Cardiovascular Nursing

Prepared by: Mabel M. Oamil, BSN, RN, MAN, CHA

THE HEART
✓ An average rate of 75 contractions per minute
✓ Approximately 108,000 times in one day
✓ More than 39 million times in one year
✓ Nearly 3 billion times during a 75-year lifespan.

✓ Each of the major pumping chambers of the heart ejects:

✓ Approximately 70 mL blood per contraction in a
resting adult.
✓ This would be equal to 5.25 liters of fluid per minute
✓ Approximately 14,000 liters per day.
✓ Over one year, that would equal 10,000,000 liters or 2.6
million gallons of blood sent through roughly 60,000
miles of vessels.
A. Structure
✓ A hollow muscular organ
✓ Lies in the mediastinum and rests
on the diaphragm
A. Structure
✓ The shape of the heart is similar
to a pinecone, rather broad at
the superior surface and
tapering to the apex.
✓ A typical heart is approximately
the size of your fist:
✓ 12 cm (5 in) in length, 8 cm (3.5
in) wide, and 6 cm (2.5 in) in
thickness.
✓ Given the size difference
between most members of the
sexes, the weight of a female
heart is approximately 250–300
grams (9 to 11 ounces), and the
weight of a male heart is
approximately 300–350 grams
(11 to 12 ounces).
A. Structure
✓ Pericardium or pericardial sac - membrane that directly
surrounds the heart and defines the pericardial cavity
✓ It also surrounds the “roots” of the major vessels, or
the areas of closest proximity to the heart.
✓ The pericardium, which literally translates as “around
the heart,” consists of two distinct sublayers:
✓ The sturdy outer fibrous pericardium - made of
tough, dense connective tissue that protects the
heart and maintains its position in the thorax
✓ The inner serous pericardium consists of two layers:
✓ The parietal pericardium, which is fused to the
fibrous pericardium
✓ Inner visceral pericardium, or epicardium,
which is fused to the heart
A. Structure
A. Structure

✓ Heart Chambers
✓ The Right atrium – low pressure chamber
✓ The Right ventricle – low pressure chamber;
✓ The Left atrium – low pressure chamber;
✓ The Left ventricle - high-pressure chamber,
A. Structure
A. Structure
✓ Heart Valves
✓ The Atrioventricular (AV) valves separate the atria from the ventricles.
₋ The tricuspid valve located between the right atrium and
ventricle.
₋ The mitral valve located between the left atrium and ventricle.
✓ The semilunar valves located between each ventricle and its
corresponding artery.
₋ The pulmonic valve is located between the right ventricle and
pulmonary artery.
₋ The aortic valve is located between the left ventricle and aorta.
A. Structure
A. Structure
✓ Cardiac Conduction System
✓ The Electrical Pathways
₋ The sinoatrial (SA) node, located at the junction of
the right atrium and the superior vena cava; the
pacemaker
₋ The AV node, located in the septal wall of the right
atrium,
A. Structure

