Cardiovascular Disorders

Adult Health Nursing

 ILOs
• Define cardiovascular disorders (CVD)
• Describe 2 Types of CVD
• List risk factors of CVD
• Explain clinical manifestation of CVD
• Enumerate diagnostic procedures for CVD
 Outline
• Definition of CVD
• Types of CVD
• Risk factors of CVD
• Clinical manifestation of CVD
• Diagnostic procedures
 Anatomy & Physiology
Cardiovascular system: is a closed
system composed of the heart, blood
vessels and blood.
 The heart pumps blood
 Blood vessels allow blood to circulate to
all parts of the body
 Function of the heart is to Pump blood
to the tissue, supplying them with
oxygen and nutrients. Removing carbon
dioxide and waste products of
metabolism.
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 Anatomy & Physiology
1. The heart
 The heart: is a hollow and muscular
organ.
 Location : it is located in the center of
the thorax, where it occupied the space
between the lungs
( mediastinum) and rest on the
diaphragm.
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 Weight : it is approximately300 gm
 Anatomy & Physiology
2. Heart wall
Epicardium outer layer, contact
with visceral pericardium.
Myocardium the middle layer,
makes up the largest portion of
the heart’s wall. It is the actual
cardiac muscle that contracts
Endocardium inner layer, lines
heart chambers & vessels.
Pericardium – surrounds the
heart and acts as a hard,
protective sac.
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 Anatomy & Physiology
3. Heart Chambers
It is contain four chambers
• Two atria: top of heart, receive blood from
veins
• Two ventricles: bottom of heart, pump
blood through arteries
• Septum: divides left from right heart

• Valves: keep blood flowing in one direction

and there are four valves: 7
Anatomy & Physiology

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Anatomy & Physiology

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 Anatomy & Physiology

Pulmonary Circulation

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 Anatomy & Physiology

Systematic Circulation
https://www.youtube.com/watch?v=pyI4Kz01ZR4

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Cardiac Conduction System

What causes the heart to

contract and pump blood?

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 Cardiac Conduction System
• The heart’s pumping action is sparked by
specialized pacemaker cells and conduction fibers
that initiate spontaneous electrical activity, causing
muscle contractions that result in a heartbeat.
• https://www.youtube.com/watch?v=RYZ4daFwMa8

• https://www.youtube.com/watch?v=924uGXR6ReE

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 Cardiac Conduction System
Sinoatrial node

AV node

Bundle of His

Bundle Branches

Purkinje fibers

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Cardiac Conduction System

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 Cardiovascular Disorders
(CVD)
 It includes all the diseases of

the heart and vascular system

 It is a major cause of disability

and premature death

throughout the world.

 Cardiovascular Disorders
(CVD)
 American Heart Association (AHA, 2014), stated

that about one in six deaths were due to

coronary heart disease

 Types of Cardiovascular
disorders
A. Preventable
• Coronary Heart Disease (CHD): is a group of diseases
that includes: angina, Ischemic heart disease, and
myocardial infarction. It is a disease in which a waxy
substance called plaque builds up inside the coronary
arteries. These arteries supply oxygen-rich blood to
heart muscle.
 Types of Cardiovascular
disorders
A. Preventable
• Coronary Heart Disease (CHD)
 Types of Cardiovascular
disorders
A. Preventable
• Heart failure: is a condition in which the heart can't
pump enough blood to meet the body's needs.

• Cardiac arrhythmia: is a group of conditions in which

the heartbeat is irregular (disturbance in the rhythm of
the heartbeat.

• Hypertension (persistently elevated blood pressure)

 Types of Cardiovascular
disorders
A. Preventable
• Rheumatic heart disease: can result
from infection which damage to
the heart muscle and heart valves
from rheumatic fever, caused by
streptococcal bacteria ,and
endocarditis .
 Types of Cardiovascular
disorders
A. Preventable
• Inflammatory heart disease:

Inflammation of the heart muscle (myocarditis), the

membrane sac (pericarditis) which surround the heart,
the inner lining of the heart (endocarditis).
Inflammation may be caused by known infectious
agents or by an unknown origin.
 Types of Cardiovascular
disorders
A. Preventable
• Atherosclerosis: narrowing or hardening of the
blood vessels.
 Types of Cardiovascular
disorders
Non-preventable
• Congenital heart disease: malformations of
heart structure existing at birth such as hales
in the septum, or abnormal formation of a
cardiac valve.
 Risk Factors

Modifiable risk factors:

• Sedentary Lifestyle

• Stress

• Diabetes Mellitus
 Risk Factors
Modifiable risk factors:
1. Elevated Serum Lipid Levels

