Cardiovascular System

Conditions

Jammaella Vernice T. Gomez, PTRP

TOPICOUTLINE
PART2
I. Conditions
II. Interventions
a. Medications
b. Cardiac Rehabilitation
 Terms
• Thrombus
– a stationary blood clot
along the wall of a
blood vessel,
frequently causing
vascular obstruction.
• Embolus
– A detached blood clot,
or foreign body, that
travels in the
bloodstream and
lodges in a blood
vessel.
• Atheroma
– A deposit or
degenerative
accumulation of lipid-
containing plaques on
the innermost layer of
the wall of an artery.
 Risk Factors
• Modifiable • Non-modifiable
– Physical inactivity
– Hypertension
– Smoking
– Dyslipidemia
– Overweight or obesity
– Diabetes
– Metabolic syndrome
– Increasing age
– Gender: male> female
– Prior history: cardiac,
peripheral vascular, or
cerebrovascular disease
– Family history: genetics
– Cultural or
socioeconomic
 Common Sx and Sy of
Cardiovascular Disorders
• Angina/ Chest pain
– Squeezing, burning, pressing,
choking, achingor bursting
pain
– Jaw, shoulder, upper trapz,
MC on (L) arm, always
follows ulnar
– (+) Levine’s Sign
– Starts 3-5 mins after
activity:
– Medication: Nitroglycerine
Pain Referral of Angina Pectoris
 Types of Angina
– Stable AP – Prinzmetal AP
• Caused by exertion • Form of unstable
• Usually experienced by angina
50-60 y/o men; 65-70 • More recurrent and
y/o females severe; suggest severe
• There could be ischemia
radiating pain on the • Often in 30-40 y/o
arm
– Angina decubitus
– Unstable AP
• Nocturnal angina
• Angina at rest
• Nocturnal dyspnea
• Severe and frequent;
accelerating angina
• Suggest high mortality
risk following MI
 Anginal scale:

0 No angina
1+ Light, barely noticeable 2+
Moderate, bothersome
3+ Severe, very uncomfortable
4+ Most severe pain ever experienced)
 Common Sx and Sy of
Cardiovascular Disorders
• Palpitations • Dyspnea (SOB)
– “Arrhythmia/ • Fainting (syncope)
dysrhythmia”
• Cyanosis
– Excessive heart beat
– Benign cause;
• Fatigue
caffeine, anxiety
– Severe cause;
coronary artery
diseases
– Mitral valve prolapsed
 Laboratory Findings
• Cardiac Enzymes • Diagnostic Tools
– CPK- MB – Chest X-Ray
– SGOT – Myocardial Perfusion
– CK Imaging
– LDH – Echocardiogram
– Cardiac Troponin→ – Cardiac
sole marker for MI Cathetherization
– Central line/ Swan-
ganz cathether
SPECIFIC CONDITIONS
CORONARY ARTERYDISEASE

• The primary impairment in CAD is an imbalance

of myocardial oxygen supply to meet the MVO2.

• This is due to the narrowing of the lumen of the

coronary arteries.
 CORONARY ARTERYDISEASE

ATHEROSCLEROSIS: hardening of thearteries

Causes:
1.Plaque
2. Thrombus
3. Spasm
 CORONARY ARTERYDISEASE
• RISK FACTORS:

MODIFIABLE NON-MODIFIABLE

•HYPERLIPIDEMIA •AGE
•HYPERTENSION •SEX
•SMOKING •RACE
•DIET •FAMILY HISTORY
•PHYSICAL •POST MENOPAUSAL
INACTIVITY
•STRESS
 CORONARY ARTERYDISEASE

CORONARY ARTERY DISEASE IN WOMEN

➢The primary signs of CAD in women

✓Unexplained, severe episodic fatigue and

✓Weakness associated with decreased ability to
perform ADLs
✓chest pain
• Crushing, heavy, squeezing
sensation commonly occurring
during emotion or exertion
 Acute Myocardial Infarction
• Is the rapid
development of
myocardial necrosis
caused by a critical
imbalance between
the oxygen supply and
demand of the
myocardium.
• MC cause: _____
• Attacks are common
in the morning
• Zones of Infarction
– Infarct
• Irreversible
• Necrotic and non-contractile
tissue
– Injury
• Reversible as long as there
is collateral circulation
• Intermediate area
– Ischemia
• reversible
• Outer area, tissue can still
be contractile
 Types
• Transmural Infarct • Non-transmural
Infarct
 MYOCARDIALINFARCTION
Signs and Symptoms:
severe unrelenting “crushing” chest pain lasting 30 minutes
or more (angina)
Pain possibly radiating down one or both arms and/or up to
the throat, neck, back, jaw, shoulders, or arms

