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CONCEPT ON OXYGENATION
GAS TRANSPORT
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CARDIOVASCULAR SYSTEM
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Efficient pumping system
Transports cellular wasteproducts to the appropriateorgans for removal from the
body.
Supplies all body tissues withoxygen and nutrients.
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Blood cells play important rolesin the immune system.
Efficient pumping system
Blood cells play important rolesin the endocrine system.
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HEART
BLOOD
BLOODVESSELS
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HEART
Located between thelungs
Above the diaphragmFurnishes the powerto maintain blood flow
throughout both thepulmonary andsystemic circulatorysystems.
Hollow muscular organ
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HEART
Weight: between 7 and 15 ounces(200 425 grams)
Size: A little larger than the size of fist.
Average total heart beats per day:100,000
Lifetime average heartbeat: 3.5 billiontimes
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Double-walledmembrane sacthat encloses theheart.
Pericardialfluid between the
layers of thepericardium toprevent frictionwhen the heart
beats.
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EPICARDIUM
external layerof the heart; part of theinner layer of pericardial sac.
ENDOCARDIUMlining ofthe heart; inner surface thatcomes in direct contact withblood being pumped throughthe heart.
MYOCARDIUMmiddle andthickest of the three layers;
consists of cardiac muscle.
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Must have:- continuous supply ofoxygen and nutrients- prompt removal ofwaste
If blood supply isdisrupted, the myocardiumin the affected area dies.
Highly specialized muscle
that beats constantly.
Coronary artery & veins
supply the blood needs ofthe myocardium.
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Atria- upper chamber of the heart- receiving chamber
- separated by interatrial septum
Ventriclelower chamber- all vessels leavingthe heart emergefrom
the ventricles-separated by
interventricularseptum
Cardiac Apex:
narrow tip ofthe heart
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Flow of blood is
controlled by the
following valves:
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Flow of blood is controlled by the following valves:
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Valve: A membranous structure in ahollow organ or passage that folds orcloses to prevent the return flow of thebody fluid passing through it.
If any of the heart valves is not workingproperly, blood does not flow properlythrough the heart and cannot be pumpedeffectively throughout the body.
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Tricuspid (TV)Controls theopening
between theright atriumand right
ventricle.
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Tricuspid:Having 3
points orcusps
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Pulmonarysemilunar valve:
located betweenright ventricleand pulmonaryartery.Semilunar:half-moon
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MitralValve (MV):located
betweenleft atriumand left
ventricle.
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Mitral Valve (MV):Bicuspid valveValve is shaped
with two points
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AorticSemilunar
Valve:
locatedbetween the
left ventricle
and theaorta.
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Valves
Atrioventricular valvesclosure of AV valves = S1 or first heart sound
LUB
tricuspid
mitral Semilunar valvesclosure of SVS2 or second heart sound DUB
pulmonic
aortic
EXTRA HEART SOUNDS
S3ventricular gallop CHF
S4atrial gallop MI, HPN
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Systemicand
PulmonaryCirculation
Makes possiblethe importantfunction of blood:
Bringing oxygento the cells andremoving waste
products.
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SYSTEMIC CIRCULATION
Includes blood flow to all
parts of the body except thelungs.
Oxygen-rich blood flows out
of the heart from the leftventricle into arterial
circulation.
Oxygen-poor blood returnsto the heart through the
veins and flows into the right
atrium.
PULMONARY CIRCULATION
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PULMONARY CIRCULATION
Flow of blood between the heart and lungs.
Blood flows out of the heart from the right ventricle
and through the pulmonary arteriesto the lungs.
This is the only place in the body where arteries
carry oxygen-poor blood.
In the lungs, waste material (CO2)from the body is exchanged for oxygen
from the inhaled air.
The pulmonary veinscarry the
oxygen-rich blood into the left atriumof the heart.
This is the only place in the body
where veins carry oxygen-rich
blood.
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To pump blood effectively
throughout the body, thecontraction and relaxation (beating)of the heart must occur in exactlythe correct sequence.
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The rate and regularity of the
heartbeat is determined byelectrical impulses from nervesthat stimulates the myocardium ofthe chambers of the heart.
