Cardiac Drugs

Classifica-tion

ACE Inhibitors

Beta Blockers

Ca+ Channel Blockers

K+ Channel Blockers

MOA

↓ conversion of A-I to A-II; vasodilator

decreases HR

decreases conduction

slows action potential (fibrillation)

*atenolol *carvedilol *metoprolol *sotalol

*verapamil *diltiazem *amlodipine *nifedipine *felodipine *nicardipine

*amiodarone

Drug Names

*captopril *enalapril *lisinopril *ramipril *trandolapril *fosinapril

Cardiac Treat-ment

*Alpha's dine & sin *clonidine, *prazosin HTN, AV block, SVT, A.fib/flutter, bradycardia, impaired peripherial circulation, stable angina

HTN, CAD, SVT, A.fib/flutter, junctional dysrhythmia, chronic stable CAUTION - in asthma pt's angina bronchospasms; & DM pts - can mask s/s of hypoglycemia

hypoT, dizziness, fatigue, headache, ARF, ↑K+, angioedema, Side Effects skin rash, cough, loss of taste, N/V/C, GI irritation

Nursing Management

N/V, brady, P hypoT, fatigue, bronchospasms, hyperglycemia, head/dizz, drowsiness, CHF, ED

*ortho BP, LFT's, weight *assess BP, HR, skin, facial (daily or weekly) edema, K+ serum, renal tests *hold if apical < 60 *hold SBP or < 100 bmp

Treatments O2, atropine, pacemaker, drug dosage adjusted or discontinued O2, bb, treat underlying cause, antipyretics-fever, analgesics-pain

remove cause, bb, observation O2, remove cause, IV adenosine, amiodarone, bb, CCB, cardioversion, observation O2, digoxin, bb, CCB, warfarin, cardioversion, ablation A.fib w/RVR*amiodarone, propafenone

O2, check meds/labs, call HCP *if new onset, continue to monitor O2, temp pacemaker, ERT, VS, atropine, check meds/labs, call HCP, permanent pacemaker O2, temp pacemaker, ERT, VS, meds/labs, call HCP, *permanent pacemaker O2, ERT, VS, meds/labs, call HCP, *permanent pacemaker ASAP

O2, bb, amiodarone, procainamide, lidocaine

CPR, defibrillate, epinephrine

Dx Tests

Description & Purpose

EKG recording for 24-48 hours correlating rhythm changes w/symptoms in diary; recorder Holter Monitoring is used to store, recall, print & analyze info for rhythm disturbances

Echocardiogram

ultrasound of chest & heart; measures EF% - IV contrast may be used to enhance images; also records direction of blood flow across valves

Pharmacologic Echo

sused as substitute for exercise stress test in people unable to exercise; dobutamine or dipyridamole infused via IV & dose increased in 5 min intervals to detect abnormalaties

Transesophageal Echocardiogram (TEE)

probe w/ultrasound transducer is swallowed & passes down esophagus; contrast may be injected IV for evaluating blood flow if atrial or ventricular septa defect is suspected

Exercise Stress Test

exercise tolerance, ADL's, rhythm disturbances, EKG changes; contraindications acute CV disease, recent MI (2 weeks), angina

Exercise Nuclear Imaging

nuclear images are taken at rest & after exercise; injection given at max HR on bicycle/treadmill & continue for 1 min to circulate; scanning done 15-60min after exercise; resting scan 60-90min after initial infusion or 24 hours later

Pharmacologic Nuclear Imaging

dipyridamole or adenosine to promote vasodilation when unable to exercise

Nuclear Cardiology

IV injection of radioisotopes; measures blood flow to heart at rest & while your heart is working harder as a result of exertion or medication; HCP suspects CAD

Single-photon Emission Computed Tomography (SPECT)

used to evaluate myocardium at risk for MI; small amounts of radioactive isotope injected via IV; detects coronary artery blood flow, intracardiac shunts, motion of ventricles, EF% & size of heart chambers

