Cardiovascular and Renal Flashcards
Stable Angina
- Triggered by physical activity
- Lasts no more than a few minutes, and subsides with rest.
- Nitroglycerin may be administered sublingually to dilate coronary arteries, permitting adequate blood flow.
Unstable Angina
- Pain occurs with increasing frequency, severity and duration over time: unpredictable
- High risk for MI
Variant angina
- Atypical, occurring without a precipitating cause
- May occur at the same time each day
- Usually caused by an arterial spasm, so hard to control
Myocardial Infarction
-Death of myocardial cells due to prolonged ischemia
-Causes: Sudden onset of ventricular fibrillation, Coronary artery blockage by embolus, thrombus, atherosclerosis or prolonged vasospasm
-Diagnosis and severity of MI:
Size of occlusion and distance from its origin impacts the extent of heart damage (Cardiac enzymes are released from damaged cells, ECG changes-depressed or elevated S-T segment)
-Treatment: early administration of thrombolytic drugs, TPA (tissue plasminogen activator), and streptokinase preferably used within 3 hours of the attack, Angioplasty, Coronary artery bypass surgery (CABG), anticoagulants, aspirin (81 mg), and Coumadin may be used
Congestive Heart Failure
-Congestive heart failure: a progressive condition in which the heart cannot pump enough blood to meet the blood and oxygen needs of other body organs.
-Compensatory Mechanisms: Frank-Starling: increased preload increases contractility, Neuro-endocrine: SNS, renin, angiotensin, ADH, Ventricular hypertrophy: increased workload causes cardiac hypertrophy
-Manifestations: Depend on the extent of cardiac dysfunction, patient age, concurrent medical illnesses, and the extent and rate at which cardiac performance becomes impaired.
-Mild symptoms: ankle swelling,shortness of breath with exertion
-Severe signs and symptoms
shortness of breath at rest,fatigue and limb weakness,neck vein swelling,rales (wet, crackly lung noises),pulmonary edema (fluid in the lungs),Cyanosis,Abnormal heart sounds.
Right Sided Heart Failure
- tends to result in a build-up of blood flowing into the right side of the heart
- This build-up results in edema of the ankles, distention of the neck veins, and enlargement of the spleen because of congestion in the veins that cannot empty properly into the heart.
Left Sided Heart Failure
-leads to a build-up of fluid in the lungs, or pulmonary edema, which causes shortness of breath
Embolus
Mass of clotted blood or other element that circulates in the blood until it lodges in a vessel, obstructing it (travels)
HTN
-Known as the “silent killer” because many clients do not have symptoms
-Primary or essential hypertension (95%): Elevated BP in the absence of other disease,Idiopathic,Typically does not cause symptoms
-Secondary:As a result of another disorder, such as kidney disease or diabetes
-Risk Factors: Advancing age,sedentary lifestyle,excess weight,excessive dietary salt and alcohol consumption, Family history of hypertension, African American ancestry
-Symptoms and Complications: Usually asymptomatic, Causes secondary effects due to long term damage to the kidneys, heart, eyes, and blood vessels.
Complications:stroke, CHF, ventricular hypertrophy, retinal damage, renal failure, aortic dissection, hypertensive crisis
-Treatment: Reduction of blood pressure to less than 140/90 mm Hg and preventing organ damage, For primary hypertension: diet, exercise and medication.For secondary hypertension: treat the underlying cause
Hypovolemic (hemorrhagic) shock
- Etiology: Hemorrhage, trauma, Surgery, extensive burns
- Results from fluid volume loss after severe hemorrhage or loss of plasma in burn patients.
- Treatment includes administration of plasma or whole blood.
Neurogenic shock
- Etiology: Damage to the central nervous system
- Due to generalized vasodilation, resulting from decreased vasomotor tone.
- Reduced blood pressure causes poor venous return to the heart and, hence, poor cardiac output.
- The decreased vasomotor tone may be due to spinal anesthesia, spinal cord injury, or certain drugs.
Anaphylactic shock
- Etiology: Allergic Reaction
- Accompanies a severe antigen-antibody reaction, such as occurs in an incompatible blood transfusion
Cardiogenic shock
- Etiology: Cardiac arrhythmias, Myocardial infarction
- The result of extensive myocardial infarction. It is often fatal, but there are drugs to combat it.
Circulatory Shock
- Early Effects:Anxiety, restlessness, thirst, tachycardia
- Progressive Effects:Lethargy, weakness, cool/moist/pale skin, low BP, tachycardia, weak/thready pulse, tachypnea, oliguria, metabolic acidosis
- Decompensated:Stupor, confusion, arrhythmias, weak/slow pulse, metabolic acidosis, acute respiratory distress syndrome, multiple thrombi, acute liver failure, acute renal failure, paralytic ileus, GI hemorrhage
Coronary Artery Disease
- Narrowing of the coronary arteries resulting in narrowed lumen and decreased blood flow through arteries
- Risk factors:Obesity,Hypertension,Smoking,Sedentary lifestyle,High-cholesterol diet
- Narrowing of the lumen due to atherosclerosis or embolus blocks blood supply.
- Causes ischemia: Short term: angina,Long enough to cause an infarct and lead to tissue necrosis: MI