✓ Cardiac Conduction System

✓ The Electrical Pathways
⎼ The bundle of His, a bundle of specialized muscle
fibers in the myocardial septum,. The bundle of His
divides into right and left branches.
⎼ Purkinje fibers, which propagate electrical impulses
into the endocardium and on to the myocardium.
A. Structure
A. Structure
✓ Cardiac Conduction System
✓ The Electrical Impulse Activity
₋ Phases of the electrocardiogram (ECG) are
labeled P. Q. R. S, and T.
⎼ The P wave represents atrial depolarization.
⎼ The PR interval represents the time from the
beginning of atrial depolarization to the
beginning of ventricular depolarization.
⎼ The QRS complex represents ventricular
depolarization.
⎼ The T wave represents ventricular
repolarization.
A. Structure
✓ Cardiac Conduction System
✓ The Electrical Impulse Activity
₋ Normal sinus rhythm
⎼ Heart rate is 60 to 100 beats per minute.
⎼ P waves precede each QRS complex.
⎼ PR interval is 0.12 to 0.2 second.
⎼ QRS complex is 0.04 to 0.1 second.
⎼ Conduction is forward and cyclical through the conduction
system.
⎼ Rhythm is regular with no abnormal delay.
A. Structure
A. Structure
✓ Cardiac Conduction
✓ The Electrical Impulse Activity
✓ ST segment elevation
✓ Flattened or depressed T
waves
✓ Absence of P waves usually
✓ Disappearance of Q waves
A. Structure
✓ Cardiac Conduction System
✓ The Electrical Impulse Activity
✓ Electrophysiological properties of the heart::
✓ Excitability
✓ Automaticity
✓ Contractility
✓ Refractoriness
✓ Conductivity
A. Function
The heart has electrophysiologic, mechanical, and neurologic properties
that coordinate to produce effective myocardial contraction and pumping
of blood.
✓ Cardiac output (CO) - volume of blood ejected by each
ventricle in 1 minute; CO = SV (stroke volume) X HR (heart
rate).
1. Stroke volume - amount of blood ejected by the left
ventricle per heartbeat. Several factors influence CO
indirectly by affecting the SV.
2. Heartrate - number of heart beats per minute. Normal is
60 to 100 beats/ minute.
A. Function
A. Function
The heart has electrophysiologic, mechanical, and neurologic
properties that coordinate to produce effective myocardial
contraction and pumping of blood.
✓ Cardiac cycle – complete heartbeat, or cardiac cycle, consists of
two phases in response to electrical stimulation.
1. Systole is the contraction phase.
2. Diastole is the relaxation (filling) phase.
The Cardiac Cycle
A. Function
✓ Heart sounds result from vibrations caused by valve closure and ventricular
filling.
1. The first heart sound (SI) is associated with tricuspid and mitral valve
closure; best heard at the APEX of the heart
2. The second heart sound (S2) is associated with aortic and pulmonic valve
closure; heard at the BASE of the heart
3. The third heart sound (S3), known as ventricular gallop, occurs during the
rapid ventricular filling stage of diastole.
4. The fourth heart sound (S4), or atrial gallop, is linked to resistance to
ventricular filling, as in hypertrophy or injury of the ventricular wall.
A. Function
✓ Neurologic factors regulating heart function.
✓ Sympathetic nervous system stimulation
✓ Parasympathetic nervous system stimulation,
✓ The response of chemoreceptors, located in the carotid and aortic
bodies, to decreased O, and increased CO, concentrations is to
increase the heart rate.
✓ The response of baroreceptors, located in the aortic arch, carotid
sinus, vena cava, pulmonary arteries, and atria, is to decrease or
increase heart rate, resulting in blood pressure changes.
BLOOD FLOW through the Heart
Cardiovascular System
✓ ASSESSMENT
✓ Health History:
✓ chief complaint,
✓ present illness,
✓ onset, duration,
✓ location,
✓ precipitating and
✓ alleviating factors
 Cardiovascular System
✓ ASSESSMENT
✓ Health History: Explore…
₋ Positive family history for cardiovascular disease
₋ Age (The incidence of cardiovascular disease increases after age 40.)
₋ Gender (Mortality from cardiovascular disease is greater in men than in
