Cardiovascular Disorders Proper

Cardiovascular Disorders

Nio C. Noveno, RN

nionoveno@yc Cardiovascular Diseases 2

OXYGENATION (Cardiovascular)

DIAGNOSTIC ASSESSMENT

Chest x-rayFluoroscopyCardiac Enzymes

LDH - elevated in 48 hrsSGOT CPK – elevated 4-24 hrs

CPK-MM [skeletal muscles]CPK-BB [brain]CPK-MB [myocardium, cardio-specific]

Echocardiography [Ultrasound cardiography]Electrocardiography [ECG] – electrical activity


CARDIAC ENZYMES

AST/SGOT 5 – 40 U/LCPK

M 12 – 70F 10 – 55

CPK-MB 0 %LDH 45 – 90 U/LMyoglobin < 85 ng/mLTroponin I < 0.03Troponin T < 0.2CRP < 0.8 mg/dL


ELECTROCARDIOGRAPHY ECHOCARDIOGRAPHY




Electrocardiography [ECG] – graphic record of the electrical activity of the heart




Electrocardiography [ECG]




Stress test (treadmill)Transesophageal echocardiography [TEE]AngiocardiographyPositron Emission Tomography [PET]Coronary ArteriographyCardiac catheterizationHemodynamic monitoring




Coronary Arteriography - introduction of radiopaque catheter into brachial or femoral artery [arteriotomy w/ percutaneous puncture] to ascending aorta to coronary artery for fluoroscopy

Nursing InterventionNPOVital signsCheck for bleeding at puncture siteCheck color of extremity and pulses


ARTERIOGRAPHYCARDIAC

CATHETERIZATION



DIAGNOSTIC ASSESSMENTCardiac Catheterization - catheter into heart & BV to :

measure O2 conc., saturation, tension & pressure of heart chambersDetect shunts, heart output & pulmonary outflowRight CC – antecubital v → VC → R A&V → Pulm a. Left CC – brachia/femoral a → aorta → R V

Nursing InterventionBefore: NPO, allergic hx, mark distal pulse, instruct pt thudding sensations in chest & strong desire to cough and transient heat

After: VS, peripheral pulses, site, chest pain, bed rest for 12-24hrs;Femoral site – bleeding inflammation, tenderness, apply sandbag & ice on site, HOB >30°, avoid flexing femoral region




Hemodynamic Monitoring: assessment of circulatory status

Central Venous Pressure [CVP] (N= 5-12 cms H2O)Catheter into external jugular vein → antecubital or femoral v. → vena cava

Provides information on blood volume & adequacy of venous return

Reveals right atrial pressure

Route for drawing blood samples, administration of fluids or meds and pacing


CVP



DIAGNOSTIC ASSESSMENTHemodynamic Monitoring (CVP)

Nursing InterventionPt. in supine. Changes in position, coughing or straining during reading may result to inaccuracies of readings

Zero point of manometer should be at a level with the pt’s R atrium (midaxillary line)

To measure CVP: turn stopcock so that IV solution flows into manometer filling to about 20-25cm level, then turn stopcock to let flow the solution in the manometer into pt.

Observe the fall in the height of column of fluid in manometer. Read where it stops.



DIAGNOSTIC ASSESSMENTHemodynamic Monitoring

Swan-Ganz Pressure (N=5-12 cms H2O)Catheter into external jugular vein/subclavian → superior vena cava → R atrium → tricuspid valve → R vent → pulm a. → pulm capillary [pulm capillary wedge pressure]Interpretations of Pressure Readings:

Pulmonary Artery Pressure [PAP]: 10-20 mmHg;- increased in pts w/ chronic pulmonary disease & CHF

Pulmonary Capillary Wedge Pressure: 4-12 mmHg- indicative of pressure in the L cardiac chambers


Swan-Ganz Procedure

PAWP CATHETER


The PRESSURE Guidelines

P ressure monitor

R ise slowly to reduce orthostatic hypotension

E ating must be considered

S tay on medications

S topping or skipping is discouraged

U ndesirable responses

R emind to exercise, stop alcohol

E liminate smoking, educate


Pharmacology

Nitroglycerin

MOA: relaxes vascular smooth system, ↓myocardial demand for O2, ↓ LV preload by dilating veins, thus indeirectly ↓afterload

