Cardio

NCM112J
CARDIOVASCULAR SYSTEM | PREPARED BY : SHEENA DE LOS REYES

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OVERVIEW ON THE ANATOMY & PHYSIOLOGY OF THE CARDIOVASCULAR SYSTEM
THE CARDIOVASCULAR SYSTEM

PERICARDIUM
● A closed system of the heart and blood vessels
● The cardiovascular system (your heart and blood ● A double serous membrane
vessels) supplies your body's organs with oxygen ● Thin, fibrous sac, composed of 2 layers:
and nutrients so your organs can do their jobs. ○ Visceral Pericardium
■ next to the heart
○ Parietal Pericardium
FUNCTIONS OF THE CARDIOVASCULAR SYSTEM ■ tough fibrous tissue attaches great
vessels, diaphragm, sternum,
● The heart pumps blood vertebral column
● Blood vessels allow blood to circulate to all parts of ■ supports heart in the mediastinum
the body ■ outside layer
● Cardiovascular system delivers oxygen and ● Serous fluid fills the space between the layers of
nutrients and to remove carbon dioxide and other pericardium
waste products ● Parietal Space
● Cardiac Electrophysiology ○ between two layers, normally filled about
○ cardiac conduction system generates & 20 mL fluid, which lubricates surface of the
transmits electrical impulses that heart and reduces friction during systole
stimulate contraction of myocardium
● Cardiac Hemodynamics
○ blood flow in the cardiovascular system
principle that fluids from a region of higher
pressure to one of lower pressure;
responsible for blood flow normal
circulation generated during systole &
diastole.
THE HEART
LAYERS OF THE HEART WALL
● Endocardium
○ inner layer
○ consists of endothelial tissue
○ lines inside the heart and valves
● Myocardium
○ middle layer
○ made up of muscle fibers
○ responsible for the pumping action
○ mostly cardiac muscle
● Epicardium
○ outer layer
○ parietal pericardium
● The heart is a muscular organ that pumps blood
○ connective tissue layer
and is enclosed in a membranous sac. This sac
allows the heart to beat without friction.
○ sac is called the PERICARDIUM. “Peri”
means around, “cardium” means heart
● Lies in a rotated position within chest cavity
● Apical Pulse (PI) Point of Maximal Impulse
● Pulsation created during normal ventricular
contraction
● Located intersection of midclavicular line of chest
wall & fifth intercostal space
● Located under thorax; occupies space between
lungs (mediastinum) & diaphragm
● Weighs approximately 300 q (10.6 oz)
CARDIOVASCULAR SYSTEM
PREPARED BY : SHEENA DE LOS REYES
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CHAMBERS OF THE HEART
● Heart Chambers
MYOCARDIAL THICKNESS AND FUNCTION
○ pumping action of heart accomplished
rhythmic relaxation & contraction of
muscular walls of 2 chambers (Atria) & 2 ● Varying thickness of Atrial / Ventricular wall are
bottom chambers (Ventricles). due to the workload required by each chamber
● Atria ○ more workload = thicker
○ Thin-walled ● Ventricles are thicker than Atria
○ Receiving chambers ○ Because there is little resistance as blood
○ Right and Left flows out of the atria and into ventricles
● Ventricles during diastole.
○ Thick-walled ● Left Ventricle is thicker than Right Ventricle
○ Discharging chambers ○ It must overcome high aortic and arterial
○ Right and Left pressures, whereas the right ventricle
○ Left ventricle is thicker than the right contracts against a low-pressure system in
the pulmonary arteries and capillaries
SYSTEMIC AND PULMONARY CIRCULATION
● Oxygenation left side is a pump to the systemic

circulation
● Unoxygenated right side is a pump to the
pulmonary circulation
PULMONARY CIRCULATION
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● Right side of the heart
● Right atrium & Right ventricle distributes venous
blood (deoxygenated blood) to the lungs via the
pulmonary artery (pulmonary circulation) for
● Arteries bring blood AWAY from the heart oxygenation.
● Veins bring blood TOWARD the heart ● Pulmonary artery
● Arteries usually carry blood with much oxygen ○ the only artery that carries deoxygenated
● Veins usually carry blood with little oxygen blood
● The RIGHT ATRIUM receives blood from all tissues ● The right atrium receives venous blood returning
of the body through veins. This blood is oxygen to the heart from the:
poor. ○ superior vena cava (head, neck, upper
extremities)
○ inferior vena cava (trunk, lower extremities)
○ coronary sinus (coronary circulation)
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SYSTEMIC CIRCULATION ○ Pulmonary
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● Left side of the heart

● Left atrium and Left ventricle distributes
oxygenated blood to the remainder of the body via
the aorta
● The left atrium receives oxygenated blood from the
pulmonary circulation via four pulmonary veins.
CONDUCTING SYSTEM OF THE HEART
● Once inside the right ventricle, the blood passes

through the pulmonary semilunar valve into the
pulmonary arteries
● The pulmonary arteries carry oxygen-deficient
blood to the lungs
● Once inside the lungs, the blood vessels branch
until they reach one cell layer thick. These
capillaries combine with the alveoli of the lungs for
● Sinoatrial (SA) node the exchange of oxygen and carbon dioxide.
○ Primary pacemaker ● The blood now has much oxygen. It returns to the
● Atrioventricular (AV) node heart by the pulmonary veins. There are four
○ Secondary pacemaker pulmonary veins that empty into the left atrium
● Bundle of His ● The blood then must pass through the mitral valve
○ bundle of specialized conducting tissue (bicuspid valve) into the left ventricle.
● Purkinje Fibers ● From the left ventricle the blood passes through the
○ terminal point of conduction system AORTIC SEMILUNAR VALVE in the aorta.
● The contraction of the left ventricle sends blood rich
in oxygen all over the body. There are three arteries
that bring blood to the head, neck, and upper
THE CONDUCTION SYSTEM extremities. There is one major vessel that brings
blood to the abdomen and lower extremities.
● Inherent and rhythmical beat is due to ● Arteries are the large vessels that bring blood away
autorhythmic fibers of the cardiac muscle from the heart. These vessels branch into smaller
● These fibers have 2 important functions: arterioles which eventually branch into capillaries
○ Act as the pacemaker which are only one cell thick.
○ Form the conduction system ● The primary responsibility for initiating the
heartbeat is with the SINOATRIAL NODE. This is
located on the posterior wall of the right atrium.
HEART VALVES
● Once this electric current is generated, atrial muscle
contracts forcing blood into the ventricles. Once this
● 4 valves permit blood flow in only one direction. occur the heartbeat moves to another region called
● Valves the atrioventricular node.
○ composed of thin leaflets of fibrous tissue
● Once this occurs, the AV node sends electrical
○ open and close in response to the
impulses through electrical impulses through a
movement of blood pressure changes
series of BUNDLE BRANCHES ending in
within the chambers.
PURKINJE FIBERS that stimulate the ventricles to
○ open as blood is pumped through
contract.
○ close to prevent blood from flowing back
○ held in place by chordae tendineae (heart
strings)
● Atrioventricular (between atria and ventricles)
○ Tricuspid
○ Bicuspid or mitral
● Semilunar (between ventricle and artery)
○ Aortic
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● May be replaced
● Lub Dub = Heart Sound
ASSOCIATED GREAT VESSELS OF THE HEART
● Aorta
○ Leaves left ventricle
● Pulmonary arteries
○ Leaves right ventricle
● Vena cava
○ Enters right atrium
● Pulmonary veins (four)
○ Enter left atrium
CORONARY CIRCULATION
● Blood in the heart chambers does not nourish the

myocardium
● The heart has its own nourishing circulatory
system
○ Coronary arteries
○ Cardiac veins
○ Blood empties into the right atrium via the
coronary sinus
CARDIAC PATHOLOGY
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● Rapid heart beat
● = Inadequate blood
● = Angina Pectoris
BLOOD SUPPLY
● The blood supply of the heart comes from the

