Chapter 2: Cardiovascular Disorders PDF

Al-Rawdah University College Medical surgical 2 Chapter 2 : Cardiovascular disorder Prepared by : Bast Ahmad, RN, MSN  : Objectives student will be able to: 1. Explain the anatomy and physiology of the cardiac system. 2. Differentiate between diagnostic pr...

Al-Rawdah University College Medical surgical 2 Chapter 2 : Cardiovascular disorder Prepared by : Bast Ahmad, RN, MSN  : Objectives student will be able to: 1. Explain the anatomy and physiology of the cardiac system. 2. Differentiate between diagnostic procedures related to the cardiac system and to have knowledge about patient assessment. 3. Differentiate between MI& angina in relation to clinical picture and Diagnostic tests. 4. Gain knowledge & other cardiac infections& complications. 5. Discuss blood vessels disorders& hypertension.  Anatomy and Physiology of the heart The heart is a hollow, muscular organ located in the center of the thorax, where it occupies the space between the lungs (mediastinum) and rests on the diaphragm. It weighs approximately 300 g. Three layers: endocardium, myocardium, epicardium The heart is encased in a thin, fibrous sac called the pericardium. Four chambers: Right atrium and ventricle, left atrium and ventricle Atrioventricular valves: tricuspid and mitral Semilunar Valves : Aortic Valves / Pulmonary Valve Coronary Arteries: The left and right coronary arteries and their branches supply arterial blood to the heart. These arteries originate from the aorta just above the aortic valve leaflets.  Conduction System Conduction system first stimulates contraction of the atria and then the ventricle. The SA node, the primary pacemaker of the heart, is located at the junction of the superior vena cava and the right atrium. The SA node in a normal resting adult heart has an inherent firing rate of 60 to 100 impulses per minute. The electrical impulses initiated by the SA node are conducted along the myocardial cells of the atria via specialized tracts called internodal pathways.  Conduction system The impulses are then conducted to the AV node, which is located in the right atrial wall near the tricuspid valve. The AV node coordinates the incoming electrical impulses from the atria and after a slight delay (allowing the atria time to contract and complete ventricular filling) relays the impulse to the ventricles. The impulse is conducted through a bundle of specialized conducting tissue, referred to as the bundle of His. Which then divides into the right bundle branch (conducting impulses to the right ventricle) and the left bundle branch (conducting impulses to the left ventricle).. Impulses travel through the bundle branches to reach the terminal point in the conduction system, called the Purkinje fibers. Normal ECG Cardiac Hemodynamics Ejection fraction: percent of end diastolic volume ejected with each heart beat (left ventricle) Cardiac output (CO): amount of blood pumped by ventricle in liters per minute. CO = SV × HR  Cardiovascular assessment Inspection Skin color to assess perfusion. Inspect the face, lips, and fingertips for cyanosis or pallor. Cyanosis is a bluish discoloration of the skin, lips, and nail beds and indicates decreased perfusion and oxygenation. Pallor is the loss of color, or paleness of the skin or mucous membranes, as a result of reduced blood flow, oxygenation, or decreased number of red blood cells. Patients with light skin tones should be pink in color. For those with darker skin tones, assess for pallor on the palms, conjunctiva, or inner aspect of the lower lip..cont Jugular Vein Distension (JVD). Inspect the neck for JVD that occurs when the increased pressure of the superior vena cava causes the jugular vein to bulge, making it most visible on the right side of a person’s neck. JVD should not be present in the upright position or when the head of bed is at 30-45 degrees. Precordium for abnormalities. Inspect the chest area over the heart (also called precordium) for deformities, scars, or any abnormal pulsations the underlying cardiac chambers and great vessels may produce. Extremities Upper Extremities: Inspect the fingers, arms, and hands bilaterally noting Color, Warmth, Movement, Sensation (CWMS). Alterations or bilateral inconsistency in CWMS may indicate underlying conditions or injury. Assess capillary refill by compressing the nail bed until it blanches and record the time taken for the color to return to the nail bed. Normal capillary refill is less than 3 seconds. Lower Extremities: Inspect the toes, feet, and legs bilaterally, noting CWMS, capillary refill, and the presence of peripheral edema, superficial distended veins, and hair distribution. Document the location and size of any skin ulcers..cont Edema: Note any presence of edema. Peripheral edema is swelling that can be caused by infection, thrombosis, or venous insufficiency due to an accumulation of fluid in the tissues. Deep Vein Thrombosis (DVT): A deep vein thrombosis (DVT) is a blood clot that forms in a vein deep in the body. DVT requires emergency notification of the health care provider and immediate follow-up because of the risk of developing a life-threatening pulmonary embolism. Inspect the lower extremities bilaterally. Assess for size, color, temperature, and for presence of pain in the calves. Unilateral warmth, redness, tenderness, swelling in the calf, or sudden onset of intense, sharp muscle pain that increases with dorsiflexion of the foot is an indication of a deep vein thrombosis (DVT). Auscultation Auscultation is routinely performed over five specific areas of the heart to listen for corresponding valvular sounds. The aortic area is the second intercostal space to the right of the sternum. The pulmonic area is the second intercostal space to the left of the sternum. Erb’s point is directly below the pulmonic area and located at the third intercostal space to the left of the sternum. The tricuspid (or parasternal) area is at the fourth intercostal space to the left of the sternum. The mitral (also called apical or left ventricular area) is the fifth intercostal space at the midclavicular line.  