12.1 Cardiovascular Overview

The coronaries perfuse the myocardial tissue with oxygen-rich blood. There are four chambers of the heart. Valves between the chambers communicate between the aorta and pulmonary veins.
Blood starts on the right side of the heart, getting perfused to the lungs to get oxygenated, and returns to the left atrium, where it is expelled from the left ventricle to the body.
Cardiac output is how much blood is exiting the aorta each minute.
Stroke volume is the amount of blood that exits the left ventricle during systolic contraction.
Preload and afterload are terms that encompass the amount of stretch and force that is required prior to contraction and during contraction, respectively.

12.2 Dysrhythmia

Myocardial cells generate action potential and stimulate neurological impulses to cause contraction.
Bradycardia is a slow heartbeat, less than 60 bpm. If slow enough, the patient may report dizziness or near syncope. Interventions may require discontinuing medications that are causing this issue. If the patient is asymptomatic, no intervention may be required.
Tachycardia is a heart rate of over 100 bpm, and may be due to exercise, fever, stress, or pain. If a tachycardia dysrhythmia occurs, medications may be required.
Ectopic beats are premature beats that occur in either the ventricles or atria. One common cause is excessive caffeine consumption.
Heart blocks range from first, second, and third degree. Depending on the degree of heart block, monitoring of aggressive interventions such as pacing may be required.
Atrial dysrhythmias are fast and can be regular or irregular. Treatments include medications, cardioversion, or ablation.
Ventricular dysrhythmias are more life-threatening and require resuscitative efforts such as CPR and the use of the AED.
Asystole rhythm shows a flat line with little to no evidence of cardiac rhythm and requires resuscitative efforts such as CPR.
Nursing care will center around the type of dysrhythmia and if perfusion has been restored.

Pathophysiology of HF can be linked back to modifiable and nonmodifiable risk factors. The most common cause of HF is coronary artery disease and/or coronary artery blockage.
Right-sided heart failure manifests when increased fluid pushes fluid back into the pulmonary system, congesting the right side of the heart and causing the right ventricle to fail. Left-sided heart failure manifests from left ventricular failure and cannot effectively pump blood throughout the body.
Clinical manifestations of HF include dyspnea, edema, orthopnea, chest pain, cough, and weight gain.
Nursing interventions of HF include daily weights, keeping the head of the bed in high Fowlers, clustering care, monitoring medication adherence, and educating patients on modifiable risk factors.
Common pharmacological therapies include ACE inhibitors/ARBs, beta-blockers, diuretics, and nitrates.

Hypertension, often known as the “silent killer,” is a preventable disease, but has paramount effects on overall health.
Uncontrolled blood pressure has been linked with stroke, heart failure, myocardial infarction, kidney disease, and death.
Hypertensive urgency includes symptoms of headache, blurred vision, and chest pain, while malignant hypertension are these symptoms plus target organ damage.
To obtain accurate blood pressure readings, measurements should be taken on two different occasions using a properly sized cuff. The patient should be positioned in a comfortable environment and should refrain from eating or smoking for 30-45 minutes prior to the assessment.
Interventions for hypertension center around the education of risk factors, medication compliance, lifestyle changes, and evaluating appropriate responses to therapies. Therapies are initially aimed at diet, exercise, and weight loss. If lifestyle modifications are ineffective, pharmacological therapies are implemented.
Nursing care includes teaching about reduced sodium intake, education on lifestyle modification, and assessment of medication effects.
When evaluating outcomes, the patient should have a reduction of blood pressure readings or verbalization about making lifestyle modifications.

MI events have a high mortality rate and morbidity rate if not appropriately addressed.
Ischemia occurs when there is a temporary lack of blood flow, but is restored by medications and rest, whereas infarction is tissue death from a completely occluding thrombus.
Risk stratification by identifying high-risk individuals, thorough medical history, and medication reconciliation (certain medications can cue the nurse if the patient has a history of MI) is paramount to eliminate occurrence of a cardiac event.
Symptoms of MI include chest pain, shortness of breath, jaw pain, fatigue, palpitations, or nausea.
Urgent interventions center around revascularization and administration of medications to dilate coronaries and prevent further platelet aggregation.
Nursing interventions are gauged at optimizing oxygenation, reducing cardiac workload, and improving survivability.
Evaluation of care is dependent on the patient’s degree of infarction. More invasive and aggressive interventions may be required for STEMI compared to NSTEMI. The care and evaluation are tailored to the patient’s diagnosis and clinical presentation.

Arteriosclerosis and atherosclerosis can cause narrowing of the arteries and reduced blood flow due to plaque formations.
Carotid artery disease may or may not cause symptoms depending on the severity of the blockage, or the number of vessels blocked. Comorbidity management influences the risk of vascular disease incidence.
Small AAA may be asymptomatic, but larger ones will cause cool clammy skin, diaphoresis, dizziness, fainting, tachycardia, nausea and vomiting, shortness of breath, and severe, sudden abdominal pain.
Nursing responsibilities include hemodynamic stabilization, pre- and post-monitoring of patients undergoing revascularization procedures, and education on lifestyle adjustments.
Medical management is first-line therapy with lifestyle modifications and adherence to medications. Surgical intervention is necessitated when blockages advance or vascular rupture is evident.

The peripheral vascular system comprises veins that return blood to the heart, arteries that bring blood away from the heart, and arterioles.
The pathophysiology of venous insufficiency is that blood cannot return to the heart as efficiently and pools with bluish discoloration, whereas in arterial insufficiency, blood is not getting to the limbs efficiently, manifesting with pain, altered pulses, and diminished hair growth.
Comorbidity management influences the risk of peripheral vascular disease incidence.
Diagnostics include ultrasound, ankle-brachial index, and labs to identify risk factors.
Nursing responsibilities include pain management, activity restriction, medication management, wound care, and surgery if indicated.
Evaluation of goals center around reduction of wounds, ability to participate in exercise, and adherence to healthy lifestyle.
Medical management is first-line therapy with lifestyle modifications and adherence to medications. Surgical intervention is necessitated when blockages advance.