Cardiovascular Function Flashcards
What are the different nursing diagnoses’ for cardiovascular functions?
- Decreased Cardiac Output
- Ineffective Tissue Perfusion
An acute inflammatory process of the pericardium - can lead to increased fluid around the heart
These can lead to this disease:
- Infections
- MI (heart attack)
- TB
- Cardiac Trauma
- Malignancy
- Autoimmune
Pericarditis
Collection of fluid resulting from pericarditis
Pericardial Effusion
When fluid puts pressure on the heart - as result of pericarditis
Cardiac Tamponade
This type of pericarditis is characterized by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium
Cardiac output and cardiac reserve become fixed
Symptoms include:
- Ascites
- Pedal edema
- Dyspnea on exertion
- Fatigue
- Kussmaul sign (irregular breathing pattern)
Constrictive Pericarditis
Inflammation of the heart muscle and conduction system that develops slowly and can be from a virus, bacteria, fungal, allergic reaction, chemical exposure, radiation, or inflammatory disorder
Myocarditis
This results from necrosis caused by direct invasion of the offending organism, toxic effects of exotoxins, or destruction of cardiac tissue by immunologic mechanisms
Myocardial injury
This can cause problems with contractility or conduction and harm cardiac muscle tissue
Penetration of organisms, blood cells, toxins, immune substances into myocardium
What is the function of the heart valves?
Promote directional flow of blood through the chambers of the heart
What are the disorders that result from a dysfunction of the heart valves?
- Congenital defects
- Trauma
- Ischemic damage
- Degenerative changes
- Inflammation
The narrowing of heart valves - limits amount of blood that can travel through it
Stenosis
Heart valve does not open as it should - limits amount of blood that can travel through it
Atresia
What does increased workload cause?
Hypertrophy and increased oxygen demand which can lead to heart failure
Blood backflows - causes increased workload, chambers can dilate to accompany blood that is not moving forward
Regurgitation
What are the two main valve disorders?
Mitral and aortic valve
Colonization (infection) of the heart valves and the endocardium by a microbial agent - leads to the formation of bulky, friable vegetations and destruction of underlying cardiac tissues - build-up of bacteria on valves
Infective Endocarditis
What do vegetations release?
Loci - small collections of cellular debris enmeshed in fibrin strands of clotted blood
Infectious loci continuously release bacteria causing persistent bacteremia
May present as septic emboli
What are the portal of entry for infective endocarditis?
- Persons with damaged endocardial surface defects can get endocarditis from simple infections like URI or gum massage
- Intravenous drug use (needle, skin flora, contaminated product)
What are different ways damaged endocardial surfaces can occur?
- Valvular disease
- Prosthetic heart valves
- Congenital heart defects
What is heart failure?
- Decrease in pumping ability of the heart
- Decrease in cardiac reserve
- Adaptive mechanisms that serve to maintain the CO that also contribute to the progression of heart failure
In response to heart failure, which system will act to increase heart rate, contractility, vasoconstriction, and ADH?
Sympathetic Nervous System
What does decreased CO lead to?
Increase renin-angiotension-aldosterone - leading to more vasoconstriction and fluid retention
Increased filling of the heart allows myosin and actin to more fully align, causing an increased force of contraction and increased stroke volume
The Frank-Starling mechanism
When the heart muscle enlarges in attempt to compensate by increasing in sarcomeres and mitochondria, decreasing in capillary density, increasing in extracellular matrix which leads to myocardial fibrosis and ventricular wall stiffness
Myocardial Hypertrophy and Remodeling
Represents failure of the right heart to pump blood forward into the pulmonary circulation
Right-sided Heart Failure
Where does the blood back up into with right-sided heart failure?
The systemic circulation - causes peripheral edema and congestion of the abdominal organs
Represents failure of the left heart to move blood from pulmonary circulation into the systemic circulation
Left-Sided Heart Failure
Where does the blood back up into with left-sided heart failure?
Into the pulmonary circulation (lungs)
Impaired ejection of blood from the heart during systole - decreased ejection fraction
Systolic Heart Failure
Impaired filling of the ventricles during diastole - smaller ventricular chamber size, ventricular hypertrophy, poor ventricular compliance
Diastolic Heart Failure
These signs are common for which type of heart failure?
- Pulmonary congestion
- Restlessness
- Confusion
- Tachycardia
- Fatigue
Left-Sided Heart Failure
These signs are common for which type of heart failure?
