Efnisyfirlit

• 1 Anatomy and physiology
• A look at the cardiovascular system
• Right to the lungs . . . and left to the body
• Where the heart lies
• Heart structure
• The pericardium
• Fibrous fits freely
• Serous is smooth
• And fluid in between
• The wall
• The chambers
• Upstairs . . .
• . . . where the blood comes in
• Downstairs . . .
• . . . where the blood goes out
• The valves
• Forward flow only
• On the cusps
• Conduction system
• Electrical stimulation
• Start with a bang
• Slow and fill
• Impulsive signal
• Just in case
• Mechanical events
• Contract (systole) . . .
• . . . and relax (diastole)
• Output = rate × volume
• Blood flow
• Blood vessels
• Built for high speed . . .
• . . . and low pressure
• Frequent flyer miles
• Circulation
• Returns and exchanges
• Branching out
• Division = addition = perfusion
• Dilation is another part of the equation
• A large area of low pressure
• No backflow
• The heart gets its part
• From the right . . .
• . . . and from the left
• Superficially speaking
• Quick quiz
• Scoring
• Suggested references
• 2 Assessment
• Obtaining a health history
• Chief complaint
• A full menu of causes
• Pinpointing pain
• Going steady?
• Don’t skip this beat
• Maybe it was that triple shot of espresso
• No big deal—unless . . .
• Barely breathing
• Fainting facts
• Midlife crisis
• Claudication interrogation
• In your face (and arm and leg)
• Since when?
• Personal and family health
• All in the family
• Getting personal
• Also related
• Performing a physical assessment
• Shopping list
• Dressed down
• Assessing the heart
• Checking out the chest
• Location, location
• Not normally there
• From resonance to dullness
• Borderline trouble
• Have a plan
• Determine the dub
• Listen for the lub
• S3: Classic sign of heart failure
• S4: An MI aftereffect
• Making the grade
• Sit up, please
• Assessing the vascular system
• Start at the top
• Take this lying down
• Artery check!
• The pulses get pluses
• Moving on up
• Recognizing abnormal findings
• Abnormal skin and hair findings
• How swell!
• Abnormal pulsations
• Pulses here, there, everywhere
• Weak ones, strong ones
• Heave ho! What a thrill!
• Abnormal auscultation findings
• Low-pitched
• Medium-pitched
• High-pitched
• High-pitched and blowing
• Low-pitched and rumbling
• Quick quiz
• Scoring
• Suggested references
• 3 Prevention and risk reduction
• Understanding cardiovascular disease
• Heart-breaking numbers
• Hocus focus
• Risk assessment
• What’s the score?
• Other applications
• Risk factors
• Nonmodifiable risk factors
• With every beat of my heart
• Vascular variations
• Hormones: Helpful or hurtful?
• Genes on the scene
• History lesson
• Modifiable risk factors
• The damage done
• Stuck on you
• Quitters wanted
• High is good, low is bad
• Tri this on for size
• Take it down a notch
• Track progress (or lack thereof)
• Dangerous deposits
• Taking control
• DASH into a proper diet
• Mighty meds
• It’s cool to comply
• What’s your type?
• Diabetic disturbances
• Putting a number on it
• Obesity outcomes
• Nothing to snore at
• Reasons to move
• Quick quiz
• Scoring
• Suggested references
• 4 Diagnostic tests and procedures
• A look at diagnostic tests and procedures
• Cardiac enzymes and proteins
• Troponin I and troponin T
• Creatine kinase
• Creatine kinase (CK-MB)
• Myoglobin
• First, but not as reliable
• Homocysteine
• C-reactive protein
• B-type natriuretic peptide
• A grade for heart failure
• Lipid studies
• Triglycerides
• What’s normal?
• What’s abnormal?
• One test leads to another
• Total cholesterol
• What’s your level?
• Lipoprotein fractionation
• This is good
• This isn’t
• Coagulation tests
• Partial thromboplastin time
• Prothrombin time
• Excellent choice, sir!
• Count to 10 (or more)
• Activated clotting time
• Out-of-body experiences
• Electrocardiography
• 12-Lead electrocardiogram
• A test with 12 views
• Waves of waves
• Don’t sound the alarm—yet
• Continuous cardiac monitoring
• Hardwire versus wireless
• Job description
• Exercise electrocardiography
• Stop in a hurry
• Drugs do it, too
• Holter monitoring
• Electrophysiology studies
• Hemodynamic monitoring
• Arterial blood pressure monitoring
• Making waves
• Pulmonary artery pressure monitoring
• Many ports, many uses
• What are you reading?
