Chapter 81:Cardiovascular Disorders

Sasha Persaud

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Homework

vAssignment due on March 6th by 9:00 am

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Learning Objectives (still have to figure
which ones are ours.)

1. Explain the rationales for the following laboratory

tests: CK, LDH, AST, troponin, lipid levels, and
BNP.
2. Differentiate an angiocardiogram from an
arteriogram, including nursing considerations for
each procedure.
3. Describe the role of the nurse during and after the
following procedures: echocardiogram, ECG stress
test, and an electrophysiology study.
4. Identify nursing considerations before and after a
cardiac catheterization.
5. Identify the rationale for performing a PTCA.
6. Compare andCopyright
contrast the following surgical
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Introduction

vCardiovascular system:
o Is responsible for supplying oxygen to body
organ and other tissues (perfusion).
o Made up of the heart, arteries and veins (blood
vessels)
o Myocardium – heart muscle that pumps blood to
other parts of the body

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Anatomy and Physiology Review
Pericardium à covering of the heart à protects heart
Septum à muscular wall that separate the heart into two halves à right and left
v Right atrium
o Deoxygenated blood from venous system à fed by the superior and
inferior vena cava
o Blood from the coronary sinus à returning from the heart muscle
v Tricuspid valve à separates the right atrium and right ventricle
v Right ventricle à has enough pressure to close the tricuspid valve and open the
pulmonic valve à propels blood into the pulmonary artery and the lungs
v Pulmonary artery to lungs à blood reoxygenated à pulmonary vein à left
atrium
v Left atrium à blood from pulmonary vein flows in
v Mitral valve à separates the left atrium and the left ventricle
v Left ventricle à systolic contraction causes increase pressure à close the
mitral valve à open the aortic valve
v Aortic valve à blood from the left ventricle flows through this valve and into
the systemic arterial circulation

https://www.youtube.com/watch?v=GMBSU-2GK3E
https://youtu.be/aDXABSb0_p8?si=fESW8NQAATU9tucs

Diastole à passive flow from AàV

Systole à active flow from AàV via contraction

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Signs & Symptoms of Cardiovascular
Disorders

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Prevention of Cardiovascular Disorders

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9Common Medical Treatments #2

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10Common Medical Treatments #3

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The Nursing Process

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19Abnormal Conditions That May Cause
Cardiovascular Disease #1
v Arteriosclerosis: refers to conditions where artery walls thicken, harden, and lose elasticity, commonly
known as "hardening of the arteries.”
v Atherosclerosis, the most common type, involves fatty deterioration of the arterial smooth muscle
walls.
o Over time, arteries absorb more circulating lipids, leading to narrowing (stenosis) or possible
complete closure of the artery.
o The buildup of fat and mineral deposits in the arteries is called plaque.
v Arteriosclerosis and atherosclerosis are often used interchangeably and may affect heart valves,
potentially leading to hypertension or coronary artery disease (CAD).
v Diet:
o Diet high in saturated fats is linked to increased blood cholesterol levels.
o Unsaturated fats (e.g., olive oil, corn oil) raise cholesterol less than saturated fats (e.g., butter,
eggs, meats).
o People metabolize cholesterol differently, affecting their risk for cardiovascular diseases.
o Cholesterol management involves monitoring blood cholesterol levels and adjusting diet,
medications, and exercise.
o The balance between HDL (good/happy cholesterol) and LDL (bad/lousy cholesterol) is more
important than the total cholesterol level. **When total cholesterol exceeds 150, the risk of CAD
increases.**

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Abnormal Conditions That May Cause
Cardiovascular Disease #2
v Hypertension (HTN)
o Leading cause of MI, cardiac damage, kidney damage, heart failure, and CVA
o The condition of the heart and blood vessels has the greatest effect on blood pressure.
o Although HTN cannot be cured, treatment can usually bring blood pressure to within the normal
range.
o Malignant hypertension
o Increased blood pressure can damage small arterioles and contribute to arteriosclerosis, creating
a vicious circle.
o The heart works harder to pump blood, leading to hypertrophy (enlargement) of the heart
muscle.
o May have known causes (e.g., kidney failure, blood vessel malformations, certain tumors,
endocrine disorders) or be essential hypertension (unknown cause).
o Managing hypertension include:
§ Exercise regularly
§ Moderation in eating
§ Avoid tension, anxiety, smoking, excessive alcohol, caffeine, and sodium intake
o Severe hypertension symptoms can include: Headache, fatigue, shortness of breath (dyspnea),
edema (swelling), nocturia (nighttime urination)

