872: CV diagnoses

Heart failure

• heart is unable to maintain a sufficient CO to meet the body’s demands

• Can lead to blood becoming backed up in the veins causing congestion/fluid buildup in the lungs and peripheral tissue

• Can either be right or left sided

S+S of heart failure

• SOB

• Fatigue and confusion

• Chest pain

• Edema in the legs, hands, and feet

• Pulmonary edema

• Rales

Arrhythmias

Changes to the speed and repolarization of the cardiac conduction system that cause abnormal rhythms of the heart

S+S of arrhythmias

• fatigue or weakness

• Dizzy or lightheaded

• Fainting or near fainting spells

• Rapid heartbeat or pounding in chest

• SOB and anxiety

• Alternating fast and slow HR

• Sweating

• Collapse and sudden cardiac arrest

Atherosclerosis

• a progressive disease in which fatty deposits accumulate inside the wall of mod-large sized arteries

• This plaque accumulation can eventually impede the flow of blood through the vessel

• When it occurs in the coronary arteries it is CAD and then in the periphery it’s PAD

Myocardial ischemia

• an inadequate supply of oxygenated blood to the cardiac muscle cells due to atherosclerotic build up in one or more of the coronary arteries. This results in an imbalance between oxygen supply and demand

• Symptoms typically present when lumen is 70% occluded

• New ST segment changes or T wave inversion on multiple leads of the EKG

S+S of myocardial ischemia

• angina pectoris

• Lightheaded

• Dyspnea

• Diaphoresis

• Weakness

• Syncope

Myocardial infarction

• prolonged myocardial ischemia resulting in cardiac muscle cell death causing necrotic, non contractile heart tissue

• Usually caused by a complete blockage of blood supply to heart muscle due to either severe plaque buildup or a piece of plaque breaking off and traveling downstream

• May cause ST segment elevation on an EKG

S+S of an MI

• crushing chest pain or pressure than can occasionally radiate to the arm, jaw, neck, throat, or back

• Cool and clammy skin

• Lightheaded

• SOB, dyspnea

Peripheral artery disease

• chronic, occlusive arterial disease of medium and large sized peripheral vessels due to atherosclerotic build up

• Diminished oxygenated blood supply to affected extremities

• Primarily affects the LEs

S+S of PAD

• pulses may be decreased or absent

• Extremity might be pale on elevation and dusky red on dependency

• Intermittent claudication during early stages of disease

• Pain in extremity during rest

• Late stage may also present with muscle atrophy, trophic changes

• Critical stage: resting or nocturnal pain, skin ulcers and gangrene

Valvular disease

• dysfunctional cardiac valves and can be classified as either narrow (stenosis) or leaky (regurgitation)

• Blood leaks back into the chamber that it came from and not enough blood can be pushed forward through the heart

S+S of valvular disease

• syncope

• SOB

• Chest pain

• Fatigue

• Fever

• Rapid weight gain

• Irregular heartbeat

• Can lead to heart failure

• Heart murmur sound

HTN

• chronic elevations in BP

• Primary or essential: no known cause for the elevation

• Secondary or nonessential: caused by an identifiable medical problem

S+S of HTN

Acute Symptoms

• severe headaches

• Chest pain

• Dizzy, nausea, vomiting

• Difficulty breathing

• Blurred vision

• Anxiety

• Confusion

• Buzzing in ears

• Nosebleeds

• Abnormal heart rhythm

Chronic: cardiac hypertrophy and/or atherosclerosis

Aortic aneurysm

• Weakening in the aortic wall causing the diameter of the aorta to exceed 4cm

• A ruptured aorta typically results in death before patient can reach the OR

S+S of aortic aneurysm

• usually asymptomatic and discovered during routine physical exams

• Pulsating feeling in the belly

• Chronic mid abdominal and/or LBP

• Weak, scratchy voice

Venous insufficiency

When inadequate muscle action, incompetent venous valves or venous obstruction occurs that limits venous blood flow

