2.

Platelet adhesion
CARDIOVASCULAR DISORDERS 3. Atheroma (Fatty plaque)
Dr. Six Tatualla, RN LDL, Macrophages, Monocytes
4. Occlusion
Internal Carotid Artery
Most common site of occlusion in the brain a. Partial – Angina Pectoris
b. Total – Myocardial Infarction
Propranolol
Hyperthyroidism only
Signs and Symptoms
Systole 1. Asymptomatic
Contraction 2. Chest pain
Systemic Circulation

Diastole Diagnostic:
Relaxation 1. Lipid Profile
Coronary Circulation o NPO (12)
Gravidocardia Total Cholesterol <200 mg/dl
Pregnant women with cardiac problem LDL <160
Triglycerides <200
HDL >40

Heart Sounds 2. Stress ECG (Treadmill Test)

S1 – AV valve closure – “lub” 3. Angiography (Cardiac Catheterization)
S2 – SL valve closure – “dub”
S3 – Normal - <35, Abnormal - >35 y/o Management:
S4 – Abnormal – Valve defects, CHD, RHD, HF, MI 1. Anti-lipidemics
a. Statins
Coronary Circulation Simvastatin
MCA Inhibits HMG-COA Reductase -  LDL
RCA synthesis
 PIVA  SE – Myalgia
 Marginal Artery  AE – Hepatotoxicity
LCA  ALT (SGPT)
 LADA  AST (SGOT)
o Most common place of occlusion  Alkaline Phosphatase
 Partial – Angina b. Bile Acid Sequestrants
 Total – MI Cholestyramine
 Circumflex Artery Colestipol
Bind with Bile Acid -  Fat absorption
Blood Pressure  SE – Constipation
CO x SVR (TPR) c. Fibric Acid Derivatives
Clofibrate
Cardiac Output Gemfibrozil
Amount in 1 minute  triglyceride synthesis
4-6 lpm d. Niacin (Vitamin B3)
Multiple side effects
Stroke Volume 2. Risk Factor Modification
Amount in 1 beat
SV (60-80 ml/beat) x HR (60-100/min) Nursing Management
Nursing Diagnosis:
 Knowledge Deficit
Coronary Atherosclerosis  Ineffective health maintenance
 Narrowing of Coronary Artery (LADA) due to
formation of plaque (atheroma) 1. Health Teaching
a. Smoking cessation
Risk Factors: b. Weight reduction
Non-modifiable Modifiable Normal BMI (18.5 – 24.9)
Age Hypertension c. Regular Physical Exercise
 Male – 45 y/o DM Aerobic Exercise – Brisk walking
 Female – 55 y/o Hyperlipidemia d. Diet
Gender Obesity  Unsaturated Fat
Race  Male - >40”  Complex carbohydrates
 Black Americans  Female - >35”  Potassium
Family history/Genetics  BMI  30  Sodium, Saturated, Simple Complex
OCP (Estrogen is bad) e. Stress Reduction
Sedentary lifestyle f. Moderate Alcoholism
Smoking Beer
 Nicotine Red wine
 Carbon monoxide 1 glass per day
Diet
  Trans Fat
 Sat. fat
Angina Pectoris
 Unsat. fat  Chest pain due to partial occlusion of coronary artery
secondary to atherosclerosis
  Complex CHO
Fiber (F & V)
Causes:
  Simple CHO
 Atherosclerosis
Bad
 Thrombosis
  Sodium
 Vasoconstriction.
  Potassium
o Exposure to cold
Fruits
o Emotional stress
Pathophysiology o Exertion
1. Injury to the endothelium o Eating heavy meals
 Hyperthyroidism
  Anemia  Toxicity – Tinnitus or GI Bleeding
o Decrease in oxygen carrying capacity.  Administer after meals
o  Hemoglobin  Assess for bleeding
3. Beta-Blockers
Pathophysiology Metoprolol
1.  Myocardial tissue perfusion Inhibits Beta-1 receptors in the heart to  HR, 
2. Anaerobic metabolism myocardial tissue perfusion.
3. Lactic Acid production  SE: Bradycardia
4. Chest pain  Assess apical pulse (PMI)
o 5th ICS
Signs and symptoms: o Left midclavicular line
1. Precordial (Chest) or Sternal Pain  Contraindicated:
2.  PR,  RR (Sympathetic) o Bronchial asthma
3. Cool Clammy skin o COPD
4. Pallor; Cyanosis (Late) 4. Calcium Channel Blockers
5. Anxiety and fear Amlodipine
Inhibits calcium influx across myocardial cells to 
Diagnostics: HR, thereby increasing myocardial tissue perfusion.
1. ECG – 12 leads
a. P – Atrial Depolarization Nursing Management:
b. QRS – Ventricular Depolarization Ineffective Tissue Perfusion: Cardiac
c. T – Ventricular Repolarization 1. Assess VS, PS
d. U wave 2. Monitor pulse oximetry.
i. Abnormal – Hypokalemia
 O2 sat - >95%
S/sx: Muscle Weakness (Legs),
  95% - Hypoxia
Constipation, Dysrhythmia
3. Position: Semi-Fowlers
ii. Normal – Purkinje Fibers
4. Home: NTG (SL, 3 doses, every 5 mins)
5. Hospital: Oxygen at 2-3 lpm via Nasal Cannula
P < 0.11 secs
6. Stop smoking.
QRS < 0.12 secs
PR interval 0.12 – 0.20 secs Surgical Management:
QT segment 0.32 – 0.40 secs 1. CABG
1 small box 0.04 secs  Open heart surgery
1 big box 0.20 secs  Thoracotomy
 Graft
ECG Readings for Angina: o Saphenous Veins – Most common
 ST Depression / Down sloping
o Cephalic Vein
o Basilic Vein
o Internal Mammary Artery
 T-wave Inversion 2. Percutaneous Transluminal Coronary Angioplasty
 Cardiac catheterization
 Closed heart surgery

