Cardiovascular Disease Flashcards
What is secondary prevention?
healthcare designed to prevent the recurrence of cardiovascular evens (heart attack, stroke) in patients diagnosed with CVD
Flow of blood?
IVC/SVC -> RA –> RV –> Pulmonary Valve –> Pulmonary Artery –> Pulmonary Veins –> LA –> LV –> Aorta
Deoxygenated blood enters the ____ and leaves through the _____
- Superior and Inferior VC, into the right atrium
- Pulmonary atery
Blood in the right atrium will flow through the ___ into the RV
Tricuspid valve
Oxygenated blood will enter through the ___
Pulmonary veins into the LA
Blood from the LA will flow through the ___ into the LV
Mitral/Bicuspid valve
Blood will flow from LV through the ___ to the Aorta and the rest of the body
Aortic valve
Mean arterial pressure?
The resistance against which the ventricles must contracts
What is resistance dependent on? (3)
- radius of arterioles
- length of vessels
- blood viscosity
Arterial BP?
Regulated by the sympathetic nervous system, the RAAS system and renal function
In Vasodilation ____
less resistance, less pressure
In vasoconstriction ____
increased resistance, more pressure
When does the FRS stop classifying risks?
After 80 y/o
Why don’t we intervene as much in the elderly?
- Focus on quality of life
- Interactions with medications may be worse than the condition itself
- benefit vs risk assessment
There is a ____ in elderly with chronic disease or living in LTC facilities or assisted-living residences
high risk of malnutrition
When do women have decreased CVD risk? Increased? Why?
- decrease prior to menopause, then increases after menopause
- due to decline in estrogen
Explain the protective effects of estrogen
Postitive effect on the inner layer of artery wall, helping to keep blood vessels flexible
Is hormone replacement therapy beneficial for the prevention of CVD?
NO
What is the average age of menopause?
51-54 years old
What induces menopause at younger age?
Hysterectomy
What are some effects on CVD risk in menopause?
- BP increase
- LDL increases
- HDL declines or remains the same
- TGs increase
What angina?
Chest pain that is a warning of heart disease - occurs when the heart does not get as much oxygen as it needs.
What are 2 types of angina?
Stable and non-stable
What is stable angina?
Reversible, and occurs with increased demand on the heart, plaque is stable
Unstable angina?
May be associated with a heart attack, plaque is unstable
___ of people aged 65 or older with diabetes die from some form of heart disease, where ___ die of stroke
68%
16%
Adults with diabetes are ___ more likely to die from heart disease than adults without diabetes
2-4 times
What is an echocadiogram?
Electrodes are attached the patients chest, and essentially is an ultrasound scan of the heart tat shows structure and function of heart. Shows info such as heart pumping and chamber sizes
what is an electrocardiogram?
Patient will have electrodes attached to upper chest, arms and legs, connect to machine and heart rhythm is recorded on a machine to produce EKG - detect for normal heart rhythms.
What is a stress test?
Used to determine the effects of exercise on the heart, and detect arrhythmias and diagnose the presence or absence of coronary artery disease
How does a stress test work?
Walking on treadmill, and monitoring electrical activity of heart (EKG), blood pressure will also be monitored.
Which test is more valuable in diagnosing heart failure or heart valve function?
Echo
Which test is emergent in patients with chest pain and heat attacks?
EKG
What would be used to detect tachycardia, bradycardia, atrial fibrillation ?
EKG
What typically comes first, EKG or echo?
Typically EKG, then echo may be ordered to evaluate underlying structural or functional disorders that may be the cause of the rhythm.
What is cardiac catherization?
Passing a catheter via arm, groin or neck to open blocked artery, could also aid in visualization, angiogram
What is an angiogram?
X-ray test that uses dye and camera to take photos of blood flow within an artery, or vein.
What is another name for angioplasty?
PTCA (Percutaneous transluminal coronary angioplasty)
What is angioplasty/PTCA?
“Ballon” - where a deflated ballon is attached to a catheter and is guided into a narrowed vessel, will inflate and then relieve the blockage. A stent (more permanent) may be inserted afterwards.
