Aug 13, 2012

Cardiovascular Disorders
Anatomy and Physiology - HEART
- Center of the thorax
- 300 g in weight; cone shaped and tilted forward and to the left
o Size and weight are influenced by
Age
Gender
Body weight
Physical condition
Heart condition (disease)
- Pumps blood to the tissues and supplies them with oxygen and other nutrients
- Size of a fist
- Location: mediastinum
o In a rotated position
o Right ventricle > lies anteriorly, beneath the sternum
o Left ventricle > situated posteriorly
o Close proximity to chest wall > pulsation created by the normal ventricular
contraction is easily detected = Apical Pulse / Point of Maximum Impulse (PMI)
- Layers:
o Pericardium
Thin, fibrous sac which encases the heart
Layers:
Visceral
o Adheres to the epicardium
Parietal
o Envelops the visceral pericardium
o Tough fibrous tissue that attaches to the great vessels,
diaphragm, sternum and vertebral column
o Supports the heart in the mediastinum
The space between visceral and parietal is called pericardial
space
o Filled with about 20 ml of fluid
o Lubricates the surface of the heart
o Reduces friction during systole
Pericardial space (between; consist the fluid)
o Epicardium
Exterior layer
o Myocardium
Heart muscle
Responsible for the contractility (pumping action) and function of the
heart
Made up of muscle fibers
Composed of specialized cells called Myocytes > which form an
interconnected network of muscle fibers
Fibers encircle the heart in a figure-of-eaight pattern, forming a
spiral from the base (top_ of the heart to the apex (bottom)
during contraction
facilitates a twisting and compressive movement of the heart
that begins in the atria and moves to the ventricles
Sequential and rhythmic pattern of contraction + muscle fibers
relaxation =maximizes the volume of blood ejected with each
contraction.
Controlled by the conduction system
o Endocardium
Innermost layer
Consist of endothelial tissue and lines the inside of the heart and
valves
- Pumping action > accomplished by the rhythmic relaxation and contraction of the
four chambers muscular walls
o Diastole
Relaxation phase
All four chambers relax simultaneously
Allows the ventricles to fill in preparation for contraction.
Period of Ventricular Filling
o Systole
Refers to the events in the heart during contraction of the

two top chambers (atria systole)

o Occurs first, just at the end of diastole
Two bottom chambers (ventricular systole)
o Follows the atria systole
The process allows the ventricles to completely fill prior to ejection of blood
from the chambers
Chambers
Right Side
Right Atrium and Right Ventricle
Distributes venous blood (deoxygenated blood) to the lungs via the
pulmonary artery (pulmonary circulation) for oxygenation.
Right Atrium
Receives blood returning from the
o Inferior vena cava
o Superior vena cava
o Coronary sinus cardiac vein
Right ventricle
o Contracts against a low pressure system within the
pulmonary arteries and capillaries
Left Side
Left atrium and left ventricle
Distributes oxygenated blood to the remainder of the body via
the aorta
Left Atrium
Receives oxygenated blood from the pulmonary circulation via
four pulmonary veins.
Left ventricle
2 times more muscular than the right ventricle
To overcome the high aortic and arterial pressure
Valves
Four valves
Permit blood to flow in only one direction
Composed of thin leaflets of fibrous tissue
Open and close in response to the movement of blood and pressure
changes within the chambers
Types:
Atrioventricular Valves
o Separate the atria from the ventricles
o Tricuspid Valve
Composed of 3 cusps or leaflets
Separate the right atrium from the right ventricle
o Mitral / Bicuspid Valve
Composed of 2 cusps
Lies between the left atrium and the left ventricle
o During diastole
Tricuspid + Mitral = open >allowing blood in the
atria to flow freely into the relaxed ventricles.
o Ventricular systole starts
Ventricles contract
Blood flows upward into the cusps or the tricuspid
and mitral valves > T + M = closes
T and M pressure increase = the papillary
muscles and the chordae tendineae maintain
valve closure.
Papillary muscles
o
located on the sides of the
ventricular walls
o Connected to the valve leaflets buy
thin fibrous bands called Chordae
Tendineae
Contraction of papillary muscles
Causes the chorea tendineae to become
taut, keeping the valve leaflets
approximated and closed.
Prevents backflow of blood into the artia
(regurgitation) as blood is ejected out into
the pulmonary artery and aorta

o
-

Heart
o

Semilunar Valves

o
o
o
o

Composed of three leaflets which are shaped like halfmoons.

