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CARDIOVASCULAR DISORDERS
Assoc. Prof. I. S. TIONKO
CARDIAC DISORDER
PATHOPHYSIOLOGY
ASSESSMENT FINDINGS
INTERVENTIONS
ECG:
Ventricular and Atrial Rate: <60 in Adult,
Ventricular and Atrial Rhythm: Regular,
QRS Shape and Duration: Usually normal,
but maybe regularly abnormal, P Wave:
Normal and consistent shape, always in front
of the QRS, PR Interval: Consistent interval
between 0.12-0.20 s, P:QRS- 1:1
ECG:
Ventricular and Atrial Rate: >100bpm in
Adult, Ventricular and Atrial Rhythm:
Irregular, QRS Shape and Duration: Usually
normal, but maybe regularly abnormal, P
Wave: Normal and consistent shape, always
in front of the QRS but maybe buried in the
preceding T Wave PR Interval: Consistent
interval between 0.12-0.20 s, P:QRS- 1:1
ECG:
Ventricular and Atrial Rate: 60-100bpm in
Adult, Ventricular an
d Atrial Rhythm: Irregular, QRS Shape and
Duration: Usually normal, but maybe
regularly abnormal, P Wave: Normal and
consistent shape, always in front of the QRS,
PR Interval: Consistent interval between
0.12-0.20 s, P:QRS- 1:1
MEDICATIONS
I. DYSRYTHMIAS
-
A. SINUS DYSRYTHMIAS
A.1 Sinus Bradycardia
- when the sinus node creates
an impulse at a slower-thannormal rate
Digitalis Administration
Calcium Channel Blockers
Beta Blockers
No medications given.
B. ATRIAL DYSRYTHMIAS
B.1 Premature Atrial Complex
(PAC)
- An ectopic beat that
originates in the atria and is
discharged at a rate faster
than that of SA Node
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ECG:
Ventricular and Atrial Rate: Depends on
the underlying cause, Ventricular and Atrial
Rhythm: Irregular due to early P Waves,
creating a PP interval that is shorter than the
others. This is sometimes followed by a
longer-than-normal PP interval, but one that
is less than twice the normal PP interval.
This type of interval is called a
NONCOMPENSATORY PHASE QRS Shape
and Duration: The QRS that follows the
early P wave is usually normal, but it maybe
abnormal. It maybe absent (blocked PAC) , P
Wave: An early and diff. P wave may be
seen in the Y-wave, other P waves in the
strip are consistent, PR Interval: The early P
wave ahs a shorter-than normal PR Interval,
bur still between 0.12-0.20 s interval
between 0.12-0.20 s, P:QRS- 1:1
ECG:
Ventricular and Atrial Rate: 250-400 (atrial
rate), 75-150 (ventricular rate) , Ventricular
and Atrial Rhythm: Atrial rhythm is regular,
but the ventricular rhythm is usually irregular
bec. of a change in AV conduction, QRS
Shape and Duration: Usually normal, but
maybe regularly abnormal, P Wave: Saw
toothed shape. These waves are referred as
F waves, PR Interval: multiple F waves
maybe difficult to determine the PR interval,
P:QRS- 2:1. 3:1, 4:1
ECG:
Ventricular and Atrial Rate: Atrial rate:300600, VR: 120-200 in untreated fibrillation,
Ventricular and Atrial Rhythm: Normal,
QRS Shape and Duration: Usually normal,
but maybe regularly abnormal, P Wave: No
discernible P waves; irregular undulating
waves are seen and are referred as F or
fibrillatory waves, PR Interval: Cant be
measured, P:QRS- many:1
Proper monitoring.
C. VENTRICULAR
DYSRYTHMIAS
C.1. Premature Ventricular
Contraction (PVC)
- dysrhythmia that is produced
by an ectopic beat originating
in a ventricle and being
discharged at a rate faster
than that of the next normally
occurring beat.
