1:44 M age 1121 Chapter Cardiology Objectives art 1: Cardiovascular natomy and hysiology, ECG Monitoring, and Dysrhythmia nalysis (begins on p. 1127) fter reading art 1 of this chapter, you should be able to: 1. Describe the incidence, morbidity, and mortality of cardiovascular disease. (p. 1126) 2. Discuss prevention strategies that may reduce the morbidity and mortality of 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. cardiovascular disease. (p. 1126) Identify the risk factors most predisposing to coronary artery disease. (p. 1126) Describe the anatomy of the heart, including the position in the thoracic cavity, layers of the heart, chambers of the heart, and location and function of cardiac valves. (pp. 1127 1128; also see Chapter 3) Identify the major structures of the vascular system, the factors affecting venous return, the components of cardiac output, and the phases of the cardiac cycle. (pp. 1128 1130; also see Chapter 3) Define preload, afterload, and left ventricular end-diastolic pressure and relate each to the pathophysiology of heart failure. (see Chapter 3) Identify the arterial blood supply to any given area of the myocardium. (p. 1128; also see Chapter 3) Compare and contrast the coronary arterial distribution to the major portions of the cardiac conduction system. (p. 1128; also see Chapter 3) Identify the structure and course of all divisions and subdivisions of the cardiac conduction system. (pp. 1129 1130; also see Chapter 3) Identify and describe how the heart s pacemaking control, rate, and rhythm are determined. (p. 1130; also see Chapter 3) Explain the physiological basis of conduction delay in the V node. (see Chapter 3) Define the functional properties of cardiac muscle. (see Chapter 3) Define the events comprising electrical potential. (see Chapter 3) List the most important ions involved in myocardial action potential and their primary function in this process. (see Chapter 3) Describe the events involved in the steps from excitation to contraction of cardiac muscle fibers. (p. 1130; also see Chapter 3) Describe the clinical significance of Starling s law. (see Chapter 3) C t HJ 1121 28
1:45 M age 1122 17. Identify the structures of the autonomic nervous system and their effect on heart 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. rate, rhythm, and contractility. (see Chapter 3) Define and give examples of positive and negative inotropism, chronotropism, and dromotropism. (see Chapter 3) Discuss the pathophysiology of cardiac disease and injury. (pp. 1142 1185) Explain the purpose of ECG monitoring and its limitations. (p. 1130) Correlate the electrophysiological and hemodynamic events occurring throughout the entire cardiac cycle with the various ECG waveforms, segments, and intervals. (pp. 1134 1141) Identify how heart rates, durations, and amplitudes may be determined from ECG recordings. (pp. 1134 1141) Relate the cardiac surfaces or areas represented by the ECG leads. (pp. 1131 1132, 1140) Differentiate among the primary mechanisms responsible for producing cardiac dysrhythmias. (pp. 1140, 1142 1185) Describe a systematic approach to the analysis and interpretation of cardiac dysrhythmias. (pp. 1141 1185) Describe the dysrhythmias originating in the sinus node, the V junction, the atria, and the ventricles. (pp. 1144 1185) Describe the process and pitfalls of differentiating wide QRS complex tachycardias. (pp. 1174 1176) Describe the conditions of pulseless electrical activity. (pp. 1182 1183) Describe the phenomena of reentry, aberration, and accessory pathways. (pp. 1143 1144, 1153, 1184 1185) Identify the ECG changes characteristically produced by electrolyte imbalances and specify their clinical implications. (p. 1185) Identify patient situations where ECG rhythm analysis is indicated. (pp. 1142 1185) Recognize the ECG changes that may reflect evidence of myocardial ischemia and injury and their limitations. (p. 1140) Correlate abnormal ECG findings with clinical interpretation. (pp. 1142 1185) Identify the major mechanical, pharmacological, and electrical therapeutic objectives in the treatment of the patient with any dysrhythmia. (pp. 1142 1185) Describe artifacts that may cause confusion when evaluating the ECG of a patient with a pacemaker. (pp. 1131, 1179, 1181 1182) List the possible complications of pacing. (pp. 1181 1182) List the causes and implications of pacemaker failure. (pp. 1181 1182) Identify additional hazards that interfere with artificial pacemaker function. (pp. 1181 1182) Recognize the complications of artificial pacemakers as evidenced on an ECG. (pp. 1181 1182) art 2: ssessment and Management of the Cardiovascular atient (begins on p. 1186) fter reading art 2 of this chapter, you should be able to: 1. Identify and describe the components of the focused history as it relates to the 2. 