Cardiovascular Diseases and Conditions

Coronary Artery Disease (NUR 340)

• Cardiovascular disease (CVD) is a leading cause of death in the U.S.
• One in four deaths is attributed to heart disease.
• More than half of these deaths are men (statistics).
• Two out of every three women who died unexpectedly had no prior symptoms (statistics).
• The total cost associated with heart disease is $207 billion annually (statistics).

Objectives

• Review the current state of CVD in the U.S.
• Discuss the basic pathophysiology of CVD.
• Review assessment methods related to CVD.
• Explore treatment options for angina and myocardial infarction.

Statistics

• Heart disease causes one out of every four deaths.
• More than half of heart disease deaths involve men.
• Two-thirds of women who died suddenly of heart disease had no prior symptoms.
• The total cost of the problem is $207 billion a year.

Heart Disease Death Rates (2015-2017)

• Rates were adjusted for population size (data source).
• Data source: National Vital Statistics System, National Center for Health Statistics, CDC.
• A map showing varied rates of heart disease deaths across US counties.

Healthy People 2020/2030 Goals

• Decrease the number of coronary heart disease deaths.
• Improve cardiovascular health.
• Increase dietary adherence among at-risk individuals.
• Increase the number of adults recognizing and responding to heart attack symptoms.

Pathophysiology

• Coronary arteries supply blood to the heart muscle.
• Plaque buildup in arteries, narrowing the arteries reduces blood flow.
• Reduced blood flow deprives the heart of oxygen leading to decreased functioning (ischemia).
• The layers of an artery includes the Intima, media, and externa (diagram).

Arteriosclerosis vs. Atherosclerosis

• Arteriosclerosis refers to the abnormal thickening and hardening of arteries.
• Atherosclerosis involves the build-up of plaque in the inner layers of the arteries, leading to arterial blockage.

Atherosclerosis

• Plaque build-up in arteries can narrow or block the arteries.
• When plaque detaches, blockages can occur or embolism can happen.
• Severe atherosclerosis can lead to embolism or thrombosis.
• Blood clots can prevent blood flow and cause issues with blood pressure or oxygenation to extremities.

Plaque Formation

• Low-density lipoprotein (LDL) enters the inner lining of the artery.
• Oxidized LDL causes inflammation and attracts immune system cells (monocytes).
• Monocytes transform into foam cells which consume LDL (diagram).
• Foam cells release growth factors that encourage atherosclerosis.

Location of CVD

• Coronary arteries (around the heart).
• Peripheral arteries (PAD – Honan pp. 530-538).
• Subclavian arteries.

Collateral Circulation

• The body reroutes blood flow through new or smaller blood vessels due to occlusion.
• Occlusion (blockage) can lead to blood rerouting (diagram).
• The body adapts gradually to adapt to reduced blood flow.

Peripheral Artery Disease (PAD)

• Increases mortality and morbidity.
• Leads to critical limb ischemia.
• Symptoms can vary, with potential for weakness, numbness, and pain.
• Treatment options include vasodilators, anticoagulants, and surgical intervention.

Coronary Blood Flow

• Cardiac output (blood pumped by ventricles) = stroke volume x heart rate.
• Stroke volume (amount ejected per heartbeat).
• Heart rate (determined by the autonomic nervous system).
• Preload and afterload impact contractility and ejection fraction.
• Ejection fraction measures the percentage of blood pumped out of the left ventricle.

Coronary Arteries

• Left artery supplies blood to the anterior wall and lateral wall (circumflex).
• Right artery provides blood to the inferior and posterior walls.
• All are located above the aortic valve.

Supply and Demand

• Increased oxygen demands (heart) due to higher activity.
• Decreased oxygen supply due to blockage or narrowing of arteries.
• Either deficiency can lead to cardiovascular events.

Assessment

• Health history (risk factors, symptoms)
• Clinical manifestations (symptoms)
• Lab values/diagnostics (e.g., cholesterol, blood tests, ECG, etc)

Risk Factors

• Nonmodifiable: age, genetics, gender, ethnicity
• Modifiable: diet, smoking, hypertension, hyperlipidemia, obesity, lifestyle, stress and habits

Metabolic Syndrome

• Insulin resistance.
• Abdominal obesity.
• Dyslipidemia.
• Hypertension.
• Elevated C-reactive protein (CRP).
• Elevated fibrinogen.