Auscultation The first heart sound (S1) identifies the onset of systole, when the atrioventricular (AV) valves (mitral and tricuspid) close and the ventricles contract and eject the blood out of the heart. The second heart sound (S2) identifies the end of systole and the onset of diastole when the semilunar valves close, the AV valves open, and the ventricles fill with blood. S1 corresponds to the palpable pulse. When auscultating, it is important to identify the S1 (“lub”) and S2 (“dub”) sounds, evaluate the rate and rhythm of the heart, and listen for any extra heart sounds. EXTRA HEART SOUNDS Extra heart sounds include clicks, murmurs, S3 and S4 sounds, and pleural friction rubs. Palpation Palpation is used to evaluate peripheral pulses, capillary refill, and for the presence of edema. When palpating these areas, also pay attention to the temperature and moisture of the skin. PULSES Compare the rate, rhythm, and quality of arterial pulses bilaterally, including the carotid, radial, brachial, posterior tibialis, and dorsalis pedis pulses. Bilateral comparison for all pulses (except the carotid) is important for determining subtle variations in pulse strength. Carotid pulses should be palpated on one side at a time to avoid decreasing perfusion of the brain. The quality of the pulse is graded on a scale of 0 to 4, with 0 being absent pulses, 1 being decreased pulses, 2 is within normal range, 3 strong and 4 being increased (also referred to as “bounding”). use a Doppler ultrasound to determine the presence or absence of the pulse.  Palpation CAPILLARY REFILL The capillary refill test is performed on the nail beds to monitor perfusion, the amount of blood flow to tissue. Pressure is applied to a fingernail or toenail until it pales, indicating that the blood has been forced from the tissue under the nail. This paleness is called blanching. Once the tissue has blanched, pressure is removed. Capillary refill time is defined as the time it takes for the color to return after pressure is removed. If there is sufficient blood flow to the area, a pink color should return within 2- 3 seconds after the pressure is removed. EDEMA Edema occurs when one can visualize visible swelling caused by a buildup of fluid within the tissues. If edema is present on inspection, palpate the area to determine if the edema is pitting or nonpitting. Press on the skin to assess for indentation, ideally over a bony structure, such as the tibia. If no depression occurs, it is referred to as nonpitting edema. If depression occurs, it is referred to as pitting edema. Note the depth of the indention and how long it takes for the skin to rebound back to its original position. The indentation and time required to rebound to the original position are graded on a scale from 1 to 4. Edema rated at 1+ indicates a barely detectable depression with immediate rebound, and 4+ indicates a deep depression with a time lapse of over 20 seconds required to rebound. HEAVES OR THRILLS A thrill is a vibration felt on the skin of the precordium or over an area of turbulence, such as an arteriovenous fistula or graft.  Coronary artery disease Angina pectoris (Ischemic Chest Pain) Angina is chest pain that happens because there isn't enough blood going to part of your heart. It can feel like a heart attack, with pressure or squeezing in your chest. It’s sometimes called angina pectoris or ischemic chest pain. It's a symptom of heart disease, and it happens when something blocks your arteries or there's not enough blood flow in the arteries that bring oxygen-rich blood to your heart. Angina usually goes away quickly. Still, it can be a sign of a life-threatening heart problem. It's important to find out what's going on and what you can do to avoid a heart attack. Usually, medicine and lifestyle changes can control angina. If it's more severe, you may need surgery, too. Or you may need what’s called a stent, a tiny tube that props open arteries.  :Risk Factors for Coronary Artery Disease Nonmodifiable Risk Factors: 1- Family history of CAD 2- Increasing age 3- Gender (men develop CAD at an earlier age than women)  :Modifiable Risk Factors Hyperlipidemia, Cigarette smoking, tobacco use, Hypertension,.Diabetes mellitus, Metabolic syndrome, Obesity , Physical inactivity Types of angina: Stable angina. This is the most common. Physical activity or stress can trigger it. It usually lasts a few minutes, and it goes away when you rest. It isn't a heart attack, but it can be a sign that you're more likely to have one. Unstable angina. You can have this while you're at rest or not very active. The pain can be strong and long-lasting, and it may come back again and again. It can be a signal that you're about to have a heart attack. Microvascular angina. With this type, you have chest pain but no coronary artery blockage. Instead, it happens because your