Cardiovascular Diseases

Cardiovascular Diseases
Cardiovascular Disease (CVD) includes dysfunctional conditions of the heart, arteries, and veins
that supply oxygen to vital life-sustaining areas of the body like the brain, the heart itself, and other
vital organs. If oxygen doesn't arrive the tissue or organ will die.
Ischemic Heart Disease is the technical term
for obstruction of blood flow to the heart. In
general this results because excess fat or
plaque deposits are narrowing the veins that
supply oxygenated blood to the heart. Excess
buildup of fat or plaque are respectively
termed arteriosclerosis and atherosclerosis.
Equally significant would be inadequate
oxygen flow to the brain, which causes
a stroke.
High Blood Pressure (hypertension) often
results from this excess fat or plaque buildup
because of the extra effort it takes to circulate blood. Even though the heart works harder,
blockages still shortchange the needed blood supply to all areas of the body. The body's amazing
survival systems will mask the subtle damage that is occurring from this extra wear and tear, but
not forever. High blood pressure is called "The Silent Killer" because the first warning sign is
an angina attack or a deadly heart attack or a stroke.
Kidney disorders (which leave extra fluids, sodium, and toxins in the body), obesity, diabetes, birth
control pills, pregnancy, smoking, excess alcohol, stress, and thyroid and adrenal gland problems
can also cause and exacerbate a high blood pressure condition.
Damage to the heart tissues from CVD or from heart surgery will disrupt the natural electrical
impulses of the heart and result in cardiac arrhythmia (an abnormally high or abnormally low
heart rate). Individuals often don't realize the aftermath and side effects that invasive surgical
procedures leave. Sudden fluctuations in heart rate can cause noticeable palpitations, with an
associated faintness, or dizziness, and if severely abnormal could interfere with blood flow and even
initiate a heart attack.
Proper ranges of cholesterol are also important in the prevention of heart attack or stroke. Total
blood cholesterol above 200 mg/dl, LDL cholesterol above 130 mg/dl, HDL cholesterol below 35
mg/dl; and lipoprotein(a) level greater than 30 mg/dl are indicators of problematic cholesterol.
Cholesterol is not actually a damage mechanism but is more an indicator of compromised liver
function, and increased risk of heart attack.
Infection of the heart, carditis and endocarditis, is an additional complication that can occur as a
result of a weak immune system, liver problems, heart surgery, or from an autoimmune disorder
like rheumatic fever. Endocarditis is quite common in persons with compromised immune systems
from HIV or AIDS. If not appropriately handled, permanent heart muscle damage can occur from
the infection.
What is Cardiovascular Disease (Heart Disease)?
Heart and blood vessel disease cardiovascular disease also called heart disease includes
numerous problems, many of which are related to a process calledatherosclerosis.
Atherosclerosis is a condition that develops when a substance called plaque builds up in the
walls of the arteries. This buildup narrows the arteries, making it harder for blood to flow
through. If a blood clot forms, it can stop the blood flow. This can cause a heart attack or stroke.
A heart attack occurs when the blood flow to a part of the heart is blocked by a blood clot. If
this clot cuts off the blood flow completely, the part of the heart muscle supplied by that artery
begins to die. Most people survive their first heart attack and return to their normal lives to enjoy
many more years of productive activity. But having a heart attack does mean you have to make
some changes. The doctor will advise you of medications and lifestyle changes according to
how badly the heart was damaged and what degree of heart disease caused the heart
attack. Learn more at our Heart Attack website.
An ischemic stroke (the most common type) happens when a blood vessel that feeds the brain
gets blocked, usually from a blood clot. When the blood supply to a part of the brain is shut off,
brain cells will die. The result will be the inability to carry out some of the previous functions as
before like walking or talking. A hemorrhagic strokeoccurs when a blood vessel within the
brain bursts. The most likely cause is uncontrolled hypertension.
Some effects of stroke are permanent if too many brain cells die after a stroke due to lack of
blood and oxygen to the brain. These cells are never replaced. The good news is that some
brain cells don't die they're only temporarily out of order. Injured cells can repair themselves.
Over time, as the repair takes place, some body functioning improves. Also, other brain cells
may take control of those areas that were injured. In this way, strength may improve, speech
may get better and memory may improve. This recovery process is what rehabilitation is all
about. Learn more about stroke.
Other Types of Cardiovascular Disease
Heart failure: This doesn't mean that the heart stops beating. Heart failure, sometimes called
congestive heart failure, means the heart isn't pumping blood as well as it should. The heart
keeps working, but the body's need for blood and oxygen isn't being met. Heart failure can get
worse if it's not treated. If your loved one has heart failure, it's very important to follow the
doctor's orders. Learn more at our Heart Failure website.
Arrhythmia: This is an abnormal rhythm of the heart. There are various types of arrhythmias.
The heart can beat too slow, too fast or irregularly. Bradycardia is when the heart rate is less
than 60 beats per minute. Tachycardia is when the heart rate is more than 100 beats per
minute. An arrhythmia can affect how well the heart works. The heart may not be able to pump
enough blood to meet the body's needs. Learn more at our Arrhythmia website.
Heart valve problems: When heart valves don't open enough to allow the blood to flow through
as it should, it's called stenosis. When the heart valves don't close properly and allow blood to
leak through, it's called regurgitation. When the valve leaflets bulge or prolapse back into the
upper chamber, its a condition called mitral valve prolapse. When this happens, they may not
close properly. This allows blood to flow backward through them.
What are the risk factors for heart disease?
Risk factors for heart disease include:
Smoking
High blood pressure (hypertension)
High cholesterol
Diabetes
Family history
Peripheral artery disease
Obesity
Risk factors
[edit]Age
Age is an important risk factor in developing cardiovascular diseases. It is estimated that 82
percent of people who die of coronary heart disease are 65 and older
[6]
. At the same time, the
risk of stroke doubles every decade after age 55.
[7]

