CARDIOV DEFINITION & ETIOLOGY PATHOPHYSIOL CLINICAL DIAGNOSTIC EXAM COMPLICATIONS COLLABORATIVE CARE NURSING

ASCULAR CLASSIFICATION OGY AND FINDINGS MANAGEMENT

DISEASE MANIFESTATION
S

Hypertensi -also known as - number of BP rises with any -Severe Routine urinalysis -Heart attack or Periodic monitoring of BP  -Periodic monitoring
on high or raised factors increase in CO or headaches. Basic metabolic panel stroke. • Home BP monitoring of BP
blood pressure, is increase BP, SVR. Increased Nosebleed. (serum glucose, Aneurysm. • Ambulatory BP monitoring  Home BP
a condition in
including (1) CO is sometimes sodium, potassium, (if indicated) monitoring
Fatigue or Heart failure.
which the blood obesity, (2) found in the chloride, • Every 3-6 mo by health
confusion. Weakened and  • Ambulatory BP
vessels haveinsulin person with carbon dioxide, BUN, care provider once BP is
Vision narrowed blood monitoring (if
persistently raisedresistance, (3) prehypertension. and creatinine) stabilized
problems. vessels in your indicated)
pressure. high alcohol Later in the course Complete blood count Nutritional therapy (see
intake, (4) high of hypertension, Chest pain. Serum lipid profile kidneys. eTable 33-1)  Every 3-6 mo by
salt intake (in the SVR rises and (total lipids, Thickened, • Restrict salt and sodium health care provider
Difficulty
-Can be primary or salt-sensitive the CO returns to triglycerides, HDL and narrowed or torn blood • Restrict cholesterol and once BP is
breathing.
secondary patients), (5) normal. the LDL cholesterol, vessels in the eyes. saturated fats stabilized
hypertension Irregular
aging and hemodynamic total-to-HDL Metabolic • Maintain adequate intake  Nutritional therapy
heartbeat.
perhaps (6) hallmark of cholesterol ratio) syndrome. of potassium (see eTable 33-1)
Blood in the
sedentary hypertension is Serum uric acid Trouble with • Maintain adequate intake  Restrict salt and
urine.
lifestyle, (7) persistently 12-lead memory or of calcium and magnesium sodium
stress, (8) low increased SVR. electrocardiogram understanding. Weight management  Restrict cholesterol
potassium this persistent (ECG) Regular, moderate and saturated fats
Dementia.
intake, and (9) elevation in SVR physical activity
 Maintain adequate
low calcium may occur in
intake of potassium
intake. various ways.
 Maintain adequate
intake of calcium
and magnesium
 Weight
management
 Regular, moderate
physical activity
Angina refers to chest - Myocardialis usually caused  shortness of  History and physical heart attack, Drug therapy  Reducing
pain that occurs by obstruction of at breath. examination sudden death caused • Antiplatelet therapy (e.g., anxiety. Explori
intermittently over ischemia, least one large by abnormal heart aspirin,
 nausea. ng implications
a long period with usually epicardial coronary rhythms, and clopidogrel [Plavix])
 fatigue. ECG (12-lead)
the same pattern secondary to artery with unstable angina • Nitroglycerin that the
of onset, CAD atheromatous  dizziness. • ACE inhibitors, ARBs diagnosis has
Chest x-ray
plaque, resulting in  profuse • β-adrenergic blockers for the patient
duration, and a mismatch sweating. Exercise stress tests • Calcium channel blockers and providing
intensity of Coronary between  anxiety. • Lipid-lowering drugs† information
symptoms. Vasospasm myocardial oxygen  Chest pain Echocardiogram Management of risk factors
demand vs. supply for coronary about the
that precipitates artery disease‡ illness, its
Nuclear imaging
Chronic ischemia. Coronary revascularization treatment, and
Myocardial studies
stable • Percutaneous coronary methods of
angina ischemia intervention (PCI)
Electron beam CT preventing its
secondary • Coronary artery bypass
scan progression are
Prinzmetal’s tomicrovascula graft (CABG) surgery
Angina important
r disease Positron emission nursing
affecting tomography
Microvascular interventions.
angina the small, distal
branches of the Coronary angiography  Preventing
 coronary pain. The nurse
arteries Laboratory studies: reviews the
assessment
• Cardiac troponin
findings,
Rupture of identifies the
thickened • CK-MB
plaque, level of activity
exposing • Myoglobin that causes the
thrombogenic patient’s pain,
surface • Lipid panel and plans the
patient’s
activities
• CBC accordingly.
 Decreasing
• C-reactive protein
oxygen
• Homocysteine demand. Balan
Exercise ECG  cing activity and
rest is an
important
aspect of the
educational
plan for the
patient and
family

Myocardia is used In an MI, an Vasospasm. This Chest pain ECG. ST elevation rrhythmic  Administer
l synonymously area of the is the sudden Shortness of signifying ischemia; complications, mecha Concurrent drug therapy oxygen along
Infarction myocardium is constriction or peaked upright or nical complications, • Antiplatelet therapy
with coronary breath with medication 
permanently narrowing of the inverted T wave left • Anticoagulation therapy
occlusion and destroyed coronary artery. Indigestion indicating injury; ventricular aneurysm f Emergent reperfusion therapy to
heart attack, yet because development of Q ormation, ventricular therapy assist with relief
MI is the most plaque rupture Decreased oxygen Tachycardia and waves signifying septal rupture, • PCI of symptoms.
and supply. The tachypnea prolonged ischemia or associated right • Thrombolytic therapy*
preferred term as
subsequent decrease in Fever necrosis. ventricular infarction, • CABG surgery  Encourage bed
myocardial oxygen supply
thrombus ventricular rest with the
ischemia causes occurs from acute
formation result Cardiac enzymes and pseudoaneurysm, and back rest
acute coronary in complete blood loss, other issues.
anemia, or low isoenzymes. CPK-MB elevated to help
syndrome (ACS) occlusion of the
blood pressure. (isoenzyme in cardiac decrease chest
that can result in artery. muscle): Elevates discomfort and
myocardial death. The spectrum Increased demand within 4–8 hr, peaks in
dyspnea.
of ACS for oxygen. A rapid 12–20 hr, returns to
includes heart rate, normal in 48–72 hr.  Encourage
unstable thyrotoxicosis, or changing of
angina, non- ingestion of
LDH. Elevates within positions
ST-segment cocaine causes an
8–24 hr, peaks within frequently to
elevation MI, increase in the
72–144 hr, and may
and ST- demand for help keep fluid
take as long as 14
segment oxygen.
days to return to from pooling in
elevation MI. normal. An LDH1 the bases of
greater than LDH2 the lungs.
 (flipped ratio) helps  Check skin
confirm/diagnose MI if temperature
not detected in acute
and peripheral
phase.
pulses
frequently to
Troponins. Troponin I
(cTnI) and troponin T monitor tissue
(cTnT): Levels are perfusion.
elevated at 4–6 hr,
 Provide
peak at 14–18 hr, and
return to baseline over information in
6–7 days. These an honest and
enzymes have supportive
increased specificity manner.
for necrosis and are
therefore useful in  Monitor the
diagnosing patient closely
postoperative MI for changes in
when MB-CPK may
cardiac rate and
be elevated related to
skeletal trauma. rhythm, heart
sounds, blood
Myoglobin. A heme pressure, chest
protein of small pain,
molecular weight that respiratory
is more rapidly status, urinary
released from output, changes
damaged muscle
tissue with elevation in skin color,
within 2 hr after an and laboratory
acute MI, and peak values.
levels occurring in 3–
15 hr.
Sudden is unexpected a sudden Global ischemia  Chest pain Electrocardiogram -Cardiac arrest Drug therapy* Perform CPR
Cardiac death resulting disruption in with or (ECG) • Antiplatelet therapy (e.g., (cardiopulmonary
Death from a variety of cardiac consequences at discomfort. aspirin, resuscitation) and monitor
cardiac causes. function the cellular level  Heart palpita Blood tests clopidogrel [Plavix]) cardiac rhythm.
An estimated produces an that adversely tions. • Nitroglycerin
382,800 people affect organ • ACE inhibitors, ARBs Give 1 mg epinephrine with
abrupt loss of  Rapid or Chest X-ray
experience SCD function after • β-adrenergic blockers an IV or an endotrachial tube
CO and irregular
yearly.1 resuscitation. The • Calcium channel blockers (breathing tube), and repeat
cerebral blood heartbeats.
main Echocardiogram • Lipid-lowering drugs† every 3 - 5 minutes. You can
flow. the consequences  Unexplained Management of risk factors
wheezing. also give vasopressin 40U,
affected person involve direct Nuclear scan for coronary but one time only.
cellular damage  Shortness of  artery disease‡
may or may not breath.
and edema Coronary Coronary revascularization
have a known Continue CPR and
formation  Fainting or catheterization • Percutaneous coronary
history of heart medication until the cardiac
near fainting. intervention (PCI)
disease. SCD rhythm returns to normal or
 Lightheaded • Coronary artery bypass
is the patient expires.
ness or graft (CABG) surgery
often the first dizziness
sign of illness 
for 25% of
those who die
 of heart
disease.30