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CONDUCTION
SYSTEM:
Bundle of His
atrioventricular(A-V) node
sinoatrial node(S-A node)
Bundle of His
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Bundle of His
Sinoatrial Node(S-A node)
Located in theposterior wall of theright atrium near theentrance of thesuperior vena cava.
Establishes the
basic rhythm of theheartbeat.
NATURAL
PACEMAKER
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Bundle of His
Sinoatrial Node Electrical impulsesfrom the S-A node start
each wave of musclecontraction in the heart.
Impulse in the right
atrium spreads over themuscles of both atria,causing them to contractsimultaneously.
The contractionforces blood into theventricles.
(DIASTOLE)
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Bundle of His
Atrioventricular Node
Impulses from the S-Anode travel to the A-Vnode or atrioventricularnode.
It is located on the
floor of the right atriumnear the interatrialseptum.
The A-V node
transmits the electricalimpulses on to theBundle of His.
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Bundle of His
Bundle of His
Named for Wilhelm His, Jr.,
a 19thcentury Swiss physician.
Located within the
interventricular septum.
Branches of the Bundle of
His carry the impulse to the
right and left ventricles and the
Purkinje fibers.
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Bundle of His
Purkinje Fibers
Named for Johannes
Purkinje, a 19thcentury
physiologist.
Simulation of Purkinje
fibers causes the ventricles
to contract simultaneouslyforcing blood into the aorta
and pulmonary arteries.
SYSTOLE
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Activities of theelectrical conduction
system of the heart
can be visualized as
wave movements on amonitor or an
electrocardiogram.
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P waveis due to the
contraction (stimulation) of
the atria.
QRS complex shows the
contraction (stimulation) ofthe ventricles. The atria
relax as the ventricles
contract.
T waveis the relaxation
(recovery) of the ventricles.
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When a stethoscope is used to listen to the
hearbeat, two distinct sounds are heard. They arecalled the lubb-dupp sounds.
Lubb sound: Caused by the tricuspid and mitral
valves closing between the atria and the ventricles.
Dupp sound: Caused by the closing of thesemilunar valves in the aorta and pulmonary arteries
as blood is pumped out of the heart.
- Shorter and higher pitched sound.
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Arteries
Veins
Lumen: Opening within
the vessels through
which blood flows.
Capillaries
A t i
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Arteries
Large blood vessels that carry
blood away from the heart to allregions of the body.
High oxygen content: bright red
color of arterial blood
Endarterial: pertaining to the
interior or lining of an artery.
end: within arteri: artery
al: pertaining to
A t
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Aorta
Aorta: Maintrunk of the
arterial system
and begins fromthe left ventricle
of the heart
Coronary Artery
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Coronary Artery
Coronaryartery:branchesfrom the
aorta andsuppliesblood tothe
myocardium
A i l
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Arterioles Arterioles:Smaller,thin branches
of arteries.Carry bloodto the
capillaries.
Capillaries
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Capillaries Serve as the anatomic
units connecting the arterialand venous circulatory
systems.
Smallest vessel in the
body (thinner than hair).
Slower blood flow
through the capillaries
allows for the exchange of
oxygen, nutrients, andwaste materials between
tissue fluids and
surrounding cells.
V in
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VeinsForm a low-pressure collecting system to
return the waste-filled blood to the heart.Thinner walls and are less elastic thanarteries.
Have valves thatallow blood to flowtoward the heart but
prevent it from flowingaway from the heart.
Venules: small veins thatjoin to form the larger veins.
Th V C
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The Venae Cavae
Two large veins that enter theheart.
Superior vena cava (SVC) brings
blood from the upper portion of thebody.
Inferior vena cava (IVC) bringsblood from the lower portion of thebody.
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PULSE: Rhythmic expansion andcontraction of an artery
produced by the pressure of theblood moving through the artery.
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BLOOD
PRESSURE:Measurement ofthe amount of
pressure exertedagainst the wallsof the arteries.
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DIASTOLIC: Occurs whenthe ventricles
RELAX
LOWESTpressure againstthe walls of thevessels.
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SYSTOLIC:Occurs whenthe ventricles
CONTRACT
HIGHEST
pressure againstthe walls of thevessels.
