CARDIOVASCULAR

SYSTEM
DISORDERS
ANGINA
 Cardiovascular System Disorders
Angina
Angina is the medical term for chest pain or discomfort caused by a
temporary disruption in the flow of blood and oxygen to the heart. People
describe angina discomfort as a squeezing, suffocating or burning feeling –
usually in the centre of the chest, behind the breastbone.

Key facts about angina Angina or a heart attack?

It’s your heart telling you that If you are experiencing chest pain
it needs more oxygen. for the first time, seek medical
You need to stop what you’re attention immediately. If you
doing, rest and/or take your have already been diagnosed with
medication. angina and you are experiencing
It’s almost always a sign that unusual symptoms, or if your
you have blocked arteries and medication isn’t working, see a
heart disease. healthcare provider immediately.
It’s usually a short-lived You could be experiencing the
event – lasting for a few emergency signs of a heart attack.
minutes.
It’s a warning that without What does angina feel like?
treatment, you are at risk for
heart attack, irregular Often during physical activity
heartbeat (arrhythmia) and or stress.
cardiac arrest When you are in a very cold
(cardiopulmonary arrest). place.
After a large meal.
 Types of angina
The two most common types of angina are stable and unstable. Stable
angina (angina pectoris) can be managed with medication and lifestyle
changes. Unstable angina may not respond to rest or nitroglycerin. It
needs urgent attention.

Stable angina Unstable angina

Usually lasts 5 minutes; rarely Often happens while you are
more than 15 minutes. resting.
Triggered by physical activity, It occurs suddenly. You feel chest
emotional stress, heavy pain you did not have before.
meals, extreme cold or hot Discomfort lasts longer than
weather. stable angina (more than 20
Relieved within 5 minutes by minutes).
rest, nitroglycerin or both. Not relieved by rest or
Pain in the chest that may nitroglycerin.
spread to the jaw, neck, arms, Episodes may get worse over
back or other areas. time.
May feel like the burning What you can do if you experience
sensation of heartburn or an episode of unstable angina:
indigestion. Unstable angina should be
What you can do if you treated as a medical emergency.
experience an episode of stable Your doctor will do tests to find
angina: out if you are experiencing
Track what triggers it. unstable angina.
Record how long it lasts. You may need medical treatment
Note what helped ease the to prevent a heart attack.
pain.

Causes
Angina occurs when there’s not enough blood flow to the heart as a
result of heart disease. Without enough blood, the heart doesn’t
get enough oxygen. This triggers the chest pain.
Angina pain can be triggered by:
physical activity
exercise
emotional stress
extreme temperatures (either hot or cold)
heavy meals
drinking alcohol
smoking

Symptoms
Angina symptoms can vary from person to person, between men and
women (see below), and by the type of angina you have. The main
symptoms of angina are:
Shortness of breath or difficulty breathing
Pain
Tightness, pressure or discomfort in the centre of the chest
Ache or discomfort in areas other than the chest: jaw, shoulder,
arms or back
A burning sensation that feels like indigestion or heartburn
Burning or cramping pain
More common in women – vague pain, pain in the neck or throat
Fatigue
Be aware Women may describe their angina symptoms differently
than men. They are more likely to experience:
vague pain in the centre of the chest
pain in the neck or tightness in the throat
the feeling of a panic attack, anxiety
dizziness, fainting
sweating at night
fatigue
When to call your doctor If you have chest pain that is new,
worsening or constant, seek medical care immediately. You are at
greater risk of:
heart attack
irregular heartbeat (arrhythmia)
cardiac arrest
 CORONARY
ARTERY DISEASE
(CAD)
 Coronary Artery disease (CAD)
Coronary artery disease (CAD), or coronary heart disease, develops when
the coronary arteries become too narrow or cholesterol blockages develop
in the walls. The coronary arteries are the blood vessels that supply
oxygen and blood to the heart.
CAD tends to develop when cholesterol builds up on the artery walls,
creating plaques. These plaques cause the arteries to narrow, reducing
blood flow to the heart, or can cause inflammation in and hardening of the
walls of the blood vessel. A clot can sometimes obstruct blood flow,
causing serious health problems.

Coronary arteries form the network of blood vessels on the surface of the
heart that feeds it oxygen. If these arteries narrow, the heart may not
receive enough oxygen-rich blood, especially during physical activity.
CAD can sometimes lead to a heart attack. According to the Centers for
Disease Control and Prevention, it is the most common type of heart
disease Trusted Source in the United States, where it accounts for more
than 655,000 deaths Trusted Source every year.
 Causes Symptoms
CAD develops as a result of injury CAD develops as a result of injury
or damage to the inner layer of a or damage to the inner layer of a
coronary artery. This damage coronary artery. This damage
causes fatty deposits of plaque to causes fatty deposits of plaque to
build up at the injury site. build up at the injury site.

