MS1 (#9): VASCULAR DISORDERS, CARDIOMYOPATHIES AND INFECTIOUS CARDIAC DISORDERS

Arteriosclerosis

Hardening of the arteries; a diffuse process where muscle fibers and endothelial lining of small arteries/arterioles become thickened[cite: 1].

Atherosclerosis

A chronic inflammatory disease characterized by the hardening and narrowing of arteries due to the buildup of lipids, calcium, and fibrous tissue (plaques) on the intimal layer[cite: 1].

LDL (Low-Density Lipoprotein) Normal Function

The main carrier of cholesterol from the liver to peripheral tissues, regulated by LDL receptors for membrane fluidity, steroid hormones, and bile acid production[cite: 1].

Atherosclerosis Risk Factors

High LDL, smoking, hypertension, diabetes, and toxins that cause endothelial dysfunction and activation[cite: 1].

Pathological LDL Leakage

Process where damaged endothelium allows LDL to enter subendothelial space, undergo oxidation into oxLDL, and trigger inflammatory plaque formation[cite: 1].

Fatty Streaks

Early atherosclerotic lesions that are yellow and smooth, protruding slightly into the lumen, composed of lipids, elongated smooth muscle cells, and foam cells (reversible)[cite: 1].

Fibrous Plaques

Progressive atherosclerotic lesions composed of smooth muscle cells, collagen fibers, plasma components, and lipids, forming a fibrous cap over a lipid core[cite: 1].

Complicated Lesion

Dangerous stage of atherosclerosis where the fibrous cap ruptures or erodes, exposing the lipid core and triggering platelet aggregation and thrombosis[cite: 1].

Direct Results of Atherosclerosis

Lumen narrowing (stenosis), obstruction by thrombosis, aneurysm, ulceration, and rupture[cite: 1].

Indirect Results of Atherosclerosis

Malnutrition and subsequent organ fibrosis supplied by sclerotic arteries[cite: 1].

Isometric Exercise for Atherosclerosis

Static exercises (muscle contracts without joint movement, e.g., plank, wall sit) to promote blood flow and encourage collateral circulation[cite: 1].

Endurance Building in Vascular Disease

Instructing the patient to walk to the point of pain, rest until pain subsides, and resume walking to develop collateral circulation[cite: 1].

Peripheral Artery Disease (PAD)

Disease involving thickening of arterial walls resulting in progressive narrowing of arteries in upper and lower extremities, most commonly lower extremities[cite: 1].

PAD Onset

Tends to be bilateral and typically becomes symptomatic in the 6th to 8th decades of life[cite: 1].

Intermittent Claudication

Ischemic muscle pain, numbness (paresthesia), or weakness with walking due to increased oxygen demand, relieved by rest[cite: 1].

Hallmark Signs of PAD

Sudden ischemic pain, weak/absent pulse, cold extremity, pallor/mottling, dependent rubor, and hair loss on extremities[cite: 1].

Ankle-Brachial Index (ABI)

Non-invasive test comparing ankle vs. brachial systolic blood pressure calculated as Ankle Systolic BP / Brachial Systolic BP[cite: 1].

ABI Interpretation Values

Normal: 1.0–1.4; Borderline: 0.9–1.0; Moderate PAD: 0.5–0.9; Severe PAD:

Arteriography

Imaging test using contrast dye and X-rays to visualize arteries; considered the gold standard for diagnosing PAD[cite: 1].

Inflow Surgical Procedures

Surgeries improving blood supply from the aorta to the femoral artery (e.g., Aorta to Femoral)[cite: 1].

Outflow Surgical Procedures

Surgeries providing blood supply to vessels below the femoral artery (e.g., Femoral to lower arteries)[cite: 1].

Femoropopliteal Bypass Graft

Surgical placement of a grafted vessel to bypass an arterial blockage and restore lower leg circulation[cite: 1].

Percutaneous Transluminal Angioplasty

Insertion of a balloon-tipped catheter through the skin (usually via femoral or radial puncture) to inflate and stretch the artery/break plaque[cite: 1].

Atherectomy

Catheter procedure using a grinding tool to remove plaque from the arterial wall[cite: 1].

Pharmacologic Therapy for PAD

Antiplatelet medications to enhance blood flow, such as Pentoxifylline, Cilostazol, Aspirin, Clopidogrel, Dipyridamole, and Ticlopidine[cite: 1].

Contraindicated Actions in Lower Extremity Arterial Occlusion

Leg elevation (overcomes perfusion pressure causing rest pain/ischemia) and direct heat application (skyrockets metabolism/O2 demand leading to tissue necrosis)[cite: 1].

