Cardiovascular Disease (Power Point)

Question 1

Risk Factors for Cardiovascular Disease

Answer 1

Hyperlipidemia
Hypertension
Excess weight (especially the abdomen)
Physical inactivity
Smoking 
Psychological stress
Positive family history
Kidney failure
Diabetes

Question 2

Nonmodifiable factors:

Answer 2

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)

Question 3

Modifiable factors:

Answer 3

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

Question 4

Laboratory tests(Cardiac Markers):

Answer 4

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

Question 5

Troponin T

Answer 5

<0.10 ng/ml

Question 6

Troponin I

Answer 6

<0.03 ng/ml

Question 7

Creatine kinase (CK)
Female vs male

Answer 7

Females: 30 – 135 units/ml
Males: 55 – 170 units/ml

Question 8

Total cholesterol

Answer 8

< 200 mg/dL

Question 9

Triglyceride

Female vs Male

Answer 9

Females: 35-135 mg/dL
Males: 40-160 mg/dL

Question 10

HDL

Female vs Male

Answer 10

Females: >55 mg/dL
Males: >45 mg/dL

Question 11

LDL

Answer 11

<130 mg/dL

Question 12

HDL : LDL ratio

Answer 12

3:1
Elevated: risk or factor of CAD

Question 13

Homocysteine

Answer 13

<14 mmol/dL

Question 14

Highly sensitive C-reactive protein:

Answer 14

< 1 mg/dL

Over 3 mg/dL = AT RISK

Question 15

More labs:

Answer 15

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

Question 16

Desired Blood Pressure: For people over 60:

Answer 16

Below 150/90

Question 17

Desired BP: For people younger than 60:

Answer 17

Below 140/90

Question 18

patients whose blood pressures are above these goals should be

Answer 18

treated with drug therapy

Question 19

Essential (Primary) risk factors for Hypertension

Answer 19

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

Question 20

Secondary risk factors for hypertension:

Answer 20

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

Question 21

Patho for Hypertension - Systemic arterial BP =

Answer 21

• Cardiac output (CO) & peripheral vascular resistance (PVR)
• CO = SV x HR
• PVR maintained by autonomic nervous system

Question 22

Patho for Hypertension: Stabilizing mechanisms (Control BP)

Answer 22

• Arterial baroreceptors (vasodilation)
• Regulation of body fluid volume (Diureces decreases BP)
• Renin-angiotensin-aldosterone system: Increase PVR
• Vascular autoregulation: Perfusion of tissues

Question 23

Assessment of Hypertension includes

Answer 23

Patient history
Physical assessment: headaches, flushed, dizziness (Do orthostatic hypotension BPs), fainting
Often asymptomatic
Psychological assessment: Stress
Diagnostic assessment: Secondary - Urinalysis, ECG

Question 24

Lifestyle Modifications to make when having Hypertension =

Answer 24

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

Question 25

Drug Therapy for Hypertension =

Answer 25

Diuretics
Calcium channel blockers
ACE inhibitors
Angiotensin II receptor antagonists
Aldosterone receptor antagonists
Beta-adrenergic blockers
Renin inhibitors

Question 26

Angina: definition

Answer 26

Substernal chest discomfort

Low O2 in heart muscle = ischemic

Question 27

Angina pain:

Answer 27

Radiating to the left arm
Precipitated by exertion or stress
Lasting less than 15 min

Question 28

Angina relieved by

Answer 28

Relieved by nitroglycerin, oxygen, or rest

Few associated symptoms

Question 29

Prevalence of A-fib: Associated w/

Answer 29

atrial fibrosis and loss of muscle mass

Question 30

A-fib is common in

Answer 30

heart disease such as hypertension, heart failure, coronary artery disease

Question 31

In A-fib Cardiac output can

Answer 31

decrease by as much as 20% to 30%

Question 32

Risk Factors for A-fib

Answer 32

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

Question 33

Clinical Manifestations of A-fib

Answer 33

Multiple rapid apical impulses: disorganized
Increased ventricular response: 120-200 bmp
Decreased ventricular filling
Decrease CO
NO P WAVE

Question 34

Interventions for A-fib

Answer 34

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

Question 35

Patho for Peripheral vascular disease (PVD): Arteriosclerosis

Answer 35

Thickening or hardening of arterial wall
Often associated with aging
Influenced by genetic factors or lifestyle habits
Can cause MI

Question 36

Patho for Peripheral vascular disease (PVD): Atherosclerosis

Answer 36

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

Question 37

Risk Factors for Atherosclerosis:

Answer 37

Low HDL-C
High LDL-C 
Increased triglycerides
Genetic predisposition
Diabetes mellitus
Obesity 
Sedentary lifestyle
Smoking
Stress
African-American or Hispanic ethnicity
Older adult

Question 38

Interventions for Atherosclerosis

Answer 38

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

Question 39

Deep Vein Thrombosis:

Answer 39

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

Question 40

hypertension can cause

Answer 40

stroke, MI, and death
Essential: hyperplasia = thickening
Secondary: Kidney disease