2. Surprising Facts About Heart Disease
Spending time with friends and family can lower your heart attack
risk.
Studies have found that people who live by themselves are two times
more likely to have a heart attack than people who live with a
roommate or partner.
One hypothesis explaining this effect is that spending time with friends
and family can mitigate stress and fend off depression—both of which
are risk factors for heart disease.
3. Many heart attacks occur on Monday mornings
• Researchers have noticed that heart attacks are particularly common
during the fall and winter, and on Monday mornings. This is believed
to be the case because the body has to work harder to pump blood,
which is thicker in the morning. At the same time, in the morning, the
body’s stress hormones such as cortisol spike.
4. • Cardiovascular events — such as heart attacks or chest pain caused by
heart disease — rarely occur during sexual activity, because sexual
activity is usually for a short time.
8. Non Modifiable Factors
>Age (40yo)
>Gender (Men)
>Family History
Modifiable Risk Factors
>Smoking
>Hypertension
>Obesity
> High cholesterol
>Stress
9. Care and management
• A full care history is essential in order to provide high-quality care for
patients with atherosclerosis.
The assessment must include the identification of risk factors and
symptoms of any cardiovascular disease. The care and management
includes:
• Health promotion to prevent the disease must include advice on a
healthy diet and regulating the lipid levels within normal range. Regular
physical examination by a person’s physician in order to monitor their
blood pressure and cholesterol levels should be encouraged.
10. • Advice on the cessation of smoking and alcohol consumption should
be offered as these are identified risk factors in atherosclerosis.
• Patients should be advised to lose weight if obesity is a problem
• Encourage the patient to undertake programmed exercise under the
supervision of healthcare professionals. This will help in lowering
their weight and cholesterol level, and in reducing their blood
pressure and stress.
11. Pharmacological interventions for atherosclerosis
• The aim of medications in the treatment of atherosclerosis is to
restore blood flow and prevent the disease. The medications include:
• antihypertensives such as beta-blockers
• anticoagulant therapy with heparin
• lipid-lowering drugs such as simvastatin
• antiplatelet drugs.
• In some patients, surgical procedures, such as balloon angioplasty,
may be indicated to improve the blood flow through the vessel.
12. Medicine management
• Statins are the name given to a group of cholesterol lowering medicines, which are available
on prescription or in low doses over the counter at pharmacies in the UK. Statin therapy is
recommended for adults at high risk of cardiovascular disease (heart attack, stroke or peripheral
artery disease) and also those who already have a history of cardiovascular disease.
Statins work by reducing the amount of bad (LDL) cholesterol in the blood. They do this
by blocking the synthesis of cholesterol in the liver cells; the cells then get their supply of
cholesterol from the blood, thereby lowering the blood cholesterol level.
Some side effects have been documented with this medication including headache, stomach
upset, altered liver function and some muscle pain but these side effects are usually mild, easily
recognizable and reversible. It is essential to note that many people will have no side effects at
all from this medication.