What may a catheter be used to insert?
A stent or a ballon (usually ballon first)
What does CABG stand for?
Coronary Artery Bypass Graft
What is CABG?
A blood vessel is removed from somewhere else in the body and is grafter to coronary arteries as to bypass the narrowed coronary artery
What is the purpose of CABG?
To improve blood flow in the coronary arteries and reduce the risk of death from CAD
When is CABG used?
When the narrowing or blockage is severe or when several vessels affected
Can CABG have more than on bypass at a time?
Yes
What is another name for a MI?
Heart attack
What is a heart attack?
When blood flow to a section of the heart becomes blocked, not enough oxygen to heart.
What happens if blood flow is not restored quickly enough?
Heart muscle may begin to diet, and damage can be mild, severe or cause lifelong problems or death
What are the 5 common warning signs of a heart attack?
- Pain or discomfort ion chest
- Lightheadedness, nausea, vomiting
- Jaw, neck or back pain
- Discomfort in arm/shoulder
- SOB
What is STEMI?
ST -segment elevation myocardial infarction - more severe
Why is STEMI more severe?
Coronary artery is completely blocked off, and all heart muscle being supplied by the affected artery starts to die
What does an elevated ST segment of the EKG indicate?
STEMI - relatively large amount of heart muscle damage is occurring is occurring
What is the ST wave?
On EKG - between ventricular depolarization and depolarization (contraction and relaxing)
What is non-STEMI?
Less severe, where the blood clot occludes the coronary artery and only portion of the heart muscle being supplied by affected artery will begin to die
Which MI produces an elevated ST wave?
STEMI
What 3 biomarkers are used to diagnose an MI ? (TLC)
Troponin
Lactate dehydrogenase
Creatine Kinase
What is the most sensitive and specific test for myocardial damage?
Troponin
Why is troponin most specific/sensitive?
Increased specificity when compared to creatinine kinase, a superior marker of MI
When is creatinine kinase (CK-MB) test relatively specific?
When skeletal muscle damage not present
Lactate dehydrogenase is more specific than troponin (T/F)
F
When does troponin peak?
12 hours
When does CK-MB peak?
10-24 hours
When does LDH peak?
72 hours
What are the 5 ways to lower risk of second heart attack?
- Take medications
- Follow-up with doctors
- Participate in Cardiac Rehab
- Manage risk factors
- Get support
What diet may be recommended for prevention and for those who have suffered and MI?
Mediterranean diet
What what the key point in the Primary Prevention of CVD with a Med diet supplemented EVOO or nuts?
When compared to control, incidence of CVD for those consuming Med diet with EVOO or nuts say ~20% decrease in CVD over 5 years
What are some recommended foods on the med diet?
- Olive oil
- Tree nuts and peanuts
- Fresh fruits
- Veg
- Fish (fatty fish, seafood0
- Legumes
- White meat
- Sofrito
- Wine if drinker
What is discourage on med diet?
- Soda
- Commercial bakery goods
- Red and processed meats
Canada’s Food Guide is secondary prevention (T/F)
False - Primary prevention
What are some signs and symptoms of stroke?
- Weakness
- Trouble speaking
- Vision problems
- Headache
- Dizziness
What is the acronym to lear the signs of a stroke?
FAST
What does FAST stand for?
Face –> Is it drooping?
Arms –> Can you raise both?
Speech –> Is it slurred or jumbled?
Time –> to call 911 right away
What is Atrial Fibrillation?
Irregular heartbeat, which can disrupt the flow of blood through the heart
What is treatment of AF directed towards ?
- Heat rate control
- Anti-coagulation based on clients symptoms and risk factors
What are the nutritional implication and nutrition intervention of AF?
- Vit K intake consistent
- Other nutrients that affect clotting or vitamin absorption should be consistent
Disability occurs in ___ of stroke survivors
75%
What changes can occur after a stroke?
- Physical
- Mental
- Emotional
What does the severity of a stroke depend ont?
Size and location in the brain and the damage
What physical disabilities can be caused by stroke?
