VALVULAR HEART DISEASE

I.

di"retics, digitalis

MITRAL VALVE PROLAPSE

Occurs when the cusps of the mitral valve billow upward into the atrium during systolic contraction Diagnostics: echocardiography, stress test, chest x-ray, cardiac catheterization Manifestations: asymptomatic; Management: symptomatic treatment (aspirin to prevent TIA, antibiotics, beta-blockers

VII.

PULMONIC VALVE DISEASE

Usually congenital defects Causes: o mitral stenosis, o p"lmonary emboli, o chronic l"ng diseases Can lead to decreased cardiac output Manifestations: o m"rm"rs, o #atig"e, o dyspnea Management: o treat the "nderlying ca"se

II.

MITRAL VALVE STENOSIS

Mitral valve becomes calcified and immobile and the valvular orifice narrows !an res"lt to heart #ail"re and decreased cardiac o"tp"t Manifestations: atrial #ibrillation decreased exercise tolerance, dyspnea, orthopnea, m"rm"rs Management: oral di"retics and $a % restricted diet in heart #ail"re, anticoag"lants, digitalis, beta-blockers

INFECTIOUS DISORDERS OF THE HEART

1. PERICARDITIS

III.

MITRAL VALVE REGURGITATION

Occurs when much pressure is generated within the left ventricle to be generated to the aorta resulting to backflow of blood to the left atrium &ress"re is re#lected back to the p"lmonary veins and arteries Manifestations: asymptomatic "ntil cardiac o"tp"t #alls, m"rm"rs, atrial #ibrillation, p"lmonary mani#estations Management: restrict physical activities, restrict sodi"m, di"retics, digitalis

ac"te or chronic in#lammation o# the pericardi"m Assessment: precordial pain pain (inspiration, co"ghing ) s'allo'ing pain 'orse 'hen s"pine pericardial #riction r"b #ever ) chills elevated *(! ct+ Management: &osition: side lying, high ,o'ler-s, "pright ) leaning #or'ard Admin+ analgesic, corticosteroids, $.AID-s Avoid aspirin ) anticoag"lants Antibiotics Di"retics ) digoxin /onitor #or complications: !ardiac Tamponade

2. MYOCARDITIS

IV.

AORTIC STENOSIS
Caused by calcification of the valve and stiffening of the aortic valve Manifestations: initially asymptomatic, angina pectoris, syncope, dyspnea Management: avoid vigoro"s physical activity, antibiotics, digitalis, beta-blockers

V.

AORTIC REGURGITATION
Blood propelled into the aorta propels back to the left ventricle through an incompetent valve Manifestations: initially asymptomatic, palpitations, m"rm"rs, lo' (& Management: same #or aortic stenosis

ac"te 0 chronic in#lammation o# the myocardi"m Etiology: (acterial : staphylococc"s 0 pne"mococcal 1iral : coxsackievir"s 0 m"mps 0 in#l"enza &arasitic : Toxoplasmosis 2adiation 0 3ead /eds: 3ithi"m 0 !ocaine Assessment: #ever pericardial #riction r"b gallop rhythm m"rm"r p"ls"s alternans (reg"lar alternation o# 'eak and strong beats 'itho"t changes in cycle length .0. o# 4, !hest pain Management: &osition: (ed rest 0 sitting "p or leaning #or'ard /onitor p"lse rate ) rhythm Admin+ #or #ever ) pain 3imit activities Admin+ digoxin 0 antidysrhythmics 0 antibiotics as prescribed $.AID-s 0 analgesics 0 salicylates

3. ENDOCARDITIS

VI.

