ncm 106 cardiac disorders
TRANSCRIPT
-
8/10/2019 NCM 106 Cardiac Disorders
1/87
CARDIAC DISORDERSMs Hassen Zabala, RN, MAN
July 22, 2013
-
8/10/2019 NCM 106 Cardiac Disorders
2/87
HEART FAILURE
Definition
Heart failure is a condition in whichthe heart can no longer pump
enough blood to the rest of thebody.
-
8/10/2019 NCM 106 Cardiac Disorders
3/87
Causes, incidence, and risk factors
Heart failure is present when: Your heart muscle cannot pump (eject) the blood out of the heart
very well. This is called systolic heart failure.
Your heart muscles are stiff and do not fill up with blood easily. Thisis called diastolic heart failure.
As the heart's pumping action is lost, blood may back up inother areas of the body.
The most common cause of heart failure is coronary artery
disease (CAD), a narrowing of the small blood vessels thatsupply blood and oxygen to the heart.
Heart failure can also occur when an infection weakens theheart muscle. This condition is called cardiomyopathy.
-
8/10/2019 NCM 106 Cardiac Disorders
4/87
Other heart problems
that may cause heart
failure are:
Congenital heart disease
Heart attack
Heart valve disease
Some types of abnormal
heart rhythms
(arrhythmias)
Other diseases that can
cause or contribute to
heart failure:
Emphysema
Overactive thyroid
Severe anemia
Underactive thyroid
-
8/10/2019 NCM 106 Cardiac Disorders
5/87
Structure of the Heart
-
8/10/2019 NCM 106 Cardiac Disorders
6/87
Circulation of the Heart
-
8/10/2019 NCM 106 Cardiac Disorders
7/87
Symptoms
Cough
Fatigue, weakness,faintness
Loss of appetite
Need to urinate at night
Pulse that feels fast orirregular, or palpitations
Shortness of breathwhen active or afterlying down
Swollen (enlarged) liveror abdomen
Swollen feet and ankles
Weight gain
-
8/10/2019 NCM 106 Cardiac Disorders
8/87
Signs and tests
Signs of heart failure:
Fast or difficult breathing
Irregular or fast heartbeat and abnormal heart sounds
Leg swelling (edema)
Neck veins that stick out (are distended)
Sounds ("crackles") from fluid buildup in the lungs, heardthrough a stethoscope
Swelling of the liver or abdomen
-
8/10/2019 NCM 106 Cardiac Disorders
9/87
An echocardiogram (echo) is often the best testto diagnose, learn the cause of, and monitor
heart failure.
Other imaging tests are:
Cardiac stress tests
Heart catheterization
MRI of the heart
Nuclear heart scans
-
8/10/2019 NCM 106 Cardiac Disorders
10/87
Echocardiogram Cardiac stress test
-
8/10/2019 NCM 106 Cardiac Disorders
11/87
Cardiac catheterization MRI of heart
-
8/10/2019 NCM 106 Cardiac Disorders
12/87
Nuclear heart scans
-
8/10/2019 NCM 106 Cardiac Disorders
13/87
Lab tests:
Check how well kidneys are working (BUN,
creatinine, creatinine clearance, urinalysis)
Look for a low blood count or anemia -- completeblood count (CBC)
Test for brain natriuretic peptide (BNP)
Watch sodium and potassium levels in blood
-
8/10/2019 NCM 106 Cardiac Disorders
14/87
Treatment
These medicines:
Help the heart muscle pump better
Keep blood from clotting
Lower cholesterol levels
Open up blood vessels or slow heart rate
Replace potassium
Rid body of excess fluid and salt (sodium)
-
8/10/2019 NCM 106 Cardiac Disorders
15/87
The following surgeries and devices may berecommended for certain patients with heart
failure:
Coronary bypass surgery (CABG) and angioplasty mayhelp improve blood flow to the damaged or weakenedheart muscle.
Heart valve surgery may be done if changes in a heartvalve are causing your heart failure.
