NSB603 Intrductin t Cardithracic Nursing Lecture 1a HEART OBJECTIVES Describe pathphysilgy f heart failure, CAD, angina/mi List Rx fr angina/mi Evaluate effectiveness f interventins HEART PATHWAY Frm Bdy Right Atrium Right Ventricle Pulmnary Artery Lungs Frm Lungs Left Atrium Left Ventricle Arta Bdy RA Tricuspid valve RV Pulmnary valve Pulmnary artery LA Mitral valve LV Artic valve Arta If xygenated bld is 98%, what is the dexygenated bld levels? Apprximately 75% Atriventricular (AV) valves tricuspid and mitral (biscuspid) Separate the atria frm the ventricles Have 3 and 2 separate cusps, have chrdae tendineae Semilunar (SL) valves artic and pulmnic Prevents backflw frm arta and pulmnary arteries int the ventricles Prblems here cause regurgitatin and backflw 3 cusps like half mns smaller penings than AV ndes Are nt cnnected t chrdae tendineae
3 layers f the heart Endcardium, mycardium and epicardium Innermst utermst The endcardium is made up f a thin smth layer f epithelium and cnnective tissues and lines the hearts inner chambers, valves, chrdae tendineae (tendinus crds) and papillary muscles Is where mst heart disease affect such as Rheumatic Heart Disease Heart is situated in the space between the lungs the mediastinum in the middle f the chest It sits behind the sternum and just abve the diaphragm, 2/3s f the heart lie t the left f the midline f the sternum, the remaining 3 rd lies t the right The base, r psterir surface f the heart is frmed by the left atrium, a small prtin f the right atrium and prximal prtins f the superir and inferir venae cavae and the pulmnary veins The frnt-anterir surface f the heart lies behind the sternal and cstal cartilages frmed by prtins f the right atrium and the left and right ventricles The hearts apex r lwer prtin, is frmed by the tp f the left ventricle and lies just abve the diaphragm at apprximately the level f the 5 th intercstal space in the midclavicular line Heart starts at the 2 nd intercstal space HEART FAILURE Right Sided Heart Failure Left Sided Heart Failure LHF leads t RHF RHF leads t LHF LHF leads t RHF much quicker than RHF leads t LHF RIGHT SIDED HEART FAILURE If the right sided heart isn t pumping well, the bld will back up, therefre yu will nt receive gd bld supply t the left side f the heart, therefre bld pressure will drp Right sided heart failure will lead t left sided heart failure (generally within apprximately 2years), and verall heart failure Are mre susceptible t edema Bld is pling/backing up at right ventricle Bld returning t the heart will need t have mre frce t enter Veins dn t pump bld back t the heart, s pressure in the RV means that the bld will pl in the veins as they cant push it back int the heart Therefre, peripheral edema in trunk and legs Less vlume leaving the RV, meaning that it isn t clearing the bld effectively. Still requires bld t cme back in thugh, as the LV is pumping bld ut LV cntinues t pump bld, cntinues t frce int failing RV, end up with a larger RH If RH becmes larger and is treated, bld vlume in RV lwers, leading t flppy RV, and decreased pump vlume
Therefre have t be careful when administering diuretics.fixes dema, but des nt wrk well fr the heart and filling/pumping vlumes. Nt much bld t be xygenated as less pumping vlume, therefre less vlume fr the LV t pump t the bdy By prescribing diuretic/high levels f diuretic depending, yu can end the patient int heart failure, as they can t sustain their BP, drps, and cant service the bdy/heart sufficiently Peple with peripheral edema ften have brwn legs Due t the pressure in the vein as it cannt return, s the RBCs are pushed int the tissue, they die & the haem stains the tissue Peripheral edema is an early sign n RHF Can tell if it is chrnic r acute, depending n edema, clur, skin, patient histry/cmmunicatin Whether r nt they urinate much during the day, but a lt at night (kidneys are mre perfused as they are lying dwn and fluid return is easier) Liver prblems/failure As this is befre the RV, bld pls/cngesting in the liver prtal HTN Alternatively, the lungs will nt exhibit signs as they are abve the RV Kidney prblems Nt enugh pressure t perfuse the nephrns, therefre n urine Jugular Venus Pressure Drugs Infrms us hw well the RV is functining JVP n patient sitting upright (lking visually fr pulses) Pressure n a nrmal functining heart shuld nly be 0-6mm Mecury r cmh2o If there in increased JVP, apprximately 21-33cms, can indicate RHF The further back yu lay smene, the easier it is t see their JVP Nrmal functining heart will display a JVP when lying dwn Want t see JVP lwer in the neck, t ensure that we are seeing the end f the JVP, ensuring that it isn t hiding under the jaw Lasix, beta-blckers (eg. Digxin) If yu treat a patient with an increased JVP, shuld ask whether r nt they take medicatin at hme ask! What, hw