TRICUSPID VALVE DISEASE

Tricuspid stenosis or regurgitation Causes decreased cardiac output and increased right atrial pressure Manifestations: neck distention, peripheral edema, m"rm"rs Management:

In#lammation # the inner lining o# the heart Assessment: #ever, anorexia, 't loss, #atig"e cardiac m"rm"rs 5ane'ay-s lesions 6ssler-s nodes &etechiae, splinter hemorrhages in nailbeds .plenomegaly Management balance activity '0 rest

antiembolism stockings monitor emboli: o Splenic s"dden abd+ pain radiating to 3 sho"lder 0 rebo"nd tenderness on palpation o Renal #lank pain radiating to groin, hemat"ria poly"ria

'ypertension )nfections

1) DILATED CARDIOMYOPATHY
@s"ally both ventricles dilate, myocardial #ibers degenerate and replaced by #ibrotic tiss"e Associated 'ith in#ections, metabolic problems, ne"rom"sc"lar problems, toxins, pregnancy, connective tiss"e disorders and genetic predisposition similar in heart #ail"re 2est and avoid stress 2estrict sodi"m in diet Di"retics, nitroglycerin, anticoag"lants, antidysrhythmics as ordered !ardiac de#ibrillation Avoid alcohol 4eart transplant

4. RHEUMATIC FEVER/RHD
&ericarditis that #ollo's expos"re o# child to throat and skin in#ection ca"sed by 7ro"p A (-hemolytic organisms 82epeated bo"ts 'ith permanent scarring o# the valves 24D heart failure

Management:

Jones Criteria /a9or /inor TERMS !arditis &olyarthritis !horea :rythema marginat"m ."bc"taneo"s nod"les ,ever Arthralgia :levated :rythrocyte .edimentation 2ate &ositive ! 2eactive &rotein &rolonged &-2 interval Chorea

2) HYPERTROPHIC CARDIOMYOPATHY
$isproportionate thickening of the myocardium that leads to obstruction of blood flow Causes* o genetically transmitted, idiopathic Manifestations* may lead to death ;asymptomatic Management: medications as ordered, avoid alcohol 8."rgery: myotomy

3) RESTRICTIVE CARDIOMYOPATHY
!a"sed by #ibrosis and thickening in the heart that ca"ses the ventricles to lose their ability to stretch /anagement: no speci#ic interventions b"t goals are aimed to diminish heart #ail"re

disorder ca"sing invol"ntary movement o# spasms

aneway!s lesion non-tender, small erythemato"s or hemorrhagic mac"les or nod"les in the palms or soles, 'hich are pathognomonic o# in#ective endocarditis Ossler!s nodes pain#"l, red, raised lesions on the #inger p"lps, indicative o# the heart disease s"bac"te bacterial endocarditis+ "rythema marginatum pink rings on the tr"nk and inner s"r#aces o# the arms and legs C Reactive #rotein a plasma protein that increases d"ring in#lammation

CORONARY ARTERY DISEASE

$arro'ing or obstr"ction o# one or more coronary arteries as a res"lt o#: o (therosclerosis o (rteriosclerosis RISK FACTORS /odi#iable !igarette smoking hypertension :levated ser"m cholesterol Diabetes mellit"s &hysical inactivity 6besity !hronic stress % Type A personality $on-modi#iable 4eredity and race % African Americans Advancing age 7ender % men and postmenopausal women Sign & Symptoms: normal d"ring asymptomatic period chest pain palpitations dyspnea syncope co"gh or hemoptysis excessive #atig"e

Management of RF/RHD Aspirin or steroid Initially &enicillin #or ;< days .econdary &rophylaxis: &enad"r = >-? 'eeks &henobarbital or haloperidol #or chorea Digoxin #or heart #ail"re Di"retics #or heart #ail"re 2est, ade="ate #eeding and #l"id balance

CARDIOMYOPATHY
Unkno'n ca"se > ma9or types $ilated %congestive& cardiomyopathy 'ypertrophic cardiomyopathy Restrictive cardiomyopathy 2isk #actors (lcohol abuse #regnancy

Diagn !"i# T$!"%

+, ., 0, "CCardiac Catheteri/ation Blood lipid level

Medical Management* 1itrates (ntiplatelets

(ntilipemics Beta2(drenergic Blockers Calcium Channel Blockers

Surgical Management

a.

