Cardiovascular disease

Also called heart disease is a class of diseases that involve the heart, the blood vessels (arteries,
capillaries, and veins) or both. Cardiovascular disease refers to any disease that affects the cardiovascular
system, principally cardiac disease, vascular diseases of the brain and kidney, and peripheral arterial
disease.
Coronary Artery Disease (CAD)
-Is the most prevalent type of cardiovascular disease in adults. It is the obstruction of blood flow
thru the coronary artery, through the heart muscles.
Atherosclerosis-
-Abnormal accumulation of lipid, or fatty, substances and fibrous tissue in the lining of arterial
blood vessel walls. These substances create blockage and narrow the coronary vessels in a way
that reduces blood flow to the myocardium.
-Between 30-50 years old, may manifest as Angina pectoris or M.I



Pathophysiology























Fatty streaks of
lipids deposited in
the intima of the
arterial wall
Attraction of
inflammatory cells
Macrophages,infiltrate with
injured vascular endothelium
and ingest lipids,which turns
into foam cells
Activated macrophages,release biochemical substances that
can further damage the endothelium,attracting platelets and
initiating clotting
Continue progression involves
an inflammatory response,
begins injury to the vascular
endothelium
Protrude into the lumen of the vessel,narrowing it and
obstructing bloodflow.
Smooth muscle cells within the vessel wall, proliferate and form
a fibrous cap over a core filled with lipid and inflammatory
infiltrate deposits called atheromas or plaque
Multiple effects of
the arterial wall
Medications:

Statins- Blocks cholesterol synthesis, lower LDL and triglycerides level and
increase HDL levels.
Nicotinic Acids- Decrease Lipoprotein synthesis,lower LDL and triglyceride
level and increase HDl levels.
Fibric acids or fibrates-decrease the synthesis of cholesterol
Bile acid sequestrants or Resins- bind cholesterol in the intestine, increase its
breakdown and lower LDL level with minimal effect on HDLs.


Management
Medical management of atherosclerosis involves modification to risk factors like
smoking cessation and diet restrictions. Additionally, a controlled exercise
program combats atherosclerosis by improving circulation and functionality of the
vessels. Exercise is also used to manage weight in patients who are either obese,
lower blood pressure, and decrease cholesterol. Often lifestyle modification is
combined with medication therapy. For example, statins help to lower cholesterol,
antiplatelet medications like Aspirin help to prevent clots, and a variety of
antihypertensive medications are routinely used to control blood pressure. If the
combined efforts of risk factor modification and medication therapy are not
sufficient to control symptoms, or fight imminent threats of ischemic events, a
physician may resort to interventional or surgical procedures to correct the
obstruction





Angina Pectoris
-Is a clinical syndrome usually characterized by episodes of paroxysms of pain or
pressure in the anterior chest.
-cause is insufficient coronary bloodflow, resulting in a decreased oxygen supply
when there is increased myocardial demand for oxygen in response to physical
exertion or emotional stress.

Pathophysiology
-Usually caused by Atherosclerotic disease, associated with a significant
obstruction of a major coronary artery. Normally, the myocardium extracts a large
amount of oxygen from the coronary circulation to meet its continuous demands;
increase demand flow through the coronary arteries needs to be increased, when
there is blockage in a coronary artery flow cannot be increased and ischemic
results.

Medication:
Nitroglycerin
- a vasoactive agent, to reduce myocardial oxygen consumption which
decreases ischemia and relieves pain.


Beta-adrenergic blocking agents
-Metoprolol (Lopressor,Toprol), Atenalol (tenormin)
-Reduce myocardial oxygen consumption by blocking beta-adrenergic
sympathetic stimulation to the heart.
Calcium channel blocking agents
-these agents decrease sinoatrial node automaticity and atrioventricular node
conduction, resulting in a slower heart rate and a decrease in the strength of
heart muscles contraction.
Antiplatelet and anticoagulant Medications
-Aspirin, clopidogrel and ticlopidine,heparin
-To prevent platelet aggregation and subsequent thrombosis which impedes
bloodflow.


Nursing Management

-Administer oxygen
-Give prompt pain relief with nitrates or narcotic analgesics as ordered
-Monitor V/S, status of cardio pulmonary function, monitor ECG
-Place patient in semi-high fowlers position
-Provide emotional support health teachings and discharge instructions
-Instruct client to notify physician immediately if pain occurs and persist,
despite rest and medication administration























Myocardial Infarction

-Heart Attack
- the death of myocardial cells from inadequate oxygenation, often caused
by a sudden complete blockage of a coronary artery; characterized
by localized formation of necroses (tissue destruction) with subsequent
healing by scar formation and fibrosis.





Pathophysiology

In Myocardial Infarction, inadequate coronary blood flow rapidly results in
myocardial ischemia in the affected area. The location and extent of the infarct
determine the effects on cardiac function. Ischemia depresses cardiac function and
triggers autonomic nervous system responses that exacerbate the imbalance
between myocardial oxygen supply and demand. Persistent ischemia results in
tissue necrosis and scar tissue formation, with permanent loss of myocardial
contractility in the affected area. Cardiogenic shock may develop because of
inadequate CO from decreased myocardial contractility and pumping capacity.











Medication

-Aspirin,Nitroglycerine,Morphine, beta-blocker

Thrombolytics- purpose is to dissolve the thrombus in a coronary artery.
(thrombolysis) allowing blood to flow through the coronary artery again
(Reperfusion).

Analgesics-
-Morphine sulfate
- To reduce pain and anxiety, reduce preload and afterload.

Angiotensin- Converting Enzyme inhibitor
-ACE inhibitor
-prevents the conversion of Angiotensin 1 to Angiotensin 11
-decrease the oxygen demand of the heart.




Nursing Management

-Administer oxygen as ordered to relieve dyspnea and prevent arrhythmias
-Establish a patent IV line
-provide pain relief; morphin sulfate IV
-provide bed rest with semi fowlers position
-Monitor ECG and hemodynamic procedure
-Administer anti-arrhythmias as ordered
-Monitor I & O report if no less than 30ml/hr
-Maintain full liquid diet with gradual increase to soft, low salt
-Maintain quiet environment
-Administer stool softener as ordered
-Administer anticoagulants,thrombolytics as ordered and monitor for S/E




-Provide client teaching and discharge instruction concerning effects of MI
healing process
-Medical regimen; have purpose schedule dosage
-Risk factors with necessary lifestyle modification
-Dietary restrictions; low salt low cholesterol avoidance of caffeine
-Resumption of sexual activity as ordered (usually 4-6 weeks)
-Need to report the following symptoms; increase persistent chest pain, pain,
dyspnea, weakness, fatigue, persistence palpitation light headed nest
-Enrollment of client and cardiac rehabilitation program