NR 507-EDAPT WEEK2-CARDIOVASCULAR DISORDERS
CARDIOVASCULAR DISORDERS
Cardiovascular disorders are prevalent in primary care. Many of the disorders develop over several years, due to the risk factors to
which individuals have been exposed. For each disorder covered in this unit, a discussion of risk factors will be included. For the
concepts covered below, clinical application of each disease will be provided so that students can understand the importance of
pathophysiology in diagnosing and treating the disease.
Prerequisite knowledge:
For this content, you should have a basic knowledge of cardiac anatomy; know the differences between the right and left sides of the
heart, in terms of structure and function. You should also possess solid knowledge of the unidirectional blood flow through the
heart. For example, deoxygenated blood arrives to the right side of the heart, travels to the pulmonary arteries to release CO2 and
pick up oxygen. At this point, the oxygenated blood is carried from the lungs through the pulmonary veins to the left side of the
heart where it eventually reaches the aorta to carry oxygenated blood out to the body organs. The cellular physiology related to
cardiac contraction is another important basic concept to know, as electrolytes (sodium, potassium and calcium) play a major role in
muscle contraction. Finally, the concepts of preload, afterload, and contractility are essential to understand, as all of these can be
affected in some way when a person has cardiovascular disease.
What is Coronary Artery Disease (CAD)?
CAD is considered the leading cause of death in the United States (U.S.). It is the result of longstanding atherosclerosis.
Atherosclerosis begins with damage to the endothelium. It is the endothelium, under normal functioning that maintains balance
between the vasoconstrictive and vasodilation actions, prevents platelets from aggregating and control of the production of fibrin.
When the endothelium becomes damaged, our familiar inflammatory processes occur. Macrophages attach to the endothelium,
setting up phagocytosis; plaque formation and vasoconstriction also occurs marking the beginning of atherosclerosis. The plaque
lesions located in the vessels become enlarged which allows the plaque to progress within the enlarged vessel lumen. The plaque
lesion disrupts normal blood flow and causes thrombus formation which can be triggered by cardiac risk factors such as elevated
LDL, cholesterol, smoking and diabetes. So, why is this a problem? Well, the plaque takes decades to develop in the coronary
arteries. With mild disease, blood flow can get through the arteries and the patient is asymptomatic. Overtime, this build up can lead
to narrowing which results in decreased oxygen supply. When atherosclerosis reaches a clinically significant level, the patient will
begin to experience angina. Further progression of the disease will result in acute coronary syndrome (ACS), formerly known as
myocardial infarction (MI).
The major risk factor for the development of CAD is family history. There is a 50% higher risk for individuals to develop heart disease
if they have a first degree relative (especially father) or sibling who has suffered from ACS or premature cardiac death (< age 55
years). Lifestyle also impacts risk, especially tobacco use and even secondhand smoke exposure. It is always important for the NP to
stress smoking cessation with all patients who smoke tobacco, in order to decrease the patient’s risk for CAD. Sedentary lifestyle will
also increase one’s risk for developing CAD. Physical inactivity can lead to overweight (BMI 25–29.9) or obesity (BMI 30 and above).
Male gender, hypertension, Elevated total cholesterol, elevated low-density lipoprotein (LDL), and/or decreased high-density
lipoprotein (HDL) are also risk factors, as well as diabetes mellitus.
- Family history is a risk factor that cannot be modified. Patients with hyperlipidemia, obesity and hypertension can improve
modify these risk factors with life-style changes and medications.
- The pulmonary veins carry oxygenated blood from the lungs to the left side of the heart. Pulmonary arteries carry
deoxygenated blood from the heart to the lungs; deoxygenated blood is transported from the right side of the heart to the
lungs; deoxygenated blood is transported from the right side of the heart, not the left side
- CAD, myocardial ischemia, and MI form a pathophysiologic continuum that impairs the pumping ability of the heart by
depriving the heart muscle of blood-borne oxygen and nutrients.
PATHOPHYSIOLOGY OF CAD
When plaque develops in the arterial circulation in the heart, it restricts the movement of blood throughout the vessel. The heart
tissue cannot get enough oxygen, especially when the heart requires more, like during exercise or activity. This is called coronary
insufficiency.
