🛌Adult Nursing Care Unit 4 – Cardiovascular Disorders

Anatomy and Physiology Review

• The cardiovascular system consists of the heart, blood vessels (arteries, veins, and capillaries), and blood
• The heart has four chambers: right atrium, right ventricle, left atrium, and left ventricle
  • Atria receive blood from the body (right) and lungs (left)
  • Ventricles pump blood to the lungs (right) and body (left)
• Cardiac cycle includes systole (contraction) and diastole (relaxation) of the heart chambers
• Coronary arteries supply oxygenated blood to the heart muscle (myocardium)
  • Left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA) are the main coronary arteries
• Electrical conduction system of the heart controls the heartbeat
  • Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, bundle branches, and Purkinje fibers
• Baroreceptors in the aortic arch and carotid sinuses help regulate blood pressure
• Cardiac output $(CO) = Stroke Volume (SV) × Heart Rate (HR)$

Common Cardiovascular Disorders

• Coronary artery disease (CAD) occurs when plaque builds up in the coronary arteries, reducing blood flow to the heart
  • Can lead to angina (chest pain) or myocardial infarction (heart attack)
• Heart failure (HF) is the inability of the heart to pump enough blood to meet the body's needs
  • Can be classified as left-sided, right-sided, or biventricular
• Hypertension (high blood pressure) is a persistent elevation of blood pressure above 130/80 mmHg
• Arrhythmias are abnormal heart rhythms, such as atrial fibrillation (AFib), ventricular tachycardia (VT), and bradycardia
• Valvular heart disease involves dysfunction of the heart valves (mitral, aortic, tricuspid, or pulmonary)
  • Can be caused by stenosis (narrowing) or regurgitation (leaking)
• Peripheral artery disease (PAD) is the narrowing of arteries in the legs, arms, or other parts of the body
• Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE)

Risk Factors and Prevention

• Non-modifiable risk factors for cardiovascular disease include age, gender, family history, and race/ethnicity
• Modifiable risk factors include smoking, obesity, physical inactivity, unhealthy diet, and stress
  • Controlling these factors can help prevent or delay the onset of cardiovascular disorders
• Hypertension, diabetes, and dyslipidemia (abnormal cholesterol levels) are also significant risk factors
• Regular exercise (at least 150 minutes per week) and maintaining a healthy weight can reduce cardiovascular risk
• Eating a balanced diet low in saturated and trans fats, sodium, and added sugars can promote heart health
  • Diets rich in fruits, vegetables, whole grains, lean proteins, and healthy fats (Mediterranean diet) are recommended
• Stress management techniques like meditation, deep breathing, and yoga can help reduce stress-related risk factors
• Regular check-ups with a healthcare provider can help identify and manage risk factors early

Signs and Symptoms

• Chest pain or discomfort (angina) is a common symptom of CAD
  • Can be described as pressure, squeezing, fullness, or pain in the center of the chest
• Shortness of breath (dyspnea) can occur with heart failure, valvular heart disease, or pulmonary embolism
• Palpitations (feeling of skipped, rapid, or pounding heartbeats) may indicate an arrhythmia
• Fatigue and weakness can be signs of heart failure or anemia related to cardiovascular disorders
• Swelling (edema) in the legs, ankles, or feet can be a sign of heart failure or venous insufficiency
• Syncope (fainting) or lightheadedness may occur with arrhythmias or valve disorders
• Cyanosis (bluish discoloration of the skin) can indicate poor oxygenation due to heart or lung problems
• Claudication (leg pain with walking) is a common symptom of peripheral artery disease

Diagnostic Tests and Procedures

• Electrocardiogram (ECG or EKG) records the heart's electrical activity
  • Can detect arrhythmias, ischemia, or signs of a previous heart attack
• Echocardiogram uses ultrasound to visualize the heart's structure and function
  • Assesses chamber sizes, wall thickness, valve function, and ejection fraction (EF)
• Stress tests evaluate the heart's response to physical exertion or pharmacological stress
  • Can be performed with ECG, echocardiography, or nuclear imaging
• Cardiac catheterization involves inserting a catheter into the heart to measure pressures and visualize coronary arteries
  • Coronary angiography can identify blockages in the coronary arteries
• Blood tests can detect cardiac biomarkers (troponin, BNP), lipid levels, and other risk factors
• Holter monitor is a portable ECG device worn for 24-48 hours to detect intermittent arrhythmias
• Computed tomography (CT) and magnetic resonance imaging (MRI) can provide detailed images of the heart and vessels

Treatment Options

• Lifestyle modifications, such as diet, exercise, and stress management, are essential for all cardiovascular disorders
• Medications can help manage symptoms and prevent complications
  • Antiplatelets (aspirin, clopidogrel) and anticoagulants (heparin, warfarin) prevent blood clots
  • Beta-blockers, ACE inhibitors, and ARBs help control blood pressure and protect the heart
  • Statins and other lipid-lowering agents reduce cholesterol levels
  • Diuretics (furosemide, bumetanide) reduce fluid overload in heart failure
• Revascularization procedures restore blood flow to the heart or other affected areas
  • Percutaneous coronary intervention (PCI) involves using a stent to open blocked coronary arteries
  • Coronary artery bypass grafting (CABG) surgically bypasses blocked arteries using grafts from other vessels
• Valve repair or replacement surgery may be necessary for severe valvular heart disease
• Pacemakers and implantable cardioverter-defibrillators (ICDs) can help manage arrhythmias
• Cardiac rehabilitation programs provide supervised exercise, education, and support after a cardiac event

Nursing Interventions and Care

• Assess vital signs, including blood pressure, heart rate, and oxygen saturation, regularly
• Monitor for signs and symptoms of complications, such as chest pain, shortness of breath, or arrhythmias
• Administer medications as prescribed and educate patients about their proper use and potential side effects
• Assist with diagnostic tests and procedures, ensuring patient comfort and safety
• Provide wound care and dressing changes for surgical incisions (CABG, valve surgery)
• Monitor fluid balance, intake, and output in patients with heart failure
• Encourage early ambulation and progressive activity to prevent complications and promote recovery
• Collaborate with the multidisciplinary team (physicians, dietitians, physical therapists) to provide comprehensive care
• Offer emotional support and reassurance to patients and their families

Patient Education and Lifestyle Modifications

• Teach patients about their specific cardiovascular disorder, its causes, and potential complications
• Emphasize the importance of medication adherence and provide strategies for remembering to take medications
• Educate patients on the signs and symptoms of worsening condition and when to seek medical attention
• Encourage smoking cessation and provide resources for quitting (nicotine replacement therapy, support groups)
• Teach heart-healthy diet principles, including limiting saturated and trans fats, sodium, and added sugars
  • Encourage consumption of fruits, vegetables, whole grains, lean proteins, and healthy fats
• Stress the importance of regular physical activity and help patients set achievable exercise goals
  • Recommend starting with low-intensity activities and gradually increasing duration and intensity
• Teach stress management techniques, such as deep breathing, meditation, or yoga
• Encourage patients to attend cardiac rehabilitation programs and support groups
• Emphasize the importance of regular follow-up with healthcare providers to monitor progress and adjust treatment plans as needed