Cardiac/Vascular Nurse Exam Secrets Study Guide (30 page)

Complications associated with atrial septal defects include pulmonary hypertension, arrhythmias such as atrial fibrillation, Eisenmenger syndrome, right-sided heart failure, shortened life expectancy, stroke, and heart failure. Patients with larger defects have a higher risk of high blood pressure leading to lung problems and congestive heart failure. If surgery is not performed, patients with these comorbid conditions are at a higher risk for death. Eisenmenger syndrome occurs when pulmonary resistance increases because of prolonged high blood flow from the shunt. Eventually, the shunt reverses and causes cyanosis.

Surgical mortality rate is less than 0.1%. In younger adolescents, surgical closure is effective in preventing complications, with excellent prognosis.

Pulmonary embolism

Complications associated with pulmonary embolism depend on the extent and degree of disease. The most common complications associated with the condition include pulmonary hypertension, cor pulmonale, heart failure, heart attack, and stroke.

Pulmonary embolism can lead to death if left untreated. Approximately 33% of undiagnosed or untreated individuals die of the condition due to complications. Also, reoccurrence of the condition increases with initial diagnosis of the disease. Early treatment of pulmonary embolism decreases the risk of serious side effects and proactive continued monitoring of the condition prevents the reoccurrence of pulmonary embolism.

Patients who develop pulmonary embolism from a deep venous thrombosis may develop permanent leg swelling, discomfort, discoloration, chronic nonhealing ulcerations, and atrophic skin changes.

Deep venous thrombosis

The complications of deep venous thrombosis include pulmonary embolism and postphlebitic syndrome. Blood clots in the thigh have a higher rate of leading to pulmonary embolism than deep venous thrombosis of the lower leg.

The prognosis of deep venous thrombosis is good with early intervention. However, untreated deep venous thrombosis can lead to serious complications such as pulmonary embolism, stroke, heart attack, and sudden death. Also, maintaining regular check-ups, being compliant with pharmacologic agents, using graduated compression stockings, and increasing physical activity, all decrease complications of deep venous thrombosis.

Venous insufficiency

Complications of venous insufficiency include chronic pain, dermatitis, chronic nonhealing ulcers, hemorrhage, recurrent cellulitis, deep and superficial thrombophlebitis, pulmonary embolism, heart attack, stroke and even sudden death. Complications associated with nontreatment of venous insufficiency include recruitment of veins, deep venous thrombosis, pulmonary embolism, venous ulceration, and secondary lymphedema.

Potential complications associated with surgical ablation include infection, peripheral nerve damage, and arterial injury. Adverse events associated with radiofrequency ablation and endovenous laser therapy include skin burns, injury to adjacent tissues, and injury to deep veins. Additionally, side effects associated with sclerotherapy include allergic reaction, cutaneous necrosis, and loss of limb.

The prognosis of venous insufficiency depends on the extent and degree of the condition, presence of other comorbid conditions, and patient’s age and overall general health.

Valvular disease

Most patients diagnosed with valvular disease can live their normal lifespan without any interruption of quality of life or become impacted by symptoms. However, in some patients diagnosed with the condition, the disease progresses over time leading to complications such as congestive heart failure, stroke, blood clot formation, myocardial infarction, and sudden death.

The prognosis of individuals diagnosed with valvular disease depends on the extent and degree of the condition, age of the patient and presence of other comorbid conditions. Pharmacologic management and lifestyle changes may improve a patient’s prognosis and prevent the onset of more serious complications such as congestive heart failure, stroke, blood clot formation, myocardial infarction, and sudden death.

Cardiac vasospasm

Complications associated with cardiac vasospasm include myocardial infarction, arrhythmias, tachycardia, ventricular fibrillation, heart failure, stroke, and sudden death. Complications depend on the degree and extent of cardiac vasospasm, age of patient and presence of other comorbid conditions.

General preventive measures that individuals can take to reduce the risk of cardiac vasospasm and disease complications include avoiding the triggers of vasospasm such as cocaine or stress. Decreasing risk factors for heart disease in general is also beneficial.

Angina pectoris

In most cases, angina pectoris is typically a symptom and dissipates as the underlying condition is treated. It is not a typically a serious condition and most patients will not experience any complications such as myocardial infarction, heart failure, or stroke due to angina pectoris.

Treating underlying causes of angina pectoris decreases the risk of developing complications or other comorbid conditions. However, in more severe cases in individuals with comorbid cardiovascular conditions, patients may experience myocardial infarction and/or arrhythmias. Elderly patients who are in poor health with other comorbid conditions are more likely to experience more-serious complications compared to younger patients who are in good health.

Angina pectoris, especially unstable angina and cases not responding to nitrates, should always be taken seriously.

Atrial fibrillation

Chronic atrial fibrillation leads to complications that include clot formation, thromboembolism, heart failure, and potential for heart attack and stroke. Acute atrial fibrillation can lead to more-serious complications, as the body is unable to handle the severity of the condition.

Nearly half of patients experiencing atrial fibrillation treated with pharmacologic agents including dysrhythmia agents do not experience a reoccurrence at 12 months. However, individuals with underlying comorbid conditions should have those conditions addressed to prevent reoccurrence of atrial fibrillation as well as other comorbid cardiovascular complications. Severe complications, including myocardial infarction, thromboembolism, and stroke occur more often in undiagnosed individuals and those who are noncompliant with treatment.

Arrhythmias

Complications of arrhythmias include stroke, congestive heart failure, and thromboembolism. Severe complications including myocardial infarction, thromboembolism, and stroke occur more often in undiagnosed individuals and those noncompliant with treatment.

