Common cardiovascular disorders

Below are several common cardiovascular disorders, along with their causes, pathophysiology, signs and symptoms, diagnostic test findings, treatments, and nursing interventions.

Cardiovascular disorders: Aneurysm, abdominal aortic

Abdominal aortic aneurysm, an abnormal dilation in the arterial wall, most commonly occurs in the aorta between the renal arteries and iliac branches. More than 50% of patients with untreated abdominal aneurysms 6 cm or larger die within 2 years of diagnosis, primarily from aneurysmal rupture. More than 85% of patients with large aneurysms die within 5 years.

Cardiovascular disorders: What causes it

Aneurysms commonly result from atherosclerosis, which weakens the aortic wall and gradually distends the lumen. Other causes include:

  • fungal infection (mycotic aneurysms) of the aortic arch and descending segments
  • congenital disorders, such as coarctation of the aorta, Marfan syndrome, and collagen vascular disorders
  • trauma
  • syphilis
  • hypertension

Cardiovascular disorders: Pathophysiology

Degenerative changes in the muscular layer of the aorta (tunica media) create a focal weakness, allowing the inner layer (tunica intima) and outer layer (tunica adventitia) to stretch outward. The resulting outward bulge is called an aneurysm. Blood pressure within the aorta progressively weakens the vessel walls and enlarges the aneurysm.

Cardiovascular disorders: What to look for

Signs and symptoms of an aneurysm include:

  • asymptomatic pulsating mass in the periumbilical area
  • possible systolic bruit over the aorta on auscultation
  • possible abdominal tenderness on deep palpation
  • lumbar pain that radiates to the flank and groin (imminent rupture)

If the aneurysm ruptures, look for:

  • severe, tearing abdominal and back pain
  • weakness
  • sweating
  • tachycardia
  • hypotension
  • circulatory collapse

Cardiovascular disorders: Memory jogger

When assessing for signs and symptoms of abdominal aortic aneurysm, remember to jog a few LAPS:

Lumbar pain that radiates to the flank and groin (a sign of imminent rupture)
Abdominal tenderness on deep palpation (possible sign)
Pulsating mass in the periumbilical area
Systolic bruit over the aorta (possible sign)

Cardiovascular disorders: What tests tell you

  • Serial ultrasonography or computed tomography (CT) angiography determines aneurysm size, shape, and location.
  • Anteroposterior and lateral X-rays of the abdomen can detect aortic calcification, which outlines the mass, in at least 75% of patients.
  • Aortography shows the condition of vessels proximal and distal to the aneurysm and the extent of the aneurysm. However, this test may underestimate aneurysm diameter because it shows only the flow channel and not the intraluminal clot or dilated walls.

Cardiovascular disorders: How it’s treated

Usually, abdominal aneurysm requires resection of the aneurysm and replacement of the damaged aortic section with a Dacron graft.

Risky business

Focus Topic: Cardiovascular disorders

Large aneurysms or those that produce symptoms involve a significant risk of rupture and require immediate repair.

If the aneurysm appears small and asymptomatic, the practitioner may delay surgery, opting first to treat the patient’s hypertension and reduce risk factors. Keep in mind, however, that even small aneurysms may rupture. The patient must undergo regular physical examinations and ultrasound checks to detect enlargement, which may indicate imminent rupture.

Endovascular grafting may also be used to repair an abdominal aortic aneurysm. In this minimally invasive procedure, the surgeon will insert a catheter with an attached graft through the femoral or iliac artery and advance it over a guide wire into the aorta, where he’ll position it across the aneurysm. A balloon on the catheter expands, affixing the graft to the vessel wall and excluding the aneurysm.

