Chapter 13: Cardiovascular Alterations

Students learn to interpret cardiac assessment findings through auscultation, including the differentiation of normal heart sounds and the clinical significance of abnormal sounds and murmurs. The chapter then addresses coronary artery disease, exploring how atherosclerotic narrowing of coronary vessels leads to inadequate myocardial perfusion and ischemia. Three distinct presentations of angina are discussed: stable angina triggered by exertion, unstable angina signaling acute coronary risk, and vasospastic or Prinzmetal angina caused by coronary artery constriction. The distinction between acute coronary syndromes classified as STEMI with complete coronary occlusion versus NSTEMI with partial occlusion is critical for determining appropriate reperfusion strategies. Diagnostic confirmation relies on electrocardiographic findings and cardiac biomarkers, particularly troponins. Emergency management emphasizes rapid reperfusion through primary percutaneous coronary intervention or fibrinolytic therapy, supported by antiplatelet and analgesic medications. The chapter covers both percutaneous coronary intervention techniques including angioplasty and stent placement, as well as coronary artery bypass grafting for surgical revascularization. Heart failure pathophysiology is explored through the lens of compensatory neurohumoral activation involving the renin-angiotensin-aldosterone system and sympathetic nervous system, which ultimately leads to maladaptive cardiac remodeling. Classification distinguishes between reduced ejection fraction and preserved ejection fraction phenotypes, each requiring tailored therapeutic approaches. Pharmacological management includes renin-angiotensin system inhibitors and beta-blockers, while severe cases may necessitate mechanical circulatory support devices or extracorporeal membrane oxygenation. The chapter concludes with additional cardiovascular pathologies including dysrhythmias managed through pharmacological, ablative, or device-based interventions; inflammatory conditions such as pericarditis and infectious endocarditis; and aortic alterations encompassing aneurysmal disease and acute dissection requiring urgent surgical intervention.