women; however, this difference decreases after menopause.)
₋ Race (Mortality is greater for nonwhites than whites.)
₋ Smoking (The risk of cardiovascular disease is two to four times greater
for cigarette smokers than nonsmokers.)
 Cardiovascular System
✓ ASSESSMENT
✓ Health History: Explore…
₋ Hypertension, particularly elevated systolic pressure – headache is the
most common symptom because of the increased pressure within the
arterial circulation.
₋ Hyperlipidemia (The ratio of high-density lipoproteins [HDL] to low-
density lipoproteins [LDL] is the best predictor.)
₋ Obesity (Contributes to the severity of other risk factors.)
₋ Sedentary lifestyle
₋ Diabetes (Uncontrolled elevated blood glucose level increases risk.)
₋ Stress (May contribute to developing coronary artery disease.)
₋ Hormonal contraceptives.
 Cardiovascular System
✓ ASSESSMENT
✓ Cardinal Signs & Symptoms:
₋ pain over the lower sternal region and the upper abdomen
characterized by heavy vicelike, "belt-squeezing pain that may radiate
to the shoulders, neck, and down the arms (Associated symptoms
may include electrocardiogram [ECG] changes and arrhythmias. This
pain may indicate myocardial ischemia.)
₋ palpitations characterized by rapid irregular or pounding heartbeat
(This symptom may be associated with arrhythmias or ischemia.)
₋ intermittent claudication characterized by extremity pain with exercise
(This may indicate peripheral vascular disease.) - results from
muscular activity without adequate oxygenation, relieved after rest.
 Cardiovascular System
✓ ASSESSMENT
✓ Cardinal Signs & Symptoms:
₋ dyspnea characterized by difficult breathing or shortness of breath
with activity (i.e., dyspnea on exertion), in the supine position (i.e..,
orthopnea), or sudden onset at night (i.e.., paroxysmal nocturnal
dyspnea) (This is commonly associated with compromised cardiac
function.)
₋ fatigue with or without activity (This may be associated with
decreased carbon dioxide [CO].)
 Cardiovascular System
✓ ASSESSMENT
✓ Cardinal Signs & Symptoms:
₋ syncope with or without dizziness (This can result from a sudden
decrease in CO.)
₋ diaphoresis with associated clamminess and cyanosis (This
reflects decreased CO and decreased peripheral perfusion.)
₋ edema or weight gain greater than 3 lb. in 24 hours. (indicate
HF)
 Cardiovascular System
✓ ASSESSMENT
✓ Physical Examination
✓ Vital signs - Assess vital signs, particularly pulse rate, blood pressure, and
respirations. Increased BP and pulse may indicate cardiovascular disease.
✓ Dorsalis pedis pulse is located on top of the foot.
✓ Popliteal pulse is at the back of the knee.
✓ The posterior tibial pulse is slightly below the malleolus of the ankle.
✓ The femoral pulse is in the inguinal area.,
Cardiovascular System
 Cardiovascular System
✓ ASSESSMENT
✓ Physical Examination
✓ Inspection
₋ Observe general appearance for signs of distress, anxiety, and
altered level of consciousness.
₋ Inspect the lips and buccal mucosa for central cyanosis, which
reflects hypoxia.
₋ Inspect the peripheral extremities for cyanosis and a capillary
refill time of less than 3 seconds.
₋ Assess jugular venous pressure and observe for venous
distention.
 Cardiovascular System
✓ ASSESSMENT
✓ Physical Examination
✓ Palpation
✓ Palpate all peripheral pulses including carotid, brachial, radial, femoral,
popliteal. dorsalis pedis, and anterior tibial. Grade 0, no pulse; 1+,
weak; 2+ , normal; 3+ increased; 4+, bounding.
✓ Palpate the precordium to locate the point of maximal impulse or the
apical impulse.
✓ Carotid artery is on the anterior portion of the sternocleidomastoid
muscle at the level of the lower margin of the thyroid
 Cardiovascular System
✓ ASSESSMENT
✓ Physical Examination
✓ Auscultation.
✓ Systematically auscultate the heart for normal and abnormal heart
sounds, murmurs, and friction rub, covering four main areas: aortic,
pulmonary, mitral, and tricuspid.
Cardiovascular System