Thromboangiitis Obliterans (Buerger's Disease)

Non-atherosclerotic, segmental, recurrent inflammatory disorder of small and medium-sized arteries and veins of upper and lower extremities[cite: 1].

Key Risk Factor for Buerger's Disease

Strongly associated with heavy tobacco use and marijuana use[cite: 1].

Buerger's Disease Pathophysiology

Acute phase forms inflammatory thrombus causing vessel blockage; chronic phase leads to thrombosis, fibrosis, and severe tissue ischemia[cite: 1].

Hallmark Signs of Buerger's Disease

Intermittent claudication of feet, hands, or arms; rest pain; ischemic ulcerations; cold sensitivity; superficial vein thrombosis[cite: 1].

Medical Management of Buerger's Disease

Complete cessation of tobacco and marijuana, avoidance of cold, analgesics, antibiotics, and IV Iloprost for rest pain and ulcer healing[cite: 1].

Surgical Options for Buerger's Disease

Sympathectomy, spinal cord stimulator implantation, bypass surgery, or finger/toe amputations for painful gangrenous ulcers[cite: 1].

Positioning for Buerger's Disease

Careful balance: neutral or slightly dependent positioning for perfusion, avoiding excessive elevation which worsens arterial ischemia[cite: 1].

Raynaud's Phenomenon

Episodic vasospastic disorder of small cutaneous arteries, most commonly affecting fingers and toes[cite: 1].

Raynaud's Demographics

Primary occurrence in young women, typically between 15 and 40 years of age[cite: 1].

Primary Raynaud's (Raynaud's Disease)

Vasospastic disorder occurring in the absence of an underlying primary medical condition[cite: 1].

Secondary Raynaud's (Raynaud's Syndrome)

Vasospasm associated with underlying conditions, such as connective tissue diseases (lupus, scleroderma, rheumatoid arthritis) or trauma[cite: 1].

Characteristic Color Sequence of Raynaud's

White (pallor from vasospasm), Blue (cyanosis from pooled deoxygenated blood), and Red (rubor/hyperemia as blood flow returns)[cite: 1].

Raynaud's Sensations

Numbness, tingling, and burning pain during color changes, usually bilateral and symmetrical[cite: 1].

Management of Raynaud's Phenomenon

Avoid cold exposure, nicotine, and stress; take Calcium Channel Blockers to relieve vasospasms[cite: 1].

Atherosclerosis Delivery Truck Metaphor

Normal: delivery truck (LDL) drops cholesterol at the right address (cells); Atherosclerosis: truck crashes through fence (damaged endothelium), dumps cargo in wrong yard (arterial wall), cargo rots (oxidized LDL), and attracts scavengers (macrophages) creating a junk pile (plaque)[cite: 1].

Endothelial Dysfunction Early Changes

Endothelial injury from smoking, hypertension, diabetes, or toxins results in increased permeability to LDL, decreased nitric oxide, and increased adhesion molecules[cite: 1].

Buerger's Disease Acute vs Chronic Phase

Acute phase: formation of an inflammatory thrombus blocking the vessel; Chronic phase: thrombus organizes, inflammation subsides, and thrombosis/fibrosis occur causing severe tissue ischemia[cite: 1].

Non-Atherosclerotic Disease Characteristics

Driven by inflammation, autoimmune reactions, or structural abnormalities (not LDL/lipid plaque buildup), often affects younger patients, and involves small/medium arteries and veins[cite: 1].

Buerger's Foot & Leg Care Nursing Instructions

Teach daily foot checks for wounds/redness, regular podiatrist and vascular MD visits, wearing a wide shoe box, lotion application, careful nail trimming, and avoiding tight waistbands or knee-high hose that constrict the popliteal space[cite: 1].

Raynaud's Pathophysiology Mechanism

Caused by an imbalance between vasodilation and vasoconstriction due to abnormalities in vascular, intravascular, and neuronal mechanisms, possibly starting from a defect in basal heat production that reduces cutaneous vessel dilation capacity[cite: 1].

Secondary Raynaud's Underlying Causes

Associated with connective tissue disorders (systemic lupus erythematosus, rheumatoid arthritis, scleroderma), trauma, or obstructive arterial lesions[cite: 1].

Hyperemia in Raynaud's

Exaggerated reflow of excess blood causing intense redness (rubor) when oxygenated blood returns to digits following vasospasm resolution[cite: 1].

Buerger's Disease Diagnostic Exclusion Criteria

Diagnosis requires ruling out autoimmune diseases, diabetes, thrombophilia (inherited clotting tendencies), and other sources of emboli[cite: 1].

Nursing Care for Extremities in Buerger's Disease

Discourage vigorous rubbing, scratching, crossing of legs, and prolonged sitting/standing; encourage walking and wearing protective shoes with pressure area padding[cite: 1].

