CARDIOVASCULAR DISORDERS

Coronary arteries - Levine’s signs

- Give blood supply to heart - Dyspnea
Branches - N/V
- Right coronary artery - Dizziness
o Right atrium Diagnostic exams
o Right ventricle - Cardiac catheterization
 Inferior/posterior o Visualize coronary arteries
- Left coronary artery o Uses contrast media (iodine dye)
o Circumflex artery  left atrium  lateral o Catheter insertion site: femoral artery
o Left anterior descending artery  left o Pre procedure
ventricle  anterior  Increase OFI
 Extend the affected leg to
Coronary artery diseases prevent bleeding
Causes  Assess digital pulses
- Atherosclerosis - ECG
- Arteriosclerosis o Check electrical activity of the heart
o Decrease blood flow to the heart   Angina
decrease O2 delivery  anaerobic  Ischemia: T wave
metabolism  lactic acid  chest pain inversion (reversible)
Types  MI
- Angina pectoris  Ischemia: T wave
- Myocardial infarction inversion (reversible)
 Injury: ST segment
Angina elevation (reversible)
- Chest pain caused by ischemia (reversible)  Infarction: pathologic Q
Types wave (irreversible
- Stable angina - Cardiac enzymes
o Predictable o Elevate during injury
o Precipitating factors o Earliest indicator: myoglobin
 Exertion o Most reliable: troponin I
 Eating heavy meals o Most cardiac specific: CK MB
 Exposure to cold  Angina: normal
 Emotional stress  MI: elevated
o Relieved by rest and Nitroglycerine Onset Peak
- Unstable angina/pre infarction CK MB 4-6 hours 18-24 hours
o Unpredictable LDH 24 hours 48-72 hours
o Pain may happen at rest Troponin I 3 hours 7 days
- Variant angina/prinzemetal Myoglobin 1 hour 4-6 hours
o Coronary artery vasospasms Management
o Same each time each day (early AM) MEDICATIONS
- Nitrates
Myocardial infarction o Nitroglycerine
- Chest pain caused by ischemia (reversible)  Angina: decreases pain
o Duration is longer  increase injury  MI: vasodilation
(reversible)  death of cells  infarction  Routes
(irreversible)  Sublingual
- Cause: coronary artery thrombosis o Retain saliva
Signs and symptoms o Burning
Angina MI sensation under
Quality Stabbing Same tongue is
Squeezing normal
Location Retrosternal Same o Proper storage
Substernal light sensitive
Radiation Jaw Same  Dark
Neck place
Shoulders of
Arm contain
Stomach er
Duration <15 mins > 15 mins o Stock
Relieving factors Rest Morphine replacement
Nitroglycerine sulfate every 6 hours
- Chest pain
 CARDIOVASCULAR DISORDERS

o Maximum dose: o Blood vessel:

