cardio diseases Flashcards
the silent killer
HTN
BP formula
BP =SVRxCO
how to be diagnosed with HTN
- persistently high BP/current use of HTN meds
- based on 2 or more BP readings on 2 or more office visits
normal BP range
<120 and <80
elevated (pre-hypertension) range
120-129 and <80
HTN stage 1 range
130-139 or 80-89
HTN stage 2 range
> 140 or >90
primary HTN
AKA: idiopathic, essential
- 90-95% of all cases
- persistently elevated SVR
- usually reversable
how to diagnose white coat HTN
ambulatory BP monitoring
secondary HTN
5-10% of cases
- caused by another medical condition
sources of tyramine
aged food such as wine and cheese
S&S of HTN
freq. asymptomatic
- fatigue
- dizziness
- angina
what to be careful of with tyramine
eating tyramine on a MAO-I can fatally increase BP
target organ complications (5 main ones)
heart: CAD, LVH, HF
brain: TIA, CVA
blood vessels: PVD
kidneys: CKD
eyes: retinopathy
BP considered a HTN crisis
SBP>180
DBP>120
hypertensive urgency
severe HTN but no target organ damage
- develops over hours to days
what is hypertensive emergency and 4 causes of it
severe HTN plus target organ damage
- pre-eclampsia
- not taking meds
- head injuries
- aortic dissections
malignant HTN
- develops quickly, causes organ damage, very hard to control even with meds
- most often seen in middle aged black men
- involves target organ damage including papilledema
3 main complications of HTN crisis
HTN encephalopathy
renal insufficiency
aortic dissection
aortic dissection
tearing and shearing of endothelial lining
- chest pain, reduced pulses
what is metabolic syndrome
group of risk factors that increase a persons chance of developing CV disease, stroke, and DM
3 of what 5 problems are needed for dx of metabolic syndrome
abdominal obesity
high triglycerides
low LDL cholesterol
high BP
high FBS
what is considered abdominal obesity
men: waist greater than 40”
women: waist greater than 35”
high triglycerides = ?
over 150mg/dL or on drug tx
low LDL = ?
men: less than 40
women: less than 50
or on drug tx
“high bp” = ?
SBP greater than or equal to 130
DBP greater than or equal to 85
or on drug tx
*** jumping to 2.25 material and on, here
what is considered a high fasting blood sugar
greater than or equal to 100mg/dL
name for when lipids accumulate and migrate into smooth muscle cells
fatty streak
fibrous plaque
collagen convers the fatty streak
- vessel lumen is narrowed
complicated lesion
- plaque rupture
- thrombus formation
- further narrowing or total occlusion of vessel
collateral circulation
chronic ischemia leading to angiogenesis
CRP indicates? normal range?
indicates weak blood vessels
- normal <0.5mg/dL
goal for LDL level
less than 100 good
less than 70 best
HDL goal range
> 45 good
60 best
fibrinogen good range
200-400mg/dL
two causes of angina
- too much demand
- not enough supply
vessel is at least what % blocked for angina to occur
70%
what causes stable angina
myocardial ischemia in large coronary arteries
what makes stable angina worse
- strong temps
- strong emotions
- smoking
- drinking
S&S of stable angina and tx
pain on exertion lasting from 5-15 mins
- rest, NTG
what causes prinzmetals angina and what probs is it related to
coronary vasospasm
- heavy smokers
- chronic migraines
- raynauds
prinzmetals may occur…?
at rest
tx for prinzmetals
NTG, CCB, and moderate exercise may help to open vessels back up
microvascular angina is from what part of the heart
myocardial ischemia in the small branches of coronary arteries
who usually has microvascular angina
most menopausal women
triggers and tx for microvascular angina
triggered by ADLS
tx: NTG, same as CAD
what is silent ischemia and who does it often occur in
- myocardial ischemia without pain
- diabetics d/t neuropathy
most common way to find out about silent ischemia
EKG changes
unstable angina
rupture of thickened plaque
- part of ACS (heart attack)
- occurs at rest
- NTG does not relieve pain
angina S&S
chest pain (exclusions apply)
tachycardia
anxiety
SOB (main SX for elderly)
syncope
hypotension
S&S in women for angina
fatigue **most prominent
epigastric pain “indigestion”
SOB
throat pain
LFA pain
short acting nitrates
SL NTG tab or spray
- decrease myocardial O2 needs/preload
can you keep NTG in a childproof bottle
no
how often to change bottle of NTG
Q6mo
when is it recommended to take NTG as prophylaxis
before exertion or exercise
sign that the NTG is working
you feel tingling
three long acting nitrates
isosorbide dinitrate
isosorbide mononitrate
NTG paste or patch
what are BB DOC for what kind of angina
long term management, not acute probs
what is a last resort drug to try for angina
ranolazine (ranexa)
what does ranolazine do
prolongs QT interval
what progresses to ACS
CAD
common term for acute coronary syndrome
heart attacks
what is the severity of the ACS based on
amount of blockage and O2 demand
what does unrelieved ischemia lead to
myocardial necrosis
what 3 things are considered ACS
unstable angina
NSTEMI
STEMI
if pt has chest pain….
ALWAYS figure out cause
what is a serial EKG
EKG taken every couple hours to diagnose ACS
sign of ischemia on an EKG
inverted T wave or ST depression (can be there even after an MI is resolved)
sign of injury on an EKG
ST elevation
- looks like fireman’s hat or grave stone-> EMERGENCY
sign of infarction on EKG
ST elevation, T wave inversion, pathologic Q wave
what labs are included in serial cardiac enzymes
troponins
creatine kinase
myoglobin
LDH
levels of troponin
increase in 4-6 hours
peak in 10-12 hours
return to normal in 24-36 hours
levels of creatine kinase
increase in 6 hours
peak in 18 hours
return to normal in 24-36 hours
myoglobin levels
rises within 2 hours
peaks in 3-15 hours
no end time
can be misleading as this is released simply from injured muscles
LDH (late sign)
increases 7-14 days after cardiac event
immediate tx for heart probs
MONA
morphine
Oxygen
NTG
ASA (asprin)
immediate tx for STEMI
emergent PCI within 90 mins
- thrombotics within 30 mins if no cath lab
how many chest tubes does a CABG pt usually have
3
vessels commonly harvested for CABG
saphenous vein is most common
- R or L. internal mammary artery
8 AMI core measures
- ASA at arrival
- ASA for d/c
- ACE-I or ARB for LVSD
(LV EF <40%) - smoking cessation counseling
- BB for d/c
- fibrinolytics within 30 mins if no cath lab
- PCI within 90 mins
- statin for d/c
MONA, Be A Special Friend Please
- morphine
- oxygen
- NTG
- ASA
- BB
- ACE or ARB
- statin/smoking cessation
- fibrinolytics
- PCI
fast five for chest pain
stay with pt
quick cardiac assessment
get help STAT
get VS
apply O2 if needed
3 age related cardiac changes
decreased cardiac output
loss of vessel elasticity
less efficient valves in the veins
