Chamberlain Nurse Practitioner Track
NR 507 - Advanced Pathophysiology (2023)
Edapt – Week 2 Cardiovascular Disorders (3 Modules)
Modules: What is Coronary Artery Disease? Heart Failure, and Heart
Valve Disorder
What is Coronary Artery Disease?
Cardiovascular disorders are prevalent in primary care. Many of the
disorders develop over several years, due to the risk factors to which
individuals have been exposed. For each disorder covered in this unit, a
discussion of risk factors will be included. For the concepts covered below,
clinical application of each disease will be provided so that students can
understand the importance of pathophysiology in diagnosing and treating
the disease.
Prerequisite knowledge:
For this content, you should have a basic knowledge of cardiac anatomy;
know the differences between the right and left sides of the heart, in
terms of structure and function. You should also possess solid knowledge
of the unidirectional blood flow through the heart. For example,
deoxygenated blood arrives to the right side of the heart, travels to the
pulmonary arteries to release CO2 and pick up oxygen. At this point, the
oxygenated blood is carried from the lungs through the pulmonary veins
to the left side of the heart where it eventually reaches the aorta to carry
oxygenated blood out to the body organs. The cellular physiology related
to cardiac contraction is another important basic concept to know, as
electrolytes (sodium, potassium and calcium) play a major role in muscle
contraction. Finally, the concepts of preload, afterload, and contractility
are essential to understand, as all of these can be affected in some way
when a person has cardiovascular disease.
Coronary Artery Disease
Which of the following is a modifiable risk factor for Coronary Artery
Disease (CAD)?
Age.
Family history.
Obesity.
Menopause.
,Feedback: Obesity is a modifiable risk factor; the other listed risk factors
are non-modifiable.
Coronary artery disease (CAD) is mainly the result of:
Hypertension.
Hyperlipidemia.
A history of myocardial infarction.
Longstanding atherosclerosis.
Feedback: Atherosclerosis is the major cause of CAD.
Which of the following is a non-modifiable risk factor for Coronary Artery
Disease?
Obesity.
Hyperlipidemia.
Hypertension.
Family history.
Feedback: Family history is a risk factor that cannot be modified. Patients
with hyperlipidemia, obesity and hypertension can improve modify these
risk factors with life-style changes and medications.
Coronary Artery Disease
In Coronary Artery Disease (CAD), pumping ability of the heart can be
impaired due to the deprivation of oxygen.
True
False
Feedback: CAD, myocardial ischemia, and MI form a pathophysiologic
continuum that impairs the pumping ability of the heart by depriving the
heart muscle of blood-borne oxygen and nutrients.
Blood Flow
Which of the following statements correctly describes the flow of blood
between the heart and lungs:
The pulmonary arteries carry oxygenated blood from the lungs to the
heart.
,Oxygenated blood is transported from the lungs to the right atrium of the
heart.
Deoxygenated blood is transported from the left ventricle to the lungs via
the pulmonary arteries.
Oxygenated blood is transported from the lungs to the heart via the
pulmonary veins.
Feedback: The pulmonary veins carry oxygenated blood from the lungs to
the left side of the heart. Pulmonary arteries carry deoxygenated blood
from the heart to the lungs; deoxygenated blood is transported from the
right side of the heart to the lungs; deoxygenated blood is transported
from the right side of the heart, not the left side.
What is Coronary Artery Disease (CAD)?
CAD is considered the leading cause of death in the United States (U.S.). It
is the result of longstanding atherosclerosis. Atherosclerosis begins with
damage to the endothelium. It is the endothelium, under normal
functioning that maintains balance between the vasoconstrictive and
vasodilation actions, prevents platelets from aggregating and control of
the production of fibrin. When the endothelium becomes damaged, our
familiar inflammatory processes occur. Macrophages attach to the
endothelium, setting up phagocytosis; plaque formation and
vasoconstriction also occurs marking the beginning of atherosclerosis. The
plaque lesions located in the vessels become enlarged which allows the
plaque to progress within the enlarged vessel lumen. The plaque lesion
disrupts normal blood flow and causes thrombus formation which can be
triggered by cardiac risk factors such as elevated LDL, cholesterol,
smoking and diabetes. So, why is this a problem? Well, the plaque takes
decades to develop in the coronary arteries. With mild disease, blood flow
can get through the arteries and the patient is asymptomatic. Overtime,
this build up can lead to narrowing which results in decreased oxygen
supply. When atherosclerosis reaches a clinically significant level, the
patient will begin to experience angina. Further progression of the disease
will result in acute coronary syndrome (ACS), formerly known as
myocardial infarction (MI).
The major risk factor for the development of CAD is family history. There is
a 50% higher risk for individuals to develop heart disease if they have a
, first degree relative (especially father) or sibling who has suffered from
ACS or premature cardiac death (< age 55 years). Lifestyle also impacts
risk, especially tobacco use and even secondhand smoke exposure. It is
always important for the NP to stress smoking cessation with all patients
who smoke tobacco, in order to decrease the patient’s risk for CAD.
Sedentary lifestyle will also increase one’s risk for developing CAD.
Physical inactivity can lead to overweight (BMI 25–29.9) or obesity (BMI 30
and above). Male gender, hypertension, Elevated total cholesterol,
elevated low-density lipoprotein (LDL), and/or decreased high-density
lipoprotein (HDL) are also risk factors, as well as diabetes mellitus.
C.G., a 47-year old male presents to the primary care clinic with
complaints of chest pain that occurs when he is working out at the gym.
He describes the pain as substernal chest pressure that radiates to the left
arm.
He indicates that the pain and pressure subside once he is home, has
showered and is resting. He has not had any other associated symptoms
including dyspnea, diaphoresis or nausea and vomiting. He also tells the
NP that his father died of a heart attack at the age of 54 years old. He
does report a previous medical history (PMH) of hypertension (HTN) and
indicates that he has been taking metoprolol (Lopressor) for the last two
years.
He has a 30-pack-year history of smoking. He reports today that he would
like to take measures to stop smoking. He also indicates that he has been
eating a low-fat diet since he started working out 2 months ago.
The NP conducts an exam and the subjective and objective findings reveal
the following:
Vital signs: BP 144/94; HR 84; RR 20; afebrile; Height: 5’9”; Weight: 187 lbs.;
BMI: 27.6
Subjective Objective
Chest pain on exertion Hypertensive
Radiation to the left Overweight
arm
Relieved with rest
PMH: HTN, smoking
Family History:
Premature cardiac
death in father at, age
