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CARDIOVASCULAR DISORDERS

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Concept: Oxygen Debt

 Demand exceeds supply
 Management: Reduce demand and increase supply
Cardiac Disorders
of oxygen
 Nursing Interventions: Bed rest and positioning

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Hypertension Hypertension
 Persistent elevation of BP; 140 mmHg systolic and  Types
90 mmHg diastolic (WHO)  Primary/Essential
 Most significant risk factor for CVD’s  no specific cause/multivariate
 Regarded as “silent killer”  Secondary
 Hypertensive Crisis  Due to co-morbidity
 Emergency/Urgency  S&Sx
 Diagnostic Criteria for Hypertension:  throbbing occipital headache, dizziness, visual disturbance;
 2 consecutive days of elevated BP within 2 weeks edema, epistaxis, retinal hemorrhages

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2017 AHA BP Classification Complications of HTN

 Atherosclerosis
 CAD
 CVD/CVA
 PAOD

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Management Step I
Begin lifestyle modifications:
Weight reduction
Moderation of alcohol intake
Regular physical activity
Smoking cessation If patient fails to achieve the desired
 Step 1 – Lifestyle Modification Reduction of Na intake BP or make significant progress

 Focus: wt. reduction

Continue lifestyle modifications:

 Step 2 – Inadequate Response Beta-blockers or diuretics

ACE inhibitor, Ca channel blocker or
Alpha receptor antagonist If patient fails to achieve the desired
 Monotherapy (Diuretics/Beta Blockers/ACEI) BP or make significant progress

 Step 3 – Inadequate Response

Increase drug dosage OR
 Monotherapy (Dosage adjustment/Shift) Substitute another drug in same class OR
Add a 2nd antihypertensive from a different class
If patient fails to achieve the desired
 Step 4 – Inadequate Response BP or make significant progress

 Combitherapy Add a2nd or 3rd antihypertensive or diuretic

if not yet prescribed

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Coronary Artery Disease/ASHD/IHD

 Occlusion of the coronary arteries that results to

impaired perfusion of the myocardium
 Main Risk Factor: HTN
 Concept: Oxygen Debt
 Mechanism: Atherosclerosis
 Outcome: Ischemia
 Classic Manifestation:
 Chest Pain “Angina Pectoris”
 Types: Stable or Unstable

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Coronary Artery Disease Angina Pectoris

• S – Sudden
• A –Anterior Chest
• V – Vague
• E – Exertion Related
• R – Relieved by rest or Nitrites
• S – Short Duration

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CAD Assessment ECG

 Other S&Sx:  ECG changes – ST elevation, presence of U-waves,
T wave inversion
 Dyspnea  Zone of ischemia – T wave inversion
 Diaphoresis  Zone of injury – ST elevation
 Zone of necrosis – enlarged Q wave
 Inc. RR, HR, & BP
 Diagnostics:
 ECG – T wave inversion
 Cardiac Biomarkers
 Coronary Angiography

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Coronary Angiography Coronary Angiography

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Nursing Care Medical Management

 Bed Rest  O2 therapy
 Pharmacotherapy:
 Position: HOB elevated
 Nitrates
 DBE  Tablet or Patch
 Avoid stress  Anti-HTN agents
 Close monitoring (esp. ECG)  Anti-Platelet drugs
 PCI – Percutaneous Coronary Intervention
 Percutaneous Transluminal Angioplasty (PTCA)
 Coronary Stent
 Surgical Mgmt:
 CABG

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Percutaneous Coronary Intervention Coronary Artery Bypass Graft

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Myocardial Infarction Assessment

 Heart wall damage due to cessation of blood  Chest pain
flow in the coronary circulation  DOB
 Death of myocardial cells from inadequate  Diaphoresis
oxygenation, often caused by a sudden,
complete blockage of a coronary artery  Inc. BP then drops
characterized by localized formation of necrosis  Inc. HR, RR, & Temp
with subsequent healing by scar formation and  n/v
fibrosis.
 Mechanism: AA  Diagnostics:
 Atherosclerosis  ECG
 Arteriospasm  Cardiac Biomarkers

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ECG
 ECG changes – ST elevation, presence of U-waves,
T wave inversion
 Zone of ischemia – T wave inversion
 Zone of injury – ST elevation
 Zone of necrosis – enlarged Q wave

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Possible Complications of MI Management of MI

 Arrhythmia – V-Fib Goals of Management
➢ Relief of pain
 Cardiogenic Shock ➢ Decrease cardiac workload

 Ventricular Rupture ➢ Prevent complications

➢ Nursing Care:
 Pericardial Effusion
➢ CBR without BRP
 Cardiac Tamponade ➢ Position: HOB elevated