smallest coronary arteries aren’t working the way they should, so your heart doesn’t get the blood it needs. The chest pain usually lasts more than 10 minutes. This type is more common in women. Prinzmetal's angina (variant angina). This type is rare. It might happen at night while you're sleeping or resting. Your heart arteries suddenly tighten or narrow. It can cause a lot of pain. Clinical Manifestations Chest pain is the symptom, but it affects people differently. Burning Discomfort Dizziness Fatigue Feeling of fullness in the chest Feeling of heaviness or pressure Upset stomach or vomiting Shortness of breath Squeezing Sweating Pain behind the breastbone, which can spread to the shoulders, arms, neck, throat, jaw, or back. Causes Angina usually happens because of heart disease. A fatty substance called plaque builds up in your arteries, blocking blood flow to your heart muscle. This forces your heart to work with less oxygen. That causes pain. You may also have blood clots in the arteries of your heart, which can cause heart attacks. Less common causes of chest pain include: A blockage in a major artery of your lungs (pulmonary embolism) An enlarged or thickened heart (hypertrophic cardiomyopathy) Narrowing of a valve in the main part of your heart (aortic stenosis) Swelling of the sac around your heart (pericarditis) Tearing in the wall of your aorta, the largest artery in your body (aortic dissection) Diagnosis Symptoms …. 12 lead ECG. may show changes indicative of ischemia such as T-wave inversion. Stress test. This checks how your heart is working while you exercise. Blood tests , troponin I AND CK-MB ( lots of them are released when the heart muscle is damaged, as in a heart attack ). Imaging tests. Chest X-rays can rule out other things that might be causing chest pain, like lung conditions. Echocardiograms and CT and MRI scans can create images of the heart. Cardiac catheterization Coronary angiography ( injection of the dye into the blood vessels of the heart. The dye shows up on an X-ray, creating an image of the blood vessels ) They may do this procedure during cardiac catheterization. Treatment Treatment depends on how much damage there is to the heart. For people with mild angina, medicine and lifestyle changes can often help their blood flow better and control their symptoms. Lifestyle changes Medicines Heparin, heparin prevents the formation of new blood clots. Nitrates or calcium channel blockers to relax and widen blood vessels, letting more blood flow to the heart Beta-blockers to slow the heart down so it doesn't have to work as hard Blood thinners or antiplatelet medications to prevent blood clots Statins to lower the cholesterol levels and stabilize plaque Oxygen therapy is usually initiated at the onset of chest pain in an attempt to increase the amount of oxygen delivered to the myocardium and to decrease pain  Cardiac procedures If medications aren't enough, you may need to have blocked arteries opened with a medical procedure or surgery. This could be: Angioplasty/stenting. The doctor threads a tiny tube, with a balloon inside, through a blood vessel and up to your heart. Then, they inflate the balloon inside the narrowed artery to widen it and restore blood flow. They may insert a small tube called a stent inside your artery to help keep it open. The stent is permanent and usually made of metal. It can also be made of a material that your body absorbs over time. Some stents also have medicine that helps keep your artery from getting blocked again. Coronary artery bypass grafting (CABG), or bypass surgery. Your surgeon takes healthy arteries or veins from another part of your body and uses them to go around the blocked or narrowed blood vessels.  :Nursing Diagnoses Ineffective cardiac tissue perfusion secondary to CAD as evidenced by chest pain or other prodromal symptoms Death anxiety related to cardiac symptoms Deficient knowledge about the underlying disease and methods for avoiding complications Noncompliance, ineffective management of therapeutic regimen related.to failure to accept necessary lifestyle changes  :Nursing Interventions.a. Treating Angina: administer medications.b. Reducing Anxiety.c. Preventing Pain Myocardial infarction (MI) coronary occlusion and heart attack, MI is the most preferred term as myocardial ischemia causes acute coronary syndrome (ACS) that can result in myocardial death. In an MI, an area of the myocardium is permanently destroyed because plaque rupture and subsequent thrombus formation result in complete occlusion of the artery. In each case of MI, a profound imbalance exists between myocardial oxygen supply and demand. Causes The causes of MI primarily stems from the vascular system. Vasospasm. This is the sudden constriction or narrowing of the coronary artery. Decreased oxygen supply. The decrease in oxygen supply occurs from acute blood loss, anemia, or low blood pressure. Increased demand for oxygen. A rapid heart rate, thyrotoxicosis, or ingestion of cocaine causes an increase in the demand for oxygen. Clinical Manifestations Chest pain. This is the cardinal symptom of MI. 