Nausea

Diaphoresis

Sudden dimness or loss of vision, loss of speech

 MYOCARDIALINFARCTION
• Continuous midthoracic or
interscapular pain
• Isolated (R) biceps pain
ATYPIC • (L) ear pain
AL • Pain relieved by
antacid
S/Sx:
• Unexplained intense
(women) anxiety, weakness and
fatigue
• Breathlessness
• Dizziness
 MYOCARDIALINFARCTION
HEART ATTACK IN WOMEN
1 MONTH PRIOR TO
DURING THE ATTACK
ATTACK
• UNUSUAL FATIGUE • DYSPNEA
• SLEEP • WEAKNESS
DISTURBANCES • UNUSUAL FATIGUE
• DYSPNEA • COLD SWEAT
• INDIGESTION / GERD • DIZINESS
• ANXIETY • NAUSEA
• HEART RACING • ARMS WEAK/ HEAVY
• ARMS WEAK / HEAVY
 PERICARDITIS
• Inflammation of thepericardium
• Pericardial friction rub (auscultation)
 PERICARDITIS
Signs and symptoms:
oSubsternal pain
oPain referral to the neck, upper trapz, Upper
back,
(L) supra clavicular area, (L) Arm and (L) costal
margins
oWith history
Pain of chills,by
aggravated fever, weakness
Pain relieved by
deep breathing,
leaning forward,
laughing, coughing
sitting upright or
and trunk
holding breath
movements
Pathophysiology
 Cardiac Tamponade

• (Excess pericardial fluid)

• Not painful
• Pt can suffer cardiac arrest d/t too much compression of
the heart.
 Congestive Heart Failure
• A condition which the
heart is unable to
maintain adequate
circulation of the
blood to meet the
metabolic demand of
the body.
• L Congestive Heart • R Congestive Heart
Failure Failure
– Blood is not – Blood is not
adequately pumped adequately returned to
into the systemic the heart from the
circulation systemic circulation
– Results into: – Results into:
• Pulmonary edema • Peripheral edema
• Cough, dyspnea, • Ascites
orthopnea • Digital cyanosis
• Weakness and fatigue • Weakness and fatigue
 ANEURYSM

• An abnormal dilatation in the arterial wall, vein or

the heart

• Causes:
✓ Trauma / weight lifting
✓ Congenital vascular disease
✓ Infection
✓ Atherosclerosis
 ANEURYSM
A. Thoracic aneurysm : involves the ascending, transverse,
or descending portion of the aorta
-PSEUDOLUMEN

A. Peripheral aneurysm
• Most commonsite:
✓ Femoral artery
✓ Popliteal artery
 ANEURYSM

C. Abdominal Aortic Aneurysm

(AAA)
✓ Aorta, JUST BELOW THE KIDNEY
(IMMEDIATELY BELOW THE
TAKEOFF OF THE RENAL
ARTERIES)

• (+) Pulsating mass in the abdomen

with abdominal pain and back pain
 ANEURYSM
Signs andsymptoms:
ANEURYSM
✓ Palpable, pulsating mass
in the abdomen
✓ Abdominal heartbeat
when lying down
✓ Dull ache in the abdominal
flank or low back
✓ Groin and/or leg pain
✓ Weakness of legs
RUPTURED ANEURYSM
✓ Sudden, severe chest pain
with a tearing sensation
✓ Pain radiating to
POSTERIOR THIGH
✓ Pain extends to the neck,
shoulders, between scapulae,
lower back or abdomen
✓ Pain not relieved by position
Peripheral Vascular Disorders
 PERIPHERAL
VASCULAR
DISORDERS
Thrombus,
embolism or Arteriosclerosis
trauma to an Obliterans
artery

Thromboangitis
Raynaud’s disease
Obliterans
 Arterial Disease
• Arteriosclerosis Obliterans
– Chronic, occlusive arterial disease of medium
and large-sized vessels
– Associated with:
• Hypertension
• Hyperlipidemia
• CAD
• CVA
• Diabetes
– Decreased or absent pulse
– Pale in color especially when elevated
– Early stages may indicate intermittent
claudication
– In late stages may exhibit ischemia,
ulcerations, gangrene and trophic skin
changes
– Affects primarily LE
• Thromboangiitis obliterans
– Chronic inflammatory
vascular occlusive disease
of small arteries and veins
• Occurs most commonly in
young adults, largely males
who smoke
• Affects both UE and LE
• Patients may experience
paresthesia, cyanotic cold
extremity, fatigue and risk of
gangrene and ulceration
• Raynaud’s
phenomenon
– A functional episodic
vasomotor disease of
small arteries and
arterioles, not likely to
cause ischemic
necrosis
– Primary Idiopathic
– Secondary: SLE and
scleroderma
 Venous Disease
• Varicose Veins
– Distended, swollen and tortuous
veins
• Superficial vein thrombophlebitis
– Clot formation and acute
inflammation of the superficial veins
• Deep vein thrombophlebitis
– Clot formation and inflammation at
the deep veins
• Usually occurring at the lower extremity
secondary to venous stasis
 VENOUSDISEASE
THROMBUS FORMATION
• venous stasis
• hypercoagulability
• Injury to the venous wall.
• General signs and symptoms includes
inflammation, tenderness, pain swelling and skin
discoloration
• Positive of Homan’s sign
• May precipitate pulmonary embolism
 Medical Surgical Intervention
• PTCA
• IV Stents
• CABG
• Heart Transplant
 PERCUTANEOUS TRANSLUMINAL
CORONARY ANGIOPLASTY

