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Cardiovascular Function
A look at cardiac anatomy…..
Major Function:
Diastole
Relaxation/Repolarization
1. Isovolumetric relaxation phase
2. Filling phase
Heart Valves
Atrioventricular valves
Mitral valve (bicuspid valve)
Tricuspid valve
Semilunar Valve
Aortic Valve
Pulmonic Valve
ONE-WAY VALVE
Coronary Arteries
1. Left Coronary Artery
a. Left Main Coronary Artery
i. Left anterior descending
artery
ii. Left circumflex artery
2. Right Coronary Artery
i. Posterior descending artery
PULSE PRESSURE
• difference between the systolic and the diastolic
pressures
• It is a reflection of stroke volume, ejection velocity,
and systemic vascular resistance.
• normally is 30 to 40 mm Hg
• indicates how well the patient maintains cardiac
output
Blood Pressure
POSTURAL BLOOD PRESSURE CHANGES
Gravitational redistribution of approximately 300
to 800 mL into the lower extremities and GI
system immediately upon standing.
Postural (orthostatic) hypotension occurs when
the BP drops significantly after the patient
assumes an upright posture.
It is usually accompanied by dizziness,
lightheadedness, or syncope.
Postural (orthostatic) hypotension
Example:
NURSING ALERT
• Do not palpate temporal or carotid arteries
simultaneously, because it is possible to decrease the
blood flow to the brain.
Jugular Venous Pulsations
APICAL IMPULSE
•A broad and forceful apical impulse is known as
a left ventricular heave or lift.
Thrill
•Abnormal, turbulent blood flow within the heart
may be palpated with the palm of the hand as a
purring sensation.
•associated with a loud murmur.
Normal heart sounds
SUMMATION GALLOP
Murmurs are created by turbulent flow of blood
in the heart.
• Parasympathetic stimulation:
reduces the heart rate (negative chronotropy),
reduces AV conduction (negative dromotropy),
reduces the force of atrial myocardial contraction
(negative inotropy)
The decreased sympathetic stimulation results in dilation of
arteries, thereby lowering blood pressure.
DETERMINING VENTRICULAR HEART RATE
FROM THE ELECTROCARDIOGRAM
Sequence method
DETERMINING VENTRICULAR HEART RATE
FROM THE ELECTROCARDIOGRAM
1500 method
• Atrial fibrillation
causes a rapid,
disorganized, and
uncoordinated
twitching of atrial
musculature.
Atrial Fibrillation (a-fib)
Atrioventricular Nodal Reentry Tachycardia
Remember!
Don’t perform carotid sinus massage
on older patients.
Ventricular Tachycardia
Ventricular Fibrillation
Remember:
Acute dysrhythmias may be treated with
medications or with external therapy.
• A pacemaker is an
electronic device that
provides electrical
stimuli to the heart
muscle.
Management of
Patients with
Coronary Vascular
Disorders
Coronary Artery Disease (CAD)
•Most prevalent type of cardiovascular disease in
adults
•results from the narrowing of the coronary
arteries over time due to atherosclerosis
(coronary atherosclerosis)
•The primary effect of CAD is the loss of oxygen
and nutrients to myocardial tissue because of
diminished coronary blood flow.
•Angina pectoris
•ischemia
•infarction
Diagnostic studies
•Electrocardiography
•Cardiac catheterization
•Blood lipid levels
Surgical procedures
1. PTCA
2. Laser angioplasty
3. Atherectomy
4. Vascular stent
5. Coronary artery bypass grafting
Medications
1. Nitrates to dilate the coronary arteries and
decrease preload and afterload
2. Calcium channel blockers to dilate coronary
arteries and reduce vasospasm
3. Cholesterol-lowering medications to reduce
the development of atherosclerotic plaques
4. b-Blockers to reduce the BP in individuals who
are hypertensive
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.
Types of angina
• Variant angina (also called Prinzmetal’s angina):
• pain at rest with reversible ST-segment elevation;
thought to be caused by coronary artery vasospasm
Clinical Manifestations
Pharmacologic therapy
Nitroglycerin (NTG)
•Nitrates are the standard treatment for angina
pectoris.
•Potent vasodilator
NTG might be given in several routes:
•Sublingual or spray
•Oral capsule
•Topical agent, and
•IV
Guidelines
1. Instruct the patient to make sure the mouth is
moist, the tongue is still, and saliva is not
swallowed until the nitroglycerin tablet dissolves.
If the pain is severe, the patient can crush the
tablet between the teeth to hasten sublingual
absorption.
Guidelines
2. Advise the patient to carry the medication at all
times as a precaution. However, because
nitroglycerin is very unstable, it should be carried
securely in its original container (eg, capped dark
glass bottle); tablets should never be removed and
stored in metal or plastic pillboxes.
Guidelines
3. Explain that nitroglycerin is volatile and is
inactivated by heat, moisture, air, light, and
time. Instruct the patient to renew the
nitroglycerin supply every 6 months.
Guidelines
4. Inform the patient that the medication should
be taken in anticipation of any activity that
may produce pain. Because nitroglycerin
increases tolerance for exercise and stress
when taken prophylactically (ie, before angina-
producing activity, such as exercise, stair-
climbing, or sexual intercourse), it is best taken
before pain develops.
Guidelines
5. Recommend that the patient note how long it
takes for the nitroglycerin to relieve the
discomfort. Advise the patient that if pain
persists after taking three sublingual tablets at
5-minute intervals, emergency medical
services should be called.
Guidelines
6. Discuss possible side effects of nitroglycerin,
including flushing, throbbing headache,
hypotension, and tachycardia.
