CARDIOVASCULAR DISORDERS

Disorder Definition Signs and Medical Surgical Pharmacological Nursing management

symptoms management management management
Acute Ischemic is defined by the -Vision problems, Intravenous In mechanical Tissue plasminogen  Positioning.
Attack sudden loss of such as blindness thrombolysis embolectomy, a activator, r-tPA, (known Position to prevent
blood flow to an in one eye or surgeon inserts a as alteplase) is approved contractures,
area of the brain double vision Advanced imaging small plastic tube into by the Food and Drug relieve pressure,
with the resulting -Weakness or techniques with an artery in the Administration to treat attain good body
loss of neurologic paralysis in your automated patient's upper leg or ischemic stroke. alignment, and
function. It is limbs, which may interpretation to arm and threads it Doctors administer prevent
caused by be on one or both identify patients with under X-ray guidance Alteplase IV r-tPA through compressive
thrombosis or sides, depending large areas of brain into the blocked artery an IV in the arm, neuropathies.
embolism that on the affected at risk of the brain. dissolving the clot and  Prevent flexion.
occludes a cerebral artery Mechanical improving blood flow to Apply splint at
vessel supplying a -Dizziness and embolectomy is an the part of the brain being night to prevent
specific area of the vertigo advanced, minimally deprived. flexion of the
brain. -Confusion invasive surgical affected extremity.
-Loss of treatment designed to Aspirin  Prevent
coordination remove a blockage in Prevents more clots adduction.
-Drooping of face the blood vessel. Prevent adduction
on one side of the affected
A thrombectomy is shoulder with a
an innovative surgical pillow placed in
procedure used to the axilla.
remove blood clots  Prevent edema.
from arteries and Elevate affected
veins. Blood clots can arm to prevent
disrupt the normal edema and
flow of blood to a part fibrosis.
of the body, causing  Full range of
life-threatening motion. Provide
conditions such as full range of
pulmonary embolism motion four or five
or an acute stroke. times a day to
maintain joint
mobility.
 Prevent venous
stasis. Exercise is
helpful in
preventing venous
stasis, which may
predispose the
patient to
thrombosis and
pulmonary
embolus.
 Regain balance.
Teach patient to
maintain balance
in a sitting
position, then to
balance while
standing and begin
walking as soon as
standing balance is
achieved.
 Personal hygiene.
Encourage
personal hygiene
activities as soon
as the patient can
sit up.
 Manage sensory
difficulties.
Approach patient
with a decreased
field of vision on
the side where
visual perception
is intact.
 Voiding pattern.
Analyze voiding
 pattern and offer
urinal or bedpan
on patient’s
voiding schedule.
 Be consistent in
patient’s
activities. Be
consistent in the
schedule, routines,
and repetitions; a
written schedule,
checklists, and
audiotapes may
help with memory
and concentration,
and a
communication
board may be
used.
 Assess skin.
Frequently assess
skin for signs of
breakdown, with
emphasis on bony
areas and
dependent body
parts.
Heart Failure Heart failure is a -Shortness of Supplemental Coronary bypass ACE Inhibitors. ACE  Administer
condition that breath with activity Oxygen. The need for surgery. If severely inhibitors slow the medications and
develops when or when lying supplemental oxygen blocked arteries are progression of HF, assess the patient's
your heart doesn’t down is based on the degree causing your heart improve exercise tolerance, response to them
pump enough -Fatigue and of pulmonary failure, your doctor decrease the number of  Assess fluid
blood for your weakness congestion and may recommend hospitalizations for HF, balance, including
body’s needs. This -Swelling in the resulting hypoxia. coronary artery and promote vasodilation intake and output,
can happen if your legs, ankles and bypass surgery. The and diuresis by decreasing with a goal of
heart can’t fill up feet Cardiac procedure involves afterload and preload. optimizing fluid
with enough blood. -Rapid or irregular Resynchronization taking a healthy blood volume
It can also happen heartbeat Therapy. CRT vessel from your leg, Angiotensin II Receptor  Weigh the patient
when your heart is -Reduced ability to involves the use of a arm or chest and Blockers. ARBs block the daily at the same
too weak to pump exercise biventricular connecting it below conversion of angiotensin I time on the same
properly. -Persistent cough pacemaker to treat and above the blocked at the angiotensin II scale, usually in
or wheezing with electrical conduction arteries in your heart. receptor and cause the morning after
white or pink defects. The new pathway decreased blood pressure, the patient urinates
blood-tinged improves blood flow decreased systemic (a 2- to 3-pound
mucus Ultrafiltration. to your heart muscle. vascular resistance, and [0.9- to 1.4-kg]
-Swelling of the Ultrafiltration is an improved cardiac output. gain in a day or a
belly area alternative Heart valve repair 5-pound [2.3 kg]