Coronary arteries
● Right coronary artery:
○ right atrium
○ inferior wall (ventricle)
● Left coronary artery
○ circumflex: lateral wall (left ventricle)
○ anterior descending - anterior surf (left
ventricle)
● The venous drainage of the heart
● Cardiac veins
● Coronary sinus
PHYSIOLOGIC CHARACTERISTICS OF
THE CONDUCTION CELLS
● Automaticity (Rhythm)
○ myogenic not neurogenic
● Excitability (Stimuli)
○ response
● Conductivity
○ electrical impulse
VALVE PATHOLOGY ● Contractility
————————————————————————————— ○ chemical energy into mechanical work
● Incompetent valve = backflow and repump ● Refractoriness
● Stenosis = stiff = heart workload increased ○ no stimulation contraction
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CARDIAC ACTION POTENTIAL
● Depolarization
○ exchange of ions creates a positively
charged intracellular space and a
negatively charged extracellular space that
characterizes the period
● Repolarization
○ Once depolarization is complete, the
exchange of ions reverts to its resting state;
this period is known as Repolarization
● Repeated cycle of depolarization and
repolarization
THE HEART: CARDIAC OUTPUT

THE CARDIAC CYCLE
● Cardiac output (CO)

● Refers to the events that occur in the heart from
○ Amount of blood pumped by each side of
the beginning of one heartbeat to the next.
the heart in one minute
● 3 major sequential events:
○ CO = (heart rate [HR]) × (stroke volume
○ Diastole
[SV])
○ Atrial systole
○ Normal HR = 60-100 bpm
○ Ventricular systole
● Stroke volume
● Atria contract simultaneously
○ Volume of blood pumped by each ventricle
● Atria relax, then ventricles contract
in one contraction
● Systole = contraction
● Ejection Fraction (EF)
● Diastole = relaxation
○ Amount of blood pumped with each
ALL THREE SOURCES EMPTY INTO THE RIGHT ATRIUM
contraction in relation to the volume of
blood available
○ Normal EF = 60% THE CARDIAC CYCLE
HEMODYNAMICS ● The cardiac cycle is the events that occur in one

complete heartbeat
● The cardiac cycle has 2 phases
● DETERMINANTS OF CARDIAC OUTPUT
○ Contraction of the heart (systole)
○ Preload
○ Afterload
○ Relaxation of the heart (diastole)
○ Contractility ● The atria and ventricles have different functions
○ Heart rate during the cardiac cycle
● When the atrium is contracting, blood flows into the
PRELOAD ventricles. Therefore, the ventricles have to be
————————————————————————————— relaxing
● Generated by the blood volume in the ventricles at ● When the atria are in systole, the ventricles are in
the end of the diastole (ventricular end diastolic diastole
volume. ● Electrical activity of the heart can be measured by
an electrocardiogram (EKG or ECG).
AFTERLOAD ● EKG’s are electrical tracings of each part of the
————————————————————————————— cardiac cycle
● Resistance, impedance or pressure that the ● Each time a different part of the heart contracts, an
ventricle must overcome to eject its blood volume. electrical impulse can be recorded from different
areas on the thorax
CONTRACTILITY
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● Force with which the heart contracts
HEART RATE
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● The number of times your heart beats per minute
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PATHOLOGY OF THE HEART
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● Damage to AV node = release of ventricles from
control = slower heart beat
● Slower heart beat can lead to fibrillation
● Fibrillation = lack of blood flow to the heart
● Tachycardia = more than 100 beats/min
● Bradycardia = less than 60 beats/min
CHAMBERS OF THE HEART
● During the relaxation phase (diastole), all four

chambers relax simultaneously, which allows
ventricles to fill preparation for contraction.
● Systole REGULATION OF HEART RATE
○ refers to the events in the heart during
contraction between atria & ventricles.
● Increased heart rate
● This synchronization allows the ventricles to fill
○ Sympathetic nervous system
completely prior to ejection of blood from these
■ Crisis
chambers.
■ Low blood pressure
○ Hormones
DIASTOLE
■ Epinephrine
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■ Thyroxine
● All 4 chambers are relaxed.
○ Exercise
● AV valves are open, semilunar valves are closed
○ Decreased blood volume
● Decreased heart rate
ATRIAL SYSTOLE
○ Parasympathetic nervous system
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○ High blood pressure or blood volume
● Occurs as atrial muscles contract in response to an
○ Decreased venous return
electrical impulse initiated by the SA node.
○ In congestive heart failure, the heart is
● Lasts for 0.1 sec
worn out and pumps weakly.
● Atrial depolarization causes atrial systole
■ Digitalis works to provide a slow,
● It contributes a final 25 mL of blood to each
steady, but stronger beat.
ventricle
● End of atrial systole = end of ventricular diastole
● End diastolic volume = 130 mL
VENTRICULAR SYSTOLE
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● The pressure inside the ventricles rapidly increases
forcing the AV valves to close.
● Lasts for 0.3 sec
● Isovolumetric contraction lasts for 0.05 sec when
both the semilunar and atrioventricular valves are
closed
EFFECT OF THE HEART RATE ON

CARDIAC OUTPUT
● Baroreceptors
○ specialized nerve cells located in the aortic
arch and in both right and left internal
carotid arteries, sensitive changes in blood
pressure (BP).
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THE CARDIOVASCULAR SYSTEM: DIAGNOSTIC PROCEDURES AND HEALTH HISTORY
CARDIAC ASSESSMENT NON-MODIFIABLE

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● Health History ● Family history
○ Obtain description of present illness ● Age
○ Chief complaint ● Gender
■ Chest pain, SOB, Edema, etc. ● Race or Ethnicity
○ Assess risk factors ● Socioeconomic status
HISTORY OF PRESENT ILLNESS PAST MEDICAL HISTORY
● Onset ● Major illnesses

○ When did the chief complaint occur ○ Hospitalizations
○ Surgeries
● Prior occurrences of this problem ○ Significant injuries
● Medications
● Progression ● Allergies
○ Is this problem getting worse or better ● Immunizations
○ Is there anything that the patient does ● Gynecologic and obstetric history (women)
that makes it better or worse
● Quality FAMILY HISTORY OF HEART ATTACKS