- Fatigue
- Peripheral venous pressure
- Enlarged spleen and liver
- Distended jugular veins
- Anorexia and complaints of GI distress
- Weight gain
- Edema
Right-Sided Heart Failure
This type of congenital heart defect is characterized by holes in the wall that separates the heart chambers
Septal defects
This type of congenital heart defect is characterized by a combination of pulmonary valve stenosis, a large ventricular septal defect, misplacement of the aorta directly over the ventricular septal defect, and right ventricular hypertrophy
Tetralogy of Fallot
This congenital heart defect is characterized by the failure of the ductus arteriosus - the vessel between the aorta and the pulmonary artery - to close after birth
Patent ductus arteriosus
This congenital heart defect is characterized by the narrowing of the aorta
Coarctation of the aorta
A bulge in the wall of a vessel
Aneurysm
Unilateral pouchlike bulge with a narrow neck - most often found in the circle of Willis in the brain circulation
Consists of a small, spherical vessel dilation
Saccular aneurysm
Spindle-shaped bulge encompassing the entire diameter of the vessel - most often found in the thoracic and abdominal aorta
Characterized by gradual and progressive enlargement of the aorta
Fusiform aneurysm
Hemorrhagic separation of the medial layers of the vessel wall creating a false lumen - acute, life-threatening condition
Involves hemorrhage into the vessel wall with longitudinal tearing of the vessel wall to form a blood-filled channel
Dissecting aneurysm
Pulsating hematoma resulting from trauma and commonly mistaken for an abdominal aneurysm
False aneurysm
A condition of imbalance of the lipid components of the blood
Dyslipidemia
This type of dyslipidemia is due to abnormalities in blood lipid and cholesterol levels that develop independent of other health problems or lifestyle behaviors (usually genetic)
Primary
This type of dyslipidemia is associated with other health problems, or secondary to other health problems (obesity, diet, metabolic changes)
Secondary
An excess of lipids in the blood
Hyperlipidemia
What are the types of lipids?
Triglycerides, phospholipids, and cholesterol
Determine if these types of lipids are good or bad:
- Low-density lipoprotein (LDL)
- High-density lipoprotein (HDL)
- Triglycerides
- Bad
- Good
- Bad
‘Hardening of the arteries’ - plaque (cholesterol, lipids) builds up in the arteries, causing narrowing of the vessel
Atherosclerosis
What are the risk factors of atherosclerosis?
- hypercholesterolemia
- cigarette smoking
- hypertension
- family history of premature CHD
- age (men 45 years and older; women 55 years and older)
- HDL cholesterol < 40 mg/dL
- CRP levels - inflammatory markers
- Homocysteine levels
What are the major complications of atherosclerosis?
- Ischemic heart disease
- Myocardial infarction
- Stroke
- Peripheral vascular disease (PVD)
What are the clinical manifestations of atherosclerosis?
- Narrowing of the vessel and resulting ischemia
- Vessel obstruction due to plaque hemorrhage or rupture
- Thrombosis and formation of emboli
- Aneurysm formation
This disease is also known as peripheral arterial disease and characterized by poor circulation to extremities
Etiology: atherosclerosis (plaque buildup in the arteries)
Symptoms: may have none, cramping in legs during activity, cold skin in extremities, aching and weakness in extremities, red/blue discoloration, thick/opaque toenails, sores that will not heal
Peripheral Vascular Disease
What are the complications of Peripheral Vascular Disease?
- Higher risk for strokes, heart attack
- Limb ischemia (amputations, gangrene)
Disease characterized by the narrowing or blocking of vessels supplying the heart
Coronary Artery Disease
This type of Coronary Artery Disease is characterized by plaque accumulating in large arteries, narrowing, and occludes more than 50%
Obstructive
This type of Coronary Artery Disease is characterized by plaque in the large arteries, but less than 50% occlusion
Non-obstructive
Small vessels do not vasodilate when there is increased demand for oxygen
Coronary Microvascular Disease
Chest pain or discomfort caused when your cardiac muscle does not get enough oxygen
Angina
What are the three features of pain associated with unstable angina?
- Occurs at rest (or with minimal exertion), usually lasting more than 20 minutes (if not interrupted by nitroglycerin).
- It is severe and described as frank pain and of new onset.
- It occurs with a pattern that is more severe, prolonged, or frequent than previously experienced.
A low-pressure system that returns blood flow to the heart
Venous System
The pressure in the right atrium because blood from the systemic veins flows into the right atrium of the heart
Central Venous Pressure (CVP)
Tissue blood flow is regulated on a minute-to-minute basis in relation to tissue needs and on a longer-term basis through the development of _________
Collateral circulation
What are the disorders of the venous circulation?
