Cardiovascular System Review

Nursing Board Review
Cardiovascular System
The Cardiovascular System
Normal Anatomy
The heart is located in the LEFT side of the
mediastinum
Consists of Three layers- epicardium,
myocardium and endocardium
The epicardium covers the outer surface of
the heart
The myocardium is the middle muscular
layer of the heart
The endocardium lines the chambers and
the valves
The layer that covers the heart is the
PERICARDIUM
There are two parts- parietal and visceral
pericardium
The space between the two pericardial
layers is the pericardial space
The heart also has four chambers-
two atria and two ventricles
The Left atrium and the right
atrium
The left ventricle and the right
ventricle
The heart chambers are guarded by
valves
The atrio-ventricular valves-
Tricuspid and bicuspid
The semi-lunar valves- Pulmonic and
aortic valves
The Blood supply of the heart comes from
the Coronary arteries
1. Right coronary artery supplies the
RIGHT atrium and RIGHT ventricle,
inferior portion of the LEFT ventricle,
the POSTERIOR septal wall and the two
nodes- AV (90%) and SA node (55%)
2. Left coronary artery- branches into the
LAD and the circumflex branch
The LAD supplies blood to the anterior
wall of the LEFT ventricle, the anterior
septum and the Apex of the left ventricle
The CIRCUMFLEX branch supplies the
left atrium and the posterior LEFT
ventricle
The CONDUCTING SYSTEM OF THE
HEART
Consists of the
1. SA node- the pacemaker
2. AV node- slowest conduction
3. Bundle of His – branches into the Right
and the Left bundle branch
4. Purkinje fibers- fastest conduction
The Heart sounds
1. S1- due to closure of the AV valves
2. S2- due to the closure of the semi-lunar
valves
3. S3- due to increased ventricular filling
4. S4- due to forceful atrial contraction
Heart rate
Normal range is 60-100 beats per minute
Tachycardia is greater than 100 bpm
Bradycardia is less than 60 bpm
Sympathetic system INCREASES HR
Parasympathetic system (Vagus)
DECREASES HR
Blood pressure
Cardiac output X peripheral resistance
Control is neural (central and
peripheral) and hormonal
Baroreceptors in the carotid and aorta
Hormones- ADH, aldosterone,
epinephrine can increase BP; ANF can
decrease BP
The vascular system consists of the arteries,
veins and capillaries
The arteries are vessels that carry blood
away from the heart to the periphery
The veins are the vessels that carry blood to
the heart
The capillaries are lined with squamos cells,
they connect the veins and arteries
The lymphatic system also is part of the
vascular system and the function of this
system is to collect the extravasated fluid
from the tissues and returns it to the blood
Cardiac Assessment
Laboratory Test Rationale
1. To assist in diagnosing MI
2. To identify abnormalities
3. To assess inflammation
Laboratory Test Rationale
4. To determine baseline value
5. To monitor serum level of
medications
6. To assess the effects of
medications
LABORATORY PROCEDURES
CARDIAC Proteins and
enzymes
CK- MB ( creatine kinase)
Elevates in MI within 4
hours, peaks in 18 hours
and then declines till 3 days

enzymes
CK- MB ( creatine
kinase)
Normal value is 0-7 U/L
CARDIAC Proteins and enzymes
Lactic Dehydrogenase (LDH)
Elevates in MI in 24 hours,
peaks in 48-72 hours
Normally LDH1 is greater
than LDH2
enzymes
Lactic Dehydrogenase (LDH)
MI- LDH2 greater than
LDH1 (flipped LDH pattern)
Normal value is 70-200 IU/L
enzymes
Myoglobin
Rises within 1-3 hours
Peaks in 4-12 hours
Returns to normal in a day
enzymes
Myoglobin
Not used alone
Muscular and RENAL disease
can have elevated myoglobin
Troponin I and T
Troponin I is usually utilized for
MI
Elevates within 3-4 hours, peaks
in 4-24 hours and persists for 7
days to 3 weeks!
Normal value for Troponin I is
less than 0.6 ng/mL
Troponin I and T
REMEMBER to AVOID IM
injections before obtaining
blood sample!
Early and late diagnosis can
be made!
SERUM LIPIDS
Lipid profile measures the
serum cholesterol,
triglycerides and lipoprotein
levels
Cholesterol= 200 mg/dL
Triglycerides- 40- 150 mg/dL
SERUM LIPIDS
LDH- 130 mg/dL
HDL- 30-70- mg/dL
NPO post midnight (usually
12 hours)
Holter Monitoring
A non-invasive test in which
the client wears a Holter
monitor and an ECG tracing
recorded continuously over a
period of 24 hours
Holter Monitoring
Instruct the client to resume
normal activities and maintain
a diary of activities and any
symptoms that may develop
ECHOCARDIOGRAM
Non-invasive test that studies
the structural and functional
changes of the heart with the use
of ultrasound
No special preparation is needed
Stress Test
A non-invasive test that studies
the heart during activity and
detects and evaluates CAD
Exercise test, pharmacologic
test and emotional test
Stress Test
Treadmill testing is the most