✓ ASSESSMENT
✓ Perform a respiratory assessment.
✓ Perform an abdominal assessment,
 Cardiovascular System
✓ ASSESSMENT
✓ Laboratory and Diagnostic Studies
a) White blood cell (WBC) count can detect signs of infection.
b) Lipid profile examines cholesterol (LDL and HDL) and
triglycerides.
c) Cardiacenzymes examine levels of creatinine phosphokinase,
troponin, and lactate dehydrogenase.
d) Blood
coagulation studies examine prothrombin time and partial
thromboplastin time.
e) Chest radiograph can determine heart size and silhouette and
visualize the pulmonary system.
 Cardiovascular System
✓ ASSESSMENT
✓ Laboratory and Diagnostic Studies
a) Holtermonitoring (ambulatory ECG) allows for 24-hour
continuous measurement of the heart's electrical activity.
b) Exercise ECG (graded exercise test) evaluates electrical
activity during physical stress; a chemical-induced ECG
stress test is used if the client is unable to walk or bike
for a long period of time.
 Cardiovascular System
✓ ASSESSMENT
✓ Laboratory and Diagnostic Studies
a) Echocardiography yields information about cardiac
structures (especially valvular) and function.
b) Radionuclide testing evaluates ventricular function
and myocardial blood flow and detects areas of
myocardial damage. Radionuclide testing includes
positron emission tomography, multiple-gated
acquisition, and thallium scanning.
 Cardiovascular System
✓ ASSESSMENT
✓ Laboratory and Diagnostic Studies
a) Cardiaccatheterization enables measurement of chamber
pressures and oxygen saturation.
b) Arteriography
visualizes coronary arteries with injections of
radiopaque contrast media.
c) Ventriculography visualizes ventricles with injection of radiopaque
contrast media.
d) Central venous pressure reflects filling pressure of the right
ventricle and helps assess cardiac function and intravascular
volume status.
 Cardiovascular System
✓ ASSESSMENT
✓ Laboratory and Diagnostic Studies
a) Pulmonary artery pressure and pulmonary artery wedge pressure
measure left heart pressures.
b) Arterial
line allows continuous monitoring of peripheral arterial
pressures.
c) Swan-Ganz catheter inserted into the subclavian artery to measure
pulmonary arterial pressure
 Cardiovascular System
✓ NURSING DIAGNOSES
✓ Decreased cardiac output.
✓ Impaired gas exchange
✓ Activity intolerance
✓ Acute pain
✓ Risk for infection
✓ Disturbed sleep pattern
✓ Anxiety
✓ Deficient knowledge
✓ Interrupted family processes
 Cardiovascular System
✓ PLANNING AND OUTCOME IDENTIFICATION
✓ The major goals of the client with a cardiovascular problem include:
✓ enhancement of cardiopulmonary status,
✓ increased gas exchange and activity tolerance,
✓ prevention of pain and infection,
✓ improved sleep pattern,
✓ reduction of anxiety,
✓ adherence to a self-care program with an understanding of the disease
process and its management, and improved family functioning.
 Cardiovascular System
✓ IMPLEMENTATION
✓ Assess cardiopulmonary status.
✓ Assess level of consciousness, heart rate and rhythm, heart
sounds, blood pressure, peripheral pulses, peripheral edema, skin
color and temperature, respiratory rate and lungs.
✓ Monitor arterial blood gasses and pulse oximetry.
✓ Monitor ECG and telemetry.
✓ Monitor the client's intake and output; maintain 30 ml/hour urinary
output, using a urometer to ensure accuracy.
 Cardiovascular System
✓ IMPLEMENTATION
✓ Enhance cardiac output. Establish a patent I.V. line to administer fluids. An I.V.
infusion control device should be used to control rate and volume to be
infused.
✓ Promote gas exchange.
✓ Collaborate with the respiratory therapist and administer oxygen to
maintain oxygen saturation levels of 95% to 100% if no other disease
process is present.
 Cardiovascular System
✓ IMPLEMENTATION
✓ Promote gas exchange.
✓ Encourage the client to maintain semi-Fowler's position while resting in
bed; keep the client on bed rest or chair rent to decrease oxygen
myocardial consumption.
✓ Instruct the client to cough, deep-breathe, and turn frequently, which can
decrease pooling of fluid in the lungs. Instruct the client to breathe in
through the nose and out through the mouth three times and then cough
forcefully on the fourth breath.
 Cardiovascular System
✓ IMPLEMENTATION
✓ Increase activity tolerance. Balance periods of rest and exercise, Assist the
client as needed with activities of daily living and self-care.
✓ Promote comfort. Assess the client's description of chest discomfort,
including location, radiation, pain duration, and what precipitated pain.
✓ Prevent infection.
✓ Monitor skin integrity of lower extremities and incisions from cardiac
surgery.
✓ Assess insertion sites from invasive procedures for signs of redness,
warmth, edema, and pain.
✓ Monitor vital signs, especially for fever.
✓ Assess breath sounds for changes associated with pneumonia in clients
after surgery and those requiring bed rest.
 Cardiovascular System
✓ IMPLEMENTATION

