NUR 219: Cardiovascular Disease

for pathopharmacology fall 2025 at purdue university with Renbarger and Swartzell

diagnostic tests

ECG/EKG, echo, stress test, c xray, imaging

ECG/EKG

illustrates conduction actvity of the heart and abnormalities (electrolytes); can moniter arrythmias, MI, infection, pericarditis

echocardiogram

US records images of the heart and valve movements; used for valve abnormailities, congenital defects, changes in function or structure

stress test

checks for exercise induced problems; bicycle, step, treatmill

chest x ray

shape and size of heart, pulmonary congestion w/ heart failure

nuclear imaging

used dye; access size of MI, perfusion, function

cardiac cath/angio

pass a cath up ventricle and inject dye to visualize inside of heart, measure pressures, assess valve and heart function, blood flow to and from heart

tropinin

blood protein released with cardiac muscles when damaged, diagnostic for MI

doppler study

microphone placed over vessels to record peripheral sounds

blood tests

triglycerides, cholesterol, sodium, potassium, calcium; hgb, hct

ABG

assess current O2 level and acid-base balance in blood

dietary modification for cardiac issues

lower fat intake and sodium

cessation of tobacco use in cardiac pt

nicotine is a vasoconstrictor + HR

coronary artery disease (CAD)

angina pectoris and myocardial infarction

cardiac dysrhythmias

arrythmias and cardiac arrest

congenital heart defects

ventricular septal defect, valvular defects, tetralogy of fallot

inflammation and infection of the heart

rheymatic fever. infective endocarditis, pericarditis

angina pectoris

O2 deficit to heart muscle

classic angina pectoris

occurs with exertion

variant angina pectoris

vasospasm at rest

unstable angina pectoris

prolonged pain at rest; may precede MI

autoregulation

heart adapts to its own needs via vasodialation

angina pectoris S/S

chest tightness (w/ radiation to neck and left arm), pallor, diaphoresis, nausea

angina pectoris treatment

rest, coronary vasodialator→nitroglycerin

atherosclerosis

plaque buildup w/in arterial walls

arteriosclerosis

narrowing of arteries

vasospasm

contraction of arteriolar smooth muscles

myocardial infarction

death of myocardial tissue d/t ischemia

MI causes

thrombus build up, vasospasm in partial occlusion→total occlusion, part of thrombus breaks awayt

time before MI is irreversible

20-30 minutes

myocardial fiber regeneration

do NOT regenerate, replaced by fibrous tissue

MI S/S

substernal chest pain radiating to L arm, shoulder, jaw, neck; pallor, diaphoresis, dizziness, weakness, dyspnea, anxiety and fear, hypotension

silent MI

pain interpreted as gastric discomfort

MI diag

MI diag

EKG and serum enzymes

MI complications

25% will die immediately, cardiogenic shock, CHF

cardiogenic shock

impaired pumping of left ventricle→decreased output→hypoxia

MI treatment

MONA, ER visit, recovery and prevention KEY

MONA

morphine, oxygen, nitro, aspirin

arrhythmia

deviation from normal cardiac rhythm

arrhythmia causes

damage to conduction, electrolyte imbalance, fever, hypoxia, stress, infection, drug toxicity

too fast arrhythmias

prevents adequate filling during diastole→ decreased cardiac output

too slow cardiac arrhythmias

reduces output to tissues including brain and heart

sinus node abnormalities

brady, tachy, sick sinus syndrome 

sick sinus syndrome

alternating between brady and tachy; needs pacemaker

atrial conduction abnormalities

atrial flutter and atrial fibrillation

atrial flutter

atrial rate of 160 to 350 bpm

a fib

rate over 350 bpm; pooling of blood in the atria→ thrombus risk, use anticoagulant

