Chapter 1 of 613% of exam

Cardiovascular

The cardiovascular section of the Adult CCRN test plan covers acute coronary syndromes, aortic disease, pericardial and structural problems, dysrhythmias, heart failure, shock and the procedures used to treat them. Most questions ask you to recognize early loss of cardiac output, read hemodynamic data and choose the safest next action.

Acute coronary syndrome and reperfusion

Chest pain is the classic presentation, but older adults, people with diabetes and women can present with only fatigue, dyspnea or weakness. The first step is an ECG to look for ST changes, followed by serial markers. For ST-elevation MI, time to reperfusion drives outcome, so door-to-device and door-to-drug targets matter.

Atypical presentations

Little or no chest pain is common in older adults, people with diabetes and women; treat new dyspnea or fatigue as possible ischemia and get an ECG.

MedlinePlus (NLM), Heart attack

Primary angioplasty timing

Angioplasty should ideally be done within 90 minutes of hospital arrival.

MedlinePlus (NLM), Heart attack

Thrombolytic timing

When used, clot-dissolving drugs are ideally given within 30 minutes of arrival and usually no later than 12 hours after symptom onset.

MedlinePlus (NLM), Heart attack

Pericardial disease and tamponade

Pericarditis causes sharp, positional chest pain that eases when the patient leans forward, often with a friction rub, and is treated with anti-inflammatory therapy. Fluid in the pericardial sac can progress to tamponade, which is an emergency. After cardiac surgery or MI, watch for both early and late (Dressler) pericarditis.

Tamponade findings

Hypotension with distended neck veins, faint heart sounds, tachycardia and a blood pressure that falls on inspiration.

MedlinePlus (NLM), Cardiac tamponade

Tamponade treatment

Drain the fluid (pericardiocentesis or surgical window); fluids and pressors only support preload and pressure until drainage.

MedlinePlus (NLM), Cardiac tamponade

Pericarditis therapy

NSAIDs given with colchicine are the usual treatment; aspirin with colchicine is used after MI.

MedlinePlus (NLM), Pericarditis; Pericarditis - after heart attack

Dressler syndrome

Late pericarditis weeks after MI or heart surgery, often with fever and effusion; tamponade is a key complication.

MedlinePlus (NLM), Pericarditis - after heart attack

Aortic dissection and hypertensive crisis

A tearing pain that moves to the back, with a blood pressure difference between the arms, suggests dissection. Heart rate and blood pressure are lowered first, and ascending dissections go to surgery. Malignant hypertension is defined by organ damage, not by a number alone.

First drug in dissection

Beta-blockers are the first-choice IV agents to reduce heart rate and blood pressure.

MedlinePlus (NLM), Aortic dissection

Where the tear is decides the plan

Ascending dissections are treated with surgery; descending ones may be managed medically or surgically.

MedlinePlus (NLM), Aortic dissection

Malperfusion

New abdominal pain, falling urine output or limb changes can mean the dissection is compromising branch arteries.

MedlinePlus (NLM), Aortic dissection

Hypertensive emergency

Optic nerve swelling, retinal bleeding, confusion, chest pain or reduced urine output with very high pressure mean IV therapy in hospital.

MedlinePlus (NLM), Malignant hypertension

Dysrhythmias, drugs and hemodynamic monitoring

Know which drugs are dangerous in which rhythms, what a vasodilator infusion can do over time, and how to read pulmonary artery catheter values. Cardiogenic shock combines a low cardiac index with high filling pressures.

Verapamil and accessory pathways

IV verapamil is contraindicated in atrial fibrillation or flutter with an accessory pathway such as Wolff-Parkinson-White because it can trigger ventricular fibrillation.

DailyMed, verapamil injection label

Nitroprusside and cyanide

Beyond brief or low-rate use, nitroprusside releases cyanide; worsening acidosis or confusion is a reason to stop and report.

DailyMed, sodium nitroprusside label

Normal PA catheter values

Cardiac index 2.8–4.2 L/min/m²; wedge pressure 4–12 mm Hg; right atrial pressure 0–7 mm Hg.

MedlinePlus (NLM), Swan-Ganz catheterization

Cardioversion and clots

Anticoagulation may be needed before elective cardioversion of atrial fibrillation to prevent stroke from atrial clot.

MedlinePlus (NLM), Cardioversion; Atrial fibrillation

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