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. . . PIIVS101.ot;v or CARDIOVASCULAR .'A'SLLÆ LT.)' TERMS • Aortai The largest artery in the the aorta originates from left ventricle Of the heart and extends doun 10 the abdomen. where it branches Off. • Aortic Arch: The of the aorta. it branches into the trunk. left common carotid artery, and left subclavian artery. e The chordae tendineae are thin strong inelastic fibrous cords that extend from 'he free edge of the cusps of the atrioventricular valves (the tricuspid and mitral Wives) the apices of the papillary muscles within the righl and left ventricles respcctively. / hey transmit the force of the contracting papillary muscles during ventricular s stoli to the cusps of the valves to prevent the valves from prolapsing into the atria duc to tlr higher pressures generated in the ventricles, Cardiac conduction systertÆ the inition and distribution of impulses through t)' myocardium that coordinate the cardiac cyelc. Cardiac cycle: A heartbeat: it consists of complete series of systolic and Wastolv: event. Cardiac output: the volume of blood pumped from the ventricle mint" e. cla•ulated multipl>ing stroke volume by heart rate (beats minute). CO is dependent on the stroke volume (S V) and heart rate (HR): CO = HR x Si Stroke volume: the amount of blood (IJIL) ejected per beat by the left venricle jnto the aorta (or from the right ventricle into the pulmonary artery). Systole: The time period when the heart is contracting. The period specifically ouring which the left ventricle of the heart contracts. Diastole: in the cardiac cycle, period of relaxation of the heart muscle, accomsxmied by the filling of the chambers With blood. Preload: also known as the left ventricular end-diastolic pressure (LVEDP). is the amount Of ventricular stretch at the end of diastole. Afterload: also known as the systemic vascular resistance (SVR), is the amount or resistance the heart must overcome to open the aortic valve and push the blood volume out into the systemic circulation Vasoconstriction: is narrowing or constriction of the vegels. Vasodilation: is the widening of the blood vessels. HEART Structure of Heart: The heart is a roughly cone-shaped hollow museuiar organ. It is about 10 cm long and is about the size of the owner's fist. it weighs about 22.5 in women and is heavier in mer, (about 310 g). e Position or Eeart: The heart lies in the thoracic cavity in the mediastinum between the lungs. It lies obliquely, a little more to the left than the right, and presents a base above, and an apex Layers of the Heart: NES Page 2.

. . . NOTES There are tin-ee I: yer. of Heart • I. Pericardium! Epicardium 2. Myocardium Layer 3. Endocardium Layer Chambers o' thc Ileart: Ihe heart is made up of4 chambers: I. Righi Atrium 2. Left Atrium 3. Rigle Ventricle 4. Left Ventricle Heart Valve.;: • Atrioventricular Valve a. ricuspid b. Bicuspid / Mitral • Semi lunar Valve a. l•ulmonic b. notlic Right Side of Heart: • Tricuspid: Between Right Atrium and Right Ventricle • Pulmonic Valve: Between Right Ventricle and Pulmonary Trunk'?ul arteries Left Side of Heart: • M itral: Between Left Atrium and Left Ventricle • Aortic Valve: Between Left Ventricle and Aorta CONDUCTION SYSTEM OF THE HEART AV Node Bundle Of I-lis a) Right bundle branch b) Left bundle branch Purkinje Fibres NES Page 3.

. . . .00)) CIRCULATION Superior and Inferior vena cava . Right Atrium (Deoxygented blood) I ricuspid valve Right Ventricle Pultnonic vaivc Pulmonary arteries Lungs Pulmonary •vein (Oxygented blood) Leti atrium Bicuspid/Mitral valve i.eii ventricle Aorlic valve Aoriå.

. . . RCA SA Acute Marginal (AM) terior descending artery (RPDA) CORONARY ARTERY NOTES CORONARY ARTERIES Aorta LAD S: Left Main (17 LCA[Lcft Main LCX Lev-r CORONARY ARTERY 3 4 6. 7, RPI RPL •are RPC SEPTAL A.C MAR 3 Right Coronary An ery LCx i; 13 17 20 27. 20 PROX LAD LAD DIST 1 tst 2nd DIAG SEPTAL PRCX 1 rat 0B MARC 2nd 00 02 3rd L PDA 3rd 2 3.