These deposits consist of These deposits consist of

cholesterol and other inflammatory cholesterol and other inflammatory
products from cells. This buildup is products from cells. This buildup is
called atherosclerosis. called atherosclerosis.

If pieces of plaque break off or If pieces of plaque break off or

rupture, platelets will cluster in the rupture, platelets will cluster in the
area in an attempt to repair the area in an attempt to repair the
blood vessel. This cluster can block blood vessel. This cluster can block
the artery and reduce or block the artery and reduce or block
blood flow, which may lead to a blood flow, which may lead to a
heart attack. heart attack.

Complications
A heart attack occurs when the heart muscle does not have enough blood
or oxygen, such as when a blood clot develops from plaque in one of the
coronary arteries.
The formation of a blood clot is called coronary thrombosis. This clot, if it
is big enough, can completely stop the supply of blood to the heart in
that blood vessel.
Symptoms of a heart attack include:
chest discomfort
mild or crushing chest pain
coughing
dizziness
shortness of breath
a gray pallor in the face
 general discomfort
panic
nausea and vomiting
restlessness
sweating
clammy skin
The first symptom is usually chest pain that spreads to the neck, jaw, ears,
arms, and wrists, and possibly to the shoulder blades, back, or abdomen.
Symptoms can be more atypical in women.
Changing position, resting, or lying down is unlikely to bring relief. The
pain is often constant but may come and go. It can last from a few minutes
to several hours.
A heart attack is a medical emergency that can result in death or
permanent heart damage. If a person is showing symptoms of a heart
attack, it is vital to call emergency services immediately.

Treatment
There is no cure for CAD. However, there are ways that a person can
manage the condition.
Treatment tends to involve making positive lifestyle changes, such as
quitting smoking, adopting a healthy diet, and getting regular exercise.
Doctors may also prescribe medications to prevent the progression of
CAD.
However, some people may need to undergo medical procedures.

Prevention
Controlling blood cholesterol levels can help reduce a person’s risk of
CAD. To better control blood cholesterol levels, consider:
being more physically active
limiting alcohol intake
avoiding tobacco
adopting a diet with less sugar, salt, and saturated fats
People who already have CAD should ensure that they control these
factors by following the doctor’s recommendations.
 Risk factors
The following factors increase a person’s risk of developing CAD:
having high blood pressure, or hypertension
having high levels of low-density lipoprotein, or “bad,” cholesterol
having low levels of high-density lipoprotein, or “good,” cholesterol
having diabetes, in which the body cannot effectively remove sugar
from the bloodstream
having obesity
smoking, which increases inflammation and increases cholesterol
deposits in the coronary arteries
Some risk factors are not lifestyle-related. These may include:
having high levels of the amino acid homocysteine, which one 2015
study Trusted Source linked to a higher incidence of CAD
having high levels of fibrinogen, a blood protein that encourages the
clumping of platelets to form blood clots
having a family history of CAD, with early onset (before 55 years for
male relatives, before 65 years for female relatives)
for women, having been through premature menopause
for men, being over 45 years of age

Diagnosis
A doctor can perform a physical examination, take a thorough medical
history, and order a number of tests to diagnose CHD and other types of
heart disease. Example of tests include:

Electrocardiogram: This records the electrical activity and rhythm of the

heart.
Holter monitor: This is a portable device that a person wears under their
clothes for two days or more. It records all the electrical activity of the
heart, including the heartbeat.
Echocardiogram: This is an ultrasound scan that monitors the pumping
heart. It uses sound waves to provide a video image.
Stress test: This may involve the use of a treadmill or medication that
stresses the heart in order to test how it functions when a person is active.
Coronary catheterization: A specialist will inject dye through a catheter
they have threaded through an artery, often in the leg or arm. The dye
shows narrow spots or blockages on an X-ray.
CT scans: These help the doctor visualize the arteries, detect calcium within
fatty deposits, and characterize any heart anomalies.
Nuclear ventriculography: This uses tracers, or radioactive materials, to
create an image of the heart chambers. A doctor will inject the tracers into
the vein. The tracers then attach to red blood cells and pass through the
heart. Special cameras or scanners trace the movement of the tracers.
Blood tests: Doctors can run these to measure blood cholesterol levels,
especially in people at risk of high blood cholesterol levels.

The usual cause is the buildup of plaque. This causes coronary arteries to
narrow, limiting blood flow to the heart. Coronary artery disease can range
from no symptoms, to chest pain, to a heart attack.

