Atherosclerosis

ALIA GUL
BSN 4TH
KMU INS
 Introduction
Definition:
• Atherosclerosis is a condition in
which plaque builds up inside the
arteries, leading to reduced blood
flow (American Heart Association,
2023).
Key Points:
• Plaque consists of fat, cholesterol,
calcium, and other substances
(World Health Organization, 2022).
• • It can affect any artery, including
those of the heart, brain, legs, and
kidneys.
 Causes

Risk Factors (Mayo Clinic, 2023):

• High cholesterol
• Hypertension (high blood pressure)
• Smoking
• Diabetes
• Obesity
• Physical inactivity
• Family history of heart disease
 Common Symptoms :
• Chest pain or angina
• Shortness of breath
• Fatigue
• Weakness in limbs
(especially in peripheral

Symptoms
artery disease)

Silent Condition: Many

people have no symptoms
until the artery is severely
narrowed or blocked.
 How It Develops:
• Damage to the endothelium (inner lining of the artery)
leads to plaque formation.
• Over time, plaque hardens and narrows the arteries.
Pathophysiology • This reduces oxygen-rich blood flow to organs and
tissues.
• Ruptured plaque can lead to blood clots, increasing the
risk of heart attacks or strokes.
 Medications:
• Statins (to lower cholesterol)
• Anti-hypertensives (to manage blood pressure)
Medical • Antiplatelet drugs (to prevent clotting)
Lifestyle Changes:
Management • Healthy diet (low in saturated fats, rich in fruits
and vegetables)
• Exercise (regular physical activity)
• Quit smoking
 Procedures:
• Angioplasty: Balloon catheter is used to open
narrowed arteries.
Surgical
• Stenting: Placement of a stent to keep
Management arteries open.
• Bypass surgery: A healthy artery is used to
bypass a blocked artery.
 Nursing
Management
Nursing Interventions:
• Monitoring vital signs and
symptoms.
• Educating patients on lifestyle
changes.
• Administering prescribed
medications.
• Monitoring for complications such
as clots or signs of heart attack.
 Serious Health Risks:
• Heart attack (National Institutes of Health,
2021)
Complications • Stroke
• Peripheral artery disease (PAD) (American
Heart Association, 2023)
• Chronic kidney disease
 Summary:
Atherosclerosis is a preventable condition with
appropriate lifestyle changes and medical
management.
Early detection and intervention are critical in
reducing complications and improving quality
Conclusion of life.
 References
• 1. American Heart Association. (2023). What is Atherosclerosis? Retrieved
from https://www.heart.org/en/health-topics/cholesterol/about-
cholesterol/atherosclerosis

• 2. Mayo Clinic. (2023). Atherosclerosis: Causes, symptoms, and treatment.

Retrieved from https://www.mayoclinic.org/diseases-
conditions/atherosclerosis/symptoms-causes/syc-20350569
• 3. National Institutes of Health (NIH). (2021). Understanding
Atherosclerosis and its Complications. Retrieved from
https://www.nhlbi.nih.gov/health-topics/atherosclerosis
• 4. World Health Organization (WHO). (2022). Global Statistics on
Cardiovascular Diseases. Retrieved from https://www.who.int/health-
topics/cardiovascular-diseases
ENDOCARDITIS

BY: KALSOOM
BSN 4TH SEMESTER
KMU INSPESHAWAR
 ENDOCARDITIS

▶ Endocarditis is an infection of the lining of the endocardium.

There are two types of endocarditis: Rheumatic endocarditis and
Infective endocarditis .
1) RHUEMATIC ENDOCARDITIS:
▶ Rheumatic endocarditis is a unique form of endocarditis caused
by rheumatic fever which typically affects school age children.
Early diagnosis and treatment with antibiotics is critical.
2) INFECTIVE ENDOCARDITIS :
▶ A microbial infection of the endothelial surface of the heart.
Typically developed in people with prosthetic heart valves or
structural cardiac defects (valve disorder or HCM ). More common
in older adults with immunosuppressive treatment.
 PATHOPHYSIOLOGY

▶ Injury or deformity of the hearts inner lining leads to the formation of

clots. Microorganism typically bacteria like staphylococci and
streptococci, invade these clots. These infected clots called
vegetations, grow on the hearts inner surface, especially on the
valves, and can spread through the bloodstream to other parts of
body. As the infection grows, it becomes protected by new layers
of clots, making it harder for the immune system to attack it . This
can cause damage to heart structures like valve tears ,deformities
or abscess in the heart .
RISK FACTORS

o History of heart disease

o Rheumatic fever
o Prosthetic heart valve
o Intravenous drug use
o Invasive medical procedure (surgeries, dialysis or catheterization )
o Immunosuppression
o Age (older individual have risk due to degenerative valve changes)
o Bacteremia
 CLINICAL MANIFESTATIONS

 Primary symptoms with infective endocarditis are fever and

Heart murmurs .
 Cluster of patechiae may be found on body .
 malSl, painful nodules (Osler nodes) in the pads of fingers or toes
 Hemorrhage with pale centers (Roth spots) caused by emboli
may be observed in the fundi of the eyes.
 Splinter hemorrhage (i.e. reddish brown lines and streaks) under the
fingernails and toenails
 Cardiomegaly, tachycardia, heart failure or splenomegaly may occur.
 CNS manifestation include headache, cerebral ischemia's and strokes.
 DIAGNOSIS

▶ Three or more blood cultures in a 24- to 48-hour period (or every

30 minutes if the patients condition is unstable) to identify
the causative organism .
▶ Patients may have an elevated WBC counts. In addition patient
may be Anemic and have a positive rheumatoid factor and an
elevated ESR.
▶ Doppler echocardiography may reveal the development of heart
failure.
 TREATMENT

MEDICAL MANAGEMENT
▶ An antibiotic is prescribed, based on the infecting organism; an IV antibiotic lasting 4
to 6 weeks is usually prescribed, followed by a course of oral antibiotics . Numerus
antimicrobial regimens are in use but penicillin is usually the treatment of choice.