Pulmonic Valve
Valve between right ventricle and pulmonary
artery
Aortic Valve
Valve between the left ventricle and aorta
Closed during diastole
Pressure in the pulmonary artery and orta
decreases
Causing blood to flow back toward the
semilunar valves
o Fills the cusps with blood and
closes the valves
Forced open during ventricular systole as blood is
ejected from the R and L ventricles into the pulmonary
artery and aorta.

Coronary Arteries
L and R arteries and the branches > supply arterial blood to the heart
Arteries > originate from the aorta just above he aortic valve leaflets
Heart > high metabolic requirements, extracting approximately 70% to
80% of the Oxygen delivered
Are perfused during diastole
Heart rate increases = diastole time is shortened > may not allow
adequate time for myocardial perfusion.
Result > patient at risk for myocardial ischemia (HR>100), esp.
patient with CAD
L Coronary Artery
Has three branches
o Left main coronary artery
Artery from the point of origin to the first major
branch
Two branches arises
Left anterior descending artery
o Courses down the anterior wall of
the heart
Circumflex artery
o Circles around to the lateral left
wall of the heart
Vessels involved in ASHD CAD 3:
R Coronary Artery
Left Anterior Descending Artery
Left Circumflex
o

Three
1.
2.
3.

Right Coronary Artery

Leads to the inferior wall of the heart
Posterior wall > receives blood supply by an additional branch
from the R coronary artery call posterior descending artery
Coronary Veins
Superficial to the coronary arteries
Venous blood returns to the heart primarily through the
coronary sinus (located posteriorly in R atrium)

Coronary Circulation
- Needs a constant supply of O2 and nutrients to contract efficiently and conduct
impulses
- Major blood vessels
- Blood flow through myocardium is greatest during relaxation (diastole) and reduced
during contraction (systole)
- Rapid/prolonged contractions interfere with blood supply to the heart
- Anastomoses (connections) btw RCA and LCA
- Potential to open up and provide collateral circulation
- Collateral circulation alternative source of blood
- When obstruction develops gradually, other capillaries tend to enlarge to meet
metabolic needs
- RCA supplies R side of heart and inferior part of LV SV node, AV node
- anterior descending anterior wall of ventricles, anterior septum, bundle branches
- L Circumflex L atrium, lateral and posterior walls of LV
- Implications
o RCA blockage -> conduction disturbances of AV node (arrhythmias)
o LCA - > Impair pumping ability of LV (CHF )

Cardiac Cycle
- Refers to the alternating sequence of diastole (relaxation) and systole (contraction)
coordinated by the conduction system
- Cycle
o 2 atria relaxed and filing with blood
o AV valves open because of pressure and ventricles are relaxed
o Blood flows into ventricles almost emptying atria
o Conductions system stimulates atrial muscle to contract forcing any blood into
the ventricles
o Atria relax
o 2 ventricles contract and pressure increases in V
o AV valves closed
o (Brief moment) all valves closed, ventricular myocardium continues to
contract building up pressure (isovulmetric phase)
o Increasing pressure opens up the semilunar valves(blood forced into
pulmonary and aorta)
o Contraction needs to be strong to overcome opposing pressure in the artery
o Atria fills again, ventricles relax
o Start the cycle again
Pulse
-

The pulse indicated the heart rate

During ventricular systole, it expands the arteries
Weakness or irregularity is in a peripheral pulse (radial) indicates a problem
Apical pulse rate measures at the heart itself
Pulse deficit difference between apical and radial
Common causes: coartation of aorta / stenosis

