Cardiovascular Disease (Power Point) Flashcards
Risk Factors for Cardiovascular Disease
Hyperlipidemia Hypertension Excess weight (especially the abdomen) Physical inactivity Smoking Psychological stress Positive family history Kidney failure Diabetes
Nonmodifiable factors:
Age
Gender: Post menopausal women
Ethnic background: American Indians, Native Alaskans at a premature death of younger than 65
-Asians less likely
Family history of Cerebral Vascular Disease (CVD)
Modifiable factors:
Personal habits:
Cigarette use: Coronary Artery and Peripheral vascular
- pack/years
Physical inactivity
Obesity: BMI more than 30, more of African Americans, Mexicans Americans, and Native Hawaiians
Psychological variables: highly competitive, overly stressed, hostility and easily frustrated
Laboratory tests(Cardiac Markers):
Troponin: muscle protein that is released when heart is injured - not found in healthy patients
Creatine kinase (CK): enzyme specific to the brain and skeletal muscles - will rise from vigorous exercise
Serum Lipids: Cholesterol, Triglyceride
HDL (High Density Lipoprotein-good)
LDL (Low Density Lipoprotein-bad)
Homocysteine: amino acid
Highly sensitive C-reactive protein: inflammatory marker - determining patients who are at risk for CAD
Troponin T
<0.10 ng/ml
Troponin I
<0.03 ng/ml
Creatine kinase (CK) Female vs male
Females: 30 – 135 units/ml
Males: 55 – 170 units/ml
Total cholesterol
< 200 mg/dL
Triglyceride
Female vs Male
Females: 35-135 mg/dL
Males: 40-160 mg/dL
HDL
Female vs Male
Females: >55 mg/dL
Males: >45 mg/dL
LDL
<130 mg/dL
HDL : LDL ratio
3:1
Elevated: risk or factor of CAD
Homocysteine
<14 mmol/dL
Highly sensitive C-reactive protein:
< 1 mg/dL
Over 3 mg/dL = AT RISK
More labs:
Microalbuminuria: protein in the urine, small amounts endothelial disfunction –> Cariod Vascualr Disease
Blood coagulation studies: PT/INR –> A-fib, Endocarditis, Cardiac surgery, thrombus, hip and knee replacements
PTT –> long term heparin therapy
ABG –> Tissue oxygenation or CO2 removal –> acid-base stats
Fluids and electrolytes: hypokalemia cause electro instability and cardiac arrest, toxicity
hyerkalemia = slow ventricular response–> death
Erythrocyte count: increased in heart disease to compensate for decrease in oxygen
H&H: relatesd to hemorrhage, anemia, heart failure, can be elevated in hypovolemic shock and diaphoresis (dehydration)
Leukocyte count: from heart attack and inflammatory disease, stoke, heart disease, especially in post menopausal women
Desired Blood Pressure: For people over 60:
Below 150/90
Desired BP: For people younger than 60:
Below 140/90
patients whose blood pressures are above these goals should be
treated with drug therapy
Essential (Primary) risk factors for Hypertension
Family history African-American ethnicity Hyperlipidemia Smoking Over 60 or postmenopausal Excessive Na and caffeine intake Obesity Inactivity Excessive alcohol intake Low𝐾^+, calcium, or magnesium intake Excessive/continuous stress
Secondary risk factors for hypertension:
Kidney disease
Primary aldosteronism: increased aldosterone
Pheochromocytomia: tumors in the adrenal medulla
Cushing’s disease: excessive glucocorticoids from the adrenal cortex
Coarctation of the aorta: narrowing of the aorta
Brain tumors
Encephalitis
Pregnancy
Drugs: estrogen, oral contraceptive, glucocorticoids, mineral corticoids, diet pills, immunosupressants, erthopoiten
Patho for Hypertension - Systemic arterial BP =
- Cardiac output (CO) & peripheral vascular resistance (PVR)
- CO = SV x HR
- PVR maintained by autonomic nervous system
Patho for Hypertension: Stabilizing mechanisms (Control BP)
- Arterial baroreceptors (vasodilation)
- Regulation of body fluid volume (Diureces decreases BP)
- Renin-angiotensin-aldosterone system: Increase PVR
- Vascular autoregulation: Perfusion of tissues
Assessment of Hypertension includes
Patient history
Physical assessment: headaches, flushed, dizziness (Do orthostatic hypotension BPs), fainting
Often asymptomatic
Psychological assessment: Stress
Diagnostic assessment: Secondary - Urinalysis, ECG
