Classifica-tion ACE Inhibitors Beta Blockers Ca+ Channel Blockers K+ Channel Blockers

conversion of slows action potential

MOA
A-I to A-II; vasodilator decreases HR decreases conduction (fibrillation)

*captopril *atenolol *verapamil *amiodarone

*enalapril *carvedilol *diltiazem effects of digoxin
Drug Names
*lisinopril *metoprolol *amlodipine *propafenone
*ramipril *sotalol *nifedipine *procainamide
*trandolapril *Alpha's dine & sin *felodipine *ibutilide
*fosinapril *clonidine, *prazosin *nicardipine *sotalol

HTN, AV block, SVT,

HTN, a.fib/flutter,
HTN, CAD, SVT, A.fib/flutter, bradycardia,
SVT, junctional A.fibw/RVR
Cardiac A.fib/flutter, junctional impaired peripherial
Treat-ment dysrhythmia, chronic stable circulation, stable angina dysthythmia, chronic SVT,
angina
CAUTION - in asthma pt's - stable angina VT/VF
bronchospasms; & DM pts - can mask s/s
CAUTION - in HF
of hypoglycemia

HF, AV block, pulmonary toxicity,

hypoT, dizziness, fatigue,
headache, ARF, K+, angioedema,
Side Effects
skin rash, cough, loss of taste,
N/V/C, GI irritation
N/V, brady, P hypoT,
fatigue, bronchospasms,
hyperglycemia, head/dizz,
drowsiness, CHF, ED
AV block (prolonged PR interval),
painful breathing, cough, SOB,
bradycardia, hypoT, pulmonary
weakness in arms/legs, trouble
edema, CHF, headache, dizziness,
walking, dizziness,
flushing, rash, fever,chills
lightheadedness

*ortho BP, LFT's, weight *I/O, s/s of CHF,

*assess BP, HR, skin, facial (daily or weekly) pulm.edema/lungs, daily *assess BP, RR, apical & radial
edema, K+ serum, renal tests *hold if apical < 60 weight, pain level pulses, renal & LFT
*hold SBP <100 *hold HR>120 or <60
*hold if SBP < 100 *BP & HR q3-4h
Nursing *safety/safety/safety
*ASA/NSAIDs may reduce *avoid EtOH, OTC's, & *hold if apical < 60
Manage- *keep all aptmts-MD, labs, etc. &
ment effectivness hazardous tasks if dizzy; rise *hold if SBP < 100 follow diet plan
*full effect on BP slowly *may cause 1 HB *avoid EtOH, smoking, OTC's,
may not be seen *do not stop abruptly *take with meals swallow whole, wax may be found
for 3-6 wks *caution use with *pines are for BP; varapimil in stool
African Americans & diltiazem for dysrhythmias*
Classifica-tion Direct Vasodilators
relax arteriolar smooth muscle,
MOA causing
blood vessel dilation
*hydrazaline
*nitroglycerin
Drug Names (sublingual, patch, & paste)
*isosorbide mononitrate
*sodium nitroprusside
Cardiac HTN, chronic stable
angina, HF after MI
Treat-ment
headache, dizziness,
palpitations/tachy,
Side Effects N/V, hypoT, flushing
*reactions lessen with prolonged
use/dose adjust
*take on an empty stomach
*if headache develops treat
w/ASA or acetaminpohen
*advise patient to take an
Nursing
additional dose prior to anticipated therapy; restrictions of saturated
Manage-
ment stress & have drug accessible at all
times *keep record of attacks
*assess pregnancy status
*avoid EtOH
*do not mix w/other drugs
Statin Drugs Antiplatelet
inhibit synthesis of decrease platelet aggregation &
cholesterol in liver inhibit thrombus formation
*atorvastain
*ASA
*lovastatin
*clopidogrel
*simvastatin
bisulfate
*fluvastatin
MI or re-infarction,
CAD, stroke
HDL CONTRAINDICATED pregnancy
(3rd trimester), bleeding disorders or
CAD
thrombocytopenia
CAUTION
PUD, hepatic/renal disease
NVCD, elevated liver
hematuria, bruising, epistaxis,
enzymes, myopathy,
confusion, GI ulcers or upset,
rhabdomylosis,
hemorrhage
GI disturbances, rash
*monitor LFT's prior to *take with food/milk
& q6-12wks after *advise patient of prolonged
start of therapy bleeding time; notify HCP of
*use in adjunction with diet unusual bleeding
*may cause dizziness or
fat & cholesterol drowsiness
*review dietary habits, weight, & *inform HCP before undergoing
exercise patterns any procedures or new drug
*CK - if muscle pain or weakness therapy
occurs *NO ASA or NSAIDs
Anticoagulation
prolong the formation
of blood clotting
*warfarin
Antidote = Vitamin K
PT- 9.6-11.8seconds
INR- 2-3x norm (1.5-2.0)
*heparin, *enoxaprin
Antidote = Protamine Sulfate
aPTT therapeutic - 60-80
A.fib/flutter, MI, DVT,
PE, stroke
CONTRAINDICATED
thrombocytopenia
CAUTION
PUD, severe HTN, hemophelia
HR, BP, bruising, petechiae,
black/tarry stools, bleeding in
urine/gums, vasculitis,
hemorrhage
*avoid all IM injections
*inspect & teach for abnormal
bleeding
*teach a diet consistent in vitamin
K is essential
*med ID bracelet, electric razor,
soft toothbrush
*contact HCP prior to taking any
OTC or
herbal therapy
 Cardiotonics

