OCCULUSIVE DISORDERS:
ARTERIOSCLEROSIS, ANGINA, MI
ARTERIOSCLEROSIS:
 Narrowing of arteries or hardening of arteries caused by a buildup of lipids,
collagen & smooth muscle cells.
 Blood flow through is decreased causing decreased perfusion to body cells.
 One type of Arteriosclerosis is Arthrosclerosis
ATHROSCLEROSIS: plaque formation or fatty deposits on the linings of the major
arteries.
ANGINA PERTORIS: (or Myocardial Ischemia)
 When coronary arteries lose elasticity & become narrowed due to plaque
formation, the heart muscle receives less blood & oxygen.
 It is a temporary inadequate blood supply to myocardial tissue.
5 E’s precipitate:
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Eating a healthy meal
Exercise
Exertion
Emotional stress
Exposure to extreme temperature
Also, smoking & arterial spasms
SIGNS & SYMPTOMS:
 Squeezing pain lower sternum that radiates to left shoulder, also to right
shoulder, jaw, & ear.
 The symptoms increase in frequency & severity over time
 Severity depends on amount of collateral circulation
-collateral circulation: shunting of blood from narrowed larger vessels to
surrounding smaller vessels.
DIAGNOSTIC TESTS:
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Patient history
Stress test (thallium)
Laboratory test- HDL, LDL
Coronary Arteriogram
TREATMENTS:
 Rest
 Vasodilatation (NTG) 3 NTG 15min apart
 Surgical
-PTCA: percutaneious transluminal coronary angioplasty, “balloon surgery”
-Stent: implanted into stenosed vessel, preventing it from collapsing.
Balloon is used then removed & stent left in place.
COMPLICATION:
 If piece of plaque breaks off & occludes artery CABG surgery is needed.
CABG:
 The internal mammary artery, saphenous vein or synthetic graft is grafted
to the aorta & passed beyond the occlusion in the coronary vessel.
 Meds: NTGvasodilation
beta blockers
calcium channel blockers
 low fat, low cholesterol, NA restricted
 rest periods
 limit fat to 30g a day
 exercise 3-5 times week for at least 20min
MYOCARDIAL INFARCTION: leading cause of sudden death of men & women
 MI: obstruction in the coronary artery resulting in death (necrosis) to the
tissue supplied to the artery. (first 24 hours are most crucial time)
CAUSE:
 Atherosclerosis, thrombus, embolism
 Most common: atherosclerosis
 Most commonly affected is left ventricle
If a large coronary artery is obstructed & client does not have sufficient
collateral circulation client may die immediately, “massive MI”
NORMAL:
LDH2 is normally higher than LDH1: after MI it flips
LDH1 (which is specific to cardiac muscle tissue) is higher than LDH2
SYMPTOMS:
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Chest pain (heaviness, tightness)
Low sternal pain
Pain NOT relieved by NTG
S.O.B- diaphoresis – anxious
Nausea & vomiting
Pulse irregular, rapid, & weak
BP drops
Skin pale then cyanotic
DIAGNOSES:
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Cardiac isoenzymes (CPU MB LDH)
EKG
Radioactive isotropic scan
First 3 days after infarction- s/s low grade fever, elevated WBCs
4-7 days: infarct tissue softest & weakest
Collateral circulation may take as long as 2-3 weeks after
2-3 months muscle will regain strength
MEDICAL MANAGEMENT:
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Reduce workload of heart.
In ICU on monitor 3 dysrthymias may occur after
V-fib
Bradycardia (atropine)
Tachycardia (lanoxin)
2 types: A-fib (lanoxin) V-tach (lidocaine or cardioversion)
SURGICAL MANAGEMENT:
 PTCA- percutaneous transluminal coronary angioplasty
 CABG
PHARMALOGICAL:
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Oxygen
Morphine for pain
Nitrates (IV or Sublingual)
Sedatives
Stool softener
Thrombolytic Therapy (within 3-6 hours of infarct) dissolves clot
Streptolsinase
Eminase
Activase
Complication: bleed. Nursing intervention: monitor amesis/tarry stools
 Heparin therapy (ASA usually not given with heparin)
 ASA to prevent vasoconstriction
DIET:
 Acute stage: clear liquids (reduce workload of heart) progressed to low
sodium –low fat –low cholesterol
 Avoid caffeine, extreme hot/cold foods
ACTIVITY:
 Decrease workload of heart.
