Cardiac/Vascular Nurse Exam Secrets Study Guide (19 page)

Pharmacologic management of angina pectoris involves use of antiplatelet agents such as aspirin, anticoagulants like heparin, beta-adrenergic blockers, lipid-lowering agents, nitrates such as nitroglycerin, isosorbide dinitrate and isosorbide mononitrate, and calcium channel blockers such as nifedipine, amlodipine, verapamil, and diltiazem.

Lifestyle modifications include weight loss for obese patients, reduction of saturated fats and sodium in diet, increase in physical activity, cessation of smoking, stress reduction and management, and cessation of alcohol and illicit drug use.

Addressing cardiovascular comorbid conditions and receiving proper treatment post myocardial infarction may prevent the onset of angina pectoris. Also, individuals with a family history of cardiovascular disease and/or a medical history of heart disease should monitor symptoms closely.

General preventive measures that individuals can take to reduce the risk of angina pectoris and disease complications include maintaining proper lipid levels, blood pressure, glucose levels, healthy weight, healthy diet low in sodium and saturated fats, avoiding smoking, controlling diabetes, managing stress and anxiety, reducing alcohol consumption, and avoiding illicit drug use.

Treatment and prevention of atrial fibrillation

The goals of treatment of atrial fibrillation include controlling heart rate, restoring sinus rhythm, controlling ventricular response, preventing complications such as thromboembolism and other cardiovascular complications. Treatment approaches include lifestyle modifications, pharmaceutical management, and use of assistance devices. Electrical conduction management of the heart can be maintained with synchronized electrical cardioversion and permanent atrial pacemaker. Pharmacologic management of atrial fibrillation involves the use of use of beta-adrenergic blockers; digitalis antiplatelet agents like aspirin; anticoagulants such as Coumadin and heparin; antidysrhythmia agents; and calcium channel blockers such as nifedipine, amlodipine, verapamil, and diltiazem. Other pharmacologic agents used to treat comorbid cardiovascular conditions include lipid-lowering agents and nitrates such as nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate. Note that rate control (beta-blockers, etc) with anticoagulation is equivalent to rhythm control with respect to mortality. More invasive approaches include AV node ablation, radiofrequency catheter ablation, and surgical maze procedure.

Addressing cardiovascular comorbid conditions and receiving proper treatment post–myocardial infarction may prevent the onset of atrial fibrillation. Also, individuals with a family history of cardiovascular disease and/or a medical history of heart disease should pay careful attention to their symptoms.

General preventive measures that individuals can take to reduce the risk of atrial fibrillation and disease complications include maintaining proper lipid levels, blood pressure, glucose levels, healthy weight, healthy diet low in sodium and saturated fats, avoiding smoking, controlling diabetes, managing stress and anxiety, reducing alcohol consumption, and avoiding illicit drug use. Also, to make sure respiratory comorbidities like chronic obstructive pulmonary disease (COPD) are under good control, as this is a common source of atrial fibrillation in the elderly.

Treatment and prevention of arrhythmias

The treatment of arrhythmia depends on the type of arrhythmia including bradycardias, supraventricular tachycardias and ventricular tachycardias. In addressing bradycardias, practicing clinicians will assess whether an underlying condition such as thyroid dysfunction is present and treat the underlying cause to correct the problem. Another approach with undetermined bradycardias or necessary medications includes the use of a pacemaker.

In addressing tachycardias originating either in the atria or ventricles, treatment may involve the use of vagal maneuvers such as straining or coughing, antiarrhythmic agents, cardioversion, and cardiac ablation. Implantable devices such as a pacemaker or implantable cardiac defibrillator may also be used. In more severe cases, surgery may be performed, which involves the maze procedure, ventricular aneurysm surgery, or coronary bypass surgery.

Patients diagnosed with an arrhythmia will be recommended to make lifestyle changes that include maintaining a healthy diet low in saturated fats and sodium, increase physical activity, quit smoking, reduce caffeine and alcohol intake, reduce stress, and avoid stimulants. Vagal maneuvers such as gagging, holding breath, and coughing may be recommended as well.

