Download Instruction: Answer the following questions briefly.

Instruction: Answer the following questions briefly.
1. Explain the process of pulmonary and systemic circulation. Pathway of blood flow through
the heart.
Answer. The right side of the heart pumps blood into the pulmonary circuit; the left side of
the heart pumps blood into the systemic circuit.
2. Explain and enumerate the different classifications of Cardiovascular Disease.
Answer. Classifications:
Conduction disorders (Dysthymias)
† Supraventricular Rhythms
† Ventricular Dysrhythmias
† Atrioventricular Conduction Blocks
† Ventricular Conduction Blocks
Myocardial disorders (Coronary Heart Disease)
 Angina pectoris
 Acute Myocardial Infarction
 Sudden Cardiac Death
Structural Disorders
 Valvular Hearth Diseases
 Cardiomyopathy
 Infectious Disorder
3. Give the pathophysiology, sign / symptoms and nursing care for the following disorders.
Inflammatory
Heart Disease
Pathophysiology
Sign and
Symptoms
Nursing Care
Rheumatic Fever/
Rheumatic Heart
Disease
Rheumatic Fever +recurrent
infection -> Cross immune
response between host and
streptococcal antigens ->
Abnormal reactionautoimmunity disease ->
rheumatic pancarditis and
Endocarditis in valves ->
erosion of valve leaflets ->
fibrous thickening and thickened
valves -> stenos is and
regurgitation.
-Fever
-Painful and tender joints - most
often in the knees, ankles,
elbows and wrists
-Pain in one joint that migrates
to another joint
-Red, hot or swollen joints
Small, painless bumps (nodules)
beneath the skin
-Chest pain
-Fatigue
-Jerky, uncontrollable body
movement s- most often in the
hands, feet and face.
-Monitor vital signs
Such as: blood pressure, apical
pulse and peripheral pulse.
-Monitor cardiac rhythm and
frequency.
-Semi fowler bed rest
in a position that is 45 degrees.
-Encourage the patient to stress
management techniques (quiet
environment, meditation).
- Medical collaboration in terms
of oxygen delivery and therapy.
Endocarditis
structural abnormalities of the
cardiac valve for bacterial
adherence, the adhesion of
circulating bacteria to the
valvular surface, and the ability
of the adherent bacteria to
survive on the surface and
propagate as vegetation or
systemic emboli. Certain
bacteria, if present in the
bloodstream, may colonize the
initially sterile vegetation
composed of fibrin and platelets;
bacterial growth enlarges the
vegetation, further impeding
blood flow and inciting
inflammation that involves the
vegetation and adjacent
endothelium. The true incidence
of endocarditis complicating
each the bacterial species
-Fever and chills
-Fatigue
-Night sweats
-Shortness of breath
-Paleness
-Persistent cough
-welling in your feet, legs or
abdomen
-Unexplained weight loss
-Blood in your urine
-Monitor vital signs
Such as: blood pressure, apical
pulse and peripheral pulse.
-Monitor cardiac rhythm and
frequency.
- Medical collaboration in terms
of oxygen delivery and therapy.
Myocarditis
The term myocarditis refers to
an inflammatory response within
the myocardium that is not
secondary to ischemic events or
cardiac rejection in the setting of
transplantation. The presence of
myocyte necrosis is required for
certain types of myocarditis —
specifically, lymphocytic
myocarditis that is triggered by
viruses and augmented by
autoimmunity — and the
myocyte damage is believed to
be mediated both by direct
invasion of the myocardium and
by immune insult.
Pericarditis develops quickly,
causing inflammation of the
pericardial sac and often a
-Shortness of breath during
exercise, Fatigue, Palpitations
light headedness, Irregular
heartbeat, Sudden loss of
consciousness, Fever,
Bluish or Grayish discoloration
of the skin,
Fluid retention with swelling of
legs, Ankles and feet, Headache,
Body aches, Sudden breath.
-Monitor vital signs
Such as: blood pressure, apical
pulse and peripheral pulse.
-Give a comfortable position
(semi-fowler position).
-Monitor pain characteristics
and administer analgesics as
needed and use salicylates
around the clock.