Aneurysm

Localized sac or dilation formed at a weak point in the wall of an artery (e.g., ballooning/bulging of a weakened arterial wall).

Congenital Aneurysm Etiology

Caused by primary connective tissue disorders such as Marfan's syndrome, Ehlers-Danlos syndrome, or Turner's syndrome.

Mechanical Aneurysm Etiology

Results from post-stenotic dilation or arteriovenous fistula due to extra pressure and turbulence after narrowing.

Traumatic Aneurysm (Pseudoaneurysm)

Caused by penetrating or blunt arterial injuries (e.g., knife wound, catheter puncture) where blood leaks and is contained by surrounding tissue.

Inflammatory Noninfectious Aneurysm

Caused by immune system attacks on the vessel wall in conditions like lupus, Takayasu arteritis, or Kawasaki disease[cite: 1].

Infectious (Mycotic) Aneurysm

Caused by bacterial, fungal, or spirochetal infections eroding the arterial wall[cite: 1].

Thoracic Aortic Aneurysm (TAA)

Localized dilation occurring in the thoracic aorta; most common site for a dissecting aneurysm[cite: 1].

Aortic Dissection

Creation of a false lumen between the intima and media layers of the arterial wall as blood surges through an intimal tear[cite: 1].

Pathophysiology of Aortic Dissection

Intimal tear → blood enters media separating layers → cardiac pulsations increase pressure/dissection → potential rupture or organ ischemia[cite: 1].

Hallmark Signs of TAA

Constant, boring pain when supine, dyspnea, paroxysmal brassy cough, hoarseness, stridor, aphonia, and dysphagia[cite: 1].

Nursing Management for TAA

Semi-Fowler's position, quiet environment, opioids/sedatives, IV antihypertensives, avoiding heavy lifting, and strict avoidance of abdominal/chest palpation[cite: 1].

Abdominal Aortic Aneurysm (AAA)

Balloon-like bulge in the abdominal aorta, most commonly caused by atherosclerosis[cite: 1].

Hallmark Signs of AAA

Often asymptomatic, but may cause abdominal/back pain (radiating to legs), pulsatile abdominal mass, diminished femoral pulses, and abdominal bruits[cite: 1].

Impending AAA Rupture Signs

Abdominal distention, sudden severe back pain, pale/clammy skin, decreased pulse pressure, and rapid thready pulse[cite: 1].

AAA Diagnostic Procedures

CT scan with 3D reconstruction, Transesophageal Echocardiogram (TEE), chest X-ray, and ECG[cite: 1].

Rheumatic Heart Disease (RHD)

Permanent damage to heart valves caused by rheumatic fever, following an untreated or undertreated Group A streptococcal infection[cite: 1].

Jones Criteria Major Diagnostic Criteria

Carditis, Polyarthritis, Chorea (Sydenham's/St. Vitus' dance), Subcutaneous Nodules, and Erythema Marginatum[cite: 1].

Jones Criteria Minor Diagnostic Criteria

Fever (≥38.5°C), Polyarthralgia, Prolonged PR interval on ECG, and Elevated ESR (≥60 mm/h) or CRP (≥3.0 mg/dL)[cite: 1].

Diagnostic Standard for Group A Strep

Throat Culture is the gold standard; supplemented by Rapid Antigen Detection Test and Antistreptococcal antibodies[cite: 1].

Signs of Streptococcal Infection to Report

Sudden sore throat, diffuse throat redness/exudate, swollen cervical lymph nodes, pain on swallowing, fever (101°F–104°F), headache, and nausea[cite: 1].

Pericarditis

Inflammation of the pericardium (sac enclosing the heart), commonly leading to excess fluid accumulation (pericardial effusion)[cite: 1].

Hallmark Signs of Acute Pericarditis

Pericardial friction rub (scratching/grating sound), sharp sudden chest pain radiating to neck/shoulders/back (eased by sitting upright), and fever[cite: 1].

ECG Finding in Pericarditis

Diffuse elevation of ST segments without significant changes in QRS morphology[cite: 1].

Pericarditis Surgical Procedures

Pericardiocentesis (fluid removal for cardiac tamponade), partial pericardiectomy, or total pericardiectomy (for constrictive pericarditis)[cite: 1].

Nursing Management for Pericarditis

Bed rest, place patient in an upright position to ease pain/respiration, provide oxygen, monitor I&O, and assess friction rub[cite: 1].

Myocarditis

Inflammation of the heart muscle (myocardium) usually caused by viral infections, toxins, or drugs, leading to weakened contractility and heart failure[cite: 1].

Myocarditis Pathophysiology

Initial trigger → immune activation → myocardial injury/inflammation → myocardial dysfunction → scar tissue (fibrosis) remodeling → impaired cardiac pumping[cite: 1].