○ Is there pain, and if so what type how
would the patient describe it FAMILY HISTORY OF HEART ATTACKS
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● Radiation ● If family members had a heart attack before the
○ Do the symptoms radiate to anywhere in age of 50 years old
the body, and if so, where? ○ Your risk of heart disease, attack, and
stroke is increased
● Scale
○ On a scale of 1 to 10, how bad is it IS YOUR HEART HEALTHY
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● Timing ● Many with family history of early heart attacks also
○ When do the symptoms occur? ○ Overweight / Obese
○ At night, all the time, in the mornings, etc ○ Smoke
○ Not physically active
CARDIOVASCULAR HISTORY TAKING
○ Not choosing healthy foods and drinks
○ Have high cholesterol
● Chest pain ○ Have high blood pressure
● Dyspnea ○ Have diabetes
● Palpitation and Syncope
● Edema STEPS TO PREVENT HEART DISEASE
● Intermittent claudication —————————————————————————————
● Systematic symptoms ● Talk to your doctor about
○ Your family history of early heart attacks
CARDIOVASCULAR RISK FACTORS ● Improve your heart health through
○ Healthy living habits
● Modifiable ○ Treating or preventing medical conditions
● Non-modifiable
DRUG HISTORY
MODIFIABLE
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● Physical inactivity ● Here you should list all the medications that the
● Diet patient is taking including the dosage and
● Obesity frequency of each prescription. If the patient is
● Diabetes unsure about their medications.
● Stress ● Eye drops
● Tobacco ● Inhalers
● Alcohol ● Sleeping pills
● Oral contraceptives
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● OTC Drugs
● Vitamin supplements
PERIPHERAL PULSES
● Herbal remedies
● Illicit or recreational drug use ● Bilaterally
● Simultaneously
○ Rate, Rhythm, Quality
ADDITIONAL ASSESSMENT AREAS ● Light touch
● 0 = absent
● Health perception and management ● 1 = palpable
● Nutrition and metabolism ● 2 = normal
● Elimination ● 3 = full
● Activity and exercise ● 4 = full and bounding
● Sleep rest patterns
● Cognition and perception
● Self-perception and self-concept HEART SOUNDS
● Roles and relationships
● Sexuality and reproduction GALLOPS
● Coping and stress tolerance —————————————————————————————
● The heart sounds then come in triplets and have
the acoustic effect of a galloping horse; they are
CARDIAC ASSESSMENT
called gallops.
PHYSICAL EXAMINATION MURMURS

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● Vital signs (BP) ● Created by the turbulent flow of blood
● Inspection of the skin ● The causes of the turbulence may be a critically
● Inspection of the thorax narrowed valve, a malfunctioning valve that allows
● Palpation of the pulses regurgitant blood flow, a congenital effect of the
● Auscultation of heart sounds ventricular wall, a defect between aorta and
pulmonary artery, or an increased flow of blood
through a normal structure.
PERIPHERAL PULSES
● Pulse Quality
LABORATORY CARDIAC ENZYMES
○ 0 = Pulse not palpable/absent
○ +1 = weak thready pulse CREATINE KINASE (CK-MB)
○ +2 = diminished pulse
○ +3 = easy to palpate ; full pulse
● Elevates within 4 hours
○ +4 = strong ; bounding pulse
● Peaks in 8 hours
● Decline til 3 days
HEART SOUNDS ● Normal value = 0 – 7 U/L
● S1 = due to closure of AV valves TROPONIN I AND T

● S2 = due to closure of semilunar valves
● S3 = due to increased ventricular filling
● Elevates within 3-4 hours
● S4 = due to forceful atrial contraction
● Peaks in 4-24 hours
● Persists for 7 days – 3 weeks
THORAX ● Normal value = less than 0.6 ng/mL
LACTIC DEHYDROGENASES (LDH)
● Elevates in 24 hours
● Peaks in 48-72 hours
● Normal value = 105 – 333 IU/L
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LABORATORY PROCEDURES CARDIAC CATHETERIZATION
● Cholesterol = 200 mg/dl ● Insertion of a catheter into the heart and

● Triglycerides = 40- 150 mg/dI surrounding vessels
● Structure and performance of the heart valves and
● Serum Lipids surrounding vessels
○ LDL = 130 mg/dL
○ HDL = 30-70 mg/dL PRE-CARE
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● History and Physical
ELECTROCARDIOGRAM (ECG) ● Lab work- EKG, ECHO, CBC
● NPO
● A non-invasive procedure ● Pre-procedural teaching
● Electrodes and wires attached
● There is no risk of electrocution POST-CARE
● Avoid muscular contraction / movement —————————————————————————————
● Monitor vital signs
STRESS TEST : TREADMILL TESTING ● Monitor extremity distal to the catheter insertion
● Consent ● Keep leg immobilized
● Light meal or fast for 4 hours ● Vital signs
● NO smoking, alcohol and caffeine ● Check for bleeding at insertion site
● Walking shoes, comfy clothes ● Measure I&O
● Notify MD: chest pain, dizziness, SOB
● Avoid hot shower for 10-12 hours INTRA TEST
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● Fluttery feeling
● Warmth and metallic taste
NURSING MANAGEMENT
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● Strict bed rest
○ 6 – 12 hours
● May turn side to side but bed should not be
elevated more than 30 degrees and legs always
straight
ECHOCARDIOGRAPHY ● Encourage fluid intake to flush
● Immobilize arm
● Dye allergy
● A non-invasive ultrasound test
● Used to examine the size, shape, and motion of
cardiac structures. PULMONARY ARTERY PRESSURE
● Normal = mean 15 mm Hg
TRANSESOPHAGEAL ECHOCARDIOGRAPHY
● Measurement helpful in:
○ Assessing LV function
● provides clearer images because ultrasound waves ○ Assisting in determining etiology of shock
are passing through less tissue ○ Evaluating response to medical
● involves threading a small transducer through the interventions
mouth and into the esophagus ● Capable of measuring:
○ RA pressure
○ PA systolic pressure
ILIUM SCAN ○ PA diastolic pressure
○ Mean pulmonary artery pressure
● Radiotracer ■ 4.5-13 mm Hg
○ injected into a vein ○ Pulmonary artery wedge pressure
○ emits gamma radiation as it decays.
● A gamma camera scans the radiation area and
creates an image.
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CENTRAL VENOUS PRESSURE (CVP) MONA
● Pressure in vena cava or right atrium M – morphine

○ Indirect measurement of right ventricular O – oxygen
pressure N – nitroglycerin
● Normal CVP = 0-8 mm Hg A – aspirin
○ 4-10 cm H20
● Elevated REVIEW QUIZ
○ hypervolemia
○ heart failure Arteries = carry blood away from the heart
● Low Capillaries = are the site of gas exchange
○ decreased preload related to hypovolemia Veins = carry blood back to the heart
● Complications
○ infection 1. The circulatory system brings blood to and from
○ pneumothorax the body, while the cardiovascular system brings
○ air embolism blood to and from the lungs only.
TRUE OR FALSE
CARDIAC IMPLEMENTATION
2. Arteries carry mainly oxygenated blood.
1. Assess the cardio-pulmonary status TRUE OR FALSE
● VS
● BP 3. The systemic and pulmonary circuits meet at the
● Cardiac assessment capillary beds.
TRUE OR FALSE
2. Enhance cardiac output
● Establish IV line 4. Which of the following carries blood to the lungs?
A. capillaries
3. Promote gas exchange B. pulmonary arteries
● Administer 02 C. pulmonary veins
● Position client in Semi-Fowler's D. aorta
● Encourage coughing and deep breathing
exercises 5. Blood becomes oxygenated in the lungs through
gas exchange into
4. Increase client activity tolerance A. capillaries
● Balance rest and activity periods B. arterioles
● Assist in daily activities C. bronchioles
● Provide strict bed rest if indicated D. venules
● Soft foods
● Assistance in self-care 6. Put the structures in order of how blood flows
from the heart out to the body and back again:
5. Promote client comfort
● Assess the client's description of pain and 1. aorta 5. venules
chest discomfort 2. arteries 6. veins
● Administer meds as prescribed: 3. arterioles 7. vena cava
● Morphine = MI 4. capillaries
● Nitroglycerine = Angina
● Diuretics = CHF
7. Exceeding which of the following serum
6. Promote adequate sleep cholesterol levels significantly increases the risk of
coronary artery disease?
7. Prevent infection A. 100 mg/dl
● Monitor skin integrity of lower extremities B. 150 mg/di
● Assess skin site for edema, redness and C. 175 mg/dl
warmth D. 200 mg/dl
● Monitor for fever
● Change position frequently 8. Which of the following blood tests is most
indicative of cardiac damage?
8. Minimize patient anxiety A. Lactate dehydrogenase
● Encourage verbalization of feelings, fears B. Complete blood count
and concerns C. Troponin I
● Answer client questions. D. Creatine kinase
● Provide information about procedures and
medications
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9. An adult is admitted for a cardiac catheterization.

