Cardiac/Vascular Nurse Exam Secrets Study Guide (15 page)

Peripheral aneurysms in the extremities are typically asymptomatic and do not require treatment due to their low risk of rupture. Treatment of peripheral aneurysms depends on the presence of symptoms, the location of the aneurysm, and whether the blood flow through the artery is blocked.

Prevention of aneurysms

Few options are available for the prevention of aneurysms, but individuals should maintain proper blood pressure control, avoid smoking and stimulant drugs, avoid straining, use caution with aspirin use, exercise regularly, and maintain proper cholesterol levels.

Factors that put individuals at higher risk for aneurysms that cannot always be prevented or controlled include family history of aneurysms, hypertension or high cholesterol, natural aging, and diabetes. Secondary types of hypertension that could put an individual at high risk for aneurysms include renal disease, pheochromocytoma, Cushing syndrome, thyroid or pituitary dysfunction, and/or pregnancy.

Pharmaceutical approaches to atherosclerosis treatment

Treatment recommendations for atherosclerosis are based on the size and location of the plaque. Typically, plaques found early can be treated successfully with pharmacologic approaches. Pharmacologic agents are typically used first line to decrease blood viscosity, and reduce the risk of detachment or plaque size.

Pharmacologic agents used for the treatment of the disease include cholesterol-lowering medications such as statins. Antiplatelet medications are also used such as aspirin, ticlopidine, and clopidogrel. In situations where the atherosclerotic plaque is unstable, anticoagulants like heparin and warfarin are used. Concomitant risk factors are also treated including antihypertensives (beta-blockers, calcium channel blockers, angiotensin-converting enzyme [ACE] inhibitors) for hypertension, antidiabetic medications for diabetes, and pharmacological agents for smoking cessation.

Lifestyle modifications and surgical approaches to atherosclerosis treatment

Lifestyle modifications include physical exercise, healthy diet, dietary supplementation, smoking cessation and treatment of comorbid conditions.

However, surgery may be performed if a plaque is large, inhibiting blood flow, and/or at risk for embolizing. Surgery or other procedures are used for individuals that present with more severe symptoms such as end organ dysfunction. Surgical approaches include angioplasty, endarterectomy, thrombolytic therapy, and bypass surgery. These approaches are used to physically expand narrowed arteries or create new additional blood supply connections.

Prevention of atherosclerosis

Preventing the onset of atherosclerotic plaque formation and/or progression of atherosclerosis includes stress reduction, smoking cessation, maintaining a diet low in saturated fats and sodium, physical exercise, as well as maintaining proper body mass index, blood pressure, blood sugar, and cholesterol levels. Patients should also reduce their homocysteine levels.

Patients with multiple risk factors should consult a practicing clinician to reduce prophylactically the risk of developing cardiovascular disease or experiencing heart attack and/or stroke.

Factors that put individuals at higher risk for plaque formation that cannot always be prevented or controlled include family history and natural aging.

Treatment and prevention of Buerger’s disease

The main treatment for patients with Buerger’s disease is smoking cessation, which will halt progression of the disease. Individuals who continue to smoke with Buerger’s disease will likely have their digits amputated. Patients who need help to quit smoking should consult with their practicing clinician for alternatives like nicotine gum or patches.

Other options for the treatment of Buerger’s disease include anticoagulation agents or antiplatelet agents to improve blood flow, surgery to cut nerves in infected painful areas, as well as digit amputation due to extensive infection or gangrene. Experimental therapies with prostaglandins and thrombolytics have been used experimentally with some success.

Patients with Buerger’s disease should dress any cuts or scrapes in the affected areas to prevent infection. Any cuts or scrapes that do not heal properly or in a timely manner should be addressed by a clinical practitioner.

The cause of Buerger’s disease remains unclear, but has been strongly linked to cigarette smoking and tobacco use. Therefore, smoking cessation is essential to preventing the onset and progression of the disease. Overall, the underlying mechanism of Buerger’s disease is immunologic, but remains unknown.