A pacemaker can help treat slow heart rates or helpboth sides of your heart contract at the same time.
A defibrillator sends an electrical pulse to stop life-
threatening abnormal heart rhythms.
-
8/10/2019 NCM 106 Cardiac Disorders
16/87
END-STAGEHEART FAILURE
Severe heartfailure occurswhen treatments
no longer work. Intra-aortic
balloon pump(IABP)
Left ventricularassist device(LVAD)
-
8/10/2019 NCM 106 Cardiac Disorders
17/87
VALVULAR HEART DISEASE
Definition
Heart valve disease occurswhen your heart's valves do
not work the way they should.
-
8/10/2019 NCM 106 Cardiac Disorders
18/87
-
8/10/2019 NCM 106 Cardiac Disorders
19/87
What Are the Types of Valve Disease?
Valvular stenosis. This occurs when a valveopening is smaller than normal due to stiff orfused leaflets. The narrowed opening may
make the heart work very hard to pump bloodthrough it. This can lead to heart failure andother symptoms (see below). All four valvescan be stenotic (hardened, restricting blood
flow); the conditions are called tricuspidstenosis, pulmonic stenosis, mitral stenosis oraortic stenosis
-
8/10/2019 NCM 106 Cardiac Disorders
20/87
Valvular insufficiency. Also called
regurgitation, incompetence or "leaky valve",this occurs when a valve does not close tightly.If the valves do not seal, some blood will leakbackwards across the valve. As the leak
worsens, the heart has to work harder tomake up for the leaky valve, and less bloodmay flow to the rest of the body. Dependingon which valve is affected, the conditioned is
called tricuspid regurgitation, pulmonaryregurgitation, mitral regurgitation or aorticregurgitation.
-
8/10/2019 NCM 106 Cardiac Disorders
21/87
-
8/10/2019 NCM 106 Cardiac Disorders
22/87
What Causes Valvular Heart Disease?
Valve disease can develop before birth(congenital) or can be acquired sometime duringone's lifetime.
Congenital valve disease. Most often affects theaortic or pulmonic valve.
Bicuspid aortic valve disease is a congenital valvedisease that affects the aortic valve. Instead ofthe normal three leaflets or cusps, the bicuspid
aortic valve has only two.
-
8/10/2019 NCM 106 Cardiac Disorders
23/87
Acquired valve disease. Rheumatic fever is caused by an untreated bacterial infection
(usually strep. throat). The heart valves become inflamed, theleaflets stick together and become scarred, rigid, thickened
and shortened. This leads to mitral regurgitation. Endocarditis occurs when germs, especially bacteria, enter the
bloodstream and attack the heart valves, causing growths andholes in the valves and scarring. This can lead to leaky valves.
Mitral valve prolapse (MVP) is a very common condition,causes the leaflets of the mitral valve to flop back into theleft atrium during the heart's contraction.
Other causes of valve disease include: coronary arterydisease, heart attack, cardiomyopathy (heart muscledisease), syphilis (a sexually transmitted disease),hypertension, aortic aneurysms, and connective tissuediseases.
-
8/10/2019 NCM 106 Cardiac Disorders
24/87
What Are the Symptoms of Valve
Disease?
Shortness of breath and/or difficulty catchingyour breath.
Weakness or dizziness.
Discomfort in your chest. You may feel a pressureor weight in your chest with activity or whengoing out in cold air.
Palpitations.
Swelling of your ankles, feet or abdomen.
Rapid weight gain. A weight gain of two or threepounds in one day is possible.
-
8/10/2019 NCM 106 Cardiac Disorders
25/87
How Are Valve Diseases Diagnosed?
After the physical exam, the doctor may order
diagnostic tests. These may include:
Echocardiography
Transesophageal echocardiography
Cardiac catheterization (also called an angiogram)
Radionuclide scans
Magnetic resonance imaging (MRI)
-
8/10/2019 NCM 106 Cardiac Disorders
26/87
How Is Heart Valve Disease Treated?
