Coronary Heart Disease

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• Coronary Heart Disease

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Pericarditis

• Acute infectious pericarditis
• Either dry or exudative
• Exudative restricts cardiac filling and
  emptying, decreases cardiac output and tissue
  perfusion
• Chronic constrictive pericarditis
• Fibrosis of the pericardial sac pericardial
  layers adhere to each other.
• Causes scarring and thickening of pericardium.
• Decreases cardiac filling and contracting.
• Leads to decreased cardiac output and heart
  failure.

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Pericarditis Clinical Manifestations

• Bacterial pericarditis
• Onset
• High Fever
• Flu like
• Symptoms
• Leukocytosis
• Increased ESR
• Anorexia, weight loss
• Acute stages
• Weight loss, anorexia, nausea

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Pericardial Effusion -Treatment

• Anti-inflammatory Medications
• Invasive Procedures
• Pericardiocentesis
• Open Heart Surgery
• Intrapericardial Sclerosis
• Pericardiectomy

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Pulmonary Edema

• Extreme shortness of breath or difficulty
  breathing
• A feeling of suffocating or drowning
• Wheezing or gasping for breath
• Anxiety, restlessness or a sense of apprehension
• A cough that produces frothy sputum that may be
  tinged with blood
• Excessive sweating
• Pale skin
• Palpitations

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Cardiac Tamponade

• Cardiac tamponade can occur due to
• Dissecting aortic aneurysm (thoracic)
• End-stage lung cancer
• Acute MI
• Heart surgery
• Pericarditis bacterial or viral infections
• Wounds to the heart

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Defibrillation

• Defibrillation is a process in which an
  electronic device gives an electric shock to the
  heart.
• Re-establishes normal contraction rhythms in a
  heart having dangerous arrhythmia or in cardiac
  arrest.

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Pacemaker

• Single-Chamber Pacemakers Only one wire (pacing
  lead) is placed into a chamber of the heart.
• Dual-Chamber Pacemakers Wires are placed in two
  chambers of the heart. One lead paces the atrium
  and one paces the ventricle.

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Pacemaker

• Rate-Responsive Pacemakers Sensors
  automatically adjust to changes in a person's
  physical activity.
• Other devices Such as implantable cardioverter
  defibrillators designed primarily for other
  purposes, can function as pacemakers in certain
  situations.

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Cardiac Ablation

• Atrial Fibrillation
• Atrial Flutter
• AV Nodal Reentrant Tachycardia
• AV Reentrant Tachycardia
• Atrial Tachycardia
• Risk Factors
• Bleeding
• Puncture of the heart
• Damage to heart's electrical system
• Blood clots
• Pulmonary vein stenosis
• Kidney damage

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Cardiac Resynchronization Therapy (CRT)

• The ideal candidate for a CRT device is someone
  with
• Moderate to severe CHF symptoms, despite
  lifestyle changes and medication . 
• A weakened and enlarged heart muscle .
• A significant electrical delay in the lower
  pumping chambers (bundle branch block).

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Cardioversion

• NPO at least eight hours prior to the procedure.
• Informed Consent
• Take regularly scheduled medications before the
  procedure.
• Diabetics need to discuss dosing prior to the
  procedure.
• Patient should bring a list of all medications
• No lotions or ointments to chest or back as this
  may interfere with the adhesiveness of the
  shocking pads.
• No jewelry on chest.

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Sudden Cardiac Death (SCD)

• SCD causes half of all heart disease deaths.
• In SCD, electrical problems keep the heart from
  pumping the right way, when suddenly, the heart
  stops working.
• Treating someone in SCD requires paddles to
  shock the heart.
• FYIIn a heart attack, a blockage in blood
  vessels slows or stops blood flow.

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Dilated Cardiomyopathy

• Most often follows MI and ventricular tissue
  remodeling
• Coronary artery disease is most common cause in
  US patients
• Up to 30 of cases have genetic cause
• Numerous risk factors may precipitate
• 50 of cases lack identifiable cause

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Left Ventricular Assist Device (LVAD)

• Waiting for a heart transplant
• Hearts function can become normal again
• Not a good candidate for a heart transplant
• Risks
• Blood Clots
• Bleeding
• Infection
• Device malfunction
• Right heart failure

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Cardiac Transplantation

• Reasons for Transplant
• Coronary artery disease
• Cardiomyopathy
• Valvular heart disease
• Congenital heart defect
• Failure of a previous heart transplant
• Risk Factors
• Medication Side Effects
• Cancer
• Infection

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Nursing Management

• Clinical status and procedure dictate patient
  management.
• Patients NPO at least 6 hours.
• Complete assessment before procedure including
  when meds were last taken.
• Pretreat patients with history of anaphylactic
  reaction to contrast dye.

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Nursing Management

• Discharge criteria include
• Stable vital signs
• Review DASH for Hypertension
• Increase in calcium and decrease in sodium.
• No evidence of complications at access site
• Ability to ambulate without assistance.
• Voiding without difficulty

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• Nursing Care of Patients with Cardiac Disorders

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Dilated Cardiomyopathy

• Most often follows MI and ventricular tissue
  remodeling.
• Coronary artery disease is more common cause in
  US patients.
• Up to 30 of cases have genetic cause.
• Numerous risk factors may precipitate
• 50 of cases lack identifiable cause.