✓ Promote adequate sleep. Attempt to cluster nursing interventions

to provide the client with several hours of uninterrupted sleep.
✓ Minimize anxiety. Offer the client opportunities to ventilate his
feelings. Answer his questions truthfully and develop a trusting
and caring relationship with him and his family
 Cardiovascular System
✓ IMPLEMENTATION
✓ Provide client and family teaching.
✓ Teach the client and his family the basic pathophysiology of the underlying
disease process.
✓ Teach the client measures to reduce modifiable risk factors, including the
importance of a low-fat, low-cholesterol, low-sodium diet, smoking cessation,
and adequate exercise.
✓ Teach energy conservation measures.
✓ Discuss medications, including possible adverse effects and interactions.
✓ Discuss danger signs and symptoms requiring prompt medical attention
including chest pain, increased shortness of breath, sudden onset of fever,
irregular heartbeats, and weight gain of more than 2 pounds in less than 24
hours.
✓ Discuss with the client the necessity of advance directives and durable power
of attorney for health care.
 ARRHYTHMIAS
✓ Description. any sinus rhythm deviating from normal.
✓ Etiology. altered impulse formation, altered impulse conduction or both.
✓ Pathophysiology. Myocardial cells that have been injured or replaced
with scar tissue do not have the ability to respond to sinoatrial (SA)
node impulses, other cardiac cells can assume the pacemaker
properties. When any other part of the heart except the SA node
initiates the heartbeat, an arrhythmia occurs.
✓ Assessment findings.
✓ Nursing management.
 ARRHYTHMIAS
✓ SINUS TACHYCARDIA
✓ Description. a heart rate greater than 100 beats
per minute, originating in the sinus node.
Characteristics:
✓ The rate is 100 to 180 beats per minute.
✓ P waves precede each QRS complex.
✓ PR interval is normal.
✓ QRS complex is normal.
✓ Conduction is normal.
✓ Rhythm is regular.
 ARRHYTHMIAS

✓ SINUS TACHYCARDIA
✓ Etiology. Causes of sinus tachycardia include exercise, anxiety,
fever, drugs, anemia, heart failure, hypovolemia, and shock.
✓ Assessment findings.
✓ occasional palpitations
✓ Hypotension
✓ angina with cardiovascular disease.
✓ Nursing management.
 ARRHYTHMIAS
✓ SINUS BRADYCARDIA
✓ Description. a heart rate less than 60 beats per minute
originating in the sinus node.
✓ Characteristics:
✓ Rate is less than 60 beats per minute.

✓ P waves precede each QRS complex.

✓ PR interval is normal.

✓ ORS complex is normal.

✓ Conduction is normal.

✓ Rhythm is regular.

✓ Etiology. include drugs, vagal stimulation, hypo endocrine

states, anorexia, and hypothermia or sinus node involvement
in myocardial infarction.
 ARRHYTHMIAS

✓ SINUS BRADYCARDIA
✓ Assessment findings.
✓ Fatigue
✓ Lightheadedness
✓ Syncope.

✓ Nursing management.
 ARRHYTHMIAS
✓ ATRIAL FIBRILLATION
✓ Description. disorganized and uncoordinated twitching of atrial musculature
caused by overly rapid production of atrial impulses.
✓ Characteristics:
✓ Rate. Atrial rate is 350 to 600 beats per minute; ventricular response rate is 120
to 200 beats per minute.
✓ P wave is not discernible, with an irregular baseline.
✓ PR interval is not measurable.
✓ QRS complex is normal.
✓ Conduction is normal through the ventricle and irregular through the
atrioventricular (AV) junction because of the overwhelming number of impulses
from the atria.
✓ Rhythm is irregular and usually rapid unless controlled.
 ARRHYTHMIAS
✓ ATRIAL FIBRILLATION
✓ Etiology. Causes are atherosclerosis, rheumatic mitral valve stenosis, heart
failure, congenital heart disease, chronic obstructive pulmonary disease,
hypothyroidism, and thyrotoxicosis.
✓ Assessment findings.
✓ Palpitations
✓ Dyspnea
✓ pulmonary edema
✓ signs of cerebrovascular insufficiency.
 ARRHYTHMIAS

✓ ATRIAL FIBRILLATION
✓ Uncontrolled atrial fibrillation with a ventricular rate over
100 bpm is at risk for low cardiac output caused by loss
of atrial kick.
✓ The nurse should assess for palpitations, chest pain or
discomfort, hypotension, pulse deficit, weakness, dizziness,
syncope, shortness of breath and distended neck veins.