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Abnormal Conditions That May Cause
Cardiovascular Disease #3
v Malignant Hypertension
o Medical emergency
o Symptoms include morning headaches, blurred vision, dyspnea, uremia
o Risk uncontrolled HTN, not taking tx, abruptly stopping BP pills which can
cause BP to suddenly skyrocket
o Systolic > 200 mm Hg, Diastolic > 150 mm Hg
o Tx: Nitroprusside (vasodilator), fenoldopam (vasodilator), nicardipine or
labetalol (all IV)
o Without tx will cause L ventricular failure, stroke or kidney failure
o Reduce BP by 25% in 1st hour, then to 160/100 in next 2-6 hrs, and to
normal over 24-48 hrs
o Rapid reduction -> cerebral ischemia, MI, renal failure
o BP checks every 5-30 mins
o Administer O2
o Monitor for target organ damage: seizures, dysrhythmias, chest pain
o Usually admitted to the ICU where they receive IV antihypertensive therapy
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Abnormal Conditions That May Cause
Cardiovascular Disease #4
v Hypotension
v 3 Causes of Hypotension:
o Rate Problems (heart rate issues): Heart rate too fast or too slow.
o Pump Problems (heart function or structure issues):
• Myocardial infarction (MI) (heart attack)
• Cardiomyopathy (enlarged and stretched heart cavity)
• Acute cardiac or aortic insufficiency
• Prosthetic valve dysfunction
• Cardiac tamponade (heart compression from fluid buildup)
• Pulmonary embolism (blood clot in lungs)
• Medications affecting heart function
o Volume Problems (issues with blood or fluid volume):
• Hemorrhage (excessive blood loss)
• Gastrointestinal fluid loss (vomiting, diarrhea)
• Renal injury or disease (kidney problems)
• Central nervous system injury (spinal injury or brain damage)
• Sepsis (infection causing widespread inflammation)
• Medications or diseases affecting vascular tone
• Any condition causing large-volume fluid losses.
v Treatment depends on the underlying cause of hypotension. It will vary based on whether the issue is related to the heart
rate, heart function, or volume.

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Conditions Affecting the Heart’s Rhythm
#1
v Cardiac Arrhythmia?
o An arrhythmia (or dysrhythmia) is an irregularity in the heartbeat's rhythm.
o It occurs when there is a disruption in the normal sequence of electrical impulses in the heart.
v Causes of Arrhythmias:
o Myocardial infarction (MI) (heart attack)
o Electrolyte imbalances (especially potassium)
o Other heart and circulatory disorders
o Severe trauma or electric shock
v Types of Arrhythmias:
o Categorized by the site of origin of the abnormal electrical impulses:
§ SA node (sinoatrial node, the natural pacemaker of the heart)
§ AV node (atrioventricular node)
§ Bundle branches
§ Purkinje network (the network of fibers that distribute electrical impulses through the
ventricles)
§ It can originate in the atria, septum, or ventricles.
v Arrhythmias can vary in severity and impact, from benign and harmless to life-threatening. The
treatment and management depend on the type and underlying cause.

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20Conditions Affecting the Heart’s
Rhythm #2

v 3 Main Cardiac arrhythmias (or dysrhythmia)

o Sinus tachycardia
§ Heartbeat is greater than 100 beats per minute.
§ It can be present postoperatively and in instances of high fever, decreased
oxygenation, excessive fluid or blood loss, extreme emotion, overactive
thyroid, or strenuous exercise.
o Sinus bradycardia
§ Heartbeat is less than 60 beats per minute.
§ Sinus bradycardia can occur with digitalization, or it can be a symptom of
heart block.

o Premature ventricular contraction (PVC)

§ An irregularity in the heart’s ventricular rhythm.
§ A premature contraction initiated in the ventricles before the normal SA
node–conducted beat.
§ Can be relatively benign; indicators of early cardiac problems; or progress
to more malignant ventricular arrhythmias.