Medications Diuretics ("water pills")
Antiarrhythmic medications. Control the heart's rhythm
Vasodilators. Lessen the heart's work; encourages bloodto flow in a forward direction, rather than backwardsthrough a leaky valve.
ACE inhibitors. A type of vasodilator used to treat highblood pressure and heart failure
Beta blockers. Treat high blood pressure and lessen theheart's work by helping the heart beat slower and lessforcefully. Used to decrease palpitations in some patients.
Anticoagulants ("blood thinners")
-
8/10/2019 NCM 106 Cardiac Disorders
27/87
Surgeries
heart valve repair orreplacement.
percutaneous balloon
valvotomy.
-
8/10/2019 NCM 106 Cardiac Disorders
28/87
-
8/10/2019 NCM 106 Cardiac Disorders
29/87
Dilated cardiomyopathy
-
8/10/2019 NCM 106 Cardiac Disorders
30/87
Hypertrophic cardiomyopathy
-
8/10/2019 NCM 106 Cardiac Disorders
31/87
Symptoms
Some people who develop cardiomyopathyhave no signs and symptoms during the earlystages of the disease. Cardiomyopathysymptoms may include:
Breathlessness with exertion or even at rest Swelling of the legs, ankles and feet
Bloating of the abdomen due to fluid buildup
Fatigue
Irregular heartbeats that feel rapid, pounding orfluttering
Dizziness, lightheadedness and fainting
-
8/10/2019 NCM 106 Cardiac Disorders
32/87
Causes Long-term high blood
pressure
Heart valve problems
Heart tissue damage from aprevious heart attack
Chronic rapid heart rate Metabolic disorders
Nutritional deficiencies ofessential vitamins or
minerals, such as thiamin(vitamin B-1), selenium,calcium and magnesium
Pregnancy
Excessive use of alcoholover many years
Abuse of cocaine orantidepressantmedications, such as
tricyclic antidepressants Use of some chemotherapy
drugs to treat cancer
Certain viral infections,which may injure the heart
and trigger cardiomyopathy Iron buildup in your heart
muscle (hemochromatosis)
Genetic conditions
-
8/10/2019 NCM 106 Cardiac Disorders
33/87
Types of cardiomyopathy
1. Dilated cardiomyopathy.
This is the most common type ofcardiomyopathy
the pumping ability of your heart's mainpumping chamberthe left ventriclebecomes less forceful; becomes enlarged
(dilated) and can't effectively pump blood outof the heart
occurs most often in middle-aged people andis more likely to affect men
-
8/10/2019 NCM 106 Cardiac Disorders
34/87
2. Hypertrophic cardiomyopathy.
involves abnormal growth or thickening ofyour heart muscle, particularly affecting the
muscle of your heart's main pumping
chamber. the heart tends to stiffen and the size of the
pumping chamber may shrink, interfering with
your heart's ability to deliver blood to your
body.
tends to be more severe during childhood.
-
8/10/2019 NCM 106 Cardiac Disorders
35/87
3. Restrictive cardiomyopathy
heart muscle becomes rigid and less elastic,meaning the heart can't properly expand and
fill with blood between heartbeats.
most often tends to affect older people.
least common type and can occur for no
known reason (idiopathic). The condition may
also be caused by diseases elsewhere in thebody that affect the heart.
-
8/10/2019 NCM 106 Cardiac Disorders
36/87
Complications
Heart failure.
Blood clots. Valve problems.
Cardiac arrest and suddendeath.
-
8/10/2019 NCM 106 Cardiac Disorders
37/87
Tests and Diagnosis
Chest X-ray
Echocardiogram.
Electrocardiogram (ECG).
Cardiac catheterization and biopsy.
Cardiac magnetic resonance imaging (MRI).
Blood tests. One blood test can measure B-type natriuretic peptide (BNP), a protein
produced in your heart.
-
8/10/2019 NCM 106 Cardiac Disorders
38/87
Treatment
Dilated cardiomyopathy ACE inhibitors to improve your heart's pumping
capability, such as enalapril (Vasotec), ramipril
(Altace) and captopril (Capoten).