Cardiac Output
- Blood ejected from L ventricle / minutes
- Ave: 5.6 L / min
- CO = stroke vol x HR
o Stroke volume: blood ejected / heartbeat
o Increased amt of blood returns to the heart (SNS stimulation), heart stretched
more and force of contraction increases proportionately
o Preload: venous return
o Afterload: resistance to L Ventricular ejections (peripheral resistance)
Vascular System
- Arteries
- Arterioles (smallest)
- Capillaries (site of diffusion, O/CO2 exchange, supply of nutrients)
- Venules
- Veins
- Valves
- Lymphatics drains the lymph fluids
Arteries and Veins
- 3 Layers
o Tunica Intima
Endothelial cells secretes substances that can adjust the dilatation
and constriction of blood vessels
o Tunica Media
Smooth muscle that controls the diameter and lumen size of the blood
vessels
o Tunica Adventitia
Outermost
Autoregulation
- Localized vasodilation and vasoconstriction regulated by reflex and adjustment
- Decrease in pH and O and increased CO2 and release of chemical mediators >
vasodilation
- Norepinephrine / Epinephrine, angiotensin > systemic vasoconstriction (Alpha 1
receptions)
Blood
-

Pressure
Pressure of blood against systemic arterial walls
Systolic pressure pressure exerted by the blood when ejected by the LV
Diastolic pressure pressure that occurs when the ventricles are relaxed
BP = CO x PR
Peripheral resistance:
o Decrease lumen

o
o
Blood
o
o
o
o
o

Vasoconstriction
Obstruction of blood vessels
Pressure Controls
Baroreceptors (Pressoreceptors) aortic arch and carotid sinus
Stretch Receptors vena cava and right atrium
Anti-diuretic hormone
Aldosterone: primary fx: Na Reabsorption with Water
Renin-Angiotensin System

Properties of Cardiac Muscle

- Automaticity
- Excitability
- Conductivity
- Contractility
Cardiac Conduction System
Conduction system
- Atrial contraction depolarization in the P wave
- Ventricular contraction depolarization in the ventricles (QRS)
- T-Wave ventricular repolarization
ECG
Control of Heart
- Heart rate and force of contraction controlled cardiac control center (medulla)
- Baroreceptor (aorta and carotid) changes in BP > cardiac center > SNS/PNS
- SNS increase heart rate and contractility and vasoconstrictions
- PNS vagus nerve stimulation slows heart rate
- Beta receptors in the heart
Nursing History
- Non modifiable
o Age
o Gender
o Race
o Heredity
- Modifiable
o Stress
o Diet
o Exercise
o Cigarette
o Alcohol
o HPN
o Hyperlipidaemia
o DM
o Obesity
o Contraceptive pill
o Personality type
Physical Examination
- Inspection
o Skin color
o JV distention
o Respiration
o PMI
o Edema
- Palpate
o Peripheral pulses
o Apical pulse
- Auscultate
o Heart sounds (s1-apex, AV closure, s2-base, semilunar valve closure, s3, s4)
o Murmurs
o Pericardial friction rub
- Percussion
o Note: dullness (heart is a solid organ)
- Common clinical manifestation
o Dyspnea
Dyspnea on exertion
Orthopnea
Paroxysmal dyspnea
o Chest pain
o Edema

o
o
o

Syncope caused by narrowing of blood vessels; common carotids supply the

brain (anterior part of the brain)
Palpitation because of the abnormality of the conduction and contractility of
the heart
Fatigue - related to Oxygen hypoxemia

Diagnostic Tests
- Cardiac Enzymes
Enzyme
CPK MB
LDH
Troponin
Myoglobin

Onset
4-5 hours
Within 24 hours
Within 3 hours
1 hour

Peek
18-24 hours
48-72 hours
Up to 7 days
4-6 hours

Normal Values
0 4.7 ng/ml
70-200 IU / L
Less than 0.6 ng/ml
1.85 g / ml

Complete Blood Count

Serum Lipids
o Cholesterol
o Triglycerides
o HDL/LDL
- Electrolytes
o Any imbalance can result to arrhythmias and dysrhythmias
Increase
Decrease
Potassium
Vent dysrhythmia
Vent dysrhythmia assystole
Sodium

