamole infused via IV & dose achieved; aminophylline given to
c Echo increased in 5 min intervals to detect prevent or reverse
abnormalities side effects of dipyridamole

Transesophag probe w/ultrasound transducer is throat anesthetized; designated

eal swallowed & passes down esophagus; driver needed;
Echocardiogr contrast may be injected IV for bite block placed-suctioning as
am evaluating blood flow if atrial or needed;
(TEE) ventricular septa defect is suspected no eating/drinking until gag reflex

exercise tolerance, ADL's, rhythm pt to wear comfortable clothes/shoes &

disturbances, EKG changes;
Exercise
contraindications acute CV disease,
Stress Test
recent MI (2weeks), angina
Nuclear images are taken at rest & after
exercise; injection given at max HR on
Exercise bicycle/treadmill & continue for 1 min to
Nuclear circulate; scanning done 15-60min after
exercise; resting scan 60-90min after initial
Imaging infusion or 24 hours later
walk as quickly as possible; hold bb&
caffeine
24 hrs prior to procedure; no smoking3
hrs prior; test is terminated for
chest discomfort
explain to eat only a light meal
between scans; certain medications
may need to be held for 1-2 days
before the scan

dipyridamole or adenosine topromote hold all caffeine products 12 hours

Pharmacologi vasodilation when unable to exercise prior to procedure; hold bb & CCB 24
c Nuclear hours prior
Imaging

IV injection of radioisotopes; establish IV line - pt will have to lie

measures blood flow to heart at rest & still on back with arms extended for20
Nuclear while your heart is working harderas a minutes; repeat scans are performed
Cardiology result of exertion or medication; HCP within afew minutes to hours after the
suspects CAD injection

Single-photon for MI;

Emission small amounts of radioactive isotope establish IV line;
Computed injected via IV; detects coronary artery ECGmonitoring
Tomography blood flow, intracardiac shunts,motion of
(SPECT) ventricles,

Dx Tests Description & Purpose Nursing Considerations

 contrast injected to examine withhold food/fluids 6-18 hours; give
structure & motion of heart &coronary
Cardiac sedative; instruct patient to deep
arteries; also provides information to
Catheterizatio breath when dye is injected; assess
determine need for angioplasty or
n circulation, peripherial pulses, color,&
stenting
sensation q15min/1 hour after

small amount of blood removed, mixed

Multigated w/radioactive isotope & reinjected; establish IV line, EKGmonitoring;
EKG's used for timing, images acquired procedure involves little risk
Acquisition during cardiac cycle; indicated for MI,
Scan (MUGA) HF, valvular HD,
cardiotoxic drugs on the heart

Magnetic used for vascular occlusive disease

& AAA; same as MRIbut with use contraindicated w/allergies tocontrast or
Resonance implanted metal devices
Angiography of gadolinium as IV contrast
(MRA)

evaluates heart muscle, coronary artery

circulation, pulmonary veins, thoracic procedure is quick & involveslittle to no
Cardiac CT risk; assess for shellfish allergies
aorta,pericardium; IV contrast
Scan

invasive study to record cardiac discontinue antidysrhythmic

Electro- electrical conduction using cathetersvia meds several days prior to study; NPO
physiology femoral & jugular veins into rightside of 6-8h, IV sedation if needed; frequent VS
Study (EPS) heart; dysrhythmia can be induced &
terminated & continuous EKG after procedure

injection of contrast into veins check for iodine allergy; mildsedative;

Peripherial or arteries followed by serial x- rays to check extremity puncture, pulsation,
Arteriography detect atherosclerotic plaques, warmth,motion, swelling, bleeding;
& Venography occlusions, aneurysms,or trauma

