Cardiovascular Disorders Proper

Cardiovascular Disorders

Nio C. Noveno, RN

OXYGENATION (Cardiovascular)

DIAGNOSTIC ASSESSMENT

Chest x-ray
Fluoroscopy
Cardiac Enzymes
LDH - elevated in 48 hrs
SGOT
CPK – elevated 4-24 hrs
CPK-MM [skeletal muscles]
CPK-BB [brain]
CPK-MB [myocardium, cardio-specific]
Echocardiography [Ultrasound cardiography]
Electrocardiography [ECG] – electrical activity

nionoveno@yc Cardiovascular Diseases 2

CARDIAC ENZYMES
AST/SGOT 5 – 40 U/L
CPK
M 12 – 70
F 10 – 55
CPK-MB 0%
LDH 45 – 90 U/L
Myoglobin < 85 ng/mL
Troponin I < 0.03
Troponin T < 0.2
CRP < 0.8 mg/dL


ELECTROCARDIOGRAPHY ECHOCARDIOGRAPHY




Electrocardiography [ECG] – graphic record of the
electrical activity of the heart




Electrocardiography [ECG]




Stress test (treadmill)
Transesophageal echocardiography [TEE]
Angiocardiography
Positron Emission Tomography [PET]
Coronary Arteriography
Cardiac catheterization
Hemodynamic monitoring




Coronary Arteriography - introduction of radiopaque
catheter into brachial or femoral artery [arteriotomy
w/ percutaneous puncture] to ascending aorta to
coronary artery for fluoroscopy

Nursing Intervention
NPO
Vital signs
Check for bleeding at puncture site
Check color of extremity and pulses


CARDIAC
ARTERIOGRAPHY CATHETERIZATION


Cardiac Catheterization - catheter into heart & BV to :
measure O2 conc., saturation, tension & pressure of
heart chambers
Detect shunts, heart output & pulmonary outflow
Right CC – antecubital v → VC → R A&V → Pulm a.
Left CC – brachia/femoral a → aorta → R V

Before: NPO, allergic hx, mark distal pulse, instruct pt
thudding sensations in chest & strong desire to cough and
transient heat

After: VS, peripheral pulses, site, chest pain, bed rest
for 12-24hrs;
Femoral site – bleeding inflammation, tenderness, apply
sandbag & ice on site, HOB >30°, avoid flexing femoral
region Cardiovascular Diseases
nionoveno@yc 10



Hemodynamic Monitoring: assessment of circulatory
status
Central Venous Pressure [CVP] (N= 5-12 cms H2O)
Catheter into external jugular vein → antecubital
or femoral v. → vena cava

Provides information on blood volume &
adequacy of venous return

Reveals right atrial pressure

Route for drawing blood samples, administration
of fluids or meds and pacing

CVP



Hemodynamic Monitoring (CVP)

Pt. in supine. Changes in position, coughing or
straining during reading may result to inaccuracies of
readings

Zero point of manometer should be at a level with the
pt’s R atrium (midaxillary line)

To measure CVP: turn stopcock so that IV solution
flows into manometer filling to about 20-25cm level,
then turn stopcock to let flow the solution in the
manometer into pt.

Observe the fall in the height of column of fluid in
manometer. Read where it stops.

Hemodynamic Monitoring
Swan-Ganz Pressure (N=5-12 cms H2O)
Catheter into external jugular vein/subclavian
→ superior vena cava → R atrium → tricuspid
valve → R vent → pulm a. → pulm capillary
[pulm capillary wedge pressure]
Interpretations of Pressure Readings:

Pulmonary Artery Pressure [PAP]: 10-20 mmHg;
- increased in pts w/ chronic pulmonary disease
& CHF

Pulmonary Capillary Wedge Pressure: 4-12 mmHg
- indicative of pressure in the L cardiac
chambers

