Cardiovascular Conditions: Psychosocial and Vocational Issues PDF

# Cardiovascular Conditions ## Introduction - The cardiovascular system consists of the heart and a network of blood vessels. - The heart acts as a pump that forces blood to and from the lungs and throughout the body. - It is a strong and powerful muscle located somewhat to the left of the center...

# Cardiovascular Conditions ## Introduction - The cardiovascular system consists of the heart and a network of blood vessels. - The heart acts as a pump that forces blood to and from the lungs and throughout the body. - It is a strong and powerful muscle located somewhat to the left of the center of the chest. - The heart muscle itself is called the **myocardium** and it is enclosed in an outer covering called the **pericardium** and the inner surface is called the **endocardium**. - The myocardium is a special type of muscle that has the ability to work continuously with only brief periods of rest between contractions. - Systole - Diastole - The myocardium requires oxygen and nutrients to survive, like all muscles of the body. A separate network of blood vessels called the **coronary vessels** supplies the heart muscle with blood. - Coronary arteries - Coronary veins ## The Heart - The heart has - 4 chambers - 4 valves - The heart's nerve conduction system maintains its regular, rhythmic beating. - **SA node** is the "pacemaker" of the heart which initiates the contraction. - **AV node** - **Bundle of His** - **Purkinje fibers** ## Arteriosclerosis - A general term referring to conditions in which walls of the arteries become thickened or less elastic, obstructing circulation and diminishing blood flow. - It is caused by plaque buildup along the interior vessel wall which causes stenosis. - Symptoms develop _slowly_ and are generally nonexistent until blood flow is diminished. - At this point, individuals may experience pain, fatigue, or altered function in the body part affected. - Plaque can also contribute to **thrombus** formation -> **embolus**. ## Hypertension - A sustained elevation of systolic or diastolic (or both) pressure in the arteries. - Blood pressure (BP) normally _fluctuates_ with physical activity, becoming lower at rest and higher with changes in posture, exercise, or emotion. - Although hypertension in and of itself is not disabling, it is a major health problem because of its associated high risk. **Different Types of Hypertension:** - **Primary or Essential Hypertension** - Most common type - Gradual onset and few, if any, symptoms - Cause is unknown - May be discovered for the first time during a routine physical examination - **Secondary Hypertension** - Hypertension being a symptom of another medical condition - **Malignant Hypertension** - Less common, but **more severe** type - Abrupt onset, **more severe** symptoms - Associated with **more complications** - Because symptoms are often vague or even nonexistent, hypertension may go undetected until complications such as heart attack, stroke, or visual problems arise. **Blood Pressure Categories:** | Blood Pressure Category | Systolic mm Hg (upper number) | Diastolic mm Hg (lower number) | |---|---|---| | Normal | Less than 12O | Less than 80 | | Elevated | 120-129 | Less than 80| | High Blood Pressure (Hypertension) Stage 1 | 130-139 | 80-89 | | High Blood Pressure (Hypertension) Stage 2 | 140 or higher | 90 or higher | | Hypertensive Crisis (Consult your doctor immediately) | Higher than 180 | Higher than 120 | ## Treatment of Hypertension - Primary goal is to lower BP and reduce the risk of complications such as heart attack, stroke, or kidney failure. - In mild cases, lifestyle modification may be sufficient. - Learning how to _reduce stress_ or learning to _avoid chronic stressful situations_ may also be important in the overall treatment. - In cases when lifestyle modification is insufficient or when BP is too elevated to control with lifestyle modification alone, **medications** is necessary. ## Psychosocial Issues Regarding Hypertension - Although there usually are no symptoms associated with primary hypertension, the **consequences of untreated hypertension can be severe.** - Consequently, treatment of hypertension is essential to preventing disability and/or death. - However, some may not comply with not only medications prescribed but also in medical appointment schedule and making necessary lifestyle changes. ## Vocational Issues Regarding Hypertension - **Isometric activities** such as pushing, lifting, or carrying heavy objects can increase blood pressure during activity and may need to be avoided. - Chronic, sustained **stress** may also be inherent in many jobs. - The major impact hypertension has on employment is the **disability** that can occur if it is uncontrolled. ## Aneurysm - A dilation or ballooning out of a weakened arterial wall. - Often associated with arteriosclerosis and hypertension, but may also result from a congenital abnormality. - **Dissecting Aneurysm** - Symptoms experienced vary according to its **location.