1. Lidocaine/IVP, drip
Initial bolus dose: 75-100 mg
then 50-100 mg within 10-15
min, as needed
Continuous IV drip is D5W, 4:1
concentration
2. Procainamide: IV drip bolus dose:
300 mg
3. Bretylium: continuous infusion if
Lidocaine and procainamide
are ineffective
ECG:
Ventricular and Atrial Rate: Depends on
the underlying rhythm, Ventricular and
Atrial Rhythm: Irregular due to early QRS,
creating one RR interval thats shorter than
the others. PP interval may be regular,
indicating that the PVC did not depolarize the
sinus node, QRS Shape and Duration:
Duration is 0.12 s or longer, bizarre shape
and abnormal, P Wave: Visibility of P wave
depends on the timing of the PVC; may be
absent or in front of QRS. If the P wave
follows the QRS, the shape of the P wave
may be different, PR Interval: If the P wave
is in front of the QRS, the PR interval is less
than 0.12 s, P:QRS- 0:1, 1:1
ECG:
Ventricular and Atrial Rate: Atrial rate:
depends on the underlying cause , VR: 100200, Ventricular and Atrial Rhythm:
Usually regular, QRS Shape and Duration:
Duration is 0.12 s or more, P Wave: difficult
to detect, PR Interval: Very Irregular ,
P:QRS- Difficult to determine
ECG:
Ventricular Rate: >300 bpm, Ventricular
Rhythm: Extremely irregular, QRS Shape
and Duration: Duration is 0.12 s or more,:
Irregular,
undulating
waves
without
recognizable QRS complex
ECG:
Absent QRS complex, P waves maybe
apparent for short duration
Epinephrine
Na HCO3 to relieve lactic acidosis
which causes unsuccessful
defibrillation
CARDIAC DISORDER
PATHOPHYSIOLOGY
ANGINA PECTORIS
-
clinical
syndrome
usually
characterized
by
episodes
or
paroxysms of pain or pressure in the
anterior chest. The cause is usually
insufficient coronary blood flow.
ASSESSMENT FINDINGS
Angina Pectoris
Heart Failure
ECG abnormalities
INTERVENTIONS
Controlling Cholesterol
MEDICATIONS
3Hydroxy-3methylglutaryl
Abnormalities
coenzyme A (HMG-CoA)
CABG
Dietary Measures
Dysrythmias
Treatment
1. Percutaneous Transluminal
Coronary Angioplasty
2. Percutaneous Transluminal
Revascularization (PTMR)
Vasodilators (Nitrates)
Beta- adrenergic blockers
Calcium channel blockers
Platelet Aggregation Inhibitors
Anticoagulants
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MYOCARDIAL INFARCTION
formation of localized necrotic
areas within the myocardium.
Prolonged ischemia lasting more
than 35 45 minutes produces
irreversible cellular damage and
necrosis of the myocardium
3.
4.
Intravascular Stenting
Laser therapy
Surgical Management:
1. Coronary Artery Bypass Graft (CABG)
Nursing Interventions:
1. Diet- Low Na, low fat and low
cholesterol, high fiver
2. Avoid saturated fats
3. White meat- chicken without
skin, fish are low in saturated
fats
4. No restrictions are placed on
activity within the patients
limitations
CLINICAL MANIFESTATIONS
Pain described as transient, paroxysmal
substernal or precordial pain. Heaviness
or tightness of the chest, indigestion,
crushing, Radiates down both arms, left
shoulder, jaw, neck and back. Precipitated
by activity or exertion and relieve by rest
or nitroglycerine
Diaphoresis
Dyspnea
Pallor
Faintness
Palpitations
Dizziness
Digestive Disturbance due to vagal
simulation
Medical Management:
1.
Goals
a. Prevention of further tissue
injury and limitation of infarct
size
b. Maximize myocardial tissue
perfusion and reduce
myocardial tissue demands
2.