Buerger’s disease is typically not life threatening, but the death rate is higher in patients that continue to smoke and due to other comorbid conditions such as emphysema or cancer. The disease is associated with amputation in up to 36% of patients. Major amputations are nearly twice as common in patients who continue to smoke.

Treatment and prevention of Raynaud’s phenomenon

Treatment of Raynaud’s phenomenon involves self-care for patients with mild forms of the phenomenon including keeping hands and feet warm and avoiding trauma to digits. However, in more moderate to severe cases, pharmacologic management to reduce degree and extent of condition as well as to prevent tissue damage and treat any underlying causes of the condition can be used.

Pharmacologic agents used in the treatment of Raynaud’s phenomenon include calcium channel blockers to dilate blood vessels, alpha-blockers to counteract the constriction of blood vessels as well as vasodilators to dilate and relax blood vessels.

Patients diagnosed with Raynaud’s phenomenon should avoid over the counter agents such as cold remedies that contain pseudoephedrine, beta-blockers, and oral contraceptives due to impact on blood circulation. They should also avoid stress and occupational hazards, such as tools that vibrate the hands.

Other options for patients with severe primary or secondary Raynaud’s phenomenon include nerve surgery to reduce frequency and duration of symptoms, chemical injection to block sympathetic nerves affected and/or amputation due to the development of infection or gangrene.

Patients diagnosed with the condition should dress warmly in cold climates, take precautions outdoors, and consider moving to a warmer climate.

Self-care approaches that can reduce the degree and frequency of Raynaud’s phenomenon include smoking cessation, physical activity, stress management, avoidance of vasoconstrictors such as caffeine, maintain hands and feet carefully avoid stress triggers and occupational hazards.

In order to avoid complications, individuals having a Raynaud’s attack should move to a warmer area, wiggle fingers and toes to stimulate blood circulation, place hands/feet behind knee caps, under armpits, under warm water and/or massage hands and feet. Also, relaxation techniques such as cognitive behavior therapy, biofeedback, breathing techniques or meditation may also improve Raynaud’s symptoms when stress triggers the attack.

Cardiomyopathy treatment and prevention

Treatment of cardiomyopathy depends on the type, extent, and degree of disease. Patients with mild disease may only require lifestyle modifications and short-term pharmacologic treatment, whereas patients with more moderate-severe disease may require pharmacologic management and/or surgery. Lifestyle modifications include smoking cessation, diet low in saturated fats and sodium, physical activity, alcohol and drug cessation, weight loss in overweight individuals, resting, reducing stress, and treating underlying comorbidities such as diabetes and high blood pressure. The goals of cardiomyopathy management include treatment of comorbid conditions such as diabetes and congestive heart failure, control symptoms, prevent disease progression, and reduce associated risks and complications. Pharmacologic agents used for the treatment of cardiomyopathy include diuretics, ACE inhibitors, beta-blockers, calcium channel blockers, anticoagulants, antiarrhythmia agents, antibiotics and corticosteroids. Surgical approaches include septal myectomy, surgically implanted devices such as left ventricular devices or implantable cardioverter defibrillators and heart transplant. Another nonsurgical approach used by clinical practitioners is alcohol septal ablation, which uses ethanol to shrink thickened tissue in the myocardium.

Dilated cardiomyopathies can be treated with a combination of pharmacologic agents and/or surgical approaches. Pharmacologic agents used for treatment of this condition include angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers, and beta-blockers. For more serious cases of dilated cardiomyopathies, implantable cardioverter defibrillators (ICDs) or pacemakers may be implanted to coordinate the contractions between the left and right ventricles and reduce the chance of sudden cardiac death.

Hypertrophic cardiomyopathy can also be treated with a combination of pharmacologic agents and/or surgical approaches. Pharmacologic agents include beta-blockers and calcium channel blockers. Other surgical options include implantation of ICDs or pacemakers and septal myectomy. Alcohol ablation is another option for patients not candidates for surgery.