3. 4. C t HJ patient with cardiovascular compromise. (pp. 1187 1191) Identify and describe the details of inspection, auscultation, and palpation specific to the cardiovascular system. (pp. 1191 1194) Identify and define the heart sounds and relate them to hemodynamic events in the cardiac cycle. (pp. 1192 1193) Describe the differences between normal and abnormal heart sounds. (pp. 1192 1193) 1122
1:45 M age 1123 5. Define pulse deficit, pulsus paradoxus, and pulsus alternans. (pp. 1194, 1222) 6. Identify the normal characteristics of the point of maximum impulse (MI). (p. 1193) 7. Based on field impressions, identify the need for rapid intervention for the patient 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. in cardiovascular compromise. (pp. 1186 1194) Describe the incidence, morbidity, and mortality associated with myocardial conduction defects. (p. 1216) Identify the clinical indications, components, and the function of transcutaneous and permanent artificial cardiac pacing. (pp. 1179, 1181 1182, 1206, 1207 1208) Explain what each setting and indicator on a transcutaneous pacing system represents and how the settings may be adjusted. (pp. 1207 1208) Describe the techniques of applying a transcutaneous pacing system. (pp. 1206, 1207) Describe the characteristics of an implanted pacemaking system. (pp. 1179, 1181 1182) Describe the epidemiology, morbidity, mortality, and pathophysiology of angina pectoris. (pp. 1211 1212) Describe the assessment and management of a patient with angina pectoris. (pp. 1213 1214) Identify what is meant by the OQRST of chest pain assessment. (pp. 1187 1188) List other clinical conditions that may mimic signs and symptoms of coronary artery disease and angina pectoris. (p. 1212) Identify the ECG findings in patients with angina pectoris. (p. 1213) Based on the pathophysiology and clinical evaluation of the patient with chest pain, list the anticipated clinical problems according to their life-threatening potential. (p. 1212) Describe the epidemiology, morbidity, mortality, and pathophysiology of myocardial infarction. (pp. 1214 1215) List the mechanisms by which a myocardial infarction may be produced from traumatic and nontraumatic events. (p. 1214) Identify the primary hemodynamic changes produced in myocardial infarction. (pp. 1214 1215) List and describe the assessment parameters to be evaluated in a patient with a suspected myocardial infarction. (pp. 1215 1216) Identify the anticipated clinical presentation of a patient with a suspected acute myocardial infarction. (pp. 1215 1216) Differentiate the characteristics of the pain/discomfort occurring in angina pectoris and acute myocardial infarction. (p. 1215) Identify the ECG changes characteristically seen during evolution of an acute myocardial infarction. (p. 1216) Identify the most common complications of an acute myocardial infarction. (pp. 1214 1216) List the characteristics of a patient eligible for fibrinolytic therapy. (pp. 1218 1220) Describe the window of opportunity as it pertains to reperfusion of a myocardial injury or infarction. (p. 1218) Based on the pathophysiology and clinical evaluation of the patient with a suspected acute myocardial infarction, list the anticipated clinical problems according to their life-threatening potential. (pp. 1214 1220) Specify the measures that may be taken to prevent or minimize complications in the patient suspected of myocardial infarction. (pp. 1216 1220) Describe the most commonly used cardiac drugs in terms of therapeutic effect and dosages, routes of administration, side effects, and toxic effects. (pp. 1199, 1200, 1218; also see Chapter 6) C t HJ 1123