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Normal seated adult: 134/84 mm Hg.
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Blood tests chapter 15Test for bloodoxygen levels can
be obtained througha monitor attachedto a finger
pulse oxymeterNormal value 95%
A i h
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- Radiographic study ofblood vessels after theinjection of a dye; resultingfilm is an angiogram.-Considered to be the most
accurate method of obtaininganatomic & pathologicvascular anatomy.-Performed through arterial
puncture, commonly, thefemoral artery
Angiography
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CoronaryAngiography:-performed todetect obstructionin the coronaryarteries of theheart.
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CARDIACCATHETERIZATION (CC)-catheter is passed into a vein orartery and guided to the heart(arm, neck, groin).-when catheter is in place,contrast medium is introduced to
produce an angiogram todetermine how well heart isworking (angiography)-Coronary arteries are viewed-O2 concentration can be
measured across all chambersand walls of the heart.
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CARDIACCATHETERIZATION(CC)
- Abnormal results will
mean1. presence of coronary
artery disease2. valvular heart disease3. ventricular aneurysm
4. ventricular enlargement.
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ANGIOCARDIOGRAPHY-uses contrast medium andchest x-rays to visualize thedimensions of the heart and
large blood vessels.-resulting film is anangiogram
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PHLEBOGRAPHY
- Venography-Technique of preparingan x-ray image of veinsinjected with a contrastmedium material.-Uses: diagnose deepvein thrombosis,distinguish blood clotsand other obstructions
such as tumors, orlocate suitable vein forcoronary bypass graft.-Resulting film is aphlebogram.
ELECTROCARDIOGRAPHY
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- Process of recording
electrical activity of themyocardium.-Record of the electricalactivity is known as theelectrocardiogram.
ELECTROCARDIOGRAPHY
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STRESS TESTS-ECGs used to assesscardiovascular healthand function during andafter application ofstress such as exercise
on a treadmill.
THALLIUM STRESS TESTS
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-flow of blood through theheart during activity isassessed through the use of
thallium during a stress test.
ULTRASONIC DIAGNOSTIC
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ULTRASONIC DIAGNOSTICPROCEDURES
ECHOCARDIOGRAPHY(ECHO)-ultrasonic diagnosticprocedure used toevaluate structures andmotion of the heart.
- may be performedtransthoracically(device tranducer onthe chest).
-Echo: sound-Cardio: heart-Graphy: to record
ULTRASONIC DIAGNOSTIC
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ULTRASONIC DIAGNOSTICPROCEDURES
TRANSESOPHAGEAL
ECHOCARDIOGRAPHY(TEE)-ultrasonic procedurethat images the heart
from inside the esophagus
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CARDIOLOGIST: specializes indiagnosing and treating abnormalitiesand disorders of the heart.
HEMATOLOGIST: specializes indiagnosing and treating diseases anddisorders of the blood and blood-forming tissues.
CORONARY ARTERY
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CORONARY ARTERYDISEASE
Stages:
I. Myocardial InjuryAtherosclerosis
II. Myocardial IschemiaAngina PectorisIII. Myocardial NecrosisMyocardial infarction
CORONARY ARTERY
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CORONARYARTERYDISEASE (CAD)
-Atherosclerosisof the coronaryarteries that maycause:
angina pectoris myocardial
infarction sudden death
EDISEASE
CORONARY ARTERY
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DISEASE
CORONARY ARTERY
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ATHEROSCLEROSIS
Hardening and
narrowing of the
arteries due to a
buildup of cholesterolplaques.
athero: plaque or fatty
substance
sclerosis: abnormalhardening
DISEASE
CORONARY ARTERY
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ATHEROMA: Plaque (fatty deposit) withinthe arterial wall; characteristic ofatherosclerosis.