H20 Toxicity

Diuretics use / HF

Calcium

AV block/Tachycardia
Shortened at interval
Muscle weakness

Prolonged of interval vent

tachycardia

MG

Hypotension
Prolonged PR interval
Wide QRS complex

Fibrillation

BUN
o

Chest
o
o
o
ECG
o 0.04 sec and 0.1 millivolt 1 box
o 6 chest leads
V1-V6
V1-V3 Septal defect Septal Wall (Atrium or Ventricular =
multiple vessels)
V1-v4 Anterior Defects
V5-V6 Lateral Wall Defects
2-3 ABF Inferior wall ischemia/infarction Right
coronary Artery
1 ABL High lateral wall infarction Left Coronary Artery
o Initial dx and monitoring of arrhythmias
o Non invasive
o Holter-monitor worn to record ECG changes while pursuing daily activities;
what activities of the px can induce arrhythmia
o Echocardiagraphy reflected sound waves records the image of the heart and
valve movements; Heart structure and valve movement
Invasive Hemodynamic Monitoring
o Central Venous Pressure
Monitors right side of the heart
The tip of the catheter is inside the Right atrium
Common with px with hypervolemia
Nursing responsibility
Consent
Explain the procedure
Patient must be relaxed
o The reading will be altered if patient is tachypnic or
brachydic
0 point of manometer at level of R atrium

Renal fx
Creatinine
X-Ray
Silhouette of the heart
Left ventricular hypertrophy image retrosternal fullness
Right ventricular hypertrophy image retrocardia fullness

Record initial reading must be done in the same position

Concurrent reading must be done in the same position
Change dressing, IV fluid bag, manometer and tubing every 24
hours
Hold breath when cath is changed
Check daily for infection
Pulmonary Artery Pressure (PAP) / Pulmonary Capillary Wedge Pressure
(PCWP)
For patients with Cor Pulmonale
Nursing responsibility
Consent
Explain procedure
Check baseline VS or attach to ECG monitor
Position: Supine
Adjust transducer at phlebostatic axis or sternal notch
Observe insertion site for information, swelling and bleeding
Deflate balloon after reading
o If a balloon is left inflated, no blood will enter from the R
ventricle to enter the pulmonary circulation
Cardiac Catheterization
Passing a catherter to the blood vessel to:
Visualize the inside of the heart
Measure pressures
Asses valve and heart function
Right Sided Catheterization
Antecubital or femoral vein
Measures R atria and ventricle pressure
Left Sided Catheterization
Retrograde catheterization
Transseptal Catheterization
Nursing Responsibilities
Pre procedure:
o Consent
o Explain procedure
o Asses allergies to seafoods and iodine
o Document wt and ht
o Baseline VS
o Inform of fluttery feeling / warm, flushed feeling and
desire to cough
Post procedure
o VS q 30 mins for 2 hours
o Asses for chest pain or dysrhythmias
o Monitor for bleeding and hematoma
o Keep extremely extended for 4-6 hours
o CBR for 6-12 hours
o Increase fluid intake
Cardiac angiography
Contrast dye injection to visualize blood flow and any obstructions
Blood flow in peripheral vessels can be assessed with Doppler studies
(microphone that records the sound of blood flow)

o
o

HEART DISEASES
- Coronary Artery Disease (CAD)
o Narrowing or obstruction of one or more coronary arteries as result of
Atherosclerosis Dyslepedemia
Arteriorsclerosis immune defects
o Common with narrowing of arteriosclerosis
Signs and symptoms
Chest pain
Palpitation
Difficulty in breathing / dyspnea
Syncope / loss of consciousness
Cough or hemoptysis
Excessive fatigue
o Management
Nitrates
Antiplatelets
Antilipemics
Beta adrenergic blockers
Calcium Channel Blockers

Surgery
PTCA
Atherectomy
CABG
o Nursing Management
Encourage to reduce the risk by modifying lisfestyle
Admin prescribed meds
Diet: low fat, low cholesterol, low Na
Angina Pectoris
o Types:
Stable
Unstable
Prinzmetal exposure to cold weather
Intractable unrelieved by any type of meds; very suggestive of MI
o Causes:
Exertion
Emotion
Exposure to cold
Excessive smoking
Excessive eating
o Assessment:
Pain patterns
Mild to moderate
Retrosternal choking, heartburn, pressing, bursing squeezing
Radiating to neck, jaw, shoulder, arms L
3-5 minutes
Relieved by rest and nitroglyceride