Swan-Ganz Procedure

PAWP CATHETER


The PRESSURE Guidelines
P ressure monitor
R ise slowly to reduce orthostatic hypotension
E ating must be considered
S tay on medications
S topping or skipping is discouraged
U ndesirable responses
R emind to exercise, stop alcohol
E liminate smoking, educate


Pharmacology
Nitroglycerin

Interventions:
MOA: relaxes vascular
Monitor BP & AP
smooth system, ↓
Have client sit or lie
myocardial demand
down (first time)
for O2, ↓ LV preload
by dilating veins, NO defibrillation over
thus indeirectly ↓ area of nitro patch
afterload Assist during ambulation


Pharmacology
Nitroglycerin cont…

Health Teachings:
Oral:
– Take on an empty stomach, with a glass of water.
SL:
– Take at first sign of anginal pain
– Take every 5 mins to a maximum of 3 doses
• NO relief, seek MD
– Stinging or biting sensation
– Protect from light, moisture and heat
Transderm patch:
– OD in AM
– Rotate sites


Pharmacology
Lidocaine
MOA: decreases cardiac
excitability, cardiac conduction
is delayed in the atrium or
ventricle
Drug interactions:
– ↑ effects with Phenytoin,
Undesirable effects: Procainamide, Propranolol,
quinidine,
– ↓ or ↑ HR
– ↑ risk of toxicity with ß-
– ↓ BP
adrenergic blockers, cimetidine
– Confusion
Drowsiness (1st sign of
–
toxicity)
– Dizziness
– Nausea, vomiting
– Seizures (severe toxicity)
– Cardiac arrest


Pharmacology
Lidocaine cont…

Interventions:
• Give I.V.
• Monitor serum levels: 1.5-5 mcg/ml
• Monitor EKG, BP, PR
• Monitor I & O
• Do not mix syringes with cefazolin and amphotericin
B
• Have Dopamine available for circulatory collapse
• Assist and provide safety


Pharmacology
Interactions:
ACE INHIBITORS
– Probenecid: ↓
MOA: suppress the RAAS; blocks elimination
the conversion of angiotensin I
– NSAIDs: hypotensive
to angiotensin II
effect
– Other anti-HTN: ↑
Undesirable effects:
hypotensive effects
– Gastric irritation
– Hyperkalemia
– Headache
– Dizziness
– ↑ HR
Interventions:
– Angioedema
– Assess for renal function
– Cough
– Do not give with food
– Maculopapular rash
– Pruritus
– Do not take potassium-
– Infection
rich foods
– Hyperkalemia


Pharmacology
ACE INHIBITORS cont… ACE INHIBITORS cont…

S VR/PVR decreased C ough; contraindicated
with renal artery
T reatment for MI stenosis

R elease of aldosterone is low H ypotension;
hyperlipidemia
O occult diabetic nephropathy
F ood has less taste;
L VD after MI is low WOF hypotension


Pharmacology
A dminister without
Angiotensin II receptor blockers (ARB)

regard to meals
MOA: blocks angiotensin II
from binding with
angiotensin receptors; R enal function tests –
lowering BP review
Information:
B locks vasoconstriction
– Same with ACE inhibitors
effect of RAAS

S alt substitution or
potassium supplements
is not allowed


Pharmacology
Alpha adrenergic blockers

S yncope; sexual
MOA: blocks alpha1
dysfunction
adrenergic receptors
resulting in vasodilation of
arteries and veins;
I ncreased drowsiness;
decreases PVR; relaxes
orthostatic
smooth muscles of
hypotension, HR
bladder and prostate

N eed to be recumbent
– Same as other anti-HTN
for 3-4 H after the
meds
initial dose
– WOF: 1st dose syncope
• 2-3 H post initial dose