** - In some instances, there are no symptoms until the aneurysm becomes large enough to create pressure, causing pain at the site. - In other cases, there are no symptoms until the aneurysm ruptures, which could result in _sudden_ death. - Surgical treatment may be possible if diagnosed early or if surgery is not contraindicated. ## Coronary Artery Disease (CAD) - A condition in which the coronary arteries that supply blood and oxygen directly to the heart muscle (myocardium) become _narrowed_. - This is a condition usually caused by atherosclerosis. - **Ischemia** -> **Angina Pectoris** (stable angina and unstable angina) - Diagnosis of angina is based on symptoms, laboratory evaluations, ECG, stress test, or an echocardiogram. - **Anoxia** -> **Necrosis **-> **Myocardial Infarction** - Not all individuals with angina go on to develop MI and not all people with MI have first experienced angina. - Total occlusion of a coronary vessel so that the heart muscle receives no blood supply can occur because of: - **Atherosclerosis** - coronary arteries become totally occluded - **Thrombus** - blood clot; formed in a coronary artery, occluding the blood flow - **Embolus** - that has lodged in a coronary artery, occluding blood flow - Once a portion of the heart muscle has been destroyed, it **cannot regenerate.** ## Epidemiology of CAD - An estimated 13.7 million Americans have CHD - **Atherosclerosis** is the most prevalent cause of CAD ## Etiology of CAD - **Atherosclerosis** - **Hyperplasia of arterial muscles** - **Coronary artery spasm** - **Coronary Artery Thrombus** ## Clinical Manifestation of CAD - **Angina Pectoris** - **Myocardial Infarction** - **Sudden cardiac death/ cardiac arrest** ## Complications of CAD - **Arrhythmias** - **Pump failure** - **Dyspnea** - **Cardiac syncope ** - **Cyanosis** - **Fatigue** - **Cardiac rupture** - **Cardiac tamponade** - **Shock** ## Myocardial Infarction (MI) - "Heart attack." Means there has been **death of part of the heart muscle.** - It is a potentially **life-threatening condition** which requires immediate medical attention. - In the initial stages of MI, pain may be treated with **narcotics**, **thrombolytic drugs**, **anticoagulants**, and **oxygen supplementation.** - **Emergency department** -> **coronary care unit (CCU)** -> **surgical revascularization** ## Cardiac Rehabilitation - Crucial in the treatment of MI to improve their **exercise capacity**, **return to work**, and **reduce the risk of mortality.** - **Educational sessions** (lifestyle changes, dietary restrictions, smoking cessation, and graduated exercise training) - **Psychological and vocational counseling** are also important - **Exercise training** ## METS (Metabolic Equivalents) - Is the **unit or level used to estimate the oxygen requirements to perform a task**. - Helps to determine the **energy cost** of physical activities and provides a method for describing the **functional capacity** or **exercise tolerance** of individuals and the physical activity level in which they can participate safely. ## Psychosocial Issues Regarding MI - **Low self-esteem and depression** - **Stress** (influenced by individuals' _psychological_ reactions to the heart attack) - **Emotional disability** (severe depression or anxiety) - **Denial** - **Social reaction** (reaction and emotion) - **Guilt, low self-esteem,** and **self-blame** - **Sexual readjustment** - Education, appropriate counseling and reassurance ## Vocational Issues Regarding MI - Most individuals after appropriate cardiac rehabilitation are able to return to moderate levels of activity. - **Work activity should not exceed individuals' limits** - **Work environments with controlled temperature** are preferable - **Stress** brought by the individuals' job ## Congestive Heart Failure (CHF) - Aka **Heart Failure**, **Cardiac Decompensation**, **Cardiac Insufficiency** - The inability of the heart to pump enough blood to supply the oxygen requirements of the body tissues. ## Classification of CHF - **By the site of heart failure** - **By the level of CO and direction** ## Left-Sided Heart Failure - More common than right-sided - Failure of the **left ventricle** to pump blood to the vital organs and periphery. - Decreased left ventricular output caused fluid to accumulate in the lungs, precipitating **dyspnea**, **orthopnea**, and **paroxysmal nocturnal dyspnea.** ## Right-Sided Heart Failure - "Cor pulmonale" - Resulting from failure of the **right ventricle** to pump sufficient blood to the lungs. - The most common cause of right ventricular heart failure, however, is **left ventricular failure.** - Any condition that increases pressure in **pulmonary vessels.** - Produces **congestive hepatomegaly, ascites, and edema.** ## Biventricular Failure - Both sides of the heart are affected. - This can cause the same symptoms as both left-sided and right-sided heart failure. ## Compensated Heart Failure - Heart returns to normal functional status with **decreased CO & exercise tolerance**. ## Diastolic Heart Failure - Left ventricle becomes **stiff and hypertrophies**. - **Low ejection rate**. ## Systolic Heart Failure - Left ventricle is **weak and flabby**. ## High Output Failure - Failure with an elevated cardiac output occurs when tissue **demands** for oxygenated blood **exceed** the heart's ability to supply it. ## Low Output Failure - Failure with decreased cardiac output is caused by the **decreased pumping ability of the myocardium.** ## Forward Failure - The heart fails to **expel enough blood in the arterial system.