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21Conditions Affecting the Heart’s
Rhythm #3

vAtrioventricular heart block

v Heart Block:
o Heart block is not a disease itself but is associated with other heart diseases, particularly coronary artery disease
and rheumatic heart disease.
o Atrioventricular (AV) heart block results in weak heart contractions that don't effectively send blood from the atria to
the ventricles.
o Pulse rate can drop as low as 30 beats per minute in severe cases.
v Pacemaker Use:
o A pacemaker is used to provide an external stimulus to the heart when contractions are too weak or irregular.
o External pacemakers are generally temporary, while internal pacemakers are often necessary for life-sustaining
cardiac rhythms.
o Pacemaker functioning: It stimulates the heart by sending electrical impulses through wires and electrodes inserted
into the heart.
o Indications for Pacemaker Use: Heart block (lack of electrical activity initiation), irregular or paroxysmal
arrhythmias in the atria or ventricles. Permanent pacemakers may be implanted if there is frequent difficulty with
heart contractions.
v Pacemaker Implantation:
o A permanent pacemaker is implanted under the skin (usually near the subclavian or lower abdominal area).
o A portable pacemaker (size of a cell phone or MP3 device) is used in clinical settings.
v Pacemaker Maintenance:
o Some patients may discontinue pacemaker use gradually, depending on the heart's rhythm.
o Others cannot live without it.
o Battery replacement for internal pacemakers is needed every 5-10 years, typically done on an outpatient basis.

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Conditions Affecting the Heart’s Rhythm
#4

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Conditions Affecting the Heart’s Rhythm
#5
v Fibrillation
o Fibrillation refers to the quivering of muscle fibers.
o It results in disorganized twitching that disrupts normal heart function.
v Types of Fibrillation:
o Atrial Fibrillation:
§ Atrial fibrillation involves disorganized twitching of the atrial muscles.
§ Common in clients with atherosclerosis or rheumatic heart disease.
§ Irregular pulse due to loss of coordination between the atria and ventricles.
§ Treatment depends on the cause and may include:
• Digoxin, beta-blockers, or calcium channel blockers to slow electrical impulses from the atria to the
ventricles.
• Anticoagulants to prevent blood clots.
• Cardioversion (electrical or medication-based) to restore normal rhythm.
• Atrial ablation (procedure using a catheter to destroy abnormal tissue) if other treatments fail.
o Ventricular Fibrillation:
• Ventricular fibrillation is a twitching of the ventricular muscles, causing a completely disorganized
rhythm.
• It prevents the heart from circulating blood properly.
• Most dangerous type of fibrillation and a medical emergency.
• If untreated, it leads to cardiac arrest and is fatal. Immediate intervention (e.g., defibrillation) is required to
save the person.

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22Conditions Affecting the Heart’s
Pumping Function #1

vTissue perfusion
vHeart failure (HF) (congestive heart failure [CHF])
o Cardiac decompensation, cardiac insufficiency,
cardiac incompetence
o Left-sided heart failure
o Right-sided heart failure
o Hemodynamic monitoring
o Measure I&O and weigh the client daily

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23Conditions Affecting the Heart’s
Pumping Function #2

vHeart failure (HF) (cont.)

o Edema: accumulation of fluid in interstitial
spaces
§ Ascites: peritoneal cavity
§ Anasarca: interstitial spaces in skin
§ Pulmonary edema: lungs; left-sided heart
failure, medical emergency
§ Dependent edema: depends on body position
§ Pitting and nonpitting edema: presence or
absence of indentations in swollen areas of
body
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24Conditions Affecting the Heart’s
Pumping Function #3

vCardiomyopathy
o Dilated or congestive cardiomyopathy
o Hypertropic cardiomyopathy
o Restrictive cardiomyopathy

