HS2-Cardiovascular Disorders Learning Package PDF

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Health Sciences 2 HSCI 10146 Cardiovascular Disorders Cardiovascular Disorders

OVERVIEW Coronary artery disease, (CAD), also called arteriosclerotic heart disease (ASHD), is the most common form of heart disease. Coronary artery occlusion may lead to myocardial ischemia resulting in angina, myocardial infarctions, dysrhythmias, and heart failure (HF) which is also known as congestive heart failure (CHF). In this package you will learn about the following cardiovascular disorders:      

atherosclerosis and arteriosclerosis hypertension (HTN) coronary artery disease (CAD) angina myocardial infarction (MI) heart failure (HF)

These disorders develop due to tissue ischemia and the clinical behaviours result from cellular hypoxic changes related to the cardiovascular system. It is important that, as a registered practical nurse, you have sound knowledge of these major ischemic disorders because in your nursing practice, you will be caring for many patients with these health problems. Heart disease research is rigorous which is why prevention of heart disease has become a major nursing focus.

LEARNING OBJECTIVES Throughout this learning package you will develop knowledge and understanding of:  terminology related to specific cardiovascular disorders  the pathophysiology, epidemiology, etiology/risk factors, clinical manifestations, and diagnostics for specific cardiovascular disorders

Health Sciences 2 HSCI 10146 Cardiovascular Disorders PRE-CLASS ACTIVITIES

1Atherosclerosis and hypertension (HTN) are major risk factors in both, coronary artery disease (CAD) and stroke, which is also known as cerebral vascular accident (CVA). A major risk factor for atherosclerosis is HTN and vice versa. Complete the following in preparation for class: 1. Recall from semester one, the anatomy and physiology of blood vessels. Regardless of cause, the basic pathogenesis of atherosclerosis involves a vascular change. A vessel’s inner layer is damaged, the lumen of a blood vessel is diminished in size, or the vessel wall loses its elasticity and is weakened. Ultimately any or all of these changes interferes with blood flow and produces ischemia. Three types of blood vessels: arteries, veins and capillaries. Arteries and veins have three layers - arteries the layers are thicker. Inner most layer is tunica intima- made of epithelial tissue and provides smooth surface so blood can flow through the vessels. Middle layer (arteries) is smooth muscle and elastic fibre layer- tunica media- helps regulate BP because it contracts or dilates blood vessels. Sympathetic nervous system causes smooth muscle to contract (vasoconstriction). PNS causes vasodilation and the Outermost layer is fibrous connective tissue layer - tunica adventitia - attaches blood vessels to surrounding tissues. Arteries carry blood away from the heart, they have thicker walls, can withstand high pressure, carries oxygenated blood. Capillaries are the smallest, consist of one cell with thick walls, responsible for the exchange gases (nutrients, waste, o2 and co2) between blood and tissue cells. Veins carry deoxygenated blood from the body toward heart, thinner walls, they contain valves that prevent backflow of blood. Atherosclerosis Atherosclerosis is a type of arteriosclerosis and is the underlying disease process in most cases of CAD and stroke. 2. Describe the following terms: Term

Description

atheroma

Fat deposits on the inside of arterial walls. Also called plaques

atherosclerosi s

Accumulation plaque on inside of blood vessel walls. Accumulation of fatty materials (cellular waste and lipids, cholesterol, calcium).

Health Sciences 2 HSCI 10146 Cardiovascular Disorders

arteriosclerosi s

They clump together and attach to arterial wall. Plaques create surface where blood clots can form. Fatty plaques begin to harden. Blood vessels begin to lose elasticity, become hardened or sclerotic

