Cardiovascular system

1
 Outlines

• Coronary artery disease .

• Hypertension

• Valvular heart diseases

• Heart failure .

• Cardiac surgery
Coronary Arteries
• Left Main or left
coronary artery (LCA)

• Right coronary artery

 Coronary artery disease Def.
• refers to any group of symptoms attributed to
obstruction of the coronary arteries.
• Coronary artery disease is caused by plaque
buildup in the wall of the coronary arteries that
supply blood to the heart .Plaque is made up of
cholesterol deposits. Plaque buildup causes the
inside of the arteries to narrow over time. This
process is called atherosclerosis.
 Forms of Coronary artery disease.

• Ischemic heart disease : coronary arteries

gradually narrow over many years so heart
receives less oxygen-rich blood.
• Acute Coronary Syndrome is when
occlusion of one or more of the coronary
arteries occurs suddenly, usually following
plaque rupture forming a clot , resulting in
decreased oxygen supply to the heart muscle.
 Angina pectoris
Chest discomfort resulting in an insufficient supply
of oxygen to meet the demands of the heart
muscles (myocardial tissue). It includes:

1-Stable angina.

2-Unstable angina
• Stable angina. This is the most common.
Physical activity or stress can trigger it. It
usually lasts a few minutes, and it goes away
when you rest.
• Unstable angina. Patient suffer it at rest. The
pain can be strong and long-lasting, and it may
come back again and again.
 Acute Myocardial Infarction
Heart attack
An infracted area of the heart means that dies (necrosis)
from inadequate oxygen supply. It occurs due to prolonged
occlusion of coronary arteries.

Causes of Acute Myocardial Infarction

• Atherosclerotic lesion.
• Acute or chronic blockage of coronary artery.
Risk factors of Coronary heart disease

Lack of regular
physical activity
Obesity
HyperlipidemiaL ow HDL <
40 Smoking
Elevated LDL / TG

Risk
factors
Hypertension Diabetes

Age-- > 45 for

Family history male/55 for
female
 Diagnosis
• At least 2 of the following:

Ischemic symptoms

Diagnostic ECG changes

Serum cardiac marker
elevations
• There are seven (7) nursing diagnoses for myocardial
infarction (heart attack) nursing care plans (NCP):
• Acute Pain
• Activity Intolerance
• Anxiety
• Risk for Decreased Cardiac Output
• Risk for Ineffective Peripheral Tissue Perfusion
• Risk for Imbalanced Fluid Volume
• Deficient Knowledge
• Other possible nursing care plans
 Nursing Priorities

• Relieve pain, anxiety.

• Reduce myocardial workload.
• Prevent/detect and assist in treatment of life-
threatening dysrhythmias or complications.
• Promote cardiac health, self-care.
 Nursing Interventions
• Administer oxygen along with medication therapy to assist with relief
of symptoms.
• Monitor and document characteristics of pain, Administer
medications as Antianginals such as nitroglycerin, Analgesics such as
morphine and anticoagulant with MI.
• Monitor the patient closely for changes in cardiac rate and rhythm,
heart sounds, blood pressure, chest pain, respiratory status, urinary
output, changes in skin color, and laboratory values
• Encourage bed rest with the back rest elevated to help decrease
chest discomfort and dyspnea.
• Encourage changing of positions frequently to help keep fluid from
pooling in the bases of the lungs.
• Check skin temperature and peripheral pulses frequently to monitor
tissue perfusion.
• Provide information in an honest and supportive manner.
Hypertension
 Hypertension
• Hypertension ̶ or elevated blood
pressure ̶ Silent killer - is a serious medical
condition that significantly increases the risks
of heart, brain, kidney and other diseases.
• Hypertension is a major cause of premature
death worldwide.
• An estimated 46% of adults with
hypertension are unaware that they have the
condition
 Primary vs. secondary hypertension
• Primary hypertension is also known as
essential hypertension. a specific cause isn’t
known. It’s thought to be a combination of
genetics, diet, lifestyle, and age.
• Secondary hypertension is due to other
diseases as kidney or hormonal problems.
 What are the complications of
uncontrolled hypertension?
• Chest pain, also called angina.
• Heart failure.
• Irregular heart beat which can lead to a sudden
death.
• Peripheral vascular disease.
• kidney damage, leading to kidney failure.
• Stroke.
• Complications during pregnancy.
• Eye damage.
 MANAGEMENT AND TREATMENT
• Anti-hypertensive drugs
• blood pressure monitor.
• Eat healthy foods that are low in salt and fat.
• Reach and maintain best body weight.
• Avoid alcohol
• Be more physically active.
• Quit smoking and/or using tobacco products.
• Work on controlling anger and managing stress
 The six key nursing diagnoses
• Risk for decreased cardiac output
• Acute pain (typically headache)
• Activity intolerance
• Ineffective coping
• Imbalanced nutrition (more than body
requirements)
• Knowledge deficit
 Nursing Priorities
• Maintain/enhance cardiovascular functioning.
• Prevent complications.
• Provide information about disease
process/prognosis and treatment regimen.
• Support active patient control of condition.
 Nursing Interventions

• Adherence with medication

• Encourage the patient to improve nutrient intake
and weight loss.
• Encourage restriction of sodium and fat
• Emphasize increase intake of fruits and vegetables.
• Implement regular physical activity.
• Advise patient to limit alcohol consumption and
avoidance of tobacco.
• Assist the patient to develop and adhere to
an appropriate exercise regimen.
 Valvular disease
• The heart contains two AV valves (mitral
and tricuspid) and two semilunar valves
(aortic and pulmonic), which control
unidirectional blood flow.

