INTRODUCTION
Cardiovascular disease (CVD) is a general term encompassing heart attack, stroke, and other disorders of the
heart and blood vessel system. The term Heart Disease refers only to the diseases of the heart and blood
vessel system within the heart. cardiovascular disease is the leading health problems in the Western world. It
is the number one cause of death in the United States, claiming well in excess of 1 million lives annually. An
estimated 59.7 million Americans have heart and blood vessel disease, although many do not know it because they
have no overt symptoms. Traditionally thought of as a disease primarily affecting men, cardiovascular diseases
is a growing problem for women. It is responsible for the deaths of as many as 500,000 women a year in the
United States. In fact, more women die from cardiovascular diseases than from all forms of cancer combined.
Lower levels of estrogen during and after menopause are thought to increase a woman's risk for CVD. African-American
women are at greater risk than women of other ethnic backgrounds.
DESCRIPTION
The cardiovascular system is made up of the heart and blood vessels. Blood is pumped by the
heart and circulated throughout the body through the blood vessels.
ANGINA PECTORIS
The arteries that supply blood to the
heart are called the coronary arteries. If the heart's blood vessels narrow, the amount of blood they
supply to the heart may be insufficient to provide the oxygen the heart needs. This oxygen deprivation is
what causes a type of chest pain known as angina pectoris. A heavy, tight pain in the chest area characterizes
angina, usually after some type of exertion. The pain usually recedes with rest.
MYOCARDIAL INFARCTION (MI) / HEART ATTACK
If the coronary arteries that carry oxygen and nutrients to the heart muscle become obstructed, the flow of the
blood is cut off completely, and a heart attack, or myocardial infarction (MI), can occur, resulting in damage to
the heart muscle. Arteriosclerosis, or hardening of the arteries, and the presence of a thrombus, or clot, in
a blood vessel are the most common causes of obstruction. Arteriosclerosis is responsible for most of the
deaths resulting from heart attacks. Spasms of the coronary arteries can also result in a heart attack. A heart
attack may feel as if someone is applying intense pressure to the chest. This pain may last for several minutes ,
often extending to the shoulder, arm, neck, or jaw. Other signs of heart attack include sweating, nausea, vomiting,
shortness of breath, dizziness, fainting, feelings of anxiety, difficulty swallowing, sudden ringing in the ears, and loss of
speech. The amount and type of chest pain vary from one individual to another. Some people have intense pain,
while others feel only mild indigestion. Some have no symptoms at all. a situation referred to as a "silent" heart
attack.
HYPERTENSION (HIGH BLOOD PRESSURE)
Hypertension, also known as high blood pressure, is often a precursor to heart problems. Hypertension is an extremely
common form of cardiovascular disease. It usually results from a decrease in the elasticity or a reduction in the
interior diameters of the arteries or both, which may be caused by arteriosclerosis, defects in sodium metabolism,
stress, nutritional deficiencies, and enzyme imbalances. Kidney disease, hyperthyroidism, disorders of the pituitary
or adrenal glands, and heredity may be contributing factors. People considered to be at high risk are those with diabetes,
those who smoke, or those who already have had a heart attack or stroke. Because it is essentially painless,
especially in the early stages, many people don't even know they have it - hence the term "silent killer". By
the time hypertension causes complications that result in symptoms (such as rapid pulse, shortness of breath,
dizziness, headaches, sweating), the disorder is more difficult to treat. Untreated hypertension is the leading
cause of stroke and also greatly increases the risk of heart attack, heart failure, and kidney failure. Treatment
seeks to lower blood pressure to less than 140 mm Hg (millimeters of Mercury) systolic and less than 90 mm Hg
diastolic for most people. Treatment for those with diabetes and chronic kidney disease aims to lower blood
pressure to less than 130 mm Hg systolic and less than 80 mm Hg diastolic. For people aged 50 and older, systolic
blood pressure may be a more important cardiovascular risk factor than diastolic pressure.
MoonDragon's Health & Wellness: Hypertension (High Blood Pressure)
OTHER TYPES OF CARDIOVASCULAR DISEASE
Other types of cardiovascular disease include heart failure, arrhythmias, and valvular disease.
HEART FAILURE
While a heart attack occurs because of an interruption in blood flow to the heart, heart failure is
characterized by inadequate blood flow from the heart - the heart fails to pump enough blood to meet the body's needs.
Symptoms include fatigue, poor color, shortness of breath, and edema (swelling due to the accumulation of
fluid in the body's tissues), especially around the ankles.
MoonDragon's Health & Wellness: Atherosclerosis & Arteriosclerosis
ARRHYTHMIAS
Arrhythmias are disturbances in the normal rhythm of a heartbeat. There are different kinds of arrhythmias. Some
are quite dangerous - even immediately life-threatening - while others may be merely annoying (or scarcely
noticeable), and pose no particular danger.
- Palpitations is a term that refers to the feeling of a pounding heartbeat, whether regular or irregular.
- Tachycardia is an abnormal increase in the resting heart rate.
