Dr soad abd el Dr soad abd el hameedhameedCardiovascular

system

Out lineOut line

Out line I- IntroductionII- Normal heart functionIII- Age related changesIV- Heart failureV- Coronary heart diseasesVI- Hypertension

Objectives.

II- Normal heart function:Normally, the cardiovascular system serves as a closed system for the flow of blood.

This system functions to deliver oxygen, nutrients, and other substances to all body cells and to remove the waste products of cellular metabolism.

The heart drives blood through the blood vessels into two separate:

The right side of the heart: is concerned with pulmonary circulation and pumps blood to the lungs .

The left side of the heart: pumps blood to the systemic circulation through the aorta, supplying blood to all areas of the body except the lungs.

Age-related changes of the cardiovascular system:

-The muscular layer of the left ventricle becomes 25% thicker

-Myocardial elasticity decreases, and there is an increase in rigidity of the heart muscle .

-Cardiac output decreases by 25% (i.e., volume of blood pumped by the ventricles).

-The aorta and other large arteries lose elasticity.

-The ability of the vessels to stretch decreases approximately 50% by the age of 80.

-The valves of the veins become less efficient, increasing the risk of varicose veins or stasis ulcers .

-In general, blood vessels become less elastic and narrower, in part because of calcium deposits that accumulate on the vessel walls.

-A gradual rise in blood pressure occurs with age. The increase in blood pressure is a result of a decline in arterial elas ticity and an increase in peripheral resistance .

-Blood flow through the kidneys also decreases. These changes in vessel arterial elasticity and blood flow to the kidney account for the gradual increase

in blood pressure with age.

HEART FAILURE Heart failure is a condition that occurs

when the heart is unable to pump enough blood to meet the body's metabolic demands .

Symptoms of heart failure

Edema (general or dependent)FatiguePoor exercise toleranceDyspnea on exertionParoxysmal nocturnal dyspneaOrthopneaAltered mental status (e.g., confusion, especially in the elderly)

• Disorders that increase the risk of developing heart failure include:

Angina MI (myocardial infarction)

Diabetes (uncontrolled) Hypertension Coronary artery disease

Diagnostic Tests: Electro-cardiography (ECG) Chest X-ray

Cardiac catheterization

Echocardiography and Laboratory blood test

Medical Treatment:

1 -Diuretics decrease total blood volume and circulatory congestion

2 -Digoxin is also used in the management of heart failure to strengthen myocardial contractil ity

Nursing care•Assessment of the immune

system1 -Health History

2 -Medication 3 -Physical Examination

4 -Diagnostic Tests Nursing Diagnosis

Interventions.

CORONARY ARTERY DISEASE

AnginaAngina is caused by atherosclerotic heart disease. The most prominent symptom of angina is chest pain. The chest pain with angina typically is severe and causes a feeling of tightness, pressure, or suffo cation. The pain may radiate down the left side of the body to the neck, jaw, shoulders, or arms .

The pain of angina may result from

•-Exercise or physical exertion (eg, climbing stairs)

-Exposure to cold

-Eating a large meal -Stress

Risk factors for coronary heart

disease• Aging• High blood pressure ·.Elevated blood

pressure• Smoking :cigarettes • Diabetes mellitus (hyperglycemia ) • Obesity • Stress • Lack of exercise • Family history of a myocardial infarction

Myocardial Infarction

MI (Myocardial Infarction) occurs when areas of the heart are deprived of blood, causing tissue death and destruction .

Symptoms indicating an MI include chest pain (not relieved by rest or by nitroglycerin). The pain occurs suddenly over the (lower) substernal area and is the most common symptom .

HYPERTENSIONDefinition:

Hypertension is a sustained elevation in blood pressure. "Systolic pressure is greater than 140 mmHg or the diastolic pressure is above 90 mmHg.

Caring for the Patient with Hypertension:

There are many drugs available; the physician may prescribe a different antihypertensive drug as diuretics and beta blockers.

The patient is monitored for any adverse reactions related to the medications. Common side effects of the antihypertensives include orthostatic hypoten sion, hypotension, dizziness, fatigue, nausea, vomit ing, depression, and impotence.

Obtain the blood pressure and pulse rate immediately before each dose of an antihypertensive.

Patient and Family Teachingmedication -

-rise slowly from a sitting or lying position . -Follow dietary restrictions concerning sodium or fat .

-Do not use a salt substitute unless approved by the physician .

-Take the diuretics early in the morning unless directed otherwise .

-Avoid the use of alcohol . -Lose weight if overweight and weigh weekly to monitor

weight loss or gain . -Stop smoking, and reduce the intake of dietary

saturated fat and cholesterol for overall cardiovascular health .

-If taking an antihypertensive that causes hypokalemia, include foods high in potassium in the diet (e.g., bananas, orange juice) .