 First 24 hours bedrest
 Stress test prior to discharge to determine activity level
HEALTH PROMOTION:
 Proper diet, exercise, stop smoking, cardiac rehab program, esp for women
because women have worse prognosis than men.
CONGESTIVE HEART FAILURE: weakened muscle that cannot meet metabolic
needs of body.
 Can be right or left sided
RIGHT SIDED:
 Congestion in inferior vena cavaedema in extremities then in trunk of
body (edema in ankles, thighs,& abdomen)
 Enlarged liver & enlarged spleen
 Distended neck veins
 Oliguria
LEFT SIDED:
 blood backs up left ventricle, left atrium & pulmonary veins
 lungs become crystallized (patient cyanotic, spits up blood, dyspnea,
restlessness) moist respirations (crackles on auscultations)
 tachy
 decreased BP
 decreased urinary output
 confusion as blood oxygen level decreases
GOAL MEDICAL MANAGEMENT:
 Improve circulation to coronary arteries & reduce workload of left
ventricles
TREATMENT:
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Oxygen
Bedrest with HOB elevated
Diuretics (lasix) restrict fluid, daily weights, measure abdominal girth
Digatalis-strengthens contraction of heart muscle
SUGICAL INTERVENTIONS:
 Intra-aortic balloon
 Ventricular assist device
 Cardiomyopathy
PHARMOLOGICAL:
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Diurel
Lasix
Vasodilators NTG
ACE inhibitors-angiotension converting enzyme, to reduce BP & peripheral
resistance & improve cardiac output ie Capoten & Vasotec
 Morphine Sulfate (if pain) during acute phase to reduce anxiety
DIET:
 Limit fluid intake
 Lo NA
 Daily weight
ACTIVITY:
 Varies from bedrest with HOB elevated to ambulatory
HEALTH PROMOTION:
 Low-fat diet high fiber diet calorie balance
 Regular exercise program
 Stress reduction program
COR PULMONALE: heart is affected because of lung condition that interferes
with CO2 & O2 exchange pulmonary artery vasoconstriction pulmonary
hypertension. Right ventricle pumps against pulmonary pressure & enlarges &
weakens in an attempt to pump blood into the lungs.
SIGNS & SYMPTOMS:
 Same as right sided heart failure
CARDIAC TRANSPLANTATION: who?
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Cardiomyopathy
End-stage CAD
Valvular disease
Heart donor must be compatible with recipient
Recipient is on immunosuppressant’s: Imuran, ATG, Sandimmuine etc
PERIPHERAL VASCULAR DISORDERS:
 Venous Thrombus/Thrombophlebitis:
Phlebitis=inflammation of the wall of the vein without clot
Thrombophlebitis=inflammation of the wall of the vein with a clot
3 factors cause the formation of a clot:
 Pooling of blood
 Vessel trauma
 Problem with coagulation
RISK FACTORS:
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Prolonged bedrest
Leg trauma
Oral contraceptives
Obesity
Varicose veins
Hip fracture
Total hip/knee replacement
2 TYPES OF THROMBI:
 Superficial thrombus
 DVT
CAUSE:
 Trauma to vein (IVs)
DIAGNOSTIC TEST:
 Venous Doppler
SIGNS & SYMPTOMS:
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Reddened streak over skin
Warmth & tenderness at site
Unilateral edema of affected extremity
Positive Homans sign
Complaints that leg feels tight or heavy
COMPLICATION: PE
 S/S sudden chest pain
 Dyspnea
 Tachypnea
MEDICAL MANAGEMENT:
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Warm compresses
NSAIDs
Elevate extremity
Support hose
Bedrest
SURGICAL MANAGEMENT:
 Tromblectomy: removal of clot
 Greenfield vena cava filter or umbrella filter= placed in inferior vena cava to
prevent traveling clot from lower extremities to the lungs, heart, or brain
PHARMALOGICAL:
 If a client is at risk for Thrombus, anticoagulant therapy can be initiated.
