CARDIOVASCULAR

SYSTEM

COMPONENTS OF THE HEART

Potassium
- responsible for heart muscle
contraction
Inotropic agents
- myosin/actin (myogenic cells) =
glucose (O2)
Chambers
● Left & Right Atrium - receiving
chambers
DISEASES
● Left & Right Ventricles - pumping
chambers
CORONARY ARTERY DISEASE
Receives blood:
● Superior vena cava Non - Modifiable Risks
● Inferior vena cava ● Gender (M - below 40, F - above 40)
- Largest vein ● Age
● Family History
Aorta - largest aorta
Modifiable Risks
Heart ● Stress
- Pumps 5L of blood, 22% kidneys ● Hypertension
- Circulatory organ ● Obesity (more than 25% of ideal
- Works with blood vessels in body weight)
maintaining bp ● Elevated cholesterol
- Primary compensatory organ ● Smoking
- No mitosis (cell division)
- Has a pacemaker ANGINA PECTORIS
- Pain from the chest due to coronary
BP = cardiac output x systemic vascular insufficiency in the absence of MI.
resistance
 Management:
ATHEROSCLEROSIS VS. ARTERIOSCLEROSIS 1. Complete Bed Rest
2. NPO
3. Oxygen (High Flow - 4-6 Lpm)
4. Diet (after acute attack)
- Low fat, cholesterol, salt

Medication
● Nitroglycerin
- Acute
- Route: Sublingual (SL)
- Onset: 1-3 mins.
Types - Duration: 30 mins.
● Stable - Sign of efficiency: burning or
- <50% stinging sensation
- 4E’s (Exercise, Extreme - Take max. 3 doses at 5 mins
Temp., Excessive eating, interval (3:5)
Emotional stress)
- Relieved by stress Maintenance:
● Unstable (Pre-infare, Crescendo, - Applied OD in AM
Acute Coronary insufficiency) - Rotating site
- >50% - Less non - hairy area
- Attacks (frequency, intensity,
duration) Storage:
- Relieved by Nitroglycerin - Cool, dry, dark place
● Prinzmetal/Atypical (Work-a-holic - Replace stocks (opened - 3
heart syndrome) months, unopened - 6
- No obstruction months)
- Vasospasm
Evaluate effectivity:
Pathophysiology: - Relieved chest pain
Partial obstruction - decreased blood supply
- decreased O2 - vasospasm - triggers SE:
bradykinin & prostaglandin - chest pain (<15 - hypotension (dull headache,
mins) - SNS - A. Medulla - Epi & Norepi - dizziness)
vasoconstriction - other S/S
● Beta blockers 2
Signs & Symptoms: - “Lol”s (metoprolol,
● Pulse propranolol…)
● Upset/Apprehensive - SE : decrease HR
● Lightheadedness
● Shortness of breath ● Calcium channel blockers
● Excessive sweating - Verapamil, Nifedipine,
Diltiazem
 - SE: decrease BP
● Platelet - Aggregation Inhibitors
- ASA, Bypindamol, Ticlopidine
- SE: bleeding, ototoxicity
● Anti - coagulant
- Heparin, Warfarin
- SE: Bleeding
Pathophysiology:
Total obstruction - no blood supply - anoxic -
anaerobic glycolysis - glucose or lactic acid
Glucose - myosin/actin
Lactic acid - SNS - A. Medulla - N & E -
vasoconstriction - other pulse
Symptoms:
● Pulse

Diagnosis:
Heparin Warfarin
● Enzymes
Route IV/SC Oral - Most Sensitive: Trop I
(elevates in 30 mins.)
Advantage Fast Long half - Most Indicative: CK-MB
life
(myocardium)
Labs APTT PT, IMR - Most Definitive: ECG
(1:2) - Lactic Dehydrogenase (LDH)
> LDH 1 - <LDH 2
Antidote Protamine Vitamin K > LDH 2 - LDH1 > LDH2
Sulfate
(LDH flip)
- Multisystem
Platelet Count : involvement
- <150,000 (prone to bleeding) a. BUN, CREA
- <30,000 spontaneous bleeding (Kidneys)
b. AST, ALT
Surgery (Liver)
- Percutaneous Transluminal
Angioplasty
Compens Decompen Refract
- Stent
atroy satory ory
> Avoid MRI
>Control : BP, Glucose, Cholesterol Time 4-24 hrs After 4-24 -
hrs
MYOCARDIAL INFARCTION
Patho. Ischemia Injury Infarc
- Most common acute biologic crisis
Change
- Myocardial cell necrosis
- Occlusion ECG ST ST Deep Q
- caused by coronary artery Elevation Depressio waves
obstruction (Ventricul n + Wave
- leads to anaerobic glycolysis ar inversion
Tachycar
dia)

