UNIT – 6

NURSING MANAGEMENT OF PATIENTS WITH

CARDIOVASCULAR PROBLEMS

REVIEW OF ANATOMY AND PHYSIOLOGY OF CARDIO-

VASCULAR SYSTEM

The cardiovascular system, also known as the circulatory

system, is responsible for transporting blood, nutrients, oxygen,

carbon dioxide, hormones, and waste products throughout the

body. It consists of the heart, blood vessels (arteries, veins, and

capillaries), and blood.

The Heart

The heart is a muscular organ located in the thoracic cavity,

between the lungs. It has four chambers:

Right Atrium: Receives deoxygenated blood from the body via

the superior and inferior vena cavae.

Right Ventricle: Pumps deoxygenated blood to the lungs via the

pulmonary artery.

Left Atrium: Receives oxygenated blood from the lungs via the

pulmonary veins.

Left Ventricle: Pumps oxygenated blood to the body through

the aorta.

The heart wall has three layers:

Endocardium: The innermost layer lining the chambers.

Myocardium: The middle, thick, muscular layer responsible for

contraction.

Pericardium: The outer layer, consisting of a double-walled sac.

Blood Vessels

Blood vessels are categorized into three main types:

Arteries: Carry blood away from the heart. They have thick,
elastic walls to withstand high pressure.

The largest artery is the aorta.

Arteries branch into smaller arterioles.

Veins: Carry blood towards the heart. They have thinner walls

than arteries and often contain valves to prevent backflow.

The largest veins are the superior and inferior vena cavae.

Veins branch into smaller venules.

Capillaries: Tiny vessels where the exchange of gases, nutrients,

and waste occurs between blood and tissues. They connect

arterioles and venules.

Blood Circulation Pathways

There are two main circulatory pathways:

Systemic Circulation: Carries oxygenated blood from the left

ventricle through the aorta to the body and returns

deoxygenated blood to the right atrium.

Pulmonary Circulation: Carries deoxygenated blood from the

right ventricle to the lungs via the pulmonary artery and returns

oxygenated blood to the left atrium via the pulmonary veins.

Cardiac Cycle

The cardiac cycle consists of two main phases:

Systole: The phase of contraction where blood is pumped out

of the chambers.

Atrial systole: Atria contract to push blood into the ventricles.

Ventricular systole: Ventricles contract to pump blood into the

pulmonary artery and aorta.

Diastole: The phase of relaxation where the heart chambers fill

with blood.

Atrial diastole: Atria relax and fill with blood from the veins.

Ventricular diastole: Ventricles relax and fill with blood from

the atria.

Electrical Conduction System

The heart's electrical conduction system controls the heart rate

and rhythm:

Sinoatrial (SA) Node: Located in the right atrium, it acts as the

natural pacemaker, initiating the electrical impulse.

Atrioventricular (AV) Node: Located between the atria and

ventricles, it delays the impulse before passing it to the

ventricles.

Bundle of His: Pathway for electrical signals to travel from the

AV node to the ventricles.

Purkinje Fibers: Network that spreads the impulse through the

ventricles, causing them to contract.

Blood Composition

Blood is composed of:

Plasma: The liquid component, containing water, electrolytes,

proteins, hormones, and waste products.

Red Blood Cells (Erythrocytes): Carry oxygen from the lungs to

the body and carbon dioxide back to the lungs.

White Blood Cells (Leukocytes): Part of the immune system,

defending against infection.

Platelets (Thrombocytes): Involved in blood clotting.

Regulation of Cardiovascular Function

Several mechanisms regulate cardiovascular function:

Autonomic Nervous System: Controls heart rate and vessel

diameter. The sympathetic nervous system increases heart rate

and constricts blood vessels, while the parasympathetic

nervous system decreases heart rate.

Baroreceptors: Detect changes in blood pressure and send

signals to adjust heart rate and vessel tone.

Hormones: Various hormones like adrenaline, noradrenaline,

and antidiuretic hormone (ADH) affect heart rate and blood

pressure.
NURSING ASSESSMENT: HISTORY AND PHYSICAL ASSESSMENT

Nursing Assessment of Cardiovascular Disorders: History and

Physical Assessment

History Taking

Chief Complaint (CC)

Ask about the primary reason for the patient's visit. Common

complaints include chest pain, shortness of breath, palpitations,

dizziness, or fatigue.

History of Present Illness (HPI)

Onset: When did the symptoms start?

Location: Where is the pain or discomfort located?

Duration: How long do the symptoms last?

Characteristics: Describe the quality of the pain (e.g., sharp,

dull, burning).

Aggravating/Alleviating Factors: What makes the symptoms

worse or better?

Radiation: Does the pain radiate to other areas (e.g., arm, jaw)?

Timing: Are symptoms constant or intermittent?

Severity: Rate the pain on a scale of 1 to 10.

Past Medical History (PMH)

Cardiovascular Diseases: Previous diagnoses of hypertension, myocardial infarction, heart failure,

arrhythmias, or congenital heart defects.

Other Chronic Conditions: Diabetes, kidney disease,

hyperlipidemia, etc.

Surgical History: Previous cardiac surgeries or procedures (e.g.,

angioplasty, bypass surgery).

Medications

Current medications, including dosages and adherence.

Over-the-counter medications and supplements.

Family History
Cardiovascular diseases in close relatives (e.g., parents,

siblings).

Age of onset and outcomes of any cardiovascular conditions.

Social History

Lifestyle Factors: Smoking, alcohol consumption, diet, exercise

habits.

Occupation: Job-related stress or exposure to harmful

substances.

Living Situation: Support system at home.

Review of Systems (ROS)

General: Weight changes, fatigue, fever.

Cardiovascular: Chest pain, palpitations, dyspnea, edema.

Respiratory: Shortness of breath, cough, wheezing.

Gastrointestinal: Nausea, vomiting, abdominal pain.

Neurological: Dizziness, syncope, confusion.

Peripheral Vascular: Claudication, varicose veins, temperature

changes in extremities.

Physical Assessment

General Appearance

Observe for signs of distress, anxiety, or discomfort.

Note body position (e.g., leaning forward to relieve pain).

Vital Signs

Blood Pressure: Measure in both arms; note any differences.

Heart Rate and Rhythm: Check for regularity, rate, and

presence of any irregularities.

Respiratory Rate: Observe for normal or labored breathing.

Temperature: Note any fever which could indicate infection.

Oxygen Saturation: Use a pulse oximeter to assess oxygen

levels.

Inspection

Chest: Look for scars, deformities, or visible pulsations.

Skin: Assess color (pallor, cyanosis), temperature, and presence

of edema.

Jugular Veins: Evaluate for jugular venous distension (JVD)

indicative of right-sided heart failure.

Palpation

Precordium: Palpate for heaves or thrills (indicative of turbulent

blood flow).

Peripheral Pulses: Check for symmetry and strength (radial,

brachial, femoral, popliteal, posterior tibial, dorsalis pedis).

Edema: Press over the shin for pitting edema, which can

indicate heart failure.

Auscultation

Heart Sounds: Listen for S1 and S2 sounds, noting any murmurs,

clicks, or extra heart sounds (S3, S4).

Lung Sounds: Check for crackles (rales), which can indicate

pulmonary congestion or heart failure.