It is important to reduce or control your risk factors and seek treatment to

lower the chance of a heart attack or stroke if you are diagnosed with CAD.
Schedule a consultation with our doctors to address your CAD.
 PERIPHERAL
ARTERY DISEASE
(PAD)
 Peripheral Artery Disease (PAD)
Peripheral artery disease (PAD) is plaque buildup in your leg arteries. Your
leg arteries carry oxygen and nutrient-rich blood from your heart to your
arms and legs. Other names for this are peripheral vascular disease or
peripheral arterial disease.
Shaped like hollow tubes, arteries have a smooth lining that prevents blood
from clotting and promotes steady blood flow. When you have peripheral
artery disease, plaque (made of fat, cholesterol and other substances) forms
gradually inside your artery walls. Slowly, this narrows your arteries. This
plaque is also known as atherosclerosis.

Many plaque deposits are hard on the outside and soft on the inside. The
hard surface can crack or tear, allowing platelets (disc-shaped particles in
your blood that help it clot) to come to the area. Blood clots can form around
the plaque, making your artery even narrower.
If plaque or a blood clot narrows or blocks your arteries, blood can’t get
through to nourish organs and other tissues. This causes damage ― and
eventually death (gangrene) ― to the tissues below the blockage. This
happens most often in your toes and feet.
PAD can get worse faster in some people more than others. Many other
factors matter, including where in your body the plaque forms and your
overall health.
 Peripheral Artery Disease (PAD) Symptoms
The most common symptom of
peripheral artery disease is leg pain
during exercise or when at rest (usually
felt in the calves or thighs).

Other symptoms include:

Cold hands or feet

Tingling, numbness, or burning pain
in your hands or feet
Pain that doesn’t go away with rest
(that may be worse in the morning)
Cramping muscle pain in the calves The image on the left shows
when walking uphill or downhill a normal artery. The right
Pain that gets worse with time shows an artery narrowed
Swelling in your feet and legs by atherosclerosis, causing
Feeling tired after walking short PAD.
distances

Stages of peripheral artery disease

Healthcare providers can use two different systems — Fontaine and
Rutherford — to assign a stage to your PAD. The Fontaine stages, which
are simpler, are:

I: Asymptomatic (without symptoms).

IIa: Mild claudication (leg pain during exercise)

.
IIb: Moderate to severe claudication.

III: Ischemic rest pain (pain in your legs when you’re at rest).

IV: Ulcers or gangrene.

 Complications of peripheral artery disease
Without treatment, people with PAD may need an amputation — the
removal of part or all of your foot or leg (rarely your arm), especially in
people who also have diabetes.
Because your body’s circulatory system is interconnected, the effects of PAD
can extend beyond the affected limb. People with atherosclerosis of their
legs often have it in other parts of their bodies.

Common cause of peripheral artery disease

Atherosclerosis that develops in the arteries of your legs — or, less
commonly, your arms — causes peripheral arterial disease. Like
atherosclerosis in your heart (coronary) arteries, a collection of fatty
plaque in your blood vessel walls causes peripheral vascular disease. As
plaque builds up, your blood vessels get narrower and narrower, until
they’re blocked.

Risk factors for peripheral artery disease

Compared with nonsmokers of the same age, people who smoke and have
PAD are more likely to:
Die of heart attack or stroke.
Have poorer results with bypass surgery procedures on their legs.
Have a limb amputation.
Regardless of your sex, you’re at risk of developing peripheral arterial
disease when you have one or more of these risk factors:
Using tobacco products (the most potent risk factor).
Having diabetes.
Being age 50 and older.
Being African American.
Having a personal or family history of heart or blood vessel disease.
Having high blood pressure (hypertension).
Having high cholesterol (hyperlipidemia).
Having abdominal obesity.
Having a blood clotting disorder.
Having kidney disease (both a risk factor and a consequence of PAD).
 Peripheral Artery Disease (PAD) Treatment
Treatment for peripheral artery disease (PAD) includes a variety of
interventions, involving lifestyle changes, medications, and surgery. Some
of these surgeries include amputation, atherectomy, and percutaneous
transluminal angioplasty (for larger blood vessels or necrosis cases)

Peripheral Artery Disease (PAD) Nursing Interventions

Nurses can encourage clients to:
Eat low-fat diets
Exercise regularly
Avoid smoking cigarettes and drinking alcohol
Control blood pressure with medication (if necessary)
Maintain a healthy weight
Wear compression stockings or anti-embolic devices (during air travel
and long periods of sitting.)