P$&#'"an$ '! T&an!(')ina( C & na&* Angi +(a!"*

o a balloon2tipped cathether is "s"ally inserted into the femoral artery and inflated several times to reshape the lumen reduces coronary stenosis by e3cising and removing atheromatous pla4ues a, b, c, d, e, f,

,.

A"-$&$#" )*
o

&allor ,aintness &alpitation Dizziness Diaphoresis Dyspnea

."bsternal or &recordial pain choking, heartb"rn, pressing, b"rning, s="eezing+ 2adiating to the le#t sho"lder and "pper arm and may travel do'n to the elbo', 'rist and #ingers 6evine!s sign Aggravated by activity 2elieved by rest

Diagn !"i# T$!"%

"CCardiac Catheteri/ation8 "3ercise testing CT scan Myocardial scintigraphy Coronary angiography

#.

C & na&* A&"$&* .*+a!! G&a/"ing

o involves the bypass of a blockage in one or more of the coronary arteries "sing the saphenous veins, mammary artery or radial artery as conduits or replacement vessels t"bes that act as mechanical scaffold to reopen the blocked artery

0.

In"&a# & na&* !"$n"ing

o

Collaborative Management of (1-)1( #"CTOR)S Me"i#ation:

VASODILATORS

C & na&* a&"$&* ,a((

n angi +(a!"*

CORONARY ARTERY .YPASS GRAFTING 1CA.G)

8$"rsing /anagement: ;+ Daily management o# hypertension8 A+ .top smoking as soon as possible+8 >+ Avoid passive smoke8 ?+ &lan a reg"lar exercise "nder medical s"pervision B+ I# over'eight, lose 'eight C+ ,ollo' a healthy heart diet+ D+ 2ed"ce .tress E+ Allo' ade="ate time #or rest and relaxation

:##ects: $irect rela3ing effect on vascular smooth musle, res"lting in vasodilation o isosorbide dinitrate %)sordil& 9 nitroglycerin o transdermal nitrodisk %patch& 9 1itrol: 1itrobid %Ointment&: (myl 1itrate,

.ETA6 .LOC7ERS

ANGINA PECTORIS
chest pain res"lting #rom myocardial ischemia; a symptom o# an existing disease; no necrosis Transient chest pain ca"sed by )1SU55)C)"1T B6OO$ 56O7 to the myocardium resulting in myocardial ischemia,

:##ects: $ecrease myocardial o3ygen demand by decreasing heart rate: B#: myocardial contractility and calcium output o (tenolol %Tenormin& o #ropanolol %)nderal& o Metoprolol %6opressor& o 1adolol %Corgard& o #indolol %;isken& o "smolol %Brevi2bloc& o Medication*

CALCIUM CHANNEL .LOC7ERS

;asodilation < reduce myocardial contractility < spasm= decreasing cardiac workload+ 1ifedipine %#rocardia: (dalat: Calcibloc&: ;erapamil %Calan&: $iltia/em %Cardi/em&

Types of Angina 1. S"a,($ o triggered by a &2:DI!TA(3: degree o# exertion or emotion (eg+ *alking A< #eet 2. Un!"a,($ o triggered by an @$&2:DI!TA(3: degree o# exertion or emotion 3. P&in2)$"a(/3a&ian" o similar to classic angina b"t longer and /AF 6!!@2 AT 2:.T 4. In"&a#"a,($ o "nresponsive to treatment 4. N #"'&na( o associated 'ith 2:/ sleep d"ring dreaming 6. Angina 0$#',i"'! o occ"rs 'hen the client reclines and lessens 'hen the client sits or stands "p 5. P !"6in/a&#"i n o occ"rs a#ter /I Causes: E!s "3ertion "motion "3posure to cold "3cessive smoking "3cessive eating Assessment: &ain pattern: /ild % moderate

:##ects: o o o

P(a"$($" Agg&$ga"i n In-i,i" &!

