1. ANGINA MYOCARDIAL INFARCTION HEART BLOCK CONGESTIVE HEART FAILURE DISORDERS OF THE HEART

2. OBSERVATIONS TO REPORT IN PATIENT’S WITH CARDIAC DISORDERS Color changes Changes in pulse rate or rhythm Changes in BP Edema Disorientation Pt. c/o SOB Pt. c/o chest pain/pressure/discomfort Diaphoresis Pt. c/o N&V Subjective or Objective????

3. ANGINA PECTORIS “Pain of effort”- when coronary arteries are unable to carry enough blood to meet the heart’s demand for oxygen Can develop gradually or suddenly Increase stress on heart

5. ANGINA PECTORIS Factors that could bring on an attack:  Exertion  Heavy eating  Emotional stress

6. ANGINA PECTORIS S&S: Pain with exertion/exercise Pain/pressure/discomfort Pale/flushed face Diaphoretic Treatment: Drugs Avoid stress/sudden exertion

7. MYOCARDIAL INFARCTION (MI) Heart attack: An acute MI occurs when the coronary arteries are blocked. Part of the heart muscle supplied by these vessels becomes ischemic. Unless circulation is restored quickly, the cells die (infarction)

8. MYOCARDIAL INFARCTION Can be caused by occlusion in coronary artery that “feeds” the heart.

9. MYOCARDIAL INFARCTION S&S: Pain/discomfort/pressure in chest Heaviness in armRestlessness N&VCyanosis Irregular pulse/respirations Diaphoretic Anxiety/weakness SOB Syncope Hypotension

10. MYOCARDIAL INFARCTION Treatment is directed towards: 1. Relieving pain 2. Reducing heart’s activity (work load) 3. Altering clotting ability of blood (drugs) 4. Administering drugs to dissolve clot

11. What is the difference between an MI and an angina attack?

12. HEART BLOCK Condition that develops due to interference in the electrical current through the heart. The flow of this electrical current through the heart muscle makes the normal cardiac cycle. Pacemaker- electronic device that is implanted under the chest muscles that carries electrical current through the heart muscle to replace the “lost control.”

14. CONGESTIVE HEART FAILURE (CHF) Failure of the R side of the heart to pump efficiently, which results in congestion of the lungs. At first the heart enlarges (hypertrophy) to compensate for additional loads. Eventually, it can no longer maintain flow. Because the weakened heart moves less blood with each pump, fluid backs up in the lungs. The heart looses it’s “squeezing power”, and the heart must work harder to maintain the blood flow. The body (especially lungs)becomes congested with fluid, which is why it is called congestive heart failure.

17. Causes of CHF High blood pressure Heart attack Valve problems Obesity

18. S&S of CHF Dyspnea Orthopnea- difficulty breathing unless sitting upright Edema Fatigue Cough Ascites- fluid in abd. Confusion associated with hypoxia (not enough O2) Enlarged heart

19. S&S of CHF

21. Treatment of CHF Drugs to diuresis (urinate to lose fluid) Low sodium diet Fluid restriction Daily weights High fowler’s position Assist with ADLs Monitor I&O TED stockings

22. Complications of CHF Acute Pulmonary Edema- life threatening, acute episode where lungs fill with fluid

23. Review Questions 1. Why do patients who suffer from R sided heart failure experience pulmonary symptoms? 2. What is the difference between angina and an MI? 3. What is the relationship between coronary arteries, ischemia, and infarction in an MI? 4. What are symptoms of an MI? 5. How do we treat heart block? 6. Why would you see edema in CHF, especially in the feet?

24. Review Questions 7. What position is best for pulmonary edema? 9. How is atherosclerosis related to CHF? 10. Is a large heart a better functioning heart? Explain