- Bradycardia is the opposite, and abnormally slow heart rate.
- Ectopic beats are premature beats (often felt as "skipped" beats).
- Flutter and fibrillation are situations in which the normal steady beating of
the heart are converted by electrical error into a rapid twitching of the heart muscle. This
ineffective functioning results in an insufficient supply of blood being carried to the body's tissues.
Electrical conduction in the heart originates in the SA node and travels through the AV node to the ventricles,
resulting in a heart beat.
Tachycardia is an abnormally fast heart rhythm. Common symptoms associated with tachycardia are
palpitations, dizziness, chest pain, shortness of breath, and even fainting spells. Sometimes tachycardias
are so mild that they're not even noticed; but some tachycardias may be life-threatening. Most cases of
tachycardia are due to an abnormal electrical pathway known as a re-entry circuit. When an electrical
impulse gets into the pathway, it may start traveling in a loop, causing the heart to contract with each
impulse through the pathway. As a result, the heart beats very rapidly. Types of tachycardia that are most
common among the general population include AV Nodal Re-entrant Tachycardia, accessory pathway
tachycardia, atrial fibrillation, atrial flutter, and ventricular tachycardia.
VALVULAR DISEASE
Valvular disease is a term for disorders that impair the functioning of one or more of the heart's valves. It may
be caused by congenital defect, or it may be the consequence of illness such as rheumatic fever or endocarditis
(infection of the heart muscle). Mitral valve prolapse (MVP) is a condition in which the mitral valve, which
controls blood flow from the left atrium to the left ventricle (the heart's main pumping chamber), protrudes too
far into the left atrium while it is pumping. In many cases, this causes no symptoms at all, although some
people experience occasional fatigue, dizziness, palpitations, and/or vague chest pain. Mitral valve prolapse
also causes a distinctive sound that a skilled health care provider can identify by means of a stethoscope. This
condition is now known to be rarer than once thought. And for most of those who do have MVP, it is not
thought to lead to severe complications.
SYNDROME X
Syndrome X, also known as the metabolic syndrome, is a syndrome characterized by a number of signs of overall
poor health. People with syndrome X are more likely to suffer strokes than other people. About a quarter of
all American adults are estimated to have syndrome X. That means they have at least 3 of the 5 common
conditions associated with the syndrome:
- Abdominal obesity.
- High blood sugar.
- High blood pressure.
- High triglyceride levels.
- Low HDL (good) cholesterol levels.
While diabetes significantly increases the risk for stroke, it has been found that for people who have not
been diagnosed with diabetes, having a metabolic syndrome can be as powerful a risk factor. Based on a
recent study, it is estimated that 20 percent of all strokes could be prevented by getting out of the
syndrome X category. The role of nutrition in achieving this is crucial.
Unfortunately, despite remarkable new technology for both diagnosis and treatment of heart-related
conditions, the first sign of cardiovascular disease may be a life-threatening calamity.
Disorders of the cardiovascular system are often far advanced before they become symptomatic.
An estimated 25 percent of people who have had heart attacks have no previous symptoms of heart
trouble. Every minute, someone in the United States dies of a heart attack. According to a recent study, the
blockages in arteries that can lead to a heart attack or sudden death appear to start forming early in life,
in young adults and adolescents as young as age 15.
Cardiovascular disease is not an inevitable result of aging. Many preventive measures can be
taken to avoid heart disease. Controllable factors that can contribute to heart disease include
smoking,
high blood pressure,
excessive alcohol consumption,
elevated serum cholesterol, a type-A personality,
stress,
obesity,
a sedentary lifestyle, and
diabetes.
You can alter your lifestyle to keep your heart healthy.
COMMON CIRCULATORY SYSTEM DISORDERS
Common disorders of this system include:
- Diseases relating to the blood vessels.
- Diseases of the heart.
- Blood dyscrasias (abnormalities); these diseases can involve the bone, bone marrow, liver, or spleen.
Observations that need to be reported to medical care staff or health care provider in
a patient with disorders of the circulatory system are:
- Color change, pallor or cyanosis, redness.
- Cool to touch.
- Hot to touch.
- Changes in pulse rate or rhythm.
- Changes in blood pressure.
- Edema.
- Disorientation.
PERIPHERAL VASCULAR DISEASES
The blood vessels that serve the outer parts of the body, particularly those of the hands and
feet, are referred to as peripheral (toward the outer part) blood vessels. Diseases of
these vessels affect the parts of the body through which they pass. The health of these vessels
also influences heart function.
Peripheral vascular diseases that affect the arteries diminish the flow of the blood to the
extremities. Tissues through which the narrowed arteries pass may not get the nourishment they
need. Areas affected are the extremities: the arms, legs, and brain. The signs and symptoms
associated with decreased peripheral circulation are:
- Burning pain during exercise.
- Hair loss over feet and toes.
- Thick and rigid toenails.
- Dusky red skin or cyanotic, brownish skin.
- Dry and scaly or shiny skin.
- Chronic edema of the feet and legs.
