JAFAD COLLEGE OF NURSING SCIENCE.

ORU IJEBU
MEDICAL SURGICAL NURSING II
PRESENTATION FOR GROUP 1
Names of group members Matric no
1.AWOBAYIKUN OYINDAMOLA JCONS/22B/020
2.ILELADEWA IMOLEAYO JCONS/22B/032
3.KALEJAYE OREOLUWA JCONS/22B/035
4.ABASS OYINKANSOLA JCONS/23A/001
5.ABDULAZEEZ SAVIOUR JCONS/23A/002
6.ABEEB ABIBAT JCONS/23A/003
7.ADEBANJO TAIWO JCONS/23A/004
8.ADEBAYO AYOMIDE JCONS/23A/005
9.ADETUNJI WALIYAT JCONS/23A/006
10.ADEYEMI CHAMPION JCONS/23A/007

LECTURER IN CHARGE:
MRS. AGHOLOR M.O

TABLE OF CONTENTS

1. Anatomy and physiology of the

cardiovascular system
2. Assessment of patient with
cardiovascular system
3. Dysrhythmia
4. What is coronary artery disease
5. Structural infections and
inflammatory cardiac disorders
6. Neoplasm
7. Problem of peripheral circulation
8. Nurses role in the prevention of
cardiovascular problems
9. Special procedures in the
management of cardiovascular system
disorders.
AWOBAYIKUN ONYINDAMOLA
JCONS/ 2022B /020
Anatomy and physiology of the
cardiovascular system

Your heart and blood vessels make up the

circulatory system. The main function of
the circulatory system is to provide oxygen,
nutrients and hormones to muscles, tissues
and organs throughout your body. Another
part of the circulatory system is to remove
waste from cells and organs so your body
can dispose of it.
Your heart pumps blood to the body
through a network of arteries and veins
(blood vessels). Your circulatory system
can also be defined as your cardiovascular
system. Cardio means heart, and vascular
refers to blood vessels.
The heart
The heart itself is made up of 4 chambers, 2
atria and 2 ventricles. De-oxygenated blood
returns to the right side of the heart via the
venous circulation. It is pumped into the
right ventricle and then to the lungs where
carbon dioxide is released and oxygen is
absorbed. The oxygenated blood then
travels back to the left side of the heart into
the left atria, then into the left ventricle from
where it is pumped into the aorta and
arterial circulation.The heart is a conical
hollow muscular organ situated in the
middle mediastinum and is enclosed within
the pericardium. It is positioned posteriorly
to the body of the sternum with one-third
situated on the right and two-thirds on the
left of the midline. The heart measures 12 x
8.5 x 6 cm and weighs ~310 g (males) and
~255 g (females). It pumps blood to
various parts of the body to meet their
nutritive requirements. The Greek name for
the heart is cardia from which we have the
adjective cardia.
Weight. Approximately the size of a
person’s fist, the hollow, cone-shaped heart
weighs less than a pound.
Mediastinum. Snugly enclosed within the
inferior mediastinum, the medial cavity of
the thorax, the heart is flanked on each side
by the lungs.
Apex. Its more pointed apex is directed
toward the left hip and rests on the
diaphragm, approximately at the level of the
fifth intercostal space.
Base. Its broad posterosuperior aspect, or
base, from which the great vessels of the
body emerge, points toward the right
shoulder and lies beneath the second rib.
Pericardium. The heart is enclosed in a
double-walled sac called the pericardium
which is the outermost layer of the heart.
Fibrous pericardium. The loosely fitting
superficial part of this sac is referred to as
the fibrous pericardium, which helps protect
the heart and anchors it to surrounding
structures such as the diaphragm and
sternum.
Serous pericardium. Deep to the fibrous
pericardium is the slippery, two-layer serous
pericardium, where its parietal layer lines
the interior of the fibrous pericardium
Layers of the Heart
The heart muscle has three layers and they
are as follows:
Epicardium. The epicardium or the visceral
and outermost layer is actually a part of the
heart wall.
Myocardium. The myocardium consists of
thick bundles of cardiac muscle twisted and
whirled into ringlike arrangements and it is
the layer that actually contracts.
Endocardium. The endocardium is the
innermost layer of the heart and is a thin,
glistening sheet of endothelium hat lines
the heart chambers.
Chambers of the Heart
The heart has four hollow chambers, or
cavities: two atria and two ventricles.
Receiving chambers. The two superior atria
are primarily the receiving chambers, they
play a lighter role in the pumping activity of
the heart.
Discharging chambers. The two inferior,
thick-walled ventricles are the discharging
chambers, or actual pumps of the heart
wherein when they contract, blood is
propelled out of the heart and into
circulation.
Septum. The septum that divides the heart
longitudinally is referred to as either the
interventricular septum or the interatrial
septum, depending on which chamber it
separates.
Relations
Anteriorly: the body of the sternum, and
adjoining costal cartilages; left lung, and
pleura (apex)
Posteriorly: oesophagus, descending
thoracic aorta, azygos, hemiazygos veins,
and thoracic duct
Superficially : bifurcation of the main
pulmonary trunk
Inferiorly: diaphragm
Laterally: lungs, pleura
ial layers
Chambers of the Heart
The heart has four hollow chambers, or
cavities: two atria and two ventricles.
Receiving chambers. The two superior atria
are primarily the receiving chambers, they
play a lighter role in the pumping activity of
the heart.
Discharging chambers. The two inferior,
thick-walled ventricles are the discharging
chambers, or actual pumps of the heart
wherein when they contract, blood is
propelled out of the heart and into
circulation.
Septum. The septum that divides the heart
longitudinally is referred to as either the
interventricular septum or the interatrial
septum, depending on which chamber it
separates.
Blood Vessels
Blood circulates inside the blood
vessels, which form a closed transport
system, the so-called vascular system.
 As the heart beats, blood is propelled
into large arteries leaving the heart.
Arterioles. It then moves into
successively smaller and smaller
arteries and then into arterioles, which
feed the capillary beds in the tissues.
Veins. Capillary beds are drained by
venules, which in turn empty into veins
that finally empty into the great veins
entering the heart.
Tunics
Except for the microscopic capillaries,
the walls of the blood vessels have three
coats or tunics.

Tunica intima. The tunica intima, which

lines the lumen, or interior, of the
vessels, is a thin layer of endothelium
resting on a basement membrane and
decreases friction as blood flows
through the vessel lumen.
Tunica media. The tunica media is the
bulky middle coat which mostly consists
of smooth muscle and elastic fibers that
constrict or dilate, making the blood
pressure increase or decrease.
Tunica externa. The tunica externa is the
outermost tunic composed largely of
fibrous connective tissue, and its
function is basically to support and
protect the vessels.
Physiology of the Heart
- Intrinsic conduction system: sets the
basic rhythm, composed of special
tissue found nowhere else in the body
- Cardiac cycle and heart sounds:
- Systole (contraction) and diastole
(relaxation)
- Length: approximately 0.8
seconds
- First heart sound (“lub”): caused
by the closing of the AV valves
- Second heart sound (“dub”):
occurs when the semilunar valves
close at the end of systole

Physiology of the Heart

 As the heart beats or contracts, the
blood makes continuous round trips-
into and out of the heart, through the
rest of the body, and then back to the
heart- only to be sent out again.
Intrinsic Conduction System of the Heart
The spontaneous contractions of the
cardiac muscle cells occurs in a
regular and continuous way, giving
rhythm to the heart.

Conduction System of the Heart

Anatomy and Physiology
Cardiac muscle cells. Cardiac muscle
cells can and do contract
spontaneously and independently,
even if all nervous connections are
severed.
Rhythms. Although cardiac muscles
can beat independently, the muscle
cells in the different areas of the heart
have different rhythms.
Intrinsic conduction system. The
intrinsic conduction system, or the
nodal system, that is built into the
heart tissue sets the basic rhythm.
Composition. The intrinsic conduction
system is composed of a special
tissue found nowhere else in the body;
it is much like a cross between a
muscle and nervous tissue.
Function. This system causes heart
muscle depolarization in only one
direction- from the atria to the
ventricles; it enforces a contraction
rate of approximately 75 beats per
minute on the heart, thus the heart
beats as a coordinated unit.
Sinoatrial (SA) node. The SA node has
the highest rate of depolarization in
the whole system, so it can start the
beat and set the pace for the whole
heart; thus the term “pacemaker“.
Atrial contraction. From the SA node,
the impulse spread through the atria
to the AV node, and then the atria
contract.
Ventricular contraction. It then
passes through the AV bundle, the
 bundle branches, and the Purkinje
fibers, resulting in a “wringing”
contraction of the ventricles that
begins at the heart apex and moves
toward the atria.
Ejection. This contraction effectively
ejects blood superiorly into the large
arteries leaving the heart.
The Pathway of the Conduction
System
The conduction system occurs
systematically through:
SA node. The depolarization wave is
initiated by the sinoatrial node.
Atrial myocardium. The wave then
successively passes through the
atrial myocardium.
Atrioventricular node. The
depolarization wave then spreads to
the AV node, and then the atria
contract.
AV bundle. It then passes rapidly
through the AV bundle.
Bundle branches and Purkinje fibers.
The wave then continues on through
the right and left bundle branches,
and then to the Purkinje fibers in the
ventricular walls, resulting in a
contraction that ejects blood, leaving
the heart.
Cardiac Cycle and Heart Sounds
In a healthy heart, the atria contract
 simultaneously, then, as they start to
relax, contraction of the ventricles
begins.

Systole. Systole means heart

contraction.
Diastole. Diastole means heart
relaxation.
Cardiac cycle. The term cardiac cycle
refers to the events of one complete
heartbeat, during which both atria and
ventricles contract and then relax.
Length. The average heart beats
approximately 75 times per minute,
so the length of the cardiac cycle is
normally about 0.8 seconds.
Mid-to-late diastole. The cycle starts
with the heart in complete relaxation;
the pressure in the heart is low, and
blood is flowing passively into and
through the atria into the ventricles
from the pulmonary and systemic
circulations; the semilunar valves are
closed, and the AV valves are open;
then the atria contract and force the
blood remaining in their chambers
into the ventricles.
Ventricular systole. Shortly after, the
ventricular contraction begins, and
the pressure within the ventricles
increases rapidly, closing the AV
valves; when the intraventricular
pressure is higher than the pressure
in the large arteries leaving the heart,
the semilunar valves are forced open,
and blood rushes through them out of
the ventricles; the atria are relaxed,
and their chambers are again filling
with blood.
Early diastole. At the end of systole,
the ventricles relax, the semilunar
valves snap shut, and for a moment
the ventricles are completely closed
chambers; the intraventricular
pressure drops and the AV valves are
forced open; the ventricles again
begin refilling rapidly with blood,
completing the cycle.
First heart sound. The first heart
sound, “lub”, is caused by the closing
 of the AV valves.
Second heart sound. The second
heart sound, “dub”, occurs when the
semilunar valves close at the end of
systole.
Cardiac Output
Cardiac output is the amount of blood
pumped out by each side of the heart
in one minute. It is the product of the
heart rate and the stroke volume.

Stroke volume. Stroke volume is the

volume of blood pumped out by a
ventricle with each heartbeat.
Regulation of stroke volume.
According to Starling’s law of the
 heart, the critical factor controlling
stroke volume is how much the
cardiac muscle cells are stretched
just before they contract; the more
they are stretched, the stronger the
contraction will be; and anything that
increases the volume or speed of
venous return also increases stroke
volume and force of contraction.
Factors modifying basic heart rate.
The most important external
influence on heart rate is the activity
of the autonomic nervous system, as
well as physical factors (age, gender,
exercise, and body temperature).
In summary, the cardiovascular system
plays a crucial role in delivering oxygen
and nutrients to the body's tissues and
removing waste products.
Understanding its anatomy and
physiology is essential for nurses to
provide effective care and management
of cardiovascular conditions.