Percussion

Assess for cardiac enlargement by percussing the chest and

noting the borders of cardiac dullness.

Additional Assessments

Capillary Refill: Assess capillary refill time in the nail beds,

noting delays that could indicate poor perfusion.

Orthostatic Vital Signs: Measure blood pressure and heart rate

in different positions (lying, sitting, standing) to check for

orthostatic hypotension.

Documentation and Reporting

Document findings comprehensively and accurately in the

patient’s medical record.

Report any significant abnormalities or changes in the patient’s

status to the healthcare team promptly

INVASIVE AND NON-INVASIVE CARDIAC PROCEDURES

Non-Invasive Cardiac Procedures

Electrocardiogram (ECG or EKG)

Purpose: Measures the electrical activity of the heart.

Procedure: Electrodes are placed on the skin to record the

heart's electrical signals.

Indications: Arrhythmias, myocardial infarction, electrolyte

imbalances.

Echocardiography

Purpose: Uses ultrasound to create images of the heart.

Procedure: A transducer placed on the chest emits sound

waves that reflect off the heart structures.

Indications: Valve disorders, heart failure, cardiomyopathy,

congenital heart disease.

Stress Testing

Purpose: Evaluates the heart’s response to physical exertion.

Procedure: The patient exercises on a treadmill or stationary

bike while heart rate, blood pressure, and ECG are monitored.

Indications: Coronary artery disease, exercise-induced

arrhythmias, ischemia.

Holter Monitoring

Purpose: Continuous ECG recording over 24-48 hours.

Procedure: The patient wears a portable ECG device that

records heart activity during normal activities.

Indications: Intermittent arrhythmias, syncope, palpitations.

Cardiac Magnetic Resonance Imaging (MRI)

Purpose: Provides detailed images of the heart and great

vessels.

Procedure: Uses magnetic fields and radio waves to produce

heart images.

Indications: Cardiomyopathy, congenital heart disease,

myocarditis, pericardial disease.

Cardiac Computed Tomography (CT)

Purpose: Visualizes coronary arteries and other heart

structures.

Procedure: X-ray images taken in rapid succession, often with

contrast dye.

Indications: Coronary artery disease, aortic aneurysm,

pulmonary embolism.

Tilt Table Test

Purpose: Evaluates causes of syncope (fainting).

Procedure: The patient lies on a table that tilts to change their

position, while heart rate and blood pressure are monitored.

Indications: Unexplained syncope, autonomic dysfunction.

Invasive Cardiac Procedures

Cardiac Catheterization

Purpose: Diagnoses and treats cardiovascular conditions.

Procedure: A catheter is inserted into a blood vessel and guided

to the heart; contrast dye may be used.

Indications: Coronary artery disease, valve disorders, congenital

heart defects.

Coronary Angiography

Purpose: Visualizes the coronary arteries.

Procedure: Performed during cardiac catheterization; dye is

injected to highlight coronary arteries.

Indications: Suspected coronary artery disease, chest pain,

abnormal stress test results.

Percutaneous Coronary Intervention (PCI)

Purpose: Opens narrowed or blocked coronary arteries.

Procedure: Often involves balloon angioplasty and stent

placement during cardiac catheterization.

Indications: Acute myocardial infarction, unstable angina,

significant coronary artery stenosis.

Electrophysiology Study (EPS)

Purpose: Diagnoses and treats abnormal heart rhythms.

Procedure: Catheters are inserted through veins to the heart to

map electrical activity.

Indications: Arrhythmias, syncope, unexplained palpitations.

Pacemaker and Implantable Cardioverter-Defibrillator (ICD)

Insertion

Purpose: Regulates heart rhythm.

Procedure: A device is implanted under the skin with leads

extending to the heart.

Indications: Bradycardia, heart block, ventricular tachycardia,

ventricular fibrillation.

Atherectomy

Purpose: Removes plaque from coronary arteries.

Procedure: A catheter with a rotating shaver or laser removes

plaque during cardiac catheterization.

Indications: Coronary artery disease, calcified plaques,

restenosis after angioplasty.

Balloon Valvuloplasty

Purpose: Opens narrowed heart valves.

Procedure: A balloon-tipped catheter is used to dilate the valve

during cardiac catheterization.

Indications: Mitral stenosis, aortic stenosis, pulmonary valve

stenosis.

Transcatheter Aortic Valve Replacement (TAVR)

Purpose: Replaces a diseased aortic valve.

Procedure: A new valve is inserted via catheterization without

open-heart surgery.

Indications: Severe aortic stenosis, high surgical risk patients.

DISORDERS OF VASCULAR SYSTEM – HYPERTENSION,

ARTERIOSCLEROSIS, RAYNAULD’S DISEASE, ANEURYSM AND

PERIPHERAL VASCULAR DISORDERS

Hypertension (High Blood Pressure)

Etiology

Primary (Essential) Hypertension: No identifiable cause,

multifactorial (genetics, lifestyle, diet).

Secondary Hypertension: Results from underlying conditions

(kidney disease, endocrine disorders, medications).

Pathophysiology

Increased arterial pressure due to high resistance in blood

vessels.

Over time, leads to damage of blood vessels, heart, kidneys,

and other organs.

Clinical Manifestations

Often asymptomatic.

Headaches, dizziness, blurred vision, shortness of breath.

Severe cases: chest pain, stroke symptoms, kidney damage.

Diagnostic Tests

Blood Pressure Measurement: Multiple readings over time.

Labs: Kidney function (creatinine), electrolytes, fasting glucose,

lipid profile.

EKG: Detects hypertensive heart disease.

Echocardiography: Assesses heart function and structure.

Medical Management

Medications: Diuretics, ACE inhibitors, ARBs, beta-blockers,

calcium channel blockers.

Lifestyle Modifications: Weight loss, exercise, smoking

cessation, limiting alcohol intake.

Surgical Management

Rarely needed, except in cases of secondary hypertension

where surgical correction of the underlying cause is required.

Nutritional Management

DASH Diet: Dietary Approaches to Stop Hypertension; rich in

fruits, vegetables, whole grains, low-fat dairy.

Salt Restriction: Limit sodium intake to <1500 mg/day.

Nursing Management

Monitoring: Regular blood pressure checks, medication

adherence.

Patient Education: Importance of lifestyle changes, medication

side effects, and regular follow-ups.

Support: Encouragement and resources for lifestyle changes.

Arteriosclerosis

Etiology

Aging process.

Contributing factors: high blood pressure, smoking, diabetes,

high cholesterol.

Pathophysiology

Thickening and hardening of arterial walls due to accumulation

of fatty deposits and loss of elasticity.

Clinical Manifestations

Often asymptomatic until advanced stages.

Angina, claudication, hypertension, signs of organ ischemia.

Diagnostic Tests

Blood Tests: Cholesterol levels, blood glucose.

Imaging: Ultrasound, CT angiography, MRI.

Stress Testing: Evaluates blood flow under stress.

Medical Management

Medications: Statins, antihypertensives, antiplatelets.

Lifestyle Modifications: Smoking cessation, exercise, healthy

diet.

Surgical Management
Angioplasty: Opens narrowed arteries.

Bypass Surgery: Creates a new pathway for blood flow.

Nutritional Management

Low-fat, high-fiber diet.

Increase intake of fruits, vegetables, whole grains.

