Cardiac Disease Notes

CARDIAC DISEASE - inadequate blood supply depriving the
- are the leading cause of death in the cardiac muscle cells with oxygen needed
United States form men and women of all for their survival.
racial and ethnic groups. 2. Angina Pectoris - refers to chest pain

that is brought about by myocardial
CARDIAC DISEASE || CORONARY ARTERY ischemia
DISEASE 3. Atypical
 CAD is the most prevalent type of Prevention
cardiovascular disease in the adult a. Controlling cholesterol abnormalities:
 Results from the focal narrowing of Dietary Measures
the large and medium-sized coronary Physical Activities
arteries. Medications
 Atherosclerosis is an abnormal b. Promoting cessations of Tobacco use
accumulationof lipid, or fatty c. Controlling DM
substances, and fibrous tissue in the d. Managing hypertension
lining of arterial blood vessel walls. It

is the most common cause of CAD. PREVENTION
Non-modifiable Risk Factors:  Controlling cholesterol
 Family history abnormalities
 Age: Men-above 45 Women-above  Dietary measures
55  Physical activity
 Gender: men develop CAD at an early  Medications
age than women  Promoting cessation of Tobacco use
 Race: higher incidence of heart  Controlling DM
disease in African Americans than in  Managing hypertension
Caucasians
Modifiable Risk Factors: CARDIAC DISEASE || ANGINA PECTORIS
 Smoking  Chest pain resulting from
 Metabolic Syndrome- DM, obesity, atherosclerosis or myocardial
hypertension, hyperlipidemia, excess ischemia
body fat around the waist  Types of Angina:
 Physical inactivity 1. Stable angina - predictable and
Clinical Manifestations consistent pain that occurs on
1. Ischemia exertion and is relieved by rest