For improved skin integrity, increased circulation, and reduced discomfort,

nursing goals for PAD clients include:
Avoiding extreme cold and dressing loosely.
Not smoking.
Avoiding bending the knees or crossing legs (may restrict blood flow).
Taking antiplatelets, anticoagulants, or cholesterol drugs, as prescribed.
Avoiding wearing clothing or shoes that are too restrictive.
Following a low-fat diet and including exercise.
 HIGH BLOOD
PRESSURE
(HYPERTENSION)
 High Blood Pressure (Hypertension)
Narrow blood vessels, also known as arteries, create more resistance for
blood flow. The narrower your arteries are, the more resistance there is,
and the higher your blood pressure will be. Over the long term, the
increased pressure can cause health issues, including heart disease.
Hypertension is quite common. In fact, since the guidelines changed in
2017, nearly half of American adults could now be diagnosed with this
condition.
Hypertension typically develops over the course of several years. Usually,
you don’t notice any symptoms. But even without symptoms, high blood
pressure can cause damage to your blood vessels and organs, especially the
brain, heart, eyes, and kidneys.
Early detection is important. Regular blood pressure readings can help you
and your doctor notice any changes. If your blood pressure is elevated,
your doctor may have you check your blood pressure over a few weeks to
see if the number stays elevated or falls back to normal levels.
Treatment for hypertension includes both prescription medication and
healthy lifestyle changes. If the condition isn’t treated, it could lead to
health issues, including heart attack and stroke.

Blood Pressure Ranges

Blood Pressure SYSTOLIC DIASTOLIC
Category (mm Hg) (mm Hg)

Healthy Less Than 120 and Less Than 80

Elevated 120 - 129 and Less Than 80

Stage 1 Hypertension 130 - 139 or 80 - 89

Stage 2 Hypertension 140 or Higher or 90 or higher

Hypertension Crisis Over 180 or over 120

 Categories define blood pressure
Five categories define blood pressure readings for adults:
Healthy
A healthy blood pressure reading is less than 120/80 millimeters of mercury
(mm Hg).
Elevated
The systolic number is between 120 and 129 mm Hg, and the diastolic
number is less than 80 mm Hg. Doctors usually don’t treat elevated blood
pressure with medication. Instead, your doctor may encourage lifestyle
changes to help lower your numbers.
Stage 1 hypertension
The systolic number is between 130 and 139 mm Hg, or the diastolic
number is between 80 and 89 mm Hg.
Stage 2 hypertension
The systolic number is 140 mm Hg or higher, or the diastolic number is 90
mm Hg or higher.
Hypertensive crisis
The systolic number is over 180 mm Hg, or the diastolic number is over 120
mm Hg. Blood pressure in this range requires urgent medical attention. If
any symptoms like chest pain, headache, shortness of breath, or visual
changes occur when blood pressure is this high, medical care in the
emergency room is needed

Categories define blood pressure

Hypertension is generally a silent condition. Many people won’t
experience any symptoms. It may take years or even decades for the
condition to reach levels severe enough that symptoms become obvious.
Even then, these symptoms may be attributed to other issues.

Symptoms Trusted Source of severe hypertension can include:

flushing
blood spots in the eyes (subconjunctival hemorrhage)
dizziness
 Causes of high blood pressure
There are two types of hypertension. Each type has a different cause.

Primary hypertension Secondary hypertension

Essential hypertension is also called
primary hypertension. This kind of Secondary hypertension often
hypertension develops over time. occurs quickly and can become
Most people have this type of high more severe than primary
blood pressure. hypertension. Several
A combination of factors typically conditionsTrusted Source that may
play a role in the development of cause secondary hypertension
essential hypertension: include:
Genes
Some people are genetically kidney disease
predisposed to hypertension. This obstructive sleep apnea
may be from gene mutations or congenital heart defects
genetic abnormalities inherited problems with your thyroid
from your parents. side effects of medications
Age use of illegal drugs
Individuals over 65 years old are chronic consumption of alcohol
more at risk for hypertension. adrenal gland problems
Race: Black non-Hispanic indiviuals certain endocrine tumors
have a higher incidence of
hypertension.
Living with obesity
Living with obesity can lead to a few
cardiac issues, including
hypertension.
High alcohol consumption
Women who habitially have more
than one drink per day, and men
who have more than two drinks per
day, may be at an increased risk for
hypertension.
SHOCK
 Shock
The term “shock” may refer to a psychologic or a physiologic type of shock.
Psychologic shock is caused by a traumatic event and is also known as
acute stress disorder. This type of shock causes a strong emotional
response and may cause physical responses as well.
The focus of this article is on the multiple causes of physiologic shock.
Your body experiences shock when you don’t have enough blood
circulating through your system to keep organs and tissues functioning
properly.
It can be caused by any injury or condition that affects the flow of blood
through your body. Shock can lead to multiple organ failure as well as life-
threatening complications.
There are many types of shock. They fall under four main categories, based
on what has affected the flow of blood. The four major types are:

1. Obstructive shock
2. Cardiogenic shock
3. Distributive shock
4. Hypovolemic shock
All forms of shock are life-threatening.