Hallmark Signs of Myocarditis

Arrhythmias (S3 and S4 gallops, faint S1), dyspnea, fatigue, and fever[cite: 1].

Myocarditis Diagnostic Gold Standard

Endomyocardial biopsy confirms diagnosis (though a negative biopsy does not fully rule it out)[cite: 1].

Myocarditis Pharmacologic Management

Beta blockers, ACE inhibitors, diuretics, antiarrhythmics (Quinidine), and inotropes/cardiac glycosides (Digoxin) to improve contractility[cite: 1].

Infective Endocarditis

Infection of the inner lining of the heart (endocardium) and heart valves by microorganisms (usually bacteria), forming vegetative lesions[cite: 1].

Infective Endocarditis Risk Factors

Rheumatic or degenerative heart disease, recent invasive instrumentation (IV, GU, respiratory), dental procedures, and IV drug use[cite: 1].

Hallmark Signs of Infective Endocarditis

Fever/chills, petechiae on palate/fingernails, Osler nodes (painful raised lesions on fingers/toes), Janeway lesions (painless lesions on palms/soles), and heart murmurs[cite: 1].

Nursing Priorities in Infective Endocarditis

Monitor for signs of heart failure, track renal status (BUN, creatinine, urine output), watch for systemic embolization, and teach antibiotic prophylaxis before dental/surgical procedures[cite: 1].

Cardiomyopathy (CMP) Definition

Group of diseases affecting the heart muscle (myocardium) that impairs pumping capacity and can lead to heart failure[cite: 1].

Primary vs Secondary Cardiomyopathy

Primary: idiopathic etiology where myocardium is solely affected; Secondary: myocardial disease caused by a known systemic condition (hypertension, diabetes, toxins)[cite: 1].

Dilated Cardiomyopathy (DCM)

Pumping chamber (left ventricle) becomes enlarged (dilated) and cannot pump effectively; most common cause is coronary artery disease or MI (more common in middle-aged men)[cite: 1].

Hypertrophic Cardiomyopathy (HCM)

Abnormal thickening of the heart muscle (mostly left ventricle), making filling difficult; frequently genetic/inherited and more severe in childhood[cite: 1].

Restrictive Cardiomyopathy (RCM)

Heart muscle becomes rigid and stiff, preventing expansion and filling between beats; least common type, often caused by amyloidosis or idiopathic factors in older adults[cite: 1].

Arrhythmogenic Right Ventricular Dysplasia

Rare cardiomyopathy where right ventricular muscle is replaced by fatty/fibrous scar tissue, leading to severe dysrhythmias[cite: 1].

Cardiomyopathy Pharmacologic Management

Beta blockers (Propranolol, Metoprolol) for HCM, ACE inhibitors, Diuretics (Furosemide), Inotropes (Dobutamine, Digoxin for DCM), and Anticoagulants (Warfarin)[cite: 1].

Nursing Management for Cardiomyopathies

Semi-Fowler's position, daily weights (report >3 lb/1.4 kg gain), low-sodium diet, fluid restrictions, avoiding alcohol/smoking, and preventing straining during bowel movements[cite: 1].

Rare Congenital Aneurysm Causes

Focal medial agenesis, tuberous sclerosis, and Menkes' syndrome.

Noninfectious Inflammatory Aneurysm Causes

Giant cell arteritis, Bechet's syndrome, systemic lupus erythematosus, Kawasaki disease, and periarterial inflammation like pancreatitis.

Thoracic Pressure Symptoms in TAA

Pressure on trachea/bronchi causes dyspnea and brassy cough; pressure on laryngeal nerve causes hoarseness, stridor, and aphonia; pressure on esophagus causes dysphagia.

Hemodynamic Rupture Indicators in AAA

Decreased pulse pressure (due to lower circulating volume and high HR), rapid thready pulse, and abdominal distention[cite: 1].

Jones Criteria Polyarthralgia Rule

Monoarthritis or polyarthralgia can count as major criteria in moderate/high-risk populations (after excluding other causes)[cite: 1].

Jones Criteria Specific Inflammatory Cutoffs

ESR ≥60 mm/h and C-reactive protein (CRP) ≥3.0 mg/dL indicate minor criteria for rheumatic fever[cite: 1].

Embolization Target Organs in Endocarditis

Watch for kidney damage (hematuria), lung involvement (pleuritic chest pain), spleen involvement (upper left quadrant pain), and brain involvement (paresis)[cite: 1].

Hypertrophic Cardiomyopathy Specific Drugs

Beta blockers (Metoprolol) and Calcium Channel Blockers (Verapamil) to lower heart rate and improve ventricular filling[cite: 1].