Chapter 5: Providing care for patient with

Cardiovascular disorder
Anatomy of Cardiovascular System
Cardiovascular system consists of:
Heart
 Blood
Artery
Vein
 Arteries and Veins
• Blood enters the heart through veins and
leaves the heart through arteries.
• Arteries carry oxygenated blood
• The smallest arteries are called arterioles
• The smallest veins are called venules.
• Veins have thinner walls than arteries because
VP is lower than AP
Structure of the Heart
Consists of three layers:
• Epicardium (is pericardium that surrounds the heart).
• Myocardium (thickest part of the heart; consists of cardiac muscle)
• Endocardium (inner lining of heart chambers).
The four chambers of heart
• Two atria (upper chambers) smaller and thinner
• Two ventricles (lower chambers) larger and stronger
Note that:
• AV valves control blood flow b/n the upper and lower chambers .
The Valves of heart
• There are four valves in the heart:
•Tricuspid.
•Bicuspid (mitral).
•Pulmonic.
•Aortic.
Assessment: Subjective Data
Typical concerns expressed by client with cardiac disorder are:-
• chest pain dyspnea
• edema fainting
• palpitations diaphoresis
• fatigue.
Types of Dyspnea
• Exertional ( shortness of breath during activities).
• Orthopnea (difficulty breathing when lying down).
• Paroxysmal nocturnal dyspnea (person suddenly awakes, sweating,
and having difficulty breathing).
Assessment: Objective Data
A head-to-toe assessment of a cardiac client
should include assessments of:
• Skin.
• Neck veins.
• Respirations.
• Heart sounds.
• Abdomen.
• Extremities.
 Common Diagnostic Tests
Laboratory Tests
Arterial Blood Gases, Complete Blood Count, Platelet Count, Hemoglobin, Hematocrit, Electrolytes,
Cardiac enzymes, Erythrocyte sedimentation rate, Glucose, Prothrombin time,
Partial Thromboplastin time, International Normalized Ratio, Serum Lipids

Radiologic Tests
Chest X-rays, Cardiac positron emission tomography scan, Radionuclide angiography,
Technetium pyrophosphate scanning, Thalium scan

Other Diagnostic Tests

Cardiac biopsy, Cardiac catheterization, Echocardiogram, Holter monitor, MRI,
Pericardiocentesis, Pulse oximetry, Stress test, Arterial plethysmography, Venous plethysmography
Disorders of the heart
Dysrhythmia
• Is an irregularity in the rate, rhythm & conduction of heart.
• Symptoms: fainting, fatigue, dyspnea, chest pain, and
palpitations.
Bradycardia ( HR < 60 beats/minute).
• Caused by myocardial infarction, electrolyte imbalances,
heart block, drug toxicity, intracranial tumors and vomiting.
Tachycardia( HR > 100 beats/minute).
• Caused by exercise, emotional stress, fever, medications,
pain, anemia, pericarditis, heart failure and tobacco use
Atrial Dysrhythmias
Atrial Fibrillation
• Occurs when uncoordinated firing of electrical impulses in atria causes
irregular/ineffective contractions of heart.
• It is the most common chronic arrhythmia
• Is not life-threatening , but increases the risk for blood clots and strokes.
Cause
 abnormality in the electrical system of the heart.
S/SX
• Asymptomatic
• Irregular pulse
• Feeling faint (syncope)
• Palpitations
• Dyspnea
Treatment
• digoxin
• warfarin
Arterial flutter –is abnormal heart rhythm that occurs in the atria of the heart
Atrioventricular Blocks
• In AV blocks, the electrical conduction is interrupted to
some degree between the atria and ventricles.
• The extent of interruption is classified as First degree,
Second Degree or Third Degree AV Blocks.
• Cardiac arrest: is the cessation of functional circulation of the