The client asks the nurse if she will be asleep
during the cardiac catheterization. What is the
best answer for the nurse to give?
A. "You will be given a light general
anesthesia."
B. " You will be sedated but not asleep."
C. "The doctor will give you an anesthetic if
you are having too much pain."
D. "Is it important for you to be asleep?"
10. An adult has just returned following a left heart

catheterization. What is it essential for the nurse to
do?
A. Check her peripheral pulses.
B. Maintain her NPO.
C. Apply heat to the insertion site.
D. Start range of motion exercises
immediately
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CORONARY ARTERY DISEASE

● Narrowing of the large and medium-sized
CORONARY ARTERY DISEASE coronary arteries
● Deposition of atheromatous plaque in the vessel
Also known as: wall
● Insufficient blood flow to the heart muscle from
● Atherosclerotic Heart Disease
narrowing of coronary artery may cause chest pain
● Coronary Atherosclerosis
● Coronary Arteriosclerosis
● Coronary Heart Disease CANDIDATES FOR CAD
● Causes / Risk Factors

● Heredity
● High levels of cholesterol in the blood
● Smoking
● Diabetes
● Obesity
● High blood pressure
● High fat diet
● Lack of exercise
● Emotional Stress
RISK FACTORS
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● Age
○ > 45 / 55
● Sex
○ Male, Female menopausal
● Family History
○ DM, HPN, Hyperlipidemia
● Smoking
○ Sedentary Lifestyle
NON-MODIFIABLE FACTORS
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● Age
● Gender
● Family History
● Ethnicity
MODIFIABLE FACTORS
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● Physical Inactivity (31%)
● Unhealthy living (21%)
● Overweight and Obese (18%)
● High Cholesterol (11%)
● Current Smokers (14%)
● Alcohol (5%)
PHASES OF CORONARY HEART DISEASE
● Normal coronary artery

● Atherosclerosis
● Atherosclerosis with blood clot
● Coronary spasm
● Refers arterioscerotic and atherosclerotic changes

in the coronary arteries supplying the
myocardium.
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HOW TO CONFIRM CAD
● History
● Physical Examination
● Cardiac Enzyme
● ECG
● Angiography
CARDIAC ENZYMES
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● A blood test that allows your doctor to see if you
have had a heart attack
● An increase in the enzymes may indicate heart
muscle damage such as myocardial infarction
PATHOPHYSIOLOGY OF CAD ● These enzymes include:
● CPK – creatinine phosphokinase
● LDH – lactate dehydrogenase
● GOT – glutamic oxaloacetic transaminase
COMPLICATIONS
● Heart attack
● Heart failure
● Heart Rhythm Abnormality
PHARMACOLOGIC THERAPY
MANIFESTATIONS OF CAD
● Nitrates
● Extreme fatigue ● Beta Blockers
● Shortness of breath ● Calcium Channel Blockers
● Dizziness ● ACEinhibitors
● Lightheadedness ● Statins
● Fainting ● Imipramine
● Chest pain and pressure (angina)
● Heart palpitations
SURGICAL INTERVENTIONS
● Swelling in your legs and feet (edema)
● Swelling in your abdomen
● Fluid in your lungs causes cough / congestion ● Coronary Angioplasty
● Difficulty sleeping ● Stents
● Coronary Artery Bypass Grafting (CABG)
● Percutaneous transluminal coronary angioplasty
SIGNS AND SYMPTOMS OF CAD (PTCA)
● Chest pain (Angina Pectoris)

NURSING MANAGEMENT OF CAD
● Myocardial Infarction
● Diaphoresis
● ECG Changes ● Encourage health promotion through decreasing
● Dysrhythmias risk factors:
● Chest heaviness ○ Diet – low sodium, low fat
● Dyspnea ○ Lose weight
● Fatigue ○ Exercise – at least 30 of aerobic 5x a week
● Palpitations ○ Stop tobacco products
● Sweating ○ Monitor and control blood sugar
● Weakness ○ Monitor BP and lipid levels
● Dizziness ○ Reduce stress
● Nausea
● Edema of lower extremities
● Cyanosis
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● Results from coronary artery VASOSPASMS
HEALTH TEACHINGS
● May occur at rest
● Lifestyle changes
● Weight control SIGNS AND SYMPTOMS OF ANGINA PECTORIS
● Stress management
● Healthy diet ● Pain and discomfort in the chest is a most
● Exercise common symptom of angina pectoris.
● Smoking cessation ● The symptoms of stable angina pectoris lasts from
a few seconds to 15 minutes
● Some other symptoms of angina pectoris are:
○ Fatigue
● Is a small metal coil with meshlike openings ○ Dizziness
placed in the coronary artery during the PTCA. ○ Anxiety
○ Nausea
○ Abnormal sweating
CORONARY ARTERY BYPASS GRAFT (CABG) ○ Breathing problems
● Is a technique for revascularizing the myocardium ○ Heartburn
● A surgical procedure in which a blood vessel from ○ Indigestion
another part of the body is grafted onto the
occluded coronary artery below the occlusion in
such a way that blood flow bypass the blockage. TREATMENT OF ANGINA PECTORIS
PERCUTANEOUS TRANSLUMINAL CORONARY ● The goals of pharmacotherapy are to reduce

ANGIOPLASTY morbidity and to prevent complications
● Referred to as balloon angioplasty ● Modification of risk factors
● Uses a sedation and local anesthesia, a balloon ● Beta blockers
tipped catheter is inserted through the skin and ● Nitroglycerin
threated from a peripheral artery into the ● Calcium channel blockers
decreased coronary artery. ● ACE inhibitors
● Antiplatelet drugs
HEALTH TEACHINGS ● Statins
—————————————————————————————
● Life style changes
● Weight control
MYOCARDIAL INFARCTION
● Stress management
● Healthy diet ● A result of a blocked left anterior descending
● Exercise coronary artery
● Smoking cessation
PATHOPHYSIOLOGY
ANGINA
● Chest pain that occurs when part of your heart

muscle does not get enough oxygen-rich blood.
3 COMMON TYPES OF ANGINA
STABLE ANGINA
—————————————————————————————
● The typical angina that occurs during exertion
● Relieved by rest and drugs SIGNS AND SYMPTOMS OF A
● Severity does not change MAJOR HEART ATTACK
UNSTABLE ANGINA ● Chest pain / discomfort

————————————————————————————— ● Shortness of breath
● Occurs unpredictably during exertion and emotion ● Pain / discomfort in the jaw, neck, back, arm, or
● Severity increases with time shoulder
● Crescendo angina ● Feeling nauseous, lightheaded, or unusually tired
VARIANT ANGINA
—————————————————————————————
● Prinzmetal
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TIME COURSE FOR SERUM MARKERS IN ACUTE

ECG CHANGES IN MYOCARDIAL INFARCTION MI
Test Onset Peak Duration

● ST-segment elevation
● T-wave inversion Troponin 3 – 12 hours 18 – 24 Up to 10
● Abnormal Q wave hours days
CK (total) & 3 – 12 hours 18 – 24 36 – 48