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. Shortness of breath. Because of increased oxygen demand and a decrease in the supply of oxygen, shortness of breath occurs. Indigestion. Indigestion is present as a result of the stimulation of the sympathetic nervous system. Tachycardia and tachypnea. To compensate for the decreased oxygen supply, the heart rate and respiratory rate speed up. The patient may experience such as coolness in extremities, perspiration, anxiety, and restlessness. Fever. Unusually occurs at the onset of MI, but a low-grade temperature elevation may develop during the next few days. Prevention A healthy lifestyle could help prevent the development of MI. Exercise. Exercising at least thrice a week could help lower cholesterol levels that cause vasoconstriction of the blood vessels. Balanced diet. Fruits, vegetables, meat and fish should be incorporated in the patient’s daily diet to ensure that he or she gets the right amount of nutrients he or she needs. Smoking cessation. Nicotine causes vasoconstriction which can increase the pressure of the blood and result in MI. Assessment and Diagnostic Findings The diagnosis of MI is generally based on the presenting symptoms. Patient history. The patient history includes the description of the presenting symptoms, the history of previous cardiac and other illnesses, and the family history of heart diseases. ECG. ST elevation signifying ischemia Exercise stress test. Determines cardiovascular response to activity (often done in conjunction with thallium imaging in the recovery phase). Cardiac enzymes and isoenzymes. CPK-MB (isoenzyme in cardiac muscle) ,Troponins ( Troponin I (cTnI) and troponin T (cTnT) ) , Myoglobin (A heme protein of small molecular weight that is more rapidly released from damaged muscle tissue ). Electrolytes. Imbalances of sodium and potassium can alter conduction and compromise contractility. WBC. Leukocytosis (10,000–20,000) usually appears on the second day after MI because of the inflammatory process. ESR. Rises on second or third day after MI, indicating inflammatory response. ABGs/pulse oximetry ( May indicate hypoxia ) Lipids (total lipids, HDL, LDL , total cholesterol, triglycerides, phospholipids). Elevations may reflect arteriosclerosis as a cause for coronary narrowing or spasm. Echocardiogram. To assess ejection fraction (blood flow), and valve configuration/function. Coronary angiography. Visualizes narrowing/occlusion of coronary arteries.  Management The goals of medical management are to minimize myocardial damage, preserve myocardial function, and prevent complications. Pharmacologic Therapy Aspirin-1 Nitroglycerin -2 Morphine -3 Plavix -4 beta-blocker-5.Thrombolytic are used to treat some patients with acute MI -6 O2 therapy -7 Morphine administered in IV boluses is used for MI to reduce pain and anxiety. ACE Inhibitors. ACE inhibitors to decrease blood pressure and for the kidneys to secrete sodium and fluid, decreasing the oxygen demand of the heart. Thrombolytics. Thrombolytics dissolve the thrombus in the coronary artery,(alteplase )  Management Emergent Percutaneous Coronary Intervention ( PCI ) The procedure is used to open the occluded coronary artery and promote reperfusion to the area that has been deprived of oxygen. PCI may also be indicated in patients with unstable angina and NSTEMI for patients who are at high risk due to persistent ischemia. Emergent CABG ( Coronary artery bypass grafting )  Nursing Considerations Minimize the number of times the patient’s skin is punctured Monitor for acute dysrhythmias and hypotension Start IV lines before thrombolytic therapy; designate one line to use for blood draws Draw blood for laboratory tests when starting the IV line Monitor for reperfusion: resolution of angina or acute ST-segment changes.Check for signs and symptoms of bleeding  :Nursing Diagnoses Ineffective cardiac tissue perfusion related to reduced coronary blood flow Risk for imbalanced fluid volume Risk for ineffective peripheral tissue perfusion related to decreased cardiac output from left ventricular dysfunction Death anxiety related to cardiac event Deficient knowledge about self-care  Heart Failure Congestive heart failure, or heart failure, is a long-term condition in which the heart can’t pump blood well enough to meet the body’s needs. the heart is still working. But because it can’t handle the amount of blood it should, blood builds up in other parts of the body. Most of the time, it collects in the lungs, legs and feet Ejection Fraction (EF), is used to measure the amount of blood that the heart pumps each beats. to help determine if systolic or diastolic dysfunction is present. Types of congestive heart failure ❑ Left-sided heart failure. ❑ Right-sided heart failure. ❑ Left-sided heart failure occurs when the heart loses its ability to pump blood. This prevents organs from receiving enough oxygen. The condition can lead to complications that include right-sided heart failure and organ damage. There are two types: Systolic heart failure: The bottom pumping chamber of your heart called the left ventricle is too weak to pump blood out to your body. Diastolic heart failure: The left ventricle is stiff and can’t relax appropriately, making it difficult to fill with blood. ❑ Right-sided heart failure. The right side of the heart pumps blood from the body back to the lungs, where it refills with oxygen. Right-sided heart failure means the heart’s right ventricle is too weak to pump enough blood to the lungs. As a result: Blood accumulates in the veins, vessels that carry blood from the body back to the heart. This buildup increases pressure in the veins. The pressure pushes fluid out of the veins and into other tissue. Fluid accumulates in the legs, abdomen or other areas of the body, causing swelling.