- Muscle weakness
- Numbness
- Appetite loss
- Speech loss
- Vision loss
- Paralysis
What ares some emotional problems cause by stroke?
- Anxiety
- Mood swings
30-50% of stroke survivors suffer from what?
post-stoke depression
What are some cognitive deficits that occur after a stroke?
Problems with attention and memory
If there is right-sided weakness, which side would the brain lesion be on?
Left side
What does stroke nutrition therapy consist of ?
Low in sodium, high in fruits, veg, whole-grains and free or low-fat dairy products (help keep BP under control)
What are some other considerations in stroke nutrition therapy?
- Eat heart healthy foods
- Attain a healthy weight
What is the recommendation of fibre for stroke patients?
20-30 g of fibre/day
- 2 cups fruit
- 3 cup vegetables
- 3 oz. whole grains
What should always be recommended when increasing fibre intake?
Increase water intake
What are other dietary recommendations for stroke?
- Eat fish twice a week (salmon, mackerel - low sodium varieties)
- Increase omega3s (flaxseed, walnuts)
What are some nutrition therapy interventions for those with high TGs?
- Eat moderate carbs
- Stay at healthy weight
- Choose fats wisely, limit cholesterol
- Fruits, veg
- Non-fat/low-fat milks
- Limit alcohol, low sodium and choose lean meats
What are some recommendations for “choosing fat wisely” for those with high TG?
- Substitute SFA with MUFA,PUFA (esp omega 3)
- Limit SFA from plant and animal sources
- Eat very little trans fats
What are the 4 key recommendations for those with high TGs?
- Avoid extreme carb/fat intake
- Limit added sugars as much as possible
- Limit alcohol as much as possible
- Include at least 30 min of moderate PA on most days
(T/F) Only overweight/obese patients with elevated TG/LDL need to keep SFA intake below 7% of total energy
False, this recommendation stand regardless of weight
Which SFA is coconut oil mostly comprised of?
87% SFA, where most is lauric acid
(T/F) Coconut oil does not increase total cholesterol and LDL to the same extent as butter
True
(T/F) Coconut oil does not increase total cholesterol and LDL to a greater extent than MUFA/PUFA
FALSE
(T/F) since Coconut oil increases HDL, and does not increase LDL/total cholesterol as much as butter, it is recommended as an alternative to non-hydrogenated vegetable oils
False (does increase HDL, but NOT recommended compared to non-hydrogenated vegetable oils)
What are some lasting effects of stroke?
-Limited mobility, deeding difficulties, urinary/fecal incontinence, constipation and reduced oral hygiene
What are some nutritional complications of a stroke patient?
- dysphagia
- reduced intake
- modified texture diet
- potential for malnutrition
- reduced speech
Who is responsible for overall care and prescriptions?
Physician
Who is responsible for improving muscle strength and coordination, mobility?
PT
Who is responsible for helping individual to conduct ADL?
OT
Who plans for discharge
Social workers
What is the role of psychologists in stroke patients?
Manage post-stroke depression
Who is responsible for front line care, medications, feeding, hydration, positioning, monitoring vital signs?
Nurse
What are two types of heart failure?
Chronic or Congestive
What is heat failure?
The heart is pumping, but not as strong as it should
Explain how in HF the pumping becomes less effective
1) Injury to heart or congenital abnormality
2) Compensatory actions to maintain cardiac output (Norepi and activation of RAAS)
3) Ventricular muscles undergo hypertrophy, , working harder
What are some risk factors for HF?
- Hypertension
- Ischemic Hear disease
- DM
- Heavy alcohol/substance abuse
- Chemotherapy
- Family history
- Smoking
- Hyperlipidemia
What are some symptoms of HF?
- Breathlessness
- Fatigue
- Leg swelling
- Confusion
- Orthopnea
- Paroxysmal nocturnal dyspnea
Which symptom of HF is very susceptible in the elderly?
Confusion
Signs of HF?
- Lung cracks
- Peripheral edema
- Low BP
- Heart murmur
- Heart rate > 100 BPM
Which sides of heart can fail?