Multiple explanations have been proposed to explain why age increases the risk of
cardiovascular diseases. One of them is related to serum cholesterol level.
[8]
In most
populations, the serum total cholesterol level increases as age increases. In men, this increase
levels off around age 45 to 50 years. In women, the increase continues sharply until age 60 to
65 years.
[8]

Aging is also associated with changes in the mechanical and structural properties of the
vascular wall, which leads to the loss of arterial elasticity and reduced arterial compliance and
may subsequently lead to coronary artery disease.
[9]

[edit]Gender
Men are at greater risk of heart disease than pre-menopausal women.
[10]
However, once past
menopause, a womans risk is similar to a mans.
[10]

Among middle-aged people, coronary heart disease is 2 to 5 times more common in men than
in women.
[8]
In a study done by the World Health Organization, gender contributes to
approximately 40% of the variation in the sex ratios of coronary heart disease
mortality.
[11]
Another study reports similar results that gender difference explains nearly half of
the risk associated with cardiovascular diseases
[8]
One of the proposed explanations for the
gender difference in cardiovascular disease is hormonal difference.
[8]
Among women, estrogen
is the predominant sex hormone. Estrogen may have protective effects through glucose
metabolism and hemostatic system, and it may have a direct effect on improving endothelial cell
function.
[8]
The production of estrogen decreases after menopause, and may change the female
lipid metabolism toward a more atherogenic form by decreasing the HDL cholesterol level and
by increasing LDL and total cholesterol levels.
[8]
Women who have experienced early
menopause, either naturally or because they have had a hysterectomy, are twice as likely to
develop heart disease as women of the same age group who have not yet gone through
menopause.
[12]

Among men and women, there are differences in body weight, height, body fat distribution,
heart rate, stroke volume, and arterial compliance.
[13]
In the very elderly, age related large artery
pulsatility and stiffness is more pronounced in women.
[14]
This may be caused by the smaller
body size and arterial dimensions independent of menopause.
[15]