Addressing cardiovascular comorbid conditions and receiving proper treatment post–myocardial infarction may prevent the onset of arrhythmias. Also, individuals with a family history of cardiovascular disease and/or a medical history of heart disease should pay careful attention to signs and symptoms of disease.

General preventive measures that individuals can take to reduce the risk of arrhythmias and disease complications include maintaining proper lipid levels, blood pressure, glucose levels, healthy weight, healthy diet low in sodium and saturated fats, avoiding smoking, controlling diabetes, managing stress and anxiety, reducing alcohol consumption, and avoiding illicit drug use.

Treatment and prevention of atrial flutter

Lifestyle modifications, pharmacologic management and invasive approaches are used to treat atrial flutter depending on the impact on quality of life and presence of other comorbid conditions. Treatment involves slowing the heart rate and restoring cardiac rhythm as well as prevention of blood clot formation.

Pharmacologic approaches used for the treatment of atrial flutter include calcium channel blockers such as diltiazem and verapamil; beta-blockers such as metoprolol and esmolol; class I antiarrhythmics such as procainamide and quinidine; class III antiarrhythmics such as amiodarone, dofetilide, and ibutilide; and cardiac glycosides such as digitalis.

More invasive approaches include cardioversion and catheter ablation. Patients diagnosed with atrial flutter respond better to catheter ablation than patients diagnosed with atrial fibrillation.

Patients diagnosed with atrial flutter will be recommended to make lifestyle changes that include maintaining a healthy diet low in saturated fats and sodium, increasing physical activity, quitting smoking, reducing caffeine and alcohol intake, reducing stress, and avoiding stimulants.

Addressing cardiovascular and respiratory comorbid conditions and receiving proper treatment post myocardial infarction may prevent the onset of atrial flutter or atrial fibrillation. Also, individuals with a family history of cardiovascular disease and/or a medical history of heart disease should pay careful attention to the signs and symptoms of disease.

General preventive measures that individuals can take to reduce the risk of atrial flutter and disease complications include maintenance of proper lipid levels, blood pressure, glucose levels, healthy weight, healthy diet low in sodium and saturated fats, management of stress and anxiety, reduction of alcohol consumption, and avoidance of illicit drug use.

Treatment and prevention of Wolff-Parkinson-White syndrome

Lifestyle modifications, pharmacologic management, and surgery are options for treatment of Wolff-Parkinson-White syndrome. The goal of treatment is to reduce tachycardia and restore normal heart rhythm.

Pharmacologic approaches used to treat Wolff-Parkinson-White syndrome include antiarrhythmic agents such as adenosine and procainamide.

The most effective and curative approach for the treatment of Wolff-Parkinson-White syndrome is radiofrequency catheter ablation. However, surgical destruction of the accessory pathway may be performed and be effective, but radiofrequency catheter ablation is typically the most safe and efficacious curative approach.

Patients diagnosed with Wolff-Parkinson-White syndrome will be recommended to make lifestyle changes that include maintaining a healthy diet low in saturated fats and sodium, increasing physical activity, quitting smoking, reducing caffeine and alcohol intake, reducing stress, and avoiding stimulants. Other vagal maneuvers may be recommended to reduce a patient’s heart rate including coughing and bearing down as during a bowel movement.

Wolff-Parkinson White syndrome is not preventable, but not all patients develop symptoms. Addressing cardiovascular comorbid conditions and receiving proper treatment post myocardial infarction may prevent the onset of complications associated with Wolff-Parkinson-White syndrome. Also, addressing modifiable risk factors and addressing other cardiovascular comorbid conditions promptly will reduce the likelihood of complications associated with the syndrome.

General preventive measures that individuals can take to reduce the risk of disease complications include maintaining proper lipid levels, blood pressure, glucose levels, healthy weight, healthy diet low in sodium and saturated fats, exercising regularly, avoiding smoking, controlling diabetes, managing stress and anxiety, reducing alcohol consumption, and avoiding illicit drug use.