ather: plaque
oma: tumor
DISEASE
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ATHEROSCLEROSIS
A. PREDISPOSING FACTORS
Sexmen
RaceBlack
Smoking Hyperlipidemia
Obesity
Sedentary lifestyle
Diet high in saturated fats DM
Hypothyroidism
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ATHEROSCLEROSIS
B. SIGNS AND SYMPTOMS
Chest pain
Dyspnea Tachycardia
Palpitations
Diaphoresis
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ATHEROSCLEROSIS
C. TREATMENT
Percutaneous Transluminal Coronary Angioplasty
(PTCA)done in patients with single occluded vessel
Revascularize myocardium
Prevent angina
Increase survival rate
Coronary Artery Bypass and Graph Surgery (CABG)
Single or 2 or more occluded vessels
CLEARING BLOCKED ARTERIES
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PERCUTANEOUS through the skin
Percutaneous Transluminal CoronaryAngioplasty (PTCA)
STENT metal mesh implanted in acoronary artery to provide support to
the arterial wall to prevent restenosis.RESTENOSIS describes the conditionwhen an artery that has been opened by
angioplasty closes again.
TRANSLUMINAL within the lumen of
an artery
CLEARING BLOCKED
ARTERIES
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(PTCA) - STENTARTERIES
Deflated balloon catheter and vascular
stent is being led through artery.Balloon catheter carrying stent is
approaching narrowed area of artery.
CLEARING BLOCKED
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(PTCA) - STENTARTERIES
Balloon catheter carrying stent is in place
in narrowed section of artery prior to
inflation.
Vascular stent has been fully extended
through the inflation of the balloon
catheter. Lumen of artery has been
widened.
CLEARING BLOCKEDARTERIES
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(PTCA) - STENTARTERIES
Vascular stent has been fully extended and the ballooncatheter is being removed. Expanded stent keeps arterylumen open.
CLEARING BLOCKEDARTERIES
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ARTERIES
CORONARY ARTERY BYPASS GRAFT (CABG)Requires opening the chest.Piece of vein from the leg is implanted on the
heart.Bypass a blockage in the coronary artery and
improve flow of blood to the heart.
CORONARY ARTERY BYPASS GRAFT (CABG)
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CORONARY ARTERY BYPASS GRAFT (CABG)
Autologous veinsare graftedbetween the aortaand just below the
occlusion in thecoronary arteries toprovide adequateblood flow to theheart.
ANGINA PECTORIS
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ANGINA PECTORIS
clinical syndrome characterized by paroxysmalchest pain that is usually relieved by rest or by
taking NTG d/t temporary myocardial ischemia
CORONARY ARTERY
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ANGINA PECTORIS:
Severe episodes of
spasmodic choking or
suffocating chest pain.
Due to interference
of oxygen supply to the
myocardium.
DISEASE
ANGINA PECTORIS
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ANGINA PECTORIS
A. PREDISPOSING FACTORS Sexmen
RaceBlack
Smoking
Hyperlipidemia
Obesity
Sedentary lifestyle
Diet high in saturated fats DM
Hypothyroidism
ANGINA PECTORIS
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ANGINA PECTORIS
B. PRECIPTATING FACTORS
Excessive strenuous physical exertion
Extreme emotional response
Exposure to cold environment
Excessive intake of foods rich in saturated
fats
ANGINA PECTORIS
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ANGINA PECTORIS
C. SIGNS AND SYMPTOMS LEVINES SIGNhand clutching of heart
Chest painsharp, stabbing, excruciating, crushingsubsternal pain
Usually radiates from back, shoulder, arms, axilla, and jawmuscles
Usually relieved by rest or by taking NTG
Dyspnea
Tachycardia
Palpitations
Diaphoresis
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NURSING MANAGEMENT
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NURSING MANAGEMENT
1. Enforce CBR.
2. Administer medication as ordered.
1. Nitroglycerin (NTG)
2. Beta-blockerspropanolol
3. ACE inhibitorscaptopril
4. Ca-channel blockers - nefedipine
NURSING MANAGEMENT
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NURSING MANAGEMENT
3. Administer O2 inhalation as ordered
4. Place client on semi-fowlers position
to promote lung expansion
5. Monitor strictly VS, IO, ECG tracing
6. Provide a dietary intake low in Na,
Saturated fat and caffeine (stimulant)
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MYOCARDIAL INFARCTION (MI)
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MYOCARDIAL INFARCTION (MI)
The terminal stage of CAD characterized bypermanent malocclusion leading to necrosis
and scarring
TYPES
Transmuralmost dangerous type; both R and L
Coronary arteries are blocked
Subendocardialocclusion of 1 coronary artery
CORONARY ARTERY
DISEASE
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MI due to blood clot
DISEASE
MYOCARDIAL INFARCTION
(MI)HEARTATTACK
Occlusion (closing off)
of a coronary artery
resulting in an infarct ofthe affected
myocardium.
