CORONARY VASCULAR

DISORDERS

LEILA C. BONDOC, MD
Coronary Artery Disease
Coronary artery disease (CAD) is a condition that
affects your coronary arteries, which supply blood to
your heart. With CAD, plaque buildup narrows or
blocks one or more of your coronary arteries. Chest
discomfort (angina) is the most common symptom.
CAD can lead to a heart attack or other complications
like arrhythmia or heart failure.
• Picture two traffic lanes that merge into one due to
construction. Traffic keeps flowing, just more slowly.
With CAD, you might not notice anything is wrong
until the plaque triggers a blood clot. The blood clot is
like a concrete barrier in the middle of the road.
Traffic stops. Similarly, blood can’t reach your heart,
and this causes a heart attack.
• You might have CAD for many years and not have
any symptoms until you experience a heart attack.
That’s why CAD is a “silent killer.”

• Other names for CAD include coronary heart disease

and ischemic heart disease. It’s also what most
people mean when they use the general term “heart
disease.”
• Forms of coronary artery disease
• There are two main forms of coronary artery disease:
1. Stable ischemic heart disease: This is the chronic form. Your
coronary arteries gradually narrow over many years. Over
time, your heart receives less oxygen-rich blood. You may feel
some symptoms, but you’re able to live with the condition day
to day.
2. Acute coronary syndrome: This is the sudden form that’s a
medical emergency. The plaque in your coronary artery
suddenly ruptures and forms a blood clot that blocks blood
flow to your heart. This abrupt blockage causes a heart attack.
• The main complication of coronary artery disease is a
heart attack. This is a medical emergency that can be fatal.
Your heart muscle starts to die because it’s not receiving
enough blood.
• Over the years, CAD can also weaken your heart and lead
to complications, including:
• Arrhythmias (like atrial fibrillation).
• Cardiac arrest.
• Cardiogenic shock.
• Heart failure.
CAUSES OF CORONARY ARTERY DISEASE
Atherosclerosis causes coronary artery disease.
Atherosclerosis is the gradual buildup of plaque in
arteries throughout your body. When the plaque
affects blood flow in your coronary arteries, you have
coronary artery disease.
Plaque consists of cholesterol, waste products,
calcium and fibrin (a substance that helps your blood
clot). As plaque continues to collect along your artery
walls, your arteries become narrow and stiff.
• Plaque can clog or damage your arteries, which limits or
stops blood flow to a certain part of your body. When
plaque builds up in your coronary arteries, your heart
muscle can’t receive enough blood. So, your heart can’t get
the oxygen and nutrients it needs to work properly. This
condition is called myocardial ischemia. It leads to chest
discomfort (angina) and puts you at risk for a heart attack.
• People who have plaque buildup in their coronary arteries
often have buildup elsewhere in their body, too. This can
lead to conditions like carotid artery disease and peripheral
artery disease.
RISK FACTORS FOR CORONARY ARTERY DISEASE

Risk factors you can’t control (non-modifiable risk factors)

1. Age: As you get older, your risk for CAD goes up. Men
and people AMAB face a higher risk after age 45. Women
and people AFAB face a higher risk after age 55.
2. Family history: You have a higher risk if your biological
family members have heart disease. It’s especially important
to learn if they have premature heart disease. This means
they were diagnosed at a young age (father or brother
before age 55, mother or sister before age 65).
• Lifestyle factors that raise your risk
1. Diet high in saturated fat or refined carbohydrates.
2. Lack of physical activity.
3. Sleep deprivation.
4. Smoking, vaping or other tobacco use.
• Cardiovascular conditions that raise your risk
1. Atherosclerosis.
2. High blood pressure.
3. High LDL (“bad”) cholesterol.
4. High triglycerides (hypertriglyceridemia).
• Other medical conditions that raise your risk
1. Anemia.
2. Autoimmune diseases, including lupus and rheumatoid arthritis.
3. Chronic kidney disease.
4. Diabetes.
5. HIV/AIDS.
6. Metabolic syndrome.
7. Overweight/obesity.
8. Sleep disorders like sleep apnea.
• Risk factors that affect women and people assigned
female at birth
1. Early menopause (before age 40).
2. Endometriosis.
3. History of gestational diabetes, eclampsia or
preeclampsia.
