decreased mobility of the patient with cardiac disease and the impaired
circulation that accompany these disorders contribute to the development of
intracardiac and intravascular thrombosis. Intracardiac thrombus is especially
common in patients with atrial fibrillation, because the atria do not contract
forcefully and blood flow slows through the atrium, increasing thrombus
for-mation. Intracardiac thrombus is detected by an echocardiogram and treated
with anticoagulants, such as heparin and warfarin (Coumadin). A part of the
thrombus may become detached (embolus) and may be carried to the brain,
kidneys, intestines, or lungs. The most common problem is pulmonary embolism.
The symptoms of pulmonary embolism include chest pain, cyanosis, shortness of
breath, rapid respirations, and hemoptysis (bloody sputum).
pulmonary embolus may block the circulation to a part of the lung, producing an
area of pulmonary infarction. Usually, there is a significant decrease in
oxygenation measured by arterial blood gas analysis or pulse oximetry. Pain
experienced is usually pleuritic; it increases with respiration and may subside
when the patient holds the breath. Cardiac pain is usually continuous and does
not vary with respirations. However, it may be difficult to differentiate by
symptoms alone. The patient usually undergoes a ventilation-perfusion scan or a
pulmonary arteriogram for definitive diagnosis.
embolism may manifest as cerebral, mesenteric, or renal infarction; an embolism
can also compromise the blood supply to an extremity The nurse must be aware of
such possible complications and be prepared to identify and report signs and