Damage to the
myocardium impairs the
hearts ability to pump
blood through the body.
CORONARY ARTERY
DISEASE
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MI due to blood clot
DISEASE
MYOCARDIAL INFARCTION
(MI)HEARTATTACK
INFARCT: Localized
area of necrosis (tissue
death) caused by an
interruption of the blood
supply.
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MYOCARDIAL INFARCTION (MI)
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MYOCARDIAL INFARCTION (MI)
B. SIGNS AND SYMPTOMS Chest painexcruciating, visceral pain, substernal, rarely
precordial Radiates from back, shoulder, arms, axilla, jaws and abdominal muscles
Not relieved by rest or NTG
dyspnea
hypothermia initial rise in BP
cool, moist, ashen skin
mild apprehension, restlessness
occasional findings:
split S1 and S2 Pericardial friction rub
Rales/crackles
S4atrial gallop
MYOCARDIAL INFARCTION (MI)
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MYOCARDIAL INFARCTION (MI)
C. DIAGNOSTICS Cardiac Enzymes
CPK-MBCreatinine Phosphokinase
LDHlactic acid dihydrogenase
SGPT (ALT)Serum Glutamic Pyruvate Transaminase
SGOT (AST)Serum Oxaloacetic Pyruvate Transaminase
Treponin testincreased levels
ECG
ST segment elevation
Widening of QRS complexes arrhythmia
Peaked T waves
Serum uric acid and cholesterol elevated
CBCWBC elevated
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MYOCARDIAL INFARCTION (MI)
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MYOCARDIAL INFARCTION (MI)
D. NURSING MANAGEMENT(Goal : decreasemyocardial workload)
6. Diet: GL to soft diet low in Na, saturated fats and
caffeine7. Monitor v/s, I&O, ECG strictly
8. Encourage patient to take 20-30cc/week of
whisky or brandyinducesvasodilation
9. Assist I surgical procedure CABG
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ANTIHYPERTENSIVEMEDICATIONS
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MEDICATIONSACE InhibitorsBeta-blockersCalcium channel blockersDiuretics
Additional Medications:
StatinsDigoxinNitroglycerinAnticoagulantAntiarrhytmicTissue plasminogenactivator
VasoconstrictorVasodilator
Administeredto lower
bloodpressure
ANTIHYPERTENSIVEMEDICATIONS
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MEDICATIONS
ACE Inhibitors (Angiotensin Converting Enzyme)
- treat hypertension and CHF- interfere with action of kidney hormonerenin that causes the heart muscles tosqueeze.
Calcium channel blockers- treat hypertension, angina and arrythmia-reduce the contraction of the muscles thatsqueeze bloodmuscles tight
Beta-blockers slow the hearbeat
Diuretics- treat hypertension and CHF- increase urine secretion to rid the body of
excess sodium and water.
ANTIHYPERTENSIVE
MEDICATIONS
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MEDICATIONS
Statins
- cholesterol-lowering drug- reduce LDL or other lipids in the blood
Digoxin
- also known as digitalis
- treatment of atrial fibrillation-slows and strengthens heart contractions
Nitroglycerin
- vasodilator
- relieve pain of angina
- may be administered sublingually, through the
skin (patch), or orally as a spray.
