CNA Cardiovascular Nursing (CCN(C)) cheat sheet

Chest pain history uses OPQRST: onset, provocation/palliation, quality, radiation, severity, and timing; associated dyspnea, syncope, palpitations, edema, and claudication complete the symptom review.

Orthostatic vital signs: a fall in systolic BP of at least 20 mmHg or diastolic of at least 10 mmHg within 3 minutes of standing supports volume depletion or autonomic dysfunction.

JVP is assessed with the patient at 30 to 45 degrees; a venous column more than 3 cm above the sternal angle suggests elevated right atrial pressure.

Auscultation identifies S1 and S2, paradoxical splitting, S3 as volume overload, S4 as a stiff ventricle, murmurs, rubs, and distant heart sounds.

MAP = (SBP + 2 × DBP)/3; a common minimum perfusion target is 65 mmHg, individualized in chronic hypertension.

Cardiac output = heart rate × stroke volume; cardiac index = CO/body surface area, with normal about 2.5 to 4.0 L/min/m².

CVP is normally 2 to 8 mmHg; trends with examination and lactate are more useful than a single value for volume status.

12-lead ECG within 10 minutes of ED arrival for suspected ACS; serial high-sensitivity troponin using 0/1h or 0/2h algorithms; BNP/NT-proBNP supports HF diagnosis but is confounded by age, renal function, and obesity.

Echocardiography reports EF, wall motion, valve function, and chamber size; EF ≥50-55% is generally normal.

Sinus rhythm: rate 60-100, upright P in I and II, one P before each QRS, PR 0.12-0.20 s, QRS <0.12 s.

Atrial fibrillation: irregularly irregular, no discrete P waves; management addresses rate/rhythm control, CHA2DS2-VASc stroke risk, and anticoagulation.

Narrow-complex regular SVT: vagal maneuvers then adenosine if stable; unstable tachycardia with a pulse requires synchronized cardioversion.

Wide-complex tachycardia is VT until proven otherwise; pulseless VT or VF requires immediate defibrillation and CPR.

Asystole and PEA are nonshockable: CPR, epinephrine, and treatment of reversible causes such as hypoxia, hypovolemia, acidosis, electrolytes, tamponade, toxins, and thrombosis.

AV block: first-degree PR >0.20 s; Mobitz I progressive PR prolongation; Mobitz II fixed PR with dropped QRS; third-degree AV dissociation.

Torsades de pointes: polymorphic VT with prolonged QT; IV magnesium, electrolyte correction, and removal of QT-prolonging drugs.

Telemetry monitoring includes alarm customization, daily review of QTc, potassium and magnesium optimization, and immediate 12-lead ECG for rhythm change.

Symptomatic bradycardia: atropine first for most patients; pacing, dopamine, or epinephrine when atropine is ineffective or inappropriate.

ACS includes STEMI, NSTEMI, and unstable angina; diagnosis combines symptoms, serial troponin, and ischemic ECG changes.

STEMI: primary PCI target ≤90 min from first medical contact at a PCI center, or ≤120 min with transfer; fibrinolysis within 30 min door-to-needle if PCI is unavailable and symptom onset <12 h without contraindications.

Aspirin 162-325 mg chewed at ACS presentation unless contraindicated; add a P2Y12 inhibitor and anticoagulation per protocol.

Oxygen is indicated for SpO2 <90% or respiratory distress, not routinely for normoxemic patients.

Nitrates are contraindicated in hypotension, right ventricular infarction, and recent PDE5 inhibitor use; they relieve ischemia by venodilation.

Secondary prevention after ACS: dual antiplatelet therapy usually for 12 months, high-intensity statin, beta-blocker, ACE inhibitor/ARB especially with reduced EF, smoking cessation, and cardiac rehabilitation.

GRACE and TIMI scores estimate ischemic risk; bleeding risk scores guide antithrombotic duration.

Mechanical complications of STEMI include papillary muscle rupture, ventricular septal rupture, free-wall rupture, and cardiogenic shock.

NSTEMI/unstable angina: early invasive strategy for high-risk features such as dynamic ST changes, rising troponin, heart failure, or refractory ischemia.