Signs and Symptoms

rapid, weak, or absent pulse confusion
irregular heartbeat anxiety
rapid, shallow breathing decrease in urine
lightheadedness thirst and dry mouth
cool, clammy skin low blood sugar
dilated pupils loss of consciousness
lackluster eyes
chest pain
nausea
 Causes of shock
Anything that affects the flow of blood through your body can cause shock.
Some causes of shock include:
severe allergic reaction blood infections
significant blood loss dehydration
heart failure poisoning
burns

Types of shock
1. There are four major types of shock, each of which can be caused by a
number of different events.
2. Obstructive shock 3. Distributive shock
3. Cardiogenic shock 4. Hypovolemic shock

Obstructive shock Cardiogenic shock

Obstructive shock occurs when Damage to your heart can
blood can’t get where it needs to decrease the blood flow to your
go. A pulmonary embolism is one body, leading to cardiogenic
condition that may cause an shock. Common causes of
interruption to blood flow. cardiogenic shock include:
Conditions that can cause a
buildup of air or fluid in the damage to your heart muscle
chest cavity can also lead to irregular heart rhythm
obstructive shock. These include: very slow heart rhythm
pneumothorax (collapsed
lung)
hemothorax (blood collects
in the space between the
chest wall and lung)
cardiac tamponade (blood or
fluids fill the space between
the sac that surrounds the
heart and the heart muscle)
 Distributive shock
Conditions that cause your blood vessels to lose their tone can cause
distributive shock. When your blood vessels lose their tone, they can
become so open and floppy that not enough blood pressure supplies your
organs. Distributive shock can result in symptoms including:
flushing
low blood pressure
loss of consciousness
There are a number of types of distributive shock, including the
following:
Anaphylactic shock
is a complication of a severe allergic reaction known as anaphylaxis.
Allergic reactions occur when your body mistakenly treats a harmless
substance as harmful. This triggers a dangerous immune response.
Anaphylaxis is usually caused by allergic reactions to food, insect venom,
medications, or latex.
Septic shock
is another form of distributive shock. Sepsis, also known as blood
poisoning, is a condition caused by infections that lead to bacteria
entering your bloodstream. Septic shock occurs when bacteria and their
toxins cause serious damage to tissues or organs in your body.
Neurogenic shock
is caused by damage to the central nervous system, usually a spinal cord
injury. This causes blood vessels to dilate, and the skin may feel warm and
flushed. The heart rate slows, and blood pressure drops very low.
Drug toxicities and brain injuries can also lead to distributive shock.

Hypovolemic shock
Hypovolemic shock happens when there isn’t enough blood in your
blood vessels to carry oxygen to your organs. This can be caused by
severe blood loss, for example, from injuries.
Your blood delivers oxygen and vital nutrients to your organs. If
you lose too much blood, your organs can’t function properly.
Serious dehydration can also cause this type of shock.
 How is shock diagnosed?
First responders and doctors often recognize shock by its external
symptoms. They may also check for:
low blood pressure
weak pulse
rapid heartbeat
Once they’ve diagnosed shock, their first priority is to provide lifesaving
treatment to get blood circulating through the body as quickly as
possible. This can be done by giving fluid, drugs, blood products, and
supportive care. It won’t resolve unless they can find and treat the
cause.
Once you’re stable, your doctor can try to diagnose the cause of shock.
To do so, they may order one or more tests, such as imaging or blood
tests.

Imaging tests
Your doctor may order imaging tests to check for injuries or damage to
your internal tissues and organs, such as:
bone fractures
organ ruptures
muscle or tendon tears
abnormal growths
Such tests include:
ultrasound
X-ray
CT scan
MRI scan

Blood tests
Your doctor may use blood tests to look for signs of:
significant blood loss
infection in your blood
drug or medication overdose
HEART FAILURE
 Heart failure
Overview
Heart failure — sometimes known as congestive heart failure — occurs
when the heart muscle doesn't pump blood as well as it should. When this
happens, blood often backs up and fluid can build up in the lungs, causing
shortness of breath.
Certain heart conditions, such as narrowed arteries in the heart (coronary
artery disease) or high blood pressure, gradually leave the heart too weak
or stiff to fill and pump blood properly.
Proper treatment can improve the signs and symptoms of heart failure
and may help some people live longer. Lifestyle changes — such as losing
weight, exercising, reducing salt (sodium) in your diet and managing
stress — can improve your quality of life.
However, heart failure can be life-threatening.
People with heart failure may have severe symptoms,
and some may need a heart transplant or a ventricular
assist device (VAD).
One way to prevent heart failure is to prevent
and control conditions that can cause it,
such as coronary artery disease, high
blood pressure, diabetes and obesity.