o o o (S(%(cetylsalicylic (cid& $ipyridamole %#ersantin& Ticlopidine

ANTICOAGULANTS
G Heparin Sodium o Inactivates thrombin and other clotting #actors inhibiting conversion o# #ibrinogen #ibrin, there#ore #ibrin clot #ormation is prevented+ Warfarin Sodium Sodium ; !icumarol o Inhibit hepatic synthesis o# 1it+H

1URS)1- )1T"R;"1T)O1S )n $RU- T'"R(#> 1itroglycerine Therapy o (ssume sitting or supine position 'hen taking the dr"g+ o Take a maxim"m o# 0 doses at ? minute interval o -radual change of position o 6##er SO7%sip of water& before giving S6 nitrates o Instr"ct client to avoid drinking alcohol: smoke

6bserve #or .:: 'eadache: flushed face: di//iness: faintness and tachycardia,

Beta2 (drenergic Blockers o (ssess pulse rate be#ore administration o# the dr"g o Administer 'ith #ood o $o not administer #RO#(1O6O6 to clients with asthma and hypoglycemia o 7ive extreme ca"tion in clients 'ith heart #ail"re o 6bserve #or .:: nausea: vomiting: mental depression: mild diarrhea: fatigue and impotence Calcium2Channel Blockers o (ssess 'R and B# o /onitor 'epatic and Renal 5unction o (dminister + hour ac or . hrs pc, (fter meals, #latelet (ggregation )nhibitors o Assess #or signs and symptoms of bleeding o $o not give (S( with coumadin o Observe for (S( to3icity2 T)11)TUS 'eparin Sodium o Assess #or signs and symptoms of bleeding o Antidote: #ROT(M)1" SU65(T" o I# administered .I+, $o not aspirate: and do not massage o Monitor #TT or (#TT levels o @sed #or a ma3imum of . weeks Coumadin o (ssess for signs and symptoms of bleeding o Antidote: ;)T,@ o Monitor #T o Minimi/e green leafy vegetables in the diet, 1ote* .2? minutes without O3ygen supply %brain& causes death 0?2A? minutes without O3ygen supply %heart& causes death

Collaborative Management for Myocardial )nfarction %oals of T&eatment G #revention of further tissue damage an" limitation of infarct si/e G Ma3imi/e myocardial tissue perfusion an" reduce myocardial tissue demands a+ Ac"te .tage: Admin+ prescribed medications : M& '& (& A& G Morphine Sulfate G ')y$en #A*( G (itrates G Aspirin +idocaine (Jylocaine ,eta-.loc/ers (propranolol, timolol 0Throm.olytics (streptokinase, "rokinase Anticoa$ulants (heparin, 'ar#arin0co"madin 'u&sing Management: &romoting Tiss"e 6xygenation and Tiss"e &er#"sion &romoting Ade="ate !ardiac 6"tp"t &romoting !om#ort &romoting rest &romoting Activity &romoting $"trition and :limination &romoting 2elie# o# Anxiety and *ell- (eing ,acilitating 3earning Teaching and !o"nseling Re(a)ilitation *Dis#(a&ge afte& MI+: ;+ Discontin"e smoking A+ Diet >+ *eight 2ed"ction ?+ &rogressive exercise B+ /aintenance /edication C+ 2es"mption o# sex"al activity is 1-2 wee/s #rom discharge D+ .tress /anagement Techni="es Tea#(ing %ui"elines in Resuming Se,ual A#ti-ity: o 2es"me i# able to climb A #lights o# stairs o (e#ore: rest is impt+ 0 avoid large meals 0 'ear loose #itting clothes 0 nitro be#ore sex 0 "s"al environment 0 sex at room temperat"re 0 #oreplay o D"ring: com#ortable position 0 sel#-stim"lation 0 oralgenital 0 avoid anal o 3emale position: side lying or rear entry position o Male #osition : reverse missionary or sitting position