Coronary is a type of blood  is caused by -Atherogenesis as -Pain or History and physical -Heart failure. Drug therapy (1) position patient upright
Artery vessel disorder plaque buildup a complex discomfort in other examination Over time, CAD can • Antiplatelet therapy (e.g., unless contraindicated
Disease that is included in in the wall of interaction of risk areas of the upper lead to heart failure. aspirin, and administer
and Acute the general the arteries that factors including body including the ECG (12-lead) clopidogrel [Plavix]) supplemental oxygen,
-Abnormal
coronary category of supply blood to cells of the artery arms, left shoulder, heartbeat. – • Nitroglycerin (2) assess vital signs, (3)
Chest x-ray
syndrome atherosclerosis. the heart (calle wall and the blood back, neck, jaw, or • ACE inhibitors, ARBs obtain a 12-lead ECG, (4)
-An abnormal
d coronary and molecular stomach. Exercise stress tests • β-adrenergic blockers provide
heartbeat is called
arteries). messages that -Difficulty • Calcium channel blockers prompt pain relief test with
an arrhythmia.
Plaque is made they exchange. A breathing or shortn Echocardiogram • Lipid-lowering drugs† a nitrate followed by an
up of useful organizing -Chest pain. Management of risk factors opioid
ess of breath. Nuclear imaging
cholesterol theme, which -Heart attack. for coronary analgesic if needed, and
-Sweating or studies
deposits. emerged first from -Sudden death. artery disease‡ (5) auscultate heart and
"cold sweat"
Plaque buildup laboratory studies Electron beam CT -Related arterial Coronary revascularization breath sounds.
causes the and has now Fullness, ind • Percutaneous coronary thee patient will most likely
igestion, or choking scan diseases.
inside of gained currency in intervention (PCI) be distressed and may
the arteries to the clinic, accords feeling (may feel Positron emission • Coronary artery bypass have pale,
narrow over inflammation a like "heartburn") tomography graft (CABG) surgery
time major role in all -Nausea or cool, clammy skin. the BP
stages of vomiting. Coronary angiography Acute Coronary Syndromeand HR may be elevated.
atherogenesis Ausculta-
Laboratory studies: 12-lead and continuous
Inflammation also tion of the heart may
ECG monitoring
participates in the • Cardiac troponin reveal an atrial (S4) or a
local, myocardial, IV access ventricular (S3)
and systemic • CK-MB
complications of O2 therapy gallop. A new murmur
atherosclerosis. • Myoglobin heard during an anginal
Drug therapy* attack may
• Lipid panel
• Nitroglycerin indicate ischemia of a
• CBC papillary muscle of the
• Morphine sulfate mitral valve.
• C-reactive protein the murmur is likely to be
• Aspirin transient and disappear
• Homocysteine when
• β-adrenergic blockers
symptoms stop.
• ACE inhibitors, ARBs
Heart is an abnormal -Coronary HF is classified as -Shortness of History and physical -Kidney damage or Treatment of underlying Respiratory Monitoring
Failure clinical syndrome artery disease,
systolic or diastolic breath (dyspnea) examination failure. Heart failure cause • Monitor pulse oximetry,
that involves including failure (or when you exert can reduce the blood respiratory rate, rhythm,
inadequate myocardial dysfunction). yourself or when • Determination of flow to your kidneys, • Circulatory assist devices depth, and effort of
pumping and/or infarction Patients can have you lie down. underlying cause which can eventually (e.g., ventricular respirations to evaluate
filling of the heart. isolated systolic or cause kidney failure if changes
• Hypertension, diastolic failure or Fatigue and • Serum chemistries, assist device)
left untreated. in respiratory status.
It is a major health including weakness. cardiac markers, BNP
a combination of • Daily weights • Auscultate breath
problem in the hypertensive both. Heart valve problems. sounds, noting areas of
Swelling (edema) in or NT-proBNP level
United States. "is crisis • Sodium- and, possibly, decreased or absent
your legs, ankles liver Heart rhythm
chapter discusses fluid-restricted diet ventilation and presence
the management • Rheumatic and feet.
function tests, thyroid
problems.
of adventitious
and nursing care heart disease function tests, CBC, sounds to detect presence
Rapid or irregular Liver damage.
of patients of pulmonary edema.
• Congenital heartbeat. • High Fowler’s position
experiencing this lipid profile, kidney • Monitor for increased
heart defects
syndrome
(e.g., Reduced ability to function tests,
• O2 by mask or nasal restlessness, anxiety, and
exercise.
 ventricular Persistent urinalysis cannula work of breathing to detect
septal defect) cough or wheezing increasing hypoxemia.
-Can be: Left- with white or pink • Chest x-ray • BiPAP Oxygen Therapy
sided heart • Pulmonary blood-tinged
failure ,right-sided hypertension • 12-lead ECG • Circulatory assist device:
phlegm. • Administer supplemental
heart failure, intraaortic balloon pump
• Hemodynamic O2 or other noninvasive
systolic heart •
Cardiomyopath monitoring • Endotracheal intubation ventilator support (e.g.,
failure ,diastolic bilevel positive airway
y (e.g., viral, and mechanical ventilation
heart failure. • 2-dimensional pres-
postpartum,
echocardiogram • Vital signs, urine output at sure [BiPAP]) as needed
substance
least q1hr to maintain adequate O2
abuse) • Nuclear imaging levels.
studies • Cardiac • Continuous ECG and
•
catheterization pulse oximetry monitoring • Monitor the O2 liter flow
Hyperthyroidis
m • Hemodynamic monitoring rate and placement of O2
(e.g., intraarterial BP, delivery device to ensure
• Valvular O2 is adequately
disorders (e.g., PAWP, CO). delivered.
mitral stenosis) • Change O2 delivery
device from mask to nasal
• Myocarditis. prongs during meals as
tolerated to sustain O2
levels
while eating.
• Monitor the effectiveness
of O2 therapy to identify
hypoxemia and establish
range of O2 saturation.
Positioning

• Position patient to
alleviate dyspnea (e.g.,
semi-Fowler’s position), as
appropriate, to improve
ventila-
tion by decreasing venous
return to the heart and
increasing thoracic
capacity.
Dysrhythmi abnormality in a - is caused by - Rhythm - shortness of -Electrocardiogram - stroke, heart - the patient is in full arrest, - Circulatory care;
as physiological changes in disturbances result breath, weakness, failure, or sudden use current Dysrhythmia
rhythm, especially heart tissue from abnormalities dizziness, cardiac arrest cardiopulmonary management; Emergency
in the activity of and activity or of impulse lightheadedness, resuscitation guidelines. If care; Vital signs
the brain or heart. in the electrical formation, impulse fainting or near the patient is not in full monitoring; Cardiac care;
signals that conduction, or fainting, and chest arrest, the first step of Cardiac precautions;
- are classified as control your both. pain or discomfort. treatment is to maintain Oxygen therapy;
supraventricular ar heartbeat. Bradyarrhythmias . ABCs. Low-flow oxygen by Fluid/electrolyte
rhythmias or These changes result from nasal cannula or mask may management; Fluid
ventricular arrhyth can be caused decreased intrinsic decrease the rate of PVCs. monitoring; Shock
mias. by damage pacemaker Higher flow rates are management: Volume;
Supraventricular a from disease, function or blocks usually needed for the Medication administration;
rrhythmias originat injury, or in conduction, patient with VT, and if Resuscitation;
e between the genetics. Often principally within pulseless VT or VF occurs, Surveillance
sinus node and there are no the AV node or the the patient needs immediate
the atrioventricular symptoms, but His-Purkinje endotracheal intubation,
 node. some people system and support of breathing
Ventricular arrhyth feel an irregular with a manual resuscitator
mias heartbeat. bag. The most important
intervention for a patient
with pulseless VT or VF is
rapid defibrillation (electrical
countershock). If a
defibrillator is not available,
and the arrest was
witnessed, begin chest
compressions and, as soon
as possible, give a sharp
blow to the precordium
(precordial thump or
thumpversion) to try to
convert VT or VF into a
regular sinus rhythm.
Maintain CPR between all
other interventions for
patients without adequate
breathing and circulation.
Infective -is an infection of -Heart - Damage to - headache, -Electrocardiogram Blood cultures to Prophylactic Treatment. the - Prophylactic Treatment.
Endocarditi the endocardial inflammation endothelial surface fatigue, nausea, or identify and treat the situations and conditions the situations and
s can be caused from pain. exact bacterium, virus, requiring antibiotic conditions re- quiring
-IE can be by infections, or fungus that is prophylaxis antibiotic prophylaxis are.
classified as particularly anatomic or causing the infection in
subacute or acute. from viruses or traumatic changes endocarditis or Drug Therapy. Accurate
the subacute form bacteria; pericarditis identification of the
Drug Therapy. Accurate
medicines; or infecting organism is the
typically affects Cardiac troponins or identi"cation of the infecting
damage to the key to successful
those with creatine kinase-MB, organism is the key to
heart’s tissue treatment of IE. Long-term
preexisting valve which are blood successful treatment of IE.
or muscle from
disease and has a markers that increase Long-term
autoimmune treatment is necessary to
diseases, when there is damage
clinical course that treatment is necessary to kill dormant bacteria within
medicines, to your heart. Since
may extend over kill dormant bacteria within the valvular vegetations.
environmental there are no specific
months. In the valvular vegetations. Complete elimination of
factors, or blood tests for
contrast, the acute Complete elimination of the the organism generally
other triggers. myocarditis, these
form typically organism generally takes takes weeks, and relapses
The causes of markers are useful to
affects those with weeks, and relapses are are common.
heart show injury to the heart
healthy valves and common.
inflammation muscle. However, they Initially, patients are
manifests as a
may vary are also increased with Initially, patients are hospitalized and IV
rapidly progressive
depending on heart attack or heart hospitalized and IV antibiotic therapy,
illness. IE can also
the part of the failure and do not antibiotic therapy, based on blood cultures,
be classified
heart that is necessarily mean you is started. !e effectiveness
based on the
affected—the have myocarditis. They based on blood cultures, is of therapy
cause (e.g., IV
endocardium, are often normal in started. the effectiveness of
drug abuse IE
the cases of subacute or therapy.
[IVDA IE], fungal
myocardium, or chronic myocarditis.
endocarditis) or
site of involvement the
C-reactive protein
(e.g., prosthetic pericardium.
(CRP) or erythrocyte
valve endocarditis sedimentation rate
[PVE]). (ESR), which may
indicate inflammation
in the body if higher
than normal
Complete blood count
to look for higher levels
of white blood cells,
which might indicate
infection
Serum cardiac
autoantibodies (AAbs),
which are antibodies
that your body may
start to make if you
have myocarditis.
These antibodies
recognize your own
heart muscle.
Testing for specific
organisms, such as
Borrelia burgdorferi,
which causes Lyme
disease;
Mycobacterium
tuberculosis, which
causes tuberculosis;
HIV; or hepatitis C

