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# 44609 C t PHNJ A Bl d P N 1121 C/M/Y/K

Cardiology

ObjectivesPart 1: Cardiovascular Anatomy and Physiology, ECG Monitoring,

and Dysrhythmia Analysis (begins on p. 1127)

After reading Part 1 of this chapter, you should be able to:

1. Describe the incidence, morbidity, and mortality of cardiovascular disease. (p. 1126)2. Discuss prevention strategies that may reduce the morbidity and mortality of

cardiovascular disease. (p. 1126)3. Identify the risk factors most predisposing to coronary artery disease. (p. 1126)4. Describe the anatomy of the heart, including the position in the thoracic cavity,

layers of the heart, chambers of the heart, and location and function of cardiacvalves. (pp. 1127–1128; also see Chapter 3)

5. Identify the major structures of the vascular system, the factors affecting venousreturn, the components of cardiac output, and the phases of the cardiac cycle.(pp. 1128–1130; also see Chapter 3)

6. Define preload, afterload, and left ventricular end-diastolic pressure and relateeach to the pathophysiology of heart failure. (see Chapter 3)

7. Identify the arterial blood supply to any given area of the myocardium. (p. 1128;also see Chapter 3)

8. Compare and contrast the coronary arterial distribution to the major portions ofthe cardiac conduction system. (p. 1128; also see Chapter 3)

9. Identify the structure and course of all divisions and subdivisions of the cardiacconduction system. (pp. 1129–1130; also see Chapter 3)

10. Identify and describe how the heart’s pacemaking control, rate, and rhythm aredetermined. (p. 1130; also see Chapter 3)

11. Explain the physiological basis of conduction delay in the AV node. (see Chapter 3)12. Define the functional properties of cardiac muscle. (see Chapter 3)13. Define the events comprising electrical potential. (see Chapter 3)14. List the most important ions involved in myocardial action potential and their

primary function in this process. (see Chapter 3)15. Describe the events involved in the steps from excitation to contraction of cardiac

muscle fibers. (p. 1130; also see Chapter 3)16. Describe the clinical significance of Starling’s law. (see Chapter 3)

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17. Identify the structures of the autonomic nervous system and their effect on heartrate, rhythm, and contractility. (see Chapter 3)

18. Define and give examples of positive and negative inotropism, chronotropism,and dromotropism. (see Chapter 3)

19. Discuss the pathophysiology of cardiac disease and injury. (pp. 1142–1185)20. Explain the purpose of ECG monitoring and its limitations. (p. 1130)21. Correlate the electrophysiological and hemodynamic events occurring throughout

the entire cardiac cycle with the various ECG waveforms, segments, andintervals. (pp. 1134–1141)

22. Identify how heart rates, durations, and amplitudes may be determined from ECGrecordings. (pp. 1134–1141)

23. Relate the cardiac surfaces or areas represented by the ECG leads.(pp. 1131–1132, 1140)

24. Differentiate among the primary mechanisms responsible for producing cardiacdysrhythmias. (pp. 1140, 1142–1185)

25. Describe a systematic approach to the analysis and interpretation of cardiacdysrhythmias. (pp. 1141–1185)

26. Describe the dysrhythmias originating in the sinus node, the AV junction, the atria,and the ventricles. (pp. 1144–1185)

27. Describe the process and pitfalls of differentiating wide QRS complextachycardias. (pp. 1174–1176)

28. Describe the conditions of pulseless electrical activity. (pp. 1182–1183)29. Describe the phenomena of reentry, aberration, and accessory pathways.

(pp. 1143–1144, 1153, 1184–1185)30. Identify the ECG changes characteristically produced by electrolyte imbalances

and specify their clinical implications. (p. 1185)31. Identify patient situations where ECG rhythm analysis is indicated. (pp. 1142–1185)32. Recognize the ECG changes that may reflect evidence of myocardial ischemia

and injury and their limitations. (p. 1140)33. Correlate abnormal ECG findings with clinical interpretation. (pp. 1142–1185)34. Identify the major mechanical, pharmacological, and electrical therapeutic

objectives in the treatment of the patient with any dysrhythmia. (pp. 1142–1185)35. Describe artifacts that may cause confusion when evaluating the ECG of a patient

with a pacemaker. (pp. 1131, 1179, 1181–1182)36. List the possible complications of pacing. (pp. 1181–1182)37. List the causes and implications of pacemaker failure. (pp. 1181–1182)38. Identify additional hazards that interfere with artificial pacemaker function.