ILELADEWA IMOLEAYO
JCONS/22B/032
Assessment of patient with
cardiovascular system
General examination Introduction The
purpose of examining the cardiovascular
system is to assess the function of the
heart as a pump and arteries and veins
throughout the body in transporting oxygen
and nutrients to the tissues and
transporting waste products and carbon
dioxide from the tissues. Your assessment
of the cardiovascular system is important
because cardiovascular disease is the
most prevalent health care problem in the
United Kingdom. Over 250 000 deaths per
year are attributed to cardiovascular
disease [13]. History taking The patient’s
history is his health status major subjective
data source. Physiological, psychological,
and psychosocial information (including
family relationships and cultural
influences) can be obtained which will
inform you about the patient’s perception of
his current health status and lifestyle [14].
It will give insight into actual and potential
problems as well as provide a guide for the
physical examination. It is important to use
open questioning to elicit the patient’s
presenting complaint [15]. Provides the
diagnosis most often: history, physical,
or diagnostic tests [16]. ▪ History: 70%. ▪
Physical: 15% to 20%. ▪ Diagnostic tests:
10% to 15%. Components of the health
history 1. Biographical data Begin by
asking the patient his name, address,
telephone number, birth date, age,
birthplace, Social Security number, race,
nationality, religion, and marital status. Also,
find out the names of anyone living with
the patient, the name and telephone
number of the person to call in an
emergency, and the patient usual source of
health care

2.Chief complaint and history of present

illness The most common chief complaint
of the cardiovascular system include chest
pain, dyspnea, fatigue and weakness,
irregular heartbeat, and peripheral changes
(especially dry skin
and extremity pain). In some patients, chest
pain may radiate
to other body parts, including the jaw, back,
left arm, right arm,
elbows, little fingers, teeth, and scrotum.
Further elucidation of the
symptom/complaint should establish
the frequency, duration, exacerbation, and
severity of
symptoms; assessment tools provide a
framework for
assessment, and SOCRATES is a popular
tool:
▪
S‐Site-where is the pain?
The pain of myocardial ischemia may be
located in the
jaw, throat, both arms, retrosternal, and in
the back. The
pain from pericarditis may be in the central
chest, back, or
shoulders. Aortic dissection pain is located
retrosternal
and radiates into the back and the abdomen.
▪ O-Onset: when did it start?/sudden vs
gradual?
Angina may be precipitated by exercise,
emotion, or cold
weather. Pain associated with ACS may
present at rest, on
exertion, or in the early hours of the
morning on wakening.
Pericardial pain may follow a period of
flu‐like symptoms
or occur 3‐6 weeks after acute MI.
▪ C-Character: sharp/dull ache/burning
Myocardial ischemia is described as tight
and crushing but
may also be an ache or heaviness. Aortic
dissection pain
has a tearing quality, and pericardial pain is
severe and
constant.
▪ R-Radiation: does the pain move anywhere
else?
Cardiac pain tends to radiate; ischemic pain
may radiate
from the chest to the arms, jaw, or back.
The pain of aortic
dissection often radiates into the back and
occasionally the
abdomen. Pericardial pain is frequently
referred to as the
trapezius ridge (shoulder).
▪ A-Associations: other symptoms
associated with the
pain
Patients with myocardial infarction may
present with
dyspnea, diaphoresis, nausea, syncope, and
extreme
anxiety. Patients with ACS may present with
one or
several symptoms. In pericarditis, the pain
is worse on
inspiration. Aortic dissection may be
associated with collapse and neurological
involvement if the dissection
compromises a major vessel to the head
and neck [18].
▪ T-Time course:
worsening/improving/fluctuating/time
of day dependent
Myocardial ischemia may have a sudden
onset, and the
pain may last for longer than 20 minutes
without relief.
Aortic dissection tends to be of sudden
onset and remains
constant. Pericarditis and myocarditis may
be preceded by
a history of viral or flu‐like symptoms [18].
▪ E-Exacerbating/Relieving factors: anything
makes the
pain worse or better?
Angina may be exacerbated by exercise,
emotion,
following meals, or extreme weather
temperatures.
Pericardial pain is relieved by leaning
forwards and made
worse by deep inspiration [18].
▪ S-Severity: on a scale of 0 to 10, how
severe is the pain?
Whilst many patients with cardiac pain will
describe the
pain on the high end of a scale of 0–10,
some patients,
notably older patients and those with
diabetes, may
experience little or no pain [18].
3. Past health history
The nurse asks for childhood diseases such
as rheumatic fever
as well as chronic illnesses such as
pneumonia, tuberculosis,
thrombophlebitis, pulmonary embolism, MI,
diabetes mellitus,
thyroid disease, or chest injury when
determining the patient is
past clinical history.
The nurse also asks about occupational
exposures to
cardiotoxic materials. Finally, the nurse
seeks information
about previous cardiac or vascular
surgeries and any previous
cardiac studies or interventions [19].
4. Risk factors
A significant part of history is the
identification of risk factors
for cardiovascular disease. Risk factors are
categorized as
major uncontrollable risk factors; major risk
factors that can be
modified, treated, or controlled; and
contributing risk factors
[2].
An evaluation of lifestyle and risk factors
pertinent to cardiac
disease should be undertaken. It is
important to be nonjudgmental but to ask
questions sensitively and objectively.
Key lifestyle factors include cigarette
smoking, misuse of
alcohol, recreational drug use, lack of
exercise and/or obesity.
Cigarette smoking is the strongest
modifiable risk factor for
heart disease. Seek to evaluate if the
patient has ever smoked
and if so, how much and for how many
years [18].
Other contributing factors
▪ Stress
▪ Sex hormones
▪ Birth control pills
▪ Excessive alcohol intake.
5. Family history
The family history offers information about
a potential
predisposition to disease (e.g., heart
attacks) and whether a
patient may have cause to be especially
concerned about a
specific disease (e.g., mother died from
cancer). Patients might
be reluctant to talk about relatives’ illnesses
if they were mental
diseases, epilepsy, or cancer. Constructing
a genogram of the
patient’s family history will be useful for
quick referral [20].
The nurse also inquiries about
cardiovascular problems such as
hypertension, elevated cholesterol, coronary
artery disease,
MI, stroke, and peripheral vascular disease
[21].
6. Social and personal history
Although the physical symptoms provide
many clues regarding
the origin and extent of cardiac disease,
social and personal
history also contribute to the patient’s
health status. The nurse
inquiries about the patient’s family, spouse
or significant other,
and children. Information about the
patient’s living
environment, daily routine, sexual activity,
occupation, coping
patterns, and cultural and spiritual beliefs
contribute to the
nurse’s understanding of the patient as a
person and guides
interaction with the patient and family.
Physical examination
The physical examination aims to gather
objective data to
confirm or refute any differential diagnoses
identified from the
focused history. An initial assessment
should clarify if the
patient is in pain or anxious, and any
evidence of dyspnea,
pallor, diaphoresis, or cyanosis would
require urgent
investigation. Examination of the
cardiovascular system should
include the whole circulatory system, not
just the heart, and
utilizes the following approach: inspection,
palpation, and
auscultation [19].
The general approach to heart assessment
Appropriate patient preparation is essential
to obtain accurate
findings during the cardiovascular
examination. The patient
should be comfortable and calm, as anxiety
may elevate the
blood pressure or change the heart rate or
rhythm [14].
▪ Explain to the patient what you are going
to do.
▪ Ensure that the room is quiet, warm, and
well-lit.
▪ Expose the patient’s chest only as much
as is needed for
the assessment.
▪ Position the patient in a supine position or
sitting position.
▪
Stand to the patient’s right side, and the
light should come
from the opposite side of where you are
standing so that
shadows can be accentuated.
Equipment needed for examination
▪ Stethoscope with a bell and diaphragm
▪ Sphygmomanometer
▪ Two 15-cm rulers
▪ Watch with second hand
▪ Examination light for tangential lighting
▪ Tape measure.
Cardiac assessment requires examination
of all aspects of the
patient to be evaluated, using the standard
steps of inspection,
palpation, and auscultation. A thorough and
careful
examination helps the nurse detect subtle
abnormalities as well
as obvious ones [7].
While taking the history and before
inspecting the
cardiovascular system, you must assess
the general condition
of the patient as a routine. The following
points need to be
examined from the cardiovascular point of
view [9].
Dysmorphic features
▪ Look for periorbital puffiness and loss of
lateral eyebrows,
which suggests hypothyroidism.
▪ Depressed bridge of the nose-can occur
with Down’s

KALEJAYE OREOLUWA
JCONS/22B/035
DYSRHYTHMIA
Dysrhythmia, also known as arrhythmia,
refers to abnormalities in the heart's rhythm,
which can lead to irregular heartbeats.
These irregularities can manifest as the
heart beating too fast (tachycardia), too
slow (bradycardia), or with an irregular
pattern.

History
• Not all symptoms may be present
• Client may note irregular heartbeat
• Palpitations
• Chest discomfort
• Shortness of breath
• Dizziness
• Diaphoresis
• Weakness
• Syncope
• Nausea

Physical Findings
Sinus bradycardia: ECG normal, heart rate
< 60 bpm. A heart rate below 40 bpm is
usually a
junctional rhythm originating in the ventricle.
Look for irregular PR intervals to determine
heart
block or sick sinus syndrome.
Sinus tachycardia: ECG normal, heart rate >
100
bpm, blood pressure constant
PSVT (Atrioventricular nodal re-entrant
tachycardia): ECG abnormal - rhythm
regular,
fast, atrioventricular block usual as seen by
a
prolonged PR interval, systolic BP constant,
electrical alternans rare
SVT (Orthodromic atrioventricular re-
entrant
tachycardia): ECG abnormal - rhythm
regular,
atrioventricular block not present, systolic
BP
constant, electrical alternans common
especially at
high heart rates
Atrial fibrillation: ECG abnormal, rhythm
irregular, P waves not visible, systolic BP
changing. At high rates there is risk of
developing
Wolfe-Parkinson-White syndrome in some
individuals - look for delta waves on the Q
wave
(slurred QRS)
Atrial flutter: ECG abnormal, ventricular
rhythm
is usually regular, P waves have a well
defined
saw-tooth pattern. If rate is
< 120 bpm, there may be no symptoms, if >
120
bpm, there may be hemodynamic instability
Premature ventricular contractions (PVC):
ECG
normal with occasional wide and bizarre
QRS
complexes. Pulse volume is diminished or
absent
during PVC
Ventricular tachycardia: ECG abnormal,
rhythm
may be regular or irregular. There are no
comprehensive ECG criteria for diagnosing
VT,
but the presence of a rate
> 150 bpm, wide and bizarre QRS
complexes,
atrioventricular dissociation and presence
of
fusion beats, suggest ventricular
tachycardia.
Hypotension, dyspnea, diaphoresis may
also be
present.
Torsades de pointe: ECG abnormal, rhythm
regular or irregular. QRS complexes appear
to
change appearance and size, looks like they
are
twisting. Hypotension, dyspnea, diaphoresis
may
also be present.
Ventricular fibrillation: ECG abnormal,
unintelligible, no identifiable waves,
complexes or
rhythms. No heart rate detectable,
hemodynamically very unstable.
Differential Diagnosis
• Multifocal atrial tachycardia
• Sinus tachycardia with multiple premature
atrial
contractions
• Sick sinus syndrome
• Wolfe-Parkinson-White syndrome
• Atrioventricular block
Complications
• Heart failure
• Myocardial infarction
• Cerebrovascular accident
• Thromboembolism
• Wolff-Parkinson-White syndrome
• Cardiac arrest
Diagnostic Tests
• 12 lead ECG
• Arrange for 24-hour Holter monitoring
• Bloodwork - TSH, CBC, INR, PTT CK,
Troponin T

The most common types

are as follows:
Sinus arrhythmia
A cyclic increase in heart rate associated
with
inspiration and decrease in heart rate with
expiration. No clinical significance and is
common in the elderly and children.
(Current
Medical Diagnosis and Treatment, 38th
edition,
1999, p389)
Sinus Bradycardia
Heart rate < 60 bpm; impulse originates in
SA
node, but is slowed through the AV node.
Usually
bradycardia is an accidental finding and can
be
normal for the young or for athletes. Severe
bradycardia can be an indication of sinus
node
pathology, such as sick sinus syndrome or
heart
block, wherein the SA node does not
generate or
transmit a signal to the atria
(Livingston, M., 2001, eMedecine Journal,
2:7)
Sinus Tachycardia
Heart rate >100-160 bpm; is caused by
rapid
impulse formation from the SA node
(Current
Medical Diagnosis and Treatment, 38th
edition,
1999, p389)
Narrow QRS Complex Tachycardias:
Paroxysmal Supraventricular
Tachycardia (PSVT)
The most commonly occurring paroxysmal
tachycardia. Episodes may last from
seconds to
hours. Rate is usually 160-220 bpm and are
regular even with exercise and position
changes.
Supraventricular Tachycardia (SVT)
Accessory pathways between atria and
ventricles
allow an avoidance of the delay at the AV
node,
thus predisposing the heart to re-entry
tachycardia.
The QRS is usually narrow and the P wave
occurs
after the QRS (the PR interval is greater
than the
RP interval) (1999, The Merck Manual, Sec.
16,
p205)
Atrial Fibrillation (A.Fib)
This is the commonest arrhythmia. There
are three
classifications of A.Fib.
1. Paroxysmal - which is self-terminating
2. Persistent - which can be converted to
sinus
rhythm
3. Chronic
Atrial Fib. is the only common arrhythmia in
which the ventricular rate is rapid and the
rhythm
is highly irregular. The atrial rate can be >
350
bpm, most are not conducted through the
AV
node. The ventricular rate can be normal or
> 150
bpm and there is usually a difference
between the
radial rate and the apical rate (Rosenthal, R.,
2002.
Atrial Fibrillation, eMedecine Journal, 3:1)
Atrial Flutter
This is less common than A.Fib and is most
often
associated with COPD. Atrial rates can be
as high
as 250-300 bpm with transmission of every
second
impulse through the AV node, which gives a
ventricular rate of about 150 bpm.
Ventricular
rate is usually regular and the P waves have
a
distinct saw-tooth appearance, especially in
leads
II, III and AVF. (Ganz, L., Ahluwalia, M., 2002,
eMedecine Journal, 3:1)
Wide QRS Complex Tachycardias:
Premature Ventricular Contractions
These beats have a wide QRS complex, are
not
usually preceded by a P wave, usually there
is a
pause before the next normal beat.
Bigeminy and
trigeminy are rhythms in which every
second or
third beat is a PVC. Usually benign in
patients
without heart disease.
Ventricular Tachycardia (VT)
Three or more consecutive ventricular
premature
beats. The rate is > 100 bpm (usually 150-
200)
and is moderately regular. The complexes
are
wide and there is AV dissociation. There are
also
fusion beats. It is either sustained - lasting
> 30
seconds, or unsustained - lasting < 30
seconds.
VT may be asymptomatic or can be
associated
with syncope, dizziness, diaphoresis or
nausea.
VT can quickly deteriorate into ventricular
fibrillation

Torsades de Pointes
This is a variant of VT. The complexes are
wide
and bizarre and look like the axis is
changing
(QRS from positive to negative and back).
Usually associated with drugs or conditions
that
increase the QT interval. (Ernoehazy, W. Jnr.,
2001, eMedecine Journal, 2:12)
Ventricular fibrillation (VF)
VF is a pulseless arrhythmia that is irregular
and
chaotic. The heart can no longer pump
blood
around the body. VF is the primary cause of
sudden cardiac death. VF is most
commonly seen
following an MI. VF can be coarse or fine.
The
heart rate is irregular, usually > 300 bpm,
and a
waveform that resembles a squiggle that
fades to a
flat line. (Kazzi, A., 2001 eMedecine Journal,
2:8)
Pulseless Electrical Activity (PEA)
A clinical condition "characterized by loss
of
palpable pulse (or ventricular contraction)
in the
presence of recordable cardiac electrical
activity."
ECG recording may show myocardial
infarction,
signs of hyperkalemia, prolonged QT
interval
related to tricyclic drug overdose. PEA is
caused
by an inability to generate a strong
contraction in
spite of adequate electrical impulse. "PEA is
always caused by a profound global cardiac
insult."