Symptoms
Heart failure can be ongoing (chronic), or it may start suddenly (acute).
Heart failure signs and symptoms may include:
Shortness of breath with activity or when lying down
Fatigue and weakness
Swelling in the legs, ankles and feet
 Rapid or irregular heartbeat
Reduced ability to exercise
Persistent cough or wheezing with white or pink blood-tinged mucus
Swelling of the belly area (abdomen)
Very rapid weight gain from fluid buildup
Nausea and lack of appetite
Difficulty concentrating or decreased alertness
Chest pain if heart failure is caused by a heart attack

Causes
Heart failure often develops after other conditions have damaged or
weakened the heart. However, heart failure can also occur if the heart
becomes too stiff.
In heart failure, the main pumping chambers of the heart (the ventricles)
may become stiff and not fill properly between beats. In some people, the
heart muscle may become damaged and weakened. The ventricles may
stretch to the point that the heart can't pump enough blood through the
body.
Over time, the heart can no longer keep up with the typical
demands placed on it to pump blood to the rest of the body. Heart
failure can involve the left side (left ventricle), right side (right
ventricle) or both sides of your heart. Generally, heart failure begins
with the left side, specifically the left ventricle — your heart's main
pumping chamber
 Types of heart failure
Types of heart failure Description

Fluid may back up in the lungs,

Left-sided heart failure
causing shortness of breath.

Fluid may back up into the abdomen,

Right-sided heart failure
legs and feet, causing swelling.

Systolic heart failure (also

The left ventricle can't contract
called heart failure with
vigorously, indicating a pumping problem.
reduced ejection fraction)

Heart failure with The left ventricle can't relax or fill

preserved ejection fraction fully, indicating a filling problem.

Any of the following conditions can damage or weaken your heart and can
cause heart failure. Some of these can be present without your knowing it:
Coronary artery disease and heart attack.
Coronary artery disease is the most common form of heart disease and the
most common cause of heart failure. The disease results from the buildup
of fatty deposits in the arteries, which reduces blood flow and can lead to
heart attack.
A heart attack occurs suddenly when a coronary artery becomes
completely blocked. Damage to your heart muscle from a heart attack may
mean that your heart can no longer pump as well as it should.
High blood pressure.
If your blood pressure is high, your heart has to work harder than it should
to circulate blood throughout your body. Over time, this extra exertion can
make your heart muscle too stiff or too weak to properly pump blood.
Faulty heart valves.
The valves of the heart keep blood flowing in the proper direction. A
damaged valve — due to a heart defect, coronary artery disease or heart
infection — forces the heart to work harder, which can weaken it over
time.
 Damage to the heart muscle.
Heart muscle damage can have many causes, including certain diseases,
infection, heavy alcohol use, and the toxic effect of drugs, such as cocaine
or some drugs used for chemotherapy. Genetic factors also can play a role.
Inflammation of the heart muscle (myocarditis).
Myocarditis is most commonly caused by a virus, including the COVID-19
virus, and can lead to left-sided heart failure.
A heart problem that you're born with (congenital heart defect).
If your heart and its chambers or valves haven't formed correctly, the
healthy parts of your heart have to work harder to pump blood, which may
lead to heart failure.
Abnormal heart rhythms (arrhythmias).
Abnormal heart rhythms may cause your heart to beat too fast, creating
extra work for your heart. A slow heartbeat also may lead to heart failure.
Other diseases.
Long-term diseases — such as diabetes, HIV, an overactive or underactive
thyroid, or a buildup of iron or protein — also may contribute to chronic
heart failure.
Causes of sudden (acute) heart failure also include:
Allergic reactions
Any illness that affects the whole body
Blood clots in the lungs
Severe infections
Use of certain medications
Viruses that attack the heart muscle