• Potential PAP patients
• Tight is right
• Cardiac output monitoring
• On the rocks or room temperature
• Cardiac index: The better assessor
• Cardiac catheterization
• A multipurpose procedure
• Cardiac calculations
• Confirming common problems
• Imaging and radiographic tests
• Echocardiography
• Echo, echo
• How picky
• A big fan of two-dimensional echocardiography
• TEE combination
• Echo abnormalities
• Coronary CT angiography
• Cardiac magnetic resonance imaging
• Look at leaflets
• Lose the jewels
• Cardiac positron-emission tomography
• Cardiac blood pool imaging
• Various variations
• 99mTc pyrophosphate scanning
• Scanning the hot spots
• Thallium scanning
• Cold-hearted
• Duplex ultrasonography
• Two-step process
• Diagnosing duplex
• Additional arterial analysis
• Venography of the lower limb
• Not for everyone
• Quick quiz
• Scoring
• Suggested references
• 5 Treatments
• A look at treatments for cardiovascular disorders
• Drug therapy
• Surgery
• Coronary artery bypass grafting
• Construction ahead
• CABG candidates
• CABG caveat
• Reading the map
• In and out
• Postperi problems
• Minimally invasive direct coronary artery bypass and totally endoscopic coronary artery bypass
• It’s a good thing
• Heart transplantation
• No guarantee
• Rejection and infection
• When the body says no
• Vascular repair
• Life and limb
• Repair despairs
• Flow check
• Keep your guard
• Valve surgery
• Attention to prevention
• Pressure points
• It gets complicated
• Blood check
• Breathing check
• Med check
• Ventricular assist device insertion
• More output, less work
• A temporary diversion
• Right or left or both?
• Balloon catheter treatments
• Percutaneous balloon valvuloplasty
• Balloon bungles
• Percutaneous transluminal coronary angioplasty
• Shorter stay, fewer bucks
• Best working conditions
• Harrowing narrowing
• Intra-aortic balloon pump counterpulsation
• What for?
• How so?
• Quick response required
• Weaning ways
• Cardiovascular resynchronization techniques
• Defibrillation
• Act early and quickly
• Who’s in charge here?
• Ready . . .
• . . . set . . .
• . . . go!
• One more time
• It worked!
• Implantable cardioverter-defibrillator
• Power station nearby
• Synchronized cardioversion
• Small shock
• Back in control
• Use your hands
• Write it down
• Permanent pacemaker insertion
• And the nominees for insertion are . . .
• Setting the pace
• Temporary pacemaker insertion
• Dire straits
• When you have more time
• When to use . . .
• . . . and when not to
• Suited for surgery
• Quick quiz
• Scoring
• Suggested references
• 6 Arrhythmias
• A look at arrhythmias
• Sinus node arrhythmias
• What nerve!
• Sinus arrhythmia
• Breathing easy
• On the alert
• Sinus bradycardia
• No symptoms? No problem.
• Symptoms? Problem!
• Check the ABCs
• Sinus tachycardia
• Pulse check!
• Hard on the heart
• Slow it down
• Getting at the history
• Part of the plan
• Sinus arrest
• Failing to make an appearance
• Taking a break
• Too many for too long
• Don’t let sleeping pauses lie
• When matters get even worse
• Arresting the arrest
• Sick sinus syndrome
• Blocked exits
• Check for speed bumps
• Make up your mind!
• That sinking feeling
• When the solution is part of the problem
• Keep a running total
• Atrial arrhythmias
• Triple play
• Premature atrial contractions
• A sign of things to come
• A hallmark moment
• The patient’s part
• Atrial flutter
• A flitter, a flutter
• Rating the ratio
• Misleading pulses
• A shocking solution
• Become a convert
• Keeping watch
• Atrial fibrillation
• That fabulous filter
• Fast and furious
• Preexisting problems
• Goal: Reduce the rate
• A jolting recovery
• Resuming a commanding role
• Radio blackout
• Atrial tachycardia
• Hold it right there!
• Fast but regular
• Feel the rhythm
• Making a bigger block
• Going into overdrive
• Keeping tabs on troublemakers
• Junctional arrhythmias
• Which way did the impulse go?
• Junctional mimic
• Bad PR
• Premature junctional contraction
• When upside down your feeling
• That quickening feeling
• Junctional escape rhythm
• Backward and upside down
• I may be slow, but at least I’m regular
• Accelerated junctional rhythm
• Low-down, dizzy, and confused
• Junctional tachycardia
• Compromisin’ rhythm
• Setting the pace
• Ventricular arrhythmias
• You’ve lost your kick
• Potential to kill
• Premature ventricular contraction
• This could get serious
• Complex configuration
• The pause that compensates
• PVCs all in a row
• Ruling out trouble
• Outward signs tell a story
• Stat patient stats
• Ventricular tachycardia
• Running on empty
• Not everyone likes uniforms
• Headed for trouble
• Looking for some stability
• A permanent relationship
• Assume the worst
• Teacher, teacher
• Ventricular fibrillation
• 911 emergency
• Jump start
• ABCs of AEDs
• Speedy delivery
• Idioventricular rhythms
• Conduction foibles and pacemaker failures
• An absent P . . .