- Cool skin temperature of feet and legs.
- Difficulty with ambulation.
When the arteries are affected, the blood flow may be seriously interrupted. This condition requires immediate
medical treatment. Vascular ulcers may occur. These are sores that start because of the poor circulation of
the blood in the legs. These ulcers are difficult to treat and may take months to heal.
Treatment is aimed at:
- Increasing local circulation.
- Positioning and specific prescribed exercise can promote arterial flow and venous return.
- Sometimes an oscillating (rocking bed) is employed to improve the circulatory flow. The
oscillating bed rocks up and down in cycles, raising the patient's feet 6 inches above his head
and then lowering them 12 to 15 inches. The steady rhythm provides both passive exercise for
the patient and some circulatory stimulation.
- Nothing that would hamper the patient's circulation is permitted.
- Preventing injuries that heal poorly.
ATHEROSCLEROSIS
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Cross-section through a coronary artery undergoing progressive atherosclerosis.
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Atherosclerosis is a common form of vascular disease.
- Roughened areas known as atheromas, which are growths developed over deposits of fatty
materials, form on the inner walls of the arteries and narrow the vessels.
- The vessels of the heart and brain, and those leading to the legs from the body, are often
affected.
- The atheromas gradually grow larger until they eventually block blood flow to the parts and
organs served by the affected vessels.
- Sometimes clots that have formed over the irregular areas in the vessel walls break off and
travel as emboli to block distant vessels.
- The narrowing of vessels can lead to serious complications, such as:
- Formation of blood clots.
- Angina pectoris.
- Myocardial infarction (MI).
- Strokes (CVA) (also known as brain attacks).
- Gangrene.
The exact cause of this vascular disease is unknown, but several factors seem to increase the
risk that a person will develop it. These factors include:
- Hypertension.
- Diabetes mellitus.
- Overweight.
- Heredity.
- Smoking.
- Stress.
- Lack of exercise.
- Diets high in cholesterol and fats.
Treatment includes:
- Exercise.
- Proper diet.
- Reduction of stress.
- Control of smoking and obesity.
MoonDragon's Health & Wellness: Atherosclerosis & Arteriosclerosis
VARICOSE VEINS
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Veins contain valves to prevent the backward flow of blood.
A. External view of the vein shows wider area of valve.
B. Internal view with the valve open as blood flows through.
C. Internal view with the valve closed.
D. Vein with weakened valve causing a varicose vein.
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The veins can also cause problems. Varicose veins form when the valves in the veins in the
legs become weakened. This means:
- The blood does not flow through the veins as it should.
- The veins become distended and visible through the skin.
- The veins become inflamed (phlebitis).
- A blood clot may form in the vein.
Report the following signs:
- Pain or aching in the legs.
- Signs of inflammation (warmth and redness).
Remember to never rub or massage the area of a varicose vein.
MoonDragon's Health & Wellness: Varicose Veins
TRANSIENT ISCHEMIC ATTACK
Transient ischemic attack (TIA) is a temporary interruption of the blood flow to part of the
brain. The symptoms may be:
- Weakness or paralysis of any extremity or the face.
- Vision problems.
- Difficulty with speech.
- Difficulty with swallowing.
These symptoms come on quickly and may last from just a few minutes to 24 hours. There are no
permanent effects. However, a TIA is usually a warning that a brain attack will occur at some
time. If you have any of these symptoms listed, report them to your health care provider immediately.
MoonDragon's Health & Wellness: Stroke
HYPERTENSION (HIGH BLOOD PRESSURE)
Hypertension (high blood pressure) is often a precursor to heart problems.
Hypertension is an extremely common form of cardiovascular disease. It may have no known
origin, or it may follow illnesses that affect such organs as the blood vessels, kidneys,
or liver. High blood pressure promotes the development of
arteriosclerosis,
which further narrows the vessels. This increases blood pressure from a decrease in the
elasticity or a reduction in the interior diameter of the arteries (or both).
Defects in sodium metabolism, stress, nutritional deficiencies,
and enzyme imbalances.
Kidney disease,
hyperthyroidism,
disorders of the pituitary or
adrenal glands, and
the use of
oral contraceptives
can also lead to hypertension, and heredity may be a factor.
Because it is essentially painless, especially in the early stages, many people don't even
know they have it - hence the term "silent killer." High blood pressure, besides increasing
the risk of developing atherosclerosis, it increases the stress on the heart, the damage
to the blood vessel walls, so they are more apt to rupture and further limits the blood
flow to the organs of the body. By the time hypertension causes complications
that result in symptoms, the disorder is more difficult to treat. Untreated hypertension
is the leading cause of stroke, and also greatly increases the risk of heart attack, heart
failure, and kidney failure.
Symptoms:
- Flushed face.
- Rapid pulse.
- Shortness of breath.
- Dizziness.
- Headaches.
- Sweating.
- Nosebleeds.
- Blurred vision.
- Changes in speech pattern.
Report immediately to your health care provider any of the signs and symptoms of hypertension.
