Saint Louis University

School of Nursing
Baguio City

DEFINITION
NYHA FUNCTIONAL
CLASSIFICATION
WARNING SIGNS & SYMPTOMS
PREDISPOSING FACTORS
COMPLICATIONS
QOL MANAGEMENT
DEFINITION
♥ CARDIOVASCULAR
DISEASE
Cardiovascular diseases
(CVD) are diseases of the
circulatory system which
includes all disease of the
heart and blood vessels.

♥ QUALITY OF LIFE
Quality of life (QOL) is an
overall general well-being that is
determined through a patient’s
self-reports on how he/she is
satisfied on matters that are
important to him/her in relation
to QOL domains: health &
functioning, socioeconomic,
psychoemotional and family
domains.
NYHA FUNCTIONAL CLASSIFICATION
In 1928 the New York Heart Association published a
classification of patients with cardiac disease based on clinical
severity and prognosis.
Parameters:
♥ Limitations on physical activity
♥ Symptoms with ordinary physical activity (undue fatigue,
shortness of breath [SOB] palpitations dyspnea and/or
anginal pain)
♥ Status at rest
 Class I Class II Class III Class IV
Limitations Severe/
on Physical Unable to
Activity None Slight Marked perform any
physical
activity
Symptoms None Symptomatic Symptomatic Discomfort
with (No shortness with ordinary at less than with any
Ordinary of breath activities ordinary activity.
Physical upon: (Mild activities (Severe
Activity walking shortness of (Shortness of shortness of
regular pace breath upon: breath upon: breath: cannot
on level walking at a walking at a even tolerate
indefinitely; distance of up distance of walking
climbing 1 or to 200m; less than around the
2 flights of climbing up 1 200m; house;
stairs without flight of stairs climbing 1 inability to
stooping, slowly; doing flight of perform any
doing household stairs half- household
household chores and way; doing chores or
chores- ADLs) household ADLs; mostly
washing, chores and bed-bound
laundry; ADLs) patients)
doing
activities of
ADLs-taking
a shower,
getting
dressed)
Status at Comfortable Comfortable Comfortable Symptomatic
Rest (fatigue, dyspnea)
WARNING SIGNS & SYMPTOMS
CARDIAC SIGNS AND SYMPTOMS
Patients with cardiovascular disorders commonly have one or
more of the following signs and symptoms:

Act fast, call for an emergency!

PREDISPOSING FACTORS

Non-Modifiable Risk Factors

a) Age
♥ Aging increases the risk of damaged and narrowed
arteries and weakened or thickened heart muscle.
 b) Sex
♥ Men are generally at greater risk of heart disease.
However, women's risk increases after menopause.

c) Family history
♥ A family history of heart disease increases the risk of
coronary artery disease.

d) Race
♥ Filipinos have the second highest risk of CVD among
Asians.
Modifiable Risk Factors
a) Smoking
♥ Nicotine constricts
blood vessels, and
carbon monoxide can
damage their inner
lining, making them
more susceptible to
atherosclerosis.
♥ Management: Smoking cessation

b)High blood pressure, High blood cholesterol levels and

Obesity
♥ Uncontrolled high blood pressure can result in hardening
and thickening of arteries, narrowing the vessels through
which blood flows.
♥ High levels of cholesterol in the blood can increase the
risk of formation of plaques and atherosclerosis
♥ Management: medications, proper diet, exercise
MEDICATIONS
Cholesterol Lowering Drugs
♥ Used to lower LDL (”bad”) cholesterol, raise HDL
(”good”) cholesterol and lower triglyceride levels
♥ Include statins, resins and nicotinic acid (niacin),
gemfibrozil and clofibrate.

Blood Pressure Drugs

♥ Used to lower blood pressure.
♥ Used with therapy for cardiac arrhythmias (abnormal
heart rhythms) and in treating chest pain (angina).

