This document discusses the management of patients with complications from heart disease. It begins by defining factors such as preload, afterload, and contractility that influence cardiac hemodynamics. Both noninvasive and invasive methods for assessing these factors are described, including measuring jugular venous distention, mean arterial blood pressure, and using a pulmonary artery catheter. Causes, clinical manifestations, and emergency management of cardiac arrest are also reviewed, along with medications commonly used in cardiopulmonary resuscitation.

1. MANAGEMENT OF PATIENTS WITH
COMPLICATIONS FROM HEART
DISEASES

2. CARDIAC HEMODYNAMICS


3. FACTORS THAT REQUIRE HEMODYNAMIC
MONITORING

Preload – the amount of myocardial stretch just
before systole caused by the volume of blood
presented to the ventricle.




Venous return – the volume of blood that enters the
ventricle
Compliance - the elasticity or the amount of “give” when
blood enters the ventricle.
Afterload – the amount of resistance to ejection of
blood from a ventricle
Contractility – the force of ventricular contraction;
related to the status of myocardium.

4. The determinants of stroke
volume.
The SV is determined by
the amount of preload presented
to the ventricle, the amount of
afterload or resistance to
ventricular ejection, and the
strength of cardiac contractility.

5. NONINVASIVE ASSESSMENT OF CARDIAC
HEMODYNAMICS
1.
2.
3.
4.
Measuring jugular venous distention –
estimates right ventricular preload
Positive hepatojugular test – identifies
elevated left ventricular preload
Mean arterial blood pressure - an
approximate indicator of left ventricular
afterload
Activity tolerance – may be used as an
indicator of overall cardiac functioning.

6. JUGULAR VENOUS DISTENTION
POSITIVE HEPATOJUGULAR TEST

7. Mean arterial blood pressure
where:
•is cardiac output
•is systemic vascular resistance
•is central venous pressure

8. INVASIVE ASSESSMENT OF CARDIAC
HEMODYNAMICS
Pulmonary artery catheter - is diagnostic
procedure used to detect heart anomalies,
monitor therapy, and evaluate the effects
of drugs.
- It allows direct, simultaneous
measurement of pressures in the right
atrium, right ventricle, pulmonary artery,
and the filling pressure ("wedge" pressure)
of the left atrium.

9. PULMONARY ARTERY CATHETER

10. AD…

11. CARDIAC ARREST
-
-
Occurs when the heart ceases to produce
an effective pulse and circulate blood.
It may be caused by a cardiac electrical
event such as ventricular fibrillation,
progressive profound bradycardia, or when
there is no heart rhythm at all (asystole).
It may follow respiratory arrest

12. -
-
It may also occur when electrical activity
is present but there is ineffective cardiac
contraction or circulating volume, called
pulseless electrical activity (PEA).
PEA can be caused by hypovolemia,
hypoxia,
hypothermia,
hyperkalemia,
massive pulmonary embolism, myocardial
infarction and medication overdose.

13. CAUSES OF CARDIAC ARREST

14. CLINICAL MANIFESTATIONS
Loss of consciousness, pulse and BP
 Ineffective respiratory gasping may occur
 The pupils of the eyes begin dilating within
45 sec
 Seizures may or may not occur
Take note:



For adult and child: carotid pulse is assessed
For infant: brachial pulse is assessed

15. EMERGENCY MANAGEMENT
Cardiopulmonary resuscitation (CPR)
- Provides blood flow to vital organs until effective
circulation can be re-established.
1.
2.
3.
It consists of the following steps:
Airway – maintaining an open airway.
Breathing – providing artificial ventilation by
rescue breathing
Circulation – promoting artificial circulation by
external cardiac compression; administer
medication therapy.

16. 4.
Defibrillation with standard defibrillator
or autonomic external defibrillator (AED)
for ventricular tachycardia and
ventricular fibrillation.

17. MEDICATIONS USED IN CPR
Oxygen – improves tissue oxygenation and
corrects hypoxemia.
 Nursing considerations:
• Use 100% FiO2 during resuscitation.
• Recognize that no lung damage occurs
when used for less than 24 hours.
• Monitor dose by pulse oximeter.
1.

18. 2.

Epinephrine (Adrenalin) – increases systemic
vascular resistance and blood pressure;
improves coronary and cerebral perfusion
and myocardial contractility.
Nursing considerations:
•
•
Administer 1 mg every 3 – 5 minutes by IV
push or through the ET tube.
Avoid adding to IV lines that contain alkaline
solution (eg. Bicarbonate)

19. 3.

Vasopressin (Pitressin) – increases systemic
vascular resistance and BP
Nursing considerations:
• Give 40 U IV one time only

20. 4.

Atropine – blocks parasympathetic action;
increases SA node automaticity and
AV conduction.
Nursing considerations:
• Give rapidly as 2.0 to 2.5 mg IV push or through
the ET tube
• Be aware that less than 0.5 mg in the adult can
cause the heart rate to decrease to a worse
bradycardia.
• Monitor patient for reflexive tachycardia.

21. Sodium bicarbonate (NaHCO3) – corrects
metabolic acidosis.
 Nursing considerations:
5.
•
•
Administer initial dose of 1 mEq/kg IV; then
administer the dose based on the base deficit
calculated from arterial blood gas values.
Recognize that to prevent development of
rebound metabolic alkalosis, complete
correction of acidosis is not indicated.

22. Magnesium – promotes adequate
functioning of the cellular sodiumpotassium pump.
 Nursing considerations:
• May give diluted over 1 – 2 minutes or IV
push.
• Monitor for hypotension, asystole,
bradycardia, respiratory paralysis.
6.