Echocardiography
(echo) to look for heart
valve problems,
problems in the
structure or function of
the heart, or a
thickening of the
pericardium
Electrocardiogram
(ECG or EKG) to look
for changes in your
heart’s electrical
activity, which do not
necessarily indicate
myocarditis,
endocarditis, or
pericarditis. It may help
distinguish a heart
attack from pericarditis.
Cardiac
magnetic resonance
imaging (MRI) to
detect inflammation
and swelling of the
myocardium and
 pericardium. Your
doctor may also use
MRI to look for
complications of
endocarditis in other
parts of the body, such
as the brain, which
may indicate stroke.
Acute s inflammation of Acute Acute  Sharp, History and physical  Constrictive Treatment of underlying The management of the
Pericardits the pericardium (t pericarditis m pericarditis devel piercing che examina- pericarditis. disease patient’s pain and anxiety
he flexible two- ay result from ops quickly, st pain over tion: pericardial Although • Bed rest during acute
layered sac that infection, causing the center or friction rub, uncommon, • Nonsteroidal anti- pericarditis is your primary
envelops the autoimmune or inflammation of left side of some people inflammatory nursing consideration.
heart) that begins inflammatory the pericardial sa the chest, pulsus paradoxus with pericarditis, drugs
suddenly, is often disorders, c and often which is • Laboratory: CRP, particularly • Corticosteroids
painful, and uremia, a pericardial effus generally ESR, white those with long- • Pericardiocentesis (for
causes fluid and trauma, ion. Inflammation more intense blood cell count term inflammati tamponade)
blood components myocardial can extend to the when • Electrocardiogram on and chronic • Pericardial window (for
such as fibrin, red infarction (MI), epicardial breathing in. • Chest x-ray recurrences, tamponade or ongoing
blood cells, and cancer, myocardium  Shortness • Echocardiogram can develop pericardial effusion)
white blood cells radiation (myopericarditis). of • Computed permanent
to enter therapy, or Adverse breath when tomography thickening,
the pericardial sp certain drugs hemodynamic reclining. • Magnetic resonance scarring and
ace. Infectious peric effects and rhythm imaging contraction of
 Heart
arditis is most disturbance are • Pericardiocentesis, the pericardium.
palpitations.
often viral or rare, although pericardial  Cardiac
idiopathic. cardiac  Low-grade window tamponade
tamponade is fever. • Pericardial biopsy
possible  An overall
sense of
weakness,
fatigue or
feeling sick.
 Cough.
 Abdominal
or leg
swelling.

Myocarditis  is an inflammation Viruses. Many Myocarditis is  Chest pain.  Electrocardiog  Heart failure. chronic constrictive pericar- Decreased CO is an
of the heart viruses are inflammation of  Rapid Untreated, myo ditis is a pericardiectomy. ongoing nursing diagnosis
ram
muscle commonly myocardium with or abnormal carditis can in the care of
(myocardium). My associated necrosis of cardiac (ECG). This damage your surgery is performed
heart
ocarditis can with myocardit myocyte cells. rhythms (arr noninvasive heart's muscle before the patient becomes the patient with
affect your heart is, including Biopsy-proven my hythmias) test shows your so that it can't clinically unstable. myocarditis. Focus your
muscle and your the viruses that ocarditis typically heart's pump blood
 Shortness interventions on man-
heart's electrical cause the demonstrates effectively.
of breath, at electrical aging the signs and
system, reducing common cold inflammatory  Heart attack or
rest or patterns and symptoms of HF. Select
your heart's ability (adenovirus); infiltrate of the stroke.
during nursing measures
to pump and COVID-19; myocardium with can detect
physical  Rapid or
causing rapid or hepatitis B and lymphocytes, abnormal
activity. abnormal heart
abnormal heart C; parvovirus, neutrophils, rhythms. to decrease cardiac
 Fluid rhythms
rhythms which causes a eosinophils, giant workload. these include
retention (arrhythmias).
(arrhythmias) mild rash, cells, granulomas,  Chest X- placing the patient
usually in or a mixture. with swelling  Sudden cardiac
of your legs, ray. An X-ray in a semi-Fowler’s
children (fifth ankles and image shows death. position, spacing activity
disease); and feet. and rest periods,
the size and
herpes simplex  Fatigue.
virus shape of your
 and providing a quiet
heart, as well
environment. Carefully
as whether you monitor medica-
have fluid in or tions that increase the
around the heart’s contractility and
heart that might decrease preload,
indicate heart
failure. afterload, or both.
Evaluate the effectiveness
 MRI. Cardiac of your interven-
MRI will show tions on an ongoing basis.
your heart's
size, shape
and structure.
This test can
show signs of
inflammation of
the heart
muscle.

 Echocardiogra
m. Sound
waves create
moving images
of the beating
heart. An
echocardiogra
m might detect
enlargement of
your heart,
poor pumping
function, valve
problems, a
clot within the
heart or fluid
around your
heart.

 Blood
tests. These
measure white
and red blood
cell counts, as
well as levels of
certain
 enzymes that
indicate
damage to your
heart muscle.
Blood tests can
also detect
antibodies
against viruses
and other
organisms that
might indicate
a myocarditis-
related
infection.

 Cardiac
catheterizatio
n and
endomyocardi
al biopsy. A
small tube
(catheter) is
inserted into a
vein in your leg
or neck and
threaded into
your heart. In
some cases,
doctors use a
special
instrument to
remove a tiny
sample of heart
muscle tissue
(biopsy) for
analysis in the
lab to check for
inflammation or
infection.

Rheumatic A condition in caused Is a chronic and  Fever. History and physical  Heart failure. -Bed rest Provide comfort and
Fever and which permanent by rheumatic f progressive form  Swollen, examination This can occur • Antibiotics reduce pain. 
rheumatic damage ever, an of damage to tender, red • Laboratory findings from either a • Nonsteroidal
heart to heart valves is inflammatory di the heart valves and • Chest x-ray severely antiinflammatory drugs
disease caused sease that can resulting in extremely • Echocardiogram narrowed or • Salicylates Provide diversional
by rheumatic feve affect many dysfunction of painful joints • Electrocardiogram leaking heart • Corticosteroids activities and sensory
r. The heart valve connective the heart. It is a
 is damaged by tissues, complication of an — valve. stimulation.
a disease process especially in autoimmune particularly  Bacterial
that generally the heart, disorder called the knees endocarditis.
begins with a strep joints, skin, or acute rheumatic f and ankles. This is Promote energy
throat caused by brain. ever (ARF), which  Nodules an infection of conservation
bacteria called The heart valv is in turn (lumps the inner lining
Streptococcus, es can be precipitated by under the of the heart. ...
and may inflamed and group A skin) Prevent injury
 Complications
eventually become streptococcal  Red, raised, of
cause rheumatic f scarred over infections of the lattice-like pregnancy and
ever. time. throat rash, usually delivery due to
on the chest, heart damage.
back, and  Ruptured heart
abdomen. valve.
 Shortness of
breath
and chest
discomfort.