Restrictive cardiomyopathy treatment involves symptom management. Self-care is recommended in which patients monitor sodium and water intake. Pharmacologic agents may also be recommended including diuretics, antihypertensive agents, and antiarrhythmia agents.

Cardiomyopathy can be prevented by managing comorbidities and environmental factors. Although patients with familial cardiomyopathy cannot prevent onset of disease, they can reduce extent and degree of disease through self-care and proper disease management. In order to prevent onset of cardiomyopathy and decrease disease progression, individuals should avoid alcohol and drug consumption, avoid smoking, maintain proper blood pressure, eat diet low in saturated fats and sodium and maintain an active lifestyle.

Patients should also undergo regular examinations by their clinical practitioner, follow practitioner’s advice regarding cardiomyopathy management and adhere to pharmacologic treatment regimens.

Congestive heart failure treatment and prevention

Treatment of congestive heart failure depends on the extent and degree of disease. Patients with mild disease may only require lifestyle modifications and short-term pharmacologic treatment, whereas patients with more moderate-severe disease may require pharmacologic management and/or surgery. Lifestyle modifications include smoking cessation, diet low in saturated fats and sodium, reduced fluid intake, physical activity depending on patient’s health, alcohol and drug cessation, weight loss in overweight individuals, resting, reducing stress, treating underlying comorbidities such as diabetes and high blood pressure.

The goals of treatment include controlling excess fluid accumulation, improving cardiac function and reducing cardiac workload.

Treatment guidelines recommend that patients with congestive heart failure should not intake more than 2000 mg of sodium per day. Patients need to aggressively monitor their body weight, as rapid weight gain could be due to fluid accumulation. Therefore, if patients experience weight gain of more than 2 to 3 lbs over 2 to 3 days, they should contact their clinical practitioner immediately.

Pharmacologic agents used for the treatment of congestive heart failure include diuretics, ACE inhibitors, digoxin, beta-blockers, calcium channel blockers, anticoagulants, antiarrhythmia agents, antibiotics, and corticosteroids.

Surgical approaches include coronary artery surgery or catheter procedures, such as angioplasty or intracoronary stenting, to restore blood flow. Other options include heart transplantation, left ventricular assist devices, and pacemakers.

Congestive heart failure can be prevented by managing comorbidities and environmental factors. Although patients with familial congestive heart failure cannot prevent onset of disease, they can reduce extent and degree of disease through self-care and proper disease management.

In order to prevent onset of congestive heart failure or decrease disease progression, individuals should avoid alcohol and drug consumption, avoid smoking, maintain proper blood pressure, eat a diet low in saturated fats and sodium, reduce fluid intake, treat other comorbidities and maintain an active lifestyle.

Patients should also undergo regular examinations by their clinical practitioner, follow the practitioner’s advice regarding congestive heart failure management, and adhere to pharmacologic treatment regimens.

Teatment and prevention of cor pulmonale

Current treatments reduce symptoms and complications of disease, which are geared toward addressing the underlying cause of the disease. The type of treatment depends on whether cor pulmonale occurs acutely or evolves chronically.

The use of pharmaceutical agents such as vasodilators (nifedipine and other calcium channel blockers), diuretics (furosemide), anticoagulants (warfarin), cardiac glycosides (digoxin), methylxanthines (theophylline), and endothelin receptor antagonists (bosentan) can be used for treatment of Cor Pulmonale.

In some patients, the disease can progress rapidly, while in others the disease can become chronically maintained. Surgery is an option for advanced cases where heart defects are the source of failure. Also, in more severe cases, heart and/or lung transplantation may be recommended.

Supplemental oxygen may also be prescribed to increase blood oxygen levels.

Prevention of cor pulmonale includes avoidance of environmental factors that can lead to chronic pulmonary hypertension such as cigarette smoking, tobacco use, and inhalation of toxic fumes, chemicals and/or smoke. A pulmonary specialist should monitor patients with cardiopulmonary disease in order to prevent the onset of cor pulmonale. Adolescents with serious heart murmurs caused by various cardiac defects should be monitored and treated throughout their lifespan in order to prevent onset of cor pulmonale.