Cardiovascular High Acuity

Introduction: Functions of the heart: pumps nutrients out to tissues and takes away metabolic waste, delivers oxygen and removes CO2

Risk Factors: Classification

  1. nonmodifiable- age, race, gender, genetics
  2. modifiable- smoking, diet, activity, cocaine abuse, hypertension control, diabetes mellitus control
  3. contributing- obesity, type A personality, stress

Anatomy and Physiology: Blood supply is provided by: coronary arteries

  1. Right coronary artery
  2. Left coronary artery (aka Widow maker)
  1. Left anterior descending
  2. Circumflex

Cardiac cycle

  1. Diastolic-filling phases, ventricle receive blood from atria, coronary
    arteries fill
  2. Systolic-ejection phase, ventricle pressure greater than aortic
    pressure, 90% of the heart’s oxygen consumption occurs during contraction

Cardiac output=SV * HR

Stroke volume: made of preload, afterload and contractility
Preload- Sterling’s law, ventricle filling
Afterload- tension during systolic ejection
Contractility- contractile force of the cardiac muscle

Compensatory Mechanisms- increased chamber size, thickened ventricle wall, increased HR

Angina Pectoris- chest pain from insufficient myocardial oxygen supply

Angina Classifications

  1. Stable- consistent pattern of cause, intensity, duration relieved by rest, nitroglycerin, or combination of both
  2. Unstable- changes in quality, duration, severity, or frequency of pain or trigger of pain
  3. Prinzmetal or Avarent- 15% die, no cause of onset, occurs at rest, caused by a vasospasm, occurs most commonly 12-8am

Causes of Angina- anemia, thrombosis to coronary artery, vasospasm of coronary artery, increased activity with increased oxygen demand, decreased diastolic filling time

Diagnositc Test Findings- EKG- decreased ST-segment with or without T wave inversion, increased ST-segment, stress testing, cardiac cath, CBC

Patient Care Goals: relieve acute pain and decrease cardiac workload

Strategies for patient care: decrease environmental stress, oxygen, morphine, nitroglycerin, assess ECG monitor and document, heart and lung sounds, VS, pain characteristics- location, duration, intensity, precipitation and relief, talk with patient about CABG, identify risk factors and lifestyle changes, family refer to CPR instruction and teach how to activate EMS