3. Use of hormonal birth control.
• Symptoms of chronic CAD include:
1. Stable angina: This is the most common symptom.
Stable angina is temporary chest pain or discomfort
that comes and goes in a predictable pattern. You’ll
usually notice it during physical activity or emotional
distress. It goes away when you rest or take
nitroglycerin.
2. Shortness of breath (dyspnea): Some people feel
short of breath during light physical activity.
• There are four main types of angina:
1. Stable angina.
2. Unstable angina- Happens without warning.
Can happen even if you’re resting or sleeping.
Doesn’t last the same amount of time (and can last a
long time) or has the same cause each time.
3. Microvascular angina.
Microvascular angina is a type of angina (chest pain)
that happens because of problems in the small blood
vessels bringing oxygenated blood to the heart. If the
heart muscle doesn't get enough oxygen, it will be
damaged and start to die. Microvascular angina can
be treated with medicine and lifestyle changes.
4. Prinzmetal (variant) angina.
Prinzmetal angina (vasospastic angina or variant
angina) is a known clinical condition characterized by
chest discomfort or pain at rest with transient
electrocardiographic changes in the ST segment, and
with a prompt response to nitrates. These symptoms
occur due to abnormal coronary artery spasm.
 Symptoms of a CAD include:
1. Chest pain or discomfort (angina). Angina can range
from mild discomfort to severe pain. It may feel like
heaviness, tightness, pressure, aching, burning,
numbness, fullness, squeezing or a dull ache. The
discomfort may spread to your shoulder, arm, neck,
back or jaw.
2. Shortness of breath or trouble breathing.
3. Feeling dizzy or lightheaded.
4. Heart palpitations.
5. Feeling tired.
6. Nausea, stomach discomfort or vomiting. This may
feel like indigestion.
7. Weakness.
• Women and people AFAB are more likely to have
additional, atypical symptoms that include:
1. Shortness of breath, fatigue and insomnia that
began before the heart attack.
2. Pain in their back, shoulders, neck, arms or belly.
3. Heart racing.
4. Feeling hot or flushed.
DIAGNOSIS OF CAD
1. History and Physical examination
2. Vital signs
3. Ask you about your medical history.
4. Ask you about your lifestyle.
5. Ask you about your family history. They’ll want to
know about heart disease among your biological
parents and siblings.
• Tests that help diagnose coronary artery disease
1. Blood tests: Check for substances that harm your
arteries or increase your risk of CAD.
2. Cardiac catheterization: Inserts tubes into your
coronary arteries to evaluate or confirm CAD. This test is
the gold standard for diagnosing CAD.
3. Computed tomography (CT) coronary angiogram:
Uses CT and contrast dye to view 3D pictures of your
heart as it moves. Detects blockages in your coronary
arteries.
4. Coronary calcium scan: Measures the amount of calcium in the
walls of your coronary arteries (a sign of atherosclerosis). This
doesn’t determine if you have significant blockages, but it does help
determine your risk for CAD.
5. Echocardiogram (echo): Uses sound waves to evaluate your
heart’s structure and function.
6. Electrocardiogram (EKG/ECG): Records your heart’s electrical
activity. Can detect old or current heart attacks, ischemia and heart
rhythm issues.
7. Exercise stress test: Checks how your heart responds when it’s
working very hard. Can detect angina and blockages in your
coronary arteries.
MANAGEMENT AND TREATMENT FOR CAD
A. Lifestyle changes play a big role in managing CAD.
Such changes include:
1. Don’t smoke, vape, or use any tobacco products.
2. Eat a heart-healthy diet that’s low in sodium, saturated
fat, trans fat and sugar. The Mediterranean diet has been
proven to lower your risk of a heart attack or stroke.
3. Exercise: Aim for 30 minutes of walking five days a
week, or find activities you enjoy.
4. Limit alcohol.
• Risk factor management
1. Diabetes.
2. High blood pressure.
3. High cholesterol.
4. High triglycerides (hypertriglyceridemia).
5. Overweight/obesity.
• Medications
1. Medications to lower your blood pressure.
2. Medications to lower your cholesterol.
3. Medications to manage stable angina. These
include nitroglycerin and ranolazine.