Treatment and prevention of ventricular fibrillation

Ventricular fibrillation is a serious medical condition that should be treated as a medical emergency. If an individual is suspected of having an acute ventricular fibrillation episode, then a practicing clinician may perform cardiopulmonary resuscitation and will shock the heart using an external defibrillator. The goal of treatment is to restore normal heart rhythm to reestablish proper cardiac output and blood oxygenation. The shock is given as soon as possible and, if a defibrillator is available, even before cardiopulmonary resuscitation (CPR).

Pharmacologic agents will also be administered to control the individual’s heart rate and function. Pharmacologic agents used to treat ventricular fibrillation include vasopressors or sympathomimetics such as epinephrine, antidysrhythmia agents such as lidocaine, amiodarone, bretylium tosylate, and procainamide, and electrolytes such as magnesium sulfate, sodium bicarbonate, and calcium chloride. A more invasive approach includes the use of an implantable cardiac defibrillator post an acute ventricular fibrillation episode to prevent sudden cardiac death.

Addressing cardiovascular comorbid conditions and receiving proper treatment postventricular fibrillation may prevent the onset of complications associated with the condition. Also, addressing modifiable risk factors and addressing other cardiovascular comorbid conditions promptly will reduce the likelihood of complications associated with the condition.

General preventive measures that individuals can take to reduce the risk of ventricular fibrillation and complications associated with the condition include exercising regularly, maintaining proper lipid levels, blood pressure, glucose levels, healthy weight, healthy diet low in sodium and saturated fats, avoiding smoking, controlling diabetes, managing stress and anxiety, reducing alcohol consumption, and avoiding illicit drug use.

Treatment and prevention of ventricular tachycardia

Treatment of ventricular tachycardia depends on the degree and extent of the condition. It also varies on the individual patient, patient’s general health and presence of other comorbid conditions. In some individuals, emergency management is necessary, and in others, no treatment is required. Treatment involves lifestyle modifications, pharmacologic management and. in more severe cases, surgical approaches.

If an individual has acute ventricular tachycardia and is pulseless or symptomatic, defibrillation is necessary. Cardiopulmonary resuscitation (CPR) is also often necessary. The goal of treatment is to restore normal heart rhythm to reestablish proper cardiac output and blood oxygenation.

Pharmacologic management of ventricular tachycardia involves treatment with antiarrhythmia agents such as lidocaine, procainamide, amiodarone, sotalol, mexiletine, acebutolol, atenolol, metoprolol, flecainide, propafenone, and quinidine.

Addressing cardiovascular comorbid conditions and receiving proper treatment post ventricular tachycardia may prevent the onset of complications associated with the condition. Also, addressing modifiable risk factors and addressing other cardiovascular comorbid conditions promptly will reduce the likelihood of complications associated with the condition.

General preventive measures that individuals can take to reduce the risk of ventricular tachycardia and complications associated with the condition include maintaining proper lipid levels, blood pressure, glucose levels, healthy weight, healthy diet low in sodium and saturated fats, exercising regularly, avoiding smoking, controlling diabetes, managing stress and anxiety, reducing alcohol consumption, and avoiding illicit drug use.

Treatment and prevention of intermittent claudication

Lifestyle modifications, pharmacologic management and, in more severe cases, surgical intervention are used for the treatment of intermittent claudication.

Lifestyle modifications include treatment of other comorbid cardiovascular disease, management of hypertension and high cholesterol, maintenance of proper glucose levels, increased physical activity, compliance with diabetes treatment, cessation of smoking, and/or avoidance of alcohol or illicit drug use.

Pharmacologic agents used to treat intermittent claudication include pentoxifylline and cilostazol, which act by dilating blood vessels, increasing blood flow to the extremities and reducing clot formation. Surgical approaches used for patients with peripheral arterial disease and intermittent claudication include angioplasty and cardiopulmonary bypass surgery. Other surgical approaches used for peripheral arterial disease and intermittent claudication include transcatheter intervention and peripheral vascular bypass.