Angiotensin receptor blockers (ARBs) for those
who can't take ACE inhibitors, such as losartan
(Cozaar) and valsartan (Diovan).
Beta blockers to improve heart function, such as
carvedilol (Coreg) and metoprolol (Lopressor,
Toprol-XL).
-
8/10/2019 NCM 106 Cardiac Disorders
39/87
Digoxin (Lanoxin). Increases the strength of heart
muscle contractions; tends to slow the heartbeat. Diuretics. Make you urinate more frequently and
keep fluid from collecting in your body.
Commonly prescribed diuretics for heart failure
include bumetanide (Bumex) and furosemide
(Lasix). One diuretic, spironolactone (Aldactone),
may also be helpful in treating scarring of your
heart tissue. ICD
-
8/10/2019 NCM 106 Cardiac Disorders
40/87
-
8/10/2019 NCM 106 Cardiac Disorders
41/87
Septal ablation.Also called septalalcohol ablation,this is a treatmentin which a smallportion of the
thickened heartmuscle isdestroyed byinjecting alcohol
through a catheterinto the arterysupplying blood toit.
-
8/10/2019 NCM 106 Cardiac Disorders
42/87
Pacemaker implantation ICD
-
8/10/2019 NCM 106 Cardiac Disorders
43/87
Restrictive cardiomyopathy
Treatment focuses on improvingsymptoms.
salt and water intake monitoring and
weight monitoring
diuretics for sodium and water retention
medications to lower blood pressure andcontrol fast or irregular heart rhythms.
-
8/10/2019 NCM 106 Cardiac Disorders
44/87
Heart transplant & Ventricular assistive
devices (VADs)
-
8/10/2019 NCM 106 Cardiac Disorders
45/87
-
8/10/2019 NCM 106 Cardiac Disorders
46/87
Stress Cardiomyopathy
Broken heart syndrome
S/sx: Chest pain
Shortness of breath
An irregular heartbeat
A generalized weakness
Cx: Death
Disruptions in your heartbeat
A fast or slow heartbeat
Backup of fluid into your lungs (pulmonary edema)
-
8/10/2019 NCM 106 Cardiac Disorders
47/87
Test & diagnosis:
Personal history and physical exam
Electrocardiogram (ECG)
Chest X-ray
Echocardiogram Blood tests
Treatment
angiotensin-converting enzyme (ACE) inhibitors beta blockers
diuretics
-
8/10/2019 NCM 106 Cardiac Disorders
48/87
What is pericarditis?
Definition
The hearts sits in the center of the chest and issurrounded by a sac called the pericardium.
This sac has two layers, one that fits tightlyonto the heart muscle and another looserlayer surrounding the inner layer.Inflammation of these tissue layers
surrounding the heart is referred to aspericarditis.
-
8/10/2019 NCM 106 Cardiac Disorders
49/87
What causes pericarditis? Idiopathic
Mechanical injury to theheart Heart attack and Dressler's
syndrome
Heart surgery and postpericardiotomy syndrome
Infection Bacterial
Viral Fungal
HIV
Tumors or cancer
Connective Tissue Disease Rheumatoid arthritis
SLE
Sarcoidosis
Metabolic diseases Uremia (kidney failure)
Hypothyroidism
Medication Reactions Side effects of phenytoin
(Dilantin), hydralazine(Apresoline) andprocainamide (Pronestyl,Procan-SR, Procanbid).
-
8/10/2019 NCM 106 Cardiac Disorders
50/87
-
8/10/2019 NCM 106 Cardiac Disorders
51/87
How is pericarditis diagnosed?
Physical Evaluation
Diagnostic Testing
Electrocardiogram
Chest x-ray
Echocardiography
Blood testing
-
8/10/2019 NCM 106 Cardiac Disorders
52/87
What is the treatment for pericarditis?