MYOCARDIAL INFARCTION
."dden decrease o# oxygenation d"e to red"ced coronary blood #lo' that res"lts to destr"ction o# myocardial tiss"e in regions o# the heart+ Causes: o Thromb"s o :mboli o Atherosclerosis $o#ation: 6eft anterior descending artery % anterior or septal 'all /I or both Circumfle3 artery% posterior 'all /I or lateral 'all /I Right coronary artery % in#erior 'all /I o Three areas 'hich develop in /I: a+ T wa"e in"ersion (zone o# hypoxia b+ ST ele"ation (zone o# in9"ry c+ #atholo$ic % wa"e (zone o# in#arction $iagnostic Studies +, Total C@ levels ., 6$' 0, (ST A, "CAssessment &ain pattern: o .evere, prolonged cr"shing s"bsternal pain; kni#elike that may radiate to 9a', back ) le#t arm o 3:1I$:-. .I7$ ,ever 6lig"ria Anxiety and Apprehension &allor 0 cyanosis 0 coolness o# ext+0 *eak p"lse Ac"te &"lmonary :dema :levated !H-/(, elavated 3D4, A.T

E($#"& #a&0i g&a) an0 i"! # )+ n$n"!

C'M#'(E(TS '3 EC4 # wa"e 5 atrial depolari6ation #R inter"al 5 impulse tra"el from atria to pur/in7e fi.ers %RS comple) 5 "entricular depolari6ation ST se$ment 5 plateau of action potential T wa"e 5 "entricular repolari6ation U wa"e 5 indicates electrolyte im.alance %T inter"al 5 "entricular refractory time

CARDIAC DYSRHYTHMIAS
Abnormal heart rhythms o#ten detected beca"se o# associated mani#estations o# dizziness, palpitations, and syncope ETIOLOGY Dist"rbance in the > ma9or mechanisms: o Automaticity 6 .in"s Tachycardia 6 .in"s (radycardia 6 &remat"re Atrial !ontraction 6 &remat"re 1entric"lar !ontraction 6 Torsades de &ointes o 6 Conduction ,irst Degree A1 block

6 6 o 6 6 6

.econd Degree A1 block Third Degree A1 block Reentry of impulses Atrial ,l"tter Atrial ,ibrillation 1entric"lar ,ibrillation

Management: 6 !ardioversion, 6 anti-dysrhythmics (digitalis, ="inidine, etc , 6 !alci"m !hannel (lockers, 6 (eta adrenergic blockers ATRIAL FI.RILLATION 6 2apid, chaotic atrial depolarization #rom a reentry disorder 6 ABB2DBB bpm 6 A1 node is bombarded 'ith more imp"lses than it can cond"ct Management: 6 Antidysrhythmics, 6 beta-blockers, 6 De#ibrillation

Clinical Manifestations &alpitations .yncope &allor Diaphoresis Altered mentation 4ypotension .l"ggish !2T Decreased "rine o"tp"t :!7 changes

SINUS DYSRHYTHMIAS
o o SINUS TACHYCARDIA 2apid, reg"lar rhythm at a rate of +BB2+CB bpm 6cc"rs in response to : 6 increased sympathetic stimulation or decreased parasympathetic stimulation, 6 medications (eg. At&opine/ nit&ates/ epinep(&ine+, 6 stress, 6 ca##eine, 6 nicotine, 6 hyperthyroidism, 6 hypercalcemia, 6 #ever, 6 heart #ail"re, 6 #l"id vol"me loss

VENTRICULAR DYSRHYTHMIAS
o o o o &remat"re 1entric"lar !ontraction 1entric"lar Tachycradia 1entric"lar ,ibrillation 1entric"lar Asystole

PREMATURE VENTRICULAR CONTRACTION 6 &remat"re ventric"lar beats associated 'ith /I, acidosis, alcohol, heart #ail"re, !AD, nicotine, hypermetabolic states 6 a cardiac irreg"larity in 'hich the "entricled contracts .efore its anticipated time& 6 Dangero"s Management: 6 lidocaine 6 other antidysrhythmics TORSADES DE POINTES 6 ,orm o# ventric"lar tachycardia in 'hich the %RS comple)es appear to .e constantly chan$in$ 6 Usually results from dru$ to)icity or electrolyte im.alance 6 *t is an emer$ency Management: 6 3idocaine, 6 De#ibrillation, 6 !ardioversion

o Management: 6 aimed at treating the "nderlying ca"se, bed rest, oxygen, 8meds as ordered SINUS .RADYCARDIA o 8.A node #ires less than C< times per min"te o $ormal in some people (eg+ Athletes