blood due to failure of the heart to contract effectively.
• It is a medical emergency
Cause
• coronary heart disease
• Ischematic heart disease
 Inflammatory Disorders
• Rheumatic Heart Disease.
A complication of rheumatic fever that is linked to group A
streptococcus following an upper respiratory infection.
• Endocarditis
• Is inflammation of endocardium and heart valves
• Pericarditis
• An inflammation of the membranous sac surrounding the heart.
• Causative organisms are viral, bacterial, fungal, or parasitic.
S/SX: Chest pain(Sudden onset) , fever, myalgia, SOB
Valvular Heart Disease
• Occurs when the valves do not open and close properly.
• A thickening of the valve tissue, causing the valve
opening to be narrow, is called valvular stenosis.
Mitral Valve Prolapse
• Is a cardiomyopathy resulting from the mitral valve not
regulating the flow of blood between the left atrium and
left ventricle of the heart.
Cause
• Mitral insufficiency- the valve leaflets and papillary
muscles become damaged
Occlusive Disorders
•Arteriosclerosis
• Narrowing and hardening of the arteries.
• Three types:
• Atherosclerosis -fatty deposits called plaque on
inner lining of vessel walls.
• Calcific sclerosis - calcium deposits on the
middle layer of the wall of the arteries.
• Arteriolar sclerosis - a thickening of the
arterioles caused by hypertension.
 Angina Pectoris
• Is a chest pain caused by temporally inadequate blood and
oxygen supply to the myocardial tissues.
Medical management
Nitroglycerin
 propranol
• Calcium channel blocker
Verapamil
• Anti platelet agent
Asprin
heparin
• Surgical treatment: intracoronary stent, a coronary artery
bypass graft.
Myocardial Infarction (MI)
• Caused by an obstruction in a coronary artery resulting in necrosis
• usually due to atherosclerotic plaque, a thrombus, or embolism.
Medical management
• Analgesics
- morphine
- Pethidine
• Beta blockers
- propranolol
• Thrombolytic- chest pain less than 24 hrs.
-Streptokinase
• Reduce anxiety
Congestive Heart Failure (CHF)
• Occurs when the heart is no longer capable of meeting the
oxygen needs of the body. The heart is literally failing.
Mgt
• Beta-blocker
• Angiotensin II receptor blocker
• Hyrilizine
• Digitals
• Calcium channel blocker
Peripheral Vascular Disorders
• Phlebitis - inflammation in the
wall of a vein without clot
formation
• Thrombosis- formation of a
clot in a vessel.
• Thrombophlebitis -formation
of a clot due to an inflammation
in the wall of the vessel
Varicose Veins-also known as
varicosities, they are visibly
prominent, dilated, and twisted
veins.
Hypertension (HTN)
• Also known as high blood pressure, it is defined
as an elevated arterial blood pressure.
• Often the hypertensive client may not be
experiencing any symptoms
• This disease called silent killer
Routine investigations
• Urine strip test for protein and blood
• Serum creatinine and electrolytes
• Blood glucose – ideally fasted
• Blood lipid profile ideally fasted for
consideration of triglycerides
• Electrocardiogram
Possible underlying cause
• Low potassium with ↑plasma sodium
• Raised serum creatinine
• Proteinuria or haematuria
• Sudden onset of hypertension
Therapeutic problems
• Multiple drug contraindications
Special situations
• Unusual blood pressure variability
• Hypertension in pregnancy(eclampsia)
•Contributory factors
• Overweight
• Excess alcohol
• Excess salt intake
• Lack of exercise
• Environmental stress
Classification of blood pressure levels
Category Systolic blood pressure Diastolic blood pressure
(mmHg) (mmHg)