1:45 M age 1124 32. Describe the epidemiology, morbidity, mortality, and physiology associated with 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. C t HJ heart failure. (pp. 1220 1221) Identify the factors that may precipitate or aggravate heart failure. (pp. 1220 1221) Define acute pulmonary edema and describe its relationship to left ventricular failure. (pp. 1220 1221) Differentiate between early and late signs and symptoms of left ventricular failure and those of right ventricular failure. (pp. 1220 1221) Define and explain the clinical significance of paroxysmal nocturnal dyspnea, pulmonary edema, and dependent edema. (pp. 1221 1222) List the interventions prescribed for the patient in acute congestive heart failure. (pp. 1223 1224) Describe the most commonly used pharmacological agents in the management of congestive heart failure in terms of therapeutic effect, dosages, routes of administration, side effects, and toxic effects. (pp. 1999, 1200, 1223; also see Chapter 6) Define and describe the incidence, mortality, morbidity, pathophysiology, assessment, and management of the following cardiac related problems: Cardiac tamponade (pp. 1224 1225) Hypertensive emergency (pp. 1225 1226) Cardiogenic shock (pp. 1226 1229) Cardiac arrest (pp. 1229 1233) Identify the limiting factor of pericardial anatomy that determines intrapericardiac pressure. (p. 1224) Describe how to determine if pulsus paradoxus, pulsus alternans, or electrical alternans is present. (pp. 1222, 1224) Explain the essential pathophysiological defect of hypertension in terms of Starling s law of the heart. (pp. 1221, 1226) Rank the clinical problems of patients in hypertensive emergencies according to their sense of urgency. (pp. 1225 1226) Identify the drugs of choice for hypertensive emergencies, cardiogenic shock, and cardiac arrest, including their indications, contraindications, side effects, route of administration, and dosages. (pp. 1999, 1200, 1226, 1227 1229, 1230; also see Chapter 6) Describe the major systemic effects of reduced tissue perfusion caused by cardiogenic shock. (pp. 1226 1227) Explain the primary mechanisms by which the heart may compensate for a diminished cardiac output and describe their efficiency in cardiogenic shock. (pp. 1226 1227) Identify the clinical criteria and progressive stages of cardiogenic shock. (pp. 1226 1227) Describe the dysrhythmias seen in cardiac arrest. (p. 1229) Explain how to confirm asystole using the 3-lead ECG. (p. 1229) Define the terms defibrillation and synchronized cardioversion. (pp. 1199, 1204) Specify the methods of supporting the patient with a suspected ineffective implanted defibrillation device. (p. 1201) Describe resuscitation and identify circumstances and situations where resuscitation efforts would not be initiated. (pp. 1229 1233) Identify communication and documentation protocols with medical direction and law enforcement used for termination of resuscitation efforts. (pp. 1232 1233) Describe the incidence, morbidity, mortality, pathophysiology, assessment, and management of vascular disorders including occlusive disease, phlebitis, aortic aneurysm, and peripheral artery occlusion. (pp. 1233 1237) 1124
1:45 M age 1125 55. Identify the clinical significance of claudication and presence of arterial bruits in a 56. 57. 58. 59. 60. 61. patient with peripheral vascular disorders. (pp. 1233 1237) Describe the clinical significance of unequal arterial blood pressure readings in the arms. (p. 1236) Recognize and describe the signs and symptoms of dissecting thoracic or abdominal aneurysm. (pp. 1233 1234) Differentiate between signs and symptoms of cardiac tamponade, hypertensive emergencies, cardiogenic shock, and cardiac arrest. (pp. 1224 1229) Utilize the results of the patient history, assessment findings, and ECG analysis to differentiate between, and provide treatment for, patients with the following conditions (pp. 1186 1237): Cardiovascular disease Chest pain In need of a pacemaker ngina pectoris suspected myocardial infarction Heart failure Cardiac tamponade hypertensive emergency Cardiogenic shock Cardiac arrest Based on the pathophysiology and clinical evaluation of the patient with chest pain, characterize the clinical problems according to their life-threatening potential. (p. 1212) Given several preprogrammed patients with cardiac complaints, provide the appropriate assessment, treatment, and transport. (pp. 1186 1237) C t HJ 1125