Guidelines
Most physicians prescribe application of topical
nitroglycerin paste three or four times daily or every 6
hours (excluding the midnight dose), and application of
the nitroglycerin patch every morning and removed at
10 PM.
This dosing regimen allows for a 6- to 8-hour nitrate-
free period to prevent the body’s development of
tolerance.
Other medications
•Beta Adrenergic Blocking Agents
•Calcium Channel Blocking Agents
•Aspirin
•Heparin
•Oxygen Therapy
ACUTE CORONARY SYNDROME (ACS)
an emergent situation characterized by an acute
onset of myocardial ischemia that results in
myocardial death if definitive interventions do not
occur promptly.
ACUTE CORONARY SYNDROME (ACS)
The spectrum of ACS includes:
•Unstable angina
•NSTEMI
•STEMI
Myocardial infarction (MI)
•Cardiac biomarkers
•ECG
•Echocardiography
•Cardiac Stress testing
•Cardiac catheterization
Begin routine medical interventions:
MONA
• Supplemental oxygen
• Nitroglycerine • Beta blocker
• Morphine • ACE inhibitor
• Aspirin 162-325 mg • Anticoagulation therapy
Management of Patients with
Structural, Infectious, and
Inflammatory Cardiac Disorders
VALVULAR HEART DISORDERS
Valvular Heart Disease
NURSING ALERT
Patients with myocarditis are sensitive to
digitalis.
• They must be closely monitored for digitalis toxicity,
which is evidenced by dysrhythmia, anorexia, nausea,
vomiting, headache, and malaise and BLURRED OR
DOUBLE VISION and GREENISH-YELLOW HALOS
AROUND IMAGES.
Nursing Management
Intracardiac thrombus
atrial fibrillation
Mural thrombi
Deep vein thrombosis (DVT)
PERICARDIAL EFFUSION AND
CARDIAC TAMPONADE
• Pericardial effusion refers to the accumulation of fluid
in the pericardial sac.
Management: Pericardiocentesis
Cardiac arrest
The heart is unable to pump and circulate blood
to the body’s organs and tissues
Arteriosclerosis
• most common disease of the arteries
•hardening of the arteries
Atherosclerosis
•Changes consist of the accumulation of lipids,
calcium, blood components, carbohydrates, and
fibrous tissue on the intimal layer of the artery
Arteriosclerosis vs Atherosclerosis
Treatments
•Change in LOC
•Pulsatile mass in periumbilical area
•Systolic bruit over aorta
•Lumbar pain that radiates to the flank and groin;
severe, persistent abdominal and back pain
•Weakness, sweating, tachycardia, hypotension
Test and treatments
Buerger’s disease is an
occlusive disease of
the median and small
arteries and veins.
The distal upper and
lower limbs are
affected most
commonly.
Clinical Manifestations
• Intermittent claudication
• Ischemic pain occurring in the digits while at rest
• Aching pain that is more severe at night
• Cool, numb, or tingling sensation
• Diminished pulses in the distal extremities
• Extremities that are cool and red in the dependent
position
• Development of ulcerations in the extremities
Interventions
•Heat; erythema
•Swelling
•Pain
Diagnostic Tests
• Doppler ultrasonography: confirms diagnosis by
checking leg for clots.
Treatments
• Prevention of pulmonary embolism.
• Elevate the affected leg: prevents thrombus
enlargement.
• Anticoagulants: thin the blood.
• Thrombolytics: dissolve the thrombus.
• Filter (umbrella) placement: traps emboli before they
can reach the lungs.
Varicose Veins
• Varicose veins are
abnormally enlarged
superficial veins of
the lower extremities.
• They occur most often
in the saphenous
veins located on the
insides of the lower
extremities.
Causes
•Familial predisposition
•Congenital weakness of the vein
•Obesity, pregnancy, abdominal tumors
prolonged standing, major surgeries, prolonged
bed rest.
•Trauma
Clinical Manifestations
• Edema
• Cramping or pain in affected extremity
• Heaviness in affected extremity
• Itching, redness, rash
• Phlebitis
Diagnostic Tests
• Palpation: May feel the veins when they are not
visible.
• X-ray: assesses functioning of deep veins.
• Ultrasonography: assesses functioning of deep
veins.
Treatments
• Elevating the legs
• Elastic stockings (support hose): compress the veins
and prevent them from stretching and hurting.
• Surgical stripping: removes varicose veins.
• Sclerotherapy (injection therapy)
• Laser therapy: cuts or destroys tissue.
Assessment and
Management of Patients
With Hypertension
Hypertension
• Hypertension is an abnormally
high pressure in the arteries.
• peripheral vasoconstriction.
• Vasoconstriction decreases
blood flow to end organs
Causes
• Primary hypertension • Lifestyle: obesity,
• Secondary hypertension sedentary lifestyle, stress,
smoking, excessive
• Pheochromocytoma
alcohol consumption,
• Hyperthyroidism increased salt intake
• Hyperaldosteronism • Arteriosclerosis
• Cushing’s syndrome
• Renal disease
CLASSIFICATION OF BLOOD PRESSURE FOR ADULTS
Clinical Manifestations
180/120 mmHg
HYPERTENSIVE EMERGENCY
Hypertensive emergency
• situation in which blood pressure must be lowered
immediately (not necessarily to less than 140/90 mm
Hg) to halt or prevent damage to the target organs.
HYPERTENSIVE URGENCY
Hypertensive urgency
• a situation in which blood pressure must be lowered
within a few hours.
• Blood pressure is elevated but there is no evidence of
impending or progressive target organ damage.
• Elevated BP associated with severe headache,
nosebleeds or anxiety are classified as urgencies.
end