( anasarca )  Clinical Manifestations Right Sided Left Sided Viscera and peripheral Pulmonary congestion, crackles congestion ”S3 or “ventricular gallop Jugular venous distention (JVD) Dyspnea on exertion (DOE) Dependent edema Orthopnea Hepatomegaly Dry, nonproductive cough Ascites initially Weight gain Oliguria Causes of HF Coronary artery disease and/or heart attack. Cardiomyopathy (genetic or viral). Heart issues present at birth (congenital heart disease).. High blood pressure (hypertension). Arrhythmia. Kidney disease. A body mass index (BMI) higher than 30. Tobacco and recreational drug use. Alcohol use. Medications such as cancer drugs (chemotherapy). Symptoms Shortness of breath. Waking up short of breath at night. Chest pain. Heart palpitations. Fatigue Swelling in the ankles, legs. Weight gain. Need to urinate while resting at night. A dry, hacking cough. A full (bloated) or hard stomach. Loss of appetite upset stomach (nausea). Complications Irregular heartbeat. Sudden cardiac arrest. Heart valve problems. A collection of fluid in your lungs. Pulmonary hypertension. Kidney damage. Liver damage. Diagnosis and Tests Assessment Blood tests. Cardiac catheterization. Chest X-ray. Echocardiogram. Heart MRI (magnetic resonance imaging). Cardiac computed tomography (CT). Electrocardiogram (EKG or ECG). Stress test. Genetic testing.  Management and Treatment OF HF Improve the patient's life style (A low-sodium (2 to 3 g/day) diet and avoidance of drinking excessive amounts of fluid ) Medication (ACE inhibitors, beta-blockers, diuretics) Surgery ( LVAD ) There’s no cure for heart failure. As congestive heart failure gets worse, the heart muscle pumps less blood to the organs, and patient move toward the next stage of heart failure. Since patient can’t move backward through the heart failure stages, the goal of treatment is to keep the patient from moving forward through the stages or to slow down the progression of the heart failure. Treatment will depend on the severty of heart failure  :Nursing Diagnoses Activity intolerance and fatigue related to decreased CO Excess fluid volume related to the HF syndrome Anxiety related to breathlessness from inadequate oxygenation Powerlessness related to chronic illness and hospitalizations Ineffective therapeutic regimen management related to lack of knowledge  Nursing intervention and Education Medications Diet: low-sodium diet and fluid restriction Monitoring for signs of excess fluid, hypotension, and symptoms of disease exacerbation, including daily weight Exercise and activity program Stress management Prevention of infection Know how and when to contact health care provider Include family in education  Pulmonary Edema Pulmonary edema is the abnormal accumulation “fluid in the lungs.” Fluid accumulation in the lungs can lead to shortness of breath, coughing up of foam and loose mucus( frothy secretion ) , wheezing, chest tightness and difficulty breathing. Pulmonary edema can be life-threatening and requires immediate medical treatment. Causes 1.Cardiogenic Cardiogenic pulmonary edema means fluid backs up in the lungs from a heart problem. The most common cause of cardiogenic pulmonary edema is congestive heart failure. When the left side of the heart stops pumping blood correctly, the blood backs up into the blood vessels in the lungs. As the pressure in the blood vessels increases, fluid is pushed into the air sacs in the lungs. 2.Non cardiogenic Non cardiogenic pulmonary edema occurs when other diseases cause fluid to accumulate in the lungs. the blood vessels in the lungs become inflamed or injured. The blood vessels then become leaky, and fluid goes into the air sacs. Acute respiratory distress syndrome (ARDS). In ARDS, inflammation is the main problem, with causes that include: Pneumonia. Sepsis (severe infection). Trauma. Pancreatitis. Drugs. Signs and symptoms Pulmonary edema can come on suddenly (acute) or develop as a long-term (chronic) condition. cool and clammy skin, cyanosis Shortness of breath (dyspnea), especially during movement or lying down. Coughing up blood or frothy mucus. Wheezing. Gasping for air. Feeling like suffocating. Chest tightness or pain. Swelling in the legs. Tiredness. Diagnosis and Tests Physical exam Blood tests. Chest X-ray Ct scan  Management and Treatment Oxygen ( nasal cannula , face mask , non breathe , ventory , CPAP, Ventilator ) Medications as Diuretics (furosemide), vasodilators Improving the life style Minimize exertion and stress Surgery  Infectious Cardiac Disorders Infective endocarditis: inflammation of the inside lining of the -1 heart chambers and heart valves.Myocarditis: an inflammatory process involving the myocardium -2.Pericarditis : refers to an inflammation of the pericardium -3 Endocarditis Endocarditis is inflammation of the inside lining of the heart chambers and heart valves (endocardium). It is caused by a bacterial or, rarely, a fungal infection. Endocarditis can involve the heart muscle, heart valves, or lining of the heart. Causes Endocarditis begins when germs enter the bloodstream and then travel to the heart. Bacterial infection is the most common cause of endocarditis , endocarditis can also be caused by fungi. Birth defect of the heart Damaged or abnormal heart valve New heart valve after surgery Long-term intravenous line in place Central venous access lines Injection drug use, from the use of unclean (unsterile) needles Recent dental surgery Other surgeries or minor procedures to the breathing tract, urinary tract, infected skin, or bones and muscles Clinical Manifestations.Fever and a heart murmur.1 petechiae may appear in the conjunctiva and mucous membranes..2.Cardiomegaly, heart failure, tachycardia, or splenomegaly may occur.Patients may be tachycardia or may report chest pain.3.The WBC count and ESR may be elevated.4.Dyspnea.5.Orthopnea -6.oliguria -7 8-Roth spot  :Tests that may be done include 1. Blood culture to help identify the bacteria or fungus that is causing the infection 2. Complete blood count (CBC), 3. C-reactive protein (CRP) 4. An echocardiogram to look at the heart valves ,detect inflammation, pericardial effusion or tamponade, and heart failure 5. Computed tomography (CT) Treatment 1. Antibiotics through a vein (IV or intravenously). 