Type of heart failure

A single risk factor may be enough to cause heart failure, but a combination
of factors also increases your risk.
Risk factors for heart failure include:
Coronary artery disease.
Narrowed arteries may limit your heart's supply of oxygen-rich blood,
resulting in weakened heart muscle.
Heart attack. A heart attack is a form of coronary artery disease that occurs
suddenly. Damage to your heart muscle from a heart attack may mean your
heart can no longer pump as well as it should.
Heart valve disease.
Having a heart valve that doesn't work properly raises the risk of heart
failure.
High blood pressure.
Your heart works harder than it has to if your blood pressure is high.
Irregular heartbeats.
These abnormal rhythms, especially if they are very frequent and fast, can
weaken the heart muscle and cause heart failure.
Congenital heart disease.
Some people who develop heart failure were born with problems that
affect the structure or function of their heart.
Diabetes.
Having diabetes increases your risk of high blood pressure and coronary
artery disease. Don't stop taking any medications on your own. Ask your
doctor whether you should make changes.
Some diabetes medications.
The diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) have
been found to increase the risk of heart failure in some people. Don't stop
taking these medications on your own, though. If you're taking them, ask
your doctor if you need to make any changes.
Certain other medications.
Some medications may lead to heart failure or heart problems. They
include nonsteroidal anti-inflammatory drugs (NSAIDs); certain
anesthesia medications; and certain medications used to treat high blood
pressure, cancer, blood conditions, irregular or abnormal heartbeats,
nervous system diseases, mental health conditions, lung and urinary
problems, inflammatory diseases, and infections.
Alcohol use.
Drinking too much alcohol can weaken the heart muscle and lead to heart
failure.
Sleep apnea.
The inability to breathe properly while you sleep results in low blood-
oxygen levels and an increased risk of irregular heartbeats. Both of these
problems can weaken the heart.
 Smoking or using tobacco.
If you smoke, quit. Using tobacco increases your risk of heart disease and
heart failure.
Obesity.
People who have obesity have a higher risk of developing heart failure.
Viruses. Certain viral infections can cause damage to the heart muscle.

Complications
Complications of heart failure depend on the severity of heart disease, your
overall health and other factors such as your age. Possible complications
can include:
Kidney damage or failure.
Heart failure can reduce the blood flow to your kidneys, which can
eventually cause kidney failure if left untreated. Kidney damage from heart
failure can require dialysis for treatment.
Heart valve problems.
The valves of the heart, which keep blood flowing in the right direction,
may not work properly if your heart is enlarged or if the pressure in your
heart is very high due to heart failure.
Heart rhythm problems.
Heart rhythm problems may lead to or increase your risk of heart failure.
Liver damage.
Heart failure can cause fluid buildup that puts too much pressure on the
liver. This fluid backup can lead to scarring, which makes it more difficult
for your liver to work properly.

Prevention
Lifestyle changes you can make to help prevent heart failure include:
Not smoking
Controlling certain conditions, such as high blood pressure and diabetes
Staying physically active
Eating healthy foods
Maintaining a healthy weight
Reducing and managing stress
 CARDIAC
MEDICATIONS
 Cardiac Medications
Sacubitril/valsartan
This is the first in a class of heart Nursing points:
failure medication called angiotensin Sacubitril/valsartan should not be
receptor neprilysin inhibitors. It given with an ACE inhibitor.
combines an angiotensin receptor
blocker (valsartan) with a neprilysin Adverse effects:
enzyme inhibitor (sacubitril). Adverse effects include dizziness,
Neprilysin breaks down natriuretic fatigue, cough, hypotension, and
peptides, which are responsible for hyperkalemia.
sodium and water loss when Indications:
ventricles are overloaded. Delaying Sacubitril/valsartan is indicated
their breakdown lengthens their to reduce the risk of
effects and removes more sodium hospitalization and death in
and water from the body, decreasing patients with chronic heart
intravascular volume and blood failure and reduced ejection
pressure, resulting in decreased fraction.
preload and afterload.

Angiotensin receptor blockers

Similar to ACE inhibitors, ARBs block the Nursing points:
action of angiotensin II. However, they work ARBs and ACE inhibitors
at a different level of interaction with angio shouldn’t be used
ten – sin II, reducing the risk of hyperkalemia interchangeably. ACE
or cough that’s seen with ACE inhibitors. inhibitors are preferred
ARBs block angiotensin II receptors in the over ARBs because they’re
blood vessels and the adrenal glands. In the associated with a decrease
blood vessels, ARBs cause venous and arterial in morbidity and mortality.
dilation to reduce both preload and afterload.
Blocking angiotensin II receptors in the
Adverse effects:
ARBs are well tolerated
adrenal glands decreases the release of
and have minimal side
aldosterone, which in turn increases the
effects.
excretion of sodium and water.
 Beta-blockers
Beta-blockers block the effects of Nursing points:
adrenaline, which comes on in Fluid retention may worsen heart
response to stressful situations. failure but can usually be managed
Beta-blockers are prescribed in the with diuretics. If bradycardia or
treatment of these four conditions: hypotension are problematic, the
Angina. provider may reduce the beta
Heart attack. blocker dose. Because of decreased
Congestive heart failure. heart rate and blood pressure
Abnormal heart rhythms. associated with beta blockers, they
Dosage of these medications must shouldn’t be administered at the
be adjusted for the desired response. same time as ACE inhibitors.
Your doctor will monitor you for Adverse effects:
dizziness (due to low heart rate) Adverse effects of beta blockers
kidney and liver problems. include fluid retention, fatigue,
bradycardia, and hypotension.