commonly used stress test
Used to determine CAD, Chest
pain causes, drug effects and
dysrhythmias in exercise
Stress Test
Pre-test: consent may be
required, adequate rest , eat
a light meal or fast for 4
hours and avoid smoking,
alcohol and caffeine
Post-test: instruct client to
notify the physician if any chest
pain, dizziness or shortness of
breath . Instruct client to avoid
taking a hot shower for 10-12
hours after the test
Pharmacological stress test
Use of dipyridamole
Maximally dilates
coronary artery
Side-effect: flushing of
face
Post-test: instruct client to
notify the physician if any chest
pain, dizziness or shortness of
breath . Instruct client to avoid
taking a hot shower for 10-12
hours after the test
Pharmacological stress test
Pre-test: 4 hours fasting,
avoid alcohol, caffeine
Post test: report
symptoms of chest pain
CARDIAC catheterization
Insertion of a catheter into the
heart and surrounding vessels
Determines the structure and
performance of the heart
valves and surrounding
vessels
CARDIAC catheterization
Used to diagnose CAD,
assess coronary atery
patency and determine
extent of atherosclerosis
Pretest: Ensure Consent,
assess for allergy to seafood
and iodine, NPO, document
weight and height, baseline
VS, blood tests and document
the peripheral pulses
Pretest: Fast for 8-12

hours, teachings,
medications to allay
anxiety
Intra-test: inform patient of a
fluttery feeling as the catheter
passes through the heart;
inform the patient that a feeling
of warmth and metallic taste
may occur when dye is
administered
Post-test: Monitor VS and cardiac rhythm
Monitor peripheral pulses, color and
warmth and sensation of the extremity
distal to insertion site
Maintain sandbag to the insertion site if
required to maintain pressure
Monitor for bleeding and hematoma
formation
Maintain strict bed rest for 6-12 hours
Client may turn from side to side but bed
should not be elevated more than 30 degrees
and legs always straight
Encourage fluid intake to flush out the dye
Immobilize the arm if the antecubital vein
is used
Monitor for dye allergy
CVP
The CVP is the pressure
within the SVC
Reflects the pressure under
which blood is returned to
the SVC and right atrium
CVP
Normal CVP is 0 to 8 mmHg/ 4-10 cm
H2O
Elevated CVP indicates increase in
blood volume, excessive IVF or
heart/renal failure
Low CVP may indicated hypovolemia,
hemorrhage and severe vasodilatation
Measuring CVP
1. Position the client supine with bed
elevated at 45 degrees
2. Position the zero point of the CVP
line at the level of the right atrium.
Usually this is at the MAL, 4th ICS
3. Instruct the client to be relaxed and
avoid coughing and straining.
CARDIAC ASSESSMENT
ASSESSMENT
1. Health History
Obtain description of present
illness and the chief complaint
Chest pain, SOB, Edema, etc.
Assess risk factors
CARDIAC ASSESSMENT
2. Physical examination
Vital signs- BP, PP, MAP
Inspection of the skin
Inspection of the thorax
Palpation of the PMI, pulses
Auscultation of the heart sounds
CARDIAC ASSESSMENT
3. Laboratory and diagnostic studies
CBC
cardiac catheterization
Lipid profile
arteriography
Cardiac enzymes and proteins
CXR
CVP
EEG
Holter monitoring
Exercise ECG
CARDIAC
IMPLEMENTATION
1. Assess the cardio-pulmonary
status
VS, BP, Cardiac assessment
2. Enhance cardiac output
Establish IV line to administer
fluids
CARDIAC
IMPLEMENTATION
3. Promote gas exchange
Administer O2
Position client in SEMI-Fowler’s
Encourage coughing and deep
breathing exercises
CARDIAC
IMPLEMENTATION
4. Increase client activity tolerance
Balance rest and activity periods
Assist in daily activities
5. Promote client comfort
Assess the client’s description of pain
and chest discomfort
Administer medication as prescribed
CARDIAC
IMPLEMENTATION
6. Promote adequate sleep
7. Prevent infection
Monitor skin integrity of lower
extremities
Assess skin site for edema, redness and
warmth
Monitor for fever
Change position frequently
CARDIAC
IMPLEMENTATION
8. Minimize patient anxiety