Supplemental O2 by nasal
cannula. This increases
myocatdial O2 supply and relieves
pain
3.
Cardiac monitoring to detect
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CARDIAC DISORDER
PATHOPHYSIOLOGY
4.
5.
6.
ASSESSMENT FINDINGS
dysryhythmias
PTCA may be done to reopen an
occluded artery
Diet: low cholesterol, low salt
Bed rest is usually prescribed for
24-48 hours to o2 demand.
Progressive ambulation is
implemente4ted ASAP, unless
there are complications
Nursing Management
1. Promote oxygenation and
tissue perfusion
2. Promote adequate Cardiac
Output
3. Promote Comfort
4. Provide rest
5. Promote gradual in activity
6. Promote Proper Nutrition and
Elimination
7. Promote Relief of Anxiety and
Feeling of Well-Being
8. Facilitate learning
INTERVENTIONS
MEDICATIONS
Maybe asymtomatic
fatigue, shortness of breath
light-headedness, dizziness,
syncope, palpitations, chest
pain and anxiety
Physical Examination of the heart
discloses an extra heart sound
referred as mitral click
Symptoms of Heart Failure
Medical Management:
1. Symptomatic
2. Advised to eliminate caffeine
and alcohol
3. Stop smoking
Surgical Intervention
1. Mitral Valve Repair or
Replacement in advanced
stages
Nursing Management:
1. Health education
2. Instruct patients to take the
3.
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4.
5.
MITRAL STENOSIS
AORTIC REGURGITATION
-
Medical management
1. Antibiotic prophylaxis therapy
2. Treat CHF
Medical Management
1. Antibiotic prophylaxis
2. Treat dysrythmias and HF
Asyymptomatic
forceful heart beat
marked arterial pulsations that are
palpable
exertional Dyspnea
fatigue
Surgical Management:
1. Valvuloplasty
2. Mitral Valve Replacement
Prophylactic Antibiotics
Anticoagulants - Warfarin
(Coumadine)
Nursing Management:
1. Health education
2. Instruct patients to take the
prescribed medications on time
and complete the drug
3. Tell the patients to avoid
caffeine and alcohol
4. Encourage the patient to read
drug labels carefully
5. Explore with the patients
possible diet, activity, sleep
and other lifestyle
Surgical Management:
1. Aortic valvuloplasty
2. Valve Replacement
Nursing Intervention:
1. Health education
2. Instruct patients to take the
prescribed medications on time
and complete the drug
3. Tell the patients to avoid
caffeine and alcohol
Prophylactic Antibiotics
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AORTIC STENOSIS
aortic valve is narrowing of the
orifice between the left ventricle and the
aorta.
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Asymtomatic
exertional Dyspnea
dizziness and syncope
angina pectoris
Low BP
rough-loud systolic murmur is heard in the
aortic area
systolic crescendo-decrescendo murmur
LVH- 12 lead ECG
2D-Echo- diagnose and monitor the
progression
Pressure tracings form the aorta
higher systolic pressure in the LV than
the aorta during systole
4.
5.