Interventions:Monitor BP & APHave client sit or lie

down (first time)NO defibrillation over

area of nitro patchAssist during ambulation


PharmacologyNitroglycerin cont…

Health Teachings:Oral:

– Take on an empty stomach, with a glass of water.SL:

– Take at first sign of anginal pain– Take every 5 mins to a maximum of 3 doses

• NO relief, seek MD– Stinging or biting sensation– Protect from light, moisture and heat

Transderm patch:– OD in AM– Rotate sites


Pharmacology

Lidocaine

MOA: decreases cardiac excitability, cardiac conduction is delayed in the atrium or ventricle

Undesirable effects:– ↓ or ↑ HR– ↓ BP– Confusion– Drowsiness (1st sign of

toxicity)– Dizziness– Nausea, vomiting – Seizures (severe toxicity)– Cardiac arrest

Drug interactions:– ↑ effects with Phenytoin,

Procainamide, Propranolol, quinidine,

– ↑ risk of toxicity with ß-adrenergic blockers, cimetidine


Pharmacology Lidocaine cont…

Interventions:• Give I.V.• Monitor serum levels: 1.5-5 mcg/ml• Monitor EKG, BP, PR• Monitor I & O• Do not mix syringes with cefazolin and amphotericin

B• Have Dopamine available for circulatory collapse• Assist and provide safety


Pharmacology ACE INHIBITORS

MOA: suppress the RAAS; blocks the conversion of angiotensin I to angiotensin II

Undesirable effects:– Gastric irritation– Headache– Dizziness– ↑ HR– Angioedema– Cough– Maculopapular rash– Pruritus– Infection– Hyperkalemia

Interactions:– Probenecid: ↓

elimination– NSAIDs: hypotensive

effect– Other anti-HTN: ↑

hypotensive effects– Hyperkalemia

Interventions:– Assess for renal function– Do not give with food– Do not take potassium-

rich foods


Pharmacology ACE INHIBITORS cont…

S VR/PVR decreased

T reatment for MI

R elease of aldosterone is low

O occult diabetic nephropathy

L VD after MI is low

ACE INHIBITORS cont…

C ough; contraindicated with renal artery stenosis

H ypotension; hyperlipidemia

F ood has less taste; WOF hypotension


Pharmacology Angiotensin II receptor blockers (ARB)

MOA: blocks angiotensin II from binding with angiotensin receptors; lowering BP

Information:– Same with ACE inhibitors

A dminister without regard to meals

R enal function tests –review

B locks vasoconstriction effect of RAAS

S alt substitution or potassium supplements is not allowed


Pharmacology Alpha adrenergic blockers

MOA: blocks alpha1adrenergic receptors resulting in vasodilation of arteries and veins; decreases PVR; relaxes smooth muscles of bladder and prostate

Undesirable effects:– Same as other anti-HTN

meds– WOF: 1st dose syncope

• 2-3 H post initial dose

S yncope; sexual dysfunction

I ncreased drowsiness; orthostatic hypotension, HR

N eed to be recumbent for 3-4 H after the initial dose


Pharmacology Beta adrenergic blockers

MOA: blocks ß1 (heart) or ß2 (lungs) receptors to prevent the release of catecholamines; decreases contractility, renin release and sympathetic output

Caution: – COPD– CHF– Sinus bradycardia– Heart block– DM

B radycardia

L ipidemia/libido decreased

br O nchospasm

C HF; conduction abnormalities

K onstriction, peripheral vascular

E exhaustion; emotional depression

R educes glucose


Pharmacology Calcium channel blockers

MOA: blocks Ca2+ influx into the cells causing decreased contractility, decreased PVR and low BP

Undesirable effects:– Hypotension– Headache – Dizziness– Peripheral edema– Constipation

Interventions:• Elevate extremity affected• Increased dietary fiber;

increase OFI• Take with meals or milk


Pharmacology Central alpha2 agonist

MOA: decreased release of adrenergic hormones from the brain resulting in a decrease PVR, hence BP

C ontrols release of adrenergic hormones

A dverse effects: low BP, hepatotoxicity, hemolytic anemia

T ransient drowsinessA rterial pressure is

loweredP aradoxical HTN with

propranololR ecord baseline VSE valuate weight and liver

functionS lowly taper the doses


Pharmacology

Vasodilators

MOA: direct relaxation of vascular smooth muscles, decreases afterload

D ilates vascular musclesI ncreases renal and

cerebral flowL upus-like reaction (fever,

facial rash, muscle and joint ache, splenomegaly)