• . . . and a bizarre QRS . . .
• . . . make for one dizzy patient
• Electronic surveillance
• Asystole
• Start me up
• Atrioventricular blocks
• A troubled relationship
• Under the knife
• Class consciousness
• First-degree AV block
• Blocked but not bothered
• Second-degree AV block, type I
• Lonely Ps, light-headed patients
• Keep an eye on the ECG
• Second-degree AV block, type II
• Jumpin’ palpitations!
• Pick up the pace
• Third-degree AV block
• Beats of different drummers
• Loss of productivity
• Mixing up your Ps and Qs
• Sinking spell
• Bundles of troubles
• Bundle-branch block
• Impulsive behavior
• Wide world of complexes
• Right bundle-branch block
• Opposing moves
• Left bundle-branch block
• Slurring your R waves
• Quick quiz
• Scoring
• Suggested references
• 7 Inflammatory and valvular disorders
• A look at inflammatory disorders
• Endocarditis
• Green growth
• Type talk
• Treat, or else
• What else?
• Subacute signs
• Be supportive
• Check progress
• Stay the course
• Myocarditis
• Vague signs, sudden recovery
• And to complicate matters . . .
• Feeling the flab
• Upping the ante
• It’s only for a while
• Pericarditis
• There’s the rub
• A short time later . . .
• Then what?
• Forward feels better
• Where’s the echo?
• Going in
• Heavy-duty treatments
• Watch the clock
• Class begins
• A look at valvular heart disease
• Mitral insufficiency
• System failure
• For the not so young at heart
• Mitral stenosis
• Trouble ahead
• Not going with the flow
• Out of control
• Aortic insufficiency
• Consider the complications
• ACE of spades
• Aortic stenosis
• Surgical solutions
• Pulmonic stenosis
• Quick quiz
• Scoring
• Suggested references
• 8 Degenerative disorders
• A look at degenerative disorders
• Acute coronary syndromes
• Plaque’s place
• Risky business of acute coronary syndromes
• Types of acute coronary syndrome
• It hurts when I do this
• Four forms of angina
• My, my, MI pain
• Initial approach in the evaluation of chest pain
• MI relief
• Status checks
• Things heat up
• Teach, review, document
• Cardiomyopathy
• Kidneys kick in
• Detrimental dilation
• Hypertrophy hazards
• Ins and outs
• When to call
• Heart failure
• Quality time
• Daunting difficulties
• It’s not all heart
• Adept at adaptation
• Less to look for
• Preparing for discharge: Sodium down, potassium up
• Hypertension
• One thing leads to another
• Risky business
• Why? Why? Why?
• Secondary isn’t small
• Problems plus
• Detecting heart damage
• Time for a change
• Pharming out therapy
• Pulmonary hypertension
• Heart and lung lead the way
• Sans treatment
• Diverse therapies
• Quick quiz
• Scoring
• Suggested references
• 9 Vascular disorders
• A look at vascular disorders
• Aortic aneurysm
• Bumpy road ahead
• Thin and thinner
• Wide vessel, slow flow
• Blood forces
• When symptoms arise
• Acute expansion
• Rush to respond to rupture
• Rupture response
• Peripheral arterial disease
• Location and timing
• Back to the classics
• Let’s not forget the rest
• Better blood
• Drugs and surgery
• Embolectomy, grafting, amputation—oh, my!
• Lower the risk
• Patient precautions
• Thrombophlebitis
• Deep vein, deep trouble
• Even more trouble
• Risk on the rise
• Superficial swell
• Drugs and surgery
• Pardon the interruption
• Stockings, soaks, and elevation
• Make veno go
• Quick quiz
• Scoring
• Suggested references
• 10 Emergencies and complications
• A look at cardiac emergencies
• Cardiac trauma
• Not always obvious
• Penetrating truths
• Accident report
• Look for more
• Look out for the lungs
• Meds and other measures
• Cardiac check-in
• Fluids in and out
• Outside help
• Cardiac tamponade
• Quick fill, quick response
• That’s not all
• When pressure is low
• More to do
• It’s a paradox
• Cardiogenic shock
• Shocking stats
• Other offenders
• Lower and lower output
• Treatment ABCs
• Increase flow
• Decrease resistance and pressure
• Bring in the hardware
• End-stage effort
• Even more
• Monitor, record, and then monitor more
• Minimize movement
• Provide regular rest and support
• Hypovolemic shock
• The road to shockville
• Where, oh where, has the blood volume gone?
• Fashion forward
• ABCs and ABGs
• Clot concerns
• Quick quiz
• Scoring
• Suggested references
• Appendix and index
• Practice makes perfect
• Index