 Flat T wave Acute Myocardial Infarction

 Sudden chest pain due to myocardial
necrosis/infarction secondary to total occlusion.
2. Exercise ECG or Stress ECG Test Cause:
 Can undergo if patient has NO Chest Pain.  Atherosclerosis (CAD)
 Light breakfast  Thrombosis
 Light clothing  Embolism
 Avoid caffeine, tea, chocolate, cola.  Direct trauma
 Avoid bronchodilators. o Gunshot wounds
3. Coronary Angiography (Cardiac catheterization) o Stab wounds
 Assess for allergies to seafood.
 Bedside med – Epinephrine Types of Acute Coronary Syndrome
 Sites  Stable
o Brachial artery o <15 mins
o Femoral artery o Relieved by NTG and rest.
 Post procedure – Extended  Unstable
  OFI – 2-3 L/day o 15-30 mins
4.  ESR / CRP o Unrelieved
o At rest
Management: o Pre-infarction
1. Nitrates – Nitroglycerine
 Prinzmetal (Variant)
ISDN, ISMN (Isordil)
o At night
Dilates the veins – if 3, arteries
o Due to coronary vasospasm
 Preload (Stretch, venous return)
 Route – SL (Capillaries)  Myocardial Infarction
o >30 mins
 Prophylaxis – Oral
 SE: Headache, Orthostatic Hypotension
Signs and symptoms:
 Storage: Dark Amber
1. Chest Pain
 Can store up to 6 months a. P – unrelieved by NTG and rest
 Onset: 2 -3 mins. b. Q – tight, squeezing, heavy pressure
 Problem: Tolerance c. R – jaw, neck, shoulder, upper arm, back,
o To prevent: NTG free at bedtime epigastric pain (DM, elderly)
2. Aspirin – Anti-platelet d. S – severe
ASA (Salicylates) e. T – >30 mins; >45 mins
Inhibits platelet aggregation 2. Cool, clammy skin
 3.  PR,  RR Indication: Indication:
A. Fibrillation V. Fibrillation
4. Levine’s Sign V. Tachycardia Pulseless V. Tachycardia
5. Sense of impending doom Supraventricular Tachycardia Asystole
6. Pallor, cyanosis

