CARDIOVASCULAR PT.1

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heart failure

occurs when the heart is not able to meet the needs of the circulatory system. can be via ventricular dysfunction, diastolic dysfunction, or cardiopulmonary conditions. main risk is HTN, which is modifiable and can reduce incidence by 50% if treated aggressively. other risks include CAD, chronic inflammation, DM, obesity, and alcohol misuse to name a few. causes can be primary (directly damages the heart), or precipitating (increases workload of the heart).

left sided HF

results from inability of LV to empty adequately during systole or to fill adequately during diastole. blood backs up into the LA and increases pulmonary hydrostatic pressure, leading to fluid leakage/pulmonary edema. blood begins to back up in the lungs, showing pulmonary congestion, crackles, dyspnea, orthopnea (difficulty breathing when lying), and paroxysmal nocturnal dyspnea (SOB at night).

right sided HF

results from RV not pumping effectively during systole. leads to fluid backup in the venous system that moves into tissues and organs. most commonly caused by LVF, but can also be from COPD leading to cor pulmonale. blood begins to back up in the body, showing systemic congestion/edema, JVD, ascites, weight gain, and hepatomegaly.

ejection fraction

percentage of blood pushed out of the LV with each contraction. normal range is 50-70%.

HFrEF (systolic failure)

inability for the heart to pump blood effectively caused by decreased contractility, increased after load/resistance, and mechanical abnormalities. shows decreased LVEF.

HFpEF (diastolic failure)

inability of the ventricles to relax and fill during diastole, resulting in decreased SV and CO. HTN is the primary cause. dx is based on s/s of heart failure, a normal LVEF, and LV diastolic dysfunction. is more common in older adults.

HF diagnostics

echocardiograms are the gold standard and provide info on LVEF, heart valves, and presence of effusion or thrombus. it is important to treat the underlying cause of HF. BNP is a good indicator of HF; should be less than 100 pg/mL, but will be severely elevated in HF. ambulatory monitors, CXRs, 6-min walk tests, MRIs, stress tests, and angiograms can also be used.

HF interprofessional care

main treatment goal is to treat the underlying cause and contributing factors. important to maximize CO, improve ventricular function and quality of life, and preserve target organ function. O2 therapy can help relieve dyspnea and fatigue, while physical and emotional rest can help conserve energy and decrease oxygen needs. exercise/cardiac rehab programs should be implemented as well, with these patients needing 30 min of exercise at least 3 times a week.

heart healthy diet

diet critical for patients with hx of CVD or HF. includes whole grain bread instead of refined white bread, limiting saturated fats, avoiding trans fats, opting for low fat protein options such as lean meats or skim milk, and limiting sodium. sodium intake is usually no more than 2g/day. individualize client food recommendations and consider cultural backgrounds. fluid restriction may be needed for clients in the later stages of disease. important to provide education on reading food labels.

HF nursing interventions

nurse should monitor respiratory status and administer O2 therapy PRN; maintain the HOB at 45-90º, monitor hemodynamic status, Is and Os, edema, administer prescribed drugs, educate the client on managing symptoms, and collaborate with the healthcare team. it is important to weigh the client daily. a weight gain of 3lbs over 2 days or a gain of 3-5lbs over a week should be reported to healthcare provider. most accurate weight is standing.

dilated cardiomyopathy

occurs when dilation of the ventricles impairs the heart’s ability to contract. muscle fibers become weakened, and ineffective contractions reduce CO and cause HF (in 25-40% of cases). can occur via viral infections, autoimmune disorders, infective myocarditis, alcohol use, cocaine, etc. s/s include decreased exercise capacity, fatigue, dyspnea, PND, and orthopnea. progression can show a dry cough, palpitations, n/v, anorexia, extra heart sounds, and s/s of HF. dx involves doppler echocardiography, monitoring BNP serum levels, and a biopsy of the myocardium. nurse should monitor diet, practice cardiac rehab, teach CPR, and possibly refer client to home health or hospice.

hypertrophic cardiomyopathy

results from thickening of LV walls and septum, preventing adequate blood refilling and decreasing CO. more common in young male athletes. ventricular contractions are rapid and forceful and relaxation is impaired. has genetic links. s/s include exertion dyspnea, fatigue, angina, and syncope. client can be asymptomatic until a serious cardiac event happens. client should avoid strenuous activity and dehydration, elevate their feet, and know that vasodilators can worsen pain. surgery involving removing part of the septum can be used. EKG can be used as screening.