Medicines Nonsteroidal anti-
inflammatory drugs(ibuprofen)
Narcotic pain medication
[codeine, hydrocodone(Vicodin) or oxycodone(OxyContin, Roxicodone)]
Corticosteroids
Surgery Pericardiocentesis (a thin
needle is inserted throughthe chest wall into thepericardial sac)
-
8/10/2019 NCM 106 Cardiac Disorders
53/87
Pericardotomy (cutting a hole inthe pericardial sac)
Pericardectomy (removing the sac
completely)
-
8/10/2019 NCM 106 Cardiac Disorders
54/87
Myocarditis
Definition
inflammation of heart muscle.
Causes
Viruses
Sarcoidosis
immune diseases (such as systemic lupus, etc.)
Pregnancy
Others
-
8/10/2019 NCM 106 Cardiac Disorders
55/87
Symptoms
pain in the chest
weakening of the heart muscle
heart failure symptoms
shortness of breath
Fatigue
fluid accumulation in the lungs
Etc
heart rhythm irregularities from inflammationand/or scarring of the electrical system of theheart.
-
8/10/2019 NCM 106 Cardiac Disorders
56/87
Diagnosis
Blood tests for heart muscle enzymes(CPK levels) can be elevated
Electrical testing (EKG) can suggest
irritation of heart muscle and
demonstrate irregular beating of the
heart
Nuclear heart scan testing can show
irregular areas of heart muscle.
-
8/10/2019 NCM 106 Cardiac Disorders
57/87
Treatment
Treatment measures mainly
involves alleviating heart failure
(salt restriction, water pills, ACEinhibitors, beta blockers, etc.) and
treating as well as monitoringheart rhythm abnormalities.
-
8/10/2019 NCM 106 Cardiac Disorders
58/87
Endocarditis
Definition
Endocarditis is a serious infection of one of
the four heart valves.
Cause
Endocarditis is caused by a growth of bacteria
on one of the heart valves, leading to an
infected mass called a "vegetation".
-
8/10/2019 NCM 106 Cardiac Disorders
59/87
What are the symptoms?
fever,
fatigue,
chills,
weakness
aching joints and muscles, night sweats,
edema in the leg(s), foot (feet), and abdomen,
malaise,
shortness of breath, and
occasionally, scattered small skin lesions.
anemia, blood in urine, elevated white blood cell
count, and a new heart murmur.
-
8/10/2019 NCM 106 Cardiac Disorders
60/87
Who is at risk for endocarditis?
People with existing diseases of
the heart valves (aortic stenosis,
mitral stenosis, mitralregurgitation, etc.) and people
who have undergone heart valvereplacements
-
8/10/2019 NCM 106 Cardiac Disorders
61/87
How is endocarditis diagnosed?
Transesophageal echocardiography
-
8/10/2019 NCM 106 Cardiac Disorders
62/87
How is endocarditis treated?
Aggressive antibiotics, generally givenintravenously, usually for 4-6 weeks.
Amoxicillin
Ampicillin Erythromycin
Gentamicin
Vancomycin
surgical replacement of the valve
-
8/10/2019 NCM 106 Cardiac Disorders
63/87
HYPERTENSION
Blood pressure is a measurement of the force againstthe walls of your arteries as your heart pumps bloodthrough your body.
The top number is called the systolic blood pressure,and the bottom number is called the diastolic bloodpressure.
High blood pressure (hypertension) is when your bloodpressure is 140/90 mmHg or above most of the time.
If your blood pressure numbers are 120/80 or higher,but below 140/90, it is called pre-hypertension.
-
8/10/2019 NCM 106 Cardiac Disorders
64/87
Essential HPN
no cause of high blood
pressure is found
Secondary HPN
Chronic kidney disease
Disorders of the adrenal gland(pheochromocytoma or Cushingsyndrome)
Pregnancy
Medications such as birth control pills,diet pills, some cold medications, andmigraine medications
Renal artery stenosis
Hyperparathyroidism
-
8/10/2019 NCM 106 Cardiac Disorders
65/87
Symptoms
If you have a severe headache, nausea or
vomiting, bad headache, confusion, changes
in your vision, or nosebleeds you may have a
severe and dangerous form of high bloodpressure called malignant hypertension.
