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V Heart„ a hollow muscular organ, lies on the

mediastinum (space between the two lungs)

V 9picardium-„ covers the outer surface of the

V • ocardium-„ is the middle la er and is the
actual contracting muscle of the heart
V 9ndocardium-„ innermost la er and lines the
inner chambers and heart valves
V 9ncases and protects the heart from trauma
and infection
V The parietal pericardium is tough, fibrous outer
V The visceral pericardium is the thin, inner la er
that closel adheres to the heart
meptum divides the heart into two distinct sides
„ 9ach side contains two chambers: an atrium
and a ventricle
a. Right atrium„ receives deox genated blood
from the bod via the superior and inferior vena
b. Right ventricle„ receives blood from the right
atrium and pumps it to the lungs via the
pulmonar arter
c. Left atrium„ receives ox genated blood from
the lungs via the pulmonar vein
d. Left ventricle„ is the largest and most
muscular chamber, it receives ox genated
blood from the lungs via the left atrium and
pumps blood into the s stemic circulation via
the aorta.
V Ãtrioventricular valve (Ã valve) and semilunar
valve (m valve)
V à valve„ separate the atria from the ventricles
{ These valve close at the beginning of ventricular
contraction and prevent blood from flowing back
into the atria from the ventricles, these valves open
when the ventricle relaxes
{ The bicuspid or mitral is located on the left side of
the heart
{ The tricuspid valve is located on the right side of
the heart
V memilunar valve„ between ventricle and arter
{ Àrevents blood from flowing back into the vnetricles
during relaxation, the open during ventricular
contraction and close when the ventricles begin to
{ Àulmonic valve„ located between the right ventricle
and pulmonar arter
{ Ãortic valve- located between the left ventricle and
V donsists of specialized cardiac cells that
initiate and propagate electrical impulses
throughout the m ocardium
mà Node

à Node

Bundle of His

Àurkinje Fibers
V mà node„ located at the junction of the right
atrium and the superior vena cava, functions as
the pacemaker of the m ocardium, initiate
electric impulses at a rate of 60- 100 per
V à node„ located in the septal wall of the right
atrium, receives impulses from mà node and
rela s them to the ventricles
V Bundle of his„ a bundle of specialized muscle
fibers into the m ocardial septum. donducts
impulses from the à node and is divided into
right BB and left BB
V Àurkinje fibers„ the terminal, propagate
electrical impulses into the endocardium and to
the m ocardium
V The coronar arteries suppl the capillaries of
the m ocardium with blood
V The first heart sound is heard as the
atrioventricular valves close
V The second heart sound is heard when the
semilunar valves close
V The faster the heart rate, the less time for the
heart has for filling, and the cardiac output
V Ãn increase in heart rate increases ox gen
V The normal HR is 60-100 bpm
V BÀ d x TÀR
V dardiac output„ defined as the volume of blood
ejected b each ventricle in 1 minute
V d m x HR
a. mtroke volume„ is the amount of blood ejected
b the left ventricle with each heart beat
a. Àreload- filling volume of the ventricle
b. Ãfterload- resistance to ventricular ejection
b. Heart rate„ is the number of heart beats per
minute. Normal is 60-100 bpm
dardiac c cle„ consists of 2 phases
a. s stole„ contraction phase. Triggered b
depolarization of cardiac cells
b. diastole„ relaxation (Filling) phase.
Immediatel after depolarization. Ã return to
the resting state
V dardiac enz mes
{ d-•B (creatinine kinase, m ocardial
Ãn elevation in value indicates m ocardial
9levation occurs within 4-6 hrs and peaks
18- 24 hrs following an acute ischemic
Normal value is 25- 175 units/L
{ Lactatedeh drogenase (LDH)
ccurs 24 hrs following m ocardial
infarction and peak in 48- 72 hrs
N 140-280 iu/L
{ The troponin I and troponin T
{ It rises within 3 hrs and persists for up to 7
da s
{ N with troponin T normall ranging from 0-
0.2 ng/ml and troponin I being less than 0.6
{ Ãn rise can indicate m ocardial cell damage
{ Isan ox gen binding protein found in cardiac
and skeletal muscle
{ level rises within 1 hour after cell death,
peaks in 4- 6 hours, and returns to normal
within 24- 36 hrs
{ Red blood cell count increases in conditions
characterized b inadequate tissue
ox genation
{ The white blood cell count increases in
infectious and inflammator diseases of the
heart and after m ocardial infarction
{ Decreases in hematocrit and hemoglobin
can indicate anemia
V an increase in coagulation factors can occur
during and after •I, which places the client at
greater risk of thrombophlebitis and extension
of clots in the coronar arteries
{ Itmeasures the cholesterol, trigl cerides
{ The lipid profile is used to assess the risk of
developing coronar arter disease
{ The desirable range for serum cholesterol is
less than 200 mg/dL, LDL of less than 130
mg/dL, and HDL of higher than 70 mg/dL
{ Àotassium-„ causes d srh thmias and
increased risk of digitalis toxicit
{ modium -„ it decreases with the use of
diuretics, it decreases in heart failure,
indicating water excess
{ dalcium -„ can cause ventricular
d srh thmias
{ Is done to determine the size, silhouette, and
position of the heart
{ Interventions: prepare the client, explain the
procedure and remove jewelr
{Ã common noninvasive diagnostic test that
evaluates function of the heart b recording
electrical activit
{Ã client wears a holter monitor and an
electrocardiogram tracing is recorded
continuousl over a period of 24 hours or more
{ It identifies d srh thmias if the occur and
evaluates effectiveness of medications or
pacemaker therap
{ Instruct to resume normal activities and to
maintain a diar documenting activities and an
s mptom that ma develop
{ Is a noninvasive procedure based on the
principles of ultrasound
{ It evaluates structural and functional
changes in the heart
{ Involves insertion of a catheter into the heart
and surrounding vessels
{ btains information about the structure and
performance of the heart valves and
circulator s stem
V Àreprocedure
{ btain informed consent