Encourage verbalization of
feelings, fears and concerns
Answer client questions.
Provide information about
procedures and medications
CARDIAC DISEASES
Coronary Artery Disease
Myocardial Infarction
Congestive Heart Failure
Infective Endocarditis
Cardiac Tamponade
Cardiogenic Shock
VASCULAR DISEASES
Hypertension
Buerger’s disease
Varicose veins
Deep vein thrombosis
Aneurysm
CAD
CAD results from the focal

narrowing of the large and
medium-sized coronary
arteries due to deposition of
atheromatous plaque in the
vessel wall
CAD
RISK FACTORS
1. Age above 45/55 and Sex- Males and post
menopausal females
2. Family History
3. Hypertension
4. DM
5. Smoking
6. Obesity
7. Sedentary lifestyle
8. Hyperlipedimia
CAD
RISK FACTORS
Most important MODIFIABLE
factors:
Smoking
Hypertension
Diabetes
Cholesterol abnormalities
CAD
Pathophysiology
Fatty streak formation in the
vascular intima  T-cells and
monocytes ingest lipids in the area
of deposition atheroma
narrowing of the arterial lumen 
reduced coronary blood flow 
myocardial ischemia
CAD
Pathophysiology
There is decreased perfusion of
myocardial tissue and inadequate
myocardial oxygen supply
If 50% of the left coronary arterial
lumen is reduced or 75% of the other
coronary artery, this becomes significant
Potential for Thrombosis and embolism
Angina Pectoris
Chest pain resulting

from coronary
atherosclerosis or
myocardial ischemia
Angina Pectoris: Clinical Syndromes
Three Common Types of
ANGINA
1. STABLE ANGINA
The typical angina that occurs
during exertion, relieved by
rest and drugs and the
severity does not change
Three Common Types of ANGINA
2. Unstable angina
Occurs unpredictably
during exertion and
emotion, severity increases
with time and pain may not
be relieved by rest and drug
Three Common Types of ANGINA
3. Variant angina
Prinzmetal angina, results
from coronary artery
VASOSPASMS, may occur
at rest
Angina Pectoris
ASSESSMENT FINDINGS
1. Chest pain- ANGINA
The most characteristic symptom
PAIN is described as mild to severe
retrosternal pain, squeezing,
tightness or burning sensation
Radiates to the jaw and left arm
Angina Pectoris
ASSESSMENT FINDINGS
1. Chest pain- ANGINA
Precipitated by Exercise, Eating
heavy meals, Emotions like
excitement and anxiety and
Extremes of temperature
Relieved by REST and Nitroglycerin
Angina Pectoris
ASSESSMENT FINDINGS
2. Diaphoresis
3. Nausea and vomiting
4. Cold clammy skin
5. Sense of apprehension and doom
6. Dizziness and syncope
Angina Pectoris
LABORATORY FINDINGS
1. ECG may show normal tracing if patient
is pain-free. Ischemic changes may show
ST depression and T wave inversion
2. Cardiac catheterization
Provides the MOST DEFINITIVE
source of diagnosis by showing the
presence of the atherosclerotic lesions
Angina Pectoris
NURSING MANAGEMENT
1. Administer prescribed medications
Nitrates- to dilate the coronary arteries
Aspirin- to prevent thrombus formation
Beta-blockers- to reduce BP and HR
Calcium-channel blockers- to dilate
coronary artery and reduce vasospasm
2. Teach the patient management of anginal attacks
Advise patient to stop all activities
Put one nitroglycerin tablet under the tongue
Wait for 5 minutes
If not relieved, take another tablet and wait for 5
minutes
Another tablet can be taken (third tablet)
If unrelieved after THREE tablets seek medical
attention
Angina Pectoris
3. Obtain a 12-lead ECG
4. Promote myocardial perfusion
Instruct patient to maintain bed rest
Administer O2 @ 3 lpm
Advise to avoid valsalva maneuvers
Provide laxatives or high fiber diet to
lessen constipation
Encourage to avoid increased physical
activities
Angina Pectoris
5. Assist in possible treatment modalities
PTCA- percutaneous transluminal
coronary angioplasty
To compress the plaque against the vessel
wall, increasing the arterial lumen
CABG- coronary artery bypass graft
To improve the blood flow to the
myocardial tissue
Angina Pectoris
6. Provide information to family
members to minimize anxiety
and promote family cooperation
7. Assist client to identify risk
factors that can be modified
8. Refer patient to proper agencies
Myocardial infarction
Death of myocardial tissue
in regions of the heart
with abrupt interruption
of coronary blood supply
ETIOLOGY and Risk factors
1. CAD
2. Coronary vasospasm
3. Coronary artery occlusion by
embolus and thrombus
4. Conditions that decrease
perfusion- hemorrhage, shock
Risk factors
1. Hypercholesterolemia
2. Smoking
3. Hypertension
4. Obesity
5. Stress
PATHOPHYSIOLOGY
Interrupted coronary blood flow
myocardial ischemia anaerobic
myocardial metabolism for several
hours myocardial death  depressed
cardiac function  triggers autonomic
nervous system response  further
imbalance of myocardial O2 demand and
supply
ASSESSMENT findings
1. CHEST PAIN
Chest pain is described as severe,
persistent, crushing substernal
discomfort
Radiates to the neck, arm, jaw and
back
ASSESSMENT findings
1. CHEST PAIN
Occurs without cause, primarily
early morning
NOT relieved by rest or
nitroglycerin
Lasts 30 minutes or longer
Assessment findings
2. Dyspnea
3. Diaphoresis
4. cold clammy skin
5. N/V
6. restlessness, sense of doom
7. tachycardia or bradycardia
8. hypotension
9. S3 and dysrhythmias
Laboratory findings
1. ECG- the ST segment is ELEVATED. T
wave inversion, presence of Q wave
2. Myocardial enzymes- elevated CK-MB,
LDH and Troponin levels
3. CBC- may show elevated WBC count
4. Test after the acute stage- Exercise
tolerance test, thallium scans, cardiac
catheterization
Nursing Interventions
1. Provide Oxygen at 2 lpm, Semi-fowler’s
2. Administer medications
Morphine to relieve pain
nitrates, thrombolytics, aspirin and anticoagulants
Stool softener and hypolipidemics
3. Minimize patient anxiety
Provide information as to procedures and drug
therapy
4. Provide adequate rest periods

