com .Aorta & arteries tend to become less distensible Heart becomes less responsive to catecholamines Maximal exercise heart rate declines Decreased rate of diastolic relaxation (↑in BP is more pronounced for systolic BP than diastolic BP)  Note that hypertension is NOT a normal age-related process  Compensatory mechanism are delayed/insufficient = orthostatic hypotension is common  Thickness of LV wall may increase with age due to blood vessel changes     http://nursinglectures.blogspot.

com .blogspot.      Also known as coronary HEART disease (CHD) Describes heart disease caused by impaired coronary blood flow Common cause: atherosclerosis CAD can cause the following:  Angina  Myocardial Infarction (MI) = heart attack  Cardiac dysrhythmias  Conduction defects  Heart failure  Sudden death Men are more often affected than women Approximately 80% who die of CHD are 65+ y/o http://nursinglectures.

Contraceptive . sedentary living. heredity Stress.blogspot. gender. DM.Risk Factors Non-modifiable Modifiable Age. Smoking. race. Hyperlipidemia/hypercholesterolemia Endothelial injury Desquamation of endothelial lining (peeling off) http://nursinglectures. Obesity. HPN. Alcohol. diet. MYOCARDIAL INFARCTION .Increased permeability/ adhesion of molecules LDLs & platelets assimilate into the area Plaques begins to form Decreased coronary tissue perfusion Coronary ischemia Decreased myocardial oxygenation ANGINA PECTORIS http://nursinglectures.  . Inspection:  Skin color  Neck vein distention (jugular vein)  Respiration  Peripheral edema Palpation:  Peripheral pulses http://nursinglectures.

or infiltration .com .blogspot. infection. high-pitched scratchy sound http://nursinglectures.described as a short.may be a sign of inflammation. Auscultation:  Heart sounds (presence of S3 in adults & S4)  Murmurs – audible vibrations of the heart & great vessels produced by turbulent blood flow  Pericardial friction rub – extra heart sound originating from the pericardial sac .

blogspot.      Dyspnea  Dyspnea on exertion – may indicate decreased cardiac reserve  Orthopnea – a symptom of more advanced heart failure  Paroxysmal nocturnal dyspnea – severe SOB that usually occurs 2-5hrs after onset of sleep Chest Pain – may be due to decreased coronary tissue perfusion or compression & irritation of nerve endings Edema – increased hydrostatic pressure in venous system causes shifting of plasma resulting to interstitial fluid accumulation Syncope – due to decreased cerebral tissue perfusion Palpitations Fatigue . . ECG (Electrocardiography) – graphical recording of the heart’s electrical activities.20s (3-5 squares) √ for AV block  QRS = 0. 1st diagnostic test done when cardiovascular disorder is suspected  Waves: P wave – atrial depolarization (contraction/stimulation) ▪ QRS complex – ventricular depolarization (changes are irreversible) ▪ ST segment – ventricular repolarization (changes are reversible) ▪ U wave – hypokalemia  PR interval (time for impulse to travel) = 0.10s or (<2squares) √ for electrolyte &/or ventricular imbalance http://nursinglectures.

absent P wave = atrial fibrillation b. elevated ST segment = MI d. 3rd degree heart block = prolonged PR then progressively prolonged http://nursinglectures.blogspot. Abnormalities: a. saw-tooth pattern = atrial flutter . .http://nursinglectures.

com .http://nursinglectures.blogspot.

blood = <0.↑within 3-4 days & remains elevated for 14 days http://nursinglectures.most sensitive indicator of myocardial damage) = 45-90mg/dL . Cardiac Enzymes (Cardiac Markers): 1st: Myoglobin .↑ within 3-6hrs after MI & remains elevated for 21 days upon onset of attack 3rd: Creatinine kinase (CK) – intracellular enzymes found in muscles converting ATP to ADP CK-MB – specific to myocardial tissue (↑within 4-6hrs & decreases to normal within 2-3days) ▪ male = 12-70 mg/dL ▪ female = 10-55 mg/dL th 4 : LDH (specifically LDH1.6mg/dL . blood = <70mg/dL nd 2 : Troponin* .blogspot. urine = 0 – 2mg/dL (↑within 30mins – 2hrs after MI) b.regulates calcium-mediated contractile process released during MI (Troponin T & I) .

blogspot.light breakfast on the day of the test .com .wear comfortable. on the day before until the test day . loose-fitting clothes & rubber-soled shoes on the test day . Stress Test / Treadmill Test (Treadmill Stress Test) – ECG monitoring during a series of activities of patient on a treadmill  Purposes: identify ischemic heart disease evaluate patients with chest pain evaluate effectiveness of therapy develop appropriate fitness program  Instructions to patient: get adequate sleep prior to test . alcohol.inform physician of any unusual sensations during the test .rest after the test http://nursinglectures.avoid: caffeinated beverages. tea.