[edit]Air pollution
Particulate matter have been studied for their short- and long-term exposure effects on
cardiovascular disease. Currently, PM
2.5
is the major focus, in which gradients are used to
determine CVD risk. For every 10 g/m
3
of PM
2.5
long-term exposure, there was an estimated 8-
18% CVD mortality risk.
[16]
Women had a higher relative risk (RR) (1.42) for PM
2.5
induced
coronary artery disease than men (0.90) did.
[16]
Overall, long-term PM exposure increased rate
of atherosclerosis and inflammation. In regards to short-term exposure (2 hrs), every 25
g/m
3
of PM
2.5
resulted in a 48% increase of CVD mortality risk.
[17]
Additionally, after only 5 days
of exposure, a rise in systolic (2.8 mmHg) and diastolic (2.7 mmHg) blood pressure occurred for
every 10.5 g/m
3
of PM
2.5
.
[18]
Other research has implicated PM
2.5
in irregular heart rhythm,
reduced heart rate variability (decreased vagal tone), and most notably heart
failure.
[19][20]
PM
2.5
is also linked to carotid artery thickening and increased risk of acute
myocardial infarction

Cardiac Procedures and Surgeries
If you've had a heart attack, you may have already had certain procedures to help you survive
your heart attack and diagnose your condition. For example, many heart attack patients have
undergone thrombolysis, a procedure that involves injecting a clot-dissolving agent to restore
blood flow in a coronary artery. This procedure is administered within a few (usually three) hours
of a heart attack. If this treatment isn't done immediately after a heart attack, many patients will
need to undergo coronary angioplasty or coronary artery bypass graft surgery (CABG) later to
improve blood supply to the heart muscle.
Angioplasty
(Also known as Percutaneous Coronary Interventions [PCI], Balloon Angioplasty and Coronary
Artery Balloon Dilation)

What the Procedure Does
Special tubing with an attached deflated balloon is threaded up to the coronary arteries. The
balloon Is inflated to widen blocked areas where blood flow to the heart muscle has been
reduced or cutoff. Often combined with implantation of a stent to help prop the artery open and
decrease the chance of another blockage. Considered less invasive because the body is not cut
open. Lasts from 30 minutes to several hours. Often requires an overnight hospital stay.

Reason for the Procedure
Greatly increases blood flow through the blocked artery.
Decreases chest pain (angina).
Increases ability for physical activity.
Reduces risk of a heart attack.
Can also be used to open neck and brain arteries to help prevent stroke.
Angioplasty, Laser
Similar to angioplasty except that the catheter has a laser tip that opens the blocked artery.
Pulsating beams of light vaporize the plaque buildup.

Increases blood flow through blocked arteries.
Artificial Heart Valve Surgery
(Also known as Heart Valve Replacement Surgery)
Replaces an abnormal or diseased heart valve with a healthy one.
Restores function of the heart valves.
Atherectomy
Similar to angioplasty except that the catheter has a rotating shaver on its tip to cut away plaque
from the artery.
Increases blood flow through the blocked artery by removing plaque buildup.
May also be used in carotid arteries (major arteries of the neck leading to the brain) to
remove plaque and reduce risk for stroke.
Bypass Surgery
(Also known as CABG or "cabbage," Coronary Artery Bypass Graft and Open-Heart Surgery)

Treats blocked heart arteries by creating new passages for blood to flow to your heart muscle. It
works by taking arteries or veins from other parts of your body called grafts and using
them to reroute the blood around the clogged artery. A patient may undergo one, two, three or
more bypass grafts, depending on how many coronary arteries are blocked. Requires several
days in the hospital.