Treatment for hypertension may consist of:
- Drugs that lower the blood pressure.
- Diet low in sodium.
- Diet that promotes weight loss.
- Regular exercise program.
- Quitting smoking.
- Surgical sympathectomy (a procedure in which the nerves that cause blood vessels to constrict
are cut. When the nerves are cut, the blood vessels dilate.)
- Moderation in lifestyle.
- Biofeedback techniques to lower the blood pressure.
MoonDragon's Nutrition Information: Diet Index
MoonDragon's ObGyn Information: Smoking
MoonDragon's Health Therapy: Biofeedback
MoonDragon's Health & Wellness: Hypertension (High Blood Pressure)
MoonDragon's Health & Wellness: High Cholesterol
MoonDragon's Health & Wellness: Atherosclerosis & Arteriosclerosis
HEART CONDITIONS
Heart disease may sometimes be due to an infection, but most heart disease develops because
of changes in the blood vessels. As the openings of the blood vessels become smaller, the heart
must work harder and harder to do the job of pumping blood to the body.
ANGINA PECTORIS
Angina pectoris is known as cardiac "pain of effort". The arteries that supply blood to the heart are called
the coronary arteries. If the heart's blood vessels narrow, as in atherosclerotic changes, the amount
of blood they supply to the heart may be insufficient to provide the oxygen the heart needs. This oxygen
deprivation is what causes a type of chest pain known as angina pectoris.
This may develop:
- Gradually over a period of time as atheromas develop.
- Suddenly, as the vessels constrict.
Factors that precipitate (bring on) an attack include:
- Exertion.
- Heavy eating.
- Emotional stress.
Signs and symptoms if angina pectoris that you should immediately report:
- Angina is characterized by a heavy or dull, tight pain, discomfort or pressure
in the chest area with increasing intensity. It is usually centered under the breast
bone (sternum), spreading to the left arm (or either or both arms) and up into the back,
jaw, or neck, or any combination of these sites. The person may say something like,
"It feels like an elephant is sitting on my chest".
- The pain occurs usually after some type of exertion, exercise or stress.
- Pale or flushed face.
- The person is freely perspiring.
- The person may be frightened or extremely upset.
- The pain usually recedes with rest.
Signs and symptoms may differ with individuals, but the symptoms are usually the same each
time a person experiences an attack.
Treatment of angina pectoris consists of:
- Diagnosing hidden causes. A treadmill stress test is one method of doing this.
- Teaching the person to avoid stress and sudden exertion.
- Drugs that relax the coronary arteries.
- Coronary artery bypass surgery.
- Angioplasty, a surgical procedure to open the vessels.
If you are caring for a person with angina pectoris, you may assist them by:
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- Ask first, if unknown, if the patient is being treated for angina and is on medication. If
the answer is yes, then as the patient if there is a pill or spray they can take for the
angina pain. A patient with a previous bouts of angina usually have medication that can be
taken (placed or sprayed under the tongue) to relieve pain. The most common medications of this
type is nitroglycerin. The patient may have already taken nitroglycerin prior to your
arriving to help them. If the patient has not had a nitroglycerin pill or spray within the last
five minutes (it usually relieves pain within 5 minutes), then help the patient to place one
of the tiny pills under their tongue or help the patient to administer the spray. If the pain
is not relieved after the second dose of medication, assume the patient is having a heart attack
and prepare to transport to the nearest medical facility for cardiac care.
- Helping the patient to avoid unnecessary emotional or physical stress.
- Encouraging the patient not to smoke.
- Report any signs or symptoms of an attack to the patient's health care provider at once,
especially if medication has not relieved pain within 10 minutes of initially taking it.
MYOCARDIAL INFARCTION (HEART ATTACK)
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The term myocardial infarction (MI), or heart attack, refers to a period in which the
heart suddenly cannot function properly. There are different kinds of heart attacks. They differ in
their severity and prognosis (expected outcome). The heart is muscle tissue and may become tired just
as any muscle my tire. The cells of the heart require nourishment and oxygen like all other cells.
An acute myocardial infarction occurs when the coronary arteries that carry oxygen and
nutrients to the heart muscle become obstructed (blocked). Part of the heart muscle where
the flow of blood is cut off completely becomes ischemic (loses its blood supply).
Unless circulation is restored quickly, the cells die (infarction), and a heart attack, or
myocardial infarction, can occur, resulting in damage to the heart muscle. If too much
tissue dies, the person cannot survive. Coronary heart attack is also called:
- Coronary occlusion: blockage of coronary arteries.
- Coronary thrombosis: when a thrombus (stationary blood clot) forms at the site, blocking the blood flow.
- Coronary embolism: when a moving clot or insoluble particle (embolus), which
originated elsewhere and has moved, becomes lodged in the artery.
Arteriosclerosis,
or hardening of the arteries, and the presence of a thrombus, or clot, in a blood vessel
are the most common causes of obstruction. Arteriosclerosis is responsible for most of
the deaths resulting from heart attacks. Spasms of the coronary arteries can also result
in a heart attack.
