➔ Monitor neurological, neuromuscular, and cardiovascular function
Cardiac
Cardiac: Heart Diseases
Angina Pectoris
➔ Chest pain caused by myocardial ischemia.
➔ Quick or slow in onset.
➔ Often related to coronary artery disease
Indications
➔ Retrosternal (or slightly to left of sternum) chest pain that radiates usually to left
shoulder and upper arm and proceeds down arm into fingers.
➔ May also radiate to right shoulder, neck, jaw, or epigastrium.
➔ Usually lasts less than 5 minutes.
➔ May describe pain:
◆ Mild or moderate, Squeezing, Burning, Aching, Bursting pressure, Like
gas, Indigestion, Heartburn, Aggravated by activity, Relieved by rest and
nitroglycerin, Dyspnea, Pallor, Palpitations, Dizziness, Diaphoresis
Surgical interventions:
➔ Percutaneous transluminal coronary angioplasty (PTCA).
➔ Coronary artery bypass graft surgery (CABG).
Nursing interventions:
➔ Teach about medications for prevention:
◆ Antiplatelet agents.
◆ Vasodilators.
◆ Beta-blockers.
◆ Calcium channel blockers.
➔ Pain relief: nitrates given sublingually.
➔ Teach about nitroglycerin's purpose and appropriate usage.
➔ Encourage control of modifiable risk factors:
◆ High cholesterol.
◆ Smoking.
◆ Hypertension.
◆ Diabetes mellitus.
◆ Obesity.
◆ Lack of exercise.
◆ Stress.
Physiology:
➔ Coronary arteries supply oxygen-rich blood to myocardium.
➔ Myocardial muscles facilitate transition of blood into tissues to supply oxygen
and other nutrients.
➔ Patency of coronary arteries is essential to oxygenation of myocardium.
➔ When clogged, or significantly narrowed, oxygen becomes limited.
➔ When increased myocardial oxygenation is needed, the coronary arteries dilate to
allow for increased blood flow.
Pathophysiology:
➔ Angina pectoris refers to anterior chest pain or paroxysms of pain.
➔ Major categories of angina:
◆ Stable:
◆ Predictable.
◆ Occurs with increased physical activity, other factors that increase
myocardial oxygen demand.
➔ Unstable:
◆ More dangerous.
◆ Unpredictable.
◆ May occur even at rest.
◆ Variant - Prinzmetal.
◆ Microvascular.
◆ Most commonly caused by coronary atherosclerosis - fatty, fibrous
plaques, possibly including calcium deposits, progressively narrow
coronary artery lumens.
◆ Obstruction of blood flow through coronary arteries causes decrease in
delivery of oxygenated blood to myocardium.
◆ Myocardial ischemia - produces angina.
Coronary Artery Disease (CAD):
Most prevalent form of cardiovascular disease in adults
Non modifiable risk factors:
➔ Age, Gender, Family history of heart disease
Modifiable risk factors:
➔ Smoking.
➔ Hypertension.
➔ Elevated serum cholesterol levels.
➔ Inactivity.
➔ Obesity.
➔ Diabetes mellitus.
➔ Atherosclerosis causes ischemia which results in:
➔
➔
➔
➔
Angina.
Myocardial infarction (MI).
Sudden cardiac death.
Focus is to prevent disease by modifying modifiable risk factors.
Physiology:
➔ Coronary arteries deliver oxygen-rich blood to heart muscle.
➔ Coronary arteries dilate:
◆ Allow for increased blood flow to heart muscle as needed.
◆ In response to sympathetic nervous system stimulation.
Pathophysiology:
➔ Over time, fat, cholesterol, and other substances combine to form plaque.
➔ Plaque deposits along the inner walls of the coronary arteries.
➔ Plaque buildup - atherosclerosis.
➔ Plaque increases:
◆ Internal diameter of coronary arteries reduced.
◆ Decreased blood flow (ischemia) to heart muscle.
◆ Soft plaque buildup hardens - coronary arteries stiffen.
◆ Increased myocardial oxygen demand:
◆ May result in ischemia.
◆ Atherosclerotic coronary arteries cannot effectively dilate.
Infective Endocarditis: Infection of heart lining and valves.
S/Sx:
➔ Fever.
➔ Malaise.
➔ Back and joint pain.
➔ Splinter hemorrhages under fingernails and toenails.
➔ Petechiae in conjunctiva and mucous membranes.
➔ Heart murmur.
Nursing Care:
➔ IV antibiotics for 4-6 weeks.
➔ May need surgery for heart valve replacement.
Physiology:
➔ The heart is encased in three layers:
◆ The outer layer is the epicardium.
◆ The middle layer is the myocardium.
◆ The inner layer is the endocardium, which lines the inside of the heart and
valves.
➔ Heart valves regulate the flow of blood from one chamber to another in response
to pressure changes within the chambers.
Pathophysiology:
➔ A bacterium, fungus, or rickettsia invading the endocardium causes deformity in
the valve leaflets or other cardiac structures, affecting the function of the heart.
Cardiomyopathy
Disease of heart muscle - can lead to:
➔ Heart failure.
➔ Dysrhythmias.
➔ Death.
➔ Most common form - dilated cardiomyopathy - significant dilation of ventricles
without hypertrophy of muscle.
Other forms:
➔ Restrictive cardiomyopathy.
➔ Arrhythmogenic right ventricular cardiomyopathy.
➔ Indications: signs and symptoms of heart failure.
Physiology:
➔ Myocardium is the muscular layer of the heart.
➔ Controlled contractions of the myocardium maintain cardiac output.
Pathophysiology:
➔ Dilated cardiomyopathy due to dilation of ventricles, scarring and atrophy of
myocardial cells which reduces cardiac output.
➔ Hypertrophic cardiomyopathy due to hypertrophied interventricular septum
causing obstruction to left ventricular outflow.
➔ Progressive heart failure seen with both types.
Tamponade
Pathophysiology:
➔ Excessive fluid accumulates in the pericardium.
➔ Causes decreased venous return to heart.
➔ Decreases cardiac output.
➔ Causes compression to the heart.
Cardinal signs:
➔ Decreased systolic blood pressure.
➔ Narrowing pulse pressure.
➔ Increased venous pressure.
➔ Muffled heart sounds.
Caused by:
➔ Penetrating injuries.
➔ Metastasis.
➔ Cardiac surgery.
➔ Advanced heart failure
Treatment: removal of the fluid in the pericardial sac
Cor Pulmonale: Right ventricle fails as a result of a pulmonary condition
Pericarditis: Inflammation of the pericardial sac.
Indications:
➔ Chest pain is sharp, occurs suddenly, severity varies with position changes.
➔ Pericardial friction rub auscultated.
➔ Fever may be present.
Treatment:
➔ Administration of NSAIDs and corticosteroids.
➔ Specific therapies for bacterial infection or autoimmune disorders.
Physiology:
➔ Pericardium is sac that surrounds the myocardium.
➔ There are two layers of the pericardium: inner visceral layer and outer parietal
layer or fibrous sac.
➔ The two layers are separated by a small amount of fluid that prevents friction.
Pathophysiology:
➔ Pericardium is inflamed from an acute inflammatory process.
➔ Capillary membranes are more permeable and proteins and serous fluid enter the
pericardial space.
➔ The pain fibers of the pericardium are stimulated.
➔ Excess fluid may accumulate and cause pericardial effusion or tamponade.