3 per 5 minutes  Saphenous vein (leg)
 1st: 5  Internal mammary artery
mins (breast)
 2nd: 5 ACUTE ER
mins - Priority: pain relief
 3rd: 5 o Angina: Nitroglycerine
mins o MI: Morphine Sulfate
 Patch - O2 therapy
o Placed on non - Position: fowlers
hairy part of - Tests
chest - Thrombolytics to dissolve clots
o Hairy chest: MI
shaving, clips Resumption of ADL: after 6 weeks
o Rotate Resumption of sex: after 8 weeks
application site: - Climb 2 flights of stairs
prevent burns - W/O chest pain
 Ointment: wear gloves Patient w/o problem should assume activities
 Side effects:
 Orthostatic hypotension Congestive heart failure
 Headache - Failure of the heart to pump blood
- Narcotics/Opioids: MI - Decrease cardiac output  backflow of blood
o Morphine decreases pain  congestion
- Thrombolytics - No cure
o Dissolve clots Types
o MI - Right side heart failure
o Streptokinase - Left side heart failure
o Tissue plasminogen activator (TPA) Signs and symptoms
 Given within 3 hours - Right side heart failure
- Anti coagulants: both o Systemic congestion
o Heparin  Fatigue
 IV  Oliguria
 Initial  Neck vein distention
 Protamine Sulfate  Hepatomegaly
o Warfarin  Ascites
 Oral  Bipedal edema
 Maintenance  Anasarca
 Vitamin K  Weight gain
o Side effects: bleeding  Hypertension
- Anti platelets: both - Left side heart failure
o Prevent platelet aggregation  prevent o Pulmonary congestion
clots  Fatigue
o Aspirin  Oliguria
o Side effects: bleeding  Pulmonary edema: fluid and
- Anti arrhythmic: MI blood filled alveoli
o Pathologic Q wave  arrhythmia   Dyspnea (DOB)
premature ventricular contractions  Coughing
o Irreversible  Sputum: frothy, pink
o Lidocaine  Auscultation: crackles
SURGICAL  Orthopnea
- Percutaneous Transluminal Coronary Angioplasty  Paroxysmal nocturnal dyspnea
o Insertion of a balloon tipped catheter in Management
the coronary artery to compress plaques - Position: fowlers
o Indication: narrowing (atherosclerosis) - O2 therapy
- Coronary stent - Monitor intake/output
o Insertion of a catheter with a mesh wire - Decrease OFI
in the coronary artery to compress - Diet: decrease Na
plaques - Weigh patient daily
o Indication: narrowing (atherosclerosis) - Medications
- Coronary artery bypass graft (CABG) o Inotropics
o Create a new route for reperfusion  Dopamine
o Indication: clots not dissolved by  Dobutamine
thrombolytics
 CARDIOVASCULAR DISORDERS

 Increase force of o Spironolactone

contraction  improve o Anti hypertensives
cardiac output   ACE inhibitors
increase urination  Beta blockers
o Cardiac glycosides (Digitalis)  Calcium channel blockers
 Digoxin
 Inotropic: force Hypertension
 Chronotropic: decrease heart BP classification
rate - 2-3 BP checks
 Check HR (apical) - 2-3 clinic visits
 Do not give if HR is Systole Diastole
below 60 Normal BP <120 and <80
 Normal: 0.5-2 Elevated BP 120-129 and <80
 Digitalis toxicity Stage 1 130-130 or 80-89
 Causes Stage 2 >140 or >90
o Liver disorder Hypertensive crisis >180 or >120
 Check Types/causes:
liver - Primary/essential
function o Non modifiable risk factors
test: o Lifestyles
ALT, AST - Secondary
o Kidney disorder o Pregnancy
 Check o Diseases
kidney o Medication use
function Risk factors
test:
- Age: old age
BUN,
- Race: African Americans
Creatini
- Hereditary
ne
- Diet: increase sodium and fat
o Hypokalemia
- Obesity
 Increas
- Smoking
e
- Increase stimulants
action
o Caffeine
of
o Carbonated
Digoxin
- Stress
 Check
- Inactivity/immobility
serum Signs and symptoms
potassiu - Asymptomatic: most common
m - Headache
 Over dosage - Visual changes
 Signs and symptoms - N/V
o Bradycardia - Facial flushing
o Anorexia Management
o Nausea and - Monitor BP
vomiting - Diet: decrease sodium, decrease fat
o Diarrhea - Lose weight if obese
o Abdominal - Avoid smoking
cramps
- Decrease intake of caffeinated/carbonated
o Visual changes:
drinks
halos
- Stress management techniques
 Management
- Regular exercise
o Antidote:
- Medications
Digoxin Immune
o Centrally acting adrenergic blockers
Fab (Digibind)
 Block the reuptake of
o Diuretics
Norepinephrine in the central
 Excrete excess fluids
venous nervous system  PNS 
 Furosemide
decrease BP
 Digoxin
 Clonidine (Catapres)
o Potassium
o Beta blockers
sparing diuretics  Beta receptors
o Prevent  B1 heart
hyperkalemia:  B2 lungs
digitalis toxicity
 CARDIOVASCULAR DISORDERS