Diagnostics: e. Asystole (Cardiac Standstill or Cardiac

1. ECG Arrest)
 ST Elevation  CPR
 Epinephrine (IV, ET)
 Defibrillation

 T wave inversion Nursing Management:

Acute Pain
1. Assess VS, PS, O2 Sat, ABG
2. Position – Semifowler’s
 Pathologic Q wave 3. Administer oxygen at 2-3 lpm as ordered.
4. Administer Morphine Sulfate (IV) as ordered.
5. Complete bed rest without bathroom privileges –
bedside commode.
Zones: Ineffective Tissue Perfusion: Cardiac
 Infarction – Pathologic Q Wave 1. WOF signs of  tissue perfusion.
 Injury – ST Elevation a. Restlessness/Agitation/Confusion
 Ischemia – T wave inversion b. Oliguria
c.  Peripheral pulses
2. Serum Cardiac Enzymes d. Capillary Refill – Slow >3 secs
a. CK-MB e. Pallor, Cyanosis
b. Troponin I & T – Confirmatory, longest 2. WOF complications
c. AST a. Dysrhythmias – Most common COD – V. fib.
d. Myoglobin – 1st to rise b. Heart failure
e. LDH c. Dressler’s Syndrome
 Pericarditis due to MI
Except ALT (Liver specific) d. Neurogenic shock
 Severe pain
3. Coronary Angiography (Cardiac Catheterization) e. Cardiogenic shock
4. ESR, CRP – inflammation  Pump failure
3. Administer laxatives.
Management:  Administer at night so patient will defecate in
1. Narcotics (Opioids) the morning.
a. Morphine Sulfate  Prevent Valsalva maneuver. (Vagal stimulation
b. Meperidine (Demerol) – bradycardia)
c. Nalbuphine (Nubain)
d. Codeine
 preload,  afterload CPR – BLS
 myocardial oxygen demand Indications:
 SE:  ( – ) pulse
o Respiratory Depression  ( – ) breathing
o Hypotension
o Constipation -  OFI 1. Check the LOC
o Addiction 2. Chest compression (150x per minute)
3. Open the airway.
o Pupil constriction
a. SCI – Jaw thrust maneuver
o Nausea and vomiting
b. No SCI – Head-tilt, Chin-Lift
 Assess RR/BP 4. Ventilation – 2 rescue breaths
2. Thrombolytics 5. Check pulse.
t-PA a. Adult – Carotid Artery
Streptokinase b. Child – Femoral Artery
Alteplase/ Reteplase c. Baby – Brachial Artery
Activates plasminogen – plasmin – dissolve thrombi 6. 30 compressions: 2 respirations
 Administer within 3 hours.
 SE: Hemorrhage STOP
3. Antiplatelets 1. (+) pulse, (+) respirations
Clopidogrel 2. Exhaustion
Ticlopidine 3. EMS / Medics
Dipyridamole
Aspirin – prototype
4. Antidysrythmics HEART FAILURE
a. Bradycardia  Inability of the heart to pump adequate cardiac output
 DOC: Atropine Sulfate (4-6 lpm) to meet the metabolic demands of the body.
(Anticholinergic)
b. Premature Ventricular Contraction Causes:
 Wide and bizarre QRS  Coronary Atherosclerosis
 Lidocaine  Chronic Hypertension (140/90)
c. Ventricular Tachycardia  Pulmonary embolism
 >3 PVCs  Myocardial infarct
 Lidocaine or Amiodarone  Congenital Heart Defects
d. Ventricular Fibrillation  Hyperthyroidism (Thyrotoxicosis)
 Very fast  High fever (>38.5)
 Defibrillation o Tachycardia
Cardioversion Defibrillation  Anemia
Synchronized Asynchronized
QRS or R wave
50 – 100 joules 200 – 360 joules
Pathophysiology:
Sedation No sedation 1.  Cardiac Output
 a.  SNS (Vasoconstriction - RR, PR) (+) Inotropic
b. RAAS ((Renin-Angiotensin-Angiotensin II) (+) Chronotropic
Reabsorption of sodium and water) NC:
c. ADH (Reabsorption of water)  Assess for apical pulse.
2. Congestion  SE: Tachycardia, Palpitations, Tremors
3. Congestive heart failure 3. Diuretics
Potassium Wasting
RHF LHF Loop Diuretics
Venous Congestion Pulmonary Congestion Furosemide
Manifestations: Manifestations: Inhibits sodium, water and potassium reabsorption in
1. Jugular vein distention 1. Crackles/Coarse Rales the ascending loop of henle.
2. Hepatomegaly 2. Orthopnea (3 or more)  Administer in the AM
3. Ascites 3. PND  SE: Dehydration, Hypokalemia
4. Hemorrhoids 4. Fatigue Thiazides
5. Edema (Ankle) 5. Hemoptysis Hydrochlorothiazides
6. Anorexia (Frothy, blood-tinged) Inhibits sodium, water and potassium reabsorption in
6. Exertional dyspnea the distal tubule.