(pp. 1181–1182)39. Recognize the complications of artificial pacemakers as evidenced on an ECG.

(pp. 1181–1182)

Part 2: Assessment and Management of the CardiovascularPatient (begins on p. 1186)

After reading Part 2 of this chapter, you should be able to:

1. Identify and describe the components of the focused history as it relates to thepatient with cardiovascular compromise. (pp. 1187–1191)

2. Identify and describe the details of inspection, auscultation, and palpationspecific to the cardiovascular system. (pp. 1191–1194)

3. Identify and define the heart sounds and relate them to hemodynamic events inthe cardiac cycle. (pp. 1192–1193)

4. Describe the differences between normal and abnormal heart sounds.(pp. 1192–1193)

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5. Define pulse deficit, pulsus paradoxus, and pulsus alternans. (pp. 1194, 1222)6. Identify the normal characteristics of the point of maximum impulse (PMI). (p. 1193)7. Based on field impressions, identify the need for rapid intervention for the patient

in cardiovascular compromise. (pp. 1186–1194)8. Describe the incidence, morbidity, and mortality associated with myocardial

conduction defects. (p. 1216)9. Identify the clinical indications, components, and the function of transcutaneous

and permanent artificial cardiac pacing. (pp. 1179, 1181–1182, 1206, 1207–1208)10. Explain what each setting and indicator on a transcutaneous pacing system

represents and how the settings may be adjusted. (pp. 1207–1208)11. Describe the techniques of applying a transcutaneous pacing system.

(pp. 1206, 1207)12. Describe the characteristics of an implanted pacemaking system. (pp. 1179,

1181–1182)13. Describe the epidemiology, morbidity, mortality, and pathophysiology of angina

pectoris. (pp. 1211–1212)14. Describe the assessment and management of a patient with angina pectoris.

(pp. 1213–1214)15. Identify what is meant by the OPQRST of chest pain assessment. (pp. 1187–1188)16. List other clinical conditions that may mimic signs and symptoms of coronary

artery disease and angina pectoris. (p. 1212)17. Identify the ECG findings in patients with angina pectoris. (p. 1213)18. Based on the pathophysiology and clinical evaluation of the patient with chest

pain, list the anticipated clinical problems according to their life-threateningpotential. (p. 1212)

19. Describe the epidemiology, morbidity, mortality, and pathophysiology ofmyocardial infarction. (pp. 1214–1215)

20. List the mechanisms by which a myocardial infarction may be produced fromtraumatic and nontraumatic events. (p. 1214)

21. Identify the primary hemodynamic changes produced in myocardial infarction.(pp. 1214–1215)

22. List and describe the assessment parameters to be evaluated in a patient with asuspected myocardial infarction. (pp. 1215–1216)

23. Identify the anticipated clinical presentation of a patient with a suspected acutemyocardial infarction. (pp. 1215–1216)

24. Differentiate the characteristics of the pain/discomfort occurring in anginapectoris and acute myocardial infarction. (p. 1215)

25. Identify the ECG changes characteristically seen during evolution of an acutemyocardial infarction. (p. 1216)

26. Identify the most common complications of an acute myocardial infarction.(pp. 1214–1216)

27. List the characteristics of a patient eligible for fibrinolytic therapy. (pp. 1218–1220)28. Describe the “window of opportunity” as it pertains to reperfusion of a myocardial

injury or infarction. (p. 1218)29. Based on the pathophysiology and clinical evaluation of the patient with a

suspected acute myocardial infarction, list the anticipated clinical problemsaccording to their life-threatening potential. (pp. 1214–1220)

30. Specify the measures that may be taken to prevent or minimize complications inthe patient suspected of myocardial infarction. (pp. 1216–1220)

31. Describe the most commonly used cardiac drugs in terms of therapeutic effect anddosages, routes of administration, side effects, and toxic effects. (pp. 1199, 1200,1218; also see Chapter 6)


32. Describe the epidemiology, morbidity, mortality, and physiology associated withheart failure. (pp. 1220–1221)

33. Identify the factors that may precipitate or aggravate heart failure. (pp. 1220–1221)34. Define acute pulmonary edema and describe its relationship to left ventricular

failure. (pp. 1220–1221)35. Differentiate between early and late signs and symptoms of left ventricular failure

and those of right ventricular failure. (pp. 1220–1221)36. Define and explain the clinical significance of paroxysmal nocturnal dyspnea,

pulmonary edema, and dependent edema. (pp. 1221–1222)37. List the interventions prescribed for the patient in acute congestive heart failure.

