Cardiac--HTN and AFib Flashcards
increased bp leads too…
increased risk of HF, stroke, renal disease and MI
what factors influence blood pressure
cardiac output
RAAS
local regulation
sympathetic nervous system
neurohormonal
HTN
differentiate primary vs. secondary
risk factors (physical and psychosocial)
persistent SBP >140, diastolic >90
(average of two or more properly measured readings)
primary (no identified cause), 90-95% of cases
secondary (specific cause can be identified and corrected)
risk factors: age, alcohol, smoking, diabetes, obesity, cholesterol, too much sodium, male gender
psychosocial: low socioeconomic status, social isolation, lack of support/stress, negative emotions (activate SNS and stress hormones)
pathophysiology of HTN
genetic links
water and sodium retention (increased sodium leads to water retention which leads to higher blood pressure)
stress (increased sympathetic nervous system activity)
altered RAAS
insulin resistance, hyperinsulinemia
endothelial dysfunction
clinical manifestations of HTN
severe: fatigue dizziness, palpitations, angina, dyspnea, headache,
what organs can be affected with HTN?
Heart: CAD, left ventricular hypertrophy, CHF, PVD,
Kidneys: nephrosclerosis
Eyes: retinal damage
Meds, goals, lifestyle modification
<140/90 mmHg
<130/80 mmhg for those at high risk for CAD
Meds: two main actions include reducing circulating blood volume and reducing systemic vascular resistance (diuretics, adrenergic inhibitors, vasodilators, beta blockers, angiotensin and renin inhibitors)
lifestyle modification: weight reduction, limit alcohol, dietary sodium retention (DASH diet)
Assessment for HTN
objective: older adult: take in both arms, proper size and placement of cuff, inflate cuff high enough so auscultatory gap isn’t a problem (failure to do so can result in serious underestimation of BP)
standing HTN can lead to inadequate cerebral blood flow
avoid giving vasoactive meds with meals
Hypertensive Crisis
SBP > 180 and or DBP >120 mmHg
EMERGENCY
rate more important than actual number
labetalol (Normodyne) and hydralazine (Apresoline)
Labetalol:
Antihypertensive, anti-anginal
Mixed alpha/beta effects
Decreases B/P without reflex tachycardia or significant reduction in HR
Reduces CO, SVR & BP
20 mg IV over 2 minutes
Usually ordered every 6 - 8 hours PRN
Hydralazine:
Direct peripheral artery vasodilator
Reduces B/P with reflex increase in
HR
Stroke volume
Cardiac output
10 – 20 mg IV every 4 to 6 hours PRN
Contraindication CAD
Caution > 40 years old
Atrial fibrillation v. Atrial flutter
paroxysmal or persistent
causes a decrease in cardiac output and an increased risk of stroke
Atrial flutter
sawtooth pattern, r to r’s spaced evenly
medications for atrial fibrillation
warfarin
LONG term anti-coagulation therapy (WHY? because increased risk of ischemic stroke)
Eliquis, Xarelto, Aspirin, Warfarin, etc.
Heparin
MOA: thins blood to help prevent clots
Partial Thromboplastin Time (PTT)
Used to monitor Heparin
Intrinsic system
aPTT: 30 – 40 seconds
PTT 60 – 70 seconds
Therapeutic range = 1.5 – 2.5 times control
Heparin reversal agent
Protamine sulfate 1 mg : 100 units Heparin
Altered very little by small doses of Heparin (5000 units SQ every 12 hours) or Enoxaparin (Lovenox)
Not monitored
Minimal risk of spontaneous bleeding
Warfarin
Warfarin: inhibits activation of vitamin K dependent clotting factors (Wide gap of individual response to dosage, depending on physical and biological factors)
reversal= vitamin K, faster reversal=fresh frozen plasma
LABS with Warfarin: INR/PT
Contraindicated with: aspirin, NSAIDS, Phenytoin (Dilantin) – Use cautiously, Barbiturates, Vitamin, mineral, herbal supplements
Must be closely monitored & titrated
Monthly PT/INR (normal 0.8 to 1.1, therapeutic 2.0 to 3.0)
risks:
Major bleeding 1–2%
Intracranial bleeding 0.1–0.5%
Hepato-cellular liver disease
Obstructive biliary disease
medications for A fib
want rate control
CCB’s–verapamil and diltiazem
beta blockers
digoxin (take apical pulse for one minute, must be greater than 60)
pharmacologic conversion Amiodarone