(abdomen) intervention for or replacement. If a Beta Blockers. Beta gain in a week
-Very rapid weight patients with severe faulty heart valve blockers reduce the indicates trouble)
gain from fluid fluid overload. causes your heart adverse effects from the  Auscultate lung
buildup failure, your doctor constant stimulation of the sounds to detect an
Nausea and lack of Sodium restriction. may recommend sympathetic nervous increase or
appetite A low sodium diet of repairing or replacing system. decrease in
-Difficulty 2 to 3g/day reduces the valve. Surgeons pulmonary
concentrating or fluid retention and the can repair the valve Diuretics. Diuretics are crackles
decreased alertness symptoms of by reconnecting valve prescribed to remove  Determine the
-Chest pain if heart peripheral and flaps or by removing excess extracellular fluid degree of jugular
failure is caused by pulmonary excess valve tissue so by increasing the rate of vein distension
a heart attack congestion, and that the leaflets can urine produced in patients  Identify and
decrease the amount close tightly. with signs and symptoms evaluate the
of circulating blood Sometimes repairing of fluid overload. severity of edema
volume, which the valve includes (see Assessing for
decreases myocardial tightening or Calcium Channel pitting edema)
work. replacing the ring Blockers. CCBs cause  Monitor the
around the valve. vasodilation, reducing patient's pulse rate
Patient compliance. Heart valve repair or systemic vascular and BP and check
Patient compliance is replacement may be resistance but for postural
important because done as open-heart contraindicated in patients hypotension due to
dietary indiscretions surgery, a minimally with systolic HF. dehydration
may result in severe invasive surgery or a  Examine skin
exacerbations of HF heart procedure using turgor and mucous
requiring flexible tubes called membranes for
 hospitalizations. catheters (cardiac signs of
catheterization). dehydration
 Assess for
Implantable symptoms of fluid
cardioverter- overload.
defibrillators (ICDs).
An ICD is used to
prevent complications
of heart failure. It isn't
a treatment for heart
failure itself. An ICD
is a device similar to a
pacemaker. It's
implanted under the
skin in your chest
with wires leading
through your veins
and into your heart.

Heart transplant.
Some people have
such severe heart
failure that surgery or
medications don't
help. These people
may need to have
their hearts replaced
with a healthy donor
heart.
Cardiogenic Cardiogenic shock -Rapid breathing Oxygen. Oxygen is Angioplasty and Vasopressors. These  Provide
Shock is a life- -Severe shortness prescribed to stenting. A catheter is medications are used to supplemental
threatening of breath minimize damage to inserted into the treat low blood pressure. oxygen as ordered.
condition in which -Sudden, rapid muscles and organs. blocked artery to open They include dopamine, If the patient
your heart heartbeat it up. epinephrine (Adrenaline, develops
suddenly can't (tachycardia) Pain control. In a Auvi-Q), norepinephrine respiratory
pump enough -Loss of patient that Balloon pump. A (Levophed) and others. distress, be
blood to meet your consciousness experiences chest balloon pump is prepared for
body's needs. The -Weak pulse pain, IV morphine is inserted into the aorta Inotropic agents. These intubation and
condition is most -Low blood administered for pain to help blood flow and medications, which help mechanical
often caused by a pressure relief. reduce workload of improve the pumping ventilation.
severe heart attack, (hypotension) the heart. function of the heart, may  Administer low-
but not everyone -Sweating Hemodynamic be given until other dose morphine
who has a heart -Pale skin monitoring. An If medications and treatments start to work. sulfate as ordered
attack has -Cold hands or feet arterial line is inserted other procedures don't They include dobutamine, to reduce preload
cardiogenic shock. -Urinating less than to enable accurate and work to treat dopamine and milrinone. in an attempt to
Cardiogenic shock normal or not at all continuous monitoring cardiogenic shock, decrease
is rare. It's often of BP and provides a your doctor might Aspirin. Aspirin is usually pulmonary
deadly if not port from which to recommend surgery. given immediately to congestion.
treated obtain frequent reduce blood clotting and  Minimize oxygen
immediately. arterial blood samples. Coronary artery keep blood moving demand by
When treated bypass surgery. This through a narrowed artery. maintaining bed
immediately, about Fluid therapy. surgery uses a healthy Take an aspirin yourself rest and decreasing
half the people Administration of blood vessel in your while waiting for help to anxiety, fever, and
who develop the fluids must be leg, arm or chest to arrive only if your doctor pain.
condition survive. monitored closely to create a new pathway has previously told you to  Position the patient
detect signs of fluid for blood so it can do so for symptoms of a for maximum
overload. flow around a blocked heart attack. chest excursion
or narrowed artery. and comfort.