HFrEF: EF ≤40%; HFmrEF: 41-49%; HFpEF: ≥50%; symptoms and natriuretic peptides support diagnosis.

Acute decompensated HF: congestion treated with IV loop diuretics; oxygen or noninvasive ventilation for distress; vasodilators for hypertensive pulmonary edema; inotropes for low-output states.

GDMT for HFrEF includes ARNI/ACEi/ARB, evidence-based beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor; diuretics relieve congestion.

Avoid NSAIDs, thiazolidinediones, and non-dihydropyridine calcium channel blockers in HFrEF because they may worsen fluid retention or contractility.

Daily weights: same time, after voiding, similar clothing; report gain >2-3 lb in one day or >5 lb in one week.

ICD: EF ≤35% with NYHA II-III symptoms despite ≥3 months GDMT, or survivors of dangerous ventricular arrhythmia; CRT: EF ≤35%, widened QRS, especially LBBB.

Cardiomyopathies: dilated with systolic dysfunction, hypertrophic with septal hypertrophy and sudden death risk, restrictive with diastolic dysfunction, and arrhythmogenic right ventricular.

HCM: avoid dehydration and strenuous competitive exercise; screen relatives; treat obstructive symptoms with beta-blockers or other agents.

Self-care: medication adherence, sodium and fluid guidance, vaccination, daily symptom monitoring, and early reporting of dyspnea or edema.

Systolic murmurs: aortic stenosis is crescendo-decrescendo at the right upper sternal border radiating to carotids; mitral regurgitation is holosystolic radiating to the axilla.

Diastolic murmurs: aortic regurgitation is early diastolic at the left sternal border; mitral stenosis is a mid-diastolic rumble with an opening snap.

Aortic stenosis classic symptoms are angina, syncope, and dyspnea; severe symptomatic AS warrants valve replacement, and vasodilators may cause hypotension.

Mechanical prosthetic valves require lifelong warfarin; bioprosthetic valves have shorter anticoagulation, and all prosthetic valves carry endocarditis risk.

Endocarditis prophylaxis is reserved for high-risk lesions: prosthetic valve, prior infective endocarditis, certain congenital heart disease, and cardiac transplant valvulopathy.

Congenital lesions: ASD causes a fixed split S2; VSD causes a holosystolic murmur; PDA causes a continuous machinery murmur; tetralogy of Fallot causes cyanosis and squatting.

Eisenmenger syndrome is shunt reversal from pulmonary hypertension; pregnancy and surgery carry high risk.

Adults with congenital heart disease need lifelong cardiology follow-up for arrhythmia, heart failure, endocarditis, and pregnancy planning.

PAD: claudication, cool hairless limbs, diminished pulses; ABPI <0.9 supports diagnosis, and <0.4 suggests severe disease or critical limb ischemia.

Acute limb ischemia: pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia; urgent heparin and revascularization are required.

DVT: unilateral swelling, calf pain, warmth; Wells score, D-dimer, and compression ultrasound guide diagnosis; anticoagulation prevents propagation and PE.

Virchow triad: venous stasis, endothelial injury, and hypercoagulability.

Aortic dissection: sudden tearing chest or back pain, pulse deficit, and interarm BP difference; type A is a surgical emergency, while type B is often medically managed.

AAA repair is generally considered at diameter ≥5.5 cm in men or ≥5.0 cm in women, rapid growth, or symptoms; rupture presents with hypotension, back pain, and pulsatile mass.

Venous ulcers are usually medial malleolar, moist, and less painful; arterial ulcers are distal, dry, and painful, with poor healing.

Compression therapy is avoided in severe arterial disease, typically ABPI <0.5, and in acute DVT with impending limb loss unless specialist-directed.

PE: dyspnea, tachycardia, pleuritic pain; CTPA is diagnostic; anticoagulation is standard, with thrombolysis for massive PE with hemodynamic instability.

Aspirin irreversibly inhibits COX-1; clopidogrel is a prodrug activated by CYP2C19; ticagrelor and prasugrel are P2Y12 inhibitors with bleeding risk.

Unfractionated heparin: monitor aPTT or anti-Xa; protamine reverses; LMWH is renally cleared and dose-adjusted in renal impairment.