2. Analgesics and non steroidal anti-inflammatory drugs (NSAIDs). 3. Pericardiocentesis, a procedure in which some of the pericardial fluid is removed. 4. IV fluid to restore cardiac output 5. O2 therapy 6. Surgery to replace the heart valve  :Nursing Management 1. pain management with analgesics. 2. To minimize complications, the nurse helps the patient with activity restrictions until the pain and fever subside. 3. The nurse educates the patient and family about a healthy lifestyle to enhance the patient’s immune system. 4. The nurse assesses for resolution of tachycardia, fever, and any other clinical manifestations. 5. Patients with dysrhythmias should have continuous cardiac monitoring  Pericarditis Pericarditis is inflammation of the pericardium. It becomes swollen and irritated. Pericarditis often causes chest pain and sometimes other symptoms. The main types of pericarditis are: Acute pericarditis — symptoms begin suddenly, but don’t last long Chronic pericarditis — symptoms develop gradually and persist, or may persist after an acute attack Recurring pericarditis — repeated attacks of acute pericarditis Symptoms Sharp chest pain in the center or left side of the chest. Low grade fever heart palpitations shortness of breath weakness or fatigue nausea dry cough Diagnosis Physical examination Blood tests Electrocardiogram (ECG) Chest x-ray Echocardiogram (ultrasound), CT scan or MRI scan. Treatment Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce swelling Antibiotics, if there is a bacterial infection Pain relief medication If complications develop, surgery may be needed. Complications Possible to develop constrictive pericarditis ( permanent thickening and scarring of the pericardium). Cardiac tamponade is a dangerous condition ( where too much fluid collects in the pericardium ) which puts pressure on the heart and causes blood pressure to drop dramatically. This is life-threatening and requires emergency treatment.  Atherosclerosis It is the gradual buildup of plaque in the walls of the arteries. Plaque (atheroma) is a sticky substance made of fat, cholesterol, calcium and other substances. As plaque builds up, the artery wall grows thicker and harder. This “hardening of the arteries” is usually a silent process in the early stages. as the plaque grows, the opening (lumen) of the artery narrows, leaving less room for blood to flow. This means less blood can reach to the organs and tissues. Plus, the constant force of blood flow can lead to plaque erosion or rupture, causing a blood clot to form. The symptoms Atherosclerosis often doesn’t cause symptoms until an artery is very narrow or blocked. Shortness of breath (dyspnea) heart attack. Chest pain or discomfort (angina). Heart palpitations. Fatigue. Peripheral artery disease (PAD) elevated blood pressure Diagnosis Physical exam and assessment Blood tests Angiography. CT scan. Electrocardiogram (EKG). Exercise stress test. Carotid ultrasound. Management and Treatment Lifestyle changes. Medications.( thrombolytics and anti-coagulants ) Procedures or surgeries. ( cath and pci)  Peripheral Occlusive disease Arterial insufficiency of the extremities The legs are most frequently affected; however, the.upper extremities may be involved :Clinical Manifestations.pain may be described as aching, cramping -1 inducing fatigue or weakness in exercise-2 decreased ability to walk the same distance as -3 previously A sensation of coldness or numbness.4  An aneurysms is the enlargement of an artery caused by weakness in the arterial wall. Often there are no symptoms, but a ruptured aneurysm can lead to fatal complications ( life-threatening internal bleeding ). Types The bulge can take two main shapes: Fusiform aneurysms bulge all sides of a blood vessel Saccular aneurysms bulge only on one side Aortic aneurysm The aorta is the large artery that begins at the left ventricle of the heart and passes through the chest and abdominal cavities. The most common aneurysm of the aorta is an abdominal aortic aneurysm (AAA). This occurs in the part of the aorta that runs through the abdomen. Less commonly, a thoracic aortic aneurysm (TAA) can affect the part of the aorta running through the chest. aortic aneurysms : very lethal when lying down, or they may say they feel an abdominal mass or.abdominal throbbing  Cerebral aneurysm Aneurysms of the arteries that supply the brain with blood are known as intracranial aneurysms. Due to their appearance, they are also known as “berry” aneurysms. A ruptured aneurysm of the brain can be fatal within 24 hours. 