cardiac Flashcards
Coronary Artery Disease
Coronary arteries branch from the aorta.
Arteries become CLOGGED d/t atherosclerosis.
problems with the heart
- Electrical (conduction)
- Plumbing (ARTERY BLOCKAGE, spasm, or valve issues)
- Pump (heart muscle)
Non-modifiable Risk Factors
Age- advanced
Family history
Gender- men earlier in life, women after menopause at same risk.
Ethnicity- blacks, African Americans, hispanics, native americans, indigenous people.
Genetics
shared environmental exposure.
Modifiable Risk Factors
HTN
Cigarette smoking- & second hand smoking.
Diabetes
Obesity/Inactivity
Diet
Hyperlipidemia
Depression/Stress
Patho: Ischemic Heart Problems
“a plumbing issue”
Etiology: Atherosclerosis develops in the arteries supplying the myocardium = ARTERY BLOCKAGE.
The blockage causes decreased tissue perfusion.
Is ENDOTHELIAL DYSFUNCTION.
The heart must work harder to pump the blood.
Endothelial Dysfunction
Vessels aren’t necessarily blocked but become narrowed when they are supposed to dilate.
causes of endothelial dysfunction
DM, HTN, HPL, smoking
Angina: main symptom of CAD
May be asymptomatic.
Eventually, as coronary arteries continue to narrow, the decreased blood flow may cause chest pain/ANGINA.
COMPLETE OCCLUSION = myocardial infarction.
stable angina
definition: angina- coronary blood flow is diminished but NOT BLOCKED.
There is an imbalance between oxygen supply and demand.
Is brought on by EXERTION and is relieved with REST.
Usually only last 2-5 minutes.
Most often caused by ATHEROSCLEROSIS.
coronary heart disease symptoms
ANGINA
heartburn
irregular HR
dizziness
nausea
burning sensation
cardiac chest pain symptoms
pressure or tightness
diffuse, poorly localized.
associated w/ physical exertion or other stress.
relieved with rest, usually w/in minutes.
prolonged symptoms may represent an acute coronary syndrome (MI).
non-cardiac chest pain symptoms
sharp or stabbing
focal, well localized.
may be positional, spontaneous at rest.
no predictable relation to physical exertion.
may last from seconds to even days at a time.
Atypical Angina in Women
Discomfort: Hot or burning, Tenderness.
Location: Not always the chest.
Other symptoms: Indigestion, Heart burn, Nausea, Fatigue/weakness, Lightheadedness, Dyspnea.
Angina Pectoris and Pain with Myocardial Infarction
Chest pain not brought on by exertion & may radiate to other areas.
Pain not relieved in 2-5 min.
Often accompanied by N/V, SOA, diaphoresis.
Risk for myocardial infarction increased.
what do we do with stable angina?
EDUCATION: remember rest and relaxation; DECREASING DEMAND.
Nitrates.
Prevent/treat further atherosclerosis.
TEACH ABOUT myocardial infarctions: if pain last more than 5 minutes call 911.
Cardiomyopathy: definition, causes, what it leads too
definition: Disease that affect the myocardium.
Causes: Usually idiopathic, can be caused by ischemia, HTN, inherited disorders, infections, toxins, myocarditis, auto-immune condition.
Leads to heart failure
heart failure is a _ problem
pumping problem (heart muscle)
what is heart failure?
myocardium is weakened.
pump is insufficient to pump blood forward & cant meet the body’s demands.
most common cause of hospitalizations.
Heart failure results in _ cardiac output, _ myocardial contractility, _ preload, _ afterload
decreased
decreased
increased
Increased
Etiology: Major causes of HF
REPEATED ISCHEMIC EPISODES – ischemic cardiomyopathy.
Myocardial infarction ± papillary muscle rupture.
Chronic HTN.
COPD (RVF).
Dysrhythmias.
Valve disorders; mitral insufficiency, aortic stenosis.
Pulmonary Embolus (RVF).
HF –PATHOLOGICAL changes that occur
volume OVERLOAD.
IMPAIRED ventricular filling- when does the heart fill? diastole.
WEAKENED ventricular muscle.
DECREASED ventricular contractile function- when does the heart contract? systole.
risk factors for HF
HTN: Greatest RF, DM can also contribute.
Within 6 months of MI.
Men and postmenopausal women have same risk of CV disease.
Higher incidence in Black/African-Americans.
Genetics
Major Risk Factors for HF
Age: increases with age; most common reason for hospitalization in people age 65 years and older.
Ethnicity: Black/African Americans are at higher risk than Caucasians.
Family history and genetics
Diabetes
Ischemic heart disease
Obesity
HTN
Lifestyle factors: Smoking and sedentary lifestyle.
COPD
Severe anemia
Congenital heart defects
Alcohol abuse/Drug Abuse
Viruses
Kidney conditions: Excess blood volume, edema, HTN, and accumulation of nitrogenous waste, which can weaken the heart.
What symptoms are going to be apparent with left sided HF?
Blood backs up in pulmonary circulation.
Congestion in LEFT chambers.
LV increases in size (LVH).
Back flow into pulmonary veins.
Congestion in LUNGS
Findings: Cough, crackles, wheezes, Frothy sputum, may be blood tinged, Paroxysmal nocturnal dyspnea (PND), Orthopnea.
With right sided HF?
Blood backs up in systemic circulation.
Often due to COPD with cor pulmonale.
Congestion in RIGHT chambers.
RV increases in size (RVH).
Back flow into vena cava, decreased to the lungs.
Congestion in jugular veins, liver, lower extremities.
Findings: JVD, Dependent edema, Weight gain, Hepatosplenomegaly.