• Valvular heart disease is defined according

to the valve or valves affected and the type
of functional alteration: stenosis or
regurgitation.
 Introduction
• Stenosis refers to (constriction or narrowing of valve)

• Regurgitation refers to incompetence or insufficiency closed of

valve
 What causes heart valve problems?

• • Congenital defects. A heart defect present

at birth that’s not repaired may get worse
later in life and cause problems.
• • Aging and age-related valve disease.
• . • Illnesses and conditions. Certain heart
conditions including infective endocarditis,
rheumatic fever, heart attack, poorly
controlled high blood pressure and heart
failure can scar or damage a valve
 Signs and symptoms with valvular
heart diseases
• Dyspnea on exertion
• Chest pain
• Fatigue
• Palpitations
• Hemoptysis; from pulmonary hypertension with
mitral stenosis
• Heart failure with aortic stenosis
• Peripheral edema, Ascites and Hepatomegaly with
tricuspid and pulmonic stenosis
Surgical
• Valve repair
Valvulotomy
Valvuloplasty
• Valve replacement
 NURSING DIAGNOSES
• Decreased Cardiac output related to valvular
incompetence

• Excess fluid volume related to fluid retention

secondary to valvular-induced HF

• Activity intolerance related to insufficient

oxygenation secondary to decreased CO and
pulmonary congestion
 Nursing planning
The overall goals for the patient with valve disease include:
• (1) normal heart function,
• (2) improved activity tolerance, and
• (3) an understanding of the disease process and
health maintenance measures
 NURSING IMPLEMENTATION
• Administer oxygen as needed.
• Help the client balance activities with rest periods.
• Discourage smoking
• Administer diuretics as needed.
• Encourage the client to maintain a low-sodium diet.
• Calmly explain the procedures before doing them.
• Encourage the client’s input to decisions regarding care.
• Encourage the client to begin an appropriate exercise
program
• Teach relaxation techniques
• Assist the client and the client’s family in identifying ways
to cope with stressors..
 Heart Failure

Heart failure (HF) is an abnormal

clinical syndrome that involves
inadequate pumping and/or
filling of the heart. In clinical
practice, the terms acute and
chronic HF have replaced the
term congestive heart failure
 Etiology and Pathophysiology cont.
The major causes of HF may be divided into two
subgroups:
A- primary causes:
✓ Coronary artery disease, including myocardial
infarction
✓ • Hypertension
✓ • Rheumatic heart disease
✓ • Congenital heart defects
✓ • Cardiomyopathy
✓ • Valvular disorders
B- Precipitating causes:
✓ Anemia
✓ Infection
✓ Bacterial endocarditis
✓ Hypervolemia
 Ventricular Failure
Systolic failure:
Results from an inability of the heart to pump blood
effectively.

Diastolic failure :
Is the inability of the ventricles to relax and fill during
diastole..
Clinical Manifestations
 Complications of Heart
Failure
➢ Pleural Effusion. Shift of fluid from capillaries into the
pleural space.

➢ Dysrhythmias. Changes in the normal electrical pathways

➢ Hepatomegaly., The liver becomes congested with venous

blood, especially with RV failure.

➢ Renal Failure. Due to decreased perfusion to the kidneys

and can lead to renal insufficiency or failure
 NURSING DIAGNOSES

Impaired gas exchange Decreased cardiac

related to increased output related to:
preload as evidenced by altered contractility, as
abnormal oxygen evidenced by decreased
saturation, hypoxemia, peripheral pulses,
dyspnea, tachypnea, orthopnea, chest pain and
tachycardia, restlessness. oliguria
 NURSING DIAGNOSES

Activity intolerance
Excess fluid volume related to imbalance
related to increased between O2 supply and
venous pressure and demand secondary to
decreased renal cardiac insufficiency
perfusion secondary to and pulmonary
heart failure as evidenced congestion as evidenced
by rapid weight gain, by dyspnea, shortness of
edema, and breath breath, weakness, and
sounds, increase in heart rate on
exertion.
 PATIENT & CAREGIVER TEACHING
GUIDE
Dietary Therapy
➢ Avoid using salt when preparing foods or adding salt to foods.
➢ Weigh at the same time each day, preferably in the morning,
using the same scale and wearing the same or similar clothes.
➢ Eat smaller, more frequent meals.
Activity Program
➢ Consider a cardiac rehabilitation program.
➢ Avoid extremes of heat and cold.
Ongoing Monitoring (Know the signs and symptoms of worsening
heart failure)
Health Promotion (Develop plan to reduce risk factors)
Rest
Drug Therapy
ASSESSMENT OF CARDIOVASCULAR SYSTEM

• All patients with cardiovascular disease (disorders of the

heart and major blood vessels; require similar
assessments.

Key components of the cardiovascular assessment include:

• Obtaining a health history,
• Performing a physical assessment, and
• Monitoring a variety of laboratory and diagnostic test
results
 Focused assessment is used to evaluate the cardiovascular
problems
Subjective ➢History of Present Illness.
Chest pain ----- Palpitations ----- Shortness of breath
(especially when lying down or at rest) ---- Leg pain during
exercise ---- Excess urination at night
➢Past Health History
➢Medications.
➢Surgery or Other Treatments
➢familial and lifestyle risk factors

Objective: Cardiac biomarkers (troponin, CK-MB)

Diagnostic Serum lipids
Electrocardiogram (ECG), Echocardiogram
, Cardiac CT, MRI, Cardiac catheterization
Chest X-Ray
 Objective: Physical Examination
Palpate ❖ Pulses for symmetry, quality, and rhythm
❖ upper and lower extremities for temperature and
moistureand edema

Inspect ❖skin for color and venous pattern.

❖extremities for conditions such as edema
❖ large veins in the neck distention, can be caused by
right-sided heart failure

Auscultate Blood pressure

Heart for rate, rhythm, and sounds