Signs and Symptoms:
- A heart attack may feel as if someone is applying intense pressure to the chest. The pain
may resemble severe indigestion. It is often described as "crushing" chest pain.
- This pain may last for several minutes.
- The pain may radiate into the shoulder, left arm, neck, or jaw.
- Sweating (perspiration, diaphoresis).
- Nausea.
- Vomiting.
- Shortness of breath.
- Dizziness.
- Fainting (syncope).
- Feelings of anxiety and weakness.
- Restlessness.
- Indications of shock, which include drop in blood pressure and pallor.
- Difficulty swallowing.
- Sudden ringing in the ears.
- Loss of speech.
- The amount and type of chest pain vary from one person to another. Some people have
intense pain, while others feel only mild discomfort. Many mistake the signs of a heart
attack for indigestion. Some have no symptoms at all, a situation referred as a "silent"
heart attack.
Immediate treatment has saved many people. The treatment is directed toward:
- Relieving the pain.
- Reducing heart activity.
- Altering the clotting ability of the blood.
- Administering drugs to dissolve the clot.
NURSING CARE
During the acute stage, heart attack patients require professional care. Many hospitals provide
intensive cardiac care units for these patients. Nursing care supports the therapy ordered.
Special attention must be given to:
- Noting signs of a recurrence and reporting immediately to the nurse.
- Watching for bleeding and reporting immediately.
- Assisting with activities of daily living.
- Monitoring vital signs.
Immediate treatment has saved many people. The treatment is directed toward:
- Relieving the pain.
- Reducing heart activity.
- Altering the clotting ability of the blood.
- Administering drugs to dissolve the clot.
During the acute stage, heart attack patients require professional care. Many hospitals provide
intensive cardiac care units for these patients. Nursing care supports the therapy ordered.
Special attention must be given to:
- Noting signs of a recurrence and reporting immediately to the nurse.
- Watching for bleeding and reporting immediately.
- Assisting with activities of daily living.
- Monitoring vital signs.
HEART FAILURE
Heart failure is another type of cardiovascular disease. While a heart attack occurs because of
an interruption in blood flow to the heart, heart failure is characterized by
inadequate blood flow from the heart - the heart fails to pump enough blood to meet the body's needs.
Signs and symptoms:
- Fatigue.
- Poor color.
- Shortness of breath.
- Edema (swelling due to the accumulation of fluid in the body's tissues), especially around the ankles.
CONGESTIVE HEART FAILURE (CHF)
The heart, like any other muscle will enlarge and tire if it has to work against increasing
pressure. When blood vessels narrowed by atherosclerosis increase the resistance to blood flow,
and when there is severe damage to major organs like the liver and spleen, it is more difficult
to maintain the circulation. The heart muscle may also have been damaged and weakened by
myocardial infarction. The heart must pump harder to maintain the internal flow of blood.
At first, the heart enlarges (hypertrophy) and makes up (compensates) for the additional workload.
Eventually, however, it reaches a point when it can no longer compensate. Heart failure follows.
This form of heart disease is known as congestive heart failure (CHF) or cardiac decompensation.
Signs and symptoms: The signs and symptoms are the result of the heart being unable to pump the
blood with sufficient force.
- Hemoptysis (spitting up blood).
- Cough.
- Dyspnea (difficulty breathing).
- Orthopnea (difficulty breathing unless sitting upright).
- Ascites (fluid collecting in the abdomen).
- Neck vein swelling.
- Fatiguing easily.
- Hypoxia (inadequate oxygen levels).
- Confusion.
- Edema (swelling), which develops in dependent tissues and slows blood flow, congesting the
vessels and allowing more fluid to enter the body spaces and tissues.
- Fluid accumulation in the lungs.
- Cyanosis, which occurs because fluid in the lungs makes gas exchange less efficient.
- Irregular and rapid pulse.
Treatment involves:
- Drugs to help the heart beat more strongly and regularly and to increase the output of
fluids (diuresis) by the kidneys.
- Low-sodium diet.
MoonDragon's Nutrition Information: Diet Index
- Restriction of fluids, if ordered.
- Weighing patient daily to monitor level of fluid retention.
- Monitoring apical pulse and observing for pulse deficit.
Positioning patient in orthopedic position or high Fowler's supported by pillows, or supported
in a chair. The position must be changed frequently, but changes in position should be made
slowly. Padded footboards help keep the weight of the bedding off the toes.
- Applying elasticized stockings or TED hose. TED hose are elastic anti-embolism stockings.
TED hose and Ace bandages help channel blood to the deeper vessels. They must be checked
often and reapplied every 6 to 8 hours. Check the extremities carefully for adequate
circulation. The skin should be normal color and warm.
- Assisting with activities of daily living as needed.
- Attending to general hygiene. Complete bathing is tiring, but partial baths can stimulate
circulation and provide comfort. Special attention must be given to the skin because the
combination of position, edema, and poor circulation contributes to tissue breakdown.