4. Medications to reduce your risk of blood clots.
• MEDICAL TREATMENT
• 1. BLOOD THINNING MEDICINES- HELP REDUCE THE
HEART ATTACK BY THINNING YOUR BLOOD AND
PREVENTING IT TO CLOT
• EX: LOW DOSE ASPIRIN, CLOPIDOGREL
• 2. STATINS-CHOLESTEROL LOWERING MEDICINES.IT
BLOCKS THE FORMATION OF CHOLESTEROL AND
INCREASING THE NUMBER OF HDL RECEPTORS IN THE
LIVER.IT HELPS TO REMOVE LDL FROM YOUR BLOOD
WHICH MAKES A HEART ATTACK LESS LIKELY
• EX: SIMVASTATIN,ATORVASTATIN,ROSUVASTATIN
• 3. BETA BLOCKERS – BLOCKING THE EFFECTS OF
A PARTICULAR HORMONE IN THE BODY WHICH
SLOWS DOWN YOUR HEARTBEAT AND IMPROVES
BLOOD FLOW EX: METOPROLOL,ATENOLOL,
• 4. NITRATES- VASODILATORS. USED TO WIDEN
YOUR BLOOD VESSELS. IT WORKS BY RELAXING
YOUR BLOOD VESSELS LETTING MORE BLOOD TO
PASS THROUGH THEM.IT LOWERS BP AND
RELIEVES HEART PAIN YOU HAVE.
• EX;: ISMN(ISOSORBIDE MONONITRATE),ISORDIL
SURGICAL TREATMENT FOR CAD
• 1. CORONARY ANGIOPLASTY-ALSO KNOWN AS PCI,PTCA
• FIRST DO CORONARY ANGIOGRAM- TYPE OF XRAY USED
TO CHECK BLOOD VESSELS
• PLANNED PROCEDURE FOR SOMEONE WITH ANGINA OR
URGENT TREATMENT IF SYMPTOMS HAVE BECOME
UNSTABLE
• A SMALL BALLOON IS INSERTED TO PUSH THE FATTY
TISSUE IN THE NARROWED ARTERY OUTWARDS.THIS
ALLOW BLOOD TO FLOW MORE EASILY
• A METAL STENT(WIRE MESH TUBE) IS USUALLY PLACED
IN THE ARTERY TO HOLD IT OPEN
• 2. CORONARY ARTERY BYPASS GRAFT-(CABG)
• USED FOR PEOPLE WHOSE ARTERIES ARE NARROWED OR
BLOCK
• OFF PUMP CORONARY ARTERY BYPASS – IT IS PERFORMED
WHILE THE HEART CONTINUES TO PUMP BLOOD BY ITSELF
WITHOUT THE NEED FOR A HEART LUNG MACHINE
• A BLOOD VESSEL IS INSERTED(SAPHENOUS VEIN,INTERNAL
MAMMARY ARTERY, RADIAL ARTERY)BETWEEN THE MAIN
ARTERY LEAVING THE HEART AND A PART OF THE
CORONARY ARTERY BEYOND THE NARROWED OR BLOCKED
AREA.THIS ALLOW THE BLOOD TO BYPASS THE NARROWED
SECTION OF THE CORONARY ARTERIES
• 3. HEART TRANSPLANT
• REPLACES THE HEART WITH A DONOR’S HEART.
