CARDIOVASCULAR DISORDERS

BY;Mr. M.K LAMBA M.Sc. Nsg

The cardio vascular disorders includes the disorders related to heart and blood vessels like infections of heart layers and heart, valvular disorders, arithmetic disorders etc.

HEART DISORDERS

PERICARDITISIt is an inflammation of the pericardium

the outer most covering the heart. It may be primary illness or a variety of medical and surgical disorders. It is an acute and chronic illness.

CAUSES OF PERICARDITIS: • Infections: viral, bacterial, parasitic, fungal• Myocardial injuries: cardiac trauma, surgery• Collagen diseases: Rheumatic fever,

scleroderma (connective tissue disease that involves changes in the skin, blood vessels, muscles, and internal organs), rheumatoid arthritis

• Drug reactions• Radiation therapy• Cobalt therapy• Anemia• Neoplasm

PAHOPHYSIOLOGY:Due to any of the above reason

↓ Either from infection or any other reason there

will be increased WBC and chance of fluid accumulation in the cavity

↓ Leads to dyspnea and pain aggravated by breathing due to pericardial compression

↓ Results in decrease cardiac output and cardiac

temponade

SIGNS AND SYMPTOMS• Pain: over precordium and may felt beneath of

clavicle, in neck and pain left to scapular region.

• Pain aggravated by breathing, relieving by sitting

• Dyspnea may occur as a result of pericardial compression which leads to decreased cardiac output

• Fever may be present. • ↑ WBC count

• Echocardiogram: accurately detects all pericardial effusions and provides clinically relevant information about their size and hemodynamic.

• Magnetic resonance imaging (MRI) and computed tomography (CT) in detecting pericardial thickening/ constriction and calcification as well as small loculated effusions is extremely useful in these conditions.

MEDICAL MANAGEMENT: Analgesics to relieve pain NSAID (Non steroidal anti- inflammatory agents): eg.

Spirin, Indomethacin (Indocin) These drugs with analgesic and antipyretic effects and which have, in higher doses, anti-inflammatory effects.

Corticosteroids: are two types; 1. Gluco-corticoids such as cortisol control carbohydrate, fat

and protein metabolism and are anti-inflammatory by preventing phospho- lipid release, decreasing eosinophil action and a number of other mechanisms.

2. Mineralo-corticoids such as aldosterone control electrolyte and water levels, mainly by promoting sodium retention.

MYOCARDITISIt is an inflammatory process of myocardium It

may cause heart dilation, thrombi on the heart wall, infiltration of blood cells around the coronary vessels and between the muscle fibers and degeneration of the muscle fibers themselves.

CAUSES

• Infections• Rheumatic fever• Immunosuppressive therapy• Infective endocarditis• Dilated cardiomyopathy

SIGNS AND SYMPTOMS

FatigueDyspnea PalpitationOccasionally discomfort in chest and abdomenMay have sudden congestive cardiac failure

due to the damage of myocardial tissues.

DIAGNOSTIC FINDING

Auscultation; it shows faint heart sound and systolic murmur.

Pulsus alternans (a pulse in which there is regular alteration of weak and strong beats).

Fever TachycardiaSymptoms of CHFEndomyocardial biopsy

MEDICAL MANAGEMENTBed rest the patient to decrease cardiac work load

and to decrease myocardium damage.Penicillin antibiotic to treat streptococciIf CHF Treatment;

• ACE (angiotension converting enzyme) promote vasodilation which leads to diuresis.• Digitalis like digoxin, medication increase the force of

myocardial contraction and slows down the conduction through AV needs• Dobutamin which increases cardiac contractility

ENDOCARDITISEndocarditis is an inflammation of endocardium,

especially the valves. It is common in old age due to the decreased immunologic response.

The types;i. Sub acute bacterial endocarditis: develop

gradually in several weeks to months caused by streptoccus viridans.

ii. Acute bacterial endocarditis: develop in days to weeks caused by staphylococcus aurens.

iii. Native valve endocarditis: Caused to a damaged valve.

iv. Non bacterial thrombotic endocarditis: caused by thrombotic lesions.

ETIOLOGY• Infection by an organism; staphylococcus,

streptococci and fungi etc.• Structural abnormalities of heart and great blood

vessels.• History of infective endocarditis.• Rheumatic fever• Valvalar dysfunction• Cardiomyopathy

Some procedures may cause bacterial entry;• Dental procedure• Tonsillectomy• Bronchoscopy• Esophageal varices• Esophageal dilation• Gall bladder surgery• Cystoscopy• Urethral catheterization• UTI surgery

PATHOPHYSIOLOGY

Micro organism enter into the blood stream through any way

Once the colonization of bacteria begins on endothelium and within layers of platelets

Bacteria stimulate immune system to produce antibodies

But bacteria protected by fibrin and form clots

Bacteria severely damage heart valves by deforming leaflets

The amount of damage depends on the type of organism causing infection

SIGN AND SYMPTOMS• Due to infection the symptoms are; Fever Chills Weakness Anorexia Wt loss Pallor Backache Splenomegaly Headache Joint pain

• Due to complications; Systemic embolization occur in 30-40% of clients with left

sided endocarditis. Stroke, aphasia (impaired speech), ataxia (lack of muscular

coordination). Loss of vision due to embolization of the brain or retinal artery. Petechiae (hemorrhagic spots) on neck, conjunctiva, chest,

abdomen and mouth. Pulmonary embolus Finger clubbing Cardiac murmur Finally heart failure.

DIAGNOSTIC FINDINGPhysical examinationAuscultation – cardiac murmurBlood cultureECG and echoCBCChest x- ray

MEDICAL MANAGEMENTEradicating the infective organism- by antibioticsProper treating complicationAnti micro bacterial therapy - Penicillin - Gentamicin