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Cardiovascular System Diseases and Disorders 157
can be pulmonary (lung) congestion as a result of
heart failure.
■ Treatment. Treatment of hypertensive heart disease
is related to treating the cause of hypertension. If the
hypertension cannot be cured, as with essential hyper
tension, then controlling blood pressure is necessary.
Hypertensive heart disease, like hypertension, is not
cured, only controlled.
■ Prevention. Preventing hypertensive heart disease is
achieved by preventing or controlling hypertension.
Rheumatic Heart Disease
■ Description. Rheumatic heart disease refers to the
cardiac symptoms related to rheumatic fever. Rheumatic
fever has been discussed in Chapter 5, “Immune System
Diseases and Disorders,” as an autoimmune disorder.
■ Etiology. Recall that rheumatic fever is commonly
caused by a streptococcal throat infection. The immune
system in a select group of individuals builds antibodies
that attack the bacteria and the heart tissue. All layers of the
heart might be affected, along with the valves of the heart.
■ Symptoms. All the symptoms of rheumatic fever
might be present, including joint pain and shortness of
breath. Another symptom is valvular damage leading to
stenosis (narrowing) of the mitral and aortic valves and
then to heart murmurs.
■ Diagnosis. A history of rheumatic fever, along with
a positive tropomyosin (a cardiac antibody) blood test,
is indicative of this disease. A chest X-ray showing an
enlarged heart, lung congestion, and abnormal electro
cardiogram are also positive indicators.
■ Treatment. Treatment is aimed at prevention and the
proper treatment of streptococcal infections. Valvular
stenosis increases the workload of the heart and can
cause further heart disease. During acute carditis, treat
ment includes bed rest, to reduce the workload on the
heart, and other symptomatic treatment. Severe valve
damage can lead to the need for valve surgery to correct
the deformity or replace the valve.
■ Prevention. The best defense is to prevent rheumatic
fever. Rapid diagnosis and proper antibiotic treatment
can often prevent rheumatic fever from developing.
Congestive Heart Failure
■ Description. Congestive heart failure (CHF) is a con
dition in which the heart fails to pump an adequate
amount of blood to meet the body’s needs. The car
diopulmonary and general vascular systems gradually
become congested.
■ Etiology. CHF develops slowly and usually follows
any type of cardiac condition that increases the work
load of the heart. Such diseases include MI, hyperten
sion, CAD, and rheumatic heart disease, to name a few.
■ Symptoms. The individual experiences a gradual
increase in shortness of breath. Tachycardia (tachy =
rapid, cardia = heart) and rapid breathing occur as the
body tries to compensate for decreased blood flow. As
CHF progresses, fluid builds up in the vascular system,
leading to neck vein distention and edema in the ankles
and lower legs. Right-sided heart failure leads to conges
tion of the liver and spleen. Left-sided failure leads to
congestion and edema of the lungs (pulmonary edema;
Figure 8-17).
Complementary and Alternative Therapy
Salidroside Use
in Heart Disease
S
alidroside is an herb known for its use in depression, stress, addiction, and many
nervous system health disorders. It is a glycoside found in the plant Rhodiola rosea,
also known as arctic root or golden root. Although previous studies have shown it is use
ful in some disorders of the nervous system, this study looked at its benefits to the car
diovascular system because of its antioxidant effects. It found some benefit to the use of
salidroside in cardiovascular disease due to its anti-inflammatory, antioxidant, and anti-
apoptotic (inhibiting proteins that assist in cancer cell growth) properties. Additional
research in the area was recommended before its use in clinical situations.
Source: Sun et al. (2020)
158 Chapter 8
Ankle -
edema
Hepatic —
congestion
Abdominal
edema
Pulmonary
edema —
Distended neck veins
Enlarged heart
Lower leg
edema
Spleen
congestion
Figure 8-17 Signs of congestive heart failure.