many times, what fr? LEFT SIDED HEART FAILURE If the left side desn t wrk, nthing wrks very well! Particularly lung prblems! Decreased ejectin fractin - ability f heart t push and cntract nrmally 60-80% Enlarged heart cardimypathy, leads t increased pressure n atrium leading t decreased CO Less bld vlume t head dizziness/haziness/decreased clear thught prcesses Signs f very limited xygenated bld getting t brain Septic shck/shck Peripheral bld vlume changes as it attempts t keep everything centrally Bld pressure increases as lss bld being sent t peripheries Bdy will cmpensate fr BP, when it can t maintain, the heart will pump faster t help maintain, therefre PR will increase Increased PR means that entire stretch (pen/clse) f heart is nt cmpleted, therefre BP increases Peripherally shutting dwn, PR increases, BP maintained t assist with brain functin In LHF, bld flw t gut is decreased, therefre pt experiences nausea (due t static gut) Nt much will ccur in LHF in head and arms, as that is where the fcus/1st exit pint fr bld is Will start t decrease bld flw t lwer bdy/peripheries t sustain bld flw t brain Bld can backup int RV frm LHF backs up int lungs Expect t see diminished pulses, decreased BP Main issue will be difficulty breathing due t cngestin in the lungs & pulmnary edema Due t backing up f bld in LV and RV Prblems with lungs? Prblems with RV and therefre RHF
Left main Right crnary artery prvides O2 t yur RA, RV, inferir surface f LV (~85%), psterir surface f LV (~85%) Therefre is RCA blcked, serius issues! LAD prvides O2 t anterir surface f LV, part f lateral surface f LV, Anterir 2/3 f interventricular septum Circumflex prvides O2 t LA, part f lateral surface f LV, inferir surface f LV (~15%), psterir surface f LV (~15%) Triple ventricular disease (TFD) affects all 3 f these! Left main is where all the arteries are cmbined/jined Turn int cat 1 require CABG, will be dne within the week LAD Left anterir descending (branches f left crnary artery and cardiac vein) Damage any crnary arteries high chance that yu will damage bld flw t LV Des nt fill crnary arteries straight away, heart pump pushes bld int arta, when heart relaxes, sme bld cmes back t the heart and perfuses the crnary arteries befre the heart cntracts again If PR is increased, there is a decreased relaxatin time, therefre decreased ability t perfuse crnary arteries, therefre less xygen t the heart The mre rapid yur heart rate, the less bld that ges thrugh the crnary arteries N perfusin t crnary arteries N xygen t the heart - hypxia Heart stps - angina Bld that perfuses the heart (crnary arteries), runs back int the RA RHF patients have increased pressure in the RV, making it mre difficult fr the crnary arteries t empty int the RA/RV Pressure in crnary arteries increase Inactive lifestyle patients can have a substantial (90%) blckages in their crnary arteries, but nt nly just ntice Retrgrade perfusin delivering xygenated bld t an rgan thrugh a vein Used when perfrming a surgery that interrupts the cerebral arteries Hse is placed int the femral artery and the superir vena cava can redirect bld up the internal jugular vein t supply the brain eg. when remving blckages n cerebral arteries CABG Crnary Artery Bypass Graft
CARDIAC FAILURE RX Diurese Kidney issues (kidneys begin t fail, reduce utput, mre circulating vlume, heart wrks harder, perpetuates the whle thing!) Increase cntractility Beta blckers (slws heart rate) eg. Digxin Increases perfusin elsewhere Better filling & CO Vasdilate Decrease bld pressure & reduce cardiac Wrklad HEART FAILURE Lw CO, therefre, nt perfusing brain, heart and kidneys Adequately and therefre bdy cmpensates with Renin angitensin Aldsterne system DYSLIPIDAEMIA Or Hyperlipidaemia Dys mre accurate, meaning wrng. Hyper less accurate, meaning mre but can have decreased HDLs Increase LDLs (bad chlersterl) +/- TG r decreased HDLs Athersclersis Cardivascular risk Therefre ptimise lipid prfile t reduce risk Increase HDL, decrease LDL Can lead t necrsis by increased pressure t vessel wall HDL can remve LDL and plaque frm vessel wall Causes; Primary; Genetic mutatins Family Hx Secndary; Sedentary lifestyle Increased dietary fat, chlesterl, TFA Diabetes Alchl veruse Chrnic renal insufficiency Liver disease Drugs eg. beta blckers, estrgen Decreased clearance f TG and LDL Decreased prductin r increased clearance f HDL Asymptmatic But symptmatic vascular disease Crnary artery disease Suspect CAD? check feet! Because ther arteries culd be blcked such as cartid, femral r ileac Peripheral artery disease Acute pancreatitis Chlesterl will increase Pancreas prduces insulin and enzymes t break dwn fats Inflammed? N insulin r enzymes prduced Xanthma (yellwish fatty build up that becmes present anywhere n bdy) Symptms can becme mre apparent in menpausal and peri-menpausal wmen