5. Minimize metabolic demands
Provide soft diet
Provide a low-sodium, low
cholesterol and low fat diet
6. Minimize anxiety
Reassure client and provide
information as needed
7. Assist in treatment modalities such
as PTCA and CABG
8. Monitor for complications of MI-
especially dysrhythmias, since
ventricular tachycardia can happen
in the first few hours after MI
9. Provide client teaching
MI
Medical Management
1. ANALGESIC
The choice is MORPHINE
It reduces pain and anxiety
Relaxes bronchioles to enhance
oxygenation
MI
Medical Management
2. ACE
Prevents formation of angiotensin
II
Limits the area of infarction
MI
Medical Management
3. Thrombolytics
Streptokinase, Alteplase
Dissolve clots in the coronary
artery allowing blood to flow
NURSING INTERVENTIONS
AFTER ACUTE EPISODE
1. Maintain bed rest for the first 3
days
2. Provide passive ROM exercises
3. Progress with dangling of the
feet at side of bed
AFTER ACUTE EPISODE
4. Proceed with sitting out of bed,
on the chair for 30 minutes TID
5. Proceed with ambulation in the
room toilet hallway TID
NURSING INTERVENTIONS AFTER
ACUTE EPISODE
Cardiac rehabilitation
To extend and improve quality of life
Physical conditioning
Patients who are able to walk 3-4 mph
are usually ready to resume sexual
activities
CARDIOMYOPATHIES
Heart muscle disease
associated with cardiac
dysfunction
CARDIOMYOPATHIES
1. Dilated Cardiomyopathy
2. Hypertrophic
Cardiomyopathy
3. Restrictive cardiomyopathy
DILATED CARDIOMYOPATHY
ASSOCIATED FACTORS
1. Heavy alcohol intake
2. Pregnancy
3. Viral infection
4. Idiopathic
DILATED CARDIOMYOPATHY
PATHOPHYSIOLOGY
Diminished contractile proteins
poor contraction decreased
blood ejection increased blood
remaining in the ventricle
ventricular stretching and
dilatation.
SYSTOLIC DYSFUNCTION
HYPERTROPHIC
CARDIOMYOPATHY
Associated factors:
1. Genetic
2. Idiopathic
HYPERTROPHIC
CARDIOMYOPATHY
Pathophysiology
Increased size of myocardium
reduced ventricular volume
increased resistance to
ventricular filling diastolic
dysfunction
RESTRICTIVE
CARDIOMYOPATHY
Associated factors
1. Infiltrative diseases like
AMYLOIDOSIS
2. Idiopathic
RESTRICTIVE
CARDIOMYOPATHY
Pathophysiology
Rigid ventricular wall
impaired stretch and diastolic
filling decreased output
Diastolic dysfunction
CARDIOMYOPATHIES
Assessment findings
1. PND
2. Orthopnea
3. Edema
4. Chest pain
5. Palpitations
6. dizziness
7. Syncope with exertion
CARDIOMYOPATHIES
Laboratory Findings
1. CXR- may reveal
cardiomegaly
2. ECHOCARDIOGRAM
3. ECG
4. Myocardial Biopsy
CARDIOMYOPATHIES
Medical Management
1. Surgery
2. pacemaker insertion
3. Pharmacological drugs for
symptom relief
CARDIOMYOPATHIES
Nursing Management
1.Improve cardiac output
Adequate rest
Oxygen therapy
Low sodium diet
CARDIOMYOPATHIES
Nursing Management
2. Increase patient tolerance
Schedule activities with rest
periods in between
CARDIOMYOPATHIES
Nursing Management
3. Reduce patient anxiety
Support
Offer information about
transplantations
Support family in anticipatory
grieving
Infective endocarditis
Infection of the heart
valves and the endothelial
surface of the heart
Can be acute or chronic
Etiologic factors
1. Bacteria- Organism
depends on several factors
2. Fungi
Risk factors
1. Prosthetic valves
2. Congenital malformation
3. Cardiomyopathy
4. IV drug users
5. Valvular dysfunctions
Pathophysiology
Direct invasion of microbes
microbes adhere to damaged
valve surface and proliferate
damage attracts platelets
causing clot formation
erosion of valvular leaflets and
vegetation can embolize
Assessment findings
1. Intermittent fever
2. anorexia, weight loss
3. cough, back pain and joint
pain
4. splinter hemorrhages under
nails
Assessment findings
5. Osler’s nodes- painful
nodules on fingerpads
6. Roth’s spots- pale
hemorrhages in the retina
Assessment findings
7. Heart murmurs
8. Heart failure
Prevention
Antibiotic prophylaxis if
patient is undergoing
procedures like dental
extractions, bronchoscopy,
surgery, etc.
LABORATORY EXAM
Blood Cultures to determine
the exact organism
Nursing management
1. regular monitoring of
temperature, heart sounds
2. manage infection
3. long-term antibiotic
therapy
Medical management
1. Pharmacotherapy
IV antibiotic for 2-6 weeks
Antifungal agents are given –
amphotericin B
Medical management
2. Surgery
Valvular replacement
CHF
A syndrome of congestion of
both pulmonary and systemic
circulation caused by
inadequate cardiac function
and inadequate cardiac output
to meet the metabolic demands