- Assisting with oxygen therapy. Oxygen therapy may be provided either by face mask or nasal
cannula. Because cardiac patients often breathe through the mouth, the mouth tends to be very
dry. Special mouth care may be needed.
- Providing for elimination. A bedside commode is convenient. The use of a commode is less
tiring for the patient than using a bedpan for elimination.
- Encouraging adequate nutrition. Small, easily digested meals should be provided. You may
need to assist in feeding the patient to prevent fatigue.
- Monitoring and recording fluid intake. Patients with acute heart failure may be given drugs that
increase the output of urine and alter the heart rate. Measuring the intake and output and taking
daily weights are ways of determining if fluid is being retained.
- Regularly checking vital signs. Sometimes the force of heart contraction, which propels the
blood forward into the blood vessels, does not have enough strength to make the vessels expand.
ARRHYTHMIAS
Arrhythmias are disturbances in the normal rhythm of the heartbeat. There are different
kinds of arrhythmias. Some are quite dangerous - even immediately life threatening - while
others may be merely annoying (or scarcely noticeable), and pose no particular danger.
Cardiac arrhythmia (also dysrhythmia) is a term for any of a large and heterogenous group of conditions
in which there is abnormal electrical activity in the heart. The heart beat may be too fast or
too slow, and may be regular or irregular. Some arrhythmias are life-threatening medical emergencies
that can result in cardiac arrest and sudden death. Others cause aggravating symptoms such as an abnormal
awareness of heart beat, and may be merely annoying. Others may not be associated with any symptoms
at all, but pre-dispose toward potentially life threatening stroke or embolus. Some arrhythmias are
very minor and can be regarded as variants of normal. In fact, most people will sometimes feel
their heart skip a beat, or give an occasional extra strong beat - neither of which are usually a
cause for alarm. The term sinus arrhythmia refers to a normal phenomenon of mild acceleration and
slowing of the heart rate that occurs with breathing in and out. It is usually quite pronounced in
children, and steadily lessens with age.
The term cardiac arrhythmia covers a very large number of very different conditions. The commonest
symptom of arrhythmia is an abnormal awareness of heartbeat, termed palpitations. These may be
infrequent, frequent, or continuous. Some of these arrhythmias are harmless (though annoying) but
many of them predispose to adverse outcomes. Some arrhythmias do not cause symptoms, and are not
associated with increased mortality. However, some asymptomatic arrhythmias are associated with
adverse events. Examples include increase in risk of blood clotting within the heart, and thus increase
the risk of embolization and stroke, or increase in the risk of heart failure, or increase in the
risk of sudden cardiac death. If an arrhythmia results in a heart beat that is too fast, too slow
or too weak to supply the body's needs, this manifests as a lower blood pressure and may cause
lightheadedness or dizziness, or fainting. Some types of arrhythmia result in cardiac arrest, or sudden death.
Medical assessment of the abnormality using an electrocardiogram is the best way to diagnose and
assess the risk of any given arrhythmia. Cardiac dysrhythmias are often first detected by simple but
nonspecific means: auscultation of the heartbeat with a stethoscope, or feeling for peripheral pulses.
These cannot usually diagnose specific dysrhythmias, but can give a general indication of the heart rate
and whether it is regular or irregular. Not all the electrical impulses of the heart produce audible or
palpable beats; in many cardiac arrhythmias, the premature or abnormal beats do not produce an effective
pumping action and are experienced as "skipped" beats. The simplest specific diagnostic test for
assessment of heart rhythm is the electrocardiogram (abbreviated ECG or EKG). A Holter monitor is
an EKG recorded over a 24-hour period, to detect dysrhythmias that may happen briefly and unpredictably
throughout the day.
Because arrhythmias are such a heterogenous group of conditions, treatment needs to be carefully
selected by a patient with their physician. Some arrhythmias require no treatment at all. Others
require immediate emergency treatment if death is to be avoided. Treatments include physical maneuvers,
antiarrhythmic drugs, other drugs, electricity, and electro or cryo cautery.
VALVULAR DISEASE
Valvular disease is a term for disorders that impair the functioning of one or more
of the heart's valves. It may be caused by a congenital defect, or it may be the consequence of
illness such as rheumatic fever or endocarditis (infection of the heart muscle).
While there are many causes of valvular heart disease (including rheumatic fever, congenital heart
disease, cardiac dilation, and age-related calcification of the valves), whatever the cause, heart
valve problems are generally manifested in one of two ways. Either the valve openings become too
narrow and blood has a difficult time crossing the valves (i.e., stenosis), or the valves become
incompetent, allowing blood to leak across the valves when they are supposed to be closed (i.e.,
regurgitation). Valvular stenosis causes the blocking of the blood behind the valve. This blocking or
damming up of blood leads to increased pressure in the cardiac chambers behind the valve.
Valvular regurgitation allows blood to wash backwards across the valve when the valve should be closed.