decreasses conduction
of electrical impulses

*adenosine
*digoxin
(0.8 - 2 ng/mL)
*digitoxin
(14 - 26 ng/mL)

SVT, A.fib, CHF/HF

CONTRAINDICATED
heart block, V.tach/fib, pregnancy
CAUTION
advanced HF &
renal insuffieiency

digoxin toxicity:
KCL - IV or PO
early s/s - N/V/D, brady/tachy,
PVC's, bi/trigeminy
late s/s - visual changes

*assess BP, AP, lung sounds,

JVD, weight, sputum,
extremity edema, renal &
LFT's
*teach pt's s/s of
digoxin toxicity
*no herbal drugs
*K+ rich diet; monitor K+
levels
 Anticholinergenic

antiparasympathetic; transient
phase of stimulation

*atropine

bradycardia,
Mobitz II

can't see, can't pee

can't spit, can't sh*t
tachycardia, agitation,
delirium, NVC, ED

*assess for tachycardia;

may lead to V.fib
*monitor I/O; may cause
urinary retention
*give IV over
1 minute
 Dysrhythmia EKG Characteristics Causative Agents

Sinus bb, CCB, MI, ICP/IOP,

< 60 bpm & regular
Bradycardia hypothermia, hypoglycemia,

exercise, fever, fear, anxiety, pain,

Sinus
Tachycardia
101 - 200 bpm & regular hypoT, hypovolemia, anemia, hypoxia,
hypoglycemia, hyperthyroid, MI, HF

Premature Atrial 60 - 100 bpm & irregular; stress, physical fatigue, caffeine, EtOH,
Contraction P-wave may be hidden in the tobacco, electrolyte balances,
(PAC) preceding T-wave hyperthyroid, hypoxia, COPD, CAD

Supraventricular hypokalemia, digitalis toxicity, ischemia,

150 - 220 bpm & regular;
Tachycardia CAD, cor pulmonale, rheumatic heart
P-wave often hidden in the T-wave
(SVT) disease