. . . RCA SA Acute Marginal (AM) NOTES CORONARY ARTERIES Aorta LAD S: ght posterior descending artery (RPDA) CORONARY Right Coronary An ery RY 2 3 6 7 2 10 NES Left Main LCx 17 20 21 27. 20 LCA/Left Main LCi M: CORONARY ARTERY PROX LAD LAO 01ST LAO 2nd DIAG trst PRCx CX trot 0B 2nd Oa 2nd LPDA R z.vt_1S Page 5.

. . . An electrocardiogram (ECG) is a recording of wavetOrms that reflects the electric al acavity Of the Each heart beat involves S major stages. reflected in P. QRS and T waves. thc sin and •:harx• of v, hich in assessing normality of heart functions. • P Wave: Atrial depolarization (contraction) e QRS Complex: Ventricular depolarization e T wave: Ventricular repolarization ( resting phase) ORS T Wave Placement of electrodes: Standard! Limbs Electrodes: RA: Right Arm. • LA: Left Arm. LL: Left Leg. RL•. Right Leg OR siS electrodes are located on the precordial region. pagt.

. . . V i: In tie fourth intercostal space, just to lhe right of the sternum. VI': In tl e fourth intercostal space. just to thc left of the sternum. • V3•. On line midway electrodes V 2 and VA. In tl fifth intercostal space, in the mid-ciavicuiar line. VS•. At the same level as electrode V4, in the lefl anterior axillary line. • V(,: At tne same level as electrodes VA and V5, in the left midaxillary line. ECG graph paper: The horizontal lines measure time Vertical lines measure amplitude of voltage Runs at a paper speed of 25 mm!scc Width of each small square = 0.04 seconds (Imm) Width of one large square = 0.20 seconds (200 ms) Five large boxes = one second Voltage: I mm = 0.1 mV between each block vertically One large box = 5 mm high = 0.5 millivolt (mv) Rhythm: The distances IXAween these waves is the heart rhythm (intervals between R-R waves). e Heari rate ( HR): e Number of contractions per minute) • Normal heartrate is 60— 100 beats per minute (bpm). (Count the number of R waves in a 6 second strip and multiply by 10). For example: if there are 7 R waves in a 6 second strip, the heart rate is 70 (7xlO—70). ECG Component PR Interval QRS Complex ST Segment QT Interval OT NES Normal Value 0.12 to 0.08 to 0.10 0.08 to 0.12 0.36 to 0.44 sec Page.

. . . . F. (RI "!'TIIM.S) Sip!' 69-100/min, Regular rhythm. PR normal, QRS no;tnal Sings lirndveardi•a: IIR < 60/rni1i, Regult'-• rhythm, normal, QRS norvaal Sinus Rhythm regular, Pil normal, QRS norwal/nvrrow NES Page t.

. . . atracular Tacln cardia (SVTI Atrial gachvcardia: IIR narrow QRS complex, delta waves present, Btrial Vibrillation•. Irregular rhythm, F waves. Controlled = Heart rate < • Atria! V!utter. Uncontrolled rate > I OO Saw tooth atrial pattern (flutter waves).

. . . Larb qi ide bitarre QRS > 0.12 Ventricular ('R.S Compie' Ventricular Fibrillation without any clear J' 10.

. . . No any electric.•ti octi•.ity (Flatline) Atrioventricular Ileart Blocks: •Y First degree AV blocks Second degree AV blocks Type I Second degree AV blocks Type 2 Third degree AV blocks • 1st AV' block: PR > 0.20 sec constant, onc P before every QRS. rhythm regular • god Devrce Block Type (Wenckebaq121: Progressively' lengthening PR interval. until a P Wave is not followed by n QRS complex NES.

. . . NV imet•vni normal, cropped QRS complexes with a conducCon pnitern. No coordin:dion of waves with QRS Page 12.