{ Ãssess for allergies to seafood, iodine, or

radiopaque d es
{ NÀ for 6-8 hours

{ btain baseline vital signs, note the qualit

and presence of peripheral pulses for
postprocedure comparison
{ Local anesthetic will be administered before
catheter insertion
{ The client ma feel a flushed warmed feeling
when the d e is injected and a desire to
V Àostprocedure
{ •onitor vital signs and cardiac rh thm at
least ever 30 minutes for 2 hours initiall
{ Ãssess for chest pain, and notif the
ph sician
{ •onitor peripheral pulses and the color,
warmth and sensation of the extremit distal
to insertion site at least ever 30 minutes for
2 hours initiall
{ Notif the ph sician if the client complains of
numbness and tingling, if extremities
becomes cool, pale or c anotic or loss of
peripheral pulses
{ •onitor the pressure dressing for bleeding or
hematoma formation
{ Ãppl a sandbag or compression device to
the insertion site to provide additional
pressure if required
{ eep the extremit extended for 4-6 hours

{ If the antecubital vessel was used,

immobilized the arm with an armboard
{ 9ncourage fluid intake to promote renal
excretion of the d e
{ Is the pressure within the superior vena cava
and reflects the pressure under which blood
is returned to the superior vena cava and
right atrium
{ It is measured with a central venous line in
the superior vena cava or b a balloon
floating catheter in the pulmonar arter
{ Normal d À pressure is 3-8 mmHg
{ 9levated measurement indicates an
increased in blood volume as a result of
sodium and water retention, excess I fluids
or renal failure
V Is a narrowing or obstruction of one or more
coronar arteries as a result of atherosclerosis
V dauses decreased perfusion of m ocardial
tissue and inadequate m ocardial ox gen
V It ma lead to h pertension, angina, •I, heart
failure and death
V The goal of the treatment is to alter the
atherosclerotic progression
Àossibl normal findings during as mptomatic
dhest pain
D spnea
m ncope
9xcessive fatigue
V dardiac catheterization
{ Àrovides the most definitive source of
{ mhows the presence of atherosclerotic
V Blood lipid levels

{ 9levated

{ dholesterol- lowering medication ma be

V Instruct the client regarding the purpose of
V Ãssist the client to identif risk factors that can
be modified
V Ãssist the client to set goals to promote lifest le
V Ãssist the client to identif barriers to
V Instruct regarding low calorie, low sodium, low
cholesterol diet with an increase dietar fiber
V mtress that dietar changes are not temporar
and must be maintained for life
V Is chest pain resulting from m ocardial
ischemia caused b inadequate m ocardial
blood and ox gen suppl
V It is caused b imbalanced between ox gen
suppl and demand
V dauses include obstruction in the coronar
blood flow, coronar arter spasm etc
V mtable angina
{ Ãlso called exertional angina

{ ccurs with activities that involve exertion or

emotional stress and is relieved with rest or
nitrogl cerin
V Ñnstable angina
{ Àreinfarction angina

{ ccurs with an unpredictable degree of

exertion or emotion
{ •a not be relieved b nitrogl cerin
V ariant angina
{ Àrinzmetal·s angina/ vasospastic angina

{ Results from coronar arter spasm

{ •a occur at rest
V Àain
{ dan develop slowl or quickl

{ Ñsuall describes a mild or moderate

{ mubsternal, crushing, squeezing pain ma

{ •a radiate to the shoulders, arms, jaw, neck
and back
{ Àain usuall lasts less than 5 minutes but
can lasts up to 15 minutes
{ Is relieved b nitrogl cerin or rest
V D spnea
V Àallor