of tissues
CHF
Inability of the heart to pump
sufficiently
The heart is unable to maintain
adequate circulation to meet the
metabolic needs of the body
Classified according to the major
ventricular dysfunction- Left or Right
CHF
Etiology of CHF
1. CAD
2. Valvular heart diseases
3. Hypertension
4. MI
5. Cardiomyopathy
6. Lung diseases
7. Post-partum
8. Pericarditis and cardiac tamponade
New York Heart Association
Class 1
Ordinary physical activity does
NOT cause chest pain and fatigue
No pulmonary congestion
Asymptomatic
NO limitation of ADLs
Class 2
SLIGHT limitation of ADLs
NO symptom at rest
Symptom with INCREASED
activity
Basilar crackles and S3
Class 3
Markedly limitation on ADLs
Comfortable at rest BUT
symptoms present in LESS
than ordinary activity
Class 4
SYMPTOMS are present at
rest
CHF
PATHOPHYSIOLOGY
LEFT Ventricular pump
failure back up of blood into
the pulmonary veins increased
pulmonary capillary pressure
pulmonary congestion
CHF
PATHOPHYSIOLOGY
LEFT ventricular failure
decreased cardiac output
decreased perfusion to the
brain, kidney and other
tissues  oliguria, dizziness
CHF
PATHOPHYSIOLOGY
RIGHT ventricular failure
 blood pooling in the
venous circulation 
increased hydrostatic
pressure peripheral edema
CHF
PATHOPHYSIOLOGY
RIGHT ventricular
failure blood pooling
venous congestion in the
kidney, liver and GIT
LEFT SIDED CHF
ASSESSMENT FINDINGS
1. Dyspnea on exertion
2. PND
3. Orthopnea
4. Pulmonary crackles/rales
5. cough with Pinkish, frothy sputum
6. Tachycardia
LEFT SIDED CHF
ASSESSMENT FINDINGS
7. Cool extremities
8. Cyanosis
9. decreased peripheral pulses
10. Fatigue
11. Oliguria
12. signs of cerebral anoxia
RIGHT SIDED CHF
ASSESSMENT FINDINGS
1. Peripheral dependent, pitting
edema
2. Weight gain
3. Distended neck vein
4. hepatomegaly
5. Ascites
RIGHT SIDED CHF
ASSESSMENT FINDINGS
6. Body weakness
7. Anorexia, nausea
8. Pulsus alternans
CHF
LABORATORY FINDINGS
1. CXR may reveal
cardiomegaly
2. ECG may identify Cardiac
hypertrophy
3. Echocardiogram may show
hypokinetic heart
CHF
LABORATORY FINDINGS
4. ABG and Pulse oximetry may
show decreased O2 saturation
5. PCWP is increased in LEFT
sided CHF and CVP is increased
in RIGHT sided CHF
CHF
1. Assess patient's cardio-
pulmonary status
2. Assess VS, CVP and PCWP.
Weigh patient daily to monitor
fluid retention
CHF
3. Administer medications-
usually cardiac glycosides are
given- DIGOXIN or
DIGITOXIN, Diuretics,
vasodilators and
hypolipidemics are prescribed
CHF
4. Provide a LOW sodium
diet. Limit fluid intake as
necessary
5. Provide adequate rest
periods to prevent fatigue
CHF
6. Position on semi-fowler’s
to fowler’s for adequate chest
expansion
7. Prevent complications of
immobility
CHF
NURSING INTERVENTION AFTER THE
ACUTE STAGE
1. Provide opportunities for verbalization of
feelings
2. Instruct the patient about the medication
regimen- digitalis, vasodilators and diuretics
3. Instruct to avoid OTC drugs, Stimulants,
smoking and alcohol
CHF
NURSING INTERVENTION
AFTER THE ACUTE STAGE
4. Provide a LOW fat and LOW
sodium diet
5. Provide potassium supplements
6. Instruct about fluid restriction
CHF
NURSING INTERVENTION
AFTER THE ACUTE STAGE
7. Provide adequate rest periods
and schedule activities
8. Monitor daily weight and
report signs of fluid retention
CARDIOGENIC SHOCK
Heart fails to pump adequately resulting to a
decreased cardiac output and decreased tissue
perfusion
ETIOLOGY
1. Massive MI
2. Severe CHF
3. Cardiomyopathy
4. Cardiac trauma
5. Cardiac tamponade
CARDIOGENIC SHOCK
ASSESSMENT FINDINGS
1. HYPOTENSION
2. oliguria (less than 30 ml/hour)
3. tachycardia
4. narrow pulse pressure
5. weak peripheral pulses
6. cold clammy skin
7. changes in sensorium/LOC
8. pulmonary congestion
CARDIOGENIC SHOCK
LABORATORY FINDINGS
Increased CVP
Normal is 4-10 cmH2O
CARDIOGENIC SHOCK
1. Place patient in a modified Trendelenburg
(shock ) position
2. Administer IVF, vasopressors and inotropics
such as DOPAMINE and DOBUTAMINE
3. Administer O2
4. Morphine is administered to decreased
pulmonary congestion and to relieve pain
CARDIOGENIC SHOCK
5. Assist in intubation, mechanical
ventilation, PTCA, CABG, insertion
of Swan-Ganz cath and IABP
6. Monitor urinary output, BP and
pulses
7. cautiously administer diuretics and
nitrates
CARDIAC TAMPONADE
A condition where the heart
is unable to pump blood due
to accumulation of fluid in
the pericardial sac
(pericardial effusion)
CARDIAC TAMPONADE
This condition restricts