2Atherosclerotic plaques in blood vessels are dangerous because they may: a) weaken the vessel wall b) narrow the vessel lumen thus: -increasing blood pressure -decreasing local blood flow c) have the potential to become thrombi or emboli Atherosclerosis can develop in any blood vessel, however, primarily affects larger arteries and in particular, the aorta and its branches. 3. For each of the following branches of the aorta, identify the organs/areas of the body whose blood supply would be interrupted by blockage of the arteries and discuss the consequences: a) coronary arteries: Supply oxygenated blood to the heart. Two branches: left and right branch off of the ascending aorta. Ascending aorta comes from left ventricle. Left coronary artery has two branches (Circumflex artery: supplies the left atrium and ventricle. Anterior interventricular artery: supplies both ventricles). Right coronary artery has two branches (Posterior interventricular artery: supplies both ventricles and the Marginal artery: supplies the right atrium and ventricle). If obstructed the oxygen supply to myocardial cells will be reduced→ ischemia will develop→results in decreased oxygen going to cells of the heart (hypoxia). Within minutes (because cells of the heart are not receiving o2) patient will experience chest pains (angina) and if left untreated then myocardial infarction will develop. b) common carotids: Consists of the left and right which supply blood to the head and neck. Left- second branch off of aorta. If blocked ischemic stroke will occur. c) femoral: Main arteries of the groins and legs. Branch off of the external iliac artery which comes off the common iliac artery which continues from the abdominal aorta. Peripheral vascular disease will develop if there is a blockage of the femoral artery.

4. Define the following terms: Cholesterol is a fat- does not mix with water. Blood plasma is made of water- cholesterol molecules must be wrapped in a lipo protein package for travelling through blood (done by liver). Once wrapped, it can travel through the blood stream to cells that require cholesterol.

Health Sciences 2 HSCI 10146 Cardiovascular Disorders Liver makes cholesterol. We take in increased amounts of dietary cholesterol in saturated fats and processed foods. liver makes lipoprotein to wrap excess cholesterol and deposits it in the blood vessel walls. There are five types of lipoproteins in the body. a) high density lipoprotein (HDL): Clean arteries of excess cholesterol and carries it to the liver where excess cholesterol is broken down into bile acids and eliminated. We take in more cholesterol than these can clean away. Contains 50% protein, 19% fat. b) low density lipoprotein (LDL): Carries cholesterol to cells that need it and the excess is deposited in artery walls. Contains 50% cholesterol. Can carry more cholesterol molecules than HDL. 75% of the cholesterol in our blood is wrapped in LDL. Balance between the 2 will determine a person’s blood cholesterol level. Total amount of cholesterol in the blood at any given time is the ratio of LDL to HDL 5. Explain how high serum levels of LDL adversely affect the cardiovascular system. Extra cholesterol taken in through diet is stored in the arteries by LDL. Accumulation over time causes blood vessels to narrow and become damaged. When they become damaged and heal then damaged, they harden. Large deposits of cholesterol can completely block an artery, if this occurs in the arteries heart attack will occur, in the brain then stroke occurs.

3Hypertension (HTN) Another major risk factor for coronary artery disease and stroke is hypertension. 6. Identify what a normal blood pressure measurement should be for a healthy adult, and what blood pressure reading is considered hypertension. 120/80 or less is considered normal, 140/90 range is considered hypertensive. Two major factors: cardiac output and systemic vascular resistance. Cardiac output x systemic vascular resistance = blood pressure. 7. Define and describe: a) systolic blood pressure: Systolic means the ventricles are contracting. Systolic is peak pressure (highest pressure exerted against the artery walls when the heart contracts) b) diastolic blood pressure: Diastolic is residual pressure in the artery when the ventricles relax after emptying. Diastolic means ventricles are relaxing.

Health Sciences 2 HSCI 10146 Cardiovascular Disorders c) pulse pressure: normal is 30-50. Difference between systolic and diastolic BP. 40 (Atherosclerosis, Fever, Aortic Regurge (backflow of blood). d) mean arterial pressure (MAP): average pressure in a patient’s arteries during one cardiac cycle. DBP + ⅓ of PP= MAP. Normal MAP is between 70-100 mmHG. 8. Explain how each of the following conditions may cause hypertension: a) excessive sodium and water retention Will cause in an increase in blood pressure that pushes up against the walls in the blood vessels. b) activation of the renin-angiotensin mechanism Negative feedback system in response to low blood pressure. Renin is released from the kidneys and increases blood pressure. c) arteriolar vasoconstriction The narrowing of blood vessels causes a high blood pressure due to less volume to pass through. Hypertension is known as the “silent killer” because it is asymptomatic for many years or decades. If undetected and untreated, hypertension accelerates arteriosclerosis, damages the inner layer of small blood vessels, and increases the workload of the heart.