One of the most common and effective procedures to manage blockage of blood to the
heart muscle.
Improves the supply of blood and oxygen to the heart.
Relieves chest pain (angina).
Reduces risk of heart attack.
Improves ability for physical activity.
Cardiomyoplasty
An experimental procedure in which skeletal muscles are taken from a patient's back or
abdomen. Then they're wrapped around an ailing heart. This added muscle, aided by ongoing
stimulation from a device similar to a pacemaker, may boost the heart's pumping motion.
Increases the pumping motion of the heart.
Heart Transplant
Removes a diseased heart and replaces it with a healthy human heart when a heart is
irreversibly damaged. Uses hearts from organ donation.
Recognized as a proven procedure to restore heart health in appropriately selected
patients.
Minimally Invasive Heart Surgery
(Also known as Limited Access Coronary Artery Surgery and includes Port-Access Coronary
Artery Bypass (PACAB or PortCAB) and Minimally Invasive Coronary Artery Bypass Graft
(MIDCAB)
An alternative to standard bypass surgery (CABG). Small incisions ("ports") are made in the
chest. Chest arteries or veins from your leg are attached to the heart to "bypass" the clogged
coronary artery or arteries. The instruments are passed through the ports to perform the
bypasses. The surgeon views these operations on video monitors rather than directly. In
PACAB, the heart is stopped and blood is pumped through an oxygenator or "heart-lung"
machine. MIDCAB is used to avoid the heart-lung machine. It's done while the heart is still
beating. Requires several days in the hospital.
Manages blockage of blood flow to the heart and improves the supply of blood and
oxygen to the heart.
Reduces risk of heart attack.
Improves ability for physical activity.
Radiofrequency Ablation
(Also known as Catheter Ablation)
A catheter with an electrode at its tip is guided through the veins to the heart muscle with real-
time, moving X-rays (fluoroscopy) displayed on a video screen. The catheter is placed at the
exact site inside the heart where cells give off the electrical signals that stimulate the abnormal
heart rhythm. Then a mild, painless radiofrequency energy (similar to microwave heat) is
transmitted to the pathway. This destroys carefully selected heart muscle cells in a very small
area (about 1/5 of an inch).
Preferred treatment for many types of rapid heartbeats (arrhythmias) especially
supraventricular tachyarrhythmias.
Stent Procedure
A stent is a wire mesh tube used to prop open an artery during angioplasty. The stent stays in
the artery permanently.

Holds the artery open.
Improves blood flow to the heart muscle.
An incision is made on the left breast to expose the heart. Then, a laser is used to drill a series
of holes from the outside of the heart into the heart's pumping chamber. In some patients TMR
is combined with bypass surgery. In those cases an incision through the breastbone is used for
the bypass. Usually requires a hospital stay.
Used to relieve severe chest pain (angina) in very ill patients who aren't candidates for
bypass surgery or angioplasty.