Diagnostics: Potassium-Sparing
1. Echocardiography (Ultrasound) Spironolactone (Aldactone)
 Semi-fowler’s, turned to the LEFT Inhibits sodium, water reabsorption in the distal
 Ejection Fraction tubule.
o >55%  SE: Dehydration, Hyperkalemia
o <45% - Heart Failure  Monitor the serum potassium.
 Confirmatory  ECG
2. Hemodynamic Monitoring Hypokalemia Hyperkalemia
a. CVP Flat/Short T wave Peaked T wave
 CVP catheter
 2-6 mmHg
  CVP – Right HF
  CVP – Hypovolemia ST Depression ST Elevation
(Dehydration)
b. PCWP – PAP
 Swan-Ganz catheter
 8-12 mmHg U wave Prolonged QRS
  PCWP – LHF
  PCWP – Hypovolemia
3. ECG – Prolonged PR interval
4. ABG – Metabolic Acidosis
4. ACE Inhibitors
pH 7.35 – 7.45
Captopril
PaCO2 35 – 45 mmHg
Inhibit conversion of A-I to A-II.
PaO2 80 – 100 mmHg
 SE – Cough – Non productive, Hyperkalemia
HCO3 22 – 26 mEq/L
 Monitor serum potassium
  OFI
5. Serum Electrolytes
5. BB – olol
Sodium 135 – 145
6. CCB
Potassium 3.5 – 5.0 7. Tranquilizers (Sedatives)
Chloride 80 – 110 Diazepam
Phosphate 2.5 – 11.5
 Acidosis -  Potassium Nursing Management:
o Dysrhythmia Decreased Cardiac Output
1. Assess VS, O2 sat, ABG
6. Serum Beta Natriuretic Peptide 2. Position – High fowler’s, Tripod
7. Chest X-Ray 3. Administer digoxin, dopamine or dobutamine IV.
 PMI (6th, Left ICS, MCL) 4. Administer oxygen 2-3 L
5. Diet:
Management:  Soft (Porridge)
1. Digitalis   Na
Digoxin (Lanoxin)   Simple CHO
Digitoxin   Transfat,  Saturated Fat
Stimulates calcium influx across myocardial cells 6. CBR without bathroom privileges.
 (+) inotropic,
 ( – ) chronotropic Fluid Volume Excess
NC: 1. Assess weight, intake and output, urine output,
 WOF digitalis toxicity abdominal girth
o Anorexia 2. Administer potassium-sparing diuretics –
o Nausea and vomiting Spironolactone.
o Diarrhea 3. CBR
o Abdominal pain 4.  OFI = previous 24 Urine Output + 500 ml
o Halos  500 ml (Insensible Fluid Loss)
o Dysrhythmia o Perspiration
 Antagonist – Digibind (Digoxin Immune Fab) o Respirations
 SE – Bradycardia o Feces
 Check the Apical Pulse 5. Diet:
 Diet: HIGH potassium a.  Sodium
o  Potassium =  Digitalis Toxicity b.  Potassium (Except in oliguria – Renal
2. Sympathomimetic Insufficiency)
Dopamine 6. Offer hard candies, lemon slices, ice chips.
Dobutamine – More preferred
Stimulates SNS
HYPERTENSION Vascular Disorders
 Vasoconstriction of the arteries. Arteries Veins
 Altapresyon Away Towards the heart
Oxygenated Deoxygenated
Types: Deep Superficial
1. Primary Bright red Dark red
 Essential Diseases: Diseases:
 Without cause Buerger’s Disease DVT
2. Secondary (Thromboangiitis obliterans) Thrombophlebitis
 With cause Raynaud’s Disease
 Heart failure, Renal failure, Liver failure, Aneurysm
Hyperthyroidism