Pharmacology
Beta adrenergic blockers B radycardia
L ipidemia/libido
MOA: blocks ß1 (heart) or ß2
(lungs) receptors to decreased
prevent the release of
br O nchospasm
catecholamines;
decreases contractility,
C HF; conduction
renin release and
sympathetic output abnormalities
K onstriction, peripheral
Caution:
vascular
– COPD
E exhaustion; emotional
– CHF
– Sinus bradycardia depression
– Heart block
R educes glucose
– DM


Pharmacology
Calcium channel blockers

MOA: blocks Ca2+ influx into Interventions:
the cells causing • Elevate extremity affected
decreased contractility, • Increased dietary fiber;
decreased PVR and low increase OFI
BP
• Take with meals or milk
– Hypotension
– Headache
– Dizziness
– Peripheral edema
– Constipation


Pharmacology
Central alpha2 agonist C ontrols release of
adrenergic hormones
A dverse effects: low BP,
MOA: decreased
hepatotoxicity,
release of hemolytic anemia
adrenergic
T ransient drowsiness
hormones from the
A rterial pressure is
brain resulting in a lowered
decrease PVR,
P aradoxical HTN with
hence BP
propranolol
R ecord baseline VS
E valuate weight and liver
function
S lowly taper the doses

Pharmacology
Vasodilators D ilates vascular muscles
I ncreases renal and
cerebral flow
L upus-like reaction (fever,
facial rash, muscle and
MOA: direct relaxation of joint ache, splenomegaly)
vascular smooth muscles,
A ssess for peripheral edema
decreases afterload
T ake with food
O ther SE: headache,
dizziness, anorexia,
tachycardia, hypotension
R eview BP


D iet high in K+ for all except aldactone

I ntake and output daily

U undesirable effects: fluid & electrolye imbalance

R review HR, BP

E lderly with caution

T ake with or after meals in AM

I ncrease risk of orthostatic hypotension; move slowly

C ancel alcohol


COMMON CARDIOVASCULAR DISEASES

CORONARY ARTERY DISEASE or Coronary Ischemic HD

Myocardial impairment due to imbalance between
coronary blood flow myocardial O2 demand
Manifested as:
Ischemia [Angina Pectoris] – reversible
Infarction – irreversible

Ischemia – reversible if myocardial blood flow is
↑ or the need for the demand is ↓
may progress to infarction




Angina Pectoris
Chest pain associated w/ transient myocardial
ischemia

Causes:
Atherosclerosis – most common
Vasospasm
Aortic stenosis

Kinds:
Stable [Effort] AP
Unstable [Preinfarction] AP


ASSESSMENT OF PAIN
P rovoking/precipitating

Q uality

R adiation

S everity

T iming



Angina Pectoris
Signs & Symptoms:
Substernal or precordial pain radiating to L
shoulder lasting for 3-5 mins, relieved by rest
Heaviness, tightness, squeezing precipitated
by exertion, emotion and exposure to cold
VS may be normal

Diagnostic Tests:
Nitroglycerine test – relieves pain
Blood chemistry - ↑ cholesterol
Stress test, abnormal ECG – inverted T-waves
Cardiac enzymes – N
Coronary arteriography – plaque
accumulation


Angina Pectoris
↑ O2 to the myocardium & relief of acute
attacks
Administer meds as ordered.
Short & long acting nitrates [NG]
β-adrenergic agonists [Propranolol]
Reducing demand for O2
Limit activities, moderate exercise
Sedatives, tranquilizers, antidepressants
Helping client prevent future attacks
Diet – low calorie, saturated fat
5-6 small frequent feedings
Daily exercise; avoid cold environment,
smoking



Myocardial Infarction
Life threatening condition caused by occlusion
of coronary artery or its branches leading to
death of myocardial cells

Causes:
Atherosclerosis
Thrombus
Embolus
Coronary artery spasm




Signs & Symptoms:
Steady constrictive substernal chest pain,
sever, not relieved by rest & Nitroglycerine
Symptoms of shock, increase in temp
Nausea & vomiting, diaphoresis, pallor
Anxiety and apprehension