SURGICAL MANAGEMENT
▶ Surgical intervention may be required if the infection does not respond to
medications, patient has a prosthetic heart valve endocarditis, has a vegetation
larger than 1 cm or develops complications such as a septal perforation .
 Continued…

Surgical Interventions include:

▶ Valve debridement or excision
▶ Removal of vegetation
▶ Closure of abscess or fistula
▶ Surgical valve replacement in patient with congestive heart failure
despite treatment, multiple systemic embolic episodes, valve
obstruction, uncontrolled or recurrent infection.
Surgical valve replacement improves prognosis, especially for those
with prosthetic valve infections.
 COMPLICATIONS

▶ 1. Heart Failure
▶ 2. Embolism
▶ 3. Kidney Damage
▶ 4. Sepsis
▶ 5. Meningitis
▶ 6. Myocardial Abscess
▶ 7. Conduction Abnormalities
 NURSING DIAGNOSIS

▶ 1. Risk for Infective Endocarditis: Patient is at risk for developing

infective endocarditis due to underlying heart condition, IV drug
use, or other fac tors.
▶ 2. Activity Intolerance: Patient experiences fatigue, weakness, and
shortness of breath due to cardiac inflammation and infection.
▶ 3. Pain: Patient experiences chest pain, headache, and muscle
a ches due to inflammation and infection.
▶ 4. Anxiety: Patient is anxious about diagnosis, treatment, and
potential c omplic ations.
▶ 5. Risk for Emboli: Patient is at risk for emboli due to infected
vegetation on heart valves.
 NURSING INTERVENTIONS

▶ Make sure the patient maintains bed rest to reduce myocardial

oxygen demands
▶ Monitor the patients temperature .the patient may have a fever for
weeks
▶ Encourage adequate fluid intake
▶ Watch for signs and symptoms of embolization (such as hematuria,
flank pain, pleuritic chest pain, dyspnea, left upper quadrant pain,
neurologic deficits, and numbness and tingling of the extremities).
▶ Assess the patient for signs and symptoms of heart failure, such as
dyspnea, tachycardia, tachypnea, crackles, neck vein distention,
edema, and weight gain
THANK YOU
 Pericarditis and Myocarditis

AHN 2 Unit 04 (Cardiovascular Nursing)

By: Afsha Qandeel

BSN 4th Semester
Institute of Nursing Sciences
Khyber Medical University 1
 Objectives

At the of this presentation students will be able to

• Define Pericarditis and Myocarditis
• Enlist the clinical manifestations of Pericarditis and Myocarditis.
• Describe the complications of Pericarditis and Myocarditis.
• Explain the causes of Pericarditis and Myocarditis.
• Discuss the Diagnostic test for Pericarditis and Myocarditis.
• Describe the Pathophysiology of Pericarditis and Myocarditis.
• Explain the Medical and Nursing management Of Pericarditis and Myocarditis.

2
 Definition

•Pericarditis is the inflammation of Pericardium,

the thin double layered sac surrounding the heart.
The Pericardium holds the heart in place and
helps it function smoothly. Inflammation of the
pericardium can lead to various symptoms and
complications.

3
 Types

• Acute pericarditis: Sudden onset, short-term

• Chronic pericarditis: Long-term, recurring inflammation
• Recurrent pericarditis: Multiple episodes

4
 Causes

• Viral infections (e.g., coxsackievirus, influenza)

• Bacterial infections (e.g., tuberculosis, pneumonia)
• Autoimmune disorders (e.g., rheumatoid arthritis, lupus)
• Trauma to the chest
• Cancer (e.g., metastatic)
• Radiation therapy
• Surgery
• Medications (e.g., antibiotics, anticonvulsants)

5
 Pathophysiology

Inflammation: Triggered by infections, autoimmune

diseases, trauma, or heart attack.
•Cytokine Release: Immune response causes inflammation.
•Fluid Buildup: Blood vessels dilate, leading to fluid in the
pericardial space.
•Pericardial Effusion: Fluid accumulation increases
pressure on the heart, affecting its function.

6
 Symptoms

• Chest pain (sharp, stabbing, or dull)

• Pain radiating to shoulders, neck, or arms
• Fever
• Fatigue
• Shortness of breath
• Palpitations
• Coughing

7
 Complications

• Cardiac tamponade (fluid accumulation in pericardium)

• Constrictive pericarditis (scarring, reduced heart function)
• Heart failure

8
 Diagnosis

• ECG (electrocardiogram):
In Acute pericarditis (ST segment elevation in all leads).
• Echocardiogram
• Chest X-ray
• Cardiac MRI
• Blood tests (inflammatory markers, viral/bacterial tests)

9
 Treatment

• Anti-inflammatory medications (e.g., NSAIDs, colchicine)

• Antibiotics (if bacterial)
• Antiviral medications (if viral)
• Corticosteroids (for autoimmune)
• Pain management
• Rest and monitoring

10
 Surgical Management

• Pericardiocentesis (a procedure performed to remove some of the

pericardial fluid reduce pressure and can be cultured to reveal the
causative organism.
• It is a primary surgical procedure performed to relieve symptomatic
pericardial effusion causing cardiac tamponade.

11
 Cont…

• Pericardiectomy (surgical removal of tough encasing pericardium

may be necessary to remove constrictive and restrictive inflammation
and scarring).

12
 Myocarditis

•Myocarditis is the inflammation of myocardium,

the heart muscle. It occurs when the heart
muscles become damaged due to an
inflammatory response, leading to impaired
function.

13
 Types

•Acute myocarditis: Sudden onset, short-term

•Chronic myocarditis: Long-term, persistent
inflammation
•Giant cell myocarditis: Rare, severe form

14
 Causes

• Viral infections (e.g., coxsackievirus, influenza, HIV)

• Bacterial infections (e.g., Lyme disease, streptococcal)
• Parasitic infections (e.g., Chagas disease)
• Fungal infections
• Autoimmune disorders (e.g., rheumatoid arthritis, lupus)
• Toxic substances (e.g., chemicals, medications)
• Radiation therapy

15
 Pathophysiology

•Trigger: Caused by viral infections, bacterial infections,

autoimmune diseases, or toxins.
•Immune Response: Immune activation leads to infiltration of
immune cells (lymphocytes and macrophages).
•Inflammation: Inflammatory mediators cause damage to heart
muscle cells.
•Cardiac Dysfunction: Resulting inflammation and damage can
impair heart function, leading to symptoms like chest pain,
arrhythmias, and heart failure.