Atherosclerosis and hypertension are risk factors for coronary artery disease and stroke. Risk factors are either modifiable or non-modifiable. 9. Complete the following risk factor chart for coronary artery disease and stroke: Risk Factor

Why is it a risk?

aging

The narrowing of blood vessels causes a high blood pressure due to less volume to pass through. Decrease in HDL

alcohol intake diabetes mellitus

Non-modifiable or modifiable? NM Modifiable

diet

Hyperglycemia creates excess of glucose molecules that damages blood vessel = hypertension High saturated fat diet, blood vessels narrow = hypoxia

Type 2 – Modifiable Modifiable

gender

Prevalent in women 37%, 35% morality in men

NM

Health Sciences 2 HSCI 10146 Cardiovascular Disorders genetic predisposition

Mutation in genetics, protein deficiency

NM

hyperlipidemia/ hypercholesterolemia

Cause blood vessel narrow

Modifiable

hypertension

High blood pressure

Modifiable

race

Black people at risk DOH

NM

sedentary lifestyle

Causes hemostasis

NM

smoking stress

Generalized nasal constriction Activates sympathetic nervous system, nasal restrictions

Modifiable Modifiable

Modifiable

Coronary Artery Disease (CAD) Coronary artery disease develops due to atherosclerosis, hypertension and coronary artery vasospasm. Occlusion of the coronary arteries causes myocardial ischemia or angina, and ultimately necrosis or infarction; myocardial damage, dependent on the area and extent of infarct, may cause dysrhythmias, and ultimately heart failure. Interference with the heart’s conduction system or ventricular contractions may cause ineffective pumping and decreased cardiac output. If cardiac output continues to drop, impaired peripheral circulation and ultimately, cardiac arrest will occur. 10. Complete the disease process template for coronary artery disease: Disease Process

Description

a) definition

Coronary arteries become damaged or diseased. Build of cholesterol- containing plaque Heart, circulatory system

b) body systems and organs primarily/initially affected c) normal anatomy and physiology

d) epidemiology  Indigenous People of Canada  Canada

Heart has arteries that fill blood into the myocardia. When plaque is built up is restricts the blood vessel causing hypoxia Major cause of heart disease and attack Leading cause of death in Canada 1 ½ - 2 times more occurrence in indigenous

Health Sciences 2 HSCI 10146 Cardiovascular Disorders 

global

e) pathogenesis and pathophysiology

1-10 death in indigenous from CAD

f) etiologies

Streaks of fats develop in vessel which slowly builds up. Hypertension, high cholesterol, diabetes, smoking, obesity Hypertension, high cholesterol, diabetes, smoking, obesity, DOH, Alcohol consumption, genetics, age, etc Dizziness Fatigue Chest pain (Angina) SOB Haematology and lab values. Lipid profile of the patient ECG, STRESS TEST, CARDIAC ECHO. Aspirin (Blood thinner) Beta blockers ( Control heart rate) Statins ( Lowers Cholesterol) ACE Inhibitor (BP)

g) predisposing factors and risk factors h) signs and symptoms

i) complications

j) diagnostics k) inter-professional collaborative treatments and therapies

11. Discuss the relationship between diabetes mellitus and coronary artery disease. - hyperglycemia causes damage to blood vessel’s walls - Causes fibrosis = narrowing of lumen = Hypoxia of heart cells - Type 2 have high cholesterol and hypertension which are all risk factors for CAD Angina 12. Complete the disease process template for angina: Disease Process

Description

a) definition

Intense Chest Pain when heart loses oxygen, hypoxia

b) body systems and organs primarily/initially affected

Chest muscles, Heart

c) normal anatomy and physiology

Blood normally pumps out blood to all the cells of the body. To do that it need a good supply of oxygen first. Major cause of heart disease and attack Leading

d) epidemiology

Health Sciences 2 HSCI 10146 Cardiovascular Disorders   

Indigenous People of Canada Canada global

e) pathogenesis and pathophysiology

cause of death in Canada 1 ½ - 2 times more occurrence in indigenous

j) diagnostics

Narrowed blood vessels = less oxygen = chest pain Blockage of Coronary blood vessels Exertion Eating Emotional Distress Extreme Temperature Running, Stress, Getting angry, Respiratory infection with a fever Exposure to cold weather, Large meal, Engaging in sexual activity Pale Weak Nausea Lightheadness Tiredness Weakness Feeling SOB Sweating Lipid profile, coronary angiography

k) inter-professional collaborative treatments and therapies

High fowlers, low oxygen, 3 nitro sprays every 5 minutes. Cause muscle cells to relax

f) etiologies

g) predisposing factors and risk factors

h) signs and symptoms i) complications

13. What will myocardial cells experience if a branch of a coronary artery becomes abnormally constricted or obstructed? - The cells would experience hypoxia, a depletion of oxygen, which can onset chest pain, SOB, and sometime fatal adverse events. 14. In terms of nursing considerations, describe the health teaching strategies, you, as a registered practical nurse, would implement for patients with angina. - Medication usage - Chest pain is not relieved? Query MI - Medic-alert - Identify triggers