2. Cigarette Smoking

3. Obesity

4. Excessive intake of saturated fats, carbohydrates,

and salt
 Risk Factors

Non-modifiable risk factors

• Age

• Gender

• Family History

• Race
 Nursing management
1. Assessment

1. Demographic data

2. History taking

3. Clinical manifestation

4. Physical examination

5. Diagnostic procedures
 Nursing management
Assessment

• History taking
Nursing management
Assessment
 Nursing management
Assessment

• Clinical manifestation
 Common manifestations of CVD
1. Chest pain

2. Shortness of breath
3. Palpitations
4. Edema
5. Fatigue
6. Dizziness
7. Syncope
 Common manifestations of CVD
Dyspnea
It is a subjective feeling of difficulty in breathing (Shortness of
breath)
• Onset
• Type:
– Exertional dyspnea: dyspnea occurs during effort
– Positional dyspnea: such as orthopnea (dyspnea occurs in
lying position)
– Paroxysmal nocturnal dyspnea: is the sudden onset of
difficult breathing while sleeping in supine position and
improves on acquiring the sitting or standing position. It
usually occurs 3-4 hours after sleep.
 Common manifestations of CVD
Dyspnea
• Time
• Duration
• Severity:
– Grade (1): the patient feels dyspnea on doing
more than his usual daily activities
– Grade (2): occurs when doing his usual daily
activities
– Grade (3): occurs when doing less than his usual
daily activities
– Grade (4): dyspnea occurs at rest
 Common manifestations of CVD
Dyspnea

• Precipitating factors

• Relieving factors

• Associated factors
 Common manifestations of CVD
Chest pain
)angina(

PQRST, is very useful in assessing chest pain

• Precipitating events
• Quality: Squeezing , stabbing, tightness
• Radiation or Region: radiate to back, arms,
jaw, or shoulder
• Severity
• Timing
 Common manifestations of CVD
Chest pain
)angina(

PQRST, is very useful in assessing chest pain

• Quality
 Common manifestations of CVD

Cough
• Onset: Sudden/ gradual
• Type: Dry or productive
• Severity: mild, moderate, or sever
• Timing (e.g., at night, morning, with exercise, in cold
air, outside or inside)
• Duration: greater than 3 weeks
• Precipitating factors
• Relieving factors
• Associated factors
 Common manifestations of CVD

Sputum
• Color: Yellow / green/ white/black

• Amount: small, moderate, or large

• Consistency: thick, watery or viscous

• Odour: odorless or bad odor

• Time of day
 Common manifestations of CVD

Syncope
• It is defined as a short loss of
consciousness and muscle strength,
characterized by a fast onset, short
duration, and spontaneous recovery.
 Common manifestations of CVD

Cyanosis
• It refers to bluish discoloration of the skin and
mucus membrane. There are two types of
cyanosis: central and peripheral
 Common manifestations of CVD
Cyanosis
Items Central cyanosis Peripheral cyanosis
Site Generalized and is seen also in hot Finger nail, ear lobule, skin
areas like mucus membrane of the of extremities and tip of the
back of the tongue and lips nose
Causes Circulatory or respiratory in the Poor circulation in the small
lungs problem that leads to poor blood vessels
blood oxygenation Exposure to cold
Inhalation of Improve except in congenital Do not improve
oxygen cyanotic heart disease
Clubbing Commonly present Absent
 Common manifestations of CVD
Edema
It is an abnormal accumulation of fluid in the
interstitial space and in the cavities of the
body.
• Site: peripheral/generalized

• Type: pitting/non-pitting
 Common manifestations of CVD
Edema
• Severity:
Common manifestations of CVD
 Physical examination

• The patient’s general appearance is

observed. The patient’s level of
consciousness, which is an indicator of
oxygenation of the brain, is noted. Height,
weight, and vital signs are recorded.
 Physical examination

• The patient’s internal and external jugular

neck veins are observed for distention in a
45- to 90-degree upright position. Normally,
the veins are not visible in this position.
• Distention indicates an increase in the
venous volume, often caused by right-sided
heart failure.
 Physical examination

• Clubbing of the nail beds

occurs from oxygen deficiency
over time. It is often caused by
congenital heart defects or the
long-term use of tobacco.
• The distal ends of the fingers
and toes swell and appear club
like.
 Nursing management
Assessment

• Diagnostic Procedures
 Diagnostic Procedures
LABORATORY TESTING:
1. Cardiac enzymes: Elevated levels indicate death to
heart muscles or lack of oxygen supply to the heart .
2. Cholesterol levels
3. Complete Blood Count (CBC)
 Diagnostic tests
Graphic Recording Studies:
• Electrocardiogram(ECG) graphically records
electrical current generated by the heart to
determine rate, rhythm of heat, and present of
injury at rest
 Diagnostic tests

Graphic Recording Studies:

• Exercise ECG(stress test): Records electrical activity of
the heart during exercise insufficient blood flow and
oxygen show up in abnormal waveforms. It is used to
assess heart response to an increased workload.
 Diagnostic tests
Imaging studies:-
• Chest X-ray: may detect enlargement or structural
changes of the heart
 Diagnostic tests
Imaging studies:-
• Echocardiogram (Echo): visualize heart size and shape,
heart wall thickness and motion, and cardiac valve
structure and function
 Diagnostic tests

Imaging studies:-
• Computed Tomography (CT): determines size and
condition of aortic aneurysm.

NB. aneurysm occurs when part of an artery wall weakens,

allowing it to widen abnormally
 Diagnostic tests

Imaging studies:-
• Magnetic Resonance Imaging (MRI):
detect changes in the structure of the heart
 Diagnostic tests
Invasive procedures:
• Cardiac catheterization : assesses size and patency of
coronary arteries and determines location of blockage
,assesses pumping action of both sides of the heart.