Nursing Management

Monitoring: Vital signs, signs of ischemia.

Patient Education: Disease process, lifestyle modifications.

Support: Assisting with medication adherence and dietary

changes.

Raynaud’s Disease

Etiology

Primary: Idiopathic.

Secondary: Associated with autoimmune diseases

(scleroderma, lupus).

Pathophysiology

Episodic vasospasm of small arteries, usually in fingers and

toes.

Triggered by cold or stress.

Clinical Manifestations

Triphasic color change (white, blue, red) in response to cold or

stress.

Numbness, tingling, pain.

Diagnostic Tests

Clinical History and Physical Exam: Observation of symptoms.

Nailfold Capillaroscopy: Examines capillaries under the

fingernails.

Blood Tests: Autoimmune markers for secondary Raynaud’s.

Medical Management

Medications: Calcium channel blockers, vasodilators.

Lifestyle Modifications: Avoiding cold, stress management.

Surgical Management

Sympathectomy: Rarely performed; surgical interruption of

sympathetic nerves.

Nutritional Management

No specific dietary requirements, but general healthy eating

supports overall vascular health.

Nursing Management

Monitoring: Frequency and severity of episodes.

Patient Education: Avoiding triggers, proper hand and foot care.

Support: Stress reduction techniques.

Aneurysm

Etiology

Atherosclerosis: Major cause.

Genetic Conditions: Marfan syndrome, Ehlers-Danlos

syndrome.

Other: Trauma, infection, high blood pressure.

Pathophysiology

Abnormal dilation of a blood vessel due to weakening of the

vessel wall.

Common sites: aorta (thoracic or abdominal), brain (cerebral),

peripheral arteries.

Clinical Manifestations

Often asymptomatic until rupture.

Abdominal: Pulsatile abdominal mass, back pain.

Cerebral: Sudden severe headache, neurological deficits.

Thoracic: Chest pain, difficulty breathing.

Diagnostic Tests

Ultrasound: Initial screening tool for abdominal aneurysms.

CT/MRI Angiography: Detailed imaging of aneurysm size and

location.

Cerebral Angiography: For brain aneurysms.

Medical Management

Medications: Blood pressure control, cholesterol-lowering

drugs.

Monitoring: Regular imaging to track aneurysm size.

Surgical Management

Open Surgery: Aneurysm repair with grafting.

Endovascular Repair: Minimally invasive, stent placement.

Nutritional Management

Diet: Low cholesterol, low sodium, balanced diet to maintain

vascular health.

Nursing Management

Monitoring: Signs of aneurysm growth or rupture.

Patient Education: Recognizing symptoms of rupture,

importance of regular follow-ups.

Post-Op Care: Pain management, wound care, mobility

assistance.

Peripheral Vascular Disorders

Etiology

Peripheral Artery Disease (PAD): Atherosclerosis, smoking,

diabetes, hypertension.

Venous Disorders: Varicose veins, chronic venous insufficiency,

deep vein thrombosis (DVT).

Pathophysiology

PAD: Narrowing of peripheral arteries, leading to reduced blood

flow.

Venous Disorders: Impaired blood return, leading to pooling

and increased pressure in veins.

Clinical Manifestations

PAD: Claudication, rest pain, ulcers, gangrene.

Venous Disorders: Swelling, varicose veins, leg pain, skin

changes, ulcers.
Diagnostic Tests

Ankle-Brachial Index (ABI): Compares blood pressure in the

ankle and arm to diagnose PAD.

Doppler Ultrasound: Assesses blood flow in arteries and veins.

Venography: Imaging of veins using contrast dye.

Medical Management

PAD: Antiplatelet agents, statins, cilostazol.

Venous Disorders: Compression therapy, anticoagulants for

DVT.

Surgical Management

PAD: Angioplasty, stent placement, bypass surgery.

Venous Disorders: Vein stripping, sclerotherapy, endovenous

ablation.

Nutritional Management

PAD: Low-fat, high-fiber diet, weight management.

Venous Disorders: Healthy diet to maintain ideal body weight,

reduce venous pressure.

Nursing Management

PAD: Monitoring for ulceration, teaching foot care, promoting

exercise.

Venous Disorders: Compression therapy, leg elevation, wound

care for ulcers, patient education on DVT prevention.

CORONARY ARTERY DISEASE, CORONARY ATHEROSCLEROSIS,

ANGINA PECTORIS, MYOCARDIAL INFARCTION

Coronary Artery Disease (CAD) and Coronary Atherosclerosis

Etiology

Atherosclerosis: Primary cause; buildup of plaque in the

coronary arteries.

Risk Factors: High cholesterol, hypertension, smoking, diabetes,

obesity, sedentary lifestyle, genetic predisposition.

Pathophysiology
Plaque buildup narrows coronary arteries, reducing blood flow

to the heart muscle.

Plaque rupture can lead to thrombosis, further reducing or

blocking blood flow.

Clinical Manifestations

Often asymptomatic in early stages.

Symptoms: Chest pain (angina), shortness of breath, fatigue,

heart attack.

Diagnostic Tests

Electrocardiogram (ECG): Detects ischemic changes.

Stress Testing: Evaluates heart function under stress.

Echocardiography: Assesses heart structure and function.

Coronary Angiography: Visualizes coronary artery blockages.

Blood Tests: Lipid profile, glucose levels.

Medical Management

Medications: Statins, antihypertensives, antiplatelets, beta-

blockers, ACE inhibitors.

Lifestyle Modifications: Smoking cessation, exercise, weight

management.

Surgical Management

Percutaneous Coronary Intervention (PCI): Angioplasty with

stent placement.

Coronary Artery Bypass Grafting (CABG): Bypass surgery to

create new pathways for blood flow.

Nutritional Management

Diet: Low saturated fats, high in fruits, vegetables, whole

grains, lean proteins.

Sodium Restriction: Limit sodium intake to control blood

pressure.

Nursing Management

Monitoring: Vital signs, ECG changes, symptoms of ischemia.

Patient Education: Medication adherence, lifestyle changes,

recognizing symptoms of heart attack.

Support: Encouraging cardiac rehabilitation and regular follow-

ups.

Angina Pectoris

Etiology

Coronary Artery Disease: Most common cause.

Other Factors: Anemia, arrhythmias, hypertrophic

cardiomyopathy.

Pathophysiology

Imbalance between myocardial oxygen supply and demand.

Ischemia causes chest pain or discomfort.

Clinical Manifestations

Stable Angina: Predictable chest pain on exertion, relieved by

rest or nitroglycerin.

Unstable Angina: Unpredictable, occurs at rest, more severe,

not fully relieved by rest or medication.

Variant (Prinzmetal) Angina: Caused by coronary artery spasm,

occurs at rest.

Diagnostic Tests

ECG: Detects ischemic changes.

Stress Testing: Provokes symptoms and evaluates heart

function.

Echocardiography: Assesses heart structure and function.

Coronary Angiography: Identifies blockages.

Medical Management

Medications: Nitrates, beta-blockers, calcium channel blockers,

antiplatelets, statins.

Lifestyle Modifications: Smoking cessation, exercise, stress

management.
Surgical Management

PCI: Angioplasty and stent placement for significant blockages.

CABG: Bypass surgery for severe or multiple blockages.