MEDICAL MANAGEMENT
1. Antibiotic prophylaxis to
prevent endocarditis
SURGERY: replacement of aortic valve
Patients who are symptomatic and
are not surgical candidates may
benefit form 1 or 2 balloon
Percutaneous Valvuloplasty
CARDIAC DISORDER
IV. CADIOMYOPATHY
-
PATHOPHYSIOLOGY
Stroke Volume SNS and RAA
Systemic Vascular Resistance
Na and water retention workload of
the heart Heart Failure
ASSESSMENT FINDINGS
stable and asymptomatic
signs and symptoms of Heart Failure
PND
orthopnea
fluid retention
peripheral edema
nausea
chest pain
palpitations
dizziness
syncope with exertion
sudden death with HCM
Tachycardia and extra heart sounds
2D Echo and ECG
CXR
Cardiac Cath to rule out coronary artery
disease as a cause
Endomyocardial biopsy
INTERVENTIONS
Medical management:
1. Treat the underlying cause
2. Low Na diet
3. Exercise Rest Regimen
4. Control dysrythmias with
medications
5. If there are symptoms of CHF
limit fluid intake into 2 L/day
6. Pacemaker
MEDICATIONS
Antidysythmic drugs for dysrythmia
Surgical Management
1. Heart Transplantation
2. LVAD
3. Left Ventricular Outflow Tract
Surgery
Nursing Management
1. Improve CO
2. Increase activity tolerance
3. Reduce anxiety
4. Decrease the sense of
powerlessness
5. Promote Self-Care
6. Promote Home and
Community-Based care
7. Continuing Care
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Analgesics
NSAIDS
Cortocosteroids
4.
INFECTIVE ENDOCARDITIS
-
pharmacotherapy
Assist in pericardiocentesis
Antibiotic therapy
Antipyretics
Nursing Management:
Monitor vital signs
Assess signs of organ damage
Administer pharmacotherapy
Instruct activity restrictions,
medications and signs and
symptoms of infection
Emotional support
Coping strategies
If patient received surgical
management, strict post-op
care is observed
MYOCARDITIS
- is an inflammatory process involving
the myocardium. Myocarditis can cause
heart dilation, thrombi on the heart wall,
infiltration of circulating blood cells
around coronary vessels and between
the muscle fibers.
chest pain
dysrythmias
cardiomegaly
faint heart sounds
gallop rhythm
systolic murmur
Antibiotic therapy
corticosteroids
Antipyretics
CARDIAC DISORDER
PATHOPHYSIOLOGY
ASSESSMENT FINDINGS
Left CHF
Dyspnea
PND
Orthopnea
Rales /Crackles
Moist cough
wheezing
blood tinged frothy sputum
syncope
fatigue
weakness
anorexia
hypokalemia
clubbing of fingers
polycythemia
S3,S4 sounds, pulsus alternans
PAO, PWCP, LVEDP
Right CHF
CARDIOGENIC SHOCK
(POWER/PUMP FAILURE)
MASSIVE MI Myocardial
Contractility CO Hypoperfusion
(heart, brain , kidney) Tissue Hypoxia
Organ Damage Death
1.
2.
3.
4.
INTERVENTIONS
Oxygen therapy
balanced program of activity
and rest
Sodium restricted to prevent
fluid excess
MEDICATIONS
Digitalis Therapy
Diuretic Therapy
Vasodilators
Vasodilators
Inotrophic Agents
Diuretics
Nursing Management
Provide Oxygenation
Provide rest and activity
Decrease anxiety
Facilitate fluid balance
Provide skin care
Promote proper nutrition
Promote elimination
Facilitate learning
6.
7.
8.
CARDIAC DISORDER
PATHOPHYSIOLOGY
ASSESSMENT FINDINGS
arrhythmias
Provide psychosocial support
Decrease pulmonary edema
Utilize counterpulsation to
decrease ventricular work with
severe shock
INTERVENTIONS
MEDICATIONS
ARTERIOSCLEROSIS
Prevention
a. Primary
Moderation in Na intake,
saturated fats, maintenance of
IBW, maintenance of regular
pattern of exercise, cessation of
cigarette smoking, moderation
in alcohol consumption, stress
reduction
b. Secondary
Control of HPN in high risk
groups
1.
Diuretics
a.
Thiazides
b.
Loop
c.
Potassium sparing
Adrenergic Inhibitors
a.
Beta Adrenergic
Blockers
b.
Centrally acting
alpha blockers
c.
Peripherally acting
Adrenergic
antagonists
d.
Alpha-1 adrenergic
blockers
e.
Vasodilators
f.
ACE Inhibitors
g.
Calcium Channel
Blockers
2.