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25Infectious and Inflammatory Heart
Disorders

vRheumatic heart disease

o Myocarditis, endocarditis, pancarditis, mitral stenosis
vBacterial endocarditis
o Make the person as comfortable as possible
o Instruct client to conserve energy
o Frequently note the pulse rate and quality
o Observe closely for fluctuation in body temperature
and for any symptoms of complications
vPericarditis

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26Coronary Artery Disease (CAD) #1

vAlso called ischemic

heart disease
vAngina pectoris
o Temporary loss of
oxygen to the heart
muscle
o Ischemia—if loss of
oxygen supply continues
o Myocardial necrosis—
death of heart tissue

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27Coronary Artery Disease (CAD) #2

vAngina pectoris (cont.)

o Pain patterns

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28Coronary Artery Disease (CAD) #3

vMyocardial infarction
o Heart attack, coronary thrombosis, coronary
occlusion
o Acute coronary syndrome (ACS)
o Acute myocardial infarction (AMI)
o Signs and symptoms can present differently
depending on sex, chronic conditions, and age;
can be silent (no signs or symptoms)
o Medical emergency, care in CCU during acute
phase

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29Question #2

Is the following statement true or false?

A client may receive a pacemaker to help normalize

their heart rhythm.

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30Answer to Question #2

True

Clients with slow or abnormal heart rhythms related

to malfunctioning of the conduction system may have
a pacemaker placed to help the heart maintain a
normal heart rate.

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31Inflammatory Disorders and
Complications

vThrombophlebitis: inflammation of the wall of a

vein, in which one or more clots form
o Deep vein thrombosis (DVT)
o Phlebitis
vEmbolism
o Pulmonary embolism
o Coronary embolus
o Cerebral embolism
o Peripheral embolism and thrombosis in a limb

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32Interventions for Thrombophlebitis

vIf exercise is ordered, encourage the client to wiggle

the toes, bend the knees, and turn the ankle back
and forth
vIn deep thrombophlebitis, immobilize the affected
part
vPrevent vigorous coughing or deep breathing. Try to
keep the client from straining when defecating;
administer stool softeners, as ordered
vUse warm, moist packs (low temperature)
vEnforce bed rest

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33Peripheral Vascular Disorders #1

vSymptoms
o Intermittent claudication
o Tingling and numbness
o Coldness and difference in size
o Lack of new tissue growth
vBuerger disease (thromboangiitis obliterans)
vRaynaud phenomenon
o Primary or idiopathic Raynaud disease
o Secondary or Raynaud syndrome
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34Peripheral Vascular Disorders #2

vVaricose veins
o Varicose ulcer
vTelangiectasia (spider veins)

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35Aneurysms

vAn aneurysm is an
outpouching of a blood
vessel
vForms of aneurysms
o Berry aneurysm in the
circle of Willis
o Fusiform-type aneurysm
of the abdominal aorta
o Dissecting aortic
aneurysm

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36Stroke #1

vAlso known as cerebrovascular accident (CVA)

vMajor cause of death in the United States
vTypes
o Transient ischemic attack (TIA)
§ Reversible ischemic neurologic deficit (RIND)
o Ischemic strokes
§ Due to cerebral thrombosis, cerebral
embolism
o Hemorrhagic strokes
§ Due to cerebral hemorrhage or aneurysm
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37Stroke #2
vIdentification of a stroke – FAST
o Face
o Arms
o Speak
o Time
vSudden onset most severe
vResults of stroke
o Hemiplegia, aphasia and dysphasia, brain damage,
hemianopsia (hemianopia), pain, autonomic
disturbances, personality changes
vRecovery and rehabilitation
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38Question #3

Is the following statement true or false?

When assessing if a client has suffered a stroke, one

of the questions should be “Do you know what time it
is?”

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39Answer to Question #3

False

The acronym FAST provides a quick way to assist in

identifying the most common symptoms of a stroke. F
is for face (does one side droop), A is for arms (does
one arm drift downward after the client holds them
up), S is for speak (is the speech slurred or strange),
and T is for time; however, the time is to call 9-1-1 or
notify the healthcare provider immediately if any of
the symptoms are noted due to the emergent nature
of the situation. It is not to ask the client what time it
is. It may be a question later when completing the
mental status examination.
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