13. Diagnostic studies
• Electrocardiography
• Cardiac catheterization
• Blood lipid levels
Surgical procedures:
• 1. PTCA to compress the plaque against the walls of the artery and dilate the
vessel
• 2. Laser angioplasty to vaporize the plaque
• 3. Atherectomy to remove the plaque from the artery
• 4. Vascular stent to prevent the artery from closing and to prevent restenosis
• 5. Coronary artery bypass grafting to improve blood flow to the myocardial tissue
at risk for ischemia or infarction because of the occluded artery
20. Maintenance: Nitroderm patch
• Apply once a day in the morning after bathing in non hairy area in the
chest
• Rotate site: to avoid skin irritation
to avoid tolerance
• Storage of Nitroglycerin:
-cool dry place
-patch (not open)
-If opened bottle, replace after 3 months
-If sealed in the bottle replace after 6 months
>Side effect: HYPOTENSION
> Indicator: DULL HEADACHE
21. Medications
• 1.Beta adrenergic blocker (propranolol)
• Monitor HR for bradycardia
• 2. calcium channel blockers: Vasodilator
• Monitor for Hypotension
• 3. Anti platelet drug: Aspirin
• To prevent clot formation
22. • 4. Anti coagulants
Heparin Warfarin
IV/SC Oral
PTT (25-35) PT (11-13.5)
Advantage: FAST acting Advantage: long half life
Antidote: Protamine Antidote: VIT K
26. S/sx:
• P (Persistent chest pain <15min)
• U (Upset feeling)
• L (Light headedness)
• S (SOB)
• E (excessive sweating/ diaphoresis
27. • Trop I –1st to increase, most sensitive, increased in 30 min
• CKMB- most indicative, increased 2-4h( myocarditis)
• ECG- very sure to determine stage and location
• CKMM- sensitive test for MI (present in myocardial muscles)
• BEFORE:
• LDH- peak 24 h
• LDH 1>LDH 2= LDH flip (multisystem involvement)
>LIVER
A. ALT
B. AST
KIDNEY
C.BUN
D. creatinine
28. Collaborative Mgt: O BATMAN
• O Oxygen
• B Beta blockers
• A Aspirin
• T Thrombolytics
• M Morphine
• A Ace inhibitors
• N Nitroglycerin
29. Top 3 Narcotics:
• 1. Fentanyl 10mcg- OR , respiratory arrest
• 2. Morphine Sulfate 10mg
• 3. Demerol 75mg- causes seizure
Drug of choice: Morphine sulfate (1-2mg IV)
Reasons: natural narcotic, has sedative effects, anti anxiety,
vasodilating effects
Effects: Respiratory system depression (medulla)
Antidote:?????
MONA
30. • Oxygen- increase flow 4-6L (venturi mask)
• Nitroglycerin
• Aspirin- 625mg x 2 weeks (antiplatelet), taken PC meals
Monitor: watch for bleeding
Toxicity: Tinnitus
• Thrombolytics- to dissolve clots, IV (kinase, streptokinase)
Given: 6 divided doses within 4 hours
Note: if prolonged clotting- PAUSE/ WITHHOLD
Antidote: AMINOCAPROIC ACID (AMICAR)
• Ace inhibitors- prevent activation of RAAS (of there’s kidney involve)
31. Nursing Management:
• 1. Establish IV line (MONA + T)
• 2. Administer o2 and drugs
• 3. Complete bed rest without TP
• 4. Monitor vital signs 1st 4 hours (q 15min), 1-2h (NEVER DELEGATE)
• 5. Monitor complication: ST elevation, dysrhythmias
32. Cardiac Rehabilitation:
• Maintenance meds
• A. anti coagulants- PTT
• B. anti hyperlipidemics- cholesterol level
• Activity- determination (STRESS TEST)
• Diet: low calorie,low fat, low cholesterol, low sodium,
Increased fiber (valsalva causes vasovagal response causes bradycardia)
33. COMPENSATORY DECOMPENSATORY REFRACTORY
TIME 4-24 HOURS
(crisis stage)
After 4-24 hours -------
PATHOPHYSIOLOGIC
CHANGES
Injury to the heart Ischemia Necrosis
VITAL SIGNS vitals signs
Other organs are
protected but heart is
compromised
Normal
ECG ST elevation
(ventricular tachycardia)
ST depression
T- wave inversion
Deep q waves
Non- reversible
Dysrhythmia (most
deadly)
1. Remove led
2. Defibrillation
3. Epinephrine
34. HEART FAILURE
• 1.Heart failure is the inability of the heart to maintain adequate
cardiac output to meet the metabolic needs of the body because of
impaired pumping ability.
• 2. Diminished cardiac output results in inadequate
• peripheral tissue perfusion.
• 3. Congestion of the lungs and periphery may occur;
• the client can develop acute pulmonary edema.
35. • Classification
• 1. Acute heart failure occurs suddenly.
• 2. Chronic heart failure develops over time; however, a client with
chronic heart failure can develop an acute episode.
36.
37. Nursing Management
1.Assist the client to identify precipitating risk factors of heart failure and
methods of eliminating
these risk factors.