This study source was downloaded by 100000868571561 from CourseHero.com on 07-30-2023 20:33:40 GMT -05:00
https://www.coursehero.com/file/147909023/Week-2-Edapt-Cardiovasculardocx/
, CAD SYMPTOMS
When someone has coronary insufficiency, they develop symptoms similar to a heart attack. The only different is that these
symptoms go away when the heart does not require as much oxygen. These symptoms are also called angina, and consist primarily
of chest discomfort and in some people, shortness of breath. Because the heart lacks oxygen, if someone experiences angina while
connected to an electrocardiogram, it shows that the heart is not getting enough oxygen. Therefore, one test to look for Coronary
Artery Disease is an exercise stress test.
Coronary Artery Disease can be managed with medications and other conservative treatments. When it gets worse or happens more
often, patients consider further treatment including Coronary stents and coronary artery bypass surgery.
Environment, lifestyle, and genetics play a role in a coronary artery disease. Those with environmental risk factors are more likely to
have coronary artery disease. Review the risk factors below and select the risk factors specific to coronary artery disease: Tobacco
use, sedentary lifestyle, diabetes, high cholesterol, genetics, age.
Age is a non-modifiable risk factor of Coronary Artery Disease. This along with genetic predispositions. Coronary Artery Disease gets
worse with age, but may start in a person’s 20s or 30s. The development of this condition depends also on whether the patient has
a first degree relative with a family history of Coronary Artery Disease. Knowing these things is important to identifying those at
greatest risk and initiating prevention strategies.
1) Which of the following is a non-modifiable risk factor of coronary artery disease? a.
Family history
2) Which of the following statements correctly describes the flow of blood between the
heart and lungs:
a. The pulmonary veins carry oxygenated blood from the lungs to the left side of the heart
3) In Coronary Artery Disease (CAD), pumping ability of the heart can be impaired due to
the deprivation of oxygen. TRUE
This study source was downloaded by 100000868571561 from CourseHero.com on 07-30-2023 20:33:40 GMT -05:00
https://www.coursehero.com/file/147909023/Week-2-Edapt-Cardiovasculardocx/
CARDIOVASCULAR DISORDERS
Cardiovascular disorders are prevalent in primary care. Many of the disorders develop over several years, due to the risk factors to
which individuals have been exposed. For each disorder covered in this unit, a discussion of risk factors will be included. For the
concepts covered below, clinical application of each disease will be provided so that students can understand the importance of
pathophysiology in diagnosing and treating the disease.
Prerequisite knowledge:
For this content, you should have a basic knowledge of cardiac anatomy; know the differences between the right and left sides of the
heart, in terms of structure and function. You should also possess solid knowledge of the unidirectional blood flow through the
heart. For example, deoxygenated blood arrives to the right side of the heart, travels to the pulmonary arteries to release CO2 and
pick up oxygen. At this point, the oxygenated blood is carried from the lungs through the pulmonary veins to the left side of the
heart where it eventually reaches the aorta to carry oxygenated blood out to the body organs. The cellular physiology related to
cardiac contraction is another important basic concept to know, as electrolytes (sodium, potassium and calcium) play a major role in
muscle contraction. Finally, the concepts of preload, afterload, and contractility are essential to understand, as all of these can be
affected in some way when a person has cardiovascular disease.
What is Coronary Artery Disease (CAD)?
CAD is considered the leading cause of death in the United States (U.S.). It is the result of longstanding atherosclerosis.
Atherosclerosis begins with damage to the endothelium. It is the endothelium, under normal functioning that maintains balance
between the vasoconstrictive and vasodilation actions, prevents platelets from aggregating and control of the production of fibrin.
When the endothelium becomes damaged, our familiar inflammatory processes occur. Macrophages attach to the endothelium,
setting up phagocytosis; plaque formation and vasoconstriction also occurs marking the beginning of atherosclerosis. The plaque
lesions located in the vessels become enlarged which allows the plaque to progress within the enlarged vessel lumen. The plaque
lesion disrupts normal blood flow and causes thrombus formation which can be triggered by cardiac risk factors such as elevated
LDL, cholesterol, smoking and diabetes. So, why is this a problem? Well, the plaque takes decades to develop in the coronary
arteries. With mild disease, blood flow can get through the arteries and the patient is asymptomatic. Overtime, this build up can lead
to narrowing which results in decreased oxygen supply. When atherosclerosis reaches a clinically significant level, the patient will
begin to experience angina. Further progression of the disease will result in acute coronary syndrome (ACS), formerly known as
myocardial infarction (MI).