A ssess for peripheral edemaT ake with foodO ther SE: headache,

dizziness, anorexia, tachycardia, hypotension

R eview BP


D iet high in K+ for all except aldactone

I ntake and output daily

U undesirable effects: fluid & electrolye imbalance

R review HR, BP

E lderly with caution

T ake with or after meals in AM

I ncrease risk of orthostatic hypotension; move slowly

C ancel alcohol



COMMON CARDIOVASCULAR DISEASES

CORONARY ARTERY DISEASE or Coronary Ischemic HD

Myocardial impairment due to imbalance between coronary blood flow myocardial O2 demandManifested as:

Ischemia [Angina Pectoris] – reversibleInfarction – irreversible

Ischemia – reversible if myocardial blood flow is ↑ or the need for the demand is ↓

may progress to infarction





Angina PectorisChest pain associated w/ transient myocardial ischemia

Causes:Atherosclerosis – most common VasospasmAortic stenosis

Kinds:Stable [Effort] APUnstable [Preinfarction] AP


ASSESSMENT OF PAIN

P rovoking/precipitating

Q uality

R adiation

S everity

T iming




Angina PectorisSigns & Symptoms:

Substernal or precordial pain radiating to L shoulder lasting for 3-5 mins, relieved by restHeaviness, tightness, squeezing precipitated by exertion, emotion and exposure to coldVS may be normal

Diagnostic Tests:Nitroglycerine test – relieves painBlood chemistry - ↑ cholesterolStress test, abnormal ECG – inverted T-wavesCardiac enzymes – NCoronary arteriography – plaque accumulation



COMMON CARDIOVASCULAR DISEASESAngina Pectoris

Nursing Intervention↑ O2 to the myocardium & relief of acute attacksAdminister meds as ordered.

Short & long acting nitrates [NG]β-adrenergic agonists [Propranolol]

Reducing demand for O2Limit activities, moderate exerciseSedatives, tranquilizers, antidepressants

Helping client prevent future attacksDiet – low calorie, saturated fat5-6 small frequent feedingsDaily exercise; avoid cold environment, smoking




Myocardial InfarctionLife threatening condition caused by occlusion of coronary artery or its branches leading to death of myocardial cells

Causes:AtherosclerosisThrombus EmbolusCoronary artery spasm










Myocardial InfarctionSigns & Symptoms:

Steady constrictive substernal chest pain, sever, not relieved by rest & NitroglycerineSymptoms of shock, increase in tempNausea & vomiting, diaphoresis, pallorAnxiety and apprehension

Management:Provide rest – CBR, use bedside commodeRelieve pain – demerol or morphineO2 by mask, cannula or nasal catheterECG monitoringIVF to KVO




Myocardial Infarction

Management:Diureticsβ-adrenergic agonistsAnti-arrhythmics [Procainamide, Lidocaine]Diet: no iced or very hot drinks, may precipitate arrhythmias, no gas-forming foodsMild laxatives, stool softenersIf due to thrombus: give

Thrombolytics [Streptokinase]Follow up therapy w/ anticoagulant

Heparin, Coumadin, ASA, Dicumarol




CONGESTIVE HEART FAILURE (CHF)

Inability of the heart to pump blood from the ventricles as quickly as it enters the atria leading to congestion in the lungs & systemic circulation

Causes:inflow of blood → heart is greatly reducedinflow of blood → heart is greatly increasedoutflow of blood from the heart is obstructedmyocardial damageincreased metabolic state




CONGESTIVE HEART FAILURE (CHF)

Cardiac Compensatory Mechanisms:Ventricular dilatationVentricular hypertrophyTachycardia

Forms of CHF:Left ventricular failureRight ventricular failure




COMMON CARDIOVASCULAR DISEASESSigns and Symptoms of CHF

Left-sided HF Right-sided HF

Forward Effects:Weakness, fatiguemental confusion, insomnia, anxiety, oliguria

Backward Effects:breathlessness, cough, orthopnea, crackles, ↑ PCWP, frothy sputum

Forward Effects:Decreased volume to the lungs

Backward Effects:ankle/pretibial swelling, pitting edema, abdominal distention, ascites, anorexia, JV distention, hepatomegaly splenomegaly, wt. gain, ↑ CVP


Congestive Heart Failure





CONGESTIVE HEART FAILURE (CHF)Interventions:

Improve ventricular pump performanceInotropic agents [Digitalis]Administer O2 therapy

Reduce myocardial workloadPreload:

Administer diureticsRestrict fluid & Na intakeUpright positionPhlebotomy

Afterload:VasodilatorsReduce physical and emotional stress




ACUTE PULMONARY EDEMA

Complication of L-sided HFEdema results from the heart’s inability to pump adequatelyResults in impaired oxygenation & hypoxia

Causes:Heart failureAtherosclerosisValvular disease





Assessment findings:• Dyspnea• Paroxysmal cough• Blood-tinged frothy sputum• Orthopnea• Restlessness

Diagnostic test findings:CXR: interstitial edemaABGs: respiratory alkalosis or acidosisECG: tachycardia, ventricular enlargementEMODYNAMICS: ↑ PAWP, CVP, ↓ CO





Medical management:Low-sodium diet; limit fluidsO2 therapyHigh-Fowler’s positionVS, I/O, ECG, & hemodynamicsAnalgesics VasodilatorsCardiac inotropes & glycosidesNitratesBronchodilatorsPulse oximetry





Nursing management:Assess CV & respiratory statusWithhold food & fluidProvide:

SuctioningTurningCoughingDeep breathing

Keep in High-Fowler’sAllay anxietyNote the color, amount & consistency of sputum





Home instructions:• Recognize the signs of fluid overload &

respiratory distress• Sleep with the head of the bed elevated

Complications:Digitalis toxicityFluid overloadPulmonary embolismHypokalemiaHyernatremia




CARDIOGENIC SHOCK

Failure of the heart to pump adequately, thereby educing the CO & compromising tissue perfusion

Causes:MIMyocarditisAdvanced heart blockHeart failureMetabolic abnormalitiesCardiac tamponadePulmonary embolus




CARDIOGENIC SHOCK

Assessment findings:Hypotension

SBP <90 mm HgOliguria:

<30 mL/HCold, clammy, pale skinTachycardiaRestlessness

Diagnostic findings:ABGs: metabolic acidosis, hypoxemiaECG: MI (enlarge Q wave, ST elevation)


Injury ↓Myocardial contractility

↑ HR↓ SV

↓ LV emptying

Compensation

Decompensation & death

↓ Coronary artery

perfusion

↓ CO

Myocardial hypoxia

↓Myocardial contractility

↑ Preload

Pulmonary congestion

LV dialtion & backup of blood



CARDIOGENIC SHOCK




CARDIOGENIC SHOCK

Management:O2 therapySemi-Fowler’s positionIntra-aortic balloon pumpDiureticsVasodilatorsCardiac inotropesVasopressorsAdrenergic agents




CARDIOGENIC SHOCK

Nursing management:Administer:

IVF, O2, medicationsAssess CV, respiratory status, & fluid balanceMonitor & record:

VS I/OHemodynamicsLOCLab values




CARDIOGENIC SHOCK

Complications:• Arrhythmias• Cardiac arrest• Infection

Surgical interventions:CABGHeart transplantation




COMMON CARDIOVASCULAR DISEASESMITRAL STENOSIS

Narrowing of the mitral valve openingDue to:

Rheumatic endocarditisCongenital

Assessment findings:• Fatigue• Dyspnea on exertion• Peripheral edema• Orthopnea

Diagnostic findings:CXR: enlargement of the LA & RV; pulmonary congestionECHOCARDIOGRAM: thickened mitral valve & LA enlargement




MITRAL STENOSIS

Management:Low-sodium diet; fluid restrictionsSemi-Fowler’s positionCardiac glycosidesNitratesDiureticsAnti-arrhythmicsAni-coagulantsAntibiotics




MITRAL STENOSIS

Nursing management:Administer:

IVF, O2, medicationsAssess CV & respiratory responseMonitor & record:

VS I/OHemodynamicsECG readingsLab values



COMMON CARDIOVASCULAR DISEASESMITRAL STENOSIS

Home care:Signs & symptomsActivity limitationsInfection controlOccult blood

Complications:ThrombosisEmbolismHFAtrial fibrillation

Surgery:Valve replacementOpen mitral commissurotomy




MITRAL INSUFFICIENCYIncomplete closure of the mitral valveDue to:

↑ LA pressurePulmonary HTNLA hypertrophy

Assessment findings:• Fatigue• Dyspnea on exertion• Peripheral edema• Angina pectoris• Orthopnea