• USED IF ONE OR BOTH VENTRICLES OF THE HEART ARE
NOT FUNCTIONING OR FOR SEVERE HEART FAILURE
• DONOR’S HEART IS MATCHED TO THE RECIPIENT BY
BLOOD TYPE AND BODY SIZE
• AS A HEART TRANSPLANT RECIPIENT YOU MUSTTAKE
MEDICATIONS TO PREVENT YOUR IMMUNE SYSTEM
FROM REJECTING NEW HEART.THIS DRUGS ARE
IMMUNOSUPPRESIVE MEDICATIONS
NURSING INTERVENTIONS FOR CAD
• 1. EASE SYMPTOMS- GIVE PRESCRIBED MEDS, ADVISED
TO GET SOME GENTLE EXERCISE,BREATHE RIGHT TO
EASE PAIN, COUNSELLING, DOCUMENTS COMPLAINTS
• 2. IMPROVE CORONARY ARTERY BLOOD FLOW-
ADVISED TO QUIT SMOKING, MONITOR VS, ADVISED TO
MAINTAIN A HEALTHY WEIGHTS, ADVISED TO EAT LOW
FAT,LOW SALT AND DIET THAT IS RICH IN
FRUITS,VEGETABLES AND WHOLE GRAIN
• 3. PREVENT COMPLICATIONS- MONITORING VS AND
RECORD THEM, CHECKING THE LOWER EXTREMITIES
FOR PROBLEM, GIVE PRESCRIBED MEDICATIONS
MYOCARDIAL INFARCTION
• A myocardial infarction (commonly called a heart
attack) is an extremely dangerous condition that
happens because of a lack of blood flow to your
heart muscle. The lack of blood flow can occur
because of many different factors but is usually
related to a blockage in one or more of your heart’s
arteries. Without blood flow, the affected heart
muscle will begin to die. If blood flow isn’t restored
quickly, a heart attack can cause permanent heart
damage and death.
RISK FACTORS FOR MYOCARDIAL INFARCTION
Several key factors affect your risk of having a heart attack. Unfortunately,
some of these heart attack risk factors aren’t things you can control:
1. Age and sex: Your risk of heart attack increases as you get older. Your
sex influences when your risk of a heart attack starts to increase. For
people assigned male at birth (AMAB), the risk of heart attack increases
at age 45. For people AFAB, the risk of heart attack increases at age 50 or
after menopause.
2. Family history of heart disease: If you have a parent or sibling with a
history of heart disease or heart attack — especially at a younger age —
your risk is even greater because your genetics are similar to theirs. Your
risk increases if your father or a brother received a heart disease
diagnosis at age 55 or younger. It also increases if your mother or a sister
received a heart disease diagnosis at age 65 or younger.
3. Lifestyle: Lifestyle choices you make that aren’t
good for your heart can increase your risk of having a
heart attack. This includes things like smoking, lack of
physical activity, drinking too much alcohol and drug
use.
4. Certain health conditions: Some health conditions
put stress on your heart and increase your risk for
heart attack. This includes diabetes, obesity, high
blood pressure, high cholesterol, eating disorders or a
history of preeclampsia.
CAUSES OF MYOCARDIAL INFARCTION
• The vast majority of heart attacks occur because of a blockage
in one of the blood vessels that supplies your heart. This most
often happens because of plaque, a sticky substance that can
build up on the insides of your arteries (similar to how pouring
grease down your kitchen sink can clog your home plumbing).
That buildup is called atherosclerosis.
• Sometimes, plaque deposits inside the coronary (heart)
arteries can break open or rupture, and a blood clot can get
stuck where the rupture happened. If the clot blocks the artery,
this can deprive the heart muscle of blood and cause a heart
attack.
• Heart attacks are possible without a blockage, but this is rare
and only accounts for about 5% of all heart attacks. This kind of
heart attack can occur for the following reasons:
1. Coronary artery spasm.
2. Rare medical conditions: An example of this would be any
disease that causes unusual narrowing of blood vessels.
3. Trauma: This includes tears or ruptures in the coronary
arteries.
4. Obstruction that came from somewhere else in your body: A
blood clot or air bubble (embolism) that gets trapped in a
coronary artery.
5. Electrolyte imbalance.
6. Eating disorders: Over time, these can damage your
heart and ultimately result in a heart attack.
7. Takotsubo or stress cardiomyopathy.
8. Anomalous coronary arteries (a congenital heart
defect you’re born with where the coronary arteries are
in different positions than normal in your body.
Compression of these causes a heart attack).
• Symptoms of a heart attack that people describe most
often include:
1. Chest pain (angina). This can be mild and feel like
discomfort or heaviness, or it can be severe and feel like
crushing pain. It may start in your chest and spread (or
radiate) to other areas like your left arm (or both arms),
shoulder, neck, jaw, back or down toward your waist.