-Give O2 supplement and ensure
saturation ˃90%.
-Chest pain
- dyspnea
- Night sweats, and weight loss
-Monitor vital signs
Such as: blood pressure, apical
pulse and peripheral pulse.
Pericarditis
pericardial effusion.
Inflammation can extend to the
epicardial myocardium
(myopericarditis). Adverse
hemodynamic effects and
rhythm disturbance are rare,
although cardiac tamponade is
possible.
Valvular Heart
Disease
are commonly noted.
-Place the patient in upright
position to relieve dyspnea and
chest pain.
-Provide analgesics to relieve
pain and oxygen to prevent
tissue hypoxia.
-Assess the patient’s
cardiovascular status frequently,
watching for signs of cardiac
tamponade.
Pathophysiology
Sign and Symptoms
Nursing Care
Mitral Stenosis
Mitral stenosis prompts a series
of hemodynamic changes that
frequently cause deterioration of
the patient's clinical status. A
reduction in cardiac output,
associated with acceleration of
heart rate and shortening of the
diastolic time, frequently leads
to congestive heart failure. In
addition, when AF sets in,
systemic embolization becomes
a real danger.
-Place the patient in an upright
position to relieve dyspnea, if
needed.
- Teach the patient about diet
restrictions.
- Watch closely for signs of
pulmonary dysfunction caused
by pulmonary hypertension,
tissue ischemia caused by
emboli, and adverse reactions to
drug therapy.
-Explain all tests and treatments
to the patient.
Mitral Regurgitation
MR can be caused by organic
-Cough, possibly with bloody
phlegm
-Difficulty breathing during or
after exercise (This is the most
common symptom.)
-Waking up due to breathing
problems or when lying in a flat
position
-Fatigue
-Frequent respiratory infections,
such as bronchitis
-Feeling of pounding heart beat
(palpitations)
-Swelling of feet or ankles.
-Dyspnea
-Check vital signs (heart rate
Mitral Valve
Prolapse
disease (e.g., rheumatic fever,
ruptured chordae tendineae,
myxomatous degeneration,
leaflet perforation) or a
functional abnormality (i.e., a
normal valve may regurgitate
[leak] because of mitral annular
dilatation, focal myocardial
dysfunction, or both).
Congenital MR is rare but is
commonly associated with
myxomatous mitral valve
disease. Alternatively, it can be
associated with cleft of the
mitral valve, as occurs in
persons with Down syndrome,
or a ostium primum atrial septal
defect.
-Fatigue
-Orthopnea
-Pulmonary edema (often the
initial manifestation)
and blood pressure).
-Assess heart sounds, noting
gallops, S3, S4.
-Assess manually peripheral
pulses (with weak rate, rhythm
indicated low cardiac output).
- Explain diet restrictions (fluid,
sodium).
- Routinely Assess skin color
and temperature (Cold, clammy
skin is secondary to
compensatory increase in
sympathetic nervous system
stimulation and low cardiac
output and desideration).
Mitral valve prolapse (MVP) is
characterized primarily by
myxomatous degeneration of the
mitral valve leaflets. In younger
populations, there is gross
redundancy of both the anterior
and posterior leaflets and
chordal apparatus. This is the
extreme form of myoxomatous
degeneration, known as
Barlow’s syndrome. In older
populations, however, MVP is
characterized by fibroelastic
deficiency, sometimes with
superimposed chordal rupture
due to a lack of connective
tissue support. These anatomic
abnormalities result in
-Shortness of breath, Weakness
or dizziness, Wheezing and
heavy coughing, Physical
exertion, Palpitations mild chest
pain, Fever, Rapid weight gain,
Swelling of the ankles, feet or
abdomen.
-Check vital signs (heart rate
and blood pressure).
-Assess heart sounds, noting
gallops, S3, S4.
-Assess manually peripheral
pulses (with weak rate, rhythm
indicated low cardiac output).
- Explain diet restrictions (fluid,
sodium).
- Routinely Assess skin color
and temperature (Cold, clammy
skin is secondary to
compensatory increase in
sympathetic nervous system
stimulation and low cardiac
output and desideration).
