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Cardiac/Vascular Circulation Brenda Rowe, RN, MN, JD Georgia Baptist College of Nursing of Mercer University C.O. = Stroke Vol. X Heart Rate Preload - passive stretching force exerted on ventricle muscle Contractility - force of the squeezing that the ventricle is able to achieve

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Cardiac vascular circulation l.jpg
Cardiac/Vascular Circulation

Brenda Rowe, RN, MN, JD

Georgia Baptist College of Nursing

of Mercer University


C o stroke vol x heart rate l.jpg
C.O. = Stroke Vol. X Heart Rate

  • Preload - passive stretching force exerted on ventricle muscle

  • Contractility - force of the squeezing that the ventricle is able to achieve

  • Afterload - amount of pressure the ventricle muscle must overcome to eject

  • Contraction - dependent upon conduction system


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Cardiac Effects of Digoxin

  • Positive inotropin effect: strengthens the force of contraction

  • Negative dromotropin effect: decreases conduction

  • Negative chronotropin effect: decreases heart rate

  • Improve renal perfusion


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Digoxin

* CHF, atrial fib

* digitalization

* toxic effects - N&V, diarrhea, green/yellow vision, double vision, headache, dizziness, fatigue, weakness

* monitor effectiveness

* watch for hypokalemia

* education

* antidote - digoxin immune FAB


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Nursing Interventions

  • Monitor HR - apical for 1 minute

  • Monitor Dig level - 0.5-2.0 ng/ml

  • Monitor K, Calcium, Mag - increase in calcium or decrease in K or Mag will potentiate the effect of Digoxin


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Other Cardiac Glycosides

  • inamrinone (Inocor) & milrinone (Primacor): increase force of contraction and produce a vasodilatory effect which increases cardiac output

  • Used for short term management of CHF


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Critical Thinking Exercise

  • A patient with CHF

  • Is on Digoxin, Lasix, and potassium supplement

  • What is the desired therapeutic effect?

  • Why should hypokalemia be prevented?

  • What blood work should be monitored?


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Nitroglycerin

  • Relaxes vascular smooth muscles & dilates arterial & venous vessels thus reducing afterload & myocardial consumption

  • Acute angina: sublingual, transmucosal, or translingual spray

  • Prophylactic for angina: above & topical & oral SR

  • IV: used to treat primarily hypertension


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Tolerance & Adverse Effects

  • Tolerance may develop

  • Less likely in sublingual & translingual spray

  • Most common adverse effects: headache, can have hypotension, tachycardia, syncope


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Anginal Episode

  • Have a person lie down

  • Give nitroglycerin tabs x 3, if needed, 5 minutes apart

  • If no relief – call 911


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Education

  • Smoking causes vasoconstriction which may cause angina

  • Sublingual: keep in original bottle with tight cap

  • Transdermal: nonhairy area but avoid distal parts of extremities, remove patch for 10-12 hours


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Education (cont.)

  • Increase absorption with broken skin, increase with exercise, increase temperature (avoid sauna)

  • Ointment: choose a different application site, use tissue to remove any old ointment, do not massage or rub in ointment


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Antiarrhythmics

* see after MI, cardiac surgery, CAD, electrolyte imbalance, thyroid disease

* abnormality with initiation of impulse or in impulse conduction or both

* should be monitored, most meds given IV, monitor AP (rate & rhythm)


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Antiarrhythmic Agents

Quinidine (Cardioquin) – class 1A depresses Phase 0 in depolarization

* depresses cardiac function, however inhibits vagal action so may have sinus tachycardia

* has high incidence of adverse effects with most common being GI

* monitor renal & liver function


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Lidocaine

  • Lidocaine (Xylocaine) - Class 1B depresses phase 0 but not as much as Quinidine

  • brief action so less chance of cumulative drug toxicity, make sure you have correct type of Lidocaine, tx ventricular arrhythmias

  • give IV


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Antiarrhythmic Agents (cont.)

Flecainide (Tambocor) - Class 1C markedly depresses phase 0, tx PAF or flutter & ventricular arrhymias, suppress conduction, many adverse effects

Propranolol (Inderal) - Class II depresses phase 4 depolarization, beta adrenergic blocking agent, tx arrhythmias secondary to dig toxicity, also used to tx hypertension, angina & MI


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amiodarone (Cordarone)

  • Amiodarone (Cordarone) - Class III prolongs phase III repolarization

  • increases refractory period, increases myocardial contractility, vasodilatory action

  • used to prophylaxis and therapy of vent fib

  • keep pt supine - most common AE is orthostatic hypotension


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Verapamil HCL (Calan)

  • Class IV depresses phase 4 depolarization & lengthens phase 1 & 2 of repolarization

  • calcium channel blocker, decrease myocardial contraction, decrease SA node impulse, decrease conduction, also causes CA dilatation & peripheral vasodilatation

  • also used to tx angina

  • watch for bradycardia & hypotension

  • AE - most common is constipation

  • IV solution must be protected from light

  • Administer slowly – greater than 2 minutes


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Potassium-Removing Resins

  • Sodium polystyrene sulfonate (Kayexalate)

  • oral or enema

  • AE - hypokalemia


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Antihyperlipidemics

  • Definition

  • HDL/LDL


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Statins

  • lovastatin (Mevacor)

  • Blocks synthesis of cholesterol in liver

  • Decrease LDL, increase HDL


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Bile acid sequestrants

  • cholestyramine (Questran)

  • Lower LDL levels

  • Binds bile acids in intestine


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New drugs

  • How actions differ