2. Shortness of breath or trouble breathing.
3. Fatigue.
4. Trouble sleeping (insomnia).
5. Nausea or stomach discomfort. Heart attacks can
often be mistaken for indigestion or heartburn.
6. Heart palpitations.
7. Anxiety or a feeling of “impending doom.”
8. Sweating.
9. Feeling lightheaded, dizzy or passing out.
• Heart attack symptoms in women and people AFAB
• Medical research in recent years has shown that
women and people AFAB are less likely to have
chest pain or discomfort that feels like indigestion.
They’re more likely to have shortness of breath,
fatigue and insomnia that started before the heart
attack. They also have nausea and vomiting or pain
in the back, shoulders, neck, arms or abdomen.
DIAGNOSIS OF MYOCARDIAL INFARCTION
1. History and symptoms: The provider will ask you
about the symptoms you experienced. They might also
ask someone who was with you to describe what
happened.
2. Blood tests: During a heart attack, the damage to
heart muscle cells almost always causes a chemical
marker, a cardiac troponin I, to appear in your
bloodstream. Blood tests that look for that marker are
among the most reliable methods to diagnose a heart
attack.
A. Cardiac enzymes (including troponin I and creatine
kinase(CKMB)- Raised troponin levels indicate cardiac
muscle cell death as the enzyme is released into the
blood upon injury to the heart.
CK-MB first appears 4-6 hours after symptom onset,
peaks at 24 hours, and returns to normal in 48-72
hours. Its value in the early and late (>72 h) diagnosis
of acute MI is limited. However, its release kinetics can
assist in diagnosing reinfarction if levels rise after
initially declining following acute MI.
B. C-reactive protein (CRP)- C‐reactive protein (CRP),
an acute phase reactant as downstream marker of
inflammation, has been shown to correlate with the
extent of cardiac injury in the acute phase of MI.
C. FIbrinogen - an increased plasma level of
fibrinogen is a coronary risk indicator because it
reflects the inflammatory condition of the vascular wall.
 D. homocysteine- A homocysteine test is a blood test.
It measures the amount of homocysteine, an amino
acid in the body. The test is often used to diagnose
vitamin B6, B9 or B12 deficiency. People with elevated
homocysteine may have a higher risk for
cardiovascular disease
E. Lipoproteins- Overall, high Lp(a) concentrations
(>50 mg/dL) were associated with an increased risk of
MI
F. Triglycerides - High triglycerides may contribute to
hardening of the arteries or thickening of the artery
walls (arteriosclerosis) — which increases the risk of
stroke, heart attack and heart disease.
G. Brain natriuretic peptide (BNP) -BNP is elevated in
AMI and is a quantitative biochemical marker related
to the extent of infarction and the left ventricle systolic
dysfunction
H. Prothrombin- When the PT is high, it takes longer
for the blood to clot (17 seconds, for example). This
usually happens because the liver is not making the
right amount of blood clotting proteins, so the clotting
process takes longer.
3. ELECTROCARDIOGRAM (EKG or ECG): This is one
of the first tests you get when you come to an ER with
heart attack symptoms.
4. Echocardiogram: Using ultrasound (high-frequency
sound waves), an echocardiogram generates a picture of
the inside and outside of your heart.
5. Angiogram: This test shows areas with little or no
blood flow.
6. Heart computed tomography (CT) scan: This creates a
highly detailed scan of your heart.
7. Heart MRI: This test uses a powerful magnetic field
and computer processing to create an image of your
heart.
8. Nuclear heart scans: Similar to angiography, these
scans use a radioactive dye injected into your blood.
What sets them apart from an angiogram is that they
use computer-enhanced methods like computed
tomography (CT) or positron emission tomography
(PET) scans.
• PLEASE ADMIT TO ICU UNDER MY SERVICE
• MONITOR VS SIGNS Q 1 HOUR AND RECORD
PLEASE
• NPO OR LOW FAT,LOW SALT DIET
• IVF: PLAIN NSS 1L X 12 HOURS
• LABORATORIES: CBC,UA,CHEST XRAY,
ECG,TROP I, ELECTROLYTES NA,K,CA,MG,BLOOD
CHEMISTRY AFTER 8 HOURS OF FASTING,CK-MB
TO BE EXTRACTED 2AM IN THE MORNING
• FIBRINOGEN, PROTRHTOMBIN, TIME
• 2D ECHO, CORONARY ANGIOGRAM ONCE
STABLE
• MEDICATIONS:
MANAGEMENT OF ACUTE MYOCARDIAL INFARCTION

• Treating a heart attack means restoring blood flow to the

affected heart muscle as soon as possible.