Nutritional Management

Heart-healthy diet (low in saturated fats, high in fiber, fruits,

vegetables).

Nursing Management

Monitoring: Symptoms, response to treatment, vital signs.

Patient Education: Use of nitroglycerin, avoiding triggers,

lifestyle modifications.

Support: Stress reduction techniques, cardiac rehabilitation.

Myocardial Infarction (Heart Attack)

Etiology

Coronary Artery Disease: Primary cause due to plaque rupture

and thrombus formation.

Risk Factors: Same as for CAD (high cholesterol, hypertension,

smoking, diabetes, etc.).

Pathophysiology

Complete blockage of a coronary artery, leading to myocardial

ischemia and necrosis.

Infarcted tissue loses contractility, impacting heart function.

Clinical Manifestations

Severe chest pain or discomfort, radiating to arm, jaw, back.

Shortness of breath, sweating, nausea, lightheadedness.

Silent MI: Especially in diabetics and elderly, may have atypical

symptoms or be asymptomatic.

Diagnostic Tests

ECG: Detects ST-segment elevation, Q waves, T wave changes.

Cardiac Enzymes: Elevated troponins, CK-MB.

Echocardiography: Assesses wall motion abnormalities and

heart function.
Coronary Angiography: Identifies blockages and guides

treatment.

Medical Management

Immediate: MONA (Morphine, Oxygen, Nitroglycerin, Aspirin).

Medications: Thrombolytics, antiplatelets, anticoagulants, beta-

blockers, ACE inhibitors, statins.

Surgical Management

Primary PCI: Preferred method for revascularization.

CABG: For patients with severe or multiple blockages.

Nutritional Management

Post-MI Diet: Low-fat, low-sodium, high-fiber, rich in fruits,

vegetables, lean proteins.

Fluid Management: Depending on heart function, fluid intake

may be regulated.

Nursing Management

Acute Care: Monitor vital signs, ECG, symptoms, administer

medications as prescribed.

Post-MI Care: Monitor for complications (arrhythmias, heart

failure), assist with mobility, provide emotional support.

Patient Education: Medication adherence, lifestyle

modifications, recognizing signs of recurrence.

Rehabilitation: Encourage participation in cardiac rehabilitation

programs for monitored exercise and education.

VALVULAR DISORDERS: CONGENITAL AND ACQUIRED

Valvular Disorders: Congenital and Acquired

Etiology

Congenital Valvular Disorders:

Genetic Mutations: May cause malformations of heart valves.

Intrauterine Factors: Infections, maternal drug use, or illnesses

during pregnancy.

Acquired Valvular Disorders:

Rheumatic Heart Disease: Resulting from untreated or poorly

treated streptococcal infections.

Degenerative Changes: Aging leading to calcification or fibrosis

of valves.

Infective Endocarditis: Infection of the heart valves causing

damage.

Other Factors: Trauma, myocardial infarction, connective tissue

diseases.

Pathophysiology

Congenital:

Valvular Stenosis: Narrowing of the valve, leading to increased

resistance to blood flow.

Valvular Regurgitation: Incomplete closure of the valve, leading

to backflow of blood.

Mixed Lesions: Both stenosis and regurgitation.

Acquired:

Calcific Degeneration: Commonly affects the aortic valve,

leading to stenosis.

Fibrotic Changes: Thickening and scarring of the valves, leading

to stenosis or regurgitation.

Inflammatory Damage: Rheumatic fever causes inflammation

and subsequent scarring of valves.

Clinical Manifestations

Stenosis:

Symptoms: Dyspnea, chest pain, syncope, fatigue.

Signs: Murmurs, heart failure symptoms, reduced cardiac

output.

Regurgitation:

Symptoms: Dyspnea, palpitations, fatigue, heart failure

symptoms.

Signs: Murmurs, bounding pulses, heart failure signs (edema,

ascites).

Specific Valves:

Aortic Valve: Syncope, angina, dyspnea (SAD triad for aortic

stenosis).

Mitral Valve: Dyspnea, orthopnea, atrial fibrillation.

Tricuspid Valve: Systemic congestion (hepatomegaly, ascites,

peripheral edema).

Pulmonic Valve: Less common, symptoms similar to right heart

failure.

Diagnostic Tests

Physical Examination: Murmurs, heart sounds, signs of heart

failure.

Echocardiography: Gold standard for visualizing valve structure

and function.

Electrocardiogram (ECG): Detects arrhythmias, chamber

enlargement.

Chest X-ray: Shows heart enlargement, pulmonary congestion.

Cardiac Catheterization: Assesses severity of

stenosis/regurgitation, pressures within the heart.

MRI/CT: Detailed imaging for complex cases.

Medical Management

Medications:

Diuretics: Reduce fluid overload.

Beta-blockers: Control heart rate, reduce myocardial oxygen

demand.

ACE inhibitors/ARBs: Reduce afterload, improve heart function.

Anticoagulants: For patients with atrial fibrillation or prosthetic

valves to prevent thromboembolism.

Monitoring: Regular follow-ups, echocardiograms to monitor

disease progression.

Surgical Management
Valve Repair: Preserves the patient’s valve, suitable for some

regurgitant lesions.

Valve Replacement:

Mechanical Valves: Durable, require lifelong anticoagulation.

Bioprosthetic Valves: Less durable, but typically do not require

lifelong anticoagulation.

Transcatheter Valve Therapies: Minimally invasive procedures

like TAVR (Transcatheter Aortic Valve Replacement) for aortic

stenosis.

Balloon Valvuloplasty: For certain types of stenosis, mainly in

children or select adult cases.

Nutritional Management

Low Sodium Diet: Helps manage heart failure symptoms by

reducing fluid retention.

Heart-Healthy Diet: Rich in fruits, vegetables, whole grains, lean

proteins, low in saturated fats and cholesterol.

Fluid Restriction: In severe heart failure cases, limit fluid intake

to reduce workload on the heart.

Nursing Management

Assessment: Monitor vital signs, heart sounds, signs of heart

failure.

Education:

Medication Adherence: Importance of taking medications as

prescribed.

Symptom Recognition: Recognizing signs of worsening

condition (e.g., increased shortness of breath, edema).

Lifestyle Modifications: Diet changes, exercise, smoking

cessation.

Pre and Post-Op Care: Preparing patients for surgery, post-

surgical monitoring and care, wound care, infection prevention.

Support: Emotional support, facilitating cardiac rehabilitation,

and connecting with support groups.

RHEUMATIC HEART DISEASE: PERICARIDITIS, MYOCARDITIS,

ENDOCARDITIS, CARDIOMYOPATHIES

Rheumatic Heart Disease (RHD)

Etiology

Rheumatic Fever: A sequela of group A Streptococcus infection,

typically following pharyngitis.

Autoimmune Reaction: Immune system attacks heart tissues,

causing inflammation and scarring.

Pathophysiology

Inflammation and Scarring: Affects the endocardium,

myocardium, and pericardium.

Valvular Damage: Commonly involves the mitral and aortic

valves, leading to stenosis or regurgitation.

Clinical Manifestations

Symptoms: Fever, joint pain, chest pain, heart murmurs,

palpitations, shortness of breath, fatigue.

Signs: Heart murmurs, tachycardia, pericardial friction rub,

signs of heart failure.