. . . NG Angiograpl. i". The test to detect the presence of is "coronary angiography." It Angioplaswpercutaneous Coronan (I'CI\: Angioplasty is a procedure to open arteries by artery disease. It restocqs blc.od ilow to the heart muscle without open-heart surgery. of a Patient For Procedure: • The betore the Procedure• Ensure that the consent form is signed. Base line vital signs will be done. If patient take warfarin then this may have been stopped a few days earlier to allow the effects to m•ar off the procedure. Several lests must be done including a chest x-ray. electrocardiogram (ECG) and blood tests (CDC. BUN, C,eatinine, PT, APTI). If any One of blood results relating to the kidneys is low or shows an abnormal kidney function then you will be encouraged to drink plenty of fluids, according to doctor order. On the l)a'. of the Procedure: Patient should be on fast for (4-6 hours) the procedure. The area being puncture must be free flom hair (Radial and Femoral). Patient must be cleaned (bath). IA' line should be maintained. Adminisier the prescrilE Pre op medication. Foleys catheterization should intact (if needed). v' Complece Cardiac catheterization checklist. • After the Pl ocedure: Keep the extremity straight for 6 to 8 hours if femoral attempted. Monitor Vital Signs. Check the dressing over the puncture site for evidence of bleeding and hematoma formation. No shower for 24 hours (if femoral). Au•iding bending too much or lifting anything heavy for 2-3 days. Ask the patient for any chest pain or discomiört. Check for urinary output. NI'O discontinue after 2 4 hour. NES Page 13.

. . . GASES anertal gas anaiysiy is lor diagnosing and manag•ng tl' patient •s status, Venti\9tion Staius and Acie I)rav,' from arteries (Radial. Braehie*i Compongnts Of AIIG•. NES Page 14.

. . . PH: Acidosis < 7.40 > Alkalosis PaC02: HC03: Pa02 Levels: Mild Hypoxemia: 61-80 Moderate Hypoxemia: 41-60 Severe Hypoxemia: < 40 Imbalance Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis Compensations: Respiratory Metabolic ROME Respiratorv Opposite Metabolic Equal PH (735-7.45) PaC02 (35-45) Normal Normal HC03 (22-28) Normal Normal e Nonrancorapensated: Normal!AItered. C02 OR HC03— Normal (any one). e Partiallv compensated: Nothing is normal. Fulh Corn ftgnsated: PH=Normal, C02 Bnd HC03= Altered NES Page.

. . . BASICS OE VENTILM 101 Mechanical Ventilation: Mechanical Ventilation is ventilation of the lungs by artificial means usually by o ventilator. Ventilator Settings: Respiratory rate (RR) v' Tidal Volume (VI) v' Positive end-expiratory pressure (PEEP) M Flow rate Inspiratory time (i : E) Fraction of inspired oxygen Respiratory Rate: An optimal method for setting the respiratory rate has not been established Fc mo:-i patients, an initial respiratory rate between 12 and 16 t,reaiiiS per minute is reasonable. e Tidal Volume; The tidal volume is the amount of air delivercd wilh each breath. e Positive End-Expiratory PressUre (PEEP:•. Applied PEEP is generally added to mitigate end-expiratory alveolar collapse. A typical initial applied PEEP is S H20. e Flow Rate: The peak flow rate is the maximum flow delivered by the ventilator during inspir ation inspiraton Time: Expiratory Tiruc IQlationship Ratio): During spontaneous breathing, the normal ratio is I :2, indicating that for normal patients the exhalation time is about twice as long as inhalation time. Fraction of inspired Oxygen: The lowest possible fraction of inspired oxygej, (Fi02) necessary to meet oxygenation goals should be 'iech:tnicfli VentiÅÅion: Modes o I. Volume Modes 2. Pressure Modes Page 16 NES.

. . . VCLVME MODES Control mandatory ventilation (CMV) Synchronized intermittent mandatory ventilation (SIMV) PRESSURE MODES Pressure-controlled ventilation (PCV) Pressut:e-support ventilation (PS V) Continuous positive airway pressure (CPAP) Noninvasive bi-level positive airway pressure ventilation (BiPAP) Process of Weaning Reversal of primary cause of respiratory failure. Patient •awake and resix)nsive (GCS). Optimal met:Mic status. Reducing or minimal dose of vasopressor Intact cough and Gag reflex. Pa02/Fi02rati0> 150. RSB1<80. Hemoglobin > 8 mg/dl. Optimal electrolytes. Optimal heart rate < 1201m. Optimal respiratory rate < 3 51m. Cuffleak< 110m1. Difference between BiPAP & CPAP BiPAP CPAP BIPAP machine can set to two pressure setting CPAP machines can only be set as for jnhalmion (high IPAP) and gshalaüon. ressure that remains consistent. level (referred to as IPAP) An expiratory pressure called EPAP (PEEP/CPAP level). Recommendation: Exacerbation of COPD with Resp ratory acidosis. ARD. Failure ofCPAP Hypercapnia Neuromuscular disease NES Same pressure during inhalation and exhalation. Recommendation: Pulmonary edema. Obstructive sleep apnea. COPD Pneumonia. Assistance to wean from the ventilator..