■ Diagnosis. A history and physical examination,
coupled with the symptoms of shortness of breath and
edema, are enough for a basic diagnosis of CHF. Fur
ther testing includes chest X-ray to show enlargement
of the heart, electrocardiogram to check for irregular
heart rate, and echocardiogram to view valve function.
■ Treatment. Treatment is aimed at decreasing the
workload of the heart. Diuretic medications, low-
salt diet, and fluid restrictions might be prescribed to
increase urine output and limit fluid retention, thus
reducing blood fluid volume. Cardiac medications, such
as digitalis, can be prescribed to strengthen and slow
the heartbeat.
■ Prevention. Adopting preventive lifestyle habits, such
as smoking cessation, weight control, diet modification,
and regular exercise, helps prevent this disease.
Cardiomyopathy
■ Description. Cardiomyopathy (KAR-dee-oh-MY-
OP-ah-thee; cardio = heart, myo = muscle, opathy =
disease) literally is heart muscle disease. It is a deterio
ration of the function of the myocardium. Cardiomyop
athy can be classified as primary or secondary.
■ Etiology. Primary cardiomyopathy is idiopathic, but a
high number of cases are seen in association with alco
holism. Secondary cardiomyopathy is due to a specific
cause often associated with other diseases. There are
three main types of secondary cardiomyopathy: dilated,
hypertrophic, and restrictive.
Dilated cardiomyopathy is the most common form.
The heart is enlarged (dilated), is weak, and does not
pump properly, leading to heart failure. Hypertrophic
cardiomyopathy is inherited and characterized by heart
muscle enlargement (hypertrophy), often causing the
heart valves to leak. The least common type is restrictive
cardiomyopathy, characterized by rigid muscle tissue,
making it difficult for the heart to fill with blood. This
type is usually seen in the elderly.
■ Symptoms. Common symptoms for all types of car
diomyopathy include those associated with heart fail
ure, including weakness, fatigue, shortness of breath,
and swelling of the feet and legs.
■ Diagnosis. Diagnosis of all types of cardiomyopathy
is dependent on history and physical examination along
with electrocardiogram and chest X-ray.
■ Treatment. Cardiomyopathies are incurable and often
lead to CHF, MI, and death. Treatment is based on reliev
ing symptoms and can include diuretic medications,
heart medications, and change of lifestyle behaviors.
■ Prevention. Cardiomyopathy, in most cases, cannot
be prevented. If diagnosed early, treatment can prevent
the disease from worsening.
Carditis
■ Description. Carditis (kar-DYE-tis) is a general term
describing inflammation of the heart. Forms of cardi
tis include pericarditis, myocarditis, and endocarditis,
depending on the area of the heart involved. Pericarditis
affects the serous membrane on the outside of the heart
as well as the pericardial sac. Myocarditis affects the
heart muscle layer, and endocarditis affects the inside
of the heart.
■ Etiology. All these inflammatory states can be due to
unknown causes, bacteria, and viruses or as a result of
rheumatic fever. Carditis is often secondary to a respira
tory tract, urinary tract, or skin infection. It also can be
related to dental infections or diseases of other systems.
■ Symptoms. Symptoms vary, depending on the site
and cause, but a common symptom includes varying
degrees of chest pain.
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Cardiovascular System Diseases and Disorders 159
■ Diagnosis. Diagnosis is often difficult, but a thorough
history and physical examination along with ECG, chest
X-ray, and blood cultures can be helpful.
■ Treatment. Treatment of carditis generally includes
bed rest to decrease the workload on the heart. Other
treatments depend on the cause of the disease and can
include antibiotics, analgesics, and antipyretics (anti =
against, pyro = heat, or against fever).
■ Prevention. Depending on the cause, many cases of
carditis are preventable with accurate diagnosis and
treatment of the cause.
Valvular Heart Disease
■ Description. Valvular heart disease is related to a mal
function of the heart valves. The purpose of a valve in
the heart and the vascular system is to prevent the back
flow of blood. Backflow causes extra workload on the
heart because the heart has to repump the blood.