** ## Backward Failure - When backward heart failure occurs, **one ventricle fails to empty its contents normally**, and end-diastolic ventricular pressure. ## Epidemiology of CHF - 5 million Americans are affected with CHF. - Females > males ## Etiology of CHF - MC cause is **cardiac muscle dysfunction.** - **Myocardial infarction** - **Valvular Heart disease** - **Hypertension** **arrhythmias** - **Anemia** ## Psychosocial Issues Regarding CHF - Individuals with heart failure may experience **depression and anxiety** about their present and future situation. - **Lower self-esteem** due to increased dependency on others. - **Stress** with the knowledge that their condition can result in increasing disability and death. - **Stress** for the individual and families with the uncertainty if an individual is a candidate for cardiac transplant. ## Vocational Issues Regarding CHF - Depends on the severity of the symptoms and the nature of the work. - In general, **emotional stress and physical demands on the job** should be **minimized** as much as possible. - **Extremes in temperatures** must be controlled. - Congestive heart failure is often associated with **gradual and progressive deterioration of cardiac function.** Consequently, vocational goals may need to be **short range** to accommodate potential functional decline if it does occur. ## Arrhythmia - An abnormality of the heart rate **rhythm** which may be a **dysfunction of the heart's electrical conduction system.** - Arrhythmias decrease the heart's ability to work effectively and to supply adequate amounts of blood to all of the body's organs. - **Tachycardia** - **Bradycardia** - **Dysrhythmia** or **arrhythmia** ## Causes of Arrhythmia - Usually one, or a combination of the following abnormalities in the rhythmicity-conduction system of the heart: - **Abnormal rhythmicity** of the **pacemaker.** - Shift of the **pacemaker** from the sinus node to another place in the heart. - **Blocks at different points** in the spread of the impulse through the heart. - **Abnormal pathways of impulse transmission** through the heart. - **Spontaneous generation of spurious impulses** in almost any part of the heart. ## Types of Arrhythmia - (Named for the type of disorder or the part of the electrical impulse system that is affected) - **Sinus arrhythmia** - **Sinus atrial block** (SA block) - **Atrioventricular block** (AV block) - **Incomplete AV heart block** - **Incomplete IV block** - While others may be relatively minor and require little or no treatment. ## Premature Contractions - A **contraction of the heart** before the **time** that normal contraction would have been expected. - Aka **extrasystole**, **premature beat**, or **ectopic beat**. - **Causes** - **Local areas of ischemia** - Small calcified plaques at different points in the heart - Toxic irritation of the A-V node, Purkinje system, or myocardium caused by drugs, nicotine, or caffeine ## Ventricular Fibrillation - **Factors that initiate ventricular fibrillation:** - Sudden **electrical shock** of the heart. - **Ischemia** of the heart muscle, of its specialized conducting system, or both. ## Atrial Fibrillation - A frequent cause of AF is atrial enlargement resulting from **heart valve lesions that prevent the atria from emptying adequately into the ventricles,** or from ventricular failure with excess damming of blood in the atria. - The dilated atrial walls provide ideal conditions of a **long conductive pathway as well as slow conduction,** both of which predispose to atrial fibrillation. ## Atrial Flutter - There are usually **2 to 3 beats of the atria for every single beat** of the ventricles. - Causes a **rapid rate of contraction of the atria,** usually between **200 and 350 bpm.** ## Asystole - This results from **cessation of all electrical control signals in the heart,** meaning there is no spontaneous rhythm that remains (ASYSTOLE). - Cardiac arrest is especially likely to occur during **deep** anesthesia. ## Symptoms of Arrhythmia - Depends on the type and extend of the arrhythmia but an individual may experience: - **Palpitations** - **Exertional dyspnea** - **Fatigue** - **Vertigo** - **Syncope** ## Treatment of Arrhythmia - Directed towards correcting or controlling the **factors causing the arrhythmia**. - Some may be prevented by **avoiding stimulants** such as caffeine or alcohol. ## Medications For Arrhythmia - **Antiarrhythmics** - **Digitalis** - **Beta blockers** - **Calcium channel blockers** - **Anticoagulants** - In more severe arrhythmia; an electrical shock procedure called **cardioversion** may be indicated to return the heart to a normal rhythm. - For **severe, recurrent arrhythmia** which could result in life-threatening arrhythmia, a device called an implantable automatic defibrillator may be surgically implanted. ## Psychosocial Issues Regarding Arrhythmias - **Fear and anxiety** - **Stress** - **Denial** ## Vocational Issues Regarding Arrhythmias - **Avoid excessive emotional stress** and learning to manage it. - Individuals with **anti-coagulant medication**. - **Excessive anxiety** about precipitating an arrhythmia. - **Chronic depression** further interfering with the individual's ability to work. - **Avoid activities** which could cause the pacemaker to dislodge or malfunction.