Examples: Bisoprolol, carvedilol, sustained-release metoprolol.

ACE inhibitors
Angiotensin-converting enzyme (ACE) inhibitors cause vasodilation in both
the venous and arterial systems, so they decrease both preload and afterload,
increasing blood flow to vital organ systems and improving ejection fraction.
These medications also block the enzyme needed to convert angiotensin I to
angiotensin II. Angiotensin II is a strong vasoconstrictor that raises blood
pressure, releases aldosterone, and leads to sodium and water retention. ACE
inhibitors prevent this cascade of effects.

Adverse effects: Nursing points:

Include hyperkalemia, renal failure, Although the cough can be
and a dry, persistent cough associated annoying, explain to the
with increased bradykinin. If the cough patient that it’s a side effect
is intolerable, the provider may of the medication and
discontinue the ACE inhibitors in favor encourage him or her to
of an angiotensin receptor blocker continue its use.
(ARB).
 Ivabradine
Ivabradine, the first sinoatrial (SA)- Adverse effects:
node modulator approved to treat include bradycardia and hypotension.
heart failure, decreases normal SA
node activity and lowers heart rate. It Nursing points:
Administer ivabradine as ordered if a
does not affect myocardial
contractility. ≥
patient’s heart rate is 70 bpm.

Diuretics
Diuretics help the body get rid of Adverse effects:
Electrolyte loss.
excess fluid and sodium. This
helps reduce the work the heart Nursing points:
must do. It also decreases fluid Instruct patients to decrease their dietary
buildup in the lungs and intake of sodium, weigh themselves daily,
elsewhere in the body. It is and take the diuretic early in the day to
prescribed to lower blood prevent nocturia. Hypokalemia is a side
pressure and to reduce swelling. effect of loop diuretics, so monitor patients’
serum potassium levels
Some of the common drug names
are amiloride, chlorothiazide,
Examples:
Lasix, Lozol and Aldactone. Furosemide, bumetanide, and torsemide.

Hydralazine/isosorbide dinitrate
The drugs Adverse effects:
isosorbide include headache, dizziness, and orthostatic hypotension.
dinitrate and
hydralazine have Nursing points:
Advise patients to change position slowly to
been combined
prevent falls due to postural changes in blood
into a single pill to
pressure.
reduce both
cardiac preload Indications:
and afterload This medication decreases deaths and hospitalization
through venous in African Americans, who are less responsive to
and arterial angiotensin-converting enzyme inhibitors because of
vasodilation. suspected differences in endothelial function.
BLOOD FLOW
THROUGH THE
HEART
 Blood Flow Through The Heart
Your heart itself is made of muscle nourished by blood vessels. Your heart
has four chambers. The chambers are like rooms in the “house” of your
heart. If you look at a diagram of a heart, these chambers divide into upper
and lower chambers and left and right chambers.
Atria are your two upper heart chambers. You have a left atrium and a
right atrium.
Ventricles are your two lower heart chambers. You have a left ventricle
and a right ventricle.
Between the top and bottom chambers, you have heart valves. Heart valves
open and close to allow for proper blood flow. Your valves ensure that
blood flows only in one direction. These valves are:
Aortic valve connects your left ventricle and aorta (large artery that
carries blood throughout your body).
Mitral valve connects your left atrium and left ventricle.
Pulmonary valve connects your right ventricle and pulmonary arteries
(arteries that carry blood to your lungs).
Tricuspid valve connects your right atrium and right ventricle.

Order of blood flow through the heart

The right and left sides of

your heart work together
to ensure blood flows
throughout your whole
body. Blood flows through
your heart through a
series of steps. These
steps take place in the
space of one heartbeat —
just a second or two
 On the right side On the left side
Oxygen-poor blood from all Oxygen-rich blood travels from
over your body enters your your lungs to your left atrium
right atrium through two large through large veins called
veins, your inferior vena cava pulmonary veins.
and superior vena cava. Your mitral valve opens to send
Your tricuspid valve opens to blood from your left atrium to
let blood travel from your right your left ventricle.
atrium to your right ventricle. When your left ventricle is full
When your right ventricle is full it squeezes, which closes your
it squeezes, which closes your mitral valve and opens your
tricuspid valve and opens your aortic valve.
pulmonary valve. Your heart sends blood through
Blood flows through your your aortic valve to your aorta,
pulmonary artery to your lungs, where it flows to the rest of
where it gets oxygen your body.