Physical Assessment

• Assess for chest discomfort.
• Check for arm or back pain.
• Monitor for neck or jaw pain.
• Look for trouble breathing.
• Examine for lightheadedness, sweating, or stomach discomfort.

Possible Causes of Chest Pain

• Angina.
• Pericarditis.
• Pulmonary embolism.
• Pneumonia.
• Gastric reflux.
• Anxiety or panic disorders.
• Costochondritis inflammation or discomfort in the space between the ribs and chest.
• Dissecting aneurysms are tears in the artery wall.

Clinical Manifestations of Atherosclerosis

• Ischemia (inadequate blood supply to the heart).
• Angina pectoris (chest pain due to myocardial ischemia).
• Classic signs and symptoms of myocardial ischemia (typical physical discomfort).

Angina Pectoris

• Usually associated with significant obstruction of a coronary artery.
• Presentation with varying pain characteristics (types of angina).
• Diagnosis typically through history, ECG, and cardiac biomarker analysis.

Types of Angina

• Stable.
• Unstable.
• Intractable/refractory.
• Variant/Prinzmetal's.
• Silent ischemia.

Labs

• Lipid profile: assess risk factors for atherosclerosis (cholesterol, triglycerides, and lipoproteins).
• CRP: assess inflammation.
• Cardiac biomarkers/enzymes: assess myocardial cell injury (CK, CK-MB, myoglobin, and troponin).

Diagnostic Testing

• Electrocardiogram (ECG or EKG): measure electrical activity of the heart.
• Echocardiogram (w/ or w/o TEE): assess heart structure and function through ultrasound.
• Stress test: assess the heart's response to exercise or stress.
• Cardiac catheterization: visualize and diagnose issues within the passageways.

Prevention and Medical Nursing Management

• Control cholesterol levels.
• Manage hypertension.
• Manage diabetes.
• Promote healthy lifestyle choices for long-term prevention.

Management of CAD and Angina

• Medications: morphine, oxygen, nitrates, aspirin, beta blockers, calcium channel blockers, anticoagulants.
• Surgical interventions.

Management of MI

• Medications (e.g., aspirin, nitroglycerin, morphine, beta blockers, ACE inhibitors, statins).
• Thrombolytic therapy (to break up clots).
• Reperfusion therapy.
• Cardiac rehabilitation.

Question

• Balancing myocardial oxygen supply with demand.

Diabetes Insipidus

• Deficiency of antidiuretic hormone (ADH).
• Excessive thirst and excessive excretion of large amounts of watery urine.
• Three types: neurogenic (central), nephrogenic, and psychogenic.

Diabetes Insipidus-Clinical Findings

• Decreased ADH.
• Polyuria, nocturia, polydipsia (increased urine output, nighttime urination, and excessive drinking).
• Low urine specific gravity and osmolality (reduced concentration of dissolved substances in urine).
• High plasma (blood) osmolality and sodium.
• Dehydration (significant risk).

Diabetes Insipidus: Treatment

• Goals: maintain adequate fluid volume and monitor VS, I/O.
• Nursing management: monitor, administer ADH replacement therapy (vasopressin/DDAVP), treat for dehydration (hydration).

DI-Medical Management

• Fluid replacement.
• ADH replacement (desmopressin – nasal spray or IV).
• Vasopressin tannate (IM).
• Thiazide diuretics.
• Prostaglandin inhibitors (e.g., ibuprofen).

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

• Excess of ADH leading to water retention.
• Develop dilutional hyponatremia (lower than normal sodium levels).
• Manifestations include confusion, lethargy, weakness, depression and coma.
• Medical management includes fluid restriction, diuretics, normal saline infusion.

Hyperthyroidism

• Overproduction of thyroid hormones (T3 and T4).
• Graves' disease is a common cause.
• Treatment involves radioactive iodine, antithyroid agents, and surgery.

Hyperthyroid/Grave's Disease

• Symptoms include intolerance to heat, fine straight hair, bulging eyes, facial flushing, enlarged thyroid, tachycardia, increased systolic BP, breast enlargement, weight loss, muscle wasting.
• Localized edema possible.