Management:
Provide rest – CBR, use bedside commode
Relieve pain – demerol or morphine
O2 by mask, cannula or nasal catheter
ECG monitoring
IVF to KVO



Management:
Diuretics
β-adrenergic agonists
Anti-arrhythmics [Procainamide, Lidocaine]
Diet: no iced or very hot drinks, may
precipitate arrhythmias, no gas-forming
foods
Mild laxatives, stool softeners
If due to thrombus: give
Thrombolytics [Streptokinase]
Follow up therapy w/ anticoagulant
Heparin, Coumadin, ASA, Dicumarol




CONGESTIVE HEART FAILURE (CHF)

Inability of the heart to pump blood from the
ventricles as quickly as it enters the atria leading
to congestion in the lungs & systemic circulation

Causes:
inflow of blood → heart is greatly reduced
inflow of blood → heart is greatly increased
outflow of blood from the heart is obstructed
myocardial damage
increased metabolic state





Cardiac Compensatory Mechanisms:
Ventricular dilatation
Ventricular hypertrophy
Tachycardia

Forms of CHF:
Left ventricular failure
Right ventricular failure



Signs and Symptoms of CHF
Left-sided HF Right-sided HF
Forward Effects: Forward Effects:
Weakness, fatigue Decreased volume to the
mental confusion, lungs
insomnia, anxiety,
oliguria Backward Effects:
ankle/pretibial swelling,
Backward Effects: pitting edema, abdominal
breathlessness, distention, ascites,
cough, anorexia, JV distention,
orthopnea, hepatomegaly
crackles, ↑ PCWP, splenomegaly, wt. gain,
frothy sputum ↑ CVP

Congestive Heart Failure




Interventions:
Improve ventricular pump performance
Inotropic agents [Digitalis]
Administer O2 therapy
Reduce myocardial workload
Preload:
Administer diuretics
Restrict fluid & Na intake
Upright position
Phlebotomy
Afterload:
Vasodilators
Reduce physical and emotional stress



ACUTE PULMONARY EDEMA

Complication of L-sided HF
Edema results from the heart’s inability to pump
adequately
Results in impaired oxygenation & hypoxia

Causes:
Heart failure
Atherosclerosis
Valvular disease





Assessment findings:
Dyspnea
•
Paroxysmal cough
•
Blood-tinged frothy sputum
•
Orthopnea
•
Restlessness
•

Diagnostic test findings:
CXR: interstitial edema
ABGs: respiratory alkalosis or acidosis
ECG: tachycardia, ventricular enlargement
EMODYNAMICS: ↑ PAWP, CVP, ↓ CO




Medical management:
Low-sodium diet; limit fluids
O2 therapy
High-Fowler’s position
VS, I/O, ECG, & hemodynamics
Analgesics
Vasodilators
Cardiac inotropes & glycosides
Nitrates
Bronchodilators
Pulse oximetry





Nursing management:
Assess CV & respiratory status
Withhold food & fluid
Provide:
Suctioning
Turning
Coughing
Deep breathing
Keep in High-Fowler’s
Allay anxiety
Note the color, amount & consistency of
sputum




Home instructions:
Recognize the signs of fluid overload &
•
respiratory distress
Sleep with the head of the bed elevated
•

Complications:
Digitalis toxicity
Fluid overload
Pulmonary embolism
Hypokalemia
Hyernatremia




CARDIOGENIC SHOCK

Failure of the heart to pump adequately, thereby
educing the CO & compromising tissue perfusion

Causes:
MI
Myocarditis
Advanced heart block
Heart failure
Metabolic abnormalities
Cardiac tamponade
Pulmonary embolus




CARDIOGENIC SHOCK

Hypotension
SBP <90 mm Hg
Oliguria:
<30 mL/H
Cold, clammy, pale skin
Tachycardia
Restlessness