Dx Tests

Description & Purpose

Cardiac Catheterization

contrast injected to examine structure & motion of heart & coronary arteries; also provides information to determine need for angioplasty or stenting small amount of blood removed, mixed w/radioactive

Multigated isotope & reinjected; EKG's used for timing, images Acquisition Scan acquired during cardiac cycle; indicated for MI, HF, valvular HD, (MUGA) cardiotoxic drugs on the heart

Magnetic Resonance Angiography (MRA)

used for vascular occlusive disease & AAA; same as MRI but with use of gadolinium as IV contrast

Cardiac CT Scan

evaluates heart muscle, coronary artery circulation, pulmonary veins, thoracic aorta, pericardium; IV contrast

Electrophysiology Study (EPS)

invasive study to record cardiac electrical conduction using catheters via femoral & jugular veins into right side of heart; dysrhythmia can be induced & terminated

Peripherial Arteriography & Venography

injection of contrast into veins or arteries followed by serial x-rays to detect atherosclerotic plaques, occlusions, aneurysms, or trauma

Dx Labs

Description & Purpose

Troponin - I

* earliest increase 4-6 hours, peak hours 10-24 hrs * duration of increase 4-7 days * specificity 95%; sensitivity at peak 98%

Creatine Kinase (CK)

* earlies increase 4-8 hrs; peak hours 24-36 hrs * duration of increase 36-48 hours * specificity 57-88%; sensitivity at peak 93-100%

CK-MB

* earliest increase 3-4 hours; peak hrs 15-24 hrs * duration of increase 24-36 hours * specificity 93-100%; sensitivity at peak 94-100%

Myoglobin

99-100% sensitive for MI; serum concentration rise 30-60min after MI male: 5.2-12.9 umol/L; female: 3.7-10.4 umol/L

Nursing Considerations encourage to stimulate conditions that produce symptoms; keep an accurate diary of activities & symptoms; no bath or shower

assess for allergy to shellfish; supine position on left side of equipment; no contraindications to procedure unless contrast is being used start IV infusion; monitor VS before/during/after until baseline achieved; aminophylline given to prevent or reverse side effects of dipyridamole NPO 6 hours prior; IV sedation & throat anesthetized; designated driver needed; bite block placed-suctioning as needed; no eating/drinking until gag reflex returns pt to wear comfortable clothes/shoes & walk as quickly as possible; hold bb & caffeine 24 hrs prior to procedure; no smoking 3 hrs prior; test is terminated for chest discomfort

explain to eat only a light meal between scans; certain medications may need to be held for 1-2 days before the scan hold all caffeine products 12 hours prior to procedure; hold bb & CCB 24 hours prior establish IV line - pt will have to lie still on back with arms extended for 20 minutes; repeat scans are performed within a few minutes to hours after the injection

establish IV line; ECG monitoring Nursing Considerations

withhold food/fluids 6-18 hours; give sedative; instruct patient to deep breath when dye is injected; assess circulation, peripherial pulses, color, & sensation q15min/1 hour after

establish IV line, EKG monitoring; procedure involves little risk

contraindicated w/allergies to contrast or implanted metal devices

procedure is quick & involves little to no risk; assess for shellfish allergies discontinue antidysrhythmic meds several days prior to study; NPO 6-8h, IV sedation if needed; frequent VS & continuous EKG after procedure check for iodine allergy; mild sedative; check extremity puncture, pulsation, warmth, motion, swelling, bleeding; Nursing Considerations < 0.5 ng/mL - normal 0.5 - 2.3 ng/mL - suspicious for MI injury > 2.3 ng/mL - positive for MI injury

cardiac biomarker used to diagnose MI & necrosis explain the purpose of serial sampling (e.g. 3x q6-8h); normal is 0.3 mcg/L in conjunction with serial EKG's cleared from circulation rapidly & most diagnostic if measured within first 12 hours of onset of chest pain