Patient with Grave's Disease

• Exophthalmos (bulging eyes).

"Thyroid Storm"

• Hyperthyroidism crisis (symptoms include high temperature & heart rate, dehydration).

Hyperthyroidism-Nursing Management

• Assess symptoms related to metabolic acceleration.
• Improved nutrition, coping ability, self-esteem, normal body temperature, and absence of complications.

Thyroid Tumor and Cancer

• Often accompanied by a goiter (enlarged thyroid).
• Treatment involves medications and surgery (thyroidectomy).
• Nursing priorities include airway maintenance, pain management, fluid balance, and complication monitoring (e.g. hemorrhage, hematoma, edema, hypoparathyroidism).

Hyperparathyroidism

• Excess parathyroid hormone (PTH) leading to elevated serum calcium.
• Can be life-threatening.
• Related to Vitamin D.
• Elevated calcium decreases secretion of PTH.
• Elevated calcium and phosphorus can calcify.

Hyperparathyroidism-Medical and Nursing Management

• Nursing management: hydration, mobility, dietary changes, emotional support, and monitor for hypercalcemic crisis.
• Medical management: surgical removal of abnormal parathyroid tissue.

Hypoproliferative Anemia

• Iron deficiency anemia (most common type).
• Leads to fatigue due to low cellular oxygen.
• Diagnosis involves microcytic anemia, low transferrin saturation (<20%), and low ferritin (<30 ng/mL).
• Consider iron supplements and iron-rich foods.

Megaloblastic Anemias

• Vitamin B12 deficiency (pernicious anemia).
• Low dietary intake (vegans and others.
• Lack of intrinsic factor.
• Folic acid deficiency (poor diet).
• Increased alcohol consumption.
• Hemolytic anemias, pregnancy.
• Small intestine malabsorption.

Hemolytic Anemias

• Premature destruction of red blood cells (erythrocytes).
• Increased free hemoglobin in the plasma.
• Elevated bilirubin levels.
• Low haptoglobin levels.
• Increased reticulocyte count.
• Leads to decreased tissue oxygenation.

Thalassemia

• Inherited anemia.
• Characteristics include hypochromia, microcytosis, and hemolysis (destruction).
• Alpha thalassemia: milder, usually asymptomatic.
• Beta thalassemia: more severe, can be fatal if untreated (Cooley's anemia).

Autoimmune Hemolytic Anemia

• Immune system causes the destruction of red blood cells.
• Classified as warm-body (more common) or cold-body.
• Splenectomy may be necessary in some cases.

Complications of Anemia

• Anemia with kidney disease (low erythropoietin).
• Anemia related to chronic disease (reduced response to erythropoietin).
• Anemia related to hypoxia (increased CO, dyspnea, fatigue).

Hodgkin Lymphoma

• Rare, malignant, and potentially curable cancer.
• Affects men more than women.
• Typically starts in a single lymph node.
• Characterized by the presence of Reed-Sternberg cells (diagnostic feature).

Non-Hodgkin Lymphoma

• Involves malignant B or T lymphocytes.
• Infiltrates lymphoid tissue.
• Divided into low-grade (CLL and follicular lymphoma) and high-grade (e.g., B-cell and T-cell lymphomas, Burkitt's lymphoma).
• Associated with varying prognosis and treatment needs.

Blood Transfusions

• Common blood products: red blood cells, platelets, fresh frozen plasma (FFP).
• Follow proper transfusion protocols.
• Monitor for adverse effects/reactions (usually occur within first 15 minutes).
• Jehovah's Witness patients can decline transfusions.

Transfusion Reactions

• Transfusion-related acute lung injury (TRALI): new lung injury within 6 hours of transfusion (s/s: dyspnea, fever, chills, hypoxia, cyanosis, hypotension).
• Transfusion-associated circulatory overload (TACO): hypervolemia (fluid overload) from rapid transfusion (s/s: tachycardia, JVD, crackles, hypertension, dyspnea).
• Allergic reactions: rash, pruritis, wheezing (prophylactic Benadryl/steroids).