-
8/10/2019 NCM 106 Cardiac Disorders
66/87
Diagnosis
-
8/10/2019 NCM 106 Cardiac Disorders
67/87
Complications
-
8/10/2019 NCM 106 Cardiac Disorders
68/87
Treatment
Lifestyle modification
Medications
Diuretics help the body get rid of excess sodium (salt)and water and help control blood pressure
Beta-blockers reduce the heart rate, the heart'sworkload and the heart's output of blood
ACE inhibitors help the body produce less angiotensin,which helps the blood vessels relax and open up
ARBs block the receptors so the angiotensin fails toconstrict the blood vessel
Calcium channel blockers relax and open up narrowedblood vessels
Alpha blockers reduce the arteries' resistance relaxing
-
8/10/2019 NCM 106 Cardiac Disorders
69/87
Alpha blockers reduce the arteries resistance, relaxingthe muscle tone of the vascular walls
Alpha 2 receptor agonist decreases the activity of the
sympathetic (adrenaline-producing) portion of theinvoluntary nervous system
Combined alpha and beta-blockers areused as an IV dripfor those patients experiencing a hypertensive crisis
Central agonists also help decrease the blood vessels'ability to tense up or contract
Peripheral adrenergic inhibitors reduce blood pressureby blocking neurotransmitters in the brain. This blocksthe smooth muscles from getting the "message" toconstrict.
Blood vessel dilators, or vasodilators, can cause themuscle in the walls of the blood vessels (especially thearterioles) to relax, allowing the vessel to dilate (widen)
-
8/10/2019 NCM 106 Cardiac Disorders
70/87
ANEURYSM
Definition
An aneurysm is an
abnormal widening
or ballooning of aportion of an artery
due to weakness in
the wall of theblood vessel.
-
8/10/2019 NCM 106 Cardiac Disorders
71/87
-
8/10/2019 NCM 106 Cardiac Disorders
72/87
Symptoms
The symptoms depend on the location of theaneurysm. If the aneurysm occurs near thebody's surface, pain and swelling with athrobbing mass is often seen.
Aneurysms within the body or brain often causeno symptoms.
If an aneurysm ruptures, pain, low bloodpressure, a rapid heart rate, and lightheadednessmay occur. The risk of death after a rupture ishigh.
Si d t t
-
8/10/2019 NCM 106 Cardiac Disorders
73/87
Signs and tests
physical exam.
CT scan
Ultrasound
Treatment
Surgery endovascular stent repair
Endovascular embolization.
E d l t t i
-
8/10/2019 NCM 106 Cardiac Disorders
74/87
Endovascular stent repair
THROMBOANGITIS OBLITERANS
-
8/10/2019 NCM 106 Cardiac Disorders
75/87
THROMBOANGITIS OBLITERANS
(BUERGERS DSS.)
Definition blood vessels of the hands and feet become blocked.
Cause
Caused by vasculitis (inflammation of the blood vessels).
average age when symptoms begin is around 35 years
history of heavy smoking/chewing tobacco; Raynaud'sdisease.
very uncommon in children unless if with autoimmune
diseases.
-
8/10/2019 NCM 106 Cardiac Disorders
76/87
-
8/10/2019 NCM 106 Cardiac Disorders
77/87
Symptoms Hands or feet may be pale, red, or bluish
Hands or feet may feel cold Pain in the hands and feet
Acute, severe
Burning or tingling
Often occurring at rest Pain in the legs, ankles, or feet when walking
(intermittent claudication) Often located in the arch of the foot
Skin changes or ulcers on hands or feet
Note: Symptoms may worsen with exposure to cold orwith emotional stress. Usually, two or more limbs areaffected.