Symptoms of Dysrhythmias
Symptoms of dysrhythmias can vary
depending on the type and severity but may
include:

Palpitations (feeling like the heart is racing

or fluttering)
Chest pain or discomfort
Shortness of breath
Dizziness or lightheadedness
Fainting (syncope)
Fatigue or weakness
Sudden cardiac arrest in severe cases

Pathophysiology of dysrhythmias

Dysrhythmias can occur due to various

factors disrupting the heart's electrical
system:

Abnormal electrical impulses: These can

originate from different parts of the heart,
disrupting the coordinated contraction
necessary for effective pumping.
Conduction disturbances: Problems with
the heart's electrical pathways can cause
delays or blocks in the transmission of
signals, leading to irregular heartbeats.
Electrolyte imbalances: Levels of
electrolytes like potassium, sodium, and
calcium play crucial roles in maintaining
normal heart rhythm. Imbalances can lead
to dysrhythmias.
Complications of dysrhythmias

Complications of dysrhythmias can be

serious and include:

Decreased cardiac output: Dysrhythmias

can impair the heart's ability to pump blood
effectively, leading to inadequate blood flow
to vital organs.

Stroke: Certain dysrhythmias, particularly

those involving irregular heartbeats, can
increase the risk of blood clots forming in
the heart and traveling to the brain, causing
a stroke.
Sudden cardiac arrest: In severe cases,
dysrhythmias can lead to the heart
suddenly stopping, resulting in loss of
consciousness and potentially death if not
promptly treated.

Etiology of dysrhythmias

Dysrhythmias can have various causes,

including:

Heart disease: Conditions such as coronary

artery disease, heart failure, or
cardiomyopathy can disrupt the heart's
electrical system.

Electrolyte imbalances: Abnormal levels of

electrolytes can affect the heart's electrical
activity.

Medications: Certain medications, such as

those used to treat heart conditions or
psychiatric disorders, can increase the risk
of dysrhythmias.

Structural abnormalities: Congenital heart

defects or damage to the heart's structure
from prior heart attacks or surgeries can
predispose to dysrhythmias.
Predisposing Factors
Bradycardia
• Increased vagal tone
• Decreased sympathetic drive
• Ischemia to sinoatrial node
• Drug use: digoxin, beta blockers
• Athletic activity (normal variant in
athletes)
• Injury or other insult
• Acute myocardial infarction
• Hypothermia
• Electrolyte abnormality
• Acidosis
Tachycardia
• Decreased vagal tone
• Increased sympathetic tone
• Myocardial infarction
• Hypoxia
• Hypovolemia
• Fever
• Anxiety
• Pain
• Hypothyroidism with elevated TSH
• Exercise
• Caffeine
Supraventricular tachycardia
• Digoxin toxicity
• Catecholamines
• Caffeine
• Gender (more common in males 2:1)
PSVT
• Gender (more common in females)
• Rheumatic heart disease
• Pericarditis
• Myocardial infarction
• Mitral valve prolapse
• Preexcitation syndrome
Atrial Fibrillation
• Myocardia ischemia
• Thyrotoxicosis
• Alcohol
• Sick sinus syndrome
• PACs
Atrial Flutter
• Chronic hypertension
• Valvular heart disease
• Left ventricular hypertrophy
• Coronary artery disease
• Diabetes
• CHF
• Post-op revascularization
• Digitalis toxicity
• Pulmonary embolism
Ventricular tachycardia
• Coronary heart disease
• Structural heart disease
Torsades de Pointes
• Congenital elongated QT intervals
• Antiarrhythmic drugs
• Electrolyte imbalances
Ventricular Fibrillation
• Severe coronary artery disease
• Acute myocardial infarction with
shock
• Myocardial reperfusion after
thrombolysis
Premature Ventricular Contractions
• Stress
Pulseless Electrical Activity
• Respiratory failure with hypoxia
• Massive pulmonary embolus
• Cardiac tamponade
• Cardiac rupture
• Massive myocardial infarction
• Pulmonary-respiratory arrest
• Hemothorax
• Tension pneumothorax
• Prolonged acidosis
• Decreased availability of calcium
• Sepsis
• Severe CHF
• Hyperkalemia
• Hypothermia
• Drug ingestion (TCA, digoxin,
calcium and beta blocker in
overdosage)
• Post defibrillation PEA

Diagnostic evaluation of dysrhythmias

Diagnosis involves a comprehensive
assessment, including:

Medical history and physical examination

Electrocardiogram (ECG or EKG) to assess
the heart's electrical activity

Holter monitor or event monitor for

continuous ECG monitoring over 24 hours
or longer
Echocardiogram to evaluate the heart's
structure and function

Stress test to assess the heart's response

to physical activity
Blood tests to check for electrolyte
imbalances and cardiac enzyme levels

Nursing interventions for patients with

dysrhythmias

Nursing interventions for dysrhythmias may

include:

Continuous monitoring of cardiac rhythm

and vital signs

Administration of medications to control

heart rate and rhythm, such as beta-
blockers, calcium channel blockers, or
antiarrhythmics

Assessing and maintaining electrolyte

balance through diet or intravenous
supplementation

Educating patients about lifestyle

modifications, including diet, exercise,
smoking cessation, and stress
management

Providing emotional support and education

to patients and their families about the
condition and treatment plan
Surgical procedures associated with
dysrhythmias

Surgical Procedures Associated: Surgical

interventions for dysrhythmias may include:

Implantation of a pacemaker to regulate the

heart's rhythm by delivering electrical
impulses as needed

Implantation of a cardioverter-defibrillator
(ICD) to monitor the heart's rhythm and
deliver shocks to restore normal rhythm if
dangerous arrhythmias occur
Catheter ablation to destroy abnormal heart
tissue responsible for causing
dysrhythmias
Coronary artery bypass grafting (CABG) to
improve blood flow to the heart in cases
where coronary artery disease contributes
to dysrhythmias

Pre operative procedures

Pre-operative Procedures: Pre-operative
preparation for surgical interventions may
involve:

Optimizing the patient's medical condition

through medication management and
lifestyle modifications
Stabilizing the dysrhythmia if possible
through medication or other interventions

Ensuring proper electrolyte balance through

laboratory testing and supplementation as
needed

Obtaining informed consent and providing

education about the surgical procedure and
expected outcomes

Post operative procedures

Post-operative Procedures: Post-operative
care following surgical interventions for
dysrhythmias may include:

Monitoring the patient's cardiac rhythm,

vital signs, and overall condition closely in
the recovery period

Managing pain and providing comfort

measures as needed

Preventing complications such as infection,

bleeding, or thrombosis through
appropriate wound care and medication
management
Providing patient education on post-
operative care, including activity restrictions,
medication management, and follow-up
appointments

Coordinating with other members of the

healthcare team to ensure comprehensive
care and support for the patient's recovery.

Overall, the management of dysrhythmias

requires a multidisciplinary approach
involving healthcare professionals from
various specialties to provide
comprehensive care tailored to the
individual patient's needs.
Management
Goals of Treatment
• Convert to sinus rhythm
• Relieve symptoms
• Prevent recurrence
• Prevent complications (e.g. CHF, MI,
life-threatening dysrhythmias)
Appropriate Consultation
Consult a physician if client has abnormal
ECG
pattern, refractory atrial fibrillation,
suspicion of
Wolff-Parkinson-White or "sick sinus"
syndrome.
Nonpharmacologic Interventions
Identify and remove any contributing
factors.
Client Education
• Teach client and family members the
signs of
hemodynamic compromise, including rapid
heart rate, unexplained weight gain,
worsening
dyspnea on exertion or in the night,
decreased
exercise tolerance
• Teach client about long-term medication
and its
side effects

Pharmacologic Interventions
Initial treatment prescribed only by a
physician.
Selection of treatment modality should be
based
on underlying pathophysiology.
Chronic atrial fibrillation is also treated with
anticoagulants such as warfarin.
Therapy is started as soon as possible if
there is a
history of underlying heart disease.
Monitoring and Follow-Up
• For clients taking antiarrhythmic agents,
liver
enzyme levels should be measured during
first
4-8 weeks of therapy
• Clients with risk factors for cardiac
complications of therapy should undergo
ECG
during first weeks of therapy and every 3-6
months thereafter
• Clients taking digoxin should be monitored
carefully for toxic effects
• Evaluate INR on a regular basis to monitor
therapeutic response to warfarin
Referral
Medevac clients with hemodynamic
instability
ABASS OYINKANSOLA
JCONS/23A/002

CORONARY ARTERY DISEASE

What is coronary artery disease?

Coronary artery disease (CAD) is a

narrowing or blockage of your coronary
arteries, which supply oxygen-rich blood to
your heart. This happens because, over
time, plaque (including cholesterol) buildup
in these arteries limits how much blood can
reach your heart muscle.
Picture two traffic lanes that merge into
one due to construction. Traffic keeps
flowing, just more slowly. With CAD, you
might not notice anything is wrong until the
plaque triggers a blood clot. The blood clot
is like a concrete barrier in the middle of the
road. Traffic stops. Similarly, blood can’t
reach your heart, and this causes a heart
attack.

You might have CAD for many years and

not have any symptoms until you
experience a heart attack. That’s why CAD
is a “silent killer.”

Other names for CAD include coronary

heart disease (CHD) and ischemic heart
disease. It’s also what most people mean
when they use the general term “heart
disease.”

Coronary artery disease types

There are two main forms of coronary

artery disease:

Stable ischemic heart disease: This is the

chronic form. Your coronary arteries
gradually narrow over many years. Over
time, your heart receives less oxygen-rich
blood. You may feel some symptoms, but
you’re able to live with the condition day to
day.
Acute coronary syndrome: This is the
sudden form that’s a medical emergency.
The plaque in your coronary artery suddenly
ruptures and forms a blood clot that blocks
blood flow to your heart. This abrupt
blockage causes a heart attack.
How common is coronary artery disease?

Coronary artery disease is very common.

Over 18 million adults in the U.S. have
coronary artery disease. That’s roughly the
combined populations of New York City,
Los Angeles, Chicago and Houston.

In 2021, coronary artery disease killed

375,500 people in the U.S.
Coronary artery disease is the leading
cause of death in the U.S. and around the
world.

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Symptoms and Causes

Plaque buildup in a coronary artery. Blood

clots can form on the plaque and interfere
with blood flow.
When you have coronary artery disease,
plaque builds up in the arteries that supply
blood to your heart, leading to the formation
of blood clots.
What are the symptoms?

You may have no symptoms of coronary

artery disease for a long time. Plaque
buildup takes many years, even decades.
But as your arteries narrow, you may notice
mild symptoms. These symptoms mean
your heart is pumping harder to deliver
oxygen-rich blood to your body.

Symptoms of chronic CAD include:

Stable angina: This is the most common

symptom. Stable angina is temporary chest
pain or discomfort that comes and goes in
a predictable pattern. You’ll usually notice it
during physical activity or emotional
distress. It goes away when you rest or take
nitroglycerin (medicine that treats angina).
Shortness of breath (dyspnea): Some
people feel short of breath during light
physical activity.
Sometimes, the first coronary artery
disease symptom is a heart attack.

What causes coronary artery disease?