■ Etiology. Common causes of valvular disease can be
congenital anomalies or malformations, rheumatic fever,
or endocarditis. Malfunction of a valve can be due to the
valvular opening being too narrow (stenotic) or being
too large to close properly (valvular insufficiency). Both
problems can affect all the heart valves and lead to heart
murmurs. A heart murmur is an abnormal sound in the
heart or vascular system. One complication of all valve
defects is the vascular tendency to form clots (thrombi)
on the affected areas. If the thrombus breaks loose and
becomes an embolus, it might occlude arteries leading to
major organs such as the lungs, brain, liver, or kidneys.
Another common problem of valvular heart disease is
CHF due to the increased workload on the heart.
■ Symptoms. Symptoms include chest pain, edema
(swelling) in the ankles, heart palpitations, dizziness,
and weakness. The severity of the symptoms might not
reflect the severity of the disease. In other words, some
individuals have severe symptoms with mild disease,
whereas others with severe disease might have only
mild symptoms.
■ Diagnosis. Physical examination can reveal a mur
mur and lung congestion. Chest X-ray showing an
enlarged heart and an ECG revealing arrhythmias are
indicative of this disease.
■ Treatment. Treatment depends on the cause and
severity of the disease. Minor problems might not
require treatment, but those with serious disease can
be treated successfully with medications. Typical med
ication treatments include antiarrhythmics, antibiotics
to prevent or treat infection, anticoagulants to prevent
blood clot formation, and diuretics to assist in removing
excess fluid.
■ Prevention. Prevention is aimed at controlling heart
disease by not smoking, eating a healthy diet, and daily
exercise. Diseases caused by infection are prevented by
quickly treating any infection. If medications are not
effective, open-heart surgery to repair or replace heart
valves might be performed.
Arrhythmias
■ Diagnosis. Arrhythmias (ah-RITH-me-ahs) are
abnormalities in heart rhythm due to a disturbance in
the conduction system of the heart.
■ Etiology. Often, the cause of these is unknown.
Known causes include medications, ischemia of the
heart muscle, and a previous MI. Auscultation and elec
trocardiography can diagnose arrhythmias.
■ Symptoms. Normal heart rhythm is often called nor
mal sinus rhythm and indicates that the rate is between
60 and 100 beats per minute, is regular, and is originat
ing normally from the SA node. An unusually fast (up
to 350 beats per minute) but regular heart rate is called
flutter. If the rhythm is wild and uncoordinated, it is an
arrhythmia called fibrillation (FIH-brih-LAY-shun).
Fibrillations affect the atria or the ventricles. Atrial
fibrillations are usually not serious in nature. However,
ventricular fibrillations, commonly abbreviated as V fib,
are serious cardiac arrhythmias that require emergency
defibrillation by electrical shock.
Heart block is another group of arrhythmias
caused by an interruption in the conduction system.
Heart block is divided into first, second, and third
degree, depending on the seriousness of the blockage.
Third-degree block is treated by inserting an artificial
pacemaker.
Premature or early contractions can affect the atria
or the ventricles. Premature ventricular contractions
are commonly abbreviated as PVCs.
■ Diagnosis. After physical examination, the first
diagnostic test will usually be an ECG. If this shows
an abnormal rhythm, the next step is often wearing a
Holter monitor, a small portable ECG machine that
performs a continuous monitor strip of the heart. An
exercise stress test can also be useful in diagnosis.
■ Treatment. Treatment is usually unnecessary as long
as the number of beats per minute is minimal and the
individual is otherwise asymptomatic.
160 Chapter 8
■ Prevention. Prevention is aimed at preventing heart
disease in general with healthy lifestyle behaviors and at
quickly treating any known heart disease.
Consider This...4
A new study shows that consumption of the
chemical bisphenol A (BPA), a hormone-
disrupting chemical, leads to a greater risk
of developing heart disease. BPA is found
in canned foods and plastic products. For
this reason, it is recommended to eat fewer
soups and canned vegetables and never
reheat food in plastic containers in the
microwave or eat out of plastic ware.