• Under fluoroscopy
• Surgical dilation of a blood vessel using a
small balloon-tipped catheter inflated inside
the lumen
INTRAVASCULAR STENTS
• Endoprosthesis implanted after
angioplasty to prevent re-stenosis and
occlusion in arteries
 CORONARY ARTERY BYPASS
GRAFT
• Surgical circumvention of an obstruction
in a coronary artery using an
anastomosing graft

• Saphenous vein, Internal mammary artery

TRANSPLANTATION

• Used in end-stage myocardial disease

A. HETEROTOPIC
B. ORTHOTOPIC
HETEROTOPICTRANSPLANTATION
ORTHOTOPIC TRANSPLANTATION
VENTRICULAR ASSIST DEVICE
• An implanted device (accessory pump)
that improves tissue perfusion and
maintains cardiogenic circulation
CARDIAC REHABILITATION
 Phases of Cardiac Rehabilitation
According to Braddom

• Phase I: Acute in-hospital phase

➢Begins in the cardiac unit
➢Goal: to progress the patient gradually and
safely from the initial bed rest of the CCU
to a level consistent with most ADLs
➢Phase in which educational programs for
risk factor modifications is introduce
 Phases of Cardiac Rehabilitation
According to Braddom
• Phase II: Convalescent Period
➢ Goal: To maintain early mobilization and
gradually to increase the endurance fro exercise
at the same intensity used at the end of the
acute phase program
➢ Usual activity is walking and bicycling using a
target HR
➢ This phase allows time for a firm scar to form on
the infarcted area
➢ Reducing the risk of ventricular aneurysm or wall
rupture
 Phases of Cardiac Rehabilitation
According to Braddom

• Phase III: Training Phase

➢ Actual exercise training program
➢ Begins with a symptom-limited exercise test to
screen out-patient with contraindications
➢ Results of exercise test are also used to
determine a target HR for exercise training
➢ During this phase the patient can be taught to
monitor HR or to use Borg RPE scale
 Phases of Cardiac Rehabilitation
According to Braddom

• Phase III: Training Phase

➢The usual training program: 3x/wk for 6-8
weeks
➢Each session starts with a stretching
program followed by an aerobic program
➢Each exercise should have a warm-up
period, a training period at target HR and a
cool-down period
 Phases of Cardiac Rehabilitation
According to Braddom

• Phase IV: Maintenance Phase

➢Most important phase
➢Lifelong routine
➢Needs to be addressed before the patient
starts training
➢Minimum requirement: 2 – 3 x/wk for 30
mins
Principles of Exercise Prescription
• Exercise by Heart Rate
➢HRmax must be establish first
➢Actual HRmax is the highest rate safely
achieved on a graded exercise test
➢An estimate of HRmax may be used:
➢For LE: HRmax = 220 – patient’s age
➢For UE: HRmax = 220 – patient’s age – 11
➢Target HR range = HRmax x 70% - 85%
Principles of Exercise Prescription

• Exercise by Heart Rate

➢Second method: Karvonen’s Formula
➢Target HR = (HRmax – RHR) x 50% -
60% + RHR
 Criteria for terminating an
Exercise Program
• Unstable Angina
• Resting BP 200/100mmHg
• Acute systemic illness/ Fever
• 2nd-3rd degree heart block
• Recent Embolism
• Uncontrolled Arrhythmias/ Dysrhythmias/ Palpitations
• Uncontrolled Diabetes Mellitus
• ST segment displacement > or = to 2mm
• Increase diastolic BP
• Active Pericarditis
CARDIAC GUIDELINES
CARDIAC CASESFOR IMMEDIATEMEDICAL
ATTN.
Sudden
worsening of Symptoms of
intermittent Ischemic attack
claudication

Angina that is not

relieved in 20
mins with use of
nitrates and rest
 CARDIAC CASES FOR IMMEDIATE
MEDICAL ATTN.
• Symptoms of Myocardial Infarction
• If In-patient
✓ must be returned to the care of NURSING
STAFF
• If Out-patient

✓ encourage to contact their Physician before

leaving and should not leave unaccompanied
FORREFERRAL
Palpitations >6/min
that occured >1hr
with constitutional Awakened at night
symptoms due to SOB

Fainting without Changes in anginal

warning pattern

Pulse Pressure is Patient has doubt

>40mmHg with his condition
 End of Lecture

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