Diagnostic findings:
ABGs: metabolic acidosis, hypoxemia
ECG: MI (enlarge Q wave, ST elevation)


↓
Injury ↓ SV ↑ HR
Myocardial
contractility
↓ Coronary
↓ LV emptying
artery
perfusion
LV dialtion & backup of
blood
Myocardial
hypoxia
↑ Preload
↓ CO
CARDIOGENIC SHOCK
Pulmonary
congestion Compensation

Decompensation
↓
& death
Myocardial
contractility




CARDIOGENIC SHOCK

Management:
O2 therapy
Semi-Fowler’s position
Intra-aortic balloon pump
Diuretics
Vasodilators
Cardiac inotropes
Vasopressors
Adrenergic agents




CARDIOGENIC SHOCK

Nursing management:
Administer:
IVF, O2, medications
Assess CV, respiratory status, & fluid balance
Monitor & record:
VS
I/O
Hemodynamics
LOC
Lab values




CARDIOGENIC SHOCK

Complications:
Arrhythmias
•
Cardiac arrest
•
Infection
•

Surgical interventions:
CABG
Heart transplantation



MITRAL STENOSIS
Narrowing of the mitral valve opening
Due to:
Rheumatic endocarditis
Congenital

Fatigue
•
Dyspnea on exertion
•
Peripheral edema
•
Orthopnea
•

CXR: enlargement of the LA & RV; pulmonary
congestion
ECHOCARDIOGRAM: thickened mitral valve & LA
enlargement



MITRAL STENOSIS

Management:
Low-sodium diet; fluid restrictions
Cardiac glycosides
Nitrates
Diuretics
Anti-arrhythmics
Ani-coagulants
Antibiotics




MITRAL STENOSIS

Nursing management:
Administer:
IVF, O2, medications
Assess CV & respiratory response
Monitor & record:
VS
I/O
Hemodynamics
ECG readings
Lab values



MITRAL STENOSIS
Home care:
Signs & symptoms
Activity limitations
Infection control
Occult blood

Complications:
Thrombosis
Embolism
HF
Atrial fibrillation

Surgery:
Valve replacement
Open mitral commissurotomy



MITRAL INSUFFICIENCY
Incomplete closure of the mitral valve
Due to:
↑ LA pressure
Pulmonary HTN
LA hypertrophy

Fatigue
•
Dyspnea on exertion
•
Peripheral edema
•
Angina pectoris
•
Orthopnea
•




ECHOCARDIOGRAM: enlarged LA, abnormal
movement of the mitral valve
CARDIAC CATH: ↑ LA pressure & ↑ LV pressure

Management:
Cardiac glycosides
Nitrates
Diuretics
Anti-arrhythmics
Ani-coagulants




Nursing management:
Maintain on diet; limit OFI
Keep on semi-Fowler’s position
Assess peripheral edema




AORTIC STENOSIS
Narrowing of the aortic valve
Lower CO leads to increased congestion in the
lungs causing RSHF

Causes:
Syphilis
Rheumatic fever
Atherosclerosis
Congenital malformations




AORTIC STENOSIS

Angina pectoris
•
Pulmonary HTN
•
LSHF
•
Orthopnea
•

ECG: L bundle branch block, 10 heart block, LV
hypertrophy
ECHOCARDIOGRAM: thickened LV wall,
thickened aortic valve that moves abnormally



AORTIC STENOSIS
Management:
•
Monitor lab studies
•
Cardiac glycosides
•
Nitrates
•
Diuretics
•
Anti-arrhythmics
•
Percutaneous transluminal valvuloplasty
•

Nursing management:
Assess CV & respi status
Monitor & record:
VS , I/O, Hemodynamics, ECG readings, Lab
values


AORTIC STENOSIS

Complications:
HF
•
Pulmonary edema
•

Surgery:
Aortic valve replacement
Commissurotomy



AORTIC INSUFFICIENCY

Retrograde flow of blood from the aorta to the LV
An incomplete closure of the aortic valve