Diseases of the Veins
Diseases of the veins are more common in older adults.
Age-related changes in the vessels and valves, along
with other changes in the circulatory system, contrib
ute to the overall general weakness of the vessels. Fluid
often pools in the extremities, causing edema. Disorders
of the veins are usually more serious in individuals with
other chronic disorders such as diabetes mellitus.
Phlebitis
■ Description. Phlebitis (fleh-BYE-tis; phlebo = vein,
itis = inflammation) is relatively common, especially
in the veins of the arms and lower legs. Phlebitis com
monly refers to inflammation of superficial (near the
skin surface) veins (Figure 8-18).
■ Etiology. The cause of phlebitis is often unknown, but
known causes can include injury, obesity, poor circulation,
prolonged bed rest, and infection. Injury to a vein is often
a known cause of phlebitis. Intravenous medications and
catheters can cause vein injury in the arms. Pooling of
blood, as occurs with varicose veins or physical injury to
the vessel, might lead to phlebitis in the legs.
■ Symptoms. Symptoms of phlebitis include pain,
swelling, and, often, the appearance of a red cord-like
hardening that extends along the vein from the area of
injury upward toward the heart. Occasionally, phlebitis
in the lower leg of the mother occurs after childbirth
in association with the onset of milk production. This
form of phlebitis is commonly called “milk leg.”
■ Diagnosis. Phlebitis is commonly diagnosed by phys
ical examination of veins in the legs. An ultrasound is
useful to determine the extent of the disease and to look
for clots and blockage of blood flow.
■ Treatment. Treatment of superficial phlebitis often
includes analgesics and warm compresses to reduce
pain and improve circulation. Elevation of the area
above heart level will improve venous return and
decrease edema. To improve venous return in the lower
extremities, the use of elastic or compression stockings
and exercise can be prescribed.
■ Prevention. To prevent phlebitis, participate in mod
erate physical exercise to maintain circulation and mus
cle tone and avoid smoking and sitting for long periods
of time.
Thrombophlebitis
A complication of phlebitis is the development of a
clot in the inflamed vessel, a condition called throm
bophlebitis. Clots in superficial veins rarely embolize
(break loose and travel), but clots in deep veins often
do, making this condition of serious concern in a deep
vein. Thrombophlebitis in the deep veins is called deep
vein thrombosis.
Common locations of
Figure 8-18 Superficial versus deep veins in development of phlebitis and thrombosis.
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Cardiovascular System Diseases and Disorders 161
Deep Vein Thrombosis
■ Description. Deep vein thrombosis (DVT) primarily
occurs in the lower legs, thighs, and pelvis (Figure 8-18).
Clots occurring in the femoral and pelvic veins com
monly embolize.
■ Etiology. Risk factors for DVT include the following:
■ Immobility Early postoperative ambulation
(walking) is encouraged. Prolonged bed rest
greatly increases risk.
■ Dehydration Dehydration increases blood viscos
ity (thickness) and increases the risk of thrombus
formation.
■ Varicose veins Veins already weakened with dis
ease are more likely to develop a thrombus.
■ Leg or pelvic surgery, obesity, and pregnancy These
conditions alter venous blood flow and increase risk.
■ Symptoms. These clots are generally asymptomatic
until embolization occurs, often causing a pulmonary
embolism. Pulmonary embolism is often fatal.
■ Diagnosis. A positive Homan’s test is very commonly
performed as an initial indication of DVT. Homan’s test
is performed by pulling the toes toward the knee; a posi
tive test will cause pain in the posterior calf. If squeezing
the posterior calf also elicits pain, this is indicative of
DVT and is called a Pratt’s sign. Ultrasonography, or
ultrasound imaging of the veins, is the most widely used
test to evaluate the disease.