 Pharmacologic Stress Test – use of intravenous injection of pharmacologic vasodilator (dipyridamole. or dobutamine) in combination of radionuclide myocardial imaging  To evaluate presence of significant CHD for patients contraindicated in TST  Dipyradamole blocks cellular re-absorption of adenosine (endogenous vasodilator) & increases coronary blood flow 35x above baseline levels  If with CHD. HR.blogspot. further vasodilatation does not produce increased blood flow  Dobutamine – used in patients with bronchospastic pulmonary disease .com . thus.increases myocardial O2 demand by increasing cardiac contractility. the resistance vessels distal to the stenosis already are maximally dilated to maintain normal resting flow. adenosine. & BP http://nursinglectures.

lab is equipped for viewing & recording fluoroscopic images & for measuring pressures in the heart & great vessels. & for obtaining ABG samples .Epinephrine – to counteract possible allergic reactions  Right heart Catheterization – catheter inserted into peripheral veins (basilic or femoral) then advanced into the right heart  Left heart Catheterization – catheter inserted retrograde through peripheral artery (brachial or femoral) into the aorta & left heart  Coronary Angiogram – injection of radiographic contrast medium into the heart so that an outline of moving structures are visualized & filmed  Coronary Arteriography .injection of radiographic contrast medium into the coronary arteries permits visualization of lesions in these vessels  http://nursinglectures.Cardiac Catheterization – involves passage of flexible catheters into great vessels & heart chambers under local anesthesia .com . cardiac output studies.blogspot.

blogspot. .

com . flat on bed for 6hrs  Apply pressure (5lb-sand bag) over puncture site & monitor for bleeding  Monitor v/s q15 for 1st 2hrs then q1 until stable v/s. “fluttering” sensation may be felt as catheter enters the heart  Administer sedatives as ordered  Have the client void prior to transport to cath lab  After Procedure:  Bed rest – upper extremity catheter = until stable v/s.blogspot. peripheral pulses  Immobilize affected extremity in extension for adequate circulation  Monitor for color & temperature changes of extremities  Instruct client to report tingling sensations http://nursinglectures. esp.lower extremity = 24hrs. Before Procedure:  Check consent form  √ for allergies to seafood & iodine  NPO post midnight  Baseline V/S  Explain that warm or flushing sensation may be felt upon administration of the dye. HOB not more than 30° .

inserted via antecubital vein into the right side of the heart & is floated into the pulmonary artery 4 lumens: . Balloon http://nursinglectures. Specimen collection tube – also used for administering meds 4. Pulmonary pressures:  PAP (pulmonary artery pressure) = 2030mmHg  PCWP (pulmonary capillary wedge pressure) = 8-13mmHg (√ for pulmonary edema) 3. CVP – specific to right heart RA = 0-12 RV = 5-12  Indications: increased CVP = heart failure -decreased CVP = hypovolemia 2.blogspot. Swan-Ganz Catheterization – to determine & monitor cardiovascular status. MRI – magnetic fields & radiowaves are used to detect & define abnormalities in tissues (aorta.shows actual beating & blood flow. eyeglasses)  Instruct client to remain still during the entire procedure  Inform client of the duration (4560mins)  CI: clients with pacemakers. tumors. Echocardiography – uses ultrasound to assess cardiac structure & mobility Doppler U/S – to detect blood flow of artery & vein specifically of lower extremities (No smoking 1hr before the test)    Holter Monitoring – portable 24hr ECG monitoring which attempts to assess activities which precipitate dysrhythmias & its time of the day http://nursinglectures. image over 3 spatial dimensions  Secure consent  Assess for claustrophobia  Remove metal items (jewelries. pericardiac disease) . recently implanted clips or wires . prosthetic valves. cardiomyopathy.