Mitral a form is an infection Mitral valve areas  Fatigue.  Transthoracic  Pulmonary Nonsurgical Assess Heart SoundsTo
valve of valvular heart called less than 2 square  Shortness echocardiogra hypertension. • Prophylactic antibiotic identify murmur
disease, is rheumatic centimeters of m. Sound  Heart failure. therapy
stenosis characterized by fever, which is causes an breath with waves directed • Rheumatic fever
 Heart
the narrowing of related to strep impediment to the exertion or at your heart enlargement. • Infective endocarditis Notify provider of new
the opening in infections. blood flow from the when lying from a wandlike • Sodium restriction or sudden onset or
the mitral valve, Rheumatic left atrium into the device  Atrial fibrillation. • Medications to treat or
flat.
 Blood clots
murmurs, especially if
which lies between fever — now left ventricle. This (transducer) control HF
the left atrium and rare in the creates a pressure
 Shortness
held on your • Vasodilators* (e.g., accompanied by signs
of of poor perfusion or
the left ventricle in United States, gradient across chest produce nitrates, ACE inhibitors)
breath and
the heart. This but still the mitral valve. video images • Positive inotropes (e.g., pulmonary edema
coughing
narrowing can common in of your heart in digoxin)
during the
reduce the amount developing motion. • Diuretics
night. Educate patient about
of blood the heart countries —  Transesophage • β-Adrenergic blockers
can pump, leaving can scar  Swollen • Anticoagulation therapy post-op requirements after
al
you tired and often the mitral ankles and • Antidysrhythmia drugs valve replacement surgery
echocardiogra
short of breath. valve. Left feet. • Percutaneous transluminal
m.  Prophylactic
untreated, mitr  Heart balloon valvuloplasty
 Electrocardiogr
al valve palpitations • Percutaneous valve antibiotics prior to
am (ECG).
stenosis can (rapid, replacement
lead to fluttering  Chest X-ray. Surgical any invasive
serious heart c heartbeat)  Cardiac • Valve repair
omplications catheterization. • Commissurotomy
procedures
 Heavy
coughing (valvulotomy)  Bleeding
which may • Valvuloplasty
produce • Annuloplasty Precautions
blood- • Valve replacement
(anticoagulant
stained
mucus therapy)

 Use soft bristle
toothbrush
 Maintain good
 oral hygiene
 Avoid dental
procedures for 6
months post-op

Assess respiratory status

 Lung sounds
 SpO2
 Shortness of
Breath
 Sputum

Aortic curs when the is generally In most  Fatigue History and physical  Heart failure. Nonsurgical Assess Heart SoundsTo
Valve heart's aortic found in child- elderly adults, upon examination  Stroke. • Prophylactic antibiotic identify murmur
Stenosis valve narrows. aortic stenosis is exertion. • Chest x-ray therapy
hood,  Blood clots.
This narrowing caused by a build-  Failure to • CBC • Rheumatic fever
prevents adolescence, up of calcium (a • Electrocardiogram  Bleeding. • Infective endocarditis Notify provider of new
gain weight.
the valve from or young mineral found in • Echocardiography  Heart rhythm • Sodium restriction
 Poor or or sudden onset or
opening fully, adulthood. In your blood) on the (Doppler and abnormalities • Medications to treat or
older adults, valve inadequate (arrhythmias)
murmurs, especially if
which reduces or leaflets. transesophageal) control HF
blocks blood flow AS is a Over time, this
feeding.
• Cardiac • Vasodilators* (e.g., accompanied by signs
 Infections that
from your heart causes the leaflets  Breathing catheterization affect the heart, nitrates, ACE inhibitors) of poor perfusion or
into the main to become stiff, problems. • Positive inotropes (e.g., pulmonary edema
such as
artery to your body result of RF or reducing their endocarditis. digoxin)
(aorta) and degeneration ability to fully open  Death. • Diuretics
onward to the rest Educate patient about
that may have and close 
• β-Adrenergic blockers
of your body. an etiology • Anticoagulation therapy post-op requirements after
similar • Antidysrhythmia drugs valve replacement surgery
• Percutaneous transluminal
to that of balloon valvuloplasty
 Prophylactic
coronary artery • Percutaneous valve antibiotics prior to
disease. replacement
Surgical any invasive
• Valve repair
• Commissurotomy
procedures
(valvulotomy)  Bleeding
• Valvuloplasty
• Annuloplasty Precautions
• Valve replacement
(anticoagulant
therapy)
 Use soft bristle
toothbrush
 Maintain good
oral hygiene
  Avoid dental
procedures for 6
months post-op

Assess respiratory status

 Lung sounds
 SpO2
 Shortness of
Breath
Sputum
Mitral mitral insufficienc Possible When blood  Abnormal Echocardiogra mitral valve Nonsurgical Assess Heart SoundsTo
Valve y causes abnormally flows heart sound m. This test is regurgitation usually • Prophylactic antibiotic identify murmur
Regrugatio or mitral incompet of mitral valve backward from the (heart commonly used does not cause any therapy
n ence — is a regurgitation i left ventricle to the murmur) to diagnose mitral problems. However, • Rheumatic fever
condition in which nclude: Mitral left atrium, the heard valve regurgitation. severe mitral valve • Infective endocarditis Notify provider of new
your heart's valve prolapse. volume of both through a Electrocardiogr regurgitation can lead • Sodium restriction or sudden onset or
mitral In this chambers stethoscope. am (ECG). to complications, • Medications to treat or murmurs, especially if
valve doesn't condition, increases.  Shortness including: Heart failure.  control HF
close tightly, the mitral Because a
Chest X-ray.
Heart failure results • Vasodilators* (e.g., accompanied by signs
of
allowing blood to valve's leaflets significant volume breath (dys
Cardiac MRI. when your heart can't nitrates, ACE inhibitors) of poor perfusion or
flow backward in bulge back into of blood is flowing pnea), Cardiac CT. pump enough blood to • Positive inotropes (e.g., pulmonary edema
your heart. the left atrium retrograde, especially Exercise tests  meet your body's need digoxin)
during forward cardiac when you or stress tests. • Diuretics
the heart's con output decreases • β-Adrenergic blockers Educate patient about
have been Cardiac
traction. This despite the left very active • Anticoagulation therapy post-op requirements after
catheterization.
common heart  ventricular ejection or when you • Antidysrhythmia drugs valve replacement surgery
defect can fraction appearing lie down. • Percutaneous transluminal
prevent normal.. balloon valvuloplasty
 Prophylactic
 Fatigue.
the mitral • Percutaneous valve antibiotics prior to
valve from replacement
closing tightly Surgical any invasive
and lead • Valve repair
to regurgitatio • Commissurotomy
procedures
n. (valvulotomy)  Bleeding
• Valvuloplasty
• Annuloplasty Precautions
• Valve replacement
(anticoagulant
therapy)
 Use soft bristle
toothbrush
 Maintain good
oral hygiene
 Avoid dental
procedures for 6
 months post-op

Assess respiratory status

 Lung sounds
 SpO2
 Shortness of
Breath
Sputum
Mitral also called MVP, Although the Cause of MVP is  Palpitations   Echocardiogra  Irregular heart r Nonsurgical Assess Heart SoundsTo
valve is a condition in etiology of abnormally (feelings that m. This test is hythms in the • Prophylactic antibiotic identify murmur
prolapse which the MVP is stretchy valve leafl your heart is commonly used upper heart cha therapy
two valve flaps of unknown, ets (called skipping a to diagnose mbers (atrial • Rheumatic fever
the mitral some patients myxomatous valve  beat, mitral valve fibrillation) • Infective endocarditis Notify provider of new
valve don't close have an disease). Mitral fluttering, or regurgitation.  High blood • Sodium restriction or sudden onset or
smoothly or increased valve beating too  Electrocardiogr pressure that • Medications to treat or murmurs, especially if
evenly, but bulge familial prolapse occurs in hard or too am (ECG). affects the blood control HF
(prolapse) upward incidence. the around 2% of the fast) • Vasodilators* (e.g., accompanied by signs
 Chest X-ray. vessels in the
into the left genetic population. A  Shortness lungs nitrates, ACE inhibitors) of poor perfusion or
atrium. Mitral inheritance is person can be  Cardiac MRI. • Positive inotropes (e.g., pulmonary edema
of breath. (pulmonary
valve prolapse is frequently born with the  Cardiac CT. hypertension) digoxin)
 Cough.
also known as autosomal genetic risk of  Exercise tests  • Diuretics
 Fatigue  Blood clots. Educate patient about
click-murmur dominant developing MVP. It or stress tests. • β-Adrenergic blockers
syndrome, also can be (tiredness),   Heart failure. • Anticoagulation therapy post-op requirements after
dizziness,  Cardiac
Barlow's syndrome caused by other catheterization.  Stroke. • Antidysrhythmia drugs valve replacement surgery
or health problems, or anxiety. • Percutaneous transluminal

floppy valve syndr such as some  Migraine balloon valvuloplasty
 Prophylactic
ome connective tissue headaches. • Percutaneous valve antibiotics prior to
diseases  Chest replacement
discomfort Surgical any invasive
 • Valve repair
• Commissurotomy
procedures
(valvulotomy)  Bleeding
• Valvuloplasty
• Annuloplasty Precautions
• Valve replacement
(anticoagulant
therapy)
 Use soft bristle
toothbrush
 Maintain good
oral hygiene
 Avoid dental
procedures for 6
months post-op