Blood Pressure

Optimal/normal <120 <80

Normal range 100-139 60-89

Hypertension

Grade 1 (mild) 140-159 90-99

Grade 2 (moderate) 160-179 100-109

Grade 3 (severe) >180 >110

 When to treat?
• Hypertension if
• BP > 140 systolic and/or > 90 mmHg diastolic.
• Medication Required if;
• Sustained raised BP
• > 160 systolic and/or > 100 mmHg diastolic (despite non-
pharmacological treatment)
• OR if
• BP > 140 systolic and/or > 90 diastolic
• …AND patient has target organ damage, CVD, Diabetes or 10 year
CVD risk > 20%
Indications for specialist referral

• Urgent treatment needed

• Accelerated hypertension (severe hypertension
and grade III-IV retinopathy)
• Particularly severe hypertension
(>220/120mmHg)
• Impending complications (e.g. LVF)
Coronary Artery Disease (CAD)
• Occurs when cholesterol and calcium are deposited on the
wall of the coronary artery  narrowing of the artery.
This impedes blood supply to the heart muscle.
Cause
Elevated cholesterol levels and fat intake
hypertension, diabetes, and smoking.
plaque builds up within the artery
Signs and symptoms
• Asymptomatic.
• Chest pain (angina) lasts between 3 to 5 min
• Pain may radiate to the arms, back, and jaw.
Treatment
• Life style changes and medication.
• Weight loss.
• Lower sodium, cholesterol, fat, low calorie intake,
high dietary fiber.
 low doses of aspirin.
 propranolol.
Pulmonary Edema
• Accumulation of fluid in the lungs due to ineffective pumping of
blood ( left-sided HF, AMI, or volume overload).
Sign and symptom
• hypoxia. Dyspnea when sitting
• Rapid breathing Haemptyasis
• Cyanosis Restlessness
• Distended jugular vein
treatment
• O2 administration.
• Administer morphine to relieves pain and MI.
• Administer diuretics to remove excess fluid:
Furosemide
 digoxin
Blood disorders
1. Anemia
• Is a low hgb resulting in ↓oxygen carrying capability of the blood.
cause
Blood loss, damage to the red blood cells
 Altered hemoglobin or destruction (hemolysis)
Nutritional deficiency (iron, vitamin B12, folic acid)
 Lack of RBC production in bone marrow
 A family history of anemia , such as thalassemia or sickle cell.
Signs and symptoms
• Fatigue Pallor
• Tachycardia Dyspnea
• Angina Headache
• Jaundice
Lab Diagnosis
• Hemoglobin level low.
• Hematocrit level low.
• RBC count low.
Treatment
• Correction of the underlying cause is necessary.
• Dietary modifications and supplementations
• Blood transfusion
 Types of anemia
1. Aplastic Anemia
• The bone marrow stops producing a sufficient amount of RBC,
WBC, and platelets, causing ↑ the risk of infection and
hemorrhage.
Cause
• Exposure to chemical, radiation and toxins.
S/SX
• Fatigue Pallor
• Infections Bruising (ecchymosis)
• hemorrhages Bleeding from GI tract, mouth, nose,
DX
The same with anemia
Treatment
• Blood transfusions
• Monitor vital signs .
• Record intake and output.
• Protect patient from falls.
• Avoid IM injections due to altered clotting ability.
• No aspirin due to effect of clotting ability.
• Decrease risk of bleeding
• Rest.
2.Iron Deficiency Anemia
• A lower iron in blood serum results in decreased formation of hgb
cause
• Blood loss Dietary deficiency
• Pregnancy or lactation. Aging.
Sing and symptom
• Pallor Fatigue
• spoon nails Tachycardia and tachypnea
Treatment
• Oral Iran replacement (three times a day):
• ferrous sulfate
• ferrous gluconate
• ferrous fumarate
• iron dextran given IM or IV.
3. Pernicious Anemia
• Occur when the body is unable to absorb Vitamin B12,
which is needed to make RBC, resulting in ↓ RBC count.
S/SX
• Pallor
• fatigue
• confusion
• Dementia
• Glossitis—beefy red tongue
• Nausea and weight loss
• Premature graying of hair
Treatment
• Lifelong replacement with vitamin B12.
• Transfusion of packed RBC if anemia is severe
4.Sickle Cell Anemia
is an autosomal recessive disorder in which an abnormal gene causes damage to
the RBC membrane.
S/SX
Acute pain (especially in back, chest, and long bones)
Fever
 Fatigue
 Stroke (CVA)
Hepatomegaly
 Cardiomegaly
Treatments
Administer analgesics
• Warm compresses on joint.
• Blood transfusion.
• Supplemental oxygen if hypoxic.
• Adequate hydration, using IV fluids.
• Treat infections.
Hemorrhagic disorders
1.Hemophilia
• The patient is missing a coagulation factor that is essential
for normal blood clotting.
• It is an X-linked recessive inherited disorder,
• Mostly common in males, and rarely in females.
• Hemophilia A is the result of missing clotting factor VIII.
• Hemophilia B is the result of missing clotting factor IX and
is also known as Christmas disease.
Signs and symptoms
• Tender joints due to bleeding
• swelling of knees, ankles, hips, and elbows
• blood in stool (tarry stool) due to GI blood loss
• Hematuria
DX
• PTT prolonged but PT normal.
• Decrease in clotting factor VIII
• Decrease in clotting factor IX
Treatment
Avoid aspirin.
• For hemophilia A administer factor VIII concentrates.
• For hemophilia B administer factor IX concentrates.
• No IM injections--To stop bleeding
2.Leukemia
3.Polycythemia Vera
• Is an overproduction of blood cells and a thickening of blood.
S/SX
• Excessive production of RBC, WBC and platelets.
• ↑peripheral vascular resistance  increased pressure, and vascular
stasis  thrombosis or tissue hypoxia  Organ damage
Treatment
Aim- maintaining blood flow to the smaller vessels
• Phlebotomy—the removal of 500 ml of blood—to reduce the
hematocrit level to below 45
Adequate hydration.
• Anticoagulants such as aspirin.
• Reducing uric acid level by allopurinol
• Radiation therapy.
• Antihistamine for pruritis.
Disorders of lymphatic systems
• The lymphatic system supports the function of the
cardiovascular and immune systems of the body
• They consists of two semi-independent parts
• A network of lymphatic vessels
• Lymphoid organs scattered throughout the body
Lyphadenitis –refers to inflammation of lymph
nodes

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Lymphatic vessels
• There are several orders
of vessels
• Lymph capillaries
• Lymph collecting vessels
• Lymph nodes
• Lymph trunks
• Lymph ducts

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Lymphangitis- is inflammation of lymphatic channels due to infectious or
noninfectious causes.
Causes
bacteria, mycobacteria, viruses, fungi, and parasites.
• C/M
redness, pain and rapid spread, nodular swellings lyphatic vessels
DX
• biopsy
• microscopy -including gram, fungal and acid fast staining), and
• culture - including bacterial, fungal and mycobacterial cultures.
Treatment
 medical therapy.
 surgical debridement.