Classification:
BUERGER’S DISEASE
Systole Diastole (THROMBOANGIITIS OBLITERANS)
Pre-hypertension 120 – 139 80 – 89
Stage I 140 – 159 90 – 99 Causes:
Stage II 160 – 179 100 – 109  Smoking
Hypertensive  Genetic predisposition
180 110
Crisis  Autoimmune disease (Virus, Bacteria)

Signs and symptoms: Pathophysiology:

1. Asymptomatic   Blood viscosity
2. Nuchal headache/Occipital  Thrombi formation in the arteries causing obliteration
3. Blurring of vision  Antigen triggers the immune system to form
4. Epistaxis antibodies
5. Confusion  Inflammation of the arteries

Diagnostics: Symptoms:
1. Blood Pressure 1. Intermittent Claudication
 Average of atleast 2-3 BP readings on  Calf pain on EXERTION
separate occasions. 2. Pallor (Cyanosis)
3.  Peripheral Pulses (Dorsalis pedis)
To detect specific cause: 4. Cool, clammy skin
2. Blood chemistry 5. Thin skin, thick toe nails
3. ECG
4. Urinalysis Diagnostics:
5. Chest X-ray 1. Arteriography
2. Duplex Ultrasound
Management:
Antihypertensives (Vasodilators) Management:
1. ACE Inhibitors (-prils) 1. Vasodilators
2. Beta-blockers a. Hydralazine
3. CCB (-dipines) b. Nitroglycerine
4. ARBs 2. Pentoxyfilline, Cilostazol
5. Vasodilators  To  RBC viscosity
a. Hydralazine (Apresoline)
b. Minoxidil Surgical Management:
c. NTG 1. Amputation
Smooth muscle relaxation – vasodilation a. AKA
 SE: Orthostatic Hypotension b. BKA
o Gradual change of position c. Syme’s Operation (Ankle)
o Dangling of legs
6. Alpha-Receptor Blockers Nursing Management:
a. Terazosin – BPH Ineffective Tissue Perfusion: Peripheral
7. Sympatholytics 1. Assess VS, skin temperature, skin color, peripheral
a. Methyldopa pulses.
b. Clonidine 2. Position: lower extremities – DEPENDENT (Down) –
8. Diuretics Reverse Trendelenburg
3. Administer vasodilators
Nursing Management: 4. Cover with blanket (To promote warmth – vasodilate)
Knowledge Deficit or Ineffective Health Maintenance 5. Heat lamp
1. Health teaching
a. Regular physical exercise – 20-30 mins x 3
b. Stress Reduction – meditation RAYNAUD’S DISEASE
c. Weight reduction  Intermittent vasospasm of the arteries of the hands.
d. Moderate alcohol consumption
e. Stop smoking Risk Factor:
f. Diet:  Gender – Women
 Simple CHO,  Saturated,  Transfat,   Cold exposure
Na  Genetic predisposition