Lifestyle Modifications to make when having Hypertension =
Sodium restriction
Weight reduction
Reduce alcohol intake: 1 drink a day for women, 2 for men
Exercise: 3-4 X a week 40 min a day
Decrease stress levels: relaxation techniques
Avoid smoking and caffeine
CAM: garlic and coenzyme Q10
Drug Therapy for Hypertension =
Diuretics Calcium channel blockers ACE inhibitors Angiotensin II receptor antagonists Aldosterone receptor antagonists Beta-adrenergic blockers Renin inhibitors
Angina: definition
Substernal chest discomfort
Low O2 in heart muscle = ischemic
Angina pain:
Radiating to the left arm
Precipitated by exertion or stress
Lasting less than 15 min
Angina relieved by
Relieved by nitroglycerin, oxygen, or rest
Few associated symptoms
Prevalence of A-fib: Associated w/
atrial fibrosis and loss of muscle mass
A-fib is common in
heart disease such as hypertension, heart failure, coronary artery disease
In A-fib Cardiac output can
decrease by as much as 20% to 30%
Risk Factors for A-fib
Hypertension Previous ischemic stroke: lack of O2 in the brain Transient ischemic attach (TIA): temporary lack of O2 in the brain Thromboembolic event: blood clot Coronary heart disease Diabetes mellitus Heat failure Mitral valve disease
Clinical Manifestations of A-fib
Multiple rapid apical impulses: disorganized
Increased ventricular response: 120-200 bmp
Decreased ventricular filling
Decrease CO
NO P WAVE
Interventions for A-fib
Risk for PE, VTE
Antidysrhythmics drugs - most effective: calcium channel blockers, beta blockers
CHADS₂ scoring system: low risk is given aspirin 1Xday, moderate: aspirin or warfarin, severe: INR 2-3 Warfarin, avoid foods high in Vit K and Herbs
Cardioversion
Percutaneous radiofrequency catheter ablation
Maze procedure: open chest surgical technique
Patho for Peripheral vascular disease (PVD): Arteriosclerosis
Thickening or hardening of arterial wall
Often associated with aging
Influenced by genetic factors or lifestyle habits
Can cause MI
Patho for Peripheral vascular disease (PVD): Atherosclerosis
Type of arteriosclerosis involving formation of plaque within arterial wall - usually bigger arteries such as coronary artery beds, carotid, iliac artery, femoral artery
-can be one or several arteries
Vessels become inflamed and obstruct arteries
Risk Factors for Atherosclerosis:
Low HDL-C High LDL-C Increased triglycerides Genetic predisposition Diabetes mellitus Obesity Sedentary lifestyle Smoking Stress African-American or Hispanic ethnicity Older adult
Interventions for Atherosclerosis
Assess labs: -Cholesterol: ---HDL and LDL -Homocysteine levels Nutrition therapy: leguines, nuts, limit sweets and red meats, 5-6% calories should only come from saturated fats, reduce trans fats Drug therapy Smoking cessation Exercise Complementary and alternative therapies
Deep Vein Thrombosis:
Risk factors: Active cancer, paralysis, or casting of extremity
Bedridden for more than 3 days
Major surgery with general anesthesia during the previous 3 months
Localized tenderness
Swelling of the entire leg
Calf swelling of greater than 3 cm larger than other leg
Pitting edema in one leg
Dilated superficial veins in one leg
Previous DVT
Warmth, swelling, hardness
Assessments MRI, D-dimer Venous duplex ultrasonography, a noninvasive ultrasound that assess the flow of blood through the veins in the arms and legs -Other: Doppler flow studies Impedance plethysmography
Interventions:
Rest: activity dictated by the physician
Leg elevated to increase blood flow, ted hose, compression stockings on uninfected leg
Drug therapy: Anticoagulants, unfractionated heparin therapy
Alternative to unfractionated heparine (Usually Subcutaneous) = low-molecular-weight heparin (PTT, based on patient’s weight), warfarin therapy, thrombolytic therapy(fibrinolytics)
Thromboectomy, inferior vena cava filtration device - inserted in femoral vein
Monitor for bleeding
Core measures: Precautions
- Avoid oral contraceptives
- Hydrate
- Exercise
hypertension can cause
stroke, MI, and death
Essential: hyperplasia = thickening
Secondary: Kidney disease