✓ Flat neck veins may indicate hypovolemia. Nausea and

vomiting are associated with vagus nerve activity not
tachycardic state.
 ARRHYTHMIAS
✓ ATRIAL FIBRILLATION
✓ Nursing management. Administer the prescribed treatment to
decrease ventricular response, decrease atrial irritability, and eliminate
the cause.
✓ administer prescribed medication, which may include a cardiac
glycoside or a calcium channel blocker.
✓ Assist with cardioversion.
✓ For clients with chronic atrial fibrillation, implement anticoagulant
therapy, as appropriate, to prevent thrombo-emboli from forming
in the atria.
 ARRHYTHMIAS

✓ PREMATURE VENTRICULAR CONTRACTIONS

✓ Description. Early or premature ventricular
contractions (PVCs) are caused by increased
automaticity of ventricular muscle cells. PVCs
usually are not considered harmful but are of
concern if more than six occur in 1 minute, if they
occur in pairs or triplets, if they are multifocal, or if
they occur on or near a T wave.
 ARRHYTHMIAS
✓ PREMATURE VENTRICULAR CONTRACTIONS
✓ PVCs have the following characteristics:
✓ Rate. Underlying rhythm is usually 60 to 100 beats per minute.
✓ P wave. Underlying rhythm is normal; premature beat has no P wave.
✓ PR interval. Underlying rhythm is normal; premature beat has no PR
interval.
✓ QRS complex. Underlying rhythm is normal; premature beat is wide
and bizarre (0.1 second and may have one focus or a variety of foci
(multifocal), resulting in many different configurations.
✓ Conduction is retrograde through the conduction system.
✓ Rhythm is usually irregular when premature beat occurs; it may be in
a regular pattern, as in bigeminy.
✓ Premature beats followed by a compensatory pause
 ARRHYTHMIAS
✓ PREMATURE VENTRICULAR CONTRACTIONS
✓ Etiology. Causes of PVCs include factors linked to irritability of
ventricular muscle cells. including normal variance, exercise,
increased catecholamines, electrolyte imbalance, digoxin toxicity,
hypoxia, and myocardial damage.
✓ Assessment findings. PVCs may be asymptomatic, but clinical
manifestations may include:
✓ Palpitations