Diuretics
♥ Used to help lower blood pressure. Used to help reduce
swelling (edema) from excess build-up of fluid in the
body.
PROPER DIET
GOOD NUTRITION
Eating a nutritious, well-balanced diet is one of the simplest,
most effective ways to reduce risk of CVD complications by
lowering cholesterol level and blood pressure and help to lose
or maintain ideal weight.
The Mediterranean Diet - Promoting Cardiovascular
Health
People around the Mediterranean Sea have long been known
to live longer and suffer fewer cancers and cardiovascular
ailments. Their diet—the Mediterranean diet—has long been
touted as heart-healthy and now the longest and most
scientific research study into the diet has confirmed it.
 c) Physical inactivity
♥ Lack of exercise also is
associated with many forms of
heart disease and some of its
other risk factors, as well.
♥ Management: Exercise

d)Other Illness: Diabetes

♥ Diabetes increases your
risk of heart disease. Both conditions share similar
risk factors, such as obesity and high blood pressure.
♥ Management: Proper diet, Exercise, DM medications

COMPLICATIONS
Heart Failure
♥ Occurs when the heart cannot
adequately pump blood
throughout the body.
♥ Can cause shortness of breath,
dizziness, confusion, and the
build-up of fluid in the body,
causing swelling.

Heart Attack
♥ Occurs when the coronary arteries narrow so much that
they cut off blood supply to the heart.
♥ Heart cells begin to die as they are deprived of oxygen.
♥ Symptoms include shortness of breath and severe chest
pain that may radiate to the back, jaw, or left arm.
Stroke
♥ When the heart isn’t working effectively, blood clots are
more likely to form in the blood vessels.
♥ A stroke occurs when one of these clots lodges in a blood
vessel in the brain and cuts off blood flow. Stroke
symptoms include:
 numbness on one  trouble speaking
side of the body  loss of balance or
 confusion coordination

Pulmonary Embolism

♥ Similar to a stroke,
but the blocked blood
vessel is in the lungs
instead of the brain.
♥ Symptoms include
shortness of breath, chest
pain on breathing, and
bluish skin.
Aneurysm
♥ A bulge in the wall of the artery.
♥ If an aneurysm bursts, may result to a life-threatening
internal bleeding.
Peripheral Artery Disease (PAD)
♥ Narrowing in the arteries that supply blood to the arms
and legs.
♥ The main symptom of PAD is severe leg pain when
walking.
Sudden Cardiac Arrest
♥ Occurs when the heart suddenly stops beating.
♥ Usually caused by an electrical disturbance in the heart.
♥ This will lead to DEATH if not treated immediately.

QOL MANAGEMENT
FAMILY ASPECT
♥ Reinforce family
support.
Eg. Find time to
spend time with
family, going on a
family outing

PSYCHOEMOTIONAL & SPIRITUAL ASPECT

♥ Respect and support
spiritual beliefs
Eg. Pray with the client;
boost self-confidence of the
client.
♥ Teach stress and time
management
STRESS MANAGEMENT
Meditation ♥ Promotes relaxation which creates
Stress reduction an anti-stress mechanism within
techniques the body.
Yoga ♥ Slows down heart rate and
Biofeedback decreases BP
Hypnosis and ♥ Gives time for the body to gather
imagery strength and boost energy
TIME
MANAGEMENT
 Plan activities
ahead of time
 Cluster activities
 SOCIOECONOMIC
ASPECT
♥ Maintaining social
contact
Eg. Get involve with the
different social organizations,
take time mingling with
friends.