 Prophalatic Heparin
 Levenox- lo-molecular weight heparin used prophylactic ally after hip
replacement surgery
If clot:
 Patient is placed on IV heparin
 PTT before to establish baseline & regulate dose
 Later Coumadin (po) (3-6 months)
MASSIVE DVT DRUGS:
 Streptokinase
 Urokinase
*observe for bleeding with patients on anticoagulants & avoid ASA*
DIET:
 Adequate hydration 2-3 quarts per day
HEALTH PROMOTION:
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Early ambulation
Prophylactic anticoagulants
Elevate legs
Deep breathing exercises
Avoid sitting or standing for long periods of time
Wear support hose
Don’t sit with legs crossed
VARICOSE VEINS:
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Varicosities are visibly prominent, dilated & twisted veins.
Veins most affected are lower extremities
Others include esophageal varices
Hemorrhoids
*women are more prone than men*
RISK FACTOR:
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Familial tendency
Congenital abnormalities
Pregnancy
Constrictive clothing
Occupations that require periods of prolonged standing
CAUSES:
 Incomplete absent valves & veins that lost elasticity
 Wall of vein of weakened
MEDICAL Rx:
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Elastic support hose
Elevate legs when sitting (don’t cross them)
Ankle & leg exercises
Sclerotherapy- sclerosing the vein so blood doesn’t flow through. Elastic
stockings 4-5 days after, support hose 5 weeks or more.
COMPLICATIONS:
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Necrosis at injection site
Vasospasms
Allergic response
Hemolysis (destruction of RBCs)
SURGICAL TREATMENT;
 Vein legation: tie off vein
 Vein stripping: stripping the walls of the vein
 Post Op: bedrest 24 hours, elastic stockings (5days), pain meds 30 min
before the client ambulates
PHARMOCOLOGICAL:
 Analgesics
 Anticoagulants
ACTIVITY:
 Regular exercise
 Walking improves circulation
 Ankle exercises (rotating ankle)
HEALTH PROMOTION:
 Encourage to elevate legs 6-10 inches when sitting
 Frequent position changes- not standing in 1 spot for long periods of time.
NURSING MANAGEMENT:
 Elevate legs when sitting
 Read nursing management for patients with vein stripping & scliotherapy.
BUERGERS DISEASE: inflammatory disease of small & medium arteries & veins
that leads to vascular obstruction. It effects hands & feet & can also effect
wrists & lower extremities.
SIGNS & SYMPTOMS:
 Distal tip of hands & feet are pale
 As disease progresses hands & feet become reddened when held in
dependant position.
 Pain in palm of hand & arch of foot
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Numbness, burning pain at rest
Decreased sensation in hands & lower extremities
Weak or absent pulses
Skin color changes
Sensitivity to cold
Ulcers & gangrene in later stages
Occurs between ages 20-40
There is a correlation with smoking
MEDICAL TREATMENT:
 Stop smoking you people
 Buerger Allen excercises:
-elevate leg until the blanch support them 2-3 minutes
-lower the legs until they become red for 5-10 minutes
-legs placed flat on bed with client supine for 10 minutes
-repeat exercises as tolerated
SURGICAL TREATMENT:
 Sympathectomy: excision of a segment of a sympathetic nerve to relieve
pain & prevent vasospasms in the affected area.
PHARMOCOLOGICAL:
 Analgesics to control pain
 Vasodilators to increase circulation to the affected area
NURSING MANAGEMENT:
 Stop smoking
 Avoid exposure to cold, repetitive hand movements, & stressful situations
 Encourage stress management
SECONDARY RAYNAUDS: is associated with connective tissue or collagen
vascular disease, meds, or occupational trauma.
RAYNAUDS OR PRIMARY RAYNAUDS: intermittent spasms of the digital arteries
& arterioles that results in decreased circulation to fingers & toes.
 It sometimes affects tip of nose & ears.