Causes:
Syphilis
Rheumatic fever
Infective endocarditis
Atherosclerosis
Congenital defect




Signs of LSHF
•
Dyspnea on exertion
•
Dizziness
•
Angina pectoris
•

CXR: enlarged LV, aortic valve calcification
ECHOCARDIOGRAM: LV enlargement, abnormal
valve movement



Management:
•
Antibiotics
•
Cardiac glycosides
•
Nitrates
•
Diuretics
•
ACE inhibitors
•
Anti-arrhythmics
•
Percutaneous transluminal valvuloplasty
•

Nursing management:
Assess CV & respi status
Monitor & record:
VS , I/O, Hemodynamics, ECG readings, Lab values




Complications:
HF
•
Thrombosis
•
Embolism
•
Infection
•

Surgery:
Valvuloplasty
Valve replacement



PERIPHERAL VASCULAR DISEASE
Chronic inadequate blood flow in the lower extremities

Types:
Arteriosclerosis obliterans – sclerosis of arterioles
1.
resulting in thickening of the walls & occlusion
Raynaud’s phenomenon – intermittent
2.
vasoconstriction & ischemia of fingers & toes
accompanied by pallor & cyanosis
Buerger’s disease (thromboangiitis obliterans) –
3.
inflammation of BV resulting in occlusion of the vessel

Causes:
Atherosclerosis
Vasospasm
Inflammation


Intermittent claudication
Pain at rest
Trophic changes: thickened nails, absence of hair, &
taut skin
Diminished or absent pulses in extremities (unilateral)
Temperature changes in extremities
Color changes:
Rubor, cyanosis, pallor
Ulcerations in extremities

ARTERIOGRAPHY: location of obstruction
DOPPLER STUDIES: decreased blood flow & arterial
pressure



Buerger’s disease

Raynaud’s phenomenon




Management:
Active ROM & isometric exercises
•
Antiplatelet agents
•
Vasodilators
•
Anticoagulants
•
Antilipemics
•

Nursing management:
Assess for:
Pulses
Color
Temperature
Complaints of abnormal sensations
Numbness or tingling



Home care:
Symptoms of ↓ peripheral circulation
Skin breakdown
Foot care
Avoid stress
Prolonged standing
Extremes of temperature
Constrictive clothing
Crossing legs at knee when seated




Complication:
Gangrene
•
Septicemia
•
Pressure sores
•
Acute vascular occlusion
•

Surgery:
Bypass grafting
Endarterectomy
Sympathectomy
Amputation
Embolectomy



THROMBOPHLEBITIS
Massing of RBCs in a fibrin network
Obstruction by enlarged thrombus
Results to inflammation of the venous wall causing clots
to form

Causes:
Venous stasis
Varicose veins, pregnancy, HF, prolonged bed
rest
Hypercoagulability
Cancer, blood dyscrasias, oral contraceptives
Injury to venous wall
IV, fractures, antibiotics



THROMBOPHLEBITIS
SUPERFICIAL VEINS:
Red, warm skin that’s tender to touch
DEEP VEINS:
Major venous trunks:
Edema
(+) Homans sign
Tenderness
Cramping pain,
Cyanosis
Venous distention
SMALL VEINS:
Tenderness
Induration
Minimal to no distention


THROMBOPHLEBITIS
VENOGRAPHY/ PHLEBOGRAPHY : venous filling
defects
UTZ: ↓ blood flow

Management:
Activity limitation
Antiembolism stockings
Anticoagulants

Nursing management:
Assess for Homans sign
Apply warm, moist compress
Measure & record circumference of thighs & calves
Keep patient I bed & elevate extremities


THROMBOPHLEBITIS

Complications:
Pulmonary embolism
•
Stroke
•

Surgical intervention:
Vena cava filter
Vein ligation & stripping
Thrombectomy



ARTERIAL OCCLUSIVE DISEASE
Obstruction or narrowing of the aorta’s lumen & its major
branches
Reduced perfusion
Obstruction: endogenous or exogenous