. . . Norma; Pre diabetic Diabetic Res nse Eye Opening Respons Verbat Respons'. Motor Response 'lucose Lev •au es 00 Random Fasting 1 4 1-200njg/d 101.125mg!dl GCS —NOntaneou.s Tc ain res onse Orienteci to time, place and oerson. ConiUsed. ina ro riate words. incomprehensive sounds. tes onse. Obess commands. Moves to localized ain. Flexion withdrawal from ain. Abnormal flexion. Abnormal extension. No res nse. Tolu; score: 11bA1c <5.Th, 5.7-6.40/0 Score 6 5 4 3 2 High-alert medications carry significant • injury Or death to paltents svhen they ewer. Narcotics Electrolytes Aniicoagulant bolylic tng eodc: NEAT drugs to—Look Alike/ sound Alike (LAS, i=lnsulin iqeuromuseulur blocking agent Page 18.

. . . NOTE's DRUG DOSAGE CALCULATION CONVERSIONS I liter (L) I kilogram (kg) I gram (g) I milligram (mg) I table spoon (tbsp) I tea spoon (tsp) 1000 millilitcr 2.2 pounds/ 1000 g 1000 milligrams (mg) 1000 microgram (mcg) 15 ml 5 ml FORMULA For Tablet/CapsuIes For Injection/Syrup For Iniection according to weight For ml/hr For drops Imin For infusions (concentration) Desired Dose x Ouantity Dose Available Desired Dose x Volume Dose Available Desired Dose x Volume x Weight(kg) Dose Available Total Volume Total hours a) Total amount x Drop factor Total hours x 60 b) ml/hr x Drop factor 60 c) Total volume x prop factor Time in minutes a) Desired dose x Pt weight (kg) x 60 Drug Concentration OR b) Pesired dose x 6Q min Concentration DDFQ DROP FACTOR Regular drip set [Macro set BuretroI/Chamber/Micro set/ Paediatric Chamber Blood set NES 15 gtt/ml 60 gtt/ml 10 gtt/ml Page 19.

. . . Plil: 0101: Pine Statin Nitr Sat-tan P!iöRMAC9LOG)' ACE Inhibitors Beta Blocker Ca channel blocker Anti lipemic Nitrates Alpha blockers Drug ('ategor: Beta Blockers Ca Channel BitKker: NES or i)rucv Atenolol (Tenormir•o Bisoprolol (Zebeta Metoprolei foptvi-Xl.i Propranolol (inderal I-A, innoPran Nadolo! (Coward Acebutolol ( S.•etra; ' tCaruizeJE Tiazzc Indications Cardiovnsculm• Indicati"ns: Hypertension Coronary artery disc, •se 'AD) Acute Myocardial Infarction (AMI) Angina pectoris Heart failure Arrhythmias Hypertensive crises Pregnancy induced pertension indycations: Glaucoma (topicei beta blocker) Essential tremor Migraine prophylaxis Portal hypertensicn ( •oronary arter> disea Chest pain (angina) Arrhythmia ioge 20.