MITRAL INSUFFICIENCYDiagnostic findings:

ECHOCARDIOGRAM: enlarged LA, abnormal movement of the mitral valveCARDIAC CATH: ↑ LA pressure & ↑ LV pressure

Management:Low-sodium diet; fluid restrictionsSemi-Fowler’s positionCardiac glycosidesNitratesDiureticsAnti-arrhythmicsAni-coagulants




MITRAL INSUFFICIENCY

Nursing management:Maintain on diet; limit OFIKeep on semi-Fowler’s positionAssess peripheral edema




AORTIC STENOSISNarrowing of the aortic valveLower CO leads to increased congestion in the lungs causing RSHF

Causes:SyphilisRheumatic feverAtherosclerosisCongenital malformations




AORTIC STENOSIS

Assessment findings:• Angina pectoris• Pulmonary HTN• LSHF• Orthopnea

Diagnostic findings:ECG: L bundle branch block, 10 heart block, LV hypertrophy ECHOCARDIOGRAM: thickened LV wall, thickened aortic valve that moves abnormally



COMMON CARDIOVASCULAR DISEASESAORTIC STENOSIS

Management:• Low-sodium diet; fluid restrictions• Monitor lab studies• Cardiac glycosides• Nitrates• Diuretics• Anti-arrhythmics• Percutaneous transluminal valvuloplasty

Nursing management:Maintain on diet; limit OFIAssess CV & respi statusMonitor & record:

VS , I/O, Hemodynamics, ECG readings, Lab values



COMMON CARDIOVASCULAR DISEASESAORTIC STENOSIS

Complications:• HF• Pulmonary edema

Surgery:Aortic valve replacementCommissurotomy



COMMON CARDIOVASCULAR DISEASESAORTIC INSUFFICIENCY

Retrograde flow of blood from the aorta to the LVAn incomplete closure of the aortic valve

Causes:SyphilisRheumatic feverInfective endocarditisAtherosclerosisCongenital defect




Assessment findings:• Signs of LSHF• Dyspnea on exertion• Dizziness• Angina pectoris

Diagnostic findings:CXR: enlarged LV, aortic valve calcificationECHOCARDIOGRAM: LV enlargement, abnormal valve movement




Management:• Low-sodium diet; fluid restrictions• Antibiotics • Cardiac glycosides• Nitrates• Diuretics• ACE inhibitors • Anti-arrhythmics• Percutaneous transluminal valvuloplasty

Nursing management:Maintain on diet; limit OFIAssess CV & respi statusMonitor & record:

VS , I/O, Hemodynamics, ECG readings, Lab values




Complications:• HF• Thrombosis• Embolism• Infection

Surgery:ValvuloplastyValve replacement



COMMON CARDIOVASCULAR DISEASESPERIPHERAL VASCULAR DISEASE

Chronic inadequate blood flow in the lower extremities

Types:1. Arteriosclerosis obliterans – sclerosis of arterioles

resulting in thickening of the walls & occlusion2. Raynaud’s phenomenon – intermittent

vasoconstriction & ischemia of fingers & toes accompanied by pallor & cyanosis

3. Buerger’s disease (thromboangiitis obliterans) –inflammation of BV resulting in occlusion of the vessel

Causes:AtherosclerosisVasospasmInflammation




Assessment findings:Intermittent claudicationPain at restTrophic changes: thickened nails, absence of hair, & taut skinDiminished or absent pulses in extremities (unilateral)Temperature changes in extremitiesColor changes:

Rubor, cyanosis, pallorUlcerations in extremities

Diagnostic findings:ARTERIOGRAPHY: location of obstructionDOPPLER STUDIES: decreased blood flow & arterial pressure




Buerger’s disease

Raynaud’s phenomenon




Management:• Active ROM & isometric exercises• Antiplatelet agents• Vasodilators• Anticoagulants• Antilipemics

Nursing management:Assess for:

PulsesColorTemperatureComplaints of abnormal sensations

Numbness or tingling




Home care:Symptoms of ↓ peripheral circulationSkin breakdownFoot careAvoid stress

Prolonged standingExtremes of temperatureConstrictive clothingCrossing legs at knee when seated




Complication:• Gangrene• Septicemia• Pressure sores• Acute vascular occlusion

Surgery:Bypass graftingEndarterectomySympathectomyAmputationEmbolectomy



COMMON CARDIOVASCULAR DISEASESTHROMBOPHLEBITIS

Massing of RBCs in a fibrin networkObstruction by enlarged thrombusResults to inflammation of the venous wall causing clots to form