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CONGESTIVE HEART FAILURE
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CONGESTIVE HEART FAILURE
Inability of the heart to pump
blood towards systemic
circulation
I LEFT-SIDED HEART FAILURE
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I. LEFT-SIDED HEART FAILURE
A. PREDISPOSING FACTORS 90% - mitral valve stenosis
RHD
Aging
MI
IHD
HPN
Aortic valve stenosis
I LEFT-SIDED HEART FAILURE
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I. LEFT-SIDED HEART FAILURE
B. SIGNS AND SYMPTOMS Pulmonary edema/congestion
Dyspnea, 2-3 pillow orthopnea
Productive cough (blood tinged)
Rales
Bronchial wheezing
Pulses alternans
Anorexia and general body malaise
S3 (ventricular gallop)
I LEFT-SIDED HEART FAILURE
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I. LEFT-SIDED HEART FAILURE
C. DIAGNOSTICS CXRcardiomegaly
PAPpulmonary arterial pressure
Measures pressure in right ventricle
Reveals cardiac status
PCWPpulmonary capillary wedge pressure
Measures end-systolic and end-diastolic pressure
Echocardiographreveals enlarged heart chamber
ABG analysis reveals elevated PCO2 and decreased PO2
(respiratory acidosis)
II RIGHT-SIDED HEART FAILURE
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II. RIGHT SIDED HEART FAILURE
A. PREDISPOSING FACTORS Tricuspid valve stenosis
COPD
Pulmonary embolism (char by chest pain and dyspnea)
Pulmonic stenosis
left sided heart failure
II RIGHT-SIDED HEART FAILURE
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II. RIGHT SIDED HEART FAILURE
B. SIGNS AND SYMPTOMS(Venous congestion) jugular vein distention
pitting edema
ascites
weight gain hepatosplenomegaly
jaundice
pruritus/ urticaria
esophageal varices anorexia
generalized body malaise
II RIGHT-SIDED HEART FAILURE
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II. RIGHT SIDED HEART FAILURE
C. DIAGNOSTICS CXRcardiomegaly
CVPmeasures pressure in right atrium; N = 4-10cc
H2O
Echocardiographyreveals enlarged heart chamber
Liver enzymesSGPT and SGOT elevated
II. RIGHT-SIDED HEART FAILURE
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II. RIGHT SIDED HEART FAILURE
D. NURSING MANAGEMENT
(Goal: increase myocardial contraction
increase CO; Normal CO is 3-6L/min; N stroke
volume is 60-70ml/h2o Administer medications as ordered
Cardiac glycosidesDigoxin
Loop diureticsLasix
BronchodilatorsAminophylline Narcotic analgesicsMorphine SO4
VasodilatorsNTG, xylocaine
II. RIGHT-SIDED HEART FAILURE
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II. RIGHT SIDED HEART FAILURE
D. NURSING MANAGEMENT Administer O2 at 3-4 LPM via NC as ordered
high-flow
High-Fowlers Restrict Na and fluids
Monitor v/s, I&O, and breath sounds
Weigh patient daily and assess for pitting
edema
Abdominal girth daily and notify MD
II. RIGHT-SIDED HEART FAILURE
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II. RIGHT SIDED HEART FAILURE
D. NURSING MANAGEMENT Provide meticulous skin care
Diet low in saturated fats and caffeine
Institute a bloodless phlebotomy
ROTATING TORNIQUETROTATED EVERY 15 MINUTES TO
PROMOTE A DECREASE IN VENOUS RETURN.
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PERIPHERAL VASCULAR
DISORDERSArterial ulcers
Thromboangitis obliterans /Buergersdisease (feet)
Reynauds Phenomenon (hand)
Venous Ulcers
Varicose veinsThrombophlebitis/DVT
THROMBOANGITIS OBLITERANS (TAO)
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THROMBOANGITIS OBLITERANS (TAO)
acute inflammatory conditionaffecting the smaller and medium
sized arteries and veins of the lower
extremities
THROMBOANGITIS OBLITERANS (TAO)
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A. PREDISPOSING FACTORS High risk group men 30 years old above
Chronic smoking
B. SIGNS AND SYMPTOMS Consistent to all arterialdiseases
Intermittent claudicationleg pain upon walking cold sensitivity and skin color changes
white/pallor bluish/cyanosis red/rubor
(+) especially post smoking
decreased peripheral pulses volume particularly in dorsalis pedisand posterior tibial
Trophic changes ulceration
gangrene formation
THROMBOANGITIS OBLITERANS (TAO)
THROMBOANGITIS OBLITERANS (TAO)
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THROMBOANGITIS OBLITERANS (TAO)
C. DIAGNOSTICS oscillometryreveals a decrease in peripheral pulse
volume
Doppler utzdecrease in blood flow to affected
extremity
angiographysite and extent of malocclusion
THROMBOANGITIS OBLITERANS (TAO)
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D. NURSING MANAGEMENT encourage slow progressive physical activity
walking 3-4x/day
out of bed 3-4x/day
medications as ordered analgesics
vasodilators anticoagulants
instruct patient to avoid smoking and exposure to coldenvironment
institute foot care management avoid barefoot walking
straight nails lanolin cream for feet
(-) constricting clothes
Assist in surgery: BKA
THROM OANGITIS O IT RANS (TAO)
REYNAUDS DISEASE
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REYNAUD S DISEASE
characterized by acuteepisodes of arterial
spasms involving the
digits of hands and
fingers
REYNAUDS DISEASE
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A. PREDISPOSING FACTORS high risk group women 40 years old up
smoking
collagen diseases
SLE
RA
direct hand trauma
piano playing
EXCESSIVE TYPING (tsk tsk! Lagot!)