Symptoms:
 Whitish – pallor
 Bluish – cyanosis
 Redness – erythema

Same management as Buerger’s

 2. OCP (Estrogen)
ANEURYSM 3. Hip, orthopedic, obstetric surgeries
 Permanent ballooning or distention of a part of an 4. Pregnancy
artery. 5. Diabetes mellitus – hyperglycemia
Types: Pathophysiology:
1. Cerebral Aneurysm ( ICP)  VIRCHOW’S TRIAD
o Head injury – Most common cause of  ICP o Venous stasis
o Headache severe on arising o Damage to the veins
o Anisocoria o Hypercoagulability
o VS – Cushing’s Triad
  BP,  PR,  RR Signs and symptoms:
  SBP, Wide pulse pressure,  PR 1. Edema
o Projectile Vomiting 2. Homan’s sign (Calf pain on dorsiflexion)
2. Thoracic Aortic Aneurysm Thrombophlebitis
o DOB 3. Calor – Warm
o Chest pain 4. Rubor – Erythema
3. Abdominal Aortic Aneurysm 5. Tumor – Swelling
o Pulsating abdominal mass 6. Dolor – Pain or Tenderness
o Bruits/Thrills 7. Functio Laessa
o Constipation
 Ruptured aneurysm Diagnostics:
1. Duplex ultrasound
o  BP <90 / <60
2. Venography
o  PR
o  RR Management:
o Severe aneurysm 1. Thrombolytics
2. Anticoagulants
Causes: a. Heparin
 Atherosclerosis Inhibits conversion of prothrombin or
 Chronic hypertension fibrinogen to thrombin or fibrin
 Congenital malformation  IV – Infusion pump – Accuracy
SQ – Abd. 90 - Avoid aspiration,
Types: massage
1. Saccular  Check PTT
 1 Side  x 1.5-2.
Control time: 30-45 secs
 SE: Hemorrhage
 Antagonist: Protamine Sulfate
b. Low-Molecular Weight Heparins
2. Fusiform Dalteparin, enoxaparin
 Both sides c. Warfarin (Coumadin)
Inhibits conversion of Vitamin K-dependent
Clotting Factors (X, IX, VII, II)
 Check PT
 x 1.5 – 2
3. Dissecting aneurysm 10-12 secs
 Severe abdominal back pain.  SE: hemorrhage
 Antagonist: Vitamin K
(Aquamephyton, Phytomenadione)
 Avoid GLV.
3. NSAIDs
Diagnostics: a. Naproxen (Flanax)
1. Ultrasound of the abdomen
2. CT Scan Nursing Management:
3. Chest x-ray Acute Pain
1. Assess pain scale
Management: 2. Position: ELEVATE the affected leg.
1. Antilipidemics 3. NSAIDs – First resort
2. Antihypertensives 4. Steroids – Last resort
5. Warm compress to relieve spasm
Surgical Management: Ineffective Tissue Perfusion: Peripheral
1. Endovascular Stent 1. Wear elastic/compression/anti-embolic/Ted’s
2. Resection (Removal) with anastomosis stockings.
o Before arising from the bed.
Nursing Diagnosis: 2. Avoid massage
Ineffective Tissue Perfusion: Peripheral Avoid leg crossing.
1. VS, O2 Sat, CRT, Peripheral Pulses Avoid plane travel, prolonged bus travel.
2. Position: FLAT ON BED 3. WOF signs of pulmonary embolism.
3. Administer antilipidemics and antihypertensives as a. Pleuritic chest pain.
ordered.  Upon inspiration
4. Avoid abdominal palpation; b.  PR,  RR
5. Avoid Valsalva c. SOB
a. Lactulose
b. Cathartics – Castor oil Management:
1. ET – mechanical ventilators
DEEP VEIN THROMBOSIS 2. Anticoagulants
 Femoral and Popliteal
 Formation of blood clot, thrombus

Risk factors:
1. Sedentary Lifestyle (Passive)