restrictive cardiomyopathy

stiffness of ventricles, decreasing diastolic ventricular refilling. has a poor prognosis and is the least common form of cardiomyopathy. can be via amyloidosis, cancer, and radiation therapy. s/s include fatigue/exercise intolerance, dyspnea, angina, orthopnea, syncope, palpitations, and s/s of HF. client should avoid strenuous activity and dehydration, use prophylactic antibiotics, and use conventional HF therapy.

stenosis

constriction/narrowing of valve opening, impeding forward blood flow. pressure differences on each side of the valve reflect the degree of this.

regurgitation

incomplete closure of valve leaflets that results in the backwards flow of blood.

mitral stenosis

the stiffening of the mitral valve that results in decreased blood flow from the LA to the LV. this increases left atrial pressure and volume and can lead to possible a-fib. most commonly caused by rheumatic heart disease, which can lead to scarring of valve leaflets and chordae tendineae as well as the development of contractures with adhesions between commissures of the leaflets. s/s include exertional dyspnea, exaggerated S1 sound, diastolic murmurs, palpitations, hemoptysis, and a-fib with a risk for stroke.

mitral regurgitation

the floppiness of the mitral valve, causing backwards flow of blood. can be via MI, chronic rheumatic heart disease, mitral valve prolapse, ischemic papillary muscle function, and infective endocarditis, which all cause damage to components of the valves. acute cases can show thready peripheral pulse, cool/clammy extremities, and pulmonary edema. chronic cases show weakness/fatigue, dyspnea, orthopnea, PND, S3 murmur, peripheral edema, and palpitations. chronic cases can lead to LA enlargement, ventricular dilation, and eventual ventricular hypertrophy.

mitral prolapse

an abnormality of mitral valve leaflets and the papillary muscle or chordae that causes them to prolapse back into the LA during systole. usually benign, but can lead to complications. most clients with this are asymptomatic, with only 10% showing symptoms. s/s include dysrhythmias that can cause palpitations, light-headedness, and syncope. may also lead to infective endocarditis. client should be on prophylactic antibiotics due to IE risk and take drugs as prescribed. client should also have a healthy diet, avoid caffeine and OTC stimulants, exercise, and know when to call their provider or EMS. valve surgery may be necessary.

aortic stenosis

stiffness of the aortic valve causing obstruction of blood flow from the LV to the aorta. causes a decreased CO and reduced tissue perfusion, as well as pulmonary HTN and HF. eventually shows LV hypertrophy and increased myocardial oxygen consumption. has a poor prognosis if left untreated. s/s include syncope, angina, and exertional dyspnea; a normal or soft S1 and a decreased or absent S2 will be ausculated. nitroglycerin can be used to reduce preload and BP but can worsen chest pain.

aortic regurgitation

the floppiness of the aortic valve causing backwards blood flow from the ascending aorta into the LV. chronic cases can cause ventricular dilation and hypertrophy. this decreases contractility and can lead to pulmonary HTN and RVF. acute cases can be via IE, trauma, or aortic dissection. chronic cases can be via RHD, congenital abnormalities, syphillis, CT issues, or post-op complications. acute s/s include severe dyspnea, chest pain, and hypotension. chronic s/s include angina, water-hammer pulse, soft or absent S1, and S3 and S4 murmurs.

valvular HD interprofessional care

treatment is dependent on what valve is involved and the severity of the disease. important to prevent exacerbations of HF, pul edema, thromboembolisms, and recurrent IE. prophylactic antibiotic therapy should be initiated to prevent infection. client should be on a sodium restriction and anticoagulant therapy.

valvular HD surgical therapy

can be a valve repair (preferred, has a lower operative mortality rate but may not restore total valve function) or valve replacement, which can be mechanical or artificial.

mechanical valve

can be used in valve replacement therapy and leads valves to be more durable and able to last longer. there is however, a risk of thromboembolism and a requirement for the client to be on longterm-anticoagulants.

biologic valves

can be used in valve replacement therapy. can be via bovine, porcine, and/or humans. these valves are less durable but there is no anticoagulation needed.

valvular HD nursing interventions

nursing dx can be impaired cardiac output, activity intolerance, or fluid imbalances. goals should include restoring normal heart function, improving activity tolerance, and ensuring client has an understanding of the disease process and health maintenance measures. nurse should provide early treatment of strep infections and give prophylactic antibiotics for all patients with a hx of infections. patient should be educated on s/s to report. important to individualize rest and activity, avoid strenuous activity, discourage tobacco use, do ongoing cardiac assessments to monitor drug effectiveness, monitor INR for those on anticoagulants, and provide patient teaching. notify provider for s/s of infection, HF, and bleeding, as well as planned invasive or dental work.