40% of brain aneurysms are fatal, and around 60 % of those who survive will experience a resulting neurological impairment or disability. Ruptured cerebral aneurysms are the most common cause of a type of stroke known as subarachnoid hemorrhage (SAH). Peripheral aneurysm An aneurysm can also occur in a peripheral artery. Popliteal aneurysm: This happens behind the knee. It is the most common peripheral aneurysm. Femoral artery aneurysm: The femoral artery is in the groin. Carotid artery aneurysm: This occurs in the neck. Visceral aneurysm: This is the arteries that supply blood to the bowel or kidneys. Peripheral aneurysms are less likely to rupture than aortic aneurysms. Causes Atherosclerosis Smoking Hypertension Infection Pregnancy Trauma Auto immune disease ( Systemic Lupus ) Obesity Symptoms Most aneurysms are clinically silent. Symptoms do not usually occur unless an aneurysm ruptures. However, an unruptured aneurysm may still obstruct circulation to other tissues. They can also form blood clots that may go on to obstruct smaller blood vessels. It can lead to ischemic stroke or other serious complications. Some people with abdominal aneurysms report abdominal pain, lower back pain, or a pulsating sensation in the abdomen. Thoracic aneurysms may cause swallowing and breathing difficulties, and pain in the jaw, chest, and upper back. Diagnosis Assessment Lab tests Imaging ( ultrasound , CT Angio , MRI... ) Treatment Not all cases of unruptured aneurysm need active treatment. When an aneurysm ruptures, however, emergency surgery is needed. Medications and preventive measures may form part of conservative management, or they may accompany active surgical treatment. A ruptured aneurysm needs emergency surgery. Without immediate repair, patients have a low chance of survival. Open surgery to fit a synthetic or stent graft Endovascular stent-graft surgery. Deep vein thrombosis (DVT) Occurs when a blood clot (thrombus) forms in one or more of the deep veins in the body, usually in the legs. Deep vein thrombosis can cause leg pain or swelling. Sometimes there are no noticeable symptoms. Patient can get deep vein thrombosis (DVT) if he has certain medical conditions that affect how the blood clots. A blood clot in the legs can also develop if he doesn't move for a long time. For example, you might not move a lot when traveling a long distance or when you're on bed rest due to surgery, an illness or an accident. Deep vein thrombosis can be serious, because blood clots in the veins can break loose. ( embolus ) The clots can then travel through the bloodstream and get stuck in the lungs, blocking blood flow (pulmonary embolism) or in the brain (cerebrovascular accident ) how >???????. Causes Anything that prevents the blood from flowing or properly clotting can cause a blood clot. The main causes of deep vein thrombosis (DVT) are damage to a vein from surgery or inflammation and damage due to infection or injury. Age. Lack of movement. Injury or surgery. Pregnancy. Birth control pills (oral contraceptives) Obesity. Smoking. Symptoms Leg swelling Leg pain, cramping or soreness that often starts in the calf Change in skin color on the leg — such as red or purple, depending on the color of your skin A feeling of warmth on the affected leg Deep vein thrombosis can occur without noticeable symptoms. Diagnosis Assessment and Physical exam Tests ( D-dimer blood test. D dimer is a type of protein produced by blood clots ) Dupler ultrasound. Venography. (MRI) Treatment There are three main goals to DVT treatment. Prevent the clot from getting bigger. Prevent the clot from breaking loose and traveling to the lungs or brain. Reduce the chances of another DVT. Anticoagulants Thrombolytics Filters. If patient can't take medicines to thin the blood, a filter may be placed into a large vein — the vena cava — in the belly (abdomen). A vena cava filter prevents clots that break loose from lodging in the lungs. Support stockings (compression stockings). These special knee socks help prevent blood from pooling in the legs. An arterial embolism Itis a blood clot that has travelled through the arteries and become stuck. This can block or restrict blood flow. Clots generally affect the arms, legs, or feet. An embolism is anything that obstructs blood flow. A single clot can cause more than one embolism. Pieces may break free and get stuck in other parts of the body. Some emboli travel to the brain, heart, lungs, and kidneys. When an artery is blocked, it can cause tissue damage or death in the affected area. Because of this, an arterial embolism is a medical emergency. It requires immediate treatment to prevent permanent injury. Causes high blood pressure smoking hardening of the arteries from high cholesterol surgery that affects blood circulation injuries to the arteries heart disease atrial fibrillation Symptoms coldness lack of pulse lack of movement tingling or numbness pain or spasms in the muscles a feeling of weakness Diagnosis Assessment labs ( CBC, Cholestrole profile , CRP , Cardiac enzymes , LFT , KFT ) imaging ( angiogram , Doppler ultrasound , MRI ,... ) Treatment Embolism treatment depends on the size and location of the clot. It can involve medication, surgery, or both. The ultimate goal is to break up the clot and restore proper circulation. Medications anticoagulants, to prevent blood clots thrombolytics, to desolve existing emboli intravenous pain medications Surgery Angioplasty may be performed to bypass a clot. It’s a technique used to open up blocked or narrowed blood vessels. A balloon catheter is inserted into an artery and guided to the clot. Once there, it’s inflated to open up the blocked vessel. A stent may be used to support the