S+S of venous insufficiency

• spider veins

• Varicose veins

• Skin changes, swelling and wounds

DVT

• blood clots that form in the superficial or deep veins of the LE

• Usually form due to periods of inactivity

S+S of DVT

• calf pain, tenderness, or both

• Swelling with pitting edema

• Swelling below the knee (distal) or up to the groin (proximal)

• Increased skin temp

• Superficial venous dilation

• Cyanosis in patients with severe obstruction

CV complications related to DM

• most patients with this will develop CVD due to atherosclerosis that manifests as CAD, PVD, and stroke

• Microvascular disease can result in damage to the eyes, kidneys, and nerves

• HTN, cerebrovascular disease, arrhythmias, and heart failure are also common

Pericarditis

• inflammation of the pericardium or abnormal amounts of fluid in the space between the visceral and parietal pericardia

• Can be caused by infections, inflammatory disorders, trauma to the chest, or immune system response

S+S of pericarditis

• severe retrosternal chest pain with occasional radiation to the back

• Pain worsened with deep breathing or coughing

Septal defects

• a hole in the septum of the aria or ventricles that is present at birth

• The defects can lead to hemodynamic compromise due to abnormal communication between right and left sides of the heart

S+S of septal defects

Atrial:

• murmur

• Exercise intolerance

• Arrhythmias

• Palpitations

Ventricular

• left fluid overload

• Pulmonary artery HTN

• Heart failure

Coarctation of the aorta

A narrowing of the aorta that results in obstruction of LV outflow as a consequence of a narrowing of the aorta

S+S of coarctation of the aorta

• UE HTN

• Can lead to premature CAD, ventricular dysfunction, aortic aneurysms, and cerebrovascular disease in adults if not treated

• In newborns: can lead to LE pulse oximetry, UB HTN, and shock

Cardiomyopathy

diverse group of disease that involved a disorder of the myocardial cells in which the contraction and relaxation of the myocardial cells are impaired

3 categories: dilated, hypertrophic, and restrictive

S+S of cardiomyopathy

• fatigue

• Weakness

• Syncope

• Presyncope

Medical management for heart failure

• medication: beta blockers, ACE inhibitors, diuretics, vasodilators, digoxin

• Surgery: VAD, pacemaker, valve replacement, heart transplant

Medical management for Arrhythmias

• medications

• Pacemaker

• Vagal maneuvers

• Surgery or catheter placement

Medical management for Myocardial ischemia

• surgeries to unblock the coronary artery including thrombolysis, balloon pump, angioplasty and stent placement

• Meds to reduce cardiac need for oxygen

Medical management for MI

• surgeries to unblock the coronary artery including thrombolysis, balloon pump, angioplasty, and stent placement

• Meds to reduce the cardiac need for oxygen

Medical management for PAD

• exercise training

• Meds to thin the blood and widen blood vessels such as cilostazol

• Surgery to remove the atherosclerotic plaque

Medical management for Valvular disease

• meds to alter BP, flow, and consistency

• Surgery to repair or replace dysfunctional valve

Medical management for HTN

• anti hypertensive drug therapy: beta blockers, ACE inhibitors, diuretics, vasodilators, and calcium channel blockers

• Lifestyle changes

Medical management for aortic aneurysm

surgical excision and grafting

Medical management for venous insufficiency

• Blood thinning/anticoagulation meds such as heparin and warfarin

• Compression stockings

Medical management for DVT

• blood thinning/anticoagulation meds such as heparin and warfarin

• Compression stockings

• Surgery to place filters into larger veins

Medical management for CV complications related to DM

• meds to treat the diabetes and CV disease

• Exercise training

Medical management for pericarditis

• mild disease may improve with no treatment

• Meds to reduce swelling, inflammation or treat initial infection

• Surgery to drain the pericardial sac or remove it in severe cases