HEALTH & FUNCTIONING ASPECT

♥ Reinforce coping
mechanisms to manage
physical symptoms
Eg. DBE, Take medications
Avoid tobacco, Be active, Good
Nutrition, Stress management
techniques
CARDIAC MEDICATIONS
Blood Thinners
♥ Helps to prevent harmful clots from forming in the blood
vessels.
♥ May prevent the clots from becoming larger and causing
more serious problems.
♥ Enoxaparin (Lovenox), Heparin (various) and Warfarin
(Coumadin)
Antiplatelet drugs
♥ Helps prevent clotting in patients who have had a heart
attack, unstable angina and other forms of CVD.
♥ Usually prescribed preventively, when plaque build-up is
evident but there is not yet a large obstruction in the
artery.
♥ Aspirin, Clopidogrel (Plavix)
Other Cardio Drugs
♥ Vasodilators
 Used to ease chest pain (angina).
 Also known as Nitrates.
 Commonly prescribed include: Isosorbide dinitrate
(Isordil), Nesiritide (Natrecor), Hydralazine
(Apresoline), Nitrates and Minoxidil

♥ Glycosides
 Used to relieve heart failure symptoms, especially
when the patient is not responding to ACE inhibitors
and diuretics. Also slows certain types of irregular
heartbeat (arrhythmias)
 Digoxin
 Common Cardiovascular Drugs Can Deplete Critical
Nutrients in the Body

**nutrient supplementation for the depleted nutrients should be taken as prescribed by the
physician
COMPLEMENTARY and ALTERNATIVE MEDICINES
Herbal Agents
a. Garlic
 Inhibits platelet aggregation
b. Ginkgo biloba
 Inhibits platelet activating factor
c. Ginseng
 Decreases BP (taken in low doses)
Biologically-based
a. Vitamin E
 Anti-oxidant; may protect against
oxidative stress and inflammatory process in
CVD
 Slow or stop the plaque-forming
process
 Food Sources: Sunflower seeds,
Almonds, Spinach, Avocado, Peanuts,
Asparagus, Mustard

b. Coenzyme Q10
 Anti-oxidant and free radical
scavenger; used to treat heart
failure, hypertension, and
myopathies
 Food Sources: Fish, Organ meats
(including liver, kidney & heart),
Whole wheat germ, Broccoli
 c. L- carnitine
 Involved in cellular energy
production, supplement in nutritional
deficiency, possible role in heart failure
and myocardial infarction
 Food Sources: Red meat, Nuts &
Seeds

d. Omega 3
 Decrease the risk of arrhythmias
 Decrease triglyceride levels
 Slow the growth rate of fatty plaque in the arteries
 Lower blood pressure (slightly)
 Food sources: Flaxseeds, Walnuts, Sardines,
Salmon, Beef, Soybeans, Tofu, Shrimp, Brussels
sprouts, Cauliflower

♥ Teach importance of maintaining positive affect despite

disease.
References
American Heart Association. (2012). Cardiac medications at a glance. Cardiology.

Boudi, F. B., Subhi Ali, Y. (2014). Risk factors for coronary artery disease. Medscape.

Cocchiarella, L., Andersson, G.B.J. (2001). Guides to the evaluation of permanent

impairment. 5th ed. American Medical Association.

Felce, D., & Perry, J. (1997). Defining and applying the concept of quality of life.
Journal of Intellectual Disability Research.

Miller, K. L., Liebowitz, R. S., Newby, L. K., Durham, N. C. (2003). Complementary

and alternative medicine in cardiovascular disease: A review of biologically based
approaches. Curriculum in Cardiology.

Raphael, C.; Briscoe, C.; Davies, J.; Whinnett, Z. I.; Manisty, C.; Sutton,R.; Mayet, J.;
Francis, D. P. (2007). Limitations of the New York Heart Association functional
classification system and self-reported walking distances in chronic heart failure. Heart
failure and cardiomyopathy.

Riley, K. (2010). What is heart disease? How do I prevent heart disease? American Heart
Month. American Heart Association.

Sinatra, S. T. (2014). For optimal cardio-protection & total body support. Alternative and
Integrative Medicine.

Texas Heart Organization. (2014). It’s all about eating right. HeartiFacts.

Author: Charmaine A. Baniqued, RN