One or both sides
What happens in HF?
Left or right ventricle will weaken, and canot empty as mushc asnormal
What type of HF is most common?
Left side more frequent, main pump for the systemic circulation
What does is LVEF? What does it stand for?
Left ventricular ejection fraction
-Measurement of how much blood is being pumped out of the LV of the heart
Whats another name for LVEF?
EF = ejection fraction
How is EF calculated?
amount of blood pumped out/ amount of blood in chamber
What is the normal EF?
50-70% pumped out with each contraction, comfortable during activity
What is the borderline EF?
41-40% pumped out, symptoms may become noticeable during activity
What is reduced EF?
<40% pumped out, symptoms noticeable even at rest
What is left-sided HF?
Left ventricle doesn’t contract with enough force, low LVEF
What are the consequences of left-sided HF?
- Decreased blood-flow to kidney, stimulates RAAS and aldosterone
- High pressure in pulmonary capillaries will lead to pulmonary congestion or edema
What are the two kinds of left-sided HF?
1) Reduced ejection fraction (HFrEF) / systolic failure
2) Preserved ejection fraction (HFpEF)/diastolic failure (or diastolic dysfunction
Consequences of HFrEF?
-LV cannot CONTRACT normally, and heart cannot pump with enough force to push enough blood into circulation
Consequences of HFpEF?
-LV cannot RELAX normally (stiff muscle) and heart cannot fill properly with blood during resting period between each beat
How does RHS HF usually develop?
As a consequence of LHS HF
Outline the progression of LHS HF
1) LV weakens, cannot empty
2) Decreased cardiac output to system
3) Decrease renal blood flow, stimulate RAAS and aldosterone
4) Backup of blood into pulmonary veins (since LV cannot empty .. backflow)
5) High BP in pulmonary capillaries lead to pulmonary congestion or edema
Outline the progression of RHS HF
1) RV weakens, cannot empty
2) Decreased cardiac output to lungs
3) Decreased renal blood flow, stimulates RAAS and aldosterone
4) Backup of blood and systemic circulation (venae cavae)
5) Increased venous pressure, edema in legs, liver and abdominal organs
6) Very high venous pressure causes distended neck vein and cerebral edema
Compare and contrasts RHS and LHS HF
Weakening of ventricles will result in decreased renal blood flow, which will activates RAAS and secretion of aldosterone. RHS causes decreased cardiac output to the pulmonary circulation, while LHS = systemic circulation. RHS will cause back-up in vanae cavae while LHS will cause back-up in pulmonary vein. Both cause edema.
What is stage A of HF?
High risk for HF but without structural heart disease or symptoms of HF
What is stage B of HF?
Structural heart disease but without signs/symptoms of HF
What is the NYHA class I (AHA Stage B)
No limitation of PA, ordinary PA does not cause symptoms of HF
What is stage C of HF?
Structural heart disease with prior or current symptoms of HF
What is the NYHA classification of Stage C?
Class 1
No limitation of PA, ordinary PA does not cause symptoms of HF
What is stage II NYHA?
Slight limit of PA, comfortable at rest but ORDINARY PA results in symptoms of HF
III NYHA?
Marked limitation of PA, comfortable at rest but LESS than ordinary PA causes symptoms of HF
IV NYHA?
Unable to carry on any POA w/o symptoms of HF OR HF symptoms at rest
What does Stage D HF classify as? What is it?
- NYHA IV
- Refractory HF requiring specialized interventions
What is the primary marker for HF?
B-type natriuretic peptide (BNP)
When is BP secreted?
HF - secreted when muscle fibres in the LV are stretched.
What is included in the initial work-up of HF?
- History
- Physical
- ECG
- Chest X-ray
- Biomarkers
What other biomarkers may be used to detect HF?
- electrolytes
- Creatinine
- CBC
- Troponin
- BNP
If uncertain of HF after initial workup, may check ____
BNP/ NT-proBNP
What is NT-proBNP?
Inactive fragment that is cleaved by an enzyme to release BNP
When should other diagnosis be considered?
