§  LEFT SIDE- left vent can’t except enough blood

·         Decreased cardiac output

·         Decreased blood pressure and shock

§  RIGHT SIDE- right vent can’t except enough blood

·         Increased venous pressure, jugular vein extention

·         Tamponade- Hrt can’t move at all.

Fibrous scar tissue making pericardium stick to the heart

·         Pain d/t restriction of Heart

·         Friction rub d/t HR rubs on pericardium

·         ECG changes

·         TX with pericardial Synthesis

·         Poke hole and suck all the fluid out to decrease sac

·         Problem with Tamponade not only can heart not move but because of this it causes MI d/t can’t perfuse. Now not only can’t heart not move it also can’t perfuse.

·         Altherosclerosis block coronary arteries causes tissue Ishemia

o   Anginia

o   Heart attack

o   Cardiac arrhythmias

o   Conduction deficets

o   Heart failure

o   Sudden Death

§  Pain when hearts 02 demand increases… if this person stops activity pain will be relieved

§  Pain when corary arteries spasm- not associated with activity level

§  Pain at rest, or increase or change in stable angina, pain does not stop when activity stops.

Demand > Supply= Angina

 You need to increae supply- 02

& decrease the demand- BP

§  Chest pain d/t blockage, we increased or demand but we can’t increase our supply.

·         Chest pain-

·         SOB- d/t blood settles in Lungs not 02 problem is a blood problem

·         Diaphoreses- d/t sympathetic ns release EPi & Norepi

·         N/v- women has more GI symptoms d/t SNS EPI&Norepi cause vasoconstriction.. decrease b/f to gut and kidney

·         ECG change- T seg elevated and abnormal Qwave

·         actual Qwave = abnormal

·        

·         ST elevation

·         Complete occlution or arterie

·         Translunion Problem the ischemia and nercrotic event go though entire thickness of muscle

·         NO ST elevation

·         NO stemi

·         Non qwave

·         ST depression

·         Occlusion is incomplete or intermittent- clot might be floppy.

·         Better chance or recovery only ½ wall damage

·         Acute Coronary Syndrome becomes Acute Myocardial infarction when necrosis occurs

o   Whatever is necrotic we are never getting back

If injured of ishemic we can get this back

We know necrosis has occurred by looking at serum markers how?

·         Cells rupture when necrotic

Serum Markers of Acute Myocardial Infarction

Total CK

CK-MB

TRoponin 1

·         Total CK= comes from muscles if elevated we examine CK-MB d/t suspect hrt attack

·         CK-MG=Comes from cardiac muscle if elevated indicated Heart attack

·         Troponin I= Most accuarate gold standard= yes MI

• pain/discomfort
• SNS responce ex gidistress, tachycardia/vaso contric/ anxiety, restless
• hypotension and shock- as heart fails to pum

·         Morphine= vasodialation

·         Oxygen= increase supply

·         Nitrates=dialated coronary arteries and bring more blood flow to the heart

·         Aspirin= antiplatlet

Major interventions to do wit MI?

Thromoblysis

PCI

PTCA

PTCA/stent

·         Thrombolysis

o   Best- break down clot if you got to this patient with in 2-3hrs

·         PCI- Cath femoral artery, run it in to coronary artery

o   PTCA-Heart cath balloon open up

o   PTCA with stent- use angioplasty to open up with a stent and push plaque up in walls

·         CABO

o   Different vessel and bypass the clot also very good

·         Heart failure

·         Cardiogenic shoke

·         Percarditis

·         Thromboemboli

·         Rupture of the heart

·         Ventricular Aneurysm

·         Inability of the heart to pump enough blood to meet the demand of the body

Structure of the heart changes this is bad caused by angiotension 2, rest caused by normal body process d/t they are trying to correct the situation causes dysfunction

Cardiac remodeling·        

  Myocardial hypertrophy?

o   Can’t fill the heart can’t pump it blood vessels constricted

cardiac remodoling·        

Dialated cardiomyopathy

o   Stretched you can fill it but now you can’t pump it because muscle is to skinny.