✓ Weakness

✓ Lightheadedness.
 ARRHYTHMIAS
✓ PREMATURE VENTRICULAR CONTRACTIONS
✓ Nursing management. Assess the cause (e.g. hypoxia, hypokalemia,
ischemia, pain) of PVCs and treat as indicated. Treatment is indicated if the
client has underlying disease because PVCs may precipitate ventricular
tachycardia or fibrillation.
✓ Assess for life-threatening PVCs (more than six PVCs per minute);
multifocal PVCs: a PVC every other beat (bigeminy), every third beat
(trigeminy), or every fourth beat (quadrigeminy): or PVCs that occur in a
vulnerable phase of conduction cycle (R on T), and administer lidocaine
immediately.
✓ Administer an antiarrhythmic medication, as prescribed. The medication
of choice is lidocaine or amiodarone. For long-term therapy,
procainamide or quinidine may be effective.
 ARRHYTHMIAS
✓ VENTRICULAR TACHYCARDIA
✓ Description. Ventricular tachycardia is three or more consecutive PVCs. It
is considered a medical emergency because CO cannot be maintained
because of decreased diastolic filling. It has the following characteristics:
✓ Rate is 100 to 250 beats per minute.
✓ P wave is blurred in the QRS complex, but the QRS complex has no
association with the P wave.
✓ PR interval is not present.
✓ ORS complex is wide and bizarre: T wave is in the opposite
direction.
✓ Conduction is abnormal through ventricular tissue.
✓ Rhythm is usually regular.
 ARRHYTHMIAS
✓ VENTRICULAR TACHYCARDIA
✓ Etiology. The cause is linked to irritability of ventricular muscle.
✓ Assessment findings
✓ Lightheadedness, weakness
✓ Dyspnea
✓ Unconsciousness
✓ Nursing management
✓ Administer an antiarrhythmic medication, as prescribed. If the client is
conscious, I.V. lidocaine may be indicated; if lidocaine is not successful,
procainamide or amiodarone may be indicated.
✓ If the client is conscious or if lidocaine is unsuccessful, assist with
cardioversion.
 ARRHYTHMIAS
✓ VENTRICULAR FIBRILLATION
✓ Description. Ventricular Fibrillation is rapid, ineffective quivering of ventricles that
may be rapidly fatal. This arrhythmia has the following characteristics:
✓ Rate is rapid and uncoordinated, with ineffective motions.
✓ P wave is not seen.
✓ PR interval is not seen.
✓ QRS complex is seen as an undulation with no specific pattern.
✓ Conduction is unorganized, with many foci firing at once.
✓ Rhythm is irregular without a pattern.
✓ Etiology. The cause of ventricular fibrillation is most commonly myocardial ischemia
or infarction. It also may result from untreated ventricular tachycardia, electrolyte
imbalances (eg., hypokalemia and hypercalcemia). digoxin or quinidine toxicity, or
hypothermia.
 ARRHYTHMIAS
✓ VENTRICULAR FIBRILLATION
✓ Assessment findings
✓ Loss of consciousness
✓ Pulselessness, Loss of BP, cessation of respirations
✓ Possible seizures
✓ Sudden death
✓ Nursing management
✓ Assist with defibrillation and CPR.
✓ Administer prescribed antiarrhythmic medications.
✓ Automated external devices are being placed in many stores, airlines,
organizations. and non acute care settings. These devices have defibrillator
pads that are placed on the client's chest and when the device detects
ventricular fibrillation it shocks the client automatically. This device is being used
by many laypersons with success.
Other Diseases and
Disorders
 Myocardial Infarction
✓ Description. Destruction of myocardial tissue, deprived of/inadequate
blood supply due to reduced coronary blood flow.
✓ Etiology
✓ Coronary artery narrowing - coronary artery spasm, or complete
arterial occlusion by embolism or thrombus.
✓ Decreased coronary blood flow causing an imbalance between
myocardial oxygen supply and demand.
 Myocardial Infarction

Pathophysiology.
✓ inadequate coronary blood flow/coronary circulation
✓ myocardial ischemia
✓ depresses cardiac function
✓ tissue necrosis and scar tissue formation, with permanent loss of
myocardial contractility in the affected area.
✓ Cardiogenic shock
✓ Myocardial infarction refers to death/ischemic changes in the heart
and this is not usually cause by normal activities.
Myocardial Infarction

✓ Clinical manifestations
✓ Chest pain
✓ Diaphoresis and cool, clammy, pale skin
✓ Nausea and vomiting
✓ Dyspnea with or without crackles
✓ Palpitations or syncope
Myocardial Infarction
✓ Clinical manifestations
✓ Restlessness and anxiety or feeling of impending
doom.
✓ Tachycardia or bradycardia
✓ Decreased blood pressure.
✓ Altered S3 heart sound (indicates left ventricular
failure)
✓ Most common complication is ventricular fibrillation –
that may lead to death
 Myocardial Infarction
✓ Nursing management
✓ Administer drug therapy.
✓ Administer prescribed medications, which may include morphine,
nitrates, antilipemic, thrombolytics, and anticoagulants in an acute
situation; or stool softeners during rehabilitation.
✓ Remember MONA: morphine, oxygen, nitroglycerin, and aspirin
for immediate treatment of a myocardial infarction.
✓ Provide ongoing assessment.
✓ Monitor cardiac enzymes.
✓ Monitor hemodynamic parameters as necessary through the
multi-lumen pulmonary artery catheter.
 Myocardial Infarction
✓ Nursing management
✓ Minimize anxiety. Reassure the client and explain procedures as the situation
warrants.
✓ Minimize metabolic demands. Institute a liquid diet; advance to a low-sodium,
low-cholesterol, low-fat, solid diet as tolerated. Prepare the client for treatment,
such as percutaneous transluminal coronary angioplasty and coronary artery
bypass grafting
✓ Provide client and family teaching.
✓ Encourage family members and significant others to take a cardiopulmonary
resuscitation course.
***An extension of an infarction can occur during convalescent period - After a client has one MI,
chances of recurrence in increased; therefore, indigestion as a result of MI may be one symptom
again; and this needs further assessment.
 Heart Failure