Pallor, diaphoresis, dizziness, palpitation

ECG change ST depression, T wave inversion
o Medications
Vasodilators
Nitroglycerine, amyl nitrate, isosorbide
B-Adrenergic
Propranolol, metoprolol
Ca channel blocker
Verapamil, nifedipine, diltiazem
Pit aggregating inhibitors
ASA, dypiridamole, ticlopidine
Anticoagulants
Heparin Na, Warfarin NA (Coumadin), dicumarol
Thrombus thrombolytics
o Nursing Responsibilities
Anticipate postural hypotension
Take max of 3 doses at 5 min interval
SL prep has nursing or stinging sensation
Avoid OH - tachycardia
Advise client to carry 3 tabs in his pocket; store nitroglycerine in a cool,
dry, dark placel replace stock every 3-6 months
Nitropatch applied OD in AM, rotating sites
Do not give NTG if px took Viagra or any drug for erectile dysfunction
Evaluate effectiveness (if not MI)
o Interventions
Beta blockers, calcium channel blockers
Myocardial Infarction
o Sudden dec of oxygenation due to absence of coronary blood flow that results
to destruction of myocardial tissue in regions of the heart
o Right coronary -> arrhythmia
o Left Coronary -> DEAD; comprises the cardiac output immediately
o Causes:
Thrombus
Emboli
Atherosclerosis
o Location
L anterior descending artery anterior or septal wall MI or both
Circumflex artery - posterior wall MI or lateral wall MI
Right coronary artery inferior wall MI
o Diagnostic Studies
Total CK levels
Cardiac enzymes
AST

ECG
T wave inversion zone of hypoxia
ST elevation zone of injury
Pathologic Q wave zone of infarction
o Assessment
Pain pattern: sever crushing substernal pain; knife like, viselike
May radiate to jaw, back and left arm
Fever
N/V
Anxiety
Crushing chest pain
Dyspnea
Pallor
o Nursing responsibilities
Admin prescribed meds
Morphine, Nitrogen, Oxygen, Aspirates
Lidocaine Xylocaine
Beta blockers propranolol, timolol
Thrombolytics risk for bleeding; streptokinase and uroinase
Anticoagulants heparin, warfarin/Coumadin
Oxygen at 2-4 L/min
Stool softeners and soft diet to avoid valsalva
Diet: liquid / small frequent meals; low fat, cholesterol and Na
Pos: semi fowlers to promote lung expansion
Emotional rxns: anxiety, denial, depression
Monitor thrombolytic therapy
Check for signs of bleeding
Used within 3-4 hours after onset of Sxs
6 hours golden period
Following acute episode:
Maintain CPR
Provide ROM
o Progressive Cardiac rehab
Progress to ambulation
Rehabilitation:
Early activity
o 1-2 metabolic act on tas (MET)
o Hospitals discharge: 14th day
o ADLs: 6 weeks after
o Sex: 4-8 weeks after
Guidelines
Resume if bale to climb 2 flights of stairs
Before: rest is impt / avoid large meals/ wear loose fitting
clothes/ nitro before sex / usual envi / sex at rm temp/ foreplay
During: comfortable position
Female position: side lying
Male position: sitting position
o Usual complications
Cardiogenic shock pumping ability of the LV severely impaired
Cardiac Arrhythmias lack of O causes conduction problems
CHF
Cardiac Dysrhythmias
o Abnormal cardiac rhythms that can be due to abnormal automaticity of
conduction or both
o Most common complications and major cause of MI
o Most common dysrhythmia in MI is PVCs
o PVC of >6/min is life threatening
o Predisposing factors are
Tissue ischemia
Hypoxemia
CNS and PNS influences
Lactic acidosis
Hemodynamic abnormalities
Drug toxicities
Electrolyte imbalance
o Types
Sinus
Atrial
Ventricular