·         Right sides HRT failure- Fluid back up in body

o   Back ward effect- Fluid in body

§  Hematomegly

§  Ascietes

§  Splenomagly

§  Anorexia

§  Subq edema

§  JVD

·         Left sided Hrt Failure- fluid in lungs

o   Backward effect

§  Dyspnea on exertion

§  Orthopena

§  Cough

§  Paroxysmal noctura dyspnea

§  Cyanosis

§  Basilar crackles

no 02 blood to body

o   Forward effect- no 02 in blood

§  Fatique

§  Obliguria

§  Increase hrt

§  Restless

§  Confusion

§  Anxiety

§  Blood backs up in pulm vessel

§  Pulm BP increases

§  Cap fluid in alveoli plasma will follow

o   Pink frothy fluid is result

crackles

WE HAVE NOW FAILED OUR PT

§  Damaged endocardium

§  Creates portal of entry for bacteria

Acute- hx of strept effects joint

Recurrent- extension of cardiac effect

Chronic- Perment deformatity of hrt

§  Stenotic valve

o   Hear a murmur of blood shooting through the narrow opening when the valve is open

§  Regurgiant

o   You will hear a murmur of blood leaking through the valve when value should be closed

Mitral Prolapse- valvue flaps all the time

§  Congenital associated with marfans

§  Anxious at all times

§  EPI released constantly

§  Give beta blockers to these people

• ·         Sa node- natural pace maker of hrt

• ·         Enters both atria causes them to contract to push blood to ventricals

• ·         Elecrical single reaches AV node n pauses giving ventricals time to fill

• ·         Electrical single spreads through HIS-purkinje system causes ventrical to contract and push blood in lungs

·         control electrical single of hrt build in AP of each cardiac cell

o   ARP- no matter what stimulation no ap can accure- toilet no matter how many time you try wont flush

o   RRP- really strong stimulation to evolc action potential-toilet will kinda flush but not great

o   SN-Strong response- now my toilet flushes

·         Speed of electricity thru heart & what direction is it going

·         Blocked inpulses

o   Stops impulse all together

o   Sends impulse to wrong/ineffective pathway= wrong direction

·         Aberrant

o   Arising from non-pacemmaker cell in Atrial or ventricaluar- start in wrong place

What are the problems with a blocked impulse

·         Can’t meet its self keeps going electrical patterns look circular=reenternce activation

·         Shock caused by hrt failure or degenerative shock- Heart fails to pump blood adueqTLY

o   Decreased c/o lower BP

o   Sympathetic system responds to increase HR

o   Vaso con increases resitance to blood flow

o   Increased workload on hrt worsesns hrt=failure

As this continues to worsen we end up with tissue ischemia

·         Decreased C/0= decreased perfusion

·         Tissue hypoxia=anaerobic metabolism little energy

·         Lactice acid= tissue damage

·         Inflammatory Process=mediators released increased cap permability

·         Decrease circ volume= decrease cardiac output

What is difference b/t cardiac shock and distribuative shock?

·         Where it starts cardiac starts @ heart, Distribuative start when I have bad perfusion at tissue level

Type of shock- depends on cause of shock

1. Cardiogenic
2. hypovolemic
3. distribuative- septic/anaphlactic
   

·         Carodigenic shock- caused by decrease cardiac output

·         Hypovolemic shock- caused by blood lose

·         Distribuative- start at bad perfusion at tissue level

o   Septic/anapaplatic – pipes increase= lose of fluid into vascular space

·         Positive inotrop- increase cardiac output it increases force of contraction

o   Dobutamin-drug thatincreaes force of contraction

o   Becareful- Have to be able to balance out ability of the heart

·         Fluid restriction

o   Diuretic- decrease fluid decreases the preload which decreases force of contraction

·         Rest- NO ROM

·         Intra- aortic balloon pump

o   Support hrt and take over some wrk of hrt letting hrt rest

o   During Systol- balloon collapses- creats a vacume pulls blood out of hrt

o   During Dystol- Balloon blows up- blood left fill be forced back up- perfuse coronary arteries

Complications of cardiogenic Shock

1. ARDS
2. ARF
3. DIC
4. MODS
   

·         ARDS- caused by damage of pul epitheliam causes tissue injury longer it occurs worse damge

·         ARF- Decreased perfusion to kidneys and damges kidneys

·         DIC

·         MODS

·         Lots of coagulation

·         Clots in many small blood vessels/platelets and clotting proteins used up

·         Mircroinfraction, ischemia/ Bleeding problems

What happens if anything Is below microfractions?

No tissue perfusion= tissue Hypoxia

·         The most frequent cause of death

·         Mortality rises as more organs are effected

·         First problems is with GI-renal-ards-liver-brain exxx

MODS is caused by?