MB hours hours
LDH 6 – 12 hours 24 – 48 6 – 8 days (5

hours – 10 days)
Myoglobin 1 – 4 hours 5 – 7 hours 24 hours
NURSING DIAGNOSES
● Acute pain R/T imbalance between myocardial

oxygen supply and demand
● Ineffective tissue perfusion R/T interruption of
arterial blood flow
● Ineffective coping R/T effects of acute illness and
● Impaired gas exchange related to ineffective
breathing pattern and decreased systemic tissue
perfusion.
● Anxiety related to present status and unknown
future, possible lifestyle changes, pain, and
perceived threat of death
● Activity intolerance related to fatigue
NURSING INTERVENTIONS
1. Provide Oxygen at 2 L / min

● semi-fowler's
2. Administer medications
3. Minimize patient anxiety
● procedures and drug therapy
● allow verbalization of feelings
4. Provide adequate rest periods
● bed rest during acute stage
5. Minimize metabolic demands
● Soft diet
● low-sodium, cholesterol, fat diet
6. Assist treatment modalities
● PTCA and CABG
7. Monitor for complications of MI:
8. Provide client health teachings
AFTER ACUTE EPISODE
1. Maintain bed rest for first 3 days

2. Provide passive ROM exercises
3. Progress with dangling of the feet at side of bed
4. Proceed with sitting on the bed, on the chair for 30
minutes TID
5. Proceed with ambulation in the room > toilet >
hallway TID
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DEFINITION Sulfate
Anti Thrombotic No Streptokinase

Atherosclerosis Angina Pectoris Myocardial Antidote
Infarction Aminocaproic
acid
Buildup of Chest pain Death of
plaque inside resulting from myocardial Stool Softener Colace
the artery walls coronary tissue in regions
atherosclerosis of the heart with
or myocardial abrupt
NURSING MANAGEMENT FOR HEPARIN -
ischemia interruption of
coronary blood
ANTICOAGULANT
supply
● Subcutaneous inj : G25 – 26 ½ to ⅝
● Not within 2 inches of the umbilicus
MANIFESTATIONS ● Apply gentle pressure (1–2 min)
● Rotate sites
VASODILATOR SIDE EFFECTS
● Nifedipine can cause flushing, headache,

hypotension, and peripheral edema as side effects
of its vasodilation activity
● The drug may cause reflex tachycardia if peripheral
vasodilation is marked resulting in a substantial
decrease in blood pressure
BETA BLOCKERS
● Ends in OLOL
● Action : blocks beta receptors in the heart causing
○ Decreased heart rate
○ Force of contraction
○ Rate of A-V conduction
● Side Effects :
○ Bradycardia
○ Lethargy
○ GI Disturbance
○ CHF
○ Decreased BP
○ Depression
PHARMA MANAGEMENTS
Drug Angina MI
Nitrates Yes Yes
ACE inhibitors Yes Yes
Beta-blockers Yes Yes
Calcium-channel Yes Yes

blockers
Anticoagulant Aspirin Heparin

Antidote
Protamine
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CALCIUM CHANNEL BLOCKERS
Verapamil Diltiazem Nifedipine
Headache, Headache, Headache,

flushing, flushing, flushing,
hypotension hypotension hypotension
Headache, Peripheral Peripheral

flushing, edema edema
hypotension (ankle edema) (ankle edema)
Headache, Cardiac Tachycardia

flushing, depression, A-V
hypotension block,
bradycardia
Constipation
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INFECTIOUS AND INFLAMMATORY DISORDERS OF THE HEART:

DISORDERS THAT AFFECT THE SPECIFIC STRUCTURES OF THE HEART
● Subcutaneous nodules
○ appear 4-6 weeks after onset of an acute
● Rheumatic Heart Disease
episode
● Bacterial Endocarditis
○ primarily on extensor surface of joints,
● Myocarditis
bony prominences, and scalp
● Acute and chronic pericarditis
○ invariably associated with severe carditis
● Cardiomyopathy
● Chorea
● Congestive Heart Failure
○ characterized by involuntary grimacing
and an inability to use skeletal muscles in a
RHEUMATIC HEART DISEASE coordinated man
● Mild fever
● Rheumatic fever
DIAGNOSTIC FINDINGS
○ a systemic inflammatory disease that
—————————————————————————————
sometimes follows a group A streptococcal
infection of the throat.
● Antistreptolysin O (ASO) titer
● Rheumatic carditis
○ a blood test to measure antibodies against
○ refers to the inflammatory cardiac
streptolysin O
manifestations of rheumatic fever in either
● Erythrocyte sedimentation rate (ESR) & C-reactive
the acute or later stage.
protein
● Cardiac structures that usually are affected include
○ to check for signs (markers) of
the heart valves (particularly the mitral valve),
inflammation in the blood
endocardium, myocardium, and pericardium.
MEDICAL AND SURGICAL MANAGEMENT

PATHOPHYSIOLOGY AND ETIOLOGY
● Intravenous (IV) antibiotics

● Penicillin
○ the drug of choice for group A streptococci
NURSING MANAGEMENT
● Administers prescribed drug therapy

● Monitors for therapeutic and adverse effects
● Plans diversional activities that require minimal
activity
INFECTIVE ENDOCARDITIS
● Formerly called bacterial endocarditis

● Inflammation of the inner layer of heart tissue as a
result of an infectious microorganism.
● A microbial infection of the endothelial surface of
the heart.
ASSESSMENT FINDINGS ● Rare disease, but high mortality rate
● Usually develops in older adults, or in people with
prosthetic heart valves or cardiac devices.
SIGNS AND SYMPTOMS
—————————————————————————————
● Acute rheumatic fever is most common in children

2 to 3 weeks after a streptococcal infection
● Carditis
○ inflammation of the layers of the heart
● Polyarthritis
○ inflammation of more than one joint
● Rash
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DIAGNOSTIC FINDINGS
● CBC
○ Anemia and slight leukocytosis are
common findings
● 3 blood cultures collected over 1 to 24 hours
● Transesophageal Echocardiography (TEE)
● ECG
● High doses of an IV antibiotic to which the

organism is susceptible are prescribed
● Bed rest
NURSING MANAGEMENT
● Limit activity
● Assesses for changes in weight and pulse rate and
rhythm
● Client and Family Teaching
MYOCARDITIS
● An inflammation of the myocardium the muscle

layer of the heart or inflammatory process
involving the myocardium.
● Can cause:
○ heart dilation
○ thrombi on the heart wall (mural thrombi)
PATHOPHYSIOLOGY AND ETIOLOGY ○ infiltration of circulating blood cells around
the coronary vessels and between the
muscle fibers
○ degeneration of the muscle fibers
ASSESSMENT FINDINGS
● Fever
● Chills
● Muscle aches in the lower back and thighs
● Joint pain
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● Dyspnea
● Malaise, fatigue, and anorexia
● Pale or cyanotic
● Crackles may be heard in the lungs
DIAGNOSTIC FINDINGS
—————————————————————————————
● CBC
○ WBC count is slightly elevated
● C-reactive protein
● ECG
● CXR
● Echocardiography
● Myocardial biopsy
○ may be done to obtain a definitive
diagnosis.
● Antibiotics
● Bed rest
● A viral, bacterial, fungal, or parasitic infection
● Sodium restricted diet
causes most cases.
● Cardiotonic drugs
● The usual viral agents are coxsackie viruses A and
○ digitalis and related drugs
B, influenza A and B viruses, measles, adenovirus,
● Heart transplant is necessary
mumps, rubella, rubeola, Epstein-Barr virus, and
○ in severe cases of cardiomyopathy
cytomegalovirus.
NURSING MANAGEMENT
PATHOPHYSIOLOGY AND ETIOLOGY
● Vital signs
● Daily weights
● Intake and output
● Heart and lung sounds
● Pulse oximetry measurements
PERICARDITIS
● Pericarditis is inflammation of the pericardium