Causes:
Atherosclerosis
Emboli
Thrombosis
Trauma or fracture

Risk factors:
Age
DM
Family history
Hyperlipidemia
HTN
Smoking



Femoral, popliteal or innominate arteries:
↓ decreased distal pulses
Mottling & pallor
Paralysis & paresthesia
Sudden & localized pain*
Internal & external carotid arteries:
stroke., TIA
Subclavian:
Subclavian steal syndrome
Vertebral & basilar:
TIA




Angiography findings:
The type (thrombus or embolus), location, & degree
of obstruction
Collateral circulation

Medications:
Antilipemics
Antiplatelets
Pentoxyfilline
Anticoagulants
Throbolytics




Nursing management:
Assess distal pulses, skin color, & temperature
Assess pain & give analgesics
Administer IV fluids, O2, & medications as Rx
Monitor for signs of stroke



ABDOMINAL AORTIC ANEURYSM
Dilation of or localized weakness in the medial layer of an
abdominal artery

Causes:
Atherosclerosis
HTN
Smoking

4 types:
Saccular – unilateral, pouch-like bulge
1.
Fusiform – spindle-shaped bulge; encompasses entire
2.
diameter of the vessel
Dissecting – hemorrhagic separation of the medial
3.
layer of vessel wall; creates a false lumen
False – pulsating hematoma; often mistaken for an
4.
abdominal aneurysm



Asymptomatic
Lower abdominal pain, lower back pain
Abdominal mass to the left of the midline
Abdominal pulsations
Bruits

Apparent on CXR, abdominal UTZ, aortography

Medications:
Analgesics
ß-blockers




Nursing management:
Check peripheral circulation
Observe for signs of shock:
Anxiety
Restlessness
Decreased pulse pressure
Increased thready pulse
Pale, cool, moist, clammy skin
Palpate abdomen for distention
Teach signs & symptoms of decreased peripheral
circulation




Complication:
Rupture of aneurysm
Hemorrhage
Renal insufficiency

Surgery:
Resection of aneurysm
Endovascular graft repair



CARDIOMYOPATHY
Disease of the heart’s muscle impacting the structure &
function of the ventricle
Heart failure develops later
Myocardium becomes flabby

Types:
Congestive (dilated) – chronic alcoholism
1.
Hypertrophic – idiopathic hypertrophic subaortic
2.
stenosis
Pressure overload hypertension or aortic valve
stenosis
Hypertrophic cardiomyopathy
Restrictive (obliterative) – amyloidosis, cancer
3.



CARDIOMYOPATHY

Major manifestations:
Dyspnea
•
Dry cough
•
Fatigue
•
Palpitations
•
Weakness
•

ECG: LV hypertrophy
ECHOCARDIOGRAM: decreased myocardial
function
CXR: cardiomegaly



CARDIOMYOPATHY

Management:
•
LV assist device
•
Diuretics
•
ß-blockers
•
Anticoagulants
•
CCBs
•
ACE inhibitors
•

Nursing management:
Keep in semi-Fowler’s position
Monitor ECG results
Administer O2 & medications



CARDIOMYOPATHY

Home care:
Signs & symptoms of HF
Weigh daily
Report increments of 3 lbs.
Demonstrate exercises to increase CO
Refrain from smoking & drinking alcohol

Complications:
Heart failure
•
Arterial emboli
•

Surgery:
Ventricular myomectomy
Heart transplant


ENDOCARDITIS
Endocardial lining inflammation
Destruction of heart valve leaflets

Causes:
ß-hemolytic strep infections
S. aureus, Candida, G(-)
Rheumatic heart disease
Dental procedures
Invasive monitoring
IV drug abuse



