Cardiovascular system: Heart diseases

Heart diseases can affect both children and adults. In children, they’re usually congenital, or present from birth, and they can result from abnormal development of the heart during pregnancy.

In adults, heart diseases are acquired, which means that they develop later in life, and they’re often caused by the person’s lifestyle choices.

Okay, let’s start with congenital heart diseases, which can affect the atria, the ventricles, the heart valves, and vessels.

They can cause blood flow to slow down, stop completely, or change direction. There’s no clear cause that’s been identified, but there are a number of risk factors that seem to be associated with congenital heart disease.

The most well-known factors include a family history of a congenital heart disease, certain viral infections of the mother during pregnancy, maternal diabetes, and exposure to medications and illicit drugs.

Children with congenital heart diseases could be asymptomatic or present with difficulty breathing; cyanosis, which is when the skin turns blue due to decreased oxygen in the blood; poor feeding; and failure to thrive, which means that the child is not growing as fast as they should.

Diagnosis is usually made during pregnancy or soon after birth. However, some cases are diagnosed when the child is older.

Treatment usually requires medications or surgery to correct the defect, and afterwards, children can often grow up to live a normal life without complications.

Okay, now, let’s switch our focus to acquired heart diseases that are more common in adults. The most common are coronary artery disease; heart failure; and arrhythmia, which is abnormal heart rhythm.

Risk factors for an acquired heart disease can be divided into non-modifiable, meaning they can’t be changed, and modifiable, which means they can be.

Non-modifiable risk factors include age, with biological males greater than 45 years and biological females greater than 55 years being more at risk; sex, with biological males being at a greater risk; and family history of heart disease.

Modifiable risk factors include eating a diet high in saturated fats, obesity, sedentary lifestyle, hypertension, diabetes, hyperlipidemia, smoking, and chronic alcohol use.

Okay, let’s take a closer look at the acquired heart diseases starting with coronary artery disease, where the coronary arteries that supply the heart with blood become harder and less elastic than normal.

This is usually caused by atherosclerosis, or buildup of cholesterol plaques, in the innermost wall of the blood vessel, and it can affect one or more coronary arteries.

As a result, the heart receives less blood, oxygen, and nutrients. Coronary artery disease can often be treated with lifestyle changes, like stopping smoking and improving diet and exercise.

In some cases, medications may be required to slow down atherosclerosis, open up the blocked arteries, reduce symptoms, and prevent complications.

With severe atherosclerosis, angioplasty can be used to open a blocked artery with a balloon, followed by the placement of a stent to keep the artery open.

Also, a blood vessel from another part of the body can be grafted in and used to bypass, or go around, a blocked artery.Coronary artery disease can lead to various complications including angina pectoris, or chest pain; a myocardial infarction, or heart attack; arrhythmias; and sudden death.

At first, the heart may receive enough blood during rest, but if the body demands more oxygen and nutrients, like during exercise or stressful situations, the heart has to work harder and, therefore, needs more blood itself.

It’s during these times of exertion or emotional stress that clients with coronary artery disease can experience chest pain, which is usually described as feeling pressure or squeezing.

This pain can radiate to the left arm, jaw, shoulders, and back and is sometimes accompanied by difficulty breathing, shortness of breath, fatigue, and sweating.

Usually the pain and symptoms last less than 20 minutes and subside after the exertion or stress is taken away, when the heart muscle isn’t demanding as much blood.

Many clients experience angina pectoris quite often, and they can take nitroglycerin pills that increase blood vessel diameter to allow more blood flow to the heart.Now, chest pain and the associated symptoms that last longer and are not relieved by rest and nitroglycerin can be a heart attack.

A heart attack occurs when the coronary arteries remain blocked long enough that the heart tissue starts to die from the lack of oxygen.

The most important risk factor in addition to coronary artery disease is a previous history of heart attack. Now, the first few minutes after a heart attack are extremely important because the damage to the heart is potentially reversible.

That’s why quickly identifying and treating a heart attack is super important. This is focused on re-establishing blood flow to the dying heart cells, relieving symptoms, and preventing life-threatening complications.

A potentially life-saving treatment that can be performed is fibrinolytic therapy, which uses medications to destroy the clots that are causing the blockage.

An angioplasty might also be done, where a thin tube is inserted into the blocked artery to open it up. If the client has a very severe blockage or blockage of multiple arteries, a surgery may be indicated to bypass the blocked area of the coronary artery.