-
8/10/2019 NCM 106 Cardiac Disorders
78/87
Signs & Tests
Angiography/arteriography of
the extremity
Doppler ultrasound of the
extremity
-
8/10/2019 NCM 106 Cardiac Disorders
79/87
Treatment There is no cure for thromboangiitis obliterans. The
goal of treatment is to control symptoms.
The patient must stop using tobacco and should avoidcold temperatures and other conditions that reduce
circulation to the hands and feet.
Applying warmth and exercising gently may helpincrease circulation.
Cutting the nerves to the area (surgicalsympathectomy) may help control pain. Aspirin andvasodilators may also used. It may be necessary toamputate the hand or foot if infection or widespread
tissue death occurs.
-
8/10/2019 NCM 106 Cardiac Disorders
80/87
RAYNAUDS PHENOMENON
Raynaud's phenomenon (RP) is a condition resulting ina particular series of discolorations of the fingersand/or the toes after exposure to changes intemperature (cold or hot) or emotional events. Skin
discoloration occurs because an abnormal spasm of theblood vessels causes a diminished blood supply to thelocal tissues.
White---blue---red
Affects women between 20-40 When it occurs alone, it is referred to as "Raynaud's
disease" or primary Raynaud's phenomenon. When itaccompanies other diseases, it is called secondary
Raynaud's phenomenon.
h d' h ?
-
8/10/2019 NCM 106 Cardiac Disorders
81/87
What causes Raynaud's phenomenon?
The causes of primary and secondary RP are unknown.
What are Raynaud's phenomenon
-
8/10/2019 NCM 106 Cardiac Disorders
82/87
What are Raynaud s phenomenon
symptoms and signs?
skin discoloration upon cold exposure
mild tingling and numbness of the involveddigit(s) that will disappear once the color
returns to normal. Ulcerated digits can become infected
Less common areas of the body that can be
affected by RP include the nose, ears, andtongue. While these areas rarely developulcers, they can be associated with a sensationof numbness and pain.
How is Raynaud's phenomenon
-
8/10/2019 NCM 106 Cardiac Disorders
83/87
How is Raynaud s phenomenon
diagnosed?
Physical exam No single blood test to help the doctor to confirm
the diagnosis. The doctor can order certain bloodtests (for example, sedimentation rate,
rheumatoid factor, antinuclear antibody, thyroidhormone levels, and protein levels) to excludeassociated rheumatic diseases and thyroiddisorders.
Certain maneuvers with the patient's extremitiesto exclude pinched blood vessels that canproduce symptoms that mimic RP, such as inthoracic outlet syndrome.
What is the treatment for Raynaud's
-
8/10/2019 NCM 106 Cardiac Disorders
84/87
What is the treatment for Raynaud s
phenomenon?
Management of Raynaud's phenomenon involves protecting thefingers and the toes from cold, trauma, and infection. Avoiding direct and indirect (passive or secondhand smoke) smoking
Medications that can aggravate blood vessel spasm should beavoided
Medications that dilate the blood vessels can be administered.
Calcium antagonists, such as diltiazem (Cardizem, Dilacor), nicardipine(Cardene), nifedipine (Procardia), and other medicines used in bloodpressure treatment, such as methyldopa (Aldomet) and prazosin(Minipress).
Low doses of aspirin or dipyridamole (Persantine)
Some patients with persistent symptoms can benefit by adding amedication called pentoxifylline (Trental), which makes the red bloodcells more pliable and thereby improving circulation.
Sympathectomy is
-
8/10/2019 NCM 106 Cardiac Disorders
85/87
Sympathectomy issometimes considered.In this procedure, toprevent blood-vesselspasm, the nerves thatstimulate theconstriction of thevessels (sympatheticnerves) are surgicallyinterrupted. the tiny
nerves around theblood vessels arestripped away.
-
8/10/2019 NCM 106 Cardiac Disorders
86/87
Tests
-
8/10/2019 NCM 106 Cardiac Disorders
87/87
Tests
Blood Pressure
Hypertension Tests Blood Pressure
Monitors
Heart Tests
Treatment
Embolectomy Thrombolysis
Bypass surgery