 Pericarditis ➢ DBE

➢ Close Monitoring
 CVA
➢ Diet: High in fiber
 Ventricular Failure ➢ Avoid S&S (stress and strain)

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Management of MI Cardiac Tamponade

➢ MONAR  Rapid unchecked rise in intrapericardial pressure
➢ Morphine impairs diastolic filling of the heart. Due to blood or
fluid accumulating in pericardial sac
➢ Oxygen  Possible causes:
➢ Nitrates  Effusion (cancer/bacterial infections), hemorrhage
➢ Anti-coagulants/Anti-platelets/Clot busters from trauma/ non-trauma causes, MI
➢ Rehabilitation

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Manifestations Diagnostics
 Dyspnea  CXR shows cardiomegaly and widened mediastinum
 Anxiety  Echocardiography records pericardial effusion with
 Diaphoresis collapse of cardiac chambers during diastole
 Tachycardia
 Reduced arterial BP (pulsus paradoxus )
 Narrow pulse pressure
 Neck vein distention
 Pallor or cyanosis

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“Water-bottle heart” Collaborative Management

 Nursing Care:
 Position: HOB elevated
 Maintain on bed rest
 Close monitoring
 Medical Mgmt:
 Pericardiocentesis

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Pericardiocentesis

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Heart Failure
 A condition characterized by the inability of the
heart to pump blood in response to metabolic needs
of the body
 HF - Chronic vs. CHF - Acute
 Two Types:
 R sided and L sided
 Etiology:
 Cardiac Pathology: CAD, MI, CMP, VHD, etc.
 Pulmonary Conditions: COPD

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Assessment Collaborative Management

 SOB  4 D’s
 Easy fatigability  Decrease Fluid Intake
 Weight gain  Decrease Sodium in the diet
 Edema  Digoxin
 Diagnostics:  Diuretics
 Echocardiography- decreased ejection fraction

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Left Ventricle Assist Device Cardiomyopathy (CMP)

 Myocardium around left ventricle becomes flabby, altering
cardiac function > decreased CO
 Increased HR and increased muscle mass compensate in
early stage but later stage > HF
 Types:
 Dilated (congestive)- dilated chambers contract poorly
causing blood to pool and reducing CO
 Hypertrophic (Obstructive)- hypertrophied LV cant relax
and fill properly
 Possible Causes:
 Chronic alcoholism, Infection, pregnancy and post-partum
disorders, metabolic and immunologic disorders, chronic HTN

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Assessment Collaborative Management

 S&Sx:  Nursing Care:
 Position: Fowlers
 Chest pain, dyspnea, cough, crackles, enlarged
 Bed rest
heart, dependent pitting edema, enlarged liver,  Diet: Low Na
jugular vein distention, murmur, S3 S4 sounds,  Fluid restriction
syncope  Close monitoring
 Diagnostics:  Medical Mgmt:
 Cardiac catheterization, CXR, ECG, Echocardiogram - Diuretics
- Dual chamber pacing
- Surgery: heart transplant or cardiomyoplasty

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Cardiac Resynchronization Therapy

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Pacemaker Nursing Instructions

 Check HR regularly
 Avoid exposure to magnetic devices
Vascular Disorders
 Avoid use of mobile phones directly on top of
pacemaker placement
 Avoid vigorous movement of the shoulders

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Aneurysm
• Permanent localized dilation of an artery
• sac formed by dilation of an artery secondary to
weakness and stretching of artery wall
– Fusiform – diffuse dilation affecting the entire
circumference of the artery
– Sacular – outpouching of a distinct portion only
– Dissecting – separation of artery wall layers to form a
cavity that fills with blood
• Etiology – hypertension, trauma, infection, syphilis
• Incidence – men above 50 years

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Cerebral Aneurysm

• Cerebral Aneurysm
• Severe headache
• Thoracic Aortic Aneurysm
– May be asymptomatic
– PAIN, boring and constant, during
supine position
• Abdominal Aortic Aneurysm
– Asymptomatic
– Feel their heart beating when in a
supine position
– “pulsating Abdominal mass”
– DO NOT PALPATE

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Management
 Pharmacotherapy
 Anti-HTN
 Surgery
 Clipping or Aneurysmectomy
 Stent/Graft insertion

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PVD’s = decreased blood flow

Arterial Insufficiency Venous Insufficiency
Mechanism: ischemia stasis
Appearance Pallor, cyanosis erythema
Gangrenous , cadaverous edema
Temp.: Cold warm
Pulse: Diminished , absent Non-palpable
Pain: Intermittent claudication Dull & aching
Trigger: ambulation & exertion Prolonged standing ,
immobility
MGT: Rest (dangle) Move/elevate
Ulcer: grayish pinkish

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