The major risk factor for the development of CAD is family history. There is a 50% higher risk for individuals to develop heart disease
if they have a first degree relative (especially father) or sibling who has suffered from ACS or premature cardiac death (< age 55
years). Lifestyle also impacts risk, especially tobacco use and even secondhand smoke exposure. It is always important for the NP to
stress smoking cessation with all patients who smoke tobacco, in order to decrease the patient’s risk for CAD. Sedentary lifestyle will
also increase one’s risk for developing CAD. Physical inactivity can lead to overweight (BMI 25–29.9) or obesity (BMI 30 and above).
Male gender, hypertension, Elevated total cholesterol, elevated low-density lipoprotein (LDL), and/or decreased high-density
lipoprotein (HDL) are also risk factors, as well as diabetes mellitus.
- Family history is a risk factor that cannot be modified. Patients with hyperlipidemia, obesity and hypertension can improve
modify these risk factors with life-style changes and medications.
- The pulmonary veins carry oxygenated blood from the lungs to the left side of the heart. Pulmonary arteries carry
deoxygenated blood from the heart to the lungs; deoxygenated blood is transported from the right side of the heart to the
lungs; deoxygenated blood is transported from the right side of the heart, not the left side
- CAD, myocardial ischemia, and MI form a pathophysiologic continuum that impairs the pumping ability of the heart by
depriving the heart muscle of blood-borne oxygen and nutrients.
PATHOPHYSIOLOGY OF CAD
When plaque develops in the arterial circulation in the heart, it restricts the movement of blood throughout the vessel. The heart
tissue cannot get enough oxygen, especially when the heart requires more, like during exercise or activity. This is called coronary
insufficiency.
This study source was downloaded by 100000868571561 from CourseHero.com on 07-30-2023 20:33:40 GMT -05:00
https://www.coursehero.com/file/147909023/Week-2-Edapt-Cardiovasculardocx/
, CAD SYMPTOMS
When someone has coronary insufficiency, they develop symptoms similar to a heart attack. The only different is that these
symptoms go away when the heart does not require as much oxygen. These symptoms are also called angina, and consist primarily
of chest discomfort and in some people, shortness of breath. Because the heart lacks oxygen, if someone experiences angina while
connected to an electrocardiogram, it shows that the heart is not getting enough oxygen. Therefore, one test to look for Coronary
Artery Disease is an exercise stress test.
Coronary Artery Disease can be managed with medications and other conservative treatments. When it gets worse or happens more
often, patients consider further treatment including Coronary stents and coronary artery bypass surgery.
Environment, lifestyle, and genetics play a role in a coronary artery disease. Those with environmental risk factors are more likely to
have coronary artery disease. Review the risk factors below and select the risk factors specific to coronary artery disease: Tobacco
use, sedentary lifestyle, diabetes, high cholesterol, genetics, age.
Age is a non-modifiable risk factor of Coronary Artery Disease. This along with genetic predispositions. Coronary Artery Disease gets
worse with age, but may start in a person’s 20s or 30s. The development of this condition depends also on whether the patient has
a first degree relative with a family history of Coronary Artery Disease. Knowing these things is important to identifying those at
greatest risk and initiating prevention strategies.
1) Which of the following is a non-modifiable risk factor of coronary artery disease? a.
Family history
2) Which of the following statements correctly describes the flow of blood between the
heart and lungs:
a. The pulmonary veins carry oxygenated blood from the lungs to the left side of the heart
3) In Coronary Artery Disease (CAD), pumping ability of the heart can be impaired due to
the deprivation of oxygen. TRUE
This study source was downloaded by 100000868571561 from CourseHero.com on 07-30-2023 20:33:40 GMT -05:00
https://www.coursehero.com/file/147909023/Week-2-Edapt-Cardiovasculardocx/