16
 Symptoms

• Chest pain or discomfort

• Shortness of breath
• Fatigue
• Palpitations
• Lightheadedness or dizziness
• Fever
• Coughing
• Swelling in legs, ankles, or feet

17
 Diagnosis

• ECG (electrocardiogram)
• Echocardiogram
• Cardiac MRI
• Blood tests (troponin, inflammatory markers)
• Endomyocardial biopsy (tissue sample) (Gold standard
for confirmation)

18
 Treatment

• Rest and monitoring

• Anti-inflammatory medications (e.g., NSAIDs)
• Antibiotics (if bacterial)
• Antiviral medications (if viral)
• Immunosuppressive therapy (for autoimmune)
• Medications for heart failure (if necessary)
• Pacemaker or implantable cardioverter-defibrillator (ICD)

19
 Surgical management

Ventricular assist device (VAD):

A VAD helps pump blood from the lower chambers of the heart to the rest of
the body. It's a treatment for a weakened heart or heart failure..
Intra-aortic balloon pump (IABP):
This device helps increase blood flow and reduce the strain on the heart. It's
placed in the body's main artery, called the aorta.

20
 Nursing management for Pericarditis

• Monitor Vital Signs:

Regularly assess for changes in heart rate, blood pressure, and temperature.
• Pain Assessment:
Evaluate chest pain, often sharp and worsened by breathing or lying down.
• Position for Comfort:
Help the patient sit up and lean forward to relieve pain.
• Administer Medications:
Provide NSAIDs or corticosteroids as prescribed to reduce inflammation and
pain.

21
 Cont…

• Monitor for Cardiac Tamponade:

Watch for signs like hypotension or muffled heart sounds.
• Educate the Patient:
Inform about disease management, medication adherence, and follow-up care.
Nursing management for Myocarditis:
• Monitor Cardiac Function:
• Continuously assess heart rate, rhythm, and signs of heart failure.
• Administer Medications:
Provide ACE inhibitors, beta-blockers, or diuretics as prescribed.
22
 Cont…

• Promote Rest: Encourage rest and limit strenuous activity to reduce heart
strain.
• Monitor Fluid Balance:
Check for fluid retention and restrict fluids if needed.
• Educate the Patient:
Explain the condition, treatment plan, and importance of rest during recovery.

23
 References

• Hinkle, J. L., et. al,. (2019). Textbook of medical-surgical nursing: Brunner and
Suddarth’s. 2. Lippincott Williams & Wilkins.
• Carpenito, L. J. (2020). Nursing Diagnosis Application to clinical practice.
Lippincott Williams & Wilkins.
• Mayo Foundation for Medical Education and Research. (2024, June 4).
Myocarditis. Mayo Clinic. https://www.mayoclinic.org/diseases-
conditions/myocarditis/diagnosis-treatment/drc-
20352544#:~:text=Often,%20myocarditis%20gets%20better%20on%20its%20ow
n%20or%20with%20treatment.

24
25
26
 UNIT II-CARDIOVASCULAR-NURSING

TOPIC: HYPERTENSION

• BY
SEHRISH NAZ
RN, Post RN, MSN
Assistant Professor
• Institute of Nursing Sciences, Khyber Medical University, Peshawar
Definition
• Blood pressure is the force of blood on the walls of the vessels.

• Hypertension (high blood pressure) is when the pressure in your

blood vessels is too high (140/90 mmHg or higher). It is common but
can be serious if not treated. People with high blood pressure may
not feel symptoms. The only way to know is to get your blood
pressure checked.

World Health Organization (WHO)

cont…….

• Primary Hypertension
Contributing factors:
1. Sympathetic nervous system activity
2. Diabetes mellitus
3. Sodium intake
4. Excessive alcohol intake

(Dominiczak , 2000).
• Secondary Hypertension
Contributing factors:
1. Coarctation of aorta (congenital narrowing of a short section
of the aorta)
2. Renal disease
3. Endocrine disorders
4. Neurologic disorders
5. Treat underlying cause
(Dominiczak , 2000).
Risk factors

• Advancing Age
• High cholesterol diet,
• Sex (men and postmenopausal
women) • Low fruit consumption,
Obesity
• Family history
• Diabetes.
• Sedentary life style.
• Hyperlipidemia
• Psycho-social stress
• High intake of alcohol
• Smoking
● SIGNS AND SYMPTOMS:-
● Morning occipital headache
● Fatigue
● Dizziness
● Bluring vision
● proteinuria
● Haematuria(blood in urine)
● Cardiac asthma
● Anginal Pain
● Epistaxis (Nose bleeding)
● Palpitation
● Tinnitus (Ringing in ears)
● Breathlessness.
● DIAGNOSTIC EVALUATION:-
● By measuring B.P.
● Chest X-ray
● Urinetest
● Bloodtest
● History collection
● Physical examination
COMPLICATIONS :-
● Heart disease
● Renal failure
● Cerebral haemorrhage
● Angina pectoris.
 ❏ MEDICAL MANAGEMENT
1. Diuretic: They increase frequency of urine.

Example:
● Thiazide - 40mg
● Furosemide - 20mg.

2. Beta blocker:
Prevents stimulation of beta-adrengeic receptors of sympathetic nervous system. Because
beta adrenergic receptors are responsible for vasoconstriction in blood vessels.

Example:
● Atenolol
● betaxolol
● Timolol
● propranolol
3. Vasodilators:
These drugs acts as blood vessel dilator and open vessels by relaxing their muscular walls and decreased blood pressure.
Example: Nitrates.
● Short acting: Nitroglycerine - 15-12 mg (sublingual)
● Long Acting: Isosorbide dinitrate - 5-10 mg.

4. Calcium channel blockers (calcium Antagonist):

They are used to decrease oxygen demand in Heart and improve coronary blood flow.
Example:
● Verapamil (Antiarrhythmic) (Administer empty stomach before meal).
● Nifedipine.

