‫‪Heart diseases‬‬

‫ال أبيح وال أحلل من يستغل ملفي ماديا‬

‫‪http://t.me/SNLE_KSA‬‬
Blood Flow Through the Heart

From lower
body
 Pacemaker SA node ‫اذا تعطل الـ‬
‫يشتغل االحتياطي اللي هوا الـ‬
Electrical conduction
AV node
system of the heart
‫ونقوم بدعم االحتياطي بالعالجات ألنه اليكفي الحتياج‬
‫الجسم‬
Primary pacemaker
SA node
Sinoatrial
node
Pacemaker “‫منظم لعضلة القلب‬
Bundle
of His
Temporary or permanent device that provides
Secondary pacemaker
AV node electrical stimulation and maintains the heart rate
Atrioventricular Purkinje when the client’s intrinsic pacemaker fails to
node fibers provide a perfusing rhythm.

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Pacemaker education :
1- Avoid tight clothes
2- Avoid MRI + any magnetic field
3- Avoid electrical mixer
4- Check pulse frequently
Hypertension Complications
ABC
The amount of resistance of blood pumping
through the body/arteries. Atherosclerosis
Stiff, hard blood vessels from plaque
Normal: <120/80 build up.
Prehypertension: 120-139/80-89 Aneurysms
Stage 1 HTN: 140-159/90-99 Broken kidneys , eyes, nerves,
Stage 2 HTN: >160/>100 and heart
(Renal failure, Retinopathy ”blind”,
HTN Crisis: 180/120 neuropathy, HF)
Clots
Causes?! Clot in the brain (CVA “Stroke”)
Clot in the heart (MI ” Heart Attack”)
Clot in the lung (PE “Pulmonary Emboli”)

“Signs & Symptoms”

NO Symptoms= Silent killer Intervention
ABC
Acute Headache
ABCDE
Blurred vision Beta Blockers
Chest Pain CCBs
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Nose bleeds Dilators (Vasodilators) “Nitro”
Ringing in the ears
Dizzy
 Coronary Artery Disease
The
The coronary
coronary arteries
arteries supply
supply blood,
blood, oxygen and
oxygen and nutrients
nutrients to
to your
your heart.
heart.

Coronary artery disease

is a narrowing or
obstruction of 1 or more coronary arteries

What cause this narrowing?

Fatty deposits called “plaque”
Develops on the wall of the coronary arteries
narrowing the vessels which makes it harder
for O2 to get to the heart muscle SO what
cause this? http://t.me/SNLE_KSA
atherosclerosis
CAD causes decreased perfusion of myocardial tissue and inadequate
myocardial oxygen supply leading to:
hypertension, angina, dysrhythmias, MI, heart failure, and death.
 Angina
“Angina=Acute chest pain”
Caused by severe Common types of
narrowing of the coronary Angina
arteries.
This narrowing means less Stable angina
O2 to the heart muscle. Occurs with activities that
involve exertion or emotional
stress; relieved with rest or
Nitroglycerine is giving to nitroglycerin.
open these coronary artery
in the heart. Unstable angina
Occurs with an unpredictable
degree of exertion or
REMEMBER emotion and increases in
http://t.me/SNLE_KSA occurrence, duration, and
“NitrO Open the arteries
to provide O2 to the severity over time
heart muscle” Pain may not be relieved with
nitroglycerin.
Angina intervention
Nitroglycerin

Dilators
Decrease BP
Dilates vessels
Decrease vascular resistance

Always check BP before giving nitro

Hypotension also called “Orthostatic
hypotension”
Teach pt to slowly change position
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 MI
(Heart Attack)
“MI the hurt muscle
die” Location of MI
During a heart attack “SALI”
there is a blockage in
the coronary arteries, Septal: V1, V2
so the heart muscles Anterior: V3, V4
suffocates to death.
Lateral: V5, V6, I, aVL
If blocked over 45min Inferior: II,III, aVF
these cells can die for
ever called
”NECROSIS”
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Silent MI
Diabetic patients Have silent MI with no classic S &S ; they have dead nerves from diabetic
neuropathy.
Basically meaning they can’t feel it.
 MI Intervention
“MI the heart muscle die”
(get ECG & Troponin to confirm)