Symptoms and Diagnosis of Heart Attack
Symptoms of heart attack
If you are concerned that you may be experiencing a heart attack, call 9-1-1. Minutes matter!
Learn the warning signs to familiarize yourself in case of an emergency.
Symptoms of heart disease which may lead to a heart attack
You may be experiencing cardiovascular problems if you notice that ordinary physical activity
causes you to experience the following symptoms:
Undue fatigue
Palpitations --- the sensation that your heart is skipping a beat or beating too rapidly
Dyspnea --- difficult or labored breathing
Anginal pain --- chest discomfort from increased activity
o Stable angina (or chronic stable angina) refers to "predictable" chest discomfort
such as that associated with physical exertion or mental or emotional stress.
Rest and/or nitroglycerin usually relieve stable angina.
o Unstable angina refers to unexpected chest pain and usually occurs at rest. It is
typically more severe and prolonged and is due to a reduced blood flow to the
heart caused by the narrowing of the coronary arteries in
atherosclerosis. Unstable angina is an acute coronary syndrome and should
be treated as an emergency. Learn about an unstable form of angina
called Prinzmetal angina.
Diagnosis: How do I know if a heart attack has occurred?
A doctor who's studied the results of several tests must diagnose a heart attack. The doctor will
review the patient's complete medical history.
give a physical examination.
use an electrocardiogram (ECG or EKG) to discover any abnormalities caused by
damage to the heart. An ECG is a medical device that makes a graphical record of the
heart's electrical activity.
sometimes use a blood test to detect abnormal levels of certain enzymes in the
bloodstream.
Blood tests confirm (or refute) suspicions raised in the early stages of evaluation that may occur
in an emergency room, intensive care unit or urgent care setting. These tests are sometimes
called heart damage markers or cardiac enzymes.
Heart attack: a signal of heart disease
Although you may have warning signs prior to a heart attack, the heart attack itself may be your
first symptom of an underlying problem: cardiovascular disease such as coronary artery
disease (CAD) which narrows and hardens your arteries around the heart
or atherosclerosis which is often responsible for artery-blocking clots.
To diagnose the condition, heart attack patients may be asked to undergo a number of
diagnostic tests and procedures. By learning what these tests are and why they're being done,
you'll feel more confident. These tests are important and help the doctor determine if a heart
attack occurred, how much your heart was damaged and also what degree of CAD you may
have.
Diagnostic measures "non-invasive" and "invasive"
The tests screen your heart and help the doctor determine what treatment and lifestyle changes
will keep your heart healthy and prevent serious future medical events. There are "non-invasive"
diagnotic tests and "invasive" diagnostic tests.
Non-invasive tests don't involve inserting needles, instruments or fluids into the body.
Invasive procedures can include a simple needle prick for a blood test or shot, insertion
of a tube, device or scope and major surgeries such as open-heart surgery.
Likely diagnostic procedures
If you've had a heart attack, you may have already had certain procedures to help you survive
your heart attack and diagnose your condition.
Thrombolysis: Many heart attack patients have undergone thrombolysis, a procedure
that involves injecting a clot-dissolving agent to restore blood flow in a coronary artery.
This procedure is administered within a few (usually three) hours of a heart attack.
Coronary Angioplasty/ Coronary artery bypass graft surgery (CABG): If
thrombolysis treatment isn't done immediately after a heart attack, many patients will
need to undergo coronary angioplasty or coronary artery bypass graft surgery (CABG)
later to improve blood supply to the heart muscle.
Use the following At-A-Glance charts to gain a quick understanding of possible
treatments that a heart attack patient may undergo.
Cardiac Procedures and Surgeries At-A-Glance
Implantable Medical Devices At-A-Glance
Cardiac Medications At-A-Glance
Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels and
include:
Coronary heart disease disease of the blood vessels supplying the heart muscle
Cerebrovascular disease disease of the blood vessels supplying the brain
Peripheral arterial disease disease of blood vessels supplying the arms and legs
Rheumatic heart disease damage to the heart muscle and heart valves from rheumatic
fever, caused by streptococcal bacteria
Congenital heart disease malformations of heart structure existing at birth.
Deep vein thrombosis and pulmonary embolism blood clots in the leg veins, which can
dislodge and move to the heart and lungs.
Heart attacks and strokes are usually acute events and are mainly caused by a blockage that
prevents blood from flowing to the heart or brain. The most common reason for this is a build-up
of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. Strokes
can also be caused by bleeding from a blood vessel in the brain or from blood clots.
FACTS ABOUT CARDIOVASCULAR DISEASES
CVDs are the number one cause of death globally: more people die annually
from CVDs than from any other cause;
An estimated 17.5 million people died from CVDs in 2005, representing 30% of all global
deaths. Of these deaths, an estimated 7.6 million were due to coronary heart disease and
5.7 million were due to stroke.
Over 80% of CVD deaths take place in low- and middle-income countries and occur almost
equally in men and women;
By 2015, almost 20 million people will die from CVDs, mainly from heart disease and stroke.
These are projected to remain the single leading causes of death.
CAUSES OF CARDIOVASCULAR DISEASES
The causes of CVDs are well established and well known. The most important causes of
heart disease and stroke are unhealthy diet, physical inactivity and tobacco use. These are
called modifiable risk factors.
The effects of unhealthy diet and physical inactivity may show up in individuals as raised
blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity; these
are called intermediate risk factors.
The major modifiable risk factors are responsible for about 80% of coronary heart disease
and cerebrovascular disease.
There are also a number of underlying determinants of chronic diseases, or, if you like, "the
causes of the causes". These are a reflection of the major forces driving social, economic
and cultural change globalization, urbanization, and population ageing. Other
determinants of CVDs are poverty and stress.
COMMON SYMPTOMS OF CARDIOVASCULAR DISEASES
Often, there are no symptoms of the underlying disease of the blood vessels. A heart attack
or stroke may be the first warning of underlying disease.
Symptoms of a heart attack include: pain or discomfort in the centre of the chest; pain or
discomfort in the arms, the left shoulder, elbows, jaw, or back. In addition the person may
experience difficulty in breathing or shortness of breath; feeling sick or vomiting; feeling
light-headed or faint; breaking into a cold sweat; and becoming pale.
Women are more likely to have shortness of breath, nausea, vomiting, and back or jaw pain.
The most common symptom of a stroke is sudden weakness of the face, arm, or leg, most
often on one side of the body. Other symptoms include sudden onset of: numbness of the
face, arm, or leg, especially on one side of the body; confusion, difficulty speaking or
understanding speech; difficulty seeing with one or both eyes; difficulty walking, dizziness,
loss of balance or coordination; severe headache with no known cause; and fainting or
unconsciousness.
People experiencing these symptoms should seek medical care immediately.