5. Angiotensin Converting Enzyme inhibitor:

They inhibit Angiotensin I and II Conversion.
Example:
● Captopril
● ramapril
● Benazepril
NURSING MANAGEMENT:-

ASSESSMENT:-
● Assess theAnxiety levelofpatient.
● Takemedicalhistory ofpatient.
● Ask dietpattern ofpatient.
● Assess educational levelofpatient.
Nursing DiagnosisAnd
Intervention
1. Anxiety related to disease
• Nursing Intervention-

● Provide proper knowledge about disease condition to patient.

● Provide comfortable rest to patient.
● Restrict quantity of visitors.
● Give answer to the questions of patient.
3. knowledge deficit about disease condition

Nursing Intervention
● Provide proper knowledge about disease to the patient also try to increase
Knowledge of patient about its disease.
●

4. Alteration in comfort related to disease

Nursing Intervention
● Provide comfortable Position as well as provide rest to patient with raised head
of bed or use pillow.
● Provide general care to patient.
● Give health education to patient.
● Advice patient to Avoid alcohol and smoking
References
• Hypertension - World Health Organization (WHO) World Health
Organization (WHO) https://www.who.int › Newsroom › Fact sheets ›
Detail
• Pathophysiology of Hypertension - Medscape Reference
Medscape ·https://emedicine.medscape.com › Nephrology
• Physiology, Cardiac Output – StatPearls National Institutes of Health
(NIH) (.gov) ·https://www.ncbi.nlm.nih.gov
Acknowledgement:
1. Nusrat Noreen Lecturer, CON, LRH.
2. Priyanshu Verma, BS Nursing student
Prepared by:
MALAIKA
BSN 4TH
KMU INS
 Dysrhythmia (also referred to as arrhythmia) is
any abnormality in the heart's rhythm. It involves
either irregular, too fast, or too slow heartbeats.
Dysrhythmias can occur in the atria, ventricles, or
conduction system of the heart, leading to
changes in the heart's electrical activity. They can
range from being harmless and asymptomatic to
life-threatening.
Dysrhythmias can result from a variety of causes,
including:
 Structural Heart Disease:
◦ Coronary artery disease
◦ Cardiomyopathy
◦ Valvular heart diseases (e.g., mitral valve prolapse)
◦ Heart failure
• Post-myocardial infarction (MI)
 Electrolyte Imbalances:
• Potassium, calcium, and magnesium imbalances
• Hyperkalemia or hypokalemia
• Hypercalcemia or hypocalcemia
• Hypomagnesemia
 Ischemia and Infarction:
• Myocardial ischemia or infarction can disrupt the
electrical conduction pathways in the heart.
 Autonomic Nervous System Influences:
• Stress, anxiety, and sympathetic stimulation
• Vagal stimulation (e.g., from a vagal maneuver)
 Medications:
• Antiarrhythmic drugs, beta-blockers, calcium
channel blockers
 Genetic Factors:
• Inherited arrhythmogenic disorders
. Age: Older adults are at higher risk due to age-
related changes in the heart.
• Family History: A history of heart disease or
arrhythmias.
• Hypertension: Can lead to structural changes in
the heart that predispose to arrhythmias.
• Coronary Artery Disease (CAD): Reduces blood
supply to the heart muscle, leading to arrhythmia.
• Diabetes: Increases the risk of heart disease and
arrhythmias.
 Heart Failure: Can cause electrical
disturbances in the heart.
 Electrolyte Imbalances: Low potassium or
magnesium levels.
 Drug Use: Use of stimulants (e.g. cocaine,
amphetamines) or antiarrhythmic drugs.
 Sleep Apnea: Associated with atrial
arrhythmias.
Dysrhythmias can be classified based on their origin
and rate:
 Atrial Dysrhythmias:
◦ Atrial fibrillation (AF): Rapid and irregular atrial rhythm.
◦ Atrial flutter: A rapid but regular atrial rhythm.
◦ Supraventricular tachycardia (SVT): A rapid heart rate
originating above the ventricles.
 Ventricular Dysrhythmias:
◦ Ventricular tachycardia (VT): A rapid heart rate originating in
the ventricles.
◦ Ventricular fibrillation (VF): A life-threatening arrhythmia with
erratic electrical activity in the ventricles.
◦ Premature ventricular contractions (PVCs): Extra
heartbeats originating in the ventricles.
 Bradyarrhythmias:
• Sinus bradycardia: Slow heart rate (<60 beats/min).
• Heart block: Delay or blockage of electrical impulses
through the heart, including first-degree, second-
degree (Type I and Type II), and third-degree
(complete) heart block.
 Conduction Disorders:
• Bundle branch blocks (BBB): Delay or blockage in
one of the branches of the heart’s conduction system.
• Sick sinus syndrome (SSS): A malfunction of the
sinoatrial node, resulting in irregular or slow heart
rates.
Diagnosis of dysrhythmia is typically based on the
following:
 Electrocardiogram (ECG or EKG):
◦ The primary tool for diagnosing arrhythmias.
◦ Identifies the type, rate, and origin of the arrhythmia.
 Event Monitoring:
◦ A device that records the heart's rhythm when the patient
experiences symptoms, often used for longer periods.
 Electrophysiological Studies (EPS):
◦ Invasive procedure to study the electrical pathways of the
heart, typically used in complex cases or when considering
ablation.
 Echocardiogram:
◦ Used to assess heart structure and function, particularly if
arrhythmias are suspected due to structural heart
diseases.
 Stress Testing:
◦ Can identify arrhythmias that are induced by exercise or
stress.
The treatment depends on the type of dysrhythmia,
its severity, and the underlying cause.
 Antiarrhythmic Medications:
◦ Sodium channel blockers
◦ Beta-blockers
◦ Potassium channel blockers
◦ Calcium channel blockers
 Anticoagulants:
◦ Used to prevent thromboembolic events, particularly in
atrial fibrillation (e.g., warfarin, direct oral anticoagulants).
 Implantable Devices:
• Pacemaker: For bradyarrhythmias or heart block.
• Implantable Cardioverter Defibrillator (ICD): For
patients at risk of life-threatening ventricular arrhythmias.
 Electrophysiology Procedures:
• Cardioversion: Electrical shock to restore normal
rhythm.
• Ablation therapy: Catheter ablation to destroy abnormal
electrical pathways.
Surgical interventions are less common but may be
necessary in specific cases:
 Maze Procedure:
◦ A surgical procedure used for atrial fibrillation to create
scar tissue that directs electrical impulses to normal
pathways.
 Left Atrial Appendage Closure:
◦ Performed in patients with atrial fibrillation to reduce the
risk of stroke due to clot formation in the left atrial
appendage.
Nurses play a crucial role in managing patients with dysrhythmias,
including:
 Patient Education:
◦ Educating patients about the importance of medication adherence and
recognizing symptoms of arrhythmias.
 Medications:
◦ Administering antiarrhythmic medications and anticoagulants as
prescribed.
 Preparation for Procedures:
◦ Preparing patients for invasive procedures like electrophysiology studies,
cardioversion, or ablation.
 Post-Procedure Care:
◦ Monitoring for complications following procedures, such as bleeding,
infection, or device malfunction.
 Psychosocial Support:
◦ Providing emotional support to patients dealing with the anxiety and
stress of living with an arrhythmia or undergoing procedures.
Congestive Heart Failure

