Coronary Vascular Disorders for Nursing

Heart Failure

–    Heart failure occurs when the heart can not pump enough blood to meet the body metabolic needs.
–    Heart failure can occur as left side failure or right side failure.

Types of Heart Failure

(1) Left heart failure:  inability of the left heart to pump volume of blood returned to it resulting in pulmonary congestion
•    Caused by: hypertension, mitral and aortic valve disease, ischemic heart disease, and primary myocardial diseases
•    Left side heart failure causes mostly pulmonary symptoms such as shortness of breath, dyspnea, and a moist cough

(2)Right heart failure:  inability of right heart to meet demands of venous blood return resulting in systemic congestion
•    Caused by: left heart failure (most common cause), primary vascular disease of the lungs, tricuspid and pulmonary valve disease, congenital or acquired left to right shunts
•    Right side heart failure causes systemic symptoms such as edema and swelling, jugular vein distention, hepatomegaly and weight gain.

Diagnostic Test:

•    Chest x-ray shows increase pulmonary congestion and lt ventricular (Lt H.F.), while Pulmonary congestion, cardiomegaly a and pleural effusion (Rt H.F.)
•    ABGs, Blood chemistry, hypertrophy , ECG, Echocardiography, CVP increase.

Drug therapy:
•    Analgesic (Morphine), Diuretics, angiotensin converting enzyme (captopril), dopmain, dobutamine, Nitrate (nitroglycerin), vasodilator

Ischemic Heart Disease

Definition:  Syndromes causing an imbalance between myocardial oxygen demand and supply
Ischemia: insufficient tissue oxygenation.
Infarction: a zone of tissue deprived of blood supply.

Risk Factors:


– HTN, DM and Smoking
– Sedentary life-style, Family history
– Hypertriglyceridemia

Results of Ischemic Heart Disease

– Angina Pectoris
– Acute Myocardial Infarction
– Sudden Cardiac Death
– Chronic Ischemic Heart Disease

Angina pectoris

–    Angina is chest pain caused by inadequate myocardial oxygen supply. Its usually caused by narrowing of the coronary arteries.

–    Categories of Angina:
1- In Stable angina: symptoms are consistent and pain is relieved by rest.
2- In Unstable angina: pain is marked by increasing severity, duration, and frequency. Pain responds slowly to nitroglycerin.
3- In Prinzmetal (variant) angina: pain is unpredictable and may occur at rest.
–    Clinical manifestation:
    pain, feeling pressure or compression in the anterior chest, pain radiated to the neck, jaw, or back; usually lasts 3 to 5 minutes. It usually occurs after exertion, and emotional excitement. (Dyspnea, sweating, pallor)
–    ECG shows ST segment depression and T wave inversion during angina pain.
Factors can produce anginal pain:
Physical exertion, Exposure to cold can cause vasoconstriction, Eating heavy meal and Stress → adrenalin → ↑ B.P.

Diagnostic evaluation:
•    Signs + symptoms:-
•    ECG shows ST segment depression and T wave inversion during angina pain.

Management:
•    Bed rest and avoid activities  .
•    O2 5L/min, fowler position .
•    Adminsiter medication as prescribed to increase oxygenation and to reduce cardiac workload.
•    Nitroglycerin: 5mg, direct relaxation of blood vessels and smooth muscles of coronary arteries → lead to ↑ blood supply to myocardium. Pan should be relieved within 3 minutes.
•    Reduce risk factors through diet, exercise, weight loss, smoking cessation, and stress reduction.

Myocardial infarction

Myocardial infarction

•    Refers to the process by which myocardial tissue is destroyed because of reduced coronary blood flow due to  Atherosclerosis or complete occlusion of an artery, embolus or thrombus.

Clinical manifestation:
•    Crushing chest pain radiate to the shoulder + down the arms [not after effort or emotional upset]
•    Dyspnea, pallor, diaphoresis, nausea + vomiting, elevated temprature.
•    Note : rate of MI greater in ♂ male  than ♀ female .

Diagnostic evaluation:
•    1] A: History of present illness [duration, pain]
•        B: History of previous illness [↑ BP., D.M]
•    2] ECG: enlarge Q wave, elevation or depressed ST segment and T wave inversion.
•    3] CPK most sensitive + reliable indicator in case of MI, p 6hrs → return to normal in the 3rd day.
•    4] WBC shows increase count.

Management
•    Bed rest to ↓ O2 demand.
•    Relieving chest pain, analgesics [morphine sulfate].
•    Vasodilators Nitroglycerine IV. [dilates both arteries + veins.
•    Anticoagulant [ heparin].
•    Thrombolytic [streptokinase] dissolving thrombus.
•    O2 administration.
•    ↓ anxiety
•     Patient education.

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Posted in Cardiovascular, Critical Care Nursing

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