● The inflammation can occur with or without
effusion, the accumulation of fluid between two
layers of tissue
● Classification of pericarditis
○ Acute
○ Chronic
○ Recurrent
● Etiology
○ Infectious
○ Non-infectious
ASSESSMENT FINDINGS
SIGNS AND SYMPTOMS

—————————————————————————————
● Sharp stabbing or squeezing chest discomfort
● Low-grade fever
● Tachycardia
● Dysrhythmias
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● Rest, analgesics, antipyretics

● Nonsteroidal anti-inflammatory drugs (NSAIDs)
● Corticosteroids
● Pericardiocentesis
○ needle aspiration of fluid from between
the visceral and parietal pericardium
○ may be necessary when cardiac output is
severely reduced.
● Pericardiostomy
○ a surgical opening or window is made in
PATHOPHYSIOLOGY AND ETIOLOGY the pericardium to allow the fluid to drain
when pericardiocentesis and catheter
drainage are inadequate.
● Pericardiectomy
○ surgical treatment for constrictive
pericarditis involves removing the
pericardium, or removing the surface layer
of the pericardium (decortication) to allow
more adequate filling and contraction of
the heart chambers.
ASSESSMENT
● Ask the client about the incidence and nature of

the pain and what worsens or relieves it.
● Assess for a pericardial friction rub by auscultating
heart sounds while the client briefly holds his or
her breath
○ pericardial friction rub does not disappear
● Pericardial fluid accumulation results in cardiac when the client holds the breath
tamponade, acute compression of the heart.
● The pericardial fluid occupies space the heart
DIAGNOSIS # 1
needs to accommodate for filling with blood.
● The impaired filling is reflected by a condition
called pulsus paradoxus or paradoxical pulse. ● Pain related to pericardial inflammation and
decreased myocardial perfusion
ASSESSMENT FINDINGS PLANNING AND INTERVENTIONS

—————————————————————————————
SIGNS AND SYMPTOMS
————————————————————————————— ● Assess pain status as often as vital signs
● Fever and malaise ● Assist client to a position of comfort such as sitting
● Dyspneic or complaints of heaviness in the chest upright and leaning forward
● Precordial pain ● Administer anti-inflammatory drugs and
○ pain in the anterior chest overlying the analgesics as prescribed.
heart ● Reassure the client that pericardial pain does not
● Pericardial friction rub indicate an MI.
○ a scratchy, high-pitched sound is a
diagnostic sign EXPECTED OUTCOMES
—————————————————————————————
DIAGNOSTIC FINDINGS ● Client will be free of pain or pain will be tolerable
————————————————————————————— 30 minutes after nursing interventions
DIAGNOSIS # 2
● ECG
○ ST segment elevated
● Echocardiography ● Decreased Cardiac Output related to inability of
● CBC the heart muscle to stretch completely, fill with
○ WBC & ESR elevated appropriate amount of blood, and eject a sufficient
volume during ventricular systole.
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PLANNING AND INTERVENTIONS

—————————————————————————————
● Monitor vital signs every 4 hours and as needed

● Measure urine output every hour unless output is
greater than 35mL/hour.
● Monitor for cardiac dysrhythmias
● Assess orientation
○ Confusion and disorientation are signs of
compromised cerebral arterial blood flow
secondary to decreased cardiac output.
● Instruct the client to report chest pain
● Administer supplemental oxygen as prescribed.
● Provide six small meals a day
○ avoid gas-forming foods
● Restrict caffeine and sodium
● Collaborate with the physician regarding a stool PATHOPHYSIOLOGY AND ETIOLOGY
softener.
● Administer prescribed medications
○ sedatives, anxiolytics, vasodilators,
diuretics, and antidysrhythmics.
EXPECTED OUTCOMES
—————————————————————————————
● Client will:
○ maintain normal arterial BP
○ remain alert
○ be free of chest pain
○ eliminate at least 35 mL of urine per hour.
CARDIOMYOPATHY
● a heart muscle disease associated with cardiac

dysfunction or chronic condition characterized by
structural changes in the heart muscle.
ASSESSMENT FINDINGS
3 MAJOR TYPES OF CARDIOMYOPATHY
————————————————————————————— DILATED CARDIOMYOPATHY
● Dilated cardiomyopathy —————————————————————————————
● Hypertrophic cardiomyopathy ● Signs and Symptoms
● Restrictive cardiomyopathy ○ Dyspnea on exertion and when lying down
○ Fatigued and swelling of legs
○ Palpitations and chest pain
HYPERTROPHIC CARDIOMYOPATHY
—————————————————————————————
● Signs and Symptoms
○ Syncope or near-syncopal episodes
■ sudden loss of consciousness
○ Fatigued, become short of breath
○ Develop chest pain
RESTRICTIVE CARDIOMYOPATHY
—————————————————————————————
● Signs and Symptoms
○ Exertional dyspnea
■ sensation of running out of the air
and of episodes not being able to
breathe fast or deeply enough
during physical activity
○ Ascites
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■ fluid in the abdomen
CONGESTIVE HEART FAILURE
○ Hepatomegaly
■ enlarged liver
● The inability of the heart to pump sufficient blood
to meet the needs of the tissues for oxygen and
DIAGNOSTIC FINDINGS nutrients.
● The term congestive heart failure (CHF) describes
● ECG the accumulation of blood and fluid in organs and
● Cardiac catheterization tissues from impaired circulation.
○ detects elevated pressures in the ventricles ● The inability of the heart to pump sufficient blood
of the heart to meet the body's metabolic needs.
● Endomyocardial biopsy ● An estimate of the heart's efficiency as a pump is
○ to obtain a specimen of heart tissue for its ejection fraction, the percentage of blood the
microscopic examination left ventricle ejects when it contracts.
○ The biopsy may reveal myocardial disarray,
an alteration in the usual alignment of CARDIAC HEMODYNAMICS
myofibrils, the contractile component of —————————————————————————————
muscle tissue. ● Cardiac output (CO)
○ The heart's ability to pump is measured,
the amount of blood pumped in 1 minute.
○ CO = HR × SV
● Preload
○ the amount of myocardial stretch just
before systole caused by the pressure
created by the volume of blood within the
ventricle.
● Afterload
○ the amount of resistance to the ejection of
blood from the ventricle.
MEDICAL AND SURGICAL MANAGEMENT ● Contractility
○ the force of contraction
● Diuretics, cardiac glycosides such as digitalis, and ○ related to the number and status of
antihypertensives are prescribed to promote myocardial cells.
effective heart contraction and adequate cardiac
output.
ASSESSMENT OF LEFT VENTRICULAR
EJECTION FRACTION
● Ventriculomyomectomy
○ removal of thickened myocardial muscle
from the septum
Ejection Fraction Evaluation of Fraction
○ This surgical procedure enlarges the left
ventricular chamber and allows a greater ≥ 55 % Normal
ejection of blood with each heart
contraction. 45 – 55 % Mildly reduced
● Mitral Valve Replacement
○ At the same time as the 35 – 45 % Moderately reduced
ventriculomyomectomy to correct the
< 35 % Severely reduced
leakage of blood from the left atrium into
the left ventricle.
● Heart Transplant
○ When there are no other alternatives for
TYPES OF HEART FAILURE
supporting the heart's pumping function
ACUTE HEART FAILURE
—————————————————————————————
NURSING MANAGEMENT ● A sudden change in the heart's ability to contract.
It can cause life-threatening symptoms and
● Oxygen administration pulmonary edema.
● Monitor intake and output
● Assess weight CHRONIC HEART FAILURE
● Check for dependent edema regularly —————————————————————————————
● Occurs when the heart's ability to pump effectively
is gradually compromised and its impaired
contractility remains prolonged.
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4 FUNCTIONAL STAGES OF CHF CLINICAL MANIFESTATIONS
CLASS I (MILD) LEFT-SIDED HF