Atherosclerosis causes coronary artery

disease. Atherosclerosis is the gradual
buildup of plaque in arteries throughout
your body. When the plaque affects blood
flow in your coronary arteries, you have
coronary artery disease.

Plaque consists of cholesterol, waste

products, calcium and fibrin (a substance
that helps your blood clot). As plaque
collects along your artery walls, your
arteries become narrow and stiff.

Plaque can clog or damage your arteries,

which limits or stops blood flow to a certain
part of your body. When plaque builds up in
your coronary arteries, your heart muscle
can’t receive enough blood. So, your heart
can’t get the oxygen and nutrients it needs
to work properly (myocardial ischemia). It
leads to chest discomfort (angina) and puts
you at risk of a heart attack.
People who have plaque buildup in their
coronary arteries often have buildup
elsewhere in their body, too. This can lead
to conditions like carotid artery disease and
peripheral artery disease (PAD).

Is it genetic?

Partly. Family history affects your risk of

coronary artery disease, but many other risk
factors have nothing to do with your
genetics. The choices you make every day
add up to a big impact on your risk of CAD.

What are the risk factors for coronary artery

disease?
There are many risk factors for coronary
artery disease. You can’t change all of them,
but you can manage some of them by
making lifestyle changes or taking
medications. Talk with your provider about
what you can do about these risk factors:

Being older than 45 if you’re assigned male

at birth (AMAB) or over 55 if you’re
assigned female at birth (AFAB).
Having a biological family member with
heart disease, especially a father or brother
with a diagnosis before age 55 or mother or
sister before age 65.
Eating a lot of saturated fat or refined
carbohydrates.
Not exercising enough.
Not getting enough sleep.
Smoking, vaping or other tobacco use.
Having atherosclerosis.
High blood pressure.
High LDL (“bad”) cholesterol.
Low HDL (“good”) cholesterol.
High triglycerides (hypertriglyceridemia).
Anemia.
Autoimmune diseases, including lupus and
rheumatoid arthritis.
Chronic kidney disease.
Diabetes.
HIV/AIDS.
Metabolic syndrome.
A body mass index (BMI) higher than 25.
Sleep disorders like sleep apnea.
Early menopause (before age 40).
Endometriosis.
History of gestational diabetes, eclampsia
or preeclampsia.
Use of hormonal birth control.
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What are the complications of coronary
artery disease?

The main complication of coronary artery

disease is a heart attack. This is a medical
emergency that can be fatal. Your heart
muscle starts to die because it’s not
receiving enough blood. You need prompt
medical attention to restore blood flow to
your heart and save your life.

Over the years, CAD can also weaken your

heart and lead to complications, including:

Arrhythmias (abnormal heart rhythms like

atrial fibrillation).
Cardiac arrest.
Cardiogenic shock.
Heart failure.
Diagnosis and Tests

How is coronary artery disease diagnosed?

Healthcare providers diagnose coronary
artery disease through a physical exam and
testing.

During your physical exam, your provider

will:

Measure your blood pressure.

Listen to your heart with a stethoscope.
Ask what symptoms you’re experiencing
and how long you’ve had them.
Ask you about your medical history.
Ask you about your lifestyle.
Ask you about your family history. They’ll
want to know about heart disease among
your biological parents and siblings.
All of this information will help your provider
determine your risk for heart disease.

What tests will be done?

Your provider may also recommend one or

more tests to assess your heart function
and diagnose CAD. These include:

Blood tests.
Cardiac catheterization.
Computed tomography (CT) coronary
angiogram.
Heart MRI (magnetic resonance imaging).
Coronary calcium scan.
Echocardiogram (echo).
Electrocardiogram (EKG/ECG).
Exercise stress test.
Chest X-ray.
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Management and Treatment

How is coronary artery disease treated?

Coronary artery disease treatment often

includes lifestyle changes, risk factor
management and medications. Some
people may also need a procedure or
surgery.

Your healthcare provider will talk with you

about the best treatment plan for you. It’s
important to follow your treatment plan so
you can lower your risk of serious
complications from CAD.

Lifestyle changes

Lifestyle changes play a big role in treating

coronary artery disease. Such changes
include:

Don’t smoke, vape or use any tobacco

products.
Eat heart-healthy foods low in sodium,
saturated fat, trans fat and sugar. The
Mediterranean diet is a proven way to lower
your risk of a heart attack or stroke.
Exercise: Aim for 30 minutes of walking (or
other activities) five days a week.
Limit alcohol.
Be sure to talk with your provider before
starting any new exercise program. Your
provider can also offer guidance on lifestyle
changes tailored to your needs. They may
recommend smoking cessation options or
meeting with a dietitian to discuss healthy
eating plans.

Risk factor management

Managing your risk factors for CAD can

help slow down the progression of your
disease. Work with your provider to manage
the following conditions:
Diabetes.
High blood pressure.
High cholesterol.
High triglycerides (hypertriglyceridemia).
Having a BMI higher than 25.
Medications

Medications can help you manage your risk

factors and treat symptoms of coronary
artery disease. Your provider may prescribe
one or more medications that:

Lower your blood pressure.

Lower your cholesterol.
Manage stable angina, like nitroglycerin and
ranolazine.
Reduce your risk of blood clots.
Procedures and surgeries

Some people need a procedure or surgery

to manage coronary artery disease,
including:

Percutaneous coronary intervention (PCI):

This minimally invasive procedure has
another name — coronary angioplasty. Your
provider reopens your blocked artery to help
blood flow through it better. They may also
insert a stent to help your artery stay open.
Coronary artery bypass grafting (CABG):
This surgery creates a new path for your
blood to flow around blockages. This
“detour” restores blood flow to your heart.
CABG helps people who have severe
blockages in several coronary arteries.
Complications/side effects of the treatment

Complications or side effects of coronary

artery disease treatments may include:

Bleeding.
Diarrhea.
Dizziness.
Cough.
Blood clot.
Coronary artery puncture.
Infection.
Abnormal heart rhythms.
Cardiac tamponade.
How long does it take to recover from this
treatment?

After PCI (angioplasty), you can usually get

back to normal activities within a week.
After CABG (bypass surgery), you’ll be in the
hospital for more than a week. After that,
it’ll take six to 12 weeks for a full recovery.

Care at Cleveland Clinic

Get Coronary Artery Disease Tr

Make an Appointment
Prevention
Can coronary artery disease be prevented?

You can’t always prevent coronary artery

disease because some risk factors are out
of your control. But you can lower your risk
of coronary artery disease and help prevent
it from getting worse in these ways:

Commit to quitting smoking and all tobacco

use.
Eat heart-healthy foods.
Get enough sleep.
Stay at a weight that’s healthy for you.
Learn your risk for heart disease.
Limit alcohol use.
Move around more.
Keep taking your medications.
Outlook / Prognosis

What can I expect if I have coronary artery

disease?

Your provider is the best person to ask

about your prognosis. Outcomes vary
based on the person. Your provider will look
at the big picture, including your age,
medical conditions, risk factors and
symptoms. Lifestyle changes and other
treatments can improve your chances of a
good prognosis.
Can coronary artery disease be reversed?

You can’t reverse coronary artery disease.

But you can manage your condition and
prevent it from getting worse. Work with
your healthcare provider and follow your
treatment plan. Doing so will give you the
strongest possible chance of living a long
and healthy life.

Living With

How do I take care of myself?

The most important thing you can do is

keep up with your treatment plan. This may
include lifestyle changes and medications.
It may also involve a procedure or surgery
and the necessary recovery afterward.

Along with treatment, your provider may

recommend cardiac rehab. A cardiac rehab
program is especially helpful for people
recovering from a heart attack or living with
heart failure. Cardiac rehab can help you
with exercise, dietary changes and stress
management.

Coronary artery disease and mental health

A CAD diagnosis may make you think about

your heart and arteries more than ever
before. This can be exhausting and
overwhelming. You may worry a lot about
your symptoms or what might happen to
you. Many people with coronary artery
disease experience depression and anxiety.
It’s normal to worry when you’re living with
a condition that can be life-threatening.

But the worry shouldn’t consume your daily

life. You can still live an active, fulfilling life
while having heart disease. If your
diagnosis is affecting your mental health,
talk with a counselor. Find a support group
where you can meet people who share your
concerns. Don’t feel you need to keep it all
inside or be strong for others. CAD is a life-
changing diagnosis. It’s OK to devote time
to processing it all and figuring out how to
feel better, both physically and emotionally.
When should I see my healthcare provider?

Your provider will tell you how often you

need to come in for testing or follow-ups.
You may have appointments with
specialists (like a cardiologist) in addition
to your primary care visits.

Call your provider if you:

Experience new or changing symptoms.

Have side effects from your medication.
Have questions or concerns about your
condition or your treatment plan.
When should I go to the ER?
Call 911 or your local emergency number if
you have symptoms of a heart attack or
stroke. These are life-threatening medical
emergencies that require immediate care. It
may be helpful to print out the symptoms
and keep them where you can see them.
Also, share the symptoms with your family
and friends so they can call 911 for you if
needed.

What questions should I ask my doctor?

If your provider hasn’t diagnosed you with

coronary artery disease, consider asking:

What are my risk factors for coronary artery

disease?
What can I do to lower my risk?
What lifestyle changes are most important
for me?
What medications would lower my risk, and
what are the side effects? How long do I
need to stay on these medications?
If you have coronary artery disease, some
helpful questions include:

What can I do to slow down disease

progression?
What’s the best treatment plan for me?
What lifestyle changes should I make?
What medications do I need, and what are
the side effects?
Will I need a procedure or surgery? What
does the recovery look like?
Are there support groups or resources you
can recommend?
A note from Cleveland Clinic

Learning you have coronary artery disease

can cause a mix of emotions. You may feel
confused about how this could happen. You
may feel sad or wish you’d done some
things differently to avoid this diagnosis.
But this is a time to look forward, not
backward. Let go of any guilt or blame you
feel. Instead, commit to building a plan to
help your heart, beginning today.

Work with your provider to adopt lifestyle

changes that feel manageable to you. Learn
about treatment options, including
medications, and how they support your
heart health. Tell your family and friends
about your goals and how they can help you.
This is your journey, but you don’t have to
do it alone.

ABDULAZEEZ SAVIOUR JCONS/23A/002

ADEBAYO AYOMIDE JCONS/23A/005
 Structural infections and inflammatory
cardiac disorders

Structural infections and inflammatory

cardiac disorders are conditions that affect
the heart muscle, valves, or surrounding
tissues, leading to damage, dysfunction, or
disease.

Structural Infections:

1. Endocarditis: A serious infection of the

heart valves or endocardium, typically
caused by bacteria like Staphylococcus
aureus, Streptococcus pneumoniae, or
Enterococcus faecalis. Symptoms include
fever, chills, fatigue, and heart murmur. If
left untreated, endocarditis can lead to
heart failure, stroke, or even death.
2. Myocarditis: An infection of the heart
muscle, often caused by viruses like
Coxsackievirus, Adenovirus, or Parvovirus
B19. Bacteria, fungi, or parasites can also
cause myocarditis. Symptoms include
chest pain, shortness of breath, fatigue, and
arrhythmias. Myocarditis can lead to heart
failure, arrhythmias, or even death.
3. Pericarditis:An infection of the
pericardium, typically caused by viruses like
Coxsackievirus or Influenza. Bacteria, fungi,
or tuberculosis can also cause pericarditis.
Symptoms include chest pain, fever, fatigue,
and difficulty breathing. If left untreated,
pericarditis can lead to cardiac tamponade
or constrictive pericarditis.

Inflammatory Cardiac Disorders:

1. Myocarditis (autoimmune):An
autoimmune response where the immune
system attacks the heart muscle, leading to
inflammation and damage. Giant cell
myocarditis and cardiac sarcoidosis are
examples of autoimmune myocarditis.
2. Cardiac Sarcoidosis: A condition where
inflammatory cells called granulomas form
in the heart muscle, leading to scarring and
potentially heart block, arrhythmias, or heart
failure.
3. Giant Cell Myocarditis: A rare
autoimmune disorder where large
inflammatory cells damage the heart
muscle, leading to rapid heart failure and
potentially death.
4. Takotsubo Cardiomyopathy: A condition
where extreme physical or emotional stress
triggers inflammation and heart muscle
weakness, mimicking a heart attack.
5. Cardiovascular Manifestations of
Systemic Rheumatic Diseases:Conditions
like rheumatoid arthritis, lupus, or
scleroderma can cause inflammation and
damage to the heart and blood vessels,
leading to cardiac complications.

These conditions can present with various

symptoms, and diagnosis often requires a
combination of physical examination,
imaging studies, blood tests, and
sometimes biopsy or cardiac
catheterization. Treatment depends on the
specific condition and may include
antibiotics, anti-inflammatory medications,
immunosuppressive therapy, or in severe
cases, cardiac surgery or transplantation.
Early recognition and management are
crucial to prevent long-term damage and
improve outcomes.