By Arshi Noor
Semester 4th
Institute of Nursing Sciences, KMU
What is Congestive Heart Failure?
• Congestive heart failure (CHF) is defined by the
American College of Cardiology (ACC) and the
American Health Association (AHA),is “a complex
clinical syndrome that results from any structural
or functional impairment of ventricular filling or
ejection of blood”
• CHF is a condition where the heart cannot pump
enough blood to meet the body's needs, leading
to symptoms like fatigue and shortness of breath.
 Types of Congestive Heart Failure
1. Left-sided heart failure: fluid backs up into
the lungs.
2. Right-sided heart failure: fluid builds up in
the body, especially legs and abdomen.
3. HFpEF: heart pumps normally but still causes
symptoms.
Causes of Congestive Heart Failure
The 4 most common etiologies responsible for
about two-thirds of CHF cases are
• Ischemic heart disease.
• Chronic obstructive pulmonary disease
(COPD)
• Hypertensive heart disease.
• Rheumatic heart disease.
Causes of Congestive Heart Failure
1. Coronary artery disease: reduced blood flow
to the heart muscle.
2. High blood pressure: makes the heart work
harder.
3. Diabetes: increases the risk of heart disease.
4. Heart valve disease: affects blood flow
through the heart.
5. Previous heart attack: damages heart muscle.
 Signs and Symptoms
1. Shortness of breath, especially during activity or
lying down.
2. Fatigue and weakness, making it hard to
perform daily tasks.
3. Swelling in legs, ankles, and feet due to fluid
retention.
4. Rapid or irregular heartbeat as the heart tries to
compensate.
5. Persistent cough or wheezing, often with white
or pink mucus.
 Diagnosis
1. Physical exam to check for swelling and listen
to heart sounds.
2. Blood tests to look for signs of heart failure.
3. Chest X-ray to see heart size and fluid in
lungs.
4. Echocardiogram (ECHO) to visualize heart
function.
5. ECG to check heart rhythm.
 Management and Treatment
1. Lifestyle changes: a heart-healthy diet and
regular exercise help reduce symptoms.
2. Medications: diuretics reduce fluid, ACE
inhibitors relax blood vessels, and beta-blockers
slow the heart rate.
3. Devices: pacemakers help regulate heartbeat,
and implantable devices may assist with heart
function.
4. Surgery: may include heart valve repair or bypass
to improve blood flow.
 Medications
• Common medications include:
- Diuretics: help remove excess fluid.
- ACE inhibitors: help relax blood vessels.
- Beta-blockers: slow heart rate and lower blood
pressure.
 Lifestyle Changes
1. Low-sodium diet: reduces fluid retention.
2. Regular exercise: strengthens the heart and
improves overall health.
3. Weight management: maintaining a healthy
weight helps the heart.
4. Limiting alcohol: excessive drinking can
worsen heart failure.
5. Quitting smoking: improves heart health and
reduces risks.
 Nursing Interventions
1. Monitor vital signs: check heart rate, blood
pressure, and oxygen levels.
2. Assess fluid status: track weight and swelling
to manage fluid retention.
3. Educate patients on self-care: teach them
how to manage their condition.
4. Promote adherence: encourage following
medication and lifestyle recommendations.
 Patient Education
Educate patients about:
1. Recognizing symptoms like shortness of
breath and swelling.
2. Importance of taking medications as
prescribed.
3. Following a heart-healthy diet and engaging in
safe physical activity.
 Complications of CHF
• Complications of CHF include:
• Reduced quality of life
• Arrhythmia and sudden cardiac death
• Cardiac cachexia
• Cardiorenal disease
• Liver dysfunction
• Functional valvular insufficiencies (such as functional
MR or TR)
• Mural thrombi and risk of thromboembolism (brain,
kidney, lung, major limb vessels)
• Recurrent hospitalizations and nosocomial infection
 Prognosis
• CHF is a chronic condition that can be
managed with treatment, but it requires
ongoing care and lifestyle adjustments.
 References
• 1. Brunner & Suddarth’s Medical-Surgical
Nursing
• 2. NIH NCBI - Congestive Heart Failure:
https://www.ncbi.nlm.nih.gov/books/NBK430
873/
Any Question?
 HEART BLOCK

KAMNI KUMARI
BSN 4TH
KMU INS
 HEART BLOCK
• Heart block is a problem with the heart electrical conduction
system , system that controls the rate and rhythm of heart beats.
• Heart block is a type of bradycardia. It involve the partial or
complete interruption of impulse transmission from the atrial to
the ventricles. AV block( often referred as ‘heart block’).
SYMPTOMS
Because of low cardiac output
• Shortness of breath
• Low blood pressure
• Weak pulse, cold, sweats, mental status changes
• Palpitation (irregular heart beat)
• Dizzy spills, nausea
• Fainting
 ETIOLOGY
• The most common cause of heart block is Heart attack.
• Heart muscles diseases usually called cardiomyopathy, heart
valve diseases.
• High potassium level
• Open heart surgery , medications , toxins
• Genetics can be another cause.
 TYPES OF HEART BLOCK