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http://t.me/SNLE_KSA NEXT “Clot”
Fix the clot with cath lab or clut buster’s
(-Kinase)

Cath lab
Before the procedure
-NPO 6-12 hr
-Check creatinine level “Kidney function test”
-Check iodine allergy
-Stop metformin (24 hr before/48 hr after)
Prepare the patient by shaving the insertion site
“Femoral artery, Radial artery”

After Cath lab

-Vital signs
-Positioning “Supine position”
-Check pedal pulse
-Encourage/Educate patient to increase fluid intake;
to dilute the contrast dye.
-Check creatinine level “Kidney function test”
 Angina vs MI

NOTES

Normal ST Elevation ST Depression

(NO O2) (Low O2)

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 Heart Failure
The heart’s inability to pump blood
sufficiently enough so it can’t provide
proper cardiac output to maintain the HF-Heart Failure = Pumping Failure
body’s metabolic needs. HF-Heavy Fluids = “Lungs & body”

Causes of HF
Right side heart failure
left sided heart failure
Lung diseases
“Pulmonary embolus, Pulmonary HTN
,COPD, Smoking”
Left side heart failure
“Weak heart = weak pump”
HTN
MI
Ischemic heart disease
“CAD, ACS”
Tests used to Diagnose
Heart Failure:
BNP
(b-type natriuretic peptide)
blood test:
Chest x-ray
Echocardiogram
Hemodynamic monitoring
(PCA-Pulmonary Artery Catheter) or
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Measure CVP (Central Venous Pressure)
 CHF
Right side HF Left side HF
Right
X =Peripheral “Remember Left = Lung”
Peripheral Edema Pulmonary Edema

Crackles
“Rales”
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(fluid is backing up in the right side of the
heart which causes fluid to back-up in the Dyspnea, Tachypnea
hepatic veins and peripheral veins)

Weight gain Cough with frothy pink sputum

(blood tinged sputum)
JVD
Orthopnea-SOB while
Abdominal girth increase; Ascites,
lying flat
Hepatomegaly, Splenomegaly..
Nocturnal paroxysmal
Nocturia dyspnea
CHF Interventions
Diet HF Drugs
“DR. CHF” Low SCC (Sodium, Calories, Cholesterol)
Low Sodium & Fluid (2L + 2g or LESS/day) ABCD
Daily weights ACE
(watch for no more than 2-3 lb per day and 5 lbs per
week) “End in –pril”

ARBS
Restrict fluid intake
(2L or less /day) “End in –Sartan”
Risk for Falls! Beta Blockers
(Change positions slowly!)
“End in –lol”
Check signs of Heart failure
exacerbation CCB
Check BNP and BP “-amil, dipine, zem”
(shoud NOT be increasing)
Digoxin
HOB position & elevate legs with Dilators
“pillow” “Nitroglycerine”

Fluid & Fat restriction Diuretics

“-ide, -actone”
 Cardiac tamponade
“Cardiac tamponade = Compression on the heart”

Signs & Symptoms:

Low O2 (Restlessness & confusion, SOB, Tachycardia)

BEC’s Triad
Big jugular veins distension (JVD)
Extreme low BP “Hypotension
Can’t hear heart sound “muffled”

Narrowing pulse pressure “Pulsus paradoxus

Intervention→ Pericardiocentesis
The doctor sticks a big fat needle into the pericardium heart sac to drain
“aspirate” all that fluid.

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 Shock
The types of shock include:
What is shock?
Decreased tissue perfusion, Septic shock: occurs due to a severe infection.
which causes cell hypoxia.
Hypovolemic shock: occurs due to severe fluid
If the cell hypoxia is severe
loss.
enough it will cause organ
dysfunction (MODS) and Neurogenic shock: occurs due to severe damage
to the neuro system (example: spinal injury).
eventually lead to death.
Cardiogenic shock: occurs due to a weak heart.
‫تُعد حالة طبية طارئة تُهدد حياة ال ُمصاب‬
.. ‫مما يتطلب التدخل العالجي الفوري‬ Anaphylactic shock: occurs due to an allergic
reaction

Note: Distributive shock includes septic, anaphylactic, and

http://t.me/SNLE_KSA neurogenic shock.
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