and/or nitroglycerin.
2. Unstable angina - symptoms 2. Cardiac Catherization - provides
increase in frequency and severity; the MOST DEFINITIVE source of
may not be relieved with rest and diagnosis by showing presence….
nitroglycerin. Also called NURSING MANAGEMENT
preinfarction angina or crescendo 1. Administer prescribe medication:
angina.  Nitrate - to dilate the coronary
3. Intractable or refractory angina - arteries
severe incapacitating chest pain.  Aspirin - to prevent thrombus
4. Variant angina - also called formation
Prinzmetal’s angina. Pain at rest with  Beta-blockers - to reduce BP and HR
reversible ST-segment elevation;  Calcium channel blockers - to dilate
thought to be caused by coronary coronary artery and reduce
artery vasospasm. vesospasm
5. Silent Ischemia - objective 2. Teach the patients how to manage
evidence of ischemia (such as ECG anginal attacks
changes with a stress test), but the px  Advise the Px to stop all activities
reports no pain.  Put one nitroglycerin tablet under
ASSESSMENT FINDINGS the tongue
1. Chest Pain  Wait for 5 mins.
 Precipitated by Exercise, Eating  If not relieved, take another tablet
heavy meals, Emotions like and wait for 5 mins.
excitement and anxiety,  Another tablet can be taken (third
Extreme temperature tablet)
 Relieved REST and nitroglycerin  If unrelieved THREE tablet, SEEK
2. Diaphoresis MEDICAL ATTENTION
3. Nausea and vomiting 3. Obtain a 12-lead ECG
4. Cold clammy skin 4. Promote myocardial perfusion
5. Sense of apprehension and doom  Intruct the patient to maintain bed
6. Dizziness and syncope rest
LABORATORY FINDINGS  Administer O2 @3Lpm
1. ECG may show normal tracing if  Advise to avoid valsalva maneuver
the Px is pain-free. Ischemic  Provide laxatives or high fiber diet to
changes may show ST-depression lessen constipation
and T-wave inversion.  Encourage to avoid increased
physical activities.
5. Assist in possible treatment modalities
 PTCA - Percutaneous 1. Provide Oxygen @ 2Lpm; Semi-
transluminal coronary fowler’s position
angioplasty 2. Administer medications
6. Provide information to family - Morphine: to relieve pain
members to minimize anxiety and - Nitrates, Thrombolytics, Apsirin,
promote family cooperation Anticoagulants
7. Assist the client to identify risk factors - Stool softener and hypolipidemics
that can be modified 3. Minimize px anxiety: provide
8. Refer the patient to the proper information about drug therapy and
agencies procedures
4. Provide adequate rest periods
CARDIAC DISEASES || MYOCARDIAL 5. Minimize metabolic demands: provide
INFARCTION soft diet, low sodium, low cholesterol,
- The death of myocardial tissue in low fat diet
regions of the heart with abrupt MEDICAL MANAGEMENT
interruption of blood supply. 1. Analgesic
RISK FACTORS: 2. Ace inhibitors
1. Hypercholesterolemia NURSING INTERVENTION AFTEN AN
2. Smoking ACUTE EPISODE
3. Hypertension 1. Maintain bed rest for the first 3 days
4. Obesity 2. Provide passive ROM exercises
5. Stress 3. Progress with dangling off the feet at
6. Sedentary lifestyle the side of the bed
ASSSESSMENT FINDINGS 4. Proceed with sitting out of bed, on the
1. Chest Pain chair for 30 mins. TID
 Occurs without cause 5. Proceed with ambulation in the room
 G -> toilet -> hallway TID
2. Dyspnea 6. Cardiac Rehabilitation
LABORATORY FINDINGS  To extend and improve quality of
1. ECG: the ST-segment is ELEVATED. T- life
waves inversion, and the presence of Q Physical conditioning
wave Patients who can walk 3-4mpH are
2. Myocardial enzymes: elevated CK-MB, usually ready to resume sexual
LDH, and Troponin Levels activities
3. CBC: may show elevated WBC count
NURSING INTERVENTIONS
CARDIAC DISEASES || CONGESTIVE b. Assess VS, CVP, PCWP, weigh patient
HEART FAILURE daily to monitor fluid retention
- a syndrome of congestion of both c. Administer medications (digoxin or
pulmonary and systemic circulation digitoxin, diuretics, vasodilators)
caused by inadequate cardiac output d. Provide a low sodium diet
to meet the metabolic demands of e. Provide adequate rest periods to
tissues prevent fatigue
ETIOLOGY OF CHF: f. Position patient from semi-fowler to
 Coronary Artery Disease (CAD) fowler’s for adequate rest
Valvular Heart Disease (VHD) NURSING INTERVENTIONS AFTER THE
Hypertension ACUTE STAGE
MI a. Provide opportunities for verbalization
Cardiomyopathy of feeling
Lung Diseases b. Instruct the patient about the
Post-partum medication regimen-digitalis,
LEFT-SIDED HF ASSESSMENT FINDINGS vasodilators, and diuretics
 Dyspnea on exertion
RIGHT SIDED HF ASSESSMENT FINDINGS
 Peripheral dependent, pitting
edema
Weight gain
Distended neck vein
Hepatomegaly
Ascites
Body weakness
Anorexia
Pulses alternans
LABORATORY FINDINGS
- CXR may reveal cardiomegaly
- ECG may identify cardiac
Hypertrophy
- Echocardiogram may show
hypokinetic
NURSING INTERVENTIONS
a. Assess patient’s cardio-pulmonary
status

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CARDIAC DISEASE - inadequate blood supply depriving the

racial and ethnic groups. 2. Angina Pectoris - refers to chest pain

CARDIAC DISEASE || CORONARY ARTERY ischemia

 CAD is the most prevalent type of Prevention

cardiovascular disease in the adult a. Controlling cholesterol abnormalities:

 Results from the focal narrowing of Dietary Measures

the large and medium-sized coronary Physical Activities

 Atherosclerosis is an abnormal b. Promoting cessations of Tobacco use

accumulationof lipid, or fatty c. Controlling DM

substances, and fibrous tissue in the d. Managing hypertension

lining of arterial blood vessel walls. It

Non-modifiable Risk Factors:  Controlling cholesterol

 Family history abnormalities

 Age: Men-above 45 Women-above  Dietary measures

 Gender: men develop CAD at an early  Medications

age than women  Promoting cessation of Tobacco use

 Race: higher incidence of heart  Controlling DM

disease in African Americans than in  Managing hypertension

 Smoking  Chest pain resulting from

 Metabolic Syndrome- DM, obesity, atherosclerosis or myocardial

hypertension, hyperlipidemia, excess ischemia

body fat around the waist  Types of Angina:

 Physical inactivity 1. Stable angina - predictable and

Clinical Manifestations consistent pain that occurs on

1. Ischemia exertion and is relieved by rest

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