Causes:Venous stasis

Varicose veins, pregnancy, HF, prolonged bed rest

HypercoagulabilityCancer, blood dyscrasias, oral contraceptives

Injury to venous wallIV, fractures, antibiotics




Assessment findings:SUPERFICIAL VEINS:

Red, warm skin that’s tender to touchDEEP VEINS:

Major venous trunks: Edema(+) Homans signTendernessCramping pain,Cyanosis Venous distention

SMALL VEINS:TendernessInduration Minimal to no distention




Diagnostic findings:VENOGRAPHY/ PHLEBOGRAPHY : venous filling defectsUTZ: ↓ blood flow

Management:Activity limitationAntiembolism stockingsAnticoagulants

Nursing management:Assess for Homans signApply warm, moist compressMeasure & record circumference of thighs & calvesKeep patient I bed & elevate extremities




Complications:• Pulmonary embolism• Stroke

Surgical intervention:Vena cava filterVein ligation & strippingThrombectomy



COMMON CARDIOVASCULAR DISEASESARTERIAL OCCLUSIVE DISEASE

Obstruction or narrowing of the aorta’s lumen & its major branchesReduced perfusionObstruction: endogenous or exogenous

Causes:AtherosclerosisEmboliThrombosisTrauma or fracture

Risk factors:Age DMFamily historyHyperlipidemiaHTNSmoking




Assessment findings:Femoral, popliteal or innominate arteries:

↓ decreased distal pulsesMottling & pallorParalysis & paresthesiaSudden & localized pain*

Internal & external carotid arteries:stroke., TIA

Subclavian:Subclavian steal syndrome

Vertebral & basilar:TIA




Angiography findings:The type (thrombus or embolus), location, & degree of obstructionCollateral circulation

Medications:AntilipemicsAntiplateletsPentoxyfillineAnticoagulantsThrobolytics




Nursing management:Assess distal pulses, skin color, & temperatureAssess pain & give analgesicsAdminister IV fluids, O2, & medications as RxMonitor for signs of stroke



COMMON CARDIOVASCULAR DISEASESABDOMINAL AORTIC ANEURYSM

Dilation of or localized weakness in the medial layer of an abdominal artery

Causes:AtherosclerosisHTNSmoking

4 types:1. Saccular – unilateral, pouch-like bulge2. Fusiform – spindle-shaped bulge; encompasses entire

diameter of the vessel3. Dissecting – hemorrhagic separation of the medial

layer of vessel wall; creates a false lumen4. False – pulsating hematoma; often mistaken for an

abdominal aneurysm







Assessment findings:AsymptomaticLower abdominal pain, lower back painAbdominal mass to the left of the midlineAbdominal pulsationsBruits

Diagnostic findings:Apparent on CXR, abdominal UTZ, aortography

Medications:Analgesicsß-blockers




Nursing management:Check peripheral circulationObserve for signs of shock:

AnxietyRestlessnessDecreased pulse pressureIncreased thready pulsePale, cool, moist, clammy skin

Palpate abdomen for distentionTeach signs & symptoms of decreased peripheral circulation




Complication:Rupture of aneurysmHemorrhage Renal insufficiency

Surgery:Resection of aneurysmEndovascular graft repair



COMMON CARDIOVASCULAR DISEASESCARDIOMYOPATHY

Disease of the heart’s muscle impacting the structure & function of the ventricleHeart failure develops laterMyocardium becomes flabby

Types:1. Congestive (dilated) – chronic alcoholism2. Hypertrophic – idiopathic hypertrophic subaortic

stenosisPressure overload hypertension or aortic valve stenosisHypertrophic cardiomyopathy

3. Restrictive (obliterative) – amyloidosis, cancer




Major manifestations:• Dyspnea• Dry cough• Fatigue• Palpitations• Weakness

Diagnostic findings:ECG: LV hypertrophyECHOCARDIOGRAM: decreased myocardial functionCXR: cardiomegaly




Management:• Low-sodium diet; fluid restrictions• LV assist device• Diuretics• ß-blockers• Anticoagulants • CCBs• ACE inhibitors

Nursing management:Keep in semi-Fowler’s positionMonitor ECG resultsAdminister O2 & medications