No heart Heart
 - Antidote :
function Functionin
g Aminocaproic Acid
(Amicar) IV
Vital Vital
organs organs not
functionin functioning Clotting Time - 10 - 12
g Threshold - 20 - 36
Onset - 15 mins.
Management:
1. CBR W/O BRP ● Beta Blockers “lol”
2. NPO - Control SNS
3. Administer O2 (4-6 lpm) activation
4. Establish IV Line (PNSS,D5W) ● ACE Inhibitors “pril”
5. Medication: - Prevent false
● Morphine Sulfate activation of RAAS
- Natural narcotic 6. Monitor VS, Complications
- Sedative effect (Dysrhythmia, CHF), Diet (Low fat,
- Anti- anxiety effect salt, cholesterol)
- Vasodilating effect
- IV Procedures:
- 1 -2 mg ● Coronary Artery Bypass Graft
- 8 (CABG)
- Adverse Effect : - Multiple blood vessels
Respiratory - Revascularization
Depression - Graft Sources:
- Antidote: Naloxone - Lesser & Greater
(Narcan) 1:1 Saphenous Veins
● Nitroglycerin - Internal Mammary Artery
- IV - Radial Artery
- Prevents ventricular
spasm CHRONIC HEART FAILURE
● Aspirin - Inability of the heart to maintain
- 6 -5 mg adequate supply of blood & the
- OD,oral body.
- 2 weeks (weaning - 3P’s (Pump, Passageway -
period) vasoconstriction, Passenger -
- Prevent dot formation increase BV)
● Thrombolytic
- Urokinase, Types
Streptokinase ● Left sided
- Dissolves clots - Pulmonary, oxygenation
- PRN - S&S:
- IV > Cough
> Hemoptysis
 > Orthopnea Portal Hypertension Pathophysiology:
> Pulmonary Edema Right Sided HF - Backflow of blood -
Hepatic Vein - Liver (Hepatomegaly) -
Abdominal Cavity (Pushes)

Procedure:
● Chest X-ray
● Echocardiogram
● Coronary Catheterization
- Central Venous Pressure
(CVP)
> measures pressure of right
atrium
● Right Sided
- Systemic Management:
- S&S: ● Digitalis Therapy
> Hepatomegaly - Major therapy
> Edema (generalized) - (+) inotropic (contraction), (-)
> Ascites chronotropic effects (HR)
> Distended Jugular Vein - Monitor: HR, Potassium
- Digitalis Toxicity
> Early
- GI disturbances
- VANDA
V - vomiting
A - anorexia
N - nausea
D - diarrhea
A - abdominal cramps
> Late
- Visual (Yellow/Green,
Halo around light)
- Cardiovascular
(Brady, Cardia,
Dysrhythmias)
ANTIDOTE: DIGIBIND
● Diuretic Therapy
- Increase urine output
● Loop Diuretic
- Furosemide (Lasix)
- IV
● Thiazide
- Diurine
- Oral
 ● Potassium Sparing
- Aldactone
- “Best”

D - increase potassium diet

I - increase urine output
U - undesirable effect (low K & hypotension)
R - record weight (1cc = 1 kg)
E - elderly precautions (>60 BUN,CREA)
T - take early morning or pm (not after 4pm)
I - ingest food (after meals)
C - caffeine restriction
S - slowly administer

● Dilating Agents
- Anti - Hypertensive Drugs
> Nitroprusside (Nipride)
> Hydralazine (Apresoline)
> Nifedipine
> Captopril
● Diet
- Low sodium, fat, cholesterol
(decrease viscosity)
- High fiber (constipation -
valsalva maneuver -
vasovagal response -
bradycardia)
● Lifestyle
- Adequate rest
- Quit smoking
- Limit alcohol
- Coping & relaxation