Heart Desease Definition

The term "heart disease" is often used interchangeably with "cardiovascular disease." Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke. Other heart conditions, such as infections and conditions that affect your heart's muscle, valves or beating rhythm, also are considered forms of heart disease.

Heart disease is a broad term used to describe a range of diseases that affect your heart. The various diseases that fall under the umbrella of heart disease include diseases of your blood vessels, such as coronary artery disease; heart rhythm problems (arrhythmias); heart infections; and heart defects you're born with (congenital heart defects).

Many forms of heart disease can be prevented or treated with healthy lifestyle choices. Coronary artery disease, congestive heart failure, heart attack -- each type of heart problem requires different treatment but may share similar warning signs. It is important to see your doctor so that you can receive a correct diagnosis and prompt treatment.

Learn to recognize the symptoms that may signal heart disease. Call your doctor if you begin to have new symptoms or if they become more frequent or severe.

Symptoms and Prevention of Cardiogenic Shock

Symptoms and Prevention of Cardiogenic shock. Cardiogenic shock is a physiologic state in which inadequate tissue perfusion results from cardiac dysfunction, most often systolic. The most common causes are serious heart complications. Many of these occur during or after a heart attack (myocardial infarction).

Cardiogenic shock most commonly occurs as a complication of acute myocardial infarction (MI). It occurs in 7% of patients with ST-segment elevation MI and 3% with non ST-segment elevation MI. It is a medical emergency requiring immediate resuscitation.

Cardiogenic shock can result from the following types of cardiac dysfunction:
Systolic dysfunctionDiastolic dysfunctionValvular dysfunctionCardiac arrhythmiasCoronary artery diseaseMechanical complications
Symptoms of Cardiogenic shock
Chest pain or pressureComaDecreased urinationFast breathingFast pulseHeavy sweating, moist skinLightheadednessLoss of alertness and ability to concentrateRestlessness, agitation, confusionShortness of breathSkin that feels cool to the touchPale skin color or blotchy skinWeak (thready) pulse
Prevention of Cardiogenic shock

Early coronary revascularisation in patients post-myocardial infarction (MI) and adequate treatment of patients with structural heart disease may help to prevent cardiogenic shock.
Better treatment of acute coronary syndrome seems to be reducing the rates of cardiogenic shock.

Breathing Problem After Cardio

Cardio is any type of exercise that elevates your heart rate and makes you breathe harder. Cardio exercise contributes to heart health and can be part of a healthy weight-loss program. Breathing issues or difficulties after a cardio workout can present a challenge. Learn how to anticipate, prevent and treat breathing issues after cardio to stay safe, healthy and comfortable.

Stress

Rapid breathing and shortness of breath can occur after cardio workouts even if you are in good physical health. Stress and anxiety contribute to a wide range of physical symptoms, including breathing issues. Exercising alone can give you time to think about events in your life, and in general physical activity is an excellent stress buster. When your life is pressure-filled, however, this alone time may not be as peaceful as you would like. If you are suffering from breathing problems after cardio due to heightened stress in your life, think about switching activities. Yoga and tai chi are quieter, more peaceful forms of exercise that can be calming to your body and brain. Engage in a team sport or another hobby with your friends to take your mind off your troubles.

Exercise-Induced Asthma

Exercise-induced asthma is one of the most common reasons that people have breathing issues after completing a cardio workout. Exercise-induced asthma is also referred to as exercise-induced bronchospasm, or EIB. During or after exercise, you may experience symptoms such as wheezing, a tightening in the chest, shortness of breath and coughing. Chest pain may accompany the other symptoms. EIB occurs when your airways become constricted, or narrowed, during exercise. Some people who have EIB also experience asthma attacks at other times, while others only experience asthma symptoms after cardio. Treatment for exercise-induced asthma includes using fast-acting inhalers prescribed by your doctor. You might also be directed to take an asthma maintenance drug to control and prevent symptoms. Exercising on warmer days or covering your nose and mouth with a scarf may control or eliminate symptoms.

Dehydration

Dehydration could cause breathing issues after cardio in children. Dehydration occurs when your body is excreting more liquid than you are taking in. Headache, dry skin and lips and decreased urine output are common signs of dehydration in adults and kids. Children may also experience a faster rate of breathing when they are dehydrated, according to BBC Health. A cardio workout makes you sweat, which means you need to replace those fluids. Drink water or a sports drink before, during and after physical activity to prevent dehydration.