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Cardiovascular disorders: What to do

  • Be alert for signs of rupture, which is life-threatening. Watch closely for any signs of acute blood loss, such as hypotension, increasing pulse and respiratory rate, cool and clammy skin, restlessness, and decreased sensorium.
  • If rupture occurs, get the patient to surgery immediately.
  • Evaluate the patient. Note whether the patient is free from pain and if he has adequate tissue perfusion with warm, dry skin; adequate pulse and blood pressure; and absence of fatigue. (See Abdominal aortic aneurysm teaching tips.)

Abdominal aortic aneurysm teaching tips

Focus Topic: Cardiovascular disorders

  • Provide psychological support for the patient and his family by providing appropriate explanations and answering all questions.
  • Explain the postoperative period, and let the patient know that he may be monitored in the intensive care unit.
  • Instruct the patient to take all medications as prescribed and to carry a list of current medications in case of an emergency.
  • Tell the patient not to push, pull, or lift heavy objects until medically cleared by the surgeon.

Cardiovascular disorders: Aneurysms, femoral and popliteal

Progressive atherosclerotic changes in the medial layer of the femoral and popliteal arteries may lead to aneurysm. Aneurysmal formations may be fusiform (spindle-shaped) or saccular (pouch-like). Fusiform aneurysms are three times more common than saccularan eurysms.

Femoral and popliteal aneurysms may occur as single or multiple segmental lesions, in many cases affecting both legs, and commonly occur with aneurysms in the abdominal aorta or iliac arteries. This condition occurs most commonly in men over age 50. Elective surgery before complications arise greatly improves prognosis.

Cardiovascular disorders: What causes it

Femoral and popliteal aneurysms can result from:

  • atherosclerosis
  • congenital weakness in the arterial wall (rare)
  • blunt or penetrating trauma
  • bacterial infection.

Cardiovascular disorders: Pathophysiology

An aneurysm is a localized out-pouching or dilation of a weakened arterial wall. This weakness can result from either atherosclerotic plaque formation that erodes the vessel wall or the loss of elastin and collagen in the vessel wall.

Cardiovascular disorders: What to look for

If large enough to compress the medial popliteal nerve and vein, popliteal aneurysms may cause:

  • pain in the popliteal space
  • edema
  • vessel distention and widened pulse
  • possibly symptoms of severe ischemia (in the leg or foot). Signs of a femoral aneurysm include a wide, pulsating mass above or below the inguinal ligament found on palpation.

Cardiovascular disorders: What tests tell you

  • When palpation doesn’t provide a positive identification, duplex ultrasonography, CT angiography, or arteriography may help identify femoral and popliteal aneurysms. These tests may also help detect associated aneurysms, especially those in the abdominal aorta and the iliac arteries.
  • Ultrasound can also help identify aneurysms and may help to determine the size of the popliteal or femoral artery.

Cardiovascular disorders: How it’s treated

Femoral and popliteal aneurysms require surgical bypass and reconstruction of the artery, usually with an autogenous saphenous vein graft replacement or patch arterioplasty. Arterial occlusion that causes severe ischemia and gangrene may require leg amputation if adequate blood flow can’t be restored.

Cardiovascular disorders: What to do

  • Administer prophylactic antibiotics, antihypertensives, or anticoagulants, as ordered.
  • Prepare the patient for surgery.
  • Evaluate the patient. Document whether the patient shows good color and temperature of extremities and if he no longer has pain. Pulses should be present in his extremities. (See Femoral or popliteal aneurysm teaching tips.)

Femoral or popliteal aneurysm teaching tips

Focus Topic: Cardiovascular disorders

  • Explain what an aneurysm is and how it occurs. Provide emotional support and address concerns.
  • Provide preoperative and postoperative teaching. Explain how to care for the incision after surgery and how to recognize complications.
  • Teach the patient how to assess daily for a pulse in the affected extremity.
  • Tell the patient to report recurrence of symptoms immediately.
  • Explain to the patient with popliteal artery resection that swelling may persist. Warn against wearing constrictive clothes.
  • If the patient is receiving anticoagulant therapy, suggest measures to prevent excessive bleeding.
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