Cardiovascular Function Flashcards by Bethany Koehle

What are the different nursing diagnoses’ for cardiovascular functions?

Decreased Cardiac Output
Ineffective Tissue Perfusion

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An acute inflammatory process of the pericardium - can lead to increased fluid around the heart

These can lead to this disease:
- Infections
- MI (heart attack)
- TB
- Cardiac Trauma
- Malignancy
- Autoimmune

Pericarditis

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Collection of fluid resulting from pericarditis

Pericardial Effusion

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When fluid puts pressure on the heart - as result of pericarditis

Cardiac Tamponade

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This type of pericarditis is characterized by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium

Cardiac output and cardiac reserve become fixed

Symptoms include:
- Ascites
- Pedal edema
- Dyspnea on exertion
- Fatigue
- Kussmaul sign (irregular breathing pattern)

Constrictive Pericarditis

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Inflammation of the heart muscle and conduction system that develops slowly and can be from a virus, bacteria, fungal, allergic reaction, chemical exposure, radiation, or inflammatory disorder

Myocarditis

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This results from necrosis caused by direct invasion of the offending organism, toxic effects of exotoxins, or destruction of cardiac tissue by immunologic mechanisms

Myocardial injury

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This can cause problems with contractility or conduction and harm cardiac muscle tissue

Penetration of organisms, blood cells, toxins, immune substances into myocardium

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What is the function of the heart valves?

Promote directional flow of blood through the chambers of the heart

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What are the disorders that result from a dysfunction of the heart valves?

Congenital defects
Trauma
Ischemic damage
Degenerative changes
Inflammation

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The narrowing of heart valves - limits amount of blood that can travel through it

Stenosis

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Heart valve does not open as it should - limits amount of blood that can travel through it

Atresia

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What does increased workload cause?

Hypertrophy and increased oxygen demand which can lead to heart failure

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Blood backflows - causes increased workload, chambers can dilate to accompany blood that is not moving forward

Regurgitation

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What are the two main valve disorders?

Mitral and aortic valve

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Colonization (infection) of the heart valves and the endocardium by a microbial agent - leads to the formation of bulky, friable vegetations and destruction of underlying cardiac tissues - build-up of bacteria on valves

Infective Endocarditis

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What do vegetations release?

Loci - small collections of cellular debris enmeshed in fibrin strands of clotted blood

Infectious loci continuously release bacteria causing persistent bacteremia

May present as septic emboli

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What are the portal of entry for infective endocarditis?

Persons with damaged endocardial surface defects can get endocarditis from simple infections like URI or gum massage
Intravenous drug use (needle, skin flora, contaminated product)

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What are different ways damaged endocardial surfaces can occur?

Valvular disease
Prosthetic heart valves
Congenital heart defects

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What is heart failure?

Decrease in pumping ability of the heart
Decrease in cardiac reserve
Adaptive mechanisms that serve to maintain the CO that also contribute to the progression of heart failure

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In response to heart failure, which system will act to increase heart rate, contractility, vasoconstriction, and ADH?

Sympathetic Nervous System

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What does decreased CO lead to?

Increase renin-angiotension-aldosterone - leading to more vasoconstriction and fluid retention

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Increased filling of the heart allows myosin and actin to more fully align, causing an increased force of contraction and increased stroke volume

The Frank-Starling mechanism

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When the heart muscle enlarges in attempt to compensate by increasing in sarcomeres and mitochondria, decreasing in capillary density, increasing in extracellular matrix which leads to myocardial fibrosis and ventricular wall stiffness

Myocardial Hypertrophy and Remodeling

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Represents failure of the right heart to pump blood forward into the pulmonary circulation

Right-sided Heart Failure

Where does the blood back up into with right-sided heart failure?

The systemic circulation - causes peripheral edema and congestion of the abdominal organs

Represents failure of the left heart to move blood from pulmonary circulation into the systemic circulation

Left-Sided Heart Failure

Where does the blood back up into with left-sided heart failure?