Home care:Signs & symptoms of HFWeigh daily

Report increments of 3 lbs.Demonstrate exercises to increase CORefrain from smoking & drinking alcohol

Complications:• Heart failure• Arterial emboli

Surgery:Ventricular myomectomyHeart transplant



COMMON CARDIOVASCULAR DISEASESENDOCARDITIS

Endocardial lining inflammationDestruction of heart valve leaflets

Causes:ß-hemolytic strep infections

S. aureus, Candida, G(-)Rheumatic heart diseaseDental proceduresInvasive monitoringIV drug abuse




Assessment findings:• Elevated temperature• Heart murmur• Malaise

Diagnostic findings:• BLOOD CULTURES: (+) microorganisms• ECHOCARDIOGRAPHY: valvular damage,

vegetations

Medical management:Antibiotics(+) inotropic agentsAntipyreticsAnticoagulants




Nursing management:• Administer medications• Asses CV status• Encourage rest periods

Home care:• Avoid infections• Monitor for infections specially after dental or gynecologic

exam; seek treatment• Wear ID

Complications:• Embolism• HF• Mycotic aneurysm

Surgery:Valve replacement



COMMON CARDIOVASCULAR DISEASESPERICARDITIS

Inflammation of the pericardiumMay be: fibrinous or effusive

Causes:InfectionNeoplasmsHigh dose radiation to the chestHypersensitivity or autoimmune diseaseHydralazine or procainamidePostcardiac injuryAortic aneurysmMyxedema






Assessment findings:

Pain characteristics:

Sharp, usually sudden over the sternum

Radiates to the neck, shoulders, back & arms

Increases with deep inspiration or when lying down

Decreases when sitting up & leaning forward




Diagnostic findings:ECGElevated ST segmentsQRS segments may be diminished with pericardial effusionRhythm changes may occur:

Atrial ectopic rhythms – atrial fibrillation & sinus arrhythmia

Echocardiography reveals the problem

Management:Bed as long as fever & pain persistNSAIDSCorticosteroidsAntibiotics




Nursing management:• Maintain CBR• Place on upright position• Monitor & record VS, I/O, & hemodynamics• Assess pain & give analgesics as Rx

Complications:• Pericardial effusion• HF• Chronic RSHF• Cardiac tamponade

Surgery:Pericardectomy




CONDUCTION ARRHYTHMIASDisruption in the normal events of cardiac cycleSinus Tachycardia – HR > 100 beats/min originating from

the SA node (100-160bpm); regular rhythm

Causes: fever, apprehension, physical activity, anemia, hyperthyroidism, epinephrine, caffeine

Management:Correction of underlying

causeNo stimulantsDrug of choice:

propranolol [Inderal], Digoxin




CONDUCTION ARRHYTHMIAS

Sinus Bradycardia – HR < 60 beats/min; regular rhythm

May be caused by: Excessive vagal/or ↓ sympathetic toneMI, intracranial tumors, meningitisN variation of HR in well-trained athlete

Management:Not needed, unless CO is inadequatePharmacotherapy: Atropine, IsuprelPacemakers – pulse generator to control potentially dangerous dysrhythmias





Atrial Fibrillation: Atrial rate: 35-600bpm;Vent. rate: 100-160 bpm; irregular

May be seen it pts with: Rheumatic mitral stenosis, thyrotoxicosis, hypertensive disease, cardiomyopathy, pericarditis and CHD

ManagementDigitalis, PropranololVerapamil in conjunction w/ digitalisDirect-current cardioversion



CONDUCTION ARRHYTHMIASVentricular Tachycardia – run of 3 or more consec. PVCs;

Atrial rate: 60-100bpm; Vent. rate: 110-250bpm; occ’lventricular irregularity

May be caused by: Acute MI, CAD, intoxication, hypokalemia

ManagementIV push Lidocaine, then IV dripProcainamide via IV infusionPropranolol [Inderal], BretyliumDirect-current cardioversion





Premature Ventricular Contractions – HR varies according to number of PVCs; irregular rhythm

May be caused by: Myocardial dse, CHD, hypoxiaElectrolyte imbalance [hypokalemia]Digitalis tx, stimulants

ManagementIV push Lidocaine, then IV dripProcainamide [Pronestyl]Treatment of underlying cause

Cardiovascular Disorders

THANK YOU!

Nio C. Noveno, RN

Education

Cardiovascular Disorders Proper