Assess respiratory status

  Lung sounds
 SpO2
 Shortness of
Breath
Sputum
Cardiomy is a disease of theIt's caused by a pathophysiologic   Shortness History and physical  Heart failure. Drug therapy 1. Provide oxygen at
opathy heart muscle that mutation or feature of of breath or examination Poor blood flow • Nitrates (except in
2 to 4 L/min to
makes it harder forchange in cardiomyopathy is trouble • Electrocardiogram from the left hypertrophic CMP)
your heart to pump some of the systolic breathing, • b-Type natriuretic ventricle can • β-Adrenergic blockers maintain or
blood to the rest of
genes in heart dysfunction of the especially peptide (BNP) lead to heart • Antidysrhythmics improve
your muscle left or both with physical • Chest x-ray failure. • ACE inhibitors oxygenation.
body. Cardiomyo proteins. ventricles. exertion. • Echocardiogram  Heart valve • Diuretics
pathy can lead to Hypertrophic c Reduced • Nuclear imaging • Digitalis (except in 2. Minimize oxygen
 Fatigue. regurgitation.
heart failure. ardiomyopath sarcomere  Swelling in studies  Fluid buildup hypertrophic CMP unless demand by
y also can contractility • Cardiac used to treat atrial maintaining the
the ankles, (edema).
The main types develop over increases catheterization fibrillation)
of cardiomyopath time because ventricular
feet, legs,
• Endomyocardial  Abnormal heart • Anticoagulants (if
patient at bed rest.
abdomen rhythms 3. Provide liquid
y include dilated, of high blood volumes to biopsy indicated)
and veins in (arrhythmias).
hypertrophic and pressure, maintain cardiac the neck. • Ventricular assist device diet on acute
restrictive cardio aging, or other output through the  Sudden cardiac  • Cardiac resynchronization
 Dizziness. arrest.
phase,
myopathy. diseases, such Frank-Starling therapy
as diabetes or mechanism,  Lightheaded  Blood clots • Implantable cardioverter- 4. Administer
thyroid producing the thin- ness. (emboli). defibrillator diuretic as
disease. walled dilated LV  Fainting • Surgical correction prescribed to
Sometimes the appearance that is during • Heart transplantation
cause of the observed in overt
reduce preload and
physical
disease isn't DCM activity. afterload.
known.  Arrhythmias 5. Monitor serum
(irregular potassium before
heartbeats) and after
administration of
loop diuretics.
6. Prophylactic
heparin may be
ordered to prevent
thromboembolus
formation
secondary to
venous poisoning.
7. Institute pressure
ulcer prevention
strategies
secondary to
hypoperfusion or
vasoconstriction
agents.
Vascular - is any abnormal - is any - is due to the  - Painful - Physical exam. Amputation Amputation (loss of a  - Place the client’s
Disorders condition of the abnormal blockage of the (loss of a limb) limb) legs in a dependent
cramping in Ankle-brachial index
blood vessels condition of the arteries supplying Poor wound Poor wound healing. position in relation to
(arteries and blood vessels blood to the lower one or both of (ABI). the heart to
healing. Restricted mobility
veins). The body (arteries and limbs usually your hips, improve peripheral blo
Ultrasound. Restricted due to pain or discomfort.
uses blood veins). The secondary to thighs or calf od flow
mobility due to pain or Severe pain in the
vessels to body uses atherosclerosis. muscles after Angiography.  Avoid raising the
discomfort. affected extremity.
circulate blood blood vessels The most severe client’s feet above
certain Blood tests. Severe pain in Stroke (3 times more
through itself. to circulate clinical heart level unless
blood through manifestation of activities, such the affected extremity. likely in people with PVD) specifically prescribed
itself PAD is critical limb as walking or Stroke (3 times by the health care
ischemia (CLI), climbing stairs more likely in people providers
which is with PVD)  Keep the client in a
(claudication)
associated with a neutral, flat, supine
risk of limb loss  Leg position if in doubt
and mortality due about the nature of his
numbness or
to cardiovascular peripheral vascular
events weakness problems.
 Provide insulating
 Coldness in warmth with gloves,
your lower leg socks and other
or foot, outerwear as
especially appropriate.
 Keep room
when
temperatures
compared with comfortably warm.
the other side  Instruct the client to
warm himself with
 Sores on warm drinks or baths.
your toes, feet  Never apply a direct
or legs that heat source to the
won't heal extremities. Limited
blood flow combined
 A change in occur with normal
circulation.
the color of
 Teach the client
your legs about the
vasoconstrictive
 Hair loss or effects of nicotine and
slower hair caffeine, emotional
growth on stress, and chilling,
your feet and discuss ways to avoid
or minimize these risk
legs
factors.
 Slower  Teach the client to
avoid constricting
growth of your
clothes, such as
toenails garters, knee-high
stockings and belts.
 Shiny skin  If overreplacement
on your legs of glucocortiocoid is
indicated, inform the
 No pulse or client about the
a weak pulse purpose of therapy
 in your legs or and possible adverse
effects such as
feet
cushingoid
 Erectile appearance, weight
gain, acne, hirsutism,
dysfunction in
peptic ulcer, diabetes
men mellitus, osteoporosis,
infection, muscular
weakness, mood
swings, cataracts and
hypertension.
 For a client with
decreased arterial
function but without
activity-limiting tissue
damage, encourage a
program of balanced
exercise and rest to
promote development
of collateral
circulation.

Vascular - is any abnormal - is any - is due to the  - Painful - Physical exam. Amputation Amputation (loss of a  - Place the client’s
Disorders condition of the abnormal blockage of the (loss of a limb) limb) legs in a dependent
cramping in Ankle-brachial index
blood vessels condition of the arteries supplying Poor wound Poor wound healing. position in relation to
(arteries and blood vessels blood to the lower one or both of (ABI). the heart to
healing. Restricted mobility
veins). The body (arteries and limbs usually your hips, improve peripheral blo
Ultrasound. Restricted due to pain or discomfort.
uses blood veins). The secondary to thighs or calf od flow
mobility due to pain or Severe pain in the
vessels to body uses atherosclerosis. muscles after Angiography.  Avoid raising the
discomfort. affected extremity.
circulate blood blood vessels The most severe client’s feet above
certain Blood tests. Severe pain in Stroke (3 times more
through itself. to circulate clinical heart level unless
blood through manifestation of activities, such the affected extremity. likely in people with PVD) specifically prescribed
itself PAD is critical limb as walking or Stroke (3 times by the health care
ischemia (CLI), climbing stairs more likely in people providers
which is with PVD)  Keep the client in a
(claudication)
associated with a neutral, flat, supine
risk of limb loss  Leg position if in doubt
and mortality due about the nature of his
numbness or
to cardiovascular peripheral vascular
events weakness problems.
 Provide insulating
 Coldness in warmth with gloves,
your lower leg socks and other
or foot, outerwear as
especially appropriate.
 Keep room
when
temperatures
compared with comfortably warm.
the other side  Instruct the client to
warm himself with
 Sores on warm drinks or baths.
your toes, feet  Never apply a direct
or legs that heat source to the
won't heal extremities. Limited
blood flow combined
  A change in occur with normal
circulation.
the color of
 Teach the client
your legs about the
vasoconstrictive
 Hair loss or
effects of nicotine and
slower hair caffeine, emotional
growth on stress, and chilling,
your feet and discuss ways to avoid
legs or minimize these risk
factors.
 Slower  Teach the client to
avoid constricting
growth of your
clothes, such as
toenails garters, knee-high
stockings and belts.
 Shiny skin  If overreplacement
on your legs of glucocortiocoid is
indicated, inform the
 No pulse or client about the
a weak pulse purpose of therapy
in your legs or and possible adverse
feet effects such as
cushingoid
 Erectile appearance, weight
dysfunction in gain, acne, hirsutism,
peptic ulcer, diabetes
men mellitus, osteoporosis,
infection, muscular
weakness, mood
swings, cataracts and
hypertension.
 For a client with
decreased arterial
function but without
activity-limiting tissue
damage, encourage a
program of balanced
exercise and rest to
promote development
of collateral
circulation.