Into the pulmonary circulation (lungs)

Impaired ejection of blood from the heart during systole - decreased ejection fraction

Systolic Heart Failure

Impaired filling of the ventricles during diastole - smaller ventricular chamber size, ventricular hypertrophy, poor ventricular compliance

Diastolic Heart Failure

These signs are common for which type of heart failure? - Pulmonary congestion - Restlessness - Confusion - Tachycardia - Fatigue

Left-Sided Heart Failure

These signs are common for which type of heart failure? - Fatigue - Peripheral venous pressure - Enlarged spleen and liver - Distended jugular veins - Anorexia and complaints of GI distress - Weight gain - Edema

Right-Sided Heart Failure

This type of congenital heart defect is characterized by holes in the wall that separates the heart chambers

Septal defects

This type of congenital heart defect is characterized by a combination of pulmonary valve stenosis, a large ventricular septal defect, misplacement of the aorta directly over the ventricular septal defect, and right ventricular hypertrophy

Tetralogy of Fallot

This congenital heart defect is characterized by the failure of the ductus arteriosus - the vessel between the aorta and the pulmonary artery - to close after birth

Patent ductus arteriosus

This congenital heart defect is characterized by the narrowing of the aorta

Coarctation of the aorta

A bulge in the wall of a vessel

Aneurysm

Unilateral pouchlike bulge with a narrow neck - most often found in the circle of Willis in the brain circulation Consists of a small, spherical vessel dilation

Saccular aneurysm

Spindle-shaped bulge encompassing the entire diameter of the vessel - most often found in the thoracic and abdominal aorta Characterized by gradual and progressive enlargement of the aorta

Fusiform aneurysm

Hemorrhagic separation of the medial layers of the vessel wall creating a false lumen - acute, life-threatening condition Involves hemorrhage into the vessel wall with longitudinal tearing of the vessel wall to form a blood-filled channel

Dissecting aneurysm

Pulsating hematoma resulting from trauma and commonly mistaken for an abdominal aneurysm

False aneurysm

A condition of imbalance of the lipid components of the blood

Dyslipidemia

This type of dyslipidemia is due to abnormalities in blood lipid and cholesterol levels that develop independent of other health problems or lifestyle behaviors (usually genetic)

Primary

This type of dyslipidemia is associated with other health problems, or secondary to other health problems (obesity, diet, metabolic changes)

Secondary

An excess of lipids in the blood

Hyperlipidemia

What are the types of lipids?

Triglycerides, phospholipids, and cholesterol

Determine if these types of lipids are good or bad: - Low-density lipoprotein (LDL) - High-density lipoprotein (HDL) - Triglycerides

- Bad - Good - Bad

'Hardening of the arteries' - plaque (cholesterol, lipids) builds up in the arteries, causing narrowing of the vessel

Atherosclerosis

What are the risk factors of atherosclerosis?

- hypercholesterolemia - cigarette smoking - hypertension - family history of premature CHD - age (men 45 years and older; women 55 years and older) - HDL cholesterol < 40 mg/dL - CRP levels - inflammatory markers - Homocysteine levels

What are the major complications of atherosclerosis?

- Ischemic heart disease - Myocardial infarction - Stroke - Peripheral vascular disease (PVD)

What are the clinical manifestations of atherosclerosis?

- Narrowing of the vessel and resulting ischemia - Vessel obstruction due to plaque hemorrhage or rupture - Thrombosis and formation of emboli - Aneurysm formation

This disease is also known as peripheral arterial disease and characterized by poor circulation to extremities Etiology: atherosclerosis (plaque buildup in the arteries) Symptoms: may have none, cramping in legs during activity, cold skin in extremities, aching and weakness in extremities, red/blue discoloration, thick/opaque toenails, sores that will not heal

Peripheral Vascular Disease

What are the complications of Peripheral Vascular Disease?

- Higher risk for strokes, heart attack - Limb ischemia (amputations, gangrene)

Disease characterized by the narrowing or blocking of vessels supplying the heart

Coronary Artery Disease

This type of Coronary Artery Disease is characterized by plaque accumulating in large arteries, narrowing, and occludes more than 50%

Obstructive

This type of Coronary Artery Disease is characterized by plaque in the large arteries, but less than 50% occlusion

Non-obstructive

Small vessels do not vasodilate when there is increased demand for oxygen

Coronary Microvascular Disease

Chest pain or discomfort caused when your cardiac muscle does not get enough oxygen

Angina

What are the three features of pain associated with unstable angina?

- Occurs at rest (or with minimal exertion), usually lasting more than 20 minutes (if not interrupted by nitroglycerin). - It is severe and described as frank pain and of new onset. - It occurs with a pattern that is more severe, prolonged, or frequent than previously experienced.

A low-pressure system that returns blood flow to the heart

Venous System

The pressure in the right atrium because blood from the systemic veins flows into the right atrium of the heart

Central Venous Pressure (CVP)

Tissue blood flow is regulated on a minute-to-minute basis in relation to tissue needs and on a longer-term basis through the development of _________

Collateral circulation

What are the disorders of the venous circulation?

