CARDIOVASCULAR DISORDERS

Age-related changes of the system

Heart valves become thicker and more rigid

sclerosis and fibrosis Less elasticity of vessels accumulation of calcium deposits More prominent arteries in head, neck, and extremities thinner skin, less subcutaneous fat Decreased cardiac output heart muscle losses efficiency and contractile strength (elevator than stairs, drive than walk long distance, receiving bad news, run to catch a bus) BP increases to compensate for increased peripheral resistance Less efficient O2 utilization

Primary level of Prevention-Health Promotion for the System Disorders Encourage to engage in physical activity for a minimum of 60 minutes (total) every day or as recommended by your primary health care provider. Have a physical examination before beginning a new program of exercise not smoking or drinking excessively achieving and maintaining a healthy weight eating a heart-healthy well-balanced diet. Consume a low-saturated fat, low cholesterol diet can help fight cardiovascular disease. Monitoring blood pressure Follow prescribed therapy for hypertension, elevated serum lipids and diabetes.

Secondary level of PreventionHealth Maintenance

(Diagnostic Procedures)

Non-invasive Procedures

Laboratory tests q Lipid Profile - cholesterol, triglycerides, and lipoproteins are measured to evaluate a persons risk of developing atherosclerotic disease especially if there is family history of premature heart disease or to diagnose a specific lipoprotein abnormality.

C-Reactive Protein - is a venous blood test that measures levels of CRP, a protein produced by liver in response to systemic inflammation. Higher level of hs-CRP (3.0 mg/dl or greater)may be greater at risk for CVD

Fluoroscopy is an imaging technique commonly used by physicians to obtain realtime moving images of the internal structures of a patient through the use of a fluoroscope. In its simplest form, a fluoroscope consists of an X-ray source and fluorescent screen between which a patient is placed. However, modern fluoroscopes couple the screen to an X-ray image intensifier and CCD video camera allowing the images to be recorded and played on a monitor.

 Cardiac Stress Testing - evaluate the response of cardiovascular system to stress. Helps determine the presence of CAD, cause of chest pain, functional capacity of heart after an MI or heart surgery.(example)

 Echocardiography- ultrasound test that is used

to measure the ejection fraction and examine the size, shape, and motion of cardiac structures. It is particularly useful for diagnosing pericardial effusions; determining chamber size and etiology of heart murmurs; evaluating the function of heart valves, including prosthetic heart valves: and evaluating ventricular wall motion.

 Magnetic Resonance Angiography (MRA) - examine both the physiologic and anatomic properties of the heart such as diagnosing the diseases of the aorta, heart muscle, and pericardium, as well as congenital heart lesions.

Phonocardiography recording of audible

vibrations coming from the heart and great vessels, phonograms assist in diagnosing the timing and cardiac sounds and murmurs.

Holter monitoring

vuse of holter monitor ECG can be record continuously for over a period of a day or longer on an outpatient basis. vDone to determine which dysrhythmias maybe causing clinical manifestations that may not occur during a routine ECG.

Invasive Procedures

 MRI- provides the best information on chamber size, wall motion, valvular function and great vessel blood flow.

Cardiac Catherization

radiopaque arterial and venous catheters are introduced into selected blood vessels of the right and left sides of the heart. Used to diagnose CAD, assess coronary artery patency, and determine the extent of atherosclerosis.

ANGIOGRAPHY
Angiography or arteriography is a medical

imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins and the heart chambers. This is traditionally done by injecting a radio-opaque contrast agent into the blood vessel and imaging using X-ray based techniques such as fluoroscopy.

Radionuclide imaging - thallium scanning vtest using a special camera and small amount of radioactive substance injected into the bloodstream to make an image of the blood flow to the heart.

HYPERTENSION

Hypertension
intermittent or sustained elevation in the diastolic or systolic pressure. Present when the arterial pressure is 140/90 or higher and will result to arteriosclerotic changes in the arteries throughout the body.

Modifiable Risk Factors: High Na intake Obesity Excess alcohol consumption Smoking DM Impaired Renal Failure Stress Diet

Non-modifiable Risk Factors:

Family History Age Race

Manifestations: Diastolic pressure greater than 120 mmHg

Headache

Drowsiness Confusion Tachycardia and tachypnea Dyspnea Cyanosis Seizures

Papilledema Alterations in vision or speech Dizziness Sudden fall Transient or permanent paralysis on

one side (Hemiplegia)

Non-medical Intervention

Monitor vital signs especially BP Provide safety Maintain bed rest with head of the bed elevated at 45 degrees Monitor intake and output Monitor urinary output, and if oliguria or anuria occurs notify the

physician Maintain patent airway Monitor neurological status Have emergency medications and resuscitation equipment readily available Monitor IV therapy, assessing fluid overload Increase the knowledge of the patient about the disease, its restriction and recommendations. Encourage lifestyle modification

DASH diet:

Approaches to stop hypertension (diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat)

Medical intervention:
such as Diuretics, Beta-Blockers, ACE Inhibitors, Calcium channel blockers, Angiotensin II receptor blockers and Alpha1-Blockers

Administer antihypertensive oral medications

Promoting appropriate nutrition (low sodium diet) Provide supplemental oxygen if needed

HYPOTENSIO N

Hypotension
- a decrease in blood pressure to less than 100/60 mmHG that compromises systemic perfusion -occurs when blood pressure during and after each heartbeat is much lower than usual. This means the heart, brain, and other parts of the body do not get enough blood.