Management: 6 treat the "nderlying ca"se, increase the heart rate as appropriate 6 Isoproterenol

ATRIAL DYSRHYTHMIAS
&remat"re Atrial complex (&A! Atrial ,l"tter Atrial ,ibrillation &aroxysmal Atrial Tachycardia

VENTRICULAR FI.RILLATION 6 3i#e-threatening dysrhythmia characterized by rapid, erratic imp"lse #ormation and cond"ction 'hich ca"ses a.rupt cessation of cardiac output0 6 2es"lts #rom severe /I, electroc"tion, digitalis toxicity, electrolyte imbalance Management: 6 De#ibrillation, 6 $a (icarbonate, 6 :pinephrine

PREMATURE ATRIAL CONTRACTION 6 :arly beats arising #rom the atria and interr"pting the normal rhythm 6 Associated 'ith "al"ular disorders, atrial cham.er enlar$ement, stress, fati$ue, heart failure, M*, CA!, pulmonary hpn 6 & 'aves are premat"re and di##erent #rom the normal sin"s & 'ave in appearance, shape and size Management: 6 I"inidine or procainamide

AV n 0$ D*!&-*"-)ia!
o o o ,irst degree heart block .econd degree heart block 6 /obitz type ; 6 /obitz type A Third degree heart block

ATRIAL FLUTTER 6 .ame toother atrial 'ave #ormation ca"sed by rapid reentry in the atria 6 (trial rate ranges from ..B20?B bpm 6 A1 node cannot cond"ct all the atrial imp"lses that bombard it

3*RST !E4REE A8 ,+'C9 6 !elay in the passa$e of impulse from the atria to "entricles usually occurs at the le"el of the A8 node 6 2es"lts #rom !AD, increased vagal stim"lation, congenital anomalies and digitalis administration 6 2e="ires observation and monitoring since it can progress to higher-degree A1 block

SEC'(! !E4REE A8 ,+'C9 6 /ore serio"s and some impulses are .loc/ed while others are not 6 Develops #rom !AD, digitalis toxicity, rhe"matic #ever, viral in#ections and /I 0 types: 6 Mobit/ Type + Block %7enckebach& 6 Mobit/ Type . Block 6 6 6 MOB)TE T>#" + B6OC@ Caused .y a lon$ refractory period that occurs at the A8 node &2 interval lengthens "ntil a & 'ave is not cond"cted Interventions is not re="ired as long as the ventric"lar rate remains ade="ate #or per#"sion

6 6

.acc"lar (an o"tpo"ching o# an artery 'here the medial coat is thinned Dissecting (hematoma in the artery 'all #rom a localized enlargement o# the involved artery

MOB)TE T>#" . B6OC@ 6 +e"el of the .loc/ is .elow the A8 node 6 2e="ires :!7 monitoring Management: a"minist&ation of at&opine/ inse&tion of pa#ema1e&/ 2it((ol"ing #a&"ia# "ep&essant "&ugs TH*R! !E4REE A8 ,+'C9 6 Complete a.sence of conduction of electrical impulses d"e to a block in the A1 node, b"ndle o# 4is or b"ndle branches 6 Danger o# ventric"lar standstill or asystole Management: T, of CHOICE: ;"1TR)CU6(R #(C"M(@"R

Complication: Rupture T&ia" manifestations of &uptu&e: &ain &"lsating mass .hock 6ther mani#estations: .yncope 3ight headedness hypotension Me"i#al Management: (ntihypertensives as ordered: ultrasonography every F months Su&gi#al Management: Resection and graft replacment

CARDIAC TAMPONADE
6 &ericardial e##"sion occ"rs 'hen the space bet+ the parietal ) visceral layers o# the pericardi"m #ill 'ith #l"id+8