This extra volume of blood produced by this backwash causes dilation of the cardiac chambers
receiving the extra blood. Both increased pressures and increased blood volume in any of the cardiac
chambers can eventually produce permanent weakening of the cardiac muscle, and can ultimately lead to
heart failure. Either stenosis or regurgitation in a cardiac valve causes turbulence of blood flow,
and that turbulence is detected as a "heart murmur" when the health care provider listens to the heart
with a stethoscope. Generally, heart valve problems can be readily diagnosed by performing an echocardiogram.
The Tricuspid Valve: The tricuspid valve separates the right atrium from the right ventricle.
When the tricuspid valve develops stenosis, increased pressure in the right atrium leads to high
pressure in the veins throughout the body, causing edema (swelling) of the liver, abdomen and legs.
When tricuspid regurgitation occurs, both the right atrium and right ventricle tend to dilate, reducing
the efficiency of both these cardiac chambers.
The Pulmonic Valve: The pulmonic valve separates the right ventricle from the pulmonary artery.
With pulmonic stenosis there is increased pressure in the right ventricle. With pulmonic regurgitation
there is volume overload of the right ventricle. Either way, the right ventricle can ultimately fail.
The Mitral Valve: The mitral valve separates the left atrium from the left ventricle. Mitral
stenosis causes damming up of blood in the left atrium, and ultimately in the lungs. Mitral regurgitation
causes dilation of both the left atrium and left ventricle, and can lead to failure of both cardiac
chambers. Mitral valve prolapse (MVP) is a common condition that results in one of the leaflets of
the mitral valve flopping backwards into the atrium during the contraction of the left ventricle. MVP
often involves at least mild regurgitation.
The Aortic Valve: The aortic valve separates the left ventricle from the aorta. Aortic stenosis
causes increased pressure in the left ventricle. Aortic regurgitation causes dilation of the left
ventricle. Both of these aortic valve problems can lead to heart failure.
HEART BLOCK
Heart block is a condition that develops due to interference in the electrical current through
the heart. (The flow of electrical current through the heart muscle makes the normal cardiac
cycle possible.)
An electronic device called a pacemaker is implanted under the chest muscles or in the
abdomen. An electrode carries electrical current from the pacemaker directly into the heart
muscle to replace the lost control. The electrical current signals the heart to contract. Some
pacemakers send messages only if normal messages carried by the conduction system are delayed.
This type of pacemaker is called a demand pacemaker. Other pacemakers send regular
signals to keep the heart contracting at a preset rate.
When caring for a patient with a pacemaker:
- Count and record the pulse rate.
- Report any irregularities or changes below the present rate.
- Report any discoloration over the implant site.
- Report hiccuping, because this may indicate problems.
- Keep the patient away from microwave ovens and cellular phones, because they may disrupt
the function of the pacemaker.
Patients usually function very well with pacemakers so long as they are adequately monitored.
BLOOD ABNORMALITIES
Blood abnormalities are often called blood dyscrasias. Dyscrasia is a general term which is
used to describe any abnormality in the blood or bone marrow's cellular components, such as low
white blood cell count, low red blood cell count or low platelet count.
ANEMIA
Anemia is a condition that results from a decrease in the quantity or quality of red blood
cells. There are several causes, such as:
- Poor diet.
- Low production of new red blood cells.
- Blood loss, as in hemorrhage.
Types of anemia include:
- Pernicious: Inability to absorb vitamin B-12 (most often seen in the elderly). Vitamin B-12
is required by the body to produce red blood cells.
MoonDragon's ObGyn Information: Pernicious Anemia
- Sickle Cell: Inability to form normal hemoglobin. Sickle cell anemia is transmitted
genetically. It is seen more often in African Americans.
MoonDragon's ObGyn Information: Sickle Cell Anemia
MoonDragon's ObGyn Information: Sickle Cell Neonatal Screening
MoonDragon's ObGyn Information: Sickle Cell Pregnancy Contraception
MoonDragon's ObGyn Information: Sickle Cell Prenatal Diagnosis
- Thalassemia: A group of genetic blood disorders. The oxygen-carrying component of
red blood cells, hemoglobin, consists of two different proteins, an alpha and a beta
protein. If the body doesn't produce enough of either of these two proteins, the red blood
cells do not form properly and cannot carry sufficient oxygen. The result is anemia that
begins early in childhood and is life long. It is common to people of Mediterranean heritage,
including Italians, Greeks, and Turks, and other regions, including Arabian Peninsula, Africa,
the Indian subcontinent, China and Southeast Asia.
MoonDragon's ObGyn Information: Thalassemia Anemia
- Deficiency: Inadequate intake of iron, inability to absorb iron, or excessive loss of iron.
MoonDragon's ObGyn Information: Iron Deficiency Anemia
- Dietary: Inadequate intake of iron or vitamins in diet.
Signs and symptoms:
- The person with anemia may have little energy.
- May be pale or jaundiced.
- Have dyspnea (difficulty breathing).
- Experience digestive disorders.
- May have a rapid pulse.
- May complain of light-headedness.
- Feel cold.
- Experience dizziness and/or fainting.
- Have an increased respiratory rate.
Treatment is aimed at:
- Improving the quality and quantity of the blood by giving iron supplements.