A: 200 - 600 bpm; HTN, CAD, cardiomyopathy, digoxin,

A.Flutter/
V: > or < 100 bmp epinephrine, HF, EtOH intoxication,
A.Fib
*a.flutter = F waves; a.fib = irregular* caffeine, stress, cardiac surgery

prolonged P-R interval; digoxin toxicity, bb, CCB,

1 AV Block
If R is far from P = 1st MI, CAD

2 AV Block; P-wave = longer, longer, longer,

Wenkenbach DROP = Wenkenbach digoxin toxicity, bb, CAD

2 AV Block; If some QRS's don't get digoxin toxicity, CAD, anterior MI,
Mobitz II through = Mobitz II rheumatic heart disease

severe heart disease, CAD, MI,

3 AV Block; If P's & Q's don't
complete
myocarditis, CM, bb, CCB,
agree = 3rd scleroedema, amyloidosis
caffeine, EtOH, nicotine, amniophylline,
PVC's occur at variable rates; unifocal or
epinephrine, digoxin, isoproterenol, hypoxia,
PVC multifocal, couplets, bi/tri/quadrigeminy; fever, emotional stress, exercise,
3+ sequential PVC's = VT MI, HF, CAD, MV prolapse

150 - 250 bpm; hyperkalemia, drug toxicity, acidosis,

V.Tach/V.Fib QRS's are wide & distorted; CM, MI, CAD, MV prolapse, HF,
not measurable in v.fib cardiac cath, CNS disorders
 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

ultrasound of chest & heart; measures

EF% - IV contrast may be used to enhance
Echocardiogram
images; also records direction of
blood flow across valves

sused as substitute for exercise stress test in

Pharmacologic people unable to exercise; dobutamine or
Echo dipyridamole infused via IV & dose increased in
5 min intervals to detect abnormalaties

probe w/ultrasound transducer is swallowed &

Transesophageal
passes down esophagus; contrast may be
Echocardiogram
injected IV for evaluating blood flow if atrial or
(TEE)
ventricular septa defect is suspected

exercise tolerance, ADL's, rhythm

Exercise Stress disturbances, EKG changes;
Test contraindications acute CV disease,
recent MI (2 weeks), angina

nuclear images are taken at rest & after exercise;

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

Pharmacologic dipyridamole or adenosine to promote

Nuclear Imaging vasodilation when unable to exercise

IV injection of radioisotopes; measures blood

Nuclear flow to heart at rest & while your heart is
Cardiology working harder as a result of
exertion or medication; HCP suspects CAD

used to evaluate myocardium at risk for MI;

Single-photon small amounts of radioactive isotope injected
Emission Computed via IV; detects coronary artery blood flow,
Tomography (SPECT) intracardiac shunts, motion of ventricles,
EF% & size of heart chambers
Dx Tests Description & Purpose
 contrast injected to examine structure & motion
Cardiac of heart & coronary arteries;
Catheterization 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,
(MUGA) valvular HD,
cardiotoxic drugs on the heart

Magnetic used for vascular occlusive disease &

Resonance
Angiography
AAA; same as MRI but with use
(MRA) of gadolinium as IV contrast

evaluates heart muscle, coronary artery

Cardiac CT Scan circulation, pulmonary veins, thoracic
aorta, pericardium; IV contrast

invasive study to record cardiac electrical

Electro-
conduction using catheters via femoral &
physiology Study
jugular veins into right side of heart;
(EPS)
dysrhythmia can be induced & terminated

injection of contrast into veins or arteries

Peripherial
followed by serial x-rays to detect
Arteriography &
Venography atherosclerotic plaques, occlusions,
aneurysms, or trauma
Dx Labs Description & Purpose

* earliest increase 4-6 hours, peak hours 10-24 hrs

Troponin - I * duration of increase 4-7 days
* specificity 95%; sensitivity at peak 98%

* earlies increase 4-8 hrs; peak hours 24-36 hrs

Creatine Kinase
* duration of increase 36-48 hours
(CK) * specificity 57-88%; sensitivity at peak 93-100%

* earliest increase 3-4 hours; peak hrs 15-24 hrs

CK-MB * duration of increase 24-36 hours
* specificity 93-100%; sensitivity at peak 94-100%

99-100% sensitive for MI;

Myoglobin 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