✓ Description
✓ Heart failure is a syndrome of pulmonary or systemic circulatory
congestion caused by decreased myocardial contractility,
✓ Heart failure classification
✓ Left-sided (or left ventricular)
✓ Right-sided (or right ventricular)
✓ Etiology - disorders producing decreased myocardial contractility
 Heart Failure
Pathophysiology
✓ Left-sided heart failure
✓ Congestion in the lungs from backup of blood into pulmonary veins and
capillaries because of left ventricular pump failure.
✓ As blood backs up into the pulmonary bed, increased hydrostatic pressure
causes fluid accumulation in the lungs. Blood flow is consequently
decreased to the brain, kidneys, and other tissues.
✓ Right-sided heart failure.
✓ Congestion in systemic circulation results from right ventricular pump failure.
✓ As blood backs up into systemic circulation, increased hydrostatic pressure
produces peripheral and dependent pitting edema. Venous congestion in
the kidneys, liver, and GI tract also develops.
 Heart Failure
✓ Clinical manifestations
✓ Left-sided heart failure
✓ Dyspnea on exertion, paroxysmal nocturnal dyspnea, or orthopnea
✓ Moist crackles on lung auscultation
✓ Frothy blood-tinged sputum
✓ Tachycardia with S3 heart sound
✓ Pale, cool extremities
✓ Peripheral and central cyanosis
✓ Decreased peripheral pulses and capillary refill time longer than 3 seconds
✓ Decreased urinary output (<30 ml/hour)
✓ Easy fatigability
✓ Insomnia and restlessness
 Heart Failure
✓ Clinical manifestations
✓ Right-sided heart failure
✓ Dependent pitting edema (peripheral and sacral)
✓ Weight gain
✓ Nausea and anorexia
✓ Jugular vein distention (JVD)
✓ Liver congestion (e.g, hepatomegaly), ascites, or weakness
✓ Coarse crackles, shortness of breath, and generalized cyanosis are signs
of congestion. The fluid in the lungs interferes with adequate
oxygenation.
 Heart Failure
✓ Nursing management
✓ Administer medications
✓ Provide ongoing assessment.
✓ Monitor hemodynamic parameters and heart rate and rhythm through the
multilumen pulmonary artery catheter.
✓ Weigh the client daily.
✓ Monitor serum electrolyte levels daily,
✓ Prevent complications of immobility.
✓ Provide a low-sodium diet, as prescribed
✓ Provide client and family teaching for the client with CAD.
 Acute Pulmonary Edema
✓ Description - condition of rapid fluid accumulation in the extravascular
(alveoli and interstitial) lung spaces. This condition is considered a medical
emergency.
✓ Etiology
✓ Major causes of acute pulmonary edema
✓ Left ventricular heart failure, myocardial infarction, or other cardiac
disorders
✓ Circulatory overload from infusions or transfusions
✓ Lung injury
Acute Pulmonary Edema
✓ Major causes of acute pulmonary edema
✓ Drug hypersensitivity, allergy, poisoning, or opioid overdose
✓ Central nervous system damage
✓ Pulmonary infections
✓ Certain procedures and treatments
 Acute Pulmonary Edema

✓ Pathophysiology.
✓ Engorged with blood, the pulmonary capillaries eventually cannot
hold their contents, and fluid leaks into adjacent alveoli or interstitial
spaces.
✓ Fluid accumulation causes the lungs to stiffen and impairs normal
expansion.
✓ Pulmonary edema from heart failure may be first manifested as a
cough. The cough occurs in response to fluid filling the alveolar
spaces. Pulmonary edema develops as a result of left ventricular
failure or acute fluid overload.
Good luck and GOD bless…