Peripheral disease in which is often caused  is due to the Painful -Diagnostic Amputation • Cardiovascular disease  Place the client’s
Artery plaque builds up in by blockage of cramping in one or (loss of a limb) risk factor modification
• Health history and legs in a dependent
Disease the arteries that atherosclerosis the arteries supply both of your hips, Poor wound
carry blood to your . In ing blood to the thighs or calf physical examination,
healing.
• Tobacco cessation position in relation
head, organs, and atherosclerosis lower limbs usually muscles after including palpation of to the heart to
Restricted • Regular physical exercise
limbs. Plaque is , fatty deposits secondary to certain activities, improve peripheral 
peripheral pulses mobility due to pain or
made up of fat, (plaques) build atherosclerosis. such as walking or • Achieve or maintain ideal
cholesterol, up on The most severe climbing stairs
discomfort. blood flow
• Doppler ultrasound body weight
calcium, fibrous your artery wal clinical (claudication) Severe pain in  Avoid raising the
studies
tissue, and other ls and reduce manifestation the affected extremity. • Follow Dietary Approaches
Leg numbn client’s feet above
substances in the blood flow. of PAD is critical ess or weakness. • Segmental blood Stroke (3 times to Stop Hypertension
blood. Although limb ischemia more likely in people heart level unless
Coldness in
discussions of (CLI), which is your lower leg or pressures with PVD) (DASH) diet specifically
atherosclerosis associated with a foot, especially
• Ankle-brachial index • Tight glucose control in prescribed by the
usually focus risk of limb loss when compared
on the heart, and mortality due with the other side. diabetics health care
• Duplex imaging
the disease ca to cardiovascular
• Tight blood pressure providers
n and usually events. • Angiography  Keep the client in
control
does
affect arteries t • Magnetic resonance a neutral, flat,
• Treatment of
hroughout your angiography hyperlipidemia and supine position if in
body. hypertriglyceridemia doubt about the
• Antiplatelet agent (aspirin nature of his
or clopidogrel [Plavix]) peripheral vascular
problems
• Angiotensin-converting
enzyme inhibitors  Promote
vasodilation.
• Treatment of claudication  Promote
symptoms
activity and
• Structured walking or mobility.
exercise program
 Provide care for
• Cilostazol (Pletal)
a client
• Nutrition therapy undergoing
• Proper foot care angiography or
• Percutaneous transluminal percutaneous
balloon angioplasty with or transluminal
without stent
angioplasty
• Percutaneous transluminal
atherectomy
• Percutaneous transluminal
cryoplasty
• Peripheral artery bypass
surgery
• Patch graft angioplasty,
often in conjunction with
bypass surgery
• Endarterectomy (for
localized stenosis but rarely
done)
• Thrombolytic therapy or
mechanical clot extraction
therapy (for
acute ischemia only)
• Sympathectomy (for pain
management only)
 • Amputation

Aortic  is an abnormal re caused by Abdominal aortic Sudden,  found during routine A ruptured aortic The goal of both medical Begin by performing a
Aneurysm bulge that occurs "hardening of aneurysms tend intense and medical tests, such as aneurysm can lead to and surgical management is thorough history and
in the wall of the the arteries" to occur when persistent chest a chest X-ray, CT life-threatening to prevent physical assessment.
major blood vessel (atherosclerosi there is a failure of or back pain. scan or ultrasound of internal bleeding. Because atherosclerosis is
(aorta) that carries s). the structural the heart, aneurysm rupture. Early a systemic disease, look
Pain that
blood from your Atherosclerosis proteins of detection and prompt for
radiates to your
heart to your can develop the aorta. What treatment are
back.
body. Aortic when causes these signs of coexisting
Trouble essential. Conservative
aneurysms can cholesterol and proteins to fail is cardiac, pulmonary,
breathing. therapy of small,
occur anywhere in fat build up not known, but it cerebral, and lower
Low blood asymptomatic AAAs
your aorta and inside the results in the extremity vascular
may be tube- arteries. High gradual weakening pressure. problems. Monitor the
shaped (fusiform) blood pressure of the aortic wall Loss of patient for signs of
or round (saccular) (hypertension), consciousness.
cigarette Shortness of aneurysm rupture, such as
smoking, family breath. diaphoresis; pallor;
history and age Trouble weakness; tachy-
also contribute swallowing. cardia; hypotension;
to abdominal, back, groin, or
atherosclerosis periumbilical
..
pain; changes in level of
consciousness; or a
pulsating abdomi-
nal mass.
Phelbitis  is usually nflammation of the redness. Ultrasound may include Blood-thinning .
caused by local wall of a swelling. local infection and medications. Stop the infusion at
inflammation of a trauma to a vein. Phlebitis ma Blood test abscess formation, clot the first sign
warmth. Clot-dissolving medications.
vein. vein. y result from the formation, and of redness or pain.
Thrombophlebitis Superficial phl infection of tissues visible red progression to a deep
is due to one or ebitis is most adjacent to the “streaking” on your venous thrombosis and Compression stockings
arm or leg. Apply warm, moist
more blood clots in often caused vein, or it may pulmonary embolism.
tenderness. compresses to the area.
a vein that cause by an result from trauma When pronounced Vena cava filter
inflammation. intravenous or from a surgical deep Document your
rope- or
Thrombophlebitis catheter (IV) operation or venous thrombophleb patient's condition and
cord-like structure Varicose vein stripping interventions.
usually occurs in placed in a childbirth. A long that you can feel itis has seriously
leg veins, but it vein, and the period of bed rest through the skin. damaged the leg veins, If indicated, insert a
may occur in an vein becomes and an attendant this can lead to post- new catheter at a different
arm. The irritated. lack of blood phlebitic syndrome. site, preferably on the
thrombus in the Superficial phl circulation may opposite arm, using a
vein causes pain ebitis may or also larger vein or a smaller
and irritation and not have a cause phlebitis device and restart the
may block blood blood clot form infusion.
flow in the veins to cause the
pain and
inflammation

Thrombop is an inflammatory The cause Because Warmth, ten Blood test  may include local Blood-thinning Stop the infusion at
hlebitis process that of thrombophl movement of the derness and pain i ultrasound infection and abscess medications. the first sign
causes a blood ebitis is a blood through n the affected area. formation, clot Clot-dissolving medications. of redness or pain.
clot to form and blood clot, veins depends formation, and
block one or more which can form upon contractions progression to a deep
Redness an Apply warm, moist
veins, usually in in your blood of the muscles, venous thrombosis an Compression stockings
d swelling. compresses to the area.
your legs. The as a result of: prolonged d pulmonary embolism.
 affected vein might An injury to a inactivity (such as When pronounced Vena cava filter Document your
be near the vein. An bed rest after a deep patient's condition and
surface of your inherited blood- surgical procedure venous thrombophleb Varicose vein stripping interventions.
skin clotting or during itis has seriously If indicated, insert a
(superficial throm disorder. Being convalescence damaged the leg veins, new catheter at a different
bophlebitis) or immobile for from a serious this can lead to post- site, preferably on the
deep within a long periods, illness) may lead phlebitic syndrome. opposite arm, using a
muscle (deep vein such as during to insufficient larger vein or a smaller
thrombosis, or an injury or a movement of the device and restart the
DVT hospital stay blood through the infusion.
veins, with
resultant formation
of clots and
inflammation.

Varicose are swollen, Varicose The pathophysiol bulging, bluish Varicose veins can Ulcers. Painful -antibiotics Advise patient to
Veins twisted veins that veins are a ogy of varicose veins; swelling; usually be diagnosed ulcers may form on the -skin care elevatethe legs
lie just under the common veins is related to aching pain; a by a simple skin near varicose -compression stockings 2. Caution patient to
skin and usually condition congential or feeling of physical examination; veins, particularly near Compression is essential for avoidprolonged standing
occur in the legs. caused by acquired heaviness in the however, the cause of the ankles. CVI treatment, venous ulcer or sitting
Overview. Varicos weak or abnormalities of legs and the varicose Blood clots. healing, and prevention of 3. Provide high-fiber
e veins are a damaged vein  the deep venous feet; itching; vein requires the use Occasionally, veins de ulcer recurrence. foodsto prevent
common condition walls and system, venous changes of Doppler (Duplex) ep within the legs constipation4. Teach
caused by weak or valves. Varico valves, and/or in skin color; and ultrasound. This become enlarged. simple exercise topromote
damaged vein wall se veins may fascial or vein wall nighttime leg painless test assesse venous return
Bleeding.
s and form whenever weakness. cramps. s the valve function in 4. Teach simple exercise
Occasionally, veins ve
valves. Varicose blood pressure the groin, and can to promote venous return
ry close to the skin
veins may form increases also determine how 5.Caution patient toavoid
may burst.
whenever blood inside much blood is flowing knee-length stockings and
pressure increases your veins. back into the legs. constrictive clothings
inside your veins This can
happen
because of
pregnancy,
constipation, a
tumor, or
overweight and
obesity.
Chronic Chronic venous  can be caused Chronic venous Swelling in  A test called a Recruitment of antibiotics Assess patients with
Venous insufficiency (CVI) by congenital insufficiency patho your legs or ankles. vascular or duplex veins – High venous -skin care venous insufficiency for
Insufficienc is a condition that absence of or physiology is Tight feeling ultrasound may be pressures may cause -compression stockings increases in edema,
y occurs when the damage to either due to reflux in your calves or used to examine the the recruitment of Compression is essential for stasis dermatitis, and
venous wall and/or venous valves (backward flow) or itchy, painful legs. blood circulation in adjacent normal veins CVI treatment, venous ulcer venous stasis ulcers.
valves in the leg in the obstruction of your legs. into refluxing circuits. healing, and prevention of • Assess patient’s diet and
Pain when
veins are not superficial and venous blood flow. DVT. ulcer recurrence. nutritional status and
walking that stops
working communicating Chronic venous make referrals as
when you rest. Pulmonary
effectively, making systems. It can insufficiency can necessary to a dietitian.
Brown- embolism (PE)
it difficult for blood also be caused develop from the • Choose appropriate
to return to the by venous protracted valvular colored skin, often Venous options for compression
heart from the incompetence incompetence of near the ankles. ulceration. therapy and wound
legs. CVI causes due to superficial veins, Varicose Secondary care.
blood to “pool” or thrombus deep veins or veins. lymphedema • Evaluate for the
collect in these formation as perforating veins Leg ulcers effectiveness of therapies
veins, and this favored by the that connect them that are sometimes and need for alternative
pooling is called Virchow triad hard to treat. approaches.
 stasis.
• Teach patient and family
about the
pathophysiology, clinical
manifes-
tations, complications, and
treatment of venous
insufficiency.