Your doctor might Antiplatelet medication.  Administer
suggest this surgery Emergency room doctors diuretics and /or
after your heart has might give you drugs vasodilators as
had time to recover similar to aspirin to help ordered to reduce
from your heart prevent new clots from circulating volume
attack. Occasionally, forming. These and decrease
bypass surgery is medications include preload.
done as an emergency clopidogrel (Plavix),
treatment. tirofiban (Aggrastat) and
eptifibatide (Integrilin).
Ventricular assist
device (VAD). A Other blood-thinning
mechanical device can medications. You'll likely
be implanted into the be given other
 abdomen and attached medications, such as
to the heart to help it heparin, to make your
pump. A VAD might blood less likely to form
extend and improve clots. IV or injectable
the lives of some heparin usually is given
people with end-stage during the first few days
heart failure who are after a heart attack.
waiting for new hearts
or aren't able to have a
heart transplant.

Heart transplant. If
your heart is so
damaged that no other
treatments work, a
heart transplant may
be a last resort.
Coronary Coronary artery -Chest pain or Oxygen therapy. Angioplasty and Cholesterol-modifying  Monitor blood
Arterial Disease disease is the discomfort Oxygen therapy is stent placement medications. These pressure, apical
buildup of plaque (angina) usually initiated at the (percutaneous medications reduce (or heart rate, and
in the arteries that -Weakness, light- onset of chest pain in coronary modify) the primary respirations every
supply oxygen-rich headedness, nausea an attempt to increase revascularization) material that deposits on 5 minutes during
blood to your (feeling sick to the amount of oxygen Your doctor inserts a the coronary arteries. As a an anginal attack.
heart. Plaque your stomach), or a delivered to the long, thin tube result, cholesterol levels —  Maintain
causes a narrowing cold sweat myocardium and (catheter) into the especially low-density continuous ECG
or blockage that -Pain or discomfort reduce pain. narrowed part of your lipoprotein (LDL, or the monitoring or
could result in a in the arms or artery. A wire with a "bad") cholesterol — obtain a 12-lead
heart attack. shoulder deflated balloon is decrease. Your doctor can ECG, as directed,
-Shortness of passed through the choose from a range of monitor for
breath catheter to the medications, including arrhythmias and
narrowed area. The statins, niacin, fibrates and ST elevation.
balloon is then bile acid sequestrants.  Place patient in
inflated, compressing comfortable
the deposits against Aspirin. Your doctor may position and
your artery walls. A recommend taking a daily administer oxygen,
stent is often left in aspirin or other blood if prescribed, to
the artery to help keep thinner. This can reduce enhance
the artery open. Most the tendency of your blood myocardial oxygen
stents slowly release to clot, which may help supply.
medication to help prevent obstruction of your  Identify specific
keep the arteries open. coronary arteries. activities patient
may engage in that
Coronary artery Beta blockers. These are below the level
bypass surgery drugs slow your heart rate at which anginal
A surgeon creates a and decrease your blood pain occurs.
graft to bypass pressure, which decreases  Reinforce the
blocked coronary your heart's demand for importance of
arteries using a vessel oxygen. If you've had a notifying nursing
from another part of heart attack, beta blockers staff whenever
your body. This reduce the risk of future angina pain is
allows blood to flow attacks. experienced.
around the blocked or  Encourage supine
narrowed coronary Calcium channel position for
artery. Because this blockers. These drugs may dizziness caused
requires open-heart be used with beta blockers by antianginals.
surgery, it's most if beta blockers alone aren't  Be alert to adverse
often reserved for effective or instead of beta reaction related to
people who have blockers if you're not able abrupt
multiple narrowed to take them. These drugs discontinuation of
coronary arteries. can help improve beta-adrenergic
symptoms of chest pain. blocker and
calcium channel
Ranolazine. This blocker therapy.
medication may help These drug must
people with chest pain be tapered to
(angina). It may be prevent a “rebound
prescribed with a beta phenomenon”;
blocker or instead of a beta tachycardia,
blocker if you can't take it. increase in chest
pain, and
Nitroglycerin. hypertension.