AV node abnormalities

heart blocks; can be partial (differing degrees)

heart block

conduction is excessively delayed or stopped at AV node or Bundle of His

1st degree block

prolonged time between atrial and ventricular contraction

2nd degree block

interference in one of bundle branhes; cardiac output stable

total/ 3rd degree block

no impulses from atria to ventricles→ syncope or cardiac arrest

ventricular conduction abnormalities

ventricular conduction abnormalities

bundle branch block, ventricular tachy, ventricular fibrillation

bundle branch block

interference in one of bundle branches; cardiac output stable

ventricular tachycardia

decreased filling time and force of contraction = decreased cardiac output

ventricular fibrillation

muscles contract independently and rapidly leading to hypoxemia in myocardium

arrhythmia treatments

fix underlying causes, antiarrhythmic drugs, pacemaker

antiarrhythmic drugs

beta-1 adrenergic blockers, Ca channel blockers, digoxin

pacemaker

implanted device with electrodes attached to heart muscle, stimulate contraction PRN or completely control the heart

cardiac arrest

cessation of all activity in heart

cardiac arrest treatment

restore blood flow via CPR and ACLS meds, electronic defibrillation

shockable rhythems

v fb, pVT

CHF

heart is unable to pump enough blood to me

CHF causes

heart defects, increased demands on heart

effects of CHF

decreased cardiac output and decreased stroke volume, backup congestion in circulation behind affected ventricle

compensation for CHF

tachy, pallor, daytime oligura alongside nocturia

left sided heart failure

dyspnea, pulmonary congestion, restless, confused, orthopnea, tachy, fatigue, cyanosis

right sided heart failure

fatigue, high peripheral venous pressure, ascites, enlarged spleen/ liver, distended jugular veins, anorexia, GI issues, weight gain, edema

CHF forward effects

decreased blood to tissues, dyspnea, SOB, exercise intolerance, cold intolerance, dizziness

CHF backup effects of L failure

dyspnea, cough, paroxysmal nocturnal dyspnea

CHF backup effects of R failure

edema, hepatomegaly and splenomegaly, ascites, headache, distended neck veins

environmental heart defects

rubella, maternal alcoholism, maternal diabetes

genetic heart defects

may be associated with chromosomal abnormalities

heart murmur

most detected congenital heart defect

valvular defect

abnormal blood flow

septal defect

mixing of oxygenated blood

stenosis

narrowing of a valve that restricts forward blood flow

valvular incompetence

failure of valve to close completely → backflow of blood

mitral valve prolapse

abnormally large and floppy valves →blood regurgitation

congenital heart defect treatment

surgical replacement by valves; susceptible to thrombus so take aspirin

rheumatic fever

acute systemic inflammatory and abnormal immune response after infection

rheumatic fever causes

A beta-hemolytic Streptococcus; URT infection, usually in children ages 5-15

rheumatic heart disease

follows rheumatic fever (can last years); scarred valves cause compromised heart function

rheumatic fever S/S

fever, leukocytosis, maliase, anorexia, fatigue, tachy, murmurs, epistaxis and abdob pain

rheumatic fever treatment

antibiotics (penicillinV), prompt treatment of strep

rheumatic fever complications

heart failure from valve damage, prophylaxis with penicillin before surgery and dental treatment

subacute infective endocarditis

defective heart valves invaded by organisms with low virulence (such as streptococcus viridans), which is normal mouth flora

acute infective endocarditis

normal heart valves are attacked by highly virulent organisms (such as
staphylococcus aureus)

how infective endocarditis works

microorganism from general circulation attach to endocardium and invade heart valves→ inflammation and vegetation on cuffs

infective endocarditis predispositions

abnormal tissue in heart, presence of microbes in blood, reduced host defences

subacute infective endocarditis S/S

asymptomatic; low grade fever/ fatigue, anorexia, splenomegaly, osler nodes, fever, CHF

acute infective endocarditis S/S

sudden, marked onset; fever, chills, drowsy

infective endocarditis treatment

cultures/ rapid tests to indentify causing agent→antimicrobials x 4 wks AT LEAST

pericarditis

inflammation of pericardium, grating sounds, may include effusion (fluid in pericardium)

pericarditis causes

open heart surg, MI, rheumatic fever, SLE, cancer, renal failure, trauma, viral infection, TB, radiation to mediastinum

pericarditis S/S

tachy, angina, dyspnea, cough, EKG changes, friction rub

pericarditis treatment

underlying cause, may need to aspirate fluid via paracentesis