 Conduction
Bradycardia regular, slower rate <60
Tachycardia regular, faster rate >100
Atrial flutter 160-350 / min, less filling time
Atrial fibrillation rate >300, uncoordinated, muscle contractions, no output
carding standstill, no filling
o PVCs may induce fibrillation
o Bundle branch block delayed conduction to BB
o 1st degree Heart Block delayed conduction AC node
o 2nd degree HB some beats go to AV, some dont
o 3rd degree HB no conduction to AV node, ventricles slowly contract, some
independent atrial contractions
Sinus Dysrhythmias
o Types
Sinus Tachycardia
Digitalis
Sinus Bradycardia
Atropine
Atrial Dysrhythmias
o Premature Atrial Contaction (PAC)
o Paroxysmal Atrial Tachycardia
o Atrial Flutter
o Atrial Fibrilation
o Meds
Quinidine
Ca Channel Blockers
Cardioversion
The electrical impulse waits for the R wave at the peak of the
QRS complex
Pacemaker
Long term management
Ventricular Dysrhythmia
o Premature Ventricular Contraction
o Vantricular Tachycardia
Widen QRS
Rapid firing
o Ventricular Fibrillation
Chaotic discharge rate >300
May result to clinical death
Tx: immediate defibrillation then CPR
Epinephrine
o Pacemakers
Electronic device that causes cellular depolarization and cardiac
contraction
It initiates and maintains HR
Pacing modes
Demand
Fixed Rate
Precautions
DO NOT MRI
Nursing interventions
Monitor ECG ff implantation, include VS
Make sure all the equipment in the clients unit is grounded
Observe for signs of pacemaker failure
o Cardioversion / Defibrillation
Cardioversion
Synchronous application of shock during R wave
Defib
Asynchronized electric shock to terminate VF or V tachycardia
without pulse
Nursing intervention
Client in firm, flat surface
Apply interface materials to the paddle
Grasp paddle only by insulated handles
Give command to STAND clear
Apply one of the paddles at precordium, other R parasternal
area 3rd ICS
For defibrillation, release 200-360 joule; for cardioversion, lower
energy is required
Defibrillation is done prior to CPR
o
o
o
o

CPR

CHF
o

Diazepam sedative
Indications
o CP Arrest / clinical death (breathlessness / pulselessness)
o CPR should be started < 5 mins after arrest
Types
o Basic Life Support use of mouth, hands
o Advance Cardiac Support BLS and equipment
When to stop?
o When the client is revived
o When EMS has been activated
o When the rescuer is exhausted
o When client is dead

Causes
Hypervolemia
Arteriosclerosis
MI
Valvular problems
o Types
Right sided CHF (Systemic Sx)
Fatigue
o Distended jugular veins
Ascites
Left side heart failure (Pulmonary Sx)
Cardiomegaly
o Blood tinged sputum
Chronic cough
o Acute pulmo edema
Exertional dyspnea
o Cyanosis
Orthopnea
o Weight loss
o Managements
Rest minimize O2 consumption
High fowlers or sitting
Decrease fluids and Na
Medications
Cardiac glycosides (+) inotropy / (-) chronotropy
Digitalis / digozin (Lanoxin) / digitoxin (Crystodigin)/ Lanatoside
o Guidelines
Check HR
^ K intake
Normal level: 0.5-2 ng/ml
Toxicity
o Antidote
Digoxin Immune Fab (Digibind) = Antibodies that bind to digoxin
Diuretics = H2O and Na + excretion
Loop Diuretics Furosemide (Lasix)
Potassium sparing spironolactone (Aldactone)
Guidelines:
Give in the AM
Monitor IO
S/E: Hypoalemia / hyponatremia/ dehydration/hypotension
o Rotating Tourniquet
Principles:
Apply 3 tourniquet
Inflate cuff 10 mm above diastolic pressure
Rotate q 15
Check distal pulses
Remove 1 at a time q 15 mins interval
Inflammatory Disease of the Heart
o Pericarditis
Acute or chronic inflammation of the pericardium
Assessments
Precordial pain
Pain (inspiration, coughing, and swallowing)
Pain worse when supine
Pericardial friction rub

