Cardiac Management

This article discusses the management of cardiac conditions and the importance of such knowledge to nurses. It covers the different cardiac conditions, their causes, symptoms, and risk factors. The article also explores the concepts of inflammation and oxidative stress in the pathophysiology of cardiac conditions. It provides information on the management plans and evaluation of treatment options for cardiac conditions.

Running head: CARDIAC MANAGEMENT 1
Cardiac Management
Name
Institution

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Cardiac Management
Cardiac conditions describe a range of diseases that can affect the heart’s effective
function. Some of these conditions include angina pectoris, cardiac sarcoma, arrhythmias, heart
attack, heart failure, stroke, atrial fibrillation, peripherial artery diasease and congenital heart
condition. These conditions may sometimes involve the narrowing or blocking of the blood
vessels hence affecting the muscles of the heart or even the valves, arteries or the rhythms of the
heart (Agca et al., 2017). These components are very important for an individual’s overall
health; therefore, it is essential to make changes in lifestyle if diagnosed with any of the cardiac
conditions. The lifestyle changes are also important because they slow down the progression of
the condition. If cardiac conditions are not treated, they may lead to several fatal complications
that may injure an individual’s overall health. Many cardiac conditions require the care of
clinicians as they advise on the correct diagnosis as well as treatment and management plan. This
paper is discussing the management of cardiac conditions and the importance of such knowledge
to me as a nurse.
Cardiac Conditions
The ability of the heart to fail to efficiently work can be caused by different factors
depending on the condition. Some conditions may be caused by abnormally thick heart muscles,
reduced blood flow into the heart, rigid and less elastic heart muscles or even some cancer
treatments. Some conditions may be caused by heart infections due to viruses, bacteria and fungi.
According to Mayo Clinic (2018), congenital heart defects which may be as a result of genes,
medications, and age can also lead to cardiac conditions. It is also important to note if the
exchange of oxygenated and deoxygenated blood does not keep the heart beating in a

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coordinated and normal rhythm so as to keep the blood circulating, heart conditions can be
triggered. Cardiac conditions can also be as a result of valvular heart diseases which can lead to
strenosis, regurgitation or prolapsed. Also, the buildup of cholesterol plaque inside the walls of
the artery can lead to cardiac conditions. This is because the plaque can block the arteries
partially thus decreasing the flow of blood which keeps the heart beating (American Diabetes
Association, 2016). Cardiac conditions can also be caused by unhealthy lifestyle choices like
smoking, excessive drinking of alcohol, lack of exercises, stress, eating unhealthy diet as well as
failing to manage diabetes.
The heart requires adequate supply of blood so as to normally function like other muscles
in the body. Even though the signs and symptoms varies across the different conditions,
individuals should visit a doctor if they experience chest pains, shortness of breath, pain in jaws
and neck, numbness in the legs and arms, irregular heartbeat as well as fainting. Mayo Clinic
(2018) argues that cyanosis, swelling of the legs and arms, fatigue, lightheadedness, dizziness,
fever, unusual rashes and spots, dry or persistent cough are signs of cardiac conditions.
According to Center for Disease Control and Prevention (n.d), the risk factors for
developing heart conditions include age, sex, smoking and family history. As people keep aging,
the risk of their arteries being damaged or narrowed and their muscles being weakened or
thickened increases. It also important to note that men generally are at greater risk of developing
cardiac conditions while women’s chances increase after reaching menopause (Amsterdam et al.,
2014). Also, smoking may damage the inner linings as well as constrict the blood vessels hence
susceptibility to cardiac conditions. However, poor hygiene and diet, high blood pressure, high
cholesterol levels, stress and obesity are also risk factors of cardiac conditions.

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Pathophysiology
Atherosclerosis is the major reason for cardiac conditions. Hypercholesterolaemia,
hypertension and cigarette smoking are the common risk factors for atherosclerosis. These
factors join behind a combination of mechanisms, which includes oxidation and inflammation in
the walls of the artery and with time gives rise to characteristics fatty-fibrous lesions. Physical
trauma and inflammation may cause a lesion rupture, which can prompt clinical occasions, for
example, heart attack and stroke, or resolve with plaque development. The progression of cardiac
conditions is normally set apart by the incendiary pointer CRP (C-responsive protein). Early
pointers of cardiac conditions are the inflammatory marker CD40, and the cardiovascular
myofilament protein troponin. Coronary atherosclerosis is the regular reason for heart failure.
Disordered calcium motioning to the myofilaments happens in heart failure and in
cardiomyopathy. Improved calcium flagging stifles heart failure. Neuro-humoral and
biomechanical forms, as found in hypertension, produce cardiovascular hypertrophy, which
inclines to heart failure through apoptosis. Despite the fact that cardiac conditions risks produces
lasting loss of cells on the grounds that the heart cannot recover, advancements in foundational
microorganism innovation propose that cardiac conditions can be treated or managed.
Concepts Involved
Inflammation
Inflammation is an ordinary reaction to the damage of tissues or pathogen introduction
and is a critical feature in the body's capacity to mend itself or to ward off contamination. The
provocative reaction includes the actuation of leukocytes and is to some extent intervened by a
group of cytokines and chemokines (Dokken, 2008). Despite the fact that inflammation is