ventricular filling resulting to
decreased cardiac output
Acute tamponade may happen
when there is a sudden
accumulation of more than 50 ml
fluid in the pericardial sac
CARDIAC TAMPONADE
Causative factors
1. Cardiac trauma
2. Complication of Myocardial
infarction
3. Pericarditis
4. Cancer metastasis
CARDIAC TAMPONADE
ASSESSMENT FINDINGS
1. BECK’s Triad- Jugular vein
distention, hypotension and
distant/muffled heart sound
2. Pulsus paradoxus
3. Increased CVP
4. decreased cardiac output
CARDIAC TAMPONADE
ASSESSMENT FINDINGS
5. Syncope
6. anxiety
7. dyspnea
8. Percussion- Flatness across the
anterior chest
CARDIAC TAMPONADE
Laboratory FINDINGS
1. Echocardiogram
2. Chest X-ray
CARDIAC TAMPONADE
1. Assist in PERICARDIOCENTESIS
2. Administer IVF
3. Monitor ECG, urine output and BP
4. Monitor for recurrence of
tamponade
Pericardiocentesis
Patient is monitored by ECG
Maintain emergency equipments
Elevate head of bed 45-60 degrees
Monitor for complications- coronary
artery rupture, dysrhythmias, pleural
laceration and myocardial trauma
HYPERTENSION
A systolic BP greater than 140
mmHg and a diastolic pressure
greater than 90 mmHg over a
sustained period, based on two
or more BP measurements.
HYPERTENSION
Types of Hypertension
1. Primary or ESSENTIAL
Most common type
2. Secondary
Due to other conditions like
Pheochromocytoma, renovascular
hypertension, Cushing’s, Conn’s , SIADH
HYPERTENSION
CLASSIFICATION OF
HYPERTENSION by JNC-
VII
HYPERTENSION
PATHOPHYSIOLOGY
Multi-factorial etiology
BP= CO (SV X HR) x TPR
Any increase in the above
parameters will increase BP
1. Increased sympathetic activity
2. Increased absorption of Sodium,
and water in the kidney
HYPERTENSION
PATHOPHYSIOLOGY
Multifactorial etiology
BP= CO (SV X HR) x TPR
Any increase in the above parameters
will increase BP
3. Increased activity of the RAAS
4. Increased vasoconstriction of the
peripheral vessels
5. insulin resistance
HYPERTENSION
ASSESSMENT FINDINGS
1. Headache
2. Visual changes
3. chest pain
4. dizziness
5. N/V
HYPERTENSION
Risk factors for Cardiovascular Problems in
Hypertensive patients
Major Risk factors
1. Smoking
2. Hyperlipidemia
3. DM
4. Age older than 60
5. Gender- Male and post menopausal W
6. Family History
HYPERTENSION
DIAGNOSTIC STUDIES
1. Health history and PE
2. Routine laboratory- urinalysis,
ECG, lipid profile, BUN, serum
creatinine , FBS
3. Other lab- CXR, creatinine
clearance, 24-huour urine protein
HYPERTENSION
MEDICAL MANAGEMENT
1. Lifestyle modification
2. Drug therapy
3. Diet therapy
HYPERTENSION
MEDICAL MANAGEMENT
Drug therapy
Diuretics
Beta blockers
Calcium channel blockers
ACE inhibitors
A2 Receptor blockers
Vasodilators
HYPERTENSION
1. Provide health teaching to
patient
Teach about the disease process
Elaborate on lifestyle changes
Assist in meal planning to lose
weight
HYPERTENSION
1. Provide health teaching to the
patient
Provide list of LOW fat , LOW sodium
diet of less than 2-3 grams of Na/day
Limit alcohol intake to 30 ml/day
Regular aerobic exercise
Advise to completely Stop smoking
HYPERTENSION
2. Provide information about anti-
hypertensive drugs
Instruct proper compliance and not abrupt
cessation of drugs even if pt becomes
asymptomatic/ improved condition
Instruct to avoid over-the-counter drugs
that may interfere with the current
medication
HYPERTENSION
Nursing Intervention
3. Promote Home care management
Instruct regular monitoring of BP
Involve family members in care
Instruct regular follow-up
4. Manage hypertensive emergency and
urgency properly
Vascular Diseases
ANEURYSM
Dilation involving an artery formed at a
weak point in the vessel wall
ANEURYSM
Saccular= when one side of the vessel is
affected
Fusiform= when the entire segment