com .blogspot.CHD Chronic Ischemic Heart Disease Acute Coronary Syndrome Stable Angina Variant Angina Non ST-segment Silent Elevation MI Myocardial (Unstable Angina) Ischemia ST-segment Elevation MI http://nursinglectures.

com .blogspot.Ischemia – suppressed blood flow Angina – to choke Occurs when blood supply is inadequate to meet the heart’s metabolic demands Symptomatic paroxysmal chest pain or pressure sensation associated with transient ischemia http://nursinglectures.

com .blogspot. Buerger’s Disease. Aortic regurgitation Reduced coronary tissue perfusion Decreased myocardial oxygenation Anaerobic metabolism Increased lactic acid production (lactic acidosis) Chest pain http://nursinglectures.Causes: Atherosclerosis. DM. Polycythemia Vera. HPN.

& emotional stress)  Pain location: precordial or substernal chest area  Pain characteristics: . arm.May radiate to left shoulder.. squeezing. or suffocating sensation .com . Stable angina – the common initial manifestation of a heart disease  Common cause: atherosclerosis (although those with advance atherosclerosis do not develop angina)  Pain is precipitated by increased work demands of the heart (i.e. increasing in intensity only at the onset & end of attack .Usually steady. or other chest areas . jaw.Duration: < 15mins .Relieved by rest (preferably sitting or standing with support) or by use of NTG http://nursinglectures. exposure to cold. physical exertion.constricting.blogspot.A.

Same time each day usually at early hours)  If client is for cardiac .e. reduced prostaglandin I2 production)  Pain Characteristics: occurs during rest or with minimal exercise .commonly follows a cyclic or regular pattern of occurrence (i. Variant/Vasospastic Angina (Prinzmetal Angina)  1st described by Prinzmetal & Associates in 1659  Cause: spasm of coronary arteries (vasospasm) due to coronary artery stenosis  Mechanism is uncertain (may be from hyperactive sympathetic responses..blogspot. Ergonovine (nonspecific vasoconstrictor) may be administered to evoke anginal attack & demonstrate the presence & location of spasm http://nursinglectures.B. mishandling defects of calcium in smooth vascular muscles. . Nocturnal Angina .blogspot.frequently occurs nocturnally (may be associated with REM stage of sleep) Angina Decubitus – paroxysmal chest pain occurs when client sits or stands up Post-infarction Angina – occurs after MI when residual ischemia may cause episodes of angina http://nursinglectures. E. D.

Avoidance of cold . angiogram may be used to confirm & describe type of angina  Tx: directed towards MI prevention\ . ECG.Lifestyle modification (individualized regular exercise program.PTCA (percutaneous transluminal coronary angioplasty) may be indicated if with severe artery occlusion http://nursinglectures.blogspot. TST. smoking cessation) .Diet changes . Dx: detailed pain .Stress reduction .

TransdermNTG)  sublingual (Nitrostat)  oral (Nitroglyn)  IV (Nitro-Bid)  Β-adrenergic blockers:  Propanolol (Inderal)  Atenolol (Tenormin)  Metoprolol (Lopressor)  Calcium channel blockers:  Nifedipine (Calcibloc.blogspot.Nitroglycerin (NTGs) – vasodilators:  patch (Deponit. Adalat)  Diltiazem (Cardizem)    Lipid lowering agents – statins:  Simvastatin Anti-coagulants:  ASA (Aspirin)  Heparin sodium  Warfarin (Coumadin) .

 Class I – angina occurs with    .blogspot. walking uphill. rapid. or prolonged exertion at work or recreation Class II – angina occurs on walking or going up the stairs rapidly or after meals. under emotional stress. or in cold Class III – angina occurs on walking 1-2 blocks on the level or going 1 flight of ordinary stairs at normal pace Class IV – angina occurs even at rest http://nursinglectures. walking more than 2 blocks on the level or going more than 1 flight of ordinary stairs at normal pace.