The inflammation of the heart muscles,

such as myocarditis, the membrane sac
which surrounds the heart called as
pericarditis, and the inner lining of the heart
or the myocardium, heart muscle as
endocarditis are known as the inflammatory
heart diseases. Inflammation of heart is
caused by known infectious agents, viruses,
bacteria, fungi or parasites, and by toxic
materials from the environment, water, food,
air, toxic gases, smoke, and pollution, or by
an unknown origin. Myocarditis is induced
by infection of heart muscle by virus like
sarcoidosis and immune diseases. The
symptoms include chest pain, angina, pain
in heart muscle, and shortness of breath,
edema, swelling of feet or ankles, and
fatigue. The ECG, X-ray, and MRI can
diagnose the disease; blood test and rise in
enzymes levels provide abnormality in heart
function. The treatment includes use of
antibiotics for inflammation of heart
muscle and medications. The ultrasound
imaging indicates further damage to the
heart muscle. In severe cases of infection
heart failure can occur so long-term
medications are necessary to control
inflammation. The various biomarkers are
reported for the inflammatory heart
diseases. The causes, symptoms and
treatments of inflammatory heart diseases
are described.

CAUSES AND RISK FACTORS

* Causes
*Unhealthy diet: A diet high in salt, sugar,
and saturated fats can increase the risk of
cardiovascular disease.
*Physical inactivity: A lack of regular
physical activity can increase the risk of
cardiovascular disease.
*Tobacco use: Smoking and other forms of
tobacco use can increase the risk of
cardiovascular disease.

*Harmful use of alcohol: Excessive alcohol

consumption can increase the risk of
cardiovascular disease.

Risk factors
- Bacterial, viral, or fungal infections
- Autoimmune disorders (e.g., rheumatoid
arthritis, lupus)
- Genetic predisposition
- Previous heart surgery or catheterization
- Injecting drug use
- Poor dental hygiene
- Weakened immune system

* Symptoms:

- Chest pain or discomfort

- Shortness of breath
- Fatigue
- Swelling in legs, ankles, and feet
- Palpitations or irregular heartbeat
- Fever
- Cough
- Weight loss

*Diagnosis:
- Physical examination
- Electrocardiogram (ECG)
- Echocardiogram
- Cardiac MRI or CT scan
- Blood tests (e.g., troponin, CRP, blood
cultures)
- Endomyocardial biopsy (in some cases)

*Treatment:

- Antibiotics or antifungals for infections

- Anti-inflammatory medications (e.g.,
corticosteroids)
- Immunosuppressive medications (in
autoimmune cases)
- Supportive care (e.g., rest, fluid
management)
- Surgery (in some cases, e.g., valve
replacement)

It's important to note that prompt medical

attention is crucial for effective
management and treatment of these
conditions. If you or someone you know is
experiencing symptoms, consult a
healthcare professional for proper
evaluation and care.
ABEEB ABIBAT. JCONS/23A/003

NEOPLASM
A neoplasm is a type of abnormal and
excessive growth of tissue. The process
that occurs to form or produce a neoplasm
is called neoplasia. The growth of a
neoplasm is uncoordinated with that of the
normal surrounding tissue, and persists in
growing abnormally, even if the original
trigger is removed. This abnormal growth
usually forms a mass, which may be called
a tumour or tumor.
Classification of neoplasm:
Benign neoplasms
in situ neoplasms
malignant neoplasms
neoplasms of uncertain or unknown
behavior.
Malignant neoplasms are also simply
known as cancers and are the focus
of oncology.
Prior to the abnormal growth of tissue, such
as neoplasia, cells often undergo an
abnormal pattern of growth, such
as metaplasia or dysplasia. However,
metaplasia or dysplasia does not always
progress to neoplasia and can occur in
other conditions as well. The word
neoplasm is from Ancient Greek 'new' and
plasma 'formation, creation'.
A neoplasm can be benign, potentially
malignant, or malignant (cancer).
Benign tumors include uterine
fibroids, osteophytes , and melanocytic
nevi (skin moles). They are circumscribed
and localized and do not transform into
cancer.[8]
Potentially-malignant neoplasms
include carcinoma in situ. They are
localized, and do not invade and destroy but
in time, may transform into cancer.
Malignant neoplasms are commonly called
cancer. They invade and destroy the
surrounding tissue, may
form metastases and, if untreated or
unresponsive to treatment, will generally
prove fatal.
Secondary neoplasm refers to any of a
class of cancerous tumor that is either a
metastatic offshoot of a primary tumor, or
an apparently unrelated tumor that
increases in frequency following certain
cancer treatments such
as chemotherapy or radiotherapy.
Rarely there can be a metastatic neoplasm
with no known site of the primary cancer
and this is classed as a cancer of unknown
primary origin.

CARDIAC TUMOR
Cardiac tumors (also called heart tumors)
are growths that form in your heart. They
can be either benign (noncancerous) or
malignant (cancerous). Some are harmless
or easily treatable, but others can be fatal.
In general, an earlier diagnosis can lead to
prompt treatment and better outcomes for
people with cardiac tumors.
Cardiac tumors range in size and shape.
Some are pedunculated, meaning they grow
on a stalk. Heart tumors may be smaller
than 1 centimeter in diameter or as big as
15 centimeters. Their size and location
within your heart impact your symptoms
and need for treatment.
Types of cardiac tumor
Noncancerous primary cardiac tumor:
About 75% to 95% of all primary heart
tumors are noncancerous. But they can still
be dangerous if they interfere with your
heart function and can pose a risk of stroke
if left untreated.
Noncancerous primary heart tumors that
develop in adults include.
Myxoma. This is the most common
noncancerous primary heart tumor (about
50% of all cases). It needs to be removed
through surgery to prevent serious
complications like an embolism. Myxomas
usually develop in your left atrium.
Papillary fibroelastoma. This is the second
most common noncancerous primary heart
tumor. It can affect people at any age, but
it’s usually diagnosed in people over age 60.
About 80% of the time, this tumor grows on
heart valves (usually your aortic or mitral
valve). Even if you don’t have symptoms,
your provider will recommend surgery to
reduce your risk of an embolism.
Lipoma. This tumor affects people of many
different ages. The tumor itself varies in its
presentation. It may be small, or it may be
very large. Lipomas usually develop in your
left ventricle, right atrium, or atrial septum
(the wall that separates the top chambers
of your heart)
Hemangioma. These tumors have been
diagnosed across the lifespan, from infants
to people 65 years old. They usually don’t
cause symptoms. So, they’re often
diagnosed through tests for other issues.
Hemangiomas often occur along with
tumors in your gastrointestinal tract or skin.
Noncancerous primary heart tumors that
develop in infants and children include:
Cardiac rhabdomyoma. This is the most
common type of heart tumor in infants and
children. Rhabdomyomas grow in clusters
and usually go away on their own without
treatment.
Teratoma. This tumor typically develops on
the pericardium (the sac that surrounds
your child’s heart). It can also grow from
the base of the major blood vessels
connected to their heart.
Fibroma. Unlike a rhabdomyoma, a fibroma
appears as a single tumor. It usually grows
within the muscle of your child’s ventricles.
Your child will likely need surgery to remove
this tumor since it can cause serious heart
problems.
Hamartoma. This tumor is also called
histiocytoid cardiomyopathy or Purkinje cell
hamartoma. It may affect your child’s heart
rhythm.
Cancerous primary heart tumor
About 5% to 25% of all primary heart tumors
are cancerous. Among those, the most
common form is sarcoma.
Sarcoma affects 50% to 75% of people
with Heart cancer. Sarcoma has many
subtypes. Two of the most common
include:
Angiosarcoma. This is the most common
subtype in adults. An angiosarcoma often
develops in your right atrium or pericardium.
Rhabdomyosarcoma. This is the most
common subtype in infants and children.
But it can also affect adults.
Rhabdomyosarcomas often form in groups
and can develop in any heart chamber.
Less common forms of cancerous primary
heart tumors include:
Malignant fibrous histiocytoma. This tumor
often develops in your left atrium and may
block your mitral valve, causing impaired
blood flow in the chambers of your heart.
Lymphoma. Usually, lymphoma (a cancer of
white blood cells) develops in your lymph
nodes, spleen, or bone marrow. Rarely, it
develops in your heart. This usually
happens in people who have AIDS.
Clinical manifestation of cardiac tumor
The symptoms of cardiac heart tumors are
across the board. They vary based on the
form of tumor you have and where it’s
located in your heart. Some people have no
symptoms or very mild symptoms. Others
have symptoms that signal life-threatening
heart problems.
Chest discomfort.
Dizziness and fainting.
Fatigue.
Fever and chills
Heart palpation.
Joint pain.
Loss of appetite.
Night sweats.
Shortness of breath.
Weight loss without another cause.
Causes of cardiac tumors
It’s not always clear what causes primary
heart tumors. Genetic syndromes (like
Carney complex) may play a role in causing
some noncancerous primary heart tumors.
The spread of cancer from one part of your
body (like lungs or skin) to your heart
causes metastatic heart tumors.
Diagnosis and test
Transthoracic echocardiogram.
Transesophageal echocardiogram.
Cardiac MRI.
Contrast enhanced cardiac CT scans.
PET scan.
Management and treatment
Treatment options of cardiac tumors vary
based on the type of tumor.
Noncancerous primary heart
tumors: Surgery is very successful at
removing these tumors if they’re small.
Larger tumors may be impossible to
remove. Your provider or your child’s
provider will recommend surgery if the
tumor interferes with heart function.
Children who have surgery to remove a
fibroma may also need reconstructive
surgery to fix damage to their heart.
Cancerous primary heart tumors: These
tumors can’t be removed and are often fatal.
Chemotherapy or radiation may be used to
slow the cancer’s progression. Your
provider may also provide medications to
manage complications.
Metastatic heart tumors: Treatment
depends on the source of the cancer. It may
include chemotherapy or surgical removal
of the tumor. Your provider may insert
tubes in your chest to drain excess fluid
from the tumor. They may also inject
medications into your heart to slow tumor
growth or combat fluid buildup.

Conclusion
A neoplasm is a type of abnormal and
excessive growth of tissue. The process
that occurs to form or produce a neoplasm
is called neoplasia. The growth of a
neoplasm is uncoordinated with that of the
normal surrounding tissue, and persists in
growing abnormally, even if the original
trigger is removed. Malignant neoplasms
are also simply known as cancers and are
the focus of oncology. Prior to the
abnormal growth of tissue, such as
neoplasia, cells often undergo an abnormal
pattern of growth, such
as metaplasia or dysplasia. However,
metaplasia or dysplasia does not always
progress to neoplasia and can occur in
other conditions as well. The word
neoplasm is from Ancient Greek 'new' and
plasma 'formation, creation'.
Cardiac tumors range in size and shape.
Some are pedunculated, meaning they grow
on a stalk. Heart tumors may be smaller
than 1 centimeter in diameter or as big as
15 centimeters. Their size and location
within your heart impact your symptoms
and need for treatment.
ADEBANJO TAIWO
JCONS/23A/004
VASCULAR DISORDERS AND PROBLEM OF
PERIPHERAL CIRCULATION

