Cardiovascular

Assessment &
Disorders
Cardiovascular
Assessment
• Assessment of
the cardiovascular
system evaluates
the adequacy of
cardiac output
 Techniques
Inspection:
✓Examine circulatory status and hydration
status of upper and lower extremities:

➢Colour (central and peripheral): pink,

flushed, pale, mottled, cyanosed, clubbing
➢Capillary Refill Time (CRT): brisk (< 2 sec)
or sluggish
➢Presence of oedema (central and/or
peripheral)
➢Hydration status: Skin turgor, oral mucosa,
and anterior fontanels in infants
Palpation:

• Palpate central and peripheral

pulses for rate, rhythm and volume
• Skin condition –
temperature(peripheral and central),
turgor and diaphoresis
Auscultation: • Auscultate the
Auscultate apical pulse

• Compare peripheral
pulse and apical pulse
Compare for consistency (the
rate and rhythm
should be similar).

• Auscultate the chest

Auscultate for heart sounds
and murmurs
Auscultatory
Landmarks
Palpation
 Common or Concerning Symptoms

Chest pain Palpitations Shortness of Breath: Swelling or

Dyspnea, edema
Orthopnea, or
Paroxysmal
Nocturnal Dyspnea
(PND)
Assessment
of the
Peripheral
Vasculature
Inspect for:

• Color of skin and nailbeds

• Temperature, texture and turgor
of skin
• Any lesions, edema
• Capillary refill
• Hair distribution
• Size (swelling or atrophy)
• Assess venous system.
Note any visible, dilated,
and tortuous veins
- Perform Manual
compression test
- Perform Trendelenburg test
- Elicit Homan’s Test
Trendelenburg’s Test
Homan’s Sign
Cardiovascular Disorders
 Coronary Artery
Disease (CAD)

• Also known as Coronary

heart disease, is a type of
heart disease that develops
when the arteries of the
heart cannot deliver
enough oxygen-rich blood
to the heart.
• the narrowing or blockage
of the coronary arteries,
usually caused by
atherosclerosis.
Non Modifiable • Male gender
Risk factors for • Advanced age
CAD
• Family history of heart disease
• Race
 Modifiable Risk
factors for CAD
• Cigarette smoking and
exposure to tobacco smoke
• High blood cholesterol and
high triglycerides
• High blood
pressure (140/90 mmHg or
higher)
• Uncontrolled diabetes
• Physical inactivity
• Uncontrolled stress or anger
• Unhealthy Diet
Modifiable
Risk factors
for CAD
Causes of Artery to
Narrow
• Narrowing of the artery brought
about by the deposition of
plaques, calcification and
hardening of the arteries
• Pathogenesis of
Atherosclerosis.mp4
 • Chest pain
• Palpitations
• Dyspnea
• Syncope
Signs and Symptoms • Nausea
• Numbness
Acute Coronary Syndrome
• umbrella term for situations where the blood supplied to
the heart muscle is suddenly blocked.
• is a name given to three types of coronary artery
disease that are associated with sudden rupture of
plaque inside the coronary artery: Unstable angina, Non-
ST Elevation Myocardial Infarction (NSTEMI), and ST
Elevation Myocardial Infarction (STEMI).
Acute Coronary Syndrome
Umbrella term for situations where the blood
supplied to the heart muscle is suddenly
blocked.
Is a name given to three types of coronary artery
disease that are associated with sudden rupture
of plaque inside the coronary artery: Unstable
angina, Non-ST Elevation Myocardial Infarction
(NSTEMI), and ST Elevation Myocardial Infarction
(STEMI).
Acute
Coronary
Syndorme
Diagnostic
Tests
 Management

• Primary goal : Reduce &

control risk factors &
restore blood supply to
myocardium
 Management

• Low calorie, low cholesterol, low

sodium, low fat diet
• Increase fiber in the diet
• Nitrates, Calcium Channel
Blocker, Beta Blocker and
cholesterol lowering agent
• Exercise, smoking cessation and
stress reduction
 Interventional
Procedures

• Percutaneous
Transluminal Coronary
Angioplasty (PTCA)
• Coronary Artery Bypass
Graft (CABG)
• Enhanced External
Counterpulsation (EECP)
Acute
Myocardial
Infarction
 Acute Myocardial
Infarction
• Also known as a heart attack, occurs
when blood flow decreases or stops to a
part of the heart, causing damage to the
heart muscle
• Caused by reduced blood flow in a
coronary artery due to rupture of an
atherosclerotic plaque and subsequent
occlusion of the artery by a thrombus.
• Other causes: vasospasm of coronary
artery, decreased O2 supply, and
increased demand for O2.
 Determining the Severity of
Acute Myocardial Infarction