Diagnostic Tests

Echocardiography: Evaluates valve structure and function,

detects vegetations or scarring.

Electrocardiogram (ECG): Identifies arrhythmias, evidence of

pericarditis or myocarditis.

Chest X-ray: Shows heart enlargement, pulmonary congestion.

Blood Tests: Elevated inflammatory markers (ESR, CRP), ASO

titers indicating recent streptococcal infection.

Throat Culture: Confirms presence of streptococcal bacteria.

Medical Management

Antibiotics: To eradicate streptococcal infection and prevent

recurrence.

Anti-inflammatory Medications: NSAIDs or corticosteroids to

reduce inflammation.

Heart Failure Management: Diuretics, ACE inhibitors, beta-

blockers, digoxin.

Anticoagulants: For patients with atrial fibrillation or

mechanical valves to prevent thromboembolism.

Surgical Management

Valve Repair or Replacement: For severe valvular damage.

Percutaneous Interventions: Balloon valvuloplasty for valve

stenosis.

Nutritional Management

Heart-Healthy Diet: Low in saturated fats, cholesterol, and

sodium.

Adequate Nutrition: Ensuring enough caloric and protein

intake, especially during acute phases to support healing.

Nursing Management

Monitoring: Vital signs, heart sounds, signs of heart failure,

response to treatment.

Patient Education: Importance of medication adherence,

recognizing symptoms of worsening condition, lifestyle

changes.

Support: Emotional support, facilitating follow-up care,

connecting with support groups.

Prophylaxis: Long-term antibiotic prophylaxis to prevent

recurrence of rheumatic fever.

Pericarditis

Etiology

Infectious Causes: Viral, bacterial, fungal infections.

Non-infectious Causes: Autoimmune diseases, uremia, post-

myocardial infarction (Dressler’s syndrome), trauma, radiation.

Pathophysiology

Inflammation of the Pericardium: Can lead to fluid

accumulation (pericardial effusion), restricting heart function.

Clinical Manifestations

Chest Pain: Sharp, pleuritic, relieved by sitting up and leaning

forward.

Pericardial Friction Rub: Heard on auscultation.

Fever: Often present.

Dyspnea: Due to fluid accumulation.

Diagnostic Tests

ECG: ST-segment elevation, PR depression.

Echocardiography: Detects pericardial effusion.

Chest X-ray: Enlarged cardiac silhouette in effusion.

Blood Tests: Elevated inflammatory markers (ESR, CRP), cardiac

enzymes.

Medical Management

Anti-inflammatory Medications: NSAIDs, corticosteroids,

colchicine.

Antibiotics: For bacterial infections.

Pericardiocentesis: For large effusions or cardiac tamponade.

Surgical Management

Pericardiectomy: For recurrent pericarditis or constrictive

pericarditis.

Nutritional Management

Dietary Modifications: Based on underlying cause (e.g., low

sodium for heart failure).

Nursing Management

Monitoring: Signs of cardiac tamponade, vital signs, pain

assessment.

Patient Education: Importance of medication adherence,

recognizing symptoms of recurrence.

Support: Emotional support, post-procedure care.

Myocarditis

Etiology

Infectious Causes: Viral (Coxsackievirus, adenovirus), bacterial,

fungal, parasitic.

Non-infectious Causes: Autoimmune diseases, toxins, drugs,

radiation.

Pathophysiology

Inflammation of the Myocardium: Leads to myocardial

dysfunction, arrhythmias, heart failure.

Clinical Manifestations

Symptoms: Chest pain, fatigue, dyspnea, palpitations.

Signs: Heart failure signs (edema, jugular venous distension),

arrhythmias.

Diagnostic Tests

ECG: Non-specific ST and T wave changes.

Echocardiography: Assess heart function, wall motion

abnormalities.

Cardiac MRI: Identifies myocardial inflammation.

Endomyocardial Biopsy: Definitive diagnosis, identifies

infectious agents or inflammatory cells.

Blood Tests: Elevated cardiac enzymes, inflammatory markers,

viral titers.

Medical Management

Antiviral/Antimicrobial Therapy: For infectious causes.

Immunosuppressive Therapy: For autoimmune causes.

Heart Failure Management: ACE inhibitors, beta-blockers,

diuretics.

Antiarrhythmic Medications: For arrhythmias.

Surgical Management
Ventricular Assist Devices (VADs): For severe heart failure.

Heart Transplant: In refractory cases.

Nutritional Management

Heart-Healthy Diet: To support overall cardiac function.

Fluid and Sodium Restriction: In heart failure.

Nursing Management

Monitoring: Heart rate, rhythm, signs of heart failure.

Patient Education: Medication adherence, recognizing signs of

worsening condition.

Support: Emotional support, facilitating follow-up care.

Endocarditis

Etiology

Infective Endocarditis: Bacterial (Staphylococcus,

Streptococcus), fungal, other pathogens.

Non-infective Endocarditis: Autoimmune conditions (Libman-

Sacks endocarditis in lupus).

Pathophysiology

Infection of the Endocardium: Formation of vegetations on

valves, leading to valvular damage and embolic events.

Clinical Manifestations

Fever, chills, fatigue, weight loss.

Heart Murmurs: New or changing.

Signs of Embolization: Petechiae, Janeway lesions, Osler nodes,

splinter hemorrhages.

Heart Failure: Due to valvular dysfunction.

Diagnostic Tests

Blood Cultures: To identify causative organism.

Echocardiography: TTE/TEE to visualize vegetations, assess

valve function.

Blood Tests: Elevated inflammatory markers, anemia, elevated

white cell count.

Medical Management

Antibiotics: Long-term, high-dose, based on blood culture

results.

Antifungals: For fungal endocarditis.

Heart Failure Management: If present.

Surgical Management

Valve Repair or Replacement: In cases of severe valve damage,

heart failure, or uncontrolled infection.

Debridement: Of infected tissue.

Nutritional Management

Supportive Nutrition: Adequate caloric and protein intake,

especially during prolonged illness.

Nursing Management

Monitoring: Vital signs, signs of embolic events, heart failure.

Patient Education: Importance of completing antibiotic therapy,

recognizing symptoms of recurrence.

Support: Emotional support, coordinating long-term care and

follow-ups.

Cardiomyopathies

Etiology

Dilated Cardiomyopathy: Genetic mutations, alcohol, toxins,

viral infections, autoimmune conditions.

Hypertrophic Cardiomyopathy: Genetic mutations, often

autosomal dominant.

Restrictive Cardiomyopathy: Amyloidosis, sarcoidosis,

hemochromatosis, radiation fibrosis.

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC):

Genetic mutations.

Pathophysiology

Dilated Cardiomyopathy: Dilation of ventricles, impaired

systolic function.
Hypertrophic Cardiomyopathy: Thickened ventricular walls,

impaired diastolic function, risk of arrhythmias.

Restrictive Cardiomyopathy: Stiff ventricular walls, impaired

diastolic filling.

ARVC: Fatty or fibrofatty infiltration of right ventricular

myocardium, risk of arrhythmias.

Clinical Manifestations

Dilated: Heart failure symptoms (dyspnea, orthopnea, edema),

arrhythmias.

Hypertrophic: Dyspnea, chest pain, syncope, sudden cardiac

death.

Restrictive: Dyspnea, fatigue, right-sided heart failure

symptoms.