Warfarin: INR 2-3 for most indications; mechanical mitral valves often 2.5-3.5; vitamin K and PCC reverse major bleeding.

DOACs: renal dosing required; no routine INR monitoring; idarucizumab reverses dabigatran, and andexanet alfa reverses some factor Xa inhibitors.

Amiodarone: monitor thyroid, pulmonary, liver, corneal, and neurologic toxicity plus QT; it inhibits warfarin and digoxin clearance.

Adenosine: very short half-life; contraindicated in severe asthma; flush rapidly and warn of transient chest pain, dyspnea, and bradycardia.

Vasoactive drugs: norepinephrine is first-line for septic shock and is infused centrally when possible; dobutamine is an inotrope that may cause tachycardia; nitroglycerin causes venodilation and headache; phentolamine treats norepinephrine extravasation.

Statins inhibit HMG-CoA reductase; monitor for myopathy and liver injury; high-intensity statins are used after ACS.

ACE inhibitors cause cough, hyperkalemia, and angioedema; ARNI requires a 36-hour washout after ACE inhibitor.

PCI: radial access reduces bleeding and allows early ambulation; monitor access site, distal pulses, hand perfusion, and creatinine after contrast.

Post-catheterization: bed rest and pressure dressing per protocol; back or flank pain, hypotension, or falling hemoglobin suggests retroperitoneal bleeding.

Stent patients require dual antiplatelet therapy; premature discontinuation increases stent thrombosis risk.

TAVR treats severe aortic stenosis; complications include stroke, paravalvular leak, vascular injury, and heart block requiring pacemaker.

EP study and ablation: groin and access-site care, arrhythmia monitoring, anticoagulation per protocol, and monitoring for pericardial effusion or tamponade.

Pacemaker: post-insertion sling, avoid heavy lifting and extreme arm movement, monitor incision and device function; MRI conditional devices require verification.

CABG: monitor hemodynamics, chest tube output, urine output, electrolytes, glucose, and arrhythmias; assess graft patency through ischemia signs.

Post-sternotomy: sternal precautions for about 6-8 weeks; incentive spirometry, splinting for cough, and early mobility reduce pulmonary complications.

Cardiac surgery preoperative: beta-blocker continuation, glucose control, smoking cessation, and patient teaching for incentive spirometry and sternal precautions.

BP target generally <130/80 mmHg for most adults with cardiovascular risk; individualize in older adults and frailty.

LDL-C goal <70 mg/dL for high-risk patients and <55 mg/dL for very high-risk patients; high-intensity statin is first-line.

Physical activity: 150 min/week moderate or 75 min/week vigorous aerobic exercise plus muscle strengthening twice weekly.

Cardiac rehabilitation is indicated after MI, PCI, CABG, and for stable HF; it improves functional capacity, quality of life, and mortality.

Smoking cessation: brief advice at every encounter, counseling, and pharmacotherapy with nicotine replacement, varenicline, or bupropion.

DASH or Mediterranean dietary pattern; sodium <2 g/day; limit saturated fat and added sugar.

Vaccination: influenza, pneumococcal, and COVID-19 per schedule for cardiovascular patients.

Teach-back confirms understanding; health literacy, medication reconciliation, and shared decision-making improve adherence.

Home BP monitoring: seated 5 minutes, arm supported at heart level, validated cuff, average two readings one minute apart.

Ethical principles: autonomy, beneficence, nonmaleficence, and justice guide cardiovascular nursing decisions.

Informed consent requires capacity, disclosure of risks, benefits, and alternatives, and voluntariness; the proceduralist obtains consent.

Scope of practice and delegation follow state law, organizational policy, and competency; unlicensed staff do not perform nursing assessment.

SBAR, meaning Situation, Background, Assessment, Recommendation, structures handoffs and escalations.

Rapid response or code team activation is indicated for acute deterioration unresponsive to ward-level intervention.

Evidence-informed practice uses PICO questions, appraisal of evidence levels, and integration of patient values.

Quality improvement uses PDSA cycles; root cause analysis examines systems after serious events; incident reporting is nonpunitive.

Just culture distinguishes human error from at-risk behavior and reckless conduct while encouraging reporting.

Advance directives and DNR orders require clear communication, documentation, and respect for patient goals.