Degree of altered function depends

on:
• The specific area of the heart
involved
• Presence of collateral circulation
• Size and duration of infarct. (depth
or extent of muscle affected)
Depth or Extent of muscle affected
Depth or Extent of muscle affected
Types of Myocardial
Infarction

• NSTEMI: A non-ST-
elevated
myocardial
infarction, a type
of heart attack in
which an artery is
partially blocked
and severely
reduces blood
flow.
 Types of Myocardial
Infarction

• STEMI: A common name for

ST-elevation myocardial
infarction, a type of heart
attack caused by a
complete blockage in a
coronary artery.
Various stages of myocardial
damage (Post MI)

• Insufficient blood supply to the

myocardium can result in
myocardial ischemia, injury or
infarction, or all three can coexist
Important things to remember:

Cardiac cells can withstand ischemic conditions for

approximately 20 minutes before irreversible cellular
death begins.

Cardiac muscle fibers that are starved of oxygen for more

than five minutes will die, and, because they do not divide,
dead cardiac muscle cells cannot be replaced.
 WHO criteria: if 2 (probable) or 3
(definite) of the following criteria
are satisfied:
1) Clinical history of ischemic type
Diagnostic chest pain lasting for more than 20
minutes

criteria: 2)
3)
Changes in serial ECG tracings
Rise and fall of serum cardiac
biomarkers such as creatine kinase,
troponin , and lactate dehydrogenase
isozymes specific for the heart.
Laboratory Test Biomarkers
• Troponin ( types)
1. Trop I levels rise in 3 - 12 hrs., peak at
24 hrs, and remains elevated for 5 –
10 days.
2. Trop T levels rise in 3 – 12 hrs., peak
in 12 hrs – 2days, and remains
elevated for 5 – 14 days.
Other Biomarkers
Diagnostics
• ECG
• Echocardiogram
• Stress ECG
• Holter Monitor
• Coronary angiography
• Nuclear ventriculography or
Myocardial Perfusion Scan
Complications of MI

Ischemic
(including
Mechanical Arrhythmic
failure of
reperfusion)
 Ischemic • angina, re-infarction, infarct extension

• heart failure, cardiogenic shock, mitral

Mechanical valve dysfunction, aneurysms, cardiac
rupture

Arrhythmic • Atrial or Ventricular Arrhythmias

 Medications
• First line: (MONA) morphine, oxygen, nitroglycerin, aspirin
• After confirmation of diagnosis: pharmacologic agents
- beta blockers (lol)
- Ca Channel blockers (dipine)
- ACE inhibitors (pril)
- anticoagulants (heparin)
- additional antiplatelet agents
Early Management of the
Patient MI

• Give oxygen by cannula if O2 Sat is

<90
• Sublingual Nitroglycerin
• Aspirin – 160 to 325 mg chewed
• After recording initial 12 – lead ECG,
place patient on a cardiac monitor and
obtain serial ECGs
Early Management of the
Patient MI

• Provide adequate analgesia with

Morphine Sulfate
• Administer Beta blocker within the
first 24 hrs unless contraindicated
• Administer ACE inhibitor within the
first 24 hrs.
 Next step of
Treatment
• Percutaneous coronary
intervention (PCI)
encompasses
both angioplasty and
stenting
• Clot-busting medication
• Coronary artery bypass graft
surgery (CABG)
Fibrinolytic Agents
• The goal is to infuse clot-busting
medications within 30 minutes of a
patient’s arrival at the hospital.
✓Streptokinase
✓Alteplase
✓Reteplase
✓Tenetecplase
 Dual Antiplatelet
Therapy (DAPT)

✓Aspirin + Clopidogrel or
✓Aspirin + Ticagrelor or
✓Aspirin + Prasugrel
Sample
Nursing
Diagnoses
and
Outcomes
Intensive and
Intermediate
Care
Management
Goal of Management

• To maximize cardiac output

while carefully minimizing
cardiac workload.
✓Frequent VS checking
✓Cardiac monitoring
 Intensive and
Intermediate Care
Management
• First 12 hrs of hospitalization
for patients who are
hemodynamically stable and
free of ischemic type of chest
discomfort:
✓Bedrest with bedside commode
privileges
✓Gradual increase in activity
✓Patient is on NPO until pain free
✓Clear liquids and progressed to
healthy DAT when pain free
✓Daily weight recording ;
I and O monitoring to
detect fluid retention
✓Stool softeners to avoid
Valsalva Maneuver
Cardiac Rehabilitation
• Goals are to limit the adverse
physiologic and psychologic effects
of heart disease, modify risk factors,
reduce risk of sudden death or
reinfarction, control symptoms,
stabilize or reverse the
atherosclerotic process, and
enhance the patient’s psychosocial
and vocational status.
Cardiac Rehabilitation