repaired walls. Varicose veins It is are large, swollen veins that often appear on the legs and feet. They develop when the valves in the veins do not work properly, and the blood does not flow as effectively. The varicose veins rarely need treatment for health reasons, but if swelling, aching, and painful legs result, and if there is considerable discomfort, treatment is available. There are various options, including some home remedies. In severe cases, a varicose vein may rupture, or it can develop into varicose ulcers on the skin. These will require treatment. Causes The veins have one-way valves so that the blood can travel in only one direction. If the walls of the vein become stretched and less flexible, or elastic, the valves may get weaker. A weakened valve can allow blood to leak backward and eventually flow in the opposite direction. When this occurs, blood can accumulate in a vein , which then become enlarged and swollen. The veins farthest from the heart, such as those in the legs, are most often affected. This is because gravity makes it harder for the blood to flow back to the heart. Any condition that puts pressure on the abdomen has the potential to cause varicose veins. Examples include: pregnancy constipation tumors, in rare cases Symptoms aching legs a feeling of heavy legs, especially after exercise or during sleep time skin shrinking swollen ankles telangiectasia in the affected leg (spider veins) a shiny skin discoloration near the varicose veins Red, dry, and itchy skin leg cramps when suddenly standing up Complications venous ulcers poor circulation thrombophlebitis DVT Diagnosis Assessment and physical examination Ultrasound and color-flow doppler ultrasound. Treatment If a person has no symptoms or discomfort and does not mind the sight of the varicose veins, treatment might not be necessary. Most people with varicose veins can get enough relief from home remedies, such as compression stockings. However, if a person has symptoms that do not improve easily, they may require medical treatment to reduce pain or discomfort or to address complications such as leg ulcers, skin discoloration, or swelling. Some individuals may also want treatment for cosmetic reasons, wanting to get rid of the “ugly” varicose veins. exercising reaching a moderate body weight raising the legs avoiding prolonged standing or sitting Compression stockings Surgery Laser treatments Ligation and stripping phlebectomy Hypertension Blood pressure is the force that a person’s blood exerts against the walls of their blood vessels. This pressure depends on the resistance of the blood vessels and how hard the heart has to work. Certain conditions, medications, and health factors can increase this pressure. Hypertension is blood pressure that is consistently higher than 140 over 90 millimeters of mercury (mm Hg). The systolic reading of 130 mm Hg refers to the pressure as the heart pumps blood around the body. The diastolic reading of 80 mm Hg refers to the pressure as the heart relaxes and refills with blood. The American College of Cardiology and the American Heart Association (AHA) define blood pressure ranges as: Hypertension is a primary risk factor for cardiovascular disease, including stroke, heart attack, heart failure, and aneurysm. Managing blood pressure is vital for preserving health and reducing the risk of these dangerous conditions. Having high blood pressure for a short time can be a normal response to many situations. Acute stress and intense exercise, for example, can briefly elevate blood pressure in an otherwise healthy person. For this reason, a diagnosis of hypertension requires several readings that show sustained high blood pressure over time. Causes The cause of hypertension is often not known. In many cases, it is the result of an underlying condition. High blood pressure that is not due to another condition or disease is known as primary or essential hypertension. If an underlying condition is a cause of increased blood pressure, doctors call this secondary hypertension.  Primary hypertension :high blood pressure that is multi-factorial and.doesn't have one distinct cause can result from multiple factors, including: having obesity insulin resistance high salt intake excessive alcohol intake having a sedentary lifestyle smoking Secondary hypertension has specific causes and is a complication of another health problem. Chronic kidney disease (CKD) is a common cause of high blood pressure. Other conditions that can lead to hypertension include: diabetes, due to it causing kidney problems and nerve damage cancer of an adrenal gland congenital adrenal hyperplasia hyperthyroidism, pregnancy obesity Symptoms most people with hypertension will experience no symptoms at all. sweating anxiety sleeping problems headaches and nosebleeds. Complications heart failure and heart attacks aneurysm, or an atypical bulge in the wall of an artery that can burst kidney failure stroke amputation hypertensive retinopathies in the eye, which can lead to blindness Diagnosis Assessment Blood pressure measurement ( daily for 1 week at the same time , site and position ) Management and treatment Lifestyle adjustments are the standard, first-line treatment for hypertension. Regular physical exercise Stress reduction Avoid the Smoking and alcohol Medication Medications for hypertension include: diuretics ( if need ) vasodilators The choice of medication depends on the person and any underlying medical conditions they may have. Thanks