4Myocardial Infarction

Health Sciences 2 HSCI 10146 Cardiovascular Disorders Eventually, complete occlusion of a coronary blood vessel causes death of myocardial tissue, a myocardial infarction (MI). An inflammatory response at the site of damage develops with eventual replacement of necrotic myocardial tissue with non-functional scar tissue.

15. Complete the disease process template for myocardial infarction: Disease Process

Description

a) definition

Death of Coronary cells due to the complete loss of xygen to the cardiac cells Heart

b) body systems and organs primarily/initially affected c) normal anatomy and physiology d) epidemiology  Indigenous People of Canada  Canada  global e) pathogenesis and pathophysiology

f) etiologies g) predisposing factors and risk factors h) signs and symptoms

i) complications

j) diagnostics

k) inter-professional collaborative

The coronary arteries bring the blood to the heart giving oxygen to the cardiac cells 2nd leading cause of death in Canada 3 times higher in individuals with heart disease

Thromus ( bloodclot) Vasospasm ( Blood vessel spasm) Embolus (bloot clot broken free) Obesity, Stress, Smoking, Diabetes, Bad Cholesterol, high blood pressure Diabetes, high blood pressure, overweight, smoking, family history Sub sternal chest pain SOB Low grade fever Anxiety Re-occurrence (second episodes) Arrythmia Ventricular aneurism Death 12 lead ECG Hematology Cardiac enzymes Remove blockage

Health Sciences 2 HSCI 10146 Cardiovascular Disorders treatments and therapies

02 therapy Opioids (pain) Bed rest Cardiac drugs

16. Which specific cardiac enzymes are released from myocardial cells during a myocardial infarction? Why does this happen?

17. 5Differentiate between chest pain characteristically experienced with angina and an infarct. Angina = nitroglycerin and rest MI = chest pain not relieved, gradually get worse. 6Heart Failure One major complication of myocardial infarction is heart failure, also known as congestive heart failure. It occurs when the heart is unable to pump sufficient blood to meet the demands of the body. It usually occurs secondary to another disease such as cardiac valve defects, hypertension, dysrhythmias, or chronic respiratory diseases. Initially, heart failure presents as either left-sided or right-sided failure depending on which side of the heart is initially damaged. Ultimately, if not corrected, overwork produces failure of the other side.

Health Sciences 2 HSCI 10146 Cardiovascular Disorders To begin to understand the pathophysiology of heart failure, assume that a person has experienced a myocardial infarction involving the left ventricle. Weakened left ventricular contractions decrease stroke volume and cardiac output falls. Sympathetic compensatory mechanisms, spring into action to help with declining blood pressure.

18. Describe the following terms related to heart failure: Term

Description

afterload

Resistance the heart faces when ejecting blood

cardiac compensation

Heart mechanisms fail to pump blood

cardiac output

decompensation

Amount of blood that is pumped out of each ventricle in a minute Maintains cardio output 1 Ventricular dilation 2 ventricular hypertrophies 3 sympathetic nervous stimulation 4 hormonal responses Not able to maintain cardiac output

diastole

Relaxation of heart

dilation

Enlargement of chambers of heart

hypertrophy

Heart does not contract very well

preload

Blood going into the ventricle at the end of diastole

systole

Contraction of chambers of the heart

ventricular remodelling

Involves hypertrophy of cardiac cells, which cause them to become enlarged and abnormal. Changes chape of ventricles and contraction pattern.

compensatory mechanisms

Health Sciences 2 HSCI 10146 Cardiovascular Disorders 19. Complete the disease process template for heart failure: Disease Process

Description

a) definition

Impaired cardiac pumping or filling

b) body systems and organs primarily/initially affected

Starts in heart and effects all organs

c) normal anatomy and physiology d) epidemiology  Indigenous People of Canada  Canada  global

Heart failure increasing in Canada 40 million w...