BNP < 100 pg/ml
NT-proBNP < 300 pg/ml
When should the AHF score be used in 50-75 y/o?
BNP 100-400 pg/ml
NT 300-900 pg/ml
When should the AHF score be used in >75 y/o?
NT 300-1800 pg/ml
When is it likely to be HF in 50-75 y/o?
BNP > 400 pg/ml
NT > 900 pg/ml
When is it likely to be HF in > 75 y/o?
NT > 1800 pg/ml
What can an ECHO determine?
- Decreased LV Ef
- Increased LV end-systolic and end-diastolic diameter
- Wall motion abnormalities, diastolic dysfunction
- Increase RV or RV dysfunction
- Valve dysfucntion
- Elevated PAP (Pulmonary arterial pressures)
What may be prescribed to patients with HF and volume overload to decrease BP?
Loop diuretic IV dose
How are patients monitored after administrating loop diuretic?
Weight change and/or urine output over 24 hours
When should diuretic dosage increase?
If weight change <0.5 kg or <3 L/day urine output
What may be added in conjuction to diuretics?
Metalazone, if diuretic treatment does not work even after dosage increase
What is an appropriate weight change and urine output when on diuretic?
Weight change 0.5-1.5 kg
3-5L of urine output
What weight change and urine output is suggests reducing diuretic dosage?
Weight change >1.5 kg
> 5 L urine output
What does ACE stand for?
Angiotensin-coverting enzyme inhibitor
ACE-inhibitor function
Prevent vasoconstriction
ACE-inhibitor examples
-PRIL
Enalapril
Lisinpril
Captopril
Angiotensin receptor blocker function
Prevent vasoconstriction
Angiotensin receptor blocker examples
-SARSTAN
Irbesartan
Candesartan
Losartan
Beta blocker function
Blocks effects of epi, prevents enlargements (remodelling) of heart muscle
Beta blocker examples
-OLOL
Atenolol
Metoprolol
Carvedilol
Diuretic function
Increase urination, act on kidney to rid body of sodium and water
Diuretic examples
Furosemide
Spironolactone
Function of combining valsartan and sacubitril in 1 tablet
Prevent vasoconstriction
-Sacubitril will increase natriuretic peptides that naturally increase diuresis and vasodilation will inhibit fibrosis
Which medications may induce hyperkalemia?
ACE-inhibitor (PRILS)
Ang receptor blocker (SARTANS)
And combo tablet (Sacubitril, Valsartan)
What may cause hypotension?
Ang-receptor blocker
What drug may cause taste alterations (dysgeusia)
ACE -inhibitor
What drug may mask symptoms of hypoglycemia in diabetics? (Xerostomia)
Beta blocker
What may cause muscle cramps, dehydration and electrolyte abnormalities?
Diuretics
What may cause angio-edema?
ACE-inhibitor
Ang-receptor blocker
What may be a sign that heart failure is worsening?
Weight gain
Define edema
excess fluid in cells, tissue, or cavity, results in swelling
Define ascites
fluid in abdominal cavity
Define osmosis
movement of fluid across a semi-permeable membrane
Define osmotic pressure
Force that pulls water across the membrane
Primary cations in plasma and interstitial fluid?
Na+ (high), K+(low)
Primary anions in plasma and interstitial fluid?
HCO3 - (low), Cl- (high)
Protein anion sin plasma
Primary cations in intracellular fluid?
Na+ (low), K+ high)
Primary anions in intracellular fluid?
PO43- (high), protein anions (low)
How is fluid balance assessed?
- Visual, physical exam
- Diluted lab values (sodium, albumin)
- Skin clammy
- Intake/output of urine
What classifies as liquid intakes?
All fluids that are liquid at BODY temperature
(T/F) Stool is never considered in fluid balance output
False, may be considered if diarrhea or watery stool
(T/F) Vomiting is considered in fluid balance output
True
What are the 3 main nutritional concerns of patients with HF?
1) Sodium intake
2) Fluid Intake
3) Overall nutritional adequacy due to early satiety (SOB)