- Produce congestion (fluid build-up) of the affected tissues - causes edema mostly on one side of the body - Predispose to clot formation because of stagnation of flow and activation of the clotting system - Peripheral Vascular Disease - Varicose veins - Thrombophlebitis

These develop in the veins, often due to low blood flow

Thrombi/Emboli (clots)

Clots mostly seen in the legs (calf). Can cause some fluid back-up but doesn't do a lot of damage until the thrombus breaks off (and becomes an emboli) and moves through the system Known for the Virchow Triad: - Alterations in blood flow (stasis) - Vascular endothelial injury - Alterations in the constituents of blood (hypercoagulation state)

Deep Vein Thrombosis

When an emboli stops in the lungs - disrupts blood flow

Pulmonary Embolism

Thrombosis of extremity superficial veins Typically self-resolve without treatment (warm compresses help) Upper extremity usually appear at site of venous cannulation

Thrombophlebitis

What are the seven "P"s of Acute Arterial Embolism (stops oxygen from getting to where it needs to be)

- Pistol shot (acute onset) - Pallor - Polar (cold) - Pulselessness - Pain - Paresthesia: numbness - Paralysis

What are the signs and symptoms of Acute Arterial Occlusion? (Considered a vascular emergency)

- Limb ischemia - Pain - Paresthesia - Motor weakness distal to the site of occlusion - Loss of peripheral pulses, cool skin, and pallor or cyanosis distal to the obstruction site

Death of the heart muscle due to lack of oxygen - blood flow to the heart is blocked Etiology: coronary artery disease (atherosclerosis): hardening of the arteries, blood clot that blocks blood flow through coronary arteries (usually due to fat/cholesterol) Damage is irreversible after 30 minutes of blockage Manifestations: chest pain, nausea, shortness of breath, fatigue, cold sweats, left shoulder pain

MI or Heart Attack

Pressure at the height of the pressure pulse

Systolic pressure

The lowest pressure

Diastolic pressure

The difference between systolic and diastolic pressure

Pulse pressure

Represents the average pressure in the arterial system during ventricular contraction and relaxation

Mean arterial pressure

Korotkoff sound that is marked by the first tapping sound, which gradually increase in intensity

Phase I

Korotkoff sound characterized by the period in which a murmur or swishing sound is heard

Phase II

Korotkoff sound characterized by the period during which sounds are crisper and greater in intensity

Phase III

Korotkoff sound characterized by the period marked by distinct abrupt muffling or by a soft blowing sound

Phase IV

Korotkoff sound characterized by the point at which sounds disappear

Phase V

A sustained condition of elevation of the blood pressure within the arterial circuit A primary risk factor for cardiovascular disease and a leading cause of morbidity and mortality worldwide

Hypertension (HTN)

The clinical presence of HTN without evidence of a specific causative clinical condition (age, gender, race, family history, and genetics)

Primary HTN

Elevation of the blood pressure because of another disease condition

Secondary HTN

What are the target organ systems affected by HTN?

Kidneys, heart, eyes, and blood vessels

An abnormal drop in blood pressure on assumption of the standing position Caused by the decrease in venous return to the heart due to pooling of blood in lower part of the body and inadequate circulatory response to decreased cardiac output and a decrease in blood pressure

Orthostatic Hypotension (Postural Hypotension)

An acute failure of the circulatory system to supply the peripheral tissues and organs of the body with an adequate blood supply, resulting in cellular hypoxia (lack of oxygen)

Circulatory Shock

This classification of circulatory shock is characterized by the loss of whole blood, plasma, or extracellular fluid

Hypovolemic (Trauma/Hemorrhage)

This classification of circulatory shock is characterized by the inability of the heart to fill properly or an obstruction of outflow from the heart

Obstructive (Clots)

This classification of circulatory shock is characterized by the loss of sympathetic vasomotor tone, presence of a vasodilating substance in the blood, or presence of inflammatory mediators

Distributive (Sepsis, anaphalyxis)

This classification of circulatory shock is caused by an alteration in cardiac function

Cardiogenic shock (Heart)

What are some of the causes of cardiogenic shock?

- Damage to the heart from myocardial infarction - Ineffective pumping caused by cardiac arrhythmias - Ventricular septal defect - Ventricular aneurysm - Acute disruption of valvular function - Problems associated with open heart surgery

What are the complications of shock?

- Brain oxygenation - Acute respiratory distress syndrome - Acute renal failure - Gastrointestinal complications - Disseminated intravascular coagulation - Multiple organ dysfunction syndrome

The body's extreme response to an infection (most often from lung, urinary tract, skin, or GI source)

Sepsis