Diseases of the Cardiovascular System PDF

Second lecture / Medical Nursing Ahmed K. Awad Diseases of the Cardiovascular system 10 Second lecture / Medical Nursing Ahmed K. Awad...

Second lecture / Medical Nursing Ahmed K. Awad Diseases of the Cardiovascular system 10 Second lecture / Medical Nursing Ahmed K. Awad Cardiovascular system The cardiovascular system consists of the heart, blood vessels, and blood. Its primary function is transporting nutrients and oxygen-rich blood to all body parts and carrying deoxygenated blood back to the lungs. Abnormalities or injuries to any or all parts of the cardiovascular system can result in serious health complications. Common conditions that can affect the cardiovascular system include coronary artery disease, heart attack, high blood pressure, and stroke. Components of the cardiovascular system: The cardiovascular system trusted Source is the system responsible for delivering blood to different parts of the body. It consists of the following organs and tissues: The heart: A muscular pump that forces the blood around the body. A closed system of blood vessels: These vessels include: Arteries: Vessels that carry blood away from the heart. Veins: Vessels that bring blood back to the heart. Capillaries: Tiny vessels that branch off from arteries to deliver blood to all body tissues trusted Source. There are two blood circulatory systems in the body. The first is the systemic circulatory system. This is the main blood circulatory system that transports blood to the body's organs, tissues, and cells. The second is the pulmonary circulatory system. This circulatory system moves blood between the heart and lungs. It is where oxygen enters the blood and carbon dioxide leaves the blood. 11 Second lecture / Medical Nursing Ahmed K. Awad Cardiovascular assessment: A thorough assessment of the heart provides valuable information about the function of a patient’s cardiovascular system. Understanding how to properly assess the cardiovascular system and identifying both normal and abnormal assessment findings will allow the nurse to provide quality, safe care to the patient. Pulmonary vein Mitra! valve ---- Aortic Pulmonary valve valve ----·- Tricuspid ------- valve Pericard ium Diagnostic Tests for Cardiovascular Function: 1-ECG: It is a graphic recording of the electrical activity of the heart; an ECG can be recorded with 12, leads, showing the activity from those different reference points. The standard 12-lead ECG is the most commonly used tool to diagnose dysrhythmias, conduction abnormalities, enlarged heart chambers, myocardial ischemia or infarction, high or low calcium and potassium levels, and the effects of some medications. 12 Second lecture / Medical Nursing Ahmed K. Awad 2-Auscultation: Studies heart sound using stethoscope Exercise stress test Assess general cardiovascular function Checks for the exercise-induced problem. 3-Holter monitor. In ambulatory ECG monitoring, which may occur in the hospital but is more commonly prescribed for outpatients, one lead of the patient’s ECG can be monitored by a Holter monitor. helps the physician diagnose dysrhythmias and myocardial ischemia and evaluate therapy, such as antiarrhythmic and antianginal medications or pacemaker function. t I I) ct::: < 2016 MAY ) 4-Cardiac Catheterization: Visualize the inside of the heart, measure pressure, assess valve and heart function Determine blood flow to and from the heart. 5- Angiography: (examination by X-ray of blood or lymph vessels) Visualization of blood flow in coronary artery Obstruction assessed and treated; Basic catheterization Balloon angioplasty. 13 Second lecture / Medical Nursing Ahmed K. Awad Left atrium ~ :;......;;.