1. First Degree heart block

2. Second Degree heart block
• Type1 heart block (Mobitz type 2 second degree or Wenckebach
AV block)
• Type 2 heat block ( Mobitz type 2 second degree Av block)
1. Third degree heart block
 FIRST DEGREE HEART BLOCK
• This condition occur when all the atrial impulses are conducted
successfully through AV nodes into ventricles at slower rate than normal
• Prolongation of PR interval more than 0.2 sec for more than 5 small
squares.
• Regular rhythms , Normal rate or slightly slow
• Constant PR interval from beat to other
 SECOND DEGREE HEART BLOCK
(MOBITZ 1)
• This problem occur at the level of AV node itself.
• It is a disorder characterized by disturbance, delay, or interruption of
atrial impulse conduction to the ventricle through AVN.
• Prolong PR interval until dropped QRS, constant PP interval
• Irregular rhythm
• Normal or slightly slow rate
 SECOND DEGREE HEART BLOCK
(MOBITZ 11 )
• This type of block occur below AV node at the level of hiss bundle.
• Also is considered incomplete but high risk to be completed.
• Some of electrical impulses are unable to reach the ventricle.
• Recurrent appearance of non conducted P waves which is blocked
and not followed by QRS complex.
• PR interval and PP interval are constant.
 THIRD DEGREE HEART BLOCK
• It is a medical condition in which the nerve impulse generated in the
SA node in the atrium of the heart can not propagate to the
ventricles, because the impulse is blocked, an accessary pacemaker in
lower chambers will typically activate the ventricles.
• This type of heart block is serious and usually requires a pacemaker
for treatment.
 DIAGNOSTIC FINDINGS
• History collection
• Physical Examination
• Electrocardiograms
• An electrophysiology study
• An implantable Loop recorder
• Genetic Test
 MANAGEMENT
• First degree heat block would not need treatment.
• Second degree heart block having symptoms you may need a
pacemaker to keep your heart beating like it should.
• Third degree heart block treatment almost always includes a
pacemaker.
• The drugs like atropine, epinephrine, and dopamine is a temporary
measure HR and support BP until temporary pacing is initiated.
 SURGICAL MANAGEMENT

Cardiac pacemaker implantation:

• Is a medical device that generates electrical impulses
delivered by electrodes to cause the heart muscle chambers
to contract and therefore pump blood; by doing so this device
replaces or regulate the function of the electrical conduction
system of the heart.
 NURSING MANAGEMENT
• Pre-operative care to check the vital signs of patient , monitor ECG.
• Intra-operative care check the serology, start ab IV line , check the
battery in pulse generator.
• Post-operative care to receive the patient , keep the patient in
comfortable position, check the pacing parameters.
• Monitor hear rate and rhythms.
• Monitor vital sign and level of consciousness
THANK YOU
ECG INTERPRETATION

ASMA BIBI
BSN 4TH
KMU INS PESHAWAR
OBJECTIVES

At the end of this lecture the students will be

able to:
Define ECG.
Discuss uses of ECG.
Explain electrocardiographic grid.
Describe ECG lead.
Explain waves, intervals and segment of normal ECG.
How to read ECG?
 DEFINITION

• Graphical representation of electrical activity of the heart is

obtained by placing electrodes on body surface that record
potential difference generated by heart.
ELECTROCARDIOGRAOHY: It is the technique or
procedure by which the electrical activity of the heart are
studied.
CONT..

ELECTROCARDIOGRAPH: It is the instrument that help

to recode ECG.
ELECTROCARDIOGRAM: It is the graphical record of
ECG.

Willem Einthoven: Discovered ECG in 1900.

USES OF ECG

• ECG is useful in determining and diagnosing the

following:
Heart rate
Heart rhythm
Abnormal electrical conduction
Poor blood flow to heart muscle (Ischemia)
Myocardial infarction(MI)
Coronary Artery Disease
Hypertrophy(Enlargement) of heart chamber
Electrocardiographic Grid

• Electrocardiographic grid refers to the marking on ECG

paper.
• ECG paper has horizontal and vertical lines at regular
interval of 1mm. Every fifth line(5mm) is thickened.
• X-axis represent time duration
• Y-axis represent amplitude(Voltage)
Cont…

 Horizontal Axis (Time)

• The horizontal axis represents time measured in seconds
• ECG paper has two types of boxes: small and large
boxes
• Each small box represents 0.04sec
• Each large box represents 0.2sec
• 5 large boxes = one second.
• 300 large boxes=onr minute
Cont….
Cont...

 Vertical Axis (Amplitude)

• The vertical axis measures the amplitude of a wave in
millivolt (mV)
• The height of every small box is 1mm(o.1mV)
• The height of every large box is 5mm(0.5)
Cont...

Standard Callibration:
• The first step when reading an ECG is to look for standard
callibration.
• Improper calibration an ECG may miss proper chamber
size.
• Equal to 10mm
=1mV
=10 small boxes
=2 large boxes
ECG LEADS

• Before discussing the ECG leads, we need to clarify

the difference between ECG leads and electrodes.
ELECTRODE: Piece of equipment placed on skin
surface for receiving the electrical signals.
LEAD: Graphical picture of the heart. It may be
obtained from one or more electrodes.
• ECG is recorded by total 12 leads.
 Cont...

ECG LEADS

BIPOLAR(Standard
UNIPOLAR LEADS
limb leads)

 lead 1 AUGMENTED UNIPOLAR CHEST OR

 lead 2 LIMB LEADS PRECARDIAL LEADS
 lead 3
 aVL  V1.......V6
 aVR
 aVF
Cont...
Cont...
Principle of ECG

Positive deflection: When an ECG waveform moves

toword the the top of the paper, it is called positive
deflection.
Negative deflection: When it move toword the bottom of
the paper, it is called negative deflection.
Wave: A positive or negative deflection from baseline that
indicates a specific electrical event. It include the P wave,
Q wave, R wave, S wave, T wave and U wave.
Segment: Isoelectric line between two waves.
Interval:Combination of two or more segments and wave.
WAVE FORM OF ECG
Cont...