becomes dilated
ANEURYSM
RISK FACTORS
1. Atherosclerosis
2. Infection= syphilis
3. Connective tissue disorder
4. Genetic disorder= Marfan’s Syndrome
ANEURYSM
PATHOPHYSIOLOGY
Damage to the intima and media
weakness outpouching
Dissecting aneurysm tear in the intima and

media with dissection of blood through
the layers
ANEURYSM
ASSESSMENT
1. Asymptomatic
2. Pulsatile sensation on the abdomen
3. Palpable bruit
ANEURYSM
LABORATORY:
• CT scan
• Ultrasound
• X-ray
• Aortography
ANEURYSM
Medical Management:
• Anti-hypertensives
• Synthetic graft
ANEURYSM
Nursing Management:
• Administer medications
• Emphasize the need to avoid increased
abdominal pressure
• No deep abdominal palpation
• Remind patient the need for serial
ultrasound to detect diameter changes
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
Refers to arterial insufficiency of
the extremities usually secondary
to peripheral atherosclerosis.
Usually found in males age 50 and
above
The legs are most often affected
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
Risk factors for Peripheral
Arterial occlusive disease
Non-Modifiable
1. Age
2. gender
3. family predisposition
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
Risk factors for Peripheral Arterial
occlusive disease
Modifiable
1. Smoking
2. HPN
3. Obesity
5. DM
6. Stress
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
ASSESSMENT FINDINGS
1. INTERMITTENT
CLAUDICATION- the hallmark of
PAOD
This is PAIN described as aching,
cramping or fatiguing discomfort
consistently reproduced with the same
degree of exercise or activity
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
ASSESSMENT FINDINGS
1. INTERMITTENT
CLAUDICATION- the hallmark
of PAOD
This pain is RELIEVED by REST
This commonly affects the muscle
group below the arterial occlusion
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
Assessment Findings
2. Progressive pain on the
extremity as the disease advances
3. Sensation of cold and
numbness of the extremities
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
Assessment Findings
4. Skin is pale when elevated and
cyanotic/ruddy when placed on a
dependent position
5. Muscle atrophy, leg ulceration
and gangrene
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
Diagnostic Findings
1. Unequal pulses between the
extremities
2. Duplex ultrasonography
3. Doppler flow studies
PAOD
Medical Management
1. Drug therapy
Pentoxyfylline (Trental) reduces blood
viscosity and improves supply of O2 blood to
muscles
Cilostazol (Pletaal) inhibits platelet
aggregation and increases vasodilatation
2. Surgery- Bypass graft and anastomoses
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
1. Maintain Circulation to the extremity
Evaluate regularly peripheral pulses,
temperature, sensation, motor function
and capillary refill time
Administer post-operative care to
patient who underwent surgery
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
2. Monitor and manage complications
Note for bleeding, hematoma, decreased
urine output
Elevate the legs to diminish edema
Encourage exercise of the extremity while
on bed
Teach patient to avoid leg-crossing
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
3. Promote Home management
Encourage lifestyle changes
Instruct to AVOID smoking
Instruct to avoid leg crossing
BUERGER’S DISEASE
Thromboangiitis obliterans
A disease characterized by recurring
inflammation of the medium and
small arteries and veins of the lower
extremities
Occurs in MEN ages 20-35
RISK FACTOR: SMOKING!
BUERGER’S DISEASE
PATHOPHYSIOLOGY
Cause is UNKNOWN
Probably an Autoimmune disease
Inflammation of the arteries
thrombus formation occlusion of
the vessels
BUERGER’S DISEASE
ASSESSMENT FINDINGS
1. Leg PAIN
Foot cramps in the arch (instep claudication)
after exercise
Relieved by rest
Aggravated by smoking, emotional disturbance
and cold chilling
2. Digital rest pain not changed by activity or rest
BUERGER’S DISEASE
ASSESSMENT FINDINGS
3. Intense RUBOR (reddish-blue
discoloration), progresses to