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helpful, if this reaction is constantly initiated it can have a hindering impact. Some cardiac
conditions have been viewed as a condition of continuous, inflammation of low-level, and there
is some evidence to propose that this safe enactment may go before insulin opposition in for
instance diabetic and pre-diabetic circumstances and at last might be the cause that at first
increments cardiovascular risks in these procedures. World health Organization (n.d)
recommends cross-talk between the sub-atomic pathways engaged with both aggravation and
insulin flagging, as this may give signs to the solid connection between insulin-safe states, for
instance, the metabolic disorder and type 2 diabetes, inflammation, and CVD. Benjamin et al.
(2017) discovered a diminished creation of the powerful vasodilator NO and an expanded
discharge of the vasoconstrictor and development factor endothelin-1 in subjects with the
metabolic disorder, and these variations from the norm improve vasoconstriction, however are
related with the arrival of professional incendiary cytokines. Proinflammatory cytokines cause
compound damage which includes upgraded vascular penetrability, apoptosis, enlistment of
intrusive leukocytes, and the advancement of responsive oxygen species (ROS) generation.
Zipes, Libby, Bonow, Mann, and Tomaselli, (2018) discovered serum sialic corrosive, a
marker of poor quality inflammation, to be unequivocally prescient of sort 2 diabetes in 128
patients from the of their sample study who were pursued for a mean of 12.8 years.
Notwithstanding anticipating sort 2 diabetes, this marker additionally anticipated cardiovascular
mortality autonomous of other realized hazard factors for CVD, including previous CVD. These
perceptions have driven examiners to presume a typical, obscure antecedent34 and to think about
ceaseless irritation as one possibility for this forerunner.

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Notwithstanding diabetes, weight is related with expanded dimensions of various
adipokines (cytokines discharged from fat tissue), including tumor putrefaction factor-interleukin
1β, interleukin 6, and plasminogen activator inhibitor 1 (PAI-1), all connected to the incendiary
response. The dimensions of these expert provocative cytokines regularly increment as fat mass
increments; in any case, one special case is the adipokine adiponectin, which has calming
properties and is diminished in stout subjects, fueling the interminable fiery nature of stoutness.
in spite of their endocrine properties, these privately delivered cytokines have been found to have
autocrine and paracrine properties that can impact neighboring tissues just as the whole life form.
Oxidative stress
A star flaming cytokines can improve the creation of ROS. ROS alludes to a subset of
atoms known as free radicals. It means any particle that has an unpaired electron in the external
orbital. The unpaired electron leads to the receptiveness of the atom, trying to either give an
electron to a different compound or taking protons from a different compound to acquire a steady
pair of electron. This reaction prompts the development of links between the ROS and different
mixes, modifying the arrangement and capacity of the tissues. In light of the receptive inclination
of these particles, ROS can specifically harm various cell segments, for example, plasma layers
and organelles.
ROS are created by the insusceptible framework as an approach to harm and wreck
pathogens, however they are additionally produced because of day by day living. Ordinary
digestion results in the generation of ROS, which go about as flagging atoms for both the
properties of pathophisiological and the physiological. Oxidative pressure happens when the cell
generation of ROS surpasses the limit of against oxidant barriers inside cells. According to Agca

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et al. (2017), unending oxidative stress in diabetic people and creatures, is linked to the digestion
of overabundance substrates available in the hyperglycemic state, just like the mitochondrial
brokenness linked with insulin resistance. For instance, plasma dimensions of hydroperoxides
are high in people with type 2 diabetes contrasted with nondiabetic people, and these dimensions
are conversely associated with the level of metabolic control.
The mitochondria are the major source of ROS. At the subcellular level, the etiologies of
insulin opposition and diabetes, just as their inconveniences, are profoundly identified with
deformities in mitochondrial function ((Dokken, 2008). The mitochondria produce the vast
majority of the body's required adenosine triphosphate through the procedure of oxidative.
Oxidative phosphorylation is the major source of ROS under typical physiological
conditions.There is two destinations in the mitochondrial electron transport chain that create
ROS, and the expanded motion of glucose in diabetes has been found to build ROS production.
Oxidative pressure is the factor binding together the improvement of diabetes intricacies.
As indicated by Ponikowski et al. (2016), there are four instruments by which perpetual
hyperglycemia causes diabetes confusions: enactment of the polyol pathway; expanded
arrangement of cutting edge glycosylation final results; actuation of protein kinase C, a catalyst
engaged with various atomic flagging pathways; and initiation of the hexsosamine pathway.
Through many years of research, Ponikowski and his partners found that hyperglycemia-incited
mitochondrial ROS creation enacts every one of the four noteworthy pathways of hyperglycemic
harm. Besides, blocking ROS creation or meddling with ROS flagging constricted the movement
of each of the four pathways ((Dokken, 2008). Thus, oxidative pressure is a vitally imperative
idea in the pathophysiology of the cardiac conditions.