Nitroglycerin tablets,  Explain to the
 sprays and patches can patient the
control chest pain by importance of
temporarily dilating your anxiety reduction
coronary arteries and to assist to control
reducing your heart's angina.
demand for blood.  Teach the patient
relaxation
Angiotensin-converting techniques.
enzyme (ACE) inhibitors  Review specific
and angiotensin II factors that affect
receptor blockers CAD development
(ARBs). These similar and progression;
drugs decrease blood highlight those risk
pressure and may help factors that can be
prevent progression of modified and
coronary artery disease. controlled to
reduce the risk.
Hypertensive A hypertensive -Severe chest pain In a hypertensive No surgical The traditional drug of  Monitor arterial
Crisis crisis is a severe -Severe headache, emergency, the first management choice for therapy of BP continuously
increase in blood accompanied by goal is to bring down hypertensive emergencies and note sudden
pressure that can confusion and the blood pressure as is sodium nitroprusside. increases or
lead to a stroke. blurred vision quickly as possible Intravenous labetalol decrease in
Extremely high -Nausea and with intravenous produces a prompt, readings. A
blood pressure — vomiting (IV) blood pressure controlled reduction in precipitous drop in
a top number -Severe anxiety medications to blood pressure and is a BP can cause
(systolic pressure) -Shortness of prevent further organ promising alternative. reflex ischemia to
of 180 millimeters breath damage. Whatever Other agents used are the heart, brain,
of mercury (mm -Seizures organ damage has diazoxide, trimethaphan kidneys, and/or GI
Hg) or higher or a -Unresponsiveness occurred is treated camsylate, hydralazine, tract. Note trends
bottom number with therapies specific nitroglycerin, and in mean arterial
(diastolic pressure) to the organ that is phentolamine. pressure and the
of 120 mm Hg or damaged. patient’s response
higher — can to therapy.
damage blood  Monitor hourly
vessels. The blood urine output and
vessels become note any presence
inflamed and may of blood in the
leak fluid or blood. urine.
As a result, the  Continuously
heart may not be monitor the ECG
able to pump blood fir dysrhythmias or
effectively. ST segment and T-
wave changes
associated with
ischemia or injury
 Provide oxygen at
2 to 4 liters/min to
maintain or
improve
oxygenation.
 Minimize oxygen
demand by
maintaining the
patient at bed rest.
 Help the patient
decrease anxiety,
and keep the
patient NPO or
provide a liquid
diet in the acute
phase.
 Administer nitrates
as ordered to
reduce preload and
afterload.
 Administer beta
blockers as
ordered. Labetalol
may be given as 20
to 80 mg bolus
every 10 to 15
minutes to rapidly
 lower the blood
pressure.
 Prepare the patient
and family for
surgical
intervention to
correct the
underlying cause,
if this is indicated.
Cardiomyopath Cardiomyopathy is -Breathlessness Devices to correct Septal myectomy. In  Angiotensin-  Obtain blood
y a progressive with activity or arrhythmias: this open-heart converting enzyme pressure hourly or
disease of the even at rest Pacemakers or surgery, your surgeon (ACE) inhibitors more frequently if
myocardium, or -Swelling of the implantable removes part of the  Angiotensin II the patient’s
heart muscle. In legs, ankles and cardioverter thickened heart receptor blockers condition is
most cases, the feet defibrillators (ICDs) muscle wall (septum) (ARBs) unstable.
heart muscle -Bloating of the treat irregular heart that separates the two  Sacubitril/valsarta  Monitor hourly
weakens and is abdomen due to rhythms. These bottom heart n (Entresto). urine output to
unable to pump fluid buildup devices monitor your chambers (ventricles).  Beta blockers evaluate effects of
blood to the rest of -Cough while lying heartbeat. They send Removing part of the  Diuretics decreased cardiac
the body as well as down electrical impulses to heart muscle improves  Digoxin (Lanoxin). output or
it should. There -Difficulty lying your heart when an blood flow through pharmacologic
 Ivabradine
are many different flat to sleep arrhythmia starts. the heart and reduces intervention.
(Corlanor)
types of -Fatigue mitral valve  Analyze ECG
 Blood-thinning
cardiomyopathy -Heartbeats that Septal ablation. A regurgitation. Septal rhythm strip at
medications
caused by a range feel rapid, small portion of the myectomy is used to least every 4 hours
(anticoagulants)
of factors, from pounding or thickened heart treat hypertrophic and note rate.
coronary heart fluttering muscle is destroyed cardiomyopathy.  Continuously
disease to certain -Chest discomfort by injecting alcohol monitor oxygen
drugs. These can or pressure through a long, thin Heart transplant. status with pulse
all lead to an -Dizziness, tube (catheter) into the Your doctor might oximetry.