■ Treatment. Treating DVT is aimed at reducing the
formation of more clots and preventing embolization.
Bed rest with elevation of the affected area is essential
to improve blood flow. Anticoagulants are given to
decrease potential thrombus formation; they will not
dissolve clots, only prevent the formation of new ones.
■ Prevention. Prevention is aimed at healthy life
style behaviors, including maintaining proper body
weight, exercising, and not smoking. Wearing grad
uated elastic compression stockings during times
of prolonged standing or sitting is also a preventive
measure.
Varicose Veins
■ Description. Varicose veins (VAR-ih-kohs VAYNS)
are dilated, tortuous, and elongated veins commonly
found in the legs. Blood in the legs must move upward
against the pull of gravity. Leg muscles are primar
ily responsible for this movement by contracting and
relaxing. This action pushes against the vessel wall and
pushes blood upward. Valves are necessary to prevent
backflow of blood. With varicose veins, the flow of
blood is slowed, blood collects in the veins, or both,
causing increased pressure on the vessel walls and the
valves and eventually leading to incompetent valves
(Figure 8-19). Prolonged pooling of blood in the veins
stretches the vessel wall and leads to the formation of
varicosities.
(A)
Figure 8-19 Varicose veins. (A) Moderate. (B) Extreme.
162 Chapter 8
■ Etiology. Development of varicosities can be due to
any activity that slows return flow and increases venous
pressure. Such activities as prolonged sitting, standing,
pregnancy, and obesity tend to increase the risk of
developing varicose veins. Heredity also plays a part
in this disorder; there appears to be an inherited vessel
wall weakness.
■ Symptoms. Varicose veins develop gradually. Initial
symptoms might include leg fatigue and leg cramps, and
veins often become thick, hardened, and unsightly. Poor
venous blood flow causes edema and congestion of fluid
in the extremities. This congestion slows arterial flow,
leading to stasis dermatitis and ulceration. Stasis derma
titis is characterized by edema, dry and scaly skin, and
small pinpoint hemorrhages. The skin also turns brown
in color as blood pigment accumulates in the connective
tissue. Stasis ulcers do not heal well and can necessitate
amputation of the affected area.
■ Diagnosis. Simply looking at the veins in the legs is
often enough for a simple diagnosis. A Doppler ultra
sound to evaluate blood flow can provide a more defin
itive diagnosis.
■ Treatment. Treatment includes improving vascular
flow by elevating legs, walking, and using support or
elastic hose. Surgery might be indicated to relieve dis
comfort and avoid recurrent thrombosis. Surgical treat
ment involves tying off the vessel and removing it, a
procedure commonly called vein stripping. There are
numerous superficial veins, so blood return to the heart
from this area is through alternate venous routes.
■ Prevention. Wearing compression stockings, regu
larly elevating the legs above heart level, avoiding pro
longed standing or sitting, controlling weight, and not
smoking are activities that help prevent varicose veins.
Trauma
Hemorrhage
■ Description. Hemorrhage (hemo = blood, orrhage =
burst forth) is an abnormal loss of blood. Hemorrhagic
blood loss can be external or internal, and blood loss
can be acute (sudden onset) or chronic.
■ Etiology. Acute blood loss is usually related to
trauma, whereas chronic loss is more often related to
disease processes.
External and internal blood loss, if severe enough,
can lead to exsanguination (loss of circulating blood
volume) and death. Internal blood loss can cause filling
of body cavities such as hemothorax (hemo = blood,
thorax = chest, blood in the chest cavity). Internal
bleeding might not be noticeable until a large amount
of blood has been lost and the individual begins to show
signs and symptoms of shock.
■ Symptoms. Hemorrhage can affect different vessels
and have varying results. Hemorrhage of low-pressure
vessels (the capillaries and veins) into the tissues leads
to reddish to dark purple spots on the skin and mucosa.