-Explain all tests and treatments
to the patient.
malcoaptation of mitral valve
leaflets during systole, resulting
in regurgitation. Mitral annular
dilatation may also develop over
time, resulting in further
progression of mitral
regurgitation (MR). Acute
severe MR results in congestive
heart failure symptoms without
left ventricular dilatation.
Conversely, chronic or
progressively severe MR can
lead to ventricular dilatation and
dysfunction, neurohormonal
activation, and heart failure.
Elevation in left atrial pressures
can result in left atrial
enlargement, atrial fibrillation,
pulmonary congestion, and
pulmonary hypertension.
Aortic Stenosis
When the aortic valve becomes
stenotic, resistance to systolic
ejection occurs and a systolic
pressure gradient develops
between the left ventricle and
the aorta. This outflow
obstruction leads to an increase
in left ventricular (LV) systolic
pressure. As a compensatory
mechanism to normalize LV
wall stress, LV wall thickness
increases by parallel replication
of sarcomeres, producing
concentric hypertrophy. At this
stage, the chamber is not dilated
and ventricular function is
preserved, although diastolic
compliance is reduced.
-Chest pain (angina) or tightness
-Feeling faint or fainting with
exertion
-Shortness of breath, especially
with exertion
-Fatigue, especially during times
of increased activity
-Heart palpitations — sensations
of a rapid, fluttering heartbeat
-Heart murmur
-Place the patient in an upright
position to relieve dyspnea.
-Administer oxygen as needed to
prevent tissue hypoxia.
-Keep the patient in a low
sodium diet.
- Evaluate patient’s activity
tolerance and degree of fatigue.
-Monitor the patient for chest
pain that may indicate cardiac
ischemia.
-Explain all tests and treatments
to the patient.
Eventually, however, LV enddiastolic pressure (LVEDP)
rises, which causes a
corresponding increase in
pulmonary capillary arterial
pressures and a decrease in
cardiac output due to diastolic
dysfunction. The contractility of
the myocardium may also
diminish, which leads to a
decrease in cardiac output due to
systolic dysfunction.
Aortic Regurgitation
Incompetent closure of the aortic
valve can result from intrinsic
disease of the leaflets, cusp,
diseases of the aorta, or trauma.
Diastolic reflux through the
aortic valve can lead to left
ventricular volume overload. An
increase in systolic stroke
volume and low diastolic aortic
pressure produces an increased
pulse pressure. The clinical
signs of AR are caused by the
forward and backward flow of
blood across the aortic valve,
leading to increased stroke
volume.
The severity of AR is dependent
on the diastolic regurgitate valve
-Fatigue and weakness,
especially when you increase
your activity level
-Shortness of breath with
exertion or when you lie down
-Swollen ankles and feet
(edema)
-Chest pain (angina), discomfort
or tightness, often increasing
during exercise
-Lightheadedness or fainting
Irregular pulse (arrhythmia)
-Heart murmur
Sensations of a rapid, fluttering
heartbeat (palpitations)
-Place the patient in an upright
position to relieve dyspnea.
-Administer oxygen as needed to
prevent tissue hypoxia.
- Observe the patient for
complications and adverse
reactions to drug therapy.
- Monitor the patient for chest
pain that may indicate cardiac
ischemia.
-Regularly assess the patient’s
cardiopulmonary function.
area, the diastolic pressure
gradient between the aorta and
LV, and the duration of diastole.
Tricuspid Stenosis
Tricuspid stenosis results from
alterations in the structure of the
tricuspid valve that precipitate
inadequate excursion of the
valve leaflets. The most
common etiology is rheumatic
fever, and tricuspid valve
involvement occurs universally
with mitral and aortic valve
involvement. With rheumatic
tricuspid stenosis, the valve
leaflets become thickened and
sclerotic as the chordae
tendineae become shortened.
The restricted valve opening
hampers blood flow into the
right ventricle and,
subsequently, to the pulmonary
vasculature. Right atrial
enlargement is observed as a
consequence. The obstructed
venous return results in hepatic
enlargement decreased
pulmonary blood flow, and
peripheral edema.