Role of Licensed
Practical/Vocational Nurse
(LPN/LVN)
• Administer prescribed
analgesics, antibiotics, or
other medications.
• Apply compression
devices.
• Provide wound care for
chronic venous ulcers
(consider state nurse
practice act and agency
policy).
Role of Unlicensed
Assistive Personnel (UAP)
• Assist patients in
elevating extremities to
reduce edema and pain.
• Apply elastic wraps or
compression stockings
• Provide wound care for
chronic venous ulcers
(consider state nurse
practice act and agency
policy).
Daily moisturizing
decreases
-itching and prevents
cracking of the skin.

2. Drug study

Drug Name Available Drug Class Indication Mechanism of Action Method of Side Effects/ Medication/Food Interaction Nursing
Forms Administration Adverse Effects Responsibilities
-Tablet ACE HTN, HF, Vasodilation, inhibition of the - oral Significant: Drug Interactions  Do not
Captopril Inhibitor STEMI, CRF, rennin- Hypotension, Increases lithium discontinue drug
DM1, angiotensin- aldosterone system intestinal or concentration and toxicity. abruptly after long-
nephropathy. thus by peripheral Increased risk of leucopenia term therapy
angioedema, non- with procainamide and (hypersensitivity to
inhibiting ACE, the drugs prevent productive and immunosuppresants. catecholamines
conversion of persistent cough; may have
 angiotensin I into angiotensin II, a cholestatic jaundice, Food Interaction developed, causing
potent proteinuria, Decreased serum exacerbation of
vasoconstrictor, and stimulation of neutropenia, concentration with food. angina, MI, and
aldosterone agranulocytosis, ventricular
release. thrombocytopenia, arrhythmias).
renal impairment or Taper drug
failure and gradually over 2 wk
hyperkalaemia. with monitoring.
Cardiac disorders:  Consult
Dyspnoea. physician about
Gastrointestinal withdrawing drug if
disorders: Nausea, patient is to
vomiting, diarrhea, undergo surgery
constipation, dry (withdrawal is
mouth, epigastric controversial).
discomfort,
abdominal pain,
peptic ulcer,
dyspepsia.
General disorders
and admin site
conditions:
Asthenia.
Metabolism and
nutrition disorders:
Anorexia,
symptomatic
hyponatremia,
hypoglycaemia.
Verapamil Solution CA Channel Rate control Cause vasodilation, Prevent Ca -oral Hypotension with or Drug Interaction: NOT with 2nd or 3rd
Powder Blocker with afib, from entering without syncope, May increase plasma level degree HB, or
Patch dysrhythmias, cell, work on heart and blood cerebrovascular with CYP3A4 inhibitors (e.g. bradycardia,
Angina, vessels, decrease accident, conduction erythromycin, ritonavir), nondihydropyridine
HTN, MI contractility and workload abnormalities (e.g. cimetidine. May decrease
Coronary 1st-degree AV plasma level with CYP3A4
spasm, block, bradycardia), inducers (e.g. rifampicin),
preferred for cough, neutropaenia phenobarbital, sulfinpyrazone.
those with with myeloid Increased risk of bleeding with
OAD, Good hypoplasia, aspirin. May increase
with AA. agranulocytosis, bradycardic and hypotensive
anaemia, effect with telithromycin.
thrombocytopaenia, Increased AV blocking effect
elevated with clonidine.
transaminases, Food Interaction
hyperkalaemia, May increase blood ethanol
increased BUN and levels. May increase plasma
serum creatinine, level of verapamil with
proteinuria, taste grapefruit juice.
disturbance. Rarely,
rash,
photosensitivity.
Carvedilol Injectable Beta- Heart failure Description: Carvedilol is a non- -oral Significant: Hypoten Drug Interactions  Do not confuse
form Blockers Hypertension selective β-blocker. It reduces sion with or without Additive effect with Ca channel carvedilol with
Chronic stable peripheral vascular resistance by syncope, blockers (e.g. diltiazem, captopril.
angina selective α1 receptor blockade bradycardia. verapamil), amiodarone, MAO
o Discontin
and suppresses renin-angiotensin Blood and lymphatic inhibitors, reserpine, uation of
system through non-selective β- system guanfacine, methyldopa concurrent
blockade. Carvedilol has weak disorders: Anaemia. clonidine should
membrane stabilising properties Cardiac Food Interaction
be gradual, with
and has no intrinsic disorders: Dyspnoea Decreased rate of absorption
sympathomimetic activity. , pulmonary and risk of orthostatic carvedilol
oedema. hypotension with food. discontinued first
Eye over 1–2 wk with
disorders: Visual limitation of
impairment, eye physical activity;
irritation, dry eye. then, after several
Gastrointestinal days, discontinue
disorders: Nausea,
clonidine.
diarrhoea, vomiting,
dyspepsia,  PO Take apical
abdominal pain. pulse before
General disorders administering. If <50
and admin site bpm or if arrhythmia
conditions: Asthenia occurs, withhold
, fatigue. medication and
Infections and
notify health care
infestations: Bronchi
tis. professional.
Metabolism and o Administe
nutrition r with food to
disorders: Oedema, minimize
hypervolaemia, orthostatic
weight gain, hypotension.
hypercholesterolae o Administe
mia,
r extended-
hyperglycaemia,
hypoglycaemia. release capsules
Musculoskeletal and in the morning.
connective tissue Swallow whole; do
disorders: Pain in not crush or chew.
extremities, Extended-release
arthralgia. capsules may be
Nervous system opened and
disorders: Dizziness
sprinkled on cold
, headache.
Psychiatric applesauce and
disorders: Depressio taken
n. immediately; do
Renal and urinary not store mixture.
disorders: Micturitio o To
n disorders, convert from
abnormal renal
immediate-release
function, renal
failure. to extended-
Vascular release product,
disorders: Orthostati doses of 3.125 mg
c hypotension, twice daily can be
peripheral vascular converted to 10
disease. mg daily; doses of
6.25 mg twice
 daily can be
converted to 20
mg daily; doses of
12.5 mg twice
daily can be
converted to 40
mg daily; and
doses of 25 mg
twice daily can be
converted to 80
mg daily.