P-WAVE (Show Artrial depolariziation)

• Positive in lead 1 and 2
• Biphasic in lead V1
• Downword in aVR
• Normal duration is 0.12sec
• Amplitude is 2.5 to 3 mm
Cont...

QRS Complex(Show ventricular depolarization)

• Normal duration is less than 0.12sec
• R wave are deflected positively and the Q and S waves are negative
Abnormilities:
• Broad QRS indicate
 BBB(Bundle Branch Block)
hyperkalaemia
• Narrow QRS indicate
Artrial flutter
 Artrial fibrillation
Cont...

T-WAVE (Ventricular repolarization)

• Normal duration of t wave is less than 0.2sec
• Normal T waves are upright in leads I, II, and V3-V6 and inverted
in AVR. They are less than 5 mm in limb leads, less than 10 mm
in precordial leads, and variable presentations in III, AVL, AVF,
and V1-V2
 ABNORMILITIES:
• Inverted t wave indicate
• Myocardial ischemia
• Hypokalemia
• Myocardial infarction (MI)
Cont...

U-WAVE (Repolarization of purkinji fiber)

• The U wave is a small, rounded deflection sometimes
seen after the T wave. As noted previously, its exact
significance is not known. Functionally, U waves
represent the last phase of ventricular repolarization.
Prominent U waves are characteristic of hypokalemia.
Cont...

PR interval: The PR interval is the time from the beginning of

the P wave (atrial depolarization) to the beginning of the QRS
complex (ventricular depolarization). The normal PR interval
measures 0.12-0.20 seconds (120-200 milliseconds).
 Abnormalities:
• Prolonged PR interval indicate
• 1 Degree heart block
• Bradycardia
• Shortened PR interval indicate
• Tachycardia
Cont...
QT inerval: represents the total time for ventricular
depolarization and repolarization. It measure from the begining
of the QRS complex to the end of the T wave. If there is no q
wave, then the starting point would be the very beginning of the
R wave.
• The QT interval duration depend on heart rate
 Abnormilities:
• Prolonged QT interval indicate
MI
Electrolytes imbalance
lethal ventricular dysrhythmia(torsades de pointes)
Cont...

PP Interval: Is measured from the beginning of one p wave

to the beginning of the next.
• it is used to determine atrial rhythm and atrial rate.
RR Interval: Is measured from one QRS complex to the
next QRS complex.
• It is used to determine ventricular rate and rhythm.
Cont...

ST Segment(show ealry ventricular repolarization)

• It is measured from the end of the QRS complex to the beginning of
the t wave.
• The ST segment is normally isoelectric. Above or below the
isoelectric line show a sign of cardiac ischemia.
 Abnormilities:
• ST evalvation may indicate
 STEMI
 Coronary vasospasm
 LBBB
 Left ventricular hypertrophy
 pericarditis
Cont...

• ST depression may indicate

NSTEMI
LBBB
Posterior MI
L.V.H/strain
Pericardial changes
Digoxin toxicity
How to read ECG?

• There are basic 5 steps to interpret ECG.

1. Heart rate
2. Heart rhythm
3. P wave
4. PR interval
5. QRS complex
Cont...

• Heart rhythm:(Regular or irregular)

Regular rhythm:
• Equal RR interval
• P wave present before every QRS complex
Irregular rhythm:
• unequal RR interval
• No identifiable P wave
Cont...
Cont..

• Heart rate:(Normal,Bradycardia,tachycardia)
 For regular heart rhythm
• Simply identify two consecutive R waves and count the
number of large squares between them. By dividing
this number into 300
• Rate = 300 / number of large squares between RR
interval
For example, there are 4 large boxes between RR
– rate =300/4
– the HR is 75 bpm.
Cont...

For irregular heart rhythm

• count the number of RR interval in 6 second strip and
multiply that number by 10
• rate=no. of R wave in 6 sec x 10
VALVULAR
HEART
DISEASE
PRESENTED BY HAFSA HABIB
PREPARED BY ANUM
BSN SEMESTER 4TH
KMU INS
HEART VALVE DISEASE
• Valvular heart disease occurs when one or more valves of
the heart do not open or close properly
STENOSIS: When the valve opening becomes narrow and
restricts blood flow
REGURGITATION: When blood leaks backward through a
valve
PATHOPHYSIOLOGY

 Valvular heart disease (VHD) is caused by either damage or

defect in one of the four heart valves, aortic, mitral, tricuspid or
pulmonary.
 Defects in these valves can be congenital or acquired
RISK FACTORS

 Older age (60 )

 High blood pressure
 Radiation therapy
 Endocarditis
 Diabetes
 Life style
 Infection (endocarditis)
CLINICAL MANIFESTATIONS

 Chest pain
 Palpitations (irregular heartbeats thus murmurs can be heard)
 Fatigue
 Dizziness
 Shortness of breath
 Abdominal pain ( b/c of enlarged liver)
 Leg swelling ( less blood towards the body results in leg swelling)
DIAGNOSIS

 Physical examination
 Echocardiogram (Ultrasound)
 Electrocardiogram (ECG)
 Chest X–Ray
 Cardiac catheterization
 Auscultations (murmurs)
TREATMENT

MEDICAL MANAGEMENT
 Beta–blockers, Digoxin and Calcium channel blockers.
 These medications only reduce the symptoms of VHD and may
relieve pain
SURGICAL MANAGEMENT
Surgeon repairs or replaces the damaged or diseased heart valve or
valves (minimally invasive or open heart surgery)
NURSING MANAGEMENT

 Monitor vital signs

 Elevate legs above the heart
 Assess ECG
 Monitor fluid intake to avoid fluid overload
 Monitor INR (international normalized ratio 1.1 or below)
 Assess mental status (restlessness, severe anxiety, confusion)
THANK YOU
NAME:BIBI LAIBA
INS (KMU)
SEMESTER: 4th
 DEFINATION
 TYPES & CLASSIFICATION
 PULMONARY EMBOLISM & DVT
 SIGN & SYMPTOMS
 ETIOLOGICAL FACTOR
 DIAGNOSIS
 TREATMENT
 NURSING INTERVENTION
DEFINITION:
 Venous thrombosis (VT) is blood clot formation
within vein, obstructing blood flow.
 Patient with cardiovascular disease are at risk for the
development of arterial & venous thrombosis.