NURSING INTERVENTIONS:
1. Patient teaching and
counseling
2. Teaching about medication
3. Prevent non-compliance
Intermittent claudication is an
aching, persistent cramplike
squeezing pain that occurs after a
certain amount of exercise of the
affected extremity. It is relieved by
rest
Coldness or cold sensitivity
Color changes
Ulceration and gangrene
Edema
Sexual dysfunction
SURGICAL MANAGEMENT
1. Bypass Graft
Vasodilators
Antihyperlipidemics
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2.
3.
4.
5.
6.
7.
Endarterectomy
Endovascular Surgery
Balloon angioplasty
Laser angioplasty
Stent
Amputation
NURSING INTERVENTION
1. Promote Tissue Perfusion
2. Maintain Skin Integrity and
Prevent Infection
3. Promote Activity
4. Prevent Injury
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
AORTIC ANEURYSM
intermittent Claudication
Coldness or cold sensitivity
Color changes
Ulceration and gangrene
Sexual dysfunction
Impaired arterial pulsation
Edema
MEDICAL MANAGEMENT
Exercise Program combined
with weight reduction and
cessation of tobacco and
alcohol use
Vasodilators
Antihyperlipidemics
Antihypertensives
SURGICAL MANAGEMENT
Bypass Graft
Endarterectomy
Endovascular Surgery
Balloon angioplasty
Laser angioplasty
Stent
Amputation
MEDICAL MANAGEMENT
1. Medications
Surgery:
If greater than 4 cm
Teflon/Dacron/gortex graft may be used
in a surgical repair
NURSING INTERVENTION AFTER
SURGERY:
1. Monitor VS and hemodynamic
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RAYNAUDS DISEASE
pallor
cyanotic
color sequence: white-blue-red
numbness, tingling and burning
pain
MEDICAL MANAGEMENT
Avoid exposure to cold
Quit smoking
Teach effects of smoking
Teach to avoid exposure to
cold
Discuss importance of
reducing emotional stress
Avoid drugs that causes
vasoconstriction such as pills,
beta blockers and ergotamines
NSAID
Non-narcotic analgesic
Anticoagulation therapy
Thrombolytics
Surgery
1. Amputation - Sympathectomy to
relieve vasospastic symptoms
THROMBOPHLEBITIS
pain
tenderness
palpable induration along the
course of vein
no edema
MEDICAL MANAGEMENT;
Bed rest with leg elevation
Local moist heat application
Compression support
stockings
NURSING INTERVENTIONS:
Prevent venous stasis
Prevent recurrence
Maintain IBW
Alternate standing with sitting
at work or at home
Regular Patterns of exercise
MEDICAL MANAGEMENT:
Minimize intake of green leafy
vegetables
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VARICOSE VEINS
BUERGERS DISEASE
(Thromboangitis Obliterans)
SURGERY:
Thromboembolectomy
Greenfield vena cava fiber to
prevent pulmonary embolism
NURSING INTERVENTIONS:
Maintaining tissue perfusion
Promote comfort
Intermittent Claudication
Skin Cyanosis
Pain
1.Analgesics as ordered
Anticoagulants
Calcium Channel Blockers
MEDICAL MANAGEMENT:
Elevation of affected limp for
15-30 min at a time. Average
of 20 min.]
Compression with support
stockings
Sclerotherapy
Early ambulation
SURGERY:
1. Vein ligation and stripping to
relive pain
NURSING INTERVENTION
1. Wear elastic stockings during
activities requiring long periods
of standing or during
pregnancy
2. Moderate exercise and elevate
the legs during sitting
3. Proper post-operative care
Medical Management:
1. eliminate smoking
Surgery:
1. Sympathectomy
2. Amputation of ulcerated fingers
and toes
Nursing Management:
1. during activities requiring long
periods of standing or during
2.
3.
pregnancy
Moderate exercise and elevate
the legs during sitting
Proper post-operative care
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