ENDOCARDITIS
Elevated temperature
•
Heart murmur
•
Malaise
•

BLOOD CULTURES: (+) microorganisms
•
ECHOCARDIOGRAPHY: valvular damage,
•
vegetations

Medical management:
Antibiotics
(+) inotropic agents
Antipyretics
Anticoagulants


ENDOCARDITIS
Nursing management:
Administer medications
•
Asses CV status
•
Encourage rest periods
•

Home care:
Avoid infections
•
Monitor for infections specially after dental or gynecologic
•
exam; seek treatment
Wear ID
•

Complications:
Embolism
•
HF
•
Mycotic aneurysm
•

Surgery:
Valve replacement


PERICARDITIS
Inflammation of the pericardium
May be: fibrinous or effusive

Causes:
Infection
Neoplasms
High dose radiation to the chest
Hypersensitivity or autoimmune disease
Hydralazine or procainamide
Postcardiac injury
Aortic aneurysm
Myxedema



PERICARDITIS


Pain characteristics:

Sharp, usually sudden over the sternum

Radiates to the neck, shoulders, back & arms

Increases with deep inspiration or when lying
down

Decreases when sitting up & leaning forward



PERICARDITIS
ECG
Elevated ST segments
QRS segments may be diminished with pericardial
effusion
Rhythm changes may occur:
Atrial ectopic rhythms – atrial fibrillation & sinus
arrhythmia
Echocardiography reveals the problem

Management:
Bed as long as fever & pain persist
NSAIDS
Corticosteroids
Antibiotics


PERICARDITIS
Nursing management:
Maintain CBR
•
Place on upright position
•
Monitor & record VS, I/O, & hemodynamics
•
Assess pain & give analgesics as Rx
•

Complications:
Pericardial effusion
•
HF
•
Chronic RSHF
•
Cardiac tamponade
•

Surgery:
Pericardectomy




CONDUCTION ARRHYTHMIAS
Disruption in the normal events of cardiac cycle
Sinus Tachycardia – HR > 100 beats/min originating from
the SA node (100-160bpm); regular rhythm
Causes: fever, apprehension, physical activity,
anemia, hyperthyroidism, epinephrine, caffeine

Management:
Correction of underlying
cause
No stimulants
Drug of choice:
propranolol [Inderal], Digoxin





Sinus Bradycardia – HR < 60 beats/min; regular rhythm
May be caused by:
Excessive vagal/or ↓ sympathetic tone
MI, intracranial tumors, meningitis
N variation of HR in well-trained athlete

Management:
Not needed, unless CO is inadequate
Pharmacotherapy: Atropine, Isuprel
Pacemakers – pulse generator to control
potentially dangerous dysrhythmias





Atrial Fibrillation: Atrial rate: 35-600bpm;
Vent. rate: 100-160 bpm; irregular
May be seen it pts with:
Rheumatic mitral stenosis, thyrotoxicosis,
hypertensive disease, cardiomyopathy,
pericarditis and CHD
Management
Digitalis, Propranolol
Verapamil in conjunction w/ digitalis
Direct-current cardioversion



Ventricular Tachycardia – run of 3 or more consec. PVCs;
Atrial rate: 60-100bpm; Vent. rate: 110-250bpm; occ’l
ventricular irregularity
May be caused by:
Acute MI, CAD, intoxication, hypokalemia
Management
IV push Lidocaine, then IV drip
Procainamide via IV infusion
Propranolol [Inderal], Bretylium
Direct-current cardioversion





Premature Ventricular Contractions – HR varies
according to number of PVCs; irregular rhythm

May be caused by:
Myocardial dse, CHD, hypoxia
Electrolyte imbalance [hypokalemia]
Digitalis tx, stimulants

Management
IV push Lidocaine, then IV drip
Procainamide [Pronestyl]
Treatment of underlying cause

Cardiovascular Disorders

THANK YOU!

Nio C. Noveno, RN

Cardiovascular Disorders Proper

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