Week 5: cardiovascular disorders & therapeutic procedures

● Heart failure
○ Inability of the heart to pump a sufficient amount of blood to meet the metabolic
and oxygen needs of the body
○ Early signs: tachycardia, tachypnea, profuse scalp diaphoresis, fatigue and
irritability, sudden weight gain, respiratory distress
○ Left sided HF
■ Crackles, wheezes, cough, dyspnea, orthopnea, periods of cyanosis,
retractions, tachypnea
○ Right sided HF
■ Ascites, hepatosplenomegaly, jugular vein distention, oliguria, peripheral
edema, especially dependent edema, and periorbital edema, weight gain
○ Interventions
■ Monitor for respiratory distress, apical pulse, temperature, intake &output,
daily weight, edema, provide rest
■ Administer diuretics, give potassium supplements, monitor serum
electrolyte levels, watch for digoxin toxicity
● Coronary Artery Disease
○ Damage of the heart and vessels due to buildup of plaque and/or thickening of the
arteries which decreases performance of the heart
○ Common symptoms
■ Angina (chest pain), shortness of breath, lightheadedness
○ Risk factors
■ Smoking, obesity, high fat diet
○ Treatment
■ Cholesterol modifying medications, aspirin, beta blockers, nitroglycerin
■ Stop smoking, eat a healthy balanced diet, exercising regularly
● Myocardial Infarction
○ When the myocardial tissue is abruptly & deprived of oxygen due to ischemia or
lack of blood flow to the heart
○ This typically results in chest pain, shortness of breath, fatigue, and ECG changes
(STEMI)
○ Risk factors
■ Atherosclerosis, CAD, smoking ,HTN, obesity, physical inactivity,
imparied glucose tolerance, stress
● Diagnostic tests and procedures
○ Cardiac markets
■ CK-MB (creatine kinase, myocardial muscle)
■ Elevation indicates myocardial damage
■ Normal: male = 2-6ng.mL; female = 2-5 ng.mL
 ○ Troponin
■ Rises within 3 hours and stays up for 7-10 days after myocardial injury
■ Normal values for troponin I is <0.3ng/mL and troponin T is <0.2ng/mL
○ Myoglobin
■ Levels rise within 2 hours after cell death and decline after 7 hours; not
cardiac specific, and indicates damage to other muscles too.
○ Electrolytes
■ Some electrolytes imbalance may lead to cardiac electrical changes
● Such as : potassium, sodium, calcium, phosphorus and magnesium
○ Chest X-ray
■ Determine anatomical changes of the hear such as size, silhouette, and
position
○ Electrocardiograph
■ Records electrical activity of the heart in order to detect dysrhythmias and
more
○ Holter monitoring
■ Patient wears an electrocardiographic monitor for 24 hours or more to
continuously monitor electrical activity of the heart throughout activities
of daily living
○ Echocardiography
■ Basically an ultrasound of the heart to detect valvular abnormalities,
congenital heart defects, wall motion, ejection function & cardiac function
○ Exercise electrocardiography testing (stress test)
■ Monitors the heart’s activity during exercise
○ Myocardial nuclear perfusion imaging
■ Uses radionuclide techniques and scanning for cardiovascular assessment
○ MRI
■ Produces an image of the heart or great vessels through the use of
magnetic fields, radio waves, and atomic nuclei
○ Cardiac catheterization
■ Invasive test involving the insertion of a catheter into the heart and
surrounding vessels to obtain information about the structure and
performance of the heart chambers and valves and the coronary circulation
● Therapeutic management
○ Percutaneous transluminal coronary angioplasty (PTCA)
■ Invasive, nonsurgical technique to dilate 1 or more arteries with a balloon
catheter to open the vessel lumen and improve arterial blood flow
○ Coronary artery stents
■ Used in conjunction with PTCA to eliminate the risk of acute coronary
vessel closure and improve long-term patency of the vessel
 ■ The balloon catheter bears a stent and when the balloon is inflated, the
stent is put in place to reopen the blocked artery
○ Coronary artery bypass grafting
■ The occluded coronary arteries are bypassed with the patient’s own
venous or arterial blood vessels to improve blood flow
○ Heart transplantation
■ A donor heart with similar weight to the patient and ABO compatibility is
transplanted into the patient, thus switching out the diseased heart with a
well-working new one