CARDIOGENIC SHOC7 1PO8ER/PUMP FAILURE)

6 is a shock state 'hich res"lts #rom pro#o"nd left "entricular failure "s"ally #rom massi"e M* (ursin$ *nter"entions 6 &er#orm hemodynamic monitoring 6 Administer oxygen therapy 6 !orrect 4ypovolemia 6 &harmacotherapy: ;asodilators2 1itroprusside: 1itroglycerine )notropic (gents2 $igitalis: $opamine $iuretics2 5urosemide 6 /onitor ho"rly "rine o"tp"t, 36!, arrythmias 6 &rovide psychosocial s"pport 6 Decrease p"lmonary edema 6 A"sc"ltate l"ng #ields 6 &lace in ,o'ler-s position 6 $RU-S* M(;a$ MOR#')1" (M)1O#'>66)1" ;(SO$)6(TORS $)UR"T)CS o o o @tilize Counterpulsation to red"ce ventric"lar 'ork o# the client 'ith severe shock Counterpulsation 6 involves introd"ction o# intra- aortic balloon catheter 6 A/I,!A2DI67:$I! .46!H, @$.TA(3: A$7I$A a"gments diastole, resultin$ in increased perfusion of the coronary arteries and myocardium and a decrease in left "entricular wor/load

Assessment: o ,ec/s triad: distended neck veins 0 m"##led heart so"nds 0 hypotension o !hest pain o !ardiogenic shock o Increased !1& Management: o !!@ #or hemodynamic monitoring o &:2I!A2DI6!:$T:.I. o Admin+ I1 #l"ids as prescribed

HEART FAILURE
6 Causes: a< .< c< d< e Types: *na.ility of the heart to maintain ade;uate circulation to meet the meta.olic needs of the .ody .ec& of an impaired pumpin$ capa.ility& Hyper"olemia Arteriosclerosis Myocardial *nfarction Cardiomyopathies 8al"e disorders Ri$ht-sided CH3 Systemic S)< 6 3ati$ue 6 distended 7u$ular "eins 6 Ascites 6 pittin$ edema 6 Cyanosis 6 hepatome$aly 6 increased peripheral "enous pressure 6 anore)ia = 4* distress 6 polyuria = wt& $ain

ANEURYSMS
6 6 6 &ermanent localized dilation o# an artery that enlarges grad"ally !a"ses: atherosclerosis, congenital mal#ormations, in#ection, connective tiss"e disorders, hypertension !omplications: r"pt"re, press"re on s"rro"nding str"ct"res, thrombosis and embolization

Classification of (neurysms according to* 3ocation 6 1eno"s or arterial 6 Aortic, iliac, etc++ 6 7ross appearance: ,"si#orm (localized dilations o# an artery

+eft-sided CH3 #ulmonary S)< 6 Cardiome$aly 6 .lood tin$ed sputum 6 Cou$h 6 acute pulmo edema 6 E)ertional dyspnea 6 cyanosis 6 'rthopnea 6 wt& +oss Management 6 Rest 6 Hi$h-3owlers or sittin$ 6 !ecrease fluids > (a? 6 Medications:

o o o o o o o o o

!ardiac 7lycosides % (K inotropy 0 (chronotropy digitalis 0 digoxin (3anoxin 0 digitoxin (!rystodigin 0 lanatoside (!edilanid-! Di"retics % 4A6 ) $aK excretion 3oop di"retics % ,"rosemide (3asix Thiazide di"retics % chlorthiazide (Di"ril &otassi"m sparing % spironolactone (Aldactone Inotropics % increases the strength o# contraction s"ch as "opamine *Int&opin+/ "o)utamine *Do)ut&e,+ 1asodilators 2otating To"rni="et #rinciples: o apply 3 tou&ni4uets o inflate #uff 56 mm a)o-e "iastoli# p&essu&e o &otate 4 5 mins. o #(e#1 "istal pulses o &emo-e 5 at a time 7 5 mins. Inte&-al