Modifiable Risk Factors:

Cardiovascular diseases Inadequate rest and sleep Medications Insufficient fluid intake Starvation Allergic Reactions

Non- Modifiable Risk Factors

Age Family History Sex Race

Manifestations:

-lightheadedness or dizziness -shortness of breath -fatigue -fainting -seizures -headache -temporary blurring of vision

Medical Interventions Volume resuscitation (usually with crystalloid) Blood pressure support (with norepinephrine or equivalent) Ensure adequate tissue perfusion Address the underlying problem (i.e. antibiotic for infection, stent or CABG for infarction, steroids for adrenal insufficiency, etc...) Medium-term (and less well-demonstrated) treatments of hypotension include: Blood sugar control (80-150 by one study) Early nutrition (by mouth or by tube to prevent ileus) Steroid support

Non-medical Interventions:
Monitor vital signs Providing Safety Adding electrolytes to a diet Positioning the client-lifting the legs Monitor neurologic status

 Action stat!

If the patient's systolic pressure is less than 80 mm Hg, or 30 mm Hg below his baseline, suspect shock. Quickly evaluate the patient for a decreased LOC. Check his apical pulse for tachycardia and his respirations for tachypnea. Inspect the patient for cool, clammy skin. Elevate the patient's legs above the level of his heart, or place him in Trendelenburg's position if the bed can be adjusted. Then insert a large-bore I.V. catheter to replace fluids and blood or to administer drugs. Prepare to administer oxygen with mechanical ventilation if necessary. Monitor the patient's intake and output and insert an indwelling urinary catheter to accurately measure urine output. The patient may need a central venous catheter or a pulmonary artery catheter to facilitate monitoring of his fluid status. Prepare for cardiac monitoring to evaluate cardiac rhythm. Be ready to insert a nasogastric tube to prevent aspiration in the comatose patient. Throughout emergency interventions, keep the patient's spinal column immobile until spinal cord trauma is ruled out.

TREATMENT

Coronary artery bypass surgery

Coronary artery bypass surgery, also coronary

artery bypass graft (CABG pronounced cabbage) surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease . Arteries or veins from elsewhere in the patient's body are grafted to the coronary arteries to bypass atherosclerotic narrowing's and improve the blood supply to the coronary circulation supplying the myocardium (heart muscle). This surgery is usually performed with the heart stopped, necessitating the usage of cardiopulmonary bypass; techniques are available to perform CABG on a beating heart, socalled "off-pump" surgery.

CARDIAC REHABILITATION
Cardiac Rehabilitation

Cardiac rehabilitation is a medically supervised program to help heart patients recover quickly and improve their overall physical, mental and social functioning. The goal is to stabilize, slow or even reverse the progression of cardiovascular disease, thereby reducing the risk of heart disease, another cardiac event ordeath.

Cardiac rehabilitation programs include: Counseling so the patient canunderstand and manage the disease process Beginning an exercise program Counseling on nutrition Helping the patientmodify risk factors such as high blood pressure, smoking, high blood cholesterol, physical inactivity, obesity and diabetes. Providing vocational guidance to enable the patient to return to work Supplying information on physical limitations Lending emotional support Counseling on appropriate use of prescribed medications

HEART TRANSPLANT

by physician. Emphasize the importance of using the drugs at the right timing of intake and right dosage. Drugs should not be stop abruptly without the consent of the physician because of its rebound tendencies. E- Instruct the folks to provide and maintain stress free environment to lessen the discomfort of the patient and not to aggravate the symptoms of the disease. T- Encourage the patient to perform diversionary tactics( e.g. relaxation technique, reading, music therapy etc.) and promote ambulation and nonstrenous activities.

M- Instruct the patient to take drugs as prescribed

H- Inform patients on how to prevent complications. Provide enough and appropriate knowledge to the disease and advise some lifestyle modifications. O- Instruct the patient when to return for follow up appointments with the health care giver. Reporting of any untoward signs and symptoms to the health care givers is essential. D- Advise the patients to eat healthy foods and avoid foods with high sodium and high cholesterol content.

S - E n co u ra g e th e fa m i y to su p p o rt th e l p a ti n t p h ysi l y , fi a n ci l y , e ca l n al e m o ti n a l y a n d sp i tu a l y. G i o l ri l ve e n o u g h i fo rm a ti n to th e fo l i n o ks n o rd e r fo r th e m to u n d e rsta n d th e si a ti n o f th e p a ti n t. tu o e S - G i ve sp i tu a lsu p p o rt to th e p a ti n t ri e i a cco rd a n ce to h i / h e r re l g i u s n s i o a ffi i ti n a n d b e l e fs. Le t th e p a ti n t la o i e ve rb a l ze h i / h e r fe e l n g s a n d sta y o n i s i h i / h e r si e i n e e d e d . s d f

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