Clonidine Patch Alpha Hypertension Low perip resistance through -oral Headache, Drug Interaction Not w/ asthma or CHF,
Tablet Blockers alpha blockade dilates -transdermal dizziness, Increased hypotensive effect Can cause depression,
capsule bld vessels, low preload and drowsiness, dry w/ other antihypertensives e.g. no
afterload. mouth, constipation, diuretics, β-blockers, effect on HR, or CO,
depression, anxiety, vasodilators, Ca antagonists, check BP prior to
nausea, fatigue, ACE inhibitors. Reduced giving,
anorexia, parotid antihypertensive effect and can get dizzy, weak,
pain, paraesthesia, induced orthostatic drowsy, cause periph
delusional hypotension w/ TCAs or edema,.
perception, sleep neuroleptics w/ α-receptor
disturbances, vivid blocking properties. 
dreams, impotence
and loss of libido, Food Interaction
urinary retention or May potentiate CNS
incontinence depressant effect of alcohol.
adrenal insufficiency
(IV).
Cilostazol Tablet Anticoagula Intermittent Cilostazol and several of its metabolites -Oralare cyclic AMP (cAMP)
Significant: Tachyca
phosphodiesterase IIIDrug Interactions  Monitor
nts, claudication rdia,and suppressing
inhibitors (PDE III inhibitors), inhibiting phosphodiesterase activity palpitation, Increased serum therapeutic
Antiplatelets cAMP degradation with a resultant increase in cAMP in platelets tachyarrhythmia,
and blood vessels, concentration with strong or effectiveness
& leading to inhibition of platelet aggregation and vasodilation. hypotension, moderate inhibitors of indicated by
Fibrinolytics Cilostazol and several of its metabolites are cyclic AMP (cAMP) thrombocytopenia,
phosphodiesterase IIICYP3A4 (e.g. erythromycin, ability to walk
(Thrombolyti inhibitors (PDE III inhibitors), inhibiting phosphodiesterase activity and suppressing ketoconazole, itraconazole,
leucopenia, farther without
cs) cAMP degradation with a resultant increase in cAMP in platelets agranulocytosis.
and blood vessels, diltiazem) leg pain.
leading to inhibition of platelet aggregation and vasodilation. Cardiac  Monitor for S&S
disorders: Angina of CHF. Do not
pectoris, ventricular Food Interaction give cilostazol to
extrasystoles. Increased serum patients with
Gastrointestinal concentration with high-fat preexisting CHF.
disorders: Diarrhoea meal and grapefruit juice.
, nausea, vomiting, .
dyspepsia,
flatulence,
abdominal pain,
abnormal faeces.
General disorders
and admin site
conditions: Asthenia
.
Metabolism and
nutrition
disorders: Oedema
 (peripheral, face),
anorexia.
Nervous system
disorders: Headach
e, dizziness.
Respiratory,
thoracic and
mediastinal
disorders: Rhinitis,
pharyngitis.
Skin and
subcutaneous tissue
disorders: Ecchymo
sis, rash, pruritus.
Potentially
Fatal: Rarely,
pancytopenia,
aplastic anaemia.
Streptokinase Powder for Antithrombo Destroy a clot! proteolytic enzymes that enhance -intravenous Fever, chills, back Drug Interactions Not to be used if hx of
injection tic PE, MI, DVT. the pain, abdominal Antagonistic effects with GI bleed,
conversion pain, nausea, antifibrinolytic agents e.g.
of plasminogen to plasmin, which vomiting, aminocaproic acid.
degrades the fibrin matrix arrhythmia, bruising,
rash, pruritus, acute
renal failure due to
embolism and
haemorrhage.
Cerebral, peripheral
and pulmonary
embolism. Allergic
reactions, liver
enzyme
abnormalities,
hypotension.
Potentially
Fatal: Haemorrhage
; anaphylactic shock
Simvastatin Tablet HMG Co A Can reduce Low HMG-CoA interrupting Oral Significant: Increase Drug Interactions Constipation, watch
Capsule inhibitors total and LDL conversion,of d serum May increase risk of myopathy LFT’s, Creatinine
by HMGCoA to mevalonate, low transaminase. and rhabdomyolysis with Kinase
30%, best synthesis of Blood and lymphatic concurrent use with
when used LDL system amiodarone, amlodipine, levels, myopathy’s and
with combo disorders: Anaemia. verapamil, diltiazem, rarely rhabdomyolysis.
therapy Potentially lomitapide, daptomycin, and
ezetimibe Fatal: Myopathy, colchicine.
rhabdomyolysis with Food Interaction
or without acute Increased plasma
renal failure, hepatic concentrations resulting to
failure. increased risk of myopathy
and rhabdomyolysis with
grapefruit juice. May enhance
hepatic side hepatic effects
with alcohol.

Lopid Tablet Fibrates Hypertriglyceri reduces the synthesis of VLD, Oral GI reactions, Drug Interactions GI complaints, monitor
 capsule demia, and with a dyspepsia, Reduce dosage of warfarin to LFT’s with renal pts
high concurrent increase in the rate of abdominal pain, maintain prothrombin time at
cholesterol, removal acute appendicitis, the desired level. Severe “myositis syndrome”
breaks down of triglyceride-rich lipoproteins atrial fibrillation myositis & myoglobinuria weakness, stiffness,
particles in from (rhabdomyolysis) w/ HMG-
triglycerides plasma. CoA reductase inhibitors. malaise; may potentiate
oral anticoagulants,

monitor INR very

closely

Give 30min before

meals.
Diuril Tablet Thiazide Good with AA, thiazides increase renal excretion -oral Watch with gout, slow
Injection Diuretics- of sodium, -intravenous onset of action up to 6
FIRST line chloride, potassium, elevate
plasma levels of weeks, can cause
uric acid and glucose gynecomastia and ED,
do not use

with ACE inhibitors, or

preexisting
hyperkalemia
Spironolactone Capsule Potassium Good for those blocks the effects of aldosterone -oral Ddrowsiness, Drug Interactions Watch with gout, slow
Tablet sparing Used for HTN in the renal dizziness, Increased risk of onset of action up to 6
diuretics and edema, tubule, causing loss of sodium headache, lethargy, hyperkalaemia w/ other K-
and high urine and water and leg cramps, GI sparing diuretics or K weeks, can cause
production retention of potassium disturbances (e.g. supplements, ACE inhibitors, gynecomastia and ED,
and a lowin K+ diarrhoea, cramps), angiotensin II receptor do not use
excretion. ataxia, mental antagonists, trilostane,
confusion, rashes, heparin, LMWH. Increased with ACE inhibitors, or
pruritus, alopecia, risk of nephrotoxicity w/ preexisting
hyponatraemia, ciclosporin, NSAIDs hyperkalemia
electrolyte Food Interaction
disturbances, Increased absorption w/ food.
gynaecomastia Concomitant admin w/ ethanol
may increase risk of
orthostasis.

Lasix Capsule Loop CHF, produce a prostaglandin-mediated oral Electrolyte Drug Interactions Watch with gout, and
Tablet diuretics peripheral increase in renal blood flow that disturbances Flushing, sweating attacks, potassium and calcium
edema, lower contributes restlessness, nausea, BP loss,
(including
BP. to their diuresis effect, effective in
symptomatic), increase & tachycardia w/
the not for those with
presence of impaired renal dehydration & chloral hydrate. Potentiates SULFA allergies, not
function, although hypovolemia ototoxicity of with Mitral
higher doses may be necessary especially in the aminoglycosides & other
elderly, increased ototoxic drugs. Enhanced Valve prolapse,
nephrotoxicity of cisplatin if cardiomyopathy or
blood creatinine & preeclampsia
blood triglyceride; furosemise is not given in
hypotension low doses. Decreased
including absorption w/
orthostatic sucralfate.Food
 hypotension (for IV
infusion).
Nitroprusside Powder for Vasodilators Heart Failure, Mixed Art/Ven dilator acts on Intravenous Nausea, retching, Drug Interactions Watch for CYANIDE
injection HTN smooth apprehension, Additive effect when used with poison, slow tapered
emergencies muscle to CI and  Venous headache, other antihypertensives. May off,
pressure, restlessness, prolong the fibrinolytic activity
PAOP, SVR, and BP muscle twitching, of alteplase. Risk of severe Rapid onset & duration,
retrosternal hypotension if used with use lowest dose,
discomfort; phosphodiesterase inhibitors.
palpitation, May reduce serum digoxin Hypotension, use in
dizziness, levels. short term, not after an
abdominal MI
discomfort
Digoxin Injection Antiarrhyth CHF, atrial + inotrop influences cardiac -oral Arrhythmias, cardiac Drug Interaction: Lots of DRUG
Solution mics dysrhythmias contraction, -intramuscular conduction disorder, interactions, can cause
Tablet High ventricular contraction and -intravenous bigeminy, trigeminy, ACE inhibitors (e.g. captopril),
high CO. PR prolongation, angiotensin receptor blockers
sinus bradycardia (e.g. telmisartan), NSAIDs
(e.g. indomethacin), COX-2 Hypokalemia,
inhibitors, calcium channel dysrhythmia, AV block,
blockers (e.g. verapamil, Vfib, Vtac,
felodipine, tinapamil),
antiarrhythmics  yellow vision,
weakness, anorexia
Food Interaction
Decreased peak serum
concentrations of digoxin with
food. Decreased oral
absorption of digoxin with
meals containing high fibre
(bran) or pectin.

Amiodarone Injection,sol Antiarrhyth Tx of V Tach, Works on Cardiac cell membrane, -intravenous Bradycardia, QT Drug Interactions Watch for V FIB,
ution mics prolongs prolongation, Increased concentration with
repolarization and refractory hypotension, inhibitors of CYP3A4 (e.g.
period peripheral HIV-protease inhibitors,
neuropathy, cimetidine). Reduced
photosensitivity, concentration with inducers of
optic neuropathy CYP3A4 (e.g. rifampicin,
and/or optic neuritis. phenytoin). May induce
bradycardia with β-blockers,
Ca channel blockers, and
other antiarrhythmic drugs.
Food Interaction
Increased plasma
concentrations with grapefruit
juice.

5. In nursing assessment and management of clients with cardiovascular disorders, write

down key points and takeaways.
Hypertension
- BP rises with any increase in CO or SVR
-Periodic monitoring of BP

Coronary Artery Disease and Acute Coronary Syndrome

- Atherogenesis as a complex interaction of risk factors including cells of the artery wall and the blood and molecular messages that they exchange
- Pain or discomfort in other areas of the upper body including the arms, left shoulder, back, neck, jaw, or stomach.
- auscultate heart and breath sounds the patient will most likely be distressed and may have pale, cool, clammy skin. the BP and HR may be elevated

Heart Failure
-