Dx Labs Description & Purpose Nursing Considerations

* earliest increase 4-6 hours, peak < 0.5 ng/mL - normal
hours 10-24 hrs 0.5 - 2.3 ng/mL - suspicious for MI
Troponin - I * duration of increase 4-7 days injury
* specificity 95%; sensitivity at peak
> 2.3 ng/mL - positive for MI injury
98%
* earlies increase 4-8 hrs; peak hours
24-36 hrs cardiac biomarker used todiagnose MI
Creatine
* duration of increase 36-48 hours & necrosis
Kinase (CK) * specificity 57-88%; sensitivity at peak
93-100%
* earliest increase 3-4 hours; peak hrs explain the purpose of serial
15-24 hrs sampling
CK-MB * duration of increase 24-36 hours (e.g. 3x q6-8h); normal is 0.3mcg/L
* specificity 93-100%; sensitivity at peak in conjunction with serial EKG's
94-100%
99-100% sensitive for MI;
serum concentration rise 30-60min after most diagnostic if measuredwithin
Myoglobin MI
first 12 hours of onset of chest
male: 5.2-12.9 umol/L; female: 3.7-10.4
umol/L
 Dysthymia EKG Characteristics
< 60 bmp & regular
Sinus
Bradycardia
Sinus 101 - 200 bpm & regular
Tachycardia
Premature Atrial 60 - 100 bpm & irregular;
Contraction (PAC) P-wave may be hidden
in the preceding T-wave
Supraventricular 150 - 220 bpm & regular;
Tachycardia (SVT) P-wave often hidden in the T-
wave
A.Flutter A: 200 - 600 bpm;
A.Fib V: > or < 100 bmp
*a.flutter = F waves;
a.fib = irregular*
1° AV Block
Prolonged P-R interval; If
R is far from P = 1st°
2° AV Block; P-wave = longer, longer,
Wenkenbach longer, DROP = Wenkenbach
2° AV Block; If some QRS's don't get
Mobitz II through = Mobitz II
3° AV Block; If P's & Q's don't agree
= 3rd °
complete
PVC PVC's occur at variable rates;
unifocal or multifocal,
couplets,bi/tri/quadrigeminy;
3+ sequential PVC's = VT
150 - 250 bpm; QRS's are
V.Tach/V.Fib wide & distorted; not
measurable in v.fib
Causative Agent
Bb, CCB, MI, ICP/IOP,
Hypothermia,
Hypoglycemia,
Exercise, fever, fear, anxiety,
pain, hypovolemia, anemia,
hypoxia, hypoglycemia,
hyperthyroid, MI, HF
Stress, caffeine, tobacco,
hyperthyroid, hypoxia, COPD, CAD,
electrolytes imbalance
Hypokalemia, dig toxicity,
ischemia, CAD, rheumatic heart
disease
HTN, CAD, cardiomyopathy,
digoxin, epinephrine, HF, caffeine,
stress, cardiac surgery
Digoxin toxicity, bb, MI, CAD
Digoxin toxicity, Beta Blocker, CAD
Digoxin toxicity, CAD, anterior MI,
rheumatic heart disease
Heart disease, CAD, MI,
myocarditis, MI, scleroedema,
amyloidosis
caffeine, nicotine, HF, CAD,
amniophylline, epinephrine,
digoxin, isoproterenol, hypoxia,
fever, stress, exercise, MI, MV
prolapse
Hyperkalemia, drug toxicity,
acidosis, CM, MI, CAD, MV
prolapse, HF, cardiac cath, CNS
disorders
Treatment
O2, atropine, pacemaker,
drug dosage adjusted or
discontinued
O2, beta blocker, treat
underlying cause,
antipyretics-fever,
analgesics-pain
Remove cause, observation,
Beta blocker therapy (BB)
O2, remove cause, IV, bb,
adenosine, amiodarone,
cardioversion, observation
O2, digoxin, bb, warfarin,
cardioversion, ablation A.fib
w/RVR*amiodarone,
propafenone
O2, check meds/labs, call
HCP *if new onset,
observation
O2, temp pacemaker, ERT,
VS, atropine, check
meds/labs, call HCP,
permanent pacemaker
O2, temp pacemaker, ERT,
VS, meds/labs, call HCP,
*permanent pacemaker
O2, ERT, VS, meds/labs, call
HCP, *permanent
pacemaker ASAP
O2, bb, amiodarone,
procainamide, lidocaine
CPR, defibrillate,
epinephrine