Carpal tunnel syndrome
Operating chainsaw (nyek!)
Writing (tsk tsk, kaya dapat may module eh! Grr!)
REYNAUD S DISEASE
REYNAUDS DISEASE
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B. SIGNS AND SYMPTOMS Intermittent claudicationleg pain upon walking
cold sensitivity and skin color changes
white/pallor bluish/cyanosis red/rubor
(+) especially post smoking
Trophic changes
ulceration
gangrene formation
REYNAUDS DISEASE
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C. DIAGNOSTICS oscillometryreveals a
decrease in peripheral
pulse volume
angiographysite and
extent of malocclusion
D. NURSINGMANAGEMENT
Administer medications
as ordered
Analgesics
Vasodilators
encourage pt to wear
gloves
instruct: avoid smoking
and exposure to cold
environment
VARICOSE VEINS
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abnormal dilation of the veins ofthe lower extremities d/t
incompetent valves leading toincreased venous pooling and
venostasis decreased venous
return
VARICOSE VEINS Abnormally swollen
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Abnormally swollenveins usually occurring in
the legsA varicosity is one areaof swelling.varices: plural
VARICOSE VEINS
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A. PREDISPOSING FACTORS Hereditary
congenital weakness of veins
thrombophlebitis
cardiac diseases
pregnancy
obesity
prolonged immobility prolonged standing and sitting
VARICOSE VEINS
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B. SIGNS ANDSYMPTOMS
pain after prolonged
standing
dilated tortous skin veins
which are warm to touch
heaviness in the legs
C. DIAGNOSTICS
Venography
trendelenburgs
testreveals that
veins distend
quickly < 35
seconds
incompetentvalves
VARICOSE VEINS
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D. NURSING MANAGEMENT (consistent to allvenous ulcers)
elevate legs above heart level increased venous
return (2-3 pillow elevation)
measure circumference of leg to determine swelling
antiembolic stocking, full support panty hose
medications as ordered analgesics
assist in surgery
vein stripping and ligation
THROMBOPHLEBITIS/DEEP VEIN
THROMBOSIS (DVT)
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THROMBOSIS (DVT)
A. PREDISPOSING FACTORS smoking
obesity
chronic anemia
diet high in saturated fats DM
CHF
MI
post-cannulation (insertion of various catheters) post-surgical operation
sedentary lifestyle
THROMBOPHLEBITIS/DEEP VEIN
THROMBOSIS (DVT)
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THROMBOSIS (DVT)
B. SIGNS AND SYMPTOMS
pain at the affected extremity
presence of cyanosis
dilated tortous veins
(+) HOMANS pain on calf on
dorsiflexion
THROMBOPHLEBITIS/DEEP VEIN
THROMBOSIS (DVT)
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THROMBOSIS (DVT)
C. DIAGNOSTICS venography
Doppler utz
angiography
THROMBOPHLEBITIS/DEEP VEIN
THROMBOSIS (DVT)
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THROMBOSIS (DVT)
D. NURSING MANAGEMENT elevate the legs above heart level
apply warm moist pack to relieve lymphatic congestion
measure circumference of leg muscles to determine if it
is swollen anti-embolic stockings
administer medications as ordered
analgesics
anticoagulantsheparin
prevent complications
pulmonary embolism
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