1. Supplementary oxygen
• People having trouble breathing or with low blood
oxygen levels often receive supplementary oxygen
along with other heart attack treatments. You can
breathe the oxygen either through a tube that sits just
below your nose or a mask that fits over your nose and
mouth. This increases the amount of oxygen circulating
in the blood and reduces the strain on your heart.
2. Medications
A. Anti-clotting medications: This includes aspirin and
other blood-thinning medicines.
B. Nitroglycerin: This medicine relieves chest pain and
causes blood vessels to widen so blood can pass
through more easily.
- This medicine is also used to relieve an angina attack
that is already occurring.
• Ex: Oral, Sublingual, Patch
• Nitroglycerin patches are used to prevent and reduce
the number of attacks of chest pain (angina). This
product also reduces blood pressure. In most cases,
the nitroglycerin patch will not relieve an attack that
has already started because they work too slowly.
• Nitrates are vasodilator, most common side effect
Headache
c. Thrombolytic (clot-busting) medications: Providers use
these only within the first 12 hours after a heart attack.
Ex: Streptokinase, Tissue Plasminogen activator(t-pa)
In the case of a suspected stroke, you should be given
thrombolytic medications within 30 minutes after arriving at
the hospital. (This means that you have a window of three
to 4.5 hours after the onset of your symptoms.) Getting the
medication in your system as soon as possible can reduce
the risk of permanent damage.
• Thrombolytic therapy drugs through an IV line (usually
in a vein in your arm) or through a catheter (thin tube)
that’s been placed at the site of the blood clot.
• In some cases, more treatment may be necessary,
including stenting, balloon angioplasty or open surgery.
• Your provider will also likely place you on
anticoagulants (blood thinners), such as warfarin or
heparin to reduce the risk of future blood clots.
d. Antiarrhythmia Medications
Heart attacks can often cause malfunctions in your
heart’s normal beating rhythm called arrhythmias, which
can be life-threatening. Anti-arrhythmia medications can
stop or prevent these malfunctions.
Ex: Amiodarone are also commonly prescribed for
arrhythmias. They have the ability to terminate an
arrhythmia and are usually given to prevent the
abnormal rhythm from occurring or reduce its frequency
or duration.
• Class II, beta blockers: These drugs slow down the
heart rate, often by blocking hormones such as
adrenaline. Examples include acebutolol, atenolol,
bisoprolol, metoprolol, nadolol and propranolol
e.Pain Medications
Pain medications: The most common pain medication
given during heart attack care is morphine IV. This can
help alleviate chest pain.
f. stool softener - Lactulose
NURSING INTERVENTIONS
1. Advise Schedule a checkup
2. Quit tobacco products: This includes smokeless
tobacco and all vaping products.
3. Exercise regularly: Aim for 30 minutes of moderately
intense physical activity five days a week.
4. Eat a healthy diet: Examples include the
Mediterranean or Dash diets. A plant-based diet
approach is an excellent alternative.
5. Maintain a weight that’s healthy for you: Your
primary care provider can advise you on a healthy
goal weight and provide you resources and guidance
to help you reach that goal.
6. Manage your existing health conditions: This
includes high cholesterol levels, high blood pressure
and diabetes.
7. Reduce your stress: Consider techniques such as
yoga, deep breathing and meditation.
8. Take your medications as prescribed: Don’t just take
medications when you remember to or when you have
a doctor’s appointment coming up.
9. Keep all your medical appointments:
COMPLICATIONS FROM HEART DISEASE
1. Heart failure
Heart failure occurs when the heart cannot adequately
pump blood throughout the body. The heart muscle is
very strong. However, over time, the muscle can be
affected and have trouble doing its job. The heart
starts to compensate by beating faster, building up
more muscle, or stretching to accommodate more
blood.
• Over time, these methods of compensating can
affect the heart’s function and result in heart failure.