CYANOSIS as disease advances
4. Paresthesia
BUERGER’S DISEASE
Diagnostic Studies
1. Duplex ultrasonography
2. Contrast angiography
BUERGER’S DISEASE
1. Assist in the medical and surgical
management
Bypass graft
amputation
2. Strongly advise to AVOID smoking
3. Manage complications appropriately
BUERGER’S DISEASE
Post-operative care: after amputation
Elevate stump for the FIRST 24 HOURS to
minimize edema and promote venous return
Place patient on PRONE position after 24
hours
Assess skin for bleeding and hematoma
Wrap the extremity with elastic bandage
RAYNAUD’S DISEASE
A form of intermittent arteriolar
VASOCONSTRICTION that results in
coldness, pain and pallor of the
fingertips or toes
Cause : UNKNOWN
Most commonly affects WOMEN, 16-
40 years old
RAYNAUD’S DISEASE
ASSESSMENT FINDINGS
1. Raynaud’s phenomenon
A localized episode of
vasoconstriction of the small
arteries of the hands and feet that
causes color and temperature
changes
RAYNAUD’S DISEASE
W-B-R
Pallor- due to vasoconstriction, then
Blue- due to pooling of
Deoxygenated blood
Red- due to exaggerated
reflow/hyperemia
RAYNAUD’S DISEASE
ASSESSMENT FINDINGS
2. tingling sensation
3. Burning pain on the hands and
feet
RAYNAUD’S DISEASE
Medical management
Drug therapy with the use of
CALCIUM channel blockers
To prevent vasospasms
RAYNAUD’S DISEASE
1. instruct patient to avoid situations that
may be stressful
2. instruct to avoid exposure to cold and
remain indoors when the climate is cold
3. instruct to avoid all kinds of nicotine
4. instruct about safety. Careful handling
of sharp objects
Venous diseases
VARICOSE VEINS
THESE are dilated veins
usually in the lower
extremities
VARICOSE VEINS
Predisposing Factors
Pregnancy
Prolonged standing or sitting
Constipation (for
hemorrhoids)
Incompetent venous valves
VARICOSE VEINS
Pathophysiology
Factors  venous stasis
increased hydrostatic
pressure  edema
VARICOSE VEINS
Assessment findings
Tortuous superficial veins
on the legs
Leg pain and Heaviness
Dependent edema
VARICOSE VEINS
Laboratory findings
Venography
Duplex scan
pletysmography
VARICOSE VEINS
Medical management
Pharmacological therapy
Leg vein stripping
Anti-embolic stockings
VARICOSE VEINS
Nursing management
1. Advise patient to elevate
the legs
2. Caution patient to avoid
prolonged standing or sitting
VARICOSE VEINS
Nursing management
3. Provide high-fiber foods
to prevent constipation
4. Teach simple exercise to
promote venous return
VARICOSE VEINS
Nursing management
5. Caution patient to avoid
knee-length stockings and
constrictive clothings
VARICOSE VEINS
Nursing management
6. Apply anti-embolic
stockings as directed
7. Avoid massage on the
affected area
DVT- Deep Vein Thrombosis
Inflammation of the deep veins
of the lower extremities and the
pelvic veins
The inflammation results to
formation of blood clots in the
area
Predisposing factors
Prolonged immobility
Varicosities
Traumatic procedures
Complication
PULMONARY
thromboembolism
Assessment findings
Leg tenderness
Leg pain and edema
Positive HOMAN’s SIGN
Laboratory findings
Venography
Duplex scan
Medical management
Antiplatelets
Anticoagulants
Vein stripping and grafting
Anti-embolic stockings
Nursing management
1. Provide measures to avoid
prolonged immobility
Repositioning Q2
Provide passive ROM
Early ambulation
Nursing management
2. Provide skin care to prevent
the complication of leg ulcers
3. Provide anti-embolic
stockings
Nursing management
4. Administer anticoagulants
as prescribed
5. Monitor for signs of
pulmonary embolism

Cardiovascular System Review

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Cardiovascular System Review

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Nursing Board Review

CARDIAC Proteins and

Treadmill testing is the most

Pretest: Fast for 8-12

8. Minimize patient anxiety

CAD results from the focal

Chest pain resulting

4. Provide adequate rest periods

This condition restricts

Fusiform= when the entire segment

Dissecting aneurysm tear in the intima and

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