—————————————————————————————
—————————————————————————————
● Ordinary physical activity does not cause undue
● Most often precedes right-sided cardiac failure
fatigue, palpitations, or dyspnea.
● Pulmonary congestion:
● The client does not experience any limitation of
○ Dyspnea
activity.
○ Cough
○ pulmonary crackles
CLASS II (MILD) ○ low oxygen saturation levels
————————————————————————————— ○ an extra heart sound, the S3, or "ventricular
● The client is comfortable at rest, but ordinary gallop," may be detected on auscultation.
physical activity results in fatigue, heart ● Dyspnea on exertion (DOE)
palpitations, or dyspnea. ● Orthopnea
● Paroxysmal nocturnal dyspnea (PND)
CLASS III (MODERATE)
————————————————————————————— ● Cough initially dry and nonproductive
● There is a marked limitation of physical activity. ○ may become moist over time
● The client is comfortable at rest, but less than ● Large quantities of frothy sputum
ordinary activity causes fatigue, heart palpitations, ○ sometimes pink (blood-tinged)
or dyspnea. ● Bibasilar crackles advancing to crackles in all lung
fields
CLASS IV (SEVERE) ● Inadequate tissue perfusion.
————————————————————————————— ● Oliguria and nocturia.
● The client is unable to carry out any physical ● With progression of HF:
activity without discomfort. ○ altered digestion
● Symptoms of cardiac insufficiency occur at rest. ○ dizziness
● Discomfort is increased if any physical activity is ○ lightheadedness
undertaken. ○ confusion
RIGHT-SIDED HF
LEFT SIDED AND RIGHT SIDED HEART FAILURE —————————————————————————————
● Congestion of the viscera and peripheral tissues
LEFT-SIDED HF ● Edema of the lower extremities
————————————————————————————— ○ dependent edema
● Results from various conditions that impair the left ● Hepatomegaly
ventricle's ability to eject blood into the aorta. ○ enlargement of the liver
● Ascites
RIGHT-SIDED HF ○ accumulation of fluid in the peritoneal
cavity
—————————————————————————————
● Anorexia
● Occurs when the right ventricle fails to eject its
● Nausea
total diastolic filling volume into the pulmonary
● Weakness
artery, causing congestion of blood in the venous
● Weight gain due to retention of fluid
vascular system.
● Cor pulmonale
○ a condition in which the heart (cor) is
PATHOPHYSIOLOGY AND ETIOLOGY affected secondarily by lung damage
(pulmonale).
● Prolonged pulmonary arterial vasoconstriction
results in pulmonary hypertension
○ elevated pressure in the pulmonary arterial
system
● Restlessness and anxiety
● Pale or ashen and cool and clammy skin
● Tachycardia
● Weak, thready pulse
● Fatigue
NCM112J
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● Dobutamine
ASSESSMENT AND DIAGNOSTIC METHODS
○ Medications for diastolic dysfunction
○ Possibly anticoagulants, medications that
● Assessment of ventricular function manage hyperlipidemia (statins)
● Echocardiogram ● Drug Therapy
● Chest x-ray ○ The method of giving large doses of
● Electrocardiogram (ECG) digoxin at the beginning of therapy to
● Laboratory studies build up therapeutic blood levels of the
○ serum electrolytes drug is termed digitalization.
○ blood urea nitrogen (BUN) ○ The apical heart rate is assessed for a full
○ creatinine minute before every administration and is
○ thyroid-stimulating hormone (TSH) documented in the medication
○ CBC count administration record.
○ brain natriuretic peptide (BNP) ○ Digitalis drugs are withheld if the heart
○ routine urinalysis rate is less than 60 or more than 120
● Cardiac stress testing beats/min until a physician is consulted
● Cardiac catheterization
DIAGNOSTIC FINDINGS FOR LEFT-SIDED HF SURGICAL MANAGEMENT

—————————————————————————————
● Multiple gated acquisition (MUGA) scan ● Coronary bypass surgery
○ also called a gated blood pool scan ● Percutaneous transluminal coronary angioplasty
○ measures a decrease in the ejection (PTCA)
fraction ● Other innovative therapies as indicated
○ the most accurate noninvasive test that ○ mechanical assist devices
measures the left ventricle's ejection ○ transplantation
fraction during rest and activity.
NURSING PROCESS : THE PATIENT WITH HF

MEDICAL MANAGEMENT
ASSESSMENT
● Overall goals of management of HF: —————————————————————————————
○ relieve patient symptoms ● The nursing assessment for the patient with HF
○ improve functional status and quality of focuses on observing for effectiveness of therapy
life and for the patient's ability to understand and
○ extend survival. implement self management strategies.
● Treatment options vary according to the severity of
the patient's condition and may include: NURSING DIAGNOSES
○ oral and IV medications —————————————————————————————
○ major lifestyle changes ● Activity intolerance and fatigue related to
○ supplemental oxygen decreased CO
○ implantation of assistive devices ● Excess fluid volume related to the HF syndrome
○ surgical approaches ● Anxiety related to breathlessness from inadequate
■ including cardiac transplantation oxygenation
● Lifestyle recommendations ● Powerlessness related to chronic illness and
○ restriction of dietary sodium hospitalizations
○ avoidance of excessive fluid intake, alcohol, ● Ineffective therapeutic regimen management
and smoking related to lack of knowledge
○ weight reduction when indicated
○ regular exercise PLANNING AND GOALS
● Pharmacologic Therapy
—————————————————————————————
○ Alone or in combination:
● Promoting activity and reducing fatigue
■ vasodilator therapy
● Relieving fluid overload symptoms
● angiotensin converting
● Decreasing anxiety or increasing the patient's
enzyme (ACE) inhibitors)
ability to manage anxiety
● Encouraging the patient to verbalize his or her
■ angiotensin Il receptor blockers
ability to make decisions and influence outcomes
■ select beta-blockers
● Teaching the patient about the self-care program
■ calcium channel blockers
■ diuretic therapy
■ cardiac glycosides (digitalis)
—————————————————————————————
■ other IV infusions:
● Promoting Activity Tolerance
● Nesiritide
● Reducing Fatigue
● Milrinzne
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● Managing Fluid Volume
● Controlling Anxiety
● Teaching patients self-care CLINICAL MANIFESTATIONS
● Provide patient education and involve patient in
implementing the therapeutic regimen to ● The syndrome may produce no symptoms or may
promote understanding and compliance. progress rapidly and result in sudden death.
● Fatigue
EVALUATION ● Shortness of breath
————————————————————————————— ○ not correlated with activity
● Expected Patient Outcomes ● Lightheadedness
● Demonstrates tolerance for increased activity ● Dizziness
● Maintains fluid balance ● Syncope
● Experiences less anxiety ● Palpitations
● Makes sound decisions regarding care and ● Chest pain
treatment ● Anxiety
● Adheres to self-care regimen ● A murmur of mitral regurgitation may be heard if
progressive valve leaflet stretching and
regurgitation have occurred.
ACQUIRED VALVULAR DISORDERS
● When valves do not close completely, blood flows MEDICAL MANAGEMENT

backward through the valve in a process called
regurgitation. ● Antiarrhythmic medications
● When valves do not open completely, a condition ● Calcium channel blockers / beta blockers
called stenosis, the flow of blood through the valve ● Mitral valve repair or replacement
is reduced.
DISORDERS OF THE MITRAL VALVE NURSING MANAGEMENT