Aging

Breathing issues after cardio could simply be a sign of aging. As you age, your lung function could decrease, according to the National Institutes of Health. This is especially true of older adults who also have heart disease. Lower levels of oxygen in the body can make you less tolerant to exercise, creating breathing difficulties during and after a workout. Keep your lungs healthy by not smoking. Participate in low-impact aerobic exercise as much as you can to stay healthy. Walking and swimming are examples of cardio that may not contribute to breathing issues. In the case of asthma, swimming can strengthen your upper body without triggering breathing symptoms.

Myocardial Infarction In Nursing Plan

Myocardial Infarction In Nursing Plan. Nursing care plan to the patients with Myocardial Infarction. Patients who suffer Myocardial Infarction they have many symptom include chest pain, shortness of breath, nausea, vomiting, palpitations, sweating, and anxiety or a feeling of impending doom. In physical examination to the patient with Myocardial Infarction cases appear some of general symptom like comfortable, or restless and in severe distress with an increased respiratory rate.

The Nurse in medical care to take an action as nursing intervention they will collecting data and priority nursing care plane according to the patients condition. This is some nursing care plan (NCP) for patients with Myocardial Infarction related to patient condition :

1. Nursing care plan for chest discomfort (pain) due to an inbalance Oxygen (O2) demand supply.
- Asses the severity, location & duration of pain (report)
- Administer O2 with semi-fowler's position
- Obtain a 12 lead ECG during pain
- Monitor vital signs
- Administer Nitroglycerine & Narcotic analgesics as ordered
- Administer & Monitor Thrombolytic therapy
- Ensure rest & sleep, provide a comfortable environment
- Monitor patient's response to drug therapy

2. Nursing care plan for potential Arrhythmias related to decrease cardiac output.
- Monitor cardiac rate, rythm & conduction (report any change)
- Observe vital signs, ECG, urine output, skin temp & colour
- Administer prophylactic anti-arrhythmic & other drugs as ordered
- Administer IV fluids
- Promote physical & mental rest & comfort
- Monitor laboratorium result
- Keep anti-dysrhythmic drugs & defibrillator ready

3. Nursing care plan for respiratory difficulties (dyspnoea) due to decrease CO
- Asses for any dyspnoea, abnormal breath sound (report)
- Ensure propped up position, rest & comfort
- Administer O2 & drugs as ordered
- Psycological support, give liquid diet

4. Nursing care plan for anxiety & fear of death
- Encourage patient & family to express fear or anxiety by interest, listening, caring
- Explain the procedures being done on him
- Psycological & spiritual support
- Administer morphine or other anti-anxiety drug

5. Nursing care plan for activity intolerance related to limitations imposed by Myocardial Infarction
- Explain to the patient if he need Bed rest to decrease O2 consumption
- give liquid diet & stool softners to avoid constipation
- help for personal hygienic activity
- Watch for dyspnoea, chest pain during activity
- Administer O2 as needed

6. Nursing care plan for potential for complications of thrombolytic therapy
- Watch for sign & symptom of bleeding, arrhythmias ect
- Fix cannula for IV medication & blood collection
- Protect patient from any injury
- Monitor bleeding time & coagulation profile
- Keep anti-coagulant antidote ready (protamine sulphate ect)
- Monitor vital signs

7. Nursing care plan for discharge medications, follow up & Health teachings
- Explain the name, purpose & side effect of each medicine
- Ask for regular follow up & continuing medications at home
- Teach about management of chest pain at home
- Teach how to take Nitroglycerine
- Explain diet to avoid large meals, rest after meals
- Ask to seak immediate medical aid if chest pain not relieved after taking GTN and rest.