-Aort1c valve Left ventncle R,g ven Catheter Angiography $ A.DAM Cardiac catheter Stent (wire mesh tube) Blocked coronary artery Cardiac catheter 14 Second lecture / Medical Nursing Ahmed K. Awad 6-Blood tests: Creatine kinase (CK) and its isoenzyme CK-MB are the most specific enzymes analyzed in acute MI, and they are the first enzyme levels to rise., the normal range is 5-25 IU\L. 7-The troponin test: measures the level of troponin in the blood. The troponin is sent into the bloodstream when the heart muscles are damaged. As heart damage increases, greater amounts of troponin are released into the blood. The normal range for troponin T in adults is less than 0.1 ng per milliliter. 8-Myoglobin: blood count can be used to detect muscle damage, myoglobin is a small oxygen- binding protein found in the heart and skeletal muscles, when the heart muscle or skeletal muscle is injured, myoglobin is released into the blood, and blood levels in myoglobin can rise very quickly with severe damage to Muscle can be within 1 to 3 hours after the onset of an acute MI. Myoglobin peaks in 4 to 12 hours and returns to normal in 24 hours. The normal range for the myoglobin level in the blood ranged from 25 to 72. Cholesterol, triglycerides, and lipoproteins are measured to evaluate a person’s risk for developing the atherosclerotic disease, especially if there is a family history of premature heart disease, or to diagnose a specific lipoprotein abnormality. Cholesterol < 200 mg/ di Triglycerides < 150 mg/ di HDL 60 cholesterol mg/di LDL 60- 130 cholesterol mg/di Cholesterol/ 4.0 HDL ratio 15 Second lecture / Medical Nursing Ahmed K. Awad Coronary Artery Disease Atherosclerosis: which is an abnormal accumulation of lipid, or fatty, substances, and fibrous tissue in the vessel wall. These substances create blockages or narrow the vessel, reducing blood flow to the myocardium. Risk Factors: 1. Modifiable risk factors: - Cholesterol levels - Cigarette smoking - Hypertension - Diabetes mellitus 2. non-Modifiable risk factors: - Age - Gender - Family history - Race Atherosclerosis Normal artery Atherosclerosis lntima Plaque Progression -+ -+ Formation Growth and Blood clot rupture [ ] Cleveland Clinic © 2022 16 Second lecture / Medical Nursing ILAhmed __ _ K. Awad Arteriosclerosis occurs when the blood vessels that carry oxygen and nutrients from the heart to the rest of the body (arteries) become thick and stiff — sometimes restricting blood flow to the organs and tissues. Healthy arteries are flexible and elastic. But over time, the walls in the arteries can harden, a condition commonly called hardening of the arteries. Atherosclerosis is a specific type of arteriosclerosis. Fatty Deposits Angina pectoris: is a clinical syndrome usually characterized by episodes or paroxysms of pain or pressure in the anterior chest. The cause is usually insufficient coronary blood flow. The insufficient flow results in a decreased oxygen supply to meet the increased myocardial demand for oxygen. Types of Angina: - Stable angina: predictable and consistent pain that occurs on exertion and is relieved by rest. Unstable angina (also called preinfarction angina or crescendo angina): symptoms occur more frequently and last longer than stable angina. the threshold for pain is lower, and pain may occur at rest. 17 Second lecture / Medical Nursing Ahmed K. Awad Variant angina (also called Prinzmetal’s angina): pain at rest with reversible ST- segment elevation; thought to be caused by coronary artery vasospasm. Silent ischemia: objective evidence of ischemia (such as electrocardiographic changes with a stress test), but the patient reports no symptoms. Clinical Manifestations: - 1-The pain is often felt deep in the chest behind the upper or the middle third of the sternum (retrosternal area). 2-Typically, the pain or discomfort is poorly localized and may radiate to the neck, jaw, shoulders, and inner aspects of the upper arms, usually the left arm. A feeling of weakness or numbness in the arms, wrists, and hands may accompany the pain, as may shortness of breath, pallor, diaphoresis, dizziness or lightheadedness, and nausea and vomiting. Medical Treatment: Early treatment is important Nitroglycerin: -Dilates coronary arteries. Morphine sulfate – 2-4 mg:- titrated for pain relief, decreases the blood return to the heart, decreases anxiety, relaxes the smooth muscle in the lungs, and has an analgesic effect. Oxygen at 2-4 L/min. Thrombolytic therapy – must meet the criteria of Streptokinase, Heparin, and Aspirin. Lidocaine, Calcium channel blockers, Digoxin ,Beta-blockers, Dopamine, and Dobutamine. 