Nursing management patients with cardiovascular disease or problems.

Ischemic heart disease Cardiac arrhythmias Congestive heart failure Rheumatic and other Valvular

heart disease Endocarditis, cardiomyopathies

Congenital heart disease Hypertension Heart block

Cardiac emergencies : Cardiac arrest, acute pulmonary oedema, cardiac temponode, cardiogenic shock, aneurysms and peripheral vascular disease (PVD), recent advancement in cardiology.

Coronary artery disease (CAD) or Ischemic heart diseas…

Definition Risk factors Pathophysiology PreventionsClinical manifestations Medical and nursing management Surgical management……. ..

Introduction

Normal functioning of heart is based on a balance between adequate oxygen supply and oxygen demand.

The function as an effective pump, the heart muscle must be adequately supplied with blood from the coronary arteries.

In Coronary heart disease atherosclerosis develops in the coronary arteries, causing them to be become narrowed or blocked.

When a coronary artery is narrowed or blocked partially or completely, the blood flow to the area of the heart supplied by that artery is reduced

If the remaining blood flow is inadequate to meet the oxygen demand of the heart the area may become ischemic and injured and further complications will be occur.

Definition… ….

The term coronary heart disease, also known as coronary artery disease or Ischemic heart disease, is a condition refers to diseases of the heart that result from a decrease in blood supply to the heart muscle.

RISK FACTORS FOR CHD

Non modifiable risk factors Modifiable risk factors Contributing risk factors

Non modifiable risk factors

Family history of CAD Increasing age Gender (men develop CAD at an

earlier age than women.)

Modifiable risk factors

Cigarette smoking, tobacco useHypertension Diabetes mellitus Obesity Sedentary life style Physical inactivity Hyperlipdemia or elevated cholesterol

Contributing factors

Stress Menopause… … .

PATHOPHYSILOGY

Due to risk factors Atherosclerosis primarily affects the intima

of the arterial wall and normally takes years to develop and is a gradual process.

The continued development of atherosclerosis involves an inflammatory response, which begins with injury to the vascular endothelium.

Continue… ..

The injury may be initiated by smoking, HTN and other factors.

The blockage of CA when partially or completely it will cause inadequate blood and oxygen supply to the heart muscle. It causing the ruptured plaque,is contributing for thrombus formation.

The thrombus may then obstruct blood flow, leading to sudden Cardiac death and AMI.

Preventions… … …

Modified or control the major modifiable risk factors is a major aspects.

Normalize blood cholesterol levels Cessation of smokingManaging Hypertension Maintain near normal blood glucose

levels.

Continue…

Dietary measures (TLC) Therapeutic lifestyle changes.

This includes weight loss, cessation of tobacco use and increased physical activity

Clinical manifestations… … . CAD or atherosclerosis produces

symptoms and complications according to the location and degree of narrowing of the coronary arteries, level of thrombus formation and obstruction of the blood flow to the myocardium.

Chest pain (ANGINA PECTORIS) Shortness of breath (SOB)

Assessment and diagnostic findings

History collection Complete physical examination ECGEcocardiogram Cardiac stress testCardiac catheterization

Medical management… … .

The primary goals of management patients with CAD are reducing and controlling risk factors and restoring blood supply to the myocardium.

Reducing the risk factors… …

Primary prevention. (healthy lifestyle. Education. Smoking cessation.,diatery habits changes, physical exercise. Periodic health check up… .. Etc

Restore blood supply… ..

Various techniques have been developed to open the vessels and restore blood flow through the coronary arteries.

PCI (Percutaneous coronary interventions

PCI

It is a Invasive intetventional procedure to treat angina and CAD include PTCA,

Intracoronary Stent implantation Atherectomy and brachytherapy… CABG

Pharmacologic therapy… ..

Organic nitrates (isosorbide, Mononitriate and denigrate.)

Beta blockers (reducing Cardiac work load and oxygen demand.

( e.g propranolol, Amano lol and timolol)

Pharmacologic therapy continue… ..

Calcium channel blockers (reduce the total coronary flow by blocking beta2 receptors. (nifedipine, amlodipine)

Aspirin or antiplatelet (improve the rate of survival in patients with AMI and reduce risk of MI in patients with AP and after recovery from MI.

PTCA

Atherectomy

Atherectomy is an Invasive intetventional procedure that involves the removal of the atheroma or plaque, from a coronary artery by cutting, shaving, or grinding.

Nursing management