- Eliminating the basic cause of the disease.
- Giving blood transfusions as needed.
ADDITIONAL ANEMIA LINKS
MoonDragon's ObGyn Information: Anemia Index
MoonDragon's ObGyn Information: Holistic Recommendations For Anemia Treatment
MoonDragon's ObGyn Information: Sickle Cell Anemia
MoonDragon's ObGyn Information: Folic Acid Deficiency
MoonDragon's ObGyn Information: G6PD Deficiency Anemia
MoonDragon's ObGyn Information: Anemia During Pregnancy
LEUKEMIA
Leukemia is sometimes called cancer of the blood. The causes of the many forms of leukemia
are not known. This disease may strike young or old. The number of white blood cells increases,
but the white blood cells may be of poor quality. The number of erythrocytes (red blood cells)
and platelets decreases. Patients with leukemia are highly susceptible to infection. During the
course of the disease, even minor trauma causes bleeding.
Treatment is aimed at:
- Easing symptoms and keeping the patient comfortable.
- Maintaining normal blood levels. Transfusions may be needed to combat the anemia that
accompanies the condition.
- Combating infection by using antibiotics.
- Slowing the production of abnormal white cells through chemotherapy and/or radiation therapy.
SPECIAL CARE
Patients who have cancer or anemia require special care.
- Check vital signs.
- Encourage rest and a good diet.
- Handle the patient very gently.
- Give special mouth care, because the mouth and tongue become sensitive.
- Be sure to report any signs of bleeding, such as bruises or discolorations, because further
blood loss makes the condition worse.
- Keep patient warm.
- Protect patient from falls that may result from dizziness or weakness.
- Change the patient's position often, at least every two hours.
- Provide emotional support.
MoonDragon's Health Care: Cardiovascular Patient Care
DIAGNOSTIC TESTS
Some techniques used to diagnose problems of the cardiovascular system include:
- Blood chemistry tests, such as electrolyte panels.
- Complete blood count (CBC).
- Electrocardiogram (ECG or EKG).
- Cardiac catherization and angiogram - introduction of catheter and dyes into the
vascular system under fluoroscopy.
- Ultrasound - sound waves are bounced against tissues to reflect variations in tissue density.
HEART FUNCTION SELF-TEST
Your heart is the most important muscle in your body. A simple pulse test can help you determine how
well your heart is functioning. The best time to check your pulse is first thing in the morning. The heart
rate should be between 60 and 100 beats per minute. If your pulse is under 60, your heart is functioning
at a good pace. If your pulse is above 80, you may need to change your diet and lifestyle. If your heart
pulse remains rapid, consult with your health care provider to rule out problems. A chronically high
pulse rate is often a precursor of hypertension. Taken daily, this pulse test can forewarn you of oncoming
illness.
To take your pulse, place the first two fingers of your right hand between the bone and tendon of your
left wrist. Count the beats for 15 seconds, and then multiply by 4 to find the beats per minute. A wrist
monitor can be purchased at most pharmacies that can be placed around the wrist and will test for pulse
and blood pressure. Be sure to read the instructions carefully while using these wrist monitors for accurate
results. An inexpensive stethoscope can also be purchased either alone or with a blood pressure cuff from
a pharmacy or medical supply resource for home use.
MoonDragon's Health & Wellness: Common Cardiovascular Problems & Procedures
With descriptions and helpful links to related web sites.
MoonDragon's Health & Wellness: The Circulatory System
MoonDragon's Health & Wellness: Cardiovascular Problems
MoonDragon's Health & Wellness: Cardiac Nutrition
MoonDragon's Health & Wellness: The Cardiovascular System
MoonDragon's Health & Wellness: Atherosclerosis & Arteriosclerosis
MoonDragon's Health & Wellness: Heart Attack
MoonDragon's Health & Wellness: Heartburn
MoonDragon's Health & Wellness: Hemophilia
MoonDragon's Health & Wellness: High Cholesterol
MoonDragon's Health & Wellness: Hypertension (High Blood Pressure)
MoonDragon's Health & Wellness: Rheumatic Fever
MoonDragon's Health & Wellness: Thrombophlebitis
MoonDragon's Health & Wellness: Varicose Veins
MoonDragon's Health Care: Cardiovascular Patient Care
MoonDragon's Health care: CPR - Adult One Rescuer
MoonDragon's Health Care: CPR - Adult Two Rescuers
MoonDragon's Health Care: CPR (Cardiopulmonary Resuscitation) Complications
MedLib.com: Heart Sounds
MedStudents.com: Cardiology Heart Sounds Wave Files
MoonDragon's Nutrition Information: Diet Index
MoonDragon's ObGyn Information: Smoking
MoonDragon's Health Therapy: Biofeedback
MoonDragon's Health & Wellness: Hypothyroidism
MoonDragon's Health & Wellness: Raynaud's Phenomenon
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HELPFUL PRODUCTS & FURTHER EDUCATION
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
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The Complete Guide to Natural Healing
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