VASCULAR DISORDERS

Vascular disease includes any condition

that affects your circulatory system, or
system of blood vessels. This ranges from
diseases of your arteries, veins and lymph
vessels to blood disorders that affect
circulation.
Blood vessels are elastic-like tubes that
carry blood to every part of your body.
Blood vessels include:
Arteries that carry blood away from your
heart.
 Veins that return blood back to your
heart.
Capillaries, your tiniest blood vessels,
which link your small veins and arteries,
deliver oxygen and nutrients to your
tissues and take away their waste.
Types of Vascular Disease
Some vascular diseases affect your arteries,
while others occur in your veins. They can also
happen only in specific parts of your body.
Peripheral artery disease
Like the blood vessels of your heart (coronary
arteries), your peripheral arteries (blood vessels
outside your heart) also may develop
atherosclerosis, the buildup of plaque (fat and
cholesterol deposits), inside them. Over time,
the buildup narrows the artery. Eventually, the
narrowed artery causes less blood to flow,
which may lead to ischemia, or inadequate
blood flow to your body's tissue. Types of
peripheral arterial disease include:
Peripheral artery disease: A blockage in
your legs. Total loss of circulation can lead
to gangrene and loss of a limb.
Intestinal ischemic syndrome: A blockage
in the blood vessels leading to your
gastrointestinal system.
Renal artery disease: A blockage in your
renal arteries can cause renal artery disease
and kidney failure.
Popliteal Entrapment Syndrome: A rare
vascular disease that affects the legs of
some young athletes. The muscle and
tendons near the knee compress the
popliteal artery, restricting blood flow to the
lower leg and possibly damaging the artery.
Raynaud's Phenomenon: Consists of
spasms of the small arteries of your fingers,
and sometimes toes, from exposure to cold
or stress.
Buerger's Disease: Most commonly affects
the small and medium-sized arteries, veins
and nerves. Although the cause is unknown,
 there is a strong association with tobacco
use or exposure. The arteries of your arms
and legs become narrowed or blocked,
causing lack of blood supply (ischemia) to
your fingers, hands, toes and feet. With
severe blockages, the tissue may die
(gangrene), making it necessary to
amputate affected fingers and toes.
Superficial vein inflammation and
symptoms of Raynaud's can occur as well.
Carotid artery issues
These happen in the two main carotid arteries
in your neck.
Carotid artery disease: A blockage or
narrowing in the arteries supplying your
brain. This can lead to a transient ischemic
attack (TIA) or stroke.
Carotid artery dissection: Begins as a tear
in one layer of your artery wall. Blood leaks
through this tear and spreads between the
wall layers.
 Carotid body tumors: Growths within the
nervous tissue around your carotid artery.
Carotid artery aneurysm: A bulge in your
artery wall that weakens the wall and may
cause a rupture.
Venous disease
Veins are flexible, hollow tubes with flaps inside,
called valves. When your muscles contract,
these one-way valves open, and blood moves
through your veins. When your muscles relax,
the valves close, keeping blood flowing in one
direction through your veins.
If the valves inside your veins become damaged,
the valves may not close completely. This
allows blood to flow in both directions. When
your muscles relax, the valves inside the
damaged vein(s) will not be able to hold the
blood. This can cause pooling of blood or
swelling in your veins. The veins bulge and look
like ropes under the skin. The blood begins to
move more slowly through your veins and may
stick to the sides of your vessel walls.
Symptoms include heaviness, aching, swelling,
throbbing or itching. Blood clots can form.
Varicose veins: Bulging, swollen, purple,
ropy veins, seen just under your skin.
Damaged valves within the veins cause this.
Spider veins: Small red or purple bursts on
your knees, calves, or thighs. Swollen
capillaries (small blood vessels) cause this.
Klippel-Trenaunay syndrome (KTS): A rare
congenital (present at birth) vascular
disorder.
May-Thurner syndrome (MTS): Your right
iliac artery compresses your left iliac vein,
which increases the risk of deep vein
thrombosis (DVT) in your left extremity.
Thoracic outlet syndrome (TOS): A group of
disorders that happen with compression,
injury or irritation of the nerves and/or blood
vessels (arteries and veins) in your lower
neck, armpit and upper chest area.
Chronic venous insufficiency (CVI): A
condition that happens when the venous
 wall and/or valves in your leg veins are not
working effectively, making it difficult for
blood to return to your heart from your legs.
Blood clots
A clot forms when clotting factors in your blood
make it coagulate or become a solid, jelly-like
mass. When a blood clot forms inside a blood
vessel (a thrombus), it can come loose and
travel through your bloodstream, causing a
deep vein thrombosis, pulmonary embolism,
heart attack or stroke.
Blood clots in your arteries can increase the risk
for stroke, heart attack, severe leg pain,
difficulty walking or even the loss of a limb.
Hypercoagulable states or blood clotting
disorders: Conditions that put people at
increased risk for developing blood clots
because they make blood more likely to
form blood clots (hypercoagulable) in the
arteries and veins. You can inherit these
conditions (congenital, occurring at birth) or
acquire them. These disorders include high
levels of factors in your blood that cause
blood to clot (fibrinogen, factor 8,
prothrombin) or not enough natural
anticoagulant (blood-thinning) proteins
(antithrombin, protein C, protein S). The
most aggressive disorders include
circulating antiphospholipid antibodies,
which can cause clots in both arteries and
veins.
Deep vein thrombosis (DVT): A blood clot
occurring in a deep vein.
Pulmonary embolism: A blood clot that
breaks loose from a vein and travels to your
lungs.
Axillo-subclavian vein thrombosis, also
called Paget-Schroetter Syndrome: Most
common vascular condition to affect young,
competitive athletes. The condition
develops when your collarbone (clavicle),
first rib or the surrounding muscle
compresses a vein in your armpit (axilla) or
in front of your shoulder (the subclavian
vein). This increases your risk of blood clots.
 Superficial thrombophlebitis: A blood clot in
a vein just under your skin.
Aortic aneurysm
An aneurysm is an abnormal bulge in a blood
vessel wall. Aneurysms can form in any blood
vessel, but they occur most commonly in the
aorta (aortic aneurysm) which is the main blood
vessel leaving the heart:
Thoracic aortic aneurysm.
Abdominal aortic aneurysm.
Fibromuscular dysplasia (FMD)
Fibromuscular dysplasia (FMD): A rare medical
condition in which people have abnormal
cellular growth in the walls of their medium and
large arteries. This can cause the arteries with
abnormal growth to look beaded and become
narrow. This can cause issues with the arteries,
including aneurysms and dissection.
Lymphedema
The lymphatic system includes an extensive
network of lymph vessels and lymph nodes that
helps coordinate your immune system's
function to protect your body from foreign
substances. Lymphedema, an abnormal buildup
of fluid, develops when lymph vessels or lymph
nodes are missing, impaired, damaged or
removed.
Primary lymphedema (rare): Some people
are born without certain lymph vessels or
have abnormalities in them.
Secondary lymphedema: Happens as a
result of a blockage or interruption that
alters the lymphatic system. Causes of this
include: infection, malignancy, surgery, scar
tissue formation, trauma, deep vein
thrombosis (DVT), radiation or other cancer
treatment.
Vasculitis
Your blood vessels can get inflamed because of
a medicine, an infection or an unknown cause.
This can make it hard for blood to travel
through your blood vessels. This is sometimes
associated with rheumatological conditions or
connective tissue disease. Vasculitis can also
cause an aneurysm.
Who does vasculopathy affect?
Some people are born with vascular diseases
they inherit from their parents. In these cases,
such as blood clotting disorders, they start
dealing with this issue at a younger age.
However, many vascular diseases develop over
time because of an accumulation of plaque (fat
and cholesterol) in the arteries, such as
peripheral artery disease or carotid artery
disease. Atherosclerosis, the hardening of the
arteries, can start when you’re a teen and cause
problems in middle age or later.

Symptoms and Causes

Symptoms of vascular disease
Symptoms vary depending on the type of
vascular disease.
Peripheral artery disease symptoms
Peripheral artery disease: Leg pain or
cramps with activity but improve with rest;
changes in skin color; sores or ulcers and
tired legs.
Intestinal ischemic (or mesenteric
ischemia) syndrome: Severe stomach pain,
nausea, throwing up, diarrhea, food fear and
weight loss.
Renal artery disease: Uncontrolled
hypertension (high blood pressure),
congestive heart failure and abnormal
kidney function.
Popliteal entrapment syndrome: Leg and
foot cramps, numbness, tingling,
discoloration.
Raynaud’s phenomenon: Fingers and toes
that look red, blue or white, throbbing,
tingling, redness.
Buerger’s disease: Pain in your arms, hands,
legs and feet, even at rest. Blue or pale
fingers or toes.
Symptoms of carotid artery issues
Carotid artery disease: Usually no
symptoms until having a stroke or transient
ischemic attack (TIA or mini-stroke).
Symptoms of these include trouble with
vision or speech, confusion and difficulty
with memory.
Carotid artery dissection: Headache, neck
pain and eye or facial pain.
Carotid body tumors: Palpitations, high
blood pressure, sweating and headaches.
Carotid artery aneurysm: Stroke or transient
ischemic attack (TIA or mini-stroke).
Venous disease symptoms
Varicose veins and spider veins:Swelling,
pain, blue or red veins visible on legs.
Klippel-Trenaunay syndrome (KTS): Pain or
heaviness in your leg or arm.
 May-Thurner syndrome (MTS): Swelling,
tenderness, pain in your leg, red or
discolored skin.
Thoracic outlet syndrome (TOS): Neck, arm
and shoulder pain, tingling and numbness in
your arm or hand.
Chronic venous insufficiency (CVI): Leg
cramps, heavy or achy legs, swelling or pain
in your legs.
Blood clots
Blood clotting disorders: Deep vein
thrombosis, pulmonary embolism.
Deep vein thrombosis (DVT): Pain, swelling,
warmth in your leg, red skin.
Pulmonary embolism: Coughing up blood,
chest pain, shortness of breath.
Axillo-subclavian vein thrombosis:Swelling,
heaviness or pain in your arm or hand, skin
that looks blue.
Superficial thrombophlebitis:Inflammation,
pain, warmth around your vein, red skin.
Aortic aneurysm symptoms
Thoracic aortic aneurysm: Chest pain, fast
heart rate, trouble swallowing, swollen neck.
Abdominal aortic aneurysm: Abdominal or
back pain, dizziness, nausea and throwing
up, fast heart rate (if the aneurysm ruptures).
Fibromuscular Dysplasia (FMD) symptoms
Fibromuscular dysplasia (FMD): Neck pain,
vision changes, high blood pressure, dizziness,
hearing a “whooshing sensation” or hearing
your heartbeat in your ears.
Lymphedema symptoms
Swelling, most often in your arms or legs.
Vasculitis symptoms
Not feeling well, fever, swelling.

causes of vascular disease

For some vascular problems, the cause isn’t
known. Vascular disease causes include:
High cholesterol.
High blood pressure.
Smoking or using tobacco products.
Diabetes.
Genes you get from your parents.
Medicines.
Injury.
Infection.
Blood clots.

Diagnosis and Tests

How is vascular disease diagnosed?
Your healthcare provider will want to do a
physical exam and get your medical history, as
well as a history of which diseases are in your
family. It helps your healthcare provider look for
vascular disease when you take your shoes and
socks off before they examine you.
Depending on the type of vascular disease your
provider suspects, they may do blood tests and
imaging.
How is vascular disease diagnosed?
Your healthcare provider will want to do a
physical exam and get your medical history, as
well as a history of which diseases are in your
family. It helps your healthcare provider look for
vascular disease when you take your shoes and
socks off before they examine you.
Depending on the type of vascular disease your
provider suspects, they may do blood tests and
imaging.
What tests will be done to diagnose
vasculopathy?
Many vascular diseases involve clots or
blockages in blood vessels. To diagnose these,
your healthcare provider needs to be able to see
inside your blood vessels using imaging
methods that include:
Vascular ultrasound.
Catheter angiography.
CT angiography.
MR angiography.

RISK FACTOR OF VASCULAR

DISORDERS
Modifiable risk factors that are associated with all four
major vascular conditions are:
Diabetes
Hyperlipidemia (high levels of fats in the blood, such as
cholesterol and triglycerides)
Smoking
High blood pressure
Obesity
Lack of exercise

Management and Treatment

How is vascular disease treated?
Eating healthier and exercising more can help
with many vascular diseases. For others, you
may need to take medicine or have a surgical
procedure. Vascular disease treatments vary
depending on the condition.
Peripheral artery disease treatment
Peripheral artery disease: Diet, exercise,
medicine, surgery.
Intestinal ischemic syndrome: Pain
medicine, clot-busting drugs, surgical
removal of blood clot. Angioplasty, stenting
or bypass surgery for chronic cases.
 Renal artery disease: Low-salt, heart-
healthy diet. High blood pressure medicine,
statins.
Popliteal entrapment syndrome: Surgery to
release the popliteal artery.
Raynaud’s phenomenon: Keep hands and
feet warm. Take medicine that helps blood
vessels stay open (dilated).
Buerger’s disease: Quit tobacco products.
Warm up fingers and toes. Take medicine
(vasodilators) to open blood vessels.
Treatment of carotid artery issues
Carotid artery disease: Healthier diet. Blood
thinners and cholesterol-lowering medicine.
Plaque removal (carotid endarterectomy).
Angioplasty and stenting to keep the artery
open.
Carotid artery dissection: Antiplatelets,
anticoagulants, stenting.
Carotid body tumors: Surgical removal of
the tumor.
 Carotid artery aneurysm:Antihypertensives,
cholesterol-lowering medicine, clot-busting
medicine. Bypass or stent-graft surgery.
Venous disease treatment
Varicose veins and spider veins:Removal
using heat, saltwater or laser therapy.
Klippel-Trenaunay syndrome (KTS):Same
treatment as varicose veins.
May-Thurner syndrome (MTS): Same as for
deep vein thrombosis.
Thoracic outlet syndrome (TOS):Physical
therapy, medicine.
Chronic venous insufficiency (CVI): Move
legs frequently and wear compression
stockings. Vein treatment with saltwater,
laser or removal through an incision.
Blood clot treatment
Blood clotting disorders: Same as for deep
vein thrombosis and pulmonary embolism.
 Deep vein thrombosis (DVT): Elevate your
legs. Take blood thinners and medicines for
pain.
Pulmonary embolism: Blood thinners and
thrombolytics. Procedure to remove the clot.
Axillo-subclavian vein
thrombosis:Thrombolytics, blood thinners.
Removal of the clot.
Superficial thrombophlebitis: Raise your
affected limb above your heart. Use a warm
compress. Put on support stockings. Have
the vein surgically removed.
Aortic aneurysm treatment
Thoracic aortic aneurysm: Surgery to put in
a fabric graft or a stent. This can be a major
surgery depending on the location and
surgical method.
Abdominal aortic aneurysm: Surgery to put
in a graft. An endovascular repair is less
invasive.
Fibromuscular Dysplasia (FMD)
 Blood thinners, medicine for pain.
Angioplasty. Surgery to prevent an artery
rupture.
Lymphedema
Let your arm rest above your heart level
while you lie down for 45 minutes twice
daily.
Wear a compression sleeve.
Use your affected limb for daily tasks.
Visit a specialized lymphedema clinic if your
healthcare provider recommends it.
Vasculitis
Your provider may prescribe medications
like steroids.
Complications/side effects of the treatment
Any medicine can have side effects, but the
benefits of medicines usually make them worth
taking. Side effects often go away. If they don’t,
you can ask your healthcare provider to switch
you to a different drug.
When considering a procedure or surgery, talk
to your provider about the risks and benefits.
What’s right for your neighbor may not be the
right treatment for you.