. . . ACE (Angiotensin converting enzyme) Inhibitors ARB (Angiotensin Receptor blockers) Anticoagulants Thrombolytics NES • • Benazepril (Lotensin) Captopril. Enalapril (Vasotec) Fosinopril. Lisinopril (Prinivil. Zestril) Moexipril. Perindopril. Quinapril (Accupril) Atacand (candesartan) Avapro (irbesartan) Benicar (Olmesartan) Cozaar (losartan) Diovan (valsartan) Micardis (telmisartan) Teveten (eprosartan) Apixaban (Eliquis) Dabigatran (Pradaxa) Edoxaban (Savaysa) Heparin (various) Rivaroxaban (Xarelto) Warfarin (Coumadin) Streptase (streptokinase) t-PA (class of drugs that includes Activase, alteplase) • Systemic hypertension. Myocardial infarction (MI) Heart failure Chronic kidney disease Hypertension congestive heart failure chranic kidney disease Helps to prevent harmful clots from forming in the blood vessels. May prevent the clots from larger and causing more serious problems. Often prescribed to prevent first or recurrent stroke. Indications For Warfarin! • Heart Valves Replacement. Atrial Fibrillation. Deep Vein Thrombosis and Pulmonary Embolism. Mural thrombus. Ischemic Stroke. Acute myocardial infarction (AMI) Deep vein thrombosis (D VT) Pulmonary embolism (PE) Acute ischemic stroke (AIS) Acute arterial occlusion. Occlusion of indwelling catheters. Intracardiac thrombus formation. Page 21.

. . . Antiplatelets Nitrates Antiarrhythmic NES NOTE! e Acetylsalicylic acid (Aspirin) e Clopidogrel (Plavix, Lowplat) • Cilostazol (Pletal) Glyceryl trinitrate (GTN) Isosorbide mononitrate Isosorbide dinitrai.• (isoke: Amiodarone ( coråarone, flecainide Ibutilici.• (corvc•n), v,hich can only given through iv Lidocain:• (xylocaine). which can only b: given through iv Procainamide {proca:.. procanbid) propafenone (rythmol ) • Acute coronary syndrome Post Jk*rcutaneous coronaty intervention (1'('1) with stenting Mechanical heart valves in combination with uarfar'J' Acute ischemic Post percutaneous intervention of rx•ripheral arterial di.seasc lhvice closure of an atrial septal defect (ASD) for at least six months Stable angina Post-coronary arten bypass grafting surgery Essential thrombocytosis Primary prevention of coronary artery Atrial fibrillation with a high risk of stroke. Stable angina Unstable angina Acute MI Acute coronary Heart failure Hypertension Ventricular arrhythmias. Can be given to patients with structural heart disease. Page 22.

. . . positive Inotropic NOTES quinidine (many brand names) Tocainide (tonocarid) Dobutamine • Dopamine • Epinephrine • Norepinephrine • Milrinone • Thiazide (Chlorothiazide, • Congestive heart failure Cardiogenic shock Septic shock Myocardial infarction Cardiomyopathy Edema. Congestive heart failure. Hypertension. Renal disease. Liver disease. Glaucoma. Raised intracranial pressure. Diuretics Cholesierol- lowering medications NES hydrochlorothiazide, methylchlorothiazide) Loop or high ceiling (Sulfonamides (Furosemide, bumetanide), ethacrynic acid • Osmotic (Mannitol, urea) • Carbonic anhydrase inhibitor (Acetazolaide, dichlorphenamide, ethoxolamide, methazolamide) • Potassium sparing (Spironolactone, amiloride, triamterene, eplerenone) • Atorvastatin (Lipitor) Fluvastatin (Lescol) Lovastatin. Pitavastatin (Livalo) Pravastatin (Pravachol) Rosuvastatin calcium (Crestor) Simvastatin (Zocor) Improve the function of the lining of the blood vessels. Reduce inflammation (swelling) and damage. Reduce the risk of blood clots by stopping platelets from sticking together. Make plaques (fatty deposits) less likely to break away and cause damage. To help prevent coronary vascular disease (CVD). Page 23.

. . . A.C 01) B.l.l) T.i.l) Q.I.P PRN'/ SOS Stat cas Cap Tab g mg gtt NPC KCE w: IW'PEs MEDICAL ABBREVIATIONS Before meal Once a day Twice daily Three times daily Four times daily Each day At bed time As needed Immediately Culture and sensitivit Capsule Tablet milligram drop j International unit milliliters Cubic centimeters Nothing by mouth Per oral Subcutaneous Intramusculaj Intravenous Hypertension Potassium Potassium chloride Sodiulll wei NES Page 24.

. . . NV NATIONAL INSTITUTE OF CARDIOVASCULAR DISEASE NURSING EDUCATION SERVICES Notes For Orientation Classes PREPARED BY: NES TEAM Page 1.

. . . Time & Date NOTES Notes should signed by Physician COP Vic/.