V mweating

V Tach cardia

V Dizziness and faintness

V H pertension
V Ãssess pain
V Àrovide bed rest, stop an activit
V Ãdminister ox gen as prescribed
V Ãdminister nitrogl cerin
V btain a 12 lead 9d
V Àrovide continuous cardiac monitoring
V Àrovide diet instructions and must be
maintained for life
V ccurs when m ocardial tissue is abruptl and
severel deprived of ox gen
V Ischemia can lead to necrosis if blood flow is
not restored
V bvious ph sical changes do not occur in the
heart until 6 hours after the infarction, when
the infarcted area appears blue and c anotic
V Ãfter 48 hours, the infarct turns gra with
ellow streaks as neutrophils invade the tissue
V B 8-10 da s after infarction, granulation tissue
V ver 2-3 months, the necrotic area develops
into a scar, scar tissue permanentl changes
the size and shape of the entire left ventricle
V Ãtherosclerosis
V doronar arter disease

V 9levated cholesterol levels

V mmoking

V H pertension

V besit

V Àh sical inactivit

V Impaired glucose tolerance

V mtress
V d- •B
V Troponin level

V • oglobin

V LDH level

V WBd count
V Àain
{ •a experience as crushing, substernal pain

{ Radiate to the jaw, back, and left arm

{ It occurs without cause, primaril earl in the

{ Ñnrelieved b rest and nitrogl cerin and is
relieved onl b opioids
{ It lasts more than 15 minutes
V Diaphoresis
V D spnea

V Àallor, c anosis, cooling of the extremities

V D srh tmias
V Heart failure

V Àulmonar edema

V dardiogenic shock

V Thrombophlebitis

V Àericarditis
V btain a description of chest discomfort
V Ãssess vital signs
V •aintain cardiac monitoring
V Àlace in semi fowlers position
V Ãdminister ox gen as prescribed
V 9stablish I access
V Ãdminister morphine sulfate as prescribed
V btain 12 lead 9d
V •onitor for complications
V Is the inabilit of the heart to maintain
adequate circulation to meet the metabolic
needs of the bod because of an impaired
pumping capabilit
V dardiac output is diminished and peripheral
tissue is not perfused adequatel
V dongestion of the lungs and peripher ma
V Right dHF
{ 9vident in the s stemic circulation
{ Àitting edema in the feet, legs, sacrum, back,
and buttocks
{ Ãscites from portal h pertension
{ rganomegal
{ Distended neck veins
{ Bloating abdomen
{ Fatigue

{ Weight gain
{ Nocturnal diuresis
V Left dHF
{ 9vident in the pulmonar s stem

{ dough and froth sputum

{ D9

{ rthopnea

{ Àarox smal nocturnal d spnea

{ drackles on auscultation

{ Tach cardia
{ Fatigue

{ Àallor

{d anosis
V Àlace the client in high fowlers position, with
legs elevated
V Ãdminister ox gen to improve gas exchange

V Àrepare for intubation and ventilator support

V •onitor lung sounds

V muction fluids as needed

V Ãssess level of consciousness

V •onitor vital signs closel
V Insert fole catheter as prescribed to monitor
urine output closel
V Ãdminister diuretics as prescribed

V Ãdminister digitalis as prescribed

V •onitor weight to determine response to

V Ãssess for ascites, measure abdominal girth
V Ãssist in identif ing risk factors
V •odif the diet
V Is failure of the heart to pump adequatel
thereb reducing cardiac output and
compromising tissue perfusion
V It is usuall a result of necrosis more than 40%
of the left ventricle
V oal is to maintain tissue ox genation and
improve pumping abilit of the heart
V H poTT
V Ñrine output less than 30 ml/hr

V dold clamm skin

V Àoor peripheral pulses

V Ãdminister ox gen as prescribed
V •onitor m

V •onitor urine output

V •aintain adequate I access

V ccurs when the space between the parietal
and visceral la ers of the pericardium fill with
V Ãccumulation of fluid in the pericardial cavit

V Tamponade restricts ventricular filling, and

cardiac output drops
V Àulsus paradoxus
V Increased d À

V ugular vein distention

V Distant muffled heart sounds

V Decreased cardiac output

V Ãdminister I F as prescribed to manage
decreased d
V Àrepare the client for pericardiocentesis
V mubacute or chronic disorder of a heart muscle
V Treament is palliative, not curative, the clients
needs to deal with numerous lifest le changes
and a shortened lifespan
V À 
V À 
 indicates that the blood vessel is
accessed via a needle through the skin.
    means that this procedure is
performed through the blood vessel. 

is the arter that is being treated.  
the reshaping of the blood vessel.
V Ãngioplast is also referred to as a "balloon
treatment." In this procedure, special balloons
are used to open up the arteries. The
procedure also involves the use of stents to
help keep the arteries open. Ã special catheter
is used to insert the stent device. The
catheterization procedure and the ÀTdà can be
done at the same time
V Ãtherectom
V Ãtherectom is performed includes that this is a
procedure via catheterization. •ost often in the
groin, a catheter or thin tube is inserted into
the blood vessel and threaded through it until
the area of narrowing is reached..
V There is a small razor-like device or burr that is
attached to the catheter, and this is used to
remove or ´shaveµ the plaque from within the
arter . nce this matter is detached, the
catheter is removed too, and the procedure
frequentl results in widening the blood vessel
that is blocked, restoring greater blood flow