Prevention
You can’t do anything about your age, family
history or genetics, but you can:
Manage your diabetes, high cholesterol and
high blood pressure.
Exercise regularly.
Eat healthier foods.
Move around once an hour if you have to sit
or stand for hours.
Stay at a healthy weight.
 Reduce your stress level.
Avoid tobacco products.

problems of peripheral circulation

Peripheral circulation refers to the blood flow to the body's

extremities, such as the arms and legs.
Problems with peripheral circulation can arise due to
various conditions, with the most common being
peripheral vascular disease (PVD) or peripheral artery
disease (PAD). These conditions are characterized by
reduced blood flow to the limbs, usually caused by
narrowed or blocked blood vessels. Here is a detailed
explanation of the problems of peripheral circulation:
1. Peripheral Vascular Disease (PVD):
• PVD is a condition where there is reduced circulation of
blood to a body part other than the brain or heart
• The main cause of PVD is atherosc hi lerosis, which is
the build-up of fatty deposits (plaques) that narrow the
blood vessels, typically arteries
• Atherosclerosis restricts blood flow, leading to
symptoms such as pain, numbness, and weakness in the
affected limbs.
• Other risk factors for PVD include smoking, diabetes,
high blood pressure, high cholesterol, and a family history
of the disease.
2. Peripheral Artery Disease (PAD):
• PAD is a common type of PVD that specifically affects
the arteries supplying blood to the arms or legs
• The primary cause of DAD is also atherosclerosis, where
plaques build up in the arteries, reducing blood flow to the
limbs.
• Symptoms of PAD include leg pain or cramping
(claudication) during physical activity, coldness in the legs
or feet, numbness or weakness in the legs, and slow-
healing sores on the legs or feet
• If left untreated, PAD can lead to complications such as
critical limb ischemia (tissue death), stroke, and heart
attack

SIGNS AND SYMPTOMS

Signs and symptoms of problems with peripheral
circulation can vary depending on the specific condition.
However, some common signs and symptoms include:
1. Claudication: This is pain or cramping in the legs or
arms that occurs during physical activity and is relieved
with rest. It is often a symptom of peripheral artery
disease .
2. Muscle pain or cramping: Pain or cramping in the legs
or arms, especially during exercise, can indicate reduced
blood flow to the muscles .
3. Numbness or weakness: Feeling of numbness or
weakness in the legs or arms may be a sign of reduced
blood flow .
4. Coldness or changes in skin color: The affected area
may feel colder than usual or have changes in skin color,
such as paleness or reddish-blue discoloration [.
5. Weak or absent pulses: In some cases, the pulses in the
legs or feet may be weak or absent .
6. Slow healing of wounds: Sores or wounds on the legs,
feet, or toes that take a long time to heal may indicate
poor circulation.
7. Hair loss or slower hair growth: Reduced blood flow to
the legs or arms can lead to hair loss or slower hair growth
in those areas.
8. Erectile dysfunction: In men, difficulty achieving or
maintaining an erection may be a symptom of peripheral
circulation problems .
It's important to note that these symptoms can also be
caused by other conditions, so it's essential to consult a
healthcare provider for an accurate

Causes of problems of peripheral circulation

Peripheral circulation problems can be caused by various
factors. Here are some common causes:
1. Atherosclerosis: The most common cause of peripheral
circulation problems is
atherosclerosis. This condition occurs when fatty deposits,
called plaques, build up inside the arteries, narrowing and
hardening them.
This reduces blood flow to the peripheral tissues and
organs.
2. Diabetes: Individuals with diabetes are at a higher risk
of developing peripheral circulation problems. High blood
sugar levels can damage the blood vessels, leading to
narrowing and reduced blood flow.
3. Smoking: Smoking is a major risk factor for peripheral
circulation problems. The chemicals in tobacco smoke
can damage the blood vessels, causing them to narrow
and become less elastic. This impairs blood flow to the
extremities.
4. Obesity: Excess weight puts additional strain on the
cardiovascular system and can contribute to peripheral
circulation problems . Obesity is often associated with
other risk factors such as high blood pressure and
diabetes, which further increase the risk.
5. Sedentary lifestyle: Lack of physical activity can lead to
poor circulation. Regular exercise helps improve blood
flow and keeps the blood vessels healthv.
6. High blood pressure: Uncontrolled high blood pressure
can damage the blood vessels and impair circulation. The
increased pressure can cause the arteries to narrow and
become less flexible, reducing blood flow to the peripheral
tissues.
High cholesterol: Elevated levels of cholesterol in the
blood can contribute to the development of
atherosclerosis and peripheral circulation problems [2].
Excess cholesterol can accumulate in the artery walls,
forming plaques that restrict blood.

Risk Factors for problems of peripheral circulation

Risk factors for problems of peripheral circulation, such as
peripheral vascular disease and peripheral artery disease,
can vary. Here are some common risk factors identified in
the search results:
1. Age: The risk of developing peripheral circulation
problems increases with age. Most people with peripheral
artery disease are 65 years or older.
2. Family history and genetics: Having a family history of
peripheral artery disease, heart disease, stroke, or blood
vessel disease can increase the risk of developing
peripheral circulation problems. Genetic variations have
also been found to contribute to the risk of peripheral
artery disease.
3. Lifestyle habits: Unhealthy lifestyle habits can
contribute to the development of peripheral circulation
problems. These habits may include smoking or regularly
breathing in secondhand smoke, not getting enough
physical activity, experiencing chronic stress, and
consuming a diet high in saturated fats.
4. Other medical conditions: Certain medical conditions
can increase the risk of peripheral circulation problems.
These conditions may include high blood pressure, high
cholesterol, diabetes, obesity, and certain pregnancy-
related conditions like preeclampsia or gestational
diabetes.
5.Race or ethnicity: Certain racial and ethnic groups have a
higher risk of peripheral circulation problems. For example,
African American individuals have a higher risk of
peripheral artery disease, and American Indian women
have a higher risk compared to white or Asian American
women. Hispanic and Latino adults with sedentary
lifestyles also have higher rates of lower extremity
peripheral artery disease.
6. Sex: While both men and women can develop peripheral
circulation problems, there are some differences in how
the condition affects them.
Women are more likely to have peripheral artery disease
without symptoms, but they may also experience more
complications.
How to manage promblems of peripheral circulation
Treatment and Prevention:
• Lifestyle changes play a crucial role in managing
peripheral circulation problems.
These include quitting smoking, adopting a healthy diet
low in saturated fat, regular exercise, managing other
health conditions like diabetes and high blood pressure,
and maintaining a healthy weight
• Medications may be prescribed to control risk factors
such as high blood pressure, high cholesterol, and
diabetes. Antiplatelet medications like aspirin or
clopidogrel may also be prescribed to reduce the risk of
blood clots
• Supervised exercise programs can help improve
symptoms and increase walking distance in individuals
with PAD .
• In more severe cases, minimally invasive or surgical
treatments may be necessary to improve blood flow and
relieve symptoms.
Adetunji waliyat
Jcons/23A/006.
Nurses role in the prevention of
cardiovascular problems

Cardiac nurses are essential in the prevention,

diagnosis, and treatment of heart disease, heart

attacks, and other cardiovascular problems.

Cardiac nurses are important in the fight
against

heart disease since they are needed not just to

care for patients but also to promote good
lifestyle choices.

Nurses play a crucial role in the prevention of

cardiovascular disorders. They are on the

frontlines of patient care and can make a

significant impact in promoting cardiovascular
health.

Here are a few ways nurses contribute:

1. Health promotion and Education:Nurses

educate patients and the public about

cardiovascular risk factors, healthy lifestyle

choices, and prevention strategies. They
provide
information on maintaining a balanced diet,
regular exercise, smoking cessation, and stress

reduction techniques.

2. Risk Assessment and Screening: Nurses

conduct comprehensive assessments to
identify

individuals at risk for cardiovascular disorders.

They measure vital signs, collect medical
history,

and perform cardiovascular screening tests

such as blood pressure monitoring, cholesterol
screening, and electrocardiograms (ECGs).

3. Medication Management: Nurses play a vital

role in medication management for patients

with cardiovascular disorders. They educate

patients about prescribed medications, ensure

proper administration, monitor for side effects,

and promote medication adherence.

4. Lifestyle Modification Support: Nurses assist

patients in implementing lifestyle

modifications to reduce cardiovascular risk.

They provide guidance on dietary changes,
exercise
programs, weight management, and stress
reduction techniques. They also offer
ongoingsupport and motivation to help patients
adopt and maintain these healthy behaviors.

5. Cardiac Rehabilitation: Nurses are involved in

cardiac rehabilitation programs, which help

patients recover and regain optimal

cardiovascular health after cardiac events or
procedures.

They provide education, exercise supervision,

and emotional support during this critical phase

of recovery.
6. Collaboration with Interdisciplinary Team:
Nurses collaborate with other healthcare

professionals, such as physicians, dietitians,

and physical therapists, to develop
comprehensive

care plans for patients with cardiovascular

disorders. This interdisciplinary approach
ensures

holistic and coordinated care.

7. Health Promotion Campaigns: Nurses often

participate in community health promotion

campaigns focused on cardiovascular health.

They organize and facilitate workshops,
seminars,

and public health events to raise awareness

about cardiovascular risk factors and
prevention

strategies. These campaigns may target

specific populations, such as schools,
workplaces, or

community centers.

8. Blood Pressure Monitoring: Nurses routinely

measure and monitor blood pressure in

various healthcare settings, including hospitals,

clinics, and community health centers. By
identifying individuals with high blood pressure
(hypertension), nurses can initiate early

interventions, such as lifestyle modifications or

referrals for further evaluation and treatment.

9. Patient Advocacy: Nurses act as patient

advocates, ensuring that individuals with

cardiovascular disorders receive appropriate

care and support. They collaborate with
healthcare

providers to ensure patients have access to

necessary screenings, medications, and follow-
up

appointments. Nurses also address any barriers

to care that patients may face, such as

financial constraints or language barriers.

10. Research and Evidence-Based Practice:

Nurses contribute to the prevention of

cardiovascular disorders through research and

evidence-based practice. They actively engage
in

research studies, clinical trials, and quality

improvement projects related to cardiovascular

health. By staying updated on the latest

evidence, nurses can implement effective
interventions
and promote best practices in their clinical
settings.
11.. Support for Behavior Change: Nurses play
a critical role in supporting patients in making

behavior changes to reduce their cardiovascular

risk. They use motivational interviewing

techniques to help patients identify and

overcome barriers to behavior change, set
realistic

goals, and develop action plans. Nurses provide

ongoing support and monitoring to help

patients stay motivated and achieve long-term

success.
12. Emergency Response: In emergency
situations, such as cardiac arrests or acute

myocardial infarctions (heart attacks), nurses

are trained to provide immediate care and

interventions. Their quick response, knowledge

of cardiac emergency protocols, and ability to

administer life-saving treatments, such as

cardiopulmonary resuscitation (CPR) or
defibrillation,

can significantly improve patient outcomes.

Conclusions

Nurses have a unique role in cardiac care, as

they are responsible for assessing patients,

monitoring their conditions, and providing

essential care. . Nurses also collaborate with

physicians, pharmacists, and other healthcare

providers to develop comprehensive care plans

that meet the unique needs of each patient.

By employing their expertise, knowledge, and

compassion, nurses make a substantial impact
on

promoting cardiovascular health and reducing

the burden of cardiovascular diseases in

individuals and communities.

By fulfilling these roles, nurses contribute
significantly to the prevention and management
of

cardiovascular disorders, promoting better

health outcomes and improving the overall
wellbeing of individuals and communities.

ADEYEMI CHAMPION ADEBOLA

JCONS/23A/007
TOPIC:SPECIAL PROCEDURES IN THE
MANAGEMENT OF CARDIOVASCULAR
SYSTEM DISORDERS.

1.BLOOD, UREA AND CREATININE TEST

A blood urea and creatinine test is a
common diagnostic tool used to evaluate
kidney function. Urea and creatinine are
waste products that are normally filtered by
the kidneys and excreted in the urine.
Elevated levels of these substances in the
blood can indicate impaired kidney function.
Blood urea nitrogen (BUN) is a measure of
the amount of urea nitrogen in the blood,
and high levels can suggest dehydration,
kidney damage, or other conditions that
affect kidney function. Creatinine is a waste
product of muscle metabolism, and
elevated levels can indicate kidney damage
or decreased kidney function.
The test is often ordered as part of a
routine check-up or when a person has
signs of kidney disease, such as:
Swelling in the legs, ankles, or feet.
Fatigue,Poor appetite,Difficulty
concentrating,High blood pressure.