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Dilated Cardiomyopathy Nursing Management

• Detailed history
• In-depth physical assessment of effect on ability
  to perform ADLs
• Identify risk factors/diseases that mimic DCM
• Care plan conserve energy, decrease hearts
  workload via paced or reduced activity,
  positioning, oxygen therapy

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Hypertrophic Cardiomyopathy (HCM)

• Disorder of sarcomere (contractile element of
  cardiac muscle)
• Characterized by left (and occasionally right)
  ventricular hypertrophy, also hypertrophy in
  septum

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Hypertrophic Cardiomyopathy Nursing Management

• Assess/monitor progress of disease (hemodynamic
  status and cardiac output)
• Educate about hydration, prophylactic
  antibiotics, exercise and activity restriction
• Identify and help alleviate potential stressors
• Provide realistic hope and emotional support

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Restrictive Cardiomyopathy (RCM)

• Least common type in US
• Characterized by endocardial scarring
• Usually affects one or both ventricles
• Restricts filling of blood
• Results in systolic dysfunction
• No specific treatment or cure

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Restrictive Cardiomyopathy Nursing Management

• Decrease workload of heart, conserve energy.
• Teach patient to avoid situations that impair
  venous filling or lower cardiac output.

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Hypertensive Crisis

• Urgent
• Increased blood pressure
• Severe headache
• Severe anxiety
• Shortness of breath
• Emergent
• Fluid in your lungs
• Brain swelling or bleeding
• Aortic dissection
• Heart attack
• Stroke
• High blood pressure with seizures (eclampsia), if
  pregnant

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Aortic Dissection

• Standford Classification System
• A Originated and involves ascending aorta
• B Originated and involves descending aorta

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Aortic Dissection

• Typical signs and symptoms include
• Sudden severe chest or upper back pain, often
  described as a tearing, ripping or shearing
  sensation, that radiates to the neck or down the
  back
• Loss of consciousness
• Shortness of breath
• Weakness or paralysis
• Stroke
• Sweating
• High blood pressure
• Different pulse rates in each arm

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Hemodynamic Monitoring

• Afterload
• Cardiac Index
• Cardiac Output
• Central venous Pressure
• Mean Arterial Pressure
• Preload

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Hemodynamic Monitoring

• Pulmonary Artery Pressure
• Pulmonary Capillary Wedge Pressure
• Pulmonary Vascular Resistance
• Right Ventricular Pressure
• Stroke Index
• Stroke Volume
• Systemic Vascular Resistance

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Type I Antiarrhythmics Sodium Channel Blockers

• Class 1A Disopyramide (Norpace, NAPAmide),
  Procainimide (Procanbid), Quinidine (APO
  Quinidine)
• Class 1B Lidocaine (Xylocaine), Mexiletene
  (Mexitel),
• Class 1C Flecainide (Tambocor)

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Type II Antiarrhythmics Beta-Adrenergics or
Beta Blockers

• Atenolol (Tenormin)
• Esmolol (Brevibloc)
• Toptol (Metoprolol)
• Lopressor (Metoprolol)
• Nadolol (Corgard)
• Propranolol (Inderal)
• Acebutolol (Sectral)

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Type III Antiarrhythmics Potassium Channel
Blockers

• Amiodarone (Cordarone, Pacerone)
• Bretylium, Sotalol (Betapace)
• Ibutilide (Corvert)
• Dofetilide (Tikosyn)

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Type IV Antiarrhythmics Calcium Channel Blockers

• Amlodipine (Norvasc)
• Verapamil (Calan)
• Nifedipine, (Procardia)
• Nicardipine (Cardene)
• Diltiazem (Cardizem, Tiazac)

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Angiotensin Converting Enzyme

• Benazepril (Lotensin)
• Captopril (Capoten)
• Enalapril (Vasotec)
• Lisinopril (Zestril, Prinivil)
• Quinapril (Accupril)
• Ramipril (Altace)
• Trandolapril (Mavik)

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Angiotensin II Receptor Antagonists

• Candesartan (Atacand)
• Eprosartan (Teveten)
• Irbesartan (Avapro)
• Losartan (Cozaar)
• Olmesartan (Benicar)
• Telmisartan (Micardis)
• Valsartan (Diovan)

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Alpha-Adrenergic Blockers (Alpha Blockers)

• Doxazocin (Cardura)
• Prazosin (Minipress)
• Alfuzosin (Uroxatral)
• Terazocin (Hytrin)
• Tamsulosin (Flomax)

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Diuretics

• Thiazides Chlorothiazide (Diuril),
  Hydrochlorothiazide (Microzide), Indapramine
  (Lozol), Metolazone (Zaroxolyn)
• Loop Bumetanide (Bumex) Furosemide (Lasix)
  Ethacrynic acid (Edecrin), Torsemide (Demadex)
• Potassium Sparing Amiloride (Midamor),
  Spironolactone (Aldactone) , Triamterene
  (Dyrenium), Eplereone (Inspra)