POTENTIAL NURSING DIAGNOSIS FOR SEVERE HYPERTENSION:
1. Risk for decreased cardiac output
2. Activity intolerance
3. Acute headache pain
4. Imbalanced nutrition more than body requirements
5. Ineffective coping
6. Deficient knowledge (Learning Need) regarding condition, treatment plan, self-care,
and discharge needs

VIEW SAMPLE NURSING CARE PLAN FOR HYPERTENSION
POTENTIAL NURSING DIAGNOSIS FOR CHRONIC HEART FAILURE (CHF)
1. Decreased Cardiac output
3. Excess fluid volume
4. Risk for impaired gas exchange
5. Risk for impaired skin integrity
and discharge needs

VIEW SAMPLE NURSING CARE PLAN FOR CHRONIC HEART FAILURE (CHF)
POTENTIAL NURSING DIAGNOSIS FOR ANGINA (CORONARY ARTERY DISEASE)
1. Acute pain
3. Anxiety
and discharge needs
POTENTIAL NURSING DIAGNOSIS FOR MYOCARDIAL INFARCTION
1. Acute pain
3. Anxiety/ Fear
5. Ineffective tissue perfusion
6. Risk for excess fluid volume
and discharge needs

VIEW SAMPLE NURSING CARE PLAN FOR MYOCARDIAL INFARCTION
POTENTIAL NURSING DIAGNOSIS FOR DYSRHYTHMIAS (INCLUDING DIGITALIS
TOXICITY)
2. Risk for poisoning, digitalis toxicity
and discharge needs

POTENTIAL NURSING DIAGNOSIS FOR CARDIAC SURGERY: POSTOPERATIVE CARE
CORONARY ARTERY BYPASS GRAFT (CABG), MINIMALLY INVASIVE DIRECT
CORONARY ARTERY BYPASS (MIDCAB), CARDIOMYOPLASTY, VALVE REPLACEMENT
2. Acute pain
3. Ineffective role performance
4. Risk for ineffective breathing pattern
5. Impaired skin integrity
and discharge needs

POTENTIAL NURSING DIAGNOSIS FOR THROMBOPHLEBITIS: DEEP VEIN THROMBOSIS
(INCLUDING PULONARY EMBOLI CONSIDERATIONS)
1. Ineffective tissue perfusion
2. Acute pain
3. Impaired gas exchange (in presence of pulmonary embolus)
and discharge needs

Cardiovascular Diseases

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