Preparation for the test typically involves

fasting for several hours beforehand.
During the test, a healthcare professional
will draw a blood sample from a vein in the
arm, and the sample will be sent to a lab for
analysis. The results of the test will help
healthcare providers determine the cause
of any kidney problems and develop a
treatment plan to improve kidney function.
Blood Urea Nitrogen (BUN) levels can affect
the cardiovascular system in several ways:
High BUN levels can increase the risk of
mortality in patients with heart failure,
especially during acute decompensation.
Elevated BUN levels are associated with
adverse outcomes in patients with heart
failure, indicating a potential link between
kidney function and cardiovascular health.
High BUN levels can contribute to
dehydration, which can put additional strain
on the heart and circulatory system.
In some cases, high BUN levels can be
caused by congestive heart failure or recent
heart attacks, as the heart's reduced ability
to pump blood effectively can lead to a
buildup of waste products in the blood.
High BUN levels may also be associated
with hypertension (high blood pressure),
which can increase the risk of heart disease
and stroke.

2.ELECTROCARDIOGRAM TEST
An electrocardiogram (ECG or EKG) test is a
non-invasive, painless procedure that
records the electrical activity of the heart. It
provides valuable information about the
heart’s rhythm, rate, and performance.
Doctors often use ECG tests to diagnose
and monitor various heart conditions,
including:
Arrhythmias (abnormal heart rhythms)
Coronary heart disease
Heart attacks
Cardiomyopathy (disease of the heart
muscle)
Electrolyte imbalances
Congenital heart defects

During an ECG test, several small, sticky

electrodes are attached to the skin on the
chest, arms, and legs. These electrodes are
connected to a machine that detects and
records the electrical signals produced by
the heart as it beats. The test usually takes
about 5-10 minutes to complete.
The resulting ECG recording consists of a
series of waves and intervals that represent
the electrical activity of different parts of
the heart. A cardiologist or other healthcare
professional will analyze the ECG tracing to
identify any abnormalities or potential
issues with the heart’s function.

ECG tests can be performed in various

settings, such as a doctor’s office, hospital,
or even at home with portable devices.
Depending on the patient’s symptoms and
suspected heart condition, the test may be
done while the patient is resting, during
physical activity (stress test), or over an
extended period (Holter monitor).
3.MAGNETIC RESONANCE IMAGING(MRI)
Magnetic Resonance Imaging (MRI) is a
non-invasive imaging technique that uses a
powerful magnetic field, radio waves, and a
computer to create detailed, three-
dimensional images of the body's internal
structures. MRI is widely used in medical
diagnostics because it provides clear and
detailed images of organs, tissues, and
skeletal structures without exposing
patients to ionizing radiation. Here's a
detailed overview of the MRI process and
its applications:
How MRI works
During an MRI scan, the patient lies on a
movable bed that slides into a cylindrical-
shaped machine with a strong magnetic
field. The magnetic field causes hydrogen
atoms in the body to align in a particular
direction. Radiofrequency pulses are then
applied, which temporarily disrupt the
alignment of the hydrogen atoms, and when
the radiofrequency pulses are turned off,
the atoms return to their original alignment,
releasing energy in the process. The MRI
machine captures this energy and uses
complex algorithms to generate detailed
images of the patient's anatomy.
Benefits of MRI
Non-invasive and painless procedure⁶
No exposure to ionizing radiation
Excellent soft tissue contrast and high
spatial resolution
Ability to create images in any plane (axial,
sagittal, coronal)
Useful for detecting subtle abnormalities
that may not be visible on other imaging
modalities
4.URINALYSIS
Urinalysis is a common diagnostic test that
examines the physical, chemical, and
microscopic properties of urine. This test
provides valuable insights into a person's
overall health and can help detect various
diseases, infections, and metabolic
disorders. Urinalysis can be performed as a
routine check-up, during a hospital stay, or
as a diagnostic tool for specific conditions.
Here's a comprehensive look at urinalysis
and its applications:
Components of Urinalysis
Urinalysis consists of three main
components:
Physical Examination: Assessment of urine
color, clarity, and odor.
Chemical Analysis: Testing for various
substances, such as glucose, protein,
ketones, blood, bilirubin, and leukocyte
esterase, using reagent strips.
Microscopic Examination: Analysis of urine
sediment for the presence of red and white
blood cells, bacteria, crystals, and casts
under a microscope

5.COMPUTED TOMOGRAPHY
Computed Tomography (CT) is a non-
invasive medical imaging technique that
uses X-rays and computer algorithms to
generate detailed, cross-sectional images
of the body's internal structures. CT scans
provide valuable diagnostic information and
can help detect various diseases and
abnormalities in soft tissues, bones, and
blood vessels. Here's a comprehensive
overview of CT scans, their applications,
and the benefits and risks associated with
the procedure:
How CT Works
During a CT scan, the patient lies on a table
that slides through a donut-shaped
machine called a gantry. The X-ray tube and
detectors rotate around the patient,
emitting and detecting X-rays as the table
moves. The data collected is then
processed by a computer, which generates
detailed, cross-sectional images of the
scanned body part.
Benefits of CT
Non-invasive and relatively quick procedure
High spatial resolution and excellent tissue
contrast
Ability to visualize various body structures,
including soft tissues, bones, and blood
vessels
Useful for diagnosing a wide range of
medical conditions and guiding treatment
decisions
Can be performed with or without contrast
agents, depending on the clinical indication

Other procedures include

6.ABLATION THERAPY
Ablation therapy is a procedure doctors use
to destroy abnormal tissue that can be
present in many conditions. For example, a
doctor might use an ablation procedure to
destroy a small amount of heart tissue
that's causing irregular heartbeats or to
treat tumors in the lung, breast, thyroid, liver
or other areas of the body.
Healthcare providers that perform ablation
therapy may include doctors trained in
imaging, called radiologists, heart
specialists called cardiologists, and cancer
treatment specialists called oncologists.
Doctors may use probes inserted through
the skin, flexible tubes inserted through an
artery (catheters) or energy beams. Imaging
techniques are used to guide the ablation.
The abnormal tissue can be damaged or
destroyed with various techniques,
including heat (radiofrequency ablation),
extreme cold (cryoablation), lasers or
chemicals.
Ablation therapy is called a minimally
invasive procedure because it does not
require open surgery with large cuts
through the skin and other tissues to
remove the abnormal tissue.
7.CARDIAC CATHETERIZATION
What is cardiac catheterization?

Cardiac catheterization (also called cardiac

cath or coronary angiogram) is an invasive
imaging procedure that allows your
healthcare provider to evaluate your heart
function. Your provider puts a catheter (tiny
tube) into a blood vessel in your arm or
groin and then into your coronary arteries.
Providers can use a heart catheterization to
find problems and use other procedures to
fix them, sometimes during the same
appointment. For example, your provider
could fix a heart flaw you were born with or
replace your heart valve without making a
large incision and doing traditional surgery.

When would a cardiac catheterization be

needed?

Cardiac catheterization is used to:

Find out why you’re having chest pain or

an abnormal heart rhythm.Take a tiny bit of
muscle from your heart to examine
(biopsy).Evaluate or confirm the presence
of coronary artery disease, valve disease or
disease of the aorta. Your provider may do
this as a scheduled procedure or shortly
after a heart attack.Evaluate heart muscle
function.Check your pulmonary arteries for
issues.Check on your blood flow, oxygen
level and pressure in areas of your
heart.Get more information that other tests
couldn’t provide.Determine the need for
further treatment (such as an interventional
procedure or coronary artery bypass graft,
or CABG, surgery).Place a stent to open a
blockage in an
artery.Diagnose cardiomyopathy, aortic
stenosis, mitral valve regurgitation or
pulmonary hypertension (high blood
pressure in your lungs).Help with planning
a heart transplant
8.THROMBOLYTIC THERAPY
Thrombolytic therapy (also called
thrombolysis) is the use of medications to
dissolve blood clots. Thrombolysis reduces
damage to your body’s organs and tissues
when there are clots by improving blood
flow.

Healthcare providers may use thrombolytic

therapy as an emergency treatment if you
have acute obstructions to normal blood
flow, such as a heart attack, stroke or blood
clots in the lungs (pulmonary embolism).
Your provider must start these medications
as soon as possible to increase the chance
of success. Thrombolytic therapy can also
help dissolve blood clots related to deep
vein thrombosis (DVT), peripheral arterial
disease (PAD) and other conditions.

Healthcare providers give thrombolytic

therapy either through an IV or through a
long, thin tube (catheter).

Who needs to have thrombolytic therapy?

You may need thrombolytic therapy:

If a blood clot suddenly blocks a major vein

or artery.If blood-thinning medications
(anticoagulants) haven’t reduced blood
clots related to DVT, pulmonary
embolism (PE) or PAD.
Who shouldn’t have thrombolytic therapy?

Healthcare providers don’t recommend

thrombolytic therapy if you have conditions
related to an increased risk of bleeding,
such as:

Active bleeding.Recent brain

bleed/hemorrhage (intracranial
hemorrhage).Recent brain surgery or spine
surgery.Severe high blood pressure
(hypertension).Severe kidney
disease.Recent traumatic brain injury.What
are the risks or complications of
thrombolytic therapy?

The main risk of thrombolytic therapy is

internal bleeding. About 5% of people who
have thrombolytic therapy have major
bleeds and about 1% have brain bleeds that
cause a stroke. Other risks include:
Allergic reactions.Bleeding in
the nose, stool or urine.Bleeding
or bruising at the site of IV or catheter
insertion.Blood vesselKidney damage,
especially if you have diabetes.Low blood
pressure (hypotension).Movement of the
blood clot to another part of your
body.Swollen tissue
(angioedema).Ventricular arrhythmia.
9.CORONARY ARTERY BYPASS GRAFT
SURGERY(CABG)
Coronary artery bypass graft surgery (CABG)
is a procedure used to treat coronary artery
disease. Coronary artery disease (CAD) is
the narrowing of the coronary arteries.
These are the blood vessels that supply
oxygen and nutrients to the heart muscle.
CAD is caused by a build-up of fatty
material within the walls of the arteries.
This buildup narrows the inside of the
arteries, limiting the supply of oxygen-rich
blood to the heart muscle.

One way to treat the blocked or narrowed

arteries is to bypass the blocked portion of
the coronary artery with a piece of a healthy
blood vessel from elsewhere in your body.
Blood vessels, or grafts, used for the
bypass procedure may be pieces of a vein
from your leg or an artery in your chest. An
artery from your wrist may also be used.
Your healthcare provider attaches 1 end of
the graft above the blockage and the other
end below the blockage. Blood bypasses
the blockage by going through the new
graft to reach the heart muscle. This is
called coronary artery bypass surgery.

Traditionally, to bypass the blocked

coronary artery, your provider makes a large
cut (incision) in the chest and briefly stops
the heart. To open the chest, your provider
cuts the breastbone (sternum) in half
lengthwise and spreads it apart. Once the
heart is exposed, your provider inserts
tubes into the heart. This lets the blood be
pumped through the body by a heart-lung
bypass machine. The bypass machine is
needed to pump blood while the heart is
stopped.

Possible risks of coronary artery bypass

graft surgery (CABG) include:
Bleeding during or after the surgery
Blood clots that can cause heart attack,
stroke, or lung problems
Infection at the incision site
Pneumonia,Breathing problems,Pancreatitis
Kidney failure,Abnormal heart rhythms
Failure of the graft,Death
10.DEFIBRILLATION
Defibrillation is the use of an electrical
current to help your heart return to a normal
rhythm when a potentially
fatal arrhythmia (abnormal heart rhythm) is
happening in your heart’s lower chambers
(ventricles). Also known as electrical
cardioversion, defibrillation is most
effective when a healthcare provider
delivers the shock as soon as possible after
an arrhythmia starts.
Defibrillation can help with:
Ventricular tachycardia (very fast heartbeat)
without a pulse.Ventricular
fibrillation (quivering of the heart muscle)
which is most often the cause of sudden
cardiac arrest.

What happens during defibrillation?

Your healthcare provider will follow these
steps for a cardiac defibrillation procedure:
Place two defibrillator paddles or sticky
pads (attached to the defibrillator) on your
chest. One paddle or pad will go below your
right shoulder and the other one below your
left nipple. The pads have conducting
material in them to prevent burns, but your
provider will need to put conducting
material on your chest before using the
paddles.For sticky pads, press a button on
the defibrillator to release the charge. When
using paddles, press the button on each
paddle at the same time.
Defibrillation briefly stops your moving
heart muscle to allow your heart to
generate an electrical impulse and start a
normal rhythm. In essence, defibrillation
restarts the heart.
11.HEART VALVE SURGERY
Heart valve surgery fixes or replaces one or
more of the four valves in your heart.
Your valves, located between your heart’s
four chambers, keep your blood moving the
right way. When valves are working right,
your blood should flow through your heart
in one direction each time your heart beats.
Valves act like doors that open and close
with each heartbeat, letting blood flow in
and out of the chambers. When a valve isn’t
working right, some of the blood may go
back to the chamber or room it just left.
Other times a valve may become narrow,
which may prevent blood from moving
forward. This is a problem because it keeps
your heart from working efficiently.