—————————————————————————————
● Mitral valve prolapse ● Avoid caffeine & alcohol
○ stretching of the valve leaflet into the ● Diet
atrium during systole ● Activity
● Mitral regurgitation ● Sleep
● Mitral stenosis ● Other lifestyle factors
DISORDERS OF THE AORTIC VALVE

————————————————————————————— MITRAL REGURGITATION
● Aortic regurgitation
● Aortic stenosis ● Blood flowing back from the left ventricle into the
left atrium during systole.
● Often, the margins of the mitral valve cannot close
MITRAL VALVE PROLAPSE during systole.
● Formerly known as mitral prolapse syndrome

● A deformity that usually produces no symptoms PATHOPHYSIOLOGY
● A dysfunction of the mitral valve leaflets that
prevents the mitral valve from closing completely
during systole.
PATHOPHYSIOLOGY
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● Expectorate blood (hemoptysis)
● Cough
CLINICAL MANIFESTATIONS
ASSESSMENT AND DIAGNOSTIC FINDINGS
● Chronic mitral regurgitation
○ asymptomatic ● Echocardiography
● Acute mitral regurgitation ● Electrocardiography (ECG)
○ resulting from myocardial infarction ● Cardiac catheterization with angiography
○ usually manifests as severe congestive
heart failure
● Dyspnea MEDICAL AND SURGICAL MANAGEMENT
● Fatigue
● Weakness
● Antibiotic prophylaxis therapy
● Valvuloplasty
○ usually a commissurotomy to open or
rupture the fused commissures of the
mitral valve.
● Echocardiography ○ the repair, rather than replacement, of a
cardiac valve.
● Commissurotomy
○ repair may be made to the commissures
between the leaflets
● Mitral valve replacement
● Valvuloplasty
○ surgical repair of the heart valve AORTIC REGURGITATION
● The flow of blood back into the left ventricle from

the aorta during diastole.
MITRAL STENOSIS
● May be caused by inflammatory lesions that
deform the leaflets of the aortic valve, preventing
● An obstruction of blood flowing from the left them from completely closing the aortic valve
atrium into the left ventricle. orifice.
● Most often caused by rheumatic endocarditis,
which progressively thickens the mitral valve
leaflets and chordae tendineae. PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS ASSESSMENT AND DIAGNOSTIC FINDINGS
● Breathing difficulty (dyspnea) on exertion ● Echocardiogram

○ as a result of pulmonary venous ● Radionuclide imaging
hypertension ● ECG
● Fatigue ● Magnetic resonance imaging
○ as a result of low cardiac output ● Cardiac catheterization
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CLINICAL MANIFESTATIONS CLINICAL MANIFESTATIONS
● Forceful heartbeat ● Asymptomatic

● Arterial pulsations that are visible or palpable at ● Exertional dyspnea
the carotid or temporal arteries fatigue as a result ● Dizziness
of low cardiac output ● Syncope
● Exertional dyspnea and fatigue ● Angina pectoris
● Breathing difficulties ○ frequent symptom
○ Orthopnea
○ paroxysmal nocturnal dyspnea
○ especially at night MEDICAL MANAGEMENT
●
● Antibiotic prophylaxis
● Surgical replacement of the aortic valve
MEDICAL MANAGEMENT
● Aortic valvuloplasty or valve replacement
AORTIC STENOSIS
● The narrowing of the orifice between the left

ventricle and the aorta.
● In adults, the stenosis may involve congenital
leaflet malformations of an abnormal number of
leaflets
○ one or two rather than three
● Or it may result from rheumatic endocarditis or
cusp calcification of unknown cause.
PATHOPHYSIOLOGY
● 12-lead ECG
● Echocardiogram
● Echocardiography

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NCM112J

CARDIOVASCULAR SYSTEM | PREPARED BY : SHEENA DE LOS REYES

OVERVIEW ON THE ANATOMY & PHYSIOLOGY OF THE CARDIOVASCULAR SYSTEM

THE CARDIOVASCULAR SYSTEM

LAYERS OF THE HEART WALL

CHAMBERS OF THE HEART

SYSTEMIC AND PULMONARY CIRCULATION

● Oxygenation left side is a pump to the systemic

● Left side of the heart

CONDUCTING SYSTEM OF THE HEART

● Once inside the right ventricle, the blood passes

ASSOCIATED GREAT VESSELS OF THE HEART

● Blood in the heart chambers does not nourish the

● The blood supply of the heart comes from the

CARDIAC ACTION POTENTIAL

THE HEART: CARDIAC OUTPUT

● Cardiac output (CO)

HEMODYNAMICS ● The cardiac cycle is the events that occur in one

CHAMBERS OF THE HEART

● During the relaxation phase (diastole), all four

EFFECT OF THE HEART RATE ON

THE CARDIOVASCULAR SYSTEM: DIAGNOSTIC PROCEDURES AND HEALTH HISTORY

CARDIAC ASSESSMENT NON-MODIFIABLE

HISTORY OF PRESENT ILLNESS PAST MEDICAL HISTORY

● Onset ● Major illnesses

● Quality FAMILY HISTORY OF HEART ATTACKS

PHYSICAL EXAMINATION MURMURS

● S1 = due to closure of AV valves TROPONIN I AND T

LACTIC DEHYDROGENASES (LDH)

LABORATORY PROCEDURES CARDIAC CATHETERIZATION

● Cholesterol = 200 mg/dl ● Insertion of a catheter into the heart and

CENTRAL VENOUS PRESSURE (CVP) MONA

● Pressure in vena cava or right atrium M – morphine

9. An adult is admitted for a cardiac catheterization.

10. An adult has just returned following a left heart

CORONARY ARTERY DISEASE

● Causes / Risk Factors

PHASES OF CORONARY HEART DISEASE

● Normal coronary artery

● Refers arterioscerotic and atherosclerotic changes

HOW TO CONFIRM CAD

● Chest pain (Angina Pectoris)

PERCUTANEOUS TRANSLUMINAL CORONARY ● The goals of pharmacotherapy are to reduce

● Chest pain that occurs when part of your heart

3 COMMON TYPES OF ANGINA

UNSTABLE ANGINA ● Chest pain / discomfort

TIME COURSE FOR SERUM MARKERS IN ACUTE

Test Onset Peak Duration

CK (total) & 3 – 12 hours 18 – 24 36 – 48

LDH 6 – 12 hours 24 – 48 6 – 8 days (5

Myoglobin 1 – 4 hours 5 – 7 hours 24 hours

● Acute pain R/T imbalance between myocardial

1. Provide Oxygen at 2 L / min

1. Maintain bed rest for first 3 days

Anti Thrombotic No Streptokinase

VASODILATOR SIDE EFFECTS

● Nifedipine can cause flushing, headache,

Nitrates Yes Yes

ACE inhibitors Yes Yes

Beta-blockers Yes Yes

Calcium-channel Yes Yes

Anticoagulant Aspirin Heparin