 Fever and chills

Management
Pos: side liying, high fowlers, upright or leaning forward
Admin: analgesic, corticosteroids, NSAIDs
Avoid aspirin and anticoagulants
Antibiotics
Diuretics and digoxin
Monitor for complications: cardiac tamponade
o Over accumulation of pericardial fluid
o Pericardial effusion occurs when the space bet. The
parietal and visceral layers of the pericardium fill with
fluid
o Etiology
Stab wound
Effusion
Heart surgery
o Assessment
Becks triad:
Distended neck veins
o Compressed heart due to the
cardiac tamponade, no space to
accommodate the blood coming
from the venous system, cannot
enter the R atrium
Muffled heart sounds
o Interface of the fluid not good
conductor of sound
Hypotension
o Inability of the heart to contract
Paradoxical Pulse
More than 10 mm
Chest pain
Cardiogenic shock
Increased CVP
Management
CC for hemodynamic monitoring
PERICARDIOCENTESIS
o Spinal needle will enter the medistianum and aspirate
the pericardial fluid
Admin IV fluid as prescribed
Myocarditis
Acute/chronic inflammation of the myocardium
Etiology:
Bacterial
o Staphylococcus /pneumococcal
Viral
o Mumps / influenza
Parasitic:
o Toxoplasmosis
Radiation / Lead exposure
Assessment
Fever
Pericardial friction rub
Gallop rhythm
Murmur
o Infective endocarditis
S/S of HF
Chest pain
Management
Pos: bed rest/ sitting up or leaning forward
Monitor the pulse rate and rhythm
o Can result to arrhythmia
Admin of NSAID / analgesics / salicylates for fever and pain
Limit activities
o Prevent fatigue
Admin digoxin / antidysrhythmic / antibiotics as prescribed
Endocarditis
Inflammation of the inner lining of the heart
Expect valvular problem
Assessment

Fever
Anorexia
Wt loss
Fatigue
Cardiac murmur
Janeways lesions
Osslers Nodes
Petechiae
Splinter haemorrhages in nail beds
Splenomegaly
Rheumatic heart fever (valve)
Management
Balance activity with intermitted rest
Antiembolic stockings
Monitor emboli
o Splenic sudden abd pain radiating to L shoulder /
rebound tenderness on palpitation
o Renal flank pain radiating to the groin, hematuria and
pyuria
o Cardiomyopathy
Myocardium around left ventricle becomes flabby, altering cardiac
function > decreased CO2
Inc HR and inc muscle mass compensate in early but later stage > HF
Types
Dilated (congestive)
o Dilated chambers contract poorly causing blood to pool
and reducing CO
Hypertrophic (Obstructive)
o Hypertrophied LV cant relax and fill properly
Assessment
Chest pain
Dyspnea
Enlarged heart
Crackles
Dependent putting edema
Enlarge liver
Jugular vein distension
Murmur
Gallops
Syncope
Management
Low Na diet
Dual chamber pacing
Surgery
Heart transplant
Cardiomyoplasty
o Valvular Heart disease
3 types of mechanical disruption from VHD
Stenosis or narrowing
o Doesnt open the valve
Insufficiency
o Incomplete
Mitral insufficiency
o Same + peripheral edema
Tricuspid insufficiency
o R sided HF
Treatment
Na restrictions
Open heart surgery using CP bypass for valve replacement
Medications
Anticoagulants
Nursing management
Monitor for sign of HF or pulmo edema and monitor for adverse
rxns from drug therapy
Place in upright position to relieve dyspnea
Maintain bed rest
If patient undergoes surgery, watch for hypotension
Peripheral Arterial and Venous Disease
o Arterial Disease
Buergers Disease

Occlusive disease of the median and small arteries and

veins accompanied by clot formation

Etiology
Unknown
Smoking
Males
Assessment
Intermittent claudication
Ischemic pain occurring in the digits while at rest
Cool number tingling sensation
Diminished pulse at distal extremitiy
Ulceration
o Lower extremity
Management
Amputation
Removal of the thrombus / clot supplying the area
Instruct to stop smoking
Monitor pulses
Avoid injury to extremities
Admin vasodilators ad prescribed
Reynauds Disease
Vasospasm of the arterioles and arteries of extremities
Etiology:
Cold
Stress
Smoking
Management
Stop smoking
Vasodilators
Avoid precipitating factors
Warm clothing
Avoid injuries to hands and fingers
Venous Diseases
Thrombophlebitis
Clots lead to vein inflammation
Phlebothrombus
A thrombus w/o inflammation
Common in the antecubital area
Phlebitis
Vein inflammation usually assoc. with invasive procedures
Deep Vein Thrombosis
Pain (calf or groin tenderness)
Positive Homans sign
Warm skin and tender to touch
Varicose Veins
Distended protruding veins that appear darkened and tortuous;
vein wall weaken and dilate, the valves become incompetent
Etiology
o Prolonged standing
o Pregnancy
o Obesity
o Congenital
Incidence
o female
o 35-40 y/o