18 Second lecture / Medical Nursing Ahmed K. Awad Nursing Interventions: -Instruct the patient to notify the nurse immediately when chest pain occurs. - Assess and document patient response to medication. - Identify precipitating event, if any: frequency, duration, intensity, and location of the pain. - Observe for associated symptoms: dyspnea, nausea, vomiting, dizziness, palpitations, desire to micturate. - Evaluate reports of pain in the jaw, neck, shoulder, arm, or hand (typically on the left side). - Place the patient at complete rest during anginal episodes. - Elevate the head of the bed if the patient is short of breath. - Monitor heart rate and rhythm. - Monitor vital signs every 5 min during the initial anginal attack. - Stay with a patient who is experiencing pain or appears anxious. - Maintain a quiet, comfortable environment. Restrict visitors as necessary. - Provide light meals. Have the patient rest for 1 hr. after meals. - Provide supplemental oxygen as indicated. 19  Dr:Hassan ali Myocardial infarction: Myocardial infarction (MI) is commonly referred to as a “heart attack”. Myocardial ischemia is inadequate perfusion to the myocardium that occurs from a partial or complete blockage of blood and oxygen to the heart. The major cause of a heart attack is coronary artery disease. classifications of myocardial infarction: 1. ST-elevation myocardial infarction (STEMI): ST-segment elevation on electrocardiogram (ECG) with a release of biomarkers for myocardial necrosis. 2. Non-ST-elevation myocardial infarction (NSTEMI): Biomarkers will be elevated without elevation of the ST-segment. There may be ST-segment depression, inverted T-wave, or both revealed on the ECG. T-wave inversion lioelect ric line R ST segment T-inversion ' '' ' T s r Norma l ST-segment ST-segment ST-segment T-wave elevation in stemi depression in nstemi inversion in nstemi A B C  causes of MI include the following: 1. Vasospasm. This is the sudden constriction or narrowing of the coronary artery. 2. Decreased oxygen supply. The decrease in oxygen supply occurs from acute blood loss, anemia, or low blood pressure. 3. Increased demand for oxygen. A rapid heart rate, thyrotoxicosis, or ingestion of cocaine causes an increase in the demand for oxygen. Risk factors for myocardial infarction: 1. Coronary artery disease (CAD) 2. Tobacco use 3. Dyslipidemia 4. Hypertension 5. Diabetes mellitus 6. Family history signe and sysptomes 1. Chest pain. 2. Shortness of breath. Because of increased oxygen demand 3. Tachycardia and tachypnea. To compensate for the decreased oxygen supply,  the heart rate and respiratory rate speed up. 4. coolness in extremities, perspiration, anxiety, and restlessness. 5. Fever. Myocardial Infarction Chest Pain Typical distribution of referred pain Chest pain is the cardinal symptom of Ml. It is a persistent and crushing substernal pain that may radiate to the left arm, jaw, neck, or shoulder blades. Pain is usually described as heavy, squeezing, or crushing and may persist for 12 hours or more. Images via: docton~ter.com n[drseslabs- ,.... ,..u.wu,.,..... Prevention A healthy lifestyle could help prevent the development of MI. 1. Exercise. Exercising at least thrice a week could help lower cholesterol levels that cause vasoconstriction of the blood vessels. 2. Balanced diet. Fruits, vegetables, meat and fish 3. Smoking cessation. Nicotine causes vasoconstriction Medical mangements for "MONA TASS" Aspirin prevents the formation of thromboxane A2 which causes platelets to aggregate and arteries to constrict. The earlier the patient receives ASA after symptom onset, the greater the potential benefit. In order to limit the size of infarction and give rest to the patient. Valium or an equivalent is usually given.  