-Tired and lethargic
-Fragility
-A quivering feeling in the neck
-A rapid, irregular heartbeat
called a palpitation
-Place the patient in an upright
position to relieve dyspnea.
-Administer oxygen as needed to
prevent tissue hypoxia.
-Keep the patient in a low
sodium diet.
- Evaluate patient’s activity
tolerance and degree of fatigue.
-Monitor the patient for chest
pain that may indicate cardiac
ischemia.
-Explain all tests and treatments
to the patient.
Tricuspid
Regurgitation
Tricuspid regurgitation focuses
on the structural incompetence
of the valve. The incompetence
can result from primary
structural abnormalities of the
leaflets and chordae or, more
often, be secondary to
myocardial dysfunction and
dilatation.
-Fatigue
-Declining exercise capacity
-Swelling in your abdomen, legs
or veins in your neck
-Abnormal heart rhythms
-Pulsing in your neck
-An enlarged liver
-Shortness of breath with
activity
-Check vital signs (heart rate
and blood pressure).
-Explain all tests and treatments
to the patient.
- Evaluate patient’s activity
tolerance and degree of fatigue.
-Monitor the patient for chest
pain that may indicate cardiac
ischemia.
Pulmonic Stenosis
PS can be due to isolated
valvular (90%), subvalvular, or
-Heart murmur — an abnormal
whooshing sound heard using a
-Alternate periods of rest to
prevent extreme fatigue and
peripheral (supravalvular)
obstruction, or it may be found
in association with more
complicated congenital heart
disorders. The characteristics of
the various types of PS are
described in this section.
stethoscope, caused by turbulent
blood flow
-Shortness of breath, especially
during exertion
-Chest pain
-Loss of consciousness
(fainting)
-Fatigue
dyspnea.
-To reduce anxiety, allow the
patient to express his concerns
about the effects of activity
restrictions on his
responsibilities and routine.
-Check vital signs (heart rate
and blood pressure).
Pulmonic
Regurgitation
Incompetence of the pulmonic
valve occurs by 1 of 3 basic
pathologic processes: dilatation
of the pulmonic valve ring,
acquired alteration of pulmonic
valve leaflet morphology, or
congenital absence or
malformation of the valve.
-Fatigue
-Shortness of breath, especially
during exertion
-Chest pain
-Assess mental status
-Check vital signs (heart rate
and blood pressure).
-Routinely Assess skin color and
temperature (Cold, clammy skin
is secondary to compensatory
increase in sympathetic nervous
system stimulation and low
cardiac output and desideration)
-Assess lung sounds and
determine any occurrence of
Paroxysmal Nocturnal Dyspnea
(PND) or orthopnea.
-Explain drug regimen, purpose,
dose, and side effects
Cardiomyopathy
Dilated cardiomyopathy is
characterized by ventricular
chamber enlargement and
systolic dysfunction with greater
left ventricular (LV) cavity size
with little or no wall
hypertrophy. Hypertrophy can
be judged as the ratio of LV
mass to cavity size; this ratio is
decreased in persons with
dilated cardiomyopathies.
The enlargement of the
remaining heart chambers is
primarily due to LV failure, but
it may be secondary to the
primary cardiomyopathic
process. Dilated
cardiomyopathies are associated
-Fatigue
-Dyspnea on exertion, shortness
of breath, cough
-Orthopnea, paroxysmal
nocturnal dyspnea
-Increasing edema, weight, or
abdominal girth
-Assess mental status
-Check vital signs (heart rate
and blood pressure).
-Routinely Assess skin color and
temperature (Cold, clammy skin
is secondary to compensatory
increase in sympathetic nervous
system stimulation and low
cardiac output and desideration)
-Explain drug regimen, purpose,
dose, and side effects
with both systolic and diastolic
dysfunction. The decrease in
systolic function is by far the
primary abnormality due to
adverse myocardial remodeling
that eventually leads to an
increase in the end-diastolic and
end-systolic volumes.
Progressive dilation can lead to
significant mitral and tricuspid
regurgitation, which may further
diminish the cardiac output and
increase end-systolic volumes
and ventricular wall stress. In
turn, this leads to further dilation
and myocardial dysfunction.