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Coronary Heart Disease

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... Bleeding Puncture of the heart Damage to heart's electrical system Blood clots Pulmonary vein stenosis Kidney damage Cardiac Resynchronization Therapy ... – PowerPoint PPT presentation

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Title: Coronary Heart Disease


1
  • Coronary Heart Disease

2
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3
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.

4
Pericarditis Clinical Manifestations
  • Bacterial pericarditis
  • Onset
  • High Fever
  • Flu like
  • Symptoms
  • Leukocytosis
  • Increased ESR
  • Anorexia, weight loss
  • Acute stages
  • Weight loss, anorexia, nausea

5
Pericardial Effusion -Treatment
  • Anti-inflammatory Medications
  • Invasive Procedures
  • Pericardiocentesis
  • Open Heart Surgery
  • Intrapericardial Sclerosis
  • Pericardiectomy

6
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

7
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

8
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.

9
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.

10
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.

11
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

12
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).

13
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.

14
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.

15
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

16
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

17
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

18
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.

19
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

20
  • Nursing Care of Patients with Cardiac Disorders

21
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.

22
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

23
Hypertrophic Cardiomyopathy (HCM)
  • Disorder of sarcomere (contractile element of
    cardiac muscle)
  • Characterized by left (and occasionally right)
    ventricular hypertrophy, also hypertrophy in
    septum

24
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

25
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

26
Restrictive Cardiomyopathy Nursing Management
  • Decrease workload of heart, conserve energy.
  • Teach patient to avoid situations that impair
    venous filling or lower cardiac output.

27
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

28
Aortic Dissection
  • Standford Classification System
  • A Originated and involves ascending aorta
  • B Originated and involves descending aorta

29
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

30
Hemodynamic Monitoring
  • Afterload
  • Cardiac Index
  • Cardiac Output
  • Central venous Pressure
  • Mean Arterial Pressure
  • Preload

31
Hemodynamic Monitoring
  • Pulmonary Artery Pressure
  • Pulmonary Capillary Wedge Pressure
  • Pulmonary Vascular Resistance
  • Right Ventricular Pressure
  • Stroke Index
  • Stroke Volume
  • Systemic Vascular Resistance

32
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33
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)

34
Type II Antiarrhythmics Beta-Adrenergics or
Beta Blockers
  • Atenolol (Tenormin)
  • Esmolol (Brevibloc)
  • Toptol (Metoprolol)
  • Lopressor (Metoprolol)
  • Nadolol (Corgard)
  • Propranolol (Inderal)
  • Acebutolol (Sectral)

35
Type III Antiarrhythmics Potassium Channel
Blockers
  • Amiodarone (Cordarone, Pacerone)
  • Bretylium, Sotalol (Betapace)
  • Ibutilide (Corvert)
  • Dofetilide (Tikosyn)

36
Type IV Antiarrhythmics Calcium Channel Blockers
  • Amlodipine (Norvasc)
  • Verapamil (Calan)
  • Nifedipine, (Procardia)
  • Nicardipine (Cardene)
  • Diltiazem (Cardizem, Tiazac)

37
Angiotensin Converting Enzyme
  • Benazepril (Lotensin)
  • Captopril (Capoten)
  • Enalapril (Vasotec)
  • Lisinopril (Zestril, Prinivil)
  • Quinapril (Accupril)
  • Ramipril (Altace)
  • Trandolapril (Mavik)

38
Angiotensin II Receptor Antagonists
  • Candesartan (Atacand)
  • Eprosartan (Teveten)
  • Irbesartan (Avapro)
  • Losartan (Cozaar)
  • Olmesartan (Benicar)
  • Telmisartan (Micardis)
  • Valsartan (Diovan)

39
Alpha-Adrenergic Blockers (Alpha Blockers)
  • Doxazocin (Cardura)
  • Prazosin (Minipress)
  • Alfuzosin (Uroxatral)
  • Terazocin (Hytrin)
  • Tamsulosin (Flomax)

40
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)
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