Dr:Hassan Ali Ministry of Higher Education and Scientific Research Middle Technical University Baqubah Technical Institute Department of Nursing Technology Medical nursing [4 Heart failure By Dr. Hassan Ali ‫لدى مكتبة اجلوال‬1‫النسخة االصلية‬  Dr:Hassan Ali Heart failure Heart failure (HF) is a condition in which the heart is unable to pump blood efficiently enough to meet the body's needs. This can occur because the heart's muscles are too weak or stiff, preventing it from properly filling with or pumping out blood. As a result, organs and tissues may not get enough oxygen and nutrients, leading to a variety of symptoms. 2  Dr:Hassan Ali Types of Heart Failure: 1.Left-sided heart failure: This is the most common type and occurs when the left side of the heart (which pumps oxygenated blood to the body) cannot pump effectively. There are two main types of left-sided heart failure: A.Heart failure with reduced ejection fraction (HFrEF): The heart muscle is weakened and does not pump blood effectively. B.Heart failure with preserved ejection fraction (HFpEF): The heart muscle becomes stiff, so it cannot fill with enough blood even though it may still pump normally. 2.Right-sided heart failure: This happens when the right side of the heart (which pumps blood to the lungs) cannot pump blood efficiently. Often, it occurs as a result of left-sided heart failure, but it can also be caused by lung diseases. 3.Congestive heart failure (CHF): This term is often used to describe the state when fluid builds up in the body, causing swelling, especially in the legs, ankles, and abdomen. Causes of Heart Failure: Heart failure can be caused by a variety of conditions, including: 1. Coronary artery disease (CAD): Narrowing of the blood vessels that supply the heart. 2. Heart attack (myocardial infarction): Damages the heart muscle, impairing its ability to pump. 3. High blood pressure (hypertension): Causes the heart to work harder, leading to weakening over time. 3  Dr:Hassan Ali 4. Valvular heart diseases: Problems with the heart valves that affect blood flow. 5. Cardiomyopathy: Diseases of the heart muscle that affect its structure and function. 6. Arrhythmias: Abnormal heart rhythms that can lead to ineffective pumping. Symptoms of Heart Failure: 1. Common symptoms of heart failure include: 2. Shortness of breath (especially with exertion or while lying down) 3. Fatigue or weakness 4. Swelling in the legs, ankles, or abdomen (edema) 5. Rapid or irregular heartbeats 6. Coughing or wheezing (with pink or frothy sputum) 7. Difficulty concentrating or confusion (due to reduced blood flow to the brain) 4  Dr:Hassan Ali Diagnosis: typically diagnose heart failure using: 1. Physical exam: Checking for signs of fluid retention and listening to the heart. 2. Blood tests: To check for markers of heart strain (e.g., BNP or NT-proBNP). 3. Imaging tests: Such as echocardiograms or MRIs to examine the heart's structure and function. 4. Electrocardiogram (ECG): To detect arrhythmias or previous heart attacks. 5. Stress tests: To evaluate the heart’s function under physical stress. Treatment: Heart failure treatment focuses on managing symptoms, improving heart function, and preventing the condition from worsening. Common treatments include: 5  Dr:Hassan Ali Medications: 1. Diuretics (to reduce fluid buildup) 2. ACE inhibitors or ARBs (to relax blood vessels and lower blood pressure) 3. Beta-blockers (to reduce heart rate and improve heart function) 4. Aldosterone antagonists (to reduce fluid buildup) 5. Digitalis (to help the heart pump more effectively) Lifestyle changes: 1. Reducing salt intake to avoid fluid retention. 2.Regular exercise, as advised by the nurse. 3.Weight management and stress reduction. Surgical procedures: 1. Implantable devices like a pacemaker or a defibrillator for rhythm control. 2. Heart surgery (e.g., valve repair/replacement, coronary bypass surgery). 3. In severe cases, heart transplant may be considered. 6