okay so in this video we're just going
to kind of condense and talk very
briefly about some of the things that
weren't covered in the disease specific
videos relating to the cardiac system
and some of the things you just really
need to know so this is going to bring
about a lot of kind of eclectic it's
going to seem a little bit random we're
going to talk about the things that you
really need to know for NCLEX just as
quick points okay so first of all heart
rate what is a normal heart rate well we
all know that normal heart rate is 60 to
100 sinus tachycardia is going to be
over 100 beats per minute and sinus
bradycardia is going to be less than 60
beats per minute and the way we're
obviously going to assess that is going
to be through our EKG we have our p q r
s and t this is going to be one complete
cardiac cycle this is the mechanical
representation of one complete cardiac
cycle and we're looking hoping that our
patients are between 60 to 100 beats per
minute that's going to be normal sinus
tach again is going to be greater than
100 sinus Brady is going to be less than
60 okay now very quickly let's talk
about the vascular system hopefully this
is not new information for you at all
but our vascular system consists of
arteries and veins and then there's
venules there's arterioles and there's
capillaries okay so basically we have
our heart and coming out of our heart is
going to be arteries they're going to go
to arterioles which are going to be a
little bit smaller and then we're going
to have this capillary network okay
within different organs and they're
gonna have our venules and they're going
to have our veins bringing it back to
the heart easiest way to remember this
is arteries take blood away and venules
our veins bring blood back
I remember at because I learned Spanish
back in the day and VNA means to come so
v VNA comes back to the heart a four
away arteries and then again you have
arterioles and then this is going to be
our capillary bed and the capillary
network is really what's going to be
within organs so like for example here's
a kidney
here's a kidney or pancreas there's
kidney right there
then you're also going to have of course
your your liver and those are all going
to be have all these capillary or these
uh arteries and veins within those
that's where you're kind of your Keppler
is going to branch out and and profuse
all those different areas again here's
lungs of course and so on this picture
here the red is going to indicate
arteries and your blue is going to
indicate a vein okay here's your aorta
and then here's your vena cava okay so
that's very simple
overview of the vascular system now when
we have a patient who is suspected of
having a heart attack
one thing we're going to run is where
anyone run what are called cardiac mark
markers another way to refer to this is
going to be C IPS cardiac injury profile
okay cardiac injury profile is going to
be a set of a few labs that we run to
determine the extent or the presence of
cardiac damage that's going to consist
of troponin and it's going to be
troponin I enter ponen T ck-mb and
myoglobin I know we talked about this in
our myocardial infarction lecture but
very briefly troponin is going to be
your most sensitive to cardiac damage
however it takes about 12 hours to peak
your ck-mb
is going to be a little bit less
sensitive and it takes a little bit
longer than your opponent's myoglobin
very low specificity to infarction
because this can indicate damage to
muscles in general it does peak the
fastest but very low specificity so the
number we're really going to be
concerned about is art opponents and
most of all I mean in my hospital the
number we're really looking at is our
troponin I okay if our opponent is
elevated then we're that's an indicative
of infarction okay especially we can
match that up with an EKG if we have an
EKG that shows like an ST elevation and
we have two ponens that are elevated
we're pretty work you know the patient
has a is having a heart attack
if they have a non-stemi but we have our
elevated troponin we can also determine
that they may have you having heart
Tagg some cardiac labs these are gonna
be some of the labs you're going to be
concerned about with cardiac damage
first of all is going to be potassium
argon potassium is three point five to
five we know that hypokalemia so less
than 3.5 can lead to ventricular
dysrhythmias increase the jocks and
toxicity if your patient is receiving
digoxin it can develop a you wave now
what do you wave is is it the so here's
our normal and then there'll be an
additional wave here this is going to be
our you wave and this can show up with
hypokalemia this can also lead to ST
depression again ST depression here's
our oops
so ST depression is going to look like
that so q r s and t so instead of ever
really coming up it's just going to go
below na right below our isoelectric
line and that's going to be ST
depression hyperkalemia can lead to
peaked t-waves so what you'll see with
uh with your patient because it'll have
like a T wave that's very high it may be
almost even as high as your as your QRS
and then you'll also have the widened
QRS and then it can lead to ventricular
dysrhythmias as well and again as if
this QRS continues to widen that's going
to lead to severe ventricular
arrhythmias and then you'll have your
piet T waves so what I would do this is
what I do if you have a patient who's on
like a five lead continuous cardiac
monitoring or whatever if you start
noticing that these T waves are
elevating and you know because normal T
waves going to be way down here if you
notice that this T wave starts to
elevate what I would do is I would just
kind of call a physician say hey you
know I notice the EKGs getting a little
bit funky we're getting these uh these
changes in the T wave do you mind if I
run just get like a CBC or in a BMP you
know another lab we're going to look at
that at is hematocrit a medic root is
basically percent of RBC's in the blood
it's different for males and females but
as that number goes up
as our percent of red blood cells goes
up that's going to be indicative of
dehydration why is that well if you know
part of our blood only a portion of our
blood is red blood cells as you can see
here it's 30 to 50 percent or so and the
rest is going to be different fluids and
things so if our if that continues to go
up you know and we're at 60 per hour
Matic crit that's going to mean there's
less of the other fluids which shows
that you know we are dehydrated on the
other end if our Hermetic rate goes down
hemoglobin goes down that could be
indicative of anemia another lab you're
going to want to look out for your