This can cause shortness of breath, dizziness,
confusion, and the buildup of fluid in the body,
causing swelling.
Types of congestive heart failure
1. Left-sided heart failure.
2. Right-sided heart failure.
3. High-output heart failure. This is a rare type of
congestive heart failure.
• Causes of congestive heart failure include:
1. Coronary artery disease and/or heart attack.
2. Cardiomyopathy (genetic or viral).
3. Heart issues present at birth (congenital heart
disease).
4. Diabetes.
5. High blood pressure (hypertension).
6. Arrhythmia.
8. Kidney disease.
9. A body mass index (BMI) higher than 30.
10. Tobacco and recreational drug use.
11. Alcohol use.
12. Medications such as cancer drugs
(chemotherapy).
• Left-sided heart failure is the most common cause of
right-sided heart failure. When your left ventricle isn’t
working correctly, it allows blood to back up. At some
point, this backup affects your right ventricle. Other
causes include certain lung problems and issues in
other organs.
Risk factors for congestive heart failure include:
1. Being older than 65.
2. Using tobacco products, cocaine or alcohol
3. Having an inactive (sedentary) lifestyle.
4. Eating foods that have a lot of salt and fat.
5. Having high blood pressure.
6. Having coronary artery disease.
7. Having a heart attack.
8. Having a family history of congestive heart failure.
• Congestive heart failure symptoms include:
1. Shortness of breath.
2. Waking up short of breath at night.
3. Chest pain.
4. Heart palpitations.
5. Fatigue when you’re active.
6. Swelling in your ankles, legs and abdomen.
7. Weight gain.
8. Need to urinate while resting at night.
9. A dry, hacking cough.
10. A full (bloated) or hard stomach.
11. Loss of appetite or upset stomach (nausea).
DIAGNOSIS OF CONGESTIVE HEART FAILURE

1. History and Physical Examination

2. Vital signs
3. Other health conditions you have.
4. A family history of heart disease or sudden death.
5. Use of tobacco products.
6. How much alcohol you drink.
7. Any history of chemotherapy and/or radiation.
8. The medications you take.
STAGES OF CONGESTIVE HEART FAILURE
1. Stage A
• Stage A (pre-heart failure) means you’re at a high risk of developing
heart failure because you have a family history of congestive heart
failure or you have one or more of these medical conditions:
• Hypertension.
• Diabetes.
• Coronary artery disease.
• Metabolic syndrome.
• History of alcohol use disorder
• History of rheumatic fever.
• Family history of cardiomyopathy.
• History of taking drugs that can damage your heart
muscle, such as some cancer drugs.
2. Stage B
• Stage B (pre-heart failure) means your left ventricle
isn’t working well and/or is structurally abnormal but
you’ve never had symptoms of heart failure.
3. Stage C
• People with Stage C heart failure have a congestive
heart failure diagnosis and currently have or
previously had signs and symptoms of the condition.
4. Stage D and reduced EF (ejection fraction)
• People who have Stage D HFrEF (heart failure with
reduced ejection fraction) have advanced symptoms
that don’t get better with treatment. This is the final
stage of heart failure.
• Common tests to identify congestive heart failure, its
stage and its cause include:
1. Blood tests.
2. Cardiac catheterization.
3. Chest X-ray.
4. Echocardiogram.
5. Heart MRI (magnetic resonance imaging).
6. Cardiac computed tomography (CT).
7. Electrocardiogram (EKG or ECG).
8. Multigated Acquisition Scan (MUGA scan).
9. Stress test.
10. Genetic testing.
MANAGEMENT AND TREATMENT OF CONGESTIVE
HEART FAILURE
1. Stage A treatment
• Regular exercise, such as walking every day.
• No tobacco products.
• Treatment for high blood pressure (medication, low-sodium diet,
active lifestyle).
• Treatment for high cholesterol.
• No alcohol or recreational drugs.
• Angiotensin-converting enzyme inhibitor (ACE-I) or an
angiotensin II receptor blocker (ARB) if you have coronary artery
disease, diabetes, high blood pressure or other vascular or
cardiac conditions.
2. Stage B treatment
• Treatments for Stage A.
• Angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin
II receptor blocker (ARB) if your EF is 40% or lower.
• Beta-blocker if you’ve had a heart attack and your EF is 40% or
lower (if you aren’t already taking one).
• Aldosterone antagonist if you’ve had a heart attack or if you
have an EF of 35% or less.
• Possible surgery or intervention as a treatment for coronary
artery blockage, heart attack, valve disease (valve repair or
replacement) or congenital heart disease.
3. Stage C treatment
Treatments from Stages A and B.
Beta-blocker.
Aldosterone antagonist.
Sodium-glucose transport 2 inhibitors (SGLT2i).
Hydralazine/nitrate combination if other treatments don’t stop
your symptoms and you’re African American.
Medications that slow your heart rate if your heart rate is
faster than 70 beats per minute and you still have symptoms.
• A diuretic (“water pill”) if symptoms continue.
• Restriction of sodium (salt) in your diet.
• Weight tracking every day. Tell your healthcare
provider if you gain or lose more than 4 pounds.
• Possible fluid restriction.
• Possible cardiac resynchronization therapy
(biventricular pacemaker).
• Possible implantable cardiac defibrillator (ICD) therapy.
• If the treatment improves or stops your symptoms,
you still need to continue treatment to slow the
progression to Stage D.
4. Stage D treatment
• Treatment for people who have Stage D heart failure
includes treatments for Stages A, B and C. In addition, it
includes evaluation for more advanced treatment options,
including:
• Heart transplant.
• Ventricular assist devices.
• Heart surgery.
• Continuous infusion of inotropic drugs.
• Palliative or hospice care.
NURSING INTERVENTIONS FOR HEART FAILURE

1. Advise staying at a weight that’s healthy for you.

2. Advise to eat foods that are good for your heart.
3. Exercising regularly.
4. Managing your stress.
5. Stopping the use of tobacco products.
6. Not drinking alcohol.
7. Not using recreational drugs.
8. Taking care of other medical conditions you have that
can increase your risk.
2. Heart attack
• A heart attack occurs when the coronary arteries
narrow so much that they cut off blood supply to the
heart. Often, this is the result of cholesterol buildup in
the arteries called atherosclerosis. A piece of the
cholesterol breaks off and can block the blood
vessel. The heart cells begin to die as they’re
deprived of oxygen. Symptoms include shortness of
breath and severe chest pain that may radiate to the
back, jaw, or left arm.
3. Stroke
• When the heart isn’t working effectively, blood clots are
more likely to form in the blood vessels. A stroke occurs
when one of these clots lodges in a blood vessel in the
brain and cuts off blood flow. This is called an ischemic
stroke. Ischemic stroke symptoms include:
• numbness on one side of the body
• confusion
• trouble speaking
• loss of balance or coordination
• If a person doesn’t seek treatment quickly enough,
too many brain cells may die in important areas of
the brain that control speech, strength, memory, and
more. If a person does live through the stroke, these
elements of brain function may never return or may
take time and rehabilitation to recover.
4. Pulmonary embolism
• A pulmonary embolism is similar to a stroke, but the
blocked blood vessel is in the lungs instead of the
brain. Symptoms include shortness of breath, chest
pain on breathing, and bluish skin. Because the body
is quickly deprived of oxygen, a pulmonary embolism
can turn deadly and is an emergency.
5. Cardiac arrest
• Cardiac arrest occurs when the heart suddenly stops
beating. It’s usually caused by an electrical
disturbance in the heart. Arrhythmias caused by
heart disease can lead to cardiac arrest. This will
lead to death if not treated immediately.
6. Peripheral artery disease (PAD)
• The same narrowing that occurs in coronary artery disease can
happen in the arteries that supply blood to the arms and legs. The
main symptom of PAD is severe leg pain when walking.
7. Atrial Fibrillation
• Atrial fibrillation, or AFib, is a heart condition that is rarely deadly. It
causes the upper chambers of the heart to beat irregularly or
“quiver” instead of beating strongly. This can cause a person to
experience an irregular heartbeat and a feeling of fluttering in their
chest. Having AFib can increase your risk of having a stroke or
heart failure. Because the chambers beat irregularly, blood can
easily stall in the chambers and create clots.