(pp. 1223–1224)38. Describe the most commonly used pharmacological agents in the management of

congestive heart failure in terms of therapeutic effect, dosages, routes ofadministration, side effects, and toxic effects. (pp. 1999, 1200, 1223; also seeChapter 6)

39. Define and describe the incidence, mortality, morbidity, pathophysiology,assessment, and management of the following cardiac related problems: ★ Cardiac tamponade (pp. 1224–1225)★ Hypertensive emergency (pp. 1225–1226)★ Cardiogenic shock (pp. 1226–1229)★ Cardiac arrest (pp. 1229–1233)

40. Identify the limiting factor of pericardial anatomy that determines intrapericardiacpressure. (p. 1224)

41. Describe how to determine if pulsus paradoxus, pulsus alternans, or electricalalternans is present. (pp. 1222, 1224)

42. Explain the essential pathophysiological defect of hypertension in terms ofStarling’s law of the heart. (pp. 1221, 1226)

43. Rank the clinical problems of patients in hypertensive emergencies according totheir sense of urgency. (pp. 1225–1226)

44. Identify the drugs of choice for hypertensive emergencies, cardiogenic shock, andcardiac arrest, including their indications, contraindications, side effects, route ofadministration, and dosages. (pp. 1999, 1200, 1226, 1227–1229, 1230; also seeChapter 6)

45. Describe the major systemic effects of reduced tissue perfusion caused bycardiogenic shock. (pp. 1226–1227)

46. Explain the primary mechanisms by which the heart may compensate for adiminished cardiac output and describe their efficiency in cardiogenic shock.(pp. 1226–1227)

47. Identify the clinical criteria and progressive stages of cardiogenic shock.(pp. 1226–1227)

48. Describe the dysrhythmias seen in cardiac arrest. (p. 1229)49. Explain how to confirm asystole using the 3-lead ECG. (p. 1229)50. Define the terms defibrillation and synchronized cardioversion. (pp. 1199, 1204)51. Specify the methods of supporting the patient with a suspected ineffective

implanted defibrillation device. (p. 1201)52. Describe resuscitation and identify circumstances and situations where

resuscitation efforts would not be initiated. (pp. 1229–1233)53. Identify communication and documentation protocols with medical direction and

law enforcement used for termination of resuscitation efforts. (pp. 1232–1233)54. Describe the incidence, morbidity, mortality, pathophysiology, assessment, and

management of vascular disorders including occlusive disease, phlebitis, aorticaneurysm, and peripheral artery occlusion. (pp. 1233–1237)




55. Identify the clinical significance of claudication and presence of arterial bruits in apatient with peripheral vascular disorders. (pp. 1233–1237)

56. Describe the clinical significance of unequal arterial blood pressure readings inthe arms. (p. 1236)

57. Recognize and describe the signs and symptoms of dissecting thoracic orabdominal aneurysm. (pp. 1233–1234)

58. Differentiate between signs and symptoms of cardiac tamponade, hypertensiveemergencies, cardiogenic shock, and cardiac arrest. (pp. 1224–1229)

59. Utilize the results of the patient history, assessment findings, and ECG analysis todifferentiate between, and provide treatment for, patients with the followingconditions (pp. 1186–1237):★ Cardiovascular disease★ Chest pain★ In need of a pacemaker★ Angina pectoris★ A suspected myocardial infarction★ Heart failure★ Cardiac tamponade★ A hypertensive emergency★ Cardiogenic shock★ Cardiac arrest

60. Based on the pathophysiology and clinical evaluation of the patient with chestpain, characterize the clinical problems according to their life-threateningpotential. (p. 1212)

61. Given several preprogrammed patients with cardiac complaints, provide theappropriate assessment, treatment, and transport. (pp. 1186–1237)


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