cardiac patients is going to be lipids
this going to be total cholesterol you
want to have under 200 milligrams per
deciliter LDLs that's our bad
cholesterol you wanted under 130 HDLs
happy which are high density
lipoproteins you want that between 30
and 70 and that's the good cholesterol
okay a couple of the labs I didn't write
on here but I want you to remember are
going to be B and P I know we talked
about this with heart failure that's
brain nature etic peptide and what
happens with that is as the ventricular
as the ventricles stretch as there's
increased ventricular stretch it's going
to release being Pete into the system
normal value should be under a hundred
you might notice patients with heart
failure have level levels 4000 and above
but anytime we get up over a hundred
that's going to be indicative of
ventricular stretch and heart failure
was another lab I wanted to talk about B
and P that's really a big one
indicative of heart failure okay halter
monitoring so halter monitoring is
important for patients who maybe have
angina
whether it's stable unstable or Prince
metal angina because what this can do as
you can see here this is a picture of a
halter monitor it can be worn on a
patient it's supposed to be worn 24
hours and it can be worn under their
clothes and it's going to have this
continuous EKG monitoring what the
patient needs to do is it's going to
store this data it's going to
store their EKGs and as they start to
have chest pain they need to write down
the time they have the chest pain and
what they were doing and then what can
happen from that is the physician can
take that EKG print out and they can
match it up with what the patient's
activities were and what was going on
and it can kind of give them a better
idea of angina better idea of what's
causing any abnormalities in their EKG
but that's basically halter monitoring
this patient or this picture should help
you remember what we're on this one
though let's talk about - about EKG
placement so for our five lead EKG now
as you guys know I don't like mnemonics
okay the reason I don't like pneumonic
is because I believe that if you
understand the process if you understand
what's going on you're going to better
understand and remember forever
the process and exactly what's going on
so as you can separate learning
mnemonics from learning the systems and
the processes I think you can better
understand however four EKG placement I
think that there's a very easy way to
remember the pneumonic because it's just
color based so we want to have our white
one we have our green one black red and
brown so the best way to remember this
is white on right okay
so white white on right is the first
thing to remember white sorry we have
white on right
and then you will do snow over trees and
smoke over fire
okay so white is snow right green is the
color of trees black is the color of
smoke and smoke comes out over fire
right as there's fire smoke rises over
fire so white on right and snow over
trees white over green and smoke over
fire and then our brown is our ground
and that's going to go right in the
middle all right so that's the best way
to remember five lead EKG placement last
thing we want to talk about here is
cardiogenic shock so what happens with
cardiogenic shock is the heart is unable
to maintain effective cardiac output
this can be due to various reasons heart
failure disruptions in the cardiac
function and so what we're going to see
so shock what we need to understand
really quickly those shock is is a
decreased delivery of oxygen to the body
and so as oxygen delivery is decreased
and is affected our organs are not going
to be able to function appropriately
okay so it's not necessarily low blood
volume necessarily what it is is
decreased delivery of oxygen to the
tissues and then the tissues are not
able to function without that oxygen so
what happens with our heart is for
whatever reason our heart is not beating
as it should it's not a maintaining
effective cardiac output okay cardiac
output is volume of blood out in one
minute okay so some of the assessments
we might notice with this are going to
be low urine output why is that well
we're not delivering enough oxygen to
our kidneys or our enough blood to our
kidneys so the kidneys are not able to
to work appropriate we're going to have
low urine output low BP obviously low
cardiac output we're going to thing we
want to assess most with this is our CVP
okay the reason we assess CVP is that
what that tells us is it
tells us the the right atrial preload
and what right atrial preload basically
tells us is it tells us the overall
volume volume in the system okay the
system is our body okay because what CVP
is is CVP tells us right atrial preload
basically it so it's really going to
tell us the preload and in our in the
right side of our heart okay and if we
know the preload of the right side of
our heart we basically know about how
much volume is kind of in the system so
what is preload preload is going to be
this stretch as as the ventricle fills
up okay so as the volume comes in the
the stretch the pressure exerted on
those as the volume fills up normal CVP
is going to be two to eight millimeters
of mercury okay so if you have a very
high CVP
that means that's going to be indicative
of like hypervolemia etc if we have a
low CVP that means we have a decrease in
volume okay so at CVP less than you know
- or hovering around there is going to
be indicative of low volume okay so that
might mean we need to supply more volume
however if we have a CVP of greater than
then like eight six or eight or so
that's going to mean we have high volume
and volume is not our problem okay so if
the patient is ventilated want to take
an end expiration and then you're going
to zero the transducer at the fourth
intercostal space along the mid-axillary
line and that's the location of the
right atrium okay where is that at
so mid axillary line is here under the
armpit you're gonna want it at the
fourth intercostal space and you'll have
a little transducer so this will be
going like in our jugular and then we're
going to end up with these waveforms and
we want that to be two to eight
millimeters
of mercury okay that's going to tell us
our CVP hopefully that makes a little
bit of sense about cardiogenic shock
we'll go into shock
in greater detail later but that's
really kind of what you need to know you
don't need to know a lot about shock for
the NCLEX if you start working in ICU
this is going to be a topic you're going
to want to come back to and visit quite
often if you have any question you guys
let us know those are some of the quick
NCLEX points the