ARVC: Palpitations, syncope, risk of sudden cardiac death.

Diagnostic Tests

Echocardiography: Assesses structure and function.

ECG: Identifies arrhythmias, hypertrophy.

Cardiac MRI: Detailed imaging of myocardial structure.

Genetic Testing: For inherited forms.

Endomyocardial Biopsy: In specific cases to identify underlying

cause.

Medical Management

Heart Failure Management: ACE inhibitors, beta-blockers,

diuretics, aldosterone antagonists.

Antiarrhythmics: For arrhythmias.

Anticoagulants: In patients with atrial fibrillation or

thromboembolism risk.

Surgical Management

Implantable Cardioverter-Defibrillator (ICD): For high risk of

sudden cardiac death.

Septal Myectomy: For obstructive hypertrophic

cardiomyopathy.

Heart Transplant: In end-stage heart failure.

Nutritional Management

Heart-Healthy Diet: Low in sodium, cholesterol, and saturated

fats.

Fluid Restriction: In severe heart failure.

Nursing Management

Monitoring: Vital signs, signs of heart failure, arrhythmias.

Patient Education: Medication adherence, lifestyle

modifications, recognizing symptoms of worsening condition.

Support: Emotional support, facilitating cardiac rehabilitation,

coordinating long-term care and follow-ups.

CARDIAC DYSRHYTHMIAS, HEART BLOCK

Cardiac Dysrhythmias

Etiology

Primary Causes:

Structural Heart Disease: Cardiomyopathy, myocardial

infarction, valvular heart disease.

Electrolyte Imbalances: Potassium, calcium, and magnesium

abnormalities.

Ischemic Heart Disease: Coronary artery disease, myocardial

infarction.

Conduction System Disorders: Bundle branch blocks, accessory

pathways (e.g., Wolff-Parkinson-White syndrome).

Secondary Causes:

Medications: Antiarrhythmics, beta-blockers, digoxin.

Metabolic Conditions: Thyroid disorders, adrenal gland

disorders.

Lifestyle Factors: Alcohol, caffeine, drug abuse (e.g., cocaine,

amphetamines).

Autonomic Nervous System Imbalance: Vagal tone, sympathetic

overactivity.

Genetic Conditions: Long QT syndrome, Brugada syndrome.

Pathophysiology

Abnormal Impulse Generation: Increased automaticity or

triggered activity in cardiac cells.

Abnormal Impulse Conduction: Reentry circuits, conduction

block, or pre-excitation syndromes.

Clinical Manifestations

Symptoms:

Palpitations

Dizziness

Syncope

Chest Pain

Dyspnea

Fatigue

Signs: Irregular pulse, bradycardia, tachycardia, hypotension,

signs of heart failure.

Diagnostic Tests

Electrocardiogram (ECG): Identifies type of arrhythmia.

Holter Monitor: Continuous ECG monitoring for 24-48 hours.

Event Monitor: Long-term monitoring for intermittent

symptoms.

Electrophysiological Studies (EPS): Identifies precise location

and mechanism of arrhythmias.

Blood Tests: Electrolytes, thyroid function tests.

Echocardiography: Assesses structural heart disease.

Medical Management

Medications:

Antiarrhythmics: Class I (sodium channel blockers), Class II

(beta-blockers), Class III (potassium channel blockers), Class IV

(calcium channel blockers), and others (digoxin, adenosine).

Rate Control: Beta-blockers, calcium channel blockers.

Anticoagulation: For atrial fibrillation to prevent

thromboembolism (warfarin, DOACs).

Surgical Management

Catheter Ablation: For reentrant tachycardias, atrial fibrillation,

and other arrhythmias.

Pacemaker: For bradyarrhythmias and heart blocks.

Implantable Cardioverter-Defibrillator (ICD): For life-

threatening ventricular arrhythmias.

Nutritional Management

Balanced Diet: Adequate intake of electrolytes.

Limiting Caffeine and Alcohol: Reduces risk of triggering

arrhythmias.

Heart-Healthy Diet: Low in saturated fats and sodium.

Nursing Management

Monitoring: Vital signs, ECG, electrolyte levels.

Patient Education: Medication adherence, lifestyle

modifications, recognizing symptoms of recurrence.

Support: Emotional support, coordinating follow-up care, and

rehabilitation programs.

Heart Block

Etiology

Intrinsic Causes:

Degenerative Disease: Fibrosis or sclerosis of the conduction

system.

Ischemic Heart Disease: Myocardial infarction affecting the

conduction pathways.

Cardiomyopathy: Dilated or hypertrophic cardiomyopathy.

Extrinsic Causes:

Medications: Beta-blockers, calcium channel blockers, digoxin,

antiarrhythmics.
Electrolyte Imbalances: Hyperkalemia, hypokalemia.

Endocrine Disorders: Hypothyroidism, hyperthyroidism.

Infiltrative Diseases: Amyloidosis, sarcoidosis.

Infections: Lyme disease, endocarditis, myocarditis.

Surgical Trauma: Post-cardiac surgery.

Pathophysiology

First-Degree Heart Block: Prolonged PR interval (>200 ms)

without missed beats.

Second-Degree Heart Block:

Mobitz Type I (Wenckebach): Progressive PR interval

prolongation until a beat is dropped.

Mobitz Type II: Intermittently dropped beats without PR

interval prolongation.

Third-Degree (Complete) Heart Block: No atrial impulses

conducted to the ventricles, resulting in atrioventricular

dissociation.

Clinical Manifestations

First-Degree: Usually asymptomatic.

Second-Degree:

Mobitz Type I: Often asymptomatic, may cause dizziness or

syncope.

Mobitz Type II: Can cause dizziness, syncope, palpitations.

Third-Degree: Severe bradycardia, fatigue, dizziness, syncope,

heart failure symptoms.

Diagnostic Tests

ECG: Identifies type of heart block.

Holter Monitor: Continuous ECG monitoring.

Electrophysiological Studies (EPS): For detailed evaluation in

complex cases.

Echocardiography: Assesses structural heart disease.

Blood Tests: Electrolytes, thyroid function tests, Lyme serology.

Medical Management

First-Degree: Often no treatment needed, monitor for

progression.

Second-Degree Mobitz Type I: Observation if asymptomatic,

pacemaker if symptomatic.

Second-Degree Mobitz Type II: Pacemaker implantation due to

risk of progression to complete heart block.

Third-Degree: Immediate pacemaker implantation.

Surgical Management

Permanent Pacemaker: For symptomatic bradycardia or high-

grade AV block.

Temporary Pacemaker: For acute management until a

permanent device can be placed.

Nutritional Management

Balanced Diet: Ensuring adequate intake of electrolytes,

avoiding extreme diet changes that could affect heart rhythm.

Heart-Healthy Diet: Low in sodium, cholesterol, and saturated

fats to support overall cardiovascular health.

Nursing Management

Monitoring: Vital signs, ECG, symptoms of bradycardia.

Patient Education: Importance of follow-up, recognizing

symptoms of worsening block, pacemaker care.

Support: Emotional support, coordinating care for pacemaker

insertion, post-operative care.