 For patches.blogspot. do not administer to asthmatic & diabetic clients Heparin – monitor bleeding tendencies (avoid punctures.    usually on chest wall  Instruct on evaluation of effectiveness based on pain relief Propanolols causes bronchospasm & hypoglycemia. do not massage if via SC. dry place. air-tight amber bottles & change stocks every 6months  Inform clients that headache. dizziness.    Diet instructions (low salt. always have vit K readily available (avoid green leafy veggies)  Do not discontinue the drug. have protamine sulfate available Coumadin – monitor for bleeding & PT. fish Stop smoking & avoid alcohol Activity restrictions are placed within client’s limitations NTGs – max of 3doses at 5-min intervals  Stinging sensation under the tongue for SL is normal  Advise clients to always carry 3 tablets  Store meds in cool. monitor PTT levels. use of soft-bristled toothbrush).. rotate skin sites http://nursinglectures. flushed face are common side effects. high fiber). low cholesterol. used for 2wks .g. avoid animal fats  E. White meat – chicken w/o skin. low fat.

 Unstable Angina/Non ST-Segment Elevation MI – a clinical syndrome of myocardial ischemia  Causes: atherosclerotic plaque disruption or significant CHD. ECG findings & serum cardiac markers  When chest pain has been unremitting for >20mins. New onset exertional angina (increased in severity of at least 1 class – to at least class III) in <2months 3. i. Symptoms at rest (usually prolonged. >20mins) 2.blogspot. possibility of ST-Segment Elevation MI is usually considered http://nursinglectures.e.. cocaine use (risk factor)  Defining guidelines: (3 presentations) 1. Recent acceleration of angina to at least class III in <2months  Dx: based on pain severity & presenting .

PVCs/premature ventricular contractions are common after MI) Typical ECG changes: ST-segment elevation. & ECG (changes may not be present immediately after symptoms except dysrhythmias. serum . T wave inversion http://nursinglectures.blogspot. ST-Segment Elevation MI (Heart Attack)  Characterized by ischemic death of myocardial tissue associated with atherosclerotic disease of coronary arteries  Area of infarction is determined by the affected coronary artery & its distribution of blood flow (right coronary artery. left anterior descending artery. Q wave prolongation. left circumflex artery)  Dx: based on presenting S/Sx.

com .blogspot. “someone sitting on my chest” . Manifestations: chest pain – severe crushing. profuse perspiration Feeling of impending doom  Complications: death (usually within 1 hr of onset) Heart failure & cardiogenic shock – profound LV failure from massive MI resulting to low cardiac output Thromboemboli – leads to immobility & impaired cardiac function contributing to blood stasis in veins Rupture of myocardium Ventricular aneurysms – decreases pumping efficiency of heart & increases work of LV http://nursinglectures. constricting. neck or jaw .substernal radiating to left arm.prolonged (>35mins) & not relieved by rest Shortness of breath.

blogspot. thrombosis/embolism. direct trauma ↓ myocardial contractility Myocardial ischemia ↓myocardial O2 supply ↑cellular hypoxia ↓cardiac output ↓arterial pressure Stimulation of sympathetic receptors ↑peripheral vasoconstriction ↑ myocardial contractility ↑ afterload ↑myocardial O2 demand ↑diastolic filling ↑ HR http://nursinglectures.Causes: atherosclerotic heart ↓myocardial tissue perfusion . shock &/or hemorrhage.

Time after Onset 0-0.blogspot. onset of acute inflammatory process Infarcted area becomes soft with a yellow-brown center & hyperemic edges Minimally soft & yellow with vascularized edges. scar tissue generation begins (fibroplastic activity) Complete scar tissue replacement http://nursinglectures. gross pallor of infected tissue Total .5hrs Type of Injury & Gross Tissue Changes Reversible injury 1-2hrs 4-12hrs Onset of irreversible injury Beginning of coagulation necrosis 18-24hrs 1-3days 3-7days 7-10days 8th week Continued necrosis.

adequate analgesia (Morphine via IV – also has vasodilator property) . heparin Stool softeners http://nursinglectures. IV may be given to limit infarction size & most effective if given within 4hrs of onset) Thrombolytic Therapy – best results occur if initiated within 6090mins of onset (Streptokinase & Urokinase – promote conversion of plasminogen to plasmin) Anti-arrhythmics: .ECG monitoring -sublingual NTG (unless contraindicated.O2 therapy via nasal prongs .blogspot.     Initial Management: OMEN . propanolol Anticoagulants & antiplatelets: ASA. atropine.

com .blogspot.Resection – aneurysm http://nursinglectures.Revascularization ▪ PTCA ▪ Coronary stent implantation ▪ Coronary Artery Bypass Graft (CABG) – no response to medical treatment & PTCA 2. Surgery : 1. .http://nursinglectures.