Alright, now clients that experience a complication of coronary artery disease require cardiac rehabilitation to help them recover and prevent future complications.

This process includes training to exercise safely and education where the person learns about their condition, how to avoid future episodes, how to change their lifestyle, and how to overcome their fear of future complications.

Okay, next is heart failure, which is when the heart can’t contract or fill properly, so it’s unable to supply enough blood to meet the body’s demands.

A wide variety of diseases, like coronary artery disease, heart attack, valvular disease, hypertension, and diabetes, can cause heart failure.

This can happen in two ways: either the heart’s ventricles can’t pump blood hard enough or not enough blood fills the ventricles.

Also, heart failure can affect the right ventricle, the left ventricle, or both ventricles, so someone might have right-sided heart failure, left-sided heart failure, or both.

With right-sided failure, the heart is not able to pump the blood forward to the lungs, and the blood gets backed up to the veins in the body.

So, clients will have congestion in the veins. Common manifestations of this are enlargement of the neck veins, the liver, and the spleen; ascites, or build up of fluid in the abdomen; and edema, or swelling of the lower legs.

Now, with left-sided heart failure, the blood backs up into the lungs, causing pulmonary edema, which can be life-threatening.

These clients will have difficulty breathing, especially in a supine position that allows blood to more easily flow back from the legs to the heart and eventually into the pulmonary circulation.

Okay, now, treatment of heart failure usually relies on medications to help improve the ability of the heart to pump blood and reduce the overall fluid buildup in the body.

When caring for a client with heart failure, encourage them to rest or stay physically active as outlined in the plan of care.You might need to assist them with self-care activities and ambulation.

Range-of-motion exercises can also help improve muscle strength and mobility. It’s also important to check with the nurses and the plan of care to find out if their intake and output should be monitored and how often you should measure their weight.

Also, make sure to promote a healthy diet that is low in sodium and fat. For immobile clients, be sure to assist with position changes and skin care to prevent complications like pressure ulcers.Let’s move on to arrhythmias, which is any disturbance in the heart rate, rhythm, or both and occurs when there’s a defect in the electrical conduction system of the heart.

It can be part of the normal aging process but can also result from other cardiovascular disorders, such as hypertension, coronary artery disease, and heart failure.

Other causes include thyroid diseases, certain medications, chronic use of alcohol, and excess coffee drinking. Arrhythmias range from completely benign, like an athlete who has a very slow heart rate during rest, to potentially life-threatening, like ventricular fibrillation, where the ventricle quivers rapidly instead of contracting in sync with the rest of the heart.

Some types of arrhythmias can also increase the risk for a heart attack or stroke. A client with arrhythmias often complains of heart palpitations or being aware of their heartbeat.

They may feel like their heart skipped a beat or there’s an extra beat. They could also experience difficulty breathing, dizziness, fatigue, chest pain, or feel faint.

Treatment depends on the type and the severity. Most arrhythmias are controlled with medications.

However, severe cases may require a surgical procedure or administration of electrical shock through a defibrillator. Okay, now let’s focus our attention on heart block, which is a common type of arrhythmias.

A heart block means that the heart's electrical activity starts normally, but it encounters a traffic jam as it travels through the heart, causing the heart to beat irregularly and at a slower pace.

This can be due to normal aging but can also result from a heart attack that damages the tissue needed to conduct the electrical signal.

Many clients will take medications to control the heart block; however, more severe cases require a pacemaker. This is a device that is placed under the skin in the chest and continually monitors the client’s heart beat.

If it detects a delay, it’ll send an electrical impulse into the heart, causing it to contract. A similar device is an implanted defibrillator.

When caring for a client with a pacemaker, make sure that the pacemaker’s function and battery are checked frequently. Alright, now when assisting a client that has or is at risk of heart disease, you need to report to the nurse if your client complains of chest pain, gets tired easily with normal activity or exercise, or has cyanosis of the face, lips, or fingers.

Next, report if the client feels their heart beats abnormally or if you notice they have an irregular pulse. Finally, let the nurse know if the client’s blood pressure differs from their usual reading.

All right, as a quick recap... Heart diseases can be congenital and result from abnormal development of the heart, or they can be acquired.

Risk factors for acquired heart diseases can be non-modifiable, such as age and sex, and modifiable, like eating a diet high in saturated fats and a sedentary lifestyle.

Acquired heart diseases include coronary artery disease, heart failure, and arrhythmias. When assisting with client care, remember to report any signs or symptoms of heart disease