These discolorations are called petechiae, ecchymosis,
or purpura, depending on the size or cause of the dis
coloration. Petechiae (pee-TEE-kee-eye) are pinpoint
hemorrhages. Ecchymosis (ECH-ih-MOH-sis) is a
larger area of purplish color commonly called a bruise.
Purpura (PUR-pew-rah) is spontaneous bleeding into
the tissues related to a hemorrhagic disease that might
be characterized by both petechiae and ecchymosis.
Hemorrhage of the high-pressure vessels (the arteries)
leads to forceful squirting of bright red (highly oxygen
ated) blood. The squirting of arterial blood is directly
related to the beat of the heart.
Large venous and arterial hemorrhages, if not con
trolled, can be fatal. Blood volume varies with body
size; the average adult has about 5 liters (approximately
5 quarts) of blood. Adults may lose approximately
500 ml (approximately 1 pint) of blood without any
problems. This amount is equal to the amount given
during a blood donation. Loss of 1 liter of blood, how
ever, can result in hypovolemic shock. Greater losses,
1,500 ml or more, are usually lethal. Hemorrhaging
in a closed cavity also can cause organ damage due to
increased pressure. For example, bleeding in the head
can lead to brain tissue damage or death from the
resulting increase in intracranial pressure.
Chronic hemorrhages, such as those occurring in
the gastrointestinal tract and female reproductive tract,
commonly lead to anemia. Normal menstrual bleeding
is approximately 70 to 80 ml. As discussed in Chapter 7,
“Blood and Blood-Forming Organs Diseases and Dis
orders,” replacement of the lost iron can prevent iron
deficiency anemia.
■ Diagnosis. Hemorrhage is often diagnosed by a com
plete blood count revealing a low hemoglobin count and
hematocrit. Although external hemorrhage is easy to
recognize, determining the location of internal bleeding
is much more difficult. Stool testing can help determine
bleeding in the gastrointestinal tract. A CT scan might
be needed to determine the location of internal sites.
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Cardiovascular System Diseases and Disorders 163
■ Treatment. Treatment is focused on stopping the
bleeding and replacing the blood volume, if needed,
with blood transfusions.
■ Prevention. Although not all hemorrhages can be
prevented, avoiding the causes of hemorrhage will pre
vent many of the occurrences.
Shock
■ Description. Shock can be defined in many ways, but
basically, it is extremely low blood pressure that leads to
decreased tissue perfusion (to pour through or supply
with blood).
■ Etiology. This low blood pressure can be caused by
one of three mechanisms:
■ Not enough blood volume
■ Inadequate pumping of blood by the heart
■ Vasodilatation that allows blood to pool in the ves
sels, thereby reducing circulating blood volume
Remember, the vascular system is composed of
thousands of miles of vessels. If all these vessels were to
open at the same time, the circulating volume of blood
would be zero.
Shock can be caused by a variety of situations. Every
injury brings about some degree of shock and should
be treated appropriately. No matter the cause, shock
leads to inadequate perfusion of tissues with blood.
Inadequate perfusion can cause tissue hypoxia, anoxia,
ischemia, and necrosis as discussed in Chapter 2,
“Mechanisms of Disease.” Types of shock include the
following:
■ Cardiogenic shock The leading cause of death due to
shock. This type of shock results from the inability of
the heart to pump blood adequately, often due to MI.
Treatment can involve CPR and administration of
cardiotonic and vasoconstrictor medications. (Vaso
constrictor medications cause muscle contraction of
vessels, increasing blood pressure.)
■ Septic shock The second-most common cause of
death due to shock. Septic shock usually results from
an overwhelming septicemia (bacteria or microor
ganisms in the blood). Treatment can involve admin
istering antibiotics and vasoconstrictor medications.
■ Hypovolemic shock Results from low fluid volume
and can be due to hemorrhage (often called hemor
rhagic shock), severe burns leading to loss of blood
plasma, severe vomiting, and diarrhea. Treatment
can involve blood transfusions and intravenous fluid
volume replacement.