 Moderation should be observed if palpitations. effects of ADLs on cardiac status  Diet: low salt. remind client on his activity limitations & restrictions)  Promote comfort & rest  Monitor the ff perimeters: v/s. low cholesterol.  Take prescribed NTG before sexual activity  Refrain from sexual activity after a large meal or during a tiring day. monitor v/s .Promote oxygenation & tissue perfusion (place client on semi-fowler’s. dizziness or dyspnea is observed  http://nursinglectures. ECG. familiar place.blogspot.  Perform sexual activity in a cool. O2 via nasal cannula. rate & rhythm of pulse. avoid alcohol & smoking  Take prescribe meds at regular basis  Stress management  Resume sexual activity after 4-6wks from discharge or when client can go up 2 flights of stairs without difficulty  Assume less tiring position (non-MI partner takes active role). low calories. .http://nursinglectures.

com .blogspot. 25-40y/o  Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins & nerves  Affects medium-sized arteries (usually plantar & digital vessels in the foot or lower legs)  unknown pathogenesis but it had been suggested that:    tobacco may trigger an immune response or  unmask a clotting defect. → these 2 can incite an inflammatory reaction of the vessel wall http://nursinglectures.Also known as Thromboangiitis obliterans Usually a disease of heavy cigarette smoker/tobacco user men.

digits may turn reddish blue) Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues & gangrenous changes may . may necessitate amputation http://nursinglectures.blogspot. R/T distal arterial ischemia  Intermittent claudication in the arch of foot & digits      Increased sensitivity to cold (due to impaired circulation Absent/diminished peripheral pulses Color changes in extremity (cyanotic on dependent position. Pain – predominant symptom.

blogspot.  Diagnostic methods – those that assess blood flow (Doppler ultrasound & MRI) Tx: mandatory to stop smoking or using tobacco  Meds to increase blood flow to extremities  Surgery (surgical sympathectomy)  amputation .

neuro d/o. collagen diseases.     Mechanism: intensive vasospasm of arteries & arterioles in the fingers Cause: unknown Usually affects young women Precipitated by exposure to cold & strong emotions Raynaud’s phenomenon – associated with previous injury (i.e.blogspot. chronic arterial occlusive d/o) http://nursinglectures. . occupational trauma associated with use of heavy vibrating tools. . only 1-2digits may be involved Severe cases: arthritis may arise (due to nutritional impairment)  Brittle nails  Thickening of the skin of fingertips  Ulceration & superficial gangrene of fingers (rare occasions) http://nursinglectures. Period of ischemia (ischemia due to vasospasm)      Period of hyperemia – intense redness  Throbbing  Paresthesia change in skin color = pallor to cyanotic 1st noticed at the fingertips later moving to distal phalanges Cold sensation Sensory perception changes (numbness & tingling)    Return to normal color Note: although all of the fingers are affected symmetrically.

blogspot. Decongestants) -Calcium channel blockers (Diltiazem.e. Nifedipine. Nicardipine) – decrease episodes of attacks http://nursinglectures.  Dx: initial = based on Hx of vasospastic attacks  Immersion of hand in cold water to initiate attack aids in the Dx  Doppler flow velocimetry – used to quantify blood flow during temperature changes  Serial Computed thermography (finger skin temp) – for diagnosing the extent of disease Tx: directed towards eliminating factors causing vasospasm & protecting fingers from injury during ischemic attacks  PRIORITIES: Abstinence in smoking & protection from cold  Avoidance of emotional stress (anxiety & stress may precipitate vascular spasm)  Meds: avoid vasoconstrictors ( ..

Relief of pain & symptoms 2. ineffective tissue perfusion (cardiopulmonary) 2. Nursing Dx: 1. v/s B. diet.Assessment: 1. Prevention of further cardiac damage Nursing Interventions: 1. Proper medications 3. D.blogspot. Decrease client’s anxiety 4. Impaired gas exchange 3. etc) http://nursinglectures. esp. Health teachings (meds. Hx of symptoms (pain. exercise. palpitations. Anxiety due to fear of death (clients with MI or Angina) . activities. dyspnea) 2. chest pain. C. Pain control 2. Goals: 1.

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