irregular heartbeat, lightheadedness artery supplying blood recommend a heart  Monitor patient
heart failure, a and fainting to that area. This transplant if you have activities and
heart valve allows blood to flow end-stage heart failure nursing
problem, or other through the area. and medications and interventions that
complications. other treatments no may adversely
Radiofrequency longer work. affect oxygenation.
ablation. To treat  Obtain vital signs
abnormal heart every 15 minutes
rhythms, doctors during acute
guide long, flexible phase.
tubes (catheters)  Assess the patient
through your blood for changes in
vessels to your heart. neurological
Electrodes at the function hourly
catheter tips transmit and as clinically
energy to damage a indicated.
small spot of  Assess for skin
abnormal heart tissue warmth, color, and
that is causing the capillary refill
abnormal heart time.
rhythm.  Assess for chest
discomfort
because
myocardial
ischemia may
result from poor
perfusion.
 Assess heart and
lung sounds to
evaluate the degree
in heart failure.
 Obtain vital signs
every 15 minutes
during acute
phase.
 Assess the patient
for changes in
neurological
function hourly
and as clinically
indicated.
 Assess for skin
 warmth, color, and
capillary refill
time.
 Assess for chest
discomfort
because
myocardial
ischemia may
result from poor
perfusion.
 Assess heart and
lung sounds to
evaluate the degree
in heart failure.
Arrhythmias An arrhythmia is -Palpitations (a Cardioversion: The Catheter ablation: Antiarrhythmic drugs.  Monitor blood
an uneven feeling of skipped doctor may use an During catheter These can treat tachycardia pressure.
heartbeat. It means heartbeats, electric shock or ablation, your and premature heartbeats.  Encourage patients
your heart is out of fluttering, or "flip- medication to reset the cardiologist threads They include amiodarone, to stop smoking,
its usual rhythm. It flops") heart to its regular flexible tubes called propafenone, and more. ingesting alcohol
may feel like your -Pounding in your rhythm. catheters through your However, they may cause and caffeine.
heart skipped a chest blood vessels to the the problematic side effect  Educate patients to
beat, added a beat, -Dizziness or Alcohol septal correct area of your proarrhythmia, which can avoid using
or is "fluttering." It feeling lightheaded ablation. The doctor heart. An electrode at worsen your arrhythmia or stimulants.
might feel like it’s -Fainting injects ethanol (a type the end of one of the cause a new arrhythmia. *Beware of
beating too fast -Shortness of of alcohol) through a catheters releases stimulants used in
(which doctors call breath tube into the small radiofrequency waves, Calcium channel cough and cold
tachycardia) or too -Chest pain or artery that supplies heat, or very cold blockers. Calcium channel medications and
slow (called tightness blood to the thickened temperatures to create blockers, which include herbal or
bradycardia). Or -Weakness or area of heart muscle. a small scar. The scar amlodipine and diltiazem, nutritional
you might not fatigue (feeling The alcohol kills cells, tissue blocks the help lower your blood supplements.
notice anything. very tired) and the thickened electrical waves that pressure and heart rate. Some of these
-Anxiety tissue shrinks to a cause arrhythmias. They can be used long substances contain
-Blurry vision more normal size. term. ingredients that
-Sweating This procedure allows Pacemaker: Your cause irregular
blood to flow freely doctor can implant a Beta-blockers. Beta- heart rhythms.
through the ventricle, pacemaker during blockers slow your heart  Educate patients
which improves minor surgery. After rate to treat tachycardia. how to use
symptoms. making a small cut Beta-blockers include diversion
near your shoulder, acebutolol, metoprolol, and techniques under
IV electrolytes to they guide small wires other medications. any circumstances.
help maintain fluid through your veins  Advise patients to
levels and acid-base and place them in Anticoagulants. get treatment for
balance in the body. your heart. The wires Anticoagulants help any other
They also help muscle connect to a small prevent blood clots, which underlying cause.
and nerve tissues battery-powered can result from atrial  Encourage
work properly. generator implanted fibrillation. Blood-thinning modification of
near your collarbone. medications include diet and exercise.
If the generator warfarin, rivaroxaban, and
detects an abnormal more. A side effect may be
heart rhythm, it can excessive or internal
send an electrical bleeding.
pulse through the wire
to help regulate it.

Implantable
cardioverter
defibrillator (ICD):
An ICD is similar to a
pacemaker and may
be implanted near
your collarbone,
breastbone, or ribs. It
may help if your
arrhythmias are life
threatening or put you
at risk of cardiac
arrest. An ICD can
send electric shocks to
your heart to correct
its rhythm or restart
your heart if it stops
beating.