Treating the underlying causes of arrhythmias and the arrhythmia itself decreases the risk of developing complications. However, in more severe cases, especially in individuals with comorbid cardiovascular conditions, patients may experience myocardial infarction and/or arrhythmias. Elderly patients who are in poor health with other comorbid conditions are more likely to experience more-serious complications compared to younger patients who are in good health.

Atrial flutter

Typically, atrial flutter is not considered as life threatening as atrial fibrillation. However, complications associated with atrial flutter include stroke, embolization, rate related complications, clot formation, sudden cardiac death, congestive heart failure, severe bradycardia and myocardial rate-related ischemia.

The risk of developing stroke with atrial fibrillation and atrial flutter is approximately 4%. In more severe cases of atrial flutter, especially those with comorbid cardiovascular conditions, patients may experience myocardial infarction or stroke. Elderly patients who are in poor health with other comorbid conditions are more likely to experience more serious complications compared to younger patients who are in good health.

Wolff-Parkinson-White syndrome

Complications of Wolff-Parkinson-White syndrome include hypotension, congestive heart failure, and other comorbid cardiovascular conditions.

The prognosis of patients diagnosed with Wolff-Parkinson-White syndrome varies depending on the degree and extent of disease. However, most patients respond well to lifestyle modifications and pharmacologic management. Also, more invasive approaches such as radiofrequency catheter ablation cure the condition by ablating the extra pathway, which has demonstrated good outcomes. Elderly patients who are in poor health with other comorbid conditions are more likely to experience more-serious complications compared to younger patients who are in good health.

Ventricular fibrillation

Ventricular fibrillation is a very serious condition with severe complications including congestive heart failure and sudden cardiac death. The degree and extent of complications depends on when a patient receives treatment for the condition or if the patient recognizes the symptoms and seeks treatment.

Other complications in patients who survive an acute ventricular fibrillation episode include coma, reduced mental perception, neurological problems, congestive heart failure, central nervous system (CNS) ischemic injury, myocardial injury, post defibrillation arrhythmias, aspiration pneumonia, defibrillation injury, injuries from cardiopulmonary resuscitation, skin burns, stroke, and other cardiovascular conditions.

The prognosis for patients who experience an acute ventricular fibrillation episode depends on the length the patient was in fibrillation. However, for those patients who survive an acute ventricular fibrillation episode, the survival rate averages between 2% to 25% post hospital stay. Patients who seek treatment sooner than later tend to have better outcomes over the longer term. Elderly patients who are in poor health with other comorbid conditions are more likely to experience more serious complications compared to younger patients who are in good health.

Ventricular tachycardia

Complications associated with ventricular tachycardia can be benign or very serious including congestive heart failure and cardiac sudden death. The prognosis of patients with ventricular tachycardia depends on the degree and extent of the condition. Patients who seek treatment sooner than later tend to have better outcomes over the longer term. Elderly patients who are in poor health with other comorbid conditions are more likely to experience more-serious complications compared to younger patients who are in good health.

The mortality rate of ventricular tachycardia in patients with cardiomyopathy and nonsustained disease averages 30% in 2 years. In patients with idiopathic disease, prognosis is excellent. However, patients with long QT syndrome, right ventricular dysplasia, and hypertropic cardiomyopathy are at an increased risk of sudden cardiac death.

Intermittent claudication

The prognosis of individuals diagnosed with intermittent claudication is good because the condition typically stabilizes or improves over time. The condition tends to improve over a few months, when new smaller blood vessels form to make up for the blockage or lack of blood flow to larger blood vessels in the legs.

Typically, approximately 1/3 of patients with intermittent claudication tend to improve over time, while 1/3 remains stable and another 1/3 deteriorate, mainly due to continued smoking. Graduated increased physical activity can improve the condition over time, as regular walks have demonstrated improvement in the condition.

Early intervention with physical activity provides better outcomes and improvements in the condition. Patients who seek treatment sooner than later tend to have better outcomes over the longer term. Elderly patients who are in poor health with other comorbid conditions are more likely to experience more serious complications as compared to younger patients who are in good health.

Hypotension

Complications associated with hypotension or low blood pressure include dizziness, fainting, confusion and in more serious cases, severe heart, endocrine, and/or neurological disorders. Shock is a complication of very severe hypotension, where the brain and other organ systems are deprived of oxygen and vital nutrients.

Most healthy individuals with hypotension can maintain their condition with lifestyle modifications. However, in more severe cases, practicing clinicians will prescribe pharmacologic agents and treat the underlying cause of the condition. Individuals with hypotension including neurally mediated hypotension or orthostatic hypotension need to be careful to avoid fainting and dizziness, which can be dangerous. In very severe cases of hypotension, shock is a life-threatening condition that is fatal if not treated immediately.

Compartment syndrome

Prompt diagnosis and treatment of compartment syndrome results in good outcomes, with recovery of affected nerves and blood vessels of the muscle. However, the prognosis of compartment syndrome is determined by the underlying injury leading to the condition. Delayed diagnosis and treatment can result in permanent nerve damage and loss of muscle function. Other complications include impaired function due to muscle damage, infection, cosmetic deformity, and death and limb amputation.

Increased education in patients at high risk for compartment syndrome improves prognosis and prevents serious complications due to early diagnosis and treatment.

Pulmonary edema

Complications associated with pulmonary edema include leg swelling, abdominal swelling and pleural effusion. If treated promptly, individuals diagnosed with pulmonary edema have a good prognosis. However, individuals who are not promptly diagnosed or treated may have more-serious complications or death.