Why Man in His 60's with Very Subtle ECG and Pain not Controlled with Medical Therapy

Why Man in His 60's with Very Subtle ECG and Pain not Controlled with Medical Therapy. A male in his 60's presented 30 minutes after the onset of crushing substernal chest pain.  Medics recorded 2 ECGs, one before and one after sublingual NTG, and both are similar to the first ED ECG.  The patient had never had pain like this before.  The pain improved from 9/10 to 3/10 after NTG.  Here is the initial ED ECG:

QRS axis = 11, T-wave axis = 13.  There are very subtle signs of ischemia here: minimal ST elevation in I and aVL with minimal reciprocal ST depression in lead III.  Most specific is the abnormal ST segment and T-wave in aVF: it is downsloping with a subtly biphasic (down-up) T-wave.   There is also poor R-wave progression in anterior leads, but no ST elevation to suggest acute anterior MI.  This could be, however, evidence of old anterior MI.  Also, the T-waves in V4-V6 are taller than they should be relative to the R-wave amplitude.

This ECG, especially along with the very typical history, was very worrisome, but not absolutely diagnostic of, ischemia.  Several serial ECGs showed no change, even after the pain finally resolved to 0/10 after NTG.

He was given aspirin, clopidogrel, IV nitroglycerine, and heparin, the general cardiologist was called and notified that this patient was very high risk and needed close attention.  He readily agreed, and the plan was to admit for close observation, serial ECGs and troponins, and to scrutinize for any recurrence of pain or change in the ECG.

The first troponin I then returned at 0.063 ng/ml (upper limit of normal = 0.025 ng/ml).  Repeat ECG remained unchanged.

He remained pain free and the plan remained to admit with a diagnosis of Non-STEMI on medical therapy with plan for angiogram in the morning.

Just before admission to the hospital, the patient admitted to recurrent pain and appeared uncomfortable.  Therefore, the cath lab was activated urgently.

The suspicion was for a circumflex (or obtuse marginal branch) or diagonal artery occlusion or subtotal occlusion.

At cath, there was a 95% proximal LAD stenosis, proximal to a large diagonal.  A stent was placed and the patient became pain free.

The ECG the next AM is here:

QRS axis = 50, T-wave axis = 42.  The T-wave inversion in III is resolved, but this may be only due to a change in QRS axis.  In any case, there is minimal T-wave inversion in aVL and the ST elevation is resolved.  The ST depression in III is resolved.  The abnormal ST-T complex in aVF is resolved.

The troponon I peaked at only 1.117 ng/ml.  Echo the next AM showed a new Regional Wall Motion Abnormality of the distal septum, apex, and anterolateral wall with an estimated EF of 55%.  This anterior WMA is probably stunned myocardium that will recover (although the poor R-wave progression is consistent with previous completed infarction of the anterior wall).  This patient was at risk of a very large anterolateral STEMI and loss of large amount of myocardium.

Learning Points

1. Subtle ECG findings led to very rapid evaluation and treatment of this high risk ACS
2. The ECG alone is not an indication for urgent cath.
3. The entire clinical picture was then made more clear by an elevated troponin
4. The indication for urgent cath was uncontrolled ischemia in spite of maximal medical therapy in a patient with objective evidence of ACS as the etiology of the symptoms.

When there is not a STEMI, what are the indications for emergent cath?

The indications are uncontrolled ischemia, with objective evidence of ongoing ischemia.


I.   Objective evidence of ischemia
     1. Ischemic ST elevation; ST elevation known to be due to ischemia though not diagnostic of STEMI.
            a. Not ST elevation due to a normal variant or to LVH or LBBB etc. OR
            b. Dynamic ST elevation
     2. Ischemic ST depression (see the 5 primary patterns of ischemic ST depression)
            a. Not ST depression due to hypokalemia or LVH or LBBB
            b. Dynamic ST depression
     3. Positive troponin (this is a late finding!)
     4. New wall motion abnormality on ultrasound

Ischemic T-wave inversion is not necessarily evidence of ongoing ischemia!  Rather it is often a sign of reperfusion, even if evolving on serial ECGs!

II. Inability to control the ischemia with medical therapy alone (Ongoing ischemia)
     1.  Continued, refractory ischemia on the ECG or
     2.  Continued, refractory symptoms of ischemia (espeically chest pain) or
     3.  Shock, venticular dysrhythmias, pulmonary edema


In cases in which the ECG shows active ischemia, resolution of pain may be very deceptive.  Ischemia can be symptom free.  Studies of patients with known ischemia proven by dynamic ST segments on 12-lead ST segment monitoring show frequent periods of ischemia, including ST elevation and depression, not associated with symptoms.  Thus, if there is known ischemia manifesting on the ECG, these ECG findings of ischemia must resolve along with the symptoms.