TYPES OF THROMBOSIS
1: Arterial thrombosis
2: Venous thrombosis
 VENOUS THROMBOSIS (VT) CLASSIFICATION:
1: DEEP VEIN THROMBOSIS (DVT ): when clots forms in
deep vein e.g. in extremities (in legs).
2: SUPERFICIAL THROMBOSIS (SFT): Near the skin
surface.
3: PULMONARY EMBOLISM(PE): Clots breaks, looses and
travels to lungs.
4: CEREBRAL VENOUS: Thrombosis form in veins of brain.
5: MESENTRIC VT: In intestinal veins
6: RENAL VT: in kidney veins
7: HEPATIC VEIN: Liver veins
 PULMONARY EMBOLISM: Potentially life
threatening. This disorder poses a particular threat to
people with CVD.

 Blood clot that forms in deep vein of legs &

Embolise to the lungs can cause a pulmonary
infarction where emboli can mechanically
obstruct the pulmonary vessels, cutting of the
blood supply to section of the lungs.
CLINICAL MENIFESTATIONS:
 Leg pain & swelling
 Cramping
 Weakness
 Warmth or inflammation
 Chest pain
 Shortness of breath
 Coughing up blood
 Tachycardia
 Fainting
CAUSES:
 immobility (long travel/bed rest)
 Surgery or trauma
 Cancer
 Inherited clotting disorders
 Medication(birth control, chemotherapy)
 Age
 Obesity
 Smoking
 Family history
DIAGNOSIS:
• Chest X-ray
• Ventilation perfusion lung scan
• Computed tomography pulmonary angiogram
• Ultrasound (DOPPLER)
• CT scan/MRI
• BLOOD D –DIMER: Is a helpful screening test that
identifies whether clotting and fibrinolysis are taking
place somewhere in the body.
TREATMENT:
Pt management begins with cardiopulmonary
assessment & intervention.
• Anticoagulant therapy (BLOOD THINNER)
• Low molecular weight of heparin
• Thrombolytic therapy (CLOT DISSOLVER)
• Pt are placed on WARFARINE
NURSING INTERVENTIONS:
• Encourage mobility , ambulation and exercise
• Use compression stockings or devices
• Elevate affected limb
• Avoid prolong immobility
• Monitor sign of bleeding
• Encouraged deep breathing
• Provide pain management
• Administer anticoagulant as prescribed
ANEURYSM

BY:ATHIA NOREEN
BSN:4TH SEMESTER
KMU INS PESHAWAR
 INTRODUCTION

• An Aneurysm is a localized sac or dilation formed at a weak point

in the wall of Arteries.
• It may be classified by its shape or form.
• The most common form of Aneurysm are saccular and fusiform.
A. Saccular Aneurysm
A Saccular Aneurysm Projects from only one side of the Vessel.

B. Fusiform Aneurysm
If An Entire Arterial Segment become dilated , a Fusiform
Develops.

H
• Aneurysm are Potentially Serious if they are Located
large vessel that Rupture this can lead to hemorrhage and
death.

Thoracic Aortic Aneurysm (TAA)

TAA is a dilation of Thoracic Aorta which can lead to Rupture
and life-Threatening Complication.
Classification
Stanford Type A Involve Ascending Aorta.
Sandford Type B Involve Descending Aorta.
Sign / Symptoms
Chest Pain, Back Pain, Shortness Of Breath, Coughing, Hoarseness,
Swallowing Difficulty.

Abdominal Aortic Aneurysm (AAA)

AAA is dilation of abdominal Aorta which can lead to
Rupture and life Threating Complication.

Classification
Infra-renal :Below Renal Arteries.
Juxta-Renal :Near the Renal Arteries.
Supra-Renal: Above the Renal Arteries .
Sign/Symptoms
Abdominal Pain, Back Pain, Flank Pain, Groin Pain, SOB and
Pale/Cool Extremities.

Dissecting Aorta
It is also known is Aorta Dissection, is a medical condition where
there is a tear in the inner layer of Aorta leading to blood flow
between the layers.
 Causes
Hypertension, Smoking, Atherosclerosis ,Vasculitis(Inflammation
of Blood vessels),Physical Trauma and Marphan Syndrome.

Diagnosis
Physical Examination ,Medical History(HTN, Family History Of Aneurysm,
Smoking ,Trauma / Injury),Imaging Test(Ultrasound ,Computed Tomography
Angiography CTA, Magnetic Resonance Angiography MRA, Aortography).

Medical/Surgical Management
Surgical Repair , Endovascular Stenting ,Medical Management BP Control Beta
Blocker (Decrease Blood Pressure and HR), Statins (Lower
Cholesterol),Vasodilators (Reduce Blood Vessels Constriction), Anti Hypertensive.
 Nursing Management
Nursing Management for Aneurysm Involve A
Comprehensive Approach To Care Focusing on Prevention
Early Detection and Effective Management
 Health History
 Physical Examination
 Monitor For Neurological Deficit such as weakness and Numbness
 Educate Patient and family on Procedure and Risk
 Administer Medication Is Prescribed Such As Beta blocker
 Mange Pain and Discomfort
 Prevent Complication
 Aneurysm Rupture Prevention
 Prepare Patient For Surgery
Thank You
BY:
JALWA SALEEM
BSN 4TH
KMU INS
 Sex:
The lifetime risk is three time greater in men (12.3%)
than women (4.2%)
 Smoking
 Lack of physical exercise
 Obesity
 Diabetes
 Family History
 Hypoxia
 Arrhythmias
 Ventricular Fibrillation
 Hypovolemia
 Infection
 Heart Failure