Assessment (in comparison with arterial diseases)

Arterial
Venous
Intermittent claudication
Heaviness and leg cramps
Cyanosis
Redness
Coldness
Warmth
Absent pulse
Unpalpable pulse due to edema
Loss of sensation
No loss of sensation
Gangrene ulcers
Venous stasis ulcers
Decreased capillary refill
(+) Trendelenburg test

Intervention (Peripheral)
o Lower down legs
o Wear warm socks
o Beurger Allens Exercise

Aortic

o Avoid tight clothing

o Avoid obesity
o Avoid crossing legs
o Avoid smoking and cold weather
o Femoral artery bypass
o Angioplasty
o Amputation
Intervention (Venous)
o Elevate legs
o Wear elastic stockings
o Ankle push up
o Avoid obesity
o Avoid crossing legs
o Avoid tight clothing
o Avoid smoking and prolong standing
o Vein striping and ligation
o Post op care
Elevate legs
CBR for 24 hrs
Elastic compression
Check for haemorrhage
Prevent thrombophlebitis
Aneurism
Abnormal dilation of the arterial wall caused by localized weakness and
stretching in the medial layer or wall of the artery
Types
According to morphology or form
o Fusiform
o Saccular
o Dissecting
o False (Pseudoanuerysm)
According to location
o Thoracic aortic aneurysm
S/s
Pain
Syncope
Dyspnea
Inc pulse
o Abdominal aortic aneurysm
S/s
Pulsating mass in the abd
Systolic bruit over the aorta
Tenderness on deep palpation
Abdominal or lower back pain
o Cerebral aneurysm
s/s
headache
vomiting
^ICP
Intervention
o Prevent rupture
Antihypertensive medications
Modify risk factors
o Surgery
Resection of aneurysm with Teflon/Dacron Graft
o Post Op
Monitor for haemorrhage
Flat pos / avoid SF pos
O2 as ordered
Coughing / breathing exercise
Check distal pulses
Avoid hip-knee flexion
HYPERTENSION
Abnormal elevation of BP above 140/90 mmHg based on at
least 2 readings on same condition
Brain
o Cerebrovascular accidents
Eyes
o Hypertensive retinopathy
Heart

L ventricular Hypertrophy resulting to HF or

Cardiomyopathy (Hypertophic)
Kidneys
o Hypertensive Nephrosclerosis
o

Types
Primary / Essential / Idiopathic
o Most common
o 90-95 percent of cases
o Unknown cause
Secondary
o With known cause
o Endocrine
Neochromocytoma
Hyperthyroidism
o Cardiovascular
Artherosclerosis
o Renal
Secondary to activation of renin angiotensin
system
Renal artery stenosis
o Pregnancy
Increase in blood volume
Vasospasm
Preeclampsia
Labile
o Intermittenly elevated BO
Malignant
o Sever, rapidly progressing and sustained > leads to
rapid end organ complication
White coat
o Elevation of BP only during clinical visits
Assessments
Signs and symptoms
o Headach
o Depression
o Dizziness
o
Nocturia
o Unsteadiness
o Tinnitus
o Blurred vision
o Memory loss
Asymptomatic, L ventricular hypertrophy, cerebral ischemia, renal
failure, visual disturbances including blindness, epistaxis
Management
Step care approach
o Joint Committee on Detection, Evaluation and Treatment
of High blood Pressure pp 898
Lifestyle modification
Single Drug Therapy
Mild hypertension diuretics (thiazide) beta blockers
Multi Drug Therapy
Add: ACE Inhibitors
Inc Dosage of Beta Blockers
Add beta blocker to diuretics (Thiazides)
Substitute vasodilators
All receptor blockers (sartans)
Anti-lipemics (statins)
Add: vasodilator or slow calcium channel blocker to current
regimen
Add: sympatholytic / Antiadrenergics central acting
Major side effects
Orthostatic hypertension
Dizziness
Cardiac rate alteration
Sexual disturbance
Drowsiness
Health teachings
Emphasize compliance
Therapy is usually for life
Monitor BP

Do not increase of decrease dose without doctors order

Do not abruptly discontinue meds