 During a spasm that lasts 15 minutes, fingers become pale then cyanotic. As
circulation returns fingers & fingertips become reddened & person
experiences tingling or throbbing pain in the fingers
 Some people experience pallor & cyanosis
 Episode lasts 1-2 hours
 Exposure to cold, emotional stress triggers an attack
MANIFESTATION:
 Affects (w) between 16-40 years
 Affects people that have occupations that require repetitive movements of
hands or persons exposed to vinyl chloride
DIAGNOSTIC:
 CBC, digital BP measurement & cold challenge test
 Cold challenge test: hands are placed in ice water for 20 seconds, temp of
hand is taken q5 minutes until it returns to baseline
 Sed-rate –ANA- rheumatoid factor to determine presence of autoimmune
disease
MEDICAL MANAGEMENT:
 Medication: adulate, procardia, cardezem, calan, cardene, capoten
 For finger ulcers: cipro
 For digital ulcers: trental (decreases blood viscosity & improves blood flow)
HEALTH PROMOTION:
 Avoid exposure to cold, repetitive, hand movement & stressful situations
 Quit smoking you people, avoid second hand smoke
 Stress management
ANEURYSM: bulge or dilation of a weakened section of an artery.
CAUSE:
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Main cause is atherosclerosis
Lack of elasticity in arterial wall
AAA heredity (Marfins Syndrome)
Congenital conditions
Trauma to vessel wall
Infection/inflammation
Syphilis
At risk: smokers & hypertension
Increased turbulence in the vessel
Slow production of smooth muscle cells
Incidence: AAA seen in male between ages 60-70
SYMPTOMS:
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Depends on location
Asymptomatic until they leak or pressure on structure
Upper back pain
Deep scattered chest pain
Dyspnea
Cough
Wheezing
DIANGNOSTIC:
 X-rays
MEDICAL MANAGEMENT:
 Rupture is emergency
 s/s: decreased BP, tachy, paleness, weakness, pain in back abdomen &
groin.
SURGICAL MANAGEMENT:
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Doppler U.S. to evaluate perphial vessels
Cardiac workup
Angiogram
Have 4-8 units of blood available
SURGERY:
 Synthetic graft after removal of portion of involved vessel
COMPLICATION:
 MI, stroke, renal damage, after surgery patient placed in ICU on respirator
PHARM MANAGEMENT:
 Inderol
 Symptomatic (antihypertensions)
 Analgesics
ACTIVITY:
 Avoid activity that increases pressure on arteries
HEALTH PROMOTION:
 Stop smoking
 Closely monitor BP
 Compliance with medical regimen
HYPERTENSION:
 140/90 or higher is indicative
 Prior to 55 more men, after 55 more women
RISK FACTORS:
 Family history
 Smoking
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Obesity
Lack of exercise
Diabetes
Poor education
Low socioeconomic status
Primary or Essential Hypertension: when cause is unknown
Secondary Hypertension: when cause is related to another condition
CAUSE:
 Renal : decreased blood flow to kidneys causes release of RENIN. When
rennin is released it interacts with plasma protein & forms vasopessor
called angio tension that causes vasoconstriction that leads to increased
peripheral resistance.
 Arteriosclerosis/Athrosclerosis: narrows vessel lumen because of plaque
formation  increased resistance to blood flow & more pressure is needed
to get blood through.
 Stress: stimulates the sympathetic nervous system that supplies nerves to
smooth muscle that lines the arteries. Stimulation of smooth muscle 
vasoconstriction HTN
 Hypernatremia: causes vasocongestion heart must pump with more
force.
COMPLICATIONS OF HTN:
 MI
 Stroke
 CHF
MEDICAL MANAGEMENT:
 Change in diet & lifestyle (weight loss, limit NA in diet, limit fat, cholesterol,
& apple martinis)
 Stop smoking
 Maintain adequate calcium & magnesium
 Add a diuretic or beta blocker to regimen (2 months)
 If BP still 140/90 try another drug or add another diuretic (if BP is still
140/90 or higher try adding a second or third hypertensive
PHARM MANAGEMENT:
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First start with diuretics, decrease fluid volume
Beta blockers
ACE inhibitors
Calcium Channel Blockers
Direct vasodilates
Adrenergic antagonists
Alpha receptor blockers
DIET:
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Low fat, low cholesterol, low NA
Avoid processed foods, carbonated drinks, & cereals
Adequate intake of vitamin K, magnesium, & calcium
Alcohol: 2oz of alcohol no more than twice a week