Pyelonephritis

• Infection and inflammation of the kidney pelvis (calyces, and medulla).
• Usually begins in the lower urinary tract and ascends to the kidney.
• E. coli is a common causative agent.
• Acute pyelonephritis: active infection, enlarged kidney, tubular cell necrosis.
• Chronic pyelonephritis: Repeated infections leading to progressive inflammation; kidney scarring and decreased function.

Renal Calculi ("Kidney Stones")

• Most common cause of urinary obstruction.
• Theories of stone formation: supersaturation, deficiency of substances preventing crystallization, patient volume status, and urine acidity.
• Risk factors: age (30-50 yrs), gender (male), metabolic conditions (hyperparathyroidism), gout, certain dietary factors, genetic predisposition.
• Spring and summer: commonly higher risk periods.

Renal Calculi (Clinical Manifestations & Treatment)

• Manifestations: severe flank pain (renal colic), fever, frequent urination, nausea/vomiting, hematuria (blood in urine), oliguria/anuria (low/no urine output).
• Treatment: hydration, medications (analgesics, antispasmodics, antibiotics), extracorporeal shock wave lithotripsy (ESWL), or surgical interventions

Liver Diseases

• Key functions: remove toxins, prevent nutritional deficiencies, metabolize nutrients, fight infections, produce bile, albumin, and blood products (coagulation factors).
• Diagnostics: liver function tests (LFTs), ultrasound/transient elastography, CT/MRI, and liver biopsy.
• Diseases: non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), alcoholic liver disease, hepatitis A, B, C (viral), toxic/drug induced.
• Risk factors: obesity, alcohol consumption, certain medications, other underlying health issues.

Neurological Disorders

• Types:
• Brain tumors (pituitary, meningiomas, acoustic neuroma, glioblastoma)
• Increased intracranial pressure (ICP) (Cushing's triad)
• Seizures (partial, complex, generalized)
• Meningitis (bacterial, viral)
• Encephalitis (viral)
• Bell's palsy (CN VII inflammation)
• Parkinson's Disease (Neurodegenerative disorder; slow progress; loss of dopamine)
• Multiple Sclerosis (autoimmune;demyelination)
• Myasthenia Gravis (autoimmune disorder; weakness neuromuscular junction; involves acetylcholine receptors)
• Guillain-Barré Syndrome (ascending symmetrical weakness; demyelination; often preceded by viral infection)
• Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig's Disease; degenerative disorder involving upper/lower motor neurons; gradual loss of function)

Genetic Disorders

• Genes: basic units of heredity; composed of DNA (except retroviruses); passed from one generation to the next.
• Genetics: the study of genes; determines inheritance patterns.
• Epigenetics: how environmental and behavioral factors affect gene expression without changing the DNA sequence.
• Genomics: the study of the whole genetic makeup (genome) of a person determines patterns in inheritance and mutations; includes how genes interact within a person.
• Genetic replication & Mutation: Transcription (creation of RNA from DNA); Translation (reading RNA to create proteins); Mutation (permanent DNA sequence change with various causes).
• Inheritance Patterns: Dominant vs Recessive, Autosomal vs X-linked, Complex.
• Genetic Disorders: Single Gene, Multifactorial, and Chromosomal (abnormalities in number/structure of chromosomes).

Genetic Screening and Testing

• Screening: initial detection process for various genetic conditions (general or targeted).
• Testing: more focused testing for specific reasons (family history, unusual symptoms, etc).
• Interpretation: evaluation of test results can relate to individual or family risk.

Gene Therapy

• Experimental procedure aimed at enhancing treatment of genetic diseases.
• Requires a vector (often a live virus) to deliver genes.
• Promising for inherited diseases, some types of cancers, and chronic viral illnesses (like HIV).

Nursing Considerations and Ethics

• Genetic Counseling: referral and coverages vary; includes pre-natal testing.
• Pharmacogenetics: improved use of medications; must consider individual genetic background.
• Ethics: concerns about ethically questionable practices (genetically engineered babies, playing God).

This quiz covers key aspects of cardiovascular diseases, including heart disease, atherosclerosis, and Peripheral Arterial Disease (PAD). Test your knowledge on statistics, symptoms, and risk factors associated with these conditions. Ideal for those studying health sciences or looking to improve their understanding of heart health.