■ Neurogenic shock Results from generalized vaso
dilatation and can be due to highly emotional sit
uations such as fear, surprise, pain, and unpleasant
sights. Medications and spinal anesthesia also can
lead to neurogenic shock. Treatment can involve
vasoconstrictor medications.
■ Anaphylactic shock Results from severe allergic
reactions and might be due to allergens such as
contrast dyes for diagnostic tests, bee stings, medi
cations, and blood transfusion reaction. Treatment
can involve removing the allergen and administering
antihistamines and bronchodilators.
■ Symptoms. Signs and symptoms of shock vary,
depending on the degree of the situation, and can
include facial pallor, cool and clammy skin, cyanosis,
tachycardia, tachypnea, altered mental status, syncope
(fainting), unconsciousness, oliguria, and anuria.
■ Diagnosis. Diagnosis is most often established
through a thorough medical history and physical exam.
Blood pressure less than 90/50 is recognized as shock.
■ Treatment. Treatment depends on the type of shock.
Other treatment measures include laying the individual
in a supine (on the back) position, keeping the indi
vidual warm and quiet, and elevating the feet and legs
above heart level to improve vascular return.
■ Prevention. Preventing the conditions that cause
shock is the best way to prevent it. Monitoring and man
aging these conditions can prevent the progression of
symptoms and thus prevent shock.
Rare Diseases
Malignant Hypertension
Malignant hypertension is a form of essential hyperten
sion that is considered a medical emergency. Diastolic
blood pressure can reach 130 to 170 mm Hg. Symptoms
include headache, blurred vision, and dyspnea. Without
treatment, malignant hypertension is fatal.
Cor Pulmonale
Cor pulmonale is right-sided heart failure related to
acute or chronic pulmonary disease. Increased pulmo
nary blood pressure causes hypertrophy of the right
ventricle, leading to decreased pumping ability. Poly
cythemia develops as the body tries to compensate for
164 Chapter 8
hypoxemia. This increase in red blood cell number
increases the viscosity of the blood, further increasing
the workload of the heart. Treatment involves treating
the lung disease and can also include phlebotomy to
decrease blood viscosity.
Raynaud’s Disease
Raynaud’s disease is a vasospastic disorder primarily
affecting the fingers and toes. This idiopathic disease
occurs most frequently in young women and is usu
ally related to cold temperature and emotional stress.
During vasospasm, the extremities can turn pale and
then cyanotic before returning to normal color. As the
disease progresses, small ulcers might develop on the
extremities and can lead to contractures and chronic
disability of the hands. Treatment is avoidance of cold
and application of warmth to the extremities. Cigarette
smoking is discouraged because nicotine causes further
vasoconstriction.
Buerger’s Disease
Buerger’s disease is also known as thromboangiitis
(thrombo = clot, angi = vessel, itis = inflammation)
obliterans and is an inflammation of the peripheral
vessels with clot formation. The affected individual
often has pain in the legs and feet that is made worse
with activity and improves with rest. Progression
of the disease leads to muscle atrophy, ulcers, and
gangrene. The primary cause of Buerger’s disease is
cigarette smoking. Treatment involves cessation of
smoking, exercises to improve circulation, and vessel
bypass surgery.
Polyarteritis Nodosa
Polyarteritis nodosa is a vasculitis that is characterized
by inflammatory, necrotizing lesions in many vessels.
This rare autoimmune disease is usually fatal as a result
of occlusion and rupture of the involved vessels.
Effects of Aging on the System
Heart and blood vessel diseases are a significant cause
of death and disability in older adults. As the individ
ual ages, the heart muscle loses some of its contractility,
causing a decreased cardiac output, an increased heart
rate to compensate for the changes, or both. The vessels
lose elasticity and become more rigid and narrowed.