 Block the SNS effect to heart Pericarditis

and lungs  PNS  decrease - Pericardium
heart rate  vasodilation  o Covering of the heart
decrease BP o Layer
 Bronchoconstriction  Visceral: inner
 Contraindicated:  Parietal: outer
COPD/asthma  Between
o Calcium channel blockers  Pericardial space
 Block the entry of calcium to  Prevent friction
heart cells  decrease muscle - Pericarditis: inflammation of pericarditis
contraction  vasodilation  Signs and symptoms
decrease BP - Pericardial friction rub
 Very Nice Drug o Auscultation: rubbing of hair sound
 Verapamil - Chest pain
 Nifedipine - Fever
 Diltazaem - Elevation of ESR inflammation
o ACE inhibitors Management
 Decrease BP  angiotensinogen - Pain relief: analgesics
(liver)  angiotensin I  ACE - Corticosteroids: decreases inflammation
(lungs)  angiotensin II  - Position: fowlers
stimulates  adrenal cortex 
aldosterone  Na H2O retention Cardiac tamponade
&  blood vessels  - Increase pericardial fluids (above 20ML)
vasoconstriction  elevated BP Signs and symptoms
(RAAS) - Beck’s triad
 Group of meds to prevent o Distended neck vein
conversion of angiotensin I and II o Distant heart sounds
 No stimulation of adrenal cortex o Decrease BP
and blood vessels  decrease Management
Na and H2O retention  - Pericardiocentesis
vasodilation  decrease BP o Removes excess fluids from excess space
 (-pril) Catapril by aspiration
 Management o Position: upright position
 Monitor cough
 Angiotensin 2 receptor
blockers (ARBS) Raynaud’s disease (white – blue – red disease)
o Block - Peripheral arterial arteries
stimulation of - Periodic vasospasms of small arteries of the
angiotensin 2 to hands
adrenal cortex - Cause: cold exposure
and blood - Incidence: female
vessels  Signs and symptoms
decrease Na - Color changes of hands
and H2O o White: pallor (early)
retention to o Blue: cyanosis (late)
blood vessels  o Red: perfusion
decrease BP - Skin temp: cold
o (-sartan) - Decrease or absence of distal pulses of the
o Diuretics hands
 Excretion of excess fluids  Management
decrease BP - Avoid exposure to cold
 Thiazide - Careful when handling cold items
 Low ceiling (least o Thick gloves
potent) - Avoid smoking
 Can cause hypokalemia - Medications
 Chlorothiazide (Diuril) o Vasodilators
 Loop diuretic
 Cause hypokalemia Buerger’s disease (thromboangitis obliterans)
 Furosemide - Peripheral arterial (major) and venous (minor)
 Potassium sparring diuretic disorder
 Prevents hypokalemia - Decrease blood flow to legs and feet
 Spironolactone - Cause: smoking
(Aldactone)
 CARDIOVASCULAR DISORDERS

- Incidence: male
Signs and symptoms
- Intermittent claudication
o Leg pain
o Increase in walking
o Decrease at rest
- Skin temp: cold
- Decrease or absence of distal pulses of legs
- Leg/feet necrosis
Management
- Avoid/stop smoking
- Position of legs: lower
- Medications: Vasodilators
- Amputation

Deep vein thrombosis

- Peripheral venous
- Characterized by leg inflammation and clot
formation
- Causes
o Virchow’s triad
 Venous stasis
 Hypercoagulation
 Vessel wall damage
Signs and symptoms
- Leg inflammation
- Skin temp: warm
- Leg edema
- Homan’s: dorsiflexion of the foot, calf pain
Management
- Ambulation
- ROM leg exercises
- Elevate legs only as prevention
o Contraindicated: clots
- Increase OFI
o Anti embolism stockings
 Intermittent
 Remove stockings for 30 minutes
every 8 hours
- Avoid
o Smoking
o Prolonged standing
o Cross sitting
o Leg massage
- Medications
o Thrombolytics: dissolve clots
o Anticoagulants: prevent clots