2. Encourage the client to verbalize feelings about the lifestyle changes
required as a result of the
heart failure.
3. Instruct the client in the prescribed medication regimen, which may
include digoxin, a
diuretic, ACE inhibitors, low-dose beta blockers, and vasodilators.
4. Advise the client to notify the HCP if side effects occur from the
medications.
5. Advise the client to avoid over-the-counter medications.
38. 6.Instruct the client to contact the HCP if he. or she is unable to take medications because
of illness.
7. Instruct the client to avoid large amounts of caffeine, found in coffee, tea, cocoa,
chocolate, and some
carbonated beverages.
8. Instruct the client about the prescribed low sodium, low-fat, and low-cholesterol diet.
9. Provide the client with a list of potassium-rich foods because diuretics can cause
hypokalemia
(except for potassium-retaining diuretics).
10. Instruct the client regarding fluid restriction, if prescribed, advising the client to spread
the fluid
out during the day and to suck on hard candy to reduce thirst and rest.
12. Advise the client to avoid isometric activities, which increase pressure in the heart.
13. Instruct the client to monitor daily weight.
14. Instruct the client to report signs of fluid retention such as edema or weight gain.
39. HYPERTENSION
Persistent increased BP 6 months and above
Pre hypertension-if more than 1 month
HYPERTENSIVE crisis- sudden elevation of BP
1. False activation of RAAS
2. Pheochromocytoma (benign tumor in adrenal medulla (Epi and NE)
3. MAOI + Tyramine
Drug of choice: PHENTOLAMINE MESYLATE
40. Management
• 1. Assess BP daily
• 2. LF, LS, Low cholesterol diet
• 3. Healthy lifestyle: no smoking, exercise, Proper water intake
• 4. Drugs: Vasodilators (calcium channel blockers)
• Diuretics (Diuril)
• 5. Watch for complications:
• Blurring of vision
• Decreased urine output
• Altered LOC
• Chest pain
41. Cardiogenic Shock
1. Cardiogenic shock is failure of the heart to pump adequately,
thereby reducing cardiac output and compromising tissue perfusion.
2. Necrosis of more than 40% of the left ventricle occurs, usually as a
result of occlusion of major coronary vessels.
3. The goal of treatment is to maintain tissue oxygenation and
perfusion and improve the pumping ability of the heart.
42. Assessment
1. Hypotension: BP lower than 90 mm Hg systolic or 30 mm Hg lower
than the client’s baseline
2. Urine output lower than 30 mL/hour
3. Cold, clammy skin
4. Poor peripheral pulses
5. Tachycardia, tachypnea
6. Pulmonary congestion
7. Disorientation, restlessness, and confusion
8. Continuing chest discomfort
43. Interventions
1. Administer oxygen as prescribed.
2. Administer morphine sulfate intravenously as prescribed to decrease pulmonary
congestion
and relieve pain.
3. Prepare for intubation and mechanical ventilation.
4. Administer diuretics and nitrates as prescribed while monitoring the BP constantly.
5. Administer vasopressors and positive inotropes as prescribed to maintain organ
perfusion.
6. Prepare the client for insertion of an intra aortic balloon pump, if prescribed, to improve
Coronary artery perfusion and improve cardiac output.
7. Prepare the client for immediate reperfusion procedures such as PTCA or
coronary artery bypass graft.
44. 8.Monitor arterial blood gas levels and prepare
to treat imbalances.
9. Monitor urinary output.
10. Assist with the insertion of a pulmonary artery (Swan-Ganz)
catheter to assess degree of heart failure
11. Monitor distal pulses and maintain the transducer at the level of
the right atrium if the client has a pulmonary artery (Swan-Ganz)
catheter.
45. Nursing Dx:
• Activity Intolerance related to insufficient o2 for ADLs
• Anxiety r/t breathlessness
• Imbalanced Nutrition: less than body requirements
• Impaired Tissue perfusion r/t venous congestion
• Disturbed sleep pattern r/t nocturnal dyspnea
• Powerlessness r/t Progressive nature of condition