The valves also lose some functioning and become
thick and sclerotic. These changes add to the workload
of the heart by increasing the heart rate and the blood
pressure, and the older adult can become tachycardic
with minimal exercise. Although many of the changes
in the system are due to the normal aging process, other
changes observed in older adults are directly due to
lifestyle. Many individuals have smoked for years, been
overweight, eaten a high-fat diet, endured a stressful job,
and lived a fairly sedentary life. These modifiable behav
iors contribute to the adverse changes in the cardiovas
cular system and increase the risk of chronic and acute
problems in the system over time. Most older adults are
at risk for hypertension, MI, angina, arrhythmias, CHF,
varicosities, and other cardiovascular problems.
With age, the arteries become more rigid, causing
decreased blood flow to organs and distal body tissues.
The vein valves lose some of their competency, reducing
good blood flow even further. Decreased peripheral circu
lation often results in cool or pale extremities, improper
healing, and pooling of fluid (edema) in the legs and feet.
Medications might not be as efficiently transmitted to the
body with these changes in circulation, which can affect
the therapeutic regimen for the individual.
Many older adults have postural hypotension,
which can be a significant safety problem. Postural
hypotension is the decrease or drop in blood pressure
that occurs when the individual rises to a sitting or
standing position from a reclining position. The indi
vidual usually feels very dizzy on rising and might fall.
Prevention strategies should be in place to prevent inju
ries from postural hypotension.
Summary
T
he cardiovascular system is responsible for pumping blood throughout the body, delivering nutrients and oxygen to
cells, and removing waste products. CVD affects millions of Americans. It is a significant cause of mortality, espe
cially in older adults. The risk for developing many diseases of the system can be reduced by lifestyle behavioral changes.
Common symptoms of CVD include pain, fatigue, difficulty breathing, tachycardia, cyanosis, and edema. Some of the
most common disorders of the system include hypertension, CAD, arteriosclerosis, and varicosities. Older adults are at
the greatest risk for developing heart disease, the number one cause of death in the older population.
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Cardiovascular System Diseases and Disorders 165
Review Questions
Multiple Choice
1. Which of the following risk factors for arteriosclerosis are controllable or modifiable? (Select all that apply.)
a. Heredity
b. Diet
c. Age
d. Stress
e. Smoking
f. Exercise
2. Which of the following statements are correct in relation to CAD? (Select all that apply.)
a. It is often called coronary heart disease.
b. Slow, progressive occlusion of arteries often leads to the development of collateral arteries that extend into
ischemic tissue, providing some protection against infarction.
c. It will always lead to an MI.
d. Diagnosis of CAD is made by evaluating the history, ECG, and angiograms.
e. CAD is not usually diagnosed in older adults.
f. The disease is commonly due to atherosclerosis.
Short Answer
3. Define the hemorrhage-related terms petechiae, ecchymosis, and purpura.
4. What are the functions of the cardiovascular system?
5. Which signs and symptoms are associated with common cardiovascular system disorders?
6. Which diagnostic tests are most commonly used to determine the type or cause (or both) of cardiovascular
system disorders?
7. What symptoms are usually seen in CHF?
8. What is the difference between phlebitis and thrombophlebitis?
166 Chapter 8
9. What are the most common signs and symptoms of shock?
10. What are some of the changes that occur in the cardiovascular system with age?
11. What are the definitions of the following terms?
a. Systolic
b. Diastolic
c. EKG
d. Ischemia
Matching
12. Match the term on the left with the correct descriptive text on the right.
_____ Systolic Blood Pressure a. normal is 120
_____ Diastolic Blood Pressure
b. top number on B/P reading
_____ Myocardial Infarction
c. heart ventricles contract
_____ Hypertensive Heart Disease
d. bottom number on B/P reading
_____ Rheumatic Fever
e. highest amount of pressure in the artery
_____ Congestive Heart Failure
f. heart ventricles relax
g. antibiotic
h. streptococcus
i. enlarged heart
j. pulmonary congestion
k. cardiopulmonary congestion
l. ankle edema
m. angina pectoralis
n. CPK
o. streptokinase
p. bull’s-eye
q. normal is 80
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