CONGESTIVE HEART FAILURE, CORPULMONALE, PULMONARY

EDEMA, CARDIOGENIC SHOCK, CARDIAC TAMPONADE

Congestive Heart Failure (CHF)

Etiology

Ischemic Heart Disease: Coronary artery disease, myocardial

infarction.

Hypertension: Long-standing high blood pressure.

Valvular Heart Disease: Mitral or aortic stenosis/regurgitation.

Cardiomyopathy: Dilated, hypertrophic, or restrictive.

Other Causes: Diabetes, obesity, thyroid disorders, alcohol

abuse.

Pathophysiology

Reduced Cardiac Output: Due to systolic or diastolic

dysfunction.

Compensatory Mechanisms: Activation of the renin-

angiotensin-aldosterone system (RAAS), sympathetic nervous

system, leading to fluid retention and increased cardiac

workload.

Ventricular Remodeling: Changes in the size, shape, and

function of the heart.

Clinical Manifestations

Left-Sided Heart Failure: Dyspnea, orthopnea, paroxysmal

nocturnal dyspnea, pulmonary congestion (cough, crackles,

wheezes), fatigue.

Right-Sided Heart Failure: Peripheral edema, ascites,

hepatomegaly, jugular venous distension.

General Symptoms: Fatigue, weakness, reduced exercise

tolerance.

Diagnostic Tests

Echocardiography: Assesses ejection fraction, valve function,

and ventricular size.

Electrocardiogram (ECG): Detects arrhythmias, myocardial

infarction.

Chest X-ray: Shows cardiomegaly, pulmonary congestion.

BNP/NT-proBNP: Elevated levels indicate heart failure.

Blood Tests: Electrolytes, renal function, thyroid function.

Medical Management

Medications:
ACE Inhibitors/ARBs: Reduce afterload and prevent remodeling.

Beta-Blockers: Reduce heart rate and improve survival.

Diuretics: Reduce fluid overload.

Aldosterone Antagonists: Reduce fluid retention.

Digoxin: Improves symptoms and exercise tolerance.

Lifestyle Modifications: Sodium and fluid restriction, weight

management, exercise.

Surgical Management

Device Therapy: Implantable cardioverter-defibrillator (ICD),

biventricular pacemaker.

Valve Surgery: For valvular heart disease.

Heart Transplant: In end-stage heart failure.

Nutritional Management

Low Sodium Diet: To prevent fluid retention.

Fluid Restriction: To manage fluid overload.

Heart-Healthy Diet: Rich in fruits, vegetables, whole grains, lean

proteins.

Nursing Management

Monitoring: Vital signs, weight, signs of fluid overload, response

to medications.

Education: Medication adherence, lifestyle changes, symptom

recognition.

Support: Emotional support, coordinating care, facilitating

follow-up appointments.

Cor Pulmonale

Etiology

Chronic Lung Diseases: COPD, interstitial lung disease.

Pulmonary Hypertension: Primary or secondary.

Sleep-Disordered Breathing: Obstructive sleep apnea.

Pulmonary Embolism: Acute cause of cor pulmonale.

Pathophysiology
Right Ventricular Hypertrophy and Dilation: Due to increased

pulmonary artery pressure.

Decreased Right Ventricular Function: Leading to right-sided

heart failure.

Clinical Manifestations

Dyspnea on Exertion: Most common symptom.

Fatigue, syncope, chest pain.

Signs of Right-Sided Heart Failure: Peripheral edema, ascites,

hepatomegaly, jugular venous distension.

Diagnostic Tests

Echocardiography: Assesses right ventricular function,

pulmonary artery pressures.

ECG: Shows right ventricular hypertrophy, right axis deviation.

Chest X-ray: Enlarged right ventricle, pulmonary arteries.

Pulmonary Function Tests: Assess underlying lung disease.

Right Heart Catheterization: Measures pulmonary artery

pressures.

Medical Management

Oxygen Therapy: For hypoxemia.

Medications:

Diuretics: To manage fluid overload.

Pulmonary Vasodilators: For pulmonary hypertension.

Anticoagulants: For pulmonary embolism.

Surgical Management

Lung Transplant: In select cases of end-stage lung disease.

Pulmonary Thromboendarterectomy: For chronic

thromboembolic pulmonary hypertension.

Nutritional Management

Low Sodium Diet: To prevent fluid retention.

Balanced Diet: Adequate nutrition to manage chronic illness.

Nursing Management
Monitoring: Vital signs, oxygen saturation, signs of right-sided

heart failure.

Education: Importance of oxygen therapy, medication

adherence, lifestyle changes.

Support: Emotional support, coordinating pulmonary

rehabilitation.

Pulmonary Edema

Etiology

Cardiogenic Causes: Left-sided heart failure, myocardial

infarction, valvular heart disease.

Non-Cardiogenic Causes: Acute respiratory distress syndrome

(ARDS), high altitude, neurogenic causes, toxin inhalation.

Pathophysiology

Increased Hydrostatic Pressure: Due to left-sided heart failure,

leading to fluid transudation into alveoli.

Increased Capillary Permeability: Due to direct injury to the

alveolar-capillary membrane.

Clinical Manifestations

Acute Onset: Dyspnea, orthopnea, paroxysmal nocturnal

dyspnea.

Cough with Pink Frothy Sputum.

Crackles: On lung auscultation.

Hypoxemia: Cyanosis, anxiety, agitation.

Diagnostic Tests

Chest X-ray: Bilateral infiltrates.

Echocardiography: Assess cardiac function.

ABG: Hypoxemia, respiratory alkalosis.

BNP/NT-proBNP: Elevated in cardiogenic causes.

Medical Management

Oxygen Therapy: To improve oxygenation.

Medications:
Diuretics: Furosemide to reduce fluid overload.

Vasodilators: Nitroglycerin to reduce preload and afterload.

Morphine: To reduce anxiety and preload (use with caution).

Mechanical Ventilation: In severe cases.

Surgical Management

Treat Underlying Cause: Valve surgery, coronary

revascularization for ischemic causes.

Nutritional Management

Fluid Restriction: To manage fluid overload.

Low Sodium Diet: To prevent fluid retention.

Nursing Management

Monitoring: Vital signs, respiratory status, oxygenation.

Patient Positioning: Elevate head of bed to ease breathing.

Education: Symptom recognition, medication adherence.

Support: Emotional support, facilitating follow-up care.

Cardiogenic Shock

Etiology

Acute Myocardial Infarction: Most common cause.

Severe Heart Failure: Advanced cardiomyopathy.

Valvular Heart Disease: Acute severe regurgitation or stenosis.

Cardiac Tamponade: Leading to obstructive shock.

Pathophysiology

Reduced Cardiac Output: Due to severe myocardial

dysfunction.

Hypoperfusion: Leads to tissue hypoxia and organ dysfunction.

Compensatory Mechanisms: Activation of RAAS and

sympathetic nervous system, worsening cardiac workload.

Clinical Manifestations

Hypotension: Systolic BP <90 mmHg.

Tachycardia: To compensate for low cardiac output.

Cold, Clammy Skin: Due to vasoconstriction.

Oliguria: Reduced urine output.

Altered Mental Status: Confusion, agitation.

Diagnostic Tests

Echocardiography: Assess cardiac function, valvular disease.

ECG: Identify ischemia or infarction.

Hemodynamic Monitoring: Invasive monitoring (Swan-Ganz

catheter) for precise measurements.