- Produce congestion (fluid build-up) of the affected tissues - causes edema mostly on one side of the body
- Predispose to clot formation because of stagnation of flow and activation of the clotting system
- Peripheral Vascular Disease
- Varicose veins
- Thrombophlebitis
These develop in the veins, often due to low blood flow
Thrombi/Emboli (clots)
Clots mostly seen in the legs (calf). Can cause some fluid back-up but doesn’t do a lot of damage until the thrombus breaks off (and becomes an emboli) and moves through the system
Known for the Virchow Triad:
- Alterations in blood flow (stasis)
- Vascular endothelial injury
- Alterations in the constituents of blood (hypercoagulation state)
Deep Vein Thrombosis
When an emboli stops in the lungs - disrupts blood flow
Pulmonary Embolism
Thrombosis of extremity superficial veins
Typically self-resolve without treatment (warm compresses help)
Upper extremity usually appear at site of venous cannulation
Thrombophlebitis
What are the seven “P”s of Acute Arterial Embolism (stops oxygen from getting to where it needs to be)
- Pistol shot (acute onset)
- Pallor
- Polar (cold)
- Pulselessness
- Pain
- Paresthesia: numbness
- Paralysis
What are the signs and symptoms of Acute Arterial Occlusion? (Considered a vascular emergency)
- Limb ischemia
- Pain
- Paresthesia
- Motor weakness distal to the site of occlusion
- Loss of peripheral pulses, cool skin, and pallor or cyanosis distal to the obstruction site
Death of the heart muscle due to lack of oxygen - blood flow to the heart is blocked
Etiology: coronary artery disease (atherosclerosis): hardening of the arteries, blood clot that blocks blood flow through coronary arteries (usually due to fat/cholesterol)
Damage is irreversible after 30 minutes of blockage
Manifestations: chest pain, nausea, shortness of breath, fatigue, cold sweats, left shoulder pain
MI or Heart Attack
Pressure at the height of the pressure pulse
Systolic pressure
The lowest pressure
Diastolic pressure
The difference between systolic and diastolic pressure
Pulse pressure
Represents the average pressure in the arterial system during ventricular contraction and relaxation
Mean arterial pressure
Korotkoff sound that is marked by the first tapping sound, which gradually increase in intensity
Phase I
Korotkoff sound characterized by the period in which a murmur or swishing sound is heard
Phase II
Korotkoff sound characterized by the period during which sounds are crisper and greater in intensity
Phase III
Korotkoff sound characterized by the period marked by distinct abrupt muffling or by a soft blowing sound
Phase IV
Korotkoff sound characterized by the point at which sounds disappear
Phase V
A sustained condition of elevation of the blood pressure within the arterial circuit
A primary risk factor for cardiovascular disease and a leading cause of morbidity and mortality worldwide
Hypertension (HTN)
The clinical presence of HTN without evidence of a specific causative clinical condition (age, gender, race, family history, and genetics)
Primary HTN
Elevation of the blood pressure because of another disease condition
Secondary HTN
What are the target organ systems affected by HTN?
Kidneys, heart, eyes, and blood vessels
An abnormal drop in blood pressure on assumption of the standing position
Caused by the decrease in venous return to the heart due to pooling of blood in lower part of the body and inadequate circulatory response to decreased cardiac output and a decrease in blood pressure
Orthostatic Hypotension (Postural Hypotension)
An acute failure of the circulatory system to supply the peripheral tissues and organs of the body with an adequate blood supply, resulting in cellular hypoxia (lack of oxygen)
Circulatory Shock
This classification of circulatory shock is characterized by the loss of whole blood, plasma, or extracellular fluid
Hypovolemic (Trauma/Hemorrhage)
This classification of circulatory shock is characterized by the inability of the heart to fill properly or an obstruction of outflow from the heart
Obstructive (Clots)
This classification of circulatory shock is characterized by the loss of sympathetic vasomotor tone, presence of a vasodilating substance in the blood, or presence of inflammatory mediators
Distributive (Sepsis, anaphalyxis)
This classification of circulatory shock is caused by an alteration in cardiac function
Cardiogenic shock (Heart)
What are some of the causes of cardiogenic shock?
- Damage to the heart from myocardial infarction
- Ineffective pumping caused by cardiac arrhythmias
- Ventricular septal defect
- Ventricular aneurysm
- Acute disruption of valvular function
- Problems associated with open heart surgery
What are the complications of shock?
- Brain oxygenation
- Acute respiratory distress syndrome
- Acute renal failure
- Gastrointestinal complications
- Disseminated intravascular coagulation
- Multiple organ dysfunction syndrome
The body’s extreme response to an infection (most often from lung, urinary tract, skin, or GI source)
Sepsis