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Management Plan
Cardiac conditions are regular in the surgical populace, with up to 50% of postoperative
deaths because of heart occasions. The vast majority of these occasions are ischemic, with some
being intensifications of hidden congestive heart failure. Greutmann and Pieper (2015) argue that
intense preoperative beta-adrenergic barricade can decrease ischemia and ischemic occasions.
Postoperative observing should concentrate on myocardial ischemia, with readiness for fast
treatment utilizing IV treatment. According to Marino et al. (2012), older patients with identified
cardiac condition undergoing major procedures may profit by preoperative treatment guided by
data from a catheter. A postoperative cardiac condition, which displays right on time after
medical procedure, may require forceful administration with diuretics, vasodilators, and
inotropic drugs. Mechanical ventilation should also be considered. At the point when the patient
creates extreme or stubborn dysrhythmias, serum magnesium levels ought to be enhanced and
thought given to IV utilization of amiodarone (Catapano et al., 2016). Postoperative hypertension
is normal and can encourage ischemia, heart failure, and arrhythmias well as lead to bleeding.
More current IV drugs are blood vessel explicit and can bring down blood pressure in a smooth
and unsurprising way. All severe cardiovascular disorders can be accelerated or exacerbated by
inadequate pain control, hypoxemia, and liquid or electrolyte subject.
Evaluation of Management Plans
The management plans may vary depending on the cardiac condition. However, in most
instances, antiplatelets agents may be used. It is recommended that clinicians should Use aspirin
75–150 mg/day for all patients unless contraindicated. Clopidogrel can be used where aspirin is
contraindicated, or with aspirin in patients who have recurrent events or following treatment for

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either fibrinolysis or stenting. ACE inhibitors (ACEI) or Angiotensin II receptor antagonists
(ARA) are also recommended for all patients, especially those at high risk of recurrent events,
unless contraindicated (Higgins et al., 2012). Clinicians should start early post myocardial
infarction (MI) and also consider ARA for patients who develop unacceptable side effects on
ACEI. Beta-blockers are also used to manage cardiac conditions in all patients and should only
be discontinued immediately in case of high risk patients: that is as those patients with either
significant myocardial necrosis, left ventricular systolic dysfunction, persistent evidence of
ischaemia or ventricular arrhythmia (KJain, Mehra, N., & Swarnakar, 2015).. Other medicines
used for the management of cardiac conditions include Short-acting nitrates, Aldosterone
antagonists, Anticoagulants and Statins.
To manage the risk factor of smoking patients, complete cessation and the avoidance of
second hand smoking should be highly encouraged. Physical activity of at least 30 minutes of
moderate-intensity physical activity on most days of the week should be encouraged to help
monitor weight and avoid the plaquing of cholesterols. Also, maintenance of healthy eating
patterns, with saturated fatty acid intake less than 7% and Trans fatty acid intake less than 1% of
total energy intake. 1g of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and 2g
of alpha linolenic acid (ALA) is also recommended daily (Powers et al., 2015). Patients should
also limit salt intake to less or equal to 4g per day. Hospitals should as well provide written
information and an action plan for patients who exhibit warning signs of cardiac conditions to
follow. It is also important to assess all patients for level of social support and provide follow-up
for people considered at risk by referral to cardiac rehabilitation and/or social worker or
psychologist to help avoid depression.
Other management plans for cardiac conditions include implementing a patient-centred

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approach, setting realistic goals and time frames in consultation with the patients as well as
considering strategies to support self-management, assess readiness for change and
explore barriers. This is to ensure that the patient gets the right care (Zamorano et al., 2016).
Clinicians should also provide written information and self-management resources, so as to help
the patients understand their conditions as well as the risk factors associated with them.
Critical Analysis of the Knowledge Gained
In my role as a nurse at my workplace, I have been able to play a vital role in the
education of patients and their families as well as help them adjust to life even after
hospitalization. I have gained knowledge and hands-on experience in structuring studies, creating
hypothesis, theorizing as well as gathering evidence that can lead to improved and better care of
patients. I have learnt that the causes of cardiac conditions whether in children or adults are
basically problems with the respiratory system except for people with congenital heart
conditions. This has led to the discovery that the oxygen saturation in the blood for the people
with congenital heart defects can never be higher than 90% since it does not flow through the
lungs thus an insight which can promote better care as such patients need constant monitoring. I
have also learnt that the equipment used by children and adults are different even though
manufacturers often assume that children are healthy thus the need to develop suitable equipment
for children. I have also learnt on situations where discontinuation of medication can occur to a
patient. Patients with other clinical manifestations of atherosclerotic cardiovascular disease
receive little or no formal preventive and rehabilitative care. I have also learnt that the use of
statins is suitable for the management of lipids.
The knowledge will help me provide the best care available to patients in my workplace.
It will also assist me in promoting an attitude of inquiry when carrying out my duties. Apart from

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that, my knowledge will help me ensure that finite health resources are wisely used and relevant
evidence is considered when making critical decisions.
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