Blood Tests: Cardiac enzymes, lactate levels, renal function.

Medical Management

Inotropic Agents: Dobutamine, dopamine to improve cardiac

output.

Vasopressors: Norepinephrine to maintain blood pressure.

Mechanical Support: Intra-aortic balloon pump (IABP),

ventricular assist devices (VADs).

Surgical Management

Revascularization: PCI or CABG for myocardial infarction.

Valve Surgery: For acute severe valvular disease.

Nutritional Management

Fluid and Electrolyte Management: Close monitoring to avoid

overload.

Nursing Management

Monitoring: Vital signs, hemodynamic parameters, urine

output.

Patient Positioning: Supine or semi-Fowler’s position.

Education: Post-discharge care, recognizing symptoms.

Support: Emotional support, facilitating intensive care.

Cardiac Tamponade

Etiology

Pericardial Effusion: Accumulation of fluid in the pericardial sac.

Trauma: Penetrating or blunt chest trauma.

Infections: Viral, bacterial, tuberculous pericarditis.

Cancer: Metastatic involvement of the pericardium.

Autoimmune Diseases: Lupus, rheumatoid arthritis.

Post-Cardiac Surgery: Complication of cardiac procedures.

Iatrogenic Causes: Perforation during invasive procedures (e.g.,

pacemaker insertion).

Pathophysiology

Increased Pericardial Pressure: Due to accumulation of fluid or

blood in the pericardial sac.

Compression of the Heart: Restricts ventricular filling and

impairs cardiac output.

Impaired Diastolic Filling: Decreased preload leading to

decreased stroke volume and cardiac output.

Compensatory Mechanisms: Activation of sympathetic nervous

system to maintain blood pressure.

Clinical Manifestations

Beck's Triad:

Hypotension: Due to decreased cardiac output.

Distended Neck Veins (Jugular Venous Distension): Due to

impaired right atrial filling.

Muffled Heart Sounds: Due to fluid surrounding the heart.

Pulsus Paradoxus: Exaggerated drop in systolic blood pressure

(>10 mmHg) during inspiration.

Dyspnea: Due to decreased cardiac output.

Tachycardia: As a compensatory response.

Chest Discomfort: Feelings of fullness or pressure in the chest.

Weakness, Fatigue, Syncope.

Diagnostic Tests

Echocardiography: Gold standard for diagnosis, visualizes

pericardial effusion and collapse of the right atrium and

ventricle during diastole.

ECG: Low-voltage QRS complexes, electrical alternans (variation

in QRS amplitude and axis).

Chest X-ray: Enlarged cardiac silhouette, may show a "water

bottle" or "flask-shaped" heart.

CT Scan or MRI: Provides detailed imaging of pericardial

anatomy and fluid accumulation.

Pericardiocentesis: Therapeutic and diagnostic, involves

aspiration of pericardial fluid for analysis.

Medical Management

Pericardiocentesis: Emergency procedure to relieve pressure

and drain fluid from the pericardial sac.

Fluid Resuscitation: IV fluids to maintain blood pressure and

cardiac output.

Inotropic Support: Dopamine, dobutamine to improve cardiac

contractility.

Vasopressors: Norepinephrine, vasopressin to maintain blood

pressure.

Oxygen Therapy: To improve tissue oxygenation.

Surgical Management

Pericardial Window: Surgical creation of a permanent opening

in the pericardium to drain fluid.

Pericardiectomy: Removal of part or all of the pericardium in

chronic or recurrent cases.

Nutritional Management

Fluid Restriction: To prevent fluid overload in cases of

compromised cardiac function.

Electrolyte Balance: Monitoring and correction of electrolyte

abnormalities.

Nursing Management

Monitoring: Vital signs, including blood pressure, heart rate,

and respiratory rate.

Continuous Cardiac Monitoring: Observation for changes in ECG

patterns indicative of tamponade.

Assessment: Frequent assessment of Beck's triad and signs of

worsening cardiac function.

Patient Positioning: Elevated position to ease respiratory effort.

Support: Emotional support, education about the condition and

treatment options, and facilitating communication with the

healthcare team.

CARDIOPULMONARY ARREST

Cardiopulmonary Arrest

Etiology

Cardiac Causes:

Arrhythmias: Ventricular fibrillation, pulseless ventricular

tachycardia, asystole.

Acute Coronary Syndrome: Myocardial infarction leading to

sudden cardiac arrest.

Cardiomyopathy: Structural heart disease predisposing to

arrhythmias.

Respiratory Causes:

Airway Obstruction: Choking, aspiration.

Respiratory Failure: Hypoxia, hypercapnia.

Other Causes:

Electrolyte Imbalances: Severe hyperkalemia, hypokalemia.

Toxic Ingestions: Drug overdose, poisoning.

Trauma: Severe injuries leading to hemorrhage or shock.

Neurological Causes: Stroke, intracranial hemorrhage.

Pathophysiology

Cardiac Arrest: Complete cessation of effective heart function.

Respiratory Arrest: Cessation of effective breathing.

Hypoxia and Ischemia: Rapid deterioration of organ function

without prompt intervention.

Brain Injury: Irreversible brain damage within minutes without

oxygen supply.

Clinical Manifestations

Absence of Consciousness: Unresponsive to stimuli.

Absent or Abnormal Breathing: Agonal gasps, apnea.

Absence of Pulse: No palpable pulse or central pulsations.

Cyanosis: Bluish discoloration of the skin due to hypoxia.

Loss of Muscle Tone: Limpness of the body.

Diagnostic Tests

Clinical Assessment: Assessment of pulse, breathing, and

responsiveness.

Electrocardiogram (ECG): Identifies rhythm disturbances if

present.

Blood Tests: May indicate underlying metabolic or electrolyte

abnormalities.

Imaging: Chest X-ray, CT scan, or MRI if indicated by suspected

cause.

Medical Management

Basic Life Support (BLS):

Chest Compressions: High-quality CPR to maintain perfusion.

Airway Management: Head tilt-chin lift, jaw thrust,

oropharyngeal or nasopharyngeal airway insertion.

Breathing: Bag-mask ventilation or advanced airway

management (endotracheal intubation).

Advanced Life Support (ALS):

Defibrillation: Immediate defibrillation for shockable rhythms

(VF, pulseless VT).

Medications: Epinephrine, amiodarone, vasopressin for non-

shockable rhythms or as per ACLS algorithms.

Post-Resuscitation Care:

Targeted Temperature Management: Maintaining

normothermia to minimize brain injury.

Identifying and Treating Underlying Cause: Management of

cardiac, respiratory, or other etiological factors.

Surgical Management

Invasive Procedures: Coronary angiography and percutaneous

coronary intervention (PCI) for acute coronary syndromes.

Surgical Airway: Emergency cricothyroidotomy in cases of failed

airway management.

Nutritional Management

IV Fluids: Bolus fluids to support circulation and maintain

perfusion.

Glucose Control: Monitoring and correction of blood glucose

levels if indicated.

Nursing Management

Continuous Monitoring: Observation of vital signs, cardiac

rhythm, and response to interventions.

Communication: Clear and concise communication within the

resuscitation team.

Support: Emotional support for patients, families, and

caregivers involved in the resuscitation process.

Documentation: Accurate and timely documentation of events,

interventions, and responses.